It has long been recognized that some alteration in the quality of the blood appears to precede in a causal relation any alteration of structure by disease, and that a poisoned blood-supply means diminished health and life, if not actual death. But it is only just coming to be recognized how extremely prevalent blood-poisoning is as a prolific source of a host of ordinary ailments and diseases not hitherto suspected of being associated with it. Whilst so many workers at the fascinating parasitic theory of the infectious fevers have been proving that the symptoms of such diseases are due in great measure to the poisonous chemical products, the toxins, of the malignant microbes which have invaded the body and which have to be combated by antitoxins; other observers have been investigating the effects of those bacteria, which are normally present in the body, and of those products of digestion and tissue-change, which, when disturbed by overproduction or non-elimination, poison the blood and so produce multifarious disease. In this way, it is being found, are produced not only the ordinary so-called blood-poisoningbut innumerable diseases, such as apparently gout, rheumatism, neuralgia, headache, biliousness and obscure feverish attacks including what is '
'
'
'
often termed a touch of malaria and even such unexpected conditions as general paralysis and certain kinds of insanity. So far-reaching and widespread indeed are the effects of these autointoxications that the subject is well deserving of quite as much attention as is being paid to the infectious fevers, for it affects immediately the comfort and fate of a much greater number of human lives.
3nfcian
riDct>ical
(5a3ctte
ffift*? l^ears Hgo
DISEASES OR
DUE TO
SELF-EMPOISONING
AUTO-INTOXICATION
'
auto-intoxication' should be confined to that poisoning of the system by products elaborated by the individual's own living tissues, namely, by that class of chemical products which are called leucomains, such as produce gout, neuralgia, etc. It nevertheless is also usually held to include poisoning by absorption of the products of bacterial fermentation and putrefaction in dead matter, the socalled ptomains, which produce the familiar symptoms of septicemia and infective and other fevers and irritant poisoning.
Strictly speaking,
The former class, the leucomains, seem to produce poisoning through some alteration in the activity of the ductless, glands which regulates tissue-change, whilst the ptomains resulting from the vital activity of bacteria, depend on mainly excessive fermentation or putrefaction of the and prevention disease?its causation, treatment contents of the intestinal or other cavities or and more from the chemical standpoint; and diseases surfaces. Chemically, ' these ptomains are the general looking at most of factional nervous disorders as poisonings of the closely allied to the alkaloids', which, like Mood or toxaemias. This apparent swing of the them, arc also produced by living plants, and pendulum of opinion back towards the old whose poisonous action (as of nicotine, morphine, humoral doctrine that 'the Blood is the Life' strychnine, daturine, etc.) has long been recogbut an nized as producing severe affections of the is not in reality a retrograde movement, the nervous system, such as stupor, convulsion, and represents advance on a higher platform medical progress. mania, insanity, etc.
from the Indian Medical Gazette; August 1899, Vol. 34, p. 291) The leading trend of medical science of late years has been in the direction of viewing
(Reprinted
-^nore
most modern
development of
THE INDIAN MEDICAL GAZETTE
368
of poisonous leucomains are which causes xanthocreatinin, depression and vomiting, para-xanthin and heteroxanthin, which causes rigor and convulsions, gerontin, which paralyses the nerve-centres and ganglia of the heart, and from choline it has been shown by Schmidt and Weiss that poisonous neurine may be formed by the action of bacteria?the action of neurine agreeing closely with muscarine in paralysing the heart and purging, and in being especially toxic to nerve trunks, paralysing respiration like curare. The production of ptomains is chemically a process of oxidation with the formation of sulphuretted hydrogen, carbonic acid and water as by-products. As
instances
therefore, of widely, different proby auto-intoxication is very great. Although as yet but imperfectly understood, it would seem to include the following : Firstly, the processes by which toxins, which are stored up in the body as the result of some interference with the ductless glands which produce substances indispensable to healthy life, such as when the thyroid gland is congenitally absent or ,its function extinguished by tumour or extirpation, there results cretinism or myxoedema evidently as an auto-intoxication, and feeding such patients with the thyroid glands of sheep removes the symptoms; and if the same kind The range, covered
cess
be the action of citric acid in scurvy and iron in anaemia, by supplying the blood with certain deficient substances.
seems to
Secondly, those in which chemical products healthy cell life, normally present in the blood, which become so increased by abnormal chemical activity or defective excretion, as to act as toxins such as certain products of digestion, choline, urea, causing uraemia, sugar in diabetes, acetonuria, sulphuretted hydrogen. Thirdly, those in which abnormal products are the result of microbes, and especially of the putrefactive bacteria, which invade the gastroof
intestinal
tract.
Under
this
class
comes
septicaemia, and probably malaria, and also pathological products, which produce diabetic coma-albuminuria.
But it is through the intestines that autointoxication most frequently occurs by putrefactive changes in the food. Any undue delay there of the ingested food leads to absorption into the bloods of toxic ptomains, which poison the system and produce the train of symptoms, headache, feverishness, biliousness, etc. For this, although constipation or coprastasis is the rule, it also occurs in the fermentation of diarrhoea, dysentery and cholera. The exact manner in which this auto-intoxication occurs is beginning to be ascertained. When fermentation of carbohydrates occurs, we have produced the various fatty acids, while with the decomposition of the albuminous substances, there result ammonia, sulphuretted hydrogen, indol and skatol, leucin and tyrosin,
[Aug.,
1949
'
and some other products. Aaron and others have shown that there is a constant formation of ptomains and toxins in the intestinal canal by bacterial action. The retention of all these injurious products would naturally, if absorbed ?and experiment has proved that this absorption does take place?work harmful changes in all parts of the body. The nervous system being the most delicately organized is usually the first to suffer. While we do not know positively that such is the case, yet reasoning from the fact that a cleaning out of these poisons, i.e. of the intestinal tract, often causes a prompt disappearance of the symptoms, we have at least strong The kidneys, if not presumptive evidence. acting properly, are also a most important factor in the production of auto-intoxication. Bouchard states that in the normal urine of an adult man, there is present each day a sufficient quantity of several poisonous products to have caused the death of the individual, if not excreted. We can readily see from this how small an amount of kidney disturbance may be required to produce symptoms of auto-intoxication. Among nervous symptoms probably the most common is headache. Almost all of us are acquainted with the relief that follows a thorough evacuation of the bowels. Vomiting of the so-called cerebral type occasionally occurs. Among psychic symptoms, disinclination to work, depression of spirits are all of the most frequent occurrence.
Among circulatory disturbances, tachycardia and other forms
may be mentioned
of vasomotor alteration. Skin affections are not uncommon as the result of auto-intoxication. The occurrence of urticaria as the result of the ingestion of certain foods, particularly lobsters, strawberries, and tomatoes, while at one time ascribed to idiosyncrasy, we now know to be due to auto-intoxication, for in so-called susceptible individuals, the urticaria has been prevented by keeping the intestinal canal free and active. Albuminuria may occur as a result of autointoxication : in the various forms of acute, and chronic intestinal obstruction, the exit of toxins being prevented along the 'prima via, they are absorbed and finally excreted to a considerable extent by the kidneys, on which latter they exert their poisonous action. We can readily see that albuminuria might result, or even an acute nephritis. We must regard chlorosis as due to a large extent to auto-intoxication The symptoms of general paralysis appear to be due in great part to auto-intoxication. Drs. Mott and Halliburton, in a paper recently (20th April) read before the Royal Society, show that choline (C5, H15, No.2) and nucleoproteid are produced by the acute disintegration of brain-tissue, and are absorbed into the blood. They found choline in the blood of general paralytic patients and ascertained its characteristic action on the neuromuscular mechanism of the blood-vessels. *Jour. Amer. Med. Assoc., Jan. 1899.
At:g-> 1949]
CURRENT TOPICS, ETC.
The practical outcome of these investigations is already considerable: While broadly basis, Dr. Lauder establishing on a, scientific Brunton's so-called 1 internal sewage system' of ^eatment by internal disinfectants, such as treatment at salnl -h,. salolj these observations indicate the lines of reatrnent in certain specific cases. Thus it would seem that in general paralysis and certain nervous states, where choline and neurine are i
.?
the use of food containing much such as eggs, should be prohibited, as tends to split up into the two poisonous )ases above mentioned. Even a thickly-coated may load the blood with toxins. Diabetes, Lauder Brunton believes, may find its cure in a glycolytic enzyme, although about possibly ^ quarter of a century ago he failed to extract such a substance from muscle. These attractive investigations are still in heir needed to infancy, and much care will be results as av?id interpreting merely secondary causes. Altogether this field of research in p lemical physiology is one of the most promising ln practical medicine, and bids fair to yield 1(^ults which will remove a large amount of dis-
produced, ecithin,
jecithin
^jngue
_
comforting
illhealth and disease.
369
'
'
'
often termed a touch of malaria and even such unexpected conditions as general paralysis and certain kinds of insanity. So far-reaching and widespread indeed are the effects of these autointoxications that the subject is well deserving of quite as much attention as is being paid to the infectious fevers, for it affects immediately the comfort and fate of a much greater number of human lives.
3nfcian
riDct>ical
(5a3ctte
ffift*? l^ears Hgo
DISEASES OR
DUE TO
SELF-EMPOISONING
AUTO-INTOXICATION
'
auto-intoxication' should be confined to that poisoning of the system by products elaborated by the individual's own living tissues, namely, by that class of chemical products which are called leucomains, such as produce gout, neuralgia, etc. It nevertheless is also usually held to include poisoning by absorption of the products of bacterial fermentation and putrefaction in dead matter, the socalled ptomains, which produce the familiar symptoms of septicemia and infective and other fevers and irritant poisoning.
Strictly speaking,
The former class, the leucomains, seem to produce poisoning through some alteration in the activity of the ductless, glands which regulates tissue-change, whilst the ptomains resulting from the vital activity of bacteria, depend on mainly excessive fermentation or putrefaction of the and prevention disease?its causation, treatment contents of the intestinal or other cavities or and more from the chemical standpoint; and diseases surfaces. Chemically, ' these ptomains are the general looking at most of factional nervous disorders as poisonings of the closely allied to the alkaloids', which, like Mood or toxaemias. This apparent swing of the them, arc also produced by living plants, and pendulum of opinion back towards the old whose poisonous action (as of nicotine, morphine, humoral doctrine that 'the Blood is the Life' strychnine, daturine, etc.) has long been recogbut an nized as producing severe affections of the is not in reality a retrograde movement, the nervous system, such as stupor, convulsion, and represents advance on a higher platform medical progress. mania, insanity, etc.
from the Indian Medical Gazette; August 1899, Vol. 34, p. 291) The leading trend of medical science of late years has been in the direction of viewing
(Reprinted
-^nore
most modern
development of
THE INDIAN MEDICAL GAZETTE
368
of poisonous leucomains are which causes xanthocreatinin, depression and vomiting, para-xanthin and heteroxanthin, which causes rigor and convulsions, gerontin, which paralyses the nerve-centres and ganglia of the heart, and from choline it has been shown by Schmidt and Weiss that poisonous neurine may be formed by the action of bacteria?the action of neurine agreeing closely with muscarine in paralysing the heart and purging, and in being especially toxic to nerve trunks, paralysing respiration like curare. The production of ptomains is chemically a process of oxidation with the formation of sulphuretted hydrogen, carbonic acid and water as by-products. As
instances
therefore, of widely, different proby auto-intoxication is very great. Although as yet but imperfectly understood, it would seem to include the following : Firstly, the processes by which toxins, which are stored up in the body as the result of some interference with the ductless glands which produce substances indispensable to healthy life, such as when the thyroid gland is congenitally absent or ,its function extinguished by tumour or extirpation, there results cretinism or myxoedema evidently as an auto-intoxication, and feeding such patients with the thyroid glands of sheep removes the symptoms; and if the same kind The range, covered
cess
be the action of citric acid in scurvy and iron in anaemia, by supplying the blood with certain deficient substances.
seems to
Secondly, those in which chemical products healthy cell life, normally present in the blood, which become so increased by abnormal chemical activity or defective excretion, as to act as toxins such as certain products of digestion, choline, urea, causing uraemia, sugar in diabetes, acetonuria, sulphuretted hydrogen. Thirdly, those in which abnormal products are the result of microbes, and especially of the putrefactive bacteria, which invade the gastroof
intestinal
tract.
Under
this
class
comes
septicaemia, and probably malaria, and also pathological products, which produce diabetic coma-albuminuria.
But it is through the intestines that autointoxication most frequently occurs by putrefactive changes in the food. Any undue delay there of the ingested food leads to absorption into the bloods of toxic ptomains, which poison the system and produce the train of symptoms, headache, feverishness, biliousness, etc. For this, although constipation or coprastasis is the rule, it also occurs in the fermentation of diarrhoea, dysentery and cholera. The exact manner in which this auto-intoxication occurs is beginning to be ascertained. When fermentation of carbohydrates occurs, we have produced the various fatty acids, while with the decomposition of the albuminous substances, there result ammonia, sulphuretted hydrogen, indol and skatol, leucin and tyrosin,
[Aug.,
1949
'
and some other products. Aaron and others have shown that there is a constant formation of ptomains and toxins in the intestinal canal by bacterial action. The retention of all these injurious products would naturally, if absorbed ?and experiment has proved that this absorption does take place?work harmful changes in all parts of the body. The nervous system being the most delicately organized is usually the first to suffer. While we do not know positively that such is the case, yet reasoning from the fact that a cleaning out of these poisons, i.e. of the intestinal tract, often causes a prompt disappearance of the symptoms, we have at least strong The kidneys, if not presumptive evidence. acting properly, are also a most important factor in the production of auto-intoxication. Bouchard states that in the normal urine of an adult man, there is present each day a sufficient quantity of several poisonous products to have caused the death of the individual, if not excreted. We can readily see from this how small an amount of kidney disturbance may be required to produce symptoms of auto-intoxication. Among nervous symptoms probably the most common is headache. Almost all of us are acquainted with the relief that follows a thorough evacuation of the bowels. Vomiting of the so-called cerebral type occasionally occurs. Among psychic symptoms, disinclination to work, depression of spirits are all of the most frequent occurrence.
Among circulatory disturbances, tachycardia and other forms
may be mentioned
of vasomotor alteration. Skin affections are not uncommon as the result of auto-intoxication. The occurrence of urticaria as the result of the ingestion of certain foods, particularly lobsters, strawberries, and tomatoes, while at one time ascribed to idiosyncrasy, we now know to be due to auto-intoxication, for in so-called susceptible individuals, the urticaria has been prevented by keeping the intestinal canal free and active. Albuminuria may occur as a result of autointoxication : in the various forms of acute, and chronic intestinal obstruction, the exit of toxins being prevented along the 'prima via, they are absorbed and finally excreted to a considerable extent by the kidneys, on which latter they exert their poisonous action. We can readily see that albuminuria might result, or even an acute nephritis. We must regard chlorosis as due to a large extent to auto-intoxication The symptoms of general paralysis appear to be due in great part to auto-intoxication. Drs. Mott and Halliburton, in a paper recently (20th April) read before the Royal Society, show that choline (C5, H15, No.2) and nucleoproteid are produced by the acute disintegration of brain-tissue, and are absorbed into the blood. They found choline in the blood of general paralytic patients and ascertained its characteristic action on the neuromuscular mechanism of the blood-vessels. *Jour. Amer. Med. Assoc., Jan. 1899.
At:g-> 1949]
CURRENT TOPICS, ETC.
The practical outcome of these investigations is already considerable: While broadly basis, Dr. Lauder establishing on a, scientific Brunton's so-called 1 internal sewage system' of ^eatment by internal disinfectants, such as treatment at salnl -h,. salolj these observations indicate the lines of reatrnent in certain specific cases. Thus it would seem that in general paralysis and certain nervous states, where choline and neurine are i
.?
the use of food containing much such as eggs, should be prohibited, as tends to split up into the two poisonous )ases above mentioned. Even a thickly-coated may load the blood with toxins. Diabetes, Lauder Brunton believes, may find its cure in a glycolytic enzyme, although about possibly ^ quarter of a century ago he failed to extract such a substance from muscle. These attractive investigations are still in heir needed to infancy, and much care will be results as av?id interpreting merely secondary causes. Altogether this field of research in p lemical physiology is one of the most promising ln practical medicine, and bids fair to yield 1(^ults which will remove a large amount of dis-
produced, ecithin,
jecithin
^jngue
_
comforting
illhealth and disease.
369
