At the same time, progress in our research had led us to recognize, in addition to dualism in the pathogenesis of many manifestations, the special role played by lipids. In 1938, we began to use two groups of antagonistic lipids, fatty acids and sterols. We started with a mixture of fatty acids prepared from cod liver oil for one group and with cholesterol for the other. Later we utilized only the polyunsaturated members from the group of cod liver oil fatty acids.

Fatty acids were administered intramuscularly in oily solutions or in gelatinous capsules by mouth. As with administration of placenta extract, the immediate effect was favorable on pain of an acid pattern, and adverse on alkaline pain. In both cases, the effect occurred in a few minutes. Therapeutic attempts with fatty acids were consequently limited to patients with an acid pattern pain and with this restriction, pain was efficiently controlled. We used the effect upon pain as a criterion, and we discontinued treatment in any case in which fatty acids induced or increased pain.

Subsequently, along with the effect upon pain, we used urinary pH and specific gravity as criteria for treatment with fatty acids. A persistent high urinary pH and a low specific gravity were indications for the use of these substances. In addition to the control of severe pain, interesting objective changes occurred. Unfortunately, most of them were only temporary. The following two examples taken from a group of 15 similar cases are illustrative.

L. B., 66 years old, had cancer of the right lung for which he had received only symptomatic treatment. For more than a month the patient had complained of pain in the right chest, with increasing breathing difficulty. Chest X ray examination revealed a tumor of the right lung extending from the mediastinum into the medium lobe. A diagnosis of bronchogenic cancer was made. Subsequent X ray examinations showed rapid growth with several tumors in the upper lobe and in the left lung. The general condition was rapidly and progressively deteriorating, the dyspnea and pain increasing. Two months after first symptoms, the patient was bedridden.

When the patient came under our care a few weeks later, he was dyspneic, slightly cyanotic, had persistent cough, was extremely fatigued and in almost continuous pain. By this time, we had started to use urinary specific gravity and pH as criteria for the recognition of the offbalance present. Because of low specific gravity and high urinary pH, the patient was given oral treatment with cod liver oil fatty acids. Gelatinous capsules containing 0.25 gm. of the fatty acid mixture were used in a starting dose of 0.5 gm. a day, and were increased progressively to 1.5 gm. a day. The patient made an impressive gain in a few days of treatment. The pain disappeared entirely, as did the dyspnea. The cough also almost disappeared in a few days, and in two weeks the patient was able to get out of bed. The improvement continued, and in less than two months, the patient was even able to go horse back riding. Radiologically, the tumors also showed progressive regression. We continued the treatment with a relatively high dosage—2 grams of cod liver oil fatty acids daily—for a total of two months, with evidence of continued improvement. Then, suddenly, symptoms of pulmonary congestion became apparent and the general condition rapidly became worse. Urine analyses now showed a high specific gravity and a low pH. In spite of discontinuing the medication, the patient was back in bed with increasing dyspnea. He died two weeks later with symptoms of pulmonary edema.

Mrs. D. A., 68 years old, had a cancer of the left breast for which she had undergone a radical mastectomy four years previously. Pathological examination of the lesion had shown an adenocarcinoma Grade IV, with ganglionar involvement. When the patient came under our care she was bedridden with a diagnosis of multiple bone metastases. Radiological examination showed multiple osteolytic lesions in the pelvis, femur, lower spine, ribs and skull. We instituted treatment with cod liver oily fatty acids in gelatine capsules. The dose was progressively increased, by 0.25 gm. increments, until it reached 3 grams a day. Ortho phosphoric acid was added orally in doses of 1/4 cc. of a 50% solution given in water in order to control the pain which appeared after administration of the capsules and was of an alkaline pattern. Improvement began in a few days and continued so satisfactorily that in less than six weeks the patient was up and about. Five months later, with bone lesions healed, the patient went home. I saw her in 1941, almost two and a half years later, during which time no treatment had been given. When examined at that time, she appeared in excellent condition. Subsequently, because of the war, I lost contact with her.

The increase of pain, and especially the frequent appearance of pain of an alkaline pattern after extended treatment, considerably limited the use of these cod liver oil fatty acid preparations. Furthermore, an inconsistency in objective changes was seen even when administration was guided by the acid or alkaline character of the pain. In most patients, favorable objective changes were only temporary.

During this research, we observed a very favorable response in some cases of hemorrhage, especially of the long term oozing type, treated with these preparations. Bleeding usually stopped after one injection of 1 cc. of a 10% solution of unsaturated members of cod liver oil fatty acids. We still use this preparation for this purpose, as mentioned previously.

Among the group of lipids opposed to fatty acids, we first used cholesterol with the intention of trying to influence pain having an alkaline pattern. The effect was much less impressive than that obtained with fatty acids in pain of acid pattern. In some cases, objective changes also were observed although they were less frequent and less profound than those seen with the fatty acid preparations. Cholesterol alone never produced total clinical disappearance of tumors.