Frederick William Headland

“ Concluding, then, that it is impossible to account clearly for the actions of most medicines on Mechanical or on Chemical principles, we are led to infer that their influence must for the most part be vital in its nature—that it must be such as could only be exerted in the living body. Even then we are unable to fix upon any single rule or formula which shall be capable of accounting for the actions of all at once. So it seems that the only general explanation which we can offer of the modus operandi of medicines in the cure of diseases, is to say that they operate by various counteractions. ”

“ But, though such statements are admitted to be correct in theory, it remains still to be considered whether they form a fitting basis for a classification of medicines. Now it will be observed that no theory of action enters into such an arrangement, but merely the tendency of the action of each medicine is considered; and as each medicine has naturally many distinct tendencies, it comes therefore under many different heads. But the chief practical use of a classification seems to be, that we may quickly learn from it the general action or effect of a medicine ”

“ Whenever we are in a position to inquire into the facts by chemical or other means, we find that the Eliminative medicine is itself contained in the secretion which is augmented by its action, and that when the secretion upon which it usually acts is not augmented, the medicine has passed off by some other secretion instead. ”

“ True Cholagogues.—We are not well informed as to the exact number of medicines which pass out into the secretion of bile, and act thus on the true eliminative plan. But there is no medicine which is of such great and universal utility in all liver diseases as Mercury,—in its various forms. Mercurials increase more or less all secretions; and even if we had no direct proof of their action on the liver, we might almost have affirmed that they especially increased the secretion of bile, from the obvious way in which bilious symptoms yield to their action. ”

“ Agreeing with Stahl in his view of the advantages of the "expectant" treatment of diseases, he thought it better to rely on the "vis medicatrix naturæ," than to make rash or violent attempts at a cure. He maintained that what we call a disease was in fact "no more than a vigorous effort of nature to throw off the morbific matter, and thus recover the patient." [14] He proposed, therefore, that our efforts should be directed to assist nature to procure the evacuation of a poison, promoting its elimination by acting on the various secretions—as by purgatives, diaphoretics and such medicines. ”

“ And our plan of treatment will become rational, when on the one hand, from an accurate knowledge of the symptoms of diseases, we are better enabled to meet each by its appropriate remedy, and on the other hand, from some acquaintance with the general action of a medicine, we are fitted to wield it with more skill and effect, and to apply it even in cases where it has not yet been proved beneficial. ”

“ If a medicine cannot be proved to pass into the blood or secretions, we cannot so certainly affirm that it does not act through the nerves. But the experiments of Tiedemann and Gmelin, and since then of Wöhler, have definitively settled this point. The former two have found the great majority of mineral, and many vegetable substances, in the blood of animals to which they had been administered.
Thus, from these four considerations, we are strictly justified in concluding that a medicine must pass from the stomach into the blood before its action can be manifested. ”

“ It is generally believed among scientific men that each particle of a compound body is made up of a number of indivisible atoms, each of which is inconceivably minute in size. And as these compound bodies have each a peculiar chemical constitution, so must each of their ultimate parts be composed of a peculiar arrangement of simpler atoms, and thus have a certain shape of its own more or less different from the shape of every other compound atom. Both the substance of a nerve, and the active part of a nerve-medicine, consist of a number of definite compound atoms. ”

“ It is certainly to be regarded as a very beautiful arrangement in the animal economy, that those substances which are not acted upon by an acid fluid should be subsequently subjected to the action of a free alkali, so that by the successive action of these solvents, together with the peculiar process of stomach digestion, the great majority of substances taken into the system are dissolved and rendered fit for absorption. ”

“ And when we are inclined to hazard a theory that is barely supported, we should take care to state it as a theory, and not to bring it forward as a truth. It has not been an uncommon habit among scientific authors, who should be of all men the most careful and exact, to confound assertion with fact—to mistake hypothesis for truth. ”

“ 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. ”

“ But Alcohol is a potent agent for evil as well as for good. When large quantities are taken continually for a considerable length of time, it is capable of producing a chronic injury of the brain and mind. By impairing the function of the former, it brings on the shaking paralysis of Delirium tremens. By an action on the mind, it causes the strange hallucinations and the habitual despondency which characterize that disorder. Habitual drinking may likewise cause a chronic inflammation of the liver, called Cirrhosis, which is succeeded by Dropsy. Alcohol is absorbed by the stomach ”

“ But, granting that it has been shown that introduction into the stomach is not necessary for the action of a medicine, and that when in the stomach medicines do not act by influencing the nerves, still it may be objected that the rule cannot possibly be universal. It may be urged that some poisons and medicines, as Hydrocyanic acid and Ammonia, act with such great rapidity, that we can only suppose their influence to be transmitted directly along a nerve-fibre to the nervous centre, because the process of passage in the blood to this distant part would be far too slow. ”

“ We might already have concluded that, as a general rule, it is impossible for medicines to exert their primary action on a remote part by nervous or any other agency, but that they must actually reach the part which they affect by means of the circulation. The experiments, already quoted, of Magendie, Blake, Ehbert, and others, show that even those medicines and poisons which tend most powerfully to influence the nervous centres, cannot act by nervous connexion, or without being allowed to pass on in the blood. They must actually reach the brain, before they can act upon it. ”

“ In cases of congestion on account of cardiac disease, Digitalis, which, by powerfully weakening the force of the heart, both diminishes congestion and favours absorption, is a most efficient promoter of the natural function of the kidneys. When the portal circulation is the seat of the obstruction, a mercurial, such as blue pill, which especially acts on the liver, will be a most desirable adjunct to the other remedies employed. Tobacco and Lobelia, like Digitalis, promote diuresis by diminishing the force of the heart. ”

“ From this failure we may infer that the idea that medicines differ prominently in causing or diminishing vital activity, upon which idea this and many other arrangements are founded, is in fact an erroneous one. There is no such universal distinction. A medicine which at one time raises or excites the vital forces, may at another time depress them; it may do one thing with a sick man, the other thing with a healthy man; it may have the one effect when taken for a short time in moderation, the other effect when taken for a long time or in excess. ”

“ On examination of the body after death the lungs are found to be healthy, but shrunken and bloodless; the trachea contains much frothy mucus, which may possibly have flowed into it on account of the palsy of the glottis; the cavities of the heart are full; the mucous membrane of the stomach pale. It seems then that the immediate cause of death is paralytic syncope,—a loss of power in the heart. As the mucous coat of the stomach evinces no trace of congestion, it is probable that the vomiting is not caused by irritation, but by a sedative or deranging action on the function of the Vagus nerve. ”

“ The only principles of action admitted here are these three, the same which are adopted by the disciples of Broussais. To suppose that medicines acting on the glands are only of use as revulsives, that they have no influence on the blood, and are never engaged in purging the system of peccant or morbid matter, is surely incorrect in theory. Medicines of the first class, when given in proper dose and in fit cases, are not engaged in destroying organization, nor is it invariably the case that such remedies as Mercury, Acids, and Alkalies act even as depressents, when given in moderation. ”

“ When a disease depends on a want of some material in the system, then it admits of being cured by a restorative, which, [Pg 157] 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. ”

“ The advantage of a stimulant is regulated by this rule. When there is a failure in vital energy, no Stimulant [Pg 231] will serve to prolong life, for it cannot communicate fresh vital power. But there may be no such failure of vital energy, and yet a sudden or accidental deficiency of nervous force may serve to peril the continuance of health, or even the tenure of life. For a certain degree of this nervous force is necessary both for life and health. When it is diminished, all the functions must suffer; when it fails entirely, the circulation must stop, and death ensues. ”

“ Lactic acid, the natural fuel, being deficient, the alkali with which it should combine must be present in some excess; so it seems likely that a free vegetable acid would combine at once with this alkali as the Lactic acid would have done, and thus be burnt or oxidized instead of the latter. Its action would then be simply Restorative. Requiring less Oxygen than the Proteine would need to transform it into Carbonic acid, it would thus diminish the number of the respirations, the frequency of the pulse, the temperature of the body,—and in this way allay the fever. ”

“ The impoverishing of the blood may be the ultimate action of such a medicine as Potash or Mercury, but not exactly the primary operation for which it is used in medicine. It is produced by the remedy when taken in excess, and not when given in small doses. Neurotics, or medicines which act on the nerves, are divided into those which affect the brain and spinal system, and those which are supposed to influence the ganglionic system, and through it the heart and great vessels. ”

“ Those doubts and difficulties, which are now slowly clearing away before the efforts of a few, will then be finally dispelled by the united energies of all; and instead of our present indecision and uncertainty on many points, we shall find ourselves eminently qualified to wage the conflict with disease, being skilled in that science whose name bespeaks its peculiar importance, the science of Therapeutics. ”

“ If only we could largely increase the secretion of urine, the pressure on the venous system would be diminished, and absorption of the effused fluids might take place. In some cases of dropsy caused by renal congestion, the attempt is so hopeless that it is better to resort to Diaphoretics. In obstruction on account of heart disease, or congestion of the liver, we may sometimes gain our point by combining other Diuretics with Digitalis or Blue-pill, remedies which tend to remove the causes by which the diuretic action is hindered. ”

“ A disorder of the liver by itself, i.e. unassociated with diseases of other organs, is comparatively uncommon. A failure in the secretion of bile is evidenced more or less by the well known icteric symptoms. Jaundice is often caused by an obstruction in the hepatic ducts. In such cases it is worse than useless to urge the liver to an extra formation of a secretion which can find no outlet. But other cases, in which the discoloration of the skin is in general incomplete, may be due to torpidity, congestion, or chronic inflammation of the organ. ”

“ 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. ”