THE PROBABLE MECHANISM OF THE REACTION 111 



way to their lowest split products. These can act, therefore, either 

 as (1) intoxicating agents when splitting nontoxic native pro- 

 teins to the toxic stage, (2) or as detoxicating agents when free to 

 split the partial products of digestion to the nontoxic forms or when 

 splitting a native protein to which the body has become sensitized. 

 These enzymes are counterbalanced by (b) the antiferment of the 

 serum, a variable factor. The ereptase (c) or peptolytic enzyme, 

 capable of splitting only the partly hydrolyzed proteins (toxic) to 

 the amino acid stage (nontoxic) and therefore to be regarded as a 

 detoxicating agent, not counterbalanced by an antienzyme and there- 

 fore free to act whenever present in the serum and the tissues. 



This conception of a balance of variable factors which at one time 

 may act in a detoxicating manner, and in other cases may intensify 

 a disease process, has been discussed fully in several papers and we 

 need go no further into the details at this time. (Jobling and Pe- 

 tersen, Jobling, Eggstein and Petersen, and Petersen.) 



Nonspecific Injections in Carcinoma. Von den Velden, who was 

 one of the very first to use nonspecific methods in the treatment of 

 disease (1906), early expressed the hypothesis of enzyme action as the 

 basis of the therapeutic results and has maintained this ever since. He 

 began his work using small subcutaneous doses of serum albumin and 

 ovalbumin in 5 and 10% solution. From these he passed to the use of 

 convalescent serum, tetanus antitoxin, normal horse serum, and finally 

 to the use of milk injected intramuscularly. In treating several cases of 

 inoperable carcinomata he observed that following the injection the pa- 

 tient reacted with a period of malaise and of fever for a period of 

 several days and then for a time the general condition of the patient 

 improved. There were a gain in weight, a better appetite, lessened 

 pain, etc. Under the treatment the tumor would, at times, show de- 

 cided regressive changes. With tuberculin injections Dabney ob- 

 served a similar effect. 



This experience of von den Velden is cited in this connection 

 merely because it is typical of the result achieved by all the non- 

 specific agents in the treatment of carcinomata and other malignant 

 diseases. Beard got the same result when he injected trypsin; Coley's 

 fluid and tumor autoly sates give a similar reaction; colloidal metals 

 give it. The mechanism is the same in all cases, the clinical picture 

 is identical, the results are similar, i.e., there are evidences of a 

 decided focal reaction, even of tumor regression in size, but the 

 actual proliferation of the neoplasm is not checked because the 

 vascularized portions of the tumor are in nowise interfered with, 

 the regression being due to an increase in the necrosis of the cen- 

 tral and less vascularized portion of the neoplasm. 



Let us assume that an injection of milk has been made intra- 

 muscularly in such a carcinoma case. The temperature heretofore 

 has been practically normal. Several hours after the injection there 



