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October 11, 1924


JAMA. 1924;83(15):1169. doi:10.1001/jama.1924.02660150053017

There is a common syndrome, familiar to the layman as well as to the physician, that goes with constipation and is promptly relieved by the evacuation of the bowel. The symptoms vary somewhat, ranging from indefinite "malaise," "biliousness" and anorexia, to outspoken headache and visibly coated tongue. The explanation of their origin has varied in successive generations. The designation "biliousness" is rapidly going out of style because the etiologic factors that it postulates philologically are no longer defensible. The implied hypothesis of too little or too much bile acting somehow, somewhere, has lost all scientific appeal. The progress in our knowledge of the chemistry of putrefaction has pointed to the possibility of the production of toxic compounds through the action of intestinal bacteria in food residues subjected to stasis in the bowel. The list of substances actually isolated, though usually in very small quantities, from putrescent or fermenting intestinal contents