The pathogenesis of the anaerobic corynebacterium diphtheriae, anaerobic diphtheroid, and anaerobic leptothrix infections in relation to the psychoses, neuroses, and neurotoxic states, compared with 260 cases of symptomatic physical disorder (illustrated by 17 tables)

Abstract

The subject of this thesis is the outcome of what might be termed a 'hereditary interest' in the complex problem of the relationship of chronic infections to the psychoses and allied mental disorders. Circumstances enabled me, while still a student, to undertake very humbly the continuation of my father's researches in the Scottish Asylums' Laboratory at a point where his illness and death mic:ht have proved the closing of a long and arduous chapter. That this would have been so is, as far as I know, borne out by the fact that up to the present no work directly bearing on his later bacteriological studies has been published. The researches I have undertaken during the past six rears have been an attempt to elucidate more clearly what exactly are the bacteriological factors at work, and, further, in what manner they attach the economy generally, and with what result. In my endeavour to verify and extend Ford Robertson's views I have been singularly fortunate.After nearly two years in the Laboratory of the Scottish Asylums' I had the opportunity as honorary Bacteriologist and Pathologist to the Southport Infirmary and assistant to Dr E. Cronin Lowe, (consulting pathologist and director of the Southport Infirmary laboratory) of studying a large number of private and hospital patients during the course of two years work. In addition to undertaking bacteriological research by anaerobic methods, it fell to me to organise a pathological clinique, the object of which was to

aid the physician in the diagnosis and treatment of obscure physical disorders by the method of a "diagnostic survey". The scheme evolved necessitated a sz stematic study of each patient by haematological an biochemical tests including functional efficiency tests such as the glucose tolerance and fractional test meal. Each case was also studied with a view to discovering if possible some underlying bacteriological infective condition which might have a bearing upon the state of the patient. In the course of undertaking a large number of patients by this method of approach some fifteen mental and borderland cases came under review. In many instances I was much struck by their similarity to control patients in the underlying physical disturbance found, and, while in this respect there was something in common, it was striking to note in some of the borderland, and certainly in those who were definitely, mental, the absence of clinical symptomatology, in spite of the fact that they showed more gross functional physical disorder on the average than did the non-mental cases. In gastric disorders for example non-mental patients, almost without exception, gave a clear clinical history referrible to that organ. In two mental patient however no such evidence past or present was ascertainable, although both were found to be suffering from severe gastritis and disordered secretory function. Exceptional as these two cases may appear to b this experience, which has been by no means confined to the gastric mechanism, has been enormously

amplified by the work I have carried out since then. In the study of the bacteriological flora, especially of the intestine, there were bacterial elements common to the majority of the fifteen cases which, on the other hand, were relatively infrequently met with in ordinary hospital patients. This fact further impressed itself upon me when it had to be realised that these additional infective factors were in every respect similar to those so commonly seen in the course of routine bacteriological work at the Scottish Asylums Laboratory. This evidence I believed at the time formed a valuable link which, if opportunity offered, might result in a chain of facts establishing the importance of this group of bacteria.Early in November, 1927, the New Reception hospital, (Wantage House), of St Andrews, Northampton, was opened, and I was offered the opportunity of organising the very work which had been begun amongst cases of mental disorder at the Southport Infirmary. It is not often one is fortunate enough to start from the foundation a scheme of research with a limited number of patients whose whole care clinically and scientifically comes within one's own province. Further, the facilities afforded in each department are those of the best equipped modern general hospital in miniature, a fact which has very materially contributed, not only to the extension of research, but to the correlation as far as my knowledge has permitted, of the wide range of facts and observations that have been collected in the course of nearly three years.By experience of the value both scientific and therapeutic of the diagnostic survey method of research led me to adopt it in an extended. form on all cases admitted to ':Vantage House. The following is a brief outline of t' :e scheme of research which up to the present has been undertaken on 155 patients, 137 of whom presented definite mental disorders.(1) Systematic physical examination including blood pressure, central nervous system, teeth, etc. (2) Examination of upper respirator- passages for evidence of focal infection. (3) Laboratory tests. a. Cytology of the blood. b. Biochemical examination of the blood. Non-protein nitrogen, CO₂, calcium, Van-den-Bergh, and phosphates. c. Gastric analysis by fractional method. d. Glucose tolerance. e. Urine, 24 hrs. sample. Biochemical qualitative and quantitative: examinations and cytological. f. Intestinal content. Chemical and microscopical. g. Cerebro-spinal fluid. Cytological, biochemical qualitative and quantitative in about 1/4 of the cases. (4) Bacteriological examinations of the foci throughout the alimentary canal in all cases by the anaerobic methods given in this thesis. Pelvic organs and accessory sinuses in some. (5) Radiography. Teeth and accessory sinuses in all cases, and gastro-intestinal tract in some. (6) The study of the psychological aspects past and present of each case, especially in relation to heredity, environment, and past physical disorder The above tests have been repeated as circumstances demanded and, with the exception of the gastric analysis and glucose tolerance, are carried out again

case it has been possible,under ideal circumstances of observation and control, to study and where possible correlate the mental symptoms with the underlying physical disorders. The main outlines of this scheme and the circumstances that led up to its inception have been mentioned so that those whose position it is to criticise and judge should know that the basis of this thesis has been a wide one and that the views expressed therein have been given without conscious bias and in the hope that others may be stimulated to carry out similar researches.