680 GASTRO-INTESTINAL BACTERIOLOGY 
hydrate within the intestinal canal in these infections as a therapeutic 
measure. This would be advantageous to the patient as a physio- 
logical procedure, as Coleman and Shaffer^ have shown in their clas- 
sical studies in typhoid, and it would provide continuously at least 
a minimal amount of readily utilizable carbohydrate which would 
shift the metabolism of all the intestinal organisms, pathogenic and 
non-pathogenic, in such a manner that harmless lactic acid would be 
formed by them. The bacteria under these conditions would theoreti- 
cally, and in all prol)ability practically, derive their energy from the 
readily fermentable carbohydrate and thus not only minimize their 
action upon the proteins of the intestinal contents,' but would tend to 
create an acid reaction there which in itself would be a potent agent in 
restricting the activity of the pathogenic organisms in the alimentary 
tract. 
The associated bacteria of the intestinal tract also form acids under 
these conditions; B. coli does not form indol, and other products of 
putrefaction are absent. Within a few days, under favorable circum- 
stances, the cumulative effect of a diet liberal in carbohydrate will 
lead to a considerable development of aciduric bacteria, especially 
of the bifidus-acidophilus type if any be present in the alimentary 
canal to start with.^ The intestinal contents are acid in reaction at 
this time and unfavorable for the development of the pathogenic 
types. 
It must be realized that a number of conditions may reduce the 
theoretical efficiency of a diet rich in carbohydrate in intestinal infec- 
tions; not infrequently the intestinal mucosa is inflamed and covered 
with an exudate of mucus and serum, alkaline in reaction and rather 
impermeable to intestinal medication. Stasis in the large intestine 
will frequently lead to a residue of protein derivatives there, quite 
free from carbohydrate, because the latter is readily hydrolyzed and 
absorbed as glucose. There may be, and undoubtedly is, in some 
cases, a deficiency- of the more effective lactic-acid-forming bacteria 
in the intestinal contents; whatever organisms are present, however, 
almost w-ithout exception form acids from carbohydrate, especially 
glucose. The possibility of an overgrowth with the gas bacillus must 
be borne in mind if considerable quantities of sugars are to be admin- 
istered. 
1 Arch. Int. Med., 1909, 4, 538. 
2 It is a well-attested fact that typhoid bacilli develop within the tissues of the body, 
and it might appear that a carbohydrate diet would therefore be ineffective; it is impor- 
tant to remember that the blood normally contains about 0.08 per cent glucose, an 
amount amply sufficient to. protect protein from their attack. A liberal carbohydrate 
diet should tend to maintain the concentration of blood sugar at its physiological level. 
Simonds (Jour. Infec. Dis., 1915, 17, 506) has shown that the products arising from 
the autolysis of typhoid bacilli grown in glucose media are decidedly less toxic for rabbits 
than those grown in glucose-free media when acted upon by specific lytic sera. This 
observation may well have an important bearing upon the case in question. 
•' Kendall: Boston Med. and Surg. Jour., 1910. 163, 398; 1911, 164, 288; Jour. 
Am. Med. Assn., 1911, 56, 1084; .Jour. Med. Res., 1911, 24, 411; 1911, 25, 117. Kendall 
and Walker: Boston Med. and Surg. Jour., 1911, 164, 301. Kendall and Smith: Ibid., 
1911, 165, 306. Kendall, Bagg and Day: Ibid., 1913, 169, 741. Kendall and Day: 
Ibid., 1913, 169, 753. 
