SUBSECTION 5 Compound alteratives criticism of compounds and mixed medicines

Pliny, book 24, chapter 1, bitterly attacks all compound medicines. “Human knavery, fraud and cunning have invented these shops, in which everyone’s life is put up for sale. Soon afterwards came those compounds and incomprehensible mixtures, fetched from as far away as India and Arabia; a medicine for a sore must come all the way from the Red Sea,” and so on.

He does not say this without reason. They are unquestionably much to blame for their compounds when they make endless varieties of mixtures,

as Fuchs observes. “They think they gain great credit, surpass others and show themselves more learned than the rest by making many variations. But he considers them fools: while they boast of their skill and think to make a name for themselves, they become ridiculous and reveal their ignorance and error.”

A few single medicinal substances, properly prepared and understood, are better than the heap of nonsensical, confused compounds ordinarily sold in apothecaries’ shops. “There one finds many useless, superfluous, spoiled, obsolete things, long out of date,” says Cornarius, “a collection of barbarous names given to syrups and juleps, an unnecessary mass of mixed medicines: a crude, undigested heap.”

Often, as Agrippa charges, this makes the medicine more dangerous than the disease. When they combine they know not what, or leave an unlearned apothecary to prepare it, they bring death and horror in place of health. The ancient physicians had no such mixtures: in Hippocrates’ time a simple hellebore potion was the usual purge.

Even today, says Matteo Ricci, in the flourishing commonwealth of China, “their physicians teach principles quite opposite to ours, yet are not unsuccessful in their practice. They use only roots, herbs and single substances in their medicines, and almost their entire medicine is contained in a herbal. There is no science, school, formal art or degree: each man learns privately from his master, as in a trade.” Cardano boasts that he can cure every disease with water alone, just as Hippocrates long ago treated most ailments with one medicine.

Let the best of our physicians who reason from theory demonstrate and give a sufficient explanation for those intricate mixtures. Why precisely that many ingredients in mithridate or theriac? Why these particular quantities? Could they not be reduced by half, or to a quarter? As the saying goes, “It is needless to do with more what can be done with fewer.” Three hundred ingredients in a julep, a potion or a little pill: to what end or purpose?

I do not know what al-Kindi, Capivaccius, Montagna and Simon Eitover, the best and most rational of them all, have said on this subject; but neither he nor they nor any one of them gives the reader, in my judgement, the satisfaction he should. Why these ingredients, and why so many? Roger Bacon has criticized many errors in his treatise On Degrees, explaining some things without making them clear.

Mercurialis, in his book On the Composition of Medicines, takes as examples Hamech and Philonium Romanum, compounded long ago by Hamech, an Arabian, and Philonius, a Roman, but as unsound as the rest. If they are so exact, as his account suggests, and the mixtures so perfect, why does Fernel alter one, and why has the other fallen out of use? Cardano criticizes Galen for ambitiously presuming to correct Andromachus’ theriac, and we may find fault with all the others just as fairly.

Galen’s medicines are now discredited and rejected. Most of what Nicholas Meripsa, Mesue, Celsus, Scribanius, Actuarius and others wrote long ago is despised. Mellichius, Cordus, Wecker, Quercetanus and Renodaeus, and the Venetian and Florentine states, have their respective recipes and special formulations. Nuremberg has its own, and the Augsburg Pharmacopoeia has medicines peculiar to that city’s meridian.

London has its own; every city, town and almost every private individual has his own mixtures, compounds, recipes, special formulations and rules, as though he scorned antiquity and everyone else in comparison with himself. Each must correct and alter things to display his skill; every opinionated fellow must defend his own paradox, whatever it may be. “The kings act madly; the Greeks suffer for it.” They rave, while the poor patients pay for their new experiments: ordinary people bear the cost.

These are the objections others raise, and the conclusions I may draw through the weakness of my understanding. Yet in truth there is no such fault, ambition, novelty or ostentation as some suppose. As one writer answers, the practice of compound medicines “is a most noble and useful invention, devised and introduced into medicine with great judgement, wisdom, deliberation and discretion.”

Mixed diseases require mixed remedies. The substances commonly combined relate to the affected part, some to temper its condition, others to strengthen it, some acting on one part and some on another. Cardano and Brasavola both maintain that “no single medicinal substance is without harm”: no simple medicine is free from hurt or injury. Although Hippocrates, Erasistratus and Diocles, in the infancy of this art, were content with ordinary simples,

now, says Aetius, “necessity compels us to seek new remedies and combine single substances: to correct their harmful properties, whether cold, dry, hot, thick, thin, tasteless or foul-smelling; to make them agreeable to the palate and pleasant to taste and take; and, by adding sugar or honey, to preserve them for months or years for various uses.”