Journal of Mental Science (1931) 77: 137-150. doi: 10.1192/bjp.77.316.137
© 1931 The Royal College of Psychiatrists
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Focal Sepsis in Mental Disorder: The "Pathogen-Selective" Method of Diagnosis

Arthur Pool, M.D., B.Ch.Liverp., M.R.C.P.Lond., D.P.M.

ABSTRACT

A series of cases of chronic encephalitis, confusional insanity, etc., have been investigated in order to assess the rôle of chronic sepsis as an ætiological factor.

The "pathogen-selective" technique has been employed throughout, and its utility in incriminating or exonerating particular foci of sepsis as causative has been illustrated in three cases.

Details of bacteriological results are set out in the table adjoined. They illustrate how by this simple method of using the patient's blood as a factor in culture the causative organisms can be detected, the method being based on the hypothesis enunciated by Dr. Bruce ("That the cause of mental disorder is deeper than a toxæmia, being a failure to form antibodies").

This method adds bacteriological finesse to the preparation of autogenous vaccines, and makes such more selective in their action.

Where this method is employed, unnecessary surgical intervention (Henderson—"Many a healthy abdomen has been mutilated, etc.") will be avoided and what is undertaken will be based on a demonstration of causal pathology.

Finally, owing to the fact that in this particular series we have been dealing with chronic cases in which there has been much permanent damage to the brain, results have of necessity been meagre, but we believe that the method will be found distinctly useful in cases of recent origin. Perhaps in a mental hospital one of its most useful applications will be in the investigation of the accessory sepsis which complicates so many cases of general paralysis, and which we believe contributes materially to the high mortality.