568  Opsonic  Theory  and  Tuberculosis.  {ADecJemb^rPilir- 
power  of  activating  the  leucocytes.  From  a  tuberculous  person, 
however,  in  spite  of  the  heating  process  the  appetite  of  the  cells 
for  the  bacilli  was  not  at  all  disturbed. 
Again,  a  probable  diagnosis  of  tuberculosis  can  be  made  in  those 
persons  who,  on  receiving  even  a  minute  inoculation  of  tuberculin, 
respond  with  a  very  low  opsonic  reading.  While  a  negative  phase 
does  occur  in  an  individual,  who  is  not  tuberculous,  it  is  only  after 
a  comparatively  large  dose,  and  this  negative  phase  is  ephemeral 
only.  What  most  appeals  to  one  in  point  of  interest  and  ingenuity  ? 
however,  is  perhaps  the  method  of  diagnosis  by  comparing  the 
serum  of  the  patient  with  some  other  of  his  body  fluids.  Wright 
has  shown  that  if  the  opsonic  power  of,  say,  some  of  the  effusion  from 
a  patient's  chest  is  much  lower  than  his  blood,  the  effusion  is  unques- 
tionably tuberculous  in  character.  I  shall  here  take  the  liberty  to 
intrude  upon  your  valuable  time  to  cite  a  case  illustrating  this,  and 
do  so,  because  it  is  really  unique.  A  man,  aged  30  years,  showing 
grave  constitutional  symptoms  baffled  his  physicians  as  to  his  malady. 
The  latter  suspected  tuberculosis  and,  accordingly,  some  of  his  blood 
together  with  some  fluid,  obtained  from  his  abdomen  by  tapping  was 
sent  to  the  laboratory.  The  report  from  the  laboratory  was  "  non- 
tuberculous/'  and  on  the  grounds  that  while  the  index  of  the  blood  was 
1-05,  the  fluid  was  -99  or  practically  the  same.  The  man's  condition 
became  worse.  The  clinicians  refuted  or  at  least  doubted  the  diag- 
nosis of  those  clever  laboratory  men.  The  condition  was  tuberculous 
unquestionably,  they  said,  and  once  more  blood  and  fluid  were  sent  for 
confirmation.  But  again  the  laboratory  diagnosis  came  back  "  non- 
tuberculous."  This  time  the  serum  and  fluid  both  revealed  an  index 
of  1.  The  man  shortly  afterward  died,  and  on  post  mortem,  what 
to  the  naked  eye  appeared  as  unquestionably  tuberculous  deposits 
were  found  on  the  peritoneum  and  the  pleurae,  much  to  the  chagrin 
of  the  laboratory  men,  and  to  the  delight  of  the  physicians.  How- 
ever, microscopical  examination  of  some  of  these  apparent  tubercles 
showed  the  typical  picture  of  miliary  carcinoma  or  cancer.  Could 
there  possibly  have  been  a  more  gratifying  vindication  for  these  keen 
laboratory  workers.  In  a  recent  number  of  the  London  Lancet  we  can 
read  further  evidences  of  the  prolific  work,  which  is  being  done  in  the 
Department  of  Therapeutic  Immunization  of  St.  Mary's  hospital,  by 
Wright  and  his  assistants,  and  a  large  number  of  graphic  charts  are 
shown  illustrating  the  various  phases  in  Therapeutic  Immunization. 
