634 THOMAS R. BROWN AND JOHN H. KING 



The older theories of splanchnoparesis, of reflex nervous action in 

 the cardiovascular centers, and the bacterial invasion outward from 

 the intestines into the peritoneum or blood, producing peritonitis or septi- 

 cemia, may be dismissed without discussion. 



At the present time the most popular explanation of the symptom- 

 atology of intestinal obstruction is that it is due to auto-intoxication. 

 Without discussing in detail the various causes assigned for intoxication 

 which accompanies intestinal obstruction, it may be said that at the pres- 

 ent time there are considered to be two distinct but complementary fac- 

 tors in toxemia: 



(1) The presence of bacteria in the obstructed gut. 



(2) The presence of necrotic tissue, as a substance for the elaboration 

 of the fatal toxin, through action of these bacteria. 



The metabolic complications of intestinal obstruction are not syn- 

 onomous with the fatal symptoms produced in this disease. In obstruc- 

 tion of the small intestines, changes in the metabolism are not prominent, 

 because the disease progresses too rapidly. The cardiovascular and nerv- 

 ous systems are more vitally affected. 



In chronic, slow obstruction, especially in the large bowel, a consid- 

 erable disturbance of the body nutrition may result manifesting itself 

 in loss of weight and various degrees of acidosis. When a malignant 

 tumor is the cause of the obstruction profound nutritional disturbances 

 may occur which will be discussed when tumors of the intestines are 

 considered. 



The search for a specific poison in the obstructed bowel has as yet 

 not met with much success. Various substances as alkaloids, etc., have 

 been described, but the proof of their specificity and their relation to the 

 symptoms of intestinal obstruction is still unsettled. 



The metabolic complications of intestinal obstruction are due to in- 

 terference with the body nutrition, and manifest themselves as loss of 

 weight, loss of strength, cachexia, emaciation, auto-intoxication and 

 acidosis. They are the same, whether the obstruction is in the large or 

 small intestine, provided the patient survives the disease sufficiently 

 long to permit of their development. It is not known that there are 

 any different toxic products in the small and large intestines nor is there 

 any differential effect on the metabolism in obstruction of the large and 

 small intestines. True, the symptoms and signs are sufficiently differ- 

 ent often to permit of a fairly accurate diagnosis of the site, cause and 

 character of the obstruction, but the effect on the metabolism is purely 

 quantitative and not qualitative, in obstruction of the small and large 

 bowel. 



Diverticulse of the intestines do not have any particular effect of the 

 body metabolism, except that associated with constipation or fever and 

 infection. 



