462 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



It therefore seems probable that poisons are formed as a re- 

 sult of superficial burns, which have the effect of causing hemol- 

 ysis, and which are also cytotoxic for parenchymatous cells and 

 particularly for nervous tissues. These hypothetical poisons 

 seem to be eliminated by the intestines and kidneys, which are 

 injured by the poisons in their passage through these organs, 

 The attempts to explain all the observed effects of burns as 

 due to thrombosis or to embolism by altered red corpuscles 

 seem to have failed, for the peculiar location of the lesions 

 (e.g.) duodenal ulcers, necrosis in the Malpighian bodies of 

 the spleen, etc.) does not agree with this hypothesis, and 

 there are too many evidences of the presence of some de- 

 cidedly toxic substance in the blood. There can be no ques- 

 tion that the poisonous substance or substances are formed in 

 the burned area, and not in the internal organs as a result 

 of hyperpyrexia, as shown by numerous observations. Thus, 

 if the burned area is removed immediately (in narcotized 

 experimental animals), death will be prevented, whereas if the 

 burned tissue is permitted to remain for a few hours, death will 

 occur. The poison appears to be absorbed from the burned 

 area into the blood, for if the circulation is shut off from the 

 burned area, no intoxication results ; this probably explains in 

 part why deep destructive burns of small areas, which are 

 associated with local thrombosis, are much less serious than a 

 superficial slight scalding over a large area. Apparently the 

 poison is produced chiefly or solely in the skin, for burning of 

 muscle is not followed by intoxication (Eijkman and Hoogen- 

 huyze J ). Numerous investigators have reported finding poison- 

 ous substances in the blood, tissues, or urine of burned men 

 and animals, but the reports disagree widely in details. 2 Thus 

 Dietrichs states that the blood of burned animals contains 

 hemolysins and hemagglutinins, which could not be corroborated 

 by Burkhardt 3 or by Pfeiffer. 4 The latter, however, finds that 

 the urine, serum, and organs of burned animals contain sub- 

 stances poisonous for the same and for different species, which 

 is in accord with the results of numerous earlier investigators. 

 The poisons, according to Pfeiffer are neurotoxic and necro- 



1 Virchow's Arch., 1906 (183), 377. 



2 Ravenna and Minassian (ref. in Biochem. Centr., 1903 (1), 348) state 

 that blood heated outside the body to 55-60 is toxic, and causes the same 

 anatomical changes as does death from burning, which finding is corroborated 

 by Helsted (Dissertation, Copenhagen, 1905; abst. in Nordistk Med. Ark., 

 1906 (39), July 11). 



3 Arch. klin. Chir., 1905^(75), 845. 

 * Virchow's Arch., 1905 (180), 367. 



