A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
2. Opsonins.--That phagocytosis plays an important part in the body's
resistance to bacterial invasion has long been recognized. According
to Metchnikoff, this property of leukocytes resides entirely within
themselves, depending upon their own vital activity. The recent
studies of Wright and Douglas, upon the contrary, indicate that the
leukocytes are impotent in themselves, and can ingest bacteria only in
the presence of certain substances which exist in the blood-plasma.
These substances have been named _opsonins_. Their nature is
undetermined. They probably act by uniting with the bacteria, thus
preparing them for ingestion by the leukocytes; but they do not cause
death of the bacteria, nor produce any appreciable morphologic change.
They appear to be more or less specific, a separate opsonin being
necessary for phagocytosis of each species of bacteria. There are,
moreover, opsonins for other formed elements--red blood-corpuscles,
for example. It has been shown that the quantity of opsonins in the
blood can be greatly increased by inoculation with dead bacteria.
To measure the amount of any particular opsonin in the blood Wright
has devised a method which involves many ingenious and delicate
technical procedures. Much skill, such as is attained only after
considerable training in laboratory technic, is requisite, and there
are many sources {201} of error. It is, therefore, beyond the province
of this work to recount the method in detail. In a general way it
consists in: (_a_) Preparing a mixture of equal parts of the patient's
blood-serum, an emulsion of the specific micro-organism, and a
suspension of washed leukocytes; (_b_) preparing a similar mixture,
using serum of a normal person; (_c_) incubating both mixtures for a
definite length of time; and (_d_) making smears from each, staining,
and examining with a one-twelfth objective. The number of bacteria
which have been taken up by a definite number of leukocytes is
counted, and the average number of bacteria per leukocyte is
calculated; this gives the "phagocytic index." The phagocytic index of
the blood under investigation, divided by that of the normal blood,
gives the _opsonic index_ of the former, the opsonic index of the
normal blood being taken as 1. Simon regards the percentage of
leukocytes which have ingested bacteria as a more accurate measurement
of the amount of opsonins than the number of bacteria ingested,
because the bacteria are apt to adhere and be taken in in clumps.
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