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Biodynamics vs. Pharmacodynamics

CHAPTER XLIV

   For generations it has been asserted that drugs, food, drink, etc., act upon the living organism and that disease is a something which seizes upon the organism and seeks its destruction; in a word, it is an almost universal belief that the living organism is an object to be acted upon by extraneous matter, and not the actor which seizes and appropriates or rejects food, drink, drugs, etc., and that the process of rejection is the essential disease. Due to the folly of supposing that the nature of life on the one hand and of drugs, food or drink on the other is changed because the individual has become weakened, it has proved difficult to immediately abandon the belief in the action of lifeless things.

   While in health it may be admitted that the organism acts, in disease it is said the drug acts or the food and drink act upon the organism. The folly of thinking that the relations of lifeless substances to the living organism are changed merely because the organism is sick or weak should be patent to every intelligent individual. The Hygienic theory that, in the relations between living structures and lifeless matter, the living is active and the lifeless passive, always, was first advanced by Dr. Trall in 1850. This principle is a vitally important one and must sooner or later be accepted by the men of science.

   Writing in 1865, the famous French physiologist, Claude Benard, said: ". . . when we reach the limit of vivisection, we have other means of going deeper and dealing with the elementary parts of organisms where the elementary properties of vital phenomenon have their seat. We can introduce poisons into the circulation, which carry their specific action to one or another histological unit . . . poisons are veritable reagents of life, extremely delicate instruments which dissect vital units. I believe myself the first to consider the study of poisons from this point of view, for I am of the opinion that studious attention to agents which alter histological units should form the common foundation of general physiology, pathology and therapeutics."

   Benard's idea that poisons act upon histological units and that a study of such actions would supply a foundation for therapeutics, while expressing a popular view of life, is the exact opposite of the Hygienic view. Trall had previously employed the phenomena of drug administration as a means of studying pathology, but it certainly has no relation to physiology nor can it be said to have any possible connection with any system of therapeutics that could be based upon physiological principles. Today one sees such unscientific statements as "a potential therapeutic agent (a drug) is first screened for biological activity in laboratory mammals." How any sane man can seriously speak of the biological activity of a drug (a poison) is beyond the writer's comprehension. The only possible actions of which drugs are capable are mechanical and chemical and, as these relate to the living organism, such actions are destructive.

   It was generally admitted that "the operations of medicines (drugs) are not susceptible to that precise demonstration peculiar to the sciences of chemistry and mathematics . . ." It was also admitted that, though a drug "may fulfill an indication so far as its sensible action is concerned, it may still be doubtful whether it has accomplished a single point in the curative process of the case; in fact, we know that it has not unfrequently happened that medicine has essentially aggravated the disease, without any suspicion, at the time, that it had any relation to the change which followed its operation." This simple confession of ignorance of how drugs act was repeated over and over in many forms.

   The celebrated Dr. Meigs of Philadelphia wrote in his letter on Woman and Her Diseases: "I conceive that we have not and cannot ever reasonably expect to have any very clear notions as to the methodus operandi of any medicine. Who can explain the cathartic power of jalap as contradistinguished from the emetic force attendant upon the general constitution of calicea ipecauna, or the tartrate of antimony and potash?

   "We are well acquainted with the facts, the phenomena; yet to say why tartar emetic shall produce vomiting, while sulphate of magnesia shall have the effect of a purgation, is beyond the power of the human mind . . . I do not consider myself as credulous in believing that iron has a special affinity to invigorate the tissues composing the paermatosic membrane; certainly not more so than ten thousand American physicians, who confidently administer five or twenty grains of calomel, with the utmost certainty of exciting the liver into greater or more healthy activity; squills to excite the mucous follicles of the bronchi; nitre to arouse the kidneys, or belladonna to arouse the skin; and strychnia to wake up again the torpid muscles of a paralytic leg or arm. In the methodus operandi of drugs and medicines, all our cogitations are purely empirical."

   In its issue of March, 1853 (page 672), the New Orleans Medical and Surgical Journal says: "We are free to confess that the profession knows, in reality, little or nothing of the modus operandi of therapeutic agents; from the most obvious effects of medicines, we are too ready to conclude that we appreciate their full influence upon the economy; forgetting in the meantime, all those molecular changes which are undoubtedly brought about by every perturbating agent which may be applied to, or introduced into the living system. To know that one medicine acts as a cathartic, another as a narcotic, and so on, is indeed to restrict our information to a few simple self-evident facts; but to go beyond this limit--to fathom the mysteries of therapeutics, hic opus, hic labor est--this is the Gordian knot, which as yet we are not prepared to untie. Perhaps the day is not far distant, when, by the aid of organic chemistry, we may be made acquainted with the influence of medicinal substances upon the organism; at present, however, we must be content with the knowledge of a few isolated facts and look forward to the future for more reliable information on the subject of therapeutics. The great discrepancy of opinion which everywhere exists on the peculiar action of most medicinal substances, proves conclusively how little we actually know of therapeutics."

   It must have been a pleasant feeling to have been able to look forward, hopefully, to the future to demonstrate that they were right and to have no doubts about the outcome. To be able to rely upon the "self-evident facts" that "one medicine acts as a cathartic, another as a narcotic, and so on," and to be secure in the blind belief that in the near future, organic chemistry would give them a basis for their therapeutics, must have steadied the hand that poured the poisonous drugs; but it provided no safety for the patient.

   During the more than one hundred and fourteen years that have slipped into the past since the foregoing quotation was published, chemistry and physics have undergone radical revolutions. Two whole new branches of chemistry--physical chemistry and biochemistry--have come into existence. The revolution in physics has given us nuclear physics and her sister, high energy physics. Physiology and biology have grown to maturity; pathology has come of age. Physicians, biologists, chemists, pathologists, pharmacologists, clinicians and therapeutists have performed millions of experiments trying to determine how drugs act or operate. But with all the changes that have taken place, with all the advancement that has been made, with all the study and investigation that have been done, drugs remain as actionless today as they were in the middle of the last century. How they act, if they act, is still a deep, dark secret.

   For a slightly longer time, the Hygienic explanation of the modus operandi of drugs has been before the world; but the men of science have been content to ignore it. It seems to the present writer that the time is ripe for the whole subject to be made public and subjected to the judgment of an enlightened community. But, it may be asked, are the modes of action of drugs not known? Has science not discovered the answer?

   In the meantime, the Hygienic position and explanation have been before the world for more than a hundred years. Trall gave, in the first edition (1851) of the Hydropathic Encyclopedia, what Hygienists, from that day to this, have contended is a true explanation of the modus operandi of drugs; but the profession, recognizing in this explanation, the complete destruction of the drugging practice, has persistently and consistently rejected it.

   No pen can exaggerate the importance of ascertaining the truth about this subject. For, if our position is correct, it logically follows that all drugs are absolutely poisonous and not to be introduced into nor applied upon the body. The inference from this very plainly is thakt the true mode of caring for the sick must be predicated on the employment, entirely, of some other materials.

   Our position is simply this: the symptoms or phenomena which result when a drug is taken into the body are activities of the living structures in resisting and expelling the drug, and not the actions of the drug. Hygienists teach that, instead of drugs acting on the living structures, medicinally, the body acts to resist and expel the drug; hence, they are injurious nuisances and not remedies. Admit the truth of this principle, and medicine is a dead system.

   Whether lifeless matter acts on living structure or living structure acts on lifeless matter is a problem in natural science. It is not a medical question. It may be considered by the biologist, the physiologist, the physicist, the chemist, even by the mathematician and the mechanic, as much as by the physician.

   The digestive system acts on the food substances supplied it and, in its cooperative capacities, prepares the food proper for absorption, rejecting the residium as a foreign mass incapable of subserving organic purposes. Foods do not "act as aliments of the organism." A wholesome meal would be just as active in the stomach, the function of which is impaired, as it would be in a healthy stomach; but it would not digest. A meal is digested in proportion to the functioning power of the stomach and not in proportion to the activity of the meal. It is easy to perceive that the parts of the living organism--hands, teeth, tongue, jaws, glands of the mouth, stomach, intestines, liver, pancreas, veins, lacteals, heart, arteries, etc., always act on the food to convey it to the mouth, chew it, swallow it, digest it, absorb and circulate it and make it available for the cells to assimilate it.

   If we introduce into the healthy digestive tract a ripe, mellow apple, a whole series of actions follow, by which the apple is digested and assimilated. In the mouth, the apple is chewed and mixed with saliva. It is swallowed and reaches the stomach, where its digestion proper begins. Digestion, secretion, propulsion, absorption, circulation and assimilation (processes by which the apple is made into tissue) are all work of the living system, not of the apple. Introduce into another healthy digestive tract a dose of milk of magnesia and a whole series of actions follow, by which the drug is cast out of the system. Secretion, propulsion, diarrhea (processes by which the drug is expelled), are actions of the living system, not of the drug.

   Neither the apple nor the drug do anything in the digestive tract; but the organs of this tract, perceiving the relations of these two substances to the vital structures, the vital instincts recognizing in the one a food, in the other a poison, institute the appropriate actions in each instance. The one, a food, is digested and absorbed, circulated and assimilated; the other, a poison, is recognized as a foreign, unusable and injurious substance, and the whole organic community cooperates in expelling it. The living system carries it out of the body and ejects it by the bowels. This expulsion is called the cathartic action of the drug; whereas, the action is entirely that of the living organism. As well speak of the digestive action of the apple as of the cathartic action of the drug. Catharsis, like digestion, is vital action. The drug is as passive in the digestive tract as is the apple.

   The vital "living" organism recognizes the presence of non-usable substances and institutes measures to expel them. The action that results is not that of the drug on the system, but of the system on the drug. This principle may explain the phenomena attendant upon the administration of all drugs which are supposed to possess remedial properties. These actions involve, not merely the use, but the expenditure of the energies of the organism, thus leaving the body exhausted of functioning power. The dynamic capacities of the human system, as these vary with the conditions and circumstances of life, are reduced by every dose of drug that is administered.

   We may correctly say that whatever is taken into the domain of life that is incapable of supplying nutriment for the living tissues, is speedily ejected, without compromise or reserve, through the most convenient channel. Thus it is that, when deleterious (unusable) substances are taken into the body, either as food or drink, it becomes necessary that conservative action should interpose resistance and expel the injurious material. So long as life lasts, this is to say, so long as the power of resistance remains, active resistance to incompatible substances will be manifest when they are taken into the body. The powers of life manifest a deep interest in removing toxic substances from the body.

   Trall's premise was simply that the alleged remedial agents of the medical system do not act upon the living system, but that those effects which were called remedial result wholly from the action of the living system upon or against the remedial agents. His premise was simply this: in the relations between the living organism and lifeless matter, lifeless matter remains wholly quiescent and passive. Action is the greatest characteristic of life; inertia is the leading characteristic of lifeless matter. According to this principle, all the actions we witness when a drug is administered are actions of the living system.

   Our mental vision often suffers from great errors of refraction and our preconceived notions frequently prove to be distorting media that sometimes cause the most sublime truths to appear absurd. Our general proposition involves the relations of those substances that we call drugs, chemicals, "remedies," medicines, foods, etc., to the structures of the living body. It does not involve a denial of what is called chemical action, which is but the union and disunion of elements. When elements unite, such chemical action means the formation of a third substance out of the union of two. If this were to take place in the living organism, this is to say, if the drug should combine with the cell or with some of the constituents of the cell, this would be the death of the cell. Cells resist such unions so that they can occur only after the cell is dead.

   Our position is that drugs do not act on living structures. We have nothing to do with the relations of such substances to dead tissues. A dead body is not a living one, and the relations of chemicals to dead tissues are not identical with their relations to living structures. In the one case, there is chemical affinity; in the other, there is vital antagonism. The living organism protects itself from the injurious agency of all material things-no chemical can act on organized bodies so long as they continue alive. We do not deny chemical actions on lifeless tissues. But let us think for a minute of the essential distinction between dead or lifeless and organic or living structure. Living structure acts on or appropriates or resists and expels lifeless materials-it acts upon lifeless substances. So long as the cell retains the power of resistance, it prevents the union of chemicals with its constituents.

   It is the nature or property of lifeless substance to remain quiescent and do nothing. Inertia is its leading quality. Inertia, the tendency to remain forever in the same state and place, is its nature and its last and only property. Its property is a negative one. It may be moved or impelled as acted upon from without; it cannot move or impel itself.

   Inertia is a principle indelibly stamped upon every constituent part of the universe as an indispensable necessity. The countless multitudes of suns and planets that roll through the heavens; the ocean's waves cleaving, clashing, sporting with the clouds their mists have formed; these clouds sailing on the wings of the wind, to be sprinkled by electric flash over the earth's green carpet, livening up all nature, then murmuring off along the valley, trickling down the mountain's craig or rushing headlong over the waterfall, seeping into the sandy bosom of the earth and gushing forth in bubbling fountains to return murmuring, spouting, splashing, dashing, sporting back into the "parent ocean," there to be again lifted up into the clouds to fall again--in all this vast universe of ceaseless motion, we see but the principle of inertia in operation.

   Action, as distinct from mere motion, we meet with only when we come to view organized and living bodies. In the growth of plants, the sporting myriads of winged creatures, the happy choir of feathered warblers, the buzzing, creeping, roaming, running, jumping, dancing multitudes of earth, we see action. Here we see beings that are organized and energized for action. Even in the countless contrivances of man--the iron horse, driven by steam; the motor responsive to domesticated lightening; the internal combustion engine that is harnessed to use the explosions of gasoline; the linotype machine that matches the human body in its complexity; the printing press that is the "archimedean lever" that lifts mankind upward--in all these we observe motions that are somewhat analogous with the actions of the living body. For action in its purest and truest form, we must turn to living structures for our examples.

   Living structures have the property or power of action and nothing else does, this being one of the distinctions between lifeless and living things. The nature of living structure is to act; the property of living organs is action. Living structures act on everything else, to use or to resist. This should be clear enough.

   We insist upon the full recognition of the fact that the living organism is a dynamic and initiating being and is not merely the plaything of inanimate existence around it. The so-called scientific world has gone overboard for the concept of environmentally-conditioned action and fails to recognize the genuine source of activity.

   The muscular and nervous tissues are the instruments of action. To the physiologist, the organs of the body are animated and active, every fiber pulsating with sensibility and endowed with the power to act. The conclusion is forced upon us that the characteristics of each organ are involved in the action which produces the results in all cases. The wonderful delicacy and definiteness of actions which are constantly occurring in the body imply a corresponding delicacy and definiteness of structure. We do not have to assume a wholly mechanistic view of the living organism to recognize the fact that the peculiar actions of the body are grounded in its peculiar structures. If we concede that the peculiar, definite and delicate actions of the many varied structures of the organism rest on the structural modifications there existing, we are forced to recognize that those many and varied actions that have been mistaken for the actions of drugs are not drug actions at all, but actions of the highly differentiated and acting organism. Drugs lack the structural arrangements and the energies essential to such actions.

   The medical world has labored long enough under the delusion that lifeless matter has the property or power of action. Physicians say their drugs act; Hygienists say that they remain passive. In every case, when the "action of a drug" is explained, the act described is that of the living organ in resisting and expelling the drug. The error has always been that of placing the action in the lifeless substance; whereas, it is in the living, acting, perceiving organs themselves. In all this sensing or perceiving and the resulting actions, the outer world is entirely passive; the living structure alone does the acting. Let me repeat the Hygienic principle that: in the relations between living structure and lifeless matter, the living is active and the lifeless passive; hence, in its relation to the living organism, the property of lifeless matter is inertia. This has nothing to do with the relations of lifeless matter to lifeless matter. One is a vital problem; the other is a physical or chemical problem.

   Pharmacologists speak of the effects of drugs and the actions of drugs as one and the same thing and tell us that the duration of action of a drug depends in part on the extent to which it becomes localized in various tissues, but they have no means of knowing in most cases what the drug concentration in an organ amounts to. They know only that to occasion its characteristic effect, a drug must gain access to the tissues of the body in sufficient concentration to cause the tissue to resist and expel it by appreciable action.

   If it is administered orally, the drug must first be absorbed from the intestinal tract and carried by the blood stream to the various tissues of the body. When administered by injection, drugs have to be picked up by the blood at the site of injection and carried throughout the body. When a poison is brought into contact with the living tissues of the body, by medium of the circulation, each tissue acts to resist and expel it, thus giving rise to what are mistaken for the many side actions of drugs.

   When a pharmacologist lists the effects of a drug, he lists the symptomatology and pathology of an iatrogenic disease. This is not only true when he lists what he classifies as side effects and toxic effects, but it is equally true when he lists what he calls physiological and therapeutic effects. What physicians mean by iatrogenic diseases are such things as hepatitis, phlebitis, asthma, aplastic anemia, leukemia, cataract, cancer, etc.; but these are simply more or less localized symptomatologies and pathologies growing out of a systemic poisoning. They by no means represent all of the symptoms and pathology that result from the poisoning.

   Thus, however administered, drugs come in contact with the tissues generally; consequently, all talk of "sites of action," "target organ," "target site," "tissue distribution," "reactive site," and other such expressions are but jibberish by which the technical mind combs the wool of illusion, first, over its own eyes and, then, over the eyes of others.

   The great number and complexity of differentiated structures in the human organism, each possessed of its own particular behavior pattern, makes possible a great number and variety of actions as the poison, circulated by the blood, comes in contact with the body's different tissues. It is the complexity of human structure that makes possible the many and varied types of action that have been mistakenly credited to drugs, which possess none of the structural complexity upon which must rest so many different activities. It is this great complexity of structure and the resulting diversity of actions that makes possible the many alleged side actions of drugs.

   Pharmacologists say that "the duration of action of a drug depends in part on the extent to which it becomes localized in various tissues." This statement might have some validity if it could first be proved that the drugs have any action. But it is more correct to say that the duration of action of the body in resisting and expelling the drug depends in part on the extent to which it becomes localized in various tissues. And, living tissues, by virtue of their own inherent power to do so, resist all chemical actions and reactions with chemical substances that may be taken in. So long as they are alive, they continue to resist. Only when they are no longer alive can chemical unions occur. We do not dispute that lifeless matter can act chemically and mechanically. Our position is simply this, and has been from the time Trall first stated it: in the relations between lifeless matter and the living organism, the living organism is the actor.

   We explain the alleged actions of drugs by saying that they are actions of the body. When a drug is expelled through the kidneys by diuresis, it is misbranded a diuretic. It is wrongly said to act on the kidneys, when the opposite is the truth. Diuresis is kidney action in expelling the drug.

   The effects of their drugs may be choleresis, emesis, diarrhea, diaphoresis, diuresis, expectoration, tonicity or feverishness, antiphlogistication, etc.; but how are these effects explained? How do you explain a diarrhea, except in terms of bowel action? How do you explain diaphoresis, except in terms of sweating? Do the various drugs act, as we are taught, on these various structures, to produce these effects, or do the structures act on the drugs to expel them? Is the stomach a "receptor site" for a so-called emetic and the bowels a "receptor site" for a so-called cathartic? Is it reception or expulsion that we witness? Is it drug action or vital action that is observed?

   Pharmacologists ascribe the so-called action of a drug to its selective affinity; Hygienists admit the selection, but insist that it is the living organism and not the lifeless drug that makes the selection. If it be asked: what difference does it make which acts and which is acted upon, we reply: no truth can be insignificant to the scientist. Rather, it is true that to be exact and observing, and correct in describing what we have observed, is the all-important quality of the scientific mind, which well knows that mighty consequences often hang upon apparently insignificant trivia.

   "Drugs have a modus operandi," it was frequently asserted; "and whether the system acts on them, or they on the system, what's the odds?"was frequently asked. We can only marvel at such reasoning: as though ignorance can be just as valuable as knowledge: as though it makes no difference to our conduct whether we recognize that the man eats the potato and not that the potato eats the man: whether it makes no difference that it is the living organism that appropriates and rejects things in or from its environment, or these appropriate andreject the living organism. To us, the subject is all important; the progress, the very salvation of the human race is involved in it. Unless we start right, we travel forever in the wrong direction. On the contrary, if our first premises are correct, we are on the right road.

   When a man acknowledges the principle and then asks: "Of what practical use can it be?" he evinces a lack of sagacity which can be excused only by crediting to him inferior powers of observation. To know that a certain fact, theory or proposition is true, is sufficient in itself to commend it to our consideration. Does it make any difference whether the cathartic acts on the bowels or the bowels act on the drug, so long as a copious bowel movement results? The difference is precisely that between good and evil. Does it make no difference in a case of gangrenous limb, whether the gangrenous portion casts off the body or the body sloughs off the gangrenous portion? In teaching physiology, does it make no difference whether the muscles move the bones or the bones move the muscles, whether we say the stomach digests the food, or the food digests the stomach?

   If, as we contend, the body acts against drugs, as it acts against all injurious substances, all incompatibilities, all poisons, then the inevitable inference, that no sophistry can destroy, follows that all drug medication is a war upon life.

   The significant truth that the living organism acts upon lifeless or extraneous materials and not vice versa, is a fact exactly analogous to and quite as important as if the earth revolved around the sun and not contrariwise. It is the living organism, as it is the sun, that is the center of all life, power, action, in its own domain, and not the earth or the inert things of the earth.

   It was once a self-evident truth that the earth is flat and that the sun moves around the earth. A wealth of facts were adduced to prove that the sun, the center of our solar system, revolves about the earth and rises and sets each day; but perhaps the most convincing proof was the fact that people could see, with their own eyes, the sun rise in the East each morning, travel across the heavens each day, and set in the West each evening. With an equal show of reason, the pharmacologist can prove that aconite or gamboge acts on the muscular coats of the bowels. Like the older astronomers, they are guided by appearances; but appearances are deceptive.

   It was certain to our ancestors that if the earth rolled over instead of being "kept right side up," all the water in the oceans, lakes, rivers and ponds would spill out. They were deceived by appearances. They knew nothing of the phenomena of gravitation. In like manner, men are deceived by appearances when they talk learnedly of the actions of remedies. Having no conception of what Trall called the "law of relation between living and dead matter, between the human body and drug medicines," they lack a means of interpreting what they observe.

   Medical men do not doubt that their drugs act. Indeed, do they not see the actions they perform? They know that tranquilizers calm the emotional and steady the nerves of the irritable, because they see it. They know that cathartics move the bowels, for they can see the movement; they know that diuretics act on the kidneys, for they can see the action. But physicians and pharmacologists have got the cart before the horse. They have reversed the whole order of nature and have left out of their account the real actor--the living organism. They have given us the very opposite of truth. They have made the drug the actor and the living tissues the things acted upon--drugs the subject, life the object--the former more valuable than life is itself, because life is subordinate to them. They have mistaken one of the occasions for action as the actor or for the action itself.

   Physicians and pharmacologists speak of the properties of drugs, describing such properties as an emetic property, a cathartic property, a diuretic property, a narcotic property, a soporific property, and even discuss the physiological properties of their drugs. A property is a characteristic quality belonging to a person or thing. Bodies possess certain qualities or properties which are called essential because they are invaribly found in them; these essential properties are impenetrability, extension, figure, divisibility, attraction, inertia, etc.

   Matter has physical and chemical properties, but no physiological properties and cannot perform physiological actions. No chemist and no physicist has ever discovered the alleged medicinal properties that various drugs are supposed to possess. These are fictions of the medical imagination and grow out of mistaking the actions of the body in resisting and expelling drugs for the actions of the drugs. For example, a cathartic is a cathartic, not because of any alleged cathartic property of the drug, but because the bowels expel it by catharsis. A powerful cathartic is such only because the body expels by a powerful action.

   Every truth is explainable and we can never know it to be a truth until we can explain it. When it is asserted that we know that drugs act, but we cannot explain how they act, it is revealed that what is said to be knowledge is but a belief. The point is assumed that ought to be proved. Their argument amounts to nothing more substantial than: "We know they act because we know it."

   It is important that we have clear ideas of the relations that drugs hold to the living organism and that we understand that living tissues are not reagents that drugs may act chemically upon these. The actions seen and attributed to the lifeless, inert drugs are actions of the living structures.

   When extraneous substances and conditions are brought into contact with the living organism, it must act in relation to them in one of two ways:

  1. If they are useful materials, to appropriate and utilize them.
  2. If they are non-usable materials, to resist and expel them.

It thus appears that there are two modes of vital action, each of which must be maintained, or dissolution is the legitimate and immediate result. These are preservative and conservative. So wonderfully diligent and constant is the conservative action of the organism that many physiologists have thought that "life is a forced state."

   When the physiologist mistakes the feverish excitement and heat that constitute the process of expulsion of alcoholic beverages for the invigorating effects of this protoplasmic poison, he makes the same mistake as the physician and pharmacologist who attribute the actions of the body in resisting a poison to the poison itself. Precisely this same error is made by all those who think that tissues can be nourished and diseases cured with drug poisons.

   When it is declared that "cocoa acts directly on the sensory apparatus in the same manner as does strychnine," we can accept the toxic character of cocoa, but not its alleged action. Practically everybody knows that alcohol will cause a man to hic and spew, lie down in the gutter, hug a lamp post, utter nonsense, vomit, even wallow in his vomit; but we are skeptical of the hypothesis that attempts to explain how alcohol "excites the exercise of thought." We are also skeptical of the theory that tea and coffee do the same.

   In an effort to explain drug action, pharmacologists have come up with the idea that most drugs form reversible complexes with plasma proteins and with one or more intracellular components of cells. They say that these non-specific drug attachments provide reservoirs of drugs which are in dynamic equilibrium with the drug unbound in plasma. If it is true that these drugs combine with the proteins of the blood plasma, they destroy the suitability of these proteins for use by the cells.

   An example of the destructiveness of drug unions with intracellular components is supplied us by the so-called anti-tumor drugs, which are said to be usually anti-metabolic, and which block the pathways of metabolism common to normal as well as neoplastic tissues. Their alleged anti-tumor action is explained by saying that, "in being metabolized, they become enmeshed in mechanisms essential to the normal economy of the body." For the same reason, so it is said, they are toxic. These drugs act by so impairing the normal processes of metabolism that they kill cells. In simple English, they are poisons.

   The chemical combination of drugs with plasma constituents and with cell constituents cannot explain the alleged actions of drugs, for the reason that these combinations render action impossible. It was pointed out by Trall that when arsenic combines with the tissues, it converts these into dead, but fixed, chemical compounds. Certainly, there is no action, physiological or therapeutic, in arsenate of flesh.

   Another explanation of the alleged action of most drugs used medicinally is that they change the intensity of body function by acting on physiological control systems, especially those that mediate the adaptive response of the living organism. In keeping with the medical notion that drugs have power to act, such drugs are designated pharmacodynamic agents. It is said of such drugs that they mimic or release hormones or neuro-hormones or that they serve to block the action, synthesis, release, storage, or metabolism of these hormones. In further explaining the alleged action of such substances, it is said that untoward effects are due to an exaggeration of the desired action, or to an unwanted effect on a second physiological control system.

   When it is said that drugs act by acting on physiological control systems, the very thing that needs to be proved is assumed to be true. How explain the action of the drug on the physiological control system? To assume that they act by acting is not a solution to the problem before us. To call them pharmacodynamic agents is merely to embalm in technical jargon an ancient fallacy. From the Hygienic viewpoint, we observe biodynamics and not pharmacodynamics.

   Medical students, studying in their materia medica what are designated the properties of all the poisons of the three kingdoms of nature, firmly believe everything they read of the medicinal properties of herbs and minerals, and become lost in wonder and admiration at their astonishing qualities and powers, and at the great array of cures with which the physician is equipped.

   All manners of ingenious "incentives" to action are possessed by the medical profession--drugs to cause the stomach to empty itself, drugs to occasion violent bowel action, drugs to occasion diuresis, from the gentle tonic persuasives to the powerful revulsives and when, after such abuses, the offended organs cry out in pain or fail in their functions, they have other drugs with which to silence the outcries and further goad the organs to action. The basis of our objection to the employment of these substances in treating the sick is the well established relation existing between the living organism and all extraneous substances, properties and forces.

   Drugs can have but one primary effect, when introduced into or applied to the body, and this is the effect of bringing the forces of the body into activity in defense of the integrity of the body. The nervous system is a protective system of the general organism and, while it is unimpaired and filled with energy, no noxious substance can long be tolerated in the organism. In any action of the complex organism, there must first be the decision, what is to be done; then the nerves that control action must carry the message to the appropriate structures. These organs then act as instructed. Suppose, when an emetic is swallowed, the nerve wires get crossed and convey the message to the muscles of the lower limbs, then we would walk or run or kick or jump, but not vomit.

   It may be no easy task to determine the precise methodus mendendi of the living organism in producing the many and varied phenomena which have been mistakenly considered properties of drugs--such as tonic, astringent, emetic, cathartic, diaphoretic, diuretic, expectorant, narcotic, depressant, stimulant, etc.--but if we can establish the principle of vital agency and can demonstrate it as a general cause, it will require no stretch of the imagination to accept it as the probable truth rather than endow inert drugs with mystical virtues.

   The resident forces in the various tissues, acting in their preservative capacities against that which is unusable, hence hurtful in its relations with the living organism, give rise to all the actions that follow the administration of drugs. Vital resistance in order to self-preservation is the law. Hence, what we view is not the modus operandi of drugs, but the modus operandi of the vital organism. There is no such thing as the modus operandi of a drug. This term, when applied to drugs, is a misnomer; its use tends most certainly to lead the mind astray, since it expresses a fallacy.

   On this basis, we do not say that cantharide has a "special affinity" for the kidneys, but that the poison is excreted through the kidneys; it has no diuretic property, but as a poison, is expelled by diuresis. So-called cathartics do not have a "special affinity" for the membranes of the alimentary canal, but are recognized by these membranes as unsuitable for entrance into the body and are expelled by catharsis. To express this as a law, we would say that, resident forces in the various tissues, acting preservatively, expel the non-usable substances, and this determines the modus operandi of all drugs.

   The doctrine of the older pharmacologists that drugs elect or select particular organs or structures on which to act, either therapeutically or toxicologically, constitutes the basis of the whole system of drugging the sick. The Hygienic doctrine, as developed by Trall, is the exact opposite of this. We say that the living system, the organism itself, elects or selects the particular structure or organ through which it can best expel the drug.

   It is a law of organic existence that living structures reject, resist and expel all injurious substances, that they shall act on the defensive, that they shall protect themselves from injury, and maintain so far as possible an equilibrium of organic and nervous forces--hence, the resistance and expulsive actions when any incompatible thing comes in contact with the living structures, the resistance being in direct proportion to the degree of incompatibility, and in keeping with the power of action of the organism. In extreme cases of paraplegia, when the bowels and lower extremities are paralyzed, cathartics lose their "special affinity" for the bowels.

   The actions of the living structures in relation to drugs determine the properties of the drugs--they are one thing or another, depending on the manner in which the body finds it expedient to cast them out. Some are ejected by vomiting, some by diarrhea, some by diuresis, some by diaphoresis, some by expectoration,etc. No greater blunder was ever made than that of having drugs act on the body.

   Drugs will be expelled in the most convenient manner, through the most efficient channel. In all ages, medical men have mistaken these defensive and expulsive actions for the actions of their drugs. Their drugs have acted on the stomach, on the bowels, on the kidneys, on the circulation, depending on the resistive and expulsive processes instituted by the body.

   Suppose we apply drugs to a dead organism, which, as we know, is a bundle of useless inertia: will there be any action? No action whatever will be perceived, simply because the presence of the drug will occasion no vital resistance; and there is no vital resistance, because the dead organism lacks all power of resistance. Dead organisms do not act to preserve and to repair themselves. There is no living system to act and, hence, no action. Yet, the properties of the drug would remain the same.

   If drugs are applied to the living organism, there will be increased action. If they are applied to the skin, there will be increased redness of the skin. The increased redness is caused by the increased amount of blood in the part and the increased blood in the part is sent there by the living organism to resist the drug. The phenomena of emesis, catharsis, diuresis, vesication, etc., cannot possibly occur in the dead organism. The dead body does not act to defend itself from or to cast out poisonous substances.

   If we return to the past and view the phenomena resulting when a blistering plaster was applied to the skin, we get a graphic picture of the difference between the behavior of a living and a dead organism. If capsicum, Spanish fly, caustic potash, sulphuric acid, tartar emetic or a mustard plaster was applied to the skin of a well man, the surface was first reddened, then the skin became hot, painful, inflamed, and blood serum was poured out in defense. If the application was continued, serum was poured into the "space" between the inner and outer layers of the skin, the cuticle was raised and a blister was formed. The blister formed a bar or partition between the poisonous drug and the living tissues underneath. Not until the living cells underneath have exhausted themselves does the drug combine with their substance and destroy them. The outer layer of the skin was sacrificed, being ultimately cast off, to defend the deeper tissues. The deeper layers of the skin may also be sacrificed, if necessary, to protect the more vital tissues beneath.

   Even admitting that the structural constituents with which poisons combine are not forced to do so by chemical extraction, but are set out defensively by the living principle as a sacrifice to prevent its more important tissues from being harmed, you cannot certainly prove that this is not a living sacrifice. It appears that the living body sacrifices part of itself to save its more important parts.

   How do we explain these phenomena? Were these processes the actions of the blister (the drug) or the vital structures? Does the drug act to raise the cuticle? Does it drain the capillaries of their serum? Does it act on the glands to induce them to defend themselves? What acts and why? What is acted upon? Does the drug sacrifice the outer skin or does the body make the sacrifice?

   Perhaps the solution to these questions may be found if we consider the application of a "blistering plaster" to the skin of a dead man. If we try the blister on the body of a freshly killed man (one killed in an accident), perhaps we will receive the answer. There is no apparent effect at all. There is no action and this inertia speaks louder than words. The skin does not redden; no serum is poured out; the layers of the skin do not separate; there is no smarting of the skin; there is no sacrifice of the outer skin; no healing follows. Why? Because there is no power of action in the dead organism; there is no power to resist.

   If, in and of themselves, drugs have the power to act, why is it always necessary, in order to secure the action, that they be administered to a living organism? If the blistering plaster, for example, acts, why will it not raise the cuticle of a dead man? Drugs have the same power to act on the dead surface as on the living; indeed, they have more power, if they have any, because the dead skin can offer no resistance. But, here, when there is nothing to oppose them, they have no effect at all.

   When the body is in a very low state, as in dropsies of long standing, and in all greatly debilitated patients, it is very difficult to blister or even to redden the skin with the strongest plasters. When the power of resistance is low, vesication does not take place; but it should do so more certainly under these conditions if it is the drug that acts.

   It will be noted that when there is no power to act there is no action and that when the body is feeble, its actions are feeble. This is to say that the actions of the body in resisting and expelling noxious substances are directly proportional to the integrity and vigor of the body. This is demonstrated not only in the case of a blister, but in all its other actions. A cathartic drug will be expelled with great violence if taken by the healthy and vigorous; the expulsive process may be sluggish and feeble if the drug is administered to a sick individual. Emesis, also, is feeble if a so-called emetic is administered to a feeble patient; it will be violent if the same dose of the same drug is administered to a vigorous individual.

   There are two terms that are freely and loosely used in medical and scientific literature that have no particular meaning in Hygienic literature. I refer to the terms stimulant and.tonic. A stimulant was formerly rather loosely defined as a substance that produces a rapid and transient increase in vital energy. A tonic was a substance that produced the same effects more slowly and continued to do so over a longer period of time. Both of them, as we now know, are merely means of increasing vital expenditure. It should not be difficult to understand that the excited action called stimulation is vital action and that vital action cannot be exerted or performed by matter unendowed with sensitive properties. The vital structure is capable of acting, both on external and internal physical agents, as well as on the subordinate forces of nature. This is the exact reverse of popular and scientific thought on this subject.

   If, in weakened digestion, a tonic is given, there is an apparent strengthening of the stomach. This is only apparent and evanescent. The ultimate result of such ill-advised dosing is greater digestive impairment. Actually, the stomach loses functioning power in its tussles with a tonic. The so-called tonic action of the drug is a waste of the power of the patient. This position is fundamental and, if true, all drug medication is wrong. Any system or plan of curing disease by the administration of substances that are naturally incompatible with and injurious to the structures and functions of the body is radically false. It constitutes no superstructure of science, but one of error and deception.

   Physicians have mistaken the actions of the living organism in resisting and expelling poisonous substances for remedial operations of their drugs--for a curative action in relation to disease. The physician administers an emetic and, forthwith, vomiting empties the stomach. Action occurs--of this there can be no doubt. But what was it that acted, the drug or the organism? If a purgative is given and a violent diarrhea follows, is this the action of the poison or of the living organism? Which acts and which is acted upon? What acts and why?

   Emetics occasion inflammation of the stomach, a determination of blood and nerve supply to those structures involved in ejecting the emetic from the stomach, all to protect the membranes of the stomach and expel the poison. When lobelia (a favorite emetic of the old physiomedicalists) was taken, it occasioned a pungent, burning sensation in the throat, a copious secretion from the salivary glands and mucous membranes, a distressing nausea at the stomach, then a gripping of the bowels, with a spasmodic contraction of the abdominal and dorsal muscles, and, finally, the ejection of the contents of the stomach. As the body initiates and carries out the remedial effort designed to free the stomach of the emetic, the lips will pale, the eyes become glassy, and the blood will be temporarily withdrawn from the surface and concentrated in those structures most concerned with the remedial effort.

   Lobelia, a foreign substance that cannot be used in the formation or replenishment of tissue, is resisted and expelled by actions of the body. The glands and mucous membranes pour out their fluids to dilute it and wash it away. The energies of the body are concentrated in activities in the abdominal region. There is dizziness (in the head), general muscular relaxation (simply because the main force of the body's action is directed to the abdominal region), then, the abdominal and dorsal muscles violently contract (the violence is proportional to the virulence of the drug), pressing the abdominal viscera against the stomach and this upon the diaphragm, producing vomiting. The actions of the body, especially the muscular contractions in vomiting, are quite obvious. Certainly muscular contraction is not drug action, nor is the emetic in the stomach in contact with the muscles that contract.

   The stomach itself is almost passive; the principal action is of the muscles forming the external walls of the abdomen and those of the back and loins. As before stated, these muscles are not in contact with the lobelia. If the drug acts on the stomach, what is its action? We can describe the actions of the body in expelling the drug. If it be replied that the drug first acts and the body reacts, the question still will not down-how does the drug act and what is its action? We place all the acting principle in the living organism. The foregoing reply divides it equally between the lifeless drug and the living organism. It is a strange confusion of ideas that forever confounds causes, actions and effects.

   Narcotics and anesthetics do not combine with the brain to produce stupor and insensibility. Pain or pleasure is the recognition by the mind-organ of the state or condition of the affected area. The organ of feeling (sensation), whether of pleasure or of pain, is the brain and nervous system. But feeling depends on a certain condition or degree of circulation of blood in the organ or part, as well as upon the presence of circulation in the brain and nerve centers. A lack of blood in these centers renders them inactive or reduces awareness. Pressure on the carotid arteries below the ears will produce partial or complete insensibility, according to the degree of pressure.

   There is also a close connection between respiration and feeling or sensibility. If, from any cause, respiration is suspended, sensibility is lost. If respiration is diminished, more or less, sensibility is correspondingly reduced. Pressure on the pulmonary branch of the vagus nerve will so lessen respiration as to occasion insensibility that teeth may be extracted without pain. No matter how respiration is diminished, sensibility invariably corresponds with it in degree.

   The absence of sensibility during sleep is not wholly due to the diminished respiration of the sleeping state, but is largely due to the withdrawal of blood from the brain and its concentration within the trunk. With anemia of the brain, there is diminished power of the brain centers to function. Morphine reduces sensibility in a similar manner. The vital energies, which were previously exerted toward the brain are diverted to the stomach, where the poison or enemy is to be combated. This leaves the brain inactive or stupid. Instead of the drug acting on the brain, the vital powers are drawn off from the brain to defend the stomach.

   Brain anemia, with which is also usually associated reduced respiration, results in a profound systemic depression and a loss of awareness. Toxicologists refer to the anesthetic dose of barbiturates and tell us that such a dose is practically the same in all animals. It is important for us to know that what might be called the therapeutic dose, that is, the dose which occasions so-called sleep, is only a little smaller than the so-called anesthetic dose; and the two states, sleep and anesthesia, are simply varying degrees of the same state of physiological depression. What toxicologists speak of as the "acute lethal toxicity of many barbiturates," and of which they say, "this is almost identical in various mammalian species because of the short time lapse between administration of the drug and death," is precisely the same condition, except in degree, as the so-called sleep and the state of anesthesia.

   Both the limits of our space and those of our present knowledge prevent the possibility of particularizing the peculiar methodus mendendi of all the drugs or medicinal preparations which fill the various pharmacopeias in existence. Our object is rather to demonstrate the law which governs the behavior of the living organism when in intimate relation with drugs--all collectively. We may logically assume that this law applies to the actions following the administration of all drugs and that there are not two laws governing this phenomena. If this is correct, we may confidently expect future developments to supply us with explanations that are now lacking. In the meantime, it should be evident that so long as the idea is accepted as true that drugs--lifeless, inert, passive drugs--act with a compensating power in, upon and through the living tissues, just so long will pharmacologists be forced to admit that they are ignorant of the modus operandi of drugs.

   When the people know and understand that the modus operandi of a drug is the manner in which the body resists and expels it, that when, for example, a cathartic is expelled by means of a diarrhea, they are witnessing the modus operandi of the body, that what has been mistaken for the cathartic action of the drug is the expulsive action of the living organism, then will the charm of drugs be dispelled. We may then expect to see them abandon the taking of poisonous drugs for their health.

   The question would not down and came from many sources and in many forms: if drugs are uniformly actionless, why should the action be so different in the same organ, with various substances? Why, in other words, do different effects follow different drugs, if they are actionless? Or, stripped of its superfluous verbage: why does the living system act upon, reject, resist or expel different substances in different ways, if these substances are entirely actionless? In the relations between lifeless matter and the living organism, where and what is the actor was the puzzling question to many.

   This question would have more logic to it if it were asked concerning the drug rather than the body. If drugs exert their alleged remedial influences according to the known laws of chemistry, why do we not see the uniformity of action for which these laws provide? Why do substances of the same or like chemical nature produce different results? Why should they not all act alike? Morphine and quinine have analogous chemical properties, but they do not "act" alike, as remedies. On the other hand, substances that are very unlike, such as castor oil and sulphur, have analogous actions when taken internally. The varieties of actions of which the body is capable are easily accounted for. But the marked variations in alleged drug actions are not explainable by the known laws of chemistry.

   The answer to this question would seem to lie in the inability of the body to deal with different substances in an identical manner. It finds it necessary to expel some substances through one channel and some through another, just as it expels its own waste through different channels-carbon dioxide through the lungs, urates through the kidneys, etc. Different modes of action are required to resist and expel substances of different character.

   The important fact is not so much the variety of means the body employs in getting drugs out of its fluids and tissues, but the fact that it invariably makes the effort to do so. We can easily describe the action of the body in expelling a drug from the stomach by the act of vomiting; we find it most difficult to describe or even to imagine the action of the drug on the stomach.

   But there must be a reason why certain drugs affect certain organs more than others. This is a fact that cannot be disputed. The effects that flow from taking opium differ quite largely from those that flow from taking strychnine, and those of alcohol from digitalis. Taking belladonna results in behavior that differs greatly from that that follows taking castor oil. The close observer will not miss the display of a degree of intelligence--the intelligence of instinct--in the disposal of these different drugs. From whence comes this intelligence? Certainly, it is not of the drugs. Not from the lifeless drug, but from the instincts of the living organs comes these displays of purposive activities. The actions of the body in relation to these drugs implies recognition of their presence and their relationships to the living structure-instinct, if not reason, is involved. Drugs are not supplied with either instinct or intelligence, nor with will to act.

   The living organism is abundantly supplied with instruments of action and these are powered and energized for action. The drug, on the other hand, is a homogeneous substance, lacking in all the structures that serve as instruments of action, and is not energized for action. That it is the living body and not the drug that acts may be easily shown when the drug is given or administered to a dead body. Drugs of all kinds lose the properties they are supposed to exercise when administered to an organism, the tissues of which are no longer alive. If the tissues have lost their power to act, the drug fails to act; whereas, if the power of action is resident in the drug, it should possess more potency under all such circumstances.

   If the drugs do not act, why does a piece of chalk and arsenic produce such different results? This question, like all others of similar import, confounds effect with action, results with the causes which produced them. Because chalk and arsenic are different, they are resisted and expelled differently. Different substances have different chemical affinities with the elements of the living structures. Were it not for the resistance of the living structures, these substances would enter into chemical combination with the structural elements and the structure would be destroyed. It is precisely to prevent chemical combinations of this kind that resistive and expulsive actions are instituted and, according to the degree of these chemical affinities, are the poisonous characters of these substances and, hence, the intensity of the vital actions will naturally, necessarily, properly and remedially be proportioned to the chemical incompatibilities.

   The body does not act in the same way in relation to all kinds of food. Instead, perceiving the physiological relation of all foodstuffs to the organic community, it acts on them in a manner best designed to make good use of them. And so, too, do the organic instincts perceive the pathological relations of all kinds of incompatibles or poisons and act upon them in the manner best calculated to get rid of them.

   The digestive organs in their collective capacities act on the substances supplied as food, appropriating the food proper and preparing it for absorption, rejecting the residium as a foreign and useless mass, incapable of subserving organic purposes. It may properly be said to be a law that whatever enters the precincts of life which is incapable of supplying nutriment to the organism is speedily rejected and ejected without compromise or reserve, through the most convenient channel.

   It is clear enough that the living system, by means of its acting instrumentalities--hands, teeth, tongue, salivary glands, stomach, peptic glands, intestinal and pancreatic glands, liver, muscles, absorbents, blood vessels, etc.--acts on the food to digest, absorb, circulate and, finally, to assimilate the food. After the food is used and has become waste, the same living system collects, circulates, excretes and voids the waste. All the action seen is vital action.

   It has been asked, why should the stomach resist anything that is perfectly inert and, therefore, harmless. The assumption that because it is inert, it is "therefore harmless," is the thing that we deny. If the stomach were inert and not living, it would not resist. Life implies growth, development and self-preservation. Let us suppose that the stomach should not resist inert substances, or should not act upon them until first acted upon by them. What then? The stomach might become filled with the accumulation of such substances, with the resulting destruction of its function by mechanical obstruction. It is to prevent just such catastrophes that all living tissues and organs are endowed with capacities to perceive the relation of the organism to everything brought into contact with it, that it may appropriate to structure that which is usable and reject and expel that which is non-usable. Non-usable matter is no less a poison because it is inert.

   Although the action of the body is basically the same in relation to all drugs, its actions are different in relation to different drugs--some are expelled by vomiting, others by diarrhea, some by diuresis, etc.

   The error of medical men has always been that of attributing to their medicines the actions, both physiological and pathological, of the organism. We deny that so-called medicines have any actions, "specific" or otherwise. We maintain that drugs are entirely passive in their relation to the living organism. In a remedial sense, drugs do not act at all; they may possess chemical affinities for some of the constituent elements of the tissues, and could undoubtedly combine with these elements except for the active resistance of the vital tissues. Medical men mistake the actions of resistance and expulsion for the actions of their drugs.

   How much longer is it going to take men of science to learn that those vital activities that result, when poisons are taken into the living organism, are but the efforts of the living structure (efforts of the vis medicatrix naturae, if this pleases you better) to expel from the channels of life uncongenial, foreign, unassimilable and, consequently, injurious substances? If they could but grasp this important fact, they would have learned a more valuable lesson than anything taught in medicine and pharmacology, a lesson that will guide them in life, not only in their conduct in disease, but in health as well.

   Misunderstanding the various actions of the body in relation to different drugs, as actions of the drugs, has led to great errors. The actions that follow administration of a drug follow because the drug is a poison and poisonous in doses of any size.

 


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