The Surgical Relief of Intestinal Foci of Infection in Cases of Arthritis Deformans

Abstract

IN I9I5 the writer reported before the Surgical Section of the American Medical Association, a series of fourteen cases of chronic arthritis operated upon for the removal of an intestinal focal infection. Of this list two have died, four are untraced, three are not improved, one has had a complete arrest of the disease, but is unable to-walk on account of joint fixation. Four are restored to normal activity. We attribute our failure to show a higher percentage of cures to our surgery. These early patients were all operated upon with the Lane technic, which was followed in a large proportion of cases by intra-abdominal adhesions which defeated the surgical aim by preventing the relief of the intestinal blockade. We learned in I9I5 the cause of these adhesions and a simple way to avoid them, and have not been troubled by recurrence of stasis since then, even when an operative procedure of the Lane type was used.From our observation of these patients since I913, we are of the opinion that the disease has its origin in a focal infection in the intestinal tract due to an unbalanced or perverted intestinal flora made possible by the failure of some part of the ileocacal coil to empty itself properly.Infections of the teeth and tonsils are undoubtedly the cause of many cases of arthritis, especially of recent origin, and their removal quickly clears up the symptoms. But in chronic cases the removal of tonsils and teeth has, as a rule, very little permanent effect. The reason being that an intestinal infection has taken place and a larger focus developed, so that then the clearing up of the head foci hardly affects the load of infection at all.In the examination of the intestinal tract of more than one hundred cases of chronic arthritis with the X-ray, we have been surprised at the similarity of the picture of the ileocxecal coil, and have come to the conclusion that the typical soil for development of arthritis is a congenital mobile caecum, which has been tacked back to the side wall of the abdomen by nature in an effort to lift up and anchor a prolapsing organ.By a reduplication of peritoneum starting at the right colic artery and extending to the parietal peritoneum over the right kidney, the colon is rolled and folded so that it gives the appearance of an hour-glass, with the caecum thin-walled and toneless. This seems to be an exaggeration of the condition first described by Jabez Jackson and known as Jackson's membrane. There is usually a binding down of the ileum somewhere in its terminal eight inches, increasing the torsion in the ascending colon so that the physiological function of the colon is crippled and the cwcum becomes an inert sac, which does not empty itself. This sac constantly filled with culture mediuni becomes 515

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