IV Intestinal Putrefaction Shortens Life
Uselessness of the large intestine in man—Case of a woman whose large intestine was inactive for six months—Another case where the greater part of the large intestine was completely shut off—Attempts to disinfect the contents of the large intestine—Prolonged mastication as a means of preventing intestinal putrefaction
The general measures of hygiene directed against infectious diseases play a part in prolonging the lives of old people, but, in addition to the microbes which invade the body from outside, there is a rich source of harm in the microbes which inhabit the body. The most important of these belong to the intestinal flora, which is abundant and varied.
The intestinal microbes are most numerous in the large intestine. This organ, which is useful to mammals the food of which consists of rough bulky vegetable matter, and which require a large reservoir for the waste of the process of digestion, is certainly useless in the case of man.119 In the “Nature of Man” I have dealt with this question at length, as it was an important example of what I regard as the disharmonies of the human constitution. A case upon which I have always laid great stress is that of a woman who lived for thirty-seven years, although her large intestine was atrophied and inactive, as this seems to be a remarkable proof of the uselessness of the organ in the human body. The small size or complete absence of the large intestine in many vertebrates confirms my conclusion. None the less, some of my critics think that my argument is incomplete. To strengthen it, I may call their attention to a medical observation which is as valuable as if it had been an experiment. It relates to a woman, sixty-two years old, a patient of Prof. Kocher at Berne. She had been suffering from a strangulated hernia associated with gangrene of part of the intestine, and had to be operated upon suddenly.
The gangrenous portion of the ileum having been removed, the healthy part was implanted in the skin so as to form an artificial aperture through which waste matter from the food passed to the exterior without traversing the large intestine. Although the patient was old and seriously ill, the operation, performed by M. Tavel, was quite successful. Six months later, in a new operation, the small intestine was rejoined to the large intestine so that the fæces were again able to pass to the exterior by the natural channel. In this case, then, the large intestine was thrown out of use for half a year, not only without injury to the general health, but with the result that the patient was completely cured and gained in weight. MM. Macfadyen, Nencki, and Mde. Sieber120 studied the digestive processes in the small intestine and the nutritive metabolism, and determined that these were active and healthy, the absence of intestinal putrefaction, that evil of the constitution, being specially favourable.
In six months of non-action, the part played by an organ can be satisfactorily estimated. M. Mauclaire,121 however, has put on record a case the history of which was longer. In 1902 he operated on a young woman and produced an artificial anus, there being no escape of fæcal matter by the ordinary channel. Ten months later M. Mauclaire operated a second time and shut off a portion of the intestine. He left the artificial anus, but cut across the lower end of the small intestine and inserted it near the iliac end of the descending colon (Fig. 19). For several days after the operation the fæces were passed by the normal aperture, as the small intestine now communicated directly with the large intestine, near the rectum. This condition, however, did not persist, for the fæcal matter began to flow back through the excluded portion of the large intestine, so reaching the artificial anus, and causing inconvenience. Giving up the hope that this would cease, M. Mauclaire performed a third operation twenty months later. He cut across the large intestine near the point where the small intestine had been artificially led into it (Fig. 20), so dividing the digestive tube into two parts, one of which remained in communication with the natural anus, whilst the other, consisting of nearly the whole of the large intestine, communicated with the exterior by the artificial anus. In the new state of affairs, the food refuse passed directly into the terminal portion of the large intestine, and thence, by way of the rectum, to the exterior through the normal anus without being able to pass up the large intestine towards the artificial anus. In this last operation about a yard of the small intestine and the greater part of the large intestine, the cæcum, and ascending, transverse and descending colons were removed from activity.
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. Bouchard122 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. Stern123 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. Strasburger124 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.
When I asked the relatives of Mde. Robineau if they could tell me of any special circumstance which in their opinion had contributed to the extreme duration of the life of this old lady, they replied as follows:—“We are convinced that a slight bodily derangement, present for the last fifty years, has tended to prolong the life of the old lady. It cannot be said that she has suffered from diarrhœa, but she has been often subject to frequent calls of nature.” It was most remarkable that the old lady showed no traces of sclerosis of the arteries. I may mention the strongly contrasting case of one of my old colleagues to whom a natural desire to empty the bowels came only once a week. A more frequent call was a sign of illness in his case. Now sclerosis of the arteries appeared in so marked a form that he died from it before he had reached the age of fifty years. This may be added to the list of facts which point to a close association between sclerosis of the arteries and the functions of the digestive tube.
Recently, at the suggestion of Mr. Fletcher,126 the advantage of eating extremely slowly has been recognised, the object being to prepare for the utilisation of the food materials, and to prevent intestinal putrefaction. Certainly the habit of eating quickly favours the multiplication of microbes round about the lumps of food which have been swallowed without sufficient mastication. It is quite harmful, however, to chew the food too long, and to swallow it only after it has been kept in the mouth for a considerable time. Too complete a use of the food material causes want of tone in the intestinal wall, from which as much harm may come as from imperfect mastication. In America, where Fletcher’s theory took its origin, there has already been described under the name of “Bradyfagy” a disease arising from the habit of eating too slowly. Dr. Einhorn,127 a well-known specialist in the diseases of the digestive system, has found that several cases of this disease were rapidly cured when the patients made up their minds to eat more quickly again. Comparative physiology supplies us with arguments against too prolonged mastication. Ruminants, which carry out to the fullest extent Mr. Fletcher’s plan, are notable for extreme intestinal putrefaction and for the short duration of their lives. On the other hand, birds and reptiles, which have a very poor mechanism for breaking up food, enjoy much longer lives.
Prolonged mastication, then, cannot be recommended as a preventative of intestinal putrefaction any more than the surgical removal of the large intestine or the disinfection of the digestive tube. The field lies open for other means which may probably solve the problem more completely and more practically.