During the Bradshawe lecture, Dr. William Carter made the following remarks: “According to Bonchard, one-fifth of the total toxicity of normal urines is due to the poisonous products re-absorbed into the blood from the intestines, and resulting from putrefactive changes which the residue of the food undergoes there.” In the course of the lecture, Dr. Carter fully explains that one of the benefits derived from milk diet in Bright’s disease is the small residuum deficient in toxic properties, and lays great stress on the employment of intestinal disinfectants or antiseptics that exercise their influence throughout the whole tract, suggesting naphthalin as peculiarly efficacious, thereby cutting off one source of blood contamination at its source. Although these are recent developments in medicine, Bonchard mentions that in the practice of M. Tapret cases treated on this principle did well. (Braithwaite’s Retrospect, January, 1889.)
Persons laboring under this toxic condition of the blood, with a consequent deterioration in the texture and the physiological function of the vital organs, are of that class that easily succumb to injuries or serious sickness, and of that class to whom a surgical operation of even medium magnitude is equal to a death-warrant.
The above conditions are an almost constant attendant on that condition of the sphincter described by Agnew as sphincterismus, which also is productive of hæmorrhoids and fissure, and often of fistula. That sphincterismus is caused in many cases by preputial irritation is as evident as that the same affection, or hæmorrhoids or any other rectal or anal affection, will, in its turn, produce vesical and urethral reflex actions, and primarily functional and secondarily organic changes in those parts. Besides, the great number of cases wherein the gradual and progressive march of each pathological event could be traced with accuracy has convinced me of the true cause of the difficulty being the result of reflex irritation.
Delafield, in his “Studies in Pathological Anatomy,” gives, as the first form of pneumonia, that from heart disease; in the days of Broussais this would have sounded absurd, but, to-day, some forms of heart disease are known to be the regular sequences of some particular form of kidney disease, just as some form of pneumonia attends an affected heart and that some forms of pneumonia degenerate into phthisis. When the blood change is an established fact, it is only a question as to which is the weak organ, and the organism of the individual will decide whether it will be a simple sick-headache or the beginning of a pneumonia ending in phthisis.
I have purposely dwelt on this part of this subject, owing to the recent origin and publication of many of the views connected with it; also on account of the greater ease of making the subject plain by fully discussing each step of the process; and if the views of Sir Lionel will be recalled, that a toxic element in the blood is the starting-point, and that an irritable or weakened organ invites destruction,—the induction of serious and fatal kidney disorder by the transmitted irritability and consequent injury to the kidney produced by preputial irritation in the first instance, and the supplemental blood-poisoning by intestinal absorption of septic matter, which soon brings about Sir Andrew Clarke’s “inadequacy of kidney,”—all will be readily understood. When this point is reached, a too hearty meal, exposure to variable weather, or a little extra care or anxiety, are sufficient, as determining causes, to bring life into danger.
As pointed out, many cases of Bright’s disease or other renal difficulty have their origin in this distant but visible source, and, although malarial poisoning and a great number of other causes will produce the same particular organic changes and diseases, this condition must be admitted as one of the frequent causes. The influence of the genito-urinary tract on the rest of the economy, and the importance of the sympathy it excites, or how quickly, by its being irritated, some apparently dormant pathological condition will be awakened to life and activity, is not sufficiently appreciated. As observed by Hutchinson, a patient who has once been the subject of intermittent fever is more prone, on catheterization, to have a urethral chill and fever than one who had never had the fever. (Hutchinson: “Pedigree of Diseases.”)
Ralfe observes, in his “Kidney Diseases,” that long-standing disease of the genito-urinary passages must be reckoned as among the chief etiological factors of chronic interstitial nephritis (page 227). The condition of the kidneys in cases of strictures of long standing is known not to be a reliable one, and any incentive to dysuria or to retention, no matter how slight, is apt to lead, eventually—and that even in very young subjects—to that toxic condition mentioned in a former part of this chapter as one of von Jaksch’s subdivisions of toxæmia, the ammoniæmia of Frerichs; this condition being the fatal ending of the case of the two-year-old child mentioned by Henoch, who died after the relief of a retention due to phimosis and calculi resulting from the phimotic occlusion. Having seen so many cases wherein the conditions described in this chapter were so apparently—whether from ammoniæmia due to infection, or toxæmia from the urinary tract, or uræmic toxæmia from the intestinal tract—all due to some preputial interference or irritation, I cannot help but feel that in these conditions—which, singularly, are not so prevalent with the Hebrews as with Christians—we have one factor in the cause of the shorter and more precarious vitality of the latter.
Morel, in his “Traité des Dégénérescences Phisiques,” ably discusses the degenerative and morbific influences and results of toxæmia, as well as he clearly defines their sources. The connection between toxæmia and mental affections has already been shown, and Prof. Hobart A. Hare, in his instructive and interesting prize essay on “La Pathogénie et la Thérapeutique de l’Épilepsie (Bruxelles, 1890)”, mentions that convulsive disorders resulting from the presence of some toxic substance are of frequent occurrence. How much this may enter as a partial factor into many of the cases of epilepsy which are classed in the order of “reflex” may well challenge our consideration. Hare lays great stress on the necessity of circumcision wherever there is an indication of preputial local irritation. “If practicable, circumcision should be performed; it is an operation with but small risk or danger, and easy of performance. In such circumstances it is always permissible to circumcise, were it for no other end than an acknowledged attempt to reach a cure.”