Are they quick and sudden in action? Is their effect transitory? Is it
evidenced in health as well as in disease? Do they act on the
superficial nerves, when applied to them? In each case the answer must
be a negative. In all of these particulars the operation of vegetable
bitters differs from that of Neurotics, and coincides with that of
Hæmatic medicines.
It appears that their action on the nervous and muscular systems is
secondary. They could hardly in either case effect any permanent
improvement without first acting on the blood, if we may argue from
known analogies. For Neurotics and Astringents, which operate directly
on these two systems, are alike transitory in the results of their
action.
Another demonstration is required, before the presumption thus
established can approach to a certainty.
We require proof to show that the disorders in which Tonics are used are
blood-diseases. This does not seem to be difficult.
The condition of Debility, whatever its proximate cause, seems always to
be traceable in the first place to a want in the blood, which interferes
with the due exercise of their functions by the nerves and other organs,
by impairing their nutrition. It follows fevers, and accompanies chronic
diseases, in both of which cases the blood has been exhausted by
continual waste and excretion, without the maintenance of a proper
supply. In cancerous, scrofulous, scorbutic, and dyspeptic habits, the
blood may be deteriorated by a fault in the assimilative processes. When
in these instances there is marked Anæmia, iron may be of most service;
but when the blood is poor without any apparent deficiency of red
colouring matter, then are bitter Tonics needed to improve its
condition, and form a valuable adjunct to the special remedies that the
case may require. They ought not, as a general rule, to be administered
in high fever, or when the pulse is hard, the tongue coated, or the
stomach irritable. A loss of appetite, a nervous headache, a soft
compressible pulse, a quivering tongue, a flabby condition of the
muscles, with general inertia and indisposition to exertion, are
indications for their employment. In some cases emetics and antimonials,
in others mild purgatives, are of use in preparing the system for their
reception.
It seems then that Debility is to be attributed generally to the state
of the blood; and is to be cured by improving it. By so doing we may
communicate tone to the muscular system, improve the appetite, and
increase the nervous force.
Ague, or Intermittent fever, is also a blood-disease. If it were only
from the analogy of other fevers, we might infer this. But there are
more particular proofs. This disorder is caused by the exposure of the
system to a certain peculiar poison or miasm, which is generated in the
ground in certain places, and subject to known laws. The result of the
influence of this miasm is a process in the blood which has been
compared to fermentation, and which produces regularly recurring
paroxysms of a peculiar kind. There is apparently some disturbance in
the great calorifacient process, in which the blood is concerned, and
not the nerves. Each fit commences with shivering; there is then a hot
stage; and finally sweating. The attack then goes off, seemingly as if
the poison that caused it were eliminated in the perspiration. But it is
not all gone. After working in the blood for a definite period, most
commonly two days, it again breaks out, and the same train of symptoms
recurs. Thus this strange disorder, both in its origin and in its
progress, appears to be seated in the blood. So also are its results
evidenced there. Continual Ague deteriorates that fluid, causing general
anæmia, and producing more or less enlargement of the spleen, which
could only be brought about by some faulty condition of the circulation.
Against these proofs it has been urged that the nervous system has
certainly an influence over this disorder, for that a sudden alarm has
been known to arrest it. But this may occur also with other
blood-diseases, and it does not prove that the nervous system is at all
connected with their origin. It can hardly be supposed that Goitre or
Scrofula is ever caused by a derangement of the nerves. And yet Baron
Alibert relates an authentic case of a French lady who had a large
goitre, which for a long time resisted all treatment, but which
nevertheless disappeared entirely during the brief Reign of Terror in
the French Revolution. In addition to these arguments it may be urged
that Ague is often, if not always, connected with deranged hepatic
functions, a fact that again points out that disease as a
blood-disorder.
Seeing then that the medicines of this order of Tonics differ in each
particular of their action from those remedies which influence the
nerves directly, and that the diseases in which they act beneficially
are essentially blood-diseases, there are sufficient grounds for
concluding them to be Hæmatics, or blood-medicines.
We have now to consider the remaining minor propositions, which treat of
their action as Restoratives; to ascertain whether they have been
rightly allotted to this division.
Are there in healthy blood any substances which resemble them? This will
appear to be a question of no small difficulty, when it is considered
how little information we have actually obtained respecting the chemical
composition of the vital fluid. It is nevertheless desirable that we
should inquire into it to the best of our ability.
During the last few years, many propositions, intended to throw a light
upon physiological science, have emanated from the fertile pen of M.
Liebig of Giessen, who is rightly and universally ranked among the most
illustrious of modern chemists. There are two which especially bear upon
the present subject. In his first work on Organic Chemistry (p. 182,) he
argued, that whereas the alkaloids Quina and Morphia resembled the brain
substance in their chemical constitution, they were therefore enabled
to exert a direct control over that organ by influencing its nutrition.
But it is impossible to accept this explanation. The composition of the
brain has been since more accurately investigated, and it has been shown
to consist mainly of a mixture of albumen and fat. Now there is no
reason why these substances should have a special affinity for albumen
and fat in the brain, any more than for the same elements in other parts
of the body. There is also no analogy at all between Quina and Morphia
as medicines beyond their resemblance in chemical constitution. The
theory seems to be altogether groundless.
Another, and a more important suggestion has been made by the same
chemist. He has pointed out a chemical analogy between certain vegetable
compounds and a substance which exists in the bile. He has shown that
for the most part the elements of the bile re-enter the blood after
passing into the intestine, scarcely more than the colouring matter
being finally excreted with the fæces. He has found that if an enema of
bile be injected into the rectum, it becomes absorbed there, and does
not afterwards pass out into the urine.[33] (_Animal Chemistry_, p. 77.)
What the exact function of the bile may be, is as yet undecided. Its
most important constituents are, a non-saponifiable fat, Cholesterine; a
neutral substance, Taurine; and an acid called Choleic, in combination
with Soda,--which latter is present in excess. Bile is bitter to the
taste; and ox-gall, or the bile of an ox, has been found, when
administered as a medicine, to have an action which resembles that of
Tonics. It appears that both the bitterness and the tonic action reside
in the Taurine.
M. Liebig has pointed out an important chemical resemblance between this
Taurine and the vegetable alkaloids. Of these he has singled out
Caffeine, the peculiar principle of Tea and Coffee, as most analogous to
the biliary product. From the analysis of these two substances he has
deduced the following formulæ.
Taurine = C_{4}H_{7}NO_{10}.
Caffeine = C_{8}HN_{2}O_{2}.
Then he shows that an atom of Caffeine, if added to 9 of water and 9 of
oxygen, will form two atoms of Taurine. (_Organic Chemistry_, 1842, p.
180.)
It should be remarked that a different formula for Taurine has been
arrived at by M. Lehmann and others, who assert that it contains
Sulphur. Choleic acid, and other constituents of this complicated fluid,
certainly contain sulphur. But even if Sulphur be combined with Taurine,
it is not clear that it enters with it into the blood. And the above
formula for Taurine has been confirmed by the analysis of M. Löwig.[34]
It seems to be sufficiently correct for our purpose.
With the supposed function of Caffeine as a creator of bile, however
probable or interesting, we are not now immediately concerned. We are
engaged in inquiring whether there is naturally in the blood any
substance which resembles the tonic alkaloids. Liebig has shown that
this element of the bile is intended for re-absorption into the
circulation. And without theorizing at all on the subject, it may
readily be demonstrated that, with the existence in the blood of such a
material as Taurine, we cannot say that we have not in that fluid an
analogue to substances like Quina. Taurine is soluble in water, and
crystallizable; is chemically analogous to the tonic bitter principles;
and contains the same four elements as Quina. If necessary, this
similarity could be exchanged for identity, and Quina could be formed
into Taurine in the blood.
If there be one change in the blood to which, more than to any other,
the substances which enter it are liable, it is certainly the process of
oxidation. Free oxygen is continually entering the blood through the
air-cells of the lungs.
The formula for Quina is C_{20}H_{12}NO_{2}. Adding to this 45 atoms of
oxygen, we could make out of it one atom of Taurine, together with 16 of
Carbonic acid, and 3 of water.
C_{20}H_{12}NO_{2} + 45 O = C_{4}H_{7}NO_{10} + 16 CO_{2} + 5 HO.
Thus it is conceivable that this and similar alkaloids may at the same
time supply an important material to the blood, and serve as fuel to
support the animal heat, by combining with oxygen and giving off
Carbonic acid. I would not, of course, affirm that this actually does
occur; but if it were to take place, we might gain, in this oxidation of
Quina, some clue to the production of that quickening of the pulse and
increase of the general temperature, which are affirmed by some to
follow the ingestion of the alkaloid, even in small doses. But it is now
sufficient for us if we have ascertained that there is naturally in the
system, and in the blood, a substance which resembles Quina. We may be
allowed to infer that the presence of the latter substance in that fluid
would not be unnatural to it.
Having dismissed the second of the minor propositions which relate to
Tonics as Restorative medicines, we pass on to the third. Are Quina and
the vegetable bitters necessarily excreted from the blood?
It is not easy to answer this question with certainty, because it would
be difficult to detect small quantities of this alkaloid in any of the
secretions. But all that is known on the subject is in favour of a
negative answer. A number of careful and elaborate experiments on the
passage of medicines into the urine have been made by M. Wöhler, and in
the long list of substances detected by him in that secretion, Quina is
not mentioned. Neither has it been found in any other of the secretions.
The same may be said of all the Tonic principles. There is no proof that
they are necessarily excreted, but there is every reason to suppose that
they may remain for a while in the blood.
Let us then consider the last question. Can Quina, or substances like
it, improve the condition of the blood when deficient in any of its
natural materials. We know that it is capable of curing simple debility,
ague, and remittent fevers. It appears that it has also been
successfully used of late by Dr. R. Dundas, in large doses, in the
treatment of typhoid or continued fever. Supposing it to be proved that
this agent operates in the blood, does it remedy a disease by supplying
something wanting, or by counteracting something present in that fluid?
In fine, is it a Restorative or a Catalytic medicine?
The probabilities which have been established, that it is not unnatural
to the blood, and is not always excreted from it, are in favour _à
priori_ of its being Restorative. Catalytics are generally unnatural to
the blood, and are excreted because they cannot remain in it. Besides, a
Catalytic has generally some peculiar action on the blood in health; but
a Restorative, in moderate doses, none,--only evidencing its operation
when supplying a previous want. In this also Quina and its congeners
agree with Restoratives and differ from Catalytic medicines.
Arsenic is of use in Ague; and Arsenic is decidedly a Catalytic in all
these particulars. In other respects, too, it differs widely from Quina.
The latter is employed in debility, which depends evidently on some want
in the system, and not on any morbid agent. Arsenic, on the contrary, is
of use in Lepra, which, like other skin diseases, must be caused by some
morbid agency, though we know not what precisely. But some diseases may
be cured in two ways; either by the supply of something, or by the
neutralization of something else. Perhaps Ague is one of these.
And it is not repugnant to what we know of Ague to suppose that there is
in it a want of some natural material, which would have, when present,
the effect of checking the operation of the morbid agent. The fact of
having had Ague once does not, as in the case of the Eruptive fevers,
protect a man from the disorder thenceforward. So in this sense all
persons may be said to be liable to Ague, and none protected from its
assault. But it is not the case with Ague as it is with Syphilis and
Small Pox, which diseases most persons inevitably catch who are exposed
to the virus for the first time in their lives. For, of a number of
persons exposed to the same malarious influence, only a part take the
disorder; some escape. It is generally found that those are most likely
to take it who have been previously debilitated by any cause; so that we
must suppose that the rest have in their blood some material which
serves to prevent the working in it of the Ague-poison, which apparently
must enter it. It is not unlikely then that Ague may be cured by
supplying the want of this material.
Coupling with this consideration those facts which have been previously
stated, we may reasonably conclude that Tonics are Restorative, and not
Catalytic in their action; that they supply, or cause to be supplied, a
material wanting in the blood. How this material is enabled to resist
the morbid influence of the miasm--whether it is by an antiseptic
property, such as has been attributed to Quina--I cannot determine.
Having now done my best to establish the Proposition, as applicable to
Tonic medicines, I may venture to bring forward a speculation concerning
their action, which I would not wish to rate higher than it is worth,
and still less endeavour to demonstrate as a fact.
I have already made use of Taurine, one of the principles of the Bile,
for the purpose of showing that among the natural constituents of the
blood there is a substance which chemically resembles a tonic alkaloid,
like Quina. This similarity admits of a further and more direct
application.
It is ascertained that many, if not all, of the diseases in which Quina
and its kindred medicines are found to be of use, are connected with a
derangement of the secretory functions of the liver. One of these
diseases is the debility which is consequent upon Typhoid and other
fevers. In these fevers the function of the liver is always more or less
interfered with, though more obviously in some cases than in others. In
strumous habits, in which generally bark is of signal service,--and was
very strongly recommended by Cullen, Fordyce, and others,--there is very
commonly a peculiar degeneration of the liver, which has been ably
described by Dr. G. Budd. This state is distinct from the fatty
enlargement common in Phthisis, in the early stage of which disease
Quinine is also very serviceable.
Quinine is often beneficial in Gout, in which the liver is always more
or less deranged.
Turning to periodic diseases, we find that impaired hepatic functions
are the rule, and the absence of such disorder the exception. This will
be at once admitted in the case of Dysentery, and of the Remittent and
Yellow fevers of the tropics. It is also true of Ague. It seems even
likely that the enlarged spleen may be partly caused by an obstruction
to the circulation in the liver. This affection of the spleen is not
uncommon in other liver diseases.
In Typhus fever both the spleen is disorganized and the liver deranged.
It is observed in tropical countries that severe forms of remittent not
unfrequently pass into continued fever, which seems to point to some
analogy between the two. Ague even may pass into Typhoid fever. And I
have already referred to the fact that Quina has of late been strongly
recommended in the treatment of continued fevers in general.
Dr. Watson states that in New Zealand the biliary functions suffer so
much in the intermittent which occurs there, that it is known among the
inhabitants by the name of the "Gall-fever." (_Lectures on the Practice
of Medicine_, vol. i. p. 793.)
Let us now place in conjunction with these facts the similarity which
has been pointed out between the bitter vegetable principles, and one of
the chief constituents of the re-absorbed bile. Quina and others
resemble Taurine; they tend to cure certain diseases; and these diseases
depend on deranged hepatic functions. Does not this suggest the
possibility that they may be of service by actually forming the Taurine,
or by supplying its place in the blood? It is possible that such bodies
as Quina and Cinchonia may be able to fulfil the functions of Taurine in
the blood by remaining as they are, without even changing into it.
It is just possible that the presence in the blood of this bile-product,
the supply of which has been cut off by the hepatic disease, might have
prevented the continual action of the Ague-poison.
There is another fact which gives additional probability to such an
idea. Another remedy of a different kind has been used in all the
diseases in which Quina is admissible, proving in some cases superior,
and in other instances second only to it in its beneficial action. This
is Mercury; used in remittent and yellow fevers; of the first importance
in dysentery; employed by Dr. Baillie in Ague, and pronounced by him to
be in some cases superior even to Quina. In small doses it is frequently
of use in cases of debility and scrofula. And Mercury is a Cholagogue;
_i.e._ an agent which is known to have the effect of promoting the
secretory function of the liver. Thus we may conceive that Mercury, not
given in excess, or to salivation, may operate in a different way to
produce the same end as Quina. One explanation would suffice for both.
If this connexion between Tonics and the Bile were actually established,
then we should be enabled to explain a matter which would otherwise seem
difficult to understand,--how it is that small doses of Mercury may
sometimes act as Tonics, though we know that the ultimate action of this
medicine, like that of other Catalytics, is to deteriorate the blood.
Even in scrofulous and enfeebled cases, small doses of blue pill or of
Calomel are often signally useful; and not prejudicial, as is sometimes
stated by those who confound their application with that of Mercury
given in salivating doses. Under such a course, when judiciously
enforced, we may see the dilated pupil contract to its normal size, and
the pale enervated countenance become rosy and lively; and feel the weak
compressible pulse to become hard and firm. Perhaps Mercury in such a
case may be indirectly tonic, by restoring to the blood the natural
tonic principle of the bile.
It will be conceded that it is a great merit in a theory, when it
succeeds in explaining at the same time a number of different things in
a plausible way. It seems that this hypothesis of the connexion of
Tonics with Taurine, or some such element of the Bile, is capable of so
doing. I am very far from asserting that it is proved, or from supposing
that it is at all likely to be so in the present state of our knowledge
of the subject; but I think that if not evidently true, it appears at
least reasonable. And it may be observed, that even should this idea be
completely overthrown, which is neither impossible nor unlikely, there
would still seem to be left ample evidence to prove that Quina and other
vegetable bitters act on the blood on the restorative principle,--though
in what exact way is uncertain.
ORD. V. CHALYBEATES.
(Protoxide, Sesquioxide, and Sesquichloride of Iron. Salts of
Iron:--viz., the Carbonate; Protosulphate; Persulphate; Phosphate;
Pernitrate; Peracetate; Ammonio-citrate; Potassio-tartrate. Vinum Ferri.
Chalybeate Waters.)
Most of these substances are readily soluble in water. Steel wine
contains a Tartrate. The insoluble oxides are doubtless dissolved by the
aid of the acid of the stomach; and we find that both are most active
when given in the form of hydrate, which is most easily soluble in such
a menstruum. Thus Chalybeates are capable of being absorbed; and they no
doubt are absorbed. They have been detected in the blood, and discovered
in the secretions of urine and milk.
Being in the blood, they act by an influence which they exert upon it;
for they are wanting in all the characters which distinguish
nerve-medicines. They are never sudden in their action, and the effect
which they produce is lasting.
Iron is found naturally in the blood; and the substance in which it is
found is that which constitutes the colouring material of the red
corpuscles. This is called Hæmatosin. It has been asserted by some that
the red colour of Hæmatosin does not depend upon the iron which it
contains. But however improbable this may be, it matters not here
whether it be proved so or not; for it is sufficient that it is
ascertained that Iron is essential to the chemical constitution of this
red matter. Without Iron, Hæmatosin could not exist, any more than
Albumen could continue to be Albumen, when deprived of nitrogen.
According to the analysis of Mulder,
Hæmatosin = C_{44}H_{22}O_{5}N_{3}Fe.
It is a very peculiar body, and apparently an essential and most
important constituent of the blood; for when it is deficient, as
evidenced by the paleness of the tissues in Anæmia, the whole system
suffers materially, and great and general debility is produced.
The result of the administration of an Iron medicine is the restoration
of this wanting colouring matter. For if the blood be analyzed before
and after its employment, it is found to have undergone a remarkable
change, most particularly in the quantity of Hæmatosin which it
contains. A case in illustration of this is given by M. Simon, of
Berlin. (_Anim. Chem._, vol. i. pp. 310, 313. _Syd. Society._) The solid
constituents of the blood, in a case of Chlorosis, had increased, under
the use of iron, from 128.5 to 193.5 in 1000 parts; the Globuline from
30 to 90; and the Hæmatosin from 1.48 to 4.59, in the same amount. It is
probable that the increase in the Hæmatosin is the first change; that
this then improves the condition of the blood corpuscles, increases
their number, and through them betters the condition of the blood, and
of the system generally.
In a case which came under my own observation, the blood of an anæmic
girl was found, before the use of Iron, to contain only 50 parts of
globules in 1000, instead of 120, the normal average. The
Ammonio-citrate of Iron was prescribed, in five-grain doses, three times
a day. After it had been continued for a month, the blood was again
analyzed, and the amount of corpuscles found to have increased to 76
parts. After another month, they had reached to upwards of 100 in 1000
parts of blood. In the mean time the appearance of the patient had
improved immensely.
Chalybeates have thus a most immediate and obvious effect in restoring
to the blood this wanting Hæmatosin. As the exact chemical condition of
the Iron in Hæmatosin has not been discovered, so also the precise
changes which Chalybeate medicines have to undergo before they can
supply this deficient material in a fit and proper form, are not known.
All the known soluble compounds of Iron, except the Ferrocyanide and
Ferridcyanide of Potassium, possess this Restorative power. In most
Chalybeates the Iron acts the part of a base; but in some, as the
Ammonio-citrate and Potassio-tartrate, it exists in a peculiar
condition, and cannot be precipitated from their solutions by Ammonia.
The water of Chalybeate springs generally contains a Carbonate of Iron,
held in solution by an excess of Carbonic acid. The same salt is
contained in the compound Iron mixture and pill of the Pharmacop[oe]ia,
when these are rightly prepared.
When the Iron has entered the system, it is not necessarily excreted
again from it, because it is not unnatural to the blood. To ascertain
whether Iron given in small quantities is excreted by the kidneys, I
have tested the urine of a patient who had been for some time taking
thirty drops of the Tincture of the Sesquichloride twice a day: but I
was unable to detect in it any trace of the metal.
But when given in large doses, Iron passes off by the urine and by other
secretions. Some portion may be excreted by the mucous membrane of the
intestines, and combine in the cavity of the bowel with Sulphuretted
Hydrogen. The resulting Sulphuret communicates to the fæces a
characteristic black colour. The cause of this colour was ill
understood; until pointed out by Berzelius.
When the salts of Iron pass through the glands, they generally prove to
be more or less astringent. The Chloride and Sulphate are most so; and
they will thus be mentioned again under the head of Astringent
medicines. The tincture of the Sesquichloride has obtained the
reputation of being diuretic. But this constitutes no exception to the
rule of its being astringent; for this diuretic power is owing to a
peculiar ether, formed with the spirit by an excess of hydrochloric acid
used in the preparation of the tincture.
I believe Iron to be simply and solely a Restorative remedy. By
improving the condition of the blood, it appears similar in action to
Tonics; but it is not a true Tonic, for neither in debility nor in Ague
is it of any service, unless there is at the same time Anæmia. In some
cases, even of Anæmia, Iron will not effect a cure. This must be because
the appropriative power of the system is so weakened and degenerated,
that it is incapable of consigning even this needful substance to its
proper destination.
Anæmia is the one disease in which Iron is of use. Purgative medicines
form a valuable adjunct to the treatment in most cases. Dr. G. Owen Rees
has suggested that they may be of use by removing some of the water of
the blood, so that the corpuscles, being then shrivelled by exosmosis of
their contents, may be in a fitter condition to absorb the "ferriferous
chyle." And yet, if so, the drinking of a single glass of water would
probably be sufficient to swell out the corpuscles again, and thus put a
stop to the process. It is just possible that a Cathartic may be
serviceable by purging away from the blood some effete matters, as
Sulphuretted Hydrogen, formed by the continual decomposition of the
tissues, which would have hindered the operation of the Chalybeate in
the blood, by decomposing it.
The use of Iron may, I think, be summed up by saying that it cures
Anæmia. In this way it may benefit, and sometimes cure, other disorders,
in which Anæmia is apt to be a prominent symptom. Such are
Amenorrh[oe]a, Scrofula, Cancer, chronic Ague, Hysteria, Chorea, and
Bright's disease of the kidney. But it seems that it can never be used
advantageously in these disorders, when they are unattended with Anæmia;
nor even then is it to be preferred to the other remedies specially
appropriate in each case, but ought rather to be conjoined with them.
Cancer, and granular kidney disease, may perhaps be alleviated, but are
seldom cured. In Chorea, Arsenic or Quinine may be used, with or without
Iron. Aloetic purgatives may be advantageously conjoined with
Chalybeates in Amenorrh[oe]a and Hysteria. Their use may be accompanied
by cold affusions, or by some antispasmodic stimulant. In Scrofula the
Iodide of Iron affords us a valuable double remedy. In chronic cases of
Ague, when accompanied with Anæmia, as is often the case, Iron may be
prescribed with advantage.
In general Anæmia, an occasional purge, a generous diet, with good air
and exercise should be combined, if possible, with the Chalybeate
treatment.
ORD. VI. SOLVENTS.
(_Antilithics._
The mineral Alkalies, their Carbonates, and neutral salts with vegetable
acids. Biborate and Phosphate of Soda. Benzoic and Cinnamic acids.
_Antiphosphatics._
Mineral and vegetable acids. Sour fruits.)
Of all the fluid secretions, the secretion of Urine is perhaps the only
important one which cannot cease to be fluid without immediate damage to
the system. The deposit of solid matter from this secretion is
dangerous, because tending to the formation of a solid calculus in the
kidney or the bladder, in neither case easily extracted, and acting like
a foreign body in these sensitive organs. This urine, naturally clear
and limpid, contains in it several substances which are by their nature
insoluble, but are held in solution by certain other materials. But in
some morbid states these latter materials may be wanting, or else the
insoluble bodies may be secreted in such quantity that the solvent
material is unable to hold them in solution. In such instances, these
parts of the urine may either be separated by the kidneys from the blood
in a solid state, or may be deposited from the urine after excretion or
on cooling. They then fall down in a crystalline or finely divided
state, and constitute Urinary Deposits.
Solvents are medicines which are employed to hold these insoluble
substances in solution, where there is not enough of the natural solvent
material in the system. They are medicines which tend, after being
absorbed, to pass out of the blood into the urine. Although we are
ill-informed as to the nature of the ordinary urinary solvents, yet it
is evident that they must be present, because substances which are by
their nature insoluble occur in healthy urine. And it is also evident
that these medicines are able to supply their place; for, after one is
given in a case of urinary deposit, this latter disappears, at the same
time that the solvent remedy may be detected chemically in the urine.
In this, the last order of Restorative Hæmatics, a number of apparently
dissimilar medicines are grouped together, all of which agree in this
point of their action.
The deposits in which solvents are appropriate are termed respectively
Lithic and Phosphatic. Among the first are comprehended Uric acid (also
called Lithic,) Urate of Ammonia, and the more rarely occurring Urate of
Soda. In the second set are comprised the Triple Phosphate of Ammonia
and Magnesia, and the Phosphate of Lime. These deposits are each known
by their peculiar form under the microscope.[35] They may easily be
separated from the urine, when in any amount, and tested chemically. The
Lithic deposits, (_i.e._ Uric acid and Urate of Ammonia,) are entirely
dispelled by a red heat, and are soluble in alkalies. The Phosphatic
deposits leave an earthy residue when heated, and are soluble in acids.
When thus held in solution, the former are precipitated by an acid, the
latter by an alkali, because by such a reagent that solvent is
neutralized in each case.
Now the circumstances which may cause these deposits are mainly of four
kinds. (1.) A wrong in the diet. (2.) An error in the normal reaction of
the blood, causing these matters to be deposited, _without being
themselves in excess_. (3.) The suppression of another secretion. (4.) A
fault of some process of assimilation or secretion, causing _an absolute
excess_ of these constituents of the urine.
Urinary sediments may be caused by slight variations in diet. Excessive
indulgence in animal food or in wine may cause an over-secretion of
Lithic acid. Sour drinks may cause a similar deposit, by rendering the
urine acid; and sweet fruits, containing vegetable salts of the
alkalies, may produce a phosphatic sediment, by rendering it alkaline.
Such cases may be remedied by an attention to diet.
Again, deposits may be caused by an excess of acid or of alkali in the
blood, which excess is excreted by the kidneys, and causes a lithic or
phosphatic gravel, without an excess of Lithates or of Phosphates in the
urine. Whatever be the condition of Uric acid in urine, it is certain
that it is held in solution by some matter of an alkaline nature.[36]
When this alkaline matter is neutralized by an acid, the Uric acid
precipitates. This may perhaps be caused in Rheumatic fever by an excess
of Lactic acid. The Phosphates are held in solution by Phosphoric acid,
or by that matter which gives to healthy urine its slight acid
reaction.[37] An excess of alkali in the blood, which may probably occur
in Typhoid and low fevers, will cause their precipitation. Or the alkali
may be formed in the bladder by the decomposition of the urine. This may
occur in inflammation of the bladder; or in retention of urine caused by
paraplegic paralysis.
In such cases there is no absolute excess of the deposited matter; but
it is in relative excess, for the substance which should properly
dissolve it is neutralized by a reagent of an opposite nature. Acids and
alkalies have already been mentioned as efficacious in these instances;
the former in phosphatic, the latter in lithic deposits. They directly
neutralize the disturbing cause; the alkali, or the acid. They are not
in such cases truly solvents; they do not themselves hold in solution
the insoluble material, but they set free something else that shall be
capable of doing so. (_Vide Acids; Alkalies._)
A suppression of the secretion of the skin causes a lithic deposit in
some cases, as in a common "cold." For the perspiration contains a free
acid, probably lactic or butyric; and when it is suppressed, the
secretion of this acid is thrown upon the kidneys, and the urine is
rendered more acid than naturally. The obvious indication in the
treatment is to restore the function of the skin, as by warm baths,
diaphoretics, etc.
It is in the case of urinary deposits produced in the fourth way that
true solvents are appropriate.
From some morbid condition of the system, it happens that these
insoluble constituents of the urine are secreted in absolute excess,--in
a larger quantity than in health. Now the system labours to excrete
them in solution, even when in excess; and often succeeds in doing so.
But frequently this cannot be done, it being impossible for a sufficient
quantity of the solvent material to be formed out of the blood. There is
then a deposit in the urine.
We have seen that when such matters are deposited because in relative
excess, the only fit mode of treatment consists in the administration of
an acid or an alkali, which shall neutralize the morbid reaction of the
blood. Such a case is rare; but these cases of absolute excess are much
more common. There are two ways in which we may treat them; we may adopt
either curative or palliative remedies. We may aim at the cause of the
disease, which is generally in the blood. An absolute excess of Lithates
may be caused by dyspepsia, or by a gouty disorder. This is most surely
controlled by a Catalytic medicine. (_Vide Antiarthritics._) An absolute
excess of Phosphates may be caused by an organic derangement of the
nervous centres, when it is very difficult to cure; or it may simply be
due to great nervous excitement, hard study, or melancholia. Such cases
should be distinguished from a mere alkaline condition of the urine,
without absolute excess of Phosphates, and may often be cured by
attention to the disturbed nervous functions.
Such a curative course of treatment aims at the primary cause of the
deposit; but when we are unsuccessful in our attempt to control this, or
when the excess of solid matter is so great as to be positively
dangerous, we are then driven to have recourse to palliative remedies.
These are Solvents; medicines which pass into the blood, combine there
with the peccant matters, pass out with them into the urinary secretion,
and hold them there securely in solution. Such an agent may often be
advantageously combined with the Catalytic remedy, which tends to cure
the systemic disorder. It is a blood-medicine. Its action is so far
permanent, that it effects its object definitely, dissolving and
carrying away a certain portion of insoluble matter. But as it also
passes out itself, it requires to be frequently repeated, because the
deposit continues to be formed, and requires each time a fresh portion
of solvent. It obviously acts on the Restorative principle. The deposit
should be excreted in a dissolved state, but is not. The remedy
therefore supplies a want.
Water is the simplest and most efficacious of all solvents, and should
in all cases of gravel be very freely administered. Bouchardat has
remarked that great water-drinkers are never afflicted with stone. All
the urinary deposits are, to some extent, soluble in water, although
_comparatively_ insoluble. Whenever the urine is of higher specific
gravity than it should be in health, more water should be drunk. The
average specific gravity of healthy urine is about 1.018.[38]
Acids and Alkalies are most important as solvents. They do not now act
indirectly, as in the case before mentioned, but directly dissolve the
insoluble matter. Acids dissolve a phosphatic, and Alkalies or their
carbonates a lithic deposit, in the body, as well as out of it. Although
the natural solvent may be neither an acid nor an alkali, but something
else different in nature from these, yet any thing that will rightly
dissolve the deposit will be fit to supply its place. Any of the free
Acids may serve to dissolve a precipitated phosphate. Hydrochloric is
perhaps the best of the mineral acids, although Phosphoric has been
recommended on theoretical grounds. Sulphuric is the least efficacious
because it does not always pass out in the urine. (_Vide Chap. IV._)
Sour fruits, as Currants or green Gooseberries, may be useful in
phosphatic cases; but ripe fruits have an opposite tendency. Acidulous
drinks may be recommended, as Cider, Perry, and Rhenish wines. Of the
free alkalies used to dissolve a lithic sediment, Potash is preferable
to Soda, because it forms a more soluble compound with Uric acid. The
Bicarbonates of the fixed alkalies are best, because least irritant.
Bicarbonate of Soda is contained in Vichy water. The soluble Bicarbonate
of Magnesia may be given with advantage. The Carbonate of Lithia has
been recommended by Mr. A. Ure; but it is comparatively insoluble. The
neutral vegetable salts of the alkalies, and sweet fruits which contain
them, are equivalent to the Carbonates, because converted into them in
the system, as has already been shown. They may be pleasantly
administered in the form of effervescing draughts, in the formation of
which the Carbonic acid of an alkaline carbonate is displaced by Citric
or Tartaric acid.
The danger which attends the continual use of acids, or of alkalies,
particularly of the latter, is that their long employment may engender a
condition of an opposite nature to that which they were intended to
alleviate. An acid may at length cause a lithic deposit in the urine;
or, still more frequently, an alkali may produce a phosphatic sediment.
Their administration should therefore be conducted with caution.
There are some other remedies which may be advantageously employed as
solvents for Uric acid and Urates, whose use is not attended with this
danger, and whose efficacy is a proof that the occurrence of a deposit
in the urine is not a mere question of the preponderance of acid or of
alkali in that secretion. The most important of these is the common
Phosphate of Soda, first recommended by Liebig, who discovered that Uric
acid was soluble in a solution of that salt.
If forty grains of dry Phosphate of Soda, seven grains of Uric acid, and
fifteen of Hippuric acid, be dissolved in a pint of hot water, and to
this solution two per cent. of Urea be added, a kind of artificial urine
will be formed.
Biborate of Soda, or Borax, has also the power of dissolving Uric acid,
and has been recommended in the treatment of lithic deposits by
Bouchardat and Binswanger.
Mr. A. Ure has strongly recommended Benzoic acid in these cases. It
passes out in the urine as Hippuric acid. (_Vide Prop. VI._) The amount
of the deposit appears to decrease under the use of this remedy, but
whether the formation of the Uric acid in the blood is prevented, as
supposed by Mr. Ure, or whether it is not simply held in solution by
means of the Hippuric acid, is not clear. Dr. Golding Bird recommends
also Cinnamic acid, which is contained in Cinnamon water, and in the
balsams of Peru and Tolu. It resembles Benzoic, and undergoes the same
change into Hippuric acid. The salts of these acids possess a similar
power.
Diuretics in general are useful in all cases of urinary deposit, for
they increase the quantity of the fluid part of the urine. It is
observed by Dr. Prout that healthy urine is the best solvent that we are
able to supply.
When solvent remedies are employed for the purposes above mentioned,
they not unfrequently fail altogether; and, as has been already
observed, they require, even when successful, to be perpetually
administered, or else the deposit will recur. For the solvent passes out
along with each successive quantity of the Lithic or Phosphatic matter
that is formed and excreted.
A radical cure of such deposits can only be effected by a medicine that
shall counteract the morbid process by which they are continually
produced. This cannot be done by a Restorative, but requires a Catalytic
medicine. Such remedies we must presently consider. (_Vide
Antiarthritics._)
Thus are concluded the six orders of restorative medicines; all of which
are seen to agree together in some common characters.
When a disease depends on a want of some material in the system, then it
admits of being cured by a restorative, which, in the theory of its
action, is the simplest of all known medicines. And when a morbid
process results in a diminution of the amount in the blood of some
necessary constituent, then also may a Restorative be of use in
alleviating the consequences of such a disorder; or may even effect a
cure, when the morbid process has ceased, and left only its results
behind it.
But when the _materies morbi_ is still working in the blood, a radical
cure can only be effected by a Catalytic medicine, which shall be
capable of meeting it there, and of counteracting its noxious influence.
Some Restoratives are also included among Catalytics, from a regard to a
different phase of their action. The most important of these are
Alkalies, which are of use in general inflammation, and also in
Scrofulous and Scorbutic diseases, acting in a way that is at present
but obscurely explained.
When the _modus operandi_ of a medicine is obscure, but when it is
apparent that it has the power of counteracting a disease, I have
preferred to place it among Catalytics, rather than to include it with
Restorative medicines. But there are not many cases in which we are thus
left in doubt.
The diseases curable by Catalytics are all evidently produced by an
active morbid agency. Those which are treated by Restoratives are just
as evidently remediable by the artificial supply or substitution of some
one or more of the elements of the blood.
CATALYTICS.
These constitute the second division of Hæmatic medicines. The above
name is applied to them on the assumption that their operation in the
blood results in the destruction or counteraction of certain morbid
agencies. ([Greek: kataluô].)
The differences in action between this and the preceding division of
blood-medicines have been stated at length in the remarks on Hæmatics
in general. On recurring to Prop. VII., it will be seen that it is there
stated--
"That others, (medicines of the first class,) called Catalytics, act so
as to counteract a morbid material or process, and must pass out of the
body."
The action of the remedies in this division, which are the surest and
most potent of all those that are employed in the treatment of disease,
is involved in a greater degree of doubt and obscurity than that of any
other class. Though there may be in some cases a certain dim explanation
which we may catch hold of, and strive to fix or to render definite, yet
in many instances there is not even so much as this. How can we, for
example, by any of the common terms which are made use of to designate
the actions of Mercury, of Arsenic, and of Iodine, express the
peculiarity of their influence over Syphilis, Lepra, and Scrofula,
respectively? Does it not seem better to confess our ignorance, and to
say that all we know for certain is that these remedies have the power
of antagonizing certain diseases?
Having done this, we may afterwards try, if we can, to invent for this
action a theoretical explanation. Our arguments and theories will not
affect the fact, nor will they lead us into danger, if we have first
laid down the truth, however incomprehensible, as the only secure
foundation, in such a manner that it shall be incapable of being
disturbed by the flimsy superstructure. Some philosophers have erred in
this; that they have first, with much pains and labour, erected an airy
fabric on a basis of incontestable truth,--but subsequently, relying too
much on that which they have themselves raised, they have commenced to
pull up the blocks on which it was founded, and have thus brought the
whole speculation tumbling to the ground in ruins.
Considering then that the action of Catalytic medicines in each disorder
is of a special and peculiar kind, which I think will not be denied, I
have grouped them in orders which are named according to the several
morbid states in which they are employed.
CATALYTICA.
Ord. 1. Antiphlogistica.
Ord. 2. Antisyphilitica.
Ord. 3. Antiscrofulosa.
Ord. 4. Antiarthritica.
Ord. 5. Antiscorbutica.
Ord. 6. Antiperiodica.
Ord. 7. Anticonvulsiva.
Ord. 8. Antisquamosa.
The medicines of the first order are employed in inflammatory disorders
generally, and possess an influence over the process of sthenic
inflammation, however first produced. The second order contains those
that are used in the several forms of Syphilis. The third, those that
are employed in Scrofula. The fourth, those that are found to be useful
in the cure of painful affections of the joints, as Gout and Rheumatism;
and also of Oxaluria, Lithiasis, Diabetes, and other disorders of
secondary assimilation. The fifth order contains those that are useful
in Scurvy. The sixth, those that are employed in Ague, Remittents, and
other periodic disorders, on the Catalytic principle. The seventh, those
used in convulsive disorders. Lastly, the eighth, those that are capable
of curing Lepra, Psoriasis vulgaris, and some other skin diseases.
The action of these medicines being much more obscure than that of
Restoratives, I shall therefore have less to say about them
individually, and shall not go so much into particulars. That part of
Prop. VII. which refers to Catalytics, may be divided into the following
minor propositions:--
_m. p._ 1.--That they act in the blood, and that their effect is
permanent.
_m. p._ 2.--That each of itself tends to work out a peculiar
operation in the blood.
_m. p._ 3.--That the diseases in which they are used depend on
certain morbid materials or actions in the blood.
_m. p._ 4.--That the result of the action of a Catalytic medicine
is in some way to neutralize or counteract
some one or more of these morbid processes.
_m. p._ 5.--That these medicines are all unnatural to the blood,
and must at length pass out of the system.
It might seem at first as if the first, fourth and fifth of these minor
propositions would alone suffice to include the original affirmation.
But a medicine may act in the blood, and may counteract a disorder; and
yet it may counteract the disorder in some other way than by acting in
the blood. It is necessary further to prove the disease to be a blood
disease. And the evidence of counteraction will be rendered stronger if
we can prove that the medicine employed is itself capable of setting up
in the blood some peculiar process--of causing in it a change of some
special kind. For, were it not to do so, we could hardly understand how
it could meet the requirements of one case more than of another, or how
it could at all arrest an active process in that fluid over which it
exerted itself no particular influence. And this thing, which is laid
down in the second minor proposition, can, I think, be proved in the
great majority of instances.
The following is the arrangement of the subject which I have thought it
best to adopt. We will, in the first place, consider some of the
statements ventured by authors respecting this kind of medicines: as a
comparison of these should aid us in the discovery of the truth. In the
second place, it will be convenient to enumerate the medicines contained
in the orders named above, and to proceed to prove the minor
propositions of Catalytics taken altogether. A considerable amount of
difficulty attaches to this consideration; and, as the argument which
applies to one order will apply to all, much unnecessary repetition will
be avoided by this plan. In the third place I must conclude by making
some remarks on each of the orders in succession. To proceed now to the
first of these topics.
In referring to the opinions that have been advanced on the action of
this group of medicines, our task is rendered comparatively easy by the
fact that a great number of writers on Materia Medica have failed to
recognise them collectively. It may seem strange to one who has
reflected on the subject, but it is nevertheless true, that the majority
of authors have taken no notice whatever of medicines acting in the
blood, with the exception of Acids and Alkalies, which are grouped by
some as chemical remedies. All other medicines have been generally
arranged under the two great and ill-defined heads of Nerve-medicines
and Eliminatives. I cannot find it possible, by either of these terms,
to give any idea of the real action of the many important agents which I
have included in this division.
It would seem that it has been generally supposed that
medicines,--bodies of active properties, and more or less peculiar
construction,--are able to enter and to pass through a fluid which is
still more complicated and changeable in nature than themselves, yet
that while so doing they produce no impression upon it, but proceed
passively to the solid tissues, or quietly pass out of the body, without
ever leaving behind them any trace of their action.
Certain writers have made some amends by including in their arrangements
a class termed Alteratives. But even then they have not unfrequently
laid it down as a rule that they produce, in the first place, an
impression on the nervous system, and that this has subsequently the
effect of altering the manifestations of vital force. How varied and
peculiar in nature must these nervous impressions be, to account for
actions which are often so widely different!
The medicines thus grouped as Alteratives correspond very nearly with my
division of Catalytics. The permanency of their effects, and the fact
that the disorders which they cure are blood-disorders, will
sufficiently stamp the character of the operation of these remedies.
In many works, as in those of Dr. Duncan, of Dr. A. T. Thomson, and more
lately, of Drs. Ballard and Garrod, the existence of a class of
Alteratives or blood-medicines is not even recognised or alluded to.
But in the learned classification of Dr. Pereira blood-medicines hold an
important place. All except Chalybeates are grouped together in a
sub-class, called Spanæmics, because they tend to impoverish the blood.
In addition to those which I have named Catalytics, there are here the
acids and alkalies. It is true that all these medicines, after long use,
impoverish the blood, which, indeed, suffices to prove my first point,
viz,: that they act in the blood, and that their effect is permanent.
But Dr. Pereira has founded his classification on the physiological
action of medicines, and not on their therapeutical uses, which form the
basis of mine. Thus he takes no notice of the questions of what their
ultimate destination may be, or what their primary _modus operandi_,
whether they have to remain in the blood, or to pass out of it, and
whether they can act by supplying a material to it, or by neutralizing a
material in it. The subsequent statements which Dr. Pereira has chosen
as the basis of his subdivisions, founded often on therapeutical action,
seem in certain cases to be somewhat problematical. Thus he calls Acids
"adipsa," or thirst-quenching, which very imperfectly expresses their
action. Alkalies are grouped with Salts, Iodine, and Sulphur, under the
general title of "resolventia seu liquefacientia," _i.e._ resolvents, or
liquefacients, which involves an assumption that some might be inclined
to dispute. The title of Spanæmics, applied to the whole, though
unobjectionable in a classification which is founded upon their
ultimate action in health, would be quite inappropriate in an
arrangement like mine, which has to do with their influence in the cure
of diseases. For our object in making use of such agents is not to
impoverish the blood, but to obtain such a manifestation of their power
as shall suffice to neutralize the noxious agent, and no more.
Dr. A. Billing (_Principles of Medicine, 5th edit._ pp. 70-75) considers
that Mercury, Arsenic, Colchicum, and all the medicines which have been
called Specifics, are not in fact so, but that they are capable of
subduing different kinds of inflammation by causing contraction of the
dilated capillary vessels. This explanation has certainly the charm of
simplicity, but not, in my opinion, the merit of truth. Dr. Billing
supports his argument by instancing the number of remedies that have
been used in Syphilis, and considers that they must all operate in a
similar way, both in this and in other disorders. Yet are all these
medicines of use or advantage in Ague, in Lepra, in Chorea, and in
Scrofula? But why is it not so, if all act in the same way? Their
several actions should exhibit no difference in kind, but only in
degree. It is the opinion of the same able authority that Mercury and
Iodine diminish morbid growths by starving them; that they cut off the
supply of blood by contracting the capillaries in the same way as in
other cases. But why then can we not thus remove a fatty tumour, a true
exostosis, or a malignant growth? We are seldom able by such means to
reduce the size of a tumour, unless it depends on a blood-disorder, as
Syphilis or Scrofula. The wide distinctions and the shades of difference
which exist between the operations of these several medicines are surely
too many and too serious to allow us to account for them all by one
explanation.
But we may put aside general arguments, and appeal to facts. In the
first place, it is very far from being proved that in all these
disorders the capillary vessels are dilated. But let us even admit that
it is so proved, and we are not then nearer to the establishment of the
above hypothesis. For is the action of any medicinal agent on the
capillaries constant in character?
Mr. Wharton Jones, in his Astley Cooper Prize Essay, states that he has
found the effects of medicinal solutions on the capillaries in the web
of a frog's foot to be very various. For even a solution of Sulphate of
Copper has been known to cause dilatation, and one of Atropia to produce
constriction; though the former is an astringent; and the latter a
paralyzer. So that the vessels are not nearly so much under the
influence of such agencies as Dr. Billing would seem to imagine. In
these experiments the solutions were concentrated, and applied directly.
But in the cases in point we might have two or three grains of Iodide of
Potassium, one-tenth of a grain of Arsenite of Potash, or one-twentieth
of a grain of Bichloride of Mercury, diluted down by about twenty pounds
of blood, and extended through many miles of capillary tubes! And if
simple contraction of the capillaries were required, surely Astringents,
which are known to effect this, should be the most useful of all these
medicines. But we do not find it to be so. Further, this idea must
include a virtual denial of the causation of blood disorders by special
morbid agencies.
Such are the grounds upon which is founded a denial of the existence of
specific medicines--_i.e._ of remedies which are of particular or
special use in one or more disorders. Is it reasonable to deny that
Mercury is of particular use in Syphilis? that Iodide of Potassium
exerts a special influence over secondary forms of the same malady? that
Iodine and Potash are each peculiarly adapted to scrofulous cases? or
that Colchicum will often stop a fit of the Gout when other medicines
have failed to relieve it? If we cannot deny it, we must admit such
actions to be in some degree specific. To adopt this term is to a
certain extent to confess our ignorance, and for this reason many have
objected to it; but this we cannot avoid. The word is, however,
decidedly objectionable, when it is misapplied to express the idea of
some particular medicine being the only one that can be used in a
certain disorder. For this is an exaggeration of the truth that may lead
to very serious error.
Before now proceeding to the proof of the minor propositions of
Catalytics taken collectively, I must enumerate the chief remedies which
I intend to include in the eight separate orders into which this
division of blood-medicines has been divided.
_Ord. 1. Antiphlogistics._ Antimonials; Mercurials; Alkalies;
Salines.
_Ord. 2. Antisyphilitics._ Mercurials; Preparations of Gold; Iodide
of Potassium; Sarsaparilla (?). _Ord. 3. Antiscrofulitics._ Iodine;
Bromine; Chlorine; Iodides and Bromides; Potash. _Ord. 4.
Antiarthritics._ Colchicum; Nitro-hydrochloric Acid; Lemon-juice.
_Ord. 5. Antiscorbutics._ Citric Acid; Lemon-juice; Fresh
Vegetables; Salts of Potash (?). _Ord. 6. Antiperiodics._ Arsenious
Acid; Arsenite of Potash; Alum; Chloride of Sodium. _Ord. 7.
Anticonvulsives._ Preparations of Arsenic, Silver, Zinc, Lead, and
Copper. _Ord. 8. Antisquamics._ Preparations of Arsenic; Sulphur;
Pitch.
Under each head I have given the most important of those medicines which
I conceive to act on the Catalytic principle. Other medicines may cure
some of these disorders, or at least alleviate them; either by acting as
Restoratives, as in the case of arthritic and of periodic disorders; or
by influencing the nervous system, which plan may be effectual in some
convulsive affections.
The prefix _Anti-_ involves a principle. These medicines produce certain
actions which are _contrary_ to diseased actions, inasmuch as they
neutralize them, and cannot subsist with them. It is granted that in
some cases the actions may appear similar in some respects. But this
merely shows that they move, as it were, in the same sphere, for else
one of them could not meet the other. However the operation of a
medicine may sometimes seem to resemble that of a disease, it is always
in effect contrary to it. The similarity is of a kind which does not
concern us. An acid and an alkali are so far similar, that they may both
produce heat when mixed with water, and both prove corrosive and
destructive to organized tissues; but they are practically contrary, and
when brought together they neutralize each other. Let us now proceed to
the minor propositions.
_Catalytic medicines act in the blood, and their effect is permanent._
This is simply to affirm that they belong to the class of Hæmatics, to
which Restoratives also belong. Of all that I have named, there are not
any, except Colchicum and Antimony, that possess in any degree the
action of nerve-medicines--_i.e._ that exert a sudden and transient
influence over the nervous system. I believe the sedative powers of
these medicines to be quite distinct from their Catalytic influence. In
the proof of the second minor proposition, I shall attempt to show that
each of these remedies has a peculiar action of its own on the blood,
even in health; which cannot be said of Restorative medicines. Of all
these Catalytics two things are known. When they cure a disease, they
do so definitely, so that it does not in general tend to return; and
when they only alleviate it, the improvement effected is more or less
permanent. In the second place, they are found to produce, after being
long administered, a change for the worse in the blood, a diminution in
the amount of Fibrine and of the red corpuscles. Thus they are
blood-impoverishers, when given in excess. These considerations alone,
when combined with the proof of absorption--_i.e._ that they all pass
into the secretions, and may be detected there--are conclusive as to the
fact of their being Hæmatic medicines. We pass on now to the third
proposition, which consists in the statement of a property that is
peculiar to Catalytic Hæmatics.
_Each Catalytic tends of itself to work out a peculiar operation in the
blood._
This peculiar process, established by their presence in the blood, forms
part of the known history of each Catalytic medicine. It will suffice to
demonstrate this if I condense into as few words as possible the facts
that are known on this subject, with respect to each of the orders of
this division of remedies.
Of _Antiphlogistic_ medicines, some possess a power which stamps them at
once as likely to be useful in the treatment of inflammatory disorders.
Alkalies are known to have the chemical property of holding Fibrine in
solution. By exerting this power in the blood, it seems that they may
prevent its abnormal deposition or coagulation in inflammatory cases,
and at length diminish it in quantity. On this principle they were
proposed and used successfully by Mascagni in acute inflammations. Their
efficacy in retarding the formation of crude deposits in scrofulous and
tubercular diseases may possibly be assigned to the same operation.
Potash has been extolled by Dr. Theophilus Thompson as a powerful
preservative for those who are predisposed to phthisical disease.
Alkalies in small doses, and in cases requiring them, may be
Restoratives.
Salines have been shown by Mr. Gulliver to have the effect of keeping
the blood-corpuscles apart from one another. This may partly explain
their action; for in inflammatory blood the corpuscles display a
peculiar and abnormal tendency to aggregate together in rows. Salines
also are solvents of Fibrine.
The immediate action of Mercury in checking inflammation is often very
apparent in the case of Iritis. This medicine in some way diminishes the
plasticity of the Fibrine of the blood; and probably promotes absorption
by preventing in this way a further deposit of lymph. If the blood be
analyzed after the continued use of Mercury, it is found to contain less
Fibrine than in health. It has also a peculiar action of its own in the
blood, for it sometimes produces various eruptions, particularly Eczema,
as well as a state called Mercurial fever.
Antimony has various and marked medicinal properties: in large doses
Neurotic; in all cases Eliminative. But we are now concerned merely with
an agency in the blood. It has certainly some action of this kind. When
rubbed on the skin it produces a pustular eruption; and M. Lepelletier
gives a case in which it did this when administered only internally.
Magendie found that when given to dogs it produced engorgement, and
often inflammation of the lungs. Antimony seems to exert a
blood-influence over inflammation somewhat similar to that of Mercury;
but it further adds to this a powerful sedative effect. Antimony
generally arrests inflammation by reducing the pulse; but Mercury
reduces the pulse by arresting inflammation.
Thus do Antiphlogistics exert that operation in the blood which is
essential to Catalytic medicines. The divisions of Hæmatics differ in
this: Restoratives act by being in the blood; Catalytics by working in
the blood. All we have to prove of the latter just now is to establish
this part of their action.
_Antisyphilitics_ have also this action. Mention has already been made
of the hæmatic effects of Mercurials. The action of the compounds of
Gold is similar, though these are not now often employed. But as far
back as the commencement of the eighteenth century the administration of
Gold in syphilis was strongly recommended by Dr. A. Pitcairn. He
employed the pure metal in a fine state of division. He also made use of
a mercurial which resembled our modern blue-pill, but must have been
considerably less potent, for it was given in drachm doses.
Iodide of Potassium may be said to combine the actions of Iodine and of
Potash. This medicine is very active in causing the absorption of
syphilitic nodes. Its use is sometimes followed by a slight cutaneous
eruption.
Sarsaparilla is supposed by many to exert an alterative action in the
blood; but this is not very clear, nor is its utility often very
decided.
_Antiscrofulitics_ form the third order. Iodine and its compounds have
certainly an action on the blood. When given in excess, or for a long
time, they may cause a train of symptoms to which the collective name of
_Iodism_ has been applied. The most prominent are--coryza, itching,
watering of the eyes, fever, and great constitutional depression. It
powerfully promotes absorption in certain cases. Its special actions
will be subsequently described in the remarks made on the second and
third orders of Catalytic medicines.
Potash has been already considered. Bromine and free Chlorine are very
analogous to Iodine in their operation.
_Antiarthritics_ exert an influence on the blood. This is least apparent
in the case of Colchicum, which is a somewhat mysterious remedy. But it
has been said by some to increase the amount of Urea in the urine; by
others, to promote the excretion of Uric acid. (_Vide Antiarthritics,
and Chap. IV._) Nitro-hydrochloric acid contains Chlorine, which is an
oxidizing agent, and probably exerts in the blood an action of this
kind. It is clear that it is capable of retarding the formation in the
system, and deposit in the urine, of lithic acid and oxalate of lime;
though its _modus operandi_ is not determined with certainty. This
question is of some theoretical importance, and will soon be considered
at some length.
Among _Antiscorbutics_, Potash and its salts have been already shown to
affect the blood. Their efficacy in scurvy is, however, a disputed
point. That of Lemon-juice is established. It contains Citric acid and
Potash; the former in great excess. Now either of these by itself would,
in cases requiring it, and given in small doses, act as a Restorative.
In large doses, Citric acid would disturb the reaction of the
secretions, and Potash would impoverish the blood. When both together,
the Citrate of Potash would undergo oxidation, and thus exert an
operation in the blood of a refrigerant kind. Similar materials occur in
most fresh vegetables.
_Antiperiodics_ are medicines which are used in the cure of Ague, and of
other periodic diseases, on the Catalytic principle. Tonics are used in
the same diseases on the Restorative plan; but their utility extends
also to other cases on the same grounds. Arsenic is the most potent of
Antiperiodics. The Terchloride, and the Arsenite of Potash, are the
preparations most frequently employed. Arsenic produces an evident
action in the blood. When given in slight excess, it is apt to bring on
[oe]dema of the face, and redness of the conjunctivæ. Besides causing
various nervous disorders when in large doses, its continued use may
bring on a cutaneous eruption, described by Mr. Hunt as a kind of
pityriasis, together with a failure of appetite, general depression, a
quick small pulse, hurried respiration, and sometimes swelling of the
feet. Any kind of eruption would alone constitute sufficient proof of an
operation in the blood.
The metallic salts used as _Anticonvulsives_ are all capable, when taken
for some time, of causing a deterioration of the blood. This is most
apparent in the case of Lead, which, besides a number of nervous
symptoms, tends to bring on a kind of jaundice, with general wasting of
the body. Chronic poisoning by Zinc and Copper resembles that by Lead.
The symptoms of what is called "Zincal intoxication" were recently
described to the French Academy by M. Landouzy of Rheims, as occurring
constantly among the zinc-workers. There was sometimes an [oe]dema like
that produced by Arsenic.
The production of all the known nervous disorders by the presence in the
blood of different metallic medicines, gives a strong additional
probability to the belief that these disorders, when occurring
spontaneously, are in many cases due to the presence in the blood of
some unknown poison.
Among _Antisquamics_, the last Catalytic order, we meet with Arsenic
again. Common Pitch is of almost equal utility in Lepra. It has some
action in the blood, due to some one of its bituminous principles; but
this action is not well made out, or understood. Sulphur, besides its
use externally in Scabies, is administered internally with advantage
both in this and some other skin diseases. It effects changes in the
blood, inasmuch as it is found to combine there both with hydrogen and
oxygen, and to carry them out of the system as sulphuretted hydrogen and
sulphuric acid. Dr. Pereira and others ascribe to Sulphur a resolvent
and liquefacient action.
Thus it is sufficiently shown that all of these medicines work out a
certain process or operation in the blood, and affect the condition of
that fluid. But I am very far from believing that this known operation
is in all cases the one by which they neutralize morbid poisons. This
action is probably of a much more inscrutable character.
Before proceeding further, I may here take the opportunity of insisting
again on the differences between Catalytic and Restorative medicines.
Catalytics will even in health work out their peculiar process in the
blood. Restoratives exercise in that case no particular influence. The
latter may remain in the blood; their office is supply or substitution.
Catalytics may not remain beyond a certain time; their office is
counteraction. The system then labours to excrete them. Before passing
out of the body, one or two, as Colchicum, may act on the nerves. In the
moment of excretion, the majority act as Eliminatives. But some, as the
metals used as Anticonvulsives, are astringent, and diminish secretion
generally. Mercury, Antimony, and Iodine, are among the most important
Eliminatives known. They act on all glands, but on some more than on
others. Antimony is also a special sedative to the Vagus nerve, and as
such exerts an important influence, which enables it sometimes to cut
short the process of inflammation by depressing the action of the heart.
We now arrive at the third minor proposition.
_The diseases in which these medicines are employed are active
blood-diseases._
This consideration need not detain us long, for in most cases the
correctness of the statement is universally admitted.
_Inflammation_ may be produced by a variety of blood-poisons, in each of
which instances it partakes of a special character. Thus there are the
syphilitic, scrofulous, and rheumatic inflammations. Simple inflammation
may be caused by the injury of any part or organ, external or internal.
It commences in the capillary vessels, and, if extensive, affects the
blood generally, and produces fever. The blood then contains an excess
of Fibrine, causing it, on coagulation, to exhibit the "buffy coat."
There are also found in this, according to Mulder, some peculiar
hyperoxides of Proteine. The colourless corpuscles are in excess; and
among the red corpuscles is observed a peculiar tendency to arrange
themselves together in rows. This is doubtless in some way connected
with the morbid process going on in the blood.
_Syphilis_ is evidently traceable to a special poison. This is
recognised by the fact of its communication from one person to another.
In the system of the infected person, if left alone and uncontrolled, it
breeds and increases in quantity, works out all the mischief that it is
capable of effecting, and may again be propagated to others, either by
inoculation into the blood, or by an equally direct transmission to a
tainted offspring.
_Scrofula_ is also a blood-disease. All its manifestations are
explainable on such a supposition. It is transmissible from parent to
child; and it holds good as a general rule that hereditary diseases are
seated in the blood. It is unaffected by any of those medicines that act
only on the nerves. It produces a deterioration of the blood.
_Arthritic_ disorders are always accompanied by a change in the blood.
In Diabetes grape-sugar is present there in large quantities, and has to
be excreted by the kidneys. Similarly, in Oxaluria, oxalic acid is found
there; in Lithiasis, lithic acid in excess. In Rheumatic fever there are
profuse sweats, in which the natural acid of the perspiration is
enormously increased in quantity. It is stated by Berzelius to be lactic
acid. Either this, or some other acid like it, must be formed in excess
in the blood. In Gout we have sometimes a deposit of urate of soda in
the cellular tissue opposite the small joints. The same salt has been
occasionally found in the urine in Gout. Lastly it has been detected in
the blood in that disorder by Dr. Garrod, and since him, by Dr. Bence
Jones. (_Animal Chemistry, p._ 29.) Thus, in all these disorders there
is a wrong in the blood.
_Scorbutic_ diseases, _i.e._, Scurvy and Purpura, are characterized by a
general poorness of the blood, with a special deficiency in the amount
of Fibrine and of salts. There is a general tendency to hæmorrhage and
ulceration all over the body. It has been observed that these diseases
seldom occur in persons who are accustomed to a natural and mixed diet.
_Periodic_ disorders are known to be attributable to the entrance into
the blood of a peculiar aerial poison. The mild malaria of England
excites a comparatively tractable ague; that of the Maremma and of the
Pontine Marshes, in Italy, brings on very fatal fevers; while the
remittents that are due to the exhalations from the ground on the West
coast of Africa, and in the West Indian Islands, are of a still more
virulent nature. Accurate observations have shown that they are all
caused by the exposure of the system to this poison, and by its working
in the blood.
With _Convulsive_ disorders there is more difficulty. Although these
diseases are manifested either by a derangement of the nervous system in
general, or by a disturbance of the functions of the brain or spinal
cord in particular, yet they are very rarely accompanied with an
appreciable nervous lesion. When this is the case, as in the instance of
Tetanus, which may arise from a mere irritation of the end of a nerve,
they are extremely intractable, and are not at all under the influence
of those blood-medicines which are useful in other cases. Epilepsy, too,
may sometimes be due to a bony spicula or tumour in the brain, or to the
irritation produced by intestinal worms in children; but these direct
nervous causes of such convulsive disorders are to be considered as the
exception, and not the rule. For they are more often connected with a
diseased condition of the blood.
Epilepsy and Hysteria are frequently inherited. This supplies us with
one argument. They are also apt to be brought on by various depressing
causes which affect the system in general. The strumous diathesis,
which originates in the fluids, and not in the nervous system, is
affirmed by Dr. Cheyne and Dr. Watson to be a powerful predisposing
cause of Epilepsy. Hysteria, too, is very often associated with Anæmia.
Tetanus even depends very much on certain atmospheric conditions. There
are sometimes, as it were, epidemics of Tetanus, in which the slightest
abrasion will suffice to bring it on among the people residing in a
particular neighbourhood. It is often rife in one district a long
consecutive time. Facts like this must certainly be regarded as pointing
to a condition of the blood as one, at least, of the causes of this
terrible disorder. This condition of the blood may react upon the
nerves, and maintain in them a particular morbid state. Chorea seems
also to depend primarily on the state of the blood, and is indirectly
curable by medicines which, like Iron and Quinine, improve its
condition. In a weakly and strumous child it may be brought on by a
sudden fright which would not affect one of a good constitution.
We might conclude from these facts alone that the blood is often the
seat and origin of these diseases. But there is yet a stronger reason to
induce us to suppose that they are frequently produced by some poison in
the blood, which acts on and disturbs the nervous organs without
perceptibly altering their physical construction. Many medicinal
substances present us with an artificial illustration of this action.
Lead, Copper, Mercury, and Arsenic, by their presence and operation in
the blood, are capable of causing severe and chronic nervous disorders,
particularly Paralysis and Epilepsy. Many of the vegetable Neurotics,
after their passage into the blood, bring about transient nervous
symptoms which are identical with those of disease. Thus Opium produces
coma; Belladonna, delirium; Aconite and Hemlock, paralysis; Hydrocyanic
acid, convulsions; Indian hemp, catalepsy. When the cause of these
affections is removed, the symptoms disappear; when the cause returns,
the symptoms return. The same is apparently the case with those unknown
animal poisons that operate so as to produce nervous symptoms, without a
nervous lesion.
These convulsive disorders may be treated in either or both of two ways.
We may attack the supposed cause in the blood by employing one of these
mineral Anticonvulsives; or we may simply apply our remedies to the
nervous system, the more immediate seat of the morbid manifestations,
and adopt a palliative or defensive course.
_Skin diseases_ are no doubt connected with some disorder in the blood.
We might almost presume this from the analogy of the known
blood-poisons, by nearly all of which an eruption may be produced. The
eruptive fevers, which run a certain course, depend upon contagious
poisons; but they are not under the influence of Antisquamic remedies.
These are serviceable in a class of disorders, of each of which a
cutaneous eruption is the most apparent, or the only obvious symptom.
The true squamous disorders are Lepra vulgaris and Psoriasis vulgaris.
The causes of Impetigo, Porrigo, and Scabies, are probably similar to
those of the true squamæ, for they are often curable by similar
remedies. The actual eruption of Porrigo is accompanied by a parasitic
fungus, which may sometimes be transmitted from one person to another;
and a small insect or Acarus which haunts the vesicles has been alleged
as the cause of Scabies; but it is not, after all, quite clear whether
these attendants may not be merely the concomitants or the results of
these two disorders. At all events, Lepra and Psoriasis are true blood
diseases, and are often inherited. They are more obviously under the
influence of Antisquamics than the other skin diseases.
It has thus been shown that the diseases in which Catalytics are used
are each to be accounted for by a process in the blood. The fourth minor
proposition will not be so difficult to establish as the last, although
it is in fact the most important of all.
_The action of a Catalytic results in the neutralization or
counteraction of one or more of these morbid agencies._
This has already been sufficiently proved. It is established by
experience that these remedies severally counteract the diseases named.
They have been shown to have an action in the blood; and the diseases
have been proved to be blood-diseases. Thus it is clear, that if the
former counteract the latter, and have no action on the nerves, they
must do it by some agency in that fluid, over the particles of which
both exert an influence. They are Catalytic Hæmatics; _i.e._, medicines
which, by an operation in the blood, are enabled to counteract disorders
which depend upon active morbid agencies. This is all that can be
positively affirmed of their mode of operation.
The fifth and last minor proposition relates to an important difference
between these and Restorative medicines.--The latter may remain in the
system, for if they did not do so, they could restore nothing to the
blood. But Catalytics cannot restore any thing, for they are generally
unnatural to the blood. They must sooner or later be excreted.
_Catalytics are unnatural to the blood, and must at length pass out of
the system._
Of the list of Catalytics, the only medicines that occur as constituents
of healthy blood, are Alkalies, Salts of the alkalies and earths,
Chlorine, and Sulphur. Of these, the Alkalies, and possibly also the
others, are not unnatural to the blood when administered in small
quantities, and may remain in the system and act as Restoratives, when
there is a deficiency in the blood of similar materials. But even these
substances, when given in large quantity, as is the case when they are
used for Catalytic purposes, are unnatural to the blood, and must be
excreted from it. With respect to the other Catalytics, they cannot any
of them remain naturally in the blood, under any circumstances. Their
very presence for awhile constitutes an artificial disease, and is only
to be tolerated or recommended because it may serve to counteract a
morbid action of a more serious and uncontrollable character.
The kidneys generally constitute the channel by which these Catalytics
are removed from the blood. Most of them, in passing out, act as
diuretics. To this we must, perhaps, except the salts of lead, zinc, and
copper. Doubtless some are excreted partially or entirely by the mucous
membrane of the bowels, but this we cannot so readily appreciate. The
circumstance that the astringents just mentioned are efficacious in
diarrh[oe]a seems to point to their access to the intestinal surface
from the blood.
It has already been shown that these Catalytics are all soluble in some
way in the intestinal canal, and that they are absorbed. (_Vide Prop.
I.; Prop. II._) All of them that can be detected by chemical means, have
actually been discovered in the blood. But the system will not, if it
can be avoided, suffer them to remain there long. The glands are charged
with the office of purging the blood of all morbid materials; and thus
these substances pass out in the secretions; most particularly, as I
have just said, in the secretion of urine.
Every one of the medicines of this division, enumerated
above,--excepting Colchicum and Pitch, which are difficult to recognise
chemically,--have been detected in the urine by M. Wöhler, M. Orfila,
and others. The Alkalies and Acids are combined, so as to form salts;
the vegetable salts are decomposed; Sulphur has changed into Sulphuric
acid; and the metallic bases are found to be variously combined; but all
the fixed inorganic materials remain essentially the same, however
altered in arrangement. Many of these medicines have been likewise
detected in the secretions of other glands. This subject will be
further discussed in the consideration of Prop. X., and does not
immediately concern us now.
Thus the minor propositions may be considered as proved; and all that I
have ventured to affirm of this group of medicines is, that they
counteract morbid agencies by an operation in the blood.
Now the mode of counteraction is not defined, because it is only in a
few cases that we can even guess at it. In the majority of instances it
seems inexplicable. We know that Syphilis is a poison in the blood.
Mercury also is a poison in the blood. But why does Mercury antagonize
and annihilate Syphilis? The case is the same with Scrofula and Iodine;
with Lepra and Arsenic. It is very humiliating to be baffled when we
have got thus far; when, led by the hand of Science, we have been
conducted almost to the end of this interesting inquiry, to find that we
are perfectly unable to take the last step, and thus to conclude our
adventure.
When there is no disease, a Catalytic medicine may work out its own
action in the blood, and produce a disease. But when there is some
previous disorder, the working of the Catalytic may operate so as to
counteract this already existing action, being so far similar to it,
that it acts in the same department, and may thus occasionally produce
by an accident like results; but being, nevertheless, as we have seen,
essentially contrary to it, because it neutralizes it.
Such opposite relations are met with even among natural diseases.
Vaccination and Small Pox afford us an instance of the mutual
counteraction of morbid processes. These poisons are alike in their
operation. Dr. Fouquet, of Freiburg, has tried the effects of
re-vaccination in Syphilis, on the inmates of a large military hospital,
with great apparent benefit, as it is said. These poisons are unlike in
their results. So are Ague and Phthisis; and persons who have had Ague
are said to be less liable to Phthisis than others. Again, we find that
one attack of an eruptive fever preserves the system in some way from
the renewed operation of the same poison. In these morbid phenomena we
find something of a parallel to the curious operation of Catalytic
medicines in controlling blood-diseases; for I have shown that these
remedies themselves are artificial blood-diseases.
Such ideas lead us on into the uncertain regions of speculation.
The idea that diseased actions may possibly be accounted for by
supposing the existence of special _fermentations_ in the blood, is by
no means a new one. Inscrutable as these diseased actions themselves may
be, yet, we are enabled to recognise processes of a nature analogous to
fermentation as going on in that fluid in health. Of such a kind
probably are, the change of albumen into fibrine; the changes which take
place in the starchy matters of the food before they can be oxidized
into carbonic acid; and the changes that must occur in nitrogenous
substances before absorption, as well as those that accompany afterwards
the downward progress of the same materials, from living tissue into
Urea and Uric acid, to be finally excreted from the system. It is a
curious fact that nearly every known product of organic fermentation has
been discovered in the human body in health or in disease. Lactic,
butyric, and acetic acids, have been frequently found there. Dr. Heintz
has lately added to these succinic acid, discovered in a hydatid cyst of
the liver.
The production of many disorders by the access of a known morbid
material, the working of that material on the particles of the blood
after a special fashion peculiar to itself alone, and the gradual
elimination of certain products, also peculiar to this one operation,
are circumstances in which diseases bear an obvious analogy to processes
of fermentation. The same remark applies to the working of Catalytic
medicines.
It is then just possible that one of these medicines might produce in
the blood a fermentation which should meet and neutralize the morbid
fermentation; or that it might simply determine the latter in a
different direction, and thus bring it to a desirable end. Acting in
health so as to produce a morbid change, it might operate in disease by
means of diverting into a right direction a change that is already going
on in a wrong one.
But let us leave generalities, and descend more into particulars. Are we
in a position to be able to indicate the actual nature of the changes
which we thus assume to be probable?
The term Fermentation is used to express a change or series of changes
of a special character, caused among the particles of a compound body,
by the presence of a certain other body called a Ferment. There are two
kinds of fermentation. In one the ferment itself is undergoing change,
and impresses a similar change upon a substance which is analogous in
nature to itself.[39] The process caused by a contagious disorder would
probably be of this kind. Just as the changing yeast forms and increases
itself out of the fermenting dough, so does the virus of such a disease
renew and propagate itself out of the particles of the blood.
The other kind of fermentation is simpler in action, but more
incomprehensible in character. It is produced by mere contact, without
any change in the ferment itself. Thus it is known to chemists that
spongy platinum causes the combination of oxygen and hydrogen, and
exerts generally a powerful influence over the affinities of gases and
liquids, without ever itself undergoing any change. The influence of
Emulsine, in causing, by mere contact, the Amygdaline in the bitter
almond to resolve into Prussic acid and other compounds; and that of
Pepsin or of Ptyaline, in promoting the change of Starch into Sugar, is
of this kind.
Considering that Catalytic medicines are not by their nature changing
bodies, being mostly minerals, it is not likely that they could cause
that kind of fermentation which requires that the ferment itself should
be in a state of change. The influence of contact is the one which they
would be most calculated to exert. I may remark that I have used the
term Catalytic without any reference or allusion to this sense, in which
it has been frequently employed, but merely as conveniently expressive
of undoing or destroying. I would not wish, either in the terms or in
the propositions which I have adopted, to assume for granted any thing
which is not proved, still less an idea which is purely hypothetical.
But it is not very unlikely that some of these medicines may act in a
mode which is more or less analogous to an action of fermentation of the
kind just described. They might then either cause change themselves, and
by this means alter and destroy a morbid process somewhat similar to
that which they themselves excite; or they might, by simple contact, be
able to resolve this process into a natural direction. We have seen that
when introduced into healthy blood, they invariably tend to produce a
change in it which is productive of harm; but that when there is already
an abnormal process going on there, their influence will effect the
subversion or annihilation of this other process.
And there are certain physiological considerations that render such an
idea still more intelligible and plausible.
It is to be remembered that the blood, in which we suppose such actions
to go on, is not an ordinary chemical fluid, subject to common laws,
and influences, such as we may meet with out of the body; but a very
complicated mixture, which is ever circulating and being maintained at a
high temperature, and contains a number of compound organic bodies, each
of which is liable to a series of varied metamorphoses.
It is not a very potent agency which is needed to disturb the chain of
conditions of one of those inconstant bodies which is thus continually
performing the circuit of the system.
I may briefly exemplify the series of changes, simple but momentous,
which an organic body is capable of undergoing, if I instance the
combination of elements which constitutes Urea.
By bringing Ammoniacal gas in contact with the vapour of Cyanic acid, we
produce Cyanate of Ammonia, a poisonous salt. This, when exposed for
some time to the air, changes into Urea, which is isomeric with it, but
comparatively innocuous. Urea, when heated, gives off Ammonia, and
becomes Cyanuric acid. On again heating this, hydrated Cyanic acid
sublimes. This, when brought in contact with water, becomes Bicarbonate
of Ammonia. Two equivalents of Cyanic acid, uniting in one compound,
produce Fulminic acid. This, if combined with the oxide of Silver or of
Mercury, forms a compound which is caused by the slightest friction to
explode with terrific violence. If to the elements of this dangerous
acid be added those of two equivalents of Ammonia, we again have Urea, a
substance which is continually forming in the body by the oxidation of
some of the nitrogenous tissues.--Urea with water changes lastly into
Carbonate of Ammonia. These several compounds, alike or identical in
their ultimate composition, are possessed of very different properties,
whether regarded as medicinal or as chemical agents.
A similar set of changes may be produced among the elements of Uric
acid, also an animal product.
Changes in some respect similar to these which are produced by the
Chemist are no doubt continually going on, or capable of being set up by
various influences, in the circulating blood, which is at a heat fit for
such processes; in which also is a considerable quantity of free oxygen,
as well as soda, ammonia, and other elements, in a state fit for
combination; and to all these is superadded the agency of the vital
principle, the object and effect of which is continual alteration,
destruction and reproduction.
By supposing the establishment of a set of changes in the blood, we may
possibly gain some insight into the cause of the powerful effects of
some apparently insignificant medicines belonging to this division of
Hæmatics. Neurotic medicines appear to act by their mere presence,
contact and excitation. This may not always be the case with Catalytics.
Their power cannot in all cases be clearly accounted for by a simple and
direct influence on the blood, the muscles, the nerves, or any of the
tissues. It seems sometimes as if it were on the processes that their
presence sets going, and on the products thus generated, that their
influence and power depend.
It may be observed that this idea of action by contact cannot by any
means be supposed to favour the very unreasonable theory of the efficacy
of infinitesimal doses of drugs. For such medicines must of necessity be
present in some amount, or they cannot act at all. Their operation
cannot be like that of the putrefying yeast, or of the poisons of
contagious fevers, each of which can reproduce itself out of the
elements of the changing or fermenting body. For Antimony, Mercury, and
Iodine could never make themselves out of blood, which does not contain
them. Like the Emulsine in the production of Hydrocyanic acid out of the
material of the bitter almond, they must be present in certain quantity,
or they are quite inoperative. Even a tenth of a grain would generally
be powerless, not to mention such irrational quantities as the
thousandth, millionth, or even decillionth of a grain. (_Vide_ page
54.) Experience--better even than theories and mathematics--is entirely
opposed to such chimerical fancies.
Having thus entered into a speculation concerning the probable action in
the blood of Catalytic remedies, I must once more remark that this idea
forms no part of the Proposition in which I have defined their mode of
operation. In the present state of our information on the subject, we
cannot certainly say more than that these remedies, by some
blood-action, are able to antagonize and to annihilate certain disorders
in the blood.
The resolution of a disease thus effected may, in some few instances, be
partly explained by certain chemical considerations, as will be
particularly shown in the case of Antiarthritics.
It remains for me now to add some brief remarks on the individual _modus
operandi_ of the substances included in each of the eight orders of
Catalytic medicines.
Some of these having been partly discussed above, in arguing the
Proposition, it will not be found necessary to travel over again that
portion of the ground which has already been thus traversed.
ORD. I. ANTIPHLOGISTICS.
The inflammatory process--the chief seat of which, however it may first
originate, is in the circulating blood--exerts a powerful influence over
the nervous system, and may, by this influence, cause death. When fever
is produced to any extent, there must be danger.
We are enabled in two ways to control or to mitigate this state of
things. We may produce an action on the nervous system, or we may direct
our attention to the process in the blood.
Of Neurotic medicines, which we shall have to consider hereafter, there
are some which may be made use of at the commencement of the attack,
and others which are appropriate when the process is more advanced. Of
the first kind is Antimony, considered in its Neurotic action. Employing
it in large doses, we may produce a powerful effect upon the nerves
which supply the heart, and thus, by diminishing the impulse upon the
inflamed parts, or on the vascular system generally, promote absorption
and resolution. Blood-letting produces the same action, but in an
inverse mode. Antimony diminishes the pressure on the vessels by
weakening the force of the heart; Blood-letting weakens the force of the
heart by diminishing the pressure on the vessels.
Such Neurotics as Opium are employed at a more advanced stage, when the
inflammation cannot be suddenly put a stop to, and our object is to
counteract the effects it has produced. Besides relieving the pain and
nervous irritation which are so much to be dreaded, Opium may be
employed to prevent a blood-medicine from passing out through the
bowels. Antimony and bleeding are appropriate in sthenic cases. Opium
should not generally be employed in these instances, nor should it be
given in brain disorders, or in any case where there appears to be a
determination of blood to the head.
Certain medicines of the class of Eliminatives, and certain Catalytic
remedies belonging to the present order, are employed to counteract the
inflammatory process in the blood.
Of the former, the most important are Purgatives and Diaphoretics. By
diminishing the amount of the serum of the blood, they not only tend to
check effusions, but act indirectly on the heart, in the same way as the
medicines last spoken of; and they probably also promote the passage of
morbid or of peccant materials out of the system through the glands.
Acid and saline drinks may act as Diaphoretics, besides exerting each a
peculiar influence in the fluids.
Of this Catalytic order, Antimony and Mercury are those which tend most
powerfully to check the general blood-process of inflammation. The
former is used in urgent and acute cases to make a sudden and powerful
impression, adding to its Hæmatic action a sedative effect on the heart
and circulation. Mercury exerts no such immediate influence. Diminishing
the Fibrine of the blood, and having other operations of a peculiar kind
in this fluid, it powerfully promotes absorption and counteracts
effusion, in all inflammations. The blood-action of these remedies,
though not positively slow, is slow when compared to an action on nerve.
Thus when Antimony is given in large doses, as is desirable in some
highly sthenic and dangerous attacks, its blood-action is lost in its
immediate Neurotic operation.
So that in Croup and Pneumonia, both rapid and fatal inflammations,
Antimony is far preferable to Mercury. But in Pleurisy--where there is
generally no immediate danger to be dreaded, but a subsequent effusion,
Mercury is best, being in time to lessen or to prevent this result.
From the action of both on the blood, and one on the nerves, these are
very lowering remedies. In the employment of Antimony in fevers and
inflammations, the production of nausea generally indicates that it has
taken sufficient effect; but it may sometimes be better to give such a
dose as shall cause vomiting, especially when a violent counter-irritant
action is to be desired. The increase in the quantity of saliva, and
slight soreness of the mouth, which result from its action, will show
when the administration of a Mercurial has gone far enough. It is seldom
advisable to cause copious salivation.
Alkalies dissolve the Fibrine of the blood, and appear by this to lessen
its deposition, and retard its formation. Thus, when given in large
doses, they operate as Antiphlogistics. They have sometimes been
employed with advantage in fevers of the acute or sthenic kind. Exerting
an influence over the inflammatory process considered _per se_, Alkalies
and Mercurials are more particularly efficacious in some special
varieties of inflammation, because in such cases they further counteract
the morbid agency by which the process is excited and kept up.
In the Typhoid and Eruptive Fevers, when the blood is already
sufficiently deteriorated, and it is not desirable that we should reduce
the vital powers beyond a certain point, Salines, as Nitrate and
Chlorate of Potash, supply us with a set of valuable and sufficiently
mild Antiphlogistic agents. It seems that they both exercise a solvent
power over Fibrine, and keep asunder the corpuscles which tend to adhere
together in inflammatory blood. This latter action has been observed by
Mr. Gulliver. Salts are excreted, and act on the skin, or the kidneys,
or the bowels. They are not so potent as Alkalies; for salts pass out of
the body as they went in; but Alkalies pass out into the secretions as
salts, having first combined with acid in the system, so that they must
leave behind them a certain excess of alkali in the blood, by which
their action is continued for some time. (_Vide Alkalies; Prop. VIII.;
Antimony and Mercury in Chap. IV._)
ORD. II. ANTISYPHILITICS.
These are medicines whose operation in the blood results in the
counteraction or neutralization of the syphilitic poison.
In primary forms of Syphilis, as the chancre, and early eruptions,--as
syphilitic Lichen, Roseola and Lepra,--also in syphilitic Iritis,
Mercury is the single and best remedy.
Its power is universally admitted, both by English and Continental
surgeons. It is often esteemed a specific. Among others, Mr. Hunt, in a
treatise on Syphilitic eruptions, maintains that Syphilis has a tendency
to go on without limit if left alone, but that Mercury in sufficient
doses possesses the power of totally destroying the poison, and
preventing its transmission.
Mr. Carmichael was of opinion that Mercury was only applicable in those
cases which exhibited the true Hunterian chancre, round, cup-like, and
hard, followed by a leprous eruption. But it is more in accordance with
common experience to say that the only contra-indications to the use of
Mercury in primary Syphilis are these--a scrofulous or very debilitated
state of the system; and a sloughing or irregular appearance of the
primary sore.
We may administer Mercury in two forms. It may be given as Calomel or
Blue pill, with or without Opium, and continued until it affects the
mouth. Or the Bichloride may be administered in minute doses, and may
prove efficacious without producing salivation. It should be commenced
as early as possible; and in most cases the action of Mercury in the
blood, of whatever nature that action may be, will meet and neutralize
the advance of the syphilitic virus, preventing its further
manifestation in a secondary form. It is rarely necessary to push its
action beyond the first symptom of salivation; for that will be evidence
that the system is sufficiently saturated with it. Beneficial as it
often proves when administered thus cautiously, yet, if given in excess,
or to individuals that are over-susceptible of its action, it is capable
of proving a poison every whit as noxious as the Syphilis which it was
intended to neutralize. The mercurial cachexy is quite as deplorable,
and quite as incurable as the Syphilitic cachexy.
The Terchloride of Gold may be used in Syphilis in the same way as the
Bichloride of Mercury; but it is much more seldom employed. There seems
to be a strong medicinal as well as chemical similarity between these
two metals and their compounds. Even the insoluble metal itself was used
some time ago as an Antisyphilitic, apparently with success. In 1715,
Dr. A. Pitcairn recommended finely-powered Gold as even more efficacious
than Mercury in the treatment of Syphilis.
In secondary forms of this disorder, as in Periostitis, ulceration of
the mouth and throat,--or in any of the late rashes, as Rupia,--Iodide
of Potassium is the best remedy. Its efficacy in such cases was
discovered by the late Dr. Williams. It may sometimes fail to effect a
cure; but this failure is often due to the omission of Mercury in the
treatment of the primary disease. It would seem as if it were not so
much the real secondary syphilis, but a certain smouldering action of a
part of the poison which has escaped the operation of Mercury, but has
been modified by it, which is capable of being met and controlled by
Iodide of Potassium. In cases where this remedy fails, I have found that
a course of the Bichloride of Mercury, combined with Sarsaparilla or
some bitter tonic, proves very beneficial.
But the action of the Iodide on a case of Periostitis, and the rapid
absorption that follows its exhibition, are sometimes fully as
remarkable as the influence of Mercury over the primary disorder.
Sarsaparilla is a very doubtful member of this order. It contains a
soluble principle called Smilacine. It is thought by some to purify the
blood, and also to have a kind of specific influence over it in old
syphilitic cases. If it were so, we should have from the vegetable
kingdom a distinct analogue to one of these mysterious mineral
Catalytics. But it is so rarely given without being combined with some
more powerful agent, that it is difficult to judge whether or not it may
have any striking virtues of its own.
The Antisyphilitics, particularly the insoluble compounds of Mercury,
are frequently employed as local applications to sores and eruptions.
When these have a syphilitic origin, the mercurial doubtless combats the
local manifestation in the same way that it can counteract the general
action in the blood. In other cases the Mercury may pass into the blood
of the part, and, by exerting in its antiphlogistic operation, the
result of which is to diminish its plasticity, may thus promote
absorption. Mercurial ointment, if rubbed into the skin, becomes in part
absorbed, and may thus produce salivation.
ORD. III. ANTISCROFULICS.
These are medicines which have the power of counteracting the poison of
Scrofula in the blood. Common and pernicious as is this disease, there
are not many Catalytic remedies which exert any marked control over it.
When a strumous condition is chronic, and has firmly established
itself--when it has descended through many generations of the same
family,--it is very intractable and difficult to cure. Palliative and
indirect remedies, aimed rather at the consequences than at the source
of the disorder, are often adopted with benefit. Tonics, Chalybeates,
Cod-liver oil, and cold bathing, are frequently of use in improving the
condition of the system, when debilitated by the long continuance of
strumous disorders. But the most important and direct remedies for
Scrofula are to be found in Iodine and its compounds.
It is not to be wondered at that in many cases of deeply-rooted
blood-disease, complicated perhaps with anæmia, structural change of
organs, disordered assimilation, and various nervous symptoms, all
remedies alike should prove useless. So that the experience of many
practitioners, thus frequently disappointed in their hopes of a cure,
has led them to question altogether the efficacy of Iodine in Scrofulous
disorders. But it is generally allowed that it is more beneficial in
such cases than any other medicine, and is the only remedy which is
universally applicable in Scrofula. If this be true, it follows that it
must have a special power over this blood-disease.
Burnt sponge, and the ashes of a seaweed, the Fucus vesiculosus, both of
which contain Iodine, have been used in Scrofula from very early times.
But it was not until the present century that Iodine was discovered, and
its efficacy in Scrofula, particularly in the cure of Goitre, pointed
out by Dr. Coindet of Geneva. After this it came to be generally applied
in all Scrofulous cases, and was especially recommended by M. Lugol in
France, as a specific for such maladies.
When given for some time, Iodine has the effect of impoverishing the
blood, like Mercury and many other Catalytics, diminishing in it the
amount of Fibrine. All remedies which do this favour absorption. This
effect is obviously connected with the alteration in the blood, and
there is no reason to suppose that any special stimulant action is
exerted on the absorbent vessels. Those Catalytics which favour
absorption are not all useful in the same cases, but some are most
useful in one disorder, some in another. Thus they must exert a special
action over morbid poisons; an action which is altogether distinct from
the influence over absorption, although by this latter they may be able
to cause the disappearance of effused products, and of tumours produced
in various ways.
In some rare cases Iodine has even been known to cause the absorption of
healthy glands, as the mammæ and testicles.
Iodine and Iodide of Potassium, when successful, do not merely cause the
disappearance of scrofulous tumours, but further meet and neutralize the
poison which is working in the system, and effect a more or less
permanent cure. This could hardly be done by a remedy which had only the
power of promoting absorption.
It seems that some systems are able to bear with impunity very large
doses of Iodide of Potassium. I once met with a medical man who denied
its power altogether, because he himself had frequently taken a scruple,
and sometimes a drachm at a time, without any effect. Other men are
readily affected by very small quantities, and quickly experience the
symptoms of Iodism. It is probable that in the former case the medicine
is very quickly eliminated by the kidneys; but that in the latter it
remains in the system for some time.
The Iodide of Iron is a most useful medicine for scrofulous children,
who commonly suffer under Anæmia, as it combines a Chalybeate with an
Antiscrofulic action.
Bromine and Chlorine resemble Iodine in their Antiscrofulic effects. It
is said that Scrofula and Consumption are unknown among the workmen in
bleaching factories, where Chlorine is being constantly inhaled. Thus it
has been strongly recommended that diluted Chlorine should be constantly
inhaled by consumptive patients. It is probable that part of the
efficacy of sea-side air and sea-voyages in scrofulous cases may be due
to the free Chlorine which is given off in small quantities from the
salt water of the ocean. The powers of Iodine and Bromine are shared by
their compounds; and probably Chlorine is no exception to this rule. The
bad consequences which follow the omission of common salt from the food,
are sufficient to show that this substance has a beneficial action on
the blood. Probably large doses of this article of diet would be found
advantageous in Scrofulous disorders.
It is easy to recognise such an action as that of Iodine in Scrofula,
but it is almost impossible to invent a satisfactory explanation for it.
Potash, free or carbonated, is another remedy of considerable importance
in Scrofulous diseases. It is possibly one of those Catalytics which
exert a simple chemical influence. It may act by holding in solution
fibrinous and fatty matters, and preventing their abnormal deposit in a
crude form in the shape of tubercular matter. It may also be found
useful in cases of Syphilis, when aggravated by a previously existing
strumous tendency, and where a course of Mercury cannot be safely
prescribed.
Small doses of Mercury, as an alterative, are often efficacious in
scrofulous constitutions. They appear to act simply by stimulating the
torpid liver to a performance of its proper function.[40] (_Vide_ page
144.)
Potash has been used as a prophylactic against Consumption. The efficacy
of Cod Oil in this disease has been explained by some as depending on
the Iodine which it contains in small quantities. I do not consider this
explanation to be the correct one. (_Vide Cod Oil, in Chap. IV._)
ORD. IV. ANTIARTHRITICS.
In this order are included some blood-medicines which exert a direct
influence over certain disorders which depend on some fault in the
complicated processes of assimilation and nutrition. The chief of these
diseases are, Diabetes; Oxaluria; Lithic deposit in the urine; and the
true Arthritic disorders, _i.e._, Gout and Rheumatism. Most of those
blood diseases which cannot be clearly traced to the introduction of a
poison from without may be arranged under this head, and appear to be
curable by the same set of remedial agents.
There are certain processes always going on in the blood, whose
continuance in the right direction is essential to health. When one of
these processes is disturbed, it does not generally cease, but it goes
on then in a wrong direction.
The natural processes result, on the one hand, in the preparation of fit
and proper nutriment out of the materials of the digested food, for the
growth and support of the several tissues and functions; and, on the
other hand, in the gradual change and conduction out of the body of the
products of the waste of those tissues. But when any process goes on in
a wrong direction, it results in the formation of various products
different from those which are required, and which the kidneys and other
glands are at length called upon to excrete from the system. The result
is that the general health is more or less seriously impaired.
There is also another way in which these diseases are not unfrequently
caused. A natural process may stop at a certain point, and go no
further. The material formed at that stage remains as it is. It is not
wanted; it is morbid; and it also is excreted from the body. It is
possible that these errors in the assimilative processes may sometimes
arise in the first instance from a deficiency in the blood of some
substance whose influence was necessary to the proper conduct or control
of the natural series of changes. Some of these conducting materials may
be formed by the liver; for it is found that these disorders are very
commonly connected with an impairment of the function of that organ.
Thus Mercury, which restores the secretion of the liver, is often useful
in Arthritic disorders; as also is Quinine, which has already been shown
to have a peculiar relation to liver diseases.
But these disorders, however they may first originate, consist in an
active morbid process of one kind or another; and the surest way of
counteracting this process, or of diverting it into a right direction,
is by the employment of one of the Catalytic medicines contained in this
order. Some stages of these diseases are attended with a want in the
blood of some of its ordinary constituents; which condition may be
relieved by the supply of a Restorative remedy.
Thus in this group of disorders three kinds of medicines may be
employed, which tend in various ways to improve the condition of the
blood.