Study of the Factors Involved in the Production a N D Absorption of Toxic Materials from the Intestine. by Lester

Obstruction to the passage of food through the intestine leads to adverse symptoms and complete obstruction causes death. Acute obstruction in the upper part of the small intestine is more rapidly fatal than in the intestine lower down. The symptoms are those of a severe, rapidly developing toxemia. Toxic substances accumulate in the obstructed intestine, which when injected intravenously in animals or absorbed from the abdominal cavity produce symptoms similar to those arising after acute obstruction. It has been shown by Stone, Bernheim, and Whipple (1), and later by Hartwell and his associates (2), and Murphy and Brooks (3) that the production of isolated closed loops of the intestine , with the reestablishment of intestinal continuity around the isolated loop, produces symptoms similar to those following complete obstruction of the intestine at the same level. There is an accumulation of toxic materials in these intestinal loops similar to those in the obstructed intestine. In a previous study (4) it was demonstrated that these toxic substances can be formed in such isolated closed intestinal loops, with resultant toxemia, after all food materials and digestive secretions have been previously removed by careful washing with water or salt solution. It was also shown that the secretions of the intestinal mucosa are not toxic and do not give rise to the symptoms of acute obstruction when absorbed directly from the abdominal cavity. Davis and Stone (5) have found that these secretions are not toxic even when injected intravenously in animals. This is in agreement with the observation of Murphy and Brooks. The presence of bacteria in the lumen of the intestine or in isolated closed intestinal loops is necessary for the production of the characteristic toxic substances. In the absence of bacteria, as in isolated closed intestinal loops previously rendered sterile by prolonged drainage into the abdominal cavity, many changes, even to autolysis of the mucosa through occlusion of the blood supply, may occur and no untoward symptoms result. The toxic substances can be apparently formed by the action of bacteria on the secretions of the intestinal mucosa, or on material from desquamated mucosa cells.