PRELUDES AND PROGRESS Nitroglycerin: a homeopathic remedy

IN A 1905 address on nitroglycerin, a New York physician observed, "It is difficult to explain why certain drugs have come into such general use unless it is a question of fashion as in other things, nor are we right in assuming that their popularity assures their value, much less their permanency. The study of the physiological action of drugs, first upon animals and then upon man, furnishes of course the only scientific and reliable method we have, of predicting future usefulness in the treatment of disease; still it is before the result of clinical experience alone that a drug must take or lose its place in the world's pharmacopeia.`" Arguments regarding the efficacy and mechanism of action of the organic nitrates date back more than a century. It is a little known fact that nitroglycerin would probably not be in the pharmacopeia were it not for the peculiar doctrine of homeopathy that first led to the purposeful ingestion of this chemical compound. This essay on the early history of nitroglycerin will address several issues relevant to current pharmacologic research and clinical therapeutics. The synthesis of nitroglycerin was immediately recognized as a valuable discovery; a new explosive had been invented. This discovery was noticed by a homeopathic physician whose therapeutic doctrine led him to investigate the potential medical value of organic and botanic compounds. Medical politics and economics enhanced the skepticism of 19th century "regular" or "allopathic" physicians for anything advocated by the homeopathic healers. This contributed to a delay of more than a quarter of a century before nitroglycerin was used by regular physicians. The homeopaths did not recognize the value of nitroglycerin in the treatment of angina pectoris in this interval. The early history of nitroglycerin illustrates the approach used by physicians in evaluating new