AUTOINTOXICATION 531 



included under tlie term autointoxication, and jiarticularly difficult 

 to decide the proper placing of the intoxication resultinp; from fecal 

 retention and from processes of decomposition in the alimentary 

 canal. For example, the poisoning following the eating of partially 

 decomposed canned food could not be looked upon as an autointoxi- 

 cation, and yet there is no fundamental difference whether the decom- 

 position occurs, as in this case, before the food enters the body, or 

 whether it occurs in the intestinal tract because of abnormal bacterio- 

 logical or anatomical conditions. On the other hand, since many 

 of the obnoxious products of meta])olism arc eliminated through the 

 bowels, failure of elimination through this channel ma}' lead to a true 

 autointoxication as much as may deficient renal elimination. On the 

 whole, it seems best to restrict the term autointoxication, as far as 

 possible, to the disturbances produced by products of metabolism 

 that have been formed within the tissues of the body (intermediary 

 Dietabolism) , considering as a distinct but related subject gasti-o-in- 

 testinal autointoxication. 



In the discussion of autointoxication from the standpoint of chemi- 

 cal pathology, we are interested particularly in the chemical nature 

 of the substances that cause the intoxication, and in the chemical 

 processes by which their action is kept at a mininmm, rather than in 

 the clinical features or anatomical results that may be produced. 

 Unfortunately, in but a few instances have the exact chemical sub- 

 stances causing these intoxications been accurately determined, prob- 

 ably because in most cases not one but a number of poisonous 

 substances are present; and, furthermore, we do not always know ex- 

 actly when a certain disease is to be ascribed to autointoxication, nor 

 can we always determine that the cause of a certain intoxication lies 

 in an abnormality in metabolism and not in an infection of hidden 

 nature. It is, therefore, quite impossible, with the uncertain informa- 

 tion available at this time, to consider autointoxication in a systematic 

 way, and we must limit ourselves to a consideration of certain patho- 

 logical conditions in which there appears to be an element of abnormal 

 metabolism with resulting intoxication. In some cases this intoxica- 

 tion is a prominent feature of the disorder, in others it is subordinate 

 to other manifestations of the disease; and, finally, we may have 

 marked alterations in metabohsm without evidences of disturbance of 

 health (e. g., cystinuria, alkaptonuria). 



Of the autointoxications due to the retention of poisonous products 

 of metabolism that should be excreted from the body, first in order 

 of importance stand uremia and cholemia (the latter has already been 

 considered in connection with the discussion of Icterus, Chap, xviii). 

 Of apparently less significance are autointoxications due to failure of 

 elimination of gaseous metabolic products by the lungs, and failure 

 of the excretory function of the skin. 



