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MATERIA MEDICA AND DRUG THERAPY
A MONTHLY JOURNAL FOR THE PRACTICING PHYSICIAN
CONDUCTED AND PUBLISHED BY
MERCK & CO., NEW YORK
MATERIA MEDICA AND DRUG THERAPY
A MONTHLY JOURNAL FOR THE PRACTICING PHYSICIAN CONDUCTED AND PUBLISHED BY MERCK & CO.
UNIVERSITY PLACE, NEW YORK
SUBSCRIPTION: $1.00 A YBAR, PAYABLE IN ADVANCE; FOREIGN COUNTRIES, $1.50
Some Notable Gains in Materia Medica during the Nineteenth Century
T present one of the most popular sidering, the one that holds out the greatest AT
themes of discussion in journals of hope comes from chemistry. As yet pracevery kind is the triumphs of the last tically nothing has been done with it by the century over Nature, and their relative im- therapeutist. Perhaps more than a century portance as compared with those made dur- of research will be required to gather sufing preceding centuries. The general ver- ficient facts to render it more than a dream. dict appears to be that in every department We refer to the attempt being made to disof human effort and thought no other cen- cover the connection between molecular tury is in any manner comparable with the structure and the physiological effects of nineteenth. Indeed, the consensus of opin- organic bodies. We know that the carboxyl ion is that nothing short of a millennium of group always produces a sour taste and preceding time can come anywhere near that the acidity of organic bodies increases showing so immense a gain. Some go so in the ratio of the weight of the molecule far as to hold that it requires the combined to the number of carboxyl groups that it gains of all past historic time to match the carries. It has raised the question as to successes of this one century.
whether or not the physiological and theraIt is a pleasing fact to us that in this peutic qualities of every substance are not swift and certain race for human weal, ma- functions of structure and weight. Menteria medica and therapeutics, in spite of deleeff's law is the expression of this printhe pessimistic claims of doubters, have ciple for inorganic matter. held their own with other departments of Spurred on by what is already known in modern science along lines of practical re- this direction, a host of chemists are at search and empiric discovery. So far as work on this problem because of the promgeneralization and the enunciation of fun- ise of fame and fortune which it holds out damental natural laws are concerned, very to them. They are trying to discover what little has been done, although even here is the structural cause of variations in color, there has been enough to enable the far- variations in taste, and variations in other seeing to spell out success for the workers properties, in order to know how to comof the twentieth century.
mand the production of such substances as Among the grand problems which the possess a given set of valuable properties. pioneers of therapeutic philosophy are con- Recent discoveries in the laws of solubilities are helping in the solution of this prob- for very shame openly to avow this doclem by showing how many properties are trine. The conduct of these doubters, howdue to what are known as ions, or free ever, confirms this interpretation of their atoms and free compound radicals, charged methods and silence. If pressed to explain with opposite qualities of electricity. This their true position, some of the more knowdiscovery has taught us that salt does not ing ones would no doubt confess their owe its physiological properties to mole- skepticism, and, in justification, refer to the cules of sodium chloride, but to free atoms apparent fact that most gains now being of chlorine and free atoms of sodium made in materia medica are within the limcharged respectively with positive and its of a few distinct classes of remedies. We negative electricity. The ions, therefore, have been discovering hypnotics, analgesics, have to be looked to in future to give up antiseptics, and antipyretics by wholesale the secrets of quality in accordance with and every eye is fixed chiefly upon these. the periodic law.
The men who believe that we are at the end A century ago Dr. Benjamin Smith Bar- of useful discovery ask us what we are getton, Professor of Materia Medica in the ting beside these. To superficial thinkers University of Pennsylvania, wrote in his this question is difficult to answer, but after "Collection for an Essay Towards a Ma- a little consideration it is discovered to be teria Medica of the United States” (Bulle- pointless. Are we not also getting coughtin of the Lloyd Library of Botany, Phar- relieving remedies, substances that stimumacy, and Materia Medica, No. 1, 1900; late digestion and secretion of digestive Reproduction Series, No. 1, xi): "I am not fluids, bodies that check hemorrhage ignorant that there are some persons who through the nervous system without the consider the science of medicine as a science production of a clot, local anesthetics, of extreme simplicity; who believe, or af- tasteless antiperiodics, substances that act fect to believe, that in the treatment of dis- antiseptically after reaching the bladder eases, we have arrived at something like and that relieve the victims of uric-acid the ultimatum of perfection. We are al- poisoning, serums that act as specific deready, say these persons, in possession of stroyers of diphtheria, and last, but not all the means that are necessary for the least, glandular secretions, like those of the alleviation, or for the cure, of our diseases. thyroid gland, that supply deficiencies of It is needless then to ransack nature any the normal constituents of the blood, the further.”
absence of which perverts metabolism. Suppose the men who held such views Surely these belie the claims of those who one hundred years ago should now be res- hold that discovery is being confined to but urrected and enabled to realize fully the ex- a few classes of remedies, however numertent and quality of our medical supplies, ous they may be individually. what would they be likely to think of them? It is probable that the discovery of new Let them have placed before them chloro- classes of drugs will go on until they beform, ether, cocaine, and the various ex
come as embarrassing in their numbers as ternal and internal antiseptics now at our the special new remedies already are. There command, and have them see how we will not, however, be any reasonable cause rationally use them. Would it not be a for rebellion against such progress.
The great revelation to them and a complete more there are the more will be the opporrebuke to their old-time conceit? Although tunities for natural selection to get in its we have barely made a start along the road good work and give us a decided survival of therapeutic progress, there are still many of the fittest. A proper censorship, to act medical men who act as if inwardly con- as a directing agent protecting the profesvinced of the truth of the fallacy so neatlysion from deception, is all that is needed to challenged by Prof. Barton. So numerous put everything appertaining to materia and so startling have Leen the accessions of medica on a perfectly sound basis. May this the past few years that no one now dares censorship be quickly established !
(Written for MERCK'S ARCHIVES]
death that are important factors. A few THE RATIONAL TREATMENT OF PULMO. kind and encouraging words from the NARY HEMORRHAGE
physician to the effect that the bleeding By William J. Robinson, Ph.G., M.D., New York
will soon stop and that there is no imminent
danger, act like balm on the patient and In no class of cases is the raison d'être of go far toward the actual checking of the the medical profession so apparent, in no hemorrhage. I lay special stress on the class of cases is the presence of a tactful last point. The condition of shock the paand competent physician so welcomed and tient is in tends to contract the cutaneous appreciated as in emergency cases, and no arterioles and capillaries and, by thus forcother class of cases presents in equal meas- ing the blood towards the visceral vessels, ure the opportunities for the making and increases the intrapulmonary blood-presthe unmaking of a physician's reputation; sure; the direct and immediate result of because it is in those sudden, life-threaten- this is an aggravation of the hemorrhage, ing accidents that he is enabled to demon- both in duration and in severity. Now, by strate, more than anywhere else, what his relieving the mental anxiety of the patient, skill and knowledge can do over and above the cutaneous vessels relax-as is evithe vis medicatrix nature. It therefore denced by the deathly paleness of the face follows that however uncertain and vacil- giving way to a natural color—and the lating a physician may be in his treatment amount of blood in the lungs is directly of ordinary diseases, he must have clear- diminished. We thus see that the reascut ideas and a well thought-out plan of suring words have not only a humanitarian treatment when he is called to an emer
value in that they decrease anxiety and gency case. And the young physician who suffering, but exercise a beneficial influence is always on the alert and is always found on the hemorrhage itself. well prepared to treat such cases is likely to The next thing to do, if it has not been become a successful practitioner-success- done already, is to unloosen the clothing ful financially and successful in saving of the patient and to put him down in a many human lives.
semi-recumbent position. I prefer the semiAmong emergency cases, hemorrhages recumbent to the recumbent position for from the various organs occupy a prom
the following reason chiefly: it facilitates inent place, and in this paper we will take the expectoration of the exuded blood and up the treatment of one of the commonest mucus. While we must do all in our power forms of hemorrhage--hemorrhage from to prevent further bleeding, there is no obthe lungs. Throughout this article we use ject in attempting to retain in the bronchi the term pulmonary hemorrhage as distinct and alveoli the blood that is already there; from hemoptysis; the expectoration of in fact, such retention can only have a slight amounts of blood, or a blood-tinged doubly pernicious effect; first, by its desputum requires very little treatment, composition it is likely to give rise to bronaside from that of the causative disease, chitis and broncho-pneumonia, sometimes which-in nine cases out of every ten-is of a particularly pernicious type; second, tuberculosis.
its presence prolongs an irritation and To enter into a discussion of the etiology cough, which are antagonistic to the sealand diagnosis of pulmonary hemorrhage is ing up of the bleeding vessel. In fact, the superfluous; no subject is better known; its possibility of asphyxia being caused by the differential diagnosis from hematemesis is overfilling of the bronchi with blood canmore difficult on paper than it is in real not be altogether excluded. The second practice; as a rule, a correct diagnosis is reason for my objection to the recumbent made by the patient before the arrival of posture is that such a position favors the the physician.
regurgitation of blood from the diseased The important question, then, is: What lung into the healthy one-a condition are we to do when called in to treat a case which common sense tells us must be preof hemorrhage from the lungs? .The very vented at all hazards. A third reason is first thing to do is to allay the anxiety of that in the recumbent position the heart the patient and that of his friends and rela- beat is stronger than in the semi-recumtives. It is well known that the extreme bent; and in pulmonary hemorrhage, as in shock in which we sometimes find patients all other hemorrhages, a strong heart-beat with pulmonary hemorrhage is due not so is not a desideratum; it is only in condimuch to the actual loss of blood as to tion of extreme collapse that cardiac mental and psychic influences; it is the stimulation may become imperative, as we sight of blood-especially in those with shall see later on. The patient must refirst attacks---and the fear of bleeding to main in the position he is in, as quiet as