Some of the products of the intestinal flora are undoubtedly toxic, such as the benzol derivatives (phenol, etc.) ammonium and other salts. Many of these toxins have been insufficiently studied, but it is well known that certain of them can be absorbed by the wall of the gut and act as poisons. A well known case is the toxin of botulism which was isolated and studied by M. van Ermenghem.[55] The poison, the product of a microbe which causes serious intestinal disturbance, is so fatal that a single drop given to a rabbit produces death after symptoms similar to those observed in cases of human beings poisoned by stale food. Butyric acid and the products of albuminous putrefaction are amongst the most pernicious of the microbial poisons produced in the large intestine. It is familiar that digestive disturbance is frequently associated with discharges of sulphuretted hydrogen and putrid excreta, and there is no doubt but that the microbes of putrefaction are the cause of these symptoms. It has been assumed for long that the retention of fæcal matter tends to putrefactive changes in the intestines, and that the evil consequences of constipation are due to this. Recently, however, bacteriologists have criticised this accepted view, on account of the small number of microbes found in the excreta of constipated persons. Strasburger was the first to establish the fact, and his associate, Schmidt, showed that putrefaction did not follow when readily putrescible substances were infected with material taken from cases of constipation. However, notwithstanding the exactness of these facts, I cannot accept the inference which has been drawn from them. The excreta discharged naturally in cases of constipation do not give a correct indication of the conditions inside the gut; whilst such matter contains few microbes, the substance removed after injection by an enema is extremely rich in bacteria. Moreover, analysis of the urine, in cases of constipation, shows an excess of the sulpho-conjugate ethers which are known to be products of intestinal putrefaction. Not only is there auto-intoxication from the microbial poisons absorbed in cases of constipation, but microbes themselves may pass through the walls of the intestine and enter the blood. In the maladies that are the result of constipation some of the symptoms recall those of direct infection, and it is highly probable that, if special investigations were made, microbes of intestinal origin would be found in the blood of the sick children and the pregnant or parturient women whose symptoms I have described above. The question as to the passage of microbes through the intestinal walls is one of the most controversial of bacteriological problems, and there is little agreement in the numerous publications regarding it. None the less, it is far from impossible to get a general idea of what goes on in an intestinal tract richly charged with microbes.