52 PROTEIN THERAPY 



followed by far greater depressing effects on the cardiovascular 

 system than the intravenous injection of small amounts of typhoid 

 vaccine. After milk injections Muller has observed a slight primary 

 decrease, then an increase in the blood pressure. 



While the effect on the blood pressure depends on individual fac- 

 tors the duration of the disease, the agent used, etc., the fall in the 

 blood pressure which accompanies shock effects depends largely on 

 a dilatation of the vascular bed in the splanchnic area. The peripheral 

 dilatation which one can observe with the sweating of the patient does 

 not produce the extreme drop in the blood pressure that the splanchnic 

 engorgement does. 



Different animals respond to the injection of protein split products, 

 peptone, histamin, etc., with different effects on the blood pressure, de- 

 pending on which part of the vascular bed is subject to constriction, on 

 stimulation of the vasomotor nerves, etc. The liver of carnivora responds 

 with a spasm of the capillaries with a resulting diminution of the blood sup- 

 ply to the right heart and a lowering of the blood pressure. The primary ef- 

 fect is followed by a dilatation. The liver of the herbivora is quite in- 

 different, indicating a difference in innervation. The spasm of the arteri- 

 oles of the portal area results in a passive filling of these vessels while in 

 the lungs we have also a contraction of the arterial system with a re- 

 sulting dilatation of the right heart, accompanied by a fall in pressure in 

 the left heart and the general circulation. In discussing this mechanism 

 Mantner and Pick call attention to the fact that the difference in the 

 effect of the shock poisons in herbivora and carnivora is easily explained by 

 the differences in the behavior of the various capillary systems. Simonds 

 has recently noted this same difference in the behavior of the musculature 

 of the hepatic vein and has drawn conclusions similar to those of Mantner 

 and Pick. Dale's conception of the mechanism does not quite follow that 

 here presented. 



It becomes apparent from a consideration of the possible mechanism in 

 the dog and the human after such shock effects why stimulants such as 

 adrenalin are relatively ineffective while vasodilating agents such as caffein 

 are said to be followed by more effect in the acute stage of shock depend- 

 ing on such vasoconstriction of the hepatic vein and its branches. 



The possibility that other factors enter into the change in the blood 

 pressure is by no means excluded, v. Behring laid great stress on the 

 finding of thrombi in the capillaries of the lungs in acute anaphylactic 

 shock and Hanzlik and Karsner have recently called attention to the fact 

 that the intravenous injection of a number of colloids and typical non- 

 specific agents may be followed by such changes in the finer capillaries. 



Sweating. Shortly after the subsidence of the chill the patient 

 may sweat profusely; in arthritic patients one finds this most fre- 

 quently; typhoid and pneumonic patients are less apt to sweat after 

 the injections, but may do so if the injection is followed by an in- 

 crease in temperature and a critical fall. 



