On the Elimination and Assimilation of Morbid Poisons
BMJ (Clinical Research Edition)
College; etc. TIEE distinguished author of the Address in 'Medicine recentlydelivered at Oxford, argues that recovery and subsequent immunity from such diseases as small-pox "are produced by a process of impregnation and assimilation, and not, as was early believed, and is still by some maintained, of elimination." Dr. Gull goes on to say that " the old theory of depuration, though true of gross chemical poisons, as lead, or mer-,cury, or arsenic, appears to have no application to those
... on to those operation; which take place in the body in contagious diseases, as the effect of organic poisons." The question which is thus raised is one of consider p.bc scientific interest and practical importance. I have been at some pains to arrive at Dr. GUl's meaning.and, so far as I can understand him, I find it impossible to reconcile tiis doctrine with some of the well. known facts of contagious diseases. Every pathologist will admit that in eontagious diseases there is " impregnation" of the system by s poison; but what is meant by "assimilation"? Surely there is an entire absence of proof that morbid poisons are assimilated into the sub. stance of the body as food is assimilated; and yet this appears to be the sense in which Dr. Gull employs the term assimilation with referencc to these poisons. Without doubt, there is a process of assimilation ir contagious diseases; but, so far from the organism assimilating the mor. bid poison, the exact converse occurs: the morbid poison assimilates the fluids and tissues of the body, and the result is a millionfold multiplication of the oinal poison.germ. What, then, becomes of these poisonous materials That they are ever appropriated to the use of the body by a process of assimilation, is not only unproved, but in a high degree improbable. That they are partly decomposed in the sj;stem, and then ejected by various channels, is likely; but that, in such a disease as snmall-pox, they are abundantly thrown off into the surrounding air, is absolutely certain. The whole doctrine of infection is based upon the proposition that poisonous emanations from the sick mayenter the bodies of the healthy, and there reproduce the morbid processes to which they owe their own existence. Not only does a morbid poison assate the materials of the living body, but an individual sick of an infectious disease makes others as sick as himself; he assmilates his friends and attendants. Our ignorance of the chemistry of morbid poisons does not render them the less veritable " chemical poisons". The every-day practice of disinfection in such diseases as cholera and scarlatina accords with the indisputable fact that a material virs is thrown off from the system. If the doctrine of the natural elimination of morbid poisons is to be rejected, the doctrine of infection and the practice of disinfection must also be given up, as unmeaning and useless, these corollaries being necessary correlatives of the other. The fact that the organism is not restored to its former condition after such aw disease as small-pox, so that, as a rule, it is insusceptible ,of a recurrence of the same disease, is rather adverse to than in favour of this new doctrine of assimilation. The body is unlike what it was before; it has been assimilated; and the non-recurrence of such diseases is more in accordance with the hypothesis of Mr. Simon and Mr. Paget, that certain ingredients of the body are destroyed by each specific morbid poison, andithat these ingredients not beingreproduced, that particular poison finds henceforth no materials upon which its morbific agency can work. Notonlytheskin, but the entireorganism, is, as it were, permanently scanred by the operation of the small-pox poison. I entirely agree with Dr. Gull, that " the object of medicine must rather be to limit the violence of attendant symptoms, than, with our present knowledge of therapeutics, to aim at arresting or neutralising their specific processes." It is questionable whether vaccination canwith strict propriety be called a "remedy" for small-pox. I should consider it rather as a means of prevention, or of exciting a mild and modified form of the disease. Dr. Gull goes on to say:" Yet, notwithstanding this teaching, pathology still persists in looking in another direction; and therapeutics are governed by the idea that disease is an entity which must be combated and cast out." Now here I venture to suggest, that the idea of a disease is confounded with the idea of a morbific cause. My idea of small-pox is that of an individual suffering from that disease; and, if I found such a patient in one of my wards, my belief in the doctrine of the elimination of morbid poisons would induce me to " cast him out" of the ward before he had infected the other inmates. Then, in treat-ing the sufferer from small-pox, I should act upon the idea that the small-pox virs is as veritable an " entity" as the ovum of a tape-worm; and, believing that the natural process of cure consists in casting out the poison and its products, I should endeavour to favour that process by a free current of fresh air to carry away the poisonous exhalations as rapidly as they are formed, and thus to prevent their re-entrnce into the system either through the air-passages or by other channls Apin, in treating choleraic disease, theory suggests, and practical expenence confirms, the theory that the feetid morbid secretions should not be retained within the alimentary canal, but rather permitted, nay, even assisted, to escape. One of the strongest theoretical arguments against the use of repressive means in the treatment of the contagious diseses is derived from the fact that these morbid poisons, unlike inorp.nic poisons, are rapidly self-multiplying; so that their forcible retention within the body increases their destructive agency. The mischievous consequences of driving in the rash of scarlatina are too well known to require even a passing notice. I lately saw rapid death follow the -rnression of the variolous eruption by a prolonged aplicaton of a cold wet sheet to the surface. In how many instances the analogous practice of arresting choleraic discharges by a large dose of opium has been attended with equally fatal results, it is painful to contemplate. To sum up, then; the doctrine of the elimination of morbid poisons is based upon three classes of facts. I. There are tlhrown off from the bodies of those wlho are suffering from infectious diseases poisonous materials, which have the power of imparting the same disease to others. 2. The processes by which these poisonous materials are thrown off from the bodies of the sick, are essential for the recovery of health, and an arrest of those processes is often followed by serious, and even fatal, results. In other words, while the poison escaping is destructive to others, the poison retained is destructive to the patient himself. 3. The most successful methods of treatment are such as rather assist than hinder those natural eliminative processes, which, being constant, are obviously an essential part of the cure. So that, to repeat the words of Dr. Gull, " the object of medicine should rather be to limit the violence of attendant symptoms than to aim at arresting or neutralising their specific processes."