AmMarc£i907.rm'}     The  Opsonins  and  Bacterial  Vaccines.  147 
it  was  previous  to  the  injection.  This  Wright  has  named  the 
"  negative  phase."  Sooner  or  later,  from  a  few  hours  to  several 
days,  the  opsonic  index  rises  above  the  starting-point.  This  is  called 
the  "  positive  phase."  The  amount  of  the  opsonins  in  the  blood 
remains  stationary  for  a  variable  length  of  time,  and  then  diminishes. 
As  soon  as  their  diminution  is  noted,  a  second  injection  of  the  vac- 
cine is  given,  which  is  followed  by  a  negative  phase,  but  less  pro- 
nounced than  before.  Soon  the  positive  phase  comes  on,  reaching 
a  higher  level  than  previously.  Thus  the  injections  are  repeated 
from  time  to  time  according  to  the  opsonic  index  of  the  patient's 
blood,  and  the  positive  phase  gradually  attains  a  higher  and  higher 
level,  until  it  may  be  as  high  as  or  considerably  higher  than  that  of 
a  normal  person.  In  other  words,  if  the  vaccinations  are  properly 
given,  "  never  during  a  negative  phase,"  and  as  a  result  the  patient's 
tissues  are  stimulated  to  an  increased  production  of  the  opsonins, 
phagocytosis  is  increased,  the  invading  bacteria  are  disposed  of,  and 
the  patient  recovers  from  his  infection.  The  proper  handling  of 
patients  according  to  this  method  requires  the  greatest  attention  to 
details  of  technique  for  obtaining  the  opsonic  index,  preparing  the 
vaccine,  and  the  administration  of  the  proper  dose  at  the  proper 
time. 
It  is  too  early  to  know  the  ultimate  results  that  may  be  expected 
from  the  use  of  the  vaccines,  but  from  personal  observation,  con- 
versation with  other  workers,  and  numerous  reports,  most  of  which 
are  incomplete,  it  seems  reasonable  to  believe  that  for  localized 
bacterial  infections  much  may  be  accomplished.  Especially  does 
this  seem  probable  for  acne,  furunculosis,  sycosis,  abscesses,  and 
lupus,  adenitis,  and  other  similar  tubercular  infections. 
In  incipient  pulmonary  tuberculosis  encouraging  results  have  been 
obtained  where  minute  doses  of  new  tuberculin,  ywo~o  °^  a  mim_ 
gramme  more  or  less,  have  been  given,  which  seemingly  show  that 
Koch's  original  observations  were  well  grounded  in  fact. 
Something  has  been  accomplished  in  those  diseases  in  which  the 
bacterial  infection  is  in  the  blood  stream. 
After  a  careful  consideration  of  the  literature  of  the  entire  subject 
I  believe  we  should  recognize  the  new  therapy  as  an  experimental 
procedure  of  much  promise,  but  until  more  extended  observations 
have  been  made  the  use  of  the  vaccines  should  not  be  looked  upon 
as  a  settled  method  of  treatment. 
