BACTERIAL METABOLISM \VITHIX THE BODY 709 



ducing sugars. This would suggest that unaltered lactose failed to enter 

 the tissues and blood stream in significant amounts. 



It was soon realized that prolonged feeding of carbohydrate alone 

 became harmful. This might confidently have been expected. Subse- 

 quent feeding with lactose-protein solutions were very well tolerated, no 

 evil results attributable to the protein being observed so long as the car- 

 bohydrate was fed in amounts sufficient to insure a continuous flow to 

 the lowest levels of the alimentary canal. Protein solutions without car- 

 bohydrate were found to be distinctly harmful. 



The earlier cases of bacillary dysentery treated with the protein-lac- 

 tose diet as indicated showed neither signs nor symptoms suggestive of 

 harm arising from the liberal use of lactose. Somewhat later in the 

 season, however, a striking instance of apparent harm attributable to 

 lactose feeding presented itself. Inasmuch as this case presents details 

 of importance in connection with the therapeutic application of dietary 

 procedures to bacterial infections, the salient features will be briefly 

 related. 



A young child was convalescent from a severe attack of bacillary 

 dysentery. It had passed successfully through the febrile and diarrheal 

 stages of the disease upon the lactose-protein diet, and was apparently 

 in such good condition that a more liberal regimen was indicated. Sud- 

 denly, without warning, the diarrhea reappeared together with the san- 

 guineous, mucopurulent intestinal discharges previously observed. The 

 clinical picture at first sight was one of a severe relapse. It was per- 

 fectly clear at this stage of the case that the lactose-protein feedings were 

 distinctly harmful. They aggravated the patient's condition beyond rea- 

 sonable doubt. It was observed that there was a slight difference in 

 the constitutional symptomatology of this new attack. The patient was 

 weakened very greatly, but the mental signs of profound toxemia were 

 disproportionately slight as compared with those of the initial infection. 



Repeated attempts to isolate dysentery bacilli from the feces and 

 blood-stained mucus were unsuccessful at this time, although no trouble 

 had been experienced in cultivating the organisms during the earlier 

 diarrheal period. Gas bacilli [Bacillus aerogenes capsulatus or Bacillus 

 welchii], however, were found in abundance. This had not been en- 

 countered in the dysenteric period of this case, nor had they been de- 

 tected in other dysentery cases previously studied. 



It is well known that gas bacilli are intolerant of preformed lactic 

 acid, and with this in view well-soured buttermilk was administered in 

 considerable amounts in place of the lactose-protein solution. 3 * The symp- 

 toms, including the diarrhea, promptly abated, and the patient made an 



31 The use of well soured milk in cases of overgrowth of gas bacilli in the intestinal 

 tract is an important example of the value of lactic acid milk in intestinal therapy. 

 (Kendall and Smith, Hewes and Kendall.) 



