104 PROTEIN THERAPY 



approached the same problem and lay stress on the changes that 

 occur in the hydrogen ion concentration of the exudate of the pneu- 

 monic lung, which, on being increased, makes possible a suitable 

 reaction for the augmented activity of the proteolytic enzymes. Ab- 

 derhalden in investigating the enzyme activity of pneumonic sputum 

 before and after the crisis was not able to determine the presence 

 of any peptidase before the crisis, but with the inception of the crisis 

 found such enzymes present in large amounts. The fundamental 

 idea underlying the studies in this direction has been that apart 

 from the intoxication arising directly from and incident to the 

 growth of the pneumococcus, toxic split products were absorbed from 

 the exudate, which indeed could be considered a mass of foreign pro- 

 tein undergoing slow digestion before the crisis. Active autolysis 

 once under way, only the lower and nontoxic split products would be 

 absorbed and the environments for the further proliferation of the 

 pneumococcus would become unfavorable, for, as Almaggia has shown, 

 pneumococci are very susceptible to products of autolysis. In this 

 phenomenon the reaction is primarily a local and a cellular one, in- 

 volving the liberation of sufficient leukoprotease from the disintegrat- 

 ing leukocytes and the gradual alteration in the reaction of the 

 medium so that the inhibitory factors i.e., the alkalinity and the 

 excessive amount of antiferment are overcome. Of the varieties of 

 the proteolytic enzymes entering into this reaction, Jobling and his 

 associates studied in particular the protease, as before mentioned, while 

 Petersen and Short studied the ereptase titer. 



We can assume that this latter form of enzyme activity would 

 be of favorable import in the process inasmuch as it could lead 

 only to detoxication through the complete destruction of toxic pro- 

 tein fragments. The first two charts illustrate common clinical 

 pictures in lobar pneumonia, the one recovering by lysis, the other 

 terminating fatally on the ninth day of the disease. 



Case No. 1. White man, 43 years of age, entered hospital March 14, 

 1917, after an illness of 36 hours. Diagnosis: Lobar pneumonia of lower 

 right lobe; course uneventful, recovery by lysis by the tenth day. (See 

 Fig. 4.) 



It will be observed that the ereptase titer (peptidase) remained 

 uniformly low during the first three days when examined, then in- 

 creased to approximately 3 times the former titer on the 8th day of 

 the illness and then again diminished. The increase coincides with 

 the period of clinical recovery. The antiferment titer shows the usual 

 increase early in the disease and a diminution during the period of 

 lysis that is frequently observed. 



Case No. 2. Colored man, 27 years of age, entered the hospital April 

 18, 1917, having been ill for two days. Diagnosis : Lobar pneumonia of the 

 lower left lobe; aortic regurgitation. On the third day there were evidences 



