538 DIGESTION 



now very rare example of poisoning by products formed in food is 

 that caused by "ergotoxin." 



The treatment in such cases is to encourage diarrhea by giving pur- 

 gatives. If the intoxication is of a more chronic character, the symptoms 

 are vague, consisting of drowsiness, lassitude, headache, and general de- 

 pression. The treatment here also is to clear out the intestines by a 

 good purge. There can be little doubt that many of the unhealthy condi- 

 tions of the skin leading to the formation of pimples, acne, and boils, 

 are also caused by chronic intoxication with protein decomposition prod- 

 ucts. Again, purgation is the proper treatment. 



It is unnecessary in a work of this character to go further into these 

 highly important questions. It is probable, however, that the importance 

 of the relationship of excessive protein putrefaction in the intestine to 

 many of the so-called minor diseases cannot be overemphasized. On the 

 other hand, we must be careful not to attribute every sort of chronic 

 condition to this putrefaction. Toxemia is often a shibboleth of the 

 profession. When a chronic disease cannot be diagnosed, it is put down 

 as a toxemia. This, however, is not medical science it is medical shirk- 

 ing. It is certainly unsafe at the present time to conclude that the 

 ordinary symptoms of senescence, such as hard arteries or increased blood 

 pressure, are invariably to be attributed to this cause. It will be re- 

 membered that Metchnikoff is largely responsible for such a view, and 

 also that he suggested, as the surest way to ward off the chance of such 

 intoxication, the taking of buttermilk, which would supply bacteria 

 through whose growth in the intestine the protein-destroying bacteria 

 would not be able to thrive. It is probable that the same result could be 

 attained in patients showing undoubted signs of suffering from intestinal 

 putrefaction by a change in diet in the direction of giving more carbo- 

 hydrate, for, as we have seen, if there is a plentiful supply of this food- 

 stuff in the small intestine, the bacteria do not tend to attack the protein. 



Before leaving this subject it is interesting to consider for a moment 

 the cause of the severe symptoms that follow intestinal obstruction. 

 This question has recently been diligently investigated by Whipple, 28 who 

 found that the nonprotein nitrogen of blood (page 641) becomes greatly 

 increased in intestinal obstruction. The cause for this increase in non- 

 protein nitrogen is found to be an excessive breakdown of tissue protein 

 caused by the absorption into the blood of a proteose. When this pro- 

 teose isolated from obstructed loops of intestine was injected into fast- 

 ing dogs, profound symptoms of depression were produced, followed, in 

 cases in which the dose was sublethal, by recovery in from twenty-four 

 to forty-eight hours. Along with these symptoms the nitrogen elimina- 

 tion by the urine increased by 100 per cent. A very interesting fact is 



