BACTERIAL POISONS 45 



subsequently be bound chemically or destroyed by oxidation or enzy- 

 motic hydrolysis after such entrance. In such a case the actual 

 specificity would yet depend on purely physical properties. 



In addition to the specific physical and chemical affinities be- 

 tween the poisons by certain cells there are probably also certain 

 fortuitous factors connected with the distribution and local accumu- 

 lation of the poisons which have some weight in determining the 

 location of injury. For the specific selection is not absolutely strict 

 and there are probably few parenchyma cells in the body that are 

 entirely insusceptible to injury if the poisons are sufficiently con- 

 centrated upon them. Thus, to cite an analogy from the toxicology 

 of non-bacterial poisons, in lead poisoning, as Meyer and Gottlieb 

 point out, the paralysis of the extensors of the arm occurs chiefly in 

 adults who use these muscles in the exercise of their professions 

 (painters, type-setters), while in children and in animals, in which 

 no such selective use of particular muscle groups is habitual, lead 

 paralyses are atypical, attacking legs as well as arms. It is not un- 

 likely that the frequent injury of the heart muscle by bacterial poi- 

 sons or the irregular parenchymatous changes in various organs is 

 determined by analogous fortuitous factors, in that functional activ- 

 ity and increased metabolism may predispose to injury. 



Bacterial poisons also may produce their lesions in the course of 

 excretion. This seems likely in the case of typhoid poisons in which 

 we have often seen bloody diarrhea in rabbits within a few hours 

 after intravenous injection of powerfully toxic culture filtrates. In 

 connection with the dysentery bacillus Flexner and Sweet 52 have 

 studied the conditions carefully. They succeeded in showing first 

 that the introduction of the dysentery poison into the lumen of the 

 intestine does no harm and that the toxin is slowly destroyed by 

 peptic and tryptic digestion. They concluded that probably no ab- 

 sorption of the poison through the uninjured intestinal mucosa takes 

 place. They then showed that the toxin after intravenous adminis- 

 tration is excreted by the intestine and that the inflammatory reac- 

 tions and injury of the mucosa are incident to this act of elimina- 

 tion. 



Whether or not the kidneys are injured in the same way it is 

 difficult to decide. In many infectious diseases, of course, the bac- 

 teria themselves pass through the kidney into the urine, and renal 

 injury may result from the actual presence of the bacteria in the 

 kidney; however, renal injury may also occur without this, and it 

 is not at all impossible that the conditions here are similar to those 

 just described for the intestine. 



All the facts which we have considered indicate that, although 

 most bacterial poisons can injure many different tissues, yet in some 

 cases there is a particular susceptibility on the part of an individual 



52 Flexner and Sweet. Jour, of Exp. Med., Vol. 8, 1906. 



