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JAMA. 1927;88(3):173-174. doi:10.1001/jama.1927.02680290035015.
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A well known group of symptoms—perhaps better called a syndrome—has been included by Alvarez6 under the term "intestinal autointoxication": mental haziness, "dopiness," malaise, headache, coated tongue, poor appetite and so-called biliousness are involved. Constipation is a feature, and the syndrome is promptly relieved by evacuation of the bowel. The discomfort that may attend the retention of feces, expressing itself with widely varying degrees of intensity in different persons under varying circumstances, forms the subject of personal consideration by millions of persons. Many writers have regarded, as a cause of the discomfort, hypothetic poisons supposed to be engendered in the stagnant contents of the intestine. As relief comes promptly with bowel movement, Alvarez insists that the symptoms cannot be due to a poison circulating in the blood, because in that case relief would not follow immediately after removal of the source of the poison but later, when sufficient excretion had


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