[Discussion on alimentary toxaemia] / H.D. Rolleston.

  • Humphry Rolleston
Date:
[between 1910 and 1919?]
Catalogue details

Licence: In copyright

Credit: [Discussion on alimentary toxaemia] / H.D. Rolleston. Source: Wellcome Collection.

    2/8
    Discussion on Alimentary Toxaemia Dr. H. D. Rolleston : As the uninjured skin is comparatively impervious, the other surface covering of the body or the mucous membranes constitutes the main inlet for microbes and poisons; and of the various mucous tracts, that of the alimentary is much the largest, and further, is much the most exposed to infection and intoxication. It is true that the exposed condition of the alimentary canal is specially protected by the acid gastric juice against microbic activity and by the liver against poisons, but these lines of defence may be overwhelmed and broken down. It is easy to argue that a very large number of the diseases to which flesh is heir are due to intestinal toxaemia, but the state of our present knowledge makes caution necessary. Still, although it may be difficult to prove the widespread influence of alimentary toxaemia, it is unwise to put aside possibilities until they can be definitely ruled out. A difficulty about a wide assumption as to the existence of alimentary toxaemia in the sense in which it is employed in this discussion—namely, effects in other parts of the body due to poisons apart from micro¬ organisms-—is that many of the effects assumed to be toxic may be due to the passage of micro-organisms in small numbers into the circulation and so into the tissues. The hypothesis of such an escape of micro¬ organisms has long been before us in Adami’s sub-infection with Bacillus coliy which he suggests plays some part in the production of cirrhosis, haemochromatosis, and pernicious anaemia. With the improvements in our methods of blood culture, bacteriaemia is now more commonly recog¬ nized, and in the future transient and comparatively non-virulent forms may be found to be more common than is generally realized. It is quite reasonable to believe that toxaemia and bacteriaemia of intestinal origin may occur simultaneously; this is illustrated by the frequent association of chronic pancreatitis with portal cirrhosis, for chronic pancreatitis is most readily explained as due to an ascending infection from the intestine, whereas hepatic cirrhosis appears to be the result of poisons absorbed from the portal system. Another point to be borne in mind in this discussion is that the same result, for example, nephritis, neuritis, or arthritis, may be brought about in different ways by different forms of toxaemia, of which alimentary toxaemia is one. Therefore, in considering the influence of alimentary toxaemia it is not necessary to argue that it is the exclusive cause of certain conditions : to take an extreme instance, we need not join Mr. Arbuthnot Lane1 in the obiter dictum that gynaeco- 1 Vide Discussion (part i), p. 101. logists are solely due to intestinal stasis; and further the title of alimentary toxaemia to aetiological importance in a morbid condition is not necessarily rendered invalid because in some instances other factors are proved to exert a causal influence. Thus, exogenous oxaluria, due to the consumption of rhubarb, is not disproved because oxaluria may also result from metabolic disturbances which eventually result in diabetes.
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image