THE PROBABLE MECHANISM OF THE REACTION 119 



for the increased resistance to intoxication after the injection and 

 forms part of the mechanism of antianaphylaxis. Whether an actual 

 loss of lipoidal constituents of the cell membrane takes place which, 

 when thrown into the circulation, then form part of the antiferment, 

 is not determined. 



10. An increase in the antiferment of the serum occurs after the 

 injection and persists as a rule for some days. 



"11. The alteration in the cell membrane is evidenced further- 

 more by the change in the irritability of the central nervous system 

 and in the sympathetic nervous system. 



12. There is finally a mobilization of leukocytes due to a more or 

 less specific stimulation of the bone marrow. 



While all these changes are brought about there seemingly are 

 two that are of vital importance the stimulation of the cells plasma 

 stimulation of Weichardt and the alteration of the permeability 

 of the cellular membrane. All the others are of interest and very 

 likely to take some part in the result, but all are more or less due 

 to these two fundamental changes. 



There is an increased tolerance to intoxication. The patient, de- 

 spite the fact that he may still have a positive blood culture, no 

 longer is sensitive to intoxication. The experimental basis for this 

 clinical observation has been laid by Starkenstein who demonstrated 

 that after a variety of nonspecific injections the organism becomes 

 more resistant to intoxication, even to poisons such as phenol and 

 strychnin. This is probably due to the decrease in the permeability 

 of the cell membrane that follows on the initial increase in permeabil- 

 ity. 



The toxic material is more rapidly destroyed. Due to the cellular 

 stimulation and the mobilization of the proteolytic enzymes, pro- 

 teolysis is hastened. This affects (1) the native protein of the 

 typhoid bacillus to which the body during the course of the incu- 

 bation period has been sensitized and (2) the toxic split products 

 derived from the bacillary disintegration (endotoxins) which are now 

 split to their lowest stages and eliminated. 



The lymphagogue effect (increased permeability of the capillaries) 

 floods the lymph spaces. If we conceive of typhoid fever as a local 

 disease and not a septicemia, the curative process must take place 

 at the site of the lesion. It has been demonstrated that both in nor- 

 mal and immune animals the antibody concentration is greater in 

 the plasma than in the lymph. The serum in typhoid fever is in- 

 variably rich in bacteriolytic substances, the transient and low- 

 grade bacteriemia notwithstanding. With the active passage of anti- 

 body rich plasma into the lymph spaces the destruction of the 

 typhoid bacilli will take place and healing will be explained. (This 

 theory was put forward by Teague and McWilliams.) 



The increase in the anti-enzyme in the lymph spaces makes the 



