PHAGOCYTOSIS 279 



results are most beneficial. We may often see boils apparently 

 on the point of bursting retrocede in a most striking manner after 

 a single injection of staphylococcic vaccine, and pustular acne is 

 often equally benefited. Localized lesions of pneumococcic origin 

 often clear up quickly under the action of pneumococcic vaccine : 

 thus a case of empyema of the frontal sinus, due to this origin and 

 of four years' duration, was cured in five injections, spread over a 

 period of about twqjnonths. Numerous cases of cure of chronic 

 infections of the urinary tract with B. coli have been recorded, and 

 some cases of gonorrhceal arthritis have been cured in a remark- 

 able manner. In a case of my own a patient, with five large and 

 numerous small joints affected, was completely cured in three 

 months, after having been crippled for over two years. One or two 

 undoubted cases of ulcerative endocarditis have been cured, and 

 others in which there was a haemic infection (with streptococci), 

 though the evidence in favour of a valvular infection is less con- 

 vincing. The results in cases of Malta fever are also very 

 encouraging. As a rule, however, we may say that the special 

 scope of the method is in the treatment of localized infections. 



A point of great practical importance, and one that has some 

 theoretical interest as pointing to a high degree of specificity in 

 the opsonins, is the fact that good results are sometimes obtained 

 only when the vaccine used is from a culture of the organism in 

 question from the patient himself. This is sometimes seen in 

 staphylococcic infections ; acne is occasionally very resistant to 

 stock vaccines, and yields readily to treatment with an emulsion 

 prepared from a culture from the patient's own pus. This 

 phenomenon is specially marked in the case of streptococci and 

 B. coli. 



In admitting the success of vaccine therapy, we do not neces- 

 sarily admit the truth of the theory on which it is based, nor the 

 necessity for the opsonic control of the doses. It is certainly true 

 in general that with acute lesions there is a low opsonic index, 

 and that when amelioration or cure takes place a rise to or 

 above normal occurs, but this is not invariably the case. Thus, 

 occasionally tuberculous patients improve whilst the index 

 remains low, and those with a meningococcal infection often go 

 steadily downhill whilst the index is very high, though in the 

 latter case the symptoms are in general more severe when the 

 index falls. Now it is quite true and perfectly conceivable that 

 the continued existence of a lesion in spite of a very high opsonic 



