162 THERAPEUTICS AND PHARMACOLOGY 



I myself have had the pleasure of seeing that by this cooperation 

 of medicine with organic chemistry an impulse has been given to 

 therapeutics, which, in spite of a certain opposition, cannot again 

 disappear from the sphere of research, an opinion which was held 

 and expressed on the part of chemistry by the late A. W. von Hoff- 

 mann. 



A good example is furnished by chloral, a drug formerly belonging 

 to the chemical rarities, because Liebig's method of production 

 provided no means of obtaining sufficient quantities for experi- 

 mental medical research. This body was known as a chemical sub- 

 stance as early as 1832; but its intrinsic, therapeutic value was not 

 discovered until the year 1868. It is in America more than anywhere 

 else that these investigations have received the fullest appreciation. 

 The use of chloral hydrate was based upon the idea that when taken 

 up into the blood a splitting-off of chloroform takes place, as is 

 the case outside the organism in the presence of all alkalies. This 

 point has been the subject of much controversy. There can be 

 absolutely no doubt that whenever chloral has had no soporific 

 effect, a considerable quantity of urochloralic acid can be found 

 in the urine, which must be traced back to the chloral. It is 

 equally certain, however, that small quantities of urochloralic acid 

 always are to be found in the urine after the administration of 

 chloral. But it is just as true that the main therapeutic effect de- 

 pends on the formation of chloroform. Only those who consider 

 these principles will, as is shown by clinical experience, be able 

 to observe chloral in the full unfolding of its effect. Shortly after 

 its effect had become known the Glasgow clinician, Russel, proved 

 that in conditions of excitement in typhoid fever, owing to the 

 marked increase of the alkalinity of the tissues, small doses of 

 chloral hydrate through their decomposition manifest the same 

 effect as that produced only by large doses in similar conditions in 

 other diseases. On the other hand, in gout the opposite happens. 

 Even large doses do not produce the desired effect, since alkali is 

 lacking for the decomposition. 



But we cannot judge of all organic bodies from the standpoint 

 of decomposition. Many take up substances from the organism, and 

 since the discovery that benzoic acid becomes hippuric acid, and 

 salicylic acid changes to salicyluric acid, it has been proved that the 

 opposite of decomposition takes place with a number of drugs. 

 Furthermore, it does not seem impossible that many substances 

 unite with the disease-products formed in the organism. This hypo- 

 thesis may be supported by the fact that the system itself produces 

 an acid, such as glycuronic acid, which carries off foreign substances 

 from the organism, such as camphor, phenol, etc., in the form of 

 a double combination. 



