Sepsin is very prone to produce supraorbital pain, sometimes symmetrical, more frequently sinistral, rarely on the right side. The lead headache, when lateral, is on the right side. The actual recorded relation is 7 to 3. Asthenopia is common to both lead and sepsin. The defective vision of sepsin is usually an accommodation error of temporary character, but persistent blindness from optic atrophy has more than once followed poisoning by lead. It is curious that sepsin appears to pick out the nervous and muscular structures and choroidal coat. Lead first attacks the vessels (hypertrophic peri-arteritis) of the retina.
This has been verified by John Couper. The observations of Dr. Rayner D. Batten [Ophthalmic Review, January, 1892.] make it likely that septic saturation may intensify myopia. I once saw capsular cataract with descematitis supervene in a man of forty, on ulceration of the gums, probably of specific character. Mr. Juler, of St. Mary’s. tells me that be, too, has seen cataract co-existing with intra-oral suppuration.
The Ear.-Ten persons poisoned by lead had tinnitus aurium, which is a common symptom of sapraemia.
An aching myalgia is very typical of septic poisoning combined with the “fidgets” (anaemia of anterior cornua), reminding us of saturnine muscle-ache and of the actions of certain vegetable poisons, such as Actaea racemosa, of Arnica, Eupatoria, Baptisia, and Rhus toxicodendron.
We have seen that gastralgia of persistent type may arise from passive septic invasion. There is little doubt that many of these cases are associated with unsuspected gastric ulcer.
I shall seek in another place, and at another time, to show that there is a form of gastric ulcer related to Charcot’s perforating ulcer and to chronic scrofulous sinus. It is a kind of circumscribed caries of the stomach analogous to dystrophic dental decay. It is a local necrosis of neurotic origin.
The Thyroid Gland.-I have, in my work on Septic Intoxication placed on record some curious examples of paludal and septic goitre. I say, in deference to ordinary modes of speech, “paludal” and “septic,” though in reality these are identical. It may be supposed that marsh miasmata consist of the products of decaying vegetable matter only. But a little thought will remind us that there is no swamp which does not teem with myriads of minute, short-lived animal organisms. These perpetually perish and become putrescent.
Their toxins mingle with the products of decomposing vegetable life. Miasmatic invasion and septic invasion are then one and the same thing. The clinical history of the symptoms closely coincide, and the same germicidal remedies benefit both. We have in ague a paralysis of the sympathetic with the natural circulation changed and the same arrest of haematopoiesis as in passive septicaemia. The stress of ague may fall in women with its greatest impulse on the nervous system; in men, on the articulo-muscular apparatus.
The influence of the miasmatic poisons may forsake the general nervous system and confine its effects to the floor of the fourth ventricle, and thus lead to goitre. In the same way, some persons exposed persistently to ordinary toxins will, instead of rheumatism or neuralgia, show a bronchocele with or without proptosis.
DISCUSSION.
M.O. TERRY., M.D.: The paper which we have just heard is one deserving of our serious consideration. Its clinical aspect makes it exceedingly practical and causes us to wander into other fields in line with the subtle invasion of sepsis of various forms. Many years ago I noted the fact that a mother lost her life by kissing her son, who had died of a malignant diphtheria. It has frequently come to my notice that syphilitic sores have been contracted in kissing. Recognizing the fact that there are many diseases septic in character which may be communicated from person, I took the position in a public address, delivered five years ago, in which I criticized the manner of administering communion service as given by all churches excepting, I believe, the Roman Catholic.
I have recently noticed that this subject has been under serious consideration by the Secretary of the State Board of Health of Ohio. Only a few months since, I had a very peculiar case of septic invasion. I had a case of hysterectomy nearly well. In fact, the patient was sitting up. The abdominal cicatrix was nearly healed. All of a sudden to my surprise, one day I found my patient having a temperature of 105 degree. As she had been given vaginal douches, I became suspicious at once that septic material had been introduced in this way. I found that I had good reason for my suspicion, that the douche tube had been used on other cases, and that simply carbolic acid had been used for cleansing it.
Carbolic acid has its sphere of usefulness, but is hardly adequate as an antiseptic to destroy certain septic germs. I had an opportunity of proving that a few years ago, when I poisoned two of my fingers. I tried a crystal solution of carbolic acid on one and a strong solution of nitrate of silver on the other, but still my fingers continued to suppurate. I was speedily relieved, however, by a solution of bromine (1 to 100), one of the most wonderful remedies we have in the Materia Medica for poisonous wounds of all sorts. We have a sample of septic invasion in that plain, everyday boil, when it becomes a grandfather in its carbuncular state, the pus cell insinuating itself into the surrounding connective tissue, or even it is carried by the lymphatics to other parts forming focal centres for septic invasion, which begins as a small boil, developing frequently into a carbuncle.
The practitioner of to-day, if enabled to carry out his instructions in a case of diphtheria, no longer fears what was once an expected direful result in his case, for scientific medicine has shown that a thorough and constant disinfectant, applied to the throat night and day so completely as to thoroughly remove every of ptomanic poison. We believe the paper of Dr. Blake will be suggestive for many more causes of septic invasion, a few of which I have mentioned being samples of the numerous causes which, if remaining unnoticed, cause the death of many a patient.
