338 INFECTIONS OF THE DIGESTIVE TRACT 



infection appears to me fully as important as its intensity. 

 It is doubtless true that many patients suffering from 

 neurasthenic symptoms with mental depression or 

 moderate anaemia, have been benefited by ordinary 

 therapeutic measures suggested by experience and com- 

 mon sense, but not consciously directed by the physician 

 toward the control of the putrefactive conditions in the 

 intestinal tract. The recoveries in these cases have often 

 been temporary in character, for, as already mentioned, 

 there is a strong tendency for relapses to occur. Con- 

 siderable improvement may follow a second course of 

 treatment, and a third or fourth, but after a time it is 

 noticed both by the patient and his physician that 

 relapses occur more readily than formerly; i.e. in re- 

 sponse to apparently more trivial errors of living. It 

 is also noticeable that although the correction of these 

 errors in living is still followed by improvement, the 

 improvement is not so rapid and the periods of rest and 

 recreation and careful living are less beneficial than 

 was formerly the case. This may lead to discourage- 

 ment. It is certainly true that the physician must 

 be extremely cautious about venturing a prognosis in 

 those cases of chronic excessive intestinal putre- 

 faction that are not merely of long standing but have 

 had the benefit of intelligent medical treatment and 

 long periods of exemption from depressing conditions 

 of living. The prognosis is best in those persons whose 

 symptoms have not only been of moderate duration but 

 who have had little opportunity to care for themselves 

 persons who have continued actively at work and have 



