CHAPTER XIX 



GASTRO-INTESTINAL "AUTOINTOXICATION" AND 

 RELATED METABOLIC DISTURBANCES 



Under this heading are commonly included all intoxications that 

 can be ascribed to the absorption from the gastro-intestinal tract of 

 toxic substances that have been formed within its contents, either 

 by the action of the digestive ferments or of putrefactive bacteria. 

 The propriety of considering such conditions as examples of auto- 

 intoxication is properly questioned, since it is often difficult to deter- 

 mine whether the putrefaction occurred within the body, or had 

 already taken place in the food before it was eaten. But even those 

 who would limit the use of the term autointoxication to intoxication 

 with the products of cellular metabolism, must admit the possibility 

 of products of metabolism reentering the blood from the contents of 

 the bowels through the intestinal wall, since the bile, and perhaps 

 also the intestinal juice, contain excrementitious substances which 

 may, in case of defective fecal elimination, be reabsorbed into the 

 blood. Therefore, in gastro-intestinal disturbances we have the pos- 

 sibility of both true autointoxication and intoxication by putrefactive 

 products occurring together in an inseparable way, and the common 

 inclusion of gastro-intestinal intoxication in the discussion of auto- 

 intoxication would seem to be justifiable as well as expedient. 



The sources of poisonous substances arising in the gastro-intestinal 

 tract are numerous. They may be formed either from the food-stuffs, 

 or from the secretions and excretions of the body that enter the ali- 

 mentary canal ; and they may be formed either by the digestive fer- 

 ments or by the bacteria of the intestinal contents. Hence the number 

 of these products is enormous, and we are by no means sure that those 

 that have yet been identified include the most important or most 

 toxic. To classify the poisonous substances that are known to be 

 formed in the alimentary canal, and which might, under certain 

 conditions, cause an intoxication, is extremely difficult, because of 

 the uncertainty of our information; but, using as a basis the sources 

 of the substances, they may be classilied as follows: ^ 



I. The con.stituents of the digestive secretions, including the bile 

 salts and pigments, pepsin, and trypsin. 



1 ^r<)(lifie(l from Weintravul. Er<rob. all<r. riitlml.. lSi)7 (4), 1, wlio gives ex- 

 hauHtive discussion iuid hiliiin^rapliy to tluil date. 



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