632 THOMAS E. BROWN AND JOHN H. KING 



intoxication, is a very deleterious complication of chronic appendicitis. 

 The patients may become miserable invalids, who diet themselves to such 

 a degree that they border on the verge of emaciation. As constipation 

 is such a frequent complication of this disease it will not be amiss to 

 consider that subject at this point. 



Constipation. A great diversity of symptoms and effects, on all the 

 systems of the body, has been ascribed to constipation. However it is 

 variously stated that simple constipation does not cause increase in de- 

 composition in the intestines. Little is known to what extent and under 

 what conditions normal decomposition products of putrefaction and fer- 

 mentation can cause the phenomena of disease. It is further stated that the 

 putrefactive products which occur only under pathological conditions and 

 which may cause toxic effects on the body metabolism are very few. 



The factor which mostly determines the severity of the symptoms 

 associated with constipation, is high grade intestinal stasis, resulting 

 in chronic toxemia. There has been a great deal of speculation as to 

 the causative factors which produce the symptom complex of headache, 

 lassitude and general malaise, referred generally to auto-intoxication. 

 Some have thought it due to a toxin normally present in the intestines, 

 but in excess in constipation. Others have referred the cause to an in- 

 sufficiency of the protective mechanism of the liver, or a marked over- 

 growth of Gram positive, proteolytic anaerobes, or a perversion of the in- 

 testinal ferments. Attention has been called to what a slight change in 

 molecular constitution is necessary to convert the normal amide bases 

 met with in the digestion of proteins into products of greatest toxicity, as 

 lysin to cadaverin, and arginin to putrescin. 



The metabolic complications of constipation are generally referred 

 to auto-intoxication and in this process acid intoxication was considered 

 to be a very important factor. It is necessary here to consider the bear- 

 ing of acid intoxication, as evidence in gastro-intestinal diseases, upon 

 the body metabolism. In acid intoxication there occurs an overpro- 

 duction of acids, the so-called acetone bodies Beta-oxybutyric acid, diacetic 

 acid and acetone. They occur through interference with proper oxidation 

 in the body. Of the various types of acid intoxication it is necessary 

 for us to consider only two types. 



(1) Carcinomatous acetonuria, which occurs in association with 

 malignant degeneration in the intestines and is largely caused by in- 

 sufficient assimilation of food, especially carbohydrates, in the latter stages 

 of the disease. The acetone bodies are derived from the foodstuffs 

 after absorption, or from the body tissue. The acetone bodies found 

 in the intestinal tract are probably secreted into it, and do not represent 

 acid bodies manufactured in the intestines by disease processes. Of 

 course the intestinal tract by causing malnutrition and states approaching 

 starvation favors the production of acetone bodies, but these bodies do 



