By the kindness of M. Mauclaire, I have been able to watch his patient during the last four years. I satisfied myself that after the supposed exclusion of the large intestine, food dejecta ascended the colon and emerged by the artificial anus. There was such an accumulation of waste in the large intestine that fragments did not emerge until three weeks after the meal of which they had formed part. It was only after the final operation, that in which the large intestine was separated, that the dejecta escaped only by the natural anus, whilst a little mucus containing microbes was passed through the artificial aperture. Even three years after the operation, mucus continued to escape by the latter aperture, it being shown thus that after the large intestine had ceased to be a channel for the fæces, its walls continued to secrete although otherwise it had lost its function completely. Nevertheless the condition of this patient improved and she lived perfectly well without a functional large intestine. She takes food well but has to go to stool three or four times a day and has a tendency to diarrhœa. The excreta are smooth and often nearly liquid, especially after fruit has been eaten.
The case I have been describing, and which I am still keeping under observation, demonstrates once more the uselessness of the human large intestine; it should convert the most sceptical critic. But it also shows that the suppression of nearly the entire large intestine for several years does not completely get rid of the intestinal flora. Even without this evidence, however, I do not suggest that removal of the large intestine can be thought of as a means to prevent the pernicious effect of the intestinal flora.
Is it possible, without operative interference, to take direct action against the intestinal flora by the use of antiseptics? Consideration of this is already ancient history. When the theory that the intestine was a source of auto-intoxication was propounded, M. Bouchard[122] made the attempt to cure such cases by disinfecting the digestive tube with [Greek: b]-naphthol. He found, however, that that antiseptic, like many others, not only did not completely disinfect the intestine but sometimes had a harmful effect on the body.
M. Stern[123] has shown, in an elaborate memoir, that such antiseptics as calomel, salol, [Greek: b]-naphthol, naphthaline, and camphor, when administered in quantities compatible with health, do not disinfect the digestive tube at all. More recently M. Strasburger[124] has shown that when naphthaline has been given in quantities sufficient to impart its odour to the fæces, the intestinal microbes, so far from being diminished, are even increased in numbers. On the other hand, after meals consisting of milk to which there has been added an antiseptic in the proportion of a quarter of a gram to the litre, the intestinal microbes are really reduced in number. Strasburger obtained his best results with tanocol. Two persons who used, according to this method, three to six grams of tanacol per day, displayed a notable reduction in quantity of the intestinal flora.
Strasburger’s conclusion was that “the attempt to destroy the intestinal microbes by the use of chemical agents has little chance of success.” It cannot be denied that under special circumstances it is possible to decrease the number of microbes, especially in the small intestine. But this result is small and may be followed by the contrary effect, for the natural means of defence of the intestine against microbes are weakened, and the intestine itself may be harmed more than the microbes.
Strasburger, moreover, is no convinced advocate of the use of purgatives. The diminution of the sulpho-conjugate ethers in the urine, which certainly may follow the use of purgatives, does not necessarily indicate reduced putrefaction in the intestine, but may point only to a lessened absorption of the bacterial products. Such an interpretation is supported by an observed fact; in the case of a dog belonging to Strasburger, which had a fistula of the small intestine, the diarrhœa induced by calomel was accompanied by an indubitable increase in the total quantity of intestinal microbes.
Strasburger thinks that the most favourable results can be obtained by aiding the intestine in the discharge of its normal function. If it can be brought to digest the food more completely, there is the less pabulum left for the microbes. A similar result can be reached by lowering the amount of food taken, and to this course the beneficial effects of starvation in acute diseases of the intestine may be attributed.
The general conclusion, reached after many experiments on the disinfection of the intestine, is unfavourable. Very little is to be expected from the method. None the less I cannot regard the matter as definitely settled. Cohendy has investigated the effect on the intestinal flora of thymol which was administered in several cases with the object of destroying parasites. From nine to twelve grammes of thymol were administered to each patient in the space of three days, and there was a notable antiseptic effect, Cohendy believing that the quantity of microbes had been reduced to a thirteenth.
Such facts prove only that the antiseptic treatment is available up to a certain point. To attain the results, however, such large quantities must be used that the treatment can be applied only in special cases and at long intervals. More use can be made of simple purgatives which do not kill the microbes but eliminate them by the normal channel. It has been urged repeatedly that calomel, which is often used as a purgative, acts also as an intestinal antiseptic; but it is probable that its influence in reducing the intestinal flora is merely mechanical. It has been shown that calomel, like some other purgatives, lessens intestinal putrefaction, the evidence being the decrease in the sulpho-conjugate ethers in the urine. But although the diarrhœa induced by purgatives generally has such a result, spontaneous diarrhœas such as those of typhoid fever and of intestinal tuberculosis are associated with increased putrefaction.[125]
It is clear, however these matters may be settled, that regular activity of the bowels, increased by the occasional use of purgatives, must diminish the formation of intestinal poisons, and therefore also the damage done by these to the higher elements of the body.