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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.”