CHAPTER XX 



PATHOLOGICAL CONDITIONS DUE TO, OR ASSOCIATED 



WITH, ABNORMALITIES IN METABOLISM, INCLUDING 



AUTOINTOXICATION 



During the course of metabolism innumerable organic compounds 

 are formed, some of which ai-e of a more or less poisonous nature. 

 As long as the body is in a normal condition, these injurious substances 

 are kept from accumulating in sufficient quantities to do harm; this 

 is accomplished in one of the following ways: (1) elimination from the 

 body in the urine, feces, etc.; (2) combination with other substances 

 into harmless, or relatively harmless, compounds; (3) chemical al- 

 teration into compounds that are non-toxic or relatively innocuous. 

 Therefore a harmful accumulation of metabolic products may be the 

 result of any one of the following conditions: 



(1) Failure of elimination because of abnormal conditions in the 

 eliminating organs; e. g., uremia. 



(2) Failure of neutralization by chemical combination, presumably 

 due to abnormalities in the organs or tissues through whose activities 

 the neutralization is normally accomplished; e. g., diseases of the liver. 



(3) Failure in the chemical transformation of the metabolic prod- 

 ucts; this may result either from abnormalities in the functionating 

 tissues, or through a checking of the normal steps of metabolism by 

 the failure of elimination of the end-products. 



(4) Excessive formation of certain normal products of metabolism ; 

 e. g., hyperactivity of the thyroid. 



(5) Production of abnormal toxic chemical substances; e. g., the 

 intoxication following superficial burns. 



Numerous classifications of autointoxication have been proposed 

 by various authors, some excluding from the causes of autointoxication 

 all but the products of metabohsm within the blood and tissues of 

 the body, as has been done in the preceding consideration; manj' in- 

 cluding intoxications caused by the jiroducts of gastro-intestinal fer- 

 mentation and putrefaction; and still others (v. Jaksch) including 

 even the intoxications produced by bacterial invasion of the body.^ 

 It is extremely difficult to draw the line as to just what should be 



1 See r6sum6 by Weintmud, Ergeb. der Patli., 1897 (4), 1. 



530 



