OPSONINS IN TUBERCULOSIS 261 



second day, and the rule originally laid down for the regulation 

 of the dosage was that no amount should be given which raised 

 the temperature more than *5 F. Very various opinions have 

 been expressed as to the efficacy of such treatment. There is 

 little doubt that in certain cases of local conditions, such as lupus, 

 tubercular joints, glands and genito-urinary tuberculosis, improve- 

 ment has followed its application ; but where febrile conditions 

 indicate that general disturbances are in existence, there is little 

 or no justification for its being applied, and even in many local 

 conditions the absence of benefit is so marked that by many 

 physicians the method has been abandoned. 



Active Immunisation associated with Opsonic Observations. 

 Within recent years attention has been directed to the possibility 

 of controlling the use of tuberculin-R by observations of its 

 effect on the opsonic qualities of the serum. Wright, early in 

 his work, showed that tubercle bacilli when sensitised by an 

 appropriate serum, were readily phagocyted by the polymorpho- 

 nucleate leucocytes, and the relative sensitising capacities of 

 serum from tubercular and non-tubercular cases has been widely 

 studied. According to Wright, in strictly localised tuberculosis 

 the opsonic index is persistently low, varying from '1 to '9, 

 while in tubercle with general disturbances it fluctuates greatly 

 from day to day, being sometimes below, sometimes above unity. 

 To take the former and simpler case, he holds that if the treat- 

 ment with injections of tuberculin-R be controlled by noting the 

 effect produced on the opsonic index, great improvement in the 

 patient's condition may result. Wright's interpretation of what 

 occurs is bound up with his views on the nature of the effects 

 produced. These views are briefly as follows. For 'reasons 

 unknown the opsonic qualities of the body fluids may become 

 abnormally low, and the tubercle bacilli, if they gain admission to 

 the body, can multiply locally. This multiplication is associated 

 with a still further local diminution of the opsonins. By the 

 introduction of such a substance as Koch's tuberculin-R the 

 bodily mechanism, whatever it is, which produces the opsonins 

 is stimulated, and a rise in the general opsonic index occurs. 

 Naturally this is accompanied by a passing to the site of infec- 

 tion of fluids more rich in opsonins than previously, the activity 

 of the phagocytes comes into play and the tubercle bacilli are 

 destroyed. But any such vaccination process must be controlled 

 by constant observations of the opsonic index, and it is only by 

 this means that not only good results can be obtained, but that 

 the production of harmful effects can be prevented. The reason 

 of this is that in a great many cases the injection of a bacterial 



