118 PROTEIN THERAPY 



we have given a proteose injection to a typhoid patient during the first 

 week of the illness. He has responded with the typical chill, a sweat, 

 rise in temperature curve, and a leukocytosis. Following the reaction 

 his temperature comes to normal and remains so, the patient feels well 

 and as far as can be determined is clinically cured. In some 20-30% 

 of typhoid patients injected we can observe precisely this result. 

 What has cured the patient? 



1. It has been stated that despite this clinical recovery typhoid 

 bacilli may in some instances still be cultivated from the blood of the 

 patient several days after the injection (Rohonyi). Decastello's 

 work throws much doubt on this particular point. 



2. The patient may still present rose spots, an enlarged spleen, 

 a positive diazo reaction and a leukopenia (Liidke) ; Holler in his 

 series only noticed the occasional splenic tumor after the recovery. 



3. Healing of typhoid ulcers takes place within a few days after 

 the injection, as determined by autopsy in patients dying of inter- 

 current disease, after recovery by means of nonspecific therapy 

 (v. Wiesner). 



4. Fluctuations in the antibody concentration of the serum do 

 not account for the recovery. In some cases they are increased, in 

 others actually diminished, despite comparable clinical results. Nor 

 is the hypothesis valid that when diminished it affords evidence that 

 the antibodies have been used up during the process of recovery. 

 Recovery from typhoid takes place normally in leukemic patients 

 who never produce antibodies (Moresci, Howell). 



5. The cells of the organism are all stimulated (omnicellular 

 plasmaactivation of Weichardt) when injected intravenously. The 

 stimulation can be measured in the increased activity of the glandular 

 parenchyma, in increased motility of smooth musculature, in the in- 

 creased work capacity of the heart muscle. 



6. The permeability of the cells is altered. Due to this effect 

 and the coincident stimulation above mentioned, enzymes, fibrinogen, 

 thrombokinase and glycogen are thrown into the circulation, and anti- 

 bodies, if the organism has been previously sensitized, are also dis- 

 charged from the cells and flood the blood stream. 



7. The altered permeability of the cells finds further expres- 

 sion in the augmentation of the lymph flow, directly to be observed 

 about an inflammatory focus or to be measured at the thoracic duct. 

 It is also manifest when the permeability (to certain dyes) of the 

 capillaries about an inflammatory focus is studied. The endothelium 

 becomes at first more permeable, later less so. 



8. This change in the permeability of the cell membrane whereby 

 the exchange outward and inward is augmented must of course de- 

 pend on actual changes in the physical structure of the lipoid- 

 phase which probably forms the membrane of the cell. 



9. This change in the membrane of the cell probably accounts 



