The Action of Medicines in the System. Frederick William Headland
tends.
| Dr. Pereira's Classes. | ||
| Class IV. Hæmatica. | ||
| 1. Spanæmica. | ||
| 2. Hæmatinica. | ||
| Class V. Pneumatica. | ||
| Class VI. Neurotica. | ||
| 1. Cerebro-spinalia. | ||
| 2. Ganglionica. | ||
| Class VII. Cœliaca. | ||
| Class VIII. Eccritica. | ||
| Class IX. Genetica. | ||
These groups, though differently placed, correspond to six of Eberle's seven classes. The class acting on the muscular system is omitted. The subdivision here is more accurate and scientific. Hæmatics or blood-medicines, are divided into two classes. Spanæmics the first of these, are named from their tendency to impoverish the blood.Hæmatinics including the compounds of Iron, tend to enrich it. In the first division are included the medicines commonly termed Alteratives, as well as Acids, Alkalies, the compounds of Lead, Silver, Copper, etc. In the selection of the above name attention is paid to the abstract physiological effect of these medicines, rather than to their therapeutical applications. 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. (When we shall afterwards discuss the action of nerve-medicines, it will be seen that it is very difficult, if not impossible, to enforce this distinction.) The different kinds of Narcotics form the first division, while the second includes Stimulants and vascular Sedatives. The class of Eccritics includes all medicines acting on the glands, commonly called Evacuants.
The details of this arrangement, to which I shall at present venture to object, are, first, the multiplicity of classes, and secondly, the inclusion of certain medicines in the division of Cerebro-spinals.
Three of the classes seem to be superfluous, and only tend to confuse. There is a class of Pneumatics, acting on the respiratory organs. But Expectorants are found elsewhere among Eccritics; and those medicines which influence the nerves of the lungs, among Neurotics. The same with Cœliacs; for Cathartics, found among Eccritics, are the most important medicines acting on the intestines. Genetics contain medicines which control the uterine and sexual systems, which may all be reckoned among Neurotics. And yet this multiplicity of names is consistently employed in carrying out the principle of this classification, which is, to arrange according to the different parts of the system all substances which have any tendency to act on those parts.
Dr. Pereira makes four orders of Cerebro-spinals; three include different kinds of Narcotics, very minutely subdivided; another is called Cinetics. They affect the muscular system; but it is altogether an assumption to assert that these medicines, Astringents and Tonics, do so by influencing the nerves. As to Astringents, it appears that they do not affect the nerves in any way, for which reason I shall have to make a separate class of them. For Tonics, there is great reason to suppose that in the first place they act on the blood; so that I cannot agree with Dr. Pereira, who ranks them among Neurotics. Emetics are classed by him among Eccritics; but it seems to me that their action is either external, and of an irritant nature, or when from the blood, that it is exerted upon the nerves of the stomach. The stomach is not, like most glandular organs, a simple emunctory, and it is affected by medicines in a different way. Whereas gland-medicines increase secretion, the chief action of Emetics is to cause an evacuation of the contents of the stomach by contraction of itself and of other muscles. All substances which touch the stomach cause the copious outpouring of a thin fluid by mere contact; yet we cannot for this reason call them medicines which tend to increase secretion. Emetics acting from the blood after absorption, as Tartar emetic, which generally influence at the same time either the lungs or the heart, parts supplied by the other branches of the Vagus nerve, which is distributed to the stomach, seem to me to be Specific Neurotics, probably acting on that nerve. So that in these points, as well as in some others, I am disposed to differ from Dr. Pereira.
It is apparent that in none of the classifications of this second kind is any mention made of the primary action or modus operandi of medicines in the cure of disease, as a necessary basis of such distinctions.
III. Opinions concerning the Mode of Operation of Medicines, and Classifications founded on this.
In this third division are included those writers who have attempted to account for the mode in which medicines produce each their peculiar effects after entering into the blood, and some who have classified them according to their ideas on this point. It is with such theories as these that I am more immediately concerned in this Essay. Such writers have dived into a deeper subject than those who have directed attention to the general effects or tendencies of medicines rather than to the means by which such results are attained. Thus it is not to be wondered at that they have sometimes failed. Those have erred most who have allowed their imaginations to lead them astray from facts, or to guide them in matters which are naturally incomprehensible, to which our reason gives us no clue.
Attempts have been made to account for the modus operandi of therapeutic agents generally, in three different ways.
1. On mechanical principles.
2. On chemical principles.
3. On general or vital principles.
1. Mechanical theories of the action of medicines were greatly in vogue during the seventeenth and eighteenth centuries. There is a tendency in the human mind to explain every thing; and it was only natural for men who knew little of chemistry or of physiology to resort to the science of physics, which they could comprehend, in attempting the explanation of observed phenomena.
John Locke, in his essay concerning the Human Understanding, published in 1689, gave it as his opinion, that the shapes of the minute particles of medicines were sufficient to account for their several operations.
"Did we know," said he, "the mechanical affections of the particles of rhubarb, hemlock, opium, and a man, as a watchmaker does those of a watch, whereby it performs its operations, and of a file, which, by rubbing on them, will alter the figure of any of the wheels, we should be able to tell beforehand that rhubarb will purge, hemlock kill, and opium make a man sleep." This idea did not originate with the great metaphysician. The first rudiments are to be found in the doctrines of the Methodic Sect among the Romans, a medical branch of the Epicurean school. They held that diseases depended either on constriction or relaxation of the tissues, and that medicines operated by mechanically affecting these conditions.
The simple and philosophical statement of Locke was not improved by the various applications which were subsequently made of it. At the early part of the eighteenth century these ideas derived great support from the principles inculcated by Dr. Herman Boerhaave, the learned physician of Leyden. He likewise supposed that many diseases of the solid parts were to be attributed to a weakness or laxity of the animal fibres, and were to be cured by external or internal agents, which should act mechanically on those fibres so as to increase their tenacity. Also, that disorders of the fluids often depended on their being too viscid, and that this condition might be improved by agents which should attenuate this viscidity. Dr. Archibald Pitcairn, a Scotchman, the immediate predecessor and contemporary of Boerhaave, was elected to the Chair of Physic in Leyden in 1691, and was also an able exponent of the mathematical theories. But he applied to physiology those ideas which were employed by the other to throw light upon physic; if that may be called light which was at least an improvement on the