120 PROTEIN THERAPY 



further proliferation of the bacteria difficult. Bacteria must obtain 

 their nitrogen from the lowest degradation products of proteins; they 

 cannot use peptones and proteoses and the higher split products. 

 When the antitrypsin is increased their extracellular protease is in- 

 activated and their metabolism interfered with (Wright). 



On this basis we have observations that account not only for the 

 detoxication of the patient, which is commonly observed after non- 

 specific protein injections (the euphoria being a constantly reiterated 

 clinical observation) but for the actual destruction of the bacteria and 

 the checking of their further proliferation. 



Into this mechanism other factors may and possibly do enter. 

 Thus the question of the effect of the leukocytosis has repeatedly 

 been raised. The intravenous injection almost invariably results in 

 a marked augmentation of the peripheral leukocyte count, following 

 the initial leukopenia. This has been considered as the possible 

 mechanism involved in the recovery. But it has been observed that 

 recovery may take place without the appearance of this leukocytosis. 

 Inasmuch as the blood serum itself is able to destroy the bacilli 

 without the intervention of leukocytes, their usefulness in this con- 

 nection is not of paramount interest. As a matter of fact Rous has 

 shown that the typhoid bacilli may be protected from the effects 

 of serum lysis after they are ingested by the endothelial leukocytes. 

 It is much more probable that the role of the leukocyte lies in its 

 detoxication of the bacillary proteins of typhoid bacilli already dead 

 when ingested, or so altered by serum contact that the leukocyte can 

 finally destroy them after ingestion. Of course the concentration of 

 the leukocytes in the internal organs spleen, liver, lymph glands, 

 intestinal tract, lungs, etc. immediately after the injection (during 

 the time of the peripheral leukopenia) at the very site of the chief 

 local foci of the typhoid proliferation may lend particular importance 

 to the leukocytic reaction in typhoid fever. 



Lobar Pneumonia. Let us turn to examine the effects of non- 

 specific therapy in lobar pneumonia. Blake and Russell have in recent 

 papers thrown considerable light on the questions involved in the mode 

 of infection in lobar pneumonia and their observations confirm the 

 clinical impression prevalent for a considerable period that true lobar 

 pneumonia takes place by extension of infection along the trachea. Ac- 

 cording to their study the pneumococcus invades the lung tissue at 

 some point or points near the root of the lung, spreading subse- 

 quently throughout the lobe by way of the interstitial framework and 

 the lymphatic system. It is therefore to be regarded primarily as 

 an interstitial infection of the lung. Rosenow, among others, as a 

 result of blood culture work had endeavored to place pneumonia 

 among those diseases that are primarily a septicemia and later be- 

 come localized in some tissue of predilection. But Blake and Rus- 

 sell found that the blood became infected from the bacteria having 



