Another interesting application of the same therapeutic method has been in otological conditions. B. Welt has made a stimulating contribution to the study of ear conditions in terms of the pathogenic mechanism involved and an even more valuable contribution to therapy.

Vertigo was one of the conditions studied. In a few cases, by comparing concomitant variations in the intensity of the symptom and changes in the urinary pH, we had been able to show that acid and alkaline pathogenic patterns exist, similar to those seen in pain.

Going on from there, B. Welt, in an extensive study, has shown the presence of this dualism and has successfully applied the therapeutic method discussed above, to a significant number of cases of vertigo. The major advantage of this method over other treatments for this condition lies in its extreme simplicity.

For vertigo, which has so many different causes, an etiological approach although ideal, has seemed impossible to all workers in the field especially as a routine procedure in medical practice. An initial simplification of the approach could be made by relating vertigo to acid and alkaline patterns, thus reducing treatment choice to two groups of agents. Welt, in a further step, simplified even this procedure, making the method highly applicable in routine medical practice. He administered to patients one or the other of two agents chosen from each group, such as butanol or sodium thiosulfate, being guided in his choice by clinical aspects such as changes in the symptom with the time of day or the intake of food. A favorable change in the symptom was considered to be a confirmation of this tentative diagnosis of the pattern. The treatment was then continued with the same group of agents. An increase in vertigo led to the use of the opposite group of agents. The clinical results obtained by Welt with this simple method are impressive. (190) He arrives at the following conclusions:

Summary And Conclusions

A series of 44 patients having the symptom of dizziness has been studied.

The symptom of dizziness has been analyzed according to Revici's concept concerning the alkaline or acid pattern of the symptoms.

In 80% of the analyzed cases, the responses have shown the existence of an alkaline or an acid pattern; 12% showed an inconsistent relationship: 8% showed no result.

A therapeutic approach has been devised which corresponds to the presented results.

The control of the symptom of dizziness by this therapeutic approach has been obtained in 80% of the cases.

As compared with other methods of treatment, which are prolonged and involved, Revici's approach is simple in application and effective in its results.

This therapeutic approach based on the dualistic pattern of the physio pathology of the pathological tissues is especially applicable to the symptom of vertigo, which because of the multiplicity of the etiologic and pathogenic factors make a direct medical attack almost impossible.

The evidence presented in this communication relates to the control of the acute attacks of vertigo. Recurrences were observed in this series and successfully controlled.

In the cases submitted in this communication and in subsequent cases subjected to this form of therapy, further observation by this method will indicate whether or not the lesion is permanently controlled."

Welt completed his vertigo study by using many other members of the same groups of agents as they were studied by us for other conditions. The following conclusions appear in Welt's second publication on vertigo. (191)

A series of 106 cases with the symptom of vertigo has been presented in this and a previous paper and analyzed according to Revici's concept of a metabolic imbalance which exists in pathological foci and manifests itself as a local alkalosis or acidosis.

Seven cases were eliminated for lack of data. This left a total of 99 case studies. This figure represents the sum of 42 cases termed the 1953 series and the present series of 57 cases. The two series were combined and analyzed according to sex, alkaline or acid character of the symptom, and clinical diagnosis.

The analysis showed an average good result of 80% for both series. This percentage indicates a consistent correlation of the use of Revici's method and substances with the results achieved. Additional substances from various sources were utilized in the present study. It is here again emphasized that I have submitted this article for the practical reason that the method described is simple and has been successful in its application. In addition, it gives a new systematization to clinical data in the field of otolaryngology. Finally, this communication points to a vast group of substances from widely differing sources and of different structures which have similar biochemical activities. The substances presented here are but a few, but they open a pathway for the development of other substances having similar biochemical activities. It is to be hoped that these too, may have a practical application in the field of otolaryngology.

Views on cell permeability and their relationship to fatty acids and sterols are added.

The role of foci of infection and psychological aspects in their relationship to the symptom of vertigo is amplified.

The simplicity of this method of therapy is emphasized, and its integration with a new method of systematization of clinical knowledge is indicated."