THE ROLE OF THE BOWEL FLORA IN CHRONIC 

DISEASE - JOHN PATERSON

British Homœopathic Congress, Glasgow (September 1948)

 (BHJ. Vol. LXII, 2/1973)

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 “Homœopathy 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.

bacteriological

         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 coli-typhoid 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 importance and must be the starting point for my contribution of this afternoon.  The book is unfortunately out of print, and even second-hand copies hard to come by, so I may be permitted to quote and briefly to summarize their work, as their conclusions were in opposition to the then accepted theories, as the following quotation 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 toxæmia 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 results of treatment of 500 cases of a variety of chronic diseases 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.

conclusions

         “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 of 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 Homœopathy 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 to 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 Homœopathic Congress (London) 1927, when it may be said that the potentized bowel vaccines (Bowel   Nosodes) were first introduced to Homœopathy.

         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 Bach 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 homœopathic 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 later, I offer each member of Congress a list of names of the organisms so far identified in the laboratory and clinically 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 up to date by the addition of many more remedies.

         By the cross checking method of (1) observing the clinical symptoms present when a particular organism 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 do 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 Homœopathy.

         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, submit the clinical evidence to the laboratory test and 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 homœopathic physicians 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 sub-divided 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 observations I noted that some types thus named B. Morgan (Bach) remained true to the usual maximum period of incubation 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 maximal 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 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 symptom complex or pathogenesis and definite sugar reaction according to the standard adopted in the laboratory.

         What is this laboratory standard 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 Homœopathic League which was held in Glasgow in these rooms, August 1936.

         The choice of sugars 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 classification 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 which 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 differences in agglutination 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 a modern writer on the Bacteriology of the Typhoid Salmonella.

         The justification for the arbitrary choice of sugars in any work on the non-lactose fermenting gram negative bacilli of the bowel must lie in 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.  There 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 bowel flora with their associated remedies, and explain to you 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 homœo-pathic 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 salts, carbonates and chlorides, to complex substances from the vegetable and animal kingdoms.  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 that compounds similar to these various growth factors are intermediate in the chain of processes occurring in cells which can start with simpler materials” – 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 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 reactions set up may affect these enzymes and thus finally affect 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 a 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 a very definite statement of great importance to Homœopathy and to Bacteriology – that homœopathic 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 Similars has remained unchallenged.”

         Homœopathy 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 demands such evidence.

         I have no doubt that I shall be met with criticism that it is generally accepted that diet can alter the bowel flora, and that my observations 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 sour milk could alter the flora of the 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.

         There 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 (1921).  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.  If 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. acidophiluseven to the suppression of all other types.

         In these Yale University experiments the intestinal canal was 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 Lasctose 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 pabulum for the growth of this particular organism.  In the laboratory the standard strength of all sugar solutions for the growth of organisms is only 1 percent.

         In these experiments the conclusions reached must be my 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 change was due entirely to the supply of sufficient pabulum. 

         Contrast the change 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 1M potency, say of Sulphur, supplies any pabulum for the production of B.Morgan.

         Furthermore, the change does 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 of cases where the change 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 other than 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.

         So much for the non-lactose fermenting bacilli of the intestinal tract and the role they play in the causation of chronic disease.

         But the investigation should not stop there: the question arises as to the type of bowel flora present before the change-over.  Whence cometh the non-lactose bacilli?  Were they present before, but in such small amounts as to escape attention?

         I think the control examination made over considerable periods negatives this suggestion in numerous cases, and the general opinion would be to accept the fact that the change is an example of mutation of bacteria.  The role played by the B.coli, generally considered to be a normal inhabitant of the large bowel, is little understood or even taken notice of.  From the moment the infant is put on to other than mother’s milk, coliform organisms appear in the stool and persist throughout life in great numbers.  So long as the mucosa and its enzymes remain in a healthy state the B. colicannot enter the body proper.  They are considered non-pathogenic and their main function is to break down the waste material of the bowel into simpler substances.

         As a class their variety is legion, the number of possible variants increasing in direct proportion to the number of fermentable substances used for classification.  It is calculated that with eight characters (sugar reactions) there are 256 possible variations, and the number rises to 65 536 when sixteen characters are taken as standard.

         Is there any wonder that the bacteriologist has given up the seemingly hopeless task of attempting to classify fully the B. coli of the intestinal tract, and without classification the study of pathogenesis becomes impossible – and here I had better add in parenthesis (so it would seem), as I am about to attempt the impossible.

         In 1905 to 1909 MACCONKEY adopted as his standard a very simple classification which is now generally accepted, and is to be found detailed in the System of Bacteriology, Vol. 4, published by the Medical Research Council.

MacConkey (1905) – Colon Group

________________________________________________________

Type  Glucose  Lactose  Saccharose  Dulcite          Example

________________________________________________________

1           AG           AG             O               O             B. Acidi Lactici

2           AG           AG              O              AG        B. Coli Communis

3           AG          AG              AG             AG      B. Coli Communior

4           AG          AG             AG              O       B. Lactis Aerogenes

________________________________________________________

Bach-Paterson Group (1928)

________________________________________________________

Type  Glucose  Lactose  Saccha  Dulcite               Example

________________________________________________________

1             AG            O            O            O                 B. Morgan(pure)

2             AG            O            O           AG                B.Gaertner

3             AG           O            AG        AG                  B. “No.VII”

4             AG           O            AG          O                   B. Proteus

________________________________________________________

It is encouraging to read that “in the classification of intestinal organisms the fermentation tests have in practice proved to be sufficiently constant to be of great value”.  “There is something more than mere chance behind the fact that the majority of the pathogenic races are unable to ferment lactose.”

         On the reverse side of the list of non-lactose organisms and the associated remedies I have copied out for you the MACCONKEY table, and underneath I have added for comparison, a table of members of this non-lactose group.

         If you place a pencil over and down the lactose columns you will note that the tables become exactly alike.  If by any disturbance the MACCONKEY group lost its power to ferment lactose B. Coli No. Iwould mutate to B. Morgan (pure); B. Coli No. II to B. Gaertner; B. Coli No. III to B. No. VII; B. Coli No.IV to B. Proteus.

         Has this any significance or is it a mere coincidence?  Since 1906 when NEISSER called attention to a curious variant B. Coli-mutabile – the phenomenon has been noted as indicating that the B. Coli which normally ferments lactose temporarily loses this power when first isolated from the bowel.  On a lactose acid solid medium white colonies appear which after a time show small red daughter colonies, the redness indicating that the individual bacteria therein have regained their power to ferment lactose.  If these colonies are replated they do not change but retain this property.

         On the other hand if the white colonies are replated, again there will appear some white colonies which later give red daughter colonies.

         From my observations on the plating of the non-lactose over several generations, it would seem that each of the non-lactose types in this Bach-Paterson group tend to revert to lactose fermenters – that B. Morgan reverts to B. coli I; B. Gaertner to B. Coli II; B. No. VII to B. Coli III; B. Proteus to B. Coli IV.

         I put this forward not as an established fact, but as a possible avenue for further investigation by a team of laboratory workers.

         Meantime I offer you, like my predecessors in this work, a working hypothesis for you to test out as widely as possible as to my conclusions and practice.

         It may come as a surprise to many of you to know that you personally have been assisting in working out and testing the soundness of this hypothesis.  During the past ten years or so, those of you who have sent me specimens of patients’ stool for report may have noticed that in many cases the report definitely stated that – no non-lactose bacilli had been found in the specimens, but in each case you may have been given the suggestion to try the corresponding non-lactose   Nosode and its associated remedies.  For example,: if B. Coli I was found Morgan was advised, if B. Coli II, Gaertner; if B. Coli III, No. VII; if B. Coli IV,  Proteus.  With what success, or lack of success, I now await your verdict.  From my own clinical experience I have found this working hypothesis of considerable value in the treatment of chronic disease.

         Clinical observation makes me hazard the opinion that every organism found in the intestinal tract has pathogenic power, the bowel flora forms a physiological unit and is not a miscellaneous collection of germs.

         I know that I shall be met at once by strong criticism that in the plating of a stool specimen, it would be a false hypothesis to assume that every B. Coli which forms a colony on a MacConkey plate has the same characteristics as evidenced by sugar reactions, and hence has the same pathogenic power.  How then  can one suggest treatment from the isolation and identification of a solitary B. Coli  colony.

         In my working hypothesis I accept the fact that organisms which live together on the same media, in this case the intestinal tract, are in either symbiotic or anti-biotic relationship to one another and if one can isolate a single type of organism and from the culture prepare and administer the potentized remedy (Nosode) it may be possible to disturb the balance and set up a chain of reactions in the manner I have already described.

         I would remind you that for a long period, bacteriologists relying upon their experimental evidence, mainly on animals, that non-lactose fermenting bacilli of the intestinal tract did not produce any pathological lesion, induced the physician to accept the idea that these organisms played no part in causing disease.

         I think it can now be established that the non-lactose fermenting bacilli of the intestinal tract do play a part in chronic disease, and the proof has come, not from the laboratory but from the clinical success which has followed the administration of the potentized vaccine               (Nosode) made from these organisms.

         The bacteriologist must now accept the evidence of the physician that these organisms are pathogenic – and here may I give my interpretation of the word “pathogenic”.  In derivation it means “originating disease”, but I would prefer to modify this for the purpose of this paper, as meaning “associated with disease”.  I visualize the germs as being present but not necessarily causing the symptom complex – the disease.  Such an interpretation may not be literally accurate but I suggest that it is more scientifically correct, and in any case it will help me to discuss with you the more practical aspect of this paper.  You have before you a list with two columns, one under the heading “organisms” and the other “associated remedies”.  From this it becomes possible for any physician engaged in general practice, without the technical knowledge, or the facilities, of a bacteriological laboratory, to determine for himself the role played by any of the organisms named in the first column.  In this the physician who has been fortunate enough to acquire a knowledge of homœopathic practice and is acquainted with the homœopathic Materia Medica has a peculiar advantage.  In the second column he will find many remedies used in homœopathic practice, and of which he has formed a mental picture of their pathogenesis – or “Proving”.  By compounding the symptom complexes of each of the group remedies, he can form a symptom picture of pathogenesis of the individual organism.  With this in mind he may then use the product – the potentized vaccine – the  Nosode in the treatment of disease and by his results determine whether the organism does play any role in chronic disease.  He may also, by clinical trial, determine if the  Nosode does complement and enhance, as I suggest it does, the action of the remedies in the group.  The Bowel   Nosodes have been available and been used by homœopathic physicians since 1928 and thus there should be opportunity for many of you now present to give evidence of the therapeutic value – or otherwise – of these   Nosodes.

the  Potentized Remedy And the Bowel Flora  (Paterson)

British Homœopathic Journal (April 1936) Amended List, (August 1948)

                            ______________________________________________________________________________

                                          Organisms                                                            Associated Remedies 

                          ______________________________________________________________________________

                                                   I.   B. Morgan (bach)

                                                      (a)  B. Morgan (pure)

                                                      (Paterson)              …     Alumina                 Graphites

                                                                                                  Baryta carb.           Kali carb.

                                                                                                  Calc. carb.              Mag. carb.

                                                                                                  Calc. sulph.            Nat. carb.

                                                                                                    Carbo veg.               Petroleum

                                                                                                    Carbo sulph.            Sepia

                                                                                                    Digitalis                   SULPHUR

     Ferrous carb.

                                                                                                           Medorrhinum, Psorinum, Tuberc. bov.

                                      (b) B. Morgan-Gaertner      …       Chelidon                    LYCOPODIUM

                                                                                                   Chenop.                     Merc. sulph.

                                                                                                   Hellebore                  Sanguinaria

                                                                                                   Hepar sulph.            Taraxacum

                                                                                                   Lachesis

                              ______________________________________________________________________________

                              II.  B. proteus                              …           Aurum mur.             Ignatia

                                                                                                   Apis                            Kali mur.

                                                                                                  Baryta mur.              Mag.mur.

                                                                                                  Calc. mur.                  Muriatic acid

                                                                                                  Conium                      Natrum mur.

                                                                                                  Cuprum                     Secale

                                                                                                  Ferr. mur.

                              ______________________________________________________________________________

                              III.  B. “No. VII”                         …            Arsen. iod.                 Kali carb.

                                                                                                  Bromine                    KALI IOD.

                                                                                                  Calc. iod.                   Kali nit.

                                                                                                   Ferr. iod.                   Merc. iod.

                                                                                                  Kali bichrom.           Nat. iod.

                                                                                                  Kali brom.

                             ______________________________________________________________________________

                             IV. B. GAERTNER                       …           Calc.fluor.                 Nat. phos.

                                                                                                   Calc. hypoph.           Nat. sil. fluor.

                                                                                                   Calc. phos.                PHOS

                                                                                                   Calc. sil.                    Phytolacca

                                                                                                   Kali phos.                 Pulsatilla

                                                                                                   Mag. phos.               SILICA

                                                                                                   MERC. VIV.              Zinc. Phos.

.                                                                                                                           Syphilinum

                             ______________________________________________________________________________

                            V.  B. DYSENTERIAE                   ...     ARSENICUM ALB.  Veratrum alb. and vir.

                                                                                       KALMIA

                          ______________________________________________________________________________

                            VI. SYCOCCUS(Paterson)               Antim. Tart.             Nitric acid

                                                                                       Calc. met.                 Rhus. tox.

                                                                                         Ferr. met.                THUJA

                                                                                               Nat.sulph.                      

                                                                                                                        Bacillinum

                          ______________________________________________________________________________

                            VII.   Cocci (Bowel)          …                Tuberculinum         Bacillinum

                           ______________________________________________________________________________

                            VIII.  “No  growth”           …                            MERC. SOL.

                              ______________________________________________________________________________

This table can also be of service to the physician in hospital or specialist practice, in interpreting and putting to practical use a bacteriological report.  Should there be a particular non-lactose organism reported as present, practical guidance is afforded in two directions.  Note should be made of the actual percentage of the non-lactose to other organisms present and this determines according to a proposition I formulated in a previous paper “The Potentized Drug and Its Action on the Bowel Flora”, B.H.J., April 1936, whether it is advisable to give or to withhold the administration of a Vaccine or  Nosode at that moment.

         Probably of greater importance is the fact that the finding of a particular type of non-lactose organism at once indicates to the physician a small group of remedies which he may consider as applicable to the case.  Experience has shown that where a specific non-lactose organism has been identified, a remedy from that group has given evidence of clinical action.  In chronic disease it is often impossible to get a clinical picture from which to choose a remedy and the stool examination  is thus of great value in giving guidance to a possible group of associated remedies, in such cases.

         The clinical test has proved that the non-lactose fermenting bacilli of the intestinal tract do play a role in chronic disease.

         As I have already mentioned, the bacteriological investigation should not stop there and I have offered for your future interest and assistance a working hypothesis founded upon the typing of the B. Coli.  You must no longer accept a bacteriological report which states, “no pathogenic organisms, B. coli only”.  

         The lactose fermenting bacilli of the intestinal tract – the group known as B. Coli – can  be p a t h o g e n i c  and this assertion is made not on experimental work in a laboratory but on clinical observation on the sick human.

         I suggest that in asking for bacteriological reports on stool specimens, you request that the B. Coli be typed according to the MacConkey grouping, which you will find on the reverse side of the paper before you.  I have suggested that the B. Coli according to that grouping is related to a corresponding non-lactose type and that the  Nosode of that non-lactose type with its group of associated remedies, can be used with clinical benefit in chronic disease.

         From my clinical observations, I then assert that B. Coli  can be pathogenic – that they may play a role in chronic disease.

         I appeal, not to the bacteriologist, but to the clinician to test out this working hypothesis.

         In conclusion I would borrow from Chronic Disease, A Working Hypothesis  by BACH and WHEELER, the publication with which I introduced this paper and with slight modification I would say: “My conclusions are based on twenty years work, bacteriological and clinical, and my results are such that I desire to invite as wide testing as possible of both conclusions and practice.

         “For if my colleagues can confirm me out of their experience, they will find themselves possessed of a new and powerful weapon for treatment of chronic disease, and if they cannot confirm me, then one more hopeful path will be shown to be a blind alley and we can turn to new explanations.”

References

BACH AND WHEELER (1925) Chronic Disease – A Working Hypothesis

GURNEY-DIXON (1919) Transmutation of Bacteria.

RETTGER AND CHEPLIN (1921) Intestinal Flora  (With special reference to the Implantation of the Bacillus acidophilus).  Yale University Press.

HAVENS (1935) The Bacteriology of Typhoid, Salmonella and Dystentery Infections.

HINSHELWOOD (1946) Chemical Kinetics of the Bacterial Cell.

PATERSON (1936) “The Potentized Drug and Its Action on the Bowel Flora”.  British Homœopathic Journal.

(1933) “Sycosis and Sycotic Co.” British Homœopathic Journal.

(1936) “Technique in the Preparation of the Non-lactose Fermenting   Nosodes of the Bowel and the Indications for Their Use”. 

Extracts From The Discussion

Dr. HAMILTON:I would like to thank Dr. PATERSON very much for his most interesting paper.

         It has been shown that the non-lactose fermenting organisms have been found in the stool associated with some cases of chronic disease, and in considering the application of the   Nosodes in treatment it seems to me that the following general principles should be borne in mind:

(1) Each of the non-lactose fermenting organisms is associated with a specific form of chronic disease and has its own particular and peculiar symptomatology.

         E.g. The symptomatology of Morgan  is different from that of Gaertner  or Proteus, etc.

         Also, it has been found that the symptomatology of each of these organisms is similar in many ways with that of other remedies.

         E.g., Morgan with Sulphur, Proteus with Nat. mur., Morgan-Gaertner with Lycopodium.

         These remedies have been found to be complementary to the   Nosodes.

(2)  Often in a difficult case, one cannot decide which remedy to give even after the most careful repertorization.  Two or more remedies may have equally strong indications in the case.  In these circumstances, a  Nosode is often useful since in its own symptomatology  it combines the symptoms of the other remedies.

         E.g., the use of Dys. Co. which may combine the symptoms of Arsenicum, Lycopodium and Argentum nit.

         Later, after the  Nosode has acted, the symptoms of a particular remedy will be demonstrated and this indicated remedy should now be administered.

(3)  The   Nosodes should be administered in the same manner as any homœopathic remedy.  They should not be given empirically but only on the basis of the homœopathic law “Similia similibus curentur”.  Since each  Nosode has its own symptomatology, the  Nosode should be given only when the symptoms of the patient’s illness correspond to those of the  Nosode.

         Previously we would administer the   Nosodes on a pathological basis:

         E.g., Dys. Co. in Cardiac disease and Duodenal ulcer.  Morgan Co. in Eczemas.  Proteus Co. in spasmodic conditions and Epilepsy.  In these conditions we were ignorant of the fact that other   Nosodes may be indicated.

         We may have been fortunate in obtaining a good result, but often failure was our portion and then the  Nosode would fall into disrepute.

(4)  Repetition of the  Nosode is similar to repetition of any homœopatbic remedy.  It must not be done indiscriminately nor empirically.  The changes in health following administration of the remedy should be carefully noted and only when evidence is found that improvement has ended – only then should repetition be considered.  Usually improvement after a  Nosode lasts two to three months and often much longer.

(5)  Potency of remedy.  I have based my experience on the use of the 30^th potency and have obtained excellent results.  Other potencies may also be used.  Where there is gross pathgological change the low potency of a  Nosode should be given.  But in the early stages of disease where only toxic symptoms are present, then the higher potencies may be used.

Dr. BRIGGS: it was decided by Dr.PATERSON  and myself that it would be a good thing if we could produce some evidence of the action of the remedies on the bowel flora and a good thing to put before you.  We had some quite interesting results.  For instance, I had one stool which was completely negative, i.e. showing no non-lactose bacteria: a week later it showed 100 per cent non-lactose organisms and three days later it was back again, completely negative.  Well, we want to know the reason for that.  I looked up the clinical record in this case and found that the patient had not received any treatment in hospital but she had had a long string of remedies given at various intervals, from twenty-four hours to two or three weeks, from the medical attendant before she had been admitted to hospital.  These are question marks we ant to get at.  Why should these bowel flora alter like that so rapidly?  Had one of these remedies given a fortnight before been in action for that period in which the stool showed the presence of a non-lactose organism?

Dr. JULIAN:  I have had no experience whatever with the   Nosodes though I have been interested in the subject and have listened to Dr. PATERSON and read in the Journal of his work but there are two or three points about the significance of the bowel flora in disease about which I am rather puzzled.  The first is that the appearance of those non-lactose ferments in quantity in the bowel has been assumed to have some definite significance with regard to the patient’s illness, i.e. with regard to the pathogenesis of the illness and I want to ask whether a series of control experiments have been carried out in apparently normal individuals with variations in the  bowel flora. 

Dr. BRIGGS has told us of a case coming into hospital in whose flora there were at one time no non-lactose fermenters and then 100 percent. and then none at all.  Have these changes any real significance with regard to the production of the illness or are they accompaniments of the illness that have no necessary part in the pathogenesis?  I think one can only arrive at the truth by the provision of a sufficient number of controls.  If one can take, for example, one hundred people who are apparently in normal health, if there is such a thing, and examine their stools periodically over a very long period and see what changes there were in the bowel flora then some information might be gained.  Again, it seems to me even although you can show in a diseased case that there is variation in the bowel flora, the explanation of the disease does not lie so much in the changes of the flora as in the conditions of the bowel which made those changes in the flora as in the conditions of the bowel which made those changes  in the flora possible.  That is to say, the patient is not ill because he has pathogenic organisms, but the pathogenic organisms are there because he is ill! 

         Then I would like to know whether in the course of treatment of a case when one gets the peculiar phenomenon of the cropping up of old complaints; whether that cropping up is associated with changes in the bowel flora.  I would like to try some of these but unfortunately it means that one must be prepared to accept the statement that these particular   Nosodes have a particular pathogenesis just like our drugs.  I would like more evidence before I decided that one would have to submit stools to a bacteriologist.

Dr. MITCHELL: …. I am not very clear about Morgan co.  Does it include Morgan and Bach, or is it a separate  Nosode?

Dr. MASON:  One or two things have come into my mind. … I wondered if Dr. PATERSON had done any work on the relationship of Vitamin B in the bowel and non-lactose fermenting organisms.

Dr. ROSS: … About the practical side of   Nosodes.  I do assure Dr. JULIAN and any others who have similar doubts that these preparations called   Nosodes do act.  In fact I think they are very powerful.  I suggest that they be given a chance.   So often one turns to a thing like the Bowel  Nosode when the remedies previously given have failed to cure.  It may be that there is a complication of drugs still working in the patient’s body.  The time may not be opportune for giving a  Nosode and then one is disappointed.  I have found this pretty frequently, but I have seen good results when the  Nosode was given in a clear field.

         As to the different sub-types I cannot assure myself that these special types are necessary.  They may well be.  I am not in a position to say.  I do agree that the  Nosode made from the Dysentery group is something quite distinct from the others.  It is one of my favourite remedies and I have used it for twenty years and I would not be without it.  It is a magnificent remedy.  If Dr. PATERSON could give us a little précis of all the details of Dysentery co.  it would be very valuable.  I am not certain that when B. Gaertner or Proteus are found the Dysentery would not act.  It is possible that they are similar enough. 

Dr. BOYD: I am quite convinced that the general   Nosodes as supplied, i.e. the Morgan co.,  Morgan (pure) and so on which have been produced, I believe, by collecting a large number of cultures of the particular type and then by the potency eventually being made from these, are of much greater value than what I would call auto- nosodes.  My reason is that taking it for what it is worth I have noticed repeatedly that if a culture is made when a patient is under the influence of a remedy, the auto- Nosode has no permanent or continuous effect at all and I am almost dogmatic on it as I have come across it in so many cases.  If the patient is under the influence of a remedy I find that the dose of the auto-Nosode is merely antidotal.  It is far better to get a culture potentized, give it, wait so long and then a second culture and tincture from it is much more likely to give effect.  The auto-nosodes vary from day to day according to the state of the patient and therefore potencies from them are not apt to be of such general use as the general   Nosodes.

Dr. PATERSON in reply said he wished to thank all the speakers who had taken part in the discussion and would try to answer the questions raised seriatim.

Dr. BRIGGS called attention to the sudden appearance of a 100 percent. phase of non-lactose organisms in the stool which went back to negative in three days.  That is one of the points where it is essential that there should be some collaboration between clinician and bacteriologist.  The explanation would probably be found by noting the remedies given beforehand, observing the possibility of a latent period between the giving of a remedy and appearance of this non-lactose phase.  Previous observations would suggest that there is a more or less definite latent period.

Dr. JULIAN … asks what control has been carried out in “normal” individuals to ascertain what changes take place in a person in “ordinary health”.  That he would answer by putting another question, where is one to find “normal” or “healthy” persons?  Having put the question, however, he would at the same time say that a routine examination of presumably healthy persons would be a great advantage in assessing the changes found to occur in the unhealthy.

         Until he had … evidence, Dr. JULIAN was reluctant to use the Bowel   Nosodes, but surely he does not hesitate to use such a valuable  Nosode as Tuberculinum,  which like many of the other generally used   Nosodes has its “pathogenesis” built up more from clinical observations on the sick person than by experiments on the healthy human.  Dr. BURNETT did record the effects of 30c Tuberculinum upon himself.)  Clinical Provings have usually preceded and determined subsequent “Provings on the healthy human”.

         With reference to the B. coli grouping, he would remind Dr. JULIAN that the classification was to be found in standard works of Bacteriology, and all that he would require to do is to request his bacteriologist to return the findings according to that classification.  The classification for B. coli is accepted but there was difference of opinion as to the significance of this classification, indeed as to whether B.coli had any “pathogenesis” at all and that classification was therefore quite useless.  There was no need to send specimens to Glasgow, if the physician wished to have a report of the type of B. coli present, but he would require to use the “working hypothesis” put forward by this Glasgow bacteriologist, if he wished to try out clinical tests.  He would then be in the position “to give” rather than “to suspend” his judgment as at present.

         Regarding the nomenclature.  What is Morgan co., does it include Morgan bach. Or is it a separate  Nosode?  The contraction “Co.” is for Compound and has reference to the fact that all the Bowel   Nosodes were made up from a number of the specific germ in each case, e.g. Morgan Co. is the potentized vaccine made up from some hundreds of Bacillus Morgan. All the Bowel Nosodes should really have the “Co.” appended Dysentery co., Proteus co., Gaertner co., etc.

         Now as to the term “Bach” or “Paterson” this refers to laboratory classification of the germ.  “B. Morgan (Bach)” includes the sub-types B. Morgan (pure) (Paterson) and B. Morgan-Gaertner (Paterson) and it is suggested that these sub-types have individual pathogenesis and individual   Nosodes have been prepared from these and bear the titles Morgan (pure) (Paterson) and Morgan-Gaertner (Paterson). Note that the appendage “Co.” has been dropped but should be understood as applicable.

Dr. PATRICK had reminded them that the work on the Bowel  Nosodes had given proof of the action of the potentized remedy.

         “That the potentized remedy could alter the Flora of the Bowel” was a statement of great importance which so far had not been challenged.  It was, therefore, of immediate interest to report that the Faculty of Homœopathy, through their Research Committee, were incorporating stool examination in the routine work now going on in Drug Provings.

         Dr. MASON asked about the relationship of Vitamin B to the non-lactose fermenting organisms.  He had not done any work on that but he could recall a particular case – that of a doctor with Disseminated Sclerosis – who had semt stool specimens for examination and report.  He had been very intrigued to find that this patient yielded a very high percentage of B.Morgan and that this non-lactose phase was observed to persist over a period of eighteen months and seemed to be unaffected by any remedy given during that period.  This patient (a doctor) had been giving himself injections of a Vitamin B product over a long period, and one could only speculate as to whether this had caused the change and was responsible for the prolonged phase.

         He was grateful to Dr. ROSS for giving evidence as to the beneficial action of the Bowel   Nosodes, also for giving the warning that the   Nosodes must be given at the opportune time to get this action, and that disappointment in their use (or abuse) was often due to a complication due to multiplicity of previous remedies and the Bowel   Nosodes was only given as a last resort.

         He wonders about the necessity for the sub-types, but he can find out for himself by using these sub-types and comparing his results.  The nearer one got to the similar remedy the better the result, that was the case in all homœopathic treatment.

         It was also true that one could get results with what one may call “collateral therapy” – the use of an allied remedy.

         Dysentery co.  might act with some beneficial reaction where B.Proteus or B. Gaertner was present in the stool, being allied types of non-lactose fermenting organisms, but he was sure from his experience that a better result would follow from the similar  Nosode to the organism found.

         He also, like Dr. McCRAE, finds Dysentery co.   Nosode to be something quite apart from the other   Nosodes.

         The last speaker, Dr. BOYD, had very effectively given a summary of the points raised in this discussion, and for that he wished to thank him.  There was only one other point which Dr. BOYD had offered, namely, his opinion and experience of the autogenous Vaccine against that of the stock Vaccine.  He had less effect than the compound (Co.)  Nosode made from a number of organisms taken from others.  He was referring to a non-lactose organism appearing after a remedy and the action of the autogenous vaccine in such a case.

         He (Dr. PATERSON) would support that point of view and his explanation would be that the appearance of organisms after the action of the remedy was evidence of a vital reaction on the part of the patient.  The use of any bowel  Nosode after such a reaction must be given consideration.

         An autogenous vaccine (Nosode) would be contra-indicated in such a case, and even the use of the stock vaccine also, if one had reason to believe that the “reaction” was in an ascending phase.  It was a working rule, which he adopted and advised others to follow, that if the percentage of non-lactose organisms was above 50 percent the  Nosode was contra-indicated.  The smaller the percentage of non-lactose organisms the greater the indication for the  Nosode.  Here was a paradox for the followers of PASTEUR–the less obvious by the technique of the bacteriological laboratory, the greater the indication for the clinical use of vaccine or  Nosode prepared from a specific organism.                                           

                                                                                                                                                                                  There was plenty of opportunity of Proving the therapeutic value of this working rule, be it paradox or not to the bacteriologist.

         In conclusion Dr. PATERSON thanked all the speakers and the audience for their interest and patient hearing of a long session.