“Conditions of bacterial activity in the intestine in cases of advanced,apparently primary,anemias”

The author reported results of the coördinated studies of 15 cases of apparently primary advanced anemias, in ten of which the blood picture was that of pernicious anemia. The studies related to the occurrence of phenol in the urine and in the feces; of indol in the feces and indican in the urine; of skatol in the feces; to the Ehrlich aldehyde reaction of the urine; to the Ehrlich aldehyde reaction of the feces; and to the hydrobilirubin reaction of Schmidt. In the case of indol, phenol and skatol, quantitative studies were made. The observations established the fact that in so-called primary, pernicious and allied anemias the indications of excessive putrefactive decomposition are almost regularly pronounced. These changes are associated with definite and characteristic departures in the bacterial activity of the intestinal flora studied in fermentation tube experiments. A careful study of the microscopic fecal fields, of the sedimentary fields in fermentation tubes, of the anerobic plates from the sterilized feces, and of the results of a modification of Welch's incubation test for the gas-bacillus, indicates that in nearly every instance examined the peculiar Sacchus-butyric type of bacterial decomposition here found is dependent upon B. welchii (B. œrogenes capsulatus). Evidence is furthermore brought forward to show that this organism is a prominent and perhaps specific, factor in some cases of advanced “primary” anemia. The overgwwth of the gas-bacillus is associated with a partial disappearance of B. coli. During convalescence the gas-bacillus recedes numerically and B. coli resumes a dominant position.