760 INTERNAL SECRETIONS AND PRESERVATION OF LIFE. 



normal channels cannot eliminate with sufficient speed? In- 

 deed, these eruptions show that the scales have been turned; 

 that antitoxin devoid itself of all toxic attributes when pure 

 has conquered its foe, and that the immunizing field, the 

 peripheral capillary system, is ridding itself of the remains of 

 the fray. That the following conclusions are warranted seems 

 to us evident: 



While the Hood-stream in diphtheria is adequately supplied 

 with oxidizing substance and fiHrinogen, it is deficient in trypsin; 

 hence, toxins rapidly accumulate. 



The active principle of antitoxin being trypsin, it becomes 

 active in the Wood-stream owing to the presence therein of the 

 fibrinogen and oxidizing substance, and converts the toxins into 

 benign cleavage products. 



Antitoxin is curative if used sufficiently early in diphtheria, 

 and harmless if used in any disease with which diphtheria may be 

 confounded. 



Tetanus. This is another disease in which bacilli have 

 been found only at the seat of inoculation, but not in the 

 blood. The toxins are developed so rapidly, however, that, as 

 shown by Kitasato, only animals from which the inoculated area 

 had been excised one-half hour after inoculation remained well. 

 All the conditions reviewed under the last heading, namely: 



(1) the absorption of trypsin by leucocytes and erythrocytes, 



(2) the impossibility on the part of the phagocytes to protect 

 the system by destroying the source of the toxins, prevail, there- 

 fore, and it is the only disease which has afforded any evidence 

 of remote kinship with diphtheria as regards the effects of anti- 

 toxin when used early. 



But here another course of events is inaugurated. We are 

 not dealing with a poison which tends first to stimulate the 

 adrenal system and then, by exhausting the anterior pituitary 

 body, to bring on insufficiency soon followed by arrest of adre- 

 nal functions, but with a virulent toxin which does not, to 

 any extent, primarily stimulate this system. Insidiously, and 

 almost from the start, it gives rise to adrenal insufficiency, and 

 steadily the products of metabolism accumulate in the blood. 

 We have throughout this work given reasons that seem to us 

 to demonstrate that the toxin is not the direct cause of the 



