482 GASTRO-INTESTINAL "AUTOINTOXICATION" 



malaise, lassitude, etc., but also sciatica, tetany, epilepsy, 

 eclampsia, many forms of dermatitis, various forms of nervous 

 diseases, myxedema and cretinism, chlorosis and pernicious 

 anemia, cirrhosis, nephritis, and arteriosclerosis. 1 While in 

 many cases the severity of these various conditions is apparently 

 augmented by intestinal disturbances, the etiologic relation is 

 not so clear. That long-continued intoxication of intestinal 

 origin may cause serious injury to the tissues is, however, 

 extremely probable. There is much reason for believing that 

 many cases of non-alcoholic cirrhosis are due to this cause ; 

 not improbably chronic nephritis, myocarditis, and arterio- 

 sclerosis may occasionally be the result of long-continued 

 intoxication from the same source. 



Tetany associated with gastric dilatation offers perhaps the 

 strongest case, numerous observers having reported finding a 

 marked toxicity of the stomach contents. 2 Pineles 3 considers 

 that all forms of tetany, whether of gastric origin or following 

 thyroidectomy, are due to one and the same "tetany poison." 



The relation of intestinal intoxication to the various anemias, 

 particularly chlorosis and pernicious anemia, has been repeat- 

 edly indicated and discussed. Clinical evidence strongly 

 indicates that such a relation exists, and there is no doubt that 

 hemolytic substances may be formed in the alimentary tract, 4 

 but that chlorosis and pernicious anemia do depend upon in- 

 testinal putrefaction or infection is far from established (see 

 "Anemia," Chap. xi). 



It seems highly probable that gastro-intestinal " autointoxica- 

 tion " would be a much more serious matter were it not for the 

 mechanisms of defence possessed by the body, especially in the 

 liver. 5 For example, Richards and Howland have indicated 

 the increased toxicity of indol when the oxidizing power of the 

 liver is reduced, and Herter and Wakeman have shown the 

 power of the liver to combine indol and thus remove it from 

 circulation. This topic has been discussed more fully elsewhere 

 (Chap. vii). 



1 The relation of gastro-intestinal intoxication to these various diseases is 

 reviewed by Weintraud, Ergeb. allg. Pathol., 1897 (4), 17. 



2 Bibliography by Halliburton and McKendrick, Brit. Med. Jour., 1901 (i ), 

 1607. 



3 Deut. Arch. klin. Med., 1906 (85), 491. 



4 See Kiilbs, Arch, exper. Path., 1906 (55), 73; also Herter, Jour. BioL 

 Chem., 1906 (2), 1. 



5 For discussion and literature see Lust, Hofmeister's Beitr., 1905 (6), 132. 



