342 INFECTION AND RESISTANCE 



this place, indicate in a general way that localized tuberculosis of 

 the skin, joints, intestines, and glands, with the patient quiet and at 

 rest, is apt to show a low index, while a high index may, under 

 such conditions, often point to an active pulmonary lesion. Accord- 

 ing to Wright, this depends upon the following factors : In a 

 localized lesion, with the body at rest and when systemic symptoms 

 such as fever are absent the focus is, very probably, quiescent and in 

 but slight communication with the circulation, even though it may 

 be slowly progressive. In such cases little or no antigen is being 

 discharged and, in consequence, no antibody formation is stimulated. 

 Indeed, even the small amount of antibody which is present comes 

 into but indifferent contact with the lesion because of its compara- 

 tive insulation from the body fluids. Such a lesion may be benefited 

 by rest, in that spreading is inhibited, and autointoxication, with 

 the production of a negative phase, prevented ; but it cannot be com- 

 pletely cured unless the antibodies are increased. This can be ac- 

 complished by carefully controlled vaccinations with tuberculin. At 

 the same time more effective contact of these antibodies with the 

 lesion may be attained by local applications, X-ray, etc. Or, again, 

 the same purpose may be accomplished by carefully controlled and 

 graded motion or massage of the diseased part which may be used 

 both to increase the opsonin contents by auto-inoculation and to en- 

 hance the local circulation. If this is done with care it may serve to 

 substitute entirely for the treatment with vaccines. 



On the other hand, such treatment with auto-inoculation, it must 

 be remembered, is entirely uncontrollable as to dosage, and, there- 

 fore, not to be generally recommended. 22 In active pulmonary tu- 

 berculosis, when there are s} r stemic symptoms such as rise of tem- 

 perature, the body is very probably already receiving excessive 

 amounts of antigen and vaccine treatment of any kind may be 

 dangerous. 



However we analyze the work done on tuberculo-opsonins and 

 the investigations on this subject are far too numerous to be here 

 reviewed we are forced to the conclusion that in this disease the 

 opsonic fluctuations are far more irregular than in most other condi- 

 tions. Much, 23 for instance, found no regular differences between 

 the tubercle bacillus opsonins of healthy and of diseased individuals, 

 and Koehlisch 24 obtained similar results, adding the important ob- 

 servation that animals that show a high natural resistance to the 

 human type of the tubercle bacillus invariably show an opsonic 

 index much lower than that of man. 



We may question with much justice, therefore, whether In the 



22 Meakin and Wheeler. Br. Med. Jour., 2, 1905. 



23 Much. Munch, med. Woch., p. 496, 1908. 



24 Koehlisch. Zeitschr. f. Hyg., Vol. 68, 1911. 



