340 



INFECTION AND RESISTANCE 



normal condition. In isolated cases, however, especially in tubercu- 

 losis, the index may remain high for periods as long as a month. 

 This Wright speaks of as a sustained "high tide" of immunity. 

 These laws of fluctuation are all of them entirely analogous to those 

 long well known in the- cases of other antibodies, for even in diseases 

 in which the immunity following an attack (typhoid fever, cholera, 

 plague, and others) is continued through life the antibodies disap- 

 pear from the blood after varying periods and we are forced to seek 

 the cause of the permanently high resistance, not in the circulating 

 blood, but in the ultimate physiological units the cells and tissues. 



According to Wright also, the treatment with vaccines may 

 be either reenforced or entirely replaced by a process of autoin- 

 oculation from the patient's own lesion by increasing the local cir- 

 culation, thereby throwing more of the specific antigen into the 

 blood stream. 



This reasoning has been applied, not only to the treatment of 

 tuberculosis and other conditions, but has been utilized to explain 

 fluctuations in the opsonic indices of untreated patients under the 

 influence of unusual motion of the diseased parts as in walking or 

 other exercise. Wright's meaning is well illustrated by the follow- 

 ing curve of opsonins in a case of gonorrheal polyarthritis in which 

 massage of the joints resulted in reactions similar to those ordinarily 

 elicited by vaccine injections: 



OPSONIC CURVE IN A CASE OF GONORRHEAL ARTHRITIS IN WHICH AUTO-INOCULA- 

 TION BY MASSAGE WAS PRACTICED. 



(After Wright, Douglas, Freeman, Wells and Fleming, "Studies on Immunity, 7 ' 



p. 373.) 



A further modification of the vaccine treatment of Wright origi- 

 nated in the observation that the exudate present in many infected 

 foci is often very much less rich in opsonins than is the blood serum 

 of the same patient. This is not unlikely to be due to an absorption 

 of the antibodies by the bacteria as well as by the tissue detritus in 

 the lesion. But Wright has interpreted it as a purely specific ab- 



