708 ARTHUR ISAAC KENDALL 



(Heilner, Allen). 29 It was found that young children could not retail 

 even water by mouth when the dysenteric infection was severe. The dehy- 

 dration of the tissues following the profuse diarrhea left the patients in a 

 serious condition. The addition of glucose (Allen) to the saline infusion 

 was devised to provide the tissues with an immediately utilizable source oi 

 energy as well as restore body fluid. It was also hoped that some 

 this glucose would be carried to the mesenterlc lymph nodes or other 

 tissues where bacteria might be growing within the body, and thus aid ii 

 a reformation of their metabolic products. This would mean, if it were 

 realized, that the dysentery bacilli within the tissues would produce lactic 

 acid in place of toxin so long as the glucose was available. In other 

 words, these dysentery bacilli would become potentially lactic acid microbes. 



An unexpected beneficial effect of lactose feeding was noticed. Chil- 

 dren that constantly regurgitated water appeared to retain the lactose 

 solution without difficulty. No explanation presented itself to account 

 for this peculiar result. 



At first sight, the selection of lactose as the carbohydrate for oral 

 administration might be criticized on the ground that dysentery bacilli 

 do not ferment this sugar* It should be emphasized, however, that lactose 

 is more slowly absorbed from the digestive tract than any other sugar. 

 This fact alone would increase manyfold the chances of permeating the 

 entire intestinal canal with sugar. 30 Lactose is fermented by a majority 

 of the normal intestinal bacteria and it will be remembered that -one 

 objective of the specific dietary treatment of toxic intestinal infection 

 is to reduce intestinal bacterial prcteolysis and augment lactic acid pro- 

 duction. Acidogenesis should extend the entire length of the tract to be 

 effective. 



Lactose is apparently hydrolyzed in the intestinal mucosa by the 

 enzyme lactase (Morse and Talbot). The products of hydrolysis are the 

 hexoses, glucose and galactose, both of which are readily utilized for en- 

 ergy by dysentery bacilli. Inasmuch as the dysentery bacilli are grow- 

 ing in the intestinal mucosa, the advantages of liberating fermentable 

 sugars there are obvious. 



There is of course the possibility that the intestinal mucosa and im- 

 mediately underlying tissues might be so injured by the poisons of the 

 dysentery bacilli that the cleavage of lactose might be interfered with. 

 It is not possible to disprove this contingency, but it may be stated that 

 repeated examinations of urines from a series of cases treated in this 

 manner were invariably negative with reference to the presence of re- 



29 These infusions were sterilized solutions of normal saline containing 2.5 per 

 cent of Kahlbaum's chemically pure, anhydrous glucose. From two to four ounces were 

 injected very slowly each d,ay by the subcutaneous route for several days. 



hepeated, relatively small, feedings of lactose were prescribed rather than fewer, 

 larger amounts. This was to insure the continuous presence of sugar throughout the 

 intestinal tract. 



