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Original Articles of Burr Ferguson, MD
Birmingham, Alabama

The Metchnikoff Idea
It seems the time has at last arrived when we may crystallize all 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."

For far too long, we have used this remarkable observer's work 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 discussed short-wave cabinet, mercury, arsenic, quinine, insulin, transfusions and the serums, hot and cold water, and whiskey all have an immediate effect on the most sensitive cellular system. So, since all these procedures have a common effect 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. The agent that meets all these requirements is hydrochloric acid.

Another point, which I may have left out of the paper in May World, is this: all the drugs with which I have worked lose their clinical potency with repeated use. Many counts with these agents have shown that with the lessening of the clinical effect comes a weaker stimulation of the white cells. This explains the idea of using a series of drug courses. The rests between these drug courses permit the body to re-establish a sensitiveness to the drug, so that when it is administered again, the white cells are 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* I use to illustrate this fact for occasional visitors. This patient has had several hundred injections of HCl since January, 1928. With the acid, I have kept him from the 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 104º or 105º ever burned up a germ – but the leukocytosis 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 "cut tooth." How Metchnikoff could have missed anything so simple is a mystery to me. 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 scared 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 Mechnikoff 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 side-chain theory of immunity. All of which 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 22, 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 rate 130; irregular, and the patient, a black man, had a grayish color. Truly, he was a hopeless prospect. After 3 cc of the acid, given intravenously, he almost fainted, 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 with his heart rate 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. He was given another injection on the 24th, and I saw him no more until May 4th. To my bewilderment, we found he had put on ten pounds, his heart rate was regular and 88, and he was 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 worthwhile 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 quite as important as the ability of the surgeon, the repair of the operative wounds. This feature of the wonderful work of the surgeons is left altogether to nature, and when this natural process 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 textbooks or teaching of any direct method of giving nature any positive aid beyond conventional directions for diet and general care.
As a basis for the following case report, illustrating the failure of nature in collaborating with a skillful surgeon, suppose it is said that the repair of wounds is but one of the ubiquitous activities of the white blood cells and that these cells do the most efficient work in a medium of modified alkalinity of the blood stream. If we grant that this idea renders the phenomena of repair a bit clearer, one should see a marked healing activity in surgical wounds 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 the blood. So a further stimulation of these cells would be 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 busy clinical medical man in general practice, whose time and 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 demolition of pathological tissue. Seven-to-eight thousand white cells to the cubic millimeter seems casual. But when one considers that a man of 160 pounds has about six liters of blood and that each liter has normally about eight billion of the repair and defense forces, or forty-eight billion in the circulating medium, the bountiful provision of nature is better comprehended. So, with each increase of 1,000 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 infection in a man. His wife's well-marked pallor and evident loss of weight, giving evidence of some chronic ailment, gave me really more interest than the acute illness for which I had been called. In reply to my request for information as to how she was losing so much blood, she told me that, in 1929, she had been operated on for infection about the anus and internal hemorrhoids. But that, following the operation, there had been little or no change in the bleeding and that every evacuation was accompanied by more or less pain, which was said to come from ulcerations about the anus. She said that, on the advice of the surgeon, she dilated about twice a week a much-constricted anus, which was always painful. Since there seemed to be no means of making a satisfactory rectal examination, I accepted her report of the diagnosis of the surgeon.

Clinical experiences of the past ten years having convinced me that the stimulation of the white blood cells induces a noticeable increase and activity in the healing of wounds, I felt very sure that the bleeding would be easily controlled. At once, I began the daily injection of 1-1000 solutions of hydrochloric acid (Loeser). On the fourth day, I was told there was no evidence of any bleeding, and after the first week, the patient no longer felt it necessary to dilate the anus; she felt much better. During the third week, in a series of fourteen injections of the acid, I had an opportunity for a rectal examination in my office. The anus seemed to be normal, as no undue pressure was necessary in the insertion of the proctoscope. Numerous cicatrices of smaller ulcers and several larger lesions, not completely healed, were seen, but an active process of healing was observable. The acid injections have been continued about twice a week, and after the 25th injection, 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 140 pounds. At the time of the operation in 1929, she weighed 130 pounds. Two months after the operation, her weight was about 100 pounds. In the four years since, the greatest weight has been 109 pounds. When the injections of hydrochloric acid were started on August 1, she weighed 105 pounds. Since that time, there has been a gradual increase in strength and weight, and on October 16th, she weighed 118 pounds.

One may conclude from the ready response to the stimulation of the natural repair forces by the hydrochloric acid injection, 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 1-250 hydrochloric acid four or more times so 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 repair may also be done by the injection of neo-arsphenamin – any of the several preparations of mercury, bacteriophage, or the proteids. I prefer the injection of the hydrochloric acid because of the comparative freedom from the inflammatory reaction following this injection, and 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 white 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. May we not conclude that these acid cells are the elements in the bloodstream that maintain the acid-base balance of circulating medium? If it is granted 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 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.

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