Condition in Therapy Preceding the Concentrations—

History (1839-1910.)

The story of the "Eclectic Concentrations" can not be intelligently presented without picturing, briefly, social conditions as well as various problems concerning medicine and pharmacy at and preceding the date of their introduction. Nor can this story be fairly told, even at this late day, without many regrets, even though its various phases be handled in the most sympathetic manner. Appalling is the record left in print concerning the cruelties and the crudities at that date practiced in the name of medicine. Pathetic is the recollection of the effects of the old-time standard medicines. The story is one and the same, whether the treatment be that of a strong man attacked by an acute trouble, undergoing a course of mercurial cathartics, bleeding, and cantharides blistering; of a tortured girl in the last stages of consumption, with breast a running sore from the tartar emetic plaster, or croton oil vesicant, applied by the physician; or the fever-parched, helpless child, confined in a hot, closed room, denied a breath of fresh air, vainly pleading for a spoonful of cold water or a bit of nourishing food. Alike the course of authoritative medicine and of primitive dosing, whether in Europe or America, consisted in cruelty piled on top of torture, of catharsis to physical depletion, of cupping blood through the skin, and the copious abstraction of much-needed life blood from the veins of a patient who had been starved to exhaustion, by direction of the man who blistered and bled and purged. Then, the step of the physician made the sick man shudder. At the word medicine the child would cry in fear.

According to the medical theories largely prevalent in the Mediaeval past, diseases were to be considered not as departures from the normal, but as the effects of aggressive devils or evil spirits, to be driven out by fire and sword. The era had but recently passed when religious conceptions of supernatural influences by the powers above and below were connected with bodily ailments and afflictions. Traditions that had traveled down the centuries bound men unaware of such subjection, to conceptions concerning disease difficult now to comprehend. Astrology and the influence of the planets, and the belief in the mysterious power of the number 13, is even to-day a study of men possessed of balanced education, whilst as late as the day of Culpepper the description of each plant was prefaced with the name of the planet that was supposed to dominate its action. Far back of it all, and yet influencing it all, is seen the age of imaginative conception, of poetic imagery, that constructed gods and goddesses, such as directed the affairs of men in the day of the glory of Olympus. Natural, was it not, that out of this epoch of necromancy, superstition, and fantastic poesy, diseases should have been viewed as essences from without, sent by an omnipotent Creator or an antagonistic devil to torture the flesh of man? Nor could it be expected that an empirical art, linked with such as this, should have lost its traditions by being transplanted to America.

In the opinion of even authoritative practitioners of medicine of Colonial days, the devilish or spiteful intruders could no more be subjugated by kindness than could the Prince of Evil be subdued by friendship. But yet the man of medicine might not openly view them as devils or spirits of evil, and might resent such a reflection. But, whether the ideas of old prevailed or not, the methods of old yet lingered. Although the disgusting animal remedies once favored were neglected, the most poisonous of drugs were administered in heroic dose, or the method that was the most barbarous or disagreeable, was considered, even by conservative therapeutic authorities, including the most sympathetic physicians, at the date of the introduction of the "American Eclectic Concentrations" as the remedies most likely to serve the sufferer and to save life.

In view of these conditions, need any apology be made for the fact that the remedial agents of the first part of the last century were necessarily either nauseating and disgusting, or vicious, cruel, and in dosage too often deadly? Whosoever will study the records of the past will perceive, that, whilst poisonous drugs, nauseating doses, and excruciating applications were authoritative favorites, the substances that produced the most pronounced shock were viewed with the greatest favor, even though they were directly followed by marked or even serious after-consequences, in some instances more terrible than the primary disease for which they were administered. Let any pharmacist or physician, of any school whatever, read the story of those days, as voiced in the authoritative medicaments and by the treatment of licensed physicians, as well as that given in many works then standard, on Practice and Materia Medica, and consider how he would feel now, were he to attempt to practice his art under the limitations then rigorously enforced, or what would be his course were a loved one undergoing the ordeal. To place oneself in that critical attitude is to stand where stood the protestors against medical authority, in the beginning of the last century.

The Uprising.—In that day in America the dogmatism of intolerance dominated those in power, whether in politics, religion, or medicine, and possibly nowhere was the battle more fiercely fought than in the last-named field. The physician who discredited the prevailing methods, and who was courageous enough to voice his protest, was likely to be ostracized by many of his brethren, as a person tinctured with quackery and linked with charlatanism. Intelligent and educated laymen, protesting against the barbarisms to which their loved ones were being subjected in the name of authoritative medicine, were, as a rule, neither given a respectful hearing, nor recognized as entitled to any consideration whatever. The first great American "Trust" was that formulated in behalf of medicine, medication, and dogmatism such as this, though, be it said, its votaries believed their crusade to be in the direction of the suppression of quackery advocated by men incompetent to know what was needed in medicine. Out of it all came naturally a popular uprising against the methods of "Fashionable Doctors." It was born of a wave of righteous indignation—not against individuals—but against cruelties almost universally practiced, and against fallacies that were apparent to all but those involved in their practice.

In that period also arose, of like necessity, the kindly European Homeopathic school, as an emphatic protest against all that was cruel and destructive. Even doubters of Hahnemann's theory believed that a peaceful, natural death was to be preferred to one of needless torture, and that it were better to take no medicine at all, and in a spirit of hopefulness allow nature a chance, than to follow the way of those who passed into the hands of such practitioners as the famous English Dr. Lettsom (John Coakley), concerning whose methods a critic ventured to write:

I puke, I purge, I sweats 'em,
And if they die,—I ¹Lettsom.

Into such times as these, and among such methods as then prevailed, came Wooster Beach, Samuel Thomson, John King, and other American reformers from both within and without the only authoritative school of medicine then existing, for no recognition had as yet been given the followers of Hahnemann. Moved alike by the same cry of tortured loved ones that swept over America as it did over Europe, this conglomeration of dissenters united against a common enemy. During the first part of the nineteenth century these and such as they, educated and uneducated—many qualified by law to practice medicine, but the majority ignorant of the very principles of therapy—conducted their crusade against death-dealing medicines and the wrongs of a system of medication whose votaries so often considered the advocating of kindness to the sick as rebellion against lawful authority, and the application of humane methods to the suffering, as a crime against established science. ² Throughout all America came this uprising of the people, no section being exempt. From Massachusetts to Florida, from the Atlantic to the Mississippi, the rebellion raged. It was a combination of the unorganized, unprofessional majority, assisted by an inside, rebellious, self-sacrificing, professional minority. It was a home-to-home crusade, that needed no outside witnesses, no argument from afar, because in every American household pleaded the face of a tortured loved one, or lingered the memory of one who had failed to withstand the physician's inhuman ordeal.

Thus it was that, powerless to effect reformation within the ranks, men of learning, as well as the common people, formed their "societies" in the great outside, their object being alike to serve humanity and, as they also hoped, the cause of medicine. This latter object could be attained only by discovering better, and milder, remedies than those transplanted from abroad, to be employed by somewhat similar but yet more kindly methods.

With this in view, a great section, seeking a new materia medica, turned naturally to the development of American remedies of botanic origin. ³ The preparations employed were simple and compound syrups, tinctures, acetates, juices of plants both fresh and dried, as well as powders, infusions, and decoctions of substances generally fitted for domestic preparation. As a rule the dose was large, often distressingly nauseating, and in some cases barbarous, as judged by the standards of the majority of physicians to-day, for even these "Reformers" could not, at the start, disenthrall themselves from the transplanted, Mediaeval, European medication fallacies and the methods that encompassed and entangled them. Cullen's Materia Medica and Practice, the Edinburgh and London Dispensatories, the works of Quincy and of the domestic European empiricists of that date were in many American households, and these, together with traditional precepts, could not but make an impression. Even those in rebellion against dominant methods too often imagined that a medicine, to be useful, must be disagreeable, and that the depleting action of both the cathartic and the emetic was a necessity, in the simplest ailment. The phantom of "disease devils" still lingered, and tinctured the methods even of the revolutionists. Thus it came that too many of the reform remedial substitutes, introduced to replace more barbarous remedial agents, were themselves viciously energetic, whilst the primitive surgery of those days is frightful to contemplate. Witness the treatment by his father (from which he barely escaped with his life) of that archrebel of them all, Samuel Thomson, in the case of a severely cut ankle:

No intelligent patient of to-day would tolerate either Samuel Thomson's heroic courses of lobelia medication or Beach's too frequently nauseating, botanic drug mixtures, nor would such systems be unflinchingly practiced to-day by an Eclectic or Thomsonian physician of repute, any more than would the Allopathic medicine and methods, then "Regular," be followed now by the most orthodox in the ranks. But severe as were the methods of the reformers, they were soothing and kindly, as contrasted with the blistering, bleeding, purging, and vomiting of those practicing the imported, Mediaeval system of European medication. Largely for this reason "domestic" and "Irregular" medication became the hope of a great section of the American people.

The view presented, when from this distance the epoch is taken as a whole, is surely sufficient to enable one to comprehend much that the actors, involved in the passing along, could not perceive. A far-reaching social revolution was in progress. One party believed in tradition and in authority, and held that progress must come from within, and not from without. The other party, perceiving only the wrong of methods established, as they believed, in error and superstition, became hopeless of their correction by the men practicing those cruelties. It was a far-reaching uprising, in which a people more enlightened than formerly, more independent of authority than ever a people had been before, united in a rebellion, not against individuals, but conditions. It was a campaign of education, in which the side in power was organized, trained, and all-powerful; the other was heterogeneous, composed of the ignorant as well as people of education, who presumed, for love of humanity, to demand of authority that cruelty in behalf of tradition be abolished. In this mighty uprising the alkaloids, resinoids, and such came into play, but were an incident only. They failed primarily, but yet served a mighty secondary purpose, for they hastened the day when Eclectic physicians and a great part of the dominant school should abandon heroic dosage as well as depleting medication. ⁴

Necessity for Concentrated Remedies.—The small doses of the mineral remedies, such as tartar emetic, calomel, corrosive sublimate, and the iodides, as well as the energetic organics, such as gamboge, opium, and others that the reform physicians were trying to replace with remedies more kindly in action and after-effect, were, by reason of their compactness, favorably contrasted with the large doses of such remedies as the syrups, tinctures, and crude powders, largely employed as reform substitutes. This made it essential that, if possible, concentrated representatives of the American plants be evolved. The necessity for this may be best shown by a contribution from Dr. King to the Western Medical Reformer, 1846, pp. 175 and 176:

This well recognized necessity of a more eligible pharmacy opened the door to the "Eclectic Concentrations."

Other tomes: King's

Discovery of Resin of Podophyllum the First "Eclectic Resinoid."—In 1831 (Am. Jour. Pharm., 1832, pp. 273-275) William Hodgson, Jr., made an assay of podophyllin rhizome, employing, after the methods of that date, destructive chemical reagents and heroic processes. The products obtained were all decomposition results, and thus Mr. Hodgson, through the process of too much chemistry (as now a common fault in plant examinations), failed to discover the natural energetic resinous constituent, afterward so conspicuous. ⁵

In 1847 (Am. Jour. Pharm., 1847, pp. 165-172) Mr. John R. Lewis again investigated the rhizome, and again applied too much chemistry, the result being a series of decomposition products, among which was one of slight cathartic action, very slight, as contrasted with the now well-known and simply prepared resin, eight grains being the cathartic dose as reported by Mr. Lewis. No argument is necessary to show that the resin, if present at all in his substance, existed in minute amount. Many writers, probably copying from each other, have continued voicing the error that the resin of podophyllum was discovered by Hodgson (1831), and that his product was verified by Lewis (1847). This, however, is not an excuse for the long neglect shown the real discoverer, Dr. John King, whose process of manufacture and product, as described by him (1835 and 1844), have been official in the pharmacopeias of all countries since the drug's introduction.

In 1835, Dr. John King (then a young physician of the Botanic, or "Irregular," School of Medicine), accidentally discovered, and then administered, the resin of podophyllum, which may be designated as the "resinoid fore-runner," because it constituted the first American member of that list of substances. Its discovery, and the serious consequences following the blunder of its initial administration, can best be stated in the words of Professor King, which I have, by authority, in his own handwriting:

In the midst of these speculations, a young lady, about seventeen years of age, who was present, complained of feeling ill. Having no idea of the intense activity of the article just discovered, I administered about twelve or fifteen grains. Nothing further was thought of the matter until about an hour afterward, when my attention was called to her condition. She was in severe pain and distress, cramps in the stomach and extremities, pulse small and feeble, extremities cold, excessive vomiting and hypercatharsis, and apparently sinking rapidly. Her condition greatly resembled that of a person suffering from a fatal attack of Asiatic cholera. To say that I was greatly alarmed would but feebly describe my mental condition. I ran to secure the aid of two or three professional friends, but could find none of them in their offices. Then I ran back again, trembling over what might be the consequences, and thinking out a course of treatment to pursue. A princely fortune could not induce me to undergo a repetition of such condition.

By the time I reached the patient, I had become more calm. A half-saturated, aqueous solution of potash saleratus was given, in tablespoonful doses, every ten minutes, several doses being administered before the stomach would retain it; subsequently, the intervals between the doses were lengthened. Sinapisms were applied to the wrists and ankles; a fomentation of bitter herbs, as hot as could be borne, was applied over the stomach and abdomen, changing it as often as required. In about an hour the extremities became warm, and a general perspiration soon followed, with diminishing suffering and a partial return to a feeling of health and strength. In about an hour or two succeeding the improvement, the sinapisms were removed, an infusion of slippery-elm bark was ordered to be drunk freely, and about eight grains of the Compound Powder of Ipecacuanha and Opium were given every three hours. The next morning she was decidedly better.

In the course of the second day her friends allowed her to have a little soup, which was followed by a serious gastro-enteritic inflammation. The fomentations and sinapisms were repeated, and the Diaphoretic Powders continued, as well as the slippery elm infusion, to which some prepared charcoal was added, not daring to prescribe a more active laxative. By perseverance in this course, the patient recovered in six or seven days, but, unfortunately, with some chronic gastro-enteritic abnormal condition, that remained for many years. From this experience I was so influenced that I feared to use any of the remainder of the resin until at least eighteen months had passed, when I ventured a repetition of its use, but in much smaller quantity, and with most excellent results. There, my dear Professor, you have in a nutshell my discovery, which led to further investigations, resulting in the obtainment of more or less active principles from other of our medicinal plants.

In closing, permit me to add that I have found your medicinal preparations, resinoids, concentrated remedies, etc., that I have had from you since you have entered into the manufacture, to be reliable and worthy of confidence.

Yours with Respect,
JOHN KING, M. D.

The alkaloids quinine and morphine, and the energetic resin of jalap, had but recently been established in authoritative practice as the pioneers of a new class of ultimates in plant products. These, evolved abroad from drugs of foreign origin, were naturally welcomed by the dominant school, which closely affiliated with all that came from Europe, and being energetic in small doses, they served well the heroics in practice. But it remained for Dr. King to take the first step in the direction of a similar class of American ultimates. At first Dr. King's experiments promised brilliant results. The energetic resin of macrotys ⁷(cimicifuga) was quickly followed by the resins and oleoresins of iris, black cohosh, leptandra, and others. To his mind came then, naturally, the question as to why the major part of the American materia medica in use by the "Reformers" might not yield ultimates, many of them equally valuable, which in minute amounts would parallel the large doses of their respective crude drugs. Great was his enthusiasm in this work, greater was it in behalf of improved methods for curing disease by means of small doses of palatable medicines. Little, however, did he imagine, in the enthusiasm of his discoveries, that his own hand, in a day to come, was destined to deal the most crushing blow to these same products, when, by their indiscreet use and by reason of the commercial methods that were applied in their direction, they had all but wrecked the cause of Eclecticism, to which he had devoted his life work.

The original method of making the Resin of Podophyllum, as given by Dr. King in the Medical Reformer, was as follows:

This process, without materially ⁸ altering the product, was afterwards improved by evaporating the alcoholic tincture to a cream, pouring it into cold water, and collecting the precipitated resin. This resin stands to-day, as then, typical of the cathartic side of podophyllum, but it is yet not a representative of all that lies in podophyllum. ⁹ Nor is Resin of Podophyllum an isolated unity. It is a complicated educt from podophyllum, although all attempts to obtain from it a decomposition product or a fragment as comprehensively useful as the crude resin have as yet failed, and are likely to continue failures. The products made from it are but fragments of that "resin," which, in itself, paradoxical as it may seem in the light of past criticism of the word "podophyllin," is not a true resin.

Concerning the Name Podophyllin and the Class it Headed.— Among those who advocated the name "Resin of Podophyllum," was its discoverer, Professor John King, to whom thus belongs not only the honor of discovering this substance, but of giving it the name "Resin of Podophyllum." In its introduction he employed this term, but finally, reluctantly, accepted the popular name "Podophyllin," making this the prominent name in the first edition of the American Eclectic Dispensatory (1852), though he supplemented it by calling the drug "a resin, to which the name of Podophyllin has been given."

Although the name podophyllin was attacked by Dr. Squibb and Professor Procter (see Am. Jour. Pharm., 1868, p. 1), the late Mr. William S. Merrell, of Cincinnati, who first (1847) prepared the crude, resin-like precipitate for commerce, and who first used the term podophyllin, strenuously and ably defended that name. In reply to critics, he called attention (Eclectic Medical Journal, July, 1850, p. 299) to the fact that the names for jalapin (then established in "Regular" literature), and several other like bodies which were not definite chemical compounds, were devised after that plan, and he finally informed his antagonists, who became personal in criticism, that the name podophyllin had not originated with him, but that he had, in reality, accepted it at the suggestion (to use his words) of "Professor Wood, the author of the United States Dispensatory, who is no mean authority." ¹⁰ Mr. Merrell then continued his argument by saying:

This method of nomenclature was accepted by Hill (Cincinnati) and Keith (New York), as well as by other makers of Eclectic remedies of that period, who placed a limited line of "resinoids" upon the market. They accepted, without question, the nomenclature that Mr. Merrell had suggested, although, in Eclectic literature, some very acrimonious discussions appeared concerning the drugs to which the names were applied. As before remarked, when the precipitate, more or less resinous, obtained from podophyllum peltatum, finally demanded recognition in the United States pharmacopoeia, it came before the revisers of that work as an Eclectic drug, but under a name formulated by the editors of the United States Dispensatory, a fact overlooked by some persons antagonistic to Eclecticism, who opposed that name, thinking it an Eclectic term.

The substance under consideration was, as before stated, the first member in the list of Eclectic "resinoids," alkaloids, and concentrations to attain popularity. Through the influence of Professors King, Hill, Morrow, and other contributors to Eclectic literature, as well as by reports of practitioners who used it, "podophyllin" quickly assumed a position and importance seldom attained within so short a period by vegetable remedies. Its unquestioned efficacy as a cholagogue cathartic—in that day of cathartic supremacy—established it in the practice of others as well as the Eclectic profession. Appearing in the heat of a celebrated controversy over the abuse of the mercurial preparations then so extensively employed in Regular practice, it was hailed by Eclectics as a vegetable substitute for the mercurials, and was called by them the "Eclectic Calomel. ¹¹"

Before its character was understood by the leaders in the Regular school of medicine, it became, under the name podophyllin, perhaps the most prominent of Eclectic drugs. Such conspicuity could not exist, however, with reference to a drug used so extensively in Eclecticism, without recurring introductions to members of the Regular school and in consequence, long before it was authoritatively recognized by any of their book-makers, it came into general repute with numbers of their general practitioners. Thus commercial "Phodophyllin" became a valued drug in general Regular practice, years before it received recognition either in the United States Pharmacopoeia or Dispensatory. Hence it was that, when at last it was deemed advisable to give a position in the Pharmacopoeia to this drug which had long been known to be of unquestioned value, it was found that Mr. Merrell's name, Phodophyllin, had become commercially and professionally established, at home and abroad.

Probably from ignorance of its record in Eclecticism, at least without recognition of that fact, the controversy over the name was now resuscitated, and was acrimoniously continued, when the drug knocked at the door of the U. S. P. As early, however, as 1851 (see Am. Jour. Pharm., 1868, p. 1), the late Edward Parrish had recognized the advent of these products of Eclectic pharmacy (resinoids or concentrations), and deprecated their names. He said,

This argument, however, failed to impress either the makers or the consumers of "Podophyllin," and even when the preparation became official in the United States Pharmacopoeia (1860) as "Resina Podophylli," the title of the commercial drug remained unchanged. This fact was commented upon by Dr. Squibb in 1868, who considered it "unfortunate that those whose aim should be to give accuracy and precision to matters connected with medical science and art, should so commonly refuse to this substance its proper and correct name, and adhere to the inaccurate and otherwise objectionable name of 'Podophyllin.'" He severely criticised the names affixed to the class (the Resinoids or Concentrations), of which podophyllin was a member, stating that the termination in was—:

he continued,

Notwithstanding this criticism, supported indirectly by the writings of other talented and enthusiastic leaders in Regular medicine and in pharmacy, who confined themselves to the official appellation and threw their influence in the direction of the name that was asserted as being the only scientific and proper one, little impression seems to have been made on either those who manufactured or who consumed the drug. The United States Pharmacopoeia, in each subsequent revision, has made the name "Resina Podophylli" (first given to it by Professor King), official; the influence of the majority of instructors has been continuously added thereto. But to this day, in commerce, when the drug is specified, and usually when it is prescribed by physicians, the appellation is Podophyllin.

Had the advice of Dr. King been taken, the definite resins would alone have been called resins;¹³ the oleo-resins would have been called oleo-resins, with names terminative in in; and the alkaloids would have been called alkaloids (names terminating with the syllable "ine," or "ia"); ¹⁴ whilst dried extracts would have been called extracts, dried. But the care of Dr. King and his systematic co-laborers was not effectual in controlling either the nomenclature or the composition of the many incongruous substances that, in rapid succession, between 1847 and 1860, were, by manufacturers of plant preparations, thrown on the American drug market under the titles "Alkaloids" and "Resinoids."

Enlarged Use of the Termination in.—Closely following the commercial introduction of the "Resin of Podophyllum," under the condensed name "Podophyllin," and eleven years after King had established its energetic cathartic nature, came, as already stated, the introduction of many other substances, some of similar resinous natures, others markedly different. Among the most typical of the resins, and once conspicuous by reason of the hope that it might carry the cathartic and other qualities of the crude drug from which it was evolved, was that derived from Leptandra virginica. ¹⁵

This, as finally established and used by King, was a dried hydro-alcoholic extract, and by manufacturers was called Leptandrin. Concerning it, in reply to a question, Dr. King (1880) wrote as follows:

This facsimile is presented to show the copperplate beauty of Dr. King's handwriting.

Let us emphasize the manner in which Dr. King disclaims responsibility for the word leptandrin by repeating from his letter the sentence

Note, also, his dignified criticism of the terminology employed, in the final sentence of the same communication:

At that date Dr. Alexander Wilder was in the zenith of his mentality, and was deeply concerned in the reform movement in medicine. Like Dr. King, he felt the odium of the alkaloidal-resinoidal octopus that had so unexpectedly wrapped its tentacles about Eclecticism, and he too protested against the imposition. From a letter to us, November 6, 1905, we extract as follows:

Notwithstanding these facts, and notwithstanding the fact that an in compound would probably be confused with the termination ine, already established in alkaloidal chemistry (as in morphine and quinine), the cumbersome, technical terms of precise science gave way to commercial expediency (as is yet necessarily the case in similar problems), and the terse and attractive names ¹⁶ that appealed to both the professions and the trade, became firmly established. ¹⁷

Yet, although Professor John King came finally to tolerate the innovation, whenever a substance was, to his knowledge, simply a dried solid extract, whether aqueous, alcoholic, or hydro-alcoholic, he insisted on the proper designation. For example, note how, in the following articles, over half a century ago, he differentiated between the resinous substances podophyllin (resin), iridin (oleo-resin), and the dried, hydro-alcoholic extract of zanthoxylum fraxineum:

Rapid now were the movements of the "resinoid, alkaloid" makers. Within a brief period, between 1850 and 1855, several manufacturers of medicine were rivaling each other in their efforts to establish both priority and superiority for their special makes of the respective resinoids, concentrations, and alkaloids.

Nor were the united efforts of King and others earnestly concerned in Eclectic therapy and reform medicine capable of preventing, or for a time, even, modifying the marvelous and too often unfounded claims made in behalf of the therapeutic virtues of the so-called active principles. A resinoid craze arose, similar to other professional distempers and fanaticisms, such as the American elixir craze of the early seventies, and similar fads that from time to time have risen to plague over-zealous enthusiasts. ¹⁸

Having now briefly given a history of the discovery of the concentrations, and the application of the term in to the resin of podophyllum and similar substances, let us next consider the Introduction of the Commercial "Concentrated" Principles or Resinoids.—

The Lloyd Libary Bulletin # 12: The Eclectic Alkaloids, 1910, was written by J. U. & C. G. Lloyd.