454 
Pharmacologic  Superstitions. 
/Am.  Jour.  Pharm. 
October,  19 17. 
to  be  placed  on  the  market  until  the  conclusions  of  his  laboratory 
were  clinically  tested  in  the  hospital.  Ehrlich  felt  the  need  of  clin- 
ical confirmation  in  the  claims  for  his  new  remedy,  but  it  is  extremely 
rare  that  laboratory  workers  are  able  to  present  such  direct  or  defi- 
nite evidence  as  to  the  value  of  a  therapeutic  agent. 
We  reach  conclusions  of  therapeutic  usefulness  by  a  circuitous 
route :  the  pathologist  tells  first  what  he  believes  is  the  nature  of  the 
morbid  disturbance,  the  pharmacologist  explains  how  the  drug 
seems  to  modify  the  bodily  functions,  the  practitioner  tries  if  the  ob- 
servation of  the  pharmacologist  fits  to  that  of  the  pathologist  as  one 
should  expect.  It  is  like  a  puzzle  picture:  the  color  and  shape  of 
one  piece  seems  to  indicate  its  juxtaposition  to  another;  but  only 
when  they  are  actually  fitted  into  each  other  can  we  be  sure  that  they 
really  do  belong  together.  To  change  the  simile,  we  build  up  a 
system  of  treatment  on  the  foundation  of  pathologic  hypothesis, 
using  stones  of  pharmacologic  experiments  cemented  together  by 
deductive  reasoning.  The  clinical  imperfections  of  the  structure 
may  or  may  not  be  manifest  at  once.  Only  after  the  building  has 
withstood  many  storms  can  we  be  sure  of  its  stability.  The  weak- 
nesses which  develop  may  be  due  to  the  faults  in  the  pathologic  or 
pharmacologic  building  material,  but  above  all  to  the  weakness  of 
our  dialectic  binding  together. 
Perhaps  I  can  make  my  meaning  clearer  by  concrete  examples. 
The  efifects  of  certain  drugs  in  relieving  symptoms  are  so  obvious 
that  even  the  most  casual  observer  can  convince  himself  of  their 
action.  Antimony  will  produce  emesis,  or  pilocarpin  increase  the 
secretion  of  sweat  with  such  infallibility  that  even  the  prejudiced  ob- 
server could  not  fail  to  connect  cause  and  effect ;  but  the  question  of 
whether  the  emetic  action  of  antimony  is  beneficial  in  pneumonia,  as 
the  ancients  believed,  or  whether  the  diaphoresis  produced  by  pilo- 
carpin is  useful  in  uremia,  as  we  believe,  requires  nicer  discrimina- 
tion and  cannot  be  answered  dogmatically.  The  commonly  accepted 
theory  of  uremia  is  that  the  symptoms  are  caused  by  the  retention 
of  some  poison  in  the  system,  and  that  by  the  use  of  eliminants  we 
bring  about  the  excretion  of  this  poison  through  other  channels. 
After  all,  however,  it  cannot  be  considered  as  proved  that  uremia  is 
due  to  the  retention  of  a  poison,  and  our  theories  that  purgation  and 
sweating  are  capable  of  carrying  off  this  poison  are  certainly  not 
positively  established.  But  because  of  our  belief  in  the  pathogen- 
esis of  this  condition,  and  our  faith  in  the  effect  of  eliminating  meas- 
