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The story of this revolutionary episode in medicine grows more interesting and more dramatic day by day. The suffering patients in the country districts, far from the well equipped clinics and hospitals, have at last found that something can be done for them. Whether or not it meets with general approval interests them not at all. They ask for relief -- and they get it, where the applicability of the measure to their complaint is obvious.

It would be unwise and unfair to both the medical profession and the public to discuss the merits of hydrochloric acid therapy and fail to call attention to its limitations and the actual dangers attending its use in certain cases. We have called attention to the fact that the use of the acid intravenously was followed by a considerable increase in the leukocyte count. A patient who had been suffering from myelognous leukemia, with a leukocyte count of 84,000 (the normal count being 6,500) was inadvertently given several intravenous injections of this preparation, with the result that the already high count rose to the unbelievable figure of over 400,000. Obviously, it is poor medical judgment to give a remedy that can only aggravate an existing condition.

Another important – vitally important – consideration affecting the administration of hydrochloric acid is one that depends upon accurate and painstaking investigation of the individual by the practitioner. Since this measure had the effect of stimulating the defense mechanisms of the blood, it is plain that the sudden increase of "phagocytes" at the focus of infection will be followed by the formation of pus, which, after all, is but an effort on the part of nature to attack invading bacteria. Should this sudden increase of the defense forces take place in an area where the drainage is poor, an abscess may result. For instance, a patient may have a diseased appendix that has been quiescent. A balance has developed in that patient between the defense elements and the infecting organisms. A sudden marshaling of the phagocytes at this point may stir the sleeping dogs into a first-class battle, with the result that the patient will require immediate operation. Similar situations may develop in other parts of the body, particularly in closed spaces such as the middle ear and sinuses, and the patient must be watched closely for the development of acute symptoms that might require surgical treatment.

From a prognostic standpoint, the inability of the patient to respond to stimulation is of grave significance. This is readily determined by the blood counts made at frequent intervals during a course of treatment. In fact, it is highly essential that the progress of every case be watched by an intelligent and observant physician. While astonishingly good results have been obtained by hit-or-miss methods in country districts by physicians who are without laboratory facilities, it is reasonable to assume that more care is mandatory on the part of those whose facilities are greater. The fact that there have been no reported cases of death as the immediate result of this medication speaks volumes for the safety of this measure.

It may be well to discuss in simplest terms the essential differences between the methods of hydrochloric acid medication used respectively by Ferguson and Guy. There is little to add to what we have said in the preceding paragraphs regarding Ferguson's technique and the principles upon which his reasoning has been based. He is essentially a man of practical, rather than theoretical, ideas. He proved to his own satisfaction that intravenous injections of dilute hydrochloric acid was a practical and cheap germicide, of greater potency and less destructive action than anything thus far discovered. Why, how, when, and where its action occurred were of less importance than the fact that the patient got well. Dr. Guy was more scientifically minded. Although also a general practitioner, he was determined to discover, if possible, a basis for the formation of a theory. He was a student of biologic chemistry and, from his knowledge and observation of plant life and its behavior under the influence of hydrochloric acid and the salts of potassium in the soil, he believed that certain similar principles applied to the growth and nourishment of human beings. Most importantly, he based his hypotheses on the observations of Hawk that lymph circulation, the medium by which nourishment is carried to every cell in the body, is as greatly important as the blood, and any condition, whether chemical or physical, that interferes with the flow of lymph produces a profound effect on the cells of every organ in the body. He had reduced his theory to simple and easily understood terms by a full explanation of the significance of the acid balance of the human body and the necessity for a proper maintenance of this balance for health preservation. Under normal conditions, the hydrogen-ion concentration of human lymph should be slightly on the alkaline side. Should this reaction vary too much, either on the acid or alkaline side, the patient, will develop conditions known respectively as "acidosis" or "alkalosis," either of which may be fatal. In health, the acid balance is maintained by the normal production of hydrochloric acid in certain cells of the stomach. Should this production fall short of bodily necessity, the balance must be made up. Other acids, which are the products of decomposition in the human body, such as lactic acid, fatty acids, carbonic acid, uric acid and others, are called in to fill the deficiency. These, however, are abnormal constituents of the great chemical laboratory of the human body and are ill-adapted to the requirements, for they are unable to keep in solution many of the salts which must be thrown off as waste matter in bodily excretions: sweat, expired air, urine, and feces. In the body's effort to provide acid of some sort, these harmful acids become a "monkey-wrench in the machinery," and the condition known as "acidosis" results with symptoms of general systemic poisoning. Conversely, when the hydrogen-ion concentration of human lymph falls into the acid side, due to excess production of lactic acid, fatty acids, carbonic acid, uric acid, and like poisons, the body makes an effort to neutralize these with alkaline salts, such as calcium, sodium, potassium, ammonium, and others. These also, being foreign to bodily economy, produce the condition known as "alkalosis," the general symptoms of which are similar to acidosis, but often attended with general collapse.

Dr. Guy has claimed that the mere administration of hydrochloric acid to a patient would not fulfill the necessary requirements. In his opinion, potassium salts, often lacking in the patient's food, are a necessary adjunct in the treatment aimed at bringing about a normal acid-base balance. Excess of potassium may be harmful, and the ingredients of the formula which he advocates are the result of close clinical observation by himself and others. The case reports following this line of treatment have demonstrated improvements and recoveries that, in many instances, would seem miraculous, if it were not for the basis of sound reasoning along the biochemical lines upon which the treatment was founded. Furthermore, if these reports were offered by the protagonist of such a system of therapeutics himself alone, skepticism would be justified. The fact remains, however, that infinite numbers of similar reports from men in active practice -- shrewd and experiences physicians on "the battle lines of medicine" – have come from all parts of the world. Actual and prompt clinical results to such men mean bread and butter. Satisfied patients mean an increase in clientele. These men are willing to leave research to the workers in heavily endowed laboratories. Their patients are more interested in being cured than in scientific aspects of the disease from which they are suffering. These patients ask them to "do something"; and the doctors know that unless something is "done," their patients will drift into the hands of some charlatan, who will at least give evidence of some definite form of active treatment, even though hopelessly misdirected.

The application of the principles of the hydrochloric acid therapy, or the "acid-mineral therapy" to various metabolic disturbances, such as diabetes mellitus, arthritis, and many obscure conditions, is deserving of serious consideration. The most elementary lessons in chemistry in our public schools, teach that various substances may be held in solutions of given degrees of acidity or alkalinity. When the ingredient proportions are perfectly balanced, the solution may be as clear and colorless as water; but let the acidity or alkalinity change a minute fraction of a degree, and a turbid fluid will result, with the accumulation of a precipitate at the bottom of the container. With this explanation, it is not difficult to understand how the normally clear and colorless lymph of the human body might, by a change in its chemical reaction, begin to become cloudy and deposit the salts, such as calcium, which should be held in solution. The deposit of these salts in joints must naturally interfere with the free and well-lubricated action of these joints. Could not such a change in chemical reactions explain the enormous deposits of lime salts in old arthritic patients? Similarly, if the lymph should become turbid and sluggish, is there not reason to infer that the lymph channels would become blocked, and the normal amount of nutrition be denied such structures as muscles, bones, cartilage, and skin -- in fact, every other component of the body? By the same line of reasoning, is it not likely that the products of decomposition, which should be removed by the lymph, would remain in the tissues and act as poisons to the delicate individual cells? On this basis, can we not explain the atrophies of muscles that are so characteristics of arthritis? With so many of the human body cells becoming degenerated, is it not inevitable that the blood-making cells should also be affected? Anemia is a characteristic symptom of arthritis.

The applicability of Guy's theory to diabetes mellitus is still under consideration. If it is true that by appropriate medication it is possible to restore the acid-base balance of the blood or lymph, the possibility of ultimate cure in these cases seems not unreasonable. Certainly, it seems within the bounds of probability that the tendency to acidosis from the absorption of harmful metabolic products would be lessened; conversely, the tendency for the development of hypoglycemia and alkalosis from over-dosage with insulin would be minimized. At best, insulin is only a crutch upon which the diabetic patient leans heavily, and the medical profession is still seeking some form of treatment that will correct the abnormal metabolic disturbances that have produced this distressing condition. We can see most clearly, however, that it must be the interference with the circulation of the blood and lymph in the extremities that brings about diabetic gangrene. Even a slight improvement in this circulation would provide much relief to the patient.

The most startling possibility in the development of the acid-base balance theory -- one that we approach with the same feeling that one approaches the spot where a treasure chest is said to be buried -- is that this theory might be the key to the vault in which lies the secret of cancer. Research foundations, notably the department conducted at the University of Pennsylvania by Dr. Ellice MacDonald, have been working for years on the theory that the development of cancer has a definite relationship to the pH of the blood plasma. Dr. Guy goes one step further, holding that the lymph is the responsible factor, and that, in cancer patients, the hydrogen-ion concentration is much higher than in normal individuals. It is necessary to give large doses of appropriate acids to these patients to bring the acid-base balance to normal. When this is done, in his experience, remarkable changes are seen in the new growths, some of which seem to disappear, and the lives of the patients are prolonged in comfort. He carries his theory further by claiming that there seems to be little doubt that the water supply bears a distinct relation to frequency of occurrence of this disease in certain areas or "cancer belts." He is studying this problem at the present time.

It seems but reasonable to discuss at this point the theoretical weaknesses in the claims of both Dr. Ferguson and Dr. Guy as to the efficacy of the hydrochloric acid or acid-mineral therapy. First of all, are the remarkable results that have been reported actual facts or figments of the imagination of an enthusiast? In the reports of Dr. Ferguson, we find a wealth of clinical observations, made before and after treatment, to support his statement that intravenous administration of solutions of hydrochloric acid will actually increase the polynuclear leukocytes of the blood. Ferguson stops theorizing at this point, and, perhaps, that is wise. Whether or not this increase is due to change in acid-base balance or to stimulation of hormone action is for someone else to determine. In our own studies clinically, we are forced to agree with him. The records of our cases in the wards where this procedure has been given a fair trial show conclusively that, in each case observed, there has been definite improvement as indicated by the blood-counts. Furthermore, the objection raised as to the possible toxicity of this procedure has not been borne out by the experience. A patient, suffering from some obscure cerebral disturbance, and in coma upon admission, lay unconscious for several days. Spinal drainage showed a pressure so high that, on several occasions, it could not be recorded. The Wassermann was negative; the cell count was 225, sugar 2-plus, and globulin 4-plus, culture-negative. There was choking of the discs, but definite localizing symptoms were difficult to determine because of the man's stuporous condition. Soon after admission, even in the absence of a positive spinal Wassermann, he was given 0.9 gm. neo-arsphenamin, followed by spinal drainage. This seemed to improve his general condition temporarily, but he soon relapsed into unconsciousness, became incontinent, and developed Cheyne-Stokes breathing. The end seemed imminent. By chance, Dr. Burr Ferguson, who was on his way to the AMA convention, was asked to see the patient. He agreed with the suggested diagnosis of meningo-encephalitis, with the possible development of cerebral abscess, but unhesitatingly advocated heroic doses of hydrochloric acid intravenously. Acting upon his suggestion, the man was given 20 cc of a 1-500 solution. There was no evidence of uptoward reaction. Through a misunderstanding, the second dose of the same strength was given two hours later, also with no ill effect. Injections of 1-500 solutions were continued every two days, but with little appreciable effect, except a marked increase in polynuclear leukocytosis. Several days later, the patient showed slight improvement, but was developing bedsores and pustular eruption on his back and buttocks from the continual soiling. A local application of 1-1000 HCl solution was immediately successful in bringing about rapid healing of these sores. For a time, the man was able to converse intelligently, was able to take food, and, on one occasion, climbed over the sides of the restraining crib to the floor and appeared in the ward walking normally. His spinal pressure still remained high --so high that it could not be recorded by the manometer – but his temperature came down to 99.0º F; pulse 72, and the spinal cell-count fell to 31. The man was later removed to the University Hospital and died following an operation in which a large brain tumor was removed.

A second case in the wards was that of a young man, admitted in serious condition with signs of pneumonia involving the left lung. He was treated by the usual methods and recovered from the more acute condition, but the involvement of the left lung and pleura refused to clear up. X-ray examinations showed evidence of some fluid, or thickened pleura, on the left side, and the physical signs over this area supported this diagnosis. His temperature began to develop the characteristic septic swing from normal or subnormal to 101.0º or 102.0º F, with sweating and chills. An aspiration was attempted, but no fluid obtained. He was given 1-1500 HCl injections intravenously, 10 cc, every second day. Immediately, improvement was noted in his general condition, but in a day or two he complained of considerable left-sided pleuritic pain and discomfort in breathing. The X-ray showed some increase in the shadow over the left base, and the breath sounds became more indistinct. A second aspiration was successful, and 40 cc of cloudy fluid obtained, which on examination showed pheumococci and short-chain streptococci. The patient stated that he experienced immediate relief from his pain. The following day he was much more comfortable, and the temperature began to come steadily down to normal. He was given the acid-mineral solution (formula of Guy), 12 drops every three hours, with continuation of the intravenous therapy. His condition immediately became extremely satisfactory, his temperature returned to normal, and he began eating ravenously. His leukocyte count fell to approximately normal, as might be expected where necessity for phagocytic actively no longer existed. We mention this case to illustrate the point emphasized in the first part of this introduction, that collections of pus may be expected in closed cavities when phagocytic activity is increased. In this case, however, the mere withdrawal of a portion of the infected fluid was sufficient to throw the balance in favor of the patient. A thoracotomy, with weeks and months of drainage and discomfort (to say nothing of hospital expense), seems to have been obviated by this simple therapeutic procedure.

In conclusion, we wish to say that we feel that the medical profession is probably entering upon an era of remarkable discoveries, based upon the logical theories of Dr. Guy and Dr. Ferguson, who are at the present time suffering from the stings of skepticism on the part of many of their colleagues. We realize most fully that many steps must be taken before the procedures advocated by these pioneers can be accepted by the conservatives. Careful checking of results by laboratory investigation will eventually establish or disprove the assertions made by these men. However, it seems incumbent upon progressive practitioners to make every effort to assist in clinical research that may later prove of unbounded assistance in the healing of the sick patient. We have been led along the paths of synthetic medication for too many years, to the detriment of too many sufferers, as evidenced by the growing incidence of serious blood disturbances, such as agranulocytosis, methemoglobinemia, and others. We have often relieved pain without attacking the underlying cause; we have operated when resistance was at too low an ebb; we have prescribed remedies empirically, without clear-cut knowledge of their action or collateral effect. Let us make a determined effort to follow our line of treatment with scientific exactness, and if we feel justified in assisting the work of Ferguson, Guy, and others, we may either offer conclusive proof in condemnation of its principles or congratulate ourselves on being able to support the efforts of its advocates by accurate clinical proofs and painstaking case records.

Henry Pleasants, Jr.
Associate Editor, The Medical World

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