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 diseasesare 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 sodifficult 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 tothe 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 diarrhœa 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 specialfermentationsin 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 mightproduce 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 powerfulinfluence 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, subjectto 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 producedby 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. (Videpage 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 individualmodus operandiof 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.
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 thecommencement 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 consideredper se, Alkalies and Mercurialsare 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.)
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.
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 Scrofulafrom 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 casethe 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 efficaciousin scrofulous constitutions. They appear to act simply by stimulating the torpid liver to a performance of its proper function.[40](Videpage 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.)
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 productsdifferent 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.
Acids and Alkalies are sometimes needed, and act on the Restorative principle. The true Antiarthritics are those medicines which are employed on the Catalytic plan, to meet and neutralize the morbid material or process in the blood. Andsometimes Eliminatives are made use of, which seem, by acting on the secretions of the skin, kidneys, or bowels, to be able to rid the blood of an unnatural product. Thus Guaiacum and Salines are employed in Rheumatism, and Purgatives in Gout.
These two joint affections are most characteristically under the influence of Catalytic remedies. Diabetes and Lithiasis are more under the control of Restoratives than the others.
The medicines composing this fourth order of Catalytics have been already enumerated.
That Colchicum tends in some way to neutralize in the blood the poison of Gout, and to a less degree that of Rheumatism also, is generally admitted, although various theories have been adopted to explain this action. (Vide Chap. IV. Art. Colchicum.)
In Oxaluria, the employment of Nitric acid as a remedy was first recommended by Dr. Prout. Dr. Golding Bird advised the substitution of Nitro-hydrochloric acid, which has proved to be a most valuable remedy, not only in this disorder, but also in some cases of lithic deposit. The Oxalate of Lime rarely occurs alone in the urine; there is generally along with it some Urate of Ammonia. The causes of the two deposits appear to be in some way connected. So also are the remedies similar. Dr. G. Bird has found Colchicum to be of signal service in cases of lithic deposit in the urine; and has proved the same medicine to be efficacious in Oxaluria.
I will now attempt to show how the action of these medicines may admit, on certain grounds, of a chemical explanation. There are very few Catalytic actions in which such an explanation can be attempted, but a degree of plausibility appears to attach to the idea in this case, though it cannot of course be considered to be susceptible of more than a demonstration of probability.
I have already said that in all the disorders now under consideration there are certain morbid constituents in the blood which have been recognised by chemical tests. In Diabetes there is an excess of grape-sugar formed in the blood, and excreted from it in the urine. In Rheumatism we have a painful joint affection, attended with a great development of acid in the system; and this acid, which we have many reasons for supposing to be lactic acid, is occasionally excreted by the skin. In Gout we meet with another Arthritic affection, in which there is urate of soda in the blood, and an excess of uric acid and urea in the urine. A simple excess of uric acid in this secretion constitutes Lithiasis. There is an obvious but ill-understood connexion between the last two disorders, and, indeed, between all those of which we are treating. In Oxaluria we have an abnormal formation of oxalic acid in the blood, which is excreted in combination with lime, for which base it has a great affinity. In oxalic urine there is generally an excess of urea, as I have found in many cases.
Now it seems to me that all these disorders are capable of being explained by reference to the series of changes in the blood which are associated with the respiratory process. (Vide Liebig's Anim. Chem., part i. p. 133;Dr. B. Jones' Anim. Chem., pp. 20, 118.)
It is the general opinion of modern chemists, that before the starch of the food can be applied to the maintenance of the animal heat, for which office it is chiefly intended, it passes through a series of chemical changes. First, assuming two equivalents of water, it becomes grape-sugar; next, this changes into lactic acid, which is isomeric with it; and this again combines with twelve atoms of oxygen, to form carbonic acid and water. This last change is a process of combustion, and thus produces heat. The oxygen needed for it is absorbed from the air by the pulmonary mucous membrane,and the carbonic acid formed passes out of the blood at the same surface.
Liebig was the first to point out the connexion between these changes and the phenomena of Diabetes. It is clear that if the process were to stop at the formation of grape-sugar, the condition of blood that exists in Diabetes would result. This sugar cannot be put to any use, and is excreted as fast as formed. There is an excess of urea in the whole quantity of urine passed in the day; probably because the nitrogenous food and tissues are undergoing combustion instead of the starch. Before becoming grape-sugar, starch undergoes a transitional change into Dextrine, a gummy insipid substance which has the same composition as itself. It seems that the process may even stop as early as this, and that by this stoppage another analogous disease may be produced,i.e.Diabetes insipidus. The common Diabetes is called D. mellitus. (Vide Jones' Anim. Chem.p. 120.)
If it were clearly proved that the acid of Rheumatic fever is lactic acid, then this affection might evidently be produced by a stoppage of the process at the next stage. Lactic acid has been formed; but, for some reason unknown, it is not oxidized into carbonic acid. Urea and uric acid are in excess in the urine, from the cause alleged above.
But suppose some of the sugar to be oxidized prematurely, without passing first into lactic acid. By this oxalic acid would be produced, and the phenomena of Oxaluria accounted for.
These things are only alleged as possible, and for the purpose of showing that, should they be true, the action of some useful remedies might be elucidated. It is not at all unlikely that the accuracy of such ideas may be completely established by fresh discoveries at no distant time. But let us continue.
In Gout and Lithiasis there is an excess in the system of nitrogenous matter, and thus a tendency to an extra formationof urea. These conditions are often brought on, and always aggravated, by over-indulgence in animal food. Now if we may suppose that some of the lactic acid, instead of oxidizing directly into carbonic acid, oxidizes in combination with this urea which is in excess, then uric acid and water might result, as is shown below. The uric acid passes out into the urine in excessive quantity.
Should this be the case, the great affinity existing between the course and symptoms of Gout and Rheumatism would be easily explained, there being in both disorders an impediment to the proper oxidation of lactic into carbonic acid. These things may be illustrated by a diagram, showing the results which are supposed to take place when the natural process is arrested at, or diverted from, any of its stages:—