THE LIMITS OF SERUM-THERAPY. 759 



age products? Being greatly augmented in number through 

 adrenal overactivity, it would seem as if they should be capable 

 of doing so. Such is the case in mild infections or when the 

 child's thymus and partly developed adrenal system can suffi- 

 ciently prolong the fray. But when they cannot, another cause 

 appears, one that illustrates vividly the scientific value of Metch- 

 nikoff's labors: i.e., the phagocytes are unable to reach and 

 destroy the source of the toxins. Indeed, the bacilli are in the 

 false membrane. Multitudes of cells crowd to the respiratory 

 passages or other surfaces to destroy the local focus of infec- 

 tion. And the pseudomembrane is itself but an extensive ceme- 

 tery of protective cells in which the cadavers are more numer- 

 ous than the particles of soil! But what is this exposed surface 

 when compared with the vast immunizing field which the capil- 

 lary system represents and into which the contraction of the 

 central vascular trunks incident upon adrenal overactivity 

 forces, not only the poison, but the laboratory in which it is 

 formed? 



We can now understand, it seems to us, why the virulent 

 toxins of the diphtheria bacillus accumulate so rapidly in the 

 blood-stream and soon cause what any other virulent poison 

 does: i.e., arrest of adrenal functions, after the preliminary 

 signs which denote the stage of insufficiency. . . . "The pal- 

 lor is extreme; the face has an ashen-gray hue," writes Osier; 

 "the pulse is rapid and feeble, and the temperature sinks 

 below normal." We can understand also how antitoxin acts and 

 why delay in its use compromises the issue; indeed, why it in- 

 sures death in a severe case. The trypsin of the antitoxin finds 

 in the plasma the fibrinogen and oxidizing substance it requires 

 to develop its full energy, and it soon converts the toxins into 

 harmless agencies. But this only occurs when organic lesions 

 have not been given time to hamper the mechanism of the vital 

 processes; that is to say, when necrotic foci in the liver, heart, 

 pancreas, spleen, etc., have not been given time to form, and 

 while the adrenal system is still able to recover its functions. 



And we have evidence of the adrenal system's work in 

 some cases; for what are the eruptions and other untoward 

 phenomena that occasionally follow the use of antitoxin but 

 evidences that the blood is loaded with waste-products that the 



