After a proper diagnosis has been made, the patient’s opsonic index taken, and the appropriate vaccine prepared, the patient receives his initial injection of several hundred millions more or less of the heated bacteria, and his opsonic index is watched. A short time after the inoculation is made the opsonic index falls lower thanit 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 vaccine is given, which is followed by a negative phase, but less pronounced 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, conversation 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,11000of a milligramme 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.