It is evident that the fallacies to which our observations and
experience are liable with respect to the efficacy of certain bodies, as
remedies, must be necessarily multiplied when such bodies are exhibited
in a state of complicated combination, since it must be always
difficult, and often impossible, to ascertain to which ingredient the
effects produced ought to be attributed.
How many frivolous substances have from this cause alone gained a share
of credit, which belonged exclusively to the medicines with which they
happened to be accidentally administered?[123] Numerous are the examples
which I might adduce in proof of this assertion; the history of
Bezoar[124] would in itself furnish a mass of striking evidence, indeed
the reputation of this absurd substance was maintained much longer than
it otherwise would have been, by its exhibition having been frequently
accompanied with that of more active articles. Monardes, for instance,
extols the efficacy of the _Bezoar_ as a vermifuge, but he states that
it should be mixed with the seeds of _Wormwood_. Besides, in the
exuberance of mixture, certain re-actions and important changes are
mutually produced, by which the identity of the original ingredients is
destroyed; but this subject will be introduced for discussion in the
first part of the Pharmacologia.
The practice of mixing together different medicinal substances, so as to
form one remedy, may boast of very ancient origin, for most of the
prescriptions which have descended from the Greek physicians are of this
description; the uncertain and vague results of such a practice appear
also to have been early felt, and often condemned, and even Erasistratus
declaimed with great warmth against the complicated medicines which were
administered in his time; the greater number of these compositions
present a mass of incongruous materials, put together without any
apparent order or intention; indeed it would almost appear as if they
regarded a medical formula as a problem in _Permutation_, the only
object of which was to discover and assign the number of changes that
can be made in any given number of things, all different from each
other.
At the same time it must in justice be allowed, that some of the earlier
physicians entertained just notions with regard to the use and abuse of
combination, although their knowledge of the subject was of course
extremely limited and imperfect.
ORIBASIUS[125] recommends in high terms certain combinations of
_Evacuant_ and _Roborant_ medicines, and the remarks of ALEXANDER
TRALLIANUS on a remedy which he exhibited in paralysis, serve to shew
that he was well acquainted with the fact, that certain substances lose
their efficacy when they stimulate the bowels to excess, for he cautions
us against adding a greater proportion of _Scammony_ to it; many, he
observes, think that by so doing, they increase the force of the
medicine, whereas in fact they make it _useless_, by carrying it
immediately through the bowels, instead of suffering it to remain and be
conveyed to the remote parts.
In modern Europe, the same attachment to luxuriancy of composition has
been transmitted to our own times: there are several prescriptions of
Huxham extant, which contain more than _four hundred_ ingredients. I
have already observed that all extravagant systems tend, in the course
of time, to introduce practices of an opposite kind; this truth finds
another powerful illustration in the history of medicinal combination,
and it becomes a serious question, which it will be my duty to discuss,
whether the disgust so justly excited by the _poly-pharmacy_ of our
predecessors, may not have induced the physician of the present day to
carry his ideas of simplicity _too far_, so as to neglect and lose the
advantages which in many cases beyond all doubt may be obtained by
scientific combinations. “To those,” says Sir A. Crichton, “who think
that the Science of Medicine is improved by an affected simplicity in
prescribing, I would remark, that modern pharmacopœias are shorn so much
of old and approved receipts,[126] on account of their being
extraordinary compounds, so as to be almost useless in some cases.”
In the year 1799, Dr. FORDYCE, in a valuable paper published in the
second volume of the Transactions of the Medical Society, investigated
this subject with much perspicuity and success: unfortunately, however,
this memoir terminates with the investigation of _similar_ remedies,
that is to say, of those which produce upon the body similar effects,
and he is entirely silent upon the advantages which may be obtained by
the combination of those medicines which possess _different_, or even
_opposite_ qualities; it must be also remembered that at the time this
memoir was composed by its eminent author, Chemistry had scarcely
extended its illuminating rays into the recesses of physic. Under such
circumstances, I am induced to undertake the arduous task of inquiring
into the several relations in which each article of a compound formula
may be advantageously situated with respect to the others; and I am
farther encouraged in this investigation, by a conviction of its
practical importance, as well as by feeling that it has hitherto never
received the share of attention which it merits. “I think,” says Dr.
Powell, “it may be asserted, without fear of contradiction, that no
medicine compounded of five or six simple articles, has hitherto had its
powers examined in a rational manner.” If this attempt should be the
means of directing the attention of future practitioners to the subject,
and thereby of rendering the Art of Composition more efficient, by
placing it upon the permanent basis of science, I shall feel that I have
profitably devoted my time and attention to the most useful of all
medical subjects. “_Res est maximi momenti in arte medendi, cum, Formula
in se considerata, possit esse profecto mortis vel vitæ sententia._”
PHARMACOLOGIA.|| ON THE| OPERATIONS OF MEDICINAL BODIES,| AND ON THE|
CLASSIFICATIONS FOUNDED ON THEM.
“_Medicos tandem tædet et pudet, diutius garrire de Remediis,
Specificis, et Alexipharmicis, et cæteris, nisi eorum naturam et
modum quo prosint, quodammodo ostendere et explanare possint._”