256 INFECTIONS OF THE DIGESTIVE TRACT 



power ; an observation of much significance, since it 

 gives an experimental basis to the suspicion that indol is 

 capable of acting as a depressant to the muscular 

 mechanism. The most pronounced clinical indications 

 of such action are perhaps those derived from some 

 cases of myasthenia gravis. Dr. Tuttle of the Pres- 

 byterian Hospital tells me that he has lately had under 

 observation a patient whose clinical history corresponds 

 to that of myasthenia gravis and in whom the only 

 objective sign of a pathological condition was an intense 

 and persistent indicanuria which was not much modi- 

 fied by any treatment which was instituted. It is clear 

 that cases of this type should be most carefully scruti- 

 nized from the standpoint of the possibility that the 

 depression of muscle function is dependent on the action 

 of aromatic products upon the muscles. 1 



The rapid onset of fatigue observed experimentally 

 in muscles that have been irrigated with indol and the 

 curves which such muscles show are presumably not 

 specific for indol. They derive their significance for the 

 human subject from the fact that indol is the only 

 aromatic product which is known to be absorbed in 

 quantities sufficient to render it probable that the indol 

 has a toxic influence upon the neuro-muscular system. 

 The absorption of skatol may act in an accessory manner 

 to heighten the effect induced by indol poisoning, but the 



1 1 am told that there are cases of myasthenia gravis in which 

 the indican of the urine is not excessive. This fact is not neces- 

 sarily a valid argument against the idea that indol acts as a muscle 

 poison in myasthenia gravis, for it is true that the given derange- 

 ments of function may arise from more than one poison. 



