284 INFECTIONS OF THE DIGESTIVE TRACT 



throughout the small intestine, between the stomach 

 and the obstruction. This dissemination of colon 

 bacilli above the occlusion may be an important factor 

 in favoring indol production. Where the obstruction 

 lies high, as in the upper jejunum, indicanuria is said 

 not to occur. 



The development of a complete obstruction of the 

 small intestine is followed by obstinate constipation, 

 and this may influence the putrefactive conditions below 

 the obstruction. But I have already mentioned that 

 mere constipation does not necessarily lead to indican- 

 uria. On this account it is difficult to determine the part 

 played by bacterial conditions below the obstruction, in 

 contributing to the formation of indol. It appears, on 

 the whole, that it is mainly the bacterial conditions above 

 the obstruction that determine the presence or absence 

 of an extreme indicanuria. This view is not inconsistent 

 with the fact that indicanuria may persist after the small 

 intestine has been emptied of food through repeated 

 vomiting, for it is known that indol often continues to 

 be found in the digestive tract of starving animals. 

 Small quantities of proteid (perhaps derived mainly from 

 desquamated epithelial cells) apparently suffice to insure 

 indol formation when the bacterial conditions are favor- 

 able. 



A well-marked group of cases which may provisionally 

 be classed with the simple indolic type is that which 

 may be characterized as the marantic, large-belly type 

 of chronic intestinal indigestion in children. This 

 condition has long been known to clinicians as an 



