NO. I AIR AND TUBERCULOSIS HINSDALE II5 



some time of the day well above the normal, and what is of even 

 more importance, in no case did the exercise, even though severe, 

 lower the index below the normal line — that is, the auto-inoculation 

 was never so great as to produce a negative phase and, therefore, 

 never in excess. 



It was observed during these investigations that in some bloods examined, 

 tuberculo-agglutinins appeared in association with the immune tuberculo- 

 opsonins. This must be taken as another evidence of an immunizing response 

 on the part of the organism. When the difficulties of such a method of treat- 

 ment and the danger of the weapon employed are taken into consideration 

 It will be readily understood that every now and then, in spite of the most 

 careful supervision, an excessive auto-inoculation must take place. Such an 

 over-dose is readily recognized clinically. A patient doing well on the ■ 

 grade of work prescribed for him and with no abnormality of temperature 

 suddenly complains of feeling tired, of loss of appetite and of headache; 

 and the temperature chart registers an elevation to 99° or 100° F. These 

 are precisely the symptoms which are found during the negative phase after 

 an excessive dose of bacterial vaccine. 



Thus we have a new scientific test by which the efifect of physical 

 exercise on the blood of patients has been traced. As Inman says : 



The opsonic index has shown that the exercise has supplied the stimulus 

 needed to induce artificial auto-inoculation, and that this systematic gradua- 

 tion has regulated this in point of time and amount. This co-operation with 

 the natural efforts of the blood has enabled Dr. Paterson to send his patients 

 back to their accustomed work, however hard it may be. But the investigation 

 has done more than explain a successful mode of treatment. Dr. Paterson 

 agrees with me that with the aid of the opsonic index he can regulate the 

 stimulus with scientific accuracy and obtain his results more certainly and 

 more rapidly. This, of course, involves work in the laboratory. But it also 

 means a more rapid and a more certain discharge of the patient which is the 

 main object of the sanatorium. 



Fresh air, exercise, and proper food seem then to constitute the 

 foundation of successful treatment of tuberculosis. The improve- 

 ment of the general condition of the patient and life in the open air 

 evidently needs to be supplemented by certain exercise so as to pro- 

 duce a series of auto-inoculations and probably the best method yet 

 devised is by the system of graduated labor just described. 



All sorts of exercises such as horseback riding, golfing, light 

 dumb-bell exercises and other calisthenics have been practiced for 

 many years in treating tuberculosis ; walking exercises have been the 

 feature of some of the German sanatoria referred to ; patients sent 

 to the western states and territories almost invariably practiced out- 

 door exercises, some with great harm and some with benefit. 

 Neither physician nor patient in most instances regulated these exer- 



