coming year or two, and to try to put this whole subject on a rational scientific ground? I, therefore, offer a resolution that a committee of three or five be appointed by the President, to take up this matter and report to this Society, with the view of organizing a new State institution with the purposes and plans outlined by the reader of the paper. DR. HENRY S. NOBLE (Middletown): Mr. Chairman-I should like to ask, before Dr. Crother's resolution is acted on, whether this committee would interfere with the legislative committee that the Society already has? DR. FRANK K. HALLOCK (Cromwell): I should say that it would not; that the purpose of any special committee of this kind would be to coöperate with the legislative committee. It certainly would have to depend upon the legislative committee in order to get the measure through. Will anyone remark on this subject further? DR. EDWIN AUGUSTUS DOWN (Hartford): I think the remark that Dr. Crothers made was a little indefinite. Did he mean that the committee should report to the State Society or to the legislature? Of course, the State Medical Society meets before the next session of the legislature; and if the doctor is willing to make the correction, that the committee shall report to the Society, I think it will be an improvement. Perhaps one reason that such a bill has not passed is, that many of the members felt that, inasmuch as we have a State Reformatory, this reformatory should take this particular class of cases. The committee of the legislature, to whom the matter was referred, thought so, and consequently the bill failed. The State Reformatory takes in all reformable cases, whether these are due to alcohol or not. That view of the subject should be looked into; for it is generally understood that the present State Reformatory will care for these cases. I believe, however, in a farm for drunkards, where the men can be put to work. It would be well for whoever is on the committee to bear these things in mind. DR. FRANK K. HALLOCK (Cromwell): Was this resolution of Dr. Crothers seconded? Someone then seconded it. Dr. Frank H. BARNES (Stamford): I was very glad to hear Dr. Noble and Dr. Crothers discuss this paper. They have both had years of experience, and know whereof they speak. As to the Reformatory of the state, I have talked to several men and have looked up the question, and it seems to me that it would be very dangerous to mix up alcoholics and criminals. That is the general opinion of men of experience, and I think that we should look further into the question of an inebriates' farm. It would work in nicely with the reform proposition. I will use the remainder of my time for closing the discussion in reading some more of my paper, a part of which I had to omit because of lack of time. (He then read from the paper until the time allotted him was up.) Dr. Frank K. HALLOCK (Cromwell): We now have before us the resolution of Dr. Crothers, which was duly seconded, that a special committee be appointed to investigate this subject of establishing a Colony Farm for Inebriates and bring the matter before the legislature. Will you remark on the question? If not, those in favor of having this committee appointed will say "aye"; those opposed, "no." The motion is carried, and the committee will be appointed later. The Serum Reaction in the Diagnosis of Syphilis. JESSIE WESTON FISHER, M.D., MIDDLETOWN, CONN. With the finding of the spirochata pallida, the transmission of syphilis to the higher apes, rabbits and guinea-pigs, and the Wassermann reaction, the study of syphilis has advanced more in the last few years than during as many centuries previous to these discoveries. Not the least important of the four is the Wassermann complement-fixation test for the diagnosis of this disease, because it is obtained during all stages of the affection, even in hereditary lues, while the spirochata pallida cannot be demonstrated as a rule in the tertiary stages, or the congenital forms. Only a few years have elapsed since the original Wassermann reaction was described, but it has long since passed the experimental stage, although the exact mechanism of the phenomena is still shrouded in mystery. At the present time it is a well established method of diagnosis, revealing syphilis with such certainty that Neisser (Munchen Med. Wchschr., May 25, 1907) says nothing would induce him to dispense with it, or its modifications. The public press, as well as the medical, teems with articles upon the topic of social disease, its diagnosis, prevention, and treatment, until even the lay mind is full of it. I accordingly apologize for offering even this brief contribution to the already possibly overworked subject. In fact, so much has been written, that I am sure you must of necessity be acquainted with the outline of the technic of this test for syphilis, which is based upon the principles of complement-fixation. Among the many modifications of the original Wassermann reaction that of Noguchi has been most widely adopted in this country, but it is far from being the simple vest-pocket test that Noguchi first claimed he had discovered. The Noguchi reaction is merely a simplification of the original Wassermann reaction. Both are founded upon the power possessed by certain reagents of causing complete solution, or hæmolysis of blood cells, which is indicated by the clear red color of the fluid and the complete disappearance of the blood cells. In the blood serum of a syphilitic there is an antibody, which has the power of absorbing the complement in the presence of antigen, thus inhibiting hæmolysis, and constituting what is recognized as a positive reaction. It is useless to burden you with oft-repeated and wearisome details of the technic of the test, except to mention that we have used the liquid antigen prepared by acetone fractionation of the alcoholic extract from human liver, or from guinea-pig heart and liver. The antihuman amboceptor used consisted of filter paper saturated with the serum of rabbits, which had been immunized with human blood corpuscles and was personally prepared and standardized. The complement, consisting of guinea-pig serum, was always freshly drawn and used in liquid form. In the laboratory of the Connecticut Hospital for the Insane we have adopted the Noguchi modification of the Wassermann reaction, because it is easier of manipulation than the original, requires a smaller amount of blood from the patient, obviates the necessity for inactivation of serum, and is equally, if not more, delicate. In the Noguchi reaction human blood cells are substituted for sheep corpuscles together with antihuman amboceptor. This eliminates the error, which may be produced by the hemolytic amboceptor for sheep's blood, often found in human serum, and the acetone insoluble antigen permits the use of active or inactive blood serum in this modification. The great advantage of the Noguchi modification for the general practitioner is that it only requires from fifteen to twenty drops of blood, obtained from the ear or finger, which is collected in a capillary tube, similar to but larger than those used for the Widal reaction. Specimens can easily be secured by any physician for transmission to a laboratory for examination. Tests can be made without its significance being explained to the patient, and it obviates the necessity for embarrassing questions, evasive answers, etc. In the second edition of Noguchi's book on the Serum Diagnosis of Syphilis he compares the results of his own method with that of Wassermann in 1,777 cases of known syphilis, examined by different workers using the two systems at the same time. The results show conclusively that his method gives a higher percentage of positive reactions than does the Wassermann, the figures for primary, secondary and tertiary syphilis being, Noguchi 91.7 per cent., while the Wassermann gave 84.7 per cent. of positive results. In congenital syphilis the two methods gave identical results-98 per cent. An extensive comparative test of the Wassermann and Noguchi reactions is now in progress at the experimental laboratory of the New York board of health. Either test is practically valueless unless used by a competent serologist in a well-equipped laboratory, where the reagents, amboceptor, complement, antigen, blood corpuscle suspension, and serum to be tested can be properly prepared and repeatedly standardized, and the amount of each ingredient correctly adjusted. It is worse than useless for any one without plenty of time, patience, and an infinite capacity for detail, to attempt this reaction. Only by thorough preparation is one justified in submitting reports worthy of such an important diagnositic measure. Positive findings are a distinct indication of existing syphilis, and repeated negative findings are extremely valuable as regards prognosis, although the test is not infallible, and like all other diagnostic laboratory tests must be considered in connection with all the other factors in a given case. The test is as important for the general practitioner as is the microscopic examination of gonorrhoeal secretions, or the examination of sputum for the tubercle bacilli. With this test it is now possible to make a much more exact diagnosis, institute immediate treatment, and prognosticate with a fair degree of accuracy. One negative |