1904.] the Tubercle Bacillus ly Human Blood Fluids, etc. 167 



exhaustion of the protective elements under the influence of the 

 bacterial invasion ; or, alternatively, to an antecedent deficiency in these 

 elements. 



The following considerations appear to us here to plead in favour 

 of interpreting the low opsonic power of the tubercular patients here 

 in question as the occasion and not the consequence of infection. 



(a) Very low phagocytic indices have been obtained where constitu- 

 tional symptoms were absent or insignificant. The cases denoted by 

 the serial numbers 3, 4, 5, and 8 are instances in point. 



(b) We have in practically every case found it possible to increase 

 by an inoculation of a tubercle vaccine, the opsonic power of a 

 patient's blood fluids. 



III. Distribution of Tuberculotropic Substances in the Infected Organism. 



We have made the subjoined observations on this question. It will be 

 seen that they are in consonance with the observations (see pp. 151 153) 

 we have made in connection with the distribution of the staphylococcic 

 opsonins in the infected organism, and with the induction that the 

 bacteriotropic pressure is always reduced in the actual foci of infection. 



Observation 1. 



The patient was a child set. 2 years, affected with tubercular necrosis 

 of the sternum, and with a tubercular abscess in the thigh. 



A. 



Seruin obtained from blood drawn from finger .... 1 vol. 



Physiological salt solution 1 



S. B. D.'s washed corpuscles 2 vols. 



Suspension of heated tubercle bacilli 1 vol. 



Phagocytic index (average of 20 P.W.B.C.), 3-9. 



B. 



Supernatant fluid of pus withdrawn from abscess.. 1 vol. 



Physiological salt solution 1 ,, 



S. K. D.'s washed corpuscles 2 vols. 



Suspension of heated tubercle bacilli 1 vol. 



Phagocytic index (average of 20 P.W.B.C.), I'l. 



Observation 2. 



The patient was a young man suffering from a psoas abscess due to 



tubercular infection. 



A. 



Serum obtained from blood withdrawn from finger 1 vol. 



Physiological salt solution 1 ,, 



A. E. W.'s washed corpuscles 2 vols. 



Suspension of heated tubercle bacilli 2 



Phagocytic index (average of 40 P.W.B.C.), 0-6. 



