Hahnemann as Psychiater


Hahnemann devoted the first week to observation only, without giving any medical treatment to his patient. While the old school physicians could not cure Klockenbring, Hahnemann succeeded in giving him back his health. Hahnemann had given up all his time and energies to this one patient….


SUPPLEMENT.21

HISTORY OF THE PERIOD PRECEDING THE GEORGENTHAL MENTAL HOME

IN the “Anzeiger,” a daily paper “for the use of the Law administrators, constabulary and all Civic professions, as also for the free and mutual entertainment of the reader on all kinds of useful subjects,” of March 8th, 1792, appeared an appeal signed by R.Z.Becker, editor of the paper, which read as follows:

Proposal for a much needed relief Institution for Mental Patients of the better classes.

Very often a person who is most useful to the world and to his family, and who is frequently indispensable, or otherwise important as regards position, means, feeling or intelligence, sinks through some trifling cause into an animal-like dullness of mind. He clings to some disjointed and fixed ideas, or his spirit shrouds itself in an impenetrable veil of brooding and melancholy. Moral as well as physical conditions combine ultimately to destroy the nervous system, Seeing that confusion of the intellect is one of the most distressing of all human afflictions, it is deplorable that little or no care is taken in Germany of this pitiable class of humanity.

The Asylums, usually run in connection with prisons and workhouses, are generally conducted in such a way that miserable beings are insufficiently fed. They are merely kept in close confinement in order to prevent them from doing harm to one another, and nothing more. Usually their malady is increased, and they become incurable by accessory circumstances, or by the rough and injudicious treatment of the attendants. There is usually only one doctor in charge of such an institution, although twenty would be required for the ultimate purpose of curing this large number of unfortunate inmates.

Often a physician in such a position has neither the courage nor sufficient knowledge for this special branch of work. He very soon wearies under the burden of his occupation and decides (as almost always happens)not to overwork himself- that is, he learns to regard callously the dozens or hundreds of these patients and to do nothing for them in the actual sense of the word.

These noblest of all creatures, destined for the exalted use of Reason, are here treated as wild beasts from Africa intended for exhibition would not be treated. Or they are kept like inanimate objects for three, four, ten, thirty or more years for the not altogether humane object of sooner or later giving them over to corruption in a silent grave- without contributing to the alleviation of the disease, without restoring them to the usefulness for which in their former days they had been so deserving of honour; they are kept, i say, with an indolence which does not credit to our century. This is inflicted upon the middle and lower classes of the population. “They must rest content with the existing institutions,” says the heartless onlooker.

What will the distinguished relatives do with such unfortunate beings? What is the husband to do, who has become more sensitive through his improved position and better circumstances, or the mother, with her sons who have occupied posts of honour, when they fall into this distressing condition? The most sincere sympathy, tears, honest sorrow,. the sacrifice of large sums of money avail nothing. Nothing can call back, in most cases, the health and reason of their beloved ones. Their inhuman speech, their foolish acts, repulse those who come near them and make these pitiable and helpless creatures a disgrace to the family. What is the family physician to do? One cannot expect him to have an extensive knowledge of this branch of medicine. He tries some known remedies, abandons them and replaces them with others, then he begins a long course of treatment which often fails to have the desired effect. In the end he wearies of the case, and advises the distinguished relatives to give the patient up and have him removed to an institution, But where? Perhaps to incarcerate the patient for ever in one of those asylums, to be herded with the disgraceful collection of criminals, unfortunates and sick of all kinds: there, the tumult of the insane, partially insane and maniacs of all degrees and classes, appeals any honest family. Should this be the fate of a family of exalted position — father, mother, husband or wife — without their seeing before them the faintest ray of hope that the health and reason of their beloved will be restored on this side of the grave?

Is this treatment to be meted out to people in a good position from wealthy homes? I need not add more, I think, in order to make you feel how desirable it would be to have a decent home for this class of patient. I am glad to be able to announce that a preposition in this spirit has been made by a physician who is both scientific and practical, and who is well- known to me and to the scientific world. He is taking steps to establish an institution which will accommodate about four better class mental patients. He will devote all his time to them, and they will be under his supervision both day and night. They will neither be beaten nor confined in chains, and no harsh treatment will be used in order to bring them back to reason. Everything that the deep and mature thought of the doctor can devise will be tried in order to restore body and soul to health again, such as gentle persuasion as well as the best medical treatment.

It seems desirable that, out of consideration for the family, patient who may regain their health in such a desirable institution should remain incognito. For the same reason, the name of this humane physician and the locality in which the institution is situated should remain unknown to the general public. To those people who require to make use of this hospital for some unfortunate patient, the name will be given at once, as well as detailed information of the inner working of the institution, together with the conditions for admission. They should address their enquiry in the first place to the office of the “Deutsche Zeitung” in Gotha, and the necessary information will at once be forwarded.

R.Z.BECKER Gotha, February 6th, 1792.

Councilor Becker of Gotha was Editor and owner of the “Reichsanzeiger” in Gotha, at the end of 1791 or the beginning of 1792. At first the paper was named “Der Anzeiger”, but later the paper was used by physicians for dissertations, discussions and advertisements. From the year 1806 and onwards the paper appeared under the name “Der Allegemeine Anzeiger der Deutsche.”

Hahnemann and Councilor Becker were very close friends, as we shall see later. In a letter from Konigslutter, dated November 15th, 1798,. Hahnemann openly requests his friend and patron to append his own valued signature to an article or appeal, since by that means he, Hahnemann, anticipated a greater amount of success. One may therefore accept with confidence that the foregoing appeal emanated from Hahnemann judging from the style and mode of expression. Through the appeal the attention of Duke Ernst von Gotha was drawn to this subject. The Duke.

SECOND PERIOD OF TRAVELS

wished at the same time to serve a higher cause apart from the personal help that he could give to Hahnemann and Klockenbring, for he too, like Hahnemann, was a freemason.

In Number 34 of his ” Anzeiger” (August 11th, 1792), Becker was able to write :

To friends of sufferers.

The Nursing home for mental patients of the better classes, of which the preliminary announcement was made to the public ( in No. 58, page 78, Vol. 1 of the “Anzeiger”), has now open for some time. A true father of his people found this proposition for the alleviation of human suffering desirable, that he gave up one on his country houses and had it furnished for that purpose. In this home everything was prepared to ensure the safety and kind treatment of these most unfortunate of all patients, as well as all that the art of healing could devise in order to restore them to health. The first experiment which has already been made gives hopes of happy results. The locality where this home has come into existence through the generous help of the Sovereign, is Georgenthal, an important village with a law-court and an office for forestry. It is situated in one of the most beautiful parts of the principality of Gotha at the foot of the Thuringerwald, three hours’journey from the capital, Gotha. The man who has taken charge if it, is the well-known physician Dr. Samuel Hahnemann, to whom relatives and friends of those in need of help can write directly for more detailed information.

D.H.

PSYCHIATRY AT THE END OF THE EIGHTEENTH CENTURY.

Professor Emil Krapel says in his publication “One Hundred Years of Psychiatry, a contribution to the history of human civilisation” (Berlin, published by Julius Springer, 1918 ) a work which in spite of its excellence unfortunately does not mention Hahnemann’s merits as a pioneer in this field :

The actual care of the patients was almost everywhere in the hands of “Inspectors general” or managers of asylums, whilst physicians were only consulted for bodily ailments. Only in the chief centres of science were to be found some prominent men who made it their life’s work to investigate mental diseases. There were also occasionally in hospitals and infirmaries physicians who had acquired a certain knowledge of the sufferings of mental patients from many years of observation. They lacked, however, any real professional education in that branch, and they carried on mental work as a kind of secondary duty. There can therefore be very little question of any scientific handling of this subject. Above all, their position was often an unworthy one and they had but slight influence upon the fate of the patients. Did not Professor Autenrieth in Tubingen (about 1800), in his lectures on disorders of the mind, give his audience the emphatic advice not to occupy themselves for too long a time with the treatment of mental patients ” because of the danger of becoming mentally afflicted or insane “? The result of this teaching was a terrible treatment of the insane.

“We lock up these unhappy being like criminals in cells!” exclaims Reil in 1803. ” In antiquated prisons side with the haunts of the owl, in desolate caves, over the entrances of a city, or in the damp cellars of prison houses where the sympathetic eye of the philanthropist never penetrates. We leave them there in chains to decay in their own filth.” The rule of the chain was accompanied by that of the whip. Muller tells us that the attendants of both sexes, in the Julius Hospital in Wurzburg, were well provided with various instruments for coercion and punishment, among them chains, hand-cuffs and fetters. In addition they had strong strips of oxhide covered with leather, and they made good used of them when a patient soiled himself, complained, scolded, or became violent. ” To chastise was the order of the day.”

Pinel, a French physician, tells us that in 1784 out of 100 patients admitted, fifty-seven died, and 1788 out of 151 even ninety-eight died : in later years a third or a fourth of those admitted died.

The Duke Larochefoucauld-Lianfourt, who reported on lunatic asylums to a Constitutional Assembly of the French Republic, declared : That insanity was regarded as incurable; the insane receive no treatment of any kind. Those that were considered dangerous were chained up like wild animals. ” That the evil is assumed to be incurable is a prejudice which is injurious to humanity, and this assumption is probably the deplorable reason why all hope for the insane is abandoned,” says Pinel.

SUPPLEMENT 22 HAHNEMANN IN GEORGENTHAL.

Hahnemann wrote, on May 6th, 1792 : Gotha, May 6th, 1792.

Our Duke will shortly hand over to me his hunting castle in Georgenthal (two hours distant from Gotha) and have it furnished. There I shall be able to found a small institute for the cure of wealthy insane and melancholic patients. Within a few weeks the necessary arrangements for their safety will be completed and my patients, who are already chosen, can be admitted. As soon as all this is arranged, we will consider together how we shall make it known to the public.

This little letter was probably addressed by Hahnemann to Councillor Becker in Gotha, and that on account of future Publications which Hahnemann subsequently considered necessary, according to the closing sentences in the above letter. This is also perhaps the first intimation which Hahnemann gives to his friend of the success following the article published in Becker’s paper.

Apparently one of the first letters from Georgenthal to his friend Councillor Becker in Gotha, reads as follows : Dear friend,

The case of the Princess and her letter is a curious joke. I have written to Winz and reduced 3./5, as I think with good grace, nearly as you meant me to do. I can well see that in Germany they are unable to appreciate the efforts to cure an insane person. Rath. F. from Hildburghausen, too, has excused himself in the grounds of expense. I asked for 40 thaler a month and 500 after the cure was completed. Schmid from Frankfort also seems to have been afraid of 50 thaler a month and 1,000 at the end of the cure, and therefore he has not answered. Now can anyone expect a physician to risk his reputation should he be unable to cure these patients? How can anyone expect him to face the danger which is always present with mental cases, or expect that the careful active and passive precautions necessary for the safe-keeping of such as are devoid of reason, or that the time spent, the expensive upkeep of the nurses, the selection of the medicine, etc., should all be undertaken for a trifling sum- without even thinking of the gloominess of such work? Does one not wish, for one’s own sake, to remunerate the diver more liberally than the man who walks down a few steps in safety?

Besides, it is much more expensive to cater for a fairly important establishment in the country than in Gotha. I ought really to have a daily messenger-boy at my disposal, as almost all our needs (meat, vegetables, cereals and clothing) have to come from Gotha. Indeed, I should not like to undertake so much for very small stipend. Therefore I share your opinion that I am justified in asking my rightful fees.

Do come and see me soon. We are at present in great disorder on account of building alterations, but I am quite able to spend a few hours with a good friend and especially with you. Publish this onslaught from Wien, in God’s name, in your “Anzeiger,” and, if I may ask it of you, print my reply immediately below. Adieu, faithful friend, D.H.

SUPPLEMENT 23

HAHNEMANN’S CURE OF KLOCKENBRING IN GEORGENTHAL.

(” Nekrolog” from the year 1795, containing records from the lives of remarkable Germans who died that year, by Friedrich Schlichtegroll, Year 6, Vol. I, pages 124-247. Gotha, Justus Perthes, 1797.)

Schlichtegroll tells us in his ” Nekrolog” that Geh. Kanzleisekretar Klockenbring, of Hanover, born in 1742, who was know as an author, was as learned as he was irritable. His well- being was largely dependent upon the opinion the world expressed of him. His mind had become unhinged (in1790) through an infamous pamphlet of the poet, August Kotzebue. In this essay, which was published under the name of Knigges ” Doktor Bahrdt with the iron brow” Klockenbring was attacked in the meanest way for no apparent reason. This upset his health to such an extent he became insane, with attacks of raving. Schlichtegroll continues here verbatim :

During this time, the meritorious family physician Wichmann, in Hanover, was, conjointly with others, uninterruptedly striving to cure the patient trying II the known means of medical science. Alas! In vain! Even though it seemed there was at times a clear interval, the fury of the illness was soon doubled.

About this time, the famous Dr. Hahnemann, then residing in Gotha, made known through the “Reichsanzeiger” that he intended all his time and all his capabilities to patients with diseases of the mind, and that he had already seen happy results from his method of treatment. As the treatment had to be concentrated chiefly on the mind, and therefore required much time, he only took very few patients at a time for treatment.

After many enquiries, there was only one opinion regarding Hahnemann’s skill as a physician, therefore nothing could be more desirable than that such an intelligent man should offer himself for such sad work. There was an interchange of letters on the subject, and Hahnemann declared himself ready to take the patient under his care. Madame Klockenbring came herself to Gotha to discuss more detailed conditions with him. Hahnemann had given the public the news of his projected institute in order to see if it would find any response, and until then had made no definite arrangements regarding the locality for the institution. A dilemma now arose for both parties, as an urgent case awaited admission in the person of this distinguished patient. The well-known kindness of the reigning Duke of Gotha came to the rescue. He gave up, for this purpose to Dr. Hahnemann, one wing of his hunting-castle in Georgenthal, three hours from Gotha, and also helped him in many ways to furnish it. In June, 1792, Klockenbring was brought to Georgenthal under a suitable escort and placed under the care of Hahnemann. This learned Physician has told us in. an article of his own (” Notes describing Klockenbring during his dementia,” I.s Deutsche Monatschift, February, 1796 VOL. 2-4) something if the extraordinary psychological conditions of this patient, and how the force of the illness gradually subsided. We will only give selections from the most striking parts relating to mental science, especially such as give the reader an idea of the gifted and comprehensive mind now distorted by the violence of the disease, but which, disordered as it was, yet aroused admiration.

Hahnemann devoted the first week to observation only, without giving any medical treatment to his patient. The latter spent day and night having a series of attacks; at one minute he spoke as a judge and delivered sentence; at another, he would recite as Agamemnon, or as Hector in the actual words of the Iliad, sung in the middle of a stanza of Pergolese’s Stabat Mater; or he quoted passages from the Old Testament in the original Hebrew, or sought for an old Greek melody to a song of Anacreon or the Anthology; and again changed over to passages from Milton’s “paradise Lost ” or Dante’s “Inferno”; and from these again he would turn to algebraic formula. Nothing was ever quite completed, but the new idea displaced the former with violet haste.

” The marvellous part,” says Dr. Hahnemann, “was the correctness of expression of all that his memory recalled from writings in many languages, especially of all that he had acquired in his youth.” This mixture bears testimony to his extraordinary and manifold knowledge, but perhaps also to his eager desire to be brought into prominence by it, as he did when he boasted of his intimate acquaintance with distinguished personages; he was not free from this characteristic in his normal state. He smashed everything that came to hand at that period, even his piano, and this he put together again in a peculiar manner in order, as he said, to find a complementary note, the Proslambanomenon. This man, who ordinarily knew nothing of bodily ailments, once wrote out for himself a prescription to be immediately dispensed, the rare ingredients of Which, according to Hahnemann’s deposition, were so well chosen and arranged, and so correctly calculated for the treatment of maniac of his type, that it could easily have been accepted as the work of learned physician; had it not been that the absurd signature and directions for administering it were proof of a disordered mind. By what means did the spirit in the midst of the fog of a storm-tossed imagination, without chart or rudder, find its way to so excellent a remedy for insanity, and one unknown to many a doctor, seeing that he had no books in his possession? How did he manage to prescribe it for himself in the most appropriate form and dose? Almost as astonishing was the fact that during the worst period of his mental disorder, on being questioned, he would not only know the date ( this perhaps was comprehensible, although he had no calendar ) but also the correct hour by day or night with great exactitude. As he began to improve, this power of divination became more uncertain and unreliable until with the complete return of his reason he knew neither more nor less about less it than an ordinary person. When he was completely cured, I pressed him once in a friendly way to solve this riddle for me, or at least to describe the sensation that had prompted him. ” My whole body shudders,” he replied, ” and something cold runs over me when I try to think of it; I pray you not to remind me of this thing.”

At the beginning of his recovery he had a ravenous appetite (ten pounds of bread a day besides other food did not satisfy him); at the same time he showed a tendency to deceive and offend everybody, and yet when well again he ate moderately and behaved courteously to everyone-these are symptoms previously observed in similar patients.

Richard Haehl
Richard Haehl was the author of - Life and Work of Samuel Hahnemann