608 SCIENCE PROGRESS 



use. Different figures from these appear in the original papers 

 owing to a misconception as to the actual strengths of prepara- 

 tion used ; the figures here given represent the doses as compared 

 with those now employed. 



From the data collected from observations on the opsonic 

 index many facts with an important bearing on practical treat- 

 ment have become apparent. In the case of local infections it 

 is clear that the blood is poor in anti-bacterial substances, yet 

 even this poor supply is sufficient to prevent the bacteria living 

 in the blood stream. The foci of infection themselves are always 

 found to be areas of " lowered bacteriotropic pressure," the 

 anti-bacterial substances being exhausted by the bacteria with 

 which they first come in contact. From this the indications for 

 treatment are clear : the first is to raise the opsonic content of 

 the blood by means of vaccines, and the second is to determine 

 the blood when enriched to the site of infection. Many means 

 may be adopted for this purpose : either a passive hyperaemia 

 may be produced by constriction of a limb above an infected 

 joint — the method of Bier — or active hyperaemia may be excited 

 by heat or massage or physical exercise. All these methods 

 bring blood to the site, and a non-viscid lymph of high permeating 

 power may be produced by the ingestion of citric acid ; this 

 facilitates the determination of blood to any congested area. 



In the case of an unhealed sinus, lymph may be drawn 

 through it by the use of a lotion which contains citrate of soda, 

 to prevent coagulation, and salt in greater concentration than 

 it is in the lymph to induce a flow of liquid outwards. Stagnant 

 fluids in foci should be removed by mechanical means. 



Bier had long used passive congestion in the treatment of 

 chronic arthritis, and had observed that joints other than the 

 one congested improved. This is due to the flooding of a focus 

 of infection with lymph, and thereby washing bacteria into 

 the blood stream and so setting up an auto-inoculation. The 

 possibility ol exciting auto-inoculation, which had been long 

 recognised in cases of constitutional disturbance, was first 

 observed in localised disease by Freeman. 1 This observer, 

 while investigating a case of gonorrhceal arthritis, found one day 

 a marked rise in the patient's index to gonococcus following 

 massage of the affected joint. An extended series of observations 

 followed, which demonstrated that this phenomenon occurs also 



1 Wright, Trans. Roy. Med. Chi. Soc, 1906. 



