MEDICINE IN THE TIME OF HAHNEMANN.
Professor Kussmaul writes in his “Recollections of Youth”: In the beginning of the Nineteenth Century violent unrest prevailed. It is an unpleasant theme on which I must enter, but it cannot be circumvented if I am to describe the medical practice of my young days. He who shudders at it may skip the chapter.
And Professor Puchelt, then teacher of Kussmaul, described the whole desultoriness during the first quarter of the Nineteenth Century in the following words:
We are living (1819) at a time when the most varied systems are amalgamated and combined. The evacuating and irritating, the depleting and strengthening as well as many other opposite methods of treatment stand peacefully side by side in general therapy and reciprocally restrict each other; our learned contemporaries make use of all these systems in the various diseases, although each one may have his own preference.
This confession of desultoriness in medical science strikes us all the more if we review the various systems as they follow each other in the general consideration they had achieved.
L. Hoffmann (1721 to 1807) found that most illness arose from degenerate acid humours which must either be eliminated from the body, or ameliorated by suitable” antiseptic” and “sweetening”remedies.
Stoll (1724-1788) taught that diseases were subject to a special constitution which is conditioned ” by the prevailing climate and epidemic fevers” Gastric impurities, and especially bile, were responsible for most diseases which must therefore be eliminated by means of emetics and purgatives. In addition a battle must be waged against “hidden inflammations” which were a great danger in the case of many patients. The reputation that was accorded to Stoll’s teaching can be readily recognised from the remark of Dr. F. F. Hecker’s, the subsequent author of the “Anti-Organon,” He, and with him many of his contemporaries, considered “the fortunate method of Stoll” a brilliant advance in medical science. Another physician designates Stoll as ” the greatest living clinician.”
Joh. Kampf (1726-1787) asserted that most diseases have their seat in the abdomen, and were caused by infarcts. For the elimination of these infarcts clysters were recommended, to which were added decoctions of landlion, chamomile, rye and wheat bran, and other “suitable herbs.” One physician of his day confesses that he had cured patients to whom he had administered 5,000 intestinal clysters before he succeeded in getting rid of the infarcts entirely. “Frequently the work and patience of a Hercules are required,” writes Oberhofrat and first physician-in ordinary, Dr. Kampf, ” in order to clear out the astonishingly large accumulation of years of refuse, and to master the indurated and impacted degenerations of the blood.” Kampf’s teaching also found grateful approval among the physicians. His essay was designated as a work of which ” the Germans might be proud.”
Towards the end of the nineties the system of Brown spread over Germany. Its originator, the Scotch John Brown (1736 to 1788), traced the origin of all diseases back to two causes, to a superabundance of excitability (sthenic) or the lack of excitability (asthenic). The physician’s task was, therefore, much simplified, because in the case of diseases originating from abnormal excitability remedies were employed which were “irritability reducers” as for example venesection, emetics and purgatives, sudorifics, starvation and cold water treatment, vegetable diet, bodily and mental rest. With asthenic diseases which preponderate, the stimulating remedies are used; warmth, alcohol, raw meat, spices, musk, camphor enter, opium, physical and mental exercise, etc. A more accurate diagnosis was unnecessary.
Brown says himself:
The simplicity to which medial science has been reduced is so great that a physician when he comes to the bedside only needs to ascertain three things.
1. Whether the diseases sthenic or asthenic! 2. When general, if sthenic or asthenic; 3. What was the degree of excitability.
When he has satisfied himself on these three points nothing remains for him to do but to decide on his instructions and on his system of treatment and then to carry these out by suitable remedies.
In consequence of this concerting simplicity, Brown’s system received an enthusiastic reception from the medical profession, and for a whole decade Brownish flourished in Germany. In another place we have described how Hahnemann was his decided antagonist and opposed him most violently.
Towards the end of the eighteenth century, Natural Philosophy as founded by Schelling gained an enormous influence over medicine. It soared high above all shallow thinking and based all conceptions and explanations on manifestations of the absolute. But we find here also clear indications of Brown’s doctrines, as Schelling thought that he found in them almost a confirmation of his own ideas.
To these many systems and paths in medicine was further added the doctrine of the Englishman, John Hunter (1728-1793), who in contrast to Natural Philosophy proved by his inductive mode of research, especially in inflammations, that he morbid processes followed physiologically laws, and ultimately the Frenchman, Broussais (1772-1838), who assumed that most diseases originated from engorgements and inflammations which had their seat principally in the stomach and intestines, therefore requiring the withdrawal of blood by means of leeches and venesections.
HAHNEMANN AS CHEMIST AND PHARMACIST.
Concerning Mercuries Solubilis Hahnemanni, Professor Gren said (Crell’s Annals, I, c. II, page 224.):
Through Mr. Hahnemann’s Mercurius Solubilis, Mr. Macques’ problem of obtaining a mercurial remedy which should be simultaneously very soluble and yet free from all corrosiveness, is completely solved. In my opinion merc. sol. is preferable to sweetened mercury.
In ” Prescriptions and modes of cure of Physicians of all times” (Leips., 1814,2nd edition, IV, page 24) is stated:
Science owes one of the most efficacious and mild mercurial preparations to the well-known, and on its account, the immortal Hahnemann.
And Kurt Sprengel, in his History of Medical Science (Halle, 1828, Section V, Part.2, page 592) says:
Hahnemann’s mercury is a mild and excellent preparation the remarkable use of which has been confirmed.
We may point out particularly from Hahnemann’s “Apothecaries’ Lexicon” the regulations regarding the prescription, which only became law much later; then the definite requirements as to the methods of dealing with and the storing of poisons (“regulations for poisons”) the distillation over vapour baths, the evaporation of extracts by water baths, and especially the preparation of tinctures from fresh plants, the storing of strong-smelling substances, the presence of herbariums in every chemist’s shop for the purpose of teaching, standardising and condensing a number of requirements which give proof of the deep insight into the conditions according to the scientific, as also the technical and practical side of dispensing, and which have now become compulsory.
CONTEMPORARY VIEWS ABOUT THE CHEMIST AND PHARMACIST, HAHNEMANN.
We have given in Supplements 16, 18 and 36 the extremely favorable view regarding the various writings and translations of Hahnemann in the realm of chemistry and pharmacy. We will give here collectively the general appreciations of his services to chemistry and pharmacy.
Professor Crell announced the publication of Hahnemann’s translation of De la Metherie’s ” On pure air,” in the Annals of Chemistry, 1790, I, page 85, with the following remark:
The German Natural Scientists have every reason to look forward with anticipation to the translation, which we shall soon except, from such a chemist as Dr. Hahnemann.
And when the translation had appeared, we again find in the Annals (1792, I, page 475).
Dr. Hahnemann is a man who has rendered great service to German Natural Scientists by his excellent translation of important foreign works, as we have already acknowledged.
And the same year he is again mentioned (Annals, I, Page 200).:
This celebrated chemist and (1793, II, page 124) this physician who has rendered such great service.
Professor Gottling mentions in the “Medic. Chir.Ztg.” (1794, I, page III), Hahnemann and Gren as the two men ” to whom chemistry already owes many important discoveries.”
Professor Scherer, in his “Journal de Chemie” (1799, II, page 402), calls him that “meritorious Hahnemann,” and Professor Trommsdorff in “journal de Pharmacie” (1794, II, page 48), “the worthy author” (of an essay on the chemical examination of wine) In the year 1795, he states again in the same Pharmaceutical Journal (II. second piece, page 25).
It is true, undoubtedly true, that pharmacy has made great progress; the efforts of Gren, Gottling, Hagen, Hahnemann, Hermbstadt, Heyer, Westrumb, Wiegleb, and others have not been without result.
In his review of the progress of chemistry in the Eighteenth Century, Professor Gmelin (Crell’s Annals, 1801, I, page 16-17) enumerates each of Hahnemann’s accomplishments, and particularly points out the services he has rendered in the improvement of the utensils used, and the procedure employed in the distillation of spirit, and for the “production of Natron.”
And again in the year 1826, Professor Kraus in his “Lexicon of Medicine,” (page 404) says:
Hahnemann is recognised as a good pharmacist and as such he has acquired immortal laurels through his presentation of the so- called mercurius solubilis, and partly through his treatise on “Poisoning by Arsenic,” although these doctrines were subsequently considerably improved.
HAHNEMANN ON THE PRESERVATION OF HEALTH IN THE LAST EDITION OF THE “ORGANON” In the year before his death he showed that his point of view was still exactly the same as four decades previously in 77 and 204. In 77 he mentions among other things, the disease of people who reside in unhealthy localities and particularly in marshy districts:
Who inhabit cellars, damp workshops or other confined dwellings, who are deprived of exercise or of open air, who ruin their health by over-exertion of body or mind, who live in a constant state of worry, etc. These states of ill health, which persons bring upon themselves, disappear spontaneously under an improved mode of living.
And again in 204, he points out ” all chronic affections, ailments and diseases that depend on a persistent unhealthy mode of living.”
He also tries to meet the intermittent fever, which he saw in Transylvania in the first instance, through regulating the mode of living. He says in 244:
The intermittent fevers endemic in marshy districts and tracts of country frequently exposed to inundation, give a great deal of work to physicians of the old school, and yet a healthy man may in his youth become habituated even to marshy districts and remain in good health, provided he preserves a faultless regimen and his system is not lowered by want, fatigue, or pernicious passions. It sometimes happens that when these patients exchange, without delay, the marshy district for one that is dry and mountainous, recovery apparently ensues (the fever leaves them) if they be not yet deeply sunk in disease.
The amount of importance which he laid upon diet up to his death, can be seen from the 6th Edition of the “Organon”
With the patient, his mode of living and diet…. must be taken into consideration.
244. In intermittent fevers, he demands apart from correct physical exercise, healthy intellectual occupation and regulated habits.
259. With the necessary and suitable smallness of the doses in homoeopathic treatment, it is easy to understand that during treatment everything must be eliminated from the diet, and the mode of living, which could have any medicinal action.
260. He then enumerates in a long footnote all the beverages and foods which the chronic invalid must avoid:
Coffee: fine Chinese, and other herb teas; beer prepared with medicinal vegetable substances unsuitable for the patient’s state; so-called fine liquors made with medicinal spices; all kinds of punch; spiced chocolate: highly spiced dishes and sauces; spiced cakes and ices which have been prepared with medicinal substances, as for instance, coffee, vanilla, etc.; crude medicinal vegetables for soups; dishes of herbs, roots and stalks of plants possessing medicinal qualities: as asparagus with long green tips), hops and all vegetables possessing medicinal properties, celery, parsley, sorrel, tarragon, all kinds of onions, etc.; old cheese, and meat dishes which easily decompose (as the meat and fat of pork, ducks and geese, or too young veal, and sour dishes); all kind of salads which have a medicinal secondary effect ought certainly to be kept from this kind of patient, as excess even of sugar, and salt, as also spirituous drinks which have not been sufficiently diluted with water.
ON THE ABUSE OF ALCOHOL AS A CAUSE OF BAD HUMOURS AND OLD SORES.
In “Directions for curing old sores and ulcers” (1784), Hahnemann writes:
The excessive use of brandy and liqueurs so terribly injuries the human machine that even young people are soon transformed into half living corpses. This can be seen daily. All the finer fluids of the body are violently driven out by them through the increased circulation of the blood, and the nerve centres are destroyed. The fluids of the body that are capable of condensation to a gelatinous consistency become thick and tough, the muscular fibres become shortened and their irritability destroyed. The organs of digestion, particularly, become shrunken, the stomach and intestines become like leather, insensitive, thickened and shrunken, and the villi and lacteal ducts become contracted almost to the point of obstruction. The whole process of digestion is slowed down. No wonder then that extreme debility, loss of strength, obstructions, tumours and bad humours are produced, and then on the least provocation bad sores arise.
In connection with this Hahnemann describes the harmful effects of alcohol in an individual case. A potter who had become poor through alcoholic abuse and whose health was impaired, recovered again when in the workhouse he only received water and sparingly of dry bread.
In the introduction to the “Organon”, (page 40), he speaks against the “stimulating and strengthening treatment” of the old school:
Has it ever succeeded in removing the physical weakness so often engendered and kept up or increased by a chronic disease with its prescriptions of etheric Rhine-wine or fiery Tokay? The strength gradually sank…. and all the lower, the greater the quantity of wine the patient was persuaded to drink, because the stimulation of the vital force was followed by a relaxation in its after effects.
HAHNEMANN ON HYDROPHOBIA
Hahnemann frequently expresses in detail in translation and particularly in essays, as in the “Friend of Health,” the hydrophobia of dogs, which was a frequent occurrence in his time. He treats of this subject three times, first in the year 1777, in his first translation from the English “Nugent’s Experiments on Hydrophobia” (150pages). Hahnemann was only twenty-two years old and had barely been a medical student for a year and a half. There can, therefore, hardly have been a question of personal observations and opinions in this first translation.
It is different in the case of his essay on the “Bites of dogs suffering from hydrophobia.” He prefaced his “Friend of Health” in 1792 with this essay and showed by it the great importance attached to this question.
In the year 1803 he returned to it once more and published in the “Reichsanzeiger,” No.71, :thoughts occasioned by the recommendation of the remedies against the consequences arising from bites by dogs affected with Hydrophobia,” published in the “Reichsanzeiger” of 1803, No.7 and No.49.
Hahnemann describes in his “Friend of Health” at first very emphatically the results of bites in human beings. Then he refuses to go into the question of the numerous remedies advocated against it, and confesses at the same time ” that no reliable cure is known.” He wishes only to clear away a few prejudices. Above all, faith in the undoubted effect of the internal remedies is recommended. It is due to the lack of this faith that the best external preventative measures are frequently neglected, for instance, we omit to remove the poisonous saliva from the wound immediately; if this were done, hydrophobia might not result from such a bite. The superstition exists that a dog suffering from hydrophobia would die “within a few days after having bitten,”but if a dog who had bitten did not die, then it was not suffering from hydrophobia. To this also it is due that the application of suitable remedies was neglected. (Hahnemann quotes several examples of this from the medical literature.) a third superstition was that the position of hydrophobia from the dog was only infectious when it entered the wound from a bite. (Counter examples are however quoted according to which hydrophobia had been contracted from a licking of the skin without any abrasion.) Hahnemann’s opinion that hydrophobia cab be contracted through the saliva from mere licking is still held to-day and rightly so; only we know that without an abrasion, even if invisible to the naked eye, the disease poison cannot enter the body. Hahnemann then leads up to the following instructions:
It is safer to consider the bite of a dog that has not been annoyed, as regards the treatment as the bite of a dog who is suffering from hydrophobia. This is the safest way to prevent hydrophobia. Secondly, do not trust any dog who, without being annoyed, bites other dogs and human beings, and presents a dejected and wild appearance. Such an animal should at once be destroyed as useless. This would be better than to give one single dog suffering from hydrophobia its freedom. To lock up dogs for a few days, who have been bitten, is dangerous; they must either be destroyed or kept safely locked up or a period of not less than four weeks, as cases are record showing that dogs which have been bitten only developed hydrophobia several weeks later.
Hahnemann recommends as a remedy for the consequences of a bite:
Have the wound immediately well washed with water, in which a large quantity of wood ashes has been mixed. Repeat this frequently until the surgeon arrives.
He requires the latter to cauterise the abrasion or wound, with a cauterizing stone prepared from “a caustic lye until a scab as thick as the back of a knife blade appears, whilst the moisture which exudes is absorbed by blotting paper.
If there has been no bite, the part of the skin which has been in contact with the foam of a dog suffering from hydrophobia, must be rubbed with potash and washed uninterruptedly with it for an hour. It further measures are required, cover the place with a blistering plaster.
Hahnemann cautions against the usual remedies; And yet he remarks in a foot-note as an answer to his own question:
Where does such a helpful medicine exist?
Except in Belladonna root. Would not a very strong extract of the black henbane (hyoscyamus) prepared without heat and given in sufficient quantity in the form of pills, accomplish this? There are a number of theoretical reasons which might lead me to expect excellent results from this. But the extract must be so powerful that two grains would already produce in a healthy person serious attacks, stupefaction, etc.
Can this passage be regarded as an indication that Hahnemann already in 1792 practised provings of drugs on the healthy organism?
The essay concludes with a detailed description of a dog which is suspected of suffering from hydrophobia, from which protection must be secured. The essay has an etching on the title page representing a dog in the second stage hydrophobia (See Vol. I, Chapter 7, Page 59.)
In spite of all official regulations the actual or supposed hydrophobia not decrease. In vain did a Prussian decree (February 20th) of the year 1757 order that all dogs suffering from hydrophobia should be killed, as well as those that has been bitten by them, and also that the attempt to cure dogs affected with hydrophobia was forbidden. Hydrophobia, or the condition which was, taken for it, steadily increased, and in consequence an ever increasing number of secret remedies was recommended in the news-papers. Even the Royal Government bought such a remedy, on the recommendation of a medical commission, which on investigation was discovered to be the so-called “Maywurm- Latwerge” ( a jelly of meloes) of which Hahnemann had spoken in his essay of the year 1791, and against which he had given a warning. In the year 1803 two other remedies were recommended as a cure for hydrophobia through No.7 and No.49 of the “Reichsanzeiger.” Hahnemann denounced them in a further essay, “Thoughts on the recommendation of remedies for the consequences arising from bites by dogs affected with hydrophobia” (No.71). In it he details:
The frequent occurrence of dogs being killed which were erroneously considered to be mad (for hydrophobia in dogs is very rare) and the fact that the infection through the saliva is unusual, have given rise to thousands of useless testimonial of the prophylactic powers of those much praised arcana. It is time we ceased to put any faith in such remedies which can only be said to possess a false prophylactic power. there can be no prophylactic remedy for hydrophobia which has not at the same time proved to be a true and reliable remedy against an actual outbreak of hydrophobia. Let them discover a remedy which has incontestably and permanently cured ten human beings, who were really suffering from hydrophobia; this will be, and must be the best prophylactic, but all those remedies which cannot stand this test can never be prophylactic from the point of view of reason and experience.
Hahnemann could not give such a definitely reliable prophylactic remedy even in 1803. He was chiefly concerned in warning people against the many valueless, ineffective remedies praised at the time. We have not yet progressed very far beyond his instructions of protection and cure of the year 1792, because the inoculations of Pasteur, which have been much praised have already found very important opponents.