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TOXAEMIA
 
TOXIC. The word toxic means poisonous, and in this sense is applied to certain substances and to their effects on living organisms. A person is said to be" toxic" who is suffering from the circulation of poison in the body.
TOXAEMIA.
Derived from the Greek words toxikon and haema, meaning poison and blood respectively toxaemia can be defined literally as a poisoning by toxins produced in the body cither by breakine ilown cells or the products of faulty metabolism. qr by organisms or the products of their activity. Thus, it is popularly known as a blood poisoning.
It is highly probable that in every infection some organisms escape into the blood, but in the majority of cases they are speedily killed by the defensive properties of this fluid. When this occurs the infective condition remains localiscd, spreading only by contimrity of tissue. Even then marked general disturbanccs may be associated with the condition and are therefore entirely due to the diffusion of toxic substances; that is, there is a state of toxaemia. In septicaemia the bacteria thrmselves persist and may even multiply in the blood stream.
Naturally this state of affairs is much more serious, but in extreme cases of pure toxaemia it is impossible to distinguish between the two by the signs and symptoms alone. There is then a rigor and a rapidly rising temperature together with all the sequelae of fever and even delirinm. Diarrhoea and haemorrhages may appear.
 
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Apart from such extreme toxaemias there are the more common and less virulent states. Thus many cases of indefinite ill health and headaches are due to the constant absorption of small quantities of poison from some infected focus. Such a focus may be obscure, but is more often fairly obviously located either in foul teeth, bonsils or in the bowel. In the tast case poisons are habitually absorbed from the bowel, and this is particularly true when the food in the small intestine is infected, on in case of frank constipation, with consequent rapid absorption of toxic products. There is then a condition of alimentary toxaemia. There are also cases of toxic and haemolytic jaundice, some types of cirrhosis of the liver and patients suffering from pneumonia, are generally more ill on account of the toxaemia than from interference with respiration.
The results of poisoning by drugs may be referred to as toxic, e.g. the blindness due to quinine, the haemoglobinuria due to carbolic acid, and the v arious symptoms due to excess of alcohol or tobacco. Again, certain individuals suffer from discomfort and nettle-rash following on the taking of certain articles of food which are harmless to others.
Auto-intoxication is a condition implying the absorption of toxing or poisonous substances produced within the body and meaning, literally, "self-poisoning." Such poisons may arise either from disordered chemical processes in the body or from the growth and activity of micro-organisms established in some part of the body, and there producing harmful substanccs. These substances are absorbed into the circulation and conveyed to other parts of the body.
Disorder in the chemistry of the body or, in more technical language, disorders of metabolism, may produce a variety of poisonons products. Thus in the condition known as acidosis (q.v.) there may be an increase of carbonic oxide gas or of what is known as the fixed acids in the blood. These will lower the normal alkalinity of the blood and lead to the production of a series of symptoms. Similarly an excess of alkaline substance may be present, giving rise to the condition known as alkalaemia. This is now known to be the explanation of "mountain sickness" occurring in people who have quickly ascended to high altitudes. Acidaemia or acidosis commonly occurs in diabetes, and milder states of the same condition are found in case where the diet is badly balanced in respect of the proportion of acid-base and alkali-base foods which go to make up the diet.
Self Poisoning in Diabetes and Gout
In diabetes the fault lies in the metabolism of the carbohydrates, viz., sugar and starch in the diet. as a direct consequence the fat substances in the diet are incompletely burnt up or metabolised, leading to the production of a large quantity of acid substances which, acting as poisons to the nervous system, may cause lethargy, acidosis and death if the condition is not effectively dealt with.
Gout is another example of auto-intoxication. The fault in this condition lies in the metabolism of the "purin" bodies in the food and leads to an increase of uric acid in the blood. This has a damaging effect on various structures, especially on the joints, kidneys and blood vessels.
Though not much is known on the subject, it is probable that the so-called deficiency diseases due to lack of vitamins in the food lead to the production of toxic substances in the blood, the result of disordered metabolism. Any harmful influence causing a diminution in the activity of the exeretory organs of the body and so impairing their function will lead to an auto-toxaemia. An example is afforded by the condition known as heat stroke. Exposure to excessive heat diminishes the functional activity of the central nervous system and in consequence lowers the functional activity of such exeretory organs as the liver and kidneys. These then fail to rid the body of its waste products and a condition of poisoning arises. In this indirect manner many harmful influences brought to bear on the nervous system may act in the same way.
The term auto-intoxication is, however, more generally applied to conditions in which the toxins or poisons originate in the life proeesses of micro-organisms established in the body, i.e. intestines. A!so it is applied to a more or iess chronic condition, though it would equally apply to the effects of an acute condition such as typhoid fever, septicaemia, pneumonia or any similar acute infection.
Where there exists a localised chronic infected condition in the body it is known as a "focal" infection. From such focal infections poisons are continually absorbed into the blood stream, and this is the condition most commonly referred to as "auto-intoxication." A very common site of such focal infection is found in the length of the alimentary tract. In the mouth we find focal infection of the gums and tooth sockets and of the tonsils. In this region of the body also, though not included in the alimentary tract, there may be chronic infection of the nose or of the antrum or the bone sinuses above the nose.
Blood-Stream Poisons from the Bowel
The commonest focal infection is found in the bowel. Arising primarily in the large bowel or colon, it may, and generally does, spread upward and invade the small bowel. From there it may pass into the appendix or the gall bladder, either of which may then become the principal source of infection leading to appendicitis and cholecystitis. The primary cause of bowel infection is usually constipation or, in technical terms, intestinal stasis. Food residues, and particularly the residues of protein substance, allowed to remain overlong in the large bowel undergo putrefactive, bacterial changes. The normal bacterial inhabitants of the bowel then take on abnormal behaviour and become harmful instead of helpful: or new and pernicious types of organisms become established and by their rapid multiplication starve out, as it were, the useful organisms that normally exist in the food canal. Some of the poisonous substances thus produced can be found in the urine. Indican is a common example of such a substance, the presence of which in the urine is clear proof of intestinal putrefaction. Some of these toxic substances may also be absorbed in the form of deleterious gases resulting from putrefactive changes, like hydrogen sulfide, the odor of rotten eggs. Hydrogen sulfide in the colon, is quieckly converted to sulfurous acid with corrides the intestinal wall leading to polyps.
Toxins thus formed are for the most part destroyed in the liver as the blood passes through that organ. They are converted into harmless material and exereted from the kidneys. The liver can thus be regarded as a destructor of refuse. Should however the infection become very active and prolonged this defensive action of the liver will break down, and in that case much of the poisonous material will be allowed to pass on into the general circulation. The symptoms of autointoxication are many and various, and may be associated with any organ or body system.
It can truly be said that no part of the body is immune from damage due to these circulating poisons.
The principal stress may fall on any one or more of them. There will be general symptoms of il1-health varying from mild indisposition to conditions of profound weakness and even to a fatal issue like the pancreas in diabetes. The nervous system is often prominently affected, lcading to general nervous weakness or in some cases to definite mental failure or actual insanity. Scienists are nowadays inclined to attribute many forms of mental breakdown to long continued self-poisoning, and indeed this theory is pregnant with hope for recovery in some cases of insanity hitherto regarded as incurable. The symptoms of mild intestinal toxaemia are very familiar- the mental depression, loss of appetite, nausea and, general malaise associated with a so-called "bilious" attack is a common experience of a state of anto-intoxication.
The treatment of auto-intoxication must be directed to the removal of the sources of infection. These are dealt with under the various sections dealing with the infection of the different organs of the body. Often an extensive investigation is required in order to search out the offending site of infection, but time and money so spent may be well rewarded in many cases.
How to Prevent Self-Poisoning
Prevention of self-poisoning lies in keeping the common sites of infection clean and healthy. This is dealt with in detail elsewhere. but it may here be said that in all probability the primary infection is set up in the bowel. This again is largely due to errors in diet and errors which may have their inception in the very early days of life. Wrong feeding in childhood lays the seeds of an infection of the bowel which persists and increases in severity so long as dietetic habits depart from the physiological needs of the body. Constipation is an early consequence and serves to encourage the growth of the infecting organisms. Absorption of poison from the bowel lowers the resistance of all the organs and tissues of the body, which then become an easy prey to the all-pervading organisms of disease or undergo a steady process of degeneration leading to impairment or loss of function, or it may be even to cancer, the worst form of degeneration.
Thus, undoubtedly, many forms of chronic disease arise from chronic, insiduous auto-intoxication. Faulty nutrition may therefore be rightly regarded as an outstanding cause of disease through the medium of the self-poisoning to which it so often leads, as well as eating foods that are infected with microbes like rotten meats and fish.
Focal infections are undoubtedly more common amongst the members of a highly civilized community than amongst those of more primitive habits of life. So also are the common results of such infections, and in this respect cancer in the opinion of many offers an important example. Of all the conditions of life on which health is dependent, food habits occupy the most prominent position when we come to compare these conditions in and outside of civilization. It is therefore only reasonable to presume that it is in this direction that we must look for an explanation of the striking fact that focal infection and auto-toxaemia are to a very great extent asaociated with the advance of civilization and its creation of modern diseases.
PTOMAINE POISONING.
Strictly speaking, a ptomaine is a poison elaborated by the action of bacteria on protein food, usually meat,,and it was at one time thought that all cases of ptomaine poisoning were due to the consumption of food which had become poisonous in this way. It is now known however, that in most. if not all cases of living bacteria of a harmful nature are swallowed with the food, and the poisons are produced after their entry into the body. It is therefore possible to develop ptomaine poisoning from mcat which is to all outward appearances healthy. If it has been contaminated with the bacteria in question, although in more cases than not, the food alrcady shows some signs of decomposition.
In order to simplify classification, the term ptomaine poisoning is now used to include all cases of bactcrial poisoning due to the consumption of unhealthy food, except where specific disease. e.g. tuberculosis. is conveyed.
Causal Organisms. The common causal organisms of food poisoning are two bacilli which are in many ways similar to the bacillus of typhoid fever. They are the bacillus aertryche and Gaertner'e bacillus. Other bacilli belonging to the same group known as the salmoncella group; are probably guilty in some cases: and the bacillus botulimis, which belongs to quite another family, accounts for the cases known as botulism (q.v.).
These bacilli are sometimes found in the intestiues of animals used as food or may reach the food before or after cooling. Really efficient cooking will always kill these organisms, but unfortunately the temperature of the central part of the food is often not sufficiently raised for this.
Almost all foods may become contaminated, but as the bacteria grow more freely in meat, fish and milk than in other foods, these are more often responsible. Canned and preserved foods give more opportunity for the growth of bacter a than do fresh foods. Canned foods are very liable to contamination as soon as the lid is opened. Shellfish often convey the disease when taken from water contaminated by sewage.
Symptoms of Poisoning.
The symptorns of ptomaine poisoning begin any time from a few hours to a few days after the ingestion of the food, but usually within 36 hours. The time is shorter if the food has been taken on an empty stomach. The disease commences suddenly, sometimes with a shivering attack, and usually there is a furred tonue, a rise of temperature. acute abdoninal pain of colicy type, vomiting and diarrhoea. The stools are frequent, liquid and offesive, and oocasionally contain blood. If the case ;s a severe one, there may also he collapse, cramps. and heart failure. In most cases the symptoms clear up in the course of a few lays, and the patient is soon completely well. Occasionally, in a severe case, death may occur durinr the acute stages, and in a few cases a chronic form of the infection remains, aaxd the patient suffers from recurrent attaclzs of diarrboea for some vears. The disease is especiall,y danerous in young children.
Another symptom of some cases of ptomaine poisoning, especially those due to fish, is the occurrence of nettle-rash on the hands and arms or all over the body.
The dignosis can generally he confirmed by the examination of the stools by a bacteriologist, and the same organism is usually obtainable from any of the food which has been left uneaten.
Treatment.
The treatment of ptomaine poisoning consists first of all in putting the patient to bed and keeping him there until all symptoms have disappeared. During the acute stages the diet should be very restricted and entirely fluid, but as much water may be drunk as the patient wishes, in order to replace the loss of fluid due to diarrhoea. Albumen water, barley water, chicken broth and whey are allowed and also lemon or orange juice suitably diluted. Some arrowroot may also be added very soon, but milk is best avoided as it forms an excellent culture medium for the growth of pathogenic bacteria.
The feeds should be guen in small quantities, 3 to 4 ounces every two or three hours. A little brandy is sometimes a useful stimulant to the patient. Hot femntations to the abdomen may be necessary for the relief of pain.

If the case is seen early and there is not much collapse, the best drug treatment is hourly or half-hourly doses of one drachm of a saturated solution of magncsium sulphate (epsom salts) until the bowels are freely opened.
TOXALBUMIN. The albumins belong to that great group of chemical compounds known as proteins. Many of them are poisonous, and so are called toxalbumins, a name which is applied quite independently of the source from which they are obtained.
The toxins of diphtheria, tetanus and botulism are examples of their possible bacterial origin. The venoms of snakes, lizards, spiders, etc., contain certain very poisonous bodies of the same group.
Equally important, too, are those which can be separated from some plant juices. Thus ricin, a highly toxic poison, occurs in the castor-oil seed, but does not appear in the oil. Abrin is equally important, and crotin, too, must be mentioned, the former being prescnt in jequirity seeds and the latter in croton seeds. The similar bodies known as toxalbumoses are formed during the decomposition of meat.
 
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