432 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



extremely difficult to draw the line as to just what should 

 be included under the term autointoxication, and particularly 

 difficult to decide the proper placing of the intoxication result- 

 ing from fecal retention and from processes of decomposi- 

 tion in the alimentary canal. For example, the poisoning 

 following the eating of partially decomposed canned food 

 could not be looked upon as an autointoxication, and yet 

 there is no fundamental difference whether the decomposition 

 occurs, as in this case, before the food enters the body, or 

 whether it occurs in the intestinal tract because of abnormal 

 bacteriological or anatomical conditions. On the other hand, 

 since many of the obnoxious products of metabolism are elimi- 

 nated through the bowels, failure of elimination through this 

 channel may lead to a true autointoxication as much as may 

 deficient renal elimination. On the whole, 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 metabolism}, considering as 

 a distinct but related subject gastro-intestinal autointoxication. 



In the discussion of autointoxication from the standpoint of 

 chemical pathology, we are interested particularly in the chem- 

 ical nature of the substances that cause the intoxication, and in 

 the chemical processes by which their action is kept at a min- 

 imum, rather than in the clinical features or anatomical results 

 that may be produced. Unfortunately, in but a few instances 

 have the exact chemical substances causing these intoxications 

 been accurately determined, probably because in most cases not 

 one but a number of poisonous substances are present ; and, 

 furthermore, we do not always know exactly 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 

 information available at this time, to consider autointoxication 

 in a systematic way, and we must limit ourselves to a considera- 

 tion of certain pathological conditions in which there appears 

 to be an element of abnormal metabolism with resulting intoxi- 

 cation. In some cases this intoxication is a prominent feature 

 of the disorder, in others it is subordinate to other manifesta- 

 tions of the disease ; and, finally, we may have marked altera- 

 tions in metabolism without evidences of disturbance of health 

 (e. g.j cystinuria, alkaptonuria). 



Of the autointoxications due to the retention of poisonous 

 products of metabolism that should be excreted from the body, 



