THE DISINFECTION OF THE ALIMENTARY CANAL. 
BY 
A. JACOBI, M.D., LL.D., 
NEW YORK. 
Address delivered before the 
Medical Society of the State of New York, 
February 1, 1899. THE DISINFECTION OF THE ALIMENTARY CANAL. 
By A. JACOBI, M.D., LL.D., 
NEW YORK. 
When considering the alimentary canal from any point of view, 
pathological or therapeutical, we should begin by paying particular 
attention to the mouth. It is mainly endangered in the very young, 
and most of all in the newly born. 
There are several reasons (mostly discussed by Rudolph Fischl, in 
Volkman’s Clinical Lectures, No. 220) why microbes of so little 
virulence as not to prove dangerous to the adult should be fatal to 
the newly born. It is true the phagocytic reaction is but trifling 
in the newly born, his blood is less alkaline, there is but little ten- 
dency to fever, and his lymph nodes do not respond much to inflam- 
matory irritation. However, some such protections of the adult as 
expectoration or perspiration are absent; that is why the intestines 
and the kidneys are the only eliminators. The hard part of the 
epidermis of the newly born is not developed, according to Hulot; 
the epithelia are still of an embryonal character, and there is a 
copious normal desquamation of all the integuments, both cutaneous 
and mucous. Thus, between the injured or partly lost epithelia 
ample admission is secured to the nomadic tribes of untold microbes. 
That is particularly so in the prematurely born, whose tissues are 
still more of the embryonal type than those of the mature foetus. 
Thus it may happen that some of the pyogenous cocci which are 
known to occur in normal vaginal mucus suffice to infect a newly 
born. Not the least additional factor in causing is the sym- 
biosis of schizomycetse with putrefaction microbes, whose co-operation 
becomes particularly manifest in the infections which originate either 
in the umbilicus or in the mouth. 
The newly born and the infant are left to the care of others; they 
cannot protect themselves. As they cannot expectorate, so they 
cannot gargle or wash. Their food when given hot injures the epi- 
thelia ; their mouth is washed and rubbed sore with a coarse cloth, 2 
A. JACOBI, 
dipped in unsterilized water by unclean or septic fingers. Their 
very screaming, while pulling at the mucous membrane of the pos- 
terior part of the alveolar process, through traction of the pterygoid 
muscle, induces local anaemia and rupture and necrosis of the mucous 
tissue, and causes the “ aphthae of Bednar,” which, according to 
Friinkel, frequently harbor staphylococcus citreus. Malformations 
of the mouth, such as cleft palate, add to the recesses in which bac- 
teria may find a nest. The slightest abrasions occasion the de- 
velopment of thrush, the oidium of which is capable of entering 
the oesophagus and the stomach, also the brain, the spleen, and the 
kidneys. Food, air, and fingers carry into the mouth leptothrices, 
streptococci and staphylococci pyogenes, pneumococci, bacteria coli, 
and Klebs-Loeffler bacilli, which are absolutely harmless, with few 
exceptions, as long as the surface of the oral cavity is normal, but 
enter the lymph-circulation and the blood-circulation when a superfi- 
cial lesion favors the admission of microbes. As long as no lesion 
takes place no amount of microbes establishes the diagnosis of an in- 
fectious disease. That is why our boards of health are apt to make 
mistakes and to shoot beyond the aim. For the responsibility they 
have in connection with the sanitary interests of the public is quite 
liable to carry them too far in depriving of their personal liberty 
those who, like many perhaps of us here, harbor any number of 
bacteria in their mouths without being sick. With the exception of 
what occurs in the tonsils on which the normal cpithelia may be inter- 
rupted in their close juxtaposition, they do not enter the circulation 
unless there be hypersemia, catarrh, or ulceration. Such stomatitis 
and pharyngitis were always considered a secondary symptom of an 
infectious disease; it is more probable, however, that they, particu- 
larly the adenoid organs, tonsils, etc., are the first to be infected and 
furnish the inlets of infection. That is mainly so, however, in later 
life, not in the earliest infancy; here the palatine tonsils are mostly 
still small and smooth, and are frequently and easily washed clean 
during swallowing. Later on, perhaps, influenza and measles, very 
likely scarlatina, rheumatism, and erysipelas may take their origin in 
the nasopharyngeal cavity. Cerebro-spinal and other meningitides 
are known to have been occasioned in this way. Puerperal fever in 
the newly born, osteomyelitis, and suppuration around a simple frac- 
ture have been observed under the same circumstances. In advancing 
years frequent repetitions of pharyngitis, deepening of the lacunae, 
and fistulae dating from previous abscesses give ample opportunities DISINFECTION OF THE ALIMENTARY CANAL. 
3 
to invading microbes. During infancy, also during the diseases of 
advanced age, which are complicated with unconsciousness, such as 
apoplexy, typhoid fever, or pneumonia, remnants of food remain in 
the recesses of the mouth, disintegrate and lead to irritation, inflam- 
mation, and infection. 
The oesophagus is not likely to be affected in a similar way. Still, 
twenty-five years ago I published the case of a small boy who had a 
stricture of the oesophagus from drinking lye. The autopsy revealed, 
besides fibrinous bronchitis, diphtheria of the cicatrix. 
To prevent microbic invasions the mouth should be kept clean. 
It should be washed after every meal and at bedtime with water or 
with a mild solution of borax or boric acid. Those wearing artificial 
teeth should be particularly careful. A few drops of tincture of 
myrrh in a glass of water, or a solution of salicylic acid in 500 or 
1000 parts of water, or a mild solution of permanganate of potassium 
(1:3000-4000) is quite satisfactory. The regular use of a soft 
tooth-brush or of a coarse cloth is fortunately a universal habit 
among clean people. The mouth of patients who are unconscious 
should be moistened at short intervals ; the dry typhoid tongue 
touched once or twice a day with a 1 per cent, solution of nitrate 
of silver. The composition of tooth-powders should be known ; those 
containing strong alkalies avoided. 
The use of chlorate of potassium is advisable in any case of 
incipient stomatitis. A solution of 1 part in 50 of water is mostly 
sufficient. But the internal use is often preferable in established 
and progressive cases. To have a speedy effect, it should be taken 
at short intervals—every hour or every half hour; the dose should 
be held in the mouth a minute and slowly swallowed. The daily 
dose should not exceed four or five grammes for an adult; one 
gramme or less for an infant. If the latter is not to take it, a few 
drops of a 2 or 3 per cent, solution may be brushed on the mucous 
membrane. It should never be forgotten, however, that the per- 
sistent internal use of chlorate of potassium may prove dangerous. 
Since the first cases of poisoning I published in Gerhardt’s Hand- 
buck der Kinderkrankheiten in 1876, and those reported by me to 
this Society in 1879, a great number of deaths from the same cause 
are known to have occurred. 
Tiny infants unable or unwilling to clear their mouths of food 
remnants should be given a teaspoonful or more of water after a 
meal. Washing of the mouth, when considered necessary, should be 4 
A. JACOBI, 
done with great care, and not in the newly born only, for the reasons 
detailed before. No direct local application should be made to the 
throat; the force required for that purpose and the struggle on the 
part of the little ones make them at least very unadvisable. The 
best way to get at the throat is through the nose and nasopharynx, 
which are so often the seat of chronic catarrh, ulcerations, and ade- 
noids in the very young. The regular irrigations with warm salt 
water made by means of a nasal cup (better than spoons, droppers, 
or syringes) are very beneficial. They clear the narrow cavities 
of mucus which cannot be otherwise removed and of foreign ma- 
terial which finds a ready access. Of that nature are tubercle and 
diphtheria bacilli, and saprophytes. One of our specialists objected 
some time ago to these preventive irrigations, for the reason of their 
alleged superfluousness. He said that nobody irrigated the stomach 
regularly and as a matter of prevention ; and what was objectionable 
in one cavity was so in others. He merely forgot that the stomach 
is not accessible to the atmosphere and the dust of the street; that 
there is no high road into the stomach for diphtheria, tubercle, 
and typhoid bacilli; that, on the contrary, they are destroyed by the 
normal secretion of the stomach. 
The several diseases of the mouth and throat have their own 
indications. They should not concern us here. 
The hydrochloric acid of the stomach has a germicidal effect. 
Strauss and Wurtz observed it to kill anthrax in half an hour, 
typhoid and cholera bacilli in from two to three hours. But they 
also found that the same amount of hydrochloric acid would act 
better in a test-tube than in the stomach in which it is mixed with 
chyme or combined with albumin. Thus it happens that bacilli of 
typhoid may pass the stomach uninjured. That occurs mainly when 
the stomach secretes but little hydrochloric acid—for instance, in 
hydraemia, in catarrh, or in other cases of achylia gastrica. Such 
conditions furnish at once the indication of administering hydro- 
chloric acid, both for its digestive and its germicidal action. 
Fermentations occurring in the milk on which infants and chil- 
dren are fed have been studied very extensively. They occur so 
frequently as to explain the multiple infections of the infant intes- 
tine. Lactic fermentation exhibits Pasteur’s bacillus lactis, also 
staphylo- and pneumococcus; the fermentation of casein, Duclaux’s 
tyrotrix, leptothrix buccalis, bacillus subtilis and mesentericus, and DISINFECTION OF THE ALIMENTARY CANAL. 
5 
others. Butyric fermentation is secondary to lactic fermentation, 
and is due to the presence of bacillus butyricus, which is found in 
milk contemporaneously with bacillus lactis, but remains latent until 
lactic fermentation is completed. It lives on the bacillus lactis, and 
at the expense of the lactic acid when in excess. In connection with 
this fact the excess of milk-sugar in infants’ food becomes a very 
doubtful blessing. It may be known to some that these forty years 
I have constantly taught the advisability of avoiding that excess. 
Led by observations in the nursery and at the sick-bed, I have 
always taught that cane sugar (and not milk sugar) should be added 
to the food of infants, the milk-sugar of the cow’s milk being suffi- 
cient to supply the required amount of lactic acid. 
Chronic gastritis, besides the best known symptoms, causes mental 
and emotional disturbances amounting to hypochondria. Gastric 
fermentation produces hydrogen and carbonic acid which dilate the 
stomach and cause a diffused (not localized) pain. The irritated 
gastric nerves cause a disturbance of the nerve centres, with vertigo, 
severe headache and agoraphobia, and of the heart, with cardiac 
asthma, palpitation, and an arhythmic pulse. 
The stomach is very apt to be overloaded. As long as the small 
intestine is crowded the stomach is, through reflex action, prevented 
from discharging its contents. Before the Moscow Congress Dr. 
Yon Mehring detailed the following experiment: The duodenum of 
a dog was cut and both ends fastened in the abdominal wall. When 
the lower end was completely filled with milk or other absorbable ma- 
terial, water introduced into the stomach would not leave it through 
the fistula. Two important clinical observations become thereby 
amenable to an explanation : The first is this : that babies who are 
crowded with otherwise appropriate and absorbable food may die of 
marasmus; the second, that persistent constipation keeps the stomach 
filled with the ingesta, no matter of what nature, to the detriment of 
nutrition. The latter is, in these cases, impaired because of the 
nature of the stomach, which absorbs very little besides solutions of 
salt in water, peptones and solutions of dextrine or of grape sugar, 
and alcoholic beverages. Water, for instance, is not absorbed in 
the stomach. When it is introduced into the normal stomach, it is 
expelled through a duodenal fistula established for the purpose of 
observation. 
Pepsin and rennet are secreted by the glandular cells of the 
pylorus and of the fundus; hydrochloric acid from the chlorides in 6 
A. JACOBI, 
the circulation of the surface epithelia; lactic acid is produced by 
the bacteric fermentation of the carbohydrates contained in the 
stomach. When no milk-sugar or no other carbohydrates are intro- 
duced there is no lactic acid. After a meal consisting of hydro- 
carbons there is lactic acid, however, only for some time, say half an 
hour; after this period there is hydrochloric acid. At first it com- 
bines with the salts it meets, at the same time it interferes to a 
certain extent with the transformation of starch and stops its com- 
plete saccharification. Its principal effect, when in sufficient quan- 
tities, is the prevention of abnormal fermentation and putrefaction. 
These become prevalent when a gastric disease diminishes the secre- 
tion of hydrochloric acid. 
In dilatation of the stomach, no matter whether the secretion of 
hydrochloric acid is wanting, diminished, normal, or excessive, 
mostly, however, when it is defective, the motory incompetence of 
the organ which results in undue retention of the contents, causes 
fermentation. It produces lactic, butyric and acetic acids, and 
gases. Carbonic acid and hydrogen originate in the putrefaction of 
hydrocarbons, hydrogen and sulphide of hydrogen in that of albu- 
minoids. The accumulation of ingesta may cause endosmosis of 
water into the stomach. That process may lead to constipation, 
scanty urine, dry skin, and desiccation of the muscles and the ner- 
vous system. Tetany has been observed under such circumstances, 
partly from the changes in the physical structure of the nerve tissue, 
and partly from auto-infection. 
Tuberculosis, typhoid, or other infectious ulcerations are rarely 
found in the stomach, because their bacilli meet hydrochloric acid 
during the few hours while chyme is forming. But a certain quantity 
of the acid in, and good motory power of, the stomach, beside a mere 
normal, not excessive, peristalsis are required to prevent putrefaction 
in the intestine. In the colon this putrefaction is quite common, 
and proves the introduction of microbes with the albuminoids. All 
sorts of infectious deposits, beside putrefaction, are noticeable when 
the microbes are introduced in great numbers; when the secretion 
of hydrochloric acid is insufficient; when the motory power of the 
stomach is impaired, and when the resistance on the part of the 
pylorus is incompetent. It is evident that these wants should be 
corrected. Abnormal acids in the stomach should be neutralized by 
alkalies; the motory power of the stomach increased by strychnine, 
electricity, massage, and hydrotherapeutic applications (mostly cold); DISINFECTION OF THE ALIMENTARY CANAL. 
7 
gastric catarrh relieved by occasional or regular irrigations; the 
insufficiency of pepsin by the administration of pepsin ; the absence 
or lack of hydrochloric acid by its introduction in proper amounts 
of water, in a proportion of from 2 to 5 in 1000 ; and by a fair 
amount of sodium chloride to all kinds of food, mainly to cow’s 
milk and to farinacea. 
This demand is more than merely theoretical. In thousands of 
cases observed by me, of indigestion caused by the presence of fat acid 
(while hydrochloric acid was absent, or scanty, or retarded), I have 
seen immediate improvement by giving both, alkalies from five to 
ten minutes before meals for the purpose of neutralization, and 
hydrochloric acid (correctly diluted) during and immediately after 
meals. From 8 to 15 drops of the diluted acid in a glass of water, 
mostly hot, will usually suffice. When hydrochloric acid is secreted 
or introduced in sufficient or excessive quantity, pepsin may be 
absent. In those cases the latter should be given in addition. 
To give pepsin alone, however, as a routine treatment, is rarely 
correct. For when it is absent, the epithelia are no better developed 
than the peptic glands. Thus, while pepsin is given it should be 
considered inert unless it meets hydrochloric acid in the stomach, 
or be combined with it. The wine of pepsin of the National For- 
mulary, not yet admitted to the officinal Pharmacopoeia, is composed 
on that principle. 
Putrefaction which takes place in a stomach which is weakened 
by muscular incompetency during anaemia, convalescence, dilatation, 
or by congenital muscular insufficiency, should be treated locally; 
there is no reason why the slow process of improving secretion and 
motory power should be relied on solely. It is in these cases that 
resorcin is obviously a reliable remedy. An adult may take from 
one to one and a half grammes a day, a baby from four to ten centi- 
grammes a day. If after a long search, as I have instituted it, you 
find a few reported instances of large doses which did not kill, there 
should be no temptation to give more than the small doses which I 
advise and which prove successful. The effect of resorcin is the 
more speedy and local the greater its solubility and the facility with 
which it may be combined with other drugs. 
The choice of alkalies depends in part on indications other than 
that of mere neutralization. Bicarbonate of sodium will momen- 
tarily neutralize acids encountered in the stomach, but it incites 
the secretion of hydrochloric acid, an excess of which may prove 8 
A. JACOBI, 
uncomfortable. It often causes a burning sensation. One of the 
principal objections to the bicarbonate may also lie in the evolution 
of carbonic acid. In the individual case it may be questioned 
whether its stimulating effect on peristalsis is preferable or objec- 
tionable when compared with the inflation of the stomach engendered 
by it. All carbonates have this disagreeable feature. That is why 
I prefer calcined magnesia, the “ magnesia ” of the Pharmacopoeia. 
It has the additional advantage of relieving the constipation which 
is a frequent complication, and not infrequently a direct cause of a 
putrefying process in the stomach. An adult will take from two to 
four grammes a day, in from three or four to eight or ten refracted 
doses. 
The irrigation of the stomach meets with difficulties in few in- 
stances only, with almost none in infants and children, in whom a 
catheter, No. 25 or 30 French, is sufficient. In the adult the post- 
laryngeal region may offer an occasional obstacle, which, however, 
is overcome by patience. When the pharynx is too irritable, or the 
patient refractory, the tube may be introduced through the larger, 
mostly the right, nostril. When it does not readily pass into the 
oesophagus the patient should be made to swallow, when it will 
glide down. Salt water solution of 7: 1000 may be run through it 
from a funnel or a fountain syringe which is slightly raised above 
the level of the pharynx, and lowered when the fluid and stomach 
contents are to flow out. This salt water may be mixed with a dis- 
infectant, say thymol, 1 : 3000 or 4000, or in cases of hyperacidity 
with bicarbonate of sodium 1 : 200 or 500. The temperature should 
be that of the body when this is normal, somewhat or considerably 
cooler when there is a high elevation, or warmer when there is a 
reduction of the body temperature. Alcohol should not be added to 
the injection, because its dilution is partly absorbed by the stomach. 
On the other hand, when water is injected without salt, it causes 
osmosis of the body fluids into the stomach, sometimes to such an 
extent as to visibly increase the amount returning from the stomach. 
The irrigations should amount to 100 and more cubic centimetres in 
the nursling, 200 or 300 in the child, 500 or 700 in the adult. 
They should be repeated until they return clear. The tube should 
always be withdrawn quickly so as to avoid irritation of the fauces. 
Bile is credited with antiputrid properties, which, however, are not 
possessed by it in its alkaline or neutral condition, but are connected DISINFECTION OF THE ALIMENTARY CANAL. 
9 
with the free, mainly the taurocholic, acid. As bile (mainly, how- 
ever, when exposed to air) undergoes putrefaction very readily, the 
main object during life is to keep the function of the liver normal. 
Unfortunately, whatever influence we may have over it can be 
attained only in the course of time. Neither salicylic acid, nor sul- 
phate of sodium, nor calomel can be relied on in acute cases which 
require immediate correction or disinfection, except through their 
purgative effects. 
When the acid contents of the stomach meet bile a deposit is formed 
which is dissolved in an excess of bile and in the sodium chloride 
which is formed during the neutralization of the hydrochloric acid. 
These changes are, however, not uniform, inasmuch as the acid 
gastric contents, the alkali and acid of the bile, and the alkali of the 
pancreatic juice, mix in different proportions. 
In all probability the part taken by the pancreas in digestion and 
nutrition, when fully appreciated, will certainly be recognized more 
than formerly in our therapeutics. As a preventive the use of fats— 
cream, ice-creams, fried foods, and excessive albuminoids—should be 
avoided. Mercurials appear to stimulate the action of the pancreas. 
Such stimulation, however, is apt to become excessive, and the omis- 
sion of mercurial over-medication (so common in former times) can- 
not but act favorably in the preservation of that organ. Still 
moderate mercurialization will always play an important role in its 
chronic inflammations of a sclerotic or of a syphilitic nature. So will 
the iodides. Carcinoma of the pancreas, either isolated or compli- 
cated, is in our times, unless it can be relieved by an operation, best 
treated by methylene-blue, the effects of which in retarding or even 
diminishing carcinomatous growths in all the viscera, I have too 
often noticed in these ten years to doubt their reality. Pilocarpine, 
whose action on the salivary glands appears established, may be tried 
in small doses. The stimulation of the duodenal glands by alkalies 
and bismuth may do good by exciting their vicarious action. The 
physiological incompetence of the pancreas may be rendered partly 
innocuous by the administration of animal pancreas or pancreatin. 
The former appears more physiological, for pancreatin is liable to be 
destroyed by the action of gastric acid. 
In this way the absence of the function of this viscus, which cer- 
tainly is a factor in causing intestinal toxicity, may be shorn of part 
of its deleterious effect. If not much of a curative agent in infection 
of the bowels, this method may become a preventive. 10 
A. JACOBI, 
There are, however, cases of pancreatic disease which show to a 
marvellous extent the self-help of nature. There are those in which 
indican is diminished for the following reason : One of the functions 
of the pancreas is the transformation of albuminoids into peptones, 
and of this into leucin and tyrosin. When fermenting they form 
skatol, phenol, and indol. The latter is developed in larger quan- 
tities out of pancreatin peptone than out of the albuminoids of meat; 
thus it appears that the peptic effect of the pancreatic juice (mostly 
trypsin) favors the production of indol. That is why diseases of the 
pancreas may diminish the amount of indol and its product, indican, 
to such an extent that even in obstruction of the small intestine, 
where an increase of indicanuria should be expected, the latter mav 
be absent. (Leube.) 
Another way in which nature appears to neutralize its own injuries 
is suggested in the facts that the result of peptones and their putre- 
faction, the formation of leucin and tyrosin, works its own destruc- 
tion. Amongst their final productions is phenol, a disinfectant. 
That is not only so in the normal, but surely also in the diseased 
intestinal tract. It struck me decades ago, and I suggested the 
notion in a footnote in my Treatise on Diphtheria (page 93) nearly 
twenty years ago, that the rapid recovery and improvement of the 
general condition, for instance, after typhoid fever, might be due to 
the large amount of disinfecting phenol and other substances evolved 
out of the toxic material of intestinal secretions and excretions. 
The processes of fermentation and putrefaction which take place 
in the intestine are least intense in the upper part of the gut, become 
more marked in the lower portion of the small intestine, and less 
so again in the lower colon after desiccation by fever has become 
more effective. Tn the duodenum and jejunum there is, under 
normal circumstances, no putrefaction, but fermentation oidy ; albu- 
min is not here decomposed by microbes; it is not, however, pro- 
tected any longer by hydrochloric (which is no longer met with), but 
by organic acids. Whatever microbes are found in the normal small 
intestines decompose hydrocarbons through the formation of ethyl 
alcohol and organic acids. 
The putrefaction of albuminoids which take place in the colon 
differs from pancreatic digestion. The latter furnishes alburnoses 
and peptones, lysin, lysatenin, proteinochrome, amido acids, and 
ammonium. The putrefaction of albumin furnishes the same pro- 
ducts, and proceeds further to the formation of indol, skatol, DISINFECTION OF THE ALIMENTARY CANAL. 
11 
parakresol, phenol, phenyl-propionic acid, fat acids, carbonic acids, 
hydrogen carbonoid, hydrogen sulphide, and some others, all of 
which have been studied by Nencki, Baumann, Brieger and Salkof- 
ski. Many of these products are of intense interest, because of their 
elimination through the kidneys; some, like the oxy-acids, are not 
changed at all; phenol is absorbed directly, indol and skatol have 
to be oxidized and are passed as indican and ether sulphuric acids. 
Their quantity, which depends upon the amount of intestinal putre- 
faction, determines the greater or smaller injuries suffered by the 
formerly healthy kidneys during the varied putrid and infectious 
processes or diseases. Indeed, the number of renal affections, from 
a slight and temporary irritation (with renal epithelium and hyaline 
casts and a few blood-cells) to a serious and incurable disease biought 
on by the absorption and forced elimination of toxins are very nu- 
merous. On the other hand, it requires no theoretical demonstration 
that kidneys previously diseased are not fit eliminators and add to 
the original dangers, and, finally, that in every case of intestinal 
intoxication, excessive putrefaction, or infection, the condition of the 
kidneys should he studied at once, and preserved in its form, or if 
possible, improved. Diuretics may often prove life-saving. 
Not only food, but also the albuminous secretions of the intestines, 
and bile, undergo putrefaction by themselves; that is proved by 
the fact that putrefaction takes place during starvation, no food 
being present. It is only in the foetus with its entire absence of 
intestinal putrefaction that biliary acids and coloring matter are met 
with undecomposed. 
There are other facts which prove the occurrence of putrefaction 
in the intestine, even in the absence of food or food remnants. 
The gut is capable of forming excrements without the presence of 
food or food remnants. When Hermann separated a circular piece 
of intestine from its contiguity it still became filled with a feculent 
mass. A thick conglomerate of epithelium is formed below a preter- 
natural anus. The colon of a newly horn contains frequently laige 
masses of dry epithelia. Heidenhain found fecal masses consisting 
of epithelia and numerous nuclei originating in Lieherkiihn’s glands 
in experimental inanition and during the absence of bile. A fre- 
quent instance of this are the masses of epithelia narrowing the 
lumen of the colon which may be found in the intestines of many 
newly born. 
Putrefaction inside of the gut does not reach the degree of that 12 
A. JACOBI, 
outside the body for obvious reasons, which are mainly the presence 
of organic acids and the relative exclusion of atmospheric air. In 
the intestine the absence or diminution of absorption is also a pow- 
erful factor. That is, the more putrefaction the more fluid there is 
in the interior. Besides, the quantity of food is also of much impor- 
tance. Carbon hydrates interfere with putrefaction; so does, but 
only to a certain extent, milk; more so, however, its fermented 
products—kefir, kumyss, and matzoon. Thus both theory and 
clinical experience favor the exclusion of meats and the selection of 
farinacea and milk preparations as the nutriment of patients suffer- 
ing from intestinal putrefaction. 
But Schmitz excludes casein from the praise due to milk ; that is 
another proof of the correctness of many previous observations of the 
necessity of diminishing or of suspending it in the food of sick infants 
or of invalid adults. 
Free acids interfere with putrefaction ; therein lies part of the 
advantage of hydrocarbons which furnish acids through fermenta- 
tion ; thus these co-operate with the acids of the bile. It appears 
a pretty well established fact that putrefaction may be corrected by 
the presence of acids in the upper and the absence of water from the 
lower part of the tract. To the observation that absence of gastric 
hydrochloric acid led to increased putrefaction has been added the 
knowledge, both experimental and clinical, of its correction by the 
administration of hydrochloric acid. Another indication for the cor- 
rectness of improper putrefaction and absorption of putrid material 
may also be found, perhaps, in diaphoresis, and in astringents, such 
as gallic acid and those vegetables which contain it. Many obser- 
vations point to the adjuvant effect of opiates, because of their action 
in limiting secretion; still I hesitate to recommend them as a routine 
treatment. Indeed, no treatment should be routine. 
In many a case it may be doubtful whether a microbic or toxic 
disease in a distant organ may be the result of intestinal putrefac- 
tion or not. Bacteria are but rarely found in the circulating blood 
or lymph; thus embolic deposits can but seldom take place in this 
way. In the moribund exceptions to this rule are met with, but in 
them the tissues and membranes resemble more or less those of the 
dead in regard to mechanical and chemical alterations. Fischl even 
claims that in the living the infiltration with leucocytes of the sub- 
mucous tissue, and a secondary inflammatory process caused by the 
presence in the intestines of microbes, is rather a protection to the DISINFECTION OF THE ALIMENTARY CANAL. 
13 
organism against the migration of microbes from the alimentary 
tract. Still pneumonia, for instance, has often been claimed as the 
result of such emigration of streptococcus, staphylococcus, bacillus 
pyocyaneus, or bacterium coli; so have cystitis and pyelitis. But 
the methods of research have been charged in many such cases as 
having been incorrect and unsatisfactory. It is mainly the exam- 
inations of blood that, in the opinion of critics, left much to be de- 
sired. It is particularly the method of examining the blood taken 
from a finger which is considered inaccurate, because it is thought to 
be impossible to sterilize the surface and the ducts of the cutis with 
any amount of alcohol and ether, and it is claimed that the blood to 
be employed for a conclusive examination should be taken from a 
vein. Fischl claims that of many such cases of general sepsis in- 
duced by enteritis only those described by Escherich, by Hirsch, 
and by Libman are worthy of confidence. Thus, after all, there are 
certainly some instances of a general microbic infection originating 
in the alimentary canal that are not doubted at all. On the other 
hand, it is possible, as it was suggested forty years ago by Ritter 
von Rittershayn, that when a septic enteritis and a pneumonia or 
another infectious disease are found side by side, all of them may 
result from a common septic or septico-pymmic source. 
On the foundation of 194 papers and essays which he quotes and 
of his own research E. Opitz (Zeitsch. /. Hyg. u. Infect., xxix. 
1898) arrived at the following conclusions: That the intestinal wall 
when normal is not pervious for bacteria, and that no bacteria are 
absorbed into chyle during digestion, though there be slight lesions 
of the internal surface. Even serious chemical or mechanical lesions 
permit the admission of bacteria into the circulation in exceptional 
cases only. Nor is there a proof of the entrance into the circula- 
tion of bacteria from the intestine. As far as the kidneys are con- 
cerned, he came to the conclusion that they caused no physiological 
elimination of bacteria floating in the circulation. The presence in 
the urine of bacteria, previously injected into the circulation, is 
explained, according to him, only by mechanical and chemical lesions 
of the bloodvessel walls and of renal epithelia. 
I have presented all these facts or suggestions which are taken to 
be the proofs against the alleged dangerousness of enteric putrefac- 
tion or infection in order not to be reproached with claiming too 
much myself. But after all, what does it all mean ? Of the clinical 
facts proving the existence of auto-infection there can be no doubt 14 
A. JACOBI, 
in the minds of practitioners and clinicians. If the microbes of 
these infections are not found in the circulation and in the distant 
organs, the cause must be something else. This something else is 
the toxin formed by the very bacilli. 
Nor is this all. No amount of laboratory research of a negative 
character can nullify the merest clinical observation. In my own 
laboratory I examine the urines of 100 patients a week; no two 
weeks pass, I am certain, sometimes no week, in which an otherwise 
normal specimen of urine, perhaps in some cases discolored by a 
trace of albumin, does not contain bacteria, mostly of the coli order, 
enough to cause turbidity. This condition is not always complicated 
with serious septic troubles, sometimes with none at all. But still, 
there they are, and must come from somewhere. Spontaneous 
generation does not exist, and immigration is the only explanation. 
These are facts, and as it has often happened previously, when they 
were proclaimed to be impossible, the theory will be found to require 
modification, not the facts. Those bacteria come mostly from the 
intestines, rarely from outside through the urethra. Let me show 
you how that may, and probably does, occur. 
Living tissues do not act like test-tubes or like dead membranes. 
The latter are pervious according to the simple laws of diffusion 
and osmosis; not so the former. Even the epithelial cell is an 
independent organism with an active contraction like an amoeba, and 
with independence in regard to absorption. Fat molecules, for 
instance, enter the lymph ducts, but molecular pigment is rigorously 
excluded. In the intestinal epithelia of cold-blooded animals move- 
ments and changeable processes, like feelers, in and out, backward 
and forward, have been observed equal to those in amoebae. Indeed, 
all differentiated cells choose what they mean to absorb ; for instance, 
the epithelia of the mammary or other glands which select their 
proper food or constituent. 
The practical conclusions are obvious. Disinfection must be 
resorted to. Disinfectants have sometimes been considered inoppor- 
tune or contraindicated, because they cannot be given in sufficient 
doses to destroy bacteria or toxins. It is true that it is easier to 
destroy the living cells of the organism than bacteria. Not many 
years ago, however, Prudden could prove that a one-twentieth of a 
one per cent, solution of carbolic acid would annihilate the action of 
bacteria, not, indeed, by killing, but by paralyzing them. Charrin 
followed him lately. To prevent them from evolving toxins is as DISINFECTION OF THE ALIMENTARY CANAL. 
15 
beneficial as to destroy them. This is true of such internal remedies 
as clinical experience found to be indicated in those cases which are 
evolved out of, or are complicated with, the different forms of 
enteritis or entero-colitis. Vaughan believes that much harm and 
no good can be obtained from them—perhaps he speaks of injurious 
solutions only—but every clinician knows that the eminent bacteri- 
ologist is mistaken. It is true that calomel, naphthol, naphthalin, 
salol, and camphor in medicinal doses do not diminish the number 
of bacteria, nor even of saprophytes, but the microbes become less 
virulent. “By their fruits ye shall know them.” 
I advise practitioners not to be exclusively guided by statements 
coming from those who, while being expert and recognized bacteri- 
ologists, have less clinical experience. In the test-tube they obtain 
results which do not agree with other positive observations. They 
cannot, and sometimes do not, weigh the difference between a dead 
test-tube and the action of the living cell. I cannot but ever insist 
upon the fact that a number of well-observed and regulated clinical 
facts have the same dignity that is attributed to the results of micro- 
scopical and bacteriological exhibits. Both may be delusive or con- 
clusive. When it is stated that disinfectants have not even an effect 
on putrefaction which is going on in the dilated stomach, though it 
be within reach and accessible, we know that this plea is erroneous. 
In the same way if has been claimed that intestinal putrefaction can- 
not be influenced. That is also a mistake. A number of years I 
have treated typhoid ulcerations and their offensive discharge with 
naphthalin. They were so readily disinfected, their fetor annihilated, 
and the character and number of the stools improved, that many 
seasons I made its administration a routine treatment. The same 
favorable result I often attained in the discharges of the tubercular 
intestine. In all such cases it is true, however, that the effect is 
modified by the quantity and quality of the contents, by the rapidity 
of expulsion, by the resisting power of the intestinal bacteria, and 
by the slowness or rapidity of absorption. It has been claimed 
that bacteria and their toxins are liable to be beyond reach because 
of the facility with which they enter the tissues of the intestinal 
mucous membranes. Now we are aware that we cannot reach, 
improve, or cure every case, but also that remedies may follow in the 
same tracks opened by the enemy. The result will depend on the 
quantity of bacteric or toxic material which can still be reached. 
Remedies which are to act as disinfectants of the intestines must 16 
A. JACOBI, 
be able to reach them. There are some that are known to pass the 
stomach undissolved, for instance, salol, salicin, naphthalin, and 
others. Many writers who are very doubtful in regard to other 
drugs admit that those mentioned may be of service. To permit 
soluble preparations to pass the stomach and to exhibit their effect 
in the bowels, they have been covered with keratin, which is not 
dissolved in the gastric acid or by other material of equal repute. I 
advise to try every such preparation for its merits, at least for its 
solubility. Many of them I have experimented with by exposing 
them to water, salt water, or acidulated water, and found them 
insoluble; before I did so I picked many of them out of the dis- 
charge of my patients. They withstood both stomach and bowels 
as if they had been so-called sugar-coated pills. And many will be 
the disappointments of practitioners who are so good-natured or 
confiding as to rely on claims not substantiated. 
The soluble disinfectants whose action is said to be limited, or 
nearly so, to the stomach only, are more serviceable than they ap- 
pear to be. Their solubility does not prove that they do not reach 
the intestine. This latter assertion was based on the belief in their 
absorbability while in the stomach. This organ, according to Melt- 
zer and other physiologists, absorbs but little; the soluble disinfect- 
ant is carried down into the intestine with the rest of the gastric 
contents; moreover, the effect of tincture of iodine or the iodide in 
its combination with iron or of resorcin is well established. It is 
mainly the latter which is very reliable, though in the test-tube its 
anti-fermentative action is no greater than that of chloral hydrate 
or nitrate of silver, and certainly inferior to menthol, thyme, beta- 
naphtol, or salicylic acid. 
Next to a thorough expulsion by purgatives of the infected contents 
in its efficacy in intestinal putrefaction and in secondary infection of 
the organism (partly through the general blood and lymph circula- 
tion and partly through the kidneys), stands the improvement of the 
surface of the mucous membrane. Like chlorate of potassium, which 
by healing stomatitis prevents cocci or bacilli from entering the 
circulation in the mouth, so tannin, or better, gallic acid, which is 
tolerated in large doses—from three to six or eight grammes a day 
by adults—bismuth subnitrate or subgallate, tannigen, tannalbin, or 
nitrate of silver improve the condition of the mucous membrane and 
its epithelial cover so as to limit absorption. 
During gastro-intestinal infection or intoxication the first indica- DISINFECTION OF THE ALIMENTARY CANAL. 
17 
tion is prevention by withholding or changing the food. Being 
taught by example and experience, I have not feared to deprive 
patients suffering from the vomiting and diarrhoea of gastro-intestinal 
infection of food for many hours or a day. Food introduced and 
brought up again and causing hyperistalsis and new infection is worse 
than food withheld. Of equal importance is a change in the selec- 
tion of food. Acid (lactic acid) dyspepsia requires (egg) albumin- 
water, albuminoid putrefaction in the colon demands farinaceous 
food. Milk must be withheld in these acute cases. Give no steril- 
ized or Pasteurized milk, no breast-milk. As I but lately said in 
an article on cholera infantum, in the Twentieth Century Cyclopcedia, 
under ordinary circumstances milk feeds babies, under extraordinary 
circumstances bacteria. None should be given until the discharges 
are no longer offensive. Small babies or adults may take a mild tea 
in drachm doses, or a few drops of whiskey in barley-water may be 
given in short or longer intervals. A mixture which I used and 
recommended these thirty or forty years in the infectious diseases 
of the infant, when the period of vomiting and diarrhoea and starva- 
tion had passed by, consists of 150 c.cm. of barley-water, the white 
of one egg, one or two teaspoonfuls of whiskey, and some salt and 
Milk-sugar should be carefully avoided in this condition. 
Of this mixture a teaspoonful is given every five or ten minutes. 
Dyspeptic children are very apt to suffer from erythema as the 
result of intestinal infection or auto-infection, sometimes to such an 
extent that the diagnosis between it and scarlatina may become 
doubtful. The difficulty grows in those cases in which the intestinal 
erythema is attended by a corresponding intestinal fever, which is 
not at all an uncommon occurrence, and is frequently mistaken for 
malaria. Constipation, which does or does not accompany dyspepsia, 
may in rare cases lead to the same result. The diagnosis of the con- 
dition is not always easy, for such reasons as the apparently normal 
condition of the stomach, the absence of diarrhoea, and the actual 
or alleged absence of flatulency. This erythema is frequent; it may 
last hours or days, or alternate with acute attacks of urticaria. The 
latter is, therefore, not always gastric or neurotic, but may be toxic, 
and thus share the etiology of many cases of acne and senile pru- 
ritus. \\ hen in the face it may be mistaken for erysipelas. 
This variety of erythema is sometimes seen on hands and feet, is 
symmetrical, and now and then, like urticaria, has vesicles of bullae, 
sometimes in the shape of herpes iris. When it accompanies intes- 18 
A. JACOBI, 
tinal infection, either imported or indigenous, it is usually accom- 
panied by indican and the ether sulphuric acids in the urine, which 
is liable to be very scanty and of high specific gravity. Skatol and 
indol are found in the feces. In most cases a purgative will bring 
instant relief—calomel is the best; but a lasting improvement will 
only come from protracted disinfection of the intestinal tract by 
naphthalin, salol, resorcin, oil of peppermint, small doses of calomel 
or bichloride of mercury, from large enemata containing one-twen- 
tieth per cent, of thymol, one-fortieth per cent, of permanganate of 
potassium, or from such as consist of aromatic infusions (catnip, 
mint, chamomile); from occasional purgatives, and from the regula- 
tion of the diet w hich should be so arranged as not to cause fermen- 
tation and putrefaction. The sulphites of sodium and magnesium 
have disappointed me. Menthol should not be advised; it can be 
taken, however, by older children or adults, but in capsules only. 
It has a local irritant effect and has no properties not possessed by 
other drugs. 
The practice of giving antifermentatives has preceded its theory 
for centuries. Still the theory is not quite so recent as some believe. 
In a paper on the “ Treatment of Infant Diarrhoea and Dysentery," 
published in the American Journal of Obstetrics, etc., 1876, I 
the following remarks : “ One indication is to destroy ferments. For 
that purpose most metallic preparations will do fair service. One of 
them is calomel; as to its effect as an antifermentative there can be 
no doubt. Possibly it acts by a portion of the drug being slowly 
changed into bichloride of mercury.” 
“ Alcohol certainly arrests fermentation.” “ Sometimes, particu- 
larly when the stomach can be relied on, the salicylate of sodium 
may be added to the internal treatment. . . . The salicylic acid 
may prove beneficial, both by its antifebrile and disinfectant action.” 
In my Intestinal Diseases of Infancy and Childhood, Detroit, 1887, 
I recommended calomel, bismuth, alcohol, creosote, salicylate of 
sodium, and resorcin. 
Irrigation of the intestinal tract is performed while the patient is 
on his side, with raised hips. The nozzle of the irrigator (fountain 
syringe) or of the tube connected with a funnel is introduced a few 
centimetres beyond the internal sphincter, or much more. In the 
adult with a normal sigmoid flexure a tube may be introduced from 
20 to 40 centimetres; but many reports of long distance introduc- 
tion are to be accepted with caution, for a stiff tube is able to raise DISINFECTION OF THE ALIMENTARY CANAL. 
19 
the intestine and may be felt in the hepatic region, while a flexible 
one is liable to turn upon itself. That is particularly so in infants 
and small children in whom the sigmoid flexure is multiple and can 
rarely be passed by an instrument. In them, as in most adults, the 
raising of the hip may be successful. In some cases it is advisable 
to raise the lower half of the body according to the method I have 
followed these thirty years to reduce intussusception; in these cases 
I raise the body considerably and support the abdomen by a soft 
pillow while the face is turned to one side to facilitate respiration. 
While the anus is firmly closed the liquid is allowed to flow in from 
a slight elevation, from 10 to 50 centimetres. A greater elevation 
raises the pressure to an unbearable point. A slight elevation will 
improve the tolerance of the intestinal tract, which may thus be 
filled to the ileo-csecal valve, and beyond. In rare cases the very 
stomach was reached. It is only an abnormal intestine, dilated in 
places, or bound down by previous adhesions, or normally sensitive, 
that resents the flow of the liquid by spastic contractions or pain or 
vomiting. The indication of a greater or smaller elevation is guided, 
in special cases, by the object or objects to be attained. Part of the 
liquid is absorbed, and quickly, too, sometimes. That is why, when 
that is not desirable, the irrigator should be raised. Then the 
intestine fills up more rapidly, and the return of the fluid, with the 
contents of the bowels, is more readily secured. From 1000 to 
2000 or more cubic centimetres may thus be introduced into the 
bowels of an adult with the result of a thorough cleansing. Tepid 
or cool water should be chosen in those cases in which there is hyper- 
thermy, water of the body temperature when the temperature is 
normal, hot water when there is hypothermy with or without actual 
collapse. 
Medicinal agents may be added to the water. Beside salt to form 
a physiological solution, I recommended subnitrate of bismuth in 
dysentery. In typhoid fever and tuberculous and other ulcerations, 
thymol 1 : 3000 to 5000, permanganate of potassium in the same di- 
lution ; or bicarbonate of sodium, 1 : 100 to 500, have served a good 
purpose when the secretion of mucus was excessive; less, however, 
in membranous enteritis than in the usual form of catarrh. Such 
irrigations may be repeated a number of times daily, according to 
necessity.