306 INFECTIONS OF THE DIGESTIVE TRACT 



III. THE COMBINED INDOLIC AND SACCHARO-BUTYRIC 

 TYPE OF CHRONIC EXCESSIVE INTESTINAL PUTRE- 

 FACTION 



The association of the features of the two types of 

 putrefactive decomposition already described is common. 

 In cases presenting the features characteristic of both 

 types of putrefactive decomposition the two processes 

 often vary somewhat independently. It is in a measure 

 an arbitrary matter to determine what cases fall under 

 the combined type and what cases belong under the 

 indolic or saccharo-butyric type. I would include as 

 falling under the combined type of putrefaction all cases 

 in which putrefactive anaerobes of the intestine are 

 regularly very abundant in the faeces at the same time 

 that there is a persistent indicanuria of high grade an 

 indicanuria not immediately and markedly influenced 

 by even the strictest precautions in regard to the dietary. 

 In the combined type of saccharo-butyric putrefaction 

 nervous symptoms are apt to be prominent relatively 

 early in the course of the affection. These symptoms 

 are excessive emotional irritability, an inclination to 

 mental depression, and the early onset of muscular and 

 mental fatigue. At a somewhat later period in the 

 course of pronounced cases, the haemic disturbances 

 become noticeable. The patients grow gradually more 

 and more anaemic. There may be periods of improve- 

 ment, both as regards the anaemia and the nervous 

 symptoms, but on the whole the tendency is a downward 

 one, and from year to year the patients become a little 



