THE ELEMENT PHOSPHORUS
The element phosphorus is eager for oxygen and readily oxidizable. When taken into the system it acts as a violent poison, and, in view of this, it was at first supposed—although the supposition was based on no scientific data—that it would prove to be a powerful therapeutic agent when given in minute doses. In its elementary form, phosphorus is difficult to handle, and therefore not convenient for use. Hence it was natural that a compound should be sought which could be used as a substitute for the element.
Broadly speaking, phosphorus forms three classes of salts varying in the degree of oxidation: the phosphates, containing the most oxygen, the phosphites, containing less, and the hypophosphites, least of the three. The phosphates, being saturated with oxygen, undergo little change in the body, and because of this were thought to be of little value in therapeutics. The phosphites contain less oxygen, are unstable and are not used in medicine. The hypophosphites, containing still less oxygen, stand nearest to elementary phosphorus and are easily decomposed and readily oxidized to phosphates. Hence the theory that the hypophosphites would furnish an admirable source from which to obtain the action of the element phosphorus.
CHURCHILL’S THEORY
The hypophosphites were introduced into medicine about 1855, as a substitute for elementary phosphorus by a Dr. Churchill of Paris, and later of London, who advocated their use as a specific remedy for consumption. Churchill conceived the theory that phthisis is caused by a lack of oxygen in the tissues; he therefore sought an agent capable of increasing oxidation. He was led to the use of hypophosphites for this purpose on the supposition that phosphorus exists in the organism as a biologic element in a lower degree of oxidation than the phosphate. He supposed that this form of phosphorus acts by its chemical affinity as an initiatory agent in attracting and utilizing the inspired oxygen. He believed that when this form of phosphorus, which he called the “phosphide element,” is deficient in quantity (because it had been oxidized into phosphate, or because the supply from natural sources was deficient), the degree of oxidation of the tissues is less than normal. Therefore he advocated the use of hypophosphites to supply the lacking oxidizing constituent. He believed this “phosphide element” not only to be essential for the oxidation of the tissues, but also to be the source of energy of the nervous system.
THE FACTS
The theory was a pretty one; the facts, however, did not support it. Subsequent investigations indicate that instead of consumption being due to a lack of oxygen, there is in that disease really an increased oxidation; in other words, the respiratory exchanges in this disease are exaggerated. The existence in the system of a form of phosphorus less highly oxidized than the phosphates is unproved. No evidence has been produced to show that phosphorus acts as an energizer of oxidation. There is no proof that the hypophosphites enter into general metabolism or affect disease processes in any way. Not only is there no scientific evidence for the utility of the hypophosphites, but science has long since demonstrated their worthlessness.
In 1895 Boddaert[153] published researches showing that hypophosphites are rapidly eliminated through the kidneys unchanged. Similar results have been reached by Paquelin and Joly, who attributed to the hypophosphites only the action of diuretics. In 1901 Massol and Gamel[154] found by animal experimentation that the hypophosphites did not act as diuretics, but that the hypophosphorous acid was completely eliminated in the form of sodium hypophosphite. The urea was not increased and the relation of urea to total nitrogen remained the same. Their results indicated no increase of oxidizing actions within the system. Finally, Massol and Gamel examined the urine of patients taking hypophosphites and found the same conditions: the results were the same as in the experiments on animals.