The Eclectic Revolution.

Then it was that Professor John King, M. D., the discoverer of the first of the few worthy members of the class, wrote a crushing communication to the Worcester Journal of Medicine, June, 1855, pages 225-227, from which we extract as follows:

Simultaneously with this attack of Dr. King, Professor Edwin S. Wayne, a talented pharmacist of Cincinnati, chemist of the renowned Ohio Medical College, contributed a four-page paper to the American Journal of Pharmacy, exposing the alkaloids, resinoids, and concentrations made by the American Chemical Institute, of New York.

To use the words of Professor Wayne:

Observe that Professor Wayne refers to the Eclectic members of the list as being proper products, when used "in their purity and in a scientific manner," but his analyses showed that the commercial so-called resinoids and alkaloids were, with few exceptions, mixtures of inorganic bodies, such as magnesia, and traces of vegetable extractives.

In this connection it may be stated that while Professor Wayne primarily attacked the sophisticated compounds, he also, in a logical way, opposed the dogma of a single principle being capable of paralleling a plant as a whole, or even being competent to carry the qualities of a natural textural structure obtained therefrom. He also took pains to credit the Eclectic school with the authoritative work it had accomplished, a refreshing innovation seldom found in the literature of the dominant school of those days. We quote as follows:

Professor Wayne then goes on to state facts indisputable, which Dr. King had for twenty years so faithfully observed in his advice and methods, to wit:

It is well now to summarize the results of the second analyses by Professor Wayne, which can be succinctly stated as follows (College Journal, 1856, pp. 23, 24, 25):

Lobelin.—Forty-four per cent insoluble in water and alcohol, more than half of which was magnesia.

Hydrastin.—Largely sodium chloride.

Veratrin.—Much potassium sulphate.

Senecin.—Much magnesia.

Stillingia.—Much magnesia.

Asclepin.—Much magnesia.

Gelsemin.—Much magnesia.

Cypripedin.—Much sodium chloride.

Prunin.—Much sodium chloride.

Stillingin.—Much magnesia.

Phytolaccin.—Much sodium chloride.

Myricin.—Much sodium chloride.

Helonin.—Much sodium chloride.

Podophyllin.—Much sodium chloride.

Alnuin.—Much ferrous sulphate.

Geranin.—Magnesia.

These attacks and criticisms all emanated from Cincinnati, the headquarters of Eclecticism, and were fathered both by Professor Wayne, the most conspicuous chemist in the Cincinnati Allopathic School, and by Dr. John King, the foremost authority in Eclecticism, as well as by other earnest Eclectics. Such criticisms could not well be neglected, consequently Grover Coe, of the American Chemical Institute, in the Eclectic Medical Journal, Cincinnati, February, 1856, pp. 92 to 96 inclusive, attacked Wayne personally. Because of the opportunity afforded, and the necessity for defense, it is to be regretted that, instead of the tirade of abuse, a statement of fact, and a few much needed suggestions concerning plant products were not made. In the same journal, pages 123 to 126, under the title, "Macrotin," Coe also attacks Dr. King in a like personal manner.

But in one direction, (while not accounting for the products found by Wayne), Dr. Coe strikes an as yet too long neglected fact concerning organic structures; namely, the important part played by combined inorganics. He aptly refers to the sulphur in certain plants, and had he developed this idea in the direction of other inorganics, instead of marring his paper by the personal abuse given Professor Wayne, he would have scored heavily in the controversy. His point, blemished though it be by personalities, may be reproduced as follows:

In 1855 appeared the work of Grover Coe, "Positive Medical Agents," a pretentious book of 304 pages, devoted entirely to the marvelous claims of the alkaloids and resinoids manufactured by the American Chemical Institute. Simultaneously, the author contributed many articles of like import to current medical literature. The war of the alkaloids and resinoids was now at its height. In the College Journal, Cincinnati, 1856, (pp. 45-48), Professor Wayne again attacked the entire class of these substances, and also the principle of considering the resinous precipitates as plant representatives. He showed that resins and alkaloids may or may not be characteristic of the qualities of the drug from which they are derived, and again attacked in a logical way the dogma of a single principle paralleling the plant as a whole. In the same issue of the journal, (PP. 48, 49), came a reply from Mr. Merrell, disclaiming that Wayne's article referred to his products,³⁴ from which we quote, as follows:

November, 1855, Dr. R. S. Newton, the editor of the Eclectic Medical Journal, Cincinnati, and co-editor with Dr. John King of the American Dispensatory, issued the following call for information:

To this only B. Keith & Co., the founders and owners of the American Chemical Institute, replied, (Eclectic Medical Journal, 1856, pp. 18, 19), defining their products as best they could, but in it all neglecting to refer to the charges of Wayne and King concerning the great amount of foreign bodies found in their products. ³⁵ From the article we select as follows:

Then follows Keith's certified list, in which, by means of such terms, as rd., res., etc., an attempt is made to establish their several constituents: ³⁶

LIST OF ARTICLES.

EXPLANATION.—rd., resinoid; res., resin; n. p., neutral principle; alk. p., alkaloid principle; alk., alkaloid.

From this date the controversy became vicious and personal, Eclectic and other medical literature being burdened with bitter discussions. Manufacturers of these products increased in number, and in a spirit of rivalry indiscreetly expanded their lists until the number of items included among the concentrations far exceeded reason, if proximate plant constituents, as intended by their originators, formed the basis. Under such influences the crusade of disfavor continued with repeated attacks, chiefly now from within the school to which they owed their origin. Of such, the following, from the conspicuous Eclectic authority, Professor John M. Scudder, M. D., is an example:

To this may be added such expressions as the following, from a series of articles titled "Pharmaceutical Chemistry," 1875, in which the present writer thus refers to the substances under discussion:

Finally, with a few exceptions, such as the Resin of Podophyllum and the alkaloidal salts of hydrastis and sanguinaria, came the utter neglect of these products by the Eclectic profession in behalf of the kindlier system of medication and the more rational ideas of therapeutics that came in the advent of Dr. John M. Scudder. The few items now employed are used in very small doses, in specific directions and the dosage, as a rule, is constantly decreasing. But their commercial importance did not greatly suffer by the loss of the Eclectic patronage, for about the date of their discrediting in Eclecticism, they passed into the hands of pill makers and proprietary formula compounders, and the physicians who believed in heroic dosage. But even with these people only a few items have now any standing whatever, although it can not be denied that these few are most heroically and extensively prescribed and in proprietary physic most freely swallowed.

The English Euonymin Craze.—A quarter of a century after the resinoids of America received their deathblow at the hands of the Eclectics, a peculiar craze for Euonymin struck England. The American manufacturers' lists quote two colors of the drug (see page 51), one green and the other brown. These two forms came into English demand, and owing largely to their exploitation by the celebrated Dr. Richardson, of London, so great was the "Euonymin" craze in that country that within a brief period American resinoid makers were overwhelmed with orders. ³⁷ The root, root-bark, shrub, and the shrub-bark supplies of the crude drug employed for their manipulation became exhausted, whilst the price of all forms of the crude drug doubled and trebled. We know of single orders from London for one thousand pounds, each color of Euonymin, quick delivery. From 1885 to 1890 the English Euonymin craze was at its height, and during those years the English pharmaceutical and medical press teemed with articles concerning the wonderful remedy! The various Euonymins were examined for ash, and the old question of inorganic admixture was naturally revived, especially with the green-colored drug, where aluminum hydroxide is likely to be employed to precipitate the chlorophyl-bearing structures and associated materials from the evaporated alcohol extract, said hydroxide contaminating the product. (See Note C). It was even reported that one lot of Euonymin contained much barium carbonate, a statement difficult to accept!

Numerous were the questionings and explanations naturally asked and offered, but in it all no one apparently thought to refer to Eclectic literature of the past, where, half a century before, the whole subject of the alkaloids, resins, resinoids, and concentrations, in all its phases, had been discussed in detail, and thrashed out to a finish. So it was that history unnecessarily (as is too often the case with people who read only their own literature) repeated itself, events in England, but on a smaller scale, following in nearly the track of the old alkaloidal-resinoidal-concentration epoch in America.

As abruptly as it began did the English concentration fad terminate, leaving but a few energetic resinoids, such as King's Resin of Podophyllum (representative of the class), still used in England, as it is both used as well as abused to-day, in all parts of the civilized world, as is shown in current pharmaceutical and therapeutical literature. (See Lloyd Brothers' Drug Treatise No. XX.)

The Lesson.—Comes now the lesson taught by the half century of turmoil in and among the alkaloids, resins, resinoids, and oleoresins. Shattered ambitions, blasted hopes, disappointments generally, have their uses. The resinoid craze is not an exception, for it has already served several purposes, one being the establishing of the fact that in only a few North American drugs are found either alkaloids or resins of great individual merit, another being the dispelling of the illusion that a fragment can parallel the whole, if the whole be intelligently comprehended. Eclectic physicians learned from an experience not easily forgotten the lesson that

Dried Fragments of Drugs are not Representatives of Drugs.—An experience of more than three decades, commencing in a craze for energetic, or even poisonous, proximate principles, had, as already related, taught Eclectic physicians to their own satisfaction that a toxic constituent or a mixture of the separated dried products broken out of a drug by chemical means or created from drugs by the chemist's art, useful though each might be in its own sphere, did not typify or parallel the therapeutic qualities of the whole drug. They had learned by bitter experience that a poisonous fragment or ultimate, broken out of or created from a plant by chemistry, did not represent the therapeutic qualities of the structure from which it was derived. The once prevailing hope that a single, dominating constituent, or ultimate, or a definite substance present in, or obtained from a drug, could be taken to standardize the desirable therapeutic qualities of the combined medicinal parts of a plant complexity, also passed away. In the latter days of King and Newton, and in the coming prime of Scudder's efforts, heroic doses of shock-producing remedies became exceptions in the practice of Eclectics. The administration of violent ultimates and large doses to shock the system, even as regards active cathartics (now most discreetly used, when used at all, in Eclectic medication), gave way to kindlier methods. The doctrine of humanity to the disease-weakened sufferer, not brutality to the helpless, once more revived and became not merely ideals in theory, but logical facts in a successful practice. The original Eclectic motto, "Vires Vitales Sustinete" (Sustain the vital forces), so often lost to view by some people involved in the fallacy of the nineteenth century alkaloidal-resinoidal ultimates, became, as in the days of the fathers, a legitimate Eclectic watchword. By a final, natural evolution the school, after facing disaster, passed safely through the crisis of the alkaloidal-resinoidal craze of the sixties in the century that has passed.

The Present.—At present, instead of overdoses of toxic ultimates, the trend in Eclecticism is toward greater questioning and conservatism than ever concerning vicious or possibly harmful medication. The old-time "Concentrations" have most of them been long since abandoned, displaced, or discredited as undesirable types of remedial agents. No longer are they sought as though they represented complex drugs. Small doses of kindly remedies, established by clinical study in disease, administered for curative action, not systemic shock, now universally prevail. The non-poisonous remedies, made of innocuous drugs, are now sought and are administered with a degree of therapeutic satisfaction unknown in past heroic dosage. Substances energetic or toxic, when used, are employed most cautiously and conservatively; small doses often repeated being the rule. The resins and alkaloidal salts of old, such as the sanguinarine compounds, are sometimes, but not often, prescribed; when prescribed, being in minute doses. Drug representatives such as plant textures and complexities, the poisonous constituents of which were considered as the standards of curative qualities by Eclectic pharmacists fifty years ago, and accepted as such by Eclectic physicians in the day of past evolution, are no longer therapeutic favorites, unless they are partially, or even wholly, freed from their toxic constituents. Such as opium and morphine were never Eclectic favorites, and now are most tenderly employed when employed at all, while the favorite Eclectic form of nux vomica is now a liquid preparation, in which strychnine is in minor proportion to other constituents. Thus the Eclectic methods of medication and the Eclectic remedies are, to-day, in marked contrast to those demanded under the ideas that yet prevail among physicians who believe that a remedy must be standardized in therapy from the toxic or physiological side, or who accept that therapeutic usefulness is in proportion to the poisonous viciousness of a drug. So great has been the advance among Eclectics in this direction that, as already intimated, even the preparation Resin of Podophyllum, once exclusively Eclectic, and originally employed as a drastic cathartic, has passed almost completely from Eclecticism into the practice of physicians of opposite ideals from those now prevailing in the school of its discoverer. ³⁸ Concerning the revolution the half century has wrought in the therapy of the energetics once so freely used in Eclectic practice, among which Resin of Podophyllum was typical, Professor Felter, in the Eclectic Medical Journal, July, 1909, thus tersely expresses the facts:

So long as men will blindly follow the text-book statements of the regular materia medicas that bryonia is only a drastic cathartic, and may be used for its derivative effect in dropsy, so long will they remain in ignorance of the true medicinal action of a remedy that many thousands of so-called "irregulars" are using daily, in small doses, with the most potent and beneficial effect. Perhaps no remedy illustrates the value of small dosage better than bryonia. With a wide and direct action in a variety of diseased conditions of the serous membranes and the nervous system when so given, it has in the large and drastic physiologic doses absolutely no place in medicine. When such drastic, purgative action is desired in dropsy by those who accord to it such virtues, it is passed by for other less unpleasant hydragogues. So in the large dose bryonia may be said to have no place in therapeutics. But in the small dose—how promptly it allays distress in pleuritic pain, in frontal headache, in the early stage of pneumonia, and in the milder forms of non-septic peritonitis. Few Eclectics would dispense with bryonia, and they always use it in the fractional dose.

Colocynth is another remedy of the same class. If the dose be large, gastro-intestinal inflammation is invited. If the fractional doses be exhibited, it allays irritation, prevents inflammation, and acts with marvelous precision in dysentery and allied conditions, when accompanied by sharp-cutting, colicky pains.

Ipecac was long ago recognized as having a dual action—in the large dose, emetic, and many times desirable; in the small dose, the best of anti-emetics and a remedy of supreme value in allaying gastro-intestinal irritation and inflammation. Yet, knowing and acknowledging the dual emetic and anti-emetic action of this drug in its different doses, the physicians who first made these discoveries let them rest without similar investigation concerning other equally potent drugs. Worse than this, they have refused to accept, or have chosen to ignore, the work of those who have made such investigations, which have incalculably enriched therapeutics. Podophyllum and its resinoid are now seldom employed in physiologic doses by Eclectic physicians, but as remedies, in small doses, to gently stimulate intestinal secretions, they have grown steadily in favor.

Retrospective.—We have thus briefly referred to incidents and events connected with the discovery and introduction of the "Concentrations," as well as to the passing out of the substances that, as a fad or craze, more than half a century ago, came perilously near disrupting the Eclectic school in medicine.

Out of it all came the introduction of a few resins and a few alkaloidal salts of American plants, but yet these few, introduced into the Eclectic school over half a century ago, comprise all, of any importance whatever, that are to-day used by any class of physicians. ³⁹ In this connection, to close this chapter, we can well introduce the translation from a French publication of an article by the talented scholar, Dr. Charles Rice, chairman, for three decades, of the Committee of Revision of the Pharmacopoeia of the United States:

The Eclectics form a class of physicians who reject the use of a large number of remedies of mineral origin, and particularly of all mercurial compounds, and replace them by vegetable remedies, chosen as much as possible from among indigenous plants. It is certain that the persevering and careful study that the adherents of this school have made of the action of several American plants has been very profitable to medicine in general. The regular profession never hesitate to make use of the truly useful among those discovered, whoever be the authors, but the system is very justly repudiated by the medical profession, because it is based upon a dogma. Many plants of which the Eclectics alone first availed themselves have ended by becoming the common property of the entire medical profession; every practitioner has, and ought to have, the inalienable right of employing every therapeutical agent, provided it be not a patented or secret preparation, which he considers useful to his patient, whether the pharmacopoeia has adopted it or not. But from the moment that a preparation is presented under the character of a special remedy, when its formula is unknown and kept secret, in such a manner that its preparation is monopolized by a particular firm or its composition can not be controlled by every pharmacist or physician, it should be proscribed. But such is not the case with the Eclectic preparations. Although I, like the majority of pharmacists and physicians, am not in accord with the Eclectics, from the standpoint of their theories, I must recognize the fact that they do not surround themselves with mystery; like the homeopaths, they have their pharmacopoeia, represented by the following work: "The American Dispensatory," by John King, M. D., 8th edition, Cincinnati, 1878.

Whatever opinion one may have regarding the ideas defended in this book, one can not but discover that it constitutes a precious encyclopedia of medical American plants, and their therapeutical uses. It is a very useful work for reference. Its author is as fine a botanist as a judicial observer of therapeutical effects. ⁴⁰—Translation of pages 9 and 10 of Dr. Charles Rice's "Note sur Certains Medicaments Vegetaux Americains."

This treatise would not be complete as a historical record unless the position these substances occupy now were included. We therefore give, in the following pages, Lloyd Brothers' recent prices current with notes that we believe will fairly close the subject.

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