The development of the concept of dualistic pathogenic intervention of two groups of lipids led us to a treatment employing these two types of lipid constituents of the body chosen according to the character of the manifestations. We obtained from different organic sources the insaponifiable fraction as well as the acid lipid fraction. Human placenta was widely employed. The two preparations, acid lipid and insaponifiable fraction, were used until 1943 on about 200 patients (in France, and Mexico). Some good subjective and objective results were observed. The subjective changes were most impressive. Frequently, an injection of only 1 cc. of the human placenta acid lipid preparation (5% in oil) controlled pain in a few minutes, with relief lasting for hours or sometimes even days. With the same preparation, alkaline pain increased after only a few minutes and sometimes became unbearable. In cases treated with placenta acid preparation, using acid pain pattern as a criterion, we observed some significant objective changes.

Mrs. B. B., 54 years old, with a papillary adenocarcinoma of the ovary and multiple peritoneal metastases found during exploratory laparotomy, had rapidly reproducing ascites. The patient required repeated paracenteses at short intervals. In the month just prior to coming under our care, it had been necessary to tap her once a week or even every five days. Treatment with acid lipids of placenta was instituted, with daily injections, first of 1 cc. and then of 2 cc. of the 5% oil solution. In less than two weeks, the pain was controlled and much less fluid accumulated. The patient had two more paracenteses at two and three week intervals, after which fluid no longer was a problem. The multiple tumor masses, which were very easily felt through the skin after each paracentesis, were seen to decrease rapidly and disappeared in about two and a half months of treatment. After four months, treatment was discontinued and no recurrence was seen during the three years we followed this patient.

We saw Mrs. L. S. N., 73 years old, in 1942 in a subcomatous state, with deep jaundice and with a history of primary tumor of the stomach and multiple big metastatic lesions of the liver. Her condition, which had started a few months earlier, was getting rapidly worse. When we examined her, the liver was occupying the abdomen until the pubis, and practically each of the individual metastatic tumors present at the surface of the liver was easily palpable through the thin abdominal wall.

Guided by the urine analyses—with a high pH and a low oxireduction index—we started with a treatment with 10% solution in oil of a human placenta lipoacid preparation. The doses were increased according to the analyses until they reached 3 injections daily of 2 cc. each. The patient improved, and in less than a week she was conscious again. Her condition continued to improve for more than a month when a rapid change for the worse took place. As the analyses at this time showed the opposite offbalance present, the treatment was changed. In addition to infusions with glucose and saline, glycerol in a dose of 8 drops daily with 20 drops of coramine was given. Again the response was impressively good. The general condition improved rapidly and in less than a month, the patient was out of bed and started to take care of her home. By this time, the jaundice had almost completely disappeared, although the liver remained almost of the same dimension. The patient continued to take glycerol for more than 6 months, leading an absolutely normal life. It took almost one year for the liver to come back to normal dimensions. The patient remained in perfect health for the next 9 years. Several coronary occlusions led to her death at the age of 83, from a myocardial infarction. She showed no objective or subjective signs of recurrence of either her stomach or liver condition.

Unfortunately, uncontrollable changes toward rapid tumor growth ultimately occurred in most cases treated with placenta acid lipids despite favorable objective changes at the beginning of treatment.

Clinical use of the insaponifiable fraction preparations supported observations made in animals, indicating the importance of other factors for obtaining favorable changes in tumors. With the insaponifiable fractions of placenta, marked clinical effects could be obtained only when the condition of the patient permitted the treatment to be continued for a long time. Temporary regression or even clinical disappearance was effected in several cases, only to have the tumors start growing again, this time beyond control by the medication. Even at this point, it was obvious that favorable influence with these two antagonistic groups of lipids was dependent on using the lipid which corresponded to the pattern present. It became increasingly evident that changes in the pattern occurred during treatment. Administration of acid lipidic and insaponifiable fractions induced unfavorable responses in patients with tumors in which a predominance of the same lipids was indicated by analyses. Pain increased and unfavorable changes occurred in the evolution of the disease. For example:

Mrs. A. D., a 42-year old woman, operated on for an adenocarcinoma of the breast 18 months prior to coming under our care, presented a few skin lesions near the operation scar. Radiological study revealed a few small osteolytic lesions in two ribs, and one in the skull. The analytical data showed low urinary pH, high specific gravity and high chloride index, indicating an offbalance which we attributed to predominance of fatty acids. Treatment with 2 injections daily of 1 cc. of a 5% oily solution of the insaponifiable fraction of placenta was started. This was later increased to 2 cc. twice a day. The patient left the city for a summer vacation and took the medication with her. Disregarding our instructions that treatment must be guided by further analysis, she continued it without interruption for four weeks, despite a rapid change in her condition and a constant increase in the pain after each injection. When we saw her again a month later, all the analyses had changed markedly, indicating the appearance of an opposite offbalance. Clinically, the condition also had changed. The skin was extensively involved in the vicinity of the operative scar and multiple, rapidly growing metastases were seen all over. Radiological study showed extensive new lesions in many bones. The condition had progressed in one month in a manner never seen before in any patient and we had to relate it to continued use of medication after a change in the offbalance. This change was similar to that seen in animals with massive administration of the insaponifiable lipidic preparation. Switching to placenta acid lipid preparations quickly changed the evolution of the condition in this patient. Pain was controlled and for three months the condition seemed arrested. In spite of treatment, however, it started to evolve rapidly again after that and the patient died five months following her return from vacation.