1— Compliments of Dr. Aaron. 
Intestinal Autointoxication. 
F>\ CIIAS. D. AARON, M. D., Detroit, Mich., 
INSTRUCTOR IN MATERIA MKDICA, DETROIT CODDEOE OF MEDICINE 
Kead before the Detroit Medical and :fcib«ar3jr .A&sociatioxi, 
'' October 11. J 897"* -*• S. Jl s. INTESTINAL AUTO-INTOXICATION. 
'——B.y Da 
Instruccor in M ateria Medica, Detroit College of Medicine. 
The term auto-intoxication has undergone many 
changes of meaning in the short time since it has 
been introduced into medicine. It has as yet not been 
definitely agreed upon. Auto-intoxication through 
the intestinal canal consists of the retention of normal 
and abnormal material in the intestines. The result 
of the stagnation of such material is the decomposition 
putrefaction and fermentation of the ingesta. The 
products of carbohydrate fermentation give for- 
mic, butyric, lactic, acetic and succintc acids, gases 
etc,, while the products of albuminous decomposition 
give NH3, CH4, H2 8, leucin, tyrosin, cystin, phenol, 
indol, skatol, aceton, etc. In a paper on Diarr- 
hoea and Bacteria published in The New York 
Medical Journal, May Bth, 1897, I cited several 
authorities who have shown that vast numbers of 
microbes within the intestinal canal generate poison- 
ous ptomaines and toxins which are rapidly absorbed. 
With the superabundant production and the retention 
of all these substances in the intestinal tract, a series 
of symptoms presents itself, suggesting a diseased 
condition of the digestive tract, of the respiratory 
system, of the circulation, of the kidneys, and, above 
all, of the nervous system. There is no positive proof 
that these symptoms have some definite relation with 
the poisons retained in the intestinal tract. Still, since a 
condition of auto-intoxication clearly exists, inasmuch 
as the symptoms disappear when the poisons are re- 
moved, we may safely assume that the symptoms 
presented are due to auto-intoxication. 
It is a well known fact that there is a certain relation 
between affections of the digestive tract and diseases of the nervous system. The ancients went even so far 
as to charge certain forms of vertigo to disturbances 
of digestion. The term hypochondria, originally the 
name of that part of the body situated between the 
xiphoid cartilage and the navel, implies that it was 
supposed that the abdominal cavity was the seat of 
the pathological condition. 
Intestinal auto-intoxication can become manifest 
through the nervous system, through a derangement 
of metabolism, through the circulatory system and 
through the skin. Vertigo, which appears also in 
other forms of poisoning, as through alcohol, nicotine 
and various alkaloids, is a constant symptom of intes- 
tinal auto-intoxication. We also find headache, pres- 
sure in the head, neuralgia and cerebral vomiting. 
Pyschic disturbances are often particularly marked. 
Depressed spirits, feeling of disgust, aversion to work, 
disinclination to social intercourse and melancholia 
are observed in these patients. All symptoms which 
are present in neurasthenia are present also in intes- 
testinal auto-intoxication. While we were formerly 
inclined to look upon the disturbances of digestion in 
neurasthenia as secondary symptoms, experience 
teaches that the symptoms of the digestive tract pre- 
cede neurasthenia. In certain cases there is a dis- 
turbance in the organs of sense, darkening of the field 
of vision, hallucinations, ringing in the ears and deaf- 
ness. 
Bouchard has demonstrated the toxidity of the urine 
in neurasthenic cases, and it is absolutely certain that 
poisonous products get into the blood. Indicanuria 
nearly always suggests auto-intoxication. Consti- 
pation is not necessarily co-incident with auto intoxi- 
cation, for it has been shown that the more fluid-like 
the contents of the intestine are, the more rapid is the 
absorption of poisonous material. Accordingly the urine in diarrhetic condition has been found to be 
most poisonous. In cholera the absorption of toxins 
is continuous despite frequent energetic evacuations 
of the bowels. It appears that patients in states of 
auto-intoxication feel better when constipated than 
when their intestines are filled with semi-solid materi- 
als. Again, we have an auto-intoxication in an ob- 
struction of the bowels, for the natural outflow of the 
waste material is arrested, excretion is imperfect and 
absorption of the poisonous materials which are present 
takes place quite rapidly. The eclampsia of children 
with digestive disturbances is more easily explained 
in terms of auto intoxication than on lines of the 
reflex-theory. 
Boix of France has published a book on “Cirr- 
hosis of the Liver Produced by Auto-Intoxication of 
Gastro-intestinal Origin.” He proves that in addition to 
alcohol as a cause for hepatic cirrhosis, there is an auto- 
intoxication of gastro-intestinal origin which frequent- 
ly causes cirrhosis. The author demonstrates that 
there is a peculiar form of hypertrophic cirrhosis 
which is caused by the passage through the liver of 
toxic substances produced in the alimentary canal, 
and he calls this a dyspeptic liver, so as to different- 
iate it from alcoholic liver, which designates an- 
other form of cirrhosis. 
To the class of cases in which we have a derange- 
ment of metabolism due to auto-intoxication we may 
add many cases of chlorosis. In certain eases of 
chlorosis we resort to anti-fermentative therapy and 
this implies that we believe that there is some pathol- 
ogic connection between it and auto-intoxication. 
While I do not wish to maintain that every case of 
chlorosis is traceable to auto-intoxication, I must 
mention the fact that Bouchard, Bosenbach, Coutu- 
rier and others have shown that intestinal auto-intox- ication has considerable significance in chlorosis. 
Such disturbances of the circulation as excitability 
of the heart, tachycardia, and various other forms of 
vasomotor disturbances are often due to intestinal 
auto-intoxication. 
Auto-intoxication frequently becomes visible in cer- 
tain kinds of skin affections, such as urticaria, which 
is produced in many cases by the eating of lobsters, 
cheese, etc. It was formerly regarded as an idio- 
syncrasy, but we now know that it is an intestinal auto- 
intoxication. Pick of Vienna has proven that attacks 
of urticaria can be prevented in susceptible patients 
by cleansing the intestinal tract. Singer has verified 
this, and adds that there is always an increase of indi- 
can in the urine. 
Asthma dyspeptica, which consists chiefly of 
dyspnea, can be attributed to auto-intoxication, but this 
has not as yet been proven. The symptoms of collapse 
produced by obstruction of the bowels, either acute or 
chronic, are no doubt due to auto-intoxication. The 
kidneys being compelled to elimate the poisons which 
have been absorbed through the intestinal tract are in 
this way injured. Albuminuria found in an intestinal 
stenosis and the disappearance of the albuminuria 
when the obstruction is removed are probably due to 
auto-intoxication. 
Posner has gone even so far as to maintain that 
nephritis may be superinduced by bacteria which, 
having been absorbed by the intestines, have found 
their way to the kidneys and there cause an inflam a- 
tory condition. The bacillus coli communis especially 
is apt to behave in this way. 
From all that I have cited it seems to me clear that 
auto-intoxication through the intestinal tract is a fre- 
quent phenomenon, leaving it to future investigators 
to add to the meagre information we have at present. 
32 Adams Avenue, West.