252 SCIENCE PROGRESS 



Class 2. — Constitutional disturbance accompanying a localised 

 bacterial infection may be taken as evidence of auto-inoculation 

 from the site of infection ; and it should be remembered that 

 this auto-inoculation is with a living microbe, and therefore 

 one which is capable of multiplication. Under these circum- 

 stances the examination of the blood of a patient as regards its 

 opsonic power reveals the fact that he is living " in a succession 

 of negative and positive phases " ; that is to say, the resistance 

 of the blood is lowered as an immediate result of the infection, 

 and then an increase in protective substances above the normal 

 is elaborated in response to the infection. The more advanced 

 cases of pulmonary tuberculosis are essentially of this type. 

 That this fact complicates matters as regards therapeutic in- 

 oculation will be readily understood. Two courses may be 

 followed : 



(a) The patient may be put under the condition least suitable 

 for auto-inoculation, i.e. at rest, and not until auto-inoculation has 

 been put a stop to as far as possible are inoculations employed. 



(b) A daily examination of the blood may be instituted, and 

 only very small doses of vaccine injected at opportune moments, 

 according as that examination shows evidence of recent auto- 

 inoculation or no. 



It will strike any one who has thought on this matter that 

 clinical experience has led to the adoption of probably the 

 most satisfactory method of treatment without thoroughly 

 understanding why it so acted. The patient suffering from 

 an acute bacterial infection has always been most rigidly kept 

 in bed, and has been placed upon a very low diet which consists 

 chiefly of milk — a study of the diet sheet of any of our hospitals 

 will always be found to contain a fever diet, which often only 

 consists of milk ; and in the more chronic infection by the 

 tubercle bacillus a full diet with extra milk (3 to 5 pints per diem) 

 is the rule. Now by these means the blood and lymph streams 

 are reduced to their minimum flow. The blood is at its 

 maximum of coagulability, and the least amount of lymph 

 exudes through the walls of the blood-vessels. In fact, those 

 circumstances exist which are least suitable for auto-inoculation, 

 and by these means the infection is converted as far as possible 

 into a local one. And if the blood be examined during this 

 treatment as regards its opsonic power it will be found that 

 the fluctation gradually gives way to a steady line. 



