Intestinal Fermentation And Putrefaction - Auto-Intoxication

Intestinal auto-intoxication is a toxaemia resulting from the absorption of abnormal food products under the influence of bacterial action. Intestinal auto-intoxication is responsible for a group of miscellaneous toxaemias which include cases of anemia, headaches, neuralgia, neuritis, arterio-sclerosis, rheumatism, neurasthenia, and other conditions. Some symptoms are in part mechanical, due to pressure from gas. The toxins may frequently be recognised in the stomach contents (various organic acids), in the urine (excess of ethereal sulphates), and in the breath (acetone and hydrogen sulphide gas). Alcoholic fermentation of the foodstuffs may also occur. The bowels are frequently constipated, and the motions may be ill-formed and very offensive in character. The toxic products produced as a result of fermentation of carbohydrate foods are chiefly C02, and various organic acids, such as lactic acid, acetic acid, butyric acid, and to a less extent formic and valerianic acid and acetone. The end-products of decomposition of carbohydrate foods are C02 and water, and no fermentation products are recovered from the urine with the exception of oxalic acid in oxaluria. The toxic products arising from the abnormal decomposition of proteins under the influence of bacterial action are various nitrogen and sulphur compounds, chiefly of the aromatic scries, eg, indol, phenol, skatol, and hydrogen sulphide gas (see p. 16). Other less important products are ncurin, lecithin, and cystin. The excess of nitrogen and sulphur in these putrefactive products are eliminated in the urine as ethereal sulphates, and their presence may be detected in the urine.

The dietetic treatment of cases of auto-intoxication is of the first importance. The fermentation cases should be treated with a diet chiefly protein in character. The diet should comprise various meat soups, fish, chicken, eggs, tripe, sweetbread, and scraped beef; farinaceous foods being restricted to dry toast, stale bread, and rusks. The diet must be carefully planned, the food given at regular intervals, and no food of any kind given between meals. The free use of plain water or other diluent should be encouraged. It is necessary to point out the importance of proper attention being paid to mastication of the food, to the state of the teeth, and the careful regulation of the bowels as essential points in the treatment. The special value of the soured milk treatment and of various lactic acid bacilli is separately considered on p. 540. The following dietary is appropriate to cases of auto-intoxication resulting from the abnormal fermentation of carbohydrate foods: -

7 a.m. - Tumblerful of hot water.

8 A.M.: Breakfast - Tea, 1 cup without sugar, and milk, not cream.

Good helping of fried bacon or fish, or eggs (plain, poached, or scrambled); or cold ham, or cold tongue, or grilled kidney.

I slice of thin crisp toast, with very little butter. 11 A.M. - 1 tumblerful of soured milk, with plain sweet biscuit.

1 P.M.: Lunch -(a) Fish, or chicken, or game; or chop, steak, or roast beef, or roast mutton.

(b) Biscuits, or dry roll with cheese, and with butter; cup of coffee. 4.30 p.m. - Cup of soured milk, and half-slice sponge cake or biscuit.

7 P.M.: Dinner - Clear soup, unthickened.

Meat as at Lunch, without vegetables; dry toast, and a simple gravy.

Pudding in form of custard, curds, jelly, cream, or stewed fruit, without added sugar; no coffee. 10 P.M. - Drink of hot water.

The putrefactive cases are treated with a lacto-vegetarian diet Meat, and especially red meats, are for the time cut off from the dietary. Meat soups are similarly withheld. Eggs are also excluded. The diet should comprise bread and milk, farinaceous foods, green vegetables, and fruits. An appropriate diet sheet is here given: -

7.30 A.M. - Tumblerful of hot water.

8 a.m.: Break/kit - Cereal - e.g., porridge, Hominy, Quaker oats, with cream. Toast or roll with butter, and a little marmalade if desired. 1 cup of tea.

11 a.m. - I glass of soured milk with biscuit.

I P.M.: Lunch - Egg in some form, or vegetable savoury, e.g., cauliflower au gratin, macaroni cheese, tomato savoury. Plain milk pudding with cream.

4 p.m. - 1 cup of soured milk, with piece of sponge cake.

7 P.M.: Dinner - Vegetable or milk stock soup, e.g., tomato, artichoke, potato, lentil, or onion. Fish occasionally, or egg in some form if not taken at Lunch, or vegetable savoury. Pudding - simple pudding, or stewed fruit; no savouries and no coffee.

10 P.M. - Tumblerful of hot water.

Foods Forbidden In All Cases

Patients who are specially prone to intestinal auto-intoxication have a relatively weak digestive power. Their diet must therefore be a simple one. All foods which are difficult to digest should be excluded from the dietary, and the various "extras" which can be indulged in with impunity by healthy subjects must be rigorously withheld. The following articles should only be given in the most restricted amounts: - Marmalade, jams, sugar, sweets, and confectionery; pastry, sweet cakes, new bread, and hot rolls; made-up dishes of all kinds, and all canned foods; pickles, sauces, spices, caviare, and rich gravies, lobsters, mushrooms, shrimps, sardines, salmon, mackerel, raisins, nuts, pears, and all preserved fruits.