tuberculous infection, while one nearly normal contra-indicates any but a perfectly quiescent condition.

Large doses of tuberculin must be carefully avoided lest, if the case be one of tuberculosis, it start into renewed life a latent lesion.

While as a diagnostic aid much of value may be obtained, yet it is upon its use in connection with the therapeutic inoculation of bacterial vaccines that we rest our greatest hopes.

Whatever our variations and improvement in obtaining the index may be in future, it can be said already that such inoculations when controlled by the knowledge of the index, have produced results little short of wonderful. When by it we can get the body into such a condition that will allow it to eradicate diseases that have been present for months or even for years unaffected by any other method of treatment as we can certainly often do, we must consider it a most important addition to our homoeopathic armamentarium.

If time and my part of the subject permitted I could cite cases of infection by the staphylococcus, streptococcus, pneumococcus, bacillus tuberculosis, colon bacillus, etc., that have made great advances toward recovery when thus treated. This, however, will be fully covered in the following paper and will, I trust, demonstrate to all the possibilities of the method. In closing I wish to mention that in my laboratory in Boston University we are at the present time working with and soon hope to prove that the proper administration of the correct homoeopathic remedy, has acted, does act and will act in a similar manner in increasing the resisting power of the patient. And if this can be done, homoeopathy will possess that for which we have so often been asked by our opponents, a method of positively demonstrating the action and efficiency of our remedies.

ACUTE PANCREATITIS.

The onset is characterized by sudden, severe abdominal pain; in the majority most severe in the epigastric region. This pain is of the most extreme character, at times not yielding to morphine. Nausea and vomiting set in almost at once, the vomitus at first consisting of food, later bile-stained and fecal. The patient early shows signs of collapse; the temperature is normal or only slightly elevated; the abdomen soon begins to show distension, but no real tumor is made out until 24 to 48 hours after onset; the epigastrium shows most distension, and after a few days a tumor may be palpable or even seen; icterus, pruritus, cyanosis, hiccough and other signs or symptoms may appear. (Med. Rev. of Rev.)

EIGHT MONTHS EXPERIENCE IN THE TREATMENT OF SOME SKIN AND INFECTIOUS DISEASES BY

OPSONOGENS.*

ROLLIN H. STEVENS, M. D., DETROIT, MICH.

(Printed simultaneously by the Critique and the Gazette.)

Before considering the subject matter of this paper, a word concerning the terminology is due. Ohlmacher's suggestions in this matter appeal to me as very rational and worthy of adoption. Wright's choice of the word "opsonin" as a name for the protective substance acting upon bacteria to prepare them for injestion by the phagocytes or protective body cells, is a happy one; but the word "vaccine," as a name for the preparations of bacteria used to cure disease by generating opsonins in the blood is very misleading. Vaccine is for use in the human being, but prepared for the cow, as the derivation of the word (vacca, a cow) implies. Wright's idea was that vaccine generates protective substances (opsonins) against small pox. But opsonins are specific, there apparently being one against each disease, so "vaccine" is too narrow a term. Opsonins, in Wright's system of therapy, are generated from hypodermic injections of dead bacteria prepared from the very disease it is proposed to cure, not from another disease in another animal. Therefore, the term "vaccine" for these and many other reasons should be divorced from the terminology of Wright's theory, and the general terminology made to conform to the word "opsonin," which so completely expresses Wright's idea. The word "opsonogen" (literally, that which generates opsonins) has been suggested as a substitute for the term "vaccine" in this connection, and, as it so clearly expresses the object aimed at it should receive the stamp. of approval and general use.

In beginning our work in opsonotherapy last October we were careful to have opsonic indices made, and to govern our treatment accordingly. With limited laboratory assistance, however, there are not hours enough in the day to make the opsonic indices required for each patient. So we have been guided almost entirely by clinical symptoms in repeating our doses. This I frankly acknowledge is not strictly according to Wright and our results are perhaps not fairly representative of what might be accomplished. For the same reason autogenous, opsonogens, i. e., opsonogens made from the same patient we are treating, have not always been procurable.

*Read before the American Institute of Homoeopathy, June, 1907

This was unfortunate as the best results have been secured when the autogenous opsonogen was used.

A good deal of judgment and skill is required to isolate the offending microorganism, and, to be a competent opsonotherapist, one must either be a very careful, conscientious expert bacteriololist himself, or have the services of one.

Condensed Report of Cases.

Since the latter part of October, 1806, I have treated with opsonogens the following diseases: Acne vulgaris, 14 cases; rosacea, 5 cases; furunculosis, 7 cases; impetigo contagiosa, 3 cases; sycosis vulgaris, 2 cases; psoriasis, I case; pustular syphiloderm, I case; ichthyosis, I case; cancer, 3 cases; sarcoma, 2 cases; keratosis pilaris (suprafollicularis of Unna) 2.

Acne Vulgaris.

Of the 14 cases of acne treated, 4 have been apparently well for 1 to 3 1-2 months, 8 have been markedly improved, and two did not respond.

To illustrate some of the conclusions at which I have arrived I shall describe briefly the courses of four cases of acne.

Case I. This case is fully reported in the March Medical Century. A single woman 25 years of age of decidedly lymphatic temperament, jolly and always in good health, except for constipation and the acne from which she had suffered for 8 years, following an attack of measles. When referred to me three years. ago by Dr. R. M. Richards, livid, hard, infiltrated papules, pustules and comedones literally covered her face, which, like her scalp, was very greasy. The skin of the face was lacking in tone, was red, soggy, somewhat oedematous, hairy-in fact, one of the worst cases of acne I ever saw. The posterior surface of arms and anterior surface of thighs were rough, like a grater (keratosis pilaris).

I treated her with various local applications including Roentgen ray and with internal remedies. Finally, after two applica tions at intervals of three months, of a powerful lepismatic, the face was free from pustules for several months. They gradually reappeared, though not to the same extent as at first, till last October, when she returned to me.

I then made a culture from the pustules and secured only staphylococcus albus in pure culture-the germ which I find in most cases of acne. Her opsonic index against this and staphylococcus aureus was 8. A mixed opsonogen of 200 millions of each of these cocci was prepared and injected. Five days later there was a sudden increase in pustules, larger, but more superficial than usual, and worse on the right side. In two weeks the face was somewhat improved. There were a few pustules unusually pale and shrivelled in appearance. Subsequent injections were given. ten days to four weeks apart, the last one the 18th of February.

Her face was entirely free of blackheads and pustules by the last of January-three months after beginning treatment-eight doses in all having been given.

After the second, third and fourth doses, for two to five days she was mentally depressed, cold all the time; her limbs ached, and she felt tired and sleepy. New but superficial pustules appeared on her face. Later doses did not cause these primary symptoms of the negative phase. Following this her appetite increased enormously-a very frequent result. She became cheerful again and her face improved. A curious symptom, which I have often witnessed since, was that the blackheads came half way out of the follicles, hung there for a time, and finally dropped off. This auto-expulsion of the comedo I could scarcely have believed, had I not seen it many times, and it gave me increased faith in the power of internal medicine. It demonstrated the superfluity of local treatment of acne, of which, I confess, I had always been a strong advocate (Wright advises against any local interference in acne).

One month after beginning treatment the surface of the whole body, which had always been excessively oily, became dry and itchy, and a true oczema developed on the right side of the face, persisting for about three or four weeks, gradually disappearing. The right side of the face was then as entirely free from comedoes or pustules as the left side had been early in the treatment. But the skin remained quite dry for a month lon rer. Then it became softer and contained the normal amount of oil. The legs and arms became perfectly smooth for the first time in her recollection. The patient's face remains wholly free from pustules or blackheads, the old scars scarcely show, the complexion is clear. The weight has increased.

Case 2. A sandy complexioned young man of 17 years had acne vulgaris for three years. The entire face was covered with blackheads, papules and pustules of all sizes and there were some on the back and chest. No constitutional symptoms, except occasionally a little indigestion, I injected him with 200 millions. each of a stock solution of staphylococcus aureus and albus. Twenty hours later he complained of lameness and a feeling of lassitude. The temperature was 99 at 8 A. M. This lasted only 24 hours longer, and then all general symptoms disappeared. In four days he said his face looked better than it had since he had Six days after the injection new pustules began to appear, and he was injected again with a similar dose. A reaction, not as severe as the first lasted two days, when the face cleared more than ever. All pustules were gone and only blackheads and papules remained. A week later a culture from the blackheads vielded staphylococcus citreus and albus. Injections of the citreus and albus (from another case of acne) were now begun, and thirteen more doses given from one to four weeks apart. The

acne.

case improved slowly at first but since then it has made no improvement, and though he is much better, he still has many blackheads and pustules. No opsonogen was made from his own bacteria.

Case 3. A single woman, aged 22, stenographer, nervous temperament, tall and slender. She had eczema when an infant, and had been under treatment for catarrh and enlarged tonsils since childhood. Acne developed 7 years before and has persisted, in spite of constant treatment. For months she has been much depressed mentally, has had no appetite, has suffered from chills and fever at irregular intervals for weeks, and has lost in weight. (No signs of tuberculosis or other disease to account for it). Her tongue was heavily coated with a pasty thick brown fur. Her face was covered with large red papules and pustules, and numerous scars and blackheads. The opsonic index was not worked out. Staphylococcus albus was grown in pure culture from the pus. Injections of staph. albus were given seven to seventeen days apart. In less than five weeks the whole clinical picture was changed. The mental depression, coated tongue, chills and fever, muddy complexion, and poor appetite were supplanted by a condition of physical and mental good health, while the local face lesions gradually disappeared. The menstruation, which bcfore had been very painful and delayed, became normal. She could scarcely get enough to eat, and she gained steadily in weight. She had had a great deal of dandruff in her scalp, and even that became less (a frequent result of the treatment). Aiter eight injections she seemed perfectly well, and has remained so up to the present. Thus we note many constitutional symptoms, which at first sight might seem to have no connection with the acne, clearing up under the proper remedy for the acne.

But all is not such smooth sailing as the previous case indicated and I shall report a complete failure.

A single woman 25 years old, a teacher, has had some acne for two years, but there were scarcely any pustules. The papules were for the most part non-inflammatory, and simply consisted of elevated, cone-shaped elevations of the skin, with a blackhead in the centre. They covered each cheek. Her general health was excellent. Staph. albus was found in the comedones. Injections of staph. albus, of staph. cit. and albus, and of staph. aureus and albus changing from one to the other from time to time has failed to influence the case to any marked degree, after five months of treatment. Her own opsonogen of staph. albus was used the last two times, and I have not seen her now for a month.

Rosacea.

Three of nine cases were almost wholly relieved of small pustules and erythema about the nose, cheeks, chin and forehead, after three to nine injections of staphylococcus albus. One in