MICHIGAN ACADEMY 01-^ SCIENCE. 155 



had been endeavoring to correct the gastro-intestinal disorder, to see this pa- 

 tient. From the pus in the urine I obtained abundant bacilU in smears, and 

 a pure culture of what was identified as colon bacillus of the usual type. 

 Against this bacillus the patient's phagocA^tic index was one-third less than 

 that of the phagoc^'tic index of a normal person's serum, that is to say, his 

 opsonic index was about two-thirds normal. The usual preparation was 

 made from the bacillus obtained from the urine and inoculations at inter- 

 vals of five to ten days, five doses in all, varying from 200 millions to one 

 billion bacilli, was practiced. The opsonic inclex rose in a pronounced man- 

 ner. This however was less significant than the improved local and consti- 

 tutional conditions of the patient. After the first inoculation his temper- 

 ature arose above 100 F. After three days his chills and night sweats ceased 

 not to reappear. The character of the urine changed during these first few 

 days, the pus became less abundant, thinner, not so coherent, and the foul 

 odor disappeared. From the first injection the improvement was progres- 

 sive except for several gushes of putrid pus evidently representing the empty- 

 ing of pyelo-nephric abscesses. The right kidney speedily lost its tenderness 

 and the tumor on its surface disappeared. The patient, whose treatment 

 began November 2, 1906, is now enjo}'ing active out-of-doors life, his appe- 

 tite is excellent and he has gained eighteen pounds in weight, with coincident 

 improvement in strength and spirits. The urine at the worst contains but 

 a small amount of thin pus, and ordinarily is clear. Even the distressing 

 features of his neurosis have greatly improved as was evident when he re- 

 cent 1}^ walked a distance of three miles to visit me at mj' office. I have stood 

 in readiness to intervene with further inoculations, but since the last one 

 the progress has been so steady as to make further treatment superfluous. 

 Apparently we have reached in this case what Wright would call a sustained 

 "high tide of immunity." 



Thoracic Empyema. — ]\Iy first case of thoracic empyema was seen with 

 Dr. George Sherman. The patient was a seven-year-old girl who had a 

 severe atypical pneumonia, with a crisis at the end of a week. For ten days 

 after the temperature remained at between 99° - 100°F., and then arose to 

 102 °F., accompanied with some clypnoea, and pain in the right chest. Three 

 days after this rise in temperature Dr. Sherman found dulness in the lower 

 right chest and on exploratory aspiration obtained a thick pus in a sterile 

 glass syringe. On my suggestion the poor practice of making a small inter- 

 costal incision and inserting a very small drainage tube was at once instituted 

 ■with the evacuation of some eight ounces of thick pus but no expansion of 

 the lung, evidently indicating a sacculated empyema. The next morning 

 the pus was brought to the laboratory, smears showed a diplococcus, and by the 

 next day following I had isolated the pneumococcus from which an opson- 

 ogen was prepared. Three days after obtaining the pus I visited the patient 

 and gave the first inoculation of the autogenous bacterial preparation, con- 

 taining approximateh' 20 millions pneumococci. I found her much ema- 

 ciated, weak, fretful, Avith a hectic look, temperature of 100 F., pulse 120, 

 and a profuse discharge of thick pus into the voluminous dressing. Four 

 days later the attending physician reported a pronounced improvement, 

 the appetite returned, strength increased, discharge steadily diminished 

 until it was scanty and thin sero-purulent in character, and the small drain- 

 age tube had been pushed out by the expanding lung and could not be re- 

 inserted. On the sixth day onh^ a small quantity of serum oozed from the 

 opening against which the pleura had appeared. A second inoculation was 

 then made. On the seventh day the wound had entirely closed, the little 



