CHAPTER XIX 



GASTRO-INTESTINAL " AUTOINTOXICATION * 

 AND RELATED METABOLIC DISTURBANCES 



UNDER this heading are commonly included all intoxications 

 that can be ascribed to the absorption from the gastro-intestinal 

 tract of toxic substances that have been formed within its con- 

 tents, either by the action of the digestive ferments or of putre- 

 factive bacteria. The propriety of considering such conditions 

 as examples of autointoxication is properly questioned, since it 

 is often difficult to determine whether the putrefaction occurred 

 within the body, or had already taken place in the food before 

 it was eaten. But even those who would limit the use of the 

 term autointoxication to intoxication with the products of cellu- 

 lar metabolism, must admit the possibility of products of metab- 

 olism reentering the blood from the contents of the bowels 

 through the intestinal wall, since the bile, and perhaps also the 

 intestinal juice, contain excrementitious substances which may, 

 in case of defective fecal elimination, be reabsorbed into the blood. 

 Therefore, in gastro-intestinal disturbances we have the possibil- 

 ity of both true autointoxication and intoxication by putrefactive 

 products occurring together in an inseparable way, and the com- 

 mon inclusion of gastro-intestinal intoxication in the discussion of 

 autointoxication would seem to be justifiable as well as expedient. 



The sources of poisonous substances arising in the gastro- 

 intestinal tract are numerous. They may be formed either 

 from the food-stuffs, or from the secretions and excretions of 

 the body that enter the alimentary canal ; and they may be 

 formed either by the digestive ferments or by the bacteria of 

 the intestinal contents. Hence the number of these products is 

 enormous, and we are by no means sure that those that have yet 

 been identified include the most important or most toxic. To 

 classify the poisonous substances that are known to be formed 

 in the alimentary canal, and which might, under certain condi- 

 tions, cause an intoxication, is extremely difficult, because of 

 the uncertainty of our information ; but, using as a basis the 

 sources of the substances, they may be classified as follows : l 



1 Modified from Weintraud, Ergeb. allg. Pathol., 1897 (4), 1, who gives 

 exhaustive discussion and bibliography to that date. 

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