356 BACTERIOLOGY OF THE EYE 



theory of Wright. The same holds, to a greater or less extent, for immunization 

 and treatment for Streptococci, Stajrfiylococci, Gonococci, and other organisms. 



By the injection of small doses of the dead bacteria, Wright sought to increase 

 the opsonic power, and thus to produce general and local cure. As. fur as possible 

 the organisms used were taken from the patients themselves, with the great advan- 

 tage that the vaccine was suitable to the cause of the disease. From patients with 

 furunculosis or acne the Stapliylococci were cultivated from a pustule, cooked to 

 60 C., and then in small doses injected hypodermically a method of treatment 

 which is very highly thought of by many, and one which can be used for chronic 

 cases of blepharitis ulcerosa, etc. 1 



Wright does not now insist on this for the Stapliylococcus ; he does not consider 

 that the race differences are so important in the case of this organism. For 

 Pneuniococcus and Streptococcus, however, it must be taken into account. 



With regard to tuberculin treatment, Wright has come to the con- 

 clusion that very small doses are sufficient to raise the opsonic index 

 to its maximum : -g^nnr to roW of a milligramme is sufficient to produce 

 a reaction, and a larger dose is not necessary. The dose should be 

 repeated every three weeks. It is still to be proved whether such a 

 dose is sufficient in tubercle of the eye. From the clinical point of 

 view it is quite certain that von Hippel's method of dosage, already 

 described, has been innocuous in many cases, and has given many 

 good results in ophthalmic practice. It would be very interesting if 

 the opsonic index of a case treated in this way was worked out, to see 

 if the clinical course of the disease might be compared with this 

 varying power of the serum. It would then be obvious to what extent 

 the purely clinical dosage was correct from the opsonic standpoint. 



It is impossible in every case to carry out such complicated and 

 tedious processes as are necessary in opsonic work, especially when 

 skilled assistance is not available. When a sufficiently large number 

 of cases have been worked out, the correct dosage may be ascertain- 

 able, without the necessity of always controlling it by the actual 

 opsonic index. It must first be shown whether the bacterioscopic 

 results furnish a reliable index of the progress of recovery in the 

 various forms of tubercle of the eye. 2 



Certainly Wright's method of scientific estimation and control of 

 active and passive serum treatment (e.g., in pneumococcal serum 

 treatment) deserves further and more extensive application. 



1 Nias and Paton (Lancet, 1906, p. 1500) have determined the opsonic index for tubercle 

 in cases of phlyctenular eye affections during treatment (local and gereral, but not 

 tuberculin), and state that, on the healing of ulcers, the index, which had at first been 

 very low, rose ; the index for Staphylococci in these persons was from the fir.st unchanged. 



2 It is possible that in the positive phase, which Wright states to be the time suitable 

 for further injections, the freshly introduced tuberculin may be attached to the anti- 

 tuberculin already present. 



