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Editor:These are not links below, but titles of articles. And not all articles are on the website--yet. It has been a terribly time-consuming operation from scanning very poor copy the readable text. There are many errors, without doubt. But it is interesting.
Introduction-By Henry Pleasants, Jr., A.B., M.D., F.A.C.P
Original Articles by Burr Ferguson, M.D.
The Metchnikoff Idea
Hydrochloric Acid and the Phagocytes
Hydrochloric Acid and Oxygen Content of Red Cells
Quinine and Chlorides
Intravenous Hydrochloric Acid and Blood Transfusion
Stronger Solutions of Hydrochloric Acid
Does Hydrochloric Acid Intravenously Harden Arteries?
Hydrochloric Acid as a Germicide
Acne Vulgaris and the White Blood Cells
The Healing of Wounds
Original Articles By Walter B. Guy, M.D.
Degenerative Disease and Its Etiology
Acid Mineral Chlorides in Treatment
Toxemia and Alkalosis
The Conquest of Cancer
Relation of Iron to Neoplastic Disease
Treatment of Cancer
A Further Report of Cases
Acid Mineral Therapy in Cancer
Original Articles of Other Contributors
Dilute Hydrochloric Acid Intravenously and Intramuscularly-- Therapia Sterilisans Magna? By Desiderius de Beszedits, M.D.
Nature is the Best Doctor, by William I. Howell, M.D
Hydrochloric Acid Injections Produce Leucoocytosis-- By William Howell, M.D
Hydrochloric Acid Injections in Acute Infection? By William I. Howell, M.D
Hydrochloric Acid Intravenously as a Therapeutic Measure, with Report of Cases, by W. G. Brymer, M.D., Ph.G
The Use of Hydrochloric Acid Intravenously. by M. A. Craig, M.D.
An Attempt to Rationalize HCl Therapy, by A.M.Allen, M.D.
Case Reports and Comments:
Erysipelas-Streptococcous Infection-Hay Fever-Arthritis By F. J. James, M.D
The Use of Hydrochloric Acid in the Treatment of Cancer. By 0. P. Sweatt, M.D
The Use of HCl in Hodgkin's Disease. By M. M. M
Reactions to HCl Injections. By R. L Bills, M.D
Hydrochloric Acid Intravenously in the Treatment of Puerp"
Infection. By R. S. Ingale. M.D
Treatment of Malta Fever. By C. W. Baynharn, M.D
Hydrochloric Acid in Puerperal Septicemia. By 0. F. Marcotle, M.D
The Hydrochloric Acid Intravenously. By L. D. Jackson, M.D.
HCl Applied in Nose. By A. Bursell. M.D
Hydrochloric Acid Intravenously. By Alphonso F. Raynes, A.B., B.S., M.D
A New Treatment for Burns. By C. W. Baynham, M.D
HCI Intramuscularly. By P. L Gordon. M.D
Miscellaneous Reports and Comments
Picking A Winner
The demand for reprints and previous issues of THE MEDICAL WORLD containing articles by various contributors on the subject of hydrochloric acid therapy exhausted the supply of material available. In order to meet this increasing demand, we have collected in one volume the original articles and minor comments which have been published in this magazine during the past three years.
This collection of reprints is a unique feature of medical journalism and should be of valuable aid to any physician who desires to review the literature on this subject. It must be remembered, however, that this volume covers but three years ending early in the summer of 1935, and that some extremely important contributions have been published since that date.
It is to be hoped that this volume will fill a long felt need, and that it will stimulate further individual research on this most interesting development in therapeutic procedure.
The awakening of interest on the part of the medical profession in the use of dilute hydrochloric acid intravenously intramuscularly, orally and locally in the treatment a many disease conditions warrants a condensed outline of the principles upon which this therapeutic measure is based; a resume of our own experiences with it in certain cases; a frank discussion of its limitations, and a general outline of its possibilities. The fact that this agent is so inexpensive; that it is not an exploited compound put out by pharmaceutical manufacturers, and that its usefulness was developed by two practicing physicians, working independently along entirely different theoretical lines, brings this remedy into a position of economic importance that should not be disregarded.
Since the days of Hippocrates, medicine has been seeking for some remedy which would be efficient in stimulating the resistive forces of the human body to combat disease. Even following the discovery of bacteria as the cause of most of the diseases to which human beings are susceptible, the effort to stimulate personal resistance went hand in hand with the effort to discover a germicide which would destroy the bacteria without producing harmful effects on the patient.
Metchnikoff in the early years of this century presented his theory that the resistance of the body to disease depended upon the activity of the phagocytes of the blood, the polynuclear leucocytes. It was not long after this that Ehrlich announced his discovery of "606," an arsenical preparation which would destroy the spirochete of syphilis. He believed that it was possible, through chemistry, to evolve remedies which were of tremendous sterilizing power. Without attempting to explain the intricate features of the "opsonic theory of Metchnikoff, and the "side-chain" theory of Ehrlich, the fact remains that the scientific workers of the profession split into two groups, each supporting one of these theories, although granting the logical importance of the other. In 1931, however, the theory supported by Ehrlich was allowed to pass into the discard as being untenable.
During the World War, a practicing physician, Dr. Burr Ferguson, of Birmingham, Alabama, entered the service of the United States Army Medical Corps, rising to the rank of Lieutenant Colonel, and seeing much surgical work in the hospitals of France. After the war, he volunteered his services with the Red Cross in Siberia, later being sent to Albania in the Balkans, where he studied typhus fever in association with Colonel Hans Zinsser. Returning to America he entered the Public Health Service for a few years, later resigning and taking up general practice. During these years of active military and public health work he had given much thought and attention to the effect of many of the powerful remedies which were being employed in the treatment of war wounds.
One of the first of his observations was the recovery of a long standing case of osteomyelitis following shrapnel wounds immmediately after the administration of intramuscular injectiions of salicylate of mercury. In this particular case there was no history of syphilis, and the Wassermann was negative. He studied the blood of this and other similar patients, and noted a remarkable increase in the polynuclear leucocytes following each injection. He continued his studies both during and after the service, and discovered that the same increase of polynuclear leucocytes was noted following the administration of most of the so-called specific remedies, such as arsphenamin, bismuth and others.
He presented two papers on this subject, which appeared in the British Medical Journal and the Lancet about 1928 while he was doing public health work in England. His findings were commented upon most enthusiastically by Sir Arbuthnot Lane, who stated that he believed that Ferguson had made a most important contribution to science, but that his work would be ridiculed by most of his colleagues in America. He advised him to continue his investigations.
From this time on, Dr. Ferguson studied the influence of various drugs on phagocytosis. The effect of the intravenous injection of mercurochrome was particularly powerful as a phagocytic stimulant, but its toxicity was dangerous. The same was true of other remedies. His observations showed that alcohol was an active phagocytic stimulant, but the ability of the phagocytes to combat the bacteria was lessened. He also found that nearly all of the physiotherapeutic measures, from mustard plasters and cantharides blisters to the most modern radio-thermic appliances, were of very definite value in producing a marked leucocytic and phagocytic response. The same was true of bleeding transfusion, injections of whole blood, injections of sterile milk, leucocytic extracts, bacterins and other similar measures. Their value in certain cases was unquestioned, but their action depended solely upon the principle that was as old as Hippocrates, namely the stimulation of individual resistance.
The problem before Dr. Ferguson now was to find some remedy which would be successful in stimulating phagocytosis, yet non-toxic. In 1927 he heard Dr. Granville Hanes, a noted proctologist, and studied this surgeon's technique in treating pruritus ani by injections of 1-3000 hydrochloric acid. Apparently, this acid could be used in strengths of 1-500 without any evidence of toxic effect, yet with uniformly good results clinically. Dr. Ferguson attributed this absence of toxicity to the fact that hydrochloric acid is one of the very few inorganic acids which are normal constituents of the human body, and he determined to experiment upon himself in order to discover whether it could be used safely by intravenous injection. Upon his return home, he instructed his technician to take several leucocyte counts; then give him an intravenous injection of 10 c.c. 1-500 solution hydrochloric acid. There was no severe reaction, as in the cases which had received arsphenamin, mercurochrome, donor's blood; and the leucocyte count increased very considerably with a definite increase of polynuclear percentage. With this encouragemcnt, he gave several doses of this preparation to some of the most seriously ill patients who had failed to respond to other forms of treatment. The effect was so spectacular that he continued his efforts, and reported his observations in Clinical Medicine and Surgery.
Considerable skepticism was expressed by the leaders of the medical profession not only as to the value of such a simple procedure, but also as to the veracity of the reports of clinical improvement. Strong criticism was voiced against intravenous injection of such a powerful acid, even in dilute form. Many men refused to give it clinical trial on this ground; and on several occasions Dr. Ferguson was refused permission to publish articles on the subject or to discuss the matter before medical gatherings.
THE MEDICAL WORLD gave honest support to Dr. Ferguson and permitted the publication not only of articles submitted by him, but also by other physicians, including Dr. Walter Bryant Guy of St. Augustine, Florida, who was approaching the same subject of hydrochloric acid therapy from a somewhat different angle, and whose research was of equal importance. His work deserves a brief description at this point.
Dr. Guy formulated a theory that most disease conditions, acute infections, anemias, metabolic disturbances and malignant cell overgrowths are the direct results of changes in the hydrogen-ion content of the lymph of the body which produces blockage of the lymph channels. In his studies of the growth of corn and other forms of vegetable life, he had been able to demonstrate that the absence of sufficient potassium salts in the soil would result in stunted growth, and evidence of precipitation of minute particles of iron and other substances in the stalks. When potassium was added, the growth proceeded normally; when dilute hydrochloric acid was also added, the growth was further stimulated. He studied the lymph of a large number of patients suffering from carcinoma, and found that these cases showed a hydrogen-ion much higher than normal individuals. He also found that by administering the salts of potassium in combination with dilute hydrochloric acid, either orally or by the intravenous route, these patients made remarkable clinical improvement, and the hydrogen-ion content of their lymph became normal. The publication of his series of articles in THE MEDICAL WORLD was followed by a large number of case reports by practicing physicians who greeted the new therapeutic procedure with great enthusiasm. Dr. Guy published his first book on this subject in 1934, and a revision in 1935.
Having thus far presented a brief summary or the prodigious work of Ferguson and Guy,it may be well to call attention to the fact that Ferguson was approached by one of the largest pharmaceutical houses and offered a large sum of money to cease his efforts to place his discovery before the medical profession except through the medium of products of this concern. Although in actual financial distress, he refused this offer, and has continued in general practice, thereby exemplifying the spirit of the Hippocratic Oath as few men have done. Similarly, Guy presented to the profession all of the results of his research, including his formulae and continued his work in general practice. These two instances of utterly unselfish devotion to the interests of humanity are an object-lesson to every practitioner.
While no attempt has been made to claim for hydrochloric acid therapy that its use intravenously produces the effect described by Ehrlich as "Therapia Sterilisans Magna," which he claimed for his original compound "606", it is interesting to note that laboratory research showed very definitely the actual germicidal properties of dilutions of this acid. Cultures of staphylococci and streptococci and other "organisms" were destroyed within a few minutes when mixed with dilutions 1-1000. This observation led to the use of the solution as a local application in pustular skin affections. The effect was so spectacular that its importance is no longer questioned. Ferguson demonstrated its efficacy as a urethral antiseptic in gonorrhea by being able to obtain negative smears in from two to three days, and by being able to alleviate the distressing symptoms of burning and tenesmus (spasmodic contracture of the bladder sphincter with pain and persistent desire to empty with involuntary ineffectual straining) in even less time. Even bladder irrigations of solutions as strong as 1-500 were tolerated satisfactorily by the patients, and there was no evidence of the destruction of normal tissue cells which often attended the use of other antiseptic solutions such as the silver salts, potassium permanganate and the like. Most interesting of all was the report by Ferguson of his success in the treatment of a most aggravated case of pustular syphilides (secondary stage).
The attitude of the medical profession toward the work of Ferguson and Guy has been highly amusing, and deserves a word of comment. Many of the leaders of research, whose observations coincided with the clinical results obtained by practitioners, refused to allow their names to be used in connection with the work done. Others openly ridiculed the whole theory as preposterous, and refused to allow this simple therapeutic measure to be employed in their clinics.
However, it has been found that the makers of sterile ampules admitted frankly that the demand for ampules of hydrochloric acid dilutions vastly exceeded the demands for all other preparations, and the largest consignments were delivered in the city where most of the open criticism and ridicule was heard! In other words, the leaders of the profession in many places were giving the measure a full trial and finding it efficacious, yet were unwilling to admit the fact.
The story of this revolutionary episode in medicine grows more interesting and more dramatic day by day. The suffering patients in the country districts, far from the well- equipped clinics and hospitals, have at last found that something can be done for them. Whether or not it meets with the approval of the solons interests them not at all. They ask for relief-and they get it, where the applicability of the measure to their complaint is obvious.
It would he unwise and unfair to both the medical profession and the public to discuss the merits of hydrochloric acid therapy and fail to call attention to its limitations, and to the actual dangers attending its use in certain cases. We have called attention to the fact that the use of the acid intravenously was followed by a considerable increase in the leucocyte count.
A patient who had been suffering from myelogenous leukemia, with a leucocyte count of 84,000 (the normal count being 6,500) was inadvertently given several venous injections of this preparation, with the result that the already high count rose to the unbelievable figure of over 400,000. Obviously, it is poor medical judgment to give a remedy that can only aggravate an existing condition.
Another important--vitally important--consideration affecting the administration of hydrochloric acid is one which depends upon accurate and painstaking investigation of the individual by the practitioner. Since this measure has the effect of stimulating the defense mechanisms of the blood, it is plain that the sudden increase of "phagocytes" at the focus of infection will be followed by the formation of pus, which, after all, is but an effort on the part of nature to attack invading bacteria. Should this sudden increase of the defense forces take place in an area where the drainage is poor, an abscess may result. For instance, a patient may have a diseased appendix which has been quiescent; there has developed in that patient a balance between the defense elements and the infecting oganisms. A sudden marshaling of the phagocytes at this point may stir the sleeping dog into a first-class battle, with the result that the patient will require immediate operation. Similar situations may develop in other parts of the body, particularly in closed spaces such as the middle ear and sinuses, and the patient must be watched closely for the development of acute symptoms that might require surgical treatment.
From a prognostic standpoint, the inability of the patient to respond to stimulation is of grave significance. This is readily determined by the blood counts made at frequent intervals during a course of treatment; in fact, it is highly essential that progress of every case be watched by an intelligent and observant physician. While astonishingly good results have been obtained by hit-or-miss methods in country districts by physicians who are without laboratory facilities, it is reasonable to assume that more care is mandatory on the part of those whose facilities are greater. The fact that there have been no reported cases of death as the immediate result of this medication speaks volumes for the safety of this measure.
It may be well to discuss in simplest terms the essential differences between the methods of hydrochloric acid medication used respectively by Ferguson and Guy. There is little to be added to what we have said in the preceding paragraphs regarding Ferguson's technique and the principles upon which his reasoning has been based. He is essentially a man of practical, rather than theoretical, ideas. He proved to his own satisfaction that intravenous injections of dilute hydrochloric acid stimulated phagocytosis and produced spectacular recoveries from apparently hopeless infections without harming the patient. Furthermore, dilute hydrochloric acid was a practical and cheap germicide, of greater potency and less destructive action than anything thus far discovered. Why, how, when and where its action occurred were of less importance than the fact that the patient got well. Dr. Guy was more scientifically min4ed. Although also a general practitioner, he was determined to discover, if possible, a basis for the formation of a theory. He was a student of biologic chemistry, and from his knowledge and observation of plant life and its behavior under the influence of hydrochloric acid and the salts of potassium in the soil, he believed that certain similar principles applied to the growth and nourishment of human beings. Most important of all, he based his hypotheses on the observations of Hawk, that lymph circulation, which is the medium by which nourishment carried to every cell in the body, is of as great importance as the blood; and any condition, whether chemical or physical, which interferes with the flow of lymph produces a profound effect on the cells of every organ in the body. He has reduced his theory to simple and easily understood terms by a full explanation of the significance of the acid-balance of the human body, and the necessity for a proper maintenance of this balance for the preservation of health.
Under normal conditions, the hydrogen ion concentration of human lymph should be slightly on the alkaline side. Should this reaction vary too much, either on the acid or alkaline side, the patient will develop conditions known respectively as "acidosis" or "alkalosis," either of which may be fatal.
In health the acid balance is maintained by the normal production of hydrochloric acid in certain cells of the stomach; should this production fall short of bodily necessity, the balance must be made up. Other acids, which are the products of decomposition in the human body, such as lactic acid, fatty acids, carbonic acid, uric acid and others, are called in to fill the deficiency. These however, being abnormal constituents of the great chemical laboratory of the human body, are ill-adapted to the requirements, for they are unable to keep in solution many of the salts which must be thrown off as waste matter in bodily excretions, the sweat, the expired air, the urine and the feces. In the effort of the body to provide acid of some sort, these harmful acids become a "monkey-wrench in the machinery," and the condition known as "acidosis" results with symptoms of general systemic poisoning.
Conversely, when the hydrogen-ion concentration of human lymph falls into the acid side, due to excess production of lactic acid, fatty acids, carbonic acid, uric acid and like poisons, there is an effort on the part of the body to neutralize these with alkaline salts, such as calcium, sodium, potassium, ammonium and others. These also, being foreign to bodily cconomy, produce the condition known as "alkalosis," the general symptoms of which are similar to acidosis,but often attended with general collapse. R
Dr. Guy has claimed that the mere administration of hydrochloric acid to a patient would not fulfill the necessary requirements. In his opinion, potassium salts, often lacking in the patient's food are a necessary adjunct in the treatment aimed at bringing about a normal acid-base balance. Excess of potassium may be harmful, and the ingredients of the formula which he advocates are the result of close clinical observation by himself and others. The case reports following this line of treatment have demonstrated improvements and recoveries which, in many instances, would seem miraculous, if it were not for the basis of sound reasoning along bio-chemical lines upon which the treatment was founded.
Furthermore, if these reports were offered by the protagonist of such a system therapeutics himself alone, skepticism would be justified; but the fact remains that from all parts of the world come infinite numbers of similar reports from men in active practice-shrewd and experienced physicians on "the battle line of medicine."
Actual and prompt clinical results to such men mean bread and butter. Satisfied mean an increase in clientele. These men are willing to leave research to the workers in heavily endowed laboratories. Their patients are more interested in being cured than in the scientific aspects of the disease from which they are suffering. These patients ask them to "do something"; and they know that unless something is "done" they will drift into the hands of some charlatan who will at least give evidence of some definite form of active treatment, even though hopelessly misdirected.
The application of the principles of the principles of the hydrochloric acid therapy, or the "acid-mineral therapy" to various metabolic disturbances such as diabetes mellitus, arthritis and many obscure conditions, is deserving of serious consideration. The most elementary lessons in chemistry in our public schools teach that various substances may be held in solutions of given degrees of acidity or alkalinity. When the proportions of the ingredients are perfectly balanced, the solution may be as clear and colorless as water; but let the acidity or alkalinity change a minute fraction of a degree and a turbid fluid will result, with the accumulation of a precipitate at the bottom of the container. With this explanation, it is by no means difficult to understand how the normally clear and colorless lymph of the human body might, by a change in its chemical reaction, begin to become cloudy, and to deposit the salts, such as calcium, which should be held in solution. The deposit of these salts in joints must, naturally, interfere with the free and well- lubricated action of these joints. Could not such a change in chemical reactions explain the enormous deposits of lime salts in old arthritic patients?
Similarly, if the lymph should become turbid and sluggish is there not reason to infer that the lymph channels would become blocked, and the normal amount of nutrition be denied such structures as muscles, bones, cartilage, skin, in fact every other component of the body? By the same line of reasoning, is it riot likely that the products of decomposition which should be removed by tht lymph, would remain in the tissues and act as poisons to the delicate individual cells? On this basis can we not explain the atrophies of muscles which are so characteristic of arthritis? With so many of the cells of the human body becoming degenerated, is it not inevitable that the blood-making cells should also be affected? Anemia is a characteristic symptom of arthritis.
The applicability of the theory of Guy to diabetes mellitus is still under consideration. If it be true that by appropriate medication it is possible to restore the acid-base balance of the blood or lymph, the possibility of ultimate cure in these cases seems not unreasonable. Certainly it seems within the bounds of probability that the tendency to acidosis from the absorption of harmful metabolic products would be lessened; conversely, the tendency for the development of hypoglycemia and alkalosis from overdosage with insulin would be minimized. At best, insulin is but a crutch upon which the diabetic patient leans heavily, and the medical profession is still seeking some form of treatment which will correct the abnormal metabolic disturbances which have produced this distressing condition. We can see most clearly, however, that it must be the interference with the circulation of the blood and lymph in the extremities which brings about diabetic gangrene. Even a slight improvement in this circulation would be productive of much relief to the patient.
The most startling possibility in the development of the acid-base balance theory---one which we approach with the same feeling that one approaches the spot where a treasure chest is said to be buried, is that it might be the key to the vault in which lies the secret of cancer. Research foundations, notably the department conducted at the University of Pennsylvania by Dr. Ellice MacDonald, have been working for years on the theory that the development of cancer has a definite relationship to the pH of the blood plasma. Dr. Guy goes one step further in holding that the lymph is the responsible factor, and that in cancer patients the hydrogen-ion concentration is much higher than in normal individuals. It is necessary to give very large doses of appropriate acids to these patients in order to bring the acid-base balance to normal. When this is done, in his experience, remarkable changes are seen in the new growths, some of which seem to disappear, and the lives of the patients are prolonged in comfort. He carries his theory further by claiming that there seems to be little doubt that the water supply bears a distinct relation to frequency of occurrence of this disease in certain areas or "cancer belts." He is studying this problem at the present time.
It seems but reasonable to discuss at this point the theoretical weaknesses in the claims of both Dr. Ferguson and Dr. Guy as to the efficacy of hydrochloric acid, or acid-mineral therapy. First of all, are the remarkable results that have been reported actual facts, or figments of the imagination of an enthusiast? In the reports of Dr. Ferguson we find a wealth of clinical observations, made before and after treatment, to support his statement that intravenous administration of solutions of hydrochloric acid will actually increase the polynuclear leucocytes of the blood. Ferguson stops theorizing at this point, and perhaps, is wise. Whether or not this increase is due to change in acid-base balance, or to stimulation of hormone action is for someone else to determine. In our own studies clinically we are forced to agree with him. The records of our cases in the wards where this procedure has been given a fair trial show conclusively that in each case observed there has been definite improvement as indicated by the blood-counts. Furthermore, the objection raised as to the possible toxicity of this procedure has not been borne out by our experience.
A patient, suffering from some obscure cerebral disturbance, and in coma upon admission, lay unconscious for several days. Spinal drainage showed a pressure so high that on several occasions it could not be recorded. The Wassermann (test for syphilis) was negative, the cell count was 225, sugar 2-plus, and globulin 4-plus, culture negative. There was choking of the discs, but definite localizing symptoms were difficult to determine because of the man's stuporous condition. Soon after admission, even in the absence of a positive spinal Wassermann, he was given .9 gms. neo-arsphenamin, followed by spinal drainage.
This seemed to improve his general condition temporarily, but he soon relapsed into unconsciousness, became incontinent and developed Cheyne-Stokes breathing. The end seemed imminent. By chance, Dr. Burr Ferguson, who was on his way to the A.M.A. convention, was asked to see the patient. He agreed with the suggested diagnosis of meningo-encephalitis, with the possible development of cerebral abscess, but unhesitatingly advocated heroic doses of hydrochloric acid intravenously.
Acting upon his suggestion, the man was given 20 C.C. of a 1:500 solution. There was no evidence of untoward reaction. By misunderstanding, a second dose of the same strength was given two hours later, also with no ill effect. Injections of 1:500 solutions were continued every two days, but with little appreciable effect, except a marked increase in polynuclear leucocytosis. Several days later the patient showed slight improvement, but was developing bedsores and a pustular eruption on his back and buttocks from the continual soiling. A local application of 1:1000 HCl solution was immediately successful in bringing about rapid healing of these sores. For a time the man was able to converse intelligently; was able to take food, and, on one occasion, climbed over the sides of the restraining crib to the floor, and appeared in the ward walking normally.
His spinal pressure still remained high--so high that it could not recorded by the manometer--but his temperature came down to 99.0 F; pulse 72, and the spinal cell-count fell to 31. The man was later removed to the University Hospital and died following an operation in which a large brain tumor was removed.
A second case in the wards was that of a young man, admitted in serious condition with signs of pneumonia involving the left lung. He was treated by the usual methods, and recovered from the more acute condition, but the involvement of the left lung and pleura refused to clear up. X-ray examinations showed evidence of some fluid, or thickened pleura on the left side; and the physical signs over this area supported this diagnosis. His temperature began to develop the characteristic septic swing from normal or subnormal to 101.0 or 102.0 F., with sweating and chills. An aspiration was attempted, but no fluid obtained. He was given 1:1500 injections intravenously, 10 c.c., every second day. Immediately improvement was noted in his general condition, but in a day or two he complained of considerable left-sided pleuritic pain and discomfort in breathing. The X-ray showed some increase in the shadow over the left base, and the breath sounds became more indistinct. A second aspiration was successful and 40 c.c. of cloudy fluid obtained, which on examination showed pneumococci and short-chain streptococci. The patient stated that he experienced immediate relief from his pain. The following was much more comfortable, and the temperature began to come steadily down to normal. He was given the acid-mineral solution (formula of Guy), 12 drops every 3 hours, with continuation of the intravenous therapy. His condition immediately became extremely satisfactory, his normal and he began eating ravenously. His leucocyte count fell to approximately normal, as might be expected where the necessity for phagocytic activity no longer existed. We mention this case to illustrate the point emphasized in the first part of this introduction, that collections of pus may be expected in closed cavities when phagocytic activity is increased. In this case, however, the mere withdrawal of a portion of the infected fluid was sufficient to throw the balance in favor of the patient. A thoracotomy, with weeks and months of drainage and discomfort, to say nothing of expense to the hospital, seems to have been obviated by this simple therapeutic procedure.
In conclusion we wish to say that we feel that the medical profession is probably entering upon an era of remarkable discoveries, based upon the logical theories of Dr. Guy and Dr. Ferguson, who are at the present time sufferinq from the stings of skepticism on the part of many of their colleagues. We realize most fully that many steps must be taken before the procedures advocated by these pioneers can be accepted by the conservatives. Careful checking of results by laboratory investigation will eventually establish or disprove the assertions made by these men. However, it seems incumbent upon progressive practitioners to make every effort to assist in the clinical research which may later prove of unbounded assistance in the healing of the sick patient. We have been led along the paths of synthetic medication for too many years, to the detriment of too many sufferers, as evidenced by the growing incidence of serious blood disturbances, such as agranulocytosis, methemoglobinemia and others. We have often relieved pain without attacking the underlying cause; we have operated when resistance was at too low an ebb; we have prescribed remedies empirically, without clear-cut knowledge of their action or collateral effect. Let us make a determined effort to follow our lines of treatment with scientific exactness, and, if we feel justified in assisting the work of Ferguson, Guy and others, we may either offer conclusive proof in condemnation of its principles or congratulate ourselves on being able to support the efforts of its advocates by accurate clinical proofs and painstaking case records.
HENRY PLEASANTS, Jr., Associate Editor
THE MEDICAL WORLD
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