OPSONIC INDEX AND VACCINE THERAPY 341 



sorption by the bacteria, and has utilized it for diagnostic purposes. 

 Thus, with Reid, 12 he has examined in this way the comparative 

 amounts of tubercle bacillus-opsonins in the blood, and in the local 

 exudates (peritoneal fluid) in cases suspected of tuberculosis, and 

 has determined the tuberculous nature of the condition by showing 

 a discrepancy between the two. These results have not been uni- 

 versally confirmed. 13 But therapeutically, because of this supposed 

 lack of opsonin in the fluid of lesions, Wright has advised the in- 

 crease of the local flow of lymph by poulticing, heat, drainage, Bier's 

 cups, X-rays, Finsen light, and other means of accomplishing this 

 purpose. 



All that has gone before (most of it taken directly from the 

 staphylococcus studies of Wright and his immediate followers) has 

 tended to show a very close correspondence of clinical improvement 

 with the increased opsonin contents of the blood. 



As applied to other infections, such as gonococcus arthritis, colon 

 bacillus cystitis, localized pneumococcus lesions, and many other 

 conditions of a localized character, observations of a similar general 

 significance have been made. Such reports have been made, apart 

 from the Wright school, by Emery, 14 Potter, Ditman, and Bradley, 15 

 Potter, 16 Tunnicliff, 17 Whitfield, 18 Cole and Meakins, 19 and many 

 others, and we may say with reasonable accuracy that, in localized 

 infections particularly, there is much evidence to show that clinical 

 improvement and rise of the opsonic index go hand in hand. 



There have been many exceptions to this which, in view of the 

 complicated factors involved in immunization, as well as the diffi- 

 culty of the technique, is not surprising. 



In tuberculosis in which many of Wright's earlier studies were 

 made the parallelism has -not been so consistent. Thus even the 

 early work of Bullock 20 showed that, in contrast to similar staphy- 

 lococcus investigations, the tuberculo-opsonic indices of patients may 

 occasionally be higher than normal, and similar observations were 

 made by Lawson and Stewart 21 in cases of acute pulmonary tubercu- 

 losis. 



Various investigations, too numerous to be reviewed in detail in 



12 Wright and Reid. Lancet, 1906 ; Proc. Royal Society, Vol. 77, 1906. 



13 Opie. Assoc. of Am. Phys., Washington, 1907. 



14 Emery. "Immunity, etc.," Lewis, London, 1909. 



15 Potter, Ditman, and Bradley. Journ. A. M. A., Vol. 47, 1906, p. 1722. 



16 Potter. Jour, of A. M. A., Vol. 49, 1907, p. 1815. 



17 Tunnicliff. Jour, of Int. Dis. } Vols. 4 and 5, 1907 and 1908. 



18 Whitfield. Practitioner, May, 1908. 



19 Cole and Meakins. Johns Hop. Hosp. Bull., Vol. 18, 1907. 



20 Bullock. Transact, of Lond. Path. Soc., Vol. 56, 1905, and Lancet, 

 1905, Vol. II, p. 1603. 



21 Lawson and Stewart. Lancet, 1905, Vol. II, p. 1406. 



