TISSUE AUTOLYSIS AND SHOCK

It is quite clear that in the rabbit and cat it is possible to produce death rapidly by inserting muscle or liver into the peritoneal cavity. In the fatal cases, however, it appears that the liver or muscle is infected with anaerobic gas‐producing bacilli. When we succeeded in transplanting liver in a sterile fashion in rabbits, death did not occur. Large doses of sterile peptic digests containing permeability‐increasing poly‐peptides caused death only occasionally unless contaminated, although hæmoconcentration was usually present. We were not able to confirm Moon's results on guinea‐pigs nor did our rats die after liver implantation. It must be emphasised that in comparison with muscle liver is a tissue which autolyses relatively easily, even when sterile. Moreover, in our experiments large amounts of liver were used. In addition, this was minced into a paste to give maximum opportunity for autolysis and subsequent diffusion of the digestive products. Nevertheless from their behaviour the animals did not appear to be “shocked.” It may be argued that a rabbit, which is rather a “moist” animal and probably has much body fluid, is not very suitable for experiments of this nature. Nevertheless, on the evidence produced, we believe that those authors who attach great importance to the infection associated with nearly all liver transplantation experiments are right and that autolytic products alone, although producing local loss of fluid, do not produce general effects, after absorption, whicb lead to a shocklike state. However, the presence of large masses of auatolysing tissue such as muscle must liberate substances of a polypeptide nature which affect profoundly the local blood‐vessels, causing increased permeability of the capillaries and hence the escape of plasma. It is possible that this local action of autolytic products may be of considerable importance in the production of wound shock by the promotion of fluid loss. This is a further argument for removing such tissue as thoroughly as possible. E. P. Abraham and E. Chain are responsible for the chemical work, A. D. Gardner for the bacteriological examinations, and G. M. Brown, H. W. Florey, and A. G. Sanders for the animal work. We are indebted to the Medical Research Council for a personal grant to E. P. Abraham and E. Chain and a grant towards the expenses of this work.