C10H4N4O6
O6 C4H8N4O4.
H4 O4 C6 O12.
————— —————
C10H8N4O16 = C10H8N4O16.
Such may be the action of Nitro-hydrochloric acid. It exerts a true Catalytic or counteractive influence. But we have to explain the agency of another class of very different, and apparently opposite remedies. Alkalies are employed with benefit both in Rheumatism and in Gout; particularly in the former disease. Now I conceive these to act, in Rheumatism at least, simply on the Restorative principle; supposing lactic acid to exist in excess in Rheumatic blood. This by itself may have no more tendency to oxidize into carbonic acid, than so much vegetable acid would have. In ordinary cases a free vegetable acid passes out into the urine without undergoing any change in the system. But it has been proved by Wöhler that the same vegetable acid becomes oxidized when given in combination with an alkali. So that if we introduce into Rheumatic blood a free alkali, a lactate of potash or of soda will be formed; this may then be enabled to oxidize into a carbonate, and the natural process be completed. Such appears to be the rationale of the action of alkalies. They would be inefficacious in Oxaluria, because the oxalic acid has so great an affinity for lime, that it could not be separated from this combination by an alkali.
Dr. Rees and others have found Lemon juice of great use in the treatment of acute Rheumatism. It contains Citric acid, and some Citrate of Potash; the latter being in too small amount to explain the action of the remedy. I have already shown how it seems possible that the vegetable acids may act as refrigerants in simple fever; how they may then supply the place of the natural lactic acid in the blood, and become oxidized instead of the Proteinaceous compounds. (Vide Acids.) But Rheumatic fever is a very different case, for there is here apparently an excess of lactic acid, and an arrest of its oxidation. In considering, however, the formula for Citric acid, we perceive that not only does it contain proportionally more Oxygen than Proteins, as was proved in the former instance, but more than lactic acid contains. It is
C12H5O11 + 3 HO.
Thus it is possible that it may act as a carrier of oxygen to the lactic acid, and so help it on towards its transformation into carbonic acid. It appears to be decomposed in the system, for Dr. Rees has never known it in these cases to increase the acidity of the urine. The matter is obscure; but we can discern enough of it to convince us of the possibility of different medicines acting in diverse ways so as to produce very similar results.
Colchicum has apparently some power in the diversion or control of these morbid processes, which we can only indicate, but cannot further comprehend. It is generally best to give it so that it shall neither produce purging, nor any great degree of general depression.
Mercury and other medicines which promote the secretion of the liver, are found to be of considerable use in the treatment of all of these diseases, but more especially in Gout. They seem to act by virtue of their power in eliminating and producing Bile. And it is likely that some constituent of Bile, reabsorbed into the blood, is able to exert a beneficial influence on the conduct of such processes as those which we have just now considered.
Quinine and Tonics have been strongly recommended by Dr. Todd in Gout; and they seem to be signally efficacious, both in this and in the other Arthritic disorders. This is a very interesting fact. If there should be any truth in an idea which I have explained at length in the article on Tonics (vide p. 142,) it would seem that these Tonics may be of use by supplying in the blood the place of one of the wanting elements of Bile. For in all Arthritic disorders there is more or less of hepatic derangement.
There seem then to be six separate and distinct explanations of the cure of these Arthritic diseases. There are six different modes of operation by which the same beneficial result may follow the employment of Nitro-hydrochloric acid, free Alkalies, Lemon juice, Colchicum, Mercury and Quinine.
So that if it should be proved, which is not unlikely, that the chemical theory propounded above for the purpose of accounting for the production of these disorders in the blood is a correct view of the case, then this explanation of the action of the various remedies used in such diseases would acquire an additional probability. But at present the idea is purely hypothetical, because depending upon a number of things which, although they seem likely, are far from being proved as yet.