Echinacea angustifolia and Inula helenium in the treatment of tuberculosis.
Other tomes: Thomas
V. VON UNRUH, M.D., NEW YORK, N. Y.
In the treatment of tuberculosis I employ a compound of two vegetable drugs—echinacea angustifolia and inula helenium. This compound I administer by intramuscular injections, daily, or as frequently as tolerated. No general or local toxic reactions of any kind have ever resulted.
The compound, of which 3 c.c. represent 1.33 c.c. of inula and 1.0 c.c. of echinacea, is injected on alternate sides into the gluteal muscles. Each injection carries 3 to 5 c.c. of the compound. As a working rule, I begin with 2 c.c. for the first few treatments, and then increase the dose to 5 c.c. or more, according to the severity of the case or age of the patient.
On beginning my experiments, almost four years ago, I compounded the two drugs from fluid extracts of various makes with which I worked for about six months. While failures resulted from several of the fluid extracts, results being encouraging with others, I continued my experiments. The compound is now made for me after the above drug proportions, by a firm of wholesale manufacturing pharmacists, whose name, for obvious reasons, I am constrained to withhold at this time. (This compound can be obtained from Lloyd Bros., of Cincinnati, who make it for me.)
None of the fluid extracts used in my earlier experiments have produced the effects obtained from the aforenamed special preparation. I had found that both echinacea and inula are drugs exceedingly difficult to handle pharmaceutically, especially in extracting from them the desirable active principles each contains. Many lines of experiments were made in the pharmaceutical direction, until finally a compound was evolved satisfactory from both the pharmaceutical and therapeutic aspects. This special compound is a colloidal one and does not contain an excess of alcohol.
Echinacea.—In its physiological action, echinacea produces a feeling of intoxication, flashes of heat, headaches of a dull character, dull muscular pains, subnormal pulse, cold and numb extremities and increase in the specific gravity of the urine. All these symptoms pass off gradually by themselves within several hours, showing that the drug has no continuing toxic nor detrimental effects. Deaths from overdoses have never occurred.
In its therapeutic action, the drug is found to produce direct stimulation of the katabolic processes, increase in the flow of saliva, sweat and urine, increase in glandular activity. It thus antagonizes all septic processes, facilitates the elimination of toxins from the organism, and lastly, it has a destructive effect upon the streptococci, staphylococci and other pyogenic organisms.
My own laboratory researches, conducted for a period of over three years, have shown that echinacea increases the phagocytic power of the leucocytes; it effects a shift to the right and normal in the neutrophiles ("Arneth count") where a shift to the left had previously obtained. (I refer to my detailed report on the action of echinacea upon the leucocytes read before the New York County Eclectic Medical Society, March 15). Suffice it to say at this time that echinacea does produce in the blood effects parallel with and similar to those produced by the vaccines, without any of the objectionable features of the latter. The leucocytes are directly stimulated by echinacea, their activity is increased, the percentage among the different classes of neutrophiles is rendered normal, and phagocytosis is thus raised to its best functioning capacity.
Inula.—In its physiological action inula produces dryness of mouth and throat, increased peristalsis with lumbar pain, much urging to urinate with scant results, with severe pain in the lumbar region, nausea and vertigo.
Therapeutic Action of Inula.—It controls night sweats; first increases and then decreases expectoration, promotes secretion of the gastro-intestinal glands, and exerts a direct toxic action upon the tubercle bacilli.
Several German and English investigators have experimented in the past with the alkaloid of inula, inulin or helinin. The consensus of opinion among them is that if the alkaloid can be made pure and stable the drug is of more value than creosote or guaiacol preparations in the treatment of tuberculosis, as it has none of the objectionable features of creosote, and, in proper doses, does not irritate the stomach. Since the plant contains a resin and an acid, both peculiar to it, a saccharose, and the elecampane camphor, which splits up into helinin and alant camphor, it is easily seen how difficult must be the extraction of the active principles and their separation, and how difficult must be the problem of the stability of the alkaloid. True alkaloids of inula, in a dilution of 1 in 10,000 exhibit the growth of tubercle bacilli in cultures. I have used this alkaloid to no great extent, hence can not speak authoritatively about it.
Synopsis of Case Records.—A short synopsis of case records is given here in order to present a comprehensive view without going into too many details; a few appended copies of case records will elucidate the effects and modus operandi. Without making any unverifiable claims whatsoever, I merely state here facts pointing to many remarkable results in my own experience. Other physicians of all schools to whom I have given the compound obtain similar satisfactory results. My cases comprise all types, mainly pulmonary, and include also two glandular, one case with tuberculous joint involvement, one of lupus, secondary to pulmonary infection, and two with kidney, bladder and testicle involvement.
In all, ninety-eight cases were treated by me with this remedy; of these, twenty-one are under treatment at present. Both glandular cases were cured. In incipient pulmonary cases, 100 per cent. of cures were obtained. Some of these cases recovered very rapidly within two to six weeks, while in others it was necessary to continue treatment for from two to four months before a cure or an arrest of the disease was effected. Moderately advanced cases, or second stage, resulted in 77 per cent. of cures. Many of these latter cases had complications, such as lupus, involvement of the genito-urinary tract, influenza, etc. Cases showing rapid or widespreading progress, or those with constant, grave dyspnea, I have been able to benefit and I have had such that actually responded and improved when improvement seemed hopelessly impossible. Far advanced, or third stage cases, yielded no cures. In all fifteen cases have died so far.
In cases deemed curable by present-day methods, cures or arrests of the disease have been obtained in from four weeks to eighteen months. With few exceptions these cases were ambulatory; they were not removed from their homes, nor did they follow a special diet. Several of my cases had previously been treated by other methods without result; they showed improvement under my method, and in some of them the disease was arrested. Several open type cases of several years' duration and with more than one focus of infection responded well and were arrested. In other cases of this type the remedy failed, while others again that had been declining steadily improved visibly and went on to arrest, showing no signs of return of the disease after a year and more.
I have treated two acute cases; in these the outbreak of tuberculosis followed immediately upon attacks of broncho-pneumonia; here I obtained quick results. In both only one apex was affected, and the patients resumed their occupation after five and seven weeks of treatment, respectively; the cases were entirely cleared up within three and four months, respectively, and no relapse has taken place since dismissing them, more than two years ago. (See copy of case record, No. 1.)
Cases of ten or more years' standing, which during that time had acquired a natural strong resistance, were cured without difficulty and within a few months when only one lobe was affected. Of other longstanding cases, with multiple infection and where the power of resistance was weak, some were arrested; others did not respond or improve. One case had extensive fibrosis of the whole right lung and an infection of the upper part of the left lobe for twenty-five years; lupus developed about ten years after the outbreak of the disease, and there were considerable gastro-intestinal disturbances; the lupus and the gastro-intestinal disturbances abated completely within two months, while lung and blood picture showed only a temporary improvement; the case left my hands after two and one-half months' of treatment and died six months later.
In female cases, where suppression of the menses obtained, the general result has been that the menstrual functions were restored and remained regular afterwards. One female patient, forty-one years of age in whom the disease had been present since her sixteenth year, with night sweats and positive sputum on and off during the whole time, was clinically cured without difficulty in three months in spite of the fact that for the last eighteen months prior to my treatment her symptoms indicated a steady and gradual decline. No relapse has taken place since dismissal, fifteen months ago.
Night sweats in the majority of cases were controlled with comparative ease. In cases where the injections did not stop the sweats I have given specific medicine inula in twenty drop doses by mouth, four to six times per day. Thereupon the sweats would cease within a few days; the same treatment was repeated if they reappeared.
Hemoptyses are favorably influenced by the compound. Of my cases about twenty had had hemoptyses before they came under my supervision; only three cases suffered further hemorrhages; in the others these ceased.
In the two cases with kidney, bladder and testicle involvement I used urethral injections and bladder irrigations to good advantage. For these I diluted the compound in the proportion of one to two with distilled water. The greatly enlarged prostates soon diminished under the urethral injections with massage; thereafter bladder irrigations were given every other day. The result was a decrease of pain, decrease of blood and pus in the urine until both finally disappeared and lastly, an increase in the capacity of the bladder from two and three ounces at the start to eight and ten ounces after two months of this treatment. One of these cases was my own, while the other belongs to another physician who is following out these suggestions as to treatment with the compound. This latter case is not cured as yet; still we have hope of not only ameliorating his condition, but to see his case arrested, which will require long and persevering treatment.
It may be well here to state that I am not invariably optimistic concerning the outcome of any case, especially when complicated. I have had cases very discouraging at the start respond to the treatment surprisingly quick; again, other cases which I had all reason to believe should readily respond and be cured quickly, dragged on and on; of these I have lost several. The most disconcerting feature is that tuberculous cases are open to any and all superimposed infections, such as influenza, pneumonia, etc. To treat such cases is no sinecure, and the results are far from satisfactory.
Several cases that had improved rapidly under my treatment left me, probably because they thought that they could fully recover without continuing treatment. But of these cases, when they returned with all their symptoms aggravated, only a few would show improvement re-established or ultimate cure.
As a rule, response to my treatment can be pretty accurately gauged by the "Arneth count." Whenever this blood count shows favorable progress the cases go on to recovery. Parallel with improvement in this blood count goes increase in weight, in appetite, increased phagocytosis, diminished cough and expectoration. Wherever there is no improvement in this blood count after two months, the cases may, indeed, be regarded as beyond hope. The Arneth count is a count of the polymorphonuclears and classifies them according to the number of nuclei they contain. Those with a single nucleus are placed in class 1, those with two, in class 2, and so on. A normal count would give this approximate percentage among them: Class 1-5; 2-35; 3-41; 4-17; 5-2. The most vigorous cells are those of class 3, being most active in the phagocytic power, while those of classes 1 and 2, are younger cells and not so active, and those of classes 4 and 5, are less phagocytic by reason of their approaching the process of cell division. A cell count showing the third class highest and also higher than class 1 plus 2, is regarded normal; a count showing the first two classes exceeding the third is prognostically bad. My experiments showed that even with a cell count of bad prognosis the influence of the compound or of echinacea alone will re-establish a normal or nearly normal cell count, thus raising the phagocytic power of the neutrophiles to its possible maximum.
No relapses have ever occurred in any of the clinically cured or arrested cases, as far as I have had the opportunity of re-examining them; and a re-examination was afforded me in about 60 per cent. of all cured cases, from one to two years after dismissal.
Results Obtained by Single Drugs.—"Subculoyd" inula, in injections of from 3 to 5 c.c. daily, gave these results: The tubercle bacilli are manifestly destroyed by it gauging results by microscopical findings. The effect of this drug is to be clearly seen under the microscope in the great number of bacilli showing signs of being destroyed in ever-progressing degree. There is a steady, more or less speedy, decrease in the number of normal bacilli; they swell up, become thick, heavy and granular, appear fragmentary, and disintegrate until under the microscope mere dots or broken beads are observed. These fragments or beads do not stain readily; and the usual sporoid forms show no tendency to proliferation. The process of destruction of bacilli is in proportion to the severity of each case.
This inula preparation I applied in: (a) Incipient cases in which there was no expectoration, but only the dry, small cough, and where X-ray plates and fluoroscope showed spots and mottling; (b) in cases of the open type which showed little of mixed infection or no great amount of pus. In other cases of the mixed infection type this preparation, employed singly, diminished the number of bacilli perceptibly; but the patient did not respond as readily as when the compound was used. Night sweats, when not too severe or too frequent, were controlled by injections of this inula preparation. Here I found that in really hopeless, persistent cases, where inula by injections or by mouth could not stop the sweats, atropine and other drugs of like effect—camphoric acid—were useless also.
From ten to twenty inula injections, 3 to 5 c.c. daily, will generally check the proliferation of the bacilli; thereafter I usually had to stop these injections and go back to the compound so as to avoid undue irritation or indurations from the small quantity of alcohol necessary in the "subculoyd" inula. Whenever deemed necessary these inula injections were resumed in each respective case.
"Subculoyd" echinacea, as a single remedy, in daily injections of from 3 to 5 c.c., I have used in cases that showed a few bacilli, but an abundance of cocci and pus in the sputum. The result was a more or less speedy decrease of the cocci and pus cells. One case is especially remarkable in this respect. It had started as tuberculous pleurisy with profuse hemoptysis the previous year, and when it came into my hands, showed very few bacilli, but innumerable cocci of all types, pus cells, and a great amount of connective tissue shreds with many epithelial cells; the odor of this sputum was offensive in the extreme. Here the echinacea preparation cleared up the pus in four weeks, the odor disappearing within one week; employing the compound from the fifth week on, the case was entirely cleared up within two and one-half months; the patient attended his regular occupation throughout the treatment; and there has been no relapse or reappearance of any symptoms up to the present time, fifteen months after dismissal.
Hyper-leukocytosis and leukopenia are directly improved by echinacea; the proportion of white to red cells is rendered normal; the percentage among neutrophils becomes normal; and phagocytosis is very evident where formerly no sign of it could be detected under the microscope. As many as eight bacilli enclosed within one phagocyte were counted; and this in cases where, at the beginning of treatment, the third class of neutrophils had been from 9 to 12 per cent. less than the second class. By favorably influencing phagocytosis, the number of bacilli is also diminished; but as far as the direct destructive power of echinacea upon the bacilli is concerned I have never found any practical results. When using echinacea alone I have discovered, under the microscope, no such deterioration or destruction of the bacilli as observed when employing "subculoyd" inula. Incipient cases might well be treated by inula alone. Yet, incipient cases are far less frequently coming to our offices than the open and mixed infection types. And so I prefer the compound in all cases, with the modifications spoken of before, because of the very apparent effects on the blood elements and on the elimination of toxins from the organism.
My cases have not been "picked" ones, but such as come under the hands of the general practitioner in every day routine and that in New York, no county.
Conclusions.—From the results obtained by these two drugs and their compound, I feel free to state that it is: (1) Is non-toxic; (2) increases appetite and favors assimilation of food; (3) controls night sweats; (4) materially assists in the elimination of toxins from the organism; (5) favorably influences fever, reducing the temperature to normal; (6) increases phagocytosis; (7) destroys tubercle bacilli; (8) effects an arrest of the disease or a clinical cure, in cases that are deemed curable at all, in less time than is required by other present-day methods.
For lack of space only five copies of case records are appended; the blood counts following upon the case records refer to these by initials.
1. I. McD., December 11, 1912; female; twenty-three; U. S.; 5 feet, 4 inches.
Family History.—Of three generations past, four male members on the father's side of the family died of pulmonary tuberculosis; the two brothers of the patient died of acute pulmonary tuberculosis at the age of twenty and twenty-two, respectively.
Previous Illness.—Diseases of childhood; frequent attacks of colds; occasional blood-streaked sputum for the last three years; anemia for three years. Pulse, 112; temperature, 103.6° F.; respiration, 28; shallow; left side exaggerated.
Symptoms.—Confined to bed for the last three weeks; constant fever for two weeks; constant cough; profuse muco-purulent expectoration; exhaustion; constant night sweats for two months. Moist, fine, crackling rates over whole right apex down to level of fourth rib along parastemal line. Dullness ibid.; resonance increased; vocal fremitus absent. Amenorrhea since November, 1912.
Recent History.—Had an attack of pleuro-pneumonia at the beginning of November of this year; pronounced cured by the attending physician, but had an apparent relapse at the end of November, when pulmonary tuberculosis was diagnosed and confirmed by sputum examination by the local health department. Weight before attack of pleuro-pneumonia was 108 pounds.
Diagnosis.—Sputum shows abundance of tubercle bacilli, strepto and staphylococci, pus cells, and is albumin positive. Acute pulmonary tuberculosis.
Treatment.—Injections of subculoyd echinacea and inula compound, 5 c.c. daily; inula by mouth 20 drops, q. 3 h., begun December 11. December 27, first day without fever, temperature having gradually declined since beginning of treatment; pulse, 96; out of bed for a few hours; no more night sweats since December 18. December 31, at my office, one block away; pulse, 84; cough and expectoration greatly diminished; sputum shows disintegrated bacilli. Weighs to-day, 95 pounds. January 17, 1913, she weighs 99 pounds; coughs in the morning only; amount of sputum in twenty-four hours is 1 ounce. January 22, sputum shows few strepto and staphylococci, but no more tubercle bacilli; only very little cough and expectoration in the morning. Slight infiltration remains at right apex. January 23, goes back to work, school teacher. January 31, sputum is watery, contains no pathogenic organisms, except a few diplococci and tetrads. February 11, weighs 111 pounds; eats and assimilates well. February 16, menses reappear; there had been amenorrhea since November, 1912. March 27, weighs 116 pounds; the scant morning expectoration is negative; injections discontinued. October 20, re-examined; no signs of infiltration found; slight area of flatness at right apex; no other untoward symptoms found. June 1, 1914, re-examined by three other physicians; nothing untoward found. April 15, 1915, re-examined before the county medical society, ease declared clinically cured.
2. J. T. N., February 21, 1913; male; twenty; U. S.; 5 feet, 71/2inches; 137 pounds.
Family History.—His mother and sister died of pulmonary tuberculosis within ten and six months, respectively.
Previous Illness.—Frequent attacks of colds that linger. Pulse, 132; temperature, 99.6° F.; respiration, 26; left side exaggerated.
Symptoms.—Severe, harrassing cough; profuse muco-purulent expectoration. Dullness over right apex down to third rib, also at the level of fourth rib in right axillary line; moist, fine, crackling rales over right apex; loud, wheezing rales over other point; resonance increased, vocal fremitus absent; pain over region of fourth rib in right axillary line. Icterus of both sclera.
Recent History.—Severe attack of influenza two weeks ago; lost six pounds during this time.
Diagnosis.—Sputum looks characteristically tuberculous, showing strepto and staphylococci, pus cells, is albumin positive; no tubercle bacilli in it to-day. Suspected pulmonary tuberculosis.
Treatment.—Injections of subculoyd echinacea and inula compound, 5 c.c. daily. March 6, his sputum to-day shows numerous tubercles and other organisms previously found; health department report on sputum is positive. March 11, cough is materially decreased, softer, and expectoration less. Feels better; weighs 141 ½ pounds. March 18, weighs 144 ½ pounds; has eaten only ordinary diet; coughs in the morning only. March 31, weighs 146 ⅛ pounds; fluoroscope shows dark areas at and below right apex; bronchial rales at right apex and right axillary line. April 12, only a small quantity of sputum obtained in the morning; free from tubercle bacilli. May 29, raises very little sputum in the morning only; it is albumin negative and free from tubercle bacilli. June 16, flatness at and below right apex and in right axillary line, fourth rib. No other signs and symptoms present. Injections discontinued. August 11, slight cold and cough after ocean bath; sputum is negative. October 30, another cold; sputum again negative. January 14, 1914, re-examined; no untoward signs or symptoms found. June 1, 1914, re-examined by three other physicians; nothing untoward found. April 15, 1915, re-examined before the county medical society; case declared clinically cured.
3. D. McG., June 11, 1913; male; twenty-eight; Ireland; 5 feet, 5 inches; 116 ½ pounds.
Family History.—Mother, one sister and four brothers, died of pulmonary tuberculosis.
Previous Illness.—Two attacks of pleuro-pneumonia; tuberculous lymphadenitis, operated upon in 1906, at the Manhattan Eye, Ear and Throat Hospital. Pulse, 96; temperature, 97.2° F.; respiration, 20; left side much exaggerated.
Symptoms.—One cervical lymph gland, right side, location of previous operation, is puffy and shows fluctuation. Slight cough, scant expectoration. Moist, crackling rates at right apex and right mid-axillary line, fourth to sixth ribs, also at left scapular line, third to fourth ribs; dulness at these points; pleuritic adhesions in right mid-axillary line. Pain over right lumbar region; walks with utmost effort.
Recent History.—Night sweats in 1909, lasting six months. Was given twenty-five tuberculin injections after his glands had been removed at the above named hospital. Pleuro-pneumonia in 1906, and again in April of the present year.
Diagnosis.—Sputum shows tubercle bacilli, strepto and staphylococci and pus cells; urine shows casts and pus.
Treatment.—Injections of subculoyd echinacea and inula compound, 5 c.c. daily; echinacea by mouth. June 14, sudden onset of delirium in the afternoon; pulse, 98; temperature, 102.6° F.; respiration, 40. Right lower lobe consolidated; pain in right side sweeping to front. June 15, induced perspiration has reduced temperature and pulse; mind clear; profuse diarrhea. Urine contains large amount of pus and many bladder cells. June 22, pulse 90, temperature 98.6° F.; comes to office, one block away. June 28, edema of left foot; mitral systolic murmur. July 28, weighs 126 pounds; a gain of ten pounds; goes back to work as city salesman. August 9, the puffy right cervical gland opens spontaneously; smear from it shows tubercle bacilli. August 12, urine shows albumin, pus and bladder cells. Sputum is tree from tubercle bacilli, but continues albumin positive. August 30, severe chill in the morning, put to bed; pulse, 96; temperature, 102.2° F.; pain in right side. August 31, induced perspiration has reduced pulse and temperature to normal; has passed large amount of pus in the urine. September 1, at office; pulse and temperature normal. September 4, numerous hyaline casts in the urine. September 7, weighs 121 ¾ pounds; goes back to work. September 25, 125 pounds; sputum free from tubercle bacilli and albumin negative. October 8, weighs 128 pounds. November 9, injections discontinued. January 12, 1914, slight cold, sputum is negative. Flatness over previously affected lung areas; no new signs or symptoms. Dismissed. April 14, 1914, re-examined; no return of signs or symptoms. June 1, re-examined by other physicians; no untoward signs found. July 10, re-examined by another physician who declares lung condition arrested. April 15, 1915, re-examined before the county medical society; case pronounced clinically cured.
4. K. McG., November 20, 1913; female; twenty-six; Ireland; 5 feet, 5 inches; 125 pounds.
Previous Illness.—Pleurisy, 1905; pneumonia, 1912; lymphadenitis, operated in 1911. Pulse, 90; temperature, 99.8° F.; respiration, 20; shallow.
Symptoms.—Harsh, ineffective cough; both clavicular notches of both sides much deepened; Right apex, dulness and moist, crackling rales; left apex, dulness and few interrupted, moist, crackling rales. Venous varicosities over vertebra prominens. Scar tissue over location of removed lymph glands of supraclavicular and right axillary group.
Recent History.—Had been examined at the Mt. Sinai Hospital in the spring and been told that she was suffering from pulmonary tuberculosis, and been advised to go to the country. She went to the mountains from June to end of October, returned without any improvement in her condition.
Diagnosis.—Sputum shows moderate number of tubercle bacilli, large number of strepto and staphylococci, pus cells, and some epithelial cells.
Treatment.—Has an attack of follicular tonsillitis from November 21 to 24; abed. Comes to office, November 25, when injections of subculoyd echinacea and inula compound are begun, 5 c.c. daily. Weight to-day, 125 pounds, having lost 11 pounds since August. Pulse today, 110; temperature, 99.60 F. December 2, less cough; digestive disturbances, gas and vomiting; echinacea by mouth, 20 drops, q. 4 h. December 12, cough softer and less; expectoration greatly diminished. December 24, sputum in twenty-four hours amounts to ½ ounce; it is free from tubercle bacilli, but shows other pathogenic organisms found before. Small area of consolidation at right apex; few rales remaining at left apex. December 29, sputum negative. January 5, 1914, no cough for the last five days; weighs 130 ½ pounds. January 12, examined by another physician who reports: "No signs of lung involvement found." Injections discontinued. Remains under observation. May 11, re-examined; voice and breath sounds normal; no signs of relapse; has not coughed since January 2. June 1, re-examined by other physicians; no untoward signs found. April 15, 1915, weighs 145 pounds. Re-examined before the county medical society; case pronounced clinically cured.
(This case was selected for me by another physician as a test case; he examined the patient before I began treatment; his report after I dismissed the case can be produced).
5. E. D., March 10, 1914; female; forty-one; U. S.; 5 feet, 6 ½ inches; 139 ½ pounds.
Family History.—Mother died of "consumption," and other relatives have suffered from pulmonary tuberculosis.
Present Illness.—Pleurisy at age of sixteen; she had to leave school after that because of constant cough. Pulse, 90; temperature, 99.6° F.; respiration, 19, left side exaggerated.
Symptoms.—Much cough with profuse muco-purulent expectoration. Dulness and moist rales at right apex. Flatness on left side, scapular line, location of pleurisy, eighth rib. Loss of weight during the last two years. Anorexia. Easily fatigued.
Recent History.—Has had night sweats, more or less severe, during the last eighteen months whenever she had a "heavy cold."
Diagnosis.—Sputum shows moderate number of tubercle bacilli, numerous strepto and staphylococci, diplococci, tetrads, pus tells, and few epithelial cells.
Treatment.—Injections of subculoyd echinacea and inula compound, begun with 3 c.c. daily. March 17, cough materially decreased; less expectoration; better appetite. March 25, weighs 142 ¼ pounds; coughs only in the morning; sputum shows only few tubercle bacilli, no strepto or staphylococci, but numerous leukocytes; no other findings. March 31, great general improvement; very good appetite and assimilation. April 7, feels and looks better than for many years past; no fatigue. Sputum today, shows a few disintegrated tubercle bacilli, a few streptococci and occasional leukocytes; no other findings. April 20 to April 27, severe attack of hives with consequent loss of appetite and loss of weight. April 29, weighs 140 ¼ pounds. Appetite returns as hives disappear. May 5, weighs 142 ¾ pounds. Coughs only once in the morning; expectoration consists of clot of mucus material; it is free from tubercle bacilli. May 14, has not coughed for the last week; weighs 145 pounds. At right apex no more rates, but slight flatness. Injections discontinued. July 26, re-examined; no untoward symptoms found. January 5, 1915, re-examined; no return of any signs or symptoms found. April 15, 1915, re-examined before the county medical society; case pronounced clinically cured.
In the foregoing cases the sputum examinations were verified by the department of health, as well as by Dr. T. S. Schlauch for whose conscientious co-operation I wish to express my appreciation.
In the blood counts given below, reference to the respective cases is made by initials. For greater clearness these blood counts are given separately.
Hecht: Münchener med. Wochenschrift, 1912, No. 42, page 2,277; Münchener med. Wochenschrift, 1905, No. 9, page 416; Therap. Monatshefte, 1904, page 437; British Medical Journal, 1891, II, page 838.
Arneth, J.: Die neutrophilen weissen Blutkörperchen bei Infectionskrankheiten, Jena, 1904.
Kramer, J.: The prognostic value of the Arneth blood count in pulmonary tuberculosis; New York Medical Journal, June 14, 1913.
DR. E. B. STEVENSON (Chairman): I would be glad to give time for the discussion of this paper, but the time for this section has been consumed. There are other papers we would be glad to have, but we must close this section now.
DR. F. M.ANDRUS (Nebraska): I think a paper like we have just had read deserves a vote of thanks. I therefore move that we extend the doctor a vote of thanks for his efforts along this line. Seconded and carried.
PROF. JOHN URI LLOYD: My name has been used by Dr. von Unruh, and I want to say to the members that four years ago when the doctor wrote me stating he was interested in this line of work and investigation and asked me, as a pharmacist, if I would help him in the preparation of the remedies he wanted to use, I agreed to do so providing every remedy he made be free to the world, that there should be no secrecy anywhere, and it pleases me very much to find that the doctor has made this clear in his paper. When I say to you that, to my knowledge, the doctor has used nearer twenty than ten gallons of the preparation in his work with the boards of health, you will know that he has employed enough to speak advisedly concerning the preparation.
I also noted with pleasure what the doctor said about inula, but he said he did not know why he used it. Let me ask the doctor if he will not study up the old Eclectic remedies that have been used in times gone by, when Dr. King and others were concerned to find standard remedies for the Eclectic school, and one of the remedies that I used to make in large quantities was elecampane syrup for pulmonary troubles, and it pleases me very much to find here another opportunity of calling to the attention of the world the work the Eclectics are doing in the way of giving to the world remedies that the whole world may be benefited thereby.
I want to refer to one sentence in Dr. Henderson's paper where he said the difference between the action of a remedy that is digested in the stomach and the action of a remedy which is passed through the stomach undigested may be marvellous. I accepted that fact in this colloidal compound of ipecac that I discovered some years ago, and with which we have made such a record in enteric fever—we found then the far-reaching action of that ipecac was when it had passed through the stomach into the intestines and there assimilated. We must give Eclecticism the credit for the work that has been done in that direction.
I have been very much pleased with Dr. von Unruh's paper, and I think he has admirably followed the suggestions made by me.