212 PHAGOCYTOSIS. OPSONINS AND BACTERIOTROPINS 



In colon, streptococcus, gonococcus and acne, doses of i to 3 million 

 should be used at the beginning and then gradually increased. 



In tuberculosis Wright starts with the T. R. in dilution equivalent to 

 about i/iooo mg. of the dry tuberculin substance and this is increased to 

 about 1/600 mg. 



Wright cites two general rules to be observed in the therapy of infectious diseases. 



1. In all cases where the normal antibacterial power of the blood has been lowered, 

 immunization is indicated. 



2. Whenever the blood possesses strongly active curative powers, an increase of the 

 blood supply to the infected part should be attempted in order that the antibacterial 

 elements of the blood and leucocytes may display their effect. In such cases the 

 production of hyperemia is particularly of help. Similarly, massage and other such 

 therapeutic measures can be useful. 



The therapeutic value of auto-inoculation is very slight and should not be encour- 

 aged, as in this way the exact dosage cannot be followed. 



Wright has employed these vaccines in staphylo-, strepto-, and gonococcus infec- 

 tions, as well as in coli infections, tuberculosis, malta fever and carcinoma (!) where 

 injections of the bacillus neoformans Doyen were given. 



From a critical review of the cases published, which were treated with 

 vaccines by Wright and his fellow workers, one certain conclusion can be 

 reached; namely, that given an infection, inoculations with small doses of 

 the respective dead or extracted homologous bacteria, will result in a thera- 

 peutic immunization. Although Koch had advanced the same principle 

 for the treatment of tuberculosis, it is Wright who first recognized the 

 general application of this form of immunity. Furthermore, by means 

 of his opsonic studies, he was able to prove that by the injection of even 

 the minutest doses, for example 1/1,000,000 c.cm. of tuberculin, immune 

 reactions are incited. 



In spite of this finding, investigators are still at variance over the ques- 

 tion, and two camps exist: one of which believes that the ideal treatment of 

 tuberculosis consists in the repetition of the small doses; the other, that the 

 best results are obtained by gradually increasing the dose of tuberculin 

 until very large doses are administered. Citron has found the latter course 

 more satisfactory. 



Since, as is known, tuberculin is one of the harmful agents in tubercu- 

 losis infections, it seems more advantageous to get the patient, if possible, 

 into a condition where he is able to neutralize large doses of tuberculin 

 rather than to have him at a stage where even moderate doses suffice to 

 give a reaction. 



Other questions of importance in the vaccine therapy are: first, 

 whether any parallelism exists between the increase in opsonic index and 

 improvement in the clinical manifestations; second, whether the opsonic 

 index must necessarily be used as a guide in vaccine treatment. 



As to the first, Wright has pointed out numerous cases where exact 



