INFECTIONS OF THE DIGESTIVE TRACT 283 



and is probably a common association of functional pan- 

 creatic achylia, 1 a state which is probably not uncommon. 

 Some of the most pronounced instances of indicanuria 

 with which I have met have been in cases of organic 

 structural occlusion of the common duct. There must 

 be in these cases a great diminution in the proteolytic 

 action of the intestinal digestive juice, and putrefactive 

 cleavages are doubtless due very largely to the action of 

 bacteria and especially the colon bacilli. I have noticed 

 in several cases of jaundice that the fseces held mainly 

 Gram-negative organisms of the B. coli type. In some 

 autopsies such organisms have been dominant through- 

 out the digestive tract. Bacteriological studies for the 

 identification of the organisms and their biochemical 

 characters in such cases have not yet been made. I men- 

 tion these appearances, however, as being of interest 

 in the present connection, since they were characterized 

 by the absence of putrefactive anaerobes in more than 

 very small numbers. In some instances cultural obser- 

 vations on the mixed faecal flora have borne out the view 

 that the colon bacilli were the dominant type and the 

 putrefactive anaerobes were few in number. 



Occlusions of the small intestine are almost invariably 

 followed by intense indicanuria even when the occlu- 

 sion is in the jejunal region. The bacteriological ex- 

 planation in such cases is not clear. The reversal of 

 peristalsis, above the level of obstruction, must serve 

 to distribute colon bacilli from the ileum or jejunum 



1 A. Schmidt, " Functionelle Pankreasachylie," Deutsch. Archiv 

 /. klin. Med., Ixxxvii, p. 456, 1906. 



