DI<!i:sTl\ E DISTlU{B.\.yCE8 JX OBSTRiCTIVE ICTERUS 491 



holdt ^'^ considers that increased bacterial reduction in the intestines 

 may by itself account for urobilinogeniiria. The amount of urobilin 

 and urobilinogen excreted in the feces, seems to vary directly with the 

 amount of hemolj'sis.^'* 



Digestive Disturbances in Obstructive Icterus.^ — In tase tlic iotcnis (Icpcnds 

 upon the oochision of the main hilo-passajzos by stones, tumors, etc.. the situation 

 is romplii'atod l)y tiu' clloi'ts of the ahsi-nci' of this natural secretion in the in- 

 testinal canal. Carbohydrate and protein dijjestion seem to be but little allected, 

 especially the former, but the proportion of the ingested fat that apj)ears in the 

 feces increases from the normal 7-11 per cent, to 00-SO per cent. The products 

 of bacterial decomjjositioii of the undigested fat may lead to injury of the in- 

 testinal wall and disturbance of its function. Failure of absorption of fat also 

 favors intestinal putrefaction by enveloj)ing the protein substances so that they 

 are not readily digested and absorbed. The relation of bile to intestinal putre- 

 faction is still not exactly determined. Freiiuently, but by no means always, 

 ther<^ is an increased intestinal jnitrefaction which may result in diarrhea and 

 the appearance of excessive quantities of indican and phenol in the urine. The 

 idea once held that the bile salts acted as intestinal antiseptics has not been 

 establislied by experimental investigations: however, it is possible that through 

 their fimction as natural cathartics, liy stimulation of peristalsis, they prevent 

 stagnation and putrefaction of proteins. 



3cZeit. exp. Path., 1911 (9), 268. 

 3d Robertson, Arch. Int. Med., 191.5 (15), 1072. 



4 Concerning metabolism in icterus see Vannini, Zeit. klin. Med., 1912 (75), 

 136. 



