PHAGOCYTOSIS OPSONINS AND BACTERIOTROPINS. 



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 therapeutic 

 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.c. of tuberculin, immune reactions are incited. 



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

 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 such 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 improve- 

 ment 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 in numerous cases on record, that 

 exact study has proved that such parallelism exists. This fact is probably 

 correct in the majority of instances, but it cannot be considered as an infallible 

 rule, inasmuch as the formation of opsonins is only one of a great number of 

 factors in the complicated process of healing, and consequently one should 

 not be surprised when in some instances in spite of a rising opsonic index, 

 the patient's clinical condition becomes worse, and reversely where improve- 

 ment occurs although the opsonic index does not change. 



Accordingly, the value of the opsonic index during the course of treatment 

 becomes secondary in importance to the exact clinical observation of the case. 

 Wright and his school have shown that certain bad effects may follow from 

 the injection when performed during the negative phase. With the use 

 of small doses the negative phase becomes short only one day or even less; 

 accordingly it is very probable that this state is entirely passed when an 

 injection is repeated on the fifth to eighth day. 



The tuberculin therapy at the Kraus clinic is conducted on this principle, 

 without estimation of the opsonic index. And yet, no harmful effects have 



