282 INFECTIONS OF THE DIGESTIVE TRACT 



is attacked by the colon bacilli mainly in the large in- 

 testine. It seems more legitimate to assume that they 

 are attacked in the small intestine in the manner already 

 mentioned. It is, of course, likely that in some cases 

 hydrolyzed proteids find their way into the ileum and 

 large intestine, and here it is necessary to assume that 

 the colon bacilli have migrated upward from their usual 

 habitat in order to explain the phenomenon of excessive 

 indican production. I may mention an illustration of 

 the indolic type of excessive intestinal putrefaction. The 

 patient was a lady seventy-five years of age who had the 

 peculiarity of having lived since childhood on a diet 

 consisting almost exclusively of potatoes, hominy, and 

 bread, and from which meat had been rigorously excluded. 

 She ate little food, but was well nourished and uncom- 

 monly robust. . She ultimately fell ill from a subacute 

 gastro-enteric disturbance in which there was loss of 

 appetite, irregularity of the bowels, and some signs of 

 gastritis. The faeces at this time showed fields consisting 

 mainly of Gram-negative bacilli mostly of the B. coli 

 type. 1 These fields contained extremely few putrefac- 

 tive anaerobes. Nevertheless the urine contained ex- 

 ceptionally large quantities of indican, and this was 

 apparently a persistent feature. 



The indolic type of chronic excessive intestinal putre- 

 faction is common in cases of complete or partial occlu- 

 sion of the common bile duct with or without jaundice, 



1 Two kinds of colon bacilli and a positive diplococcus were iso- 

 lated by Mr. Ward. One of these strains of colon bacilli was a 

 strong indol maker. 



