Introduction - Uppsala Monitoring Centre

idea of four humours: blood (sanguine), yellow bile (choleric), black bile (melancholic)
and phlegm (phlegmatic). Galen added four temperaments: warm, cold, dry and
moist. Had these philosophies confined themselves to working out the mechanisms
by which the medicines achieved their goal, i.e. retrospectively, they would have
caused little harm; but, unfortunately, these philosophies were used prospectively to
decide on future treatments and millions of patients have been purged, made to
vomit, bled, etc. to their detriment. The urge to purge has remained to this day and
my contempories can recall the weekly Saturday purge given whether constipated or
not. The philosophy lingers on in colonic irrigation. The salivation caused by mercury
was welcomed as showing that the evil was being washed away and the dose of
mercury was increased until the required amount of salivation had occurred. Two of
the marker drugs: black hellebore and white hellebore were used as purges and
emetics respectively and perhaps they fell into disuse partly because of the change
in philosophy. These early pseudo-philosophies meant that treatments were
designed to cause adverse drug reactions and not only caused misery but would
have hastened the death of many patients. Towards the end of the 19 th century new
pseudo-philosophers, e.g. homeopathy and some so-called complimentary
medicines, have replaced the old with the disappearance of those adverse reactions
and the appearance of other problems detrimental to patients, such as delay in
receiving an accurate diagnosis and the correct treatment and the expenditure of
large amounts of money, which might be better spent. The public, however, seems to
have a need for them and they still thrive in a scientific world beguiling patients with
placebo treatments. Galenic principles still linger in 1992. The Hausa tribe in
Northern Nigeria treat stomach ache by promoting vomiting, purgation and diuresis–
all signs of egress, so they use salicylates as well as plants to cause abdominal
distress and later use antibiotics to produce diarrhoea, i.e. egress (Etkin, 1992).
Summary
The phrase ‘combined with other medicinals to reduce or eliminate toxicity’ in 220
AD suggests that the Chinese knew about interactions, but then there is a gap until
1667 when there is the quotation ‘The mixing of things which are harmless
sometimes produces a poison.’. I have found no other references until 1880 when
the interaction of sympathetic neurotransmitters combined with chloroform
anaesthetic was discovered to be potentially fatal. This is more likely to be due to
the inadequacy of my research rather than an absence of reports. During this period
Pliny, Discorides and Galen refer to the marker drugs, but then with the exception of
Ibn Wahshïya in the 8 th century I found no further mention of them–a silent period of
300 years. There was tremendous progress in the first 1000 years after Christ, first
by the Romans and then the Arabs as they started to explore the use of drugs and
lay down the principles for their study.