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bolism, exclusive of the influence of bacteria, and those produced by bacterial life. These are generated within. the organism, and are known as endogenous toxines, and upon their influence depends the condition known as autointoxication.
2. Toxic agents introduced from without, in the ordinary acceptance of the term—poisons, and are known as exogenous toxines, and when introduced into the organism produce a condition similar to that referred to above, known as hetero-intoxication.
In order to understand the action of these toxines upon the organism, it is necessary to consider the life of a unicellular being. The phenomena of nutrition is characterized by four series of cellular action; two chemical and two physical.
(1) A physical phenomenon, endosmosis, by which nutrition passes from without to the interior of the cell.
(2) A chemical phenomenon, assimilation, the storing up of force.
(3) Another chemical phenomenon, disassimilation. The disengagement of accumulated energy.
(4) A physical phenomenon, exosmosis, by which the useless and harmful matter is thrown out of the cell. In crder that endosmosis and exosmosis may be produced, the nutritive substances must be in a state of solution. In physiology, as in chemistry, active manifestations can not take place unless the substances are dissolved. The same law is equally true in pathology of this condition. Toxemia is possible only when these substances are soluble, o in solution, in order that they may be absorbed or penetiated into the blood and interstitial fluids, and thereby modifying their chemical composition. Therefore, let us remember that toxines are substances which, when introduced into or formed within the organism, are capable of
disturbing, even more, of abolishing, the life of anatomical elements by directly, or indirectly, modifying the liquid medium containing them. This being true, let us understand that in every case of intoxication there is an alteration of the glands throughout the economy, especially those charged with the destruction and elimination of poisons. That the liver, the kidney, the thyroid gland, the suprarenal capsules, and the skin, are more or less affected. We must conclude that all work together to prevent the destruction of the organism. The source of these bodies are twofold: The gastro-intestinal tract and the proper tissue of the body. The most prolific source is a disordered bowel. There is no disease that remains local. The disordered digestion not only directly leads to the formation of putrefactive compounds in the gastro-intestinal tract, and the absorption into the blood and the nutritive tissues of juices of a most irregular and highly toxic degenerate compounds of the albumins, fats and carbohydrates of the food, but they also lead to hepatic insufficiency, a disorder that is instrumental in causing a flood of poisons to circulate through the organism, thereby modifying the chemical composition of the blood, and influences the entire economy. It is not surprising to find that the liver cells are often impaired in their function when the gastro-intestinal tract is disordered; for all of the poisons generated there are taken up by the capillaries of the portal circulation and are carried through an intricate labyrinth of closely interwoven capillaries to the liver cells; for a time the latter may withstand the stream of toxic matter, and can properly exercise their disintoxicating function, but an overwhelming mass of putrefactive material, flooding them at one time, or small quantities of putrid excrement irritating them chronically, must needs impair their function and render them inadequate to pro
tect the organism, as a whole, from bowel poisoning. When this occurs intestinal toxines filter through into the circulation beyond, exerting their deleterious effects upon the heart, the arteries and brain, and the groundwork of the eye as well as the entire organs. The change in the quantity and composition of the bile, moreover, reduces its germicidal power so that intestinal putrefaction is increased, or, at least, not checked; constipation supervenes, 1ight disassimilation of the enteric contents is prevented; the assimilation of fats is decreased, and consequently the general nutrition is disturbed. In this way a vicious circle is closed, and both in the bowel and in the tissues at large poisonous bodies continue to be formed that are capable of producing numerous disorders, among them many of the symptoms of Bright's disease.
Based upon the opinion that many cases of nephritis originate as a result of gastro-intestinal disorder and, by implication, hepatic insufficiency. And this is borne out by the experience and observation of every careful observer. We can do much for this victim by conservative treatment of the earlier stages of this disease, should treatment be directed to correcting the disordered bowel and liver. I believe that in the majority of cases early attention to the digestive tract will check the progress of the disease and not infrequently produce a restitution to the normal when the heart is considerably hypertrophied, and when the kidneys are already showing evidences of nephritis. There are many cases of Bright's disease that we do not understand. These are probably due to some obscure perversion of metabolism. Of course these are more difficult to treat, as there is nothing tangible to attack, for who can intelligently combat a tissue anomaly that is hereditary in char
acter and in which a dark, nervous element manifestly plays a commanding role? However, when nephritis is established, it is our duty to counteract the deleterious effects exercised upon the organism by the inadequacy of the renal functions. In the management of Bright's disease it is our duty to first prevent intestinal putrefaction, to stimulate hepatic functions, and to prevent, as far as possible, obscure metabolic changes. To prevent putrefactive decomposition in the intestinal tract swarming with bacteria is by no means an easy task. Nor do any remedies that we have at our disposal act under such circumstances. Therefore we must, by the administration of mercurial and saline purgatives, empty the gastro-intestinal tract. Then, and not till then, is the administration of food or remedies advisable; after the digestive tract is placed in the best possible condition, we should begin the administration of our remedies. The sulpho-carbolate of zinc and the bile acids, while neither of these substances constitute an intestinal antiseptic, the administration of either of these drugs will check, at least, the putrefactive decomposition of albumins, and as the albumins furnish the bulk of the most toxic intestinal bodies, much is thereby gained by their administration. If sufficient sulpho-carbonate of zinc is given all putrefaction will stop. When this is accomplished, the urinary evidences of bowel putrefaction also disappear, as manifested by the reduction of the indican and the other aromatic urinary ingredients that appear when albumin putrefies in the gastro-intestinal tract. The administration of the bile acids is of value; these bodies possess germicidal properties, and greatly stimulate hepatic function, thereby directly combatting the development of hepatic insufficiency and its consequences.
After this end is accomplished, the patient should be
given a generous diet, allowing only those articles of food that are the least irritating to the kidney, and they should be in as condensed or concentrated form as possible, as liquids increase the action of the already overworked organ, and increase the arterial tension. When nephritis develops, the kidney at once stops the elimination of water. We see that liquids pass the parenchyma with difficulty, and to attempt to force it through is to irritate the organ, which should be kept at perfect rest if possible. It is true that in the late stage of interstitial nephritis polyuria appears, but the urine contains few solids in solution, and there is practically nothing to eliminate. The administration of liquids is, of course, of no value to the organ, and is directly harmful to the overworked heart.
A nephritic kidney fails to properly eliminate sodium chloride. The theory has been advanced that edema is produced by the presence of sodium chloride in the tissues; that by osmotic action liquids are drawn from the blood into the tissues and edema develops. By withdrawing the chlorides I have seen edemas rapidly disappear, and albuminuria often decreases. However, during the course of nephritis, if a patient suddenly increases weight, look for edema and effusion into the cavities, and, at least, withdraw the chloride from the foods for the time being. So far as nephritic manifestations are concerned, vasodilators are of much value. When the blood pressure is relieved albumin always decreases in the urine, and the epithelium regain their tone and functional activity is near the normal; as a valuable adjunct to this treatment, rest in a warm bed, hot baths, and a quiet life, away from the cares and worry of business, and in a dry, warm climate, is the ideal form of treatment. I can not say too much in praise of judicial massage and rest in a warm bed, for