University of Nebraska Medical Center University of Nebraska Medical Center DigitalCommons@UNMC DigitalCommons@UNMC MD Theses Special Collections 5-1-1937 Focal infection : with special consideration of experimental work Focal infection : with special consideration of experimental work on the theory and disease entities resulting from it on the theory and disease entities resulting from it Lester J. Pope University of Nebraska Medical Center This manuscript is historical in nature and may not reflect current medical research and practice. Search PubMed for current research. Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses Part of the Medical Education Commons Recommended Citation Recommended Citation Pope, Lester J., "Focal infection : with special consideration of experimental work on the theory and disease entities resulting from it" (1937). MD Theses. 536. https://digitalcommons.unmc.edu/mdtheses/536 This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected].
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University of Nebraska Medical Center University of Nebraska Medical Center
DigitalCommons@UNMC DigitalCommons@UNMC
MD Theses Special Collections
5-1-1937
Focal infection : with special consideration of experimental work Focal infection : with special consideration of experimental work
on the theory and disease entities resulting from it on the theory and disease entities resulting from it
Lester J. Pope University of Nebraska Medical Center
This manuscript is historical in nature and may not reflect current medical research and
practice. Search PubMed for current research.
Follow this and additional works at: https://digitalcommons.unmc.edu/mdtheses
Part of the Medical Education Commons
Recommended Citation Recommended Citation Pope, Lester J., "Focal infection : with special consideration of experimental work on the theory and disease entities resulting from it" (1937). MD Theses. 536. https://digitalcommons.unmc.edu/mdtheses/536
This Thesis is brought to you for free and open access by the Special Collections at DigitalCommons@UNMC. It has been accepted for inclusion in MD Theses by an authorized administrator of DigitalCommons@UNMC. For more information, please contact [email protected].
neuritis and degeneretiol1s of the tracts of the spinal cord.
DiagnosiS
Speaking in generEl terms, foc;.-:d infect ion must be
thought of in all chronic ~aBeB of general ~ndifferentiat-
- 36 -
ing symptoms. There will uS1..lally be accordng to Ogilvie
(1935) a slight rise in temperature usually along towards
evening. The white blood count usually I'uns between nine
and twelve thouBand with a. definite shift to the left.
The sedimentation rate may be slightly increB.sed. Of
course bacterial cultures lead to a definite diagnosis if
positive.
Such common syndtromes, Cl.S discussed under separate~
headings previOUSly in this theSiS, should always suggest
a search for' a focus of infection. For exa'11ple, atlJ!0P:hic
arthri tis, pept ic ulcer, segrtlen tal neuritis, i:L'idoeycli-
tis, etc.,
Tonsils are consideI'ed a focus if they are buried,
bound down by adhesions and have congested faucial pillars.
A tonsillar stultln may be a focus if nus can be expressed. ~ ~ 4 _
A norr:'1C:,,,l tonsil with an interior abscess can be diagnosed
according to V.Schmidt (Oecil 1935), -oy an. examination of
the blood when an infected tonsil is massaged. There is
an increase in polymorphonuclear leucocytes of from 100 to
6000 cauP,ed by the forcing into the circulation of certs,in
toxins. Normally there is no increase or a temporary Jeuco-
penia,. Suction hns also been used to cause this phenomena.
(Worms & LeMee as in 0ecil 1935).
Ric hards (1932) diagnosed foci of infection in the
tonsils or teeth by the ba.cteremia demonstrable after massage
or other trauma to the foci.
- 37 -
Sinuses are diagno~§d as a foci by physical exami-
nation, transillumination, and X-ray. Post-nasal gripping
is suggestive according to Cecil (1935) and Byfield(1918).
Middle ear is d1a,gnosed -by routine otoscopic and hear-
ing examinations. Oaloric tests are seldom of benefit here.
Teeth are diagnosed as a source of infection by X-ray
and inspection as a rule. However many cases reauire con-, I
duct ion tests ~o be certain. i
:
i
Gynecological and urological examinations arel con-
fined to their field and are usually picked up on pomplete
la_.re exa.vninat ion, or from history. No special measures ..
necessary as a rule.
Treatment
Billings (1916) dtvides ttle treatment into prleventa
tive and the treatment of tile disease itself. Under pre-
vent ion he includes cleansing of the Ynouth, teet h .a."1d I
throat of all particles of food after eating. Both this
and removal of all perSistent overgrowths of lymphoid
th'sues in tl:re nasopharynx and throam al'e of special il'l1-
plished 'ltd th emetin in ten day periods 80 as to get rid
of the cysts.
- 38 -
He alEo recommends sLuJ:~iery in appendicitis and
cholecystitis to "relieve the patient of tile loce.l men
ance to life, of reflex dyspepsia, p...nd remove etiological
factors of systemic disease". Surgery of morbid rectal
conditions, pelvic organs in the female, prostate in the
male, and pyogenic infections of the kidney, is also in
dicated.
As to treAtment of the disease itself, the immediate
removal of foci in chronic diseases and the removal of
foci in acute diseases during late c onvalescenee is of
primary importa.nce. Importance of the removal of all foci,
both prirnaFY and secondary is apparent, for if any focus
is left the symptom remains.
Natural defenses must be built up through mental and
phYSical rest, nourishing food, restorat1 ve tonics, cheer
ful enviromnen t, good air aIld sunshine, and in some cases
[Jacterial antigens. The antisera accorCiing to Billings are
without notable good effects. Autogenous vaccine were not
beneficial as far as can be determined, but nonspecific
protein therapy and typhoid or alblimose antigens gave ae
tonlshing results in someccases. Wiltsie (1932) uses
autogenous vaccines 8..S a means of desensatizAtn:.on in
s"rthri tic and other allergic condi ti':lns. He never uses
them otherwise.
Nickel (1935) finds much more success with autogenous
vaccine ahd practically none wi th foreign protein therapy.
- 39 -
.~-
Oecil (1935) clee.ns up~ sinuses wi th suction and argy-!
ral packs. Byfield' (1918) agrees vdth this conservative
tEeatment in these cases. A dry hot climCtte is (3,lso suggest-
ed, while surgery is controversial. If tonsilB are the fooi
he suggests immediate removal with a.s little trauma as
possible.
Wl1t$ie (1934) thinks that drainage of the focus is
of primary impmrtanc8, and that if it is adequate, the
focus '!d l.l clear up unless fed from some other source be-
hind it. If the latter is true, then complete eradication
of the source will cause complete cure. As an example, he
cites many clinical cases of pyelitis which promptly clear
up followinQ' the correction of a colon infection. - '-'
In add.ition to rest, diet, psychic analysis, and sur-
gicaT removal of primary sites of infection, Wiltsie thinks
that treatment of focal infection per se cen never be
successful without the combating of "chronic intestinal
toxemia ll • WiltSie (1926) through the intravenous injection
of sodium iodide with a few brilliant results, brought to
light many unsuspected foci. A locEl reaction \'\;hic11 'Lvas'
followed -sometime later by a general reaction and an in-
crease in the leucocyte count Wc>S the usual result. Wi:' tsie
(1931) confirmed i::ds results b\r a series of 60 casee and
some controls. In SOI!!e cases of hay fever and asthma, there
resulted a decrease in the existing leucocytosis,and a re-
lief of symptoms. 1tsie expl9:ined this action at that time
- 40 -
oy the theory that the iodides a~ting on a focus, ~romot-'
eO. a lysis of exudates '. I y: £11 cn in turn released antigenic
oodies causing a stimulation of the irnmuni ty mechcmism
with a reaction at the focus.
Reta.'1 (1932) while studyi.ng the effects of hypertoni C
solutions for the reliE,:f of intracranial P±rt6Ssui'e;'con-
ceived the idea of reversing tiis process for the treat-
rnent of spinal syphlis, encephalitis lethargica, and
other inflarnmatory conditions of the brain and cord. The
intravenous inj ection of hltPotonic sodium chloride and the
simul:tlaneously performed continuous spinal drainage caused , no cerebral edema,but if drainage was not continuously
present, cerebral edema appeared. He also observed edema
in other diseased tissue, but never in healthy tif!Eme. His
reason for this fa.ct was that the capillary permeability
was increased in damaged tissues, and they therefore showed
edema first.
'Wiltsie (1934) found curiously enough that hypertonic
80diurtlllOdide influences osmotic pressure in the same way
large amount of hypotonic solution does. The mechanism is
caused by the iodide reducing the viscosity of the blood
by dehydration of its colloid particles. Tbus the osmotic
pressure is reduced and there is increaJ3ed fluid bjto the
pe:tti.vascular spaces about tile foci. If lymph drainage is
free, cure takeb place; if it'is impeded., there is an in-
creased local edema, pressure, and. pa.in ..
- 41 -
After 24 to 36 hours, the_direction of the flow may be
reversed due to the reestablishment of the normal osmotic
pressure in the capi 118,1'ie8. On the other hand the exten
sion of the inflammatory process may take place due to the
breaking down of the barriers.
Wiltsie (1929)(1932){1933) suggests that high colonic
irrigati ons are defini tely beneficial iTl all cases of focal
infection. He begins at once and says that sometimes
other foci will clear sponta..vleously. He also uses neriodic
duodenal drainage and abdominal diathermy as an aid to drain-
9.ge.
AccordJ.ng to Sollis-Oohen (1921) (1930) successful
treatment requires the :Jroduction of bacteriocidins and
other anti-bodies to destroy the invadlng bacteria and
render their toxin8 harmless. He thinks tbl3.t autogenous
vacoines are no ~ood, but that specific vaccine is neces-
sary. He uses the pathogen-selective method phich is based
on the assumption that organisms capable of growing in the
fresh whole ooagulable blood of tile patient (3,re those which ~ ~
are ~O$t pathogenic for that individual, to find the speci-
fic one. The vaccine should contain as many antigens as
p0ssible, the soluble exotoxins as well as the endotoxin8.
Davis (1936) uses counter-irritation and common ana.l-
gesics to relieve segmenta.l neuralgia whenever present.
Herrick (1902) thinlcs that malignant endocarditis
can recover. He stl.g~;est s as treatment; iron and arseniC,
- 42
ant i toxic serums and perha}Js tile use or colloidal silver .,
pre~ration, as advocated by Orede ..
Oonclusions
1) Focal infection implies the follow:i.ng poiij.ts:
a) The presence of a principal focus of pathologic
bacteria
b) The invasion of the circulation by the toxins or
oacteria themselves
c) Seauential effect from the above.
2) Focal infection must be considered as a possibility in
numerous diseases of man, especially is tHis so in child-
hood.
3) Muoh more experimental work must be (ione to disprove
the possibility of transraut8.tion of bacteria and elective it
localiz8.tion, although these theories cannot be accepted
entirely as yet.
4) There are various factors determing the invasion of ~
tissue by bacteria from a focus. They are; dilatations of
the capillaries and sluggist circulation leading to thrombi
formation, the virulence of the bacteria, the reSisting
powers of the host, the amount of drainage possible, and
a relat i ve quie8cenee~'or movement of t he tissues.
5) Any and all tissues of the body may be involved in
focal infection, the serous and synovial membrane beIng
especially susceptable.
- 43 -
6) 'fhe USUB.l primary foci are in the tonsils, teeth,
sinuses, middle ear, and genito-urinary tracts, but any
part of the body may De the primary offender.
7) The symptoms of focal infection consist of general
toxic manifestations , those referable to the primary
foous, and those referable to specific tissue infeoted
secondarily.
8 \ '1"\. ' • • • . • ... • f' t h . . . ) ~Ile QlagnoslB requIres reoognl~lon 0_ e morDld pro-
cess as secondary and tracing it to its source. The
various possibilities of secondary foci and the inadequate
methods of diagnosis of the teeth, sinuses, tonsils, etc.,
make thiE very difficult.
9) The treatment consists essentiC'illly of systemic and 10-
cal attack of both the prxmary and secondo.,ry state. Be-
oause of extreme oomplexi t lee it is successful in only a)
small percentage of cases,
10) There is much room for improvement in all diviEions
of fooal tnfeotion and a large amount of work must be
done before the diagnosis and tl'eatment of ttle candi tion.
oan bE systematized as successful.
- 44 -
. -
_Bibliog,raphy
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