524 ABWORMALITli:S /X METABOLISM 



included under the temi autointoxication, and particularly difficult 

 to decide the proper placing of the intoxication resulting from fecal 

 retention and from processes of decomposition in the alimentary 

 canal. For example, the poisoning followinu,' 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 bacteri- 

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

 of the obnoxious products of metabolism are eliminated through the 

 bowels, failure of elimination through this channel may lead to a true 

 autointoxication as much as may deficient renal elimination. On the 

 M'hole. 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 

 metaholism), considering as a distinct but related subject gastro-in- 

 testinal autointoxication. 



In the discussion of autointoxication from the standpoint of chem- 

 ical 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 minimum, 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 sub- 

 stances 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 infor- 

 mation available at this time, to consider autointoxication in a sys- 

 tematic way, and we must limit ourselves to a consideration of cer- 

 tain pathological conditions in which there appears to be an element 

 of abnormal metabolism with resulting intoxication. In some cases 

 this intoxication 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 metabolism without evidences of dis- 

 turbance 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. xvi). 

 Of apparently less significance are autointoxications due to failure of 

 elimination of gaseous metabolic products by tlie lungs, and failure 

 of the excretorv functions of the skin. 



