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Toxins are thus introduced into the blood, not only at the primary seat of infection, but also from each of these metastatic collections. Like septicæmia, this condition is due to pyogenic bacteria, the streptococcus pyogenes being the commonest organism found.

They are not apt to be present in consumption and in other forms of serious disease, attended by fever, on account of the curious effect produced by the toxins of the disease, which is often not only stimulating, but even of an exhilarating nature, or will produce a slight stupor or lethargy, such as is typical of typhoid.

The relief of tension which follows the bursting of an abscess, the removal of irritation by the escape of pus, and the casting off of bacteria and toxins, allow the tissues once more to assert themselves, and a process of repair sets in. The walls of the abscess fall in; granulation tissue grows into the space and gradually fills it; and later this is replaced by cicatricial tissue.

Fourth, to avoid poisonous and hurtful things like the toxins of infectious diseases; and alcohol, tobacco, and other narcotics, which have a harmful effect upon the muscles, valves, or nerves of your heart, or the walls of your blood vessels.

By many writers it is believed to depend upon some form of auto-intoxication, the toxins being absorbed from the gastro-intestinal tract, and those who suffer are supposed to possess what has been called an "arthritic diathesis." The localisation of the disease in a particular joint may be determined by several factors, of which trauma appears to be the most important.

In the children whom we are now considering, saturated as they are, from time to time, with the toxins resulting from repeated infection, ossification may be so interfered with as to cause softening and bending, with the evolution of a state of rickets. Between bone and muscle, too, we find a close relationship.

As the toxins are gradually eliminated from the body the symptoms abate, and if no more are introduced they disappear. Sapræmia in these respects, therefore, is comparable to poisoning by any other form of alkaloid, such as strychnin or morphin.

Thirdly, the tissues which give out this pain-cry under the torture of the toxins in the blood are, in a large majority of cases, neither the brain, nor the nerves of the eye, nor other special senses, but the nerves of common sensation which supply the face, the scalp, and the structures of the head generally, most of them derived from one great pair of nerve-trunks, the so-called Trigeminus, or fifth pair of cranial nerves.

Since the large intestine is also an organ that removes moisture and water-soluble minerals from the food and moves them into the blood stream, when the large intestine is lined with putrefying undigested food waste, the toxins of this putrefaction are also steadily moved into the bloodstream and place an even greater burden on the liver and kidneys, accelerating their breakdown, accelerating the aging process and contributing to a lot of interesting and unpleasant symptoms that keep doctors busy and financially solvent.

It may also follow a follicular tonsillitis or some infection of the mouth or throat with or without arthritis. Tuberculosis may also occasionally cause an endocarditis. Organisms may be found in a terminal simple endocarditis due to a chronic disease, as tuberculosis or cancer; such inflammations may have been caused by circulating toxins.