PART II.
SURGICAL DISEASES.
CHAPTER VI.
AUTO-INFECTION, ESPECIALLY IN SURGICAL PATIENTS.
One of the greatest advances made in pathology has been the establishment of the fact that a great many of the morbid conditions from which the human race suffer are those due to causes arising entirely from within their own systems and in consequence of deficiencies of elimination or of perverted physiological processes which, in large degree, are themselves the result of errors and indiscretions in diet, in manner of life, in habits, etc. That these general facts have been recognized for centuries is perhaps a credit to the powers of observation of practitioners of past generations. Exact knowledge, however, has come only with exact laboratory methods of research and most painstaking study of the secretions and excretions, both under normal and morbid conditions. The subject of auto-intoxication has been too commonly relegated to the domain of internal medicine, and has been supposed to be one in which the surgeon need take only passing interest.
The alkaloids are by no means the only poisonous products which the human body may produce and retain. That most important excrementitious material of all—i. e., carbon dioxide—could not be retained in the organism for more than a few moments without death as the inevitable consequence. The various soluble ferments elaborated by certain glands may exert deleterious influence, both local and general; and in the saliva are also found products which are not ferments. The biliary acids also, if they do not find free escape, may produce fatal poisoning. So also leucin, tyrosin, and all the excrementitious products which arise from insufficient liver activity, are capable of producing forms of intoxication—such, for example, as eclampsia, etc. The character of the solvent has much to do with toxicity. Thus aqueous extract of putrid matter is more poisonous than that of fecal matter, while alcoholic extract of fecal material is more toxic than that of putrid. All the alkaloids produced within the body are not poisonous. Some are found in the normal tissues, and they are, perhaps, only one of the results of the disassimilation of animal cells. Nor are all these poisons of bacterial origin, although many are formed only in the presence of microbes.
From these constantly menacing sources of intoxication man escapes by virtue of his intestinal, cutaneous, pulmonary, and renal emunctories. For instance, the usefulness of the perspiration is shown by the odor which it assumes under the influence of certain disorders. Among hypochondriacs and the inactive fatty acids are eliminated by the skin. Hence the odors of hospital wards, asylums, prisons, etc. So, too, in the case of many who suffer from deep-seated, indolent ulcers, the odor of the skin is suggestive of the presence of pus. During twenty-four hours there is eliminated from the lungs 1100 grams of carbon dioxide, water, etc., which sometimes contain ammonia and various volatile fatty acids; all of which will explain fetor of breath when it is the result of incomplete nutrition and destruction of food. Of the organs of elimination, the most important is the kidney, which does not reabsorb a part of its own products, as does the intestine. The kidneys eliminate fluids and solids, not gases. The most important of the toxic principles contained in the urine are:
1. Urea, which plays an important and useful role in the economy, since it possesses the property of forcing the renal barrier and removing along with itself the water in which it is dissolved and other toxic matters. Urea is toxic, but only in the sense that any other substance, even water, may be—i. e., it is toxic only in large doses, less than sugar, and no more than the most inoffensive salts. This is contrary to generally received views, but is established by the researches of Bouchard.
2. A narcotic substance, and
3. A sialagogue substance, whose composition is unknown;