RESULTS OF G ASTRO-INTESTINAL INTOXICATION 481 



intoxication with indol and similar substances, although we 

 have no conclusive proof that such is the case. But the violent 

 effects that follow complete occlusion of the intestine, especially in 

 the upper portion, must be due to some highly toxic substance 

 or substances. The clinical features of obstructive ileus, 

 namely, vomiting, collapse, complete muscular relaxation, and 

 subnormal temperature, are associated with the excretion of 

 large quantities of indican and other substances combined with 

 sulphuric acid, proving that intestinal putrefaction is active. 

 Undoubtedly in ileus we have a profound and rapidly fatal 

 intoxication with substances formed in the obstructed intestines, 

 but as yet we have not isolated any substances from the 

 alimentary canal that possess sufficient toxicity to account for 

 such an intoxication, except possibly the derivatives of cholin, 

 and these are probably formed in too small amounts to account for 

 the conditions observed. Two explanations may be suggested : 

 One is that the intestinal flora becomes altered because of the 

 changed conditions, and bacteria thrive that produce specific 

 soluble toxic substances, analogous to those formed by B. botu- 

 linus, or similar to the tyrotoxicon (Vaughan) that may be 

 formed in milk and milk products. Thus Clairmont and 

 Ranzi l found heat-resistant toxic substances in the intestinal con- 

 tents in ileus (experimental), and similar substances could also 

 be obtained by growing cultures of the intestinal contents on 

 bouillon. Another explanation is that many unidentified poison- 

 ous substances are produced in the alimentary canal which 

 ordinarily are destroyed, but under certain conditions may be 

 reabsorbed. That unrecognized toxic substances are formed in 

 the intestines is almost certain, for it has been repeatedly 

 shown that extracts of the contents of the alimentary canal are 

 very poisonous. Although the technic of many of these experi- 

 ments has been questionable, the results have so often been 

 obtained as to render it probable that the main contention is 

 correct. 2 Thus Magnus- Alsleben 3 has found in the upper part 

 of the small intestine of dogs (except when on milk diet) a 

 very poisonous substance which kills rabbits by respiratory 

 paralysis, but which is inert when injected into the portal vein. 

 In any case, correctly or incorrectly, a great number of disease 

 conditions have been attributed to poisons of gastro-intestinal 

 origin, including not only such minor conditions as headache, 



1 Arch. klin. Chir., 1904 (73), 696. 



2 For example, see Koger and Gamier, Compt. Kend. Soc. Biol., 1905 (59), 

 388 and 674 ; 1906 (60), 666. 



3 Hofmeister's Beitr., 1905 (6), 503. 



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