1905.] On Tubercular Infection in a Patient's Blood, etc. 



199 



persistently low opsonic power with respect to the tubercle bacillus, it may be 

 inferred, in the case where there is evidence of a localised bacterial infection 

 which suggests tuberculosis, that the infection in question is tubercular in 

 character. 



(b) Where repeated examination reveals a persistently normal opsonic power 

 with respect to the tubercle bacillus, the diagnosis of tubercle may with probability 

 be excluded. 



Illustrative case: A. B. — Case diagnosed as tubercular cystitis on the 

 evidence of pus in the urine, of the cystoscopic appearances and general 

 disturbance of health. The measurement of the tuberculo-opsonic power of 

 the blood yielded the following results : — 



Date of blood Tuberculo-opsonic 



examination. index. 



2.3.05 0-98 



14.4.05 0-99 



28.4.05 1 



18.5.05 1 



19.5.05 1-1 



2.10.05 0-97 



The inference that the cystitis and disturbance of health was not of 

 tubercular origin was confirmed (a) by the fact that an extensive series of 

 bacteriological examinations prolonged over many months revealed in every 

 case the presence of proteus in large numbers, while the tubercle bacillus was 

 never found, even when examined for by the inoscopic method of Jousset ; 

 (b) by the fact that the patient's blood possessed, anterior to treatment with 

 regard to the proteus, an agglutinating power which was three times higher 

 than the normal ; and (c) by tbe fact that very striking amelioration of the 

 cystitis, and a complete return to health has been obtained as the result of 

 the inoculation of a proteus vaccine. 



(c) Where there is revealed by a series of blood examinations a constantly 

 fluctuating opsonic index the presence of active tuberculosis may be inferred. 



C. D. — A case of severe chronic urticaria of unknown aetiology. The 

 measurement of the tuberculo-opsonic power of the patient's blood yielded 

 the following results : — 



Date of blood Tuberculo-opsonic 

 examination. index. 



20.5.05 1-3 • 



26.5.05 1-3 

 16.6.05 0-86 

 20.6.05 1-27 



p 2 



