Ai)uecimber^907m'}      Op  sonic  Theory  and  Tuberculosis,  569 
The  tables  demonstrating  the  diagnostic  and  therapeutic  problems 
are  intensely  interesting.  Withal,  the  determination  of  the  opsonic 
power  of  the  blood  in  the  hands  of  Wright,  Douglas,  and  others  in 
England  has  yielded  results  as  remarkable  as  they  are  consistent. 
Over  on  this  side  of  the  Atlantic,  however,  such  uniform  success 
has  not  been  the  rule  and  consequently  the  opsonic  theory  has  come 
in  for  a  good  deal  of  adverse  criticism.  Personally,  while  I  have 
frequently  obtained  classic  curves,  I  must  confess,  that  many  of  my 
results  have  been  provokingly  disappointing,  but  that  is  neither  the 
fault  of  Dr.  Wright,  nor  his  theory.  I  believe,  when  men  here 
shall  have  worked  as  systematically,  as  doggedly,  and  as  long  as 
have  our  English  cousins ;  when  they  cease  to  attempt  to  modify 
the  technique  as  laid  down  by  Wright,  they  will  undoubtedly  be 
able  to  produce  results  as  consistent  and  valuable,  and  not  before. 
Until  we  have  done  this,  it  is  unfair  for  us  to  pass  judgment.  That 
the  dosage  of  tuberculin  can  be  controlled  by  opsonic  determina- 
tions in  localized  tuberculosis  can  be  shown,  but  for  reasons  pointed 
out  in  the  earlier  part  of  this  paper  it  must  be  plain  to  you,  why 
this  is  out  of  the  question  in  persons,  the  victims  of  active  and 
marked  pulmonary  lesions.  Indeed  in  my  modest  opinion,  tuberculin, 
unless  given  in  very  small  doses  is  fraught  with  some  danger  in  this 
latter  type  of  cases.  At  the  Phipps  Institute,  the  concensus  of 
opinion  seems  to  be  in  favor  of  small,  very  small  doses  in  all  cases 
so  treated,  and  opsonic  determinations  seem  to  substantiate  this. 
With  such  doses,  as  has  been  in  the  past  the  custom  to  administer, 
the  patient  is  continually  kept  in  the  negative  phase,  and  not  until 
the  dose  has  been  materially  diminished  do  we  find  an  augmentation 
of  the  opsonic  power.  Of  course,  in  the  administration  of  the 
remedy,  the  idiosyncrasy  of  the  patient  and  the  questionable 
strength  of  the  remedy — because,  of  course,  the  very  nature  of  it 
precludes  standardization — must  not  be  lost  sight  of.  Aside  from 
purposes  of  diagnosis,  we  may  eventually  find  it  unnecessary  to 
resort  to  opsonic  indices  and  as  a  guide  to  inoculations  it  may  be 
relegated  to  the  background.  But  one  thing  is  certain,  and  that  is 
that  vaccine  therapy  is  here  to  stay,  and  sera  and  vaccines  will 
supplant  in  many  cases  pills  and  potions,  which  are,  alas,  too  often  as 
useless  as  they  are  unpalatable. 
