790 W. McKIM MARKIOTT 



tions. Fats in excess are also capable of setting up peristalsis by purely 

 mechanical effect in the same way as do the mineral oils. 



In order to determine the role of organic acids, the products of bac- 

 terial decomposition of fats and carbohydrates, in the production of 

 diarrhea Bahrdt and Bamberg(a l ) (&) (c) fed organic acids to animals 

 and showed by the use of the X-ray that increased peristalsis was the result. 

 They found that the lower members of the fatty acid series were more active 

 in this respect than the higher acids. Thus acetic acid produced diarrhea 

 in much smaller amounts when fed than did caproic or butyric acid. The 

 effect of acid injected directly into the duodenum was much more marked 

 than when fed by mouth. Talbot and Hill, Edelstein and Csonka, and 

 Bahrdt and McLean and others have demonstrated the presence of free 

 organic acids in diarrhea! stools and have shown that the addition of sugar 

 to the diet increased the concentration of these acids. The latter authors 

 pointed out the fact that the concentration of acids in the stools is such 

 that if the same concentration were present in the duodenum, peristalsis 

 would be greatly stimulated. That such concentration occurs in the 

 duodenum has, however, never been shown and the large intestine is barely 

 affected by the concentration of acid present. Bahrdt and McLean found 

 no greater concentration of acid in diarrheal stools than in the stools of 

 normal breast fed infants although the total amount of acid excreted by 

 the stools per day was somewhat greater in the case of the artificially fed 

 infants with diarrhea on account of the greater volume of stools passed. 

 Huldschinski(a) (&) found more volatile organic acids in the stomach of 

 infants suffering from diarrhea and fed on cow's milk than in the stomachs 

 or normal breast fed infants. The excess of free acid was, however, very 

 small and quite insufficient in itself to be the cause of the increased per- 

 istalsis. Bahrdt and his co-workers fed dogs on milk heavily infected 

 with various microorganisms and although diarrhea and vomiting occurred 

 as a result it could not be shown that there was an excess of acid in the 

 gastro-intestinal tract. They were, therefore, forced to conclude that 

 the diarrhea was due to specific bacterial toxins. Against the theory 

 that mere acidity of the intestinal contents is the chief cause of diarrhea, 

 may be stated the fact that the foods most successfully used in the treat- 

 ment of diarrhea are those containing a very considerable amount of free 

 lactic acid. Furthermore, the administration of alkalies by mouth fails 

 to check diarrhea. There is every reason why the stools should be acid 

 when the infant is fed a considerable excess of sugar, inasmuch as the 

 feeding of this excess of sugar results in the passage of some unchanged 

 sugar into the lower intestine and here.the ever present sugar fermenting 

 organisms readily attack it with the production of organic acids. 



There has been considerable reason for supposing that intestinal bac- 

 teria are in some way responsible for bringing about diarrhea, even if 

 not by the overproduction of organic acids. The products of digestion 



