Intestinal obstruction.

In earlier publications Whipple, Stone, and Bernheim (1, 2, 3, 4) have established facts which have an important bearing on this question of proteose intoxication. Some of these points will be reviewed, but for the detailed experiments the original papers should be consulted. In this work closed loops of intestine have been used because it has been established by previous experiments that an acute intoxication develops, and the toxic substance may be obtained in concentrated form in the material which accumulates in the closed loops. The intoxication noted in simple intestinal obstruction is similar, but usually less intense than that observed in dogs with closed or drained duodenal loops. Much evidence has been furnished to demonstrate that the essential toxic substance is very similar or even identical in obstruction and in closed intestinal loops. All recent work speaks strongly for the theory of a definite intoxication in intestinal obstruction and closed loops of intestine. The doubts expressed by Hartwell and Hoguet (5) have been answered by Draper (6). Hartwell and Hoguet claimed that loss of fluid and consequent dehydration of the tissues were primary and the intoxication a secondary result of this dehydration. Whipple, Stone, and Bernheim have claimed that the intoxication was primary and the dehydration of the tissues secondary to the intoxication. Draper has been able to show that a dog can be dehydrated in four days by pilocarpin to the same degree encountered in duodenal obstruction. One of us has been able to bring about a similar dehydration and blood concentration by means of pilocarpin and vigorous salt purgation 123