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NA TURE 



[April 19, 1894 



the hands of the inexperienced drugs can cause death 

 {(pap/jLaKfia — the use of medicines or poisons), so that 

 the science and art of the introduction of medica- 

 ments into the human body with the view of healing it carry 

 '■ ith due right the appropriate title of " Pharmaco-therapeutics." 

 And at one time, pharmaco-therapeutics was the most im- 

 portant branch of tiie healing art, though in our days it has 

 declined and occupies but a second, or perhaps, I should say, 

 third place ; operative surgery, proud of its victories, and as 

 admired as admirable, full of vigour and sap, has distanced the 

 ancient branch. And, again, we see hygiene, young, fresh, 

 lovely, and assured beforehand of all suffrages, taking its place 

 in the front of all medical science, confident in the future success 

 of its attempts to render the arts of healing superfluous by pre- 

 venting the malady. Why, then, it may be asked, do I essay to 

 interest you in an art which seems to be growing old under our 

 eyes ; whose past, it is true, is very honourable, but whose 

 future hardly seems to promise the triumphs that have fallen to 

 the lot of surgery and of hygiene. My reply is simple — because 

 we shall not be able to dispense with this essential branch of our 

 art ; because, as much in external as internal medicamentation, 

 we must for the present make use of pharmaco-therapeutics. 



The Prime Importance of Chemistry. 



The substances that we employ in medicine are composed of 

 chemical bodies, or are, perchance^ pure chemical bodies ; 

 and to understand their physiological action we must have 

 recourse to biology and chemistry ; while to appreciate their 

 application in disease it is necessary to study pathology and 

 therapeutics. Chemistry, in its wide sense, enables us to 

 understand the composition, the structure, and what I would 

 term the affinities of a substance, as it is chemistry that 

 enables us to analyse by tests, and to construct and reconstruct 

 by synthesis. The relations between chemistry, on the one 

 hand, and pharmaco-therapeutics and materia medica, on the 

 other, are so intimate, so indissoluble, and so obvious that 

 it almost seems to me superfluous to trouble you with their 

 consideration. However, you will not mind, I hope, if I take 

 the liberty of submitting to you a few points which may not 

 be new, but which at any rate have the merit of being 

 apropos, and may by thought upon them make us better 

 appreciate chemistry. To pile stones on the top of each 

 other is not to construct an edifice. Without a 

 definite plan, without a general view — that is, a com- 

 prehensive conception of the whole constructive scheme — 

 there can be no scientific edifice durably reared. Therefore, it 

 would not be sufficient to constitute pharmaco-therapeutics a 

 science to say that if it has arisen without preconceived ideas it 

 is founded upon observations extending from the most ancient 

 date with regard to the effects produced by the administration 

 of certain substances to the sick ; nor is it sufficient to claim 

 that pharmaco-therapeutics has availed itself of experiments on 

 healthy man and on animals, and has taken into consideration 

 physiological results and the fruits of clinical study. A sound basis 

 of operation from which to inquire into the use of medical sub- 

 stances is required. W^e must know, if we would satisfy the 

 claims of science, the mode of action of these substances, and 

 understand how it comes about that they possess the power to 

 produce or remove functional troubles. And it is here that 

 chemistry comes to our aid— chemistry in general, chemistry 

 in its largest sense. I in no way lose sight of the incom- 

 parable services of biological chemistry and physiological 

 experiment. Who of us would overlook the assiduous 

 and successful work of Coppola, Gracosa, Pellacano, 

 Albertoni, and of all that young Italian school that 

 is now marching victoriously along the route traced out for 

 them by Fraser and Brown ? The method of action of medical 

 substances has been and will be rendered more clear and com- 

 prehensible by their researches ; but this is not enough. The 

 conscientious striver after truth will always find himself face to 

 face with one problem, a problem in the solution of which lie 

 concealed — an inextricable secret so far — the true phenomena 

 of life. We recognise this, for everywhere ; where we are 

 powerless to comprehend the action of medical substances upon 

 the living organism as being due to their own inherent proper- 

 ties, we do not hesitate to call to our assistance the unknown 

 properties of living protoplasm, and attribute the phenomena 

 to them ; but it is chemistry that should tell us that we must 

 not be discouraged by the enigma of life. Enigma there is 

 doubtless, but let us recall that Lavoisier first named life "a 



NO. 1277, VOL. 49] 



chemical function," and that- — once given that the creature lives- 

 — from that it obeys neither more nor less than dead or material 

 nature the general laws of chemistry. 



Vital Phenomena and their Meaning. 



The familiar phrases "living force " or "vital phenomena' 

 serve us to design the outward expressions of condensed energy 

 in dead material, being borrowed from the manifestations of 

 life. In dead material, we are all aware, force can appear as 

 thermal energy, as electricity, as light, or as mechanical expres- 

 sion, and we can go back along this line of transformations and 

 see all the changes unmake themselves. In living protoplasm 

 — considered as the unit of the psychic and reproductive func- 

 tions — the essential phenomena are the same. There is the 

 same change of roles, the same production of warmth, elec- 

 tricity, mechanical energy, and chemical energy. We know 

 that the living cell "reacts," as we please to term it, to vari- 

 ations of temperature, electricity, light, and energy, chemical 

 and mechanical ; but this irritability in the cell, this aptitude 

 of the cell to change one form of energy for another, re- 

 sembles the transformations that take place in dead 

 material, as the stimulants of the living cell, with- 

 out which the vital phenomena do not appear, are just 

 the different forms of energy which arrive to it from its en- 

 vironment, and which it changes into chemical energy.^ For 

 life the cell must have warmth and moisture. Take away the 

 moisture or lower the temperature to the necessary point, and 

 life becomes latent or disappears. In dead nature the same takes 

 place. We are all familiar with the admirable experiments of 

 Prof Pictet, bearing upon this point. He proved by them be- 

 yond dispute that chemical energy disappeared and reappeared 

 in accordance with the temperature to which certain substances 

 were submitted, and that water is every whit as indispensable 

 as a proper temperature for the maintenance of the phenomena, 

 of life. Certain it is that life is a chemical function, but the 

 point is — Is not the chemical function a sort of Jife ? Did not 

 the father of medicine show a wonderful insight in counting, 

 water and fire among the four elements of which the universe 

 is composed ? 



Now if we examine closer the special problems which fall 

 within the scope of pharmaco-therapeutics, if we examine the 

 results which follow the introduction of drugs — healing or 

 poisonous — into the organism of man and animals, it must ap- 

 pear that we can never learn how to solve the problems without 

 looking for their explanation in these " vital elements," as I 

 may term them. The manifestations of their agency in the. 

 behaviour of living organism have so characteristic an imprint, 

 that even Claude JBernard himself did not hesitate to place 

 chemical and purely physical action in the comparative 

 background. I will give examples of my meaning. How 

 are we to understand the fact that the ingestion of in- 

 finitesimal quantities of certain substances which pass through- 

 the organism without causing in it the least change can provoke 

 such disordered chemical actions as to occasion death ? How 

 are we to understand the fact that different parts of the 

 organism seem to be able to distinguish these sub- 

 stances the one from the other? We must admit special 

 elective functions proper to the life of the cells. How are we 

 to understand the facts that nothing but a change in the. 

 quantity of their dosage, the duration of their administration,, 

 and the method of their application suffices to make of certain, 

 toxic substances stimulants or paralysants ? How are we to- 

 understand the fact that insoluble substances like arsenic,, 

 cannabis indica, and lead can defy that well-known axiom,. 

 Corpora iion agiint nisi sohita, and manifest therapeutic and 

 toxic action. We must admit the presence and agency of some 

 unknown power within the living cell. How, again, are we to 

 understand the therapeutic power exhibited by solutions of iodine 

 and bromine which have apparently been diluted to the de- 

 privation of all chemical action, unless we attribute to the living 

 cell the power of liberating the iodine and the bromine from such 

 dilute solutions ? Thanks to my compatriot and dear colleague 

 at the University of Amsterdam, Prof, van t'Hoff, thanks to the 

 admirable work of Arrhenius and of Ostwald, thanks to con- 

 gresses of physicians and chemists, light seems to me to beabou 

 to be shed upon all these dark places in pharmaco-therapeutics. 

 And it has not been Mahomet who has gone to the mour' 



' It must be remembered that all of this is qualified by Prof. Stokvis's 

 original reservation, " Once given that the creature lives." 



