ORIGINAL ARTICLES
of
Burr Furgason, M.D.
Birmingham, Ala.

THE METCHNIKOFF IDEA

Much of this is unedited because what I copied from was in an old journal of about 1933 inbad shape. Loren Parks

It seems the time has at last arrived when we may crystalize all of the millions of case histories, with their innumerable therapeutic observations, to confirm the truth of Metchnikoff's conclusion, that "the one constant element or factor in resistance, whether innate or acquired, is phagocytosis."

All too long we have used the work of this remarkable observer in the white counts as an indicator of infection for the surgeon or the internist, after which we have paid no further attention to the little bodies that keep a man from harm.

Bleeding, cupping, counter-irritants, diathermy, the much discussd short-wave cabinet, mercury, arsenic, quinine, insulin transfusions and the serums, and cold water, and whiskey, all have an immediate effect on the most sensitive cellular system. So, since all these procedures have a common efiect on this system, we must attribute an essential element in the good results to this cellular stimulation.

Now, since studies in Germany and in this country, as shown by the recent paper of Dr. S.M. Alter before the American College of Physicians in Montreal, demonstrate that cancer, diabetes and many infections are accompanied by a pathological variation of the acid-base on the alkaline side, we must look for an agent that will not only stimulate the cellular and glandular forces, but also modify the excessive alkalinity, and the agent that meets all these require­ments is----hydrochloric acid.

Another thing which I may have left out of the paper in MAY WORLD is: All the drugs with which I have worked, with repeated use, lose their clinical potency. Many counts with these agents have shown that with the lessening of the clinical effect goes a weaker stimulation of the white cells. This explains the teachings of the series of courses. These rests permit the body to re-establish a sensitiveness to the drug; so that again when it is administered the white cells are again stimulated in numbers and activity. With HCl, however, this tolerance is not established; so that the last injection is just as strong as the first. I have a case of tabes (a gradual,progressive wasting in any chronic disease) I use to illustrate this fact for occasional visitors. This man has had the HCl since January, 1928; several hundred injections. With the acid I have kept him from pain and enabled him to walk. He could not walk across a room when I saw him first in 1928. By the way, it is not the fever of malaria that helps the paretics and such cases as mine--- no temperature of 104 or 105 ever burnt up a germ, but the leucocytosis of the inflammatory reaction does destroy micro-organisms.

The fascinating thing to me about this work is that it is as old as the Eden tree and as new as a new "cut tooth." How Metchnikoff could have missed anything so simple is a mystery to me. For all the time that he was standing the profession on its beam ends in trying to make us use the white cells, we were saying that his counts might be good but, since he was only a chemist, he was treading on sacred ground when he talked to us about therapeutics. All the time these discussions were going on we were using the Metchnikoff theory in the only positive therapeutic agents then known: mercury, arsenic, and quinine. So, if Metchni­koff had known that the "specifics" were but stimulants for the white cells, Ehrlich would have been known because of his excellent salvarsan and there would never have been a side-chain theory of immunity. All of which but confirms the truth of Lord Lister's introduction of Metchnikoff to the British Medical Association in 1896, when he said: "The history of phagocytosis furnishes the most romantic chapter in pathology."

I am absolutely bewildered by the effects of these acid injections. On April 22d, 1933 a boy came to me with an ordinary myocarditis one sees sometimes in syphilis. At the city clinic he had 36 injections of arsphenamin and bismuth. The Wassermann had been brought down to 2+. But he said he could go no further with the awful reactions, nausea, chill, fever and other effects on his heart. That after the last injection of the arsenic he felt as if he would die. Heart, 130; irregular, and the negro had the grayish color that one sees regularly in his race when they are very ill. Truly a hopeless prospect. After 3 cc of the acid intravenously he almost faiinted; so that we had to withdraw the needle and put him on the table to recover. This he did in a quarter of an hour, when I finished the injection without further trouble. On the 24th he returned vastly improved in looks; heart below 100. And I was pleased to hear him say that since the fainting attack he had felt nothing but good. And that this was the first injection in the arm that had not made him worse than he was when he took it. Another injection on the 24th and I saw him no more until May 4th. To my bewilderment we found be had put on 10 pounds in weight, heart regular and 88, and a negro who is confident of the future.

If nothing else save the comfort and relief given to patients with a defi­ciency of the HCl in the stomach or to old men with alkaline urine, had been done, all the work has been well worth while in the remarkable results that follow the intravenous injection of the acid.

HYDROCHLORIC ACID AND THE PHAGOCYTES

Satisfactory surgical procedure is governed by two essential factors: first, the training, experience and skill of the operator; second, and juite as important as the: ability of the surgeon, the repair of the operativc wounds. This feature of the wonderful work of

Cc surgeons is left altogether to nature, and, when this natural p!(Ke!m fails, as we have all seen from time to time, the operation is said to be a failure or simply an improved case. So far as I know, no suggestions are made in tcxt-books or teaching of any direct method of giving nature any positive aid beyond the conventional directions for diet and general care.

As a basis for the following case !c rt, illustrating the failure of nature in collaborating witra skillful surgeon suppose it is said that the repair of wounds is but one ol the ubiquitous activities of the white' blood cells and that these cells do the most cfficient work in a medium of modi­fied alkalinity of the blood stream. If it be granted that this idea renders the phenomena of repair a bit clearer, one should we a marked healing activity in surgical wounds a a quarter Of 81 bk On the 2 th &d I was Xased to ad filt nothing but good that had not made after a stimulation of the cellular forces.

After every surgical procedure there is an increase in the numbers and activity of the white blood cells, greater or less according to the size of the wounds and the loss of blood. So a furthcr stimulation of these cells would be but an application of the conclusion of William Harvey, almost 300 years ago: "Nature herself must be our adviser; the path she marks must be our walk."

For the buss clinical medical man 'in general practice whose time an resources do not permit frequent counts of the blood cells, it might be interesting to recall the un­believable numbers of the white blood cells provided by the body, not only for the repair of wounds but also in the elimination of harmful germs and the dern3ition of pathologi. cal tissue. Seven to eight thousand white cells to the cubit millimeter seems casual. But when one considers that a man of i6o pounds has about six liters of blood and that each liter has normally about eight billion of the forces of repair and j.4ense, or forty-eight billion in the circulating medium, the bountiful provision of nature is better com­prehend d. So with each increase of i,ooo to the cubic millimeter, a billion more cells is added to each liter. It would seem that it would appeal to us to work with such a force.

To illustrate the good work of the surgeon and the failure of nature in her essential work of repair the following case is reported:

About the first of August, 1933, I was called to see a case of acute infecdove insman. A well-markedpallor and evident looso(weillit,jiving evideaceof some chronic ailment of hn wife save me really more interest than the scuft illness for which I had been cala In firply to my request for infiormatim as to how the was Was so much blood. she told me that in igig she bad been operated on for an'trifection about the anus and internal But that following the operation there had been little or no d6 se the 'a to or P P:: bleeding and that every evacuation was accompanied by mor whicl; was said to come from ulcerations about the anus. 11hat ow thi advice of the surgeon she dilated about twice a week a me& consteicl anus, which was also always pa6kL

Since there seemed to be no means of making a satisfactory rectal examins. tion I accepted her report of the diagnosis of the surgeon.

Clinical experiences of the past ten years ka!ing convinced mie that the stimulation of the white blood cells induces a noticeable i , Pase mod activity in the healing of wounds, I felt very sure that the bleeding would be easily controlled. At once I began the daily injectiom of i-iooo solutions iolf hydrochloric acid (Lacur). 0* the fourth day I was told there was ms evidence of any bleeding. and after the first week the patient me longer Gilt it necessary tj dilate the issue. and felt much better. During the third a senes of fourteen injections of the acid, I had so e week, in pportunky kit a rectal examination in my ollice. The anus seemed to be mormid. as no undue pressure was accessary in the insertion of the rMtoseopt. Numerous cicatrices of mallet ulctrs and several larger Laiku-mL am cons. pletely healed. were wee. but am active process of healing was ob;;ivable. The acid injections have been continued about twice a week and after the 2stb injectiom all lesions are completely healed.

The observations of the changes in weight of this patient indicate clearly the benefit of this plan in the healing of wounds. Before the rectal involvement this patient weighed 1140pounds. At the time of the operation in ic)29 she weighed i3o pounds. Two months after the operation her weight was about soo pounds. In the four years since the greatest wclRht has been iog pounds.

When the injections of hydrochloric acid were started on August ist she weighed ioS pounds. Since that time there has ~an :Fadual increase in strength and weight and on October 6th e weighed iig pounds.

One may conclude fiom the ready response to the stimula­tion of the natural forces of repair by the injection of the hydrochloric acid and the most satisfactory improvement in looks and feeling of well-being that the surgeon's work was well done and that the failure was altogether due to a lethargy of the white blood cells.

In all cases of elective operations which I have the oppor­tunity to see I use daily injections of 1-1000 to 1-2SO hydrochloric acid four or more times in 'order that all the natural forces of resistance may have the greatest activity at the time of the operative procedure. Clotting of the blood is hastened, consequently much less blood is lost, repair is much quickened and the convalescence shortened.

The stimulation of the natural forces of repair may also be done by the injection of neo-arsphenamin, any of the several preparations of mercury, bacteriophage or the pro­ticids. I prefer the iV'ection of the hydrochloric acid because of the comparative freedom from the inflammatory reaction following its injection. Also because my clinical observations have convinced me that a greater degree of phagocytic activity follows the acid injection than any other I have known.

This induced activity, I believe, is due to the fact that the !Nhite cells are acid in reaction, and, since hydrochloric acid Is the only inorganic acid made by the body, this acidity of the white blood cells may be logically attributed to this acid. Ma we not conclude that these acid cells are the elements in tKc blood stream which maintain the acid-basc balance of the circulating medium? f it is jiranted that this hypothesis might have in it an element of truth, the conclusion is inevitable that the hydrochloric acid is not a medicine at all in the accepted meaning of the term, but simply an essential factor in the chemical balance of the blood. Perhaps if such a conclusion could be accepted even a Christian Science practitioner might use the injections of hydrochloric acid as a very positive aid to the mental processes of his patients.

HYDROCHLORIC ACID AND OXYGEN CONTENT OF RED CELLS

Among the reports before the recent meeting in Cambridge of the American Association for the Advancement of Science was one by Dr. W. V. Macgilvra, of the Harvard Dental School, on the intravenous use of a solution of hydrochloric acid. He said: "The patient was moribund, clue to the unexpected cffects of an anesthetic. The hydrochloric acid was injected at io:iS a. in. Eight minutes later lips ~egan to twitch; in ten minutes the hands moved; in 40 minutes the patient was talking coherently." "Repeated studies of this patient since have failed to disclose anteill effects." Dr. Macgilvra said, further, that the acid had en given to six other cases, and it was found that respiration, blood pressure and pulse were increased and lost reflexes restored. r. Macgilvra said, also, that was the first time the hydro­chloric acid had been injected intravenously in man. Within the following week there was a published report in the Kansas City Star of the use of the intravenous injections of the hydrochloric acid solution in 300 guinea pi after the cessation of respiration following anesthesia. %isi; Peari Moorman, who made these determinations, said that lactic acid was also tried, but that the animals in which it was used all died. The report indicated that a search would be at once instituted for the reasons for these unusual clinical plicnomena. With whatever value there may be in some six years of observation of patients with all manner of in­fective diseases under the influence of the ipiections of hydrochloric acid solutions, it is sible something mal be sug est!d to clear uprroblems which now seem obscure, both witf the patient in ~ 'orcester and the guinea pigs in Joplin. The explanation I am about to lay before my fellows, of course, has as its raison d'etre changes in the blood cells following the in.'lection of solutions of hydrochloric acid. To any collcagui who may have read papers of mine in the past I will say at the beginning that I shall not discuss the white blood cells nor the Mctchnikoff idea, since neither the phagocytes nor the Metchnikoff theory played any part in the clinical changes I am about to describe. Early in the month of January I was called to see a patient, a man of 55, apparently dying from angina pectoris. He was alone in a hotel room 43 could give me so history of his ailment. A pard empty bottle of d tali@ on the dresser. stertorous breaching from watcAlled lungs precluft any possibility of hearing anything of the very rapid and tumultuous heart. With the aid of a bellboy I gave him an intravenous injection of a i--25o hydro. chloric acid . Before the completion of the injection of the so cc., the breathing had improved and he rested easier. Within a few minutes 16C told me he had had angina for four years durin p which time he had taken ,litalis. 11st he had taken a dose ol it a little while before I had been a led, but that he could feel no good effect whatever. During the for, y minutes following the injection of the acid solution, while the breathing was still done with appreciable effort improvement was such as to make me believe that he would recover. irwice during this period 16C got up from his bed and went across the room to the bathroom.

At the end of the kway minutes, however, the breathing became worse, edema in lungs increased. and within a few minutes the patient became unconscious in spite of a subcutaneous injection of the acid. Within something over an hour he diaL I shall attempt to show that the paping I vemcnt in this case of a torts and the recoyery =anesthesia ,,:=c case in Ma 8 , as well as the guinea pigs in the West, were all due to the stimulation of the same cellular activity by the in fr jcction of the hydrochloric acid. The explanation comes from Wisconsin. During the summer of 193? Dr. John Edmonson sr t a P, ;ii lh few weeks in the Battle CreeK sanitarium with Dr. au o . Since Dr. Edmonson had been using intramuscular injections of hydrochloric acid for several years, Dr. Roth heard reports of the clinical behavior of patients with diverse infections and ailments which had come under his observation. Some one of these reports so impressed Dr. Roth that it was determined to make an observation on any change that might be noted in the red cells.

BREAST CANCER: Readers of this paper will note that the subject of phagocytes is not brought up. study of 250 women with breast cancer in Vercelli, Italy, found that they tended to consume considerably more milk, high-fat cheese and butter than 499 healthy women. - Paolo Toniolo et al, Journal of the National Cancer Institute, 81:278-86, 1989
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PROSTATE CANCER:A 1977 study based on 111 cases with prostate cancer and 111 hospital controls showed that the cancer patients consumed more high-fat foods, including beef, pork, eggs, cheeses, milk, creams, butter and margarine. - I D Rotkin, Cancer Treatment Reports, 61:173-80, 1977
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OVARIAN CANCER Harvard University researchers asked hundreds of women with ovarian cancer to record in detail what they normally ate. There was one thing that they had eaten much more frequently than women without cancer – dairy products, especially the supposedly “healthy” dairy products such as yoghurt and cottage cheese. The problem is the milk sugar, not the milk fat, so it is not solved by non-fat products. - Cramer D W, et al, Lancet, 2:66-71, 1989
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A 16-nation study, based on WHO statistics, indicated that consumption of beef and dairy products increased the risks of lymphosarcoma by 70% and Hodgkin’s disease by 61%. - A S Cunningham, Lancet, 2:1184-86, 1976
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ALLERGIES A teenage boy in hospital with muscular and skeletal pains, bronchial asthma, abdominal pains, headache and dark circles under the eyes experienced substantial improvement within 2 days when milk and chocolate were taken out of the diet. When milk was given to him again after 3 weeks, the pallor, dark circles and other symptoms returned. - E G Weiberg, Annals of Allergy 31:209-11, 1973 ----------------------------------------------------

ANAEMIA Many studies have measured the blood iron levels of people with different diet-styles. Vegetarians consistently fared better in these tests than do meat eaters. The only people who run into trouble are the ones who eat a lot of dairy products, fatty foods, sugar and junk foods.... - John Robbins, Diet for a New America ---------------------------------------------------------------

ARTHRITIS A 38-year-old woman had, for 11 years, been suffering from steadily worsening rheumatoid arthritis. Three weeks after doctors removed all dairy products from her diet, she showed signs of improvement. In four months, her arthritic symptoms had completely disappeared.
In the interest of scientific curiosity, she once again ate some cheese and milk. The next day, her joints were swollen, stiff and painful. Her symptoms again disappeared as she resumed her abstinence from dairy products. - Parks A, British Medical Journal, 282:2027, 1981
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ASTHMA Twenty five patients with bronchial asthma were put on a strict vegetarian diet. They showed 71 percent improvement within 4 months, and 92 percent improvement within one year. The experimental diet avoided meat, dairy food, eggs, fish, sugar, chocolate, salt and other foods. - O Lindahl et al, Journal of Asthma 22:45-55, 1985
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CATARACTS Populations that consume large amounts of dairy foods have a much higher incidence of cataracts. The problem appears to be the milk sugar, lactose. In the digestive tract, lactose breaks down into two simple sugar molecules, glucose and galactose. When blood concentration of galactose increase, it can pass into the lens of the eye. . . (and) can lead to opacities of the lens. Nursing children can generally handle galactose. As we age, many of us lose this capacity to break down galactose. There are even rare cases of genetic defects in which children cannot break down galactose. These children can form cataracts within the first year of life. - Couet C et al, Journal of the American College of Nutrition 10(1):79-86, 1991
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CRIME + DELINQUENCY Researchers at the University of Washingtom found that juvenile deliquents drank a lot more milk. Male offenders consumed an average of 64 ounces of milk a day, while the control group consumed an average of 30 ounces. For girls, the figures were 35 and 17 ounces respectively. In some cases, the researchers reported, “eliminating milk from the diet can result in dramatic improvement in behaviour, especially in hyperactive children.” - Alexander Schauss, Diet, Crime & Delinquency
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DIABETES Cow’s milk protein can enter the infant’s bloodstream and stimulate the formation of antibodies which, in turn, destroy the pancreatic cells that produce insulin. Diabetes occurs when 80 - 90 percent of these cells are destroyed. Researchers from Canada and Finland found high levels of antibodies to a specific cow’s milk protein in every one of 142 diabetic children they studied. Antibodies can apparently form in response to even small quantities of cow’s milk. Cow’s milk protein can even reach a breast-feeding baby if the mother drinks milk. - Scott F W, American Journal of Clinical Nutrition, 50:728-30, 1989
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OSTEOPOROSIS MILK ACTUALLY WORSENS OSTEOPORSIS! Countries where dairy products are commonly consumed - the US and North European countries - actually have more osteoporosis than other countries. Milk does contain calcium, but diets that are high in protein, especially animal protein, causes the body to lose calcium. - Hegsted R et al, Journal of Nutrition, 111:553-62, 1981
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OSTEOPOROSIS: A study – funded by the US National Dairy Council for the purpose of showing the benefits of milk – showed that women continued to develop osteoporosis even when they drank an extra three 8-ounce glasses of low-fat milk every day for a year. Scientists who conducted the tests said this was due to “the average 30% increase in protein intake during milk supplementation.” - Recker R, American Journal of Clinical Nutrition, 2:1061, 1974
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The calcium in kale is more efficiently absorbed than the calcium in milk. - Robert P Heaney & Connie Weaver, American Journal of Clinical Nutrition, 51:656-57, 1990

The following table shows the changes in Dr. Edmonson's red cells after the injection of 10 cc. of a 1-1000 solution of the acid: Soma Ewritcris or hijactson or so cc. or a-tooo HCl on Vanows SLooo Specinsen 02 02 % uts. Has*. CD2PH %41111. Number rum Content Cap&. ration slobia Comb, ot Volving Before city power blood 1. 11:10 8.56 $1.11S 39.2 16-3 70,37 748 3L 101J. ISMS 2 . ....... 11 :S1 14-69 2M96 7os t5A 6446 7-50 34-5 3 . ....... 1:35 5-95 18.38 324 13.7 749 35-1 4 . ....... . 4:45 7.34 26-30 j6.2 I $.1 745 33-1 I quote from Dr. Roth's kind letter: "The above figures show that the injection of hydrochloric acid intravenousl does not materially change the 'c0s capacity' of the b=( while the Os content is markedly increase in 3o minutes after the injection. The COs Combining power is decreased and remains at a lower level for several hours. Similar results were noted in several other cases, except in one instance in which very little change occurred in the CO* combining power only. "I wish to suggest to you that an increased oxygen content of the blood is readily, though roughly observed by merely noticing the change in the appearance of the blood to a brighter color. In the light of the observations of Dr. Roth it would seem to me that the temporary improvement in the angina can or I and the recovery the "moribund" anesthesia case were due to the increased oxygen content following the injection of the acid. I am most grateful to Dr. Roth for the information given in this report of his determinations because of the enlargement of perspective. Phenomena for which phagocytic activity or chemical change failed to furnish an explanation now are clear. For example in December last I was called to see a young woman with a temperature of io W; respiration, 36; pulse, I I ;. great pain in involved lobe, iower lat. There was ml 7 !rnprc~vement in the heart breathing and general condition within a few minutes alter the injection of the acid. During the following three days an injection of the acid was given every day, and on the fifth day she sat up in bed to eat a breakfast of a cereal, eggs and coffee. There were no inflammatory reactions following any one of these injections. Although the. temperature was normal, I gave as a tonic an intravenous injection of i-isool solution Of HCI, following which there was a marked reaction, which 9 O;ve the nurse more to do than she had during the activity the pneumococci. After which the patient went on to an * nterrupted recovery. For the explanation of the inflam­matory reaction I have none. Nor ad I any reason satis­factory to myself for the behavior of the patient after each Wection of the acid. Her clinical improvement softened t~ c rcpret of my own lack of knowledge. Now, however, with thc information given inc by Dr. Roth ' the explanation of the clinical change seems just as simple as it would have seemed if an oxygen tent had been used. I doubt very much if the inhalation of oxygen in a tent causes an increase in the content of this element in the red cells so great as that which follows the injection of hydrochloric acid. All of us will agree that two important factors in the well ­being of these bodies of ours are copious amounts of oxygen in t c red blood cells and the maxi m activ ty of the mu Ph gocytca of the defensive force of the ind vidual. In THE :DICAL WORLD Of May, 1933,.was a paper showinq the marked increase in phagocytic activity against the staphylo­cocci after the injection of hydrochloric acid. So through the use of this basic acid of the body two of the cardinal disciples of resistance may be easily induced. In closing, congratulate Miss Pearl Moorman, of the Duncan Labora­tories, Joplin, Missouri..and Dr. W. V. Macgilvra on their use or the intravenous injections.

QUININE AND CHLORIDES
Dr. W. B. Guy has just sent to me a copy of THE MEDICAL WORLD, describing his use of the hydrochloric acid injection and your most interesting discussion of the effects of quinine in gonorrhea. In all of the determinations I have done the increase in the exudate of such infections is the direct result of the increase in numbers and activity of the white cells. In the old books on therapeutics, quinine sulphate in very large doses was highly recommended in the treatment puerperal sepsis. So basically I think we must attribute the results to an induced phagocytic activity from the potent effect of the administration of quinine. Several years ago I treated a number of cases of furunculosis by the intramuscular injection of dihydrochloride of quinine, with excellent results.

Since all these drugs that seem to do so well have a bit of chlorine as an active principle, I use the HCl in the treatment of all infective diseases which I happen to see. Not because of the chlorine but because this acid not only stimulates the essentia factor in the inflammatory reaction, but also seems to have a most potent influence on the acid-­base balance of the blood stream. And with the modification of the pathological alkalosis the phagodytes seem to engulf the invading organisms with increased avidity.

"FAVORITE MEDICINE"

Evidently Dr. W. D. Anderson has found that the drugs and procedures taught during his college life are not alto. gether satisfactory. -Like many of us, he is being forced to rely more and more on observation, h7l!*ent*c directions hope and nature for the relief of many o is patients subering from the consequences of the presence of various infecting organisms. His earnest request for information of "favorite medicine" is the reason for this paxr, in which a plan will be laid before him which may be helpful. Nature has earned the,rcputation of be' the best of e1our maladies doctors and since, by far, the greater number are the direct result of the presence of germs or their sequelse, nature must have some simple and easily understood metlM for their elimination; otherwise the well-earned reputation as leading in therapeutics could not have been maintained over so Ion a time. ' g With the recent collapse of the side-chain theory of Ehrlkh. the very last word in humoral immunity, the last vestige of faith in the "humors" ive or curktive factors protect was removed. Without Ehrlich theory it will be granted that we have no principle before us for the elimination of germs, the repair of wounds, the demolition of pathological tissue. In view of this dearth of therapeutic knowledge I wish to discuss "the one constant factor in resistance, whether innate or acquired-phagocytosis."$ I 'M etchnikoff. 24 Since the white blood cells have been used for a generation as indicators of infection or the virulence of the organisms involvcd,.it must be granted that this mobile cellular system plays an important role in all infectioqs. When it is known that countless determinations during the past ten years have shown that all of the best used drugs and procedures in time past ind time present have a more or less potent influence in artificiall stimulatin this cellular force, their considera­tion might L worth whie. Among the stimulants for the white cells a beginning might be made with one of the oldest of remedial measures of which we have record, cantharides ointment vigorously pplied in arthritis, as used in Greece early in the Christian ra. With the following erythema the early classical observ­era might have seen marked changes in the cellular icture, had Vad Lceuwenhock, the janitor in Delft, made Kis dis­covery of the microscope a bit earlier. So with mustard Elasters, counter-irritants of all kinds, cuvping, leeches or lceding of our medical forbears, or queer Y enough in the transfusions of blood of our time. So witli drugs mercury,'whether by inunctions the copious doses of calomel of the past or the intramuscular or intra­vCnous in)c n, of the present, counts before and after will Ctio 3 show an immed ate effect on the cellular system. So with arsenic, bismuth or serum injections. Also with the short wave and the following induced fever or the therapeutic arplication of the X-ray or the well-used diathermy of many 0 our colleagues. Counts before and at hourly intervals after the use of any one of the foregoing drugs or procedures will demonstrate the effect of the procedure on the white cells. So throufh this cellular system and its artificial stimulation by medica observers we have a straight line of theraE:utic endeavor to connect us up with our Greek colleagues fore we became Christians. Dr. ohn Edmonson, a local colleague, has suggested that this cellular army of defense may be definitely likened to the defensive force ol the nation. , In this national force we have' one army and one navy trained and cquippcd to resist inroads or enemies of whatever kind. That we do not have a specific army for each and every potential foe, but one centrally directed fighting force as a nucleus to which we 25 add millions of recruits by the draft when the country is in danger. So with and in the ceaseless war with the enemies of man­kind, Dr. Edmonson thinks nature uses one defensive force, and only one. Since the final proof of the truth of any theory of resistance and its control is the effects to be observed on a sick man, means for the mobilization of the cellular forces must at once be considered. Pretty well all the drugs and combina­tions of drugs have been tried and found wanting for one or many causes. So in the consideration of this plan for settin,%up more active resistance to the inroads 6f germs it g It prove worth while to use a drug hitherto unused in the treatment of inleciive diseases if we can be assured that no Pos ible harm will result and there -is any promise of the elimination of harmful micro-organisms. I The essential character of the white blood cells in resistance cannot he denied; but these cells must have a proper field in order that the best phagocytic work maybedone. Unfortu­nately, however, in cancer, diabetes and many infections it has been recently shown by various laboratory observers that there is an accompanying superalkalinity of the blood. Now, this alkalinity mu-tt be the direct result of the presence of germs to inhibit the aggressive activity of the cellular forces of defense. Perhaps this chemical reaction might be comp~red to the use of chlorine gas and in the late disagree­ment in France. The white blood cells ore acid, in reaction, circulating in an alkaline medium. Since hydrochloric acid is the only inorl anic acid made by the body it must be the basic acid Of t is most delicate chemical balance of the blood. So if there is a pathological variance of the normal balance of the blood a logical procedure would seem to indicate the injection of this essential acid. Now, such an ingection of thishydro­chloric acid solution not only seems to ve a most beneficial cffect on the blood reaction, but is also followed by an increase in the numbers and activity of the white b1lood cells. The following leucocytosis usually reaches its maximum four or five hours after the injection, but there is left a well­induced phagocytic activity that is maintained 24 hours or longer. Metchnilkod. 26 Verification of the truth of this conclusion is furnished by the followinj observations of good friends, who as yet am unable to raw conclusions from these determinations. Three billion of the staphylococcus albus were injected into a guinea pig. Examination of the cells after the injection of the orpanisms showed that 23% of white cells had engulfed the cocci. So we may conclude that this figure represents the natural p"gocytic reaction to the injection of the infecting orpanisms. Thereupon the hydrochloric acid solu­tion was injected. Within two hours 32% of the white cells were showing p~onouinced phagocytic activity in engulfing the micro-organisms. The next determination, done 24 hours after the injection of the acid, showed phagocytic: activity in 6yOlc of the white cells, an ;pKarcnt improvement Of Over 200-/0 on nature. Details o t ese determinations follow (See table on page 28). The foregoing determinations give to the wi~iter a logical reason for the clinical observations in the elimination of all varieties of germs from infected individuals, and demonstrate beyond question the value of the acid injections in augment­in%thc purely natural phagocytic activity. esides the removal of germs another daily problem of the surgeon and of those in general practice is the healing of wounds. Here too nature makes constant use of the ubiquitous activities ol the white blood cells as shown.by Dr. Carrel in 1922. "The existence of mechanisms causing leucocytcs to invade tissue in need of repair is certain. The initiation of healing seems to depend on the coming of the lcucocytes to the wounded tissue. These lcucocytcs have the important function of promoting ceH multiplication in the arts of the organisms where they accumulate." We truth of the obscrvittion of Dr.'Carrcl may be quickly mOnatrated by an artificial stimulation of the white cells bytiving a lew.daily intravenous in)'e'ctions of hydrochloric aci in preparation of patients for elective operations, or in the treatment of ulcers, infected or clean wounds. Surgeons will see an astonishingly small number of infected sutures and a marked hastening of the repair of the su i al wounds ir and shortening of the convalescence, particulairilyc if the in­octions of the acid be given every day or every other day after the operation. In recommending the hydrochloric acid injections for the 27 stimulation of all of the known and unknown forces of resist­ance in the treatment of infective diseases the writer does so with full confidence in the safety Of the procedure and the delightful hcedorn from the annoyances of the inflammatory reaction so often seen after intravenous injections. BEroas HCI Two Houns AFTaa HCI 24Houits Arysit HO 10/0--6 bacteria 20/0-1 bacter!'a 15 over 20 bacteria 210/,-2 bacteria 27o--6 bacteria 3 V. 107o-i bacteria 30/0-4 bacteria 33 , phasocytic 25%r--2 bacteria 7410 non-PhagocYlic 32%-PhagocYtic :5 680/v~non-phagocytic :4 4 so 11-10 71 lie sq~ O"wY a "Wphagocytic Readers of THE MEDICAL WORLD have only to recall the astonishing results in the treatment of cancer and of many infections reported by Dr. Walter B. Guy, of St. Augustine, Florida, following the acid injections with his own addition of various chlorides and potassium salts, to know that some powerful force is added to resistince. My good friend, Dr. Guy and I are not agreed is to the reasons for the results. He attributes the undoubted 'Clinical phenomena to the addition of the chlorides and other chemical elements, while I " It In conclusion that the cffects are due to the iguced my ' p ha tic activity and the modification of the pathological alkalminiyty of the blood. However, we are in hearty agree­ment con the good clinical cifects of the acid injections. Observations just published by Dr. Glover from the Public Health Service Institute of Health, in which definite p!oof has been furnished of the infective origin of malignant dIseascs,&vc a c( t reason for the good results reported by Dr c of these hitherto hopeless maladies. Our young colleague in Oklahoma may be disappointed in hearing of a "cure-ill" in answer to his request f6r spcr~ on "favorite medicine." If this impression is made Ile writer can only reply that hydrochloric acid, in his opinion, cures no 28 ailment of any kind, but that its injection is followed by a most marked stimulation of cellular and glandular activity not seen clinically following any one of the many other agents used for the stimula*tion of the white cells. I contend that nature has a "cure-all" defensive system, and that it is to this force that we must attribute the unquestioned clinical results. Such results but confirm the adage of the ages that nature is the best doctor. In no sense is the writer to be understood as suggestin the hydrochloric acid to take the place of well-recognized directions for hygienic care, dict and other measures found best for the particular case, but simply as adjuvant in the demolition of pathological tissue, the repair of wounds and the elimination of harmful micro-or4anisms. A solution of i-iocoo U.S.P. hydrochloric acid in distilled water has been found useful in 10 to 20 C.C. intravenous injections. this being the strength of this acid solution in the stomach. The importance of the cellular fithting forces and Tents of healing and repair is conclusive y shown by Dr. . A. Doan, of Ohio State University, in a paper on "The Neutro­pcnic State," in which he says: Roberts and Kiracke w ire among the first to recognize the importance of analyzing mumulated data in terms of white cell level and ymptornstoL. ogy. Ina review of the records of$,$= private clink patients outofcvcry 4 WAS found to have a mild granialopenia; I out of ever 2 women between t Pfawt iecnk! he apes Of 40 and 6co yesors was ncutropenic; and complaints o exhaustion and fatigue were twice as Ere uent in the granulopenic individuals as in those showing a normal whit :11 count. Furthermore, the severity of the symptoms paralleled. to a remarkable extent, the degree OF granulopenis foun& INTRAVENOUS HYDROCHLORIC ACID AND BLOOD TRANSFUSION Through the kindness of Dr. George C. Williamson, of Columbia, Tenn., the following case report is made to illustrate the remarkable changes in the blood pictures after the injection of hydrochloric acid, and in the same case the transfusion of blood, both procedures being followed by a marked stimulation of the cellular forces. On the night of April 4th Dr. Williamson, in a talk over long-distance telephone, told me he had a woman patient Of 73, apparently in a dying condition, with evidences of a 29 marked abdominal infection, with temperature and blood picture as shown in the chart, with diagnosis uncertain. I replied that I could give him no advice, but could only tell him what I would do were I present in Columbia; that I felt a marked change could be made in the blood picture by th ctidn of hydrochloric acid. Volin ten days therealfter Dr. Williamson was so good as to send charts with the information that the patient had died. So the case is reported to show the failure of the measures taken in spite of the changes in the cells. Also as an illustration of the changes in the blood that must have accompanied the clinical results reported by another Tennessecan in THE MEDICAL WORLD, Di. W. 1. Howell. Tna Kiwo's DAUGIFTERS' I&MMAL Columbia. Tennenee ZA-1107 RIWS W. B. C- Didereatiel Apt 3. 1933 3:001'. - :.750 Apt 4, 3933 gm A.M. .4co Ncutrophilea- i npbocytew--as April 4. 1933 4:30 P-M- 1.750 April S. 1933 V30 A.M. t9wNeutrophilev- 2 April :933 4:30 P-M- 0- Ncuuophi= April 933 7:30 A.M. Neutro 20,100 . philee-10 Trand&;;~-'s April1933 7.3o A.M. 26.65o Neutro, . phikw--79 Lympbocytea--114 Transition4­ April 1933 P.M. 19 SO Neutrophika-1 Lympbacytes-ts Neutrophiksr-89 Lymphocytea- I April .1933 1*30 A-M. 319 mydocytcp-- 3 April 4,1933 to c.c. i-tSoo bydrochloric acid. April 6, ig3j Transfusion $So ex. "whole blood." I have never seen such changes in the blood picture. Thcse changes give an explanation so lucid as to the reasons for the results reported bt. Dr. Howell as to make its publication useful, I would thin One can get the same effect on the stimulation of the phagocytes bl the injection of 20 or 3o c.c. of blood intra- Lympbacytee-as Lymphocytes- i Lympllocytes--48 Lymphocyter-4a Lymphocytes~-zf muscularly. in such an idjection, of course, no examination of the blood of the donor is necessary save that it is clean and free from any infection. So much time might be saved b the use of such an injection of blood or the use of hydro­c1loric acid. 30 STRONGER SOLUTIONS OF HYDROCHLORIC ACID When nature developed hydrochloric jicid in the evolution of animals by the extraction of chlorine and hydrogen from food and drink for the maintenance of the acid-base balance of the blood stream, a ver peculiar acid was the result. Its presence is essential to arl glandular and cellular activity. And the fascination of its use lies in the fact that laboratory determinations are not necessary to codfirm this statement. One may observe the changes cli ically, which, after all furnishes the final test of any theor;; for example, no theo;; ever started its clinical test with more conclusive laboratory proof than did the Ehrlich theory, and yet twentr-five years 6f faithful trial were required before the conc usion was reached that the side-chain theory was utterly worthless, thus taking its plaice along with all humoral theories as it souvenir of past belief. Dr. Paul -Roth, of Battle Creek Sanitarium, found that after the injection of to c.c. of i-iooo hydrochloric acid intravenously the oxygen content of the blood was 81MOSt doubled in 3o minutes after the injection. Hourly counts after an injection will show the immediate effect in increas­in t numbers of the white cells and the quick correction 0 ?aihmpropcr balance as shown in the differential. So when this basic acid of the body is injefcted there is an immediate cffect: on the oxygen conten t 0 the red cells, a stimulation of the phagocytic: system, and, clinically, one may see phenomena whi'Ch can only be explained by some peculiar chemical effect on the acid-base balance. With the foregoing facts and impressions as a basis, onp may always find a case for illustration of the many peculiarities of hydrochloric acid, an acid which I do not use as a medicine, as I was taught to consider drugs. It cures no ailment known to me, but simply stimulates all the known and unknown forces of resistance, the same forces that have earned for nature the reputation of being the best of doctors­the same forces which Hippocrates called "a vital spirit inherent in allOf 1,13for the correction of ailments of our kind." I On September 22 19 4 & Young Man Of If weighing 104 ruds tr. A wcll-establis&cd case of &at ma l!"a histo_~y of five years' duration, was given as the reason for the visit. In the piping voice of a little boy the anemic young man. with the character. 31 istic prolonged expiration 01 asthma, save me ItaltinglT rite story of visita from his home in Oklahoma to El Paso and Phoenix Arizona. He reported temporary itnZovement in both towns immediately after his arrival but this hclpfi ange was soon replaced by the same attacks of AkQt breathing. In spite of a ;rent quantity of mucus in both lungs asshoweass auscul-stion, there was little es "oration. White CX were 78M 00.000 per Co':* and red cells ub ssill=ter, so furnishing anfor increasing tolth white and red Cella by rite injection of hyd;JCQ- : W Since the 7. .4. AL 4. has so frequently gives the opinion that injection i - i 5?o hydrochloric add was dangerou! lot the great hemolysis Most. ins its intravenous use, I deckled to look for danger in thin ease, which I had done many times before. So I gave to cubic centimeters intravenously. 250, Putting the remaining drop of blood in acid solution as a a" at -he finish of the administration of the injection. Newhent could me me any Chan in the contour of the red cells. According to the opinion frota Chicago ' Vshould have seen this destructive Change. but I did moL The patient was asked to return the next day. This he did, and be told me tha t he had never had such an expectoration. An examination of this sputum showed a few streptococci and staphylococcii~ and umberk-a white cells; so it was not necessary to confirm the stimidation 07 the white cells by counts. Clinically I have never seen such expectoration from infected lungs following the use of the expectorants as given in materia medics as one sees after the hydrochloric acid. Six injections of the i-25o solution were given every seven days. After the first week there was a great decrease in the expectoration. a marked decrease in the severity of the asthmatic attacks and a small increase in weight. Also an increase in strength. Before beginning the acid m* t*mm he could not walk one block without stoppi one more times roest. At the end of the first week he could WaFk% bl:lk without discornforL After sixty injections of the acid the patient was apparently free from asthma, but occasionally bad at n*ht what he described " "wheezing" attacks. So the injections were continued to try to eliminate the wheez% and in the effort to get the weight back to the original 140 pounds, as at the time he weighed only i2o, a gain of 16 pounds under the influence of the acid-stimulated cells. To my utter surprise, in late November his appetite failed and he belim to lose weight. Acid injections were contin as before. After a kw days' steady loss of weight a severe attack of asthma was reported and In has lost I pounds in weight. This was a therapeutic anomaly, and as I saw it was only to be met by the injection of more hydrochloric acid. However ~tronger solutions than j-25o intravenously are painful at the Ats J injection and oftentimes this pain is continuous for several hours up to the shoulder. So on December ist I gave more acid by making up a 2 per cent solution of novocain and addinii hydrochloric acid to make a i per cent solution of the acid. To make it a series of 2 . a 2 cubic centimeters um injected deep in a g lutealmuscle. About t/soofs, cubic centimeter w" first slowly injected, and was felt by the patient as a slight stinging sensation. After one minute the anesthetizing effect of the novocain was in force. and the rest of the acid solution was very slowly injected. The discomfort following was negligible. Visits were made every 48 hOt" Or three tionow 32 a week; so that today he had the eighth injection of the 2 per cent hydrochloric acid in novaceits solution. His clinical behavior has proved the truth of the resson for the change. that is. that the only medicine better than hydrochloric acid is more of it. Today the patient weighs i i I pounds. how am had an attack of asthma ,q this month. has walked 3 miles a day to make the visits here; hemaglobta is go, red Cella 4.770 . 000 per cubic millimeter. white cells 14op, befiore the injection of din acid. As an indication of the behavior of the white cells under the influence of the acid injections a count was done on the morning of the third visit, after two injections of the i­250 solution, and was 10,400- So I fclt fairly sure of ultimate results after seeing this increase of 2,6ooooo white cells to the liter of blood over the first count 48 hours before, of 7800. As I see it, these counts illustrate vividly the power of the basic acid of the body to stimulate the one constant factor in resistance-phagocytosis. With the check in clinical improvement and loss of weight after two months of the intravenous injections and the immediate change for the better under the influence of the stronger solution intramuscularly I fCCI it Must be attributed to a direct effect on the acid-base lialance of the b" stream. At F rate, the clinical behavior of this patient shows that thi:21tramuscular injection is more potent than the intra­venous administration of the acid, in some cases. The change in the voice of this patient has been quite as marked as that in the red count. As mentioned before, on the first visit he had the voice of a small boy. Within two weeks it would have been noted as sonorous and deep in "Fultah Fisher's boardin house." The disappearance of the anemia, I think, is to X accounted for by doubling the oxygen content of the blood six times a week and by the added activity to the phagocytes in neutralizing the toxins or eliminating the germs causing the asthma. There have been no inflammatory reactions or any dis­comfort attributable to the injections of the hydrochloric acid, and in passing I might say I have given after novocain this intramuscular injection as strong as io per cent, 2 C.C. So the opinion of the colleague in the Association journal as to the danger of the injection of hydrochloric acid is wrong. 33

DOES HYDROCHLORIC ACID INTRAVENOUSLY HARDEN ARTERIES?

The observations of Dr. Miller of hardening of the arteries after a few injections of solutions of hydrochloric acid in a man of 70 are well worth consideration. In my own experi­ence the only hardening at the blood vessels I have seen was at the site of the injection of solutions much stronger than those used by Dr. Miller, and was in veins rather small. Since Dr. Miller does not say what strength of the acid solution was given his elderly patient, for purposes of this discussion suppose we say he used 1-1000 HCl or 0.01 in 10 c.c. of water.

Unless this solution is given very rapidly it is difficult for me to see how any irritation is made even at the site of the injection. As to any such effect on the arteries, I cannot see how less than i drop of hydrochloric acid in to c.c. of water in five or six liters of blood could possibly be so patent as to cause such irritation of the arteries as to cause any hardening My technician and I have had a greater number of the acid injections than any patient I have had, save one----he has had so many his history is worth a paragraph later. This technician weigh about 112 pounds---I weigh 160. Veins are rather small in both of us. In these determinations all variations of the acid solutions have been used, up to 4%. After one takes one injection of the acid solution intravenously after the strength is increased beyond 1-250, one only wants one of each strength up to 4% to feel that the investigation has gone quite far enough, for it is painful for several hours, the pain going up to the shoulder. Such intravenous injections are used rarely on patients.

When I began to give intravenous injections of the hydrochloric acid to my technician in December, 1929, she had acne, with induration of the skin and a deficiency in acid content in the stomach. She had one prominent vein, the median hasilicof right arm. With the repeated injections of the acid the walls of this vein grew thicker slowly. After the injections were made stronger the vein was usable for about a year, when I fancy I must have given some solution a bit too rapidlrt, when it became totally occluded and has continued so. is now necessary to use smaller veins. In my own case the small vein has been used regularly for about five years. One cannot see it. It can only be felt, and this technician is the only one who can strike it. Kind urological friends occasionally give me an injection of the acid and, after a few attempts, use a vein on the dorsal surface of my hand. A little personal history might not be amiss just here. After unusual physical exertion in October I had a slight lu hemorrhage WtV brain about the fissure of Rolando, sufficient to make my right side, particularly the hand and arm, rather useless. Blood pressure in the Veterans' HO was 170 Vitt! , too. After a fair amount of persuasion my Icollespue, Dr. Edwards, agreed to give me this "dangerous" drug in a solution intramuscularly. The white t tgcKr cent count a time of the injection was 8Soo. Four hours afterward it was iS, cubic millimetir. This pro­cedure was sugliested ccoa=r the lymphocytes are known to be the agents for the removal of cxtrav"ated blood and for the demolition of clots, and I felt that the injection of the acid would simply increase and make more active this purely natural pkcriamenon. I was appreciably better after three of these injections-so much so tKat I took &'leave to return home to hear a paper on the int4venous injection of HCI by Dr. C. W. Shropshire, a urologist of Birmingham.

My technician continued the intramuscular injections as given in the hospital every other day for two weeks. Since then I have had HCI intravenously or intramuscuNrly every week or ten days-and my blood pressure is now I Sol POP and there is no evidence of any hardening of the arteries. Hence I am forced to think that any hardening of the arteries in Dr. Miller's pat*-cnt came from some cduse outside of the acid injections. Now to tell Dr. Miller of the patient of 69 who has had more of thic acid injections than I have. I saw hion O;rqt on January 4, 1928, in the City Venereal Clinic, supported on one side by a young negro and on the other br, a heavy cane; both agents were necessary for locomotion. le came to the clinic, not for treatment, but to sell, paradoxically enough health insurance. His condition gave a vivid illustration of one's need for it. Tabes dorsalis, with ' a history a( i S years, was his principal malady, and he was attempting to get sufficient money from the sale of insurance to buy a wheel chair for future progress.

At this time I had been using the hydrochloric acid injections for five weeks intramuscularly; so this agent was told of what I thought to be the promise of interesting clinkal determinations. He was given io c.c. HCI c.p. i-iSoo (o.o6 in go c.c. of distilled water) intramuscularly, two such injections being given per week. The negro, boy's services were no longer necessary after the seventeenth day following the first injection. By the way this man's white count was Moo before the injection; witlin an hour thereafter the count was something above Sooo. For two years he was given two injections a week, sometimes three. During this time I began the intravenous use of the acid, and tried it on him on several occasions and each time there followed a pronounced inflammatory reaction. This was never seen after the intramuscular injections of the weak acid solution. Bismuth or 3aliCylAtC of mercury, hbwever, would be followed by a marked reaction. During the third year one injection every five days seemed sufficient for this soliciting salesman to carry on. At the end of this time I began to use still stronger solutions of the acid, and this case of tabes furnished a useful subject. It was found that solutions stronger than 1-250 were followed by reactions; the stronger the solution, the greater the reac­tion. So marked was this phenomenon that he was really sick for a few hours iffter i per cen,t. But happily his visits became less frequent and he only came whtn the numbness, incoordidation or Own was marked. On every such occasion, when we have doife a count, a marked Icucopenia has bein found. With the quick re-establishment of more nearly a normal count thele symptoms were markedly relieved. This patient is now having intramuscular injections of i-25o two or three times a month, and since he goes about the town wherever he cares to go with a small amount of occa­sional discomfort, I feel that lus malady is being kept under control and that life is a bit more livable than it would be without the :cid injections. He has had over 400 * J I injections of the acid a described, and if he has any induced hardening of the arteries I have never seen any evidence of it. It is an interesting fact that some 300 years a n Africa negroes with nervous diseases were brought to tticonst or 36 to sea level where they might be infected with the malady that we now know to have been malaria. Because these primitive people had found that such cases improved when chills and fever accompanied the more disabling maladl, would it not be entirely logical to conclude that the benefit that must have been seen was the result of the cellular stimulation that accompanied the inflammatory reaction in th~ paroxysm of malaria~ In the light of the present practice of the infection of paretics by the direct injection of the plasmodium of malaria, o~ne might conclude we were agreed that the ntgro had foun a useful therapeutic pro­cedure. So if one.can induce the essential factor of the inflammatory reaction without the chill and without the fever by the simple in ' jcction of the basic acid of the body, the acid on which the acid-base balance is maintained, one might think it worth while.

HYDROCHLORIC ACID AS A GERMICIDE

For a very long time chlorine has been known as a potent germicide in laboratories, but clinically no means for its successful use in infected wounds or ulcers has been found, so far as I know. With a few changes these manifestations of infection are treated now about as was done in the early nineties. Twenty years ago it was said that the solution had been found from which the chlorine would be liberated. The promised germicide was made from a solution of chlorin­ated lime, soda and boric acid, and theoretically it was the ideal agent for local application on infected lesions. Like the many other agents for such local application, clinical results did not come up to the laboratory promises. In the most exhaustive paper on ulcers in the Journal of the American Medical Association, January 26, 1935, among the numerous agents used in the Cook County Hospital for these lesions, the solution of lime is not mentioned. Hence we may conclude that this preparation has not proved to be of any clinical value.

In 1919 and 1920 I had the good fortune to be associated with Dr. Carl Yount, of Pittsburgh, in the Morskoi Hospital, Vladivostok, Siberia, in the service of the American Red Cross. This institution was maintained by the Red Cross for the care of war injuries, and I was a ward surgeon there. Here there were the greatest number of infected gunshot and other wounds I have ever seen grouped in one institution. All manner of antiseptics were used in the treatment of these lesions by direct application and irrigation. When one agent would fail, another would be tried, and another and another, and usually at the end of the round of antiseptics Dr. Yount would amputate the leg, arm, or finger or I would sign the death certificate. A few months ago, in thinking over the problems made by ulcers and these infected wounds, I determined to try cleaning, irrigating and dressing these lesions with a solution of 1-21o hydrochloric acid. I was seeing its good effects every day following its intravenous or intramuscular injection; so with its great chlorine content I could see no reason why it might not be used on such lesions. Results were all that I could hope for and in an attempt to get a laboratory observation on the effect of this solution on germs in a culture tube, I asked Dr. Stuart Graves, Dean of the Medical Department of the University of Alabama, for his co-operation. Ilia he vert kindly gave me, turning my letter over to Dr. Rai McBurney, Professor of Bacteriology. After a few weeks Dr. McBurney was so good as to send me the following report of his observations: University of Alabama School Of Medicine, Office of the Dean February 16. 1935 Dr. Burr Ferguson. Coiner Building
Birmingham,Alabama
Dear Doctor Ferguson:
Dr. Graves turned your letter regarding the germicidal action of a v­250squeous solution of hydrochloric acid aver to me far investilatim of this P WeTyMe'subjected twenty-fow-hout beef-infission bm& 'cultures of staphylococcus aurcus and streptococcus hcroolyticus to its action is the dilution named. Exposure of both types was at a constant temperature of 37 degrees C. for successive periods of 5, ic~ r, ant! 6o inievies and for It and 24 hours, respectively. Organic matter he ("M of 30% home servist was not added to the hydrochloric acid saindoe. The following results were obtaineds The L!eo, and 3o minute exposures failed to kill both types. 111he i. It. and 24 r exposures resulted in complete germicidal me" A su"twee from the orimal tubes bcing sterile after 24 and 48 110110i'.16cubstion at 37 degrees I - Ve were unable to try this out upon sonocom and treponesse, 38 pallidusa as we do not keep these Organisms in stock owing to their lastidi bess in culturing. Because of this and their greater vulncrability to the action of germicidal agents, in general, as compared to the organisms we have used it may be inferred that a hydrochloric acid solution of the above strength will kill them within the same time period as determined above and in all probability sooner. We were glad to be of this service to you and trust that the results may reach you in time for your paper. Very truly yaw% RALP11 McBuRmay, MA. Professor of Bacteriology. I had had the pleasure of working with lesions made by the several germs mentioned, save t e streptococcus hcmo­lyticus, and the report from Dr. McBurncy gave me a de­lightful confirmation of the rapid elimination of the organ­isms which I had seen so many times clinically. I am using the hydrochloric acid in all infective foci to which one may apply it, but as yet I am not in tion to recommend any particular strength of the solution for other infections of eye, rectum, urethra or colon. SINUS INFECTION In the winter of 1933 and 1931 it happened often that I met: colleague whose manifestations of infection were such as t make him an interesting subject in a study of the peculiarities of germs. He wore almost constantly a large green patch over the right eye. On lifting it there in bold relief were to be seen apparently every capillary in the choroid coat. The iris seemed pretty well fixed. At a glance one could see that a great number of pyogcnic organisms were being distributed throughout this cie daily. In resuse to ,d my efforts to tri the elimination o the germs, he id come to the office, where a count was done, and it was found that the white count was 12,500 per cubic millimeter. I tried to convince him that this was nature's effort to rid the eye of infection, and that, whatever surgical procedure might be done,. phagocy t . gave the only promise of the ultimate elimination of the i=ting organisms. He declined vehemently to have me stimulate the white cells and induce a greater activity with hydrochloric acid and to double the ox a t y I content of he red cells. His comment was amusing: that as uncomfortable as life was at present, he preferred it to the 39 uncertain chances of the hereafter that might follow the injection of an acid into the alkaline blood stream. As the summer came I noticed that he had discarded the green patch, although the eye was far from normal in appearance. He told me a specialist had done some work on the ethmoid cells, which were said to be the focus of infection. Gradually the inflamed eye improved, but evidences of the nicious activities of the germs were still shown in his frequent use of a handkerchief. Ile exudate was a reddish mucopurulent discharge, indicating slight bleeding, a;;a pha ocytic activit as shown in this pu~. No discussion of the Wletchnikoff i3eaw no recital of histories of clinical experi­ences with other cases of infection of the sionuses carried any weight with my good friend, in my cfforts to attempt the elimination of the pyogenic organisms. Apparently he was so convinced of the truth. of the opinion that my reasons for the injection of the hydrochloric acid were figmei~ of fancy that he would preserve his repute by neither giving nor taking this dangerous acid. During the winter 1934-1935 1 saw him rareli but when I did see him there were always evidences that c was still the host of germs. To my utter surprise he came to the office on April 193 5 a . A man, 58 years of age, weak and dispirited. del. sic told e that the day before Dr. J. P. McQueen had told him of unusually satisfactory results in his treatment of salpin­gitis by the intrav~nous injection of solutions of hydrochloric acid. He was so impressed that he at once determined to come to me, as the sinus infection was in such a state of activity that a good night's rest was impossible, bleeding was growing worse, and the exudate of pus was most annoy­ing night and day. The right eye was much reddened; ap arently again the iris, retina and choroid were involved. Ely confrere said he wanted i-2oo hydrochloric acid. I asked if he did not think this was a bit strong for the first injection. I told him that, in my opinion, this strength of the acid would give him a vivid illustration of the phenomena of the inflammatory reaction, nature's own response, to infective diseases. and that the essential factor in the reaction, the following lcucocytosis, would be most helpful, if he did not mind the fever. The intravenous injection of i-2oo was given and he returned to his office. From his cot I had hourly reports of 40 1evcr--ioi, 102 and in four hours jo4. I assured him he would not dic, and he could rest assured he would be better when the reaction had passed, as he had had the fever that is said to destroy micro-organisms, a great increase in phagocytic activity, and that his red cells now had twice as much oxygen as at the time the inrction was given. In spite of these assurances, my good friend was not altogether satisfied. However, the next morning he came in with the report of the first night's rest he had had for months, having awakened to clear the nasal passaqes only once. It was amusing to see that he brought with him a box Of 25 ampoules of 1-1000 hydrochloric acid for further use. Nothing I could say would induce him to consider another injection of the stronger solution. Exudate frPm the nose was still stained with red cells. So I was forced to tell him that, since he seemed determined not to take the acid which he seemed to like so much the day before, I should be forced to add its permicidal qualities to the intravenous injection by its injection into the infected area by a spray. This was done with a hand spray of a solution i-Soo hydrochloric acid. Of course, a sharp stinging in the nasal passages. was felt, but there was an immediate cffect in the contraction of the swollen capillaries and the consequent freedom of the passage of air-altogcther the same clinical phenomena that follow the direct ap ication of solt F."cocaine or novacain to tl - Viranes. During the month of April the intravenous injection of the acid, 1-1000, was given six days in the week, along with the nasal spray twice as strong. Improvement was steady. In the first week the exudate on handkerchiefs was no longer stained with red cells; the gain in weight was regular from 160 to 169 pounds. So great was the improvement that the visits were made in May with much less regularity. There was a total number Of 35 visits, on each of which the nasal spray as described was used and altogether 25 injections of X intravenous solution. He has not been in the office for a week-, and yesterday he told me on the street that he had not been to see me because there was no need for my services. The foregoing case is reported in detail because it was the most advanced case of the infection in which I have used this plan. Other similar infections not so far advanced have shown the same satisfactory clinical results. The recital of other histories would be but a repetition of the above described case.

The reasons seem clear. As reported in May MEDICAL WORLD Dr. Ralph McBurney, Professor of Bacteriology in the University of Alabama, found that a solution of z--25o of hydrochloric acid would sterilize cultures of the staphylococcus aureus and the atre tococcus hemolyticus in an hour. And the behavior of the sinus infection described in the first twenty-four hours illustrates the value of the cellular stimulation in stich infection.

Dr. A. M. Allen, of St. Louis, in May "WORLD," draws attention to the fact that when water is added to the solution it at once breaks up into H, OH and C. This fact is the elemental reason for the action of the solution as a germicide. He says that, when the acid solution is injected into the blood stream, there may be an enormous increase in the rate of metabolism "and therefore greatly alter the quality and quantit of osmotic interchange between intercellular and intracellular areas." Ifthisistrue,andI ant*t rDbability, would it not be quite logical to concluler that"tge' first line of defense, the phagocytic system, is; also greatly stimulated by the ipjections of hydrochloric acid? At any rate, the ch n this easily mobilized system may be witnesse4 in=; counts after the injection of the acid. Changes in the other cells cannot be shown so easily. After seeing the beneficial effects of the acid sprays in coryza and sinus infections I concluded that, in all probability, the infecting agents of asthma made the invasion throt;jh the nasal passages and that in the next case of asthma which I might see I would try this plan. Something over a week ago a little boy came to me whose recurrent attacks of asthma have apparently been controlled by intravenous injections of the hydrochloric acid. Two or three times a ar he has been to me for over two years. When I first gan it required some IS visits for the complete cessation of the difficult breathing. The succeeding attacks have been much more quickly controlled; that is, a smaller number of injections of the acid were needed. Last week he came with a moderately severe attack. As usual on the first visit I gave him the intravenous in injection, forgetting my determination to use the spray. The next day he came markedly better, rales diminished and breathing with slight effort. On this occasion I used first the intravenous injection and to then the spray of I-Soo. He Was given a bottle of it with to school shnissthruocmticornessutioteudsic it twice a day. A telephone message n the information that he is goin everi day and so far as m nformant kne * 1i *wl iW, is aving ntri le from & asthma, ich gave him so much trouble last week. The next case of asthma I may see will have the sprays of hydrochloric acid from the beginning. I have never known a drug about which there were so many diverse opinions as hydrochloric acid. Many colleagues still maintain that its injection is followed by fatal consequences. On being asked to report the mortalities one is told to wait and they will come. Others say there must be merit in the injection of the acid, but phagoc tosis by no means sufficiently explains the ood results. 6r. Allen thinks the bencfits come from the cTemical reactions, while Dr. Guy is equally convinced that disease is the result of lymph stasis and that the hydrochloric acid and the minerals serve to stimulate the flow of lymph and modify the pH of the blood. I maintain that all of the reserve forces of resist­ance are made more active by the in*cction of the acid phagocytosis is greatly increased, so is le otKygen of the Q cells, poisons are neutralized or modified and wounds are repaired more rapidly by exacdy the same force that is used by nature in healing. Indurated tissue is softened, and the exudate of serum about injuries to joints or about wounds and other lesions of the skin is quickly taken away after the stimulation of the white cells by hydrochloric acid. ACNE VULGARIS AND THE WHITE BLOOD CELLS I On November 26 1934 a lad was brought to me b his mother, with a histor; of five months' treatment wit( lights, X-rays and salves. The conventional plans of thers­Deutics were so seemingly ineffectual, I determined to look 11-r-a suggestion from nature. This was promptly found by a count of the white blood cells: 17,700 per cubic millimeter. The count was really not ri~cessarys since the many larger and smaller pustules filled with white blood cells left one in no doubt of the mobilization of the cellular defensive forces in and about the points of invasion of the pyogenic organisms. 43 Many of these pustules bore the cicatrices of incisions for the drainage of this "laudable pus." Since nature makes no purposeless efforts, I concluded that the one thing needed by this lad was more activity !nd oggressi of the cellular forces, and that this musing factor or faccors could be added by the intravenous injections of hydrochloric acid. This was done by the injection of 15 c.c. of hydrochloric acid 1-250, or 0.4 c-c- to 100 c-c- Of triple distilled water. The mother was asked to apply hot com- resses to his face for a half hour every evening,, which was ut another effort to still further mobilize the defensive forces about the lesions. Whether the results were due to the hot pack or the stimulation of the white cells by the acid, or both, one cannot say; but, at any rate, the mother told me on the second visit t hat she had never wen the lesions drain as fter the pack of the night before although no incision h:d been made. This indicated, beyond question that the induced leucocytosis had caused such an ir.flux ot white cells into the infected foci as to so increase the pressure that the skin was ruptured. For three weeks the b6y came regularly every other day, and the improvement was satis­factory, the lesions growing smaller and paler. On each of the visits he was given i5-2co c.c. of hydrochloric acid i-25o as reported before. In this series he had only one inflam­matory reaction, and this lasted only two or three hours, li~im ly the usual chill, fever and sweat one sees so rarely aftep the acid injections.' With the advent of.the holidays and.Christmas school festivals his visits to my office were irregular, but the injec­tions were given when he did come. After the lesions were- fairly well cleared up in January another invasion of the staphylococci and streptococci made its appearance behind the ritht car not particularly painful, and no redness in tho ying skin; apparently it was a sebaccous cyst. The acid was en as usual and I saw him Po more for a week. When r returned I found a great increase in the size of this fluctuating lesion, and the sebaceous cyst idea was discarded. An incision of half an inch or more was made. A copious amount of pus was evacuated, and with cotton on an sp licator, the cavity was well swabbed with hydrochloric ad 1-250, as used intravenously. Gauze saturated in the sam solution was then put in the cavity. 44 He returned in 48 hours- the packing was withdrawn and there was.only a suggestion of an exudate on the gauze from th a t . Them was absolutell no exudate on pressure from lesion: a phenomenon I had never seen until I began local use of the acid a few months ago. To complete the history of the boy. He was given in this series 25 injections of the hydrochloric acid, hot packs at night and i tablespoonful of mineral oil every night. This local use of hydrochloric acid , -as I am using it now, is a most satisfactory germicide apparently, and happily them is a cogent reason for such a procedure. For many years the germicidal value of chlorine has been well known. I wenty cars ago a (I d It preparation of chlorinated lime was Y Use . is possible that the chlorine in this alkaline preparation was not available in a potcnt form. This conclusion has been made after secin .01 the effect of the a lication of dressings saturated with utions of hydc Eloric acid on ulcers, after a thorough cleaning and irrigation of such lesions with solutions of i -c.c. to 100 C.C. of distilled water. This solution is lXngoursel just as we used solutions of bichloride of mercury or carbolic acid in the old da,,, The behavior of the abscess above described is an inalcator of the behavior of ulcers and infected wounds. From the clinical results the conclusion is inevitable that the chlorine of hydrochloric acid is a most useful germi­cide. Could it be that this chlorine of the intravenous inj qua it ,~cction of the acid adds.& noxious 1*7 to the serum of c blood, thus accounting for some o the inexplicable results following the intravenous injection of the acidt THE HEALING OF WOUNDS This is in answer to E. B., in Monthly Clinic in March MEDICAL WORLD. I Like you, I am often puzzled over'the clinical cffects of the injections of HCI. I -have had, of course, a few cases of ulcers of the duodenum and the pylorus, one of the former having been of 22 years' duration. X-ray showed active lesion. Gave her ten injections of HCI, i-j5clo, and she was clinically well. Three years thereafter a study was made of the intestinal tract,,and showed nothing but scar tissue at the site of the old lesion. This patient was 73 years old when I gave her the acid injections and is in good condition now at 78- The white cells are the essential factor in the healig of wounds, and I think on the chemical side the good effects Y~u and I have seen come from a glandular and cellular stimulation by the HCI, so making these factors in the pro. duction of the acid return to their normal roduction. I agree with you on the difficulties in unferstanding these phenomena, but if it is good for a sick man it pleases am to give it, whether I understand all of its manifold peculiarities or not. Try it on the secondary anemias and you will be still more puzzled.