Taurine = C4H7NO10.Caffeine = C8HN2O2.
Taurine = C4H7NO10.Caffeine = C8HN2O2.
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 amaterial 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 C20H12NO2. 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.
C20H12NO2+ 45 O = C4H7NO10+ 16 CO2+ 5 HO.
C20H12NO2+ 45 O = C4H7NO10+ 16 CO2+ 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 favourà prioriof 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 Catalyticin 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 antisepticproperty, 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 circulationin 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 evenshould 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.
(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 = C44H22O5N3Fe.
Hæmatosin = C44H22O5N3Fe.
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 theexact 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 Pharmacopœia, 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 beingastringent; 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 Amenorrhœa, 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 otherremedies 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 Amenorrhœa 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.
(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 holdthem 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, causingan absolute excessof 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 thesystem 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 effectsits 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, althoughcomparativelyinsoluble. 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 lithicsediment, 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 dissolvingUric 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 themateries morbiis 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 themodus operandiof 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.
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. (καταλυω.)
The differences in action between this and the preceding division of blood-medicines have been stated at length in theremarks 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 thinkwill not be denied, I have grouped them in orders which are named according to the several morbid states in which they are employed.
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 ispermanent.
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 theargument 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 primarymodus 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 classificationwhich 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. Butlet 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, andfor 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.
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 prefixAnti-involves a principle. These medicines produce certain actions which arecontraryto 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 thingsare 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.
OfAntiphlogisticmedicines, 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 thosewho 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.
Antisyphiliticshave 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.
Antiscrofuliticsform 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 ofIodismhas 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.
Antiarthriticsexert 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 theexcretion 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 itsmodus operandiis not determined with certainty. This question is of some theoretical importance, and will soon be considered at some length.
AmongAntiscorbutics, 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.
Antiperiodicsare 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 œdema 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 thefeet. Any kind of eruption would alone constitute sufficient proof of an operation in the blood.
The metallic salts used asAnticonvulsivesare 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 œdema 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.
AmongAntisquamics, 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 whichthey 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.
Inflammationmay 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 alsofound 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.
Syphilisis 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.
Scrofulais 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.
Arthriticdisorders 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.
Scorbuticdiseases,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.
Periodicdisorders 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.
WithConvulsivedisorders 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 ingeneral. 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.