Fashions in Pathogenetic Concepts During the Present Century: Autointoxication, Focal Infection, Psychosomatic Disease, and Autoimmunity

FASHIONS IN PATHOGENETIC CONCEPTS DURING THE PRESENT CENTURY: AUTOINTOXICATION, FOCAL INFECTION, PSYCHOSOMATIC DISEASE, AND AUTOIMMUNITY PAULB. BEESON* Beliefs about the etiology of many diseases have undergone substantial changes during the present century. In this essay I propose to survey the rise and fall of once-popular concepts, then to sketch some of the events that have brought us to accept different notions. Autointoxication by Intestinal Bacteria People seem alway to have desired to rid themselves of colonic contents . Hurst recounted that ancient Egyptians used to wash out their lower bowels; he went on to state that the enema reached an apex of popularity during the time of Louis XIV, who is said to have been the beneficiary of several thousand intestinal douches. And colonic lavage was a standard part of treatment in health spas through the first third of the present century [I]. Soon after the emergence of the discipline of bacteriology, it was realized that the colon contains a large mass of living bacteria. Inevitably the question rose whether this reservoir constitutes a threat to health, either by absorption of bacterial toxins or by the transport of living organisms from the bowel to other parts of the body. In 1893 Pavlov was quoted as having reported that ligation of the portal vein in animals caused fever and nephritis, and that "when the blood is prevented from passing through the liver toxemia occurs which is solely due to the fact that the liver plays a protective role against toxins which are being continually fabricated in the intestinal canal" [2]. *Professor Emeritus, Department of Medicine, University of Washington, Seattle. Address : 21013 NE 122d Street, Redmond, Washington 99053.© 1992 by The University of Chicago. AU rights reserved. 003 1-5982/93/3601-0788$0 1 .00 Perspectives in Biology and Medicine, 36, 1 ¦ Autumn 1992 13 Metchnikoff, in a philosophical treatise about aging, speculated about the size of the colon in different animal species and suggested that "the large intestine has been increased in mammals to make it possible for these animals to run long distances without having to stand still for defecation." He went on to suggest that this large accumulation of fecal material may shorten the span of life, because it "becomes a nidus for microbes which produce fermentations and putrefaction harmful to the organism. ... It is certain that the intestinal flora contains some microbes which damage health, either by multiplying in the organism, or by poisoning it with their secretions" [3]. Metchnikoff and colleagues at the Pasteur Institute attempted to change the relative proportions of bacteria in the gut by administration of lactic acid-producing bacteria; indeed for some years Metchnikoff habitually dosed himself with a culture of one organism, later designated as belonging to the acidophilus group. Thus the way was prepared for those speculations to be carried into clinical medicine. The person who specially emphasized this concept was William Arbuthnot Lane, a distinguished London surgeon (1856—1943) [4]. He became convinced that a wide variety of human ailmant is caused by intestinal stasis and autointoxication. He spoke of the colon as a cesspool, and expressed the belief that it should be evacuated three times a day, because a single daily movement left the subject constipated for 24 hours. He devised operations to speed the elimination of intestinal content, and in 1909 wrote a book entitled "The Operative Treatment of Chronic Constipation," describing methods of tacking up a sagging transverse colon, releasing constricting mesenteric bands, shortcircuiting by means of ileocolostomy, and total colectomy [5]. He was later supported in this practice by another leading British surgeon, Berkeley Moynihan [6]. All who were acquainted with Lane agreed that his surgical technique was superb. The Mayo brothers were said to have described it as the best in Europe. He was created a baronet, honored by the government of France, and awarded membership in several foreign surgical societies . In 1913 Lane delivered an address in which he attributed to intestinal stasis an astonishing list of human disorders: Gastric ulcer, gastric cancer, gall stones, cholecystitis, gall bladder cancer, loss of fat, wasting of voluntary muscles, degenerative changes in the skin, subnormal body temperature, Raynaud disease, mental apathy, stupidity, misery, insomnia , neuralgia, neuritis...