710 ARTHUR ISAAC KENDALL 



uneventful recovery. Subsequent examination of some of the lactose 

 itself revealed an extensive contamination with the spores of the gas 

 hacillus. Even so small an amount as ten milligrams sufficed to produce 

 the well-known stormy fermentation of milk, and the development of 

 the rancid odor characteristic of butyric acid. The injection of some of 

 this milk into rabbits produced the characteristic distention, foamy liver 

 and other signs of the Welch-Nuttall test, thus affording ample con- 

 firmation of the diagnosis. 



The origin of the second attack of profuse diarrhea and the obvious 

 relationship between the lactose and the aggravation of the symptoms in 

 this case is very clear. The contaminated lactose was responsible for a 

 direct implantation of spores of the gas bacilli in the digestive tract 

 of this child. 32 These spores vegetated, and the gas bacilli multiplied 

 rapidly. Inasmuch as Bacillus welchii is a most energetic fermenter 

 of carbohydrates (Simonds, Blake), producing therefrom considerable 

 amounts of butyric acid, it was in all probability the irritant effect of 

 this acid upon the intestinal mucosa which caused the diarrhea. The 

 absence of symptoms of toxemia is probably associated with the fact 

 that butyric acid is not a toxin. 



Two other patients, out of a number of dysentery cases undergoing 

 the lactose-protein treatment, also developed gas bacillus diarrhea before 

 the condition and its remedy were recognized. The administration of 

 buttermilk was as effective in arresting the process in these cases as it was 

 in the first instance. It should be mentioned in passing that gas bacillus 

 diarrhea was so prevalent two years later among patients coming to the 

 same hospital, 33 that it might be said to have existed in epidemic pro- 

 portions (Kendall and Smith). It was not transmitted through lactose 

 at this time, however, inasmuch as the infection existed prior to their 

 admission to the clinic. Buttermilk proved to be as efficacious in the 

 treatment of this group as it had been in the single cases just men- 

 tioned. 34 



To summarize: these dysentery cases and the gas bacillus infections 

 arising from them are of interest from two viewpoints: First, because 

 underlying principles of bacterial metabolism observed in culture and in 

 the normal digestive tract have a direct bearing upon the specific dietary 

 treatment of intestinal infections. Indeed, these principles are applicable 

 to any infection where the anatomical relations to the host are such that 

 full advantage may be taken of procedures which shall alter directly 

 the metabolism of the microbe in favor of the host. These conditions 



w All lactose solutions were subsequently sterilized in the autoclave, and all trouble 

 from this source was at an end. 



83 Fifty-three out of a total of one hundred and thirty-five cases of severe diarrhea 

 studied. (Kendall.) 



"Similar cases have been seen in adults; also subacute and chronic types are 

 occasionally met with. They are usually unrecognized, however. (Hewes and Kendall.) 



