108 PROTEIN THERAPY 



although greatly improved clinically. At this time a final blood examina- 

 tion was made. 



We have in Figure 6 shaded the portions when the patient 

 was making clinical improvement after each lobe was involved. The 

 evidences of clinical improvement pulse, respiration, subjective 

 symptoms and physical findings coincided with typical changes in 

 the enzyme concentration of the serum as can be observed from the 

 chart. 



An increase in the ereptase titer took place during each period of 

 improvement studied (the time blood samples were drawn is indi- 

 cated on the chart by X) but declined when the clinical condition 

 was unfavorable. The antiferment on the other hand invariably 

 tended to diminish during the favorable periods and to increase with 

 the increase in the lung involvement. These alterations are so typical 

 and so clear cut that their clinical significance cannot well be ques- 

 tioned, even though the interpretation of the changes may be open 

 to discussion. 



In the pneumonia that terminates by crisis or by lysis an in- 

 crease in the ereptase titer was invariably observed by us either 

 preceding or accompanying the clinical change. In cases that termi- 

 nated unfavorably such an increase was not found, the titer in these 

 cases usually remaining below that observed in normal individuals. 

 The antiferment titer of course does not directly influence the activity 

 of the ereptase, nevertheless as the patient improves the antiferment 

 diminishes. The entire condition is one therefore that favors a rapid 

 digestion of proteins. 



Ferment-Antiferment Balance. When we now come back to our 

 consideration of the true proteases we deal with a reaction which is 

 much more complex in its character and its possibilities for two rea- 

 sons: (a) The enzyme action may involve the splitting of native pro- 

 teins to the higher split products. If this concerns a nontoxic native 

 protein to which the body is not sensitized it implies that a new toxic 

 substance is produced in the organism itself. If on the other hand it 

 involves a toxic protein or one to which the organism has become sen- 

 sitized, then the enzyme can act, too, as a detoxicating agent when it 

 splits the protein, (b) The ferment action is balanced by an anti- 

 ferment and we have therefore to deal with two variable factors. 



For purposes of illustration the pneumonic condition will again 

 serve. Let us assume that the pneumonic focus with its mass of 

 cellular detritus represents, for the normal tissue, simply so much 

 foreign material from which it must free itself by digestion. As long 

 as digestion proceeds slowly, higher and more toxic split products 

 will be absorbed as such; digestion proceeds slowly because the leu- 

 kocytes are still living (therefore not shedding their ferment), be- 

 cause of the alkalinity of the reaction of the exudate, and the large 



