41 
be a parallelism between the amount of indican in the urine and vari- 
ous more or less severe eye disturbances. This entire subject has 
recently been discussed by de Schweinitz and others.® Certain other 
symptoms, such as some forms of headaches and neurasthenia, have, 
apparently with good reason, been attributed to these products; 
nephritis following intestinal obstruction has likewise been ascribed to 
the products of intestinal putrefaction. 
The most interesting suggestion as to a possible pathological sig- 
nificance of the products of intestinal putrefaction is that they may 
have a part in the causation of cirrhosis of the liver. The view has 
often been expressed that cirrhosis of the liver is dependent in some 
way upon autointoxication from the digestive tract. Krawkow 
claimed to have obtained cirrhosis of the liver in fowls by the feeding 
of an infusion of putrid horse meat. One of the most definite sugges- 
tions in this connection is that of Boix,^ who believed that the fatty 
acids formed as a result of gastritis were a factor in the causation of 
cirrhosis; he claimed to have obtained cirrhotic changes by the admin- 
istration of butyric and acetic acids to animals. There is, at present, 
no ground for supposing that those products (indol, skatol, phenol, 
etc.), which are usuall}^ considered the typical products of intestinal 
putrefaction, and which are largely responsible for the ethereal sul- 
phates in the urine, have much significance in this respect; some of 
the most notable failures to produce cirrhosis of the liver experimen- 
tally have been in experiments upon rabbits; that is, upon animals 
in which alcohol readily leads to a great mcrease in the excretion of 
ethereal sulphates. This b}^ no means excludes the possibilit}", how- 
ever, that in some cases such products may contribute to such a result. 
Furthermore, evidence is gradually accumulating that indol, for 
example, which has ordinarily a very low degree of toxicity, may, 
under certain conditions, become distmctl}^ toxic. Thus, Richards 
and Howland‘S found it decidedly toxic to animals whose powers of 
oxidation are lowered by potassium cyanide; similar results were 
obtained with phenol. 
Recent experiments of Porcher and Hervieux^ suggest another 
way in which the toxicity of indol may possibly become enhanced. 
These authors find indol (0^) to be but very slightly toxic, while 
OH 
comparatively small amounts of indoxyl (0^ ), injected subcutane- 
XH 
« Jour. Amer. Med. Assoc., v. 48, pp. 502, 543; 1907. 
^ Le foie des dyspeptiques, Paris Thesis, 1895. 
c These conclusions have been recently unfavorably criticized by Goannoviecs 
(Arch, int., de Pharmacodynamie, v. 15, p. 241; 1905). 
d Proc. Soc. Exper. Biol. & Med., v. 3, p. 71; 1905-6; cf. Herter, Medical Record, v. 
70, p. 788; 1906. 
e Jour, de Phys. et de Path, gen., v. 18, p. 841; 1906. 
