BACTERIOLOGICAL EXAMINATION OF MATERIAL 227 



proportional to the number of bacilli which reach the lower part 

 of the bowel; hence, the excessive number of spores "of Bacillus 

 Welchii in the stools in cases of gas bacillus diarrhea." Simonds' 

 results substantiate the work of Kendall and Day 21 to the effect 

 that children and adults with diarrhea who showed large numbers 

 of gas bacilli in the stools are made worse by feeding sugars, and 

 that prompt improvement results when the diet is changed to one 

 largely composed of protein. An absence of lactic acid by the feed- 

 ing of butter-milk still further aids in eliminating the Welch bacillus. 

 Kendall has shown by prolonged experimentation on monkeys, dogs 

 and cats that feeding with cows' milk, to which sufficient lactose 

 has been added to simulate breast milk, produces a bacterial flora 

 in such animals which approaches that of the normal nursing infant. 

 The stools take on an acid reaction, and organisms like B. bifidus 

 and the Enterococcus begin to predominate. In order to bring this 

 about, he states, it is necessary to continue the feeding for consider- 

 able periods. Kendall divides the pathological cases in which it 

 can be reasonably suspected that abnormal bacterial conditions of 

 the intestinal tract play a causative part, into those which are due 

 to the action of the bacteria upon proteins, and those in which it 

 is chiefly a matter of carbohydrate fermentation. In the case of 

 the abnormal proteolytic processes, there may be a liberation of 

 substances like histamin and other toxic amines, and there may 

 even be the formation of specific toxins such as those which have 

 been recently produced by Bull and others from the Welch bacillus. 

 Abnormal carbohydrate splitting' may result in hyperacidity and 

 in stasis of the bowel, and secondary putrefaction in consequence 

 of this. 



It is due to studies like those of the writers mentioned above 

 that we may hope to be able to exert considerable therapeutic in- 

 fluence upon abnormal intestinal conditions by altering the flora of 

 the intestine, on the one hand by controlling the diet, and on the 

 other hand by inoculating with, or, in other words, feeding bacteria 

 of a type which may correct the condition that exists. 



A detailed study of these therapeutic measures cannot be given 

 in tliis place. They are treated of in articles like those of Coleman 

 and Shaffer, 22 in Kendall's book from which we have quoted freely, 



21 Kendall and- Day, Boston Med. and Surg. Jour., 1911, 741 and 1912, 753. 

 "Coleman and Shaffer, Archiv. Inter. Med., Vol. 4, 1909. 



