DIPHTHERIA TOXINE. 85 



is upon the respiratory centres, and that only in the final stages 

 is the heart itself also affected. 



ENRIQUEZ and HALLION 1 found that the pressure of the blood 

 did not fall until after some time ; this was confirmed by BECK 

 and SLAPA, 2 who only observed a sinking in the pressure of the 

 blood shortly before death. 



Comprehensive investigations into the behaviour of the heart's 

 action in cases of poisoning with diphtheria toxine have been 

 made by ROMBERG, PASSLER, BRUHNS, and MiJLLER, 3 who con- 

 clude from the results that there is not a primary effect upon 

 the heart's action, but that the injury to the vasomotors is the 

 only direct action. The heart is only injured in consequence of 

 a deficient supply of blood. STEJSKAL* has severely criticised 

 these results and claims, on the strength of his assumed more 

 accurate experiments, that diphtheria virus does cause direct 

 injury to the heart. 



He concludes that after a very short acceleration of the heart's 

 action there occurs a short period of continuous weak action, 

 which is followed by a period of acceleration, the final result 

 being a decided decrease in the \york done by the heart, attribut- 

 able to injury of the heart rather than of the vasomotors. 



These conclusions are supported by the researches of FENY- 

 VESSY 5 and SHARP, 6 who were also able to prove the direct effects 

 of diphtheria virus upon the isolated heart of a frog. 



MOLLARD and REGAUX 7 observed myocarditic alterations in 

 the heart after death, which possibly are also to be regarded as 

 evidence of direct injury. 



EppiNGER 8 also observed serious changes, which he termed 

 myolysis, in the muscle of the heart. From this he concluded 



1 Enriquez and Hallion, "Sur les effets physiol. de la toxine diphth.," 

 Arch, de Physiol., xxvii., 515, 1895. 



2 Beck and Slapa, "Ueb. den Einfl. des D.-G. auf den Kreislauf," Wien. 

 klin. Woch., 1895, 333. 



3 Romberg, Passler, Bruhns, a.nd Miiller, " Unters. lib. d. allg. Pathol. 

 der Kreislaufstorung bei akuten Infektionskrankh.," Arch. f. klin. Med., 

 Ixiv., 652, 1899. 



4 Stejskal, " Kritisch-experim. Unt. lib. d. Herztod infolge von Diphth.- 

 Toxin.," Z.f. klin. Med., xliv., 367, 1902. 



5 Fenyvessy, "Ueb. d. Wirkg. d. D.-T. u. Antit. auf das Froschherz.," 

 Jahrb.f. Xinderh., new series, xliii., 216, 1896. 



6 Sharp, "The action of the products of the organism of diphtheria on 

 the heart of a frog," Journ. of Anat. and Physiol., xxxi., 199, 1897. 



7 Mollard and Regaux, "Le'sions du myocarde dans 1'intox. aigiie par la 

 t. d.," Ann. Past., xi., 97, 1897. 



8 Eppinger, "Die toxische Myolyse des Herzens bei Di.," Deutsch. med. 

 Woch., 1903, Nos. 15, 16. 



