THE PROBABLE MECHANISM OF THE REACTION 125 



patient would for the time being seem improved have a lowered 

 temperature, euphoria, increased vascular tone, etc., but it is hardly 

 to be expected that the changes would be sufficiently great to effect 

 the immense and relatively inert local disease process, isolated, as it 

 in a measure is, from the general circulation. Here the production of 

 toxic materials would proceed largely unmodified; these would ac- 

 cumulate, would finally get out into the general circulation to a suffi- 

 cient degree and again produce symptoms of general intoxication. 



If pneumonia were a disease characterized by a long incubation 

 period, during which there would develop not only sensitization to the 

 protein of the invading organism but in which the beginning of 

 immunization could take place, then nonspecific therapy plasma- 

 activation might aid in the process of shedding the preformed anti- 

 bodies would possibly mobilize them and so bring about recovery. 

 But beginning as it does without an incubation period of any extent 

 this factor is not involved in the mechanism. From the single large 

 dose we can therefore expect little result other than a transient one. 

 But of course there are exceptions. One such may be of interest in 

 this connection. It concerned a boy of 12 years brought to the hospital 

 after one day's illness with a frank lobar pneumonia of the upper left 

 lobe. The interne, using typhoid vaccine as a routine, by accident 

 injected a large dose (500 million organisms) intravenously. The 

 child reacted with a severe chill, the temperature increased to 107 F. 

 and he became delirious. The next morning the temperature of the 

 patient was normal, and remained so without further fluctuation. All 

 physical signs of consolidation had disappeared within 24 hours after 

 the injection. Naturally the production of such a severe reaction is 

 wholly unwarranted as a clinical method and the results are merely 

 mentioned to illustrate that while it may in rare instances be possible 

 to alter even the large pulmonary processes, such a result is quite 

 uncommon. 



Of course, when we are dealing with a bronchopneumonia the 

 conditions differ to some extent. So, too, the possibility that repeated 

 small injections used as stimulants (plasmaactivation) may be pro- 

 ductive of favorable results need not be discussed in this connection. 



Sepsis. When now we come to the diseases characterized by a true 

 multiplication of bacteria in the blood stream and observe the abrupt 

 termination of such septicemias that have been recorded following the 

 intravenous injection of the nonspecific agents (Werner, etc.), the 

 problem becomes one of decided complexity. Our effect on local in- 

 flammation falls away, we must deal wholly with the destruction of 

 bacteria multiplying in the blood stream. Here, too, the mere detox- 

 ication of the patient that has been discussed in connection with pneu- 

 monia, is not the total effect of the injection. This detoxication, the 

 result of the vascular and cellular alterations in permeability, of 

 enzyme stimulation, etc., is of course apparent in septicemia as well as 



