1905.] On Tubercular Infection in a Patient's Blood, etc. 203 



Case 2. — Man, cet. 41, Tentative Diagnosis, Pleurisy due to Malignant 

 Disease, or Tubercular Pleurisy. 



No phagocytosis obtained with the serum, heated for 10 minutes to 60° C. 

 and employed in a phagocytic mixture containing over 1 per cent. NaCl. 



The verdict of pleurisy due to malignant disease, which was based on this, 

 was confirmed on post-mortem examination. 



Case 3. — Case Tentatively Diagnosed Miliary Tuberculosis or Malignant 



Endocarditis. 



No phagocytosis obtained with the serum, heated for 10 minutes to 60° C. 

 and employed in a phagocytic mixture containing over 1 per cent. NaCl. 



The verdict of malignant endocarditis which was based on this was 

 confirmed on post-mortem examination. 



Observation 4. — Case Diagnosed Miliary Tuberculosis. 



No phagocytosis obtained with the serum, heated for 10 minutes to 60° C. 

 and employed in a phagocytic mixture containing over 1 per cent, of NaCl. 



The post-mortem examination revealed a complete absence of tubercular 

 lesions and a healing typhoid ulcer* in the ileum. 



On two other Methods by which a Diagnosis of Tubercular Infection can be 

 arrived at or Excluded. 



In addition to the methods which have been already considered, there are 

 two further methods which can be exploited in connection with the 

 diagnosis of tubercular infection. The first of these is applicable where 

 we desire to supplement the often ambiguous data furnished by the clinical 

 symptoms in the case of inoculations of tuberculin undertaken for diagnostic 

 purposes. The second is applicable where we can obtain, in addition to the 

 patient's blood, also lymph, or, as the case may be, pus from the seat of 

 infection. 



Diagnosis of Tubercular Infection by the Aid of Measurements of the Opsonic 

 Power carried out in Connection with the Inoculation of Tuberculin for 

 Diagnostic Purposes. 



Already, three years ago,| in connection with a paper on staphylococcus 

 inoculations as applied to the treatment of acne, furunculosis, and sycosis, 

 attention was directed by one of us to the close analogy between the 

 tubercular reaction of Koch and the local inflammation and general 

 constitutional disturbance which may supervene when a patient whose 



* A negative Durham-Gruber reaction had been obtained in this case, 

 t 1 Lancet,' March 29, 1902. 



