42 
ously^ are rapidly fatal. As is well known, indol, whether it be 
administered or be formed in the intestine, is normally excreted as 
indoxyl-sulphuric acid, which is also practically nontoxic. In other 
words, indol, before it can be excreted, is converted into the poisonous 
compound indoxyl. The latter is probably normally conjugated at 
once with sulphuric acid (or if present in large amounts converted 
into harmless precursors of indigo — not, according to these authors, 
into glycuronates), but it is conceivable that pathological conditions 
may arise which prevent this, and that then the indoxyl ma}^ have a 
deleterious effect.® 
A systematic study of the excretion of ethereal sulphates, phenol, 
etc., in cases of alcoholism in man vmuld probably yield interesting 
results. In a single observation upon a man with advanced alcoholic 
cirrhosis of the liver the urine contained 4.2 per cent of ethereal 
sulphates, which is lower than what is usualty considered normal; 
unfortunately, data concerning the diet and the absolute amount of 
sulphates excreted were not available. It would have been mterest- 
ing to have had phenol and indoxyl determinations in this case; it is 
possible that the liver had lost the power of neutralizing these poisons 
with sulphuric acid.^ 
2. Effect of alcohol upon the neutral sulphur of the urine. — As is well 
known, sulphur is constantly present in the urine in forms other than 
sulphuric acid. This is known as neutral or unoxidized sulphur and 
is made up of a very miscellaneous group of substances (sulphocyan- 
ates, cystin, taurin-derivatives, chondroitic sulphuric acid, oxy- and 
allox 3 rproteic acids, etc.). The taurin of the bile has long been 
quoted as an important source of the neutral sulphur. This view 
was based largely upon the work of Kunkel.^ Recent experiments 
by Shaffer ^ throw much doubt upon the correctness of this conclu- 
sion, at least as far as man is concerned.^ The elimination of neu- 
tral sulphur is not so closely dependent upon the sulphur of the food 
as is that of the sulphates.^ 
“ A suggestive illustration of the cumulative effects of two substances may be found 
in the relation of a large meat and alcohol diet to gouty manifestations. According to 
interesting observations made in Italy, neither the consumption of meat alone nor of 
alcohol with a low meat diet has a special tendency to lead to gouty attacks. Such a 
result, however, occurs frequently with a diet containing both. (Wood, Therapeutics, 
12th ed., p. 308; 1905.) 
^Edsall (1. c. and Boston Med. and Surg. Jour., v. 156, p. 181; 1907) believes that the 
increase in the ethereal sulphates, which is usually interpreted as indicating increased 
intestinal putrefaction, may be due, in part, to abnormalities in the liver, excretory, or 
various other organs. 
^^Pfliiger’s Archiv., v. 14, p. 344; 1877. 
dAmer. Journ. Physiol., v. 17, p. 374; 1906. 
e It is interesting to note in this connection that Kunkel did not include the ethereal 
sulphates with the total sulphates. 
/Folin, Amer. Journ. Physiol., v. 13, p. 99, 1905; cf. Shaffer, 1. c. 
