Women in pregnancy and child-birth frequently suffer much as the result of retention of fæcal matter, and physicians are familiar with the symptoms, which have been described as follows by M. Bouchet[52]:—“After normal parturition, in the course of which the usual antiseptic precautions have been fully pursued, and where delivery has been complete and natural, occasionally the patient is seized with chill and headache. The breath is fetid and the tongue foul. The temperature, taken in the axilla, is nearly 101° Fahr. The abdomen is inflated and painful in the umbilical region. Palpation in the iliac fossæ reveals lumps or consolidations along the colon. Thirst is intense, and there is complete anorexy. On questioning, it is found that there has not been defæcation for several days. The treatment consists of purgatives, enemas, and milk diet. In the next few days the bowels are emptied freely, the abdominal pain ceases, the temperature becomes lower, appetite is restored, and the patient recovers.”
Those who suffer from affections of the heart, liver, or kidneys are specially susceptible to the evil results of retained fæcal matter. In such patients an error of diet or constipation may bring about most serious consequences.
Such facts are well known to physicians, and it has been established that complete emptying of the lower bowels leads at once to favourable symptoms. From the other side, it has been shown by experiment that artificial retention of the fæces by ligature of the rectum puts the body in a grave condition.
If we collect our knowledge of all the facts, we cannot doubt but that the cause of the evil is multiplication of microbes in the contents of the large intestine. When the fæcal matter is free from microbes, as is the case with the meconium of the fœtus or new-born infant, it is not a source of danger to the organism. The waste of cells and the secretions which are added to the undigested food cannot do any harm. Amongst the microbes of the gut, there are some that are inoffensive, but others are known to have pernicious properties.
The ill-health which follows retention of fæcal matter is certainly due to the action of some of the microbes of the gut. There are difficulties, however, in determining the precise mode of action of these microbes. It is generally believed that they form poisonous substances which are absorbed by the walls of the intestine and so pass into the system. The phrase auto-intoxication as applied to infants, women in labour, and patients affected with diseases of the heart, liver, or kidneys, is based on this interpretation of the morbid processes involved. Attempts have been made to isolate and study the poisons in question, but there are many difficulties in the way. To distinguish between the actions of the poisons and of the microbes themselves, the latter have been destroyed by heat or by antiseptics, or been removed by filtration. Such methods, however, may alter the poisons and so are inconclusive. MM. Charron and Le Play[53] have tried to obtain exact results by heating the intestinal microbes to a temperature of about 136° Fahr., a process which probably does not seriously deteriorate the microbial poisons. Such material, injected into the veins of rabbits in large quantities, rapidly produced death, or in smaller quantities, proportionate ill-health.
Kukula[54] has tried to produce this toxic action in animals, employing microbial secretions obtained from cases of intestinal obstruction. He succeeded in producing serious symptoms, such as vomiting and curvature of the neck and back, in fact, precisely the sequence of events familiar in cases of obstruction of the bowels or other retentions of fæcal matter.
Some of the products of the intestinal flora are undoubtedly toxic, such as the benzol derivatives (phenol, etc.) ammonium and other salts. Many of these toxins have been insufficiently studied, but it is well known that certain of them can be absorbed by the wall of the gut and act as poisons. A well known case is the toxin of botulism which was isolated and studied by M. van Ermenghem.[55] The poison, the product of a microbe which causes serious intestinal disturbance, is so fatal that a single drop given to a rabbit produces death after symptoms similar to those observed in cases of human beings poisoned by stale food. Butyric acid and the products of albuminous putrefaction are amongst the most pernicious of the microbial poisons produced in the large intestine. It is familiar that digestive disturbance is frequently associated with discharges of sulphuretted hydrogen and putrid excreta, and there is no doubt but that the microbes of putrefaction are the cause of these symptoms.
It has been assumed for long that the retention of fæcal matter tends to putrefactive changes in the intestines, and that the evil consequences of constipation are due to this. Recently, however, bacteriologists have criticised this accepted view, on account of the small number of microbes found in the excreta of constipated persons. Strasburger was the first to establish the fact, and his associate, Schmidt, showed that putrefaction did not follow when readily putrescible substances were infected with material taken from cases of constipation. However, notwithstanding the exactness of these facts, I cannot accept the inference which has been drawn from them. The excreta discharged naturally in cases of constipation do not give a correct indication of the conditions inside the gut; whilst such matter contains few microbes, the substance removed after injection by an enema is extremely rich in bacteria. Moreover, analysis of the urine, in cases of constipation, shows an excess of the sulpho-conjugate ethers which are known to be products of intestinal putrefaction.
Not only is there auto-intoxication from the microbial poisons absorbed in cases of constipation, but microbes themselves may pass through the walls of the intestine and enter the blood. In the maladies that are the result of constipation some of the symptoms recall those of direct infection, and it is highly probable that, if special investigations were made, microbes of intestinal origin would be found in the blood of the sick children and the pregnant or parturient women whose symptoms I have described above.
The question as to the passage of microbes through the intestinal walls is one of the most controversial of bacteriological problems, and there is little agreement in the numerous publications regarding it. None the less, it is far from impossible to get a general idea of what goes on in an intestinal tract richly charged with microbes.