SUMMARY 51 



But it does not follow that because of such a mutual affinity, a 

 toxic effect must of necessity result. This can only occur if the 

 combination with the toxic principle implies a toxic effect. If, 

 then, we observe a toxic effect clinically, upon the central nervous 

 system, for example, this does not necessitate the conclusion that 

 the toxin does not act upon other structures of the body also, but 

 clinically the toxic effect is, of course, the only effect which excites 

 our attention. 



Remembering the curious interaction between different organs, 

 however, the thought naturally suggests itself that the toxic bacterial 

 products might exert a toxic effect not only directly but also indi- 

 rectly. This possibility has apparently not received the attention 

 which it deserves but must nevertheless be borne in mind. It is 

 perfectly conceivable that a toxin might act upon a certain organ 

 in a way to impair its function, without actually endangering the 

 integrity of the cells as such, but that the impairment of its function 

 may carry in its trail secondary effects which become apparent to 

 the clinician at once, while the primary action escapes attention. 

 Every physician is familiar with the effect of various infections upon 

 the gastro-intestinal functions, on the occurrence of constipation, 

 defective secretion of hydrochloric acid, etc., factors which we now 

 know to be controlled to a large extent if not entirely, by hormone 

 action, and it is clear in view of the interdependence of the gastro- 

 intestinal hormones, that interference at any one point in the chain 

 might readily upset the digestive equilibrium and lead to various 

 further disturbances of the metabolism. 



Then, again, as I have already pointed out, there is a certain danger 

 from the action of those very products (antibodies) which the body 

 itself forms primarily, no doubt as a defensive reaction, against the 

 products derived from the bacteria and of which more will be said 

 in later chapters. It is clear at any rate that the picture of the 

 infectious disease is unquestionably the composite of more factors 

 than we are apt to think on first consideration, and some of which 

 no doubt will be found to explain such symptoms as the mysterious 

 death from anthrax, for example, where evidences of actual disease 

 are wanting until the end is near, and where the first symptoms are 

 practically the last ones. To explain this point, undue prominence 

 has been given in the past to mechanical factors. It was suggested 

 that the occlusion of extensive capillary districts with densely matted 



