The Brooklyn Medical Journal, Jan., 1894.
_DRUG ACTION._
Chemistry makes such rapid strides of late that it is impossible for the
medical man in ordinary practice to keep pace with it. We have ptomaines
and leucomaines, and in the literature of the journals these two terms
are used indiscriminately, which is unfortunate, as tending to create
confusion. While ptomaines are those alkaloidal products of metabolism
belonging to the cadaver, or to any dead organism, whether animal or
vegetable, the term is now applied to the same products in living
tissues and which really are not ptomaines, but leucomaines. Chemically
speaking, both ptomaines and leucomaines exist in the forms of
monamines, diamines, and triamines, and have hitherto been regarded as
resulting from the oxidation of ammonium salts by abstraction of water
or from acids by substitution of amidogen. Yet the bacteriologists
assure us that they are the secretions, or rather excretions, of
bacteria, just in the same way that the strata of non-igneous rocks of
the earth are formed primarily by the secretion, and secondarily by the
excretion, of calcareous shells of diatoms, or of the cretaceous shells
of those protozoans entitled rhizapods. Elsewhere in the SUMMARY I have
expressed myself to this effect in nearly the same language, and while
it may seem pedantic, it should be borne in mind that this is the age of
terminology.
We, each of us, have our special ties—shall I say hobbies? One of us
making the eye a specially will make use of ophthalmological terms.
Another turns his attention to the technology of animal tissues, and
still another, with an eye towards the bacteriological existences, leads
us into a labyrinth of Greek and Latin technics.
We are talking of ptomaines and leucomaines, and that their existence is
probably due to bacteria. These are regarded as toxines, and certain
diseases are said to be caused by these toxines, and not from the
bacteria themselves directly, but indirectly. I appreciate the idea that
the curative results of these diseases are due to the antagonism of the
remedies to these toxines, and not to the destruction of the bacteria.
Before we inquire into the curative action of remedies we must first
find out how these toxines produce disease. The tendency is to trace the
origin of all disease to a change in the protoplasmic cells. This change
is evidently due to a toxine. A healthy physiological change in the
cells may be termed metabolism, while an unhealthy or pathological
change may be termed katabolism. The question arises, in what way does
katabolism arise from these toxines? It occurs to me that it must be due
to chemical affinity, or as it is sometimes very properly called,
_chemism_.
In a brief but very excellent article on therapeutic action by Dr.
Thomas J. Mays, of Philadelphia, in the AMERICAN THERAPIST, he commences
thus: “Every phenomenon in nature becomes intelligible only when
considered in the light of force. Any scientific system of therapeutics
must therefore be built on a broader basis than that of the mere drug
action on the animal economy.” In this he is unquestionably correct; but
when he, along with others, asserts that drug action is due to what is
termed “interference,” to me, at least, he becomes unintelligible. I am
utterly unable to take in the idea. When he refers it to molecular
motion, which, after all, is chemical change, he is right. Heat, light,
electricity, motion—each interchangeable, correlating with each other,
constituting force—must be the source of all chemical action. These are,
strictly speaking, proteodynamics. They act, as I have indicated, upon
the cell. This action may be either metabolic or katabolic, and when the
remedial agent is presented the change results. So true is this that the
_vis vitæ_ itself results from chemism, so that every action, every
change, has simply two factors—matter and dynamism.
In this connection permit me to make the following quotation from the
_Medical News_: “Of course, it had been recognized that certain diseases
are self-limited, and the phenomena of natural and acquired immunity
were duly appreciated; but it required the knowledge gained by the
advances in bacteriology to afford a rational explanation of these
phenomena. There is yet much to learn. The beginning has but been made.
Enough, however, has been seen to teach that disease has its chemistry,
and that the treatment of the future will depend upon a knowledge of
this fact and the application of chemic laws.”
The progressive physician does not believe that medicines _cure_. It is
true he uses the word just as we say the sun rises and sets when we know
that it does neither the one or the other, but that the phenomena are
due to the revolution of the earth on its axis. The cell function is the
building function, you may call it metabolism or anabolism. It is either
a building or a repairing process. Now derange the process by means of
toxines, and you have what may be called katabolism. The molecules are
disorganized, the tissues become disorganized, and the result is
impaired function. A remedy reaches the part; among the molecules of the
remedy and the molecules of the protoplasmic cells chemism takes place;
the toxine is antagonized, antidoted, neutralized, changed, and the
metabolic process is established. This is the natural physiological
process, and a healthy action results; and herein I have thought may be
the secret of the action of minute doses. I will illustrate. In the
chemical laboratory you have a combination of mercuric sulphate with
about four-fifths its weight of chloride of sodium; and heating in a
test-tube the result is mercuric chloride (HgCl{_2}), or corrosive
sublimate. Repeat the experiment by using mercurous sulphate, with about
a third of its weight of chloride of sodium, applying heat, and you have
mercurous chloride (HgCl), calomel. Here by diminishing the amount of
chlorine in one of the experiments you have quite a different result,
due to quantivalence. Why, then, if the process of katabolism be
chemical, may not a result be altogether different among the atoms of
the molecules of the cells and of the medicine, in accordance with the
law of definite proportions? If quantivalence exists among chemical
radicals, why may it not exist among organic radicals?