208 Dr. A. E. Wright and Staff-Surgeon S. T. Keid. [Oct. 21, 



The clinical symptoms, the age of the patient, and the appearances as seen 

 at the operation appearing in contradiction with this verdict, and the ascites 

 having reappeared, a second operation was performed, and a further sample 

 of ascitic fluid was obtained for examination. At the same time the clinical 

 appearances were again observed, with the result that there was now some 

 wavering as to whether the original diagnosis could be upheld. The result 

 of the phagocytic examination of the ascitic fluid, and of a sample of blood 

 from the fingers were now as under : — 



Tuberculo-opsonic index. 



Serum 1 



Ascitic fluid 1 



In view of this result the verdict previously given was sustained. 



A post-mortem examination, which followed in the course of a few weeks, 

 again threw doubt on the verdict, the naked-eye appearances being entirely 

 consistent with the theory of miliary tuberculosis affecting the peritoneum 

 and serous covering of the intestines. Microscopic examination of the 

 sections made through the miliary nodules revealed, however, a typical 

 picture of miliary carcinoma. No primary carcinomatous focus had been 

 discovered, though it was sought for on post-mortem examination. 



Observation 5. — Case of pleural effusion. Blood from the finger and fluid 

 obtained by paracentesis of chest were examined : — 



Tuberculo-opsonic index. 



Serum 0'92 



Pleural fluid 1-0 



This was taken as evidence of the absence of tubercular infection. 



Observation 6. — Case diagnosed as peritoneal tubercular peritonitis com- 

 plicated with pleurisy. Blood from the finger was examined on two 

 occasions. On the second occasion, which was 48 hours after the first 

 examination, peritoneal and pleural fluid were also examined. 



The results obtained by the phagocytic examination undertaken on this 

 second occasion were as follows : — 



Tuberculo-opsonic index. 



Serum 07 



Peritoneal fluid 0-28 



Pleural fluid 1 



The results of the comparison of the peritoneal fluid with the serum 

 obtained from the blood withdrawn from the finger were taken as evidence 

 of tubercular infection of the peritoneum. Confirmatory evidence of 

 tubercular infection was furnished further by the low tuberculo-opsonic 



