By WILLIAM I. HOWELL, M.D. Lexington, Tenn.
With the Collaboration of Burr Ferguson, M.D., Birmingham, Ala.

EDITOR:This article on hydrochloric acid therapy was published in the early 1930s. It seems very pertinent today, especially for cancer and pneumonia, where the old-timers apparently had good results with dilute hydrochloric acid.

Thirty-two years of general practice in a small town without the resources of laboratory help made me often wish I might live and work in a larger community where I might have more assistance with many of my cases. Drugs, as I had been taught to use them in the treatment of infections that came under my observation, did not have the cffect on my patients promised by my studies of materia medica. Hence, when my patients reported all too often that the were not doing well under the plan of treatment in use, changed the prescription and hoped for the best.

During those years there was the occasional visit from a detail man from some chemical house, from whom I would hear of many new specifics for this, that or the other infection. After a few trials of the new serum, drug or vaccine there still seemed to be something lacking; so I reached the conclusion that there must be something wrong about either the drug or my diagnosis. Since I felt fairly certain of the correctness of the latter, I concluded that there was still something missing about the drug.

In the hope of finding some better way for fighting germs I went to all medical meetings in my district. At these meetings the greater number of the papers by men from colleges and larger towns were on difficult surgical procedures, diagnosis, therapeutic use of the X-ray or other electrical devices. Sometimes there was a most interesting report of the use of the cystoscope and ureteral catheter for lavage of an infected kidney or passing a catheter into the gall-duct for drainage of the pus from an infected gallbladder.

In the delight of listening to such reports I felt full of confidence of what I could do with such cases on my return home if I happened to get one. Then, when the meeting was over, in the long drive back home I realized that such elaborate treatment was not for me, with the limited equipment in my district.

In 1931, on my return from such a meeting, at about the same time I saw two reports in print. One was in a Memphis newspaper reporting that in America the year before there had been some 16,000 deaths of women in childbirth. This was startling to me, and a shock. For, no doubt, many of these women had died from infection, and while I had just spent the better part of a week at a most interesting meeting, not a word had I heard about what to do for childbirth fever. Then I saw the other report, just spoken of, in Clinical Medicine and Surgery, on the treatment of pyogenic infections, by Dr. Burr Ferguson. The clinical results he said he had seen seemed unusual in that he appeared not to rely at all on any local application of germicides. Dr. Ferguson's claim that nature was responsible for the good results through the induced activity of the white blood cells following the injection of hydrochloric acid solutions intravenously, fell in with my own belief that nature was the best doctor.

At once the thought came to me that it was highly probable that nature did use these white blood cells in resistance, and if a way had been found to create a greater leucocytosis (increase in number of white cells) and to make these cells more active, it would add a lot to my medical knowledge. I had no way of checking Ferguson's report of the leucocytosis following the injection of mercury, arsenic, quinine, milk or serums; but it seemed reasonable, if true.

Since I had been trying new drugs and combinations of drugs for almost thirty years and was still changing, I decided to try the acid injection, because it was so new. I had never heard of anyone injecting an acid intravenously before, and I had heard of all the deaths that followed the injection of salvarsan when errors had been made in its neutralization; but since Dr. Ferguson said he had given thousands of injections in all sorts of infections, there did come up in my mind the objection that maybe this acid injection was just another cure-all, and every one of these that I had ever heard of was a failure.

As I thought of the plan of treatment more and more did it seem to me to be worth a trial. For if Dr. Ferguson had not seen what he claimed to have seen and if all of these drugs he reported having used as stimulants for the white cells, including the hydrochloric acid, did not produce a leucocytosis, somebody would surely have taken the trouble to disprove his claims. Even then I was nervous over the acid injection, and I decided I would not use it on any moderately sick case, but would wait until I got one that I felt sure would die anyway, when I would be taking no chance in giving the acid as recommended.

Here was another thought that came to me. Arsenic, mercury and quinine had been used for a long time by the mouth, but it was only when these drugs were used by intramuscular or intravenous injection that such remarkable results were reported, and therefore the intravenous route must be the best, because you never hear much now of the oral administration of these old drugs. It seemed possible that with hydrochloric acid, which had been used by the mouth for several hundred years, and of which I had used a great deal as an aid to digestion, I might see some clinical results I had not seen before, just as other men had seen in the change of administration of the metals.

On August 18, 1931, I found the case for the use of the hydrochloric acid. Five days before this date I had delivered this girl of 15, after a prolonged and most difficult labor, using all possible aseptic precautions in a log cabin in the woods. The large baby lived only two hours. In spite of the small size of the mother (she weighed only 90 pounds), lacerations were apparently small in size. Three days after the delivery a message was sent me that she had had a chill and a very high fever. It was a long distance to that river bottom where she lived; so in the hope that it was malaria I sent quinine and calomel.

On the fifth day another message came, telling me of the grave condition of the patient and that my immediate presence was necessary. On going into the sickroom I at once saw there had been no mistake in this urgent incssagc. The little girl was delirious; temperature, 106, pulse, 140; respiration 40; discharge from the vagina scanty and fetid in odor. Every other case had ever seen in the condition in which I found her is dead.

With much trepidation I gave her 10 c.c. 1-1500 hydrochloric acid. The following minutes were anxious ones for me, as I hardly knew what to expect as this was the first time I had ever heard of the acid being used in puerperal sepsis. The reports I had seen of Dr. Ferguson's cases of pyogenic infections of Dr. Ferguson were of gunshot or lacerated wounds.

As I sat by that bed, holding the radial pulse in that lowly log cabin, a flood of memories of teachings concerning the fatal consequences of injections of acid into the veins came over me. While in this frame of mind I noticed sweat on the neck and forehead of the patient, and along with it a slowing of the pulse. In a few minutes she was bathed in profuse perspiration. With it there was a cessation in the chatter of her delirium.

Thirty minutes after the injection of the acid I asked her how she felt. She replied that she felt much better and would like to go to sleep. Within the hour the temperature was 103 degrees,pulse, 100; respiration, 22.

During the following four days I repeated the injection of the acid each day, and on the fifth day temperature was 99, pulse 72; respiration, 18. Two days thereafter I was called again, as I was told the fever had returned. Found her with a temperature of 101, with a free discharge from the vagina. I gave her another injection as before. Save for weakness, all evidences of infection had disappeared the next day, and she went on to an uneventful recovery with a complete disappearance of the mass in the left iliac region.

This case seemed unusual to me because no local treatment or douches were used and all of the foregoing clinical changes took place under my own eyes, during the first visit, with absolutely no other treatment than the injection of the acid.

On October 10, 1931, I was called in consultation to a case of eclampsia. The patient was a primipara and in a forceps delivery, there was a small laceration. On the third day she had a hard chill and fever, and again I was called by the attending physician. I advised the injection of hydrochloric acid intravenously. The physician in charge refused to have the patient subjected to such a procedure. After a more or less heated discussion I was forced to agree to the injection of one c.c. of a mixed infection vaccine.

On the following day the patient was much worse; temperature 105, pulse, 130; respiration, 30; delirious and very restless; large mass easily felt in pelvis. My colleague then said: "It looks to me as if death is inevitable whatever we do, so you might try an injection of that damned acid." I gave the injection and witnessed the same clinical changes that I had seen in the other case just reported. Three days more and I was called again and found the patient with temperature of 104*, but she was not delirious and the mass in the pelvis was much smaller. Two other injections were given on the following days, after which she went on to an uneventful recovery. This woman has continued in good health and will be again confined in a few weeks. So nothing but good seems to have followed the injection of the acid.

Shortly after this I was called to see a case of double epididymitis. The patient was in the declining stages of acute gonorrhea. I advised the application of ice, soft diet, calomel and rest in bed. The next day the patient reported a restless night and intense pain in the testicles.

After the good results with my childbirth cases I had exchanged several letters with Dr. Ferguson. In the reprints he sent me and in his replies to my letters I was astonished at the confidence he seemed to have in the hydrochloric acid, not only for pyrogenic (fever producing)infections, but for any and all germs.

So since my results with other cases had been all that I could ask, I determined to try the same plan for the treatment of the gonorrheal complication. At that it did seem foolish, according to all of my schooling to give an injection in the arm for a swollen testicle.

There was a marked lessening of the pain after the first injection. These were continued every day as in the other cases. After the third injection, temperature was normal and testicles much smaller. With the eighth injection there was a complete disappearance of the swelling and he was discharged after the tenth injection. Since that time I have had a few other cases of epididymitis, the behavior of which was altogether like this case.

However, I have had several cases of salpingitis in which I did not get the expected good results. They would seem to get much better for a time, but the swollen tube did not disappear; but after giving these cases a few injections of lactigen they seemed to recover altogether.

In January, 1932, I was called to see a mother nursing a 10-month-old child. Found her with a temperature of 96, generalized pains in her body and legs, pulse rapid and weak, breathing shallow. There was a discharge from a ruptured infection on the last phalanx of the middle finger. A deep ulcer-like infection on the upper half of right breast about the size of a quarter. Gave her an injection of hydrochloric acid, as in the other cases. The next day there was a much more profuse discharge from both lesions and after the second injection she went on to an uneventful recovery.

In August, 1932, 1 was called by Dr. H. I. Wylie of Scott's Mill, to see a woman evidently septic, having had chills, fever and prostration for several days. There was an ulcer-like lesion on the last phalanx of a finger, edges ragged, blister-like lesions over forearm. Gland above elbow and axilla swollen and tender. Diagnosis of tularemia (rabbit or deerfly fever from a tick) was made and the use of hydrochloric acid advised. I failed in my efforts to give an intravenous injection because of the very small size of her veins; so I gave her intramuscular injections of 3 c.c. of 1-500 hydrochloric acid every day for ten days using alternate hips. At this time all evidence of the infection had disappeared. There has been no return of the infection.

Since that time Dr. Wylie has told me he had another case of tularemia which he treated in the same way, except that he used the intravenous injection and that the result was like that in the case I saw with him.

A banker in a nearby town came to me with the only carbuncle (surface and deeper tissue inflammation, with pus exudate)I ever saw on the upper lip. There were draining sinuses over the lip and the left side of his nose. Pain was being controlled by morphine. Six daily intravenous injections were used in this case with the same good results I had witnessed in the other cases in which I had used the hydrochloric acid injections.

During the summer of 1932 I had the opportunity to see a woman of 35, the mother of 5 children, three weeks after a severe hemorrhage from the lungs. Since Ferguson had reported that the injection of hydrochloric acid made the polynuclear cells attack the tubercle in a way that is not done in nature, I decided to try the same injection I had used in the preceding cases.

I advised absolute rest in bed and mineral oil for her bowels and began the injection of hydrochloric acid, 1:1500, three times a week. As the days passed her appetite began to improve, and I ordered a diet of fruits, vegetables and what meat she felt she could digest. The improvement was most satisfactory and within one month she was free from fever. In three and a half months she went from 95 to 110 pounds in weight. She had a comfortable winter and has been able to move about the house since early in the year after fifty injections of the acid. Early in March, 1931, I began another series of the acid injections, which I shall continue during the spring and summer.

In the autumn I was called to see a man of 30, a farmer whose mother had died some time before with tuberculosis of the lungs. He too, had just had a hemorrhage from the lungs, and his history and condition were typical of pulmonary tuberculosis. He decided to go to Memphis for treatment, but after six weeks he returned, saying that he had had the rest-in-bed treatment and he might have that at home just as well. Soon after his return, when he was running an evening temperature of about 101. He began to have painful urination. Specimen of urine was cloudy and well-colored with red blood.

After the first injection of the acid, 1-1500, there was a most pronounced chill, but the following fever was no greater than his daily temperature. For a few following injections of the acid I decreased the strength to 1-2000. There were no further reactions, so I again returned to the injections of the 1-1500 solution. After a month there was no more discomfort on urination and the specimens were pretty well clear. With the freedom from fever and an improving appetite, he began to increase slowly in weight; so I increased the strength of the acid solution to 1-1000, which I am giving three times a week. He continues to eat and sleep well and I shall continue the injections of the acid for a few weeks.

In the fall of 1932, after a coryza, (inflammation of mucous membranes) my grandson, a robust lad of 6, complained of a pain over the lower lobe of the right lung. Rapid onset of fever. Within two days the lower lobe was consolidated. Light diet, attention to elimination, and an occasional mustard plaster over the infected lobe were the only treatment used. In spite of the fact that I had seen no untoward consequences following the use of the acid, I feared to give it to one so young. Crisis came on the sixth day, after which he was free from fever for two days when it returned with this relapse, quickly going to 102, pulse 120. Fearful of an abscess, I determined to give the hydrochloric acid, giving 3 c.c. of 1-500 deep in the pectoral muscle. There was an improvement in his condition for the following 24 hours, when his temperature was 101, pulse and respiration much lower. I gave another injection, as on the day before, under the pectoral muscle of the other side. Fever was normal the next day, and after a convalescence of two weeks, the patient returned to school, where his attendance has been regular since the illness.

Confirming the observations of Dr. C. D. W. Colby, of Asheville, of the effect of the hydrochloric acid injections on asthma and other manifestations of the allergies, about a year ago a young married woman came to me complaining of intense itching over her body, sometimes in one area, sometimes in another. The elevations on her skin on this visit seemed to be an urticaria. She said she had taken and done everthing advised by her doctor and friends, but the itching persisted. Six injections of the acid 1-1500 were given every other day. Improvement was noticeable after the first injection and she was wholly well after the last injection.

In the summer of 1932 I saw a baby with a severe case at colitis. Frequent vomiting, abdomen much swollen, delirious, with temperature of 104*. I tried all manner of recognized plans for treatment, but the foul-smelling frequent stools continued. I had been taught that such conditions were the result of acidosis and it seemed to be going too far to give more acid. But since all other measures had failed in giving relief, I determined to give the acid in the gluteal muscle, just as I had done with my grandson. Injections were given daily. Improvement in the general condition of the child was noticeable, abdomen rapidly flattened out, fever became lower, and on the third day there was a marked change in the quality of the stools. Six injections of the acid were given, after which the child made a rapid convalescence and has continued in good health.

At 4 o'clock one morning, January, 1928, I had a telephone call from Dr. L G. Martt, Proctorville, Ohio, from a hospital in Huntington, W. Va. Dr. Martt said he had a patient in the hospital with puerperal sepsis, fifteen days after delivery. Temperature 105; pulse 140; respiration, 40. She had had two transfusions, which had failed in ameliorating the condition of the patient. Dr. Martt said be had urged the attending physicians to give the hydrochloric acid, but since the injection of the acid had been listed as a dangerous procedure, they declined to do it. On my urgent advice he determined to give the acid injection himself.

Between eight and nine o'clock on the same morning Dr. Martt called again to tell me of the remarkable effect of the acid injection. That the temperature had dropped to 103; pulse, 96, respiration, 30, and the delirium had disappeared. While the patient still had a temperature of 102, after the fourth injection of the acid she had apparently improved so much Dr. Martt returned to his home in Proctorville, Ohio. Shortly afterward attempts were made to aspirate an apparent abscess. There was a rapid rise in the temperature and pulse and the patient died within the following day.

In November last I had an acute tonsillitis of my own; temperature 102; tonsils much swollen; whitish patches over each one. Not being able to give myself the hydrochloric acid, I took calomel, aconite, gargles and painted the throat with nitrate of silver. Since I had no improvement, I called Dr. J.F. Godd, asking him to give me an intravenous injection of hydrochloric acid. He demurred, saying that it was against all reason to give an acid in the veins. On my insistence, however, the injection was given. Improvement was rapid during the following hours. I had a good night and the next day my temperature was normal. I returned to my office in the afternoon.

In every case where I have a laceration in a confinement case I give, before I leave the house, a shot of 10 c.c. of 1 to 1500 HCl in the vein, with 100% results, without fever following. Before I began this practice I was having fever once in a while of a septic nature. In cuts or lacerations of any kind I give the acid as stated above; it prevents infection. The forgoing clinical reports are experiences I have had in the administration of some 1200 injections of the hydrochloric acid. I have seen few reactions after the injection of the acid and those that I have seen quickly passed and I have seen no untoward following effects. I have been changing drugs for almost thirty years, but since I began the use of the intravenous and intramuscular injections of the hydrochloric acid, something over two years ago, there has been no change, and so far as I can see at present I shall continue to give the acid injections when I see indications of infectious diseases. I have no way of checking the chemical and cellular changes that are said to go on in the body after the injection of the acid, as I am strictly a clinical medical man of the kind that do the larger part of general practice of the country. Clinically I know hydrochloric acid injections will be followed by good results in the greater number of infections. If the cellular and clinical claims are untrue or true, it seems to me they might easily be disproved or proved in a well-equipped laboratory.

In conclusion, I can only say that I am grateful to Dr. Burr Ferguson.

Clinical experiences such as I have never known before are frequent in the application of this idea that nature is the best doctor, through the injection of this basic acid of the body. While this paper was being copied, on the 24th of April, 1933, I had the opportunity of seeing two cases whose behavior under the influence of the acid-stimulated cells seems worthwhile. One was a lobar pneumonia and the other a pyogenic blood-stream infection.

On April 23d a boy of 15 had a prolonged chill, with an intense pain in the right side. I saw him the next morning with a tempersture of 104, pulse, 120; respiration, 36; cough and expectoration of rusty mucus and pus. Lower lobe consolidated.

Hydrochloric acid, 1-1500 was given intravenously. Twenty-four hours later temperature was 101, pulse, 90; respiration, 24; Profuse expectoration and the patient comfortable. Another injection of the acid was given. I failed to see the boy on the following day because of a call in another district. On the fourth day I wasvery pleased to find the temperature normal, yellowish sputum, freedom from pain and a most encouraging appetite.

A week ago an employee in a sawmill had a lacerated wound in the right leg from a fall of lumber. I cleaned and dressed the wound, using mercurochrome. In three days the temperature was 104; pulse, 130; intense pain in infected wound. Several small incisions were made from which there was an exudate of a small amount of bloody pus. Following the intravenous injection of 10 c.c. of 1-1500 HCl there was a profuse sweat within the hour, after which there was another pronounced chill but no increase in the temperature. The next day temperature was 102; pulse,100; and the patient was much more comfortable. The discharge from the wound was much more profuse than one sees when the case of such lesions is left altogether to nature. One required no microscope to know that there had been a great stimulation in numbers and activity of the white blood cells.

Another injection of the acid was given and on the following day the patient was much better with a normal temperature. Another injection of the acid was given in order that the very active repair of the wound might be continuous. B. F.

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