Chapter 7 HOW AUTO-INFECTION AFFECTS INTESTINAL DIGESTION, AND VICE VERSA.

Intestinal indigestion is a more common form of functional disturbance than is gastric indigestion. It is a well established fact that the greater portion of the digestive work is done beyond the stomach, in the duodenum, by the hepatic and pancreatic fluids. The duodenum-very properly called the second stomach-has none of the peculiar characteristics of a receptacle that receives crude substances-the office of the stomach.

Much greater sensitiveness characterizes the digestive canal than the stomach; which is accounted for by the fact that a network of nerves, forming the sympathetic system, surrounds the bowels. The symptoms of intestinal indigestion are not always clearly defined and distinguishable from gastric indigestion, especially as the two are frequently associated.

The cecum, more than any other portion of the digestive canal, resembles the stomach, and it secretes an acid, albuminous fluid having considerable solvent properties. It is to be observed that as the cecum is only three inches in length and two and a half in diameter, and as its contents are necessarily propelled in opposition to gravity, a slight casualty will hinder or obstruct the upward movement of the pultaceous mass of the effete ingesta. The turning point in the ascending colon affords another ready hindrance to the upward and onward movement of this mass; and the gases and ancient feces beyond the turn conduce to further sluggish peristalsis, bringing about more or less obstruction and reflex irritation of the remaining length of intestinal canal. Undue retention of the contents of the cecum, and the disturbance and obstruction of the duodenum by the pressure incident to the distention of the colon with feces and gases, lead to congestion, inflammation and occasionally to ulceration of the mucous membrane in various parts of the intestinal tube.

This condition of affairs increases the occlusion (closing) of the bowels, but makes very easy indeed the entrance and propagation of micro-organisms in the sub-mucous coat of the intestine. The conditions are now ripe and rife for auto-infection. Which of the following microbes are the most active agents of progressive auto-infection: the streptococcus lanceolatus, the bacterium pyogenes, the bacillus subtilis, the staphylococci, the bacterium coli commune? They all play a part in the game, reducing the body in time to a charnel-house. Or are such substances as putrescein, cadaverin, skatol or indol-which are derived through chemical change in the putrescent mass-contributors to the spread of the poisonous taint throughout the system? Any single one or a group of the fifty or more bacterial poisons may be the responsible agents in the ensuing auto-infection. Chemical analysis of the gases resulting from decomposition reveals oxygen, nitrogen, hydrogen, carbonic acid, protocarbonated hydrogen and sulphureted hydrogen, ammonia, and sulphate of ammonia. Leucin, tyrosin, lithic acid, lithates, xanthin, cystin, keratin, sulphureted hydrogen, etc., are deposits in the urine and are signs of the derangement of the intestinal canal and liver. The external symptoms observed are the following: the tongue is large, pale, flabby and indented by the teeth at the edge of the anterior third, while its surface is white and the papill? often enlarged; the appetite may be excellent, though there is great functional derangement of the liver with lithemia, so that the sufferer is tempted to eat what he knows from experience will disagree with him; a bitter coppery taste in the mouth, due to taurocholic acid-a common symptom of lithemia or of imperfect oxidation of albumen; emaciation, fatigue, depression, headache, buzzing in the ears and deafness, disturbance of sight, loss of memory, faintness and vertigo, very marked in some cases; sometimes tenderness and pain under the cartilages of the right ribs; the fretting of the sensitive surface of the bowels by imperfectly digested, semi-putrescent food, resulting sometimes in convulsions, coma, paralysis, or in fetid diarrhea of an acid character producing a burning sensation or pain of the anus when the discharges are being passed; rumbling and twisting sensations in the region of the navel occurring with flatulency, and occasionally colicky pains which at times are so severe as to simulate poisoning.

In some people certain articles of food, without being either toxic or putrid, induce indigestion and the production of microbes in quantity amounting to one third of fecal dejections. Prof. Ch. Bouchard says:

"The consequence of this development of acid in the whole length of the digestive tube is an inflammatory condition. We notice catarrh of the stomach, ulcerative gastritis, to which patients often succumb after twenty-five years of bad stomach; these are the false cancers, as they are called, or malignant gastritis without tumor. The large intestine is inflamed; around the fecal matter are seen glairy secretions and sometimes blood (membranous enteritis)." (Op. cit., p. 159.)

In chronic inflammation of the rectum and colon there is more or less discharge of mucous, and in some cases of membranous, desquamation, with yellow or bloody mucus. The shreds, cords or complete tubular casts are discharged constantly or at varying intervals. The quantity and character often alarm the sufferer. The discharge is nothing less than a thick, tenacious mucus that had formed a thin coating on the inflamed mucous membrane, and become exfoliated in casts or thin shreds-the result of many years of morbid intestinal exaggerated action.

Microscopical examination of the desquamated intestinal membrane and mucus from a man forty years of age, revealed the following products: crystals, mostly complete; incomplete phosphates, very numerous; mucous shreds in abundance; fat globules and granules, numerous; anal epithelia; red blood globules, few; connective tissue, scanty; pus corpuscles, very few; margaric acid and detritus (substances resulting from the destruction or wearing away of the part); undigested material, mostly cellulose; leptothrix threads, micrococci; and the bacillus coli communis. Diagnosis: foul, undigested material, due to a chronic inflammation of the lower intestinal tract. The microscopical examination of mucus and desquamated membrane from a woman sixty-five years of age, disclosed that she was suffering from proctitis and colitis. She wrote: "Please tell me how long this mucous discharge must continue. I am alarmed at the quantity of membrane, cords, casts, etc., in my excreta, and I think that if this process goes on much longer there will soon be no bowels left to purify." This letter was written some weeks after contracting a severe cold, which accounts for the unusual amount of exfoliation and mucus. The sample she sent contained a large quantity of mucus, both threads and corpuscles; with a moderate number of epithelial scales, partly anal and partly intestinal. Pus corpuscles were present in small numbers; also vegetable fibres, fat, starch, muscle fibres and cellulose-the remains of undigested material. In the membranes themselves no micro-organisms were found; in the pieces containing undigested material the bacillus coli communis was found as well as micrococci, and the bacilli of putrefaction (secondary formation) were seen.