diphtheria toxin is brought about, can only be answered intelligently when we are able to explain a little more about the modus operandi of the vital functions of the human body, how food is converted into material tissue and nerve force, or about the cause of vital manifestations generally, and can explain the reason for Spencer's convertibility of force. As yet we are compelled to be satisfied with the apparently demonstrated fact, that diphtheria toxin produces an antitoxin, and that this anti-toxin, by its action upon the toxin, destroys the power of the toxin to produce its characteristic effects.

So much for the nature and cause of diphtheria, the origin and nature of a toxin, and the origin and nature of an anti-toxin. It is now in order to turn our attention to the relation this anti-toxin bears to the law of similars.

It has been claimed by some that this anti-toxin bears a homeopathic relationship to diphtheria. For an anti-toxin to sustain such a relationship to the pathological condition or to the symptomatic group that is produced by the toxin upon the existence of which its generation depends, it is necessary that the given anti-toxin have the power of producing a pathogenetic condition in a healthy human organism, similar to that which the toxin is capable of producing in a similarly healthy organism.

I am aware that some cases have been reported in which symptoms supposed to be due to anti-toxin, were alleged to closely resemble the symptoms of diphtheria. The most typical, probably, is the one reported in the Boston Medical and Surgical Journal for Feb. 17, 1898, which is as follows:

"Healthy man was injected with five cubic centimeters of diphtheria anti-toxin for prophylactic purposes. Five days later he suffered from malaise, chilliness, and vertigo. He was faint and was put to bed. Chilliness and vertigo continued; vomiting occurred. Urine thick, high-colored and almost completely suppressed. Pulse rapid and irregular. At the end of the first day general glandular enlargement, which persisted ten days. Patient much prostrated and lost ten pounds in weight. Unable to resume work for a week."

Here is a case that at first glance would seem to have been not only due to the anti-toxin, but to have been a case very closely resembling diphtheria, if not bona fide diphtheria - lacking only the membranous deposit. But in a question of such gravity one should be most careful in drawing conclusions.

It is to be noted that the anti-toxin was injected for "prophylactic purposes." This fact presupposes exposure to diphtheria, which suggests the possibility that the case may have been one of genuine diphtheria due to the exposure mentioned; the constitutional disease having developed regardless of the anti-toxin injected. The latter may possibly have assisted the organism in resisting the

toxin, until all the anti-toxin was consumed, when the toxin again reasserted its influence and the case developed as a result of the toxin and not because of the anti-toxin.

As already stated, it is self-evident that for an anti-toxin to be homeopathic to a condition produced by a toxin, it is necessary that the anti-toxin have the power to produce in the healthy organism a condition similar to that which has been produced by the toxin. It has not yet been demonstrated that anti-bodies are capable of doing this. Furthermore, it is improbable-not to say impossible that such power could equally belong to both toxin and antitoxin; for if this were true, then it would be immaterial which should be used for therapeutic purposes, for each could be trusted to produce the same effect. In other words, a toxin and its antitoxin would be pathogenetically identical, and this we know is not the case.

The foregoing quoted case proves nothing, merely furnishing food for thought and speculation. So far as I am aware, no case of greater significance has been reported, and therefore, in the present stage of the philosophy of the subject, we may regard the claim that anti-toxin is homeopathic to diphtheria, as unsustained.

The following brief undemonstrable hypothesis may be offered as a possible explanation of the modus operandi of a cure of diphtheria due to the use of anti-diphtheritic serum: The anti-toxin is introduced into the organism in which the toxin exists in an amount largely in excess of the anti-toxin, the anti-body, of its own production. The injected anti-toxin reinforces the normal antitoxin of the given case, and the toxin is neutralized. As with all cures, the cause of the difficulty being removed, the recovery of the patient is brought about by the recuperative power of the organism being allowed to exert its restorative power. As in all other conditions of lowered vitality, it may be necessary to assist nature in curing the patient, even after the cause is removed, or in some instances the unassisted vis medicatrix naturae may be all-sufficient.

If our knowledge of the nature of toxins and of anti-toxins be correct, then it becomes obvious that the modus operandi of diphtheria anti-toxin in the cure of diphtheria, bears no relation to the physiology of the human organism, but depends entirely upon its power to neutralize the disease-producing influence of the toxin; and, therefore, as homeopathy depends upon the direct influence of the therapeutic agent upon the physiology of the organism, so the modus operandi of diphtheria anti-toxin in the cure of diphtheria bears no relation to homeopathy.

I

DISCUSSION

BY JOSEPH PETTEE COBB, M.D.

Chicago, Ill.

AM in accord with our essayist that it is "a demonstrable fact that homeopathy is but one of the means by which the sick are restored to health." It is, however, the only universal law of cure which the world knows, and for this reason, if for no other, it is proper and justifiable for us to measure all other methods by its standard, and to undertake to explain any and every single instance of successful cure by this law: to see if our law will include each individual case and every successful method.

I know of no reason why our masterful chairman selected me to reply to our essayist, who has long been known as a forceful expounder of the law of homeopathy, except the fact that in an unguarded moment I filled out one of his innocent-looking circular letters and frankly stated that to me the curative action of diphtheria antitoxin seemed very like the action of our remedies, and that I believed it was another example of the homeopathic law.

It is easy to have such an impression and easy to express it; it is not so simple a matter, however, to make an argumentative proof of such a belief, and I feel very much like the four-flusher whose bluff has been called.

Our essayist states the universally accepted theory of the disease in question when he says that

The Klebs-Loeffler baccillus is the organism from which the poison comes that causes diphtheria, yet it is not necessary that this organism should be present continuously during the course of the disease. After its introduction into the human body and the giving off of the toxin, it may be destroyed and no successor take its place, and yet the patient may die of diphtheria, the effects of the toxin.

Nature's efforts at a cure consist in an attempt to wash away the bacilli by a copious discharge, and a neutralization and removal of the toxins by increasing the activity of certain cells and organs. Prominent in the means for neutralization is the development of an anti-toxin. I am not aware that any original biological investigator to-day denies this fact, though of course there are plenty of theorists who do not accept the proofs and who put up specious arguments based upon isolated points and their own lack of information trying to block the advance of science.

The spectacle is as old as the world and need not concern us, as the truth will stand; whatever happenings come to be demonstrated as facts will last whether our theories live or die.

The development of the anti-toxin is the direct result of the presence within the living organism of the toxin; it is not probable that this is the only defensive weapon which Nature produces, but it is one of them and a very important one. Whether we believe that Metchnikoff's theory of phagocytosis or Ehrlich's side-chain theory best explains Nature's method matters not, the contention. we desire to make is that Nature makes an effort to cure. She washes away invaders with a profuse secretion, she combats toxin

with anti-toxin, she increases the activity of defensive tissues and organs, including the blood, the lymphatic system and the emunc

tories.

Anti-toxins, or the elements to antidote toxin, are not present free in the blood in the uninfected animal nor are they in an active condition; there are probably two elements which go to make up anti-toxin, one of which is developed within the leucocyte as a result of direct stimulation of its defensive power by the presence of toxin within the system.

In the development of immunity by the introduction of antitoxin the same process is started, and Nature begins her defensive work as if the toxin were present or momentarily expected, and continues for a variable length of time to keep up her defense without the introduction of more anti-toxin or of any toxin. The defensive work is similar to that which she does when toxin has entered the system; the changes in certain cells and tissues (the leucocytes and blood) are similar, perhaps the same in character, though not in extent, as those brought about by infection.

Our essayist, in summing up his argument, says:

As already stated, it is self-evident that for an anti-toxin to be homeopathic to a condition produced by toxin, it is necessary that the anti-toxin have the power to produce in the healthy organism a condition similar to that which has been produced by toxin. It has not yet been demonstrated that anti-bodies are capable of doing this. Furthermore, it is improbablenot to say impossible--that such power could equally belong to both toxin and antitoxin: for if this were true, then it would be immaterial which should be used for therapeutic purposes, for each could be trusted to produce the same effect. In other words, a toxin and its antitoxin would be pathogenetically identical, and this we know is not the case.

Our essayist here confounds "idem" with "similium," both as to factors and results. Toxin and anti-toxin are not claimed to be identical but similar bodies; they do not produce identical conditions when introduced into the human body, but some of the conditions thereby produced certainly are similar in the two instances.

According to our essayist's theory rhus tox poisoning would have to be combated with rhus as a curative agency rather than with apis mel. or with some other drug producing conditions within the system similar to those of ivy poisoning.

To take another example, I would ask our essayist how he explains the prophylactic value of belladonna in scarlatina; certainly not because of any identity between the toxin of scarlatina and belladonna toxin, nor because the toxemia of the two are identical, but because of their similarity.

Moreover, diphtheria toxin and anti-toxin are similar in many respects, viz. in their morphology, in their life history and in the tissues for which they have a selective affinity; furthermore, while anti-toxin in curative doses does not produce pathogenetic symptoms, neither does the homeopathically applied remedy, but like the drug, if given in large enough doses, anti-toxin will produce pathogenetic tissue changes and symptoms, and these pathogenetic evidences are not dissimilar to the group we are undertaking to relieve.

Our essayist's hypothesis, which he states in conclusion, does not appeal to me because it neither explains the "modus operandi of diphtheria anti-toxin in the cure of diphtheria," nor does it credit the anti-toxin with bearing any "relation to the physiology of the human organism," which it certainly does; moreover, he says that "homeopathy depends upon the direct influence of the therapeutic agent upon the physiology of the organism," and does not give it the credit of having any power or effect on the pathology of the organism.

It is not my intention to undertake an argumentative proof of the hypothesis that the modus operandi of diphtheria anti-toxin in curing diphtheria is the same as the modus operandi of the cure by the homeopathically prescribed remedy. Such a statement is at present undemonstrable for two very sufficient reasons: first, we do not know just how the homeopathically applied remedy does its work, and second, bacteriological investigators are not agreed as to how anti-toxins do their work.

Hahnemann's theory of the substitution of the drug impression for the disease, and the eradication of the disease because of the inability of the two to exist coincidently, does not explain the facts as we can see them to-day. The homeopathic remedy affects the same tissues that are involved by the disease condition we are trying to combat and affects them in a similar (not identical) manner: this I take it is what we mean by the selective affinity of the drug.

The method by which the homeopathic remedy acts in diseases due to specific infections can not be dissimilar to the methods which Nature herself employs, if the homeopathic law is Nature's law of cure.

We know that the value of the homeopathic remedy is nowhere more marked than it is in just these diseases, viz.: those due to specific infection. It has been in such diseases as cholera, scarlatina, yellow fever, typhoid fever and even diphtheria, that its best relative records have been obtained, relative as compared with the results under any other method of cure.

Nature tries to effect a cure by increasing local discharges by walling off and destroying the invaders, by neutralizing, absorbing and excreting the toxin generated by the invaders; to do this she increases the activity of many different cells and tissues; when these different cells and tissues respond in a co-ordinated effort we can presume that Nature conquers, resists the invasion and restores the body to health. When the attack is overwhelming, or when the organism can not respond to the extra demands, or when the different organs work in an inco-ordinate manner, she needs help, and without help will succumb to the disease.

I imagine that the homeopathic remedy often yields its best service by co-ordinating Nature's efforts, at other times by helping most markedly some particular organ or tissue, as the work of the leucocyte, the lymphatic system or the blood. This will explain why different prescribers are able to obtain results by the use of entirely different homeopathic remedies. One remedy will be