G ASTRO-INTESTINAL FLORA OF NORMAL INFANTS 681 
Notwithstanding; these (Hfficulties, a diet rich in carbohydrate has 
been shown to l>e well tolerated in this type of infection, be it acute 
or chronic. Coleman and Shafi'er,' using the high calory diet of the 
former in typhoid fe^'er, have shown by careful chemical studies that 
the severe loss of nitrogen and of weight which occurs on a low calory 
diet can be very largely prevented by a diet comparatively rich in 
carbohydrate, and the symptoms of toxemia are materially reduced 
as well. Torrey- has shown that the changes in the intestinal flora 
in typhoid fever with the Coleman diet are, in general, a replacement 
of the more proteolytic bacteria by greater or lesser numbers of aciduric 
organisms, a change similar to that obserA'ed in bacillary dysentery,^ 
in which the same general plan of liberal feefling of lactose was tried. 
The reduction in symptoms of toxemia in typhoid patients following 
a high calory diet including several ounces of lactose is significant; it 
can hardly be explained entirely on the theory- of calories; it is very 
probable that a change in the metabolism of the typhoid bacillus is a 
potent factor in this phenomenon. 
To summarize, the important effects to be accomplished by a liberal 
carbohydrate diet in those infections where the decomposition of 
proteins or protein derivatives by bacterial activity leads to chronic 
or acute illness of intestinal origin are— a change in the metabolism 
of the offending organism resulting in the formation of lactic and 
other acids in them in jjlace of putrefactive products, and a gradual 
replacement of the proteolytic and pathogenic types by bacteria of 
the fermentative ^•arieties. 
Another type of intestinal disturbance depends upon an unusual 
or an excessive decomposition of carbohydrate. The excessive forma- 
tion of acid within the intestinal tract by an overgrowth of aciduric 
bacteria is well illustrated in young infants, especially those fed upon 
too much maltose.^ The dietary treatment of such cases is too obvious 
to require further remarks. A group of cases which vary in severity 
from mild, long-continued diarrhea of several years' duration to very 
severe acute bloody diarrhea with great prostration are apparently 
caused by an overgrowth of the gas bacillus in the intestinal tract. 
This organism is relatively intolerant of lactic acid, and a diet prac- 
tically free from carbohydrate, rich in protein, and reenforced by 
a liberal consumption of very acid buttermilk usually effects a rapid 
improvement in the acute cases, and a gradual improvement in those 
cases which are of months' or years' duration.^ Members of the 
mucosus capsidatus group of bacteria may also, by overgrowth, set 
up a fermentative type of diarrhea which resembles that of the gas 
bacillus in its general features. The dietary treatment of these cases 
is like that of gas bacillus diarrheas. 
I Arch. Int. Med., 1909, 4, 538. - Jour. Infce. Dis., 1915, 16, 72. 
3 Kendall: Boston Med. and Surg. Jour., 1911, 164, 2cSS. 
* Kendall: Ibid., 1910, 163, .322. 
8 Kendall: Jour. Am. Med. Assn., 1926, 86, 737. 
