Division IV. Class XI. Alteratives.

Alteratives are defined to be agents which change, in some insensible and inexplicable way, certain morbid actions and conditions of particular organs, or of the general system. They produce no sensible evacuation, or modification of function, by which we can in any way judge of their mode of operation. They are administered to counteract certain morbid habits of the body, or cachectic states of the constitution, and to reestablish the healthy functions of deranged organs.

Their precise modus operandi is involved in much obscurity. Doubtless much efficacy is occasionally attached to certain articles commonly regarded as alteratives, when their supposed salutary influence is wholly the result of the recuperative powers of the system. Nevertheless, an inquiry into the action of this class of agents, though it may be somewhat speculative, will not, it is believed, be wholly uninteresting to the therapeutist.

The term alterative is extremely indefinite, since nearly every article in the materia medica may alter, modify or change the action of certain organs or parts, promote diminished or suppressed secretions, restrain them if too profuse, change them if abnormal or vitiated, and thus exert either a direct or indirect alterative influence upon the system. Yet these agents produce some sensible impression, some perceptible influence upon certain organs or secretions, or upon the general system, which will characterize their action, and impress the mind with the difference between them and agents of this class which act in the manner defined above.

It can not be disputed that many of the articles which we call alteratives do act in sensible ways upon the system, as well as in the insensible manner referred to. Some of them act as general or special excitants upon certain organs or tissues, or as corroborants; but these influences do not seem to be sufficient to explain their curative action in those affections in which they are administered. There are other articles which possess very similar properties, and exert the same or similar sensible influences upon the system without producing that important alterative influence so desirable in certain chronic diseases. That the value of these agents as alteratives is dependent in part upon their sensible influence upon the system, we think can not be doubted; but their special influence in certain forms of disease must be dependent upon some action not yet determined. We may speculate on this peculiar action, but, although our reasoning may be correct, in the present state of our knowledge we can not demonstrate it to be so.

We suppose, from their known effects, that alteratives may act in the following way:
1. They may change the condition of the blood by a direct influence exerted upon it after the absorption of the remedy; and this change may be either chemical or dynamical.
2. They may in some manner effect the removal of the worn-out tissues, and favor the process of nutrition.
3. They may neutralize or change the character of decomposing or noxious agents that exist in the system as the result of some pathological process, or that have been introduced from without.
4. They undoubtedly favor elimination by stimulating the excretory organs to increased activity.

In order that alteratives should act in the ways mentioned above, it is necessary that they should be absorbed. We find that all agents of this class are soluble in the fluids of the body, and hence are necessarily absorbed; and as further proof of this, many of them may be detected in the secretions.

The alkaline alteratives, as well as the halogenous bodies, iodine, chlorine and bromine, doubtless exert their influence in all four of the ways mentioned. Thus, they change the condition of the blood by acting chemically upon it; they tend to break down the worn-out tissues of the body, and thus prepare the way for nutrition; they change the character of some of the products of decomposition, so as to permit of their excretion; and they act as direct eliminatives, stimulating one or more of the excretory organs to increased action. The vegetable alteratives may act in a similar manner; though as they are complex organic bodies, and subject to change when introduced into the system, we have no means of knowing either their chemical or dynamical influence upon the blood, or upon the tissues. That they may exert even a more powerful chemical influence than the agents first named, is not impossible. They may add something to the blood, or take something away from it; or by their mere presence they may give rise to a chemical action between the constituents of that fluid, in a manner similar to the action of emulsine, when added to the material of the bitter almond—by its presence giving rise to the formation of hydrocyanic acid.

All the agents of this class that have any well marked influence upon the system, prove directly eliminative; they either increase the secretion of the kidneys, skin or bowels, and the greater their power in this respect, the more efficient are they as alteratives. Thus the stillingia, when given in large doses, is cathartic and emetic; in small doses, it increases the secretion of the kidneys, bowels and skin. The compound sirup of stillingia produces a marked increase of all the secretions. Podophyllum, iris versicolor, juglans cinerea, alnus serrulata, chimaphila, etc., all act in a similar manner. We may say, then, that whatever action these agents have in the manner spoken of in the three first propositions, and they undoubtedly have some, they exert a beneficial influence by eliminating morbid material from the system. The reason why this action has not been fully recognized, is probably from the fact that this increase of the secretions is but gradual, and comparatively small to that produced by agents acting directly and quickly upon these organs.

In regard to the therapeutic application of this class of remedies, we will have to refer the reader to the description of the separate agents, as each of them exerts an influence peculiar to itself. As to their general application, they are employed in all chronic diseases in which there is a depraved or vitiated condition of either the solids or fluids. Thus, they are used in scrofula, syphilis, scorbutis, tabes mesenterica, chronic hepatitis, dyspepsia, chlorosis, chronic rheumatism, chronic cutaneous diseases, etc.

In many morbid conditions of the system, in which this class of agents are indicated, in addition to medicines, a change of air, diet, habits, scenery, employment, society, etc., will tend in a very marked manner to improve the mental and physical condition of the patient, and cooperate with the medicinal measures employed in restoring him to a state of health. The cold shower-bath, douche, alkaline or salt hand-bath, the medicated vapor-bath, etc., by keeping the skin in a healthy condition, and by their exciting effects upon the nervous system, also become valuable auxiliaries to the use of the remedies under consideration. In addition to these measures, especial attention should be paid to the regimen of the patient. A diet mild and unirritating in its qualities, easy of digestion, and nutritious, if taken in moderate quantities, will greatly contribute to the restoration of health; it furnishes the necessary quantity and quality of chyle for the formation of the blood, and thus acts as a healthy excitant to the vascular and nervous systems, furnishing healthy materials for the nutrition or renovation of impaired organs. In addition to the use of alteratives and a correct regimen, such agents will have to be employed from time to time as are demanded to fulfill special indications, as cathartics, emetics, diuretics, diaphoretics, sedatives, etc.

Thus it will be seen that a reliance on any one class of medicines, or on particular agents or remedial measures alone, in the treatment of these chronic diseases, would prove unsuccessful. It is by a combination of medicines, influences, and changes in the management of disease, that we accomplish cures. Repeated changes in the remedial, dietetic, physical, and mental influences, should be had recourse to in such cases. As one medicine or class of agents, one form of diet, or the physical and mental influences, lose their salutary effects upon the system, others should be substituted for them. In this way many cures may be effected that would resist a routine practice, and bid defiance to the most potent medicines. The superiority of one physician over another in many instances arises from the judicious selections and modifications which he makes in the various remedial measures employed, and in their adaptation to the various phases of the disease, and to the different states of the system.

The American Eclectic Materia Medica and Therapeutics, 1898, was written by John M. Scudder, M.D.