AUTOTHERAPY BY CHARLES H. DUNCAN, M.D. DISCOVERER AND FOUNDER OF AUTOTHERAPY Former Mechanical Engineer of the Illinois Steel Company. Co-Founder of the Volunteer Hospital. Attending Surgeon and Genito-Urinary Specialist Volunteer Hospital, New York City, 1905-1914. Honorary Member Veteri- nary Medical Association, New York City. PUBLISHED BY DR. CHARLES H. DUNCAN 2612 BROADWAY, NEW YORK CITY Copyright, 1918, by CHARLES H. DUNCAN, M. D. All rights reserved, including the translation into foreign languages, including the Scandinavian This book is dedicated to MY MOTHER that rare genius of the sick-room who possessed the combined qualities of broad sympathies, keen intuition, and uncommon good medical sense. These she inherited from her father, Dr. Charles Henry Webb of Princeton, Kentucky, for whom the author was named. Her excep- tional medical endowments were cultivated .to full fruition by her brother, Dr. James Webb of Little Rock, Arkansas, and by my father's twin brother, Dr. George W. Duncan of Franklin, Kentucky. PREFACE This volume has been prepared at the request of many physicians who have had their professional interest aroused by reading one or more of the many articles on the subject in Autotherapy that had appeared in standard medical periodi- cals during the past eight years. Autotherapy has gained wide recognition and received the unqualified endorsements not only of many well-known physi- cians and veterinarians but of leading medical, and veterinary medical societies. By means of a text-book only can the thou- sand and one questions that are constantly being asked by physicians be answered. The majority of these will be an- swered in the contents of the book, but it is essential that a satisfactory answer be given at this time to questions that are bound to occur to the reader when his attention is directed first to the subject, namely: (1) How long has Autotherapy been under continuous study? To such a question the author's reply is that he has been continuously occupied in this pursuit for the past eight years. (2) Has Autotherapy been brought before the attention of the profession in such a manner as to secure on the one hand abundant corroboration, and on the other hand such searching criticism as a new idea in therapeutics must welcome? During this period in question the author has made known his experience in the best-known media, including : The Medical Record, Lancet-Clinic, Proceedings of the Veterinary American Medical Association, Medical Era, New vi PREFACE York Medical Journal, Boston Medical and Surgical Journal, Medical Sentinel, American Practitioner, American Journal of Surgery, Therapeutic Record, Medical Times, New Eng- land Medical Gazette, Northwest Medicine, New Albany Medi- cal Journal, American Medicine, Interstate Medical Journal, Medical Council, Medical Standard, Western Medical Times, Medical World, Southern Medical Journal, International Jour- nal of Surgery, Long Island Medical Journal, Texas Medical Journal, Buffalo Medical Journal, etc., in the United States. The Paris Medicate, The Practitioner (London), Practical Medicine (Delhi), Indian Medical Gazette (Calcutta, India), British Veterinary Journal, and other foreign journals. (3) It is now an axiom that a new method of therapy, or a remedy, must be tried out at least two thousand times in order sufficiently to eliminate the possibility of spontaneous cure; effects of suggestion; wrong diagnosis, etc. If this is true, is the author's method properly grounded? The reply here is quickly forthcoming: As one of the two founders of the Volunteer Hospital in New York City ; President of the Medical Board; Operating Surgeon; Consulting Surgeon in the Dispensary; and Genito-Urinary specialist, the writer has had unlimited opportunity of amassing a preponderance of clinical evidence as to the great therapeutic value of Auto- therapy in various infections, almost weekly, during the years 1910, 1911, 1912, 1913, and 1914. Without making a sys- tematic count of the letters received, it appears there are many more than two thousand physicians scattered through- out the world who are using Autotherapy successfully, daily, in both private and hospital practice. One physician in Penn- sylvania has employed Autotherapy in over six hundred cases, and his results have been such that he has practically discarded the use of vaccines. Many have used it from three to five hundred times. Many have used it when opportunity pre- PREFACE vii sented from one to eight years. All who have used it con- scientiously and intelligently, are enthusiastic over its use. It is widely employed in veterinary medical practice; and the Veterinary Medical Association of New York City has twice officially endorsed it in the highest terms. It is not uncommon to find a battery of from two to six filters in active use in veterinary hospitals. The veterinary physicians are unanimous in vouching for the specificity of Autotherapy. It appears from the number of physicians using Autotherapy success- fully, and the official recognition it has received, and from the fact that the range of its application extends to the treatment of animals, that this mode of treatment has long passed the experimental stage and has come to the physician's hand to stay. (4) For a new method of treatment to receive prompt recognition it should be susceptible of the widest possible gen- eralization. If its use must be restricted to a few experts, or a few localities, it cannot pose as a great innovation in medi- cine. In replying to this the author will state that Autotherapy is eminently suited to wholesale application ; it may be used by any qualified medical man in any locality. (5) Is the method scientifically grounded and in harmony with the laws of biology as they are understood at the present time ? The doctrine of Autotherapy is a natural outgrowth of the accepted views of Pasteur, Ehrlich, Behring, Wright, and of all other great immunologists ; it comprises nothing that is antagonistic to science and has no foundation in any teachings of the isms of pre-scientific days. It may be used in conjunc- tion with other plans of treatment save for certain exceptions to be enumerated later. (6) What outside corroboration of the author's claims is there at present aside from case histories? Since in all inde- pendent discoveries there are usually one or more discover- viii PREFACE ers, has any reputable scientist or physician independently come upon Autotherapy ? There are numerous replies possible to this query. Several well-known clinicians in different parts of the world have devised systems of Autotherapy at a period several years subsequent to the author's initial studies and reports, which show a remarkable parallelism with the author's teachings. He is naturally in doubt as to whether these men were influenced by his writings directly or indirectly, for it is impossible to believe that his views could have been entirely unknown to them. The writer makes no claim to priority in regard to Autoserotherapy and Autodrainage, in connection with the treatment of serous effusions, and these are only remotely related to Autotherapy. They have but a limited field of application and are not outgrowths of vaccinal therapy, having been in vogue long before the time of Wright. The mechanism of cure in these cases is not yet fully under- stood. Not the least support of the author's claims is found in the reinjection of sterile pus and secretions in general for recent wounds that was successfully tried out in France for gas gangrene during the great world war, and in India for general purulent infections; and in the successful use of Autotherapy by missionaries where stern necessity demanded its continual use. (7) The technic needs further elaboration there is little in medicine but that does. There is no unanimity now regarding the dose of vaccines and sera. An important consideration is embodied in the words of the committee appointed officially to investigate Autotherapy : " It is not dangerous, or no more dangerous than the use of the vaccines and sera now in daily use among us." The main motives that have actuated the author's endeavors are: (i) The desire that all physicians may be as successful PREFACE ix in treating their patients as the author is in treating his. (2) The desire for simplicity. The author has been wholly altruistic in giving Autotherapy to physicians; there have been no secret formulas; nor is there any claim for superior skill. There has been no effort to make money out of it in any way. He has answered all inquiries and distributed freely reprints of his articles to physicians, by the thousand. He is indebted to a number of his confreres and co-workers for able and friendly criticism, time consumed and interest manifested in the development of Autotherapy. These with undimmed interest have upheld his hands and stimulated his enthusiasm in the gradual awakening of autotherapeutic pos- sibilities; and in the unfolding of new lines of medical thought, from their inception. For these and other courtesies the writer wishes to express his sincere thanks and appreciation to : Dr. Henry T. Brooks, former pathologist of the New York Post-Graduate Medical College and Hospital, Pathologist St. Mark's Hospital. Dr. George F. Laidlaw, Professor of Diag- nosis and the Theory and Practice of Medicine, New York Homoeopathic Medical College and Flower Hospital. Dr. William H. Dieffenbach, Professor of Electro- and Hydro- Therapeutics, New York Medical College and Hospital for Women. He is under obligation to Dr. Edward Preble for reviewing and editing the MSS. CONTENTS CHAPTER PAGES I. A BRIEF HISTORY OF AUTOTHERAPY . i to 5 II. THE BASIC PRINCIPLES OF AUTOTHERAPY 6 to 28 III. THE LIMITATIONS OF AUTOTHERAPY . 29 to 40 IV. AUTOIMMUNIZATION 41 tO 60 V. DESCRIPTION OF THE DUNCAN AUTO- THERAPEUTIC APPARATUS . . . 61 to 75 VI. THE PREVENTION AND CURE OF PURULENT INFECTIONS 76 to 130 VII. ACUTE GONORRHEA IN THE MALE . . 131 to 147 VIII. GYNECOLOGY AND OBSTETRICS . . . 148 to 174 IX. AUTOGALACTOTHERAPY .... 175 tO 194 X. RESPIRATORY INFECTIONS .... 195 to 258 XI. URINE AS AN AUTOTHERAPEUTIC REMEDY 259 to 275 XII. BLOOD AND BLISTER SERUM AND OTHER NON-PURULENT SEROUS FLUIDS . . 276 to 305 XIII. AUTOTHERAPY IN IVY POISONING, AN- THRAX 306 to 314 XIV. MISCELLANEOUS . . . . . . 314 to 330 Syphilis . Snake Bite Typhoid Fever Sleeping Sickness Whooping Cough Measles, Scarlet Fever and Diphtheria Eczema Erysipelas Riggs Disease INTRODUCTION In Dr. Duncan, the man, and autotherapy, the system, the old dream of curing disease with its own poison reaches its highest modern development; for this idea of curing disease with its own poison is age-old, so old that we cannot point to its beginning in the traditions of ancient medicine. The idea is found among many primitive and savage peoples. In the history of medicine, it appears, vanishes and reappears, each time a little finer and better developed than before. As a kind of practice called isopathy, it appeared nearly a century ago and, in our time, is presented anew by the bacteriologist as the most modern development of scientific medicine. In the last century, the idea appeared with Lux and the isopaths about 1820. Declaring that every contagious disease contained in its discharge the remedy for its cure, Lux prepared his remedies by diluting the discharge with water and gave this preparation by the mouth in very minute doses. In those days, the bacterial culture, the vaccine and hypodermic medica- tion were unknown. It was not from this isopathic source that Dr. Duncan derived his autotherapy but rather from the bacteriological school. The bacteriological school owes nothing to isopathy, but is rooted further back in Jenner's prevention of smallpox by the poison of a similar disease. This prevention of small- pox was a tantalizing light that danced before the eyes of the great Pasteur, with its vision of preventing all other human and animal scourges and beckoned him on and on to the prevention of anthrax and of rabies, incidentally founding the xii INTRODUCTION great science of bacteriology. Pasteur advances a step by using not a similar disease but the virus of the same disease, but he restricts himself to prevention of disease; for, true to its origin in vaccination, the effort of early bacteriology was the prevention of disease rather than its cure. Koch with his tuberculin and Behring with his diphtheria antitoxin carry the idea of prevention forward to the idea of cure. Koch's last tuberculin, the bacillus emulsion, the closest that he dared go to the full, unchanged virus of tuberculosis, marks another step forward, and the preparation of emulsions of killed bacilli was developed by Wright in his vaccine therapy. In my opinion, Dr. Duncan's Autotherapy is the logical next step after Wright. It is the use of the full, unchanged virus of disease, unaltered by heat or chemicals, that Koch indicated as the true remedy, but Koch got no further in his technique than stock emulsions of bacilli killed by mechanical grinding. Like the old isopaths, Koch missed the autogenous principle and the use of all the infecting bacteria in mixed infections. Wright added the valuable idea of autogenous origin of the virus and, curiously enough, reached the same conclusion in one respect as had the old isopaths that these remedies must be used in a very minute dose and that there should be a long interval between doses. By this time, the revival of the ancient idea of curing dis- ease with its own poison was in full swing and sweeping everything before it under the new name of immunology. Give a dog a bad name and you can hang him. Conversely, give a dog a new name and you can introduce him into very respecta- ble society. The old jibes against the isopath were forgotten. Everybody was doing it. Learned professors were trying to cure cancer and all sorts of incurable diseases by small doses of their own or their neighbor's poison. From this point, Dr. Duncan started developing his technique of autotherapy. INTRODUCTION xiii As already stated, autotherapy is the next logical step after the vaccine of Wright. It is a more nearly perfect form of the autogenous virus on which Wright insisted and it employs the full virus of disease which Koch named as his goal but did not succeed in preparing. It is well known that the best vaccine is that made from the exact strain of bacteria that attack the patient. Similar bacteria taken from another patient may be useless. Manufacturers of stock vaccines attempt to meet this difficulty by preparing the polyvalent vaccine, made from many different sources, hoping that the However, such is the myriad variety of bacteria and the char- strain of bacteria that affect the patient may be among them, acteri sties of the strain so altered by the tissue or media in which it grows, that the inclusion in the stock vaccine of the particular strain that affects the patient is a matter of chance and often a long chance. Autotherapy is an advance on autogenous vaccine therapy because there are four difficulties in applying autogenous vac- cine therapy that Dr. Duncan's method easily solves. These difficulties are: the offending bacteria or some of them may fail to grow on the culture medium; the autogenous vaccine must be treated by heat and chemicals, both of which weaken its curative power, as both Koch and Denys pointed out; the preparation of the autogenous vaccine requires the help of a skilled bacteriologist and a laboratory; finally and most important in pneumonia and acute disease, the preparation of an autogenous vaccine requires at least twenty-four hours, and in practice often longer. Moreover, any little carelessness or inattention on the part of the bacteriologist or his helpers may vitiate the product. Thus, from the time that the bacteria are taken from the patient until they are returned to him in the form of an autogenous vaccine, the material is subject to many vicissitudes, none of which are under the control of xiv INTRODUCTION the physician himself. On the other haifd, autotherapy uses the very bacteria and all of them that affect the patient, with all their poisons intact, endogenous and exogenous, in the same proportion in which they are present in the patient; there is no culture of bacteria with its uncertainties of some growing and others not ; autotherapy uses them fresh without heating or chemical preservatives; the technique is so simple that any doctor, learned or unlearned in bacteriological methods, can carry it out anywhere, in city or country, with the simple apparatus of a filter and a hypodermic syringe ; there need not be the delay of sending cultures to a laboratory and waiting for them to grow ; and every step of the process is easily under the eye and control of the attending physician. I have watched Dr. Duncan's work from the beginning, admired his tireless energy, his patient experiment and in- vestigation. He has met the common lot of reformers, cold neglect, derision, persecution, perhaps, and met them cheer- fully, recognizing frankly that this was a phase through which all new work must pass, boldly confident that the honesty of his work must sooner or later win the indifferent and the skeptical. His mind is essentially honest and sci- entific and if, at times, the enthusiasm of the discoverer colors his vision and if his boundless hope leads to occasional error, which of us can say that we ourselves, standing on the threshold of a great discovery in therapeutics, that we our- selves would reason coldly and resist the rush of enthusiasm that alone carries us upward and onward in our work. Dr. Duncan is a natural investigator and an ingenious ex- perimenter, which means that he is naturally gifted for scientific research. If any reader of this book should have a friend of wealth and philanthropic spirit who desires to benefit his race and to associate his name with the advance of medical science, I would suggest to him that the founding of an INTRODUCTION xv institution for medical research with a man of Dr. Duncan's energy and talent at the head of it, would produce results of everlasting benefit to the art of medicine and the fame of the founder. GEORGE FREDERICK LAIDLAW. NEW YORK, July i, 1918. // Medicine " Were content to mark and work on the foundation Nature lays, It would not lack supply of excellence." Dante, Gary's Translation. CHAPTER I A BRIEF HISTORY OF AUTOTHERAPY It is seldom the privilege of a clinician to report a new therapy or method of healing, and it is especially rare that a method so very effective should have been developed upon clinical experience; for clinical experience has ever occupied the minds of the world's great thinkers of all ages. The roots of Autotherapy extend far into the distant past and reach deep into the texture of our very being. Within recent years the medical world has revived the old medical axiom, " Disease carries with it its own cure," and has fixed attention upon stock and autogeneous vaccines. Alluring as have been the brilliant cures occasionally obtained with these, it is well known that the plans of Nature in curing the sick, do not include immunizing the patient to heterogeneous toxins, nor even to modified partial autogeneous toxic substances ; but she has foreordained that the patient should be immunized to his own unmodified toxin-^nmplex or toxins and toxic, tissue substances elaborated within his own body -by -the action of the infectious agents upon the body tissues. Autotherapy proves that a natural cure is brought about by autoimniunization; that is, by immunizing the patient to his 2 AUTOTHERAPY own unmodified toxin-complex. This is the fundamental basic principle upon which Autotherapy rests. A brief history of one of the first cases treated autothera- peutically and the conclusions then made, may not be out of place here. The reader will thus be able to follow, step by step, the sequence of events that ultimately led to the further development of the principle underlying the cures made by its use and its application to all localized infections. In December, 1909, there was brought into the hospital under my surgical service a patient suffering with a compound fracture of both bones of the left leg. There were also severe bruises and contusions all over his body, caused by being run over by an automobile. Infection set in and progressed in spite of all that could be done. When it became apparent that he could live but a short time, the writer, as a last resort, decided to see what effect the animal method of placing the live infect- ing microorganisms from the wound directly into the patient's mouth would have upon the course of the infection. Accord- ingly, a. few drops of pus * taken from the wound, were placed in the mouth of the patient Within two days the purulent discharge entirely disappeared leaving healthy granulations. The appetite improved, the temperature fell to normal, and he became cheerful and improved in every way. His friends then removed him from the hospital and he was lost sight of. This case set the writer thinking and he decided to make fur- ther tests upon apparently hopeless cases that came under his surgical service. It was not long before he had an oppor- tunity of making tests upon three severe cases of infection following accidental wounds. These were treated in a similar manner and in each instance the former results were confirmed. Pus by the mouth acts therapeutic ally at once, and the results *This technic has been much improved since then and the principle has been extended to include all localized infections. A BRIEF HISTORY OF AUTOTHERAPY 3 tend tSL-be permanent. Here was the first medical lact, anchored and demonstrated. It appealed to some, however, as being particularly disagreeable, even though its action is de- scribed by physicians employing this method in treating them- selves to be " like magic." The odium was intensified perforce by those who preferred to give " pretty pink pills." However, the author believed that the " physician's first duty is to cure his patient," and rather than see them die when there were means at hand that would save them, he persisted in the treatment. In the effort to make a more elegant autotherapeutic prepa- ration a dilution of pus was filtered through a Berkefeld filter and the efficacy of the filtrate tested both by the mouth and hyppdermatically. This also was found to be effective when given in the manner described. Here was a second medical fact or stepping-stone in the development of Autotherapy. With this beginning it was not long before new and startling medical facts quickly developed, until the record of each day's work resembled in some respects the successive editions of the daily press. Medical truths, everlasting and immutable, were uncovered daily. It then dawned upon the writer that all localized infections have a discharge and that the filtrate of this contained the unmodified toxins from all microorganisms present in the focus of infection. I asked myself the question : " Since this treatment is so effective in purulent infections would it be equally efficacious also in other localized infec- tions ? " Then came busy days. In quick succession many infections were treated successfully. Acute bronchitis cured within twenty- four hours; pneumonia in the early stages was checked almost instantly ; in endometritis, salpingitis, mastoid- itis, otitis media, etc., the curative reaction was apparent often within a few hours, and it tended to be permanent. As one after the other of these infections was conquered, it was real- 4 AUTOTHERAPY ized that a great secret of nature had been discovered and demonstrated beyond all shadow of doubt. As the data accumulated the writer began to give them to the profession. What concern was it of his if those physicians who had at first opposed Autotherapy were forced to reverse their expressed opinion or find themselves alone in opposition to truth? What cared he if surgeons at the hospital, through petty jealousy, used their positions and personal influence to obstruct his work; he persisted in his tests and publications. The profession at large was attracted, and letters of congratu- lation and encouragement came pouring in from broad-minded physicians all over the world. Words of appreciation came from a Medical Missionary in the far-off Philippine Islands: " I am saving the women from operations following gonor- rhea." Surgeons in India enthusiastically took up the work and published in the Indian Medical Gazette several able articles upon the subject of Autotherapy, relating prompt cures in otherwise incurable conditions. From the Portland, Oregon, General Hospital, came the words, " We feel that our pa- tients cannot get well nowadays unless we have some auto- therapy to offer them." Scarcely a month passed but that several articles referring to remarkable cures made by Auto- therapy, appeared in the standard medical periodicals. Papers on the subject of Autotherapy were read in Vienna, Budapest, Marietta, and Cleveland, Ohio; Denver, Chicago, Portland (Oregon) ; Omaha, Boston, Philadelphia, New York, etc. Veterinary physicians took it up with vigor and endorsed it in the highest terms. After a most rigid official investigation, the Homoeopathic Medical Society of the County of New York unanimously endorsed it. The odium was dispelled, and the opposing forces brushed aside by sober medical opinion. But in many hospitals where it is used for the first time the conflict begins anew ; progression versus " pretty pink pills." A BRIEF HISTORY OF AUTOTHERAPY 5 The philosopher is aroused from his dreams, for here are new facts that do not fit his systemic order of things, but rather tangle his philosophy. Those who on general prin- ciples oppose anything that is new, found here an opportunity privately to voice their sentiments. It was only occasionally that one became so bold as to oppose it upon the floor of the County Society. Now, what does this all mean? Why this odium, this en- thusiasm, this philosophical entanglement, this opposition with- out investigation ? Even to a superficial observer it means that Autotherapy marks an era in medicine. The handwriting is on the wall that has for each an almost individual meaning. Since it means for you quicker cures, fewer operations, and the use of a less number of drugs, etc., let us remember also that it means for humanity a blessing. And the world moves on. Times have changed and the profession eventually will adjust itself to the new order of things. * We move from the complex to the simple, and the obvious is the last thing we learn." Dr. Elbert Hubbard on Autotherapy. CHAPTER II THE BASIC PRINCIPLES OF AUTOTHERAPY Autotherapy is the physician's method of treating the patient with unmodified toxic substances elaborated within the latter's body, by the action of the infectious agent on his body tissues, against which the tissues react in a curative manner. Autotherapy is a new system of therapeutics. It is simple in its application ; far reaching in its effect ; and the principle upon which it rests so sound that it might with propriety be called " The Basic Principle of Therapeutics." The unmodified toxic substances may be employed in the form of the filtrate, obtained by filtering the pathogenic exu- date or other body fluids containing the toxic substances elaborated within the patient's body by the action of the infect- ing agent on the body tissues, through a Duncan Autothera- peutic Apparatus. The bacteria-free filtrate may be injected subcutaneously in all acute localized infectious diseases. In acute infections in no way connected with the alimentary tract or the respiratory system, the crude pathogenic exudate, or the filtrate may be given by the mouth. A natural or spontaneous cure of an infectious disease is due to the entrance into the blood stream of the unmodified BASIC PRINCIPLES OF AUTOTHERAPY 7 toxic substances developed within the focus of infection. When this occurs, the power of the blood serum is raised and the activity of the leukocytes stimulated, with the resultant development of specific antibodies. Autotherapy, or auto- immunization, is based on Nature's method of cure; for by Autotherapy the patient is immunized with, and therefore to, the unmodified toxic substances elaborated within his body, by the action of the infectious agent (symptom producing agent) on his body tissues. With Autotherapy, the physician simply immunizes the patient with the same unmodified toxic substances that Nature utilizes when a spontaneous cure occurs. The bacteria-free filtrate contains all of the unmodified toxic substances from all of the microorganisms, both causative and complicating, that are in the locus of infection; in the same proportion and virulence in which they appear in the patient's body, and when this unmodified bacteria-free filtrate is in- jected subcutaneously into (comparatively) healthy fixed tis- sues, resistance by these is developed to all of the toxins and toxic tissue substances (the toxin complex) within the locus of infection. The studies of Buchner * that were extended by Bail, who developed the doctrine of aggressins, show that in every in- fected area there are causative microorganisms and their toxins; and that there are also toxic tissue substances that correspond to each bacterial toxin, as enzymes, ferments, and toxic results of chemical changes in the protoplasmic molecule, etc., against which the tissues react in a curative manner. They further show the pathogenic activity of the bacterial toxin is intensified when in the presence of its corresponding associated toxic tissue substance ; and that it is the toxic tissue substances that cause wound fever in clean wounds. In other * Hiss and Zinsser, Text-book of Bacteriology. Second edition. Chapter on Aggressins and Anti-aggressins, pp. 292 and 330. 8 AUTOTHERAPY words, healthy tissues react against toxic tissue substances, as well as against bacterial toxin. His work was a laboratory demonstration, and was not employed for therapeutic pur- poses in the manner suggested by the writer. The therapeutic value of all vaccines is lowered. The influ- ence of the culture media on bacterial growth, development, biological, and morphological characteristics is beginning to be pretty well understood as new light is thrown on the sub- ject by many investigators. In France it has long been taught that the media upon which bacteria grow, modify the microorganisms, both in regard to their biological characteristics, as well as their ap- pearance. Vincent shows that it is possible to make certain non-pathogenic microorganisms pathogenic, by simply incubat- ing them on certain culture media ; and then vice versa, he may change them back again into a non-pathogenic variety by growing them again on the media upon which they originally grew. This is highly important from a therapeutic point of view, as showing the great modification and transformation and what grave dangers may be developed by the supposedly innocent culture media. Again, one investigator has shown that certain bacteria may be made fermentative or non-fermentative at will, by simply employing certain culture media. By a similar process, another shows that certain bacteria may be made gas-producing or non-gas-producing at will. One investigator has gone so far as to state it is only when bacteria are grown on culture media prescribed by the text-books, that they behave in the manner the text-books describe. If there are no conditions under which a microorganism can grow outside of the patient's body that are exactly like those in his body, then it is not difficult to understand why they should not be so grown, if the best therapeutic effect is BASIC PRINCIPLES OF AUTOTHERAPY 9 to be obtained. There are no accidental or altered toxins from the culture media in my unmodified toxin-complex, nor are the morphological or biological characteristics of the infecting microorganisms altered or changed by the simple process of filtration. For these reasons the autotherapeutic remedy in- dividualises the patient as can no other remedy. * " It is well known that the animal organism has the power of developing antibodies to any foreign albuminous substances introduced into it, which neutralise, or destroy the foreign substance. Furthermore, these antibodies are produced in' excess of the amount required to neutralize the stimulus, so that the blood of the animal so treated contains anti- bodies, some of which can be demonstrated by suitable methods. " Now bacteria are such foreign albuminous substances, and the phenomena of recovery and acquired immunity are thus explained; and it appears that when a disease does not end in recovery but becomes chronic, the mechanism has broken down " ; but if the soluble albuminous part of the bacteria be filtered to exclude the microorganisms (to prevent spread of infection) and the filtrate in the form of unmodi- fied toxic substances be introduced into a part of the body which has not been exhausted, new antibodies will be formed in excess of those required, and these will pass into the blood stream and be available against the infection. The antitoxins of both diphtheria and tetanus are developed in animals in response to the injected filtered toxins of the diph- theria and tetanus bacilli respectively. The antitoxins developed in the animal in response to these filtered toxins, tend to com- bat or antidote any further injection of toxins and also tend to rout the corresponding microorganism when it is injected into the animal. Developing active immunity in the animal to * Hiss and Zinsser. 10 AUTOTHERAPY a given microorganism by injecting the filtered toxins of that microorganism in the healthy fixed tissues, is similar to the development of active immunity in the patient to his own toxins and infecting microorganisms by injecting him with the unmodified filtered toxins from his own infecting micro- organisms. By this process we autoimtnunise the patient, i.e., immunize him to his own infecting microorganisms. Again when a patient is injected into comparatively healthy tissues with the unmodified filtered toxins from the focus of infec- tion, leukocytes are attracted to the point of injection in large numbers, and they are stimulated by the development of specific antibodies to perform a very definite function, namely to destroy that microorganism only to whose toxins they re- spond, the microorganisms from which the patient suffers. There being none of these microorganisms at the point of injection, the specific leukocytes pass on into the circulation to the focus of infection by tropism, where they tend to combat or rout out that microorganism from the soil of its recent adoption. By no other active immunising agent can that microorganism be attacked so successfully as by the anti- bodies aroused in the patient's body in response to the unmodi- fied toxin-complex of that particular organism or by the auto- therapeutic remedy. There is no certainty of cure with any heterogeneous toxin or set of toxins ; clinical experience for upwards of a century clearly proves this. Administering the stock conglomerate vaccines has been frequently termed shot-gun therapy, and empirical prescribing pure and simple, and is considered by many wholly unscientific. Sir Almroth E. Wright was the first of modern biological investigators to grasp albeit imperfectly the idea of the great therapeutic value of the autogenous agents and gave to the medical world the autogenous vaccines; but he lowered the BASIC PRINCIPLES OF AUTOTHERAPY 11 therapeutic value of the unmodified natural toxins which he took from the body which represent the exact remedy (the unmodified toxin-complex developed in the patient's body) through the elaborate process which his autogenous vaccine undergoes during its preparation. It .is the consensus of medical opinion that the therapeutic value of autogenous vaccines is superior to that of the stock vaccines, yet the therapeutic effect of all autogenous vaccine is either absent or altered by every step in the process through which it passes in the laboratory during its preparation, for the following reasons : 1. Autogenous vaccines may not include the causative micro- organisms through error in technic. 2. By the action of heat. 3. By the action of chemical preservatives. 4. By expiration of time. 5. Through changes that occur by being grown in foreign culture media. 6. By being grown outside of the body tissues. 7. By being grown under entirely different conditions. 8. Wright's autogenous vaccine does not include the unmodi- fied tissue toxic substances that correspond either to the causative microorganisms or the complicating micro- organisms. 9. Extraneous matter may creep in, thus rendering his vac- cines worthless. 10. The autogenous vaccine of Wright may not contain the complicating microorganisms of which there are many in severe infections, n. If there is an attempt made to include the complicating microorganism in the vaccine we are often compelled to make growths on several different media, or make sev- 12 AUTOTHERAPY eral different vaccines and each one is subject to errors above enumerated. For these and other reasons the therapeutic effect of a vaccine made according to Wright's method, is altered or lowered as compared with the unmodified parent antogenous toxin-complex or the autotherapeutic remedy. Again there are weighty reasons why the physicians may not use Wright's autogenous vaccines: 1. The patient may pass the crisis and die before the vaccine is prepared. 2. Not every patient can afford to have his vaccine used in his behalf. 3. It requires an extensive laboratory with ovens, thermo- stats, culture media, etc. 4. It requires a skilled bacteriologist, one on whom absolute dependence can be placed ; he is not always easy to find. 5. There is no known method of growing some pathogenic microorganisms outside of the human body. 6. We may not be able to identify all of the microorganisms present. Wright's autogenous vaccine is a near-autogenous, time- consuming, cumbersome agent of altered therapeutic value and often a poor substitute for Nature's remedy (the unmodi- fied toxin-complex), the autotherapeutic remedy; and it may not be available. Vaccine therapy at best is an imperfect imitation of natural therapy. Autotherapy is the culmination of vaccine therapy. Autotherapy is induced, natural therapy. Wright's vaccines at times give brilliant results and they often do not. It is not advisable to attempt to prepare such a highly complex, complicated remedy, subject to error, and BASIC PRINCIPLES OF AUTOTHERAPY 13 at times not obtainable, when the remedy Nature offers is at hand and often may be obtained. The autotherapeutic remedy may often be administered as early as the stock vaccines; it usually requires not more than one or two hours to pre- pare it, and it often may be given in as many minutes. If Wright's vaccine cures, such cure is due, not to the culture media, chemical preservatives, and heat, etc., but in spite of these. The Autotherapeutic remedy is the only strictly auto- genous therapeutic agent we have in fighting disease. Wher- ever a patient suffering with an infectious disease may be he has his natural remedy within his body, and it often can be obtained. The writer was the first to perfect the principles that under- lie the cures made by Autotherapy, and by so doing, has placed it upon a firm, safe, scientific basis. When a sublethal dose of any foreign protein substance is introduced into healthy tissues, the latter develop, or tend to develop, resistance that is specific or exactly antagonistic to it. If the protein substances are the unmodified toxic waste products of a disease from which the patient suffers, the tis- sues in developing specific resistance to them develop specific resistance to his disease. No other toxic substance is the exact substance that causes the symptoms from which the patient suffers, so the resistance developed by the reaction against any other substance will not be the exact reaction or resistance to the disease from which the patient suffers. It cannot be the ideal curative agent. Reaction by the tissues to toxic substances tends to develop resistance in the tissues that is specific or opposite to the toxic action or the true cure for its action. A higher degree of resistance to a toxic substance may be built up by repeated inoculation of non-lethal doses, or repeated toxic action. For example a person addicted to the use of morphine tends to i 4 AUTOTHERAPY build up in his tissues resistance to morphine to such a degree that at times he is able to take, with little or no manifest toxic action of the drug, an amount of morphine sufficient to kill several normal individuals. It is well known that we are not able to demonstrate antibodies to morphine, and in fact we know very little regarding the resistance that is estab- lished by the tissues to the repeated injection of any alkaloidal substance. But that the tissues do develop resistance to mor- phine, by repeated injections of non-fatal doses, is indisputable. In building up this resistance the tissues do not establish a resistance to arsenic, cocain, etc. ; on the contrary, they build up resistance directly antagonistic solely to or against mor- phine. When a sublethal dose of any poisonous substance is injected into comparatively healthy tissues, these tend to de- velop a resistance that is directly antagonistic to the toxic effect, or the antidote to the action of the poison in question. Let us suppose a patient is suffering with a localized infectious disease, i.e., from toxic substances that have been elaborated within his body by the action of the infecting agent upon his body tissues. Let us assume he is now injected into fixed tissues with a toxin, developed previously in agar, or in a guinea-pig or turtle, or a test-tube, originally from some other patient or source. The healthy fixed tissues adjacent to the point of the needle will then tend to develop resist- ance to the turtle, guinea-pig, or test-tube toxin, or vac- cine respectively as they tend to develop resistance to any toxic substance placed in them. As this is not the toxic substances from which the patient suffers, the resistance de- veloped to these may not be that curative resistance to the unmodified toxins from which the patient suffers. But when the patient is injected in comparatively healthy fixed tissues remote from the seat of infection, with his own unmodified toxin-complex these tissues will develop or tend to develop specific resistance to the toxic substances from which he suf- fers. The resistance to no other toxin, or set of toxins, is the exact resistance to his own toxins, for no other toxins can be identical with his own unmodified toxin-complex. The unmodified autogenous toxin-complex is the ideal thera- peutic agent, for with this we tend to combat the toxins from all the microorganisms from which the patient suffers. The autotherapeutic remedy contains the toxins from the causative and complicating microorganisms in the same pro- portion and virulence that are found in the patient's body. There is no certainty that the toxins from one patient will cure any other patient, and there is less certainty that a toxine or vaccine developed in an animal or test-tube will act therapeutically. In selecting the appropriate curative agent, the individuality of the patient must be taken into considera- tion. If a foreign toxin does not act therapeutically, it tends to be harmful, and expensive to the patient's vitality. There is no toxin that individualizes the patient as does the unmodi- fied autogenous toxin-complex, or the autotherapeutic remedy. General Rule for Autotherapy : When the pathogenic exudate or the end product (or a dilution of the same) of any localised, loosely localized, and possibly non-localised infectious disease is filtered with a Berkfeld filter and the filtrate injected hypodermic ally, or placed in healthy tissues remote from the infected area, anti- bodies specifically corresponding to all of the microorganisms in the locus of infection will tend to be developed. A corollary to this general rule that is often convenient in the application of the autotherapeutic principle is as follows : In extra-alimentary and extra-pulmonary diseases if the crude pathogenic exudates or end products are placed in the mouth, specific resistance to all of the infecting microorganisms in the lo us of infection will tend to be developed. The live 16 AUTOTHERAPY pathogenic causative microorganisms appear to be especially prompt and curative when given in this manner. Most Infections are Mixed An advanced or severe infectious disease is usually a mixed infection. There are various microorganisms other than the principal causative one present, acting as complicating factors. The reaction to be most curative must be against all of the toxins that develop symptoms ; that is, the toxins of the causa- tive microorganisms and its set of toxic tissue substances, as well as against the action of the complicating bacterial toxins and their respective set of corresponding toxic tissue substances. Complicating microorganisms which are often present are the bacilli of influenza and pseudo-diphtheria, the micrococcus tetragenes, the bacillus pyocyaneus, the staphylococcus and streptococcus, the colon bacillus, unknown microorganisms, and any one or more of these. It is the unmodified bac- terial toxins, and the associated toxic tissue substances and not alone the body of the bacteria per se, that cause a curative reaction in the tissues. When the unmodified bacteria- free toxin-complex is injected hypodermatically the same thing occurs as when Nature cures, namely, the bactericidal power of the blood serum is raised, activity of the leukocytes is stimulated by the action of the specific antibodies to overcome or combat all of the microorganisms in the locus of infection from which the patient suffers. As more antibodies are developed when the toxins are placed in subcutaneous fixed tissues, than when they are injected into the blood stream, and as by autoimmunizing the patient early, the physician may often steal a march on the slow natural method of auto- immunization; Autotherapy has distinct advantages over even the natural or spontaneous method of cure. BASIC PRINCIPLES OF AUTOTHERAPY 17 The unmodified toxin-complex is therefore the ideal thera- peutic agent for treating a patient suffering with any localized and possibly non-localized infectious disease. Furthermore my unmodified toxin-complex therapy has distinct advantages over any form of vaccine therapy, for the reason that the unmodified toxins are the parent toxins or set of toxins that are in the patient's body, the therapeutic value of which is unchanged or unaltered by the mechanical process of filtration. It must be admitted that we are not always able to identify and it is impossible to duplicate exactly the complicating micro- organisms within the locus of infection by employing the vaccines now in use ; but it makes little difference as far as the autotherapeutic remedy is concerned what they are, for all of the exact toxins from both the causative and complicating microorganisms, and all of the corresponding toxic tissue substances of each, in the same proportion and virulence in which they appear in the locus of infection are in the filtrate ready for use at the bedside. This is one of the vital points of superiority of Autotherapy over any of the vaccines. With Autotherapy we have none of the enumerated objections that vaccines offer. The autotherapeutic remedy offers practically the same convenience of stock vaccines, and the therapeutic effect is far greater than that of even the so-called autogenous vaccines. In order that the principles underlying the cures made by Autotherapy may be better understood, it is necessary that we incorporate in this first chapter the results of tests, that in logical order, would come later; hence in referring to appen- dicitis in this first chapter, it is intended here only as a brief reference to demonstrate results that throw a flood of light on the basic principles of Autotherapy. In November, 1911, the writer was called to see a patient suffering with acute appendicitis. For some time previously 1 8 AUTOTHERAPY the patient had been suffering from a catarrhal condition of the respiratory tract, which appeared to be aggravated at this time. Autotherapy of bronchitis, pneumonia and other respira- tory infections having previously been so successful in the hands of the writer, he decided to make a test in this case to learn whether the treatment of bronchitis with the filtrate of sputum would have any effect on the infection of the ap- pendix. He knew one of the most certain things in medicine is the ability of Autotherapy to stop a non-tubercular cough quickly, and as the cough was a most troublesome symptom, its relief would cause the patient to have a better chance of resisting the infection in the appendix. Accordingly he gave the patient an injection of the filtrate of sputum. The appen- dicular pain ceased in eight hours. It began to be clear at this time that the filtrate of sputum had possibly a wide range of usefulness and it was on account of this and similar tests that the writer was led to treat other abdominal infections in a similar manner. He made many tests and published his re- sults in the medical press; in these reports he stated that " There is often an atrium of infection in the respiratory tract from which the causative microorganisms in abdominal infec- tions may frequently be obtained," and he reported cases that had been cured by this elementary simple autotherapeutic treatment. Since then he has treated successfully a number of cases of acute * appendicitis by injecting hypodermatically at intervals, the filtrate of sputum. The amelioration of all symptoms was so prompt and unprecedented as to cause many physicians to be skeptical or incredulous; even the editor of a prominent medical journal earnestly besought the writer to "have a heart" and not ask him to publish what he (the editor) frankly admitted he did not believe, because the repu- tation of his journal might suffer thereby; for as yet there * See Appendicitis in index. BASIC PRINCIPLES OF AUTOTHERAPY 19 had been no scientific explanation as to how it was possible for such profound and deep-seated infections to be cured so promptly and by such simple treatment. (The true meaning the writer desires to convey in using the word " cure " in reporting his cases is that the process of destruction is checked, and the process of repair instituted in its place). The possibility, and even the probability, of this treatment having a sound scientific basis caused many to assume a " watchful waiting " attitude and to hold their judgment in abeyance ; for it has long been held by advanced scholars that the respiratory tract is often the site of entrance into the body and the nidus of many pathogenic microorganisms. If the causative bacteria can be obtained from the mucoglandular excretions of the respiratory tract, there is no logical reason why we should not expect a speedy curative reaction to set in when a filtrate of sputum is injected hypodermatically. This has been done continuously and successfully, as oppor- tunity presented itself from time to time, in the writer's hos- pital and private practice, as well as in that of other physi- cians. After some years of doubt, indifference and suspicion on the one hand, and on the other a splendid series of suc- cesses that are otherwise inexplicable, this method of treat- ing acute appendicitis, cholecystitis, etc., receives no little sup- port from the original researches of Dr. Edward C. Rosenow.* The writer would urge that these articles be read in connec- tion with Autotherapy in these conditions. Had Dr. Rosenow begun his researches with the object in view of proving many postulates of Autotherapy and of verifying the cures previously * i. Edward C. Rosenow: Elective Localization of Streptococci. Journal of the American Medical Association, November 13, 1915. 2. Edward C. Rosenow : An Epidemic of Appendicitis, and Parotitis Probably Due to Streptococci Contained in Dairy Products. The Journal of Infectious Diseases, April, 1916. 20 AUTOTHERAPY made by the writer, it would have been difficult for him to have proceeded otherwise. One of Dr. Rosenow's cases is of particular interest from an autotherapeutic point of view. " M., a cadet who previously developed symptoms of acute appendicitis on February 21 was operated on the following day and the acutely inflamed and edematous appendix removed. The lumen of this appendix was found to be very narrow and filled with bloody pus. There was no fecal concretion or other foreign body, and there were no constricting bands. The peritoneal coat was edematous and opaque and over the por- tion near the distal end was a thin fibrinous exudate. The mucous membrane was edematous and hemorrhagic through- out the larger portion, this condition extending well into the submucosa and the peritoneal coat. Sections showed an enor- mous number of streptococci within the lumen and within the infiltrated membrane. Scattered diplococci were found also in the adjacent lymph follicles and in the peritoneal coat. In the lumen there were also a few gram-negative bacilli. Cul- tures from a swab of the tonsils sent me by Dr. Reed ten days after the operation showed a preponderating number of green- producing streptococci, a few colonies of hemolyzing strep- tococci, and a large number of colonies of micrococcus catar- rhalis. The broth culture revealed a p.ure growth of a short- chained streptococcus. Two rabbits were injected with the latter culture, one of which showed hyperemia and hemorrhage in the mucous membrane and peritoneal coat of the appendix. It also showed a few hemorrhages in the tricuspid valve. Cul- tures from blood on bloodagar plates disclosed pure growths of green-producing streptococci. The emulsion of one of the areas of hemorrhage in the peritoneal coat of the appendix showed many green colonies of streptococci. On June 4, cul- tures from the tonsils were again made. The tonsils were larger than normal but not badly infected. The culture in ascites-dextrin broth was injected into one rabbit ; it developed a number of small hemorrhages in the appendix with hyper- emia and edema, as well as a marked hemorrhagic edema of the parotid and associated lymph glands." " There were also a number of hemorrhages in the muscles, BASIC PRINCIPLES OF AUTOTHERAPY 21 particularly in the adductor muscles of the thigh. The localiza- tion in the parotid is of interest especially since this individual was the janitor in the hospital in which the patients with parotitis were treated and hence may be considered a possible carrier." The last sentence is full of meaning from an autothera- peutic point of view. It is probable that all operative ap- pendicitis cases are carriers for a greater or less period of time (mark this) after the appendix has been removed. There is a probability almost amounting to a certainty that this patient could have been cured quickly by means of Auto- therapy without an operation, if other apparently similar cases in which the pain ceased within from ten to twenty-four hours, while the temperature became normal in twenty-four hours with no recurrence for from one to three years, are any criterion. (See case reports on Appendicitis.) Autotherapy in appendicitis is no longer an experiment, for it has been employed successfully for the past seven years in daily practice and has received the unqualified endorsement of many leading physicians in all parts of the world. By many it is claimed to be, not only a successful method, but the only method of treatment that will cure many profoundly septic respiratory and abdominal infections. Dr. Rosenow demonstrated by experiment on animals, that isolated streptococcus culture from appendicular lesions pro- duce appendicitis in sixty-eight per cent, of animals injected intravenously. After the first to the sixth passage, forty-five per cent, of the animals developed appendicitis. When a strain is cultured for a week or more its elective affinity or tropism is markedly altered ; only fifteen per cent, of the animals in- jected develop lesions of the appendix. (See Table.) Rosenow also shows that a certain percentage of animals injected with culture made from tonsils of individuals that 22 AUTOTHERAPY had appendicitis developed lesions in the appendix. He states that "filtrates of streptococcal culture from various diseases were injected intravenously, in some instances pro- ducing lesions in the organ from which the strains were isolated ; the lesions, however, were not due to the living micro- organisms because the broth which was inoculated and in- cubated with the tissues failed to produce any lesions. The results, while inconclusive, may be said to indicate that strep- tococci produce substances which cause injury specifically in the tissues from which the strains were isolated." Dr. Rosenow has thus demonstrated by experiment on ani- mals why it is possible to cure patients suffering with appendi- citis, cholecystitis, etc., by the writer's method of injecting the filtrate of mucus from the respiratory tract. If any greater proof were required to show that the unmodi- fied toxins of the causative microorganisms in these abdominal infections are often found in the sputum and that the in- jected filtrate acts therapeutically at once, it is supplied by Dr. Rosenow's further tests and observations. " Since different bacteria may acquire simultaneously affinity for the same tissue, diseases which resemble each other more or less closely, such as the different forms of arthritis, may be due to bacteria of different species each having elective affinity for the particular structure involved. " The results detailed in this and previous papers seem to bring the necessary experimental proof that chronic foci of infection play a most important role in causing systemic dis- ease, a fact which has been observed and frequently com- mented on by different observers." The writer has not attempted to review Dr. Rosenow's articles completely, as time and space forbid, but it will repay any one interested in Autotherapy to study them carefully, for the great curative effect of Autotherapy in many abdominal BASIC PRINCIPLES OF AUTOTHERAPY 23 infections is proved by him beyond any shadow of doubt. The object here is principally to focus attention on a few facts, developed by Dr. Rosenow's researches along autotherapeutic lines, that throw a flood of light on the writer's method of treating appendicitis, cholecystitis, peritonitis, etc., and lay at rest forever the criticism of Autotherapy that these cures could not be made because there was no precedent for them. Percentage of animals K showing lesions Source of Streptococcus 2 % la ,