588 GASTRO-INTESTIXAL "AUTOiyTOXICATIOX" 



anemia do depend upon intestinal putrefaction or infection is far 

 from established (see ''Anemia." Chap. xi). 



It seems highly probable that o-astro-intestinal "autointoxication" 

 would be a much more serious matter were it not for the mechanisms 

 of defence possessed by the body, especially in the liver.*^ For exam- 

 ple, Richards and Howland have' indicated the increased toxicity- of 

 indole when the oxidizing ])ower of the liver is reduced, and Herter 

 and Wakeman have sliown the power of the liver to combine indole 

 and thus remove it from circulation. This topic has been discussed 

 more fully elsewhere (Chap. ix). 



ACUTE INTESTINAL OBSTRUCTION 



The violent effects that follow complete occlusion of the intestine, 

 especially in the upper portion, must be due to some highly toxic sub- 

 stance or substances. The clinical features of obstructive ileus, 

 namel}', vomiting, collapse, complete muscular relaxation, and sub- 

 normal temperature, are associated with the excretion of larg-e quan- 

 tities of indican and other substances combined with sulphuric acid, 

 proving that intestinal putrefaction is active. Undoubtedly in ileus 

 we have a profound and rapidly fatal intoxication with substances 

 formed in the obstructed intestines. 



Whipple '" has demonstrated that closed duodenal loops in dogs 

 come to contain a highly toxic substance of unknown nature, appar- 

 ently formed in the epithelium of the gut rather than in its contents, 

 which causes severe splanchnic congestion, vomiting and diarrhoea 

 when injected into normal dogs. The toxic ag'ent is not destroyed by 

 autolysis, filtration or heating at 60°, yet dogs can be made somewhat 

 refractory or immune. From the contents of such loops, and from the 

 bowel above obstructions, he has isolated a very toxic proteose,'*- which 

 he believes may be responsible for the intoxication. Wliether this 

 proteose, or Avhatever the active poison may be, comes from bacterial 

 infection, autolysis, duodenal secretion, or what, is not yet agreed by 

 the numerous investigators in this field.-^ Apparently the liver does 

 not have much detoxicating effect, for dogs with Eck fistula behave 

 much the same when the intestine is obstructed, as dogs with normal 

 circulation. A similar material cannot be obtained by hydrolysis or 

 autolysis of normal duodenal mucosa, tiie obstruction being an essen- 

 tial feature. Obstruction of lower portions of the intestine has much 

 less effect,^^ and it has been suggested that the poison formed in the 

 duodenum is neutralized or destroyed farther down in the intestine.^- 

 A striking feature of intestinal obstruction is the high non-protein 



*<i For disc'ussiiin and literature see Lust. Tlofmeister's Beitr., 100,5 (G), 1,32. 



■^-'.Tour. Amer. Med. .\ss(m-.. 1!)15 (1)5), 470: 19Hi ((>7), IT); Jour. Exp. Med., 

 1910 (23), 12:{: l!tl7 (2.")), 2:51 and 401. 



«:< See Murpliy and IJrooks. Areli. Int. Med.. ini.-> (l.")), .302; Curd.. .Tour. 

 Infect. Dis.. 1014 (1.')). 124: Draper. .Tour. Anier. Med. Assoe.. 1010 (67), 1079; 

 Dragstadt, Moorliead and Hurcky. .lour. K\p. ^led.. 1017 (2.1), 421. 



