A treatise on therapeutics : comprising materia medica and toxicology, with especial reference to the application of the physiological action of drugs to clinical medicine

Front matter

‘Sir Vrs Ee weve FELEP TUT ee Te 7 8 Aw he les ted tes a yo aN

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Preface To The First Edition

Ar the present time, when the shelves of private and public libraries are groaning beneath their ever-increasing loads, when a thousand presses in every city send forth day and night their printed messages until the earth is filled with them, it seems almost presumptuous for any one to offer new volumes to the world. Indeed, art is so long, life is so short, that every student has the right to demand of an author by what authority he doeth these things, and to challenge every memoir for its raison d’étre. This being so, it assuredly will not appear egotistical for the author to state that his voluntary task was first suggested by his own wants, and that to its performance he has brought the training, labor, and experience of years spent in the laboratory, the study, the class-room, and the hospital ward.

There are a number of excellent treatises upon materia medica and therapeutics ; yet in various attempts at original research, as well as in the ward and the lecture-room of the hospital, I have keenly felt the want of something more. There are many points of view from which a subject can be looked at; there are many paths by which it may be approached ; and to me, other points of view, other modes of approach, have been far more enticing. than those

‘adopted in our standard treatises.

The old and tried method in therapeutics is that of empiricism, or, if the term sound harsh, of clinical experience. As stated by one of its most ardent supporters, the best possible development of this plan of investigation is to be found in a close and careful analysis of casés before and after the administration of a remedy, and, if the results be favorable, the continued use of the drug in similar cases. It is evident that this is not a new path, but a highway already worn with the eager but weary feet of the profession for two thousand years.

That very much has been thus accomplished it were folly to deny. Leaving out of sight the growth of the last two decades, almost all of the current therapeutic knowledge has been gained in this way.

Therapeutics developed in this manner cannot, however, rest upon a secure foundation. What to-day is believed is to-morrow to be cast aside, certainly has been the law of advancement, and seemingly must continue to be so. What has clinical therapeutics established permanently and indisputably ? Scarcely anything beyond the primary facts that quinia will arrest an intermittent, that salts will purge, and that opium will quiet pain and lull to sleep.

To establish therapeutic facts the profession clings as with the heart

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conclusion is a non-sequitur, and difference of susceptibility is no proof of dif: ference in the mode of impression. A teaspoonful of Epsom salt may purge one man, whilst it may require ounces to affect another. Evidently there is a difference of susceptibility ; but when the impression is once made it is of the same character in each case. As with man and man, so with man and the pigeon,—susceptibility is no measure or gauge of the character of the unpression.

A large number of drugs—indeed, it may be said, the larger number of important drugs—exert in the system antagonistic actions. Thus, atropia stimulates the spinal cord, but destroys the conducting power of the nerve-trunks. It is evident that as one or the other of these influences predomi nates, will there be convulsions or paralysis. Now, if for any reason one animal be exceedingly sensitive to the spinal action of atropia, that animal will in belladonna-poisoning suffer from convulsions, whilst its fellow, which is affected chiefly by the nerve-action of the drug, will, under like cireumstances, have paralysis. Here the mere clinician, with his superficial knowledge, seeing the paralyzed and the convulsed lying side by side, says, What a hopeless muddle! Poor fools, these vivisectors! they will never come to any good! In truth, the differences in symptoms in these and in many other cases simply depend upon differences in susceptibility; and the only lesson that the circumstance teaches is the importance of discovering the laws which govern these susceptibilities.

A law which governs the susceptibility to the action of drugs is, that the more highly specialized any system is, the more readily affected is it by a medicine. Thus, the cerebrum of a man is far more highly organized than that of any other animal, and consequently he is far more sensitive to the action of drugs which affect the cerebrum than are the lower forms. Again, in the frog the spinal system is especially developed,—probably, in proportion to the cerebrum, more so than in any other of the animals commonly experimented with: consequently the batrachian is excessively sensitive to remedies which, like strychnia, affect the spinal cord. In obedience to this law, we have resulting the action of opium,—an action which has been considered the strongest proof of the hopelessness of any attempt to explain the effects of drugs upon a man by experiments upon the lower animals. In man, opium vauses deep stupor and general relaxation; in the frog, it causes tetanic convulsions. The explanation of these seeming inconsistencies is, however, very evident when the whole subject is looked at. Opium in all animals has a double action, one upon the cerebrum and one upon the spinal centres. In the frog, the latter being the more highly organized, the spinal action overcomes the cerebral; in man, the cerebrum being the more sensitive, stupor replaces the convulsions: yet in man convulsions sometimes occur in opium-poisoning, and in the frog the dose can be so managed as to cause stupor.

A second law which seems to hold sway over the action of drugs upon different animals is that great differences of function in a system affect its

PREFACE TO THE FIRST EDITION. ix relation to drugs: thus, in a herbivorous animal the alimentary canal is very different from what it is in the carnivora, whose digestive organs in turn differ from those of man,—the omnivore. Medicines which act upon the alimentary canal are apt to vary in their effects upon different orders of animals.

Converse to the above law is that which renders systems which are little specialized similarly acted upon by drugs in different classes of animals.

Thus, the general structure and the functions of the circulatory system are _ very uniform among vertebrates, as is also the action of those drugs which affect chiefly the circulation: thus, aconite, or digitalis, or potash, influences in the one way the heart of the frog, of the rabbit, and of man.

There are a very few apparent exceptions to the uniformity of the action of drugs upon all animals, which seemingly contravene the laws that have been mentioned. These exceptions are so few, however, that without doubt advancing knowledge will by-and-by explain them all and show what are the laws which for the time being hold in abeyance or overcome those already stated.

An asserted fact, which has recently been brought forward as revealing the worthlessness of animal experimentation, is that some monkeys are not susceptible to the action of strychnia, whilst others are. Granting the truth of the asserted fact, it certainly is explainable. It is at least conceivable that a given species of animal may, by the gradually-acquired habit of feeding upon a substance containing a narcotic poison, acquire an insusceptibility to the influence of that poison, which shall, as it were, belong to its specific type, or, in other words, be an acquired specific character. The nervous system of the opium-eater becomes accustomed to the stimulant, and it is not impossible that a measure of the habit should be transmitted. If the Darwinian law of the gradual evolution by the survival of the fittest have any force, these curious apparent freaks of medicines in regard to their physiological action may be the result of this law, especially since it is species which are affected. It is not all monkeys that are proof against strychnia, but, as we are distinctly told, only one species of monkey; and, so far as I know, it is not all deer that are said to thrive when fed upon tobacco, but only the Virginia deer. Whether this conception be or be not a mere fancy, this much is to my mind very clear, that the few scattered exceptions ought not to outweigh the immense mass of evidence upon the other side, and that it is inconceivable that drugs, in their relations to animal organisms, differ from all other created things in not being subject to law.

In the early portion of this preface I stated that the work had grown out of a need felt by myself: that need was for a book into which should be gathered the many scattered facts in regard to the physiological action of medicine,—a book in which an attempt should be made to sift the true from the false, to reconcile seeming differences, to point out what we know and what we do not know, and to give a platform from which investigators might start forward without the necessity of being, as is so often the case, ignorant of what was already achieved, or of spending a great deal of time in a wild x PREFACE TO THE FIRST EDITION.

hunt through the almost boundless, but often scattered and inaccessible, ranges of Continental literature.

The plan of the present work has been to make the physiological action of remedies the principal point in discussion. A thoroughly scientific treatise would in each article simply show what the drug does when put into a healthy man, and afterwards point out to what diseases or morbid processes such action is able to afford relief. Unfortunately, in the great majority of cases our knowledge is not complete enough for this, and the clinical method has to be used to supplement the scientific plan.

I have added to the book a consideration of toxicology, so far as it is of interest to the physician. This has been done for several reasons. First, it was necessary to study the action of poisonous drugs upon man, in order to make out their physiological action; secondly, physicians are constantly required to diagnose and to treat cases of poisoning ; thirdly, it is often of the greatest importance for a medical man in a court of law to be able to state what are the symptoms and post-mortem appearances produced by a given poison, what diseases they simulate, and how far and in what they differ from the phenomena of these diseases. That part of the science of toxicology which treats of the recognition of poisons in the cadaver, or in food and drink, belongs to the domain of the chemist, and I have avoided it altogether. For a similar reason, in the sections on materia medica, the chemical relations of mineral substances have not been discussed at all.

Preface to the Sixth Edition The rapid exhaustion of the successive editions has not only stimulated the author to render the volume, as far as - lay in his power, worthy of the kind judgment and continued favor of his co-laborers, but has given him an opportunity to maintain its freshness. Comparatively few persons have a full conception of the rapid advancement of therapeutic science or the amount of labor involved in keeping up with such advance. Although only two years have elapsed since the last edition of this treatise, yet nearly four hundred papers have been studied in preparing the present one. An article upon Cocaine has been added, the chapter upon Disinfectants entirely rewritten, old literature restudied, and every endeavor made to have the book represent even more thoroughly than before the best therapeutic thoughts of the day.

Table Of Contents

LnTRopucTION.—Pharmacy—Therapeutics—Materia Medica—Pharmacopeia

—Preparations—Effects of Medicines—Classification. PART I.—DRUGS.

DIVISION I—SYSTEMIC REMEDIES.

Part Ii.—forces

Catoric.—Heat: its Use in Shock, Collapse, etce.—Cold: its Local Use; its Use as a Tonic; its Use in Pyrexia.

ELEcTriciry.—General Considerations ; Diagnostic Use; Use in Palsies; Use in Neuralgias; Application to Motor Apparatus; Application to Sensory Apparatus; Application to Nerve-Centres; Use as a Tonic.

Appendix

Tur ART OF PRESCRIBING MEDICINES.

TABLES.

Cc i i eee

A TREATISE

ON

TFHERAPHRUSICE.

INCLUDING

MATERIA MEDICA AND TOXICOLOGY.