UC-NRLF 
 
 $B 172 Dflfi 
 
 The Future Independence and 
 Progress of American Medi- 
 cine in the Age of Chemistry 
 
 qA ^port by 
 
 JOHN J. ABEL 
 
 Professcr of Pharmacology, Johns Hopkins Medical School, 
 
 iialtimore, Md. Editor, Journal Pharmacology 
 
 and Experimental Therapeutics. 
 
 CARL L. ALSBERG 
 
 Diri'ctcr, Food Research Institute, Stanford University, Cal. 
 Fonucrly Chief of the Bureau of Chemistry, Depart- 
 ment of Agriculture. Member, Council of Pharmacy 
 and Chemistry, American Medical Association. 
 
 RAYMOND F. BACON 
 
 Director, Mellon Institute for Industrial Research, 
 Pittsburgh, Pa. 
 
 F. R. ELDRED 
 
 ( heniical Consultant, Eli Lilly & Co., Indianapolis, Ind. 
 
 REID HUNT 
 
 1 rofessor of PharmacoloRy, Harvard Medical School, Bostor.. 
 
 Mass. Formerly of U. S. Public Health Service. 
 
 President, U. S. Phamacopceia Conventiori. 
 
 TREAT B. JOHNSON 
 
 Professor of Organic Chemistry, Yale University, New Haven, 
 Conn. 
 
 JULIUS STIEGLITZ 
 
 Chairman Department of Chemistry, University of Chicago, 
 Chicago, 111. Past President, American Chemical Society. 
 Chairman, Subcommittee on Synthetic Drugs, National 
 Research Council. Vice-Chairman, Council of Chem- 
 istry and Pharmacy, American Medical Association. 
 
 F. 0. TAYLOR 
 
 Lhief Lhemist, Parke, Davis & Co., Detroit, Mich. 
 
 CHARLES H. HERTY, Chairman 
 
 } iitor, Journal of Industrial and Engineering Chemistry, New 
 York City. Past President, American Chemical Society. 
 
5 
 
 >\ 
 
 
T177E ask the careful read- 
 ing, discussion and con- 
 sideration of this report by 
 physicians and surgeons, by 
 mothers and fathers, by edu- 
 cators, hospital directors and 
 trustees and all others whose 
 hearts are interested in the 
 welfare of the future genera- 
 tions of American children. 
 
 s:s 
 
FOREWORD 
 
 This report is the outgrowth of an editorial 
 which appeared in the Journal of Industrial and En- 
 gineering Chemistry (September, 19 18), pointing 
 out the need for intensive chemical research, under 
 more favorable conditions than exist today, devoted 
 to the alleviation of human suffering. The ensuing 
 discussion led to the appointment of a committee of 
 the American Chemical Society in January, 19 19, 
 to prepare a statement of plans and policies for the 
 facilitation of research in this field. Since that date 
 this committee has held frequent meetings, and has 
 had the cooperation and advice of leaders in the 
 several sciences which bear upon this problem. 
 
 In order that, thvj views of the committee and the 
 facts upon which- they are based should be made 
 available for the thoughtful people of this country, 
 Tho Chemical Foundation, Inc., arranged for the 
 preparation of a comprehensive report on this 
 subject. 
 
 The report has been drafted by the following Sub- 
 Committee: Julius Stieglltz, Reid Hunt, Treat B, 
 Johnson, F. R. Eldred and Charles H. Herty, 
 Chairman. 
 
 This report has received the unanimous approval 
 of the following committee : 
 
 [a] 
 
John J. Abel 
 
 Profesior' of Pharmacology, Johns Hopkins Medical School, 
 
 Baltimore, Md. 
 Editor, Journal Pharmacology and Experimental Therapeutics 
 
 Carl L. Alsberg 
 
 Director, Food Research Institute, Stanford University, Cal. 
 
 Formerly Chief of the Bureau of Chemistry, Department of 
 Agriculture 
 
 Member, Council of Pharmacy and Chemistry, American Medi- 
 cal Association 
 
 Raymond F. Bacon 
 
 Director, Mellon Institute for Industrial Research, Pitts- 
 burgh, Pa. 
 
 F. R. Eldred 
 
 Chemical Consultant, Eli Lilly & Co., Indianapolis, Ind. 
 
 Reid Hunt 
 
 Professor of Pharmacology, Harvard Medical School, Bos- 
 ton, Mass. 
 Formerly of U. S. Public Health Service 
 President, U. S. Pharmacopoeia Convention 
 
 Treat B. Johnson 
 
 Professor of Organic Chemistry, Yale University, New Haven, 
 Conn. 
 
 Julius Stieglitz 
 
 Chairman, Department of Chemistry, University of Chicago, 
 Chicago, 111. 
 
 Past President, American Chemical Society 
 
 Chairman, Subcommittee on Synthetic Drugs, National Re- 
 search Council 
 
 Vice-Chairman, Council of Chemistry and Pharmacy, American 
 Medical Association 
 
 F. O. Taylor 
 
 Chief Chemist, Parke, Davis & Co., Detroit, Mich. 
 
 Charles H. Herty, Chairman 
 
 Editor, Journal of Industrial and Engineering Chemistry, 
 
 New York City 
 Past President, American Chemical Society 
 
 [3] 
 
Digitized by tine Internet Arciiive 
 
 in 2007 witii funding from 
 
 IVIicrosoft Corporation 
 
 littp://www.arcliive.org/details/futureindependenOOamerricli 
 
INTRODUCTION 
 
 „ I r L When It became clear during the 
 
 Research for the , . *=* 
 
 J t W recent war that poisonous gas was 
 
 to constitute an important muni- 
 tion, our country called to Its service a great group 
 of Its ablest research chemists to provide efficient 
 means of defense and to solve those problems of pro- 
 duction which would provide our field forces with 
 an ample supply of this new weapon. 
 
 Not to the professional inventor nor to the acci- 
 dent of haphazard discovery was this grave respon- 
 sibility assigned, but to the trained workers in sys- 
 tematic research. Nor were these men asked to 
 undertake this vital work In the seclusion and Isola- 
 tion of their respective laboratories but they were 
 assembled at the American University Experiment 
 Station on the outskirts of the city of Washington, 
 under one roof as it were, where by daily, nay hourly, 
 conference utmost speed could be secured in the solu- 
 tion of those problems on which the question of life 
 and death so closely hung. 
 
 But these chemists found that they alone were 
 inadequate for the task. To supplement their spe- 
 cial skill and knowledge there were added to the 
 staff pharmacologists and experimental pathologists. 
 
 Through the combined efforts of these groups, 
 working in closest association and provided with 
 ample facilities for research, results were accom- 
 plished with a speed and certainty which amazed all. 
 The paths to agencies for both defense and offense 
 
 [5] 
 
? •: •• 
 
 were clearly pointed out and large scale production 
 
 quickly followed. 
 
 rpi, u „, Is there no valuable lesson for 
 
 1 he tSatUe . , . . , . . . 
 
 . . peace in this mighty and successful 
 
 j^. effort in the making of war? Is 
 
 there not another battle constantly 
 to be fought — the battle against disease? While war 
 claims its sacrifice in millions of lives, disease each 
 year claims its tens of millions. Pneumonia, influ- 
 enza, tuberculosis, cancer, meningitis, malaria, epi- 
 lepsy, insanity, feeble-mindedness, malnutrition, 
 abnormal development, and a multitude of other 
 diseases claim their many victims. And what a host 
 of wounded do we have in this destructive war of 
 peace — men, women, and children who suffer, often 
 longing for death as a relief, their efficiency crippled 
 and their future on earth beclouded I 
 
 Can we not bring to these problems the same 
 methods so successfully employed in the solution of 
 means of making war? The experience of the ages 
 is now being drawn upon in this fight against disease, 
 but the means are entirely inadequate as shown by 
 the continued ravishment of disease. Too often, in 
 default of exact knowledge, we blindly seek remedial 
 agencies. The annual drug- bill of this nation is in 
 round numbers $500,000,000, of which amount 
 $300,000,000 is spent for so-called patent medicines. 
 The number of medicaments is increasing at a tre- 
 mendous rate, beyond all proportion to the amount 
 of systematic research being devoted to the subject. 
 Thirty years ago 2,699 <^rug items were reported to 
 be on the market; today more than 45,000 are said 
 to be in use. The frailties and suffering of humanity 
 are being grossly exploited. 
 
 [6] 
 
,, J. . Several centuries ago the chem- 
 
 Medicme , , , , . . ^ „ , , 
 
 ^, ist and the physician cooperated 
 
 ^, . _ closely for the alleviation of suffer- 
 Chemistry ^. , . r • r i 
 
 ing; the chier aim or chemistry m 
 
 those days was the providing of mediclnals for the 
 use of the physician. Then the physician and the 
 chemist separated, the physician looking more and 
 more to other means to effect his ends, while the 
 chemist turned to the production of wealth in the 
 industries, as illustrated by the pioneer work of 
 Agrlcola on metallurgy, a work recently translated 
 and edited by Mr. and Mrs. Herbert Hoover. Later 
 the physician turned back somewhat to his former 
 aid and found most useful substances awaiting him. 
 For instance, ether had been discovered in the thir- 
 teenth century, but its value as an anaesthetic was not 
 definitely recognized until 1846. During the inter- 
 vening ^vc or six hundred years untold suffering 
 resulted from lack of knowledge of Its application 
 in producing insensitlveness to pain. Magnesium 
 sulphate was well known to chemists in 1694, but 
 two hundred years elapsed before It was learned 
 what great relief it gave in lockjaw, burns, and 
 strychnine poisoning. Twenty-three years elapsed 
 betwxen the discovery of amyl nitrite by the chemist 
 and the discovery of Its medicinal properties by the 
 physician; during this period tens of thousands of 
 human beings suffered the tortures of angina pectoris 
 because the chemist, pharmacologist and physician 
 were not working together. 
 
 j,i There has been a return to the 
 
 „ earlier views as to the relation of 
 
 ^, . , chemistry to medicine, liach hu- 
 
 Factory ^^^ ^^^^ ^^ "°^ recognized to be 
 
 a chemical factory in which the 
 
 most complicated chemical and physical changer 
 
 [7] 
 
are continuously taking place. When these re- 
 actions are normal from day to day, we are in 
 good health. When they are abnormal, they are 
 a direct cause of disease, as in gout, diabetes, 
 goiter, and other serious diseases. Moreover, 
 when abnormal, these fundamental chemical reac- 
 tions lower the natural resistance of the body, 
 especially to invading disease germs, and they thus 
 lead indirectly to infection, disease and death. Thus, 
 it is well known that the chief danger to the diabetic 
 patient under proper medical care is found in his 
 abnormally low resistance to infection as the result 
 of the inability of the body to maintain its normal 
 chemical reserve. Even the invading disease germs 
 in most cases carry out their fell work through chem- 
 ical agencies, through the production of potent 
 poisons (toxins) acting on the heart, the respiratory 
 nerve centers, or some other vital organ, or grad- 
 ually poisoning the whole system. 
 
 ^, . ^ The bacteriologist and patholo- 
 
 Cnemistry . , i • i i i • 
 
 M « S Z ^^^^ nave accomplished wonders m 
 
 p ,j the present and the last generations 
 
 in tracing the living carriers of the 
 great infectious diseases, and the world owes our 
 Pasteurs, Kochs, Behrings, Flexners and many 
 other valiant workers with these deadly carriers 
 of disease a debt of eternal gratitude. But the 
 fact is that bacteriologist and pathologist have 
 now definitely reached the point where they must 
 turn to chemistry for the solution of many of 
 their most important problems. As an illustration: 
 their antitoxins, their most powerful weapons in com- 
 batting invading germs, are chemical substances of 
 specific curative power but of unknown composition 
 and never isolated as yet as pure principles. They 
 
 [8] 
 
are always Injected Into our bodies in the form of 
 crude mixtures, loaded down with undesirable and 
 to some extent even harmful ingredients. The Isck 
 lation of the pure principles by chemical methods, 
 supplementing the pioneer work of bacteriologist and 
 pathologist, would prove one of the greatest ad- 
 vances in medicine, giving the practitioner the power 
 to combat an infection by swift, exact and sufficiently 
 powerful doses, where now he often acts with hesi- 
 tation and misgiving. Another Instance: coopera- 
 tion of the medical investigator with the chemist 
 (Dr. John Howland and his collaborators) has re- 
 cently led to the recognition of the fact that in 
 rickets, the scourge of many thousands of children, 
 there is a deficiency of such common chemical com- 
 ponents as lime and phosphate In the blood — a dis- 
 covery that by the same cooperation must ultimately 
 lead to successful preventive methods. But hew 
 long must the thousands of little victims wait for 
 relief? 
 
 In the ultimate cell Itself, In the protoplasm of 
 that cell, chemical reactions take place which In a 
 fundamental way determine health or sickness — and 
 of these reactions we know but little. 
 
 rp. How can chemistry, cooperating 
 
 ^, . . now with medicine as It cooperated 
 J., with the war and naval depart- 
 
 ments, help best In this battle 
 against disease? 
 
 First — The chemist is being called upon for the 
 preparation of specific medicaments for the cure or 
 alleviation of specific diseases. Salvarsan ("606^'), 
 the product of chemical research in cooperation with 
 medicine, has done more In four years for the elimi- 
 nation of syphilis than was accomplished in four cen- 
 
 [9] 
 
turies of hygiene and education. So, too, the 
 
 naturally occurring cocaine, so valuable as a local 
 
 anaesthetic and yet so often poisonous, has, by careful 
 
 chemical study, been found to be a very complex 
 
 chemical compound, to only certain parts of which 
 
 was to be ascribed its beneficent anaesthetic effect, 
 
 other parts carrying useless poisonous qualities of 
 
 no value to man. Thus was the chemist enabled to 
 
 improve on nature, and there resulted procaine, 
 
 better than cocaine because equally good as an 
 
 anaesthetic and yet without secondary poisonous 
 
 characteristics. Today a modification of quinine 
 
 gives promise as a specific cure of pneumonia; It 
 
 destroys the pneumococcus germs in glass vessels, 
 
 but it is still too poisonous to be used in sufficient 
 
 strength to combat the hosts of invading germs in the 
 
 human body stricken with pneumonia. 
 
 r»- 7j »• t So, too, the study of the pure 
 
 Field Rich . • , r r 
 
 . n • pnnciples or our organs or secre- 
 
 171 Promise \ ^ r i j • i • 
 
 tion opens up a held rich in promise. 
 
 The isolation and study of epinephrine (adrenalin) 
 has furnished a means of relieving the intense suffer- 
 ing of acute bronchial asthma, of checking hemor- 
 rhage and, used under proper conditions, of 
 carrying the strained heart through the shock of 
 operation, the critical stages of pneumonia. The 
 isolation of the active principle of glands controlling 
 normal growth, of those of digestion and metabol- 
 ism, of antitoxins, vaccines, serums, etc., as men- 
 tioned above, all await the hands of the chemist and 
 when isolated and prepared pure will place in the 
 hands of physicians material which can be adminis- 
 tered with absolute accuracy and which gives promise 
 of instantaneous effect by hypodermic injection. 
 Second — Life Is dynamic, not static; and so the 
 [10] 
 
physical chemist must be called into active partici- 
 pation in this work. The matter of health is closely 
 bound up in the delicate adjustment of speed of the 
 various chemical reactions taking place in the body. 
 These reactions may be accelerated or retarded by 
 minute quantities of catalyzers (enzymes, such as 
 pepsin) . So, too, the brilliant advances by physical 
 chemists in the study of colloids have found as yet 
 but imperfect application to the problems of the 
 body, where in nerve and cell, muscles and organs, 
 the questions to be dealt with are largely those of 
 colloidal chemistry. 
 
 ^ .. . These complex problems of the 
 
 Cooperating . , \ ^ S , ,. . 
 
 e . body are too mnnitely complicated 
 
 jciencGS 
 
 to be solved by any one class of 
 
 scientists. Preeminently chemical in their nature, 
 the chemist alone is imperfectly equipped to carry 
 them to complete and successful solution. He must 
 join hands with the pharmacologist, the pathologist 
 and the experimental biologist. For that reason 
 much of the work in progress today is halting and 
 uncertain. In a few institutions such cooperation is 
 had, though too often the chemist plays the minor 
 role. In our universities constant work is in progress 
 and should be generously supported, but too often 
 the workers are isolated and with only part time to 
 devote to research because of the claims of teaching 
 duties. Too often the chemist needs the knowledge 
 and technique of the biologist, and equally often the 
 biologist needs the chemist's information and point 
 of view. But the lesson of the war is before us and 
 we know what great results may be expected of 
 cooperation under ideal conditions of time and equip- 
 ment for research. Is not the battle against disease 
 
 [11] 
 
much more imperative in its call than the battle of 
 
 man against man? 
 
 ^ , , But the latter war was carried 
 
 Outlet for J , , 
 
 p . , out under government control, and 
 
 y , ,. since all are subject to disease it 
 
 may be argued that the prosecution 
 of similar work in times of peace should be a gov- 
 ernment undertaking, just as fire control is a com- 
 mon tax upon the inhabitants of a municipality. It 
 has been contrary, however, to the practice of our 
 legislators to provide means for carrying on funda- 
 mental scientific research in government laboratories. 
 Such laboratories exist for the enforcement of laws 
 or for other utilitarian purposes rather than for the 
 prosecution of fundamental research. In peace the 
 desire is to get away from government control. 
 
 Nor can the manufacturers of drugs be looked to 
 for the carrying out of any such undertaking. The 
 results of this work will doubtless be the elimination 
 of many ineffective drugs now manufactured, while 
 for those which persist the actual amounts to be 
 manufactured are too small to attract capital to its 
 support. 
 
 If such work is to be successfully prosecuted in 
 our midst, it must be through the practical idealism 
 of America, which can here find abundant outlet in 
 providing such conditions as will direct the future 
 energies of chemistry in America to this greatest 
 blessing to mankind, a blessing which will not be 
 confined to its own borders, but which will stretch 
 out its helping hands to all suffering humanity. 
 
 [12] 
 
THE RELATION OF THE FUNDAMENTAL 
 SCIENCES TO MEDICINE 
 
 ^, . , Chemistry is the fundamental 
 
 Chemistry . ^ i r • r 
 
 T ni ' science of the transformation of 
 
 and Fhysics t^i . • i r i i 
 
 and Li matter. Physics is the fundamental 
 
 science of the transformation of 
 energy or power to do work. Life in ail of its 
 forms, from its beginning to its end, Is the highest, 
 most complex expression of the transformation of 
 matter and of the transformation of energy. In 
 these direct statements — which will be presently elu- 
 cidated by being considered from various points of 
 view — we have the key to the trend of the most 
 important phases of modern medical research, to 
 the faith of a large group of scientific men in its 
 future. 
 
 Need for ^^ ^^ ^ ^^^^ daily becoming more 
 
 Concerted impressive, that medicine by the 
 Attack ^^^y force of the fundamental na- 
 
 ture of life in Its material aspects, 
 is turning more and more to chemistry and to phys- 
 ics for the final solution of many mighty and per- 
 plexing problems of the prevention and cure of 
 disease. Thus the great British physiologist Bayliss 
 says in the Introduction to General Physiology 
 (19 19): "As physiologists, our task is to refer, 
 as far as we can, all phenomena of life to the laws 
 of physics and chemistry." By the same token, 
 there is no undertaking which could hold out 
 greater promise of positive and far-reaching results 
 
 [13] 
 
in almost every branch of medicine than concerted 
 attack upon its problems by the close cooperation of 
 expert chemists, expert physicists, expert biologists 
 and medical men organized on the basis of this fun- 
 damental point of view : that life is the most complex 
 expression of the transformation of matter and 
 energy and that chemistry and physics are the funda- 
 mental sciences of the transformation of matter and 
 energy. There is at present in this country no re- 
 search center organized for such an attack by closest 
 cooperation under the leadership of these fiinda- 
 mental sciences. The urgent need for such an or- 
 ganization should become apparent from a more 
 detailed consideration of the propositions just now 
 laid down. 
 
 Medicine is concerned with the preservation of 
 life and we will first examine in a brief survey the 
 problem of life from its material side, which forms 
 the foundation of medical science. We will then 
 consider, again briefly, what chemistry, and to a cer- 
 tain extent physics, are chiefly concerned with, and 
 we will thus be prepared finally to turn to the main 
 part of our study, the consideration of the 'specific 
 ways in which the fundamental sciences are needed 
 to serve the science of medicine, the consideration 
 of some of the great specific problems which chem- 
 istry and physics must solve for medicine. 
 
 I. Living Organisms Are Chemical Laboratories 
 
 J., What justification have we for 
 
 Life - . .,-... 
 
 T /^L • f the sweepmg assertion that lire m 
 Is Chemical n • r i • 11 
 
 J . . all Its rorms, be it vegetable, ani- 
 
 mal or human, is the highest ex- 
 pression of the transformation of matter and of 
 energy? When we plant seeds in the fertile soil, 
 
 [14] 
 
the first stage of development consists in the 
 transformation with the aid of water of the food, 
 starches, proteins, fats, stored in the seed itself, 
 into rootlets, striking down into the soil below, 
 and into stem and stalk, striking upward to 
 reach finally the free air above. From the soil the 
 rootlets absorb water and mineral salts — potash, 
 lime, sulphates, phosphates, nitrogen in the form of 
 nitrates and ammonia ; from the air above the grow- 
 ing plant absorbs and transforms with the aid of the 
 energy of sunlight carbon dioxide, the waste product 
 of all animal life and of our cities* furnaces. From 
 these simple ingredients thus taken from soil and 
 air, the plant manufactures an infinite variety of 
 new chemical substances. Including carbohydrates 
 (starches, sugars, gums, cellulose, wood), proteins, 
 fats and oils, alkaloids (quinine, strychnine, mor- 
 phine), dyes, and Innumerable other substances. We 
 have here in our growing plants tremendously In- 
 tensive and infinitely varied chemical laboratories, 
 on the output of which all animal life and in par- 
 ticular all human life is finally dependent for its very 
 existence. 
 
 Chemists ^^ ^^ ^^^^ known that the careful 
 
 Heln guidance of the chemist in the study 
 
 Agriculturists °^ ^^^ f'\ 'P- *f Providing of 
 proper food for the plant in the 
 form of fertilizers, nitrates, ammonia, potash, phos- 
 phates — has made it possible to multiply the yield of 
 our acres at small cost by intensive cultivation; but 
 this is only a small fraction of what the chemist has 
 done, is doing and will do in raising agriculture and 
 forestry, with the aid of the expert botanist, from 
 arts to the level of exact sciences — with untold benefit 
 to mankind. 
 
 [15] 
 
j^. J Human life, like all animal life, 
 
 ^ ,, quite obviously, is also dependent 
 
 ^j . 1 J. J in its every instant on the chemical 
 LlieniicaL Aid . -' . . . 
 
 transformation of matter: from 
 
 our inception to our return to dust, we are trans- 
 forming carbohydrates, fats, proteins, salts, water; 
 every breath we draw, every motion we make in- 
 volves chemical combustion. The assimilation of 
 our food, its proper utilization, its proper elimina- 
 tion, every single function indeed of our life is de- 
 pendent on definite chemical and physical processes. 
 No wonder, indeed, is it that ultimately it is the 
 chemist and the physicist who are called to his assist- 
 ance by the watchful guardian of these complex 
 chemical laboratories, the medical practitioner, in 
 the search for the final exact knowledge for the 
 proper control of the healthy functioning of life. 
 Indeed, so profound are these relations that even 
 the ultimate questions of life, of paramount moment 
 to the race, the fertilization of the seed, the enliven- 
 ing of the ovum — so like the kindling of a flame — 
 the problems of heredity, of transmission of race 
 and character from generation to generation — all 
 these great questions are being recognized as funda- 
 mental problems for whose answer biology has at 
 length called in the aid of chemistry. 
 
 ^, . It is not surprising — as pointed 
 
 Tr J 7- evidences of the modern trend — 
 
 Underlies i i t t i i i 
 
 ni J' 7 c • that leading medical schools are 
 Medical bervice . . ^ , , r u ^i_ 
 
 increasing two and three rola the 
 
 preparation in these fundamental sciences and 
 especially in chemistry, demanded of students for 
 admission to their classes; It is not surprising that 
 pioneer medical men, engaged In research, are re- 
 turning in numbers to our universities to study more 
 
 [16] 
 
and still more chemistry and physics as they find 
 them absolutely essential to the proper development 
 of their investigations. There is no more over- 
 loaded student than the medical student of today, 
 there is no more taxed professional man than the 
 successful physician — and if these men, in the face 
 of extreme demands on their time and strength, de- 
 vote ever more of this precious time to the study 
 of the fundamental sciences or chemistry and 
 physics, there must indeed be an urgent, compelling 
 force — and that Is simply the ever-increasing 
 recognition of the fact that life has its abode In a 
 highly complex laboratory controlled by chemistry 
 and physics. 
 
 . . In this trend of recent years it 
 
 Ancient . . . , •' 
 
 ^ . , IS or mterest to note that we are 
 
 Connection of , . , |. ^ 
 
 ,, ,. . but returnmg to the earliest con- 
 
 Meaicme . F , . . , . 
 
 , sciousness or the mtimate relations 
 
 ^, . between chemistry and medicine. 
 
 Indeed, the very name chemistry 
 refers to the land of ChemI (Egypt) where chem- 
 istry originated in the temples In which priests ex- 
 perimented with simple chemicals for the prepara- 
 tion of medicinals. For many centuries indeed the 
 connection between medicine and Its daughter science 
 chemistry was so close that In the sixteenth century 
 the great physician and chemist Paracelsus stated that 
 "the true purpose of chemistry Is not to make gold, 
 but to prepare medicines." How fruitful this con- 
 ception was In the hands of Paracelsus Is shown by 
 the fact that he Introduced into medicine the use of 
 mercury, lead, sulphur. Iron, arsenic, copper sulphate, 
 laudanum — some of the drugs most valued at the 
 present day. But In spite of this valiant protest of 
 Paracelsus, chemistry drifted away from medicine, 
 
 [17] 
 
first in the effort to make gold by the conversion of 
 baser metals, later in the much more successful ef- 
 forts to create riches by the application of chemistry 
 to industrial processes, for most of our great modern 
 industries, from the making of steel and iron to the 
 manufacture of dyes, are, indeed, in largest measure 
 based on chemical processes. It is noteworthy, too, 
 that the comparatively recent return of chemistry to 
 the service of medicine was signalized at the outset 
 by Chemistry's gift to Medicine of Pasteur, one of 
 the great founders of modern medicine and one of 
 the greatest benefactors of the human race. 
 
 II. How Chemistry Attacks Its Great Problems 
 
 If we turn now to the consideration of what chem- 
 istry is occupied with, its role of the fundamental 
 science of the transformation of matter, we will 
 more clearly perceive exactly how it can and must 
 serve as the handmaiden of medicine. In their 
 efforts to understand, indeed to master the trans- 
 formation of matter, chemists have followed two 
 great lines of attack: in both of these chemistry has 
 aimed to be an absolutely exact science, as exact, 
 indeed, as mathematics — so that it may attain its 
 objects with the accuracy and reliability with which 
 we can be sure that two and tw^o make four. The 
 first of these lines of attack is what we shall call the 
 structural side — the discovery and study of the way 
 in which substances are put together or constructed; 
 the second line of attack we may call the functional 
 side — the discovery and study of the laws controlling 
 the way in which substances act upon one another. 
 
 We may compare these two lines of attack with 
 the way in which visitors, say from Mars, would study 
 what would be to them the mysteries of our terres- 
 
 [18] 
 
trial civilization. For instance, in a study of New 
 York City a whole group of Martian architects 
 would be kept busy examining minutely the mode of 
 construction of the sky-scrapers from their deep-set 
 foundations, through the steel skeletons, to their 
 thousand elaborate details of utility, convenience 
 and decoration ; they would study the construction of 
 residences, apartment houses, tenements, bridges, 
 streets, railways, subways. But quite another group 
 of men would be especially devoted to the study of 
 the laws governing the streams of life pouring 
 through these structures, banks, post-offices, fac- 
 tories, subways, and hundreds of other units of the 
 great life of the city In the act of functioning. 
 
 Constructive ,. ^^^""^ "f fi«t the structural 
 Ch ' try ^^ attack by chemistry m the 
 
 D J Study of the transformation of 
 
 iSasea on •' r i i i • 
 
 -*. matter, we find that chemistry aims 
 
 Analysis ^^ analyze every material that 
 comes under its ken in the most 
 minute fashion. It first separates and isolates the 
 pure principles, scores of which may compose a mix- 
 ture such as our blood. It studies the properties 
 of these pure principles minutely and then It pro- 
 ceeds even to a far finer analysis; It takes these pure 
 principles apart to their very atoms^ — indeed It Is 
 now engaged In dissecting and analyzing the very 
 atoms themselves — exactly as a bright-minded boy 
 would take his watch apart to the last screw and 
 wheel or his auto-engine to the last bar and nut. 
 This ultimate or molecular analysis, as we call it, 
 
 *Thus, the smallest particle of water (its "molecule") is found 
 to contain one atom of oxygen combined with two atoms of hydro- 
 gen and chemists express its "structure" by the formula H-O-H. 
 Most important principles have far more complex structures (see 
 below). 
 
 [19] 
 
can satisfy only in part the chemist's unconquerable 
 determination to know all about the thousands of 
 principles he is able to isolate in this world of ours; 
 for having taken the molecules of important prin- 
 ciples apart and studied how atom is united to atom, 
 often dozens of them in a single molecule, he does 
 not rest until he has succeeded in reconstructing 
 (synthesizing) perfectly his principles^ — very much 
 as the ambitious boy will not rest until he has recon- 
 structed his watch or his auto-engine. Having thus 
 acquired complete knowledge of the ground plan of 
 important principles which we find in nature, the 
 
 ^ ,. chemist in many an instance has 
 
 Creative r i • -i i 
 
 Ch ' tr lound It possible to improve on 
 
 nature and construct more perfect 
 
 principles — exactly as In the experience of the writer, 
 
 lads taking the engine of a motor boat apart were 
 
 able by ingenious Improvements to reconstruct it 
 
 with an Increase In Its speed and power of 20 to 25 
 
 *Thus Baeyer showed that indigo has the structure. 
 
 0=0 
 
 H 
 
 H H 
 
 H 
 
 VV" 
 
 H H 
 
 The letters C, H, O and N signify atoms of carbon, hydrogen, 
 oxygen and nitrogen, and the lines joining them show how the 
 atoms are linked up in the molecule. It took fourteen years for 
 Baeyer to solve this problem — with the result ultimately that Ger- 
 many succeeded in making real indigo out of coal tar of an annual 
 value of millions of dollars, 
 
 [20] 
 
per cent — exactly, indeed, as human intelligence has 
 always improved on nature, leading the race from 
 gloomy, damp and uncomfortable caves to houses 
 growing ever more perfect and convenient, improv- 
 ing the quality of animals by domestication, raising 
 the yield of the soil by fertilization, and protecting 
 and aiding humanity in thousands of other direc- 
 tions. It is this insistence on complete ultimate 
 analysis which gives to chemistry one of its most 
 powerful resources — for with complete knowledge 
 comes control, in the form of wise use of what nature 
 offers and also in the opportunity for improving on 
 what nature, blindly, has furnished to man. 
 
 r>i, ' ^ A simple consideration from the 
 
 r- r pomt or view now gamed will re- 
 Goes rar ^ , ^ . 1 . , . 
 B d ih ^ ^^^^ y ^^^"^ic^l investi- 
 RZleof the ^^^^^^ ^^^ become a most power- 
 Microscope in ^"1 instrument in biological, in 
 
 D. , , medical research: it is well known 
 
 Biology ana 1 . 1 , . , , ,. 
 
 Medicine , ^^ ^^^ P^^^ biology and medi- 
 
 cine have used as their greatest in- 
 strument of precision the microscope, which led in- 
 deed to the great discoveries of the cellular struc- 
 ture of living matter, of the germ theory of life — 
 as opposed to the exploded theory of spontaneous 
 generation — of the germ theory of diseases, etc. 
 But the microscope, with all its marvelous improve- 
 ments, can go no farther in analysis than the cell and 
 its divisions — whereas chemistry can and does go 
 much farther. For within the boundaries of even a 
 minute cell, there are dozens of different principles, 
 there are myriads of molecules, which defy the 
 power of the finest optical instruments; but they are 
 subject to the keen, patient, analytical and synthetic 
 quest of the chemist! "There is a constant mo- 
 
 [21] 
 
lecular Interchange between the cell and its environ- 
 ment." ''Cell-secretion, cell-respiration and cell- 
 nutrition are clearly only different aspects of the 
 same whirl of molecular activity." (Haldane of 
 Oxford.) In a word, chemistry is now called upon 
 to provide the medical investigator with the most 
 powerful ultra-microscope the world has ever 
 known, to lead him far beyond the limits of his 
 present bounds of knowledge. This in short is the 
 reason why medicine and biology in general have 
 found it necessary to turn to chemistry for the final 
 solution of many of their greatest problems : the old 
 methods stop at the limits Imposed by the micro- 
 scope — with the invocation of the aid of chemistry 
 there is no limit to ultimate analysis, down to the 
 minutest particles, the molecules and atoms. In turn, 
 the chemist needs in this service the advice, indeed 
 the undivided cooperative effort of the medical 
 investigator, the pathologist, bacteriologist. Internist, 
 for only such cooperation will bring the vital prob- 
 lems of medicine home to the consciousness of the 
 experts In the fundamental science : What the naval 
 and army experts meant to the research staff of the 
 Chemical Warfare Service, the medical leaders must 
 mean in this proposed cooperative attack on disease 
 with the aid of the fundamental sciences of life. 
 
 Wh tth ^^ ^^^^ *^^ better appreciate 
 
 ^, . , the vital possibilities of this part- 
 
 Cnemical i . .r r 
 
 M th d nership, if we turn for a moment 
 
 A T 1, J from the consideration of chemls- 
 
 Accomplished , ,. . i i 
 
 with D ^^^ ^ medicine to observe what 
 
 a complete triumph has already 
 been brought to mankind by exactly this type of 
 chemical Investigation In the domain of dyes. Origi- 
 nally dyes were obtained exclusively from natural 
 
 [22] 
 
sources — indigo and alizarin or turkey-red and a 
 few others from plants, carmine and some others 
 from animal sources. Then, in 1856 Sir William 
 Perkin accidentally prepared the first aniline dye 
 mauve (while trying to make quinine artificially), 
 and after that chemists from time to time stumbled 
 similarly on other even more valuable dyes, ma- 
 genta, methylene blue, the beautiful rhodamines, etc. 
 Already in the sixties, pioneer chemists started on the 
 finest ultimate analysis of the dyes — determining in 
 fact the exact way in which the atoms in the smallest 
 particles of each dye are joined together. Graebe 
 and Liebermann succeeded in doing this for alizarin 
 (turkey-red), Baeyer for indigo, Bernthsen later 
 for methylene-blue, and others for a number of 
 other fundamental dyes. The results of this ex- 
 ploration of the ultimate minutiae of dyes has been 
 ^ J the complete conquest by man of 
 
 r^ ^ the domain of color production: 
 
 Conquest i- • j 
 
 , ^ J alizann was at once made 
 
 of Color ^ . , . , 
 
 D J *• from coal-tar products previously 
 
 Production , . i /- 1 • 1 • j 
 
 w^asted, mstead or bemg obtamed 
 
 from madder, and large acreages were turned from 
 the cultivation of madder to the growth of wheat 
 and other needed crops. Indigo is now made arti- 
 ficially of a purity greater than that of the natural 
 product (because free from admixed rubbish and 
 foreign dyes) and the indigo fields are giving way 
 to food crops — a distinct gain to man. Even more 
 important is that by comparative studies of the struc- 
 tures of the molecules of a number of dyes, the key 
 to the whole mystery of color production, and color 
 quality has been gained by man, with the result that 
 we can now produce dyes of any given qualifications 
 as to color, shade, stability to air, to light, soap, and 
 
 [23] 
 
water, sensitiveness to light (for photographic pur- 
 poses) indeed even of two colors combined in a 
 single dye (as in the beautiful fluorescent shades in 
 silks). This complete conquest of the domain of 
 color occupied some forty years; Is it surprising that 
 jjj . chemists are quietly but absolutely 
 
 ^ ^ confident, with the aid of the 
 
 Conquest ,.,.'. i r i • 
 
 , , biological sciences and or physics, 
 
 rh't ^^ ^^ ultimate conquest in the 
 
 , ,. . , domain of life products, of medi- 
 
 oi Life . , . . 1 . , 1 
 
 cine by giving to biology the ser- 
 vice of these same methods of complete ultimate 
 analysis? But they do realize that where a little 
 over a generation sufficed for the conquest of the 
 domain of color with only a few dozen funda- 
 mentally important dyes, life with its thousands of 
 important components will be a far greater, as it is 
 a vastly more important, field of conquest, requiring 
 generations of Intensive workers. But that em- 
 phasizes so much the more the urgent need for a 
 concentrated, multiple attack — so that time may be 
 saved by swifter progress year after year. 
 
 III. Constructive Chemistry in the Service of 
 Medicine 
 
 After this preliminary survey of the aims and re- 
 sources of this phase of chemistry, let us ask now 
 without further delay, w^hat specific services construc- 
 tive chemistry can and must render to medicine in 
 the prevention and cure of disease. We find that 
 chemistry from its constructive side can be of great- 
 est services in three specific lines of attack, which 
 are arranged not in the order of fundamental Im- 
 portance but rather in the order of simplicity of 
 
 [24] 
 
attack and consequent promise of comparatively 
 
 earlier success : 
 
 ,. , I. The preparation of the 
 
 Lines of .^ j .. r ^u 
 
 J / specific medicament tor the cure or 
 
 alleviation of the specific disease. 
 
 2. The isolation, study, and, if need be, the arti- 
 ficial preparation of pure organic principles of 
 fundamental importance to our life, such as princi- 
 ples of secretion of the body organs, of which a 
 deficiency or an excess would cause disease (goiter, 
 acromegaly, dwarfism, gigantism, and probably 
 diabetes, gout, etc.). 
 
 3. The complete ultimate analysis of the constit- 
 uents of our body cells, of the components of the 
 blood, of tissues, together with the complete ultimate 
 analysis of the components of our foods — so that 
 we may have complete knowledge of the body in 
 health and of what it needs to preserve its health. 
 
 The Specific ^ Taking up first the problem of 
 
 ,, J. ^ the specinc medicament tor specinc 
 
 Medicament ^ r i 1 • 1 
 
 purposes, we nnd chemists engaged 
 
 in two lines of efi[orts: in the first, they start from 
 natural remedies already known, examine them ex- 
 haustively and with the knowledge gained improve 
 on the natural product; In the second line of effort, 
 they start out independently of natural drugs and 
 attempt to prepare the specific remedy for the de- 
 struction of the specific invading germ, or the specific 
 remedy for some faulty adjustment of the human 
 organism In disease. 
 
 A brief survey of the results obtained from the 
 study of the drug cocaine will illustrate sufficiently 
 the value of the effort to improve on natural remedies. 
 Cocaine Is a white, crystalline substance, like salt of 
 sugar, which brought in dilute solution (4 per cent) 
 
 [25] 
 
on the tongue, under the eyehd, or Injected under 
 the skin, was found by Von Anrep to suppress 
 locally all sensation of pain. It was first used in 
 
 The Story t^T'^ Xr *' ^Pthalniologist 
 ,^ . Koller, or Vienna (now of New 
 
 oi Cocaine xr i \ i 11 - 1 
 
 audits lork), and proved to be an inval- 
 
 p . uable aid to surgery for the pro- 
 
 duction of local anaesthesia, making 
 possible painless operations without recourse to 
 general anaesthesia under ether, chloroform or 
 laughing gas. But cocaine had three grave defects: 
 one, its rareness and resultant expensiveness, which 
 limited its usefulness, the other more serious defects 
 that it is difficult to sterilize, and especially that it 
 is decidedly poisonous and occasionally In minor 
 operations — In those of dentistry, for Instance — 
 fatal results ensued not warranted by the conditions. 
 Cocaine then fell under the searching scrutiny of 
 chemists, who subjected it to ultimate analysis for 
 the determination of the structure or the arrange- 
 ment of the atoms in the smallest particle, the mole- 
 cule of cocaine; there are no less than 43 atoms In 
 this molecule, arranged in a peculiarly complex, 
 labyrlnthal fashion^ and It took three successive 
 
 ^The structure of cocaine is indicated by: 
 
 Only the parts surrounded by dotted lines are of value in pro- 
 ducing local anaesthesia. 
 
 [26] 
 
attacks by leading chemists to reach a final solution 
 of the problem. With this vantage gained at how- 
 ever great a cost of mind and labor, the problem of 
 local anaesthesia immediately made tremendous 
 progress. It was found that only part of the mole- 
 cule has the beneficent anaesthetic effects of cocaine, 
 while another part is closely related to the deadly 
 principle of hemlocks, coniine, famous as the poison 
 Socrates was forced to take, and a third part is re- 
 lated to nicotine. And now the chemist was in a 
 J . position to improve on nature and 
 
 T.J invent local anaesthetics with the 
 
 on Nature . ^ . • j -^u ^ v 
 
 virtues of cocaine and without its 
 
 excessive toxicity — exactly as a conscientious mod- 
 ern architect in planning a house would insure the 
 absence of noxious rooms deficient in air, light, heat 
 or drainage. We have now, in fact, a number of 
 those artificial local anaesthetics — procaine (intro- 
 duced as novocaine), beta-eucaine, apothesine, etc., 
 and, more recent, benzyl alcohol and related prod- 
 ucts — better than cocaine, because less poisonous. 
 The extent to which they are being used in surgery 
 is growing very rapidly and they hold out to man 
 the possibility of some of the greatest advances of 
 the future in this field; even major operations, for 
 appendicitis, hernia, uterine troubles, are being per- 
 formed now under local anaesthesia, and it is to be 
 hoped that the field of general anaesthesia, with its 
 grave fundamental principle of poisoning the whole 
 system with ether, chloroform or laughing gas, will 
 grow more and more limited to unusually prolonged 
 or unusually painful operations. We have here, 
 then, a first real triumph in medicine of the science 
 that triumphed so completely in the field of dyes. 
 
 [27] 
 
In Itself, this successful effort has been an untold 
 blessing to thousands of sufferers, but the great les- 
 son the story of the conquest of local anaesthesia 
 teaches Is that it Is a golden promise of ultimate vic- 
 tory heartening the army of chemists in their grim 
 onslaught on the more profound and vast problems 
 of the chemistry of all life. 
 
 Chemistry Another rather recent, and in 
 
 Q . many respects a most important in- 
 
 I ^ e stance of this kind, Is the specific 
 Lenrosv remedy used with much success In 
 the treatment of leprosy: chaul- 
 moogra oil Is an Irritating, nauseating natural prod- 
 uct, used for perhaps sixty years In India In the treat- 
 ment of leprosy. Even in those days of uncertain 
 quality and uncertain method of administration, the 
 oil proved Its usefulness, but a positive and most 
 signal advance In the successful treatment of the dis- 
 ease was made only through the Isolation by chem- 
 istry from the nauseating natural product of clean, 
 pure acids which were combined with ethyl alcohol 
 and thus formed a new drug which could be used 
 hypodermlcally. In a recent publication, 78 cases 
 of apparent cure by this Improved drug have been 
 reported. While even greater Improvement In the 
 medicament is looked for by further painstaking re- 
 search, we have already an effective remedy for one 
 of the most hopeless of diseases — a result of the 
 active cooperation of medicine and chemistry. 
 
 Some Other Improvements of other natural 
 
 Improved ^^^^^ have similarly been accom- 
 
 Drues pHshed. A few Instances must 
 
 suffice here. Atropine, as used by 
 
 the oculist, puts the eyes out of commission for two 
 
 I28J 
 
or three days — the chemist has supplied homatropine 
 for the busy man, reducing the effect to two or three 
 hours. Morphine, the Dr. Jeykll and Mr. Hyde 
 of nature's store of remedies, with its blessed alle- 
 viation of pain, carries the curse of the habit-forming 
 drug. Chemistry found with morphine the drug 
 codeine, also in opium, whose effects resemble those 
 of morphine except that it is very much less likely 
 to produce habit. There is little codeine in opium, 
 but again chemistry easily converts morphine into 
 codeine, giving mankind an ample supply of the 
 blessed sedative shorn of its curse. Morphine is 
 similarly readily transformed into ethylmorphine 
 (dionlne), which resembles codeine in its action and 
 which has also found important applications in the 
 treatment of certain diseases of the eye. 
 
 ^, . In 1886 the pharmacologist, W. 
 
 .. , . Von Schroeder, first studied by ex- 
 
 Aid m , , - -If 
 
 n- ^. perimental work on animals the 
 
 diuretic action of caffein and at- 
 tempted to explain why this drug was uncertain 
 and not always reliable as a diuretic. Chemists 
 had, however, found another principle, theobromin, 
 very closely related to caffein in molecular struc- 
 ture and composition. What was more natural 
 for the experimental pharmacologist than to try 
 the effects of this close relative of caffein to which 
 chemical study had pointed? And, in fact, theobro- 
 min was found far more useful and dependable than 
 caffein in its diuretic action and has largely replaced 
 it. Still a third related compound, theophyllin, was 
 discovered by chemists and found the best of all. 
 The natural supply of these dr«gs being rather 
 limited, chemists solved In short shrift the task of 
 preparing them artificially in any quantity, desired. 
 
 [29] 
 
^, . ^ n/r Profound study of other natural 
 
 Lnemistry May ,. i i n i • i 
 
 TT 1 / medicaments should be pursued with 
 
 tielp Lure . . , . ^ 
 
 D . great intensity; there IS every reason 
 
 fneumonia , ,. , i-r . r 
 
 to believe thatamodincation or qui- 
 nine can ultimately be prepared which will be a spe- 
 cific cure of pneumonia. One modification, optochin 
 ( ethyl hydrocupreine ) is already known to be a specific 
 in killing pneumococcus germs in glass vessels {in 
 vitro) and is used successfully in external pneumo- 
 coccus infections, as of the eye, but it is still too 
 poisonous to be used in sufficient strength in the 
 blood to combat the hosts of invading germs in 
 pneumonia itself. No greater blessing could be 
 granted mankind than the discovery of such a spe- 
 cific, as pneumonia is one of the two diseases re- 
 sponsible for the greatest loss of life in the world 
 (tuberculosis is the other one). The tragedy of the 
 situation is the tremendous waste of life, for instance 
 during the recent influenza epidemics, while the 
 preparation of such a specific is being looked for. 
 
 c rr- No matter how ardently, how 
 
 bave lime i .,r n i i • i • i 
 
 ^Ij 1 skiliully, the work is being pursued, 
 
 the lesson of the past teaches us 
 that only by a massive coordinated attack of many 
 workers can we hope to save time and all it means 
 to us. A generation ago one of the greatest spe- 
 cialists in children's diseases in New York City lost 
 his only son through diphtheria. It was a heart- 
 breaking tragedy for him that science had not 
 brought diphtheria antitoxin into the world just a 
 few years earlier, so that he might have saved his 
 own son. In how many thousands of homes is this 
 tragedy being reenacted today in the face of dis- 
 eases which man ultimately must and will conquer. 
 Chemists, as stated above, are also attacking the 
 [30] 
 
problem of the specific remedy for the specific disease 
 
 quite independently of any compounds that nature 
 
 y, ^ . has suppHed. The greatest instance 
 
 J fc • ^^ ^^^^ ^^^^ ^^ arsphenamine 
 
 Tl^ c '£ ("606'* or salvarson), prepared 
 the bpecijic , t^i ,- • 1 1 r 
 
 i S hil' y^ Jbhrhch as the result or a sys- 
 tematic effort to prepare a drug 
 that would kill the invading germs, the spirochetes 
 of syphilis, without injury to the patient. It is again 
 to be noted that this first great successful attack on 
 a most widespread disease was brought to a success- 
 ful issue by the closest cooperation between chem- 
 istry and medicine. Dr. Ehrlich, from his earliest 
 years in medical investigation (1884) was charac- 
 terized indeed by the application of chemistry to his 
 problems. His first research work was on dyes used 
 as stains, a chemical problem. The very name "606" 
 indicates how he gradually accomplished his purpose 
 — using first one substance of a definite known molec- 
 ular structure, then another, until seeing improve- 
 ment ahead, he modified first this and then that part 
 of the structure of his molecules until finally complete 
 success was accomplished after 605 imperfect re- 
 sults, exactly as the sculptor models from his coarse 
 clay the perfect head through a long series of in- 
 complete, imperfect stages. The tremendous value 
 to mankind of this brilliant chemo-medical triumph 
 is realized when we recall, first, that "606^' and 
 later developed drugs of the same kind properly used 
 are specific cures for the disease syphilis, and, second, 
 that this disease is so widespread that it has been 
 estimated that in the United States alone we have 
 over ten million cases of the disease in its various 
 stages and dread sequels. 
 
 [31] 
 
. ^, . , Another notable instance of the 
 
 A Lnemical -r • i i • i i • 
 
 c , . artincial chemical remedy is cin- 
 byntnetic to . ,. . , ■' . . 
 
 J. J. c t ^^^P^^ (introduced as atophan), 
 
 the uric acid ellmlnant, an allevla- 
 
 tlve, and in some cases a preventive, in gout. 
 
 In the field of hypnotics, used to produce sleep 
 and allay nervous excitement (insomnia, epilepsy, 
 etc.), constructive chemistry has advanced far Its 
 
 ^ . , campaign toward complete con- 
 
 ^ quest. The advance has been made 
 
 Conquest 7 i ^• i • i 
 
 • c J *• from the earlier and sometimes dan- 
 
 gerous hypnotics, chloral and its 
 derivatives (great blessings In their day but danger- 
 ous because highly toxic, like chloroform), from the 
 hablt-forming sulphonals and trionals, to such hyp- 
 notics as barbital (introduced as veronal), luminal 
 and adalln, which are very closely related to products 
 formed naturally in the body, and produce sleep with 
 a minimum of disturbance and risk to the system. 
 Luminal is claimed to be a specific to relieve, indeed 
 
 A Ch 'I ^^ prevent, the seizures of epilepsy. 
 ;^ .J. The Importance of this Invention 
 
 . ^ ., of modern chemistry was revealed 
 
 during the war years when exhaus- 
 tion of our supplies of the drug brought in its wake 
 pathetic and fruitless appeals from nerve specialists, 
 hospitals, patients and parents. 
 
 „ , Another disease for which a spe- 
 
 Hookworm t 1 • 1 1 1 r j 
 
 ^ J , cihc chemical cure has been round 
 
 ^, . , is that caused by the hookworm, 
 Litiejnicals n > 1 i 1 •n* 
 
 aitecting over a hundred miuions 
 
 throughout the world and widespread In our own 
 
 Southern States. It is one of the most debilitating 
 
 of diseases. The chemical thymol In conjunction 
 
 with chenopodlum has been found to be a very effec- 
 
 [32] 
 
tive agent In the cure of hookworm, but again it is 
 confidently expected that some modification of thy- 
 mol could be elaborated by synthetic chemistry 
 which would be even more efficient, and would lead 
 ultimately to the complete elimination of this disease 
 from our country. 
 
 There is a tremendous, practi- 
 
 ree courges ^^j, undeveloped field for greater 
 
 Lack bpecincs i r 'c ^ 
 
 ^ ' work here — specifics are most 
 
 needed now for tuberculosis and pneumonia, and 
 
 perhaps even for cancer, to which a large proportion 
 
 of mankind falls a victim. 
 
 ^ , , In any efforts in this direction, 
 
 ^ .. . we must always remember that the 
 
 Cooperation • r i j 
 
 greatest promise for success would 
 
 be found only in closest cooperation of chemists, 
 pharmacologists and medical men. The past is 
 replete with impressive lessons emphasizing the 
 importance of such cooperation. Two or three in- 
 stances must suffice to show how Important this les- 
 son of the past is. Five centuries elapsed between 
 the discovery of ether by chemists and Its application 
 TV edlp ^^^ surgical anaesthesia, five cen- 
 
 c AT . turies of needless suffering. The 
 
 first chemical used to produce sleep, 
 chloral hydrate, was known to chemists for almost 
 forty years before the pharmacologist Llebreich dis- 
 covered that it produced in pain-racked bodies a 
 peaceful sleep from which after a few hours the 
 patient awoke greatly refreshed. Many other 
 hypnotics and sedatives were then soon found among 
 compounds long known to chemists. 
 
 All of Ehrlich's great work on the cure of syphilis 
 was accomplished when he was between 54 and 61 
 years of age, but following lines of thought which 
 
 [33] 
 
had been in his mind for 30 to 35 years; he had been 
 waiting all that time to get the full cooperation of 
 chemists, and this became possible only through the 
 munificence of Frau Speyer in Frankfort. More was 
 then accomplished in four years by chemo-medkal 
 research than in four centuries of medical effort, 
 including hygiene and education. 
 
 . „ , Amyl nitrite was discovered by 
 
 . , a French chemist in 1844, but it 
 ^ was not until 1867 that it was 
 
 found to give relief from the agonizing pains of 
 angina pectoris. Dr. Brunton, led by the results of 
 experiments of the pharmacologist and biochemist 
 Gamgee, made this discovery and thus describes the 
 first case in which the remedy was used by him: 
 "There was one poor man in the wards suffering 
 dreadfully from angina pectoris; he used to have 
 an attack every night and for two hours the unfor- 
 tunate man would sit on the edge of his bed and 
 could not move forward, backward, or to one side, 
 with his face pale and sweat pouring off it, in per- 
 fect agony. The administration of amyl nitrite 
 gave him instant and complete relief." There are 
 tens of thousands of persons in the United States 
 alone afflicted with this dread disease of the heart, to 
 whom amyl nitrite is a blessing indeed. These tragic 
 delays resulted from the wide gap that existed be- 
 tween the scientific activities of investigators in medi- 
 cine and in chemistry; they must in future be 
 prevented by Intensive, closest cooperative effort and 
 interest. 
 
 ^, nil There are hundreds of thou- 
 
 i he rroblem a r rr r • r i 
 
 , rj * • sands or sufferers rrom pamrul, 
 0/ Hastening . ,. ^ 1 • 1 1 
 
 n J' 1 consummg diseases for which the 
 £\.ei>iej . . I . . « > 
 
 remedy awaits the joint intensive 
 
 [34] 
 
efforts of chemist, pharmacologist and physician. 
 
 How many years must they wait? That is our 
 
 problem. 
 
 p The second great field of effort 
 
 p . . , . for the constructive chemist is the 
 
 c. • isolation, study, and if need be, the 
 
 becretion . •'. • • i r 
 
 preparation of pure principles or 
 
 our organs of secretion and of other principles of 
 vital importance to healthy life. One or two specific 
 accomplishments will illustrate the vital importance 
 of this work. After Schafer and Oliver, Szymono- 
 wicz and Cybulski had noted the presence of a vaso- 
 constrictor principle in the suprarenal glands, small 
 glands situated just above the kidneys, Professor 
 Th S* / Abel, of Johns Hopkins University, 
 
 E, . I • succeeded in isolating this prin- 
 Lpinephnne . , . , . . , i- \ • 
 
 ciple, epinephrine (adrenalin), in 
 
 the form of a derivative and prepared a number of 
 salts of this derivative. Later J. Takamine precipi- 
 tated the pure principle itself by means of ammonia, 
 a precipitating agent which Professor Abel had al- 
 ready used in this work, as the native compound in 
 the form of minute crystals. Its chemical structure 
 was later determined, with the result that epinephrine 
 can now be prepared artificially. The manufacturer's 
 patents having expired (in February, 1921), the 
 world is the richer for wide sources of manufacture 
 of this invaluable drug. Some of the very great ad- 
 vantages of the isolation of this pure principle are 
 these: It is injected with local anaesthetics (pro- 
 caine, etc.), causing constriction of the blood vessels 
 and preventing a rapid local loss of the anaesthetic, 
 thus reducing the amount needed very materially and 
 reducing correspondingly the danger of toxic effects. 
 Injected hypodermically, epinephrine allays within 
 
 [35] 
 
a few minutes the spasms of acute bronchial asthma, 
 an untold blessing which those can only realize who 
 have in the past witnessed helplessly the acute suffer- 
 ings of a patient. Epinephrine may also be used for 
 the quick arrest of hemorrhage of a capillary or 
 small arterial character — all blessings for man. 
 
 p . , . Very recently (unpublished work 
 
 Epvnephrrne ^^ ^^ ^ ^^ ^^^ York City) 
 
 bustams the . , . r U 
 
 jr . perhaps the most miportant of all 
 
 r, s.' n uses of epinephrine has been dis- 
 (Jperative Loses t i • • t i 
 
 covered: this is based on its action 
 
 on the heart. Injected In such a way as to provide 
 
 for very slow and gradual absorption, it Is of 
 
 extraordinary value when used in preparing old or 
 
 weakened patients for operations, fortifying the 
 
 heart against the danger of shock and failure. 
 
 rr 1. ' Of equally great value is the in- 
 
 Lpinephrine . . ^ ^ ■', ^ . . . . . 
 
 D . jection or epinephrine in this man- 
 
 in rneumonia •' . , ^ ^ - 
 
 ner in the treatment of pneumonia. 
 
 Used from the earliest stages, it reduces the danger 
 of death from heart failure to such an extent that 
 eminent physicians with its aid feel safe in depend- 
 ing on the normal resistance of the body to effect a 
 cure of this dangerous disease, thus avoiding the 
 dangers of antitoxin injections. These discoveries 
 of today emphasize the vital Importance of exhaus- 
 . tlve investigation by the joint efforts of chemist, 
 pharmacologist and physician. 
 
 rjnj^ . , More recently Dr. E. C. Ken- 
 
 r^i -7 dall, of the Mayo Foundation, has 
 C ucst isolated thyroxin, the crystalline 
 active principle of the thyroid 
 gland, which regulates the metabolism (the combus- 
 tion of our food) of the body. This principle is 
 so tremendously active that an occasional dose of 
 
 [36] 
 
a fraction of a milligram (a minute fraction of 
 a grain) is able to cure cretinism, a condition of 
 stunted growth of body and mind, and myxedema, a 
 similar condition developing in adults. The arti- 
 ficial preparation of thyroxin is only a question of 
 time and effort and one more outpost of the bulwarks 
 of life will thus have been conquered by the chemist. 
 
 n i_f V There are many other vital se- 
 
 Problems Yet . i • i • r i 
 
 rr I J cretions the isolation or whose pure 
 Untouched • . , i if 
 
 principles must be undertaken: 
 
 the isolation of the active principle of the pituitary 
 glands, controlling of normal growth, the Isolation 
 of further active principles of digestion and metab- 
 olism (for the cure of gout, diabetes and other 
 metabolic diseases), the Isolation of the active hor- 
 mone controlling normal sex functions, are a few of 
 the great problems lying almost untouched for lack 
 of workers in the field of chemical effort In the ser- 
 vice of medicine. 
 
 p Another great line of effort In 
 
 D . . , , this direction should be the at- 
 rrincipLes of • i i • • i 
 
 A tit tempt to isolate the pure principles 
 
 of antitoxins, bacterial vaccines, 
 and serums now used so widely In the cure or pre- 
 vention of Infectious diseases (diphtheria, tetanus, 
 streptococcus Infection, meningitis, etc.). The 
 fluids which are now injected contain, no doubt, only 
 very small quantities of the pure, active principles, 
 mixed w^Ith a vast proportion of Inert and In part 
 harmful matter (horse serum, etc.). Every physi- 
 cian of standing has rejoiced to have been delivered 
 from the old days when, to secure the effect of 
 strychnine, he was compelled to prescribe tincture of 
 nux vomica of an Indefinite composition, when to pro- 
 duce the effect of quinine he had to prescribe ground 
 
 [371 
 
cinchona bark, etc., etc. Chemists isolated strych- 
 nine, quinine, morphine, atropine, cocaine, hyoscya- 
 min, pure principles from the crude drugs offered by 
 . , ^ nature, with the tremendous ad- 
 
 f p vantages, hrst, or quantitative ac- 
 
 p . .J curacy in administration replacing 
 
 an approximate and sometimes dis- 
 astrous guess, and second, of putting into the hands 
 of physicians the possibilities of almost instantaneous 
 effects by hypodermic injections of pure solutions 
 of the pure principles. In the course of time it must 
 be chemists again who will place in the hands of the 
 physician the pure active principles of the antitoxins, 
 vaccines and serum mixtures, which are the real 
 curative principles and whose action must at best 
 be handicapped by the presence of a preponderance 
 of useless impurities injected into our veins and tis- 
 sues. The isolation of such specifics should be fol- 
 lowed by the exhaustive minute study of structure, 
 revealing the why and wherefore of action, opening 
 up the way possibly to refinement and improvement. 
 ^ ^ How immediately urgent intensive 
 
 K^Ul \jri6ut6Sv I /*1*1*1 1 'J 
 
 jyr , work or this kind must be consid- 
 
 ered is brought home to us by the 
 heartrending helplessness of physicians in the pres- 
 ence of certain sudden diseases when patients full 
 of strength and vitality and otherwise healthy, never- 
 theless face extinction because of the inability of the 
 ablest of physicians to reach the source of destruc- 
 tion. The treatment of pneumonia by antipneumo- 
 coccus serums holds out great promise of successful 
 combatting of one of our greatest scourges in at 
 least a fair proportion of the cases. But it is well 
 understood among physicians that the injection of 
 large quantities of serums in such treatment may be 
 
 [38] 
 
attended by new and serious dangers of anaphylactic 
 shock and other complications. These difficulties 
 without doubt would be decidedly lessened if chem- 
 ists succeeded in separating from serums the minute 
 amount of pure, active principle which must be 
 present. This problem, with others of the same 
 character, is perhaps the very greatest immediate 
 problem awaiting the attack of chemo-medical re- 
 search — and scarcely a start has yet been made 
 toward the goal I 
 
 c J j'^' Endocarditis, an infection of the 
 
 Endocarditis a . r i i • i i- 
 
 „ , , rri 1 valves or the heart, is another dis- 
 Helpless 1 ragedy , . i • i i- • j 
 
 ease berore which medicine stands 
 
 practically helpless, although the victim may be a 
 young man or young woman in the bloom of life and 
 otherwise in brilliant health ! It is scoring Its trage- 
 dies among rich and poor, the well-protected and the 
 most exposed, by the thousand each year. Antitoxins, 
 auto-vaccines, serums, are used but are of little avail, 
 although it Is known from laboratory experiments 
 that in sufficient doses they should kill the Invading 
 germ. Again, it Is most likely the huge quantity of 
 useless impurities, such as horse serum, which limits 
 the physician in the application of these remedies. 
 Might not relief be found In the swift, sure action 
 of the pure, active principle, to which the germ Is 
 sensitive, injected intravenously in measured 
 strength, bereft of Its present load of Ineffective Im- 
 purities, before the germ has Itself become immune 
 to the principle ? In the present state of tragic help- 
 Health and ^^^sness, the effort certainly would 
 F od ^^ worth making. 
 
 The third great field of effort in 
 behalf of medical science by constructive chemistry 
 is found in the exhaustive study of all the important 
 
 [39] 
 
components of the cell contents and tissues and fluids 
 of the body carried out parallel with a similar exhaus- 
 tive study of our food resources. The Martian archi- 
 tects studying the structures of New York City in the 
 way suggested above, must need examine and under- 
 stand every part, large or small, entering into the 
 edifices of the highly complex community if they 
 would undertake to keep the city in first class repair 
 and working order under the stress of the tremendous 
 wear and tear of the life flowing through its veins. 
 Thus, they would insure that into the city are 
 brought all of the myriad parts, or the materials for 
 their manufacture, needed for replacement and re- 
 pair, ranging from obvious rail, brick, stone, terra- 
 cotta, tile, beam, to the hidden finest bolts and screws, 
 levers and wheels of the controlling devices of eleva- 
 tors, of lighting, water, plumbing, drainage systems. 
 ^, . In the same way, the body 
 
 AT T? J demands an impressive variety of 
 p -I f materials tor its healthy sustenance. 
 
 In its blind effort to contribute these, 
 a part of humanity has been inclined to overeat, with 
 Its resultant ills of functional disturbances. Another 
 large proportion of humanity has been well nour- 
 ished in quantity but undernourished In regard to 
 particular units of sustenance — with the resultant 
 diseases of nourishment, berl-beri, pellagra, rickets, 
 etc. Much work has already been done by the chem- 
 ist In the exhaustive analysis of food products, such 
 as carbohydrates, fats, amino-acids, but only a be- 
 ginning, however Important, has been made, and 
 every result demonstrates more convincingly the 
 need of a much more complete knowledge. 
 
 The fundamental work of the chemist, Emil 
 Fischer, on the structure and chemistry of the sugars 
 
 [40] 
 
opened the gates for all the more recent work on 
 carbohydrate metabolism and its pathologic varia- 
 tions as found in diabetes. Again Fischer's work on 
 the amino-acids, a purely chemical study, forms the 
 
 r. J f very foundation of all modern 
 
 Fundamental \ ^ . ^ v i- 
 
 ^i . 1 o J work on protem metabolism, on 
 
 Chemical btuay . r ^ . . tttvi ^i • j 
 
 •^ protem functionmg. With the aid 
 
 of the pioneer work of this chemist, recent work has 
 
 shown that while the human body can construct a 
 
 considerable number of its needs from the common 
 
 ingredients of all foods, there are other vital, specific 
 
 needs which must be supplied to it in finished form 
 
 or else starvation of vital parts and disease and 
 
 death follow in the midst of what otherwise would 
 
 be plenty. It will be the duty of chemists to furnish 
 
 a complete statement of such specific needs, to show 
 
 just how they can be satisfied, to help out perhaps, 
 
 indeeil, by showing how certain rare and difficult 
 
 units can be manufactured artificially. 
 
 c n ^ Indeed, cooperation between 
 some Kecent j- • i i • i t i 
 
 y. . medicine and chemistry has already 
 
 scored important victories in this 
 
 field: Diseases such as scurvy and beri-beri have 
 
 been found by physicians and chemists to have their 
 
 source in the lack of certain minute but vitally 
 
 important principles — hence called vitamines — 
 
 found in some but not in all foods, and with these 
 
 Scurvy Cuted discoveries and the results of the 
 
 ^^^ analysis or a great variety of foods 
 
 PrLented P^^perly brought home to the 
 
 practitioner the world over, these 
 
 diseases should vanish from the face of the earth. 
 
 Again, in the thyroid gland minute quantities of the 
 
 chemical element iodine are found. Its absence in 
 
 the diet is likely to cause thyroid trouble such as 
 
 [41] 
 
goiter. The observation that goiter is very prev- 
 alent around the Great Lakes, especially in young 
 girls and young women, led to an attempt to pre- 
 
 P . vent the development of goiter in a 
 
 Att ked town in Ohio by the giving of 
 small quantities of sodium iodide 
 to the school-girls for short periods. The results 
 under competent medical direction have been as- 
 tonishingly good, and there is no question but that 
 this simple instance of cooperation between chem- 
 istry and medicine will lead to the prevention of 
 many thousands of cases of disease with its atten- 
 dant dangers and unhappiness! 
 
 -, , That the possibility exists that 
 
 „ ,, certain mental disorders may be 
 
 Froblems , , . . . , • • t 
 
 produced by chemical principles 
 
 taken in with our food or by toxic principles pro- 
 duced from our food under abnormal conditions is 
 shown by the fact that certain chemicals are well 
 known to affect the mind : In Beverly's History of 
 Virginia in which Bacon's Rebellion is described, a 
 striking instance of the kind is found, where a com- 
 pany of soldiers partaking of a certain herb (Datura 
 Stramonium, containing the principle hyoscyamin) 
 were lor a time rendered ludicrously "foolish" v/ith 
 all the symptoms of temporary insanity. Other 
 chemicals when inhaled are well known to laboratory 
 workers as extraordinarily and permanently dan- 
 gerous to the mind. Exhaustive, patient work of 
 the chemist side by side with the medical observer is 
 needed to bring light into this at present utterly 
 dark, unexplored field. The hardening of arteries — 
 the common enemy of man after he had passed mid- 
 dle age — again is very strongly suspected of being 
 largely dependent on little understood nutritional 
 
 [42] 
 
factors. With its resultant serious diseases — high 
 blood pressure, kidney and heart troubles — we have 
 here again an invaluable field for research by the 
 painstaking complete analytical methods of the 
 chemist, which may ultimately give the physician the 
 knowledge to prevent the effect and its consequences. 
 
 IV. Physical Chemistry and Physics in the 
 Service of Medicine. 
 
 We have been considering thus far some of the 
 accomplishments and the more numerous problems 
 in the service of medicine of only one of the two 
 great methods of attack of chemistry in the great 
 study of the transformation of matter — namely, of 
 what we have called constructive chemistry, dealing 
 with the minute analysis of the composition of mat- 
 ter and with the building up or synthesis of matter 
 on the basis of the knowledge thus gained. There 
 is, as was stated at the outset, a second equally im- 
 Ti J portant method of attack — the 
 
 Ij . study of the functional or dynamic 
 
 side of the transformation of mat- 
 ter — comparable, as will be recalled, with the study 
 by our visiting Martians of the life pulsating through 
 our million edifices in New York City as contrasted 
 with the study of the structures of the city by the 
 architectural group. 
 
 This phase of the profound study of the trans- 
 formation of matter is called physical chemistry, 
 p, . y involving the applications to chemi- 
 ChlmUtry ^^^ change of principles of physics, 
 the fundamental science of the 
 transformation of energy (of forces, of motion, 
 ttc.) . It concerns itself primarily with the laws of 
 chemical change, the limits and controls of action. 
 
 [43] 
 
The two kinds of chemical investigation go hand in 
 hand, but the fields are so enormous and difficult 
 that as a rule men are specialists in one field or the 
 other and only in rare instances have expert knowl- 
 edge in both fields. Quite obviously, since life is 
 dynamic, medicine must call into its services the 
 physical chemist, as well as the constructive chemist, 
 as we have labelled them. 
 
 A few illustrations of past accomplishments and 
 
 of future problems must suffice in the attempt to 
 
 elucidate the innumerable applications of physical 
 
 J,, J,. chemistry to medicine. The great- 
 
 Factor ii^ife ^^\ factor distinguishing dynamic 
 action, such as we have it in life, 
 from a static condition, is the time f actor , the speed 
 factor. Life is dependent in an unusual degree on 
 the proper, fine adjustment of the time relations of a 
 great many interdependent actions in the body: the 
 rate of the heart-beat (the pulse), the rate of respi- 
 ration, the rate of metabolism (the speed with which 
 our food is consumed in the blood, tissues, etc.), the 
 rate of digestion, the rate of elimination by the kid- 
 neys, skin, lungs, etc., are all of the same vital im- 
 portance to the smooth working of the healthy body, 
 as in any engine the rate of the flow of gas, the rate 
 of combustion, the movements of pistons, valves, 
 etc., are for the smooth and perfect working of the 
 machine. In fact, the wonderfully fine adjustment 
 of these speed factors in our bodies to the needs of 
 life and their marvelous capacity of self-regulation 
 and readjustment under disturbed conditions form 
 perhaps the most impressive element of life when 
 viewed from the standpoint of its material trans- 
 formations. 
 
 It is the physical chemist who has discovered the 
 [44] 
 
ni . I i^L • * laws of the speed of chemical action 
 Physical Chemist i-i.ii r ^i, ^- r ^ 
 
 r,. J r — on which all of the time factors 
 
 Discovered Laws . , , , , . ^ i j j 
 
 ^ rr I 1. of the body ultimately depend — 
 of Health , , i • i i • ^ j- • 
 
 L J and to the physical chemist medicine 
 
 is turning for aid in the solution of 
 these problems in the control of health. 
 
 As an elementary illustration, let us consider diges- 
 tion, in which we are all concerned. Anyone inter- 
 H Ith ested in the question of the speed 
 
 ^. , of digestion can prepare a very 
 
 hard boiled egg (lo minutes), 
 versus , i • V r ^i 
 
 y^ . separate the white of egg from the 
 
 ^ ^j , yolk and press the former through 
 
 and the •' i • i r • i i i 
 
 ^. r. any kind or sieve at hand; equal 
 
 Time r actor ^ , . r i \ ?i 
 
 portions (teaspoonfuls) are then 
 
 placed in three glasses of water, kept at body tem- 
 perature or a little higher ( ioo° to 120° Fahrenheit) 
 by being placed in a larger vessel of warm water, 
 the contents of the three glasses being stirred by 
 paddles moved with the aid of a little water turbine 
 or a small electric wheel. The three tumblers thus 
 prepared represent artificial stomachs. To the one 
 £rlass is added both pepsin and two or three drops of 
 dilute hydrochloric acid, to the second only the acid 
 and to the third only the pepsin. If the higher limit 
 of temperature has been used (120°), the observer 
 will note in about an hour or less that in the glass 
 (stomach) containing both pepsin and acid, the egg 
 albumin will have been dissolved — digested — this 
 representing a normal stomach; in the other two 
 glasses, representing dyspeptics lacking either acid or 
 pepsin, there will be no digestion, that is, indigestion. 
 
 ^ . , J r, . Now, it evidently is of funda- 
 Acid and Jrepsm . \ ^ . 
 
 r *' AT * mental importance to us to know 
 t unctions I\ot . \ . 1 r • 
 
 WhoUyKnoum accurately just what the functions 
 of the acid and of the pepsin are in 
 [45] 
 
speeding up (accelerating) the digestion of our food; 
 no one would engage as chief engineer say of a war 
 vessel or ocean liner any man who did not under- 
 stand thoroughly the why and wherefore for every 
 adjustment, every control in the complicated machine. 
 And here we have in the (to us) most precious 
 machines, our bodies, at the very outset an action 
 which no man, physician or chemist, has to this day 
 completely elucidated — the mechanism of the action 
 of pepsin and acid in digesting our food at the very 
 first stages of its absorption in our systems. The 
 physical chemist has clearly defined the laws and 
 mechanism of related actions with acid alone, has 
 made great progress in the study of the action of 
 accelerators (catalyzers) in general: naturally, It 
 win be to the physical chemist that medicine must 
 turn for a more profound, more concentrated attack 
 on this problem of digestion under the Influence of 
 acid and the peculiar digestive ferment called pepsin. 
 
 . , ^ Pepsin is but one of a very large 
 
 Accelerators , ^ , i 
 
 ^ ^ ,,. number or accelerators or catalyz- 
 LontroUms „ . i • n 
 
 ^ ers — called enzymes technically — 
 
 which are the speed regulators of 
 all of our body functions. The digestion of our 
 food In the stomach and Intestinal tract, its trans- 
 formation Into new materials in our blood, and its 
 storage in our organs. Its combustion In the blood 
 and tissues, all are subject to these controlling fac- 
 tors. And not a single one has been completely 
 mastered as yet by the mind of man. 
 
 A -J-* Ajx * In the little experiment tried 
 
 Acidity Anects . . . r • t 
 
 Ti iJl above, the absence ot acidity was 
 
 Health , ' , . i i • i 
 
 observed to be quite as pathological 
 
 as the absence of pepsin — and as a matter of fact the 
 
 presence or absence of acidity, or In certain cases, of 
 
 [46] 
 
its complement, alkalinity — is another of the great 
 controlling factors in the healthy functioning of the 
 body. Proper acidity of the stomach facilitates diges- 
 tion — acidity of the blood or tissues on the other 
 hand is most detrimental to combustion of our food; 
 hyperacidity of our renal secretions can be of the 
 greatest danger to the secretory organs, the kidneys. 
 Self-Regulation O^r blood has, however, a re- 
 of the Blood markable capacity to preserve its 
 
 and Its Physical- ^^™^^ ^^'^^^ ^f^^^^ ^^ alkalinity, 
 ru ' 1 to escape at the same time the 
 Chemical c ^^ r ^ • j- j i 
 
 ir*.«/«««*^;^« bcylla or hyperacidity and the 
 txplanaUon ^ /^ . ^ 
 
 Lharybdis of excessive alkalinity. 
 This wonderful capacity for self-adjustment and 
 preservation of its optimum conditions for the pur- 
 poses of life is a typical instance of innumerable fine 
 mechanisms of self-adjustment in the body, all aimed 
 at maintaining the most favorable environment for 
 the functioning and preservation of life — self- 
 adjusting mechanisms which in fact comprise for the 
 scientific investigator the most impressive points of 
 difference between living organisms and the lifeless 
 world. And yet this remarkable power of the blood 
 to maintain its normal alkalinity has been elucidated 
 in a very complete way (especially by L. Henderson 
 of Harvard University) by the application of simple 
 principles of physical chemistry to the study of the 
 composition of the blood: There are chemical 
 ^'buffers*' present, which act chemically to preserve 
 neutrality exactly as powerful springs act as mechan- 
 ical buffers to minimize the shock of impact to fast 
 moving bodies. 
 
 It is well for us to recall, moreover, that the last 
 generation of scientific workers could not possibly 
 have elucidated this wonderful mechanism of self- 
 
 [47] 
 
adjustment, for the simple reason that the discoveries 
 of the necessary fundamental facts and principles of 
 physical chemistry which Henderson applied, simple 
 as they are, had not yet been made. We must bear 
 this lesson in mind when we face other mechanisms 
 of fine self-adjustment for which at present we may 
 be at a loss to find the key. 
 
 B d W h Another question of peculiar in- 
 
 c L • * ^ terest to man as a worker is the 
 p, . , problem or the conversion of fuel 
 J elements in our food into work, 
 
 comparable with the problem of 
 the efficiency of the coal or oil consuming steam en- 
 gine or of the internal combustion engine. This is 
 essentially a problem of physics, the fundamental 
 science of the transformation of energy. Mayer 
 more than sixty years ago called attention in general 
 terms to the sources of energy for body work and 
 emphasized the fact that living organisms are sub- 
 ject to the great physical law of the conservation 
 of energy. In very recent years A. V. Hill of the 
 University of Manchester has succeeded in applying 
 in a masterly way the laws of physics in great detail 
 to the working of a muscle. 
 
 It is work of this character, leading step by step 
 to the complete understanding of most complex 
 actions of our body by the application of the prin- 
 ciples of physics and chemistry, which sustains the 
 faith of those who believe that chemists and physi- 
 cists, working in closest cooperation with the experts 
 in the various fields of biology, will ultimately ex- 
 press all the major facts of the material side of life 
 in their own exact terms and thereby give to medicine 
 the control characteristic of an exact science. How 
 necessary such encouragement of the faithful army 
 
 [48] 
 
of scientific workers is, must be apparent from the 
 
 ^ .. . way in which so eminent a physi- 
 
 Looperatwn to ,. ttu r r\ r a - 
 
 „ w . ologist as Haldane of Oxford, m 
 
 Express Major .^ . , . , .,i. , 
 
 „^ . J ., spite of his own bnlhant work, 
 
 carried out with the aid of physics 
 and chemistry, on the fine adjustment of respiration 
 to environment, despairs of the complete success of 
 the fundamental sciences in explaining the automatic 
 adaptation of the body to its life needs and to its own 
 reproduction, and falls back on metaphysical con- 
 ceptions.^ 
 
 We need but recall that every modern machine, 
 from the power engine to the loom, from the printing- 
 press to the watch, is equipped with numberless auto- 
 matically working devices of fine control and self- 
 adjustment (such as the self-adjustment of a fine 
 watch to temperature changes, by which winter and 
 summer alike it will not vary a second in the ticking 
 off of time. To the barbarian these man-made ma- 
 chines are as wonderful and complex, because not 
 understood, as are indeed the marvelously fine and 
 sensitive powers of adjustment of the living organism 
 to us, who still understand so little about them. Our 
 problem without question is a tremendously complex 
 one, but the advances already made are a sufficiently 
 brilliant promise of ultimate success, and we can best 
 hasten the advance by bringing together for closest 
 cooperative work expert workers to form a small, 
 well-organized corps, where in the past advance has 
 depended most largely on the brilliant but dispersed 
 sorties of the individual worker. 
 
 Colloidal ^ further field of investigation 
 
 Chemistry ^^^ ^^^ physical chemist, which is 
 
 of major importance to the de- 
 
 ^ Haldane, Mechanism, Life and Personality, 1914, and Organism 
 and Environment, 1916. 
 
 [49] 
 
velopment of medicine as an exact science rather 
 than an art, is the study of "colloids." Graham 
 distinguished crystalline substances such as salt or 
 sugar, from what he was the first to term colloids 
 (from coile, the Latin for glue) . Now the vital fact 
 about colloids is that they do not dissolve as would 
 salt or sugar say, in water, but colloids form sus- 
 pensions : milk is a common illustration of such a 
 suspension of fat globules and of the cheesy com- 
 ponents (casein) in a watery solution of milk sugar 
 and some salts. Clay stirred up in water represents 
 another well-known suspension. But the most im- 
 
 «,, „ portant instance of colloids is the 
 
 1 he Human f i i • ir n r i 
 
 n 1 J human body itself, all of the tis- 
 
 r llnd 1 sues, muscles, fluids of which rep- 
 resent colloidal suspensions. It is 
 for that reason that the exhaustive study of colloidal 
 chemistry is of vital importance for the develop- 
 ment of medicine as a science. Two or three specific 
 illustrations of the nature of the problems we are 
 facing must suffice here. It is well known to all of 
 us that the very stability of such a colloidal system 
 
 T> j'1 c* 1--7-* as milk is subject to disturbance by 
 Bodily Stability ,, , •'. , . t- 
 
 c '^- small changes m the system; acidity 
 
 Sensitive , • \ t i i • 
 
 (souring) leads to coagulation, 
 
 time or churning leads to the separation of cream and 
 eventually of the butter. In either event, the milk as 
 such is destroyed. All colloidal systems, and espe- 
 cially those of the body, are similarly sensitive to 
 forces affecting their stability: the kidneys are pecu- 
 liarly sensitive to acidity; the coagulation of our 
 blood, the stiffness of our muscles are instances of 
 disturbances of colloidal systems vital to our health. 
 Milder disturbances lead to ill-health, severe changes, 
 as the injection of acid into our veins, lead to death. 
 
 [50] 
 
Besides the question of stability of our colloidal 
 organs, tissues and fluids, another vital consider- 
 ation is this : Since a colloidal system represents a sus- 
 pension, we are dealing in every Instance with at least 
 two and often many more, different media of en- 
 tirely different properties. As the dweller on one of 
 the Thousand Islands must live with the problem of 
 water as well as of land, and must arrange for a 
 system of communication by water and by land, so 
 on the other hand the scientific study of our body is 
 leading us to discriminate carefully between the needs 
 of the watery fluids of the body and of the dozen 
 different suspensions in us, fatty, gelatinous, protein- 
 like, etc. 
 
 c / Surface properties of colloids 
 
 burface . ,• , • -r 
 
 Eif t ^^^ peculiarly great signihcance 
 
 In life reactions — comparable 
 roughly with the importance of shore facilities, of 
 shore stability, to our typical island inhabitant. Sur- 
 face tension, the force which makes the film of a 
 soap bubble round and which may preserve it Intact 
 even when pricked by a fine needle, is found by physi- 
 cists to vary greatly under stimuli such as electrical 
 charges or chemical changes. It is known to play a 
 fundamental role In life reactions such as in the mo- 
 tions of lower organisms, and the principles of sur- 
 face tension must find a wide field of application in 
 the study of the complex suspensions of our own 
 bodies. 
 
 Th P hU* Perhaps of even greater need of 
 
 , r, . profound study are the adsorption 
 
 and absorption phenomena of sur- 
 faces bathed by liquids : thus our organs of secre- 
 tion, all colloids, have truly marvelous powers of 
 maintaining conditions In the body favorable to life. 
 
 [51] 
 
For instance, the kidneys will prevent in very larg- 
 est measure the diluting of our blood even when 
 large volumes of water are imbibed: they respond 
 at once, eliminating the superfluous water into the 
 bladder as quickly as it is absorbed. In like fashion 
 they rapidly eliminate excessive, injurious amounts 
 of sugar, salt and other products liable to modify 
 the character of the blood. The mechanism of se- 
 lective secretion by the kidney, the mechanism, in 
 fact, of secretion by any organ, is, in spite of many 
 important investigations and their partial answers, 
 still mainly an unsolved riddle to science. And yet 
 there is no problem of greater importance to health 
 in view of the vital role played by our organs of 
 secretion. 
 f> p ' A more profound and exhaustive 
 
 . . J fundamental study of colloids holds 
 
 of Advance , . • r j 
 
 out the greatest promise or advance 
 
 in this direction: let us recall that the neutrality 
 of our blood could only be explained after physical 
 chemistry had advan^^d sufficiently to give us the 
 theory of "buffer'* neutralizing agents, one of the 
 consequences of the Arrhenius theory of ionization 
 — a great and unknown field before the year 1887. 
 Likewise the great problem of selective absorption 
 by colloid organs is probably awaiting further 
 advances in the fundamental sciences themselves. 
 It must be quite obvious that a concentrated at- 
 tack on the problems of health and disease from the 
 point of view of the fundamental sciences of chem- 
 istry and physics must include intensive study of the 
 colloidal systems which form the major structure of 
 our bodies. 
 
 [521 
 
V. The Fundamental Problem — The Chemistry of 
 the Body Cells 
 In outlining the methods by which the funda- 
 mental sciences of chemistry and physics could con- 
 tribute to the raising of medicine to the plane of an 
 exact science in maintaining health and curing dis- 
 ease, we have thus far emphasized the possibilities 
 for the solution of a number of specific and urgent 
 problems, which, however difficult, hold out the 
 promise of definite and not too remote success in a 
 coordinated attack upon them by chemistry, physics 
 and medicine: the preparation of specific remedies 
 for specific diseases, the isolation of pure principles 
 as swift, sure weapons to be placed in the hands of 
 the practitioner, the protection of health by the ex- 
 haustive analysis of food, the profound study of 
 our time reactions and their regulators, the study 
 of colloids as the basis of investigation of our organs 
 of secretion, are some of the points of vantage 
 toward which most likely the .surest approach could 
 be made. Success in these directions would bring 
 unmeasured blessings to mankmS in the prevention 
 and cure of disease and the consequent promotion 
 of happiness. 
 
 TL rz s. t But the very heart of the prob- 
 1 he Heart of . r t-r i i- i r r 
 
 th P hi -— "^ ^ ' highest form or 
 
 Th C II chemical change, lies in the pro- 
 found and complete study of the 
 chemistry of the body cells, the units of which our 
 bodies are composed. This is the most important, 
 and also by far the most difficult problem of all: 
 Its solution is vitally necessary for that ultimate com- 
 plete mastery of science over life, which will give 
 man the wisdom to maintain health ana increase the 
 life span of the greatest number. 
 
 [53] 
 
rpf^ Tj If we let our minds dwell on the 
 
 B d E f>d complexity of our body's structure 
 r II Li ^^^ functions, we must recognize 
 
 without question that man's body is 
 not a primary form of life but the result of the slow 
 processes of evolution from simpler forms through 
 the ages. The whole history of the human race is 
 indeed revealed to us in the most impressive fashion 
 by the development of the embryo, starting with the 
 fecundation of the minute human ovum, a single cell, 
 and growing slowly by a rapid multiplication of cells 
 to the fully developed infant as it appears at birth. 
 Our bodies are, in fact, wonderfully organized com- 
 munities of myriads of cells, the primal form of life. 
 And all of our life functions are still carried out as 
 in primal days by cell secretion, cell excretion and 
 cell multiplication — the change of our food into body 
 tissues, the elimination of waste products, the devel- 
 opment of the means of procreation are but instances 
 of this general truth regarding our body activities. 
 Except for the extreme differentiation of functions 
 of special cells, we still live solely through the co- 
 ordinated activities of cells. 
 jy. ^, As a result the problem of curing 
 
 r II I ^^ preventing disease is tending in 
 
 T^. ^ , an important sense toward a study 
 
 Visturbance r i % i • i j* • 
 
 of the means by which conditions 
 
 for normal cell processes may be maintained or re- 
 stored after any disturbance. In other words, we 
 are being forced to conclude that the seat of dis- 
 turbances leading to disease is the living cell which 
 the biologist justly conceives as the unit of biological 
 change. An active and normal cell development 
 therefore means good health. These activities are 
 fundamentally chemical and physical in character. 
 
 [54] 
 
Let us recall again: "Cell-secretion, cell-respiration 
 and cell-nutrition are clearly only different aspects of 
 the whirl of molecular activity" and "there is a con- 
 stant molecular interchange between the cell and its 
 environment." It is physics and chemistry that study 
 natural phenomena from the point of view of molec- 
 ular activities — it is to physics and chemistry that 
 biology must turn for the ultimate study of its units 
 of life, the cells, and we cannot overemphasize the 
 importance of increasing our knowledge of the mech- 
 anism of the chemical processes operating In these 
 hidden laboratories wherein all the fundamental re- 
 actions of life originate and take place. 
 
 ^ J Now, while multitudes of definite 
 
 Our Ignorance , . , , i , 
 
 , , chemical substances have been iso- 
 
 ^, . ^ lated from animal and veeretable 
 Chemistry . , . , .^ . r i • i 
 
 I ^i. r> 11 tissues, the identification or which 
 oj the Cell . ' ., . 111 
 
 IS a contribution to our knowledge 
 
 of the chemistry of the cell, no comprehensive and 
 exhaustive study of the contents of even a single 
 type of cell has ever been attempted. In fact, it is 
 only when we begin to consider the cell from a 
 strictly chemical point of view that we are led to 
 recognize how scanty indeed is our knowledge of 
 the chemistry of this vital biological unit. Thus, 
 Livins and ^^ ^^ "^^ ^^^" know in exact terms 
 Lifelels Material ^J P^^^^" ^"5^ chemistry what the 
 Undiscovered ^^^^^^\ ^^^ that distinguish living 
 from lifeless material: What are 
 indeed the chemical and physical forces that lead to 
 cell subdivision, the wonderful first step in life de- 
 velopment? What are the forces that lead to per- 
 petuation of life? To instinctive self-protection? 
 What are the conditions for the equilibrium in the 
 colloidal system we call protoplasm, which make an 
 
 [55] 
 
obvious difference between life and death? What 
 is the chemical structure of proteins? Of the com- 
 ponents of brain tissue, underlying the most won- 
 derful of all life processes, consciousness, memory, 
 What of thought, and feeling? What is the 
 Heredity chemistry or the physics of the 
 inheritance of body form from 
 generation to generation, even of the finer traits of 
 mind and temperament carried from parent to child 
 through the minute cells of procreation? Are some 
 of the millions of chemical molecules present even in 
 these minute cells in some way the carriers of this 
 wonderfully accurate transmission of qualities? 
 
 TJ.« p^ ,^ ^i These are but a few of the extra- 
 1 he rower of ,. ., . ,, - 
 
 Knowledge ^rdmarily important problems of 
 versus Theory chemistry and physics in the ulti- 
 mate field of cell life. They are 
 tremendous problems but many believe they are not 
 beyond the power of the human mind in control of 
 the scientific tools of chemistry and physics. Indeed, 
 until these exact sciences do shed more light on these 
 problems, there will be speculation, theory, philoso- 
 phizing — but not knowledge. It will take many gen- 
 erations of many workers to attain this knowledge, 
 but who can question for a moment that complete 
 success in these problems would spell for mankind 
 health of the body, health of the mind, and the hap- 
 piness of untold millions of sensitive beings! And 
 based on this knowledge, the medicine of the future 
 will finally succeed in attaining its present noble goal, 
 to prevent disease, to maintain health, so that to a 
 less degree there will be need of the combatting of 
 disease. 
 
 fS6] 
 
EXISTING FACILITIES FOR CHEMO- 
 MEDICAL RESEARCH 
 
 In order to form a correct judgment in regard to 
 the necessity for chemo-medical research, it is essen- 
 tial to make a survey of the facilities now available 
 in this country and contrast them with the facilities 
 existing in other countries. 
 
 Our own country, with its vast resources, should 
 
 have a leading part in this important field of work; 
 
 we cannot at this time escape the responsibility for 
 
 contributing our full share to the alleviation of 
 
 human suffering caused by disease, yet if we compare 
 
 the number and scope of our own institutions for 
 
 medical research with those of other countries it is 
 
 evident that much remains to be done before we can 
 
 aspire to leadership in this branch of research. 
 
 p .,.^ In commenting on Ehrlich*9 
 
 . , work in 19 13, a popular maga- 
 
 TT •* J c* * zine^ said: "More immediately 
 
 United States . t 1 1 • -/ 
 
 practical than any other scientmc 
 
 development of our time is the subjection of the 
 science of medicine to the principles of chemistry. 
 . . . The importance of regarding medicine as a 
 branch of chemistry and not as an independent sci- 
 ence is manifest when we remember the therapeutic 
 mysteries for a solution of which mankind is now 
 desperately groping." The value of fundamental 
 studies in relation to disease has thus been more or 
 less generally recognized for a number of years, 
 
 ' Current Opinioo 55-256. 
 
 [57] 
 
yet our survey shows that at the present time we 
 
 are far behind Europe in our facilities for chemical 
 
 research. 
 
 ^L . , While there are in the United 
 
 Chemical ^ i r • • i 
 
 e^ 7 . ^ btates a number or mstitutes and 
 
 otancipomt r 1 • e t i ^ 
 
 J f. toundations tor medical research 
 
 doing most valuable work, there is 
 none in which the problems are being approached 
 primarily from the chemical standpoint. Conse- 
 quently few new lines of chemical investigation in 
 relation to disease have been developed in this coun- 
 try and we have been largely dependent upon foreign 
 countries, especially Germany, for discoveries relat- 
 ing to the applications of chemistry to disease. In 
 considering the publications relating to chemo- 
 therapy which have appeared in this country, it is 
 remarkable to what a large extent they have followed 
 a few lines opened up in Europe. Thus the many 
 investigations on the therapeutic value of the newer 
 arsenic compounds ; the very numerous studies on the 
 action of aniline dyes, including the combination of 
 these with mercury and other metals and the work 
 on the effects of quinine derivatives in pneumonia, 
 are all based upon the work of Ehrlich. When 
 Ehrlich laid the foundations for this work he was 
 occupied with certain broad general problems (such 
 as the laws governing the distribution of chemical 
 compounds in the body) and not with specific dis- 
 eases. Work along these lines is already beginning 
 to stagnate, and it is becoming more and more 
 evident that new points of view are needed which 
 can be obtained only by a return to the study of 
 fundamentals. 
 
 It will be noted that many of the research founda- 
 tions in this country have been established for the 
 
 [58] 
 
study of certain diseases, or classes of diseases, and 
 are not therefore free to work upon broad, funda- 
 mental problems.^ 
 
 Institutes and Laboratories in the United States 
 In the United States, medical research is conducted 
 in universities, special institutes, Government labora- 
 tories and industrial establishments. 
 
 Med' al Many of the leading University 
 
 p , . Medical Schools, although by no 
 
 . . means all, have departments or 
 
 American ^, ' ,. f -j 
 
 jj . . . Pharmacology. In these a consid- 
 
 erable amount of valuable investi- 
 gation on the action of chemical substances in health 
 and disease is being done. Little of this investiga- 
 tion, however, relates to fundamental subjects; it 
 consists rather in the detailed study of some 
 
 *The importance, even for the solution of immediately practical 
 problems, of opportunities to pursue fundamental studies irrespec- 
 tive of any specific disease is strikingly shown by the circumstances 
 leading to the discovery of arsphenamine. Ehrlich was engaged in 
 a study of the chemical and physical principles which determine 
 the distribution of compounds in the animal body and had selected 
 the study of dyes since their distribution was easily determined. 
 While the purpose of these studies was purely theoretical, Ehrlich 
 found that some of the dyes seemed to have a special affinity for 
 blood corpuscles and thought that they might be of value in malaria. 
 He accordingly made a series of experiments upon bird malaria 
 and afterward determined the effects of the dyes upon parasites 
 somewhat similar to those of malaria, viz., trypanosomes. Only 
 after he had found what chemical groups made the dyes injurious 
 to the parasites did he take up the study of arsenic compounds. 
 He prepared compounds containing arsenic very similar, chemi- 
 cally, to some of the dyes and found that the same laws governed 
 their trypanocidal action. He next tried these compounds upon 
 the organism of syphilis which at that time was supposed to belong 
 to the group of trypanosomes. In this way, from a purely theo- 
 retical study, Ehrlich was led to the discovery of "606." 
 
 If the activities of Ehrlich had been restricted either by the 
 Government or by the terms of a bequest to a study of dyes or 
 of arsenic compounds, or, on the other hand, to an effort to dis- 
 cover a remedy for sleeping sickness or for syphilis, it is not very 
 probable that he would have been led to the discovery of the 
 value of certain arsenic compounds in the treatment of syphilis. 
 
 [59] 
 
substance, usually a well-known chemical compound, 
 
 upon some highly specialized tissue or organ. Among 
 
 the more fundamental subjects investigated in these 
 
 laboratories may be mentioned pioneer work on 
 
 epinephrine (adrenalin) and on the local anaesthetic 
 
 properties of aromatic alcohols. 
 
 y _. . The primary purpose of these 
 
 Instruction , . ^ . . -^ ^ \ . - 
 
 r ' .^ ,. laboratories is the instruction of 
 
 Limitations ,. i j i • i /• 
 
 ^ medical students, which or necessity 
 
 forces the staffs to cover a wide 
 field; this and the various other duties connected with 
 an academic position allow comparatively little time 
 for concentrated work on problems of major impor- 
 tance. Moreover, most of these departments are not 
 in close touch with departments of chemistry, as the 
 university pharmacologist and chemist are usually 
 interested in chemical compounds from entirely dif- 
 ferent points of view: the pharmacologist from the 
 standpoint of the therapeutist and physiologist, and 
 the chemist from the standpoint of some general 
 chemical principle. Exactly the same difficulties 
 stand in the way of departments of bio-chemistry 
 (physiological chemistry) as organized in most uni- 
 versities: primarily interested in the instruction of 
 medical students, they are doing praiseworthy work, 
 but necessarily limited in scope. 
 
 These circumstances, taken in connection with the 
 comparatively limited resources of the universities, 
 make it improbable that the character of work in 
 the minds of the committee can be satisfactorily 
 accomplished in university laboratories. 
 
 As an instance of the severe handicaps placed on 
 the University worker, the following is of interest: 
 In 1 910 a pharmacologist in one of our leading uni- 
 versities discovered and isolated from the contents 
 
 [60] 
 
of the poison glands of the tropi:al toad bufo agua 
 
 a pure chemical principle, bufagii;, which was found 
 
 to have a marked and important action on the heart, 
 
 ^ ^ of the order of the most effective 
 
 . members or the digitalis series. 
 
 American ^t j- • i- • i t i « 
 
 ^. JNow, digitalis is the most valuable 
 
 heart stimulant known to medicine, 
 but it consists of a mixture of principles and it is one of 
 the most unsatisfactory of drugs to handle, because of 
 the difficulties of securing uniform preparations of It, 
 on whose effects the physician may count with absolute 
 certainty. It is also difficult to secure reliable prepa- 
 rations for hypodermic injections with their advan- 
 tages of almost instantaneous results. A pure chemi- 
 cal principle with the same action on the heart as 
 digitalis would be free from all of these vital defects 
 and would prove an invaluable addition to our ma- 
 teria medica. With the limited resources in per- 
 sonnel, supplies, etc., our university men have not 
 been able to develop this promising investigation by 
 any large scale preparation, and now a German 
 chemist, with the munificent support of German 
 chemical industries, is moving at top speed to isolate 
 in quantity and commercialize a similar principle 
 found In a species of German toad. 
 
 It was doubtless the limitations of research in the 
 medical schools which led to the founding of a con- 
 siderable number of institutes for medical research; 
 some of these are In connection with universities or 
 hospitals, while others are entirely Independent. 
 
 The largest and most prominent of these institutes 
 is the Rockefeller Institute for Medical Research, 
 The staff of this Institute consists of ten ''members" 
 with their associates and assistants. Eight of these 
 "members" are occupied with studies on bacteriology, 
 
 [61] 
 
pathology, immunology, serology, general physi- 
 ology, diseases of animals, experimental surgery, 
 clinical researches on diabetes, heart disease, kidney 
 disease, pneumonia, yellow fever, 
 bpecial meningitis, infantile paralysis, etc. 
 
 '^^i ",.^^ , Iri the fall of 1920 announcement 
 
 Medical 1 1 j • 1 
 
 „ , was made that durmg the ensumg 
 
 Research . , r n • j- ij 
 
 in the wmter the tollowmg diseases would 
 
 United States be made the subject of special study 
 at the institute: acute lobar pneumo- 
 nia and other acute pulmonary infections, measles, 
 acute rheumatic fever, cardiac disease and nephritis. 
 Two "members" devote their time to chemical work. 
 The activities of the one relate largely to the structural 
 chemistry of nucleic acids, lipoids, and other impor- 
 tant components of the body. Under this "member," 
 also, are chemists whose work relates to chemo- 
 therapy; their researches have extended to such com- 
 pounds as derivatives of hexamethylenetetramine, of 
 certain arsenic acids and of quinine. A number of 
 these derivatives have been tested in other divisions 
 of the institute and in the hospital, for their thera- 
 peutic action. The other chemical "member" works 
 in connection with the hospital of the institute, and 
 his work at present relates chiefly to refinements in 
 the methods of blood analysis and other methods of 
 clinical interest. A third "member" of the institute 
 is working on the fundamental theory of colloids 
 and the application of other physical relations to life 
 phenomena. Part of the excellent work of this in- 
 stitute is in the direction of our chief aims, but the 
 emphasis is rather placed on the pathological and 
 other medical features of the problems than on the 
 
 [62] 
 
direct attack on the problems of medicine by means 
 of a concerted, wholly cooperative effort of leaders 
 in the fundamental sciences of chemistry and physics, 
 in pharmacology and in medicine. 
 
 The Otho S. A, Sprague Memorial Institute^ 
 which is closely affiliated with the University of Chi- 
 cago, covers in part the same class of problems as 
 does the Rockefeller Institute, but rather more em- 
 phasis is placed upon the chemical aspects of medical 
 problems. The Sprague Institute has no buildings 
 of its own, but cooperates "with existing institutions 
 wherever and whenever it seems that medical re- 
 search can be furthered." In pursuance of this 
 policy it supports work in various laboratories of the 
 University of Chicago and in several hospitals. 
 Among the major problems studied are cancer, dia- 
 betes, chronic articular rheumatism, dementia precox, 
 occupational and children's diseases. Among the 
 more strictly chemical studies may be mentioned a 
 series of investigations on the chemistry of the 
 tubercle bacillus; studies on the chemical aspects of 
 diabetes and gout, of immunology, of protein therapy 
 and of the amines obtained from proteins. 
 
 Only about half of the members of the staff give 
 full time to the Institute ; the others are engaged also 
 in the practice of medicine or in teaching. Excellent 
 as is the work being performed, there is no intensive, 
 concerted attack on problems by any such group of 
 experts as is contemplated in this report. 
 
 The John McCormick Institute for Infectious Dis- 
 eases is also located in Chicago; its problems arc 
 chiefly connected with those of infection and im- 
 munity. 
 
 [63] 
 
i^*L p -T**,*^. There are a number of other 
 
 Other Facilities . . , , , . . 
 
 , r , ^ . institutes and laboratories in con- 
 ana Laboratories . . I Till 1 
 
 nection with medical schools and 
 hospitals, founded for medical research, such as the 
 Mayo Foundation, Rochester, Minn., the George 
 Williams Hooper Foundation for Medical Research 
 of the University of California Medical School, the 
 Nelson Morris Memorial Institute for Medical Re- 
 search of the Michael Reese Hospital in Chicago, 
 the H, K, Gushing Laboratory of Experimental 
 Medicine at Western Reserve University, The John 
 Herr Musser Department of Research Medicine of 
 the University of Pennsylvania, the Bender Hygienic 
 Laboratory at Albany, and the Harriman Research 
 Laboratory at the Roosevelt Hospital in New York. 
 ^ , , In addition to the above- 
 
 c . 1 ri- mentioned laboratories and general 
 
 bpecial Diseases . . ^ ,. , , , 
 
 institutes tor medical research there 
 
 are a number of institutes, laboratories, funds and 
 foundations for the study of special diseases. Among 
 these may be mentioned the following for the study 
 of cancer: the George Crocker Special Research 
 Fund at Columbia University, the Huntington Funds 
 for Gancer Research at the Memorial Hospital, New 
 York, and at the Harvard, Medical School, the Gan- 
 cer Laboratory of the New York State Department 
 of Health at Buffalo and the Laboratory of the Bar- 
 nard Free Skin and Gancer Hospital at St. Louis. 
 There are also a number of foundations for the 
 study of tuberculosis, such as the Henry Phipps Insti- 
 tute at Philadelphia, the Trudeau Foundation for 
 Research and Teaching in Tuberculosis at Trudeau, 
 N. Y., the Research Department of the National 
 Jewish Hospital for Gonsumptives at Denver, the 
 
 [64] 
 
Kenneth Dows Fund for the Study of Tuberculosis 
 at the Johns Hopkins Hospital, etc. 
 
 A considerable amount of chemical work is done 
 at some of these foundations, but it relates largely 
 to the applications of chemistry to diagnosis and to 
 problems in bacteriology and pathology, although 
 some work is done on chemo-therapy and at the 
 Mayo Foundation Kendall is doing his important 
 work on thyroxin, a very active compound separated 
 from the thyroid gland and which can replace the 
 latter In therapeutics. 
 
 The Dermatological Research Laboratories of the 
 Philadelphia Polyclinic have done very Important 
 work on the preparation of arsphenamlne and on 
 chemo-therapeutic studies with this and other arsenic 
 and also mercury compounds, as well as on metabo- 
 lism in certain skin diseases. 
 
 The laboratories of the James Buchanan Brady 
 Urological Institute of the Johns Hopkins Hospital 
 have made studies on new antiseptics of interest In 
 urology. 
 
 The Russell Sage Institute of Pathology , In affili- 
 ation with Bellevue Hospital, New York, Is making 
 important calorlmetric studies of the metabolism In 
 various diseases. 
 
 J 1 I In none of the many Institutions 
 
 ac oj . ^^^^ ^^^^ ^^^^ enumerated, impor- 
 
 J 1 tant as is their output in research, 
 
 n^ 7. T hlffhly needed as they all are, Is 
 
 Medical ^ /. 1 r ^u 
 
 „ , , provision made for the cooperative 
 
 Problems ^ , ,1 r j- • t« 
 
 attack on problems or medicine by 
 
 great leaders In the fields of medicine and the funda- 
 mental sciences. 
 
 [65] 
 
Medical , ^^^ ""^"^y ^P^"^ annually on 
 
 Research in chemical work by the United States 
 United States Government runs into the millions. 
 Government ^^^^^^^ ^^^ °^ ^^''^ however, is for 
 Laboratories technical or economic purposes or 
 in connection with law enforcement. 
 Only a very small part of it goes for researches in 
 the lines under consideration; in fact, except for 
 some more or less incidental, but very important, 
 work in the Department of Agriculture and work 
 done by the Army and Navy with special reference 
 to military problems, almost the only research work 
 bearing directly upon the health of man is that car- 
 ried on in the Public Health Service, and especially 
 in the Hygienic Laboratory. In the latter there is 
 a small division of chemistry and also a division of 
 pharmacology in which some chemical work is done. 
 In recent years the chief activities of the division of 
 chemistry have been directed to sanitary engineer- 
 ing; but now there are prospects of some funda- 
 mental work on the metabolism of bacteria. The 
 chemical work in the division of pharmacology has 
 been largely in connection with the standards and 
 legal control of drugs, although there has been some 
 work on chemo-therapy and on the relation of chemi- 
 cal structure to physiological action; at present chemi- 
 cal work in connection with tuberculosis is being 
 developed. 
 
 Of the present Government laboratories the Hy- 
 gienic Laboratory would be the best adapted for 
 development into a medium cooperative research 
 such as that being considered. But judging from the 
 past and present, there seems little probability that 
 this will occur. Congress has never made the posi- 
 
 166-i 
 
tions in this laboratory sufficiently attractive from the 
 standpoint of salaries or of facilities and freedom for 
 work to long retain the services of chemists of 
 eminence; in the seventeen years of the existence of 
 this laboratory there have been four chiefs of the 
 chemical division and the position has been vacant 
 for about a fourth of the time. 
 
 y, , The appreciation of chemical 
 
 Ch ' IW k ^^^^ ^^ ^^^ P^^^ ^^ ^^^ medical 
 r men of the Public Health Service 
 
 on Leprosy , i r • i • 
 
 and an example or its value m 
 
 public health work were shown by a recent report 
 from the Service's Leprosy Investigation Station 
 at Honolulu and Molokai. The Director of this 
 station, in discussing leprosy, states that earlier 
 experiments with chaulmoogra oil indicated that 
 there is in this oil "a most valuable curative agent 
 or active principle appealing to chemistry for its 
 isolation, or, at least, identification''; and then 
 relates how, when the cooperation of a chemist was 
 obtained and the ethyl esters of the acids of this oil 
 were prepared and injected into lepers seventy-eight 
 of the latter were cured of the disease. Such a strik- 
 ing demonstration of the value of the cooperation 
 of chemists with physicians can hardly fail to make 
 an impression on Congress, but it seems improbable 
 that any group of chemists in the Government labora- 
 tories will be left free from routine or law-enforcing 
 problems sufficiently long to accomplish much funda- 
 mental work. Public funds, moreover, are only 
 appropriated for specific purposes and the necessary 
 freedom for work on fundamental principles would 
 therefore be practically impossible in a Government 
 institute. 
 
 [67] 
 
Medical ^^ ^^ difficult to secure accurate 
 
 Research in ^^^^ /^ '^^^'^ ^^ research work 
 Manufacturing 1^^^ '/" progress or contemplated 
 Establishments !^ ^^^dustnal laboratories, as there 
 IS always a natural desire to keep 
 such knowledge from competitors until patents can 
 be applied for or until the products resulting from 
 the research, if not patentable, are ready for the 
 market. Although a considerable proportion of the 
 drugs now in use have resulted from researches 
 carried on in the laboratories of manufacturing 
 establishments, most of this work has been based 
 upon the results of previous fundamental work in 
 universities or other institutions. Although many 
 pharmaceutical and chemical manufacturers main- 
 tain research organizations which have been an 
 important factor in reaching our present stage of 
 progress, no commercial establishment can maintain 
 a staff of specialists In the various branches of science 
 such as would be required to accomplish effective 
 work of the character now required. 
 
 Ind trial ^^^ research work of commer- 
 
 Research of ^^^^ ^^^^ ^^^^^ °^ necessity be con- 
 Great Value ^"^^ F^^'^^^y ^? ^^^ methods for 
 manufacturing known products and 
 to the discovery of new substances through the appli- 
 cation of well-established principles. Researches of 
 this kind are reasonably sure to develop Improved 
 medicinal agents of the types already In use, and in 
 this way to secure the financial returns necessary to 
 successful manufacturing operations. Such progress 
 is of great value, as It results In a gradual but steady 
 Improvement In medicinal substances and In building 
 up manufacturing facilities and experience so neces- 
 
 [68] 
 
sary to the complete development of our chemical 
 industry. 
 
 ,- . The industries could be very 
 
 Manufacturers , , /- i i r . • j 
 
 Would Assist '^f 'P^"l "jy manufacturing and sup- 
 plymg chemicals required tor re- 
 search purposes and by carrying out operations on a 
 scale not feasible outside of a well-equipped factory. 
 All of the progressive chemical and pharmaceutical 
 manufacturers would w^illingly assist in this manner, 
 and a number of firms engaged in the manufacture 
 of dyes and technical chemicals would also be willing 
 to supply chemicals and intermediates to be used in 
 the preparation of medicinal products. On the other 
 hand, research of the character contemplated would 
 be helpful to our chemical industry, as it would 
 stimulate the manufacture of distinctively American 
 medicinal products. 
 
 While we have thus in the universities, in research 
 institutes and certain Government laboratories a con- 
 siderable amount of most important worlc for the 
 discovery of the cause and prevention of disease, 
 there is not in a single institution that cooperative 
 effort of leaders in the field of organic chemistry, 
 physical chemistry, pharmacology and medicine. 
 
 Isolation Bars , ^^^. ^^°'''*. ^"i^ '^°'f«'^- . "^e 
 p have in one institute the eminent 
 
 pathologist with chemical assis- 
 tance, but lacking the constant full-time cooperation 
 of leaders in synthetic organic chemistry, in physical 
 chemistry, in pharmacology. In another institute a 
 great chemist may be working, but his brother 
 chemist, the leader in physical chemistry, and the 
 great pharmacologist, are lacking. There is thus 
 no single institute in w^hich the whole effort is based 
 on the joint attack on fundamental problems of 
 
 [69] 
 
medicine by leaders in chemistry, physics, pharma- 
 cology and medicine. 
 
 Foreign Institutes and Laboratories 
 
 jif ^' I Of the institutes in Germany 
 
 r. , . where the applications of chemistry 
 
 Kesearcn m , /• v i- / 
 
 P to the cure or disease are studied, 
 
 the Institute for Experimental 
 Therapy at Frankfort is probably the best known. 
 This Institute was founded in 1899, in recognition 
 of Ehrlich's services in standardizing diphtheria anti- 
 toxin^ and making it a much more practical remedy. 
 The name "Institute for Serum Investigation" was 
 at first proposed, but Ehrlich requested that no such 
 limitation be placed upon its scope. It was not, 
 however, until 1906 that Ehrlich realized his hopes 
 of being able to work in continuous close cooperation 
 with chemists ; this was made possible by the found- 
 ing and endowment by Frau Speyer of the George 
 Speyer House, an integral part of the Institute, but 
 devoted exclusively to chemical research in con- 
 nection with biological and especially therapeutic 
 problems. 
 
 ' It Is an interesting and apparently unwritten bit of history that 
 Ehrlich was in part led to his important work on diphtheria anti- 
 toxin by endeavors to analyze the toxic action of cocaine; it had 
 been reported that the "toxalbumins," ricin and abrin, produced 
 lesions in the liver similar to those he had seen from the "toxo- 
 phore" group of cocaine; he repeated the experiments with ricin 
 and abrin and discovered that antitoxins are formed which neu- 
 tralize these toxins in the test tube, and that the strength of the 
 antitoxin may be determined in this way. Up to that time it had 
 been generally believed that antitoxins could neutralize the effects 
 of toxins only indirectly through some obscure action upon living 
 tissues, and a cumbersome and unreliable method of standardizing 
 diphtheria antitoxin was in use. It was largely as a result of these 
 studies of Ehrlich that diphtheria antitoxin became such a trust- 
 worthy remedy. 
 
 [70] 
 
_,, ,. , ^ „ Ehrlich at once increased the 
 
 Ehrlich Calls i r^u t ^-^ ^ / u-u 
 
 , . personnel of the Institute (which 
 
 already included bacteriologists, 
 pathologists and immunologists) by securing not 
 only organic chemists, but physical and biological 
 chemists, protozoologists, etc. The result of the 
 combined efforts of this group was the discovery of 
 arsphenamine ("606") . Much work was also done 
 upon the chemo-therapy of cancer, sleeping sickness, 
 malaria, etc., and important studies have been made 
 on new classes of germicides (with the hope of find- 
 ing one which will kill or inhibit bacteria in the hu- 
 man body), on quinine derivatives, the therapeutic 
 value of dyes, etc. 
 
 Since Ehrlich's death the work has been con- 
 tinued (with Kolle as director) along both chemo- 
 therapeutic and immunological lines, and notwith- 
 standing the greatly reduced budget and personnel 
 as a result of the war, important results have been 
 obtained. 
 
 E» 7. D - The success of the Frankfort 
 
 Berlin Boasts ^ . 1 • 1 j 1 
 
 ^ , ^ Institute apparently stimulated the 
 
 Complete r 1 • r 1 1 
 
 T ^'^ ^ toundation or analogous research 
 
 Institute . . . /-. ^T^i • 
 
 institutes in Germany. 1 nus in 
 
 191 1 there was founded by private subscription and 
 
 endowment at Berlin-Lichterfelde another Institute 
 
 for Experimental Therapeutics (the Kaiser JVilhelm 
 
 Institut fiir experimentelle Therapie) ^ w4th Wasser- 
 
 mann, a pupil of Ehrlich, as director and Neuberg in 
 
 charge of bio-chemistry. This is one of the most 
 
 completely equipped institutes in the world, and is 
 
 near a similar Institute for Chemistry and also one 
 
 for Biolog}' and not far from the Pharmaceutical 
 
 Institute. It w^as planned, before the war, to found a 
 
 similar research institute for physiology. One of the 
 
 [71] 
 
subjects to which special attention is devoted is the 
 
 metabolism of bacteria, which is the fundamental 
 
 basis for the treatment of bacterial infections. 
 
 J ri' ' ' I A division for chemo-therapy, 
 A Division of . , ,. . , , , . r-'' 
 
 ^, rp, m addition to the already existing 
 
 L nemo- 1 her apy ,. • • r i • i i 
 
 division or chemistry, has been 
 
 added to the Robert Koch Institute for Infectious 
 
 Diseases, at Berlin, and placed under the directorship 
 
 of Morgenoth, one of Ehrlich's most distinguished 
 
 pupils and the discoverer of the action of ethylhydro- 
 
 cupreine, a derivative of quinine having a highly 
 
 specific action on the pneumococcus and of value in 
 
 treating local infections due to this organism. 
 
 It is interesting to recall that in this Institute 
 (which was founded by the Prussian Government 
 for Koch in 1891 ) a large amount of work was done 
 by Koch, von Behring, Ehrlich, Brieger, and others 
 on the chemical nature of bacterial toxins and anti- 
 toxins and in a search for germicides which would 
 destroy bacteria in the body. The discovery of the 
 antitoxins for diphtheria and tetanus diverted the 
 studies toward immunity, but Ehrlich always held to 
 the belief that such germicides would be discovered 
 and after spending nearly ten years in studies on 
 immunity was convinced that the prospects for over- 
 coming most infectious diseases by the use of definite 
 chemical compounds were brighter than those for 
 discovering new antitoxins, etc. Now, after nearly 
 thirty years, Morgenoth has again taken up, in the 
 same institute, these earlier lines of work of Koch 
 and Ehrlich and is obtaining encouraging results. 
 
 Ample facilities for the study of chemical com- 
 pounds in connection with the cure of disease have 
 been provided in the comparatively new (about 
 1907) and most elaborate laboratories of the 
 
 [72] 
 
Imperial Health Office at Berlin and Dahlem. Some 
 
 of the earliest and most important work on the study 
 
 CT, , of arsenic compounds in experi- 
 tilaborate , i -i- i i • • i 
 
 ^ , mental syphilis and sleeping sick- 
 
 Government -^ ^i , . T Tl 1 1 1 
 
 r , . ness was done here by Uhlenhuth. 
 
 Laboratories rr-i • rr i i • i i 
 
 1 his omce has chemical, pharma- 
 cological, zoological, hygienic and bacteriological 
 laboratories. 
 
 The Prussian Government, in 1895, established in 
 connection with the University of Marburg an Insti- 
 tute for Hygiene and Experimental Therapy, and 
 placed it under the directorship of von Behring. The 
 work of this institute has in recent years dealt largely 
 with processes of immunization to diphtheria and 
 tuberculosis, but a large amount of work on chemical 
 antiseptics has also been done. Chemical studies 
 played a large part in von Behring's work on the 
 antitoxins; he obtained his first antitoxins by the use 
 of cultures and toxins the virulence of which had 
 been lessened by the action of chemical reagents. In 
 fact, just as Ehrlich was led to some of his most 
 important work on immunity by his pharmacological 
 studies, so von Behring arrived at the conception of 
 "soluble toxins" (which led to the discovery of anti- 
 toxins) from his endeavors to explain the toxic action 
 of iodoform and also its beneficial action in the heal- 
 ing of wounds. 
 
 There are also in Germany many laboratories and 
 institutes devoted to the study of special diseases in 
 which considerable chemical work, from the stand- 
 point of treatment, is done. Thus important work 
 in chemo-therapy, especially in relation to malaria 
 and sleeping sickness, is being done in the Institute 
 for Naval and Tropical Diseases at Hamburg, in 
 which a special Chemical Division for such work has 
 been established. 
 
, ,. , / The Charite Hospital at Berlin 
 
 Institutes for ^ ^ . . , 
 
 C Stud many years maintained an 
 
 Institute for the Study of Cancer; 
 it was founded originally for the study of the cause of 
 this disease. Then for a number of years the activi- 
 ties were directed toward chemo-therapy; Emil 
 Fischer cooperated in this work and had a large num- 
 ber of new chemical compounds prepared which were 
 tested for possible therapeutic effects. More re- 
 cently the scope of the work has been enlarged and 
 such problems as the biology of plant tumors have 
 been taken up. There is also an Institute for the 
 Experimental Study of Cancer at Heidelberg and a 
 Division for the study of this disease in the Frank- 
 fort Institute for Experimental Therapy; in both of 
 these considerable chemical work, from the stand- 
 point of treatment, has been done. 
 
 Much valuable work continues to be done by the 
 University Institutes of Pharmacology, for unlike 
 the situation in this country, all of the German uni- 
 versities have for many years supported large inde- 
 pendent departments of pharmacology.^ 
 
 The only noteworthy French institutes for medical 
 and biological research are the Pasteur Institute at 
 Paris and the analogous, but smaller, Pasteur Insti- 
 tutes at Lille and Tunis. The Paris Pasteur Insti- 
 tute (founded by public subscription in 1885 for the 
 prevention and treatment of rabies) consists at 
 present of three institutes : bacteriological, serothera- 
 
 ^ The same was true of the universities of Austria, Hungary, 
 Russia, Sweden, Norway and Switzerland; and Holland has re- 
 cently established pharmacological institutes at all of the Univer- 
 sities where they were not already present. The leading veterinary 
 schools of Germany, Austria and Hungary also had independent 
 chairs and institutes of pharmacology. In fact there were about 
 as many real departments of pharmacology in these veterinary 
 schools as there are in the medical schools in the United States 
 at present. 
 
 [74] 
 
ji/f J- I peutic and biochemical, each with a 
 
 Medical ^ , . , j- • . -ri i • 
 
 „ , . number of subdivisions. Ihe bio- 
 
 Research m . . , . . , v . . r 
 
 p chemical institute has divisions or 
 
 biological chemistry, physical chem- 
 istry and **therapeutlc chemistry." 
 
 A large amount of biochemical work has been 
 done, especially by Bertrand and his co-workers, on 
 glucosldes, enzymes, the occurrence of manganese, 
 boron, etc., in nature and the effects of certain chemi- 
 cals upon the biological activities of bacteria. Many 
 physical chemical studies relating to biological prob- 
 lems have been carried on in the division of physical 
 chemistry. In the division of therapeutic chemistry 
 much work has been done on alkaloids, amines, 
 chlorine derivatives, and other compounds of phar- 
 macological interest; also Important work on the 
 relation of chemical structure to physiological action ; 
 the chemistry of a number of arsenic and mercury 
 compounds of Interest in the treatment of syphilis 
 and sleeping sickness and a long series of studies on 
 local anaesthetics from which the discovery of 
 "stovaine" resulted. 
 
 Many of the men at the Pasteur Institute are 
 "part-time" men, holding also teaching or research 
 positions in educational or other institutions. In 
 fact It Is difficult to determine how much of the work 
 mentioned above should be credited to the Institute 
 and how much to other Institutions. 
 
 Probably the Laboratories in England which have 
 done the most cooperative work on the relations of 
 chemistry to physiology and pharmacology are the 
 Wellcome Physiological and the Wellcome Chemical 
 Research Laboratories, located, respectively, at 
 Heme Hill and Snow Hill, London. These w^ere 
 
 [75] 
 
^ ,. , established in 1894 by H. S. Well- 
 
 r, , . come, of the firm Burroughs, Well- 
 
 Research m or- u ^ ^u • ..• i.- 
 
 F I nd come & Co., but the mvestigations 
 
 conducted in them have been prac- 
 tically entirely separated from the commercial in- 
 terests of this firm. 
 
 In the physiological laboratory the pharmacolo- 
 gists Dale, Laidlaw, and others and the chemists 
 Barger, Walpole, Ewins, Carr, and others made 
 many important contributions to the relations be- 
 tween drugs and certain parts of the nervous sys- 
 tem; the isolation and pharmacological study of 
 active amines from putrid meat, ergot and other 
 sources and the determination of the constitution and 
 the synthesis of some of them ; very important stud- 
 ies on anaphylaxis, the pituitary gland, on esters 
 and ethers of choline, etc., as well as many studies 
 of more purely chemical or physiological interest. 
 This laboratory has also cooperated on a number of 
 problems with the chemists of the Wellcome Chemi- 
 cal Research Laboratory (for example on the syn- 
 thesis of substances allied to epinephrine) and with 
 the chemists of the Wellcome Works (for example 
 on the relation between chemical constitution and 
 physiological action of large groups of alkaloids 
 and other organic compounds) . In the Wellcome 
 Chemical Research Laboratory important work of 
 biological interest was done on many compounds re- 
 lated to atrophine, epinephrine, etc., and chemical 
 examinations of many plants of reputed therapeutic 
 value made; among the latter may be mentioned a 
 study of the fatty acids of chaulmoogra oil, the esters 
 of which are now proving of so much value in the 
 treatment of leprosy. 
 
 Many changes in the personnel of these labora- 
 [76] 
 
tories occurred just before and during the war, and 
 whether the work will be carried on in the future on 
 the same scale seems doubtful. 
 
 Eneland to Some of the former members of 
 
 Studv ^^^ physiological laboratory are 
 
 Chemo-Medical ^ow inaugurating somewhat similar 
 P hie work m the department of phar- 
 
 macology and biochemistry of the 
 newly organized Ministry of Health, in which plans 
 have been made for the extensive prosecution of 
 studies on the relations of chemistry to biological 
 and medical problems. 
 
 Of other laboratories and institutions In England 
 in which studies on the applications of chemistry to 
 biological and medical problems are conducted may 
 be mentioned the Lister Institute of Preventive 
 Medicine (founded in 1891 for somewhat the same 
 purposes as the Pasteur Institute), In which, in addi- 
 tion to the work on problems of Immunity, serum 
 therapy, etc., some fundamental studies on the action 
 of antiseptics, and, more recently, a very comprehen- 
 sive study of the vltamlnes have been made; the 
 Liverpool School of Tropical Medicine, and its al- 
 lied laboratories, where pioneer work was done on 
 the treatment of sleeping sickness with arsenicals; 
 the Imperial Cancer Research Fund and the Cancer 
 Research Laboratories of the Middlesex Hospital, 
 Most of the Universities of England and Scotland 
 have well-equipped departments of pharmacology In 
 which much valuable work Is being done. 
 
 ... The leading institute for medi- 
 
 P ^, . cal research In Japan Is the Kita- 
 
 J sato Institute for Infectious Dis- 
 
 japan gases. This was established as a 
 
 private foundation in 1892 by Koch's pupil and co- 
 
 [77] 
 
worker Kitasato, and was modeled after the Prus- 
 sian Institute for Infectious Diseases; it was soon 
 taken over by the Government, but in 19 14 was 
 enlarged and became again a private institute. A 
 division of chemo-therapy was added and placed in 
 charge of Hata, the associate of Ehrlich in the dis- 
 covery of "606." 
 
 The Universities of Japan have departments of 
 pharmacology which seem to be at least the equal of 
 those in this country. 
 
 [78] 
 
CONCLUSION 
 
 Every single change of every living organism Is 
 unquestionably chemical and physical in its funda- 
 mental character, but the organism as a whole is still 
 far beyond the scope of the chemist and physicist. 
 No one has converted lifeless into living matter 
 without the aid of life itself. We have in life a mar- 
 velously organized system for coordinated, highly 
 complex physical and chemical reactions which are 
 in a normal condition largely self-regulating. With 
 all the advances of exact science, it will probably be 
 beyond the power of man to duplicate life's organi- 
 zation, even In its lowest and simplest forms, for 
 many, many generations to come. We still must 
 adhere to the profound advice of Bacon: "Nature 
 is to be commanded only by obeying her." 
 
 Every single biological change, in health and In 
 
 disease, is in turn fundamentally a chemical and 
 
 physical process, subject to the rigorous, exact laws 
 
 of chemistry and physics. 
 
 r •/ jTt ui. The problems of life and health, 
 Life and Health . ^ 111 j. • • 
 
 n JO- as sareguarded by medicme, are m 
 
 Uemand bcience , . ° •' . . 
 
 r^ .. , their very nature so complex that 
 
 Cooperation • 1 r 1 1 1 1 
 
 rapid successful advance demands 
 
 the cooperative effort of scientists of the highest type, 
 
 each a leader in his field and deeply Interested In the 
 
 correlated fields of science, willing to merge his 
 
 talents and his effort in the common problem for 
 
 the common good. 
 
 [79] 
 
A fundamental attack on the problem of the more 
 successful preservation of health and cure of disease 
 demands the cooperative effort of the chemist, the 
 physicist, and those experts In the fields of biology 
 who are most Immediately concerned with the scien- 
 tific study of disease, namely, the pathologist, who 
 studies the changes In the organisms produced by 
 disease, the bacteriologist, student of our chief ene- 
 mies, the microorganisms or disease germs, and the 
 pharmacologist, who investigates the effects of drugs 
 of all kinds on the organism. 
 
 The biologist — pathologist, bacteriologist, or 
 pharmacologist — would be wholly at a loss in a 
 thoroughgoing effort to chart the seas of disease and 
 health without the aid of the chemist and physicist 
 to study minutely and exhaustively those chemical 
 and physical questions which form the very breath 
 of life. 
 
 ^, . ^ J Medical Investigators are return- 
 Lhejnistry ana . , . . . ^ i 
 
 PA • N ^ ^ ^^S to the universities for the 
 study or more chemistry and more 
 physics. Others are planning to have their sons 
 study chemistry and physics exhaustively before 
 turning to the study of medicine. There are great 
 biologists who have devoted years of study to the 
 fundamental sciences with a great measure of suc- 
 cess. These are but evidences of the widespread 
 recognition of the path that promises the greatest 
 measure of progress in medicine. 
 
 But with the tremendous fields covered by each 
 
 Individual science — biology, pathology, bacteriology, 
 
 P .. . pharmacology, physics, organic 
 
 Effort a War chemistry, physical chemistry— it is 
 
 r evident that greater advances can 
 
 Lesson , , • n i 
 
 be made, more rapidly and more 
 
 [80] 
 
certainly, by the cooperativ^e effort of congenial men. 
 
 This was the lesson of the war; it must be the lesson 
 
 of peace. It will fall to the lot, therefore, of the 
 
 thoroughly trained chemist and the leader in physics, 
 
 by minute analysis of substance and function, and by 
 
 the application of the methods of synthesis, to supply 
 
 to the biologist that exact knowledge of the units and 
 
 forces from which the complex whole is elaborated, 
 
 which will ultimately raise medicine from the level 
 
 of an art to the higher level of an exact science of 
 
 healing and preservation of health. 
 
 . . T 1 We have in this country a num- 
 
 America Lacks . . ., ... 
 
 ^ .. . ber or excellent research mstitutes 
 
 Cooperative , , t i • . . 
 
 n 1 devoted to medical mvestigations, 
 
 with staffs of the highest calibre. 
 It must be said, however, without fear of contradic- 
 tion, that there is not a single organization whose 
 purpose is a determined cooperative attack on the 
 problems of disease and health, where intense chemi- 
 cal and physical research goes hand in hand with the 
 medical and biological study of disease. The impor- 
 tance of chemistry and physics has been recognized, 
 but the direction of research is still essentially in the 
 hands of medical men. No one of the scientific 
 groups alone should be entrusted with leadership. 
 All are needed for coping successfully with the com- 
 plex and formidable problems. Complete coopera- 
 tion of a staff of experts, peers in every sense, each 
 in his own field, with emphasis on the fundamental 
 chemical and physical character of the problems, has 
 nowhere been accomplished. Consequently it is pro- 
 posed that the attack be actually cooperative, from 
 the selection of the problem and the formulation of 
 the plan of work through the whole concentrated 
 effort to grapple with Nature and ultimately to 
 
 [81] 
 
conquer outpost after outpost of the complex world 
 of life. 
 
 May the day come when the lesson of the power 
 of cooperative scientific endeavor, so effectively util- 
 ized in the Chemical Warfare Service organization, 
 may be applied with equal success to the solution of 
 the problems of disease and health. 
 
 [82] 
 
Discussion Promotes 
 Progress 
 
 Members of the committee who 
 prepared the report will welcome 
 and appreciate criticism or sugges- 
 tions from its readers. It is hoped 
 that the fullest discussion of this 
 subject may be entered into through 
 the medical societies, the medical 
 journals, the press and other me- 
 diums. 
 
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