BACTERIAL METABOLISM WITHIN THE BODY 707 



protein has been deliberately applied by the author in the treatment of 

 bacillary dysentery. This is a severe infection of the intestinal mucosa 

 incited by Bacillus dysenteriae, of the Shiga, Flexner, or Flexner variant 

 types. The effects are particularly severe in young children. The in- 

 fective agent is restricted chiefly to the large intestine, and the organisms 

 do not usually penetrate tissues deeper than the mesenteric lymph nodes. 

 The essential specific feature of this treatment was to feed the patient 

 lactose solution by mouth ; glucose was injected subcutaneously for reasons 

 to be detailed later. 



Lactose was fed to permeate the entire digestive tract of the patient. 

 By so doing the metabolism of the dysentery bacilli, and of the resident 

 intestinal population as well, was shifted from protein to carbohydrate. 28 

 Two distinctly specific but related beneficial results were expected: To 

 reduce the formation of toxins by the dysentery bacilli and to prevent 

 the formation of indol and other putrefactive products by Bacillus coli 

 and other intestinal organisms. The other beneficial effect hoped for 

 would come from the acidification of the intestinal tract, due to the com- 

 bined lactic acid generation of the entire intestinal flora, both pathogenic 

 and parasitic. One of the significant results of lactose feeding was a 

 reappearance of the normal nursling lactic acid bacilli ; especially Bacillus 

 bifidus and Bacillus acidophilus. In favorably progressing cases, these or- 

 ganisms rather rapidly became prominent. Their energetic lactic acid 

 generating powers were of undoubted significance in rendering intestinal 

 conditions intolerable for the acidophobic dysentery bacilli. 21 * 28 



In addition to the oral feeding of lactose solutions, two other pro- 

 cedures for the administration of carbohydrate were 'practiced. One of 

 these was an attempt to give glucose-lactose irrigations per rectum in 

 the hope that some of the sugar would pass the sigmoid and enter the 

 absorptive areas of the large intestine. This was soon abandoned. It 

 proved to be annoying to the young patients without a proportionate gain. 

 The ether procedure was to infuse glucose solutions subcutaneously 



M The generally accepted treatment for bacillary dysentery in young children at 

 this time was starvation, upon the assumption apparently that the dysentery bacilli 

 would gradually exhaust themselves. Water alone was given. It was obvious that 

 all the intestinal microbes of necessity became proteolytic. The dysentery bacilli 

 formed toxin, the colon bacilli indol, and the entire burden of detoxicating whatever 

 of these nitrogenous products were absorbed from the intestinal tract fell upon the 

 liver. The intestinal secretions and tissues furnished the requisite protein for the 

 formation of these harmful products. 



"The antagonistic effects of lactic acid production upon the viability of dysentery 

 bacilli in the intestinal tract and dejecta have recently received unexpected substantia- 

 tion in the Report of the Medical Research Committee. 



28 It is probable that lactic acid produced by microbic action within the alimentary 

 canal and immediately in the presence of acidophobic bacteria is more effective in its 

 action than an equal quantity would be brought from a distance. The neutralizing 

 effect of salts and alkaline secretions would certainly change considerable amounts 

 of the acid to the lactate, which is far less effective in its inhibition of microbic 

 activity. 



