THE GASTRO-INTESTINAL FLORA OF NORMAL INFANTS 599 



of the bifidus-acidophilus type if any be present in the alimentary 

 canal to start with. 1 The .intestinal contents are acid in reaction at 

 this time and unfavorable for the development of the pathogenic 

 types. 



It must be realized that a number of conditions may reduce the 

 theoretical efficiency of a diet rich in carbohydrate in intestinal infec- 

 tions; not infrequently the intestinal mucosa is inflamed and covered 

 with an exudate of mucus and serum, alkaline in reaction and rather 

 impermeable to intestinal medication. Stasis in the large intestine 

 will frequently lead to a residue of protein derivatives there, quite 

 free from carbohydrate, because the latter is readily hydrolyzed and 

 absorbed as dextrose. There may be, and undoubtedly is, in some 

 cases, a deficiency of the more effective lactic-acid-forming bacteria 

 in the intestinal contents; whatever organisms are present, however, 

 almost without exception form acids from carbohydrate, especially 

 dextrose. The possibility of an overgrowth with the gas bacillus must 

 be borne in mind if considerable quantities of sugars are to be 

 administered. 



Notwithstanding these difficulties, a diet rich in carbohydrate has 

 been shown to be well tolerated in this type of infection, be it acute or 

 chronic. Coleman and Shaffer, 2 using the high calory diet of the 

 former in typhoid fever, have shown by careful chemical studies that 

 the severe loss of nitrogen and of weight which occurs on a low calory 

 diet can be very largely prevented by a diet comparatively rich in 

 carbohydrate, and the symptoms of toxemia are materially reduced 

 as well. Torrey 3 has shown that the changes in the intestinal flora 

 in typhoid fever with the Coleman diet are, in general, a replacement 

 of the more proteolytic bacteria by greater or lesser numbers of 

 aciduric organisms, a change similar to that observed in bacillary 

 dysentery, 4 in which the same general plan of liberal feeding of lactose 

 was tried. The reduction in symptoms of toxemia in typhoid patients 

 following a high calory diet including several ounces of lactose is 

 significant; it can hardly be explained entirely on the theory of cal- 

 ories; it is very probable that a change in the metabolism of the 

 typhoid bacillus is a potent factor in this phenomenon. 



1 Kendall, Boston Med. and Surg. Jour., 1910, clxiii, 398; 1911, clxiv, 288; Jour. 

 Am. Med. Assn., 1911, Ivi, 1084; Jour. Med. Research, 1911, xxiv, 411; 1911, xxv, 117. 

 Kendall and Walker, Boston Med. and Surg. Jour., 1911, clxiv, 301. Kendall and 

 Smith, ibid., 1911, clxv, 306. Kendall, Bagg and Day, ibid., 1913, clxix, 741. Kendall 

 and Day, ibid., 1913, clxix, 753. 



2 Arch. Int. Med., 1909, iv, 538. 



3 Jour. Inf. Dis., 1915, xvi, 72. 4 Kendall, Boston Med. and Surg. Jour., 1911, clxiv. 



