INFECTIONS OF THE DIGESTIVE TRACT 265 



any passage of colon bacilli from the intestine into the 

 blood (and thus through the liver into the gall-bladder) 

 makes it likely that there is in these cases an ascent of 

 the colon bacilli to the level of the common bile duct. 

 The colon bacilli travel so rapidly after death that it 

 is only through very early autopsies that one could ob- 

 tain evidence of the presence of these organisms at high 

 levels of the intestinal tract. Reliable data relating to 

 this point are at present lacking. There is, however, 

 a probability that in altered states of secretion in the 

 small intestine incidental to subacute or chronic enteritis 

 the colon bacilli do ascend above the level of their normal 

 habitat and thus become factors in the production of 

 indol and hence of indicanuria. 



That the conditions which lead to pathological indi- 

 canuria are not always the same is rendered probable 

 by the marked differences in the amenability of this 

 condition to treatment which have been observed by all 

 clinicians who have attempted to modify this condition 

 in a variety of patients. There are instances in which 

 a reduction in proteid diet is in itself sufficient to greatly 

 diminish the quantity of indican excreted. Reduction 

 in the quantity of meat which is daily taken by a patient 

 is often efficacious in effecting this end. The explanation 

 of the improvement following a diminished use of meat 

 perhaps lies in the fact that on the more limited diet 

 smaller quantities of undigested meat pass into the region 

 of the associated anaerobes and colon bacilli. A change 

 from a diet containing much meat to one in which milk 

 is substituted for meat sometimes leads to a prompt 



