INFECTIONS OF THE DIGESTIVE TRACT 317 



Thus it is that in these severe types of intestinal de- 

 rangement relapses are common and discouragements 

 frequent, even among persons who from time to time 

 are quite free from definite symptoms of disease. 



The principles entering into the management of cases 

 of chronic excessive intestinal putrefaction may be 

 divided into three groups. First, those that relate to 

 the avoidance of putrefactive bacterial contamination of 

 the food; second, those that relate to the promotion 

 of prompt digestion in and absorption from the small 

 intestine; third, those that relate to agencies designed 

 to reduce the numbers of putrefactive anaerobes living 

 in the intestinal tract. It seems hardly practicable to 

 separate here the indolic and the saccharo-butyric types 

 of decomposition from the standpoint of the practical 

 measures to be employed in modifying them, especially 

 as the subject of indolic putrefaction has been already 

 considered in part. 



The Avoidance of Putrefactive Contamination of the 

 Food. As regards the avoidance of bacterial con- 

 tamination of the food with injurious organisms it is 

 evident that care in regard to ordinary principles of 

 cleanliness must be of importance. In a large propor- 

 tion of cases of chronic excessive intestinal putrefaction 

 the hydrochloric acid of the gastric juice is secreted in 

 diminished amount and frequently no free hydrochloric 

 acid can be detected in the stomach. Often there 

 is also a moderate degree of dilatation of the stomach 

 or at least some atony. This results in a delay in the 

 emptying of the stomach, which in the absence of an 



