The Role of Auto-Intoxication or Auto-Infection in the Etiology of Disease of the Higher and Lower Nervous System

A hundred years ago, leading French alienists taught that mental disorders had their origin in abdominal disorders—cf. melancholia. This teaching has been largely disregarded, and never submitted to investigation from the standpoint of general medicine. Much attention has been drawn to the subject in the last few years, but the fringe of the subject has hardly yet been touched. In the last twenty-five years neurologists have added much information to our knowledge of their subject, especially the symptoms and minute anatomy of disease of the lower nervous system, without corresponding advance in the knowledge of etiology and treatment. It is necessary to take a less specialised conception of these disorders and investigate them from the standpoint of general medicine. (This conception does not invalidate the importance of the hereditary factor in disease.) A valuable opportunity afforded to the Edinburgh School to contribute its share in advancing knowledge, either by submitting fresh facts or disproving facts alleged by others. Reference to the author's views as published since 1900, dealing with the factor of auto-sepsis, taking origin in one or other of the mucous surfaces of the body: e.g., faulty state of teeth and gums, abnormal conditions of the digestive tract as revealed by (a) physical examination, (b) examination of stools, (c) X-rays, etc., and abnormalities in the urine, more especially the presence of bacteria, cells, etc. etc. The influence of auto-sepsis in aggravating and complicating other disorders, e.g., specific infection, tuberculosis, etc. Reference to recent work on disseminated sclerosis and to the conclusions tentatively drawn by experts from it, as to the intestinal tract being the primary source of the toxic agent responsible for the changes in the nervous system. This work has been all but ignored by neurologists. Reference to author's experience of the common disorders of the nervous system (syphilis excluded), of the physical disorders present apart from the nervous system, and the results of treatment directed to correct these physical disorders. Criticism invited on the following:— 1. The need for more clinical research work on the subject, conducted on general rather than on "neurological" or "psychiatric" lines, and more especially the collection of facts dealing with the existence of physical disorder in disease of the central nervous system. 2. The results of treatment of disease of the central nervous system will be much more favourable if these disorders are investigated and treated on general lines than on the lines largely obtaining at the present time. 3. The criticism here of unwise specialisation in nervous disorders is equally applicable to bacteriological science. The outlook and practice of bacteriologists in this direction is unfavourable to real advance in our knowledge of the etiology and treatment of the disorders in question. The fault is a serious one; it applies to the system, not to the individual. 4. The principles contended for in the above are equally applicable to departments of medicine other than the "nervous" system. Lantern slides from Dr James Dawson's work on disseminated sclerosis, and two patients suffering from disseminated sclerosis to illustrate some of Dr Chalmers Watson's views, were shown.