278 " OPSONIN-THERAPY " 



aspect, Sir Almroth Wright must receive the greatest credit for 

 its introduction. Before his researches the idea of injecting a 

 vaccine into a patient already suffering from a bacterial disease 

 was unthought of, although, of course, it was well known as a 

 method of producing immunity when disease was feared. The 

 question is often asked, Why inject more staphylococci into a 

 patient who has already too many ? The answer may, perhaps, 

 be as follows : The staphylococci which cause the lesion come 

 into contact with dead and diseased tissues only, and it is easily 

 conceivable that these may be very unsuitable to discharge so 

 vital a function as the formation of antibodies, whereas a few cocci 

 injected into the healthy tissues may cause a large amount. This, 

 however, does not explain the benefit which has been observed in 

 some cases of endocarditis and other haemal infections, for in them 

 the bacteria must be constantly gaining access to the healthy 

 endothelial cells, if to no others. But it is well known that not all 

 the tissues are equally adapted for the production of antibodies ; 

 thus, when diphtheria toxin is injected into the blood-stream little, 

 if any, production of antitoxin takes place. As a general rule, 

 when antibodies are required the blood-stream is the worst place 

 in which to inject the antigen, the serous membranes next, and 

 the connective tissues the best. Dr. Whitfield has suggested to 

 me that the reason may be that the stimulation of the opsonins 

 occurs best when dead bacteria are injected. Thus in the early 

 stage of the disease only living organisms are present, whilst later 

 we must suppose some are killed or die from some cause, and 

 then the stimulation of opsonin formation begins. The idea is 

 worth considering, but the subject is still obscure. 



As regards the nature of these results : In tubercle, speaking 

 from my own experience, I can only report a moderate degree of 

 success, and this only in small lesions, such as tubercle of the iris 

 or cornea and of tuberculous ulcers. I have had but one or two 

 encouraging results and numerous failures with tuberculous glands, 

 bone disease, etc., though others have apparently been more 

 successful. In phthisis there appears to be some slight benefit 

 when combined with other treatment, and tuberculous sinuses 

 sometimes heal very quickly. I should only recommend the 

 treatment myself as an adjunct toother methods, or when surgical 

 interference is impossible or inadvisable. 



With the diseases due to acute infections with staphylococci, 

 pneumococci, B. coli, and some other organisms, however, the 



