Chapter II., that with regard to Eliminative medicines, the

Hom[oe]opathic theory is founded on a misapprehension of facts.

It must not be inferred, from what has been said on the importance of blood-medicines, that I am disposed to agree with those who would account for all diseases by some fault in the humours of the body. For though we know that many cases of convulsive disorder, as of Hysteria, Chorea, and Epilepsy, may be reasonably accounted for by supposing the existence of a wrong in the blood, which has affected the nervous system,--yet there are doubtless many nervous affections which are primarily independent of the blood, which can only be treated by Neurotic medicines, and even then often without benefit.

Thus far I have chiefly dealt in assertions on the subject of Hæmatic medicines, but I am now about to attempt a thing which is more difficult, that is, positive proof.

I shall treat separately of Restoratives and Catalytics; each division will be divided into certain distinct orders of medicines; and of each of these orders in turn I shall attempt to prove what is laid down concisely in Proposition VII. To simplify this proof, that part of the Proposition which relates to Restoratives will be divided first into a number of minor propositions, which, taken together, imply the original one. Each must be shortly proved applicable to each order of Restoratives. The same will be subsequently done with Catalytics. Having sustained the original proposition to my own satisfaction, I shall, in some cases, venture to offer an additional hypothesis--only as hypothetical--on the action of particular medicines.

Let us now proceed to the consideration of the first division of Hæmatic medicines.

RESTORATIVES.

The general name given to the medicines in this division is founded upon a fact relative to their action, which will be acknowledged of most that I have here included--namely, that they restore to the blood certain materials in which it is deficient.[31]

I will divide them into six orders, which are all distinct and characteristic in their mode of action.

RESTAURANTIA.

Ord. 1. Alimenta. Ord. 2. Acida. Ord. 3. Alkalia. Ord. 4. Tonica. Ord. 5. Chalybeata. Ord. 6. Solventia.

On reverting to Proposition VII., which treats of the action of the first class of medicines, it will be seen that what has been there stated with respect to the action of Restoratives resolves itself into the following simple affirmations or minor propositions.

_m. p._ 1.--That they act in the blood, and that their effect is permanent.

_m. p._ 2.--That there are naturally in the blood substances which resemble or coincide with them.

_m. p._ 3.--That they are not of necessity excreted, but may remain in the blood.

_m. p._ 4.--That they are of use when a disease depends on the want of one or more materials in the blood.

It will be seen that the first minor proposition affirms them to be Hæmatic medicines, according to the definition given before. The second is required; for if there were not a necessity in the blood for substances like them, they could supply nothing. The third also is necessary, for if they were excreted in all cases, it is evident that their Restorative action could not be lasting. An exception must be made in the case of those that are used to supply something which is necessary in order that a secretion may be properly elaborated. Medicines of the Sixth Order are particularly used with this intent; as also some acids and alkalies. But these are not repugnant to the blood, like Catalytics. In the fourth place it is affirmed that being thus fitted for the blood, and allowed to remain in it, they tend to cure a disease which depends on the want of a substance similar in nature to themselves.

After giving a brief account of each of the orders of Restoratives, it will be my object to prove that these affirmations are severally applicable to each of them.

ORD. I. ALIMENTS.

An article of food is the simplest form, and in fact the type, of all medicines of this division. Out of the materials of the food the whole blood is constantly elaborated, and all the tissues are constructed.

Aliments were divided by Dr. Prout into four kinds:--(1) Aqueous; (2) Albuminous; (3) Saccharine; (4) Oleaginous. These kinds differ much in chemical conformation. The second kind alone contain Nitrogen. The last two are both called _carbonaceous_; but those of the fourth kind contain more Carbon than those of the third. The following will serve to illustrate the differences in the chemical composition of these groups.

1. Water = H O 2. Proteine = C_{40}H_{31}N_{5}O_{12} 3. Starch = C_{10}H_{10} O_{10} 4. Stearic Acid = C_{68}H_{68}O_{7}

Water is useful in dissolving the other elements, and reducing them to a state of solution which is fitted for the formation of blood, and of the other fluids of the body. We have already seen in what way these various matters are dissolved and absorbed in the _primæ viæ_, and how they pass into the circulation; that Proteinaceous and Saccharine matters pass into the capillaries of the Portal vein, and thence onwards through the liver; and that fatty matters are reduced to a kind of emulsion by the intestinal juices, and pass through the lacteals into the thoracic duct, by which they are conducted into the circulation at large.

What then are the chief uses for which these matters are required in the system, and what great functions do they fulfil?

The nitrogenous Aliments are needed particularly to supply the growth and waste of the muscular and nervous tissues, which both contain Nitrogen; as also do all the parts of the body, excepting Fat. This waste is continually going on. It depends upon the fact that, after having lasted a certain time, the particles of all these tissues are gradually displaced, oxidized, and conveyed away out of the blood into the urine and other secretions. In the urine these waste matters are found as Urea, Uric acid, and Kreatine.

The starchy and saccharine parts of the food are destined to pass through a series of changes, which ends also in their being burnt and oxidized, maintaining the animal heat, and forming Carbonic acid. Starch passes first into grape-sugar, by taking into itself two atoms of water, becoming C_{12}H_{12}O_{12}. The Ptyaline of Saliva, Pepsin of the gastric juice, and some similar principle in the Pancreatic fluid, are all capable of causing this first transformation. This sugar is more soluble than Starch. When in the blood, it undergoes a further change, the nature of which is not so clear. It is supposed to be into Lactic acid (C_{6}H_{5}O_{5}, HO_{7}) whose equivalent number is just half that of anhydrous grape-sugar, so that one atom of the latter may become two of the former. This important compound was found by Berzelius, in 1807, to exist constantly in the juice of muscle, as well as in the urine and sweat. (_Annuaire_, 1848, p. 347.) Liebig at first controverted this, but in 1847 he assented to the statement of Berzelius, which had already been further confirmed by the experiments of M. Pelouze. Many modern chemists, among whom may be mentioned Dr. Bence Jones,[32] consider that Lactic acid, or some compound nearly resembling it, is formed at this step of the process of changes connected with the function of respiration. The acid next combines with free Soda, existing in the blood; and this salt is oxidized into Carbonate of Soda and water, just as a Tartrate or a Citrate might be. (_Vide_ page 127.) This has been ascertained by Magnus and Dumas.

Fatty matters are used in the production and renovation of the adipose tissues; and may also, like the last, be burnt and oxidized to support the animal heat.

As a general rule, the diet of a man in health should contain a due proportion of all four kinds of food; for each one of them is essential, and has its proper function in the system. The albuminous material cannot be dispensed with; and is also the only food which will suffice by itself to sustain life. The mode in which it can adapt itself to perform the office of the other varieties of food was ill understood, until explained by the researches of M. Bernard.

From some experiments detailed in a paper read before the Académie Française in 1848, he concluded that the liver was capable of actually producing sugar and fat out of Proteine compounds. For he found sugar to exist in the substance of the liver when none was to be detected in the blood of the Portal vein which proceeds to it. His results have been mainly confirmed by M. Lehmann. M. Bernard states further, that the action of the liver is in some way essential to the assimilation of saccharine matters; for he has found that when sugar is injected into the veins beyond the liver, it passes out unaltered in the urine.

Thus the process of assimilation, whether of albuminous or of saccharine matters, is not so easy and so simple a thing as might at first be imagined. The study of this process is of great importance; and it appears to afford us a clue to the causation of certain disorders of the blood, of which I shall have to speak hereafter.

Upon the regulation of diet, one of the most important of the duties that devolve upon the medical man, it is not my purpose to make more than a few observations.

All kinds of food are less required by the system in inflammatory and febrile disorders; and should then be administered sparingly, or wholly denied, according to the severity of the case. But in Typhus fever long abstinence would be dangerous; the patient is in peril from extreme weakness and inanition, and, being often totally unconscious of his natural wants, requires to be carefully sustained by constant and small increments of animal and farinaceous food.

Water may be given largely whenever we wish to increase the amount of any of the fluid secretions; as the urine, to render less likely the deposition of gravel; or the perspiration, when it is desirable to promote it in fevers or other disorders.

Albuminous food is always necessary in health, and is contained not only in the flesh of animals, but in vegetable substances in their natural condition. It is recommended to restrict it in the management of gouty or plethoric patients. On the other hand, animal is more easily digested than vegetable food in many cases of dyspepsia.

In Diabetes mellitus, when a large quantity of sugar is excreted in the urine, it is a common practice to confine the patient to a diet of meat and gluten bread. This latter is a tough horny material, prepared from flour from which the starch has been separated by washing. It is thought that if no starch be given, no sugar can be formed; but it is found that, though both the amount of urine and the quantity of sugar in it are diminished by this plan, yet the latter does not wholly disappear. This may be easily accounted for, if we admit that sugar may be formed from albumen. Water should be given sparingly in this disease; for the more a patient drinks, the more urine he passes, and all of the same high specific gravity.

Fat may be given in Diabetes, for it is not proved that it can be converted into sugar; but as the contrary seems to be the case with albumen, and it being impossible to withhold this, the cure of the patient by mere dieting may be considered almost hopeless.

We have seen that Starchy and saccharine matters form an important element of the food; and that, by combining in the blood with the Oxygen absorbed in the respiratory process, they are of use in maintaining the heat of the body. In some constitutions there is a peculiar tendency to an abnormal oxidation of these materials into Oxalic acid. It appears likely that Cane-sugar is more liable to this change than Grape-sugar, although it may occur with the latter. Thus the patient is sometimes benefited by an injunction to abstain entirely from this article of food.

Fatty matters need not be given where there is organic disease of the Pancreas; as in that case they are not rightly digested. This is a rare case. They are sometimes repugnant to the stomach, from other causes.

The application of oily substances to the cure of Phthisis is a matter of considerable importance. Of late years Cod-liver oil has been used with more success than any other medicine, both as a prophylactic, and as a curative agent in this disease. When this remedy is considered separately in Chap. IV., mention will be made of several theories which have been propounded to account for its mode of operation. Liebig's idea that there is in Phthisis an excess of Oxygen in the system, would, if sufficiently supported, serve to explain its action when considered simply as oil. This Oxygen would consume the Carbon and Hydrogen in the food, and prevent the accumulation of fat. (_Liebig's Animal Chemistry_,