122 PROTEIN THERAPY 



autolysis, for if the tissues were freely supplied with blood serum, 

 with its greatly increased antiferment, autolysis could not take place. 

 We can on this basis understand that the pneumonic process, apart 

 from complications, will tend to be a short and self-limited one, for 

 even if the invading organisms are very virulent and kill off the 

 leukocytes in the alveoli, their very destruction will liberate protease 

 and when digestion is commenced, terminate the disease. 



But the crisis, although as a rule associated with the disappear- 

 ance of the organism, need not on this basis at all times imply that 

 the invasion has been overcome. The one is a physicochemical process, 

 in the other we deal with an immunity phenomenon. Blake and Rus- 

 sell describe two experimental observations that are illustrative of 

 precisely this condition one instance of recovery by crisis in which 

 the blood culture remained positive for 48 hours after the crisis 

 and clinical recovery; the others were cases with crises on the 7th 

 and 9th days, respectively, then normal temperature for several 

 days, followed by a rise in temperature and death of the animals. 

 At autopsy a resolving pneumonia was found; death in these cases 

 being due to a persistent pneumococcus septicemia. Clinically such 

 cases are occasionally encountered. They conclude that their re- 

 sults are "not out of harmony with the theory of Lord that other 

 important factors besides the development of humoral antibodies are 

 necessary to bring about recovery. It is not unreasonable to con- 

 sider pneumonia as comprising two distinct though intimately re- 

 lated processes, one always present being the local lesion, the other, 

 present in a variable number of cases, being a general infection of 

 the body as manifested by the occurrence of a pneumococcus septi- 

 cemia. Though ultimate recovery must primarily depend upon the 

 ability of the patient to prevent or terminate the general infection 

 once established, presumably through the existence or the develop- 

 ment of humoral immunity, it does not follow that recovery from 

 the local process with resolution of the pneumonic consolidation need 

 be either coincident with recovery from the general infection or de- 

 pendent on the same mechanism. In fact it would seem well estab- 

 lished by numerous clinical observations that recovery from the gen- 

 eral pneumococcus infection when it exists usually precedes, by sev- 

 eral days at least, recovery from the disease at the time of crisis. 

 On the other hand certain of the observations cited above would seem 

 to indicate that recovery from the local process as shown by a 

 rapidly resolving pneumonia may occasionally occur prior to re- 

 covery from the general infection, or even when death from the gen- 

 eral infection subsequently takes place. In view of the above con- 

 siderations it would seem not improbable that at least a dual 

 mechanism may be concerned in bringing about final recovery from 

 lobar pneumonia." The cultural experiments of Thomas and Parker 

 lend support to this view. 



