H3 Book Index:: Chapters 1-29
There is a well-known quip to squelch the braggart who is too enthusiastic about his own intelligence: "If you're so smart-why ain't you rich?"
In effect, we must ask the same question about procaine. If it is such an effective remedy in so many diseases, if it has been known to be effective in these diseases as long as seventy years ago, why isn't it being used by every doctor today? Why does the average practitioner still think of procaine only as a local anesthetic? To answer these questions, we need to look back at the medical headlines of a generation ago.
In a story entitled "Why Britain was wrong to drop it," the 'Daily Mail Doctor' wrote in that London paper as follows:
"When British doctors first began to show interest in the novocain treatment of asthma and rheumatism Oust after the second world war ended) shattering news came out of the Mayo clinic in America. Cortisone had been isolated as a drug, and was being used to make cripples walk.
"Dr. Hench, the man responsible, came to London in 1950
and was received like an Eastern potentate at the Royal Society of Medicine. The medical press hailed him. . . . So procaine was dropped as being of little interest now that the wonderous cortisone was available. . . .
"But ten years later the picture looks very different. The rosy promise of cortisone itself and of ACTH (the pituitary hormone which stimulates the flow of cortisone nom the adrenals) has not been fulfilled. It has turned out to be a twoedged weapon-curing some symptoms in the stress disorders, but making others very much worse. . . ."
The ‘Daily Mail Doctor' writes as if his personal experience with cortisone had been bitter-and bitter indeed was the disappointment of the world of medical science as it became apparent that the side effects and the long-delayed after-effects of cortisone in so many cases outweighed the benefits of this drug.
Hindsight is easy. The knowledge that has come with experience in use of cortisone in no way detracts from the accomplishment of its isolation. In its preparation and use, biochemists and medical researchers have learned much that will be of great value in the future of medicine and chemotherapy.
ACTH and cortisone are able to control such often excruciatingly painful states as rheumatic fever, arthritis, asthma, Addison's disease, certain allergies, etc. But if the treatment is discontinued, the symptoms of these diseases usually return. Moreover, the side effects often prove very disturbing: personality
changes, gastric difficulties, and the syndrome of Cushing's disease (accumulation of fat in the face, the abdomen, and the buttocks) have been observed.
The medical profession is now fully alerted to the danger of overenthusiastic and undercautious use of cortisone and ACTH, and these drugs are used now only under the most careful supervision, so that patients will not have to suffer the untoward side effects.
Possibly the most unfortunate side effect of cortisone was the way in which excitement about its discovery cut off the growing medical interest in procaine as more than a local anesthetic.
Cortisone, as well as ACTH, has an antiphlogistic effect-which as long ago as 1906 Prof. Spiess claimed for procaine. The first two drugs do their work much more rapidly and dramatically, and indeed, are often indispensable. Procaine is less spectacular and requires a longer use before there are any signs of success, but it has virtually no side effects. And just as medical science does not yet know how cortisone, ACTH, or even the time-proven aspirin work in the human body, so it has been very slow in solving the mystery of procaine's action.
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H3 Book Index:: Chapters 1-29
