64 PROTEIN THERAPY 



Serum and Lymph Enzymes. During the course of a series of 

 studies on the alterations in serum enzymes in animals after anaphy- 

 lactic shock, after the intravenous injection of protein split products, 

 of bacteria, of kaolin, of trypsin, etc., Jobling and his associates estab- 

 lished the fact that as a result of these various injections the animal 

 responded with a mobilization of proteolytic enzymes as well as of 

 lipases. Diastase was not altered to the extent that the other enzymes 

 were changed. The increase in the titer of the protease was very strik- 

 ing after severe intoxications such as those produced by typhoid or 

 colon bacilli. 



In view of the fact that the flow of the lymph is markedly augmented 

 and dilutes the blood and that the blood volume is greatly diminished after 

 shock because of the increased permeability of the vessels (Dale has re- 

 cently observed a diminution of the volume by as much as 40% after his- 

 tamin injection), Davis and Petersen studied the enzymes of the blood 

 and lymph separately after intravenous injection of colon vaccine. The 

 results of these experiments were as follows: 



Protease. The effect of the bacterial shock on the protease content of 

 the lymph and serum was marked in extent. Three types of reaction could 

 be distinguished: (a) the fluctuations in titer may occur simultaneously, 

 (b) those of serum may precede those of the lymph, and finally (c) there 

 may be no relation of the one to the other. 



Peptidase. The fluctuations of the peptidase, or ereptase titer, do not 

 parallel those of the protease; indeed the curves may be quite dissimilar. 

 As a rule the increase makes its appearance later than that of the protease 

 and is less extensive. When alterations in titer do occur they appear 

 almost simultaneously in both the lymph and serum, although in a few 

 experiments the ferment was first to be observed in the serum. It is at 

 any rate apparent that the entrance into the blood stream can be direct 

 and does not need to take place via the lymph channels, although under 

 normal conditions, i.e., feeding, this seems to be the one portal of entry. 



Lipase. While the increase in this ferment occurs in both lymph and 

 blood following shock, it seems to make its appearance first in the serum. 



In the patient the effects of nonspecific injections on the enzymes 

 are not as marked as they are in experimental animals. In a study 

 of serum alterations in patients after nonspecific therapy, Petersen 

 followed the changes to be observed in (a) the stalagmometric read- 

 ings, in (b) the total nitrogen of the serum (concentration of the 

 serum), (c) the noncoagulable nitrogen, and the titer of the enzymes, 

 (d) protease, (e) ereptase, (f) diastase and (g) esterase. 



The results were as follows: 



(a) There was a concentration of the serum. 



(b) The nonprotein nitrogen was practically unaltered. 



(c) The serum protease almost invariably decreased after the shock 

 but later increased progressively for a period of from three to four days. 



