THE PROBABLE MECHANISM OF THE REACTION 127 



(lymphatic, interstitial and external) as in lobar pneumonia, or finally 

 in true septicemic conditions, we find that no one factor can be identi- 

 fied in the mechanism as of paramount importance. 



In the local reaction the alteration of the permeability of the cells 

 and the complex changes in the inflammatory reaction that this entails 

 seem of greatest importance, together with the detoxication of toxic 

 proteins by the acceleration of enzyme activity. 



In the typical lymphatic involvement represented by typhoid fever 

 the increased permeability of the vessels and the flushing of antibody 

 rich fluids into the lymph spaces, the desensitization of the patient as 

 a result of later cell membrane changes and the general increase in 

 cellular activity, in vascular tone, in the tone of the central nervous 

 system, etc., are perhaps the more important factors. 



In pneumonia, on the other hand, we may be able to overcome the 

 effect of the intoxication for a temporary period by increasing the 

 enzymatic rate of destruction of the toxic proteins, as well as by 

 increasing the resistance of the cells to the toxic effect, but we are not 

 able sufficiently to alter the physicochemical balance that exists in a 

 more or less isolated lobar lesion, and on which the inception of the 

 crisis depends. Here, then, we have to deal largely with a transient 

 detoxication. 



In the true septicemias it seems more probable that, apart from 

 these factors that tend to diminish intoxication that is, the enzyme 

 mobilization and the decreased permeability of the cells the actual 

 destruction of the invading bacteria must be due to leukocytic diges- 

 tion and perhaps the direct effect of the serum antibodies mobilized. 

 The clumping of the bacteria and their accumulation in the internal 

 organs and bone marrow bring them in closer proximity to the leuko- 

 cytes, which, as a result of the injection, have also been concentrated in 

 the internal organs and bone marrow. 



It is at any rate apparent as a result of these considerations that 

 different disease processes are diversely affected by the nonspecific 

 agents, depending on peculiarities of localization, on the source of the 

 material that is responsible for the intoxication, on the degree of sen- 

 sitization and immunization of the patient. While nonspecific agents 

 may produce a reaction that is fundamentally alike, the effect on 

 different disease processes may differ considerably. 



