INFECTIONS OF THE DIGESTIVE TRACT 325 



beneficial if one may judge by the feelings of the patient 

 and by the diminution in the excretion of indican which 

 is noted. Among the long-standing cases of chronic 

 excessive intestinal putrefaction, especially in cases of 

 the combined indolic and saccharo-butyric type, the use 

 of hydrochloric acid is often attended by little improve- 

 ment. The stomach, indeed, often irritable or unduly 

 sensitive, may not accept even moderate quantities of 

 the acid without showing indications of slight gastritis 

 or local discomfort. The use of digestive enzymes such 

 as pepsin, trypsin, pancreatin, etc., has been much lauded. 

 It is possible that they do good in some instances, but 

 I have never been convinced that their use is really an 

 important factor in determining the ultimate outcome 

 in marked cases of chronic excessive intestinal putrefac- 

 tion. The use of an efficient diastatic ferment gives, I 

 think, more tangible results, and there are cases in which 

 a better utilization of carbohydrates is noticeable in con- 

 sequence of the use of an active diastase. The criterion 

 in such cases has been the better tolerance for carbohy- 

 drates which is manifested by the reduction in habitual 

 flatulence, especially in the upper part of the digestive 

 tract. I know of no observations claiming to demon- 

 strate a direct influence either of diastatic or proteoclastic 

 ferments upon the excretion of the ethereal sulphates or 

 indican or upon the numbers of putrefactive bacteria 

 in the large intestine. 



Careful mastication of the food is certainly an important 

 factor in determining how it shall be utilized. But one 

 may readily exaggerate the influence of this factor, and 



