DR. JOHN PATERSON
British Homoeopathic Congress, Glasgow (September 1948)
MR. CHAIRMAN, LADIES AND GENTLEMEN,
I consider it a great honour to be the first speaker on the programme of this congress, which has as its theme “Homoeopathy and Modern Research”. What I have to offer you today is the result of twenty years observations as physician and bacteriologist upon the role played by the non-lactose fermenting bacilli of the bowel in chronic disease. The subject matter of this paper then will necessarily require to be considered under two heads – (1) Bacteriological, (2) Clinical.
In 1880 the bacteriologist Eberth succeeded in isolating and identifying the B. typhosus – a non-lactose fermenting gram negative bacillus – and it was easy to provide the experimental evidence of the role this played when found in the intestinal tract.
From that date onwards other organisms were noted as present in the intestinal tract, and their isolation and identification as members of the colityphoid group easy to establish, but as they failed to give any experimental evidence of pathogenesis, they were dismissed as having no significance in the bowel flora.
The publication of the work by Bach and Wheeler, under the title chronic Disease, A Working Hypothesis in 1925 is therefore of some important and must be the starting point for my contribution of this afternoon. The book is unfortunately out of print, and even second- hand copied hard to come by, so I may be permitted to quite and briefly to summarize their work, as their conclusions were in opposition to the then accepted theories, as the following quotations shows. “A point which we particularly wish to stress is that a non-lactose fermenting gram negative bacillus in the faeces, whether it falls into a known variety or not, may be the cause of toxaemia even though it may not give rise to obvious lesions. In fact the great majority never do, nor can cause locally anything more than at the most, a little mucous colitis or some affection of that nature.
“Vaccine therapy principles warrant the belief that if disease symptoms disappear or are much ameliorated after the use of a vaccine made from a particular organism,, then that organism counts at least for something in the production of the disease symptoms.”
Acting on that assumption a polyvalent vaccine of all types of non-lactose bacilli from the bowel was prepared for hypodermic use, and the result of treatment of 500 cases of a variety of chronic disease published. The results are rather striking :
Swift and striking…… 15 per cent. Gradual and excellent…. 65 per cent. Some definite effect…. 15 per cent. Unaffected………. 5 per cent.
“our conclusions are based on ten years work, Bacteriological and Clinical, and our results are such that we desire to invite as wide a testing as possible of both conclusions and practice. For if our colleagues can confirm us out of their experience they will find themselves possessed for a new and powerful weapon for treatment of chronic disease, and if they cannot confirm us then one more hopeful path will be shown to be a blind alley and we can turn to new explanations.”
Have we tested, as widely as possible, their conclusions; have we found by experience a new and powerful weapon in the treatment of chronic disease? I trust that in the discussion to follow there may be many who can give of their experience and thus contribute to this Congress upon Homoeopathy and Modern Science, keeping in mind the new standard – the clinical test- set up by their colleagues Bach and Wheeler.
It is not the lot of all participate in this work in the bacteriological laboratory, but it was my great privilege to take up the work as bacteriologist and physician immediately after the International Homoeopathic Congress (London) 1927, when it may be said that he potentized bowel vaccines (Bowel Nosodes) were first introduced to Homoeopathy.
I shall not neglect to give anyone interested in the technical side of the bacteriological data opportunity for discussion, but at the moment I ask that they accept the statement that there was a standard technique and nomenclature in use, which I shall call the Batch technique, when I took over the work in 1928. With this technique it was possible to isolate and identify the types of non-lactose fermenting bacilli which formed the polyvalent bowel vaccine, and to proceed to the clinical study of each as to its pathogenesis.
Within the homoeopathic school the oral vaccine displaced the hypodermic preparation, and the potentized vaccine (nosode) the bacterial emulsion.
The names of the organisms which designate the bowel nosodes are familiar to most of you, but to assist any who are not acquainted, and for purposes of reference late, I offer each member of Congress a list of names of the organisms so far identified in the laboratory and clinical proved, with a list of associated remedies.
This you will note is an extract from a paper published in April 1936, entitled “The Potentized Remedy and the Bowel Flora”. This has been amended and brought p to date by the addition of many more remedies.
By the cross checking method of (1) observing the clinical symptoms present when a particular organisms was identified in the bowel and (2) observing the clinical symptoms which were ameliorated or disappeared after the giving of a particular bowel nosode, it was possible even at that time (after some eight years work) to give some tentative indications of the pathogenesis of certain types.
Now, after twenty years work, combining clinical and laboratory observations I can with confidence record the pathogenesis of each of the named types on that list. I hope you not expect me to give you the pathogenesis now, the subject matter of which takes up a full week’s course of Post-Graduate Class of the Faculty of Homoeopathy.
After ten years’ work Bach and Wheeler invited as wide a testing as possible of both their conclusions and practice.
After twenty years of clinical and bacteriological research I hereby confirm their hypothesis, that the non-lactose fermenting gram negative organisms of the intestinal tract do have a role in the causation of chronic disease, and that in the bowel nosodes I find myself possessed of a new and powerful weapon for treatment.
I have no doubt that many of you will likewise confirm the therapeutic value of the bowel nosodes, and so add your evidence to the proof that the bowel nosodes have stood up to ” the clinical test”.
But I must also, to satisfy modern science the clinical evidence to the laboratory test for that purpose I shall take the first group of organisms on the list : B. Morgan (Bach).
B. Morgan (Bach). This non-lactose fermenting organism occurs with the greatest frequency in the stool, and thus offers greatest opportunity for clinical observation. Accordingly, its “proving” is not only extensive but also detailed. To the Homoeopathic physician the “mentals” and finer details are of prime importance, but for the purpose of this paper I must pass these over and mention only the more gross pathology. The Morgan (Bach) group – which includes all the sub-types – has action mainly on the vegetative system of the body: on the mucous membrane of the whole alimentary tract from the mouth to the anus, and the prolongation of the tract into the liver.
It also acts on the mucous membrane of the whole of the genito- urinary tract. While internally it acts on mucous membrane, it has also marked action on the skin.
From the list you will notice that the main Morgan group has been subdivided into (a) Morgan (pure) and (b) Morgan-Gaertner. Is there any clinical significance of this sub-typing?
In the laboratory technique introduced by Dr. Bach the organism was named according to the sugar reaction at the end of eighteen hours incubation. An organism which produced acid and gas in glucose only, irrespective of what happened thereafter, would be named Bacillus Morgan.
In my laboratory observation I noted that some types thus named B. Morgan (Bach) remained true to the usual maximum period of incubation of of seventy -two hours, and to this I gave the name B. Morgan (pure). In other cases after the initial eighteen-hour period a change was noted so that at the maximum period of seventy-two hours the sugar reaction was that of B.Gaertner, and to this type I gave the name Bacillus Morgan-Gaertner.
All the members of the Morgan group have selective action on the liver, but there is a difference in the degree of action of the sub-types. B.Morgan-Gaertner has been found in the stool more often in the case of acute inflammation of the gall-bladder, acute cholecystitis, and B. Morgan (pure) is usually associated with the more chronic phase of gallstones. the more acute action of Morgan-Gaertner is also noted throughout the genito-urinary tract, but its main action is upon the kidney with the formation of renal calculus. B. Morgan has outstanding action upon the skin.
Here then is a clinical distinction which is in accord with the classification and technique of the bacteriological laboratory. And so throughout the organisms on this list, each has its own characteristic symptoms complex or pathogenesis and definite sugar reaction according to he standard adopted in the laboratory.
What is this laboratory and why was it adopted in the first instance? For those who are particularly interested in the technique and nomenclature, details will be found in the Transactions of the Eleventh Congress of the international Homeopathic League which was held in Glasgow in these rooms, August 1936.
The choice of sugar to constitute the test in any instance is purely an arbitrary one, and thus it follows that if one group of carbohydrates is used, one classification is obtained : if another group of sugars is selected an entirely different calcification is possible hence the confusion in assessing the pathogenesis of any named organism and comparative analysis between different teams of workers.
Even with the adoption of agreed standard sugars it was found that many factors caused variation even with the most rigid control of purity of sugars, temperature and time factor, and all possible extrinsic factors. There still remained an intrinsic factor with caused variation in fermenting powers.
“The only justification for founding a classification upon one series of experiments rather than upon the other is the fact that the classification so obtained corresponds more closely to differences brought out in other ways, such as difference in agglutinations or pathogenicity “- so writes Gurney- Dixon in his very excellent book The Transmutation of Bacteria.
“The day has passed when agglutination tests with the patient’s serum can be accepted as diagnostic evidence ” states modern writer on the Bacteriology of the Typhoid Salmonella.
The justified for the arbitrary choices of sugars in any work on the clinical observations of pathogenesis for each type.
One important factor, namely the source from which it comes, in other words the nature of the media from which it is isolated, may determine certain variations -the organism carrying, as it were the imprint of the media. Conversely the sugar reactions of an organism immediately it is capable of being isolated may give the bacteriologist the clue as to whence it has come, a fact sometimes of value in tracing epidemic outbreaks.
It was with this fact in mind that a departure was made from the more usual seventy-two hours incubation period and an eighteen hours period adopted as the standard time for identification and naming. It was hoped that variations in fermenting power at this stage might have some pathogenic significance. So it proved to be, as in the case of the sub-types of the Morgan (Bach) group.
It is now recognized that the fermentation of any particular carbohydrate is dependent upon the activity of a particular ferment or enzyme, indeed the splitting process takes place in three stages with a particular enzyme responsible for each phase. Failure to produce either acid or gas may be due either to the absence or the inhibition of a particular ferment. The is some support for the theory that the loss of power to split carbohydrate compounds is in direct ratio to the increase of pathogenicity.
Variations in sugar reactions may then be considered to have biochemical significance, since enzymes are known to be very complex protein substances, and this in turn must be considered to have relationship to pathogenesis. The study of the biochemistry of the bacterial cell thus becomes of prime importance to the modern scientist in bacteriology.
I confess I am unable to follow the chemical formulae which is to be found in the very recent publication The Chemical Kinetics of the Bacterial Cell, but I am encouraged to know that this work is being undertaken.
I would, however, draw your attention to the list of organisms of the bowels flora with their associated remedies, and explain to your that they have been placed there because, in each case, the respective bacillus has appeared in the stool of a patient subsequent to the administration of that particular remedy. The remedy was chosen according to HOMEOPATHIC principles, i.e., because it was known to have pathogenic power to produce symptoms similar to those observed in the patient.
Looking down this list one is struck by the varying degrees of chemical combinations varying from a simple element like Sulphur, through slates, carbonates and chlorides, to complex substances from the vegetable and animal kingdom. Their association in this grouping must have some significance since they have relationship to a common organism possessing specific fermentive power. It is now recognized that a sequence of cell reactions may begin with very simple chemical substances, and that from this raw material complex and varied products can be built up.
“A natural hypothesis is hat compounds similar to these various growth factors are intermediate in the chain of processes occurring in cells which can start with similar material”- so says the author I have just mentioned, and he further offers a useful analogy by asking the reader ” to think of the chemical operation of the cell less as the piecing together of a jig-saw cut into large fragments which will fit together only in one way, than as a formation of a mosaic from simple units which can be combined in innumerable ways.”
I find this hypothesis very attractive as it affords me a basis upon which to formulate my theory regarding the appearance of these non-lactose fermenting bacilli following the administration of a remedy. I can conceive that such an elementary remedy as Sulphur may set up a chain of reactions which ultimately results in the formation of a complex substance- an enzyme- and it is known that the bowel mucosa has its peculiar enzymes which act as a barrier to the bacterial invasion of the body proper.
It is reasonable to presume that the chain of reaction set up may affect these enzymes and thus finally affected the BOWEL FLORA. In the laboratory the change would be noted by the peculiar sugar reaction, which we have noted is due to specific enzyme action. From the sugar reactions of the gram negative non- lactose fermenting bacilli it is possible to formulate not only the degree of pathogenesis but also to recognize something of the biochemistry of the process.
On this hypothesis each of the bowel nosodes-products of bacterial cell activity – can be assumed to be a very complex structure of the nature of mosaic with each of the remedies in each of the particular groups forming the units which make the pattern. It matters not if they are simple or compound, animal or vegetable, each has a part in the completed structure.
In my paper “Sycosis and Sycotic Co.” published in B.H.J., April 1933, I made the statement that “as the result of one’s observation there is warrant for making as very definite statement of great importance to Homeopathy and to Bacteriology – that Homoeopathic potencies are capable of altering the flora of the bowel”. I would add a quotation from a further contribution “The Potentized Drug and its Action on the Bowel Flora” published three years later (1936). “It is a doubtful compliment to one’s work that so far such a definite claim for the potentized remedy given according to the laws of similar has remained unchallenged.
Homoeopathy has something to offer to the modern research worker in the bacteriological field and to the student of biochemistry. The work on the bowel flora has opened up a new approach, and I have tried to indicate that in modern scientific literature there is accumulating evidence to offer some explanation for the clinical observations I have made, and which I trust will give some satisfaction to the modern scientist who demand such evidence.
I have no doubt that I shall be met with criticism that is generally accepted that diet can alter the bowel flora, and that my observation might have been influenced by that fact.
Since the days of Metchnikoff (about seventy years ago) many attempts have been made to change the bowel flora-all of which had some success, but all had the same fault, the change achieved was of a temporary nature, and persisted only so long as treatment was maintained. Metchnikoff advanced his sour milk theory – that the B. Bulgaricus found in sound milk could alter the flora of he bowel and by supplanting harmful organisms promote good health and long life. It is I think, rather of interest to note, that although his clinical observations were sound, as proved by the fact that the sour milk treatment is still accepted as modern treatment, his bacteriological technique was at fault. He confused two very similar organisms. The B. Bulgaricus which he found in sour milk cannot live in the intestinal tract, whereas the B. acidophilus is an intestinal organism which can be trained to ferment milk. It was not the organism in the sour milk but the organism in the bowel which received dietary stimulus which caused activity and rapid increase in numbers to the exclusion of all other bowel organisms.
The is a record of some very detailed experiments to be found in A Treatise on the Transformation of the Intestinal Flora with special Reference to the Implantation of B. Acidophilus, published by Yale University Press (19210. The work was conducted at the Sheffield Scientific School of Yale University.
The conclusions briefly summarized are as follows :
(1) B. acidophilus given in whey broth cultures in sufficient amounts (300 c.c) can alter the bowel flora by suppressing or supplanting other organisms.
(2) Lactose (sugar of milk ) when given in sufficient quantities,300 to 500 grams per day, can also change the bowel flora,.with the appearance and preponderance of B.acidophilus.
(3) Combining the administration of B.acidophilus with lactose, comparatively small amounts were required to maintain the change in the bowel flora – (150 grams lactose and 150 c.c. whey broth.)
“The simple character of the new flora persists so long as one or other diet or preparation is continued, but reverts gradually to the normal or usual mixed type within five or six days after a return to the basal diet.’
Keeping in mind the point made earlier in this paper – that bacteria are peculiarly adaptable to environment, and indeed must train themselves to utilize whatever media is available in order to survive, it is not difficult to explain the change of bowel flora under such a set of experiments. Of one made up a mixed culture of bacteria containing but a small proportion of B. acidophilus, and inoculated this into whey broth to which lactose had been added, there would be an immediate reaction. Subsequent plating would show that there was an overwhelming preponderance of B. acidophilus even to he suppression of all other types.
In these Yale University the intestinal canal used as a test tube, and it has to be noted that it required 500 grams of lactose daily in the human subject to maintain the B. acidophilus, and that Lactose was the only sugar capable of thus altering the bowel flora, the reason given being that this sugar is incompletely absorbed in the intestine and can be found in the large intestine and give reaction on test in the stool. The lactose thus acts as a particularly utilizable strength of all sugar solutions of the growth of organisms is only 1 per cent.
In these experiments the conclusions reached must be answer to the diet critic- that in a matter of days after the return to the normal basic diet, the bowel flora returned to what it was before. The changes was due entirely to the supply of sufficient pabulum.
Contrast the changes in the bowel flora which follows the potentized remedy. By no stretch of imagination can one suggest that the administration of a single dose of IM potency, say of Sulphur, supplied any pabulum for the production of B. Morgan.
Furthermore, the change dose not usually take place until after a more or less definite latent period of ten to fourteen days, and when the change does take place it may persist for weeks and even into months. There is record cases where the changes has persisted over fourteen months and in this phase my experience has been that nothing that I know of in diet or medicinal treatment will effect a change; it seems to run its own course. Such a change must be due to the the mere change of pabulum in the intestine, and must be attributed to some disturbance of the enzyme balance of the host which withdraws or inhibits the ferment responsible for splitting up of lactose-hence the change to non-lactose fermenting bacilli.