Homeopathy and Chemotherapy by O. Leeser

HOMffiOPATHY
AND
CHEMOTHERAPY
By
O. LEESER, M.D., Ph.D. (Berlin).
HIPPOCRATES PUBLISHING COMPANY LTD.

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FOREWORD
THESE lectures were given, in the summer of 1943,
in response to a request from a number of German
refugeE" doctors in this c~ntry.
Hence the standard of knowledge assumed is
that of a non-homoeopathic general practitioner.
The publication has as its. sole aim to get diverg-
ing schools of medical thought and method better
acqua;<inted with each other. With this end in
view, a topical problem of contemporary Medicine
is examined.
O.L.
High Wycombe, Bucks.

July I945.
CHAPTER I
AN 'INTRODUCTION TO HOMOEOPATHY
IN this introduction no attempt will be made to
give anything beyond a rough sketch of the
method known as Homoeopathy. Indeed, once
you have realised that we hav.e to deal with a wide
field of applied scientific knowledge-a subject still
omitted from the ordinary medical curriculum-
you will not expect more than a bare outline.
I would suggest that as practitioners you can
best approach homoeopathy by regardillg it as a
method, indeed, the method, of individualising the
application of medicines to the sick person. In
homoeopathy it is not merely a question of con-
sidering the patient as an individual, a particular
disordered living entity, but the medicinal sub-
stance too is taken as an individual entity and
selected according to its particular merits or effects
on human beings as observed by previous tests or
experience. The trend of academic medicine is to
generalise, to diagnose and to treat illnesses and
their causes as far as these are accessible to
diagnosis and treatment. The trend of homoeo-
pathy is to individualise, to view and to treat each
patient as a person suffering under and from
particular conditions.
It may be safe to argue that both these
approaches to our problem of re-establishing the
patient in good health have their merits. On the
other hand, it is obviously unwise to neglect one
6 HOMOEOPATHY AND CHEMOTHERAPY
of them if it holds possibilities which are denied to

the other. And it is only after close study of both
methods and a practical acquaintance with each
that a fair judgment can be formed as to their
scope and limitations.
I do not propose to dwell to-day on the historic
aspects relating to the divergency of methods in
Medicine. Interesting as is the study of the growth
of applied knowledge in the course of the past
century, it would, I suggest, reveal shortcomings
on both sides. Furthermore, the task that lies
before us is to help you to understand a method
which receives no attention in ordinary medical
education. So I will assume no more than the
common knowledge that homoeopathy is a method
of applying the principle of similia similibus
curentur, which has become a mere catch-phrase
expressing the principle of similarity and its use
in Medicine. Hence the name " Homoeopathy "
derived from of'Ol.OS'=similar, and 1TdOoS'=suffering,
disorder, illness.
There may be some who share in the common
error of assuming that this method centres on
posology, in particular on the minimum dose; but
these start at the wrong end and are therefore
unable to grasp the basic idea. Then there are
those who confuse a methodical principle, a prac-
tical plan, with a dogmatic axiom, and therefore
dismiss it as unscientific. Indeed, through their
misapprehension they are even barred from a
channel of thought which would take them in a
new direction. .
The principle of similarity, of the existence of
some likeness between the sick person and the
AN INTRODUCTION TO HOMOEOPATHY 7
helpful agent, is as old as Medicine itself. Homoeo-

pathy is the break-away from its instinctive and
pre-experimental use to the establishment of a
scientific method based entirely on experimental
knowledge. Similarity of symptoms, of effects on
the human being: this is the subject of com-
parative study. The effects of natural substances,
such as are employed for medicinal purposes, are
expressed in signs and symptoms. So are the
effects of noxious causes and conditions, those
disorders which we as doctors are called upon to
remedy.
Thus, if we are to choose the medicine which has
been proved to provoke symptoms similar to those
that are observed in our individual patient, the
crucial question which arises is, "What is the
meaning and significance of symptoms in the
disordered process of life ?" Theoretically it all
hinges on this conception of symptoms. For
practical purposes all depends on how the know-
ledge of symptoms is secured and ap:(>lied.
Let us take the practical side first. Signs and
symptoms of any disease are, of course, a matter
of direct observation, either by the patient himself
or by an onlooker, including the doctor. Exactly
the same applies to disorders provoked by any
given substance which we call poison whenever
the effects exceed an undefined degree of abnor-
mality. We recall the in:B.ammation of the throat
from Belladonna; the nephritis from Arsenicum
or Phosphorus; the intestinal ulcers from some
Mercury salts; all of which may, by their appear-
ance, be indistinguishable from the signs occurring
under other conditions of diseases. It is always
8 HOMOEOFATHY AND CHEMOTHERAPY
the same kind of organism which reacts in similar

ways to various causes. The lesions from poison-
ipgs, however, provide only a very crude and
insufficient level for comparing drug effects, and
signs and symptoms of disease. To gain an
adequate knowledge of drug effects, as required by
the homoeopathic method, planned experiments
have to be made; not on animals unable to describe
their symptoms, but on human beings, the same
species which we expect to respond to our medi-
cines. From experiments on animals we can learn
only the crude poisoning effects and some inter-
mediary stages of the processes leading to them.
Comparison of similar symptoms, to be of use,
must aim at the distinctive individual features,
such as can be supplied only, or at least mainly,
by the psychosomatic unity of the human organ-
ism. It is therefore a pre-requisite to test the
substances intended as homoeopathic medicines on
-the healthy human organism. This was realised by
Samuel Hahnemann, the founder of homoeopathy
as a scientific method, the centenary of whose
death on July 2nd, 1943, passed almost without
notice in these eventful times.
A new Materia Medica had to be built up with
all the human traits such as we encounter in our
patients. The signs and symptoms known from
cases of poisoning or from experiments on animals,
when such have been noted, form no more than
the foundations of such an elaborate edifice. For
example, Arsenicum, as well as Veratrum album
(misleadingly called White Hellebore) may both
produce, amongst other effects, a severe enteritis,
indistinguishable by the local symptoms. But such
AN INTRODUCTION TO ROMOEOPATHY 9
features as have been revealed by these experi-

ments on man-" provings," to use the technical
term-make the distinction easy. The sufferer
from Arsenicum has his worst hours just after
midnight, 12-2 a.m., while with Veratrum album
the worst condition is seen in the early morning
hours, 4-5 a.m. The intense thirst for cold water
of Arsenicum is quenched by frequent small
draughts; that of Veratrum album demands great
quantities which, however, are ill tolerated and
often immediately vomited. Fears and restlessness
dominate Arsenicum ; a state of stupor, which may
alternate with mania, is characteristic for Vera-
trum. In the case of gangrene one may have to
distinguish Arsenicum from Secale cornutum,
ergot, and then it is important to know that the
arsenicum patient is worse from cold, the
ergot patient relieved by cold applications; though
in both, the limbs or the whole body may feel icy
cold. Such distinguishing features, modalities as
they are aptly called, could only be obtained by
the observations of the prover or patient himself,
able to express his sensations, emotions and
impulses.
These few examples, of course, give only a
glimpse of the subject. To give an outline in
some measure adequate to the accumulated know-
ledge and the requirements of an educated
homoeopath is impossible in the time available.
Even assuming that for each of the above,
Arsenicum, Veratrum ~lbum and Secale cornutum,
the main toxicological facts are already known, an
hour for the discussion of each would barely suffice.
When we recall the hundred or more well-proven
10 HOMOEOPATRY AND CHEMOTHERAPY
drugs, not to mention several hundreds more or

less fully proven, it will be readily seen that to
deal with the homoeopathic Materia Medica would
require many lectures. Your knowledge of
pharmacology and tOxicology, extensive though it
may be, forms but a mere stepping stone to this
wider and far more detaile~ study of pharmaco-
dynamics. And though academic pharmacology
and toxicology may have impressed you as being
particularly boring subjects, you would still find
these, as it were, living, humanized drug pictures
most enlightening and interesting. Enlightening
with regard to the sick patient as' well as to the
manifold substances of Nature in their inter-
relation to Man.
It is this teaching which you have missed in
your academic education and which, I am sorry
to say, is not yet adequately provided for.
Homoeopaths have so far failed to impress the
profession with the need for such a new and
advanced school of Materia Medica. It is this very
knowledge of pharmacodynamics which makes,
and is the measure of, a homoeopathic doctor.
The application of such knowledge follows almost
automatically; there is no place for dogma and
sectarian faith. For how else could you possibly
use these data but by comparing them with the
data gained from observing your patient? What
else could guide you in selecting the individually
fitting remedy but the similarity of symptoms ?
Facts as symptoms are or are not, but they have
no contrarium. Or what is the contrary of head-
ache? The non-existence of corresponding symp-
toms in the pharmacodynamics of a drug would
obviously be a valueless key for unlocking the
patient's symptoms. Though there is no other way
of utilising the noted symptoms but by comparing
them as to similarity, why are we to assume that
a medicine thus selected should be the most
suitable to assist the particular patient? The
pragmatic mind would answer, Assume nothing,
but test and see. That is not within our province
here, but a little thinking will convince us that at
least we have a good chance of assisting the patient
with the remedy able to elicit symptoms similar
to those he presents and feels.
As I said, the problem hinges on the meaning
of " symptoms." If symptoms were all there is in '
illness, if they were the only trouble, as the
prejudiced patient may suppose, then surely
provoking more and similar symptoms would be
an absurd proposition. It would be uncivil to
suppose this level of primitive thinking in any
physician. To him the symptoms are outward
signs of disordered life processes. These processes
themselves are due to the interaction of noxious
causes or conditions with the human organism.
The signs are given by the organism, indicating
its reactions to the noxious agents. The symptoms
in themselves are neither good nor bad, neither
friend nor foe, but they come from the side we
intend to assist.
In giving the simile, or better simiZlimum, the
medicine apt to provoke the most similar syn-
drome, our aim is not to intensify the symptoms
but the reactive processes of the disordered
organism. That is obviously a good plan in all
those cases where the defensive activities of the
organism are insufficient to overcome the noxious

influences within certain time limits, where the
disorder tends to become chronic or is so already.
Where the reactions of the organism are up
against insurmountable obstacles, say a gallstone
too big for passing the gall duct, it is clearly
useless to give the stimulating remedy. However,
the great majority of cases calling for our help
are of the kind which may benefit from speeding
up, broadening or intensifying the defence
activities. Those acute cases which develop to a
speedy and complete recovery by themselves we
may leave alone altogether.
There is, however, little doubt that in some
situations, stimulation in the proper direction by
means fully under our control may be vital.
Indeed, you are quite used to the principle when
you prescribe ipecacuanha or ammonium salts or
any so-called expectorant in bronchitis, or a
purgative in certain diarrhoeas. The remedy,
however, may be chosen somewhat indiscrimi-
nately, on a very low homoeopathic level, as it
were. Clearly, if you had the better fitting tool,
you would need less force. That is exactly the
position, once you have learned to see the medi-
cinal substances in full, as individuals, and to
discriminate between them. The more you know
of their pharmacodynamic properties, the better
you will be able to choose the remedy which best
fits your particular patient. Thus, homoeopathy
is the knowledge, which may become a highly
developed art, of finding the individually fitting
AN INTRODUCTION TO HOMOEOl'ATHY 13
remedy, from the patient's symptoms on the one
hand, and the elaborate, quasi-personified drug
pictures, on the other.
As I said, we aim at the defep.J!jye reactions of
the organism. But in givllg a stimulant tuned
in by means of signal symptoms, we may well
intensify the patient's symptoms too. He might
feel an aggravation, and in the case of a chronic
disease, perhaps an acute outburst of the original
trouble. There is, however, no danger involved.
First, the medicinal substance does not add to the
original causes and conditions of the disorder;
we have given a simile upon symptoms, not an
identical cause of disease. Active immunotherapy
takes this latter course in infectious diseases, but
then the specific germ product is dead and
attenuated, and moreover, carefully controlled as
to dosage. Equally, we have the simile under our
control. It is given only when stimulation of the
defensive activities is required and then, by
diminishing the dosage, we are able to restrict the
extent and intensity of reactions almost at will.
With some skill the initial aggravation of symp-
toms can often be kept at a level unnoticed, or
scarcely noticed, by the patient. But if he feels
and reports it, and if it corresponds to our
expectations within a certain time limit, we are
so much the surer that the remedy acts according
to plan, and that in speeding up or completing the
recovery of the patient to normal health it has
played its part.
In chronic diseases this reactivation may some-
times take even astounding forms; for instance,
when in an asthma cure an almost forgotten
eczema-residue of many' years standing becomes

acute and spreads all over the body, then the
asthma attacks cease and much later the skin
eruptions come to an end. Such occurrences
greatly modify our habitual all too simple concep-
tions of chronic diseases, and open possibilities of
removing inveterate, deep-seated derangements by
arousing the past condition of the patient, where
it took the faulty turn,-acheronta movebo-as is
done in psycho-analysis.
As already stated, one means of controlling the
reactions to the individually fitting stimulant is
to give and repeat the dose at the proper time;
another and more intricate one is to choose the
optimal quantity and form. As to the quantity,
we face the famous homoeopathic minimum dose.
That the dose has to be diminished to such a
degree as to avoid wmecessa.ry aggravation goes
without saying. How far one has to scale down
the dosage is obviously a matter of experience.
But there are one or two dominating factors to be
kept in mind. The more delicate the balance of
the disordered processes, the more subtle the
stimulative push required; hence, in general, con-
stitutional and chronic disorders require and
respond to subtler dosage than acute diseases.
Further, the better the remedy fits the individual
case, the less medicinal energy is needed. For
these and other reasons, it oftens happens that the
weight of the medicinal substance is no longer an
adequate measure for the particular task. Just
as with vaccines you Boon lea.ve behind mass and
weight a.nd resort to dilutions, 1: 10, 1: 100,
1 : 1,000,000, and beyond, so in homoeopathy a
AN INTRODUCTION TO ROMOEOPATHY 15
scale of dilutions or "potencies," as they are
called, is established. They are prepared by a
special technique designed to liberate and enhance
their potential energy. We shall come later to
that point.
Every homoeopath is free to choose from this
scale of preparations, from the ponderable mother
substances to the highest, i.e. most highly atten-
uated, potencies, whatever he thinks optimal for
the case before him. He may gain his own ex-
perience with or without regard to his teachers
or fellow-homoeopaths. There is therefore no need
to go into the antagonistic views and arguments
on these points within the homoeopathic ranks.
We may well leave that to investigation and
experience on a broader scale, brought about by
a future recognition of the homoeopathic method
and its value for the advance of Medicine.
It is of importance to keep in mind that a
medicine adapted to a particular situation is not
a food, not even on the vitamin level; in a chemical
sense it is not part of a mass equation, but com-
parable to a catalyst-activator of processes. Thus,
so long as there are molecules of the original
substance, the scientific chemist has no difficulty
whatsoever in attributing results to their inter-
action with an unbalanced equilibrium of life
processes tuned in, as it were, to this particular
catalyst.
Considerations from the point of view of the
physicist are of even greater importance for the
problem of the homoeopathic dosage. The energy
of a medicinal dose depends not only upon the
quantity but also on such structural factors as
solubility, surface, distribution in another medium

as regards distance and regularity of particles. The
homoeopathic preparation obtained by the pro-
cedure of so-called potentizing is not a 'simple
attenuation on the decimal or centesimal soale.
It achieves increasing degrees of sub-division and
regular distribution of particles in a second
medium. The progress of sub-division, of distanc-
ing and regular distribution in an indifferent
medium, is in direct proportion to the potential
energy of the medicinal particles. Experts in
physics will readily substantiate these assertions
by laws and formulae. Within the sphere. of the
lower, that is, the less atten"llated, potencies, say
up to the 6th decimal (or 3rd centesimal), being
one part of medicinal substance to 1,000,000 of
medium, these facts are conspicuous, because they
lend themselves to investigation under the micro-
scope or in the test tube. For those acquainted
with the physico-chemistry of colloids it is
unnecessary to comment further on this point.
The ingenuous, simple, but subtle technique of
homoeopathic preparation aims at and achieves
exactly the structural qualities mentioned.
All insoluble substanoes, as well as many soluble
ones, are subjeoted to the process of trituration.
One grain (0.06 gramme) of the medioinal substance
is triturated in a mortar for one hour with 99
grains of sugar of milk. The product is the first (I)
centesimal potency. You will note that no human
effort is spared, and on a very small quantity at
that, to do the job thoroughly. One grain of the
first centesimal potency together with 99 parts of
fresh sugar of milk is triturated in exactly the
same way for another hour and gives the 2nd
cent~simal potency; and in a third hour 100 grains
of the 3rd centesimal potency are made from
1 grain of the 2nd to 99 grains of sugar of milk.
At that stage the sub-division of particles is
sufficiently advanced to proceed by solution and
succussion in diluted alcohol. The latter procedure
is applied from the onset to alcoholic extracts of
plants and animals. These mother tinctures,
wherever possible, are made from the fresh plants
or animals. Alterations through drying, which
often render the products ineffective, or less
effective, are thus avoided. That is one reason
why so many herbs of old reputation, but now
obsolete and even unknown in official Medicine,
are widely and successfully used in homoeopathy ;
to mention only Pulsatilla, Bryonia, Aconite,
Rhus toxicodendron, Chamomilla, Chelidonium,
Dulcamara, Euphrasia, Hypericum, Ruta, Sym-
phytum, Thuja, not to mention many more.
Equally, the discovery of the technique of
trituration has largely enriched the homoeopathic
armamentarium. Insoluble and otherwise indif-
ferent substances like calcium, magnesium and
barium salts, light and heavy metals, also Lyco-
podium spores, are transformed by subdivision
into a state which enables direct interaction with
the living system from the mucous membranes.
Similar but more lasting and mote easily con-
trollable effects say, of calcium, magnesium, silver
or gold may then be achieved to those produced
by injecting their soluble salts into the blood-
stream.
However far reaching such augmentation of our
18 HOMOEOPATHY AND OHEMOTHERAPY
tools may be-and of improved, refined tools at

that-it is overshadowed by the prospects the
principal method holds for the future of Medicine:
the new conception and shape of pharmaco-
dynamics with all its practical consequences. The
actual achievements of modem Medicine, like the
knowledge and use of endocrine, vitamin, and
chemotherapeutic agents will not be encroached
upon, but will be substantially enhanced and com-
plemented by this infusion of new thought. To
that end homoeopathy has to come out of its
seclusion, incurred by shortcomings from within
and inflicted upon it by short-sightedness from
without. The common ground can and must be
found in science and its methods, to the benefit of
both "schools. " It is the privilege of the
homoeopath who, after all, has passed through the
academic school as well, to give and to lead, being
always, of course, conscious of his own short-
comings.
GRAFTER II
MALARIA.- QUININE
HOMOEOPATHY and Chemotherapy are both

methods of applying medicines in diseases. At
first sight they appear totally independent of each
other. The objeotive of chemotherapy is to
achieve direct internal disinfection. It aims at
destroying, or at least weakening, the germs by
chemical action of the drug itself. Homoeopatby's
plan, however, is to stimulate the defence of the
suffering organism against noxious causes and
conditions, whether germs or not. There is thus
no reason, why both methods should not exist
amicably together in any enlightened physician's
mind and practice.
Such separation of the two methods for their
different plan and purpose would, however, not
take account of the ill-defined borderlines, when
it comes to the factual processes, which are not
necessarily in accordance with the preconceived
theory. You are aware that throughout chemo-
therapy discussion is still going on-and nowhere
the exact modes of action have been ascertained
sufficiently-to decide the question, whether any
particular drug acts directly, without involving
the body-defence, as an internal germicide, or
whether stimulation of the defence plays a
dominant part in overcoming the aggressors. If
the latter should be the case, chemotherapy
would obviously enter the sphere of homoeopathy ;
not that it intended to do so and not on merits of

homoeopathic research, but b.ecause the facts do
not lend themselves to an interpretation on the
line of the original plan, but point rather to a
conception of drug action concurrent with that
of the homoeopathic method.
The views in modem chemotherapy are still in
a state of flux, dependent upon the relevant facts
revealed so far. We therefore cannot do justice
to the problem by discussing the present position
in respect of one example, say the sulphanilamides,
only. In order to obtain a detached opinion, let
us follow the historical development of chemo-
therapy in its main stages : Cinchona bark and its
alkaloid quinine in malaria, mercury and the
organic arsen-compounds in syphilis and the
sulphanilamides in the various cocci-infections.
Each stage would have to be confronted with the
corresponding chapter of homoeopathy, i.e., with
the drug pictures of cinchona (or china as the old
name is) and its main alkaloid; of mercury and
arsenic; and of sulphur and sulphides.
To see the whole in its proper setting, one
might further consider the many more remedies of
old reputation for wounds and infections. Some
other heavy metals have come lately into the
orbit of chemotherapy; penicillin has opened a
great field of research promising new insight into
anti-bacterial actions, and, with a fuller knowledge
of their active principles, the use of plants as
vulneraria may well have'a scientific revival in a
not too distant future. The time has not yet
come for undertaking a comprehensive synthesis,
while so many essential facts are undiscovered or
MALAlUA-QUININE 21
not yet seen in their proper connection. All the
same, an interim survey under a comparative
aspect as proposed may prove helpful for better
appraising both methods.
It was the success of local antisepsis which
induced the attempt of internal sterilisatio magna.
Antisepsis and chemotherapy, though both scien-
tifically bound up with the discovery of pathogenic
micro-organisms, have their ancient empirical era.
When King Mithridates and the Macedonians of
old used to cover wounds with silver lamellas, they
anticipated the antibacterial use of silver. Neither
they nor the Persians, who by law had to keep
drinking water in bright copper vessels, had a
theory of the oligodynamic action of these metals,
but they experienced the effect of it. The Homeric
Greeks fumigated with sulphur, Hippocrates used
antiseptic alcohol when dressing wounds with wine.
The biblical Jews had numerous preventive
measures against contagion, they purified the
houses of the sick, had balsamic ointments for the
lepers. The ancient Egyptians, experts in embalm-
ing, must have known the preserving virtues of
many etheric oils, gums and resins. Indeed, local
and internal use of plants, containing such
balsaIilica against infection from wounds, is
recorded through all the centuries of human
history; the old herbals abound in such remedies
for fresh and foul wounds.
For a long time the use of cinchona bark in
malaria was also on a purely empirical basis, and
we are going to investigate, whether or how far
it can be called" scientific" i.e., whether and how
far the " reasons why" are known. in our days.
By one of those remarkable whims of history this
first example of alleged chemotherapy had been,

a hundred years before chemotherapy was thought
of, the experimental starting point also of the
homoeopathic method. The idea of chemothera-
peutic action could, of course, not be entertained,
before Laveran in 1880 had discovered the
plasmodium malariae. H ahnemann experimented
with the bark ninety years before that time, in
order to find a scientific basis for its long and
well-established use. It is not certain, but probable
that the Red Indians of South America knew this
medicinal virtue of the kina-kina, i.e., the good
bark; for who else should have taught the one
who cured the malaria of a Spanish official in
Ecuador in 1630 with that bark? Eight years
later this official suggestea. the same cure for the
malaria of Countess Anna de Chinchon, wife of
the viceroy of Peru. From that cure the name of
the tree Cinchona is said to originate and the
treatment spread all over the world. Attempts at
explaining tlie curative action, when made at all,
were bound to be arbitrary. It was against just
such vague and unwarranted speculations that
Hahnemann stood up and invoked the decision of
the experimental method. When, in 1790, he
translated Cullen's Materia Medica, he found the
author attributing the specific antifebrile action of
the bark to its stomachico-tonic virtue. Then
why, Haknemann asked, do not much more potent
bitter stomach-tonics have any specific action in
intermittent fever? And he proceeded to his first
experiment on the healthy human subject, on
hims~lf, with the purpose of elucidating a known
effect on the sick. This plan distinguishes his
MALARIA-QUININE 23
undertaking from any previous drug experiments
which may have been made on man.
As this experiment is not merely one among
thousands of others, but is to be understood as a
turning point of methods in Medicine, it may be '
as weH to have it stated in Hahnemann's
own words: "lch nahm des Versuches halber
etliche Tage zweimal taglich jedesmal 4 Quentchen
gute China ein ; die FUsse, die Fingerspitzen usw.
wurden mir erst kalt, ich ward matt und schlafrig,
dann fing mir das Herz an zu klopfen, mein PuIs
ward hart und geschwind ; eine unleidliche Aengst-
lichkeit (aber ohne Schauder), eine Abgeschlagen-
heit durch aHe 'Glieder ; dann Klopfen im Kopfe,
Rote der Wangen, Durst, kurz aHe mir sonst beim
Wechselfieber gewohnlichen Symptome erschienen
nacheinander, doch ohne eigentlichen Fieber-
sohauder. Mit kurzem : auch die mir bei Wechsel-
fiebern gewohnlichen besonders charakterischen
Symptome, die Stumpfheit der Sinne, die Art
von Steifigkeit in allen Gelenken, besonders aber
die taube widrige. Empfindung, welche in dem
Periosteum Uber allen Knoohen des ganzen Korpers
ihren Sitz zu haben soheint-alle erschienen.
Dieser Paroxysm dauerte 2-3 Stunden jedesmal
und emeuerte sich, wenn ich diese Gabe wieder-
holte, sonst nicht. lch horre auf und ioh war
gesund."
" (As a matter oj experiment, I took for some
days, twice daily, a 4 drachm dose of good
Cinchona bark; my feet, finger tips, etc., first
became cold; I began to feel languid and sleepy,
then my heart started throbbing, my pulse be-
came hard and accelerated; an int~lerable anxiety
(but without rigor), a weariness through all limbs ;

then throbbing in the head, flushes of the cheeks,
thirst, in short, all the symptoms known to me
from intermittent fever, appeared one Q,fter
another, but without distinct feverish rigor. Briefly:
also the particularly characteristic symptoms,
experienced in intermittent fever, the dullness of
the senses, that kind of stiffness in all the joints,
and more particularly that numb disagreeable
sensation which seems to be located in the
periosteum over all the bones of the whole body-
all made their appearance. This paroxysm lasted
-for 2-3 hours each time and was renewed, when
I repeated this dose, but not otherwise. I left off
and I felt well.) "
There has been much argumentation, whether
the observations of H ahnemann were correct;
for some time past the power of the bark to
provoke fever has been hotly disputed. Nowadays
it is generally acknowledged, that amongst other
symptoms, fever may be part of cinchonism, be
it either from poisoning by large doses or from
hypersensitiveness to small and sometimes single
doses; in the latter case termed idiosyncrasy.
Thus Hahnemann had his facts correct; but that
does not say that his conclusions too were right.
However, he did not jump to conclusions. First,
it was not the single symptom " fever" which set
him thinking, but the full syndrome resembling
an attack of intermittent fever. Then, when struck
by the similarity of the symptoms provoked and
cured by the bark, he did not generalize his
conception without more tests, but went on testing
other drugs on this hypothesis for several years.
MALARIA-QUININE 25
Lastly, when in 1796 he announced his conclusions,
he did so not in the manner of an axiomatic
assertion, not of a law of nature, but as a scientific
method of selecting the remedy most promising
for a given case of illness. He never said, Similia
similibus curantur, but curentur. He was a good
classical scholar. In short, his is the model
of scientific procedure, despite all that has been
said by minor epigones until this very day. It is
for the sake of his paving a new road full of
promise that we have to recognize Hannemann
as one of the few great masters in Medicine.
From the historical sequel of events, to which
the china experiment acted as a spark, we turn
back to our limited subject, the relation of china
to malaria. The gist of Hannemann's observations
was apparently that the favourable action of the
bark in malaria is part of its actions on the
human organism; it can be understood from its
stimulating the reactivity of the organism in
response to just such noxious agents as those of
malaria. Though the specific cause was not known
at Hannemann's time, and though the actual
mechanism of defeating the aggressor plasmodium
with the help of china or its alkaloids is not yet
ascertained to this very day, we have to-day some
more evidence that the homoeopathic conception
as outlined is in accordance with the facts.
Before dealing with this evidence, however, let
us take up the case of chemotherapy. The issue
must not be confused by the fact that meanwhile,
in 1820 by Pelletier and Oavento'l/J, the alkaloids
quinine and cinchonine were isolated and that by
now some twenty such alkaloids have been found
in the bark. Principally the actions of the full

drug and the main alkaloids are the same, though
there are good reasons rather to stick to the entire
natural product in most cases. The chemo-
therapeutic problem is and remains : Does cinchona
or its alkaloids destroy or at least weaken the
living plasmodium in rorpore humano by direct
chemical action? The answer given by the
experiments available is decidedly negative. Even
for arresting the motility of plasmodia in vitro, a
concentration of quinine at least ten times tha.t
safely attainable in the bloodstream is required
. (appr. 1 : 10,000 against 1 : 100,000). Even the
doubled concentration of quinine-salts (1 : 5,000)
did not render, within 24 hours, malaria blood
non-infectious to man; neither did it kill plas-
modium sporozoites of mosquitoes introduced into
blood serum; the serum remained infectious. (In
neither case are the gametes concerned, these
sexual forms are resistant to quinine anyhow,
so that quinine leaves the malaria patient a
" carrier". ) Yet to the schizonts thriving on
erythrocytes in man, life is made unwholesome by
concentrations of quinine 1 : 150,000 in the blood;
the schizonts disappear from the bloodstream,
some, maybe, to the spleen, or they are forced to
develop into the sexual forms of gametes which
are incapable of producing attacks of malaria.
As matters stand at present, the case for chemo-
therapy regarding quinine in malaria is not only
not supported by experiment, but is refuted.
Several new hypotheses have been put forward in
its place; one assumes that quinine actually kills
some plasmodia and, by that, sets free antigen
MALARIA-QUININE 27
which would stimulate anti-body formation against
the remaining parasites (Yorke and Macfie, Lancet,
1924, I, 1017); another assumes simply that
quinine stimulates the production of immune
bodies; a third, that quinine, by its surface
activity, would concentrate on the surface of the
erythrocytes and render them impermeable ~o the
merozoites (sporozoites) or somehow else would
interfere with the development of schizonts. All
these hypotheses are so far not supported by facts,
but they have all abandoned the chemotherapeutic
case in favour of the stimulation theory.
The study of the alkaloid molecule as to groups
and bonds es~ential to the anti-malarial action
(cf. table p. 28) can, of course, not alter the position
as long as it is unknown with what group, be it of
schizonts or erythrocytes, the alkaloid interacts.
Anyhow, the preponderant action of the laevo-
rotatory isomerides, (for these as for most other
alkaloids,) shows that the stereo-structure of the
alkaloid is important for fitting or fixing its
correspondent cell molecule.
A modern textbook of pharmacology (Goodman
and Gilman, 1941) summarizes the present position
significantly thus: "Although quinine has been
employed for three centuries in the treatment of
malaria, the basis for its use is as empirical to-day
as it was when the Countess of Chinchon was
given a decoction of cinchona bark." That is the
verdict of modern pharma~ology 150 years after
H ahnemann' 8 experiment which it has not deemed
worth while to note or to consider. True, the
symptomatic likeness of china and malaria offers
no explanation in an analytical sense, it does ~ot
CH CH
folCOOCH
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CM
HlI.C@HCH'CH=CHZ
I
~ ~
2
c
CH N H 0 . HC . HC C lola C 101.2
QUINOLINE N
Cg ..,'~ N "SECOND HALF"
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HCO coN~CH
He CI-{
~ C ~__ CM<JH
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ISOMERIDES, C19 Hz, ON.
i. ROTATORY: CINCHONIDINE
d.. ROTATORY: CINCHONINE
eM N CH
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eH c::"'-- N
ISOMERIDES, CoHuq N. (". METMOXY-CINCHONINE
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. ROTATORY:QUININf
d.- ROTATORY: QUINIDINE
MALARIA:-QUININE 29
reveal the actual mechanisms by which similar
symptoms in either case are produced, nor the
chain of intermediary processes. The china
syndrome might even as well counterfeit a very
acute feverish cold, beginning with a chill, followed
by a sudden rush of blood to the head and pal-
pitation and then perspiration. That is, perhaps,
why a rough shot, homoeopathically rough, is
sometimes made at such colds with quinine. The
observations on the symptomatic plane could and
should, however, have served to start thinking in
the right direction about the quinine-malaria
problem. Just see how well a number of known,
but so far strange, facts would have fitted into
this line of research and interpretation.
When there is diagnostic doubt about a latent
malaria, one way of provoking an acute attack is
by smallest doses of quinine. Other measures
are cold douches, etc., capable of causing sudden
changes in blood circulation in the manner of an
acute cold. The point is that smallest doses of
quinine can, in latent malaria, provoke similar
changes in blood distribution and, by that, make
the case acute. The subdued but unconquered
schizonts may have lingered in the spleen and
perhaps liver; by the gentle quinine stimulus they
are brought into the bloodstream again, the open
struggle between the schizonts and the protoplasm
of the red corpuscles is renewed, schizonts break
up erythrocytes and cause the rigor phase followed
by fever due to the unloading and spreading of
toxic protoplasm. Though initiated for purely
is
diagnostic purposes, this occurrence an example
of how by a fitting drug in smallest dose a latent,
chronic disease can be transformed into an acute

one. One might well assume that also in the case
of malaria this is all to the good, because one
would not feel happy about a chronic struggle of
the schizonts within the depth of the spleen, with
the possible end in kachexia with severe anaemia,
spleen and liver tumor, ascites and the rest, but
that is another story. Suffice it to say that the
fact in itself confirms the similar trends of quinine
and plasmodium-malarire-effects or, better, of the
reaction of the organism against both of them;
this is just what Hahnemann's experiment on the
non-infected person could have revealed.
And what about the masked malaria attacks
which may occur many years after the infectious
process has ceased, when no more plasmodia are
to be found or even suspected? These pseudo-
attacks of general malaise, headache or neuralgias
with the typical accompaniment of chilliness, heat
and sweat, still counterfeit the china syndrome.
Maybe, non-living residue toxins are still released
from their cell fixations at intervals. The similarity
which is not one of causes but of sequels expressed
in symptoms, and the beneficial use we can make
of it in such a situation, remain all the same.
Then think of the role of quinine and malaria
in black-water fever. No doubt this haemo-
globinuric crisis is part of certain malaria cases.
The causes of this predisposition to haemo-
globinuria are still obscure; one condition may be
a low level of cholesterol which protects the
erythrocytes against haemolysis. There is, how-
ever, no doubt either that this malignant haemo-
globinuric fever is provoked or precipitated in
MALARIA-QUININE 31
most cases by quinine, according to Nocht, in
99 out of 100 cases. Further it is significant that
this mostly happens right at the beginning of the
first quinine treatment. Yet concentrations of
quinine corresponding to medicinal doses are
certainly unable to bring about haemolysis in
vitro (that needs approx. 1 : 500) ; on the other
hand there is the fact that in some cases of over-
sensitiveness as well as of poisoning, haemo-
globinuria from quinine has been observed. It
may be that similar predisposing conditions,
e.g. low cholesterol level, are also responsible here.
The point is that again the plasmodium and the
quinine affinity to the red blood corpuscles appear
similar in producing, under certain conditions, the
same sequels and that, therefore, we can probably
expect a similar mechanism in their interaction
with the red blood cells.
To the schizonts, the asexual, schizogenetic,
phase of the life-cycle of plasmodia, erythrocytes
are the indispensable.medium on which they prey
and thrive. It is with their recurrent partition
in the red blood cells that the quinine interferes;
how exactly, we do not know; but it is an
important fact that only those quinine derivatives
which can penetrate red blood corpuscles "have
shown this effect on the life of the schizonts
(Hegner, Shaw and Manwell, Am. J. Hyg., 1928,
VIII, 564). The development of the sexual
gametes in erythrocytes is not hampered but
may even be favoured by quinine, but then they
can no longer provoke malaria attacks, but need
. the alimentary duct of Anopheles to complete the
sexual phase of their life-cycle.
All the facts suggest that quinine, by its own

affinity to erythrocytes, is able to deteriorate the
living and propagating conditions of the schizonts
in the red cell protoplasm. Not a chemical
affinity of quinine to schizont, but the competitive
affinity of both towards erythrocytes is at the
bottom, and as both show similar effects, the
unknown mechanisms too are likely to prove
similar. Whether quinine spoils the protoplasma
food or releases lysins or any other anti-bodies
from the red blood, it means stimulating the
defence. That is the interpretation already forced
upon us by the apparent similarity of syndromes
expressing the respective responses of the human
organism as a whole.
It would follow that china or its alkaloid is a
suitable homoeopathic medicine in malaria. So it
is, but not for all cases the most suitable. Great
personal differences as to sensitiveness to quinine
are seen; the particularly sensitive cases would
appear the most promising; they would respond
to very small doses; while those for which quinine
is only a rough shot, obviously require massive
doses of it, not always avoiding the Scylla of
cinchonism or the Charybdis of repulsion of the
malaria into the spleen, thus making it latent
and chronic. These patients may, however, yield
better to another more fitting remedy, say, arsenic.
Though the main features of the three malaria
types are fairly constant, personal variations of
the accompanying symptoms may point to another
of the many drugs able to provoke fever of the
intermittent type.
On the other hand, the malaria-likeness is only
MALARIA-QUININE 33
a very limited cut-out of the homoeopathic drug
picture of cinchona_ Indeed, the total picture
presents so many likenesses to various common
disorders that china is frequently called for in
homoeopathic practice. These indications can,
however, not be enumerated by so many diagnoses;
such abstracted typifications remain too iar
removed from the particular china case. Even less
applicable are generalizations of the drug action,
such as roburans; they are merely empty frames.
The picture itself must be drawn from true obser-
vations, and to be recognisable, it needs to
distinguish the characteristic traits.
For a brief sketbh we may well start from that
part on which some light has already been thrown
from its malaria likeness, the affinity to circulation
and blood cells. The sudden changes of blood
afflux, of chills, heat and sweating, indicate a
peculiar rhythm of action, what our medical
ancestors used to call "erethism." Animal
experiments showing short contraction of smooth
muscles followed by prolonged dilatation do not
tell us more but less than what we can learn from
Hahnemann's vivid description of his sensations.
A step further in this process of action on the
blood vessels, we encounter the tendency to
bleeding from various organs or into the .skin or
mucous membranes. Uterine haemorrhages are
particularly marked from china; too early and too
profuse menses. To this effect the influence of
quinine on the tonus of the uteru& may well
contribute. It is known from its use as abortivum,
the miscarriages of women workers in quinin(;\
factories and also from its now rare use for

intensifying too weak labor intra partum.
The tendency to bleeding in china must not be
confused with the much rarer haemoglobinaemia
from cinchonism. The trend towards disintegra-
tion of red blood cells however is also present and
it appears connected with a distinct affinity of china
to spleen and liver, the transformer stations of
the blood. Icterus is not seldom seen in cinchona
poisoning, not necessarily of the haemolytic kind,
but also from interference with the functions of
liver cells. In distinguishing china from another
r~medy showing similar" erethism," ferrum, one
does well to remember the destructive faculty of
china. The chlorotic type of ferrum, marked by
deficiency in the anabolic phase of red blood cell
life, has a white and rosy complexion, while that
of china is an earthy or yellowish paleness, if not
distinctly icteric.
The action of quinine on the white blood cells
was the subject of early studies by Binz. He saw
that small doses stimulate and large doses inhibit
phagocytosis, and that then the amoeboid move-
ments of leucocytes are impeded; finally, the cells
disintegrate. Under medicinal doses in vivo
leucocytosis is first marked by increase in the
number of lymphocytes, later lymphopenia with
polynuclear leucocytosis occur. It has been
suggested that the leucocytosis may be caused by
contraction of the smooth muscularis of the spleen,
but then this is followed by a prolonged relaxation.
Thus ail influence exerted on the formation and
metabolism of the leucocytes seems far more
likely. Benefit, though transitory, from china in
~AR1A~QUININE 35
enlarged spleen even of leukaemic origin may be
connected with this action.
A similar biphasic action of quinine was seen
by Binz on enzymes and ferments. Very dilute
solutions increase the action of the autolytic
enzyme of the liver, and of pepsin and of rennet.
That has an apparent bearing on another detail
of the china picture as revealed by the experiments
on healthy persons' "provings." Amongst the
many digestive symptoms of china the most
characteristic are : undigested stools immediately
after eating. This" lientery" as the old physicians
called the syndrome, is not at all rare, the condi-
tion persists often over many years, but china
gives very satisfactroy results, as I have frequently
seen. The nearest diagnosis would, of course, be
achylia gastrica, though no complete degeneration
of the rennet and pepsin glands is to be assumed
in curable cases. When you read of achylia
gastric a as one of the sequels of chronic malaria,
you may well ask whether that was not due to
cinchonism, just as it will often remain debatable,
how much of a so-called malaria-kachexia is
actually quinine-kachexia. The mixed effects of
disease and drug are bound to confuse judgment
on both; the pure observations established before-
hand on the healthy, on the other hand, allow a
proper assessment of the role of the drug; and
that not in the fragmentary manner of test-tube
reactions but straight at that formative and
functional living organization with which we have
to deal. It would be an almost hopeless task to
arrive from the glass-tu be tests at the regulating
action of china in such a peculiar syndrome as
has been briefly outlined. Reversely, the test-tube

findings maY'B..afterwards assist our understanding
of the complex and specific process of interaction.
More and useful china symptoms in the digestive
sphere would have to come into a fuller picture,
e.g., the kind of flatulence, of hungry feeling
without appetite, aggravation from fruit and from
beer, milk being badly tolerated, and so on.
In the sexual sphere we should encounter a
first phase of stimulation and then a prolonged
depression of functions with great weakness.
Profound debility generally is the background
of the picture, involving also the skeletal muscles.
Here we remember that substantial doses of
quinine aggravate myasthenia gravis or make
doubtful cases manifest; that on the other hand
they, temporarily, relieve myotonia congenita,
Thomsen' 8 disease. Whether the early stages of
myasthenia gravis are benefited by small stimula-
tive doses has not been tried to my knowledge.
The large-dose effects illustrate clearly the depress-
ing phase of action on striated muscle; the first,
less spectacular, phase is commonly employed in
muscular weakness.
A similar course is followed by quinine in the
nervous system. Disturbances of hearing and
vision are early events in cinchonism. When you
give quinine sulphate in M eniere' 8 syndrome or
similar conditions of vertigo, bad hearing and ear
noises, you act unwittingly as homoeopaths, for
this syndrome is common in cinchonism. The
final effects of atrophy of auditory and optic
nerves can be left out of the discussion. But the
initial stages of increased sensitiveness of these
~--QUINrNE 37
senses supply some valuable symptoms for china.
Equally, with the peripheric sensory nerves, you
will find the ending in numbness and anaesthesia;
quinine is known as a local anaesthetic, though
long superseded by cocaine. The preceding phase
of hypersensitiveness, especially to touch and
draught, gives the more useful hints. Such
peculiarities, trifling as they may seem, like a
sensitive scalp, so that the hair is painful to touch
and combing, may well sometimes give you the
clue to a successful use of china.
Nervous and circulatory excitation combine in
the china action to dil3turb the sleep by crowding
ideas or fearful dreams, leaving confusion and
exhaustion in its wake. You may then see the
gentle stimulus of a minute dose restore normal
sleep and the patient being spared the short-
sighted palliation by a narcotic.
We might continue filling in many more details
into our sketch and even add colour to it. Over
and above the signs and symptoms from the
cell and organ affinities, one would have to
recognize china by its peculiar functional rhythm;
that erethism of blood and circulation and that
hyper-sensitiveness coming on in periodic waves
and grafted on to a state of extreme debility, a
state of affairs which is often brought about by
over-exertion of vital functions or secretions, losses
of blood or exhausting diseases.
I am afraid we have wandered some distance
from the chemotherapy-malaria problem, but then
we have been confronted with the broader issue
of china and homoeopathy.
CHAPTER III
SYPHILIS-ARSENICALIA, MEROURY, BISMUTH,
IODIDE.
IN syphilis the chemotherapeutic method has been

deliberately developed, at least for the organic
.arsenic alia. With these, therefore, we shall concern
ourselves mainly to-day. The other anti-syphilitica,
mercury, bismuth and iodides can he discussed
only cursorily. The homoeopathic relationship
of'arsen-compounds to syphilis will have to be
examined more closely.
For the organic arsenicalia we shall take
salvarsan as representative throughout, but we had
better accept the newer name arsphenamine for
it, because that recalls the chemical constitution
of the compound to our minds. To begin with a
practical aspect: Organic arsenic alia have proved
the most effective means of rendering syphilis
rapidly noninfectious. The prevention of the
spread of infection is obligatory upon the physician
over and above even his duty to cure the individual.
In all those cases where the danger of contagion
cannot be excluded, one is obliged to have recourse
to arsphenamine. (In my textbook you will find
this standpoint the subject of special reference.)
Now, as to whether arsphenamine offers the
best prospects for restoring the individual to
complete health, that is quite a different question.
o. Leeser, Lebrbuch der Homoeopathie. A. Die Mineralischen
Armeimittel, Stuttgart, 1938.
38
SYPBILIS-ARSEN., MERe., lUS., IODIDE 39
As to the actual realization of the purpose of
chemotherapy, to kill right out the spirochaetae
in vivo, that again is another question which, for
a reply, requires a critical review of the relevant
facts accumulated in the extensive literature on
the subject.
Let us consider first arsphenamine with regard
to the biological, or at least clinical, healing of the
syphilitic patient. Any conclusions must emanate
from evidence as to whether syphilis in the early
stage can be cured, and in what percentage,
without recourse to medicinal treatment. We are
here concerned only with primary and secondary
syphilis. Reliable statistical matter on this subject
is, quite naturally, not abundant. Still, we have
access to a little. In 1929 Brunsgaard pursued
enquiries into the cases of 309 living and 104
deceased persons infected with syphilis. These
cases, in which the infection dated back up to
40 years, were all upon which there was a reliable
check, out of 2,000 cases deliberately left without
treatment by Boeck (Syphilis Clinic of Oslo). It
was found that approximately 30 per cent. of
these cases healed spontaneously, that a further
30 per cent. remained without manifesting serious
disorders, that only 10 per cent. showed advanced
syphilis in the nervous system and 10 per cent.
in the cardio-vascular system. There was nothing
new in the observation that syphilis can heal
solely by the organism's defence activities, but
that in 30 per cent. of untreated cases there
should have been complete restoration and in
another 30 per cent. practically satisfactory
recovery, whereas only 20 per cent. suffered from
serious syphilitic manifestations, was a surprise to

many.
Medicinal therapy must show an improvement
on these statistical figures, if it claims to be
efficacious in the cure of the syphilitic patient.
Reliable homoeopathic statistics useful for com-
parative purposes do not, as far as I am aware,
exist. In their place we might avail ourselves of
statistics, say, concerning cases treated with
mercury; for, as we shall try to explain, mercury
can, at least in principle, be taken as frequently
indicated on homoeopathic lines in early syphilis.
.But again, as far as I know, no such statistics
exist which would satisfy modern requirements,
including those of sero-diagnosis. Present-day
statistics concerning the treatment of early syphilis
refer mainly to combined therapy, i.e., arsphena-
mine with bismuth, or with mercury and potassium
iodide, this being considered as the best method
nowadays. For this prolonged treatme~t, begin-
ning either in the primary or secondaJ'V stage of
syphilis, the average of cures is asserlJed to be
90 per cent., while the average for all variations of
treatment accepted by the official school at
present is stated to be 60 per cent. It appears,
therefore, that only what is held to be the best
method can claim appreciably better results than
those from unaided self-defence of the body.
If we follow American statements which are
based on the most comprehensive statistics, the
best routine treatment extends over a period of
70 weeks, during which weekly injections are
given according to a definite schedule: first, a
series of arsphenamine, then bismuth injections in
SYPnn..IS-ARSEN., MERe., BIS., IODIDE 41
between, or instead of the la.tter mercury with
potassium iodide; arsphenamine being continued
in increasing intervals throughout the treatment.
It is acknowledged that arsphenamine, or any
similar organic arsenicale, does not, if used alone,
suffice, if the best results are to be achieved.
That means that expectations based on the
original direct para.siticidal effect of arsphenamine
had to be reduced considerably, though, of course,
this does not mean to say that arsphenamine
could not counteract the spirochaetae on chemo-
therapeutic lines.
Now let us consider the therapeutic efficiency
of arsphenamine used alone. Experiments on
animals may easily lead to error and actually did
so originally. Syphilis in rabbits can be eradicated
rapidly by arsphenamine; syphilis in the human
being, however, requires, in the generally accepted
opinion, many months of uninterrupted treatment,
if the disease is to be cured. There may be some
individua!:;cases of sero-negative primary syphilis
in which something like the original aim of
sterilisatio magna is successfully achieved by the
first injections of arsphenamine; but only a very
few practitioners dare to cut short the treatment,
because there is no guarantee against a subsequent
serious outbreak, such a.s affecting the meninges.
In the case of rabbits, none of the pronounced
toxic opticus, liver or skin (dermatitis exfoliativa)
lesions are observed such as are seen in human
beings. Thus no conclusions from animal to man
can be made in respect of the therapeutic and toxic
index. Hence one is bound to draw one's inferences
from the observation of the clinical course of the

disease in human patients.
It is agreed that full doses of arsphenamine,
in the primary stage, generally drive the spiro-
chaetae from the surface within a fairly brief
period. That is an important achievement as
regards preventing contagion, something which
could not be counted upon before Ehrlich. One
can attribute it to the fact that, generally speaking,
arsenic alia act more rapidly than mercurialia.
That being so, it would be irresponsible on grounds
of social hygiene, not to have recourse to the
organic arsenicalia, when the risk of contagion
cannot be reasonably excluded.
These demands being satisfied, may-be sometimes
in preference to strict consideration of the indivi-
dual case, it must be left to a fully informed
physician's discretion, whether to follow a routine
plan of 70 injections or a more individualizing
course. His decision will largely depend on the
opinion he has formed on the prospects of using
arsenicalia, mercurialia, bismuth, iodides or any
other preparations, and on the means of making
sure of the results. It is therefore relevant to
know what each agent can contribute to eliminat-
ing the parasites with the least possible danger,
and how it is done. The question, how far the
reactions of the host system to any such medicinal
agent are indifferent, auxiliary or essential for the
curative effect, is not purely academic; it has an
important bearing on a proper assessment of
events which may occur in the course of treatment.
So far as clinical cure is concerned, disappearance
of the eruption on skin and mucous membranes
SYPHILIS-ARSEN., MERe., BIS., IODIDE 43
after two to three weeks of arsphenamine treatment

is of no significance. Neither does a negative
Wassermann-reaction, which for our purpose may
represent all similar sero-diagnostic reactions,
admit of a final verdict; it is seen in 75 per cent.
of the cases after eight weeks of injections. Since
one has learnt to fear serious internal relapses in
spite of that finding, it is no longer considered a
sufficient reason to discontinue the treatment.
Modern syphilis therapy insists on uninterrupted
treatment for one year after the Wa-reaction in
blood and, liquor has become negative; the sero-
diagnostic control ~s to be continued in the
subsequent years. When a pause of a month
between injections was introduced during the first
year, the sero-negative Qases were seen to be
reduced from 68 per cent. to 40 per cent. Weare
here concerned only with modern statistics and
views. The significance of rendering the serum
reactions negative, and whether that is always
desirable, may be debatable; but it should be
noted that a negative Wa-reaction does not
indicate disappearance of the spirochaetae from
the system, but only cessation of certain inter-
actions of spirochaetae and body-cell products in
which serum complement (globuline) is used up.
Thus negative Wa-reaction with latent spiro-
chaetae may well prove worse than the manifest
struggle indicated by a positive reaction. Mean-
while sero-diagnosis has to be employed, with due
reservation, faute de mieux.
Inhibition or destruction of spirochaetae by
arsphenamine in vivo has been found, in common
experience, to be incomplete; hence the combined
treatment. Bearing in mind the possibility of an

abortive cure of sero-negative primary cases, forced
cures have recently been tried under hospital
supervision, by increasing the doses five- OJ' six-fold
over a few days. The percentage of serious
arsenic poisoning, such as peripheral neuritis, fever,
haemorrhagic encephalitis, toxic dermatitis of the
exfoliative type, was, however, high. The method
has not reached beyond the experimental stage
and no opinion can be formed yet, whether the
spirochaetae can be wholly eradicated that way.
One reason for invoking the aid of mercury or
bismuth has been the observation that spirochaetae
under continued arsphenamine influence appear to
become arsen-proof. It is suggestive to compare
this acquired arsen-tolerance of the microbes to
that of the human system, as known from the
" arsenic-eaters" of Styria. The phenomenon has
been explored experimentally, mainly on mice
infected with trypanosoma; this protozoon
develops arsen-fastness more regularly than spiro-
chaetae do. At first nothing else but interaction
of microbe and arsenic ale seemed to be involved.
The trypanosomes disappeared, after a first
atoxyl-injection, completely from the blood of
infected mice for several days or weeks; then a
few trypanosomes reappeared, multiplied rapidly,
but disappeared again upon a second injection,
only to show themselves once more in the blood
after a shorter interval; the trypanosoma-free
period became shorter and shorter with each
succeeding injection, until finally atoxyl was no
longer capable of clearing the blood from trypano-
somes, even if the highest doses, not fatal to the
mouse, were used. If the blood containing such

atoxyl-fast trypanosomes was transferred to a
second mouse, atoxyl remained without effect
against the trypanosomes. The acquired property
of atoxyl-fastness is not lost or diminished in the
following generations of such trypanosomes. So
far there was nothing to suggest any interference
of the host animal in the process. But it was
discovered that arsen-fast trypanosomes did not
remain so when used for infecting rats. Thus
something peculiar to the host-species must play
a part. If the selective protection of microbes
cannot be explained without assuming BOme
assistance of the host, system, it stands to reason
that the body-activities which are anyhow at
work against the parasites, take a hand also in
their selective destruction. We shall have to
examine further, for the spirochaetae, whether
there is evidence that these body-defence activities
are even stimulated by arsenicalia.
Before doing so, let us briefly consider the
position of mercury and bismuth regarding direct
or indirect mode of action against the spirochaetae.
For mercury salts, like hydrargyrum sublimatum,
HgCla, the concentrations necessary for destroying
spirochaetae in vitro are well within the range of
those tolerated by the system. So the simplest
theory of direct parasiticidal action was long
accepted. Since the antiparasitic action is known
to be reduced by the presence of organic matter,
however, the direct mode of action is much less
certain. In order to uphold that theory, it had to
be assumed that the spirochaetae are more
susceptible to mercury than body cells; in the
46 HOMOEOPATRY AND CHEMOTHERAPY
absence of supporting facts, such assumptions ad

hoe serve to obscure rather than to clarify the
issue. If mercury, like other heavy metals, works
via the SH-group of cell constituents, there is
nothing to suggest why it should prefer those of
the spirochaetae. A number of modem authors
have abandoned the chemotherapeutic hypothesis
for mercury altogether and even assert that
mercury alone can never cure syphilis but only
assist other remedies. This extreme view can
hardly be upheld in face of the experience of
ilenturies, 'at least so far as clinical cures are
concerned. It obviously overrates direct parasiti-
cidal action which, after all, is only one possible
alternative. Of course, mercury does not cure, and
probably not even benefits, every case of syphilis.
While its exact mode of action is still unknown,
most authors take a middle course and admit
that the body defences playa part in the action
of mercury.
In homoeopathy mercury has always been
considered as a prominent simile to secondary
syphilis. The lymphocytic inflammation, localized
on skin, muoous membranes and in lymphatic
glands as seen in sub-acute mercury poisoning,
can, indeed, imitate that stage of syphilis to such
a degree that it has not seldom been difficult to
discern whether the symptoms were due to
syphilis or to mercurialism. Whatever details of
mercury- and cell-interaction may be found by
future physico-chemical analysis, this similarity in
body reactions strongly supports a conception of
the curative process as a whole that mercury
co-operates with or stimulates the body defences
against spirochaetae. What is more, the method

of comparing the syndromes of disease and of a
certain substance as to their similarity permits
us to distinguish the cases and stages where that
substance is best indicated. For mercury in
syphilis, then, the best chance offers itself, when
the infection is mainly confined to skin, mucous
membranes and lymphatic glands. Rapid invasion
of the spirochaetae into the capillary system and
bloodstream is not the course which mercurialism
is seen to emulate. These more rapid and malignant
cases correspond better to the syndrome produced
by arsenic alia.
Bismuth therapy' of syphilis is only some twenty
years old. Its exact mode of action is not known.
The small amounts of bismuth which come into
the circulation from intra-muscular injections and
reach the tissues are unable to destroy the
spirochaetae ol;ltright. Thus participation of the
body defences in its anti-syphilitic action is almost
certain. Again, one has to look to poisonings to
learn more about the processes peculiar to bismuth.
However, extremely little of the metal passes into
the circulation, when the ordinary preparations are
given per 08. Therefore toxic effects on a scale com-
parable to the sub-acute course of syphilitic infec-
tions are rare. Those known occurred mainly when
bismuth preparations were applied to wounds.
Granulating surfaces absorb bismuth more readily.
The poisoning is very similar to that of mercury,
especially on the mucous membranes of mouth,
throat and rectum; nephrosis has also been seen.
These syndromes were confirmed by bismuth
injections in animals. If anything, transition from
inHammation to gangrene occurs more quickly

under bismuth than from meroury. That points
to a more rapid pace of action on the mucous
membranes and would plaoe bismuth in between
the arsenicalia and the merourialia as regards its
usefulness in syphilis. Homoeopathic provings
have so far not oontributed to making the bismuth
indications more preoise. .
For the iodides parasitioidal action is neither
supported nor assumed. Their benefioial role in
tertiary syphilis is well established. The prolifera-
tive alterations, involving ohiefly the oonnective
tissue" of this late stage are resolved. It has been
suggested that iodides antagonize substances which
normally prevent autolysis of tissues. Whatever
the actual intermediary processes may be, taking
the affected syndromes as a whole, one cannot but
admit their resemblanoe to suoh, admittedly rare,
manifestations of ohronic iodism as mesaortitis
and iododerma tuberosum. Again, both end-
results of tissue reaction to iodides, proliferation
and dissolution, have to be aocounted for, if we
are to understand the detailed prooesses by whioh
the iodides assist the body defence in tertiary
syphilis. To some extent iodism can simulate also
the skin-, muoous membrane- and lymphatio gland-
manifestations of secondary syphilis. Certain
well chosen oases of this stage, too, are benefited
by iodides.
Coming back to the arsenicalia, we are searching
now for further evidence for or against direct or
indirect aotion. Firstly, some clinical occurrenoes
under arsphenamine treatment require attention.
There is the J arisch-H erxheim...er reaction. It is
SYPHILIS-ARSEN., MERe., BIB., IODIDE 49
seen in a number of cases, and then almost
invariably after the first arsphenamine injection.
In early syphilis the eruptions on skin and mucous
membranes are provoked, if they have not yet
appeared-or, if already present, they are intensi-
fied-the signs of inflammation, redness and
intumescence become more pronounced. At the
same time a general systemic reaction shows itself
with chilliness, fever, uneasiness and pains in mus-
cles and joints. There can be no doubt that this is a
first reaction or initial aggravation, as so frequently
encountered in any stimulative therapy. It is also
seen, if not so frequently, after the first bismuth
or mercury medication, and even after less specific
milk injections. In the case of arsphenamine it
might be argued that the focal and generalized
first reactions are directed against fragments of
destroyed spirochaetae and not against the
arsenicale. But the. close analogy of the pheno-
menon with that produced by other agents which
are not parasiticidal at least lends no support
to such a view. Moreover, microscopic findings
(Bergel) on the focal tissue-alteration point
decidedly towards reaction stimulated by the
arsenicale ; local lymphocytic inflammation around
the nests of spirochaetae was seen to be int~nsified.
Accepting the JariBck-HeTxkeimer reaction as an
initial aggravation, we should infer that in the
particular cases where it appears, the arsenicale
was the appropriate stimulant. It is not surprising
that the reaction should be somewhat excessive
considering the dosage which was not chosen so as
to stimulate defensive processes already at work.
Fortunately, in the early stages of syphilis, such
excess has no serious consequences. In the tertia.ry

stage, however, particularly with cardio-vascular
lesions, such a focal flare-up has not seldom
proved fatal.
The fact that arsphenamine acts in some cases
of syphilis as a stimulant to the body defence,
i.e., on homoeopathic lines, does not exclude the
possibility that it kills or inhibits the spirochaetae
also by direct action. That would be its chance of
curing in those cases where arsenicalia do not fit
in. the defensive processes. So far clinical evidence
of such strictly ohemotherapeutic oures is, however,
meagre indeed.
Another occurrence under arsphenamine treat-
ment is of very different import. Meningitis and
meningo-neuritis in the eady stages of syphilis
have become at least more frequent and violent
since the introduction of a.rsphenamine. These
serious events happen, when. arsphenamine alone
has been given, mostly about eight weeks after a.
\.lourse of injections has been stopped. Though
occurring only in 2 per cent. of cases so treated,
this danger has been the main reason for extending
the treatment more and more, for combining it
with bismuth or mercury and for warning against
interruption of the course of injections. Under
the circumstances mentioned in which this early
neuro-syphilis- manifests itself, there can be no
question of ascribing it to initial aggravation
through excess of stimulation. Certainly, too, the
spirochaetae cannot have been thoroughly
destroyed. The occurrence indicates that some-
times, after a. series of arsphenamine-injections,
th.e sJ?Pochae~ae become more dangerous by
I'!"
attacking vital tissues. Apparently they have
been dislodged from the surface, from skin,
mucous membranes and lymphatic glands. In the
ordinary course, without arsphenamine, they would
have been contained there, subjected tolymrhocytic
inflammation and meanwhile time would have
been allowed for immunity reactions to develop
and to take their part in the defence. Driven
into the circulation, while adequate protection has
not yet been provided, they appear more virulent;
but it is not necessary to assume that they have
acquired new invasive and aggressive properties.
Absence or breakclown of natural defences could
have the same effect. Wherever the interference
took place, it must have been due to arsphenamine.
It would follow that in some cases arsphenamine
is unsuitable and should be replaced by another,
better fitting remedy. The advice to prolong and
combine the course of injections appears not to be
the wisest, but emerges from the difficulty of
appraising any peculiar situation properly so as
to assign to it the remedy which has appropriate
sphere of action. This is where comparative
observation of the individual signs and symptoms
comes in.
Any clinical appreciation of arsphenamine has
further to take into account, how it affects the
chances of the syphilitic patient to develop
syndromes of the cardio-vascular and central nerve
system. Some fifteen years ago the general
impression was that these sequels had become
more frequent and occurred earlier after the
infection since the introduction of arsphenamine
than before that era. Several competent allt.hors
52 HOMOEOPATHY AND CHEMOTHERAJ.>Y
were of the opinion that this was due to inhibition

of natural defence, particularly immunity pro-
cesses. Modem clinicians do not deny the fact,
but ascribe it to insufficient treatment, another
reason for prolonged and combined treatment.
As this method has been in extensive use for
barely twenty years, it is perhaps too early to
form a definite opinion on that question. In days
of old, when mercury was the mainstay, we were
taught that mental paralysis and locomotor
ataxia had an approximate interval of fifteen to
twenty years from the infection. In view of what
has been said about early meningo-neuritis, some
reservation as to the effect of arsphenamine alone
on the frequency of late sequels appears not
unreasonable.
Let us now examine the experimental evidence.
A few years ago it seemed impossible to bridge
the gap between the concentration of arsphenamine
needed to kill spirochaetae in vitro and that
obtainable without danger in vivo. That seemed
to exclude a strictly chemotherapeutic action.
Recently, however, a product, mapharsen,
obtained by splitting arsphenamine under oxida-
~
ARSPHENAMINE MAPHARSEN
SYPHILIS-ARSEN., MERe., BIS" IODIDE 53
tion, was shown to fulfil the requirements for
direct parasiticidal action. It is assumed, therefore,
that this oxidation and splitting of arsphenamine
takes place in corpore. Mapharsen has been
administered also directly; being approximately
ten times more toxic than arsphenamine, it is
given in a tenth of the usual arsphenamine dose.
It is too early to say whether it has any advantage
apart from being easier to administer. Assuming
that the simpler compound is the active agent,
it has been suggested that it acts via the essential
sulphydril-compounds of the cells like glutathione
(cysteine-form). For once it is known that similar
phenyl-arsinoxides form dissociable compounds
with glutathione which annul their trypanocidal
action in vitro and in vivo. In vitro addition of
small quantities of glutathione (cysteine-form)
protects the parasites from being killed by
otherwise deadly concentrations of mapharsen. In
infected animals previous introduction of such
sulphydril compounds either considerably delays
or prevents destruction of the parasites by
arsinoxides. Lastly, also the toxic effects of large
arsphenamine doses in the non-infected animal
can be delayed or prevented by reduced gluta-
thione. That explains the old observations that
otherwise sufficiently high concentrations of
organic arsenic alia do not kill the parasites in
vitro if serum or tissue mash is added. Apparently
the sulphydril compounds of the organic matter
compete with those of the parasite cell. How much
more must this competition occur in the living
body where all the cells possess these SH-com-
pounds necessary for their respiration? If,
therefore, the respiration of the parasites should

be inhibited by the arsen,icalia before that of the
body cells, obviously special conditions have to
be assumed; none are known so far. Surely the
susceptibility of different parasites and body cells
to arsenicalia varies considerably. Streptococci,
cholera vibrio and typhoid bacilli succumb under
very small amounts of arsenic, while staphylococci,
coli bacteria and some proteus types even thrive
in those concentrations. Very low concentrations
of arsenic promote the fermentative capacity of
yeast, larger amounts depress it and finally kill
the yeast cells. Certain fungi, far from being
destroyed by solid arsenic, even convert it into
gaseous compounds. On the other side, the cells
and organs of the human body, though all
susceptible to arsenicalia, show varying degrees of
resistance to the poison. The potentially universal
action of arsenic is emphasized when it is
designated as protoplasma-poison or as capillary-
vascular poison. In general, the low organized
tissues, like connective tissue and lymphatic
glands, are much less affected. Which cells or
organs manifest signs of defence or of succumbing
in a particular case will depend not only upon the
circumstances, approach, time, quantity and form,
under which they are reached by the poison,
but also upon their individual reactivity.
Any adequate conception of the antisyphilitic
action of arsenic alia has, therefore, to take account
of the competition of the adversaries, microbe
and body, not only to die under the poison, but
also to react against it. Whether the mode of
action of the arsenicalia via the sulphydril com-
pounds proves to be the cardinal one or not, the
issue appears not as simple as the alternative, who
dies first from the arsenicale. We have touched
on some results of resistance by the spirochaetae;
the reactions of the highly organized system are,
of course, immeasurably more complex and
variated. For that, a great amount of knowledge
about their manifestations has acorued from
arsenio poisonings and has been enriched in
distinctive details by intentional "provings."
Whether these body reaotivities against arsenicalia
turn out to be inimical to the spirochaetae by
themselves, or through throwing a fuller weight of
the poison on to the microbes, or both, we shall
have to sorutinise them for similarity with
syphilitic manifestations.
Considering the location only, surely the battle-
grounds of body reactivity against spirochaetae
and arsenic alia should correspond; so should the
general rhythm and further particular means and
modes of reactivity against the living and the
inorganic aggressor . No better guidance offers
itself than to study the totality of manifestations
in a given case of syphilis with a view to finding
out whether they have the characteristics of
arsenic effects or fit better into the sphere
of another agent, say, mercury or iodide. In
short, if the body defences play any part in the
curative action-and for arsenicalia in syphilis
this is strongly emphasized by observations-
the homoeopathio aspeot comes into the fore.
It may be questioned, whether arsphenamine
and inorganic arsenious acid (arsenioum album)
are at all comparable in antisyphilitic action.
Important differences there are, no doubt, but

they do not concern the essential points. One
remembers the old empiric use of Donovan's
solution combining mercury and arsenic. Indeed,
Ehrlich aimed at perfecting the arsenic virtues by
trying out one organic compound after another;
he started with cacodylates (aliphatic arsen com-
pounds) which proved less toxic than arsenic.
Atoxyl (p-amino-phenyl-arsinic acid) was even
more effective against trypanosomes and certain
spirillae, though it did not kill them in vitro.
Finally, Ehrlich found the salvarsan, as he named
his product obtained by reducing an amino-
phenyl-arsinic acid, the most suitable for the
syphilitic infection. For our reflections we need
not dwell upon further modifications like neo-,
silver- and neosilver- arsphenamine.
Nothing in the toxic effects of arsphenamine is
alien to those known from arsenic; but some
occur less frequently and less intensely from the
organic compound. Such detoxication, to a greater
or lesser extent, by phenyl-bonds is by no means
limited to arsen. It may have to be ascribed to
easier dissociation, diffusion and elimination of
the products formed by their interaction with
cell constituents as compared with the products
from inorganic compounds. Indeed, it is not at
all unlikely that some kind of arsenic detoxication
in vivo is done by going through similar organic
bonds. Thus arsphenamine, or mapharsen for
that, would anticipate certain intermediary
measures and so quicken and concentrate the
arsen -action, offering conditions more suited to the
host organism. This sort of closer, more immediate
SYPHILIS-:ARSEN., MERe., BIS., IODIDE 57
aiming is a feature often encountered with organic,

as against inorganic, bonds; for certain purpeses
to great advantage, but by no means for all.
It appears, therefore, justifiable to view the
arsphenamine actions, so far as they involve the
body defences, under the wider aspect of arsenic
actions. The broad lines of similarity between
arsenic poisoning and syphilis have already been
mentioned. Arsenic and spirochaetae, both acting
as universal protoplasma- and cell-poisons, bring
about manifestations, potentially from every organ
or tissue, so numerous and multiform that the
subjects of comparison abound almost embarrass-
ingly. Indeed, it is far more important to point
out the limitations in the similarity and to search
for characteristics which would allow one to
distinguish a case of syphilis bearing such features
as would peculiarly indicate arsenic alia.
On skin and mucous membranes the primary
syphilitic ulcer has its counterpart in the phage-
daenic, necrotic ulcers of arsenic. If it were not
for the demands of social hygiene, one would
reserve arsphenamine for the rapidly progressing
infections which do not linger in the lymphatic
glands but tend to invade the blood at once via
the capillary vessels.
Amongst the whole host of secondary syphUitic
eruptions, there is hardly any which is not
simulated by arsenic poisonings-the ordinary
roseola and maculo-papulous exanthema being less
characteristic for arsenic, the herpetiform, vesi-
culous, the lichenoid and psoriati{o:rm eruptions
and the abnormal pigmentations more so. The
...kin plays an essential part in the defence processes
of syphilis. It has frequently been noticed that

the subsequent course of the infection is more
favourable, if the first exanthema is intensely
developed, and especially that visceral syphilis
then occurs less frequently and is milder. Intense
exanthema of the secondary phase does not call
particularly for a vehement capillary poison like.
arsenic.
The rapid and malignant progress of the
infection, involving the capillary vessels, into the
bloodstream corresponds far more to the ways
and rhythm of arsenic. The endo-meso and peri-
vascular alterations from syphilis and arsenic can
produce very similar pictures. Some authors
(Fr. Lesseri.a.) have attributed to the cell processes
in the walls of the blood vessels a main role in the
defence against the spirochaetae. One might deem
that to be rather a second chance, after the less
vital skin and lymphatic gland defences have been
by-passed. So long as an early stage of inflam-
mation is active in the walls of the vessels, and
cell degeneration or substitutive tissue prolifera-
tion has not set in, there is a good chance for
arsen stimulation. The danger of a violent
arsphenamine stimulus in gummatous lesions of
vital tissues has already been pointed out. The
same reflections apply to the cell processes in the
various organs which may be affected. There is
no need to enumerate them here. They can all be
similarly produced by syphilis and arsenic. Suffice
it to mention only the polyneuritis which in
syphilis has not seldom arsenic features and yields
to its use. The atrophic end-effects (opticus, etc.)
occurring both from the infection and from arsenic
8YPHILIS-ARSEN., MERe., BIB., IODIDE 59
intoxication are, of course, beyond the stage

curable by stimulation.
Not much more than general indications, such
as the nature, location and rhythm of the
pathological processes, can be given for or against
a short-term therapy with massive arsphenamine
doses. Only if circumstances permit, a more
discriminating choice of the therapeutic agent,
based on the more functional details up to psychic
symptoms, comes into consideration for the
individual case.
After all, syphilis is only one field amongst
many where arsenicalia may be called for as
suitable stimulants on grounds of similarity of
reactions. A discussion, however cursory, of the
wider sphere of arsenic indications appears, there-
fore, not out of place in order to bring our main
theme into a better perspective.
In the far progressed structural changes of
carcinoma the arsenic effects can be compared
generally on that broad level only; seldom can
indications be enhanced by individual charac-
teristics. Arsenic has been used from time
immemorial for malignant tumors. On the other
hand, it is one of the carcinogenic substances.
We need not go into the very limited successes
of cancer treatment with arsenicalia. But it is
interesting in this context to recall the action of
arsenic on cell mitosis; further, that in carcino-
matous cells anoxybiotic, fermentative processes
have the upper hand against the oxidative ones
(0. Warburg), while arsenic again is known to be
able to depress the oxygen consumption in cells.
This inhibition of oxidation by arsenic has been
studied chiefly on erythrocytes. Very low con-

centrations in the range of the 4-5 decimal potency
in homoeopathic terminology, such as are present
in the natural arsen spas, show this effect. Atoxyl
can produce a blood picture similar to that of
pernicious anaemia: diminished erythrocytes and
haemoglobin, with poikilocytosis and anisocytosis.
Again, what little benefit could be derived in
pernicious anaemia before the introduction of the
substitutive liver therapy, was achieved by arsenic
medication.
On the skin the hyper- and parakeratosis of
chronic arsenic poisoning is well known; again,
arsenic is widely used, sometimes with success, in
psoriasis and lichen ruber. The more acute
eruptions from arsenic are multifarious, as already
mentioned; dermatologists use arsenic on occasion
for dermatitis herpetiformis and pemphigus. All
these empirical uses conform to the homoeopathic
principle of remedy selection, but they are
homoeopathy on a low level, as it were; the
similarity applies to pathological tissue changes
only. Still, some cases offer no better distinctive
symptoms and one has to work on that level. If a
dermatitis of any kind be qualified by predominant
burning and by itching, worse from cold and from
scratching, the homoeopath would have greater
confidence in his choice of arsenicum album.
What has been said about the necrotic, phage-
daenic character of ulcers as indicating arsenic,
applies not only to syphilis. Such ulcerations
may be due to other infections or be of tropho-
neurotic origin, even transgress into gangrene, as
particularly under the deteriorated tissue con-
SYPHILIS-:A..RSEN., MERO., BIS., IODIDE 61
ditions of diabetes; always the acrid, offensive,
even cadaverous secretions would call special
attention to arsenic.
The inflammatory degenerative processes in the
inner organs which can be caused by arsenio are
so multifarious that, if diagnoses like nephritis,
hepatitis, eto., were the only and suffioient grounds
for ohoosing the simile as the appropriate remedy,
arsenio would appear well nigh a panaoea. The
ohances are slightly improved when the nature of an
infeotion is taken into acoount. For the violent
oell poison arsenic emulates more especially suoh
processes as are enoountered from the most
virulent toxins of microbes, e.g., cholera. vibrio,
typhoid and botulismus bacillus and strepto-
ooccus. Incidentally, these species show themselves
in vitro particularly sensitive to arsenioalia.
Incidental, indeed? After what has been said of
arsen action in syphilis, one would rather take
such a speoial affinity both to oertain microbes
and to the tissue and organ cells more rationally
as a clue to a similar kind of oompetitive action
in the defence play of the two antagonists.
Yet, diagnoses, even if specified by the oausative
germs, are still too wide a frame to fit the arsenic
case suffioiently. The similarity of aoute arsenic
poisoning to cholera has often been emphasized.
It goes beyond the pathological findings and the
clinical syndrome from the toxic gastro-enteritis.
Great restlessness and anxiety with fear of death,
extreme thirst quenched by frequent, but small
draughts, cold drinks being badly tolerated and
readily vomited, ohilliness and general aggravation
from oold in any form (with one noteworthy
exception referred to below) ; a pel'iodicity in the

recurrence of such symptoms as cramp-like and
burning pains and fever, aggravation during the
night, more specially in the hours immediately
after midnight-these are characteristic features
of the arsenic case. They would determine the
choice of arsenic not only in cholera, but equally
in many acute diseases, whatever the diagnosis
may be.
These modalities are abstracted from the obser-
vations in poisonings and " provings." With the
appropriate adaptation (for not all need be present
in every. case) they apply also to neuritis. Here
a great sensitiveness to touch would present
nothing peculiar, and is, therefore, insignificant for
the choice of the remedy. But the arsenic patient
bears his periodically exacerbated pains parti-
cularly ill; they make him furious; he is not at
all patient.
This intolerant attitude assumes, under less
provoking circumstances, a form of mental
peculiarities which, when noticed, may lead one
to presume that person, also under more trivial
a:fHictions or even in his normal health, to be
particularly susceptible to the arsen stimulus. He
reacts unduly, without proper sense of proportion,
to slight untidiness or irregularity in his wonted
environment; this makes him appear somewhat
pedantic.
It would be misleading to think of arsenic only
in terms of its poisonous effects progressed to
structural alterations. The precursory functional
symptoms are not less important. They can
indicate an arsenic medication, then 1i0 be more
SYFHILIS-ARSEN., MERe., BIS., IODIDE 63
delicately adjusted, in a great number of syndromes

of the allergic and vasomotor type. Many of the
pertinent symptoms are met occasionally also
under arsphenamine treatment. Then they have
been described as " nitroid crises," nitroid because
the vasomotor symptoms are similar to those
produced by nitrites. It seems somehow ludicrous
to find these occurrences interpreted by various
hypotheses excepting the obvious and simple
one offered by toxicological knowledge, namely
that these" side effects" are due to the arsenicale.
They come on with flushes, palpitation, precordial
anxiety, headache, giddiness, then progress to
cold perspiration, cyanosis with extreme anxiety
and restlessness and fear of death. Equally,
attacks similar to allergic conditions may be
provoked by arsenic; hay fever or asthma-like,
urticaria or circumscribed oedema, not omitting the
accompaniment of leukopenia and eosinophilia.
The asthma-brochiale-like symptoIDs of arsenic
are characterized by aggravation from lying down.
The same modality applies to the headaches which
may be of the megrim type. More distinctive for
arsenic in headaches is that they are relieved by
cold; that is in marked contrast to the feature
mentioned above, namely, that the chilly arsenic
patient is generally worse from cold in any form.
Enough has been said of the wide sphere of
arsen-compounds. The organic arsenicalia, spon-
sored by the chemotherapeutic conception, have
certainly an important place in it, though the
theory had to be modified. Within the limitations
given by the course of such infections as syphilis,
there seemed room for improving on the present
short-out therapy on diagnosis of the disease by

individualizing, Le., by seleoting amongst the
potential remedies that one whioh fits best in the
situation of the diseased person.
The brief summary of the use of arsenio on
homoeopathio lines may be inapt to encourage a
trial of its suggestions, but perhaps it may transmit
something of the satisfaction which accompanies
every synthetic attempt to find the sectional
integrated by a fuller aspect.
CHAPTER IV
COCCAL IN1I'EOTIONS-SULPHANILAMIDES.
OUR third example illustrating medicinal therapy

in homoeopathy as compared with chemotherapy
has to deal with recent research and experience
and it might be argued that it is too early to assess
properly the action of the organic sulphur
compounds of the sulphonamide type. However,
what is known so' far of the actions of these
preparations will be found hardly lagging behind
what little knowledge there is regarding the two
other chemotherapeutic agents which have been
discussed.
The protagonists in the new field are organic
sulphur compounds on the one hand and, on the
other, a whole group of bacteria, prominently
of the coccus type, strepto-, pneumo-, meningo-,
gono- and staphylo-cocci. For our purpose we may
restrict our discussion to these cocci. Charac-
teristic of the infections of this kind is that the
host organism reacts chiefly by the leucocytic-
endothelial tissues, manifesting purulent inflam-
mation.
The hundreds of sulphonamides so far
investigated can be represented for our immediate
purpose by the simplest, sulphanilamide, which
has the characteristics of all of them, viz.,
the sulphonamide, SOaNH2 - group linked to
65
"Ha the benzene ring, with

another amino- (NBs)
group in para- (op-
HCO
HC ,"
CH
posite) position, thus
~c p-amino - benzene -
302 1111'1. sulphonamide. A few
SULPMANtLAMIDE further preparations
call for attention in
HCONHI!CM
Me CM
HcOr "eM
CH so far as they enhance
activity in special
bacterial infections.
They have one H of
~C __. "'lot / ' " III the S02NH2-grOUP re-
so. placed by various
~Mo SULPMAPVRIDI NE' rings, e.g., by the
HcQc C pyridine-ring to form

sulphapyridine, Le.,
He
0, NH -
'OCH c~ CM
pyridyl-sulphanil-
amide, or by the
thiazole-ring to form
N sulphathiazole, i.e.,
SULPH.\TH1 AZOlE thiazole - sulphanil-
Correction: In fOl'JDula of Sulpha.- amide (in which again
pyridine, in first ring, linked to one H of the thiazole
NBs ~ add a. .. C."
group may be methy-
lated so as to form
sulphamethyl-thiazole). Th~ preparation from
which this chemotherapeutic branch originated,
prontosil, can be disregarded. It is now established
that it becomes active only after its azo-bond has
been split by reduction in corpore and thus free
sulphanilamide has been formed. That accounts
for the inactivity of prontosil in vitro against
bacteria. Originally this whole field of re-
COCCAL rNFECTIONS--SULPHA~DES 67
-+-- N search started from the

~
HCOr
N
C ~c observation that in-
~OfH 1'1 Hz
troduction of the
essential SO.NH II
He ~H He CH -group into the diazo-
~c ~c dyes was seen to give
So,.-NHz N Hz a firmer fixation of the
PRONTOSIL colour to the proteins
of wool and silk. The
idea was to fixate organic compounds by means of
the same group on to bacteria. It remains to be
seen whether a similar" fixating" property plays
any part in the anti-bacterial action. Almost
certainly it is not solely responsible for it. Im-
I
mediately the question arises, why bacteria should

be affected in preference to the cell proteins of the
system. Furthermore, it is not the SOIlNHa-group
only which has anti-coccal action, but such action is
known to appertain to many other incompletely
oxidized sulphur compounds, namely disulphides
(SH), e.g., mercaptans (aliphatic hydrosulphides)
and sulphoxides (SO), beside sulphinic (SO.H)
and sulphonic (SO.) compounds. So, if a bacterial
receptor group specific to (SOaNHs) were responsible
for the action, the other incompletely oxidized
sulphur compounds would have to be transformed
in corpore to sulphonamides, before becoming
active. As SH-compounds are present in every
cell and their progressive oxidation is in the course
of normal katabolism, it would be difficult to
conceive, why this chemical transformation should
not be brought about also by the host c~lls in
their defence. Again, if that were the case, the
part played by the medicinal sulphur compounds
could be understood to be stimulation of such

defence mechanism, that is to say, on homoeo-
pathio lines.
However, what evidence there is so far regardirlg
the sulphanilamides seems to point to other modes
of action in which the systemic defence plays only
a secondary part. Nor, on the other hand, is a
direct bactericidal effect in the original chemo-
therapeutic sense supported by present opinion
on the known facts. The interpretation of these
facts, which we shall discuss more tully, lies in
between those two theories; it is briefly that the
sulphanilamides compete with certain metabolites,
especially p-amino-benzoic acid, which are essential
for the growth and mobility and possibly the
reproduction of the bacteria in question.
Assuming this theory is confirmed no theory
will be satisfactory unless it accounts also for the
wider issue, that other and simpler, incompletely
oxidized, sulphur compounds are similarly effective.
The cardinal point to be kept in mind is that the
sulphur is indispensable in these compounds for the
anticoccal action. We may, therefore, expect to gain
a broader view on the problem by including in
our survey the old homoeopathic use of sulphur
preparations in comparable infectious processes.
Eminent amongst these is Hepar 8ulphuris
calCOlfeum, a mixture mainly of calcium-poly-
sulphides, obtained by exposing a mixture of
oyster-shell chalk and sublimated sulphur to white
heat. In experiments on healthy persons,
" provings," this preparation has been seen to
promote purulent inflammation, like boils; tritura-
tions of it have, in the experience of more than
COCCAL INFECTIONS-SULPHANlLAMIDES 69
a hundred years, proved very efficient in bringing
furunculosis and other strepto- and staphylo-coccal
infeotions to a speedy end. For another sulphur-
compound, sulphur iodide, Bier and his co-
workers more reoently have oonfirmed both the
pharmacodynamic and the ourative effects in the
same sphere.
Certainly it is a far cry from these localized
purulent inflammations to generalized septicaemia
or meningitis, and it has never been claimed by
homoeopaths that infections of that advanced
stage were cured by their usual sulphur prepara-
tions: Nevertheless, the high tribute paid to the
simple calcium sulphide in small doses by H. J.
Thomsoo (Brit. Med. Jount., II, 1935, p. 1070) in
puerperal sepsis hardly yields to sulphanilamide
results; the sulphide reduced the death-rate in
sepsis from 5.3 to 0.7 per 1,000 cases of confine-
ment. All the same, it can hardly be disputed that
the introduction of the organic sulphonamides is a
great advance in reducing the mortality in a num-
ber of the most dangerous generalized coccal
infections and in shortening the course of others. It
would be sheer doctrinairism for the homoeopath
not to avail himself of the sulphanilamides in
appropriate cases for which he has no equally
potent remedies, on the ground that the new
preparations have not been discovered and proven
on homoeopathic lines. Non-homoeopaths may at
least plead ignorance as excuse while neglecting the
simpler sulphur preparations in cases where they
are indicated and prove helpful on homoeopathic
indications.
The homoeopathic and the chemotherapeutic
way of obtaining and applying knowledge about

sulphur compounds are originally separate in
historical development as well as in theoretical
approach. It is, however, highly probable that
both schools would benefit from each other by
future contact, so deplorably lacking at present.
After all, it is facts that count and they will ,be
found congruent in the end, no matter how they
were approached or interpreted.
Homoeopathy makes no assertions on the
intersystemic chemical mechanism of drug action.
It is concerned with the interaction of drug and
person as a whole. So far as modes of drug ~ction
are elucidated by physico-chemical analysis, they
come in handy for interpreting factual knowledge
about the whole by facts disclosed about parts.
For applied knowledge, however, as medicinal
therapy is, it would be unsound and pseudo-
scientific indeed, to take the "partial" instead
of the" whole" as a basis. For one thing, we
cannot know the total of relevant processes, as
long as the complexity of the reacting organism
surpasses the sphere of physico-chemical analysis;
and even if we knew, the whole is something more
than the sum of its parts. Obviously, therefore,
a therapy dealing with persons can do no better
than rely on facts observed on that same level of
wholeness. Whatever needs for analysis and
explanation one may have, they are secondary in
sequence and rank. It is surely not more but less
rational and scientific to mistake or even reverse
this precedence.
For chemotherapy the relations between relevant
facts seem at first different. Of course, this
COCCAL INFECTIONS-SULPHANILAMlDES 71
therapy too cannot, and does not, wait for
clarification of the modes of action so as to become
" scientific." But its objects, at least at the
outset, are the microbes and, therefore, the
experimental search for facts can be pursued for
a while with simplified models, infected animals
or even bacteria cultivated in vitro. The real
test, though, comes with application to man.
Supposing the difficulties inherent in transferring
observations from one level of complexity to
another have been overcome and fallacious con-
clusions have been avoided, so that the simplified
model represents the essential processes between
germ and drug action in the human system; that
in itself is not yet an explanation, but only
preparatory experimental investigation under
simpler conditions. The mere fact that observa-
tions on infected mice have preceded those on
infected man, makes the latter observations not
more COITect or scientific, though it serves to
diminish the risks of tentative trials on man.
Only if and so far as new facts, relevant to the
drug actions on man, are disclosed, therapy
becomes more "scientific," at least potentially
so. Extension of knowledge may be obtained in
pursuance of any therapeutic hypothesis, though
the latter be found untenable in the further
course of investigation.
To come bac~ to our example: the sulphanil-
amide research started under the strictly chemo-
therapeutic hypothesis that it would kill certain
bacteria in vivo without essential interference or
assistance from the host organism; that was the
original intention for using it. If that were
confirmed, no connection could be conceived

between such a mode of sulphanilamide action
and that of other sulphur compounds which, like
the homoeopathic preparations already mentioned
can obviously have no effect against those cocci
without assistance of the body defence.
The assumptions with which chemotherapy
started have, however, not been supported by the
facts as they have become known. Once more in the
case of the sulphanilamides, too, the chemo-
therapeutic theory had to be modified to conform
with the findings. As already mentioned, in
anticipation of the discussion to follow, the
opinion at present generally accepted is that the
sulphanilamides compete with certain metabolites
which are essential for the growth and mobility
of the cocci in question. (Our discussion on the
organic arsenicalia came to a similar assumption
of competitive antagonism.) Again, if sulphanil-
amides are only one link in a chain of possible
processes leading to the defeat of bacterial
aggression, then a similar action of simpler sulphur
compounds, like inorganic hydrosulphides, through
stimulation of the body defences is perfectly
reconcilable with that modified version of chemo-
therapy. Stimulation of the normal sulphur
metabolism by suitable sulphur preparations could
furnish body -made sulphanilamides or similar
compounds to the same effect. The direct supply
of an intermediary product useful in defence
against bacteria could not be called stimulation
of the defence; we should not expect symptoms
of intensified defence activities from the infected
system or similar symptoms in deliberate
COCCAL INFECTIONS-SULPHANILAMIDES 73
" provings" of such a substance on healthy

persons. All the same, such a "progressed" sulphur
could be said to assist the defence. So conceived,
the two methods, supplementive chemotherapy
and stimulative homoeopathy, would neither
contradict nor exclude, but definitely complement
each other. Indeed, we should understand the
reasons for using the sulphanilamide drugs in cases
where extent and tempo of the infection call for
the direct subsidy of a metabolite-like compound,
but we should choose the simpler and less risky
sulphur preparations, like hepar sulphuris, where
stimulation of the available defence-means
appears to meet the case.
These reflexions on the methods do not settle
the issue, but are made to clarify the problems.
We shall have to see now whether the known
facts support or conform with such conceptions.
For the sulphanilamides, the observations in
vitro speak against direct bactericidal action in
vivo. Even bacteriostatic effect, by sulphanilamide
concentrations comparable to those obtained in
vivo, requires in vitro a favourable medium,
e.g., the presence of certain peptons. Addition of
whole blood facilitates bacteriostasis; it may even
conduce to bactericidal effect. In this case it is
doubted whether active phagocytosis plays a
similar role in vitro, as it does in vivo where it
completes the work of bacteriostasis. Anyhow,
measured by the concentrations needed in vitro,
the bacteriostatic or bactericidal effect of sulphani-
lamides appears to be favoured by several normal
constituents of the system. How they co-operate
against the bacteria is not known. The fact itself
is further evidence against the direct bactericidal

mode of action, but on the other hand does not
imply stimulation of normal tissue functions by suI-
phanilamides; it is equally conceivable as an
additional deterioration of the terrain for the
bacterial activities.
The latter course has been substantiated byob-
servations on antagonism of certain protein frag-
ments to sulphanilamides. The role of p-amino-
benzoic acid
. .NOC.coo~
HC-CH
C~ CH
has attracted
particular attention. This metabolite became
known to be essential to the mobility and growth
of the cocci (it seems to have certain vitamin-like
functions in mammals, too). Further it has been
noticed that the presence of this simple aromatic
amino-acid in the medium hampers the anti-
bacterial action of sulphanilamides. This
antagonism is interpreted as one between com-
petitors for the same groups or receptors.
Sulphanilamides would block up the bacterIUm
receptors for p-amino-benzoic acid and that would
account for the inhibitQry sequels to the bacteria.
Such competitive antagonism appears the more
probable from the similar chemical constitution
of the two compounds, both being p-amino-
benzene derivates. That would explain why the
para-position of the amino group is so essential
for the sulphanilamide action. If that group
is acetylated, the compound acetyl-sulphanil-
COCCAL INFECTIONS-SULPHANlLAMIDES 75
52 , N HZ amide becomes ineffectIve.

c Such " detoxication " of
sulphanilamides occurs in
Me
He
O
~c
eM
Clot
NH .OOC'CH,
vivo in varying proportions
so that the curative and the
noxious doses are subjected
to considerable fluctuations.
The antagonism ofp-amino-
benzoic acid to sulphanil-
amides is by no means the only one which
can be demonstrated in vitro and may also
CHs,S'CHa
CHII'SH
I dRs
CR'NHl! I
CRNBII
dOOR
CYSTEINE dOOR
METIDONlNE
be assumed in vivo. Purines and thio-amino acids,.

like methionine and cysteine, also inhibit the anti-
coccal action of sulphanilamides. But no definite
conclusions as to the mode of action can be drawn
from the antagonism of these metabolites any
more than from the synergism of certain peptones.
All the same, it is of great interest to note that
sulphydril ~ompounds of normal metabolism should
act as protectors of the bacteria. As they are
powerful reductors and the action of the cocci on
proteins is prominently reductive too, similar de-
composition products may result. In the artificial
medium, where no defensive actions such as
76 HOMOEOPATHY AND CHEMOTHERA.:PY
adequate detoxication and elimination can be

assumed, this synergism with the cocci would an-
tagonize the sulphanilamides and favour the cooci.
The competitive antagonism of sulphanilamides
to p-amino-benzoic acid is probably an essential
factor in their mode of action, but it does not
follow that it tells the full story. In vitro
experiments cannot exclude concurrent modes
such as stimulation of the body defences. For
that we have to examine the sulphanilamide
reactions in living systems.
In mice infeoted with haemolytic streptococci,
sulphanilamide is found more effective against
types of high than of low virulence. Significantly,
too, the most virulent strain of p-haemolytic
streptococci (group A Lancefield) responds best
to sulphanilamide therapy. One has tried to
explain the observation in mice experiments in
terms of a mass equation; streptococci of low
virulence would rE-quire a greater size of inocula
to bling about infection or death, hence a given
sulphanilamide dose would be spread over a
greater number of cocci and, therefore, not suffice
to inhibit all. That explanation might be plausible,
if the sulphanilamide molecules were used up in
irreversible processes such as permanent fixation
to bacterial tissue, hardly compatible with con-
tinuation of life. But all evidence points to
temporary, reversible reactions with the bacteria.
The drug is highly diffusible and rapidly excreted,
the cocci are seen to survive even prolonged
sulphanilamide medication, but their aggressive-
ness is temporarily diminished. Besides, the
preference for the most virulent strain of haemo-
COCCAL INFECTION8-SULPHANILAMIDES 77
lytic streptococci in human infection and the fact

that generalized infections at the height of the
destructive struggle respond comparatively mu('h
better to sulphanilamide than localized and mild
ones, indicate that it is the intensity of the
aggression rather than the n umber of aggressors
affected which counts in respect of the inhibitory
effect of sulphanilamide. Whe.ther' special weapons
of the cocci, U aggrE'ssines," are frustrated by
direct interference with the bacteria or by stim-
ulation of spe(lific defence measures, "anti-bodil"s,"
can not be deduced from these observations.
VirUlence and terrain are closely inter-related
alid as they are the conditions of bacterial activities
which, to all app~arance, are chiefly altered by
sulphanilamides, it is well to recall the relations
of the cocci, with which we are here mainly
concerned, to the host body under a wider
perspective. The species most susceptible to
sulphanilamides, certain strains of haemolytic
streptococci, pneumococci and meningocooci, are
as often as not found on mucous membranes
without their interfering with n'1rmal body func-
tions. Normal secretions provide the cocci with
conditions in which "to live and let live." When,
however, the terrain is altered, say, a sudden
and insufficiently compensated deprivation of
animal heat leads to stasis of ciroulation, to
impeded oxidation, accumlation of katabolic
products, disturbance of the ionic equilibrium,
in short, to the pre-stage of inflammation, the
cooci, for survival, have to adapt themselves to
the new conditions. They become invasive,
aggressive, virulent. To call the new conditions
favourable to the cocci, because they are unfavour-

able to the body, is obviously a misnomer. After
all, the cocci are forced to employ and develop
new means of self-defence in the altered medium.
Their chances are by no means good. If the body
succumbs, these aerobic microbes die with it;
if the host recovers, the bulk of the cocci fall
victim to the body defence, are assimilated by
leucocytes and macrophages, and finally eliminated;
at best, the surviving few find themselves again
on the mucous membranes, the old conditions
being restored there.
The main trend of life-processes is to free energy
by oxidation; that applies to the bacteria as well as
to the human system. Numerous reductive re-
actions are, however, interwoven in this course of
processes to make it possible at all. In our context
two reductive agents are of particular interest :
(1) the normal cell constituent cystein which, by
autoxidation to cystin (di-cystein), makes the R
of its sulphydril group available for reductive
processes. (We may ignore here its bond with
glutamyl and glycine forming the tripeptide gluta-
thione. The functions of another sulphydril
compound, thioneine, in the red blood corpuscles
may have similar important functions but they
are not yet sufficiently known.) The respiratory
cysteine-cystine system is, by means of the SH-
group, probably the main one working indepen-
dently of thermolabile enzymes. (2) Bacteria, too,
whether anaerobic or aerobic, are principally reduc-
tive agents. In providing for their Oil-needs they
reduce i.a. peptons. While the products may be
harmless on excreting surfaces, or even of assistance,
COCCAL INFEOTlONS--SULP~MIDES 79
as in the intestines for absorption and assimilation,
others, when absorbed, put at least an additional
strain on the detoxicating mechanism, e.g., the
phenols (indoxyl, etc., arising from reductive
de-amination). Produced inside the system in
quantities, and even more when they are fragments
altogether alien within the normal processes, those
products of bacterial life provoke vehement re-
actions: the complex sequence of inflammation and
fever, aiming at elimination with the least delay.
If cocci of the endotoxic type, with which we are
dealing here, extend their activities further and
Oome into the circulation, then a new danger to
the body arises out of its very defence; outright
destruction of the cocci would set free their endo-
toxic fragments, cells are poisoned to degeneration
and death, and the mutual destruction, without
intervention, usually ends fatally on both sides.
In septicaemia more streptococci are found in the
blood before than during the attacks of rigour and
fever. Once the life-and-death struggle is at its
height, both sides employ their utmost resources
of defence, though that may complete the fatal
cycle. We need not detail the weapons and their
handling on both sides; for the coccisome of their
"aggressines" are known and named from their
effects only, such as haemolysines and leucocidines.
With regard to the action of sulphanilamides,
it would appear anything but helpful if the cocci
in the bloodstream were killed outright. Inhibition
of their immediately aggressive and acutely
dangerous activities, however, giving the body
defences time to overpower and eliminate the
living but helpless cocci, would be just the thing
to be looked for. And that is what appears to

happen in the successful cases.
As to the normal sulphydril constituents of the
cells, their legitimate reduotive action might well
lead to useless and even undesirable and potentially
dangerous by-products, say, phenols. But in
doing so, they themselves supply the detoxicating
remedy; oxidized to Bulphate, they conjugate
with phenols to form ethereal sulphates. (It is
worth noting that normally only three-quarters is
excreted as fully oxidized sulphate, one quarter
remains incompletely oxidized, thus the oxidation

after the conjugation is more likely.) The con-
jugation product, as Na- or K-salt, is easily soluble
and speedily eliminated. The same qualities
account for the comparatively low toxicity of
sulphanilamides, though they are aniline com-
pounds. Assuming an increased reductive activity
of the normal sulphydril-peptides, such as may
be provoked by inorganic hydrosulphides, like
hepar sulphuris or mercaptans, undesirable pepton
fragments would acoumulate and, under certain
conditions, lead to defence reactions of the inflamm-
atory type. " Provers" susceptible to these
substances would show the corresponding symp-
toms, as actually they did more frequently than
could be attributed to incident. On the other hand,
such artificially promoted and skilfully controlled
reactions would increase a similar defence against
COCCAL INFECTlONS-8ULP.HA.NlL.AMIDES 81
coccal action-in short, conform to the homoeo-
pathic plan of assisting the body defence.
Now, where do the sulphanilamides come in !
We shall presently examine the known facts as to
whether they lend themselves to assuming direct
stimulation of defensive reactions, and we may
here anticipate that there is no proof and no
probability of it. We assume no further mode of
action than what has emerged from recent re-
search, viz., that by means of their p-aminohandle,
as it were, they keep the p-amino-benzoic acid,
essential to the cocci, away from them. If
sulpbanilaroides were formed in. the system and
their production increased by sulphur stimulation,
that would solve the problem. The sulphanilamides
would be an important link in the defensive
mechanism without being themselves capable of
setting that mechanism into motion. Artificial
addition of that ready-made link, when it is most
needed, would enormously ease the task of the
other defence measures. Of course, the body-made
compound would not necessarily have to be
identical with sulphanilamide, if only it had the
same inhibitory action. It is suggestive to think
of the normal phenol-conjugation with sulphite
or sulphate in this connection. If p-amino-phenol
were detoxicated in vivo in the same manner
to form sulphanilic acid or its easily soluble
alkali salts, such, or a slightly modified, inter-
mediary product might be found to have the same
temporary emergency function which is ascribed
to sulphanilamide. However, the missing link in
the chain of processes is not known and probably
has not so far been looked for.
There we must leave, for the time being, the

biochemical problem. It remains to examine the
facts for or against the probability that sulphanil-
amides stimulate, and not only add to, the body
defences against coccal infection. Provings of
sulphanilamides on homoeopathic lines would give
the best material on which to form an opinion;
but the only one made so far with sulphamido-
chrisoidine (prontosil rubrum)* has, besides the
known toxic effects, revealed only a number of
sulphur- and sulphide-similar symptoms which,
however, are not very distinctive. One has to rely
mainly on experience with patients treated with
these drugs. Such observations have the drawback
that they make it difficult to discern drug reactions
from the signs and symptoms of the infection.
For the toxic effects of sulphaniIamides, one should
remember that they are aniline (p-amino-benzene)
compounds. It is, therefore, not surprising that
not infrequently toxic effects are incurred which
are well known from poisoning with, or as "side
effects" of aniline and its derivates, e.g., acetani-
lide (antifebrin). The sulphon-amide group
apparently renders the anilide less toxic as may
be deduced from the far greater doses usually
employed with impunity than, say, of acetanilide.
The latter, we may recall, is transformed in corpore
to p-amino-phenol and excreted as such; we
mentioned this product as possibly subject to
detoxication by sulphate. Tentatively we may
thus ascribe any aniline-like effects to the anilide
becoming separated from the sulphonamide group
and oxidized to p-amino-phenol.
Sutlie1'lan<l~ and Roberts (ei. journ. Am. Inst. of Hom. 1944, 37, 3051.
Under sulphanilaroide medication symptoms
from the central nervous system are quite common
-headache, dizziness, tinnitus, feeling of intoxi-
cation and depression; the gastro-enteric syndrome
of anorexia, nausea, vomiting and diarrhrea is also
attributed to this central action. We encounter
very similar side effects from numerous aniline
derivates, like acetanilide, when they are employed
as antipyretics and analgesics. Cyanosis due to
methaemoglobinaemia is a far more distinctive
feature; it occurs from sulphanilamides as from
many other aniline compounds. The rarer but
more serious sequel from sulphanilamides, acute
haemolytic anaemia, too, is shared by aniline and
itsloxidation products, equally as jaundice and
toxic hepatitis are. The even rarer and most danger-
ous sulphanilamide sequel, agranulocytosis, is seen
more often from benzene, dinitrophenol and
amino-pyrine. Fever, often accompanied by a
rash and mild eosinophilia, can be distinguished as
due to sulphanilamide and not to the infection
when it occurs after several days of medication
and the fever from the original infection has
already subsided. It is of a type familiar from
the toxicology of acetanilide and similar aniline
compounds. The manifold skin eruptions, besides
allergic types as urticaria and angioneurotic
oedema, those imitating exanthemata (morbilli-
form, scarlatiniform), erythematous, erysipeloid,
petechial, purpuric, are also not distinctive for
sulphanilamide; they all occur, perhaps not so
frequently, from sulphur-free aniline compounds.
Considering the close connection of sulphur to the
skin and its inflammatory disorders, the severer
84 HOMOEOFATHY AND CHEMOTHERAFY
dermatitis exfoliativa appears more characteristic

for the sulphonamide; it is not noted from other
anilines; but we recall that it occurs as toxic
effect of arsphenamine, and there again we see
the arsen affinity to the skin made more vehement
by the aromatic bond.
Our brief summary of the toxic effects of
Bulphanilamides leaves the impression that they
have much in common with septicaemia: fever,
the central nervous and gastro-enteric syndromes,
the whole series of skin eruptions, haemolysis,
jaundice, hepatitis and the rare final development,-
agranulooytosis. Thus, at first sight, sulphanil-
amide seems a remedy in septicaemia indioated on
the homoeopathio principle. Yet, all these
symptoms are, as we saw, not characteristic for
sulphanilamide, but are shared by a great number
of aniline compounds. Indeed, it is suggestive to
ascribe them all to incidentally liberated aniline
or its oxidation products. These are similar,
partly perhaps identical, with poisonous products
of katabolism which are normally quickly detoxi-
cated and eliminated; it is, therefore, not surprising
that they should arouse syndromes similar to
septicaemia where these cell and bacteria fragments
accumulate so that even intensified detoxication
and elimination is no longer a match for them.
The intact sulphonamide bonds, however, meet
this precarious situation, partly through their
rapid excretion. Furthermore, the syndromes as
enumerated are either very common events or
destructive final effects; the first allow no distinc-
tion for selecting a homoeopathio remedy and'
t,he second signify the absence of reactions on
COCCAL INFECTIONS-SULPHAN1LAMIDES 85
which a stimulative therapy would have to rely.

True, advanced septicaemia, meningitis, etc., are
just of that kind, all the available defence
reactions are engaged, even overtaxed and
exhausted. So they are not distinctive of any
individual effort and do not indicate a peculiarly
fitting stimulant; one may even say there is, at
such a stage, no longer a call for any stimulant.
. We have to acknowledge certain limitations to
homoeopathic therapy, and exhaustion of all body
defence activities is a very definite one.
In these extreme conditions of body activities
ahd interference with them by medicinal sub-
stances, we find ourselves approaching a border-
line. Arid in matters biolC}gical such borderlines
are not defined exactly. It would be easy to
stretch the principle of similarity between remedy
and disease far enough to comprise the relation
of the effects of aniline compounds to coccal
infections. Indeed, the similarity even of chemical
constitution, identity of essential groups, between
poison and antidote is often striking. We met
it in the case of p-amino-benzoic acid and
sulphanilamide. For any competitive antagonism
on chemical lines this has to be expected. Similar
intermediary reaction takes place, but it is
isolated and not accessible to direct observation.
To extend the principle of similarity, as conceived
and applied in homoeopathy, to such extremes
serves no useful purpose; and that for the simple
reason that the remedy fitting the case cannot
be found by using isolated or indistictive criteria
for the comparison on similarity. As a matter
of fact, the virtues of sulphanilamides have not
b~en discovered with a view on any similarity

but under the assumption that they would kill
the bacteria in vivo. That proved faulty, but many
things, like America, have been discovered under
wrong premises. Sulphur, too, was used on
vague ideas of its cleansing properties against
purulent inflammations long before H aknemann
submitted it to scientific provings and found it,
especially in the sulphide form, most suitable to
promote similar reactions in man. Su Lphanilamides
might never be used in infectious diseases if they
had to wait for the theory of depriving certain
cocci of p-amino-benzoic acid by a similarly
constituted compound unhealthy to them.
From the data so far reviewed, having not
sufficient provings M judge from, we would
conclude that the reactions to sulphanilamide
do not show that degree of similarity to coccal
infections which would suggest its curative
effects to be due essentially to stimulation of the
defence. There is another criterion: if sulph-
anilamide therapy should leave the patient after
recovery in a state of improved defence, with
some measure of immunity, it would be a forcible
argument for the stimulative mode of action.
Experience has shown that it is not so. The
impression so far is that the same infections,
notably pneumonia, recur even more frequently
after sulphanilamide cures than was seen before
that therapy, but it is too early to form a definite
opinion on this point at present. Surely one
would not expect creation of complete immunity
through stimulation in these types of coccal
infection which leave behind no natural immunity.
We recall that soluble exotoxins, provoking specific
antitoxins, play only a seqondary part in the
activities of these cocci; the main threat comes
from the endotoxins, against which the more
general, less specific, defence measures of detoxi-
cation and phagocytosis are called up. Thus the
failure to promote immunity is no argument
against stimulative action of sulphanilamides,
but a lowered state of defensive preparedness
after sulphanilamide therapy, if confirmed, would
be so.
Our discussion of the problem must certainly
not he understood as establishing the com-
petitive antagonism for which some evidence
has been revealed so far, as the only mode of
action of the sulphanilamides. Nor should the
tentative explanations, how such intermediary
links may fit into a chain of defensive processes,
be taken to be more than a first attempt to
reconcile two apparently related fields of
experience.
It is beyond the scope and purpose of our
present discussion to follow up the whole range
of sulphur actions which determine its use in
homoeopathic therapy, indeed, make it the remedy
perhaps most frequently called for. Even for
the more acute actions of the sulphides, represented
by hepar sulphuris calcareum, we have had to
confine ourselves to that part of its sphere which
best lends itself to comparison with sulphanilamide
effects in coccal infections.
Thus, if, within the given limitations, your de-
mand for learning about homoeopathy has not been
satisfied, let us hope that it has been stimulated.

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HOMffiOPATHY

O. LEESER, M.D., Ph.D. (Berlin).

HIPPOCRATES PUBLISHING COMPANY LTD.

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High Wycombe, Bucks.

of them if it holds possibilities which are denied to

helpful agent, is as old as Medicine itself. Homoeo-

the same kind of organism which reacts in similar

features as have been revealed by these experi-

drugs, not to mention several hundreds more or

organism are insufficient to overcome the noxious

eczema-residue of many' years standing becomes

solubility, surface, distribution in another medium

tools may be-and of improved, refined tools at

HOMOEOPATHY and Chemotherapy are both

not that it intended to do so and not on merits of

first example of alleged chemotherapy had been,

(but without rigor), a weariness through all limbs ;

in the bark. Principally the actions of the full

He OCOCH HaC tirCt2CHCHCJ.lz

chronic disease can be transformed into an acute

All the facts suggest that quinine, by its own

factories and also from its now rare use for

has been briefly outlined. Reversely, the test-tube

IN syphilis the chemotherapeutic method has been

serious syphilitic manifestations, was a surprise to

from the observation of the clinical course of the

after two to three weeks of arsphenamine treatment

treatment. Bearing in mind the possibility of an

mouse, were used. If the blood containing such

absence of supporting facts, such assumptions ad

against spirochaetae. What is more, the method

inHammation to gangrene occurs more quickly

excess has no serious consequences. In the tertia.ry

were of the opinion that this was due to inhibition

therefore, the respiration of the parasites should

Important differences there are, no doubt, but

aiming is a feature often encountered with organic,

of syphilis. It has frequently been noticed that

intoxication are, of course, beyond the stage

studied chiefly on erythrocytes. Very low con-

exception referred to below) ; a pel'iodicity in the

delicately adjusted, in a great number of syndromes

short-out therapy on diagnosis of the disease by

OUR third example illustrating medicinal therapy

"Ha the benzene ring, with

HcQc C pyridine-ring to form

-+-- N search started from the

mediately the question arises, why bacteria should

could be understood to be stimulation of such

way of obtaining and applying knowledge about

confirmed, no connection could be conceived

" provings" of such a substance on healthy

is further evidence against the direct bactericidal

52 , N HZ amide becomes ineffectIve.

be assumed in vivo. Purines and thio-amino acids,.

adequate detoxication and elimination can be

lytic streptococci in human infection and the fact

favourable to the cocci, because they are unfavour-