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TRANSLATOR'S PREFACE.

To form a just estimate of the genius and learning of Iahnemann, and of the gradual and la orious manner in which he
developed and perfected his great Medical Reform, it is necessary
to study not only his more finished and larger works, the Organo0,
the Pure Materia Medica and the Chroic Diseases, but   so his
miscellancous medical writings, which I have here collected into
one volume. In these we trace the gradual and progressive development of the homeoopathic doctrine, and of the peculiarities of
its practice; we prceive that from the very earliest period of his
career, iahneomann felt dissatisfied with the practice of medicine
as it had hitherto existed, and that, castin  from him as much
as possible the prejudices, dogmas and false assumptions of the
schools, with which we know from his own coufessions he was
deeply imbued, he sought by various ways to improve the most
important of all arts, that of medicine, until at length,  uandoning
the time-honoured by-ways of vain speculation, he entered on the
only true but hitherto hahost unbeaten track-of interrogating
nature herself; with what success, the wonderful results furnished
by the practice we owe to his genius and labours, testif.
It is not my intention to enter here into a critical anlysis of
the writings contained in this volume, they must be read by every
student of homceopathy who wishes to become acquainted with
the Master-min; sutfice it to say, I have thought fit to in lude
in this collection, an claborate work (V Venereal Diseases) of
a date antecedent to I  tHahnemann's first notion respecting the
homaeopathic principle, which will be found to contain many
original ideas, and most important innovations on the common
practice; the date of its publication suficiently acconts for its




iv

TRANSLATOR'S PREFACE.

old-fashioned pathology and chemistry.       I have also included
a work of a popular character, consisting chiefly of Essays on
subjects connected    with  Hygiene, which      will well repay    a
perusal. The remainder of the Essays in this volume bear more
or less upon the reformed system of medicine, with the exception
of the "Dissertation on the Helleborism of the Ancients," which
could not have been omitted from      a collection of Hahnemann's
works, as it shews the extent of his acquaintance with the writings
of the ancients, and is a masterly specimen of critical acumen,
medical knowledge and philological research. It will be observed
that I have arranged the writings as much as possible in the order
of their appearance. I may mention, that this volume, besides
containing all the Essays in Stapf's collection, includes upwards of
twenty that are not to be found there, some of which were only
published after Stapf's volumes appeared (1829), but others were
either over-looked, or purposely omitted by that editor.
The notes I have added between brackets [ ] are simply such as
I have deemed requisite, in order to explain certain passages which
seemed to require elucidation.*
The remainder of Hahnemann's lesser writings which, from
their not referring strictly to the subject of medicine, from their
antiquated character, or from other causes, I have not introduced
into this collection, I shall now briefly enumerate.
I. ORIGINAL WORKS.1. Dissertatio inauguralis medica, Conspectus adfectuum      spasmodicorum    aetiologicus et therapeuticus.   Erlangae, 1779, p.p.
20, 4to.
2. Some small writings in the second part of Krebs' Medic.
Beobachtungen, Quedlinburg, 1782.       I have been unable to lay
* The " Case of Colicodynia " was translated by Dr. Russell, and the two Essays,
"tJEsculapius in the Balance," and "On the Value of the Speculative Systems of
Medicine" originally appeared in an incomplete form in the British Journal of
Homcopathy, by whom translated I am unable to ascertain; I have adopted these
translations, supplying their omissions, and making many alterations so as to constitute them more exact renderings of the originals. For these translations, therefore, I
hold myself as much responsible as for the rest, which were entirely translated by
myself.




TRANSLATOR S PREFACE.

my hand upon these, but from a reference in the next work, I
find that one of them relates to a mode of checking salivation at
its commenKcement, probably by means of liver of sulphur, or
sulphuretted hydrogen gas, as described in the PTclreal lDiseases.
3. Dircctiims bJr   cruJi/ radicall/ old sores, ancd  itdole;it
icler s, with an ae lidix, cOltaiit  a 1ore aor)])ropriate tr'eCtiient
o/i/stulas, c(ries, spdina rentosa, crancer, white s8elliyg and )yulilo-;ary conisumpltio, Leipzie, 1784, pp. 192, 12mo. This work eontains a good many useful observations on the management of the
system in general, andm of oldi ulcers in particular: it shews up the
absurdities of many of the usual modes of treating disease, illustratedl by examples chiefly derived from the author's own practice
at lIermanstadlt in Transylvania.  He gives a very nifve relation
of several cases which he had treated according to the most
approved methods of the schools, with no other result but that of
rendering his patients worse, and he mentions how they were
cured by some fortuitous circumstance, such as a total change in
their halits of life, &e. In this work he mentions that he has
invented a certaini "strengthening balsam," for thle treatment of old
ulcrs, whose composition he does not reveal, but which he offers
to supply genuine to any one.  Perhaps, like Shakspere's starved
apothecary, it was his poverty and not his will that consented to
this ulnprofessional bit of retail trade-but be this as it may,
this is probably the circumstance that has given rise to the
aecusation, magnified by transmission through a host of eager
calumniators, of his havinig sold a nostrum fohr all diseases. As
regnrds the medicinal treatment recommended in this book, it is
just what might satisfy the Edinburgh College of Physicians, but
what IHlahnemann himself, after a lperiod of reflection and labour,
some years of which were spent in retirement from practice, subsequently inveighed against with all his might; and we know that
every discovery he afterwards mnade in medicine, and every improvement hie effected in its practice, he immnediately revealed to the
world, so that all might derive from it the benefit it was capable of
affording; though as he himnself observes in his pretachee to the
('Chronic Diseases, with perhaps the slightest suspicion of a re



vi

TRANSLATOR'S PREFACE.

miniscence of the old balsam speculation, his discoveries would
have been much more profitable to himself had they been kept
secret until after his death.
4. On Poisoning by Arsenic, the remedies for it, and its medicolegal investigation.  Leipzic, 1786, p.p. 276, 8vo. This is a most
learned work and displays great chemical knowledge. I would
willingly have translated it for the present collection, but chemistry
is a science that has advanced with such gigantic strides of late
years, that a work upon the subject written upwards of fifty years
ago would be scarcely intelligible now-a-days.
5. On the dificulties of preparing soda from potash and kitchen
salt. (In Crell's Chem. Annal., 1787, pt. 2.)
6. Treatise on the prejudices existing against coal fires, on the
modes of improving this combustible, and on its employment in heating bakers' ovens.  With an appendix, containing M. M. Lanoiz
and Brun's prize essays on this subject. With three copper-plates.
Dresden, 1787, 8vo.
7. On the illuence of some kinds of gas on the fermentation of
wine. (In Crell's Chem. Annal., Vol. i, 1788, pt. 4.)
8. On the tests for iron and lead in wine.  (In Crell's Chem.
Annal., Vol. i, 1788, pt. 4.)
9. On the bile and gall-stones. (In Crell's Chem. Annal., Vol.
ii, 1788, pt. 10.)
10. On an uncommonly powerful means for checking putrefaction. (In Crell's Chem. Annal., Vol. ii, pt. 12, 1788.)  This was
translated into French by Cruet, in the Journal de Mddecine,
T. lxxxi, Paris, 1789, Nov., No. 9.
11. Unsuccessful experiments with some pretended new     discoveries. (In Crell's Chem. Annal., 1789, Vol. i, pt. 3.)
12. Letter to L. Crell, respecting heavy-spar. (In Crell's Annal., Vol. i, 1789.
13. Discovery of a new constituent in plumbago.   (In Crell's
Chem. Annal., 1789, Vol. ii, pt. 10.)
14. Some observations on the astringent principle of plants. (In
Crell's Beitriige zu den Chem. Annal., iv, x, 1789.)
15. Exact mode of preparing the soluble mercury.     (In the




TIRINSLITAOR' S PREPA(IC

7V1

Nuew // /1/ruar/isc/an Aac/hu/riht/n /  Aer/ e, for the yeari 1788 and
1789, 4th Quarter, Ilale, 1789; and in Blaidlger's AUJ  MaaZi / A(er:t, Vol. xi, pt. 5, 1789.)
16. C(oip/ te m/1o0 of/)preparig  e soj/i)I/libl  cry..r (TIn Irel/s
Cbem. Annal., Vol. ii, 17/90, pt 8,)
17. I/sol/lbi/ity of/ somlWe /meta/8 Cand t/air 0Xryd(s i/ calsltic
Ono0I/.l (In Crell's C/orw. An1al,l0,  Vol. ii, 1791, pt. 8.)
18. Maans for preve/i/gi  stliIrat Wio, (a/nd t/e dI sastloro/s /cs o/f
m1eC e     Irrr (In Bluamen backh's /mIed. Bibol/t/k, Vol. iii, 1791. pt. 3.)
19. Contrlbution/s to t/1 art of testi/l  Wi/IC  (In c/rerI 's uentrgi(  aum Arc/ir der l/ld. J01liCi Il/nd I0/ / r in /li/., Vol. iii,
Leipzie, 1792.)
20. (hin 1/e p/yarawtion o Gl/b/elrs salts acord//I itn to the nmt/ld o/ Ball/n/  (in Cr/rs (l.r  Allal., 1792, 1pt. 1.)
21i. Ph//namce/tlcal Lenrio/.  First vol, first part.  A to E.
Leipzie, 1793.- irst vol, second part. F to K. Leipzic, 1795.After the publication of these two parts the work ceased. it contains as fr as it goes a great  (1deal of useful information, though
the plan adopted does not 5(eiieI  to me to le the most felicitous
that could be devised  thu th(sth objects of natural history, in place
of being tret( of   i knef er he11ý wtl -kn(11kii n  scientific appellations,
are arraiigedl alphab((etcally undier the ni t barbarous, break-jaw
compound Germnairn words, inve4t( for the occasion: for example,
the I/IX iroica heru appears under the hideous    name of
iKi/ur:lkenlC C/IaleC/(i/daelbl/, the li/i mlas is mctamnorphosed into
Mi//nlei/c 1/1WI/rnIt i/flfaC/J/nI, and the n11(1th/1  cr/ pa into B/umenopfkrausemn7c(, which lnomenclatur:e, although it may be very
euphonious to a German ear, and very expressive to a German
understanding, is certainly far from scientific, and necessitates the
separation of things that ough1t to have been fo0und together. The
principle of the arrangemtent w1ill be best understood by likening
it to a Directory arranged alphabetiallly accIording to the Christian
names in place of the surnames of indi viduals.
22. I ma arks on t/e W///ile/berY a/id Hah/ine ma01's tetNs for
ain/e. (In the Ihtc//i;gutb/att of tile Al//. /1/ Ztq., 1793.  No. 79,
p. 630.)




viii

TRANSLATOR'S PREFACE.

23. Preparation of the Cassell yellow. Erfurt, 1793, 4to.  (It
is also published in the Act. Academ. Scient. Erford, ad ann. 1794.)
24. On Hahnemann's test for wine and the new liquor probatorius fortior. (In Tromsdorf's Journal der Pharmaziefiir Aerzte.
Vol. ii, pt. 1, 1794.)
25. Fragmenta de viribus medicamentorum positivis, sive in sano
corpore humano observatis. 2 vols. Leipzic, 1805.  This is the
germ of the Pure Materia Medica.
II. TRANSLATIONS FROM VARIOUS LANGUAGES, GENERALLY WITH
ADDITIONS AND NOTES BY HAHNEMANN.1. Physiological essays and observations, by John Stedman.
London, 1769.-Leipzic, 1777.
2. Nugent's essay on the hydrophobia. London, 1753.-Leipzic,
1777.
3. W. Falconer on the waters commonly used at Bath. 1775.
2 vols.-Leipzic, 1777.
4. Ball's modern practice of physic.--2 vols. Leipzic, 1777 and
1780.
5. Procedds chimiques, ranges m6thodiquement et definis par
M. Demachy.    On y a joint le prdcis d'une nouvelle table des combinaisons ou rapport p. s. de suite ' l'Institut de Chimie, 1769,
rdimnprinm  avec des annotations de Struve dans les descriptions des
Arts et Mdtiers. Neufchatel, V. xii, 1780.-In 2 Vols. Leipzic,
1784.
6. L'Art du distillateur liquoriste, par Demachy et Dubuisson,
avec des annotations du Dr. Struve. Paris, 1775.--In 2 vols.
Leipzic, 1785.
7. L'Art du vinaigrier, par Demachy, avec des anngtations de
Struve dans les descriptions des Arts et M tiers. Neufchatel, V. xii,
1780.-Leipzic, 1787.
8. Les falsifcations des mddicaments divoildes, ouvrage dans
lequel on enseigne les moyens de ddcouvrir les tromperies mises en
usage pour falsifier les medicaments tant simples que composns, et
o? on 6tablit des regles pour s'assurer de leur bonte. Ouvrage non
seulement utile aux mddecins, chirurgiens, apothecaires, droguistes,
mais aussi aux malades. A la Haye et h Bruxelles, 1784.Dresden, 1787.




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TRANSLATOR'S PREFACE.

title I have given enables me to state that it is nothing more than a
translation of that work, with a few additions and one or two alterations by the translator. It therefore properly belongs to this list.
19. Thesaurus medicaminum. A new collection of medical precriptions, distributed into twelve classes, and accompanied with
pharmaceutical and practical remarks, exhibiting a view of the
present state of the materia medica and practice of physic, both at
home and abroad. The second edition, with an appendix and other
additions. By a Member of the London College of Physicians.
London, 1794.-Leipzic, 1800. Hahnemann published this translation anonymously; I have given his preface to it, which is a
masterly satire on the contents of the work itself, at p. 398 of this
volume.
20. The materia medica of Albert con Haller. Leipzic, 1806.
Besides the above, many translations from the English and
Latin were made by Hahnemann for the Sammluing der auserlesensten und neuesten Abhandlungen fiur Wundirzte, Leipzic, 1783,
1784, 1787.
LONDON, July, 1851.
Appended is a fac-simile of Hahnemann's handwriting, which
may be interesting to his admirers. The little note possesses no
particular interest in itself, beyond being a good specimen of his
minute and beautiful writing at the age of 86, and shewing the
affectionate style he had of addressing his friends. The following
is a translation of it.
" To Hofrath Lehmann,*
"Dear Friend,
" I beg you to send me the third trituration in powder of the medicines in the accompanying list, which you have not yet sent me, and to
give them to Amelia, she will bring them with her to me, along with a
few lines from your pen, so that I may see that you are still alive, and
that you are well and happy, and also how your dear family are.
" Both of us here are well, and send you all our hearty regards.
" Yours,
" SAM. HAHNEMANN.
" Paris, 23rd March, 1841."
* Dr. Lehmann of C6then, to whom Hahnemann entrusted the preparation of all
his medicines up to the latest period of his life, and to whom I am indebted for this
autographic relic.
t One of Hahnemann's daughters, Madame Liebc, formerly Siiss.










COTENENTS.
PAGE
Translator's Preface.............................................     i
Fac simile of Hahnemann's writing, to face page..........................  x
Instruction for Surgeons respecting Venereal Diseases (1789)................  1
The Friend of Health, Part I. (1792))....t..:.. 189
The Friend of Health, Part II. (1795)  Fo.......... 240
Description of Klockenbring during his Insanity (1796).................... 287
Essay on a New Principle for ascertaining the Curative Powers of Drugs, with a
few glances at these hitherto employed (1796)........................ 295
Case of rapidly cured Colicodynia (1797)............................. 353
Are the Obstacles to Certainty and Simplicity in Practical Medicine insurmountable?  (1797)...................................................  358
Antidotes to some Heroic Vegetable Substances (1798).................... 374
Some kinds of Continued and Remittent Fevers (1798)...................... 382
Some Periodical and Hebdomadal Diseases (1798)......................... 395
A Preface (1800).............................................          398
Fragmentary observations on Brown's Elements of Medicine (1801).......... 405
View of Professional Liberality at the commencement of the Nineteenth Century
(1801)..........................................................  417
Cure and Prevention of Scarlet-fever (1801).............................. 425
On the Power of Small Doses of Medicine in general, and of Belladonna in
particular  (1801)..............................................  443
On a proposed Remedy for Hydrophobia (1803)......................... 447
On the Effects of Coffee, from original observations (1803)............... 450
JEsculapius in  the Balance (1805)................................... 470
The Medicine of Experience (1805)................................    497
Objections to a proposed Substitute for Cinchona Bark and to Succedanea in
general (1806).................................................542
Observations on the Scarlet-fever (1808).................................. 546
On the present want of Foreign Medicines (1808).......................  551
On the Value of the Speculative Systems of Medicine, especially as viewed in
connexion with the usual methods of practice with which they have been
associated  (1808).............................................. 556




xii

CONTENTS.

PAGE
On Substitutes for Foreign Drugs, and on the recent announcement of the
Medical Faculty in Vienna relative to the Superfluousness of the latter
(1808)....................................................  574
Extract from a letter to a Physician of High Standing on the great Necessity
of a Regeneration  of  Medicine (1808)................................ 581
Observations on the Three Current Methods of Treatment (1809)............ 592
To a Candidate for the Degree of M.D. (1809)............................ 625
On the Prevailing Fever (1809)................................... 628
Signs of the Times in the Ordinary System of Medicine (1809).............. 640
Medical Historical Dissertation on the Helleborism of the Ancients (1812).... 644
Spirit of the Homoeopathic Doctrine of Medicine (1813).................. 696
Treatment of the Typhus or Hospital Fever at present prevailing (1814)...... 712
On the Treatment of Burns (1816).................................. 716
On the Venereal Disease and its ordinary improper treatment (1816)......... 728
Nota bene for my Reviewers (1817)................................... 743
Examination of the Sources of the ordinary Materia Medica (1817).......... 748
On the Uncharitableness towards Suicides (1819).......................... 780
Treatment of the Purpura Miliaris (1821)................................ 781
On the Preparation and Dispensing of Medicines by Homoeopathic Physicians
themselves:I. Representation to a Person high in Authority (1820)............ 782
II. The Homoeopathic Physician is prevented by no existing Laws
regulating medical practice, from  himself Administering his
Medicines to his patients (1821)..............................790
III. How may Homceopathy be most certainly eradicated? (1825).... 793
Contrast of the Old and New systems of Medicine (1825).................... 800
The Medical Observer (1825)....................................... 813
How can Small Doses of such very Attenuated Medicine as Homoeopathy employs still possess great power? (1827).............................. 817
On the Impregnation of the Globules with Medicine (1829).................. 825
Allopathy: a word of Warning to all Sick Persons (1831).................. 827
Cure and Prevention of the Asiatic Cholera (1831)....................... 845
Appeal to thinking Philanthropists respecting the mode of Propagation of the
Asiatic  Cholera  (1831)..............................................  849
Remarks on the extreme Attenuation of Homoeopathic remedies (1832)....... 857
Cases illustrative of Homoeopathic Practice (1833)........................ 861
Two Cases from Hahnemann's Note-book (1843)........................ 869




INSTRUCTION FOR SURGEONS
RESPECTING
VENEREAL DISEASES,

TOGETHER WITH
A NEW MERCURIAL PREPARATION.
13Y
SAMUEL HAIINEMANN,
MDoctor of fRecJtttne.

FIRtST PUBLISHED AT LEIPZIG, rxI1789.




L.




PREFACE.

MY intention in this book is to make the medical public familiar
with a wholesome theory and an improved treatment of the diseases
herein spoken of.
Hunter, Schwediauer, Hecker, Andre, Simmons, Peyrilhe, Falk,
and some other, known and anonymous, older and more recent
authors have assisted me, partly by supplying me with what I did
not know, partly by enabling me to arrange my matter. I have
made grateful mention of their names or books.
I therefore trust my labour is not superfluous, for to the construction of a building belong not only beams and pillars, but also
partition walls and buttresses; not only stone blocks, but small
stones to fill up the intervening spaces; and well is it if they fit.
It is in every way a ticklish undertaking to propose a new
remedy, or to bring again into notice a neglected or little known
one. The person who attempts this must either be a man of high
repute, or be entirely free from any suspicion of mean objects.
Although destitute of the former, I am quite at ease respecting
the latter. I give an accurate account of the mode of preparing
an excellent remedy. Any one who has been in the habit of preparing other chemical drugs, can unhesitatingly prepare this one,
assured of the result; I conceal no step, no manipulation in the
process. The excellence of the remedy is obvious from the very
nature of the thing, and is further proved by the observations of
myself and my friends, who have seen similar advantage from its
employment. Anyone who knows a better, is at perfect liberty to
make it known and give it the preference to mine.
When I call it mine, I only mean thereby to say, that I shew a
purer and more certain mode of preparing it than my predecessors,
B2




4

ON VENEREAL DISEASES.

and give more definite instruction regarding the precautions to be
attended to in its use and its mode of action, and not that no one
has ever thought of employing anything similar.
A precipitated mercury, very similar to the "soluble mercury,"
(precipitatum mercurii carnei coloris, qui ex solutione mercurii vivi
in aqua forti paratur, affuso volatili urince spiritu) was first used internally with the best effects in syphilis, in 1693, by Gervaise Ucay,
made into pills with equal parts of oxydised mercury and some
honey-the dose, two or three grains several times a day.      I refer
the reader to his Traite de la maladie vendrienne, Toulouse, 1693,
chap. 9, though the preparation could not have been entirely free
from turbith and white precipitate.
This excellent remedy, however, subsequently fell into complete
neglect, until in recent times the progress of chemistry suggested
similar mercurial preparations; but we can hardly say that their
employment was ever greatly in vogue, with the exception perhaps
of Black's pulvis cinereus. Prepossession in favour of what was old,
although less efficacious or even prejudicial, combined with no
small prejudice' against all that could be called new and untried in
mercurial preparations or other remedies for venereal affections,
induced practitioners not to give the latter a trial, but rather to
stick to their calomel, sublimate, and Neapolitan ointment.
And yet the more recent pharmacopoeias furnish us with remedies which bear a striking resemblance to mine, and may have
occasionally been used.
Such a preparation is the mercury precipitated from nitric acid
by ammonia, pulvis mercurii cinereus, E., turpethum       album, 0.,
mercurius precipitatus dulcis, 0., as also the turpethum nigrum or
mercurius precipitatus niger, precipitated by ammonia in vapour
1 The many disappointed hopes respecting the more recent specifics for syphilis,
which their quackish vendors announced with the most exaggerated recommendations, and kept secret to the great advantage of their pockets, have served to render
practical physicians very shy of such remedies. They did not observe any of the
boasted effects of these costly nostrums, but often the injurious results from their
use; and the discovery of their composition often revealed some mercurial preparation that had long been known.




PREFACE.

from the same acid. I long made my preparation in the latter
way, until I corrected its imperfections by the changes mentioned
below.
Dr. Black is said to be the inventer 1 of the pulvis mercurii cinereus, which he directs to be made in the following way. " Take
equal parts of weak nitric acid and mercury, mix together and let
the mercury dissolve, dilute it with pure water, add ammonia until
the mercury is completely separated, wash the powder with pure
water and dry it."
I may here allude to the mercurius prcecip. fuscus Wuerzii, a
precipitate from nitric acid by potash, merely because it bears some
resemblance to mine.
All the authors of the remedies I have named sought to obtain a
pure oxyde of mercury free from corrosive acids, especially from
sulphuric and muriatic acids, and from the disadvantages of the
white precipitate and turbith; let us see if they attained their
object.
The purest saltpetre is never used for the preparation of nitric
acid; it is always adulterated with earthy muriates or neutral salts.
Even the most purified is not free from these. When mercury is
dissolved in this, heat is usually applied by means of a sand-bath,
in order to hasten the solution. The liquid is at first clouded white
but soon afterwards all becomes clear, that is to say the white precipitate at first formed is redissolved and retained in solution in
the acid in such a way that even dilution with water cannot precipitate it, and this can only be done by an alkaline solution. If the
mercury be now precipitated from this solution by any alkali, the
liberated white precipitate falls at the same time, and the precipitate
is thus adulterated by no small quantity of a very poisonous
medicine.
If we take any one of the mercurial preparations I have named,
put it into a medicinal bottle of considerable size, and place this in
a sand-bath in such a way that it lies almost inverted, but so that
SGervaise Ucay, as I have shewn above, prepared it long before him for the same
object.




ON VENEREAL DISEASES.

the powder rests upon the side; the neck of the bottle being
completely buried in the hot sand, and the bulging out part of
the bottle wherein the powder lies completely surrounded by the
sand. If heat be now gradually applied, a white deposit will take
place in the uppermost part of the glass, composed partly of corrosive sublimate, partly of calomel, these being the two preparations
into which the white precipitate is resolved by sublimation. The
weight of both together will indicate the quantity of white precipitate contained in the mercurial preparation, and every one can
easily convince himself of the truth of my assertion. If we employed
purified and redistilled nitric acid for its preparation, we should
certainly be much more sure of the result, but greatly increase
the price of the substance. But even this will not suffice to free it
from sulphuric acid.
But as the ordinary nitric acid is procured by the action of ordinary vitriol on nitre, it has frequently an admixture of sulphuric
acid. It must first be rectified over fresh nitre, before we attempt to
purify it by redistillation, and this will increase still more the value
of the dissolvent. Who could trust to avaricious apothecaries paying attention to all these particulars?
I now pass on to the precipitating agent, and it is a matter of
indifference which of them be used, (whether volatile or fixed alkali
or alkaline earths), provided only it be pure.
Common chalk, marble, oyster-shells furnish when calcined and
dissolved so as to form lime-water, a very good precipitant in many
cases. But I must here observe that all are products of the sea,
consequently, as experiment likewise demonstrates, not free from
muriatic acid.
Ordinary fixed alkali is usually obtained from potashes, which in
many cases contain an admixture of sulphuric acid, (often designedly added to it for the sake of adulteration) but chiefly of magnesia, and also ordinary kitchen salt. The water usually employed
for its purification contributes not a little to this impurity.
The potash prepared from tartar would be much more serviceable
for the purpose, if it were prepared by burning pure crude tartar
and extracting the salt therefrom by means of distilled water; but




PREFACE.

even this has the disadvantage of containing too much carbonic
acid, and when, in a watery solution, it should precipitate the mercurial oxyde from the nitric acid, it redissolves the greater part
of it again.
The carbonate of ammonia and ordinary spirits of hartshorn
possess the same disadvantages, from their excess of carbonic acid.
But caustic ammonia and that distilled with alcohol have not this
fault, but both of them, as well as the dry carbonate of ammonia
and the ordinary fluid spirit of hartshorn, contain no small proportion of muriatic acid; as we may perceive, by saturating them with
acetic acid and adding nitrate or sulphate of silver, when the chloride of silver is precipitated.
It is not indifferent what water we employ for the necessary
dilution.  Well water almost always contains a proportion of
muriatic acid and will not do for this purpose. Many springwaters also are not free from it.
It is well known that much depends on the purity of the mercury,
which is frequently adulterated with lead and bismuth. A mere
distillation of the suspected metal will not suffice; much of the
mixed metals would pass over along with it. Still less will the mere
mechanical purification by squeezing it through leather suffice; a
certain proportion of bismuth liquifies the lead in the mercury
so much, that it will also pass through the pores of the leather. A
much better plan is to get the metal by the reduction of cinnabar,
especially that in the massive form, which may be mingled with
potash, lime, or iron filings, and the metallic mercury obtained
therefrom by distillation.
If a saturated solution of the mercury of commerce in nitric
acid, diluted with equal parts of water, be boiled for half an hour
with twice as much suspected mercury as there is in the solution,
the mercury will lose all traces of foreign metals and be as pure
as that obtained by reducing cinnabar.




ON VENEREAL DISEASES.

Preparation of the Soluble Mercury.
Mercury purified in the latter manner I placed in a deep cellar,'
and poured upon it as much nitric acid of an inferior kind (distilled
with alumina or otherwise) as was necessary for its dissolution,
and stirred this several times a day, for the heaviest portion of the
solution floats closely above the mercury and soon puts a stop to its
further dissolution unless we adopt this manipulation.
After the lapse of eight days we may be certain of the saturation
of the acid, though there should always remain some undissolved
mercury at the bottom.
This solution should now be decanted off from the sediment,
evaporated and crystallized; the crystals are to be taken out, the
fluid shaken off them, and after being dried upon blotting paper
they are to be dissolved in as small a quantity of pure alcohol as
possible. By this means they will be completely freed from all
admixture of turbith and white precipitate. The solution must
now be filtered, and it will then be serviceable for use.
The precipitating agent is prepared in the following way: carefully washed eggshells are exposed to a red heat for a quarter of
an hour; they are then slaked like quick-lime, with distilled water,
and the resulting powder is put into a well stopped bottle.
When we wish to prepare the soluble mercury, we take a pound
of the fine slaked lime prepared from the eggshells, and mix it in a
large new cask with 600 pounds of distilled water, heated to 1000
or 1500, stirring well for some minutes till we are assured of the
most perfect solution.
After allowing it to remain at rest for a quarter of an hour, by
means of a tap two inches from the bottom of the cask we draw off
the pure and clear lime-water (if it be thought necessary through
an outstretched woollen cloth of close texture) into a similar cask of
equal dimensions, which must either be new or only used for this
purpose, and which must be very even and smooth inside.
1 If the cold was intense (in winter), I let the solution take place at a temperature
of 40 -Fahr.




PREFACE.

9

Into this clear lime-water we pour without delay, and stirring
continuously, a quantity of the above mercurial solution, containing
two pounds of the metal.
The black liquid soon settles, we then draw off the clear water,
wash out the heavy black sediment with distilled water into glass
jars, allow it to settle for twenty-four hours, pour off the water,
mix up the sediment with as much fresh distilled water as we have
poured off, let it again settle completely, decant the water, place
the glasses in a large pot, (filling up the intervals betwixt them
with ashes or sand) and put it in an oven just warm (2000) until
the deposit is completely dry. This may be more quickly effected
by spreading it out on white paper and heating it gradually on tin
pans over a moderate charcoal fire, taking care not to singe the
paper.
This dark greyish-black powder is the soluble mercury 1; which
name I give it because it is completely dissolved in all animal and
vegetable acids, and in water impregnated with carbonic acid; also
in the gastric juice with great speed, as every practitioner may
observe from the rapidity with which it causes the mercurial fever.
Lockowiz, near Dresden,
29th September, 1788.
Just as I had laid down my pen and was about to send my book
to press, Girtanner's work (Treatise on the Venereal disease, by
Christopher Girtanner, Gottingen, 1788) reached me and gave me
great pleasure. He has well thought over his plan and his subject.
I was glad to observe that he adopts Hamilton's excellent treatment of gonorrhoea in its essentials, and shews up the ordinary
irrational mode in its true colours; that he combats the a priori
dread of an obstruction after such a rapid suppression of the dis1 [For aw improvement on the above mode of preparing the Soluble lMercury, see
Postscript to the Venereal Diseases. This complicated preparation was afterwards
superseded in homoeopathic practice by the mercurius vivus. 8ee Reine Araneimittellehre, 3rd edit., vol. i.]




10

ON VENEREAL DISEASES.

charge, and denies the possibility of a metastasis of the gonorrhceal
matter in sympathetic chemosis; he gives the distinctive signs of
the various secondary gonorrhceas, shews where the venereal differs
from other leucorrhoeas, and the scrofulous from the venereal glandular swellings, and gives very useful instructions for preventing
the suppuration of the latter. I was rejoiced to find that he perceives that the antivenereal metal can only destroy the venereal
poison by a previous alteration in it, produced by the reactive
powers of the animal digestive and assimilative functions; that is
to say, not by mere contact or chemical affinity. I was pleased to
observe that he is deeply impressed with the hurtful character of
corrosive sublimate, a poison which has been so imprudently deified;
that he strongly recommends the strengthening plan before, during
and after the mercurial treatment, and generally rejects the French
debilitating system, and that he convincingly exposes the harm of
all excessive evacuations during the mercurial treatment. I was
delighted to see that he unmasks so beautifully the absurdity of
talking about "masked" venereal diseases, and shews up the worthlessness of preservative remedies against infection. I was glad to
find that he refutes the assertion relative to the inoculation of the
child by the semen and in the uterus, as also by the nurse's milk,
and advises the treatment of even children with the antisyphilitic
metal-all maxims which are of the utmost importance for the weal
of humanity.
How often have I wished for the concurrence of some physician
of eminence on these very points! I always hoped to obtain it,
believing that observations conducted by really practical minds
must eventually unite in truth, as the radii of a circle though ever
so far asunder at the circumference, all converge in a common
centre.
What else I deemed it expedient to extract from Girtanner, as it
was no longer possible to incorporate it with the text, I have subjoined in the form of notes.

14th October, 1788.




CONTENTS.

PREFACE.
INTRODUCTION, # 1-11.
PART FIRST.
IDIOPATHIC LOCAL VENEREAL AFFECTIONS.
FIRST CLASS. Idiopathic local venereal affections on secreting surfaces of the
body destitute of epidermis.
FIRST DIVISION. Primary Gonorrhoea.
Chap. I. Gonorrhoea in the male, ý 12-53.
Chap. II. Treatment of gonorrhoea in the male, ý 54-126.
Chap. III. Gonorrhcea in the female, ~ 127-135.
Chap. IV. Treatment of gonorrhoea in the female, ý 136-147.
SECOND DIVISIoN. Sequelae of Gonorrhoea.
Chap. I. Chronic strangury and its treatment, ý 148-152.
Chap. II. Chronic chordee, ~ 153-158.
Chap. III. Induration of the testicle,   159-165.
Chap. IV. Secondary gonorrhoea in the male and its treatment, { 166-199.
Chap. V. Secondary gonorrhoea in the female and its treatment, g 200 -206.
Chap. VI. Stricture of the urethra and its cure, ý 207-245.
Chap. VII. Induration of the prostate gland, ý 246-256.
SECOND CLASS. Idiopathic local venereal affections on parts of the body provided with epidermis.
FIRST DiviSION.-Chancre.
Chap. I. Chancre in general, and especially that in males, ~ 257-271.
Chap. II. On the ordinary treatment of simple chancre, 0 272-286.
Chap. III. Treatment of simple chancre,  287-293.
Chap. IV. Contraction of the prepuce (phimosis) and constriction of the
glans (paraphimosis), 0 294-301.
Chap. V. Treatment of phimosis and paraphimosis,  302-311.
Chap. VI. Chancre in the female, g 312-318.
Chap. VII. Treatment of chancre in the female, ý 319-32.




12

ON VENEREAL DISEASES.

Chap. VIII. Treatment of the accidents resulting from improper treatment of the chancre, ý 327-339.
Chap. IX. Venereal warts and excrescences, ~ 340-351.
Chap. X. Treatment of venereal warts and excrescences, ý 352-361.
SECOND DIVISION. Buboes.
Chap. I. Diagnosis of inguinal buboes, ý 362-383.
Chap. II. Observations on the treatment of buboes hitherto practised,
~ 384-399.
Chap. III. Treatment of buboes, g 400-410.
PART SECOND.
SYPHILIS.
FIRST DiVISION. Diagnosis of Syphilis.
Chap. I. Introduction to the diagnosis of Syphilis, ~ 411-425.
Chap. II. Diagnosis of the symptomatic local venereal affections of the
more proximate kind, ý 426-448.
Chap. III. Diagnosis of the symptomatic local venereal affections of the
more remote kind, ý 449-459.
SECOND DIVISION. Anti-venereal remedies.
Chap. I. Mercurial preparations in general, ý 460-473.
Chap. II. Particular mercurial preparations, 0 474-540.
Chap. III. Non-mercurial remedies, g 541-563.
THIRD DIVISION. Removal of the obstacles to the mercurial treatment.
Chap. I. Observations upon the ordinary preparatory and accessory treatment,   564-572.
Chap. II. Preparatory treatment, ý 573-590.
Chap. III. Prevention of the disagreeable effects of mercury,  5 591-613.
FOURTH DivisION. Nature of the soluble mercury, and its employment in venereal diseases, # 614-635.
FIFTH DIVIsION. Local affections after the treatment for syphilis.
Chap. I. Local affections that remain after a suitable treatment for syphilis
and their removal, # 636-647.
Chap. II. Local affections and secondary sufferings that follow the abuse
of mercury, ~ 648-662.
APPENDIX.
Venereal affections of new-born infants, 0 663-693.
Postscript.




INTRODUCTION.

1. THERE is much that is puzzling and inexplicable in the nature
of the venereal virus.
2. It has this peculiarity, that once communicated to the body
it increases indefinitely, and that the forces of the corporeal life
of the human being possess no power of overcoming it, and of
expelling it by their own effort, like other diseases and even
gonorrhoea. Its seat appears to be in the lymphatic system.
3. We find that neither the breath, nor the perspiration, nor
the exhalation, nor the urine of persons affected with the venereal
disease are capable of communicating either the local or the
general affection. The semen of a person affected with general
syphilis does not, according to the testimony of the most experienced observers, beget syphilitic children; mothers affected with
general syphilis only do not seem to have any power of infecting
their offspring, nor can nurses affected with syphilis communicate
the poison by their milk.
4. Usually the venereal diseases consist only of local affections;
a general malady accompanying these is something merely accidental.
5. The most remarkable thing about them is the difference
betwixt the first and the second infection.
6. The first infection gives rise only to independent local
diseases or idiopathic venereal local affections, gonorrhoea and
chancre; in their essential character buboes and condylomata
belong to these, yet as regards the period of their occurrence, they
constitute the transition into the second infection, in which the
absorption of the hitherto merely local virus of the gonorrhoea,
chancre and bubo into the general fluids, produces a state of'the
system that only makes itself known by local affections of another
description, which may therefore be called symptomatic venereal
disease, and the individual or collective phenomena of which are
usually termed general venereal disease or syphilis.
7. Many experiments shew that true gonorrheal matter when
inoculated produces chancre, and that matter from the latter gives
rise to true gonorrhoea, that consequently both of these affections




14

ON VENEREAL DISEASES.

apparently so different arise from the same virus, which only
exhibits different phenomena according as it is applied to different
surfaces.
8. Parts of the body destitute of epidermis designed for the
secretion of natural fluids, when the virus is brought in contact
with them, become subject, as Hunter demonstrated, to abnormal
fluxes of mucus and pus without loss of substance; this phenomenon is called gonorrhoea. On the other hand when applied to,
or rather rubbed into, surfaces of the body provided with epidermis, it excites specific ulcers, which on account of their corroding
character are termed chancres (ulcera cancrosa). In agglomerated
glands it gives rise to buboes.
9. As long as the virus continues in the form of these local
affections at the seat of the first infection (or in its neighbourhood,
as in buboes ) it retains unaltered the power to cause local infections, and to excite (e. g. by inoculation) similar idiopathic venereal
affections according to the nature of the part acted on. Should,
however, these local affections disappear without treatment, or
should a small portion of their matter pass into the circulation
(the second infection) this virus is thereby altered in such a
manner, that along with the development of the general malady,
besides other local affections, ulcers arise, the matter of which,
according to Hunter's careful researches, can neither, when applied
to moist surfaces, produce venereal gonorrhoea, nor when introduced into wounds develop chancre, and hence is incapable of
producing syphilis in healthy organisms.
10. The matter absorbed by the lymphatic vessels from chancre
gives rise to buboes, but the matter of the ulcers of the general
affection when driven inwards produces none. As little can the
virus of syphilis produce chancres on the genitals or gonorrhoea
from within outwards; if it break out on parts destitute of epidermis, as for instance on the alhe nasi, it forms only general venereal
ulcers, whilst the chancre virus applied to the same part produces
a nasal blennorrhoea.
11. The virus of chancre and gonorrhoea inserted into general
venereal sores or into suppurating buboes, does not aggravate
either of these, neither does the chancre become more malignant
than it was previously by the application of gonorrhoeal matter,
nor the gonorrhoea by that of chancrous matter.




PART FIRST.
IDIOPATHIC LOCAL VENEREAL AFFECTIONS.
jirst    lass.
IDIOPATHIC LOCAL VENEREAL AFFECTIONS ON SECRETING SURFACES
OF THE BODY DESTITUTE OF EPIDERMIS.
FIRST DIVISION.
PRIMARY GONORRH(EA.
CHAPTER I.
GONORRH(EA' IN THE MALE.
12. Ordinarily not long, often immediately after connexion with
a woman affected with venereal leucorrhoea, or who has in the
vagina venereal matter, the male experiences a notable, not unpleasant2 itching in the orifice of the urethra, sometimes resembling
a flea-bite, accompanied by a not disagreeable sensation of heat in
the genitals; a kind of formication is felt in the testicles; the lips
of the urethral orifice become somewhat swollen. Every gonorrhoea
is ushered in by this irritation,-the first stage of the disease.
13. The transition of the first into the second stage is accompanied by greater or less degree of tension of the penis, the sensation of a constriction in the urethra, and of a twisting formicating
1 The German name for this disease, Tripper, is derived from the principal phenomenon, the dropping from the urethra. Common people say, " es trippt," instead of
" es tripfelt "-it drops.
2 Sometimes it spreads all over the glans, causing erection of the penis and
seminal emission, and seems to incite to an abnormal exercise of the sexual function.
But the sensation is sometimes less pleasant.




16

ON VENEREAL DISEASES.

motion in the testicles. By pressing in the region of the specific
seat of the gonorrhoea, some mucus appears at the mouth of the
urethra.
14. The second stage. The tickling sensation changes, usually
after one or two days, into a painful feeling, into a shooting and
intolerable burning in the urethra when the patient makes water,
the usual seat of which is under the fraenum, namely in the navicular fossa' of the mucous membrane, behind the glans (the usual
primary seat of the gonorrhoea).
15. As long as the gonorrhoea, as in this stage, retains its
specific seat, the patient experiences no pain in making water
until the urine comes to within an inch or an inch a half of the
orifice of the urethra.
16. The natural white viscid mucus of this canal, which is
scarcely observable in health, now exudes by drops. The lips of
the glans are more than usually congested with blood; the glans
is shining, cherry-red, and transparent. The whole penis, or at
least the glans, appears fuller and thicker than it is naturally when
unerected; it seems half erected. The urine2 commences to be of
a dark-yellow colour. There occur frequent, painful erections,3
especially at night, occasionally accompanied by emission of semen.
17. Usually a short time after the occurrence of the scalding4
1 I believe Cockburn, in 1717, was the first who demonstrated gonorrhoea to be an
affection of the mucous follicles, and its original seat this spot; hence he explained
the nature of the discharge much more correctly and naturally than his predecessors
and many of his successors, who alleged that a large quantity (the gonorrhceal discharge sometimes amounts to 4 oz. in the twenty-four hours) of semen and prostatic
fluid flowed from the seminal vesicles and prostate gland, thereby giving an explanation of this phenomenon directly opposed to all sound physiology.
2 On account of the swelling of the penis, probably also on account of contraction
of the urethra by the inflammation, perhaps also because the patient, on account of
the pain, dreads to let his water come freely, the urine flows in a smaller stream
than usual; sometimes it splits on emerging from the urethra, probably on account
of the unequal contraction internally.
3 The painful erections and the scalding of the urine distinguish the primary from
secondary gonorrhcea and other discharges from the urethra.
4 Which, with its concomitant symptoms, continues until the irritating poison is
expelled with the discharge, from a few days to several weeks. If it continue some
time without any discharge, this troublesome and sometimes dangerous condition
is-usually denominated by the contradictory name of dry gonorrhoea.




PRIMARY GONORRH(EA.

17

on making water, there occurs a discharge1 of a watery white
fluid, as if it were mingled with milk.
18. The patients point to just behind the glans2 in the urethra,
as the seat of their pains, which they feel most intensely when the
penis is erected: on looking into it, we observe that it has a raw
appearance near the orifice.
19. During the continuance of this discharge, the scalding
diminishes gradually.3 In the course of time, and often alternately, this watery milky discharge changes into a thicker fluid,
resembling melted lard, becomes yellower, exactly like pus,4 and
has a peculiar disagreeable odour.
1 The interior of the urethra in the healthy state is always kept covered with a
fine, mild, viscid transparent mucus, that spontaneously exudes from the exhalent
vessels and from the excretory ducts of the mucous glandules, so that the acrid urine
may flow over without irritating it. But when irritated by the venereal poison,
these excretory ducts are compelled to pour out more of their moisture; a bountiful
provision of nature to dilute and carry off the injurious poison. The contractile
power of the urethra suffices to expel the gonorrhoea matter by drops.
2 The usual seat of gonorrhoea is from one to one and a half inches behind the
orifice of the urethra, (in some anomalous cases of a worse description the inflammation extends throughout the whole urethra, and seems to be of an erysipelatous
character.) How it is that the gonorrhceal matter should always find its way into
exactly that spot of the urethra, it is not easy to determine; perhaps it first lies at
the orifice, and thence gradually runs backwards till it reaches the spot which is
most susceptible of its irritation, and where it can be least readily washed away by
the urine.
3 There are claps almost without scalding, in which the discharge is copious, and
others in which the painful sensations precede the discharge some weeks. There
are even some, although these are rare, where the disease remains quite stationary
at the second stage (gonorrhee seche), where the scalding and even some dysuria
exists without being followed by a gonorrhoeal discharge, and among these are
some that are cured without this latter phenomenon ever occurring. If such a dry
clap be of a bad kind, the membranous portion of the urethra may become inflamed, and if not speedily relieved, a perinmeal fistula be the result.
4 The purulent character of the gonorrhceal discharge seems to indicate the
existence of an ulcer in the urethra; this is not the case however, in the ordinary
simple gonorrhea. There are several instances in which pus is produced without
loss of substance, without ulceration. The outer surface of the lungs, the costal
pleura, also the abdominal viscera have been found surrounded by pus without
the slightest trace of ulceration of these parts. In ophthalmo-blennorrhoea of scrofulous or other kinds, as also in cases of severe catarrh, there occurs a discharge of
true pus, without a suspicion of the presence of an ulcer. Were we to attribute the
ordinary yellow gonorrhceal discharge to an ulcer, it is obvious that if the whole
internal surface of the urethra were ulcerated, the size of this suppurating surface




18

ON VENEREAL DISEASES.

20. When the pains and inflammatory symptoms have subsided,
the third stage commences. The simple gonorrhoea is then usually
disposed to heal spontaneously without artificial aid; all pain
accompanying erections is gone; the power of retaining the urine,
and of discharging it in a full stream and without discomfort, is
restored; the acrid, coloured discharge takes on gradually a
whitish colour, and at length becomes colourless (in rarer cases it
remains yellowish to the last), similar in character to white of egg,
viscid (it can be drawn into strings betwixt the fingers), transparent, mild.1
21. It continues to decrease more and more in quantity, accompanied by a tickling sensation and a sort of not disagreeable itching
of the glans and urethra, exciting erections, until at length only
fibrous flakes are perceived in the urine, and even these at last
disappear along with the cessation of the tickling alluded to. The
gonorrhoea is cured, usually from four to five weeks after it first
broke out.
would not suffice to produce the quantity of pus that sometimes comes away in
gonorrhcea. And moreover as the ordinary gonorrhoea depends on a true venereal
miasm, it is impossible, if it arose from an ulcer, that any case could be cured
without mercury (without which no venereal ulcer can be radically cured); but we
find that a simple clap is often cured by the power of nature or with some slight
unmercurial remedy. In persons who have been cured of clap, the urethral mucus
often suddenly comes away yellow and puriform after being heated, after the abuse
of spirituous drinks, frequent sexual intercourse, &c. It is especially in the inflammatory stage of the clap that the discharge comes away of a purulent character,
whereas ulcers only secrete pus after their inflammatory stage is past. What we
have stated is superabundantly corroborated by innumerable dissections of the
urethra, both in cases which died during the clap and in such as had clap long
before their death. In the latter no cicatrices were found, with the exception of a
few rare cases; in the former, however, it was observed that the seat of the discharge
was not ulcerated, but only very red and raw-looking, and the coloured matter
could often be pressed out of the lining membrane, whilst the gonorrhceal pus lay
free in the mucous cavities (lacunce), that is to say in the depressions caused by the
mouths of the excretory ducts of the urethral glandules, without the slightest loss
of substance being discoverable; the lymphatic vessels were congested, as if
injected with a white fluid. Pott, Morgagni, Hunter, Stoll and others are the
authorities for these facts.
I This fluid seems to be coagulable lymph, and its innocuousness is known by this
(besides the cessation of all painful sensations) that it dries only upon one side of
the linen, and the spot it makes may be rubbed completely off without leaving
behind a coloured place, while the previous, more acrid discharge, stains and sinks
into the linen.




PRIMARY GONORRHIEA.

19

22. The above is the usual course of the gonorrhoea, but there
are innumerable varieties.
23. When the irritation from the gonorrhoeal matter advances
nearer to inflammation, the sensations of the patient are not confined any longer to the original seat of the gonorrhoea.
24. Weakness in the whole pelvic region, disagreeable sensitive,
ness in the scrotum, testicles, breast, hips, shooting extending into
the glans and great scalding on passing the urine, dark redness of
the latter, frequent painful erections and difficult passage of the
faeces are the general concomitant symptoms usually observed.
The inguinal glands are often at the same time swollen.
25. If the inflammation be more intense, the whole urethra
seems to be affected in an erysipelatous manner; it is as if shortened,
in consequence of which the frequent, sometimes continued priapism
crooks the penis downwards, (chordee), causing the most excruciating pain, and often the discharge of some drops of blood.1 The
emissions of semen that sometimes ensue are agony. The urine is
dark red, acrid, hot; the patient is forced to emit it every moment
by teaspoonfuls or even drops, accompanied by the most violent
cutting and with involuntary contortions of the features, especially
as the last drops flow out. Sometimes the patient cannot remain
a quarter of an hour on his legs (and then complete retention of
urine often ensues).   The penis is externally very painful, the lips
of the urethra gape; some swelling of the glandules along the
urethra, and a painful tumefaction of the perinaeum are observable,
frequently conjoined with tenesmus; the gonorrhoeal discharge is
then acrid, discoloured, greenish, or greyish,' sometimes even
mixed with streaks of blood; it sinks into the linen where it makes
marks of a similar colour.  The pain is great, it excites the pulse;
rigor and heat are present, especially towards evening; blood drawn
from the arm presents occasionally the buffy coat.
26. The above course which is never the normal one, and whose
violence is often dependent on a bad constitution, but more frequently on improper treatment of the patient by himself or his
surgeon, or an accession of febrile disease, a chill, fright, anger,
SWhich comes from some distended or lacerated bloodvessel of the inflamed
membrane of the urethra, over-stretched by the erections.
2 Both colours may be owing to the admixture of small quantities of blood.
c2




20

ON VENEREAL DISEASES.

vexation, riding, dancing, coition, heating liquors, purgatives, corrosive injections, &c., does not remain stationary at these symptoms,
but, if effectual aid be withheld, goes on to the most dangerous
results.
27. The priapism readily passes into mortification, the inflammation of the glandules along the urethra into suppuration, which opens
into the urethra, more rarely outwards; the tumefaction of the
perinaeum, probably in Cowper's glands, forms an abscess which in
course of time gives rise to a fistula perinmi, whereby an abnormal
outlet for the urine in this region is constantly maintained. The
prostate gland passes into inflammation and induration, less frequently into suppuration. The foreskin inflames, chiefly in consequence of the contact of the acrid gonorrhoeal matter which
penetrates betwixt it and the glans (chancres under the foreskin
and gonorrhoea preputialis are not unfrequent consequences);
it swells and gives rise to phimosis or paraphimosis. The discharge
may sometimes stop suddenly (chaude-pisse avortee) and sympathetic inflammation of the testicles or inguinal glands ensue.
28. Along with the sensation of a colicky pain in the abdomen
and a weakness in the loins and pelvis, along with pains in the
coccyx and the whole urethra, and along with inclination to
vomit, the efferent duct of one testicle, then the epididymis, and at
last also the body of the testicle, seldom of both testicles, begins to
swell, accompanied by symptomatic fever, quick, full and strong
pulse. The testicle gets soft, full and swollen, (chaude-pisse tombee
dans les bourses), by and by it becomes hard, and yet the epididymis on the top of it is harder to the touch; it is sensitive, full
of a dull pain, sometimes accompanied by shooting. It appears to
the patient to be intolerably heavy.
29. The spermatic chord also frequently swells and its bloodvessels are distended so as to become varicose, the spermatic duct
becomes hard and painful.
80. In the meantime the gonorrhoeal discharge diminishes, and,
except in a few cases, stops completely; the scalding of the urine
ceases. On the other hand, there occurs a more frequent call to
urine, a strangury, as the region of the neck of the bladder appears
to be now affected; the formerly superficial inflammation penetrates deeper into the substance of the urethral membrane. Sometimes the swelling goes alternately from one testicle to the other.




PRIMARY GONORRHCEA.

21

31. Other viscera also suffer, as has been said, from sympathetic
irritation; indigestion, flatulence, colic, tendency to vomit are the
usual symptoms.1
32. Resolution is the most frequent termination, scirrhus the
more rare,2 and mortification or suppuration the most rare.3
33. In like manner, along with the cessation of the scalding and
the occurrence of strangury, as also of most of the other symptoms,
there sometimes arises a swelling of the inguinal glands which has
but a remote resemblance to true venereal bubo, as it is only
caused by sympathetic irritation. (Slight swellings of the inguinal
glands are a usual and unimportant symptom in every gonorrhoea
of any severity, without the discharge thereupon ceasing. They go
off without further inconvenience on the cessation of the urethral
irritation.)
34. Resolution or scirrhus is the most frequent, suppuration the
rarest result.
35. Rare but much more dangerous is the ophthalmia that
occurs under similar circumstances.4 After a diminution or sudden
1 Excitement of the nervous system by passions, over-heating of the whole body
or of the genitals in particular, astringent injections, the rude employment of
bougies, purgatives, perhaps also a not sufficiently understood predisposition of these
parts may give rise to these swellings of the testicles and inguinal glands, which
with few exceptions are not venereal [syphilitic]. A mere sympathetic irritation of
the lymphatic vessels in the urethra and caput gallinaginis seems to excite the
remote swelling of these glands. A proof of this is to be found in the frequent
reappearance and disappearance of these swellings, and in their curability by antiphlogistic, sedative remedies, without mercury, which is never the case with
true venereal buboes and swellings of the testicle.  It is very rare that with
moderate care either pass into suppuration, and if this do happen the ulcers formed
are as Hunter has shewn, not venereal, and may be cured by non-mercurial means
without being followed by syphilis. Not to mention that true venereal buboes and
swellings of the testicles produced by a real metastasis of the miasm are much
larger and more painful than those arising from sympathetic irritation in cases of
suppressed gonorrhoeal discharge.
2 Induration occurs especially when the discharge cannot be re-established, and
the swelling of the testicle does not diminish.
3 Girtanner says, " it never passes into suppuration," contrary to Hunter's obserr
vations.
4 There is certainly a sympathy known to exist betwixt the visual organs and
the genital apparatus, but whether that is sufficient to account for this phenomenon
I cannot decide. Although this blennorrhoeic ophthalmia is usually attributed to a
true metastasis of the gonorrhoeal matter, this assertion remains improbable and




22

ON VENEREAL DISEASES.

cessation of the gonorrhoea (frequently from two to three days after
its suppression) in consequence of severe chill of the whole body or
of the genital organs, by the intemperate or excessive employment
of cold applications, by draughts, &c., a violent inflammation attacks
the eyes, which very soon (in a few days) usually inevitably results
in incurable blindness. At first the conjunctiva becomes inflamed,
swells and presents the appearance of a mass of raw meat, from
which a copious purulent fluid runs, soon causing inflammation of
the lower eyelid. Every glimmer of light is intolerable to the
patient. Most of the conjunctiva of the sclerotic inflames and
swells over the cornea to such an extent that the latter appears as
if sunk in a pit. A production of pus is observed to take place
behind the cornea, which becomes whitish and opaque, scales off,
and at length projects forward and bursts from the pressure of the
suppuration of the eye. The destroyed contents of the eyeball
escape, and the visual organ is for ever destroyed.'
86. Ulcers in the urethra are certainly of rare occurrence, at least
they are far from being an essential portion of the ordinary gonorrhoea when left to itself. The end of the pipe of an injecting
syringe, of the catheter, or of a hard bougie in the hands of an incautious person, may readily cause a wound in the urethral canal;
a chancrous ulcer is the consequence. The laceration of a bloodvessel in the urethra (by priapism, onanism, coition) may give rise
to something similar. An internal ulcer may also often arise from
the bursting of an abscess of the external urethral glandules.
87. A severe pain on passing water, in a circumscribed spot in
the urethra, which is renewed on introducing a catheter or bougie,
as also by external pressure on the same spot, betrays the presence
of such an ulcer. Ordinarily some blood escapes before the ulcer
occurs.2
88. In such a case though all the inflammatory symptoms of the
unproved as long as the venereal nature of the matter discharged from the eyes is
not demonstrated, as long as chancres have not resulted from inoculating it. In the
mean time we shall hesitate to allow it the name of eye-clap. I perceive that
Girtanner holds the same opinion as myself.
1 Sometimes in from four to five days after the commencement of the disease, as
Girtanner remarks.
2 And, as Girtanner alleges, sometimes true pus mingled with blood is 4ischarged
along with the ordinary gonorrheal matter.




PRIMARY GONORRH(EA.

23

gonorrhoea may have subsided, yet the pain persists in the suspected
spot even during the secondary gonorrhoea, and does not cease
until a proper course of mercury puts a stop to it and its source, the
urethral ulcer. If, in place of the antivenereal specific, astringent
injections are employed, general syphilis is the result.
39. Sometimes, though rarely, (almost never in those who have
a short foreskin, and never in those who have got none) connexion
with a diseased woman causes a sort of external gonorrhoea. With
a tickling and burning smarting sensation, there occurs, chiefly in
the region of the junction of the prepuce and glans, on the corona
of the latter and inside the lower part of the former, a secretion of
an acrid viscid matter, without our being able to detect any abrasion of the skin or visible ulceration; occasionally we may observe
through a magnifying glass that the affected part seems as if
covered with aphthme. This abnormal secretion on the spot indicated is termed preputial gonorrhoea.1
40. Sometimes it involves the whole inner surface of the prepuce
and the whole extent of the glans, at least I have noticed it also
on its apex.2
1 Sydenham seems to be the first that observed it.
2 Perhaps this last phenomenon is a not unfrequent commencement of urethral
gonorrhoea. The following case seems to throw light upon this assertion, and to
give rise to some inferences. A man who had never had clap, after an impure, halfcompulsory connexion, was affected by an almost raw, dark red spot, three lines in
diameter, at the distance of two lines from the orifice of the urethra, which exuded
but little, and caused very little uneasiness; he was otherwise free from venereal
disease. Under these circumstances he had connexion with a lady who was quite
healthy in every respect. She got from him a very violent clap and a sympathetic
bubo in the right groin, besides an abscess in the fold betwixt the greater lip and
nympha of the same side. The man now ceased to have connexion with her, and
commenced bathing the exuding spot with warm milk, whereupon the disease
gradually changed its seat, and in a few days reached the orifice of the urethra, the
lips of which commenced to inflame. Some fluid had already commenced to flow
from the orifice of the urethra when he first put himself under treatment, and in the
course of six days he was perfectly cured without further accident merely by the rapid
and vigorous use of the soluble mercury. Subsequently he did not again infect the
lady, and he is still (after one year and three-quarters) in perfect health. The lady
recovered by the external and internal use of antiphlogistics, and her abscess yielded
to mercury.
Preputial gonorrhoea seems to give evidence of a peculiar tenderness of the
epidermis of the glans; at least it is never met with in persons whose prepuce is
short, cut off, or always retracted behind the glans. The epidermis of such a glans




24

ON VENEREAL DISEASES.

41. Indubitable observations shew that the gonorrhoeal matter
may in some rare cases be absorbed, and produce general syphilis.
But the special conditions under which this may occur are not very
clear. That this may arise from urethral ulcers, which date their
origin almost invariably from some violence from without or injury
received, is self-evident and requires no further proof. But under
what circumstances the gonorrhoeal virus may, without injury of
the lining membrane of the urethra, be absorbed into the general
circulation is all the more doubtful; whether by too full living, or
on the contrary, by inordinate blood-letting and purgatives, or
generally by a debilitating regimen and internal and external relaxing remedies, the local employment of mercurial ointments and
plasters,  &c.?    Perhaps sometimes by        some peculiar morbid
diathesis, an accidental fever,' or habitual general indisposition.
All this lies in obscurity, and there is but little probability that
any metastasis of the gonorrhoeal matter is possible, except when
there is a urethral ulcer.
42. Thus much is certainly true, that it is not so much the mildness or malignancy of the infecting matter, as the various susceptibility2 of the constitution of the different subjects exposed to the
infection, that makes slighter or more severe gonorrhoea; but still
it is going too far3 to deny all modifying power to the different
degrees of the poison, as Hunter does, who also maintains that it
is the same with respect to other miasms.4
becomes thicker, and is therefore only inoculable by the venereal poison with
chancres. Perhaps the aphthous coating of the glans in these external claps
consists of small chancres. Many observers, among others Gardane, have observed
an alternation of urethral and preputial gonorrhoea, the one appearing when the
other ceased, and vice versa.
I J. Foot saw on the occurrence of the small-pox a gonorrhcea disappear and
general syphilis follow thereupon. Was it fairly ascertained that no urethral ulcer
was present?
2 Instances are not wanting where one woman has communicated clap of the
most various degrees to several men, and yet has not given it to those with whom
she was in the habit of having most frequent connexion.
3 In this Girtanner agrees with me.
4 Is it perfectly indifferent whether the variolous virus be taken from mild cases
of small-pox or from children who have died of confluent small-pox? In an
epidemic of putrid fever, I saw ten individuals who frequented the same room
attacked with almost exactly the same symptoms, whilst in other families, including
the domestics, quite different modifications of the disease obtained, and were transmitted from one member to another with almost no difference.




PRIMARY GONORRHWEA.

25

43. In most persons the first gonorrhoea seems to be the most
severe, especiallywhen it occurs in a sensitive or ardent temperament.
44. Repeated attacks of gonorrhoea seem to fortify the urethra
against a new irritation of the same kind; each time it generally
becomes unsusceptible for a new infection for a considerable time
(always longer and longer).
45. Persons who have what is called an unhealthy skin, are not
on that account more difficult to cure of gonorrhoea; and again,
those who are insensible to many irritants have often the most
obstinate gonorrhoeas.
46. Long continued scalding of the urine without the occurrence
of a discharge, indicates a bad form of gonorrhoea, which before it
breaks forth is often preceded by an anxious sort of restlessness;
and yet severe scalding does not always prognosticate a great discharge, nor slight scalding a moderate one.
47. Men rarely communicate gonorrhoea before the discharge
appears, women do so more frequently. Yet the poison is not
inactive between the period of infection and that of the appearance
of the discharge; it always in the interim causes sensations in the
urethra.
48. On surfaces of the body which are destitute of epidermis and
which are naturally moist, the gonorrhoeal virus can excite similar
discharges. It must therefore be carefully kept from the anus,'
mouth, nose,2 eyes;3 but in such situations also, as it is constantly
washed away and diminished, it cannot be easily absorbed, the
same as when it is in the urethra (consequently it can rarely give
rise to general venereal symptoms), and hence is not to be cured by
mercury.
49. But when introduced into wounds, it seems to act exactly
like the chancre virus, and to infect the body with the venereal disease (which is curable by mercury only). J. Hunter inoculated the
glans of a healthy man with gonorrhoeal matter, who thereupon
1 I saw gonorrhceal matter which had been introduced into the rectum by one of
the most unnatural of vices, give rise to chronic gonorrhoea of the rectum.
2 Duncan observed it accompanied by violent inflammation of the Schneiderian
membrane.
3 Swieten saw a true case of gonorrhoeal ophthalmia.-A common symptom in
children which during birth are infected by the local virus in their mothers' genitals
is among others a gonorrhoea of the eye.




26

ON VENEREAL DISEASES.

was attacked by chancre, then buboes, and lastly had general
syphilis.
50. Who knows but that many chancres on the glans and prepuce
might be avoided if the gonorrhoeal matter that flows out were
carefully kept from those parts?
51. If the ordinary gonorrhoea be venereal, as cannot be denied,
there are not a few other gonorrhoeas whose infecting properties
cannot be disputed, which are of a gouty, scrofulous or other
nature. These latter can often be very quickly cured, and an
inexperienced practitioner might be apt to suppose the remedy he
employed to be a specific for gonorrhoea, until its inefficacy or
hurtful character in true venereal gonorrhoea shall convince him
and others of the contrary.
52. Anyone who wishes for information upon the subject of the
non-venereal ones, which do not fall to be considered here, will do
well to consult Hecker's work.
53. The infecting power of a venereal gonorrhoea does not cease
until the discharge has completely ceased, and erections and the
emission of semen take place without the slightest pain, scalding,
or abnormal tickling sensation.
CHAPTER II.
TREATMENT OF GONORRH(EA IN THE MALE.
54. The mildest (rarest) kind of gonorrhoea requires, besides a
good diet and regimen, almost no artificial aid, although the time
required to effect the cure may thereby be much shortened.
55. The more severe (the ordinary) kind will no doubt ultimately
yield in most cases to the efforts of nature, but it will give way
more happily, more quickly, and more easily with some assistance;
the chief points to be attended to in furnishing that assistance
being the following: to allay the inflammation and pain; to check
the consequences of the morbid irritability; to second the efforts
of nature in its endeavours to throw off the poison; and in some
cases to rouse to increased action the indolent fibres. We should
not have so many points to attend to did we know of any specific
antidote to the gonorrhoeal matter.
56. If we are consulted immediately after infection, or in the




PRIMARY GONORRHCEA.

27

first stage of the disease, we may succeed in preventing many cases
of gonorrhoea by counselling diligent ablution of the penis, and injections of tepid milk1 into the urethra, which have often been
attended with complete success.
57. But we are usually consulted only when the pains compel
the patient to seek advice, in the second stage.
58. Under these circumstances we should advise a mild vegetable
diet, forbid the employment of acrid salts, of spirituous liquors and
spices, (especially pepper, brandy, pickled or smoked meat), of
pork, of fat, and all indigestible articles, and all excess in eating.
The penis should be frequently bathed or washed in tepid milk.
59. For the proper treatment of the gonorrhoea, however, in
order to remove the superficial inflammation of the urethra and to
make it insensible to the irritation of the venereal matter, (the
most important consideration in the second stage,) we should inject as often as possible into the urethra as far as the seat of the
gonorrhoea, a fluid which possesses the power of doing both these.
Three grains of opium are to be dissolved in 30 drops of sweet
spirits of nitre, and the solution mingled with an ounce of water
which contains three grains of acetate of lead in solution. The thin
tube, an inch and a half long, of the
small tin syphon here delineated, is
to be carefully inserted into the fore
part of the urethra whilst the penis is
allowed to hang down; the funnel
shaped part of the instrument is to be
held betwixt the fore finger and
thumb of the left hand, and the tepid
fluid above described dropped into
the funnel-shaped opening of the
small syphon, ten or twelve times a
day, each time for a minute or longer.
The fluid overflows out of the narrow
end, exactly at the ordinary seat of the gonorrhoea, and forces its
1 Or still better, according to Girtanner, by injections of lime-water, whereby
according to him the gonorrhoea is stifled in its germ. Does the power possessed by
this remedy give evidence of an acid character of the venereal poison? In place of
lime water he employs also a weak solution of caustic potash.




28

ON VENEREAL DISEASES.

way down by the side of the instrument, and out of the mouth of the
urethra; whereby only those parts of it are moistened which require
the application of the remedy. The patient performs this little manoeuvre himself most readily when standing. He can thereby do
no harm. All the inconveniences of the ordinary syringe are
obviated by this contrivance. (The patient should previously make
water each time.) Even when there is great sensitiveness of the
urethra, so that the syringe dare not be employed, this operation
may be performed, and that without difficulty. The rounded end
of the tube should be moistened with milk or cream before being
introduced into the urethra. We may increase the opium and
acetate of lead in the one ounce of water gradually to five grains
of each.
60. Diluent drinks should at the same time be employed. An
emulsion made with three to six pounds of water and six to eight
ounces of hemp-seed, and sweetened with two ounces of syrup of
poppies and an ounce of syrup of lemons, may be drunk daily; and
this drink, in the inflammatory stage of the gonorrhcea, will do
instead of any other internal remedy.
61. If the bowels are constipated, clysters of honey and water
should alone be used, and to render these as seldom necessary as
possible, fruit may be eaten.
62. In order to diminish the nocturnal erections, a tepid footbath for half an hour and a few drops of laudanum taken just
before going to bed, lying on the side upon an elastic mattrass, light
bed clothes and a cool apartment will be found advantageous.
63. In the course of an ordinary gonorrhoea the patient goes on
in this manner until the scalding of the urine changes into slight
itching, until the glans loses its red colour and shining transparency,
and the thin discoloured discharge changes into a viscid, colourless
mucus, small in quantity.
64. Under such treatment this result would happen in from
seven to eight days.
65. This mode of treatment is however far from being that
generally adopted. In ordinary gonorrhoeas much work is made
with many different remedies and a great deal is done, only not
what is necessary; and by a variety of manoeuvres a simple gonorrhoea is changed into a complicated and malignant, or at all events
a chronic one.




PRIMARY GONORRH(EA.

29

66. Judging from the maxim that gonorrhoea arises from venereal
poison, mercury was from time to time looked upon as the peculiar
antidote for gonorrhoea.
67. Physicians did not consider, and would not be taught by
experience, that, there being no specific for gonorrhoea, mercury
could not possibly be one, as long as this poison acts upon a
moisture-secreting surface of the body, such as the interior of the
urethra is, where it causes, so to speak, only a mechanical irritation,
and on which consequently, seeing that it lies as it were beyond
the sphere of the circulation, the anti-venereal specific cannot act.
(Gonorrhoea is a merely local disease.)
68. Some facts prove this superabundantly. A man that had
just got rid of chancres and a bubo by means of mercury, was
infected anew  and got clap, which would not have been possible,
if the gonorrhoeal irritation could have been acted on through the
circulation; for as long as the juices are filled with this metal, there
is no possibility of a penetrating venereal infection, such as a
chancre, occurring. During the mercurial treatment, cured gonorrhoea has been known to break out again, and to remain for
a long time as secondary gonorrhoea.
69. In cases of simple gonorrhoea, not the slightest use has ever
been observed from mercury; and, therefore, any unnecessary
exhaustion of the patient's strength by this metal is quite contraindicated, often even hurtful: thus, for instance, a large dose of
calomel, as of any other drastic purgative, has often been found to
be followed by increased irritation in the genitals, wide-spreading
inflammation, swelling of the testicles and inguinal glands, and so
forth.
70. Peyrilhe has recommended his volatile alkali as a specific in
venereal diseases, and especially in gonorrhoea. Observations are
awanting to corroborate this statement: in the meantime, I may
remark, that Murray has seen stoppage of the gonorrhoea and
orchitis, strangury and hoematuria follow its internal employment.
71. Now as we possess no specific remedy' for gonorrhoea, there
remains nothing for us to do" but to remove all obstacles to,
1 Otherwise the introduction of the before-mentioned (ý 59), or of some similar
fluid into the anterior part of the urethra, which has been employed by moder
physicians with such incredibly rapid success, must be regarded as such a specific:




30

ON VENEREAL DISEASES.

and to second the efforts of, nature, which generally performs the
greater part of the cure alone, though in a somewhat tedious
manner.
72. Nature herself will usually establish a copious discharge of
fluid, probably for the purpose of gradually washing away the
firmly adherent gonorrhoeal poison, and of rendering it innocuous
by extreme dilution.
73. This effort of nature is however often insufficient and difficult, at all events disgustingly tedious, since along with the
increase in the secretion of the urethral fluid, the gonorrhoeal
poison is simultaneously reproduced, and continues to exercise
its specific irritation, until the seat of the gonorrhoea grown
accustomed to the irritation becomes at length insensible to it,
whereupon the poison (from want of the objective specific irritant)
diminishes and goes away completely, whilst the sensitiveness in
the urethra vanishes, and the discharge decreases or becomes mild.
74. Hence it is no wonder that this process of nature is tedious
and accompanied by much pain, often by swelling, inflammation,
and spasm; symptoms that all demand the succours of art. It is
only a pity that the best plan has not always been pursued in
these cases, that the first of all the indications has been missed,
namely to destroy the local irritation and the local inflammation
at its very seat. The poison, or at least the inflammation, was
short-sightedly enough sought for in the general circulation, in
the primae vike, in the whole urinary system, &c.
75. It would occupy volumes to record the sometimes useless,
often hurtful remedies, usually employed in this view.
S76. Laxative salts, saltpetre, baths and venesections, appear at
first sight to be advisable, and yet their employment cannot
be allowed as a general rule, and only very rarely and exceptionally.
77. For since in the pure inflammatory state of a gonorrhoea
the whole mass of blood seldom takes part in the inflammation, it
follows that it is only in these few cases that it is admissible and
beneficial to open the vein, and none but an experienced practitioner can determine this.
78. Therefore, I know not what can be said for the frequently
repeated venesections usually employed for every case of gonorrhoea; but this I know, that in ordinary often mild-looking




PRIMARY GONORRH(HA.

81

gonorrhoeas, the system is thereby unnecessarily weakened, and
the foundation for the most obstinate secondary gonorrhoeas is
laid; and that in more severe cases, when irritability from weakness produces an accumulation of the most dangerous symptoms,
venesections, and still more repeated venesections, usually increase
the symptoms to the most frightful extent. Local blood-letting,
on the contrary, can, as will be shewn below, be more frequently
and certainly employed with benefit.
79. Warm baths, be they for the entire body or for the half only,
should likewise not be uselessly lavished in simple gonorrhoeas,
as they rob the patient of much of his strength; even in inflammatory symptoms, their employment is a matter of doubt whenever
these arise from pure morbid irritability.
80. Nitre is another favourite remedy of the French physicians
in gonorrhoea; every one that has a clap must swallow a quantity
of the universal cooling remedy, nitre. Whatever truth or untruth
there may be in the cooling virtues of this salt, experience teaches,
that when taken in the inflammatory stage in considerable quantity, it invariably does harm, on account of the great irritation of
the urinary passage it causes, not to mention that it is almost a
specific weakener of the system, and thus contributes to aggravate
the symptoms due to that state. I have seen dyspepsia, low fever,
and obstinate secondary gonorrhoea, result from its abuse in
gonorrhoea.
81. Very nearly the same may be said of the other neutral
salts.  The use of laxative salts must, therefore, (likewise on
account of the irritation to be feared and the weakness to be
expected from their use,) be confined to cases in which clysters
of honey-water fail to keep the bowels open. Glauber's salts given
in drachm doses until an effect is produced, will suffice. In cases
of impurities in the stomach, a moderate emetic will be serviceable, and diminish the irritation of the genitals caused by the use
of laxative salts.
82. Still more dangerous are the drastic purgative medicines, so
frequently used in gonorrhoea. Their usual effects are,-increase
of the inflammation of the genitals, suppression of the gonorrhoea
with all its dreaded concomitants, such as swelling of the testicles,
inflammation of the perinaeum, chordee, &c. Jalap root and resin,
gamboge, scammony, agaric, colocynth, the purgative extracts




32

ON VENEREAL DISEASES.

(extr. panchym. cathol.), but above all, aloes and its preparations,
are apt to produce these results.
83. There is still another sort of empirical remedies that are
said to remove the gonorrhoeal discharge rapidly. Such are, the
os sepie, olive oil with citron juice, alum, sugar of lead, &c., given
internally. These things must, on the one hand, be very injurious
to the system, whilst on the other they can often do no good to
the disease.
84. In like manner, in the second stage of gonorrhoea, all kinds
of balsams, and all irritating and very astringent injections into
the urethra, must be avoided, as hurtful and dangerous.
85. But more horrible still than all I have mentioned, is the
mendacious counsel, which has been devised by wickedness,-that
a person affected by gonorrhoea should have connexion with a pure
virgin, and that he would thereby get quit of his disease.-In this
case, the unhappy wretch inoculates the poor girl with the same
poison that pervades his own genitals, and sensibly aggravates his
disease by an accession of inflammation, while he has the fearful
reflection that he has added a fresh crime to the original cause of
his malady.
86. Finally, in the third stage of an ordinary clap, after the
complete cessation of the scalding and all other painful sensations
of these parts, especially the troublesome erections, when the discharge has become lessened, almost colourless, mild, and viscid,
so as to be drawn into strings betwixt the fingers, nature may be
assisted in the following manner.
87. I refer now to a gonorrhoea neglected under the ordinary
treatment, which most certainly requires such aid, for if the best
antiphlogistic and sedative local treatment have been vigorously
employed from the commencement, all the discharge ceases of
itself either in a week or a little longer.
88. On account of their calefacient and stimulating, but at the
same time also their diuretic, inspissating and strengthening powers,
the natural balsams of copaiba, Tolu, Canada, but especially the
Rackasira-balsam1 and the other turpentine-like substances are of
1 As early as 1695 Job. Vierzigman makes mention of these and similar remedies
with the greatest approbation. See Disp. de Phimosi, Cor. 22.




PRIMARY GONORRH<EA.

33

use in these cases. They may be given alone, or rubbed up
with sugar, or dissolved in water by means of yolk of egg, or in
the form of pills to the extent of 50 or 100 grains daily.1 Care
should be taken not to give them before this stage, when the
irritability has ceased.
89. This is the time when linseed tea, the Thebaic tincture, and
the bathing of the genitals must be left off, but the diet must be
allowed of stronger and more nutritive articles.
90. If, however, we have to do with very lax systems, or such
as have been treated with remedies of a too relaxing character,
in which the third stage of the gonorrhoea comes to be of a tedious
character, and in which, though the disagreeable sensations in the
urethra have all gone off, the discharge still continues in considerable quantity, yellowish and of some consistence, it is necessary
to abridge this stage energetically, in order to avoid the occurrence of gleet.
91. Besides the internal use of tonics and balsams, the inner
secreting surface of the urethra must be roused2 from its inactivity, as old skin diseases are cured by blisters, chronic catarrhs
by sternutatories, or habitual perspirations by a flannel shirt.
92. One, two or four grains of caustic potash or corrosive sublimate dissolved in eight ounces of water will form the best injections
for this object. The frequency of their repetition should be regulated by the degree of irritation that these injections manifest on
the affected parts;3 if it be slight, they may be repeated the oftener.
93. In this way we may eradicate this malady in a short space
The most certain sign that the balsams have been given too soon is the occurrence of retention of urine, the renewal of the scalding, &c.; in that case their use
is to be discontinued.
2 These stimulating injections have many things in common with tonic remedies;
when they rouse to activity the lax fibres, the latter gain a tone, whereby they are
put on a par in point of strength with the unrelaxed fibres; they then react with a
power peculiar to the natural tense fibres. We may therefore reckon these artificial
stimulating remedies among the number of tonics, just as in certain respects cardamoms and ginger deserve to be called tonic stomachics, as much as the bitter and
astringent vegetable substances.
3 We should take care to ascertain beforehand that the organism has no tendency
to morbid irritability and erysipelatous inflammation, which will be perceived from
the characteristics of this kind of constitution given below, and will be known not to
exist if the previous painful sensations in the urethra were confined to the actual
seat of the gonorrhoea.




84

ON VENEREAL DISEASES.

of time from those organisms that are apt to entertain chronic
gonorrhoea (from five to seven days of injection usually suffice);
we must only take care not to excite any inflammation by means
of the instrument used, by diluting or concentrating the injection
to keep up the stimulation in a moderate yet sufficiently great
degree. But this is a matter requiring some skill which the
beginner is rarely possessed of.
94. These stimulating injections properly employed are at the
same time a good preservative against secondary gonorrhoea, which
usually depends on weakness and laxity of the urethral fibres and
of the excretory ducts of the mucous glands.
95. On the other hand, in those systems in which the inflammatory gonorrhoeal symptoms were of an erysipelatous character,
and which possessed a high degree of that irritability from weakness, they must not be used, nor yet in those cases where after a
long-lasting dry gonorrhoeal irritation the discharge is with difficulty established, or where tendency to strangury, to sympathetic
bubo, and hernia humoralis, or to abscess of the perinmeum exists;
and in general not as long as the discharge continues thin and
watery.
96. Along with these irritating injections and the internal use of
the balsams, the part should be frequently bathed with cold water,
and bark taken in order to aid in the complete recovery of the body.
97. By such means an ordinary gonorrhoea usually terminates
soon and without further ailments.
98. But this is not always the fortunate result. A bad constitution of body and other circumstances often give rise to the
above mentioned violent and even dangerous symptoms, the relief
of which will now occupy our attention.
99. Persons who are of weakly constitution and who have a
liability to a number of nervous complaints, spasms, and erysipelatous inflammations, are very often subject to the most severe
gonorrhoeas.
100. In such cases the malady is not limited to the special and
1 If the practitioner will not employ the small syphon (0 59), but will make use of
the unsafe syringe, he would do well to have the end of the pipe made quite round
and two lines in breadth, increasing in thickness rapidly from the end backwards,
so that it cannot be introduced more than half an inch; if this be done, no injury
can occur to the internal part, without the greatest want of caution.




PRIMARY GONORRH(EA.

35

ordinary seat of the gonorrhoeal virus. The inflammation extends
in an erysipelatous manner along the urethra, and frequently
extends to a considerable distance over the adjacent parts, accompanied by the most violent and serious symptoms, such as I have
described above (~ 23-25) as occurring in the worst form     of
gonorrhoea. The whole array of malignant gonorrhoeal symptoms
may ensue without the virus that entered the urethra necessarily
being, as some think, of a peculiarly bad nature. The corporeal
constitution which is so unfavourable in this case has besides other
evils a peculiar morbid irritability resulting from nervous weakness, the characteristics of which I shall point out more accurately
below.
101. In consequence of this kind of constitution, the frequent
or even persisting erections (priapism) and curvature (chordee)
of the penis, the pains in the whole organ on urinating and on
being touched, the redness of the penis and of the perinseum and
even of the adjacent parts, the strangury, the discharge of a green
or grey matter, and all the other obvious inflammatory symptoms,
have this peculiarity, that by the relaxing antiphlogistic treatment
not only are they not removed, but they are very often thereby
aggravated.
102. Repeated venesections, purgatives, nitre, and the other
empirical remedies, do harm in such cases, even in those to all
appearance most purely inflammatory; and laxative salts, relaxing
fomentations and drinks, are not admissible.
103. The only things that do good in such cases, are derivative
irritants applied at a distance, and tonic antiphlogistic sedatives
employed locally and internally.
104. To this end we may, in a case where there is a constant
increase in the violence of the erysipelatous inflammatory symptoms of the above described kind, apply a blister or mustard
sinapism  on the sacrum; bathe the affected parts with a lukewarm fomentation, made by boiling one-part of oak-bark in 30 of
water, and on removing it from the fire, infusing in it half-a-pint
of elder-flowers and a third of opium; and make the patient drink
elder-flower tea, mixed with from 15 to 20 drops of tinct. thebaici.
We should also use the injection into the urethra described in
~ 59, but should, according to circumstances, diminish the quantity
of sugar of lead in it.
D2




36

ON VENEREAL DISEASES.

105. Rest on a horizontal hard couch, moderate coverings over
the body, a well-aired not too warm room, and a nutritious easily
digestible vegetable diet,1 consisting of barley-water, oatmealgruel, sago, rice, groats, and farinaceous puddings, will be of use.
Clysters of asafoetida, prepared by rubbing it up with water into
the appearance of milk, will serve to keep the bowels open.
106. But if the morbid irritability of the body, its abnormal
nervous weakness, and its tendency to this kind of bad inflammation, is developed in the highest degree,2 and if by this treatment
the symptoms become if not aggravated at all events not ameliorated, we should adopt another method.
107. We must endeavour to discover if bilious impurities of the
primae vie are not the cause of this aggravation (which is sometimes accompanied by febrile symptoms), in which case it will be
necessary to give one, or, according to circumstances, several
emetics.
108. Besides this, cold half baths, or foot baths, must be used
once or twice daily for two or three minutes at a time, and cold
compresses frequently renewed must be kept to the affected parts
(of the same kind as the above described tepid ones, only stronger),
and the employment of a sufficient quantity of bark in wine, in
some cases, particularly towards night, combined with laudanum,
as also the acid elixir of Haller taken several times a day in doses
of 40 drops, are of the greatest service. The patient should lie
only on the side, not on the back. Above everything, we should
diligently employ the careful injection (~ 59) into the urethra of a
fluid, which without possessing any -astringent power, shall most
rapidly remove the irritation.     According to the experience of
myself and others, from five to ten grains of opium, with as much
gum arabic, dissolved by trituration in an ounce of water, is the
most suitable preparation for this object. In addition to these
means, clysters of a similar solution of opium in water are of
I We must take especial care to forbid the use of the very diuretic vegetables, as
water-cresses (sisymbr. nasturt.), parsley (ap. petrosel.), hops (humul. lup.), and an
excess of asparagus; as also the hard husked seeds, as lentils, beans and peas, espe
cially if cooked sour; and, as a general rule, much vinegar and strongly fermented
liquors are to be avoided, on account of their irritating effects on the urinary organs.
2 In such cases there is generally rapid pulse, much pain, and copious thin discharge.




PRIMARY GONORRH(EA.

37

excellent service, after we have procured a copious evacuation of
the bowels, according to the counsel of Schwediauer.
109. Under such treatment all the bad symptoms usually yield,
the gonorrhoeal irritation commences to limit itself to its circumscribed specific seat in the anterior part of the urethra, and there
again ensues a simple, mild clap, which is easily removable by
nature or slight artificial aid. However, the patient must, during
the remainder of the treatment, remain either entirely in bed, or at
all events confined to one room, he must not lay aside the suspensory
bandage, and must keep to low diet, as the disease is very apt to
return.
110. But as good and extensive acquirements are required in
order to judge of the nature of the malady and of the patient's
constitution, as well as of the suitable remedies, a physician will
be required, and the attendant surgeon will not fail to call one in
in such a case, for the sake of his own reputation. He will determine whether opium, blisters, &c., are to be used along with the
strengthening remedies.
111. Persons of strong, robust systems, with firm tense fibre,
swart, animated countenance, of violent disposition, and in the
habit of taking much exercise, are more disposed to pure inflammatory gonorrhcea than others.
112. Moreover, violent and long continued exercise (especially
during great heat or cold), dancing, riding, the ingestion of
indigestible or strongly seasoned dishes (especially with pepper),
and heating or spirituous liquors, anger, very hot rooms, late lying
in bed, violent purgatives, irritating injections, the incautious
introduction of bougies, onanism, coition, &c., especially in the
above described constitution, are very apt to change a slight, mild
gonorrhoea into a very inflammatory one.
113. The symptoms, which in the above described constitution
are to be regarded as purely inflammatory, and to demand antiphlogistic treatment, are: violent scalding on making water; the
escape of some drops of blood after the operation of urinating;
great pain on touching the urethra, especially in the region of the
peculiar seat of gonorrhoea, from one to one and a half inch'
1 The most characteristic pathognomonic sign that the gonorrhoeal symptoms, be
they ever so intense, are of a purely inflammatory character, and do not depend on




38

ON VENEREAL DISEASES.

behind the orifice of the urethra; the discharge of a greenish or
greyish thin ichor; frequent tension of the penis, especially its
curvature downwards; and sometimes a febrile attack.
114. I put in the same class, because it demands the same
treatment, the dry, scalding clap (gonorrhee seche), which occurs
after an impure connexion in some individuals, and often lasts
several weeks before the discharge sets in, and may even be cured
without any discharge occurring, especially by the diligent injection of a watery solution of opium into the urethra.
115. In general it will be found useful in all such affections to
employ a tepid foot-bath, especially at night, emollient poultices of
linseed-meal, or bread-crumb with boiling milk, combined with a
little saffron, well mixed together into a paste and applied lukewarm; as also injections1 of warm milk, with infusion of saffron
or opium; together with the most cooling diet, linseed tea, strict
abstinence from exercise, a horizontal, quiet, hard, cool couch;
rarely venesection.
116. The priapism, the painful curvature of the penis, the micturition of blood, the phimosis and paraphimosis, demand, in
addition to the above, the application of leeches to the affected
parts, a poultice with a good quantity of opium in it (often a
fiftieth part), steam fomentations from an infusion of elder flowers,
as also the internal use of laudanum, especially at night.
117. The same treatment is to be adopted for the violent pain
in passing water, the painful inflammation of the perinaeum, and
the dry scalding of urine. We may, in addition, employ in these
cases frequent injections of equal parts of opium and isinglass, or
gum arabic, dissolved in 60 parts of warm (800 Fahr.) water.
irritation from weakness or an erysipelatous constitution, J. Hunter rightly alleges
to be the limitation of the scalding of the urine to the special seat of gonorrhoea; a
fact we would do well to remember in practice.
1 The small syphon described at ý 59 should be employed for the injection, or if
there be a prejudice against using it, we may employ the syringe described in the
note to 0 93 with caution, taking care, while we regulate the piston-rod of the
syringe with the right hand, to compress the urethra just in front of the scrotum
with the left thumb and forefinger, so that the gonorrhceal virus may not be carried
by the injected fluid beyond the special seat of the disease, and thus give rise to fresh
inflammation, which is dangerous in proportion as it extends nearer the bladder.
Some deny that the gonorrhoeal virus can produce inflammation beyond the proper
seat of the disease.




PRIMARY GONORRH(EA.

39

118. The febrile symptoms decline spontaneously when the pain
is diminished, so that we need not use any means specially for
them.
119. If on the diminution or suppression of the gonorrhoeal
discharge (~ 28, 29), the testicles swell, they must be put in a
suspensory bandage, and held up thereby sufficiently, yet gently.
The testicles, in their suspensory bandage, should be dipped every
half hour or every hour for some minutes in quite cold water,'
and at the same time a tepid (~ 116) poultice should be applied
around the penis. The same cold applications should be made to
the inflamed perinmeum, or to the groin, when under similar circumstances the inguinal glands (~ 33) are swollen.
120. In these cases, a cautious injection into the urethra of
warm infusion of saffron or of opium (~ 108) may be of great use
in restoring the discharge, whereupon the tumefaction disappears
spontaneously.2   We may for the same end employ as an enema
half a drachm of opium dissolved in a pint of water, which is also
often effectual in removing the accompanying strangury.
121. The repeated exhibition of a gentle emetic, even though
the stomach be not affected with bile or dyspepsia, in addition to
the above mentioned topical applications, and an occasional opiate
at night, will often succeed in restoring the discharge and dissipating the swelling of the testicles. But when all other means fail,
a few doses of soluble mercury will often restore the discharge, as
I can attest from    experience.   The introduction of a bougie
covered with ammonia3 will seldom be required to bring back
the gonorrhoea.
122. Until this has taken place, there is always danger of the
occurrence of complete retention of urine, which will demand
immediate relief. The appliances described in ~ 120 being continued, we may order a tepid half-bath with chamomile and soap,
1 Care should be taken not to use warm applications for sympathetic buboes.
2 The swelling of the testicle is seldom capable of being resolved before the sixth
day after its appearance.
3 I would not advise (seeing that along with other irritations of the urethra, the
mere introduction of a common bougie excites inflammation of the testicle,) this mode
of restoring the clap, especially with fresh gonorrhceal matter, and in the inflammatory stage of the disease.




40

ON VENEREAL DISEASES.

and apply leeches to the perinmeum, or a blister to the sacrum.
Every thing of a diuretic character should be avoided in the food
and drink.1
123. If, as seldom happens, the discharge cannot be restored, and
swelling of testicles or inguinal glands continues, we must then
change the compresses of cold water for vinegar and sal-ammoniac,
or endeavour to bring about a revolution by rubbing Naples ointment into the scrotum or bubo, as soon as all the inflammatory
symptoms of the gonorrhoea are gone; but not before, otherwise
the irritation in the bubo is readily transferred to the testicles, or
from one testicle to another, or we may expect other annoying
symptoms.
124. Still more rarely do these sympathetic swellings proceed
under this treatment to suppuration; if this do take place, it is a
simple abscess with usually nothing of a venereal nature in it. It
will become quite healthy in character, if it be not so already,
under the diligent employment of bark externally and internally.
The inflammation of the perinaeum also does not always yield to
the repeated application of a cold (500) decoction of oak-bark,
which is usually so effectual, but sometimes passes on to suppuration. If the abscess be not connected with the urethra," and no
urine escape by it, it also is of a simple character, and curable
without mercury.
125. It still remains to speak of the treatment of that rare but
dangerous attendant of suppressed gonorrhoea-the purulent ophthalmia (~ 24), which goes on rapidly to complete blindness. The
1 If notwithstanding all these means the retention of urine continues with its
threatened fatal consequences, we should carefully introduce a catheter (a gum
elastic one is preferable), and draw off the water. If this, perhaps in consequence
of swelling of the prostate, be impossible, we must have recourse to perforation of
the bladder through the rectum with the trocar (taking care to avoid the seminal
vesicles), or to opening the neck of the bladder from the side.
2 In order to prevent this, it must be opened as early as possible; that is to say,
whenever the inflammation presents a shining, soft elevation, in which the general
pains are concentrated to a mere throbbing. If this be neglected, the abscess usually
bursts also internally into the urethra, whereby a serious disease, the urinary fistula,
occurs; which requires, besides the internal employment of mercury, good external
applications and the use of the elastic catheter, through which we must allow the
urine to flow each time it is passed until the cure is effected, which generally takes
a long time.




PRIMARY GONORRH(EA.

41

first and most important point is to restore the gonorrhoeal discharge. We must make use of all the procedures spoken of
(~ 119-121), except the cold compresses, as early and vigorously
as possible; the tepid narcotic injections into the urethra, frequently repeated small emetics, the plentiful internal administration of opium, and even, if all other means fail, the introduction
of a bougie covered with ammonia. At the same time we must
constantly apply to, or still better, bathe the eye in, water cooled
with ice, mixed with a thousandth-part of sugar of lead. Tepid
foot baths, or half baths, venesections, blisters to the sacrum,
scarifications of the conjunctiva, leeches to the temples, must not
be neglected, nor incisions in the cornea if pus be accumulated
betwixt its layers.   But I would advise in preference to this
operation, local fumigations with cinnabar,1 and the application of
a poultice of mandragora root. Some say they have seen advantage from the employment of hemlock and monkshood.
126. As regards preputial gonorrhcea (~ 39), the symptoms it
occasions are of no great importance-sometimes a moderate
degree of phimosis, and a slight discharge from the inferior part
of the glans and prepuce; frequent washing with a mucilage of
gum arabic is almost of itself sufficient to cure every case of this
affection in a short space of time. But if it penetrate deeper, or if
it be obstinate, it requires the internal use of mercury like other
venereal affections, conjoined with cold and astringent applications.
CHAPTER III.
GONORRH(EA IN THE FEMALE.
127. As the genital organs of the female are less composite in
their character, generally less sensitive and of laxer tissue than
those of the male, it follows that gonorrhoea in the female should
also present less complicated, less violent, indeed often unrecognisable symptoms. And such is the case.
3 As long ago as 1556, Gabriel Fallopius (De morbo Gallico, Batav., 4to, 1564,
cap. 69) observed this sympathetic metastasis of gonorrhoea (lippitudinem rebellem,
quwe adnatam inflammat membranam et corneam excoriat), and cured it with cinnabar fumigations.




42

ON VENEREAL DISEASES.

128. The simple venereal leucorrhoea, when the vagina is only
affected by it in a minor degree, is often so painless, and the functions as well as the appearance of the genitals appear to be so
natural, that even experienced persons might often take the discharge merely for a symptom of weakness, scrofula, chlorosis,' &c.,
did not the general constitution of the patient testify plainly to the
contrary, or should we not have ascertained that she had infected
one or more men with gonorrhoea. Did we possess any specific
antidote to gonorrhoea, its discovery would be very easy, and on
the other hand the frequent spread of this affection occasioned by
the difficulty of detecting 2 the venereal character of a simple gonorrhoea in the female, might be prevented.
129. But the case is quite different with the gonorrhoea of a
complicated character in the female. It comes on with a sensation
of warmth in the genital organs, and a tickling sensation causing
desire for coition, with frequent erection of the clitoris. These premonitory symptoms however soon give place to pains accompanied
by some discharge from the vagina.
130. The patient experiences in a few days a fulness, tension and
burning in the vagina and labia, which along with increased heat
and swelling, especially towards the lower commissure, are intolerant of the slightest touch. The urethra is inflamed at its orifice,
in worse cases throughout its whole extent; the scalding on making
water is as painful as in males. The clitoris is excessively sensitive.
Coition or contact is impossible; walking, sitting and making
water almost unendurable.
131. An acrid ichorous discharge of various colours issues from
the whole inner surface of the vagina, or at least from beyond its
1 A leucorrhoea arising from onanism is as obstinate as any of a venereal origin.
2 Girtanner mentions some circumstances that should serve to distinguish the
venereal from the unvenereal leucorrhoeas; the latter appear at first only before the
commencement of each menstrual flux, afterwards they also continue a few days
after its cessation, and then cease for from eight to fourteen days; they cause the
diminution and at length gradually the total disappearance of the catamenia, whereupon the leucorrhoea begins to flow continually. They are also generally accompanied
by pains in the loins, a dragging in the thighs, debility of the legs, pale complexion,
dyspepsia and hysteria, and at length sterility, all which serve to distinguish them
pretty well from venereal gonorrhoea.




PRIMARY GONORRH(EA.

43

sphincter muscle, and from     the myrtiform   ruge, and in more
severe cases from the urethra.
132. When exercise or over-heating of the body or of the genital
organs is not avoided, or when injurious irritating remedies are
given internally, there occurs also, as in males, sometimes a sympathetic swelling of the inguinal glands or inflammation of the
perinseum, along with diminution of the discharge. In bad cases
there may also occur retention of urine, likewise dependent on
sympathetic irritation.
133. When the disease is of a more violent character, we perceive deep seated glandular inflammations in the body of the labia
majora, which become painful, increase in size, and generally form
abscesses betwixt their inner surfaces and the nymphe 1 which
burst.
134. Gradually the discharge from the vagina becomes thicker
and more like pus; the scalding of the urine begins to diminish,
and after a longer or shorter time at length ceases, along with the
other troublesome and painful symptoms.
135. If the gonorrhoea be near its termination, (nature frequently
takes many months to cure it), the discharge becomes, as in men,
colourless, mild and viscid before it completely ceases.
CHAPTER IV.
TREATMENT OF GONORRH(EA IN THE FEMALE.
186. In general its cure is attended with fewer difficulties than
in the male, but so much the more tedious is it.
137. In mild cases of gonorrhoea in the female, we have little
else to do than to remove the irritation in the vagina and to
strengthen the relaxed parts.
138. We fulfil all these indications by the simple treatment of
making eight or ten times daily, repeated injections into the
1 De Home observed almost in the same place in the internal surface of the great
and small lips and in the vagina, occasionally some points (perhaps the orifices of
similar glandular suppurations) which poured out a large quantity of watery pus,
and might occasionally be regarded as secondary gonorrhoea in the female. He cured
it by opening these small fistulous ducts.




44

ON VENEREAL DISEASES.

vagina of fifteen grains of sugar of lead, and eight grains of opium
dissolved in an ounce of water. (~ 59.)
139. If this be not strong enough we may use in place of the
sugar of lead, from 10 to 15 grains of sulphate of zinc, which will
certainly prove effectual. About a fortnight is required to effect a
cure.1
140. We must treat with contempt the old bugbear of the dangers of suppressing a gonorrhoea which goes off without leaving
behind it scalding of urine, strangury or other inconvenience.
Every thing that removes the local irritation and alters the specific
gonorrhoeal disposition, cures the ordinary gonorrhoea. But only
locally, some one may retort; to which I reply, certainly, and most
properly too, for it is merely a local malady.
141. These remedies will not be found to be too strong when
compared with those for gonorrhoea in the male, more especially as
the texture of the vagina, especially in the case alluded to, is
astonishingly lax, spongy and unirritable, and not to be compared
with any part of the male genital organs.
142. The more severe kind of gonorrhoea in the female, however,
requires a different mode of treatment. Of the remedies proposed
in the treatment of gonorrhoea in the male, the only admissible
ones are the opiated linseed tea and the local sedative antiphlogistic compresses, as the excessive pain of the inflamed parts renders
all injections impossible.
143. In this case we must make frequent applications of tepid
poultices of linseed-meal, combined with saffron, to the external
parts, and these must be repeated until the diminishing inflammation and tumefaction of the vagina admits of the injections at first
of tepid and at length of cold infusion of saffron, which should be
continued until the scalding of urine and the pain of the other
parts of the genital organs are completely removed. Injections
of 10 grains of opium  with gum-arabic in an ounce of water, will
also be of the greatest service.
1 Girtanner advises fresh lime water or an equally strong solution of caustic
potash to be injected from six to eight times daily into the vagina, by which process,
he asserts, gonorrhoea in the female will be cured in five or six days; a period of
time so short as, if experience corroborates the assertion, would point to an almost
specific power of these antacid remedies against the gonorrhoeal virus.




PRIMARY GONORRH(EA.

45

144. On the occurrence of the glandular abscesses (~ 133) on
the internal surface of the labia majora, we have nothing particular
to do. The swelling will be resolved if that is possible by the
external fomentations, or burst from the same treatment. We
must in that case take care to keep open the ulcer, which is always
somewhat deeply seated, and when the gonorrhoea has lost all its
inflammation, give the soluble mercury till slight mercurial fever
is produced, partly in order to prevent the serious effects of the
absorption of the virus into the general circulation, partly to effect
the most speedy healing up of the ulcer; which according to my
experience is most surely and easily effected by this means.
145. During the inflammatory stage of the disease, we should
prescribe as in the case of males, a mild vegetable diet, a general
cool regimen, and the strictest rest. The only other things
required are an enema of honey-water to keep the bowels open, a
mild opiate at night, and, in the purely inflammatory state, a few
tepid foot-baths. Venesection is seldom requisite.
146. When the injections of the opium    solution (~ 143) have
removed the violent irritation, the inflammatory symptoms and the
pains, we should go on with the narcotic astringent injections
(~ 138, 139) until the cure is perfect.1
147. A syringe with a pipe at least two-thirds of an inch thick
and with a rounded end perforated with several small holes, but
having a narrow canal, is best for such injections; we are sure not
to injure the internal parts with it, and the fluid is propelled far
in and made to remain as long as possible. The thickness of the
pipe dilates the myrtiform folds of the mucous membrane and the
fluid comes in contact with the whole surface, thereby relieving
the irritation and washing away the virus. The patient can herself most effectually perform the injections by lying on the back
with the shoulders elevated, and the knees drawn up and separated;
in this way the injected fluid can remain longest in the vagina, act
longest on the affected parts and develope the greatest power.2
1 Or we may employ for this end the lime-water so strongly recommended by
Girtanner.
2 Still more convenient is Girtanner's instrument, which consists of an india rubber
bag instead of the usual syringe, adapted to the cylindrical pipe.




46

ON VENEREAL DISEASES.

SECOND DIVISION.
SEQUELAE OF GONORRH(EA.
CHAPTER I.
CHRONIC STRANGURY AND ITS TREATMENT.
148. In cases of obstinate gonorrhoea, especially in the male,
when the bladder and neighbouring parts have been implicated in
the erysipelatous inflammation and unskilfully treated, there sometimes remains a frequent painful inclination1 to make water, a
burning or shooting pain in the urethra, often as far as the glans,
pressure on the bladder after the evacuation of the urine, and a
disagreeable sensation in the perinaeum; a pitiable disease that in
course of time lays the foundation for thickening of the walls of the
bladder, ulceration of it, urinary calculus, and even dilatation or
suppuration of the pelvis of the kidneys.
149. If these symptoms be not owing to stone in the bladder, or
stricture of the urethra, which may both be ascertained by means
of the catheter, or swelling of the prostate gland, which may be
ascertained by the catheter and the introduction of the finger into
the rectum, they depend on the above mentioned cause; but the
patient need not therefore fear, as he often does, that there still
exist uneradicated remains of the venereal disease in his system,
to occasion these sufferings.
150. These grave symptoms may often be removed by frequent
bathing of the genitals in cold, and even the very coldest water,
(whereby the weak parts are strengthened and their irritability
diminished), and by the injection of a solution of opium. (~ 108.)
151. If this remedy be used for several weeks without effect,
(which very seldom is the case), the employment of opium inter1 These sufferings are usually caused by a renewed irritation, resulting from spasm
and weakness, and an irregular reaction of the bladder against the urethra. In the
healthy state, before the evacuation of the urine, the neck of the bladder and the
urethra are contracted and the bladder is relaxed, but when the urine is to be
passed, the bladder contracts, and first the neck of the bladder and then the urethra
relaxes, and after the urine has flowed out the two latter contract before the first
becomes relaxed; whereas in this case the natural operations of these parts are
reversed, or at least take place in a perverted order.




SEQUELE OF GONORRH(EA.

47

nally and externally (in topical applications and clysters) is,
according to my experience, of excellent service.
152. If this do not suffice, besides the last named remedy, the
application of a blister to the sacrum, or the introduction of a
seton into the perinaeum will produce the desired effect.
SCHAPTER II.
CHRONIC CURVATURE OF THE PENIS.
153. The curved erection of the penis (chordee) sometimes persists after the removal of the gonorrhoea and its attendant symptoms. It renders coition painful, often impossible, or at all events
unprolific.
154. An induration of the membrane of the urethra, or thickening of a part of the corpora cavernosa is usually the cause of this
affection.
155. Recourse is usually had to venesections and purgatives,
although they cannot be of the slightest benefit, and often do much
injury to the system.
156. The internal use of hemlock is said to be of use; the extract
may at the same time be applied outwardly. If this do not succeed,
mercury should be rubbed into the affected part, and bark taken
internally as Schwediauer advises. Good results may be anticipated
from the employment of electricity.
157. These things may prove serviceable when the symptom
does not depend on too great induration and adhesions of the
corpora cavernosa, or of the substance of the urethra. In worse
cases, however, when the remedies just mentioned are inefficient
against the cartilaginous adhesions, De la Peyronie has found the
baths of Bareges useful.    (These baths greatly resemble the
other warm alkaline mineral waters containing sulphuretted hydrogen, at Aix, Baden, Toplitz, Kirschberg, Wolkenstein, &c.)   In
order that they may do more good than the other remedies, I
believe they ought to be used in the form of douche on the affected
parts.
158. Peyrilhe asserts that he has cured those almost osseous
indurations by the internal employment of volatile alkali, and by
applications of diluted soap lie.




48

ON VENEREAL DISEASES.

CHAPTER III.
INDURATION OF THE TESTICLE.
159. In general this only remains after injudicious treatment of
the sympathetic swelling of this gland; it is worst when at the
same time the spermatic chord is thickened, varicose and scirrhous.
This affection is often very tedious, often incurable. If the epidydimis only be indurated, it is of less importance, it does not
interfere with the reproductive faculty.
160. In cases of induration of the testicle that is not of too long
standing, the application of a compress imbibed with a strong
decoction of oak-bark has proved of excellent service in my hands.
Others have recommended the internal use of hemlock and local
fumigations with cinnabar, along with repeated emetics; I have
never seen the slightest utility from any of these means in any
kind of induration.
161. Some have advised, in addition, the rubbing-in of Neapolitan ointment into the scrotum     and perineum, together with
the internal use of mercury (but as no lymphatics proceed from
the scrotum to the testicles, this does no good, unless from the
mere friction) and the external and internal employment of decoction of mezereum. Poultices with belladonna leaves have also
been enjoined. Where nothing else succeeded, good effects have
been perceived from electricity (especially from the electrical bath
and the simple spark, or very small shocks from the Leyden jar).
Acrel has seen good results from the internal use of a decoction of
an ounce of ononis-root in water.
162. Some reckon amongst the best remedial means the inoculation of an artificial gonorrhoea (by the introduction of gonorrhoeal matter by means of a bougie, or by the injection of diluted
ammonia 2); others speak disparagingly of it.
163. Schwediauer advised a warm poultice of fresh mandragora
root to be applied to the scrotum. Van Swieten trusted to a
1 Girtanner advises that ammonia ointment be rubbed in several times daily at
the perinasum and scrotum. I have experienced its efficacy in other glandular
swellings.
2 Girtanner recommends a simple, clean bougie for this purpose.




SEQUELE OF GONORRHCEA.

A9

medicament composed of two ounces of crabs'-eyes and a pint of
Austrian wine, four tablespoonfuls to be taken night and morning.
Aepli of Diessenhofen completely cured a peasant of scirrhous and
ulcerated testicles by the administration internally of fifteen or
sixteen green lizards, raw, cut into pieces. We frequently have
to alter the constitution before resorting to local remedies.
164. If the cure progresses favourably, the hardness of the
epidydimis is the last to disappear. Before the body of the testicle decreases, it first becomes soft, and softer1 than in the
natural state, as Hunter observed and I can testify.
165. If all attempts prove fruitless, and the testicle remains
very sensitive to touch, or traversed by agonizing shoots, grows
rapidly in volume, &c., we may perform      castration without tying
the spermatic cord. If however the latter up into the abdominal
ring be thickened, knotted and hard, this operation is impracticable. Still it rarely passes into cancer.2
CHAPTER IV.
SECONDARY GONORRH(EA IN THE MALE AND ITS TREATMENT.
166. The mucous discharge3 from the urethra, which continues
undiminished from a primary gonorrhoea long after the cessation
of the scalding of urine and of the painful erections, is termed
secondary gonorrhoea (gleet).
167. The same appellation may be given to the discharge that
recurs after excitation of the passions, after severe exercise, excesses in fermented liquors, or after repeated coitus.4     All these
re-exciting causes tend to change the mucous colourless gleet into
a puriform discharge.
1 Almost pappy.
2 Girtanner is of opinion that induration of the testicle never passes into cancer.
3 Perhaps I should add " without venereal miasm," but the infecting power of
clap and of gleet has not yet been accurately determined by observers, especially as
in reality there are gleets whose continuance, as will be seen, depends on their
venereal nature, I mean those arising from ulcers in the urethra.
4 That the gleet occasioned by excessive coition is not produced by a new infection, we know from this, that it comes on immediately after the act, that it is
accompanied by scarcely any pain, and from other circumstances.




50

ON VENEREAL DISEASES.

168. Seeing that there is no universally efficacious remedy for
gleet, and seeing that things that do good in some cases, do
manifest injury in others, it follows that this affection may arise
from several causes.
169. Sufficient for practical purposes may be the division into
gleet from irritability, gleet from local or general weakness, gleet
from habit, gleet from ulcers of the urethra, and gleet from    strictures of the urethra; although there may also be some from
scrofulous and gouty causes, as would seem to be shewn by some
cases.
170. The cure of these kinds of gleets would often not be
attended with such difficulty if it were easy to ascertain the cause 1
in every case with certainty. But the following distinctive marks
will suffice in most cases.
171. The gleet from irritability chiefly affects those persons who
are subject to irritable weakness of the nerves and frequent indisposition, and in whom during the primary gonorrhoea the pains
extend beyond the special seat of gonorrhoea to the neighbouring
parts, and give rise to the above described bad symptoms.
172. Along with this gleet there is usually a disagreeable irritating sensation in the urethra, which however is not fixed to any
particular spot; the distinctive features of the other gleets are not
present, and their remedies manifestly aggravate it.2
173. It has this peculiarity, that when it is getting better it is
aggravated by the use of mercury, irritating clysters and purgatives, by drinking much tea, by anger and other passions, or by
slight excesses in venery, in eating and in drinking, and after it
has ceased for some time is brought back again by such causes.
174. If we can remove the irritability from the system, or from
the genitals if they only are the seat of irritability, then the gleet
will go off of its own accord. Therefore the method I recommended (~ 150-152) for the irritation of the bladder and the
accompanying pains in the urethra remaining after gonorrhoea
should be adopted.
1 Sometimes it appears to be quite inexplicable, as is observed in those gleets that
cease of their own accord after the fruitless employment of the most approved
remedies.
2 In this kind of gleet we must neither employ irritating nor styptic injections if
we would avoid aggravating it and exciting erysipelatous inflammation.




SEQUELAJ OF GONORRHOEA.

51

175. The genital parts are to be bathed in cold astringent
fluids, as a strong decoction of oak-bark, a solution of common
vitriol or of alum in cold water, and the like, and a tepid solution
of opium in water (in the proportion of one to sixty) should be
injected' into the urethra, if that can be done without causing
irritation.
176. Should there be no opportunity of doing all this, the continued and repeated dipping of the genitals in plain cold water
will often answer the purpose alone; especially conjoined with
moderate exercise in the open air and a cold foot-bath for some
minutes every day.
177. A general tonic treatment of the whole system, especially
in obstinate cases, will contribute much, often more than anything
else, to the removal of this kind of gleet, which is usually caused
by an improper treatment of the original gonorrhoea by the abuse
of Neapolitan ointment, venesections, purgatives and irritating
injections during the inflammatory period.
178. Gleet from habit. Excessive coition and the unnecessary
use of the bougie during the third stage of gonorrhoea, frequent
infections, and other causes, may bring the excretory ducts of the
mucous glands into a state of insensibility and induration, whereby
they lose the power both of expanding and contracting themselves.
Through their callous orifices they permit the escape of a quantity
of the mucus concreted in the glands which would else be taken
up again by the absorbent vessels. The discharge becomes almost
like an issue, like that in chronic ophthalmo-blennorrhoea.
179. Astringent2 or relaxing injections have no effect on this
kind of gleet.
180. The discharge is not so copious or so watery as that in
gleet from weakness: the urethra is painless and will readily bear
the introduction of a bougie; but that arising from weakness may
in course of time degenerate into this kind, if treated too remissly
or not at all.
181. This kind of gleet must be treated, at least in the first
1 By means of the small syphon (g 59).
2 If this kind of gleet arises from long-lasting gleets from weakness, styptic
injections may frequently cause inflammation of the urethra, sympathetic swelling
of the testicles and other inconveniences.
2E




52

ON VENEREAL DISEASES.

place, with stimulating injections, for which a solution of a grain
of corrosive sublimate in four ounces of water will suffice. The
injection must be performed for the first two or three days, twice,
afterwards three or four times daily. We may then, if the
urethra bears this injection without any sensation, diminish the
quantity of the water for the solution, in order to make it stronger.
182. If we suspect that the injection does not penetrate to the
affected part (for the fluid rarely goes more than four or five
inches into the urethra), we may introduce a bougie covered with
onion-juice and dipped into the solution of sublimate. In obstinate cases we may roll the bougie in finely pulverized red precipitate, and leave it but an instant in the urethra.
183. If, as ought to happen, the discharge hereupon increases,
we cease and wait until the discharge diminishes to less than its
usual quantity. We may then employ a solution of turpentine
in water by means of yolk of egg, gradually increasing its strength
until the cure is complete, or if it be delayed make use of strong
astringent injections (~ 188).
184. These are the cases, especially when the disease is obstinate, in which the internal use of cantharides-tincture 1 has sometimes appeared to produce wonderful effects. We may try it in
obstinate cases. Frequent horse exercise has also proved of use.
185. Gleet from weakness, notwithstanding its frequency, has
been denied by some2 who were unable to reconcile the idea of
weakness with increased secretion, but as weakened glands and
excretory vessels do not throw out an increase of humours from
their own energy, but because, when weakened, they yield to the
impetus of the bloodvessels, and are thus compelled, as it were, on
account of the diminution of their reactive force, to receive a
quantity of fluid, which they permit to flow in excess from their
excretory orifices almost crude and but half concocted, in consequence of their inability to offer any resistance. We may therefore say that in this increased secretion they are rather passive
than active. This is sufficiently evident from the mode of action
of the remedies that are efficacious.
1 As early as 1698 this was recommended by Martin Lister (Exercit. obs. 12) in
gonorrhoea, but if used at the commencement it might prove injurious.
2 Particularly Hunter.




SEQUELIE OF GONORRHCEA.

53

186. Ordinarily this kind of gleet occurs in persons of phlegmatic constitution who have weakened the genital organs by
excessive venery or onanism,1 or by the abuse of relaxing drinks
and baths, or in those in whom the primary gonorrhcea was
accompanied by little irritation, but much discharge. Probably
the relaxing method of treatment continued till the third stage,
and the use of a quantity of laxative salts, or of saltpetre, and
repeated venesections, contribute in no small measure to its production, as also the employment of sedative injections continued after
the cessation of the scalding.
187. These gleets have this peculiarity, that almost no pain
accompanies them, or at most only a sense of weakness in the loins
and testicles, which hang down loosely. The discharge of a thin
fluid is more copious than in the other kinds. It often diminishes
and increases again almost without any cause, but the latter
occurs usually after venereal excitement, the former sometimes
after the inordinate use of wine, &c.
188. The genitals should frequently be bathed, for a minute at
a time, in very cold water in which some common vitriol has been
dissolved, and a similar footbath may be used for several minutes.
Along with this, injections of a strong decoction of oak-bark may
be employed, and the strength gradually increased. If all this
fails, a solution of one part of white vitriol in thirty parts of water
may be injected.
189. The internal administration of bark, horse exercise, the
open air and nourishing diet, with a little wine, may greatly
further the cure. Finally we may have recourse to electricity,
i. e. small sparks drawn from the genitals.
190. Venereal gleet.    Modern authors go too far when they
allege the presence of ulcers in the urethra to be so excessively
rare in gonorrhoea, although they are quite right in asserting that
1 The itching in the genitals that usually occurs towards the termination of a
gonorrhoea, causes frequent erections, and if the patient, as might be anticipated,
do not resist this sensation by abstinence, exercise and temperance, but if he rather
obey what seems to him a healthy call of nature, by onanism or repeated coitus, he
will often bring on this kind of gleet. We must take care to warn him against this
erroneous conduct.




54

ON VENEREAL DISEASES.

they are quite non-essential1 to venereal gonorrhoeas, and do not
frequently occur.
191. These ulcerations may arise from the laceration of considerable bloodvessels in the urethra during spasmodic erections and
coitus, from blows and other injuries from without, and from
wounds of the internal lining membrane by the syringe, the
catheter, or the bougie, &c. The gonorrhceal matter transforms
these wounds into true chancres. In some rare cases they are
formed by an abscess of an external urethral gland bursting into
the canal.
192. We know this to be the cause of a gleet when during the
gonorrhoea pure blood has flowed from the urethra, or when one
or other of the exciting causes we have indicated above has occurred, but especially when, after the cessation of the inflammatory
period of the gonorrhoea, the bougie touches a small raw, painful
spot, causing a pain that is felt exactly in the same situation on
touching the urethra externally. Hence it happens that even
after the judicious treatment of the original gonorrhoea the discharge continues to flow, though in less quantity; and it may
occur that after the employment of astringent injections symptoms
of lues venerea may begin to shew themselves.
193. It is self-evident that after the recognition of the cause
of these gleets, the last-mentioned remedies should not be made
use of. Even the internal employment of balsamic remedies is
contra-indicated.
194. The only remedy we can have confidence in is a good
preparation of mercury (such as the soluble) given in gradually
increasing doses until mercurial fever (~ 290) is developed. By
this medicine alone, without the employment of any injection, this
kind of gleet, with all traces of general venereal symptoms, will
be easily, certainly and radically cured, and this remedy tends to
aggravate every other kind of gleet.
195. Gleets from strictures in the urethra seldom occur imme1 It may well be that cicatrices are so seldom discovered in the urethra after
death, for we often can scarcely observe in the glans or prepuce a trace of the
chancres that formerly existed, provided they were not very large or deep, and were
only cured by the internal use of mercury, and not by caustics.




SEQUELAB OF GONORRH(EA.

55

diately after the gonorrhoea; they often appear twenty or thirty
years thereafter. They consist of a scanty, almost colourless,
mild, mucous discharge, with retention of urine, or at least diminished size of the stream of urine.
196. The bougie is the only way to detect their cause, by
revealing the strictured spot.
197. It ceases spontaneously after removing the stricture, without any additional aid, wherefore I must refer the reader to the
treatment of the latter affection (~ 207-245).
198. If the body have much predisposition to scrofula or gout,
gleets often become complicated thereby.
199. The internal use of crude antimony, of burnt sea-weed, of
purple foxglove, and bathing in sea water, will perform in the case
of the first what the remedies recommended for the other gleets
are unable to effect, and extract of monk's-hood, cold baths and
electricity will do the same for the last.
CHAPTER V.
SECONDARY GONORRIHEA IN THE FEMALE AND ITS TREATMENT.
200. The usual seat of this is the vagina, rarely the uterus, and
still more rarely the urethra. To all appearance it does not differ
from ordinary leucorrhoea; its very origin is undiscoverable if it
have not continued to flow immediately after the venereal gonorrhoea. Its varieties are much less numerous than those in the
male.
201. If it is already of long standing, it belongs to the gleets
from habit, and must be treated entirely by stimulating injections
(~ 181) gradually increased in strength.
202. After pursuing this treatment for ten or twelve days we
should pause, in order to see whether the discharge will decrease
in a few days; in which case, the strong astringent cold injections,
recommended above for primary gonorrhoea in women, especially
a strong decoction of oak-bark combined with alum, must be
employed until the discharge ceases, and even for a couple of weeks
thereafter.
I As urethral calculi only cause gleets when they have produced strictures in the
urethra, as they often do, their treatment does not belong to this place.




56

ON VENEREAL DISEASES.

203. But as in women we are unable to determine accurately
in every case whether it be a gleet from habit or from weakness,
we would do well in most cases (seeing that on account of the
loose texture and inferior sensibility of the parts we have less to
fear than in the case of the male urethra) to combat the malady at
once with injections possessing both a stimulating and strengthening character. An injection of an ounce of blue vitriol dissolved
in a pint of water, or of three or even four ounces of white vitriol
in the same quantity of water, will be found very serviceable.
204. Should we, on the first injections of this fluid, meet with
any disagreeable, painful and inflammatory symptoms, we will
know from that that the gleet belongs to those arising from irritability. We must leave them off and treat the case only with
injections of cold, even ice-cold water; and at length we may have
recourse to a decoction of oak-bark. If the irritability be excessive
(which will be ascertained by other symptoms, the rapid pulse, the
character of the primary gonorrhcea, &c.) we may substitute injections with tincture of opium.
205. If along with a gleet of this kind there be symptoms of a
gouty or scrofulous disposition, they must first be eradicated as far
as possible by suitable remedies for these states, before we proceed
with the local treatment.
206. If, however, on the introduction of the syringe a painful
internal spot should be observed, without any induration of the
mouth of the womb or other signs of internal cancer (the acrid
nature, discoloured appearance or specific odour of the ichor discharged, the shootings from the hips into the pelvis, &c.) being
present, we may suspect a venereal ulcer in the vagina; for which
the internal use of mercury (~ 614 et seq.), without any local
means, is alone efficacious.
CHAPTER VI.
STRICTURE OF THE URETHRA AND ITS CURE.
207. All the phenomena of obstructed flow of urine, when no
stone was present, were formerly attributed to cicatrices and excrescences in the urethra, which without examination were termed
carunculee and collosities, and in conformity with the prevalent




SEQUELE OF GONORRH(EA.

57

notion, were held to be the relics of ulcers in the urethra, which
were taken for granted to exist in every case of gonorrhoea.
208. This opinion was for long the general one, until by an
enormous number of autopsies it was proved that cicatrices and
fleshy excrescences in the urethra were of very rare occurrence,
and that in the great majority of instances all the symptoms
ascribed to that cause arose from narrowing and constriction of the
urinary canal, without actual thickening of its substance.
209. Although we do not allege that these strictures are always
the effect of gonorrhoea, this at least is certain, that they are
chiefly to be found in men who have been affected by this fashionable complaint; but yet a disposition to rheumatism1 may contribute not a little towards this, especially as they usually occur only
in the middle or advanced periods of life (often 20 or 30 years
after the patient has had gonorrhoea).    What a distance betwixt
the probable cause and the effect! Hence it happens that strictures are very rarely met with in the place where the gonorrhoea
has its special seat; usually further backwards: whence we may
infer, at least thus much, that it cannot be with propriety ascribed
to simple ordinary gonorrhoea. Severe strictures have been met
with in persons who had had very slight gonorrhoea (or even none
at all), and those who have had the most violent gonorrhoeas have
remained free from strictures. Neither can they be ascribed, as it
was formerly supposed they might, to the use of the bougie or of
injections in the treatment of gonorrhoea; for, according to Hunter,
strictures have occurred when gonorrhoeas have been removed
without these appliances. Be this as it may; as the actual exciting
cause is still involved in obscurity, and as the general opinion has
hitherto attributed strictures to a previous gonorrhoea, I feel myself
necessitated to say what is essential regarding them.
210. Probably any severe irritation of the urethra (i. e. by
urethral calculi) or any inflammation of it, more than merely
superficial, is capable of making it liable to strictures.
1 A man, 58 years old, had for many years been troubled with pain in the hips,
especially after drinking a little wine. His hitherto unnoticeable urethral stricture
once increased suddenly, and the most fearful retention of urine took place. Whilst
this disease prevailed and I sought to relieve him from it, he had not the slightest
attack of his rheumatic sufferings, not even when I let him drink wine; only the
stricture appeared to be aggravated by it.




58

ON VENEREAL DISEASES.

211. Moreover it is subject to this affection in common with
other canals of our body; as examples of continued strictures I
may instance, constrictions of the oesophagus (I had recently an
opportunity, at an autopsy, of observing a great contraction of the
middle portion of the stomach) and those of the bowels, especially
of the colon; the spasmodic strictures of the nasal duct at the
lacrymal sack, of the gullet and of the bowels, have also some
resemblance to urethral stricture.
212. Strictures are constrictions, or narrowings of the urethra
as if it were drawn together by a thread, which are most frequently
met with in the vicinity of the bulbus, much more frequently
anterior to it, (from five to three inches from the orifice,) and very
seldom behind it; they either constrict the canal more or less
uniformly all round towards the centre, or only at one side more
than the other.
213. In consequence of the bladder reacting against the constriction of its excretory canal, and not being able to get rid of its
contents easily, there often occurs a frequent anxious call to make
water; the coats of the bladder become thickened, the posterior
part of the urethra, as far as the stricture, gradually dilates (often
also the ureters up to the kidneys, sometimes the pelves of the
kidneys1 themselves) in proportion to the degree of the stricture;
and the internal membrane of this portion of the canal, distended
and irritated by the stagnating urine, exudes a gleety looking
mucus, or its coats inflamed or corroded by the acrid urine, if the
stricture continue or contract still further, form an abscess which
opens externally and usually gives rise to a perineal fistula, whereby
nature is forced to provide a new passage for the urine.
214. The patient does not in general notice his malady, or think
fit to seek advice for it, until the stricture has attained a serious
height. The stream of urine commences to grow smaller and
smaller, the desire to pass water more frequent, and still he appre1 A pressive dull pain in the region of this organ (one kidney is usually the worst)
indicates this affection, and the same pain with a roundish elevation in the side,
speedily followed by the passage of a uniformly mixed whitish urine, with puriform
sediment and diminution of the swelling, indicates an abscess of the renal pelvis
common in severe chronic strictures, which often comes on in consequence of serious
errors of regimen, as I have frequently had an opportunity of observing.




SEQUELA OF GONORRH(EA.

59

hends nothing bad. Inflammation may occur, and even an abscess
in the course of the urethra, still he regards it only as a local
affection that will go off of itself, and does not suspect that it
arises from the diminished flow of urine (which he may at that time
have not deemed worthy of notice), or from the slow and unnoticed
advance of the constriction of the urinary canal. It is often only
when the urine passes by drops, or when complete ischuria has
occurred, along with anxious desire to pass water, that he applies
for aid; when inflammation, mortification and death are at the
door.
215. Strictures that gradually increase to the highest pitch
without intermission, in which the urine does not pass at one time
more at another less freely, are termed persistent or continuous.
On introducing the bougie we find at one time just the same
amount of resistance as at another. The contraction remains
under all circumstances, under every regimen the same, only that
it goes on imperceptibly increasing until at last it will not permit
even the smallest bougie to penetrate into the bladder. It is
diminished neither by antispasmodic nor yet by derivative irritating remedies.
216. Externally the affected part generally presents a whiter
appearance than the other parts of the urethra, and it frequently
appears as if drawn together. The contracted part is seldom an
inch in length, usually not more than a line; there is rarely more
than one present in the urethra.
217. This persistent stricture never comes on immediately after
gonorrhcea, and usually only attains its acme at the end of the
middle period of life (between 48 and 60). It alone is accompanied
by that sort of gleet (~ 195-197) that goes off spontaneously after
the cure of the stricture.
218. The spasmodic stricture is the very opposite of the persistent.
It does not remain in exactly the same spot, but sometimes moves
an inch forwards or backwards. The bougie that would formerly
pass easily, becomes all at once impeded in its passage or completely stopped; occasionally also it is pushed back again, after
lying there for some time.
219. In these cases the urethra is very irritable and sensitive,
and with difficulty bears the introduction of the bougie or its continuance in the urethra, but more readily after the passage of the




60

ON VENEREAL DISEASES.

urine, although this is denied by Hunter, and after the local or
internal employment of antispasmodic remedies. It is increased
by the use of astringent or stimulating medicines.
220. It has the greatest similarity to the irritation of the bladder (~ 148 et seq.), and the spasm of the neck of the bladder
accompanying that state, and apparently contributes much to
aggravate that affection. It is the only kind of stricture that can
occur soon after bad gonorrhoeas; it may also have much to do
with the retention of urine (~ 25) that often accompanies them.
221. Very rarely (at most only after the removal of persistent
strictures) is it the sole affection of the urethra; most frequently
it is merely the concomitant of the persistent contraction caused by
an urethral calculus, or of inflammation of the neck of the bladder.
I am unable to say with certainty whether it may not in course of
time assume the persistent form.
222. It almost never happens that a persistent stricture exists
without a spasmodic one, and if it do it can only be a very slight
one. The narrower the persistent one is, and the more it obstructs
the exit of the urine, the more frequently does the spasmodic one
accompany it, and the more intense it is.
223. Hunter is unable to determine whether the spasmodic
stricture is behind or in the persistent one. I believe I have
always noticed the former; for I have frequently only required to
press upon the stricture with a bougie too large to enter it, in
order by this remote irritation to remove in a revulsive manner
the spasm behind it, whereupon I could easily penetrate through
the spasmodic stricture with a smaller bougie, which before this
manipulation could not pass through it.
224. We may always recognise the complication of the persistent
stricture with the spasmodic one in this way: a bougie not too
large for the first two or three inches of the urethra cannot penetrate to the neck of the bladder, but when pushed in from four to
six inches it meets with an insurmountable obstacle (the persistent
stricture) at all times, which, however, a smaller bougie (except in
the worst cases) passes with ease, except occasionally (the spasmodic
stricture) when its passage is more or less difficult.
225. Three modes are known of curing the persistent or permanent stricture (whereby no attention is at first paid to the accompanying spasmodic contraction), of which the two first are adapted




SEQUELJE OF GONORRH(EA.

61

to the case in which a small sound can still be passed, but the last
is required when even the smallest bougie cannot pass. The first
consists in the gradual dilatation of the stricture; the second in
causing ulceration of it; the third in burning through it with
caustics. All three are practicable if the contraction be not seated
exactly in the curvature of the urethra, in which case perhaps
there is no remedy but the knife.
226. By the first method,' we endeavour to pass the largest
bougie that can be made with a little force2 to pass through the
stricture, and allow it to remain a few minutes in the urethra,
or as long as the patient can bear its presence there without great
discomfort. If he can bear it for an hour at a time, we then take
a larger one, with a point of a conical shape, and try to introduce
it. We press it in cautiously, and for a short time also in an
intermitting manner, and with a slight twisting movement. If it
spring back, either we have not hit the opening of the constriction,
or it is too narrow to admit the instrument, and we must use a
smaller one. But if it penetrates in and remains fast we are certainly in the stricture, especially when the introduction has caused
no pain and the point of the bougie is squeezed flat. We remove
it again when the patient can bear it no longer, and endeavour on
a subsequent occasion to make it penetrate further. If it pass
through the stricture, we next try a larger one, and then again
one still larger, until we have overcome the contraction, that is to
say, until we are able to introduce into the bladder a bougie of
from two to two and a half lines in diameter; for should there be
obstacles farther backwards, we must proceed as with the first
stricture.
227. The bougie must be neither too soft, else it will easily
bend, nor too hard, otherwise        we might readily, as often
happens with the catheter, especially when due caution is not
1 This mode of curing strictures of the urethra by the pressure of bougies, was
known as early as the year 1560, when a physician of Nimes whose name has been
lost, (see the 22nd of the 37 observations appended to Laz. Reverii Obs. Med., Lugd.
4, 1659,) cured them with leaden sounds.
2 The stricture is often so narrow, that bougies sufficiently small to pass through
it at first, and at the same time of adequate strength, cannot be procured: in this
case we make use of catgut harp-strings of gradually increasing thickness, making
their extremity round, and introducing them covered with oil.




62

ON VENEREAL DISEASES.

exercised, push through a false passage near the stricture in the
spongy body of the urethra. We become aware of this having
occurred, when, in introducing the instrument, we make way,
with much suffering to the patient, without at all facilitating the
passage of the urine; and we avoid this accident in the case I
speak of, by the employment of elastic bougies and carefulness.
We ought also to withdraw the bougie from time to time, in order
to observe whether or no its point be bent up. Should we allow
the bougie to remain some time in the urethra, especially at night,
it ought to be bent over about an inch at the top, and fastened
with a thread behind the glans, in order to prevent its slipping
into the bladder, an accident that could only be remedied by
opening the bladder by the lateral operation to extract this foreign
body, which is attended by much danger. The bougies ought not,
as they usually are, to be made conical throughout their whole
length, but they should be uniformly of the same thickness, consequently cylindrical, and should only be somewhat narrower at
their point. The patient must soon learn to introduce the bougie
himself; he will be best able to pass it with facility into himself;
he will be best able to feel the part that is to be dilated, and will
not be liable to make a false passage near the stricture even with
a harder bougie.
228. We should not discontinue the use of the bougie in consequence of the presence or occurrence of a swelling of the testicles,
as in the case under consideration this swelling is usually the effect
of the stricture of the urethra, of an urethral calculus, or of an
abscess of the glands of the canal, and by the employment of the
bougie would in the first case be removed, in the second relieved,
and in the third not aggravated.
229. Sometimes, especially in cases of irritable nervous weakness, and when the stricture already causes troublesome symptoms,
as difficult passage of the urine, irritable bladder, &c., there is
usually present along with the persistent stricture, as has been said,
also a spasmodic contraction, generally behind the former. This
is an obstinate and frightful malady. In this case, if the ordinary
bougie will not pass, we must resort to all sorts of expedients in
order to gain our object. We press a large bougie against the
persistent stricture for a minute, and then try the smaller bougie
which ought to be introduced. If this do not succeed, we must




SEQUEL& OF GONORRHCEA.

63

tickle or gently rub the perinaeum, whilst with the other hand we
press the bougie against it. If this too fail, we should try the
immersion of the whole genitals in cold water, and the employment
of a tepid foot-bath. If the spasm be frequently in the way, we
may place a seton in the perinaeum. In this case, certainly the
best time for introducing the bougie is immediately after making
water.
230. We must besides ascertain and make the patient avoid all
that increases the spasm. In order more certainly to diminish the
irritability, the patient should frequently pass his water, should
use cold baths, take exercise in the open air, shun spices and
heating as well as relaxing drinks, and take internally quassiapowder. Astringent tonics, as bark, iron, &c., increase the spasmodic constriction in my experience.
231. This mode of removing persistent strictures by gradual
dilatation is certainly the easiest, but at the same time the most
uncertain method. Even though by advancing to the very largest
bougie, we have got so far that the dilated constriction of the
urethra allows the free passage of the urine, the patient is notwithstanding not yet perfectly cured nor guaranteed against a relapse.
For a long time to come he must still introduce the thick bougie
from time to time, every eight hours at least, and let it remain
there some hours, otherwise the place where the stricture is gradually contracts again, so as not to allow the passage of the largest
bougie, and so on. He must never travel without providing himself with bougies in case of necessity, as the tendency of the dilated
part to contract again is not radically cured.
232. If the patient take upon himself to assist in this dilatation,
he can, after some smaller bougies have been passed, rapidly go to
larger and much larger ones, and by means of the irritation produced in the affected part, create a small amount of inflammation
and suppuration (the second method) which gradually rids him
completely and radically of his malady.     The texture of the
contracted part is always a morbid abnormality, and hence it is
much more readily brought into a state of inflammation and suppuration than the healthy portion of the urethra.
233. In order more certainly to attain this object, the forcible
pushing through of the stricture with a bougie of large diameter
has been advised, and this manoeuvre has sometimes been wonder



64

ON VENEREAL DISEASES.

fully successful; probably in this case a small part of the internal
membrane in the stricture was thereby torn, and thus suppuration
was produced, or the forcible stretching might have caused a
contusion and thereupon inflammation proceeding to suppuration,
or the circular fibres of the contracted urethral muscle might have
been paralyzed by the force applied, or even torn, whilst the
dilatable part of the stricture yielded. The last is the most probable, for cases have been observed in which, after this forcible
manoeuvre, the stricture disappeared suddenly and without relapse.
234. In spite of all this, this operation is attended with much
uncertainty, and its performance is not advisable. With the force
employed it may easily happen, as we work in the dark, that we
miss the stricture or its central point, which is often far from being
in the axis of the urethra, and so form a false passage.
235. In order to attain the same object with certainty, we take
a horn staff of the thickness of a bougie that fits the commencement of the urethra, we bend this by means of heat into a slightly
curved form, and scrape down half an inch of its end, till it has
almost uniformly the thickness of the bougie that hitherto readily
passed through the stricture. This smaller end will form a sort of
process to the rest of the staff (of which we smooth down somewhat
the abrupt point of junction), just as if a smaller staff projected from
a larger one. We first insert this smooth round horn staff into
the urethra, in such a manner that its smaller end (up to the larger
portion) passes through the persistent stricture, and if we can rely
on the patient's steadiness, we allow him to push it in further
hmself, until the thicker portion passes through the stricture. It
will at once be seen that in this way the smaller terminal portion
shews the way and guides the whole horn-staff, so that it must
accurately follow the direction of the urethra, and cannot take a
false direction. In this way we shall attain our object with much
greater certainty. Should we think the horn-sound too inflexible,
we may before using it let it soak for some time in linseed oil.
236. More peculiarly belonging to the ulcerating method is the
destruction of the stricture with corrosive substances, with which
we may arm the bougie we introduce, or the instrument itself may
be entirely1 composed of irritating matters.
1 Philip, a Portuguese, (see A. Lacuna, Method. exstirp. carune. Rom. 1551, 12,




SEQUELAE OF GONORRH(EA.

65

237. For this purpose, we select the largest bougie of uniform
size throughout that can pass into the anterior part of the urethra,
in the abruptly truncated extremity of which we make a circular
excavation, and fill this with red precipitate, firmly pressed in.
This is to be moistened on the sides with oil and passed up to the
stricture, and pressed against it for a minute. This is to be repeated
once daily, until the stricture, having gradually passed into suppuration, will easily admit the thickest bougie.       Then, until the
healing process is finished, we insert twice a day into the urethra,
and allow to remain there a quarter of an hour, a large sized
bougie, not armed with red precipitate, but moistened with a solution of myrrh in yolk of egg, in order that the cicatrix which is
formed may be sufficiently wide. This troublesome operation is
somewhat tedious, but it effects a radical cure.
238. By this method we may in most cases (even in those in
which the smallest sound or harp-string cannot get through the
stricture) be independent of the third mode, which Hunter teaches,
for burning through the narrowest strictures, and which, as far as
my experience goes, may be best performed in the following manner.
239. We take a tube of fine silver of the size of the thickest
bougie and slightly curved, and we introduce this, the opening at its
extremity being closed by a plug at the end of a wire, which runs
backwards and forwards in the cavity of the tube, so that we may
remove this plug whenever the extremity of the tube has reached
the stricture. Were the tube unprovided with this plug, the mucus
of the urethra would enter its cavity. As soon as we have removed
the wire with the plug, we push in, in place of it, another wire of
fine silver, at the end of which a piece of lunar caustic is fastened
p. 34,) was the first who, in the middle of the 16th century, destroyed strictures of
the urethra, by means of a corrosive mass composed of verdigris, orpiment, &c.,
wherewith he armed the end of a bougie. A similar treatment, variously modified,
continued to be used from time to time, until Le Daran, a few years before the
middle of this century, began to trumpet forth the excellence of his secret bougies,
which were composed entirely of corrosive ingredients, and consequently they frequently excited inflammation and suppuration in healthy parts of the urethra, besides
a number of other ill effects, which rendered their use inadmissible, before his object,
the destruction of the stricture, was attained. Guerin improved them.




66

ON VENEREAL DISEASES.

in a small forceps.1 By means of the wire we press this caustic
into the stricture for a couple of seconds, draw it back into the
tube, and remove both; and this operation we repeat every second
day,2 until we can pass through the stricture with the tube. It is
well to inject tepid milk immediately after the operation, in order
to avoid the irritation which the caustic that flows from the cauterised part might produce on the adjoining healthy urethra. It is
obvious that this method needs great caution.
240. Both these latter methods are of service when there is
scarcely any opening remaining in the stricture, and where consequently the first method is not suitable. In case of inflammatory
symptoms manifesting themselves, we ought to allay them by
means of cold applications, tepid foot-baths, &c.
241. When an urethral calculus may have occasioned the stricture, a passage for it outwards may be made in either of the two
last mentioned ways. If the stricture be still permeable, and if
the stone be seated in the region of the scrotum, the symptoms
it gives rise to might easily be confounded with those of a
spasmodic stricture, if we neglect to ascertain its presence by the
use of a metallic sound, which as soon as it touches the stone,
communicates to a delicate touch a peculiar grating sensation. I
have seen, after retention of urine from strictures owing to this
cause, the urethral calculus discharged by the efforts of nature
through a dangerous abscess in the perinaeum.
242. It is rare that the spasmodic stricture (~ 218-224) remains
long after the destruction of the permanent one, so as to demand
special treatment. On the other hand, in the treatment of strictures of the urethra merely by dilatation, the spasm persists as
long, and recurs from time to time, until all the tendency of the
part (where the permanent stricture was seated) to contract again
has gone off; which may sometimes last all the patient's life, if
we do not perform the radical cure of the stricture after the second
or third manner.
1 In the mode in which a small piece of drawing-chalk is fastened at the end of a
porte-crayon; a small pair of pincers, which embraces the caustic or chalk in its
hollow blades, whilst a ring pushed from behind effects the approximation of the
blades, and holds fast the substance they enclose.
2 In most strictures we do not require to do it more than twice.




SEQUELAE OF GONORRHAEA.

67

243. Before the spasm after the destruction of the persistent
stricture goes off, we would do well, especially if it closes the
urethra very suddenly after the withdrawal of the bougie, to
employ a hollow catheter of gum-elastic,1 which the patient should
bear about with him, in order to draw off his urine at any time.
244. Frequent immersion of the genitals in cold water will completely dissipate the spasmodic stricture, especially if we endeavour
to remove the morbid irritability of the organism by the use of
external and internal tonic remedies. If it be already of long
standing and if this method do not succeed, a seton introduced
into the perinaeum will greatly diminish and in course of time
remove the malady.
245. Those subject to this affection must frequently pass their
urine, and never retain it long. They must guard against chills,
excessive passions, heating liquors and spices, and debauchery.
CHAPTER VII.
INDURATION OF THE PROSTATE GLAND.
246. When neither paralysis of the bladder nor inflammation
of its neck (in bad cases of gonorrhoea), nor a stone in the bladder,
is the cause of the retention of urine, and when the introduction
of the bougie or sound into the urethra detects no stone nor stricture, and yet the urine will not flow in spite of every effort, we
may suspect a morbid condition of the prostate gland.
247. A finger moistened with oil is to be introduced into the
rectum and directed towards the pubic region. If this be the
cause of the retention, we shall here detect a hard body pressing
in upon the rectum, often of such a size that we are obliged to
pass the finger from one side to the other in order to ascertain the
whole magnitude of this indurated prostate gland.
248. We may easily imagine to what a considerable extent this
tumefied body must compress from both sides, and block up the
commencement of the urethra, and how dangerous retention of
urine may result therefrom.
1 These are also the best we can use when a retention of urine is produced by a
merely spasmodic stricture. It should be introduced by suitable manipulations into
the bladder, and helped into the neck of the bladder by a finger placed in the rectum.
r2




68

ON VENEREAL DISEASES.

249. In such cases the ejaculation of the semen is very painful.
250. A bougie1 or catheter carefully introduced will easily draw
off the urine; but this is only a transient remedy. The best plan
is to insert an elastic catheter and to assist its passage through the
neck of the bladder by introducing a finger into the rectum.
251. If we could with certainty disperse this glandular induration, we should then be able to promise ourselves permanent
benefit, a cure. But as yet we know no remedy that can be
relied on.
252. The internal use of hemlock has sometimes been of use,
also burnt sponge, but especially burnt sea-weed and sea-bathing,
as this affection is often of a scrofulous nature. Poultices of
mandragora root frequently applied to the perinmeum are said
to have proved very efficacious in dispersing this indurated gland.
Purple foxglove, crude antimony, hartshorn and electricity, perhaps
also local fumigations with cinnabar, might be tried.
253. A seton inserted and long maintained in the perinaeum
the openings of which were two inches distant, once succeeded in
reducing to a great extent an indurated prostate.
254. The best palliative remedy is, immediately after withdrawing the bougie to insert in the bladder, according to Pichler's
plan, a catheter of gum elastic (without any spiral wire in its
cavity) to let the urine flow through it, to fasten it in front of the
glans and close up its extremity, only removing it about once a
week in order to remove the calculous concretion that may be
attached to it.
255. If, in a case of swelling of this sort, the urine do not
flow on the introduction of an ordinary catheter, and if the instrument encounter an obstacle just behind the neck of the bladder
(a rare affection which Hunter has best described), it is to be
apprehended that a small swollen portion of the indurated prostate projecting into the bladder forms here a sort of valve, which
lies upon the mouth of the bladder and obstinately prevents the
egress of the urine.
256. In this case a very much curved, large-sized bougie introduced into the bladder has sometimes proved serviceable, the urine
1 The urine usually flows off by the side of it, but not without some effort of the
bladder.




CHANCRE.

69

flowing past it. If this should not be effectual, we should carefully introduce a catheter, and whenever it has reached this valvelike projection, press it with the handle downwards, whereby its
further bent extremity will almost always slip past and to the
outside of the abnormal body into the bladder, and permit the
urine to flow off.
teconb   Ilass.
IDIOPATHIC LOCAL VENEREAL AFFECTIONS ON PARTS OF THE BODY
PROVIDED WITH EPIDERMIS.
FIRST DIVISION,
CHANCRE.
CHAPTER I.
CHANCRE IN GENERAL AND ESPECIALLY THAT IN MALES.
257. The venereal infection is most readily communicated to
surfaces of the body that are destitute of epidermis; hence the
much greater frequency of gonorrhoea than all the other venereal
symptoms. Next in point of frequency are the affections that
occur on parts of the body provided with a delicate epidermis; in
the latter case there occur ulcers which are termed chancres. The
thinner the epidermis the more easily does the infection take
place and the more does the chancre thus produced extend.
258. The most usual seat of the venereal infection is the genital
organs; hence chancre in the male generally makes its appearance
in the fossa where the glans unites with the prepuce, especially
on either side of the insertion of the frenum, next in point of
frequency on the internal surface of the prepuce and its border,
on the glans, and sometimes on the external surface of the genitals, e. g. on the scrotum.
259. Should the lips of the mouth, the nipple, or a wound on
any other part of the body be touched with this virus, chancre
will be the result in either sex.




70

ON VENEREAL DISEASES.

260. A small dark-red elevated spot appears, in some cases
thirty-six hours, rarely several days after the impure coitus, and
with painful itching it forms a hard, inflamed pimple filled with
pus, that rapidly developes itself into an ulcer. When the chancre
first appears it is raised above the surface of the skin; but its
hard, light-red (or dirty yellowish-white) base is a little sunk
below the suety whitish borders whose periphery is inflamed and
indurated, but very defined. When touched the patient experiences severe pains, and we can feel that the hardness of the
whole ulcer extends very deep. The matter that exudes is of a
greenish yellow colour. Such is the chancre, which gradually
increases in superficial extent and depth, accompanied by pains
more of a gnawing than shooting character.
261. Those chancres that have their seat in the inner surface of
the prepuce are much more painful and inflamed, and generally
larger than those that occur on other parts; the induration in and
surrounding these chancres is more perceptible and more considerable than when they occur on the glans.
262. At the junction of the prepuce with the glans they are at
first often no bigger than millet seeds; their most frequent seat
is on either side of the frenum, where they readily eat around
them and rapidly destroy this part.
263. Chancres on the glans are rare; the inflammation, pain
and hardness of the small abscess is not so great as in those on
other parts; their borders do not usually project like those on the
prepuce for example, but the whole ulcer is as it were excavated
in the body of the glans.
264. More painful and more inflamed are the chancres occurring on those parts of the genitals covered with a thicker epidermis, on the body of the penis, or on the anterior part of the
scrotum. In these situations they appear in the form of pimples
that become covered with a slough, on the falling off of which a
larger one is produced. The same is the case with chancres produced by the inoculation of the virus in wounds or parts covered
by a firm epidermis.1
The inoculation with chancre virus on parts covered by a thick epidermis (by
means of wounds in the arms, thighs, &c.) produces more painful and serious symptoms (inflammation, swelling, violent pains) than in the glans, lips, prepuce, &c.




CHANCRE.

* 71

265. All chancres on a given spot would probably always present
the same phenomena, as the inoculating virus is perhaps of only
one and the same nature, and seldom milder or more malignant in
itself, if the various corporeal constitutions did not themselves
cause those great varieties in the malignancy of the chancre (gonorrhoea, buboes, &c.), by the numerous modifications of their
reaction.
266. It follows from this, as experience also teaches, that to
treat these idiopathic venereal ulcers with the greatest success,
we should pay particular attention to the peculiar constitution of
the body in every case, which with proper attention we can soon
learn from the course of the chancre and its accompanying symptoms.
267. In a diathesis that has a more than ordinary tendency to
inflammation, the chancre will inflame to a considerable extent
round about, and acquire great depth; the reverse will happen in
cases of an opposite character. In a system peculiarly liable to
irritability, the chancre will cause great pains, will have a blackish
and discoloured appearance, and excrete a thin ichor.
268. The earlier the chancre begins to form sloughs, the greater
is the tendency to sphacelus,2 whereby the whole penis is often
lost. We may apprehend great haemorrhage in such ulcers, when
they erode the parts about them much.
269. In general the chancre appears later than the gonorrhoea
from the same infection (perhaps they often are primarily caused
by the gonorrhoeal discharge remaining on those parts), and its virus
may therefore be frequently removed by merely wiping the part or
washing it with lime-water; they also appear more rarely, for we
may reckon that gonorrhoeas occur four times as often as chancres.
They occur more rapidly on the prepuce; still more rapidly betwixt
the junction of the prepuce and glans, especially at the frenum;
most slowly on the other parts, probably because the epidermis is
thicker.
1 Andre observes that the worst chancres affect in a very mild degree those persons who are only liable to the mildest infections, and that the interval betwixt the
infection and appearance of the chancre is of the same length in most persons who
have been several times inoculated with very different viruses.
2 The inflammation of the chancre is usually of an erysipelatous character, hence
the great tendency to sphacelus, as Girtanner has also observed.




72

ON VENEREAL DISEASES.

270. The earlier a chancre breaks out after infection, the more
is it disposed to inflammation; the later it appears, the more readily
will the blood be inoculated by the poison, and lues venerea produced.
271. There are but few diseases of the body that have not been
occasionally overcome by the efforts of nature. Chancre and lues
venerea are to be reckoned amongst those few. If circumstances
do not occur to produce the absorption of the virus out of the
ulcers into the general mass of the circulating fluids (whereon
buboes and lues venerea, diseases of still greater gravity than
chancre, ensue), they may remain in the same place for several
years without the least change, except perhaps growing somewhat
larger.
CHAPTER II.
ON THE ORDINARY TREATMENT OF SIMPLE CHANCRE.
272. It is generally asserted that next to inveterate syphilis that
has fastened on periosteum, ligaments and tendons, no venereal
affection is more hard to cure than a chancre of considerable size
and depth. The most skilful practitioners rejoice if they are able
to cure a deeply rooted chancre within four to six weeks, by means
of a host of external and internal medicaments, that inconvenience
the patients not a little, and if they can be certain that in the
course of treatment the virus has not slipped into the general mass
of the circulating fluids, wandering about there undestroyed.
273. The most distinguished masters of our art are unable to
promise to themselves that they will succeed in expelling it from
its intrenchments in less time, assuredly not without the local
employment of corrosive remedies. Without the latter, which are
regarded in the light of an open assault, whilst the treatment by
inunction or the internal use of the ordinary mercurial preparations
is looked upon as an attack from behind, without these local
corrosives, I repeat, they consider the art as impotent to eradicate
this virulent ulcer.
274. How uncertain they are upon the subject, is evident from
this, that some hold the local employment of mercurials as useless,
whilst their opponents know besides the antivenereal metal no
efficacious topical application for chancre, but yet neither can




CHANCRE.

73

adduce sufficient reasons based upon facts for their contradictory
assertions.
275. Did the latter know that their local mercurial remedies
have no effect on chancres if they be not of a corrosive nature, or
at least become such in the sore, that consequently no form of
mercury unprepared in the general circulation is capable of eradicating the venereal virus; and were the former aware that their
non-mercurial septics, equally with their mercurial caustics, possess
the undoubted power of exciting the lymphatic glands to absorb
the local venereal poison (and thus give rise to general lues, which
can then only be eradicated by the internal use of mercury), that
they moreover cause much pain without being of any material service, they certainly would not at the present day be quarrelling
with one another, they would amicably discard their errors on
either side.
276. All the objects we would propose to obtain by the employment of local caustics would certainly be best obtained by the use
of lunar caustic. It coagulates and destroys with the rapidity of
fire, and with the least possible inflammation, all moist animal
parts. But how much pain does not the use of even this substance
occasion! It makes a slough, beneath which the remainder of the
virus cannot escape; when this falls off the ulcer looks clean; we
flatter ourselves that recovery is at hand; it dries up, and behold the
inguinal glands become painful, a bubo appears-the premonitory
symptom of lues; or suddenly the curative process is arrested, the
pain the caustic occasions prevents its further use, proud flesh shoots
up, which must now in its turn be destroyed. Frequently things do
not go on so well with the employment of caustics; under this
treatment the edges of the chancre we wish to destroy turn over,
tubercles appear round about it, the ulcer commences to bleed
readily, it is the seat of constant pain, it eats all about it incessantly, and becomes a true cancerous sore.
277. Instances are recorded of small chancres having been burnt
away by the repeated vigorous application of nitrate of silver,
without being followed by lues venerea; but so rare are such
cases (Simmons has observed some, I confess I have not been so
fortunate), that it is highly dangerous to reckon on such a piece of
good luck.
278. But even let us take for granted that with proper care no




74

ON VENEREAL DISEASES.

evil results ensue. Supposing the chancre to disappear without
these bad effects, still (I need only refer adepts in the medical art
to their own experience) caustics are cruel remedies in chancres,
which from the torture they occasion in most cases, change the
local virus into a general affection,' consequently do more harm
than good.
279. If my enemy remains in front of me, I remain always on
my guard, I am convinced I have not yet conquered him; but I
cannot be said to overcome him if I drive him into an inaccessible
corner.
280. There is not a single one of all the so-called corrosive sorecleansing remedies,2 from calomel to blue vitriol, from lunar caustic
to sugar of lead, which does not at the same time possess astringent,
vessel-contracting properties; that is to say, the power of exciting
the lymphatic vessels to absorb, and which does not display all this
power in the local treatment of chancre. Could we find any remedies that would more certainly transform a chancre into lues
venerea than these?
1 Girtanner asserts that the absorption of the virus is so rare an event under
merely local treatment, that I can scarcely believe my own eyes when I read the
following words of his: " Of the many chancres," says he, " which I have treated
merely by local remedies, without employing any internal medicines, not more than
two cases have occurred in which after the treatment was completed, lues venerea
broke out."  Truly an incredibly small number only to be accounted for by a perhaps almost specific power in the caustic potash, which was his local remedy (which
I confess I have not yet tried); but still too large, when we consider that under the
appropriate treatment by the best preparation of mercury given internally, it is
impossible that in any case lues can occur after the chancre has disappeared under
its use. I do not therefore understand what he says further on: 1" Supposing the
virus were absorbed (from the chancre), the mercury would not prevent this absorption, and could not hinder the occurrence of the general disease. Mercury never
prevents lues venerea; but it cures it when it has occurred: it never destroys the
latent virus, (is it more latent in idiopathic chancre than in general syphilitic ulcers?)
but it eradicates the poison when it has developed its external effects." As if it did
not exhibit its effects in cases of merely local chancre. In what a dilemma does he
not place himself also with his lime-water or solution of caustic potash in phimosis!
Still I have such confidence in the unprejudiced mode of thinking of this author, that
I am sure he would strike out the greater part of this chapter, if he had for some
time cured chancres with the mercurial fever produced by soluble mercury. No
external treatment cures so easily, certainly, and quickly.
2 Pulverized glass even, certainly a powerful remedy for cleansing sores, which
acts by mechanical irritation without any corrosive power, scarcely forms an exception, but it has not yet been employed in chancre.




CHANCRE.

75

281. The universal embarrassment that prevails in the treatment
of a chancre concealed beneath a phimosis, when the patient will
not submit to the often dubious operation, shews how ill ordinary
practitioners can dispense with the employment of caustics.
282. But in order to cure chancre, local caustics are not the only
things they use, they have recourse also to the internal employment
of the antivenereal metal! That this is done proves that the former
are insufficient of themselves; perhaps, also, it is had recourse to
because experience suggested that the ill effects of the local applications should be prevented by the internal remedy. Of a truth they
required to introduce all the larger quantity of mercury into the
interior of the body, in order to endeavour to destroy the virus that
had been driven into the system by these local applications (for that
this takes place all are agreed); and on the other hand they found it
necessary to come to the aid of the slow, sleepy efficacy of the
mercurial treatment hitherto employed, in order to do something
for it in a reasonable time.
283. But when are we sure that we have conquered the enemy
by this double assault?  We are answered: 1st, when the local
affection is gone and the chancre cured; 2nd, when as much mercury has been introduced into the body as will suffice to affect the
mouth until the commencement of ptyalism, and a little beyond;
3rd, if, after this, signs of syphilis appear, we must have recourse to
a new course of mercury.
284. The third point shews sufficiently the want of confidence
to be placed in the ordinary mode of treatment; the second is
undecided, as we sometimes witness a very rapid action of mercury
on the mouth, and on the other hand there are cases in which it is
impossible to cause salivation by the greatest amount of mercury
(sooner would the vital powers succumb), and yet neither in the
one case nor the other is the venereal virus eradicated. The first
is of no value as a diagnostic sign, for every chancre disappears
when its poison has receded into the body by the use of external,
astringent, irritant, or corrosive substances. The mere application
of blotting-paper will cure chancre equally well.
285. I shall shew further on, the great disadvantages attending
the concomitant employment of the different mercurial preparations in this case, the danger of the salivation accompanying them,
that can never properly be guarded against, and the ruinous effects




76

ON VENEREAL DISEASES.

on the system of the long continued use of mercury (until the
mouth is affected).
286. Could we discover an easier and surer mode of curing
chancre with certainty, I imagined it must supersede that hitherto
in vogue, and be much more acceptable both to physicians and
patients. I hope to be able to shew such a method in the following
pages; but I have my doubts whether the prejudice in favour of
the old method will allow it to gain a footing.1
CHAPTER III,
TREATMENT OF SIMPLE CHANCRE.
287. I shall be very brief on this point, as I would be merely
anticipating what I have to say when treating of syphilis, were I
now to describe the better mercurial treatment. I shall therefore
say nothing more than this: in order to cure a chancre radically,
the soluble mercury must be given in increasing doses, until the
mercurial fever that supervenes has completely cured the chancre,
without the employment of the slightest topical application. From
seven to fourteen days are sufficient in ordinary cases.
288. I shall merely mention what I mean by mercurial fever,
and what is the appearance of a cured chancre. The special method
of using the mercury to be employed for chancres, is the same as
that for syphilis, to which I refer the reader at ~ 614-635, and
which should be followed in every respect, even in regard to the
removal of all unfavourable symptoms that should be avoided
during mercurial treatment.
289. I am unable to determine whether the eradication of the
venereal virus by mercury depends on a chemical decomposition,2
1 The mechanical expulsion of the venereal virus by the infinitely divisible and
excessively heavy globules of mercury is a whim long since exploded, which is
forced to take for granted that the hurtful salivation is alone efficacious; it is completely refuted by the power of a few grains of oxydised mercury in deeply rooted
syphilis, and by the efficacy of as few grains of sublimed mercury in the less severe
venereal symptoms.
2 In imitation of Schwediauer, Harrison repeatedly inoculated recent chancrous
matter which he had previously mixed with Plenek's mucilaginous preparation of
mercury, in different parts of the body of a healthy person, without ever being able
to cause a venereal ulcer or lues venerea.




CHANCRE.

77

or perhaps I should say neutralization (something after the manner
in which the corrosive oil of vitriol instantaneously becomes tasteless and mild when combined with lead, or like arsenic with sulphur),
or, as the expression is, on the specific irritation which it excites
in our body-which is not to be confounded with the injurious
irritation (irritability from weakness, chronic trembling, &c.) which
the long continued use of mercury creates, even without destroying
the venereal poison;-but this is certain, that the true destruction
of the miasm depends neither on stuffing the greatest possible
amount of mercury into the body in the shortest space of time, as
has hitherto been imagined, nor in the affection of the mouth (in
salivation, which often does so little good, it is certainly affected),
nor on any other copious evacuation that the metal is liable to produce in some cases, as ptyalism, diarrhoea, diaphoresis (as Sanchez
alleges), or diuresis, but rather on that specific alteration of the
body which may not inaptly be termed mercurial-fever, in which a
disagreeable sensation in the mouth is a common but only accidental symptom.
290. The following is a description of the mercurial fever.-The
patient gets a metallic taste in the mouth, a disagreeable smell in
the nose, a painless, audible rumbling in the bowels, an earthy
complexion, a pinched nose, blue rings round the eyes, pale
leaden-coloured lips, an uninterrupted or frequently recurring
shuddering (always getting stronger) that thrills deeply, even into
the interior of the body. His pulse becomes small, hard and very
rapid; there is an inclination to vomit, or at least nausea at everything, especially at animal diet, but chiefly a very violent headache
of a tearing and pressive character, which sometimes rages without
intermission in the occiput or over the root of the nose. The
nose, ears, hands and feet are cold. The thirst is inconsiderable,
the bowels constipated, great sleeplessness, the short dreams of a
fearful character, accompanied by frequent slight perspirations.
The weakness is extreme, as also the restlessness and anxious
oppression which the patient thinks he never before felt anything
like. The eyes become sparkling as if full of water, the nose is as
if stuffed from catarrh; the muscles of the neck are somewhat
stiff, as from rheumatism; the back of the tongue is whitish. At
this period the patient experiences, if all goes on well, some dis



78

ON VENEREAL DISEASES.

comfort in swallowing, a shooting pain in the root of the tongue,
on both sides of the mouth a looseness or setting on edge of the
teeth (the gums recede a little towards the root of the teeth,
become somewhat spongy, red, painful, swollen); there is a moderate swelling of the tonsils and sub-maxillary glands, and a
peculiar rancid odour from the mouth, without the occurrence,
however, of a notable increase in the secretion of saliva, and
without diarrhoea or immoderate perspiration. Four days seems
to be the usual favourable period of duration of a fever of this
sort, and its best crisis consists only in the permanent disappearance of every venereal symptom and the complete extirpation of
the miasm. This picture is taken from an exquisite case of very
severe mercurial fever.
291. For the eradication of the venereal poison a sufficient
amount of the febrile action just described, in degree proportioned
to the obstinacy of the venereal affection, is required. The result
of the treatment depends on this, not on the copiousness of the
evacuations. Accompanying slight, inconsiderable febrile action,
there may often occur uncontrollable perspirations, a flow of fetid
urine, a choleraic diarrhoea, or a salivation to the extent of ten
pounds daily; the venereal symptoms cease for the time, but
they return again, not because the latter are too strong, but
because the former was too weak. We may always pronounce
such evacuations during the mercurial fever as injurious, but only
as regards their debilitating effects on the body, for they cannot
prevent the cure of the venereal affection, if there have only
occurred febrile action of the kind alluded to, of sufficiently
strong character, on which all their efficacy depends. If we can
prevent the violent evacuations, as I will attempt to shew how
when I come to speak of the treatment of syphilis, we shall
thereby increase the intensity of the fever which is so efficient,
and spare the patient's strength.
292. While giving the soluble mercury for the cure of chancre
until this action is developed, we should dress the ulcer with tepid
water or leave it without any application.
293. Whilst the above described affection of the organism, the
mercurial fever, pursues its course, the chancre commences without the aid of local remedies to assume the appearance of a clean




CHANCRE.

79

suppurating sore, and heals up in a few days, that is to say, there
is formed (without subsequent occurrence of lues, and without
pain or swelling of the inguinal glands) a healthy cicatrix, of the
natural colour and consistence of the neighbouring parts; it presents indeed at first a somewhat deeper red colour, and on several
parts small elevations if the chancre was very old, but gradually
both these appearances disappear. In general the ulcer is healed
up before the mercurial fever is completely gone. It is a matter
of indifference whether there were one or several chancres, whether
they were old and large or small and recent, if only the intensity
and completeness (~ 290) of the mercurial fever be proportioned
to them.
CHAPTER IV.
CONTRACTION OF THE PREPUCE (PHIMOSIS) AND CONSTRICTION
OF THE GLANS (PARAPHIMOSIS).
294. Phimosis is not a frequent symptom accompanying gonorrhoea if the prepuce was not previously naturally too narrow, in
which case the gonorrhoeal matter that insinuates itself betwixt it
and the glans can readily produce inflammation or chancre.
295. This symptom occurs most generally when one or several
chancres seated on the inner surface of the prepuce become considerably inflamed, thereby violently irritating the loose cellular
tissue, and causing it to swell and become thickened, and its occurrence, if it be not evidently produced by other violent causes (such as
over-heating the parts by walking, dancing, riding, coitus, onanism,
ardent drinks and spices), always depends on a particular predisposition of the system to irritability, as this inflammation is
usually of an erysipelatous character.
296. In this affection the prepuce projects over the glans in the
form  of a shining, transparent, inflamed,1 tense, painful swelling,
so that the dilatation and retraction of this skin, and the exposure
of the chancres for the purpose of their local treatment is impossible, and even passing water is a matter of difficulty in conseI And at the same time it is of a pale colour. This circumstance should not
allow us to regard the danger as less, as Girtanner rightly remarks.




80

ON VENEREAL DISEASES.

quence of the narrowing of the urethral opening; this condition is
termed phimosis.
297. The matter from the ulcer becomes accumulated in the
interior, and increases still more the swelling, irritation and
inflammation; it may even, if not relieved, bore through the
prepuce, and thus effect a passage outwards. The abscess thus
opened outwardly is often so considerable in size that the glans
forces itself out through it, and the remainder of the prepuce at
the opposite side forms a distinct swelling.
298. This catastrophe will be so much the more rapidly brought
about, when, as is sometimes the case, there was in the healthy
state a natural contraction of the prepuce, consequently an impossibility of retracting it behind the glans.
299. But if the prepuce be accustomed to retract itself easily,
spontaneously, behind the glans, or to remain habitually behind it,
and if in this state of affairs it be affected by the chancrous
inflammation; or if, when the prepuce is already contracted by
inflammation, we bring it behind the glans, regardless of the
impossibility of again drawing it over; or if, after retracting the
prepuce affected by chancres, for the purpose of dressing the
ulcers on it or on the glans, we imprudently leave it so retracted
until the inflammation and distension render its replacement impossible; or if under similar circumstances the act of coition be
performed, there will occur the troublesome and dangerous affection termed Spanish collar, paraphimosis, or constriction of the
glans.
300. We can easily perceive that it must be accompanied by
much more violent symptoms than phimosis (which is often its
producer), for in it the prepuce compresses itself, and its tension
and swelling are soon so increased that it, together with the
glans whose afferent vessels are thereby completely constricted, is
affected by gangrene. It resembles a tumour composed of several
rings.
301. This gangrene not unfrequently extends to a part of the
corpus cavernosum of the penis.




CHANCRE.

81

CHAPTER V.
TREATMENT OF PHIMOSIS AND PARAPHIMOSIS.
302. If chancres be the cause of either of these two affections,
it will be requisite while resorting to external measures, even
though we should be called in late1 to the case, immediately to
commence the chief means, which is to destroy the poison as
quickly as possible by the internal use 2 of soluble mercury.
303. As soon as the mercurial fever commences, which may be
brought about on the second, third, or at latest the fourth day, all
the inflammatory swelling caused by the chancre-poison disappears, in consequence of the miasm    being exterminated, as also
what there is of an erysipelatous character in it, by the revulsion
caused by the febrile commotion.     In the case of paraphimosis
the mercurial fever also removes the chief stumbling-block: the
chancres heal.
304. I said, this should be done during the employment of
external means. Before the soluble mercury can perform even its
most rapid service, the most powerful local means must be used as
soon as possible, in order to avoid the urgent danger.
305. In all cases of inflammatory contraction or retraction of
the prepuce, we must enforce strict rest, lying on one side on a
horse-hair or straw mattrass in a cool room and with light coverings, and the abstinence from all exciting passions, drinks and
spices.
306. In phimosis we should frequently inject with caution
beneath the prepuce tepid milk in which 100th part of saffron has
been steeped for some time, in order to bring away or at least
dilute the acrid pus, so as to prevent it bursting through the substance of the prepuce like a pent-up abscess. To the base of the
inflammatory swelling we should apply several leeches, and there1 I have found the beneficial effects of rapidly employing soluble mercury even
when gangrene had already commenced, if the most powerful local means were at
the same time made use of.
2 In urgent cases we should commence with half a grain of soluble mercury, and
increase the dose by a grain every twelve hours until the artificial fever sets in.
We would do well to combine the mercurial with half its weight of opium.




82

ON VENEREAL DISEASES.

with draw off an adequate quantity of blood. Some advise the
application of warm emollient poultices; but they are injurious:
they relax the part, and make it less able to resist the pressure of
the blood; the swelling and inflammation are thus increased. We
should rather apply to the affected part, immediately after the
leeches are removed, ice-cold water mixed with a twentieth part of
extract of lead or sugar of lead and a fiftieth part of laudanum,
renewing the application every minute. A few tepid footbaths
may not be disadvantageous.
307. We should proceed in very much the same manner in
cases of constriction of the glans by the retracted inflamed prepuce. We may omit the leeches, but the ice-cold compresses or
immersion of the penis in water of that temperature should be
repeated as frequently as possible. After a few hours, when the
greater part of the inflammation has subsided, we must grasp the
swollen glans in the hand, and by means of a gentle gradual pressure, attempt to press back the blood accumulated in it, and
thereby diminish its size to such a degree that, seizing the prepuce
with the nails of the thumb and forefinger of both hands, we may,
by exercising some force, be able to draw it over the glans. This
will succeed in most cases.
308. It is only after we have several times tried this manoeuvre
without success that we should proceed to the operation. In
order that we may not be induced to have recourse to it at first,
before every other means has been tried, we should consider that
there are very few cases in which the operation is indispensable,
partly because it cannot be done without great care and difficulty,
partly because it usually increases the irritation still more, and
usually is followed by sloughing, partly because the patient rarely
submits to it at the right time. In simple gonorrhoeas it is also
injurious for this reason, that the wound is almost inevitably
infected by the miasm, and turns into a chancre.
309. In all cases where the operation is unavoidable, we must
search at the neck of the swelling for the part of the prepuce that
presents the greatest resistance to dilatation, which will be found
to be its anterior border; beneath this we insert the point of a
curved bistoury, and slit it up to the extent of a quarter or a third
of the whole length of the prepuce. Having removed the constriction in this manner, if the prepuce cannot be easily drawn over




CHANCRE.

83

the glans we may leave it behind the glans until the cure is completed.
310. If it can be drawn over, we must take care, during the
healing-up of the chancre under the mercurial course, and during
the closing-up of the wound, to push it frequently backwards and
forwards over the glans, partly in order to prevent the prepuce
uniting with the glans, partly also in order that the orifice of the
prepuce may not contract during the healing, and thus form a
phimosis. A similar manoeuvre is necessary also in the case of
venereal phimosis, when the chancres beneath it commence to heal
under the internal use of mercury, in which case the prepuce is
apt to unite with the glans if this movement be not employed to
prevent this taking place. The oedema often remaining after the
operation is best dissipated by a strong saturnine lotion or decoction of oak-bark.
311. If however, in the case of paraphimosis, gangrene have
already set in, relief must be given as speedily as possible. In
such a case the following mode of procedure affords almost immediate relief; at least it is the best of all expedients.-Two ounces
of finely powdered oak-bark are to be boiled slowly in two pounds
of river-water for five hours, down to one pound of fluid, strained
through a cloth, the strained sediment diluted with four ounces of
white wine and this also strained; the two fluids are then to be
mingled together, and soft rags moistened with the decoction
when perfectly cold, to be applied cold and fresh every half-hour.
I have observed that by this procedure all odour has gone off by
the fifth hour. From that moment the gangrene ceases and the
sphacelated part will be thrown off by healthy suppuration in the
course of four days.   The requisite manual aid should not be
neglected, the operation on the prepuce will sometimes be indicated if there be still time for it. The same decoction, only
ice-cold, may also be employed when, after the operation for paraphimosis (~ 309), the prepuce cannot be drawn over the glans.
CHAPTER VI.
CHANCRE IN THE FEMALE.
312. In the case of women we may very readily convince ourselves of the truth of Hunter's maxim, that the idiopathic venereal
G2




84

ON VENEREAL DISEASES.

poison produces gonorrhoea when applied to surfaces of the body
destitute of epidermis that in the healthy state secrete moisture,
and chancres when applied to those parts that are naturally dry
and covered by epidermis. We cannot find any chancres in the
female genital organs where no epidermis exists.
313. The ulcers that occur on the inner surface of the genitals
of females when they are affected by gonorrhoea differ very much
from chancres. They are usually seated in the folds betwixt the
labia majora and nymphm, are formed slowly out of inflamed hard
swellings, have a deep, concealed seat in the body of the labium,
probably in its glandular parts, and have very minute openings
which must be artificially enlarged and kept open. They always
secrete a muco-purulent fluid until they heal up; in all their
external characters they differ from the chancre. They resemble the
ulcers of the glands along the urethra in gonorrhoea in the male.
They have only a partial resemblance to chancres in this, that
they cannot be cured without mercury, because by the contact
with the gonorrhoeal matter they become venereal.
314. Chancres,1 on the contrary, are seated, in their usual form,
only on those parts of the female genitals which are invested with
epidermis, and generally just where that is about to cease; in
persons who do not make a trade of voluptuousness, right in the
border of the labia majora, at the inferior commissure and on the
prepuce of the clitoris in rarer cases, and in such as have a more
delicate skin, also on the external surface of the larger lips, on the
mons veneris, on the anus and the perinveum. In public prostitutes, on the other hand, and other persons of a similar description, the chancres are seated from the above reason sometimes
deep in the vagina, on the nymphae, &c. Large chancres on the
labise cause these to swell considerably.
315. The chancres on the external parts invested with a thicker
epidermis, as the mons veneris, perinaeum, &c., resemble those of
males which are observed on the penis, scrotum, &c., and are,
like these, usually covered by a scab, beneath which a larger one
is always formed when the first falls off; they are excessively
painful.
1 They are of the same nature and same appearance in the female as in the male
sex.




CHANCRE.

85

316. Probably the latter sometimes arise when the matter from
chancres on the internal border of the genitals, where they always
remain moist, repeatedly comes in contact with these external
parts, and thus gradually complete the inoculation through the
thicker epidermis. At any rate this is often the case with respect
to those on the fourchette and on the anus.
317. The simple construction of the female genital organs
in those parts where the chancre can occur does not allow of any
such complex symptoms as occur in the more complicated male
genitals.
318. The only chancres they are subject to that men are not,
are those on the nipples, which they generally get by suckling
those children whose lips are affected by true chancres. They eat
rapidly about them, and if not speedily checked by the antivenereal specific they soon destroy the nipples.
CHAPTER VII.
TREATMENT OF CHANCRE IN FEMALES.
319. As the parts are not of so complex a character as in the
male, we have as a general rule less serious symptoms to combat.
320. The external treatment has hitherto been the same as that
of chancres in the male, by local remedies of corrosive, astringent,
irritating character, precipitate ointment, saturnine lotions, solution of corrosive sublimate, &c. Such treatment is as prejudicial in
females as in males, and even more so, because the absorbing
surface is larger, and they have frequently several chancres at the
same time. Just as, in males, the employment of irritating and
corrosive remedies, whether mercury enter into their composition
or not, always increases the absorbing power of the lymphatic
vessels, so from the same reasons this happens all the more readily
in females; perhaps also because the whole vascular system in
females is more irritable. Astringent substances' are injurious in
proportion to their energy. These topical applications, moreover,
cause a great deal of local mischief: they alter the chancre, as in
1 Experience teaches that of all remedies that promote the absorption of the
poison in chancres, none act so powerfully as the preparations of lead; they are
therefore of all the most hurtful in such cases.




86

ON VENEREAL DISEASES.

males, into ulcers that eat round about them, into spongy excrescences, into sycotic condylomata, &c.
321. We ought therefore to abandon this destructive method,
and during the proper treatment by internal mercurial remedies
dress the chancre, either not at all or with something quite indifferent.1
322. As regards the internal treatment, practitioners are much
more at a loss than in the case of chancres in the male.        We are
advised to continue the treatment an extraordinary2 long time,
and to use twice as much mercury as we do for the male sex.
323. This destructive method will be easily superseded by the
employment of a better mercurial preparation and the requisite
circumspection. I have not found it necessary to employ longer
time nor to use more soluble mercury for the cure of chancres in
females than in males.3
324. Attending to the rules to be hereafter (~ 591 et seq.) laid
down for preventing violent evacuations (ptyalism, diarrhoea, &c.),
I likewise in their case rose from a very small to a larger dose of
the soluble mercury, in order if possible to bring on a sufficiently
strong mercurial fever betwixt the fourth and seventh days,
reckoning from the commencement of its employment; and during
that time I caused the chancre to be dressed only with tepid milk
I Andre also advises that nothing but tepid water be applied to chancres during
his alterative mercurial treatment.
2 Andr6 and some others advise the use of internal mercurial remedies for nine or
ten weeks before we can with certainty pronounce the chancres in the female cured
and all the virus eradicated out of the body. It would probably be a matter of
difficulty to determine when this had occurred, if they employed local remedies.
The best indication would be wanting to them (the spontaneous cure of the chancre)
if they repelled it locally. Moreover the weakness and uncertainty of their mercurial preparations required that they should employ for so long such a large quantity
of mercury, frequently without any real result and to the certain injury of the
constitution.
3 A woman who for some days had a bubo, and for a year several chancres on the
inner border of the labium majus of the same side, the largest of which measured
from four to five lines in diameter, but who was otherwise healthy, took, without
employing any local remedy, three grains of soluble mercury in five days. The
artificial fever came on strongly and characteristically; four days afterwards, after
all the pains in the head and all the fever were gone, the chancres, together with
the small bubo, had completely disappeared; for a year and a half she has remained
perfectly free from all complaints.




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or water. In ordinary cases from ten to twenty days sufficed to
complete the cure.
325. If the chancres spread very much, and extend deep into the
vagina, we should fill that part with charpie during the treatment,
so that the granulations, when they cicatrize, shall not contract
the vagina.
326. We should proceed in the same way with chancres on the
nipples, that is to say, we should treat the body only internally,
without the employment of any external means; but here we
must endeavour to produce the mercurial fever as quickly as possible, in order to prevent, if possible, the rapid destruction of these
soft parts by the virulent ulcer.
CHAPTER VIII.
TREATMENT OF THE ACCIDENTS RESULTING FROM IMPROPER
TREATMENT OF THE CHANCRE.
327. The chronic phimosis (from induration and thickening of
the prepuce) that remains after the cure of the chancre, especially
when performed in the ordinary manner, increases with the lapse
of time, especially if the orifice be too small for the full stream of
urine.  It becomes scirrhous, and lays the foundation for a
number of disagreeable symptoms.
328. In order to remove this evil, we draw the thickened portion of the prepuce over the glans, grasp it tightly, and cut it off
cautiously, without injuring the glans. While the wound is healing the prepuce must be frequently pushed back over the glans, in
order to prevent the cicatrix, and thereby the orifice of the prepuce, from contracting again.
329. Where the scirrhus pervades the whole prepuce, it must
be cut away entirely, or it may be merely slit up at a convenient
point in order to allow the patient to perform the act of coition.
330. Hunter alludes to a kind of false chancre that seems to
result from the previous improper treatment of a true one. Its
diagnostic marks are as follow.- It is only met with in persons who have previously (frequently only four to eight weeks
before) been affected with real (idiopathic venereal) chancres; it
never occurs exactly on the cicatrix of the healed-up chancre, but




88

ON VENEREAL DISEASES.

close beside, or at least not far from it; it does not extend so
rapidly nor so extensively as the true one; is not so painful nor so
inflamed; has not such a hard base, and does not cause buboes by
absorption, like the true chancre.
331. Of quite a different nature are those chancres that by a
long abuse of mercury, and perhaps also by the use of improper
external remedies, have degenerated into malignant ulcers. Such
ulcers secrete much thin acrid ichor, are excessively sensitive and
painful, their borders are very elevated, violet-coloured and hard;
in a word, they resemble old scrofulous ulcers and are of a similar
nature.
332. In these cases there may be no longer any venereal miasm
in the system.    The abuse of mercury and other debilitating
methods have caused the whole body to take on the scrofulous
disposition, and have produced a cachexia of morbid irritability,
and the ulcers do not effectually heal up before this condition of
the organism is improved.
333. A further employment of mercury aggravates them perceptibly. The most powerful antidotes to this cachexia, cold baths,
country air, bark, opium,1 exercise, ammonia, and local tonics are
of service.
334. When, in cases where there is an original predisposition to
debility, nervous diseases and erysipelas, the chancres, which have
in such states of the constitution already a tendency to abnormal
inflammation, are treated with irritating local remedies and with
an excessively long employment of mercurials, purgatives and
tepid baths, it sometimes happens that the morbid irritability of
the system increases to such a degree, that even after the healing
up of the chancres, inflammation of such intensity is developed on
the genitals that a dangerous affection occurs, which some have
improperly termed cancer of the penis.
335. The swelling of the whole organ is great, the heat considerable, the colour bright red. Suppuration beneath the whole of
the skin and prepuce rapidly ensues, and ulcerations break out
here and there. In such cases a portion or the whole of the glans
is not unfrequently lost, sometimes also the urethra and even the
1 It is in such cases that Turnbull's external employment of the opiate solution in
(degenerated) chancres has such excellent effects.




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whole of the penis are destroyed by the suppuration, if the disease
be not arrested in time.
336. Here also mercury will be found injurious. I have found
no good results from anything besides the free internal employment of bark with ammonia and opium, and a very strong and
ice-cold decoction of oak-bark (if we are called in good time,
strongly impregnated with opium) applied fresh every hour or half
hour. When the danger is past and the ulcer commences to heal,
we must, in order to prevent a relapse, make use of the other
remedies usually employed for irritability with weakness.
337. Those chancres which have only been aggravated by the
abuse of corrosive remedies, of which the borders become suddenly
everted, very sensitive and excessively painful, which bleed easily,
eat around them, and are beset with tuberculous indurations
(a sort of cancerous ulcer), demand speedy aid. The affected part
is to be constantly bathed with a lotion composed of one part of
laudanum with twenty or ten parts of water, and bark largely
combined with opium is to be given internally until the pain
begins to yield. The ulcer will then begin to assume a more
healthy character, and may now be cured generally with mild
digestives (of cocoa-nut oil, yolk of egg and Peruvian balsam, &c.),
if the venereal miasm have been previously destroyed by an appropriate mercurial course.
338. It is usual to stop the profuse haemorrhage of an old
chancre (when the miasm has not yet been destroyed from within)
when it throws off an artificial or self-generated thick slough, by
means of applications of turpentine.  In many cases the local
employment of opiates as palliatives is indispensable, especially
when the recurrence of haemorrhage is kept up by irritability from
nervous weakness.
339. The spongy excrescences that protrude from chancres that
have been treated with local remedies of an irritating character
belong to the class of degenerated chancres, among which I reckon
the sycotic condylomata, of which I am about to treat.




90

ON VENEREAL DISEASES.

CHAPTER IX,
VENEREAL WARTS AND EXCRESCENCES.
340. Very little of a positive character has been written concerning the nature of the condylomatous warts, and the place they
should hold among venereal affections is still so undetermined,
that I must take leave not to regard them as a symptom of
syphilis, but to place them among the idiopathic venereal affections.
341. They certainly never appear, like gonorrhoea and chancre,
immediately after local inoculation, but in this they resemble
buboes; but still the humour they exude possesses, like the pus of
inguinal buboes, the power of producing local infection,1 a property
that seems only to belong to the idiopathic venereal symptoms.
342. Their power to cause local inoculation, and the fact that
when not of a horny hardness the internal use of mercury can
alone eradicate them, as I have frequently observed, amply suffice
to refute Hunter's opinion, that they are mere consequences of
the venereal malady, and not themselves of venereal nature.
343. Thus much is certain, that they are not a primary symptom
of immediate infection, but that they only appear from the neglect
or improper treatment of the proper chancre. Usually when the
latter are treated only by external remedies of an irritating and
astringent character,2 the chancre, without losing its idiopathic
venereal virus, gradually changes its appearance, the irritated sensitive fibres attain a luxuriant growth, and excrescences arise on
the former seat of the chancres; at least I have never seen a case
where the chancres were healed according to my plan, only by the
internal employment of the best mercurial preparation without
the slightest topical application, where any such excrescence remained. We would therefore not be wrong in regarding this as
a degeneration of the chancre, standing in the same relation to
that as a gleet does to the primary gonorrhoea.
344. Their seat therefore is the locality where chancres may
Andr6 saw a venereal wart upon the glans communicate gonorrhoea to a female.
2 The power these remedies possess of causing the lymphatic vessels to absorb
is the reason why we seldom observe condylomata unaccompanied by some symptoms of syphilis.




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occur after an impure coitus; the prepuce, glans, clitoris, the
orifice of the urethra, the labia, &c., and in those places most
generally where the epidermis is thickest, round about the anus,
in the perinieum, on the scrotum, &c.
345. Their appearance is various; they are sometimes broad
and furnished with a pedicle, in which case they are termed fig
warts; or they are long-shaped, and resemble a cock's comb; or
their head sprouts out enormously, giving them the appearance of
cauliflowers, &c.; and writers have classified them according to their
resemblance to buttons, onions, strawberries, mulberries, and so on,
without reflecting that these names indicate no difference of nature,
but only depend upon an accidental conformation, consequently
are of no essential utility, and cannot influence the mode of treatment. More interesting is a knowledge of their nature and of
their course.
346. The warts on the prepuce, glans, clitoris and labia, are
generally harder and drier than those on other parts; sometimes
they are painless, and then they not unfrequently wither and
disappear spontaneously (probably when the venereal poison they
contain retreats inwardly into the general circulation); sometimes
they inflame, and then usually degenerate into cancerous ulcers.
347. In addition to these, immediately after improper treatment
of chancres with local irritating substances, spongy growths shoot
out rapidly on the penis and in the vagina, which sometimes have
little or no sensibility.
348. The condylomata on the nates and perinweum are also
spongy, and the hollows and furrows in the skin betwixt them
are usually ulcerated and painful. In this condition their surface
appears full of chaps, which exude a fetid ichor. They are attended
by gradually increasing inflammation and painful burning, until
they in the course of time degenerate into fistulous ulcers of the
rectum, &c.
349. But hard growths of this kind are also met with in this
position, which are often covered with scales and inflamed, and
even accompanied by violent pains; injudicious local treatment
(without efficient internal assistance) readily transforms them into
cancerous ulcers.
350. The non-venereal warts and excrescences on the genital
organs of both sexes are distinguished from the venereal ones by




92

ON VENEREAL DISEASES.

this: that the former have their roots in soft healthy skin, that
they are usually of soft texture, dry and flesh-coloured, also that
no venereal symptoms either have preceded or accompany them;
whereas the base of the venereal ones is upon a hardened part,
they are inflamed, and are always preceded by other idiopathic
venereal affections, and generally accompanied by several symptoms of syphilis; more particularly there usually exist betwixt
them ichor-secreting venereal fissures.
351. If the excrescences are only seated on the anus, before we
can pronounce them venereal, or treat them as such, we must pay
attention to their diagnostic marks, and also endeavour to ascertain whether they do not result from sodomy, or from some acrid
discharge from heemorrhoids, or from leucorrhoea, as not unfrequently happens, or whether they are not relics of external piles.
CHAPTER X.
CURE OF VENEREAL WARTS AND EXCRESCENCES.
352. If we have convinced ourselves of the venereal nature of
the condylomata, from the above signs and from the history of the
case, we proceed to the treatment, which divides itself into external and internal.
353. As a general rule, these excrescences must not be primarily
treated by local remedies,' for the same reason as I have given for
condemning the topical treatment of chancres. If, as we have
every reason to believe is the case, these excrescences be malignant transformations of the chancre owing to local treatment, the
injudiciousness of such appliances will be more palpable, and the
usual bad effects of their employment afford ample corroboration
of this assertion.
354. We must consequently discard what made them from
chancres into condylomata-the irritating and styptic local remedies, and make use of a judicious internal administration of mercury,2 unless which had been neglected they had not degenerated
1 They produce syphilis, if that be not already present, or cause them to degenerate into spreading ulcers.
2 When Dease adduces as proof that mercury is of no use for warts, and that they
consequently contain no venereal virus, that they sometimes have remained uncured
although the patient has long used the metal and been salivated almost to death, he




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93

into that condition; in a word, in order to cure them radically, we
must do what ought to have been done long ago.
355. The administration of (soluble) mercury serviceable in this
case, and the rules for its employment, are the same as for the
more remote degree of syphilis (for they belong to the most obstinate local affections), to which latter I refer the reader, in order
to avoid unnecessary repetition.
356. I may merely observe that a properly developed (and rather
strong) mercurial fever (~ 290) cures all true venereal warts and
excrescences; that is to say, they dry up and fall off whole or in
fragments, or (but this is rare) they put on a healthy suppurative
process and ulcerate away.
357. Those warts that do not fall off nor suppurate away, nor
gradually disappear by this internal destruction of the virus, are
usually of a horny character; at all events are innocuous and nonvenereal.
358. If, notwithstanding, we wish to get rid of them, they may,
like all other non-venereal warts, according to circumstances, be
removed by tying them with a wzx thread and gradually drawing it
tighter, or they may be burnt off with lunar caustic, or cut off with
the scissors. Some have also advised to apply onions boiled in
oil until the warts become soft, and then sprinkle over them
powdered mezereum, whereby they are changed into mucus, that
may easily be scraped off.
359. But as it nevertheless sometimes happens (although very
rarely in the case of the non-venereal remains of formerly venereal
excrescences) that they again grow after removal by the ligature
or scissors, we would do well, immediately after their removal by
these instruments, if we observe any disposition on their part to
grow again, to touch the part once or twice with lunar caustic;
except in such cases, when, in spite of the radical destruction of
the venereal miasm by the mercurial fever, such a wart still
remains inflamed and painful, in which very rare case' we must
abstain from all topical applications, and content ourselves with
should have remembered that such abuse of mercury often leaves uncured other
local affections evidently dependent on the venereal poison, which a rational administration of mercury eradicates rapidly and radically.
1 Morbid irritability must be the cause of this phenomenon.




94

ON VENEREAL DISEASES.

destroying the cancerous or scrofulous constitution of the humours
by hemlock, cold baths, opium, ammonia, setons in the neighbourhood, &c.
360. Peyrilhe recommended, in order to destroy the large spongy
excrescences in the vagina, to apply butter of antimony with great
caution, and immediately thereafter to cleanse with injections of
lime-water the parts where this easily spreading caustic may have
touched the healthy tissues. He prefers it to the lunar caustic,
because the slough formed by the latter does not fall off under
36 hours; which would allow sufficient time to renew the excrescence beneath it. We may act in a similar manner by excrescences
on the male genitals. I would not however advise any beginner in
surgery to resort to this method. The judicious internal employment of mercury must always precede it.
361. The rectal and perineal fistule arising from condylomata,
are hardly ever benefitted by the ordinary employment of mercurials in the shape of calomel, Neapolitan ointment, &c. The
soluble mercury is, as it generally is, more powerful in such cases,
when all the morbid irritability of the body, which is almost always
present, is subdued before its employment, and when at the same
time topical fumigations with cinnabar, &c., are not neglected.
SECOND    DIVISION.
BUBOES.
CHAPTER I.
DIAGNOSIS OF INGUINAL BUBOES.
862. The swelling produced in the inguinal glands by the desiccation of a chancre that has been treated only locally, that is to
say by the absorption of the idiopathic venereal poison, is the most
ordinary kind of bubo. We need not here dwell on the diagnostic
marks of the swellings in the groin occasioned by the sympathetic
irritation of the gonorrhoeal inflammation, as they are not of a
venereal nature, and have been already discussed when treating of
gonorrhoea.




BUBOES.

95

363. Seeing that the lymphatic system consists partly of single
absorbent vessels and trunks, partly of glands, that is, as far as we
at present know, of the division, reunion and interlacing of their
smallest branches, we might easily suppose, a priori, that the former would be less frequently affected, irritated and inflamed, by
the passage through them of the virus after its absorption from
chancres than the glands.
364. And this opinion is corroborated by experience, which
teaches us that the simple lymphatic vessels are seldom affected,
and almost only after the small glands along their course have
already been swollen.
365. When such an occurrence does take place, if, for instance,
the seat of the absorption was a chancre on the prepuce or the
glans, a lymphatic vessel in the neighbourhood along the dorsum
of the penis will be found thickened and indurated, apparently
terminating at the root of the penis beneath the pubis, or it will
be felt to run into the inguinal region, interrupted in its course
by elevated tubercles (small buboes).
366. Something similar, it is alleged, occurs from the absorption
of gonorrhoeal matter. A cord-like thickening of a lymphatic vessel
with small knots upon it is formed upon the penis, usually taking
its origin from an indurated part on the prepuce, which frequently
presents a raw appearance on the inner surface, a sign that it
should be regarded as something more than an immediate metastasis of the gonorrhoeal matter (which appears to me to be quite
incomprehensible). The same thing happens, though more rarely,
from the absorption of the chancre virus from the female genitals.
The vessel leading to the gland feels like a cord, and is painful;
small glandular swellings are also produced in its course.
367. Usually however, as has been said, this does not occur;
the absorbents opening into the chancre generally convey the
poison, without being affected themselves, to the nearest larger
gland, where the angles of the anastomoses and the interlacings
of the finer lymphatic branches retard the passage of the humours,
and thereby allow the poison time, and give it the opportunity of
exercising its irritant power.
368. Here the idiopathic venereal virus is arrested1 on its way
1 The glandular swelling however does not appear at any time to arrest with cer



96

ON VENEREAL DISEASES.

to mingle with the mass of the blood, whilst it, without in the
meantime altering its nature, develops that specific painful inflammation and tumefaction in the lymphatic gland, termed bubo, the
immediate result of the absorption of the virus from a chancre,
more rarely from a primary gonorrhoea, and still more rarely from
the uninjured skin, and the proximate source of lues venerea by
its further absorption by the lymphatic vessels into the general
circulation.
369. The absorbed poison usually settles in the nearest gland
towards the centre of the circulation; in the case of chancres on
the prepuce or the glans, ordinarily in the groin of the same side;
from chancres of the frenum however, and from absorbed (gonorrhoeal?) virus from the urethra, on either side without distinction,
and often on both sides. But as the situation of these glands varies,
so there are buboes which are seated pretty deeply under Poupart's
ligament in the thigh, others close to the os pubis, and others
again that are located in the abdomen right over or above the
ligament indicated. If the absorbed poison be in greater activity,
several glands may be affected at once.1
370. In women affected with chancres of the genitals on the
clitoris, on the mons veneris, &c., they occur also on the same
side, but at the commencement of the round ligament of the
womb, whence they pass into the abdomen; probably these are
lymphatic vessels inflamed by chancre-virus only. If the chancres
be seated quite far back, at the posterior part of the labia or on
the perinmeum, buboes are developed along the furrow formed
betwixt the greater labium     and the thigh.    The other seats of
buboes in the female are the same as in the male.
371. If the chancres be seated on the hand or arm (by the introduction of the chancre-virus into wounds, ulcers, &c.), the absorbed
tainty the venereal poison from passing into the mass of the fluids, not even when it
goes on to suppuration; which fact may be alleged in opposition to those who say
we should regard the bubo as a critical metastasis, and who therefore direct all their
efforts to cause it to suppurate; certainly in most cases a measure of very doubtful
utility.
I Some chancres on the prepuce of an officer of very dissolute habits, who had at
the same time gonorrhoea, were merely covered by him with blotting-paper, and not
otherwise attended to. He continued his dissipation, and got not only a bubo in
both groins and suppuration of Cowper's glands, causing a perineal fistula, but also a
similar affection in each axilla




BUBOES.

97

virus is also transplanted into the nearest lymphatic gland towards
the heart, usually not far from the elbow at the inside of the biceps
muscle, but also occasionally in the axillary glands.
372. Chancres on the lower lip in one instance gave rise to
buboes on both sides of the neck over the submaxillary glands.
373. The infection of the glands proceeds rather slowly; they
have been observed. to swell after from six days to several weeks
subsequent to the local destruction of the chancre.
374. Chancres that are not treated at all impart their poison
much more rarely and slowly to the glands than those treated by
local corrosive, irritating substances. Of twenty chancres treated
solely topically,' probably not one case occurs in which absorption
does not take place; whereas I have seen many chancres that were
subjected to no treatment persist for years on their seat, without
the occurrence of buboes or lues venerea.
375. Venereal buboes commence with a slight pain in the groin,
an almost characteristic anxiety in the chest, and a small, hard
swelling, which if it be not restrained by a scrofulous diathesis, by
external remedies, the inunction treatment, &c., soon rises up (and
then the swollen gland is from the first very painful), inflames,
and passes on to suppuration.
376. At first and when still small, this venereal glandular swelling may be pushed hither and thither in the cellular tissue; we
observe that but a single gland is affected; its boundaries are very
circumscribed. It is only when inflammation has perceptibly set
in (the inflamed part is bright red), that its size increases considerably, and then suppuration soon ensues.
377. An abscess occurs, which only differs from the 'chancre as
to size, in other respects its nature is exactly the same.
378. Occasionally an erysipelatous inflammation accompanies
the swelling, or watery fluid accumulates there (cedema), and the
suppuration advances tardily.
379. If we take into consideration all these signs, and if we are
convinced by the history of the disease of the venereal origin of
the bubo, we shall very readily be able to distinguish it from others
of a similar character.
Girtanner's caustic alkali must be considered an exception, and must possess a
specific antivenereal power which destroys the poison, and thus eradicates it directly.
H




98

ON VENEREAL DISEASES.

380. Buboes from other causes are usually softer, and generally
more easily dispersed. There are usually several glands swollen
at once; in scrofulous affections, glands in other parts of the
body are likewise affected. Non-venereal buboes are commonly
less painful, and often complicated with catarrhal or hectic fever,
in such a way, that the fever was already there before their appearance. They are so far from being amenable to mercury, that they
are rather aggravated by its use (and can only be combatted by
means of tonics, especially the cold-bath, rubbing in of volatile
ointment, burnt sea-weed, small doses of ipecacuan not pushed
to emesis, shower-baths, &c.). Non-venereal buboes increase more
slowly, or even should they swell more rapidly, they do not readily
pass into suppuration. If they do suppurate, more than one gland
takes on the process, and sinuses are more apt to be formed, which
is not the case with true venereal buboes.
381. A species of unhealthy suppurating venereal buboes sometimes remains after the treatment by mercurial inunction; the
irritating qualities of the large quantity of mercury rubbed in
seems to be the cause of this phenomenon. A more dilatory
employment of the inunction treatment, on the other hand, is
apt to change enlarged but not suppurated inguinal glands into
scirrhus.
382. In young persons buboes are apt to become scrofulous, in
old persons they tend to become cancerous.
383. A surgeon who exercises a due amount of attention will
not easily mistake a hernia, an abscess in the groin, or an aneurism
in the thigh for a venereal bubo.
CHAPTER II.
OBSERVATIONS ON THE ORDINARY MODE OF TREATING BUBOES.
384. When satisfied from  the symptoms present of the real
venereal character of the bubo, it is almost universally the custom
to attempt to disperse the inguinal swelling, discarding the ancient
notion that they are critical metastases of the poison and real
beneficial processes of nature, and that the way pointed out by
nature ought to be followed, which seeks to convert them into
abscesses, in order thereby at once to get rid of the venereal virus




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99

in the best manner.1    This delusion has, as I have said, been discarded and it is now sought to disperse them.
385. To accomplish this object no better method was known
than to rub in mercurial ointment (lard rubbed up with an equal
weight of the quick metal) in the region situated betwixt the place
of absorption (the chancre) and the deposit in the gland (the bubo);
that is to say, the mercury was introduced into the system in the
same way in which it had received the poison, in order that this
metal should pass through the gland, and thus, as was imagined,
destroy the poison at the diseased place.
386. This treatment, founded merely upon the course of the
lymphatic vessels, seems highly advisable in an anatomical point
of view, and Hunter takes great credit to himself for the discovery;
it involved the a priori unproved (and certainly groundless) supposition that mercury (it mattered not whether in the form of oxyde,
solution or salt)2 chemically destroys, as mercury, the venereal
poison by mere contact; and if under the inunction treatment it
passed through the swollen gland, it must necessarily come in
contact with all the poison, and therefore destroy it in its seat.
387. I admit the propulsive power of this metal, whereby it
removes mechanically some obstructions of the glands-for in truth
perhaps not above the two-hundredth part of the metal is oxydised
in the Neapolitan ointment; the result of the inunction treatment
moreover shews that the virus located in the inguinal gland really
yields to this ointment; but the inefficacy of all applications of
mercurials to chancres, and their injurious power (especially that
of the mercurial ointment) in hastening the absorption of the
poison from chancres into the general circulation, might have
taught that the mercury does not destroy the venereal poison as
mercury, not ex opere operato, but that a previous reaction of the
powers of the whole system (the mercurial fever) is required to do
that, either by directing the action of the mercury dissolved in the
fluids of the body to lay hold of the poison, or by extinguishing
the venereal irritation through the instrumentality of the specific
1 Hence the injurious advice given by ignorant practitioners even of the present
day, as soon as an inguinal swelling appears to indulge in dissipation, drinking and
venery, to ride, and in a word to do every thing to cause these parts to inflame and
suppurate. Nothing could be advised more repugnant to sense.
2 Or united with the fatty acid in the form of a salt.
H2




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ON VENEREAL DISEASES.

irritation excited in the whole sensitive system, or by means of a
peculiar change effected upon the metal during its concoction in
the secundae viae (probably by its combination with some assimilating substance from the animal juices) to render it capable of
effecting a chemical neutralisation of this virus.
388. This preparatory action of the animal organism on the
metal before it is capable of eradicating the venereal virus, should
not have been overlooked; its oversight has been the cause of so
many false steps in the treatment of venereal diseases, that the
history of this divine antisyphilitic specific leaves us in uncertainty
whether it have hitherto done more good than harm to suffering
humanity.
389. The innumerable instances of buboes and of general lues
caused by the merely local treatment of chancres by mercurial
topical applications,' and of buboes by the merely propulsive force
of the quick mercury contained in the ointment, would have
diverted the observer from a prejudicial theory to one of a more
beneficial character, had he not been led astray by certain accessory circumstances.
390. The internal employment of the mercury, namely, was
combined with its external application (to the chancre); hence
it followed as a natural consequence, that from the efficacy
of the former, the injurious character or inefficacy of the latter
could not be perceived. Buboes were dispersed by rubbing Neapolitan ointment into the groin, but the effects of the propulsion
of the venereal virus into the general circulation which inevitably
follow this treatment were not waited for, but the rubbing-in process was persisted in much longer, and in some cases the patient
was actually cured, and thus general (undeveloped) lues was produced, to be cured if so be it might.
391. If it were possible for the general lues venerea to break
forth during the employment of the very minutest portion of
mercury, it would certainly always be observed in the interval
1 If the virus be not absorbed into the circulation from the chancre under the
application of the mercurials, it will remain for ever undestroyed under their local
employment; this is an incontrovertible maxim of experience: otherwise the infinitely rare case must occur, in which the mercurial applied to the small surface
would be absorbed in sufficient quantity to produce the same effects as arise from
the internal use of the metal (mercurial fever, &c.).




BUBOES.

101

betwixt the disappearance of the bubo and the termination of the
rubbing-in treatment; and in truth it was always noticed, if any
considerable period of time were allowed to elapse after the disappearance of the bubo before resuming the rubbing-in (a convincing proof that the virus was not destroyed by direct contact
with mercury as mercury); or if after ever so long a continuance
of the rubbing-in, the action of a sufficiently intense mercurial
fever did not ensue, consequently the treatment was left incomplete, the lues broke out some time thereafter; in this case the
bubo had long disappeared, and yet the lues broke out.
392. The observation, that the same quantity of mercurial ointment rubbed into parts whence the lymphatic vessels do not pass
through the swollen inguinal glands, although it did not dispel
the latter so rapidly, yet effected a cure as often, might have taught
medical men that as in these cases the disappearance of the bubo
depended on the radical destruction of all the venereal poison, it
was foolish to deprive themselves of this most certain criterion of
the true destruction of the virus contained in the inguinal tumour,
by the useless local dispersion of the bubo. For immediately after
the local dispersion of the bubo by the Neapolitan ointment, the
venereal virus still exists in the system as intact as when during
the internal mercurial treatment the venereal inguinal bubo is
still present, only that in the latter case the persistence of the
bubo gives me the full assurance that the cure is not complete;
but this is wanting in the first case, and the physician deceives
both himself and his patient with a vain hope. For how is it
possible to demonstrate to both immediately after the inunction
treatment that the patient is not cured? It is only after the lapse
of several months, that the breaking out of the lues venerea will
shew them how greatly they have been deceived; every unprejudiced person will perceive how foolishly the physician has acted, in
himself extinguishing the light which alone could guide him along
the dark path to this desired goal.
393. Let it not be alleged that recent lues venerea requires no
more time nor mercury for its cure than buboes and chancres, and
that, consequently, it is a matter of indifference whether we have
to destroy the local or the general virus. For even though it
should in general require less time and mercury for the cure of
lues, it will always be much more difficult (at all events for the




102

ON VENEREAL DISEASES.

ordinary treatment) to cure lues, when it presents itself under such
an obscure form, and often takes such a long time before its
presence can be ascertained by indubitable signs; and even these
indubitable signs are often removed from the observation of the
physician by the smallest dose of mercury, long before we can
entertain an idea of the radical cure of the disease.  The employment of mercury should be persisted in until the complete
cure is accomplished.  But when is it accomplished? by what
sign shall we recognise the extinction of the virus?
394. How then can it be a matter of indifference whether the
venereal virus be treated in the form of lues or of buboes and
chancres, seeing that the latter especially and only' Idraw the
infallible boundary-line betwixt the complete and incomplete extinction of the miasm, when without local treatment and by the
sole internal employment of mercury they are cured and disappear
without leaving a trace behind, whereas the undeveloped or concealed lues has nothing of the sort to shew.
395. But on the other hand, how useless was the anxious direction of those who insisted on the necessity of rubbing in the
mercurial ointment exactly upon the part where the metal must
by means of the absorbent vessels pass through the swollen gland,
seeing that in many cases there does not exist a sufficiently extensive surface of the kind required for effecting this rubbing-in; as,
for example, when the bubo is seated near the body of the genital
organ or close to the pubic region in males, or on the round ligaments of the uterus or betwixt the labia and thigh in females.
396. But even this result of doubtful value could often not be
effected by the rubbing-in process performed on the most convenient spot (for example, on the thigh when the bubo was seated
below Poupart's ligament), it often remained hard and swollen
without going on either to resolution or suppuration; lues venerea
might thereupon ensue or not. The virus often only lies latent
in this indurated gland, and often breaks out visibly when the
inunction treatment, which debilitates by long-continued irritation
and violent evacuations, is discontinued, and the scrofulous diathesis excited by it is removed.
1 I have elsewhere shewn the deceptive character of the sign of the extinction of
the virus drawn from the severe affection of the mouth by mercury.




BUBOES.

103

397. If however it be frequently powerless to cure a single
bubo, how often must this be the case where there is a bubo on
each side, where even the most zealous advocate for the rubbing-in
system would not venture to rub in as much mercury as would
suffice to disperse the buboes and destroy the virus in the whole
system, as the quantity of mercury that would be required for
such a purpose would ruin the constitution.
398. Moreover, the rubbing-in of the Neapolitan ointment at a
distance   will at the utmost only succeed in dispersing a slightly
inflamed bubo, but not one of any considerable size that is on the
point of suppurating, far less one that is already in a state of
suppuration; on the contrary, a long continuation of the inunction
not unfrequently makes the bubo, when at length it suppurates,
an unhealthy, fistulous, corroding ulcer.
399. Now as every physician who is skilled in his profession has
recourse to the internal exhibition of mercury when there is
betwixt the place of absorption and the bubo no suitable place for
rubbing in the ointment, or when two buboes are present at once,
when suppuration has already commenced in the bubo, or when
after repeated employment of the inunction method for buboes
and their consequences there still ensue symptoms of lues, what
is it that prevents him from   employing it alone at the very commencement, in every case of bubo,2 if it be not partly that he has
overlooked those objections to the rubbing-in system, partly that
he has sometimes found his calomel, his corrosive sublimate, &c.,
inefficient and uncertain, or, in a word, if it be not because he has
not been acquainted with such an excellent preparation as the
soluble mercury is?
1 In cases where there is no surface of the body betwixt the place of absorption
of the poison and the bubo fitted for the rubbing-in, it has been the custom of some
to perform the operation on the bubo itself; but they did not consider that the
ointment cannot in such a case penetrate through the lymphatic vessels directly to
the empoisoned gland, and that the friction on this place would tend to promote that
inflammation and suppuration that was sought to be avoided.
2 In order to maintain the excellence of the ointment at the expense of the
internal employment of the mercury, instances are adduced where, during the use of
the latter means, buboes are said to have appeared, without the chancre being
removed by local remedies. A careful examination of such cases, however, will
shew that the chancres were not left without local applications, to which however
the injurious power of increasing the absorbing faculty of the lymphatic vessels was
not considered to be attributable.




104

ON VENEREAL DISEASES.

CHAPTER III.
TREATMENT OF BUBOES.
400. The same reasons 1 that have induced me when treating of
chancre to refer to the treatment of lues, lead me to do the same
in the present case in reference to the employment of the soluble
mercury, as neither more nor less is required for the cure of the
one than the other, namely, a sufficiently severe mercurial fever
(~ 290), taking care to avoid all the hindrances to the cure, as I
shall hereafter (~ 573-613) endeavour to show how.
401. For the reasons given above we must avoid all external
remedies, all rubbings-in of ointment; we must discard all other
mercurial preparations which are either inefficient or uncertain in
their operation, and make use of the soluble mercury in preference to all others.   We can employ it in all stages of the inguinal
swelling, at its onset, when it swells, and even when it is suppurating.2 In the first and second case, on the occurrence of the
factitious fever the buboes decrease and disappear (the sole and
most certain sign of the true cure and complete extinction of the
miasm); in the third it has often, contrary to all expectations,
produced its dispersion,3 and even when this was no longer pos1 In order to avoid repetition.
2 When Girtanner says, " During the suppurative process mercurial preparations
are highly injurious. As long as the patient is taking mercury, not only does the ulcer
not heal up, but it becomes aggravated and more virulent", he either means-but
this construction the sentence will not bear-an ancient bubo degenerated under an
excessive employment of mercury, or, as that cannot be his meaning, he intends to
discountenance an irritating, ineffectual mercurial treatment of the ordinary stamp.
He would invariably have seen the reverse from a mercurial fever rapidly developed
by soluble mercury. In that case he would not have needed to expose his patients
to the risk of having lues venerea, as he now does, when he forbids the employment
of mercury not only during the suppurative process, but even after the bubo is
healed up, " until symptoms of syphilis display themselves." Why this delay if his
former maxim (p. 250) be correct, as it undoubtedly is, "that syphilis always supervenes if we allow the bubo to come to suppuration"? " If given before this period
(previous to the appearance of the syphilis)," he says further on, " it has absolutely
no other effect than to debilitate uselessly the patient's system." How I pity every
honest man whom the badness of his mercurial puts in such a fright that may be so
prejudicial to his patients.
3 Certainly the most desirable termination of the venereal glandular swelling, if
it can be effected along with the simultaneous eradication of the miasm (g 420).




BUBOES.

105

sible it hastened the concoction of the pus, and the abscess was a
pure healthy ulcer that soon healed up, almost without pain and
without any ulterior consequences, for in this case the virus was
at the same time destroyed, which is the final aim of all treatment
for venereal maladies.
402. When, in such cases, I was convinced of the impossibility
of resolution, I first excited a slight commencement of mercurial
fever. I then discontinued the medicine, and as soon as the bubo,
after having burst in a healthy manner, commenced to heal up, I
excited by means of rapidly increased doses of soluble mercury, a
second more severe mercurial fever, which effected the cicatrisation and the complete eradication of the virus. Lint dipped in
milk is the best compress to employ.
403. If called on to treat a bubo of long standing that is
already in a state of unhealthy suppuration,' we must first ascertain the cause of its malignant character before we proceed to the
administration of the soluble mercury. If it have been mistreated
with emollient local remedies, we must employ balsamic digestive
remedies (composed of myrrh, yolk of egg and cocoa-nut oil) or
a mixture of decoction of oak bark with wine; if the ill-effects
were caused by irritating and corrosive substances, we must have
recourse to the local use of opium; but if the whole constitution
be ruined, this obstacle must be previously removed as much as
possible, in the manner detailed below (~ 573-585), if we would
obtain rapid and radical aid from the mercurial treatment; above
all we should seek to remove the debility and the irritability,
which has probably been caused by the long-continued employment of an excessive quantity of mercury and by the accessory
treatment usually employed in conjunction with it.
404. We have to remove almost the same obstacles, and to
employ almost the same preliminary treatment, where a longcontinued inunction of Neapolitan ointment or other inappropriate
external remedies have produced induration of the inguinal
tumour. We should endeavour to remove the irritable, weak and
scrofulous disposition by means of bark, opium, cold bathing,
In all cases of abscesses of glands, especially in unhealthy ones, we should take
especial care to avoid the use of emollient and relaxing applications.




106

ON VENEREAL DISEASES.

exercise in the open air, gentle emetics, burnt sea-weed and
volatile alkali, and we may employ externally with advantage
douches of sal-ammoniac dissolved in vinegar, dry cupping, and
sea-bathing,' in order to disperse the induration. If there be still
relics of the virus present, the internal administration of the
soluble mercury, after the system is improved, will hasten the
resolution.
405. Multiplied observations have established it as a maxim,
that it is best to let a bubo that has suppurated2 burst of itself.
It is the least painful process; the opening that is formed allows a
free passage to the pus, prevents the suppurating bubo from
closing up too soon, and leaves the most inconsiderable cicatrix.
406. Should we deem it advisable to make an artificial opening,
we ought, according to the advice of the most eminent authors, to
give a preference to the caustic potash, which is said to give much
less pain and to make an opening of a more lasting character than
the knife. The wound that remains is said to degenerate into an
unhealthy state much more readily when the knife is used than
when the caustic is employed. But be that as it may, the caustic
makes an opening much more suitable for the discharge of the
pus, and one through which we can more readily observe the
internal character of the abscess, and manage it more conveniently, as Franz Renner3 long ago taught.
407. It is only in cases where the opening of the bubo from
other important reasons becomes a matter of urgency, and when
the abscess is ripe and ready to burst, that the knife should be
preferred to the caustic.
408. But as the suitable employment of mercury often succeeds
1 Girtanner recommends volatile ointment to be rubbed in.
2 We may hasten the process, if it should advance too slowly, by applying warm
roasted onions, boiled in soap-water; or where the inflammation is greater by venesections, leeches to the part, and emollient fomentations impregnated with saffron.
3 " When the bubo is red and soft to the feel it should be opened. I seldom do
this with fleam, lancet or knife, but generally by the application of lapis caustic. so
as to make a pretty large opening, in order to allow the waste and impurity to be
the better discharged; and in this way we can obtain a much better view of what is
going on in the interior than by any other method, and can evacuate and cleanse the
abscess more conveniently," &c. (Ein new Handtbiichlin, 4to, Niirnberg, 1559,
p. 94.)




BUBOES.

107

in resolving buboes after suppuration has commenced, or when
that is not possible, facilitates and hastens their bursting, I scarcely
ever find it requisite to open them.
409. I have never required to make use of the resolvent power
of emetics, useful though they undoubtedly are, along with the
soluble mercury.
410. When it is doubtful whether a bubo arises from the sympathetic irritation of a declining gonorrhoea or from the true
metastasis of the venereal poison from chancres, it is always
advisable, before resorting to the employment of mercury, to
try the effects of compresses moistened with ice-cold water, which
speedily disperse that arising from the sympathetic gonorrhoeal
irritation, but have no effect on the true venereal one, or at
most will prevent it from anticipating the resolvent powers of the
soluble mercury by too rapid inflammation and suppuration. If
we should consider it still practicable to disperse a venereal bubo,
we may employ some other expedients in addition to the administration of the soluble mercury.    A   cool, hard couch, leeches
applied near the swelling,1 and ice-cold water compresses will be
found serviceable.
1 Girtanner advises the rubbing-in of volatile ointment beneath the gland.




PART SECOND.
SYPHILIS.
FIRST DIVISION.
DIAGNOSIS OF SYPHILIS.
CHAPTER I,
INTRODUCTION TO THE DIAGNOSIS OF SYPHILIS.
411. When the virus that produces the local affections of
chancres, gonorrheea and buboes, is absorbed into the general
circulation, it gives rise to an universal disease of the body, whose
visible effects may shew themselves on all the external parts; with
the exception probably of the seat of the previous gonorrhoea and
the situation of the former chancres and buboes.
412. When thus assimilated to the body, the virus changes its
nature almost entirely: from being previously a violent, rapid,
painful, inflammatory (very infectious) virus, it becomes (with the
exception of the affections of the tendons and bones) almost painless., slow and insidious, and the more insidious the longer it has
lain latent in the body; it no longer gives rise to chancre, gonorrhoea or bubo,' either in the same body or in that of another
individual, by inoculation.
413. The venereal virus cannot be communicated to and incorporated into the general fluids of the body otherwise than by
absorption from one of the two local affections that are caused
directly by local infections (gonorrhoea? and chancre), and from
them alone can buboes (the precursors of lues) arise; some rare
1 The cases that seem to shew it can do this are not quite clear; on the contrary,
they admit of a good many objections and doubts.




DIAGNOSIS OF SYPHILIS.

109

cases excepted, where the absorption occurs from an unaffected
part, that is to say, where the chancre-virus penetrates into the
circulation without injury to the epidermis.
414. According to Hunter, out of 10,101 persons affected with
lues, in one case at the very most might the virus applied to the
glans have been absorbed into the system without giving rise to
local symptoms. A hundred of these might be infected by the
absorption of the poison from gonorrhoea, whilst 10,000 receive
the lues venerea by the absorption of the virus from chancres,
almost always in consequence of their merely local treatment.
415. In the stomach the chancre virus is digested without
infecting the system, as Hunter found. Neither the breath nor
the perspiration of individuals affected with the venereal disease
communicates syphilis to healthy persons.
416. Where the disease has been communicated to mothers by
persons employed to suck out the milk, and to nurses by strange
infants, this happened by means of chancres on the lips, which
produced similar ulcers on the nipples, then buboes in the axilla,
and thence syphilis. Nurses, by giving their breasts on which
are chancres or the chancre virus to their infants, cause the
latter to have chancre on the lips, &c. Mothers inoculate their
children in the act of parturition; the chancres or gonorrhoeal
matter in their genitals is rubbed in through the tender epidermis
of their bodies, or penetrates into the genitals, mouth, eyes, nose,
or anus of the little creatures. The virus of general lues is not
communicated to the foetus either by the semen of the father or
by the blood of the mother; and just as little is the pus from
general venereal ulcers capable of producing either syphilis or
idiopathic venereal local affections by inoculation, according to
the observations and experiments of Hunter and some others.
417. Simple wounds in persons affected with syphilis may be
treated and cured by the ordinary vulneraries; the general venereal virus in the system apparently does not complicate them,
perhaps because the syphilitic poison itself determines the places
where it shall break out.
418. The nature of syphilis consists in a peculiar irritation of a
specific character distributed throughout the whole organism,1
1 Perhaps only in the lymphatic system?




110

ON VENEREAL DISEASES.

which gives rise to divers local changes and symptoms that are
accompanied by an insidious, scarcely observable inflammation,
and which shews itself, but only in sensitive individuals, by a slight
fever with uneasiness,' sleeplessness, anorexia, headache, and so
forth. This fever appears at first to be of a rheumatic character,
and then gradually degenerates into hectic. The fever may be
present before the local affections break out (and then it is easily
curable by mercury), or vice versa.
419. Syphilis may be disposed to break out more rapidly by all
sorts of derangements of the system, chills, overheatings, fevers,
and the like; and on the other hand, scrofula, gout, rheumatism,
erysipelas, &c., may be excited by its irritating action.
420. The tendency of this disease to be roused into activity and
to have its symptoms aggravated, in an especial manner, by cold,
is shewn partly by this, that in hot countries it is far from spreading so rapidly, and does not attain nearly the height, and can also
be more readily cured than in colder climates; partly also by this,
that the symptomatic venereal local affections appear only on the
external surface of the body, and chiefly on those parts that are
most exposed to the cold air.
421. Although, as has been observed, all parts of the body seem
to be infected by the lues venerea at once, yet some local affections
appear usually sooner than others. The former may be called
those of a proximate, the latter those of a more remote kind; the
latter generally occur at a much later period than the former,
often only after these are healed, and then the susceptible part is
probably, before their outbreak only, in a state of simple infection.
422. Before proceeding to an enumeration of the local affections, I must observe that the older authors, and even those of the
most recent period, indicate such a large number of symptoms
and modes of breaking out of syphilis, that one is uncertain
whether they have been deceived or have sought to deceive others.
All kinds of cutaneous eruptions, ulcers, indurations and swellings
of the fluid, soft and firm parts, of the bones and ligaments, all
1 There is usually an anxious solicitude about the incurability of the enemy
within and its devastating progress. With grief they see the poison that nature is
unable to eradicate gradually preying upon their organism, nor is it possible to
allay their anxiety by reasoning with them, nor to comfort them.




DIAGNOSIS OF SYPHILIS.

111

conceivable diseases of the brain, nerves and viscera, in a word,
all maladies of the body that did not yield to a slovenly system of
treatment were pronounced to be venereal.
423. This multiplication of pretended venereal symptoms dates
from that remote period when no proper attention was paid to the
course of this disease, and when ignorance of the diagnosis and
treatment of chronic diseases was concealed under an array of
names that were either pure inventions or had no definite meaning
attached to them: they were attributed to magic, to the omnipotent influence of sidereal influences or of the Archaeus, to the
morbific principle of the acids, to hypochondriasis, to piles, to
spasms, to the venereal disease, to infarctus, &c., for the purpose of
enabling physicians to include them, with a good grace, in the list
of diseases excessively difficult to cure, and so to obtain for an
uncertain art a surer footing with the uniniated, to give it a more
important air and to increase the profits of its professors.
424. In addition to this, everything that did not yield to the
general mode of treatment by purgatives and venesections, but
was cured by salivation, was said to be of a venereal character,
because it was assumed that the latter alone were amenable to
salivation.1 Dropsies, hydrocephalus, cutaneous affections, old
scrofulous ulcers, pulmonary consumptions, inveterate agues, &c.,
were cured by salivation, and thereupon these maladies, by this
mode of reasoning, were pronounced to be venereal affections.
425. In order to escape from this labyrinth of opinions which
complicated to such an extent the true nature of syphilis, and so
effectually effaced the boundary line betwixt truth and error, we
shall proceed upon the safe path of scepticism, and only describe
those symptoms of syphilis the genuineness of which is not called
in question by any writer of eminence or practitioner of experience, but shall pass over in silence all other alleged symptoms,
until indubitable facts shall remove all doubts as to their hitherto
assumed origin.
1 Hence the work made about so-called masked syphilitic diseases and their
vaunted cure by mercurials, generally by salivation. How were they recognised
beneath this mask? Was not the inference drawn from the efficacy of the remedy?
By a similar process of ratiocination obscure diseases may henceforth be considered
of a scorbutic character if they are curable by water-cresses.




112

ON VENEREAL DISEASES.

CHAPTER II.
DIAGNOSIS OF SYMPTOMATIC VENEREAL LOCAL AFFECTIONS OF
THE MORE PROXIMATE KIND.
426. The most certain symptoms and local affections of syphilis
of the more proximate kind are the venereal spots, among which we
may include venereal pimples, ulcerations of the skin and mouth,
onychia and rhagades on the hands.
427. From   six weeks to several months, at most-and that
rarely-six months after the presumed absorption of the idiopathic
venereal poison, the skin of the anterior part of the body, first on
the pit of the stomach, then on the forehead, face, and so on, is
observed to present a bright coloured, spotted appearance. These
spots become in course of time of a definite form, rose-red and
darker. On those parts the skin shines through the epidermis as
if semi-transparent, especially in warm weather or when the body
is otherwise very warm. These spots do not however project
above the general surface of the skin where they are located, nor
do they occasion pain or itching. There the lightest coloured
spots gradually disappear, the darker ones remain and assume a
round form of from four to ten lines in diameter. In course of
time the epidermis covering them scales off, and the spot seems to
be scarcely red any more. We might suppose it was going away
entirely. But soon afterwards it appears again, the epidermis
again scales off, and this takes place several times successively.
The more frequently this takes place the more elevated (though
but slightly so) the rougher, the more yellowish red1 and hard is
the epidermis that comes off; the spots then begin to be surrounded by a whitish circle. The warmer parts of the body,
betwixt the nates and betwixt the legs, present redder spots than
those exposed to the air.
428. The more frequently the spot throws off its epidermis, the
rougher, harder and thicker does it become, and then it is termed
a scab (schorf).
429. Every scab that comes off is replaced by a new one of
larger size.
430. At first the spot beneath the scab that falls off is dry, but
1 They are then called rust spots (copper-coloured spots).




DIAGNOSIS OF SYPHILIS.

113

at last, when it becomes too thick to allow the exhalations to
escape, a humour is formed beneath the scab, which rapidly dries
and forms a scaly base.
431. Beneath the latter the skin becomes corroded by the acrid
humour, and after several scabs have been thus thrown off there
occur open venereal ulcers,
432. These spots are frequently seated at the borders of the
hairy parts of the body, on the chest about the hairy part of the
axilla, on the temples, round the forehead and behind the ears,
at the border of the hairy scalp, at the circumference of the hairy
parts of the genitals, and so forth; also betwixt the shoulders, and
then the hairs fall out from those parts; also on the beard, the
eyebrows, &c.
433. In the palms of the hands and soles of the feet they also
throw off one layer of epidermis after another; on account of the
natural thickness of the latter no scabs are formed in these situations, but the furrows in the skin termed the lineaments at last
crack, the epidermis splits and forms raw chaps, which go by the
name of venereal rhagades.
434. On other parts of the body also, as has been said, there
occur no dry scabs of the above described kind. If, for instance,
the spots are on parts that are usually covered by other parts of
the body opposite to them, betwixt the nates, betwixt the scrotum
or.the labia majora and the thigh, in the popliteal space and under
the arms, where the transpiration is more copious, they do not
become covered by a dry bark, but are invested with a moist
greyish white substance, through which a humour exudes.
435. When, as is not unfrequently the case, venereal spots
occur beneath the nails of the fingers, they also shine through of
a red colour. Gradually the root of the nail is affected, the nails
fall off, and a new, irregular, imperfect one appears. If no remedial means are used, then venereal ulcers are formed at the root
of the nails, which are called venereal onychia.
436. All these cutaneous affections, even after their transformation into scabs and ulcers, are wonderfully free from pain.
427. The so-called venereal pimples or venereal, itch are just as
little sensitive; they arise from small, reddish spots, much less
raised above the skin than other pimples; they have not such
dark areolse, and neither itch nor burn. They appear mingled




114

ON VENEREAL DISEASES.

with the copper-coloured spots on the forehead and other parts.
Some are deeply seated in the skin, and these produce bran-like
scales; others, though also seated deeply in the skin and in like
manner small and red, possess a hardness like small buttons, and
there exudes from their apices a small drop of reddish coloured
lymph.' It is only on those parts of the body that are covered by
other parts, in the flexures of the elbows and knees, &c., that
they are somewhat painful and exude more moisture. Just as, on
the external surface of the body, the general venereal ulcers above
mentioned gradually arise from venereal spots, so is it with the
ulcers in the throat and mouth,2 which on account of their
earlier appearance I shall treat of before the ulcers of the skin,
although they resemble each other in their essential nature.
438. The dark-red, painless spots on the tonsils of the throat,
at the back part of the inside of the cheeks, on the palate, on the
lateral aspect of the tongue (in the angles of the lips?) are often,
on account of their want of sensitiveness, not observed, until, after
frequent, generally unnoticed throwing-off of the thin epidermis,
they become somewhat elevated, and until a moist, whitish crust
covers the part, which cannot be wiped off, becomes thicker and
thicker, and eats more and more into the subjacent substance.
1 They may be distinguished from so-called heat-spots and other pimples on the
skin by the latter forming small abscesses, or soon dispersing and disappearing
without causing any change in the skin, as Girtanner rightly observes.
2 Andr6 does not regard ulcers of the tonsils as a sign of general lues, but as an
idiopathic venereal affection or something similar, that is to say, as a transference
of the chancre to these parts, because he says that the chancre on the genitals manifestly declines when the ulcers on the tonsils appear; that the latter occur soon after
the disappearance of the former; that tonsillar ulcers frequently occur without any
other symptom of syphilis, and that, like chancres, they are capable of producing
local infection, as for instance by kissing. The first proofs are of no value, even
though they were correct, if the power of causing local infection be not certain, which
we have great reason to doubt. Moreover, this does not agree with the observation
that chancres, whenever the poison for the production of a bubo (most assuredly an
ulcer very analagous to the chancre) has been absorbed, are not always thereby in the
least ameliorated; they may cause all this and still go on increasing. Now as all the
circumstances whence the physician must draw his inferences of this kind, in general
involve to such a degree the honour of the patient, our enquiries will often elicit
the most downright falsehoods on the part of persons otherwise of most trustworthy
character. The ulcers of the tonsils are of the same nature as other symptomatic
venereal ulcers, whose great difference from chancres may be readily perceived by
comparing the description of chancres (ý 260) with that of ulcers of the tonsils
(ý 438-447).




DIAGNOSIS OF SYPHILIS.

115

439. In these soft, warm, moist parts covered with such a
thin epidermis, the venereal spots pass much more rapidly into
ulcers than when they are seated on the more external surface of
the body, and their transition into tonsillar ulcers is at first so
little observed, both on that account and because they are not
particularly perceptible to the feeling or the sight.
440. When their tough crust falls off from the motions of these
parts, swallowing, &c., or from an impulse from within, we observe
somewhat excavated round ulcers, with well-defined whitish borders.
441. These venereal ulcers of the throat are so little sensitive
that they do not cause any actual pain, but only on swallowing a
feeling of rawness and slight shooting as if the outer skin of that
part had come off; the part whereon they are seated too is neither
swollen nor hot, their circumference and base is not hard, as is
the case in other ulcers of the tonsils, quinsy, &c.      Still these
ulcers spread more rapidly and are a little more sensitive than the
other general venereal cutaneous ulcers on the surface of the
body. In some few cases they impede speech a little.
442. The tonsils' are usually the first (and in most cases the
only) parts of the mouth that are affected by venereal ulcers.
443. Sloughs or ulcers in the throat that do not occur till a
year after the disappearance of the idiopathic venereal local affection (e. g. a chancre) do not seem to be of a venereal character.
444. Venereal spots on the skin last several months before they
form scabs, and these again some months before they penetrate
sufficiently deep to constitute open cutaneous ulcers, so that the
latter often only appear from ten to thirty months after the
absorption of the chancre poison into the general circulation.
445. Although the venereal cutaneous ulcers usually arise only
from the scabs of the venereal spots and from the venereal pimples, appearing as discrete ulcers, from six to ten lines in diameter,
chiefly confined to the anterior surface of the body, first in the
forehead and top of the head, in the face, alae nasi, on the muscles
SScorbutic ulcers usually attack first the gums, which then bleed very easily,
before they reach the tonsils; they are not like the venereal ulcers of a defined
round form, they have no whitish borders, no whitish-grey excavated bottom; on
the contrary, they are angular, bluish and filled by spongy looking flesh; scorbutic
ulcers are accompanied by other symptoms of scurvy, and venereal ulcers usually
by symptoms of syphilis.




116

ON VENEREAL DISEASES.

of the neck, &c., but afterwards also on the legs, principally over
the tendinous expansions (fascie); yet this is not always the case,
for when the spots are seated very closely together, the small
ulcers unite to form a larger one which has sometimes a diameter
of six inches, as I have not unfrequently observed upon the vertex
and forehead, on the sides of the neck and other parts, as also on
the legs. But even when as large as this they retain as much as
possible the rounded form.
446. On other parts also where spots are but rarely observed,
e. g. on the body of the penis, we see venereal ulcers occur, which
however differ from those lying on muscular parts or bones in
being somewhat more sensitive and painful; they increase more
rapidly in extent, and their red bottom, covered with small
elevated fleshy granulations, becomes raised, like a cancerous
growth, almost above the borders, which are however neither
everted nor discoloured, nor hard, as they are in cancer.
447. On the other hand, the other general venereal ulcers on firmer
parts already alluded to, have some, though but a shallow depth,
often only one line,' still oftener but half a line of depth. Their
bottom, which is rose-coloured, smooth and firm, spreads out in
an undulating manner, is raised slightly towards the borders, that
are almost level with the sound skin; there is no perceptible inflammation nor hardness about the borders nor surrounding them.
They have this peculiarity, that they almost always retain their
round form. They are distinguished by the indolence of their
course: they arise gradually, without any previous symptoms of
inflammation, itching, burning, &c., out of copper-coloured spots
and venereal eruptions, are accompanied by very insignificant
pains, even when of considerable extent; they secrete a thickish
not viscid matter, like melted tallow, and of a pale green colour;
they are sometimes covered with a cheesy substance. They may
sometimes be healed up by means of astringents; but then others
occur in other parts. As a general rule the general venereal ulcers
on the head, &c. (the parts nearest the heart), heal up before those
1 Besides the skin they appear to destroy only the cellular structure containing
the fat, at all events the depressed, hard, shining cicatrix appears to be closely
united to the underlying solid parts, e. g. the muscle, and the latter loses its power
of movement. The hairs upon the seat of the ulcer do not again grow, as their roots
are destroyed.




DIAGNOSIS OF SYPHILIS.

117

on more distant parts, e. g. the legs, just as at first they appeared
sooner on the former than on the latter parts. Does the healing up
of a portion of such ulcers give evidence of a diminution of the
syphilitic virus (I believe it remains the same), or does the cause
of the phenomenon consist in this, that these parts have at length
become insensible to the venereal irritation, whilst the newly
attacked parts, unaccustomed to this irritation, have.more susceptibility for it?  The first general venereal ulcers, for example
those on the tonsils, are more sensitive and spread more rapidly,
and the other symptomatic venereal ulcers become all the more
indolent in their extension, and all the less sensitive the longer
the virus has existed in the body. (Even gonorrhoeas become all
the milder the oftener they occur in the same individual, and he
becomes less susceptible to infection. These are facts that demonstrate a predisposition for the poison, which the above serves to
explain, at least to illustrate). General venereal ulcers do not
propagate by inoculation either idiopathic venereal virus or lues
venerea. All these circumstances are sufficient to distinguish
them from all other kinds of ulcers.
448. Pulmonary phthisis occurring without haemoptysis and
during the existence of evident local affections of syphilis that has
not been treated medicinally," should be regarded as venereal in its
nature. When I said that lues venerea only attacks external
parts (according to the best observations), venereal phthisis is no
exception to this. The lungs have, in reference to the air that
surrounds us, a great resemblance to the external cutaneous surface; their transpiration is even greater, and they are oftener
exposed to the cold of the atmosphere (on account of the frequent
respirations) than the skin; why then, seeing that the lungs are
obnoxious to similar diseases,2 should we hesitate to believe that in
this case they will also follow the nature of the skin, and on
account of their frequent exposure to the cold air be liable to
venereal eruptions and ulcers? 3
1 We might add: which, along with the syphilis may be rapidly and radically
cured by simple mercurial fever, without any need for salivation. It has also
sometimes cured non-venereal phthisis by revulsion.
2 Various cutaneous eruptions are accompanied by chest-diseases, and the drivingin of the former is often followed by the occurrence of the latter.
3 A poor woman, forty years of age, had had for some years several venereal




118

ON VENEREAL DISEASES.

CHAPTER III.
DIAGNOSIS OF THE SYMPTOMATIC VENEREAL LOCAL AFFECTIONS
OF THE MORE REMOTE KIND.
449. I have already stated that these affections usually occur
many months and even some years after the absorption of the
idiopathic venereal virus, often after all the affections of the proximate kind are healed and gone, sometimes by topical applications,
sometimes by the internal employment of mercury in quantity
sufficient to cure them, but not to eradicate the infection in
distant parts. Sometimes they occur along with affections of the
proximate kind, seldom without any pre-existence of the latter so
as to constitute the sole local symptoms of lues venerea.
450. In all cases the symptoms of the more remote kind testify
to the greatest obstinacy of the syphilitic virus, which has become
as chronic and insidious as possible.
451. In this case also the nature of the poison betrays itself by
its usual course of selecting those parts of the body for its seat
which lie nearest to the cold atmosphere.
452. The tendinous expansions (fasciae) and the periosteum         on
those bones that are of the hardest structure and not covered by
muscle (consequently the coldest), on the bones of the skull, especially the most projecting parts of the parietal and frontal bones,
on the dorsum of the nasal bones, on the anterior flexure of the
ulcers on the hairy part above the forehead and on its upper part, also occasionally
a dry cough. In the year 1787, these ulcers having been healed up by means of
mercurial plasters, the anterior part of the thigh and leg became affected with many
ulcers of the same kind. She also applied various things to these parts, and a
number of them healed up. She now became affected by a more violent cough,
great dyspncea and moderate fever, that was ameliorated on the occurrence of purulent expectoration. The expectoration was very copious; her strength did not,
however, diminish proportionably; the ulcers on the legs were still present in considerable numbers, but, as she said, without pain. I made her lay aside the plasters
and take in the course of eight days six grains of soluble mercury in increasing
doses. She became affected by severe sickness, disgust at food, and a feeling of
illness that she could not describe, but without a trace of ptyalism. She was at the
same time costive in the bowels. In the mean time the cough and expectoration
went off, the breathing became as free as if she had never ailed anything in that
respect. The ulcers were healed up in the course of fourteen days after the first
dose of the remedy, and for fourteen months she has been quite free from all venereal
and chest affections.




DIAGNOSIS OF SYPHILIS.

119

clavicle, on the coracoid process, on the external protuberance of
the elbow (more rarely on the internal one), on the anterior
surface of the tibia, seldom on the ribs, become gradually enlarged
by a hard swelling, which either extends without any well-defined
limits, or is of a circumscribed round shape (venereal nodes). It
is, especially in the former case, so hard, and is so closely attached
to the bone, that one would take it and it has been considered as
an osseous tumour.
453. These tumours and nodes are at first unaccompanied by
pain, and are usually not noticed until with the lapse of time
pains occur in them, that gradually increase in severity, so that it
seems to the patient as if the bone were hacked to pieces or
crushed, as if it consisted of two dry pieces that were rubbed
against one another, or as if something were gnawing therein. They
occur in greatest intensity at night, especially towards the morning,
but in some rare cases they are equally severe during the day.
454. At this period the swelling is very painful on being
touched. At first there does not seem to be any inflammation;
but in this later stage it sets in and increases ever more and
more, until at length the swelling gradually-often some years
after its first appearance--bursts, and discharges an albuminouslooking matter.
455. In these circumstances the subjacent bone is almost always
corroded, on account of the destruction of the periosteum, or at least
it is very nearly approaching to a carious state and is swollen.1
1 In order that we may be able to treat these swellings in time, we must be
satisfied of their venereal nature, which is sometimes difficult In order to aid our
diagnosis the following circumstances should be attended to.-Rheumatic swellings
of the bones, and pains, usually occur at the joints where the osseous structure is
spongy; they are preceded by redness and inflammation of the superincumbent soft
parts, pain and fever, and when these symptoms, which are usually of a sudden
character, are past, then only does the node commence to deposit its calcareous
matter in the ligaments; gradually it becomes free from pain. Cold baths, frictions
and aconite diminish and remove commencing rheumatic nodes. By warm applications to parts affected with rheumatic pains the pain is ameliorated; cold baths are
a good remedy for them. They are not only not diminished (permanently) by the
most violent mercurial fever, on the contrary, they are thereby aggravated and
rendered more obstinate and incurable. Distilled spirits cause fever, but no pain in
the rheumatic nodes.
Venereal nodes and periosteal swellings, on the other hand, are seated in the
parts indicated above (ý 452) of the bones of densest structure, probably never on




120

ON VENEREAL DISEASES.

456. It is, however, difficult to determine the time when the
node changes into the abscess which is fraught with so much
danger to the bone beneath.       There is little inflammation present,
and that which may exist is too slight to produce a properly
elaborated pus; a thick mucous albuminous matter is formed that
lies close upon the bone and corrodes it. This circumstance and
the hardness of the node prevent us perceiving any fluctuation.
457. But if we carefully consider the inflammation, slight though
it be, and the throbbing and shooting pains experienced by the
patient in the centre of the node, it will not be impossible to
discover the formation of this kind of abscess.1
458. On no part of the body do the bones lie nearer to the
atmospheric air, in other words are covered with so little and such
soft parts, as in the nose. Hence the delicate nasal bones are
usually the first that are acted upon by the venereal virus after
the soft parts covering them (the Schneiderian membrane) are
completely or partly destroyed. Generally the ethmoidal and
the capsules of the joints. At their first appearance they are quite destitute of
pain; it is only afterwards that they are accompanied by it, without any perceptible
local inflammation, without swelling of the skin, and it increases so progressively
that it attains at length such a degree of severity that the pains of the nodes not
only continue to gnaw uninterruptedly (especially after midnight), but even merely
touching the part becomes quite intolerable. The contents of the swelling, when it
is cut into, are of an albuminous character. External warmth increases these pains
in the bones; they are also aggravated by cold baths, by friction, and by partaking
of spirituous liquors. Aconite and bitter vegetable extracts afford no relief. An
adequately strong mercurial fever removes the pain speedily and permanently.
If a faithful confession of the previous infection be made, or if there are present
several symptoms of syphilis, we can the more speedily become convinced of the
true nature of these nodes and pains in the bones.
The barometrical pains of the elevated cicatrix (callus) of an old fracture of a
bone cannot easily be confounded with the pains of venereal nodes, partly on account
of the difference in the shape of the swelling, partly because the history of his
case given by the patient helps us in our diagnosis, partly also because the pains of
the callus usually occur when the weight of the atmosphere is diminished, and are
more of a tearing and drawing than of a gnawing and boring character, and are
besides ameliorated by the cold shower-bath, which increases those of venereal nodes.
1 Gardane includes among the symptoms of syphilis that sensitiveness of the
mouth of the womb which is increased to intolerable pain on the occurrence of the
catamenial period, on the introduction of the finger or of the male organ, and which
is frequently the cause of miscarriage (probably also of cancer of the womb). I
myself have frequently observed this affection, but am unable to determine if it is
venereal, as I have had no opportunity of treating it. Gardane recommends the use
of cinnabar fumigations for it.




ANTIVENEREAL REMEDIES.

121

turbinated nasal bones, that is to say the most delicate ones, are
the first destroyed; then the vomer, the palatial bones, and lastly
the maxillary bones.
459. But as has been said before, the bones beneath the venereal nodes become also corroded, and necrosis is the result, which
does not differ from ordinary caries from other causes, except that
S it is more rapidly cured by the aid of mercury.
SECOND     DIVISION.
ANTIVENEREAL REMEDIES.
CHAPTER I.
MERCURIAL PREPARATIONS IN GENERAL.
460. Ever since the wide diffusion' of the venereal disease,
immediately after the discovery of America, when mercury was
apparently at the first used for this disease, no one has been able
to deny with reason the specific curative powers of this metal in
that fearful disease; although from the year 1515 until the middle
of that century, medical men having been frightened by the murderous employment of that drug by empirical practitioners, sought
to replace it, first by guaiac, then by sarsaparilla and bark.
461. But as this liquid metal can only be brought by artificial
preparation into a fit state to be taken into intimate combination
by the fluids of our body2 in sufficient quantity, so an infinite
number of mercurial preparations were invented, the almost end1 Girtanner, by adducing the original authorities, renders it highly probable that
it first came from America in the year 1493, and was first brought to Barcelona by
the ships of Columbus.
2 Mercury does not act on the venereal virus until it is dissolved in our juices,
and then it developes its effects in a pretty uniform manner in the secundae vise.
Mercurial preparations that are not powerless all act upon the mouth, but with
different degrees of intensity, pure quicksilver and corrosive sublimate less powerfully than the others. All produce the same taste when dissolved in the saliva; the
saliva of those that are salivated has a similar odour, by whatever preparation the




122

ON VENEREAL DISEASES.

less list of whose names in the ancient dispensatories, especially
those of Falk and Baldingen, and in the London pharmacopoeia,
fills us with astonishment. It would be sad indeed if only those
who had extensively tested all these mercurial preparations in
their own experience were qualified to treat the venereal disease
properly. A long series of generations were not sufficient to do
so. Strictly speaking we require but one, the best preparation.
Had medical men always had in view the attributes of such an
one, based on true physiological and therapeutical principles, they
had not fallen into such adventurous speculations.
462. Now how can we ascertain which among the innumerable
mercurial preparations is the most efficacious, the most certain, and
the mildest, seeing that in this pitiable disease we should regard
Celsus's maxim of cito, tuto et jucunde as our highest aim, much
more than in almost all other corporeal ills, which beneficent
nature alone is often able to conquer without any aid from man?
463. I think I do not err, if, as an answer to this, I lay down the
following maxim, that that mercurial preparation is the most efficacious, the most certain and the mildest which is completely soluble in
our juices, can readily be taken up by the system of absorbent vessels,
and, not rendered corrosive by combination with any chemical substance, is capable of exciting the pure and simple specific powers of
this metal. Such a preparation will possess the virtue of producing definite effects, which it will be in the power of the physician to regulate, diminish and increase with certainty.
464. The farther all known preparations diverge from these
attributes, so much the more inefficacious, so much the more
injurious are they; cinnabar and turbith may serve as examples.
I shall briefly pass in review the most ordinary preparations
judged by this standard.
465. As regards the corrosive mercurial medicines, it will
ptyalism may have been produced. The greatest difference among them that is noticed
by the superficial observer consists partly in their greater or less solubility in water,
which differs widely from the property they possess of being assimilated by our
juices, as they possess this property in very various degrees quite independent of
their solubility (thus the sublimate is much less assimilable by our juices than
oxydised mercury); partly in their action on the prime vias (thus corrosive sublimate, the yellow, white and red precipitates, act chiefly in a poisonous manner on
the stomach, calomel chiefly on the bowels).




ANTIVENEREAL REMEDIES.

123

readily be granted that it is impossible there can exist in the
mineral acids to which they owe their excessive acridity anything
curative of the venereal virus (for the dessiccant and antiseptic
power that they display in wounds and elsewhere does not come
into play here). Among these corrosive preparations I include
the nitrate of mercury, the corrosive sublimate, the various white
precipitates,' the red precipitate,2 calomel and turbith.3
466. If greater efficacy in this disease has sometimes been
observed from the use of these preparations than from the less
active ones, this arose from the accidental irritant qualities of the
acids combined with them, but only in the same manner as other
not specific irritant remedies act, such as the volatile alkali, the
acrid resin of guaiac, mezereum, lobelia and cantharides-also from
their exciting an accidental fever which sometimes promotes the
cure of syphilis by mercury, by rousing the activity of the nervous
power, increasing the force of the circulation, and thus as it were
facilitating the detection of the recondite virus by the only specific
drug, or because, by setting up an irritation of a different kind,
they silenced the venereal irritation, as rheumatic pains are subdued by blisters, dysentery by ipecacuan, or intermittent fever by
arsenic; these substances thus remove affections without possessing
any specific action upon the diseases just named.
467. But, as I have said, the borrowed irritation of these preparations is far from contributing materially to the cure of the
venereal affections; it often smothers the specific power of the
metal to such a degree, and is so uncertain in its action, that it
not unfrequently happens that we may kill, but are unable to
cure a patient affected by inveterate syphilis, with calomel, sublimate, nitrate of mercury, white and red precipitates and turbith.
468. Were it easy to prepare mercurial salts with vegetable
acids in a ponderable definite form, it would be much preferable
to administer these than those just described. But this cannot be
1 Mayerne was, I believe, the first who in 1659 recommended the internal use of
ordinary white precipitate.
2 About the year 1535 Matthioli first recommended the internal use of red precipitate (calcined and washed a second time) five grains for a dose. According to
Girtanner it was Joh. Vigo who first employed it as early as 1513.
3 William Cowes was, I imagine, the first who in 1575 counselled the internal
use of turbith in syphilis.




124

ON VENEREAL DISEASES.

done, and moreover such salts in a concentrated form have something in them that excites the sensitive fibres of the primne viae
much more readily to evacuations upwards and downwards than
to absorption into the secundas viav, where alone the mercury is
truly efficacious. Experience also shews that they readily cause
salivation, and still frequently fail to effect the cure.
469. On the other hand, as might be supposed, it is inadvisable
to employ internally for the treatment of syphilis the almost insoluble mercurial preparations, such as cinnabar, Ethiops mineral
prepared by the humid process (pulvis hypnoticus) or by the dry
process, for they usually produce no perceptible action, and then
perhaps all at once, though rarely, cause ptyalism.
470. The cause of this uncertainty may be, either that we are
unable always to determine how much there is in these preparations capable of being taken up by our fluids, or what quantity
there is in them capable of penetrating into the secundae vie; but
this well-grounded objection of uncertainty of action applies also
to Plenck's mucilaginous preparation of mercury, and to those preparations in which the quicksilver is extinguished by sugar, honey,
crabs'-eyes, fatty substances, balsams, &c.
471. If it is sought to lay the blame in such cases on the great
variety in the susceptibility of the absorbent vessels of the primse
viae, I reply that this very circumstance is to be attributed to
these preparations, that they are not of such a character as to
enable them to be uniformly received into the system by every
degree of susceptibility of these vessels, and I am fully convinced
that the fault of this occurrence lies in the infinite variety of the
solubility of these preparations in the gastric juice, and the extraordinary variety of their capability for being taken into the
secunda vise, and not in the great difference of the solvent and
absorbent powers of our system (which it is not possible to conceive can exist to such an extent).
472. What there is of a serviceable character in these latter
preparations consists in the proportion of mercury that has been
oxydized in them during their preparation; but as this varies so
much (according to the nature of the medicine, the temperature
of the atmosphere, or the force, time and skill of the preparer) that
sometimes the twentieth part, but often scarcely the two hundredth
part of the metal employed is oxydized, it follows that we can




ANTIVENEREAL REMEDIES.

125

never reckon confidently on obtaining a certain effect; these preparations must sometimes be almost inert, while at other times
when the physician expects a moderate effect he finds the most
violent action occur from their use.
473. Of equally uncertain effect are the mercurial fumigations,
whether cinnabar, calomel or amalgam be employed for this end,
partly on account of the difficulty of applying them equally to all
parts of the body at once, whilst avoiding a respiration of them,
partly on account of the very various absorbent power of the
cutaneous vessels. In the employment of this, as in that of the
other mercurials we have mentioned, we are not in a position to
calculate the quantity of the metal introduced into the body, and
yet we should have a positive knowledge of the dose of the remedy
as well as of its potency, in order to allow us to make an accurate
repetition of a medicinal experiment.
CHAPTER II.
PARTICULAR MERCURIAL PREPARATIONS.
474. Mercurial ointment has been employed since the thirteenth
century in various forms, and with various admixtures, for the
cure of leprosy, itch, and other cutaneous diseases. At the end of
the fifteenth century it was at once employed to combat the
venereal disease that had then gained a fearful height, as it was
held to be a similar cutaneous disease.
475. Its use has never been quite abandoned; and notwithstanding that attempts have been made from time to time to replace it
by some better internal remedy, as occurred in preceding centuries
as well as especially about the middle of the present century, yet
it has at all times been resorted to in extreme cases. In recent
times also, after the fond dream of the omnipotence of corrosive sublimate was dispelled, the ointment was again promoted
to the rank of an antisyphilitic remedy.
476. The chief reason for the preference given to it, I believe,
lies in this, that it is imagined: "1. That the greater the quantity'
of mercury that can be introduced into the body in a given time,
1 No other way was known of introducing the largest quantity of mercury into
the body but by means of the ointment.




126

ON VENEREAL DISEASES.

the greater is the certainty of curing the venereal disease. 2. That
the metal when rubbed into the skin does not incommode the
primae vie like the preparations of mercury given internally: and
3. That by means of frictions we can apply the mercury exactly to
the spot where its presence is most required, in order to be
efficacious."
477. It is very easy to refute these three maxims that have served
to obtain for inunctions such a great preference in practice. The
first is overthrown by the experience that the smallest quantity of
mercury, if it do but excite a sufficiently strong mercurial fever
(~ 290) is capable of eradicating the greatest degree of the most
deeply rooted syphilis, and that the subtle exhalation proceeding
from the saliva of a salivated person, which is certainly impregnated with a scarcely ponderable quantity of the metal, has
sometimes succeeded in curing the venereal disease. On the other
hand, we often find that some almost incurable diseases are the
result of a larger quantity of mercury gradually introduced into
the body; such as, irritability from weakness, hectic fever, chronic
trembling, scrofula, caries of the bones, and so forth, without the
venereal poison being thereby eradicated. The second point is
weakened by the observation that colicky diarrhoeas not unfrequently result from  frictions with mercury.    As regards the
third maxim I have already expressed by opinion (~ 387), where I
shewed that the mercury must first permeate the whole mass of
the blood, and undergo a sort of digestion or intimate assimilation,
before it is capable of overcoming venereal affections, that, consequently, the local power of this metal over the venereal poison is
illusory, and often does more harm than good.
478. But the following maxims, deduced from experience,
irrefragably demonstrate the doubtful propriety of employing
frictions. 1. The quantity of metallic or oxydised mercury that
can be introduced into the body by rubbing in the ointment
cannot be determined, and is entirely uncertain. 2. There are
often obstacles that prevent the rubbing-in. 3. The frictions are
often not suitable for the disease. 4. They are frequently injurious.
479. In reference to the first point, it should be remembered,
that the power of the person who rubs in the ointment can never
be determined, can never be relied on. If strong rubbing-in




ANTIVENEREAL REMEDIES.

127

favours the absorption, if it be done more weakly the absorption
will be much less. But if, as some allege, stronger friction prevents
the absorption, the same variety in reference to the quantity of
mercury that penetrates into the body will occur, but in the
inverse ratio of the force employed in the rubbing-in.
480. Be this as it may, however, this at least is certain, that
when the force employed in the rubbing-in is less, the oxydation1
of the minute mercurial globules, and consequently the solubility
of this metal in our juices, is not favoured to such an extent as by
stronger frictions. The same undeterminable variety in the demetallization2 of the mercury occurs also in the preparation of the
ointment itself, which is considered good when we can no longer
see metallic globules in it.   How deceptive is this sign!     There
are ointments of exactly the same appearance which, according to
the different manner in which they are prepared,2 contain from a
two-hundredth to a thirtieth part of the metal in the nonmetallic form.    But in the Neapolitan     ointment it is only the
mercury that has been oxydised by friction that is efficacious
against the venereal poison, whereas the metallic globules, even
though they be invisible to the eye, are absolutely insoluble in
our juices, and only possess a mechanical propelling power. Who
can fail to perceive here an infinity of unavoidable causes which
may render the power of the ointment on our system extremely
various?
481. The absorbing power of the cutaneous vessels is inconceivably various, and cannot be relied on. There are skins so
constituted that they will not take up the ointment at all, and yet the
physician is unable to detect them accurately; and on the other
SI cannot say with certainty whether the rubbing employed in the preparation of
the mercurial ointment oxydises the metal, or whether a combination of the latter
with the fatty acids occurs; the latter appears to me the more probable. This
however is certain, that it is only that part of the mercury that has become nonmetallic in the ointment that is the really serviceable part against the venereal
virus.
2 The warmth or coldness of the ingredients, the hardness or softness of the fatty
substance, the purity of the mercury or its adulteration with other metals (in the
latter case it is more easily rubbed down), the employment or withholding of turpentine, the force exerted by the preparer, his skill, and the time he expends on its preparation, render different specimens of the Neapolitan ointment extremely different,
although they have all the same appearance.




128

ON VENEREAL DISEASES.

hand there are some individuals on whose skin if we but lay the
ointment,' we cause the most severe ptyalism. Even in the same
individual the skin is more susceptible to the ointment under
certain circumstances than under others; and even one part of
the skin may be more susceptible than another.2
482. But admitting we always knew with certainty (although this
is incredible) what proportion of oxydised mercury the ointment
contained, and what quantity of it entered the system, how can
we know what length of time the vessels of the skin will take to
deliver up their contents into the general circulation, seeing that
they are more active at one time than at another, in order that,
when the absorbent vessels have scarcely brought their contents
that just suffice to produce salivation into the general circulation,
we may not, by a fresh rubbing-in of the ointment excite an uncontrollable attack of this fearful excretory process, before the
mercury first rubbed in has commenced to act?
483. With regard to the second point (~ 478), the frictions not
unfrequently cause, especially in delicate and sensitive individuals,
erysipelatous inflammations, desquamation of the epidermis or painful itching herpetic eruption,3 rendering their further employment
impossible.
484. But even were this not the case, the circumstances of
every patient do not admit of our using this method. Not only its
troublesome and repulsive character, neither of which are inconsiderable, but also its suspicious      character often    forbids   its
employment, for the process of rubbing-in and the presence of
venereal disease are so intimately associated in people's minds,
1 A healthy, very sensitive man was affected with pediculi on the hairy parts of
the genitals, and anointed that portion of his skin with a piece of Naples ointment,
the size of a hazel nut, only once, and that quite superficially, without rubbing it in
in the least.  Soon afterwards he had to make a journey during the prevalence of a
cold, moist wind. After the lapse of twenty-four hours he was attacked by uncontrollable ptyalism that lasted four weeks.
2 What a quantity of ointment must remain on the patient's linen, and on his skin,
and on the hand or glove of the person who performs the frictions, that we cannot
weigh, and that must differ in every case.
3 These effects are not produced only by ointments mixed with turpentine.
Rancid fatty matters produce them; and in all mercurial ointments the fatty matter
is already rancid, probably because the metal absorbs its acids. The sudden occurrence of ptyalism prevents their further employment, and not less frequently are we
obliged to desist on account of their long continued inutility.




ANTIVENEREAL REMEDIES.

129

and this operation is so difficult to be concealed from all observation, that it exposes every patient, whose good name should be a
matter of inviolable sanctity to the physician, to injurious reports
of this kind.
485. With respect to the third point (~ 478); in cases of deeply
rooted syphilis that has existed a long time, whose symptoms have
become in the highest degree insidious and chronic, and are seated
no longer in the soft superficial parts, but in the tendinous expansions, or have even attacked the periosteum or bones themselves,
where the virus is obstinately concentrated, the rubbing-in of the
ointment is very rarely able to extirpate the disease.
486. In reference to the fourth point, or the injurious effects of
the mercurial ointment, we must bear in mind, that the frictions
must be continued for a long time in order to be of any considerable service; and in that case the long-continued irritation exercised by such a large quantity of mercury on the fluids and solids
of the body, gives rise to a number of chronic and often incurable
diseases, that are sometimes worse than the venereal disease
itself.
487. The fluids of the body become acrid, its fibres are thrown
into abnormal vibrations and relaxed, and the vital force is
gradually melted down to such a degree, that impaired digestion,
sleeplessness, debility, flying heat, hectic fever, chronic ulcers,
caries of the bones, tumours, scrofula, irregular rheumatic pains,
and chronic trembling, are the most ordinary results of this
employment of mercury.
488. The equivocal repulsion of the local virus from buboes into
the general circulation, and the lues venerea that not unfrequently
thence arises may justly be attributed, as experience shows, to
mercurial ointment, when it is rubbed into parts where, as has
been shewn above, the mercury must be conducted by the absorbent vessels through the bubo.
489. It is by no means a rare thing in practice to meet with
buboes that, by the long-continued employment of such frictions,
have become scirrhous, and ultimately cancerous.
490. According to Fabre's observations, of twenty patients
treated with frictions, fifteen became affected with ptyalism, which
often comes on so unexpectedly, and in spite of every precaution is so
uncontrollable, that either the life of the patient is thereby endanK




130

ON VENEREAL DISEASES.

gered, or those parts that are affected by this disgusting, weakening
and painful discharge are seriously injured. Corroding ulcers in
the mouth and on the tongue, loss of the palate and uvula, caries
of the alveoli and of the spongy bones of the nose, are common
results. The more modern, almost playful employment of the
ointment seems to be a modified copy of this frightful picture;
but it is on the whole the same thing; the terrors of the salivation
are somewhat more carefully avoided, without on that account
curing more cases of the venereal disease, and the terrible effects
(~ 649) are almost more frequent than before.
491. Inunctions of the ointment when gonorrhoea is present
frequently transform the latter into an almost incurable gleet,
probably in consequence of the excessive relaxation of the lymphatic system and the morbid irritability they occasion.
492. What can I say of the hurtful nature of frictions when
they are employed in those cases in which a previous injudicious
employment of mercury has already complicated the venereal
affection with an accession of those chronic non-venereal diseases
(~ 487)?
493. The treatment of venereal diseases by frictions is usually
commenced1 with venesections, purgation and tepid baths. By
these means it is imagined that the system is best prepared for
this mode of using the mercury. Then two drachms or a drachm
and a half, seldom only one drachm of the ointment (composed of
one drachm of the fluid metal, rubbed up with the same quantity
by weight of lard) is slowly rubbed in beside a coal fire, upon the
lower extremities, usually every other day; by and bye the same
process is repeated on the upper extremities; the patient is required to keep his room, and drink frequently of some thin warm
drink. This process is continued until salivation commences,
which is sought to be checked by discontinuing the medicine and
by the employment of purgatives, baths, diuretic remedies, ptisans
and clean linen. When the mouth has again returned to a state
of quiescence, the frictions are again continued with the same or
even increased quantities of the ointment, until fearful symptoms
forbid their further employment, or until the venereal symptoms
disappear and the patient appears to be cured. Finally, venesec1 In accordance with the alterative method usually adopted at Montpellier.




ANTIVENEREAL REMEDIES.

131

tions, purgatives and baths are again made use of. During the
whole treatment no solid food is allowed. However great the
hunger may be, the patients dare not partake of anything but
soups.
494. On an average, thirty-two drachms of ointment and about
forty-five days are required for a moderate degree of lues venerea;
but sometimes forty-eight drachms1 of ointment (three ounces of
mercury!) have been rubbed in, and above three months employed
in the treatment.
495. The treatment of syphilis by fumigations with mercury is,
after the rubbing-in treatment, the most ancient" mode of treating this disease, and for this purpose cinnabar is used. In later
times it fell into oblivion, except that it was still employed by
some rude people (as I found to be the case among the Wallachs
of Transylvania). Recently experiments with it have been instituted
(Lalouette 3 is the principal person who has revived it), expedients
being devised for keeping the vapour away from the mouth during
its use, and in place of cinnabar, the vapour of volatilized calomel,
or of mercury amalgamated with tin, has been selected.
496. Although this vapour is very penetrating, wound-cleansing
and dessicative, and moreover when the inspiration4 of it is
avoided, does not readily cause salivation or diarrhoea, yet its
employment for the complete eradication5 of syphilis is scarcely
advisable.
497. It should be borne in mind that the quantity of mercury
that on each occasion penetrates into the organism in the form of
vapour is quite undeterminable, and can never be relied on, as will
be sufficiently obvious without my testimony; experience also
shews that this method of treatment is only of some utility in
slighter cases of syphilis, in cutaneous affections and the like, as
1 Girtanner says from twelve to thirteen ounces of ointment; six and a half
ounces of mercury!
2 Cataneus first brought it into use in 1505.
3 He has however had few imitators.
4 Which the older physicians did not always employ proper precautions to prevent,
and by the dreadful accidents that their rude practice gave rise to, they brought
this means into great discredit.
5 The local employment of mercurial fumigations with proper care will always
remain one of the most excellent remedies for the removal of obstructions and the
improvement of malignant diseases.
K 2




132

ON VENEREAL DISEASES.

an accessory means along with the employment of other mercurial
remedies; and it not unfrequently becomes injurious when there
is too great sensitiveness and inflammation of the sores, in dry
and spasmodic asthma, great emaciation of the body, in ulceration
of the womb and the like.
498. I have also sometimes noticed, from its local employment,
chancres pass into buboes, and the local virus thereby driven into
the general circulation. An immense number of authors       have
observed convulsions, general trembling and fatal apoplexies result
from the use of cinnabar fumigations.
499. In the modern employment of mercurial fumigations, it is
the custom to prepare the system, as in the case of frictions, by
baths, venesections and purgatives. Then according to Lalouette's
method the patient is placed in an apparatus (usually a box made
expressly, where the head of the person who is seated therein, in
a state of nudity, projects through the lid, and his neck is so
enveloped and all apertures are so closed that no vapour can
escape) in which the whole body is played on by the vapour, but
the mouth is not touched by it. The calomel is made to evaporate
in a sublimating apparatus introduced beneath the seat.
500. The fumigation is repeated usually every other day, and
from half a drachm to one drachm and a half of calomel is
employed (cinnabar or mercury amalgamated with tin is seldom
used), and the patient is at the same time made to drink frequently some warm thin ptisan.
501. On an average about three ounces of one of these substances are required to complete satisfactorily the treatment of a
moderate syphilis (with symptoms of several kinds) in thirty days
or thereabouts.
502. Attempts are often made with success to cure or to ameliorate malignant venereal ulcers or slight pains in the bones by
means of small local fumigations.
503. The employment of corrosive sublimate in venereal diseases
is also pretty ancient,2 but it was previously avoided by regular
1 From Job. Benedict (1510) up to the most recent times.
2 Richard Wiseman (Sev. chir. treatises) was the first who in 1676 alluded to the
employment by empirical practitioners of a watery solution of corrosive sublimate in
water for syphilis; and according to Malouin it was about that time very much used
as an internal remedy under the name of remede du Favalier. Stephen Blankaart in




ANTIVENEREAL REMEDIES.

133

physicians as a dangerous method of treatment, or it was confined
chiefly to the practice of the mystic physicians, until, about the
middle of the present (18th) century, a more convenient mode of
administering it with safety was discovered.
504. It has this advantage, that it can be introduced into the
system in a determinate small quantity, that it does not frequently excite salivation, at least not long-continued salivation,
and in obstinate gleets does more good than harm. It has often
succeeded in curing children affected with slight symptoms of
syphilis, in whom the other preparations of mercury could not be
employed with safety. It has also proved of service in some slight
symptoms of syphilis in adults, and another especial advantage it
possesses is that during its use patients do not require to be so
strictly confined to their room as during the employment of
frictions and calomel, because it seldom excites salivation, and
because it does not produce such excessive debility as the other
ordinary mercurial preparations, with the exception of the mercurius nitratus and the oxyde of mercury.
505. This is, however, all the good I can say of it, for on the
other hand it is, 1st, often inefficacious to effect any considerable
amelioration, and, 2nd, its use is attended by peculiar ill effects
and disadvantages.
506. As regards the first point, it has seldom, when given internally, been of much use in chancres, in buboes, especially such as
are of long standing and have hard borders and a cancerous
appearance, in condylomata and other venereal growths, in swellings of the bones, and generally in inveterate symptoms of
syphilis. I have employed it without success in chancres and
1690 also made mention of its employment. Thereafter, in 1717, Turner alluded to its
empirical employment against this disease. The better method of using it, however,
remained unknown until in 1742 Sanchez heard from a German physician who had
been some time in Siberia that it was the custom in that country (as travellers have
mentioned since 1709) to give in syphilis sublimate dissolved in brandy, conjoined
with the use of vapour baths. Sanchez instituted experiments with it, and a few
years afterwards communicated the results to the celebrated Van Swieten, who
promulgated this method about the year 1754 in letters to Benvenuti and Hundertmark, and subsequently at greater length in the fifth volume of his Commentaries,
and, without making mention of the vapour baths (according to Sanchez the most
efficient part of the treatment), praised it above its merits, having been deceived
by the mendacious eulogiums of his flatterers.




134

ON VENEREAL DISEASES.

general syphilitic ulcers, notwithstanding that I have gradually
increased it to the very largest doses.
507. It has besides this deceptive character, that the adventitious
acridity it derives from the muriatic acid combined with it, enables
it to excite an irritation foreign to the mercury it contains, which
(by counter-irritation) lulls for a time the venereal symptoms;
which, however, when the patient thinks himself cured, usually
again burst forth with redoubled violence. During its use the
ulcers in the throat are cured in an almost miraculously short
space of time; but this cure is generally of a deceptive character,
for on leaving it off, similar symptomatic venereal affections arise,
or the same disease appears and spreads with greater rapidity than
before.
508. With regard to the second point (~ 505), it is one of its
great faults, that its acrid character1 obstinately prevents its
entrance into the lymphatic vessels of the primme vie. Besides
this, its taste is horrible; a sensitive stomach cannot bear it at all.
Oppression of the stomach, inclination to vomit, colic, inflammatory
eruptions on the skin, are often the accompaniments of its use.
Hectic fever has been laid to its charge, which is produced by
small ulcerations in the stomach caused by its corrosive properties.
Brambilla, a respectable witness, has observed it give rise to
blindness and deafness, spitting of blood, phthisis, hectic fever,
and abortion.
509. As a general rule, its employment is contraindicated where
there are, slow fever, derangement of the alimentary canal, tendency to haemoptysis, fluent haemorrhoids, melancholic temperament, disposition to violent mental emotions, gout, spasmodic
affections, or other symptoms of an irritable, nervous system, and
a dry constitution.
510. After preparing the body in the good French style, by
1 Barchusen has misled Girtanner to apprehend the presence of arsenic in the
corrosive sublimate made in Holland. I doubt if arsenic be more poisonous than
corrosive sublimate, but still more do I doubt (although Bergman has shewn the
possibility of the union of these two substances in the process of sublimation) if
corrosive sublimate be ever really adulterated with arsenic. With the exception
of Barchusen, whose chemical knowledge cannot be very implicitly trusted to, no
chemist has observed this mixture. The modes Girtanner employs for detecting the
presence of arsenic in corrosive sublimate are either dangerous or unsatisfactory.
Those mentioned in my work On Arsenical Poisoning are easier and surer.




ANTIVENEREAL REMEDIES.

135

means of purgatives, venesections and baths (but these are not so
absolutely insisted on for the corrosive sublimate treatment, as for
that with other mercurial preparations), it is usual to commence
the treatment with the daily dose of a quarter1 of a grain dissolved
in two pints of fluid, and to increase the dose until it amounts to
one grain in the day. In the case of children an eighth of a grain
is at first given daily, and increased to one fourth of a grain in a
pint of fluid.
511. On an average, twenty-eight grains and about forty days
were required to remove moderate venereal symptoms in adults.
From six and a half to ten grains were sufficient for children.
512. Sanchez, who revived the use of corrosive sublimate, employed conjointly with this remedy, after the Siberian method,
frequent Russian vapour-baths, and by this combination he cured
an immense number of internal and external chronic maladies,
which he, without any proof, asserted to be masked venereal
affections, (for there is scarcely any tedious or complicated malady
that he does not consider as a consequence of syphilis). These
affections were usually cured,2 as might be expected, from the
powerful diaphoretic means (the vapour-baths) alone; but they
were not always venereal diseases because a plan of treatment
succeeded wherein a mercurial remedy was at the same time used.
He makes infinite confusion with the symptoms of syphilis; it is
certain that the maladies so cured were seldom of that nature, or
only a small proportion of them, in which corrosive sublimate and
diaphoretic remedies can, as is well known, prove serviceable, or
if they were syphilitic then the cure was not permanent, and only
in appearance.3
513. Calomel has for a long time,4 but especially since the
commencement of this century (the 18th), been one of the most
1 Swieten gave twice a day a fifth of a grain dissolved in half an ounce of brandy.
I may mention here, incidentally, that Girtanner is wrong when he says of this
solution, that corrosive sublimate does not dissolve well in brandy.
2 The sublimate did not need to contribute more than its irritating powers.
3 I do not make mention of the corrosive sublimate clysters of Royer, or of the
analogous baths of Baum6, as the former caused painful tenesmus, and both are
unserviceable, as experience has shewn.
4 The surgeon David de Planis Campy (la verolle recogneue. 8. Paris, 1623)
seems to be one of the first who gives the recipe for the Pilules de la violette (p. 174),




136

ON VENEREAL DISEASES.

frequently used mercurial remedies for syphilis, and that especially
on this account, that the supposed poisonous acridity of the metal
was presumed to be corrected and sweetened' in it, and experience
taught that this preparation, of all the internal remedies then
known, had the least corrosive qualities.
514. The following maxims, deduced from experience, however,
are opposed to its reputed mild nature and much vaunted efficacy
in the treatment of syphilis.      1. The ordinary semitransparent
lanceolated colomel in the form of cakes contain no mean proportion of sublimate. In this form it often occasions violent vomiting.
If this be not the case, and if it be purer, still it causes almost
specifically enormous alvine evacuations, which are accompanied
by pains and great weakening of the body. 2. If it be quite pure,
it is an almost insoluble mercurial salt, in which the small quantity
of muriatic acid (often less than a sixth of the whole) is saturated
with so much mercury, that but very little of it is dissolved in the
gastric juice and passes into the absorbent vessels, whilst the coliclike irritation of the bowels it produces expedites its expulsion.
3. The portion of it that penetrates into the secundae viae excites
almost uncontrollable ptyalism, a fault that seems to be most
peculiarly attached to it of all mercurial preparations next to the
ointment. It possesses all the powers inherent in the latter, of
causing weakness of the body and the innumerable chronic maladies thence accruing (~ 649); or if possible it even excels the
ointment in this.
515. Attempts have been made in vain to deprive calomel of its
irritating effects on the bowels, by subjecting it to repeated sublimation. The excess of its purgative property is best removed by
boiling it in a large quantity of water along with a tenth part of
which, along with purgatives, were at that time much used in syphilis, and he lauds
in rather an empirical manner their efficacy in this disease; they contain calomel, a
scruple for a dose.  Mayerne followed in 1650 with his pulvis calomelanicus.
(Oswald Croll, in 1608, was perhaps the first who described, though obscurely, the
mode of making this mercurial preparation.)
1 The white precipitate sweetened by boiling with sal-ammoniac has the same
action as the calomel. Girtanner gives the preference to Hermbstidt's white
precipitate before all others (I do not know why), and proclaims him as the discoverer
of the sweet mercury prepared from turbith and kitchen salt, although he has done
nothing more than make some improvements on the mode pointed out in the Laborant
(2nd pt. pp. 155, 156).




ANTIVENEREAL REMEDIES.

137

sal-ammoniac, as has been the custom in recent times, or by mere
boiling in water (as F. Hoffman used to do), with the intention of
thereby depriving it of the corrosive sublimate adhering to it;
it is also sometimes combined with opium.
516. Of late years' it has been used as a chief remedy for
syphilis in combination with some earthy powder, or made into
pills with diascoridium. After a methodic preparatory treatment
by venesections, purgatives and baths, the patient being strictly
kept to one well warmed room, and partaking especially of warm
drinks, first, two grains were given, and the dose increased daily
by about a grain, and if still no ptyalism occurred the dose was
elevated to a scruple daily, and thereafter the dose was decreased
daily in the same manner in which it had been increased.
517. If it was wished to perform the treatment without salivation, as has been latterly the custom, either the doses were not
increased so rapidly, or when the disgusting evacuation occurred
strong purgatives were given, which often did not, but sometimes
did, stop it, though with but small advantage in regard to the eradication of the venereal virus, but with such manifest loss of strength
(~ 648, 649), that this so-called alterative method of treating
syphilis usually lasted longer than that by salivation, and was
often not so efficacious in destroying the virus as the latter.
518. All the ills that can arise from the employment of any
irritating, debilitating mercurial treatment (~ 648, 649) have been
observed from even the gradual administration of calomel; the
production of scrofula and erysipelas, the gouty diathesis, obstinate ulcers in the mouth and on other parts of the body, caries of
the nasal bones, wasting fever, and in short every malady that can
be produced by long-continued mercurial irritation and depression
of the strength. Even in this case physicians failed to perceive
that mercury loses its effect upon the venereal virus in proportion
as it causes any increased evacuation, be that ptyalism or diarrhoea,
or whatever other inordinate excretion.2
519. Still more celebrated in modern times is the so-called
1 In olden times it was sought to remove the disease by large doses, often from a
half to a whole drachm given at once. A dangerous procedure!
2 Clare's method of rubbing-in the calomel on the interior of the mouth does not,
it is true, incommode the bowels, but it readily produces salivation, and is incapable
of curing syphilis of any great intensity.




138

ON VENEREAL DISEASES.

mixed method   of curing syphilis by means of frictions and corrosive sublimate at the same time; whereby it was thought to unite
the advantages of both, after the frequent insufficiency of both
used separately had been perceived.
520. I shall not dilate upon its disadvantages, as they are the
same as I have pointed out relative to both methods separately;
except that they affected the system more severely than the
employment of a single mercurial preparation, and that less of the
ointment was used, consequently the excessive salivation caused
by it was to a certain extent avoided. Indeed it was often possible
to do more by the combination of the two than by either
separately.
521. For this purpose it was usual, after the ordinary preliminary treatment, either to give these two remedies in alternation,
administering at one time the corrosive sublimate alone, and at
another the frictions without the corrosive sublimate, or both were
employed at once, from one to two drachms of ointment every
third or fourth day, and from a quarter to a whole grain of corrosive sublimate dissolved in two pints of water daily.
522. In order to remove syphilis in this manner, twelve drachms
to four ounces of ointment, and from one drachm to fifteen grains
of corrosive sublimate, according to circumstances, and a period of
from thirty to one hundred days were required; on an average,
nineteen drachms of ointment and twenty-eight grains of corrosive sublimate in forty-eight days, in moderately deep-rooted
cases.
523. To gain the same end, especially for symptoms of the
proximate kind, recourse was also had to fumigations combined
with frictions; in which case a smaller quantity of ointment, or
less calomel for fumigating was required than when either process
was employed alone.
524. Three ounces of ointment and twelve drachms of cinnabar,
or calomel, were on an average the quantity required for the eradication of moderate venereal affections.
525. I shall not describe the still more mixed methods, in
which more than two different mercurial preparations were given
at once, plainly proving, if I mistake not, that frequently neither
1 Gardane is said to have invented it.




ANTIVENEREAL REMEDIES.

139

the employment of a single one of the mercurials ordinarily used,
nor yet the mixed employment of two of them at once, sufficed to
cure a high degree of syphilis.
526. I may here mention the not very new preparation, the
so-called Mercurius nitratus' (Solutio mercurialis, Edin., Mercurius
liquidus, Aqua mercurialis, Paris), or the solution of mercury in
nitric acid. I admit that in some cases it acts in a milder and
more antiseptic manner than corrosive sublimate, and for that
reason sometimes does more for the cure of syphilis than the
latter; also that it equally seldom excites ptyalism. I will also
admit, that by employing it we can substitute the uncertain form
of the mere solution for the more defined one of the crystallized
nitrate of mercury; also that it has this advantage, when the
solution has been prepared by the heat of a sand-bath, that it is
not decomposed by the muriatic acid in the primpe viae into the
pernicious white precipitate, like that dissolved in vegetable acids;
certainly a great recommendation! But all this does not make it
into a good preparation; it always remains a corrosive metallic
salt, with which we must, as with all the preparations of mercury
with mineral acids, on account of its accidental corrosive properties, frequently go   much more cautiously to work than          the
obstinacy of the venereal affections will admit of. Its acridity
easily excites vomiting in sensitive stomachs; colics and oppression
of the stomach are no unusual concomitants of its employment,
and if we are thereby necessitated to give it in smaller doses we
shall seldom obtain our object of a radical cure. Profoundly
rooted syphilis is as seldom cured by it as by corrosive sublimate, because, like every other mercurial salt formed by a mineral
acid, it is, on account of its irritating property, taken up by the
absorbents of the bowels and brought into the general circulation,
only in the smallest undeterminable quantity. It deceives us by
the adventitious irritation it excites, which smothers the venereal
symptoms by its greater intensity, or by a mere superficial cure,
1 As early as 1676 Charas employed a similar solution of mercury (essentia mercurialis), respecting which it has been asserted, without reason, that it was powerless,
and resembled a weak dilution of aqua fortis, because the greater portion of the mercury was precipitated from it by the large quantity of water used; distilled or pure
spring-water has not this effect; well-water precipitates white precipitate and
changes the liberated nitric acid into nitrate of soda, but not into aqua fortis.




140

ON VENEREAL DISEASES.

as, for instance, a deceptive amendment in the ulcers of the
mouth.
527. A    third of a grain is given at first and the quantity
gradually increased until from two to three grains are given daily,
dissolved in two pints of liquid.
528. Mercury changed into powder by laborious shaking, then
calcined, dissolved in vinegar, and made into pills with manna,
was the composition of Keyser's Dragees, of which from        1000 to
3000 often had to be taken before the desired effect ensued.
This expensive2 remedy has gone out of fashion, as it also occasions diarrhoea and salivation, and is very often unable to cure
deeply-rooted syphilis. From forty to seventy days were usually
required for the treatment.
529. The limited character of my design does not require that
I should attempt the thankless task of describing the remaining
mercurial preparations of this kind, which bear a great resemblance to those already treated of.
530. More nearly allied in nature to the best preparation of
mercury is on the one hand, Plenk's mucilaginous mercury, a
remedy that is indebted for the efficacy it possesses to the oxydation of the mercury, by being rubbed up with mucilage. In this
oxydised state the metal is very mild and not at all irritating, at
least to the primae viae; it is readily dissolved by the gastric juice,
and brought without difficulty into the general circulation, where it
destroys the venereal poison with the greatest power. This is the
ideal excellence of this remedy.
531. We may bestow       the same commendation       on  Belloste's
pills,3 the mercurial pills of the London and latest Edinburgh
pharmacopoeia, or the trituration of mercury with honey, sugar,
or crabs' eyes. These preparations owe their mildness to the
absence of mineral acids, and their efficacy to the portion of
1 Keyser's remedy is nothing new. Bernhard Penot had (before 1613) a shorter
mode of preparing this remedy. Theatr. Chym. lib. I, p. 654.
2 Twenty-seven livres' worth of these pills were required for the (often fruitless)
treatment. ParaUlle des diff. m6th. de tr. la mal. v6n. Amst. 1794, p. 178-272.
3 The first pills of this sort that were used in Europe (in 1537) for syphilis were
the Barbarossa pills (almost the first preparation that was much given internally for
this disease), the dose of which was one pill daily, which contained about four grains
of mercury, extinguished by rubbing.




ANTIVENEREAL REMEDIES.

141

oxydised mercury they contain that is so soluble in our fluids, and
that is produced by rubbing up mercury with any of these
substances.
532. But how much is the value of such preparations diminished
when we know how unequal, how indefinite is the small portion
of oxyde of mercury that is produced by rubbing up with mucilage,
&c. The temperature during the operation, the strength of the
mucilage, but more than all the strength and skill exercised by
the operator during the rubbing-up process, are subject to such
great varieties, and render these and the other preparations I have
mentioned, such uncertain, I had almost said such useless, remedies, that we may well hesitate before bestowing on them even a
moderate amount of praise.
533. I shall not dwell upon the fact, that in Plenk's solution
the greater part of the mercury falls again to the bottom, and
that it cannot be kept above eight days in summer; for this
objection he has obviated by his pills, which, however, on the
other hand, become excessively hard, and pass undigested through
the bowels if they be not prepared fresh every day. The greatest
disadvantage attendant on the employment of these preparations is,
that they sometimes cause sudden salivation, sometimes diarrhoea,
sometimes they produce no effect, and seem to be quite powerless;
a plain but unnecessary proof of the truth of my assertions. They
contain often scarcely the eightieth, but sometimes again the
twentieth part of the mercury rubbed up in them, in the oxydised form.
534. Pure oxyde of mercury alone, without the slightest admixture of anything acrid, that, without causing any inconvenience to
the primae vice, is unobservedly, easily and certainly assimilated by
the juices of our body, and may be given in determined quantities,
is the most powerful and surest mercurial preparation, and is superior
to all others, which, either from the quantity of active matter they
contain being undeterminable, or from their corrosive acridity, or
also from their insolubility, are injurious or untrustworthy.
535. In this important respect the mercury oxydised1 per se, has
1 There is an extremely ancient though previously seldom used remedy that was
highly recommended for the treatment of syphilis by Anthony Gallus, in 1540, under
the name of prrcipitatum rubrum solare, but its mode of preparation was first made
known in 1693, by Gervaise Ucay.




142

ON VENEREAL DISEASES.

become justly celebrated, and it is certainly among the preparations hitherto employed, the one best calculated, with proper
precautions, for removing the highest degree of inveterate syphilis, speedily, easily, and surely.
536. Of this oxydised mercury, (merc. calcin., Lond.) one grain
is given daily, and the dose gradually increased up to three
grains daily, until amendment ensues or the mouth becomes
affected. It does not so readily (for what reason is not known)
produce true salivation, and seldom diarrhoea or vomiting, if it
do not encounter any muriates in the stomach. As this last circumstance was not understood, it was usual to mix it with some
preparation of opium in order to guard against this effect.
537. The mode of preparing this substance is well known, but
the experienced professional man must be aware how extremely
difficult, intricate and tedious is its true preparation.  These difficulties in its manufacture are so excessive that it is one of the
dearest medicaments. Now, as in the matter of pharmaceutical
preparations the frequency of the adulteration of a remedy is
always in the direct ratio of its price, I shall not be discredited
in asserting that this drug is very seldom to be obtained genuine.
The corrosive red precipitate' is probably the substance most frequently used for its adulteration.
538. I cannot tell why such an expensive, untrustworthy and
circuitous mode of preparing a pure mercurial oxyde has been
sought to be retained. I know not why medical men did not
undertake more frequently to precipitate a pure metallic oxyde
from the solution in nitric acid, and to bring it into general use
in the treatment of venereal diseases. It has been prepared, but
assuredly a number of serious accidents2 have been observed from
its administration, the source and remedy of which it was thought
impossible to discover.
539. Chemistry should have taught them that their solvents,
1 We may convince ourselves of its presence by boiling with acetic acid; it
remains undissolved whilst the oxydised mercury is taken up in solution.
2 The mere. prceip. fuscus Wuerzii has, according to Girtanner, fallen into disuse.
Black's pulv. mercur. cin. (certainly one of the best of the ordinary preparations)
still retains its position. It is given at first in from one to two grains daily, and
gradually increased to six grains. It is far from being free from faults, as I have
shewn in the preface, but it approaches near to my soluble mercury.




ANTIVENEREAL REMEDIES.

143

as also all their precipitants, were contaminated with muriatic
or vitriolic acid, which imperceptibly adulterated their precipitate with those dangerous mercurial precipitates (see Preface).
As regards turbith, it is well known to have frequently caused
death, and I once saw a strong person die in strong convulsions
from taking two grains of white precipitate.
540. We can expect the best effects only from a mercurial oxyde
precipitated from pure nitrate of mercury by lime free from all
admixture; we may expect that well-prepared soluble mercury will
remove the most deeply engrafted syphilis easily and surely. But
of this more below.
CHAPTER III.
NON-MERCURIAL REMEDIES.
541. The dreadful effects of injudicious mercurial treatments,
and their frequent inefficacy, has from time to time diverted the
attention of practitioners from the divine metal, the true antisyphilitic specific, and their conscientiousness led them to resort
to remedies from the vegetable and animal kingdoms, in order to
avoid the poisonous effects that, according to them, every medicine
in general, and mercury in particular, exercises on the human
body.
542. It is probable that the venereal disease at the commencement of its extension over Europe spread much more rapidly, and
in its rapid course produced more disastrous symptoms than are
now observed. The inexperience of physicians that then prevailed
might have rendered them unable to meet the horrible effects of the
virus, and patients were readily abandoned to the practice of rash
empirics; the disgrace of the disease also might have the effect,
as is still the case, of driving the sufferers to these nameless vagabonds, partly seduced by their wonderful promises, and partly in
order to recover their health in privacy. These unconscientious
advisers, who were always provided with the most active medicines, had as usual no object but to fill their purses quickly, and
in a short time to bring about the deceptive semblance of a cure
without caring for the after-effects.  Hence it happened not
unfrequently that from their furious salivation the most dangerous dilapidations and maimings of the body resulted, which were




144

ON VENEREAL DISEASES.

often more horrible than the venereal disease itself; many died
from these effects, whilst the lues venerea more rarely proved
fatal. What could be more natural than that physicians generally
laid the blame upon the mercury, and hesitated to employ it?
What could be more natural than that from an early period (from
15151) they looked about for non-metallic remedies, which, as
they believed, were more suited to the human body?
543. Guaiac wood was the first lucky hit in this way, which the
Chevalier von Hutten, before any one else, undertook to praise in
a book specially written for that purpose,2 alleging that it had
worked miracles on him after the fruitless employment of the
most dangerous mercurial treatment. He died nevertheless of
syphilis.
544. The antivenereal plants probably first derived their reputation from America; for want of mercury the inhabitants of that
continent tried their most potent plants for this disease, and in
many respects they may have caused at least alleviation of the
disease.
545. After guaiac wood, cinchona bark,3 sarsaparilla,4 and,
finally, ceanothus and lobelia, gradually obtained a reputation in
Europe. From the resemblance of their mode of action to that of
these plants, we added to them mezereum, conium, walnut-husks
and dulcamara. Ammonia, opium and lizards completed the list.
546. Guaiac wood was and is still given in a strong decoction
in water of from one to several ounces per diem, drunk warm; it
is an acrid vegetable substance, possessing much power to act on
the skin and urinary secretion. The small green twigs of this
tree, which the Americans use, are probably still more powerful
than the hard, dry wood employed by us.       It is most useful in
soft, spongy systems.5
547. Sarsaparilla fell gradually into complete disrepute, until
later6 physicians again commenced prescribing it to the extent
1 Girtanner says as early as 1509.
2 After him an enormous number of others.
3 According to Girtanner in the year 1525.
4 According to Girtanner in 1530.
5 Girtanner alleges that it speedily causes incurable consumption in weak and
thin persons.
0 Especially W. Fordyce. Girtanner has never seen any good effects from its use.




ANTIVENEREAL REMEDIES.

145

of three ounces daily in strong watery decoction.' Cinchona bark
underwent the same fate, but has as yet found no resuscitator.
548. Of lobelia, which was so much recommended by the North
Americans, a handful of the dried roots is boiled in twelve pints
of water down to six or nine pints, and half a pint of this is given
to the patient, at first twice, thereafter four times a day, until the
diarrhoea it causes becomes intolerable. It is then left off for
three or four days, and again given until the cure is completed.
549. Mezereum2 has been considered to possess similar properties.3 Two drachms of this were boiled in three pints of water
down to two pints, and half a pint drunk from twice to four times
daily. The stalks of dulcamara were prescribed to the extent of
two drachms daily, boiled in water and mixed with milk. A
much larger quantity could be given by increasing the dose
gradually.4 The green husks of walnuts are said to have been not
much less efficacious.5
550. I have elsewhere observed that many very different irritant
substances are capable of producing amelioration in venereal affections, inasmuch as the counter-irritation caused by them alters
the morbid disposition of the primarily affected parts, and the
SAs much as fifteen pounds of this dear medicament were used for one treatment.
2 I find as early as 1553, in the works of Augerius Ferriere of Toulouse (De
pudendagra lue hispan. lib. duo. Antwerp, 1564, p. 26), this shrub much recommended for this disease in the form of decoction.
3 Especially in pains of the bones and venereal cutaneous diseases.
4 So that it shall not occasion convulsions or vomiting, as Girtanner remarks,
who recommends this plant highly in this disease.
6 Girtanner speaks very highly of this remedy, to the extent of two ounces daily in
decoction, when it is fresh, and in the form of extract for the most inveterate symptoms.
This writer also recommends a perfectly new non-mercurial remedy, the Astragalus exscapus (he gives an engraving of it), from the reports of his friends in nodes of the
bones, venereal cutaneous eruptions, venereal warts, &c. Winterl first mentioned it
as an ordinary domestic remedy for this disease in Hungary; after him Quarin
spoke highly of it; Hunczovsky has seen good effects from it in gout, but not in
venereal affections. It causes purging, diuresis, most frequently copious diaphoresis,
and a kind of cutaneous eruption. One ounce boiled in a pint of water down to
three-fourths is given daily.
The ledum palustre may probably act in a somewhat similar manner, especially in
venereal skin diseases; of this we should give, daily, at first half an ounce, gradually
increasing the dose to an ounce in infusion.




146

ON VENEREAL DISEASES.

pains they are subject to (e. g. the venereal pains in the bones) are
alleviated by the greater irritant effects of the drug.
551. It is in this way that the most of these plants appear to
have acted when they have done any good; at all events this is
the case with the purgative herbs, lobelia and mezereum, and the
diuretic and diaphoretic ones, guaiac, walnut shells and dulcamara. In this respect this good effect resembles that of turbith,
corrosive sublimate and blisters (applied to swellings of the bones).
(The mucilaginous diuretic sarsaparilla may contribute not a little
to the diminution of the morbid irritability.)
552. If they be given in conjunction with the mercurial treatment, their irritating power may also assist the action of the
metal, but only in the manner in which ginger assists in strengthening the stomach when given along with bitters, which it is
unable to do of itself. Perhaps also, when by a long-continued,
fruitless use of mercury, the body has become insensible to the
curative stimulus of this metal, the new, unaccustomed irritation
of these drugs may have caused amelioration, and on this account
they were regarded as antivenereal.
553. The last-mentioned plants may often, when given quite
alone, in consequence of their great depurative power, have cured
a number of external diseases, even such as are of a painful
character, which from want of pathological knowledge had been
considered as venereal. With respect to mezereum and guaiac at
least, it is certain that they cannot cure the most indubitable
incipient sign of syphilis, e. g. the copper-coloured spots; how
then could they remove inveterate lues?
554. But more than this, it was the custom formerly (and is so
still) for physicians, in ignorance of venereal semeiotics, to look
upon diseases arising from the long use of mercury, such as caries,
tumours, rheumatic symptoms, scrofula, &c., as of a true venereal
nature, and when guaiac, mezereum, and the like, removed these
affections, to laud these plants as antisyphilitic remedies.1 The
foreign irritation of these drugs, especially of guaiac, has not
unfrequently been of great service in those after-sufferings resulting from the long-continued use of mercurial treatment, which
1 Some of the ancients were more discerning than these short-sighted persons
when they said: luis venerec mercurius antidotum, mercurii gu9aicum.




ANTIVENEREAL REMEDIES.

147

had arisen from morbid irritability and dissolution of the humours:
obstinate ulcers, trembling, febrile states, and the like, the first of
which are still sometimes mistaken for venereal.
555. I may be permitted to entertain almost the same notions
respecting Peyrilhe's antidote to venereal disease, ammonia. With
the exception of caries and nodes of the bones, aphthae of the
vagina, scirrhous buboes and urinary fistule, he alleges that it is
specific for all other venereal symptoms. Of ammonia obtained
from sal-ammoniac by means of potash, he directs from fifteen to
eighteen grains (and in bloated individuals as much as thirty
grains) dissolved in four or five ounces of fluid, to be taken early
in the morning and four hours after dinner, and this to be continued for about eight days, then to be left off for the same time
and again used as long, again omitted and again used, until the
affection is removed. I believe this substance to be really a
powerful adjuvant in the treatment of venereal diseases, and I go
so far as to believe that if any medicine can be of use in syphilis,
besides mercury, this is the one.
556. Plenk, Murray and others affirm       that they have seen
following its employment increased inflammation of the venereal
ulcers, inflammatory suppression of gonorrhoea with swelled testicle,
strangury with hematuria, and several other disagreeable effects.
It has proved of much service in my hands in chronic affections
resulting from a long course of mercurial treatment, and has
materially aided in diminishing the morbid irritability.
557. Before all other remedies, however, opium2 owes its reputation to this virtue. Hunter could not succeed in curing the
slightest venereal symptoms with opium, although he gave it in
increasing and at length in the very largest doses, whereby he
once killed a man without previously curing his disease. He and
Grant, like myself, found it a chief remedy in the morbid irritability resulting from the abuse of mercury.
558. Hemlock has probably just as little specific virtue in
syphilis, and all the action it has may be owing to its peculiar
1 Lemery and Sylvius had already recommended ammonia in syphilis, as Girtanner
remarks.
2 It is no novelty to give it in venereal diseases. I found that Fernel frequently
employed it in syphilis as early as 1556. Willis and Simon Pauli followed his
example, as Girtanner observes.
L 2




148

ON VENEREAL DISEASES.

irritant power, and even when it has proved serviceable for supposed venereal after-sufferings, it might have acted by virtue of its
sedative and anti-scrofulous powers.
559. The lizard which was first employed in America, and subsequently also in Europe, according to report with extremely
happy effects, in inveterate syphilis with nodes, pains in the bones,
ulcers and slow fevers, besides other diseases, is the lacerta agilis,
L., a large (greenish coloured) species; the smaller varieties also
are useful, though in a less degree. They reside in old walls,
and prey upon spiders, flies, ants, earth-worms, crickets and
locusts.
560. We take the living animal, quickly cut off its head, tail
and legs, extract the viscera, skin it, and cut it into a number of
small bits, which we make the patient swallow with some liquid,
while still alive and warm, either alone or covered with liquorice
powder, or rolled up in a wafer, but without further preparation.
Of the larger kind the flesh of one or two is to be swallowed daily,
of the smaller kind that of several. From twenty to one hundred
are required to complete the treatment.
561. The chief effects resulting from their use are, increased
heat of the whole organism, a certain amount of nausea, a (frequently copious) flow of yellowish opaque saliva, occurring after
twelve or twenty-one have been taken, sometimes sooner, a (sometimes profuse) fetid diaphoresis, fetid urine, and also occasionally
copious bilious alvine evacuations.
562. According to the observations of some writers they are
probably not less efficacious when the flesh is minced fine, made
into pills by means of flour, and so swallowed. This however
remains to be determined by experience. This remedy deserves
attention, as it is in itself so harmless. Its chief efficacy seems to
reside in the volatile alkaline component parts. It may be very
powerful, but we are unable to determine if it can radically cure
true syphilis.
563. But whilst the other reputed antisyphilitic remedies are
for the most part only able to cure accessory symptoms, heterogeneous remnants of the venereal disease, and the various
affections produced by the irritation occasioned by the abuse of
mercury, all of which have been considered to be venereal merely
on account of their co-existence with syphilis, it always remains




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.

149

an established fact that mercury is the only thing that removes
all sorts of venereal affections with certainty, so that we have no
need to look about us for any other remedy for venereal diseases,
provided the preparation we possess be of the very best kind.
THIRD DIVISION.
REMOVAL OF THE OBSTACLES TO THE MERCURIAL
TREATMENT.
CHAPTER I.
OBSERVATIONS ON THE ORDINARY PREPARATORY AND ACCESSORY
TREATMENT.
564. Those to be subjected to the mercurial treatment (with
very few exceptions) are prepared, after the French fashion (~ 493),
by purging, venesections and tepid baths;1 the last, moreover, are
employed often during the whole treatment and during the aftertreatment (Haguenot was the first who sought to make their use
general), but the first are used at various intervals. At the same
time a watery, non-nutritious diet is given, consisting chiefly of a
multitude of tepid and warm drinks; and all this is done in order
to guard against any symptom of the venereal disease inimical to
the cure, and to make the mercury all the more efficacious.
565. I have often puzzled myself in vain to determine how this
preparatory treatment could have the effect of preventing all ill
consequences during the treatment, and I believe I have found
that all this is done under the erroneous impression that all
possible disagreeable symptoms occurring during the mercurial
treatment, even the salivation that especially ensues under this
method, are of a purely inflammatory nature, and depend solely
on tension of the fibres and an excess of red blood. This must
1 The number used in the preparatory treatment at Montpellier is usually thirty,
without reckoning what are employed when salivation sets in and after the treat.
ment.




150

ON VENEREAL DISEASES.

have been the indication that guided the originators of this
method, or they must have chosen it for want of something else to
do, for in no other case, except to remove the most violent pure
inflammatory diathesis of the organism, is it capable of doing the
slightest good; in all other states of the body whatsoever it is
quite the reverse of beneficial.
566. Now as pure inflammatory diseases and symptoms are
rare amongst us now-a-days, especially among the inhabitants of
large towns, and all those symptoms in this kind of diseases that
can be regarded as inflammatory are chiefly of scorbutic, erysipelatous, scrofulous, rheumatic, or of that character which I have
termed irritability from nervous weakness, and as all strengthdestroying, debilitating and enervating treatment aggravates all
the symptoms in the latter case, as experience teaches, we perceive
on the one hand how inappropriate that common treatment by the
so-called alterative, emollient, attenuating, relaxing and antiphlogistic method is, and on the other hand how much of the frequently disastrous results of that French plan of treating lues
venerea must be ascribed to this abominable weakening system.
567. There are few      constitutions so   good   as to  be   able
to bear up against the force of this strength-wasting method,'
and not very many in which the amendment produced by the
mercury does not suddenly come to a stand-still in the middle of
the treatment, in which an enervating, uncontrollable salivation2
does not occur, which eats away the nasal and palatial bones and
gives rise to corroding, often sloughing ulcers of the mouth and
tongue; in which the borders of bubonic abscesses do not suddenly become everted, spread in a cancerous manner, pour out
fetid corrosive ichor, and terminate in mortification; in which
cutaneous ulcers and condylonata do not take on an unhealthy
1 This method, which in the opinion of its defenders is best calculated to check
the salivation and to point out to the mercury the direct way of eradicating the
virus, is termed the alterative treatment. The Spanish physician Almenar, as Girtanner observes, was one of the first to insist on the use of purgatives and baths
for this purpose; Chikoyneau reiterated his maxims, and Haguenot increased the
number of baths to be used.
2 Astruc mentions that Morand employed on five soldiers the same kind of frictions; of three of these who got no baths one only had slight salivation, but the two
others who daily employed baths at the same time were salivated violently and for a
long time.




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.         151
suppuration, become painful, and degenerate into deep sinuses
and fistulous ulcers; in which swellings of the periosteum  do not
occasion more speedy caries of the bones beneath, and in which
sinking of the strength, uncontrollable diarrhoeas, debilitating
perspirations, and the whole array of symptoms of hectic fever,
do not occasionally effect the deliverance of the unhappy sufferer
from the methodical, artificially produced disease, by conducting
him prematurely to the final goal of all mortals (~ 648, 649).
568. This French folly of pretending to assist the action of
mercury by enervating the body is carried to such a height, that
when in the treatment of venereal diseases the last named disagreeable symptoms occurred, which were chiefly produced or at
least aggravated by the debilitating accessory treatment, frequently
nothing more was done than to renew 1 or to increase the antiphlogistic method, to the destruction of the patient.
569. Physicians did not observe that the serious symptoms that
occur during the use of mercury in this disease are seldom of a
purely inflammatory character, and that when they will not yield to
the antisyphilitic metal, an excess of corporeal strength and of pure
strong blood is certainly not the cause of this phenomenon; in a
word, they imagined they had to do with savage Gauls and rude
Germans whose seething blood required to be drawn off, whose
flaming nervous force had to be smothered by pouring in streams
of water, and whose over-tense fibres needed to be relaxed by
soaking in a succession of warm baths, so as to prevent the irritating metal exciting the most uncontrollable inflammatory symptoms; whereas they really had only to deal with their degenerate
descendants, their mere shadows, whose already weak blood they
draw off in large quantity, in order to make it still more watery
by deluging it with ptisans; whose delicate stomachs and bowels
they weakened into dyspepsia by mucilaginous fluids and laxatives,
and whose skin, that was already frequently too sensitive to every
change of weather, they weakened by heated apartments and
repeated baths, to the highest degree of irritability and extreme
susceptibility to take cold. Experience teaches often enough that
1 As may be seen in the fourth part of Observations faites et publides sur les diffgrentes mfthodes d'administrer le mercure dans les maladies veneriennes, par de Horne.
Paris, 1779.




152

ON VENEREAL DISEASES.

those cases in which this method was employed to its full extent
on the most approved principles had almost always the saddest
termination. We cannot readily conceive of anything more inappropriate than to weaken fibres that ought to be strengthened,
to abstract vital force that ought to be multiplied, and to diminish
the tone of the nerves that require strength for the due performance of their operations!
570. If it be alleged that this method is directed more against
the venereal affection than against the symptoms to be dreaded
from the employment of the mercurial treatment, why, it may be
asked, should the venereal disease, whose nature is the very opposite of purely inflammatory, be combatted with antidotes calculated
for subduing the most violent inflammatory fever of a sunburnt
savage?
571. If it be contended that the bad symptoms and obstinate
after-sufferings during the treatment of venereal diseases may
arise from the irritating metallic poison used, I will readily grant
that they occur even where the French preparatory and accessory
treatment has not been employed, but I am all the more astonished that the latter can be prescribed along with the mercury,
seeing that it is productive of equal injury, and thus lends a
helping hand to the devastations of the mercury.
572. If it be asserted that the venesections, the confinement to
a heated room, the streams of warm drinks, and the baths, constitute a diaphoretic treatment, which is to keep the mercury from
irritating the bowels and salivary glands, I ask, what is the object
of the anti-diaphoretic purgatives?  I ask, has not experience
shewn that such a sudorific treatment most frequently creates a
tendency to take cold, whose effects are worse in proportion to the
weakening tendency of the diaphoretic treatment?
CHAPTER II,
PREPARATORY TREATMENT.
573. If there be any general method whereby those who enter
into a venereal hospital must be artificially prepared for the mercurial treatment, the very nature of the thing shews us a directly
opposite system should be adopted, since laxity of fibre and




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.       153
nervous weakness have come to be the chief ingredients of all the
chronic diseases of our age.
574. In most cases of old-standing syphilis1 we observe a general weakness of the body, a pale countenance, a dull eye, relaxed
muscles, and frequently, on account of the low fever kept up by
the venereal irritation, a weakened digestion, a small, unsteady,
very rapid pulse, tendency to cramps, and all the signs of increased
morbid irritability of the whole nervous system.
575. All these symptoms indicate tonics for the preparatory
treatment, which are all the more necessary because without them
the mercury increases the delicate state of the constitution, or
thereby is prevented from exercising the requisite power over the
venereal virus.
576. If they be neglected, then the low fever and tendency to
scrofulous inflammation increases, and, what is worst, on the
administration of the smallest quantity of mercury a dysenteric
diarrhoea, an uncontrollable diaphoresis, or most commonly an
irrepressible salivation, breaks out, that consumes all the strength,
and frequently leaves behind it the after-sufferings often alluded
to, frequently without having eradicated the syphilitic virus.
577. Not unfrequently a tendency of the system to rheumatic
and gouty acridities, to scrofula and to scorbutus, forms an impediment to the mercurial treatment; and these diatheses must
previously be removed if we would not see these affections uncommonly aggravated during or after the venereal treatment, or if
we would employ the mercury with certainty and efficacy.
578. Accordingly, in order to diminish beforehand the morbid
liability to the above (~ 576) evacuations, and to eradicate the
unfavourable diatheses alluded to, it is, for the reasons given,
indispensably necessary to employ the strengthening preparatory
treatment according to circumstances, with special regard to the
removal of the scrofulous, scorbutic or other disposition, according
as the one or the other betrays its presence by its diagnostic
marks.
579. Among general tonic remedies I reckon footbaths, half,
and at length whole baths of cold (500) water, each used for a few
1 Also in cases of idiopathic venereal diseases, especially those for which mercury
has already been employed in vain.




154

ON VENEREAL DISEASES.

minutes, once or several times a day, combined with energetic
frictionl of the parts bathed. For internal remedies, at first the
bitter vegetable extracts (if the morbid irritability is very great),
before proceeding to the astringent bitter medicines, as cinchona
and the like. If the body is bloated and full of indolent juices, we
may at first combine them with carminative and stimulating things,
as cardamoms, peppermint oil, and so forth, in order to accelerate
their action. Among the best of strengthening remedies I reckon
the use of moderate exercise in the open air. Great irritability
from weakness, with urgent, painful symptoms, demands the
cautious external and internal employment of opium, combined
with the strengthening treatment. But if the irritability from
weakness be not excessive, we may soon have recourse to bark,
iron-filings and sulphuric acid as internal tonics. I now come to
the accessory treatment of the prevailing morbid concomitant
diathesis.
580. It is only in the case when previous to or during the
employment of the strengthening method the tongue becomes
white, and thirst for cold water, severe headache, a full, hard
pulse, &c. occur, without any bad taste in the mouth, fulness of
the abdomen, indigestion, or commotion of the bile, then and then
only must we make a moderate bleeding, which paves the way for
the tonic treatment, which may then be gradually increased.
581. If we combine the tonic treatment with the fresh expressed juices of the cochlearea, the arum root, and the water-cress,
and aid it by fermented liquors, fresh fruits, and exercise in the
open, dry air, we shall subdue the scorbutus, which offers the
greatest impediments to the cure of syphilis. For if, without this
precaution, we proceed at once to the employment of the mercurial
treatment on a scorbutic venereal patient, there occur, in the midst
of the most energetic action of this metal, rapidly spreading foul
ulcers, which give sufficient evidence of their non-venereal nature
by their being worst at this particular time.
582. The strengthening method alluded to, combined with the
employment of carbonate of ammonia and small doses of ipecacuan 2
1 With woollen towels.
2 So that for a couple of weeks every forenoon is passed in constant nausea and
slight heaving.




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.

155

or burnt sea-weed, will prevent the scrofulous diathesis interfering
with the cure of syphilis.
583. In like manner guaiac resin dissolved by the combined
action of potash and alcohol, but especially the extract of aconite
conjoined with the tonics indicated above, more especially with
the cold bath, is generally sufficient to destroy the gouty diathesis
in the system.
584. Steel filings will remove the chlorotic disposition, and,
along with the other tonic remedies, help to increase the red parts
of the blood.
585. A tendency to erysipelas demands great moderation in the
use of meat and similar articles of diet, and the plentiful use of
fruit and whey combined with the general strengthening method.
586. Haller's or similar acid elixirs will moderate or remove
inflammatory dispositions of unknown, indefinite or composite
character.
587. It is only after having strengthened the fibres in this or
some similar manner, thereby bringing the tone of the nerves into
more uniform and powerful vibrations, and after having diminished or removed the obvious accessory disease,1 that we should
undertake to attack the syphilis with mercury.
588. Let it not be objected that such a preparatory treatment
would consume much time and put off for a long period the
employment of the mercury. If the morbid accessory diathesis be
strong, and the chief ingredient of the composite disease, then
nothing more expedient, nothing more appropriate can be conceived, let it last ever so long. But even in the very worst cases
we shall have advanced so far with the general or special strengthening treatment (if it were at all applicable) in from three to five
weeks, that we shall be able to commence the use of the metal.
589. Sometimes it is requisite to continue the tonic treatment
along with the mercury, which, with the exception of the cold
baths, may be done without restriction 2 in the most of such cases.
1 Also where hysteria is present we must adopt some similar preparatory treatment, or at least be always on our guard for fear of the occurrence of convulsions.
The occurrence of the catamenia demands the intermission of the mercury until it is
past; bleeding hemorrhoids demand a similar precaution.
2 Only that the strengthening remedies should not be given all day, but only two
hours before and two hours after dinner.




156

ON VENEREAL DISEASES.

590. It is only when the symptoms of syphilis are very violent
and urgent, and when they constitute the major part of the composite disease, whilst the accessory morbid diathesis constitutes its
minor part, only in such cases can we employ the mercury at
once, combined with the tonic treatment.
CHAPTER III.
PREVENTION OF THE DISAGREEABLE EFFECTS OF MERCURY.
591. It has been proved by thousands of observations that no
deeply rooted venereal virus can be expelled by any visible, far
less excessive evacuations, diarrhoea, salivation,1 diuresis and diaphoresis, and that these rather have the effect of palpably hindering2 the metal in its antisyphilitic action, and ought consequently
to be avoided.3
592. Whether the threatened salivation can be kept back by
the use of powdered sulphur, my experience has not yet taught
me; still, the trials of others lead us to anticipate much advantage
from it, as also the expectation deduced from chemical science,
that the sulphur, penetrating the mass of blood, effects a mineralization of the dissolved metal (Ethiops mineral), and suddenly
renders it inefficacious.
593. Some advise that the patient should be exposed to severe
cold, others that he should be kept very warm, both with the view
of checking the salivation; but both frequently fail of their object,
especially when the exciting cause that could indicate one or other
of them is lost sight of.
594. If a previous chill have caused an inconsiderably small
quantity of mercury, that has been given, to act on the salivary
glands, without there being present any plethora, a diaphoretic,
moderately warm treatment may be of service. If plethora and
an inflammatory fever be the cause of the rapid salivation, then
1 It is remarkable that as early as the commencement of the sixteenth century
(1502) the Spaniard Almenar sought to prevent and remove salivation by every
possible means, in order the better to cure this disease.
2 At all events by diminishing the mercurial fever.
3 Sydenham says, in his Epist. resp. ad Henr. Paman, that a remedy must destroy
the venereal poison in the body directly, without evacuation, in order to deserve the
name of an antisyphilitic specific.




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.

157

sometimes a venesection, but most certainly a general cool treatment, cold air, &c., will tend to check it.
595. But what are chiefly relied on are drastic purgatives,1
under the supposition that the salivation will thereby be suddenly
brought to a stop, although many thousands of cases demonstrate
the impropriety of this treatment. The salivation is not thereby
restrained; on the contrary, it often increases still more when the
action of the purgative is over, especially when, as is often the
case, irritability was the cause of the sudden ptyalism. Moreover,
who is ignorant of the debility that such a powerful evacuant
medicine, or the repetition of such purgatives as are usually prescribed, leaves behind it, each of which is equivalent to a venesection in its weakening effects? In a word, experience and reflection
are equally opposed to this proceeding, as hurtful as it is useless.
596. Were we better acquainted with the nature of camphor
than we are, much might be expected from its use.   But both the
constitution that indicates it in this case, and the dose in which it
can be of service, are still uncertain. I have often experienced
the opposite from its use, and sometimes maintained in full force,
for certain purposes, ptyalisms persisting from irritability, by the
daily administration of six grains of camphor; but the salivation
that occurred was destitute of smell. Perhaps it is most powerful
as an antidote to salivation, when the latter has resulted from
suppressed perspiration.
597. Linnaeus observed chronic salivation cured by an infusion
of white hore-hound; the infusion prepared with wine likewise
merits attention. Sanchez lauds the efficacy of vapour baths for
preventing salivation: they do not however prevent it, as the
Chevalier von Hutten piteously relates.
598. Morris found contrayerva, in the dose of two scruples
twice a day, efficacious in obstinate cases. Others have advised
blisters to the nape.
599. I mention these things in their proper place, but believe
that we shall always meet with more success if we prevent the
ptyalism before-hand, than if we rely upon checking it when it
has already commenced.
600. For this end it will be most expedient, in all the states of
1 Desault brought them into great repute for this evacuation, about the year 1730.




158

ON VENEREAL DISEASES.

the system above spoken of, whether a general weakness and irritability, or any other accessory disposition, constitute the obstacle
to the mercurial treatment, to regard the general (~ 578, 579) or
specially directed (~ 580-585) tonic treatment as the chief preventive remedy of salivation, and by no means to neglect its
employment. Still we would do well, in obstinate cases of composite venereal disease, to precede the use of the mercury by a
local treatment of the mouth, which shall communicate the greatest
possible tone to the salivary glands, and give them sufficient firmness to resist the too facile penetration of the mercurial irritation.
601. For this purpose I have found in my experience that the
best thing to do, is for some days previously to hold in the mouth or
move themfrequently hither and thither, substances that are strongly
astringent without causing nausea. I have often found of service
an electuary of catechu or kino, mixed with a portion of alum, and
with the addition of some syrup. I have employed a cold solution of
sulphate of zinc, and also alum and sulphuric acid, with much
benefit, to gargle or rinse out the mouth.
602. If we have to do with some (rare) cases of syphilis accompanied by such urgent symptoms as to require the immediate use
of the mercury, we must, immediately after the first dose of the
mercury, proceed to strengthen the mouth (~ 601), and if that
will not suffice to prevent those hurtful evacuations, we must have
recourse to external remedies also. A strong solution of alum or
sulphate of zinc in water, frequently applied, quite cold (or cooled by
ice), round the whole neck, has proved uncommonly useful to me.
603. In very irritable, emaciated, debilitated subjects, especially
in such as have already suffered salivation from a previous employment of mercury, the early administration of this metal is always
of doubtful propriety. In spite of every precaution we shall sometimes, especially if the obstinate symptoms of syphilis demand
large doses of the antivenereal metal, be completely unable to
prevent salivation by these external remedies.
604. If this take place we must immediately discontinue the
mercury, and besides the external use of the ice-cold compresses
(~ 602) frequently renewed, we should uncover or shave the head,
pour over it cold water, and again dry it, whilst we envelop the
feet in warm coverings, or place them every four hours in a tepid
(960) foot-bath for a quarter of an hour. The patient must rest in a




REMOVAL OF OBSTACLES TO MERCURIAL TREATMENT.

159

cool dark room, in a sitting posture, with a light covering over him,
His attention should be engaged with amusing stories,withmusic, &c.
605. As chewing greatly excites the salivary glands, we should
not allow at this time any other articles of diet besides thin soups,
or easily digestible vegetables in the form  of puree, with beer,
milk and the like; but solid food, tasty and sweet things, especially coffee, as also everything that excites disgust, must be
avoided. If the thirst is great, we may give sour drinks and food.
606. We may at the same time continue assiduously the use of
the astringent electuary gargle (~ 601), combined with an eighth
part of laudanum. It is under these circumstances that I have
also found good effects from the internal employment of opium'
(sometimes combined with Minderer's spirit.)
607. If the bowels are constipated, they should be opened by
one or several clysters of vinegar.
608. I think I have been able to convince myself, by some
experiments I have instituted, that drinks saturated with sulphuretted hydrogen gas do in a short time remove all the irritation produced by the presence of mercury in our fluids, as this
remedy rapidly penetrates all the vessels, and instantaneously
mineralizes the mercury wherever it encounters it. We should
give from six to eight grains of some good preparation of hepar
sulphuris in the form of pills within twelve hours, and cause the
patient to drink thereafter a large quantity of warm tea, made
sour with lemon juice or cream of tartar.
609. But the surest way to prevent salivation is always a
gradual, cautious employment of mercury, and especially the selection of such a preparation from which such an injurious effect is
least to be apprehended. I have already sufficiently pointed out
that the ordinary mercurial preparations (especially the insoluble
precipitates combined with mineral acids, the turbith mineral, the
red and white precipitates, and calomel, as also Keyser's dragees,
frictions, &c.) possess this disadvantage in a high degree, with the
exception of corrosive sublimate and nitrate of mercury, also
Plenk's mucilaginous mercury, but almost only when it is least
powerful, but especially the mercury oxydized per se, partly
1 According to the experience of Hunter, Girtanner and myself, it has certainly
great power in salivation, although Bloch denies it.




160

ON VENEREAL DISEASES.

because it is not very apt to excite this evacuation of itself, partly
and chiefly however because it can be given in determinable small
doses that we may rely upon penetrating into the fluids, which is
not the case with the mucilaginous. I have found that the soluble
mercury uncommonly seldom produces salivation, not only on
account of its peculiar nature, but also particularly because it acts
in such small, such definite doses, so very uniformly, and far more
certainly and mildly than that oxydized per se.   If we commence its use in very small doses, and only increase it gradually,
paying great attention to the state of the mouth, and if we employ
at the same time the accessory treatment pointed out, we shall
very rarely be surprised by salivation, even in those urgent cases
in which it is requisite to give it at the very commencement, or if
it do come on it may readily be checked by some of the means
indicated. So much is this the case that when I deemed salivation
of use in certain non-venereal affections, I never thought of employing the soluble mercury for its production; in such cases
calomel best answered my purpose.
610. Violent diarrhoeas are not easily avoided during the employment of the ordinary mercurial remedies, for either the preparation itself is a purgative, such as calomel, or it becomes such
from the muriates that are present in the primme viae (white
precipitate), like the mercury introduced into the system by the
rubbing-in process, the nitrate of mercury prepared in the cold,
Keyser's dragees, and Plenk's preparation; substances of which
the first and last, if perchance they be very well prepared, contain
an unexpected quantity of oxydized mercury, which may be transformed by the muriates in our system into a quantity of white
precipitate sufficient to excite all at once violent diarrhoea; the
other preparations named are always ready, the moment they
come in contact with a gastric juice impregnated with muriates, to
change entirely into that strong, noxious purgative, white precipitate. The addition of opium to these remedies is of little use.
611. Regarding the soluble mercury we may be sure, that even
though we neglect the rules for diet given below, it will excite no
purgation, but only one or a couple of loose stools, because the
small dose of it prescribed, even were it all changed in the
stomach into white precipitate, is not sufficient to cause drastic
evacuations.




NATURE OF THE SOLUBLE MERCURY, ETC.

161

612. If, as sometimes happens, a violent continued perspiration
disturb the action of the mercury, a cool regimen and the employment of sulphuric acid, will speedily check this evacuation. Some
have found bark very useful.
613. The diuresis that is more rarely observed, may be stopped
by a diaphoretic regimen and the intercurrent exhibition of cinchona bark, as long as we know of no remedy that possesses the
power of specifically checking this evacuation.
FOURTH DIVISION.
THE NATURE OF THE SOLUBLE MERCURY AND ITS
EMPLOYMENT IN VENEREAL DISEASES.
614. Well prepared soluble mercury (see Preface) is of a blackish
grey colour and tasteless. It may be dissolved in vinegar, and in
water impregnated with carbonic acid, without leaving behind a
trace of turbith mineral or of white precipitate.
615. The rapidity of its action shews that it is almost instantly
dissolved in the gastric juice. It very quickly combines with the
saliva in the mouth, and then immediately produces the peculiar
mercurial taste.
616. When the proper diet is observed (~ 619) it causes no disagreeable sensation in the stomach or in the bowels, no vomiting,
no diarrhoea, but passes directly, and in the course of a few hours,
dissolved by the process of digestion, into the mass of the fluids.
617. It is only when there are muriates in the primae viae that
there is an exception to this; in that case there occurs slight
nausea, or one or two loose stools. But it is usually taken so rapidly into the general mass of the fluids, that even in this case there
is seldom time for its complete conversion into white precipitate.
618. As it is in every case the duty of a patient to avoid overloading his stomach, which he cannot transgress with impunity under
any moderate treatment, we may safely expect from any man whose
nature is not quite bestial, that in the treatment of such an im.
M




162

ON VENEREAL DISEASES.

portant disease as syphilis is, he will observe a slight restriction in
diet which will cost him such a small sacrifice and have so much
influence on the well-being of his future days.
619. In order to obtain this object and to remove all traces of
muriates from  the primae vie, if the antivenereal remedy is to be
taken, as is usually the case, in the morning, we let the whole supper of the previous evening consist of some uncooked fruit. The
following morning we allow the dose of soluble mercury to be taken
as early as possible in some distilled water, and nothing to be partaken of for four or six hours thereafter; then if there be great thirst1
the patient should take a little more distilled water, or cow's milk,
or if there be weakness, a draught of good wine; so that during a
period of twenty hours nothing shall enter the stomach that contains
a trace of muriate of soda. At dinner time (noon) he makes an
ordinary or moderate meal of anything2 that comes to table, excepting the flesh and fat of geese, ducks and pork. We may allow
those accustomed to it a glass of wine.
620. We may give the soluble mercury either alone, or in order
to make the dose appear larger, rubbed up with some liquorice or
mallow root. If we have to do with persons who are not to be
trusted to in the observance of dietetic rules, we may add a half or
whole grain of opium.
621. Although in the case of very sensitive but healthy persons
who are very obedient in respect to diet, I have sometimes not had
occasion to use more than one grain of soluble mercury in all, in
order to cure moderate idiopathic venereal symptoms and commencing syphilis, yet I have met with cases in which sixty grains
were necessary.
622. This extreme variety depends, as far as I have been able to
observe accurately, on this, that in the first case the mercurial fever
(~ 290) occurred as rapidly as could be wished for. But when I
1 This should be endeavoured to be avoided; for during its continuance there seems
to be developed in the gastric juice, or to be deposited therein from the blood, an ammoniacal or muriatic acridity. The distilled water may be used either cold, or in the
form of tea, made with liquorice and linden flowers, provided we dispense with the use
of sugar. The thirst may also be quenched in the morning by means of fruit.
2 Meat may be partaken of along with the vegetables as long as the former is not
contraindicated by the advent of the mercurial fever or any other inflammatory
state.




NATURE OF THE SOLUBLE MERCURY, ETC.

163

was forced to use such a large quantity, the reason was, that either
some circumstance suddenly occurred that frequently interrupted
the employment of the medicine, or that previously much mercury
had been used in vain, or that (in the case of persons of good constitution who could not, on account of their avocations, omit appearing in public every day) I had to excite and maintain a gradual
(slow) mercurial fever.
623. On an average however I have found, that in order to eradicate a moderately severe syphilis, not more than eight grains were
required, while for a severe and deeply rooted case, about twelve
grains were needed.
624. But if we wish and are able to excite, 1st, a rapid mercurial
fever (febris mercurialis acuta), a still smaller quantity is necessary in
the very severest cases; but if, 2ndly, on account of the circumstances
that may arise, we must divide the mercurial fever into two or three
small attacks, then more, sometimes much more, than the quantity
indicated is required; but much the largest quantity is necessary
when from the above reasons we have to excite, 3rdly, an unnoticeable mercurial fever (febris mercurialis lenta). I beg that these
three cases may be carefully distinguished.
625. In the first case I must be satisfied that no tendency to
salivation exists, or that the patient has previously used mercury
without having incurred this evacuation. In that case I gave from
the very first large doses of the soluble mercury, and increased
them rapidly, in order to excite quickly a severe mercurial fever,(probably from a half to one, two, three grains; or in robust subjects and severe cases of lues, one, two, three, four grains.)
626. In the second case (~ 624), usually when there was present
a tendency to salivation, or when this evacuation hAd already occurred during a previous employment of mercury, I increased the
quantity of the soluble mercury very gradually, so that I could
leave it off on the slightest appearance of salivation, employ measures
to combat it (in the progressive scale of from 1/i tol11, )a,  34, 1, 11/4
grain). I calmed the irritation of the mouth and recommenced
after an interval of from eight to fourteen days, to increase the
dose (from about '/2 to 1, 11/2 up to 2 grains), and so on until the
syphilis had completely disappeared.
627. In the third case (~ 624) I used for eight or ten days only
M2




164

ON VENEREAL DISEASES.

one quarter of a grain' daily, then for about the same period one
grain, then two, then four grains, until all traces of the lues were
destroyed. Patients of this sort must either be otherwise of very
healthy robust constitutions, or else they must be unremittingly
treated with tonics at the same time, in order that the long continued irritation shall not injure them. On the slightest affection
of the mouth the mercury was discontinued for one or even several
days, and the precautions I have described employed to combat
this accident.
628. As a rule it is good, after the complete disappearance of the
venereal symptoms, and the occurrence of a proper mercurial fever,
especially in the rapid treatment (to which, when it is admissible,
I give the preference), at once to discontinue the soluble mercury,
and to wait and see whether or no the same symptoms do not reappear after four or five weeks. If nothing occurs we may, even in cases
of deeply rooted syphilis, rest assured that a cure has been effected
(even without waiting till this time has elapsed, we can be perfectly
sure of the cure, if a sufficiently severe mercurial fever made its
appearance); but should the same symptoms shew themselves, the
mercurial fever must have been too weak, an error we must seek to
repair by endeavouring, after the lapse of this time, to develope a
new and much more severe mercurial fever than the first was
(which is done with more trouble and by means of doses increased
more rapidly), whereby all remains of the venereal poison will be
certainly eradicated to the very last trace. But this is a very rare
case, that can only happen to an inexperienced practitioner.
629. Recent buboes, simple chancres, and commencing lues, require almost the same degree of mercurial fever; but lues with
symptoms of the more remote kind, with nodes, &c., as also condylomata and old degenerated chancres and so forth, require the more
severe fever.
630. If we wish to prevent a painful and inflamed bubo from
suppurating, by the speedy destruction of the venereal virus, or
timeously avert the threatened danger in phimosis and paraphimosis
from chancres, a severe mercurial fever must be quickly excited.
* This dose given for four or five successive days without increase frequently sufficed with sensitive individuals to produce an adequate artificial fever, and thereby to
effect a perfect cure.




NATURE OF THE SOLUBLE MERCURY, ETC.

165

Accordingly directing our attention to the preservation of the
salivary glands, of which I have treated in the previous chapter, we
should here increase the doses of soluble mercury from 2 to 3,
4, 5 grains, and whenever the fever shews itself of sufficient severity,
call a halt, and then terminate gradually what we were forced to
commence violently.
631. All the doses spoken of in this chapter are to be understood
as daily doses, as it is well always to wait for twenty-four hours,
and during that time to observe the effects of each dose.
632. In cases where I have found no special preparatory means
requisite, e. g., in otherwise healthy, robust subjects, not only are
no venesections, baths, or diet drinks prescribed, but not even a
dose of laxative medicine, even should there be plenty of time for
all this, for in the medical art nothing unnecessary should be done.
When circumstances demand it, I prescribe not only every one of
them, but I even give previously, or during the course, emetics,
when obstinate impurities of the stomach, derangements of the bile,
and so forth, present obstacles to the treatment.
633. As mercury does not cure syphilis by causing evacuations
(~ 591) (but often thereby makes it more obstinate), but as it rather
only cures the disease by the gradual or sudden antipathic irritation
of the fibres of a specific nature (I do not deny that there may be
a chemical neutralization or destruction of the venereal virus by
the mercury dissolved and assimilated in the fluids of the circulation); it follows, that the physician, carefully avoiding all severe
mercurial evacuations (salivation, diarrhoea, &c.), should direct his
especial attention to develope the above (~ 290) described mercurial
fever1 in the manner indicated, in a degree accurately proportioned
to the intensity and age of the lues, and of the idiopathic venereal
affection.
634. Thus, when all circumstances are favourable, the most inveterate lues may be radically removed in the course of a few days
1 I lay it down as an already proved axiom, that the effect of the mercury on the
venereal poison stands in direct relation to the intensity of the mercurial fever, and
is diverted by any attack on the mouth, the bowels, and other excreting organs; but
the mercurial fever is so much the greater, the less mercury there has previously been
used; and the milder and more soluble the mercurial preparation employed is, the
more rapidly it is introduced into the system, and the more completely all evacuations arc avoided during its use.




166

ON VENEREAL DISEASES.

by a severe mercurial fever, while a slighter degree of recent syphilis, a single chancre, &c., may require a long time for its cure (let
alone an old standing case of syphilis) if we do not produce an
obvious mercurial fever, but administer the mercury in too weak
doses, and do not increase them sufficiently when the symptoms
are about to disappear.
635. If during the latter mode of treatment, which is of very
doubtful propriety, the system should, from the long continued
mercurial irritation, have become very sensitive and weakly, as often
happens if the tonic treatment have not at the same time been employed, it must be resorted to immediately after the termination of
the mercurial treatment, or still better, immediately on the appearance of the debility and symptoms of irritability, and be energetically
continued until the body can be pronounced sound in every respect.
On this account also we must beware of a too sleepy employment of
mercury, as it only tends to make the virus more obstinate, and
even disposes the system to let it break out still more virulently,1
when the metal is no longer in the fluids.
1 I gave a peasant, who was affected with some condylomata on the anus, scarcely
observable pains in the bones of the shoulder, and small ulcers in the tonsils of the
throat, in the course of seven weeks, 121 grains of soluble mercury, divided into equal
small doses. In the first two or three days all the symptoms were alleviated, without
his having experienced the slightest mercurial fever; the ulcers had disappeared from
the mouth, the pains in the bones were gone, and the condylomata were painless and
dry. His amelioration remained in this state until after this small number of powders had been used. He thought he required no further aid, discontinued attendance,
and only returned after the lapse of four weeks. His mouth was now covered to the
lips with ulcers; an ulcer 21 inches in length and half as broad, had eaten away the
upper surface of the penis, the anus was beset with similar ulcers, humid fissures,
and a number of moist condylomata; the pains in the bones were intolerable, and the
patient seemed to be weary of life. I now gave him 12 grains of soluble mercury, to
take the first day 3, the second 4, and the third 5 grains. He had a very severe
fever without salivation, and after five days not a trace of his venereal malady remained. The ulcers were healed, the pains gone, and the warts dried up and gradually
fell off. At the present time, after 2j years, he is as well as ever. From this it
appears 1st, that a sleepy employment of mercury rather excites than cures the
venereal disease; 2nd, that the point of importance is not the quantity of mercury introduced into the system, but the adequate intensity of the mercurial fever.




LOCAL AFFECTIONS AFTER THE TREATMENT OF SYPHILIS.         167
FIFTH DIVISION.
LOCAL AFFECTIONS AFTER THE TREATMENT OF
SYPHILIS.
CHAPTER IL
LOCAL AFFECTIONS THAT REMAIN AFTER A SUITABLE TREATMENT
OF SYPHILIS AND THEIR REMOVAL.
636. There are few local affections dependent for their morbid character on the virus of syphilis that should remain in the body after
a rational employment of soluble mercury.' I shall only make
mention of the warts, the periosteal and osseous swellings, and the
caries of the bones.
637. The venereal warts must be uncommonly hard and old if
they do not wither and fall off, or otherwise disappear, under a
mercurial fever of due intensity, or, as more rarely happens, terminate in healthy suppuration.
638. If after complete extinction of the virus there remain some
old, horny, large warts, they may be removed by surgical means.
They may either be tied with a waxed thread, by drawing which
daily tighter and tighter, they will be gradually perfectly dried up
and so fall off, or they may be cut off close to* the root, and the
wound touched once or several times with lunar caustic, and
when the last slough falls off the wart is completely removed.
639. But if they are in situations where they do not cause any
inconvenience, if they are not very large or elevated, we may in
many cases allow them to remain. They are innocuous, and generally disappear gradually of their own accord.
640. It is almost the same with the periosteal and osseous
swellings. They usually diminish gradually of themselves after
I'We have still greater advantages in the treatment of chancres and buboes; for if
we have once cured them by internal mercurial remedies oniy, we may be assured of
the eradication of the idiopathic virus. But in syphilis, especially when it is of long
standing, the local affection is often so masked, so very similar to other diseases, that
we cannot be immediately certain of the cure, if we cannot be convinced of the intensity of the previous mercurial fever; but especially difficult is it to decide, when
local affections remain that present the appearance of uncured venereal ones, for
then the eradication of the virus be-comes a matter of only doubtful probability.




168

ON VENEREAL DISEASES.

the complete eradication of the lues venerea. The parts exposed
to the more remote kinds of local diseases are affected by a perceptible swelling whose removal we should not attempt to obtain
by pushing the employment of the mercury too far. Even were
the virus not completely eradicated in them, it cannot be again
absorbed into the system from them, and so cause fresh symptoms
of syphilis; but it will be destroyed, provided the mercurial fever
was of sufficient intensity. In the latter case the swelling and
induration will usually remain stationary, shewing that the virus
has been destroyed; after some time it declines spontaneously if it
be not too hard, and if the patient be not too aged.
641. I have already said that such nodes usually pass spontaneously into a mucous suppuration, which on account of the
ensuing destruction of the periosteum, becomes dangerous for the
bone beneath. Under the adequate mercurial fever the unhealthy
pus already formed becomes changed, and not unfrequently resolved; a true cure, which at the most only leaves behind it a
painless elevation of the node. If the result be so fortunate, it
often remains a matter of uncertainty whether an abscess was
previously formed, as its existence is so difficult to discover while
the lues is still uncured. It is however a matter of great indifference; it suffices if the cure is effected.
642. But if the abscess have gone too far, if the mercurial fever
have indeed deprived it of its venereal character, but is unable to
effect its resolution, then there is always danger of the bone being
corroded after the destruction of the periosteum. We must ascertain
the existence of the abscess in order to be able to treat it locally.
643. It is moreover not difficult to discern the presence of this
non-venereal abscess (however difficult the discovery of the venereal abscess may be), as its existence cannot be doubted if during
the adequate mercurial fever, or a few days thereafter, a throbbing
pain continues or occurs in the centre of the periosteal node; a
sensation that differs widely from the agonizing pains of the still
venereal node.
644. We should then make a sufficiently deep and extensive
incision, evacuate the pus, clean the ulcer, taking care not to
remove any of the sound periosteum, and we should treat the
wound like an ordinary ulcer. When we make this opening we
perceive a pus of a mucous character certainly, but mostly well




LOCAL AFFECTIONS AFTER THE TREATMENT OF SYPHILIS.       169
concocted, whereas what existed before the mercurial treatment
was merely an albuminous fluid.
645. This it is that after corroding the periosteum causes caries
of the bone. If the mercurial treatment is at an end, and the
node, on account of the persistence of the pains, opened and
cleaned, we shall soon be able to discover the caries, if it exist. It
is now no longer venereal, if the mercurial fever was of sufficient
intensity, and, like all other caries from external causes, it will
take on the healing process, and will require to be treated by
similar remedies.
646. If the caries be superficial, advantage will be derived from
scraping the bone, from the employment of the actual cautery,
from sprinkling it with euphorbium powder, from touching it with
a solution of -nitrate of silver, and so forth. If it penetrate more
deeply, and be already seated in the interior of the hard tubular
bone,, it is generally accompanied by slow fever, brought on by
the acrid ichorous secretion. We should bore holes in different
parts of the bone, and deep enough to allow of the escape of the
matter, and then treat the interior with a solution of lunar caustic
or nitrate of mercury,' &c. Caries of the spongy bones, e. g. of
the nose., requires a cautious injection of the latter remedies,2 and
the moderate introduction of the vapour of a small portion of
cinnabar into the nose.3 If all these kinds of caries are mere
remains of the cured syphilis, they will be susceptible of cure
without much diffic-ulty'; but much more destructive and obstinate, as also more frequent, is the caries produced by the irritation
of mercury and from the morbid condition of the fluid and solid
parts thence resulting, of which more anon.
647. The swelling~s of the ligaments, tendons and tendinous
aponeuroses that remain are very obstinate. If, as is however seldom
the case, they have not yielded on the extinction of the venereal
virus by mercury, we must combat them by the application of
1One part of each dissolved in from 300 to 400 parts of water, to which should be
added thirty parts of tincture of myrrh or aloes.
2 Girtanner commends strongly the repeated injection of a solution of caustic
potash, or the same remedy used as a gargle.
3 Without however drawing in air by the nose, in order to prevent the vapour
from getting into the lungs.




170

ON VENEREAL DISEASES.

blisters. If this prove ineffectual, and they still remain painful
after the mercurial fever (a sign that they have become nonvenereal abscesses), they must be opened. They must then be
treated with proper vulnerary (one part of corrosive sublimate
dissolved in from 400 to 500 parts of water) and balsamic remedies.
CHAPTER II.
LOCAL AFFECTIONS AND SECONDARY SUFFERINGS THAT FOLLOW
THE ABUSE OF MERCURY.
648. We might a priori suppose that a drug like mercury,
which produces such tremendous effects on the body (such as mercurial fever, salivation, &c. are), must by a long-continued and too
frequent employment weaken the strength to a great degree, and
set the fibres into morbid, irritable vibrations, the source of all
sorts of chronic diseases that are difficult to cure, of rheumatic,
erysipelatous, and especially of scrofulous (scorbutic) and chlorotic
character, of trembling, of low, wasting fevers, of malignant, corroding ulcers of the soft and hard parts of the human body, &c.
And this is just what we find from experience, which presents us
with thousands of lamentable instances of this sort, produced by
the immoderate use of inunctions, mercurial plasters, calomel and
the like.
649. Gonorrhoeas are transformed into gleets, and those already
cured again commence to discharge; buboes take on an unhealthy
suppuration, become deep and excavated, excrete a large quantity
of acrid fetid ichor, evert their hard borders, and eat about them
in a cancerous manner, accompanied by agonizing pains; close to
the seat of the previously healed chancre numerous ulcers break
out; the constitutional syphilitic ulcers break out again, or become altered in their nature; they inflame, excrete much matter,
get a hard base, a cancerous look, and 'are painfully sensitive;
condylomata discharge much ichor, and are corroded into deep,
painful fistulous ulcers; others grow into sensitive, spongy swellings, almost impossible to be got down; we perceive on different
parts the periosteum thickened and painful; venereal ulcers in the




LOCAL AFFECTIONS AFTER THE TREATMENT OF SYPHILIS.    171
throat that have healed up again break out; the tonsils swell again
and become sore; the palate also becomes affected by intolerable
shooting pains, studded over with small ulcers, and at length perforated; the uvula sloughs off, a fetid smell proceeds from the
nose, which, along with the antrum Highmorianum (in the worst
cases) are gradually eaten out; the body becomes pale and lax,
the digestion is deranged, the catamenia disappear, the legs swell
sometimes, the patient is excessively sensitive to all impressions,
to heat and cold; there is great weakness and despondency; his
nights, full of pains and restlessness, are martyrdom to him; the
bowels are at one time constipated, at another purged; towards
evening he has transient debilitating heats, and his pulse usually
ranges from 100 to 130 in the minute; only for a few, often
fixed, hours during the day do his agonizing pains lessen somewhat; at other times they prevail constantly, especially during
the night. There are stiffness of the joints and chronic trembling.
One or both eyes are affected by amaurosis.
650. There are various causes for these ill effects of mercury,
which have mostly been already mentioned in the former parts of
this book. It has been usual to lay down the following pernicious
maxim for the treatment of venereal disease: that as much mercury
as possible must be introduced into the system-though modern
physicians have wisely added this limitation (which however is unsatisfactory and, on account of the nature of the ordinary mercurial
preparations, impracticable)-in as short a time as possible without causing salivation. Had they been aware that success depends
upon the adequate intensity of the mercurial fever, and not on
the introduction of an enormous quantity of the metal into the
system, they had forborne to lay down this pernicious rule.
Moreover, as the nature of the ordinary mercurial preparations
rendered it impossible to know whether much or little of the
active part of the metal got into the circulation in a given time, it
could not but happen that sometimes too much was imperceptibly
dissolved in the juices, and occasioned horrible devastations.
Besides this it has hitherto been the custom to employ the irrational French weakening system, both during and after the treatment, which did all that was possible to assist the irritating and
debilitating power of the mercury.
651. But what did more than all the causes I have mentioned to




172

ON VENEREAL DISEASES.

render the ordinary mercurial treatment so injurious, was the unpardonable inattention to the connexion betwixt cause and effect,
for the symptoms that arose during the treatment from the mercurial irritation were considered to be genuine venereal symptoms,
and were combatted anew with a still longer continuance of the
mercury, to the injury of the patient, who thus became the victim
of stupidity. Weak, chlorotic, scrofulous, or scorbutic subjects,
those, namely, who had become affected with spreading ulcers in
the mouth, from the quantity of mercury they had taken, were
dosed with still larger quantities of this irritating metal, and caries
took possession of the nasal and palatial bones; these were still
held to be venereal, the consequence of which was, that the malady
increased to the most horrible, often fatal, extent. Buboes that
had, by a succession of errors, degenerated under the long continued
employment of mercury into spreading ulcers, were treated by an
increased administration of mercury, and mortification or cancer
(or whatever this sloughing diathesis may be called), hectic fever,
hemorrhages, diarrhoeas, night sweats and death, were the result.
652. And yet what opportunities presented themselves for deducing this maxim, that the very first day when the amendment of
the venereal symptoms stood still under the judiciously increased
administration of the mercury-that the very first hour, when, under
the mercurial treatment, new affections, new pains, new abnormalities
presented themselves, or the previous genuine venereal symptoms were
aggravated-we should pause; and that state of the body that presented these obstacles to the venereal treatment, be it scrofula, chlorosis, erysipelas, gout, scorbutus, or only weakness and irritability,
should be combatted, and the (frequently irritating) mercurial preparation, the usual exciting cause of such morbid diathesis, should be
discontinued immediately. All the pains that remain, increase, or
arise during the mercurial treatment, all local affections, further,
swellings, ulcers, caries of the bones, &c., that break forth anew,
increase or occur for the first time during the use of mercury, are
no longer of a purely venereal nature, they are often of a totally
non-venereal character, and can never be cured1 by the further
administration of ever so large doses of this metal-but will, on the
contrary, be aggravated. If this maxim had been kept in view,
1 A cure might occasionally have been effected by a dangerous salivation.




LOCAL AFFECTIONS AFTER THE TREATMENT OF SYPHILIS.      173
there would not assuredly be so many unfortunate beings whose
health has been undermined and destroyed by misdirected mercurial
treatment.
653. I say, no longer of a purely venereal nature, for all those
whose sufferings have been aggravated by the continued or renewed
mercurial treatment, are not therefore free from all taint of the
venereal virus. In deeply rooted syphilis occurring in scrofulous,
scorbutic, gouty, erysipelatous, chlorotic, or otherwise weakly irritable individuals, the ordinary inappropriate mercurials may, after a
debilitating preparatory treatment, or along with a similar accessory
treatment, be given in such a drowsy fashion, that this metal can
scarcely do more than exercise its weakening irritation, but not its
antisyphilitic power; and then it will happen that the concomitant
morbid diathesis gains so much the upper hand, that when we would
endeavour to destroy the venereal virus (which is now almost concealed beneath symptoms foreign to it, so as scarcely to be cognizable) by means of a further or increased employment of mercury,
the slow fever, the scrofulous ulcers, &c., arising from the concomitant diathesis, increase to such a height that the patient is in danger
of losing his life, or a chronic dyscrasia is the result, and still all
remains of syphilis may not thereby have been eradicated.
654. The traces of the venereal virus in the system are not at
once cognizable amid these exacerbations, and amid these obvious
injurious effects of the mercury. It is only when, by an energetic
(often tedious and lengthened) treatment of another kind, the patient has perfectly recovered from his accessory diseases, and has
regained his health, then only does the syphilis again rear its head
in an unmistakeable manner, the symptoms proper to it still remain,
which may not be removed by any remedy in the world, any tonic,
anti-scorbutic, anti-scrofulous, and anti-chlorotic drug-but only,
and that easily, by the renewed employment of a good mercurial
preparation alone. This event alone (we have no other mode
of proving it) demonstrates by the result, that during the former
unfortunate mercurial treatment the syphilitic virus was still undestroyed.
655. This is the place to dispel the delusion that after such an
excessive administration the mercury still remains almost ineradicably in the system, and gives rise to all the horrible devastations,
the hectic fever, corroding ulcers, caries of the bones, trembling,
wandering pains, &c.




174

ON VENEREAL DISEASES.

656. The metallic mercury occasionally found in the cavities of
the bones proves nothing; we may carry this about with us without
our health being thereby affected. How can an insoluble substance
beyond the circulation act upon the latter? But, it is replied, this
fluid metal is a proof of the probable coexistence of a dissolved portion of mercury in our fluids! As long as we are unable to prove
its existence in our fluids more accurately than by supposition in
those chronic diseases, so long may we be allowed to ascribe their
obstinacy to other causes, which as I have shown in many places,
are not far to seek.
657. The fact of gold growing pale and brittle when worn by
those who have this metal in their fluids, the destruction of the
vermin on their head, but chiefly the non-infecting power of their
chancres, &c., gives us distinctly to understand that where these
phenomena are awanting, there can be no question of the existence
of mercury in the circulation. According to accurate observations
we may with certainty assert that the portion of mercury dissolved
in the circulation to-day will be no longer present after the lapse of
four weeks, but will be indubitably expelled by its own constant
irritation through some excretory channel. We may perhaps' at
first find traces of the metal in the saliva of a person undergoing
ptyalism; but shall we be able to detect any after the lapse of three
weeks from the last dose of mercury?
658. Should it be still time to suspect an excess of this metal in
the secundie vise, in order to remove the secondary sufferings from
a mis-directed mercurial course, sulphuretted hydrogen as a drink
(~ 608), or used as a bath in a similar form, may prove of service.
659. The removal of the other symptoms, occasioned or aggravated by the mercurial treatment, is to be conducted on nearly the
same principles as I have laid down in regard to the preparatory
treatment (~ 579-586). We may employ in addition, country air,
sea voyages, the diligent use of cold bathing, especially in the sea,
and in many cases the use of the Pyrmont waters. The sores
should be dressed with cleansing and strengthening remedies, especially with a solution of lunar caustic, with the addition of essence
of myrrh and tincture of Opium, the latter of which, both externally
and internally, must be the chief remedy in many of these cases.
1 Cruikshank's experiments do not allow that any mercury exists either in the
saliva or in the urine of a person undergoing salivation.




LOCAL AFFECTIONS AFTER THE TREATMENT OF SYPHILIS.      175
660. This same medicament, consisting namely of one part of
nitrate of silver dissolved in from 500 to 600 parts of distilled water,
to which is added 30 parts of laudanum, and 40 parts of essence of
myrrh, will be the very best injection1 for the caries of the bones,
produced or aggravated by the same cause. All that surgery requires to do besides, consists in an appropriate extension of the
fistulous orifices that occur, in order to remove the dead pieces of
bone conveniently and without employing any force, and in making
suitable openings at the most dependent points, in order to allow
the matter to escape. A numb sensation of the external integuments of the cheeks, and the severe pain inwardly at that part,
enables us to discover a collection of matter shut up in the antrum
Highmorianum, which we should endeavour to let out by extracting
the third molar tooth of the same side, and boring through the
alveolar cavity, and through this hole the injections should be
performed.
661. But besides these operations the chief thing we have to
attend to in such cases of caries of the bones, which are generally
kept up by irritability from weakness, is the general constitutional
treatment. If any other accessory diathesis be present at the same
time, we should bear it in mind. The remedies serviceable for the
latter should therefore be continued with the general tonic treatment, which should be gradually increased to the very utmost
extent. Cold steel baths for the whole body, exercise in the open
air, bathing the shaven head in ice cold water, general frictions,
steel, bark, wine, &c. With these tonics we must combine opium,
wherewith we shall best be able to soothe the sleepless painful
nights, and we should also give it in combination with tonics as a
general rule, in order to moderate the irritability for which it is
almost specific in this combination, as Glant has remarked, and I
have had opportunities of observing. In this combination I have
also employed ammonia with the best effects.
662. Sarsaparilla in strong decoction, taken to the extent of three
ounces daily, and large doses of assafoetida or hemlock, are said to
be of great use in this caries of the bones.
1 Should the disease, as usually happens, have its primary seat in the back of the
palate, the nitrate of silver mixed with 8000 parts of water, and used as a gargle (also
combined with laudanum), will prove the best remedy.




APPENDIX.

VENEREAL AFFECTIONS OF NEW-BORN INFANTS.
663. The venereal affections of new-born infants have very rarely
been an object of investigation on the part of medical men, partly
because they have seldom come under their cognizance, partly
because these poor creatures often survive their birth but a few
months, partly because their disease has often been mistaken.
Doublet1 has given us the best information on this subject; I shall
follow him in many of the subsequent remarks.
664. Most authors hold them to be an infection in the mother's
womb; others, but few,2 consider the venereal affections of infants
to be local inoculation,3 and degenerations and extensions of the
disease. I must confess that I incline to the latter opinion, for
several reasons.
665. That the cure of the pregnant mother of the venereal
disease is followed by the birth of healthy children proves nothing,
as no one can be cured of syphilis without at the same time
losing the local and idiopathic venereal affections. On the other
hand, syphilis may seem to be born with the children, because
in them all symptoms follow each other more rapidly, and local
affections pass so rapidly into general maladies; their bodies
are more tender and irritable, their skin is much more delicate, and the circulation twice as rapid as that in adults.
But has any one ever observed in infants immediately after their
birth, the copper-coloured spots or the ulcers of the tonsils, or
genuine open syphilitic ulcers on the surface of the body, or
I And now Girtanner.
2 Among these, more especially Girtanner.
3 The inoculation of healthy nurses by venereal infants is no rare occurrence.
How could the latter however communicate chancres to the nipples when sucking, if
they had not themselves chancres seated on the outer or inner surface of the lips, that
is to say, idiopathic venereal ulcers, which constitutional syphilis can never produce?




VENEREAL AFFECTIONS OF NEW-BORN INFANTS.

177

even the venereal itch? That these are found after several weeks
or months proves nothing. On the other hand, we find those
parts of the bodies of new-born infants affected with the venereal
inoculation, which, either on account of their being destitute
of epidermis, are capable of being inoculated in adults also, or
are most pressed upon or rubbed in the passage through the
female parts. Their epidermis is still so delicate (so much the
more so, as these children on account of the mother's indisposition
can seldom be carried to the full term, or are otherwise weakly and
delicate), that on those parts the poison can penetrate through the
epidermis, which, from an opposite reason, cannot occur in adults.
But I shall admit all these affections to be of a general syphilitic
character, whenever any one shall shew me such a child was born
of a mother that had been infected with syphilis, but who was
completely free from all local idiopathic venereal affections on and
in the genitals, from gonorrhea, chancres, and condylomata.
666. We find, 1st, the following affections on parts where adults
also may be inoculated without any previous injury. The eyelids,
especially the upper ones, are swollen; the eyes are at first affected
by dry inflammation, subsequently they usually discharge an acrid,
purulent whitish-green, often copious matter (blennorrhoea of the
eye from local inoculation); during sleep the lids stick together.
(This is one of the chief diagnostic marks of this sad disease in
children.) Spots on the cornea, hypopyon, blindness, are not very
frequent effects of it. The ears also are apt to discharge similar
matter.
667. The corners of the mouth, the frenulum of the tongue, the
anterior part of the gums, are studded over with small ulcers, which
are very hard at their bottom and all around them-true chancres.
Buboes in the parotid gland, at the angle of the lower jaw, &c.,
ensue.
668. The nostrils discharge a purulent matter (nasal blennorrhoea), they are also stopped up with masses of hardened
pus.
669. Inflammation of the genitals, chancres in the glans and
labia; strangury, swelling of the scrotum and of the external labia,
and fissures and pustules at the anus, are common symptoms.
Gonorrhoea however, is not found in male children; but from the
female genitals there exudes a yellowish matter, that may easily be
N




178

ON VENEREAL DISEASES.

distinguished from the discharge of a natural fluid, to which all
new-born female infants are subject.
670. The affections of new-born infants, 2ndly, on parts where
adults are not infected without being wounded, are most frequently
regarded as signs of syphilis communicated to them in the womb,
although they are manifestly quite the reverse; they are inflammations of the skin on parts of the body where the skin alone is
stretched over projecting bones, which have been during delivery
particularly rubbed against the genital parts of mothers that are
covered with the chancrous discharge, and thus have been inoculated (per diapedesin) through the thin epidermis. They are of
the following kinds:
671. The region of the coronal suture, the protuberance of the
parietal and occipital bones, the shoulders, the region of the
sacrum and hip bone, the ankles and the heels, are externally
reddened and inflamed. The epidermis soon falls off, the sore
places extend and become covered with a white crust, beneath
which an acrid, fetid ichor exudes.1 When these parts become
black, mortification is nigh, the sign of approaching death.
672. A similar inflammation of the skin and ulceration attacks
from the same cause the neighbourhood of the navel, in consequence of this part being very much strained during the process
of delivery; and moreover the natural inflammation that takes
place in infants before the navel string falls off may favour the
action of the virus on that part.
673. The affections that constitute the transition of the idiopathic virus into the general circulation in adults are also not unfrequently met with in infants some time after birth, I mean the
glandular swellings. These buboes occur in them in the cervical
glands, in the parotid gland, and in the axillary glands, either from
the chancres on the lips or from similar ulcers (~ 671) on the head
and shoulders-in the groins from chancres on the genitals or from
similar sores on the sacrum and hip bones, the ankles, &c.-or also
in any of these situations, from the direct penetration of the chancre
poison through the external integuments, without any previous chancres; and this occurs much more frequently in these delicate creatures
1 Or these parts rise up in inflamed, brown, soft swellings, which usually pass
into dangerous suppuration.




VENEREAL AFFECTIONS OF NEW-BORN INFANTS.

179

than in adults. These glandular swellings,like those in adults, usually
terminate in suppuration if the virus be not destroyed by mercury.
The suppuration of the parotid gland has a great tendency to
involve the bony structure of the mastoid process.
674. The symptoms of general lues always occur only after
several weeks,1 sometimes (according to some authors) not before
eight months after birth. The skin becomes covered with bluish
spots, which, as in adults, become in course of time somewhat
elevated, and gradually are covered with a greyish dry crust. Or
there are at first merely excoriations. Subsequently there are
formed at these parts venereal ulcers, which arise most rapidly in
the axilla, betwixt the thighs and betwixt the nates, and have a
white, suety-looking appearance. The whole skin is also sometimes covered with bran-like points. General venereal ulcers also
appear in the mouth and on the tonsils. Single elevated pustules
are formed on the dorsum of the fingers and toes, which rapidly
pass into ulcers and cause the nails to fall off by the roots. Running
chaps appear at the anus. Swellings of the bones, however, and
gonorrhoea in the male, are not met with in infants.
675. Such children are usually very weak and emaciated; their
skin, especially that of the face, is of a bluish colour, shrivelled
and full of wrinkles, like an old person's.
676. The usual mode of treating the venereal diseases of newborn infants at Vaugirard consists in treating the mothers before
they are born or while they are at the breast. None of the metal
is given to the infant directly.2
677. If the mother be subjected to treatment before her confinement, she is treated with diluent drinks, bitters, mild purgatives, baths and mercurials, so as to alleviate her disease and to
facilitate her delivery; but after delivery, from the twelfth day
onwards, she is made to rub in every other day from one to two
drachms of mercury at a time, so as that she shall use from three
to four ounces in the course of five, twelve, or even twenty weeks.
During this course she suckles the infected infant, or even a
1 Girtanner says, in from ten to fourteen days.
2 Now, according to Girtanner, they are subjected to the fumigation treatmentor they get eighty drops of Swieten's solution of corrosive sublimate every night:
both of these are either useless or hurtful procedures.
N2




180

ON VENEREAL DISEASES.

couple of them, in order to impregnate them with the antisyphilitic
specific along with the milk.
678. It is observed that children whose mothers have been
treated with mercury before their confinement suffer little inconvenience from the mercurialized milk (they are already used to
the metallic impression); those however who have experienced
none of the influence of the mercury on their fluids before their
birth, on using this milk become pale and get belly-ache, heat and
loss of appetite, especially if they are kept not warm enough, or
too warm. In this case the frictions are discontinued, and soothing
medicines, mucilaginous drinks and clysters are employed.
679. Very soon the putrid hospital aphthie attack and carry off
a large number of these children.
680. In course of time, about the sixth week, slow fever, diarrhoea, &c. usually set in, whereby many are destroyed.
681. The rest gradually escape the danger; the venereal symptoms disappear, and there only remains a greater or less liability
to the common diseases of children.
682. From all this we learn nothing more than that the venereal affections of new-born infants are curable, for as regards
the mode of treatment, it is burdened with such a vast number
of evils that it cannot be recommended for imitation. Let us
for a moment consider how much injury the health of the pregnant woman must at first suffer from the five to twenty weeks
of mercurial irritation, and how aimless such a treatment is, as
not only are they not cured by it, but it is not intended for their
cure! If the mother have syphilis in a great degree, this treatment, continued for a considerable time, affords no relief either to
the mother or to the infant; the latter usually dies. Rendered
liable to various diseases from the treatment during pregnancy,
or from ordinary ailments, or from other circumstances, the
mother is often not in a position to suckle her child, and then the
wet-nurse who takes it gets venereal fissures and ulcers on the
nipples from the chancrous mouth of the child, whereupon inflammation of the mamma, stoppage and drying up of the milk, usually
ensue. The chancres on the lips and frenulum linguae of the
infant impede or prevent its sucking. But besides this, how
tedious is this treatment, how often does not the death of the little
sufferer anticipate its termination, or if that does not happen, how




VENEREAL AFFECTIONS OF NEW-BORN INFANTS.

181

many are carried off by the hospital air, how many (if some few
do go through all this), how many, I repeat, of these few, by the
instrumentality of this long-continued mercurial irritation that
makes their fluids acrid, their fibres weak and irritable, are rendered
liable both to dangerous maladies and to chronic dyscrasias, to
which death itself is often preferable! Of the injury that accrues
to the mothers and nurses from such a treatment I shall say nothing further, as I have already spoken        of the disadvantages
attending the inunction treatment.
683. From an institution so conducted I can imagine no real
advantages to society which could outweigh all the sacrifices con*nected with it; but this we see, that the French nation' probably
surpasses all other civilized2 people in delicacy of sensibility for
suffering mankind.
684. I shall not stop to consider the other mode commonly
practised of curing children of the venereal disease, as they usually
only come under treatment when they are a year and a half old or
still older, and are treated with solution of corrosive sublimate, as in
adults, only with smaller doses. A tenth, an eighth, a quarter, and
at length as much as half a grain is given them daily in different
kinds of mild fluids, frequently with greater success than in adults.
But how many of them die before they attain this age, before
they are brought under the action of this remedy, be it ever so
efficaciously administered! Besides, my business at present is
with new-born infants.
685. The medical police could arrive at a much shorter way for
attaining this object3 of preserving these young citizens of the
state, if they kept in view the maxim that I have been induced
from a multitude of observations and reasons to propound as an
1 The only hospital for syphilitic children that I know of is the Hospice de Charitd
of Vaugirard, which requires enormous sums of money for its maintenance.
2 Germans.
3 Girtanner says, "a venereal mother is generally (on account of the bad state of
her lymph, whereby she is unable to nourish the foetus) confined in the sixth or
seventh month, without any other exciting cause, and the child is usually dead: or
the movements of the foetus cease in the sixth or seventh month, and at the end of
the pregnancy the child is born dead and half decayed. If it is alive it has a very
thin and emaciated appearance, and soon dies." What a loss for posterity I How
necessary is the cure of the syphilitic mother in her pregnancy, to prevent the state
experiencing a great loss!




182

ON VENEREAL DISEASES.

axiom; if they were convinced that syphilitic children have only
become so by their local infection in the genitals of their mothers
during parturition,1 and that pregnant women are not more difficult to cure of their venereal affections, without injury or premature labour, than other weak persons are to be freed from this
disgraceful malady.
686. If the first point is conceded to me, all the greater objections are made to the last. Let it be remembered however that
to dread ill effects from a radical mercurial treatment for pregnant women and their offspring, and on that account to leave both
uncured till after birth,2 implies that the treatment is more dangerous than the disease itself. If the inunctions, calomel, &c. are
of this character, I am sorry for it. As far as I am aware the
cautious administration of soluble mercury indicated in this book
is not so; I am indebted to it for the lives and health of many
mothers and their offspring. I must refer to what I have already
said as regards its employment in this case. A physician who is
such in the true sense of the word, will understand how to supply
what is necessary for the accessory circumstances.
687. If however we are called on to treat a new-born infant
affected with venereal symptoms, there is very little hope for it if
the symptoms are in their highest degree, if the child is much
emaciated and cannot take the breast, or if its mother cannot
suckle it. But even in such circumstances we ought not to despair.
688. In the last case we shall not be able to do much without a
wet nurse, as the poor creature will hardly be able to contend
with the process of accustoming it to unnatural food and the
attacks of such a dangerous malady, without succumbing. We
may however attempt to nourish it (and this we must at all events
1 In public lying-in institutions no woman affected with syphilis should be allowed
to be confined without being cured of all her venereal symptoms. If little can
be done, we should at least treat and cure their genitals by the local application of a
strong solution of lead, in order to prevent the child being infected during delivery.
The syphilitic virus can afterwards be eradicated by an appropriate mercurial treatment after parturition. But the latter may also be done during pregnancy, and
that is the preferable course to pursue.
2 Who can reckon the number of abortions that occur in those unfortunate beings
who are with methodical over-cautiousness designedly left uncured of their syphilitic
complaints until after delivery.




VENEREAL AFFECTIONS OF NEW-BORN INFANTS.

183

do if it be unable to suck) with goat's milk for drink, and in the
commencement without any other food, until the case takes a
favourable turn (and then it will be able to partake of pounded
biscuit, &c.), and on the very first day we are called in, after
purging the primae viae of their impurities, commence with the
soluble mercury,' which is the only preparation that from its mildness, certainty and rapidity of action, holds out to us any hope,
where no other remedy is admissible.
689. In most cases not more than one grain of soluble mercury
will be required. We may rub it up with a drachm of liquoriceroot powder, and of this mixture give the first day (for we should
give but one dose daily) five grains, the second seven grains, and
so on, until we observe a marked alteration in the complexion,
restlessness, rumbling in the bowels, fetor of the breath, heat in
the eyes, &c., the signs of the mercurial fever. If the signs are but
of moderate intensity, and the change in the venereal symptoms
not striking, we may repeat the last dose; otherwise not, for if the
mercurial fever was sufficiently strong it would fully perform its
service, and remove the venereal affection. The infant may take
the medicine in its goat's milk, and not partake of anything else
until the cure is effected.
690. If the child can, immediately after birth, take its infected
mother's breast, we should only treat the latter with soluble mercury, in the doses above indicated for adults; but we should
commence immediately after being called in, and attend to the
accessory treatment and precautions2 required in such cases. The
child will recover by partaking of her milk, if any adequate mercurial fever is developed in her.
691. Similar doses of the antisyphilitic metal and similar precautions must be employed in the case of the nurse (even though
she be perfectly well) who suckles the child in place of its mother,
partly in order that she may not be infected herself, partly in
order that the child may be restored to health by partaking of her
medicated milk, which will be the case if she get a sufficiently
intense mercurial fever.
1 Girtanner also considers it best to give the child mercury.
2 If the circumstances are not urgent we may delay the treatment until the
twelfth day after confinement.




184

ON VENEREAL DISEASES.

692. If the child cannot or will not take the breast, or if there
be none to give it, we must endeavour, after its recovery, to send
it into the country and allow it to be reared by some experienced person.
693. During the treatment the child must be bathed and gently
washed twice a day in a tepid decoction of marsh-mallow root, for
a few minutes. The sores and excoriations should be dusted with
lycopodium powder, or dressed with lint. Its linen should be
changed twice a day until it is quite recovered; it should be
carried about, and the air in the apartment should be renewed as
often as possible. If there be constipation, soap and water injections should be used; the aphthae may be cured by frequently
touching them with water acidulated with from 1/iwth to 1/50th part
sulphuric acid.
POSTSCRIPT.
(Whilst these sheets were going through the press I have been
enabled to make the following additions and corrections.)
As regards the preparation of the soluble mercury (see Preface),
I have found that in order to deprive the nitrate of mercury of all
traces of muriate of mercury, there ought to be no free acid at all
in the metallic salt before the precipitation is performed. Accordingly I find it requisite to wash the crystallized mercurial salt
with about a tenth of its weight of distilled water, and then dry it
on bibulous paper before proceeding to dissolve and precipitate.
I have further observed that ammonia carefully prepared contains
but an inconsiderable quantity of muriatic acid, and may consequently be appropriately used instead of the egg-shell lime to
precipitate the (in this case white) soluble mercury. But as no
acid is more frequently met with in nature than this muriatic acid
which is so prejudicial to our object, and as it may, in spite of the
greatest carefulness on the part of the operator, exist in a small
proportion in our preparation, we would do well to change by a




POSTSCRIPT.

185

simple operation the white precipitate that may be present into
the much more innocuous calomel. For this end we boil the
crude precipitate, in place of sweetening it, in fifty times its weight
of distilled water for an hour, then pour off the water and dry the
sediment on bibulous paper for use.
If it be objected to (~ 619) that muriates exist even in the cleanest
stomach, which, let the oxyde of mercury thus prepared be ever so
free from white precipitate, would soon decompose it and change it
in the alimentary canal into something similar, my observations
teach me, that the ingestion of white precipitate already prepared,
in consequence of its forming small, insoluble, corrosive masses,
causes much more poisonous effects, than that which is only changed
in the stomach, by decomposition, into amazingly fine heavy particles of white precipitate, which only cause a slight griping, and
enveloped in the mucus of the bowels are soon expelled. But even
this need not be dreaded, if in place of any other fluid, a couple of
glasses of Selters or Piilna water be drunk, for as I have found by
numerous experiments, the carbonic acid redissolves the white precipitate that has already been formed, and even the turbith
mineral, and retains it in solution until this gas is driven off by a
considerable amount of heat, so that the metal (in that case it must
have been prepared with lime water, or with caustic potash) cannot
be precipitated from the fluid. If this precaution be adopted in
taking the medicine, even the inconsiderable griping that occurs
from the oxyde of mercury may be prevented, if that be deemed
necessary.
Among the most powerful antidotes to the ulcers that degenerate
into corroding sores (~ 331, 381, 403, 648, 649), or are caused by
the abuse of mercury, I must, from my experience since the foregoing was written, place the sulphuretted hydrogen gas, spoken of
at ~ 608, as it is preferable to all other remedies for removing all
affections arising from the long continued irritation of mercury,
the pains in the limbs, the low fever and night sweats, and the
exhausting salivation.
A young man was, on account of a gonorrhoea and small chancre,
so mistreated by a barber-surgeon with enormous quantities of
calomel for six weeks, that besides having an immoderate salivation,
he got also severe hectic fever, profuse night sweats, tearing pains
in the limbs, trembling, and large pustules all over the body, which




186

ON VENEREAL DISEASES.

being aggravated (and these aggravations the quack considered to
be venereal symptoms) by additional quantities of mercury, degenerated into large deep ulcers (some were an inch and a half in
diameter), surrounded by inflamed elevated borders, and covered
with a suety looking substance. The worst symptoms were the
ulcerations in the throat, at the posterior nares, in the tonsils, on
the palate and uvula; in this situation, one large ulcer seemed to
be eating away all the parts; from the mouth and nose bloody pus
flowed; he could not utter any intelligible sounds; he was emaciated and excessively feeble. All the remedies used were of no
avail until I gave him ten grains of hepar sulphuris within twentyfour hours, which produced a rapid amelioration of all the symptoms,
so that the other remedies required, the sulphuric acid for the low
suppurative fever, and a solution of lunar caustic for the foul
ulcers in the mouth, were speedily beneficial. He was soon so well as
to be able to enjoy the open air, and whilst he was out, his room was
thoroughly aired. This course was attended by increasing benefit
for some weeks, and he had almost completely recovered when he
one day, by staying out too long in severe weather, took cold, and
was confined to the house in a febrile state. The precaution of
opening the window was omitted, without my being aware of it.
His former symptoms now rapidly returned, the ulcers in the throat
and on the other parts of the body broke out with increased
violence, and even the glans penis was rapidly perforated by deep,
rapidly spreading ulcers here and there, but not on the seat of the
former chancre. The fever with the night sweats, the pains in the
limbs and the salivation returned, and increased daily in violence.
I made use of every thing that had previously proved serviceable,
but without success; in the course of a few days he was brought to
the verge of the grave. He would take nothing more, had frequent
hiccough, recognised his friends no longer, and could not move
himself. I now began to suspect that the confined atmosphere of
the room might perhaps be loaded with mercurial vapour, which
had again penetrated his system, and thus caused a recurrence of
these sufferings. I ventured to give the half-dead patient three
I had also to give the healthy person who slept in the same room the same remedy
for salivation and night sweats, that had arisen spontaneously, so saturated was the
air of the room with mercurial exhalations.




POSTSCRIPT.                     187
grains of hepar sulphuris every hour, with such good results, that
in the course of twelve hours I observed some traces of amendment, and by continuing this and the former remedies, I gradually
restored him to life and health, and I did not neglect to place a
solution of hepar sulphuris for some weeks in his room, in
order completely to mineralize and to destroy the mercurial vapour
in the room, by the evaporation of the sulphuretted hydrogen. I
leave every thinking man to draw his own inferences from this
striking case.
END OF THE VENEREAL DISEASES.




C




THE FRIEND OF HEALTH.
BY
SAMUEL HAHNEMANN,
MDoctor oft jdictne, A  jember of tte acaaemp of Siences of d8entf,
an4l of t1ee Eonomical  octet  of tip~tag.







PART IT.

PREFACE.
WHEN we behold the large family of mankind acting as they do,
when we see with what perseverance they go through their more
or less important spheres of action, which some wretched passion
often traces out for them, when we see how they all strive after
the attainment of some kind of happiness, be it ease, rank, money,
learning, amusement or excitement, scarcely deigning to cast a
single glance towards the real blessings of this world, wisdom and
health, which beckon them back into Eden, we can scarcely
refrain from pitying a race of such noble origin and high destiny.
My mission permits me not to point out the means of ennobling
the mind; it behoves me only to preach upon the greatest of corporeal blessings, health, which scarcely any take the trouble to
seek after, and few know how to value until it is lost. It will
scarcely be credited when I assert that nought is shunned more
earnestly, nay is held to be more disgraceful, than rational care
about the health.   We indeed hear it occasionally remarked that
this or the other article of diet is wholesome or hurtful, that this
or that remedy is a specific for this or that disease, this or the
other habit is injurious; in the higher and lower circles of society,
people interest themselves with fashionable modes of treatment,
marvellous diseases, cases of sudden death, beautifying remedies,
and anecdotes about physicians.
But all this is only vain trifling.
1 Published at Frankfort on the Main in 1792.




192

THE FRIEND OF HEALTH.

The lover of highly spiced dishes exclaims against the indigestible nature of puddings; the tea-drinker can speak like a book
about the evils of spirit-drinking; the lady who has a weakness
for coffee talks learnedly on the coarse juices of her who has a
liking for beer; and the guzzler of puddings declaims upon the
poisonous nature of mushrooms.
Hearken to that gouty fellow how well he can describe the
hurtful character of the day-labourer's life; to that young gentleman with his pimpled face, how he depicts the disadvantages of a
sedentary life; hear how that lady who sticks close to her tapestry
work inveighs against the dangers of dancing; and how the
dancing nymph points out that much sewing causes greensickness. All know something, only not what is wholesome for
themselves.
To take ourselves to task about our pernicious habits, to study
our own system, to follow the regimen most appropriate for our
own constitution, and heroically to deny ourselves everything that
has a tendency to undermine our own health, or that may already
have done so, to bestow a thought upon all this, is held to be
puerile, old-fashioned, and vulgar. The courtier rebels at the idea
of attending to the advice of his physician on dietetic points;
the young lady who excels in dancing would think it beneath her
to listen to the warning voice of her mother; the romance-reading
damsel scorns to be corrected by the sarcasms of her old-fashioned
uncle; and the wild student will not be persuaded by his banker
to frequent better company.
I readily grant that excessive concern about one's health is an
evil; that there is no occasion for an active lad to trouble himself about fur-boots, for a rosy-cheeked lass to interest herself
in the various kinds of obstetric forceps, or for the pleasure-seeker
to concern himself about hospitals; but everything has its proper
bounds; every human being his particular sphere, which he ought
to be thoroughly conversant with, and which he should blush to be
unacquainted with.
If the minister of state were to possess no thorough knowledge of
medical police, the chief municipal magistrate no accurate notion
respecting the arrangement of prisons, workhouses and hospitals,
if the general officer were to know his hospitals only by plan, if the
student who has completed his studies were to bring away with him




PREFACE.

193

from the university no knowledge of physiology or anatomy, if the
laughing girl were to enter into the married state without ever
having heard of a mother's duties, if the governess can do nothing
but descant on silly gentilities to her chlorotic pupils, and if the
pedantic usher, enveloped in a mist of phrases, elegances and
verbiage, were unable to perceive how numbers of hopeful boys
entrusted to his care fall victims to the most enervating vices, how
unfit for their respective spheres these persons would be. Indeed
I should like to know if there is any condition in life, where some
medical knowledge and some care for our own and our neighbour's
health are not necessary, or if it is ridiculous or degrading, beyond
the mere rude routine of our actual business, to devote some time
to the finer but often not less important study of the structure and
modes of preservation of the human body.
Of course I do not mean to say that the works of Frank, or
Howard, or Fritz, or Haller, or Levret, or Whytt, are for such persons as these, and I should commit a most egregious blunder
were I to recommend a total reformation in the plan of education
to those who have made it their special study. But, jesting apart,
for all these there are studies of general utility, springs to which
all may resort with profit, for they flow only to supply the wants
of all the conditions of life.
Oh! that in the following pages I were so fortunate as to be
able to contribute something to the happiness of mankind, if they
would listen to the voice of a warm friend of his fellow creatures,
as if it were the voice of a friend! In a few years, nay days, and
we have reached the termination of our earthly life; would that I
could now and then prolong it were it but for a few hours, would
that I could improve it were it only in trivial things I




?--;--
7 --
cT -~--~
r --n%;~4:~i.~,;~ C,

CANINE RABIES.

THE BITE OF MAD DOGS.
THE disease that results from the bite of rabid animals, most
frequently of mad dogs, is of such an extraordinary and terrible
character, that we are struck with horror on beholding a patient
affected by it, and the mere description of his sufferings causes us
to shudder. Among a thousand persons affected by real hydrophobia, often not one is saved. The most vigorous constitution,
the best physician, the most recondite remedies, and the most
implicit obedience of the patient and his friends, are in most cases
all of no avail; in the possession of perfect consciousness the
unfortunate being is usually, amid the most fearful symptoms,
hurried off in a few days to an untimely end.
The patient feels an accession of pain in the bitten part, which
may either be perfectly healed or still an open wound, it becomes
surrounded by a blue border; a creeping sensation proceeds from
it up to the throat, which feels as if contracted. The patient has
pain in the head and stomach, and sometimes bilious vomiting.
His sleep is disturbed by frightful dreams, he becomes restless,
the hands, feet and tip of the nose grow cold, the features distorted.
He thinks he sees fiery sparks dancing before his eyes. He feels




THE BITE OF MAD DOGS.                  195
neither hunger nor usually thirst, the tongue is moist but covered
with viscid mucus, stools and urine suppressed, or he passes them
of natural colour, but with pain. The pulse is weak and jerking, but not inflammatory.   He cannot bear the approach of
any liquid without trembling all over, with wild, anxious, sad
expression. In like manner he cannot bear anything glittering,
bright or white, anything approached suddenly towards him, loud
talking, a draught of air, &c. In the lucid intervals he speaks
rationally, but in a more timid, rapid and nervous manner than
usual; a hacking cough, sometimes combined with hiccough,
interrupts his speech. His face becomes always paler and more
distorted, the anxiety that dominates over all his actions is
expressed also by the cold clammy sweat on his face and hands,
his eyes are tearful and the pupils dilated. He tosses convulsively
about in his bed. He seeks to run away. At length he hides his
face, becomes quieter and expires.
The post mortem examination exhibits usually nothing abnormal.
The extreme tension and excessive irritability of the nervous
system and the sense of self-preservation shewn in the anxious
dread of approaching dissolution, these are the sole characteristics
of this fearful disease.
I shall not here enter into a description of the countless reme.
dies that have been proposed for it; their enormous quantity is of
itself to a certain extent a proof that no sure mode of cure is yet
known, otherwise that would be adhered to. I shall merely
endeavour to remove some erroneous notions prevalent on the
subject, and thus if possible endeavour to render this disease of
less frequent occurrence.
The first and most prejudicial of these is the great confidence
reposed in certain remedies said to be infallible, among which I
allude chiefly to internal remedies. Some persons are bitten by a
dog supposed to be mad. They use with all speed the renowned
specific, and none of them takes the hydrophobia; all recover from
their wounds without any serious consequences following; and in
all the country round nothing is talked of but the wondrous
curative virtues of, it may be, the may-worm electuary,' or what1 [A nostrum for the hydrophobia purchased at an extravagant price by the Prussian
Government.]
02




196                 THE FRIEND OF HEALTH.
ever else these patients used. It follows, of course, that in similar
cases occurring in this district nothing more will be done than
to give the bitten individuals the may-worm electuary. One of
these, however, dies of hydrophobia, but the vaunters of the nostrum can furnish reasons for its inutility in this case, at all events
this single unfortunate case is regarded as the exception, against
the many successful ones. Should it happen a third time that
some one or other in the neighbourhood is inoculated with the
poison of a mad dog, so that in the course of nature he must be
affected by the hydrophobia, the electuary is at once confidently
administered to the unfortunate individual, and it is only by the
sad termination of this case that the remedy falls into disrepute.
Had the first cases of reported success been more carefully
investigated, it would have been found that these first patients
had received no true virus of rabies into their wounds, and that
consequently the electuary had no difficulty in curing, as there
was nothing to cure. The subsequent unfortunate cases might
then have been prevented, had not such implicit confidence been
placed in this internal remedy, but the far more trustworthy external preventive remedies been employed.
But what are the best external preventive remedies, and how
can we confidently pronounce on the madness of an animal?
These questions shall be answered farther on.
Thus much is certain, that the commencement of the malady
is at first merely local. The poisonous saliva of the animal lies at
first inactive in the bitten wound. The wound heals, and not the
slightest inconvenience is experienced, until, after a longer or
shorter period, symptoms of irritation of the nervous system, and
along with them the fatal hydrophobia make their appearance.
Could we at first extract the poisonous saliva from the wound as
completely as we can a splinter or a bullet, it would be impossible
that rabies could result from such a bite. But if it be already
present we know no remedy whereby it may be certainly cured.
Hence all trusting to such specifics is unsafe and injurious if we
have not already frequently tested their efficacy on fully developed
hydrophobia.
The second error which may prove injurious, is the belief, that
a dog has communicated the poison by its bite if he die within a
few days of rabies, and has not communicated it if he continue




THE BITE OF MAD DOGS.

197

alive; consequently that a dog that soon dies with the symptoms
of this disease, which fear magnifies excessively, was mad, but that
one that recovers could not have been mad. In the former case
(and who can deny it, as we know as yet so little of the maladies
of the domestic animals) it might have been quite a different
disease that the dog had which inflicted the bites, and the remedies
employed for these bites thus falsely acquire a reputation as
specifics for hydrophobia. In the latter case in spite of all the
danger, none is apprehended; the only useful remedies for the
parts infected by the virus are neglected, and the fatal disease
is in all certainty allowed to break out.
We find in the records of medicine many instances1 in which the
severe bite of a dog that afterwards died with all the signs of
rabies, infected some persons but not others, without the latter
employing anything, and on the other hand there are undeniable
instances shewing that dogs of whose bite persons have died of
hydrophobia have remained alive.
To refer to but one case of the latter sort, I may mention
that Martin Lister, in the 13th vol. of the Philosophical Transactions, relates the case of a robust young man, who six weeks after
being bitten, became affected by hydrophobia, of which he died
fourteen days thereafter. At the same time, the same dog bit a
little dog, which died the day following of rabies; but the large dog
itself recovered, and was quite well eight weeks after it had been
mad.
A similar instance of a rabid dog which recovered, some children,
at the risk of their lives, diligently washing its wounds, is to be
found in the 20th volume of this instructive collection, where we
also meet with the cases of two young men, related by Dr. Kennedy,
who recovered from  the hydrophobia without employing any means.
Had any of the renowned specifics been used in these cases, would
not the cure have been infallibly ascribed to it? Can a medicine
be extolled as infallible for this disease, or even as very useful, that
has not cured at least ten cases of developed hydrophobia?-Where
is there such a medicine?2
1 Vaughan saw from twenty to thirty persons bitten by a mad dog, of whom only
one among them, a boy, died of hydrophobia, the rest escaping unaffected.
2 Unless it be perhaps the root of belladonna. Might not a very strong extract of
black henbane, prepared without heat, administered in sufficient quantity in the form




198

THE FRIEND OF HEALTH.

The third error is the delusion entertained even by physicians,
that the virus of mad dogs can only cause infection when introduced into the wound caused by a bite, or some other open
wound.
As a proof of the incorrectness of this, cases are not rare where
mad dogs have merely licked the external skin, and yet have communicated the disease. Two boys, as we learn from De la Prime,
in the 20th vol. of the Philosophical Transactions, frequently
cleaned with their hands the wounds of a dog that had been bitten
by a mad dog; many months afterwards, without ever having been
wounded, they both were attacked simultaneously by hydrophobia,
which lasted a week, when the eldest recovered, and said timidly to
his father, " I am well." The same happened to the other. They
remained well three or four days, then again had violent attacks of
hydrophobia for a week, and thereafter recovered without relapsing.
Likewise in the 23rd vol., we find the history of two servants, who
frequently inserted their fingers into the throat of a dog (that had
been bitten by another rabid dog, and did not die for three weeks
afterwards), in order to feel if there was anything the matter with
it. Both were affected by hydrophobia without having been
wounded; the stronger of the two recovered without using any
medicine, but the younger died of hydrophobia on the third day.
I myself knew a boy whose face was licked by a dog that was
going mad, and who died of hydrophobia.'
It is in general the safest plan to consider the bite of an unirritated dog as that of a mad dog, and to treat it accordingly. This
is the surest way to guard against hydrophobia.
The wound should be immediately washed out with water in
which a quantity of potash has been mixed, and this should be
repeated frequently, and until the surgeon arrives, who should
bring with him a piece of caustic potash, and touch the open wound
therewith until a slough the thickness of the back of a knife is
formed, whilst the moisture that exudes should be removed by
blotting-paper. The pain is not very severe, the slough falls off in
of pills, be able to cure this disease? A number of theoretic reasons lead us to have
strong hopes that it might. But the extract must be so strong that two grains of it are
sufficient to cause in a healthy individual, troublesome symptoms, stupefaction, &c.
1 Ccelius Aurelianus, Palmarius, Van Hilden, Callisen, Odhelius, Gruner, and
Morando have recorded similar cases.




THE BITE OF MAD DOGS,

199

a few days, and the clean wound soon heals.    If this is done first
of all and very quickly, we may feel quite at ease, and do all in our
power to comfort and console the patient,1 and tranquillize his
circulation. A moderate blood-letting in plethoric individuals, or
a glass of wine given to persons of an opposite constitution, will
suffice for this purpose. If this frightful disease can by any means
be prevented, it is by such means; but not by any internal medicine
hitherto known.
The part of the skin which, although not broken, may have been
wetted by the saliva of a dog which has become suspicious from
having bitten others, must be diligently rubbed with potash, and
washed continually for an hour with a solution of the alkali. If a
blister be afterwards applied to the spot, then all danger will be
more than warded off.
No dog should be trusted that bites people unirritated, and has
a gloomy wild expression. It is far better to kill too many of these
often useless beasts, than to allow one actually rabid to roam at
large; man's life is too precious, and should be held paramount to
every other consideration. Merely to shut up for a few days dogs
bitten by a mad one, is always dangerous, as examples are not
awanting where they only became mad several weeks after being
bitten. They must either be killed, or be kept in safe custody for
at least four weeks, before they are trusted; the former must
absolutely be done in case the dog that inflicted the bite was very
suspicious.
A dog may be suspected of commencing rabies when it ceases to
be friendly, will scarcely wag its tail on being patted by those it
likes best, appears very tired and lazy, is cross and dejected, dreads
the light, and creeps into dark corners, where it lies down without
sleeping. It never barks, not even when there is the greatest cause
for it doing so; it merely growls at any thing approaching it
suddenly, and springs out at it. The eyes are dim, the tail and
ears hang down. At this stage the bite commences to be dangerous.
1 A clergyman was affected by chronic hydrophobia merely from imagining that a
dog that had bitten him was mad. He would have died had not a physician pointed
out to him the erroneous nature of his idea. He soon recovered after the physician
had succeeded in convincing him, and without taking any edicine.




200

THE FRIEND OF HEALTH.

This state lasts but half a day, or a whole day, and then the
second stage of rabies breaks out. The animal no longer knows its
own master, eats and drinks no more, becomes restless, growls
with a hoarse whine, without ever barking, goes about threateningly with dependent head, red watery eyes, having a sad expression
and directed towards the ground. It involuntarily moves the lower
jaw in a mumbling manner; its leaden-coloured tongue, dripping
with saliva, hangs out of the mouth; the tail is stuck betwixt the
legs; the hairs of the whole body stand out in a disorderly manner.
It tries to run away, snaps at every thing before it, and runs along,
irrespective of the road, without apparent object, straight and
crooked, at a quick, usually unsteady pace. Other dogs run away
from it.
The wood-cut at the head of the article represents a dog in this
state.
THE VISITER OF THE SICK.
If it be not from want of something better to do or from mere
curiosity, which, as the story goes, is among the attributes of the
fair sex-if, in a word, it be not from some important object that
Mrs. X visits Mrs. Z in her serious febrile disease, if she does it
out of Christian, sisterly, or cousinly affection and friendship, I
fear I should be denounced as a bad man were I in this last case
to forbid such visits. And yet it must be done; I must forbid
them, but I beg to be heard before being condemned.
Malignant fevers that spread among the people have usually, at
all events often, a contagious character, notwithstanding that
some of my colleagues have endeavoured, most learnedly, to prove
the contrary. It is safer to consider them so, as it is in all cases
safer to believe in a little too much hell than too little, in order
that we may take greater precautions to preserve ourselves from




THE VISITER OF THE SICK.

201

it, whether it be a reality or only a sort of a woodcut in rerum
natura. It is likewise quite praiseworthy to make our children
believe that the brook that flows by is somewhat deeper and more
fearful than it actually is.
The very probably contagious nature of prevalent fevers being
conceded, it must be highly criminal, at least very imprudent, for
the healthy lady to sit beside her deadly-sick gossip for hours at a
time without the slightest necessity.
" She would be very much offended if I did not visit her; what
would the relations say to my impoliteness? I am told she longed
to see me-if she should die without me seeing her once more, I
should never forgive myself! "  Such excuses might probably be
considered as valid by a gallant man; but they have no weight
with me, for I am not a gallant man. Admitting she had a real
affectionate desire to see her friend once more, this good intention
must remain unfulfilled, just as many good things in this world
must remain undone because they cannot be done, or at least not
without great injury or palpable danger.
If you wish to save your friend from drowning you must be
able to swim; if you cannot, do not jump into the water after him
-for any sake don't! but run for assistance, and if he is drowned
by the time assistance arrives, then help to drag the water for
him; help with all your might to bring him back to life, or if
all is of no avail, follow his body to the grave. There are in like
manner cases where you can do nothing but pray when your
neighbour is being burnt to death in the fourth story and your
heart is bleeding for him.
Your sick friend most probably knows you no longer in her
delirium; but supposing she would know you, you may, when she
recovers, make up in many ways for this neglected service of love,
as such unnecessary and dangerous visits to the sick are commonly
called. (Would that we poor creatures began to testify our friendship more in deed and in truth than in empty compliments and
visits; there is already enough of the empty and windy in this
world of ours!)
No one requires fewer persons about him than a dangerously
sick person, himself nearly related to death, which slumbers in
solitude beneath grave-mounds, as we learn from friend Hain.
Who does the patient who is seriously ill prefer having near




202

THE FRIEND OF HEALTH.

him? none but the necessary person, at the most a father, a
a mother or a spouse, but best of all the sick-nurse and the doctor
(two persons ordained by God and placed, like Uriah in the battle,
in the thickest of the fight-forlorn hopes quite close to the
advancing enemy, without any hours of relief from their irksome
guard-two very much misunderstood beings, who sacrifice themselves at hard-earned wages for the public weal, and, in order to
obtain a civic crown, brave the life-destroying, poisoned atmosphere,
deafened by the cries of agony and the groans of death).
Let patients affected with contagious fevers be left to these two,
the only necessary, the only useful individuals, and to a beneficent
God; they alone can attend to them properly, from their hands
must they expect all the good that we can wish for them, life and
health.
The anxious lady that visits her sick friend can do her no
manner of good; all she can do will be to shew her a pockethandkerchief which she has moistened with her sympathizing
tears, irritate her morbid nerves with chattering, help to spoil the
air of the close sick-room with her breath, increase the noise that
is often so hurtful to patients, disarrange the good order by her
officious interference, give well-meant but erroneous advice, and,
what is of still greater consequence, carry back the disease with
her into her own house.
Let it not be alleged that the sick-nurse and the doctor must
run the same risk if the doctrine of contagiousness be true. They
do so no doubt to a certain degree, as the deaths of many doctors
and nurses shew. But they do not do so as much as Madam
Gossip, and this is the reason.
The Creator of mankind has so ordained that habit shall be
a protector against many dangers. Thus the chimney-sweeper
gradually accustoms himself to the smoke from wood, which would
choke anyone else, and he can, if it be not too intense, easily exist
in it. The glass-blower from gradual custom withstands the most
intense heat of his furnace, and goes much closer to it than other
persons can. The Greenlander, a man like ourselves, laughs and
jokes in a degree of cold that would freeze to death those unused
to it. The courier who travels many hundred miles in a few days,
and the runner who makes a day's journey in a few hours; the
fisherman who spends much of his life in the water without taking




THE VISITER OF THE SICK.

203

cold, and the Scotch miner who lives to the age of a hundred
years in his unhealthy occupation, are all proofs of this.
In like manner some stout-hearted men can gradually accustom
themselves to the exhalations of the most infectious diseases,
and their system in course of time becomes quite insensible to
them. There are some layers-out of dead bodies in large cities
who attain a great age, and have breathed the exhalations from
thousands of corpses that have died of infectious diseases. There
have also been grave-diggers who in the time of a pestilence have
buried the last inhabitant of their district.
But it is only cautious nurses and physicians that can rejoice in
this immunity from infection; they must accustom themselves to it
very gradually, continue to habituate themselves and employ
various precautions in order not to be destroyed by the murderous
exhalation.
A casual visiter cannot pretend to such advantages, she must
be totally unused to the insidious miasm, and in all probability she
runs the greatest risk to her life. She may be happy if her imprudence does not make orphans of her children, or even cause
the death of all of them, without any fault of theirs.
PROTECTION AGAINST INFECTION            IN  EPIDEMIC
DISEASES.
For every kind of poisonous exhalation there is in all probability
a particular antidote, only we do not always know enough about
the latter. It is well known that the air of our atmosphere contains two-thirds of a gas that is immediately fatal to man and beast,
and extinguishes flame. Mixed up along with it is its peculiar




204

THE PRIEND OF HEALTH.

corrective; it contains about one third of vital air, whereby its
poisonous properties are destroyed; and in that state only does it
constitute atmospheric air, wherein all creatures can live, grow and
develop themselves.
The suffocative and flame-extinguishing exhalations in cellars in
which a quantity of yeast or beer has fermented, is soon removed
by throwing in fresh slaked lime.
The vapour developed in manufactories where much quick-silver
is employed, together with a high temperature, is very prejudicial
to health; but we can in a great measure protect ourselves against
it by placing all about open vessels containing fresh liver of
sulphur.
To chemistry we are indebted for all these protective means
against poisonous vapours, after we had discovered, by means of
chemistry, the exact nature of these exhalations.
But it is quite another thing with the contagious exhalations
from dangerous fevers and infectious diseases. They are so subtle
that chemistry has never yet been able to subject them to analysis,
and consequently has failed to furnish an antidote for them. Most
of them are not catching at the distance of a few paces in the open
air, not even the plague of the East; but in close chambers these
vapours exist in a concentrated form and then become injurious,
dangerous, fatal, at a considerable distance from the patient.
Now as we know of no specific antidotes for the several kinds of
contagious matters, we must content ourselves with general prophylactic means. Some of these means are sometimes in the power
of the patient, but most of them are solely available by the nurse,
the physician, and the clergyman, who visit the sick.
As regards the former of these, the patient, if not too weak, may
change his room and his bed every day, and the room he is to
occupy may, before he comes into it in the morning, be well aired
by opening the doors and all the windows. If he have curtains to his
bed he may draw them to, and let the fresh air circulate once more
through his room, before the physician or clergyman comes to visit
him.
The hospitals used by an army in a campaign, which are often
established in churches, granaries, or airy sheds, are for that reason
much less liable to propagate contagion, and also much more
beneficial for the patients than the stationary hospitals, which are




PROTECTION AGAINST INFECTION, ETC.

205

often built too close, low, and angular. In the latter, the nurses,
physicians, and clergymen often run great risks. And what risks do
they not constantly run in the half under-ground damp dwellings
of the lowest class of the people, in the dirty cellars of back courts
and narrow lanes that the sun's reviving rays never shine in, and
the pure morning air never reaches, stuffed full with a crowd of
pauper families, where pale care, and whining hunger seem for
ever to have established their desolating throne!
During the prevalence of contagious diseases the poisonous
qualities of the vitiated air are concentrated in such places, so that
the odour of the pest is plainly perceptible, and every time the
door is opened, a blast of death and desolation escapes.  These
are the places fraught with greatest danger to physician and clergyman. Is there any mode whereby they can effectually protect their
lungs from the Stygian exhalation, when the crying misery on all
sides appeals to them, shocks them, and makes them forgetful of
self?  And yet they must try to discover some preventive! How
are they to do so?
I have said above, that we may gradually accustom ourselves to
the most poisonous exhalations, and remain pretty well in the midst
of them.
But, as is the case with accustoming ourselves to every thing, the
advance from one extreme to the other must be made with the utmost
caution, and by very small degrees, so it is especially with this.
We become gradually accustomed to the most unwholsome prison
cells, and the prisoners themselves with their sighs over the inhuman injustice of their lot, often, by their breathing and the
exhalations from their bodies, gradually bring the few cubic feet of
their atmosphere into a state of such pestilential malignity, that
strangers are not unfrequently struck down by the most dangerous
typhoid fevers, or even have suddenly died by venturing near them,
whilst the prisoners themselves, having been gradually accustomed
to the atmosphere, enjoy a tolerable health.
In like manner we find that physicians who see patients labouring under malignant fevers rarely and only occasionally, and
clergymen whose vocation only requires them to pay a visit now
and then, are much more frequently infected than those who visit
many such cases in a day.
From these facts naturally proceeds the first condition for those




206

THE FRIEND OF HEALTH.

who visit such sick-beds for the first time, "that they should in the
commencement rather see their patients more frequently, but each
time stay beside them as short a time as possible, keep as far away
as possible from the bed or chamber utensil, and especially that
they should take care that the sick room be thoroughly aired before
their visit."
After these preliminary steps have been taken with proper
caution and due care, we may then, by degrees, remain somewhat
longer, especially beside patients with the slighter form of the
disease, and of cleanly habits, we may also approach them sufficiently close to be able to feel their pulse and see their tongue,
taking the precaution when so near them, to refrain from breathing.
All this can be done without any appearance of affectation, anxiety,
or constraint.
I have observed, that it is usually the most compassionate, young
physicians, who, in epidemics of this sort, are soonest carried off,
when they neglect this insufficiently known precaution, perhaps
from excessive philanthropy and anxiety about their patients; that
on the other hand, the hard hearted sort of every-day doctors who
love to make a sensation by the large number of patients they visit
daily, and who love to measure the greatness of their medical skill
by the agility of their limbs and their rapidity, most certainly escape
infection. But there is a wise middle path (which young clergymen
who visit the sick are counselled to adopt), whereby they may unite
the most sensitive and warmest philanthropy with immunity to
their own precious health.
The consideration "that a precipitate self-sacrifice may do them
harm but cannot benefit the patient, and that it is better to spare
one's life for the preservation of many, than to hazard it in order to
gratify a few," will make the above first precaution acceptable, viz.by very gradually approaching and accustoming ourselves to the
inflammatory material of the contagion, to blunt by degrees our
nerves to the impression of the miasm (morbid exhalation) otherwise
so easily communicable. We must not neglect to impress the
same precautionary measures on the attendants of the sick person.
The second precaution is "that we should, when visiting the
patient, endeavour to maintain our mind and body in a good
equilibrium. "  This is as much as to say, that during this
occupation we must not permit ourselves to be acted on by




PROTECTION AGAINST INFECTION, ETC.

207

debilitating emotions; excesses in venery, in anger, grief and
care, as also over-exertion of the mind of all sorts, are great
promoters of infection.
Hence to attend either as physician or clergyman a dear friend
sick of the prevalent fever is a very dangerous occupation, as I
have learnt from dear-bought experience.
We should endeavour moreover to preserve as much as possible
our usual mode of living, and whilst our strength is still good we
should not forget to take food and drink in the usual manner, and
duly apportioned to the amount of hunger and thirst we may
have. Unusual abstinence or excess in eating and drinking
should be carefully avoided.
But in this respect no absolute dietetic rules can be laid down.
It has been said that one should not visit patients when one's
stomach is empty, but this is equally erroneous as if it were to be
said, one should visit them with an empty stomach. One who
like myself is never used to eat anything in the forenoon, would
derange his digestion and render himself more susceptible of
infection were he, following the old maxim, to eat something for
which he had no appetite and visit his patients in this state; and
vice versa.
On such occasions we should attend more than ordinarily to
our desires for particular articles of diet, and procure if possible
that for which we have most appetite, but then only eat as much
as will satisfy us.
All over-fatigue of the body, chills and night-watchings, should
be avoided.
Every physician who has previously been engaged in practice,
every clergyman and nurse will of course have learned to get over
the unnecessary repugnance he may feel.
Thus we become gradually habituated to the occupation of
tending patients suffering from malignant fevers, which is fraught
with so much danger and cannot be compensated by any amount
of pecuniary remuneration, until at length it becomes almost as
difficult to be infected at all as to get the small-pox twice. If
under all these circumstances we retain our courage, sympathizing
compassionate feelings, and a clear head, we become persons of
great importance in the state, not to be recompensed by the
favour of princes, but conscious of our lofty destiny and rising




208

THE FRIEND OF HEALTH.

superior to ourselves, we dedicate ourselves to the welfare of the
very lowest as well as the highest among the people, we become as
it were angels of God on earth.
Should the medical man experience in himself some commencing
signs of the disease, he should immediately leave off visiting the
patient, and if he have not committed any dietetic or regiminal
error, I would recommend, notwithstanding I have endeavoured in
this book to avoid anything like medicinal prescriptions, the
employment of a domestic remedy, so to speak, empirically.
In such cases I have taken a drachm of cinchona bark in wine,
every three quarters of an hour, until all danger of infection
(whatever kind of epidemic fever the disease might be) was completely over.
I can recommend this from my own experience, but am far
from insisting upon the performance of this innocuous and powerful
precaution by those who are of a different opinion. My reasons
would be satisfactory if I could adduce them in this place.
But as it is not enough to protect ourselves from infection, but
also necessary not to allow others to come in the way of danger
through us, those who have been engaged about such patients
should certainly not approach others too nearly until they have
changed the clothes they had on when beside the patients for
others, and the former should be hung up in an airy place where
no one should go near them, until we again need them to visit
our patients. Next to the sick-room, infection takes place most
easily by means of such clothes, although the person who visits
the patient may not have undergone any infection.
A highly respectable and orderly individual who for years had
never walked anywhere, but only to his office at the fixed hours,
had a female attendant with whom he was on very friendly terms,
an old good-natured person, who without his knowledge employed
all her leisure hours in making herself useful to a poor family living
about a hundred yards from his house, who were lying sick of a
putrid fever, the prominent character of which was, a malignant
typhoid fever. For a fortnight all went on well; but about this
time the gentleman received some intelligence of a very annoying
and depressing character, and in a few days, although to my
certain knowledge he had seen no one affected with such a disease,
he got, in all probability from the clothes of his attendant who




PROTECTION AGAINST INFECTION, ETC.

209

was often very close to him, exactly the same kind of malignant
fever, only much more malignant. I visited him as a friend with
unreserved sympathy as I ought, and I fell sick of the same fever,
although I had been already very much accustomed to infection.
This case, together with many other similar ones, taught me
that clothes carry far. and wide the contagious matter of such
fevers, and that depressing mental emotions render persons susceptible to the miasm, even such as are already used to its
influence.
It would appear that the lawyer who draws up a will, the notary
and the witnesses would, on account of not being habituated to such
impressions, run much greater risk of being infected in these cases.
I do not deny it; but for them there are modes of escape which
are not so accessible to the other persons of whom we have
spoken.
Where there is nothing, the sovereign has lost his rights, there
is no will to be made. But when wealthy persons wish to make
their last will and testament on their sick bed, there are two circumstances in favour of the lawyer and his assistants. As in the formalities of a legal testament, the patient's bed often cannot remain
in its usual situation, and as moreover it is essential for such a
testament that the testator should be in full possession of his
intellectual faculties, it follows that for those patients who are not
absolutely poor another room and another bed may be got ready,
thoroughly aired and free from infectious atmosphere. They
do not need to remove thither until all this has been properly
performed a short time before.
The weakness of the intellect in such patients generally keeps
pace with their corporeal weakness, and a patient who possesses
sufficient strength of intellect to make his will would not allege
that he is too weak to be removed to another bed and room.
How little chance there is of the legal officials catching the
infection under these circumstances (provided they take moderate
care not to approach the patient nearer than necessary), I need
not dwell upon.
I should mention that after one has once accustomed himself to
any particular kind of miasm, for example the bloody flux, the
nerves remain for a considerable time, often for years, to some




210

THE FRIEND OF HEALTH.

degree insensible to the same kind of disease, even though during
all that time we may have had no opportunity of seeing patients
affected with that disease, and thus as it were of keeping the
nerves actively engaged in keeping up this state of specific unsusceptibility. It gradually goes off, but more slowly than one would
suppose. Hence with moderate precaution a nurse, a physician,
or a clergyman, may attend dysenteric patients this year if they
have had to do with similar patients several years previously. But
the safest plan is to employ even in this case a little blameless
precaution.
But as the superstitious amulets and charms of our ancestors'
times did harm, inasmuch as full credit was given to their medicinal virtues, and better remedies were consequently neglected, so
for like reasons the fumigations of the sick room with the vapour
of vinegar, juniper-berries and the like, is inadvisable, although
the majority of my colleagues highly recommend it, and assert
that the most infectious miasms of all kinds have thereby been
overpowered and driven away, and thus the air purified.
Being convinced of the contrary, I must directly contradict
them, and rather draw upon myself their disfavour than neglect
an opportunity of rendering a service to my fellow-creatures. But
as the spoiled (phlogisticated, foul, fixed, &c.) air can never be
restored to purity or turned into vital air by means of these
fumes, and as there is not a shadow of a proof that the subtle
contagious exhalations, whose essential nature is quite unknown to
us and not perceptible to our senses, can be weakened, neutralized,
or in any other manner rendered innocuous by these fumes, it
would be foolish, I would almost say unjustifiable, by recommending such fumigations for the supposed purification of the air, to
encourage ordinary people in their natural indolence and indisposition to renew the air of their apartments, and thereby expose
every indifferent person who comes in contact with them to a
danger to his life, which will be all the more obvious and great, the
more confident he has been made by the futile representation that,
without driving away the disease-spreading miasm by means of
repeated draughts of air, the pestilential atmosphere of the sick
room has been converted into pure healthy air by means of simple
fumigations with vinegar and juniper berries. That is just like




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211

the old superstition of hanging an eagle-stone at the hip of the
woman in labour, at the very moment when all hopes of saving
her, even by the forceps, are over.
When a physician or clergyman enters an unfumigated chamber
he can at once tell by his sense of smell whether his needful order
to air the room has been obeyed or not. All sick people make
a disagreeable smell about them. Therefore the freedom from
smell of a chamber is the best proof that it has previously been
aired, but if fumigations have been had recourse to, the latter
becomes doubtful and suspicious. Neither the physician nor the
clergyman, neither the sick-nurse nor the patient, require perfumes when they have to think and speak seriously concerning a
matter of life and death. They should never be used
IN OLD-WOMEN'S PHILOSOPHY
THERE IS SOMETHING GOOD, IF WE ONLY
KNOW WHERE TO FIND IT.
I hope by this section, at all events by the title of it, to have
made my peace for all future times with that, please heaven, small
portion of my fair readers who suspect me of heresy from the
faith of our grandmothers, and I should be sorry to fall out with
these respectable old people, certainly I should.
So let us hasten from the preface to the main point of our
matter. I once lived in a place where the midwife, who was there
called emphatically the wise woman, gave to all newly confined
(peasant) women a good large quantity of brandy. Even I had to
submit to this inevitable fate, and I did it without a murmur.
r2




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THE FRIEND OF HEALTH.

For who dare say a word against the Parce, especially against the
third and last of them?
I was assured that this fiery spirit did great good in many
cases. With folded hands I held my peace, as was reasonable,
and looked on, and I found that in this locality there were
actually many puerperal women who when left to themselves had
serious symptoms arising from weakness or excessive irritability
of the nervous system, accompanied by impurities of the stomach
and bowels, or by plethora-in these the brandy did real service,
but these were exactly the cases in which we find opium (a very
analagous thing) of use.
Here then the old-woman's philosophy was really right for
once. But what became of the other cases in which the brandy
was poured into the poor creatures in a useless and hurtful
manner? I shall say nothing about that, because at the present
time the third fate is still much too intractable, and has even
become fearful to the sons of IEsculapius.
" If you are a woman, tie a man's stocking round your swollen
neck, and it will subside; say, I said it." This good counsel of
the old dame is true in so far as slightly swollen cervical glands in
lymphatic constitutions only require a warm covering in order
to dissipate the swelling, more especially a covering which (as
will readily be done by a woollen cloth on the tender skin of
a lady's neck) shall cause friction and produce irritation and redness. Thus far the old women's philosophy is again correct. But
why a dirty stocking? might we not use flannel-and how! in
true inflammations of the throat what good will a dry, woollen,
heating covering do?-Here the old witch holds her tongue, and
so do I, for it is advisable to do so in her presence.
Swollen cervical glands are cured by the lucky hand of some
wise woman or midwife, who must, each time that the moon is on
the wane, in silence press thrice upon the swollen glands with her
thumb, in a crucial manner. Superstition places much confidence
in this semi-magical remedy, which sometimes is actually of great
service. Thus much is certain, that glandular swellings in middleaged individuals of lymphatic constitutions who have not much
general scrofulous disposition, not unfrequently disappear rapidly
by rubbing and moderate pressure.      Thereby is produced an
increased circulation of the blood and a greater activity of the




OLD-WOMEN'S PHILOSOPHY.

213

lymphatic vessels, and even an incipient inflammation, whereby
the swelling is removed. In so far the vaunted petticoat wisdom
is right.
But what the period of the wane of the moon has to do with the
matter, we, who belong to the inferior class of untlanscendental
doctors, are too dull to perceive, because, alas, we are not endowed
with the super-subtle sixth or perhaps seventh sense; were it
otherwise we might see the great importance of the triple and
crucial pressure, more especially if the excessively lucky precaution is observed of commencing and carrying out the operation
from beginning to end without speaking a word, which indeed it
were almost too much to expect from an ordinary woman.
THINGS THAT SPOIL THE AIR.
It cannot be indifferent to those of my readers who wish to
enjoy a long and healthy life whether the air of their rooms possess
the necessary degree of purity or not.
There are many familiar things that render the air that we
breathe more or less unsuitable for the maintenance of life, so my
readers must listen to the warnings of a friend.
Flowers are an ornament to a room, and if we are content to
deck one room with but a few of extreme beauty, and very few, on
account of their perfume, it will not much signify; it is rather
praiseworthy than blameworthy. The more we refresh our senses
in an innocuous manner the more lively and easy does our
power of thinking become, the more capable and disposed for
business are we, and the delight of the sight and the smell in
flowers, the pride of lovely nature, is especially of this character.
But an excess does harm in all things, so it does likewise.




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here. A large bouquet of lilies, tuberous plants, love-flowers,
centifolia, jasmine, lilac, and so forth, makes such a strong perfume in a small room that many sensitive persons have occasionally been made to faint by them. This does not depend so
often on the antipathy of the nervous system to such odours as it
does on the injurious property of such strong-scented flowers of
quickly spoiling the air and rendering it unfit for respiration.
Other writers have already called attention to this fact, so that I
need not dwell longer on it, and will content myself with having
repeated the warning.
People who wish to be very genteel, love to burn in the evening
more candles than are necessary; and if they are entertaining
company, they light up chandeliers, sconces and all the other receptacles for candles they may possess, in order that the fashionably
dressed ladies and gentlemen may see each other well. It is considered a capital holiday spectacle to see so many candles burning
at once; it dazzles one's eyes so brilliantly that we scarcely know
where we are; it also costs a good round sum.
But if we view all this display of candles in the proper light, we
shall find that they spoil the air in a very ugly manner. Considering that they are only lighted for a number of guests who are to
be well feasted, who, seated in close rows, pollute the atmosphere
for each other by their breathing and exhalations, in one word
that they are only lighted for feasts and balls, considering this,
I say, I know not what sort of complimentary speech I can make
to my entertainer for purposely depriving me of the little bit of
pure God's-air, and giving me the very worst sort instead, in
which an animal could with difficulty sustain life.  Amid how
many attacks of faintness will not yon lady express her thanks to
him, after having worked away for hours at her toilette, preparing
for the festivities, in the endeavour to diminish by one third the
capacity of her chest by means of a whale-bone apparatus, until,
drawn in so tightly as to look like a wasp, she could scarcely take
in air enough to support life in a pure atmosphere! Relish it
who may-I must say, for my part, that I have no wish to be
regaled with so many candles in a room.
He who wishes to act wisely will not tarry in the room where
he has dined, and where the vapour from the warm food has deteriorated the air, until it has been thoroughly aired.




THINGS THAT SPOIL THE AIR.

215

It is very unwholesome to sleep in rooms where, as is often the
case among the lower classes, there is a store of green fruit. A
quantity of phlogiston that exhales from the fruit in the form of
their odour soon approximates the pure atmospheric air to the
condition of phlogistic and unhealthy air.
Also store-rooms of other kinds, where domestic articles and
food from the animal and vegetable kingdoms are kept in quantity,
such as oils, candles, lard, raw, boiled, and roasted meat, pastry,
&c., are not healthy places for people to dwell in. It should
be observed that everything that emits much smell, perceptibly
vitiates the atmosphere.
In foul linen the excretions from the skin are present, and
no rational person would submit to have them kept or washed in
his room for similar reasons, but also for delicacy's sake.
No one who can avoid it should sleep in the room in which he
remains during the day. The beds part very gradually with the
exhalation they have received from the sleeper during the night,
and continue to vitiate all day long the air of the room, even
though it had been thoroughly aired in the morning.
Six busy watchmakers do not spoil the air nearly so much as
two workmen engaged in sawing wood. I would therefore advise
that the workshops in manufactories, especially where much
corporeal exercise is employed, should be built rather too high
than too low, rather too airy than too close, and be they ever so
cleanly and well situated they should be frequently aired. It is
incredible in how short a time in such cases the air of the room
becomes vitiated and unfit for respiration. The miserable, sick
aspect and the great mortality of the workmen of many manufactories renders further proof of my proposition superfluous.
Working with unclean wool, with oil-colours, or with things for
which burning charcoal is employed, is for other reasons not
innocuous.
But even though the air should not be altered in its composition,
it may become hurtful in another way by the mixture of something extraneous. Such is especially moisture.
Reservoirs attached to chamber-stoves, wherein the water is kept
hot for domestic use, are in this respect injurious. For this reason
also, workmen who are engaged in drying wet things in highly
heated rooms, cabinet-makers, turners, potters, bookbinders, &c.,




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are very liable to swellings and other affections proceeding from
relaxation of the absorbents.
A person who from an idea of extreme convenience should,
notwithstanding the vicinity of a water-closet, keep a night-chair
in his sleeping apartment, should bear in mind that the disgusting
exhalation from it spoils the air uncommonly, and renders the
bed-chamber in which we pass a third of our life (if it be not very
roomy) a very unwholesome place of abode. There are however
many houses so ill-arranged as either to have no water-closet at
all, or where it is at such a distance as not to be very accessible in
the night.
If this is the case, and cannot be remedied, we should have a
small closet constructed of stone in the corner of some public
room near the bed-chamber which has a good opening to the
outside of the house, and a well fitting door to enter at. In this
place we may, under such circumstances, place the night-chair,
and have it carried out afterwards, without having to fear any
vitiation of the air or bad smell.
We should not permit large thickly-leaved trees to stand close
to the windows of a house. In addition to their preventing the
access of daylight and of the pure air, their exhalations in the
evening and at night are not very favourable to health. Trees at
a distance of from ten to twelve paces from the house admit the
air much more readily, and cannot be sufficiently recommended, as
well on account of their beautiful appearance and their pleasant
shade, as on account of the wholesomeness of their exhalations by
day. If we have the choice we should have the windows of our
bed-room to the east, where the view is quite free, uninterrupted
by very close trees, and unpoisoned by the febrile exhalation from
a marsh.
Poverty has brought many injurious habits into this world, one
of the worst of which is that where persons in the lower ranks of
life, especially women, sit over a vessel filled with red hot charcoal,
in order thereby to save themselves the expense of a stove in
winter. The closer the room is shut up in such circumstances,
and the more the external air is excluded, the more dangerous and
fatal is this habit, for the air inside will thereby soon become
a stupifying poison.
We feel a pressive, stupifying headache, that seems to bore




THINGS THAT SPOIL THE AIR.

217

through both temples, at the same time we experience an inclination to vomit, which however is soon suppressed by a rapidly
increasing comatose state, in which we sink helplessly to the
ground and generally die without convulsions.
When the person falls down the clothes are apt to catch fire
from the burning charcoal, and indeed fires have often originated
in this manner, which are all the more dangerous because it is
only when they have fairly burst forth that they will be observed
by strangers, seeing that the person who originates it is too
stupified to be able to extinguish the first flames.
Not less dangerous to life is it to close the valve in the chimneys
of stoves that are heated from within, as long as the stove continues
full of glowing cinders. From motives of economy people often
like to retain the heat in the room. An economy that is very illdirected. The more glowing charcoal there is in the stove, and
the tighter the valve is closed, the quicker is the air vitiated, just
as it is by a brazier full of red hot charcoal standing free in the
room, and there ensue accidents just as bad as those above
described, and not unfrequently fatal.
The valves in the chimneys of stoves are solely intended to
moderate the draught of air into the stove and the violence of the
fire, or in the event of the soot in the chimney catching fire to
prevent a destructive conflagration by entirely shutting the chimney. If this latter should happen, every sensible person will as
soon as he has shut the valve at once open the doors and windows
in order to remove the air of the room that has been deteriorated
by the confined fire.
We should rather seek to save wood by using well constructed
stoves, than, by stopping up every hole and cranny in the doors
and windows, exclude every breath of air, as is done by many
persons of slender and of moderate means. Such persons must be
ignorant of the incalculable value of air, who paste up with paper
every chink and hole, and even hang up cloths before their doors,
and thus retain all the unwholesome exhalations from the pores of
the skin and from the lungs in their small rooms, so as to respire,
instead of life and health, disease and death. I have seen melancholy examples of this nature, and I fear that my warning will
have some difficulty in penetrating to the miserable cellars they
have themselves selected.




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THE FRIEND OF HEALTH.

Deathly pale and spiritless they feel an unknown poison permeating all their bloodvessels, they feel their health gradually
being undermined, just as the water that runs down from their
windows rots the window-frames; cachexy, dropsical swellings
and pulmonary consumptions carry them off after having seen
their children die around them of low, wasting diseases, which
they attribute principally to teething or bewitchment, or reduced
by rickets to cripples. Where is the compassionate man who will
teach them something better?
THERE IS GOOD EVEN IN HURTFUL THINGS.
It is well known that the tailor's trade is not one of the healthiest
of occupations. We find in these good folks, if they are diligent
workmen, usually emaciated legs, knock-knees, a dragging of the
left leg, round shoulders, the head bent forwards, drawn-in abdomen,
and so forth. Their complexion shews very plainly the unhealthiness of their occupation; loss of appetite, piles, constipation, weakness of the body, itch, &c., are things quite common among them,
and yet there are cases in which this mode of life has been favourable
to health.
A young man in England was born with the feet turned inwards.
A surgeon whom his mother consulted pronounced the deformity
incurable. When he grew up, he could only walk with difficulty
upon the outer border of his feet and heels, he always knocked one
foot against the other, and frequently fell; the muscles of his thighs
and calves were extremely attenuated, and the turned-in feet were
so deformed, that shoes of a particular shape and tie had to be
made for him.




THERE IS GOOD EVEN IN HURTFUL THINGS.

219

The poor-house authorities bound him   apprentice to a tailor,
thinking that this was the only trade that his deformity permitted
him to follow.
In this work, whereby one usually sits at the shop-board, as is
well known, with the legs crossed, he observed a gradual change in
his limbs, which, without the slightest employment of external or
internal remedies, continued to turn outwards. In the course of
three years they attained their natural position, so that he could
wear ordinary shoes, they were indeed directed more than usually
outwards. The muscles of his legs grew stout, and his body was so
well formed that he enlisted in the marines, and thence-forward
remained in the service.
Probably in this case a peculiar stiffness (rigidity) of the muscles
that adduct the foot was the cause why the abductor muscles could
not maintain the balance of power, and so allowed the foot to be
drawn inwards. The strain upon the former, when the legs were
crossed at his work, stretched and relaxed them more, and thus the
abductor muscles of the leg and foot were enabled gradually to
attain their natural opposing power; indeed the latter gained in
this way an excess of power, and his feet were turned outwards
more than is usual.
Joiners and cabinet-makers usually have the right shoulder
higher than the left, because they exert the former most during
their work. It might be tried whether individuals whose left
shoulder was the highest, would not become straight by following
these trades.
In like manner, to give another example of the good effects of
hurtful things, there have been cases where by a stab of a sword
in the chest, purulent deposits in its cavity that threatened a fatal
result, have been opened, and where, after the murderous wound
was healed, general health was the result.
So also, persons who were paralysed on one side of the body, on
being struck by lightning, have recovered the perfect use of their
limbs.
I knew a melancholic gentleman who in a fit of the spleen
wounded the veins in his neck, and after losing several pounds of
blood, recovered from his melancholy madness.
Cases have been recorded of patients who, in order to put a period
to their sufferings, swallowed large doses of opium, and attained




220

THE FRIEND OF HEALTH.

their object in this way-that they did not indeed die, but were
completely delivered from their disease.
And how many instances might be cited where persons have
become wiser and better by disease, or have grown healthier by
calamity, misery and hunger, and have become more useful members of society! I know a physician, to whom the world owes
much, who would never have adopted this honourable profession,
had not the delicate state of his health when a young man almost
compelled him to do so.
He who has made a narrow escape from drowning learns to swim,
and by this accomplishment is enabled to save the lives of others.
The police-inspector has his house burnt down, and the fireengines of the place are put by him into a state of perfection.
Yon prince would not have placed the lands of his subjects in a
state of security against inundations, had not some of his own
estates been fearfully inundated; and had not his throne been
several times shaken by the thunderstorm, he would not have introduced the valuable lightning-conductor into his dominions.
Pfeffel and Euler must lose their sight in order to surpass the
most of their fellow-beings in poetical and mathematical talent;
and if we had space, we might adduce many other examples of
benefits derived from injurious things, to the glory of the Creator.
DIETETIC CONVERSATION WITH MY BROTHER,
CHIEFLY ABOUT THE INSTINCT
OF THE STOMACH.
He. Are you not ashamed of yourself to be eating pears early
in the morning? you will chill your stomach, and then you can't
say I did not warn you.
I. Certainly not, for I have no fear of such a catastrophe. But
tell me, at what time of day should one eat fruit?




DIETETIC CONVERSATION.

221

He. After dinner, and as a rule, after having taken something
warm into the stomach; such was the opinion of our ancestors, and
they were no fools.
I. But we moderns on the contrary are of course? and this I
would almost concede to you for the sake of peace, if this verdict
only applied to some of us. But tell me, can the stomach of different individuals be regulated by one general rule, even were it as
old as the twelve commandments. Is not every one's stomach as
peculiar as every person's foot, which the shoe of another will not
and cannot fit?
He. Yes, I grant you that; but we can take the measure of the
foot, it is something visible and tangible, but who can tell the exact
and peculiar condition of the stomach?  Would we not act more
wisely, by following in its proper place, the general rules for it laid
down by wise men; and not attempting to speculate further on
such a ticklish subject?
I. Did then the wise men of former generations know every
individual stomach, its condition and requirements, so clearly as to
enable them to lay down those general rules for their posterity,
which were suited for each one of the innumerable varieties of
stomachs?  Is that possible?
He. Not that exactly! but you moderns have apparently been
more lucky in finding a general rule for the stomach (dietetics as it
is commonly termed), as I guess from your eating fruit in the
morning.
I. Just so, I just wished you to tell me that the moderns were
diet-mongers. They are but too much so, to reply seriously to
your irony. In their law-giving mania they imagine themselves
just as wise, and make just as many mistakes, as the ancients.
He. In what horrible uncertainty, brother, would we be groping
about in a matter of such importance for preserving the proper
standard of health! how unlucky would we be were what you say
correct!
I. Neither unlucky, nor yet in horrible uncertainty, I should
think.
This article in our vital breviary is of such great importance
that it is certain the beneficent Creator could not have founded it
upon the shifting standard of the professional dietists; he must
have given us an infallible guiding principle to direct us in the




222

THE FRIEND OF HEALTH.

selection of food and drink. Could any one seriously attempt to
bring up good children according to the literal principles of a
pedagogic book?   What think you? the good Claudius will cut
off his finger if this be true.
He. And what then is your infallible guide to the only saving
system of dietetics?
I. Just what you yourself usually follow, without thinking
about it?
He. And what is that I demand, you tantalizing fellow?
I. I should suppose, "Moderation and attention to what best
suits your individual constitution in every condition." I will
allow a finger to be cut off if this be not the natural religion of
the stomach and the only infallible dietetic rule for every one.
He. No doubt, if we had the instinct of beasts, you might be right.
I. What mutilater of the rights of man could have told you
that our beneficent mother Nature has not endowed us with just as
much instinct as we require?   Who teaches the infant to prefer
its mother's milk to pastry?  Who instructs him that is sunk in
grief and distress to take a glass of wine? Who tells the patient
ill of a bilious fever to avoid meat? the dysenteric patient to pant
for grapes?   Who tells us when we are hungry, when thirsty?
A rotten egg is just as repulsive to us as it would be dangerous to
life, and arsenic is as abhorrent to a delicate tongue as it is fatal
to the stomach.
But all these are only striking fragmentary reasons for the
reality of a beneficial instinctive principle in us. I am incapable
of erecting a scholastic system upon it, irrefragable though it be
in itself.
Do not retort by referring me to the appetite with which the
parched brandy-drinker pours in his murderous liquor; to the ravenous hunger with which the glutton fills the very last cubic line of
his stomach with hurtful chef-d'oeuvres of the culinary art; to the
greediness wherewith the hypochondriac swallows his malt liquor,
which has frequently before caused him dangerous colics; to the
coffee-drinking woman who will give her last farthing in order to
purchase the enervating drink, although she is just about to lose
her last pair of black teeth, or must sigh over her unfruitful marriage amid the reproaches of her husband.
To retort in that way would be as if from the innumerable daily




DIETETIC CONVERSATION.

223

examples of want of conscientiousness we should seek to prove
that there was no such thing as conscience.
Oh my brother! he who has preserved this delicate, neverdeceptive feeling for the good and the noble, in all its simplicity
and innocence, and exercises it with the readiness of an unsophisticated child, for his own and his brother's benefit; he asks not if
there be human beings so degenerate as to presume to demonstrate away the conscience to a mere shadow, who assert knavery
to be a necessary fashion, and a Sybarite's life to be a lawful recreation. In like manner he who, moderately enjoying the gifts of
God, has made it his study to discover the reality of his desires
for articles of food, and has by degrees acquired a facility in being
able to determine before he sees it, and from the mere name
alone, whether this or that food, this or that drink, would agree
with him at the time,-he does not enquire if there be men who
bid defiance to all nature's wholesome hints, turn a deaf ear to all
her warnings, confound the mere tickling of the palate with a
sufficiency, and repletion with the satisfaction of their wants, and
acknowledge no dietetic rule besides the gratification of their taste,
their indolent habits, and the example of their neighbours. He
enquires not about them, I repeat, nor does he imitate them in
the crowd of ailments and maladies that from time to time endeavours harshly enough to call them back to resolutions of temperance. Do not however take up my observations as though I
imagined that the instinct of our stomachs should in all cases
indicate even particular varieties of nutritious articles which we
must especially partake of in order. to keep in good health; this
would be foreign to the purpose of the Creator.
In its healthy state the human stomach only needs an instinct
to direct us to certain classes of food, which we should partake of
from time to time if we would continue in right good health.
Thus for instance, the peasant who has overworked himself says to
his wife when she is about to set before him cheese and eggs, " I
wish you would make me a little salad; if you have any sour milk,
give me a little of the whey in place of any food, or something else
sour."  Or if, during a couple of holidays, he has not had an
opportunity of working at all, he only asks for some weak soup for
supper, or will not eat anything at all. Or if he has been dissipating for several days he asks her for something strong, something




224

THE FRIEND OF HEALTH.

tasty, a bit of bacon, cheese, peas and the like. In this case he
would feel as if he wanted something more were he to get nothing
but a dish of milk; he does not name any article of food in particular that he must absolutely have, he only wishes something of a
very nutritious character. In like manner many persons of from
eighty to ninety years of age commence from mere instinct to live
upon honey, sugar and milk. Who informs them that such substances only will keep their fibres in a pliant condition?
But whenever we get into a morbid state and accustom    ourselves to attend dispassionately to the wants of our stomach, then
the voice of this true guardian of our life becomes louder and
more audible. We perceptibly lose our appetite for certain classes
and even varieties of food, and a desire for other classes and
varieties is developed, without our knowing why. The pleuritic
patient calls for water, cold water, the patient ill of putrid fever
demands beer; soups and the like are intolerable to both.
The delicate woman in the family way puts chalk into her
mouth, and if we keep it from her she scrapes the lime from the
wall and consumes it. She knows not that she has an intolerable
acid in her stomach, and still less does she know the chemical
property of the chalk of neutralizing and removing acids. What
teaches her to swallow greedily this specific for her ailment?
what else but the awakened wise instinct implanted by the infinitely wise Creator?
The man who is extremely exhausted from starvation desires a
spoonful of wine; what tells him that a supply of meat and bread,
which an ignorant person would endeavour to force him to swallow,
might prove fatal to him?
I saw a lying-in woman who after a difficult labour suffered from
intolerable after-pains and a great loss of blood. She cried for
coffee, although when she was well she could scarcely endure it.
Who told her that her haemorrhage resulted from atony of the
womb, and this from diminished irritability of the fibres, and that
the specific remedy for this was coffee? A few cups of very strong
coffee were given to her, and haemorrhage and pains ceased suddenly; opium would have had no effect in such a case.
A person who has contracted a bilious fever from anger and
vexation, longs for nothing so much as fruit, who tells him that
this is almost the only thing that can do him good?




DIETETIC CONVERSATION.

225

And so I might give you many more examples of the expression
of the instinct of the stomach, did I not fear to weary you. We
understand it under the terms appetite and repugnance, two very
important but much neglected monitors for our well-being I
If we would only study this voice of nature often enough, and in
a perfectly unprejudiced manner, we would obtain a great facility
in understanding its feeblest manifestations; we should be able
thereby to escape a large number of diseases, and in many cases to
attain to long life without difficulty.
But we find (as a proof of all I have said) that this small voice
of nature is only audible to persons who live upon very simple
articles of food, and that they come at last to understand it in a
very remarkable manner; almost just as the cattle, which we allow
to range at large over the fields, never swallow a plant that would
hurt them, but only those that are suitable for them; but when
they are ill they often recover if we drive them out to the meadows
where they can instinctively select the food that will do them
good.
But how often does it happen that cattle before whom we place
hurtful plants mixed with good hay, are gradually induced to
swallow the former along with the latter, and so grow ill? Just as
often (let me be permitted to employ this appropriate comparison
as regards animal nature in general) as a gentleman gets ill at the
richly furnished table by the artistic mixtures of his cook; the taste
of the healthy person decoys him into eating unwholesome things
without knowing they are so; or the viands become unwholesome
by the contradictory mixtures, and the palate is seduced, deceived.
But as the Creator did not wish to limit our appetite when in
health specially to one single particular kind of food or drink, and
only directed our stomach's instinct to general classes of nutriment,
in order that we might remain healthy and useful members of
society in every condition, under various relations, in all degrees of
latitude, and under all circumstances of fortune, so he sought to
avert all injurious consequences that might arise from this instinct
of the stomach, that is so much less limited than is the case with
the lower animals, by endowing us with an accurate, definite sense
of when it is time to leave off or to partake of food and drink.
This sense, which we term hunger, thirst and satiety, is, in the
case of healthy persons who have not much choice of food, almost




226

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the only guardian of their health. This feeling, this instinct as I
may term it, is in persons who regard moderation as one of the
greatest of virtues, so watchful, so active-they hear this internal
voice as distinctly as any animal to which we especially attribute
instinct, so distinctly that they can determine to a mouthful when
they have taken enough for their health; that they would deny
themselves half a glass of wine or beer beyond what would agree
with them. (The sick man, however, whose imagination has got a
wrong direction, does not belong to this class.) And it is this
last kind of bodily sensation (hunger, thirst, satiety), dear brother,
that I, as a physician, cannot sufficiently recommend to be kept in
an active state.
Moderation, strict moderation, that is not to be bribed by a
pampered, corrupt palate, is a sublime corporeal virtue, without
which we cannot become healthy nor happy.
This virtue, which is nothing more than faithful obedience to the
internal voice of our digestive organs relative to the proper quantity
of nutriment we should take in, has the most perceptible influence
even'over all other virtues (which in fact do also consist mainly in
some kind of moderation or another)-and just as certain is it that
excess is always accompanied by at least one vice.
We may readily attain sufficient proficiency in this attention to
ourselves, but on the other hand it is much more difficult to maintain in an active and understandable condition, under the various
circumstances of life, that instinct, those secret hints of our digestive organs which beckon us to certain classes or even certain
varieties of nutriment that are most wholesome for the particular
state of our system for the time being. If you desire it however,
you may acquire even this latter art, but only after having perfected yourself in the former one.
But where is the wise man to be found who is capable of rightly
dictating to me in a book once for all what and how much I ought
to eat and drink? To me, an isolated individual with a peculiar
constitution, in all the daily varying relations of my life, and the
circumstances of my health?  I must judge by my own sensations
what and how much will suit me; I must know it, or no one else
can, unless, perhaps, my ordinary medical attendant.
Do not blame me therefore, brother, if I am somewhat prejudiced
against those general dietetic rules for sensible persons; do not




DIETETIC CONVERSATION.

227

blame me if I eat or drink this or that at this or that time, and
again pass over whole periods for meals without taking anything, as
I do all this only when I am so inclined.
He. But tell me what is meant by depraved appetite, which
makes so many people ill?   Most derangements of the stomach
seem to me to proceed from that cause.
I. Tell me, on the other hand, whence do most of the moral deformities come into the world? is it not from misguided, perverted
feeling for the good and the desirable?   And these erroneous
directions of our moral faculty, whence come they, if not from a
seared conscience and ignorance of what is good and desirable?
He. Ignorance you say, and I take you at your word. Consequently in order that your analogy should hold good, we require,
in order to carry out a rational system of diet, a historical
knowledge of wholesome and unwholesome articles of food; and
hence the dietists should be most acceptable to us.
I. There is not and cannot be any thing which as a general rule
is absolutely unwholesome or wholesome. Just as bread is useless
to him that has an inflammatory disease, and to him that has his
belly full, and as belladonna can in certain cases restore the health,
so none of the other general maxims of the dietists can be accounted
good-such as, veal is the most wholesome butcher's meat, chervil
is a wholesome vegetable, &c.
How can a thing that we can swallow be, under all circumstances
and in every condition of the body, universally wholesome, healthful, innocent, hurtful, or poisonous?  There is a time for every
thing, says the king-sage, and to my mind he speaks much more
sensibly than most of the dietists.
It is, however, very good and laudable (and in this respect you
are right) to have some knowledge of the various articles of food,
their nature and properties, before entering on the great world, in
order that we may avoid mistaking toad-stools for mushrooms, or
swallowing a solution of corrosive sublimate for liqueur. But I
should like if our dietists were more careful and exact in respect of
these matters, I should like them to enter more into details, and
that their maxims in regard to the particular constitution of the
body in which this or that article of food makes this or that peculiar
impression, were derived more from trustworthy and select authorities and from their own experience, than from mere hear-say.
o2




228

THE FRIEND OF HEALTH.

But this is a herculean task, and a useful system of diet of this
kind will long remain ideal only. And with this, adieu, dear
brother. Think over the subject and tell me on some future occasion where you think I am wrong.
AN OCCASIONAL PURGATIVE, SURELY THAT CAN
DO NO HARM.
My dear Doctor,
I have been advised to apply to you, as you have the
character of always telling people in a pretty straightforward
manner what they ought to do. It occurs to me, and my familysurgeon also has often reminded me, that it is surely high time for
me, my wife and my children, to take a good dose of purgative
physic. "Your honour," he is always saying, " only think what
a quantity of dirt must accumulate in the abdomen in the course
of half a year, if the refuse be not swept out and cleansed away at
least once a month." The like of us, to be sure, do not understand
it, but one would think, that of all the food and drink we take,
somewhat must occasionally stick in the body, though it may not
be so desperately bad as my surgeon alleges. Thinks I to myself, if everything collects in the body in that way, then my
shepherd, who is in his seventieth year and has never taken any
medicine in his life, must carry about with him in his belly an
accumulation of impurities enough to fill a barrel. But my surgeon ought to know more about the matter than I do. The fellow
has, as he assures me, had great experience during the seven
years' war; he has amputated a fearful number of arms and legs
in the military hospitals, and helped to extract many bits of
broken skulls. Do not blame me, doctor, for adopting his views;




AN OCCASIONAL PURGATIVE.

229

the chap makes an impression on one with his talk. He looks
as fierce as a savage, stammers out horrible Latin and Greek
words, gesticulates with his arms, and distorts his features to such
an extent that one cannot help being moved when one listens to
him. And what he says may be perfectly correct; and is there
any greater blessing than health? What a lot of diseases with Greek
and Latin names one might get in one's gullet by neglecting the
proper precautions! My wife and children are very precious to
me; they are all lively and ruddy, and as sound as a nut. May
God keep them so! But all my household must lend a hand, and
work according to their abilities. After being busy all day in the
open air they get a brave appetite for their meals. None of them
ail in the least, that is true. If we could but prevent their suffering hereafter! If you should think a good purgative advisable for
us, please to send us our portions, and say how we should take
them. The chemist will tell you the ages of myself and family.
You may send the stuff to us by the brewer's cart.
I am, &c.
W. von TEUTON,
Schloss Berghausen,                              Retired Captain.
1st October.
Answer.
My dear Captain,
It is well that you have not given the preference to the
idle talk of your Bramarbas of a surgeon over your sound judgment, as so many in your situation do.
You appear to appreciate the truth of that very sensible maxim,
"The whole need not the physician, but they that are sick."
Who would take medicine if there was nothing the matter with
him?   Is there any better preventive of diseases than a good
robust state of health? That you enjoy, as I perceive from your
letter, along with your family; do you wish for anything better?
It is only in cases of excessive over-loading of the stomach in
delicate persons and such as are afflicted with chronic diseases
that the circumstance occurs of nature being too weak to expel
the ordure at the right time, and we require to assist her by




230

THE FRIEND OF HEALTH.

means of a purgative medicine. But in the healthy state, nature
is able of herself to evacuate the useless refuse of the food, and
that infinitely better than can be done by our good art.
Therefore, trust me, take no physic, neither you nor your
family. Anything else that you have to ask I shall be happy to
inform you of. Let your barber-surgeon stick to your beard; the
inferior class of these gentry usually only understand the art of
make healthy people less healthy, and the sick worse than they
were; they bring nothing out of the military hospital with them
but disregard for the sufferings of others. Farewell.
ON MAKING THE BODY HARDY.
Modern instructors and other clear-headed men have deeply
felt the necessity of making young persons destined for various
pursuits and for fighting their way in the great world, hardy, as
they term it, and thereby rescuing them from that effeminating
and coddling mode of rearing which has for long been the privilege of fashionable people, in which they have been encouraged by
the ordinary class of physicians, who are accustomed to reap a
golden harvest from the fur-coats, fur-boots, fur-caps, the heated
rooms, the intemperance, the warm drinks, and the destructive
passions of their clients.
The many unfruitful marriages, the delicacy and bad health of
the richer classes have excited attention, and it has been found that
these favourites of fortune have been changed into the most
wretched specimens of humanity by the habits of life they adopt,
that many of their families gradually die out inevitably, and that
the delicate members that may still remain of some, encompassed




ON MAKING THE BODY HARDY.

231

by a host of diseases and pains, joylessly drag out their existence,
without any pleasure in life, in the midst of their abundance of
the good things of this world, like the fabled Tantalus of heathen
mythology.
The open air was never warm enough, it chilled the young ambassador; the comfortable travelling carriage was altered a dozen
times in order to exclude every breath of air.
The prince was not allowed to walk, for how easily might he not
get his feet wet, and in consequence die suddenly of apoplexy!
The young count, destined to be a general, slept in beds of
the softest eider-down, was fed upon sweet cakes, coffee, highly
seasoned dishes, two servants must wait on him to assist him to
dress, but not before ten o'clock in the morning, because the
tender plant might have withered if exposed to the rude morningair. And so he grows up, enters upon his important post, and
must now play the iron denizen of camps; only imagine!
In like manner there are king's-messengers who would be suffocated in a peasant's heated cot, and rangers of the royal forests
who would catch their death if they were forced to wade through
the snow.
How many toothaches and diarrhoeas has not last night's opera
occasioned! what an amount of colics, rheumatisms, sore-throats
and erysipelas will not our to-morrow's illumination give rise to!
I said before, that effeminacy is the privilege of the rich, fashionable classes; I am wrong! This privilege has been said to belong to
the nobility. In order to appear fashionable, the manners of haut
ton have been assumed by the very lowest classes. A merchant's
wife, nay a hair-dresser's lady, would think it a disgrace not to be
able to talk about vapours, perte blanche and digestive lavements
from her own experience. The son of the poor secretary takes his
afternoon nap on soft pillows, and the ostler's daughter eats her
Swiss biscuits with her sugared coffee; she would blush to wash
her own clothes.
These depraved habits have crept in, even among country
people: for the farmer's daughter can undoubtedly not consider
herself thoroughly educated until she has acquired the blanched
complexion of the French lady. She carries on an affected courtship with the downy-bearded young squire, Fritz, with his false
calves, artificially enlarged thighs, and coat padded with feathers;




232

THE FRIEND OF HEALTH.

a striking contrast to the shirt of mail of his great-grandfather.
Siegwart, Idris, Musarion, Grecourt, and Ecole des Filles! are you
not partly to blame for this climax of enervation?
But the philanthropic genius of the last quarter of this century
saw all this abomination and destructive degeneracy, and deplored
it. It resorted to bathing in cold rivers.
In these the tender sprouts of gentle lineage were immersed;
they were forced to tramp over the frosty ground, bare-footed,
bare-headed and with uncovered chest, and to rest for but a few
hours on a hard bed.
Of thy good intention, dear genius, there could not be a
doubt, even though the poor children from these experiments got
their hands and feet frostbitten, died of consumption and catarrhal
fevers, or in other ways shewed in lamentable manner that a hothouse plant should not be transplanted in November in order to
accustom it to the northern climate.
Thy good intention, I repeat, could not be doubted, only the
interpreters of thy counsels did not quite enter into thy spirit, and
by their imperfect execution of them caused thy name to be
reviled among the heathen.
Allow me (if I understand thee better) to translate thy heavenly
ideas into the common language of mortals, and if not to inculcate
doctrines, at least to throw out hints, as to how the effeminate
race may be changed into men bearing at least a distant resemblance to the rock-like bodies of the ancient Germans; how they
may, if engaged in business, manfully encounter the dangers of
their calling, regardless of all variations in the weather, undergo
the labours of life with courage and strength, and see their greatgrandchildren play like young eagles around their untottering
knees.
Father Hippocrates, whose knowledge of mankind was of the
most profound, remarks in one part of his writings that changes
from one extreme to another cannot be undertaken without danger and caution, and I cannot too strenuously insist upon the
truth of this observation. Nature does nothing without preparation; all her operations are performed gradually, and the more
complex and artistic the work is that she performs, so much the
more cautiously and gradually does she do it.




ON MAKING THE BODY HARDY.

238

She never goes from summer to winter without interposing the
transition period of autumn.
The cherry tree loaded with fruit would immediately wither and
die if January followed immediately after June. She knows better
how to prepare it for the winter's frost. She first causes the tree
to drop its fruit, protects the buds for the next year by means of
hard barks and balsamic resins, and during five months diminishes
the circulation of its juices so gradually that the sap-tubes contract and the moisture in them is evaporated almost to dryness by
January; she sends cold and ever colder nights and days, so that
the biting frost, when it arrives, finds the tree prepared to encounter its tyranny. In an equally gradual manner does she put
the sap again into circulation, until its activity, fostered by the
increased warmth of spring and its rains, is in a condition to bear
the full glow of the dog-days.
Let us imitate nature-let us never make January to follow
close upon June, nor July upon January, if we do not wish
our tender plants to be blasted and withered by both of these
extremes.
The hardening of the human creature in respect to heat and
cold no doubt is commenced with greatest safety in childhood
(with older persons it is more difficult to effect such changes, just
as it is more difficult to transplant an old tree to a new soil), but
we require to exercise the greatest caution at first with these
tender creatures, in order to prevent numbers of them from
remaining behind, withering and fading during the transition to a
mode of life to which they are unused!
When the sunshiny days commence, the gardener removes the
shutters from the windows of his forcing frames; when the air
becomes warmer he opens the windows to allow of the entrance of
fresh air; he opens them more and more as the warm weather
becomes more constant, and only transfers permanently to the
open air the tender plants which he has thus accustomed as it
were to the atmosphere, when he no longer dreads the occurrence
of night-frosts.
The modem hardening methods seem to bear a great resemblance to the incautious transference of hot-house plants to the
open air in February.
It is incredible what man can endure if he be gradually habitu



234

THE FRIEND OF HEALTH.

ated to it. The Russian leaps into the ice-covered Neva the
instant he creeps out of the stewing-hot sweating bath; the Halle
brewer plunges into the Saale after roasting half naked beside his
brewing vat; the negro readily endures the heat of the equator,
and works under it like a horse; the Greenlander goes forth to
hunt the bear by moonlight in a cold of which we can form no
conception, and returns to his lowly hut, which is filled by the
exhalations from the large oil-lamp, and from his own and other
families, with a deteriorated air that would almost suffocate a
stranger; here he is cheerful and gay, and gratifies his palate with
things that disgust would prevent us bringing near our lips.
If it be supposed that there are peculiar varieties of the human
species, that would be to make a great mistake; they have come
from their mother's womb as delicate and soft as any of ourselves.
All these people, however, give their children no other education but their own example; they abandon them to their own will
until they have attained a good age.
The young creature at first creeps on all fours after his father as
far as he can, in heat and in cold, and creeps home again when he
can go no farther. This he does day after day, until he can bear
it better and go farther; no one forces him, he turns back again
when he has had enough, but he is always acted on by that most
powerful of all agents in education, the imitative faculty, the
desire to act as like his father as possible; this is a stimulus that
will not easily induce him to do anything that might endanger his
life, because he can unrestrainedly attend to his sensations of pain,
and of his own free-will return to a place of security. The
stronger of the children of these people (their young offspring
know not the pleasure of mischief, as ours do) assist the weaker,
pull them out of the snow, fetch them away from the burning
sand-desert, or rescue them by swimming when they fall into the
water, and thus the child learns gradually (but only gradually, be
it observed) to endure as much as his father can.
The objection might fairly be made to what I have said that
this kind of gradual accustoming to heat and cold, and so forth, is
not applicable to our education and to our mode of living.
This objection is a fair one, I repeat, but only partially so.
True, the father and the mother among us cannot become Samojedes or Ethiopians, but the teacher of the children (be he a




ON MAKING THE BODY HARDY.

235

peasant, a schoolmaster or a tutor) must have brought this kind of
hardening process to a certain degree of perfection in his own
person, he ought to have several children at once under his superintendence, for the purpose of exciting emulation among them.
Here it is much worse on the part of the teacher to err on the
side of doing too much than too little. He may leave it to the
free-will of the children to inure themselves; he does it before
them, they imitate him, each according to his strength, and none
must be forced to overstep the latter.
The teacher cannot put himself in the situation of the boy,
cannot enter thoroughly into his feelings, consequently the boy
must be allowed to draw back when he wishes to do so. He will
rather have sometimes to keep him back, for imitation is often too
powerful a spur.
It is best that these exercises should be carried on in the presence of the pupils only, without any other spectator, for then all
present would be animated by the same mind.
But to send one's children with bare feet, head, chest and arms
through the crowded streets of a town, accompanied by a well
clothed tutor, amid the jeers of the boys in the street, and the
audible expressions of compassion from the windows, would be to
turn to ridicule an affair of great seriousness, and to inspire the
children with an invincible repugnance to the hardening system
generally.
When the children have played long enough in their ordinary
clothing in the cold or in the heat, and if they have advanced so far
as to be able in such guise to bear both extremes readily, we may
proceed to diminish the amount of their clothing somewhat and by
degrees, and even allow them to go with sundry parts of their person uncovered when they are alone.
But this should not be done in the severest winters, for the
bodies of children will not be able to stand so much cold; there is
besides no possible case when their being habituated to it would
be necessary. Even beggar-children find rags to put their feet in,
when they have no shoes; and we should only seek to prepare our
children for the positions in which they may chance to be placed I
Here I must refer to what I should long since have spoken about.
The new hardening-system commits the usual fault, of seeking to
harden the body only in reference to the endurance of cold. But




236

THE FRIEND OF HEALTH.

would it not be just as delicate, to be unable to endure heat?
Persons who cannot bear the heat of the sun, or of very warm
rooms, are liable to the most serious, even fatal accidents; why are
they not accustomed to this also? To be able to endure cold, will
not require much effort on the part of the Russian, but the
alternations of heat and cold and vice versa (this great promoter of
diseases in the delicate denizens of towns), these he endeavours to
learn to endure by his alternate sweating and ice-water baths; to
these he seeks to become quite indifferent. He attains his object, as
we well know, and is the hardiest soldier history makes mention of.
But in the case of children this habituation to heat must also
take place only gently and by degrees, and we should take care that
they have not too much given them to do at first. They should
have for their instructor a wise man, who knows the capabilities of
each of his pupils, and he must not urge them on but rather keep
them back, if he sees that his example is likelyto make them go too far.
Frequent recreation (without witnesses, or among suitable companions) in the open air, in summer, will furnish many opportunities for this.
For pupils of more mature age, there can be no better opportunity
for hardening them against the variations of temperature, than
little pedestrian excursions. Here under the rational guidance of
their master, they have at the same time an opportunity of habituating themselves to other inconveniences and dangers of the
world; I allude to fatigue, the various atmospheres of different
houses, to draughts, and damp.
One may be able to bear very well the pure, dry, cold air of
winter, and the heat of summer, but readily get ill in a damp
cellar-like room.
Draughts of wind are something quite different from the open
air, and a damp stocking in cold weather may often cause one who
is used to swimming to be laid on the bed of sickness. And yet all
these are incidents occurring in human life, which can scarcely be
escaped by him who mixes with the world, or who does not dread
dangerous consequences to his health from such every-day trifles.
In all these exercitations it is necessary to employ caution when
accustoming ourselves to them, beginning with the less and going
on to the greater, but always only gradually, interruptedly and by
progressive advances.




ON MAKING THE BODY HARDY.

237

Very young children, that is, such as are not above seven years
of age, cannot become very habituated to the deteriorated air of
rooms. If we carry things too far with them we render them liable
to become ricketty.
But since if we wish to render ourselves useful for business, we
must also live in unhealthy deteriorated air, and be particularly
anxious to preserve our health in it, so we must endeavour to
render growing children capable of living not only in pure country
air, but also in rooms; in rooms filled with people they must be
able to exist at first for half an hour at a time, then for a whole
hour, for several hours, and at length for whole days; and the
hardening process must put them in a condition to remain well
in spite of this, the most pernicious of all situations in which man
can be placed. If their habituation be performed gradually, they
will be able to do this bravely. Those children, however, should
not be under ten or twelve years of age if we do not wish the
whole plan to fail.
Pedestrian expeditions afford many opportunities for this also;
these the teacher should direct, limit and define with wisdom and
forbearance.
A teacher who is acquainted with the habits of life of the lowest
class of peasants' children, and has observed how they have to bear
all the discomforts of life, and to get a hardy body thereby, will be
enabled to employ many of their practices upon his pupils.
When the peasant-lad, for instance, falls through the ice and gets
wet up to the knees, he commences to jump about more vigorously
than his companions; in order not to be laughed at, he carries on
this process of warming himself by moving about until either he becomes quite dry, or until he can bear it no longer; he then goes home
and dries his stockings. If he has got himself chilled, he does not
much care, he only waits till he is dry and then runs out again to
play with his companions.
If he has the care of horses he gains courage, if of oxen he
learns patience, if he has to cart dung he learns to overcome his
feelings of disgust, if he is engaged in mowing grass he acquires
caution in handling sharp instruments, the rigour of the schoolmaster tends to make him docile, listening to a wretched sermon
teaches him to be silent-from going barefoot his feet lose their
tendency to get corns, gout and dropsy, climbing makes him lose




238

THE FRIEND OF HEALTH.

his liability to turn giddy. His black bread needs no layer of
butter, and his water requires not the addition of sugar and
lemon-juice.
To unite the good that is to be found in this station of life with
the cultivation of the mind, such is, in my opinion, the ne plus ultra
of a rational and suitable education.
Gleaning corn in August, sheep-washing, crab-catching, tending
the cattle in all kinds of weather in the open fields, as well when
he remains motionless beside them   as when he runs after them
over the hills, fetching wood from the distant forest in all weathers,
the damp school-room, the fair that excites disgust at the excesses
committed, the three-hours sermon in the cellar-like church-all
these are excellent exercises and modes of hardening the body,
which would be serviceable to a person in after life, whatever
position he might occupy.
In the centre of a great and populous city it is utterly impossible to bring up healthy children, and equally so to harden their
frames. Should they walk all through the town in order to get
into the open country, they would be tired before they could
escape from the depraved air of the city. Tired children could
not endure any of the exercises we have proposed without getting
ill; they would require strength, I might say a superlative degree
of strength, to stand heat or cold, wind, damp, &c. Should they
drive out of town, there are several difficulties in the way: to
endure all sorts of weather seated in an open carriage can only be
done by robust, grown-up people. Should they only drive out
in good weather, then, during bad weather, confined to the air of
the town rooms, they would go back farther than they had gone
forward from the few exercises in the country. In shut-up carriages the space is so confined that the depravation of the air by
breathing soon attains to a great height. If the carriage windows
be let down, a draught is produced which the poor hot-house plants
cannot bear.
In small towns of about a couple of thousand of inhabitants, or
in the environs of larger towns, it is more possible to rear healthy
and hardy children with proper care, provided we withdraw them
gradually and as much as possible from the enervating influences
of genteel life, and allow them to pass at least one third of the day
in the open air, mindful always of their relative strength and of




ON MAKING THE BODY HARDY.             239
the necessity of accustoming them gradually to all that is strange
and unusual to them.
Children can be brought up healthy and hardy most easily and
certainly at a distance from towns, for example on an estate or in
a village residence, but the circumstances of all parents do not
admit of this, and equally certain is it that we may, even in the
most healthy villages, make our children delicate and puny. To
do this we need only to deprive them of their freedom, to leave
them usually shut up in the low, damp, hot room, to overload
their stomachs, and to let them sleep in hot, soft feather beds, to
encourage uncleanliness, and so forth.
But on the other hand the propinquity of a town offers so many
advantages for the cultivation of the mind of growing children,
that we should make the greatest sacrifices in order that, in all the
circumstances in which we parents may be placed, we may give or
cause to be given to the bodies and minds of our children the
development most suitable for their destined situation in life.




PART     II.1
SOCRATES AND PHYSON.
ON THE WORTH OF OUTWARD SHOW.
Socr. I am pleased that thou comest nearer me, Physon; I
have been admiring thy beautiful garment at a distance.
Ph. It cost me a great many drachmas; thrice must the purple
shell-fish yield its costly dye to produce this rich colour. Now
none can compare with me; the greatest in Athens enviously
makes way for me, and, only think I before I inherited my property, nobody cared an iota for me.
Socr. Then I presume thou art now worth infinitely more, art
infinitely happier, than formerly, when thou usedst to dig my
little garden for a scanty hire.
Ph. I should think so indeed! He that can regale himself for
hours together at the most richly furnished table with the most
delicious viands, that can set before twenty guests wine from the
Cyclades fifty years of age, and complete their intoxication with
the music of the lute and the sweet voices of female choristers,
that can drive over great estates as the sole possessor, and can
issue his commands to a hundred slaves-should such an one not
be deemed happy?
Socr. But thou wast formerly a healthy, sensible man before
thou inheritedst the property; thou hadst thy house, wast beloved
by thy wife, thy children and thy neighbours; thou earnedst thy
bread, together with an excellent appetite and robust health.-At
what dost thou value thy fortune?
Ph.-At five millions.
1 Published at Leipzig, in 1795.




ON THE WORTH OF OUTWARD SHOW.

241

Socr. How much richer dost thou esteem a man with a sound
reason than that unfortunate maniac Aphron.
Ph. The greater richness of the former is to be measured by no
amount of wealth.
Socr. At what price wouldst thou part with thy five children?
Ph. Certainly not for all my wealth. Physicians would be
kings could they make women fruitful or save children from death.
Socr. Thou art right, but in that case thy wife could not have
been much less valued?
Ph. By Juno! I would not part with her for millions if she
still lived! The charming woman, with whose fidelity and thriftiness, and goodness, and excellent manner of bringing up children
when I used to live upon boiled beans, all the treasures of the earth
were not to be compared.
Socr. But blindness, lameness, a pair of deaf ears, and a lingering fever, thou wouldst suffer for an inconsiderable sum?
Ph. Zeus forbid! Dost thou imagine that this prospect of the
sun gilding the mountain tops as in the morning it issues forth from
the misty ocean, diffusing life and joy over all the habitable globe,
that the melting song of Apollo's rival, the nightingale, that my
warm blood, the healthy breath of my lungs, my strong stomach
and my refreshing sleep, could be bartered by me for any amount
of gold?
Socr. Hygieia preserve them to thee! But it seems from thy
calculation that thou hast not become richer by thine inheritance
than the sea-shore would become by the addition of a spoonful of
sand. What are thy boasted five millions when compared with
the innumerable millions of thy former blessings! Of a truth,
when thou commencest to esteem thyself happy only after thou
hast got this little addition, when thou lookest down so contemptuously on thy former apparently poor condition, I must pity
thee; thou shewest thereby that thou hast never rendered the
thanks due from thee to the immortal gods! I am sorry for thee,
thou that wast formerly so brave a man!    Did they formerly
regard less beneficially thy well-meant offering of salt and roasted
flour, than they do now thy proud sacrifice of a bull? I am sorry
for thee!
Go into the dark at midnight and feel the costliness of thy
purple garment; thou seest nought, thou feelest nought but that
R




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THE FRIEND OF HEALTH.

thy nakedness is covered, and was not this also the case when thou
performedst thy hard manual labour for a few oboli. Are the
flatteries of thy fawning guests dearer to thee than formerly was
the pressure of thy master's hand when he was pleased with thee?
Dost thou really walk softer on thy gold-embroidered carpets than
thou usedst to do on the unpaid-for green turf? Perhaps the dark
Persian wine now quenches thy thirst better than the spring that
formerly trickled forth beside thy moss-grown cottage; perhaps
thou risest now more refreshed from thy soft bed at noon, to which
time a splendid supper caused thy sleep to be prolonged, than thou
didst formerly from thy not very soft straw matrass, which the
fatigues of the day's work made welcome to thee?   Probably flamingoes' tongues served on gold plate, though from repeated repletion thou hast but little hunger left, are much more relished than
milk and bread after hard work! Perhaps the thousand forced
and artificial endearments of the hired girls that hover round thee
now afford a purer, more permanent enjoyment to thy senses,
nearly worn down to obtuseness, than did formerly the artless,
trusting embrace of thy true and hearty wife in rare moments of
happiness, when the unadorned black hair fell artlessly upon her neck
browned by the sun, her constant heart throbbed for thee alone,
and love for thee alone streamed forth from her dark eyes. Perhaps
we live more secure from diseases, lightning, and thieves, in marble
pillared palaces, filled with numbers of dear-bought slaves, in beds
inlaid with ivory, and beside bags filled with the precious metals,
than in the lowly cottage covered with ivy, provided with the
necessaries of life for several days to come, among honest neighbours and friends? Physon! Physon! mistake not the destiny of
man, forget not the happiness of thy former days which the gods
granted to thee, and which were dear to thee. Only ask thyself, if
ever thou hast an hour to spare for this purpose, whether thou hast
not more cause to envy thy former lot, than others have to envy
thee thy present life I
Knowest thou the man that has just passed us clad in a coarse
woollen garment?    In his venerable aged form beams universal
philanthropy. That is Eumenes,the physician. The many thousands
that he yearly makes by the practice of his art, he does not spend
on fine country houses and on the other vain trifles of the luxurious. His happiness consists in doing good I About the tenth




PLANS FOR ERADICATING A MALIGNANT FEVER.

243

part of his large income he uses for his limited wants, the rest he
puts out to interest in the state.  And how? thou askest me.
To the poor he gives his aid, his medical skill. With his stores he
supports the convalescent families until they can again help themselves, and with the costliest of his wines he revives the dying.
He seeks out the miserable in their dirty hovels, and appears to
them as a beneficent divinity; yes, when the all-vivifying sun, the
image of the unknown God, refrains from shewing the dying its
life-bestowing face, and even at midnight, he appears in the huts of
the miserable to assist them, and lavishes on them consolation,
advice and aid. They worship him as our ancestors worshipped the
beneficent demi-gods, Osiris, Ceres and 1Esculapius. Wilt thou
soon commence to envy him?     Go, Physon, and engage in some
better pursuits, and then count on my esteem.
PLANS FOR ERADICATING A MALIGNANT FEVER,
IN A LETTER TO THE MINISTER OF POLICE.
Sir,
You will, no doubt, yourself, see the results that the infection that was brought to * * * four weeks ago might produce
if its farther spread be not arrested, still I consider it to be a duty,
as I have, here and there, had considerable experience in extensive
epidemics, to offer my mite at the altar of fatherland, in the form
of some unpretending propositions.
Taking into account the malignancy of this fever, if the epidemic
be left to itself, it may, in the course of half-a-year, at this season,
and in the present condition of the town, sweep away about 250
individuals, a considerable human capital, seeing that it is especially
adults, the most useful class, that will first and most certainly be
cut off by it. Should it, as soon will happen, once penetrate into
R2




244

THE FRIEND OF HEALTH.

the damp dirty houses of the poor, who are already often rendered
liable speedily to catch the disease, by unhealthy miserable fare, by
sorrow and depression, it is difficult, very difficult, to extinguish it
in these situations. In addition to this, there is the carelessness of
the common people, who incline to Turkish fatalism, as the most
convenient of all creeds respecting Providence, and their want of
reflection in only considering as dangerous what they can see with
their eyes, such as a flood or a conflagration. From these they
will flee, but they are indifferent to a murderous pestilential vapour,
because it does not fall within the cognizance of their coarse senses.
So the ignorant person fearlessly approaches a charged electric
battery, and smilingly enters the pit filled with poisonous gases,
though his predecessor may just have been brought out of it dead.
Every one thinks he possesses enough strength to resist the enemy
of life. But vain are his expectations; the giant himself if breathed
on by the breath of death sinks down, and the wisest loses his
consciousness. Resistance is not to be thought of. In flight, in
flight alone, is safety.
The only means on which we can rely for checking epidemics in
their birth, is the separation of the diseased from the healthy. But
if it be left to the public to preserve themselves from infection,
every one for himself, even with the help of published advice,
experience teaches us that all such recommendations do little good
-and often, in spite of the best intentions, cannot be carried out.
But just as the police, when a conflagration breaks out in the town,
does not leave it to the caprice of the possessor of the house, to extinguish the fire in the way he thinks fit, but makes itself the necessary
arrangements, and erects the fire-stations to be employed without
delay, if necessary in opposition to the will, and even in spite of
the resistance of the owner of the tenement-acting upon the just
principle, that the security of the community ought to weigh infinitely more than the property of an individual-in like manner,
I assert it ought not be left to the individual's caprice to nurse his
relatives affected with infectious disorders, in his house, since it is
not to be presumed that he has either sufficient power, or judgment, or opportunity, to prevent the spread of the disease, and no
amount of wealth on his part, no damages expressible in figures,
can compensate for the life of one, not to speak of many families,
fathers, mothers, husbands, wives, children, endangered by him.




PLANS FOR ERADICATING A MALIGNANT FEVER.

245

Of a truth if ever the better part of the public ought anxiously
to look to the authorities and to the police for protection, it is in
the case of the invasion of epidemics, if the protecting divinities of
fatherland do not stretch forth their powerful hands on that occasion, where else can we look for deliverance from the danger?
I could easily exhibit a picture of the most frightful scenes, that
still haunt me from similar epidemics, whereby the most uncosmopolitan soul must be deeply moved-but to you, sir, such things
are not unfamiliar, and you require not such reasons to induce
you to put your hand to the work.
Taking for granted, then, that you concede the above premisses,
I make bold to make the following preliminary proposals, for
whose efficacy experience is my warranty, and thereon I stake my
honour.
They may all be set in action in the course of a few days; in
this case speed saves expense and human life.
1. Let an hospital or other public building without the gates of
the town be prepared, solely for the reception of such patients;
the court-yard must be surrounded by a stone or wooden fence, as
high as a man.
2. From twenty to thirty cheap bedsteads are requisite, provided
with straw matrasses and frieze coverings.
3. The male and female nurses-of whom there should be one
for every four or five patients-must always remain in the house
with their patients, and should never go outside the door. The
food and medicines they require should be brought to them daily
in the open court by persons who should immediately afterwards
retire, so that the two parties shall not approach within three
paces of each other, and nothing should be brought from the
house into the town.
4. In order to enforce this regulation, place a guard of two
soldiers before the outer door, which they only are to open, and
command them to let none but these persons and the physician
and surgeon in and out.
5. A small sentry-box formed of boards will protect them from
the weather, outside of which should hang a linen (or, still better,
an oil-cloth) cloak for the physician and surgeon, which they
should put on when they enter the house and lay aside on leaving it.
6. The medical officers should get a written notice of the mode




246

THE FRIEND OF HEALTH.

in which it is desirable that they should protect themselves and
others from infection, and the attendants of the sick should get
instructions of a similar character.
7. All who fall ill of this malignant nervous fever in the town
(the police officers should get a gratuity for all they detect) should
be removed to the hospital by their friends in a covered sedan
chair, kept for this purpose in the court-yard of the hospital, and
there they should be taken care of and cured-(at the expense of
their friends?).
Persons so dangerous to the community cease to belong to their
friends; from the nature of their malady they come under the
surveillance and care of the state, like a highwayman, a madman,
a murdering quack-doctor, an incendiary, a robber, a poisoning
courtesan, &c. They belong to the state until they are rendered
innocuous. Salus publica periclitatur is the simple standard for
determining all the wholesome regulations of a philanthropic police
in such cases. To forbear pulling down neighbouring houses during
a spreading conflagration, in consequence of the unreasonable
request of their owners, this is a fault that no police now-a-days
would commit. In the case we allude to, however, there is no
pulling down, but on the contrary, building up. Men's lives, not
houses, are to be saved.
Should my patriotic general propositions meet with your approbation, I shall not fail, if no one else does it, to treat of the
subject'in greater detail, and to furnish, in writing, the additional
plans for the general weal, as circumstances prevent me taking a
personal share in them.
If I could thereby prevent some misfortune, I should feel myself
richly rewarded. But the reason why I, a private individual,
occupying no official post, and not intimately connected with this
country, wish to lend my aid in this matter, is owing to this, that
I think that in such public calamities the motto should be sauve
qui peut! and hence I am wont to exert myself to the utmost, and
to save what can be saved, be it friend or foe.
I am, &c.
DR. H.




PLANS FOR ERADICATING A MALIGNANT FEVER.

247

More particular directions.
The police officials ought to ascertain where any person has
been suddenly taken ill in the town, or has suddenly complained
of headache, rigor, stupefaction, or has rapidly become very weak
and delirious; they should report what they learn to the appointed
physician, who, after a rapid but careful examination, during
which he attends to the directions below for avoiding infection,
sees that the patient is conveyed to the hospital. At the same
time the police officer receives his fixed remuneration.'
The large hall of the hospital should be divided longitudinally
by means of a partition of boards; the one part so divided to form
the patient's ward, whilst the other and much narrower division
forms a kind of passage, into which the bedstead of each patient,
which should be placed on castors, may be pushed through a trap
door in the partition, in such a manner as that only the patient
in the bed shall come into the passage, whereon the trap-door falls
to again. Here the physician examines the external and internal
condition of the patient, in the presence of the surgeon, then he
causes him to be pushed back into the ward, and the next patient
to be brought forward, and so on.
But before performing this examination, and indeed before the
arrival of the physician, all the windows of the passage should be
opened in order to air it. Before the patients are brought in they
must be closed.
The physician, accompanied by the surgeon, both covered with
the oil-cloth cloak,2 visits the patients twice a day, and questions
them at a distance of three paces. If he require to feel their pulse,
he must do this with averted head, and immediately afterwards
wash his hand in a basin containing water and vinegar. If the
1 If this remuneration be considerable (about a thaler [3s. 6d.] for the discovery
of every case of this kind), the progress of the epidemic will be speedily checked,
there will soon be no more sick to be separated from the healthy. The sick will be
discovered in time, before they can (easily) communicate the infection. Again in
human life and in the smaller sum required, will be the manifest result.
2 When the disease is particularly malignant in its character, it is advisable to have
a hood attached to the cloak, which the medical officer may draw over his head when
he makes his visit, for it has been observed that the contagious matters attach themselves most readily to wool and hair.




248

THE FRIEND OF HEALTH.

patient's face be directed towards the light, it is not difficult to
observe the state of the tongue at a distance of three paces.      At a
less distance it is scarcely possible to avoid the danger of inhaling
the patient's breath,' whence the contagious principle spreads
farthest and most powerfully.
When the patient has a clean tongue,2 as is found in those who
are most dangerously ill, it is often advisable to give him large
quantities of bark and wine, in place of any other medicine; and
as it is to be apprehended that the nurse might make away with
the wine, it is better to prescribe the bark and wine mixed, or for
the physician to mix it himself. After every visit the medical
officers should wash their hands and faces in vinegar and water.
The nurses must also be warned not to hold their faces near the
patient's mouth, and after every time they raise up, turn or touch
the patient, they should immediately wash their hands and faces.
It is advisable to use a mixture of vinegar and water for the purposes of ablution.
Each bed should be provided with a linen matrass well stuffed
with straw,3 over which is spread a linen sheet, and on this a piece
of oil-cloth4 about three feet in length, whereon the nates and
back of the patient lie.
There should be two frieze-coverlets for each bed, in order that
the one may hang all day long in the open air, whilst the other is
covering the patient. They should be washed once a week by the
nurses, together with the rest of the patient's linen, either in the open
court yard, or beneath a shed only covered at top. They should
first be washed clean in merely tepid water with soap, and sub1 The odour of the contagious miasm of malignant typhus fever is a kind of earthy,
mouldy smell, like that from old graves newly opened. It has little or no resemblance
to the odour of putrid flesh.
2 This disease was chiefly a gaol-fever without anything in the first passages.
3 Matrasses equally, smoothly and firmly stuffed with some vegetable substance,
as barley-straw, hay or moss, are for this object preferable to feather beds. The
former allow the exhalations to pass through, do not retain the miasm so long, and as
they are not so yielding form no wrinkles, and are cooler: they prevent the formation
of those often fatal bed-sores (sphacelus a decubitu) so often met with in malignant
fevers.
4 By its smoothness it prevents the formation of bed sores, and catches the faeces
that often pass involuntarily in patients seriously ill. They may be easily removed
without soiling the bed linen or matrass, which has a very bad effect on the purity
of the air.




PLANS FOR ERADICATING A MALIGNANT FEVER.

249

sequently scalded with boiling water, care being taken to avoid the
steam that rises, and they should not be washed a second time
until the whole is almost quite cooled down.'
The oil-cloth should also be frequently wiped with a wet cloth.
Every day at noon all the windows of the sick-room should be
opened, and a draught of air kept up for an hour, during which
the patients' beds should be pushed through into the ante-room,
and remain there all the time.
In the centre of the ward should stand a stove, heated from
within.2
The most trustworthy of the nurses must be responsible for the
accurate carrying-out of these directions, as well as those of the
physician.
Those nurses who have already attended patients affected with
the complaint are more secure from infection than those who have
not. To the former should be assigned the duty of the more immediate attendance on the patients. A new nurse should during
the first days only be employed in work at some distance from the
patients, such as scrubbing, sweeping, &c., until she is gradually
habituated to the miasm.
The state of the health of the whole household should be every
day carefully investigated by the physician, even though they consider themselves to be quite well.        They should each day be
reminded of the directions for their own preservation.
The excrements of the patients should be carried in well covered
night-stools to the most distant part of the court or garden, and
1 A washerwoman in America had to wash some dirty clothes, that had been
brought over by a ship from England (among them were some that had been worn
by a person who had recently recovered from small-pox in London), and she was immediately thereafter infected with malignant small-pox, from the hot steam that arose
from the wash-tub. Boerhaave has brought forward abundant proof of the frequency
and facility with which washerwomen are infected. He recommended soap not to be
used in washing, probably because he thought that the miasmatic matter was more
apf to be volatilized by it; but this danger is only to be apprehended from the
employment of hot water.
2 Stoves heated by a fire in their interior, and still more open fire-places, renew
the air of the room very effectually as long as the fire burns (and also to a certain
extent at other times), because the flame must always have fresh nourishment from
the air which it draws through the vent-hole of the stove in large quantity. At the
same time pure fresh air penetrates through the chinks of the windows, or through
the air-holes above them, into the room.




250

THE FRIEND OF HEALTH.

there emptied in such a way that the wind shall blow the exhalations from them away from the bearer. This should be done by
those of the nurses who are most habituated to the contagious virus
(not by the new-comers), upon a thick layer of saw-dust, and the
ordure immediately covered with one or several bundles of lighted
faggots or straw, whereupon the nurse should withdraw, and allow
the excrement to be consumed by the fire.
Two of the attendants who have been longest in the service
should be appointed the bearers of the sedan-chairs, for the purpose
of fetching new patients from the town. For this purpose they
should each time put on clean clothes, and apply to the sentry, who
will give them from a chest in the sentry-box a clean linen cloak,
which they are to put on, leaving their house cloak hanging up on
the outside of the sentry-box; they fetch the patient in the chair,
and whenever they have brought him within the inner door (whence
he is removed by others into the sick-ward), they take off their
clean cloak and return it into the custody of the sentry.
All the attendants, male and female, should wear a linen cloak
in the house, reaching down to the feet; this should be washed at
least once a fortnight.
The attendants cook the meals for themselves and the convalescents, but they ought to be supplied daily with fresh meat and
vegetables; half a pound of the former should be reckoned as
the daily allowance of each person. The male attendants should
get about three pints of good beer a-piece, the females somewhat
less.
They should get double the amount of the daily wages usual in
the town. It would be well to promise them additional remuneration in the event of the happy termination of the epidemic. It is
inconceivable the power to prevent infection possessed by the
beneficent emotions, hope, content, comfort, &c., as also by the
strengthening qualities of good living, and of that liquor that is so
refreshing to such people, beer!
They should moreover have no lack of wood, soap, vinegar,
lights, tobacco, snuff, &c.
If a clergyman is wanted for any of the patients, his visit must
be paid in the presence of the physician, and the same formalities
must be gone through as when the latter makes his visit, namely,
the passage must be well aired before the bed containing the




PLANS FOR ERADICATING A MALIGNANT FEVER.

251

patient is pushed through the trap-door. The physician instructs
him how near and in what manner he may approach the patient.1
When a patient dies he must be immediately pushed through
on his bed into the passage, and left there until the physician has
convinced himself of his decease. The corpse is then to be covered
with straw, and carried out on his bed into the court-yard or
dead-house, where he is to be put, along with the clothes in which
he died, into a coffin well stuffed with straw; the corpse should be
covered with straw and, in the presence of the physician and clergyman, conveyed to the churchyard in silence. The grave should
be four feet in depth, and the coffin should rest upon a layer of
faggots, and straw piled upon the top of it up to the level of the
top of the grave. After the lapse of three days in this manner,
the grave should either be covered over with earth, or, still better,
the straw ignited and the miasmatic virus consumed along with
the corpse, or at least dried till it is rendered innocuous. This is
a precautionary measure that cannot be too forcibly recommended.
When a patient recovers so as to be able to be restored to his
friends, he should be taken into a clean room, the key of which
should be kept by the physician alone, and there put into a bath
and well washed over all the body, not excepting the hair, at first
with clean warm water, and then sprinkled all over with vinegar
before being finally dried. He is then to put on the clean clothes
which his friends have sent him; and all his old clothes, without
exception, are to be burnt in the court-yard, in the presence of
the physician,2 and finally he is to be accompanied home by the
physician and surgeon.
Whenever a patient has recovered or died, the wooden closestool he has used must be burnt in the open air, and the pot-dechambre broken and the fragments thrown into the fire.
After the epidemic has been subdued, the male attendants
should not be dismissed until they have whitewashed the whole of
the interior walls of the house, not only the sick ward, but every
1 By incautiously approaching the beds of such patients, I have frequently seen
the most promising young clergymen infected and die.
2 Too much care cannot be taken to secure the destruction of such things, as the
paltry love of gain of the nurses induces them to keep them for themselves, in spite
of the danger to themselves and others of doing so.




252

THE FRIEND OF HEALTH.

other room, and the females not until they have thoroughly
scrubbed all the floors, all the wood-work and all the utensils.
The sick-ward should then be heated in the early morning as
much as possible, at least up to 1000 Reaum., and after this heat
has been kept up for two hours, all the windows should be opened
and kept so till night.
Before they quit the house, both male and female attendants
should bathe themselves, each sex in separate apartments, and all
their articles of clothing and the linen they have used during their
residence in the hospital should be placed in an oven of about the
temperature of a baker's oven after the bread has been removed
(about 1200 Reaum), and kept there for at least a quarter of an
hour,' the vent-hole being duly regulated the time.
After this is done, all the other linen or woollen articles which
have been used by the patients, the straw matrasses (after taking
out the straw), the towels, sheets, &c., should also be exposed for
fully an hour to the same heat in the oven, and thereafter the
bedsteads, after they have been well scoured, should be put in the
oven and left there till it cools.
The straw out of the matrasses, the accumulated sweepings,
rags, bandages, scrubbing cloths, brooms, and other articles of
small value, should be burnt in the court-yard in the doctor's
presence.
In his presence the attendants should leave the house all together and the sentinels should be withdrawn.
The house may be allowed to stand empty, and reserved for
similar purposes on a future occasion, one of the best-deserving
male attendants, with his wife, being allowed to live in it gratuitously as housekeeper. Their business would be to see that the
1 The pestiferous miasmata which have become attached to clothes, linen, beds,
&c., can according to my observations be expelled from such things and destroyed
by no means more certainly than by a heat of upwards of 1000 Reaum., the higher
the temperature the better, even should the articles suffer a little from its effects.
The celebrated Cook expelled in this manner the morbific vapours that had become
attached to the cabins of his ships and infected the walls; the efficacy of this
measure is well known. The earliest physicians discovered the wholesome effect of
fire and heat in destroying the plague virus, and their excellence is corroborated in
our infectious epidemics by Howard, Lind and Campbell. It is moreover remarkable
that all the infection of typhus fever ceases when ships are under the line.




PREVENTION OF EPIDEMICS IN TOWNS.

253

building is kept in good repair (in case it is required for another
epidemic).
A house of this description and so arranged might subsequently
be used with the greatest advantage, with some slight modifications, in epidemics of small-pox, measles, dysentery, and other
infectious maladies dangerous to the population, and might be the
means of preserving many useful citizens to the state.
There might be a few beds kept there permanently for the
reception of all sick journeymen, beggars and trampers from the
inns and lodging houses (a fine being imposed for the concealment
of such cases), whereby a source of epidemics of no small importance, but one that is frequently overlooked, might be effectually
checked at its origin.
This should be the duty imposed upon the housekeeper in
return for his free dwelling, but at the same time he should
receive an adequate (not paltry ) remuneration for each patient
who recovers, whenever he leaves the house.
SUGGESTIONS FOR THE PREVENTION OF EPIDEMICS
IN GENERAL, ESPECIALLY IN TOWNS.
A well-ordered police should take care that rag-gatherers are
not allowed to live anywhere but in isolated houses near the paper
mills,2 nor should they be permitted to have in any house in the
town a place where they may deposit the rags by little and little,
1 If the remuneration be not very small, he and his friends take good care to
be ever on the watch for any such patients that may have slipped into the town,
and he will do his utmost to obtain it as speedily as possible by the rapid recovery of
the patient, to the great advantage of the state (and of the patients).
2 Which should never be built close to towns and villages.




254

THE FRIEND OF HEALTH.

only to remove them when they have collected a large quantity.
The regulations prevalent in Electoral Saxony should be adopted,
viz.: that the rag-gatherer should keep in the open street with
his barrow or cart, by some signal summon around him those who
have rags to sell, and not remain in the town with his collection of
rags, but go into the country, and when he puts up at a country
inn, leave his cart in the open court-yard, or before the door of
the inn; in a word, leave it in the open air. He should be forbidden, under penalty of imprisonment, to pick out from his heap
of rags and sell to others for their use any articles of clothing that
may be still fit for wear.
They should also be forbidden to wear such articles themselves
or put them on their children, which they will often do, to the
great detriment of their health, as I have often observed. I have
seen a malignant epidemic of small-pox spread over the country
from so doing.
The paper-mills should be so arranged that the supply of the
crude rags should be kept in well ventilated buildings far away
from the dwelling houses, and the reception of the rags from the
gatherer, and the weighing of them, in order to determine the
sum he is to receive, should be carried on in a shed only covered
at top.
The dealers in old clothes should only be allowed to carry on
their trade in open shops, and should not be permitted to sell
them in their houses under penalty of imprisonment. All the
linen and articles of clothing they have for sale in their shops
should be previously washed, not excepting even the coloured and
woollen articles; and a police officer should be charged to examine
if they be washed, who should overhaul the whole contents of the
shop on undetermined days. Every article that he finds still dirty
should become his property after having shewn it to the inspector
of police in the presence of the dealer.'
It should only be permitted to the burghers of the town to deal
in old clothes. Jews engaging in this trade should be deprived of
I Should it be feared that such an article of clothing, probably worn by a sick
person, might prove dangerous to the policeman, it should be considered that the
poor broker, in order to avoid such a loss, will most certainly take care to have none
but clean washed things in his shop, and thus the police agent will have little or
nothing to confiscate.




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255

their letters of protection. Women found carrying it on should
be put in the House of Correction.
The civic-crown merited by him who improves the prisons has
been gained from us Germans by an Englishman - Howard.
Wagnitz follows in his steps. It is inconceivable how often the
most destructive vapours are concentrated in these dens of misery,
fraught with death to those that enter them; how often their visiters
are prematurely sent to the grave by fatal typhus. Destructive epidemic diseases often have their origin in these death-laden walls.
There are several kinds of prisons. I shall here allude only to
those where the imprisonment is for life and to those gaols where
prisoners guilty of capital crimes are kept until the termination of
their trial, often for several years, the visitation or inspection of
which is not unfrequently the cause of infectious diseases. Even
when the prisoners themselves have not been ill of such fevers,
their exhalations, their breath, and the miasm lurking about their
dirty clothes, have often occasioned malignant fatal fevers. Heysham, Pringle, Zimmermann, Sarcone and Lettsom adduce a
number of cases of this kind.
Now as in the true spirit of laws that are free from all barbarity,
even the punishment of death should have (and can have) no other
aim than to render an incorrigible criminal innocuous, and to
remove him from human society, what else can both these kinds
of imprisonment be than rendering the prisoner harmless, in the
former case for life, in the latter for a certain time pending the
duration of the trial. None but Syracusan tyrants could dream
of uniting a more inhuman object with such prisons.
If then the gaol even for capital offenders can and ought to be
nothing but a means of depriving them of all opportunity of
injuring society, in that case every torture that is unnecessarily
inflicted on them when thus in custody is a crime on the part of the
police. I only allude here to the pain inflicted on them by unhealthy
(disease-producing) prisons. In order to avoid this, prisons should
never be raised less than four feet above the ground, and the
openings of the windows, while they are sufficiently narrow,
should be always so long as to allow the free access of fresh air.
Where two windows opposite each other cannot be obtained (which
is the best plan), there ought to be at least three windows for each
small cell. The floor should either be paved with slabs of stone




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THE FRIEND OF HEALTH.

or, better, with rounded stones, so that it may be deluged and
scrubbed, once a week, with boiling water. The walls and roofs
should be lined with wooden boards, like the peasants' houses, in
order to allow of their being also washed with hot water,' as is
customary with the country people. By these means these dismal
habitations are at all events rendered dry residences, and the
cachexias and tumours so frequently met with in such as have
undergone a long imprisonment are in a great measure prevented.
If it were possible to construct an air-hole for the purpose of carrying off the deteriorated vapours into the open air, gaols would
thereby lose much of their dangerous aptitude to generate pests.
The prisoner should have at least once a week a bundle of fresh
straw for his bed. His bed-cover, together with his clothes and
linen, should be washed at least once a week in hot water. He
himself should be forced, before putting on his clean clothes, to
wash his body all over. His chamber utensil should be emptied
daily, and rinsed out with boiling water. He should be allowed
to walk about in the open air at least once a week, for at least an
hour at a time.
When he is removed from prison, his cell must be prepared for
the reception of future prisoners by washing anew the floor, the
walls and the roof with hot water, and by placing a small stove in
it, the funnel of which goes out at the window.  With this the cell
is to be heated very highly, so that the heat shall almost take away
one's breath (up to 1200 Reaum.), and then the stove should be
again removed, supposing it is not allowed to have one in the cell.
If not, an iron tube communicating with the open air should
open in the floor of the cell, passing in winter through a heated
stove, in order to conduct in a supply of fresh warm air.
It is great cruelty to shut up many prisoners together without
allowing at least 500 cubic feet of space and air for each. If this
be not allowed, the better ones among the prisoners are exposed to
much annoyance by the bad behaviour of the worse ones; and it is
incredible the rapidity with which that most destructive of all
1 The exhalation from these wretched creatures, that constantly tends to decomposition, and the animal poison developed from their breath, whereby the air of their
narrow cells is deteriorated, attaches itself in great quantity to the walls of gaols,
and in course of time degenerates into a pestilential miasm; by the process above
described it is removed and washed away by the boiling water.




PREVENTION OF EPIDEMICS IN TOWNS.

257

animal poisons, the virus of the most fatal pestilence, is generated.
Police authorities, be humane!
I scarcely need to remark, that the (often long-continued) imprisonment of debtors who are frequently deserving of compassion,
ought to be made at least as innocuous for the health of the
prisoners, of the turnkeys, and of those who visit them, &c., as that
of criminals.
When foreign prisoners or field-hospitals are introduced into a
healthy country in time of war, whether temporarily or permanently, the authorities, if they have it in their power to act, should
take care that an epidemic is not thereby brought into the country.
Prisoners of war, who are not unfrequently suffering from typhus
and putrid fevers, in their transit through a country, are generally,
when remaining for the night in towns, lodged in the town-halls,
apparently in order that they may be kept more securely. But
how often has this practice given rise to the spread of epidemics!
It would be safer to quarter them in large coach-houses, stables,
barns, &c., outside the town, to make them lie undressed on straw
matrasses, keeping them warmly covered in winter, and in this
manner retaining them until their march can be renewed.1 If the
season of the year admit of it, they must be compelled to wash
each other's clothes and linen with hot water, and to dry them in
the open air.
The most destructive pestilences are most easily engendered by
military-hospitals. It would be the most disgraceful barbarity even
in an enemy, to erect them in the middle of towns.
But if, nevertheless, this is done, there remain for the poor
town's-man, if they bring pestilence along with them, as they
usually do, very few means of preserving the life and health of
himself and family, and these he should carefully attend to.
If he will not or cannot leave the town, he must at all events avoid
all intercourse and communicationwith the sick,with infected houses,
and even with those who frequent such houses. If they bring him any
thing he should take it from them at his house-door or in the open
court. Should it be articles of clothing or linen, he should not
make use of them before he has plunged them into hot water mingled
1 On the march they have plenty of air and exercise; in this way they get rest
and warmth, and are incapacitated from making their escape.




258

THE FRIEND OF HEALTH.

with vinegar, in the open court, or thoroughly fumigated them
with sulphur. Should it be articles of food,1 let him not partake of
them before preparing them on the fire, or otherwise heating
them.
Infectious diseases have even been communicated by money and
letters; the former may be washed in boiling water, the latter
fumigated with sulphur.
Although the animal poisons called infectious miasmata are not
infectious at the distance of several paces in still open air, so that
we may (with the exercise of great care) preserve our house free
from infection in the midst of houses where the malady is raging,
we should remember that a draught of air can carry the miasm
arising from a sick person to a distance of many paces, and then
occasion infection.
On that account we should avoid traversing narrow lanes where
we should have to pass close by a sick person, and for a similar
reason we should shun narrow passages through houses. Above all
we should refrain from looking into an open window and conversing
with people in whose house or room cases of infectious disease may
exist.
Acquaintances kiss each other or shake hands; this ceremony
should be omitted when the danger is so imminent, as also drinking out of another's glass. We should particularly avoid making
use of a stranger's water-closet, or allowing a stranger to use
ours.
At such times we should never bring second-hand furniture2
into our premises.
Domestic animals that are given to rove, such as dogs and cats,
often carry about with them in their hair the virus of infectious
1 A person who is exposed to the danger of infection, should not allow his courage
to sink, should not leave off any of his accustomed comforts, rest, exercise, food, or
drink; but he should also carefully avoid all excess in any of these things, as also in
passions, venereal excitement, &c. The other prophylactic measures that should be
adopted will be found in the first part of the " Friend of Health." A slight increase
of stimulants, such as wine, tobacco and snuff, is said to be a powerful prophylactic
against infectious disorders.
2 I have seen putrid fevers occur periodically for many years in the country, merely
by old furniture, which had belonged to persons who had died of such affections,
coming into other families by purchase.




PREVENTION OF EPIDEMICS IN TOWNS.

259

diseases. For security's sake it is advisable to get rid of them at
such times, and not to allow strange dogs or cats to approach us.
The drying up of marshes and old ditches close to human dwellings has frequently been the occasion of the most murderous
pestilences.1
If the fosse surrounding the town is to be cleared out or dried
up, as is highly desirable for the health of the inhabitants of all
towns, this work should only be undertaken in the depth of winter.
The water should be carried off in the form of ice-layers, and the
ice that forms again in a few nights should next be taken away,
and so on till no more water remains.
But as the removal of the mud from town-ditches is much
preferable to letting it gradually dry up, seeing that throughout
the whole time required for the latter, noxious vapours are constantly exhaling, there is no better time for removing it than in
severe cold. The mud which is always in a state of putrefaction
is always warm, and never freezes so much as to prevent its being
easily dug out in winter. We can also more readily dispense with
draught-cattle on account of the excellent condition of the roads
in severe frosty weather.
After great inundations on flat land, the spontaneous drying up
of which cannot be expected to take place in a short time, it is
requisite that all should lend a hand to cut ditches through and
round about the inundated country; but if it is impossible to
drain off the water into the river on account of its low level, a
number of small wind-mills must be erected in order to pump off
the water as quickly as possible and dry the land; for if this be
not done the water readily takes on the putrefactive process, giving
rise from spring to autumn to dysenteries and putrid fevers.
The low-lying houses that have been inundated by the water are
1 I saw the fortieth part of the inhabitants of a large town die of typhus, in consequence of the incautious draining of the town fosse.
Whenever the slime of such a town fosse, which may have been accumulating for
many, perhaps hundreds of years, is deprived of the fresh water covering it, the half
putrified animal matters contained in it immediately pass into the last stage of
decomposition. This last stage of decomposition of animal substances is infinitely
more poisonous than all the previous ones, as we may see in the rapid fatality of the
exhalations from cess-pools which have not been cleared out for thirty years or more.
Of this more hereafter.
s2




260

THE FRIEND OF HEALTH.

a fertile source of epidemic diseases (see Klckhoff). The police
authorities must see that every householder digs a deep ditch
round his premises, and especially round his dwelling-house; that
he has all his windows and doors open for the greater part of the
day; that he occasionally lights fires even in summer; and that
in winter, at all events before he rises in the morning, all the
doors and windows are left open for an hour at a time.
There are places that are destitute of the (often unacknowledged)
benefit of a sufficient supply of fresh flowing water, in place of
which the inhabitants are obliged to make use of spring or rain-water
brought from a distance, or to put up with rain-water only. In all
such cases they collect their supply of water for a long time in large
reservoirs, in which it becomes stale in a few days and furnishes a
very unwholesome drink, the source of many diseases.     Soon, it
again becomes clear and inodorous; but in a short time the
putrefaction recommences, and so it goes on until the water is all
consumed, the greater part of it in a very bad state. I shall not
here attempt to determine whether these disadvantages might not
be obviated by the construction of artificial aqueducts on no very
expensive scale, or of (very deep) wells; but I am convinced that
in flat localities on firm soil it is possible to resort to one or other
of these plans, whatever may be alleged against it by the paltry
parsimony of many corporations, who look on unmoved whilst many
such communities gradually die out. In the absence of such a
radical cure, I would advise every householder to keep his supply
of water in casks, in which for every 400 pounds of water one
pound of powdered wood charcoal should be thrown, which,
according to the discovery of Lowitz, possesses the power of preserving water from putrefaction and of making stale water sweet.
The clear fluid may be drawn off when required through a tap
provided with a tight linen bag.
A similar precaution against the production of disease is
adopted in large ships that go to sea, which are often reduced to
great straits on account of a deficient supply of fresh water. But
many causes conspire in ships to produce destructive' diseases.
1 Major Nante observed during the war betwixt England and North America a
pestilential gaol-fever break out on board the fleet lying off the Havana, of such
severity that numbers of men who seemed to be in perfect health died after an illness
of not more than from three to four hours.




PREVENTION OF EPIDEMICS IN TOWNS.

261

Among these are the mode of feeding the crew so much in vogue,
with often half-decayed, dried and salted meat, with unwholesome
fatty substances of various kinds; the want of fresh air when
during continued storms they have to pass many days together
below deck with the port-holes closed, when the exhalations from
their bodies increase to a pestilential fetor; the exhaustion of the
sailors when kept at work too long, during which their wet clothes
check the perspiration. These causes engender and      keep  up
scurvy, dysentery, and other maladies.
The risk of such disorders may be avoided by the following
measures: supplying vegetable food, and in the absence of green
herbs, dried legumes that so easily ferment; sour-crout; sometimes brown sugar in place of oil; brandy for strengthening;
meat-soups boiled down and dried, in place of kept meat; maltliquor to drink in addition to water; the division of labour into
eight-hours' work; care that the crew have always dry clothes to
put on, and that their habits are cleanly; frequent pumping out of
the necessary; and the purification of the air between decks by
means of large braziers of burning charcoal according to Cook's
method. The frequent washing with sea-water of the various
utensils, the floor, the walls and the decks, must not be neglected.
If powdered charcoal be mingled with the sea-water used in
scrubbing, the stench of the walls will be effectually got rid of.
In addition to all this care should be taken not to take on board
sick persons, or such as have scarcely recovered from illness; and
all the utensils and furniture should be frequently exposed to the
air on deck when the weather is good.
By the employment of Sutton's method of conducting leaden
pipes into all parts of the ship which all terminate in the kitchen
fire-place, the deteriorated air will most certainly be drawn off by
the fire. But Cook's braziers do much more, for they heat the
walls, and thus destroy the contagious matter much more effectually. Hale's ventilators (a kind of wooden bellows) are little
used in ships. Would not the so-called garden-cress (lepidium
sativum) be a valuable vegetable, or at all events be useful on
board ship as a medicine, in order to diminish the noxious matters
in the first passages?  The facility with which its seed grows is
well known. We only need to strew it upon a piece of old wet
sail cloth, and cover it with unravelled pieces of old moistened tow.




262

THE FRIEND OF HEALTH.

In towns where no rapid stream of water can be conducted
through even the small streets wherein the animal excrements, the
washing-water, the urine and other impurities of men and animals
can be carried off without doing any harm, covered cess-pools
cannot be dispensed with.
These cesspools are always a bad thing for the health of man,
from their aptitude to engender, or at least to promote, pestilence.
In order to render them as innocuous as possible, they should be
built up with masonry, not only on the roof and walls, but they
should also be paved on the floor with stones cemented together,
in order that the putrefying impurities may not sink into the
ground, but be capable of being taken clean away. They must be
frequently cleansed out, and the odour removed quickly.
The time selected for cleansing them should be during the prevalence of a strong wind, more especially one from the north, northeast, east or south-east, and those days should be avoided when a
long period of warm rain, calm and foggy weather, with a low state
of the barometer prevails.
Though we are not able to adduce any instances in which the
exhalations from oldprivies have spread a pestilence of any duration,
yet no good police which attends to the health of the community
should permit them; and moreover, cases have occurred where
workmen suffocated in such places have spread such a virulent
exhalation from their clothes, that many of those approaching them
have been cut off by typhus fever.
In order to avoid the pestilential poison proceeding from animal
substances in the last stage of putrefaction, the most destructive of
all poisons, the removal of such murderous pits should be advised,
and no sensible person will object to this.
But when they are already in existence and require to be cleared
out, we must not go to work incautiously. The simplest method
of freeing such pits from their poisonous exhalations is always the
lowering into them of small loose bundles of ignited straw attached
to a wire, since there is rarely in them any inflammable gas that
might endanger the house by its ignition. These bundles are to
be let down to the depth at which they will almost be extinguished
by the vapour, and then they should be allowed to burn out. This
process is to be repeated with larger and larger ignited bundles
until the stratum of gas is removed to the very floor of the pit, and




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atmospheric air occupies the place of the fire-extinguishing gas.
But our precautionary measures should not cease here: for it is
not only want of atmospheric air that kills the workmen in such
situations, but still more the vapour that rises, though not to any
great height in consequence of its weight, from stirring up
the human excrement that has entered on the last stage of putrefaction. In order to render this as harmless as possible, a quantity
of dry faggots ignited should be thrown into the pit, sufficient to
cover all the bottom of it, and there they should be left till they are
totally consumed. The heat thus generated will, after the lapse of
an hour, have rendered the odour innocuous to at least a foot in
depth. This quantity should then be removed by the workmen;
faggots are then to be burnt as before on what is beneath, whereupon the next layer is removed, and so on until it is all cleared
away.
Should it really prove true that the most of our police authorities
have abolished burials in churches, we should not be thereby set
quite at our ease. The old graves still exist in our churches, in
which the last and most poisonous stage of decomposition of the
dead bodies has not yet ceased to emit its destructive emanations.1
Hence alterations and building operations in the floors of such
churches are fraught with manifest danger to the life of the workmen and the congregations in the churches, whence diseases may
spread over a considerable portion of the population.
In June 1773, a grave was opened in the church of Saulieu in
Burgundy, and church-service performed soon afterwards, in consequence of which, 40 children and 200 grown-up people, together
with the clergyman and sexton, were assailed by the exhalation
that arose, and carried off by a malignant disorder. Moreover it
has not yet been perfectly ascertained how many years the contagious principle may remain attached in undiminished virulence to
the buried corpses of those who have died of malignant diseases.
In many countries the lying in state of all bodies is very properly
forbidden. But in others where not so much enlightenment pre1 It should be borne in mind that the most fatal gas generated by the last stage of
putrefaction does not readily rise, but is heavy, and not unfrequently reposes in a low
stratum above the corrupting matter, until it is stirred up, and is thus rendered
dangerous to life.




264

THE FRIEND OF HEALTH.

vails, infectious diseases are often propagated by the exposure of
such poisonous bodies, of which I could adduce many examples
from Saxony.
In 1780 a girl brought a putrid fever with her to Quenstaidt
from Aschersleben. All her numerous brothers and sisters and
her parents took ill of it, one after the other, but they all gradually
recovered except one grown-up daughter, who died of bed-sores.
I took the greatest pains to prevent the disease being propagated
to others from this house. I succeeded in this for five months,
until this girl had to be buried. The young men of the village
bore the body in a coffin nailed up according to my directions, to
the grave. Here, from their attachment to the deceased, they disobeyed the strict orders given by my friend, the clergyman; they
forced open the lid of the coffin in order to see the corpse once
more before it was let down into the grave. Others, moved by
curiosity, approached. The third and fourth day thereafter all
those that had been guilty of this excess, lay mortally sick of this
fever, as also all those who had come near the grave (some of them
from neighbouring villages), to the number of eighteen, of whom
only a few escaped death. The epidemic of putrid fever spread
around at the same time.
Is it not desirable that those important personages in the state
called inspectors of the dead and corpse washers, whose business it
originally was to form a silent judgment respecting the kind of death
that had occurred and to verify the decease, should receive from
the juridical medical officer accurate instructions on this by no
means easy point, before undertaking such an important, such an
exceedingly important duty? How many lives of those apparently
dead might they not be instrumental in restoring, how many cases
of murder might they not detect, and, what interests us peculiarly
in this place, how often might they not discover that some who
have died without having been seen by any physician, might have
laboured under contagious diseases!
We should not be too rash with bodies brought to the dissecting rooms, not receive such as we may suspect to have died of
contagious diseases, nor keep the subjects until they are in the
last stage of putrefaction, nor, for the sake of bravado, have too
much to do with macerated parts in a state of extreme decomposition, and often melting away under our touch, which can no




PREVENTION OP EPIDEMICS IN TOWNS.

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longer teach us anything.    Examples are not wanting of the
students who were merely looking on being rendered dangerously
ill thereby.
But chiefly are the contagious pestilences in towns harboured,
renewed, promoted and rendered more contagious and more murderous, in the small low, old houses situated close to the townwalls, huddled together in narrow damp lanes, or otherwise deprived
of the access of fresh air, where poverty dwells, the mother of dirt,
hunger and despondency. In order to save firing and the expensive rent, several miserable families are often packed close together,
often all in one room, and they avoid opening a window or door
to admit fresh air, because the cold would enter along with it. He
alone whose business takes him into these abodes of misery can
know how the animal matters of the exhalations and of the
breath are there concentrated, stagnant and putrefying; how the
lungs of one are struggling to snatch from those of another the
small quantity of vital air in the place, in order to render it back
laden with the effete matters of the blood; how the dim, melancholy light from their small darkened windows is conjoined with
the relaxing humidity and the mouldy stench of old rags and
decayed straw; and how grief, envy, quarrelsomeness and other
passions strive to rob the inmates completely of their little bit of
health. In such places it is where infectious pestilences not only
smoulder on easily and almost constantly when a spark falls upon
them, but where they take their rise, burst forth and even become
fatal to the wealthy citizens.
It is the province of the authorities and the fathers of the
country to change these birth-places of pestilence into healthy,
happy human dwellings. Nothing is left for me but to turn my
face away from them and to keep my compassion to myself.
If however the inmates of them be not without employment,
their systems, accustomed to meagre fare and hard work, resist
infections tolerably well; but when they are out of work, when
dearness of the first necessaries of life and famine prevail among
them, then, from these dirty sources of misery and woe, diseases
of malignant character and pestilences perpetually issue. It is
only since the fearful years 1771, 1772 and 1773 that some rulers
have learned, from the dangers to which they themselves were
exposed, to provide for the safety of their many thousand subjects




266

THE FRIEND OF HEALTH.

by establishing corn-granaries and flour-magazines against seasons
of scarcity.
I must make the general observation belonging to this place,
that most of our towns are not adapted, not calculated, to promote
health. High town-walls and ramparts are now generally acknowledged to be useless for towns that are not fortified. That they
are injurious by preventing the access of fresh air will also be
readily conceded. But that the masses of houses of most towns
are too closely huddled together is not yet generally seen, and
when it is, it is attempted, but without success, to be excused,
by the greater facilities offered for business and trade by having
everything within a small circle.
In towns about to be built it should not be allowed to build
houses higher than two stories, every street should be at least twenty
paces in width and built quite straight, in order that the air may
permeate it unimpeded, and behind every house (the corner houses
perhaps excepted), there should be a court-yard and a garden as
broad and twice as long as the house. In this way the air may be
readily renovated, behind the houses in the considerable space
formed by the adjoining gardens, and in front in the broad
straight streets.   This arrangement would be so effectual for
suppressing infectious diseases and for preserving the general
health,1 that if it were adopted most of the precautionary measures
against pestilence I have inculcated above would be rendered to a
great degree superfluous. What advantages in this respect do not
Neuwied, Dessau, &c. possess!
The handsome, roomy, high and airy butchers' shops we meet
with in some towns (e. g. Dresden) are not so good as the open
butchers' stalls standing in market places and only covered by a
roof. A putrid stench is always concentrated in the shops built
for the sale of meat.
1 The deteriorated air in closely built towns with high houses is especially injurious to children, and gives rise to those deformities of the beautiful human figure
denominated rachitis, which consists of a softening of the bones, combined with
laxness of the muscles, inactivity of the lymphatic system and a high degree of
irritability. The non-medical observer does not readily notice the large number of
these pitiable little monstrosities in closely built towns, partly because a great many
of them sink into the grave in the first years of their life, partly because the cripples
who escape conceal themselves for shame from the public gaze.




PREVENTION OF EPIDEMICS IN TOWNS.

267

The shops for the sale of stock-fish and herrings should be
situated in the open air, at the outside of the city-gates; the disgusting stench that proceeds from them is sufficient evidence of
their unwholesomeness.
Were it possible to banish entirely from the interior of towns
all the manufactories and warehouses of the butchers, soap-boilers,
parchment-makers, catgut-spinners, glue-boilers, and all other
trades that are engaged with animal substances that become
readily decomposed, and to transfer them to special buildings
outside the town-gates, this would be a great advantage as regards
infectious diseases. I have seen many butchers' houses in narrow
lanes completely cleared of their inmates in epidemics, whilst the
houses in the neighbourhood suffered much less severely.
It is astonishing how the indolence of that class of men who
cherish their prejudices inspires them with such deep respect for
some things that appear horrible to them, so that there is with them
but little difference betwixt them and things that are holy. It can
only be attributable to this unaccountable prejudice that the
bodies of dead domestic animals, as also those persons who have to
do with them, have been considered as not to be meddled with
and as exempt from the regulations of a good police. Owing to this,
great confusion and injuries to the health of the community have
resulted. In this place I shall only complain of the custom of
leaving the bodies of dead domestic animals in the open air, on
greens and commons not far removed from the dwellings of man,
a custom so opposed to all ideas of the preservation of health.2 If,
as is assuredly the case, all putrefying animal substances make a
horrible impression on our senses, if, moreover, all contagious
diseases are hatched in corruption, how can we imagine that such
large masses of putrefying flesh of horses and horned cattle, particularly during periods of great mortality among cattle, can be a
1 It is curious that in almost all languages the same expressions are applied to the
most horrible as well as to the most revered things--schaudervoll, sacer, 'awful, are
instances in point.
2 Does this custom originate in the vanity of man, who thinks to vindicate his right
to the title of sole lord of creation by assuming to be alone worthy of the high honour
of being buried beneath the ground, and to shew his supreme contempt for animals
(even of such as are most useful and most valuable to us), gives them the vilest
names and leaves them unburied in the open air, in defiance of nature which seeks
to conceal all putrefying processes from the public gaze?




268

THE FRIEND OF HEALTH.

matter of indifference as far as human health is concerned. The
thing speaks for itself!
It is in large well-regulated towns only that I have met with
some (although seldom sufficient) attention directed to the sale of
spoilt food, especially animal food. In districts where fish abound,
many kinds, especially smaller ones, are brought to market with
all the signs of putrefaction upon them. They are chiefly purchased by poor people, because they are cheap-nobody gives
himself any concern about the matter, and the labourer when he
is taken ill throws the blame of his sickness on any cause but the
right one. Nobody concerns himself; the seller of this pernicious
food returns home after having pursued his avocation unimpeded.
The authorities who may perchance hear of it, say to themselves:
Where there is no complainant, there is no judge. Can such be
called Fathers of the town?
Other kinds of spoilt food can also produce infectious typhus
fever.
In large manufactories and workhouses where the workpeople
live in the house, those who fall ill should, whenever they commence
to complain, be immediately separated from the healthy workmen,
and kept apart until they have completely recovered their health.
And even where the workmen reside out of the house but come
to work together in large workrooms, it is the duty of the
master manufacturer, especially at the time of the prevalence of
epidemics, to send home immediately such of the workmen as
begin to complain of illness. Great care should be taken always,
but especially when disease is about, to have the workrooms and
warerooms well aired and clean.
Public schools are generally places for the diffusion of contagious
diseases, such as small-pox, measles, scarlet fever, malignant sore
throat, miliary fever, (hooping-cough?) and many skin diseases.
If schoolmasters in general were given to attend more to the physical and moral training of their pupils than to cramming their
memories, much mischief of this character might be prevented.
It should be impressed upon them not to admit any sick child to
the classes, whose altered appearance betrays the commencement
of a disease. Besides, a sick child can learn nothing.
In times of prevailing sickness the clergymen should publicly
warn the members of their congregations, not to come to church




ON THE SATISFACTION OF OUR ANIMAL REQUIREMENTS. 269
when they are feeling indisposed, and thereby expose their neighbours to danger.
I cannot here enter into details regarding the power of bad
arrangements in poor-houses, houses of correction, orphan asylums
and invalid hospitals, as also of ordinary hospitals and infirmaries,
in producing and promoting infectious diseases, and still less can I
describe the best plans for such institutions designed for the relief
of the most miserable classes of society. The subject is too important, and in many respects much too vast to be dismissed here
with a few words.
ON THE SATISFACTION         OF OUR ANIMAL REQUIREMENTS, IN ANOTHER THAN A MEDICAL
POINT OF VIEW.
MAN seems manifestly created for enjoyment. This is the language of the infant when it cries for its mother's breast; this is
the language of the shivering old man as he pokes the fire; this is
the language spoken by the child playing with its doll, of the girl
eager for the dance, of the youth disporting himself in the bath, of
the matron preparing for the domestic festival, of the delighted
look of the father returning home from his daily work, as old and
young run out to meet him.
All creation around him is happy and rejoices; why should
man, endowed as he is with finer sensibilities, not do so likewise?
Certainly he ought to do so. But in his choice of enjoyments
and in the quantity of them he indulges in, he alone transgresses
the bounds of moderation; he alone of all living beings. No
animal living in a state of freedom partakes of any food except
what is suitable for its nature and health; it consumes no more
than what it requires for its well-being; it drinks not after its
thirst is quenched; rests itself only when it is weary; and indulges
in sexual pleasures only when the period for the propagation of




270

THE FRIEND OF HEALTH.

its species has arrived, and when its matured irresistible instinct
attracts it to the delightful object of its desires.
The satisfaction of our animal requirements has no other object
than the preservation of our life, our health, our species; the
pleasure accompanying it is lively and great in proportion to the
strength and completeness of the requirement, but in the happiest
class of human beings (those who live in conformity with nature)
it instantly assumes a shade of indifference as soon as the requirement has received the appropriate degree of satisfaction.
When we pass the boundary line beyond this moderation, as is
so frequently the case among the higher and middle ranks of
society, luxury, gluttony and depraved sensuality commence.
Persons in easy circumstances are apt to imagine that the excessively multiplied indulgence in excitement of the senses of all
kinds is to live in the true sense of the word. "I have lived much,"
says the enervated voluptuary; to me it seems that he has lived
little.
To every human being only a certain amount of corporeal
enjoyments has been allotted, which his nervous system is capable
of partaking of and of indulging in only to that amount without
prejudice to the health. The temperate man easily discovers
these limits assigned to his organization by experience uninfluenced
by partiality, and in the observance of the laws he has discovered
he is happy, happier than the intemperate man can have any
idea of.
But if, seduced by bad example or by the flattering advantages
of fortune, I should exceed the measure of indulgence consistent
with my health, I shall find that this excess is at first repugnant to
my senses. There occur satiety, disgust-the warnings of nature in
her wisdom! But if I go on undeterred, making it my business to
force more indulgences upon my body than is consistent with its
well-being; if I employ ingenious methods, by means of stimulants
of various kinds, to coax the nerves fatigued by the excess, to the
reception of new and immoderate enjoyments, I shall doubtless at
length be enabled to indulge in debauchery, that is, to burden
my nerves with an unnatural number of impressions, which the
temperate man could not bear; but this is only a semblance of
greater enjoyment. There is no reality in it.
In proportion as we seek to increase, to multiply our animal




ON THE SATISFACTION OF OUR ANIMAL REQUIREMENTS.     271
enjoyments by unnatural means, our other senses become blunted,
and commence to derive less and less pleasure from a number of
enjoyments.
By spices, condiments, and fiery wines, the gourmand must
seek to keep the nerves of his tongue up to the mark to enable
them to allow still more food to pass down his throat, and at
length he comes to such a state that even his highly seasoned
dishes are relished no more, and he must stir up his respected
chef de cuisine to invent something new to tickle the languid
palate of his poor master, and so to over-stimulate the cardiac orifice
of his stomach that it shall forget its office to reject what is superfluous. If his honour have fully satisfied his appetite with the first two
dishes, the omnipotent genius of his cook must follow these up by
one or more dozen dishes, which by their elegant appearance,
their enticing odour, the dissimilarity of their taste, and their
stronger seasoning, shall deceive, ever anew, ever more powerfully,
the sister senses, and particularly the sense of taste.
But this is only a vain artifice, an imaginary greater enjoyment,
not a real enjoyment, accompanied by inward entire gratification.
It is all vain, vain pitiable imagination.
The thresher regales himself with his black rye-porridge, with his
potatoes and salt, much more than his worshipful lord and master,
though his meal may not perhaps have cost a thousandth part of
the latter's sumptuous repast. The former is gay and happy over
his frugal fare, and sleeps soundly until the cheerful morn wakes
him up refreshed and vigorous; whilst the latter in his satiety
finds the world too small for him, and his dull, dream-beset slumber
scantily fills up the long hours of night, until he rises unrefreshed
from his soft down bed, with confused head, foul tongue, and
spasmodic yawning.
Whose repast was worth most? which of the two had the
higher, the more genuine enjoyment, the greater sensuous pleasure?
The ploughman who only drinks his pot of beer in an ale-house
on a Sunday after church, has in the few hours he spends over it
perhaps twice as much enjoyment for his few half-pence as
my Lord Mayor who can boast perhaps of having swallowed
during the week a thousand times as much money in luscious
Constantia wine. The former quenched his thirst on working-days
at the spring behind his cottage, and was refreshed; whilst the




272

THE FRIEND OF HEALTH.

latter was made hot, sleepy and stupid, by the excessive quantity
of his costly liquor.
Which of the two best enjoys life? which has the higher
enjoyment?
In vain does the libertine imagine that the disgusting dissipation of his faculties that were created for higher objects can procure
him great pleasure and real enjoyments. Not to speak of the
enervation and the innumerable sufferings that must result from
his head-strong folly; not to speak of how incapable he is rendering himself for future paternal joys, or of the deep lamentable
furrows he is ploughing in his youthful brow; not to mention
these and a thousand other considerations (which I purposely
avoid touching upon); he is the unhappy slave of a habit which
from  the falsely dazzling, inebriating goblet confers on him  far
more pains than pleasures.     Poor fellow! he knows not the
ecstatic feeling of a rare, an ardent embrace of the faithful wife,
whose virtue and modesty inspire the deepest respect, and can
conjure love of the real sort into her enraptured husband.
But he who has a fancy for the dregs of beastly lust may
drink them to satiety in the shameless intercourse with mercenary
courtesans. Soon will all his fine feelings be blunted in such
laudable society; true love, that daughter of heaven, is to this
deluded being a ridiculous absurdity. Soon does his sexual
passion become deadened to such a degree, that, in order to excite
it, he must resort to a number of coarse stimulants and aphrodisiacal arts, revolting to every chaste imagination. Exhaustion of
body and mind, self-contempt, disgust for life, and a wretched and
premature death, such are the natural results of this destructive
intemperance.
The wealthy classes in other respects seek to distinguish themselves by the refinement of their manners, of their appearance,
and of all the things wherewith they are surrounded; why do
they in the gratification of their animal requirements sink so far
beneath the poorest classes of the people, and I might say still
lower?   Apparently for this simple reason, that they are bent on
having much enjoyment here below, and this they might have, if
they knew the proper, the true, the sole means of attaining it;
that genuine mother of ecstatic, inexhaustible enjoyment, that rich
awarder of pleasure-moderation!




A NURSERY.

273

A NURSERY.
I lately paid a visit to one of my relations.  Our conversation soon turned upon my favourite subject, children. My fair
cousin (her husband very properly left her to speak) talked like a
book about physical education, and made me very desirous to see
her young family.
She led me to the corridor at the back of the house that abutted
on the court-yard, and opened the door of a dark, low receptacle
full of disgusting smells, which she informed me was her nursery.
A steaming tub in which dirty linen was soaking stood in the
front of the room, surrounded by some low washerwomen, whose
unmannerly chattering polluted the ear, as the vapour from the
dirty hot water did the lungs. The steam condensed into drops
ran down the window panes.
I expressed to my fair cousin my incredulity as to the utility of
this arrangement, and hinted how much the emanations from the
clothes that were being washed must deteriorate the air the little
ones had to breathe, how the excessive humidity thereby engendered relaxed all the fibres of our bodies, and must consequently
be doubly injurious to children of a tender age.
"Do you really mean to say," cried she, '" that washing causes
any pollution? I'm sure I see no dirt made by it, and a little
moisture can't do much harm."
"I allude to the invisible, but very injurious, deterioration of the
air, the bad effects of which on such delicate creatures as children
are, you must have heard of."
" Oh," she replied, " I fumigate occasionally with juniper berries,
and they soon remove all impurities."
I now perceived that a learned demonstration of the difference
betwixt the properties of azotic gas and pure oxygen, although they
differ but slightly in odour, and not at all in appearance, would
have been quite incomprehensible to my dear cousin, nor could I
hope to make her understand how a prolonged sojourn in impure
air acted as a slow poison on animal life, especially at a tender age,
and how impossible it was that children could enjoy even tolerable
health in such an atmosphere, and so forth. Neither did I venture to




274

TITE FRIEND OF ITEALTH.

speak of the quantity of humidity that was imperceptibly taken up
by the warm air of the room from the scalding water, and equally
imperceptibly absorbed by the open mouths of the absorbent vessels
in the child's soft body, whereby the natural exhalations were obstructed. Nor did I attempt to prove to her by the syllogism in
Barbara, though I had it on my scholastic tongue, that fumigation
with juniper berries and such-like things would rather tend to
phlogisticate and deteriorate the air, but could never transform the
impure air into vital gas.-However, as I have said, I luckily suppressed my spirit of logical refutation that was about to burst
forth, and endeavoured to bring forward some argumentum ad
hominem.
" It is possible," I said, "that I may be mistaken, and that you,
my esteemed cousin, contrary to all expectation, are in the right in
supposing that the frequent repetition of a washing festival in a
nursery, together with the exhalations that arise from the blankets
hung to dry near the stove there, may be without any unfavourable
influence on the health of children, and I shall give up my point at
once when you produce me your dear little children, who doubtless
are very lively and stout."
"Produce them," she replied, "I cannot, but you may see them
yourself back there. I don't know what ails my poor Freddy
yonder; he is nine years old, but cannot walk well without his
crutches."
At these words a little miserable looking figure crawled towards
us with difficulty. His knees were bent inwards, and his legs
completely destitute of muscle. His head drawn backwards, stuck
betwixt his shoulders; his face was pale and withered; his eyes
dull, but projecting beyond the prominent forehead. His large ears
stuck out; his nostrils were expanded; his broad tongue always
hung partially out of his half-open mouth. His emaciated arms
could scarcely support him on his crutches.
He soon returned panting to his little arm-chair, to rest himself
after this slight exertion.
I involuntarily shrugged my shoulders, and heaved a deep sigh.
A mixed feeling of gratitude to God and profound pity took
possession of me, as I called my own rosy cheeked Fritz to my
side and bade him shake hands with this innocent victim of a false
and injurious method of bringing up children. My little urchin




A NURSERY.

275

kissed this poor object affectionately, and asked him what was it he
drank out of the large jug beside him. " My afternoon coffee "was his reply, and at the same time he poured out a cup for my
boy, who, however, refused it, as he was not in the habit of drinking things he was not acquainted with.
"You do not seem to approve of that," said my cousin, " but
what else can the child drink, it is the only thing that seems to do
him good; he cannot enjoy any thing else."
" Do him good?" I hastily asked, in a paroxysm of half-suppressed but extreme anger-and I turned away from the odious
sight.
Oh! what an inclination I felt to give this unhappy mother a
severe lecture, and to shew her that a drink which sets our blood
in agitation, whilst it exalts the irritability of our muscular fibre to
such a degree as in course of time to render it quite lax, and to
weaken it so that it trembles-which gradually exhausts our vital
heat-which, possessing no nutritive properties in itself, unnaturally
stifles hunger and thirst, and which communicates a false overstrained liveliness to its votaries, who are often reduced to the last
stage of weakness, that like a transient intoxication leaves behind
it an opposite state of the nervous system,-how injurious such a
drink must be for the delicate child, endowed as it is with great
irritability, and how impossible it is that such a badly treated
creature can become any thing but rachitic and cachectic in the
last degree-a shrivelled diminutive of a human being, for whom
death were the most desirable lot.
With all these evident truths I should have wished to fan the
smouldering spark of a mother's love in her breast, but I refrained
from so doing because it occurred to me that coffee was the favourite
beverage of mamma herself, so suppressing my feelings, I mildly
gave her to understand that in my opinion coffee should only be
an occasional beverage of persons above forty years of age, or employed in certain cases as a medicine.
"I suppose, my censorious cousin," was her reply, "you would
be for depriving the little creature yonder at the table of her
favourite food? "
It was some kind of confectionery which the girl three years
old, who could not stand on her legs and could not be taught to
walk, was swallowing with a degree of greediness that excited my
T2




276

THE FRIEND OF HEALTH.

disgust and horror. This pale, bloated creature had a rattling at
the chest, slavered at the mouth, had a dull look, a projecting
abdomen, and, as I learned, little sleep, and a perpetual diarrhoea,
whereby, my cousin assured me, all impurities of the body were
discharged.
I begged her to try whether she herself would remain in good
health if she were constantly eating sweet things, and if she would
not get sour eructations, worms, deficient or excessive appetite
and diarrhoea, and if so, how much more the delicate stomach of a
child who was incapable of taking exercise, and in whom there
was a natural tendency to acidity.
This seemed to make some impression on her, especially when I
begged her to try the strength of my home-made vinegar, which
was made of sugar and yeast alone.
"I wish you would advise me what to do for the miserable
skeleton yonder in the cradle at the side of the stove; it has constant cold sweats, it does not sleep, and is always crying as if it
were on the rack. It has fits occasionally. I wish God would
mercifully take it to himself, its sufferings are so heart-rending to
witness. I have already buried three boys, peace be with them!
they all died of teething. The little fellow has been about his
teeth these three months; he is always putting his little hands
to his mouth. I only trust he has not got into this state from
the evil eye of some bad people, as my mother-in-law confidently
asserts must be the case; it was she tied the scarlet rags round its
little hands. They are said to be good for bewitchment. She also
often fumigates with nine kinds of wood."
" What harm," I replied, "could the poor innocent child have
done to the bad people? where are these bad people that possess
the power to make ill by a few words a healthy child fed moderately on wholesome food and strengthened by exercise in the
open air and cleanliness? I am perfectly convinced," I continued
with some bitterness, caused by the sight of so much misery, " I
am convinced that if you left off letting the poor child suck such a
quantity of chewed bread from that bag, whereby its stomach is
made sour and overloaded, if you would clean and dry it often
enough so that all the stench I observe about its cradle were
removed, if you would not cover it up so warm, would wash it all




A NURSERY.

277

over every day with cold water and take it away from the unnatural heat of the stove, if you would send it or, better, take it
yourself frequently into the open air, would never give it unwholesome food, nor overload its stomach with the most wholesomethe little creature might still be able to enjoy life, it would not
have to whine so much at all the misery you heap upon it and
which you attribute to teething and witchcraft; it would become
healthy and lively, in a word it would be to you a source of joy, and
not, as now, one of sorrow. Believe me, teething-diseases are almost impossible, almost unheard of among quite healthy children;
this name is a mere invention of ignorant persons, and is applied
by them to children's diseases which they know nothing about,
and the blame of which they lay upon nature, whereas they are in
reality the fault of the mothers, the nurses and the doctors!
None of my six children have manifested any serious illness when
cutting their teeth; when I looked into their mouths I usually
found their teeth as I expected, planted along their gums in an
even row. Why do we hear those everlasting complaints about
the pretended teething diseases of children, for which we have
ourselves to blame?"
I went on in my overflowing zeal to give her to understand, in
the most decided manner, what a poisonous atmosphere the air of
this low, dark, hot room was, filled as it was with exhalations of all
kinds, and so often with the emanations from the dirty clothes
washed in it-how well children were worth the trouble of giving
them a roomy, high, bright, frequently aired and extremely clean
room to stay in during those hours of the day which they do not
spend in the open air, which is quite indispensable for little
children.
" Come, Fritz," I added, "let us quit this wretched children's
hospital and clear our lungs in the autumnal breeze outside from
this bad air. God will provide for these helpless children in the
cold earth, including the poor cripple whose sad state causes your
tears to flow. Come away!"
My cousin was much affected, wished to have more advice from
me, wished to thank me, and so forth. But I hastily took my
leave, exclaiming that she had got quite enough to do for the
present if she made those changes which my compassionate zeal




278

THE FRIEND OF HEALTH.

had induced me to suggest, and away I went with my stout and
healthy little Fritz.1
ON THE CHOICE OF A FAMILY PHYSICIAN.
Dear Doctor,
Since I left your neighbourhood I have felt a want, to
supply which I am sure you are able, and I now write to request
you to do so. When anything happens to me I know not what
1 [Respecting the fate of this same Fritz or Frederick Hahnemann, the only son
of the founder of Homoeopathy, nothing is known for certain. To those conversant
with Hahnemann's Materia Medica his name is very familiar, as it constantly
appears among the early proved medicines, and indeed he seems to have been one of
the most devoted and daring among those who were the pioneers of our pathogenetic
knowledge. In 1811 he wrote an admirable reply to Hecker's attack upon the
Organon, which may still be read with interest and profit.* After taking his degree
in Leipzic, he contracted a matrimonial alliance with a widow, who I believe still
lives in Dresden with a daughter, but who, according to what I have heard, was not
well qualified to make his married life happy. This marriage gave great offence to his
father, and led to an estrangement between them which was never removed. Frederick
left the paternal roof and set up in practice in Wolkenstein, a small town in the
Saxon Erzgebirge where his success obtained him great celebrity, so much so that it
is said his house was beset with crowds of patients. The jealousy of his professional
brethren was aroused, and by some intrigue a letter was obtained from the Medical
College of Saxony forbidding him to practise. Young Hahnemann on this was
obliged to remove, but before doing so he wrote a most contemptuous letter to the
College, which gave great offence, as it was intended it should. What became of
him for a long time after that is not known. I find it stated in the Augsburg Allg.
Ztg.f. Hom. that he went to Edinburgh and staid there several years, but I am
unable to ascertain the truth of this statement. In the same journal it is mentioned
that some years previous to 1830 a traveller calling himself Frederick Hahnemann
had visited the interior of Pennsylvania and cured many people by means of small
powders. Since that time no authentic traces of him have been met with, and I was
last year assured by his sister, who cherished his memory with a sister's love, that
she knew not whether he was dead or alive, never having heard any tidings of him
since he quitted his native country.]
* This work is entitled Friedrich Hahnemann's des Sohnes Widerlegung der Anfwelle Hecker's auf
das Organon der rationellen Heilkunde." Dresden, 1811.




ON THE CHOICE OF A FAMILY PHYSICIAN.

279

doctor to apply to; and yet you have repeatedly and urgently
recommended me to pay more than ordinary attention to my
health. We have here many doctors whom you know, and also
some with whom I presume you are not acquainted. Some of
them have pressed their services upon me, have got themselves
recommended to me in various ways, and some have even recommended themselves. Now I know very well what recommendations
are, especially to a person of my rank. It is the most forward,
the most insolent, I might say the most impudent, that gets the
best recommendation, though he may be the most ignorant and
most immoral of the lot. Either monstrous vanity (and you know
full well that this is always allied to ignorance) trumpets forth that
its important possessor is the mighty hero he thinks himself to be,
who can boldly offer himself for the most important posts without
fear of a repulse; or a mixture of self-satisfaction and avarice
makes him fertile in all kinds of devices in order to enlist in his
interest those whose recommendation may be serviceable, whilst
the latter are weak enough to bring all their influence to bear in
his favour.
Such is the character of most recommendations, and he who
trusts to them will have to put up with sorry trash; I have no
faith in them, and must be perfectly satisfied in my own mind
before I can make my choice.
But tell me, dear Doctor, how can I become satisfied in my case?
On what principles must I choose a physician in order to avoid the
bait of the ordinary run of recommendations, in which we are
not always sharp enough to perceive the point of the hook? Pray
give me your advice.
Yours, &c.
Prince of *  *  *
My dear Prince,
You are right in supposing that I am not well acquainted
with the medical men of your capital; I know none of them sufficiently well, and I perceive with pleasure that you have a decided
objection to receive the recommendations of those who are unknown to you.
Without being oneself a very great physician, it is impossible to
form an immediate judgment respecting the scientific attainments




280

THE FRIEND OF HEALTH.

of another physician; therefore you as a non-medical person must,
in order to be able to select a really good man of this profession,
have recourse to some circuitous methods, which shall guide you to
your object with not less certainty than the knowledge attained by
school learning can bestow. Certain trivial things in their outward appearance, a certain mode of conducting themselves when
professionally engaged, and some other accessaries characterize
the different classes of medical men.
Look how A. walks into the assemblage that reverentially
expects him, with carefully measured steps, with expanded chest
and elevated head; how he announces the dignity of his great person
by a gracious, slow inclination of his body, and how he decides the
most important questions with a few short words and a disdainful
air. He only honours the great people in the company with his
notice, he flatters them in high sounding phrases, in order to be
entertained by them in return, and he talks about the highest
personages in the land and the greatest savants, as he would about
the most ordinary trifles which may be estimated with the fifth
part of a glance. Merit rewarded or neglected, heart-breaking
domestic occurrences, danger and delivery, life and death, are all
the same to him; nothing produces any change in his frigid
manner, or at the most they elicit from him a witty remark, which
the crowd of his admirers do not omit to acknowledge with their
plaudits. He talks the modern languages with the most refined
accent; his house is the model of fashion and the furniture in the
best taste.
You surely would never be so foolish, Prince, as to seek to make
a display by selecting such a Khan among Doctors.    Such an
eccentric part must engage the whole mind of the best actor; it
has to be learned, rehearsed, played. Who can be surprised that
the details of a case of disease are tiresome to him, and that he
defers till to-morrow doing anything for the urgent symptoms of
some poor man, the sole support of a wretched family, because
he must go and leave his card on some lord who is passing through
the town. His medical wisdom must, in the face of all these
fashionable accessaries, be but a thin coating which he has enough
to do to keep well polished, so that all uninvited enquiring glances
may be arrested by its mirror-like gloss, and be repelled without
having penetrated its shallow depth.




6N THE CHOICE OF A FAMILY PHYSICIAN.

281

Should I advise you to select B. I felt half inclined to do so!
See: by half-past four in the morning he is in his carriage, for
this morning he has thirty visits to pay to patients. His horses
foam with the rapidity of the pace, and have to be changed for
fresh ones in a few hours. Whilst he drives along he is seen to
bend in deep meditation over a long clearly written list, wherein
the names and abodes of the patients who are sighing for him, and
the minute at which he believes he will be at each of them, are
carefully marked. He looks at his watch which indicates the
seconds, he calls to the coachman who instantly draws up. Out
he jumps, says a few words to his servant and runs up the stairs.
Doors fly open at his approach, three steps bring him to his
patient's side. He feels his pulse, asks him a couple of questions,
and without waiting a reply he calls for pen, ink and paper:
and after deep reflection for two seconds in his chair he suddenly
dashes off the complex prescription, politely hands it to the patient
for his uninterrupted use with a few solemn words, rubs his hands
together, makes his bow and disappears, in order to be with
another patient six seconds afterwards, on whom also he bestows
his two minutes of advice; for his presence is in such great
request that he is perfectly unable to devote a longer period to
each patient. He wipes the perspiration from his brow, complains
of having too much to do, makes his servant call him half a dozen
times out from a party where he stays altogether only half an
hour; beckons to him every surgeon he meets, in order to whisper
a few important words in his ear, pointing at the same time to
some houses or streets. At his consultation hour his ante-room
teems with the friends of patients, sick-nurses, midwifes, surgeons,
and patients.  There he dispenses in profusion, prescriptions,
recommendations, advice-like tickets for the theatre.
Do you still hesitate, prince, to select this the most renowned
practitioner in the town, whose residence every child knows, who
according to the unanimous opinion of the whole public owes his
great and wide-spread reputation to his indefatigable industry,
his enormous experience and knowledge of disease, which must of
necessity procure him such an extensive practice?  Methinks I
hear you insinuate that with such a superabundant practice the man
cannot attend to any of his patients properly, cannot in a few
minutes maturely reflect upon all the circumstances of each case,




282

THE FRIEND OF HE5ALTH.

and still less find the proper remedies for it, seeing that the greatest
and best physicians sometimes require half and whole hours for
the consideration of similar cases. You will doubtless consider him
to be some delusive, fleeting phantom, whose charlatanism consists
in having too much to do, and whose only recommendations are a
light hand, agile legs, and fleet horses. Well, I presume you will
be inclined to look out for some one else.
Possibly your approbation may be bestowed on the next most
celebrated practitioner, Dr. C., late surgeon in the army. He
unites in his person to perfection all the arts that can enhance his
superiority as a physician. His very appearance gives an aristocratic dignity to our science. His dress is in the last style of
fashion. The cloth of his coat-which by the way is not yet paid
for-could not have cost less than thirty shillings the yard, and
the pattern of his gold-embroidered waistcoat excites the admiration of every lady. Those ambrosial curls on his hair, which are
dressed thrice a day, are the work of the greatest artist in town.
Look how elegantly he sticks out the little finger of his left hand,
and how neatly he advances his foot-calumny asserts that he
does so in order to show off his diamond rings and sparkling
buckles. See with what grace he kisses the lily hands of dames
and damsels, how charmingly he seats himself beside them on the
sofa in order to feel their pulse in his inimitable manner, with
what sweet words he commences the conversation, how fascinatingly
he carries it on, and how artfully his philanthropic spirit revives
it when it commences to flag, with scandalous half-invented
anecdotes about other families, who had unfortunately made
him   their confidant.   In  order to charm     the  ears of his
curious auditors he never forgets to tell them about all the false
teeth, stuffed backs, and pertes blanches, of all their friends and
neighbours; but all this he does in mysterious whispers and under
the solemn promise of inviolable secresy, which he had not
omitted to swear to observe in all the other houses. If he is ever
at a loss for something else to talk about, he delights to pass his
colleagues in malicious review. This one has no knowledge of the
world, that one is deficient in anatomical knowledge, the other
has a repulsive appearance; a third wants genius, a fourth has got
a bad pronunciation, a fifth has no skill in dancing, a sixth has
little practical talent; and so he goes on to a seventh and a tenth,




ON THE CHOICE OF A FAMILY PHYSICIAN.

283

ascribing to them all, heaven knows what faults. Every unsuccessful case of his colleagues is retailed from house to house, and he
takes care at the same time, by delicate insinuations, to extol the
wonderful powers of his own far superior genius. To the wife
who complains of her husband he gives ingenious reasons to
confirm her suspicions; and on the other hand, he expresses to
the husband by a few dexterous shrugs of his shoulders the honest
sympathy he feels for him on account of the unhappiness the
conduct of his wife must occasion him. Those who employ him
must prefer him to all his colleagues, for he launches out into
praise of everything about them. Thus any ordinary looking
children are darling angels, the new furniture of the room is in
the best possible taste, the pattern of the knitted purse has not its
equal for ingenuity of invention, the cut of the new gown forms
an epoch in fashion, the favourite daughter's wretched strumming
on the piano is the music of the spheres, her stupid remarks are
sparks of the most brilliant genius. He has the complaisance to
allow his patients to drink their favourite mineral waters, and to
take their favourite medicines as often as they choose, and deferentially conforms to their fancies with regard to having their medicine
in the form of powders, pills, draughts, or electuaries. He can
also give it them as liqueur, lozenges, or confections. He whispers
many a sly word in the chamber-maid's ear; and no one gives
more in christmas-boxes to the servants who bring him his annual
presents. He is perfectly conscious of his own talents; before
ladies he parades his profound knowledge of the Greek and Hebrew
languages, and his nocturnal studies of the Latin author Hippocrates; to the police magistrate he exhibits his botanical lore;
to the clergyman his anatomical acquirements; and to the mayor
his skill in writing prescriptions.
"In a calumnious mind no love for mankind can dwell," methinks I hear you say, " and he whose head is occupied in trying
to ingratiate himself by the elegancies of the toilette, by indirect
self-praise, and all sorts of dishonourable practices, cannot possess
any real merit."
The fear of wearying you, my prince, prevents me pursuing
further the disagreeable occupation of displaying more of these
caricatures composed of fragments, and which are by all means to
be shunned. Thank God! their number is daily diminishing,




284

THE FRIEND OF HEALTH.

and it cannot be a matter of much difficulty for you to find a
good physician if you will only be guided by your own feelings.
Search for some plain man of sound common sense, who takes
great pains to ascertain the truth of all he hears and says, and
does not merely look to its passing muster, who knows how to give
clear and condensed information respecting everything that belongs
to his art, and never obtrudes his opinion unasked or at an
improper time, and who is no stranger to everything else important for man as a citizen of the world to know. More especially
let the man you choose be one who does not shew temper nor get
angry, except when he beholds injustice, who never turns away
unmoved from any except flatterers, who has but few friends but
these men of sterling principle, who listens attentively to the complaints of those who seek his aid, and does not pronounce an
opinion without mature reflection, who prescribes but few, generally
single, medicines in their natural state, who keeps out of the way
until he is sought for, who is not silent respecting the merits of
his colleagues, but does not praise himself; a friend to order,
quiet and beneficence.
And when, my prince, you have found such a person, as is not
so very difficult now-a-days, no one will rejoice more than
Yours, &c.,
S. H.
P.S. One word more! Before you finally fix on him, see how
he behaves to the poor, and if he occupies himself at home unseen
with some useful work!




CONTENTS OF THE FRIEND OF HEALTH.
PART I.
PAGE
Introduction...........................................  191
The bite of mad dogs......................................   195
The visiter of the sick......................................  200
Protection against infection in epidemic diseases..................  203
In old women's philosophy there is something good, did we know
where to find it..................................2.....  211
Things that spoil the air....................................  213
There is good even in hurtful things............................ 218
Dietetic conversation with my brother, principally respecting the
instinct of the stomach..................................  220
An occasional purgative, surely that can do no harm?..............  228
On making the body hardy................................. 230
PART II.
Socrates and Physon. On the worth of outward show.............. 240
Plans for eradicating a malignant fever, in a letter to the Minister of
Police......................................................243
More particular directions on the same subject.................... 247
Suggestions for the prevention of epidemics in general, especially in
towns.................................................    253
On the satisfaction of our animal requirements in another than a
medical point of view..................................   269
A nursery................................................... 273
On the choice of a family physician.............................. 278







DESCRIPTION OF KLOCKENBRING
DURING HIS INSANITY.1
After having been for several years much occupied with the
treatment of diseases of the most tedious and desperate character
in general, and with all sorts of venereal maladies, cachexise,
hypochondriasis and insanity in particular, with the assistance of
the excellent reigning duke, I established three years ago a convalescent asylum for patients affected with such disorders, in
Georgenthal, near Gotha.    Hither the privy secretary of the
chancery, Klockenbring, of Hanover, who lately died from the
effects of a surgical operation in the 53rd year of his age, was
brought and placed under my care. He was a man who in his
days of health attracted the admiration of a large portion of Germany by his practical talents for business and his profound sagacity,
as also by his knowledge of ancient and modern lore, and his acquirements in various branches of science.
His almost superhuman labours in the department of state police,
for which he had a great talent, his constant sedentary life, the
continued strain upon his mind, together with a too nutritious diet,
had, five years before the mental alienation occurred, brought on
a deranged state of the system, which gradually assumed the form
of offensive whimsicality and intolerable ill-humour; I am unable
to say how much his copious indulgence in strong wines contributed
to bring on this state.
His hypochondriasis had already attained a considerable height
when that most disgusting satire of a petulant and degenerate wit,
SFrom the Deutsche Mowntsschrift. February 1796.




288

DESCRIPTION OF KLOCKENBRING

Barth mit der eisernen Stirne, appeared, wherein he found himself
held up to ridicule in a manner that would have set even the coldest
philosopher on fire. His mind, that was almost too sensitive to
honour and fair fame, sank deep into the dust beneath this
hail-storm of abusive accusations, which were, for the most part,
without foundation, and left it to his disordered nervous system to
complete the sad catastrophe.
In the winter of 1791-2, the most fearful furious madness burst
forth, that for half a year completely baffled all the most assiduous
treatment of one of the greatest physicians of our age, Dr. Wichmann, physician to the Hanoverian court.
He was brought to me towards the end of June, in a very
melancholy state, accompanied by the strong keepers.
His bloated body, which in his days of health was somewhat
unwieldy, now exhibited a wondrous agility, quickness and flexibility in all its movements.  His face was covered with large
reddish-blue elevated spots, was dirty, and bore an expression of
the greatest mental aberration. Smiles and grinding of the teeth,
inconsiderateness and insolence, cowardice and defiance, childish
folly and unlimited pride, desires without want-such was the
admixture of traits displayed by the patient.
For the first fortnight I only observed him without treating him
medicinally.
Incessantly, day and night, he kept on raving, and was never
composed for a quarter of an hour at a time. When he sank
down exhausted on his bed, he rose to his feet again in a few
minutes. He either pronounced with the most threatening gestures capital sentences on criminals, which he often declared his
former superiors to be; or he lost himself in declamations of a
heroic character, and spouted, as Agamemnon and Hector, entire
passages from the Iliad; then he would whistle a popular song,
roll about on the grass, and sometimes vary his amusements by
singing a stanza from Pergolese's Stabat mater. Anon it would
occur to him to relate to his honest keeper, Jacob, the bargain
made by ancient Jacob with Esau, about the birth-right, in the
exact words of the Hebrew text; but he finished nothing that he
began, for some new idea constantly led him into a different region;
thus he would sing an ode of Anacreon, or of the Anthologia, to
what he imagined to be an ancient Greek melody, or he would




DURING HIS INSANITY.

289

burst forth in an agony of weeping and sobbing, often throwing
himself at the feet of the amazed attendant. But all at once he
would often suddenly arise and with the most extraordinary hideous
roars, hurl imprecations at his enemies, mingled with passages from
Milton's Paradise Lost and Dante's Inferno; or he would mutter a
form of exorcism for evil spirits in the Vandal tongue, point with
any stick he could lay his hands on to the four quarters of heaven,
write magical characters on the sand at his feet, make the sign of
the cross, &c., and then he would burst out into immoderate fits of
laughter, or recite an amorous rhapsody from some play, and, in
the fire of his deluded imagination, he would warmly embrace one
of his cold keepers, taking him for his beloved Daphne.
The most wonderful thing was the correctness with which he
delivered all the passages from writings in all languages that
occurred to his memory, especially all that he had learnt in his
youth. The farrago he uttered was certainly a proof of his great
acquirements in languages, but was at the same time a kind of
ostentatious display of learning, which shone through all his extraordinary actions.
But nothing equalled the confidential friendship in which he
pretended he had lived with emperors and queens, the love affairs
he had had with princesses, his relationship to the highest personages in the world, &c., of which he often talked under the seal
of the strictest confidence to his keepers, with laughably important
gestures and half-whispered words.
In his worst period he called every one thou, and would not allow
any one to address him otherwise.
When he was awake and alone he always kept talking to
himself.
If his conversation was disordered, his other behaviour was not
less so.
In spite of all remonstrances he tore and hacked to pieces his
attire and his bed, generally when unobserved, with his fingers, or
with fragments of glass and the like.
Every instant he had some urgent desire, he wanted to eat or to
drink, or he wished for some article of dress, or some piece of furniture, or a musical instrument, or some one of his private friends,
or tobacco, or something else, although at first all food was rejected,
laid aside, thown out or dirtied, and in spite of his rapid pulse and




290

DESCRIPTION OF KLOCKENBRING

white tongue, all drink was put aside,' spilt, mixed with all sorts of
impurities, and at length poured out. He never waited till he got
one thing before ordering another.
By taking his piano to pieces and setting it together again in an
absurd manner, he endeavoured in the midst of the most tremendous noise and the most absurd tricks, to discover the ancient
complementary tone of harmony, the repoaXcqPavoerov, he drew up
algebraic formulas for it, explained them and his important projects
to his keepers, and day and night he was always exceedingly busy.
At first he ran about and bellowed, mostly at night.
He exhibited a great inclination to dress himself up, so as to
give himself an amazingly majestic or half heroic, half MerryAndrew-like appearance. He painted his face with variously
coloured dirt, fat and such-like things, curled his hair, drew up his
shirt collar and pulled down the ruffles of his shirt, scarcely ever
went without a wreath of hay, straw, flowers, or something similar
on his brow, never without a kind of girdle over his hips, a
pathognomonic sign that he felt some disorder in the organs seated
there2 that required attention; but what kind of attention? his
instinctive somnambulic sensibility did not teach him so much.
But he once put my metaphysical learning fairly at fault, when
one evening, in the midst of the most extravagant paroxysm
of folly, he hastily called for pen, ink and paper, and though
on other occasions he would not listen to anything about corporeal diseases, he now wrote a prescription3 which he wished
to be made up immediately. The extraordinary ingredients of
this were so extremely well arranged and so admirably adapted
to the cure of an insanity of this sort, that for the moment I was
almost tempted to consider him a very well instructed physician,
had not the ridiculous direction he gave as to how it should be.
used-namely, with a few bottles of burgundy as a vehicle, to be
followed up by lard-given another turn to my thoughts.         But
1 At the worst period his nervous system was so powerfully influenced by the
irritation of his disordered imagination, that 25 grains of tartar emetic only caused
him usually to vomit moderately three times, sometimes even less frequently.
2 He never forgot this appendage, even when he ran or rolled about naked, which
sometimes could not be prevented.
a The commencement was: R. Sem. Dature, gr. ij, &c.




DURING HIS INSANITY.

291

how was it that in the midst of the very hurricane of its most
extravagant passion, his mastless and helmless mind lighted on a
remedy so excellent for insanity and unknown to many physicians? How came he to prescribe it for himself in the most
appropriate form and dose?
Scarcely less remarkable was the circumstance that in the very
worst period of his insanity he would, when asked, tell not only
the exact day of the month (that one could understand, though he
had not an almanack), but even the true hour by day and by
night, with astonishing accuracy.
As he began to improve, this faculty of divination became always
more and more vague and uncertain, until at last, when his reason
was completely restored, he knew neither more nor less about the
matter than other people.
When he had completely recovered I begged him, in a friendly
manner, to explain this enigma to me, or at least to describe the
sensation that used to teach him this knowledge.
"I shudder, and a cold chill comes all over me," he replied,
"when I think about it; I must beg of you not to remind me of
this subject." And yet at that time he was able to talk with
perfect sang-froid about his whole previous madness.
The first and worst period of his insanity he described as a
death-like state, and indicated the day on which he felt as if he
awoke.
From time to time, especially when he commenced to improve,
he used to give me things that he had written, among which I
often found some subjects which must have cost him much profound meditation. The chief part of these consisted of sonnets
and elegies in various languages upon his present state, or addressed to his friends, odes to God, to his king, to me, to my family,
&c. The language of these was usually correct, and they were
interspersed with quotations from the ancient poets and philosophers, or the Bible, of which book chapter and verse were given
with great accuracy, although, as I before remarked, he had not a
single book at his command.
Whilst he was still very ill he wrote his autobiography in
classical Latin, composing a portion each day, and although he
i He had no access to books or writings of any sort.
v2




292

DESCRIPTION OF KLOCKENBRING

kept no copy he always resumed the thread of his tale exactly
where he had left off.
But all these prose essays, odes, romances, ballads, elegies, &c.,
though in themselves often irreproachable, always betrayed their
origin by something ludicrous about them. They were either
written on pieces of paper torn into a triangular form, or if on
square pieces they were written so that the lines ran obliquely
across the sheet, the writing commencing in one of the corners.
Or he drew various kinds of geometrical figures, in which he
childishly wrote in a small hand these compositions, which sometimes consisted of the most sublime dithyrambics.
His whim was to apply the triangular figure and the number
three wherever he could; thus he folded his bed-clothes and laid
his pillow in a triangular manner, he disenchanted his drink, his
food and his clothes by spitting thrice, by making the sign of
the cross thrice, &c., and this folly he kept up partially until
very near the period when he had almost recovered his full
reason, and in every other respect could be perfectly well trusted
by himself.
His propensity to compose verses 1 was remarkable, and this was
especially the case when his reason was somewhat restored; these
chiefly consisted of popular songs conveying a moral lesson, combating popular prejudices, &c., illustrated by examples, many of
which were excellent, in the style of ancient times.     He set them
to simple appropriate melodies, in the same style, and often sang
them, accompanying himself on the piano, which he played with
great skill.2
In the midst of all these sometimes very pleasing performances,
1 He played very well on the flute, but even after his reason had been considerably restored I could not allow him to do so, nor yet to play the organ, which he
did in a most masterly style, as both these instruments threw him into paroxysms
of madness. Even during the height of his mania he was uncommonly sensitive
to certain things. Although my presence was always very agreeable and consolatory to him, yet he often begged me, especially when he was still considerably
insane, not to put my hand on his arm or to touch his bare hand; it went through
his marrow and bones, so he expressed himself, like an electric shock.
2 I repeatedly requested him, when he was completely restored, to compose me a
small poem by way of a souvenir. He tried to do so, but was unable to produce
anything tolerable, just as previous to his malady he had but little talent for making
rhymes.




DURING HIS INSANITY.

293

to which I did not in the least incite him, the rest of his behaviour, especially when one noticed him      unseen, was very foolish,
adventurous, grotesque.
But I must do him the justice to say, that in all his oral and
written communications, and even when he was not observed,
both during the periods of his greatest insanity and afterwards, he
never shewed the slightest traces of any unbecoming behaviour in
regard to sexual morality, but very frequently the very reverse.
On this point he was certainly no saint in the strict meaning of
the word, still he was much better than most men of the world.
His body was in this respect in the most untainted and healthy
condition; he must have therefore felt all the more deeply the
calumnies that had been spread concerning him, and especially the
satire alluded to above.
Loyalty to his sovereign and affection for his family and for
some of his deceased friends, was perceptible through all the stages
of his malady.
Much as he loved    and esteemed me, even in the height of his
madness, as also after his complete recovery, and though he was
obliging and pleasant to every one after his recovery, yet he
became malicious, deceitful and offensive as he was passing from
the first state into the last, I mean when his reason was just beginning to dawn, when he was able to entertain himself with visitors
for half-hours at a time, and when he could behave himself quite
well as long as he was noticed. A most puzzling phenomenon! This
perverted state of the disposition, in which head and heart seemed,
so to speak, to have mutually lost their equilibrium, was accompanied in a corresponding degree by an astonishing canine hunger,
1 I never allow any insane person to be punished by blows or other painful
corporeal inflictions, since there can be no punishment where there is no sense of
responsibility, and since such patients only deserve our pity and cannot be improved,
but must be rendered worse by such rough treatment. He often however shewed
me with tears in his eyes the marks of the blows and stripes his former keepers had
employed to keep him in order. The physician of such unfortunate creatures ought
to behave so as to inspire them with respect and at the same time with confidence;
he should never feel offended at what they do, for an irrational person can give no
offence. The exhibition of their unreasonable anger should only excite his sympathy
and stimulate his philanthropy to relieve their sad condition.




294           DESCRIPTION OF KLOCKENBRING, ETC.
or to speak more correctly, insatiableness.' They both went away
together gradually, when, under the medicines used, health and
reason were completely restored.
His friendship, which I enjoyed for two years after his complete
restoration, has richly repaid me for these and thousands of other
sad moments I passed on his account.
Before he quitted my establishment he shewed to the public, by
his translation of a statistical work of Arthur Young, his regenerated intelligence in a very advantageous manner, and after he
quitted me, the government of his native land bestowed on him, in
place of his former too toilsome office, the direction of the lottery,
which he continued to hold till his death, which was caused by a
retention of urine.
Peace be with his ashes!
1 He was not satisfied with ten pounds of bread daily, besides other food. When
he had recovered his health he ate very moderately, I might almost say extremely
little.




ESSAY ON A NEW PRINCIPLE FOR ASCERTAINING
THE   CURATIVE     POWERS OF DRUGS,
WITH A FEW GLANCES AT THOSE HITHERTO EMPLOYED.'
AT the commencement of this century, the unmerited honour was
conferred on chemistry, more especially by the Academy of
Sciences of Paris, of tempting it to come forward as the discoverer
of the medicinal virtues of drugs, particularly of plants. They
were subjected to the action of fire in retorts, generally without
water, and by this process there were obtained, from the most
deadly as from the most innocent, very much the same products,
water, acids, resinous matters, charcoal, and from this last, alkali;
always the same kind. Large sums of money were thus wasted
on the destruction of plants, before it was perceived that none of
the important component parts of vegetables could be extracted by
this fiery ordeal, far less that any conclusion respecting their
curative powers could be come to. This folly, which was, with
divers variations, perpetrated for nearly half a century, gradually
produced an unfavourable impression on the minds of modern
physicians, which had been in the mean time more enlightened
respecting the chemical art and its limits, so that they now almost
unanimously adopted an opposite view, and denied all value to
chemistry in the search for the medicinal powers of drugs, and in
the discovery of remedial agents for the diseases to which humanity
is liable.
In this they palpably went too far. Although I am far from
conceding to the chemical art a universal influence on the materia
medica, I cannot refrain from alluding to some notable discoveries
1 From Hlufeland'e Journal der practischen Arzneykunde. Vol. ii, Part iii. 1796.




296

SUGGESTIONS FOR ASCERTAINING

in this respect which we have to thank it for, and to what it may
hereafter effect for therapeutics.
Chemistry informed the physician who sought a palliative remedy for the evils occasioned by morbid acids in the stomach, that
the alkalis and some earths were their remedies. If it was desired
to destroy in the stomach poisonous matters which had been swallowed, the physician applied to chemistry for the antidotes that
should speedily neutralize them, before they should injure the
alimentary canal and the whole organism. Chemistry alone could
tell him that the alkalis and soap were the antidotes of acid
poisons, of vitriol, of aquafortis, of arsenic, as well as of the poisonous metallic salts; that the acids were the counter-poisons of
the alkalis, of quicklime, &c., and that for speedily counteracting
the effects of all metallic poisons, sulphur, liver of sulphur, but
especially sulphuretted hydrogen, were effectual.
It taught him to remove lead and tin from a cavity of the body
by living quicksilver, to dissolve iron that had been swallowed by
acids, and ingested glass and flint by fluoric and phosphoric acids,
in the way it is seen to take place, with respect to the last
substance, in the stomach of fowls.
Chemistry produced vital air in its purity, and when the
physiologist and clinical observer perceived its peculiar power of
maintaining and increasing the vital energy, chemistry showed
that a part of this power lay in the great specific caloric of this air,
and furnished a supply of it, which neither the therapeutic materia
medica nor clinical experience could do, from many different
sources, in greater and greater purity.
Chemistry alone could supply a remedy for those suffocated by
fixed air, in the vapour of caustic ammonia.
What would the Galenic school have done in cases of suffocation
from charcoal vapour, had chemistry not pointed out vital air, the
second component of atmospheric, as the proper thing wherewith
to inflate the lIngs?
Chemistry discovered a means of destroying the remains of
poisons which had penetrated the system, by administering sulphuretted hydrogen in drinks and baths.
What but chemistry taught us (with nitrous ether and acetate
of potash) how to dissolve those gall stones that often give rise to
so many most troublesome diseases?




THE CURATIVE POWERS OF DRUGS.

297

For centuries, chemistry has been applied to by medicine for a
remedy for stone in the bladder, and with what result?  Those
that applied to it know best. It has at all events done something,
since it has brought soda saturated with fixed air into repute. A still
better remedy will be found in the employment of phosphoric acid.
Were not all sorts of medicinal agents applied to mammae in
which the milk had curdled and caused pain?  This was a hopeless, fruitless way. Chemistry showed a true remedy in fomentations of hartshorn, which renders curdled milk once more fluid.
Chemical experimentation with colombo root and morbid bile,
showed that that vegetable substance must be a remedy in deranged
biliary secretion in the human body, and medical experience has
confirmed the accuracy of chemical induction.
Does the practitioner seek to know if a new remedy is of a heating description? Distillation with water, by showing the presence
or absence of an ethereal oil, will with few exceptions suffice to
solve the problem.
Practice cannot always tell by sensible signs if a vegetable substance possess astringent properties.  Chemistry discovers that
astringent principle, sometimes of no small use in practice, and
even its degree, by means of sulphate of iron.
The science of dietetics alone cannot tell if a newly-discovered
plant possess anything nourishing in its composition. Chemistry
shows this, by separating its gluten and its starch, and can, from
the quantity of these ingredients, determine the degree of its nutritive quality.
Although chemistry cannot directly point out medicinal powers,
yet it can do this indirectly, by demonstrating the powerlessness of
medicines, in themselves powerful, from being mixed; or the
noxious properties of mixtures of medicines, in themselves innocuous. It forbids us, when we seek to produce vomiting by means
of tartar emetic, to add to it substances containing gallic acid, by
which it is decomposed; it forbids us to drink lime water when
we seek to obtain benefit from the astringent principle of cinchona
bark, by which it is destroyed; it forbids us, if we do not wish to
produce ink, to mix bark and iron in the same potion; it forbids
us to make the Goulard lotion powerless by adding alum; it
forbids the mixture of an acid with those laxative neutral salts
having cream of tartar for their bases, which remove acids from




298

SUGGESTIONS FOR ASCERTAINING

the primme vise; it forbids us to render poisonous, by admixture,
those otherwise innocuous substances, diaphoretic antimony and
cream of tartar; it prohibits the use of vegetable acids during a
milk diet, (whereby an insoluble curd would be formed,) and
when acids are required for digestion, it points to the vitriolic
acid.
It furnishes the tests for detecting the adulteration of remedies,
extracts the deadly corrosive sublimate from calomel, and teaches
the difference betwixt the latter and the poisonous white precipitate which it so closely resembles.
These few examples may suffice to show that chemistry cannot
be excluded from a share in the discovery of the medicinal powers
of drugs. But that chemistry should not be consulted with respect
to those medicinal powers which relate, not to hurtful substances
to be acted on immediately in the human body, but to changes
wherein the functions of the animal organism are first concerned,
is proved, inter alia, by the experiments with antiseptic substances,
respecting which, it was imagined that they would exhibit exactly
the same antiputrefactive power in the fluids of the body, as they
did in the chemical phial. But experience showed that saltpetre,
for instance, which out of the body is so highly antiseptic, shows
exactly opposite qualities in putrid fever and in tendency to
gangrene; the reason of which, I may mention, though out of
place here, is, that it weakens the vital powers. Or shall we seek
to correct the putrefaction of matters in the stomach with saltpetre? An emetic will remove them at once.
Still worse for the materia medica was the advice of those who
sought to ascertain the medicinal powers of its various agents, by
mixing the unknown drug with newly-drawn blood, in order to
see whether the blood grew darker or lighter, thinner or thicker;
just as if we could bring the drug into the same immediate contact
with the blood in the artery, as we can in the test-tube; just as
if the drug must not first undergo an infinity of changes in the
digestive canal, before it can get (and that only by a most
circuitous method) into the blood. What a variety of appearances
does not the blood itself present when drawn from the vein,
according as it is taken from a heated or a cool body, by a smaller
or larger opening, in a full stream or by drops, in a cold or warm
room, in a flat or a narrow vessel.




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But such paltry modes of ascertaining the powers of medicines
bear on their face the stamp of their worthlessness.
Even the injection of drugs into the bloodvessels of animals is for
the same reason a very heterogeneous and uncertain method.
To mention only one circumstance,-a teaspoonful of concentrated
cherrylaurel-water will most certainly kill a rabbit, when taken
into the stomach, whereas, if injected into the jugular vein, it
causes no change, the animal remains lively and well.
But at all events, some will say, the administration of drugs to
animals by the mouth will furnish some certain results respecting
their medicinal action. By no means! How greatly do their
bodies differ from ours! A pig can swallow a large quantity of
nux vomica without injury, and yet men have been killed with
fifteen grains. A dog bore an ounce of the fresh leaves, flowers, and
seeds of monkshood; what man would not have died of such
a dose?  Horses eat it, when dried, without injury. Yew leaves,
though so fatal to man, fatten some of our domestic animals.
And how can we draw conclusions relative to the action of medicines on man, from their effects on the lower animals, when even
among the latter they often vary so much?       The stomach of
a wolf poisoned with monkshood was found inflamed, but not that
of a large and a small cat, poisoned by the same substance. What
can we infer from this?   Certainly, not much, if I may not say,
nothing. Thus much, at least, is certain, that the fine internal
changes and sensations, which a man can express by words, must
be totally awanting in the lower animals.
In order to try if a substance can develope very violent or dangerous effects, this may in general be readily ascertained by
experiments on several animals at once, as likewise any general
manifest action on the motions of the limbs, variations of temperature, evacuations upwards and downwards, and the like, but never
anything connected or decisive, that may influence our conclusions
with regard to the proper curative virtues of the agent on the
human subject. For this, such experiments are too obscure, too
rude, and, if I may be allowed the expression, too awkward.
As the above-mentioned sources for ascertaining the medicinal
virtues of drugs were so soon exhausted, the systematizer of the
materia medica bethought himself of others, which he deemed of a
more certain character. He sought for them in the drugs them



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selves; he imagined he would find in them hints for his guidance.
He did not observe, however, that their sensible external signs are
often very deceptive, as deceptive as the physiognomy is in indicating the thoughts of the heart.
Lurid-coloured plants are by no means always poisonous; and
on the other hand, an agreeable colour of the flowers is far from being
any proof of the harmlessness of the plant. The special qualities of
drugs, which may be ascertained by the smell and the taste, will
not allow us to form any trustworthy conclusions respecting untried
substances. I am far from denying utility to both these senses in
corroborating the probable properties of drugs which have been
ascertained in other ways, but I would counsel, on the other hand,
great caution to those who would form their judgment from them
alone. If the bitter principle strengthens the stomach, why does
squill weaken it?  If bitter aromatic substances are heating, why
does marsh rosemary diminish the vital temperature in such a
marked manner?     If those plants only are astringent that make
ink with sulphate of iron, how is it that the highly astringent principle in quinces, medlars, &c., cannot furnish ink?
If the astringent taste gives evidence of a strengthening substance, why does sulphate of zinc excite vomiting? If the acids are
antiseptic, why does arsenious acid produce such rapid putrefaction
in the body of one poisoned by it? Is the sweet taste of sugar of
lead a sign of its nutritive properties? If the volatile oils, and
everything that tastes fiery on the tongue, are heating for the
blood, why are ether, camphor, cajeput oil, oil of peppermint, and
the volatile oil of bitter almonds and cherrylaurel, the very reverse?
If we are to expect a disagreeable odour in poisonous plants, how
is it so inconsiderable in monkshood, deadly nightshade, and foxglove? why so imperceptible in nux vomica and gamboge? If we
are to look for a disagreeable taste in poisonous plants, why is the
most deadly juice of the root of jatropha manihot merely sweetish,
and not the least acrid?  If the expressed fatty oils are often
emollient, does it follow that they are all so, even the inflammatory
oil expressed from the seeds of the jatropha curcas? Are substances
which have little or no smell or taste destitute of medicinal powers?
How is it that ipecacuan, tartar emetic, the poison of vipers, nitrogen, and lopez-root, are not so? Who would use bryony-root
as an article of diet, on the ground that it contains much starch?




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Perhaps, however, botanical affinity may allow us to infer a
similarity of action? This is far from being the case, as there are
many examples of opposite, or at least very different powers, in one
and the same family of plants, and that in most of them. We shall
take as a basis the most perfect natural system, that of Murray.
In the family of the coniferae, the inner bark of the fir-tree
(pinus sylvestris) gives to the inhabitants of northern regions a
kind of bread, whereas the bark of the yew-tree (taxus baccifera)
gives-death. How come the feverfew (anthemis pyrethrum), with
its burning root, the poisonous cooling lettuce (lactuca virosa), the
emetic groundsel (senecio vulgaris), the mild scorzonera, the innocuous cudweed (gnaphalium arenarium), the heroic arnica (a. montana),
all together in the one family of the composite?  Has the purging
globularia alypum anything in common with the powerless statice,
both being in the family of the aggregatke? Is there any similarity
to be expected betwixt the action of the skirret root (sium sisarum)
and that of the poisonous water-dropwort (tenanthe crocata), or of
the water-hemlock (cicuta virosa), because they are in the same
family of the umbelliferde? Has the not harmless ivy (hedera helix),
in the family hederaceae, any other resemblance to the vine (vitis
vinifera), except in the outward growth? How comes the harmless
butcher's-broom (ruscus) in the same family of the sarmentacece
with the stupifying cocculus (menispermum cocculus), the heating
aristolochia, and the asarum europaum? Do we expect any similarity of effect from the goose-grass (galium aparine) and the often
deadly spigelia marylandica, because they both belong to the
stellate? What resemblance can we find betwixt the action of the
melon (cucumis melo) and the elaterium (momordica elaterium), in
the same family of the cucurbitacete? And again, in the family
solanacece, how comes the tasteless great mullein (verbascum thapsus), along with the burning Cayenne pepper (capsicum annuum); or
tobacco, which has such a powerful spasm-exciting action on the
primm viae, with nux vomica, which impedes the natural motions of
the intestines? Who would compare the unmedicinal perriwinkle
(vinca pervinca) with the stupifying oleander (nerium oleander), in
the family contorte?  Does the watery moneywort (lysimachia
nummularia) act similarly to the marsh trefoil (menyanthes trifoliata),
or the powerless cowslip (primula veris), to the drastic sowbread
(cyclamen europatum), in the family of the rutacee?  From  the




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strengthening effects of the bear-berry (arbutus uva ursi) on the
urinary apparatus, can we infer the heating, stupifying action of
the rhododendron chrysanthum, in the family bicornes? Among
the verticillate, can any comparison be made betwixt the scarcely
astringent self-heal (prunella vulgaris) or the innocent bugle (ajuga
pyramidalis), and the volatile germander (teucrium marum), or the
fiery marjoram (origanum creticum)? How can the powers of the
verbena (v. offcinalis) be said to resemble those of the active hyssop
(gratiola oficinalis), in the familypersonate? How different are the
actions of the glycyrrhiza and geoffroya, although in the same family
of the papilionacece! In the family of the lomentacece, what parallel
exists betwixt the properties of the ceratonia siliqua and those of
the fumatory (fumaria officinalis), of the polygala senega and the
Peruvian balsam (myroxylon peruiferum)? Or is there any likeness
in properties amongst the nigella sativa, the garden rue (ruta
graveolens), the peony (peonia officinalis), and the cellery-leaved
crowfoot (ranunculus sceleratus), although one and all are in the
family of the multisilique? The dropwort (spircea filipendula) and
the tormentil (tormentilla erecta) are united in the family senticose,
and yet how different in properties! The red currant (ribes rubrum),
and the cherry-laurel (prunus laurocerasus), the rowan (sorbus
aucuparia), and the peach (amygdalus persica), how different in
powers, and yet in the same family of the pomacees     The family
succulente unites the wall-pepper (sedum acre) and the portulaca
oleracea, certainly not because they resemble each other in effects!
How is it that the stork's-bill and the purging-flax (linum catharticum), the sorrel (oxalis acetosella), and the quassia (q. amara), are
in the same family?     Certainly not because their powers are
similar!   How various are the medicinal properties of all the
members of the family ascyroidece   and of those of the dumosce!
and of those of the trihilatc! In the family tricoccce, what has the
corrosive spurge (euphorbia officinalis) in common with the box
(buxus sempervirens), which has such a decided influence on the
nervous system? The tasteless rupture-wort (herniaria glabra),
the acrid phytolacca decandra, the refreshing goosefoot (chenopodium ambrosioides), and the biting persicaria (polygonum hydropiper), what a motley company in the family oleracece!       How
dissimilar in action are the scabride!  What business has the




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mild, slimy, white lily (lilium candidum) beside the garlic (allium
sativum), or the squill (scilla maritima); what the asparagus (a. offi
cinalis) beside the poisonous white hellebore (veratrum album), in
the family liliacet?
I am far from denying, however, the many important hints the
natural system may afford to the philosophical student of the
materia medica and to him who feels it is his duty to discover
new medicinal agents; but these hints can only help to confirm
and serve as a commentary to facts already known, or in the case
of untried plants they may give rise to hypothetical conjectures,
which are, however, far from approaching even to probability.
But how can a perfect similarity of action be expected amongst
groups of plants, which are only arranged in the so-called natural
system, on account of often slight external similarity, when even
plants that are much more nearly connected, plants of one and the
same genus, are sometimes so different in their medicinal effects.
Examples of this are seen in the species of the genera impatiens,
serapias, cystisus, ranunculus, calamus, hibiscus, prunus, sedum,
cassia, polygonum, convallaria, linum, rhus, seseli, coriandrum, ethusa,
sium, angelica, chenopodium, asclepias, solanum, lolium, allium,
rhamnus, amygdalus, rubus, delphinium, sisymbrium, polygala, teucrium, vaccinium, cucumis, apium, pimpinella, anethum, seandia,
valeriana, anthemis, artemisia, centaurea, juniperus, brassica. What
a difference betwixt the tasteless tinder amadou (boletus igniarius)
and the bitter, drastic boletus laricis; betwixt the mushroom
(agaricus deliciosus) and the agaric (agaricus muscarius); betwixt
the woody stone moss (lichen saxatilis) and the powerful Iceland
moss (lichen Islandicus /)
Though I readily admit that, in general, similarity of action
will be much oftener met with betwixt species of one genus, than
betwixt whole groups of families in the natural system, and that
an inference drawn from the former will have a much greater
degree of probability attaching to it, than one from  the latter;
yet my conviction compels me to give this warning, that, be the
number of genera ever so many whose species resemble each other
very much in their effects, the lesser number of very differently
acting species should make us distrustful of this mode of drawing
inferences, since we have not here to do with mechanical experi



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ments, but with that most important and difficult concern of
mankind-health.1
As regards this method also, therefore, we come to the conclusion, that it cannot be considered as a sure principle to guide us
to the knowledge of the medicinal powers of plants.
Nothing remains for us but experiment on the human body.
But what kind of experiment? Accidental or methodical P
The humiliating confession must be made, that most of the
virtues of medicinal bodies were discovered by accidental, empirical
experience, by chance; often first observed by non-medical persons.  Bold, often over-bold, physicians, then gradually made trial
of them.
I have no intention of denying the high value of this mode of
discovering medicinal powers-it speaks for itself.    But in it there
is nothing for us to do; chance excludes all method, all voluntary
action. Sad is the thought, that the noblest, the most indispensable of arts, is built upon accident, which always pre-supposes
the endangering of many human lives. Will the chance of such
discoveries suffice to perfect the healing art, to supply its numerous desiderata?   From   year to year we become acquainted with
new diseases, with new phases and new complications of diseases,
with new morbid conditions; if, then, we possess no better method
of discovering the remedial agents around us than chance allows,
nought remains for us to do but to treat these diseases with
general (I might often wish with no) remedies, or with such as
have seemed to be of service, in what we imagine, or what appear
to us to be, similar diseased states. But how often shall we fail in
accomplishing our object, for if there be any difference, the disease
cannot be the same!      Sadly we look forward into future ages,
when a peculiar remedy for this particular form of disease, for this
I Conclusions relative to similarity of action betwixt species of a genus become
still more hazardous, when we consider that one and the same species, one and the
same plant, frequently shows very various medicinal powers in its different parts.
How different the poppy head from the poppy seed; the manna that distils from the
leaves of the larch from the turpentine of the same tree; the cooling camphor in the
root of the cinnamon laurel, from the burning cinnamon oil; the astringent juice in
the fruit of several of the mimosse, from the tasteless gum that exudes from their
stem; the corrosive stalk of the ranunculus from its mild root!




THE CURATIVE POWERS OF DRUGS.

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particular circumstance, may, perhaps, be discovered by chance, as
was bark for pure intermittent fever, or mercury for syphilitic
disorders.
Such a precarious construction of the most important science
-resembling the concourse of Epicurean atoms to make a worldcould never be the will of the wise and most bountiful Preserver
of mankind. How humiliating for proud humanity, did his very
preservation depend on chance alone. No! it is exhilarating to
believe that for each particular disease, for each peculiar morbid
variety, there are peculiar directly-acting remedies, and that there
is also a way in which these may be methodically discovered.
When I talk of the methodical discovery of the medicinal powers
still required by us, I do not refer to those empirical trials usually
made in hospitals, where in a difficult, often not accurately noted case,
in which those already known do no good, recourse is had to some
drug, hitherto either untried altogether, or untried in this particular affection, which drug is fixed upon either from caprice and
blind fancy, or from some obscure notion, for which the experimenter can give no plausible reason, either to himself or to others.
Such empirical chance trials are, to call them by the mildest
appellation, but foolish risks, if not something worse.
I speak not here, either, of the somewhat more rational trials,
made occasionally in private and hospital practice, with remedies
casually recommended in this or that disease, but not further
tested. These, also, are performed, unless under the guidance of
some scientific principle, to a certain degree at the peril of the
health and life of the patient; but the caution and practical skill
of the physician will often avail to smooth much that is uneven in
his half-empirical undertakings.
As we already possess a large number of medicines, which are
evidently powerful, but concerning which we do not rightly know
what diseases they are capable of curing, and moreover, others
which have sometimes proved serviceable, sometimes not, in given
diseases, and concerning which we have no accurate knowledge of
the exact circumstances under which they are applicable, it may
not at first sight appear very necessary to increase the number of
our medicinal agents. Very probably all (or nearly all) the aid
we seek lies in those we already possess.
Before I explain myself further, I must, in order to prevent
~




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misapprehension, distinctly declare that I do not expect, and do
not believe, there can be a thoroughly specific remedy for any
disease, of such and such a name, burdened with all the ramifications, concomitant affections and variations, which, in pathological
works, are so often inconsiderately detailed as essential to its
character, as invariably pertaining to it. It is only the very great
simplicity and constancy of ague and syphilis that permitted remedies to be found for them, which appeared to many physicians to
have specific qualities; for the variations in these diseases occur
much more seldom, and are usually much less important than in
others, consequently bark and mercury must be much more often
serviceable than not so. But neither is bark specific in ague, in
the most extended sense of the term,' nor mercury in syphilis, in
its most extended sense; they are, however, probably specific in
both diseases, when they occur simple, pure, and free from all
complication. Our great and intelligent observers of disease have
seen the truth of this too well, to require that I should dwell
longer on this subject.
Now, when I entirely deny that there are any absolute specifics
for individual diseases, in their full extent, as they are described
in ordinary works on pathology,2 I am, on the other hand, convinced that there are as many specifics as there are different states
of individual diseases, i. e., that there are peculiar specifics for the
1 Pity it is, that it was not observed why, for example, of the seven-fifteenths of
all the so-called agues in which bark was useless, three-fifteenths required nux
vomica or bitter almonds, another fifteenth opium, another fifteenth blood-letting,
and still another fifteenth small doses of ipecacuan, for their cure! It was thought
sufficient to say, " Bark was of no use, but ignatia cured;" the why was never satisfactorily answered. Were it a case of pure ague, bark must be of service; where
there were complications, with excessive irritability, especially of the primae viae,
however, it was no longer a pure case of ague, and it could not do good; here were
now reasons for choosing as a remedy, or as an auxiliary means, ignatia, nux
vomica, or bitter almonds, according to the different conditions of the system; and it
could not and should not have been wondered at, that bark was not useful.
2 The history of diseases is not yet advanced so far that we have been at pains to
separate the essential from the accidental, the peculiar from the adventitious, the
foreign admixture, owing to idiosyncrasy, mode of life, passions, epidemic constitutions, and many other circumstances. When reading the description of one disease,
we might often imagine it was a compound admixture of many histories of cases,
with suppression of the name, place, time, &c., and not true, abstractedly pure,
isolated characteristics of a disease separated from the accidental (which might be
afterwards appended to it, as it were). The more recent nosologists have attempted




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pure disease, and others for its varieties, and for other abnormal
states of the system.
If I mistake not, practical medicine has devised three ways of
applying remedies for the relief of the disorders of the human body.
The first way, to remove or destroy the fundamental cause of the
disease, was the most elevated it could follow.   All the imaginings
and aspirations of the best physicians in all ages were directed to
this object, the most worthy of the dignity of our art. But, to use
a Spagyrian expression, they did not advance beyond particulars;
the great philosopher's stone, the knowledge of the fundamental
cause of all diseases, they never attained to. And as regards most
diseases, it will remain for ever concealed from   human weakness.
In the mean time, what could be ascertained respecting this point,
from the experience of all ages, was united in a general system of
therapeutics. Thus, in cases of chronic spasms of the stomach,
the general weakness of the system was first removed; the convulsions arising from tape-worm were conquered by killing that
animal; the fever arising from noxious matters in the stomach was
dissipated by powerful emetics; in diseases caused by a chill the
suppressed perspiration was restored; and the ball was extracted
that gave rise to traumatic fever. This object is above all criticism, though the means employed were not always the fittest for
attaining it. I shall now take leave of this royal road, and
examine the other two ways for applying medicines.
By the second way, the symptoms present were sought to be
removed by medicines which produced an opposite condition; for
example, constipation by purgatives; inflamed blood by venesection, cold and nitre; acidity in the stomach by alkalis; pains by
opium. In acute diseases, which, if we remove the obstacles to
recovery for but a few days, nature will herself generally conquer,
or, if we cannot do so, succumb; in acute diseases, I repeat, this
application of remedies is proper, to the purpose, and sufficient, as
to do this; their genera should be what I call the peculiar characteristics of each
disease, their species the accidental circumstances.
Before all things, we have to attend to the chief disease; its divergencies and
concomitant circumstances only demand particular aid when they are serious, or
offer obstacles to recovery; they demand our chief attention, and the primary
disease may be less regarded, when the latter, by passing into the chronic state, has
become of less importance, and is less urgent, whilst the former has gradually
become the chief disease.
x2




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long as we do not possess the above-mentioned philosopher's stone
(the knowledge of the fundamental cause of each disease, and the
means of its removal), or as long as we have no rapidly-acting specific,
which would extinguish the variolous infection, for instance, at
its very commencement. In this case, I would call such remedies
temporary.
But if the fundamental cause of the disease, and its direct means of
removal, are known, and we, disregarding these, combat the
symptoms only by remedies of this second kind, or employ them
seriously in chronic diseases, then this method of treatment (to
oppose diseases by remedies that produce an opposite state) gets
the name of palliative, and is to be reprobated. In chronic
diseases it only gives relief at first; subsequently stronger doses of
such remedies become necessary, which cannot remove the primary
disease, and thus they do more harm the longer they are employed, for reasons to be specified hereafter.
I know very well that habitual constipation is still attempted to
be cured by aloetic purgatives and laxative salts, but with what
melancholy results! I know well that efforts are still made to
subdue the chronic determinations of blood of hysterical, cachetic,
and hypochondriacal individuals, by repeated, although small
venesections, nitre, and the like; but with what untoward consequences! Persons living a sedentary life, with chronic stomachic
ailments, accompanied by sour eructations, are still advised to
take repeatedly Glauber's salts; but with what disastrous effects!
Chronic pains of all kinds are still sought to be removed by the
continued use of opium; but again, with what sad results! And
although the great majority of my medical brethren still adhere to
this method, I do not fear to call it palliative, injurious, and destructive.,.ý I beseech my colleagues to abandon this method (contraria
contrariis) in chronic diseases, and in such acute diseases as take
on a chronic character; it is the deceitful bye-path in the dark
forest that leads to the fatal swamp. The vain empiric imagines
""it to be the beaten highway, and plumes himself on the wretched
power of giving a few hours' ease, unconcerned if, during this
specious calm, the disease plant its roots still deeper.
But I am not singular in warning against this fatal practice.
The better, more discerning, and conscientious physicians, have
from time to time sought for remedies (the third way) for chronic




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diseases, and acute diseases tending to chronic, which should not
cloak the symptoms, but which should remove the disease radically, in one word, for specific remedies; the most desirable, most
praiseworthy undertaking that can be imagined. Thus, for instance, they tried arnica in dysentery, and in some instances
found it a useful specific.
But what guided them, what principle induced them to try
such  remedies?   Alas! only a precedent from    the empirical
game of hazard, from domestic practice, chance cases, in which
these substances were accidentally found useful in this or that
disease, often only in peculiar unmentioned combinations, which
might perhaps never again occur; sometimes in pure, simple
diseases.
It were deplorable, indeed, if only chance and empirical apropos
could be considered as our guides in the discovery and application
of the proper, the true remedies for chronic diseases, which
certainly constitute the major portion of human ills.
In order to ascertain the actions of remedial agents, for the
purpose of applying them to the relief of human suffering, we
should trust as little as possible to chance; but go to work as
rationally and as methodically as possible. We have seen, that
for this object the aid of chemistry is still imperfect, and must
only be resorted to with caution; that the similarity of genera
of plants in the natural system, as also the similarity of species of
one genus, give but obscure hints; that the sensible properties of
drugs teach us mere generalities, and these invalidated by many
exceptions; that the changes that take place in the blood from
the admixture of medicines teach nothing; and that the injection
of the latter into the bloodvessels of animals, as also the effects on
animals to which medicines have been administered, is much too
rude a mode of proceeding, to enable us therefrom to judge of the
finer actions of remedies.
Nothing then remains but to test the medicines we wish to investigate on the human body itself. The necessity of this has been
perceived in all ages, but a false way was generally followed,
inasmuch as they were, as above stated, only employed empirically
and capriciously in diseases. The reaction of the diseased organism,
however, to an untested or imperfectly tested remedy, gives such
intricate results, that their appreciation is impossible for the most




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acute physician. Either nothing happens, or there occur aggravations, changes, amelioration, recovery, death-without the possibility
of the greatest practical genius being able to divine what part the
diseased organism, and what the remedy (in a dose, perchance, too
great, moderate, or too small) played in effecting the result.
They teach nothing, and only lead to false conclusions.          The
everyday physicians held their tongues about any harm that
ensued, they indicated with one word only the name of the
disease, which they often confounded with another, in which this or
that remedy appeared to do good, and thus were composed the
useless and dangerous works of Schroder, Rutty, Zorn, Chomel,
Pomet, &c., in whose thick books are to be found a monstrous
number of mostly powerless medicines, each of which is said to
have cured radically this and at least ten or twenty other diseases. 1
The true physician, whose sole aim is to perfect his art, can
avail himself of no other information respecting medicines, thanFirst-What is the pure action of each by itself on the human
body?
Second-What do observations of its action in this or that simple
or complex disease teach us?
The last object is partly obtained in the practical writings of the
best observers of all ages, but more especially of later times.
Throughout these, the, as yet, only source of the real knowledge
of the powers of drugs in diseases is scattered; there we find it
faithfully related, how the simplest drugs were employed in accurately described cases, how far they proved serviceable, and how
far they were hurtful or less beneficial.     Would to God such
relations were more numerous!
But even among them contradictions so often occur, one condemning in a certain case what another found of use in a similar
case, that one cannot but remark that we still require some
1 To me, the strangest circumstance connected with these speculations upon the
virtues of single drugs is, that in the days of these men, the habit that still obtains
in medicine, of joining together several different medicines in one prescription, was
carried to such an extent, that I defy (Edipus himself to tell what was the exact
action of a single ingredient of the hotch-potch; the prescription of a single remedy
at a time was in those days almost rarer than it is now-a-days.  How was it
possible, in such a complicated practice, to distinguish the powers of individual
medicines?




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natural normal standard, whereby we may be enabled to judge of
the value and degree of truth of their observations.
This standard, methinks, can only be derived from     the effects
that a given medicinal substance has, by itself in this and that
dose, developed in the healthy human body.
To this belong the histories of designedly or accidentally swallowed medicines and poisons, and such as have been purposely
taken by persons, in order to test them; or which have been
given to healthy individuals, to criminals, &c.; probably also
those cases in which an improper powerfully acting substance has
been employed as a household remedy or medicine, in slight or
easily determined diseases.
A complete collection of such observations, with remarks on the
degree of reliance to be placed on their reporters, would, if I mistake not, be the foundation stone of a materia medica, the sacred
book of its revelation.
In them alone can the true nature, the real action of medicinal
substances be methodically discovered; from     them  alone can we
learn in what cases of disease they may be employed with success
and certainty.
But as the key for this is still wanting, perhaps I am so fortunate as to be able to point out the principle, under the guidance
of which the lacunae in medicine may be filled up, and the science
perfected by the gradual discovery and application, on rational
principles, of a suitable specific  remedy for each, more especially
for each chronic disease, among the hitherto known (and among still
unknown) medicines. It is contained, I may say, in the following
axioms.
Every powerful medicinal substance produces in the human body
a kind of peculiar disease; the more powerful the medicine, the more
peculiar, marked, and violent the disease.2
We should imitate nature, which sometimes cures a chronic
disease by superadding another, and employ in the (especially
chronic) disease we wish to cure, that medicine which is able to proI In this Essay my chief object is to discover a permanently acting specific
remedy for (especially) chronic diseases. Those remedies which remove the fundamental cause, and the temporary acting remedies for acute diseases which in some
cases receive the name of palliative medicines, I shall not touch on at present.
2 Non-medical people call those medicines which produce the most powerful specific
diseases, and which therefore are actually the most serviceable poisons.




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SUGGESTIONS FOR ASCERTAINING

duce another very similar artificial disease, and the former will be
cured; similia similibus.
We only require to know, on the one hand, the diseases of the
human frame accurately in their essential characteristics, and
their accidental complications; and, on the other hand, the pure
effects of drugs, that is, the essential characteristics of the specific
artificial disease they usually excite, together with the accidental
symptoms caused by difference of dose, form, &c., and by choosing
a remedy for a given natural disease that is capable of producing
a very similar artificial disease, we shall be able to cure the most
obstinate diseases.1
This axiom has, I confess, so much the appearance of a barren,
analytical, general formula, that I must hasten to illustrate it
synthetically. But first let me call to mind a few points.
S    I. Most medicines have more than one action; the first a direct
action, which gradually changes into the second (which I call the
indirect secondary action). The latter is generally a state exactly
the opposite of the former.2 In this way most vegetable substances
act.
II. But few medicines are exceptions to this rule, continuing
their primary action uninterruptedly, of the same kind, though
always diminishing in degree, until after some time no trace
of their action can be detected, and the natural condition of the
1 The cautious physician, who will go gradually to work, gives this ordinary
remedy only in such a dose as will scarcely perceptibly develope the expected
artificial disease, (for it acts by virtue of its power to produce such an artificial
disease,) and gradually increases the dose, so that he may be sure that the intended
internal changes in the organism are produced with sufficient force, although with
phenomena vastly inferior in intensity to the symptoms of the natural disease; thus
a mild and certain cure will be effected. But if it is sought to go rapidly to work,
with the otherwise fit and properly chosen remedy, the object may be certainly
attained in this way too, though with some danger to life, as is often done in a rude
manner by quacks among the peasants, and which they call miraculous, or horse
cures, a disease of many years' standing being thereby cured in a few days; a proceeding that testifies to the truth of my principle, while at the same time it shows
the hazardous nature of this mode of effecting it.
2 Opium may serve as an example. A fearless elevation of spirit, a sensation of
strength and high courage, an imaginative gaiety, are part of the direct primary
action of a moderate dose on the system: but after the lapse of eight or twelve hours
an opposite state sets in, the indirect secondary action; there ensue relaxation,
dejection, diffidence, peevishness, loss of memory, discomfort, fear.




THE CURATIVE POWERS f F DRUGS.

318

organism is restored. Of this kind are the metallic (and other
mineral?) medicines, e.g. arsenic, mercury, lead.
III. If, in a case of chronic disease, a medicine be given, whose
direct primary action corresponds to the disease, the indirect
secondary action is sometimes exactly the state of body sought to
be brought about; but sometimes (especially when a wrong dose
has been given) there occurs in the secondary action a derangement for some hours, seldom days. A somewhat too large dose of
henbane is apt to cause, in its secondary action, great fearfulness;
a derangement that sometimes lasts several hours. If it is troublesome, and we wish to diminish its duration, a small dose of opium
affords specifically almost immediate relief; the fear goes off.
Opium, indeed, in this case, acts only antagonistically, and as a
palliative; but only a palliative and temporary remedy is required,
in order to suppress effectually a transitory affection, as is also the
case in acute diseases.
IV. Palliative remedies do so much harm in chronic diseases,
and render them more obstinate, probably because after their first
antagonistic action they are followed by a secondary action, which
is similar to the disease itself.
V. The more numerous the morbid symptoms the medicine
produces in its direct action, corresponding to the symptoms of the
disease to be cured, the nearer the artificial disease resembles that
sought to be removed, so much more certain to be favourable will
the result of its administration be.
VI. As it may be almost considered an axiom, that the symptoms of the secondary action are the exact opposite of those of the
direct action, it is allowable for a master of the art, when the
knowledge of the symptoms of the direct action is imperfect, to
supply in imagination the lacunae by induction, i. e. the opposite of
the symptoms of the secondary action; the result, however, must
only be considered as an addition to, not as the basis of, his
conclusions.
After these preliminary observations, I now proceed to illustrate
by examples my maxim, that in order to discover the true remedial
powers of a medicine for chronic diseases, we must look to the specific
artificial disease it can develope in the human body, and employ it in
a very similar morbid condition of the organism which it is wished
to remove,




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The analogous maxim, that in order to cure radically certain
chronic diseases, we must search for medicines that can excite a
similar disease (the more similar the better) in the human bodywill thereby also become evident.
In my additions to Cullen's Materia Medica, I have already observed that bark, given in large doses to sensitive, yet healthy
individuals, produces a true attack of fever, very similar to the
intermittent fever, and for this reason, probably, it overpowers,
and thus cures the latter. Now after mature experience, I add,
not only probably, but quite certainly.
I saw a healthy, sensitive person, of firm fibre, and half way
through with her pregnancy, take five drops of the volatile oil of
chamomile (matricaria chamomilla) for cramp in the calf of the leg.
The dose was much too strong for her. First there was loss of consciousness, the cramp increased, there occurred transient convulsions
in the limbs, in the eyelids, &c. A kind of hysterical movement
above the navel, not unlike labour-pains, but more annoying,
lasted for several days. This explains how chamomile has been
found so serviceable in after-pains, in excessive mobility of the
fibre, and in hysteria, when employed in doses in which it could
not perceptibly develope the same phenomena, that is, in much
smaller doses than the above.
A man who had been long troubled with constipation, but was
otherwise healthy, had from time to time attacks of giddiness that
lasted for weeks and months. Purgatives did no good. I gave
him arnica root (arnica montana) for a week, for I knew that it
causes vertigo, in increasing doses, with the desired result. As it
has laxative properties, it kept the bowels open during its employment, by antagonistic action, as a palliative; wherefore the constipation returned after leaving off the medicine; the giddiness,
however, was effectually cured. This root excites, as I and others
have ascertained, besides other symptoms, nausea, uneasiness,
anxiety, peevishness, head-ache, oppression of the stomach, empty
eructation, cuttings in the abdomen, and frequent scanty evacuations, with straining. These effects, not Stollen's example, induced me to employ it in an epidemic of simple (bilious) dysentery.
The symptoms of it were uneasiness, anxiety, excessive peevishness,
head-ache, nausea, perfect tastelessness of all food, rancid bitter
taste on the (clean) tongue, frequent empty eructation, oppression




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315

of the stomach, constant cuttings in the abdomen, complete absence
of faecal evacuations, and instead, passage of pure grey or transparent, sometimes hard, white, flocculent mucus, occasionally
intimately mixed with blood, or with streaks of blood, or without
blood, once or twice a day, accompanied with the most painful
constant straining and forcing. Though the evacuations were so
rare, the strength sank rapidly, much more quickly, however (and
without amelioration, but rather aggravation of the original affection), when purgatives were employed.          Those affected were
generally children, some even under one year old, but also some
adults.  The diet and regimen were proper.        On comparing the
morbid symptoms arnica root produces with those developed by
this simple dysentery, I could confidently oppose to the totality of
the symptoms of the latter, the collective action of the former.
The most remarkable good effects followed, without it being necessary to use any other remedy. Before the employment of the
root, I gave a powerful emetic,1 which I had occasion to repeat in
scarcely two cases, for arnica sets to right the disordered bile (also
out of the body), and prevents its derangement. The only inconvenience resulting from its use in this dysentery was, that it acted
as an antagonistic remedy in regard to the suppression of faeces, and
produced frequent, though scanty evacuations of excrement; it
was consequently a palliative; the effect of this was, when I discontinued the root, continued constipation.2
In another less simple dysentery, accompanied by frequent
diarrhoea, the arnica root might be more useful and suitable, on
account of this latter circumstance; its property of producing
frequent faecal evacuations in its primary direct action would
constitute it a similarly acting, consequently, permanent remedy,
1 Without using the arnica root, the emetics took away the rancid bitter taste
for but one or two days; all the other symptoms remained, though they were ever
so often repeated.
2 I had to increase the dose daily, more rapidly than is necessary with any other
powerful medicine. A child of four years of age got at first four grains daily, then
seven, eight, and nine grains. Children of six or seven years of age could at first
only bear six grains, afterwards twelve and fourteen grains were requisite. A child
three quarters of a year old, which had taken nothing previously, could at first bear
but two grains (mixed with warm water) in an enema; latterly six grains were
necessary.




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SUGGESTIONS FOR ASCERTAINING

and in its secondary indirect action it would effectually cure the
diarrhoea.
This has already been proved by experience; it has been found
excellent in the worst diarrhoeas. It subdues them, because, without weakening the body, it is capable of causing frequent evacuations.
In order to prove serviceable in diarrhoeas without faecal matter,
it must be given in such small doses as not to produce perceptible
purgation; or in diarrhoeas with acrid matters, in larger purgative
doses; and thus the object will be attained.
I saw glandular swellings occur from the misuse of an infusion
of flowers of arnica; I am much mistaken if, in moderate doses,
it will not remove such affections.
We should endeavour to find out if the millefoil (achillea millefolium) cannot itself produce haemorrhages in large doses, as it is
so efficacious in moderate doses in chronic haemorrhages.
It is not to be wondered at that valerian (valeriana officinalis) in
moderate doses cures chronic diseases with excess of irritability,
since in large doses, as I have ascertained, it can exalt so remarkably the irritability of the whole system.
The dispute as to whether the brooklime (anagallis arvensis) and
the bark of the misletoe (viscum album) possess great curative
virtues or none at all, would immediately be settled, if it were
tried on the healthy whether large doses produce bad effects, and
an artificial disease similar to that in which they have been
hitherto empirically used.
The specific artificial disease and the peculiar affections that the
spotted hemlock (conium maculatum) causes, are not nearly so well
described as they deserve; but whole books are filled with the
empirical praise and the equally empirical abuse of this plant. It is
true that it can produce ptyalism, it may therefore possess an excitant
action on the lymphatic system, and be of permanent advantage in
cases where it is requisite to restrain the excessive action of the
absorbent vessels.1 Now as it, besides this, produces pains (in large
doses violent pains) in the glands, it may easily be conceived that
1 If employed in inactivity of these vessels, it will first act as a palliative; afterwards do little one way or other; and lastly, prove injurious, by the production of
the opposite condition to that wished for,




THE CURATIVE POWERS OF DRUGS.

317

in painful induration of the glands, in cancer, and in the painful
nodes that the abuse of mercury leaves, it may be the best remedy,
in moderate doses, not only for curing almost specifically this
peculiar kind of chronic pains, in a more effectual and durable
manner than the palliative opium and all other narcotic remedies
which act in a different manner, but also for dispersing the glandular
swellings themselves, when they either have their origin, as above
described, in excessive local or general activity of the lymphatic
vessels, or occur in an otherwise robust frame, so that the removal
of the pains is all that is required in order to enable nature to cure
the complaint herself. Painful glandular swellings from external
injuries are of this description.'
In true cancer of the breast, where an opposite state of the
glandular system, a sluggishness of it, seems to predominate, it
must certainly do harm on the whole (it may at first soothe the
pains), and especially must it aggravate the disease when the system, as is often the case, is weakened by long-continued suffering;
and it will do harm all the more rapidly, because its continued
use produces, as a secondary action, weakness of the stomach
and of the whole body. From the very reason that it, like other
umbelliferous plants, specifically excites the glandular system, it
may, as the older physicians remarked, cure an excessive secretion
of milk. As it shows a tendency to paralyse the nerves of sight in
large doses, it is comprehensible why it has proved of service in
amaurosis. It has removed spasmodic complaints, hooping cough,
and epilepsy, because it has a tendency to produce convulsions. It
will still more certainly be of use in convulsions of the eyes and
trembling of the limbs, because in large doses it developes exactly
the same phenomena. The same with respect to giddiness.
The fact that fools parsley (cethusa cynapium), besides other
1 A healthy peasant child got, from a violent fall, a painful swelling of the under
lip, which increased very much in the course of four weeks in hardness, size, and
painfulness. The juice of the spotted hemlock applied to it, effected a cure without
any relapse in fourteen days. A hitherto uncommonly healthy, robust girl, had
severely bruised the right breast, whilst carrying a heavy burden, with the strap of
the basket. A small tumour arose, which for six months increased in violence of
pain, in size, and hardness, at each monthly period. The external application of
spotted hemlock juice cured it within five weeks. This it would have done sooner,
had it not affected the skin, and produced there painful pustules, in consequence of
which it had frequently to be discontinued for several days.




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affections, as vomiting, diarrhoea, colicky pains, cholera, and others
for the truth of which I cannot vouch (general swelling, &c.), produces so specifically imbecility, also imbecility alternately with
madness, should be of use to the careful physician in this disease,
otherwise so difficult of cure. I had a good extract of it prepared
by myself, and once, when I found myself, from much mental work
of various kinds coming upon me in rapid succession, distracted
and incapable of reading any more, I took a grain of it. The effect
was an uncommon disposition for mental labour, which lasted for
several hours, until bed-time. The next day, however, I was less
disposed for mental exertion.
The water hemlock (cicuta virosa) causes, among other symptoms,
violent burning in the throat and stomach, tetanus, tonic cramp of
the bladder, lockjaw, erysipelas of the face, head-aches, and true
epilepsy; all diseases for which we require efficient remedies, one
of which, it may be hoped, will be found in this powerfully-acting
root, in the hands of the cautious but bold physician.
Amatus the Portuguese observed that cocculus seeds (menispermum cocculus), in the dose of four grains, produced nausea,
hiccough, and anxiety in an adult man. In animals they produced
a rapid, violent, but when the dose was not fatal, a transitory stupefaction. Our successors will find in them a very powerful medicine,
when the morbid phenomena these seeds produce shall be more
accurately known. The Indians use the root of this tree, among
other things, in malignant typhus (that accompanied by stupefaction).
The fox-grape (paris quadrifolia) has been found efficacious in
cramps. The leaves cause, in large doses at all events, cramp in
the stomach, according to the still imperfect experience we possess
of the morbid phenomena they are capable of developing.
Coffee produces, in large doses, head-aches; it therefore cures, in
moderate doses, head-aches that do not proceed from derangement
of the stomach or acidity in the primse vive. It favours the peristaltic motion of the bowels in large doses, and therefore cures in
smaller doses chronic diarrhoeas, and in like manner the other
abnormal effects it occasions might be employed against similar
affections of the human body, were we not in the habit of misusing
it. The effects of opium in stupifying the senses, and irritating
the tone of the fibres, are removed by this berry in its character




THE CURATIVE POWERS OF DRUGS.

319

of an antagonistic palliative remedy, and that properly and effectually, for here there is no persistent state of the organism, but
only transitory symptoms to be combated. Intermittent fevers,
too, where there is a want of irritability and inordinate tension of
the fibres, precluding the employment of the otherwise specific
bark, it apparently suppresses in large doses, merely as a palliative
remedy; its direct action, however, in such large doses, lasts for
two days.
The bitter-sweet (solanum dulcamara) produces, in large doses,
among other symptoms, great swelling of the affected parts and acute
pains, or insensibility of them, also paralysis of the tongue (and of the
optic nerves?). In virtue of the last powerful action, it is not to
be wondered at that it has cured paralytic affections, amaurosis,
and deafness, and that it will render still more specific service in
paralysis of the tongue, in moderate doses. In virtue of the two
first properties, it is a main remedy in chronic rheumatism, and in
the nocturnal pains from the abuse of mercury.  In consequence
of its power of causing strangury, it has been useful in obstinate
gonorrhcea, and from its tendency to bring about itching and
shooting in the skin, it shows its utility in many cutaneous eruptions and old ulcers, even such as arise from abuse of mercury.
As it causes, in large doses, spasms of the hands, lips and eyelids,
as also shaking of the limbs, we may easily understand how it
has been useful also in spasmodic affections. In nymphomania it
will probably be of use, as it acts so specifically on the female
genital organs, and has the power of causing (in large doses) itching and pains in these parts.
The berries of the black nightshade (solanum nigrum) have caused
extraordinary convulsions of the limbs, and also delirious raving.
It is, therefore, probable that this plant will do good in what are
called possessed persons (madness, with extraordinary, emphatic,
often unintelligible talking, formerly considered prophesying and
the gift of unknown tongues, accompanied by convulsions of the
limbs), especially where there are at the same time pains in the
region of the stomach, which these berries also produce in large
doses. As this plant causes erysipelas of the face, it will be useful
in that disease, as has already been ascertained from its external
employment. As it causes, to a still greater degree than bittersweet, by being used internally, external swellings, that is, a




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transient obstruction in the absorbent system, its great diuretic
power is only the indirect secondary result; and hence its great
virtue in dropsy, from similarity of action, is plainly perceptible; a
medicinal quality of so much the greater value, as most of the
remedies we possess for this disease are merely antagonistically
acting (exciting the lymphatic system in a merely transitory
manner), and consequently palliative remedies, incapable of effecting a permanent cure. As, moreover, in large doses it causes not
only swelling, but general inflammatory swelling, with itching, and
intolerable burning pains, stiffness of the limbs, pustular eruptions,
desquamation of the skin, ulcers, and sphacelus, where is the wonder
that its external application has cured divers pains and inflammations? Taking all the morbid symptoms together that the black
nightshade produces, we cannot mistake their striking resemblance
to raphania, for which it will, most probably, be found to be a specific remedy.
It is probable that the deadly nightshade (atropa belladonna)
will be useful, if not in tetanus, at least in trismus (as it produces
a kind of lockjaw), and in spasmodic dysphagia (as it specifically
causes a difficulty of swallowing); both these actions belong to its
direct action. Whether its power over hydrophobia, if it do
possess any, depends on the latter property alone, or also on its
power of suppressing palliatively, for several hours, the irritability
and excessive sensitiveness that are present in so great a degree in
hydrophobia, I am unable to determine. Its power of soothing
and dispersing hardened, painful and suppurating glands, is owing,
undeniably, to its property of exciting, in its direct action, boring,
gnawing pains in these glandular swellings. Yet I conceive that
it acts antagonistically, that is, in a palliative and merely temporary manner, in those which proceed from excessive irritation of
the absorbent system (with subsequent aggravation, as is the case
with all palliatives in chronic diseases); but, by virtue of similarity, that is, permanently and radically, in those arising from
torpor of the lymphatic system.  (Then it would be serviceable in
those glandular swellings in which the spotted hemlock (conium
maculatum) cannot be used, and the latter will be useful where
the former does injury.) As, however, its continued employment
(by reason of its indirect secondary action) exhausts the whole
body, and when given in too large, or too often repeated doses,




THE CURATIVE POWERS OF DRUGS.

321

has a tendency to produce a gangrenous fever, its good effects will
sometimes be destroyed by these secondary bad consequences,
and fatal results may ensue (especially in the case of cancerous
patients, whose vital powers have been exhausted by the sufferings
of many years), if it be not cautiously employed. It produces
directly mania (as also, as above described, a kind of tonic cramp);
but clonic cramps (convulsions) it only produces as a secondary
action, by reason of the state of the organism that remains after
the direct action of belladonna (obstruction of the animal and
natural functions).  Hence its power in epilepsy with furor is
always most conspicuous upon the latter symptom, whilst the
former is generally only changed by the antagonistic (palliative)
action of belladonna, into trembling, and such-like spasmodic
affections peculiar to weakened irritable systems. All the spasmodic
symptoms that belladonna produces in its direct primary action
are of a tonic character; true, the muscles are in a state of paralytic relaxation, but their deficient irritability causes a kind of
immobility, and a feeling of health, as if contraction were present.
As the mania it excites is of a wild character, so it soothes manias
of this sort, or at least deprives them of their stormy nature. As
it extinguishes memory in its direct action,' nostalgia (home sickness) is aggravated, and, as I have seen, is even produced by it.
Moreover, the increased discharge of urine, sweat, menses,
faeces, and saliva, which have been observed, are merely consequences of the antagonistic state of the body, remaining after an
excessive exaltation of the irritability, or else sensitiveness during
the indirect secondary action, when the direct primary action of
the drug is exhausted, during which, as I have several times
observed, all these excretions are often completely suppressed by
large doses for ten hours and more.   Therefore, in cases where
these excretions are discharged with difficulty, and excite some
serious disease, belladonna removes this difficulty permanently
and completely, as a similarly-acting remedy, if it be owing to
tension of the fibres, and want of irritability and sensibility. I
say, purposely, serious disease, for only in such cases is it allowable
to employ one of the most violent of medicines, which demands
such caution in its use. Some kinds of dropsy, green sickness,
1 It will, therefore, be useful in weakness of memory.




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&c., are of this nature. The great tendency of belladonna to
paralyse the optic nerve, makes it important, as a similarly-acting
remedy, in amaurosis.1 In its direct action it prevents sleep, and
the deep sleep which subsequently ensues is only in consequence
of the opposite state produced by the cessation of this action. By
virtue, therefore, of this artificial disease, belladonna will cure
chronic sleeplessness (from want of irritability) more permanently
than any palliative remedy.
It is said to have been found beneficial in dysentery; probably,
as in its direct action it retards the stool, in the most simple cases
of diarrhoea, with suppressed faecal evacuations, and rare motions,
but not in dysentery with lienteric diarrhoea, where it must do
positive harm. Whether, however, it is appropriate for dysentery,
by reason of its other actions, I am unable to say.
It produces apoplexy; and if it have, as we are told, been found
serviceable in serous apoplexy, it is owing to this property.
Besides this, its direct action causes an internal burning, with
coldness of the external parts.
Its direct action lasts twelve, twenty-four, and forty-eight hours.
Hence, a dose should not be repeated sooner than after two days.
A more rapid repetition of ever so small a dose must resemble in
its (dangerous) effects the administration of a large dose. Experience teaches this.
The fact that henbane (hyoscyamus niger) in large doses diminishes remarkably the heat of the body and relaxes its tone for a
short time in its direct action, and therefore is an efficacious
palliative remedy when given in moderate doses inwardly and
outwardly in sudden attacks of tension of the fibres and inflammation, does not fall to be considered in this place. This is not the
case, however, with the observation, that this property only
enables it to palliate very imperfectly, in any dose, chronic affections with tension of the fibre; in the end, however, it rather
increases than diminishes them by its indirect secondary action,
which is exactly the opposite of its primary action.     On the
other hand, it will help to assist the power of the strengthening remedy in chronic relaxation of the fibres, as in its primary
action it relaxes, and in its secondary action it tends all the more
I have myself seen the good effects of it in this disease.




THE CURATIVE POWERS OF DRUGS.

323

to elevate the tone, and that in a durable manner. In large doses
it likewise possesses the power of producing hlemorrhage, especially bleeding of the nose, and frequently recurring catamenial
flux, as I and others have ascertained. For this reason it cures
chronic hamorrhages, in small doses, in an extremely effectual
and lasting manner. The most remarkable thing is the artificial
disease it produces in very large doses, suspicious, quarrelsome,
spitefully- calumnious, revengeful, destructive, fearless,' mania
(hence, henbane was termed by the ancients altercum); and this is
the kind of mania it specifically cures, only that in such cases a
tenseness of fibre sometimes hinders its effects from being permanent. Difficulty of moving, and insensibility of the limbs, and
the apoplectic symptoms it produces, it may also very probably be
capable of curing.    In large doses it produces, in its direct
primary action, convulsions, and is consequently useful in epilepsy,
probably also in the loss of memory usually accompanying it, as
it has the power of producing want of recollection.
Its power of causing in its direct action sleeplessness with constant tendency to slumber, makes it in chronic sleeplessness a
much more permanent remedy that the frequently merely palliative opium, especially as it at the same time keeps the bowels
open, although only by the indirect secondary action of each dose,
consequently in a palliative way. It causes dry cough, dryness of
the mouth and nose, it its direct action; it is, therefore, very
useful in tickling cough, probably also in dry coryza. The flow of
mucus from the nose, and the flow of saliva observed from its use,
only belong to its indirect secondary action. The seeds cause convulsions in the facial and ocular muscles, and by their action on the
head, cause vertigo, and a dull pain in the membranes lying under
the skull. The practical physician will be able to take advantage
of this. Its direct action lasts scarcely twelve hours.
The thorn-apple (datura stramonium) causes extraordinary waking
dreams, unconsciousness of what is going on, loud delirious talking, like a person speaking in sleep, with mistakes respecting
personal identity. A similar kind of mania it cures specifically.
It excites very specific convulsions, and has thus often proved
1 The subsequent indirect secondary action is a kind of faint-heartedness and
fearfulness.




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useful in epilepsy.   Both properties render it serviceable in the
case of persons possessed. Its power of extinguishing recollection
should induce us to try it in cases of weak memory. It is most
useful where there is great mobility of the fibre, because its direct
action in large doses is increased fibrous mobility. It causes (in
its direct action?) heat and dilatation of the pupil, a kind of dread
of water, swollen, red face, twitching in the ocular muscles,
retarded stool, difficult breathing; in its secondary action, slow,
soft pulse, perspiration, sleep.
The direct action of large doses lasts about twenty-four hours;
of small doses, only three hours.  Vegetable acids, and apparently
citric acid in particular, suddenly put a stop to its whole action.1
The other species of datura seem to act in a similar manner.
The specific properties of Virginian tobacco (nicotiana tabacum)
consist, among other things, in diminishing the external senses,
and obscuring the intellect; it may therefore be useful in weakness
of mind. Even in a very small dose, it excites the muscular action
of the primae vise violently; a property which is valuable as a
temporary oppositely-acting remedy (as is well known, though it
does not fall to be considered here); and as a similarly-acting
remedy it is probably serviceable in chronic disposition to vomiting
and to colics, and spasmodic constriction of the oesophagus, as indeed experience partially corroborates. It diminishes the sensibility
of the primse vime; hence its palliative power of lessening hunger
(and thirst?) In larger doses, it deprives of their irritability the
muscles of voluntary motion, and temporarily removes from them
the influence of the cerebral power. This property may give it, as
a similarly-acting remedy, curative powers in catalepsy; but this
very property makes its constant employment in large quantities
(as with tobacco-smokers and snuff-takers) so injurious to the
tranquil state of the muscles belonging to the animal functions, that
a tendency to epilepsy, hypochondriasis, and hysteria, are in course
of time developed. The remarkable fact, that the employment of
tobacco is so agreeable to insane persons, arises from the instinct
i A patient, who was always violently affected by two grains of the extract of the
plant, once experienced not the slightest effects from this dose. I learned that he
had partaken of the juice of a large number of red currants: a considerable dose of
pulverized oyster-shells at once restored the full efficacy of the thorn-apple.




THE CURATIVE POWERS OF DRUGS.

325

of those unfortunates to produce a palliative obtuseness in the
sensibility of their hypochondria  and brain (the two usual seats of
their complaints). But as it is here an oppositely-acting remedy,
it gives them but temporary relief; their desire for it increases,
but the end for which it is taken is not attained,-on the whole, the
complaint is thereby increased, as it renders no permanent service.
Its direct action is limited to a few hours, except in the case
of very large doses, which extend to twenty-four hours (at the
farthest).
The seeds of the poison-tree (strychnos nux vomica) are very
powerful; but the morbid symptoms it produces are not yet accurately known. The most I know concerning them is derived from
my own observation. They produce vertigo, anxiety, febrile rigor,
and in their secondary action a certain immobility of all parts, at
least of the limbs, and a spasmodic stretching, according to the
size of the dose. Hence they are useful, not only, as is already
known, in intermittent fever, but in cases of apoplexy. In their
first direct action, the muscular fibre has a peculiar mobility imparted to it, the sensitive system is morbidly exalted to a species of
intoxication, accompanied by fearfulness and horror.        Convulsions ensue. The irritability seems to exhaust itself during this
continued action on the muscular fibre, first in the animal, then in
the vital functions. On passing into the indirect secondary action,
there occurs a diminution of the irritability, first in the vital finctions (general perspiration), then in the animal, and lastly in the
natural functions. In the latter, especially, this secondary action
lasts several days. During the secondary action, there is a diminution of sensibility. Whether in the primary direct action the
tonicity of the muscle is diminished, to be proportionately increased
in the secondary action, cannot be accurately determined; this
much, however, is certain, that the contractility of the fibre is as
much diminished in the secondary action, as it was increased in the
direct action.
If this be true, nux vomica produces attacks similar to hysterical
1 To this belongs the feeling of insatiable hunger, which many insane persons
suffer from, and for which they generally appear to use tobacco; at least, I have seen
some, who had no desire for tobacco, especially such as were affected with melancholia,
who had very little hunger.




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and hypochondriacal paroxysms, and this explains why it is so often
useful in these complaints.
Its tendency to excite, in its primary direct action, the contractility of the muscles, and cause convulsions, and then again in
its secondary action to diminish to an excessive degree the contractility of the muscles, shows such a resemblance to epilepsy, that
from this very circumstance we must have inferred that it would
heal this disease, had not experience already demonstrated it.
As it excites, besides vertigo, anxiety and febrile rigor, a kind
of delirium consisting in vivid, sometimes frightful visions, and
tension in the stomach, so it once quickly subdued a fever in a
laborious reflective mechanic in the country, which began with
tension in the stomach, followed by a sudden attack of vertigo, so
as to make him fall, that left behind it a kind of confusion of the
understanding, with frightful, hypochondriacal ideas, anxiety, and
exhaustion. In the morning he was pretty lively and not exhausted,
but in the afternoon, about two o'clock, the attack commenced.
He got nux vomica, in increasing doses, one daily, and improved.
At the fourth dose, which contained seventeen grains, there
occurred great anxiety, immobility and stiffness of the limbs, ending
in a profuse perspiration. The fever and all the nervous symptoms
disappeared, and never returned, although for many years previously he had from time to time been subject to such attacks
suddenly occurring, yet unaccompanied by fever.
Its tendency to cause cramps in the abdomen, anxiety and pain
in the stomach, I availed myself of in a dysenteric fever (without
purgings), in persons living in the same house with dysenteric
patients. In these cases it diminished the feeling of discomfort in
the limbs, the feverishness, the anxiety, and the pressure in the
stomach; it produced the same good results in some of the patients,
but as they had simple dysentery without diarrhoea, it made the
evacuations still rarer, from its tendency to cause constipation.
The signs of deranged biliary secretion showed themselves, and the
dysenteric evacuations, though rarer, were accompanied by just as
great tenesmus as before; and were of as bad a character. The
symptom of loss of taste, or perverted taste, remained. Its tendency
to diminish the peristaltic movements was therefore disadvantageous
in the true simple dysentery. In diarrhoeas, even such as are of a
dysenteric character, it will be more serviceable, at least as a pal



THE CURATIVE POWERS OF DRUGS.

327

liative remedy. During its employment, I witnessed twitching
movements under the skin, as if caused by live animals, in the
limbs, and especially in the abdominal muscles.
St. Ignatius' bean (ignatia amara) has been observed to produce
trembling of several hours' duration, twitchings, cramps, irascibility,
sardonic laughter, giddiness, cold perspiration. In similar cases it
will show its efficacy, as experience has partly demonstrated. It
produces febrile rigor, and (in its secondary action?) stiffness of
the limbs, and thus it has cured, by similarity of action, intermittent fever, which would not yield to bark; probably it was that
less simple form of intermittent in which the complication consisted of excessive sensitiveness and increased irritability (especially
of the primae viae). But the other symptoms it can produce must
be more accurately observed, before we can employ it in those
cases for which it is exactly suited from similarity of symptoms.
The purple foxglove (digitalis purpurea) causes the most excessive
disgust at food; during its continued use, therefore, ravenous
hunger not unfrequently ensues. It causes a kind of mental derangement, which is not easily recognisable, as it only shows itself
in unmeaning words, refractory disposition, obstinacy, cunning,
disobedience, inclination to run away, &c., which its continued use
frequently prevents. Now as, in addition to these, it produces in
its direct action violent headaches, giddiness, pain in the stomach,
great diminution of the vital powers, sense of dissolution and the
near approach of death, a diminution of the rapidity of the heart's
beats by one half, and reduction of the vital temperature, it may
easily be guessed in what kind of madness it will be of service; and
that it has in fact been useful in some kinds of this disease, many
observations testify, only their particular symptoms have not been
recorded. In the glands it creates an itching and painful sensation, which accounts for its efficacy in glandular swellings.
It produces, as I have seen, inflammation of the Meibomian
glands, and is a certain cure for such inflammations. Moreover, as
it appears to depress the circulation, so does it seem to excite the
absorbent vessels, and to be most serviceable where both are too
torpid. The former it assists by virtue of similarity, the latter by
virtue of antagonism of action. But as the direct action of foxglove
persists so long (there are examples of its lasting five or six days),
it may, as an antagonistically acting remedy, take the place of a




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permanent curative agent. The last observation is in reference to
its diuretic property in dropsy; it is antagonistic and palliative, but
nevertheless enduring, and valuable on that account merely.
In its secondary action it causes a small, hard, rapid pulse; it is
not therefore so suitable for patients who have a similar (febrile)
pulse, but rather for such as have a pulse like what foxglove produces in its direct action-slow, soft. The convulsions it causes in
large doses, assign it a place among the anti-epileptic remedies;
probably it is only useful in epilepsy under certain conditions, to
be determined by the other morbid symptoms it produces. During
its use, objects not unfrequently appear of various colours, and the
sight becomes obscured; it will remove similar affections of the
retina. (Its tendency to produce diarrhoea, sometimes so adverse
to the cure, is counteracted, as I have ascertained, by the addition
of potash.)
As the direct action of foxglove lasts occasionally several days
(the longer its use is continued, the longer lasts the direct action
of each dose; a very remarkable fact, not to be lost sight of in
practice), it is evident how erroneously those act, who, with the
best intentions, prescribe it in small but frequently repeated doses,
(the action of the first not having expired before they have already
given the sixth or eighth), and thus in fact they give, although
unwittingly, an enormous quantity, which not unfrequently causes
death.1 A dose is necessary only every three, or at most every two
days, but the more rarely the longer it has been used. (During
the continuance of its direct action, cinchona bark must not be
prescribed; it increases the anxiety caused by foxglove, as I have
found, to an almost mortal agony.)
The pansy violet (viola tricolor) at first increases cutaneous eruptions, and thus shows its power to produce skin diseases, and
consequently to cure the same effectually and permanently.
Ipecacuanha is used with advantage in affections against which
nature herself makes some efforts, but is too powerless to effect the
desired object. In these ipecacuanha presents to the nerves of the
I A woman in Edinburgh got for three successive days, each day, three doses,
each dose consisting of only two grains of the pulverized leaves of foxglove, and it
was a matter of surprise that she died from such small doses, after vomiting for six
days. It must be remembered, however, that it was the same as if she had taken
eighteen grains at one dose.




THE CURATIVE POWERS OF DRUGS.

329

upper orifice of the stomach, the most sensitive part of the organ
of vitality, a substance that produces a most uncongenial disgust,
nausea, anxiety, thus acting in a similar manner to the morbid
material that is to be removed. Against this double attack, nature
exerts antagonistically her powers with still greater energy, and
thus, by means of this increased exertion, the morbid matter is the
more easily removed. Thus fevers are brought to the crisis, stoppages in the viscera of the abdomen and of the chest, and in the
womb, put in motion, miasmata of contagious diseases expelled by
the skin, cramp relieved by the cramp that ipecacuanha itself produces, their tension and freedom restored to vessels disposed to
hamorrhage from relaxation, or from the irritation of an acrid
substance deposited in them, &c. But most distinctly does it act
as a similarly acting remedy to the disease sought to be cured, in
cases of chronic disposition to vomit without bringing anything
away. Here it should be given in very small doses, in order to
excite frequent nausea, and the tendency to vomit goes off more
and more permanently at each dose, than it would with any palliative remedy.
Some benefit may be anticipated in some kinds of chronic palpitation of the heart, &c., from the administration of the rose-bay
(nerium  oleander), which has the power of causing palpitation,
anxiety, and fainting. It causes swellings of the abdomen and
diminution of the vital temperature, and seems to be a most powerful vegetable.
The morbid symptoms produced by the nerium antidysentericum
are not sufficiently known to enable us to ascertain the cause of its
real remedial powers; but as it primarily increases the stools, it
apparently subdues diarrhoeas as a similarly acting remedy.
The bear's-berry (arbutus uva ursi) has actually, without possessing any acridity perceptible to the senses, not unfrequently increased
the difficulty of passing water, and the involuntary flow of urine,
by some power peculiar to itself; thereby showing that it has a
tendency to produce such affections, and hence, as experience also
testifies, it is capable of curing similar disorders in a permanent
manner.
The golden-flowered rhododendron (rhododendron chrysanthum)
shows, by the burning, formicating, and shooting pains it produces
in the parts affected, that it is certainly fitted to relieve, by simin




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larity of action, pains in the joints of various kinds, as experience
also teaches. It causes difficulty of breathing and cutaneous
eruptions, and thus it will prove useful in similar disorders, as also
in inflammation of the eyes, because it produces lacrymation and
itching of the eyes.
The marsh-tea (ledum palustre) causes, as I have ascertained,
among other effects, difficult, painful respiration; this accounts for
its efficacy in hooping cough, probably also in morbid asthma.
Will it not be useful in pleurisy, as its power of so greatly
diminishing the temperature of the blood (in its secondary action) will hasten recovery?   It causes a painful shooting sensation in all parts of the throat, as I have observed, and hence its
uncommon virtues in malignant and inflammatory sore throat.
Equally specific is, as I have noticed, its power of causing troublesome itching in the skin, and hence its great efficacy in chronic
skin diseases.
The anxiety and the faintings it occasions may prove of use in
similar cases. As a transitory and antagonistically acting powerful
diuretic and diaphoretic remedy, it may cure dropsies; more
certainly, however, acute, than chronic.
On some of these properties depends its reputation in dysentery.
But were they real cases of dysentery, or some of those painful
diarrhoeas so often taken for it?   In the latter case it may, as a
palliative remedy, certainly hasten the cure, and even help to
complete it; but in true uncomplicated dysentery, I have never
seen it of any use. The long-continued weakness it occasions was
against its being used for a length of time, and it ameliorated
neither the tenesmus nor the character of the excretions, though
these became more rare. The symptoms of deranged biliary secretion were rather worse during its use, than when the patients
were left without medicine. It causes a peculiar ill-humour, headache, and mental confusion; the lower extremities totter, and the
pupils dilate. (Do both the latter symptoms, or merely the last,
belong to the secondary action only?)  An infusion of ten grains
once a day was a sufficient dose for a child six years old.
The primary direct action of opium (papaver somniferum) consists
in transitory elevation of the vital powers, and strengthening the tone
of the blood-vessels and muscles, especially of those belonging to the
animal and vital functions, as also in excitation of the mental




THE CURATIVE POWERS OF DRUGS.

331

organs-the memory, the imagination, and the organ of the passions;-thus, moderate doses are followed by a disposition to work,
sprightliness in conversation, wit, remembrance of former times,
amorousness, &c.; large doses by boldness, courage, revenge, inordinate hilarity, lasciviousness; still larger doses by furious madness,
convulsions.   The greater the dose, the more do the individuality,
the freedom, and the voluntary power of the mind suffer in sensations, and in power of judgment and of action. Hence, inattention
to external disagreeable circumstances, to pain, &c. This condition,
however, does not last long. It is gradually followed by loss of
ideas, the pictures of fancy fade by degrees, there supervene relaxation of the fibre, sleep. If the use of elevated doses is continued,
the consequences (indirect secondary action) are, weakness, sleepiness, listlessness, grumbling, discomfort, sadness, loss of memory
(insensibility, imbecility), until a new excitation by opium, or
something similar, is produced. In the direct action, the irritability
of the fibre seems to be diminished in the same proportion as its
tone is increased; in the secondary action, the latter is diminished,
the former increased.1 The direct action, still more than the secondary action, prevents the mind from taking cognizance of sensations (pain, sorrow, &c.), and hence its great pain-subduing power.
(In cases where only the direct action as a cordial is necessary, it
will be requisite to repeat the administration of it every three or
four hours, that is, each time before the relaxing secondary action,
which so much increases the irritability, ensues. In all such cases
it acts merely antagonistically, as a palliative remedy. Permanent
strengthening powers are not to be expected from it used in this
manner, least of all in chronic weakness. This, however, is a
digression.)
But if it is wished to depress permanently the tone of the fibre,
(I give this name to the power of the fibre to contract and relax
completely), to diminish permanently the deficiency of irritability,
1 There occurs a marked sensitiveness, especially for things that produce disagreeable effects, for fright, grief, fear, for inclement weather, &c. If the mobility of the
fibre which occurs secondarily is called increased irritability, I have nothing to
object to the term; its sphere of action, however, is but small: it is either that the fibre
is too relaxed, and cannot contract much, or that it is in a too contracted condition,
and is relaxed easily indeed, but not sufficiently, consequently is incapable of making
any powerful effort. In this condition of the fibre, the tendency to chronic inflammation is unmistakeable.




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as is the case in some cases of mania, in such circumstances we
may employ opium with success, as a similarly acting remedy, given
in elevated doses, and making use of its indirect secondary action.
We must consider the treatment which consists in giving opium
in true inflammatory diseases, e.g. pleurisy, to be according to
this principle.
In such cases, a dose is necessary every twelve or twenty-four
hours.
It appears that this indirect secondary action has been made use
of on the principle of a similarly acting remedy; which, as far as I
am aware, is not the case with any other medicine. Opium has,
for instance, been given with the greatest success, (not in true
venereal diseases, for that would be a delusion,) but in the disastrous effects that so often arise from the abuse of mercury in
syphilis, which are sometimes much worse than the syphilis itself.
Before illustrating this employment of opium, I must say something appropriate to the subject, concerning the nature of syphilis,
and introduce here what I have to say concerning mercury.
Syphilis depends upon a virus, which, besides other peculiarities that it developes in the human body, has an especial
tendency to produce inflammatory and suppurating swellings of the
glands (to weaken the tone?), to make the mechanical connexion
of the fibres so disposed to separation, that numerous spreading
ulcers arise, whose incurable character may be known by their
round figure; and lastly, to increase the irritability. Now, as such
a chronic disease can only be cured by a remedy capable of
developing a disease of similar character, no more efficacious
remedy could be conceived than mercury.
The most remarkable power of mercury consists in this, that in
its direct action it irritates the glandular system, (and leaves behind
it glandular indurations as its secondary indirect action,) weakens
the tone of the fibres and their connexion, and disposes them to
separation in such a manner, that a number of spreading ulcers
arise, whose incurable nature is shown by their round form; and
lastly, increases uncommonly the irritability (and sensibility).
Experience has confirmed it as a specific; but as there does not
exist any remedy exactly similar to the disease, so the mercurial
disease (the changes and symptoms it usually produces in the body)
is still very different from the nature of syphilis. The syphilitic




THE CURATIVE POWERS OF DRUGS.

333

ulcers are confined to the most superficial parts, especially the
deuteropathic ones, (the protopathic ulcers increase slowly in extent,) they secrete a viscid fluid in place of pus, their borders are
almost level with the skin (except the protopathic ones), and are
almost quite painless (excepting the protopathic ulcer, that arising
from the primary infection, and the suppurating inguinal gland).
The mercurial ulcers burrow deeper, (rapidly increase in size,) are
excessively painful, and secrete sometimes an acrid thin ichor;
sometimes they are covered with a dirty cheesy coating, their borders also become everted. The glandular swellings of syphilis remain
but for a few days; they are either rapidly resolved, or the gland
suppurates. The glands attacked by mercury are stimulated to
increased action by the direct action of this metal, (and thus glandular swellings from other causes disappear rapidly under its use,)
or they are left in the state of cold indurations during the indirect
secondary action. The syphilitic virus produces induration of the
periosteum of those bones which are nearest the surface and least
covered with flesh; they are the seat of excessive pains. In our
days this virus, however, never produces caries, notwithstanding
all my researches to discover the contrary. Mercury destroys the
connexion of the solid parts, not of the soft parts only, but also of
the bones; it first corrodes the most spongy and concealed bones,
and this caries is only aggravated the more rapidly by the continued
use of the metal.    Wounds which have arisen from        external
violence are changed by the use of mercury into old ulcers, difficult of cure; a circumstance that does not occur with syphilis.
The trembling, so remarkable in the mercurial disease, does not
occur in syphilis. From the use of mercury there ensues a
slow, very debilitating fever, with thirst, and great and rapid
emaciation.   The emaciation and weakness from syphilis come on
slowly, and remain within moderate limits. Excessive sensitiveness and sleeplessness are peculiar to the mercurial disease, but not
to syphilis. The most of these symptoms seem to be owing rather
to the indirect secondary action, than to the direct action of the
mercury.
I have been so circumstantial on this subject, because it is often
very difficult' for the practitioner to distinguish the chronic
SStoll (Rat. Med. Part iii, p. 442,) doubts if there are certain signs of a perfectly
cured syphilitic disease, i. e., he himself knew not the signs whereby this disease i
distinguishable from the mercurial disease.




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mercurial disease from the symptoms of syphilis; and thus he will
be apt to consider symptoms as belonging to that disorder, whilst
they are only mercurial, and go on treating them with mercury,
whereby so many patients are destroyed; chiefly, however, because
my object is to depict the mercurial disease, in order to show how
opium can cure it, by virtue of similarity of action.
Opium raises the sinking forces of patients suffering from the
mercurial disease, and allays their irritability, when its direct
action is kept up, that is, when it is given at least every eight
hours; and this it does as an antagonistically-acting remedy.
This happens, however, only when it is given in large doses,
proportioned to the degree of weakness and irritability, just as it
is serviceable only in large and oft-repeated doses in the excessive
irritability of hysterical and hypochondriacal patients, and in the
excessive sensibility of exhausted individuals. The normal condition of the body seems thereby to be restored; a secret metamorphosis seems to take place in the organism, and the mercurial
disease is gradually conquered. The convalescent patient can only
bear smaller and smaller doses.   Thus the mercurial disease
seems, to be vanquished by the palliative antagonistic power of the
opium; but any one who is aware of the almost uneradicable
nature of the mercurial disease, the irresistible manner in which it
destroys and dissolves the animal frame when it is at its height,
will be convinced that a mere palliative could never master this
excessively chronic malady, were it not that the secondary effects
of opium were very analogous to the mercurial disease, and that
these tended to overcome the latter. The secondary effects of the
continued use of opium in large doses, increased irritability, weakness of the tone, easy separation of the solids, and difficult curability of wounds, trembling, emaciation of the body, drowsy
sleeplessness, are very similar to the symptoms of the mercurial
disease; and only in this do they differ, that those of mercury,
when they are severe, last for years, often for a lifetime, whilst
those of opium last but hours or days. Opium must be used for a
long time, and in enormous doses, for the symptoms of its
secondary  action to last for weeks or longer.     These brief
secondary effects of opium, whose duration' is limited to a short
time, are thus the true antidote of the mercurial secondary effects
in their greatest degree, which are almost unlimited in their




THE CURATIVE POWERS OF DRUGS.

335

duration; from them alone, almost, can one expect a permanent,
true recovery. These secondary actions can develope their curative
power during the whole treatment, in the interval betwixt the
repetition of the doses of opium, as soon as the first direct action
of each dose is passed, and when its use is discontinued.
Lead produces, in its primary action on the denuded nerves
(belonging to muscular action?) a violent tearing       pain, and
(thereby?) relaxes the muscular fibre to actual paralysis; it
becomes pale and withered, as dissection shows, but its external
sensibility still remains, though in a diminished degree. Not only
is the power of contraction of the affected fibres diminished, but
the motion that still remains is more difficult than in other similar
relaxations, from almost total loss of the irritability.1 This, however,
is observed only in the muscles belonging to the natural and animal
functions, but in those belonging to the vital functions this effect
occurs without pain and in a less degree. As the reciprocal play
of the vascular system becomes slower, (a hard, slow pulse,) this
satisfactorily explains the diminished temperature of the blood
attending the action of lead.
Mercury also diminishes the mutual attraction of the various
parts of the muscular fibres, but increases their susceptibility for the
stimulus, so as to impart to them an excessive mobility.  Whether
this effect be the direct or the indirect secondary action, it suffices
that it is very enduring; and hence, even if of the latter character,
it would be very efficacious, as an oppositely-acting remedy in the
lead disease; if of the first character, however, it will act as a
similarly-acting remedy. Rubbed in externally, as well as given
internally, mercury has an almost specific influence over the lead
disease. Opium increases in its direct action the contraction of
the muscular fibre, and diminishes its irritability. By virtue of
the former property, it acts as a palliative in the lead disease; by
the latter, however, permanently, as a similarly-acting remedy.
From the above idea of the nature of the lead disease, it will be
seen that the service this metal (lead) has afforded, when cautiously
used in diseases, depends entirely on its antagonistic, though un1 The convulsive vomiting and dysenteric diarrhoea which sometimes follow the
ingestion of large quantities of lead, must be explained on other principles, and do
not fall to be considered here; neither does the vomiting that ensues from large
doses of opium.
o:  o;
~/ ee
*e




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commonly long-lasting, action, the consideration of which does not
belong to this Essay.
The true nature of the action of arsenic has not yet been accurately investigated. Thus much I have myself ascertained, that
it has a great tendency to excite that spasm in the blood-vessels,
and the shock in the nervous system, called febrile rigor. If it be
given in a pretty large dose (one-sixth or one-fifth of a grain) to an
adult, this rigor becomes very evident. This tendency makes it a
very powerful remedy as a similarly-acting medicine in intermittent
fever, and this all the more, as it possesses the power, observed by
me, of exciting a daily-recurring, although always weaker, paroxysm,
even although its use be discontinued. In typical diseases of all
kinds (in periodical head-ache, &c.), this type-exciting property of
arsenic in small doses (one-tenth to at most one-sixth of a grain in
solution) becomes valuable, and will, I venture to guess, become
invaluable to our perhaps bolder, more observant, and more cautious
successors. As its action lasts several days, so, frequently-repeated
doses, be they ever so small, accumulate in the body to an enormous, a dangerous dose. If, then, it be found necessary to give a
dose daily, each successive dose should be at least a third smaller
than the previous one. A better procedure is, when we have to
treat short typical diseases with, say, two days' interval, always to
prescribe a dose only for one fit two hours before it is expected,
pass over the following fit without giving any arsenic, and another
dose only about two hours before the third fit. It will be best to
act so even in the case of quartan fever, and only commence
to treat the series of intermediate paroxysms when we have
attained our object with regard to the first series of paroxysms.
(In the case of longer intervals, as seven, nine, eleven, and fourteen
days, a dose may be prescribed before each fit.)   The continued
use of arsenic in large doses gradually causes an almost constant
febrile state; it will thus, as indeed experience has, to a certain
degree, taught us, prove useful in hectic and remittent fever, as a
similarly-acting remedy, in small doses, (about one-twelfth of a
grain). Such a continued employment of arsenic, however, will
always remain a masterpiece of art, as it possesses a great disposition to diminish the vital heat and the tone of the muscular fibre.
(Hence the paralyses from a strong dose, or a long-continued and
incautious employment of it.) (These latter properties will enable it




THE CURATIVE POWERS OF DRUGS.

337

to prove of service as an antagonistic remedy in pure inflammatory
diseases.) It diminishes the tone of the muscular fibre, by diminishing the proportion and cohesion of the coagulable lymph in the
blood, as I have convinced myself, by drawing blood from persons
suffering from the effects of arsenic, more especially such as had a
too inspissated blood before the use of this metallic acid. But not
only does it diminish the vital heat, and the tone of the muscular
fibre, but also, as I think I have fairly proved to myself, the sensibility of the nerves.  (Thus, in cases of maniacs, with tense fibre,
and inspissated blood, a small dose of it procures quiet sleep, in its
character of an antagonistically-acting substance, where all 6ther
remedies fail. Persons poisoned by arsenic are more composed
about their state, than might be expected. Thus, it generally
seems to kill more by extinguishing the vital power and sensibility,
than by its corrosive and inflammatory power, which is only local
and circumscribed. This being borne in mind, the rapid decomposition of the bodies of those poisoned by arsenic, like cases of
death by mortification, will be readily comprehended.) It weakens
the absorbent system, a circumstance whence, perhaps, we may one
day derive some curative power (as a similarly or as an antagonistically-acting remedy?), but which must be always a powerful
objection to its long-continued use. I would direct attention to
its peculiar power of increasing the irritability of the fibre, especially of the system of the vital functions. Hence cough, and
hence the above-mentioned chronic febrile actions.
When arsenic is used for a length of time, and in pretty large
doses, it seldom fails, especially if diaphoretics and a heating diet
be used simultaneously, to cause some chronic cutaneous disease (at
least desquamation of the skin). This tendency renders it an
efficacious remedy in the hands of the Indian physician, in that
frightful skin disease, elephantiasis. Would it not also be serviceable in pellagra?  If it be truly (as is confidently affirmed) of
service in hydrophobia, it must act by virtue of its power to diminish
(the influence of the nerves on) the attraction of the parts of the
muscular fibre and its tone, as also the sensibility of the nerves,
therefore antagonistically. It produces acute, continued pains in
the joints, as I have seen. I shall not attempt to determine how
we may avail ourselves of this property in a curative point of
view.




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What influence the arsenic disease, the lead disease, and the
mercurial disease, may have over each other, and if the one may be
destroyed by means of the other, future observations can alone
decide.
Should the accidents produced by a long-continued use of arsenic
become threatening (besides the employment of sulphuretted
hydrogen in drinks and baths to extirpate what still remains of the
substance of the metal), the free use of opium in the same manner
as in the mercurial disease (see above) will be of service.
I revert again to vegetable substances; and first, I shall mention
a plant, which in violence and duration of action, deserves to be
placed alongside the mineral poisons; I allude to the yew (taxus
baccata). Great circumspection must be employed in the use of
its various parts, more particularly of the bark of the tree when in
flower; the cutaneous eruptions, with signs of gangrenous decomposition of the fibre, which sometimes occur several weeks after
the last dose, the fatal catastrophe that sometimes takes place
suddenly, sometimes several weeks, after the last dose, with symptoms of mortification, &c., teach us this. It produces, it appears,
a certain acridity in all the fluids, and an inspissation of the lymph;
the vessels and fibres are irritated, and yet their functions are more
impeded than facilitated. The scanty evacuations, accompanied by
tenesmus, the dysuria, the viscid, salt, acrid saliva, the viscid, foetid
sweat, the cough, the flying acute pains in the limbs after perspiration, the podagra, the inflammatory erysipelas, the pustules on
the skin, the itching and redness of the skin, underneath which
the glands lie, the artificial jaundice, the horripilation, the continued fever, &c., it produces, are all proofs of this. But the
observations are not accurate enough to enable us to determine
which is the primary, which the secondary action. The direct
action seems to continue for a considerable time. A lax, unexcitable state of the fibres and vessels, especially of those belonging to
the absorbent system, which seem partly deprived of vital power,
appears to be its secondary action. Hence the perspiration, the
flow of saliva, the frequent discharge of watery urine, the hemorrhages (a dissolved state of the red parts of the blood); and after
large doses, or too long-continued employment, the dropsy, the
obstinate jaundice, the petechie, the gangrenous decomposition of
the fluids. Employed cautiously in gradually-increased doses, it




THE CURATIVE POWERS OF DRUGS.

339

may, as indeed experience has partly shown, be employed with
lasting advantage in a similar derangement of the fluids, and in a
similar state of the solids; in a word, in similar morbid states to
those it is capable of producing. In induration of the liver, jaundice,
and glandular swellings, with tense fibre, in chronic catarrh, catarrh
of the bladder (in dysentery, dysuria, tumours, with tense fibre?),
in amenorrhoea with tense fibre. (On account of its long-enduring,
direct action, it may sometimes be of permanent service as an
antagonistically-acting remedy in rachitis, in amenorrhoea with
relaxation, &c. But this does not belong to our subject.)
The monkshood (aconitum napellus) excites formicating, also acute
tearing pains in the limbs, in the chest, in the jaws; it is a prime
remedy in pains of the limbs of all kinds (?); it will be serviceable
in chronic tooth-ache of a rheumatic character, in pleurodynia, in
face-ache, and in the consequences of the implantation of human
teeth. It causes chilling pressure in the stomach, occipital headache, shootings in the kidneys, excessively painful ophthalmia,
cutting pains in the tongue; the practitioner will be able to employ
these artificial diseases in similar natural diseases. It has a peculiar
tendency to produce giddiness, faintings, debility, apoplexy, and
transient paralysis, general and partial paralysis, hemiplegia, paralysis of particular limbs,-of the tongue, of the anus, of the
bladder, obscuration of vision and temporary blindness, and singing
in the ears. It is also just as serviceable in general and partial
paralysis of the parts just mentioned, as experience has in a great
measure proved;-as a similarly-acting remedy, it has in several
cases cured incontinence of urine, paralysis of the tongue, and
amaurosis, as also paralysis of the limbs. In curable marasmus,
and partial atrophies, as a remedy capable of producing similar
morbid symptoms, it will certainly do more than all other known
remedies.   Successful cases of this kind are on record. Almost as
specifically does it produce convulsions, general as well as partial,
of the facial muscles, of the muscles of the lips on one side, of the
muscles of the throat on one side, of the ocular muscles. In all
these last affections it will prove useful, as it has also cured
epilepsies. It causes asthma; how, then, can it be wondered
at, that it has several times cured different sorts of asthma?
It produces itching, formication in the skin, desquamation, reddish eruption, and is hence so useful in bad cutaneous affections
z2




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and ulcers.  Its pretended efficacy in the most obstinate venereal
sufferings was probably only founded on its power over the
symptoms of the mercury that had been previously employed
in that disease; and this conclusion is justified by what we
know of its action.   It is valuable to know that monkshood, as
an exciter of pain, cutaneous affections, swellings, and irritability,in a word, as a similarly-acting remedy, is powerful in subduing
the similar mercurial disease, and is even preferable to opium, as
it leaves behind it no debility. Sometimes it causes a sensation
about the navel, as if a ball rose up thence, and spread a cold
feeling over the upper and back part of the head; this would
lead us to use it in similar cases of hysteria. In the secondary
action, the primary coldness in the head seems to change into a burning sensation. In its primary action are observed general coldness,
slow pulse, retention of urine, mania; in its secondary action, however, an intermitting, small, rapid pulse, general perspiration, flow of
urine, diarrhoea, involuntary faecal evacuation, sleepy intoxication.
(Like several other plants that produce a cooling effect in their
primary action, it resolves glandular swellings.) The mania it
causes is a gay humour alternating with despair. As a similarlyacting remedy, it will subdue manias of that sort. The usual
duration of its efficacy is from seven to eight hours, excepting in
cases of serious effects from very large doses.
The black hellebore (helleborus niger) causes, if used for a long
time, severe head-aches, (hence, probably, its power in some mental affections, also in chronic headaches,) and a fever; hence its
power in quartan fever, and hence also, partly, its efficacy in
dropsies, the worst kinds of which are always accompanied by
remitting fever, and wherein it is so useful, aided by its diuretic
power. (Who can tell whether this belongs to its primary, or, as
I am inclined to think, its secondary action?  This power is allied
to its property of exciting to activity the blood-vessels of the
abdomen, rectum, and uterus.) Its power of causing a constrictive,
suffocating sensation in the nose, would lead us to prescribe it in
similar cases (as I once did in a kind of mental disease). The
frequency with which it is confounded with other roots is the reason
why we are only in possession of these few true data of its effects.
The boring, cutting pain that the internal use of the meadow
anemone (anemone pratensis) causes in weak eyes, led to its success



THE CURATIVE POWERS OF DRUGS.

341

ful employment in amaurosis, cataract, and opacity of the cornea.
The cutting headache caused by the internal employment of the
inflammable crystalline salt obtained by distillation with water,
would lead us to employ this plant in a similar case. Most likely it
is on this account that it once cured a case of melancholia.
The clove gilliflower (geum urbanum), besides its aromatic qualities, possesses a nausea-exciting power, which always causes a
febrile state of body, and hence its service in intermittent fever,
when used as an aromatic along with ipecacuanha.
The principle that constitutes the medicinal power of the kernel
of the cherry (prunus cerasus), of the sour cherry (prunus padus),
of the peach (amygdalus persica), of the bitter variety of the
almond (amygdalus communis), and more especially of the leaves of
the cherry-laurel (prunus laurocerasus), possesses the          peculiar
property of increasing the vital power and contractility of the
muscular fibre in its direct action, as notably as it depresses both
in its secondary action. Moderately large doses are followed by
anxiety, a peculiar cramp of the stomach, trismus, rigidity of the
tongue, opisthotonos, alternately with clonic cramps of various
kinds   and   degrees, as its    direct action;'     the irritability  is
gradually exhausted,2 and in the secondary action the contractility
1 If it is sought to deny the primary action of the principle of bitter almonds,
which I have represented as producing the phenomena of increased power of contraction in the muscular fibre and exaltation of the vital power, on this ground,
that in some cases of monstrous doses, death occurs almost instantaneously without
any perceptible reaction of the vital power or pain, as great a mistake would be
made, as if all pain should be denied to death by the sword, and it should be affirmed
that the stroke of the sword did not produce a peculiar condition different from the
death that followed it. This pain will be just as intense, although perhaps less than
momentary, as the sensation of anxiety and torment will be indescribable, which
may and must follow a fatal dose of cherry-laurel water, though its action lasts
scarce a minute. This is proved by the case recorded by Madden, of excessive
anxiety in the region of the stomach (the probable region of the chief organ of the
vital power) of a person killed in a few minutes by a large dose of cherry-laurel
water. That in this brief space of time, the whole series of phenomena that follow a
not fatal dose, cannot make their appearance, is easily understood; yet it is probable
that changes and impressions, similar to those of the direct action I have described from
nature, do actually take place in the animal organism, in this short time (until a few
instants before death, i. e., the few instants that the indirect secondary action lasts).
Thus, electrical phenomena  ay be seen, when they can be gradually passed
before the eyes; but in the lightning rapidly flashing before us, we scarce can tell
what we see or hear.
2 A small lizard (laoerta agilis), that had moved about pretty rapidly for a minute




342

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of the muscular fibre and the vital power sink in the same degree
that they had previously been exalted. There follow cold, relaxation,
paralysis,-which also, however, soon pass off.
(Cherry-laurel water has now and then been used as a domestic
analeptic, in debility of the stomach and body, that is, as an
oppositely-acting palliative, and, as might have been guessed, with
bad effect. The result was paralysis and apoplexy.)
More remarkable, and peculiarly belonging to our subject, is
the curative power of its direct action (which consists in a kind of
febrile paroxysm) in intermittent fever, especially, if I mistake
not, in that kind of intermittent depending on a too great contractility of the muscular fibre, which is incurable by bark alone.
Equally efficacious has black cherry water proved in the convulsions of children. As a similarly-acting remedy, cherry-laurel
water will prove efficacious in diseases from too tense fibre, or
generally where the contractility of the muscular fibre far exceeds
its relaxing power; in hydrophobia, in tetanus, in the spasmodic
closure of the biliary excretory ducts and similar tonic spasmodic
affections, in some manias, &c.,1 as several observations have
shown. In proper inflammatory diseases it also deserves attention,
where it would, to some extent, operate as a similarly-acting
remedy. If the diuretic property observed from the bitter-almond
principle lies in its indirect secondary action, we may hope much
from it in dropsy, with a chronic inflammatory condition of the
blood.
The power of the bark of the sour cluster-cherry (prunus padus)
over intermittent fever lies likewise in the bitter-almond principle
it contains, by means of which it comports itself as a similarlyacting remedy.
Of the sundew (drosera rotundifolia) we know nothing certain,
except that it excites cough, and hence it has been of use in most
catarrhal coughs, as also in the influenza.
in diluted cherry-laurel water, I placed in concentrated cherry-laurel water. The
motions became instantly so excessively rapid, that the eye could scarcely follow
them for some seconds; then there occurred one or two slow convulsions, and then
total loss of motion: it was dead.
STonic (and clonic) spasms without an inflammatory state of the blood, and when
the conciousness is little affected, appear to be the peculiar sphere of action of the
principle of bitter almonds, as it, as far as I know, does not elevate the vital temperature even in its direct action, and leaves the sensitive system unaffected.




THE CURATIVE POWERS OF DRUGS.

343

The curative principle in the flowers and other parts of the
elder (sambucus niger), appears to lie in its primary direct action
of exalting the contractive power of the muscular fibres belonging
chiefly to the natural and vital functions, and of raising the temperature of the blood, whilst, in its indirect secondary action,
it brings down the strength of the muscular fibre, lowers the
temperature, relaxes the vital activity, and diminishes sensation
itself. If this be the case, as I think it is, the good that it does in
the true spasm of the finest extremities of the arteries, in diseases
from  a chill, catarrhs, erysipelas, is in virtue of its similarity of
action. Have not the elder species the power of producing transitory erysipelatous inflammation?
Various kinds of sumach, considered to be poisonous, e. g., rhus
radicans, appear to possess a specific tendency to produce erysipelatous inflammation of the skin and cutaneous eruptions. May it
not be useful in chronic erysipelas, and the worst kinds of skin
diseases?  When its action is too violent, it is checked by elder,
(a similarly-acting remedy?).
Camphor in large doses diminishes the sensibility of the whole
nervous system; the influence of the, as it were, benumbed vital
spirits (if I may be allowed to use a coarse expression), on the senses
and motion is suspended. There occurs a congestion in the brain,
an obscuration, a vertigo, an inability to bring the muscles under
the dominion of the will, an incapacity for thought, for sensation,
for memory.     The contractile power of the muscular fibres,
especially of those belonging to the natural and vital functions,
seems to sink to actual paralysis; the irritability is depressed in a
like degree, especially that of the extreme ends of the blood-vessels,1
that of the larger arteries less, and still less that of the heart.
There occur coldness of the external parts, small, hard, gradually
diminishing pulse, and on account of the different state of the
heart from that of the extreme ends of the bloodvessels, anxiety, cold
sweat. The above condition of the fibre causes an immobility of
the muscles, e. g., of the jaws, of the anus, of the neck, that
resembles a tonic spasm. There ensue deep slow breathing,
1 The nervous power and its condition seems to have most influence on these,less on the larger vessels, least of all on the heart.




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fainting.1 During the transition to the secondary action, there
occur convulsions, madness, vomiting, trembling. In the indirect
secondary action itself, the awakening of the sensibility, and, if I may
be allowed the expression, the mobility of the previously benumbed
nervous spirit first commence; the almost extinguished mobility of
the extremities of the arteries is restored, the heart triumphs over
the previous resistance. The previous slow pulsations increase in
velocity and in fulness, the play of the circulating system attains,
or in some cases (from larger doses of camphor, from plethora, &c.)
surpasses, its former state,-the pulse becomes more rapid, and
more full. The more motionless the bloodvessels were previously,
the more active do they now become; the temperature of the
whole body becomes increased, with redness, and uniform, sometimes profuse, perspiration. The whole process is ended in six,
eight, ten, twelve, or at most twenty-four hours. Of all the
muscular fibres, the mobility of the intestinal canal returns latest.
In every case where the contractile power of the muscular fibres
greatly preponderates over their power of relaxation, camphor, as
an antagonistically-acting remedy, procures rapid but only palliative relief; in some manias, in local and general inflammations, of
a pure, of a rheumatic, and of an erysipelatous character, and in
diseases arising from a chill.
As in pure malignant typhus, the system of the muscular fibre,
the sensitive system, and the depressed vital power, present something analogous to the direct primary action of camphor, it operates
as a similarly-acting remedy, that is, permanently and beneficially.
The doses must, however, be sufficiently large to produce the
appearance of a still greater insensibility and depression, but given
seldom, only about every thirty-six or forty-eight hours.
If camphor actually removes the strangury caused by cantharides,
it does this as a similarly-acting remedy, for it also causes strangury. The bad effects of drastic purgatives it removes, chiefly as
a suspender of sensation, and a relaxer of the fibre (consequently
an antagonistic, palliative, but here, admirable remedy).    In the
2A proof, according to Carminati, that camphor, far from extinguishing the
irritability, only suspends it so long as the muscles are in connexion with the
benumbed state of the nerves-is, that when all sensation is extinguished by means
of camphor, the heart, if cut out, continues to beat all the more strongly for hours
afterwards.




THE CURATIVE POWERS OF DRUGS.

345

bad secondary effects of squill, when they are chronic-a too
easily excitable action of the contractile and relaxing power of the
muscular fibre-it acts only as a palliative, and less efficaciously,
unless the doses be frequently repeated. The same may be said
with regard to its effects in the chronic symptoms caused by the
abuse of mercury. As a similarly-acting remedy, it is eminently
serviceable in the long-continued rigor of degenerated (comatose)
intermittent fevers, as an adjunct to bark. Epilepsy and convulsions dependent on relaxed fibre deprived of its irritability, are
rapidly cured by the similar action of camphor. It is an approved
antidote to large doses of opium, in which it is chiefly an antagonistic palliative, but efficacious in consequence of the symptoms
being but transitory. In like manner, opium is, as I have ascertained, an excellent antidote to large doses of camphor. The
former raises the sunken vital power and diminished vital temperature caused by the latter, antagonistically, but in this case
effectually. A curious phenomenon is the action of coffee in
relation to the direct action of large doses of camphor; it makes
the stomach, whose irritability was suspended, spasmodically
mobile; there occur convulsions, vomiting, or when given in
clysters, rapid evacuation; but neither does the vital power become
raised, nor do the nerves become relieved from their stupified
state, they rather become more stupified, as I think I have observed.
As the most striking effect of camphor on the nerves consists in
this, that all the passions are lulled, and a perfect indifference to
external things, even of the most interesting character, occurs, as
I have ascertained, it will accordingly be of service as a similarlyacting remedy in manias, whose chief symptom is apathy, with
slow, suppressed pulse, and contracted pupil,-also, according
to Auenbrugger, retracted testicles.  It is by no means advisable to use it in manias of every description. Used internally,
camphor removes acute general and local' inflammations, and
also such as are chronic, in a few hours; but in the former case,
the' doses must be very often repeated to admit of anything efficacious being performed, i. e., always a new dose before the secondary
action comes on. For in its secondary action, camphor does but
the more strengthen the tendency to renewed inflammation, makes
it chronic, and predisposes the organism chiefly to catarrhal diseases,
and the bad effects of a chill. Used externally for a length of




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time, it can do more good, and its bad effects may be easily
remedied in another manner.
The patrons of new medicines generally commit the error of
carefully but injudiciously concealing the disagreeable effects
of the medicines they take under their protection.'      Were it not
for this suppression of the truth, we might, for instance, from the
morbific effects the bark of the horse-chesnut (aesculus hipposcastanum) is able to produce, form a just estimate of its medicinal
powers, and determine if, for instance, it is suitable for pure intermittent fever, or some of its varieties; and if so, which.   The sole
phenomenon we know belonging to it is, that it produces a constrictive feeling in the chest. It will accordingly be found useful
in (periodical) spasmodic asthma.
The symptoms produced on man by the phytolacca decandra
deserve to be particularly described. It is certainly a very medicinal plant. In animals it causes cough, trembling, convulsions.
As the bark of the elm (ulmus campestris), when exhibited internally, produces at the commencement2 an increase of cutaneous
eruptions, it is more than probable that it has a tendency to produce
such affections of itself, consequently, that it will be serviceable
in them, which is amply proved by experience.
The juice of hemp leaves (cannabis sativa) is, it would seem, a
narcotic, similar in action to opium. This is only in appearance,
however, and owing to the imperfect accounts we have of its
pathogenetic action. I am much mistaken if it do not possess differences indicative of peculiar medicinal powers, if we but knew it
sufficiently. It produces dimness of vision; and in the madness
caused by it there occur many phenomena, generally of an agreeable character.
It appears as if saffron (crocus sativus), in its direct action,
brought down the circulation and vital heat. Slow pulse, pale
1 Thus we often read, that this or that powerful medicine has cured so many
hundred cases of the worst diseases, without causing the slightest had effects. If
this last be correct, we may certainly infer the perfect inefficacy of the drug. The
more serious the symptoms it causes, the more important is it for the practitioner.
2 In order to draw a favourable induction from the aggravating action of a drug
in a disease, this aggravation must occur at the commencement of its use, that is,
in its direct action; in such cases only can it be considered a similarly-acting efficacious remedy. The morbid aggravations occurring so often subsequently (in the
indirect secondary action) prove the contrary in ill-chosen remedies.




THE CURATIVE POWERS OF DRUGS.

347

face, vertigo, exhaustion, have been observed. In this stage most
probably occur the melancholy and headache that have been
observed from its action, and in the second stage (the indirect
secondary action), occur the senseless, extravagant gaiety, the
stupefaction of the senses, the increased action in the arteries and
heart, and lastly, the haemorrhage which have been observed from its
use. For this reason it may be useful in restoring flows of blood that
have been checked, as a similarly-acting remedy, as its power of
increasing the circulation occurs first in the secondary action;
consequently, the opposite must take place in its direct action. It
has been found useful as a similarly-acting remedy in vertigo and
headache, with slow pulse. In some cases of melancholia with
slow pulse, and in amenorrhoea, it appears also to be of service as
a similarly-acting remedy. It has (in its direct action) produced
death by apoplexy, and is said to have proved efficacious in similar
affections (probably in relaxed organisms). The phenomena of its
secondary action point to much increased irritability of the fibre,
hence probably the cause of its so readily producing hysteria.
The darnel (lolium temulentum) is such a powerful plant, that he
who knows its pathogenetic action must congratulate the age
when, for the benefit of humanity, its application shall be known.
The chief phenomena of the direct action of the seeds are cramps,
apparently of a tonic character (a kind of immobility), with relaxation of the fibre and suspension of the vital spirits, great anxiety,
exhaustion, coldness, contraction of the stomach, dyspnoea, difficult
deglutition, rigidity of the tongue, pressive headache and vertigo
(both continue longer than is known from any other drug, in the
greatest degree, for several days), noises in the ears, sleeplessness,
insensibility, or weakness of the external senses, red face, staring
eyes, sparks before the eyes. In the transition to the secondary action, the cramps become clonic, there occur stammering, trembling,
vomiting, diuresis, and (cold) perspiration (cutaneous eruptions,
ulcers on the skin?) yawning (another kind of cramp), weak sight,
long sleep. In practice, cases of obstinate vertigo and cephalalgia
present themselves, which we are inclined to avoid treating, from
their incurability. The darnel appears to be made expressly for
the worst of such cases, probably also for imbecility, the opprobium of medicine. In deafness and amaurosis something may be
hoped from its use.




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Squill (scilla maritima) appears to possess an acrid principle that
remains long in the body; the mode of operation of which, from
want of accurate observation, cannot be very well separated into
primary and secondary action. This acrid principle possesses a tendency to diminish for a long period the capacity of the blood for
caloric, and hence to establish in the organism a disposition to
chronic inflammation. Whether this power can be applied to useful
purposes, instead of being, as hitherto, a stumbling-block to the use
of the drug itself, I am unable, on account of the obscurity of the
subject, to determine. As, however, this power must certainly
have its limits, at least in the commencement it has only an acute
inflammatory action, and afterwards, especially after long-continued
use, leaves behind it the slow chronic inflammatory action; so
it seems to me to be rather indicated in pure inflammations with
tense fibre, when its use is otherwise required, than in a cold or
hectic inflammatory condition of the fluids and mobility of the
fibre. The incomparable aid derived from squill in inflammation
of the lungs, and the extraordinary injury inflicted by its continued
employment in chronic purulent consumption of the lungs, as
also in pituitous consumption, prove this satisfactorily; there is no
question here of palliative relief. This acrid principle puts the
mucous glands in a condition to secrete a thin, instead of a viscid
mucus, as is the case in every moderately inflammatory diathesis.
Squill causes a great degree of strangury, shewing thereby that it
must be very useful in restoring the secretion in the suppression of
the urine accompanying several kinds of dropsy, as daily experience confirms. Rapid, acute dropsical swellings appear to be its
chief sphere of action. It has cured some kinds of tickling cough,
because it can of itself cause cough.
That most incomparable remedy, white hellebore      (veratrum
album), produces the most poisonous effects, which should inspire
the physician who aspires to perfection with caution, and the hQpe
of curing some of the most troublesome diseases that have hitherto
usually been beyond medical aid.  It produces in its direct action
a kind of mania, amounting from larger doses to hopelessness and
despair; small doses make indifferent things appear repulsive to
the imagination, although they are not so in reality. It causes in
its direct action, a. heat of the whole body; b. burning in different
external parts, e.g., the shoulder-blades, the face, the head;




THE CURATIVE POWERS OF DRUGS.

349

c. inflammation and swelling of the skin of the face, sometimes
(from larger doses) of the whole body; d. cutaneous eruptions,
desquamation of the skin; e. a formicating sensation in the hands
and fingers, tonic cramps; f. constriction of the gullet, of the
larynx, sense of suffocation; g. rigidity of the tongue, tough mucus
in the mouth; h. constriction of the chest; i. pleuritic symptoms;
k. cramp in the calves; 1. an anxious, (gnawing?) sensation in the
stomach, nausea; m. gripes, and cutting pains here and there in
the bowels; n. great general anxiety; o. vertigo; p. head-ache
(confusion of the head); q. violent thirst. On passing into the
indirect secondary action, the tonic cramps resolve themselves into
clonic cramps; there occur, r. trembling; s. stammering; t. convulsions of the eyes; u. hiccough; v. sneezing (from the internal
use); w. vomiting (when at its height, black, bloody vomiting);
x. painful, scanty evacuations, with tenesmus; y. local, or (from
large doses) general convulsions: z. cold (from large doses, bloody)
sweat; aa. watery diuresis; bb. ptyalism; cc. expectoration;
dd. general coldness; ee. marked weakness; ff. fainting; gg. long,
profound sleep.-Some of the symptoms of its direct action, 1. m.
n. p. q., would lead us to use it in dysenteric fever, if not in dysentery. The mania it causes, together with some symptoms of its
direct action, e. f. g. h. n. q., would lead us to employ it in hydrophobia, with hopes of a good result. A dog to which it was given
had true rabies, lasting eight minutes. The ancients speak of it
with approbation in hydrophobia. (In tetanus?) in spasmodic constriction of the gullet, and in spasmodic asthma, it will be found
specific on account off. and h. It will prove of permanent advantage in chronic cutaneous diseases, on account of c. and d., as
experience has already shown with regard to herpes. In so-called
nervous diseases, when they are dependent on tense fibre or inflammatory symptoms, (a. q.) and the symptoms in other respects
resemble the veratrum   disease, it will be of benefit; so also in
manias of a like character.-The landlord of a country inn, a man
of firm fibre, robust make, red blooming countenance, and somewhat prominent eyes, had almost every morning, soon after
waking, an anxious feeling in the stomachic region, which in the
course of a few hours involved the chest, producing constriction
there, sometimes amounting to complete loss of breath; in the
course of a few hours the affection attacked the region of the




350

SUGGESTIONS FOR ASCERTAINING

larynx, and suffocation became imminent (swallowing solids or
fluids being impossible); and as the sun declined it left these
parts, and became confined to the head, with timorous, despairing,
hopeless, suicidal thoughts, until about ten o'clock, when he fell
asleep, and all the morbid symptoms disappeared. The mania
resembling that peculiar to veratrum, the firm fibre of the patient,
and the symptoms f. g. h. 1. n., induced me to prescribe three
grains of it every morning, which he continued for four weeks,
with the gradual cessation of all his sufferings; his malady had
lasted four years or more.-A woman, thirty-five years of age,
after having had many epileptic attacks during her pregnancies,
was affected a few days after her last delivery, with furious delirium and general convulsions of the limbs. She had been treated
for ten days with emetics and purgatives, without effect. At
midnight every night she was attacked by fever, with great restlessness, during which she tore all the clothes off her body, especially what she had about her neck. Cinchona bark always made the
fever a few hours later, and increased the thirst and anxiety; the
expressed juice of stramonium, used according to Bergius' method,
soon quelled the convulsions, and produced some rational hours,
in which it was ascertained that her worst symptom (except the
fever) was the suffocating feeling in the throat and chest, besides
pains in all her limbs. More, however, it could not do; on the
contrary, its continued use seemed rather to increase the last mentioned serious symptoms; the face was swollen, the anxiety infinite,
the fever greater. Emetics did no good; opium caused sleeplessness,
increased the restlessness; the urine was dark-brown, the bowels
much constipated. Blood-letting, which was evidently not adapted
for this case, was, moreover, contra-indicated by the excessive
weakness. The deliria returned, notwithstanding the extract of
stramonium, with increased convulsions and swelling of the feet.
I gave her in the forenoon half a grain of veratrum powder, and a
similar dose in the afternoon at two o'clock. Deliria of another
kind made their appearance, along with viscid mucus in the
mouth, but no fever returned, the patient slept, and in the morning passed white cloudy urine. She was well, quiet and rational,
except that the great weakness continued. The suffocating sensation in the throat was gone, the swelling of the face fell, as also
that of the feet, but the following evening, without her having




THE CURATIVE POWERS OF DRUGS.

351

taken any medicine, there occurred a constrictive sensation in the
chest.  She therefore got another half grain of veratrum      the
following afternoon; this was followed by scarcely perceptible
delirium, tranquil sleep, in the morning copious discharge of
urine and a few small evacuations. For two more days she got
half a grain of veratrum in the afternoon. All her symptoms
disappeared, the fever vanished, and the weakness yielded to a
good regimen.
I shall on a subsequent occasion' record a case of spasmodic colic
still more rapidly cured by it. As a producer of mania and spasms
it has shown itself useful in cases of persons possessed. In hysterical
and hypochondriacal attacks, dependent on tense fibre, it will be
useful, as has been practically proved. Inflammation of the lungs
will find in it a powerful remedy. The duration of its action is
short; limited to about five, at most eight or ten hours, inclusive
of the secondary action; except in the case of serious effects from
large doses.
Sabadilla seed causes confusion of the intellect and convulsions,
which it can also cure; the peculiarities of its action, however, are
not yet known. It also causes a creeping sensation through all
the limbs, as I have experienced, and is said to produce pain in
the stomach and nausea.
The agaric (agaricus muscarius) produces, as far as I can ascertain, a furious and drunken mania (combined with revengeful, bold
resolves, disposition to make verses, to prophesy, &c.), exaltation
of the strength, trembling and convulsions, in its primary direct
action; and weariness, sleep, in its secondary action. It has
therefore been employed with benefit in epilepsy (caused by
fright), combined with trembling. It will remove mental affections and possession, similar to those it causes. Its direct action
lasts from twelve to sixteen hours.
The nutmeg (myristica aromatica) diminishes the irritability of
the whole body, but especially that of the primue vime, for a considerable time. (Does it not increase the contractile power of the
muscular fibre, especially of the primse viae, and diminish its capability of relaxing?) In large doses it causes an absolute insensibility of the nervous system, obtuseness, immobility, loss of
1 See next article.




352             THE CURATIVE POWERS OF DRUGS.
reason, for its direct action; headache and sleep for its secondary
action. It possesses heating properties. May it not be useful in
imbecility, combined with laxness and irritability of the prime
vise?-against the first as a similarly, against the second as an
antagonistically-acting remedy?  It is said to have done good in
paralysis of the gullet, probably as a similarly-acting remedy.
Rhubarb is useful in diarrhoeas without feecal evacuations, even
in the smallest doses, more in consequence of its tendency to promote the action of the bowels, than on account of its astringent
power.
The topical pain-producing applications, as cantharides, mustard
plasters, grated horse-radish, spurge-laurel bark, crushed ranunculus acris, the moxa, allay pain often permanently, by producing
artificially pain of another kind.




CASE OF RAPIDLY CURED COLICODYNIA.

L------IE, a compositor, 24 years of age, lean, of a pale and earthy
complexion, had worked at the printing-press a year and a half
before he came to me, and then for the first time suddenly felt
great pain in the left side which obliged him to keep his bed, and
which after several days went away under the use of ordinary
medicines. Ever since that, however, he had experienced a dull
disagreeable sensation in the left hypochondrium. Some months
afterwards, when he had overloaded his stomach with sweet beersoup flavoured with caraway, he was attacked with a severe colic,
the violence of which he could not express, but at the same time
could not say whether it corresponded with the colicodynia which
succeeded it.
The attack passed off this time, I don't know how, but he
observed, that after it he could not bear certain kinds of food.
The mischief increased unobserved, and the colicodynia with its
distinctive symptoms took firm root.
The worst kinds of food for him were carrots, all sorts of cabbage, especially white cabbage and sour-crout, and every species of
fruit, but pears in particular.
If he were so incautious as to eat any of these things within
eight days after an attack which had been brought on by them,
the liability was so increased that he could not eat even a morsel
of a pear, for example, one or two weeks after without bringing on
another severe attack.
The course of a severe attack was as follows. Four hours or four
hours and a half after eating of such food-having previously felt
quite well-a certain movement was felt about the umbilical
region; then there took place suddenly, always at the same place,
1 From Hufeland's Journal derpractischen Arzneykunde. Vol. iii, 1797.
2A




354

CASE OF RAPIDLY CURED COLICODYNIA.

a pinching as if by pincers, but attended with the most intolerable
pain which lasted half or a whole minute, and each time suddenly
went away with borborygmus extending to the right groin-about
the region of the coecum. When the attack was very bad the pinching came back, and the subsequent borborygmus more and more
frequently, until in the worst attacks they were almost constant.
There occurred also the sensation of a constriction above and
below, so that flatus could pass neither upwards nor downwards.
The uneasiness and pains increased from hour to hour, the abdomen swelled and became painful to the touch. Along with all this
suffering, which resembled a fever, there came an inclination to
vomit, with sense of constriction of the chest, the breathing was
shorter and attended with more and more difficulty, cold sweat
broke out, and there came on a sort of stupefaction with total
exhaustion. At this period it was impossible for him to swallow a
drop of liquid, much less any solid food. Thus he lay stupified and
unconscious, with swollen face and protruded eyes, and without
sleep for many hours; the attack of spasmodic colic gradually subsided by diminution of the pain, then followed some escape of flatus
either upwards or downwards, and so the attack went off, (sometimes only after sixteen or twenty-four hours from its commencement). The strength only returned after three or four days, and
thus he was again like a person in health, without any other
uneasiness except the dull fixed pain before described, and general
weakness and sickly appearance. He could not positively say
whether this dull pain went off during the severe attacks or not,
but he thought it did.
In these circumstances he could not retain his situation at
the printing-press; he became a compositor. The attacks always
recurred under the condition described, and had continued to do
so for more than a year when he put himself under my care.
It might easily be supposed that the attacks arose from flatulence; this however was not the case. He could take, without
the least inconvenience, a good meal of dry peas, lentils, beans or
potatoes, and he was obliged to do so moreover, as his position did
not allow him the opportunity of getting much else.
Or it might be supposed to arise from some kind of fermentation in the primae vise, or from some idiosyncrasy in respect to
sweet things. But nothing was further from the case. He could




CASE OF RAPIDLY CURED COLICODYNIA.

355

take cakes baked with yeast, and sugar and milk as much as he
pleased, even to satiety, without the slightest threatening of colic,
although the first attack seemed, as I have said, to be occasioned
by the beer soup.
Or could an injurious acidity have occurred within the four
hours (for the attack never occurred sooner, after partaking of the
above things)? This was not the cause. Lemon-juice and vinegar
were both innocuous. Neither did he ever vomit sour matter,
either during the retching that occurred with the attack or when
ordered an emetic.   None of the absorbent earths or alkalis were
of any use to him, whether taken during or before the attack.
A physician had suspected tape worm, and subjected him to
Herrnschwand's treatment,' without any result. Neither before
nor after had he passed anything which had the smallest resemblance to a tape-worm or indeed to any kind of worm at all.
When he came to me the idea of tape-worm       had taken so firm
a hold of his mind that I was obliged to order him all that was
peculiar in the methods of Nuffer and of Clossius.3 He used all the
medicines with patience, and pressed me to try every means with
this view. Tartrate of antimony, gamboge, scammony, male-fern
(four ounces daily for four days together), charcoal, artemesia in
large quantities, colocynth with oils, castor oil, tin, iron, sabadilla,
sulphur, petroleum, camphor, assafoetida, and laxative saltsnothing was left untried; but they were given, as I have said,
rather on account of his urgent request than to satisfy my own
conviction, for besides the fact that no worms were ever seen, the
two symptoms which I have so often observed to attend worms
were absent, viz., the deeply wrinkled countenance and the sensation of a cold stream winding itself towards the back immediately
after a meal.
Immediately after the    iabadilla, which produced a creeping
1 [Herrnschwand's method consisted chiefly in the employment of the powder of
male-fern root, followed by purgatives, principally castor-oil.]
2 [Madame Nuffer's method, which was purchased by the French Government for
18,000 livres, consisted mainly of the administration of the powder of the male-fern
root, accompanied by a number of complex directions which were to be implicitly
followed to ensure success.]
3 [Clossius' method was to feed the patient during four weeks on salted meat, cheese,
and a good allowance of wine, and thereafter to give drastic purgatives consisting
chiefly of gamboge.]
2A2




856

CASE OF RAPIDLY CURED COLICODYNIA.

sensation like ants upon the skin (formication) and a heat in the
stomach and over the whole body, I let him try the test of eating
a piece of pear. It appeared indeed as if the attack had returned
quite mildly, but after I had left him without medicine for eight
days and again tried him with a small piece of pear, the colic came
on just as bad as ever.
I have forgotten to mention that I had already previously tried
all sorts of powerful so-called antispasmodic remedies at the commencement of the paroxysm. Small doses of ipecacuanha taken
dry, lukewarm  foot-baths and larger baths, opium, and cajeput
oil, without any result, even without any palliative effect. I only
sought to palliate the symptoms at that time in order that he
might continue without molestation to use cinchona bark and to
wash with cold water, to get the better of his weakness.
As his condition required immediate help, inasmuch as the
colicodynia began to appear even upon the use of the smallest
quantity of vegetable food, and as all I had done at his entreaty
had been of no service whatever, I determined to give him a medicine which produced very similar morbid symptoms. The similarity of the griping pain, anxiety, constriction of the chest, fever,
loss of strength, &c., produced by veratrum album appeared to me
calculated to give permanent relief.
I gave him four powders, each containing four grains, and told
him to take one powder daily, but to let me know at once if any
violent symptoms appeared. This he did not do. He did not
return until five days thereafter. His unlimited confidence in my
aid had nearly played him an awkward trick. The benefit I had
promised from the powders had induced him to take two instead of
one daily. After the second powder, without his having eaten
anything injurious, there began an attack which he could not otherwise describe than as his spasmodic colic, or something very like it.
This did not prevent him, however, from taking the third and
fourth powder the following day (taking thus sixteen grains in
rather less than two days), upon which, this artificial colic, if I may
so speak, increased to such a dreadful extent, that, to use his own
expression, he wrestled with death, covered with cold sweat and
almost suffocated.  He had required the remaining three days to
recruit, and had returned for further directions. I reprimanded
him for his imprudence, but could not avoid notwithstanding




CASE OF RAPIDLY CURED COLICODYNIA.        357
comforting him with the prospect of a good issue. The result
confirmed it; under the use of tolerably good diet he regained his
strength, and he has not had for half a year even a threatening of
an attack, although from time to time he has eaten of the food
which before was so injurious to him, but in moderation, as I
impressed upon him he should. Since this event he has taken no
more medicine, and no tapeworm was passed after the use of the
veratrum.
The dull pain in the left hypochondrium likewise went at the
same time.




ARE THE OBSTACLES TO CERTAINTY AND
I
SIMPLICITY     IN   PRACTICAL     MEDICINE
INSURMOUNTABLE P
Dr. Herz's essay ""On the Medicinal uses of the Phellandriurn
aquaticum," &c., in the first part of the second volume of the Journal
der practischen Arzneykunde, plunged me into a sort of melancholy,
which only by dint of long-continued reflection has given place to
a remote but lively hope.
Here one of the most thoughtful physicians of our time, after
twenty years of active practice, finds himself obliged repeatedly to
make the open, but most melancholy acknowledgment: (p. 40.)
"That we can lay no claim to the attainment of the ideal of
simplicity in medical treatment."
"That the hope of ever arriving at perfect simplicity in medical
practice, cannot be otherwise than very feeble" (p. 47).
The obstacles to pure observation of the effects of medicines in
the various diseases, he enumerates with most overwhelming fulness
of detail, and there he leaves us alone in the old well-worn path of
uncertainty, almost without a cheering glance at a better ftiturity,
a simpler, surer method of cure; unless we are to reckon his very
complaints as foreshadowing coming improvements, just as the
impassioned warmth of the sceptical casuist has always appeared to
me a proof of that immortality he would deny.
I myself felt the external hindrances to our art more than I could
have wished; they continually beset my sphere of action; and I,
too, long considered them insurmountable, and had almost made up
my mind to despair, and to esteem my profession as but the sport
of inevitable accident and insuperable obstacles, when the thought
I From Hufeland'8 Journal der practischen Arzneykunde, Vol. iv, Part iv, page
106. 1797.




ARE THE OBSTACLES, ETC.

359

arose within me, "are not we physicians partly to blame for the
complexity and the uncertainty of our art? "
OBEDIENCE OF PATIENTS.
I have seen medical men take under their care patients who
had only half confidence, and from whose demeanour any one might
perceive that they put themselves under the physician whom they
had chosen, not from any enthusiastic regard for him, nor from
a strong desire to be relieved from their sufferings. How could
implicit obedience be expected from   such persons?   And even
when they spoke of, and commended in common place terms,
strict attention to the physician's orders, could he trust them,
and with confidence ascribe the issue to his prescriptions, his medicines? By no means!
DIET AND REGIMEN.
It is a constant complaint of physicians that patients will not
observe the prescribed diet. " Who shall give them assurance of
such compliance? and how impossible, then, is it to determine the
issue of a disease, or the effect of the remedies employed, since on
this point in no case can any certainty be attained?"
Pardon me! We may be perfectly sure of such as with implicit
confidence entrust themselves to the care of their almost worshipped
physician. Of course, others are less to be relied upon.
Methinks, however, that medical men when thus complaining,
do not draw a sufficient distinction between, 1st, the errors of diet
which produced and kept up the patient's disease; 2nd, their
ordinary indifferent diet; and, 3rd, the new dietetic regulations
laid down by the physician.
If, with respect to the first of these (the correction of the errors
of diet), the physician thinks that he does not possess sufficient
authority with his patient, who will not pay strict attention to
rules, rather let him dismiss such fickle-minded persons; better no
patients at all than such!
Who, for example, would undertake to cure a drunkard of
induration of the liver, who merely consulted the physician en
passant, because, perhaps, he met him in the street; or had some
business-matters to arrange with him; or, because the physician
has come to reside in the neighbourhood; or has become a con



860    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
nexion of his; or for some other trifling reason, but not from
having implicit confidence in his skill?  What immense influence
the medical man must have with such a confirmed debauchee, to
feel assured that he will pay attention to his orders, and daily
diminish his allowance of the poisonous liquor!
A patient with such bad habits must shew, by some considerable
sacrifice, that he intends to submit himself entirely to the will of
the physician. The physician would do well to try to dissuade
him from submitting to treatment; to represent to him, in strong
terms, the difficulties which his ruinous vice throws in the way,
and the magnitude of the disease. If he return repeatedly, and
express his willingness to make any sacrifices, then, what should
prevent the physician trusting him, so long as he sees indubitable
proofs of his resolution? If he cannot withstand temptation, then
let him go his way; he will, at any rate, not bring discredit on
the art, nor disappoint the hopes of the much-deceived physician.
Are there not enough of patients, who, when solicitously advised
by a universally esteemed physician, will, for example, scrupulously
abstain from eating pork during a quartan fever, and for months
afterwards; who will carefully avoid potatoes, if they are asthmatic
or leucophlegmatic; sedentary occupations, if they are gouty; and
sour wine, if suffering from the wasting diseases of youth brought
on by venereal excesses?
In the case of a woman affected with a nervous disorder, should
not a good physician be able to effect a gradual diminution in the
quantity of coffee taken; or, if otherwise, will he not be able to
perceive that she will not follow his advice?  From my own experience I can say, that it is no uncommon circumstance to meet
with both these cases; and in each the physician may reckon with
certainty on his observation.
If we go to work in this manner, we shall attain to a high degree
of empirical certainty. Is this not certainty?  Or does the statesman, the teacher, the lawyer, the merchant, the general, possess
any other than empirical certainties?    Or is there any other
positive rule to guide us, in any imaginable profession in which
the free-will of man is involved?
But is the ordinary diet of those classes of the community who
are not altogether corrupted, of such an objectionable nature, that
we are compelled, in every disease, to prescribe a new one?  This




IN PRACTICAL MEDICINE INSURMOUNTABLE?

361

is one of the rocks on which so many physicians split. In every
acute or chronic disease that comes under their notice, they earnestly insist on a very complicated artificial system  of diet, withholding many things, and ordering a host of others.
Do we physicians, however, know with such extreme precision,
the effects of all kinds of food, as to be able with certainty to say,
in this case such and such an article of diet is to be taken, and this
and that other to be avoided! How does experience refute our
fancied omniscience!
For what a length of time did our forefathers insist in their socalled acute (putrid) fevers with diminished vital power, on watery
drinks, tea, &c.; and exclaimed against beer and wine as little
better than poison-which, however, the patients long for so much,
and which is now the main support of our practice! How long did
we forbid fresh meat in cases of haemorrhage from passive plethora,
in wasting pulmonary complaints, in scurvy, and in most other
chronic non-gastric diseases, where it is now reckoned, if not a
perfect panacea, at any rate indispensable! A universal diet, like
a universal medicine, is an idle dream; but speaking generally,
nothing is more wholesome than fruit in abundance, and green
vegetables ad libitum; and yet they frequently oppress the stomach
of those who have poverty of the blood, of exhausted persons, and
those suffering from the effects of a sedentary life, and increase in
them the disposition to acidity, flatulence, and diarrhoea! Roastbeef and raw ham are considered more difficult of digestion for a
relaxed stomach than veal boiled to rags. Coffee has the reputation
of strengthening and assisting digestion, and yet it only hastens
the expulsion of half-digested food from the bowels. I have
seen children deprived of the breast-milk, crammed to death
with wafer-biscuits, and perishing in numbers of jaundice. My
expostulations on the indigestible nature of this unleavened and
hard-baked mass of dough, were of no avail against the plausible
folly of my colleagues-" it is impossible to imagine anything
lighter (in weight), or more delicate (to the touch)!"
I once knew an ignorant over-officious practitioner prescribe
such a severe diet to a healthy young woman after a favourable
first-labour, that she was on the eve of starvation. She held up
for some days under this water-gruel diet-all meat, beer, wine,
coffee, bread, butter, nourishing vegetables, &c., were denied her;




362    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
but at last she grew excessively weak, complained of agonising
after-pains, was sleepless, costive, and, in short, dangerously ill.
The medical attendant attributed all this to some infraction of his
dietetic rules. She begged to be allowed some coffee, or broth, or
something similar. The practitioner, strong in his principles, was
inflexible: Not a drop! Driven to desperation by his severity and
her hunger, she gave way to her innocent longings, drank coffee,
and ate in moderation whatever she fancied. The practitioner
found her, on his next visit, much to his surprise, not only out of
danger, but lively and refreshed; so he complacently noted down
in his memorandum-book the excellent effects of slop-diet in the
treatment of lying-in women. The convalescent took good care not
to hint to him her natural transgression. This is the history of many,
even published observations! Thus the disobedience of the patient
not unfrequently saves the credit of the physician.
Is the error calculi, in such a case, the fault of the art or the
patient, or is it not rather the fault of the physician?
The artificial diet prescribed by the physician, is frequently
much more objectionable than the accustomed diet of his patient;"
or, at least, he frequently does wrong in rejecting the latter all at
once.
As the physician would do well, in order to observe more distinctly and simply the course of the disease and the effects of his
medicines, not to give any orders at all about the diet, except with
regard to articles of which he possesses a positive knowledge, and
these will be but few; he would also be consulting the good of his
patient by not depriving him of any thing which long habit had
rendered innocuous, or perhaps indispensable.
A country midwife fell sick of a gastric fever. I purged her. I
ordered her for drink, water and weak beer, and extreme moderation in eating. At first, things went on very well; but, after a
few days, a new continued fever, with thirst, wakefulness, weariness, confusion of ideas, came on to such an extent as to render
her state dangerous. I left none of the ordinary remedies untried.
All in vain. I now left off every thing, from the sulphuric acid to
the soup (at that time I was not sufficiently acquainted with the
properties of opium), and promised to prescribe something on my
return. I informed the relations of the danger I apprehended.
The following day I was told that the patient was recovering, and




IN PRACTICAL MEDICINE INSURMOUNTABLE?

363

that I need not give myself any farther trouble. To my astonishment, I saw her pass my window, a few days afterwards, perfectly
recovered. I subsequently learned, that when I had discontinued
the medicine, a quack had been called in, who had given her a
large bottle of essence of wood, his universal medicine, and told
her to take so many drops of it. No sooner had she tasted the
brandy in it than she gained, as it were, new life. She took the
drops by table-spoonfuls, and, after a good sleep, she rose completely
cured.
This happened when I first began practice, else I should have
ascertained at the commencement that, when in health, she could
not live without her daily dram, consequently could not recover
without it.
It is far less frequently necessary than most physicians think, to
make a material alteration in the diet of patients suffering from
chronic complaints, at least in ordinary cases; in acute diseases,
the awakened instinct of the patient is often considerably wiser
than the physician who does not consult nature in his prescriptions.
I do not now allude to cures effected by dietetic rules alone,
which, if simple, are not to be despised, and which are very serviceable in many cases. What I particularly call attention to is,
the frequently useless change of diet, when treating a case with
medicine, whereby the simplest method of treatment is rendered
complex, and a composite result is produced, of which I would defy
(Edipus himself to guess what part was owing to the new diet,
and what to the medicine.
We must certainly prohibit what we know to be hurtful in this
or that complaint; but this can at the most be but two or three
articles of diet in chronic diseases; the gradual disuse of which (for
sudden suppression is always dangerous in such affections), cannot
produce any great revolution in the system; cannot, therefore,
have much effect in deranging the pure action of the medicine we
are using.
If it be necessary to make considerable changes in the diet and
regimen, the ingenuous physician will do well to mark what effect
such changes will have on the disease, before he prescribes the
mildest medicine.
A deeply rooted scurvy can often be cured by the united action




364    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
of warm clothing, dry country air, moderate exercise, change of
the old salted meat for that freshly killed, along with sour-crout,
cresses, and such like vegetables, and brisk beer for drink.
What would be the use of medicine in such a case? To mask the
good effects produced by the change of diet!  Scurvy is produced
by a system of diet opposite to this, therefore, it may be cured by
a dietetic course-the reverse of that which produced it; at any
rate, we may wait to see the result of this method, before we begin
with our medicines.
Why should we render the syphilitic patient, for example, worse
than he is by a change of diet, generally of a debilitating nature?
We cannot cure him by any system of diet, for his disease is not
produced by any errors of the sort. Why then, should we, in this
case, make any change?
Since this occurred to my mind, I have cured all venereal
diseases (excepting gonorrhoea), without any dietetic restrictions,
merely with mercury (and, when necessary, opium); the metal has
not a debilitated constitution to act upon, and my patients recovered
more rapidly than those of my colleagues. I also knew for certain,
that every change that took place, either for the better or the
worse, was owing to the medicine.
An old colonel, with "fair round belly," and apparently fond of
the pleasures of the table, had suffered for the last forty years from
ulcers almost all over the legs, and issues on the thighs. His food
consisted of the strongest and most nutritive materials,-he drank
a good deal of spirits, and, for several years past, he had been in
the habit of taking a monthly purge. Otherwise, he was vigorous.
I allowed the issues to heal up, made him keep his legs rolled up
in a narrow flannel bandage, and immerse them daily a few minutes
in cold water, and afterwards dress them with a weak solution
of corrosive sublimate. I made not the slightest alteration in his
diet; I even did not forbid the monthly purge, as he was so constantly in the habit of taking it. In the course of a year, his legs
gradually healed, and his vigour rather increased than diminished
in this his seventy-third year. I watched him for two years,
during which he remained perfectly well, and I have since had good
accounts of his health. The legs have always continued completely
healed. Can I suppose that he would have recovered more rapidly
or permanently had I deprived him of his eight or ten dishes, and




IN PRACTICAL MEDICINE INSURMOUNTABLE?

365

his daily allowance of liquors?  Had I changed his diet, and had
he grown worse, would I have known whether this unfavourable
turn proceeded from the food so much lauded in works on dietetics,
but so different to what he had been accustomed to, or from my
external applications, for I gave nothing internally? It would
have been easy for me to conform to the schools, and sacrifice my
patient methodically to the ordinary dietetic regulations; but how
could I at the same time abide by my conviction, my conscience,
and that prime guiding principle of the physician, simplicity!
I have no intention of exalting myself at the expence of my
brethren, when I acknowledge that I have cured the most difficult
chronic diseases, without any particular change of diet.
I consider that I do quite enough if I advise moderation in all
things, or diminish or forbid altogether particular articles of diet,
which would be prejudicial to the'object I wish to accomplish; as,
for example, acids, when I am employing stramonium, belladonna,
foxglove, monk's-hood, or henbane (the effects of these medicines
being entirely counteracted by vegetable acids); or salted meats,
when I prescribe oxyde of mercury; or coffee, when I am giving
opium.
Thus, if my treatment fail, I know that I have done no harm by
an artificial system of diet (how much that is dangerous and hypothetical is there not in our dietetic regulations!), I know it is owing
to the medicine used that the case grew worse, or, at least, did not
improve.
If amendment ensue, then I know that the medicine produced
it, as it certainly was not owing to any change in the diet.
Hippocrates, himself, if I recollect right, hints at something
similar in his aphorisms, when he says, that medicine and the vis
naturct produce much more considerable and profound changes in
diseases than any small irregularity in diet.
How near was this great man to the philosopher's stone of physicians-simplicity! and to think that after more than two thousand
years, we should not have advanced one single step nearer the
mark! on the contrary, have rather receded from it!
Did he only write books? or did he write much less than he
actually cured?  Did he do this so circuitously as we?
It was owing to the simplicity of his treatment of diseases alone,
that he saw all that he did see, and whereat we marvel.




366    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
CLIMATE, WEATHER, STATE OF THE BAROMETER, ETC.
Should we abandon ourselves to despair, because we do not know,
to a nicety, what is the exact influence which a slight change in
geographical position, a small variation of the hygrometer, the barometer, the anemometer, the thermometer, ýc., exercises upon the
action of our medicines or our patients?
According to many observations of the first medical men, it is
not so very difficult to arrive at a pretty accurate general knowledge of the differences produced by a warmer or colder climate on
the nature and treatment of ordinary diseases. They are, for the most
part, merely differences in degree. The most opposite climates never
produce a completely opposite code of medical laws. Is not bark
as efficacious for the cure of pure intermittent fever in Mexico as
in Norway; in Batavia and Bengal (the only difference being in
quantity), as in Scotland?  The venereal disease is cured in China
by mercury, just as it is in the Antilles. In our country, we have
inflammations and suppurations of the liver of the same nature as
in the tropics; although, in the latter regions, they are twenty
times as numerous as here, that makes not the slightest difference
in the treatment, as in both situations mercury and opium (or
something better still) are serviceable. Typhus, and similar fevers,
are here as there fatal, if treated by bloodletting and nitre (not,
indeed, so rapidly here as there)! They must also be treated in
our country with bark and opium (not, indeed, in such large doses
as there), in order to increase the strength. These varieties of
climate do not change the treatment in nature, but only in degree,
and such differences are determinable.
But that the powers given by nature to man and habit will
triumph over all variations of climate, to the preservation of life and
health, is proved by there being inhabitants in the island of Terra
del Fuego, as well as on the banks of the Ganges, in Lapland, as
well as Ethiopia, in the seventieth as well as the third degree of
latitude.
And are we so ignorant of the other influences which the nature of
the soil and country have upon diseases; so very ignorant that we
cannot reckon the influence they would have on our practice? Do
we know nothing of the different effects produced by a residence
in a hilly country and on the sea-coast, on haemoptysis and phthisis;




IN PRACTICAL MEDICINE INSURIMOUNTABLE?

367

nothing of the action of the effluvia from marshes and seething
intramural grave-yards in the production of intermittent fever, and
diseases of the liver and lymphatic system; nothing of the power
of pure air on those affected with rickets and those debilitated
by sedentary occupations; nothing of the advantages of a level
country over confined Alpine valleys, the cradle of cretinism, goitre,
and idiocy; nothing of the peculiar power of certain winds and
seasons in the production of inflammatory, or asthenic diseases, or
of the effect of a low state of the barometer on the apoplectic;
nothing of the influence of the air of hospitals in the production
of gangrene and typhus?
And it is only these, and similar great and important differences,
which exercise a marked influence on health and life itself, which
it is necessary for us to know in our treatment of diseases. We
do know them, and can calculate their influence.
The influence of the finer shades of these differences is too insignificant to prevent us treating successfully the ordinary diseases.
The vital power and the proper medicine generally obtain the
victory over any influence which such very fine shades of differences
could exert.
What might be said of the Creator, who, having afflicted the
inhabitants of this earth with a vast host of diseases, should at the
same time have placed an inconceivable number of obstacles in the
way of their cure; to discover the influence of each of which would
defy the greatest efforts of the physician-a knowledge of which
in their full extent (if they were of such great importance) could
not be attained by the greatest genius?
We cure diseases in pestilential dungeons, although we cannot,
at the same time, impart to the patient the vigour of the mountaineer. Who would desire us to transform the delicate city lady
into the buxom peasant girl? We remove, however, most of the
ailments of the former. The sedentary man of business seeks at
our hands only tolerable health, for the nature of things denies us
the power of giving him the strength of the blacksmith, or the
ravenous appetite of the porter.
"But," objects some one, "look what a perceptible influence
a slight variation of the temperature, moisture, or relative proportion of oxygen and nitrogen in the atmosphere, a slight change in
the wind, a higher or lower state of the barometer, a greater or




368    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
less quantity of atmospherical electricity, and a thousand other
physical powers, small though they may be, which are perhaps, as
yet unknown to us, sometimes have upon diseases, at least upon
the nervous, hysterical, hypochondriacal, and asthmatic!"
Shall I speak out what I think?    It appears to me much less
profitable to endeavour to ascertain (which is moreover impossible)
all the degrees and varieties of the influence of those physical impressions, when they approach the minute, than to do our endeavour to
fortify the sufferers against all these innumerable impressions, by implanting in them a certain degree of strength, whereby their system
will be enabled to resist these, and many other still unknown
physical impressions; just as I consider it much more practicable
to dispel the morose ideas of the melancholic by medicine, than to
abolish for him the countless evils of the physical and moral world,
or to argue him out of his fancies.
Or could all the physical and moral adverse circumstances of
the atmosphere, and of human life, be more effectually prevented
exercising their pernicious influence on the gossamer nervous system of yon nervous, spasmodic, chlorotic girl, did we, with angels'
understanding, completely investigate and maturely weigh, in
quality and quantity, all these impulses in their full extent, than if
we should restore her monthly periods?
I do not believe that it is the smallness of our knowledge, but
only the faulty application of it, that hinders us from approaching,
in medical science, nearer to certainty and simplicity.
A young man, twenty years of age, the son of an oil manufacturer, thif and weakly, had been from his childhood subject to a
spasmodic asthma, which used always to increase- from the commencement of autumn until the depth of winter, and gradually
decline from that period until the mild weather in spring. Every
year he had grown worse, and this autumn he hoped might be his
last. Already (I saw him first at Michaelmas) the attack commenced more violently than the last year at this time. The
probable issue was evident. Last year, and for years past, every
fall of the barometer, every south-west, and more particularly
north wind, every approaching fall of snow, every storm of wind,
had brought on, an asthmatical fit of hours and days in duration,
when he not unfrequently passed the night with both hands grasping the table, exerting all his strength to draw the smallest




IN PRACTICAL MEDICINE INSURMOUNTABLE?

869

quantity of breath, and every moment in dread of suffocation.
The intervals between such fits were occupied by slighter attacks,
brought on by a draught of air, the vapour from the heated oilcakes, dust, a cold room, or smoke. He told me of these symptoms
with the utmost difficulty of utterance, elevating his shoulders to
draw a scanty breath, and this at a season of the year when his
condition was as yet pretty tolerable.
I could expect no good effects from a change of place. So I
allowed him to remain in his father's house, exposed, as it was, to
every wind, and all the inclemencies of the weather; I let him
take his usual diet; I only advised that his fare should be, if anything, more nutritious than otherwise; I let him occupy the
same sleeping apartment, and continue his work in the oil manufactory, and, as far as his strength allowed, engage in agricultural
employments.
The first medicine I administered was ipecacuan, in the smallest
doses; they produced no nausea, neither did doses of five grains; the
latter quantity caused purgation and relaxation of the system. The
submuriate of antimony and the sulphate of copper, in quarter of
a grain doses, produced no better results. Both of these substances,
as well as asarum root, each used singly, caused the same bad
effects.
I shall refrain from stating what other medicines, celebrated in
asthma, did not effect; and shall only mention, that squills and
bark, each employed separately, did-what they often do-they
increased the difficulty of breathing, and made the cough more
frequent, shorter, and drier.
A medicine was required which could produce anxiety, and
diminish the easy action of the bowels. The choice fell naturrally on nux vomica. Four grains given twice daily removed
gradually, but perceptibly, the constriction of the chest; he remained free from the spasmodic asthmatic attacks, even in the worst
autumn weather-even in winter, in all winds, all storms, all
states of the barometer, all humidity of the atmosphere, during
his now increased domestic, manufacturing, and travelling business,
in the midst of the oil vapour, and that without any important
change in his diet, or any in his place of abode. He had been in
the habit, when there was but small prospect of cure, of rubbing
his whole body every night with a woollen cloth. Although it did
2B




370    ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
not seem to do any good, I did not let him discontinue it while
taking the last medicine, as he had been so long accustomed to it.
He now slept comfortably at night, whereas formerly he had
passed the whole night in an arm-chair, bent forwards, or leaning
against the wall, and coughing without intermission. During this
season, which had threatened to be so dangerous to him, he gained
strength, agility, cheerfulness, and capacity of resisting inclement
weather. It was only severe attacks of cold that could cause the
slightest return of asthma, and these he speedily got rid of.
Besides this medicine, nothing at all was employed.
Should I, instead of adopting this treatment, have observed
attentively all the meteoric changes, and scrupulously calculated
their effects on his most susceptible frame? And had I been able
to do this, could I have added weight to the diminished atmospheric pressure, supplied the loss of atmospherical electricity,
maintained an equilibrium between day and night, dried up the
moisture in the air, changed the north into the south wind,
reined in the storms, and warded off the attraction of the moon?
And had I been able to do all this, should I have better attained
my object?
MEDICINES.
Here the question arises, Is it well to mingle many kinds of medicines
together in one prescription; to order baths, clysters, venesections,
blisters, fomentations and inunctions all at once, or one after the other
in rapid succession, if we wish to bring the science of medicine to
perfection, to make cures, and to ascertain for certain in every case
what effect the medicines employed produced, in order to be able to
use them with like, or even greater success in similar cases?
The human mind is incapable of grasping more than one subject at a time-it can almost never assign to each of two powers
acting at the same time on one object its due proportion of
influence in bringing about the result; how, then, can we ever
expect to bring medical science to a greater degree of certainty,
if we deliberately combine a large number of different powers
to act against a morbid condition of the system, while we are
often ill acquainted with the nature of the latter, and are but
indifferently conversant with the separate action of the component
parts of the former, much less with their combined action?




IN PRACTICAL MEDICINE INSURMOUNTABLE?

371

Who can say for certain, that the adjuvant or the corrective in
the complex prescription does not act as the base, or that the
excipient does not change the whole character of the mixture?
Does the principal ingredient, if it be the right one, stand in need
of an adjuvant? Does it say much for its fitness if it require a
corrective; or why does it require the aid of a director?   "I
thought I would complete the motley list, and thereby satisfy the
requirements of the schools!" exclaims the Doctor.
Does opium mingled with ipecacuan cause sleep, because the
excipient in the recipe has been invested with the dignity of the
principal ingredient? Does the ipecacuan here perform the part
of base, adjuvant, corrective, director, or excipient? Does it cause
vomiting because the prescriber wills it?
I have no hesitation in asserting that whenever two medicines
are mingled together, they almost never produce each its own
action on the system, but one almost always different from the action
of both separately-an intermediate action, a neutral action,-if I
may be allowed to borrow the expression from chemical language.
The more complex our receipts, the more obscure will it be in
medicine.
That our prescriptions are composed of a smaller number of
ingredients than those of Amatus Lusitanus, avails us just as little
as it availed him that Andromachus framed still more complex
prescriptions than he. Because the mixtures of both these worthies
are more complicated than our own, does that render ours simple?
Why should we complain that our science is obscure and intricate, when we ourselves are the producers of this obscurity and
intricacy?  Formerly I was infected with this fever; the schools
had infected me. The virus clung more obstinately to me before it
came to a critical expulsion, than ever did the virus of any other
mental disease.
Are we in earnest with our art?
Then let us make a brotherly compact, and all agree to give
but one single, simple remedy at a time, for every single disease,
without making much alteration in the mode of life of our patients,
and then let us use our eyes to see what effect this or that medicine
has, how it does good, or how it fails.-Is not this as simple a way
of getting over the difficulty as that of Columbus with the egg?
Is it really more learned to prescribe from the chemist's shop a
2B2




372     ARE THE OBSTACLES TO CERTAINTY AND SIMPLICITY
number of complicated combinations of medicines for one disease
(often in one day), than with Hippocrates to treat the whole course
of a disease with one or two clysters, perhaps a little oxymel and
nothing else?  Methinks to give the right, not the many-mixed,
were the stroke of art!
Hippocrates sought the simplest from out an entire genus of
diseases; this he carefully observed and accurately described.  In
these simplest diseases he gave single simple remedies from the
then scanty store.  Thus he was enabled to see what he saw-to
do what he did.
I hope it will not be considered unfashionable to go to work
with diseases as simply as did this truly great man.
Any one who should see 'me give one medicine yesterday,
another to-day, and a third different from either to-morrow, would
observe that I was irresolute in my practice (for I am but a weak
mortal); but should he see me combine two or three substances in
one prescription (and ere now this has sometimes been done), he
would at once say, "The man is at a loss, he does not rightly
know what he will be at "-1" He is wavering "--" Did he know
which one of these was the proper remedy, he would not add to
it the second, and still less the third!"
What could I rejoin?    Nothing.'
Should any one ask me what is the mode of action of bark in
all known diseases, I would confess that I know but little concerning it, notwithstanding the number of times I have used it
alone and uncombined. Should any one ask me, however, what
bark would do if combined with saltpetre, or still more with some
third substance, I would at once acknowledge my benighted ignorance, and would bow before any one as before a very divinity,
who would enlighten me on the subject.
Dare I confess, that for many years I have never prescribed
1 The reason which has been frequently given, that we require, by pleasant additions
to the medicine, to render it more agreeable to the patient, or give it a more convenient
form for administration, and conceal the disagreeable taste, smell, and colour, is
entirely without weight. Grown up patients, whose confidence is ready in one scale
of the balance to kick the beam when a bitter, nauseous powder is placed in the
other scale, have too scanty a supply of that quality for my taste. I would abandon
them to those needy traders, who, for the sake of the miserable fee will prescribe the
most dainty sweetmeats, and are willing to submit to all the airs and disobedience of
their patients. We all know how to manage children in such case without hurting
them.




IN PRACTICAL MEDICINE INSURMOUNTABLE?

373

anything but a single medicine at once, and have never repeated
the dose until the action of the former one had ceased; a venesection alone-a purgative alone-and always a simple, never a compound remedy, and never a second until I had got a clear notion of
the operation of the first?  Dare I confess, that, in this manner, I
have been very successful, and given satisfaction to my patients,
and seen things which otherwise I never would have seen?
Did I not know that around me there are some of the worthiest
men, who in simple earnestness are striving after the noblest of
aims, and who by a similar method of treatment have corroborated my maxims, assuredly I had not dared to confess this
heresy. Had I been in Galileo's place, who can tell but that I
might have abjured the idea of the earth revolving round the sun I
But the dawn begins to glimmer in the horizon!-who can fail
to perceive a feeble ray of it in our Herz's commentary on his two
cases, to which we alluded above?
What would he not now give that in both instances he had
prescribed nothing but the phellandrium, and had met with the
same success he did! I, for my part, would willingly give the
best, the most satisfactory of all my observations that he had done
this.




ANTIDOTES TO SOME HEROIC VEGETABLE
SUBSTANCES.'
CAsEs of poisoning often put the practitioner in great straits. It
is necessary to administer the specific antidote without delay. But
where are the particular antidotes to be met with?
From   the time of Nicander to the 16th century, when, if I
mistake not, Pare first set his face against them, grand plans were
formed by medical men for discovering nothing less than an universal specific for every thing they called poison; and they included
under the denomination of poison, even the plague, philtres,
bewitchment, and the bites of venomous animals. This extravagant
object they sought to obtain by equally extravagant mixtures, such
as their mithridate, theriac, philonium, diascordium, &c., and then
again, there was a time when all these unimportant compounds
were thought to be surpassed by the powerless bezoar and the
electuary of jewels. We now know how ridiculous all these efforts
were.
The more rational spirit of modern times did not, however, completely abandon this illusory idea of the possibility an universal antidote2 for all poisons. Among other things, it was sought for in
vinegar. But in place of giving us a faithful detail of the cases in
which it was truly useful and those in which it did no good, they
1 From Hufeland's Journal derpract. Arzneykunde. Vol. v, p. 1, 1798.
2 There are at least four kinds of antidotes by means of which the hurtful substance may beI. Removed:
1. By evacuation (vomiting, purging, excising the poisonous bite).
2. By enveloping (giving suet for pieces of glass that have been swallowed).
II. Altered:
1. Chemically (liver of sulphur for corrosive sublimate).
2. Dynamically (i. e. their potential influence on the living fibre removed)
(Coffee for opium).




ANTIDOTES TO SOME HEROIC VEGETABLE SUBSTANCES.        875
endeavoured to persuade us that it was specific against everything
that bore the name of poison, and yet it is, e.g., of no use in poisoning by opium, and of little or none in that by camphor.
Others saw in milk and fatty substances a supposed universal
antidote for all kinds of poisons, but no good can be effected by
them, except in cases where inflammatory and mechanically irritating substances have been swallowed.
Emetics seemed to be more generally useful in cases where poisons had been swallowed; but they are by no means so in all
cases. They are only serviceable when the quantity of injurious
matter, that has been swallowed and is to be evacuated, is considerable in amount. Besides their unadvisableness in cases of
poisoning by arsenic, as I have elsewhere1 shewn, the following
cases will suffice to dispel the illusion of their being universal antidotes.
The efforts of our age to discover a peculiar antidote for each
individual poison, or at least for particular classes of poisons, are
not to be mistaken, and I give in my adhesion to them.
Powerful, heroic, medicinal substances, without which the medical art would be as completely paralysed as the mechanical arts
would be without steel and fire, are apt to give rise to violent
effects, even in a very small excess of dose, in certain states of the
body, as also in idiosyncratic or otherwise very irritable subjects,
and these effects the physician must know how to remove in order
that the cause he advocates may not suffer.
Antidote to camphor-opium. Antidote to opium-camphor.
1. A girl, five years of age, had swallowed a quantity of camphor,
calculated at from eight to ten grains. About ten minutes afterwards she grew pale, became cold, her look fixed; then she became
faint, speechless, and senseless.  In a short time the head became
drawn to the right shoulder, and remained in that position; the
rest of the body was limp; the senses extinguished. Occasionally
the arms were moved involuntarily. The eyes were turned upwards.
There was foam at the mouth. The breathing was scarcely perceptible.
Placed in a warm bed, she occasionally seemed to recover herself
a little. Strong coffee was given her; but thereupon the sense1 [ Ueber (ie Arsenikvergiftung. 1786.]




376

ANTIDOTES TO SOME

lessness obviously increased. Violent vomiting set in, (the camphor
was in part ejected) but no relief ensued therefrom, the deathagony seemed to increase always more and more.
I poured four drops of tincture of opium into her mouth, but
could not observe if they were swallowed, but as I imagined I
perceived some signs of amendment after watching carefully for
some minutes, I continued to ply her with opium by the mouth,
and also (as much seemed to flow out of the mouth again, on
account of the inactivity of the oesophagus) by clysters of water
mixed with some drops of thebaic tincture.
As far as I could reckon, she might have taken by both methods
nearly two grains of opium, (a quantity that under other circumstances would certainly have killed a child of that age) when she
recovered perfectly without the employment of any other remedy.
A tranquil sleep of some hours, accompanied by general perspiration, restored all her former liveliness.
In this case it was remarkable how greatly the coffee increased
the too powerful action of the camphor.
In other cases I have observed that these two substances taken
soon after one another, or together, caused a great and rapid tendency
to vomit, a circumstance that might perhaps be turned to account
in practice.
The great specific power of opium in removing so speedily the
dangerous effects of too large doses of camphor, seems to justify
me in regarding camphor, on the other hand, as one of the most
powerful antidotes of opium, as Halle also observed in some degree.
And, if we examine the affair accurately, did not the enormous
dose of opium that I gave in the above case become innocuous in
consequence of the camphor previously swallowed.
Camphor is known, from the observations of others, as an antidote to cantharides and squills.
Antidote to arnica--vinegar.
2. A man of an irritable system, in the prime of his life and
otherwise healthy, during the prevalence of the influenza in April
of this year, took, for a headache of several days duration, occasioned probably by this epidemic, six grains of arnica root, a dose
that he deemed inconsiderable, as he had previously taken with
the greatest benefit, for autumnal fevers, from 15 to 17 grains daily




HEROIC VEGETABLE SUBSTANCES.

377

and even twice a day. After the lapse of about eight minutes, he
was attacked by frightful palpitation of the heart, which at length
became so violent that he could only utter a few words with great
difficulty. His look was staring and anxious. A general coldness
pervaded his frame, and vertigo almost deprived him of hearing
and sight. The open air seemed to revive him, but the effect was
not lasting. He tried to promote vomiting, but the efforts to
vomit only increased his stupefaction, his anxiety, and his vertigo.
His lower jaw fell.
He was scarcely able to indicate his desire for vinegar (by this
time three quarters of an hour had elapsed). Strong wine-vinegar
was brought him, and he felt revived. He drank several ounces
at once, but soon perceived that he experienced most relief when
he did not drink a draught but only took a little every instant. In
the course of half an hour after commencing to use the vinegar he
was restored without further traces of these accidents.
If there be any remedy that we require to regulate carefully by
the actual constitution of the subject whom we are treating, it is
that tremendous irritant arnica, which may be given in the leucophlegmatic cachexies of children of ten years, especially in autumnal diseases and when the pulse is soft, in doses of twelve
grains without the slightest bad results; and on the other hand,
in certain states of the body where there is already present a
general and exalted irritability, eight grains of it in a dose will
kill the strongest man in a few hours, as I have known to occur
in some instances.
The pathognomonic discrimination of the cases, and when it is
at hand, vinegar, will in future prevent such accidents.
Antidote to cocculus indicus-camphor.
3. A druggist, of fine sensibility and otherwise healthy, although
but recently convalescent from an acute disease, some years ago
wished to ascertain the taste of the cocculus seed, and as he considered it a powerful substance he weighed out a single grain of it,
but did not take quite the half of this into his mouth, rolled it
about with his tongue over his palate, and he had not swallowed it
two seconds when he was seized with the most dreadful apprehensiveness. This anxiety increased every moment; he became cold
all over; his limbs became stiff, as if paralysed, with drawing pains




878

ANTIDOTES TO SOME

in their bones and in the back. The symptoms increased from hour
to hour, until, after the lapse of six hours, the anxiety, the stupefaction, the senseless stupidity, and the immobility had risen to the
greatest height, with fixed, sullen look, ice-cold sweat on the forehead and the hands, and great repugnance to all food and drink.
At the slightest increase or decrease of the temperature of the air
(750 Fahr.) he expressed his displeasure; every loud word put him
in a passion. All that he could still say was that his brain felt as
if constricted by a ligature, and that he expected speedy dissolution.
He gave no indication of inclination to vomit, of thirst, or of any
other want in the world. He wished to sleep, as he felt a great
inclination to do so, but when he closed his eyes he immediately
started up again, so frightful, he asserted, was the sensation he
felt in his brain on going to sleep, like the most hideous dream.
The pulse was very small, but its frequency was not altered.
In these frightful circumstances I was called in. A few drops
of thebaic tincture appeared not to agree with him. This led
me to fix upon a strong camphor-emulsion, which I administered to
him, a tablespoonful about every minute. I soon observed a happy
change in his expression, and after he had thus taken fifteen grains
of camphor, his consciousness was restored, the anxiety gone, the
heat natural-in something less than an hour. He perspired a
little during the night, slept pretty well, but the following day he
was still uncommonly weak, and all the parts, which during the
direct action of the cocculus were yesterday painful internally, were
to-day uncommonly painful externally to the slightest touch. The
bowels remained constipated for several days. It is very probable
that all these after-sufferings could have been prevented if, in place
of giving fifteen grains of camphor, I had at once given thirty.
During the increase of the symptoms from the cocculus, he
attempted to smoke tobacco with considerable aggravation; they
also increased from taking coffee, though not so strikingly as from
the other.
Antidote to gamboge (and other drastic gum-resins)--salt of tartar.
4. I saw a child of three years old take a tincture containing two
grains of gamboge, prepared with dissolved salt of tartar, without
the slightest sickness or evacuation, with the exception of an uncommonly profuse flow of urine.




HEROIC VEGETABLE SUBSTANCES.

Alkalies probably destroy the drastic property of other purgative
gum-resins, especially if the latter are still present in the stomach,
but not as in the other cases I have adduced, dynamically, by an
opposite influence upon the sensitive and irritable fibre, but chemically, by decomposing the resin.
Antidote to datura stramonium-vinegar (and citric acid).
5. In a woman rather advanced in life, there occurred from two
grains of the extract of stramonium, taken in two doses within eight
hours, stupefaction, anxiety, convulsions of the limbs and involuntary weeping; symptoms that were frightfully increased by
partaking of coffee. They rapidly disappeared after taking a few
ounces of strong vinegar.
Besides vinegar, citric acid is also a specific antidote to stramonium, as I have shewn in another place,' from the use of currants,
which contain the latter, and I am very much mistaken if the true
antidote of all the solanacece be not vinegar, citric and malic acid.
Antidote to ignatia-vinegar.
6. A paralytic stiffness in the lower limbs, with involuntary
twitchings in them, great anxiety, coldness of the whole body, with
dilatability of the pupil, &c., were the symptoms produced in a
youth of 20 years, by an over-dose of ignatia. His head was free,
his consciousness perfect; but on account of the anxiety, he could
not express himself properly. Intelligence of a somewhat unpleasant nature aggravated his condition; the same was the case with
coffee and smoking tobacco.
For this unpleasant state I gave some camphor, but no good was
thereby effected. But on letting him drink very strong vinegar,
eight ounces in the course of half an hour, he was restored so completely that the same afternoon he was able to make one of a party
of pleasure.
In poisoning with nux vomica I would also advise vinegar, as it
is nearly allied in the natural order of botany to the former.
Antidote to veratrum album-coffee.
7. I had the greatest difficulty in restoring two children, the one
1 [ See page 324, note.]




380

ANTIDOTES TO SOME

a year and three quarters old, the other five years old, who had
both taken white hellebore by mistake, the former four grains, the
latter seven grains. Those conversant with such matters will
consider both to be of themselves fatal doses, and as long as no
antidote is known, absolutely fatal.
But few minutes elapsed before the greatest changes were observable in both children. They became quite cold, they fell
down, their eyes projected like a suffocating person's, the saliva
ran continually from their mouths, and they seemed devoid of
consciousness, when I saw them half an hour after the accident.
It had already been tried to incite them to vomit by means of a
feather, without success, indeed with an aggravation of their
symptoms, as I was told. Milk administered by clyster and poured
down the throat in large quantities had had no effect, except the
production of scanty vomiting, which did no good, but only increased the faintness.
When I arrived both seemed to be at the point of death. Distorted, projecting eyes, disfigured, cold countenance, lax muscles,
closed jaws, imperceptible respiration. The infant was the worst.
The impending death by apoplexy, the failing irritability, at once
induced me to combat the symptoms if possible with strong coffee.
I introduced, as far as the clenched jaws would allow me, the warm
coffee into the mouth, but I chiefly sought to give it in large
quantity by means of the enema. It was successful. In the course
of an hour all the danger was gone. The heat, the consciousness,
the respiration returned. A sleep of several hours, during which
the breathing was slower than usual, refreshed them. All the operations of the animal economy were again almost in good order.
But the children remained weak, emaciated, and every night before
midnight were attacked with a kind of fever, that threatened to
prove fatal in a chronic manner. Peruvian bark given for a fortnight, however, removed this sequela, and as I am informed, they
are still (a year and a half have since elapsed) in the enjoyment of
good health.
I may here observe, that in the case of severe poisonings we
have not unfrequently to combat a remnant of chronic affections,
because the antidote of the noxious substance even though it be
specific, only acts in a contrary sense, consequently, belongs to the




HEROIC VEGETABLE SUBSTANCES.

381

class of palliatives which are unable to remove the secondary effects
of the poison that has been swallowed, especially if it has had time
to make some inroads on the system. Moreover, we must not
imagine that an antidote can be such a perfect counterpoison of the
poison as that all the symptoms of the latter shall be covered by
it, as two triangles with equal sides and angles cover one another;
nor can it, consistently with all analogy, be denied, that the noxious
substance, in combination with an antidote ever so appropriate,
must develope a new action, which could not have been anticipated
from each singly, and which will play its part in the body for a
longer or shorter time. Thus after poisoning by opium, which has
been removed by giving a considerable quantity of coffee, we
perceive an extraordinary secretion of urine, even in persons in
whom the accustomed coffee did not produce this effect of itself;
and a grain of opium in an infusion of from one to one and a
half ounce1 of coffee, taken once or several times a day, gives
perhaps the most sure and powerful diuretic that the medical art
possesses.
Antidote to mezereum-camphor.
8. An otherwise robust man took mezereum internally for some
complaints that he had. But as he continued the use of this drug
even after the disappearance of these complaints, he became affected
with intolerable itching over the whole body, which did not allow
him an hour's sleep. He discontinued the medicine, came to me
thirty-six hours afterwards, and assured me that he could no longer
endure the itching, which increased every hour-the first direct
action of mezereum lasts very long. I gave him thirty grains of
camphor, six grains to be taken every six hours, and before he had
taken it all, his itching had disappeared.
1 According as the patient was more or less accustomed to the use of coffee.




SOME KINDS OF CONTINUED AND REMITTENT
FEVERS.1
The actual number of genera and species of sporadic and
epidemic fevers is probably much greater than is laid down in the
works on pathology and nosology. Indeed the morbific agencies
that act on the human body are so numerous, their intensity and
duration of action so various, that the diseases they give rise to
must present a great variety of character.
Although the great epidemics have been more frequently described than the small ones, the sporadic diseases, still these
diseases,.which present such very different characters, have been
confounded under the same name, so that I may be permitted to
inquire if they are not quite distinct.
Sporadic fevers are still more diverse and still less known, and
it is just from this latter cause, and in consequence of their
frequency, that they in general make as many victims as epidemic
fevers. Sporadic fevers are no doubt more difficult to describe
than the latter, for the fewer the number of observations, the
more difficult is it to deduce from them a specific character.
The following facts, imperfect though they be, may however
serve as a contribution to the history of these fevers.
I. In January of this year, a kind of sporadic fever, apparently
more of a continued than a remittent character, at least in its first
stages, prevailed among the children. In spite of the heat of skin,
the patients experienced continual rigors and great lassitude; the
memory was impaired. The respiration was excessively short and
spasmodic; some of them had a troublesome cough; the urine
1 From Hufeland's Journal derpractischen Arzneykunde. Vol. v. 1798.




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.

383

was high-coloured, and sometimes deposited a red sediment; there
was scarcely any trace of gastro-intestinal derangement; there
was an evacuation of the bowels every day, almost quite regularly;
the brow was often covered with cold sweat.
Evacuant remedies weakened the patients without producing
any amelioration; cinchona bark also produced an injurious effect.
The younger the children the worse was the disease. Many sank
beneath it, chiefly those in whom the continued fever no longer
presented, towards the last, marked intermissions.
A few grains of arnica root produced a rapid change. Although
there was in general no amelioration, the fever which till then had
appeared to assume a continued character changed into an uninterrupted series of paroxysms of intermittent fever, the rigor of
which lasted an hour, and the heat (with very short respiration) a
little longer, terminating in general perspiration. On the cessation of the perspiration the rigor presented itself anew, so that this
state continued day and night.
On the one hand the shortness of the stages, and on the other
the congested state of the chest, the dyspnoea and suffocating
cough, contra-indicated the employment of cinchona. St. Ignatius'
bean on the contrary produced effects that were truly surprising.
I gave it in large doses, every twelve hours; to children from nine
months to three years of age, from 112 to 2/3a f a grain; to those
between four and six years, from 1 grain to 11/2 grain; to those
between seven and twelve years, from 2 to 3 grains. In general
this remedy appears to be more suitable than cinchona in intermittent fevers characterised chiefly by a longer duration of the
heat. The fever terminated at the end of two or three days
without leaving any traces, or any weakness.
Ignatia also removed completely, or nearly so, the dyspnoea and
suffocating cough in those that presented these symptoms.
II. In the commencement of March of the same year, many
children, my own among the rest, were attacked by a fever which
also affected adults, though to a much less extent. In addition to
the actual paroxysms I noticed the following symptoms: tension
and pressure in the forehead just above the orbit on one side,
extending in severe cases to below the parietal region; pressure at
the stomach as from   a weight; tension at the scrobiculus cordis




384     SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
and violent tensive pains (colic) round the navel, accompanied by
clay-coloured diarrhoea, the stools being very fetid, or by constipation
alternating with fetid flatus; constant coldness of the limbs without
rigor; humour very bad (morose, disagreeable); rapid emaciation,
without great debility; absence of signs of derangement of the bile
or of other impurities in the first passages, at least in the stomach;
tongue clean, moist, rarely covered with a somewhat whitish fur;
taste in the mouth natural, sometimes sour; feeling of tension
throughout the body, pupils slightly contracted, not dilating in
the dark.
At noon precisely the paroxysms were always renewed with a
very distinct rigor, lassitude, somnolence, sopor, and lastly the
cheeks burning, but without thirst. Even when the fits were not
very severe the patients felt an unconquerable aversion for all
kinds of food.
Exactly at midnight a slight attack of a similar character made
its appearance: the patient cried out, tossed about in bed; the
limbs were cold. There was rarely at night general perspiration,
after which all the symptoms disappeared until the following day;
but in that case the fever reappeared the third day, and so it
went on.
The greatest freedom from fever was found in the morning.
When the patient rose, the headache, the tension throughout the
body, and the abdominal pains reappeared, but the appetite continued good; the same was the case in the evening.
During this apparent remission the patients expressed a great
desire to eat pork.  On satisfying this desire to satiety, there
occurred more relief than aggravation.
The essential nature of this fever appeared to consist in a diminution of the sensibility and a kind of clonic spasm of the fibre.
The fever shewed itself in the greatest intensity when the wind
blew for a long time from the east.
It was not dangerous, but it was obstinate and troublesome.
Emetics scarcely produced amelioration for one day; notwithstanding their employment, the following day the fever continued
its usual course. Laxatives and the remedies usually employed
for acridities completely failed.
Cinchona and ignatia, given in small or large doses, aggravated




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.       385
the patient's state. Arnica, though it palliated the bad humour,
the headache, &c., had only an antisymptomatic effect, it did not
produce permanent amelioration.
The immobility of the pupil, the pressive, tensive pain in the
scrobiculus and around the umbilicus, together with the general
sensation of tension throughout the body; the sopor, the
apparently insignificant diminution  of the strength, and  the
relief afforded by the occasional perspirations, the benefit produced
by the ingestion of pork, which exercises a great influence on the
contractility of the fibre, and finally the aggravation occasioned by
the east wind, all these symptoms led me to regard opium as the
remedy indicated. The fetid stools and flatus, whilst the stomach
continued in a normal state, contraindicated its employment all
the less as the clay-colour of the evacuations betrayed a spasmodic
state of the excretory biliary ducts. I accordingly give this remedy
in the morning before the fit, in the dose of '1/th of a grain to an
infant of five years, 3/loths of a grain to one of seven and another
of eight years, 7/2oths of a grain to one of ten years. I took myself
half a grain. The symptoms disappeared completely in the course
of the day. Twelve hours afterwards, in the evening, I gave a
still weaker dose, and the fever did not return either the following day or on any subsequent day; the constipation likewise
ceased. The patients were cured.
III. In the month of April there prevailed an influenza essentially different from that which had been observed five years
previously. I know not if the studies that were made of it at that
time were correct, or if I am mistaken in my appreciation of the
disease. I shall therefore only draw attention to one single point
of dissimilarity and leave to my readers the trouble of comparing
the others.
In the epidemic of 1782 there was scarcely a third or even
a fourth of the inhabitants who were riot attacked by a fever
presenting all the symptoms of a catarrho-rheumatic fever, though
it only lasted seven days. In general they were all affected in the
same degree; though there was no danger except to debilitated
subjects, to old people, and those suffering from pulmonary consumption. In the influenza of the present year, on the contrary,
nine tenths scarcely had anything more than slight traces of the
2c




386    SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
malady, without fever; the other tenth, on the contrary, were
attacked by fever, and danger was imminent.
Patients who had none of the febrile symptoms did not usually
seek advice, and were not considered to be affected by the epidemic.
It was difficult to observe them, and their symptoms were not
perceived by unobservant medical men. All their functions went
on regularly; the only characteristic symptoms they presented
were drawing and paralytic pains in some part of the body-some
had them in the nape, others only in the external parts of the
neck, or only in one half of the chest, in others they were confined
to the back, one arm, a thigh, or a few fingers. These fixed pains
troubled the patients for weeks, and all the resources of domestic
medicine, as the infusion of elder-flowers, the juice of elder-berries,
fumigations and emetics, were of no use. When, on the contrary,
recourse was had to the appropriate remedy for influenza, the
pains ceased quickly in the course of two days or even less.
Other patients had pains in several limbs at once, accompanied
by fever.
Those who had at the same time febrile symptoms experienced,
before the hot stage, for several hours, and even for some days, a
rigor that recurred from time to time, that was aggravated by every
movement, and was accompanied by ill-humour, pusillanimity and
despair. The patients complained at the same time of weight in
the head and dulness, symptoms which they did not consider as
headaches, and a difficulty of swallowing, which soon shewed itself
on the external parts of the neck and on the nape, or which
changed into insufferable tension that did not permit of the
slightest motion of the neck, and was aggravated by the touch.
In the back they experienced a disagreeable drawing; on the
chest a similar very painful sensation, and throughout the body,
especially in the thighs, a well marked paralytic stiffness. The
patients felt the sensation of laziness and lassitude most when
seated.
After another and more violent rigor (sometimes accompanied
by very great anxiety at the heart) which generally appeared in
the evening, and in bad cases sooner, the most violent tensive and
pressive headache came on just above the orbits and, in many of
the patients, in the occiput also. The anxiety increased, the face




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.        387
became swollen, the eyes red; added to these was a violent heat
which lasted six, twelve or more hours, and in some cases till death,
which occurred on the fourth, seventh or fifteenth day.
In the mild cases, when the heat diminished, it passed every
day (for the paroxysms were usually quotidian, towards the evening, although latterly without rigor) after midnight into general
Sdiaphoresis, often characterized by an excessive fetor, and which,
in the most favourable cases, only lasted till six o'clock in the
morning, but beyond that time in -the bad cases. When the
perspiration was not very copious, and when it ceased at the
time first mentioned, there ensued, throughout the day, a great
amelioration of all the pains and the headache; if, on the contrary, it lasted longer and was more abundant, there occurred
more disagreeable affections; the head again became confused,
and was from time to time affected by pains; the pains on the
external parts became twice or even four times more severe
during the perspirations that occurred by day, and there was
reason to dread the supervention of a continued, a deadly fever.
During the first days there was obstinate constipation; in the
most severe cases there was suppression of the urinary secretion
that continued sometimes even till death ensued; in these cases
there was no perspiration during the greatest severity of the heat
of body, and there occurred delirium and tossing about, premonitory symptoms of approaching death. In the most favourable
circumstances, the day following the first febrile heat, the urine,
small in quantity, was of a greenish-black colour, opaque, passing
the following days, until the recovery was complete, into green
and light green.
In the worst cases the tongue was dry and brown to its very
point, or when it was slightly moist it was brown or covered by a
black coating, and it was yellow in the less serious cases. Notwithstanding the dryness of the tongue, the thirst was not great,
and the patients generally expressed a wish for acidulated drinks,
rarely for pure water. When amendment ensued they asked for
beer. In the mildest cases they felt a bitter taste on the tongue;
in less favourable circumstances this taste was very disagreeable;
it was not present at all in those cases that presented the most
dangerous character. All alleged that they perceived the natural
taste of solid and liquid food, though it excited the greatest repug2c2




388    SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
nance in them. The first stools were black, fetid; afterwards they
became of a greenish-brown colour.
After a constipated state of the bowels had lasted several days,
there generally occurred a diarrhoea, similar to that attending
colic, with aggravation of the symptoms.
In the bad cases, there was sleeplessness that lasted until death
took place; nothing approaching to sleep was observed except a
sort of drowsiness, that lasted a few minutes, with delirium and
tossing. As the disease diminished, the patient got some sleep
before midnight; but even in the most favourable circumstances it
only lasted until three o'clock.
The most troublesome symptoms were: dejection and despair,
paralytic stiffness, drawing and tensive pains in the external parts,
especially in the tendinous and membranous aponeuroses, as it
seemed, and in the periosteum of the affected parts; weight in the
head, alternating with tensive, drawing and pressive headache, and
loss of memory.
The character of the affection seemed to betray pain and irritation of the sensitive fibre.  Coryza, properly so called, never
occurred. In some cases, stitches in the side with expectoration of
blood were added to the array of symptoms, but these stitches in the
side were not attributable to inflammation.
Sometimes the fever was accompanied at night by attacks of
suffocation.
There was never either swelling or redness in the part, even in
cases where the pain was excessive, with the exception of some
cases where the fingers were very sensitive, swollen and red; in
one single case the hepatic region was tumefied.
The most annoying drawing headache was often accompanied by
nausea that lasted several hours, by faintness and rigors. The
catamenia were generally premature and degenerated into metrorrhagia.
The most powerful emetics did not cause vomiting, but sometimes
nausea, that lasted for whole days, alternating with syncope;
sometimes a single abundant stool occurred, with aggravation of all
the symptoms; or again, very small doses of these emetics brought
on excessive vomiting for several hours, as often as twenty times,
and in severe cases even thirty-six times, always succeeded by
obvious aggravation. (Sometimes spontaneous vomiting occurred




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.          389
for twenty-four consecutive hours, and the disease went off entirely.)
If, as very seldom happened, the emetics occasioned moderate
vomiting, the matter vomited usually consisted of a black, fetid
substance, resembling in appearance the grounds of coffee; and,
when that was the case, all the other symptoms became speedily
aggravated. All attempts made to provoke vomiting by tickling
the fauces with a feather only produced loss of strength and increase
of the pains.
A similar effect was produced by every kind of laxative, even the
mildest kinds, especially when there was present a predisposition
to diarrhoea. Thus I saw four grains of rhubarb produce, in the
case of a boy of eleven years of age, more than forty stools in the
course of two days, and increase the intensity of the symptoms.
Many patients sank beneath the constant diarrhoea.
When diaphoretics, which were employed by the poorer classes,
sometimes produced the desired effect, excessive perspiration came
on, causing an aggravation of all the symptoms. In some patients
an abundant uniform transpiration manifested itself until death.
Vegetable acids, which were employed by the medical practitioners in great quantities, occasioned vomiting and diarrhoea,
followed by aggravation. Taken by the patients according as their
feelings dictated, they seemed to refresh them, but they could only
take a very small quantity at a time. In the most violent attacks,
they 'only desired to moisten their lips, and found themselves
refreshed thereby.
Mineral acids seemed not to be useful.
Venesection was hurtful in every stage of the disease, but especially when the fever was severe; death, then, often ensued about
the fourth day. Even when the fever seemed slight at the commencement, bleeding' was instantly followed by fainting, prostration of strength, increase of the pain, and aggravation of the
disease.
Opium subdued the heat and the excessive perspiration, also the
1 The local practitioners constantly had recourse to bleeding; they thus caused
the death of many patients. If, by chance, a vigorous subject survived after a hard
struggle, they raised shouts of triumph, and pretended they had saved him by means
of a well-timed bleeding, or by their resolvents and evacuants. One of themselves
sank under a similar treatment too exactly followed out, though every effort had been
made to dissuade him from it.




390    SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
delirium and the somnolence; but it increased the constipation; in
general it did not seem to remove the malady radically.
Camphor, on the contrary, surpassed all the expectations that
could have been formed of it; it was efficacious, and I may say
specific, in all the stages of the disease, accompanied or not by
fever, especially when it was given as early as possible and in large
doses. A large number of patients recovered by its use in the space
of four days, in spite of the gravity of their symptoms.
At the commencement I was very cautious in its use, and did
not give to adults above from fifteen to sixteen grains per diem, in
almond-milk; but I soon perceived that in order to produce a speedy
recovery, it was necessary to give, even to weak subjects, thirty
grains, and to more robust individuals, forty grains in the twentyfour hours. The favourable result was never long delayed; the
constipation ceased; the bad, or at least the bilious taste, rapidly
went off, together with the nausea and discomfort; the weight and
pain in the head diminished from hour to hour; the febrile rigor
was smothered in its birth; the heat diminished; and in those
cases where there had been no perspiration, or where it had been
abundant, there occurred a general mild diaphoresis, with diminution of all the drawing tensive pains in the external parts. The
strength soon returned, along with appetite and sleep; the despondency changed into strength and hope, and the patient recovered
his health without a drawback.
I am afraid that this rapid disappearance of the symptoms, the
yellow, brown or black coating of the tongue, the nauseous and
bitter taste, the constipation, and the sickness, removed often
within the twenty-four hours by the use of camphor alone, given in
large doses, will not please the orthodox partisans of the saburral
school.  Nature, to be sure, often refuses to conform to the
requirements of systems: the more's the pity for the dogmatic
physician who attempts to fight against her!
When I had been summoned in time, and the disease, in spite of
the gravity of its commencement, had radically disappeared at the
end of four days, or six at the most, there did not remain a single
morbid symptom, not even lassitude.
A nervous lady of great spirit, could not be consoled during the
first days for the loss of her betrothed, whom she loved tenderly;
he had died of the disease, and she it was who had tended him.




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.        391
She lost her appetite and refused all food. I was advised to prescribe an emetic for her in order to restore the appetite, but I
refused to do so; she was threatened with an attack of influenza,
and I merely ordered a glass of wine and sought to raise her spirits.
Her numerous avocations, and still more, her intelligent mind
and the consolations of her friends, assuaged her grief; the next
week she was more calm, felt her appetite returning, and obtained
a little rest in sleep. She only felt some vague pains in the bones,
for which she neglected to consult me. Fifteen days after the
death of her friend she was seized with a febrile rigor that lasted
two hours, and with all the signs of the most violent form of the
prevailing epidemic. As regarded her disposition, she was a prey to
the most profound despair: day and night she only spoke of her
lover, calling him by name, and promising that she would soon join
him. Her restlessness was excessive, the tongue was covered with a
black coating, she had disagreeable eructations, with bitter taste in
the mouth. The heat, the pains in the neck and limbs, the violent
headache, filled me with well grounded apprehensions as to the
result. I prescribed from fifteen to eighteen grains of camphor the
first two days, and an emetic, in consequence of the persistence
of the eructations and the bitter taste. The only effect the emetic
had was to cause nausea, which lasted several hours; a fresh dose
of camphor was given to remove the spasm, and then she had slight
vomiting of mucus. Still she felt no relief, and every thing seemed
to prognosticate a fatal termination. She spoke of nothing but
her lover; her whole body was burning, the face puffed, the
pulse 130. Thirty grains of camphor given within the twenty-four
hours produced a slight moisture of the skin, and diminished the
heat and bitter taste of the mouth. The following day she got
thirty-six grains, and the day after forty; she slept quietly, spoke
no more about the deceased, felt consoled, and regained her
courage. She got up and asserted that she felt nothing now except
little or no pain in the head and limbs, and she asked for something
to eat. Thirty more grains of camphor given on the two following
days, re-established her health completely, and from that time she
was able to resume her usual occupations.
I only know one case out of more than a hundred where the
camphor failed. A lady of rank, very hysterical, subject to hysteria
from her youth, had been attacked by influenza. She had taken




392    SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
with good effects twenty grains of camphor in the twenty-four
hours, and I prescribed for her fifteen more, to be taken in the
space of twenty hours, against some inconveniences that remained.
She immediately experienced profuse perspiration, which, in the
course of sixteen hours, increased to a very violent degree, with
intense heat, faintness and anxiety. The state of the patient was
very serious, but half a grain of opium allayed the anxiety, heat
and sweat, in less than an hour. I prescribed it anew in much
larger doses with much success, and the cure was complete.
The nature of the influenza which generally goes on to copious
evacuations (and on the other hand, sometimes to an excessive suppression of the evacuations), in this case resisted its own specific,
probably in consequence of having undergone a modification from
the hysterical constitution of the patient.
Before I had ascertained all the efficacy of camphor in this
extraordinary disease, I was forced to content myself with opium
and cinchona; the first during the hot and sweating stages, the
second during the remission. Troublesome and difficult as were
these cases, nevertheless the employment of these substances sufficed
to remove (although only after several days) the coating of the
tongue and the bitter taste, and by degrees all the affection. But
after it had been subdued, the convalescents could no longer bear
the bark; no sooner was it taken than it was ejected. In the
epidemic of 1782, I find among the large number of remedies
employed by physicians, camphor mentioned incidentally, but no
effect superior to that of the other therapeutic agents is attributed
to it.
What induces me to believe that on that occasion these various
medicaments were employed in a blind and arbitrary manner, is
that among many other remedies arnica1 is equally recommended
for this affection. This substance, though efficacious in many
other diseases, is very dangerous in this one. I have seen a robust
man affected with influenza, and already convalescent, die in the
space of twenty-four hours and a half with all the signs of poisoning, after taking eight grains of arnica-root, the fatal effects of
which shewed themselves by coldness, vertigo, palpitations, anxiety,
and loss of voice. Had I at that period known the specific
1 Languth, Diss. histor. catarrh. epidem., 1782, Helmstadt, p. 157.




SOME KINDS OF CONTINUED AND REMITTENT FEVERS.      8 93
remedy for this kind of poisoning, viz., vinegar, I might have
saved this patient's life. The extract of aconite2 employed in the
same way in this epidemic is equally prejudicial.
This last influenza, in common with all others, as I have had
opportunities of convincing myself, presents as a characteristic
feature the power of affecting indiscriminately all persons, whatever their constitution may be, a power which the plague of the
Levant scarcely possesses in such a high degree. Most epidemic
diseases attack chiefly persons in good health; but there are
persons affected with chronic diseases, among which I may merely
mention severe nervous affections and mental alienation, who are not
affected by them; or if so, the old affection is suspended in its
course and the new one takes possession of the system; or finally,
and this happens tolerably often, the first is cured by the second.
It is not so with influenza. Not only does it attack indiscriminately all individuals affected with chronic maladies, but it complicates itself with them and aggravates them. It is when it
remains latent itself, that it stirs up and aggravates any ancient
disease which may perhaps have slumbered for a long time, and
the chronic symptoms thus aggravated no longer yield to the
remedies formerly employed with success against them, but only
to the specific for the influenza. It reproduces deafness, ophthalmia, cough, asthma, pains in various parts, especially in the chest,
head, viscera or limbs, ancient spasms, hypochondriasis, melancholia, all those sufferings that had long been cured; the epidemic
constitution and the presence of a few of the symptoms of
influenza alone lead us to recognise the existence of influenza,
masked by these chronic maladies. Sometimes it has occasioned
paralysis, either by metastasis, or in parts previously painful.
A child of twelve years of age, in a district where this epidemic
was raging, was seized with characteristic tearing pains in all the
limbs, with tensive headache and intolerable pains in the eyes.
Having taken a chill, all the signs of the disease disappeared,
but the child lost its sight. The pupils were much dilated and
unaffected by the strongest light. The employment of fifteen
grains of camphor daily, continued for a fortnight, rapidly
restored vision without the employment of any other remedy.
2 tOp. cit. p. 144.




394    SOME KINDS OF CONTINUED AND REMITTENT FEVERS.
About the same time in the mother of this child there was reproduced a melancholia with despair and tendency to suicide, a
disease which had disappeared several years previously. Besides
tensive pains in the head and anxiety in the precordial region,
she complained of drawing pains in the limbs. Of all the remedies given, camphor chiefly contributed to her cure.
A month after the termination of the epidemic there was
observed a chronic remission of this fever having a sporadic
character. It had this peculiarity, that the pains experienced by
individuals in whom convalescence had set in after the influenza,
recurred either without fever, or accompanied by a kind of intermittent fever, with quotidian or tertian type. The great lassitude,
the prostration, the faintness and the sweat, characteristic of
influenza, were entirely awanting. The heat was moderate, the
cold all the more obstinate, though not inducing much shivering.
Cinchona, but still.better, ignatia, removed the febrile symptoms,
but the pains became constant. Camphor failed completely; the
ledum palustre, on the contrary, in doses of from six to seven
grains, three times a day for adults, produced permanent relief.
In some obstinate cases I was forced to have recourse to aconite,
which cured them rapidly. I am sorry that I only had an opportunity of treating a small number of those cases that presented
themselves at the end of the epidemic, so that I am unable to
judge if this plant, whose medicinal properties are much greater
than those of ledum, would not have enabled me to attain my
object much more rapidly in all the cases that presented themselves to my notice.




SOME PERIODICAL AND HEBDOMADAL DISEASES.'

I. A young man, recently recovered from a spasmodic asthma,
having drunk some wine, contrary to the dietetic rules I had laid
down for him, was heated by it and began to quarrel and fight
with his companions. After violent muscular exertion he was
seized with an attack of asthma, which became worse and worse,
and towards the end of the night reached its greatest intensity.
The following day and some days afterwards he felt great lassitude.
A week afterwards, without appreciable cause, a similar attack came
on, also followed by lassitude. From that time the fits, together
with the consequent weakness, came on regularly every Monday
afternoon. Eight grains of St. Ignatius' bean once diminished
the attack in a marked manner and the weakness did not occur;
but strangely enough, the following Monday this attack came on
again with renewed force. Cinchona-bark given the following
Monday, in the dose of half a drachm in the morning and a
drachm after dinner, completely suppressed the fit, and after two
more doses all traces of the affection had disappeared.
A circumstance worth mentioning is, that previously the cinchona had always failed in the same person against his asthma
when it was continued and not periodical.
II. A lying-in woman, aged 40, one Sunday met with a severe
mortification, when confined of her fifth child.  Besides other
disagreeable symptoms, there came on a sensation of formication
that gradually extended from   the sacrum   up to betwixt the
scapulae, so that by Friday it reached the nape. A sudden stiffness
occurred at that spot. The patient experienced at the same time
1 From Hufeland's Journal der pract. Arzneykunde. Vol. v, Pt. i. 1798.




896

9OME PERIODICAL AND

a violent febrile rigor which lasted several hours, followed by diaphoresis which continued till late at night and terminated in
profuse sweat. The following day she complained of nothing but
lassitude, and on taking the least repose, even if seated, she had
general sweat, somewhat cold, during the whole day. A disagreeable sensation of formication, extending from the nape to above
the occiput, came on every afternoon and lasted till bedtime.
There was no bad taste in the mouth, the tongue was clean, but
the appetite almost absent. From that period the same fit of
intermittent fever, characterized by the same symptoms and by
the same termination, occurred on the Thursday and the following
Thursdays for several weeks.
When the patient came to consult me she concealed the exciting
cause of her disease, viz., the mortification. The normal taste and
the cleanness of the tongue contra-indicated the use of an emetic.
There was evidently in this case an intermittent fever with a quotidian type, and another with a hebdomadal type. The employment of
ignatia continued for a week, until the Thursday,entirely removed the
febrile symptoms affecting the head. Given also on the Thursday the
hebdomadal attack far from diminishing, reappeared, on the contrary, with more violence, but was not followed by lassitude. I
discontinued the treatment during the subsequent week; indeed
all the corporeal functions were performed regularly, the febrile
commotion in the evening and the perspirations by day had disappeared, gaiety, appetite and sleep were restored. From that time
I administered every Thursday, with great success, a suitable dose
of cinchona. The hebdomadal fever did not return and the patient
was cured.
III. A very hypochondriacal man suffered in the spring of last
year from a periodical hematuria, the type of which he could not
remember. There was at the same time fever, great debility and
sleeplessness. He had a relapse of his disease in the month of
May of this year. I combatted the accessory febrile symptoms
with remedies adapted at the same time for the hemorrhage, to wit,
ipecacuanha given on an empty stomach in the morning, so as to
occasion nausea for four hours, and in the evening sulphuric acid.
The accessory febrile symptoms sensibly diminished, but the hematuria reappeared the fourth day at seven o'clock in the morning,
immediately after awaking, as on the first occasion, and twice on




HEBDOMADAL DISEASES.

397

the seventh day thereafter at the same hour. Notwithstanding all
the prejudices against the employment of cinchona-bark in hemorrhages, I gave a suitable dose of it every evening before going to
bed, fearing to miss the hour in the morning when it ought to be
given.
Not knowing if the fit, in place of offering a hebdomadal type,
would not recur every three days and a half, as frequently happens,
and if an attack might not be expected on the afternoon of Thursday, I prescribed a dose of cinchona for that day at noon, at the
same time continuing the evening dose. But before the patient
could take it, an attack of hematuria, though not a very severe
one, occurred on the Thursday morning about eight o'clock.
I had thus learned: 1st, that the curative power of the evening
dose did not last till the following day; 2nd, that the semi-hebdomadal type was not bound to precisely the first hour of the second
half of the fourth day, but that it could also occur at the regular
hour of the hebdomadal paroxysm. I consequently altered my
treatment: I thereafter gave every morning a dose of cinchona,
taking care to have the patient awakened an hour before his usual
time of waking, at six o'clock, permitting him either to go asleep
again, which he generally did, or to get up. In the course of a
fortnight the hematuria was quite cured.
The hebdomadal type which diseases sometimes observe, recurring towards the middle of the fourth day, (the fourth day?) the
seventh, fourteenth, twenty-first, thirty-first days (the middle of
the fourth week), &c., appears to differ essentially from the daily
aggravation of most diseases which we observe to take place in the
evening, and from the types of quotidian, tertian and quartan
intermittent fevers. Experience has taught us that St. Ignatius'
bean does not suit the first of these types, which seems peculiar to
hysterical, hypochondriacal and spasmodic diseases.




A  PREFACE.1

I have translated the book entitled " Thesaurus Medicaminum,
a new collection of medical prescriptions, distributed into twelve
classes, and accompanied with pharmaceutical and practical remarks
exhibiting a view of the present state of the materia medica and
practice of physic, both at home and abroad. The second edition,
with an appendix and other additions. By a member of the London
College of Physicians. London: F. Baldwin, 1794, 8vo.," introducing into the body of the work formulas derived from the London
and Edinburgh Pharmacopoeias and from Lewis, and adding some
notes, under the signature of Y., which to some of my readers may
facilitate if it do not altogether enable them to dispense with the
journey to Anticyra.
If, as the preface to the original informs me, even in London,
medical frankness requires the vegis of anonymousness, in order to
escape being chid; I need not say a word as to its expediency for
some time past in our own dear fatherland!      If I, the German
editor, would not be less frank, what other course was there for me
to pursue? However, as truth can neither be more true nor less
true, whether it be said by a man with an imposing array of titles
or by one perfectly unknown to fame, the indulgent reader will
please to regard merely what is said.
It will be perceived that the original is one of the most recondite
collections of selected, at least of elegant prescriptions; but it will
also be observed that the writer of the notes is no friend to compound medicines. But how, it will be asked, did he come to
edit this work? To which I answer, solely for that very reason!
1 The work to which this is prefixed was translated by Hahnemann, and published anonymously in the year 1800, under the title of Arzneischatz oder Sammlung
gewildter Bezepte, aus dem englischen; Leipzig, bei G. Fleischer.




A PREFACE.

399

I wished to shew to my countrymen that the very best prescriptions
have a hitch somewhere, are unnatural, contradictory, and opposed
to the object for which they are designed. This is a truth that
should be proclaimed from the housetops in our prescription-loving
times. When will the time come when I shall see this folly eradicated?  When will the physician learn that the cure of his cases
requires few, quite simple, but proper, perfectly suitable remedies?
Will they for ever deserve the ridicule of such as Arcesilas? Will they
never cease to mingle together a heap of remedies in one prescription, each of which (for in the general use of compounds it is
impossible to investigate the nature of the several ingredients)
remains to the greatest physician often but an imperfectly known,
often a wholly unknown thing?  If Jones, in London, uses every
year three hundred pounds of cinchona-bark, what accurate, what
perfect knowledge do we obtain of the peculiar mode of action of
this powerful remedy? Very little indeed! What do we know of
the pure special mode of action of that powerful substance, mercury, the monstrous consumption of which in medical practice
would seem to imply a thorough knowledge of its relation to our
bodies?  Very little! Little besides the empirical apothegm that
was enunciated 300 years ago: "it cures the venereal disease," all
else are untrustworthy fragments. What certain knowledge do we
possess respecting opium that could lead us to such a frantic abuse
of it? Little or nothing of a sure character! What of Camphor?
Scarcely anything!
Would that Arcesilas were still alive to know that physicians are
still at variance as to whether mercury is capable of producing a
change in the strength, mobility and sensibility of the fibres (and in
the pulse), in a word, can cause a peculiar kind of fever or no, whether
bark is antipyretic, merely by virtue of its being a bitter astringent
substance like a mixture of gentian and polygonum, or by some
peculiar inherent principle-whether opium strengthens or weakens
-whether camphor is cooling or heating, _and that those who
contend for the one opinion as well as those who defend the other,
have both forgotten to state the special conditions of their conclusions. But if the power of these substances of every-day use be so undetermined, how much less known must not those of rarer use be I
If such remarkable obscurity prevail respecting single medicines, to what a zero in point of value must the phenomena sink,




400

A PREFACE.

which result from the ordinary tumultuous employment of several of
such unknown drugs mixed together, in diseases-in diseases, those
abnormal states of the human body-the most intricate of all
organized beings-that are in truth not easily cognizable in individual cases! It is as though one should throw blindfold a handful
of balls of various sizes upon an unknown billiard table with
cushions of various angles, and should pretend to decide beforehand
what effect they would all conjointly produce, what direction each
would take, and what position they would finally occupy after
their many deflections and their unforeseen mutual concussions!
And yet the results of all mechanical forces are much more easily
determined than those of dynamic forces.
" In a mixed prescription the case is far otherwise," methinks I
hear it contended, " for there the prescribing physician determines
for each ingredient the part it shall play in the human body: this
one shall be the base, this other the adjuvant, a third the corrective,
that one the director and this one the excipient!   It is my
sovereign command that none of these ingredients venture to quit
the post assigned it in the human body! I command that the
corrective be not backward in concealing the blunders of the base,
that it cover all the delinquencies of this principal ingredient and
of the adjuvant, and direct them for the best; but to go out of its
rank and situation and to take upon itself a part of its own contrary to the base, I hereby positively forbid it! Now, adjuvant!
to thee I assign the office of Mentor to my base, support it in
its difficult task; but mind, thou art only to take it by the
arm, but not to do anything else of thine own accord, or dare to
act contrary to the order which I have given to the base to cause
a certain amount of vomiting; but thou must by no means presume in thine ignorance to undertake any expeditions on thine
own account, or to do anything different from the intention of the
base; thou must, though thou art something quite different, act
entirely in concert with it; that I command thee! I assign to you
all conjointly the highly important business of the whole expedition:
see that you expel the impure humours from the blood, without
touching in the slightest degree the good ones; alter, transform,
what you discover to be in improper combination, in a morbid
state. Remember that the commission to alter and to transform
gives you unlimited authority to change, God knows or knows not




A PREFACE.

401

what (just as in warlike tactics it is usual for the general to
possess more knowledge than his sovereign lord). You are to
diminish the irritability of the muscular fibre, to lessen the sensibility of the nerves, to procure sleep and rest. Do you see the
convulsions in yonder arm? I wish them to be quieted, and the
spasm in the sphincter muscle of the bladder to be removed!
That fellow there has the jaundice; I command you to bleach him
and to deobstruate his biliary ducts, whether their impermeable
condition be owing to spasm or to a mechanical obstacle, or
to some degeneration of the liver.  In that hysterical woman,
and in those old skin diseases, all my long years of treatment and
my employment of extracts of spring herbs have proved useless,
from which I infer that there are obstructions in the capillary vessels
of the abdomen-my favourite way of accounting for morbid affections. Now you, most worthy base! were, only a few days since
(and that is a great thing in my estimation), accredited to me in
one of the latest pamphlets as a sure deobstruent. I therefore give
you a commission to resolve those indurations (though I myself
am unacquainted with the invisible indurations and know not
what menstruum can dissolve them, what liquifier can melt them,
or whatever else the comfortable expressions of our school may be)
-enough, you will know quite well what is to be done when you
yourself get upon the spot. Sommering, to be sure, says that hard,
swollen glands do not consist of constricted vessels, but on the
contrary of unnaturally dilated vessels. But what care we for
what that dreamer says. We physicians have been in the habit of
deobstruating for so many centuries. Suffice it to say, I command you, base! to deobstruate for me.     See yonder typhus
patient, my dear base saltpetre!  I pray you to advance and
check the putrefactive process, as you did a year ago to my pork
ham. Do not attempt to excuse yourself by alleging that hitherto
you have always been unfortunate in all your expeditions; I give
you for an ally the sulphuric acid, to support you in all your
attacks, although those fantastic chemists would try to persuade
us that you do not agree with it, that neither of you remain what
you were, that you mutually change into nitric acid and sulphate
of potash. What nonsense! just as if such a thing were possible
without the permission of the physician who presides over prescriptions! Enough that I command you to extinguish the putrid
2 D




402

A PREFACE.

fever; for that purpose you have received from me your diploma
of base. Moreover, I put at your service a troop of auxiliary,
corrective and directing substances.-My dear base, opium! here
I have an obstinate, painful cough to combat. You, who have
received from the Asclepiades the office of subduing all spasms
and pains, be they ever so different in character, just as the seven
planets were commissioned in the almanacks a century ago to
preside over this and that part of our body-to you I give the
commission sanctioned by tradition. But I have been informed
that you have often a bad propensity to constipate the bowels.
But in order that this may not happen I give you as auxiliaries
this and that laxative ingredient, and that your action may
not be disturbed by these, is your own look out; why else
should I constitute you the base! Moreover as you sometimes
occasion heat, and are given to check exhalation, I give you camphor as a corrective, in order to counteract this bad habit of yours.
Some one lately asserted that you lost all your properties when
camphor was given along with you. But do not let that lead you
astray. How can the saddle-horse allow himself to be obstructed
by the draught horse?  Each of you must do your duty as it is
indicated for you in the authorized Materia Medica, whence our
opinion is derived. It has also been told me that the stomach is
deranged by you, but to prevent you playing this trick I have
included in the prescription along with you several stomachic
remedies, and will allow a cup of coffee to be drunk after you are
taken, which assists digestion, as the writings of practitioners
allege-regardless of those newfangled persons who assert of it
that it destroys your power: but you must not allow yourself to
be rendered powerless; for that reason I have appointed you the
base."
And thus, as though they were independent beings endowed
with free volition, each ingredient in a complete prescription
has its task allotted to it, vel invitissima Minerva Hygeiaque,
in many other respects also. For there are many learned considerations in a regular classical prescription.  This indication
and that one must be fulfilled; three, four and more symptoms
must be met by as many different remedies. Consider, Arcesilas!
how many remedies must be artistically combined in order to
make the attack at once from all points. Something for the ten



A PREFACE.

403

dency to vomit, something else for the diarrhoea, something else
for the evening fever and night-sweats, and as the patient is so
weak, tonic medicines must be added, and not one alone, but
several, in order that what the one cannot do (which we don't
know) the other may.
But what if all the symptoms proceeded from one cause, as is
almost always the case, and there were one single drug that would
meet all these symptoms?
" That would be a very different thing. But it would be inconvenient to search for such an one; we put in one prescription
something to meet every indication, and thus we fulfil the requirements of the school."
But do you thereby satisfy the requirements of the art, of the
precious human life?
" No man can serve two masters."
But do you seriously believe that your hotch-potch will do
what you assign to each of its ingredients, just as if they
were things that did not mutually react upon each other,
that did not influence each other, or that would refrain from
doing so at your command?   Does it not occur to you that two
dynamic agents given together can never effect that which both,
given separately at different times, would do-that an intermediate
action must ensue which could not have been foreseen beforehand
-and that this must be still more the case when several are given
together! Who could tell beforehand that opium given along
with coffee would in most cases exert merely a strong diuretic
action? who could have predicted it of these two remedies?  Will
opium still stupify if ipecacuan be combined with it?  You perceive that they do not act according to your will, nor according to
your atomic principles! The combination of these two dynamic
powers causes anxiety and perspiration.
"But tartar-emetic will be more apt to excite vomiting, if on
account of the weakness of the stomach I combine with it cinchona bark? "
Very little or not at all, my short-sighted friend!
" Why had the white hellebore so little effect on that patient? "
Because you gave at the same time a clyster of chamomile!
"What terrific effects ought not a good extract of stramonium
to have! according to medical authors. They are a pack of liars!
2D2




404

A PREFACE.

A short time ago I gave it to a very sensitive patient in a strong
dose in a draught. It had no effect, not the slightest."
Probably you mixed it with oxymel?
" Yes, I did! But what harm can that do?      It was only the
excipient; only four ounces."
Several ounces of that vegetable acid? Well, you need not
wonder that no effect was produced.-Did I not see you the other
day prescribe salt of tartar mixed with gamboge?     What was
your object in doing so, and what effect had the powder?
"The first was in order to loosen the mucus, and the second to
expel the worms forcibly; but to my astonishment it did not
cause a single evacuation of the bowels."
That does not surprise me! Know that two, not to speak of
three or more substances, when mingled together do not produce
the same result that might be expected from them if given singly
and at different times, but a different dynamical intermediate
action, whether you wish it or no. In that case the systematic
arrangement of your ingredients is of no avail, nor the part you
allot to the base and bases, to the adjuvant and adjuvants, to your
corrective, director and excipient.  Nature acts according to
eternal laws, without asking your leave; she loves simplicity, and
effects much with one remedy, whilst you effect little with many.
Seek to imitate nature!
To write very composite recipes, and several of them in the
course of the day, is the climax of parempiricism; to administer
quite simple remedies, and not to give a second before the action of
the first has expired-this and this alone is the direct way into
the inner holy place of art. Make your choice!




FRAGMENTARY OBSERVATIONS ON BROWN'S
ELEMENTS OF MEDICINE.'
In section xviii he politely apologises for being obliged to make
use of the phrases, deficient, exhausted, consumed, accumulated, superfluous excitability, owning to the novelty of the doctrine and the
poverty of common language. But this is no excuse for the man
who boasts (cccxii) of having now reduced the art of medicine
to an exact science which will at no distant day receive the appellation of Doctrine of Nature (note to DCLXXnII), and of being the
first who has made it a demonstrated science (see end of the
Preface). He who would teach a new science for which he must
employ new ideas, ought to employ for them new, appropriate,
unequivocal terms, or make use of the old words attaching new
meanings to them for the new expressions. But as Brown employs
the old expressions unexplained and without attaching to them
new meanings, he must permit the reader to understand them in
their old signification, and when we read, that excitability, a certain quantity or a certain energy of which has been assigned to every
being upon the commencement of its living state (xviii), may be worn
out by stimuli (cccIx) and yet afterwards be drawn forth by new
stimuli, he must not be offended if we believe that we have read
nonsense.
1 From iHufeland's Journal der pract. Arzneykunde, Vol. v, Pt. 2, p. 52, 1801.
[Hufeland himself puts the following note to this masterly criticism:-" These
observations are from the pen of one of the most distinguished of German physicians,
who, however, as he himself expresses it, 'as long as literary chouanerie makes the
highways unsafe,' will not permit his name to appear, which, in my opinion, is a
good plan, in cases where reasons and not the authority of names are to decide.
I must, however, observe that the author has read nothing either for or against the
Brunonian system, and therefore we may be all the more certain that we have here
the unprejudiced opinion on this subject of a practical physician of matured experience and reflection."I




406

FRAGMENTARY OBSERVATIONS ON

xxi, ~,,, Emetics and purgatives, fear, grief, &c., diminish
the sum-total of excitement, and are debilitating;-but from no
other reason, not because they are other than stimulating agents,
-they are stimulants but are debilitating, that is, weakly stimulant, owing their debility (he should have said, debilitating power)
to a degree of stimulus greatly inferior to the proper one."
If all excitement, all the conditions of life and health, are owing
to stimulus, and to no other cause (xxII), no stimulus is of itself
capable of diminishing the excitement. Either the external condition for life and health does not solely depend upon what is
termed ", stimulus," or if it do, then a stimulus, be it even a weak,
an insufficient one, cannot debilitate. It is only (but Brown does
not make this proviso) when it is the sole stimulus acting upon
the body for a long time, all other greater stimuli being in the
mean time excluded, that a debilitating effect can be produced,
not, however, in consequence of the smallness of the acting
stimulus, but in consequence of the absence of the greater (accustomed) stimuli. If it were otherwise, a man in good health, who
would feel still more enlivened by drinking four ounces of wine,
would be tremendously debilitated if at that time in place of four
ounces he should take but four drops in his mouth, and would be
debilitated four times as much if he took only one drop.
An addition to the condition of life, be it ever so small (a weak
simple stimulus), can never become a minus, can never debilitate.
If, however, it do debilitate (as purgatives, fear, grief, and so forth
do), whilst the sum-total of the usual means requisite for sustaining life (heat, food, &c.) remains undiminished, in that case its
debilitating power must be owing to quite a different cause than
the smallness of the stimulating power.
Who can fail to perceive the justice of these conclusions?
A healthy, excitable girl, in the full possession of all stimuli
requisite for health, dies instantaneously on suddenly hearing
the tragical intelligence that her lover has been stabbed. If this
was merely a simple but only a small stimulus, it must have been
just a small addition to the not defective sum of all the other
stimuli. How could this small addition do harm, how could it
destroy life, and that instantaneously, if it merely acted as a
simple stimulus and in no other manner?
Who can fail to perceive the correctness of these inferences?




BROWN'S ELEMENTS OF MEDICINE.

407

He carries out his delusion so far as to assert (xxi, 1), that
"fear and grief are only lower degrees of confidence and joy."
Were I to dare to make such allegations, I could make anything
out of everything, for it is very easy to be a scholastic sophist.
No, my dear friend! there are two scales; at the top of the one
stands indifference, and below that come vexation, grief, despair.
The other scale has indifference at its lowest part, whence it
mounts up to confidence, to joy, to rapture.
If it is allowed to Brown to infer from     identity of effects,
identity of causes, we may be permitted to infer from opposite
effects, opposite causes, and to consider cold and grief, warmth
and joy, as opposite powers (because they exhibit opposite effects),
yet in such a way as that the strengthening property of the latter,
like the debilitating property of the former cannot depend on
their common attributes as stimuli, but must depend upon attributes that in the former are of a directly opposite nature to those
in the latter.
In xx and xxi Brown reckons poisons and typhus contagions
among the above powers (whose debilitating power depends on the
smallness of the stimulation that they produce on the body).
Well now, if a man in full possession of all the health-sustaining
external stimuli (the sum-total of which is from 3000 to 3010
daily) should choose, after drinking his last glass of wine, to get
into a pit filled with carbonic acid, and if in ten minutes thereafter he is brought out dead, irrecoverably dead, what is it in this
case that prevents the continuance of life?  Is it the addition of
the too small and therefore debilitating stimulus of the fixed
air?  Let us compute the sum of its stimulating energy at 1, or
if you will at 'iooooooth, in that case the sum of all the stimuli that
have acted upon him during the last twenty-four hours, inclusive
of the carbonic acid inspired, will amount to 3001 or 3000 llooooooth.
He has been acted on every preceding day by as many (more or
fewer) stiniuli, there has occurred in this last day neither diminution
nor increase of the stimuli up to the moment of his death. What
then prevented him living? It is evident that it was an agent
that proved so excessively injurious to him, not in consequence of
the smallness of its stimulating energy, but on account of its
enormous power of quite a different nature.
He tries to get over the difficulty (xxi, ) by saying that the




408

FRAGMENTARY OBSERVATIONS ON

debilitating stimuli produce their debilitating effects partly by
means of a disagreeable relation to the excitability, or by their
causing a disagreeable sensation.   But he is very inconsistent
to boast in one page that he has reduced physiology and pathology
to one or two principles, and in the next page quasi aliud agendo,
to put a couple of qualitates occults in the corner, which, in case
of necessity, when the defects of the vaunted chief supports of his
system are exposed, he may bring forward as already established
principles, and attach to them, according to his fancy, any meaning they may be required to bear. But through all these parts
assigned to auxiliaries, accessory springs of action, and accessory
agents, the boasted simplicity of his so-called system vanishes into
nothing. Now all the specific effects of poisons, contagions, &c.,when
it suits the purpose of Brown and his followers, and the omnipotent
words, " stimulants, weakly stimulant," will not do, can be referred
to " a discordant combination of powers," and the specific remedial
powers of this or that medicine, sometimes to the "agreeable
relation that the exciting power bears to the excitability," sometimes to an " agreeable sensation; "    and thus his retreat is
covered! How artful! but at the same time how disingenuous!
To his overstrained objections to cold in asthenic diseases(ccxcii) "In diseases of great and direct debility, cold must be
most carefully avoided, as it is always of a directly debilitating
operation, and never of service but in sthenic diseases, and those
that are in a progress to indirect debility "-which is repeatedly
alluded to, I must oppose my experience, which is the same as
that of many others, that during many years when I was still
ignorant of any specific remedies for old chronic diseases, I have
frequently combatted them successfully solely with cold washing, cold
foot-baths, and also with immersion for one minute at a time in water
of from 500 to 600 Fahr. One case however among many others
is so remarkable that I cannot refrain from detailing it. A man
somewhat advanced in years, but still possessing considerable
strength, had had for five years from unknown cause a paralytic
affection of his left arm. The movements he could perform with
it were very weak and small, and the sensibility of it also was
much diminished. Once upon a time when he was on a visit to a
relation, and there was no one to fetch the fish for the supper out
of a frozen tank, he gets up quietly, breaks the ice, leans over it and




BROWN'S ELEMENTS OF MEDICINE.

409

passes nearly one hour with both arms in the ice-cold water before
he can get out the required number of fish. He comes and brings
them to the great delight of his host, but immediately complains
of pains in the affected arm, which in the course of a few hours
inflames. The following day the pain and inflammation were
gone, and his arm had acquired its healthy sensibility and all the
powers of health. The paralysis was cured and remained so.
Should he have remained uncured to support Brown's erroneous
maxims?
Brown, like all short-sighted, unpractical physicians, always
looked only to the primary and incipient action of the remedy, but
not to the after effect, which is, however, the chief thing.
ccxcviii. "In spasms and convulsions, in the internal, in the
external parts, in bleeding discharges, in the direful delirium of
fevers and other very violent diseases, in asthenic inflammation;
when those stimuli, which have a more permanent influence, fail,
or act to no good purpose; the virtue of the diffusible stimulants,
the principal of which is opium, is eminent." What a general
way of speaking, and how empirical! What an immense deal the
man can do with opium! I only wish I could do the like. To
cure internal and external spasms with opium better than with any
other remedy, any one else would find somewhat difficult.
ccxcIx. "When the action of all the other powers by which life
is supported, is of no effect, they (that is, wine, brandy, opium)
turn aside the instant stroke of death." No one took them more
copiously and more variously than the Master who wrote this; how
is it that they did not turn aside the stroke of death from himself
(at his moderate age), and so avert the stigma from his doctrine?
cccI. "A higher place in the scale is claimed by musk, volatile
alkali, camphor;--however, in every respect the preparations of
opium  are sufficient for most purposes of high stimulating."
According to this, opium ought to be quite adequate for the cure of
most chronic diseases, and of others that he ascribes to a high
degree of debility, as poisonings of all sorts, &c. In that case it
would be a real panacea, and we should scarcely require any other
remedy.   He could certainly have seen and treated but few
chronic diseases, and assuredly no cases of poisoning with white
hellebore, arsenic, &c., otherwise he would not have asserted such
falsehoods.




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FRAGMENTARY OBSERVATIONS ON

According to this paragraph, camphor should possess the same
powers as opium, only in a somewhat less degree; and yet actual
experience shows that their effects are exactly opposed; the one removes the effects of the other. How little Brown knew about the
things whereof he speaks so confidently!
ccci. " In diseases depending upon great debility [consequently
according to him, in acute typhus, putrid and bilious fevers, the
Levantine plague, &c.] animal soups should be given." But animal
soups are utterly abhorred by them; will he in spite of the disgust
they occasion force them upon the patients?   They would agree
with them admirably!
cccIIi. In the case of a convalescent in whom stimulants should
be continued, he recommends that " in his movements he should
first use gestation." The old school, profoundly ignorant of nature,
with whose fables Brown, the reformer of medicine, is still so chokefull, also considered riding without succussion as coming under
the category of strengthening remedies, and ranged this passive
motion alongside the active ones (such as walking, digging, and
other manual exercises), and yet the former acts antagonistically to
the latter, and is antiphlogistic, antisthenic, debilitating (at all
events in its primary effect), greatly diminishing the pulse, causing
vomiting and nausea, &c. The reader will easily perceive how
opposed this is to truth and nature.
cccvin, (, " The remedies of asthenic diathesis, to whatever part
they are applied, stimulate that part more than any other." This
is also one of his maxims that carries us away by its god-like simplicity. Pity that it is fundamentally false-that it is completely
opposed to all true experience. Tincture of opium applied to the
pit of the stomach causes no sensation on the spot to which it is
applied, but speedily relieves hysterical vomiting. When applied
there, or to the neck, or to any other sensitive part of the body, it
checks (in a palliative manner) some diarrhoeas, removes the apoplectic death-like coldness, stiffness and unconsciousness caused by large
doses of camphor, the abdominal pains produced by belladonna, and
the sopor of typhus, though at the seat of its application no perceptible change is observable. And I could adduce a hundred
other examples opposed to the generality of the maxim     "that
medicines act more strongly at the part where they are applied than
elsewhere." This is a pure invention of his own.




BROWN'S ELEMENTS OF MEDICINE.

411

cccvII. " Inanition of the vessels (penury of blood) takes place
in asthenic diseases in an exact proportion to their degree." In
pestilential typhus fevers, where sometimes only a few hours elapse
in the transition from health to death, or in the sudden fatal cases
caused by cherry-laurel water, by carburetted hydrogen, by exposure
to the exhalations from cesspools, by the vapour of charcoal, by carbonic acid, by fright, where the interval betwixt health and death
often scarcely amounts to a couple of minutes, how could such an enormous deficiencyof blood "in anexact proportion to the degreeof these
asthenic diseases" have occurred in such a short time?  Whither
has the blood gone? It would be ridiculous to expose still further
the absurdity of this assertion on which he prides himself so much.
According to this paragraph he considers the most efficacious
remedy for asthenic diseases to be (artificial) filling of the vessels
with blood! Just as if healthy blood could be prepared in a diseased body, just as if blood could be manufactured all at once by
means of opium, wine, and forced-down animal soups, in such
diseases, in the same way as butter is made in a churn, or beer in
a brewing vat! What sort of blood?     How different is chlorotic
blood from that of phthisical subjects! Ast parva non curat philosophus.
cccix. " When the excitability is worn out by any one stimulus,
any new stimulus finds excitability and draws it forth, and thereby
produces a further variation of the effect." The fact is no doubt
true, that a second medicine again acts when the one just given no
longer does any thing. But the cause of this phenomenon, what
is it? It is impossible that it can be as Brown says.
If stimulants do not differ among each other in kind, but only in
degree and strength (an unconditional main dogma of Brown's,
cccxil, cccxIII), then it is impossible that the second stimulant
could act anew, after the first stimulant has ceased to be able to
act. An increased dose of the first must necessarily effect all that
could be expected from the second stimulant, if they differed from
each other only in degree and strength; but the first, even when
given in a stronger dose, now does nothing more, whereas the
second acts anew, consequently they cannot differ merely in degree,
they must differ in kind (modo), If however, this be the case, the
whole Brunonian system falls to the ground.
Moreover, how can the second stimulus still find excitability and
draw it forth, as he here asserts, when it has been already worn




412

FRAGMENTARY OBSERVATIONS ON

out by the first? Whence came the new excitability? from his
fancy, or from the resources of the animal economy, whose existence he will not acknowledge?  Tertium non datur. If it come
from the latter source, then indeed it may sometimes flow more
slowly and with greater difficulty, sometimes too quickly and
impetuously. But then the second and only remaining mainstay
of his system breaks down. Behold there a more natural origin of
diseases, which these words of his betray against his will. Had he
wished or been able to be consistent, he would not have ventured
to touch this ticklish point, which gives him a slap in the face.
That all this nonsense is his actual meaning, is evident from the
following assertions in
cccxII, cccxiii. "The effects of all external powers upon us do
not differ among themselves; they produce life, activity, health
and disease, by the same operation, by the same stimulus. Hence it
follows that things which restore health cannot act otherwise than
by one and the same stimulus."
" Several things that produce the same effect are then identical
with each other, are one and the same thing."
This is far from being the case when the action is complex; for
even according to Brown, the medicines do not establish health in
the system so very immediately, so unconditionally, so independently of the corporeal powers, so entirely without previous reaction,
as the apple-tree lets the apple fall on the grass.
But if the effect be brought about by composite actions, the
prime agent on which the action depends may certainly be very
different.
Windmills, horse-power, steam-engines and capstans worked by
men, may all empty a reservoir of water; the dry atmospheric air
also that extends over the reservoir empties it; but does it
therefore follow that wind, horses, fire, men, and the dry atmosphere are one and the same thing?         There are also many
powers that exercise a double action, a primary and a secondary,
and several among them that resemble each other in their primary action, and not a few that do so in their secondary action.
If then the careless observer looks only to the resemblance of the
primary action of some powers (as Brown often did), or only to
their secondary actions, or to similarity of actions, be they primary
or secondary, he may often be misled to infer an identity of cause
from some similarity of these one-sided actions, as usually happened




BROWN'S ELEMENTS OF MEDICINE.

413

to Brown. In making deductions from similar false premisses, I
might with equal justice say, that a watery vegetable diet, and
strong animal soups were one and the same thing, for they both
(in their primary action on the body) cause satiety. The same
effects have the same cause, therefore watery vegetable nutriment
and beef-tea are one and the same thing. And thus the false
scholastic deduction is made.
cccxiv. " In asthenic diseases the administration first of diffusible stimulants, for the purpose of bringing back the appetite
[even in every diseased body?] for the greatest remedy, food, as
well as keeping the food on the stomach and assisting in the digestion of it [will they do so in every diseased body?], then the application of heat, then the use of less diffusible and more durable
stimulants: as animal food, without and with seasoning, wine,
gestation, gentle exercise, moderate sleep, pure air, exertion of
mind, [can the mind of one affected with melancholia be exerted?]
exertion in passion and emotion, [even in idiots and raving maniacs?]
an agreeable exercise of the senses; all those reproduce health, by
no other operation but that of only encreasing excitement."
This then sums up all Brown's therapeutics for diseases of, and
accompanied by, weakness! That kind nature and youth will,
assisted by such an appropriate regimen, (for it is nothing more)
and even by itself, cure diseases having far other producing causes
than deficiency and excess of excitability, is a phenomenon daily
witnessed by the unprejudiced observer, which however must be
explained away or denied by Brown in order to support his scholastic system.
But without reckoning this divine power, and granting that all
these diseases depended on a morbid degree of excitability, and
could only be removed by the remedies indicated by him (but
which were used long before his time), what becomes of the myriads
of diseases that cannot be cured by these remedies?  It avails us
little that he ascribes them all also to deficiency or excess of excitability. All that we want is that he should cure them. We shall
see if by this regimen, the large number of mental diseases, the
epilepsies, the venereal lues, the mercurial wasting, the pellagra,
the plica polonica, (I reject the name of local diseases, the refuge of
the Brunonians, for these affections) will be cured.  Hic Rhodus!
hic salta!
Or will this regimen, whose curative effect cannot be looked for




414

FRAGMENTARY OBSERVATIONS ON

under a considerable time, cure asthenia, which often kills healthy
individuals in a few hours or even minutes (the bad kinds of typhus
fevers, the Levantine plague, apoplexy, the accidents caused by
laurocerasus, azotic and carbonic acid gas, carburetted hydrogen,
veratrum album, arsenical vapour, &c.)?
DCLXXVII. " As it now happens, that either direct or indirect
debility proves hurtful, hence we have a third case given, where we
have to combat both sorts of debility."
Who could have believed that a scholastic pedant who plumes
himself so much on his logical forms, who reckons for us in figures
on a scale of his own exactly the degree of the exciting power and
excitability, would have so far forgotten himself, as Master Brown
does here at the end of his immortal work?  How! both kinds of
debility conspiring to make one disease in one body?
In the first place, I should like to know, as he (notes to XLVII
and LxxXII) fixes the standard of health at 40 degrees of excitability
-the predisposition to direct debility in the degrees below 40 down
to 25,-complete and extreme direct debility from 25 to 0,-the predisposition to sthenia in the degrees from 40 to 55,-sthenia itself
in the degrees from 55 to 70,-and indirect debility in the degrees
from 70 to 80;-I should like to know in what part of this scale
(which he is so proud of) he could place the mixed form of debility
he speaks of, by what figures he would expound this supposed
excitability? Here he says nothing about the figures of his table,
which he is so fond of putting forward elsewhere.
Here he prudently ignores them and attempts in a note, by means
of mere words, I know not whether I should say to conceal or to
increase the hiatus. He brings forward many examples where in
one disease direct debility occurs along with indirect, indirect with
direct debility. Granted that the man whom he there supposes to be
affected with typhus had got thereby a direct debility of 10 (30 degrees below 40) that is 40 - 30, but in the meantime, by means of
great corporeal motion, had contracted an indirect debility of 70
(30 degrees above 40) that is 40+30, can the man thereby have
aggravated his state and be now labouring under indirect and at
the same time direct debility? If Brown's excitement theory be
not entirely false and his scales not the mere offspring of his fancy,
must not instantaneous health or the degree of 40 ensue, since 40
minus 30 and plus 30, gives 40, the sum of excitability?
If this be not the result of the meeting of the two opposed debili



BROWN'S ELEMENTS OF MEDICINE.

415

ties, I should like to know what it is then?   What part of his
excitability-scale is not already occupied?
Either there is not a spark of truth in his excitement theory or
his scale of excitability, or the man must, although already affected
by typhus, be instantly restored completely to health or nearly so by
the added corporeal exertion, according to Brown's whole theory
and his vaunted scale. But if, as must naturally happen, the man
visibly aggravates his malady by this fatigue, as Brown himself
confesses, this circumstance overthrows his whole system.
If the extraordinary accumulation of excitability in a case of
typhus, imagined by Brown, can and must be aggravated by corporeal exertion, as experience teaches and as he here admits, then
either the corporeal motion cannot remove the excitability, otherwise in this case health would ensue or almost ensue, or there can
be in typhus no accumulation of excitability. Plus and minus
cannot co-exist without mutually annihilating one another.
It is impossible that a state of accumulation of excitability can be
aggravated by a power that diminishes excitability (according to
his whole theory), therefore the aggravation that ensues is a refutation of his whole beautiful excitement theory and his tabularly
expressed accumulation and exhaustion of excitability, to which,
according to him, all the conditions of life may be referred.
Brown gives us no information as to the state (and degree) in
which we must suppose the excitability to exist when the two
debilities meet together. That he himself did not know how to
conceive this state is obvious from his extraordinary and ambiguous
assertions relative to this point.
Thus, as the direct debility of the man affected with typhus must
amount to at least 70 degrees of accumulation of excitability, to
what height did the degrees rise since his state was aggravated by
corporeal exertion? The degrees of the accumulation could certainly
not be the least diminished, otherwise the disease had not been aggravated, at all events it had been transformed into a sthenic disease (at
60); the state must then have sunk suddenly and far below 40 into
indirect debility, in order to be able to express the great aggravation
that has ensued at least by the degree 10. In the former case, seeing
that for the commencement of the treatment of the simple direct
debility Brown prescribes ten drops of laudanum, he must prescribe
for its cure eight drops or less; in the latter case, however, as he




416

FRAGMENTARY OBSERVATIONS, ETC.

orders for the commencement of the treatment of the simple indirect debility 150 drops, he must for a worse degree have administered 200 drops and upwards. But no! his vaunted consistency
forsakes him here.
" When the affection," he says (DCLXXXVI), " is more a mixture
of both sorts of debility, these proportions of the doses must be
blended together."
Though this is purposely worded so as to be incomprehensible,
it can only have this one meaning, that we should from the two
select an intermediate number betwixt the dose increasing from a
few drops and that decreasing from many drops. Therefore a
medium proportion betwixt an increasing and decreasing progression. Very strange! In this case, from the beginning to the end
(if both debilities were pretty equal in point of strength) 80 drops
should be given uninteruptedly, which is contrary to his other
modes of treatment and opposed to the nature of the thing. And
how if the direct debility was greater than the indirect, or the
latter greater than the former, what state is present, what is to be
done for it?  He himself does not actually know what he should
direct to be done for cases which he can make clear neither to
himself nor to others, and what would he advise to be done in this
dilemma?    He prudently forbears giving any detailed information
on the subject, and merely in the note to DCLXXVII cunningly
says, (possibly in order to escape observation in the confusion?)
" A judicious physician will find plenty of scope for the exercise of
his judgment in these mixed states." In a word, he leaves us,
with a bow to the reader, in the lurch, not only here but in the
treatment of all asthenias, " because," as he assures us in this paragraph, " there is scarcely any asthenic disease where such a mixed
state is not present." So almost all asthenic diseases consist of an
unknown mixture of both debilities, whereof he knows not how to
impart any information in reference to the change therefrom resulting in the body, and to the accompanying state of excitement and
excitability, nor to give us any advice on the subject! Heaven
help us! throughout the whole transparent work he has dazzled us
with a flaring straw fire, here it sinks down into ashes, and he leaves
us, with a smile, surrounded by a howling wilderness in the darkness
of night.




VIEW OF PROFESSIONAL LIBERALITY AT THE
COMMENCEMENT OF THE NINETEENTH CENTURY.'
I do not here refer to that low, envious trading spirit, for which
the pressure of want is often the cause that can best be pleaded in
excuse; I wish to say a few words about the professional jealousy
of medical men among themselves, which is the prevalent custom
in Germany (in the southern more than the northern parts), a
bellum  omnium    contra omnes, which has had       a most injurious
influence on the prosperity of one of the noblest arts, and the one
which stands most in need of improvement-medicine.             For no
sooner has a colleague made a suggestion that must be for the
general good, put forward a perhaps useful proposition, discovered
something profitable, than instantly the professional jealousy of
his colleagues (with very few exceptions) falls foul of him in order
to bury in oblivion or if possible to destroy the novelty by spoken
or written depreciations, insinuations, sophistries, or even injurious aspersions, and all because-it did not originate with themselves. Instead of seeing, as we do in England and Scotland,
fraternal meetings, and societies of physicians and surgeons, animated by the desire to promote the welfare of humanity, and
1 From the Allgemeiner Anzeiger d. D. No. 32. 1801. [This article is interesting
in reference to the history of the discovery of Belladonna as a prophylactic for
scarlatina. It will be seen that in the first instance Hahnemann did not reveal the
name of the remedy he employed for that purpose, which may possibly account in
some degree for the unwillingness of his colleagues to test the efficacy of the remedy
he furnished them with, but they had not this excuse after 1801, for in that year he
announced the prophylactic to be belladonna, as will be seen in the next essay, and
yet many years elapsed before they put his prophylactic to the test, whereby its
utility was, as is well known, signally verified by some of the best physicians of the
day.]
2E




418

VIEW OF PROFESSIONAL LIBERALITY AT THE

investigating medical subjects for the purpose of mutual improvement and perfection, without party-spirit, without seeking selfaggrandisement, without ministering to individual vanity--we see
the German medical men (with few exceptions) completely divided
among themselves, each acting by himself, pro modulo ingenii,
occasionally appropriating the useful discoveries of others, but
quite silently, without betraying by the slightest sign that anyone
else has anything to recommend him, or that they were indebted for
anything whatsoever to this one or the other. Not only do theymake use of the propositions and inventions of others without
betraying the least thankfulness, but they often throw out spiteful
insinuations against the originator, at all events always (few are
the exceptions!) without taking any public part in promoting and
perfecting the proposition or discovery, particularly if it proceed
from a German physician; far more likely are they to do so if it
belong to a foreign physician. How much this egotistical professional jealousy prevents the shooting forth and vigorous growth of
our divine healing art, which is still in the condition of an undeveloped bud, must be evident to every non-professional person.
Were it not for this paltry self-seeking spirit, of a truth Germany
alone, with its great intellectual talents, could effect a regeneration of the great art.
How spitefully Wichmann was assailed when he exposed the
prevalent fallacies respecting difficult teething! How infamously
the same clique calumniated that unenvious favourite of the Asclepiadean muse-Hufeland, whose whole soul is animated by truth
alone! How was Tode, how was Sommering treated! Were the
men that could act in this manner exclusively devoted to the
beneficent art whose aim is the weal of humanity?
Ever sadder, ever more gloomy are the prospects of the development of our art in the new century; without friendliness and
good-fellowship among its professors it will remain but a bungling
art for another century.
Let it not be retorted that there now exists, at least among the
followers of the Brunonian system, an esprit de corps. The rallying motto of a sectarian name is incapable of exciting to sober,
calm scientific investigation; it only rouses the explosive spirit
of accusations of heresy to a fierce volcanic flame. Truth and
the weal of humanity should be the only motto of the genuine




COMMENCEMENT OF THE NINETEENTH CENTURY.

419

elucidators of the art and the watch-word of their brotherly, peaceful
bond of union, without slavish adherence to any sectarian leader, if
we would not see the little good that we know completely sacrificed
to party-spirit and discord. In these times, when accusations of
heresy are so rife, the most important question that is ever put is,
"Art thou of Paul, art thou of Cephas or of Apollos? "-Would it
not be far better to say, "Brother! what is the peculiar mode of
action of cinchona bark on the healthy individual? so that we
may at length learn how to employ it with confidence in diseases,
seeing that we have hitherto blindly wasted many thousand hundred-weights of it, at one time doing good, at another harm,
without knowing what it was we did."   Would it not be better to
say, "Dear colleague! let us together investigate and observe the
many and various kinds of intermittent fevers, and let us unite in
laying before the world the discoveries we thus make, as to which
kind among them may be, caeteris paribus, always cured by cinchona, which by sal-ammoniac, which by chamomile, which by
ignatia, which by capsicum, &c."-" God forbid! who would consent to such an exposure of himself as to confess to his colleagues
or to the public that he did not know everything?  Those around
me must be impressed with the belief that I am infallible, that I
embrace the whole sphere of the art, as I hold a ball in my hand,
that the inmost secrets of medical science lie clearly open to my
all-seeing eye, like the seed-receptacle of an apple cut through the
middle. I dare not say one word that could betray that something was still to be discovered or that there was any room for
improvement. But the notion that another and more especially a
German colleague could teach us something more, or could make
any fresh discovery, must not be uttered, must be to the best of
our ability scouted."
Such is the spirit that has prevailed in Germany during the
latter half until the end of the bygone century; the benefactors of
their race, and with them the good spirit that inspired them with
zeal for the common weal, were sought to be kept down and set
aside. Just as theological polemics have never produced a desire
for truth, a perception of the high object of our existence or
genuine virtue and devotional feeling-just as the personal squabbles of literary men have never succeeded in developing the love of
art, the true aesthetic feeling, enlightened taste, and artistic
2 E2




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VIEW OF PROFESSIONAL LIBERALITY AT THE

okill-in like manner it needs no great sagacity to understand
that the mutual detractions of medical men can have no other
result but the depreciation and obscuration of their art, which is,
without that, the most obscure of all arts.
Honourable, non-medical friends, endowed with a desire to
promote the well-being of mankind and who have had the advantage
of a scientific education!-the energies of my life, which have been
devoted to promote the welfare of the community, have also been
cramped and kept under by this unpatriotic spirit of many of the
medical men of Germany.
As soon as I stepped forth among my colleagues, not without
nearly twenty years of preparation, not without many long years
of Pythagorean silence, to contribute here and there something to
the improvement of our art, I found that I had lost my accustomed peace and quietness, and had fallen among a crowd of
professional brethren, who (with few exceptions) regard nothing
impartially; I was maligned. And how easy it is to persecute, to
malign an art, which has hitherto been founded on everchanging maxims, in which by the force of authorities, learned,
empty terminology, sophistry, scholastic, stereotyped dogmas, and
imaginary experience, black was made to appear white, just as any
one pleased, especially where the judgment was perverted by
depravity of heart, egotism and illiberality.
It is undoubtedly true that truth penetrates even through the
thickest clouds of prejudice, but the often too tedious conflict
of the opposing elements conveys a disagreeable, a discouraging
impression to the mind. Thus at the commencement of my
career, on account of my discovery of the best anti-venereal medicine, the soluble mercury, I was abused in the most vulgar manner
in a journal notorious for its outrageous vituperations, and also
elsewhere, but the common experience of Europe in a few years
removed the slander from this remedy and worthily appreciated a
discovery that I had unselfishly revealed for the good of humanity,
in order to make amends for the death of thousands who had been
literally dissolved by the abuse of the feebly anti-venereal preparations of corrosive mercury. The same thing happened when I was
afterwards again (to pass over the bad reception some other useful
truths met with) abused in the same vituperative journal on
account of my " new principle," where I taught a mode of learning




COMMENCEMENT OF THE NINETEENTH CENTURY.

4,21

to look at diseases from a point of view that directs us almost
unmistakeably to the appropriate remedy for every case-shewing
how to discover from the positive nature of medicinal agents the
diseases for which they are suitable. But because this kind of
system differed so much from the ordinary one, because it was so
simple, so unartificial and (purposely) so free from the sacred
arabesques of the learned language of the schools, it made very
little impression, it was not cultivated by German medical men,
but was sought to be quietly shelved by them.
Now, once more, at the end of the century that has just
expired, my zeal for the welfare of mankind misled me to announce a prophylactic remedy for one of the most destructive
of children's diseases, scarlet-fever. Scarcely a fourth part of the
number I might have expected subscribed for it. This luke-warm
interest shewn for such an important affair discouraged me, and I
arranged that the subscribers should receive a portion of the
medicine itself, in order to satisfy them, in case my book on the
subject should not be published.      The   subscribers consisted
chiefly of physicians1 who had epidemics of scarlet-fever in their
neighbourhood. At least thirty of these, whom I begged by
letter to testify to the truth, and to publish the result (be it what
it might) in the Reichs-Anzeiger, made no reply.
Two others, unsolicited by me, Dr. Jani in Gera and Dr. Miiller
in Plauen, wrote something on the subject, but, good heavens!
in what a spirit! Is this the way one colleague treats another in
Germany?     Is an affair of such importance for mankind to be so
readily dismissed?
After the latter had said in No. 215 of the R.A., 1800, "that in
the epidemic he witnessed no child took scarlet-fever who had
used this medicine for two or three weeks," he repents of his
honesty and feels himself compelled in No. 239 "to deny the
truth of his former declaration (the facts brought forward by himself!) because one child took the scarlet-fever. This case proves
SA good many private individuals got the medicine sent them; but the basest
mendacious insinuations of their ordinary medical attendants prevented themfrom
savinj their children by its means.




422

VIEW OF PROFESSIONAL LIBERALITY AT THE

more against the efficacy of the remedy than 500, where the
individuals seem to have been protected by it, prove for it."
What monstrous logic! Mercury is, as is well known, the
best and sole remedy in the venereal disease; thousands have
been cured by its means. "No," quoth Bavius, " I could shew
you at least twenty cases where it did no good. Mercury is of no
use; these twenty cases certainly prove more against the efficacy of
the remedy than your thousands of successful cases prove for it.
Therefore we should rather let ourselves be eaten up by the venereal
disease than have it cured by mercury, because out of many
thousand cases there are twenty where it does no good."-"A single
case in which cinchona bark failed in intermittent fever proves
more for the worthlessness of this bark than 500 cases in which it
was efficacious for it."  What a delirium  of logic! The good
Dr. Miiller has once upon a time heard of the deduction a minori
ad majus, and seeks to apply that here. In like manner the wag
made the deduction a minori ad majus in the Miillerean fashion:
" Since it feels hard to lie upon a single feather on the bare floor,
this proves more against the softness of feathers than a bed filled
with millions of eider-feathers for their softness; I will therefore never more sleep upon feather-beds after having lain so hard
upon one feather."
But perhaps Dr. Miiller invented this pleasant piece of sophistry
only in order to eradicate from the minds of the uniniated, by
one (philanthropic) blow, this German invention, not proceeding
from himself. Be it so, my friend! But have you anything
better to substitute for the remedy? Is there to be found in medical writings a single mode of treating scarlet-fever on which we
may rely? We shall not say a word about a preventive remedy.
According to the directions usually given, there is not a single
symptom that can be removed without several worse ones being
excited. It may be said of the old mode of treatment of every
acute disease: " With our medicines and without our medicines
the primary fever goes off in twenty-one days, or the patient dies
in the meantime, he might not have died had he not taken our
medicines."
Dr. Jani, on the other hand, says in No. 255, that his scarletfever was complicated with malignant typhus-fever and acute
herpetic-fever, and very rarely ran a regular course.




COMMENCEMENT OF THE NINETEENTH CENTURY.

423

He then seeks to prove " that my preservative does not protect
unconditionally."  He might have spared himself the pains.   God
himself cannot create a remedy that shall be unconditionally eficacious, that when used wrongly, at an inappropriate time, in an
improper place, or under adverse circumstances, shall yet of necessity
do good.
"After it became universally prevalent, and was raging among
them like an evil demon, he allowed ten families, consisting of
thirty-six children, to use my remedy.    Three children in one
family were attacked by scarlet fever whilst using it (?). Of the
thirty children of the remaining nine families who used it for a
month, none was attacked by scarlet-fever. But as far as was
known none of them were exposed to infection."
Therefore it was no     merit of Hahnemann's prophylactic
that just those nine families with their thirty children remained
free amidst all the others. This miracle is owing solely to the
fact that they were not exposed to infection (scilicet) at a period
when, as he asserts, scarlet-fever was universally prevalent. When
an epidemic of scarlet-fever (which generally does not spare two
out of a hundred children in the place) is universally prevalent,
does the mere circumstance " of not having been exposed to
the infection as far as was known" suffice to preserve from
infection?   Were that the case, it were impossible that any
epidemic of scarlet-fever could ever arise, because no child of
sensible or at least of timorous parents would ever be knowingly
exposed to infection!
" But because it was not I, but another, and what is worse, a
German physician who discovered the remedy, it must be allowed us,
in order that the honour may not be given to the preservative, to
ascribe the wonderful, unheard-of exemption of the nine families,
to a notoriously inefficient cause, in order that we may be enabled
to shelve Hahnemann's prophylactic remedy before the very eyes
of the all-seeing public."
Here are striking features of the professional liberality among
the physicians of our time! Here is a fine specimen of zealous
endeavour to clear up the truth, of warm interest in promoting an
affair of infinite importance to humanity.
The furtherance of every means, be it ever so small, that can
save human life, that can bring health and security (a God of love




424

VIEW OF PROFESSIONAL LIBERALITY, ETC.

invented this blessed and most wondrous of arts!) should be a sacred
object to the true physician; chance, or the labour of a physician,
has discovered this one. Away, then, with all grovelling passions at
the altar of this sublime God-head, whose priests we are!
We all strive after a common, holy object; but it is not easy to
be attained. It is only by joining hand in hand, only by a brotherly union of our powers, only by a mutual intercommunication
and a common dispassionate development of all our knowledge,
views, inventions and observations, that this high aim can be
attained:-the perfecting of the medical art.
But why the most trustworthy remedy sometimes does not
answer in our private practice-this every observant physician who
has grown gray in his profession, and who possesses at the same
time a knowledge of mankind, can easily account for from his own
experience. Hospital patients, whom the unprejudiced clear-sighted
physician never loses sight of, are certainly much more favourable
for determining the truth, though even with them, deceptions,
mistakes, insufficiency, and a thousand other opposing accessory
circumstances, are unavoidable.
But how we may fail to attain our object in private practice,
particularly as regards my preservative, and how failure is to be
avoided, I shall explain in my forthcoming little work.
Physi  of Germany be brother, b fair, e just
Physicians of Germany, be brothers, be fair, be just!




CURE AND PREVENTION OF SCARLET FEYER.1

P R EFACE.
Had I compiled a large book upon scarlet fever, I should have
obtained, through the usual channels of publication, at least as much
in the way of honorarium as by the subscription for this little book.
But as according to Callimachus, a great book is a great evil, and
is soon laid aside, one of my chief aims, to wit, to excite a great
interest in a subject of so much importance to humanity as this is, in
order clearly to ascertain the truth by bringing the observations of
many to bear upon it-could not have been fulfilled so well by the
large book as by the mode I have adopted.
Up to this period it is impossible that the corroboration of my
assertion could be complete. The extract of belladonna, which I
caused to be delivered to my subscribers, might have lost its power
by the great distances it was sent, and by the long period it had
been kept. Occasionally it fell into the hands of some who had
neither the ability nor the good will to administer its solution in an
appropriate manner. The precautions laid down in this book could
not all be enumerated in a small paper of directions, where on
account of the danger of misusing the medicine, it was necessary to
direct that only the very smallest dose should be administered.
Moreover it is probable that the thorough admixture of the few
drops with a sufficient quantity of the fluid in which it should be
taken, was generally neglected; a circumstance the neglect of which
makes this and every other medicine many hundred times less powerful than they would be were they properly combined with the
diluting fluid. The hurry and inaccuracy of young doctors of the
' This was published as a pamphlet at Gotha, in 1801.




426

CURE AND PREVENTION OF SCARLET-FEVER.

present day are well known, and we know also how little dependence we can place on our private patients.
In addition, very inclement weather, and in general what is understood by a chill (which I have forgotten to allude to in the text),
present obstacles by no means slight to the power of belladonna
as a preventive of scarlet-fever. Children should be carefully
preserved from it, without however completely excluding them from
the open air, and if this precaution be neglected, the dose of the
remedy should at all events be increased.
There may also be many other circumstances unknown to me to
diminish the power of belladonna. The philanthropic physician
ought to endeavour to discover and to avoid them.
It is only in accordance with my well known maxim (the new
principle) that small-pox, to give one example from among many,
has an important prophylactic in the cow-pox, which is an exanthematous disease, whose pustules break out after the sixth day of
inoculation, with pain and swelling of the axillary glands, pain in
the back and loins, and fever, and surrounded by an erythematous
inflammation-that is to say, constituting altogether a disease very
similar to variola. And in like manner, a medicine which causes
symptoms so similar to those of the invasion of scarlet-fever, as
belladonna does, must be one of the best preventive remedies for
this children's pestilence. It should however be put to the test
with candour, carefulness and impartiality-not cursorily or hurriedly, not with the design of depreciating the originator of it at
the expense of truth.
But if its efficacious prophylactic power has incurred and may
still incur opposition from prejudiced, ill-disposed, weak-minded
and cursory observers, I may be allowed to appeal against their conduct to the more matured investigation of the clear-sighted, dispassionate portion of the public, and to trust to time for a just
verdict. I should esteem myself happy if I should see, some years
hence, this scourge of mankind in any measure diminished by my
labours.




CURE AND PREVENTION OF SCARLET-FEVER.

At the commencement of the year 1799 small-pox came from
the neighbourhood of Helmst'dt to Kanigslutter' which spread
slowly around, and though not mild in character, the eruption was
small, warty looking, and accompanied with serious symptoms,
especially of an atonic kind. In the village it came from, the
scarlet fever was prevalent at the same time, and, mixed up with
the latter, the small-pox made its appearance in Konigslutter.
About the middle of the year the small-pox ceased almost entirely,
and the scarlet-fever then commenced to appear alone and more
frequently.
HISTORY OF THE SCARLATINA EPIDEMIC.
In this as in all other epidemics the scarlet-fever shewed itself
to be the most spreading and contagious of all the maladies that
befal children.  If a single child was affected with it, not one of
its brothers and sisters remained exempt, nor did it fail to affect
other children who came too close to the patients, or to things that
had come in contact with their exhalations.2    Parents above thirty
years of age who are in the midst of many children affected with
scarlet fever, usually in dirty damp rooms, get. now and then in
place of the general eruption a very painful pustular erysipelas of
the face, or the peculiar scarlatina sore-throat-always along with
some degree of fever.
In its main symptoms this epidemic of scarlet-fever resembled
1 [Where Hahnemann at that time resided.]
2 Among children under fifteen years of age that may be exposed to contagion in
epidemics of scarlatina, hardly one in a thousand escapes the disease, though they
may only be affected by the specific sore throat, or a combination of some of the
other symptoms; from fifteen to twenty years of age scarcely one in five hundred is
spared; from twenty to thirty years the infection becomes always rarer. It is very
seldom that persons above thirty are affected by the perfect scarlet-fever exanthema,
and then only in the most malignant and fatal epidemics.




428

CURE AND PREVENTION OF SCARLET-FEVER.

the scarlatina of Plenciz.1 In some families the disease was of a
mild form, but generally it was of a bad kind.
When it occurred in the mild form it generally remained mild
in the whole family living together. There occurred a slight
feeling of weariness, a kind of faint-heartedness, some difficulty of
swallowing, some fever, red face and hot hands. There then
appeared, usually the very first day, along with slight itching, the
spots of various shape, and sometimes paler, sometimes redder, on
the neck, the chest, the arms, &c., which disappeared again in
from three to four days, and the desquamation that followed was
scarcely observable on the fingers, and almost nowhere else.
Towards evening only the patients laid down in bed for a short
time, but the rest of the day they went about. The sleep was
pretty tranquil, the bowels usually somewhat less open than when
in health, the appetite usually not much diminished.
Very different was the course of the bad form of scarlet fever
that prevailed in most families. Generally 2 the seventh day after
the infection had been communicated it broke out suddenly and
unexpectedly, without any previous feeling of illness; seldom was
it that horrible dreams on the previous night served as a prelude
to it. All at once there occurred an unusual timidity and fearfulness, rigor with general coldness, especially in the face, the hands
and the feet, violent pressive headache, especially in the forehead,
above the orbits. Pressure in the hypochondria, chiefly in the region
of the stomach; in most cases there occurs a very unexpected attack
of violent vomiting, first of mucus, then of bile, then of water, recurring at intervals of from twelve to twenty-four hours, accompanied
by an ever increasing weakness and anxiety, with trembling. The
parotid and sub-maxillary glands swell and become hard and painful, swallowing becomes very difficult, with shooting pains. After
rigors that last from twelve to twenty-four hours, the body becomes
excessively hot, accompanied with itching burning, the head, neck,
hands (forearms) and feet (legs) are hottest, and swollen so as to
present a shining appearance, which lasts to the end of the disease.3
I Opera medico-phyeica. Tract iii, Sect. iii. Vindob. 1762.
2 Those symptoms not described by Plenciz I have had printed in italics, but
those that correspond with his are in the usual Roman type.
a The sudden disappearance of the redness with the fatal termination without
obvious cause observed in some of the qpidemics of 1800, I had not an opportunity




CURE AND PREVENTION OF SCARLET-FEVER.

429

(Almost every paroxysm of heat terminates in profuse sweat, which
however only affects the rest of the body, but not the head, hands
and feet). On these swollen parts, but first in the pit of the
throat, then on the arms and legs, there appear about the second
day variously shaped cinnabar coloured spots of various sizes that
readily grow pale on any slight chill; these spots are scarcely raised
above the level of the skin, and are always accompanied by smarting, itching, burning; as the disease advances they spread out into
a connected, but less vivid redness. On the outburst of the eruption,
the fever does not diminish; on the contrary, the greater the redness
the more violent is the fever. In the meantime the sore-throat
increases, swallowing becomes very painful, in the worst cases
almost impossible. The interior of the mouth, the tongue and the
palate are inflamed, very painful, raw, and as if ulcerated all over.
In very bad cases the swelling of the cervical glands almost closes
the jaws, and from between the teeth, which can be but slightly
separated, there flows almost incessantly a very viscid and very
fetid saliva, which can scarcely be expelled from the mouth in
consequence of the tongue being so painful. In like manner, in
the worst cases the lining membrane of the nose is ulcerated. At
this period the voice becomes weak, suppressed and unintelligible,
and respiration difficult. The taste in the mouth is putrid; the
stools, which are usually rarely passed, have the odour of assafoetida. A  drawing pain in the back and cutting bellyache are
characteristic symptoms, which, together with pressive headache,
in bad cases persist in alternation day and night, but in less dangerous cases only recur in the evening after sunset, along with
increase of anxiety and timidity. In the very worst cases there
are alternate paroxysms of agonising tossing about, raving, groaning, grinding of the teeth, floccitations, general or partial convulsions
and comatose stupefaction or sopor, with half-shut eyes and head
bent backwards.    The urine, which is light-coloured, and the
faeces, are passed involuntarily, and the patient sinks down to the
bottom of the bed. The grumbling, complaining disposition increases from day to day. The smallest quantity of food, even in
of seeing. Probably this depended on a peculiar complication, and I am not aware
if my preservative, which is only for pure scarlatina, would have the power of averting this.




480

CURE AND PREVENTION OF SCARLET-FEVER.

the slighter cases, perceptibly and immediately increases the anxiety,
more than in any other disease.
From the fourth to the seventh day, if death do not ensue, the
skin rises up, or rather the pores of the skin on the reddest places
become elevated, especially about the neck and the arms, in
small, close, pointed miliary vesicles (somewhat resembling goose's
skin), which at first, as the redness of the rest of the skin declines,
appear extremely red, but afterwards, or when cold is applied,
grow pale and at length quite white; they are however empty,
and contain no fluid.
Neither the greater intensity nor the more general extension of
the redness of the skin, nor yet the occurrence of these empty
miliary vesicles, diminish the fever after the manner of a critical
eruption; the former indeed is rather a sign of an increased intensity of fever which can only subside as this redness decreases.
The bad form of scarlatina lasts from nine to fourteen days, and
the disgust at food lasts about the same time. As the appetite
returns, the patient first wishes for fruit, then meat, he generally
prefers pork.
As the convalescence progresses, there is, in addition to the
uncommon emaciation, a stiffness, causing the patient to go half
bent, that lasts several days, sometimes weeks; it is a kind of contraction of the joints, especially the knees, with a feeling of stiffness
in the abdomen.
During the fever, blood-red spots now and then appeared on the
sclerotic; in some the cornea of one or both eyes was completely
obscured; others (probably badly treated patients) were rendered
imbecile.
At length the epidermis gradually peels off on the places where
the redness appeared, and even where there was only burning
itching without subsequent redness; on the hands and feet it
comes off in large pieces, like pieces of a torn glove, but on the
other parts only in larger or smaller scales. In one case the nails
of the fingers and toes also fell off. The falling off of the hair
only commenced some weeks or months after the fever; in one
case it went the length of total baldness.
Among the after-sufferings the following were prominent:
long-continued debility, a very disagreeable feeling in the back, as
if it were asleep (narcosis), pressive headache, a painful sensation




CURE AND PREVENTION OF SCARLET-FEVER.

431

of constriction in the abdomen only felt on bending backwards,
abscesses in the interior of the ear, ulceration of the lining membrane of the nose, ulcerated angles of the mouth, other spreading
ulcers in the face and other parts of the body, and generally a
great tendency of the whole skin to ulceration (unhealthy skin as
it is termed). In addition to the above, a great hurriedness in
speaking and acting, fits of sleepiness by day, crying out in sleep,
shuddering in the evening, puffiness and earthy colour of the countenance,1 swelling of the hands, feet and loins, &c.
TREATMENT OF SCARLET-FEVER.
Anyone who chooses may read for himself in the works of the
various authors the infinity of medicines and modes of treatment
invented for this disease (from blood-letting and leeches to bark,
from gargles and clysters to blisters, from antispasmodic, derivative,
antiseptic to refrigerant, resolvent, purgative, involvent, humectant,
alexiteric, incitant, asthenic, and God knows what other ingenious
modes of treatment) intended to meet the thousand imaginary
indications. Here we often see the ne plus ultra of the grossest
empiricism: for each single symptom a particular remedy in the
motley, mixed, and repeated prescriptions; a sight that cannot
fail to inspire the unprejudiced observer with feelings at once of
pity and indignation!
For my own part, when summoned to cases of the fully developed
disease (where there was no question of prevention or suppressing
its commencement), I found I had to combat two different states
of body that sometimes rapidly alternated with one another, each
of which was composed of a convolute of symptoms.
The first: the burning heat, the drowsy stupefaction, the agonising tossing about with vomiting, diarrhoea, and even convulsions,
was subdued in a very short time (at most an hour) by a very
small quantity of opium, either externally by means of a piece of
paper (according to the size of the child, from a half to a whole
inch in length and breadth) moistened with strong tincture of
opium, laid upon the pit of the stomach and left there until it
1 Neither Plenciz nor I observed the jaundice symptoms that were noticed in some
of the epidemics of 1800.




432

CURE AND PREVENTION OP SCARLET-FEVER.

dries;1 or if there is no vomiting, internally, by giving a small
quantity of a solution of opium.
For external use I employed a tincture formed by adding one
part of finely pulverised crude opium to twenty parts of weak
alcohol, letting it stand in a cool place for a week, and shaking it
occasionally to promote the solution. For internal use, I take
a drop of this tincture and mix it intimately with 500 drops of
diluted alcohol, and one drop of this mixture likewise with other 500
drops of diluted alcohol, shaking the whole well. Of this diluted
tincture of opium (which contains in every drop one five-millionth
part of a grain of opium) one drop given internally was amply
sufficient in the case of a child of four years of age,2 and two drops
in that of a child of ten years, to remove the above state. It is unnecessary to repeat these doses oftener than every four or eight hours,
in some cases not more than every twenty-four hours, and that
sometimes only a couple of times throughout the whole fever, for
which the more frequent or more rare occurrence of these symptoms must be our guide.
Where also, during the further progress of the disease, the same
symptoms appeared accompanied by constipation of the bowels,
opium so applied externally, or given internally in such doses,3
never failed to produce the desired effect. The result, by no means
of a transient character, appeared at most in an hour, sometimes
within a quarter of an hour, and just as rapidly from the external
application as from the internal administration.
Larger doses than the above, occasion raving, hiccough, unappeasable peevishness, weeping, &c.-an array of factitious sympI For infants and other children who will not lie still long enough, we should hold
the paper on with the point of the finger until it is dry, (which requires about a
minute) and then we should throw away the paper, in case they swallow it.
2 For younger children I mixed one drop of this with ten teaspoonfuls of water and
gave them, according to their age, one, two, or more spoonfuls.
3 The smallness of the dose in wHich the medicine that acts upon the whole system of the living organism, when it is suitable to the case, produces its desired effect,
is incredible, at least it is incredible to my colleagues, who think it requisite to
give to infants at the breast opium in half-grain doses, and who are ready
enough to attribute the sudden death by poisoning that often ensues to a multitude
of other causes. The drops for internal use must be intimately mixed with from one
to four tablespoonfuls of fluid (water or beer) just before they are administered.




CURE AND PREVENTION OF SCARLET-FEVER.

433

toms which, when they are not severe, disappear spontaneously in
a few hours, or may be more speedily removed by smelling at a
solution of camphor.
The second morbid condition that occurs in the course of this
disease: the increase of fever towards evening, the sleeplessness, the
total loss of appetite, the nausea, the intolerable lacrymose peevishness, the groaning, that is, the state where opium does and must do
harm,-this state was removed in a few quarters of an hour by
ipecacuanha.
For this end, immediately on the occurrence of this state, or
during its persistence, I gave, according to the age of the child,
ipecacuanha, either in substance in the dose of a tenth to half a
grain in fine powder; or I employed the tincture prepared by
digesting in the cold for some days one part of the powder with
twenty parts of alcohol, of this one drop was mixed with a hundred
drops of weak alcohol, and to the youngest children a drop of this
last was given, but to the oldest ones ten drops were given for a
dose.
I found these two remedies as indispensable as they were generally completely suficient 1 not only to ward off the fatal termination, but also to shorten, diminish and alleviate the scarlet-fever.
I cannot imagine a more suitable mode of treatment, so rapid and
certain in its results I found it.
As regards moral and physical accessory dietetic means in the
treatment of a fully developed case of scarlet-fever, I would advise
that we should try to dispel all fear by means of kind and cheering
words, by nice little presents, by holding out hopes of a speedy
recovery-and on the other hand, we should allow the patient a
free choice of all kinds of drinks, and warmer or cooler coverings to
suit his feelings. The patient's own feelings are a much surer
guide than all the maxims of the schools. We must only take care
kindly to keep the patient from taking solid nutriment too soon, or
in too great quantity during his convalescence.
I Even in the very worst cases I never employed either gargles, or fomentations,
or vesicatories, or sinapisms, or clysters, or venesections, or leeches. When the
urgent febrile symptoms in their whole connexion were fully met, the result which is
(vainly) sought to be obtained by each of these appliances occurred spontaneously.
The illusory and meddling, pedantic opus operatum should, in this enlightened century,
never constitute the chief business of the earnest practitioner.
2F




434

CURE AND PREVENTION OF SCARLET-FEVER.

PROTECTION AGAINST SCARLET-FEVER.
I. Prophylaxis.
But even under the most appropriate and certain medical treatment of developed scarlatina of a bad type there is always the risk
of death, of the most miserable death, and the amount of the countless
sufferings of the patients is not unfrequently so great that a philanthropist must wish that a means could be discovered by which those
in health might be protected from this murderous children's pestilence, and be rendered secure from it, more especially as the virus is
so extremely communicable that it inevitably penetrates to the most
carefully guarded children of the great ones of the earth. Who can
deny that the perfect prevention of infection from this devastating
scourge, and the discovery of a means whereby this divine aim may
be surely attained, would offer infinite advantages over any mode of
treatment, be it of the most incomparable kind soever?
The remedy capable of maintaining the healthy uninfectable by the
miasm of scarlatina, I was so fortunate as to discover. Ifound also
that the same remedy given at the period when the symptoms indicative of the invasion of the disease occurs, stifles the fever in its very
birth; and, moreover, is more efficacious than other known medicaments in removing the greater part of the after-sufferings following
scarlatina that has run its natural course, which are often worse
than the disease itself.
I shall now relate the mode in which I made the discovery of
this specific preservative remedy.
The mother of a large family, at the commencement of July
1799, when the scarlet-fever was most prevalent and fatal, had
got a new counterpane made up by a sempstress, who (without the
knowledge of the former) had in her small chamber a boy just
recovering of scarlet-fever. The first mentioned woman on receiving it, examined it and smelt it in order to ascertain whether it
might not have a bad smell that would render it necessary to hang
it in the open air, but as she, could detect nothing of the sort,
she laid it beside her on the pillow of the sofa, on which some
hours later she lay down for her afternoon's nap.-She had unconsciously, in this way only (for the family had no other near or
remote connexion with scarlatina patients), imbibed this miasm.



CURE AND PREVENTION OF SCARLET-FEVER.

435

A week subsequently she suddenly fell ill of a bad quinsy, with the
characteristic shooting pains in the throat, which could only be
subdued after four days of threatening symptoms.
Several days thereafter, her daughter, ten years of age, infected
most probably by the morbific exhalations of the mother or by the
emanations from the counterpane, was attacked in the evening by
severe pressive pain in the abdomen, with biting itching on the
body and head, and rigor over the head and arms, and with paralytic stiffness of the joints. She slept very restlessly during the
night, with frightful dreams and perspiration all over the body,
excepting the head. I found her in the morning with pressive
headache, dimness of vision, slimy tongue, some ptyalism, the
submaxillary glands hard, swollen, painful to the touch, shooting
pains in the throat on swallowing and at other times. She had not
the slightest thirst, her pulse was quick and small, breathing
hurried and anxious; though she was very pale she felt hot to the
touch, yet complained of horripilation over the face and hairy scalp;
she sat leaning somewhat forwards in order to avoid the shooting
in the abdomen which she felt most acutely when stretching or bending back the body; she complained of a paralytic stiffness of the
limbs with an air of the most dejected pusillanimity, and shunned
all conversation; " she felt," she said, "as if she could only speak
in a whisper." Her look was dull and yet staring, the eyelids
inordinately wide open, the face pale, features sunk.
Now I knew only too well that the ordinary favourite remedies,
as in many other cases, so also in scarlatina, in the most favourable
cases leave everything unchanged, and therefore I resolved in this
case of scarlet-fever just in the act of breaking out, not to act as
usual in reference to individual symptoms, but if possible (in
accordance with my new synthetical principle) to obtain a remedy
whose peculiar mode of action was calculated to produce in the
healthy body most of the morbid symptoms which I observed
combined in this disease. My memory and my written collection
of the peculiar effects of some medicines, furnished me with no
remedy so capable of producing a counterpart of the symptoms
here present, as belladonna.
It alone could fulfil most of the indications of this disease, seeing
that in its primary action it has, according to my observations, a
tendency to excite even in healthy persons great dejected pusillani2F2




436

CURE AND PREVENTION OF SCARLET-FEVER.

mity, dull staring (stupid) look, with inordinately opened eyelids,
obscuration of vision, coldness and paleness of the face, want of
thirst, excessively small, rapid pulse, paralytic immobility of the
limbs, obstructed swallowing, with shooting pains in the parotid
gland, pressive headache, constrictive pains in the abdomen, which
become intolerable in any other posture of the body besides bending forwards, rigor and heat of certain parts to the exclusion of
others, e. g., of the head alone, of the arms alone, &c. If, thought
I, this was a case of approaching scarlet-fever, as I considered was
most probable, the subsequent effects peculiar to this plant-its
power to produce synochus, with erysipelatous spots on the skin,
sopor, swollen, hot face, &c.-could not fail to be extremely appropriate to the symptoms of fully developed scarlatina.
I therefore gave this girl of ten years of age, who was already
affected by the first symptoms of scarlet-fever, a dose of this medicine (1/42,oooth part of a grain of the extract, which according to my
subsequent experience is rather too large a dose).1   She remained
quietly seated all day, without lying down; the heat of her body
became but little observable; she drank but little; none of her
other symptoms increased that day and no new ones occurred.
She slept pretty quietly during the night, and the following morning, twenty hours after taking the medicine, most of the symptoms
had disappeared without any crisis, the sore throat alone persisted,
but with diminished severity, until evening, when it too went off.
The following day she was lively, ate and played again, and complained of nothing. I now gave her another dose, and she remained
well, perfectly well-whilst two other children of the family fell ill
of bad scarlet-fever without my knowledge, whom I could only
treat according to my general plan detailed above; I gave my convalescent a smaller dose of belladonna every three or four days,
and she remainedin perfect health.
I now   earnestly desired to be able if possible to preserve the
1 At least, if given for a preventive object, too large a dose for a child of this age,
but probably exactly appropriate for the so far advanced symptoms of scarlet-fever,
but this I do not know for certain. I cannot therefore advise an exact imita
tion of this case, but yet neither can I advise that it should not be copied, for the
scarlet-fever is a much more serious evil than a few troublesome symptoms produced
by a somewhat too large dose of belladonna.




CURE AND PREVENTION OF SCARLET-FEVER.

437

other five children of the family perfectly free from infection.
Their removal was impossible and would have been too late.
I reasoned thus: a remedy that is capable of quickly checking a
disease in its onset, must be its best preventive; and the following
occurrence strengthened me in the correctness of this conclusion.
Some weeks previously, three children of another family lay ill of a
very bad scarlet-fever; the eldest daughter alone, who, up to that
period, had been taking belladonna internally for an external
affection on the joints of her fingers, to my great astonishment
did not catch the fever, although during the prevalence of other
epidemics she had always been the first to take them.
This circumstance completely confirmed my idea. I now hesitated not to administer to the other five children of this numerous
family this divine remedy, as a preservative, in very small doses,
and, as the peculiar action of this plant does not last above three
days, I repeated the dose every 72 hours, and they all remained
perfectly well without the slightest symptoms throughout the whole
course of the epidemic, and amid the most virulent scarlatina emanations from their sisters who lay ill with the disease.
In the mean time I was called in to attend another family,
where the eldest son was ill of scarlet-fever.  I found him in the
height of the fever, and with the eruption on the chest and arms.
He was seriously ill, and the time was consequently past to give
him the specific prophylactic remedy. But I wished to keep the
other three children free from this malignant disease; one of them
was nine months, another two years, and the third four years of
age. The parents did what I ordered, gave each of the children
the requisite quantity of belladonna every three days, and had the
happiness to preserve these three children free from the pestilential
disease, free from all its symptoms, although they had unrestricted
intercourse with their sick brother.
And a number of other opportunities presented themselves to me
where this specific preventive remedy never failed.
In order to prepare this remedy for preventing the infection of
scarlet fever, we take a handful of the fresh leaves of the wild 1
1 For my experiments I have only employed the wild belladonna gathered in its
natural habitat, but I doubt not that the cultivated sort will display the same powers,
if it be grown in a situation very analogous as to soil and position to the natural ones
vide Tahnemann's Apotheker-Lexicon. Art. Belladonna-schlaf beere.




438

CURE AND PREVENTION OF SCARLET-FEVER.

belladonna (atropa belladonna, Linn.) at the season when the flowers
are not yet blown; these we bruise in a mortar to a pap, and press
the juice through linen, and immediately (without any previous
purification) spread it out scarcely as thick as the back of a knife,
on flat porcelain plates, and expose it to a draught of dry air, where
it will be evaporated in the course of a few hours. We stir it about
and spread it out again with the spatula, so that it may harden in
a uniform manner until it becomes so dry that it may be pulverised.
The powder is to be kept in a well stopped and warmed bottle.
If we now wish to prepare from this the prophylactic remedy,
we dissolve a grain of this powder (prepared from well preserved
belladonna extract evaporated at an ordinary temperature) in one
hundred drops of common distilled water, by rubbing it up in a
small mortar; we pour the thick solution into a one-ounce bottle,
and rinse the mortar and the pestle with three hundred drops of
diluted alcohol (five parts of water to one of spirit), and we then
add this to the solution, and render the union perfect by diligently
shaking the liquid. We label the bottle strong solution of belladonna.
One drop of this is intimately mixed with three hundred drops of
diluted alcohol by shaking it for a minute, and this is marked
medium solution of belladonna. Of this second mixture one drop is
mixed with two hundred drops of the diluted alcohol, by shaking
for a minute, and marked weak solution of belladonna; and this is
our prophylactic remedy for scarlet fever, each drop of which
contains the twenty-four millionth part of a grain of the dry belladonna juice.
Of this weak solution of belladonna we give to those not affected
with scarlet-fever, with the intention to make them uninfectable by
the disease,-to a child one year old, two drops (to a younger child
one drop),-to one two years old, three,-to one three years old,
four,-to a child four years old (according to the strength of his
constitution), from five to six,--to a five years old child, from six
to seven,-to a six years old child, from seven to eight,-to a seven
years old child, from nine to ten,-to an eight years old child, from
eleven to thirteen,-to a nine years old child, from fourteen to sixteen drops; and with each successive year up to the twentieth, two
drops more (from the twentieth to the thirtieth, not above forty
drops)-a dose every seventy-two hours (well stirred for a minute




CURE AND PREVENTION OP SCARLET-FEVER.

439

with a teaspoon in any kind of drink) as long as the epidemic lasts,
and four (to five) weeks thereafter.'
Should the epidemic be very violent, it would be safer, if the
children could bear it, to let the second dose be taken twenty-four
hours after the first, the third dose thirty-six hours after the second,
the fourth forty-eight hours after the third, and thereafter to let
the subsequent doses be taken every seventy-two hours until the
end, in order that the system may not at first be taken by surprise
by the miasm.
This course of medicine does not disturb the health of the children.
They may and indeed ought to follow the mode of life of healthy
individuals, and keep to their usual drinks, food, and ordinary
recreation and exercise in the open air, but they must take care to
avoid excess in any of these things.
The only thing I must prohibit is the use of too much vegetable
acid, of sour fruits, of vinegar, &c. The action of belladonna is
thereby enormously increased, as my experience (contrary to the
assertions of ancient writers) has taught me.
In case of the occurrence of such a case of the injurious and too
violent action of belladonna (from this or any other cause), we
should make use of its peculiar (according to my observations
specific) antidote, opium, externally or internally, in doses similar
to those I have above indicated, for the external or internal treatment of natural scarlatina.
There are, however, cases in which we are forced to give the
above doses of belladonna oftener than every seventy-two hours.
A delicate girl, three years of age, who was successfully using the
belladonna as a preservative, in the above dose, beside her sister
who had scarlet-fever, bruised her hand severely one day with the
door of the room, and thereby fell into a mental and bodily condition so favourable to the reception of the infection, that, notwithstanding that she had taken the prophylactic the day before,
she presented in a few hours all the signs of approaching scarletfever; but two drops of the weak solution of belladonna given
immediately removed these symptoms just as quickly, without any
further effects. From that time forward she took the medicine
1 It seems to me somewhat probable that a similar employment of belladonna would
also preserve from mneasles.




440

CURE AND PREVENTION OF SCARLET-FEVER.

only every three days (as previously), and she remained quite free
from the scarlet fever and well.
We would therefore do well in the event of such sudden accession of violent mental depressions, occasionally, when requisite, to
give one or two extra doses. We will also sometimes meet with
children who possess naturally such timorous, tranquil dispositions,
that in them the dose above indicated for children of their age will
not suffice to protect them from scarlet-fever; the physician may
therefore be allowed to increase it somewhat, and to stir the drops
up with somewhat more fluid, and for a minute longer. I may
observe, that it is scarcely credible how much this and every other
medicine loses in power (so as even to be unserviceable for protecting from scarlet-fever), if we allow it to be licked simply and
unmixed with anything from a spoon, or give it only on sugar,
or, though dropping it into a fluid, administer it without stirring it well up with it. It is only by stirring, by brisk, longcontinued stirring, that a liquid medicine obtains the largest
number of points of contact for the living fibre, thereby alone does
it become right powerful. But the well-stirred dose should not be
allowed to stand for several hours before it is administered. Water,
beer, milk, and all such excipient fluids, when allowed to stand,
undergo some decomposition, and thereby weaken the vegetable
medicinal agent mixed with them, or even destroy it completely.
I would, moreover, advise that the medicine bottle should be
locked up after every time of using it. I once saw a little girl of
four years old fill up a medicine bottle with brandy, whence, as
she confessed to me, she had previously drunk out all the medicine,
which was also made with spirit and colourless. She had mounted
on the table, had taken the bottle down from a high cupboard in
the wall, and was about to fill it up with what she supposed to be
a similar fluid, in order that her parents might not discover what
she had done, when I entered the room.
II. Suppression of the Scarlet-fever in its first germs.
Although a practitioner will seldom be so fortunate as to accomplish this extinction of the fever in question in its birth by
means of belladonna, because it is not usual to send for him at
the very beginning when the miasm attempts its first partial
onslaught, and when uneasy dreams, paralytic stiffness of the




CURE AND PREVENTION OF SCARLET-FEVER.

441

limbs, pressive headache, rigor over one or other limb and over
the head, constitute almost the only symptoms of the still feeble
reaction of the system, yet it is a real fact, and, according to my
by no means small experience, beyond all doubt, that it is capable
of extinguishing the approaching fever with all its concomitant
symptoms in the course of from twenty-four to forty-eight hours,
and of restoring the previous state of health without the slightest
bad consequences. To accomplish this object I found it best in
this case to administer the half of the dose recommended above
as a preventive every three hours, until all the symptoms had disappeared, and then to continue giving a full dose only every
seventy-two hours in order to protect the patient from all further
infection.
I have, indeed, even in cases where there was already shooting
pain and swelling of the cervical glands and increased heat of skin,'
that is, when a more considerable degree of natural reaction
against the miasm was present, always succeeded in attaining my
object by similar doses given at similar intervals of time, but I cannot recommend this practice to any practitioner who is not a most
accurate observer, because should he chance to overlook symptoms
of a more advanced stage that may be present, it must always remain
a doubtful matter, whether, in such a case, by the addition of a
new and powerful agent, the advanced disease would be suppressed
and extinguished, or a tumultuous commotion be excited in the
diseased system without any good result.
But least of all is it probable that our object would be attained
by giving belladonna, and it is certainly not advisable to attempt it,
if there are present greater heat, redness of face, great thirst,
inability to leave the bed, vomiting and cinnabar-coloured eruption,
in other words, fully developed scarlatina. It does not seem
suited for administration in the height of the fever, just as Peruvian bark cannot be given in the middle of the hot stage of a
paroxysm of intermittent fever with advantage or without producing a bad effect on the system.
AFTER-SUFFERINGS.
On the other hand, belladonna displays a valuable and specific
power in removing the after-sufferings remaining from scarletfever-an object that our forefathers, as we know, vainly strove to
But without increased redness.




442

CURE AND PREVENTION OF SCARLET-FEVER.

attain. Most medical men have hitherto regarded the consequences
of scarlatina as at least as dangerous as the fever itself, and there
have been many epidemics, where more died of the after-affections
than of the fever.
The puffiness of the face, the swelling of the hands and feet,
&c., the cachexy, the slow evening fever with shuddering, the
stiffness of the limbs, the sense of constriction of the abdomen
on holding the body erect, the formication and sleeping (narcosis)
in the spine, the inflammation of the glands, the suppuration
inside the ears, the ulcers on the face, on the lining membrane of
the nose, at the angles of the mouth, &c., the extraordinary
debility of the whole body, the sleepy, dull disposition, alternating
with excessive hurry in talking and acting, the calling out in sleep,
the pressive headaches, &c., will be specifically and rapidly removed
by the same doses of this remedy as suffice (v. supra) for prophylactic purposes, or according as the practitioner judges expedient
by smaller or larger doses of it. Sometimes all that is required is
to give the doses somewhat more frequently.
It is only in some particular cases, where the original disease was
very violent, and advice has been sought for the after-sufferings too
late, that I have witnessed what is termed the unhealthy skin, that
is, the tendency to a solution of continuity in the solid parts, to
ulceration, sometimes to such a degree, that belladonna is no
longer of service. In such and other similar cases the most excellent remedy was the inspissated juice of the matricaria chamomilla,
dried at a natural temperature in the air-of this a grain was first
of all dissolved in 500 drops of water and mixed intimately with 500
drops of alcohol, and of this solution one drop was mixed with 800
drops of diluted alcohol-of this last diluted solution one drop
(1/fooooth of a grain of the inspissated juice) was given every day to
a child of a few years old, two drops to one of ten years of age, and
so forth; the medicine being previously well mixed with any liquid,
and in a few days all tendency to ulceration of the skin was
removed, the so-called unhealthy skin was cured-a disease in every
case much dreaded by every medical man who does not know of
this excellent but very heroic remedy.
The suffocating cough that sometimes follows the disease is also
removed by chamomilla, especially if there is at the same time a
tendency to flushing of the face, accompanied by horripilation
over the limbs or back.




ON THE POWER OF SMALL DOSES OF

MEDICINE IN      GENERAL, AND
OF  BELLADONNA        IN  PARTICULAR.1
You ask me urgently, what effect can 'ioo,oooth part of a grain of
belladonna have? The word can is repugnant to me, and apt to
lead to misconceptions. Our compendiums have already decided
what medicines and certain doses of them can do, and have told us
exactly what we are to use; they have determined these matters so
decidedly that we might consider them to be symbolic books, if
medical dogmas were to be believed as articles of faith. But, thank
God, they are not yet; it is well known that our materia
medicas owe their origin to anything but pure experience, that
they are often the inanities of our great-grandfathers, unenquiringly
repeated by their great-grandsons. Let us not, then, interrogate
the compendiums, let us ask nature: what effect has 1/ioo,oooth of a
grain of belladonna? But even in this shape the question is too
wide, and it can only become more definite and answerable by
stating the ubi, quomodo, quando, quibus auxiliis.
A very hard dry pill of extract of belladonna produces in a
robust, perfectly healthy countryman or labourer usually no effect.
But from this it by no means follows that a grain of this extract
would be a proper, or too weak a dose for this or a similar stout
man if he was ill, or if the grain were given in solution,-certainly
not! On this point let the pseudo-empiricism of the compendiums
hold its tongue; let us hear what experience says. The most healthy
robust thresher will be affected with the most violent and dangerous
symptoms from one grain of extract of belladonna, if this grain be
dissolved thoroughly in much (e. g. two pounds of) water by rubbing,
the mixture (a little alcohol being added, for all vegetable solutions
1 From IHufeland's Journal. Vol. vi, Pt. 2. 1801.




444

ON THE POWER OF SMALL DOSES OF MEDICINE.

are rapidly decomposed') made very intimate by shaking the fluid
in a bottle for five minutes, and if he be made to take it by spoonfuls within six or eight hours. These two pounds will contain
about 10,000 drops. Now if one of these drops be mixed with
other 2000 drops (six oz.) of water (mixed with a little alcohol),
by being vigorously shaken, one teaspoonful (about twenty drops)
of this mixture given every two hours, will produce not much less
violent symptoms in a strong man, if he is ill. Such a dose contains about the millionth part of a grain. A few teaspoonfuls of
this mixture, will, I assert, bring him to the brink of the grave, if
he was previously regularly ill, and if his disease was of such a
description as belladonna is suitable for.
The hard grain-pill finds few points of contact in the healthy
body; it slides almost completely undissolved over the surface of
the intestinal canal invested with a layer of mucus, until it (in this
manner itself covered with mucus), completely buried in excrement,
is speedily expelled in the natural manner.
Very different is it with a solution, and particularly with a
thorough solution. Let this be as weak as it may, in its passage
through the stomach it comes in contact with many more points of
the living fibre, and as the medicine does not act atomically but
only dynamically, it excites much more severe symptoms than the
compact pill, containing a million times more medicine (that rests
inactive), is capable of doing.
But how is it, I am asked, that excepting yourself no other physician has ever observed that remarkable action from belladonna
(and other medicines) in so small a dose? The answer is not difficult. In the first place, because many may only have experimented
with watery solutions, whose medicinal power, as above stated, is
gone in a few hours, destroyed by the internal fermentation of the
water; secondly, because many physicians, ignorant of the purely
1 Plain water even is liable to constant fermentation, especially when vegetable
substances are mingled with it, and these lose their medicinal power in a few hours.
Without the addition of a little spirit we cannot preserve them half a day in their
integrity. Exposed vegetable juices go on to fermentation a minute after their
exposure. We might drink a large quantity of hemlock juice without injury if it has
stood for twenty-four hours in a moderate temperature; it then is changed into a
kind of vinegar. To some vegetable juices I have had to add one third, to others as
much as equal parts of spirits of wine, in order to prevent their fermentation.




ON THE POWER OF SMALL DOSES OF MEDICINE.

445

dynamical action of medicines, are prevented from instituting any
experiments of this nature by their invincible prejudiced incredulity;
thirdly, because no physician deigns to observe and to study the
positive and absolute effects of medicines, most of them being content to learn by rote the traditions in the works on materia
medica, in other words, the general, often imaginary, use of the
medicines-" belladonna is of use (and is of no use) in hydrophobia "
-" is of use (and is of no use) in cancer of the face," &c. "We
don't need to know anything more." What organs it deranges
functionally, what it modifies in other ways, what nerves it principally benumbs or excites, what alterations it effects in the circulation and digestive operations, how it affects the mind, how the
disposition, what influence it exerts over some secretions, what
modification the muscular fibre receives from it, how long its action
lasts, and by what means it is rendered powerless; all this the
ordinary physician wishes not to know, and therefore-he does not
know it. Such being his ignorance, he often regards the peculiar
effects of small doses of belladonna as natural morbid changes, and
thus he will never know what small doses, not to speak of the very
smallest doses, of belladonna do, since he does not know what
effects belladonna produces, nor does he desire to know them.
To the ordinary practitioner it is incredible that a given person,
when sick, needs only to take a millionth part of the same drug
that he swallowed when well without it having any particular effect,
in order to be violently acted on; and yet this is undeniably the case.
It is a fact, that in disease the preservative power, together with all
the subordinate, nameless forces (some of them almost resemble
the instinct of animals), is much more excitable than in health,
when the reason and the power of the animal machine being in
their complete integrity stand in no need of such anxious guardians.
How well the patient. distinguishes betwixt drinks that will do him
good, and such as would be prejudicial to him! An individual
affected with an acute fever, smells from afar the approach of an animal soup, to which his now wakeful, still unknown life-preserving
faculty evinces the greatest repugnance. He would vomit violently
were we to bring it too near him.
If lemon-juice is good for him-see! at the very mention of it,
his countenance expresses pleasure and desire, and yet when he
was well how indifferent were they both to him!




446

ON THE POWER OF SMALL DOSES OF MEDICINE.

In a word, all the powers, whose very names we are ignorant of,
which have reference to the preservation of life and the avoidance
of destruction, are infinitely'more excited in disease. What an
enormous quantity of freshly made soup it would take to excite a
healthy stomach to violent vomiting! But look, the patient ill of
acute fever does not require a drop for this purpose; the mere
smell of it, perhaps the millionth part of a drop, coming in contact
with the mucous membrane of the nose, suffices to produce this
result.
Will medical men ever learn, how small, how infinitely small,
the doses of medicines may be in order to affect the system powerfully when it is in a morbid state?  Yes, they affect it powerfully
when they are chosen improperly; new violent symptoms are added,
and it is usual to say (whether correctly or not, this is not the place
to decide), the disease has undergone an aggravation. They affect it
equally powerfully when they are suitably selected; the most serious
disease often yields in a few hours. The nearer the disease approaches
the acute character, the smaller are the doses of medicine (I mean
of the best selected one) it requires in order to disappear. Chronic
diseases also combined with debility and general derangement of
the health, do not require larger ones. It is only in cases where
along with a local affection, the general health seems to be good
that we must proceed from the at first small doses to larger ones,
to the very largest however in those cases where the medicine only
can act in a palliative manner.
Those who are satisfied with these general hints, will believe me
when I assert, that I have removed various paralytic affections
by employing for some weeks a quantity of diluted solution of
belladonna, where for the whole treatment not quite a hundredthousandth part of a grain of the extract of belladonna was required,
and that I have cured some periodical nervous diseases, tendency
to boils, &c., by not quite a millionth of a grain, for the whole
treatment.
If the appropriate medicine in solution is efficacious in such a
small dose, as it assuredly is-how highly important on the other
hand is it, that in the event of the remedy being improperly selected, such a small dose can seldom excite such serious symptoms
(ordinarily termed aggravations of the disease) as that they
shall not soon disappear spontaneously, or be readily removed by
some trifling antidote.




THOUGHTS SUGGESTED BY THE RECOMMENDATION
OF A REMEDY FOR THE EFFECTS OF THE
BITE OF MAD DOGS.+
Since the most remote times a number of remedies have been
recommended as preventives of this horrible disease, accompanied
by numerous certificates to attest their efficacy for several generations.  The arcanum generously purchased some years ago by the
Prussian government, which received the sanction of a medical
commission and was at last authoritatively disclosed-I mean the
worthless electuary of the meloe majalis may serve as a specimen of
all the rest.
All were at length found to be valueless, one was worth just as
much as another, that is to say, worth nothing! What a fearful
condition to find onesself at a moment of such imminent danger to
life, left in the lurch by a remedy publicly and universally vaunted
as infallible! The drowning man clutches at the rope thrown to
him-the only one at hand-it breaks, and see, he sinks to rise
no more!
But how is it that men have been so universally, so completely
deceived in all these nostrums for rabies?
Had the real cause of the deception in all these cases been
known, the rroT0v iEvo--assuredly not the. slightest attention
would have been paid even at their first announcepnent to any of
these nostrums, which have now been proved to be powerless-we
should, on the other hand, have long since discovered a certain, a
true remedy for the disease.
The source of the delusion that contributed to the celebrity of
all the nostrums hitherto advised, was the circumstance that it was
1 From the Beicks-Anzeiger. No. 71, 1803.




448

ON A PROPOSED REMEDY FOR HYDROPHOBIA.

deemed sufficient to bring forward proofs that the remedy in question
preserved from hydrophobia so many persons who had been bitten by
supposed mad dogs.
But of ten dogs that have bitten persons and animals, and which,
from dread of injury, people are more disposed to consider mad
than not, frequently not two are really rabid. But it is very rare
that any one takes the trouble to obtain a regular verification of
the fact of their being really rabid, they are pursued, slaughtered,
and all the ten are held to be mad. Whether the dog really had
the disease, remains in most instances undecided and improbable.
Now out of a hundred persons bitten, who can prove that a
single one among them was wounded by a really rabid dog?
And on the other hand, it is well known that of persons bitten,
nay, lacerated by dogs really mad, it is very far from the case that
all will be affected by hydrophobia. Instances are known of twenty
persons having been bitten by a rabid dog, of whom only one or
two were seized with the disease, whilst the eighteen or nineteen
used no medical or surgical preventive and yet retained their
health. (Had the nostrum been given to these latter eighteen or
nineteen, many would have sworn that the remedy had destroyed
the virus and preserved them from the disease.)
Both these circumstances-the frequency with which dogs are
considered and killed as mad (i. e., the rarity of really mad dogs),
and the rarity of the inoculation of the really rabid saliva, have
furnished the material for the thousand empty testimonials as to the
prophylactic power of those vaunted nostrums. We should now,
however, once for all cease to pin our faith on such remedies, for
which a mere (delusive) prophylactic power is alleged; we should
once for all cease to grasp at shadows in an affair of such importance, and fraught with so much danger to mankind!
If the vapour of nitric acid, in a state of ebullition, were not at
the same time one of the most trustworthy remedies for the jailfever, Smith would have exerted himself in vain to assert its prophylactic power for the contagion of this typhoid fever.
In like manner there cannot be any prophylactic of hydrophobia,
that does not prove itself to be at the same time a really efficacious
remedy for the fully developed hydrophobia.
Let us begin at this as our starting point. Let a remedy be
discovered that has already cured at least ten persons, really




ON A PROPOSED REMEDY FOR HYDROPHOBIA.

449

affected with hydrophobia, without exception and permanently;
this will, this must be, likewise the best prophylactic; but any
substance that cannot stand this test, can never, in the eyes of
reason and experience, be considered as a trustworthy prophylactic. Let the best extinguisher of burning wooden buildings
be discovered (be it vitriol or potash) and this will also be the best
preservative of wood from fire.
If the remedy of the schoolmaster of Schoneiche, announced by
the philanthropic Wiesand of Pretzsch, had only made a commencement such as I have indicated, and had only cured two persons
really affected with hydrophobia, his secret would be worth a
considerable reward, and had it cured a number without ever
failing, his reward should be very large and his memory should
always be held in honour. Then we should at length possess a
genuine remedy for one of the most fearful of diseases, hydrophobia.

2 a




ON THE EFFECTS OF COFFEE.

FROM ORIGINAL OBSERVATIONS.1
In order to enjoy a healthy and long life, man requires foods
which contain nutritious, but no irritating, medicinal, parts, and
drinks which are either merely diluent, or diluent and nutritious
at the same time, but which contain no medicinal and irritating
component parts, such as pure spring water and milk.
In the way of accessaries to stimulate the taste, the only substances that have been found to be harmless and suitable for the
human body are kitchen salt, sugar and vinegar, all three in small,
or at all events, moderate quantities.
All other accessaries, which we term spices, and all spirituous
and fermented liquors, bear a greater or less resemblance to medicines in their nature. The nearer they resemble medicines, the
more frequently and the more copiously they are taken into our
bodies, the more objectionable are they, the more prejudicial to
health and long life.
Most objectionable of all is the frequent use of purely medicinal
substances of great power as articles of diet.
Among the ancients, wine was the only purely medicinal drink,
but the wise Greeks and Romans at least never drank it without
diluting it plentifully with water.
In modern times many more purely medicinal drinks and condiments have been added to our diet: snuffing and smoking
tobacco, chewing tobacco and hemp-leaves, eating opium and
agaric, drinking brandy, several kinds of stimulating and medicinal beers, tea2 and coffee.
1 Leipzic, 1803.
2 Chocolate belongs to the nutritious articles, when it is not too highly spiced;
otherwis it is objectionable, or even hurtful.




ON THE EFFECTS OF COFFEE.

451

Medicinal things are substances that do not nourish, but alter
the healthy condition of the body; any alteration, however, in the
healthy state of the body constitutes a kind of abnormal, morbid
condition.'
Coffee is a purely medicinal substance.
All medicines have, in strong doses, a noxious action on the sensations of the healthy individual.    No one ever smoked tobacco
for the first time in his life without disgust; no healthy person
ever drank unsugared black coffee for the first time in his life
with gusto-a hint given by nature to shun the first occasion for
transgressing the laws of health, and not to trample so frivolously
under our feet the warning instinct implanted in us for the preservation of our life.
By continuing the use of these medicinal articles of diet (whereto
fashion and example seduce us), habit gradually extinguishes the
noxious impressions that they at first made upon us; they even
become agreeable to us, that is to say, the disagreeable impressions their ingestion at first produced do not strike us so much as
we go on using them, and their apparently agreeable effects upon
our organs of sensation gradually become necessary to us. The
ordinary run of mankind esteems even factitious wants as happiness, and gradually associates with their satisfaction the idea of
relish.
Perhaps also, inasmuch as by their use we become to a certain
degree sickly, our instinct tries from time to time at least to alleviate this indisposition occasioned by the continued use of these
medicinal articles of diet, by means of the palliative relief which
they are capable of affording to the malady produced from time
to time by themselves.
In order to understand this proposition, we must take into
consideration the fact that all medicines produce in the body con1 In proportion as the substances we call medicines can make the healthy body
sick, so are they calculated to remove the abnormal states dangerous to life, which
go by the name of diseases. The sole end of medicines consequently is, to change
the abnormal, the morbid state, that is, to transform it into health. Used by themselves, and when no disease is present, they are absolutely hurtful things for health
and normal life. Their frequent use as articles of diet deranges the harmonious
concordance of our organs, undermines health and shortens life. A wholesome
medicine for a healthy individual is a contradiction of terms.
2G2




452

ON THE EFFECTS OF COFFEE.

ditions the opposite of one another.     Their commencing action
(primary action) is the direct opposite of their secondary action,
that is, of the state they leave behind in the body when their
primary action has ceased some hours.1
Most medicines produce, both in their primary and secondary
action, disturbances in the healthy body and disagreeable sensations and pains, a certain set of these in their primary action and
another opposite set in their secondary action, and even their prolonged employment excites no agreeable effects in the healthy
individual.
Only the few medicinal substances that the refinement of a
sensual world has chosen to introduce among articles of diet,2 form
in some degree, an exception to this, at least in their primary
action. They possess the peculiar property, when continued to be
used in moderation, to create in their primary action a sort of
artificial exaltation of the ordinary state of health, an artificial
exaltation of the life and almost only agreeable sensations, whilst
the disagreeable effects their secondary action tends to develop
remain for some time of little importance, as long as the individual is pretty well in health, and leads in other respects a healthy
and natural mode of life.
To this small class of medicines introduced into our dietary
belongs coffee, with its partly agreeable, partly disagreeable effects,
both of which, strange though it may appear, are but little-known.
Its irregular, unrestricted use in ordinary life, at almost all
times of the day, its employment in such various strength and
quantity, its preparation under the most dissimilar conditions, its
general use by persons of the most various ages and constitutions,
of the most different health and habits of life, deprives the observer
of all means of seeing its action aright, and makes it excessively
difficult to ascertain its true action, and thence to draw pure
inferences. So a disk may be covered with the clearest characters
and words, but all will be unrecognisable if the disk be whirled
round with great rapidity; in that case everything runs together,
even to the eyes of the most sharp-sighted.
1 For instance, to-day jalap powder purges, and to-morrow and the next day there
follows constipation.
2 These are, as before said, wine, spirits, opium, tobacco, tea, coffee, &c.




ON THE EFFECTS OF COFFEE.

453

It is only by accurate, prolonged, unprejudiced observation, as
free as possible from all source of deception, and by carefully
tracing back the phenomena to their cause, that we can obtain
accurate knowledge respecting the most important of all beverages,
coffee.
Its primary action is in general a more or less agreeable exaltation of the vital activity; the animal, the natural, and the vital
functions (as they are called) are artificially exalted by it during
the first hours, and the secondary action that ensues gradually
after the lapse of several hours is the opposite-disagreeable
feeling of existence, a lower degree of vitality, a kind of paralysis
of the animal, natural and vital functions.1
When    a person   unaccustomed to the use       of coffee drinks
a moderate quantity, or one accustomed to its use drinks an
immoderate2 quantity, for the first hours the self-consciousness,
the feeling of his existence, of his life, becomes more lively.   He
gets a circumscribed redness of the cheeks, a redness which does
not become gradually lost in the surrounding parts, but which
presents the appearance of a well-defined red spot.        The forehead and palms of the hands become warm and moist. He feels
warmer than before; he feels agreeably, yet uneasily warm.
There occurs a kind of voluptuous palpitation of the heart, somewhat resembling that occurring during great joy. The veins of
the hands swell. Externally also he is warmer to the feel than
natural, but this warmth never comes to the length of heat, even
after a large quantity of coffee (it sooner turns into general perspiration); none ever become burning hot.
Presence of mind, attention, sympathy become more active than
1 " When I awake in the morning," writes a genteel, consummate coffee-drinking
lady, "I have the power of thinking, and the activity of an oyster."
2 The expressions moderate and immoderate must only be understood in a relative
and individual sense; they cannot be defined by fixed magnitude and figures of
universal acceptation. Thus a certain prince, H. C. v. C., reared in luxury, who is
now dead, required for an allowance, every time he drank coffee, an infusion of fourteen ounces of the roasted bean, whereas we meet with persons who are very strongly
affected by a quarter of an ounce. Each person must fix his own standard according
to his peculiar corporeal system. One can bear more than another. Moreover the
whole series of agreeable symptoms of the primary action of coffee I have here
described does not appear in everyone, at all events not all at once, but only one at
a time, some in one, others in another, in this one more, in that fewer.




454

ON THE EFFECTS OF COFFEB.

in the healthy natural state. All external objects appear to excite
a feeling of pleasure, they take on, if I may be allowed the expression, a joyous varnish, and if the quantity of coffee taken was very
great, they assume an almost over-pleasing lustre.' During the
first hours the coffee drinker smiles contented with himself and
with all external objects, and this property it was that mainly
tended to make coffee a social beverage. All the agreeable sensations communicated are speedily increased to enthusiasm (though
only for a short time).   All sorts of disagreeable recollections, or
disagreeable natural feelings cease during this kind of blessed
fever.
In the healthy natural states of the human being, left to themselves, disagreeable sensations must alternate with agreeable ones;
this is the wise arrangement of our nature. During the primary
action of this medicinal beverage, however, all is delight, and even
those corporeal functions which in the natural state of health are
accompanied by an unpleasant sensation almost bordering on pain,
are now performed with extreme ease, almost with a kind of
pleasure.
In the first moments or quarters of an hour after awaking, particularly when this takes place earlier than usual, every one who is
not living completely in a state of rude nature, has a disagreeable
feeling of not thoroughly awakened consciousness, of confusion, of
laziness, and want of pliancy in the limbs; it is difficult to move
quickly, reflection is a labour.
But, see, coffee removes this natural disagreeable sensation, this
discomfort of the mind and body, almost instantaneously; we suddenly become completely alive.
After completing our day's labour we must, in the course of
nature, become lazy; a disagreeable feeling of weight and weari1 If the quantity of coffee taken be immoderately great and the body very excitable and quite unused to coffee, there occurs a semilateral headache, from the upper
part of the parietal bone to the base of the brain. The cerebral membranes of this
side also seem to be painfully sensitive. The hands and feet become cold; on the
brow and palms cold sweat appears. The disposition becomes irritable and intolerant;
no one can do anything to please him. He is anxious and trembling, restless, weeps
almost without cause, or smiles almost involuntarily. After a few hours, sleep comes
on, out of which he occasionally starts up in affright. I have seen this rare state
two or three times.




ON THE EFFECTS OF COFFEE.

455

ness in our bodily and mental powers makes us ill-humoured and
cross, and compels us to give ourselves up to the requisite rest and
sleep.
This crossness and laziness, this disagreeable weariness of mind
and body on the approach of natural sleep, rapidly disappears on
taking this medicinal beverage, and a dispersion of sleepiness, a
factitious liveliness, a wakefulness in defiance of nature occurs.
In order to live we require food, and see! nature compels us to
seek it and to replace what has been lost, by hunger, or gnawing
uncomfortable sensation in the stomach, a tormenting longing for
food, a quarrelsome crossness, chilliness, exhaustion, &c.
Not less uncomfortable is the feeling of thirst, nor is it less a
wholesome provision of nature. Besides the longing desire for
liquids which our body needs for its restoration, we are tormented
by a dryness of the throat and mouth, a dry heat of the whole
body, that to a certain extent impedes the respiration, a restlessness, &c.
We drink coffee-and see! we feel but little or nothing more of
the painful sensations of hunger, nor of the anxious, longing sensation of thirst. Genuine coffee-drinkers, especially those ladies
addicted to its use, who are deprived of the opportunity of recovering from the bad effects of this drink by occasional exercise in the
open air, experience little or nothing more of the real sensations of
hunger and thirst. In this case the body is cheated of its nutriment and drink, and the cutaneous vessels are at the same time
unnaturally forced to absorb from the atmosphere as much moisture
as is requisite to carry on the functions of life. Confirmed coffeedrinkers pass much more urine than the quantity of fluids they
drink. The most natural demands of nature are stifled.    (Thus
they gradually approach-thanks be to the divine beverage!-to
the condition of the blessed spirits above; a true commencement
of beatification here below.)
The all-bountiful Preserver of all living beings, made the healthy
man feel uncomfortable on taking exercise immediately after having
satisfied his appetite with food; this uncomfortable feeling was
intended to compel us to leave off our business and to rest both
the body and the mind, in order that the important function of
digestion might be commenced undisturbed. A lassitude of body
and mind, a constriction in the region of the stomach, a kind of




456

ON THE EFFECTS OF COFFEE.

disagreeable pressure, a fulness and tension in the abdomen, &c.,
on taking exercise, remind us, when we attempt to exert our
energies immediately after a meal, of the rest that is now required
-and if we attempt to exercise our thinking faculty, there occurs
a lassitude of the mental powers, a dulness of the head, a coldness
of the limbs, accompanied by warmth of the face; and the pressive
sensation in the stomach, combined with a disagreeable sensation
of tension in the abdomen, becomes still more intolerable,
proving that exerting the mental powers at the commencement of
the process of digestion is more unnatural and more hurtful than
even exertion of the body.
Coffee puts a sudden stop to this lassitude of mind and body, and
removes the disagreeable sensation in the abdomen after a meal.
The more refined gourmands drink it immediately after dinnerand they obtain this unnatural effect in a high degree. They become gay, and feel as light as though they had taken little or
nothing into their stomach.
The wise Regulator of our nature has also sought to compel us
by disagreeable sensations to evacuate the accumulated excrement.
There occurs an intolerable anxiety conjoined with a no less disagreeable feeling of straining, whereby all the agreeable sensations
of life are put a stop to, and, as it were, swallowed up in it, until
the evacuation is commenced. It is a necessary part of our nature
that there should be some effort in the expulsion of the excrements.
But this has been provided against by the refining spirit of our
age, which has sought to elude this law of nature likewise. In order
artificially to promote and hasten the time required for digestion,
which in the order of things is several hours, and to escape the
anxious, frequently slowly increasing call to stool, the degenerate
mortals of our times, who strain after enjoyment and have a
childish dread of all uncomfortable sensations, find their means of
escape in coffee.
Our intestines excited by coffee (in its primary action) to more
rapid peristaltic movements, force their contents but half digested
more quickly towards the anus, and the gourmand imagines he has
discovered a splendid digestive agent. But the liquid chyme which
serves to nourish the body can in this short time neither be properly altered (digested) in the stomach, nor sufficiently taken up by
the absorbents in the intestinal canal; hence the mass passes




ON THE EFFECTS OF COFFEE.

457

through the unnaturally active bowels, without parting with more
than the half of its nutritious particles for the supply of the body,
and arrives at the excretory orifice still in a half-liquid state. Of
a truth a most excellent digestive agent, far surpassing nature!
Moreover, during the evacuation itself the anus is excited by the
primary action of the coffee to more rapid dilatation and contraction, and the faeces pass out soft, almost without effort, and more
frequently than in the case of healthy individuals who do not partake of coffee.
These and other natural pains and disagreeable sensations, which
are a part of the wise ordering of our nature, are diminished and
rendered almost unnoticeable by the primary action of coffee-and
the disastrous effects of this are not perceived, or even dreamt of.
Even the sexual desire, which in our age has been exalted into
the chief of all pleasures, is excited by the primary action of coffee
more than by any other artificial means. As quick as lightning
there arise voluptuous images in the mind from very moderate
exciting cause, and the excitation of the genitals to complete ecstasy
becomes the work of a few seconds; the ejaculation of the semen
is almost irrestrainable. The sexual desire is excited by coffee from
ten to fifteen years too soon, in the tenderest, immaturest age, in
both sexes; a refinement 1 that has the most perceptible influence
on our morality and mortality-not to speak of the earlier impotence that follows as a natural consequence therefrom.
In an individual of very irritable temperament, or who has
already been enervated by the copious use of coffee and a sedentary
life, the effects I have mentioned appear in a still more prominent
light. Every unprejudiced person must perceive in the corporeal
derangements and sensations effected by coffee, something unnatural, an over-stimulation. An excessive sensitiveness, or a gaiety
greatly disproportioned to the object of it, a tenderness almost partaking of a convulsive character, an inordinate sorrowfulness, a wit
that is not altogether under the restraints of reason, an excessive
distortion of the features approaching to caricature, under circum1 Enjoyment I enjoyment! is the cry of our age-quicker, uninterrupted enjoyment of life at whatever cost! and this object is to a certain degree attained by means
of this beverage, that accelerates and squanders the vital powers.




458

ON THE EFFECTS OF COFFEE.

stances where a mere smile, a little joke, a slight perplexity, a
moderate expression of grief or sympathy, would have sufficed.
Even the muscles of the rest of the body exhibit an unnatural,
excessive activity-all is life, all is motion (though there may be
but little cause for it) during the first hour after partaking of
strong, or (to use the often inaccurate language of the world) good
coffee. The ideas and the pictures of the fancy flow in rapid succession and in a continuous stream before the seat of the imagination and sensation in the brain-an artificially accelerated, artificially exalted life!
In the natural state we require some effort to remember clearly
things long past; immediately after taking coffee the stores of
memory spring, so to speak, into our mouth-and the consequence
often is loquacity, hurried chattering, and letting things escape
from our lips that we ought not to have spoken about.
Moderation and purpose are entirely awanting. The cold considerate earnestness of our forefathers, the firm steadfastness of will,
of resolve, and of judgment, the endurance of the not rapid but
powerful movements of the body, adapted to the object in view, that
used to constitute the original national character of the Germans
-the whole sublime original stamp of our descent disappears before
this medicinal beverage, and changes into over-hasty disclosures,
hurried resolves, immatured judgments, frivolity, changeableness,
talkativeness, irresolution, flighty mobility of the muscles, without
the production of any durable impression, and theatrical behaviour.1
I well know that in order to revel in the dreams of fancy, in
order to compose frivolous novels, and light, playful witticisms, the
German must drink coffee-the German lady requires strong coffee
in order to sparkle with wit and sentiment in fashionable circles.
1 Who can tell what enervating dietetic practices it was by which those admirable
heroic virtues of patriotism, love of children, inviolable constancy, unshakeable integrity, and strict fulfilment of duties (the well-known attributes of bygone times),
have in our days almost all dwindled down into paltry egotism! Likewise the single
heroic crimes of the middle ages and of remote antiquity, the antagonists of those
virtues, are now-a-days (by what enervating dietetic practices?) split up into petty
intrigues, concealed trickeries and artifices, and distributed over myriads of individuals-compelling the uncontaminated person to exercise much caution every step
he takes I Which is the more injurious, a single bomb-shell or a million of invisible
hooks distributed every where to catch the feet of the unwary?




ON THE EFFECTS OF COFFEE.

459

The ballet dancer, the improvisator, the conjuror, the juggler, the
sharper, and the keeper of a faro-bank, all require coffee, as likewise
the fashionable musician for his giddy rapidity of execution, and the
omnipresent fashionable physician, to enable him to rush through
his ninety visits in a forenoon. Let us leave to these people their
unnatural stimulant, together with its evil effects to their own
health and the welfare of mankind!
But this much is at least certain,-the most refined sensualist,
the most devoted debauchee, could have discovered on the whole
surface of the globe no other dietetic medicinal substance besides
coffee,1 capable of changing our usual feelings for some hours into
agreeable ones only, of producing in us for some hours, rather a
jovial, even a petulant gaiety, a livelier wit, an exalted imagination
above what is natural to our temperament, of quickening the movement of our muscles to a kind of trembling activity, of spurring on
the ordinary quiet pace of our digestive and excretory organs to
double velocity, of keeping the sexual practice in an almost involuntary state of excitation, of silencing the useful pangs of hunger
and thirst, of banishing blessed sleep from our weary limbs, and of
artificially producing in them even a kind of liveliness when the
whole creation of our hemisphere fulfils its destiny by enjoying
refreshing repose in the silent lap of night.
Thus we despotically overthrow the wise arrangement of nature,
but not without injury to ourselves!
When the first transient effect of coffee has departed after a few
hours, there follows gradually the opposite state, the secondary
action. The more striking the former was, so much the more
observable and disagreeable is the latter.
All persons do not suffer equally from the abuse of a medicinal beverage such as coffee is.
Our systems are so admirably arranged that if we live agreeably
to nature in other respects, a few errors in diet, if they be not too
great, are tolerably harmless.
Thus, for instance, the day-labourer or peasant in Germany
drinks brandy, which is so pernicious in itself, almost every morning; but if he only take a small portion at a time, he will often

I And to a certain extent tea also.




460

ON THE EFFECTS OF COFFEE.

attain a pretty considerable age. His health suffers little. The excellence of his constitution and his otherwise healthy mode of
life counteract the injurious effects of his dram almost without
letting a trace appear.
Now, if instead of brandy the day-labourer or peasant drink
a couple of cups of weak coffee, the same thing occurs. His robust
body, the vigorous exercise of his limbs, and the quantity of fresh
air he inhales every day, repel the hurtful effects of his beverage,
and his health suffers little or nothing in consequence.
But the bad effects of coffee become much more perceptible
when these favourable circumstances are not present.
Man can, no doubt, enjoy a kind of health, though his occupation confines him to the house-or even to one room-even though
he has to live a very sedentary life in the room, and his body is
delicately constituted, provided he live in other respects conformably with his state. Under the moderate use of only easily digestible, mild, simple, purely nutritious, almost unspiced food and
drink, along with a prudent moderation of the passions and
frequent renewal of the air in the rooms, even women, without
any great exercise,1 enjoy a kind of health which doubtless can
be readily compromised by external causes, but which, if these are
avoided, may still be termed a moderate degree of health. In
such persons the action of all morbific substances, that is, of
all medicines, is much more striking and severe than in robust
individuals accustomed to labour in the open air, who are able to
bear some very hurtful things without particular injury.
These weakly dwellers in rooms live in the low level of their
health but half a life, if I may use the expression; all their sensations, their energy, their vital functions, are somewhat below par,
and they eagerly resort to a beverage that so powerfully exalts for
some hours their vital energy and their feeling of existence,
unconcerned about the results and the secondary action of this
palliative.
This secondary action resembles their state before partaking of
the coffee, only it is somewhat stronger.
When the few hours of the above described primary action of
1 Under such circumstances prisoners also.




ON THE EFFECTS OF COFFEE.

461

this medicinal beverage, that representation of artificially exalted
vital energy, is gone, there then gradually creeps on a yawning
drowsiness and greater inactivity than in the ordinary state, the
movements of the body become more difficult than formerly, all the
excessive gaiety of the previous hours changes into obtuseness of
the senses. If, during the first hours after drinking the coffee,
the digestion and the expulsion of the excrements were hastened, now   the flatus becomes painfully incarcerated in   the
intestines, and the expulsion of the faeces becomes more difficult
and slower than in the former state. If, in the first hours, an
agreeable warmth pervaded the frame, this factitious vital-spark
now gradually becomes extinguished, a shivering sensation is felt,
the hands and feet become cold. All external agents appear less
agreeable than before. More ill-humoured than ordinarily, they
are more given to peevishness. The sexual passion which was
excited by the coffee in the first hours becomes all the colder and
more obtuse. A kind of speedily satiated ravenous hunger takes
the place of the healthy desire for nutriment, and yet eating and
drinking oppress the stomach more than previously. They have
greater difficulty in getting to sleep than formerly, and the sleep is
heavier than it used to be before they took coffee, and on awaking
they are more sleepy, more discouraged, more melancholy than
usual.
But look! all these evils are rapidly driven away by a renewed
application to this hurtful palliative-a new, artificial life commences-only it has a somewhat shorter duration than the first
time, and thus its repetition becomes ever more frequently necessary,
or the beverage must always be made stronger in order to enable
it again to excite life for a few hours.
By such means the body of the person whose occupation confines him to his room degenerates all the more. The injurious
effects of the secondary action of this medicinal drink spread
farther around, and strike their roots too deeply to allow of their
being again effaced, if only for a few hours, by a mere repetition
of the same palliative more frequently or in stronger doses.
The skin now becomes generally more sensitive to the cold, and
even to the open air though not cold; the digestion becomes
obstructed, the bowels become constipated for several days at
a time, flatulence occasions anxiety and causes a number of painful




462

ON THE EFFECTS OF COFFEE.

sensations. The constipation only alternates with diarrhoea, not
with a healthy state of the bowels. Sleep is obtained with difficulty, and bears more resemblance to a slumber that causes no
refreshment. On awaking there are remarkable confusion of the
head, half-waking dreams, slowness of recollecting himself, helplessness of the limbs, and a kind of joylessness that throws a dark
shade over all God's lovely nature. The beneficent emotions of the
heart, warm philanthropy, gratitude, compassion, heroism, strength
and nobility of the mind, and joyousness, change into pusillanimity,
indifference, insensible hardness of heart, variable humour, melancholy.
The use of coffee as a beverage is continued, and sensitiveness
alternates ever more with insensibility, over-hasty resolves with
irresolution, noisy quarrelsomeness with cowardly compliance,
affectation of friendship with malicious envy, transient rapture with
joylessness, grinning smiling with inclination to shed tears-symptoms of constant hovering betwixt excitement and depression of the
mind and the body.
It would be no easy task for me to indicate all the maladies,
that under the names of debility, nervous affections and chronic
diseases, prevail among the coffee-drinking set, enervating humanity
and causing degeneration of mind and body.
But it must not be imagined that all the evil results I have
named occur to every coffee-bibber in the same degree! No, one
suffers more from this, another from that symptom of the secondary
action of coffee. My description includes the whole coffee-drinking
race; all their maladies which arise from   this source I have
arranged together, as they have from time to time come under my
notice.
The palliative agreeable sensation which the coffee distributes for
some hours through the finest fibres, leaves behind it, as a secondary action, an extraordinary susceptibility to painful sensations,
which always becomes greater and greater, the longer, the oftener,
the stronger and the greater the quantity in which the coffee is
drunk. Very slight things (that would make scarcely any impression on a healthy person not accustomed to the use of coffee) cause
in the coffee-drinking lady megrim, a frequent, often intolerable
toothache, which comes on, chiefly at night, with redness of the
face and at length swelling of the cheek-a painful drawing and




ON THE EFFECTS OF COFFEE.

463

tearing in different parts of the body, on one side of the face, or at
one time in one limb, at another in another.' The body has a special
tendency to erysipelas, either in the legs (hence the frequency of
old ulcers there) or (when suckling) in the mammae, or on one half
of the face. Apprehensiveness and flying heat are her daily complaints, and nervous semilateral headache her property.2
From moderate errors of diet and disagreeable mental emotions
there occur painful affections of the chest, stomach and abdomen
(known by the inaccurate name of spasms)-the catamenia come
on with pains, are not regular, or the discharge is less copious and
at length quite scanty; it is watery or slimy; leucorrhoea (generally of an acrid character) prevails almost the whole time, from
one period to another, or completely supersedes the menstrual
flux-coition is often painful.      The earthy, yellowish or quite pale
complexion, the dull eye surrounded by blue rings, the blue lips,
1 This drawing tearing in the limbs caused by coffee in its secondary action and
when its use is persisted in for a long time, is not in the joints, but from one joint to
the other. It appears to be more in the flesh or cellular tissue than in the bones, is
unattended by swelling or other abnormal appearance, and there is scarcely any
tenderness on touching the part. Our nosologists know nothing about it.
2 The megrim above alluded to, which only appears after some exciting cause,
as vexation, overloading of the stomach, a chill, &c., generally very rapidly and at all
times of the day, differs entirely from the so-called nervous hemicrania. The latter
occurs in the morning, soon or immediately after waking, and increases gradually.
The pain is almost intolerable, often of a burning character, the external coverings of
the skull are also intolerably sensitive and painful on the least touch. Body and mind
seem both to be insufferably sensitive. Apparently destitute of all strength, they
seek a solitary and if possible dark spot, where, in order to avoid the daylight, they
pass the time with closed eyes in a kind of waking slumber, usually on a couch raised
in the back, or in an arm chair, quite motionless. Every movement, every noise increases their pains. They avoid speaking themselves and listening to the conversation
of others. Their body is colder than usual, though without rigor; the hands and feet
in particular are very cold. Everything is distasteful to them, but chiefly eating and
drinking, for an incessant nausea hinders them from taking anything. In bad
cases the nausea amounts to vomiting of mucus, but the headache is seldom alleviated thereby. The bowels are constipated. This headache almost never goes off
until evening; in very bad cases I have seen it last thirty-six hours, so that it only
disappeared the following evening. In slighter cases its original producer, coffee,
shortens its duration in a palliative manner, but it communicates to the system the
tendency to produce it after a still shorter interval. It recurs at undetermined
times, every fortnight, three, four weeks, &c. It comes on without any exciting
cause, quite unexpectedly; even the night previously the patient seldom feels any
premonitory signs of the nervous headache that is to come on the next morning.
I have never met with it excepting among regular coffee drinkers.




464

ON THE EFFECTS OF COFFEE.

the flaccid muscular tissue, the shrivelled breasts, are the external
signs of this miserable hidden state. Sometimes the almost suppressed menses alternate with serious uterine hemorrhages. In
males there occur painful hemorrhoids and nocturnal emissions of
semen. In both sexes the sexual power becomes gradually extinguished. The normal exuberant energy of the embrace of a
healthy couple becomes a worthless bagatelle. Impotence of both
sexes and sterility, inability to suckle a child, ensue.-The monster
of nature, that hollow-eyed ghost, onanism, is generally concealed
behind the coffee-table (though indulgence in the perusal of meretricious novels, over-exertion of the mind, bad company and a
sedentary life in close apartments, contribute their share).
As an inordinate indulgence in coffee has for its secondary effect
to dispose the body greatly to all kinds of disagreeable sensations
and most acute pains, it will be readily comprehended how it,
more than any other hurtful substance we are acquainted with,
excites a great tendency to caries of the bones. No error of diet
causes the teeth to decay more easily and certainly than indulgence in coffee. Coffee alone (with the exception of grief and the
abuse of mercury) destroys the teeth in the shortest space of time.1
The confined air of a room and overloading the stomach (especially at night) contribute their share to this effect. But coffee by
itself is quite capable of destroying in a short space of time this
irreparable ornament of the mouth, this indispensable accessory
organ for distinct speech and for the intimate mixture of the food
with the digestive saliva, or at least of rendering them black and
yellow. The loss of the front (incisor) teeth is chiefly due to the
abuse of coffee.
If I except the true spina ventosa, there occurs scarcely a
single case of caries of the bones in children (if they have not
been over-dosed with mercury) from any other cause than from
coffee?   Besides these, there are in children other deep-seated
1 Observations on which I can depend have convinced me of this.
2 These ulcerations of the bones, which lie concealed beneath elevated, hard,
bluish-red swellings of the soft parts, exude an albuminous looking mucus, mixed
with some cheese-like matter. It has very little smell. The pains of the affected
part are very shooting in their character. The rest of the body presents a pure
picture of the coffee dyscrasia.




ON THE EFFECTS OF COFFEE.

465

flesh abscesses that take a long time of bursting and then have
but a small orifice, which are often solely to be ascribed to the
action of the coffee.
As a rule, coffee acts most injuriously on children; the more
tender their age, the worse its effects. Although it is incapable of
itself of producing true rickets, but can only accelerate them, in
conjunction with their special exciting cause (food composed of
unfermented vegetable substances, and the air of close, damp
rooms), yet it of itself excites in little children, even when their
other food is wholesome and the air in which they live good, a
kind of infantile hectic, which is not much less sad in its results.
Their complexion becomes pale, their muscles quite flaccid. It is
only after a long time that they learn to walk a little, but then
their gait is uncertain, they easily fall, and wish always to be
carried. They stammer in their speech. They wish for a great
variety of things, but relish nothing heartily. The drollery, hap.
piness and liveliness that characterize the age of childhood are
changed into indolent dejection; nothing gives them pleasure,
nothing makes them contented; they enjoy only a sort of half life.
They are very easily startled, and timid. Diarrhoea alternates with
costiveness. Viscid mucus rattles in their chest as they breathe,
especially when they are asleep, which no amount of coughing
can remove: they have always got a wheezing at the chest. Their
teeth come with much difficulty and with convulsion fits; they are
very imperfect, and fall out decayed before the period for changing
them arrives. Mostly every evening, just before bed-time or after
lying down in bed, they get redness and heat on one or both
cheeks. They sleep very imperfectly, toss about at night, often
want to drink; they then perspire, not only on the forehead,
but also on the hairy scalp, particularly at the back of the head,
and whine and moan in their sleep. They get through every
disease with difficulty, and their recovery is very slow and imperfect.
They are frequently subject to a chronic inflammation of the eyes,
not unfrequently accompanied by an eruption in the face, along
with a peculiar relaxation of the upper eyelid, which prevents them
raising it, even when the redness and swelling of the lids are but
moderate. This kind of ophthalmia, that often lasts for several
years, making them frequently lie upon the face, with constant
2H




466

ON THE EFFECTS OF COFFEE.

peevishness and crying, or conceal themselves in a dark place where
they remain lying or sitting in a stooping posture; this ophthalmia,
I say, chiefly affects the cornea, covers it with red vessels and at
last with dark spots, or there occur phlyctenulae and little ulcers on
it, that often eat deeply into the cornea and threaten blindness.
This ophthalmia and that rattling at the chest and the other ailments above described, attack even infants at the breast, who take
nothing but their mother's milk, if the mother indulges in coffee
and inhabits a close room. How penetrating must not the hurtful
power of this medicinal beverage be, that even infants at the breast
suffer from it!
After children, coffee acts, as I have said, most injuriously on the
female sex, and on literary people whose occupation is sedentary,
and confines them     to their rooms.     To these may be added
workmen engaged in a sedentary trade.
The bad effects of coffee are, as I have above mentioned, most
effectually diminished by great activity and exercise in the open
air,-but not permanently removed.
Some individuals also find out as if by instinct, a sort of antidote
to coffee in the use of spirituous liquors. It is impossible to deny
that they do possess some antidotal powers. These are, however,
mere stimulants, without any nutritive quality; that is to say, they
are likewise medicinal substances, which, when daily used as articles
of diet, produce other injurious effects, and yet are unable to prevent
the hurtful action of the coffee from     taking effect,-what they
cause are artificial ameliorations of the vital functions, followed by
morbid effects, though of a different, more complex nature.
Leaving off the use of coffee1 is the chief remedy for these insi1 It is by no means easy to do away with an inveterate habit of using coffee.-I
first endeavour to convince my patients seriously of the urgent and indispensable
necessity of discontinuing its use. Truth grounded on obvious experience seldom
fails to produce conviction-almost never, when it is urged from the philanthropic
heart of a physician, who, convinced himself of the goodness of his cause, is thoroughly
penetrated by the truth of his maxims. Nothing will then prevent their reception,
there is no question of any private interest on the part of the doctor; and nothing
but pure gain on the side of the party he wishes to convince.
If we have attained this object (whether this is the case or no, he who has a knowledge of human nature can tell by the way the patient receives his advice), we may
advise that the quantity of coffee taken be reduced by a cup every three or four days,
and allow the last breakfast-cup to be continued for a week longer, until this 'can




ON THE EFFECTS OF COFFEE.

467

dious and deeply penetrating injurious effects, and corporeal
exercise in the open air tends to promote the subsequent recovery.
If however body and mind be sunk too low, there are some medicines very useful for that state, but this is not the proper place to
enumerate them, as I am not at present writing for medical men.
When I describe the daily use of coffee as very prejudicial, and
when I shew from observations and experience of many years that
it relaxes and withers the energy of our body and mind, some may
retort upon me the appellation "medicinal beverage," which I must
unhesitatingly bestow upon coffee.
"Medicines are surely wholesome things," says the uninitiated.
They are so; but only under certain indispensable conditions.         It
is only when the medicine is suitable for the case that it is wholesome. Now no medicine is suitable for health, and to employ a
medicine as a beverage in the ordinary healthy state, is a hurtful
procedure, a self-evident contradiction.
I prize the medicinal powers of coffee when it is appropriately
employed as a medicine, as much as those of any other medicament.
There is nought superfluous in God's creation; every thing is
created for the weal of mankind, particularly the most powerful
things, to which class coffee belongs in an especial degree. But
let the following facts be borne in mind.
Every single medicine develops in the healthy human body some
special alterations, that are peculiar to itself exclusively. When these
either be left off at once, or it may be continued on every alternate day for another
week, according to circumstances.
If we have to do with persons on whom we can rely, the affair is managed in the
course of four weeks. But should some faint-heartedness or indecision on the part of
slaves to coffee make its accomplishment difficult, or should the weak state of the
health make its discontinuance be too severely felt, we would do well for every cup
of coffee we take away, to allow a cup of tea to be drunk, until in the course of a week
nothing but tea (a similar but lesser evil) is drunk, and this, as it has not had time to
become a habitual beverage, may be more easily diminished, until at last nothing
more of the sort is taken, but only a couple of cups of warm milk for breakfast, in
place of coffee or tea.
Whilst thus breaking off the habit, it is indispensable that the body be refreshed and
strengthened by daily walks in the open air, by amusements of an innocent character,
and by appropriate food, if we wish that the injurious effects of the coffee should disappear, and the individual be confirmed in his resolution to give it up.
And if all goes on well, it will not be a bad plan for the doctor, or a friend in his
stead, to assure himself from time to time of the true conversion of his patient, and if
necessary, uphold his resolution, when the force of example in company seems to
cause it to waver.                                      2-  2




468

ON THE EFFECTS OF COFFEE.

are known, and when the medicine is employed in cases of disease
that have an almost exact similarity with the alteration that the
medicine is capable of itself producing (in the healthy body), a
radical cure takes place. This employment of the medicine is the
curative one, the only one to be relied on in chronic diseases.
In speaking of this power of a medicine to alter the human body
in a manner peculiar to itself, I allude to its primary or initiatory
action. I have said above that the primary action of a medicine
(for some hours after it has been taken) is the direct opposite of its
secondary action, or the state in which it leaves the body whenever
its first action is past.
Now if the primary action of a medicine be the exact opposite of
the morbid condition of the body we seek to cure, its employment
is palliative. Almost instantaneous amendment ensues,-but a few
hours afterwards the malady returns and attains a greater height
than it had before the employment of the remedy; the secondary
action of the medicine, which resembled the original disease, aggravates the latter. A miserable method of treatment when we have
to do with a chronic malady.
I shall give an example. The primary action of opium in the
healthy system is to cause a stupifying snoring sleep, and its secondary action-the opposite-sleeplessness. Now if the physician
will be so foolish as to treat a morbid, habitual sleeplessness with
opium, he acts in a palliative manner. The stupid, snoring, unrefreshing sleep speedily follows the ingestion of the opium, but its
secondary action, as I have stated, is sleeplessness, an addition to his
already habitual sleeplessness, which is now accordingly aggravated.
Twenty-four hours afterwards the patient sleeps still less than
before he took the opium; a stronger dose of the latter must now
be given, the secondary action of which is a still greater sleeplessness, that is, an aggravation of the malady, which the foolish man
imagined he was curing.
In like manner, coffee proves a bad palliative remedy when it is
used as a medicinal agent, for example, in cases of habitual constipation proceeding from inactivity of the bowels 1-as is often done
by medical men. Its primary action is, as I have before stated,
the reverse of this state,-it therefore acts here as a palliative, and
if it be used for the first time, or only on rare occasions, it speedily
1 As is usually the case with those who lead a sedentary life in their room.




ON THE EFFECTS OF COFFEE.

469

produces a motion of the bowels, but the following days, under the
secondary action, the constipation becomes all the greater. If we
again seek to remove this in the same palliative manner by means
of coffee, more of it must be drunk, or it must be made stronger,
and still the habitual constipation is not thereby eradicated, for it
always returns more obstinately on the recurrence of the secondary
action of the coffee, whenever this palliative administration of the
coffee is discontinued, or stronger and more frequent potations of
it are not taken, which always aggravate the disease and entail
other maladies.
It will be found that the medical excuses offered by coffeedrinkers in justification of this habit almost all rest on some such
palliative relief it affords them, and yet nothing is more certain
than the experience that a long-continued palliative employment
of a drug is injurious, but the palliative employment of drugs as
articles of diet is the most injurious of all.
Therefore when I, whilst deprecating its abuse as an every-day
beverage, commend the great medicinal virtues of coffee, I do the
latter merely in reference to its curative employment for chronic ailments that bear a great resemblance to its primary action,' and in
reference to its palliative employment in acute diseases threatening
rapid danger, which bear a great resemblance to the secondary
effects of coffee.2 This is the only rational and wise mode of
employing this medicinal beverage which is abused by hundreds of
millions of individuals to their hurt, is understood by few, but
which is extremely wholesome when used in its proper place.
1 For example when, in a person unaccustomed to the use of coffee, there is present
(it may be a habitual) indisposition, composed of a frequent, painless evacuation of
soft faeces and frequent inclination to go to stool, an unnatural sleeplessness, excessive irritability and agility, and a want of appetite and thirst, but without any diminution of the perception of the flavour of food and drink, in such a case coffee will,
must effect a radical cure in the course of a short time. In like manner it is, in the
frequently dangerous symptoms brought on by a sudden, great, joyful mental
emotion, the most suitable, trustworthy, curative medicine, and also in a certain
kind of labour-pains, which bear much resemblance to the primary effects of coffee.
2 The following are examples of the excellent palliative employment of coffee in
diseases that come on rapidly and require speedy relief: sea-sickness, poisoning by
opium in those unaccustomed to the use of coffee, poisoning by veratrum album, the
apparent death of drowned, suffocated, but especially of frozen persons, as I have
frequently had the satisfaction of witnessing.




mESCULAPIUS IN THE BALANCE.

Ars autem tam conjecturalis cum sit (praesertim quo nune habetur modo) locum
ampliorum dedit non solum errori verum etiam imposturae.-BAco DE VERULAM,
Augm. Scient.
After I had discovered the weakness and errors of my teachers
and books, I sank into a state of sorrowful indignation, which had
nearly altogether disgusted me with the study of medicine. I was
on the point of concluding that the whole art was vain and incapable of improvement. I gave myself up to solitary reflection, and
resolved not to terminate my train of thought until I had arrived
at a definite conclusion on the subject.
Inhabitants of earth, I thought, how short is the span of your
life here below  with how many difficulties have you to contend at
every step, in order to maintain a bare existence, if you would
avoid the by-paths that lead astray from morality. And yet
what avail all your dear-bought, dear-wrung joys, if you do not
possess health?
And yet how often is this disturbed-how numerous are the
lesser and greater degrees of ill-health-how innumerably great
the multitude of diseases, weaknesses and pains, which bow man
down as he climbs with pain and toil towards his aim, and which
terrify and endanger his existence, even when he is supported by
the rewards incident to fame, or reposes in the lap of luxury. And
yet, oh man! how lofty is thy descent I how great and God-like
thy destiny! how noble the object of thy life! Art thou not
destined to approach by the ladder of hallowed impressions, ennobling deeds, and all-penetrating knowledge, even towards the great
Spirit whom   all the inhabitants of the universe worship?   Can
that Divine Spirit who gave thee thy soul, and winged thee for
such high enterprizes, have designed that you should be helplessly
1 Published at Leipzic in 1805.




AESCULAPIUS IN THE BALANCE.

471

and irremediably oppressed by those trivial bodily ailments which
we call diseases?
Ah, no I The Author of all good, when he allowed diseases to
injure his offspring, must have laid down a means by which those
torments might be lessened or removed. Let us trace the impressions of this, the noblest of all arts, which has been devoted to the
use of perishing mortals. This art must be possible-this art
which can make so many happy; it must not only be possible, but
already exist. Every now and then a man is rescued, as by miracle, from some fatal disease! Do we not find recorded in the
writings of physicians of all ages, cures in which the disturbance of
the health was so great that no other termination than a miserable
death seemed possible?   Yet such cases have been rapidly and
effectually cured, and perfect health restored.
But how seldom have these brilliant cures been effected when
they were not rather ascribable, either to the force of youth overmastering the disease, or to the unreckoned influence of various
fortunate circumstances, than to the medicines employed I But
even were the number of such perfect cures greater than I observe
them to be, does it follow from that that we can imitate them with
similarly happy results? They stand isolated in the history of the
human race, and they can but very seldom, if at all, be reproduced
as they were at first occasioned. All we see is, that great cures
are possible; but how they are to be effected, what the power, and
the particular circumstances by which they were accomplished, and
how these are to be controlled so that we may transfer them to
other cases, is quite beyond our ken. Perhaps the art of healing
does not consist in such transferences. This much is certain: an
art of medicine exists, but not in our heads, nor in our systems.
" But," it is urged in reply, " are not people cured every day in
the hands of thoughtful physicians, even of very ordinary doctors,
nay, even of most egregious blockheads?"
Certainly they are; but mark what happens. The majority of
cases, for the treatment of which a physician is called in, are of
acute diseases, that is, aberrations from health which have only a
short course to run before they terminate either in recovery or
death. If the patient die, the physician follows his remains modestly
to the grave; if he recover, then must his natural strength have been
sufficient to overcome both the force of the disease and the usually




42

4E7SCULAPIUS IN THE BALANCE.

obstructing action of the drugs he took; and the powers of nature
often suffice to overcome both.
In epidemic dysentery, just as many of those who follow the
indications afforded by nature, without taking any medicine at all,
recover, as of those who are treated according to the method
of Brown, of Stoll, of C. L. Hoffmann, of Richter, of Vogler, or by
any other system. Many die, too, both of those treated by all
these methods, and of those who took no medicine; on an average
just as many of the one as of the other. And yet all the physicians
and quacks who attended those who recovered boasted of having
effected a cure by their skill. What is the inference?  Certainly
not that they were all right in their mode of treatment; but perhaps, that they were all equally wrong. What presumption for
each to claim, as he did, the credit of curing a disease, which in the
milder cases uniformly recovered of itself, if gross errors in diet
were not committed!
It were easy to run through a catalogue of similar acute diseases,
and show that the restoration of persons who in the same disease
were treated on wholly opposite principles could not be called cure,
but a spontaneous recovery.
Until you can say, during the prevalence of an epidemic dysentery
for example, "Fix upon those patients whom you and other experienced persons consider to be most dangerously ill, and these I
will cure, and cure rapidly and without bad consequences."
Until you can say this, and can do it, you ought not to vaunt that
you can cure the dysentery. Your cures are nothing but spontaneous recoveries.
Often-the thought is saddening!-patients recover as by a
miracle when the multitude of anxiously changed and often repeated nauseous drugs prescribed by the physician is suddenly left
off or clandestinely discontinued. For fear of giving offence, the
patients frequently conceal what they have done, and appear before
the public as if they had been cured by the physician. In numerous instances, many a prostrate patient has effected a miraculous
cure upon himself not only by refusing the physician's medicine,
but by secretly transgressing his artificial and often mischievous
system of diet, in obedience to his own caprice, which is in this
instance an imperious instinct impelling him to commit all sorts of
dietetic paradoxes. Pork, sour-crout, potato-salad, herring, oysters,




JESCULAPIUS IN THE BALANCE.

47$

eggs, pastry, brandy, wine, punch, coffee, and other things most
strongly prohibited by the physician, have effected the most rapid
cure of disease in patients, who, to all appearance, would have
hastened to their grave had they submitted to the system of diet
prescribed by the schools.
Of such a kind are the apparent cures of acute diseases. For
those beneficial and useful regulations for the arrest of pestilential
epidemics, by cutting off communication with the affected district,
by separation and removal of the sick from the healthy; by fumigation of the affected abodes and furniture with nitric and muriatic
acid, &c., are wise police regulations, but are not medicinal cures.
In the infected spots themselves, where a further separation of
the infected from the healthy is not to be thought of, there the
nullity of medicine is exhibited. There die all, if one may be
allowed the expression, who can die, without being influenced by
Galen, Boerhaave, or Brown, and those only who are not ripe for
death recover.    Nurses, physicians, apothecaries, and surgeons,
are all alike borne to their grave.
At the same time it is undeniable, that even in such calamities,
so humiliating to the pride of our art, occasional, but rare cures
occur, effected obviously by medicine, of so striking a character,
that one is astonished at so daring a rescue from the very jaws of
death; these are the hints afforded by the Author of Life, " THAT
THERE IS A HEALING ART."
But how did it act here?   What medicine did the real good?
What were the minute particulars of the disease, in order that we
may imitate the procedure when such a case recurs? Alas! these
particulars are and must remain unknown; the case was either
not particularly observed or not reported with sufficient exactness.
And the medicine?      No; a single medicine was not given; it
was, as all learned recipes must be, an elixir, a powder, a mixture,
&c., each composed of a number of different medicinal substances.
Heaven knows which of them all did good.1 "The patient also
1 Let it not be asserted "that all the substances only did good because of their
combination, that nought must be added to nothing taken from it, to enable us to
repeat the fact." But many ingredients are never of equal goodness and power in
any two chemists' shops, not even in the same shop at different times. Even the
same mixture will be different in the same shop to-morrow to what it was to-day,
according as one ingredient was added sooner than the other, more fully pulverized,




74

AESCULAPIUS IN THE BALANCE.

drank an infusion of a variety of herbs; the composition of this I
do not recollect, nor does the patient remember the precise quantity he took."
How can any one imitate such an experiment in an apparently
similar case, since neither the remedy nor the case are accurately
known?     Hence all the results attempted by future imitators are
deceptive; the whole fact is lost for posterity. All we see is, that
cure is possible; but how is it to be effected, and how an indefinite
case can tend to perfect the art of medicine, that we do not see.
"But," I hear exclaimed, "you must not be too severe upon
physicians, who are but men, amid the hurry and bustle which
infectious diseases in circumscribed spots bring with them."
"In chronic diseases he will come off more triumphant; in
these he has time and cool blood at his service in order to exhibit
openly the truth of his art; and in despite of Moliere, Patin,
Agrippa, Valesius, Cardanus, Rousseau and Arcesilas, he will
show that he can heal not only those who would get well of themselves, but that he can cure what he will and what he is asked to
cure." Would to Heaven it were so! But as a proof that physicians
feel themselves very weak in chronic diseases, they avoid the
treatment of them as much as possible. Let a physician be called to
an elderly man, paralysed for some years, and let him be asked to
exhibit his skill. Naturally he does not openly avow how impotent
this art is in his hands, but he betakes himself to some byway of
escape-shrugs his shoulders-observes that the patient's strength
is not sufficient to enable him to undergo the treatment (in general
a very exhausting, debilitating procedure in the hands of ordinary
practitioners), speaks with a compassionate air of the unfavourable
season and inclement weather, which must first be over, and of
the healing herbs of spring, which must be waited for before
the cure can be attempted, or of some far-distant mineral waters
where such cures have been made, and whither, if his life be
spared, the patient will be able to proceed in the course of six or
eight months. In the meantime, not to expose himself, he orders
or rubbed-up more strongly with the other ingredients, according as the atmospheric
temperature was lower to-day, to-morrow higher, the ingredients more accurately
measured to-day than to-morrow, or according as the preparer of the prescription
was more attentive to-day, less to-morrow; and many other circumstances may
occur to mar human calculations.




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475

something, of the effects of which he is not at all sure; this he
does in order to amuse the patient and to make a little money out
of him at the same time; but certain relief he cannot give. At
one time he wishes to remove the asthenia by internal or external
stimulants; at another fortify the tone of the muscular fibre with
a multitude of bitter extracts,1 whose effects he knows not, or
strengthen the digestive apparatus with cinchona bark; or he seeks
to purify and cool the blood by a decoction of equally unknown
plants, or by means of saline, metallic and vegetable substances of
problematic utility, to resolve and dissipate suspected but never observed obstructions in the glands and minute vessels of the abdomen; or by means of purgatives he thinks to expel certain impurities
which exist only in his imagination, and thereby hasten by a few
hours the sluggish evacuations. Now he directs his charge against
the principle of gout; now against a suppressed gonorrhcea; now
against a psoric acridity, anon against some other kind of acridity.
He effects a change, but not the change he wished. Gradually,
under the pretext of urgent business, the physician withdraws from
the patient, comforting himself and at length the patient's friends
when they press him for his opinion, that in such cases his art is
too weak.
And that his so vaunted art is too weak, on this comfortable,
soft pillow he reposes in cases of gout, consumption, old ulcers,
contractions and so-called dropsies, cachexias of innumerable varieties, spasmodic asthmas, angina pectoris, pains, spasms, cutaneous
eruptions, debility, mental affections of many kinds, and I know
not how many other chronic diseases.
In no other case is the insufficiency of our art so strongly and
so unpardonably manifested as in those distressing diseases from
which hardly any family is altogether free; hardly any in which
some one of the circle does not secretly sigh over ailments, for
which he has tried the so-called skill of physicians far and near.
In silence the afflicted sufferer steals on his melancholy way,
borne down with miserable suffering, and, despairing in human
aid, seeks a solace in religion.
1 We often read in the histories of cases, even of distinguished physicians, such
observations as this: " I now gave the patient the bitter extracts "-as if the bitter
vegetable substances were not all very various in their peculiar actions!




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" Yes," I hear the medical school whisper with a seeming compassionate shrug, "Yes, these are notoriously incurable evils; our
books tell us they are incurable." As if it could comfort the
million of sufferers to be told of the vain impotence of our art!
As if the Creator of these sufferers had not provided remedies for
them also, and as if for them the source of boundless goodness did
not exist, compared to which the tenderest mother's love is as
thick clouds beside the glory of the noon-day sun!
" Yes," I hear the school continue to apologize, " the thousand
defects in our civic constitution, the artificial, complicated mode
of life so far removed from nature, the chameleon-like luxury
enervating and deranging our natural constitution, are answerable
for the incurable character of all these evils. Our art is quite
excused for being incapable of the cure of such cases."
Can you then believe that the Preserver of our race, the Allwise, did not design these complexities of our civic constitution
and our artificial mode of life to increase our enjoyment here, and
to remove misery and suffering?    What extraordinary kind of
living can that be to which man cannot accustom himself without
any gYeat disturbance of his health?  The fat of the seal and the
train-oil eaten with bread made of dried fish bones as little prevents the Greenlander from enjoying health in general, as does
the unvaried milk-diet of the shepherds on the Swiss mountains, the purely vegetable food of the poorer Germans, or the
highly animal diet of the wealthy Englishman. Does not the
Vienna nobleman accustom himself to his twenty or thirty covers,
and does he not enjoy just as much health as the Chinese with his
thin rice soup, the Saxon miner with nothing but potatoes, the
South Sea islander with his roasted bread-fruit, and the Scottish
Shighlander with his oatmeal cakes?
I am ready to admit that the contest of conflicting passions and
of many enjoyments, the luxurious refinement, and the absence of
exercise in fresh air that prevail in the labyrinthine palaces of
great cities, may give occasion to more numerous and more rare
diseases than the simple uniformity that obtains in the airy hut of
the humble villager. But that does not materially alter the
matter. For our medical art is as impotent against the watercolic of the peasant of lower Saxony, the Tsimer of Hungary
and Transylvania, the Radesyge of Norway, the Sibbens of Scot



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477

land, the Hotme of Lapland, the Pelagra of Lombardy, the Plica
Polonica of certain Sclavonic tribes, and various other diseases
prevalent among the simple peasantry of various countries, as it is
against the more aristocratic disorders of high life in our large
towns. Must there be one kind of medical art for the former, and
another for the latter; or if it were only once discovered, would it
not be equally applicable to both? I should think so!
It may not certainly exist in our books, nor yet in our heads,
nor be taught in our schools, but there is such a thing for all that;
it is a possibility.
Occasionally a regular brother practitioner stumbles by a lucky
hit upon a cure which astonishes half the world about him, and
not less himself; but among the many medicines he employed he
is by no means sure which did good. Not less frequently does
the neck-or-nothing practitioner, without a degree, whom the
world calls a quack, make as great and wonderful a cure. But
neither he nor yet his worshipful brother practitioner with a
diploma knows how to eliminate the evident and fruitful truth
which the cure contains. Neither can separate and record the
medicine which certainly was of use out of the mass of useless and
obstructing ones they employed; neither precisely indicates the
case in which it did good, and in which it will certainly benefit
again. Neither knows how to abstract a truth which will hold
good in all future time, an appropriate, certain, unfailing remedy
for every such case that may occur hereafter. His experience in this
case, remarkable though it seemed, will almost never be of service
to him in any other. All that we learn is, that a helpful system
of medicine is possible; but from these and a hundred other cases
it is quite manifest that as yet it has not attained the rank of a
science, that even the way has yet to be discovered how such a
science is to be learned and taught. As far as we are concerned,
it cannot be said to exist.
Meanwhile, among these brilliant but rare cures there are many
(vulgarly called pferdecuren [horse cures]), which,- however great
the noise they might make, are not of a character to be imitated,
salti mortali, madly desperate attempts by means of the most
powerful drugs in enormous doses, which brought the patient into
the most imminent danger, in which life and death wrestled for
the mastery, and in which a slight unforeseen preponderance on




478

faSCULAPIUS IN THE BALANCE.

the side of kind nature gave the fortunate turn to the case: the
patient recovered himself and escaped from the very jaws of death.
A treatment with a couple of scruples of jalap-resin to the dose
is by no means inferior in severity to the helleborism of the
ancient Greek and Roman physicians.
Such modes of treatment are not very unlike murders, the
result alone renders them uncriminal, and almost imparts to them
the lustre of a good action, the saving of a life.1
This cannot be the divine art, that like the mighty working of
nature should effect the greatest deeds simply, mildly, and
unobservably, by means of the smallest agencies.
The ordinary practice of the majority of our practitioners in
their treatment of diseases resembles these horrible revolutionary
cures. They partially attain their object, but in a hurtful way.
Thus they have to treat, for example, an unknown disease accompanied by general swelling. On account of the swelling it is in their
eyes a disease of daily occurrence; without hesitation they call it
dropsy (just as if a single symptom constituted the essential
nature of the whole disease!), and they briskly set to work with
the remark: " the water must be drawn off, and then all will be
right." Away they go at it, attacking it with a frequent repetition
of drastic (so-called hydragogue) purgatives, and, see! what a
wonderful event takes place-the abdomen falls, the arms, the
legs and the face grow quite thin!   "Look what I can do, what
is in the power of my art; this most serious disease, the dropsy, is
conquered! with only this slight disadvantage, that a new disease,
which nobody anticipated, is come in its place (properly, has been
brought on by the excessive purgation), a confounded lientery,
which we must now combat with new weapons."
Thus the worthy man comforts himself from time to time, and
yet it is impossible that such a procedure can be called a cure,
where the disease, by means of violent unsuitable medicines, only
loses a portion of its outward form and gains a new one; the
change of one disease for another is not a cure.
I Thus a cruel usurper vibrates betwixt the scaffold and the throne, a small
unfortunate accident brings his head to the block, and he dies amidst the curses of
the nation; or a small moment of luck that did not enter into his calculations puts
the crown on his head, and the same nation falls down and worships him.




JESCULAPIUS IN THE BALANCE.

479

The more I examine the ordinary cures, the more I am convinced, that they are not direct transformations of the disease
treated into health, but revolutionizings, disturbances of the
order of things by medicines, which, without being actually appropriate, possessed power enough to give matters another (morbid)
shape. These are what are called cures.
"The hysterical ailments of yonder lady were successfully removed by me!"
No! they were only changed into a metrorrhagia. After some
time I am greeted by a shout of triumph: "Excuse me! I have
also succeeded in putting a stop to the uterine haemorrhage."
But do you not see how, on the other hand, the skin has become
sallow, the white of the eye has acquired a yellow hue, the motions
have become greyish-white, and the urine orange-coloured.
And thus the so-called cures go on like the shifting scenes of one
and the same tragedy!
The most successful cases among them are still those where the
revolution effected by the drug developes a new disease of such a
sort, that nature, so to speak, is so much occupied with it as to
forget the old original disease and let it go about its business, and
is engaged with the artificial one until some lucky circumstance
liberates it from the latter. There are several kinds of such lucky
circumstances. The leaving off of the medicine-youthful vigour
-the commencement of the menstrual flow or its cessation at the
proper periods of life-a fortunate domestic occurrence-or (but
this is certainly of rare occurrence, still it sometimes happens like
a ternion in the game of lotto) among the many medicines prescribed pell mell, there lay one that was appropriate and adapted
to the circumstances of the case-in all these instances a cure may
occur.
In like manner, mistakes of the chemist respecting the medicines
and signs in prescriptions have often been the occasion of wonderful cures. But are such circumstances recommendations for the
(till now) most uncertain of all arts? I should rather think not.
By treatment the ordinary physician often understands nothing
more than a powerful, violent attack upon the body with things
that are to be found in the chemist's shop, with an alteration of
the diet, secundum artem, to one of a very extraordinary, very
meagre character. "The patient must first be powerfully affected




480

4  ESCULAPIUS IN THE BALANCE.

before I can do him any good; I wish I could but once get him
regularly laid up in bed!" But that the transition from bed to
the straw and the coffin is so very easy, infinitely easier than to
health, he says nothing about that.
The physician of the stimulating school is in the habit of prescribing in almost every case an exactly opposite diet (such is the
custom of his sect): ham, strong meat soups, brandy, &c., often in
cases where the very smell of meat makes the patient sick, and he
can bear nothing but cold water; but he too is by no means
sparing in his use of violent remedies in enormous doses.
The schools of both the former and the latter class authorise
a revolutionary procedure of this sort: " No child's play with your
doses," say they, "go boldly and energetically to work, giving
them strong, as strong as possible!" And they are right if treating means the same thing as knocking down.
How does it happen that, in the thirty-five centuries since
Asculapius lived, this so indispensable art of medicine has made so
little progress?  What was the obstacle? for what the physicians
have already done is not one hundredth part of what they might
and ought to have done.
All nations, even remotely approaching a state of civilization,
perceived, from the first, the necessity and inestimable value of this
art; they required its practice from a caste who called themselves.physicians. These affected, in almost all ages, when they came in
contact with the sick, to be in perfect possession of this art; but
among themselves they sought to gloze over the gaps and inconsistencies of their knowledge by heaping system upon system, each
made up of the diversified materials of conjectures, opinions, definitions, postulates, and predicates, linked together by scholastic
syllogisms, in order to enable each leader of a sect to boast respecting his own system, that here he had built a temple for the
goddess of health-a temple worthy of her-in which the inquirer
would be answered by pure and salutary oracles.
It was only the most ancient times that formed an exception to
this rule.
We were never nearer the discovery of the science of medicine
than in the time of Hippocrates. This attentive, unsophisticated
observer sought nature in nature. He saw and described the




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481

diseases before him accurately, without addition, without colouring,
without speculation.' In the faculty of pure observation he has
been surpassed by no physician that has followed him. Only one
important part of the medical art was this favoured son of nature
destitute of, else had he been completely master of his art; the
knowledge of medicines and their application. But he did not
affect such a knowledge-he acknowledged his deficiency in that he
gave almost no medicines (because he knew them too imperfectly),
and trusted almost entirely to diet.
All succeeding ages degenerated and wandered more or less from
the indicated path, the later sects of the empirics-worthy of all
respect-and to a certain degree, AretMeus,2 excepted.
Sophistical whimsicalities were pressed into the service. Some
sought the origin of disease in a universal hostile principle, in some
poison which produced all maladies, and which was to be contended
with and destroyed. Hence the universal antidote which was to
cure all diseases, called theriaca, composed of an innumerable multitude of ingredients, and more lately the mithridatium, and similar
compounds, celebrated from the time of Nicander down almost to
our own day. From these ancient times came the unhappy idea,
that if a sufficient number of drugs were mixed in the receipt, it
could scarcely fail to contain the one capable of triumphing over
the enemy of health-while all the time the action of each individual ingredient was little, or not at all known. And to this practice
Galen, Celsus, the later Greek and Arabian physicians, and, on the
revival of the study of medicine in Bologna, Padua, Seville, and
Paris, in the middle ages, the schools there established, and all
succeeding ones, have adhered.
In this great period of nearly two thousand years, was the pure
observation of disease neglected. The wish was to be more scientific, and to discover the hidden causes of diseases. These once
discovered, then it were an easy (?) task to find out remedies for
1 The speculative writings under his name are not his, neither are the three last
books of the aphorisms. The want of the Hippocratic lonicisms, the absence of the
very peculiar language of this man, must convince any one of this, who knows any
thing about such matters.
2 Graphic as are his descriptions of disease, he yet only described them amalgamated together in complete classes, from many individual cases of disease: this
Hippocrates did not do, but modem pathologists do it.




482

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them. Galen devised a system for this purpose, his four qualities
with their different degrees; and until the last hundred and fifty
years his system was worshipped over our whole hemisphere, as
the non plus ultra of medical truth. But these phantoms did not
advance the practical art of healing by a hair's breadth; it rather
retrograded.
After it had become more easy to communicate thought, to
obtain a name by writing hypotheses, and when the writings of
others could be more cheaply read-in a word, after the discovery
of printing-the systems rapidly increased, and they have crowded
one on another up to our own day. There was now the influence
of the stars, now that of evil spirits and witchcraft; anon came the
alchymist with his salt, sulphur, and mercury; then Silvius, with
his acids, biles, and mucus; then the iatromathematicians and
mechanical sect, who explained every thing by the shape of the
smallest parts, their weight, pressure, friction, &c.; to these succeeded the humoral pathologists, with certain acridities of the fluids;
then the tone of the fibres and the abnormal state of the nerves was
insisted on by the solidists; then, according to Reil, much was due
to the internal composition and form of the most minute parts, while
the chemists found a fruitful cause of disease in the development
of various gases. How Brown explained disease with his theory of
excitability, and how he wished to embrace the whole art with a
couple of postulates, is still fresh in our recollection; to say
nothing of the ludicrously lofty, gigantic undertaking of the
natural philosophers!
Physicians no longer tried to see diseases as they were; what
they saw did not satisfy them, but they wished by a priori reasoning to find out an undiscoverable source of disease in regions of
speculation which are not to be penetrated by terrestrial mortal.
Our system-builders delighted in these metaphysical heights,
where it was so easy to win territory; for in the boundless
region of speculation every one becomes a ruler who can most
effectually elevate himself beyond the domain of the senses. The
superhuman aspect they derived from the erection of these stupendous castles in the air concealed their poverty in the art of healing.
"But, since the discovery of printing, the preliminary sciences
of the physician, especially natural history and natural philosophy,




IESCULAPIUS IN THE BALANCE.

483

and, in particular, the anatomy of the human body, physiology,
and botany, have greatly advanced."
True: but it is worthy of the deepest reflection how it comes
that these useful sciences, which have so manifestly increased the
knowledge of the physician, have contributed so little to the improvement of his art; their direct influence is most insignificant,
and the time was when the abuse of these sciences obstructed the
practical art of healing.
Then the anatomist took upon him to explain the functions of
the living body; and, by his knowledge of the position of the internal parts, to elucidate even the phenomena of disease. Then
were the membranes, or the cellular tissue of one intestine, continuations of the membranes or cellular tissue of another or of a
third intestine; and so, according to them, was the whole mystery
of the metastasis of diseases unravelled to a hair. If that did not
prove sufficient, they were not long in discovering some nervous
filament to serve as a bridge for the transportation of a disease from
one part of the body to another, or some other unfruitful speculations of the same kind. After the absorbents were discovered, anatomy immediately took upon herself to instruct physicians in what
way medicines must permeate them, in order to get to that spot of
the body where their remedial power was wanted; and there were
many more of such material demonstrations put forward, much to the
retardation of our art. It often reigned despotically, and refused to
acknowledge every physician who handled his scalpel otherwise than
according to the mode taught in the schools-who could not, without
hesitation, give the name of each little depression on the surface
of a bone, who could not, on the instant, give the origin and
insertion of every smallest muscle (which sometimes only owed its
individual existence to the scalpel). The examination of a physician for a degree consisted almost solely in anatomy: this he was
obliged to know off by heart, with a most pedantic precision; and
if he did this, then he was prepared to practise.
Physiology, until Haller's time, looked only through the spectacles of hypothetical conceits, gross mechanical explanations, and
pretensions to systems, until this great man undertook the task of
founding the knowledge of the phenomena of the human body upon
sensible observation and truthful experience alone. Little has been

2 12




484

JESCULAPIUS IN THE BALANCE.

added since his time, except so far as newly-discovered products,
newly-discovered physical powers and laws, have conspired to explain the constitution of our frame. But from these, little has
been incontrovertibly established.
In general, natural philosophy often offered its services, somewhat presumptuously, to explain the phenomena in the healthy and
diseased body. Then were the manifest laws which, in the inorganic world, regulate the extrication, confinement, and diffusion
of caloric, and the phenomena of electricity and galvanism, applied,
without change and without any exception, to the explanation of
vital operations; and there were many premature conclusions of a
similar kind.
But none of the preliminary sciences has assumed so arrogant
a place as chemistry. It is, indeed, a fact that chemistry explains certain appearances of the healthy as well as the diseased
body, and is a guide to the preparation of various medicines;
but it is incredible how often it has usurped the right of explaining
all physiological and pathological phenomena, and how much it has
distinguished itself by authorising this or that medicine. Gren,
Tromsdorff, and Liphardt, may serve as warning examples of this.
It is, I repeat, a matter for most serious reflection, that while
these accessory sciences of medicine (in themselves most commendable) have advanced within these last ten years to a height and a
maturity which seems not to be capable of much further advancement, yet, notwithstanding, they have had no marked beneficial
influence on the treatment of disease.
Let us consider how this has happened.
Anatomy shews us the outside of every part which can be separated with the knife, the saw, or by maceration; but the deep
internal changes it does not enable us to see; even when we examine the intestines, still it is only a view of the outside of these
internal surfaces that we obtain; and even were we to open live
animals, or, like Herophilus, of cruel memory, dissect men alive, so
little could we penetrate the minute structure of parts lying remote
from view, that even the most inquisitive and attentive observer
would relinquish the task in dissatisfaction.  Nor do we make
much greater discoveries with the microscope, unless the refracting
power favour us with optical illusions. We see only the outside




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485

of organs, we see only their grosser substance; but into the innermost depths of their being, and into the connexion of their secret
operations no mortal eye can ever pierce.
By means of pure observation and unprejudiced reflection, in
connexion with anatomy, natural philosophy, and chemistry, we
have a considerable store of very probable conclusions regarding
the operations and vital phenomena of the human body (physiology), because the phenomena in what is called a healthy body
remain pretty constant, and hence can be observed frequently and,
for the purposes of comparison, from all the different points of view
afforded by the various branches of knowledge bearing upon them.
But it is no less true, than striking and humbling, that this anthropological or physiological knowledge begins to prove of no use as
soon as the system departs from its state of health. All explanations
of morbid processes, from what we know of healthy ones, are
deceptive, approaching more or less to what is untrue; at all events,
positive proofs of the reality and truth of these transferred explanations are unattainable; they are from time to time refuted by
the highest of all tribunals-experience. Just because an explanation answers for the healthy state of the frame, it will not answer
for the diseased. We may admit it or not as we please, but it is
too true, that in the moment when we attempt to regard the state
of the disease physiologically, there drops before our previously
clear light of physiology a thick veil-a partition which prevents all
vision. Our physiological skill is quite at fault when we have to
explain the phenomena of morbid action. There is almost no part
of it applicable! True, we can give a sort of far-fetched explanation,
by making a forced transference and application of the physiological
systems to pathological phenomena; but it is only illusory and
misleads into error.
Chemistry should never attempt to offer an explanation of the
abnormal performances of the functions in the diseased body, since
it is so unsuccessful in explaining them in the healthy state. When
it predicts what, according to its laws, must happen, then something quite different takes place; and if the vitality overmasters
chemistry in the healthy body, how much more must it do so in
the diseased, which is exposed to the influence of so many more
unknown forces. And just as little should chemistry undertake to
give a decision upon the suitableness or worthlessness of medicines,




486

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for it is altogether out of its sphere of vision to determine what is
properly healing or hurtful, and it possesses no principles and no
standard by which the healing efficacy of medicines, in different
diseases, can be measured or judged of.
Thus has the healing artist for ever stood alone-I might say
forsaken-forsaken by all his renowned auxiliary sciences-forsaken
by all his transcendental explanations and speculative systems. All
these assistants were mute, when, for example, he stumbled upon an
intermittent fever which would not yield to purgatives and cinchona bark.
" What is to be done here? what is with sure confidence to
be set about?" he inquires of these his oracles.-Profound silence.
-(And thus they remain silent up to the present hour, in most
cases, these fine oracles.)
He reflects upon the matter, and comes, after the fashion of men,
to the foolish notion, that his uncertainty what to do here arises
from his not knowing the internal nature of intermittent fever.He searches in his books, in some twenty of the most celebrated
systematic works, and finds (unless they have copied from one
another) as many different explanations of intermittent fever as
books he examines. Which of them      is he to take for his guide?
They contradict one another.
By this road he finds he will make no progress.
He will let intermittent fever just be intermittent fever, and
turns his attention solely to learn what medicines the experience
of bygone ages has discovered for intermittent fever, besides cinchona bark and evacuants. He proceeds to search, and to his
amazement discovers that an immense number of medicines have
been celebrated in intermittent fever.
Where is he to begin?    Which medicine is he to give first;
which next, and which last?     He looks round for aid, but no
directing angel appears, no Hercules in bivio, no heavenly inspiration whispers in his ear which of all the number he ought to
select.
What is more natural, what more appropriate to the weakness
of man, than that he should adopt the unhappy resolution (the
resolution of almost all ordinary physicians in similar cases ),
" that as he has nothing to direct his choice to the best, he had
better give a number of the most celebrated febrifuge medicines




ZSCULAPIUS IN 'THE BALANCE.

487

mixed together in one prescription. How will he ever otherwise
get to the end of the long list, unless he take several at a time?
As he can find no one who can tell him if there is any difference in
the actions of these different substances, he considers it better to
mix together many than few;1 and if the operation of each of these
different ingredients really differs from that of the others, it would
certainly, he thinks, be better, in this case, to collect several and
many such reputedly antifebrile substances in one receipt."
" Among the many substances in his elixirs, pills, electuaries,
mixtures, and infusions, surely (thus he philosophizes) there must
be one which will do good. Perhaps the most effectual happens
also to be the freshest and most powerful medicine therein; and
perhaps the substances less adapted or even obstructive to the
cure, are happily the weakest in yonder chemist's shop. Perhaps! yes we must hope for the best, and trust to good luck!"
Periculosae plenum opus aleae! What are we to think of a
science, the operations of which are founded upon perhapses and
blind chance.
But suppose the first or second, or all the trains of mixed drugs
have not done any good, then I must ask, whence did your authors
derive the information, that A or B, or Y or Z, was useful in intermittent fever?
" It stands written of each of these remedies in the works on
Materia Medica."
But whence is their knowledge obtained? Do the authors of
these books anywhere assert that they themselves have given each
of these substances alone and uncombined in intermittent fever?
" Oh no!      Some give authorities, or quote other works on
1 The learned excuse for the great complexity of our ordinary prescriptions, " that
most of the ingredients were added from rational reasons, that is to say, on account
of the particular indications in each case-and that regular prescriptions must
have an orthodox form, a basis (fundamental medicine), a corrective (something
added in order to correct the faults of the basis), an adjuvant (an auxiliary substance
to support the weakness of the basis), and an excipient (a substance that supplies the
form and vehicle)-is partly palpable school-cunning, like the latter excuse-partly
fancy, like the former. For why does the opium you add not cause sleep, why do
your additions of neutral salts fail to open the bowels, and your aqua sambuci to keep
the skin moist? Why does that not happen, as a rule, for which you added each
particular substance, if it was properly indicated as you allege?




488

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Materia Medica; others make the statement without any reference
to its source."
Turn up the original authorities!
" The most of these have been convinced not by personal experience; they again refer to some antiquated works on Materia
Medica, or such authorities as these:     Ray, Tabernaemontanus,
Trajus, Fuchs, Tournefort, Bauhin, and Lange."
And these?
" Some of them refer to the results of domestic practice;-peasants and uneducated persons, in this or that district, have found
this or that medicine useful in a particular case."
And the other authorities?
" Why, they aver that they did not give the medicine by itself,
but, as it became learned physicians to do, combined with other
simples, and found advantage from it. Still it was their impression that it was this drug, and not the other simples, that was
of service."
A fine thing to rely on truly, a most delightful conviction,
grounded upon opinions destitute even of probability!
In one word: the primary origin of almost all authorities for
the action of a simple medicine is derived, either from the confused
use of it, in combination with other drugs, or from domestic practice, where this or that unprofessional person had tried it with
success in this or that disease (as if an unprofessional person could
distinguish one disease from another).
Truly this is a most unsatisfactory and turbid source for our
proud Materia Medica. For if some of the common people had
not, at their own risk, undertaken experiments, and communicated
the results of these, we should not have known even the little we
do at present about the action of most medicines. For, with the
exception of what a few distinguished men, to-wit, Conrad Gesner,
Stoerk, Cullen, Alexander, Coste, Willemet, have done, by administering simple medicines alone and uncombined, in certain diseases,
or to persons in health, the rest is nothing but opinion, illusion,
deception. Marcus Herz thought the water-hemlock cured phthisis,
although he gave it combined with various other drugs.'     On the
1 This is the general but most unjustifiable procedure of our medical practitioners:
to prescribe nothing by itelf--no, always in combination with several other things




.ESCULAPIUS IN THE BALANCE.

489

other hand, to me the statement of Lange (in his Med. Domest.
Brunsv.) is of much greater weight, namely, that the common
people have employed it uncombined in this disease, frequently
with good effect, than what the worthy doctor thought; and for
this simple reason, because he gave it mixed with other drugs,
while the others gave it simply by itself.
The Materia Medica of remote antiquity was not worse furnished.
Its sources were then the histories of cures effected by simples,
recorded in the votive tablets; and Dioscorides and Pliny have
manifestly derived their account of the operation of simple medicines from the rude observations of the common people. Thus,
after the lapse of a couple of thousands of years, we are not a step
advanced! The only source of our knowledge of the powers of
medicines, how troubled is it! and the learned choir of physicians
in this enlightened century, contents itself with it, in the most
serious contingency of mortals, when the most precious of earthly
possessions-life and health-are at stake! No wonder that the
consequences are what they are.
He who, after such experience of the past, still expects that the
art of medicine will ever make a single step towards perfection by
this road, to such an one nature has denied all capacity of distinguishing between the probable and the impossible.
To fill to the brim the measure of deception and misapprehension attending the administration of medicine to the sick, the
order of apothecaries was instituted,-a guild which depends for
existence on the complicated mixtures of drugs. Never will the
complicated formulae cease to prevail, as long as the powerful
order of apothecaries maintains its great influence.
Unlucky period of the mediaeval age, which produced a Nicolaus
the ointmentmaker (Myrepsus), from whose work the Antidotaria
and Codices Medicamentarii were compiled in Italy and Paris;
and in Germany at first in Niirnberg, about the middle of the
sixteenth century, the first Dispensatorium was written, by the
well-meant zeal of the youthful Valerius Cordus. Before these
in an artistic prescription! "No prescription can be properly termed such," says
Hofrath Gruner in his Art of Prescribing,, " which does not contain several ingredients at once "-so, in order to see clearer, you had better put out your eyes!




490

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unhappy events, the apothecaries were merely unprivileged venders
of crude drugs, dealers in simples, druggists; (at the utmost, they
might have some theriac, mithridate, and a few ointments, plasters,
and syrups, of the Galenic stamp, ready on demand, but this was
optional on their part). The physician bought only from those who
had genuine and fresh materials, and mixed these for himself,
according to his own fancy; but nobody prevented him from
giving them to his patients in their simple and uncombined state.
But from the time when the authorities introduced dispensatories-that is, books full of compound medicines, which were to be
kept ready made-it became necessary to form the apothecaries
into a close corporation, and to give them a monopoly (on condition that they should have always a stock of ready prepared
medicinal mixtures), whereby their number was fixed and limited,
in order that there should not be too many of them, which might
cause these costly compounds to hang upon their hands and become
spoilt.
It is true, that after the authorising of the complicated mixtures in dispensatories, which was the first step to mischief, had been
taken, the second-the granting a privilege of the exclusive sale
of these expensive mixtures to apothecaries-was neither an unexpected, nor an unjust proceeding; but had the public approval
of these senseless mixtures not preceded it, then the trade in
single medicinal substances would have remained as it was at first;
and there would have been no need of apothecaries' privileges,
from which infinite injury has gradually accrued to the healing
art.
The earliest dispensatories, and those nearly down to our own
time, called each compound formula by an alluring name after the
disease which it was to remove, and after each, the mode of its
administration was described, and numerous commendations of its
virtues. By this the young physician was led to employ these compositions in preference to the simple medicines, especially as the
former were authorised by the government.
The privileged apothecaries did what they could to increase the
number of these formulas, for the profit derived from these mixtures was immensely greater than would have been derived from
the sale of the simple drugs employed in their composition; and
thus, gradually, the small octavo dispensatory of Cordus grew into




AESCULAPIUS IN THE BALANCE.

491

huge folios (the Vienna, Prague, Augsburg, Brandenburg, Wirtem.
burg, &c. dispensatories). And now there was no known disease for
which the dispensatory had not certain ready-made compounds, or,
at least, the formulas for them, accompanied by the most eulogistic
recommendations of them. The professor of the healing art was now
prepared, when he had such a receipt-book in his hand,--fll of
receipts for every disease sanctioned by the highest authorities in
the land I What does he want more to make him perfect as a healer
of disease? How easy has the great art been made to him I
It is only quite lately that a change has taken place in the
matter. The formulae in the dispensatory have been shorn of their
auctioneering titles, and the number, especially of those which
were to be kept ready compounded, has been lessened. Still plenty
magisterial formulae remain.
The spirit of the advancing age had at length expunged from
the list of drugs the pearls and jewels, the costly bezoar, the
unicorn, and other things, which were formerly so profitable to the
apothecaries; simple processes for preparing the medicines were
laid down; no one now required alcohol to be ten times rectified,
or calomel twelve times distilled; and the establishment of more
stringent price-regulations for the chemists threatened to convert
their hitherto golden shops into silver ones, when things unobservedly took a turn more favourable to the apothecary, and
more disastrous to the art of medicine.
The former medicinal laws' had already begun to restrict the
compounding of the mixtures to the apothecaries, and thus, in
some measure, to impose restrictions on the physicians. The more
recent statutes completed the work, by preventing physicians from
converting the simple drugs into compound mixtures for themselves, as well as forbidding them to give any medicine directly to
the patients, and, as the expression was, " to dispense."
Nothing could have been done better adapted to ruin the true art
of medicine.
Such regulations may have been adopted from one of three reasons:1st. Was it owing to the notorious ignorance of the physicians of the present day, which rendered them unable to prepare
a tolerable combination of drugs, or even to measure out the
1 For example, the Constitutiones Frederici II Imperatoris.




492

4bESCULAPIUS IN THE BALANCE.

simple medicines, that they were prevented from executing this
mechanical operation on account of incompetence, as midwives are
not allowed to use forceps? If this was the case (what a dreadful
supposition!) how could they write a prescription, that is, directions for combining a variety of substances in the most proper
manner, if they themselves were not masters of the operation which
they described?
2d. Or were they made in order to enrich the apothecaries, whose
incomes suffered by the physicians themselves dispensing their
medicines? If the whole system of medicine existed for the benefit
of the apothecaries alone,-if people fell sick solely for the profit
of apothecaries-if learned men became physicians, not so much
for the purpose of curing the sick, as for the sake of assisting the
apothecaries to make their fortunes-then there would be good
reasons why the dispensing of medicines was forbidden to physicians, and a monopoly of it confirmed to the apothecaries alone.
3d. Or were they passed for the benefit of patients? One would
suppose that medicinal laws would be made chiefly for the benefit
of the sick! Let us see, if it were possible that patients could be
benefitted by these laws.
By not himself dispensing, the physician loses all dexterity, all
practice in the manipulations necessary for the compounding
together of various substances which generally act chemically on
each other, and decompose one another more or less in this process
or the other. He gradually becomes less experienced in this art,
until at last he can no longer give any detailed and consistent
directions at all,' until at length he gives directions for compounding that are full of contradictions, and make him the laughingstock of the apothecary.    He is now completely at the mercy of
the apothecary; and the doctor and patient must be content to
take the medicine as the apothecary or his assistant (or even his
shop-boy) pleases to compound it.
If the physician wants to order equal parts of myrrh rubbed up
with camphor in the form of powder, he very likely does not know,
1 It soon comes to this, indeed this is almost universally the case; the physician no
longer attempts to invent a prescription for himself, he must copy all his prescriptions from some well-known prescription manual, in order to avoid the danger of
committing pharmaceutical blunders and contradictions, if he attempted to compose
a prescription for himself.




ESCULAPIUS IN THE BALANCE.

493

from his want of acquaintance with pharmaceutical manipulations,
that these two substances never can form a powder; but the longer
these two dry substances are rubbed together, the more they become
converted into a greasy mass, a kind of fluid. Then the apothecary
either sends to the patient this soft mash, instead of a powder, with
a sarcastic observation, much to the annoyance of the physician;
or he deceives the doctor, to keep in his good graces, and gives the
patient something different from what the doctor prescribed, some
brown powder, smelling of camphor. Or the physician, perhaps,
writes a prescription for hlemoptysis, consisting of alum and
kitchen-salt rubbed together. Now, although each of these sub
stances, separately, is dry, yet out of the triturated combination no
powder results, but a fluid, which the physician, not himself accustomed to dispense, could never have anticipated. What will
the apothecary do in a case like this?  He must either annoy or
deceive the writer of the prescription.
Now, can these and a thousand other similar collisions tend to
the welfare of the patient?
Errors, mistakes of every kind, which the apothecary or his
assistants commit in the preparation of the compound, through
ignorance, hurry, confusion, inaccuracy, or deceit from interested
motives, are, to the man of science and knowledge, who wishes to
test such a combination, a problem, which, when vegetable substances constitute the ingredients, it often defies his powers to
solve,-how much more so for a physician who has never had an
opportunity of acquiring a practical knowledge of pharmacy, or of
compounding the medicines himself, indeed is prohibited from
doing so! How is he ever to discover the adulterations or the
mistakes which the person who makes up his prescription may have
committed? If he cannot detect them, which, owing to such limitations of his knowledge, is very probable, what mischief must and
does thence accrue to the patient! If he cannot detect them, what
an object of ridicule he must be, when his back is turned, to the
apothecary's shopboys!
By forbidding physicians themselves to dispense, the apothecary's income is secured in the most satisfactory manner. What
regulations respecting the prices of drugs can check his overcharges? And even if the prices of the drugs are fixed by law, his
conscience often does not prevent him from employing a cheaper




494

AESCULAPIUS IN THE BALANCE.

substitute (quid pro quo), instead of the expensive one that is
prescribed. Many apothecaries have carried on this kind of deception to a great extent. This practice has been in vogue for more
than fifteen hundred years. We may learn something of this sort
from  Galen's little book, entitled rqi AiVTahho.d'vwv; and the
multitude of books which treat of the adulteration of drugs and
deceptions practised by the apothecaries, constitute of themselves
no small library.
How well adapted is the whole business of treatment for the
welfare of the sick!
"But the medicinal regulations do not provide only for the
apothecary, they are for the interest of the physician also I The
latter gets four-pence for every prescription."
So, the same for a prescription that he copies out of a printed
receipt book as for one that it takes him an hour to compose!
Since that law was passed, of course he prefers making use of
borrowed, ready-written (i. e. unsuitable) prescriptions; he can
write a number of such ones in the course of a forenoon-but he
must write a great many, more than are good for the patient,
because he is paid by the number of his prescriptions, and because
he requires many four-pences in order to live, to live well, to live
in style!
Alas! we may bid adieu to the progress of the art, to the cure
of the sick!
Not to speak of the degradation to a learned man, to an artist
of the highest rank, as the physician ought to be-to be paid by
the number of his prescriptions (like the copyist by the number of
the sheets he copies), or by the number of his courses (like a
common messenger), it seems to me that the result is not commensurate with the arrangement. The physician becomes a mechanical workman, his occupation becomes a labour that requires the
least reflection of all trades; he writes prescriptions (it matters
not what) for whose effect he is not answerable, and he pockets
his money.
How can he be made responsible for the result, when he does
not prepare the medicine himself? ' The preparation is entrusted
1 Properly speaking, the business of treatment is a kind of contract which the
patient makes with the physician alone; do ut facias. The physician solemnly pro



AESCULAPIUS IN THE BALANCE.

495

by the state to another (the apothecary), who also is not answerable for the result (except in the case of palpable, enormous mistakes), and over whom we have no control with respect to many
inaccuracies in the preparation of compound medicines, for after
the mixture is made, it is absolutely impossible in many cases to
prove that which ought to be proved against him.
From the very nature of the thing-it concerns the cure of the
noblest of created beings, it concerns the saving of human life,
the most difficult, the most sublime, the most important of all
imaginable occupations!-from the very nature of the thing, I
repeat, the physician should be prohibited, under the severest
penalties, from allowing any other person to prepare the medicines
required for his patients; he should be required, under the severest
penalties, to prepare them himself, so that he may be able to vouch
for the result.
But that it should be forbidden to the physician to prepare his
own instruments for the saving of life-no human being could
have fallen on such an idea a priori.
It would have been much more sensible to prohibit authoritatively Titian, Guido Reni, Michael Angelo, Raphael, Correggio or
Mengs from preparing their own instruments (their expressive,
beautiful and durable colours), and to have ordered them to purchase them in some shop indicated! By the purchased colours,
not prepared by themselves,' their paintings, far from being the
inimitable masterpieces they are, would have been ordinary daubs
and mere market goods. And even had they all become mere
common market goods, the damage would not have been so great
as if the life of even the meanest slave (for he too is a man!)
should be endangered by untrustworthy health-instruments (medicines) purchased from and prepared by strangers.
Under these regulations should there happen to be one single
mises to give his aid and to administer efficacious medicines prepared in the best
way-a promise which, with such legal arrangements, he cannot redeem, and which
can only be performed by a third party, the apothecary, who is not bound by any
contract to the patient. What inconsistency!
1 I never knew any great enamel-painter who did not require to prepare his own
colours, if he wished to have permanent, brilliant colours, and to produce masterpieces; if he be forbidden to prepare his own colours he will not be able to furnish
any but wretched daubs.




496             AESCULAPIUS IN THE BALANCE.
physician who should wisely wish to avoid that injudicious mode
of prescribing multifarious mixtures of medicines, and for the
weal of his patients and the furtherance of his art should wish to
prescribe simple medicines in their genuineness, he would be
abused in every apothecary's shop until he abandoned a method
that was so little profitable to the apothecary's purse; he must
take his choice of either being harrassed to death or of abandoning it and again writing compound prescriptions. In this case
what course would ninety-nine doctors out of a hundred choose.?
Do you know?    Ido!
Therefore adieu to all progress in our art! Adieu to the successful treatment of the sick!




THE MEDICINE OF EXPERIENCE.

Man, regarded as an animal, has been created more helpless than
all other animals. He has no congenital weapons for his defence
like the bull, no speed to enable him to flee from his enemies like
the deer, no wings, no webbed feet, no fins,-no armour impenetrable to violence like the tortoise, no place of refuge provided by
nature as is possessed by thousands of insects and worms for their
safety, no physical provision to keep the enemy at bay such as
render the hedgehog and torpedo formidable, no sting like the
gadfly, nor poison-fang like the viper;-to all the attacks of hostile
animals he is exposed defenceless. He has, moreover, nothing to
oppose to the violence of the elements and meteors. He is not
protected from the action of water by the shining hair of the seal,
nor by the close oily feathers of the duck, nor by the smooth
shield of the water beetle; his body, but a slight degree lighter
than the water, floats more helplessly in that medium than that
of any quadruped, and is in danger of instant death. He is not
protected like the polar-bear or eider-duck by a covering impenetrable to the northern blast. At its birth the lamb knows where
to seek its mother's udder, but the helpless babe would perish if
its mother's breast were not presented to it. Where he is born
nature nowhere furnishes his food ready made, as she provides
ants for the armadillo, caterpillars for the ichneumon-fly, or the
open petals of flowers for the bee. Man is subject to a far larger
number of diseases than animals, who are born with a secret
knowledge of the remedial means for these invisible enemies of
life, instinct, which man possesses not.    Man alone painfully
escapes from his mother's womb, soft, tender, naked, defenceless,
helpless, and destitute of all that can render his existence supportable, destitute of all wherewith nature richly endows the worm
of the dust, to render its life happy.
Where is the benevolence of the Creator, that could have
1 Published at Berlin in 1805.
2K




498

THE MEDICINE OF EXPERIENCE.

disinherited man, and him alone of all the animals of the earth, of
the bare necessities of life?
Behold, the Eternal Source of all love only disinherited man of
the animal nature in order to endow him all the more richly with that
spark of divinity-a mind-which enables man to elicit from himself
the satisfaction of all his requirements, and a full measure of all conceivable benefits, and to develop from himself the innumerable advantages that exalt the children of this earth far above every other living
thing-a mind that, indestructible itself, is capable of creating for
its tenement, its frail animal nature, more powerful means for its
sustenance, protection, defence and comfort, than any of the most
favoured creatures can boast of having derived directly from nature.
The Father of mankind has chiefly reckoned on this faculty of
the human mind to discover remedial agents, for his protection
from the maladies and accidents to which the delicate organism of
man is exposed.
The help that the body can afford itself for the removal of
diseases is but small and very limited, so that the human mind is
so much the more compelled to employ, for the cure of the diseases
of the body, remedial powers of a more efficient kind than it has
seemed good to the Creator to implant in the organic tissues alone.
What crude nature presents to us should not form the limit for
the relief of our necessities; no, our mind should be able to
enlarge her resources to an unlimited degree for our perfect
well-being.
Thus the Creator presents to us ears of corn from the bosom of
the earth, not to be chewed and swallowed in a crude and unwholesome state, but in order that we should render them useful as
nutriment by freeing them from the husk, grinding and depriving
them of everything of an injurious and medicinal nature, by fermentation and the heat of the oven, and partaking of them in the form
of bread-a preparation of an innocuous and nutritious character,
ennobled by the perfecting power of our mind. Since the creation
of the world the lightning's flash has destroyed animals and
human beings; but the Author of the universe intended that the
mind of man should invent something, as has actually been done
in these latter days, whereby the fire of heaven should be prevented
from touching his dwellings-that by means of metallic rods boldly
reared aloft he should conduct it harmless to the ground. The




THE MEDICINE OF EXPERIENCE.

499

waves of the angry ocean reared mountains high threaten to
overwhelm his frail bark, and he calms them by pouring oil upon
them.
So he permits the other powers of nature to act unhindered
to our harm, until we discover something that can secure us
from their destructive force, and harmlessly avert from us their
impressions.
So he allows the innumerable array of diseases to assail and
seize upon the delicate corporeal frame, threatening it with death
and destruction, well knowing that the animal part of our organism
is incapable, in most cases, of victoriously routing the enemy,
without itself suffering much loss or even succumbing in the
struggle;-the remedial resources of the organism, abandoned to
itself, are weak, limited and insufficient for the dispersion of
diseases, in order that our mind may employ its ennobling faculty
in this case also, where the question concerns the most inestimable
of all earth's goods, health and life.
The great Instructor of mankind did not intend that we should
go to work in the same manner as nature; we should do more
than organic nature, but not in the same manner, not with the
same means as she. He did not permit us to create a horse;
but we are allowed to construct machines, each of which possesses
more power than a hundred horses, and is much more obedient to
our will. He permitted us to build ships, in which, secure from
the monsters of the deep and the fury of the tempest, and furnished with all the comforts of the mainland, we might circumnavigate the world, which no fish could do, and therefore he
denied to our body the piscine fins, branchie and float, that were
inadequate to perform this feat. He denied to our body the rustling wings of the mighty condor, but on the other hand, he allows
us to invent machines filled with light gas, that with silent power
lift us into far higher regions of the atmosphere than are accessible to any of the feathered tenants of the air.
So also he suffers us not to employ the process of sphacelus, as
the human corporeal organism does for itself, in order to remove a
shattered limb, but he placed in our hand the sharp, quickly-dividing knife, which Faust moistened with oil, that is capable of
performing the operation with less pain, less fever, and much less
danger to life. He permits us not to make use of the so-called
2&2




500

THE MEDICINE OF EXPERIENCE.

crises, like nature, for the cure of a number of fevers; we cannot
imitate her critical sweat, her critical diuresis, her critical abscesses
of the parotid and inguinal glands, her critical epistaxis, but he
enables the investigator to discover remedies wherewith he may
cure the fever more rapidly than the corporeal organism is capable
of producing crises, and to cure them more certainly, more easily,
and with less suffering, with less danger to life and fewer aftersufferings, than unassisted nature can do by means of crises.
I am therefore astonished that the art of medicine has so seldom
raised itself above a servile imitation of these crude processes, and
that it has at almost all periods been believed that hardly anything
better could be done for the cure of diseases than to copy these
crises, and to produce evacuations in the form of sweat, diarrhoea,
vomiting, diuresis, venesections, blisters or artificial sores.  (This
was and remained the most favourite method of treatment from the
earliest times till now; and it was always fallen back upon, when
other modes of treatment founded on ingenious speculations disappointed the hopes they had raised.) Just as if these imperfect and
forced imitations were the same thing as what nature effects in the
hidden recesses of vitality, by her own spontaneous efforts, in the
form of crises! Or as if such crises were the best possible method
for overcoming the disease, and were not rather proofs of the
(designed) imperfection and therapeutical powerlessness of our
unaided nature! Never, never was it possible to compel these
spontaneous endeavours of the organism by artificial means (the
very notion implies a contradiction), never was it the Creator's will
that we should do so. His design was that we should bring to
unlimited perfection our whole being, as also our corporeal frame
and the cure of its diseases.
This design has hitherto been in part fulfilled by pure surgery
alone. Instead of acting like unassisted nature, which can often
only throw off a splinter of bone in the leg by inducing a fever
attended by danger to life, and a suppuration that destroys almost
all the limb, the surgeon is able by a judicious division of the irritable integuments to extract it in a few minutes by means of his
fingers, without occasioning any great suffering, without any considerable bad consequences, and almost without any diminution of
the strength. A debilitating slow fever, accompanied by intolerable pains and uninterrupted torturing to death, is almost the sole




THE MEDICINE OF EXPERIENCE.

501

means the organism can oppose to a large stone in the bladder;
whereas an incision made by a practised hand frees the sufferer
from it often in a quarter of an hour, spares him many years of
torment, and rescues him from a miserable death. Or ought we to
attempt to relieve a strangulated hernia by an imitation of the
mortification and suppuration, which are the only means, besides
death, that nature possesses against it?  Would it suffice for the
rescue and preservation of life, did we not know of any other mode
of stopping the hemorrhage from a wound in a large artery than by
causing a syncope of half-an-hour's duration, as nature does?
Could the tourniquet, bandage and compress be thereby dispensed
with?
It has always been a matter worthy of the greatest admiration
to see how nature, without having recourse to any surgical operation, without having access to any remedy from without, does often
when left quite unassisted, develop from itself invisible operations
whereby it is able,-often it is true in a very tedious, painful and
dangerous manner-but still really to remove diseases and affections of many kinds. But she does not do these for our imitation!
we cannot imitate them, we ought not to imitate them, for there
are infinitely easier, quicker and surer remedial means which the
inventive faculty implanted in our mind is destined to discover, in
order to subserve the ends of medicine, that most essential and
most honourable of all earthly sciences.
AT8A' Acbyyog 'rTif 2  Ao'yoX C4r ctro.
GREG. MAG.
Medicine is a science of experience; its object is to eradicate
diseases by means of remedies.
The knowledge of diseases, the knowledge of remedies, and the
knowledge of their employment, constitute medicine.
As the wise and beneficent Creator has permitted those innumerable states of the human body differing from health, which we term
diseases, he must at the same time have revealed to us a distinct
mode whereby we may obtain a knowledge of diseases, that shall
suffice to enable us to employ the remedies capable of subduing
them; he must have shewn to us an equally distinct mode whereby
we may discover in medicines those properties that render them




502

THE MEDICINE OF EXPERIENCE.

suitable for the cure of diseases,-if he did not mean to leave his
children helpless, or to require of them what was beyond their
power.
This art, so indispensable to suffering humanity, cannot therefore remain concealed in the unfathomable depths of obscure
speculation, or be diffused throughout the boundless void of conjecture; it must be accessible, readily accessible to us, within the
sphere of vision of our external and internal perceptive faculties.
Two thousand years were wasted by physicians in endeavouring
to discover the invisible internal changes that take place in the
organism in diseases, and in searching for their proximate causes
and a priori nature, because they imagined that they could not
cure before they had attained to this impossible knowledge.
If the fruitlessness of these long-continued endeavours cannot
be regarded as a proof of the impossibility of this undertaking, the
maxim of experience that they were unnecessary for the cure, might
suffice to shew its impossibility. For the great Spirit of the Universe, the most consistent of all beings, has made that only possible
which is necessary.
Although we never can attain to a knowledge of the internal
corporeal changes on which diseases depend, yet the observation of
their external exciting causes has its uses.
No alteration occurs without a cause. Diseases must have their
exciting causes, concealed though they may be from-us in the
greater number of cases.
We observe a few diseases that always arise from one and the same
cause, e.g., the miasmatic maladies; hydrophobia, the venereal
disease, the plague of the Levant, yellow fever, small-pox, cow-pox,
the measles and some others, which bear upon them the distinctive
mark of always remaining diseases of a peculiar character; and,
because they arise from a contagious principle that always remains
the same, they also always retain the same character and pursue
the same course, excepting as regards some accidental concomitant
circumstances, which however do not alter their essential character.
Probably some other diseases, which we cannot shew to depend
on a peculiar miasm, as gout, marsh-ague, and several other diseases
that occur here and there endemically, besides a few others, also
arise either from a single unvarying cause, or from the confluence




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503

of several definite causes that are liable to be associated and that
are always the same, otherwise they would not produce diseases of
such a specific kind, and would not occur so frequently.
These few diseases, at all events those first mentioned (the
miasmatic), we may therefore term specific, and when necessary
bestow on them distinctive appellations.
If a remedy have been discovered for one of these, it will always
be able to cure it, for such a disease always remains essentially identical, both in its manifestations (the representatives of its internal
nature) and in its cause.
All the other innumerable diseases exhibit such a difference in
their phenomena, that we may safely assert that they arise from a
combination of several dissimilar causes (varying in number and
differing in nature and intensity).
The number of words that may be constructed from an alphabet
of twenty-four letters may be calculated, great though that number be; but who can calculate the number of those dissimilar
diseases, since our bodies can be affected by innumerable and still
for the most part unknown influences of external agencies, and by
almost as many forces from within.
All things that are capable of exercising any action (and their
number is incalculable1), are able to act upon and to produce
1 Some of these are, e. g., the innumerable varieties of odours, the more or less
noxious exhalations from organic and inorganic substances, the various gases that
possess such different irritating properties, that act upon our nerves in the atmosphere, in our manufactories and in our dwellings, or rise from the water, the earth,
animals and plants;-deficiency of pure, open air, the indispensable aliment of our
vitality,-excess or deficiency of the sun's light, excess or deficiency of both kinds
of electricity, differences in the pressure of the atmosphere, in its humidity or
dryness, the still unascertained peculiarities of mountainous regions compared with
low-lying plains and deep valleys; peculiarities of climate or situation on large
plains and on deserts destitute of plants or water, compared with the sea, with marshy
districts, hills, woods, the various winds; the influence of very changeable or too
uniform weather, the influence of storms and other meteoric phenomena; too great
heat or cold of the air, defect or excess of warmth in our clothing, in our rooms; the
constriction of various parts of the body by different articles of dress; the degree
of coldness or heat of our food and drink, hunger or thirst, excessive quantities of
food or drink, their noxious or medicinal nature, and their power of causing changes
in the body, which are inherent in some (as wine, spirits, beer prepared with more or
less hurtful plants, drinks containing foreign ingredients, coffee, tea, exotic and indigenous spices, and highly seasoned viands, sauces, liqueurs, chocolate and cakes, the
unknown, noxious or health-deranging properties of some vegetables and animals




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changes in our organism which is intimately connected with and in
conflict with all parts of the universe-and all may produce different effects as they differ among themselves.
How various must be the effects of the action of these agencies,
when several of them at once and in varied order and intensity
exercise their influence on our bodies, seeing that the latter are
also so variously organized and present such diversities in the
various conditions of their life, that no one human being exactly
resembles another in any conceivable respect!
Hence it happens that with the exception of those few diseases
that are always the same, all others are dissimilar' and innumerable, and so different that each of them occurs scarcely more than
when used as food), and are imparted to others by careless preparation, decomposition, falsification or adulteration (e. g. ill-fermented and imperfectly baked bread;
underdone animal and vegetable viands, or other articles of diet spoilt in various
ways, decomposed, mouldy or adulterated for the sake of gain; liquid and solid food
prepared or kept in metal vessels; made up, drugged wine; vinegar sharpened with
acrid substances; the flesh of diseased animals; flour adulterated with gypsum or
sand; corn mixed with injurious seeds; vegetables mixed with or changed for dangerous plants, from malicious motives, ignorance or poverty); want of cleanliness of
the body, of the clothing, of the dwelling, hurtful substances which get into the food
during its preparation and keeping, from want of cleanliness or from negligence;
dust of various unwholesome kinds arising from the substances used in manufactories
and workshops; the neglect of various police arrangements for the protection of the
well-being of the community; excessive weakening of our corporeal powers; too violent active or passive exercise; inordinate excretions from various organs; abnormal exertion of certain organs of the senses; various unnatural positions and attitudes attendant
on different kinds of work; neglect of the employment of various parts, or general
inactivity of the body; irregularity in the periods devoted to rest, meals and labour;
excess or deficiency of sleep; over-exertion in mental employments generally, or in
such as especially excite or fatigue certain faculties of the mind, or which are of an
injurious and forced character; overpowering or enervating passions produced by
certain kinds of reading, education, bad habits and employment; abuse of the sexual
function; reproaches of the conscience, uncomfortable domestic affairs, annoying
family relations, fear, fright, vexation, &c.
1 To this head belong a number of diseases which, owing to a want of accuracy in
the comparison of all their symptoms, have been regarded as identical maladies,
merely from the circumstance of some one striking resemblance, e. g., dropsy, scrofula, wasting, hypochondriasis, rheumatism, spasms, and so forth. The very circumstance that in one case one mode of treatment was successful that was of no
avail in ten others, should have shewn that the difference was not properly
observed. It might, it is true, be said that there is a middle sort betwixt those
specific and these dissimilar diseases of a mixed character, e. g., tetanus, prosopalgia,
diabetes, pneumonia, phthisis, cancer, &c., and that although a great number of




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once in the world, and each case of disease that presents itself
must be regarded (and treated) as an individual malady that never
before occurred in the same manner, and under the same circumstances as in the case before us, and will never again happen precisely in the same way! 1
The internal essential nature of every malady, of every individual case of disease, as far as it is necessary for us to know it, for
the purpose of curing it, expresses itself by the symptoms, as they
present themselves to the investigations of the true observer in
their whole extent, connexion and succession.
When the physician has discovered all the observable symptoms
of the disease that exist, he has discovered the disease itself, he
has attained the complete conception of it requisite to enable him
to effect a cure.
In order to be able to perform a cure, it is requisite to have a
faithful picture of the disease with all its manifestations, and in
addition, when this can be discovered, a knowledge of its predisposing and exciting causes,2 in order, after effecting the cure by
cases of each of these diseases present dissimilar characters, and therefore require
a different treatment, yet some cases present so much resemblance among themselves in their symptoms and mode of cure, that they should be considered as the
same malady. This distinction, however, has not much practical, consequently
little real, value, for we ought to observe and investigate accurately each case, in
order to find out what is the suitable remedy. If I have discovered this, it is a
matter of great indifference whether I then become aware that this same disease,
with all its symptoms and witi the same curative indications, has presented itself
to me before, as this knowledge could not lead me to any other or better mode of
cure (and the cure is the aim of all kinds of diagnosis of disease) than to the efficacious and best adapted one.               -
1 How   were it possible to arrange such inconjungibilia into classes, orders,
genera, species, varieties and sub-varieties, like organic beings, and to give names
to such states of the extremely composite psychico-corporeal microcosm, subject as
it is to such varied irritations by such innumerable agencies, states that are capable
of such an infinity of modifications and shades of difference! The millions of
morbid cases that occur perhaps but once in the world require no names-we only require to cure them. Diseases have been associated together according to some merely
external resemblance, or from some similarity of cause or of one or other symptom, in
order that they might be treated by the same medicine, with a small outlay of trouble!
2 In like manner the teacher chiefly requires to observe the actions and conduct
of an undisciplined new pupil, in order to lead him in the way of virtue by means of
the most appropriate tuition. To effect this reformation it is not necessary either
that he should know the ever inscrutable internal organisation of his body, or that




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means of medicines, to enable us to remove these also-by means
of an improved regimen-and so prevent a relapse.1
In order: to trace the picture of the disease, the physician requires to proceed in a very simple manner. All that he needs is
carefulness in observing and fidelity in copying.2 He should
entirely avoid all conjectures, leading questions and suggestions.
The patient relates the history of his ailments, those about him
describe what they have observed in him, the physician sees,
hears, feels, &c., all that there is of an altered or unusual character
about him, and notes down each particular in its order, so that he
may form an accurate picture of the disease.
The chief signs are those symptoms that are most constant,
most striking, and most annoying to the patient. The physician
marks them down as the strongest, the principal features of the
picture. The most singular, most uncommon signs furnish the
characteristic, the distinctive, the peculiar features.
He allows the patient and his attendants to relate all they have
to say without interrupting them, and he notes down everything
attentively-he then again enquires what were and still are the
most constant, frequent, strongest and most troublesome of the
symptoms-he requests the patient to describe again his exact
sensations, the exact course of the symptoms, the exact seat of his
sufferings, and bids the attendants once more detail, in as accurate
terms as they are able, the changes they have observed in the
patient, and which they had previously mentioned.3
he should be able to inspect the equally inscrutable internal operations of his mind.
In addition to this he certainly requires to know (if he can ascertain it) the cause of
his moral deterioration, but only in order to be able to ward it off from him in future
-and so prevent a relapse.
1 If no obvious predisposing and exciting causes are perceptible, whose future
avoidance is within the power of man, then all our aims are attained by effecting the
restoration by means of remedial agents. The physician must neither invent, conjecture, nor extort from the patient any exciting cause.
2 If we are not desirous of producing a likeness, we may draw a dozen faces on a
piece of paper or canvass in an hour, but a single striking portrait requires just as
much time and a much greater power of observation and fidelity in the representation.
3 The physician should never put leading questions in the course of his investigations. He should not suggest either to the patient, or to the attendants, the symptoms
that may be present, or the words they should use to describe them, in order not to




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The physician thus hears a second time what he had formerly
noted down. If the expressions correspond with what was already
related, they may be considered as true, as the voice of internal
conviction; if they do not correspond, the discrepancy must be
pointed out to the patient or those about him, in order that they
may explain which of the two descriptions was nearest the truth,
and thus what required confirmation is confirmed, and what required alteration is altered.'
If the picture be not yet complete, if there be parts or functions
of the body regarding whose state neither the patient nor his
attendants have said any thing, the physician then asks what they
can remember respecting these parts or functions, but he should
frame his questions in general terms, so as to cause his informant
to give the special details in his own words.2
When the patient (for, except in cases of feigned diseases, most
reliance is to be placed on him as regards his sensations) has, by
these spontaneous or almost unprompted details, put the physician
in possession of a tolerably complete picture of the disease, it is
allowable for the latter to institute more particular enquiries.3
mislead them to say any thing that may be untrue, half-true, or different from what
is actually the case, or, in order to please the physician, to reply in the affirmative to
what is not strictly founded on truth, for in this way a false idea of the disease and
an unsuitable mode of treatment must be the result.
The greatest reliance is to be placed on the accurate, although occasionally somewhat coarse expressions of the patient and his attendants, respecting his ailments.
1 We cannot rely on the patient or his attendants possessing such an accurate me -
mory, that after a short interval of time they should repeat in exactly the same form
and manner the expressions that may at first have been inaccurately or hastily chosen.
There will certainly then occur variations, which must be pointed out to them, so
that they may select more accurate or definite expressions in the description of their
sensations and convictions.
2 For example: How is it as regards the flecal evacuations?-how does the urine
flow?-how is it with the sleep by day and by night?-how is his disposition?-how
the thirst?-what sort of taste in the mouth?-what kinds of food and drink
does he relish most, what agree with him best?-has each of them its natural perfect
taste?-has he any thing to state respecting the head, the limbs, or the abdomen? &c.
3 For example: How often has he an alvine evacuation, what is the character of it,
is it accompanied or not by pains? Is the sleep profound or light?-He then asks
more minutely, e. g., are the sufferings complained of persistent or remitting? how
often do they occur? only in the room? only in the open air? only during rest or
during motion of the body? at what time of the day or under what conditions? what
precedes, what accompanies, and what follows them?-And finally, he addresses quite




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The answers to these last more special questions however, which
have somewhat the character of suggestions, should not be accepted
by the physician at the first response as perfectly true, but after
making a noteof them on the margin he should make fresh enquiries
respecting them, in a different manner and in another order,' and
he should warn the patient and his attendants in their answers to
make accurate replies, and to make no additions, but merely to tell
the exact circumstances of the case.
But an intelligent patient will often spare the physician the
trouble of making these particular enquiries, and in his account of
the history of his disease, will usually have made voluntary mention
of these circumstances.
When the physician has completed this examination he notes
down what he has silently observed in the patient during his visit,2
and he corrects this by what the attendants tell him-how         much
of this was or was not usual with the patient in his days of
health.
He then enquires what medicines, domestic remedies, or other
modes of treatment have been employed in former times, and what
have recently been used,-and especially the state of the symptoms
before the use or after the discontinuance of all medicine. The
former form he regards as the original state; the latter is in fact
an artificial form of the disease, which however he must sometimes
accept and treat as it is, if there is any pressing emergency in the
specific questions: Does he start in his sleep? does he groan  talk in his sleep?
what does he talk about? was the whitish evacuation mucus or faeces? &c.
1 For example: How he behaved, what he did in his sleep? what the motions
consisted of? does the symptom only occur only in the morning, only when at rest,
when lying, or when sitting? what happens when he raises himself up in bed? &c.
2 For example: If the patient tossed restlessly about, and how he behaved;
whether he was sulky or quarrelsome, hasty or anxious, unconscious, comatose;
whether he spoke in a low voice, or incoherently or otherwise; what kind of complexion he has, what appearance the eyes present, what expression of countenance is
shewn, what is the state of the tongue, the breath, the smell from the mouth, or the
hearing; how much the pupils are dilated, how rapidly and to what extent they alter
in the dark and light; the state of the pulse, of the abdomen, of the skin in general,
or of particular portions of it as regards moisture and temperature; whether he lies
with his head thrown back, uncovered, or closely covered up, whether he lies only
on his back, with his mouth open, with the arms above the head, or what other
position he assumes; with what amount of exertion he raises himself up; and any
thing else that may strike the physician, or is observable by him.




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case that will not admit of any delay. But if the disease is of a
chronic character, he lets the patient continue some days without
taking any medicine, to allow it to resume its original form, until
which time he defers his more particular examination of the morbid
symptoms, in order that he may direct his treatment towards the
persistent and unsophisticated symptoms of the chronic malady, but
not towards the evanescent, ungenuine, accidental symptoms, produced by the medicines last used-as it will be necessary to do in
acute diseases where the danger is urgent.
Finally, the physician makes general enquiries as to any exciting
causes of the disease that may be known. In ten cases we shall
not find one where the patient or his friends can assign a certain
cause. If, however, there have happened one respecting which
there can exist no dubiety, it generally occurs that it has been
voluntarily mentioned by them at the commencement of their
account of the disease. If it is necessary to make enquiries respecting it, it usually happens that very uncertain information is
elicited on this head.1
I except those causes of a disgraceful2 character, which the
patient or his friends are not likely to mention, at all events not of
their own accord, and which, consequently, the doctor should
endeavour to find out by dexterously framing his questions, or by
private enquiries. With these exceptions it is a hurtful, or at all
events, a useless task to endeavour to ferret out other exciting
causes, by means of suggestions, especially as the medical art knows
very few of these (I shall mention them in their proper places) on
which we can base a trustworthy mode of treatment, regardless of
the particular signs of the disease they have induced.
By exercising all this zealous care the physician will succeed in
1 Such a query should never have a definite character. But even when it is
framed quite in a general fashion (e. g. how did the disease arise, what was its cause?)
such a question usually only incites the patient and his friends to imagine or invent
some probable cause, which might appear probable to a physician who does not possess a great knowledge of mankind, and so deceive him.
2 For example: meditated suicide, onanism, excesses in wine, spirits or food-in
unnatural debauchery- indulgence in meretricious reading; venereal disease;
mortified pride; thwarted revenge; childish superstitious fear; an evil conscience;
unhappy love; jealousy; domestic quarrels and grief about some family secret, about
debts-straitened circumstances, hunger, unwholesome food, &c.




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depicting the pure picture of the disease, he will have before him
the disease itself, as it is revealed by signs, without which man, who
knows nothing save through the medium of his senses, could never
discover the hidden nature of any thing, and just as little could he
discover a disease.
When we have found out the disease, our next step is to search
for the remedy.
Every disease is owing to some abnormal irritation of a peculiar
character, which deranges the functions and well-being of our
organs.
But the unity of the life of our organs and their concurrence
to one common end does not permit two effects produced by
abnormal general irritation to exist side by side and simultaneously
in the human body. Hence our
First maxim of experience.
When two abnormal general irritations act simultaneously on
the body, if the two be dissimilar, then the action of the one (the
weaker) irritation will be suppressed and suspended for some time
by the other (the stronger 1); and, on the other hand, our
Second maxim of experience.
When the two irritations greatly resemble each other, then the
one (the weaker) irritation, together with its effects, will be com1 This maxim of experience will be better elucidated by another, namely: when
(as in the case of palliatives) the general (medicinal) irritation that is applied is the
exact opposite of that already existing in the body (the morbific irritation), the latter
will be suppressed and suspended with remarkable rapidity-but when the general
(medicinal) irritation employed is dissimilar and heterogeneous to that already present
in the body (the morbific irritation) in every other respect (as is the case in merely
revolutionary modes of treatment, by revulsions and so-called general remedies), the
morbific irritation will only be suppressed and suspended, provided the new irritation is much stronger than that already present in the system,-and only rapidly
when this new irritation is excessively violent.
If the opposed, heterogeneous, dissimilar irritations are diseases, of pretty much
the same intensity, as however is rarely the case, so that they cannot suspend
one another at all, or not for any length of time, then they (when uncured) unite to
form a single disease which may moreover be cured as a single, uniform disease,
notwithstanding that this kind has been termed complex diseases.




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511

pletely extinguished and annihilated by the analogous power of
the other (the stronger).
(Illustration of the first maxim.) If a person be infected at the
same time by, for instance, the miasmata of measles and small-pox
(two dissimilar irritations), and if the measles have appeared first,
it immediately disappears on the day of the eruption of the smallpox, and it is only after the latter is completely gone that the
measles again returns and completes its natural course. The red
rash that had already commenced to shew itself disappeared, as I
have frequently observed, on the eruption of the small-pox, and
only completed its course when the small-pox was dried up.'
According to Larrey, the plague of the Levant immediately remains
stationary whenever the small-pox begins to prevail, but again
returns when the latter ceases.
These two corporeal irritations are of a heterogeneous and dissimilar character, and the one is therefore suspended by the other
-but only for a short time.
(Illustration of the second maxim.) If the two abnormal corporeal irritations be of a similar nature, then the weaker will be
entirely removed by the stronger, so that only one (the stronger)
completes its action, whilst the weaker was quite annihilated and
extinguished. Thus the small-pox becomes an eradicator of the
cow-pox; the latter is immediately interrupted in its course whenever the miasm of the small-pox that was previously latent in the
system breaks out, and after the small-pox has run its course the
cow-pox does not again appear.
The cow-pox miasm, which in addition to its well-known effect
of developing the cow-pock with its course of two weeks' duration,
has also the property of giving rise to a secondary eruption of
small red pimples with red borders, particularly in the face and
forearms (and under certain unknown circumstances it produces
this effect usually soon after the desiccation of the pocks), permanently cures other cutaneous eruptions wherewith the inoculated
person was already, though ever so long before, affected, if this
1 I saw an infection of the epidemic febrile swelling of the parotid gland (mumps)
immediately yield when the protective inoculation with small-pox had taken effect,
and it was only after the lapse of fourteen days, when the areolar redness of the
pocks had passed away, that the mumps again appeared and completed its regular
course of seven days.




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cutaneous disease was only tolerably similar to that cow-pox exanthema.I
These two abnormal irritations cannot exist simultaneously
in the same body, and thus the morbific irritation that appears
last removes that which previously existed, not merely for a short
time, but permanently, in consequence of being analogous to the
latter; it extinguishes, annihilates and cures it completely.
It is the same thing in the treatment of diseases by means of
medicines.
If the itch of workers in wool be treated by strong purgatives,
such as jalap, it gradually yields almost completely, as long as the
purgatives are continued, as the action of these two abnormal
irritations cannot co-exist in the body; but as soon as the effect
of the artificially excited irritation ceases, that is to say, whenever
the purgatives are discontinued, the suspended itch returns to its
former state, because a dissimilar irritation does not remove and
destroy the other, but only suppresses and suspends it for a time.
But if we introduce into a body affected by this itch a new irritant-of a different nature, it is true, but still of a very similar
mode of action-as for example the calcareous liver of sulphur,2
from which others besides myself have observed an eruption produced very similar in character to this itch, then, as two general
abnormal irritations cannot co-exist in the body, the former yields
to the latter, not for a short time merely, but permanently, as
that last introduced was an irritation very analogous to the first;
that is to say, the itch of the wool-workers is really cured by the
employment of the calcareous liver of sulphur (and for the same
reason by the use of sulphur powder and sulphureous baths).
1 That it is this secondary eruption (of pimples), or even the mere tendency of
vaccine to cause this accessory eruption, but not the cow-pox itself which cures
those pustular exanthemata is evident from this, that these exanthemata remain
almost unaltered as long as the proper cow-pox is running its course, and only disappear when the disease comes to the period corresponding to the occurrence of the
secondary eruption of vaccinia, that is to say, after the cow-pocks are dried up.
But the vaccine disease has a tendency to cause not only that secondary eruption of
discrete, elevated pimples, but also another accessory eruption in the form of confluent miliary (and also exuding) tetters (but, as it seems, not on the face, forearms
and legs), and it is also capable of curing a similar cutaneous affection.
2 The baths impregnated with sulphuretted hydrogen gas excite the same itch
like eruption, in the flexures of the joints especially, which itches most at night, and
they therefore cure the itch of the wool-workers rapidly and radically.




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513

Those diseases also which the casual observer considers as
merely local' are either suppressed for some time by a fresh irritation applied to this part, where the two irritations are of dissimilar or opposite tendency, as, for example, the pain of a burnt
hand is instantly suppressed and suspended by dipping it in cold
water, as long as the immersion is continued, but it immediately recurs with renewed violence on withdrawing the hand
from the water-or the first is entirely and permanently destroyed, that is to say, completely cured, when the last irritation is
very analogous to the first. Thus, when the action of the remedy,
e. g., the artificial irritation applied to the burnt hand, is of a
different nature, it is true, from the burning irritation of the fire,
but of a very similar tendency, as is the case with highly concentrated alcohol, which when applied to the lips produces almost the
same sensation as that caused by a flame approached to them,
then the burnt skin, if it be constantly kept moistened with the
spirit, is-in bad cases in the course of a few hours, in slighter
ones much sooner-completely restored and permanently cured of
the pain of the burn. So true is it that two irritations, even
when they are local, cannot co-exist in the body without the one
suspending the other, if they are dissimilar, or the one removing
the other, if the added one have a very similar mode of action
and tendency.
2 The unity of the life of all organs, and their concurrence to one common
end, will hardly permit of a disease of the body being or remaining merely local,
just as the action of no medicine can be purely local, in such a manner that
the rest of the body shall take no part in it.,It certainly takes a part, although
in a somewhat less degree than the place on which the so-called local affection
is most obvious, or to which the so-called local medicine is applied.-Persons
who suffer from herpes are, according to Larrey, exempted from the infection of
plague, and the Europeans in Syria who have issues and perpetual blisters remain
free from the infection of the Levantine plague, as observed in our own time by
Larrey and in ancient times by G. F. van Hilden and F. Plater. So far are herpetic
eruptions and artificial external ulcers from being purely local affections, that when
they are present the system is not susceptible of such a violent and general irritation
as the Levantine plague. But it is only during the continuance of this corporeal
irritation, which is dissimilar to that it wards off, and no longer, that it can prevent
its occurrence. Two children affected with epilepsy kept free from this disease (the
epilepsy was suspended) as long as an eruption on the head that they both had
persisted; but when this healed up the epilepsy returned (N. Tulpius, lib. i, obs. 8).
In like manner, obviously general diseases of the body have been-not cured, but
suppressed and suspended by nature, which is powerless to cure them, by means of
2L




514

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In order therefore to be able to cure, we shall only require to
oppose to the existing abnormal irritation of the disease an appropriate medicine, that is to say, another morbific power whose effect
is very similar to that the disease displays.
As food is requisite for the healthy body, so medicines have been
found efficacious in diseases; medicines, however, are never in themselves and unconditionally wholesome, but only relatively so.
The pure aliments of food and drink taken until hunger and
thirst abate, support our strength, by replacing the parts lost in
the vital processes, without disturbing the functions of our organs
or impairing the health.
Those substances however which we term medicines are of a
completely opposite nature.      They afford no nourishment.       They
are abnormal irritants, only fitted for altering our healthy body,
disturbing the vitality and the functions of the organs, and exciting
disagreeable sensations, in one word, making the healthy ill.
There is no medicinal substance whatsoever that does not possess
this tendency,1 and no substance is medicinal which does not
possess it.
It is only by this property of producing in the healthy body a series
torpid ulcers of the legs, by the physician by means of issues, because both issues
and ulcers of the legs, if they have existed some time, are abnormal general irritations; but the attacks of apoplexy, asthma, &c., recur immediately when the ulcers
of the legs and the issues heal up. An epileptic patient remained for a long time
free from his attacks, as long as the issue was kept open, but the epilepsy returned
immediately and in a worse shape than before, when it was allowed to close.
(Pechlinus, Obs. phys. med., lib. ii, obs. 30). From this it is obvious that irritations
apparently local, when they have existed some time, usually become general irritations
of the body, and if they are sufficiently intense, can either suspend or cure general
maladies of the body, according as the two opposed irritations were of heterogeneous
or of analogous character.
I A medicine which given to a healthy individual alone and uncombined, in sufficient quantity, causes a determinate action, a certain array of symptoms, retains the
tendency to excite the same even in the very smallest dose.
The heroic medicines exhibit their action even when given in small doses, to
healthy and even strong individuals. Those that have a weaker action must be given
for these experiments in very considerable doses. The weakest medicines however
only shew their absolute action in such subjects as are free from disease, who are
delicate, irritable and sensitive;-in diseases, in like manner, they all (the weakest
as well as the strongest medicines) shew their absolute actions, but so intermingled
with the symptoms of the disease, that only a very experienced experimenter and fine
observer can distinguish them.




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515

of specific morbid symptoms, that medicines can cure diseases, that
is to say, remove and extinguish the morbid irritation by a suitable
counter-irritation.
Every simple medicinal substance, like the specific morbific
miasmata (small-pox, measles, the venom of vipers, the saliva of
rabid animals, &c.) causes a peculiar specific disease-a series of
determinate symptoms, which is not produced precisely in the same
way by any other medicine in the world.
As every species of plant differs in its external form, in its
peculiar mode of existence, in its taste, smell, &c., from every other
species and genus of plant-as every mineral substance, every salt
differs from all others in both its external and internal physical
qualities, so do they all differ among themselves in their medicinal
properties, that is to say, in their morbific powers; each of these
substances effects an alteration in our state of health in a peculiar,
determinate manner.
Most substances belonging to the animal and-vegetable kingdoms,'
are medicinal in their raw state. Those belonging to the mineral
kingdom are so both in their crude and prepared state.
Medicinal substances manifest the nature of their pathogenetic
power, and their absolute true action on the healthy human body,
in the purest manner, when each is given singly and uncombined.
Many    of the most active medicines have already occasionally
found their way into the human body, and the accidents they have
given rise to have been recorded.2
1 Those plants and animals which we employ as food, have the advantage of
containing a greater quantity of nutritious parts than the others, and moreover, their
medicinal powers in their raw state are either not very great, or if they are great are
destroyed and dissipated by drying (as in the case of arum-root), by the expression
of the noxious juice (as in the case of the cassava), by fermentation, by smoking and
by the power of heat in roasting, baking and boiling, or are rendered innocuous by
the addition of salt, sugar, and especially of vinegar (in sauces and salads). If we
allow the recent expressed juice of the most deadly plants to remain only for a single
day in some warm place, it undergoes the complete vinous fermentation and
loses much of its medicinal power; if it stand several days, it passes through the
acetous fermentation, whereby it loses all medicinal power, the sediment that is
deposited from it is then perfectly harmless, and is similar to wheat-starch.
2 If we compare the occasional happy cures effected by these medicines, the most
prejudiced person must be struck with the extraordinary resemblance that exists
between the symptoms caused by the medicines on the healthy body, and those
whereby the disease it cures is characterized.
2 L2




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In order to follow still farther this natural guide and to penetrate more profoundly into this source of knowledge, we administer
these medicines experimentally, the weaker as well as the stronger,
each singly and uncombined, to healthy individuals, with caution,
and carefully removing all accessory circumstances capable of
exercising an influence; we note down the symptoms they occasion
precisely in the order in which they occur, and thus we obtain the
pure result of the form of disease that each of these medicinal
substances is capable of producing, absolutely and by itself, in the
human body.1
In this way we must obtain a knowledge of a sufficient supply of
artificial morbific agents (medicines) for curative implements, so
that we may be able to make a selection from among them.2
Now, after we have accurately examined the disease to be cured,
that is to say, noted down all its appreciable phenomena historically
and in the order in which they occur, marking particularly the
more severe and troublesome chief symptoms, we have only to
oppose to this disease another disease as like it as possible, or in
other words, a medicinal irritation analagous to the existing irritation of the disease, by the employment of a medicine which pos1 In order to ascertain the effects of less powerful medicines in this manner, we
must give only one pretty strong dose to the temperate healthy person who is the
subject of the experiment, and it is best to give it in solution. If we wish to ascertain the remaining symptoms which were not revealed by the first trial, we may give
to another person, or to the same individual, but only then after the lapse of several
days, when the action of the first dose is fully over, a similar or even a stronger portion, and note the symptoms of irritation thence resulting in the same careful and
sceptical manner. For medicines that are still weaker, we require, in addition to a
considerable dose, individuals that are, it is true, healthy, but of very irritable delicate
constitutions. The more obvious and striking symptoms must be recorded in the
list, those that are of a dubious character should be marked with a sign of dubiety,
until they have frequently been confirmed.
In the investigation of these medicinal symptoms all suggestions must be as carefully avoided, as has been recommended for the investigation of the symptoms of
disease. It must be chiefly the mere voluntary relation of the person who is the
subject of the experiment, nothing like guess-work, nothing obtained by dint of cross
questioning, that should be noted down as truth, and still less, expressions of sensations that have previously been put in the experimenter's mouth.
But how, even in diseases, amid the symptoms of the original disease, the medicinal symptoms may be discovered, is a subject for the exercise of a higher order of
inductive minds, and must be left to masters only in the art of observation.
2 My Fragmenta de viribus medicamentorum are something of this kind.




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517

sesses the power of exciting as nearly as possible all these symptoms,
or at all events, the greater number and severest, or most peculiar
of them, and in the same order,-in order to cure the disease we
wish to remove, certainly, quickly and permanently.
The result of a treatment so conformable to nature may be confidently depended on, it is so perfectly, without exception, certain,
so rapid beyond all expectation, that no method of treating diseases
can shew anything at all like it.
But here it is necessary to take into consideration the immense
difference, that can never be sufficiently estimated, betwixt the
positive and negative, or as they are sometimes termed, the radical
(curative), and the palliative modes of treatment.
In the action of simple medicines on the healthy human body
there occur in the first place phenomena and symptoms, which may
be termed the positive disease, to be expected from the specific
action of the medicinal substance, or its positive primary (first and
principal) effect.
When this is past, there ensues, in hardly appreciable transitions,' the exact opposite of the first process (especially in the
case of vegetable medicines), there occur the exact opposite
(negative) symptoms constituting the secondary action.
Now, if in the treatment of a disease we administer those medicines whose primary symptoms, or those of its positive action,
present the greatest similarity to the phenomena of the disease,
this is a positive or curative mode of treatment, that is to say,
there occurs what must take place according to my second maxim
of experience, rapid, permanent amelioration, for the completion
of which the remedy must be given in smaller and smaller doses
repeated at longer intervals, to prevent the occurrence of a relapse;
if the first or first few doses have not already sufficed to effect
a cure.
Thus, to the abnormal irritation present in the body another
morbid irritation as similar to it as possible (by means of the
medicine that acts in this case positively with its primary sympS1 o that in this transition stage symptoms of the first order still alternate with
symptoms of the second, until the second order attains the ascendency and
appears pure and unmixed.




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THE MEDICINE OF EXPERIENCE.

toms) is opposed in such a degree that the latter preponderates over
the former, and (as two abnormal irritations cannot exist beside
each other in the human body, and these are two irritations of the
same kind) the complete extinction and annihilation of the former
is effected by the latter.'
Here a new disease is certainly introduced (by the medicine)
into the system, but with this difference in the result, that the
original one is extinguished by the artificially excited one; but
the course of the artificially excited one (the course of the medicinal symptoms), that has thus overcome the other, expires in a
shorter time than any natural disease, be it ever so short.
It is astonishing that, when the positive (curative) medicine
employed corresponds very exactly in its primary symptoms with
those of the disease to be cured, not a trace of the secondary
symptoms of the medicine is observable, but its whole action
ceases just at the time when we might expect the commencement
of the negative medicinal symptoms. The disease disappears if it
belong to acute diseases in the first few hours, which are the
duration allotted by nature to the primary medicinal symptoms,
and the only visible result is-recovery-a real dynamic mutual
extinction.
In the best cases the strength returns immediately, and the
lingering period of convalescence usual under other modes of
treatment is not met with.
Equally astonishing is the truth that there is no medicinal
substance which, when employed in a curative manner, is weaker
than the disease for which it is adapted-no morbid irritation for
which the medicinal irritation of a positive and extremely analogous nature is not more than a match.
If we have not only selected the right (positive) remedy, but
have also hit upon the proper dose (and for a curative purpose
incredibly small doses suffice), the remedy produces within the
1 Thus when a person unaccustomed to drinking brandy has heated and exhausted himself to the utmost by some rapid, violent exertion, (e.g. putting out a fire
or teaping corn) and complains of burning heat, the most violent thirst and heaviness
of the limbs, a single mouthful (half an ounce) of brandy will probably in less than
half an hour remove the thirst, heat, and heaviness of limbs, and make him quite
well, because brandy given to healthy persons unaccustomed to its use usually
causes in its first action thirst, heat and heaviness of the limbs.




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519

first few hours after the first dose has been taken a kind of slight
aggravation (this seldom lasts so long as three hours), which the
patient imagines to be an increase of his disease, but which is
nothing more than the primary symptoms of the medicine, which
are somewhat superior in intensity to the disease, and which ought
to resemble the original malady so closely as to deceive the
patient himself in the first hour, until the recovery that ensues
after a few hours teaches him his mistake.
In this case the cure of an acute disease is generally accomplished by the first dose.
If, however, the first dose of the perfectly adapted curative
medicine was not somewhat superior to the disease, and if that
peculiar aggravation did not occur in the first hour, the disease is,
notwithstanding, in a great measure extinguished, and it only requires a few and always smaller doses to annihilate it completely.1
If, under these circumstances, in place of smaller doses, as large
or larger ones are administered, there arise (after the disappearance of the original disease) pure medicinal symptoms, a kind
of unnecessary artificial disease.2
But the case is quite different with palliative treatment, where
a medicine is employed whose positive, primary action is the opposite
of the disease.
Almost immediately after the administration of such a medicine
there occurs a kind of alleviation, an almost instantaneous suppression of the morbid irritation for a short time,3 as in the case cited
1 In the more special part I shall discuss how far it is necessary in the treatment of
chronic diseases, even after the complete restoration of health, to continue giving for
some months longer a small quantity of the same medicine that cured the disease,
but at ever longer and longer intervals, in order to eradicate every trace of the
chronic disease in the organism that has been for years accustomed to its
presence.
2 Should we observe that the person recovering under the action of the curative
medicine requires to continue taking an equally large or even larger dose in order to
prevent a relapse, this is a positive sign that the cause that has produced the disease
still exists, and this must be removed to render the recovery permanent-an error of
diet (abuse of tea, coffee, wine, spirits, &c.), or some other pernicious habit (e.g. prolonged suckling of delicate females, the abuse of the sexual function, sedentary
habits, continued quarrelling, &c.)
3 Sec the first maxim of experience and the observation attached to it.




520

THE MEDICINE OF EXPERIENCE.

above of. the cold water applied to the burnt skin.             These are
called palliative remedies.
They prevent the impression of the morbid irritation on the
organism only as long as their primary symptoms last, because
they present to the body an irritation that is the reverse of the
irritation of the disease; thereafter their secondary action commences, and as it is the opposite of their primary action, it coincides with the original morbid irritation and aggravates it.'
During the secondary action of the palliative, and when it has
been left off, the disease becomes aggravated. The pain of the
burn becomes worse when the hand is withdrawn from                the cold
water than before it was immersed.
As in the (positive) curative mode of treatment in the first hour
a slight aggravation usually ensues, followed by an amelioration
and recovery all the more durable, so in the palliative method
there occurs in the first hour, indeed       almost instantaneously, a
(deceptive) amelioration, which, however, diminishes from hour
to hour, until the period of the primary, and in this case palliative,
action expires, and not only allows the disease to reappear as it
I Ignorance of this maxim of experience was the cause why physicians have hitherto
selected, almost exclusively, palliative remedies for the treatment of diseases; the
flattering, almost instantaneously ameliorating action that first ensued deceived
them. In like manner the parents of a morally diseased (naughty) child deceive
themselves when they imagine that a sweet cake is the remedy for its peevishness and rudeness. It certainly grows quiet immediately after receiving the
first cake, but on the occasion of another fit of wilfulness, bawling and noise from
unruliness, the palliative cake again given does not prove so efficacious; we must
give it more cake, and must at last overload it with cakes, and yet at last this
produces no good result. The child has, on the contrary, only become more stubborn,
naughty and unruly in consequence of the palliative.  The poor parents have now
recourse to other palliatives; toys, new clothes, flattering words-until at length
these are no longer of any avail, and gradually induce the opposite state, an increase
of the original moral disease in the child it was wished to cure, namely, confirmed
naughtiness, stubbornness, wildness. If, at the beginning and on the very first occasion in which it beat or scratched its brothers or sisters or attendants, the curative
agents of reprimand and the rod had been employed in adequately strong dose, and
repeated a few times on the occasion of subsequent (assuredly slighter) fits of,passion, they would not have failed to cure the malady positively, permanently and
radically. The naughty child would, it is true, on the first application of the rod,
and for the first half hour, prove somewhat more unruly, bawl and cry somewhat
louder, but it would subsequently become all the more quiet and docile.




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521

was before the use of the remedy, but somewhat of the secondary
action of the medicine is added, which, because the primary action
of the remedy was the opposite of the disease, now becomes the
very reverse, that is to say, a state analogous to the disease.
This state is an increase, an aggravation of the disease.
If it is wished to repeat the palliative aid, the former dose will
now no longer suffice; it must be increased,' and always still
further increased, until the medicine no longer produces relief,
or until the accessory effects, whatever these may be, of the medicine continued in ever increased doses, are productive of bad consequences, that forbid its further employment, bad consequences
which, when they have attained a considerable height, suppress the
original malady that has hitherto been treated (in conformity with
the first maxim of experience), and, in place thereof, another
new and at least as troublesome disease appears.2
Thus, for instance, a chronic sleeplessness may be frequently
suppressed for a considerable time by means of daily doses of opium
given at night, because its (in this case palliative) primary action is
soporific, but (in consequence of its secondary action being sleeplessness, accordingly an addition to the original disease) that only
by means of ever increasing doses, until an intolerable constipation,
an anasarca, an asthma, or other malady from the secondary action
of opium, prohibits its further employment.
1 In addition to innumerable other confirmative examples see J. H. Schulze's
Diss. qua corporis humani momentanearum alterationum specimina quaedam expenduntur, Halae, 1741, ý 18. Besides the increase of the dose, we see also that recourse
is had to a frequent change of palliatives, at least in those chronic diseases for which
there are many, as, for example, in hysterical fits. Thus we see the changes rung so
long and so frequently on asafcetida, castor, galbanum, sagapenum, hartshorn, tincture
of amber, and finally opium in ever increased doses (for each of these is in its
primary action only the probable opposite of the disease and not its analogue,
consequently only the first two or three doses of them give relief, but on subsequent
occasions they produce less and at length no amelioration)-in order to give some
alleviation as long as that can be done-until the store of palliatives is exhausted, or
until the patient is tired of these undurable cures, or is afflicted with a new disease
from the secondary action of these medicines, which now requires another mode of
treatment.
2 If we are so fortunate as to succeed in removing this disease caused by the
palliative, the first original one generally reappears, shewing that (according to the
first maxim of experience) it has only been pushed aside and suspended by the newly
developed, dissimilarly irritating disease, but that it has not been destroyed or
cured.




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If, however, but a few doses of the palliative medicine be employed for a habitual malady, and then discontinued before it can
excite an important accessory affection, it is then speedily and
clearly apparent, that it is not only impotent against the original
malady, but that it moreover aggravated the latter by its secondary
effects.  This is truly but negative relief.  If, for instance, in the
case of chronic agrypnia sought to be cured, the patient only
obtained too little sleep, in that case the evening dose of opium will
certainly immediately cause a kind of sleep, but when this remedy,
which here acts only in a palliative manner, is discontinued after a
few days, the patient will then not be able to sleep at all.'
The palliative employment of medicines is only useful and
necessary in but few cases-chiefly in such as have arisen suddenly
and threaten almost immediate danger!
Thus, for example, in apparent death from freezing (after friction
to the skin and the gradual elevation of the temperature) nothing
removes more quickly the want of irritability in the muscular fibre,
and the insensibility of the nerves, than a strong infusion of coffee,
which in its primary action increases the mobility of the fibre and
the sensibility of all the sensitive parts of the system; and is consequently palliative as regards the case before us. But in this case
there is danger in delay, and yet there is no persistent morbid state
to be overcome, but whenever sensation and irritability are again
excited and brought into action even by a palliative, the uninjured
organism resumes its functions, and the free play of the vital processes maintains itself again, without the aid of any further
medication.
In like manner, cases of chronic diseases may occur, for example,
hysterical convulsions or asphyxias, where the temporary assistance
of palliatives (as eau de luce, burnt feathers,. &c.,) may be urgently
demanded, in order to restore the patient to his usual undangerous
1 If we have to combat a case of excessive sleepiness, opium, being a medicinal
irritant, very analagous in its primary action to the disease before us, will remove it
in the very smallest dose, and if some of the other primary effects of this medicine
(e. g. snoring in a state of comatose sleep, with open mouth, half shut eyes, with the
pupils directed upwards, talking in sleep, want of recollection on awaking, inability
to recognise those around, &c.,) resemble those symptoms present in the disease, (as
is not unfrequently the case in typhoid diseases) the original malady is overcome
rapidly and permanently, and without any after-symptoms, the opium being in this
case a curative and positive remedy.




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523

morbid state, for the cure of which, the totally different durable
aid of curative medicines is required.
But where all that is capable of being effected by a palliative is
not accomplished in a few hours, the bad consequences spoken of
above commence to make their appearance.
In acute diseases, even such as run their course in the shortest
time, we would better consult the dignity of medicine and the welfare of our patients, by treating them with curative (positive) mediccines. They will thereby be overcome more certainly, and on the
whole more rapidly, and without after-complaints.
However, the bad consequences of the palliative 1 in slight cases
of acute diseases are not very striking, not very considerable. The
chief symptoms disappear in a great measure after each dose of the
palliative, until the natural course of the disease comes to an end,
and then the organism, which has not been very seriously deranged
during the short time by the secondary effects of the palliative,
again resumes its sway, and gradually overcomes the consequences
of the disease itself, together with the after-sufferings caused by
the medicine.
If, however, the patient recover under the use of the palliative, he
would also have recovered equally well and in the same space of
time, without any medicine (for palliatives never shorten the
natural courses of acute diseases), and would thereafter more readily
regain his strength for the reasons just given.  The only circumstance that can in some measure recommend the physician who
practises in this way, namely, that the troublesome symptoms are
occasionally subdued by his palliatives, offers to the eyes of the
patient and his friends some apparent, but no real advantage over
the spontaneous recovery without the use of medicine.
Hence the curative and positive treatment possesses even in diseases of a rapid course, a decided advantage over all palliative
alleviations, because it abridges even the natural periods of acute
diseases, really heals them before the time for completing their
course has expired, and leaves behind no after-sufferings, provided
the perfectly suitable curative agent has been selected.
1 This circumstance also makes palliatives unserviceable, that each of them is
usually employed to subdue a single symptom only-the remaining symptoms either
rest untouched, or are combatted by other palliatives, which all possess accessory
actions, that stand in the way of recovery.




524

THE MEDICINE OF EXPERIENCE.

It might be objected to this mode of treatmeit, "'that physicians from the earliest periods of the existence of the medical
art, have (to their knowledge) never employed it, and yet have
cured patients."
This objection is only apparent; for ever since the existence of
the art of medicine, there have been patients who have really been
cured quickly, permanently, and manifestly by medicines, not by
the spontaneous termination of the course of acute diseases, not in
the course of time, not by the gradual preponderance of the energy
of the system, but have been restored in the same manner as I
have here described, by the curative action of a medicinal agent,
although this was unknown to the physician.1
Occasionally,2 however, physicians suspected that it was that
1 In order to determine this, we must select the cases detailed by some perfectly
truthful and accurate observer, where some disease not of an acute character, limited
by nature to a certain short course, but some long-lasting disease, was cured permanently and without any sequele, not by a mixture of all sorts of different drugs, but
by a single medicinal substance. This we should certainly find to have been a
(curative) medicine very analagous in its primary effects to the disease. Had it been
a palliative, given in ever increasing doses, the apparent cure would not have been
permanent, or at least, not without some after-disease. Unless by the instrumentality
of a positive (curative) medicine, no rapid, gentle, permanent cure ever took place,
nor in the nature of things, could it ever occur.
In the strikingly rapid and permanent cures by means of composite prescriptions
(if indeed the mixture of several drugs of unknown properties, in order to accomplish
some equally unknown end, deserves a scientific notice), we shall likewise find the
remedy that strongly predominates in it to be of a positive character-or the mixture
constituted a medicine, of combined indeterminable action, in which each ingredient
did not perform its own proper function, but was altered in its action by the others,
and where in consequence of the mutual dynamic neutralizations that occurred, an
unknown medicine remained, which effected in this case what no mortal can divine
wherefore it did it, and what, for a variety of reasons (dependent on the frequently
different strength of the individual drugs in different laboratories, on the mode of
mixing the compound, which can hardly be performed in exactly the same way again,
and on the constant variety that exists among cases of nominally the same disease),
can never be imitated again; in one of the above mentioned peculiar or miasmatic
diseases that always remain identical.
2 Thus Hippocrates, or the author of the book entitled Hepli ridrwv rwv Kar'
&v0pwwrwv (Basil. 1538, frob. pag. 72, lin. 35.) has these remarkable words: &h Ta s&,osa
yovooS ylive7rat, KCal && rT bat)ota irposqepdLpe/v a EK votoetvrw  TLyridvorarL 'ovY (rripayyouptny
irb avr-b iroiEEl OvK oaav, KCa Eorav i-rb avrT b 7ranvEL" Kcal 8J  Kara' rb &vrb, &ar7rp 1
arpayyovplq inWrb rTiv avr&W yierateal Ka rav-e-ral-bc rb 1iLelpE  4erors Iaveratia.-In like
manner, some later physicians have occasionally noticed that the power of rhubarb
in producing belly-ache was the cause of its colic-subduing virtues, and that in the




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525

property of medicines (now confirmed by innumerable observations)
-of exciting (positive) symptoms analogous to the disease, by
virtue of a tendency inherent in them-which enabled them to
effect real cures. But this ray of truth, I confess, seldom penetrated the spirit of our schools, enshrouded as they were in a cloud
of systems.
When the remedy has been discovered by this mode of procedure,
so conformable to nature, there still remains an important point,
namely, the determination of the dose.
A medicine of a positive and curative character, may, without
any fault on its part, do just the opposite to what it ought, if given
in too large a dose; in that case it produces a greater disease than
that already present.
If we keep a healthy hand in cold water for some minutes, we
experience in it a diminution of temperature, cold; the'veins become invisible, the fleshy parts become shrunken, their size is
diminished, the skin is paler, duller, motion is more difficult.
These are some of the primary effects of cold water on the healthy
body. If we now withdraw the hand from the cold water and dry
it, no long time will elapse before the opposite state ensues. The
hand becomes warmer than the other (that had not been immersed),
we notice considerable turgescence of the soft parts, the veins
swell, the skin becomes redder, the movements more free and
powerful than in the other-a kind of exalted vitality.   This is the
secondary or consecutive action of the cold water on the healthy
body.
This is, moreover, almost the greatest dose in which cold water
can be employed with a permanent good result, as a positive (curative) medicinal agent in a state of (pure) debility analagous to its
above described primary effects on the healthy body. I repeat,
the "greatest dose"; for if the whole body should be exposed to
the action of this agent, and if the cold of the water be very conemetic property of ipecacuanha lay the reason why it checked vomiting in small
doses. Thus Detharding (Eph. nat. cur., cent. 10, obs. 76) saw that an infusion of
senna-leaves, which causes colic in healthy persons, cured colics in adults, and he is
of opinion that this must be caused by analogy of action. I need not dwell on the
propositions of others (J. D. Major, A. Brendelius, A. F. Dankwerts, &c.) to cure
one disease by means of another artificially excited disease.




526

THE MEDICINE OF EXPERIENCE.

siderable,1 the duration of its application must at least be very
much shortened, to a few seconds only, in order to reduce the dose
sufficiently.
But if the dose of this remedy be in all respects much increased
above the normal amount, the morbid symptoms peculiar to the
primary action of the cold water increase to a state of actual
disease, which the weak part it was intended to cure by its means
cannot or can scarcely remove again. If the dose be increased
still more, if the water be very cold,2 if the surface exposed to the
water be larger3 and the duration of its application much longer
than it ought to be for an ordinary curative dose of this agent,4
there then ensue numbness of the whole limb, cramp of the muscles,
often even paralysis;   and if the whole body have been immersed
in this cold water for an hour or longer, death ensues, or at least
the apparent death from freezing in healthy individuals, but much
more speedily when it is applied to feeble individuals.
The same is the case with all medicines, even with internal ones.
The reaper (unaccustomed to the use of spirits) exhausted by
heat, exertion and thirst, who, as I have said above, is restored in
the course of an hour by a small dose, a single mouthful of brandy
(whose primary action shews a state very similar to that sought to
be combatted in the present instance), would fall into a state of
(probably fatal) synochus, if under these circumstances he were to
1 In a greater amount of debility 700 may be proportionately as considerable a degree of cold in the water, as 600 for a less amount.
2 For example, 400 Fahr.
3 For example, the entire leg.
4 For example, two hours.
6 There are, no doubt, exceptions to this, where advantage has followed from excessively large doses of the positive (curative) medicinal agent, in certain cases that
occasionally come under the observation of the master in the art. Thus I saw the
remedial power of the primary paralysing action of a very large dose of this agent,
strikingly illustrated in the case of a man (in Thuringia) whose right arm had been
for many years almost completely paralysed, and always as if numb and cold. In
the Christmas season he wished to get some fish out of a frozen tank, in order to give
a treat to some of his friends. He could not catch them with his left arm alone; he
required to employ the lame arm also, which was not capable of so much movement.
He might have been engaged with it in the ice-cold water for upwards of half-anhour. The consequence of this was, that soon afterwards the paralysed arm inflamed
and swelled, but in a few days it got quite well and as strong as the other; the
paralysis was permanently cured.




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527

drink, in place of a single mouthful, a couple of pints at once;the same positive remedial agent, only in an excessive, injurious
dose.
Let it not be supposed that this injurious effect of excessively
large doses appertains only to medicinal agents applied in a positive
(curative) manner. Equally bad results ensue from excessive doses
of palliatives,-for medicines are substances in themselves hurtful,
that only become remedial agents by the adaptation of their
natural pathogenetic power to the disease (positively or negatively)
analogous to them, in the appropriate dose.
Thus, to give an example of negative (palliative) medicines, a
hand very much benumbed by cold, will soon be restored in the
atmosphere of a warm room.1 This moderate degree of warmth is
efficacious in this case as an agent of antagonistic tendency to the
numbness from cold, that is to say, as a palliative; but its employment is not attended with any particular bad effects, because the
dose is not too strong and the remedy need only be used for a
short time, in order to remove the moderate and rapidly produced
morbid state it is wished to cure.
But let the hand which has become completely benumbed and
quite insensible from the cold (frost-bitten), be quickly immersed
for an hour in water of 120~ Fahr., which is not too great for a
healthy hand, and the part will inevitably die; the hand mortifies
and falls off.
A robust man, much over-heated, will soon recover in a moderately cool atmosphere (about 65~ Fahr.) without experiencing any
appreciable disadvantage from this palliative; but if immediately
after being so over-heated he has to stand for an hour in a cold
river (wherein he might probably have remained without any bad
result when not in a state of heat), he will either fall down dead,
or be affected by the most dangerous typhus.
A burnt part will be alleviated in a palliative manner by cool
water, but will become sphacelated if ice be applied to it.
And the same is the case with internal remedies also. If a girl,
excessively over-heated by dancing, swallow a quantity of ice,
every one knows what usually ensues,-and yet a small tablespoon
I For example, of 800 Fahr. at a distance from the stove.




528

THE MEDICINE OF EXPERIENCE.

ful of cold water or a minute quantity of ice would not do her any
harm, although it is the same palliative, only in a smaller dose.
But she would be certainly and permanently cured, even though
excessively over-heated, if she were to choose a small, appropriate
dose of a remedy whose primary effect is analogous (curative) to
the state she is in; for instance, if she should drink a little very
warm tea mixed with a small portion of heating spirituous liquor,'
(rum, arrack or the like), in a moderately heated room, walking
quietly about;-but a large glass of alcoholic liquor would, on the
other hand, throw her into a high fever.
None but the careful observer can have any idea of the height
to which the sensitiveness of the body to medicinal irritations is increased in a state of disease. It exceeds all belief, when the disease
has attained a great intensity. An insensible, prostrated, comatose
typhus patient, unroused by any shaking, deaf to all calling, will
be rapidly restored to consciousness by the smallest dose of opium,
were it a million times smaller than any mortal ever yet prescribed.
The sensitiveness of the highly diseased body to medicinal irritations increases in many cases to such a degree, that powers commence to act on and to excite him, whose very existence has been
denied, because they manifest no action on healthy robust bodies,
nor in many diseases for which they are not suited. As an example
of this, I may mention the heroic power of animalism        (animal
magnetism), or that immaterial influence of one living body upon
another produced by certain kinds of touching or approximation,
which displays such an energetic action on very sensitive, delicately
formed persons of both sexes, who are disposed either to violent
mental emotions or to great irritability of the muscular fibres.
1 This latter example shews at the same time the correctness of the maxim, that
when the morbid state is in an extreme degree, and we have only a few hours to effect
the cure, the employment of the positive (curative) medicinal agent in a very small
dose is infinitely preferable to that of the palliative, even though the latter be at first
administered in very small quantity. Even should the latter do no harm, it is at all
events certain that it does no good, whereas the smallest dose of the suitable curative
agent can save life, though there may be only a few hours for the performance of
the cure.




THE MEDICINE OF EXPERIENCE.

529

This animal power does not manifest itself at all between two
robust healthy persons,-not because it does not exist, but because,
according to the wise purposes of God, it is much too weak to shew
itself betwixt healthy persons, whereas the same influence (quite
imperceptible when applied by one healthy person to another) often
acts with more than excessive violence in those states of morbid
sensibility and irritability, -just as very small doses of other curative medicines also do in very diseased bodies.
It is analogous to the medicinal powers of the application of the
magnet in disease and the contact of a morbid part with the other
metals, to which the healthy body is quite insensible.
On the other hand, it is as true as it is wonderful, that even the
most robust individuals, when affected by a chronic disease, notwithstanding their corporeal strength, and notwithstanding that
they can bear with impunity even noxious irritants in great quantity (excesses in food and alcoholic liquors, purgatives, &c.)-yet
as soon as the medicinal substance positively appropriate to their
chronic disease is administered to them, they experience from the
smallest possible dose as great an impression as if they were
infants at the breast.
There are some few substances employed in medicine which act
almost solely in a chemical manner-some which condense the dead
fibres as well as the living (as the tannin of plants), or loosen them
and diminish their cohesion or their tension (as the fatty substances)-some which form a chemical combination with hurtful
substances in the body, at least in the primae viae (as chalk or the alkalies which combine with some deleterious metallic oxydes or some
acrid acid in the stomach-sulphuretted hydrogen water with the
most dangerous metals and their oxydes); others which decompose
them (as alkalies or liver of sulphur do the noxious metallic salts);
others which chemically destroy parts of the body (as the actual
cautery). With the exception of these few things and the almost
purely mechanical operations of surgery on the body, amputation
which merely shortens the limb, and blood-letting which merely
diminishes the amount of that fluid, together with some mechanically injurious and insoluble substances that may be introduced
into the body-all other medicinal substances act in a purely dyna2




530

THE MEDICINE OF EXPERIENCE.

mic manner,1 and cure without causing evacuations, without producing any violent or even perceptible revolutions.
This dynamic action of medicines, like the vitality itself, by
means of which it is reflected upon the organism, is almost purely
spiritual in its nature; that of medicines used in a positive (curative) manner is so most strikingly with this singular peculiarity,
that while too strong doses do harm and produce considerable
disturbance in the system, a small dose, and even the smallest
possible dose, cannot be inefficacious, if the remedy be only otherwise indicated.
Almost the sole condition necessary for the full and helpful
action is that the appropriate remedy should come in contact with
the susceptible living fibre; but it is of little, almost of no importance how small the dose is which, for this purpose, is brought to
act on the sensitive parts of the living body.
If a certain small dose of a diluted tincture of opium is capable
of removing a certain degree of unnatural sleepiness, the hundredth or even the thousandth part of the same dose of such a
1 In the change of diseases into health, as rapid and direct as it is powerful and
mild, by means of the positive (curative) and dynamic mode of treatment, all those
abnormal assaults on the organism called constitutional remedies, revulsions and
evacuations, all emetics, purgatives, diaphoretics, and so forth, are as useless as they
are injurious. The medicines employed for their production accomplish these revolutionary, disturbing, violent effects chiefly by the excessive doses in which they are
given. The various specific medicinal properties of tartar emetic, ipecacuanha,
asarum, &c., are not perceived during their abuse as emetics, but by these properties they may become much more efficient remedial agents when used in small
doses. In like manner, the many medicinal virtues of those substances abused as
purgatives (for which object the true physician almost never or very rarely requires
them) are designed for far more useful ends than they have hitherto been used for.
It is only when they are given in excess that they cause that tumultuous, hurtful
effect-and almost all other medicines may become emetics and purgatives if administered in over-doses. The so-called deranged stomach, the so-called signs of
fermenting impurities in the prima vis, and of disorder or disturbance of the bile, such
as, bitter taste, headache, anorexia, disgust, nausea, stomach-ache, and constipation,
usually indicate a treatment totally different from violent emetics and purgatives;
the disease in its whole extent is often completely removed in a few hours by a couple
of drops of the appropriate curative medicine, and all those threatening symptoms at
once disappear, without evacuations and in such an imperceptible manner that one
knows not whither they have gone.
It is only when substances of a completely indigestible, or foreign and very poisonous nature, oppress the stomach and bowels, that it is permitted in some few cases
to effect their expulsion by such evacuant medicines.




THE MEDICINE OF EXPERIENCE.

531

solution of opium suffices almost equally well for the same end,
and in this way the diminution of the dose may be carried much
farther without the excessively minute dose ceasing to produce the
same curative result as the first; of which more will be said in
the special part.
I have said that the contact of the medicinal substance with the
living, sensitive fibre is almost the only condition for its action.
This dynamic property is so pervading, that it is quite immaterial what sensitive part of the body is touched by the medicine in
order to develope its whole action, provided the part be but destitute of the coarser epidermis-immaterial whether the dissolved
medicine enter the stomach or merely remain in the mouth, or be
applied to a wound or other part deprived of skin.
If there be no fear of its causing any evacuation (a peculiar
vital process of the living organism, which possesses a peculiar
power of nullifying and destroying the dynamic efficacy of the
medicines), its introduction into the rectum or application to the
lining membrane of the nose, fulfils every purpose, e. g., in the
case of a medicine which has the power of curing a certain pain
in the stomach, a particular kind of headache, or a kind of stitch
in the side, or a cramp in the calves, or any other affection occurring in some part that stands in no anatomical connexion with the
place to which the medicine is applied.
It is only the thicker epidermis covering the external surface of
the body that presents some, but not an insurmountable obstacle
to the action of medicines on the sensitive fibres underneath it.
They still act through it, though somewhat less powerfully. Dry
preparations of the medicine in powder act less powerfully through
it; its solution acts more powerfully, and still more so if it be
applied to a large surface.
The epidermis is however thinner on some parts, and consequently the action is easier in those situations. Among these the
abdominal region, especially the pit of the stomach, the inguinal
regions and the inner surface of the axilla, the bend of the arm,
the inner surface of the wrist, the popliteal space, &c., are the
parts most sensitive to the medicine.
Rubbing-in the medicines facilitates their action chiefly on this
account, that the friction of itself renders the skin more sensitive,
and the fibres, rendered thereby more active and susceptible, more
2 M 2




532

THE MEDICINE OF EXPERIENCE.

apt to receive the impression of the specific medicinal power,
which radiates thence over the whole organism.
If the groins be rubbed with a dry cloth until their sensibility
is exalted, and the ointment of the black oxyde of mercury then
laid upon them, the effect is the same as though we had rubbed
the same place with the mercurial ointment itself, or as though
the ointment had been rubbed in, as it is usually incorrectly
expressed.
The peculiar medicinal power of the remedy, however, remains
the same, whether it be employed outwardly or inwardly, so as to
be brought into contact with the sensitive fibres.
The black oxyde of mercury taken by the mouth cures venereal
buboes at least as rapidly and certainly as the rubbing-in of
Naples ointment upon the groins. A foot-bath of a weak solution
of muriate of mercury cures ulcers in the mouth as rapidly and
certainly as its internal administration, especially if the part that
is to be bathed be previously rubbed. Finely levigated cinchona
powder applied to the abdomen cures the intermittent fever which
it can cure by internal use.
But as the diseased organism is altogether much more sensitive
for the dynamic power of all medicines, so also is the skin of
diseased persons. A moderate quantity of tincture of ipecacuanha
applied to the bend of the arm effectually removes the tendency to
vomit in very sick individuals (by means of its primary power to
excite vomiting).
The medicinal power of heat and cold alone seems not to be so
exclusively dynamic as that of other medicinal substances. Where
these two agents are employed in a positive manner, the smallest
possible dose of them does not suffice to produce the desired effect.
When it is requisite to obtain relief rapidly they both have to be
employed in greater intensity, in a larger dose (up to a certain
amount). But this appearance is deceptive; their power is just
as dynamically medicinal as that of other medicines, and the difference in given cases depends on the already existing habituation
of our body to certain doses of these stimuli, to certain degrees of
heat and cold. The heat and cold to be employed in a medicinal
manner must surpass this accustomed degree by a little, in order




THE MEDICINE OF EXPERIENCE.

5833

that it may be employed in a positive manner with success (by
a great deal, if it is to be used in a negative or palliative manner.)
The temperature of blood-heat is for most people in our climate
higher than the usual degree for the skin, and consequently a
footbath of 98~ to 990 Fahr. is sufficiently temperate and warm
enough to remove positively heat in the head (if no other morbid
symptoms are present); but in order to alleviate in a palliative
manner the inflammation of a burnt hand, we require to use
water considerably colder than we are accustomed to bear comfortably in healthy parts of the body, and the water should be,
within certain limits, so much the colder the more severe the
inflammation is.1
What I have here stated respecting the somewhat greater dose
of heat and cold for curative purposes applies also to all other
medicinal agents to which the patient has already been accustomed. Thus for medicinal purposes we require to administer
to persons hitherto accustomed to their use doses of wine, spirits,
opium, coffee, &c., large in proportion to the amount they were
previously accustomed to.
Heat and cold, together with electricity, belong to the most
diffusible of all dynamic medicinal stimuli, their power is not
diminished nor arrested by the epidermis, probably because its
physical property serves as a conductor and vehicle for their medicinal power, and thus helps to distribute them. The same may
be the case with regard to animalism (animal magnetism), the
medicinal action of the magnet, and in general with regard to the
power of the external contact of metals. The galvanic power is
somewhat less capable of penetrating through the epidermis.
If we observe attentively we shall perceive that wise nature
produces the greatest effects with simple, often with small means.
To imitate her in this should be the highest aim of the reflecting
mind. But the greater the number of means and appliances we
1 At first we require for this palliative amelioration, even should the inflammation
be great, only a cool water of about 700 Fahr., but from hour to hour we must use
somewhat colder water; at length as much as well-cold (520 Fahr.) and even
beyond that, in order to obtain the same amount of relief as at first (and provided we
know no better remedy). We must from time to time increase the degree of cold,
as is required in the internal employment of other palliative means.




534

THE MEDICINE OF EXPERIENCE.

heap together in order to attain a single object, the farther do we
stray from the precepts of our great instructress, and the more
miserable will be our work.
With a few simple means, used singly one after the other, more
frequently however with one alone, we may restore to normal
harmony the greatest derangements of the diseased body, we may
change the most chronic, apparently incurable diseases (not unfrequently in the shortest space of time) into health-whereas we
may, by the employment of a heap of ill-selected and composite
remedies, see the most insignificant maladies degenerate into the
greatest, most formidable, and most incurable diseases.
Which of these two methods will the professor of the healing
art who strives after perfection, choose?
A single simple remedy is always calculated to produce the
most beneficial effects, without any additional means; provided it
be the best selected, the most appropriate, and in the proper dose.
It is never requisite to mix two of them together.
We administer a medicine in order if possible to remove the
whole disease by this single substance, or if this be not completely
practicable, to observe from the effect of the medicine what still
remains to be cured. One, two, or at most three simple medicines
are sufficient for the removal of the greatest disease, and if this
result does not follow, the fault lies with us; it is not nature, nor
the disease, that is to blame.
If we wish to perceive clearly what the remedy effects in a
disease, and what still remains to be done, we must only give one
single simple substance at a time. Every addition of a second or
a third only deranges the object we have in view, and when we
wish to separate the effects of the remedy from the symptoms of
the morbid process (seeing that at the most we may indeed be able to
know the symptoms of the action of a simple medicine, but not the
powers of a mixture of drugs, that either form combinations
among, or are decomposed by, one another, and these it will never
be possible for us to know), we now no longer see what portion of
the changes that have taken place is to be ascribed to the disease,we are unable to distinguish which of the changes and symptoms
that have occurred are derived from   one, which from another
ingredient of the compound remedy, and consequently we are
unable to determine which of the ingredients should be retained




THE MEDICINE OF EXPERIENCE.

535

and which discarded during the subsequent treatment,-nor what
other one we should substitute for one or other or for all of them.
In such a treatment none of the phenomena can be referred to its
true cause. Wherever we turn, nought but uncertainty and obscurity surrounds us.
Most simple medicinal substances produce in the healthy human
body not few, but on the contrary, a considerable array of absolute
symptoms. The appropriate remedy can consequently frequently
contain among its primary effects an antitype of most of the
visible symptoms in the disease to be cured (besides many others
which render it suitable for the cure of other diseases).
Now the only desirable property that we can expect a medicine
to possess, is this, that it should agree with the disease-in other
words, that it should be capable of exciting per se the most of the
symptoms observable in the disease, consequently, when employed
antagonistically as a medicine, should also be able to destroy and
extinguish the same symptoms in the diseased body.
We see that a single simple medicinal substance possesses in
itself this property in its full extent, if it have been carefully
selected for this purpose.
It is therefore never necessary to administer more than one
single simple medicinal substance at once, if it have been chosen
appropriately to the case of disease.
It is also very probable, indeed certain, that of the several medicines in a mixture, each no longer acts upon the disease in its own
peculiar way, nor can it, undisturbed by the other ingredients,
exert its specific effect,-but one acts in opposition to the other
in the body, alters and in part destroys the action of the other, so
that from this combination of several powers that dynamically
decompose each other during their action in the body, an intermediate action is the result, which we cannot desire, as we cannot
foresee, nor even form a conjecture respecting it.
In the action of mixtures of medicines in the body, there occurs
what, indeed, must occur according to the maxim of experience
given above (viz.:-that a general irritation in the body removes
another, or else suppresses it, according as the one irritation is
analagous or antagonistic to the other, or provided the one be
much more intense than the other)-the actions of several of the




536

THE MEDICINE OF EXPERIENCE.

medicines in the compound partially destroy one another,1 and
only the remainder of the action, which is not covered by any antagonistic irritation in the mixture, remains to oppose the disease; whether this be suitable or no, we cannot tell, as we are
unable to calculate what actually will remain.
Now, as in every case, only a single simple medicinal substance
is necessary; no true physician would ever think of degrading himself and his art, and defeating his own object, by giving a mixture
of medicines. It will rather be a sign that he is certain of his
subject if we find him prescribing only a single medicinal substance, which, if suitably chosen, cannot fail to remove the disease
rapidly, gently and permanently.
If the symptoms be but slight and few in number, it is an unimportant ailment that scarcely requires any medicine, and may be
removed by a mere alteration of diet or regimen.
But if-as rarely happens-only one or a couple of severe symptoms be observable, then the cure is more difficult than if many
symptoms were present.     In that case the medicine first prescribed may not be exactly suitable, either because the patient is
incapable of describing the extent of his ailments, or because the
symptoms themselves are somewhat obscure and not very observable.
In this more uncommon case we may prescribe one, or at most,
two doses of the medicine that appears to be the most appropriate.
It will sometimes happen that this is the right remedy. In the
event of its not being exactly suitable, which is most commonly
the case, symptoms not hitherto experienced will reveal themselves, or symptoms will develop themselves more fully, that the
patient has not previously noticed, or only in an       indistinct
manner.
From these symptoms which, though slight, now shew themselves more frequently and are more distinctly perceptible, we may
now obtain a more accurate picture of the disease, whereby we
1 This is the reason why the frequently enormous doses of heroic medicines of various kinds in a complex prescription are often taken without any great effect. A
single one of these powerful ingredients would often occasion death in the large
dose.




THE MEDICINE OF EXPERIENCE.

587

may be enabled to discover with greater and even the greatest certainty the most appropriate remedy for the original disease.
The repetition of the doses of a medicine is regulated by the
duration of the action of each medicine. If the remedy acts in a
positive (curative) manner, the amendment is still perceptible after
the duration of its action has expired, and then another dose of
the suitable remedy destroys the remainder of the disease. The
good work will not be interrupted if the second dose be not given
before the lapse of some hours after the cessation of the action of
the remedy. The portion of the disease already annihilated cannot
in the mean time be renewed; and even should we leave the patient several days without medicine, the amelioration resulting
from the first dose of the curative medicine will always remain
manifest.
So far from the good effect being delayed by not repeating the dose
until after the medicine has exhausted its action, the cure may on
the contrary be frustrated by its too rapid repetition, for this
reason, because a dose prescribed before the cessation of the
term of action of the positive medicine is to be regarded as an
augmentation of the first dose, which from     ignorance of this circumstance may thereby be increased to an enormous degree, and
then prove hurtful by reason of its excess.
I have already stated that the smallest possible dose of a positively acting medicine will suffice to produce its full effect. If, in
the case of a medicine whose action lasts a long time, as for instance
digitalis where it continues to the seventh day, the dose be repeated frequently, that is to say, three or four times in the course
of a day, the actual quantity of medicine will, before the seven
days have expired, have increased twenty or thirty-fold, and thereby become extremely violentI and injurious; whereas the first dose
1 The following circumstance must also be taken into consideration. We cannot
well tell how it happens, but it is not the less true, that even one and the same dose of
medicine, which would suffice for the cure, provided it were not repeated before the
action of the remedy had ceased-acts ten times as powerfully, if the dose be divided,
and these portions taken at short intervals during the continuance of the action of
the medicine; for example, if the dose of ten drops, which would have sufficed for the
cure, be divided among the five days during which the action of the medicine lasts,
in such a manner as that one drop of it shall be taken twice a-day, at the end of the




538

THE MEDICINE OF EXPERIENCE.

(a twentieth or thirtieth part) would have amply sufficed to effect
a cure without any bad consequences.
After the expiry of the term of action of the first dose of the
medicine employed in a curative manner, we judge whether it will
be useful to give a second dose of the same remedy. If the disease have diminished in almost its whole extent, not merely in the
first half-hour after taking the medicine, but later, and during the
whole duration of the action of the first dose; and if this diminution have increased all the more, the nearer the period of the action of the remedy approached its termination-or even if, as
happens in very chronic diseases, or in maladies the return of
whose paroxysm could not have been expected during this time, no
perceptible amelioration of the disease have indeed occurred, but
yet no new symptom of importance, no hitherto unfelt suffering
deserving of attention have appeared, then it is in the former case
almost invariably certain, and in the latter highly probable, that
the medicine was the curatively helpful, the positively appropriate
one, and, if requisite, ought to be followed up by a second-and
finally even, after the favourable termination of the action of the
second, by a third dose if it be necessary and the disease be not in
the mean time completely cured,-as it often is, in the case of
acute diseases, by the very first dose.
If the medicine we have chosen for the positive (curative) treatment excites almost no sufferings previously unfelt by the patient,
produces no new symptom, it is the appropriate medicament and
will certainly cure the original malady, even though the patient and
his friends should not admit that any amendment has resulted from
the commencing doses,-and so also conversely, if the amelioration
of the original disease take place in its whole extent from the
action of the curative medicine, the medicine cannot have excited
any serious new symptoms.
Every aggravation, as it is called, of a disease that occurs during
the use of a medicine (in doses repeated before or immediately
after the expiry of its term of action), in the form of new symptoms
not hitherto proper to the disease, is owing solely to the medicine
five days the same effect is not produced as would have occurred from ten drops
given at once every five days, but a far more powerful, excessive, violent effect, provided that the medicine was a curative and positive antidote to the disease.




THE MEDICINE OF EXPERIENCE.

539

employed (if it do not occur just a few hours before inevitable
death, if there have taken place no important'error of regimen, no
outbreak of violent passions, no irresistible evolution of the course
of nature by the occurrence or cessation of the menstrual function,
by puberty, conception, or parturition); these symptoms are always
the effect of the medicine, which, as an unsuitably chosen positive
remedy, or as a negative (palliative) remedy, either ill-selected or
given for too long a time, and in too large doses, develops them
by its peculiar mode of action to the torment and destruction of
the patient.
An aggravation of the disease by new, violent symptoms during
the first few doses of a curative medicine is never indicative of feebleness of the dose (never requires the dose to be increased), but it
proves the total unfitness and worthlessness of the medicine in this
case of disease.
The aggravation just alluded to by violent, new symptoms not
proper to the disease, bears no resemblance to the increase of the
apparently original symptoms of the disease during the first few
hours after the administration of a medicine selected in a positive
(curative) manner, which I formerly spoke of. This phenomenon
of the increase of what seem to be the pure symptoms of the disease, but which are actually predominant medicinal symptoms
resembling those of the disease, indicates merely that the dose of
the appropriately selected curative medicine has been too large-it
disappears, if the dose has not been enormously large, after the
lapse of two, three, or at most, four hours after its administration,
and makes way for a removal of the disease that will be all the
more durable, generally after the expiry of the term of the action
of the first dose; so that, in the case of acute affections, a second
dose is usually unnecessary.
However, there is no positive remedy, be it ever so well selected,
which shall not produce one, at least one slight, unusual suffering,
a slight new symptom, during its employment, in very irritable,
sensitive patients,-for it is almost impossible that medicine and
disease should correspond as accurately in their symptoms as two
triangles of equal angles and sides resemble each other. But this
unimportant difference is (in favourable cases) more than sufficiently




540

THE MEDICINE OF EXPERIENCE.

compensated by the inherent energy of the vitality, and is not even
perceived except by'patients of excessive delicacy.
Should a patient of ordinary sensibility observe during the
duration of the action of the first dose, an unusual sensation, and
should the original disease appear at the same time to decline, we
are unable to determine with precision (at least not in a chronic
disease) from this first dose, whether or no the medicine selected
was the most appropriate curative one. The effects of a second
dose of equal strength, given after the first has exhausted its action,
can alone decide this point. From the action of this, if the medicine was not perfectly or exceedingly appropriate, there will again
appear a new symptom (but not often the same that was observed
from the first dose, usually another one) of greater intensity (or
even several symptoms of a like character), without any perceptible
progress occurring in the cure of the disease in its whole extent;if, however, it was the appropriate positive medicine, this second
dose removes almost every trace of a new symptom, and health is
restored with still greater rapidity, and without the supervention of
any new ailment.
Should there occur from the second dose also some new symptom
of considerable severity, and should it not be possible to find a
more appropriate medicine (the fault of which may however lie
either in a want of diligence on the part of the physician, or in the
smallness of the supply of medicines, whose absolute effects are
known) in the case of chronic diseases, or acute diseases that do
not run a very rapid course, a diminution of the dose will cause this
to disappear, and the cure will still go on, though somewhat more
slowly. (In this case also the energy of the vitality aids the cure).
The choice of the medicine is not inappropriate if the chief and
most severe symptoms of the disease are covered in a positive
manner by the symptoms of the primary action of the medicine,
while some of the more moderate and slighter morbid symptoms
are so only in a negative (palliative) manner. The true curative
power of the predominant positive action of the remedy takes place
notwithstanding, and the organism regains full possession of health
without accessory sufferings during the treatment, and without
secondary ailments thereafter. It is not yet decided whether it is




THE MEDICINE OF EXPERIENCE.

541

advantageous in such a case to increase the doses of the medicine
during the continuance of its employment.
If, during the continued employment of a curative medicine
without increasing the doses (in a chronic disease), fresh symptoms
not proper to the disease should, in the course of time, present
themselves, whereas the first two or three doses acted almost without any disturbance, we must not seek for the cause of this impediment in the inappropriateness of the medicine, but in the regimen,
or in some other powerful agency from without.
If, on the other hand, as is not unfrequently the case when there
is a sufficient supply of well known medicines, a positive medicine
perfectly appropriate to the accurately investigated case of disease,
be selected and administered in a suitably small dose, and repeated
after the expiry of its special duration of action, should none of the
above alluded to great obstacles come in the way, such as unavoidable evolutions of nature, violent passions, or enormous violations
of regiminal rules, and should there be no serious disorganisation
of important viscera, the cure of acute and chronic diseases, be they
ever so threatening, ever so serious, and of ever so long continuance,
takes place so rapidly, so perfectly, and so imperceptibly, that the
patient seems to be transformed almost immediately into the state
of true health, as if by a new creation.
The influence of regimen and diet on the cure is not to be overlooked; but the physician needs to exercise a supervision over
them only in chronic diseases, according to principles which I shall
develop in the special part of my work. In acute diseases, however
(except in the state of complete delirium), the delicate and infallible
tact of the awakened internal sense that presides over the maintenance of life, speaks so clearly, so precisely, so much in conformity
with nature, that the physician needs only to impress on the friends
and attendants of the patient, not to oppose in any way this voice
of nature, by refusing or exceeding its demands, or by an injurious
officiousness and importunity.




OBJECTIONS TO A PROPOSED SUBSTITUTE FOR
CINCHONA BARK,
AND TO SUCCEDANEA IN GENERAL.'
In the commercial world the spirit of substitution has been
lately boldly stalking abroad.  A   large number of substitutes
for coffee have been proposed and offered at low prices-and no
small number of substitutes for hops in beer have been sought
for.
It would have required no great experience to perceive a priori
that infusions of burnt barley would taste like burnt barley, of
burnt chicory-root and carrot would taste like burnt chicory-root
and carrot, and of burnt cyperus would taste like burnt cyperus,
and that each would act in its own peculiar way on the health of
man, but that none of them would either taste like coffee, or yet
be capable of developing on the human organism the effects to be
anticipated from genuine coffee.2
If the substitutes for coffee had injurious effects on the health,
yet they were actually, and in comparison with the injurious
nature of coffee, quite inconsiderable, for before being used as
drinks these substances were roasted, and thereby deprived of
the greater portion of their power of deranging the health of the
body.
Much more important and more objectionable as regards the
health were the substitutes for hops in beer, which have been proposed and recommended. Notwithstanding that the hop is undoubtedly a medicinal substance, and that the daily use of its decoction
in beer must affect the health, yet it has long been observed that
this bitter substance in beer (though it would be better that the
1 From the Reichs-Anzeiger, No. 57, 1806.
2 This mistake had however an accidental, important good effect on all the inhabitants of Europe: since then some millions of dollars fewer have been drawn from
our part of the world, and the very bad effects of over-indulgence in genuine coffee
on the health and the morals, have been diminished.




OBJECTIONS TO A PROPOSED SUBSTITUTE, ETC.

543

more wholesome unhopped beer made from air-dried malt, were
generally used, especially that made from wheat) agreed better
than any other with our constitutions, and if only a moderate
quantity of it enter into the composition of the beer, it appears at
length to become almost quite innocuous to us.
But what excuse can be offered for forcing us to use in our
daily drink completely new medicinal substances, such as wormwood,
feverfew, and other drugs of still more unknown action, as psoralia, &c., in the form of unchanged vegetable decoctions, in place of
hops in beer? What pests in the form of newly developed chronic
diseases are we not threatened with, which must infallibly result
from the use of decoctions of medicinal herbs in such quantities,
the effects of which on the human body are quite unknown!1
We may read the bad effects on the human health from the
frequent use, e. g., of wormwood, in Lange (Domestica brunsv.,
p. 112), and in Vicat (Matiere med., p. 40). The bad effects of the
other substitutes for hops are not so easily proved.
But what do the projectors of the substitutes for hops they
recommend care about the injury they do, provided they only
taste bitter!
It is fortunate that all these bitters, which the true physician
has reason to suspect, are, when used in the preparation of beer,
suspected also by the drinkers, and are usually rejected by them
from a sort of instinct.
Of a not less injurious tendency are all the so-called succedanea
for powerful, established medicinal substances, particularly for
cinchona-bark.
I have nothing more to say respecting Breitfeld's substitute
for cinchona than the following:
1. That there is no such thing as a succedaneum or substitute for
bark, nor is it possible that there can be;
1 Medical men imagine, it is true, that they know the effects of, e. g., wormwood
and feverfew. They consider them as absolutely wholesome. This is however
a delusion. They have employed both these substances only in diseases in which
the slow recovery was dependent often on quite other circumstances than the medicines given; they have used them only in combination with other drugs. But few
know what harm these herbs can do to the human body when given singly in large
quantities.




544    OBJECTIONS TO A PROPOSED SUBSTITUTE FOR CINCHONA,
a. Because every plant has its own peculiar medicinal
mode of action that is not to be found in any other plant in
the world-and no other plant is cinchona; therefore it
stands to reason that cinchona can be replaced by nothing
but by cinchona itself.
As little as a willow, an ash, or a horse-chesnut tree, corresponds in external and botanical respects with a cinchona tree,
so little do the medicinal powers of the barks of said trees
resemble the cinchona bark. In like manner a mixture of
calmus, gentian and gall-nuts may indeed be much more
aromatic, more bitter and more astringent than cinchona
bark; but it can never be cinchona bark.
b. Because all the substitutes for cinchona that have
hitherto been proposed, inclusive of Breitfeld's, were only useful
where cinchona would have been of no use, and consequently
would do no good where cinchona is indicated, and could do
no good-therefore they cannot replace the latter.
2. That Breitfeld's is undeserving of consideration because it is
composed of several vegetable substances-a circumstance that,
owing to the ever-varying quality of the different ingredients, the
different modes in which they are dried and preserved, the coarser
or finer pulverization of the several substances, and even the impossibility of mingling them always in the same manner, must
always give a different product, as is the case with all compound
medicines.
3. That no one has yet determined the accessory medicinal
effects of the several ingredients of his mixture, whereby they
must evidently excite an accessory action different from that of
cinchona, and of an injurious nature, which the prescribing physician cannot take into calculation, as he does not know what it is.
Provided the cinchona bark be not employed in excessive doses,
nor given repeatedly where it can be dispensed with, nor where it
can do no good, nor yet where it must do much and often irremediable injury-not one tenth part of the valuable bark that has
been hitherto wasted will be required. Then it would not be too
dear; then the two millions and a half of dollars which Europe
yearly pays to South America for bark might be diminished to




AND TO SUCCEDANEA IN GENERAL.

545

250,000, and if we were wiser physicians, to 50,000 dollars, to the
great advantage of our patients.
Would it be very difficult to cultivate this invaluable tree in
Europe, seeing that it grows on the Andes1 at a height of 7692
feet above the level of the sea?
In conclusion I must express my regret that Mr. Breitfeld has
not devoted his well-meant labours to a less thankless subject.
1 Properly speaking, on the Cordilleras de los Andes, the highest range of mountains in the known world, which includes the whole western side of South America.

2N




OBSERVATIONS ON THE SCARLET-FEVER.

The malignant scarlet-fever that has prevailed in Germany for
eight years and proved fatal to many thousands of children and
older persons, often so unexpectedly, so rapidly, and with symptoms
never before heard of under such circumstances, this murderous
disease, termed scarlet-fever by almost every one, is really anything
but scarlet-fever; it is a new disease never seen in Germany before
the year 1800, which, on account of the red rash that usually
accompanies it, might be termed purpura miliaris, and which, then
for the first time, spread from the west, over Hesse, Bamberg,
Beyreuth, Thuringia and Voigtland, to Saxony, and thence since
that time has extended in all directions.
If it can be proved that this is a new disease and is widely different from the old genuine scarlet-fever (which old people can
still very well remember to have noticed in their youth in themselves and others), we can very well understand how it happened,
that the medical men did not know how to act in this new disease,
and that at first all who were likely to die, slipped through their
hands; indeed that their endeavours did more harm than good, as
they were always under the delusion that they had to do with the
old genuine scarlet-fever, and thus they were misled by this extraordinary confounding of names and things, to treat the new disease
in the same way as they had been used to treat the true scarletfever (by means of keeping the patient warm, administering elderflower tea, &c.). Such a mistake, such a confounding in diagnosis
and treatment of two such very different diseases, must naturally
have a very unfortunate result, as experience has shewn it to have
had by the many thousands who have fallen victims to this new
disease.
1 From the Ally. Anzeig. der Deutschen, No. 160. 1808.




OBSERVATIONS ON THE SCARLET-FEVER.

547

This disease is new among us, I repeat, for there is not the
slightest trace of such a purple miliary fever having ever before
prevailed in Germany.
The epidemic in Strasburg, decribed seventy-three years ago by
Salzmann, was a white miliary fever-white vesicles on a white
skin-and differed from our new miliary fever in this, that children
and old people were almost entirely exempted from it, and it chiefly
affected youths and adults between twenty and forty years of age;
sore throat was very rarely met with in it.
The miliary epidemic described by Welsch, of Leipzic, 150 years
ago, consisted of a white, millet-seed sized exanthema, and only
affected lying-in women; probably it was a disease brought on by
keeping them too warm.
The most recent miliary epidemic which Briining observed thirtysix years ago, in the neighbourhood of the Lower Rhine, differs also
from our new disease in this, that children of five years and under
generally remained free from it, and women were more frequently
attacked than men,-that it had its critical days, and was likewise
a white miliary rash, resting for the first few days on red spots,
which went off on the seventh day, leaving the white miliary rash
standing from three to seven days longer on the white skin.
The epidemics that bear the greatest resemblance to our present
purple miliary, are those observed by David Hamilton, long ago
(1710) in India, and Charles Allione (in 1758) in Turin.
Other observers only mention having occasionally observed a
miliary fever in single individuals, which were usually only brought
on by the use of heating, diaphoretic remedies, especially of opiates,
did not prevail epidemically, and are described by them in a most
vague manner.
That our miliary fever is new and very different from the true
scarlet-fever, the following comparison will shew.
The new red miliary-fever        The old, genuine scarlet-fever
(which for the last eight years has been
called scarlet-fever)
attacks persons of all ages;       attacks only children until their 12th
year (Sim. Schulze) - attacks only
children, almost never adults (Plenciz,
Sennert);
the eruption consists of purple-red  the redness of the skin is an erysipela2 2




548

OBSERVATIONS ON THE SCARLET-FEVER.

(Jani), of dark red spots' (verging on
brown), which on being pressed with
the finger do not leave a white spot but
remain unchanged, of a dark red colour,
of sharply defined, discrete patches of
redness,
always thickly studded with dark-red
miliary papule, which are not so much
elevated above the level of the skin
as stuck deep in it, yet distinctly perceptible to both the eye and the touch.
This exanthema attacks in an indeterminate manner, now this, now that
part of the body-there is no part of the
body for which it has a peculiar affection, or to which it attaches itself in a
peculiar manner (Stieglitz). Most frequently the favourite spots for its attack
are the covered parts and flexures of the
joints; most rarely the face. The rash
is usually accompanied by swelling
(Stieglitz).
This exanthematous fever has not a de
tous fire-coloured redness (Sennert);a bright scarlet redness, resembling
erysipelas in colour and in this, that it
immediately disappears on pressure with
the finger and shews a white spot,
which however immediately resumes its
red colour (Navier); the redness is like
the colour of a boiled lobster (Act. med.
Berol.);-a cinnabar redness (Plenciz).
The smooth shining redness of the
skin runs imperceptibly into the neighbouring white parts, in unnoticeable
shades, like erysipelas, and is never
well defined;-it becomes from time to
time, now a little paler, now a little
redder, and almost every instant it
spreads imperceptibly farther, and then
retires to its original seat (Navier).
None of the above-mentioned authors
allude to miliary elevations of the bright
red parts of the skin;-the skin of the
reddened parts is quite even and smooth
(Hahnemann);-the red parts of the
skin are quite smooth and destitute of
inequalities or elevations (Plenciz, Op.
tract. iii, p. 49)-and in this the scarlet
fever differs from every kind ofmiliary
fever (Plenciz, ib., p. 58).
The redness of the true scarlet-fever
prefers attacking first the uncovered
and but slightly covered parts, which
swell as far as the redness extends. At
first the redness and swelling occur on
the face (De Gorter, Plenciz)-at first
in the face, neck, and chest (Plenciz)
-the scarlet redness first appears, with
some swelling, on the face (neck and
chest), the hands, and the outside of
the feet, and from these parts it spreads
out in an erysipelatous manner (in the
worst cases) all over the body (Hahnemann).
In every genuine scarlet-fever the

SHence we may unhesitatingly call it purple miliary (purpura miliaris). Who
could confound this dark red rash with the bright fiery colour of scarlet cloth?




OBSERVATIONS ON THE SCARLET-FEVER.

549

termined, regular course, like other exanthematous fevers (Stieglitz); - the
eruption remains here and there for an
indeterminate  period, often  several
weeks; there is no fixed period for its
departure.
The red miliary rash often disappears
suddenly at indeterminate times, with
increased danger to life, usually followed suddenly by death.
The eruption may be copious or almost not at all present, the mildness or
malignancy of the disease not depending
on that (Stieglitz). Where the eruption is almost imperceptible the danger
is often greatest, the fever most malignant;-where there is a general full
eruption, the disease is often mild and
slight.
It is only the dark red miliary
patches that perspire, and it is only
when the whole body is covered with it
that the patient perspires all over, as
in the epidemic at Wittenberg.
This new miliary disease, falsely said
to be scarlet-fever, which first appeared
about the middle of the year 1800,1

redness appears on the parts named
simultaneously with the febrile heat,
and in mild cases is perceptible for from
three to four days (Plenciz, Sennert), in
bad cases, seven days (Plenciz)-and
goes off by becoming gradually paler
from day to day. The parts that first
became red, become first pale (Plenciz).
None of the above authors makes
mention of a sudden disappearance of
the redness of true scarlet-fever during
the fever. After the gradual fading of
the redness up to the fixed days mentioned above, there occur apyrexia and
desquamation (Sennert, Plenciz, De
Gorter, Sim. Schulze). Even after
death the hitherto red spots remain
coloured and turn violet (Navier).
The fuller and more extended the
redness of true scarlet-fever is, the more
malignant is the fever always (Hahnemann).
None of the reddened parts in true
scarlet-fever perspire during the disease
(in this all the authors I have mentioned
are agreed), if the skin is moist it is so only on the parts that are not yet reddened.
No erysipelas perspires, and as little does
the scarlatina redness. It is only when
the fever comes to an end, and the redness
has gradually gone off, that there sometimes occurs general perspiration, and
thereafter desquamation of the skin
(Sim. Schulze), and the disease may also
go off without any perspiration-(Act.
med. Berol.)
The true scarlet-fever is an old disease, which has been accurately observed for two centuries in Germany

1 In the first half of the year 1800 true scarlet-fever still prevailed, and a couple of
months thereafter the new miliary fever made its appearance.




550

OBSERVATIONS ON THE SCARLET-FEVER.

and, like every new pestilence, raged
as a most murderous epidemic where it
first appeared (there was no mild epidemic of it), and then from time to
time recurred, often several times in a
year in the same place (not unfrequently attacking the same persons a
second time), during the first years still
attacked several families in succession;
during the last years did not, it is true,
cease for any length of time, but did
not prevail quite epidemically again,
but rather attacked single families, or
even single individuals, in one place
(though it was not less fatal)-it seems
in the course of a few years to have a
tendency to become extinguished completely, like the English sweating-sickness at the commencement of the 16th
century.
Besides the diaphoretics, elder-flower
tea, &c., and the warm beds wherewith
it was sought to retain the eruption on
the skin (usually without success), purgatives, especially mercurial medicines,
are said to have done good in this exanthematous fever; but aconite along
with a moderately cool regimen saved
the most. It were foolish to judge of
the power of belladonna from its administration in this new miliary fever,
which, as we see, is anything but scarlet-fever.

and other countries, always appeared
only as an epidemic and pandemic, always attacked indiscriminately, and
with scarcely any exception, every child
that had not had the disease (never
those who had already had it), seldom prevailed in malignant, often in
mild, sometimes in perfectly mild epidemics (Sydenham, De Gorter, Nenter,
Junker) scarcely proving fatal to one
child in a thousand, never, or very
seldom, occurred sporadically, and the
reason of this was, that as it almost always attacked pandemically all children who had not previously had it,
there were not under 6 or 8 years
enough   subjects to infect in order
to show its epidemic character, hence
it almost never recurred in less than
6, 8, or 12 years, and on account of
this rarity of its recurrence, the oldest
practitioners scarcely ever saw it oftener than three times in their lives,
and it was quite unknown to our
younger practitioners.
In this old, true scarlet-fever, belladonna is useful, both as a prophylactic,
and as a remedy.




ON THE PRESENT WANT OF FOREIGN MEDICINES.

The loud complaints that are uttered respecting the want of
foreign medicines, and recently the lamentation on this subject (in
No. 176 of the Allg. Anz.) from our esteemed philanthropic Faust,
went to my heart, particularly as I recently got from one of the
most celebrated laboratories in one of the most famed cities in Germany, in place of choicest, best myrrh which I had ordered, lumps
of a gum-resin having somewhat the appearance of myrrh, but
which, on being pulverized, had a most nauseous odour, apparently
the product of some unknown umbelliferous plant, and which was
anything but myrrh.
" What will be the result of this blockade of Europe, what the
end of this deficiency of the most indispensable foreign drugs?"
anxiously exclaim both physicians and patients-" particularly as
the most sagacious men consider the substitution of one medicine
for another to be a lamentable mistake, as no substance in nature
possesses the same qualities as any other, nor is it possible that it
can, for they are characteristically different in externals, and as veal
cannot turn into mutton or pork, neither can quitch-grass be
transformed into sarsaparilla."
Of a truth, this daily increasing deficiency of foreign drugs
seems likely to become a great, an inconceivably great want.
We should no doubt find the warehouses of the druggists and
apothecaries as well and constantly filled as before, notwithstanding that there is a real deficiency of most of the exotica, and a
manifest want of foreign medicinal products, but-only with goods
which, thanks to the known abilities of the adulterators, with the
exception of an external resemblance, possess little or nothing of
the actual nature of the genuine drugs, carefully stored in jars,
chests, and boxes, whereon the honourable name has been for
a long time painted in durable oil-colours, to guarantee the gen1 From the Allgemeiner Anzeiger der Deutschen, No. 207. 1808.




552      ON THE PRESENT WANT OF FOREIGN MEDICINES.
uineness of their contents! But good heavens! what a quid pro
quo will the connoisseur find in them! Every philanthropist must
shudder at the effects such fabrications must produce on the sick.
It is not far from the truth to say, that the connoisseur can no
longer meet with any genuine extra-European medicines.
This want is great and incalculable, but I feel almost disposed to
assert that it is a just judgment of God for the incredible abuse
that has heretofore been made of these drugs. It may readily
happen to the spendthrift that he may suffer from want, and that
justly.
When we consider how many pounds of cinchona alone any
physician in large practice has hitherto used in his practice (it is
notorious that a London medical man used 500 pounds annually),
and how large the number of physicians is who give large quantities of medicine, we are horrified at the quantities of foreign
drugs hitherto consumed.
But, gracious God! was this not an abuse of thy noble gifts?
Was the large number of draughts, teas, mixtures, electuaries,
drops, powders, pills, administered at short intervals by tablespoonfuls and tea-spoonfuls, often alternated with one another
several times a day, and the first one scarcely tasted, put aside, and
replaced (or rather supplanted) by two or three other drugs-was
the enormous quantity of drugs employed for fumigations, dry and
humid applications, half and whole baths, clysters, &c.-was all this
not an abuse of the noble, precious products of foreign countries
brought from such great distances?
If it could be proved that such a multitude of drugs was necessary and indispensable for the patients' relief, then it would be
quite a different thing. In that case the blame would rest with
the Ruler of the earth, who, seeing we require so much, ought to
have supplied these our necessities by making them grow in larger
quantities on our hazel-trees, willows, in our meadows, woods and
on every hedge.
But all honour be to Him, the wise Preserver of mankind!
Such an expenditure, such a waste of exotic and indigenous drugs
was never required in order to cure the sick. It was not merely a
waste (for in that case it would simply have been analogous to
lighting our pipe with a bank note)-no, it was an actual sin
against true art and against the welfare of sick humanity.




ON THE PRESENT WANT OF FOREIGN MEDICINES.

553

Do not the poor, who use no medicine at all, often recover much
sooner from the same kind of disease than the well-to-do patient,
who has his shelves filled with large bottles of medicine? The
latter often remains much longer poorly after his treatment is
finished, and must often go from one watering place to another in
order to get free from the after-sufferings left in him by the
monstrous quantity of powerful drugs he took, which were usually
totally inappropriate and consequently hurtful in their character.
It must some time or other be loudly and openly declared; and so
let it now be loudly and unreservedly proclaimed before the whole
world, that the medical art stands in need of a thorough reform from
head to foot. What ought not to be done has been done, and what
is of the utmost importance has been totally overlooked. The evil
has become so crying that the well-meaning mildness of a John
Huss no longer avails, but the fiery zeal of a rock-firm Martin
Luther is needed to sweep away the monstrous leaven.
There is no science, no art, not even any miserable handicraft,
that has kept pace so little with the progress of the age; no art
has remained so fixed in its original imperfection as the medical art.
Medical men followed at one time this fashion, at another a
different one, now this school, now that, and when the more
modern method appeared unserviceable they sought to revive some
ancient one (that had formerly shewn itself worthless). Their
treatment was never founded upon convictions, but always upon
opinions, each of which was ingenious and learned in proportion as
it was valueless, so that we are now arrived at this point, that we
have the unhappy liberty of hopelessly selecting any one of the
many methods, all of which halt in an almost equally grievous
manner, but we have actually no fixed standard for treatment, no
fixed principles of practice that are acknowledged to be the best.
Every physician acts according as he has been taught by his
school or as his fancy dictates, and each finds, in the inexhaustible
magazine of opinions, authorities to whom he can appeal.
The method of treating most diseases by scouring out the stomach and bowels;-the method of treatment which aims its medicinal darts at imaginary acridities and impurities in the blood and
other humours, at cancerous, rachitic, scrofulous, gouty, herpetic
and scorbutic acridities;-the method of treatment that presupposes
in most diseases a species of fundamental morbid action, such as




554      ON THE PRESENT WANT OF FOREIGN MEDICINES.
dentition, or derangements of the biliary system, or haemorrhoids,
or infarctus, or obstruction in the mesenteric glands, or worms, and
directs the treatment against these;-the method which imagines it
has always to do with debility, and conceives it is bound to stimulate and re-stimulate (which they call strengthen);-the method
which regards the diseased body as a mere chemically decomposed
mass which must be restored to the proper chemical condition by
chemical (nitrogenous, oxygenous, hydrogenous) re-agents;-another method that supposes diseases to have no other original cause
but mucosities-another that sees only inspissation of the juicesanother that sees nought but acids-and yet another that thinks it
has only to combat putridity;-the method that imagines it must
act specially and can act absolutely on the skin, the brain, the
liver, the kidneys, or some other single organ;-the method that
conceives it must search for and treat only spasm or paralysis
in diseases, only a derangement of the antiquated functiones
naturales, vitales, animales, or the revival of this doctrine, the
derangement of the irritability, the sensibility, or the reproductive faculty;-the method that proposes to direct its attention to
the supposed remote exciting causes of disease;-the method that
prescribes* medicines indiscriminately in diseases, in order to be
able to discard those that do harm and retain those that seem to
be of use (ajuvantibus et nocentibus);-the method that, according
to the mere names that the disease before them seems to have in
books, goes to work with prescriptions got out of the self-same
books;-the method that merely attends to particular symptoms in
diseases in order to suppress these by some palliative antidote
(contraria),-and that method that boasts of being able to subdue
the disease by assisting and promoting the efforts of nature and
the natural crises;--all these modes of treatment, many directly
opposite to one another, have each their authorities and illustrious supporters; but nowhere do we find a universally applicable,
efficacious standard of treatment accredited in all ages.
Imagine the embarrassment in which a physician must be placed
when he comes to the sick-bed, as to whether he should follow
this method or the other, in what perplexity he must be when
neither the one nor the other mode of treatment avails him; how
he, misled now by this, now by that view, feels himself constrained to prescribe now one, now another medicinal formula,




ON THE PRESENT WANT OF FOREIGN MEDICINES.

555

again to abandon them and administer something totally different,
and finding that none will suit the case, he thinks to effect, by the
strength of the doses of the most powerful and costly medicines,
that cure which he knows not (nor any of his colleagues either)
how to bring about mildly by means of small, rare doses of the
simple but appropriate medicine. All this he does the more
readily seeing that the prevailing system derived from England
commands him to assail his poor patients with large, with enormous doses of the most active medicines. He is thus in the habit
of forcing the disease to take itself off by administering repeated,
frequently alternated and varied mixtures of large doses of very
powerful, expensive medicines. The disease no doubt is removed,
it yields to the force brought against it; but if death be not the
result, there arise other diseases, new maladies, that entail the
necessity of a long, expensive after-treatment, because all these
numerous, dear, strong drugs were for the most part unsuitable,
were not accurately adapted to the cure of disease in all its parts.
Thus the ruination of human health goes hand in hand with
the lavish waste of so many costly foreign drugs-the way of
destruction! This was assuredly not the intention of the allbountiful, wise Creator, who in nature effects many and great
and multifarious objects with few, simple means, and apparently
insignificant appliances, and has certainly so ordained the medicines he created, that each should have its own immutably fixed
uses, its certain, unvarying curative power, with which it should
be able to effect, in excessively small doses, many and great things
for the weal of (God-beloved) man, if we, instead of interminably
talking and writing mere empty conjectures and hypotheses, would
but endeavour to become better and more accurately acquainted
with it. Dixi et salvavi animam. Let us become better, and all
will soon go better.




ON   THE    VALUE    OF THE     SPECULATIVE      SYSTEMS
OF   MEDICINE,
ESPECIALLY AS VIEWED IN CONNEXION WITH THE USUAL
METHODS OF PRACTICE WITH WHICH THEY HAVE
BEEN ASSOCIATED.'
Although it has ever been man's endeavour to discover and
explain the connexion of the various constituents of the living
body, and the manner of their reaction upon each other, and upon
external forces; to tell how they give rise to those living instruments (organs) which are requisite to the maintenance of life; and
how, out of the necessary organs, a self-contained whole-a living
healthful individual-is formed and upheld; it has been found impossible, though it has been often tried, to explain these, either on
the principles of mechanics, or physics, or chemistry, or the laws of
liquid and solid bodies in the inorganic world; or by gravitation or
friction, or by impulse, or vis inertice, or by the laws of the attraction and cohesion of several similar bodies touching each other
at many points, or the repulsion of dissimilar; nor has it been explained by the forms of the individual elementary substances which
compose man's body, according as these might be described as flat,
or pointed, or spherical, or spiral, or capillary, or as rough or
smooth, angular or hooked; or by the laws of elasticity, of the
contractive and expansive power of inorganic substances, or of the
diffusion of light and production of heat, or of magnetic, electric,
or galvanic phenomena, or by the mode of operation of substances
containing oxygen, hydrogen, carbon, or azote, or of the acids,
earths, or metals, or of gelatin, albumen, starch, gluten, or sugar.
But though all the component parts of the human frame are to
be found in other parts of nature, they act together in their organic
From the Allgem. Anz. der Deutschen, No. 263. 1808.




ON THE SPECULATIVE SYSTEMS OF MEDICINE.

557

union, to the full development of life, and the discharge of the
other functions of man, in so peculiar and anomalous a manner
(which can only be defined by the term vitality), that this peculiar (vital) relation of the parts to one another and the external
world, cannot be judged of or explained by any other rule than
that which itself supplies; therefore, by none of the known laws of
mechanics, statics, or chemistry. All those theories, to which age
after age has given birth, when brought in contact with simple
experience, and tried by an impartial test, have ever been found to
be far-fetched and unfounded.
Yet, in spite of the uniform disappointment of these innumerable
attempts, the physiologists and pathologists would still return to
the old leaven; not because they saw any likelihood of these
hypotheses leading to useful discoveries in the art of healing, but
because they placed the essence of the medical art, and their own
chief pride, in explaining much even of the inexplicable. They
imagined it impossible to treat scientifically the abnormal states of
the human body (diseases), without possessing a tangible idea of
the fundamental laws of the normal and abnormal conditions of the
human frame.
This was the first and great delusion they practised on themselves and on the world. This was the unhappy conceit which,
from Galen's days down to our own, made the medical art a stage
for the display of the most fantastic, often most self-contradictory,
hypotheses, explanations, demonstrations, conjectures, dogmas, and
systems, whose evil consequences are not to be overlooked. Even
the student was taught to think he was master of the art of discovering and removing disease, when he had stuffed his head with
these baseless hypotheses, which seemed made for the express purpose of distracting his brains, and leading him as far as possible
away from a true conception of disease and its cure.
From time to time, it is true, an accumulation of facts, often of
a nature to arrest the least attentive observer, forced on men the
conviction that the doctrine of the structure and functions of the
human body in the healthy state (physiology), and of the inward
changes consequent on the generation of disease (pathology) which
deduces them from atomical and chemical principles, is an erroneous one; but in avoiding this error,-still misled by the vain
fancy that the business of the medical profession was to explain every




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ON THE VALUE OF THE

thing,-they fell into the opposite, but not less dangerous evil of
superstition.
At one time, men created for themselves an imaginary incorporeal something, which guided and ruled the whole system in its
vicissitudes of health and disease (Van Helmont's Archceus, Stahl's
Animal Soul); at another, they flattered themselves they had discovered the secret of physical constitutions and temperaments, as
well as of the origin of particular diseases and epidemics, in the
constellations of the stars, in an influence emanating from the
heavenly bodies, many millions of miles distant;-or (according to
the modern wide-spread notion, based on ancient absurdities), the
human body, in agreement with the old mystic number three,
developed itself in triplicity, presented a miniature of the universe
(microcosm, macrocosm), and thus, by means of our knowledge of
the great whole, miserably defective as it is, was to be explained to
a hair's-breadth.  That which had baffled clear chemistry and
physics, dim, self-unintelligible mysticism and frenzied fancy were
to bring to light: old astrology was to explain what puzzled modern
natural philosophy.
Thus did the leaders of the medical sects and their followers,
whenever they sought to analyse health and disease and its cure,
deviate more or less widely from the truth; and the only use of
piles of folios, quartos, and octavos, which cost a lamentable expenditure of time and energy, is to frighten us from indulging in a
like explanation-mania, and teach us that all such immense exertions are nothing but pernicious folly.
But if these physiological refinements and pathological would-be
explanations, as regards their proper object, the cure of disease, are
rather prejudicial than helpful, as no unprejudiced person will
deny, of what possible use are they?
" Surely the physician," I fancy I hear one exclaim, "requires
a theory at once for a clue, a thread on which to string his ideas
and systematic practice, and a line to direct him at the sick-bed.
Every artist, who is not a mere mechanic, must desire to have some
connexion of ideas in his mind as he works, concerning the character of the object on which he is to labour, and the nature of the
condition into which he is to mould it."
True, I reply; but this clue must neither be a flimsy cobweb nor
a false guide: for then it were worse than none.




SPECULATIVE SYSTEMS OF MEDICINE.

559

The materials of the mechanical workman, indeed, have physical
and chemical properties, and can only be fitly and fully employed
by one who is well acquainted with these properties.
But it is quite otherwise with the treatment of objects whose
essential nature consists in vital operations-the treatment, namely,
of the living human frame, to bring it from an unhealthy to a
healthy condition (which is therapeutics), and the discipline of
the human mind, to develop and exalt it (which is education). In
both cases, the matter on which we work is not to be regarded and
treated according to physical and chemical laws like the metals of
the metallurgist, the wood of the turner, or the cloth and colours
of the dyer.
It is impossible, therefore, that either physician or teacher, when
caring for mind or body, should require such foreknowledge of his
subject-matter as shall lead him by the hand, as it were, to the
completion of his work, as, perhaps, a knowledge of the physical
and chemical properties of the materials helps and conducts the
metallurgist, the tanner, and other such craftsmen, to the perfection of theirs. The vocation of both those others demands quite
another kind of knowledge, just as their object, a living individual,
is quite different.
Nor are they at all more assisted by metaphysical, mystical, and
supernatural speculations, which idle and self-sufficient visionaries
have devised respecting the inner absolute essential nature of the
animal organism; respecting life, irritability, sensibility and reproduction, and the essential nature of the mind.
Which, indeed, of the ontological systems regarding the (undiscoverable) nature of the human soul promises to afford any aid to
the teacher in the execution of his noble office? He might well
lose himself in the interminable labyrinth of abstract speculations
on the ego and the non-ego, on the essences of the soul, &c., which
extravagant self-conceit has in all ages wrung from the racked
brains of hosts of sophists; but no advantage that will reward
his pains will he draw from these transcendental subtleties. It has
not been given to mortal man to reason a priori on the nature of
his own soul.
The wise teacher is aware of this; he spares himself this fruitless trouble, and, in aiming at as wide an acquaintance as possible
with his subject-matter, confines himself to the a posteriori, to that




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which the mind's own acts have revealed concerning itself, to empirical psychology. More on this subject in this stage of being he
cannot, more he need not, know.
Just so is it with the physician. That which binds in so wonderful an organization the (may be originally chemical) constituents of the human frame in life-which causes them, in spite of
these their original nature, to act in quite an unmechanical and
unchemical manner-which excites and impels them, when thus
combined, to such automatic performances (which do not obey any
of the known laws of mechanics, and differ from every chemical
process, and all physical phenomena); this fundamental force does
not reveal itself as a distinct entity; it can only be dimly surmised
from afar, and is for ever concealed from all inquiry and observation. No man is acquainted with the substratum of vitality, or
the a priori hidden arrangement of the living organization-no
mortal can ever dive into it, nor can human speech, either in prose
or verse, even faintly shadow it forth: the attempts ends in fiction
and sheer nonsense.
Throughout the course of the two thousand years and upwards
in which men have prided themselves on the cultivation of philosophy and medical science, no single step, not the smallest, has
been made towards an a priori knowledge of the vitality of the
bodily frame or of the intellectual energy (the soul) which actuates it. All that inflated bombast, passing for demonstration,
abounding in words, but void of sense-all the antics and curvets
of the sophists, about indiscoverable things, are ever vain, and to
the modest spirit of the true philosopher perfectly insufferable.
We cannot even conceive a path that should lead us to such
knowledge.
No, not a glimpse shall frail mortality ever obtain of that which
lies deep hidden in the sacred recesses of the Divine Creating
Mind, far, immeasurably far, beyond the grasp of human comprehension!
All, therefore, that the physician can know regarding his subject-matter, vital organization, and all that it concerns him to
know, is summed up in that which the wisest among us, such as
Haller, Blumenbach, Wrisberg, comprehended and taught under
the term physiology, and which we might designate the empirical
knowledge of vitality, viz.: what the appreciable phenomena are




SPECULATIVE SYSTEMS OF MEDICINE.

561

which occur in the healthy human body, and what their connexion
is; the inscrutable how they occur, remaining entirely excluded.
I pass on to pathology, a science in which that same love of
system which has crazed the brains of the metaphysical physiologists,
has caused a like misapplication of intellect in the attempt to
search into the essential nature of diseases, that whereby affections
of the system become manifest diseases. This they term the doctrine of proximate, internal causes.
No mortal can form a clear conception of what is here aimed at,
to say nothing of the impossibility of any created intelligence, even
in imagination, finding a road to an intimate view of what constitutes the essence of disease; and yet hosts of sophists with important looks, have affected to play the seer's part in the matter.
After humoral pathology (that conceit, which took especially
with the vulgar, of considering the diseased body as a vessel full of
impurities of all sorts, and of acridities with Greek epithets, which
were supposed to cause the obstruction and vitiation of the fluids
and sdlids, putrefaction, fever, everything, in short, whereof the
patient complained, and which they fancied they could overcome by
sweetening, diluting, purifying, loosening, thickening, cooling, and
evacuating measures) had, now under a gross, now under a more
refined form, lasted through many ages, with occasional interludes
of many lesser and greater systems-(to wit, the iatro-mechanical
system,the system which derives disease from the originalform of the
parts, that which ascribes them to spasms and paralysis, the pathology of the solids and nerves, the iatro-chemical system, &c.) the seer
Brown appeared, who, as though he had explored the pent secrets of
Nature, stepped forward with amazing assurance, assumed one primary principle of life (excitability), and would have it to be quantitively increased and diminished in diseases, accumulated and
exhausted, made no account of any other source of disease, and persisted in considering all disease from the point of view of want or
excess of energy. He gained the adherence of the whole German
medical world, a sure proof that their previous medical notions had
never convinced and satisfied their minds, and had only floated before
them in dim and flickering forms. They caught eagerly at this onesidedness, which they persuaded themselves into believing was genuine simplicity. All the other fundamental, vital forces which were
supposable enough (though, at the same time, little serviceable to a
2o




562

ON THE VALUE OF THE

true view and cure), they gladly cast aside, out of love to his subtle
doctrine, and found it highly convenient to be pretty nearly exempted from all further thought on disease or its cure. All they
had now to do, was arbitrarily to determine, with a little help from
the imagination, the degree of excitability in diseases according to
the scale of their master, in order, by sedative or exciting measures-for all remedies, according to his new classification, were at
once divided thus-to screw up or let down the degree of excitability assumed in each case. And what was after all, this his onesided excitability?  Could he attach any definite and intelligible
idea to it?  Did he not overwhelm us with a flood of words destitute of any clear meaning?  Did he not draw us into a treatment
of disease, which, while it answers in but few instances, and then
imperfectly, could not but in the preponderating remainder give
rise to an aggravation or speedy death?
The transcendental school repudiated the idea of having but one
fundamental, vital force.  The reign of dualism    commenced.
Now we were fooled by the natural philosophers. For of such
seers there was no lack; each fell on a new aspect of things-each
wove a different system, having nothing in common but the morbid propensity, by inward self-contemplation not only to give an
exact a priori account of the nature and universal constitution of
things, but, moreover, to look on themselves as the authors of the
whole, and, according to their own fashion, to construct it for and
out of themselves. Every hint they deemed themselves to have
gathered on life in the abstract, and the essential nature of man
was-like their whole conception-so unintelligible, so hollow
and unmeaning, that no clear sense could be drawn from it.
Human speech, which is only fitted to convey the impressions
of sense, and the ideas immediately flowing from them-generalizations, each one of which is easily insulated into concrete
examples, and thus brought home and typified to the sense-refused
to embody their conceits, their extravagant fantastic visions; and,
therefore, they had to babble them forth in new-fangled, highsounding words, superlunary collocations, eccentric rhapsodies, and
unheard-of phrases without any sense, and got involved in such gossamer subtleties, that one felt at a loss to know which was the
most appropriate-a satire on such a misdirection of mental energy,
or an elegy on its ill success. We have to thank the natural phi



SPECULATIVE SYSTEMS OF MEDICINE.

563

losophers for the disorder and dislocation of many a young doctor's
understanding. Moreover, their self-conceit was yet too much inflated for them to bring forward many views on diseases or their
cure, except what they now and then put forth on their dualism,
their polarization and representation, their reflex, their differentizing, and indifferentizing, their potentizing and depotentizing.
This natural philosophy still lives and flourishes in a forced animation of matter, and in ecstatic hallucinations concerning the modelling and ordering of the world and its epitome-man. Incorporeal
and ethereal, it still soars aloft beyond our solar system, beyond
the bounds of the actual; and does not seem likely yet awhile to
descend from its super-sublime elevation to the lowly sphere of
practice (the cure of man's diseases), nor indeed-so far has it
overstrained its power-to be able to do so.
But lately there has shot out a branch from this tree, that
seemed to have more reference to the medical art.         This new
doctrine, to give us an insight into the nature of disease, bethought
itself of serving up afresh the old functiones animales, naturales,
vitales, though under new names. But what imaginable expedient
have they for ascertaining the exact degree in which the sensibility,
irritability, or reproduction, they themselves (arbitrarily) dealt
out to each of the organs, are, in individual cases, increased,
diminished, or changed in quality-to which of these, preferably to
the rest-and (for there is scarcely an organ in the human frame to
which any one of these three properties can be denied) what is the
part played by each organ with reference to these three great
divisions in any given case of disease, and what intimate and
absolute condition of the whole system thence arises, whence it
may be clearly seen what is the appropriate, and in every respect
suitable, remedy?    What an unsolvable problem!       And yet its
solution is indispensable to the practitioner, if he is to make any use
of the system.1  And-lest we should, after all, be only quibbling
about words-what do these three words, sensibility, irritability,
and reproduction, precisely stand for, in concrete ideas?
1 If, indeed, this laying down of three prime organic functions, means nothing
more than an approximative view, on which nothing is intended to be built, and least
of all, medical practice, in this case, I can find no fault with this antiquated scheme,
which simply, as a view, is rational and harmless enough, though of no practical
utility.
2o2




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How impossible is it by all these barren a prioris to obtain such
a just view of the different maladies as shall point out the remedy
suited to each-the sole genuine aim of the healing art! How
can one justify to a sound judgment the seeking to make these
speculative subtleties, which can never be made concrete and
applicable, the chief study of the practical physician?
It is one of the regulations that most clearly mark the wisdom
of the all-consistent, all-merciful Creator, that what would be useless to man has been rendered impossible to him.
The teacher is well aware, that as he is shut out from an ontological acquaintance with the absolute nature of the soul (since it
would profit him nothing), besides empirical psychology, he needs
to know nothing but the practical aberrations of the human mind
and heart, and the methods whereby to lead each misguided wanderer back to the paths of virtue-to carry his noble work to its
highest perfection.
Socrates, the instructor of men, with his practical knowledge of
mankind, his delicate moral sense, and fine perception of what
makes the true happiness of man, needed but a historical knowledge of the faults of those with whom he had to do, in order,
by the application of the fittest arguments, and his own better
example, to allure them back to virtue. He was informed of
Aristodemus that he slighted the Deity; he gathered from some of
his expressions the symptoms of this perversion of mind, and the
particular prejudices that held him back from religious feeling;
and this sufficed him to teach him better, and to elicit from his
own confessions, the arguments that were to shut him up to reverence for the Deity. Assuredly he needed not to institute any
researches on the essence of the human mind, or the metaphysical
nature of this or that delinquency of heart to attain the godlike
aim.
And, in like manner, besides a historical acquaintance with the
constitution of the human frame in a healthy state, the physician
needs but in the same way to know the symptoms of the particular
malady (further, indeed, he cannot explore, as it would serve him
nothing), in order to remove it, supposing he then knows the right
remedy.
Or, after all, is this all a mistake, and does the design and dignity
of the medical art lie rather in vapoury theorizing, than in skill in




SPECULATIVE SYSTEMS OF MEDICINE.

565

curing diseases? Then, indeed, those word-mongers, who neither
do nor cure, must bear away the palm!
Yet, if these metaphysical speculations and systems concerning
the essential nature of disease (supposing they possessed some,
though it were the veriest shadow of probability) were of some, the
least possible value to the physician, (and some value, methinks,
that, after all, must surely possess, which has been the cause of so
much ado), then we cannot but conclude that this race of systemframers and system-followers must, at any rate, form the better
and more successful practitioners, since they are possessed of that
which-to believe them-is the true and only solid basis of the art
of medicine!
But alas! it is these very men who refute, at the sick-bed, their
own bragging boast of being the confidants of Nature; it is these
very men who are the most helpless, when they are not the most
disastrous, practitioners.
Not a single founder or follower of any of the many medical
systems could or (if he could, as now and then, perhaps, he
might) would dare to carry out his system faithfully and vigorously
into practice, without doing the greatest injury to his patients; so
that they would have been far better off wanting medical aid
altogether.1 They were obliged, if they did not wish to see all die
before them, either to betake themselves to the do-nothing (expectant) system; or, contrary to the professed tenets of their school,
to return secretly to the least harmless expedients of earlier times,
the revulsive, purgative, and palliative measures of humoralism and
suburralism.
But we need not very particularly examine their method to
perceive, that, at any rate, it did not take its rise in true philosophy, nor lift its aspirations to the lofty heights of reason and
consistency.
One might have expected, that, in the cure of disorders which,
in their own opinion, they had right learnedly defined a priori,
and reduced to most simple principles, they would only have each
time employed a single simple medicine (and watched its effect), a
1 I may refer, in place of any other of the thousand well-known instances, to that
notorious instance of the Brunonian treatment, in the case of one of the sons of the
renowned Peter Frank, of Vienna.




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substance whose action was quite known to them in extenso, the
best known, most appropriate, only applicable-according to the
general rule binding on all: what may be effected by a simple
remedy one should not seek to attain by means of compound ones:
quod potest fieri per pauca &c.
But nothing was farther from their thoughts. In the main
thing, the application of the beautiful simple theory-in practicethey kept faithfully to the old beaten track (though with the constant addition of the newest, most fashionable remedies), a plain
proof that their system was framed for show-for a make-believe,
and not for use.
In direct opposition to plain common sense, they attack disease
by complex mixtures of medicines, none of which they are more
than superficially acquainted with, and of these medicinal pots
pourris they often give several together, and many in one day:
"' haud leve obstaculum penitiori virium in medicamentis cognitioni
objicit, quod rarissime simplicia, sed ut plurimum composita, nee
haec sola, sed aliorum usu interpolata usurpentur." 1
Such a mode of proceeding, of itself, knocks all the pretensions
to philosophical simplicity and consistency of these a-priorists [a
priori men] on the head. No single physician on the face of the
globe, neither the framer of the system nor his followers, uses a
simple unmixed medicament, and then waits till its action is exhausted before giving another!
Even supposing the virtues of each single medicine were exactly
known, this employment of the many-mixed, this pell-mell administration of several substances at once, each of which must have a
different action, would in itself be highly absurd, and produce a
blind and confused practice. For how complicated must the interaction be of so many ingredients; how impossible to trace back
the combined effect on the patient to them each individually, in
order, in the subsequent treatment, to omit or diminish the one
and increase the other! But this will not do with these hotchpotch doses; they produce, thus united, such a resultant, that no
one can tell what is owing to this or the other ingredient in the
combined effect. No one can tell which ingredient vitiated the

1 Fr. Hoffmann, Med. Rat, vol. iii, s. ii, c. 37,  10.




SPECULATIVE SYSTEMS OF MEDICINE.

567

action in such and such a manner, or which altogether antagonized
the other, and neutralized its effect.
But the case is worse still, and the proceeding more reprehensible, when we consider that the action of each, or, at any rate, of
the most of these substances thus huddled together, is individually
great and yet unascertained.
Now, to mix in a prescription a number of such strong disordering substances, whose separate action is often unknown, and only
guessed and arbitrarily assumed, and then forthwith, at a venture,
to administer this mixture, and many more besides, thick upon one
another, without letting a single one do its work out upon the
patient, whose complaint and abnormal state of body has only been
viewed through illusive theories, and through the spectacles of
manufactured systems-if this is medical art, if this is not hurtful
irrationality, I do not know what we are to understand by an art,
nor what is hurtful or irrational.
It is usual at this point, for want of anything else to say, to
excuse one's self by saying, " the several ingredients in a prescription are to be chosen with reference to the various aspects of the
(hypothetically assumed) inward condition of the body, or, indeed,
of the symptoms."
Just as if one single simple substance, if it were but rightly
known, might not conform to several, many, all of the (un-ideal)
aspects of the complaint,-as if all the numerous symptoms could
be covered by a medley, whose ingredients, so unknown in their
action, in combination counteract and, in an unforeseen manner,
vitiate and neutralize each other!
This motley mixing system is nothing but a convenient shift
for one who, having but a slender acquaintance with the properties of a single substance, flatters himself, though he cannot find
any one simple suitable remedy to remove the complaint, that by
heaping a great many together there may be one amongst them
that by a happy chance shall hit the mark.
Whether this mode of treatment be successful, or the reverse,
in neither case is anything to be learnt from it, nor can it cause
the medical art to make a hair's-breadth of progress.
Has there been a change for the better-to which of the ingredients of the medley, or the many successive medleys, treading on
each other's heels, is it owing? This must ever remain a problem.




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"All you have to do, in a similar case, is to repeat the same
mixture, or succession of mixtures, in the same order."
Fond fool!    The case exactly coinciding with that will never
occur-can never occur again.
Moreover, it is always difficult to prepare mixtures a second
time precisely the same as the first, and how much more so when
a long interval intervenes. The same recipe often brings out a
very dissimilar compound, when it is given to several apothecaries
at the same time to make up. This results from many causes.
It is not likely, either, often to happen that the patient will
take these mixtures, not unfrequently disgusting both to taste and
smell, in the exact quantity and time prescribed. Are you quite
sure that he has even tasted this or that nauseous dose, and that
he has not substituted for it a less disagreeable domestic remedy,
to which his improvement is due?
And now, on the contrary supposition, that he is no better for
the medley dose, or even somewhat worse, which ingredient,
among so many, is to be blamed for this result, that it may be
omitted in the recipe on a future occasion?
"That is what no one can tell, so it is better never to repeat
the whole mixture."
I should regret much thus to throw away the gold with the
dross. Have I not happily cured the disease by the employment
of a single ingredient, which I picked out from the prescription of
my predecessor, which had long been used with bad effects, because
I knew that it must be the only efficacious one for the case
before me?
How unwise is it, therefore, to prescribe such mixtures-uninviting often to the eye, the smell, and the taste-of drugs, not one
of which is rightly known in itself, or in connexion with the rest!
Am I told "The properties of the medicines are not unknown"?     I ask: Are the half-dozen words which the Materia
Medica contains regarding each to be called information, exact
information?'  Often it is nothing more than a list of names of
1 How honestly our Friedrich Hoffmann speaks on this subject:" Quomagis in artis exercitio utile est, veras et non fictas medicamentorum, pro
tam diversa corporum et morborum ratione, vires intimius nosse, eo magis utique
dolendum, immo mirandum est, quod, si dicere licet, quod res est, perpauca sint
remedia, quorum virtutes et operationes certe ac recte perspectae, sed pleraeque spem




SPECULATIVE SYSTEMS OF MEDICINE.

569

diseases, in all of which the substance in question is said to have
been useful (frequently a long list, so that the falsehood is manifest.1)  Names of diseases, did I say?         Heaven knows to what
states of body these names were given, and what wisdom presided
over the assigning of them!
And whence do these medical authorities draw their data?
Surely not from an immediate revelation? In truth, one would
almost be induced to believe they must have flowed to them from a
direct inspiration, for they cannot be derived from the practice of
the physicians, who, it is well known, hold it beneath their dignity
to prescribe one single, simple medicament, and nothing more, in
a disease, and would let the patient die, and the medical art ever
remain as a no-art, sooner than part with their learned prerogative
of prescribing artistically compounded receipts.
As, therefore, the authorities in materia medica, if I may speak out
a little, cannot have obtained the greater part of their data as to the
supposed virtues of the pure, simple medicinal substance from the
experience2 of learned physicians, since scarcely anything of the
kind is to be obtained from them, whence do they get it?
atque expectationem, curantis frustrentur, quia verae pharmacorum facultates in
Democriti quasi puteo adhuc latitent!-pauca certe supersunt, quae fidae et expertae
virtutis, plurima vero infida, suspecta, fallacia, ficta." (Med. rat., t. iii, s. ii, c. 3, g i.)
1 And how dangerous are such falsehoods! " In nullo mendacio majus est periculum, quam in medico." (Plin., Hist. Nat. lib. 29, c. 1.)
2 Although it is certain that the Materia Medica can and must be the daughter
of experience, yet even it has given way to arbitrary opinions, ideal and dreamy hypotheses, and has allowed itself to be moulded to-day into one form, and on the morrow
into a new form, exactly as the dominant medical system for the time being commanded.   The remedies employed by the ancients, as alexipharmaca, cephalica
splenica, uterina, had afterwards to undertake the office of antispasmodic and antinervous remedies. When the prevailing system assumed tension and laxity of the
fibres as the foundation of disease, the very same medicines which had hitherto performed a different part were forced to be twisted into one of these two directions. But
did the reigning system require blood-cleansing or morbid-acridity-destroying means,
then the quondam tonica, or sedantia, or diaphoretica, or eccoprotica, or diuretica,
were quickly transformed into mundificantia, antiscorbutica, antiscrophulosa, anti.
phorica, &c. Then, when Brown needed for his system only stimulating and debilitating remedies, those very remedies which formerly had been marshalled unde
many other titles, are immediately enlisted in the two new regiments, and at will
drafted into one or the other; and as he more particularly required diffusible and
permanent stimuli, unfettered fancy was not long at a loss-medicines were speedily
raised to one or the other rank, just as if one had but to utter the fiat, and the substances could not choose but obey the commands of the exalted man, at his pleasure




570

ON THE VALUE OF THE

Most of the imputed virtues of the, simple drugs have, in the
first place, obtained a footing in domestic practice, and been
brought into vogue by the vulgar and non-professional, who often
cannot judge of the genuineness of the medicine; often do not
give it the right name; least of all, can correctly determine the
state of the body in which it is said to have been useful. I say
" said," for even with them, if needs be, now this now that family
recipe has been outwardly or inwardly applied; so that at last it
is impossible to say what has really been beneficial, granting the
complaint itself has been perfectly recognised, which, however, by
such observers, it never is.
Barren information of this sort was collected by the old herbalists, Matthioli, Tabernaemontanus, Gesner, Fuchs, Lonicer, Ray,
Tournefort, Bock, Lobel, Thurneisser, Clusius, Bauhin, &c., very
briefly, superficially, and confusedly, and interwoven with baseless
and superstitious conjectures, intermingled with that which the
unciting Dioscorides had in a similar manner collected; and from
this unsifted catalogue was our learned-looking Materia Medica
supplied. One authority copied another, down to our own times.
Such is its not very authentic origin.'
to enter on one or the other function. Just as if the primary action of cinchona
would spread more slowly through the system, or its secondary action last much
longer than that of the equally little understood opium! As matters till then had
stood, the system maker had only to dictate which new part this or the other medicine had to assume, whether it was to be an invertens, a revertens, or a torpens
(Darwin); and, see, it must suffer itself to be so employed, until for the behoof of a
new system, it is christened anew, and is as peremptorily required to discharge
another office.
" But if you refer the action of the medicines to their chemical bases, as the very
newest system does," I hear some one reply, "then, assuredly, you will act conformably to nature." In this way some medicines are (as arbitrarily as before)
reckoned carbonaceous and others hydrogeneous, and to each of these summarilydivided classes peculiar (fictitious) modes of action despotically assigned. But
cabbage, roast-beef, and wheaten cakes, contain also plenty of nitrogen, carbon or
hydrogen-where then do we discover in them those properties which were so liberally
allotted to these elementary substances?
What is to become of an art (to which the charge of human life has been committed)
iffancy and caprice are to have the upper hand in it?
1 How uninquiringly our writers on materia medica have adopted the statements
proceeding from these impure sources is evident, among other things, from this, that
they enumerate among the virtues of crude medicines such as were originally
derived from the mere suppositions of our superstitious forefathers, who had child



SPECULATIVE SYSTEMS OF MEDICINE.

571

The few books that form an exception to this (Bergius and
Cullen), are all the more meagre in data respecting the properties
ishly enough asserted certain medicinal substances to be the remedies of certain
diseases, merely on account of some external resemblance of those medicines with
something appreciable by the senses in those diseases (signature), or whose efficacy
rested only on the authority of old women's tales, or was deduced from certain of
their properties that had no essential connexion with their fabulous medicinal
powers. Thus the roots of the orchis and of the saloop, merely because, on account
of their resemblance in shape to a pair of testicles, the ancients perceived in this an
augury of their utility in aiding the sexual function, are still said to be analeptics
and aphrodisiacs. The hypericum is still esteemed as a vulnerary, because the
ancients stamped it with this character on account of the trifling circumstance that
its yellow flowers, when rubbed betwixt the fingers, give out a blood-red juice,
which procured for it the name of John's blood. Whence do the chelidonium, the
berberis-bark and the turmeric derive the reputation they enjoy in our Materia
Medica as remedies for the jaundice, but from this, that formerly it was imagined
that the yellow milk of the first and the yellow colour contained in the two last was
a sure sign (signature) that they must be useful in a yellow disease?  And whence
does chelidonium in particular get its name and its fabled efficacy in dimness of
vision, if not from the old story that the swallows restore the sight of their young
ones by means of this plant! The tasteless dragon's-blood is still, merely on
account of its name and blood-red colour, said to be good for bleeding gums and
hmemorrhages! Ranunculus ficaria and scrophularia nodosa are said to be useful for
piles, merely because the roots of both these vegetables present a knotty appearance
similar to the hemorrhoidal tumours. Madder obtained its reputation as an emenagogue on account of its containing a dark red colour; and because animals, when fed
upon it, have the red colouring matter deposited in their bones, therefore it is celebrated in the Materia Medica as especially useful in diseases of the bones!  Saponaria is still always celebrated in our books as a valuable solvent and detergent
medicine, because the decoction of its root, when beaten up, forms a froth like a
solution of soap, although otherwise it is totally different in its nature from
soap, and it loses its frothing property not like the latter by the addition of acid, but
on the contrary but adding alkali to it. And does soap itself derive its reputation
for dissolving obstructions and indurations in the body, from any other source except
from the conceit, that as in household operations and chemical manipulations it
exercises a solvent property, it must do the same in the living organism also?
Because the cabinet-makers make use of three coloured woods in their trade under
the common name of sandal-woods, they must therefore enjoy in medicine a common
power (in the so-called blood-purifying drinks), although the yellow (and white)
kind (santalum album) is obtained from a totally different tree from the red kind
(pterocarpus santalinus), and causes very violent and serious effects, of which, however, the materia medica knows nothing. Because the bark of cinchona tastes bitter
and astringent, therefore the bitter and astringent barks of the ash, horse-chesnut,
willow, &c., were considered to possess the same action as cinchona bark,-just as
though the taste could determine the action! Because some plants have a bitter
taste, especially gentiana centaureum, called fel terrae, for that reason only practitioners were convinced that they could act as substitutes for the bile! From the
circumstance of the root of the carex arenaria possessing an external resemblance to




572

ON THE VALUE OF THE

of the medicine; consequently, as they for the most part, the
latter especially, reject the vague and doubtful, we can gain little
positive knowledge from them.
One only among thousands, Murray, gives the cases in which
the medicines were used. But on this point the authorities generally clash with one another, one affirming one thing and another
another, and so the decision still remains frequently quite doubtful. In many of the cases he lamented-oh that he had done so in
most of the cases!-that the medicine was not employed alone,
but in combination with several others, so that we are once more
plunged into darkness.
The authorities cited even here leave the reader often in doubt
as to the nature and exact constitution of the disease in which
they employed the remedy.
How little the greater number of these observers are to be relied
on, is evident, were it only from this, that they commonly assert,
that "the remedy in their hands had never been detrimental,
never done the least harm, even when it had done no good;" for
every powerful medicine must invariably do injury where it fails to
do good; a proposition which does not admit of a single exception.
Behold again, then, manifest untruth!
But what is the anxious reader to learn even from this sole critically sifting and best of all materia medicas? Certainly little of a
positive character!-little of a positive character concerning the
only implements of healing! Righteous heaven!
Consider how uncertain must be the use of drugs so extremely
imperfectly known, against diseases which are as diverse as the
clouds in the sky, whose recognition, even by the best of methods,
is tedious, and whose number is legion!
Nay more. Consider how extremely precarious, I might say,
blind, that practice must be, where states of disease, misviewed
through the coloured medium of ideal systems, are attacked by
sarsaparilla root, it was inferred that the former must possess the same properties as
the latter. Therapeutists have attributed to the stellated anise the same expectorant
qualities as are possessed by anise seeds, merely because the latter have a resemblance in taste and smell to the seed capsules of the former, and yet some parts of
the tree (ilicium anisatum) that bears these capsules is used in the Philippine islands
as a poison for suicidal purposes.-This is what I call a philosophical and experimental origin of the materia medica!




SPECULATIVE SYSTEMS OF MEDICINE.

573

means of many such almost unknown medicines, mingled together
in such a prescription, or in many such! On this I let the curtain
drop.Thus we find, spite of the well nigh uninterrupted revolutions of
the physiological, pathological, and therapeutic theories, during two
thousand years and more, according to mechanical, atomical, chemical, ideal, pneumatical, and mystical theories, and owing to this
infantile state of knowledge as to the real properties of simple medicines,-we still find-even in this century which in every other
respect is hastening towards perfection-we still find, I repeat, that
only a very small proportion of human ailments can in such a manner be removed as shall leave the physician the merit of having been
the undoubted author of the cure. Either the remaining maladies
remained as uncured as before the days of Galen, or, thanks to
medical practice, in the room of the original ones there have arisen
new distempers of a different aspect: or the energy of the still
vigorous life, backed usually by the secret disuse of the drugs, itself
got the better, in the course of time, of the disease that oppressed
it; or single symptoms, hitherto stubborn, yielded to some lucky
accident, wherein no one could trace the connexion of cause and
effect; or else the unfailing termination of all earthly woes stepped
in to settle the matter.
Such is the fearful but too true condition of the medical art
hitherto, which, under the treacherous promise of recovery and
health, has been gnawing at the life of so many of the inhabitants of earth.
Oh! that it were mine to direct the better portion of the medical
world, who can feel for the sufferings of our brethren of mankind,
and long to know how they may relieve them, to those purer principles which lead directly to the desired goal!
Infamy be the award of history to him who, by deceit and
fiction, maims this art of ours, which is intended to succour the
wretched!
All-compensating, divine self-approval, and an unfading civic
crown to him who helps to make our art more beneficial to mankind!




ON SUBSTITUTES FOR FOREIGN DRUGS,
AND ON THE RECENT ANNOUNCEMENT OF THE MEDICAL FACULTY
IN VIENNA RELATIVE TO THE SUPERFLUOUSNESS OF
THE LATTER,.
When the imperial government of Austria exerts itself to supply
the want of foreign drugs that is to be feared by indigenous substitutes, the intention is certainly patriotic; but when the medical
Faculty thereupon utters an oracular deliverance as to which of
the foreign drugs are quite superfluous, which may be in some
measure dispensed with, and which are quite indispensable, it is in
many points decidedly wrong.
The utility or superfluousness of a medicine is not a thing to be
decreed by any medical faculty, just as it was absurd of the
Parisian parliament to take upon itself to forbid the use of antimony as a medicine in 1566, and by a contrary edict to allow of
its employment in 1669. Neither parliament nor faculty can do
such a thing. The art of healing the sick remains a free art, which
can make use of all substances in the whole of the great kingdom
of nature, without any exception, for the relief of the sick.
Let us only teach physicians principles of universal applicability,
according to which the powers of drugs may be ascertained and
tested with certainty, as to what each is incontrovertibly useful
and suitable for, to what cases of disease each is unexceptionably
adapted, and what is the proper dose; and then each physician
would naturally only make use of those, which are most certainly
the most suitable for each case of disease and the most serviceable,
whether they come from the east or from the west,2 or are found
1 From the Allgemeiner Anzeiger der Deutschen, No. 327. 1808.
2 But if from the obstruction of our maritime commerce he is deprived of this medicine or the other, he is naturally deprived of what he can no longer obtain, and so he
does what he can in diseases with those medicines that are still at his command,
which he must also know accurately as respects their internal properties and powers.
But if he can obtain them, then no Faculty in the world has any right to prohibit him




ON SUBSTITUTES FOR FOREIGN DRUGS.

575

at home,-and then he would, from        his own perfect conviction,
and from irrefragable reasons, of his own accord leave many foreign
drugs totally unemployed in his practice, or only use them in a few
well defined cases.
But we are by a long way not so far advanced as this. No
principles are yet universally recognised, according to which the
curative powers of medicines (even of such as have never yet been
employed at the sick-bed) can with certainty be ascertained, a
priori, without first subjecting them to the infinitely tedious process of testing them in hap-hazard fashion at the sick-bed, which is
almost never convincing, and is usually attended with injurious
effects. This obscure mode ab effectu in morbis, whereby little or
nothing is determined, has, moreover, the cruel and unpardonable
disadvantage, that the individual, naturally so irritable in disease,
is readily aggravated by so many blindly instituted experiments,
and may even fall a victim to them, especially since the recent
fashion of prescribing large doses of powerful medicines has been
adopted.
But as long as the former better way is not established in the
state, and the latter mode only is so, which has been from the beginning acknowledged to be unserviceable and insufficient-so
long will contradictory opinions of physicians relative to the curative powers of the different medicines continue; none will be able
to convince the other of the fallacy of his opinion, none will be
able to bring forward irrefragable proofs of the correctness of his
own views. Almost every one entertains a different idea respecting the power of this medicine and of that, and no one can shew
any proofs for his particular opinion.
So also the present declaration of the faculty is nothing more
than the private opinion of certain individuals as to what they consider to be the probable properties of the medicines in question,
using them, or decree their rejection. But if a Faculty can shew on satisfactory
grounds, e. g., that pearls are exactly the same substance as muscle and oyster shells,
in that case no sensible physician who is convinced of the fact will employ the costly
pearls, but will voluntarily use in place of them, oyster and muscle shells. The
identity of salts, earths, and metals may, however, be ascertained by well-known
chemical principles, but the curative powers of vegetable medicines do not depend
upon their chemically cognizable constituents, but upon principles of quite a different
sort, which have not yet been ascertained.




576

ON SUBSTITUTES FOR FOREIGN DRUGS.

founded upon what they have heard or read somewhere about
them, or upon what each may have experienced in his individual
practice, wherefrom they pretend to guess that such and such is
the case.
In order that a judgment should be valid much more is required,
generally recognised principles are requisite, to which the judicial
court may be able to appeal. If it can shew none then its judgment must be merely a collective individual opinion, principally of
those colleges that act as spokesmen, which can no more be considered absolute truth, than the private opinion of any welleducated physician in the country. The majority of votes cannot
in this instance determine the standard, as many may form
erroneous conclusions as well as one, as long as no recognised
principle proves the basis of their verdict. (So, a few years ago,
many thousand physicians thought and maintained that Brown's
doctrine was the only true one, and yet they all were mistaken.)
If a medicine appears to one or several practitioners never to
be useful in the disease for which it has been recommended by
others, no inference can be drawn from this circumstance. For it
remains to be seen,-1, whether it was in each case exactly the
same disease that had been treated by its eulogist (nature presents
an infinite variety of diseases, that are often confounded with one
another; it is excessively rare that exactly the same disease is met
with twice); 2, whether it was exactly the same drug (the practitioner often is ignorant of the signs that mark the genuineness of
the drug); 3, whether the medicine was always given in these experiments singly and alone, or in combination with things that were
capable of altering its efficacy; (as long as physicians do not treat
a determinate disease with a single unmixed medicinal substance,
but, as is done by them all, mingle it with other powerful drugs,
so long it is impossible to draw any, not even a probable conclusion
from all their assertions relative to the curative powers of this or
that medicament; they all prove nothing at all); 4, whether the
medicine was given in the most appropriate dose; (have not the
doses of most medicines been hitherto left to mere caprice! Must
there not, from the very nature of such powerful substances, be a
point over and under which this or that medicine cannot be prescribed, without-on account of its very quantity-producing this
or that effect, or failing to produce such effect?) 5, whether it was




ON SUBSTITUTES FOR FOREIGN DRUGS.

577

given at a proper or improper period of the disease; 6, whether
the (often nasty tasting, nasty smelling) medicine was taken at all,
or taken only in part, or not at all; 7, whether some important
external influences, or some circumstances peculiar to the constitution of the patient promoted the recovery, and various other
considerations.
In like manner, one or several physicians may imagine that they
have repeatedly cured the same disease with a certain medicine,
and yet notwithstanding their honesty, this may be untrue. If we
carefully investigate the above points, we shall invariably find
that there is some element of inaccuracy, either that the cases
of disease were different, or that the medicine was given either not
alone, but in combination with other powerful drugs, or very soon
after some other medicines.  One or other of these imperfections,
usually both, occur almost always in the treatment, whether the
result was successful or the reverse.
Where then shall we able to find a series of pure observations in
practice, that shall be able to establish the curative powers of
a single medicine on sure principles?      And yet the Vienna
Medical Faculty in the first division of its resolutions, decrees that
not only the semen cince, but colocynth, copaiva-balsam, quassia,
sabadilla, sassafras, senega, and even cascarilla are quite superfluous.
And yet but lately, the far-famed Hofrath Hecker, of Berlin,
asserted in a voluminous essay published in the Allg. Anzeiger
der D. (No. 221), "that cascarilla is not only equal in curative
virtues to cinchona bark, but is much superior to it."      I say
asserted, for in a thousand words he did nothing more than what
the Faculty did in two words; he only asserted, but proved nothing.
He does not adduce a single case (and could not adduce one) in
which cascarilla had been used alone in ague, still less does he shew,
in which of the infinitely numerous varieties of ague, cascarilla
proved serviceable, when given purely and alone, in order that we
may see whether it was certainly and really alone useful in the
same cases in which cinchona is, or whether in other cases also,
where the latter is of no use, or perhaps might be useful only in
certain other (what?) cases of ague, but just not such ones as cinchona is alone suitable for. He has, consequently, just as all the
rest of the herd of our medical authors are in the habit of doing,
2P




578

ON SUBSTITUTES FOR FOREIGN DRUGS.

deduced with much prolixity: that he has asserted, and not that
he has proved and made the matter clear;-transeat cum cleteris.
Now as both parties, the Vienna Faculty and Hofrath Hecker,
so flatly contradict each other, which is in the right?
Unhappy art, in which such direct contradictions are possible!
What incalculable evil may not daily and hourly be poured forth
on suffering humanity from thy cornucopia, which is as vast as the
whole range of opinions!
The Faculty rejects this first class as quite superfluous, "because
either they are powerless (that they cannot say of the substances
named) or any physician can substitute for them indigenous
drugs, their well known succedanea." What are these indigenous succedanea; why does not the Faculty name them?      It
says they are well known. But how can such succedanea be
known when they are simply impossible?
Among vegetable drugs there are no true succedanea, there can
be none.    The powers of each of these medicinal substances
accurately speaking (and what friend to humanity would not try to
be accurate when dealing with substances on which depend the
sickness and health, the pains, the death and the life of suffering
mankind?) are so multifarious, so peculiar, so different from those
of any other drug, that a vegetable medicinal substance can only
be replaced by itself, that is by a plant of exactly the same genus
and species. There are, no doubt, substances which have one property or another in common with that which it is required to replace. But what becomes of the many other properties that each
possesses peculiarly by itself?
He who is ignorant of the whole range of properties of the one
drug, and likewise of the individual powers of the other which is to
be used as its substitute, will certainly find it an easy matter to
substitute the one for the other! Hence we see that apothecaries,
because they have no more than a superficial acquaintance with the
one and the other drug, in respect to their power of altering the
organism, find it so easy when their own interests are concerned,
to substitute the one for the other in making up their prescriptions.
-Poor patients!--" We believe," so the apothecaries have always
said in their hearts, "that turpentine is the same as copaiba-we
believe that gentian is as good as quassia; therefore let us substi



ON SUBSTITUTES FOR FOREIGN DRUGS.

579

tute the one for the other." If, as we know but too well, in the
whole range of medicine, conjecture can usurp the place of conviction,
if this be a mere matter of belief and guess-work, in that case the
conscience of such persons is no doubt satisfied,-before the medical authorities, before the world,-but is it so likewise before the
omniscient Deity to whom human life is so precious, who endowed
medicines with their inconceivable variety of wonderful properties
and virtues, in order that man should investigate them and apply
them for the relief of his brethren?
Hear it, our wiser, more conscientious posterity! now-a-days the
substitution of one medicine for another, and the whole doctrine of
succedanea, which has hitherto constituted the partie hortense of the
apothecary-system, has even received the sanction of Faculties;
different medicinal substances are decreed by high medical authorities to be all the same, to possess the same action, not the hundredth
part of whose true, peculiar powers have hitherto been known!
Hear it, our wiser, more conscientious posterity! to our country
practitioners, who have never been held to be too richly endowed
with knowledge, the talent for careful discrimination, and a clear
spirit of observation, now there is preached an indifferentism, right
welcome to their habitual indolence, in the choice of remedies
(those important instruments of life and death), an indifferentism
the grave of all philosophy, of all conscientious discrimination, of
all accurate, genuine, estimation of things!
Avaunt thou medical art, still in the babbling infancy that confounds all things with one another! Whilst thou still slumberest
in thy cradle, all around thee the impulse to well-directed activity
has long since been awakened, and has escaped from the trammels
of ignorant credulity. Each of the devoted disciples of the new
school investigates the differences and the specific properties of the
things that belong to his own department; calmly and on irrefragable principles decides upon the rank that belongs to each, and
assigns to it the accurately defined boundaries of its proper sphere;
in order that out of all this individualization a philosophically
arranged whole may proceed, in order that, consistent, incontrovertible, appropriate, living truth may thence arise.
And yet thou still continuest to sleep?  Hitherto crammed to
satiety with the sweet baby-food of hypotheses and pleasant figments, and stunted in thy growth by the eternal swaddling clothes
2 P 2




580

ON SUBSTITUTES FOR FOREIGN DRUGS.

of authorities that discountenance all investigations and stifle all
liberty of thought, thou hast not yet, dear medicine of the past,
entered the ranks of the progressive arts, nor assumed the decisive
language of the other manly studies!
The deep earnest spirit of our age demands that the differences
of things and of their properties should be ascertained in a more
accurate and minute manner before we can venture to institute
comparisons between them, not to speak of decreeing the substitution of one for another. When we shall have investigated the general
array of the properties and most of the powers of every single
medicinal substance, which produce such various effects on the
human organism, and when we shall have them displayed plainly
and in their rich completeness before our view,-then, and not
till then, may we be permitted to make a relative estimate of the
nature and properties of the various substances, and to institute
comparisons between the curative powers of the different medicines;-to do this sooner were presumption, that could not even
be excused by the plea of ignorance.
Succedanea of the medicines that are not chemical, but that act
specifically, which shall be perfect substitutes for others, there are
not and cannot be, for one medicine is not the same as another,and succedanea that shall be partial and half-and-half substitutes
for others (if such were necessary), cannot be found until the
medicinal properties of the several drugs accurately and completely
displayed before the eyes of the world, are available for the purpose
of instituting a perfect comparison among them. Then, and not
till then, will it be possible to pronounce incontrovertible, irrefragable judgments and verdicts.




EXTRACT FROM A LETTER TO A PHYSICIAN OF HIGH STANDING
ON THE GREAT NECESSITY OF A REGENERATION
OF MEDICINE.1
Dearest friend,
It is not in order to * * * you, no! it is on account
of your intrinsic excellence and the irresistible attraction your
excellent heart has for me, that I must give myself the pleasure of
exposing to you my whole course of thought and conviction, which
I have long felt a desire to do publicly.
For eighteen years I have departed from the beaten track in
medicine. It was painful to me to grope in the dark, guided only
by our books in the treatment of the sick,-to prescribe, according
to this or that (fanciful) view of the nature of diseases, substances
that only owed to mere opinion their place in the materia medica;
I had. conscientious scruples about treating unknown morbid states
in my suffering fellow-creatures with these unknown2 medicines,
which, being powerful substances, may, if they were not exactly
suitable (and how could the physician know whether they were
suitable or not, seeing that their peculiar, special actions were not
yet elucidated) easily change life into death, or produce new
affections and chronic ailments, which are often much more difficult to remove than the original disease. To become in this way
a murderer, or aggravater of the sufferings of my brethren of
mankind, was to me a fearful thought,-so fearful and distressing
was it, that shortly after my marriage I completely abandoned
1 From the Allgem. Anzeiger d. D., No. 343. 1808.  [The physician to whom
this letter was addressed is the celebrated Hufeland, with whom Hahnemann was
long on terms of intimate friendship.]
2 Respecting many medicines we have numbers of contradictory opinions, which
have been repeatedly refuted by experience, and a great array of physical, chemical
and natural historical information; but our books afford us no instruction as to what
are the exact cases of disease for which they are adapted and in which they may be
confidently relied on as curative agents. They are almost entirely unknown in a
special medicinal point of view.




582

LETTER UPON THE NECESSITY

practice and scarcely treated any one for fear of doing him harm,
and-as you know-occupied myself solely with chemistry and
literary labours.
But children were born to me, several children, and in course of
time serious diseases occurred, which, because they afflicted and
endangered the lives of my children-my flesh and blood-caused
my conscience to reproach me still more loudly, that I had no
means on which I could rely for affording them relief.
But whence could I obtain aid, certain, positive aid, with our
doctrine of the powers of medicinal substances founded merely on
vague observations, often only on fanciful conjecture, and with the
infinite number of arbitrary views respecting disease in which our
pathological works abound?-a labyrinth in which he only can
preserve his tranquillity who accepts as gospel those assertions
relative to the curative powers of medicines because they are repeated in a hundred books, and who receives, without investigation, as oracles, the arbitrary definitions of diseases given in
pathological works, and their pretended treatment according to
hypothetical notions, as described in our therapeutical works,who ascribes all the cases of death that occur under his treatment,
not to his own practice of shooting blindfold at the mark-who
does not attribute the aggravation and prolongation of the acute
diseases he treats and their degeneration into chronic maladies,
and the general fruitlessness of his efforts when he has to treat
diseases of long standing, to the uncertainty and impotence of his
art-no! he ascribes death and ill-treated disease and all, solely
to the incurableness of the disease, to the disobedience of the
patient, and to other insignificant circumstances, and so accommodating and obtuse is his conscience, that he satisfies himself with
these excuses, though they are in many ways delusive, and can
never avail before an omniscient God; and thus he goes on treating diseases (which he sees through his systematic spectacles) with
medicinal substances that are far from being without influence on
life and death, but of whose powers nothing is kinown.
Where shall I look for aid, sure aid? sighed the disconsolate
father on hearing the moaning of his dear, inexpressibly dear, sick
children. The darkness of night and the dreariness of a desert all
around me; no prospect of relief for my oppressed paternal heart!
In an eight-years' practice, pursued with conscientious atten



OF A REGENERATION OF MEDICINE.

583

tion, I had learned the delusive nature of the ordinary methods of
treatment, and from sad experience I knew right well how far the
methods of Sydenham and Frederick Hoffmann, of Boerhaave and
Gaubius, of Stoll, Quarin, Cullen, and De Haen, were capable of
curing.
" But perhaps it is in the very nature of this art, as great men have
asserted, that it is incapable of attaining any greater certainty."
" Shameful, blasphemous thought," I exclaimed.-What, shall
it be said that the infinite wisdom of the eternal Spirit that animates the universe could not produce remedies to allay the sufferings of the diseases it allows to arise?  The all-loving paternal
goodness of Him whom no name worthily designates, who richly
supplies all wants, even the scarcely conceivable ones of the insect
in the dust, imperceptible by reason of its minuteness to the
keenest mortal eye, and who dispenses throughout all creation life
and happiness in rich abundance-shall it be said that He was
capable of the tyranny of not permitting that man, made in His
own image, should, even by the efforts of his penetrating mind,
that has been breathed into him from above, find out the way to
discover remedies in the stupendous kingdom of created things,
which should be able to deliver his brethren of mankind from their
sufferings often worse than death itself? Shall He, the Father of
all, behold with indifference the martyrdom of his best-loved
creatures by disease, and yet have rendered it impossible to the
genius of man, to which all else is possible, to find any method,
any easy, sure, trustworthy method, whereby they may see diseases
in the proper point of view, and whereby they may interrogate
medicines as to their special uses, as to what they are really,
surely, and positively serviceable for?
Sooner than admit this blasphemous thought, I would have
abjured all the medical systems in the world!
No! there is a God, a good God, who is all goodness and wisdom! and as surely as this is the case must there be a way of
his creation whereby diseases may be seen in the right point of
view, and be cured with certainty, a way not hidden in endless
abstractions and fantastic speculations!
But why was it never discovered in the two or two and a half
thousand years during which there have been men who called
themselves physicians?




r584

LETTER UPON THE NECESSITY

Doubtless because it was too easy-because, like the xahoaycaOiAc
in the choice of the youthful Hercules, it was quite simple, and
neither capable nor standing in need of being decked in any of the
tawdry tinsel of subtle sophistries and brilliant hypotheses.
Well, thought I, as there must be a sure and trustworthy
method of treatment, as certainly as God is the wisest and most
beneficent of beings, I shall seek it no longer in the thorny thicket
of ontological explanations, in arbitrary opinions, though these
might be capable of being arranged into a splendid system, nor in
the authoritative declarations of celebrated men-no, let me seek
it where it lies nearest at hand, and where it has hitherto been
passed over by all, because it did not seem sufficiently recondite
nor sufficiently learned, and was not hung with laurels for those
who displayed most talent for constructing systems, for scholastic
speculations and transcendental abstractions. It only sufficed for
me, whose conscience was not of that ordinary practical character
that it allow me to deliver up to death my children who were
in danger, in order to please any system, any leader of a party
whatsoever. Accordingly I have made no ostentatious parade of
my simple little book (Medicine of Experience 1) that teaches this
method, quite contented with having found it myself, contented
with having, in the simple style that belongs to truth, revealed it
to my brethren, as far as it was possible to do so by writing, that
is, without demonstration at the sick-bed in an hospital.
" How, then, canst thou "-(this was the mode of reasoning by
which I commenced to find my way)- -"ascertain what morbid
states medicines have been created for? (can this be done by
experimenta per mortes in diseases themselves? Alas! the two thousand five hundred years during which this way alone has been
followed, shew that it is beset with innumerable, insurmountable
illusions, and never leads to certainty).
" Thou must," thought I, " observe how medicines act on the
human body, when it is in the tranquil state of health. The alterations that medicines produce in the healthy body, do not occur in
vain, they must signify something; else why should they occur?
What if these changes have an important, an extremely important
signification. What if this be the only utterance whereby these
[' Vide antea, p. 497.]




OF A REGENERATION OF MEDICINE.

585

substances can impart information to the observer respecting the
end of their being; what if the changes and sensations which each
medicine produces in the healthy human organism, be the only
comprehensible language by which-if they be not smothered by
severe symptoms of some existing disease-it can distinctly discourse to the unprejudiced observer respecting its specific tendencies, respecting its peculiar, pure, positive power, by means of
which it is capable of effecting alterations in the body, that is,
of deranging the healthy organism, and-where it can cure-of
changing into health the organism that has been deranged by
disease!"   This was what I thought.
I carried my reflections farther. "How else could medicines
effect what they do in diseases than by means of this power of
theirs to alter the healthy body?"-(which is most certainly different in every different mineral substance, and consequently
presents in each a different series of phenomena, accidents, and
sensations.') Certainly, in this way alone can they cure.
But if medicinal substances effect what they do in diseases, only
by means of the power peculiar to each of them of altering the
healthy body; it follows that the medicine, among whose symptoms those characteristic of a given case of disease occur in the
most complete manner, must most certainly have the power of
curing that disease; and in like manner that morbid state which a
certain medicinal agent is capable of curing, must correspond to
the symptoms this medicinal substance is capable of producing in
the healthy human body! In a word, medicines must only have
the power of curing diseases similar to those they produce in the
healthy body, and only manifest such morbid actions as they are
capable of curing in diseases!
" If I am not deceived "-I thought further-" such is really the
case; otherwise how was it that those violent tertian and quotidian
fevers, which I completely cured four and six weeks ago without
1 Each one of the many thousand genera of plants must possess a different medicinal action; in truth, even the several species must differ from each other in this
respect, for their permanent differences of appearance announce them as things differing in kind. Here, then, we have fulness and abundance, here we have a divinely
rich store of curative powers! Take comfort, sick humanity I What are still required
for your relief are, free sagacious men, who have the strength to emancipate themselves from the strong slave-chains of ancient prejudice and theories.




586

LETTER UPON THE NECESSITY

knowing how the cure was effected, by means of a few drops of
cinchona tincture, should present almost exactly the same array
of symptoms, which I observed in myself yesterday and to-day,
after gradually taking, while in perfect health, four drachms of
good cinchona bark, by way of experiment?"
I now commenced to make a collection of the morbid phenomena which different observers had from time to time noticed as
produced by medicines introduced into the stomachs of healthy
individuals, and which they had casually recorded in their works.
But as the number of these was not great, I set myself diligently
to work to test several medicinal substances on the healthy
body,' and see, the carefully observed symptoms they produced
corresponded wonderfully with the symptoms of the morbid states
they could cure easily and permanently.
Now, it was impossible for me to avoid regarding as incontrovertible the maxim that disease was not to be made the subject of
ontological and fanciful speculation as though its cure were an
eternal enigma, but that it was only necessary that every disease
should present itself to the practitioner as a series or group of particular symptoms, in order to enable him to infallibly extinguish
and cure it by means of a medicinal substance, capable of producing of itself the same morbid symptoms in the healthy body
(provided always that the patient avoids every ascertainable external cause of this disease, in order that the cure should be
permanent).
I perceived that this view of diseases-regarding them always
according to the sum of all the symptoms presented by each individual case-was the only right one, and the only one available for
the curative treatment, and that the forms of disease described in
our pathological works (those artistic pictures made up of fragments of dissimilar diseases) would in future be unable to conceal
from us the true aspects of the malady as nature presents it to us
at the sick-bed-that the therapeutic doctrines of the numerous
systems, abounding as they do in imaginary curative indications
and arbitrary modes of treatment, could not henceforth mislead the
1 The results I had collected four years ago, will be found in my book: Fragmenta
de viribus medicamentorum positivis sive in sano corpore humano observatis. Lipsie
apud Barth, 1805.




OF A REGENERATION OF MEDICINE.

587

conscientious practitioner, and that no metaphysical and scholastic speculation respecting the first hidden cause of diseases (that
favourite plaything of rationalism) which can never be ascertained
by mortal reason, would henceforth render it necessary to invent
any chimerical mode of treatment.
I perceived that the only health-bringing way, without any
admixture of human inventions, without any display of learning,
was discovered.
But it had not yet been trodden! I had to tread it alone,
depending on my own powers, on my own resources; I did so with
confidence and with success.
"Take the medicines according to the symptoms careful and
repeated observation has shewn they produce in the healthy body,
and administer them in every case of disease that presents a group
of symptoms comprised in the array of symptoms the medicine to
be employed is capable of producing on the healthy body; thus
will you cure the disease surely and easily. Or, in other words,
find out which medicine contains most perfectly among the symptoms usually produced by it in the healthy body the sum of the
symptoms of the disease before you; and this medicine will effect a
certain, permanent, and easy cure.
This law, dictated to me by nature herself, I have now
followed for many years, without ever having had occasion to
have recourse to any one of the ordinary methods of medical practice. For twelve years I have used no purgatives for bile or mucus,
no cooling drinks, no so-called solvents or deobstruents, no general
antispasmodics, sedatives, or narcotics, no general stimulants or
tonics, no general diuretics or diaphoretics, no rubefacients or
vesicatories, no leeches or cupping glasses, no issues, in fact none of
the appliances prescribed by the general therapeutics of any system
whatever, to fulfil indications of cure they have themselves invented. I practised solely in accordance with the above law of
nature, and in no single instance did I deviate from it.
And with what result?     As might have been expected, the
satisfaction I have derived from this mode of treatment I would not
exchange for any of the most coveted of earthly goods.
In the course of these investigations and observations, which
occupied many years, I made the new and important discovery,
that medicines in acting on the healthy body, exhibit two modes of




588

LETTER UPON THE NECESSITY

action and two series of symptoms entirely opposite to one another,
the first immediately or soon after their ingestion (or shortly after
contact with the sentient living fibre of any part of the body)and the second, the very opposite, soon after the disappearance of
the first;-that moreover, when the medicines correspond to the
case of disease before us in regard to these first, primary (medicinal) symptoms, or, in other words, when most of the symptoms
of the disease we have to combat are to be met with among those
which the medicine selected tends to develop in the first hours of
its action on the healthy subject (in such a manner as that the
symptoms of the disease and the primary symptoms of the medicine
shall present the greatest possible similarity to one another), then,
and then only, will a permanent cure result; the morbific irritation
present being, as it were, overcome, displaced and extinguished by
another very similar irritation-produced by the medicine-in an
extremely, an incredibly short time. This I termed the curative
(radical) method of treatment (which produces permanent health,
most certainly and without any after-sufferings).
On the other hand I perceived,-what was now easy to be foreseen,-that by adopting an opposite method, that is to say, if
(according to the ordinary mode of procedure, contraria contrariis
curantur) the primary action of the medicine we employ be just the
opposite of the symptoms of the disease (for instance, if we give
opium for habitual sleeplessness or chronic diarrhoea, wine for
debility, or purgatives for chronic constipation), only a palliative
relief, only an amelioration for a few hours will be the result, for,
after these few hours have passed, the period for the second stage of
the medicinal action comes on, which is the contrary of the first
action and the analogue of the morbid state it is sought to cureconsequently it causes an addition to the disease and an aggravation of it.
In the ordinary practice, whenever symptoms are attacked
with medicines,1 this is always done, according to the principles
of art now laid down, only in this palliative manner. The medical
art as hitherto practised, knows not the curative treatment pointed
out above.
But this discovery of mine is so important, that if it were known
1 For in addition to the system of alleviating symptoms, there are in the ordinary
practice many others, if possible still more arbitrary, and still more unsuitable modes
of treatment.




OF A REGENERATION OF MEDICINE.

589

and acted upon, experience would teach every one that it is only
by the curative employment of medicines (similia similibus) that a
permanent cure-this is especially observable in the case of chronic
diseases- can be obtained by the smallest doses in a short time;
whereas the ordinary palliative method, according to which, every
physician without exception on the face of the globe, is accustomed
to combat symptoms (if any contraria whatsoever can be found),
can only alleviate them for a few hours, and must permit the
malady, after the expiry of these few hours, to shoot forth more
rankly than before, unless the physician-as is not unfrequently
the case-prolong the joke for a few days by giving frequently
repeated and always stronger doses.   But then, on    the other
hand, by such large doses of the-not curative and homoeopathically adapted-medicine, and by the secondary action of these
large doses, he creates new morbid states, which are often more
difficult to cure than the original malady, and which often enough
terminate in death.
It must be plain to all, without further demonstration on my
part, that it is impossible this hurtful palliative system of treatment
can avail in the case of chronic diseases, or restore unalloyed health
to those suffering from them; and this is what experience also
teaches us, namely, that by no system of treatment hitherto pursued
could chronic maladies be removed in a short time and health be
restored; though, occasionally, after a long period of time, such a
happy event might be brought about, and health be restored by
the spontaneous efforts of nature, by some curatively adapted
remedy accidentally prescribed among others, by some mineral
water also accidentally suitable to the case, or by other fortuitous
circumstances.
Besides inflicting often irreparable injury on the health of man,
the palliative system wastes an incredible quantity of expensive
drugs, because they must be given in large, often monstrous quantities, to the patients, in order to effect some, though but apparent
good results.  Thus we see Jones of London requiring three
hundred pounds of cinchona bark per annum, and other physicians
using several pounds of opium a-piece in the course of the year.
Precisely the contrary is the case with the physician who treats
according to the curative method. As he only needs the smallest,
but analogous medicinal irritation, in order to extinguish speedily
an analogous morbid irritation, his requirements in the way of




590

LETTER UPON THE NECESSITY

good drugs (even of such as are most constantly used) are so small
that I hesitate to make even a probable estimate of them, in order
not to excite incredulity; so small that the blockade of Europe
may be kept up for a long time to come so far as he is concerned.
By pursuing this method of treatment, which differs from all
others, which is indeed almost their exact opposite in every respect, the curative physician radically cures with amazing certainty,
and in an incredibly short space of time, even chronic diseases of
the most ancient date, provided among the remedies he is intimately 1 acquainted with there exists a suitable one.
If the principal, the sole mission of the physician be, as I believe it is, the cure of diseases, the deliverance of our brethren of
mankind from those innumerable tortures that disturb the tranquil enjoyment of life, that often make existence unbearable, or
expose it to danger, and that even obstruct the functions of the
mind; how can he, if a sensitive heart still beats within him, or if
in his bosom there glows a spark of that holy fire that warms and
incites the true man to aspirations for the good of humanity-how
can he hesitate for a moment to choose this better, this much
more efficacious method of treatment, and to trample under foot
the delusions of all former medical schools, even should they be
three thousand years old?     They have never yet taught us how to
cure our fellow-men2 in a manner that shall satisfy our conscience, but only how we may present to the people an appearance
of learned wisdom and deep penetration. To the weak-minded
alone, injurious delusions and prejudices are holy and inviolable
1 Of medicines whose action has been accurately ascertained I possess now almost
thirty, and of such as are pretty well known, about the same number, without
reckoning those with which I am not entirely unacquainted. Entirely unaided, it
would be impossible for me to make up for all that has been neglected by my predecessors in my short life, though I have never allowed even the usual pleasures of
existence to interfere with my work. I would, ere this, have communicated to the
world the large number of medicines whose properties I have investigated since 1804,
and have published the whole in German, were it not that the publisher of the
Fragmenta has begged me to delay doing so on account of the badness of the times.
2 The little of a positive character to be found amid the enormous mass of medical
writings consists in the accidentally discovered mode of cure of two or three diseases
which always arise from identical miasmata; these are, the autumnal marsh ague,
the lues venerea, and the itch of workers in wool; to these must be added that most
fortunate discovery, the protection from variola by means of vaccination. And these
three or four cures take place only according to my principle similia similibus.
Nothing more of a positive character can be exhibited in the whole medical art
since the time of Hippocrates; the cure of all other diseases remained unknown.

40,




OF A REGENERATION OF MEDICINE.

591

from the circumstance of their having been once established in the
world-because they are grown over with the moss of antiquity;
the truly wise man, on the contrary, joyfully crushes delusion and
prejudice beneath his powerful tread, in order to clear the ground
for the altar of everlasting truth, which needs not the rust of antiquity to serve as a guarantee of its genuineness, nor the charm of
novelty or of fashion, nor any voluminous, verbose system to make
it comprehensible to us, nor the sanction of imposing authorities,
but which, eloquent with the voice of God, speaks aloud, in accents never to be forgotten, to the inmost heart of every unprejudiced man.
It was requisite that some one should at length beat the way,
and this I did.
The way now lies open. Every attentive, zealous and conscientious physician may freely tread it.
What though this way, which alone leads with certainty and
safety to the goal of health, and which I, setting aside all current
prejudice, discovered by a calm observation of nature, is directly
opposed to all the dogmas of our medical schools, just as the
theses which Luther of yore courageously posted on the door of
the Schlosskirche of Wittenberg were opposed to the mindenslaving hierarchy-the fault lies neither with Luther's truths
nor mine. Neither he nor I deserved the venom of the prejudiced.
" Refute," I cry to my contemporaries, " refute these truths if
you can, by pointing out a still more efficacious, sure and agreeable mode of treatment than mine-and do not combat them with
mere words, of which we have already too many.
"But should experience shew you, as it has me, that mine is
the best, then make use of it for the benefit, for the deliverance
of humanity, and give God the glory! "
But you, my dearest friend! endowed with the mild spirit of a
Melancthon, that would fain unite all opposing parties, bear with
me,-since illusion will not amalgamate with truth,-bear with
the pure-minded seeker after truth, who is inflexible in his convictions, incorruptible by the false doctrines and illusions of systems,
even though you may not venture to take a bold glance into the
reddening dawn, that must inevitably usher in the long wished-for
day.




OBSERVATIONS ON THE THREE CURRENT
METHODS OF TREATMENT.1
There have been till now but three current modes of treatment
(the treatment of diseases having apparently not yet been discovered,) viz.: the treatment of the name, the treatment of the symptom, and the treatment of the cause.
TREATMENT OF THE NAME.
Interchangeable remedies, compound prescriptions.
The method which from the remotest time has always found the
most partisans, which is the most convenient of all, is the treatment of the name.   " If the patient has the gout, give him sulphuric acid; the remedy for rheumatism is mercury; cinchona is
good for ague, simaruba for dysentery, squills for dropsy."  Here
the mere name of the supposed disease is sufficient to determine
the parempiric 2 for a remedy which crude, indiscriminating experience has sometimes found useful in diseases that have been
superficially termed gout, rheumatism, ague, dysentery, dropsy,
but have neither been accurately described nor carefully distinguished from similar affections.
From the very frequent cases of the failure of this quackish sort
of practice, which is so repulsive to me that I cannot dwell long
upon it, some well-intentioned adherents of this method were
from time to time induced to seek for several remedies for each
name of a disease; the rude experience of domestic practice, the
oracles of old herbalist books, or fantastic speculation (signature),
I From IHufeland's Journal of Practical Medicine, vol. xi, pt. 4. 1809.
2 Parempiricism may stand for the evil demon, empiricism for the good genius of
experience.




THE THREE CURRENT METHODS OF TREATMENT.

593

were the gross sources whence these remedies flowed in abundance.
This was the plan pursued: " If A should not answer, try B,
and if this will not do, a choice lies among C, D, E, F, G; I have
often found H and K of service; others recommend most highly
J and L, and I know some who cannot sufficiently praise M, U
and Z, whilst others extol N, R and T. S and X also are said not
to be bad in this disease. Some English physician recently recommended Q in preference to all others in this affection; I certainly
would be inclined to give it a trial."
" How frequently have I formerly cured ague with cinchona,"
says another practitioner, " and yet of late years I have met with
some cases where I could do nothing with it. One of these, in
which bark had long been used in vain, I might almost say with
injury to the patient, an old woman in the neighbourhood cured
with chamomile tea. One of my colleagues cut short two cases
of ague with a few emetics, in which neither chamomile tea nor
bark in the largest doses was of the slightest service. I tried
this method in cases where neither of the two latter medicines did
good, but the emetics did no good in them; I bethought myself
of giving sal-ammoniac, and to my astonishment the patients
recovered. Yet have I met with cases where, after bark, chamomile and emetics were tried in vain, sal-ammoniac also was of no
use. Just about that time I read that gentian and sometimes
nux vomica were useful in ague.    I tried them. The former
answered in two cases, the latter in three, where neither gentian
nor the other medicines were useful. Belladonna is also said to
have cured certainly and thoroughly some agues where all other
remedies had been fruitless; and some assert they have met with
the same result from the use of James' powder and calomel. The
bark of mahogany and that of the horse chesnut have also been
lauded; but I don't believe they have much power, I can't tell
why. We all know what good effects opium often has. Recently
I was much struck with a case of quartan ague, that had tormented a robust peasant for a year and a half, in spite of the
employment of every conceivable remedy; to my astonishment it
yielded to a few drops of tincture of ignatia, sent to him by a
foreign professor. And, between you and me, I must give credit
to our hangman for having occasionally effected radical cares of
2Q




594

OBSERVATIONS ON THE

agues that were ineffectually treated by myself and my colleagues
with the above remedies, by means of some red drops, which I am
credibly informed contained arsenic, although he caused with it in
some cases chronic complaints, dropsy and even death. So obstinate and capricious are agues sometimes! "
My friend, do you never suspect that all these were different
kinds of agues, or rather intermittent diseases differing completely
from one another?    If it were possible that an ague could be so
capricious and obstinate, wherefore did it yield so readily to one
remedy? Do you not suspect that there may be more than one, that
there may be perhaps twenty different kinds of intermittent fever,
which parempirical imbecility has included under one head, has
asserted all to belong to a single species (intermittent fever), and
has sought to combat all with a single remedy, whereas each
requires its peculiar remedy, without thereby deserving to be called
capricious or obstinate.
" Ah! but the practical physician has neither the inclination
nor the time to draw such fine distinctions betwixt similar diseases
and to assign to each its appropriate remedy. If the patient tells
us he has intermittent fever, I and my colleagues give him'" (you
fool! do you not wish to become a bit wiser?) "at first an emetic
or two; if that does no good, or does harm, we then give him
cinchona; if that does not cure in large doses, neither the common
sort nor the royal bark, we then give-"
Just so; you blindly give one after the other until you hit upon
the right one. But you can only go on with your experiments
as long as the patience, the purse, or the life of your patient lasts!
Your obedient servant, doctor!
And thus there arose long lists of simple drugs (interchangeable
remedies, succedaneums) which were all, without distinction, said
to be serviceable for one disease.
Out of these lists of the names of drugs, the more elegant
physicians, to give themselves an air of rationality whilst they
were guilty of the grossest parempiricism, constructed their compound prescriptions,-three, four or six ague remedies, five, six or
eight dropsy remedies, all jumbled together, drawn at hap-hazard
from  the list, which were recorded in their manuals under the
name "Intermittent fever," " Dropsy," and used in practice by
coupling them with some kind of spirit, syrup, &c. In this case, too,




THREE CURRENT METHODS OF TREATMENT.

595

the mere name of the disease was combatted, but, by your leave,
reader, much more methodically! with several weapons at a time.
" If one ingredient in the mixture does not do any good, then the
second and the third, or if all these strings break, the fourth, the
sixth, the eighth, tenth, fifteenth, must effect the desired object."
Thenceforth no one would look so unlearned as to prescribe only a
single medicine.'-Thenceforth no prescription was given that did
not contain a hotch-potch of simple drugs; and that not for investigated, definite diseases, but for mere names of diseases! Parempiricism could not ascend higher, common sense could not descend
lower.
TREATMENT OF THE SYMPTOM.
General indications; general remedies. Routine remedies.
The impossibility of discovering sure remedies for vague names of
diseases, induced now and then more conscientious physicians to
distinguish diseases more accurately. Those that were evidently
dissimilar were separated, the similarities of many of them were
investigated, and those that were considered to be connected
were united    in  classes, orders, and   species, &c., according    to
the similarity of their exciting causes, the functions that were deranged, the identity of their seat in the body, the peculiar tone of
the fibres, and some common symptoms.
By means of this historical view     of the apparent relations and
differences, they sought to make us better acquainted with the
nature of the innumerable diseases, and to persuade us that
then we knew      enough about them, to enable us to cure them
after that.   Some resorted to generalizing (the ordinary pathologists), others to subdividing (the nosologists).
But all this labour (and that at the hands of men like Rudolph
Augustin Vogel or Wichmann) was only successful in so far as it
1 If Brown could have the merit, though himself a practical physician, of having
lifted for us the curtain which conceals the secret workings of the organism from our
art, yet this merit is reduced to a nullity by that general, injurious and most erroneous maxim of his (Elements of Medicine, ý xcii): " The cure of any disease of
considerable violence, and scarce of any at all, is never to be entrusted to any one
remedy; the use of several remedies is preferable to that of one "-a precept that
would alone prove his incapacity as a teacher of medicine. Nothing is less known
or less investigated in nature than the powers of medicinal substances, our weapons!
How can we learn them otherwise than by using them singly? Or is a single drug,
if it be the proper one, less powerful to remove a single disease than a mixture of
several that counteract each other's action?




596

OBSERVATIONS ON THE

had reference to the description of the course of some epidemic
diseases that frequently recurred in pretty well defined characters,
and to the description of endemic diseases of a fixed stamp, and of
diseases whose cause was evident (the symptoms produced by some
poisons-lead, charcoal-vapour-or infection by some miasms that
never altered their character much-syphilis, itch).       Still in all
these, indescribable varieties occur, which often alter the whole affair.
(For as all other diseases, whatever be their outward resemblance-for example, the dropsies and tumours, the chronic skin
diseases and ulcers, the abnormal fluxes of blood and mucus, the
infinite varieties of pains, the hectic fevers, the spasms, the so-called
nervous affections, &c.-present such innumerable differences among
themselves in their other symptoms, that every single case of disease must as a general rule be regarded as quite distinct from all
the rest, as a peculiar individuality, it is evident that any general
descriptions of them in entire classes must not only be superfluous
but must lead to error.)
However, I forbear at present from attempting to estimate their
services to our art, and shall only observe that the pathological and
nosological investigators who possessed this kind of historical
knowledge were not much happier       in their treatment than those
who treated mere names of diseases.
These in particular were the persons who (in combination with
the therapeutists by profession), as a forlorn hope, invented the
make-shift of decyphering the appropriate remedy from the description of the disease, of devising for diseases arranged in ranks
and orders some general plan of treatment that should be suitable
for every one of them, that is to say, the method of treatment according to general indications, the method of treatment by means
of so-called general remedies. " The indications of impurities in
the alimentary canal demand evacuations upwards and down1 Even the model of graphic description, even the most natural picture of the very
constantest of all diseases, those of an endemic character, never guides us to the
remedy;-the most accurate amount of pellagra, yaws, sibbens, pian, ringworm,
tsimir, water-kulk, plica polonica, &c., throws no light on the specific remedy that
is capable of removing each of these maladies quickly, easily, and radically; this remains still concealed from our eyes in the bosom of nature. What hint, then, could
be derived for the appropriate remedy from the general description of those diseases
whose character was less constant, which presented more varieties among each other,
and were more vague?




THREE CURRENT METHODS OF TREATMENT.

507

wards, heat demands cooling medicines, fluxes demand astringents,
putridity antiseptics, pains sedatives, weakness tonics, spasms antispasmodics, constipation purgatives, dysuria diuretics, a dry skin
diaphoretics." Under the guidance of the frequently misunderstood results of experience, the evacuants, the cooling remedies,
the astringents, the antiseptics, the sedatives, the tonics, the antispasmodics, the purgatives, the diuretics, and the diaphoretics were
devised, and here was at once a complete system of therapeutics,
for the over-completeness of which some other classes of remedies
were invented for symptoms that were often but the offspring of
fancy, such as incisives, solvents, diluents, &c.
I know not which parempiricism is preferable to the other,
whether the treatment of the name of the disease, or the treatment
of the name of particular symptoms.    Suffice it to say, that this
method had much greater attractions for the superficially instructed, much greater than most of the other methods with a
trace of rationality in them, hence it was that most generally pursued by those who wished to be considered really learned physicians of a better stamp than the common herd. Of all the false
methods of treatment it will undoubtedly have the longest run,
because it does not necessitate much care nor much thought. It is
undoubtedly very agreeable for the physician to feel himself so
powerful, or at all events to appear to be able to promote perspiration here, urine there, to lull pain here, to excite there, to bind here,
to loosen there, to incise here, to expel there, to strengthen here,
to cool there, to check spasms here, and putridity there, to accomplish all that he commands his cohorts of medicines to do. How
often the practitioner cannot do all this, how often he finds himself
deceived in his expectations relative to the medicines which have
been stamped as general remedies by his teachers, he knows full
well himself.
But admitting there were such general remedies that would here
and there certainly promote perspiration, assuredly cause a flow of
urine, strikingly soothe pain, infallibly strengthen, undeniably resolve, loosen, purge, and cause vomiting, powerfully act upon the
secretion of mucus, in every case cool, allay every spasm, and
check every inordinate discharge, unhesitatingly transfer congestions from a more to a less important seat, will all this, supposing it went on ever so beautifully, cure the disease? Oh, no! in




598

OBSERVATIONS ON THE

most cases not. Something striking has been preformed, but
health has not been restored, and that was what had to be done.
At one time the physician soothes with his opium for a few
hours cough and pains in the chest; after sixteen hours, however,
the painful cough increases to a still more frightful extent-he
produces a stupified sleep with it, but the patient is not refreshed
thereby, his sleeplessness and anxiety become all the greater. The
physician does not care for this; he increases the dose of his palliative, or he is contented with having shewn his power to allay
cough and to cause sleep, though the patient is made worse thereby, though he should even die. Fiatjustitia et pereat mundus.
Here is a case of dropsy; very little urine is passed. Our doctor
will promote its flow. His squill stands at the head of his diuretic
picquet. Beautiful! it instantly causes a great flow of urine, but
on continuing its use, alas! always less and less water comes.
Symptoms of atonic inflammation and mortification ensue, the
anorexia, debility and restlessness increase with the swelling.
Then if nothing more will avail, he allows the patient to die
quietly, after having shewn that he has the power of causing a
flow of urine for some days.
Squill has been used many thousands of times as a diuretic
(during all the ages it has been employed it was never observed
that it was only diuretic in a palliative sense) and yet how seldom
has dropsy been cured by it! only when a kind of suppressed
menstruation was the cause.
The physician who is consulted diagnoses this malady to be.gastric; he purges, and re-purges. But behold the fever increases,
the taste becomes more disagreeable, the breath and the excrements more fetid, the sclerotic yellower, the tongue more furred
and browner, the ideas get confused, the lips tremble, stupifying
slumber takes the place of sleep, &c. He is sorry to see his
patient hurrying on towards his grave, but he is happy that he possessed the power of energetically purging away the impurities.
What is the matter with you? "C I put myself in a violent passion,
my head is like to burst, I have spasms in my stomach, the bile
rises incessantly into my mouth." You will, perhaps, take a bilious
fever, take this emetic immediately.-Look! he throws up bile, he
vomits again and again, he will vomit up his very inside-the
night of death obscures his sight, whilst he is bathed in cold per



THREE CURRENT METHODS OF TREATMENT.

599

spiration. "I have done my duty," says the doctor to himself; " I
have done all I could to clear away the bad bile."
And thus it is with the whole array of general remedies. The
respectable doctor does much, only not what he ought;-he produces remarkable effects, but very seldom health.
Thousand-fold experience could teach him, if he would but let
himself be taught, that in dropsy he only requires to remove the
morbid disposition, in order to see the water disappear by ways
which nature knows best how to choose for herself,-but that his
designed removal of the water by the urinary organs, or by stool,
effects a cure as seldom as tapping it off with the trocar; when a
cure does ensue, it must be because the diuretic remedy was accidentally at the same time the proper remedy for the disease upon
which that kind of dropsy depended.
Thousand-fold experience could teach him, if he would but let
himself be taught, that no pain can be removed permanently and
advantageously to the patient except by a remedy that affords
relief to the fundamental disease; that, consequently, opium very
rarely allays pains permanently with desirable results, and only
when it is the true remedy for the disease on which they depended.
That opium is often the best remedy in diseases most free from
pain, and attended with the greatest amount of sopor, that he does
not and will not know. He is proud of his power of palliating,
and of being able to allay pains for a few hours; but the aftereffects-they do not trouble him. Nil nisi quod ante pedes est.
Where the short-sighted individual thought that it was absolutely necessary to remove bucketfuls of fetid mucus and excrement
by means of all sorts of emetics and purgatives, in order to preserve
life, in such a case a single drop of the tincture of arnica-root will
often remove, in the course of a couple of hours, all the fever, all
the bilious taste, all the tormina, the tongue becomes clean, and
the strength is restored before night. Short-sighted being I
But the poisonous bile, stirred up by rage and passion, how can
it be subdued without causing it to be vomited clean away? My
short-sighted friend! a single dose, an almost imperceptibly small
quantity of the right medicine will, without any evacuation of bile,
have restored all to the right state before the second day dawns.

' Frequently the extract of chamomile.




600

OBSERVATIONS ON THE

The patient has not died as he would have done after your emetic;
he has recovered.
How often are blood-letting and nitre abused, to combat symptoms of heat!      Lay aside your life-shortening, temporizing
remedies, remove the disease on which the accelerated pulse
depends, by the appropriate remedy, and the heat ceases of its own
accord. But I perceive you are not concerned about the cure of
the disease, to subdue the heat is your object. Then rather open
one of the large arteries until the last drop of blood is drained
off, you will thereby attain your object more surely and more
completely!
And thus it is always with your favourite general remedies.
They render you the service of sometimes shewing you to be a
mighty physician. Only it is a pity that the patient who peradventure recovers (slowly and painfully enough!), seldom, seldom
owes his recovery to them.
But the general remedies just as often do not perform the effects
they desire. Only look, how their antiphlogistic remedies often
actually increase the inflammation, how their tonics increase the
weakness, their purgatives the symptoms of impurities in the
alimentary canal, their solvents the quantity of mucus and the
hardness of the abdomen, their sedatives the pains, their derivatives
the congestions, their diaphoretics the dryness of the skin, their
diuretics the want of urine and oedema!
And if they sometimes succeed in checking this or that symptom
for a time, or in effecting this or that striking evacuation, how
comes it that the disease notwithstanding sometimes assumes a
worse turn? Am I right in asserting that they were not the proper
remedies for the disease?
In like manner, the poor fellow unable to swim, struggles away
with awkward partial movements of his arms and legs, to sink all
the more certainly to the bottom.
In ordinary every-day practice however, it is not required that we
should trouble ourselves with anxiously attending to single symptoms. " When once we have got over the first irksome years incidental to young beginners-years they undoubtedly are of irksomeness
and care, when we are still anxious to discover the adequate, the
helpful, the best for our patients, and when the tender conscience of
youth gives us much trouble-when once we have got over these




THREE CURRENT METHODS OF TREATMENT.

601

pedantic years, and have got some way into the period of divine
routine, then it is a real pleasure to be a practical physician. Then
we have only to assume a dignified mode of carrying the head, speak
in a tenor voice so as to inspire respect, give great importance to the
movements of the three first fingers of the right hand, and present
a certain authoritative something in the whole management of the
voice and attitudes of the body, in order to be able to exercise
perfectly in all its details, the golden art of the savoir faire of the
routine physician. Of course the smallest details of the attire of
the equipage, of the furniture, and of the array of servants, must
all be in harmonious keeping.
" If our whole thinking power and memory during the four-andtwenty hours of each day are completely absorbed in such matters,
this renders us all the more successful as physicians. Our whole
practice, be it said betwixt ourselves, consists in two or three
innocuous mixtures, well known to the chemist, in as many compound powders adapted for all cases, in an expensive tinctura
nervino-roborans, a few juleps, and a couple of formulas for pills,
either for acting on the blood or the bowels (nostrums and routine
remedies if you will), and with these we get on capitally. My
steaming horses rattle up to N.'s door, I descend from my carriage
assisted by the respectful domestic, with helpful speed, but with
an air of deep thought and a dignified mien. The attendants of
the patient throw open both wings of the door of the sick-room.
In silence and with abased head stand esteem, confidence, and
semi-devotion in a row, to allow the deliverer to approach the sick
bed. ' How did you sleep last night, my good friend?-your
tongue!-your pulse! The powders ordered yesterday may be
discontinued. The mixture prescribed here is to be taken alternately with the pills indicated below, followed by the julep every
half-hour.' Taking a pinch of snuff with an air of profound gravity,
seizing my hat and stick and making a practised bow, the degree
of which is regulated for every one in particular according to his
supposed importance or rank, this constitutes the whole of the
important comedy (shall I call it business?) for which we are paid as
a consultation, and which we repeat as often per diem as the serious
looks of the surrounding friends seem to render it necessary; for
they are the barometer of the danger, since we have neither time
nor inclination to ascertain it for ourselves in all our cases."  And




602

OBSERVATIONS ON THE

how many visits of this sort do you pay in one day? " Do you
imagine, you simpleton, that I can keep up my establishment with
less than several dozens of visits in a forenoon? "-What Herculean
mental labour!-" Ha! ha! ha! to scribble down on a long strip
of paper one of the eight or ten routine prescriptions that I can
reckon up on my fingers, and can seize on in the dark without a
moment's thought, the first, the best that occurs to me at the
moment, without the least reflection; do you call that mental
labour? It is a much more difficult matter for me to find a pair
of handsome bays to supply the place of my used-up afternoon
horses! hoc opus, hic labor!
" I have just now also much difficulty in thinking of the appropriate dishes for the sixth entree of the entertainment we are to give
to-morrow fortnight, so that it may be distinguished for its rarity
in respect of the season of the year, for its suitable elegance, and
for its brilliant tastefulness. Et hoc opus et hic labor!"
The so-called favourite remedies are in great vogue; without
being able to give the slightest reason for so doing, one physician
of the ordinary stamp will mix with every prescription, prepared
muscle-shells, a second always manages to introduce magnesia, a
third invariably adds spiritus mindereri, a fourth can scarely write a
prescription from which purified nitre is excluded, a fifth brings into
all his prescriptions the inspissated juice of the root of triticum
repens, a sixth thinks he cannot give the extract of dandelion often
enough, a seventh seasons every draught with opium, and an eighth
endeavours to bring in cinchona everywhere, whether it is suitable or
not, and so it goes on. Most every-day physicians have, they know
not why, their favourite remedies. Anything more indolent and parempirical cannot be imagined. How should all the countless array
of infinitely various diseases, each of which demands a peculiar
mode of treatment, always accommodate themselves to one and the
same remedy, which the doctor may happen to have taken under
his sublime protection?   Sooner might a cabinet-minister be
chosen from mere caprice, and it be taken for granted that the
subjects of the prince will be sufficiently obedient and intelligent
as to make harmony of the false gamut.
To stake constantly on the drawing of one and the same number always betrays a bad lotto-player. He must certainly occasionally win, but how much, or rather how little can he win? And




THREE CURRENT METHODS OF TREATMENT.

603

does he not continually lose, these few miserable cases excepted,
by not winning? Does he not render himself ridiculous to all the
world?
TREATMENT OF THE CAUSE.
Treatment founded on the internal essence of the disease.
In a practically useful point of view we may divide diseases in
general into two classes; diseases having a visible, simply material
cause, and diseases having an immaterial dynamic cause.
The first class, the diseases having an obvious, simple, material
cause, such as a splinter stuck in the finger, a stone swallowed, a
concretion in the biliary ducts or the bladder, an accumulation of
plum-stones in the coecum, an acrid acid in the stomach, a fragment of the skull pressing on the brain, a too-prolonged frenum
to the tongue, &c., are much less numerous than the diseases of
the second class.
The indication for treatment is obvious. All are agreed that
it consists in the removal of the material cause, be that mechanical,
be it merely chemical, or a mixture of both.        This generally
suffices to effect a cure, provided no considerable destruction of
the organ has occurred.
Its consideration does not concern us at present.
We shall occupy ourselves with the mode of curing the second
class of diseases, the countless array of all other diseases properly
so called, of an acute, sub-acute, and chronic character, together
with the numerous ailments, indispositions, and abnormal states,
having an immaterial dynamic cause.
It is the natural tendency of the human mind to seek for the
exciting causes of the phenomena he sees about him, and hence we
see, that no sooner does a disease show itself, than every one
occupies himself with attributing it to some source, that which
seems to him to be the most likely one. But we should be greatly
mistaken if, from this irresistible propensity to seek a cause for an
effect, we should infer a necessity for such knowledge in order to
effect a cure.
For very few diseases of the latter class do we know the dynamic
cause even by name, of none do we know the nature. Into the
secrets of nature no created mind can penetrate. And yet as
regards diseases, it is imagined that both can be known. The
ordinary physician has this in common with the generality of people,




604

OBSERVATIONS ON THE

that he imagines he can assign an exciting cause for every perceptible alteration in the health, and those physicians who were
apparently the wisest, imagined that they could penetrate even to
the internal essence of diseases, and that they were thereby enabled
to cure them.
Owing to the very nature of the thing, it is impossible that the
essential nature of most of the dynamic causes derived from without
can ever be ascertained.
How much have not some attempted to demonstrate to us respecting the influence of the seasons and of the various states of the
weather, as exciting causes of diseases! We were told of the
variations in the thermometer and barometer, the various winds,
and the alternations of moisture and dryness of the atmosphere for
a whole year, or at least for several months, before the occurrence
of an epidemic, and the murderous disease was attributed quite offhand and without much consideration to the weather that prevailed
during all that long period, just as if the disease could be derived
from the state of the weather, or as if they bore the relation to one
another of cause and effect. But granting that there was something in this, at least in the variations of the seasons, as the cause,
or at least partly the cause of particular kinds of diseases, how
little comfort can the physician derive from these unalterable
accompaniments of the world's course, how little assistance do they
render him in proving the indications from which he can bid
defiance to the epidemic actually prevailing! Were the season of
the year and the previous state of the weather really the cause of
the prevailing distemper, it would avail him little or nothing to
know this, seeing that from this cause the specific remedy for the
pestilence cannot be deduced, cannot be decyphered.
Fright, fear, horror, anger, vexation, a chill, &c., are impressions
that do not present themselves in a concrete form, that cannot be
subjected to physical investigation.
How and to what extent these impressions derange the human
system, what especial kind of disease they produce in it, is so entirely unknown to us, that we obtain not the slightest hint for the
treatment of the diseases they give rise to, by being informed of
the names of their probable source-fright, fear, vexation, anger,
&c. The most abstract investigation into the metaphysical nature
of fright affords the physician no instruction relative to the proper




THREE CURRENT METHODS OF TREATMENT.

605

treatment of its effects, never expresses the name of the appropriate remedy for the acute symptoms arising from fright-the
name of opium. This is not the place to indicate the shorter, more
natural way by which this remedy has been discovered for these
accidents.                                               *It is very easy to say that we may attribute itch to the itch
miasm, the venereal disease to the venereal miasm, variola to the
variolous miasm, ague to the marsh miasm. By pronouncing these
names not the slightest advance is made to obtaining a more accurate knowledge of these diseases, nor yet to their appropriate
treatment. The morbific miasms are as thoroughly unknown to
us as regards their internal nature, as the diseases themselves they
produce. Their essential nature is quite beyond the reach of our
senses, and their true remedies will never be learned from what
the schools can teach us regarding their exciting causes.  All that
has been discovered relative to their remedies has been discovered by
mere accident, by unpremeditated experience. But the way to seek
for them purposely and to find them will never be deducible from
aught we can ascertain respecting the internal cause of the disease.
What amount of knowledge respecting the cause and essential
nature of endemic diseases would suffice to reveal to us their true
remedies?   For us weak mortals there will ever remain an impassable gulf betwixt such a fancied knowledge and the remedy.
Reason will never discover a logical connexion betwixt the two!
Were even a God to enlighten us in regard to the invisible alterations produced in the interior of the minutest portions of our
body by the miasm of that most tedious, periodical endemic disease
that prevails in a portion of Lunenburg and Brunswick-the waterkulk (water-colic) as it is termed, which the eye of the practised
anatomist cannot discover, and were our mind, that is cognizant
only of sensuous impressions capable of understanding such transcendental instruction, this intuitive knowledge would never guide
us to the discovery of the only specific and infallible remedy-the
veratrum album. But this is not the place to shew the shorter, more
natural way in which the remedy for this disease may be sought
and found.
Neither the name of goitre, nor its probable cause (a residence
in mountain valleys) whispers to our mind the name of its remedy
which was revealed by mere accident-the burnt sponge.




606

OBSERVATIONS ON THE

Why then should we falsely and proudly pretend that we can cure
diseases from our knowledge of their dynamic causes?
For the accidents and diseases produced by commercial and
pharmaceutic poisons the appropriate remedies have partially been
discovered, but it was neither speculative investigation into the internal nature of these diseases nor physico-chemical analysis of
their cause-the poisons-that taught us these specific antidotes,
but a much shorter procedure, and one much more consonant
with nature. It is not very long since these hurtful substances
were attempted to be removed, often with very unhappy results,
by emetics, diluent drinks or purgatives, as if they oppressed
the stomach and bowels in a merely mechanical manner. Now,
we know how to combat many of them        like morbific causes of
the second class, of dynamic nature, by their appropriate antidotes. They effect an alteration of the whole system in a peculiar,
to us unknown manner, and their effects can never be cured like
mere local mechanical irritations, as was formerly imagined.
Others went much more learnedly to work, and divided them, in
an entirely apodictic manner, just as though they had been inspired thereto by a God, into acrids, narcotics, narcotico-acrids, &c.,
and agreeably to this arbitrary classification, dictated their remedies in an equally arbitrary manner;-a true picture of the mode of
procedure of the schools, classifying natural diseases, and assigning
the remedies for them! Arbitrariness, conceited arbitrariness, and
self-satisfied pride!
Thus belladonna and nux vomica were, with arbitrary despotism,
ranked among the narcotic poisons, and the vegetable acids, lemon
juice and vinegar, were cavalierly appointed their antidotes. Unfortunately for them, their assumed omniscience could here be put to
an infallible test, and their error detected in the very act. It was
proved that vegetable acids were the very substances that most
aggravated the symptoms. And so it will usually be found, that the
very opposite of what they assert is often the truth.
Sed saeculorum commenta delet dies.
It never could have entered into the imagination of this church
beyond whose pale there is no salvation, to assign opium as the
antidote of the one, camphor as that of the other of these powerful
substances, as experience has shewn to be the case.
But they were not content with dragging in as it were by the




THREE CURRENT METHODS OF TREATMENT.

607

ears, or inventing external causes for diseases, or with arbitrarily
attributing to them some peculiar nature, and, I cannot say searching for (for one can only search for a thing when there are well
grounded traces and indications of its existence), but rather
imagining and inventing remedies directed against this supposed
nature. They went still more learnedly to work, and concocted
in their brains all sorts of internal causes of diseases.
The ambitious notion that they were capable of referring most
diseases to one or a couple of internal causes, now became the
origin of the many sects among physicians, each successive one
of which was more fantastic than its predecessor.
One of these, and that not the worst, expressed the in some
degree special life and the peculiarities and particular actions of
each individual organ, by the figurative name of an Archteus, a
kind of particular spirit of this or that part, and imagined that
when this or that part suffered they required to soothe its particular Archaeus, and give its thoughts another direction. It appears
to me that they meant to make a confession of the incomprehensibility of all the phenomena of disease, and a confession of their
inability to satisfy the requirements of these supernatural things.
Others thought to persuade us that a predominance of acid was
the proximate cause of all diseases, and they prescribed nothing
but alkalies. An attempt to ally itself with them was made by
the old sect which referred all kinds of acute diseases, especially
the epidemic maladies, to a common poison which they contended
often developed itself in the interior of the body, and sought for
the antidote of this poison, which they believed to be the general
excitant of most diseases, in absorbent alkaline earths, but especially in the stony concretions found in the stomach of an antelope
(bezoar) and in the most heating spices mixed with opium (mithridate, theriac, philonium, &c.). Their abuse of the earthy powders
has extended down to modern times, and their evil demon, the
empirical universal abuse of opium, has now possessed some sects
of the present time, who have thought of other reasons for their
misapplication of this remedy for special cases as a positively
universal remedy.
C. L. Hoffmann imagined that he had an equal right to set forth
as a universal truth his own particular notion that almost all




608

OBSERVATIONS ON THE

diseases arose from a kind of putridity, and were to be cured with
remedies which his school denominates antiseptics.
No one will question his right any more than they will that of
the other leaders of sects, who perceived in diseases nothing but
acridities in the blood; demonstrated these for our edification by
far-fetched, scholastic arguments, and in an off-hand manner at
once invented the remedies for the black bile, for the psoric, arthritic, scrofulous, rachitic, muriatic and God knows what other
kinds of imaginary acridities, until the moderns, unmindful of the
medio tutissimus, founded a religion equally exaggerated in the
opposite direction, in which the fluids were entirely banished from
the list of morbific causes, and the production of disease was attributed to the solids alone.
In this way the poor diseases were ascribed now by this pigheaded fellow and now by that, at one time to this, at another to
that cause. All this time they remained in quiet possession, and
never suffered themselves to be disturbed.
Let it not be supposed that on the whole more diseases were
cured by one sect than by another. To excogitate causes of diseases,
speculative modes of their production, and to found systems
thereon, were what was aimed at; but not to cure them. The
former undertaking exalts the artist much nearer the stars than
the latter, and thus diseases remained just as before, uncured,
except such of them as would get well of their own accord, that is,
under any arbitrary treatment whatsoever.
The doctrine of bad humours long enchained mankind, the
dominion of acridities and perverted juices long prevailed. But
as the specific anti-acridity remedies could not so readily be found
out, the whole joke usually and principally consisted in producing
evacuations. With the exception of a few empirical drinks and
several kinds of mineral waters prescribed at hap-hazard, which
the humoral physician commanded to enter the blood, to sweeten
it, to correct it, and to expel by sweat and urine the impure parts
of it separated from the good portion as if by magic, the principal
manoeuvre of the humoral school consisted in the evacuation of
the bad blood (bleeding mania) and in the expulsion of the impure
fluids by the mouth and anus (stercoralism, saburralism).
How? did they pretend to let out the impure blood only?




THREE CURRENT METHODS OF TREATMENT.

609

What magician's hand could separate, as through a sieve, the
depraved from the good blood within the blood-vessels, so that
only the bad would be drawn off and the good remain?     What
head is so rudely organized as to believe that they could effect this?
Sufficient for them that streams of blood were spilt, of that vital
fluid for which even Moses shewed so much respect, and that
justly.
The more refined humoralists, in addition to the impurities in
the blood, alleged besides, the existence of a pretended, almost
universal plethora, as an excuse for their frightful, merciless bloodlettings; they also gave out that these acted derivatively, depressed
the tone, and ascribed many other subtle scientific effects to
them. They acted, as we see, like other sects, quite arbitrarily,
but obviously with   an  endeavour (not indeed to cure, that
would be vulgar, no!) to give to their arbitrary procedures the
highest possible colouring of rationality.
Reasons equally excellent, aims equally sage, had the humoralsaburral physicians for their innumerable emetics and their strong
and mild purgatives. "Consider the quantity of impurities that
are thereby purged from the blood, only look at the contents of
the chamber utensil! When all that has been removed, then
the body will be purified from all bad humours. Consider, moreover, what a quantity of impurities must daily remain and collect
in the body from the food and drink we take in;-it must be
purged away, and that repeatedly, if we do not wish the patient
to die. Observe also how most patients complain of tense or at
all events painful abdomen, or at least of unnaturally shaped
hypochondria, furred tongue and bad taste; who can fail to perceive from these signs that the germs of all fevers, the actual cause of
all diseases, lie in the impurities of the first passages? Yes, we must
certainly purge, and that frequently and strongly, in order to
bring away the material cause of the disease. The excellence of
our method is shewn by this, that we are in high estimation as
skilful physicians. The patient feels that he gets a good equivalent for his money, he perceives how the medicine acts on his
body, and he sees with his own eyes the impurities that are expelled from  him! Who can deny that all this speaks to the
convictions of the people, who can doubt that our church alone
holds the true faith?"




610

OBSERVATIONS ON THE

" I cannot quite agree with you, brother," says another branch
of the saburral school, "when you ascribe all diseases to the bile.
I maintain that they all depend upon the phlegm in the first
passages. The phlegm must be energetically cut into, diligently
dissolved; the phlegm, I say, must be properly purged away, in
order to extirpate the disease by the roots. All your bilious and
putrid fevers are masked pituitous fevers, all conceivable diseases
now-a-days depend upon phlegm, and if patients treated according
to our method are long in recovering, we yet can boast of our
system that it is radical and lucrative."
Thus would Blennophilos (in the style of his whole art) descant
still more discursively upon the advantages of his system, whilst
Eucholos, greatly displeased at hearing the bile denied to be the
universal cause of diseases, could not refrain from making an
equally vigorous speech in defence of bile, which demands a
general employment of emetics and purgatives. " Bile, bile must
be expelled," was the conclusion of his philippic, " diligently and
universally, upwards and downwards must it be expelled, for it is
the originating cause of all diseases! "
Accordingly the poor world was for more than half a century
properly cleared out upwards and downwards, so that any one
must have thought that it was thoroughly cleansed of all impurities. All a mistake, said Kiimpf, they are not nearly enough
dissolved and purged, at least they have not had half enough of
the only efficacious process from below. The source of all diseases
has been sought for in an entirely wrong place. Whence proceed
the many hundreds of hypochondriacal and hysterical nervous
diseases, the hitherto mysterious chronic diseases of the better
classes, whence all the pulmonary, hepatic, splenic, cutaneous and
cephalic diseases, and I may say all other diseases, whence do they
all proceed if not from infarctus and lodgments in the abdomen?
By means of solvent clysters in hundreds must these be dissolved
and purged away if we wish to avert death. Heavens! how purblind the world has been not to have discovered before now, this
the only possible remedy for the only possible cause of all diseases!
And verily, there could scarcely be a more lucrative method for
the practitioner; by no other could he so beautifully get over the
difficulties of his indications as by this, by which, without requiring to give any further reason, holding up the fearful talisman




THREE CURRENT METHODS OF TREATMENT.

611

of infarctus in order to work uncontrolled in the dark, beyond the
ken of the common sense of the uninitiated, and with the hocuspocus of several hundred clysters (composed of a number of unintelligible ingredients) he could-how wonderful!-bring bodily to
light the dreaded infarctus in all its hideous deformity. Making
omelettes in a hat is child's play to this.
If, sighed Tyro, I only knew all the external signs by which
lodgments could be diagnosed in any human being, if I only knew
what infarctus really is, what part of the intestines (of so many, of
almost all persons!) is constituted so torpid, as to harbour in such
an imperceptible manner these Protean masses, and what causes
their greyish colours, their various shapes, consistences, and odours,
as they are to be found arranged in a tabular form in Klimpf's
work! The difficulties of the subject make me quite ill! since
there are no sure external signs of their existence, who can tell
whether some such horrors do not lurk in my own entrails?
Grieve not, dear Tyro! that your five senses are inadequate to
enable you to discover all this. The game of infarctus and infarctus-clysters is already played out. It was only a financial
manoeuvre, if it was not a pious self-deception of the inventor.
By a succession of clysters we may make the bowels of even the
healthiest peasant into an organ for the production of unnatural
faeces, of masses of mucus of every variety of form and colour.
Other modern visionaries attributed almost all diseases they
could not cure to a step-sister of the infarctus, I mean to obstruction of the minutest vessels of the abdomen. They have not
mentioned any signs by which this may with certainty be recognised. Here, therefore, was another subject of panic terror for
the poor easily frightened patients, another rich draught of fish in
the dark! But be comforted!       They immediately discovered
in their nightcap the most effectual remedies for it. The vast
number of mineral waters and baths that still continue daily to
gush forth from the bosom of the earth to the great advantage of
the presiding physicians of each watering-place, which, like the
waters of Bethesda, are good (we know not how) for all conceivable
maladies, must consequently be also capable of clearing away the
obstructions of the finest vessels of the abdomen and of the mesenteric glands-id quod erat demonstrandum. Moreover, the saponaria, the taraxacum, the antimonial medicines, especially the anti2n2




612

OBSERVATIONS ON THE

monial soaps, invented in defiance of all chemistry, as they become
spoilt in an hour, soap itself, ox-gall, the triticum repens, and
above all, ye, our more than harrow and plough, noble neutral
salts, known to us at least by name! What can resist your solvent
powers!
Bravely spoken!
But have you ever witnessed, whether and how they perform
this solvent action? What divine revelation has pointed them out
to you as solvent remedies, since experience teaches nothing
thereof to our senses, can shew no proofs of it-since all is hidden
from  our view?   Are you convinced of the existence of your
imaginary obstructions?  Are you aware that Sommering found
the enlarged glands, which you consider obstructed, actually the
most pervious to injections of mercury? Do you know that when
you successfully employed muriate of baryta, or muriate of lime in
some cases of scrofulous disease, you did not dissolve, as you fondly
dreamt, but only separated the saccharine acid in them, discovered
by Fischer, which was the cause of the tumefaction in the glands?
Where, now, are your obstructions? Of what value are your
solvent remedies, seeing that there is nothing to dissolve?
But whence proceed the great number of children's diseases, that
carry off one-half of all that are born, before their fifth year? One
replies, " I consider the process of dentition as almost the sole cause
of the diseases and the mortality of children. We shall find, if we
view the matter aright, that from  the very first weeks of their
existence they begin to suffer from this troublesome teething, and
thus it goes on for several years. The poor creatures are always
engaged in this teething process, some one tooth or other is always
attempting to come through.     Hence we refer all their whining,
their capricious tempers, their working with the fingers in the
mouth, their pallor, their bowel-complaints, their enlarged abdomens, their starting in their sleep, their restlessness, their turning
and twisting, their convulsions, all their febrile symptoms, in short,
everything that can happen to them, if we are unable to cure it,
not to our ignorance, by no means!-but to one sole cause, that is
as inevitable as the Turkish fate. The parents have nothing to
blame us for. For if the dear child gets some well-known disease,
hooping-cough, measles, small-pox, &c., and dies of it, we always
have the capital excuse, that the process of dentition had something




THREE CURRENT METHODS OF TREATMENT.

613

to do with it. We have the same excuse when secondary diseases
occur after these maladies, as marasmus, cough, diarrhoea, ophthalmia, deafness, ulcers of this or the other part.  For all these
tedious convalesences no one is ever to blame, the troublesome
dentition is alone in fault. God bless that man who invented this
difficult teething! For, thank heaven! it always gives us something to do with children! Only it is shocking that the stupid
peasant children get their rows of white teeth with no bad symptoms, quite unawares, as it were, without any aid from us, or, indeed,
any medical assistance.  For it might so happen that the families
that employ us might fall upon the horrible idea, that kind nature
knows how to bring through the teeth without the aid of man, and
can actually place them quite silently in the mouth, like rows of
pearls, if the awkward officiousness of medical men, and a townlife, that great producer of children's diseases, did not hinder
her."This opinion is flatly contradicted by a colleague, who, with the
usual exaggeration, attributes the whole array of children's diseases to no other cause but worms. He carries this delusion so far
as to attribute a number of epidemic fevers prevalent among children solely to worms, "because they so often pass worms when
affected by them."   I am very much astonished that he does not
begin to seek the exciting cause of small-pox, measles, and scarletfever in intestinal worms only, for in them also worms often are
expelled (in consequence of matters repugnant to them being
present in the bowels). If he cures children's diseases by means
of iron, semen contra, jalap-powder or calomel, and worms have
thereby been expelled, in that case the diseases, according to his
notion(fallacia causae, non causae ut causae) must have been produced by worms, and this even if no worms but only mucus is
passed (purging with jalap and calomel always causes a discharge
of mucus). That must undoubtedly have been worm-mucus, he
alleges.-What peculiar kind of mucus have the lumbrici, that it
can be distinguished from all other kinds of mucus? And the seeds
of the Persian artemesia, jalap, iron, and calomel, can they cure no
other diseases besides those that arise from worms? With regard
to the first, experience has shewn me that it can, and as for the
others the whole medical world is convinced that they can.
And are you sure that your worm-symptoms, a distended abdo



614

OBSERVATIONS ON THE

men, bulimy alternating with anorexia, itching of the nose, blue
rings surrounding the eyes, dilated pupils, &c., and even the discharge of lumbrici, are incontestable symptoms of vermicular
disease? May they not rather be symptoms of a state of ill-health
co-existing along with an accumulation of lumbrici, which may be the
cause and not the effect of the collection of worms? Does not this
ill-health persist even after the expulsion of many worms, does not
this cachexy often last till death, and yet sometimes no worms may
be discovered on dissection?
Should the intestines sometimes be found to be perforated, and
should we assume that these creatures have themselves effected the
perforation (and not rather have merely crept through it), it
seems to be so foreign to their nature thus to bore through their
place of abode, that we often find them quietly remaining in the intestines of robust children up to the period of manhood, frequently
in considerable numbers, without causing any inconvenience, and
apparently doing nothing so unnatural as perforating the bowel
unless they are excessively irritated by some totally different
disease of the child (which ought to have been removed in time
by other remedies).
" Away with such gross exciting-causes of diseases!" exclaims
the solidist in the narrow sense of the term, " such doctrines are
not suited to our metaphysical age! Nervous debility is alone the
cause of most of the diseases of our degenerated race now-a-days.
Nervous debility and relaxed tone of the fibre, nothing else. All
the diseases of our time maybe referred to this!"-And the remedies
for this nervous debility, that excludes all other causes? Tell us,
my friend, what are they?-"' What else except those incomparable
remedies, cinchona bark, steel, and the bitter extracts?"-And how
so?-"C Why, look you, that every thing that is bitter, as Cullen has
justly remarked, acts as a tonic; whatever corrugates the tongue, like
the salts of iron, must strengthen the fibre, and what can resist
bark, with which we can tan hides? Now we have almost nothing
else to do in diseases than to remove the nervous debility and to
raise the tone of the fibre, consequently these medicines fulfil all
our ends."-This would be all very fine if it were all true. If only
the innumerable varieties of diseases did not produce innumerable
varieties in the functions and states of the solidumn vivum, which
short-sightedness alone could dream of comprehending in a single




THREE CURRENT METHODS OF TREATMENT.

615

word!   If you only knew the infinite varieties of the effects of the
variouc bitter substances! If cinchona-bark only ceased to be a
powerful remedy when all its tanning properties were extracted
from it by means of lime-water! If you could but attribute all the
various effects of iron to its astringent property!
" Even these causes of diseases," I hear some one say, "are not
subtle enough for our superfine decennium, but as regards the
mode of treatment, that smells strongly of crude notions. Far more
subtle is the nature of diseases, far more subtle let their mode of
treatment be! Nothing less forms the basis of both than substrata of the various gases. The new system of chemistry alone
opens the portals of life.
" Know, that all the derangements that occur in our functions
arise from a deficiency or excess of oxygen, of caloric, of hydrogen,
of azote, or of phosphorus, consequently that they can only be
cured by superoxydating or disoxydating, by supercalorifying or
decalorifying, by superhydrogenizing or dehydrogenizing, by superazotizing and disazotizing, by superphosphorizing or dephosphorizing remedies."
This sounds very finely in theory and reads well on paper; it is
also in the spirit of the prevailing ideas. But for every case of
disease I should require the supernatural assistance of a seer, to
make for me all these generalities concrete, in every case to reveal
to me whether the disease depends on deficiency or excess of azote,
oxygen, &c., and what the chemical antidotes of this particular
chemical state are, for these subjects may indeed be speculatively
excogitated with some semblance of probability, but being mere
products of reason are not cognizable by the senses in individual cases. Every assertion that has some truth at bottom (all medical
systems contain a portion of truth) is not of practical utility.
" We must go still higher," insists a celebrated teacher of dynamology, who has been reared on thp etherial milk of critical philosophy, "we must mount up to the original source of diseases, the
altered composition and form of matter." This ontological maxim,
however near to the truth it may appear a priori to the thinker
conversant with natural science in general, and with the probable,
arrangement of our organism, is entirely useless to the practitioner;
it cannot be applied to the treatment of individual diseases. In
like manner, what Bruce says about the remotest source of the




616

OBSERVATIONS ON THE

Nile is of no practical utility at its Delta. Still this teacher of
natural science has approximated much more closely than we
might have expected to what pure experience teaches, in his special
views relative to diseases, and particularly fevers, and given much
less scope to mere probabilities than his dogmatical and credulous
predecessors. Though a love of system guides all his steps, he
always honestly points out where his deductions run counter to the
maxims of experience, and has a wise respect for the latter. The
medical thinker may educate himself under him, but when he is at
the sick-bed, let him not forget that these views are mere individual
ideas, mere hints, and that from   them no remedial means can be
deduced.
The view of the medical art that Wilmans presents to the reflecting physician seems to be that most consistent with nature of all
others, but if we would not wander from the right way, we must
confine ourselves to his preliminary observations.
The schools have already adopted his classifications. All speculations in medicine, that proceed from pure empiricism, lead to
particulars and not to the philosopher's stone, if I may be allowed
to borrow a metaphor from a false art.
In dialectic sophistries, in bold assertions, (in shameless selfpraise), and in disregard of the infinite multiplicity of nature, manifested in the varieties presented by diseases and by their remedies, all
known founders of medical sects were, however, far surpassed by
that deceiving parempiric, Brown, who, though not himself engaged
in the treatment of diseases, limited all possible curative considerations to exciting and diminishing excitement, and presented to the
eyes of the world the greatest of all medical absurdities, "that
there can only be two or three diseases, which are distinguished
from each other by no other difference besides a plus and minus of
excitement, and a corresponding accumulation of excitability."
The therapeutics adapted to this notion were easily supplied: " seek
for stimulating substances and for such as are as little stimulant1 as
1 It surprises me that his adherents have of their own accord substituted an explanation of the latter substances, which was not that of their master, and could not be
his, if he wished to be consistent. He nowhere makes mention of remedies that
abstract stimulation.  His sthenia-lessening substances were such as debilitated
solely by the smallness of their stimulus (Elements of Medicine, 0 xc, cclii).




THREE CURRENT METHODS OF TREATMENT.

617

possible; these are the true remedies." And for the first of these
objects, I should imagine, one or two drugs would amply suffice.
Had he wished to avoid contradictions, he should only have named
one of the volatile and one of the fixed stimuli instar omnium, and
not several; for if one can effect everything, what is the object of
having several?
Perhaps, however, he felt the untenableness of his simplifications, perhaps he himself had experienced that the drunkard could
not exchange his brandy for musk or camphor. In order to complete his edifice, he must have ignored even patent facts and daily
experience.
But I need not enter into all the contradictions he must have
felt within himself, nor what it cost him to deny the most palpable
facts, in order to become the founder of a bran-new, unheard-of
sect; suffice it to say, no medical sectarian, apparently, knew less
about nature than he, but none understood better than he, by
means of illusory syllogistic ratiocination, to elevate a few true (and
from the novel point of view in which he placed them, apparently
new) maxims, into the only ones, to weave over all defects by his
obscurity of stating them, and to assert so despotically the superiority of his subtle mind in secularizing all other incontrovertible
truths. -Probably he would himself have confessed that he had
made fools of the world, had his excessive use of his diffusible
stimuli allowed him to live longer.
There is no absurdity that has not already been maintained by
some sophist, and in all ages the mania for simplification has been
the chief stalking horse of system manufacturers of the first rank.
Thus one in his theories asserted that the world was formed
exclusively by fire, another that it was produced by water only;a third contended that all living beings were formed from one
egg;-thus Descartes ascribed the universe to his imaginary vertebrae;-thus the Alchemists forced the infinite multiplicity of
chemical substances into the triangle, salt, sulphur and mercury.
What cared they for the numerous varieties of metals?       They
prided themselves on dictatorially fixing the number of metals at
seven, and these they falsely and boldly referred to a single original substance, their metal-seed.  What else was it but proud
simplifying mania, to decree our little terrestrial globe to be the
end and centre of all creation, and to imagine the thirty thousand




618

OBSERVATIONS ON THE

suns scattered throughout space to be scarcely more than lamps
for its illumination?
Still, I feel provoked at the wiseacre who sought to measure the
great science of medicine with a span, himself acquainted with
hardly any other diseases than perhaps the gout,' a few rheumatisms, some catarrhs, some haemorrhages, and the malignant
croup.
From his theoretical sins, of which I must not speak in this
place, I revert to those immediately concerning the treatment of
diseases.
There never was a doctrine so calculated to mislead the practical
physician, nor one so dangerous for the beginner.
According to him we must not trust anything to the powers of
nature (xcv), we must never rest with our remedies, we must
always either stimulate or debilitate. What a calumniation of nature, what a dangerous insinuation for the ordinary half-instructed
practitioner, already too officious! What a ministration to his
pride to be deemed the lord and master of nature!
""We should never use one single remedy alone, but always
several at once in every disease"! (xcii.)  This is the true sign of
a spurious system of medicine. Quackery goes always hand in
hand with complex mixtures of medicines, and he who can inculcate (not merely permit) such a system, is toto ccelo removed from
the simple ways of nature and her rule, to effect many objects by
one single means. This single axiom, invented for the purpose of
confusing men's minds and making a mystification of treatment,
must already have cost many their lives.
He makes no distinction betwixt palliative and curative remedies. Like a bungler, he always recommends only such as are of a
palliative character,2 which, by an action the direct opposite of the
state of the malady (LxxxIII, LXIV), at first subdues the symptoms
(for a few hours), to leave afterwards a state the opposite of that
1 It is remarkable how Brown treats of gout with disproportionate prolixity, I
might almost say pragmatically (Q dci, et seq.), whilst he has scarcely a couple of
empty, superficial words to say about other special diseases of the greatest importance.
2 I am not ignorant of the great value of palliatives. For sudden accidents that
have a tendency to run a rapid course, they are not only often quite sufficient,
but even possess advantages where aid must not be delayed an hour or even a
minute. In such cases and in such alone are they useful.




THREE CURRENT METHODS OF TREATMENT.

619

produced by the temporary remedy. Thus opium is his true
panacea in all diseases arising from and attended by debility. What
a climax of parempiricism and what a mistake-to recommend a
medicine as a general strengthener which after the lapse of a few
hours, during which it excites the strength, subsequently allows it to
sink all the deeper, deeper than before its employment, to prevent
which stronger and ever stronger doses must be given!         And
what experienced practitioner is ignorant of the effects resulting
from a continued employment of opium in elevated doses. This
drug, that strengthens only in a palliative manner, but that is,
more than any other remedy, in its after-effects weakening and
productive of an increased sensitiveness to pain, Brown could
recommend universally and without any limitation as the universal
and appropriate remedy for all sorts of diseases, whose character
is weakness, even such as are of a most obstinate and chronic
character (ccci, ccxcvIIi). He who fails to perceive in all this the
perfect picture of a parempiric has lost the use of his eyes.  It is
only in the special and very rare cases in which opium is at the
same time the specific remedy for the disease, that it cannot
debilitate, and when it is employed in very small doses as a palliative in robust constitutions and along with strengthening regimen,
it apparently does not weaken. This is the source of the delusion.
But of really curative drugs, the true weapons of the true physician,-which remove the disease permanently and radically, by
first exciting an affection similar to the disease present,-of these
he says never a word, he does not even know their names. He
that knows them I term a restorer, a discoverer of the medical art, as
he calls himself. Thus he had not the most distant idea-to give a
single example-that a burnt finger may be held for a long time
in cold water before it (when taken out and dried) shall cause no
more pain-indeed vesication occurs all the more certainly if socalled antiphlogistic, debilitating remedies be applied to this local
inflammation. He has not the least idea that the opposite of all
this occurs if the burnt finger be held in alcohol.' Where now
1 Look at the reaper excessively heated by working in the heat of the sun; with
what does he allay his thirst most certainly and most effectually, with what can he
do this better than with a little brandy. Brown's antisthenic palliatives, cold water,
&c., could scarcely refresh him for an instant.




620

OBSERVATIONS ON THE

are your palliative anti-sthenic, where your palliative anti-asthenic
remedies?    How far they are behind!
What true, experienced physician knows not the palliative
debilitating power of cold and of cold water?      Brown had no
need to put forward as a novelty the debilitating property of cold
and of the cold bath. But when he announces it to be a positively
debilitating thing, he shews that he does not know it, just as he
views many other things in a false manner. It is only for the
moment during its application that it debilitates (palliatively),
whilst in its subsequent effects it manifests itself as one of the
most excellent of strengthening remedies (as a curative and permanently remedial means). The greatest weakness of a limb, a
frost-bite, is confessedly cured by nothing more quickly than by
cold water. This may stand for one of the thousands of instances
of the curatively strengthening effects of cold water.
He knows no other cause of diseases besides either a too violent
excitement by means of stimuli (sthenia), the continued action of
which causes indirect weakness, or too little excitement by means
of too weak stimuli (direct debility). The former includes all
purely inflammatory diseases, and the latter all other diseases that
bear the stamp of debility. The former are cured by venesections,
cold, water-drinking, &c., the latter by heat, soups, wine, brandy,
and particularly opium. In this manner all the countless diseases,
varying infinitely in kind, are cured by him (on paper) or directed
to be cured.    The crudest parempiricism, the most audacious
ignorance, could not go farther than this. According to this all
epilepsies,1 all dropsies, all endemic diseases, all melancholias, are
to be certainly cured by opium, brandy, heat and beef tea! Has
anyone ever experienced a certain, radically good result from such
treatment in such diseases?  Is he making game of us?   Does he
want to consign completely to the tomb the medical art, sunk as
it already is down to the administration of a few routine drugs?
But no! he is in the highest degree rational. He permits no
treatment to be undertaken before ascertaining all the inimical
influences that have preceded the disease, whether they could act
1 He knows of no epilepsy with excess of good blood, no sthenic dropsy, no sthenic
haemorrhages,no asthenic catarrhs, though nature knows them and not unfrequently
produces them.




THREE CURRENT METHODS OF TREATMENT.

621

in a too exciting or in a debilitating manner, and from these alone
he will allow the nature of the disease and its treatment can be
determined (but always only for two objects, viz., whether we
should debilitate or strengthen). But the very circumstance of
his making this investigation the only indispensable indication,
betrays that he has treated disease in his study only, that he
speaks as a blind man would do about colours. In all the cases of
sudden disease and such as occur among the common people, who
could ascertain in every instance and in the most exact manner,
before commencing the treatment of any disease, what was the
kind of injurious agency (as Brown affects to discover in every
case) had occurred long before; whether the malady was preceded
entirely or only in some degree by an excess of stimuli, or entirely
or only in some degree by too weak stimuli, or in how far it was
preceded by greater stimuli mingled with deficiency of stimuli
(and in what proportion?); whether a sthenia has changed into an
indirect or direct debility, or the latter into the former, or whether
one sort of asthenia has conjoined with another, and (what nonsense!) brought about a mixed state, in which the excitability of
eighty degrees, -that divine revelation to the inspired Brown, is
exhausted or accumulated?   Who can always institute a comparison between the strength of these noxious influences and the
sum total of excitability assigned to the individual, modified as it
is said to be by age, sex, constitution, climate, country, &c.?
What experienced practitioner can assert that a tenth part of his
patients or the friends of his patients could, would or should give
accurate information on all these hyperbolical or hair-splitting
questions, give a detail of all previous agreeable or disagreeable
mental emotions, of the impressions of the various degrees of
temperature to which they may have been exposed throughout a
considerable lapse of time, of the exposures to too much or too little
sunlight (a stimulus of no mean intensity!),, or to a more or less
dry, moist, impure or pure air for some considerable period, of the
divers kinds of more or less nutritive, sapid, seasoned or unseasoned articles of food that may have been indulged in, the quantity of more or less strong, vinous or watery drinks that may have
~ been taken, the frequency of indulgence in venereal excitement,
the degree and quantity of exercise that has been taken, the
nature of the amount, the degree and the frequency of all previous




622

OBSERVATIONS ON THE

mental excitement by means of reading, conversation, amusement,
music, &c.?  And even supposing among many families one could
be found who after some weeks of interrogation (for it is impossible
that such a variety of questions could be asked in one day) was
able and willing (supposing the greater part had not been already
forgotten) to answer the most of these questions, how painfully,
how fruitlessly I may say, must not the poor doctor rack his
brains, in order to estimate and compare these hundreds of thousands of various influences, to calculate their exact effect on the
patient whose excitabilitywas at first so and so much, to estimate the
resulting sum total, and to discover the amount inBrunonian degrees
of the excess of the noxious powers of over-stimulation over those of
the deficiency of excitement, or the excess of the powers of the
latter over those of the former, and all this in connexion with the
particular subject before him! No single circumstance of importance must remain unascertained, or be left out of the list, or be
omitted in the calculation, neither must the lesser circumstances
(which constitute something considerable by virtue of their number) be forgotten, unascertained, omitted or unestimated, otherwise the whole reckoning will turn out false!
I need scarcely remark, how vain, how impossible, how senseless,
such a mode of procedure (which, according to Brown's maxims,
~ xI, xii, LxxvIII, c, &c., cannot be pushed too far, seeing that all
the investigation of disease depends on it) must be in every-day
practice-what an enormous amount of trouble and time must be
expended in the investigation and consideration, before the treatment of a single case can be commenced; and in the time thereby
lost the disease must unobservedly pass into another stage, if it do
not in the interim terminate in death. A conscientious Brunonian
would probably never arrive at the period when he would commence
the treatment, with all this investigation and effort to form a just
estimate. And after all, nothing more would have been ascertained
but the point respecting the sthenia on which the disease depends,
or respecting the direct or indirect debility! Is this the only thing
we require to know in order to effect a cure? Well then, know that
debility is present in all endemic diseases. Now, quick! cure me
all the countries infected with ringworm, pellagra, plica polonica,
sibbens, yaws, pian, water-colic, &c. Do you want nothing but
fixed and diffusible stimuli? Here you have opium, caloric, brandy,
bark, beef-tea.-Cure me them quickly!




THREE CURRENT METHODS OF TREATMENT.

623

God help us! what a mass of nonsense a single unpractical
book-maker can rake together and inflict on weak lamb-like mortality, in defiance of all common sense!
But let us do him justice! whilst we see that the glory which was
to constitute the apotheosis of this original head vanishes, whilst the
Titan who sought aimlessly to heapPelion on Ossa, quietly descends
from the rank of heroes-whilst we see that his colossal plan to turn
everything topsy-turvy in the domain of IEsculapius is dashed to
pieces, and that the myriads of special diseases cannot be referred
by him to one or two causes, or what is the same thing, be decreed
by him to consist of two or three similar diseases only varying in
degree, nor their infinite variety be cured by two or three stimulants or non-stimulants;-whilst we consign all these arabesque
excentricities to the domain of fable, let us not forget to do him
the justice to acknowledge that with a powerful arm he dispersed
the whole gang of humoral, acridity, and saburral physicians, who
with lancet, tepid drinks, miserable diet, emetics, purgatives, and
all the nameless varieties of solvents, threatened to destroy our
generation, or at least to deteriorate it radically, and reduce it to
the lowest possible condition,-that he reduced the number of
diseases requiring antiphlogistic treatment to three per cent of their
former amount (~ ccccxcii), that he determined more accurately the
influence of the six so-called non-natural things on our health, that
he refuted the imaginary advantage of vegetable over animal diet, to
the advantage of mankind;-that he restored to the rank of a medicinal agent a judicious diet, and that he reintroduced the old distinction between diseases from defect of stimulus and those from excess
of stimulus, and taught with some degree of truth, the difference of
their treatment in a general way.
This may reconcile us with his manes!
His disciples, proudly wrapt in the mantle of their Elijah, support
his doctrine utcunque with much noise (the sign of a not very
good cause), deafen us with the Brunonian cant about degrees of
excitability, which they consider to be exalted and depressed by previous noxious agencies just as they please, prate about simple and
compound, direct and indirect debility, about diatheses and predispositions as (imaginary) distinguishing signs of the general from the
local diseases, about (pretended) diffusible and fixed stimuli-and
treat their patients right and left with compulsory soups, wine and




624      THE THREE CURRENT METHODS OF TREATMENT.
opium; they are become sufficiently cunning to engraft from
vulgar medicine what is requisite and indispensable, and when
beef-tea, rum and opium do not suffice, they employ the excellent
bark (which their master decried) in intermittent fever (protesting
all the while that they use it only in its quality of a fixed stimulus),
and turpentine oil in dropsy, but under cover of the Brunonian
explanatory formula: "that turpentine possesses the exact degree
of stimulant power necessary in this case." Thus have I seen the
devout monks in a monastery dine upon partridges on a Friday, but
not before the Prior had made the sign of the cross over them,
accompanied by the transmuting blessing-fiat piscis!




TO  A   CANDIDATE      FOR   THE    DEGREE      OF  M.D.'
I have read your notes of the lectures on therapeutics of your
celebrated professor. You are quite right to learn all these things,
and to take notes of them. We ought to know what our predecessors and contemporaries have imagined. In like manner I
often allow my patients to tell me what they think their disease is
and what it proceeds from, what sort of witchcraft produced it and
what were the sympathetic remedies and foolish means they have
used for it. I like to know what sort of ideas people form of
things. The same with you in your college, where you learn
the fables those people who imagine themselves to be sagacious
physicians have invented respecting all those things which they do
not understand, and which no one in the world can know a priori.
Of course there will be many extraordinary freaks of imagination
and daring maxims that find no corroboration in nature, and
much more learned stuff, which at all events sounds very profound
and wise, because it is paraded in grand, florid and metaphorical
language,-there the oxygen and hydrogen poles in the human
body, intensified factors, the ganglionic system, the centre of vegetative life, a peculiar irritable or a totally distinct sensitive system
within us, must play parts in the comedy we have ourselves invented. Beautiful shadows on the wall! But when they come to
the bedside of the patient, one will see a synochus systematis irritabilis, where the other, who has been taught by the self-same
master, firmly and obstinately asserts he finds the exact opposite,
for the signs of the one and of the other as taught ex cathedra are
as nonessential and undecisive as they are vague and indeterminate. Now should it so happen that one of them has divined the
real meaning of the system-monger, what advantage does the
healing art thereby gain?  None at all! No subtle theorizing
1 From the Allgem. Anzeig. der Deutschen, No. 227. 1809.
2s




A

626         TO A CANDIDATE FOR THE DEGREE OF M.D.
respecting the essential nature of fever ever points directly to
what should and must be useful for it. The theoretical house of
cards stands quite isolated in its imposing majesty, but is hollow
and empty within, and does not even contain an indication for the
appropriate remedy for the disease, the inspired revelation of whose
essential nature is here solemnly announced. 0 quanta species,
cerebrum not habet! The whole jingle of theoretical flourishes is
far from being of the same use to the directions appended to it as
to what is to be used in the disease, that the premisses are to the
deduction in a logical syllogism-no! they more nearly resemble
the sound of the trumpet and drum in the street wherewith the
mountebank seeks to announce the quid pro quo which he proposes
to juggle before his delighted spectators in the afternoon. For
see, what the professor imagines to be of service in this case or the
other, is just as arbitrary, has no firm foundation, and is not the
result of experience, but is inferred from the most superficial view
of the case, and only asserted with the satisfactory 4VTOds ga.
For a single genus of fevers there will be found almost the whole
materia medica: give the patient, gentlemen, draughts of bitter
and aromatic plants (does this mean that we are to give colocynth,
squills, ignatia, nux vomica, aloes? also yellow sandal-wood,
dittany, abelmoschus seeds, rose-wood?), or saccharine oils in tea
(including the oil of laurocerasus and the distilled oil of bitter
almonds?).
The whole concern with its many definitions of fever and its
superfine pedantry in pulse-feeling-which everyone finds to vary
almost every hour, and which feels different at every modification of
the patient's temper-all these are no doubt glittering things, but
they are at the same time utterly vain, affording no comfort and
no assistance, obscuring our vision like a mist when we seek to
cure our patients. On account of the learned mist which obscures
and does not illuminate, we neither perceive the true state of the
patient, nor that wherewith we might afford him relief.
Only ask yourself, if you knew all that off by heart, would you
be able by means of it to form an accurate conception of the
disease, and could it aid you to cure the disease?     No doubt
you would be able to treat it with all the array of proposed remedies,
but whether one of these is the best and most suitable, and which
among them it is that solely and especially can and must be of ser



TO A CANDIDATE FOR THE DEGREE OF M.D.

627

vice, that you will not know; the professor himself does not know it,
otherwise he would only have mentioned this sole best and most
suitable remedy, and no other. When the therapeutic professor
can put together a number of general artistic, flowery, phrases
respecting things that none can know, and can dash a learnedlooking varnish over the hypothesis of his own invention, the
whole affair appears to be all right; but when he attempts to
apply it to the relief of disease-the proper object of the medical
art-his learned, theoretical apparatus leaves him in the lurch;
he then runs over, in a purely empirical manner, just like the
most unreflecting, routine practitioner, a number of names of
medicines--" there, make what you can of that! you may put all
the names together into a bag, and according to your fancy draw
out one or several, it is quite immaterial, you may use this one or
that one!" Here, where the question is to afford relief, we find the
most stupid syncretism and empiricism, and there, where theorizing is the question, we find the most sublime, mystical, and
incomprehensible phrases in use, as elevated as if they had been
solemnly delivered by a divinely inspired oracle from the cave
beneath the tripod of the Delphian Apollo. But cease to entertain a
reverential awe for these magic mutterings; they are mere empty
sounds that have no connexion with the simple, certain and rapid
delivery of your fellow-creatures from  the pangs of disease;
they are but sounding brass and a tinkling cymbal.

2s2




ON THE PIREVAILING FEYEI{.1
The medical men of the present time, by regarding the fever that
has prevailed for a year past in Germany, and indeed throughout
the greater part of Europe, as a common ague or intermittent
fever of some other ordinary kind, and by treating it as such
(every one knows with how little success!) have given a fresh proof
of the imperfection of the ordinary medical art, I might almost say
of its absolute futility.
When one thing expresses itself differently from another, and
exhibits different properties and actions, it requires very little discriminating skill to regard it as a thing of a different character!
And when one disease shews itself iin its course, its symptoms and
all its phenomena quite different from another well known disease,
surely every person endowed with ordinary reason must perceive
that the former must be another, a peculiar disease, differing completely from the one already known; and, as a necessary consequence, to be treated quite differently, and entirely according
to its peculiar properties.
Not so our dear ordinary system of medicine, whose maxim
seems to be to leave everything in the old way, to take everything
quite easily, and to spare ourselves as much reflection as possible.
Our ordinary medical system, I say, felt -no hesitation in declaring
this new peculiar fever to be an ague and (what should prevent
it?) treating it accordingly. For mark! dear reader, the medical
art has but a single intermittent fever, what is called ague in the
books; therefore there must be in nature no other typical fever.
Quasi vero.
And thus the misunderstood fever at present prevailing is treated
by practitioners like the ordinary ague that occurs in autumn and
From the Ailkem. Anz. der DeUtsc1ken, No. 261. 1809.




ON THE PREVAILING FEVER.

629

in marshy districts,-right away with emetics and purgatives, with
sal-ammoniac (opium), millefoil, buckbean, centuary, and cinchonabark, which has been considered as almost omnipotent. By means
of the first mentioned, the (imaginary) febrile matter was to be
dissolved, or expelled, but by the last the type was to be extinguished.  But what was the effect of this general plan of
operation (which was long since introduced for the ordinary
autumnal marsh intermittent fever) when employed against the
misunderstood fever at present prevailing? I appeal to the experience of all countries where it has raged, if it was not attended with
bad effects, if it was not often the case that more disease (even death)
and long-lasting indisposition were not often thereby promoted, than
would have been the case without all those unsuitable medicines,
and actually was the case among poor people who used none of them?
These substances, and particularly the bark given in large
quantities, certainly sometimes suppressed the paroxysms (when
they did not change the fever into an acute rapidly fatal one) for
a longer or shorter time,-but they did not thereby generally
restore the patients to health; they generally became in other
respects worse, they became subject to very painful local diseases
in place of the suppressed paroxysms, or they languished with
nervous symptoms and wasting affections, which were worse than
the typical fever itself.
These dangerous mistakes were in the first place owing to this,
that practitioners as usual did not distinguish the disease, did not
examine what particular, peculiar symptoms were proper to this
prevailing fever as distinguished from all other kinds of inter.
mittent fevers, whereby it was rendered quite a distinct, peculiar
disease; and, in the second place, that they did not know how to
discover the peculiar, specifically suitable remedy for this peculiar
fever.
Can that be termed a medical art which has no power to perform
its two sole duties-the discriminating observation of diseases,
and the discovery of the appropriate, specific remedy?
In ordinary diseases which (God be praised!) tend to get well of
themselves, the ordinary practice of medicine can contrive to conceal its inefficiency and hurtfulness-there it can, to use its own
language, dissolve, purge, depress, stimulate, and do whatever else
it will with remedies, that the most unreflecting caprice suggests




630

ON THE PREVAILING FEVER.

to it;-some persons certainly get well under the treatment, let
the doctor act as madly as he pleases. Good constitutions often
even then gain the victory (not unfrequently with the aid of
throwing away unsuitable, injurious medicinal mixtures) not only
over the disease itself, but also over the newly added maladyover the blind treatment of the unknown disease by means of
inappropriate, therefore hurtful medicines, and out of the number
of those that die no one can tell how many who had originally a
moderate attack of the disease succumbed solely in consequence of
the interference of the art.
But in the diseases that do not soon go off spontaneously, that
will not allow themselves so complaisantly to be overcome by the
dear vis medicatrix naturte-such as the fever at present ragingin them it will be quite obvious that the ordinary medical art is
not very far from being a scientifically propped-up monster and a
misleading phantom, and its practice with few exceptions a futile
injurious procedure. Almost all its efforts tend but to aggravate
(when the reverse does not happen, as it does sometimes, in consequence of the accidental and lucky admixture of some addition to
the methodical medicinal compound) or to excite new maladies,
often not less to be dreaded than the original disease. Thus, in
the present instance, by the injudicious suppression of the paroxysms of the prevailing fever there are produced a continued
morbid, chronic febrile state, periodical spasmodic nervous affections, asthma, stiffness of the joints, swelling of the glands,
constant or periodical discharges of blood, or long continued suppression of the menses, but particularly excessively painful local
diseases, and many other wasting affections, which no sensible
person can term a cure.
I shall endeavour to describe the peculiarities of this fever, as
they present themselves, when it has not been altered by drugs, and
then I shall shew what medicines must be suitable for it, afford
relief, and restore health.A difference of sex, of constitution, of age and of the immediate
exciting cause (whether it was anger, grief, a fright, excess in
sensual indulgence, a debauch, &c., that first caused the fever to
break out),-also, to a certain extent, the climate and the state of the
weather, sometimes occasion at first some variety in the course
and form of the fever. But the following is its general course.




ON THE PREVAILING FEVER.

631

Often for several days or weeks before it breaks out there are
observed, headache in the evening, bitter taste in the mouth, and
heaviness in the legs.
1. In bad cases the fever commences as a continued one, and
goes on without intermission in almost equal violence day and
night, constituting, as it were, a single paroxysm, which ends, if
inadequately treated, the ninth, eleventh or fourteenth day with
death-or it subsides (and this it is very apt to do) into a continued
chronic state, wherein certain sufferings are more severe at one
time of the day than at another;
2. Or it resolves itself (either spontaneously or by the commencement of appropriate treatment) into tertian or quotidian
fits. The remissions, however, do not in the most cases constitute a genuine intermission, not a state of absolute freedom from
disease; a few or many of the sufferings persist (though in a less
degree) and the fever is therefore only to be regarded as a remittent one, which is especially the case in its worse forms, the
paroxysms of which do not terminate under eight, twelve, sixteen,
and even twenty-four hours.
(It is only a very small minority of these fevers that have true
intermissions, but, notwithstanding this, their nature is the same,
and they require the same mode of treatment.)
In both kinds, which often pass into one another, the shivering
or rigor (which sometimes passes into violent shaking and chattering of the teeth) is not (as it is in ordinary agues) accompanied
by real external coldness, but it is a merely internal shuddering
sensation of cold (internal rigor), during which the patient is
hot (in some cases only naturally warm) to the touch all over, but
chiefly so on the hands and feet.
This cold stage commences with thirst, vertigo, and a drawing
tearing (mixed with shooting) from the legs upwards, which, when
it, according to the patient's sensation, gets up into the head,
produces heat of the head, headache, nausea, &c.
In the continued kind the sensation of flying heat in the head
alternates almost unremittingly with rigor; often both are present
at once (the patients complain of " internal rigor, and of their head
being at the same time so warm that the heat mounts up into their
head, with nausea"). At the same time the patients feel hot all
over the body, without themselves being aware that they are so,




632

ON THE PREVAILING FEVER.

on the contrary, they wish the room to be strongly heated, wrap
themselves closely up, and only complain of the so-called flying
heat rising up into the head.
In the chronic, degenerated kind of the continued fever, the
rigors with external heat of the body and of the hands are not unfrequently conjoined with actual coldness of the feet, then the
patients complain that after going to bed at night they cannot get
warm, whereas when they waken in the morning they feel so hot.
As a rule, the rigors in the continued variety come on from very
slight causes, on getting up, even on sitting up in bed and on the
slightest movement, often even every time the patient drinks,
even warm beverages.
In the paroxysms of the remitting sort also, the so-called heat
is, according to the patient's description, generally only a feeling
of strong warmth rising to the head, often accompanied by burning in the eyes and redness of the face (this is the only heat they
feel, not that of the rest of the body), with which is conjoined a
series of other affections of the sensibility and irritability, which
together constitute the so-called hot stage.
The most frequent complaint is the headache, which they usually
describe as a tearing pain in the skull, mingled with shootings,
also as a bursting pain, often also as a digging in the brain and as
if it would be forced out superiorly, whereby a throbbing in the
occiput not unfrequently supervenes, which deprives them of consciousness, or jerks in the head from before backwards. They
have this headache even while lying, but on rising up, or even
moving the head, either the shoots or the blows (jerks) in the
head increase to an intolerable degree.
Patients of a different constitution complain, instead of this
headache, that their head feels so heavy, so stupid, so dizzy, that
they are so forgetful and intoxicated, that everything appears to
them wrong, that there is hissing and roaring in the brain. This
state in the hot stage often turns into real unconsciousness and
loss of reason, that often lasts many hours and even degenerates
into violent mania and raving madness.
But an equally frequent symptom in the hot stage is the anxiety
(generally combined with palpitation of the heart and sweat on
the brow), which often rises to the most fearful height, during
which the patients complain that they cannot control themselves,




ON THE PREVAILING FEVER.

633

and not unfrequently in these dreadful moments they commit
suicide, either by strangling or hanging themselves.
In the continued variety of this fever, this anxiety usually becomes aggravated after midnight, especially after three o'clock,
when the patients cannot endure to remain in bed, but must walk
about, until they sink down exhausted. In this kind of fever the
kind of pain which the patient experiences during the day is at
the same time aggravated so as to be intolerable, whether it be in
the head, the chest, one of the limbs, the uterus, the urinary
organs or elsewhere. In the slighter degrees of this continued
fever there occur after midnight, half remembered, anxious phantasies, deliria, tossing about of the body and limbs.
The disposition of our fever-patients is also very much affected
by precordial anxiety even when no fit is present.   They are
timorous and easily vexed by trifles, and, according to their temperament, either very dismal and full of fears of impending death,
or intolerant, impatient and weary of life, occasionally so much so
as to induce them to commit suicide.
A third symptom occurring along with the hot stage of the
paroxysms is nausea, a faint feeling, such as is apt to accompany
horrible pain, which often tends to increase into retching for several hours, and vomiting of sour, bitter or watery fluid.
In the continued kind the nausea often comes on in conjunction
with the anxiety, vertigo, faintness and trembling. Even when
no actual retching is present the patient has a constant feeling in
his stomach as if he could vomit incessantly.
The vertigo is one of the most frequent symptoms of this fever.
It often comes on at the commencement of the rigor, on any
slight movement, and is accompanied by the nausea, the noise in the
ears, the obscuration of the vision and the faintness. The patients
feel as if they would fall rather sideways and forwards than backwards.   In the chronic continued variety the vertigo happens
chiefly in the morning.
Not less characteristic of this fever and a very frequent phenomenon is the trembling, especially of the limbs, which sometimes
occurs alone, sometimes conjoined with the anxiety, the heat of
head, the attacks of faintness and vertigo, and also with the sickness. Most frequently of all, the trembling shews itself at the
commencement of the hot stage.     In the chronic, continued




634

ON THE PREVAILING FEVER.

variety it sometimes becomes the most prominent symptom, and
then attacks only one limb at a time; it occasionally appears only
when lying down, and not at all when moving.
The paroxysms of some children are ushered in with clonic
spasms and epileptic convulsions; seldom are they mere tonic continued flexures of their limbs at the commencement of the heat.
The perspiration (which usually smells sour or sourish) usually
occurs in the paroxysms of the remittent kind, not, as is the case
in the autumnal intermittent fever, during the heat, but (very
characteristically) afterwards, often only some, several or even
many hours afterwards,' often also not until the patients get up,
or move about, or when they fall asleep some hours after the heat.
In the mean time the worst symptoms of the fits, the precordial
anxiety, the pains of the head and other parts, the weight and
stupid feeling in the head, the loss of reason, &c., go off, but
usually not until the perspiration comes on, however long it may
delay.2 In the chronic continued variety of this fever, the perspiration comes on when moving slightly, even when eating, but
especially on the recurrence of the pains, and whenever the
patients go to bed and cover themselves up. During the slightest
sleep most of them become immediately covered with perspiration.
In the kind of fever consisting of repeated paroxysms, the thirst
from the very commencement of the fit, even before it comes on,
until the end, is unquenchable, but though the patients drink
very often, they take but little at a time, for every liquid becomes
repulsive to them the moment they partake of it; there also often
occurs immediately after drinking either shuddering or nausea
and retching; this kind of thirst is also not unfrequent during the
remissions. If the fever assumes the chronic type, there sometimes occurs complete adypsia, though not often.
Along with the sinking feeling and retching sickness there is
conjoined disgust at all kinds of food, chiefly at meat, butter, &c.
Even when, in the fevers that pass into the chronic form, food and
drink begins to taste tolerably, there still occurs after it is partaken
of, sinking and nausea-or anxiety, as if from difficulty of breath1 Generally the flow of urine remains suppressed just as long.
2 There are some of these fevers where perspiration never ensues, only during the
anxiety there may be a little on the head; in these cases the perspiration is sometimes replaced by clonic spasms.




ON THE PREVAILING FEVER.

635

ing, so that there is a desire felt to open the doors and windows.
In the chronic continued fever, periods of anorexia and bulimy
sometimes occur alternately.
On taking any food, the sense of taste appears as if extinguished;
food tastes, even during the remission, just like hay or straw; but
immediately after partaking of it the mouth becomes completely
filled with a bitterness like gall, just like after vomiting from taking
an emetic; and there occur nausea, or bitter or sourish-bitter eructations. In some there occur even whilst eating, especially eating
bread, bitterness in the mouth. More rarely does it happen that
there is constant bitterness of the mouth, and in that case the
bitterness is much increased after every meal. At the commencement of a paroxysm the bitter or bitter-sour eructations are of
frequent occurrence.
The usual sensation in the mouth is dryness of the fauces, with
feeling of mucus upon the tongue, not unfrequently combined with
a feeling of rawness in the fauces. Frequently, after awaking in
the morning, the taste in the mouth is bitter, rarely like that of
rotten eggs.
The urine is generally dark and of a greenish-brown colour.
There often appear burning itching eruptions all over the body,
or on different parts of it; sometimes a very frequently occurring
cough.
The sleepiness by day in the continued kind of this fever is
great. Even in the morning soon after awaking, whether they
are seated or standing, their eyes often close, frequently in the act
of talking.
Very characteristic of all the states of this fever is the intolerance
of movement or of muscular exertion. Immediately on the occurrence of a fit their limbs appear stiff, as if paralysed; they must
instantly lie down, and even when lying they feel as if paralysed.
If the patients get up during the heat, then shuddering occurs, not
unfrequently with sudden chilling of the hands and feet, they feel
sinking, the vision becomes obscured, a faintness supervenes. Also
when the paroxysm is not upon them, the least movement deprives
them  in a few moments of all strength.      Trembling, vertigo,
nausea, obscuration of vision, roaring in the ears and fainting,
these symptoms so characteristic of our fevers, frequently come on
on the least movement, and the strongest men often fall to the




636

ON THE PREVAILING FEVER.

ground before we are aware of it. Also in the intermission and in
the chronic continued state, the patients cannot bear to stand even
for a short time; obscuration of vision and vertigo, shortness of
breath, and even fainting, are the result. All the pains they
usually suffer are especially increased by movement of the body,
or of single limbs. On putting their foot to the ground they feel
the shock in their head, or shootings go through it.
All the symptoms are alleviated by lying.
But still more injurious to them in every condition of this fever
is movement in the open air; this deprives them suddenly of
strength, produces in them either shuddering and rigor (followed
by perspiration) or shortness of breath, or drawing in the limbs,
or increased tearing shooting headaches; at the same time it
diminishes the dizziness, maziness and intoxicated feeling in the
head, which however soon recur on coming back into the room.
A kind of pressive pain in the chest, or rather in the scrobiculus
cordis, with sense of suffocation, is a not unusual symptom at the
commencement of and during the heat; it often occurs simultaneously with the precordial anxiety. Pain, like rawness in the
chest, is far from being rare, and the same may be said of drawing
pains in the back, as if from a strain.
This fever seems sometimes to cease suddenly of its own accord,
but more frequently by the use of some medicines unsuitable for
it, especially cinchona-bark; but on the other hand, there occur at
the same time vicarious affections, periodical nervous maladies,
suppression of the menses, or periodical, very painful discharge of
coagulated blood and mucus from the womb or urinary organs, or
anus, and other intolerable painful local affections, and even
aberrations of the mind. In proof of their origin and that they
are only degenerated and masked forms of this fever, there remain
several of the above-named characteristic affections peculiar to
this fever, and the vicarious maladies themselves become aggravated at certain times of the day. The aggravations usually occur
from four o'clock in the afternoon until three or four o'clock in the
morning in some, but in others from three in the morning until
four in the afternoon. The other twelve hours are much more
endurable.
For these vicarious maladies (masked fever) the only efficacious
medicines are those that are capable of curing the original fever.




ON THE PREVAILING FEVER.

637

Nothing can do good and restore health but the medicines specially suitable (specific) for this fever, that is, such as are capable of
exciting similar symptoms in the healthy human body.
Let my readers endeavour to find out in Hahnemann's Fragmenta
de viribus medicamentorum positivis what medicine it is that causes
the following symptoms, characteristic of this fever: Rigiditas
artuum-juncturarum mobilitas diminuta-torpor omnium membrorum-instabilitas, infirmitas pedum, genuum-lassitudo ingens
-tremor-tremor pedis alterutrius et genuum-lapsus virium
subitus-syncope-gravitas capitis ebriosa, vertiginosa-ebriosa
capitis obtenebratio-vertigo cum scotomia-nisus in decubitum
-impotentia caput erigendi, in dorso reclinati ob vertiginem et
scotomiam-respiratio extra lectum    angusta, difficilis; in lecto
justa-dolor pectoris respirationem  suffocans-anxietas ingenspalpitatio -anxietas autochiriae  cupida-mortis timor-mortem
instare putat-anxietas diaphoresin gignens, ad minimum frontis
-post anxietatem    nausea, vomituritio-deliquescentia cordis--
horripilatio primo, tum calor angorem creans-horrescentia-genae
calidae cum  horrore interno-faciei caloris sensus cum   horrore
corporis caeteri-calor internus capitis cum frigore corporis-ardor
in oculis sine inflammatione-calor cum lecti appetentia-dilacerans capitis dolor eundo auctus-pulsationes vel ictus aliqui in
capite-airo libero auctus capitis dolor et crurum     lassitudoanorexia cibi-anorexia maxime panis-regurgitatio amari et acidi
saporis-impatientia parvorum malorum-pavor-phantasiae nocturnae semi-vigiles-phantasiae delirae terribiles-eruptio miliaris
ardenti pruriens-ardens pruritus per totum corpus.
The seed   which is capable of producing these symptoms, is
of all known vegetable medicines the only one that is also
capable of curing a great part of this prevalent fever in a short
time, that is, of transforming it into health,3 but this is only to be
done by giving at first about every fourth day, afterwards every
sixth or eighth day, a very small dose of it. The smallest particle
of it in powder, or a small portion of a drop of a solution of it,
every drop of which contains a trillionth of a grain of this seed, is
1 I Strychnos nux vomica.]
2 Especially when the sinking of the forces is not so striking, the food still
tastes naturally, and there is only a continual bitter taste in the mouth.




638                ON THE PREVAILING FEVER.
an amply sufficient dose and suited for the purpose; no other
medicine, of course, being used intercurrently, either inwardly or
outwardly.
It will, however, be noticed, that in the enumeration of the
symptoms of our fever there are some not perfectly contained in
this plant, consequently which cannot be perfectly covered by it,
and this is especially the case with regard to the worst form of
this fever.
On the other hand, there is a mineral1 which, in its extraordinary action on the human body, is capable of exciting those
symptoms which make up our fever, in a much more perfect
manner, and consequently of curing it with much greater certainty
and completeness, particularly those kinds in which every action
is followed immediately by shuddering or nausea, or bitter taste;
in which the taste of food and drink is extinguished, but still
there is no constant bad or bitter taste in the mouth, and in
which only whilst eating or soon thereafter there occurs some
bitterness in the mouth for a short time; in which vertigo,
nausea, trembling, and rapid sinking of the strength increase to
the greatest degree; in which drink is often desired, but little is
drunk at a time; in which perspiration only occurs some time
after the heat, or not at all; in which paralysis of the irritable
or sensitive fibre prevails, and pains of the most intolerable kind
unite, are conjoined with great anxiety of heart; for all these symptoms are completely contained in the sphere of action of this
mineral on the human body, therefore it can cure these when it is
brought to bear upon them, it can cure the greatest and worst portion of our fevers quickly, easily, and with the greatest certainty.
But what do I say?   Has not this mineral almost irretrievably
incurred the ban of the medical art?    But what cares the free
investigator of truth, who only sees in the whole kingdom of
nature the fatherly love of God dispensing blessings with a liberal
hand?   Nothing is unconditionally to be rejected; everything is
a beneficent gift of God; and among God's good gifts, the greatest
are just those that are injurious to the world in the hands of fools;
they were. only created for the use of the wise, who alone are capable of employing them for the weal of mankind, and to the glory
of the beneficent Deity.
1 [Arsenicum album.]




ON THE PREVAILING FEVER.

639

How can it be imputed to the very powerful medicinal substances as a fault, that when given in our gross medicinal weights,
in drachms, scruples and grains, they are still much too large for
wholesome use? so that the ordinary drachm, scruple and grain
practitioners must almost abandon their employment in consequence of their enormous powerfulness, whilst the smallest
quantity which these short-sighted beings can think of employing
must still be something that they can measure in their medicine
scales.
But if a tenth part of a grain of this mineral was still often
found to be dangerous, in other words, too powerful, what was to
have prevented physicians, if they had but reflected a little, from
trying whether a thousandth, a millionth of a grain, or still less,
was not a moderate dose, and if even such a small fragment of a
grain was found to be too gross a dose of this most powerful of all
medicinal agents (as it is in fact), what should have prevented
them from diminishing this fractional quantity still more, until
they found that a sextillionth of a grain in solution becomes a
mild and yet sufficiently powerful (in our case specifically curative)
dose, when administered every five to ten days?  Here also, of
course, it must be employed singly and alone, and without the
administration of any intercurrent medicine whatever.
In the immoderate perspirations in the worst kind of the fever,
and in the continued unconsciousness, when a remedy is required,
camphor affords speedy relief, but only in a palliative manner;
it cannot be continued without injury, nor used as a permanent
remedy. The excessive perspirations which it here suddenly diminishes, it is capable of exciting itself in the healthy body, but only
in its secondary action; hence its employment in this case is only
palliative.




SIGNS    OF   THE    TIMES    IN   THE    ORDINARY
SYSTEM     OF   MEDICINE.1
Art of physic is a most appropriate name for designating the
practice hitherto pursued by physicians, of whom we might say
that they (in place of healing) only physic, that is, give medicines
-it matters not what-in diseases.
Such a procedure can never, until it alters for the better, be
termed healing art.
But that this drugging business has not altered up to this time
and gives no signs of wishing to alter and better itself, we learn
from innumerable circumstances occurring every day, and also from
the following:Who would have believed that in the nineteenth century a physician with a real degree in a university town (Dr. Becker of Leipsic)
could give a commission to another regular physician in a university town (Dr. Nothlich of Jena) for the sale of his quack
medicines2 and could puff off his rubbish as infallible in these
terms: they effect a certain cure, &c.? This has been done in No.
293 of this Journal.
A quack nostrum is a medicinal agent prepared in a certain invariable manner, for public sale,which is puffed off as efficacious for several
named diseases, or for one disease, whose name includes several
morbid states differing from each other, each of which will require
for its cure an essentially different, peculiar remedy.
Such are Dr. Becker's dental medicines offered for sale by
Dr. Nothlich.
1 From the Allgemeiner Anzeiger der Deutschen. No. 326. 1809.
2 Essence for scurvy of the teeth, tincture for caries of the teeth, tooth-powder
and spirit for toothache.




SIGNS OF THE TIMES, ETC.

641

Now, who would have believed that a physician would have
publicly advertised a spirit for the toothache as certain to cure?
Mark, one and the same spirit as certainly efficacious for the
innumerable array of the very different kinds of pains in the teeth!
When the toothache does not arise from the effects of an external
injury immediately preceding it (for then only is the toothache
merely local and idiopathic),-its aching always represents only the
chief symptom  of a malady of very various character distributed
throughout the whole system, arising from such things as suckling
a child too long, abuse of the sexual function, of spirituous liquors,
of coffee or tea, from fright, from anger, from grief, from too
violent exercise and overheating of the body, or from fatigue, from
a chill, from over-exertion of the mind, from a sedentary life, from
working among warm damp things, &c.
The toothache is as various in character as are the internal
maladies that produce it.   Hence as those different kinds of
internal malady cannot be removed by one and the same medicament, neither can the varieties of toothache depending upon
them.
Hence one medicine is useful only in one kind, another in
another kind of toothache;-one1 is only of service in those
toothaches that occur in fits, most violently at night, with redness
of the cheek, that during the fit seem to be quite unbearable, that
do not affect any one tooth in particular, that in their slightest
degree consist of formicating pecking pains, when more severe
cause a tearing pain, and in their greatest severity occasion a
shooting pain extending often into the ear, that most frequently
come on soon after eating and drinking, are somewhat relieved by
the application of a finger that has been dipped in water, but are
much increased by drinking cold things, and that generally leave a
swelling of the cheek. This kind affects persons of capricious disposition who are very much disposed to anger, and have been
rendered irritable by means of coffee.
Quite another medicine2 is of service in those cases where the
pain in the gum is of a gnawing, fine shooting character, but that
in the nerve of the tooth is drawing, jerking (as if the nerve were
violently drawn and suddenly let loose again) with chilly feeling,
1 Camomilla.   2 Pulsatilla.
2T




642

SIGNS OF THE TIMES IN THE

combined with paleness of the face, occurring most frequently in
the evening, more rarely in the morning, increased by a warm
room and the heat of the bed, relieved by cool air blowing upon it,
not increased by chewing, but brought on by the use of the toothpick. It affects persons of mild, quiet disposition, disposed to
shed tears.
Another totally different, peculiar medicine1 is required for the
cure of that toothache that only affects a hollow carious tooth, with
a drawing, boring pain as if it were being forced out of its socket,
and single, rare, coarse shoots, which cause a shock through the
whole body, with painful, frequently suppurating swelling (epulis)
in the gum. It generally comes on quite early in the morning in
bed, does not permit of chewing, is generally renewed and aggravated most by opening the mouth in the open air, and by exertion
of the mind in reading or reflecting.   It usually attacks only
persons of hasty choleric temper, who render themselves irritable
by the use of spirituous liquors and coffee, and are not much in
the open air.
Besides these three most common kinds of toothache there are
many other not rare kinds, one of which only occurs in the morning on partaking of warm fluids, another where the tooth only
pains whilst chewing, still another which only affects the front
teeth with obtuse pain, another where the tooth aches chiefly when
touched which causes a pressive throbbing pain, again another which
attacks all the carious teeth at once, where the gums are swollen
and painfully sensitive to the touch, whilst single jerks dart
through the periosteum of the jaw, which, in its slighter form,
consists of jerking pressure, but in its more severe form of a digging tearing pain and burning stitches, and along with which the
incis6r teeth are often painful on respiring through the mouth,
and yet another kind that occurs only from cold air, mostly in the
morning, with rush of blood to the interior of the head, that makes
the tooth loose with a formicating pain in it, and on chewing there
occurs a sensation as if it would fall out, whilst at the same time
there is a tearing pain in the gum.
When the state of the system otherwise indicates them, hyoscyamus is the sole, peculiar remedy of the last form of toothache, and
1 Nux vomica.




ORDINARY SYSTEM OF MEDICINE.

643

the north pole of the magnet the sole remedy for the second last
one; but both these remedies are unserviceable in all other kinds
of toothache, which, as peculiar diseases of different kinds, require
for their certain permanent cure each its own peculiar appropriate
remedy, but they are aggravated or rendered more lasting by every
other medicine not specifically suitable for them.
I say remedy, and do not thereby imply any palliative, which
merely deadens the pain somewhat for one or more quarters of an
hour, only to return subsequently all the more severely, and with
fresh annoying symptoms in its train, but I imply a medicinal
agent which is quite appropriate to the disease, and completely
eradicates and removes the pain in the course of a few hours, so
that for a long time, often as long as life lasts, it does not again
occur. Of such a character must the medicines be, each of which
is certainly and permanently curative for a particular kind of toothache, and at the same time for the internal malady of the system
on which it depends.
What a self-deception, then, it is, which can only be excused by
the plea of total ignorance, for a physician, without knowing the
many essentially different kinds of toothache, to imagine that there
is but one toothache, and that but a single toothache-medicine is required (and that his own)-and thus by means of opium (the chief
ingredient of all nostrums for the toothache) he only sometimes,
and for a short time, deadens the general sensibility, whilst he
creates many new sufferings-and yet in his puffing advertisement
he dares to assert, that his spirit is a certain remedy for the
toothache!
What a palpable falsehood this is, for it is impossible that essentially different diseases (in the very nature of things) can be cured
by one and the same medicine, and every medicine which does not
do good, that is, which is unsuitable, does harm.

2T2




MEDICAL HISTORICAL DISSERTATION ON THE
" HELLEBORISM OF THE ANCIENTS,'
INTRODUCTION.
1. It is my intention to speak of the helleborism of the ancients,
that very celebrated operation by which the ancient physicians
were accustomed to treat with great daring the greater number of
chronic diseases of the most obstinate character by a medicament
of excessive violence, the veratrum album, and not unfrequently
effected, as if by a miracle, a radical cure. This ancient method
is most worthy of attention, and the more so as in our days the
use of this grand remedy has been more completely abandoned,
both in general and in particular in the treatment of chronic
diseases, so neglected by modern physicians who are in the habit
of giving any medicine for any chronic disease.2
2. In this essay we shall proceed in the following order: first,
we shall enquire into the antiquity of this drug and its primitive
1 [The original of this, which is in the Latin language, and is the thesis presented
by Hahnemann to the Leipzic Faculty of Medicine in order to obtain the license to
practise, bears the following title, Dissertatio historico-medica de helleborismo veterum.
Lipsiae, MDCCCXII. I have thought it best to translate it, because the Latin
language is so little cultivated now among medical men, that the original would be
but little read by them, and this essay is too valuable to be cast aside unread, if we
would wish to form a just estimate of the learning and genius of Hahnemann.]
2 Thus Ernst Horn, Medical Vice-Director of the Charit6 hospital, and Professor
of Physic at the Medico-Chirurgical College of Berlin, asserts (Anfangsgriinde der
med. Klinik, pt. ii, ch. 7) that he knows of only one treatment for all chronic diseases
whatsoever, which is to remove the debility by any excitant, it matters not what, the
indications for the use of which are left almost to chance (i. e. no account being
taken of the specific quality of such medicine, and of the immense variety of chronic
diseases). This is the manner in which the rational physicians of our days have
mingled together and confounded medicines and diseases, and whilst they pretend to
find in every medicine a remedy for every disease, they actually cure none at all.




ON THE HELLEBORISM OF THE ANCIENTS.

645

employment; then we shall examine if our veratrum is the same
plant that the ancients used for the production of helleborism;
then we shall indicate the places which were celebrated for the
growth of the best kinds of this plant, and the signs by which its
good quality was distinguished;,and finally, we shall speak of the
employment of veratrum, both in general, in ordinary cases, and
for the great treatment, the helleborism itself. The period when
its employment was first introduced, that in which its use was
abandoned, the most favourable season for the treatment, the
circumstances that contra-indicated its use, the maladies that demanded helleborism, then the preliminary treatment to which the
patient was subjected, the preparation of the medicament, its
form, its dose, the substances that were combined with it, the
regimen prescribed to the patient after taking the veratrum, the
remedies used to obviate and correct the evils and dangers that
usually accompanied its use, in order to ensure a safe and perfect
cure; such are the subjects that will come under our attention.
In conclusion, we shall briefly mention the employment of the
helleborus niger among the ancients.
3. In my researches into this ancient mode of treating diseases,
I shall proceed only up to the middle ages, I shall leave it to others
to treat of the employment of veratrum album and helleborus niger
in modern times.
Earliest medicinal employment of hellebore.
4. In the remotest periods of Grecian history, the people, robust
in body but of uncultivated mind, when oppressed by calamities or
afflicted by diseases, trembling with a vain and childish superstitious dread of the anger of the gods and with a fear of demons,
were less solicitous about warding off evils than about ascertaining the will of the gods with respect to the issue of the evil or
their future fate, and only demanded of physicians vaticinations
and prognostications respecting the periods of the crises, the convalescence or death-in those times I say, physicians were looked
upon rather as augurs than as practical sustainers of health,
that is to say, as men who removed diseases by means of remedies.
5. At that time the art of medicine could scarcely be said to
exist, the number of medicaments was most insignificant.
6. Among this small number of medicines however, veratrum




646

MEDICAL HISTORICAL DISSERTATION

album is found, and occupies the first rank, thus being one of the
most ancient as well as efficacious of remedies.
7. Thus, about the year 1500 before our era, a certain Melampus
son of Amithaon, a most celebrated augur and physician, first at
Pylos, then among the Argivans, is said to have cured the daughters
of Proetus, king of the Argivans, who in consequence of remaining
unmarried,' were seized with an amorous furor 2 and affected by a
wandering mania;3 they were cured chiefly by means of veratrum
album,4 given in the milk of goats fed upon veratrum, which
Melampus had observed to produce purgative effects on these
animals.5 From this circumstance the great fame of this plant
is derived.
8. In later times, it was stated by a certain interpolator of
Theophrastus' History of plants,6 repeated in the self-same words
by Rufus the Ephesian,7 and Dioscorides,8 that this cure effected
by Melampus, was due to the helleborus niger, hence this plant
was denominated Melampodium. But that this is an error9 we
shall shew in a few words.
9. I shall not waste time by citing in corroboration the testimony of Herodotus, whom Sprengel, otherwise a most weighty
authority in medical history, affirms, though erroneously,10 to have
attributed the cure of the daughters of Proetus to veratrum album.
1 Appolodor., Biblioth. Lib. ii, cap. 2.
2 Avicenna, Lib. ii, de medicamentis simplicibus. Artic. Charbak, (in Oper. Roma,
1593, fol. p. 269) corroborates this in these words:3 They wandered through the woods like cattle.
4 Galen, in the book de atra bile, cap. 7.
5 C. Plinii sec. Hist. nat., lib. xxv, cap. 5, sect. 21. He seems to indicate that
Melampus fed the goats upon veratrum album (in order to render their milk medicinal
for the treatment), this we may infer from what he adds: " nigro (elleboro) equi,
boves, sues necantur, itaque cavent id; cum candido vescantur."
6 See below in the note to ~ 17.
7 In Oribasii, Collectorum medicinalium (Venet. op. Aid. 8), lib. vii, cap. 27, p. 251.
8 Mater. Med., lib. iv, cap. 151.
9 This has been already suspected by J. H. Schulze, in his Diss. de Elleborismis
veterum, p. 3, 4. (Halae, 1717, 4).
10 Geschichte der Arzneikunde, pt. i, p. 121. The passage of Herodotus which he
cites (lib. ix, cap. 33) says nothing but that Melampus was offered a reward by the
Argivans to cure the Argivan women who were affected with mania, that he demanded
the half of the kingdom for his remuneration, and that he at length obtained it.
Herodotus does not say a word about the remedy used by Melampus in the treatment.




ON THE HELLEBORISM OF THE ANCIENTS.

647

10. Suffice to say, that in the earliest period of Grecian history
no other evacuant medicine seems to have been known to the physicians, who were still tyros in their art, and therefore that none
other could have been used by Melampus for this treatment except
this plant, which is now termed veratrum album, and that it was
termed   by them    hellebore, nT'~o~io  v, thereby denoting that it
was their sole and well known evacuant (purgative.)1
11. But in process of time, and if I am not deceived, soon after
the time of Hippocrates the son of Heraclides, another evacuant
medicine having been discovered, the physicians of that time seem
to have applied to this new purgative plant the name that had
been used for the most ancient and hitherto unique purgative
(hellebore), adding by way of distinction the word black, as though
they should say purgans (helleborum) 2 nigrum.         And thus in all
probability the appellation black hellebore arose, as indicating the
later discovered plant.
12. That such was actually the case, appears from this: that no
writer is found prior to the 100th Olympiad, who makes mention of
black hellebore, because it had not yet been discovered, or, which
comes to the same thing, it had not yet come into use; there is
no writer, about and before that time, who applies to the plant
which was the only one employed by the ancients for evacuating
(vomiting), anything but the bare term, hellebore.4
1 The word Hlellebore, the name of the sole and universally known emetic, received
by use such an extended signification that it was applied to the operation itself,
and sometimes signifies vomiting. Thus Hippocrates (sect. iv, aph. 13) xrpOc roTc
'XXECpove, &c.
2 Helleborus and Helleborum are used indifferently.
3 The Praenotiones Coacae attributed to Hippocrates, are so full of archaisms, and
written in such a hard, rude, rough and abrupt style, that Grimm in the index to his
German version (vol. ii, p. 586) suggests that they were probably the writings which,
long before the time of Hippocrates, were preserved in the temple of JEsculapius at
Cos. In this very ancient monument of the art of medicine, there is frequent mention
made of iXX~d6poc, as the root that causes evacuation by vomiting (veratrum album),
-but in none of these places do we find black hellebore spoken of, because, most
likely, it had not at that time been discovered (as we shall shew hereafter when
treating of the helleborus niger), nor is the word XEVKOr ever found added to XX~~i6poc,
that being the only one known.
4 Thus Galen (in Comment. ad Hippocr., Sect. v, aph. 1) says: XXiCopov Xvcbv
crX  w ctwOa  vvojlaidsLv EXEgeopov, obX, orep rbv JLXKava, we.rk xrpoaOcljrc, " they
(the ancients) were accustomed to call (the white) hellebore by that simple word and
not with any addition, as they did the black hellebore."




648

MEDICAL HISTORICAL DISSERTATION

13. Thus, as I have stated in a note, the very ancient authors of
the Praenotiones coacae, and also Ctesias,1 who was almost contemporaneous with Hippocrates, when they are evidently speaking of
the veratrum album, make use of the bare term hellebore only.
Moreover, in the genuine writings of Hippocrates 2 there is not a
single passage where he uses the word AAhh~opo without meaning
the veratrum album, and none in which he adds the word Ahevg,
for this simple reason, that there was as yet no occasion for applying this distinctive epithet to the plant which was the only evacuant
at that period, the black hellebore not having been discovered, or
no name having yet been given to it. In his genuine writings the
expression ehh'AoAoog i  g is never used, as I shall shew hereafter.
14. Even in the times shortly posterior to the age of Hippocrates,
(as we see in the pseudo-Hippocratic writings of his sons and disciples,) though mention is made of ihgfog pI~lag, still the most
ancient veratrum is always only alluded to under the simple appellation of hellebore.
15. It is indeed certain that in almost all human affairs, the
primitive thing is denoted specially by the simple word, whilst the
derived and compound name is applied to a thing that is similar,
but that has been discovered later; and is, consequently, newer
than that to which the simple word is applied.
16. Hence it is obvious that in the earlier times of Greece there
was but one single hellebore (and that the veratrum album); and that
if the so-called black hellebore, after Hippocrates' time, became
known, the word "black" was added to it, but it was not till after
the lapse of a considerable time and after the black hellebore had
long been in use, that the original hellebore could and did receive
the addition of AhEuto.3
1 A fragment of Ctesias in Oribasii, Collect., lib. viii, cap. 8.
2 Sect. iv, aphor. 13, 14, 15, 16.-Sect. v, aphor. 1.-In the book de fracturis (op.
edit. Chart. t. xii, p. 203 and 257), and in the book, de articulis, (ibid. p. 434)-These
two books are both genuine writings of Hippocrates or of his grandfather, and are
written in the same unadorned style. As regards the latter book (which is merely
a continuation of the book de fracturis, as Galen has demonstrated in his preface to
the book de articulis) Ctesias the Coan, refuses to admit it as a work of his relative
Hippocrates (a lucid testimony to the genuineness of the book), as Galen also relates
(Comment. iv, in lib. de Articulis, Op. edit. chart. xii, p. 452).
3 The primitive signification of the word hellebore in the age of Hippocrates and
some time afterwards, remained so strongly impressed on the memory of all who then




ON THE HELLEBORISM OF THE ANCIENTS.

649

17. Another proof of the greater antiquity             of the   (white)
hellebore   is, that    in   times   now    remote    (when    the   more
recent origin of the black hellebore could not be unknown) an
author worthy of all confidence, Theophrastus the Eresian, distinctly refers Melampus' cure to the veratrum           album, when     he
says, that it could not have been effected by the use of the black
hellebore, which is deleterious to most animals, in consequence
of which they will not touch it, but rather by that of the veratrum
album, which the sheep (and also the goats) eat, and thereby purge
themselves, which led to the discovery of its medicinal power:
vacleiJv  d t      cV iAv, says he,' x' '2Iwrowv, vxal (3ou, xe Ug, to' Ha
0ou   e vgjae: o rov"Tov T                     -ov  ' v  eaoOcti'  7ro 6TeC#,2 w d a  ouou
Trpwov eTvo^~wOvc  Tiv Svw'clv, ^arpopio' wv   e/Evwv.3
flourished, that the physicians of that age (i. e. the immediate successors and
disciples of Hippocrates, in the writings termed pseudo-Hippocratic) although they
commenced to give the name of black hellebore to the new plant, always continued
to designate the first one by the simple word iXXi~opoc, nor did it ever occur to them
to distinguish by any adjective that medicine which had hitherto been the sole and
was the most ancient evacuant. Had the black hellebore been discovered before
the time of Hippocrates, and had it long been employed (concurrently with veratrum
album) the simple appellation of the primitive hellebore would have long since become
obsolete, and they would have been forced immediately after Hippocrates to employ
the distinctive appellation "white;" but at that time this appellation had not come
into use, and was only commenced a century later, after the black hellebore had
already been employed for upwards of half a century. Indeed Theophrastus the
Eresian (about the year 330 before our era) in his history of plants often denominates
it by the single word, but sometimes he calls it eXX6iopoc XsEVKO. In like manner it is
called XvicbC in the apocryphal continuation of the book attributed to Hippocrates,
De victu acutorum, commencing from the words: KaiCao S, yap-(Op., t. xi, p. 175) by
an anonymous author (one of the empirical sect rendered famous by Serapion of
Alexandria), who in all probability composed the appendix about two centuries after
Hippocrates. At length in more recent times the veratrum is more often mentioned
with the distinctive adjective, under the name of EXhgopoc XevKbc and that the more
frequently as the use of the helleborus niger became more common.
1 Theophrastus, Hist. plant. ed Stapelii, lib. x, cap. ii. (In this edition among
other marks of haste and error, the fourth and fifth books are condensed into one,
the numerical order of the subsequent books is consequently designated by lower
numbers than they ought, thus that which ought to be the tenth and last is here
termed the ninth.)
2 In ancient times this word irp6oara was used to signify all sorts of cattle, oxen,
sheep and goats, as Galen teaches us (Comment. i, ad Hippocr. lib. de articulis, ed.
Chart. t. xii, p. 306).
3 The appendix to this sentence in the same chapter of Theophrastus-KaXovia 6l
Tbi ~iXavid rtvec i roT rs7Evroc ial avevp6vroc MEXaln7r6ov, (ji Icivov rpWrTOv




650

MEDICAL HISTORICAL DISSERTATION

18. This passage agrees with the words of Pliny: "alterum
genus (hellebori, Melampodem) invenisse tradunt, capras purgari
pasto illo amimadvertentem, datoque lacte earum sanasse Proetidas
furentes," 1 (although a little further on he again refers the plant
of Melampus to helleborus niger, led into error probably by his
compiling habits.)
19. The observations of Theophrastus are corroborated by this
passage of Haller: "Not only        do mules freely eat of this plant,
but even the cattle feed in spring on the tender leaves of the veratrum   album, whereby they purge themselves, but when the leaves
become more expanded they cease eating them, until the tender
rElTov7o-' IcaOalpovar & icai iag abrvrc ai rpodara, avvE7r'sovT7I  rtva Err6'yf, cal
tic iXXa Se 7rXEwo XpwTrat-is said to be a spurious passage introduced by some
sciolist. For it is contradicted by what Theophrastus says before, viz., that hellebore
is abhorred by swine and that it kills them. But if by the word tcaOaipovat is to be
understood not a medicinal purgation but a sort of bath by aspersion only-this
would suffice to make us reject the passage as spurious, for it is an expression unworthy of such an illustrious man (Theophrastus) and repugnant to common sense,
as must be evident to every reader. The origin of this old woman's tale is hereby
revealed, and it is this, that Blackfoot (MfXaitrrov.) could not possibly have employed
for the cure any other than black (~tiXac) hellebore. Certainly a most extraordinary
sort of argument I This clumsily attached patch, is then to be rejected, it smells of
the mysticism of the Therapeutists, who piqued themselves on treating diseases
by prayers and incantations. This school flourished at Alexandria a century
and a half before our era (two centuries after Theophrastus), just at the time
when the rivalry of the Kings of Egypt and Pergamus about their libraries encouraged by hopes of gain the interpolators of books and the Diascevastm of manuscripts, to manufacture whole books, or to insert or add supposititious parts to genuine
works, in order that they might appear more complete (see Galen, Comment. ii, in lib.
iii, Epidem. p. 411.-Comment. i, in lib. de nat. hom. p. 127, and his preface to Comment. ii, of the same book, p. 128.)
Therefore (it may be said en passant) it appears more than probable, not only that
the whole ninth chapter (of the tenth book of Theophrastus' History of Plants) is
spurious, but that it proceeds from the pen of the same interpolator. For the falsifier
not only relates, but actually approves and commends the ridiculous superstitions and
magical incantations of the doctrines of his own time (which could never have
entered into the imagination of Theophrastus, who was imbued with the philosophy
of Aristotle, and of the author of the Moral Character), which proceeded from the fertile
brains of the Therapeutists, who were nourished on the absurdities of the East. In
fact the whole style of the passage is that of this stamp of men. Moreover, the end
of the eighth chapter is connected with the beginning of the tenth much more
naturally and logically, and passes into it, as it were, in a continuous stream, if we
expunge that jejune ninth chapter, so unworthy of Theophrastus, the production of a
perverted mind, stuffed full of magic, incantations, and divinations.
1 Histor. natur., lib. xxv, sect. 21.




ON THE HELLEBORISM OF THE ANCIENTS.

651

leaves again appear the following spring."       Pallas 2 also asserts
that in Russia the horses eat the young leaves of the veratrum
album, without any other effect than the production of looseness of
the bowels.
20. But the chief thing, and that on which the whole affair
turns, is that goats feed upon the veratrum, which Lucretius3 testifies to when he sings:
" Praterea nobis veratrum est acre venenum,
At capris adipes et coturnicibus auget."
21. But the most lucid testimony to this fact is furnished by
Galen, a most weighty authority on the subject of the history of
medicine among the ancients, and an author worthy of all confidence. He speaks of the treatment we have related as of a thing
very generally known and admitting of no doubt.        "Until now,"
he says,4 " physicians have attempted to cure melancholia by
means of vomiting produced by veratrum album. Indeed none
who is acquainted with Greek literature could have failed to read
or hear of the story of the maniacal daughters of Proetus who
were cured by Melampus by means of this evacuant; from which
circumstance this evacuation (viz. helleborism) remained celebrated
for two or three centuries and more, but during that time all
physicians have employed this medicine (veratrum album)."
From   the description given by the ancients of the white hellebore
does it follow that it is the same plant as our veratrum album?
22. But we must enquire further if the (white) hellebore, used
by the ancients for helleborism, is indeed the veratrum album 5 or
not.
1 Hist. stirp. Helv. N. 1204; and in Vicat's Matiere m6dicale tiree de Halleri hist.
stirp. Berne, 1776. 8.
2 Bussische Beise. Vol. II. 190.
3 In his Carmen de natura rerum, lib. iv, v. 642. This celebrated poet flourished
a century before our era.
4 'Iarpwv--rdaOoc EXayoXLoKbv--irLXtspobvrvw-r7 aepa7rEiy t g6 &  X 6pov T0o
XEvrcoD KcaOa6pesg. Obticu yap obrw g araiisEvrb   rte TV r  v ick 'E'X   rEOpap4i vowv, Wg
LITr' avyvcEva Vat, fTir'aKiflICOivaL, rg TIpoLrov0 vyarTpaq yiaviaEag irb MEX&i70roSoS
laO9vaL reaOapOeraag O7brt, W(Tr ob rpd 6taroaov aK   TWv r1 rptLaood~LwO, &aXhCh roXk
7rXtO6vwv ivaolov rT icaOapawEC raivrfyS oartis, Icai iravrwv rw-v iv rq Jitratv Xp6ovy
KXeprEVoiv rTy ap/dIaKy. Galen., De atra bile, cap. 7.
5 Cornelius Celsus already employed this name in his Libri de Medicina.




652

MEDICAL HISTORICAL DISSERTATION

23. And first let us look at the description  of this plant left us
by Theophrastus, who was an intelligent and learned naturalist,
which it is to be regretted is so short, and buried as it were in a
corrupted text.
24. He treats of both kinds of hellebore in one and the same
chapter. "The hellebores," he says "both the black and the
white species, bear a common equivocal name, but authors differ
respecting their form and appearance. Some say they are similar,
except as to colour, which in the root of one is white, in that of
the other black, but the leaves of the black kind resemble in colour
those of the laurel, whilst those of the white kind resemble in colour
the leaves of the pear-tree." Then there follows a most corrupted
text: o;  ou' 6aU o'e na; yovIrm, roiVAE 0C'; EaET  V  OeVr' (vu~ v I
O'vCfIX " S, Ppav v rCpo''ý' Cpuhov Vi 7TTU'TXI(TTOV 8^oIov TCP' TOVd 6s^xog,
pJhog   ov {, lixeg, &c. The first words of this sentence have been
very properly changed by Scaliger and the editor Stapel into oi Y'
avopolc0g0 Ahyore, in order that they should present a kind of opposition to the words in the principal period: ol jiv yoi o'aog EivaCi.
As regards the rest of the sentence, xavA v SF &c., these writers,
in other respects very sagacious, suppose it to allude solely to the
black hellebore, and do not think that in this description Theophrastus ever refers to the white, but in this they greatly err, for
some of these words refer to the black, others to the white; moreover it is impossible but that Theophrastus must allude in this
place to the white, because throughout the chapter he continually
speaks alternately of the white and of the black, and describes the
one after the other in such a manner as to demonstrate the distinction between them, and wherein they differ in their various
parts. Therefore if he wished to be consistent it was necessary
that he should in this place insert some description of the white
hellebore before proceeding to describe the black.
25. The following is the mode in which it seems to me possible
to restore the words, mutilated as they have been by the injury of
time, and mixed up among each other in a most confused manner:
01 S' a&voP..o'ac?YOvTroe, TOIIv3e r(aI2v e~vi m T'V (Oýýjv xCIAov PLV (To

1 Hist. plant., lib. x, cap. 11.




ON THE HELLEBORISM OF THE ANCIENTS.

653

Aetvtoiv 1) LV6e,  Js1, ijpOIov ' 7O TO  vDevO' V o v S(T e  ~ pavoe 2) '3 UV
Ca~Po'a, 6Ahov 7rAacTV ITTOv, j ox0 Sxov e" " E&S.
26. Indeed it is the veratrum   album   only whose stem, with its
attached flowers, could be likened to the flowery stem of the asphodel (which Theophrastus himself, lib. viii, cap. 12, calls &v1z mov3);
certainly not the helleborus niger, which has almost no stem.
But as regards the character of this stem, "which rises singly
from the root, and in which moreover the leaves grow alternately 4
from protuberances," Theophrastus speaks of it under the general
term  ferulaceus [like a ferule] or O'Polov r    vad'Osi  (see lib. vii,
cap. 2, where he applies this character expressly to the hellebore, that
is to say, to the white hellebore.) This is the character that
specially distinguishes the stem of the veratrum album, and is not
at all applicable to the helleborus niger, which has hardly any
stem.
27. Therefore we see that Theophrastus writes in this manner:
"Those who allege that they (the white and black hellebore) are
different, thus describe their respective forms: The stem of the
white hellebore resembles (in its florescence) that of the asphodel,
and (on account of the single stem that ascends from its root, and
the disposition of its leaves) has the appearance of a ferule; but
the black hellebore, on the contrary, has a very short stem, large
leaves, divided into broad lobes," &c.
28. To this rather superficial description of Theophrastus, let us
add the brief one of Dioscorides, whereby it will be better apparent, that by their white hellebore the ancients understood nothing
else than veratrum album, and that all the signs they mention as
proper to it prove it to be the very same plant.
29. The words5 that bear upon        our subject are: 'E      Ig0opfo0
1 I have only added these two words; the remainder of the text of Theophrastus
I have preserved in its integrity, only somewhat changing the order of the words.
2 These three words have very properly been supplied by Scaliger.
3 MFyOrrov  7r&avrTwv (the bulbous plants) o6 da6ESXog, 6 ydp ivO'ptIcoc ftyTrrog.
In like manner Dioscorides (lib. ii, cap. 199) gives to the stem of the asphodel, with
its flowers, the name of " AdvOpEog ": dac6sXo9:-- Xwv-KavXbv--X6fov 'xovra
Eir' ccpov dvOoQ, KraXovovyvv dvOptcov.
4 Not oppositely. TO vapOncKySec, he says, otopovo6avXov-3Xacridveit c  7rapaXX\d
r'C )vbhXa--obc icK roS aiTro) itLpove r WV yovTrwv, cXX' vaaXXaKd-OlrpotrpOV TOvTrq
rvb KavXbv igX-6 'iXXkopo( (Ical b CivOpeioc). Hist. pl., lib. 7, e. 2.
5 Materia Med., lib. iv, c. 150; written as it would seem before Pliny's work on




654

MEDICAL HISTORICAL DISSERTATION

ACvX<; tma 'E%'C -  J10'P.O14 roi" ' TO v a aoy'Lov 1-xav~kv N S e Ahaiffcov,
oMOiAov,  Qrp.oIA ofj"evov, o 're  oTCI  ý  oiCeaCar Pj14 - 11 VS iai =kalJ
}7rO zet0       Aiot pwhlaOoV  zucO CH VP Wy1oXV, WcS6EE   z'OPJMIVot (TVP-7E
wvTru.  These words, with a slight change, putting, for example,
XoMAov after sEfloi0"jbsvov, will read thus: " The white hellebore has
leaves resembling those of the greater plantain, a stalk a palm in
height, enveloped in coats2 (the sheaths of the leaves), and hollow
when it commences to dry. Its roots are numerous, delicate (the
fibrils), fixed to a small and oblong bulb like an onion.
30. If he says that the stalk is only a palm in height, whilst in
reality it often attains the height of a cubit and two cubits, this
error is to be attributed to the writers from whom he has compiled.
He himself being a Cilician, does not seem to have known the
plant from   actual inspection, because (d Aesuds 6A'hyacXoV Q(e~rC, as
Theophrastus in his Hist. Plant., lib. x, c. 11, calls it) it grows in
but few parts of Greece. For the same reason, viz., not having
himself seen the plant, he does not give an accurate description of
the colour of the leaves.    Moreover, it grows, as he says, in mountainous districts, not dAv 7paXF o   (in rugged places), but in      the
alpine and subalpine meadows and moist plains.3
31. The description which the ancients have left us of the white
hellebore, though very superficial, still proves clearly that it is
Natural History; the latter translates and copies whole passages from Dioscorides
without ever mentioning his name, shewing a kind of envy and rivalry by no means
rare among contemporaries.
1 Murray (Apparat. Medicam., vol. v, p. 149) doubts whether the plantain of the
ancients was the same as ours, but he is wrong to do so, for that by the word
arnoglossus Dioscorides really implies our greater plantain, is obvious from several
things: first, because the title of the chapter that treats of arnoglossus (Dios.
Mat. Med., lib. ii, c. 153) is, in some ancient manuscripts, rrpi dpvoyXJaarov
irra7trXhpov, i. e., on the seven-nerved plantain (and that is precisely the
number of nerves the leaf of the great plantain possesses): second, because
the Arabic version of Avicenna (Lib. de Simpl. Medicam. Art. Charbak-Abiadh.
Opera., Romac 1593, fol. cit.) expresses the word aipvoyXdfaaoo by..1  ) LWI
-a word which to this day, in Arabic, signifies our plantain, as Forskal testifies,
who saw it (Plant. Aegypt. et Arab., p. lxii), and who himself gives it that name.
2 Jacquinus, in his description of veratrum album, Flora Austriaca, plate 135.
p. 18, says, " almost all the stem is enveloped in the sheaths of the leaves.
3 The description of Pliny (Hist. Nat., lib. 25, sect. 21) is evidently taken from that
of Theophrastus and Dioscorides (thus, for instance, he attributes to the white
hellebore the leaves of wild beet-beta incipiens, as he calls it-thus rendering
the TEvrTXov  ypiov of Dioscorides), it is therefore not much to be relied on.




ON THE HELLEBORISM OF THE ANCIENTS.

655

the same plant as our veratrum album, although the ancient works
on natural history generally describe natural objects in a loose
and superficial manner.
32. To the above we may add the very weighty authority of
Avicenna, who describes the Dioscoridean veratrum    album under
the name of LAI.....j       by which very name, as Forskal an
eyewitness testifies, the veratrum  album  is still called in those
regions.'
33. But the most important argument to prove the identity of
the white hellebore of the ancients with our veratrum album, still
remains, viz.The effects of both are not only similar but absolutely identical.
34. Among those who doubt if the plant which the most ancient
Greeks designated by the single word AA~C'oog, but afterwards
termed white hellebore, was actually our veratrum album, the most
distinguished is a man who formerly rendered great service to the
materia medica, John Andrew Murray,2 who complains " that the
arguments to prove that it is the same plant are soughtfor rather in
the similarity of its effects, which may be identical in many different
plants, than in the description of the plant, which is very imperfect."
35. As to what relates to the description and delineation of the
plant by the ancients, we have already seen that it is not absolutely
imperfect.
36. But with respect to that doctrine (the unhappy source,
alas! of succedanea and substitutes)-" that no plant possesses
peculiar properties of its own, but that a host of different plants
produce the same effects on the human body, which are, therefore,
vague and uncertain," here this man, great and distinguished as
he was, errs in common with most of the physicians of this age.
37. For the great Creator of the universe has implanted in every
medicament a constant rule of action; to each he has given
peculiar, specific, certain powers, which are of the most constant
and unvarying character, although, unfortunately, medical men
1 Materia Medica Kahirina, in the appendix to Descript. Anim. in itinere orientali,
Hafn. 1775, 4, p. 152.
2 Appar. medicam. Vol. v, p. 149. Cl. Salmasius also (in Exercit. de Iomonymis
hyles iatricae, Traj. ad Bhen. 1689 fol.) thinks that " the hellebore of the ancients is
lost, and does not exist among us."




656

MEDICAL HISTORICAL DISSERTATION

have not investigated, and have almost entirely neglected them
hitherto. The properties that existed in a medicament a thousand
years ago are the same as they now possess, and as they will possess for ever.
38. But I would ask, what reason have you for affirming so
confidently, that many different plants have the same effects,
when it is well known that the peculiar and positive effects of all
medicines have been so little investigated by medical men, that
they are almost unknown to them, and it seems as though they
thought their ignorance on this subject to be something quite
legitimate and meritorious?   How do they know then, that many
plants possess the same properties? In place of devoting themselves to experimental investigation they delude themselves with
their vain conceits and preconceived opinions.
39. No one species of plants has the same external form and
appearance as another, and in like manner, each possesses a certain peculiar power proper to itself, which is not to be found in
any other species of the same genus, and still less in any other
genus. As the external appearance differs, so also does the internal medicinal power!
40. This peculiar and specific power of acting on the system,
which the great Creator has implanted in every medicine, is
proved to be of such a constant character that it cannot be doubted
-that the oxyde of copper, for example, when taken internally,
excited many thousands of years ago, when it was first discovered,
the same anxious vomiting which it caused eighteen centuries ago,2
and the same which it causes to day,-that the oxyde of lead and
cerussa, when applied externally, shewed in the earliest times the
same refrigerating qualities, and the same power of constricting
the pores of the skin,' that it manifests at the present day,-that
the cantharis taken by the mouth caused in ancient times the
same dysuria, the same hematuria, the same dysenteric affection of
the bowels,3 that it does now,-that opium exhibited in the most
remote times the same specific quality, that, taken in a large dose,
it caused the same prostration, with chilliness of the external
1 Diosc. Mat. Med., lib. v., cap. 87.
2 A'varaLYv XEt JVcIKTKtcV, lA7rXaartoc)lv-Diosc., Mat. Med., lib. v, cap. 103.
3 Avaovpotri 7TroXXcic S  alaa arpotevrat 6l1t opwv" pFTrat J' a~.ro7C Kar
KotLXav 'Ofiota ro7' r ' vffTnYvrepitwv.-Diosc., hXAf., cap. i.




ON THE HELLEBORISM OF THE ANCIENTS.

657

parts of the body,' as it does to-day; and so with all other
medicaments.
41. From the collection of the peculiar and specific powers of
any medicine observed from its use in ancient times, are we not
justified in inferring, that a medicine which in our own days
produces the same effects on the human body must be identical
with the ancient one? There is certainly nothing that should
prevent us coming to this conclusion.
42. I may here be permitted to compare the properties of the
white hellebore of the ancients with those of our own veratrum
album.
43. The properties of the white hel-  The properties of the veratrum album
lebore as observed by the ancient phy- as observed by more modern physicians.
sicians.
At first there occurs heat of the throat  Internal heat with dislike to drinks.1
and stomach.'                        Burning about the precordial region.2
Heat of the tongue and throat.3

Many are suffocated.2
After violent and ineffectual efforts
to vomit, suffocation;3 the face swells,
the eyes are prominent, the tongue protruded from the mouth.
If vomiting comes on late, st~'angulation.4 The face excessively red.

Heat of the fauces.4
Inflammation in the interior of the
mouth.5
Constriction of the throat.6
Strangulation of the fauces.7
Strangulation about the throat.8
Strangulation, spasm, constriction of
the throat.9
Swelling of the oesophagus, with
dread of suffocation.10

1 MlOcwvoC ai broi rovrvroc, r apaicoXovO9E ICaraoopd,ET  ICaraZEog.-Diosc.,
aXEZ., cap. xvii.

1 Antyllus in Oribas., Collect., lib. viii,
cap. 6, p. 278.
2 Ctesias, apud Orib., loc. cit.
3 Herodotus, in Orib., Collect. lib. viii,
cap. 7, p. 284.
4 Antyllus, loc. cit.

S. Grassius, Misc. Nat. Cur., dec. i,
an. 4, p. 93.
2 J. de Muralto, Misc. Nat. Cur., dec. ii,
an. 2, p. 240.
3 C. Gesner, Epist. Med., p. 69.
4 Bergius, Mat. Med., p. 872.
5 Greding, Vermischte Schriften, pp.
31, 36.
Winter, in Bresl. Samml., 1724, p. 268.
7 Lorry, de Melanchol. ii, pp. 312, 315.
8 J. de Muralto, loc. cit.
9 Reimann, Bresl. Samml., 1724, p. 535.
to C. Gesner, loc. cit.
2u




658

MEDICAL HISTORICAL DISSERTATION

The parts belonging to respiration
are constricted, with great difficulty of
breathing.1
Often deprived of their voice.2
Loss of the voice and the senses.3
Gnashing of the teeth; the mind is
deranged.4
Delirium.5
In almost every case hiccough; in
many the mouth quivers and twitches."
Continual and violent hiccough.7
Muscular contractions (cramp), especially in the muscles of the calves,
thighs, arms, extremities of the feet,
andchiefly in the hands,8
Also in the muscles of mastication.9
As if strangled, he falls down with
his teeth clenched like a strangled
victim.'o
1 Herodotus, loc. cit.
2 Antyllus, loc. cit., p. 280.
3 Antyllus, loc. cit., p. 281.
4 Herodotus, loc. cit.
5 Antyllus, loc. cit.
6 Antyllus, loc. cit., pp. 281, 282.
7 Antyllus, loc. cit., p. 282.
8 The second day after taking the
white hellebore.
9 Antyllus, loc. cit., p. 282.
0o Herodotus, loc. cit.

Loss of breath.'
As if strangled, they are in great
danger of suffocation.2
Inspiration very laboured and difficult.3
Stammering.4
Loss of voice.5
Loss of vision.6
Almost complete loss of the senses.7
Delirium.8
Hiccough.9
Hiccough for half an hour.1'
Hiccough all day.'1
Spasm.12
Cramp of the calves.13
Spasms in the hands, in the fingers.14
Attempts to vomit, with trismus.1"
1 P. Forestus, 1. xviii, obs. 44.
2 L. Scholzius, ap. P. Schenk, lib. vii,
obs. 178.
3 Benivenius, ap. Schenk, loc. cit.,
obs. 174.
4 S. Grassius, loc. cit.
5 RMdder, in   Alberti Jurispr. Med.,
obs. 15.
6 0. Borrichius, Acta. Hafn., t. vi,
p. 145.
7 Vicat, Plantes venen. de la Suisse,
p. 167.
8 S. Grassius, loc. cit.; Greding, loc.
cit., pp. 35, 41, 42, 43, 49, 51, 54, 66,
69, 86.
9 J. de Muralto, loc. cit.; Smyth, in
Medic. Communic., vol. i, p. 207.
1o C. Gesner, loe. cit.
"1 Greding, loc. cit., p. 43.
12 J. de Muralto, loc. cit.
13 Reimann, loc. cit.; Lorry, loe. cit.
14 Greding, loc. cit., pp. 62, 71.
'~ Greding, loc. cit., pp. 82, 83.

- I



ON THE HELLEBORISM OF THE ANCIENTS.

659

Prostration of the strength.1        Excessive weakness.1
Loss of consciousness.2              Pulse almost extinct, imperceptible.2
Threatening of syncope.3
Loss of consciousness.4
Enormous efforts to vomit, even to
syncope.5
Excessive vomiting.3                 Enormous, horrible, severe, most violent vomiting.6
44. In the face of such a remarkable resemblance of the symptoms caused by these two plants, who can deny that the very same
plant which    now    grows in   our gardens was that which        the
ancients made use of for the production of helleborism?        Where,
I ask, can another plant be found which shall shew these same
peculiar effects on the human body that are produced by the
(white) hellebore of the ancients, and our veratrum album? The
external character of the plant resembles that described by the
ancients, the name is the same as that given to it by the Romans,1
it has the same properties now as formerly, there is the same
danger attending its use now as formerly, it is undoubtedly the
same plant.
Parts of Greece where the best grew.
45. The white hellebore grew in few parts of Greece, and, as I
have above stated, in the moist plains of high mountainous regions. In the most remote times Theophrastus approved most
of that which grew most abundantly in the Oeta hills near Pylaea
in Pyra; then that of Pontus; then that from Elaea; and lastly,
Antyllus, loc. cit., p. 278.        ' Benevenius, Smith, Vicat, loc. cit.
2 Antyllus, loc. cit.               3 Vicat, RUdder, loc. cit.
3 Antyllus, loc. cit., p. 283.      3 Lorry, loc. cit.
4 Forestus, loc. cit.
5 Greding, loc. cit., p. 68.
6 Many observations of Forestus, Lorry,
Vicat, loc. cit., and Lentilius, lisc. Nat.
Cur., dec. iii, an. 1, app. p. 130, and
Ettmiiller, Oper., tom. ii, pt. 2, p. 435.
1 Cornelius Celsus, who wrote in the time of Augustus in his books on medicine,
always speaks of it under the name of veratrum album.
2 Pyra was a plain near Pylaea in the chain of Mount Oeta (which, running from
Thermopylae to the Ambracian gulf, extended as far as Doris) where Hercules is said
to have burned himself on a funeral pile (Pliny, Hist. nat., lib. xxxv, cap. 11) in order
to obtain the honour of being received among the gods.
2u2




660

MEDICAL HISTORICAL DISSERTATION

that which grew in the bay of Malia;1 he disapproves of those
from Parnassus and Aetolia as being hard and dangerous in their
effects.
46. In later times the two towns of Anticyra were celebrated for
their white hellebore, namely, the town of Anticyra on the Phocian
coast,2 where the helleborian medicine was best prepared for medicinal use, and the other town of the same name in the gulf of
Malia near Mount Oeta, and not far from Thermopylhe, which attained much celebrity on account of the excellence of the hellebore
that came from this part.3
47. It is probable that the hellebore did not grow naturally in
the country about the Phocian Anticyra, because the range of
Mount Oeta did not extend that length,4 but that it was either
brought from there or cultivated by the inhabitants in gardens,
and proved to them a source of profit.         In the time of Pliny5
the white hellebore used still to be cultivated in the island of
Thasos.
48. In the time of Rufus, a Galatian white hellebore used to be
1 In Stapel's edition of Theophrastus the reading VpacoaXkterrc (iXXopoc) is wrong.
There was no place of that name in Greece (for it could not be referred to the river
Massalia in Crete); the Massaliotic country was situated on the frontiers of Gaul,
of which there can be no question here. We should read paXLWrr), from the country
about the gulf of Malia, where excellent hellebore was procured, as Strabo testifies.
The derivation of O'Xxro  aX\(ur) c is from the ancient but destroyed city MaXi(t just
as ateICEXLk(1'  is derived from aULrEXy& or paataXtauW'r7 from luaaaaXig, as Strabo tells
us (Geogr., lib. iv, 270), a Phocian colony in Gaul, now called Marseilles.
2 Situated between the town of Crissa and Marathon (and the Pharygian promontory) (Strabo, Geogr., lib. ix, edit. Amst. p. 640, collated with p. 647), but in D'Anville's map it is placed wrong.
3 Strabo (Geogr., lib. ix, p. 640)-Elra (after the gulf of Crissa) 'Avricvpa (in
Phocis) b ovvoc rzj iard rTv piaXtaiKv IK6Xrov, Kal rv 'Oirilv ' ical S) baart, Ecdi
rOb iXX,opov bEreffOat rbv a  TE7iov, ivra-Oa 1i acE(vdTEaOatL PEXrcov, iKai cia TTro
troqtplv Sevpo wrokXXouSc IaOadpffET al S Epa7rdac Xdptv yivEafOat ycap rtL OaiaaoEt6&C (dppaicov iv y r  WicPKI, peO' ov acKEvdiScaOat, rbv olralov ihXXiopov. In like manner Stephanus, the Byzantine, (Libr. de urbibus) says: 'Avrincvpa trt6XEc io, " Jia
<4hctoEoc, i. iv MaXLtiroty * vrTaa fatft rbv iXXcopovy VEaOat ro70v CTarov.
4 The nature of the country about Phocian Anticyra, which Pausanias (Graec.
descr., p. 652, ed. Hanoviae, 1613) describes thus: rd a& 4pr rd nrsip 'AvriKcpatv
trETpwSr--ayav-was such, that the black hellebore might grow there spontaneously,
but not the veratrum album; the veratrum of Phocian Anticyra must therefore either
have been brought from Doris, where it grows and where mount Oeta extends, or
cultivated in the garden.
5 Hist. nat., lib. xiv, cap. 16.




ON THE HELLEBORISM OF THE ANCIENTS.

661

sold, which, however, he condemns as being very bad.1           Pliny
pronounces the hellebore of Parnassus to be the fourth best, and
says it used to be adulterated with the Aetolian.2 Dioscorides tells
us that the veratrum of Galatia and Cappadocia was white and
resembled a rush, and that it possessed a greater suffocating
power;3 it does not appear to have been disliked in his time.
After the time of Dioscorides, the Galatian veratrum commenced
to be reckoned one of the good kinds, the Sicilian kind then also
got into notice; but it was not considered so good.4     Thus in the
course of time several kinds of white hellebore, some from one
country and some from another, were considered good and sought
after, and less care than previously was exercised in their selection.
Signs of its good quality.
49. The ancient physicians selected for employment those fibres
of the roots that were moderately rigid,5 friable, soon causing
sneezing when brought near the nose,6 fleshy, of equal thickness
throughout,7 and they rejected those that were too pointed, like
the fibrils of a rush, and from which, when broken, dust escaped,
(for this was a sign that the root was old). They ought to have a
narrow medulla and taste moderately hot.
50. But of all who have described the way to choose the veratrum album the most accurate is Aetius (who seems to have drawn
his description from Posidonius); these are his words-" The best
hellebore is that which, from   one root, sends forth many fibres,
which are short, rigid, not rough, nor thin at their ends, nor
ending in a point like the tail of a mouse, very white internally,
but externally of a yellowish colour, heavy, having a friable medulla not so soft as to be able to be bent, but apt to break across,
1 See a fragment in Oribasii Collect., lib. vii, cap. 27, p. 249.
2 Hiist nat., lib. xxx, sect. 21.
3 Mat. Med., lib. iv, cap. 150.
4 See a fragment in Oribasii Collect., lib. viii, cap. i, p. 271.
5 Dioscorides, in the place already cited, has: perpiow rErayIvoc, or as other
manuscripts have it: reravWjsri, which Sarrazin renders moderately extended; but
this is certainly an obscure if not a false reading. Rasarius after Archigenes (ap.
Oribas., 1. c. lib. viii, c. 2) more clearly renders this quality of the good fibres by the
term rigid. Aetius likewise makes use of the term: icdpoq rTrava.
6 Herodotus, apud Oribas. Collect., lib. viii, cap. 4, p. 276.
7 Herodotus, loc cit.




662

MEDICAL HISTORICAL DISSERTATION

and when broken, diffusing around a sort of smoky and pure cloud
(if, however, they emit dust, this is a sign of the oldness of the hellebore). Good hellebore has at first a sweetish1 taste, which then
becomes acrid for a short time, and afterwards excites a great heat
in the mouth, causes a great flow of saliva and deranges the
stomach."2
51. Others condemn that kind which produces a copious flow of
saliva, because it causes too easily the strangulating sensation in
the throat; but they are wrong, for this is only a sign of the
greater medicinal virtue of the hellebore, and indicates that a
smaller dose of it should be given.
52. The earliest physicians preferred that which was gathered
during the wheat harvest, but Aetius rightly gives the preference
to that which has been collected in the spring, for at that season of
the year the plant still contains all its juices. 3
Medicinal uses of Veratrum album.
53. The ancient physicians used veratrum album in two different ways-first, the ordinary use for obtaining speedy and
obvious effect; the second, the grand cure for inveterate chronic
diseases, the latter they termed helleborism.
54. In general the ancient physicians employed the veratrum
album for the purpose of exciting vomiting, and the helleborus
niger for purging.4    Throughout the writings of the most ancient
I Archigenes (loc. cit., lib. viii, cap. 2, p. 272,) also says: " all kinds of hellebore
have a sweetish taste.
2 Aitius (lib. iii, cap. 126, ed. Aid.): Kpairwroc iXXiopoc  a &trd pui lCrP C 7 ravv
iroXXka Xwv idpap  Kal trara 7rptiK cp ial rirava  al tcpvra (read a pvaca) al ob
anrorXiyovra EiC 56O, oba IftEWOUvpiovra' XEUKv  i & abopa EvT70OEv, IKTOb Se 'XporTpa
v7rdpXal, papia, EvrEpiWVyV EXovra EsiOpvrra (read EivpvrTTov') ob KcaLT7rrTpEva &l
paXkacdrjrta, a XX Karapyvvidsva KavXr76bv, caTrvWAE Ti EV T?  apafirtL %rEptEXovra Kca
avEvrTa, Ka l o3ro KcaOap6v* rb yap RovLoprwso 7rakXaLv SrfXool rYOv XXgopov" Sb 6
ayaObS ~LtapaaanOtel, Trpwirov tpiv yXvKVTiriroS i~,pantv rap'Xct, aiiOtL Si SptL/frlrTog
Ppaxfia* -  rT& Si roViro rvpfiWpLv i3aXvpav  ITOLrol t7rEpi rb a rba ca Kai aEXov ayit
7roXVv, Kal r6v Trrdo xaov dvarpiTrEt.
3 Loc. cit. AE Si fapoS vaMlaOat rov iXXEiopov, rti r7  pilrS iylgVfovoVrbral.
4 See Aretaeus, Curat. chronic. morb.,lib. ii, cap, 13, p. 136, edit. Boerhavii.-Pliny
(lib. 25, sect. 22) says: "Nigrum purgat per inferna, candidum autem per vomitum."
In like manner Rufus (loc. cit., lib. vii, cap. 26, p. 250) and many others testify to the
same effect; but the thing speaks for itself in all the writings of the ancient phy.
sicians. One only, the author of the pseudo-Hippocratic book De afectibus internis




ON THE HELLEBORISM OF THE ANCIENTS.

663

physicians, when they speak       of purging upwards,1 they always
allude to the veratrum    album, even though the word " hellebore "
is not added; but when they speak of purging downwards either
the black hellebore is understood, or they mention the name of the
purgative to be administered. But in later times2 the remedy
used to produce the one or the other operation is not understood,
but usually mentioned expressly.
Of the lesser treatment with veratrum album, without preparatory
treatment of the patient.
55. The earliest physicians seem to have employed this medicine,
without previous preparation of the patient, in ordinary and acute
diseases when they wished to procure evacuation upwards, as they
termed it, that is, vomiting.
56. Hippocrates used to give the veratrum album at once, and
without preliminary treatment of the patient in urgent cases, 3 and
whenever he wished to evacuate quickly by vomiting.
57. The symptoms which he considered to indicate veratrum
were-want of appetite, corroding sensation in the stomach, vertigo
with obscuration of sight and bitter taste in the mouth, without
fever;4 in general, he ordered it to be given in cases where the
(Opera Hippocr., edit. Foesii, sect. v, p. 118), orders (if the text be genuine) the black
hellebore to be used for promoting evacuation upwards, but he has found no imitators
among all the physicians of antiquity.
SThus before, during and immediately after the time of Hippocrates the words
iXXiopog and vomiting were synonymous terms. Therefore the Latin versions of the
Greek medical writings are wrong, when the question is concerning the evacuation
by veratrum album (which was always by vomiting) to render the work caOaipav by
"purgare," because the Roman physicians never employed this word alone (i. e.
without the addition of " per superiora ") to express " to excite vomiting," or " to evacuate by vomiting," although the Greeks could employ Kcaaipstv alone to express
vomiting.
2 From and a little before our era.
3 See the book De fracturis (ed. Chart. t. xii, p. 203). He there says: a"LELvov
'XXi~opov 7rL7rit(TrcLv aiOrftEpov, 7 ry repily; in this place he speaks of the employment of vomiting by hellebore in order to guard as rapidly as possible against swelling, trismus, acute fever and sphacelus from a bruise in the sensitive parts in the
vicinity of the calcaneum. This recommendation he confirms in another place (sect.
iv, aph. 10) where he says: <papparaietv Iv r~fat Xirv 6isa, iv Opyi, abir0Y'pov"
XPoviELv ytap 6v To fi 7rotorotit7 KcaKOV.
4 Sect. iv, aphor. 17.




664

MEDICAL HISTORICAL DISSERTATION

pains and morbid symptoms were in the upper part of the body,
and when the other symptoms seemed to demand evacuation.1
58. In this manner his successors up to the time of Galen ordinarily employed the veratrum in order to cause vomiting, as we
find in the pseudo-Hippocratic and other writings.
59. That the veratrum was then given in a smaller and even in
a very small dose is a mere conjecture, for Hippocrates nowhere
makes mention of the dose. It was only at a later period that
physicians mentioned the dose of veratrum album which they employed for common use, as well as for the production of helleborism.
60. As the earliest physicians up to the time of Hippocrates
neither knew nor employed any other emetic besides veratrum
album; when they wished to evacuate upwards, they could only
make use of this medicine for obtaining prompt and immediate
relief by diminishing the dose; 2 they would have to diminish the
dose whether of the crude root, or of the infusion, or of the
decoction.
61. Those physicians who immediately followed Hippocrates, in
order to mitigate the effects of veratrum     in its ordinary employment, imagined various ways of administering it without giving it
by the mouth, a mode of administration very repugnant to the
dogmatic school of that age, which was more intent on theorizing
upon the nature of things than on practising rationally.3
62. Accordingly, Plistonicus and Dieuches, followers of this
sect, 4 as also Diodes (who flourished thirty years before them)
strove to excite mild vomiting by means of this medicine intro1 Sect. iv, aphor. 18.
2 This milder treatment by diminished doses seems to be alluded to by Hippocrates
himself in the following place (De fracturis. Operum edit. Chart. tom. xii, p. 257):
\XX'iopov fiaXOadrcbv rTriraL Xp  airpEpov; the expression paXOaKorv-slightapplied to hellebore would seem to indicate a smaller dose of it. Also in another
place (De Artic., tom. xii, p. 362) Tv  Ka Elr6r~f jTOc I, E 4ELvY a,7v0 p7Eavppaov--if the
person vomit easily, he should get a slight emetic (" which does not exhaust him too
much," according to Galen's explanation).
3 Mnesitheus (one of this sect who lived about 320 years B. C.) shews some fear of
this kind. The following are his words (in Oribas. Collect., lib. viii, cap. 9):
" There is great danger attending the drinking of hellebore; for either the patient is
restored immediately to health, or he is subject to much and long-continued suffering;
remedies of this sort should not therefore be given unless all the safer modes of treatment have been exhausted."
4 Contemporaries of Mnesitheus.




ON THE HELLEBORISM OF THE ANCIENTS.

665

duced as a suppository by the anus, or as a pessary by the
vulva, or employed as an epithem. 1
63. But the principal mode of mitigating the effects of hellebore was that invented by Philotimus,2 a physician of the same
school, and contemporary of the above, which was adopted by all
the practitioners of the succeeding ages.    When it was desired to
produce a milder and more expeditious vomiting, he introduced a
root of veratrum   album into a radish,3 and (as we are informed by
the physicians who immediately followed him) having extracted the
veratrum the following day, he gave the radish thus impregnated
with the medicinal power of the veratrum to be eaten either alone
or with oxymel.4      " By this means," says Rufus, " vomiting was
most rapidly excited, which would not have occurred so successfully by the employment of hellebore alone."
64. Rufus likewise mentions that in his time evacuations upwards were produced by employing footbaths of hellebore.5
65. For the same object Herodotus, a pneumatic physician, and
contemporary of Rufus, gave two spoonfuls of the decoction of
hellebore to those who did not require violent evacuation.6
66. On the other hand Galen, who gave hellebore with considerable timidity, ingenuously confesses " that it seemed to him
dangerous 7 to give the veratrum album to sick persons in his time
without preparing them for it, as their juices, which had been rendered viscid by idleness and luxury, required first to be purified."
67. Antyllus gave to old men, children, &c., a small quantity of
the infusion of hellebore.8
1 As Rufus mentions (apud Oribas., 1. c. lib. vii, cap. 27, p. 266).
2 See Rufus, 1. c.
3 Aitius (as we learn from Antyllus and Posidonius) gives the following prescription:-" Six drachms of the fibres of the root of veratrum are to be inserted into
a radish which has been pierced with a reed, the following day they are to be
taken out, care being taken not to leave any of the bark of the veratrum inside; the
radish is to be cut in pieces and then eaten along with oxymel."-(lib. iii, c. 120.)
4 Loc. cit. The same method is recommended by Pliny (Hist. nat., lib. xxv, sect.
24) and Galen (lib. i, de method. med., ad Glauc., cap. 12). It is, however, easy to perceive that from such a process it is impossible that the medicine can always be the
same or in the same quantity, as Murray observes (Apparat. med., tom. v, p. 158).
6 Rufus, loc. cit.
6 In Oribas., loc. cit., lib. viii, cap. 3, p. 276.
7 Tb rolvvv bt6ovatL KXXopov avwv 70ro  rposatrafaatl, ropaXEpbv, &c. See Galen,
Comment. ii, in Hippocrat. lib. defracturis, (edit. Chart. t. xii, p. 203).
8 In Oribas., 1. c. lib. viii, cap. 5, p. 277.




666

MEDICAL HISTORICAL DISSERTATION

68. But I shall now proceed to the more important treatment
of chronic diseases by means of veratrum album, to which the
ancients gave the name of
Helleborism.1
69. Serious and inveterate diseases in general the earliest physicians endeavoured to cure by means of large doses of veratrum,
but they shewed a great deal of caution and care in their employment of it, partly because they sought to overcome a disease, as
they imagined, by. a medicine of a more violent character2 than the
disease itself; partly because they sought to produce the least
possible amount of inconvenience from its use.
70. In the earliest times, physicians knew of no other medicine
for combatting chronic diseases, with the exception of a few, except
the veratrum    album, to which, when all common resources had
failed, they resorted as to an anchor of safety.
71. " The white hellebore" says Aretaeus,' "is the most efficacious, not only of the emetics, but also of all evacuant medicines,
not indeed by the quantity and variety of the excretions it occasions (for cholera does the same), nor yet by the intensity and
violence of the vomitings (in this it is surpassed by sea-sickness),
1 We find the word k\XE~opijEuv used by the anonymous continuer of the Hippocratic book, De diaeta acut. (edit. Chart., t. xi, p. 165), and the author of the sixth
book, De Epid. (1. c., t. ix. p. 360); in these places it refers to the use of hellebore in
diseases as an emetic; but the substantive XXs~optE/i6c, referring to the grand cure
was first employed by Aretaeus (de curatione diuturnorum morborum, lib. ii, cap. 13);
and later, Caelius Aurelianus (Chronic., lib. i, cap. 4), in his barbarous language improperly applies the term helleborismus to the decoction of veratrum.
2 Galen explains the operation of the larger doses of hellebore in a much too
mechanical and gross manner when (in his Comment. i, on the Epidem. vi of Hippocr.)
he says-" if the disease is of very long standing and cannot be eradicated as with a
lever, we employ the veratrum album," (iXXECopiELtV siv ldv ra'vv Xp6vLOv  76' rd0oc,
Kal Oj oiv dlVroc rtC poXXEidac 6eSMvov, el~ ravra yap AXX6dpp Xpyw'/Aa).
1 'Ear 6 XEVKOd (1X\gopoC) ori c iETrjpiwv (conjecture of Wigan for iper,/ptov of
the text) to6vov, aXAA ral vlJirdivrwv oY o  KaOaprrjphwv 6b vvarararoc, ov r4
7rXk'OE Kal Tr 7roLeiXiy rrlc gfcrcpLiLOc O' rdsE yap Kal XoXEptl 7rp rLr" oS' 0 'vrdTraL ICKa
P3iP rTfft Tri rTo'iat EIErTOt'TL Lg roS E yap vavTrl Kal raXaarTa KpE w  ov" r aXXaa Svvai Kal
7rotodr7r ofrtr (aviXy' TyrEp bytiag Trog KipdvovTag rOteEL, iCal 1n' 76iy i KcaOpfr,
eal d~ri ptrt cpKp ivratL. 'Arap Kcal raCvrmiv TWVv Xpovhiv vofiawv '!i av Itpv~ywv,
iv acravaSijry ra X hora d KEa, ro 7  E tovvov iI7rijptov 7rvpi 'iKov yap, ig a6vauv,
XEvKO i!XXg opoC, rcal i, rt  p irp 7rip pyapyrat KKaLcaiov, roV7   7 rXov EXXgopoCg EiaTo
7rapfKlOwv vrp'jaaelt, eVtrvotav pIv iE tvaorvoiac, it apolrl e E6XpoiIv cal darb
alcikEriTg, ebaapKcill. (De curat. chronic., lib. ii, cap. 10, ed. Boerh., p. 136.)




ON THE HELLEBORISM OF THE ANCIENTS.

667

but by the quality and remarkable power with which it restores
the sick to health by means of a slight and far from violent evacuation. It is moreover the sole remedy of all chronic diseases which
have already taken deep root in the constitution, if other remedies
fail. It resembles the power of fire; and what is effected by the combustion of fire, that hellebore does still more completely in the
interior of the body, giving to the asthmatical an easy respiration,
to the pale faced a florid complexion, and to the emaciated a robust
body."
When helleborism began to be practised and how long its use was
continued.
72. Before the age of Hippocrates many physicians were afraid
to employ this " grand cure," because they were ignorant of the
doses and of the caution necessary to be employed in the use of
hellebore; those who used it however, not unfrequently did harm
by their rude mode of exhibiting it.
73. This we learn from Ctesias, a physician of the Cnidian
school, a relation and almost a contemporary of Hippocrates, but
a little his junior: " In the times of my father and grandfather," 1
says he, "no physician administered hellebore, for they knew not
the proper mode of administering it, nor the proper dose in which it
should be given. If, however, they sometimes gave a patient a
draught of hellebore, they warned him that he ran a great risk. Of
those who took it many were suffocated, few benefitted. But now
we see it given with perfect safety."
74. After the authors of the Praenotiones Coacae, Hippocrates
himself, who flourished about the year 436 B. c., employed helleborism boldly, and taught the precautions it was requisite to take
in its use, but as was his wont, in very few words, which I shall
quote when I come to treat of the mode of employing it.
75. In later times helleborism underwent various changes
of fortune. For the medical sects that arose after the time of
Hippocrates, applied their minds more to obtain a paltry renown for
vain speculations and theoretic subtleties, than to the careful treatment of diseases; therefore in consequence of their ignorance or
1 In a fragment preserved by Oribasius, Collect., lib. viii, cap. viii, p. 285.




668

MEDICAL HISTORICAL DISSERTATION

neglect of the precautions requisite in employing hellebore, the
use of this root came to be regarded as dangerous and fell into
disrepute.1
76. Still it was employed by many physicians of those times, as
may be learned from the writings that were given out under the
name of Hippocrates (called pseudo-Hippocratic).2
77. But it was principally the Anticyran physicians of this
period who practised helleborism, ex professo, if I may be allowed
to use the expression, and they pursued it vigorously for several
centuries. A great number of sick persons from other countries
who had been given up by other physicians, travelled to both
Anticyras (towns, as I before stated, in great repute for this treatment), in order to be cured of the most protracted and serious
diseases by means of the potent employment of hellebore.
78. Afterwards, Themison,3 founder of the          methodic   sect,
began to recommend this mode of treatment by means of large
doses of veratrum,4 but his books on chronic diseases      have been
lost.
79. Cornelius Celsus,6 who followed him, says very little in his
writings respecting the use of veratrum album, but he mentions it
incidentally; it is doubtful if he employed it himself.
80. Thereafter Aretaeus of Cappadocia, a man gifted with the
genius of Hippocrates, who flourished in the reign of Domitian,
wrote a good deal of useful matter relative to helleborism.
81. Then Rufus (apparently the Ephesian7) and the pneumatic
SSee above, in the note to ý 61, the observation of Mnesitheus, the dogmatic
physician.
2 See the apocryphal continuation of Hippocrates' book, De victu acut. (edit. Chart.
t. xi, pp. 165, 175, 180),-as also the pseudo-Hippocratic books, De Morb. popul.,
especially the fifth (which was most probably written by a Coan physician, perhaps
by the son of Draco), the sixth (probably written by Thessalus), and the seventh
(written by several hands)-and finally, the books De affectionibus and De internis
afectibus, in many places.
3 About the year 63 B. c.
4 Pliny, Hist. natur., lib. xxv, sect. 53.
6 Quoted by Caelius Aurelianus (Tard. Passionum, lib. i, cap. 1.)
6 In the commencement of our era.
7 That the fragments quoted by Oribasius are from the works of Rufus of Ephesus
seems to be borne out by this, that a part of them is to be found in a manuscript
containing the anatomical works of Rufus of Ephesus, translated into Latin by
J. P. Grassus, in the Principes artis medicae of Henr. Stephanus, 1567, fol., p. 128.




ON THE HELLEBORISM OF THE ANCIENTS.

669

physicians, Herodotus and Archigenes, who flourished at the close
of the first century of the Christian era, made great efforts to
propagate and teach the use of hellebore, as the fragments of their
writings preserved by Oribasius clearly testify.
82. But not long after them        appeared Claudius Galen       of
Pergamus, founder of a sect, the torch and trumpet of general
therapeutics, a man more desirous of inventing a subtle system
than of consulting experience. Disdaining to learn the powers of
medicines by instituting experiments, he gave the bad example of
generalizing and framing hypotheses.2 He neglected the employment of veratrum album, or rather he dreaded it. In very few
places of his most copious writings (which certainly prove the
fecundity and subtlety of his mind) is mention made of this celebrated medicine. To be sure, in his book, Quos purgare oporteat,
he repeats, principally from Hippocrates and Rufus, the preliminary precautions and rules for the employment of helleborism, but
he adds nothing of his own which would lead us to infer that he
approved of it himself; on the contrary, he says: "We have
sometimes given in oxymel, radishes in which the fibres of white
hellebore had been left for twenty-four hours, in order to excite
gentle vomiting by this means "; which is as much as to say, that
he did not employ the grand cure, but only sometimes used the
gentle method of Philotimus. He elsewhere3 recommends the same
gentle use of veratrum. Moreover, in his commentaries on the
Hippocratic writings he now and then says something about hellebore in a superficial and imperfect manner, thereby shewing that
he had a great objection to the serious employment of this root.
Thus when Hippocrates4 orders, for a contusion of the heel got
1 This, the greatest celebrity in the medical schools, and almost the only authority
for thirteen centuries, flourished at Rome after the middle of the second century of
our era.
2 He indicated all the powers and qualities of all simple medicaments, not by
experiments upon the human body, but by mere conjecture: thus he arbitrarily
placed both the hellebores in the third order of hot and dry substances (in the 11th
book De simpl. med. facultate, t. xiii, p. 173), whereas it is impossible that these two
medicines, which have a totally opposite medical action on the human body, can be
of the same quality.
3 In the first book of the Method. medend. ad Glauconem, cap. 12.
4 Or his grandfather, who by some is thought to be the author of the books De
fracturis and De articulis.




670

MEDICAL HISTORICAL DISSERTATION

by leaping from a height, apparently for the purpose of preventing
tetanus and gangrene, hellebore to be given, that same day or
the next, before the fever comes on, or when it is slight or not
continued, Galen confesses that " he would not dare to give hellebore, even if there was no fever," 1 so far was he from making use
of the helleborism of the early physicians.
83. I know not whether it was the mere example of Galen, or the
dogmatic style of his writings which were repeated literally in all
medical writings as though they had been the oracles of an infallible
God, or if it was from other causes, that the physicians who immediately followed 2 him almost entirely neglected helleborism; thus
much however is certain, that for almost two centuries it was very
little used, until a man distinguished equally in medicine and in
surgery, Antyllus,3 paid so much attention to this mode of treatment that he is justly regarded as the greatest authority in laying
down the precautions it was requisite to use in the employment of
this means.
84. Shortly after him Posidonius, a physician of no mean reputation, as may be seen from the fragments of his writings preserved
by Aetius, rivalled Antyllus in the attention he devoted to helleborism.4
85. Thereafter the grand cure by hellebore again declined sensibly and fell into disuse. In fact Oribasius, about the year 362,
in his Collecta, dedicated to the emperor Julian (called the apos1 HpEl7 bi ovi' aTrvpS7rq roXA)fJLEv S&diova (iXXE~opov). Comment. ii, in librum De
Fracturis (edit. cit., tom. xii, p. 204).
2 Caelius Aurelianus, who seems to have been a contemporary of Galen, and not
to have lived after him, recommends the employment of helleborism in epilepsy
(1. c. lib. i, cap. 4). His dialect is African, not pure Roman, but rude and rough.
3 This author flourished about the year 330 of our era; fragments of his writings
have been preserved by Oribasius and Aitius; Sprengel has published a separate
edition of them.
4 That he wrote in the time of Oribasius, and some time before him (about the
year 360), is apparent from this, that Oribasius in his chapter on epilepsy (Synopsis,
lib. viii, cap. 6), transcribes word for word, without mentioning his authority, Posidonius' method of treating this disease, which Aitius (Tetrab. ii, Serm. ii, cap. 13)
ascribes to Posidonius. But our Posidonius (whom some, for what reason I know
not, call Possidonius, though the etymology of the word, as well as the Aldine
edition of the Greek text, and Photius also-p. 565-all make the word IooaEtiwvioe)
must not be confounded with the more ancient philosopher of the same name, whom
Strabo calls the friend of Ptolemy (Geogr., lib. xi, p. 491).




ON THE HELLEBORISM OF THE ANCIENTS.

671

tate), has brought together many observations of the ancients on
the subject of helleborism, but where he ought to have given
instructions concerning it himself (in the Synopsis to his son
Eustathius), he does not say a word about it.
86. But in the following century Asclepiodotus, abandoning in
a great measure the doctrines of his fanatical preceptor Jacobus
Psychrestus (about the year 460), revived the practice of helleborism, which had long been neglected and discontinued, and
gained great reputation by his wonderful cures of very obstinate
and serious diseases by means of this medicine.' But of all the
physicians of antiquity he was the last who practised this way, for
after him the employment of helleborism fell into oblivion, nor
was it afterwards restored by any of the Arabian physicians.2
87. So also Aetius the Amidenian, who about the year 5453
arranged in sixteen books, with much order and clear method, all
the writings of the ancients on the treatment of diseases that
remained, carefully extracts from Antyllus and Posidonius what
relates to helleborism, but adds nothing from his own experience.
88. In like manner Alexander of Tralles, who composed twelve
books in the Greek language on the art of medicine, about the year
555, in the time of Justinian, was so prejudiced, like the rest of his
contemporaneous colleagues,4 against the use of this root, that he
greatly prefers the Armenian stone (fossil oxyde of copper) to veratrum   album, "as an     evacuant medicine without the harm        and
danger that attend the employment of veratrum album." 5
1 'AaerX 6Soroc-rro- XEvro6 iýXXeCpov 7raXaL Trv Xp"ia'v,rTroXwXtvav-avrbg
aVEicaivEral, Kal o0i aViroýv avtarov v6fovg idaaro (Photii Mvpt6etgXov, p. 1054, edit.
Schotti, Rothomagi, 1653, fol.).
2 Mesue, who flourished during the reign of the caliph Al Rashid, about the year
800, a man of such celebrity that he was termed the evangelist of physicians, contributed much to the almost complete abandonment of the use of veratrum album.
In his book De Simpl., cap. 30, he says, " There are two kinds of hellebore, the
white and the black; the latter is more wholesome than the white, which produces
most terrible symptoms."
3 The learned Dr. Carl Weigel (Aetianarum exercitationem specimen, Lips., 1791,
4, p. 8) proves that Aitius flourished about the years 540 and 550, but that Alexander of Tralles is to be referred to the sixth decenium of that century.
4 J. Friend (Hist. de la med., t. i, p. 160) says: "Ce m6dicament, si renomm6
parmi les anciens, etait (du temps d'Alexandre de Tralles) djai devenu tout-A-fait
hors d'usage."
5 Book i, at the end of the chapter De melancholicis.




672

MEDICAL HISTORICAL DISSERTATION

89. Afterwards indeed Paulus of Aegina, who wrote his seven
books on medicine about the year 640, in Greek, describes cursorily the mode of practising helleborism among the ancients, but
as far as can be understood he does not seem to have employed it
himself.1
90. Finally Johannes, the son of Zacharias, surnamed Actuarius,2 only makes mention of veratrum      album   incidentally,3 and
only after the description of others.
Of the seasons of the year, the diseases, and the subjects in which the
ancients considered helleborism suitable or unsuitable.
91. The earliest physicians considered the spring the most suitable season for the evacuations by hellebore, next to that the
autumn, and if a choice were capable of being made betwixt winter
and summer, they preferred the latter for the evacuations upwards,
the former for those downwards.
92. They prohibited the employment of helleborism in asthmas,
coughs, and internal ulcers (such as pulmonary consumption5 and
suppuration of the liver); also in cases of hemoptysis, even when
the patient seemed to be in good health, they feared lest its use
should occasion the rupture of a blood-vessel in the lungs, especially of those who were thin, had a narrow chest, and a long neck,
i. e. were of a phthisical habit (for persons of that description have
generally tubercles in the lungs, breathe with difficulty, and are
harrassed by cough6); also in diseases of the throat and neck, in
the pain at the opening into the stomach of those who had a difficulty of vomiting,7 also in lientery,8 in commencing amaurosis, in
affections of the head that were accompanied by violent pains at
1 Lib. vii, cap. 10.
2 From a passage in Myrepsus, who wrote about the end of the thirteenth century, quoted from Actuarius, it seems that the latter could not have flourished after
the year 1280 (see Freind, loc. cit., p. 463, 464).
3 Method. med., libr. v, cap. 8.
4 Hippocr., sect. iv, aph. 4 and 6.
5 Hippocr., sect. iv, aph. 8.-Rufus quoted by Oribasius, Collect., lib. vii, cap. 26, p.
244.
6 Rufus, 1. c., p. 245.
7 Rufus, 1. c., pp. 244, 245.
s Hippocr. 1. c., aph. 12.




ON THE HELLEBORISM OF THE ANCIENTS.

673

intervals, with redness of the face and congestion of the vessels;
and lastly, in the hysterical suffocation.1
93. It was not allowed to use it in any febrile disease, except
some cases of quartan ague.2
94. Moreover, the vomitings provoked by hellebore were not
thought to be suitable for obese persons,3 nor for the plethoric,4
nor for those subject to syncope.
95. It was with difficulty borne by persons of a timid or pusillanimous disposition; this treatment requires a greater amount of
fortitude than almost any other thing; wherefore it was not considered suitable for women, or old men or children.5
96. It was chiefly employed in diseases of long-standing without
fever, in insanity,6 melancholia,7 in inveterate pains of the feet and
hips, pains of the joints,8 the commencement of the gout,9 epilepsy,10
spasms of the facial muscles," laziness of the mind,'2 loss of conAitius, quoting from Antyllus and Posidonius, lib. iii, cap. 121.
2 Galen, lib. i, De method. med. ad Glauconem, cap. 12. -Rufus, 1. c., p. 264.
3 Rufus, 1. c., p. 245.-Hippocrates seems to me to allude to this when he says
(sect. iv, aph. 16): 'EXXiopog i7rtivSvvoJ roltL rc a aapKe  vydac (as though he had
said " fleshy persons ") Xovat, aCrata4dv yap i~EroEit,-wherefore for this same reason
he orders (sect. iv, aph. 6) thin persons to be evacuated upwards: Trov iaXvovb--avt
Opap[uaicvetv.
4 Aitius, lib. iii, cap. 124.
5 Rufus, 1. c., p. 245.
6 C. Celsus, De medicina, lib. ii, cap. 13, with whom all ancient medical authors
agree.
7 Aretaeus, Curat. diut., lib. i, cap. 5.-Galen, De atra bile, cap. 7.-Pliny, Hist.
nat., lib. xxv, sect. 94-" Efficacius elleborum," he says, " ad vomitiones et ad bilem
nigram extrahendam."
8 Rufus, 1. c., p. 263.-AUtius, 1. c., cap. 121.
9 Aretaeus, Curat. diut., lib. ii, cap. 12, Kca ycip roiat roayputcoToi iXXigopoc rob "ya
aKoc &aXXa& v roletL 7rpWTrytL 7rpooToXat o To 7TracOeoc.
10 Celsus, 1. c.-and Caelius Aurelianus, Tard. pass., lib i, cap. 4, ý 108-111.
11 Celsus, lib. iv, cap. 2.
12 It was not only employed for mental imbecility, but remarkable to relate, it was
also used for healthy individuals given to literary studies in order to sharpen their
intellect, as Pliny informs us (Hist. nat., lib. xxv, sect. 21): " Ad pervidenda acrius,"
he says, " quae commentabantur, saepius sumptitabatur veratrum;" as an example, I
may mention the case of Carneades the Academician, who (see A. Gellius Noct. Att.,
lib. xvii, cap. 15) " scripturus adversus Stoici Zenonis libros superiora corporis
elleboro candido purgavit."  The same Carneades, we are told by Valerius Maximus
(lib. viii, cap. 7), " cum Chrysippo disputaturus, helleboro se ante purgabat ad exprimendum ingenium suum attentius et illius refellendum acrius."  It is to this em2x




674

MEDICAL HISTORICAL DISSERTATION

sciousness (apoplexy), vertigo which caused confusion of the head,
(fanatics,1) inveterate paralysis,2 obstinate headache,3 lethargy,
vertigo, white leprosy4 and        elephantiasis5 and      other cutaneous
diseases; also in baldness, falling out of the beard, nightmare,
developed hydrophobia,6 renal calculi, ancient crudities,7 the
coeliac disease,8 leucophlegmasia, diseases of the spleen,9 struma,10
concealed cancer, though it seems to have been less suitable for
the ulcers themselves;11 in a word, in an almost innumerable
multitude of diseases.12
ployment of veratrum album for the purpose of sharpening the intellect that Lucian
of Samosata refers (pfiwv Trpaatc, Op., tom. i, p. 564, edit. Reitzii): ov -stprt yEvicraL
aob6,,?v Jil rpiSc E04 roD i\XX~opov 7ripy-" thou canst not become wise unless
thou thrice usest hellebore;" and in like manner Horace, by the words: " Tribus Anticyris insanabile caput," means to ridicule a dullard whose stupidity could not be
removed by three courses of hellebore.
So frequent and so well known was the treatment of mental infirmities by hellebore at Anticyra in ancient times that the name of this town was often used to denote
the process of helleborism itself, and the word Anticyra was used when helleborism
and hellebore were meant. Hence that sarcasm which Horace directs against misers
(lib. ii, Sat. iii, v. 82, 83):" Dando est ellebori multo pars maxima avaris;
" Nescio an Anticyram ratio illis destinet omnem"i. e. I should think that all the hellebore that can be found should be devoted to the
treatment of misers.
Persius also says (Sat. iv, v. 16)" Anticyrae melior sorbere meracas,"
it were better that thou shouldst swallow pure hellebore.-This is an imitation of
Horace (Epist. ii, v. 137.)" Expulit elleboro morbum bilemque meraco."
' Rufus, 1. c.
2 Aetius, 1. c., cap. 12.-Cael. Aurelianus, 1. c., lib. ii, cap. 1.
3 Rufus, 1. c.-Aretaeus, Cur. diut., lib. i, cap. 2.
4 Rufus, 1. c.
5 Pliny, 1. c., lib. xxv, sect. 24.
6 Rufus, 1. c., p. 263, " It causes," he says, "those who already have a dread of
water, to dread it no longer; and this fact was anciently known to the peasants who,
when their dogs became affected by the disease, purged them with hellebore, and this
led physicians sometime after to give hellebore to a man affected with the same
disease."
7 Rufus, 1. c.--Pliny, 1. c.
8 Celsus, 1. c., lib. iv, cap. 16.-Aretaeus, Cur. diut., lib. 2, cap. 7.
9 Rufus, 1. c., p. 264.
to Celsus, lib. v, cap. 28, ý 7.
11 Rufus, 1. c.
12 Aitius (quoting Antyllus and Posidonius), 1. c. cap. 121: ro 7 i s&aptOjEp v i(p'Wo
raEiOwv EvciNsItcLo iEtLv 6b \XXopo, ovb pStov thd ro rXijOoC.




ON THE HELLEBORISM OF THE ANCIENTS.

675

97. In a disease which from its nature is of a chronic character,
it was considered much better to administer the veratrum in the
commencement of the malady before it had acquired greater
power, because most such diseases became from long habit in the
course of time unconquerable.1
98. But in the case of diseases consisting of periodical attacks
and intermissions, it was not thought advisable to employ the medicament where the paroxysms recurred at short intervals, but only
where the intervals were longer.    In diseases, however, which presented great and regular intermissions, it was deemed expedient to
commence the treatment a long time before the attack, but if the
intermissions were short and irregular, the hellebore was to be had
recourse to after the termination of an attack, especially in
epilepsy.2
Preparatory treatmentfor helleborism.
99. When it was deemed necessary to employ the veratrum, the
patient was put on a regulated diet, which was in general, according to the advice of Hippocrates,3 for those who vomited with
dificulty that they should before taking the medicine have their
bodies moistened by plenty of nourishment and repose (the pseudoHippocratic books, particularly the sixth book of Epidemic diseases,
add, " by the bath.")    The doctrine of the later physicians wasthat they should be made to practise artificial vomiting.
100. Even those who vomited easily were ordered to vomit three
times before they commenced the great medication; first, after
supper;4 secondly, when their stomach was empty; and lastly, after
having partaken of radishes5 (or origanum, or hyssop, or rue6).1 Rufus, 1. c., p. 264.
2 Rufus, 1. c., p. 265.
3 Sect. iv, aph. 13.-Also Celsus, libr. ii, cap. 15.
4 After supper, and also when fasting or coming out of the bath, the patients provoked vomiting, either by tickling the fauces with their fingers, or with a feather
dipped in oil.
5 From a pound to a pound and a half of pungent radishes were eaten after a
moderate meal with water for drink; the patient then waited a whole hour until
nausea and eructations commenced; then by means of the finger or a feather introduced into the fauces he provoked vomiting, and this was called vomiting from
radishes. Archigenes, cited by Oribasius, 1. c., lib. viii, cap. i, p. 270.
6 " Herbs lightly boiled should be eaten."  Rufus quoted by Aitius, lib. iii, cal.
119.
2x2




676

MEDICAL HISTORICAL DISSERTATION

Others ordered the patients to vomit three times immediately after
supper; and then to wait two or three days before drinking the
hellebore.
101. But those who were known to vomit with difficulty, were
prepared a long time previously, as long as three weeks,2 and on
repeated occasions (e.g. every third or fourth day) were subjected
to vomiting,3 in such a manner that the patient should be made to
vomit more frequently the nearer the time approached for taking
the medicine, attention being paid to the strength of the body in
order that he should not be weakened more than necessary by
these, for this treatment requires more than any other thing,
strength on the part of the patient.4
102. Therefore betwixt the several vomitings three or four days
were allowed to elapse, during which the body was refreshed by
food easy of digestion, by repose, and by amusement of the mind.
103. After the last vomiting, one or two days5 intervened before the patient took the veratrum, during which time the bowels
were opened by means of a clyster,6 baths were used, and a
spare diet.
Mode of exhibiting the veratrum album for the purpose of inducing
helleborism.
104. There were three general methods of administering veratrum; in infusion, in decoction, and in substance.
105. The kind that was preferred7 was that in which the root
was cut with scissorss into coarse particles, resembling our coarser
Aitius, lib. iii, cap. 127.
2 Archigenes, 1. c., p. 267.
3 To those that vomited with great difficulty, the most that used to be ordered was
generally four vomitings after supper, and two after radishes. Archigenes, 1. c., pp.
267-271.
4 Rufus, 1. c., p. 266.
5 Archigenes, 1. c., p. 268.
6 Archigenes, 1. c.-Aitius, lib. iii, cap. 127.
7 Rufus, 1. c., p. 266.
8 In a passage in Antyllus preserved by Aitius (lib. iii, cap. 128), this preparation
of the root is termed 4aXwarbv (cut with scissors). Oribasius quotes the same passage
(Collect. i, 8, cap. 5, p. 277); but Rasarius renders it incorrectly, "in ramenta derasam."-Antyllus, a little further on (Aitius, 1. c., cap. 131), describes this operatibn




ON THE HELLEBORISM OF THE ANCIENTS.

677

kinds of groats (which the ancients called bruised polenta), or of
the form and size of sesame-seeds.1 The coarser particles were
selected when it was wished to produce milder vomiting,2 but care
was taken that they should be of equal size, and not mixed up
with the finer dust, lest the vomiting that ensued should occur at
unequal periods.3
106. Some gave as the largest dose to robust patients two
drachms and a half (= 180 of our grains) of this granulated preparation;4 others only gave two drachms5 (=         144 grains) as the
largest dose, ten oboli (= 120 grains) as the moderate dose, and
eight oboli (=     96 grains) as the smallest dose.        It was given
either in water, or in wine, or in raisin wine,6 or in decoction of
lentils; but to persons out of their mind it was given (in order
that they might not be aware that they were taking it) in broth,7
or in oxymel,8 or in pills.9
107. This most simple preparation of veratrum album caused
vomiting more rapidly than the others, and for the most part in
less than two hours brought up the bile and the pituita without
much disturbance,10 then, after the medicine itself had been ejected
by the vomiting, the evacuation ceased in from four to five hours.1
108. Another mode was to bruise the root in a mortar, and to
more at length: rd ricaip  at Xagv trkvE n   aXtis siE aXtTwrs) (of the size of groated
wheat) JEyiOrf  7rtrvpJdsjl. He orders these particles cut by the scissors to the size of
groats to be wiped with a cloth, in order to remove the small dust, and thus prevent
suffocation. Archigenes (1. c., p. 272) recommends that the coarse fibres of the
hellebore should have one or two longitudinal incisions made in them before being
cut in pieces.
1 Paulus Aegineta, lib. vii, cap. 10.
2 Rufus, 1. c., p. 266. These coarser particles offered fewer points of contact to the
lining membrane of the stomach, so that the largest dose of this preparation was
considered no more than equal to a smaller dose of the fine powder; moreover this
larger size of the particles prevented their descent into the intestines, and the production of purging downwards.
8 Archigenes, 1. c., p. 272.
4 Aitius (quoting Antyllus and Posidonius), 1. c., cap. 131.
5 Archigenes, in Oribasius, lib. viii, cap. 2, p. 273.
6 Wine prepared from the dried grapes.
7 Archigenes, 1. c.
8 Composed of honey and vinegar.
9 Archigenes, 1. c., p. 275. The finest powder was employed for the pills.
o1 "AvEvv -roXXoiv i  rapaypoi3, Antyllus, in Aitius, 1. c., cap. 128.
" Antyllus in Oribas., 1. c., p. 277, and in Aitius, 1. c., cap. 128.




678

MEDICAL HISTORICAL DISSERTATION

separate the very fine dust by means of a very close sieve.1 To
the bolder patients the coarser powder2 was given in the dose of
a drachm   and two oboli (- 96 grains).      This preparation confessedly acted slower,3 vomiting often occurring only after four or
five hours, but it brought away all the bile and pituita, certainly
not without the risk of causing spasms (cramps) 4 and too violent
vomiting, on account of the too great abundance of the evacuation,
but it was useful in various ways.
109. For the most part the fibres of the roots were bruised up
along with the medulla, but sometimes the most fleshy fibres were
moistened with a sponge, and the swollen bark split up longitudinally with a needle; after drying it again in the shade it was
bruised, and thereby, it was thought, a more efficacious medicine
was obtained."
110. The infusion of veratrum album was also employed. Five
drachms (- 310 gr.) of the cut particles of the root were macerated for the space of three days6 in half a hemina (=     5 oz. 3 drs.)7
of rain water; the liquor was then strained and administered
warm to old persons, children," and hectic subjects.9
111. Others considered the decoction the most certain preparation,10 and they prepared it in the following way: one pound
1 The finest powder being thus removed was made into pills with thickened
honey (Aitius, 1. c., cap. 131); 96 grains of these pills were given when it was
deemed requisite to employ this form.
2 AIitius, 1. c., cap. 131.-To the insane this coarser powder was given generally
in cakes or broth, in order to deceive them (Archigenes, 1. c., p. 274).
3 A~tius, 1. c., cap. 128.
4 2vvo\XKic, Aetius, 1. c.
5 Pliny, Hist. nat., lib. xxv, sect. 21.-Archigenes, 1. c., p. 272.
6 This long maceration in water greatly diminished the power of the veratrum,
for all parts of plants when mixed with water undergo fermentation, and the longer
this maceration and infusion are continued the more are the medicinal powers
weakened, unless spirituous fluids, obtained by the distillation of fermented vegetable substances, are added, which, however, the ancients were not possessed of.
The root of veratrum album, unless thoroughly dried, is more prone to the decomposition of its constituent parts than the roots of other plants; its powder is particularly apt to become mouldy and to ferment, unless perfectly dried. Mouldiness very
quickly destroys almost all the medicinal power of plants.
7 Massarius, De ponderibus et mensuris, Tiguri, 8, 1584, lib. iii, cap. 14.
8 Antyllus, in Oribasius, 1. c., p. 277; in Aitius, lib. iii, cap. 129.
9 Aetius, 1. c.
o10 Herodotus, 1. c., p. 275.




ON THE HELLEBORISM OF THE ANCIENTS.

679

(== 144/5 oz.) of veratrum, cut into small pieces with scissors,1 was
macerated for three days in six heminas (-= 644/ oz. of water, and
then boiled down over a slow fire to one third less; the root was
then removed, and to the liquor two heminas (= 213/5 oz.) of
honey2 was added to thicken it,3 so that it should not spoil,4 or,
according to Archigenes,5 to make it of the consistence of an
electuary. Archigenes gave to a person prepared for the helleborism a small mystrum 6 (= 260 to 288 of our grains) of this
syrup for a dose; Herodotus gave to robust subjects one mystrum,
but to those who did not require to be evacuated two spoonfuls
(=  144 grains).7   Others gave the decoction inspissated with a
third of honey, in the dose of a large spoonful8 (108 gr.), to be
licked up by the patient, whereby they affirmed that the occurrence of spasms and of excessive evacuation was avoided.9 Others
formed the inspissated decoction into pills, which they gave principally to insane persons in order to deceive them.10
Substances that were mixed with the veratrum. Sesamoides.
112. But the ancient physicians did not always employ such a
simple method of administering the veratrum album. Some added
to the infusion origanum, or absinthum, or natrum, others mixed
it with thapsia," and others with the wild grape.12
113. But the principal thing that was mingled with the medicine white hellebore was a certain kinds of seed called sesamoides,
1 'E-aXltap'vov, Aitius, 1. c., cap. 129.
2 Archigenes, 1. c., adds double the quantity of honey (= 43 '/5 oz.)
3 This long boiling and inspissation diminished not a little the strength of the
medicine, so that the doses of this inspissated preparation, though not small in bulk,
were actually of but little strength.
4 Herodotus, 1. c., p. 275.
5 In Oribasius, lib. viii, cap. 2.
6 See Massarius, 1. c., lib. iii, cap. 30, 31, compared with cap. 2.--The cotyle
contained 153/5 of our ounces of honey; the large Attic mystrum contained an
eighteenth part of the cotyle, the small mystrum on the other hand only a twentyfourth part.
7 In Oribasius, 1. c., p. 275.
8 Massarius, 1. c., cap. 38.
9 Atius, 1. c., cap. 130.
10 Archigenes, 1. c., p. 275.
11 The root of the Thapsia Asdepium, Linn.
12 The seed of the Delphinium staphisagria, Linn.




680

MEDICAL HISTORICAL DISSERTATION

in consequence of their (oval) form bearing a resemblance to the
seeds of the sesame; 1 they were also called Anticyran hellebore or
Anticyricon, not because the plant that furnished the sesamoid
seed had any resemblance to the white hellebore, but partly
because this seed excited vomiting2 like hellebore, partly because
to those undergoing helleborism3 it was given at Anticyra in
Phocis,4 in order to prevent the suffocation arising from       the use
of the veratrum    album,5-at least so the Anticyrans persuaded
themselves and others.
114. Anticyra in Phocis, was, as I have said, very celebrated in
ancient times for the treatment by hellebore, the best preparation
of veratrum album for the production of helleborism being made
there, wherefore, as Strabo relates,6 a large number of persons
resorted thither for the sake of the treatment. There grew moreover in Phocis a remedy resembling sesame, with which they
prepared the hellebore of Oeta.      Thus Pliny says: " in Anticyra
insula-ibi enim tutissime sumitur elleborus, quoniam sesamoides
admiscent."7
115. Sometimes, for the purpose of procuring vomiting, the
sesamoides were given alone, in the dose of one drachm (72
grains),s rubbed up with oxymel; when it was intended to
"Granum sesamae (sc. simile)." Pliny, Hist. nat., lib. xxii, sect. 64. Also
Dioscorides, lib. iv, cap. 152: ari'ppa 3iolov oaijadpy.
2 At& r T icaOalpEL2, avTrov TOd ' Tripa 7rapaA7rnrl i XXh py, Galen, De simpl, med.
fac., lib. viii, cap. 18, ý 11.
3 Ati rd piyvvaOatl v raTg rcaOdpasat r7 XEvIyc ikXXsop, Dioscorides, lib. iv,
cap. 152.
4 Strabo, 1. c.
5 N~irapo itcOic-Zv1ityEYCraI-\t-I46potItv, Kai? aaoV rvlyst. See the continuation of the book De victu acutorum (Opera Hippocrat. et Galeni, edit. Chart., t. xi,
p. 182.)
6 Aid roVro Tarosrln/tIv 6po 7roXXo iV KaOapCEosW K at &pa7rEiac XaptL. yivEaOa yyap
rtL aaOapLoticS obppafcov -v r  b(KLICtE, p, T  ov afcKvdaEaOat rov olralov EXX~opov.
(Geogr., lib. ix, p. 640.)
7 Hist. nat., lib. xxv, sect. 21. Pliny is however wrong in here stating Phocian
Anticyra to be an island, for it was situated on the continent, half a mile from the
port. Pausanius (Geogr., lib. x, p. 682, edit. Hanoviae, 1613) has lucidly described
its situation. Livy also testifies to the same when he says (lib. xxvi, cap. 26) " breve
terra iter eo (Anticyram)-ab Naupacto est."
8 Pliny, lib. xxii, sect. 64.-The pseudo-Hippocratic continuer of the book De
Diaeta acutorum (edit. Chart. t. xi, p. 182) orders a large dose: atapaloelstg a vw




ON THE HELLEBORISM OF THE ANCIENTS.

681

cause helleborism, one third part of these seeds was added to the
dose of veratrum.1
116. In the earliest times,2 this seed which it was usual to mix
with the veratrum album for the production of helleborism, was
called by the simple term sesamoid, but subsequently it was called
great sesamoid, not on account of the size of the plant, but evidently
because it was used in the great cure (helleborism), and because it
was considered superior to another seed of the same name,3 but
chiefly in order to distinguish it from a certain white sesamoid,
which was called the small4 sesamoid.
117. It is not certainly known what plant this emetic seed
sesamoid belonged to, which in those days was mixed with the
veratrum album, chiefly at Anticyra 5 of Phocis, in order to diminish the suffocation. Theophrastus says: the seed of a small
plant, helleborine, is to be mixed with hellebore when that is
administered, in order to facilitate its emetic action.6 The name
helleborine was probably given to it because it resembled the hellebore in its emetic action, and its seed seems to have been the same
as what was afterwards termed         (great) sesamoid.      The plant
raOalpEi i 7rd6atg t ytLO6Xv paxp tg  araOpbc (a drachm and a half)s g o5visXera
r"rptypqivov.
SThe same continuer of the book De diaet. acut., loc. cit.-Dioscorides teaches a
more definite proportion (lib. iv, cap. 152): "As much of the seed as can be held with
three fingers, with an obolus and a half (  eighteen grains) of veratrum album in
hydromel."
2 This word does not occur in the genuine writings of Hippocrates. The first that
mentions it is Diocles (who flourished twenty years after Hippocrates' death), see the
dictionary of Erotianus (Op. Hipp. et Galeni, edit. Chart. t. ii, p. 133).
3 In the time of Theophrastus (Hist. plant., lib. x, cap. 11), the seed of the black
hellebore also bore the name of sesamoid, and this, as Rufus (in Oribas. Collect., lib.
vii, cap. 27, p. 251) alleges, resembles the seed of the cnicus (carthamus) and taken
in the dose of two drachms it purges downwards more violently than the root itself.Dioscorides asserts the same thing: sv Kial avnrb (Kcaprovrov Er iXXs6pov piXavog)
KaXofitv ol 0v 'AvrtKIC1vpqj 0raoJiosIFaj. (Lib. iv, cap. 151.)
4 The seed of an unknown plant, the dose of which, in order to produce purging
downwards, Dioscorides (lib. iv, cap. 153) and Rufus (1. c., p. 255) fix at half an acetabulum (a measure that can hold nine of our drachms).
5 Hence the reason why this sesamoid was termed Anticyricon (Pliny, 1. c.), and
at Anticyra itself it was even called hellebore, though this was an abuse of terms; by
strangers it was termed Anticyran hellebore. See Galen, De facult. simpl., lib. viii.
6 MiYEy rap 1rp1  r)7v rdOrv, Oiii rts i Ftpr,, rb rjS 6XXcgoptvh apripLa. Hist.plant.,
lib. x, cap. 11.




682

MEDICAL HISTORICAL DISSERTATION

whence this was derived bore a great outward resemblance to
erigeron or senecio,1 with its white flowers, slender root and bitter
seed.
118. We might, then, say with great plausibility, that this was
the seed of some species of erigeron (acris? graveolens? viscosus?)
seeing that our erigeron acris is highly emetic, as Stedman's observations 2 demonstrate, who saw violent vomiting ensue merely
from the application of the recent plant to the skin. Cullen 3 also
observes, that the common people make use of this plant as a
powerful emetic. If this be so, how powerful the seeds must have
been when taken in the form of potion and brought in contact
with the nerves of the stomach, seeing that in general the whole
power of the plant is concentrated in the seeds, as is seen, for
instance, in   the seeds of the conium      maculatum, and     of the
helleborus niger.
Regimen to be employed to assist the emetic action of the veratrum
album.
119. As soon as the patient had drunk the veratrum, cold water
was given to him to rinse his mouth, and perfumes were employed
to remove and avert a premature nausea.4
120. If the strength admitted of it the patients were desired to
remain seated; if they were weak they were made to lie down on
a bed on the ground, for two or three hours, to smell perfumes,
and to rinse their mouth with cold water. It was sought to amuse
them by some entertaining story; their limbs were rubbed and
ligatures were applied to them; they were advised to keep quiet,
lest the medicine should be ejected by vomiting sooner than it
ought.
121. After two or three hours they were placed in a suspended
or elevated bed and swung about, and thus allowed to vomit.
1 Rufus, 1. c., p. 250.-Pliny, 1. c., "caetera," he says, " simile erigeronti herbae.
In like manner Dioscorides says (1. c., cap. 152): IouKCv r) r6a pcyipovr7.
2 Edinburgh Medical Essays, vol. ii, art. 5.
3 Materia Medica, vol. ii.
4 Vomiting which occurred too soon (before two hours) was generally considered
to be inefficacious for the removal of the disease, and it was observed that where it
occurred too late (commencing only after four or five hours) it produced great prostration of the strength and terrible symptoms.




ON THE HELLEBORISM OF THE ANCIENTS.

683

122. At first, the patients in whom the emetic action went on
properly, felt heat in the fauces and oesophagus; then the saliva
flowed copiously into the mouth, and was often ejected by spitting.
After the lapse of some time they vomited part of the food that
had been taken before, and part of the medicine, along with
pituita. This was repeated after some time; and after they had
ejected the medicine and the food, they vomited first pituita with
a small portion of bile, then pituita with a large proportion of bile,
and finally, pure bile. During that time they had slight hiccough,
very red face, swollen veins, small and quick pulse.
123. When the vomiting went on right, the countenance resumed its proper colour, the pulse became larger, the hiccough
ceased. They now vomited gradually at longer intervals.1     The
bowels were frequently moved, although the evacuation in other
respects might have been moderate.2
124. If the hiccough was excessively troublesome during the
evacuation, melicrat,3 in which rue had been boiled, was given
them to drink, and thereafter a little warm water, which they were
made to vomit again.4 The body was rubbed over with oil, and,
after the lapse of two hours, they were made to take a bath and
appropriate food was supplied to them.5
Remedies employed in cases where the vomiting did not take place
properly.6
125. In order to remove the obstacles to the right performance
of the vomiting, the following things were always in readiness: a
high and swinging hammock and a bed with a soft mattress,7
sponges, posca,s and melicrats prepared in various ways, one of
which contained decoction of hyssop, another origanum, another
rue, another thyme; there were also oils, diluted infusion of veratrum album, cupping glasses, little wedges, a feather, glove fingers,
clysters, fomentations, wine, &c.
Antyllus, in Oribasius, Collect., lib. viii, cap. 6, pp. 277, 278.
2 Aitius, 1. c.
3 Honied water.
4 By putting the finger into the fauces.
5 Antyllus, 1. c.
6 Chiefly from the instruction of Antyllus, in Oribasius, 1. c.
7 Aetius, lib. ii, cap. 132.
8 Vinegar diluted with water.




684

MEDICAL HISTORICAL DISSERTATION

126. If the patients were seized with vomiting sooner than they
ought, and there was reason to fear lest the medicine should be
rejected before any advantage could be derived from it, cold water
was given to rinse their mouths with incessantly, and if this did
not allay the premature vomiting, diluted vinegar was employed,
the limbs were bound with ligatures, and frictions were applied to
them; they were directed to keep in their mouths something
seasoned with kitchen salt, to keep silence, not to move, but to
sit upright.
127. If by these means the inclination to vomit was not stopped, cupping-glasses well heated were applied to the back and
scrobiculus cordis, and a small quantity of hot water was given
the patients to drink occasionally; if however this did not allay
the desire to vomit, a small quantity of the juice or decoction of
wormwood was given.      Two or three of these remedies always
sufficed to arrest this inclination to vomit and to overcome the
aversion of the stomach.
128. On the other hand, if the vomiting was too long delayed,
and the patients did not commence to evacuate at the proper time,
some gave the patient to drink warm honey and water in which
rue had been boiled, or oil mixed with water' (hydrelaeum), others
placed the patient on an elevated couch, the head directed downwards, and made him put his finger into his mouth and irritate
the uvula and tonsils, so as to excite vomiting. Moreover he was
told to flex and extend alternately his back and legs as much as
possible, and to beat with his fists on the abdomen.
129. If the evacuation could not be obtained by these means,
the patient was placed in the suspended hammock and swung
about,2 he was at the same time exhorted or ordered to endeavour
to vomit by introducing into his mouth his fingers covered with
some nauseous oil or with a solution of scammony.
1 Aetius, 1. c., cap. 133, where Cornarius has erroneously translated the words
Xpovtolovfr KaiOdpaewg, by perseverante vomitu, in place of cunctante vom4tu.
2 Hippocrates forbids those who have taken veratrum to indulge in sleep or
repose; he orders that they shall be made to move about continually.-'Er')v 7iri
rTI iXX6Copov, rpOb piv rdc crtviVctac!i r~Wv iawyiCrwv pahXXov dyEtv, 7rpbo ~6 Tro
ViTrovg, icatl pji KLvijfLac, tlaaTooyv rXo 6 iEO  I cal t? vavrthlry, 0 rt civrLTffg rT awd ara
rapdarEL (sect. iv, aphor. 14).-'E7r)rv PoiXQy pd~ ov dyetiv TrO iXhEopove, civeL  r
ouipa (sect. iv, aphor. 15).




ON THE HELLEBORISM OF THE ANCIENTS.

685

130. If even this would not do, eight or ten feathers from a
goose's tail, dipped in some nauseous oil (oil of iris or of cypress'),
or fingers of a glove made of soft leather, twelve finger-breadths
long, stuffed in front with wool and smeared with some ointment,
were introduced into the fauces, and in this way nausea and
vomiting were excited.
Treatment of the bad and serious symptoms occasioned by the action
of veratrum.
131. Those who are in danger of suffocation after they have
drunk veratrum, have a moderate flow of saliva, and, in spite of
the most violent effort to vomit that arises, do not bring anything
off their stomach; their face swells, the eyes project, the respiratory organs are constricted, with the greatest difficulty of breathing; in some the tongue is projected and the whole body covered
with profuse perspiration; in others the jaws are closed, with
chattering of the teeth, and the mind becomes affected.3
132. This feeling of strangulation, which usually occurs in those
who vomit with difficulty, was allayed by the continual drinking
of melicrat in which rue had been boiled or some other of those
substances which have already been mentioned as useful in the
irritation of the stomach.
133. If, however, this affection was of a very urgent character,
three or four cupfuls 4 of the diluted helleborine medicine5 were
given, which, possessing the same properties as the veratrum
already taken would best produce the emetic action. Other substances called emetics were prohibited, as they are of a different
quality, and only irritate the stomach without expelling the veratrum taken at first.6
134. If none of these remedies succeeded in removing the
danger of impending suffocation, the bowels were acted on by a
very acrid clyster, in order to give some relief to this symptom
1 Oil rendered very fragrant by boiling in it the buds of the cypress (an Egyptian
tree).
2 Antyllus, 1. c., pp. 278-280.
3 Herodotus, in Oribas., 1. c., p. 283.
4 The cup (cyathus) contained twelve drachms (= 142/sths of our drachms), see
Massarius, 1. c., p. 43.
5 The infusion or decoction of veratrum album.
6 An ingenious idea and mode of practice, and perfectly conformable to nature.




686

MEDICAL HISTORICAL ISTORICAL  ISSERTATION

and to afford time to obtain other remedies. Then the patient
was made to swallow three oboli (36 grains) of galbanum, or to
drink three cupfuls of very old urine, these being considered useful
for removing suffocation.'
135. But if this also failed to relieve the suffocation, a powerful sternutatory was applied to the nostrils, the patient was assiduously swung about in the suspended hammock, and his fauces
irritated by the introduction of feathers.
136. If there occurred loss of voice and consciousness, the little
wedges were introduced betwixt the teeth of the patient on both
sides, and feathers or the glove-finger introduced into the fauces
in order to excite vomiting and remove the affection. Sneezing
was excited by means of the powder of veratrum itself (or of
euphorbium); and it not unfrequently happened that on sneezing
a mass of pituita was expelled, which in consequence of remaining
too long in the stomach had caused the suffocation and loss of
breath.
137. When this means failed, the patient was laid upon a linen
cloth, which was held up by stout young men, and the patient
at one time thrown up into the air, at another swung from side to
side. If all these commotions and succussions failed to restore
him to consciousness, it was thought there was no other remedy
for bringing him back to life.3
138. The hiccough that occurred to every one who took veratrum
was not interfered with if it was slight and at long intervals; it
was considered to be useful in exciting the stomach to action.4
But when it was very severe, and if the mouth was affected with
vibration and twitching, melicrat in which rue was mixed was
prescribed to be drunk warm after every hiccough.
139. If this did no good, a sternutatory was employed, and if
the affection still persisted, cupping-glasses were applied the whole
length of the spine, ligatures were applied to the limbs, and they
were heated either by fermentations or by putting them in warm
water. It was endeavoured to frighten or insult the patient, or
Antyllus, 1. c.
2 Aetius, lib. iii, cap. 132.
3 A saturated infusion of coffee would be useful here.
4 Antyllus, 1. c, p. 281.




ON THE HELLEBORISM OF THE ANCIENTS.

687

he was ordered to keep in his breath a long time, or to inspire
and expire very slowly.'
140. For those symptoms that occurred as frequently as the
hiccough, the muscular contraction and the cramp, chiefly in the
legs, in the thighs, in the arms and muscles of mastication, also in
the extremities of the feet and hands, if they were violent it was
sought to allay them by plentiful inunctions, by the application of
heat, by frictions and fomentations of the affected parts, by
strongly compressing the muscles with the hands, and by giving
castoreum internally.
141. Moreover if the vomiting was abundant, as it often was in
many of those who laboured under cramp, this affection was
usually removed by baths frequently repeated.2
142. The vomiting, if excessive, was allayed by the administration of the hottest drinks, by ligature of the limbs, and violent
frictions, also by the application of cupping glasses now to the
hypochondria, now to the back, and then tearing them forcibly
away. It is stated that wormwood given in drink was excellent
for stopping the vomiting. But if the vomiting persisted, medicines to cause sleep were employed, as it was believed that sleep
had the power of stopping the excretions.3
143. For the loss of strength that ensued recourse was had to
food and wine, and if the patient had been excessively evacuated
he was revived by the administration of bread soaked in old wine
diluted, or in omphacomel.4
Conclusion.
144. Such was the mode of producing helleborism employed by
the ancients, which was more dangerous in appearance than in
reality, as most of the earliest physicians assert. For besides the
passage5 in Aretaeus, a very distinguished physician, which I
1 Antyllus, 1. c., pp. 281, 282.
2 Antyllus, 1. c., pp. 282, 283.
3 Antyllus, 1. c., and Aetius, 1. c., cap. 134. Hippocrates also (sect. iv, aph. 15)
advised repose and sleep, in order to arrest the evacuation caused by hellebore: E7rVv
Sra raaat (/3oVAy, roy XXA~opov,) V vov 7roi-t, IKai t) KlivEt.
4 Honey, mixed with the juice of unripe grapes, was termed omphacomel.
5 'Tytia oC TOVC Kciovra 7troier E 'i K  ir' 6XiyJ KaOidpcff, tKal Es i acpi ivrTcirt.
Chron. curat., ii, cap. 10.




688

MEDICAL HISTORICAL DISSERTATION

formerly  quoted as authoritative, we find the following in Rufus:2
"The administration of hellebore seems to have been a very
serious matter, wherefore it is that many medical men and patients
eschewed the employment of this medicament; but he who is
acquainted with the whole art and apparatus of helleborism, and
administers veratrum, will find that there is nothing more convenient than this medicine, that it is an excellent remedy for
procuring evacuations, and that it can scarcely do any harm." The
testimony of Pliny agrees with this, where he speaks concerning
his own time thus: " In former times it (veratrum) was considered
a terrible remedy, but latterly it was so commonly used, that many
engaged in study were in the habit of taking it frequently in order
to facilitate their comprehension of their studies." 3
145. It is not, however, my intention to recommend to my fellowmen that Herculean treatment by which, under the name of helleborism, the ancients attempted tp remove so many and such serious
diseases, by giving large doses of veratrum album, and whereby they
often succeeded in doing so in a most miraculous manner, for I know
not if it could be reconciled with our habits and modes of treatment. No one is better aware than myself of the force of habit and
of its influence on the art of healing itself (which however from
its very nature ought to be quite free). If it did not reign despotically over the medical art, it is very possible that the treatment
with veratrum with some modifications might be now-a-days
turned to great advantage in relieving some of the worst and most
inveterate of the diseases to which man is liable.
146. This much is certain, that the same diseases may be eradicated with much milder and even with the very smallest doses of
veratrum, provided the medicine is exactly suitable to the disease,
nor could the ancients have cured by helleborism any other
diseases besides those for which veratrum was generally and, in
any dose whatever (provided it were not too strong), adapted.
147. This, indeed, is evident from    this passage from   the
ancients:4 " It is not the vomiting whereby the veratrum  album
1 In 0 71.
2 In Oribasius, 1. c., p. 263.
3 Hist. nat., lib. xxv, sect. 21.
4 IoXXoi Xai6vrEe TO P XXopov Kcai ar4avres ailrv cKaOapOqaiav iiv ov,3v idXwt,




ON THE HELLEBORISM OF THE ANCIENTS.

689

is of use in chronic diseases, for many have taken and digested
veratrum with hardly any purgation, and yet have experienced not
less benefit from its use than those who had been evacuated by
this medicine."
148. It is to be regretted, therefore, that all those chronic
diseases for which this medicine is from its nature the most appropriate and, indeed, the only' remedy, should be left uncured by
modern physicians, owing to the aversion to employ veratrum,
which, however, may be given in such minute doses, that whilst
they are powerful enough for any disease, be it ever so chronic, they
are incapable of causing any bad effects worth mentioning on the
human body.
OF THE BLACK HELLEBORE.
149. This medicine is termed black on account of the black
colour of its roots externally, which in the veratrum (white hellebore) are extremely white. It remains for me to make a few
remarks upon it, partly on account of its name, partly because the
physicians of Anticyra who, as a rule, devoted themselves to the
practice of helleborism, were accustomed to employ the black
hellebore also as an auxiliary in the treatment of chronic diseases.
150. In the time of Hippocrates the black hellebore was scarcely
or not at all known, or at least not yet designated by this name;
for neither in his genuine writings nor in those of his predecessors
or of his grandfather (Praenotiones Coacae, and the books De
Fracturis and De articulis) is any mention whatever made of this
plant or of this name.
151. The only place where this name occurs (De victu acut.,
t. xi, p. 44), although no one has ever doubted that Hippocrates
was its author, is certainly not a genuine work of his.2
& i7;jeOrfav  oivsv irrov rYv icaOapO'vrwv.-(Aitius, quoting from Antyllus and
Posidonicus, lib. iii, cap. 122.
1 For as every disease differs from every other in such a manner as to demand a
special medicine appropriate to its nature, to be selected carefully from the great
store of the most diverse medicines, by which alone it can be cured quickly, safely,
and permanently, so all the other remedies less adapted to the disease present, are
either useless, or contrary, or hurtful.
2 It is more than probable that the book under the title of De ictus ratione in
morbis acutis, which has generally been alleged to be Hippocratic, was written by
2 Y




690

MEDICAL HISTORICAL DISSERTATION

152. It follows of necessity, therefore, that this new plant (the
black hellebore) which was employed as a purgative, was either
discovered or named' some time after Hippocrates; for it is both
mentioned in the pseudo-Hippocratic writings of those physicians
who were his immediate successors, and is described by Theothree or four different authors. The first part was by Hippocrates himself, and is called
Liber de Ptisana (see Athenaei Dipnosoph.,'lib. ii, p. 57, also Caelius Aurelianus and
Pliny) and it contained nothing except the use of ptisan (" nihil continabat nisi
ptisanae usum "-see Plin., Hist. nat., lib. xviii, sect. 15, and lib. xxii, sect. 66). This
book seems to have begun at the words: oUcde (3i) poio d~a ypaijc E'vat (1. c., p. 7)
and to have gone on to the words: aKiptLS ~EwpSv, but not farther. What follows
immediately, from the words: 6svvq B6 7rXEvpoS (1. c., pp. 36-116) is doubtless an
addition (in which the discourse concerning ptisan is suddenly broken off) apparently
by the same author who wrote the prologue to the beginning of the book upon
ptisan. This addition certainly contains many excellent observations respecting the
diet in acute diseases, but it is plain they are of a more recent date; for here (1. c.,
p. 42) we observe a scrupulous selection of " the internal vein in the flexure of the
elbow to be opened in pleurisy," and in that part of the text (p. 44) which particularly engages our attention at present, not only are black hellebore and peplium recommended as purgatives, and a subtle distinction made between the effects of each,
but several aromatic seeds are added to the formula of the purgative medicine on
account of their pleasant odour, an artificial luxury only met with in more recent
times, as history teaches us. Moreover, in this place (p. 44, also p. 3) many other
cathartics (dXXa 7roXXa rwv i7rnXrcrwv) are alluded to, which could not have been done
before the time of the reign of the Ptolemies; for it was only then that in consequence
of commerce having extended to near and distant nations, the number of medicines was
increased, kings themselves having in those days (within 300 years before our era)
devoted themselves to the study of medicine. As to the peplium which is alluded to
here, it was not, if I am not mistaken, known to Theophrastus a hundred years after
Hippocrates; and this spurious addition to the book on ptisan could not have been
written at that time for this reason, that the peplium is mentioned along with the
black hellebore. This is, moreover, confirmed by the resemblance this addition bears
to the first book De mulierum morbis, which is certainly pseudo-Hippocratic.  The
author of this book (probably the same person) expresses the same idea in the same
words: i7rrXiov bvaCiv elvat Icarapp~IcTLKOb.-Finally, the reproaches and vituperation addressed to other medical men, because they employed too few medicines, the
acrimonious partizanship for a particular sect, the abstruse ratiocinations concerning
the nature of things, the later dogmas respecting the artificial classification of diseases and their names, the scrupulous selection of some particular vein to be opened
in a certain disease,-all these things, which are vehemently discussed by the anonymous author of the afore-mentioned prologue and addition to the book on ptisan, are
nowhere to be found in the genuine writings of Hippocrates.
1 Perhaps Hippocrates himself had already begun to employ this plant (as seems to be
implied towards the end of his book De vulneribus capitis, t. xii, p. 128: rovrov Xprl
rTtv KcdroW KcoCXiv bTroKaOipati taptcibcy, ", rt XoXkv ayE), but if so it had not yet
received its distinctive appellation.




ON THE HELLEBORISM OF THE ANCIENTS.

691

phrastus with the addition of the word " pAhg " to distinguish it
from the original hellebore (veratrum album) which for so many
ages, until the discovery of this new plant, had been the only
evacuant medicine, and which therefore, as might be expected,
was known by the simple name only.'
153. But it remains to be enquired whether or not the black
hellebore of the ancients is the same as our helleborus niger. And
this is a question of no small difficulty to decide if we stick to
Sarrazin's text2 of Dioscorides, which is that commonly followed;
but if we bring to our aid the different readings of different manuscripts, and examine the thing critically, it appears from the text
thus restored that it is the same plant as our own; it would then
read thus: "EXe: i       a    A aAM XXh 0, 'rAcrTiv4 7rp0' O E0E, AhrOTTOve
S 3-%<c2 rovr i    -Taýce, xcet ECiavrTesC XCZi VOTXEl Ev H  o Xavg o A3CzUg,4
X"Aw ^ E\ x     vc, VSe  60v f (Pv6Ct, rr  TX "Se al  '0 ý0I6/,5 XCal 3v ar^ Ha XCe
HIix    S' oiJS'- ýP t a ' '  Me i A  rTCZ e 2i )A, (.Ed c1C4,  oboveii c n Tvog  X0a
pollvud0ou ~Triva, Sv xieV X   % o .cI.-- that is to say, "its leaves
are green, like those of the plane-tree, but less, more divided,
blacker, and slightly rough, the stalk short, the flowers white,
purpled, like a rose; the seed resembles that of the carthamus;the roots are small below, black, depending from a head like an
onion, and these are the parts used in medicine."
' See above ý 10-16.
2 Materia Med., lib. iv, cap. 151.
3 The words 7rpbc rad ro0 eaovvvMiov which exist in the ordinary text may be left
out; they are not to be found in some manuscripts.
4 Sarrazin's text has rpaXciV; but with Serapion (De Simpl.) we may read PpaXIc,
for the stalk of hellebore, if it have any, is very short, but not rough.
5  have restored the word 'ooEtsiij, which is to be found in some manuscripts in
place of porpvycj, which we find in Sarrazin's text, but which has no sense. In
this rendering, pojoiar, I am fully borne out by Avicenna's Arabic version of this
passage, (lib. ii,De medicamentis simpl.Art. CharbakAswad: j. A\  c.5  ".3
that is: " similar in its form to a rose." That the word 0porpvW6%, on the contrary,
was not to be found originally in the text, appears from this, that it does not exist in
a certain edition of the book, as the marginal notes of Sarrazin attest; that it got
into the text at a very early period (perhaps from some marginal correction which
was intended to supply the word io)&ouLij that had been almost effaced by the inju*y
of time) may be suspected from the same place in Avicenna, who immediately afterwards adds the version of this spurious word porpvwsy (which has no sense if it refer
to the flowers), and renders it " the fruit of the botry," following some copy of Dioscorides which he employed, and which without doubt had received from the margin
into the text, in place of the genuine Posouts, that unmeaning substitute porpv4arl.
2Y2




692

MEDICAL HISTORICAL DISSERTATION

154. With this restoration of the text it will be seen that
Dioscorides' description of the plant corresponds pretty strongly
to our helleborus niger. For our hellebore has also rosaceous
flowers with white petals, the external surface of which is covered
with red coloured spots, like little clouds, which grow purple as
the flowering advances. Bellon moreover asserts that he has found
on Mount Olympus the helleborus niger with reddish flowers.'
155. But Theophrastus- of Eresus, describes this plant2 still
better (according to Scaliger's and my own reading3), in these
words: To' p PEavov fJ? v nvvop v--(3pp Ov ~opCp,, QL ov    TVzltaTov,
IIIifo0 ESov  P    E11X6;,  oe C E{ l T  PTj XýPvov TIE H      ElYELO
<PiAov, Toxxvvpi6ov a' Ci tac TarT;       rTr g   a  Xpysa p.o-igow.  That
is to say: "the stalk is very short, the leaf rather large and
divided into broad lobes, attached to the root itself, and spread
upon the ground; the roots are numerous, small, and are the parts
made use of."   Scaliger, however, in place of   taTToIrov, proposes
to read TTrhtavoOr  ov, probably following Pliny;    but he has no
reason for doing so, for it is quite right as it stands, and is analogous to the Greek compounds rhixxrpT,         rThaTxacto, hr#aTthAAO,
&c., and the leaves of the black hellebore have in reality that
form.
156. Finally, that the plant of the ancients is indubitably the
same as our own is not less shewn by this, that Avicenna describes
the black hellebore of Dioscorides under the name of      _tm l       -
and that Forskal, an eye witness, testifies that in the East the
helleborus niger goes by the same name to this day.5
157. " It grows," says Dioscorides, "in rough, elevated and dry
places, and that which grows in those places is esteemed the best;
such is the case with the black hellebore of Anticyra,6 and it is the
' Petri Bellonii, Observat. sing. et memorab. rerum in Graecia, Asia, &c., per
Clusium, Antwerp, 1589.-8.
2 Hist. plant., lib. x, cap. 11.
3 See above, where I have criticised the text of Theophrastus, in reference to
veratrum album, 24-27.
4 "Platano similia " says Pliny, Hist. nat., lib. xxv, sect. 21.
6 See Mat. Med. Kahirina, in the Appendix to Descript. animalium in itinere
orientali, p. 152.
6 Such is the character of the country about Anticyra, as described by Pausanius
(Graeciae descr., Hanoviae, 1613, p. 682): rd & b5pq rad Onp 'AvriKvpav trfrpw'l rT7
tyav Earc, wai iv abro-i 0~6EraL t  tacra 6 XXi`opogo  6 p v ovv LaeXac Ea7 yaarpi
lraO0parov, &c. Among us it also grows "in places similar to those described by
Dioscorides and Pausanius.




ON THE HELLEBORISM OF THE ANCIENTS.

693

best." He also praises that which grew in Helicon, Parnassus, and
Aetolia, but prefers the Heliconian. Theophrastus likewise prefers
this to the others; he mentions that it grows also in Boeotia, in
Euboea, and in many other places.        Rufus1 also commends that
which grew in Lycestes, and above the Ascanian marsh.
158. According to Dioscorides, the preferable roots are those
which have swollen and fleshy fibres, a small medulla, and an acrid
burning taste.
159. The ancients believed that it purged by stool without
difficulty the black and the yellow bile, as also the pituita,2 and
that it was also useful in intermittent fevers.3      They gave it in
chronic and hemicranial headache, in mania,4 in melancholia,5 in
dropsy without fever,6 in epilepsy,7 in paralysis,8 in long standing
gout,9 in diseases of the joints,10 in inflammation of the liver," in
chronic jaundice,12 in old affections of the trachea.13     Aretaeus14
gave black hellebore in oxymel at the commencement of lethargy,
in order to cause moderate purging.
160. If they wished to purge strongly, they administered a
drachm   (=  72 gr.) of the root, if mildly, three oboli,15 (= thirty
six gr.) or four oboli (= forty-eight gr.) either in melicrat or in
decoction of lentils, or in broth. They mingled with it scammony
or salt.16 Others gave two drachms of the powder of the dry root
by itself, in sweet wine, or in oxymel, or in decoction of lentils, or
in ptisan,17 or in chicken broth, if they wished to purge gently;
I L   ibasius, 1. c., p. 249.
2 AGtius, lib. iii, cap. 27. Freind (Histoire de la medecine, ii, p. 167) is wrong in
saying that Johannes Actuarius was the first to allege that the hellebore (the black
one, for it is this that Actuarius is speaking of in the place referred to) acts without
difficulty; for none of the ancient physicians (if we except that insignificant Arabian
author, Avenzoar) considered it dangerous.
3 Aitius, 1. c.
4 Rufus, 1. c., p. 251--Atius, 1. c.
5 Dioscorides, lib. iv, cap. 151.-Celsus, lib. ii, cap. 12: "veratrum nigrum aut
atra bile vexatis, aut cum tristitia insanientibus, aut iis, quorum nervi parte aliqua
resoluti sunt."
6 Pliny, 1. c., lib. xxv. sect. 22.-Actuarius, Method. medend. lib. v, cap. 8.
7 Dioscor., 1. c.                  13 Paulus Aegineta, lib. vii, cap. 4.
8 Dioscor., 1. c.-Pliny, 1. c.    14 Curat. Acut., lib. i, cap. 2.
9 Pliny, 1. c.                    15 Dioscor. 1. c.
10 Dioscor. 1. c.-Pliny, 1. c.     16 Pliny, 1 c.
11 Corn. Celsus, 1. c., lib. iv, cap. 8.  17 Decoction of pearl-barley.
12 Aetius, 1. c.




694

MEDICAL HISTORICAL DISSERTATION, ETC.

but if they wished to cause a severe purgation, they gave one
drachm of the root mixed with three oboli of scammony.1
161. It was used externally in obscuration of the eyes;2 in difficulty of hearing it was introduced into the ears and kept there for
two or three days;3 it was applied to swellings on the neck;4 it entered into the composition of an ointment, with which parts affected
with scabies were covered;5 it was applied, mixed with vinegar, to
vitiligo, impetigo, and lepra;6 it was boiled with vinegar to make
a gargle for toothache;7 it was applied to the abdomen of dropsical
persons, made up with flour and wine,8 and finally it was used
externally for callous fistulous openings for two or three days.9
162. The seed, which is a more violent purgative than the root
(and went by the name of sesamoides),10 was given for the same
purposes, but in a smaller dose than two drachms, in melicrat."
163. The black hellebore, with which the ancient physicians
cured many chronic diseases, has also fallen into disuse in our
times (or other plants have been substituted for it), although it is
certain that it is an excellent and highly estimable medicine, if it
be exactly suitable and appropriate to the disease for which it is
administered.
* Rufus, 1. c, p. 251.           7 Dioscor., 1. c.-Pliny, 1. c.-Galen, De
2 Pliny, 1. c.                      Simpl. med.fac., lib. vi.
3 Dioscor., 1. c.                8 Dioscor., 1. c.
4 Pliny, 1. c.                   9 Dioscor., 1. c.-Galen, 1. c.
5 Dioscor., 1. c.               10 See above, note to ~ 116.
6 Dioscor., 1. c.               " Rufus, 1. c., p. 251.




ANALYSIS
OF THE ESSAY ON
THE HELLEBORISM OF THE ANCIENTS.
Introduction,  1.
Earliest medicinal employment of hellebore, 4 4.
From the description given by the ancients of the white hellebore, does it follow
that it is the same plant as our veratrum album? ~ 22.
The effects of both are not only similar, but absolutely identical, ý 34.
Parts of Greece where the best hellebore grew, ~ 45.
Signs of its good quality, ý 49.
Medicinal uses of veratrum album, 5 53.
Of the lesser treatment with veratrum album, without preparatory treatment of
the patient, ý 55.
Helleborism, 69.
When helleborism began to be practised, and how long its use was continued,
S72.
Of the seasons of the year, the diseases and the subjects to which the ancients
considered helleborism suitable or unsuitable, ~ 91.
Preparatory treatment for helleborism, ~ 99.
Mode of exhibiting the veratrum album for the purpose of inducing helleborism,
S104.
Substances that were mixed with the veratrum; sesamoides, ~ 112.
Regimen to be employed to assist the emetic action of the veratrum album,
119.
Remedies employed in cases where the vomiting did not take place properly,
125.
Treatment of the bad and serious symptoms occasioned by the action of veratrum,
S131.
Conclusion, ~ 144.
Of the black hellebore, ~ 149.




SPIRIT OF THE HOM(EOPATHIC DOCTRINE OF
MEDICINE.'
It is impossible to divine the internal essential nature of diseases
and the changes they effect in the hidden parts of the body, and
it is absurd to frame a system of treatment on such hypothetical
surmises and assumptions: it is impossible to divine the medicinal
properties of remedies from any chemical theories or from their
smell, colour or taste, and it is absurd to attempt, from such
hypothetical surmises and assumptions, to apply to the treatment of
diseases these substances, which are so hurtful when wrongly administered. And even were such practice ever so customary and ever so
generally in use, were it even the only one in vogue for thousands
of years, it would nevertheless continue to be a senseless and pernicious practice to found on empty surmises an idea of the morbid
condition of the interior, and to attempt to combat this with
equally imaginary properties of medicines.
Appreciable, distinctly appreciable to our senses must that be,
which is to be removed in each disease in order to transform it
into health, and right clearly must each remedy express what it
can positively cure, if medical art shall cease to be a wanton
game of hazard with human life, and shall commence to be the
sure deliverer from diseases.
I shall show what there is undeniably curable in diseases, and
how the curative properties of medicines are to be distinctly perceived and applied to treatment.
What life is can only be known empirically from its phenomena
and manifestations, but no conception of it can be formed by any
1 This essay appeared in a journal twenty years ago, in those momentous days
(March 1813) when the Germans had no leisure to read and still less to reflect upon
scientific matters. The consequence of this was that these words were not listened
to. It may now have more chance of being perused, particularly in its present less
imperfect form. (Reine Arzneimittellehre, 2ter. Thl. 1833.)




SPIRIT OF THE HOM(EOPATHIC DOCTRINE OF MEDICINE.       697
metaphysical speculations a priori; what life is, in its actual essential nature, can never be ascertained nor even guessed at, by
mortals.
To the explanation of human life, as also its two-fold conditions,
health and disease, the principles by which we explain other
phenomena are quite inapplicable. With nought in the world
can we compare it save with itself alone; neither with a piece of
clockwork nor with an hydraulic machine, nor with chemical processes, nor with decompositions and recompositions of gases, nor yet
with a galvanic battery, in short with nothing destitute of life.
Human life is in no respect regulated by purely physical laws,
which only obtain among inorganic substances.       The material
substances of which the human organism is composed no longer
follow, in this vital combination, the laws to which material substances in the inanimate condition are subject; they are regulated
by the laws peculiar to vitality alone, they are themselves animated just as the whole system is animated. Here a nameless
fundamental power reigns omnipotent, which suspends all the
tendency of the component parts of the body to obey the laws
of gravitation, of momentum, of the vis inertie, of fermentation, of putrefaction, &c., and brings them under the wonderful
laws of life alone,--in other words, maintains them in the condition of sensibility and activity necessary to the preservation of the
living whole, a condition almost spiritually dynamic.
Now as the condition of the organism and its healthy state
depend solely on the state of the life which animates it, in like
manner it follows that the altered state, which we term disease,
consists in a condition altered originally only in its vital sensibilities and functions, irrespective of all chemical or mechanical principles; in short it must consist in an altered dynamical condition,
a changed mode of being, whereby a change in the properties of
the material component parts of the body is afterwards effected,
which is a necessary consequence of the morbidly altered condition
of the living whole in every individual case.
Moreover the influence of morbific injurious agencies, which for
the most part excite from without the various maladies in us, is
generally so invisible and so immaterial,1 that it is impossible that
' With the exception of a few surgical affections and the disagreeable effects




698

SPIRIT OF THE

it can immediately either mechanically disturb or derange the
component parts of our body in their arrangement and substance,
or infuse any pernicious acrid fluid into our bloodvessels whereby
the mass of our humours can be chemically altered and destroyedan inadmissible, improbable, gross invention of mechanical minds.
The exciting causes of disease rather act by means of their special
properties on the state of our life (on our health), only in a
dynamic manner, very similar to a spiritual manner, and inasmuch
as they first derange the organs of the higher rank and of the
vital force, there occurs from this state of derangement, from this
dynamic alteration of the living whole, an altered sensation (uneasiness, pains) and an altered activity (abnormal functions) of each individual organ and of all of them collectively,whereby there must also
of necessity secondarily occur alteration of the juices in our vessels
and secretion of abnormal matters, the inevitable consequence of
the altered vital character, which now differs from the healthy state.
These abnormal matters that shew themselves in diseases are
consequently merely products of the disease itself, which, as long
as the malady retains its present character, must of necessity be
secreted, and thus constitute a portion of the morbid signs (symptoms); they are merely effects, and therefore manifestations of
the existing internal ill-health, and they do certainly not react
(although they often contain the infecting principle for other,
healthy individuals) upon the diseased body that produced them,
as disease-exciting or maintaining substances, that is, as material
morbific causes,1 just as a person cannot infect other parts of his
own body at the same time with the virus from his own chancre
or with the gonorrhoeal matter from his own urethra, or increase
his disease therewith, or as a viper cannot inflict on itself a fatal
bite with its own poison.2
produced by indigestible foreign substances, which sometimes find their way into
the intestinal canal.
1 Hence by clearing away and mehanically removing these abnormal matters,
acridities and morbid organisations, their source, the disease itself, can just as little
be cured as a coryza can be shortened or cured by blowing the nose frequently, as
frequently as possible; it lasts not a day longer than its proper course, although the
nose should not be cleansed by blowing it at all.
2 [These statements are not strictly correct, at least as regards the chancrous and
gonorrhceal matters, for it is well known that chancres may be produced on different
parts of the body of an individual by inoculation from his own chancre, and the




HOM(EOPATHIC DOCTRINE OF MEDICINE.

699

Hence it is obvious that diseases excited by the dynamic and
special influence of morbific injurious agents can be originally only
dynamical (caused almost solely by a spiritual process) derangements of the vital character of our organism.
We readily perceive that these dynamic derangements of the
vital character of our organism which we term diseases, since they
are nothing else than altered sensations and functions, can also
express themselves by nothing but by an aggregate of symptoms,
and only as such are they cognisable to our observing powers.
Now as in a profession of such importance to human life as
medicine is, nothing but the state of the diseased body plainly
cognisable by our perceptive faculties can be recognised as the
object to be cured, and ought to guide our steps (to choose conjectures and undemonstrable hypotheses as our guide would be
dangerous folly, nay crime and treason against humanity), it
follows, that since diseases, as dynamic derangements of the vital
character, express themselves solely by alterations of the sensations and functions of our organism, that is, solely by an aggregate of cognisable symptoms, this alone can be the object of
treatment in every case of disease. For on the removal of all
morbid symptoms nothing remains but health.
Now because diseases are only dynamic derangements of our
health and vital character, they cannot be removed by man otherwise than by means of agents and powers which also are capable
of producing dynamical derangements of the human health, that
is to say, diseases are cured virtually and dynamically by medicines.1
gonorrhceal process may be excited in the eye by the incautious application of the
discharge to that organ by the patient himself.]
1 Not by means of the pretended solvent or mechanically dispersing, clearing-out,
and expulsive powers of medicinal substances, not by means of a (blood-purifying,
humour-correcting) power they possess of electively excreting fancied morbific principles, not by means of any antiseptic power they contain (as is effected in dead,
putrifying flesh), not by any chemical or physical action of any other imaginable
sort, as happens in dead material things, as has hitherto been falsely imagined and
dreamt by the various medical schools.
The more modern schools have indeed begun in some degree to regard diseases as
dynamic derangements, and also intended in a certain manner to remove them
dynamically by medicines, but inasmuch as they have failed to perceive that the sensible, irritable and reproductive activity of life is in mode et qualitate susceptible of




700

SPIRIT OF THE

These active substances and powers (medicines) which we have
at our service effect the cure of diseases by means of the same
dynamic power of altering the actual state of health, by means
of the same power of deranging the vital character of our
organism in respect of its sensations and functions, by which they
are able to affect also the healthy individual, to produce in him
dynamic changes and certain morbid symptoms, the knowledge of
which, as we shall see, affords us the most trustworthy information concerning the morbid states that can be most certainly
cured by each particular medicine. Hence nothing in the world
can accomplish a cure, no substance, no power effect a change in
the human organism of such a character as that the disease shall
yield to it, except an agent capable of absolutely (dynamically)
deranging the human health, consequently also of morbidly altering its healthy state.'
On the other hand, however, there is also no agent, no power
in nature capable of morbidly affecting the healthy individual,
which does not at the same time possess the faculty of curing
certain morbid states.
Now, as the power of curing diseases, as also of morbidly affecting the healthy, is met with in inseparable combination in all
medicines, and as both these properties evidently spring from one
and the same source, namely from their power of dynamically
deranging human health, and as it is hence impossible that they can
act according to a different inherent natural law in the sick to that
according to which they act on the healthy, it follows that it must
be the same power of the medicine that cures the disease in the
sick as gives rise to the morbid symptoms in the healthy.2
Hence also we shall find that the curative potency of medicines,
an infinity of changes, and to regard the innumerable varieties of morbid signs (that
(infinity of internal alterations only cognisable by us in their reflex) for what they
actually are, the only undeceptive object for treatment, but as they only hypothetically
recognise an abnormal increase and decrease of their dimensions quoad quantitatem,
and in an equally arbitrary manner confide to the medicines they employ the task of
changing to the normal state this one-sided increase and decrease, and thereby
curing them; they thus have before their view nothing but chimeras, both of the
object to be cured and of the action of the medicine.
I Consequently no substance, for example, that is purely nutritious.
2 The different result in these two cases is owing solely to the difference of the
object that has to be altered.




HOM(EOPATIIIC DOCTRINE OF MEDICINE.

701

and that which each of them is able to effect in diseases, expresses
itself in no other mode in the world so surely and palpably, and
cannot be ascertained by us by any purer and more perfect
manner than by the morbid phenomena and symptoms (the kinds
of artificial diseases) which the medicines develop in healthy individuals. For if we only have before us a register of the peculiar
(artificial) morbid symptoms produced by the various medicines
on healthy individuals, we only require a series of pure experiments to decide what medicinal symptoms will always rapidly and
permanently cure and remove certain symptoms of disease, in
order to know, in every case beforehand, which of all the different
medicines known and thoroughly tested as to their peculiar symptoms must be the most certain remedy in every case of disease.'
I Simple, true and natural as this maxim is, so much so that one would have
imagined it would long since have been adopted as the rule for ascertaining the curative
powers of drugs, it is yet a fact that it has hitherto been far from being recognised.
During the many thousands of years over which history extends, no one fell upon
this natural method of ascertaining the curative powers of medicines a priori and before
their application to diseases. In all ages up to the present times it was imagined
that the curative powers of medicines could be learned in no other way than from
the result of their employment in diseases themselves (ab usu in morbis); it was
sought to learn them from those cases where a certain medicine (more frequently a
combination of various medicines) had been found serviceable in a particular case of
disease. But even from the efficacious result of one single medicine given in an
accurately described case of disease (which was rarely done), we never can know
the case in which that medicine would again prove serviceable, because (with the
exception of diseases caused by miasms of a fixed character, as small-pox, measles,
syphilis, itch, &c., and those arising from various injurious agencies that always
remain the same, as rheumatic gout, &c.), all other cases of disease are mere individualities, that is to say, all present themselves in nature with different combinations
of symptoms, have never before occurred, and can never again occur in exactly the
same manner; consequently a remedy in one case can never allow us to infer its
efficacy in another (different) case. The forced arrangement of these cases of
disease (which nature in her wisdom produces in endless variety) under certain
nosological heads, as is arbitrarily done by pathology, is a human performance
without reality, which leads to constant fallacies and to the confounding together of
very different states.
Equally deceptive and untrustworthy, although in all ages generally introduced,
is the determination of the general (curative) actions of medicines from special
effects in diseases, where in the materia medica-when, for example, here and there,
in some cases of disease during the use of a medicine (generally mixed up with
others) there occurred a more copious secretion of urine, perspiration, the irruption
of the catamenia, cessation of convulsions, a kind of sleep, expectoration, &c.-the
medicine (on which was conferred the honour of having ascribed to it more than to the




702

SPIRIT OF THE

If then we ask experience what artificial diseases (observed to
be produced by medicines) can be beneficially employed against
certain natural morbid states; if we ask it whether the change to
health (cure) may be expected to ensue most certainly and in the
most permanent manner:
1. by the use of such medicines as are capable of producing
in the healthy body a different (allopathic) affection from that
exhibited by the disease to be cured,
2. or by the employment of such as are capable of exciting in
the healthy individual an opposite (enantiopathic, antipathic) state
to that of the case to be cured,
3. or by the administration of such medicines as can cause a
similar (homoeopathic) state to the natural disease before us (for
these are the only three possible modes of employing them), experience speaks indubitably for the last method.
But it is moreover self-evident that medicines which act heterogeneously and allopathically, which tend to develop in the healthy
subject different symptoms from those presented by the disease to
be cured, from the very nature of things can never be suitable and
efficacious in this case, but they must act awry, otherwise every
disease must necessarily be cured in a rapid, certain and permanent manner by any medicine whatsoever, be its action ever so
different. Now as every medicine possesses an action different
from that of every other, and as, according to eternal natural laws,
every disease causes a derangement of the human health different
from that caused by all other diseases, this proposition contains a
': others in themixture the effect produced) was instantly elevated to the rank of a diuretic,'a diaphoretic, an emmenagogue, an antispasmodic, a soporific, an expectorant,
and thereby not only was a fallacium cause committed by confounding the word during
with by, but quite a false conclusion was drawn aparticulari ad universale, in opposition
to all the laws of reason, and indeed the conditional was made unconditional. For a
substance that does not in every case of disease promote urine and perspiration, that
does not in every instance bring on the catamenia and sleep, that does not subdue
all convulsions, and cause every cough to come to expectoration, cannot be said by
a person of sound reason to be unconditionally and absolutely diuretic, diaphoretic, emmenagogue, soporific, antispasmodic, and expectorant! Indeed it is impossible
that in the complex phenomena of our health, in the multifarious combinations of
different symptoms presented by the innumerable varieties of human diseases, the
employment of a remedy can exhibit its pure, original medicinal effect, and exactly
those derangements of our health that we might expect from it. These can only be
shewn by medicines given to persons in health.




HOM(EOPATHIC DOCTRINE OF MEDICINE.

703

self-evident contradiction (contradictio in adjecto), and is selfdemonstrative of the impossibility of a good result, since every
given change can only be effected by an adequate cause, but not
per quamlibet causam. And daily experience also proves that the
ordinary practice of prescribing complex recipes containing a
variety of unknown medicines in diseases, does indeed do many
things, but very rarely cures.
The second mode of treating diseases by medicines is the employment of an agent capable of altering the existing derangement of
the health (the disease, or most prominent morbid symptom) in
an enantiopathic, antipathic, or contrary manner (a medicine employed palliatively). Such an employment, as will be readily seen,
cannot effect a permanent cure of the disease, because the malady
must soon afterwards recur, and that in an aggravated degree.
The process that takes place is as follows: According to a wonderful provision of nature, organized living beings are not regulated
by the laws of unorganized (dead) physical matter, they do not
receive the influence of external agents, like the latter, in a passive
manner, but strive to oppose a contrary action to them.' The
living human body does indeed allow itself to be in the first
instance changed by the action of physical agents; but this change
SThe expressed, green juice of plants, which is in that state no longer living,
when spread upon rinen cloth and exposed to the sun's light, soon loses its colour
and becomes completely decomposed, whereas the living plant that has been kept in
a cellar deprived of light and thereby blenched, soon recovers its full green
colour when exposed to the same sun's light. A root dug up and dried (dead), if
buried in a warm and damp soil, rapidly undergoes complete decomposition and
destruction, whilst a living root in the same warm damp soil sends forth gay sprouts.
-Foaming malt-beer in full fermentation rapidly turns to vinegar when exposed to
a temperature of 960 Fahr. in a vessel, but in the healthy human stomach at the
same temperature the fermentation ceases, and it soon becomes converted into a mild
nutritious juice.-Half-decomposed and strong-smelling game, as also beef and other
flesh meat, partaken of by a healthy individual, furnish excrement with the least
amount of odour; whereas cinchona-bark, which is calculated powerfully to check
decomposition in lifeless animal substances, is acted against by the intestines in such
a manner that the most fetid flatus is developed.-Mild carbonate of lime removes
all acids from inorganic matter, but when taken into the healthy stomach sour
perspiration usually ensues.-Whilst the dead animal fibre is preserved by nothing
more certainly and powerfully than by tannin, clean ulcers in a living individual,
when they are frequently dressed with tannin, become unclean, green and putrid. A
hand plunged into warm water becomes subsequently colder than the hand that has
not been so treated, and it becomes colder in proportion as the water was hotter.




701

SPIRIT OF THE

is not in it as in inorganic substances, permanent (-as it ought
necessarily to be if the medicinal agent acting in a contrary manner to the disease should have a permanent effect, and be of durable
benefit-): on the contrary, the living human organism strives to
develop by antagonism,' the exact opposite of the affection first
produced in it from without,-as for instance, a hand kept long
enough in ice-cold water, after being withdrawn does not remain
cold, nor merely assume the temperature of the surrounding
atmosphere, as a stone (dead) ball would do, or even resume the
temperature of the rest of the body, no! the colder the water of the
bath was, and the longer it acted on the healthy skin of the hand,
the more inflamed and hotter does the latter afterwards become.
Therefore it cannot but happen that a medicine having an action
opposite to the symptoms of the disease, will reverse the morbid
symptoms for but a very short time,2 but must soon give place to
the antagonism pervading the living body, which produces an
opposite state, that is to say, a state the direct contrary of that
transient delusive state of the health effected by the palliative (one
corresponding to the original malady), which constitutes an actual
addition to the now recurring, uneradicated, primary affection,
and is consequently an increased degree of the original disease.
And thus the malady is always certainly aggravated after the
palliative-the medicine that acts in an opposite and enantiopathic
manner-has exhausted its action.3
SThis is the law of nature, in obedience to which, the employment of every
medicine produces at first certain dynamic changes and morbid symptoms in the
living human body (primary or first action of the medicines), but on the other hand,
by means of a peculiar antagonism (which may in many instances be termed
the self-sustaining effort), produces a state the very opposite of the first (the secondary or after action), as for instance, in the case of narcotic substances, insensibility
is produced in the primary action, sensitiveness to pain in the secondary.
2 As a burnt hand remains cold and painless not much longer than whilst it
remains in the cold water, but afterwards feels the pain of the burn much more
severely.
3 Thus the pain of a burnt hand is subdued by cold water quickly, it is true, but
only for a few minutes, afterwards however, the pain of the burn and the inflammation become worse than they were previously (the inflammation or secondary action of
the cold water makes an addition to the original inflammation of the burn, which is
not to be eradicated by cold water). The troublesome fulness of the abdomen in cases
of habitual constipation, appears to be removed, as if magically, by the action of a
purgative, but the very next day the painful fulness returns together with the




IIOM(EOPATHIC DOCTRINE OF MEDICINE.

705

In chronic diseases,-the true touch-stone of a genuine healing
art,-the injurious character of the antagonistically-acting (palliative) remedy often displays itself in a high degree, since from its
repeated exhibition in order that it should merely produce its
delusive effect (a very transient semblance of health) it must be
administered in larger and ever larger doses, which are often productive of serious danger to life, or even of actual death.'
There remains therefore, only a third mode of employing
medicines in order to effect a really beneficial result, to wit, by
employing in every case such an one as tends to excite of itself an
artificial, morbid affection in the organism similar (homoeopathic),
best if very similar, to the actual case of disease.
That this mode of employing medicines is and must of necessity
be the only best method, can easily be proved by reasoning, as it
has also already been confirmed both by innumerable experiences
of physicians who practise according to my doctrines, and by
ordinary experience.2
It will, therefore, not be difficult to perceive what are the laws
of nature according to which the only appropriate cure of diseases,
the homceopathic, takes place, and must necessarily take place.
The first of these unmistakeable laws of nature is: the living
organism is incomparably less capable of being affected by natural
diseases, than by medicines.
A multitude of disease-exciting causes act daily and hourly upon
us, but they are incapable of deranging the equilibrium        of the
health, or of making the healthy sick; the activity of the lifesustaining power within us usually withstands the most of them,
constipation, and becomes worse afterwards than before. The stupified sleep caused
by opium is succeeded by a more sleepless night than ever.-But that the state that
subsequently occurs is a true aggravation, is rendered evident by this, that if we
design again to employ the palliative (e. g. opium for habitual sleeplessness or chronic
looseness of the bowels), it must be given in a stronger. dose, as if for a more severe
disease, in order that it should produce its delusive amelioration for even as short a
period as before.
I As for instance, where opium is repeated in always stronger doses for the suppression of urgent symptoms of a chronic disease.
2 I may adduce merely a few examples from daily experience; thus, the burning
pain produced by the contact of boiling water on the skin, is overpowered and
destroyed, as in the case of cooks by approaching the moderately burnt hand to the
fire, or by bathing it uninterruptedly with heated alcohol (or turpentine), which causes a
2z




706

SPIRIT OF THE

the individual remains healthy. It is only when these external
inimical agencies assail us in a very aggravated degree, and we are
especially exposed to their influence, that we get ill, but even then
we only become seriously ill when our organism has a particularly
affectable, weak side (predisposition), that makes it more disposed to
be affected by the (simple or compound) morbific cause in question, and to be deranged in its health.
If the inimical agents in nature that are partly physical and
partly psychical, which are termed morbific injurious agents, possessed an unconditional power of deranging the human health,
they would, as they are universally distributed, not leave any one
in good health; every one would become ill, and we should never
still more intense burning sensation. This infallible mode of treatment is practised
and found to be corroborated by varnishers and others engaged in similar occupations. The burning pain produced by these strong spirits and their elevated temperature, then remains alone present, and that for but a few minutes, whilst the
organism, hommeopathically freed by them from the inflammation occasioned by the
burn, soon restores the injury of the skin and forms a new epidermis through which
the spirit can no longer penetrate. And thus, in the course of a few hours, the
injury caused by the burn is cured by a remedy that occasions a similar burning
pain (heated alcohol or turpentine), whereas if treated with the ordinary cooling palliative remedies and salves, it is transformed into a bad ulcer and usually continues to
suppurate for many weeks or months with great pain. Practised dancers know from
old experience that those who are extremely heated by dancing are very much
relieved for the first moment by stripping themselves and drinking very cold water,
but thereafter infallibly incur a fatal disease, and they do not allow persons excessively heated to cool themselves by exposure to the open air or by taking off their
clothes, but wisely administer a liquor whose nature is to heat the blood, such as
punch or hot tea mixed with rum or arrack, and in this manner, walking at the same
time gently up and down the room, they rapidly lose the violent febrile state induced
by the dance. In like manner no old experienced reaper, after inordinate exertion
in the heat of the sun, would drink anything in order to cool himself but a glass of
brandy; and before an hour has elapsed, his thirst and heat are gone and he feels quite
well. No experienced person would put a frost-bitten limb into warm water, or seek
to restore it by approaching it to the fire or a heated stove; applying to it snow, or
rubbing it with ice-cold water, is the well-known homoeopathic remedy for it. The
illness occasioned by excessive joy (fantastic gaiety, trembling restlessness and uneasiness, palpitation of the heart, sleeplessness) is rapidly and permanently removed
by coffee, which causes a similar morbid affection in persons unaccustomed to its use.
And in like manner there are many daily-occurring confirmations of the great truth,
that nature intends that men should be cured of their long-standing diseases by
means of similar affections of short duration. Nations, for centuries sunk in listless
apathy and serfdom, raised their spirit, felt their dignity as men, and again became
free, after having been ignominiously trodden in the dust by the western tyrant.




IOMQEOPATHIC DOCTRINE OF MEDICINE.

707

be able to obtain an idea of health. But as, taken on the whole,
diseases are only exceptional states of the human health, and it
is necessary that such a number of circumstances and conditions,
both as regards the morbific agents and the individual to be
affected with disease, should conjoin before a disease is produced
by its exciting causes, it follows, that the individual is so little liable
to be affected by such injurious agencies, that they can never unconditionally make him ill, and that the human organism is capable of
being deranged to disease by them only by means of a particular
predisposition.
But it is far otherwise with the artificial dynamic agents which
we term medicines. Every true medicine, namely, acts at all times,
under all circumstances, on every living, animated body, and excites in it the symptoms peculiar to it (even in a perceptible form if
the dose be large enough) so that evidently every living human
organism  must always and inevitably be affected by the medicinal
disease and infected so to speak, which, as is well known, is not
the case with respect to medicines.'
All experience proves incontestably, that the human body is
much more apt and disposed to be affected by medicinal agents
and to have its health deranged by them, than by the morbific
injurious agencies and contagious miasms, or, what is the same
thing, that the medicinal powers possess an absolute power of
deranging human health, whereas the morbific agencies possess
only a very conditional power, vastly inferior to the former.
To this circumstance is owing the possibility of the cure of
diseases by medicines generally (that is to say, we see, that in the
diseased organism the morbid affection may be effaced, if it be
subjected to the appropriate alteration by means of medicine);
but in order that the cure should take place, the second natural
law should also be fulfilled, to wit, a stronger dynamic affection
permanently extinguishes the weaker in the living organism, provided the former be similar in kind to the latter; for the dynamic
alteration of the health to be anticipated from the medicine should,
1 Even the pestilential diseases do not affect every one unconditionally, and the other
diseases leave many more individuals unaffected, even when all are exposed to
changes of the weather, of the seasons, and to the influences of many other injurious
impressions.
2z2




708

SPIRIT OF THE

as I think I have proved, neither differ in kind from or be
allopathic to the morbid derangement, in order that, as happens in
the ordinary mode of practice, a still greater derangement may
not ensue, nor should it be opposite to it, in order that a merely
palliative delusive amelioration may not ensue, to be followed by
an inevitable aggravation of the original malady, but the medicine
must have been proved by observations to possess the tendency to
develop of itself a state of health similar to the disease (be able to
excite similar symptoms in the healthy body), in order to be a
remedy of permanent efficacy.
Now, as the dynamic affections of the organism (caused by
disease or by medicine) are only cognisable by the phenomena of
altered function and altered sensation, and consequently the similarity of its dynamic affections to one another can only express
themselves by similarity of symptoms; but as the organism (as
being much more liable to be deranged by medicine than by
disease) must be more susceptible to the medicinal affection, that
is to say, must be more disposed to allow itself to be influenced
and deranged by medicine than by the similar morbid affection, it
follows undeniably, that it will be freed from the morbid affection
if we allow a medicine to act on it, which, while differing 1 in its
nature from the disease, resembles it very closely in similarity of
symptoms, that is to say, is homoeopathic; for the organism, as a
living, individual unity, cannot receive two     similar dynamic
affections at the same time, without the weaker yielding to the
stronger similar one, consequently, as it is more disposed to be more
strongly affected by the one (the medicinal affection), the other,
similar, weaker one (the morbid affection) must necessarily give
way, whereupon it is cured.
Let it not be imagined that the living organism, if a new similar
affection be communicated to it when diseased by a dose of homceopathic medicine, will be thereby more seriously deranged, that is,
burdened with an addition to its sufferings, just as a leaden plate
already pressed upon by an iron weight is still more severely
1 Without this difference in the nature of the morbid affection from that of the
medicinal affection, a cure were impossible; if the two were not merely of a similar,
but of the same nature, consequently identical, then no result (or only an aggravation of the malady) would ensue; as for example, if we were to touch a chancre with
other chancrous poison, a cure would never result therefrom.




HOM(EOPATHIC DOCTRINE OF MEDICINE.

709

bruised by placing a stone in addition upon it, or a piece of copper
heated by friction must become still hotter by pouring on it water
at a more elevated temperature. No, our living organism does not
behave passively, it is not regulated by the laws that govern dead
matter; it reacts by vital antagonism, so as to surrender itself as
an individual living whole to its morbid derangement, and to
allow that to be extinguished within it, when a stronger affection
of a similar kind, produced in it by homoeopathic medicine, takes
possession of it.
Such a spiritually reacting being is our living, human organism,
which with automatic power expels from itself a weaker derangement (disease), whenever the stronger power of the homoeopathic
medicine produces in it another but very similar affection, or in
other words, which, on account of the unity of its life, cannot suffer
at the same time from two similar general derangements, but must
discard the primary dynamic affection (disease), whenever it is
acted on by a second dynamic power (medicine) more capable of
deranging it, that has a great resemblance to the former in its
power of affecting the health (its symptoms).       Something similar
takes place in the human mind.'
But as the human organism even in health is more capable of
being affected by medicine than by disease, as I have shewn above,
1 For example: a girl plunged into grief by the death of her companion, if taken
to see a family where the poor, half-naked children have just lost their father, their
sole support, does not become more sorrowful from witnessing this touching scene,
but is thereby consoled for her own smaller misfortune; she is cured of her grief for
her friend, because the unity of her mind cannot be affected by two similar passions
at once, and the one passion must be extinguished when a similar but stronger
passion takes possession of her mind, and acts as a homceopathic remedy in extinguishing the first. But the girl would not be tranquillized and cured of her grief for
the loss of her companion, if her mother were angrily to scold her (heterogeneous,
allopathic agency), but on the contrary, her mind would be still more distressed by
this attack of grief of another kind; and in like manner the sorrowing girl, if we
were to cause an apparent but only palliative alleviation of her grief, by means of a
gay entertainment, would subsequently in her solitude sink into still more profound
sadness, and would weep much more intensely than previously for the death of her
friend (because this affection would here be only of an opposite, enantiopathic
character).
And as it is here in psychical life, so is it in the former case in organic life. The
unity of our life cannot occupy itself with, and take in two general dynamic affections
of the same kind at once; for if the second be a similar one, the first is displaced by
it, whenever the organism is more affected by the last.




710

SPIRIT OF THE

so when it is diseased, it is beyond comparison more affectable by
homoeopathic medicine than by any other (whether allopathic or
enantiopathic), and indeed it is affectable in the highest degree,
since, as it is already disposed and excited by the disease to certain
symptoms, it must now be more liable to be deranged to similar
symptoms (by the homceopathic medicine)-just as similar mental
affections render the mind much more sensitive to similar emotions-; hence only the smallest dose of them is necessary and
useful for their cure, for altering the diseased organism into the
similar medicinal disease, and a greater one is not necessary on this
account also, because the spiritual power of the medicine does not
in this instance accomplish its object by means of quantity, but
by potentiality and quality (dynamic fitness, homceopathy),-and
it is not useful that it should be greater, but on the contrary injurious, because whilst the larger dose, on the one hand, does not
dynamically overpower the morbid affection more certainly than
the smallest dose of the most appropriate medicine, on the other
hand it imposes a complex medicinal disease in its place, which is
always a malady, though it runs its course in a shorter time.
Hence the organism will be powerfully affected and possessed by
the potency of even a very small dose of a medicinal substance,
which, by its tendency to excite similar symptoms, can outweigh
and extinguish the totality of the symptoms of the disease; it
becomes, as I have said, free from the morbid affection at the very
instant that it is taken possession of by the medicinal affection, by
which it is immeasurably more liable to be altered.
Now as medicinal agents do of themselves, even in larger doses,
only keep the healthy organism for a few days under their influence, it will readily be conceived that a small dose, and in acute
diseases a very small dose of them (such as they must evidently be
in homoeopathic treatment), can only affect the system for a short
time, the smallest doses however, in acute diseases, only for a
few hours, for then the medicinal affection substituted for the
disease passes unobservedly and very rapidly into pure health.
The nature of living organisms seems not to act otherwise in the
permanent cure of diseases by means of medicines than in accordance with these, its manifest laws, and thus indeed it acts, if we
may use the expression, according to mathematical laws. There is
no case of dynamic disease in the world (excepting the death




HOMIEOPATHIIC DOCTRINE OF MEDICINE.                  711
struggle, and when it comes under this category, extreme old age
and the destruction of some indispensable viscus or member),
whose symptoms can be met with in great similarity among the
positive effects of a medicine, which will not be rapidly and permanently cured by this medicine. The diseased individual can be freed
from his malady in no more easy, rapid, certain, reliable and
permanent manner, by any conceivable mode of treatment,1 than
by means of the homoeopathic medicine in a small dose.
1 Even those striking cures occurring in rare instances in ordinary practice take
place only by means of a homceopathically appropriate medicine, which forms the
chief agent in the receipt, into which it may have been accidentally introduced. Physicians hitherto could not have chosen the medicines homoeopathically for diseases, as
the positive effects of the medicines (those resulting from their administration to
healthy persons) have not been investigated by them, and accordingly remain
unknown to them; and even those which have been known otherwise than by my
writings, were not regarded by them as serviceable for treatment,-and moreover,
the relation of the effects of medicines to the symptomnis of the disease they resemble
(the homceopathic law of cure), which is requisite in order to effect radical cures,
was unknown to them.




TREATMENT OF THE TYPHUS OR HOSPITAL FEVER
AT PRESENT PREVAILING.
As all ordinary modes of treatment with emetics, blood-letting,
acetate of ammonia, elder-flower tea, juniper juice, cold and
warm baths, naphtha, musk, opium, camphor and cinchona-bark did
so much havoc in this disease, and the somewhat more appropriate
remedies, chamomile, serpentaria, valerian, and muriatic acid were
but indifferent comforters, moved by purely philanthropic motives,
I here propose an efficacious mode of treatment, in order to preserve perhaps from death by this pestilence the remaining victims,
if ordinary prejudices do not prevent its employment.
This fever has two principal stages. In the first period (which
is all the shorter the worse the disease is to be) there are present, full, increased sensation of the pains usually present, with
intolerable bad humour, sensation of heat in the body, and especially in the head, dry feeling or actual dryness in the mouth
causing constant thirst, bruised feeling in the limbs, restlessness,
&c.; but in the second period, that of the delirium (a metastasis of
the whole disease upon the mental organs) no complaint is made
of all those symptoms-the patient is hot, does not desire to drink,
he knows not whether to take this or that, he does not know those
about him, or he abuses them, he makes irrelevant answers, talks
nonsense with his eyes open, does foolish things, wishes to run
away, cries aloud or whines, without being able to say why he
does so, has a rattling in the throat, the countenance is distorted,
the eyes squinting, he plays with his hands, behaves like a madman, passes the excrements unconsciously, &c.
In the first period of the pains and consciousness, two vegetable
substances are of use and generally quite remove the disease at its
commencement-the bryonia alba and the rhus toxicodendron.
1 From the Allgem. Anzeig. der Deutschen, No. 6. 1814.




TREATMENT OF THE TYPHUS, ETC.

713

We take a drachm of the powdered root of bryonia, shake it up
with ten drachms of alcohol and allow it to stand for six hours so
as to extract all its medicinal power. In the meantime we pour six
drachms of the strongest pure alcohol into each of twelve bottles,
which should be of such a size that this quantity does not fill them
completely, and then we number them. Into the first of these
bottles, marked No. 1, we drop a single drop of the tincture
prepared as above, and shake it strongly for three minutes; then
from this bottle No. 1, we drop a single drop into bottle No. 2,
and shake it strongly for the same length of time; then again,
from this we drop a single drop into bottle No. 3, and thus we go
on until each bottle has received a drop from the preceding one, so
that bottle No. 12, is impregnated with a drop from No. 11, and
thereafter, like all the preceding ones, is strongly shaken for three
minutes.
It is this last bottle, No. 12, which contains the bryonia tincture
in the suitable dilution, and which may be successfully employed
in the first stage of the disease.
If, for instance, the patient complains of dizziness, shooting (or
jerking-tearing) pains in the head, throat, chest, abdomen, &c.,
which are felt particularly on moving the part -in addition to the
other symptoms, the hemorrhages, the vomiting, the heat, the
thirst, the nocturnal restlessness, &c., we give him on a piece
of sugar a single drop from bottle No. 12, in the morning, in
preference to any other time, for the fever tends to increase towards night. Improvement takes place in the course of four and
twenty hours, and as long as the improvement goes on, we give
him no other medicine, nor even repeat the same one; for none of
the medicines here recommended can be used oftener than once (in
the dose of a drop)-seldom can they be given a second time with
advantage.
In this interval, until it is time for giving the second medicine,
we may, in order to satisfy the desire of the patient for medicine
and to quiet his mind, give him something innocuous, e. g. a few
tea-spoonfuls of raspberry juice in the course of the day, or a few
powders of milk-sugar.
If, now, the amendment produced by the single dose of bryonia
goes off in the course of two, three, or four days, that is to say, if
the patient then complains of shooting pains in one or other part of




714

TREATMENT OF THE TYPHUS OR

the body, whilst the part is at rest; if the prostration and anorexia
are greater, if there is harrassing cough or such a debility of
certain parts as to threaten paralysis, we give a single drop of the
tincture of rhus toxicodendron, prepared in the same way as the
above and diluted to the same degree, so that one drop of the
tincture prepared with a drachm of the powder of the leaves and
ten drachms of alcohol, is added to a bottle containing six drachms
of strong alcohol and mixed by being shaken strongly, and from
this one drop is added to a second bottle and so on, until the last
of the twelve bottles has been impregnated by a drop from No. 11,
and, like all the previous ones, has been strongly shaken, just as
was the case in preparing the diluted tincture of bryonia.
Of this highly diluted tincture of rhus toxicodendron we give in
the last-mentioned case, or if the symptoms I have described occur
at the very commencement of the attack, we give, at its very commencement, a single drop from bottle No. 12, on sugar, and no
more, nor any other medicine as long as the improvement is manifest and continued, unless it be (on the days when he is getting no
medicine) some of the above-mentioned innocuous substances.
Neither of the medicines can be used in a lower dilution or in a
larger dose; they are too strong.
No domestic remedies of any kind, perfumes, pure wine, herbteas, clysters, fomentations or the like should be used any more
than other medicines, if we wish the case to turn out successfully. We
should only put upon the patient the amount of bedclothes he feels
agreeable, and keep him neither too warm nor too cool, and we
should let him drink or eat what he has a fancy for; he never
wishes for anything that will not do him good.
The whole disease will generally be removed by a single drop of
the second or of the first medicine (according as the one or the
other is indicated, without the addition of any other.) But rhus is
suitable more frequently than bryonia, and hence can be more frequently used at first and alone.
If, notwithstanding, the disease should pass into the abovedescribed stage of delirium and mania, then hyoscyamus niger
meets all the indications of the case.
A tincture from the leaves of this plant should be prepared, (the
extracts of it are generally of indefinite strength or quite powerless) and diluted in the above-described manner, but only through




HOSPITAL FEVER AT PRESENT PREVAILING.

715

eight bottles, and a single drop from the last bottle, No. 8, given
upon sugar, and during the following days of amelioration only
the above-described innocuous things given instead of medicine,
for then reason, strength, tranquillity, appetite, &c. usually return
completely, although they might have seemed to be almost entirely
lost, and the patient an inevitable prey of death.
This medicine also should not be given oftener than one single
time; a single drop of the tincture diluted in this manner almost
always suffices.
Nothing particular need be administered for local inflammations or swellings, nor yet for eruptions, twitchings, long-continued
constipation, diarrhoea, anorexia, vomiting, hemorrhages or cough
that occur in this disease. Those symptoms which arise from the
main disease also go off simultaneously with its disappearance,
under the use of the remedies I have directed to be given.
But there sometimes occurs a third state, a sort of lethargy of
the internal common sensorium, a kind of half-paralysis of the mental
organs. The patient remains indolently lying, without sleeping or
speaking; he scarcely answers whatever we may do to induce him
to do so, he appears to hear without understanding what is said or
without allowing it to make any impression on him (the few words
he says are whispered but not irrelevant); he appears to feel
almost nothing, and to be almost immovable, and yet not quite
paralysed.
In this case a remedy is useful that previously used to be employed
in large doses for purposes not very clearly defined; I mean the
sweet spirit of  nitre.   It must be so old, that is to say, so
thoroughly sweetened that it no longer reddens the cork of the
bottle.   (It then contains in a concrete form, nitrous oxyde,
respecting whose power the experiments of Dr. Beddoes give us
important hints.)
One drop of this is to be shaken up with an ounce of water, and
given by tea-spoonfuls so as to be consumed in the four and twenty
hours. In the course of a few days this state passes into health
and activity.'
[ In the introduction to the proving of rhus toxicodendron (R. A. M. L., pt. ii, p. 358),
Hahnemann refers with satisfaction to his success in the treatment of this epidemic
of typhus.-" Of 183 patients whom I treated for this affection in Leipzic, I did not
lose one, which excited a great sensation among the members of the Russian Government then occupying Dresden, but was taken no notice of by the medical authorities."]




ON THE TREATMENT OF BURNS.'
It is to be regretted that Professor Dzondi, of Halle, should have
recommended as the only sure, efficacious and best remedy for
burns, a means of the injurious nature of which all who have
much to do with fire are perfectly convinced. Has he then instituted comparative experiments with all remedies recommended for
this purpose, that he can now with any degree of truth vaunt his
cold water as being the only sure, the best remedy? In such
injuries the question is, not what shall give relief for the first few
moments, but what shall most speedily render the burnt skin entirely
destitute of pain and heal it. This can only be determined by comparative experiments, not by speculation.    But it has already
been settled by observations, which may easily be repeated, that it
is exactly the opposite of cold water that heals burns most rapidly.
For with the true physician the object should be to heal, not to
relieve for a few moments.
Slight burns-for example, when a hand has been scalded with
hot-water of from 1800 to 1900 Fahr.-heal without any application, in the course of from twenty-four to forty-eight hours; but
they take a somewhat longer time to do so if we employ cold
water in order to give relief at first. For such slight injuries
hardly any remedy is requisite, least of all one like cold water,
which delays the cure.    But for large, severe burns, the best
remedies are not so generally known, and the public requires some
instruction on that subject; it is in these that cold water especially shews itself to be the most wretched palliative and in some
cases the most dangerous remedy that can be conceived. Comparative experiments and observations will, I repeat, convince
every one most conclusively, that the exact opposite of cold water
1 From the Allg. Anz. d. D., No. 156, 1816. In reply to Professor Dzondi's recommendation of cold water in the same journal, No. 104.




ON THE TREATMENT OF BURNS.

717

is the best remedy for severe burns. Thus the experienced cook,
who from the nature of his occupation must so often happen to
burn himself, and must consequently have learned by experience
the remedy for burns, never puts his hand that he has burnt with
boiling soup or grease into a jug of cold water (he knows from
experience the bad consequences of so doing), no, he holds the
burnt spot so near to the hot glow of the incandescent coals, that
the burning pain is thereby at first increased, and he holds it for
some time in this situation, until, namely, the burning pain becomes considerably diminished and almost entirely removed in this
high temperature. He knows, if he does so, that the epidermis
will not even rise and form a blister, not to speak of the skin suppurating, but that, on the contrary, after thus bringing his hand
near the fire, the redness of the burnt spot, together with the
pain, will often disappear in a quarter of an hour; it is healed all
at once, quickly and without any after-sufferings, though the
remedy was at first disagreeable. To this method he gives decidedly the preference, because he knows from experience that the
use of cold water, which at first procures for him a delusive alleviation, will be followed by blisters and suppuration of the part,
lasting for days and weeks.
The maker of lackered ware and other workmen who use in
their business alcohol and etherial oils, and who have to do with
boiling linseed oil, know from experience that the most rapid and
permanent way to cure the most severe burns and to get rid of
the pain, is to apply to them the best alcohol and oil of turpentine, substances which on a sensitive skin (as that of the mouth,
the nose, the eyes) cause a pain of burning like fire, but in cases
of burning of the skin (the slightest, more severe, and even the
most serious ones) act as a most incomparable' remedy. True,
they know not the rationale of this cure-they only say, "" One
bad thing must drive out another"; but this they know from
multiplied experience,--that nothing will make the burnt spot
painless and cause it to heal without suppurating, except rectified
alcohol and oil of turpentine.
Does Professor Dzondi imagine that it would never have ocurred
to these workmen to use cold water as a palliative remedy imme1 Homoeopathic.




718

ON THE TREATMENT OF BURNS.

diately after burning themselves? Any child who had burnt itself
would in its alarm fly to cold water; it would not require any
advice to do so; but the workman has repeatedly tried it to his
own injury, and experience, which in such cases is always purchased
at the expense of one's own suffering, has taught and convinced
him that the very opposite of cold water is the surest, quickest
and truest remedy for even the worst burns: he has been rendered
wise by experience, and in all cases he greatly prefers the remedy
which at first causes pain (alcohol, oil of turpentine) to that which
deludes by instantaneous relief to the pain (cold water).
Let Professor Dzondi only make upon himself, as he offers to
do, one pure comparative experiment, and he will be convinced
that he has made a grievous mistake in recommending cold water
as the only sure and best remedy for burns.
Let him plunge both his healthy hands at the same instant into
a vessel full of boiling water, and retain them there for from two
to three seconds only, and withdraw them both at the same time;
they will, as may easily be imagined, be both equally severely
scalded, and as the hands belong to one and the same body, if one
hand be treated with cold water and the other with alcohol or oil
of turpentine, the experiment will furnish a pure comparison and
convincing result. This case will not admit of the excuse offered in
that of the burns of two different individuals, where the bad consequences that always result when the hand is treated by cold water
are sought to be ascribed to impure humours, bad constitution, or
some other difference in the one so treated to the one that has
been much more easily cured by alcohol. No, let one and the
same individual (best of all the professor himself, in order to convince him), scald both his hands in the most equal manner before
competent witnesses, and then plunge one hand (which we shall
call A) into his cold water as often and as long as he pleases, but
let him hold the other hand (which we shall call B) uninterruptedly in a vessel full of warmed alcohol, keeping the (covered)
vessel constantly warm. In this the burning pain of the hand B
rises in a few seconds to double its intensity, but thereafter it will
go on diminishing, and in three, six, twelve, or at most twentyfour hours (according to the degree of the burn) it will be
completely and for ever removed, but the hand, without the production of any blister, far less of suppuration, will become covered




ON THE TREATMENT OF BURNS.

719

with a brown, hard, painless epidermis, which peels off in a few
days, and appears fresh and healthy, clad in its new skin.
But the hand A, which the Professor plunges into cold water as
often and as long as he pleases, does not experience the primary
increase of pain felt by the hand B; on the contrary, the first
instant it is as if in heaven; all the pain of the burn is as if
vanished, but-after a few minutes it recommences and increases,
and soon becomes intolerably severe if cold water be not again
used for it, when the pains are likewise in the first instants as if
extinguished; this amelioration, however, also lasts but a few
minutes; they then return even in this colder water, and in a
short time increase to greater and greater intensity. If he now
puts his severely burnt hand into the coldest snow water, he runs
the risk of sphacelus, and yet after a few hours he can find no
relief from the pains in water that is less cold. If he now withdraws his ill-treated hand from the water, the pain, instead of
being less than it was immediately after the scald, is four, and six
times greater than it was at first; the hand becomes excessively
inflamed, and swells up to a great extent with blisters, and he
may now apply cold water, or saturnine lotion, lead ointment,
hemp-seed oil, or any other of the ordinary remedies he likes;
the hand A, treated in this manner, inevitably turns into a suppurating ulcer, which, treated with these ordinary so-called cooling
and soothing remedies, at length heals up, after many weeks or
even months (solely by the natural powers of his body), with
hideously deformed cicatrices and tedious, agonizing pains.
This is what experience teaches us with respect to burns of any
severity.
If Professor Dzondi imagines he knows better than is here
stated, if he believes he is certain of the sole curative power of
cold water, which he lauds so much, in all degrees of burns, then
he may confidently undertake to institute the above decisive,
purely comparative experiment before competent witnesses. It is
only by such an experiment that truth will be brought to light.
What risk does he run if his cold water will procure as rapid relief
for the hand A as the warm alcohol will for the hand B?
But no! I pity the poor hand; I know very well how it would
be! Let the Professor, if he is not quite so sure of the efficacy of
cold water in severe burns, perform but a small portion of this




720

ON THE TREATMENT OF BURNS.

experiment, let him dip only two fingers of each hand into boiling
water for two or three seconds, and let him treat the fingers of
hand A and those of hand B in the way above described, and
this little comparative experiment will teach him how wrong he
was to recommend to the public as the only, best and efficacious remedy in all degrees of burns, cold water, an agent which,
though it is uncommonly soothing in the commencement, is subsequently so treacherous, so extremely noxious. For severe burns
he could not advise anything more injurious than cold water
(except perhaps the ointments and oils ordinarily used for burns),
and in slighter cases where no blister would rise if left alone,
blisters come on when they are treated with the palliative cold
water.
In the meantime, before Professor Dzondi can make known the
result of this decisive experiment upon himself, it may be useful
for the public to know that one of the greatest surgeons of our
times, Benjamin Bell' of England, instituted a similar experiment
for the instruction of the world, which was almost as pure as the
one I have proposed. He made a lady who had scalded both arms
apply to the one oil of turpentine, and plunge the other into cold
water. The first arm was well in an hour-but the other continued
painful for six hours; if she withdrew it an instant from the water
she experienced in it much more intense pain, and it required a
much longer time for its cure than the first.2 He therefore recommends, as A. H. Richter3 had already done, the application of
brandy,4 he also advises that the part be kept constantly moistened
1 Heister already knew and had recommended the treatment of burns by oil of
turpentine, which has recently created so much sensation in England: " expeditum
quoque hic esse solet terebinthinae oleum; siquidem opportune ac saepius corpori
illinatur."
2 See Physisch-Medic. Journal, herausgegeben von Kiihn, Leipzig, 1801, Jun.,
s. 428.
3 Anfangsgr. d. Wundarz., Bd. i.
4 The strongest alcohol heated is much more excellent in burns of various parts, even
where the epidermis has come off; but in scalds of the whole body (from which no one
ever recovered under the usual mode of treatment with cold water, saturnine lotions,
burn-salves or oils, all died generally within four days), we must content ourselves
with ordinary spirits made very warm, or at least commence the treatment for
the first hours with this, and constantly renew this warm application, keeping
the patient warmly wrapped up in bed. Of all conceivable modes of treatment this
is the best.




ON TIE TREATMENT OF BURNS.

721

with it.' Kentish 2 also greatly prefers, and that very properly, the
spirituous remedies to all others. I shall not adduce the experience confirmatory of this I have myself had.
From all this it appears that Professor Dzondi has made a
mistake, and that cold water, far from being a curative agent, is,
on the contrary, an obstacle to the cure of slight burns, and occasions a great aggravation of more serious ones, that in the highest
degree of such lesions, it even exposes the part to the risk of
sphacelus, if the temperature of the water applied be very low (just
as warm applications are apt to cause mortification of frost-bitten
limbs), and that on the other hand, warm alcohol and oil of turpentine are inestimable, wonderfully rapid, perfectly efficacious,
and genuine remedies for burns, just as snow is for frost-bitten
limbs.
The adherents of the old system of medicine ought not longer
to strive against the irresistible efforts towards improvement and
perfection that characterises the spirit of the age. They must see
that it is of no use doing so. The accumulated lumber of their
eternal palliatives, with their bad results, stands revealed in its
nothingness before the light of truth and pure experience.
I know very well that the doctor insinuates himself uncommonly into the affections of his patient, if he procures him a
momentary heavenly relief by plunging the seriously burnt part into
cold water, unmindful of the evil consequences resulting therefrom, but his conscience would give him a much higher reward than
such a deluded patient ever can, if he would give the preference to
the treatment with heated alcohol (or oil of turpentine), which is
only painful in the first moments, over all traditional pernicious palliatives (cold water, saturnine lotions, burn salves, oils, &c.); if he
could be taught by experience and pure comparative experiments,
that by the former means alone is all danger of mortification
guarded against, and that the patient is thereby cured and relieved
of all his sufferings, often in less than a hundredth part of the time
required for the cure by cold water, saturnine lotions, salves and
oils.
So also the girl heated by dancing to the highest degree of fever,
and tormented by uncontrollable thirst, finds the greatest refresh1 Benjamin Bell's System of Surgery, Vol. v.
2 On Burns, London, 1797.
3A




722

ON THE TREATMENT OF BURNS.

ment for the first few moments from exposure to a draught of air
and from drinking a glass of ice cold water, until she is taught by
the speedy occurrence of a dangerous or even fatal illness, that it
is not what affords us the greatest gratification for the first few
moments that is for our real welfare, but that like the pleasant
cup of sin, it is fraught with evil, often with ruin and death.
ADDITION TO THE FOREGOING ARTICLE.1
When ancient errors that should justly sink into oblivion are
attempted to be palmed off upon the world anew, he who knows
better ought not to neglect to publish his convictions, and thereby to
consign the pernicious error to its proper ignominous place, anf to
exalt the true and the salutary to its right position, for the welfare of
mankind. It was this idea that guided me in No. 156 of this
Journal,2 where I displayed the inestimable advantages of warm
spirituous fluids for the rapid and permanent healing of extensive
burns, over cold water, which only alleviates for an instant, but
whose results are extremely pernicious.
The most convincing test of the relative value of these two
opposite methods, viz., the curative (the really healing) method,
(the employment of warm spirituous fluids, such as alcohol or oil
of turpentine), and the palliative (alleviating) method (the use of
cold water, &c.), are furnished firstly, by pure comparative experiments, where burns of two limbs of the same body are simultaneously treated, the one by the one method, the other by the other;
secondly, by the expressed convictions of the most unprejudiced
and honourable physicians.     One single such authority, who,
knowing the worthlessness as facts of the favourite pre-conceived
notions of the age, dispossesses his mind of them, and rejecting
the old pernicious errors from genuine conviction, is not afraid to
claim for truth its merited station, is worth thousands of prejudiced
upholders and combatants for the opposite.
1 From the Allgem. Anzeiger der Deutschen. No. 204. 1816.
2 [See above.]




ON THE TREATMENT OF BURNS.

723

Thousands of over hasty advocates of the pernicious employment
of cold water in serious burns, must hold their peace before the
expressed convictions of that most upright of practical physicians,
Thomas Sydenham, who despising the prejudiced opinion that has
prevailed universally from Galen's time till now, morbi contrariis
curentur (therefore cold water for burns), and influenced by his
convictions and by truth alone, thus expresses himself:1 "As an
application in burns, alcohol bears the bell from all other remedies
that have ever been discovered, for it effects a most rapid cure.
Lint dipped in alcohol and applied, immediately after the injury, to
any part of the body that shall have been scalded with hot water
or singed by gunpowder, will do this, provided that as long as the
pain lasts the spirit be renewed; after that, only twice a-day will
suffice." Let him who can prove this to be false come forward!
Or, who can contradict one of the best and most enlightened
practical surgeons of our time, Benjamin Bell, when from his
extensive experience he alleges:2 " One of the best applications to
every burn of this kind is strong brandy, or any other ardent spirit;
it seems to induce a momentary additional pain, but this soon
subsides and is succeeded by an agreeable soothing sensation. It
proves most effectual when the parts can be kept immersed in it;
but where this cannot be done, they should be kept constantly
moist with pieces of old linen soaked in spirits."
Kentish, who, as a practitioner in Newcastle, had to treat the
workmen who were often fearfully burnt in the coal pits, considers
very carefully in his book3 all the claims preferred in favour of
cold water and all other cooling remedies for burns, and he finds as
the result of all his experience, contrary to the great prejudice he
1 Opera. Lipsiae, 1695, p. 343, [Edit. Syd. Soc. p. 255]. " Ambustis extus
(admovendus), quo casu omnibus remediis, quotquot adhuc inventa fuere, hie liquor
(spiritus vini) facile palmam praeripit, cum curationem quam cito absolvat;-nempe
si lintea spiritu vini imbuta partibus ab aqua fervente, pulvere pyris, vel simili laesis,
quam primum hoc infligitur malum, applicentur, eademque dicto spiritu madefacta
subinde repetantur, donec dolor ab igne penitus evanuerit, et postea solum bis in die."
That cold external applications to burnt parts render them liable to increase of pains,
that such parts soon become altogether painless from the application of external heat
as he had often witnessed, is testified by the great observer, John Hunter, in his
work On the blood and inflammation, p. 218.
2 System of Surgery, 3rd Edit. Vol. v.
3 On Burns, London and Newcastle, 1797, two Essays.
3A2




724

ON THE TREATMENT OF BURNS.

felt in favour of these long used things, that under their use no
single person who had got a severe burn on a great part of his
body ever recovered, but that all were cured who were treated by
the speediest possible application and frequent renewal of hot
turpentine.
But no proof for the truth of this can be so strong as that which
is afforded by comparative experiments performed simultaneously
on one and the same body. In my former paper I cited the case of
a lady who got both her arms burnt, one of which was treated by
Bell with cold water, but the other was kept covered with oil of
turpentine; in the first the pains persisted for a much longer time
and a much greater period was required for the cure than in the
last, which was treated with the volatile oil.
Another experiment of a not less convincing character is related
by John Anderson.1 "A lady scalded her face and right arm with
boiling grease; the face was very red, very much scalded, and the
seat of violent pains; the arm she had plunged into a jug full
of cold water. In the course of a few minutes oil of turpentine
was applied to the face. For her arm she desired to continue the
use of the cold water for some hours, because it had formerly been
of service to her in burns (she could not say whether those had
been more severe or less so than the present one). In the course
of seven hours her face looked much better and was relieved. In
the meantime she had often renewed the cold water for the arm,
but whenever she withdrew it she complained of much pain, and
in truth the inflammation in it had increased.  The following morning I found that she had suffered great pain in the arm during the
night; the inflammation had extended above the elbow, several large
blisters had risen, and thick eschars had formed on the arm and
hand. The face on the contrary was completely free from pain, had
no blisters, and only a little of the epidermis had become detached.
The arm had to be dressed for a fortnight with emollient remedies
before it was cured."
Who can read these honest observations of illustrious men without being satisfied of the much superior healing power of the
application of spirituous fluids to that of cold water, which affords
a delusive alleviation, but delays the cure?
1 Kentish's second essay on burns, p. 43.




ON THE TREATMENT OF BURNS.

725

I shall not, therefore, adduce my own very extensive experience
to the same effect. Were I even to add a hundred such comparative observations, could they prove more plainly, strongly, and convincingly than is done by these two cases, that (warm) spirituous
fluids possess an inestimable advantage over the transiently alleviating cold water in the case of severe burns?
How instructive and consoling, then, for mankind is the truth
that is to be deduced from these facts: that for serious and for the
most severe injuries from burning, though cold water is very hurtful
for them, spirituous applications (warm alcohol or oil of turpentine)
are highly beneficial and capable of saving many lives.
These proofs will serve to guide the great numbers of mankind
who require help, to the only effectual method, to the only health
bringing (sanative) remedy, without which, in the case of extensive
burns (that is, where the greater part of the surface of the body
has been scalded or burnt), delivery from death and recovery is
perfectly impossible, and has never been witnessed.
This one single, and, as I have imagined, not unworthy object of
my essay, was evidently not perceived by Professor Dzondi, as is
proved by his violent letters to me; he only perceives in my
remarks an attack upon his opinion. It is a matter of very little
interest to me to find that cold water which has already been
recommended ninety-nine times by others for burns, from a predilection in favour of this palliative whose effects are so injurious, is
now served up to us again for the hundredth time, and I should feel
ashamed to make use of a Journal so useful in promoting the happiness of the people as this is, for the purposes of merely personal
recrimination and discussion. Moreover, as in the article I allude
to I advised him to convince himself of the truth of my assertions
by an experiment upon himself, my object was thereby to inform
every one of the conditions necessary to be observed in order to
constitute a really convincing pure experiment of this kind.
I avail myself of this opportunity to expose the disadvantage
of cold water (and other ordinary palliatives) in the treatment of
serious burns, and call the attention of the public to the only
effectual remedies, warm spirituous fluids, in order that they may
avail themselves of them in the hour of need. This is not any
mere idea of my own, but it has been clearly proved and irrefra



726

ON THE TREATMENT OF BURNS.

gably demonstrated by the observations of the most honourable
and illustrious men of our profession (Sydenham, Heister, B. Bell,
J. Hunter, Kentish), and especially by the convincing comparative
experiments of Bell and Anderson.
I shall only observe further, that the burnt parts must be kept
moistened uninterruptedly with the warm spirituous fluid, e. g.
warm alcohol, for which end the linen rags soaked in it should
first be simply laid upon the injured parts, and then, in order
to prevent evaporation, and to keep all warm, covered with pieces
of woollen cloth or sheepskin. If a very large portion of the
surface of the body is burnt, then some one will be obliged to
devote himself entirely and constantly to the external care of the
patient, removing the pieces of cloth or skin one by one, and
pouring with a spoon warm alcohol (or oil of turpentine) over the
linen rags upon the skin (without removing them), then as soon as
they are dry, covering up the part and going on to others, so
that when the last part has been moistened and covered up, it
is time to commence again with the first part, which, in the case of
such a volatile fluid as warm alcohol, has in the meantime generally
become dry. This process must be continued day and night unremittingly, for which purpose the person engaged in performing it
must be changed every two hours for a fresh one. The chief
benefit, especially in severe and very serious injuries from burns,
depends on what is done within the first twenty-four hours, or in
the worst cases, the first forty-eight hours, that is, until all trace
of the pain of the burn is permanently removed. A basin should
be at hand containing very hot water, which should be frequently
renewed, in which some vessels full of alcohol should stand, of
which the attendant takes out the warmest for the purpose of
wetting the rags, whilst the rest stand in the basin in order to
remain sufficiently warm, so that there never shall be a want of
warm alcohol for the purpose of pouring on the rags. If the parts
of the body on which the patient is obliged to lie are also burnt,
the rags, dipped in warm alcohol, should be applied to them at the
commencement, and a layer of water-proof cloth spread underneath; these parts can subsequently be wetted from above without
being removed. If the greater part of the body is burnt, the first
application must only consist of warm brandy, in order to spare the




ON THE TREATMENT OF BURNS.                727
first shock to the patient, which is the worst, the second wetting
should be performed with stronger alcohol, and afterwards the
very strongest alcohol may be used. And as this operation must
be continued uninterruptedly during the night, the precaution
must be used of keeping the candle (or lantern) at a good distance,
otherwise the warm spirituous vapour rising from the skin might
readily catch fire, and prove destructive to the patient.
If the burn has been effected with gunpowder, the small black
particles should not be picked out of the skin before all traces of
the pain of the burn are permanently removed.




ON   THE VENEREAL        DISEASE     AND   ITS ORDINARY
IMPROPER     TREATMENT.1
As long as the defects of the constitutions of countries put difficulties in the way of matrimony, as long as celibacy shall be considered
fashionable and marriage as a political yoke, in place of being
regarded as the most honourable connexion of the two sexes for
their mutual moral and physical perfection, but especially for the
development of the really human and of the divine and immortal
in them; as long as the notable difference of both sexes shall be
viewed merely as an object of sensuality, and nothing more dignified is seen in an union with the opposite sex than a mere animal
copulation, and not a mutual communication and fusion of the
excellencies of both to constitute a more noble whole, so long will
the all-powerful sexual passion thus unnaturally separated from
moral duty seek its gratification in the arms of common prostitution, and as a necessary consequence not fail to contract the
destructive lues, and so long is the extinction of such a communicable virus not to be thought of.
It is the duty of the physician to cure patients ill of this disease
who trust themselves to his care, as the object of medicine (like
that of legislation) is not so much the prevention of the evils
incident to humanity as the correction of those which exist.
Medicine should therefore prove itself to be really the helpful art
it professes to be in this disgraceful and destructive malady, if it
would act up to its pretensions. Its services should be rendered
with all the more facility and certainty in this case, as the venereal disease is one of those happy few that remain always the same
with respect both to their origin and nature (and consequently
cannot be mistaken at its commencement), and the specific remedy
for which (mercury) was discovered by a lucky hit in domestic
practice shortly after the invasion of the disease, now 323 years

1 From the Allgcm. Aiiz. d. DP., No. 211, 1816.




ON THE VENEREAL DISEASE, ETC.

729

ago. We might therefore have expected that physicians would at all
events in this disease have acted judiciously, and in this long
period of time have learned the way to cure this disease radically,
easily and permanently, although their treatment of all other
diseases might have remained, as indeed it has, mere subjective
and objective delusion; which might to a certain extent be excused, since almost all other diseases differ so widely from each
other and among themselves, and the appropriate remedy for
each several case remained an eternal problem until homoeopathy
solved it.
But no! physicians have mistaken even this so easily cognisable
venereal disease, and a fallacious and pernicious treatment of it is
the consequence of this mistake.    Up to this hour almost all the
physicians of the habitable globe, in Pekin as in Paris and Philadelphia, in London as in Vienna, in Petersburg as in Berlin, have
bungled the venereal disease from its very commencement, and have
regarded the local removal of the chancre as the main point of
the treatment of syphilis, and the simultaneous employment of mercury as a mere accessory; and it is publicly taught that if the
chancre have existed but for a few days, its mere local destruction
is all the treatment required.' And yet there can be nothing more
inappropriate, nothing more pernicious than this procedure.
I shall in the first place shew its inappropriateness. The analogy with other miasmatic exanthematous diseases would lead us
to infer that the venereal disease arises only by infection by
means of corporeal contact. Now all infectious diseases have this
character in common, that on the part of the body where the
virus was first applied, at first no alteration is perceptible, although
the inoculation may have taken place. If we scrape off the epider1 The boldest propounders of this erroneous doctrine were Girtanner and A. F.
Hecker. The former says (Treatise on the venereal disease, Girttingen, 1803, p. 215),
" Recent chancres must be only locally cured, burnt or driven off. The poison must
be destroyed at the commencement on its seat, for then it has not yet had time to
be absorbed" (?)-and Hecker roundly asserts (On the venereal disease, 2nd edition,
p. 67), " In the chancre the poison lies as it were out of the system," " therefore it
yields (p. 180) to a mere external treatment (by desiccative and corrosive remedies)
without any ill effects" (?), and if it date from not more than twelve days (p. 182), it
must " only be treated with external, local means." Almost all other authors incline
to the same opinion, though they do not express themselves so distinctly-Hunter,
Bell, Schwediaur, &c.




730

ON THE VENEREAL DISEASE

mis on a child's arm till we come to the sensitive cutis vera, and
rub thereon either the matter of small-pox or the lymph of cowpox, for the first few days there will be no change at all perceptible
on this spot; it is only after the fourth day in the case of cowpox inoculation, and much later in that of small-pox inoculation,
that a change begins to appear on the inoculated spot, and it is
only on the seventh day that the perfect cow-pox vesicle is formed on
this spot, amid febrile symptoms, and the small-pox pustule on the
twelfth or fourteenth day. Neither of them appears before the internal
infection and development of this disease is completed in the system.
So it is with the measles and other acute exanthematous diseases:
namely, the part whereon the infecting virus was first brought does
not produce the eruption peculiar to each disease, before the whole
organism has undergone a change and is completely infected. And
on the other hand, the perfect production of the specific eruption is
an infallible proof of the completed internal infection and development of the miasmatic disease in every case. The cow-pox prevails
throughout the body as soon as the cow-pox vesicle is produced in
its perfect form with its red, hard areola, at the part where it was
first introduced, and so it is with other inoculable diseases. But
from the moment when the miasm has taken, and the whole living
organism has become aware of (has perceived) the presence of its
action, the poison is no longer only local at the point of inoculation; a complete infection would still occur, even though the seat
of inoculation should be cut out. At the very moment when the
inoculation has taken, the first general attack on the system has
occurred, and the full development of the disease is in all probability not to be avoided by the destruction of the inoculated
part.
In the case of the bite of the mad dog, where the system was
predisposed to be affected by the miasm,' we possess undeniable
observations to shew that even cutting out2 and removing the
1 For in many of those bitten by the rabid dog the poison does not infect; of
twenty persons bitten, usually from eighteen to nineteen escape without injury,
even though they do not use any antidote whatever. Hence the undeserved recommendation of so many pretended preventive remedies; they may all easily protect,
if the poison has not taken in those bitten, as is so often the case.
SA girl of eight years old, in Scotland, was bit by a mad dog on the 21st March
1792; a surgeon immediately cut the piece clean out (kept it suppurating and gave




AND ITS ORDINARY IMPROPER TREATMENT.

731

bitten part does not afford any protection from the occurrence of
hydrophobia.
Small-pox would still be developed, even though at the moment
the inoculation was effected the inoculated part were cut out.
So far is the miasm from remaining local when once it has been
inoculated in the body. When that has taken place, the complete
infection of the whole system and the gradual development of the
miasmatic disease in the interior cannot be prevented by any local
treatment.
But the disease can only be considered as completely developed
in the whole organism when the perfect pock has appeared on the
seat of inoculation.
Thus the miasmatic exanthematous diseases indicate their completion in the interior by the occurrence of one or more shut
boils of smaller or greater size.
Thus the pustula maligna appears on the part that has been
touched (some four days previously) by the blood of a cow which
has died of malignant anthrax, and in like manner the cow-pock
or small-pock appears generally and primarily on the part inoculated or its vicinity, and the same is the case with the itch of
wool-manufacturers.
The last-named disease belongs to the chronic exanthematous
diseases (like the venereal disease), and in it nature also produces
the itch vesicles, at first in the neighbourhood of the part that
was originally touched by the itch-virus, e.g., betwixt the fingers
and on the wrist, if the hands (palms) were first infected. As
soon as the itch vesicles have made their appearance this is a sign
that the internal itch-disease is already fully developed. For at
first there is actually no morbid change observable on the infected
part, no itching, no itch-vesicles. Usually from nine to twelve or
fourteen days after the application of the itch-virus there occurs,
along with a slight fever, which is not noticed by many persons,
the eruption of the first itch vesicle-nature requires this time, in
order to complete the full infection, that is to say, the development
of the itch-disease in the interior throughout the organism. The
itch-vesicles that now appear are hence no mere local malady, but
mercury till slight salivation was produced), and, notwithstanding, hydrophobia
broke out and death followed the fortieth day after the bite.-The new London
Medical Journal, Vol. ii.




732

ON THE VENEREAL DISEASE

a proof of the completion of the internal disease. The itch-miasm,
as soon as it has contaminated the hand, remains no longer local
the instant it has caused inoculation, but proceeds to alter the
interior of the organism and to develop itself into this peculiar
disease until the entire infection is accomplished, and then only
(after several days) does the eruption produced by the internal
malady appear on the skin, and that at first in the vicinity of the
original point of infection. These itch-vesicles are an abnormal
organ produced by the inner organism upon the skin, designed by
nature to be the external substitute of the internal disease, to
take the latter upon itself, to absorb it as it were, and so to keep
it subdued, slumbering and latent. That this is the case is evident
from this, that so long as the vesicles remain on the skin and continue to itch and discharge, the internal disease cannot make its
appearance, and from  this also, that whenever it is partially destroyed on the skin, without any previous cure being effected of
the internal itch disease (especially if it be of somewhat long standing
and have attained to any extent) by means of the internal employment of its specific remedy, sulphur, this internal disease then
bursts forth rapidly, often in a frightful manner, in the form of
phthisis, asthma, insanity, dropsy, apoplexy, amaurosis, paralysis,
and it not unfrequently occasions sudden death.
A very similar process is observed in the case of the venereal
disease. On the spot where the venereal virus was first rubbed in
(e. g. during an impure coitus), for the first days, in like manner,
nothing morbid is observable. The virus has indeed first come in
contact with the living fibres at that part, but at the moment that
the inoculation has taken place, that is, when the living body has felt
(perceived) the presence and action of the poison, that same moment
it is no longer only local, it is already the property of the whole
organism. From that instant the specific (venereal) alteration in
the interior advances onwards until the venereal disease has completely developed itself in the interior, and it is only then, that nature,
oppressed by the internal malady, produces the abnormal organ,
the chancre, which it has formed for the purpose of keeping in
subjection the internal disease, in the neighbourhood of the part
primarily infected.1 In the neighbourhood, I say, for it does not
' At first as a vesicle, which increases in a few hours and grows into an ulcer
with a hard base.




AND ITS ORDINARY IMPROPER TREATMENT.

733

always arise on the seat of the primary application of the virus, it
sometimes appears on the scrotum, &c., sometimes, though more
rarely, only in the groin, in the form of inguinal bubo, which is
also a kind of chancre.
In order to subdue and form a substitute for the internal
venereal constitutional disease, nature produces the chancre; for
as I have seen, chancres remaining untouched for as long as two
or three years (certainly enlarging gradually in that time), do not
permit the more general venereal disease to break out. As long
as the chancre remains uninterfered with, no venereal affection,
no symptoms of syphilis are to be met with on any other part of
the body.
It is very probable that the infection during impure coitus takes
place in the first seconds, and then no washing or cleansing of the
genitals is of any avail, nature from that time proceeds uninterruptedly in her course, altering the whole internal organism in the
manner peculiar to this disease. But from the moment of the
primary local infection, nature requires in our days, several,
usually seven, ten or fourteen days, not unfrequently three weeks,
there are even some instances of its requiring five, six, seven or eight
weeks before it has completed the development of the venereal
malady in the interior, and it is only then, as a sign of the completed internal general venereal disease, that the chancre appears
on the skin, and this chancre, the evidence of the now internal
affection, is designed by nature to assume, as it were, the palliative
office of substitution, relieving and keeping in subjection the latter.
For the first thirty or forty years after the occurrence of the
venereal disease, that is, from the year 1493 until the first third of
the following century, this infecting virus was much worse than it
is now; nature then strove much longer before it allowed the
completion of the general internal disease in the organism; often
several months elapsed after the local infection before the chancre
then burst forth. At that time too, the opposing action of the
body and the general ill state of health before its appearance, as
the signs of the development of the venereal disease going on in the
interior, were much more distinct and striking1 than now-a-days,
1 Passing over the testimony of several physicians of that time, such as C.
Torclla, N. Massa, A. Ferro, P. Hanschard, I would merely refer to the descrip



734

ON THE VENEREAL DISEASE

when the infecting virus is much milder. The venereal disease
pursues the same course even yet, for since that period it has only
decreased in violence, but its nature is not altered. Even at the present day there is, immediately after the infection, absolutely nothing
abnormal to be perceived on the spot: the change only goes on in
the interior, and a general feeling of illness is felt by sensitive
individuals for some days or weeks, until the thorough alteration
of the organism is effected by the venereal poison, and it is only
after this that the chancre is produced by nature on the suitable
spot, and is the infallible sign of the perfect development of the
venereal disease in the entire organism, and the silencer of the
internal malady. After the breaking out of the chancre the previous feelings of debility and fatigue, the dulness of the sensorium
commune, the depression of the spirits, the earthy complexion
with blue borders round the eyes, &c., go off. The internal
venereal disease then remains as it were enchained (latent) and
concealed, and can never break out as syphilis, as long as its external substitute and silencer remains uninterfered with on its
seat; but when the in-dwelling venereal disease is completely destroyed and cured by the sole internal employment of the best
mercurial preparation, then the chancre heals up of itself without
the aid of the slightest external remedy; if however it is driven off
by external means, without curing the internal malady, the latter
inevitably bursts forth in the form of syphilis.
From a consideration of this mode of the production and of this
nature of the venereal disease, and of this true signification of the
chancre, which are founded on incontrovertible observations, what
plan of treatment of this disease would suggest itself to any person
endowed with common sense?         Certainly none other-for I have
a high idea of sound unprejudiced common sense-than the following: " Treat the venereal affection of the whole system     by the
tion in Luisini Collectio script. de morbo gallico, Venet. 1566, t. i, given by H.
Frascatorius at p. 163 and 173, and by Fallopius at p. 667, of the sufferings of those
then infected before the outbreak of the chancre (then called caries), and it is
astonishing to find how generally ill and miserable the infected crawled about for
months, without the slightest change being observable on their genital organs, until
at length after the internal development of the venereal disease was completed, the
chancre burst forth in full fury, and the general state of ill health moderated, and, as
it were, retired.




AND ITS ORDINARY IMPROPER TREATMENT.

735

best internal remedy until it is completely eradicated, that is to say,
until the thoroughly cured organism no longer requires any virulent
chancre, any external silencer and substitute for the now annihilated
internal venereal disease, and from the period of the completed internal cure, it must become a healthy ulcer, without any assistance from
without, and rapidly heal up of its own accord, without leaving
behind the slightest trace of its previous existence." 1
Thus, I imagined, plain common sense would advise and carefully
warn against meddling with the chancre by any local application,
either before or during the internal treatment, that might cause its
premature disappearance, for it is the only certain sign of the indwelling venereal disease, and it only can, by its persistence,
infallibly demonstrate to the patient and to the physician, that the
cure of the disease throughout the organism is not completed,
whilst on the other hand, by its perfect spontaneous healing under
the internal exhibition of mercury (without the employment of
any sort of external remedy), it gives the most irrefragable proof
that the cure is completed, and that nature no longer requires this
substitutive organ for an in-dwelling venereal malady, since it has
been completely healed and annihilated by the medicine given
internally.
But as experience moreover incontrovertibly teaches us, that
when the chancre is driven off by local means, and nature is thus
deprived of the silencer and substitute of the internal venereal
disease by external desiccative or corrosive applications, it then
invariably happens that either an inguinal bubo soon occurs, or
after a few months the general venereal disease (syphilis) breaks
out; we might have imagined, that physicians would have had the
sense to perceive the importance of preserving the chancre inviolate, and without disturbing it by any,external remedy whatsoever, have made it their duty to employ only internal treatment,
with the best antivenereal medicine, until the system was completely cured of this disease.
But no!-In spite of all these loud speaking facts, proving the
1 It is worthy of remark that any chancre burnt off without the preliminary cure
of the internal disease, always leaves behind it a certain amount of redness and
hardness as long as the virus in the interior is not destroyed; a bubo must then
occur in its stead, which assumes the office of substitution, and keeps the internal
affection in abeyance.




736

ON THE VENEREAL DISEASE

true nature and signification of the chancre, almost all the physicians and surgeons of the habitable globe have gone on regarding
it as a purely local and at first insignificant ulcer confined to the
outer surface of the skin, and have exerted themselves to dry it up
and destroy it by local means as rapidly as possible, and have even
considered this destruction of the chancre as the chief object of
their treatment, just as though the venereal disease proceeded from
it (the chancre) as its source, just as if the chancre were the originator and producer of the venereal disease; whereas it is only an
evidence of the fully developed internal malady, which they might
have inferred from this, that the consequence of the local destruction of a chancre' performed ever so early, and even on the very first
day of its appearance, was always a subsequent breaking out of
syphilis; and they might also have learned this from the incontrovertible experience, that not a single patient escapes syphilis if his
chancre have been only locally destroyed.2
Now, as the in-dwelling venereal malady can never break out as
long as the chancre, undisturbed by external applications, remains
on its seat (however long it remains there) and as the venereal disease
at every period, whether it has broken out as syphilis or betrays its
hidden existence merely by the presence of the chancre (or the
bubo) can only be radically cured3 by the use of (the best preparation of) mercury (when the chancre heals up spontaneously without the aid of external remedies) I would ask if it be not very
'John Hunter's Treatise on the venereal disease, p. 551-553 (Leipzic edition).
2 Hunter, op. cit., p. 531. " Not one patient out of fifty will escape syphilis if the
chancre be only locally destroyed."-So says Fabre also (Lettres, supplement a son
traite des maladies veneriennes, Paris, 1786)-" A chancre always causes syphilis if it
be only treated with external remedies." Let it not be supposed that these local
irritating corrosive remedies caused a recession of the virus from the chancre into the
interior of the body, and thus produced the syphilis. No! a chancre destroyed locally
without employing any irritant remedies, produces the same result. " Petit (so says
Fabre, loc. cit.) excised a portion of the nymphm of a woman on which some chancres
had existed for some days; the wound healed, it is true, but the syphilis broke out
notwithstanding." And this might naturally have been expected, as the venereal
disease exists completely in the body before the chancre appears, and is only prevented bursting forth by the presence of the chancre on the skin.
3 Fritze On the venereal disease, Berlin, 1790, and Sam. Hahnemann, Instruction
for surgeons respecting venereal diseases. Leipzic, 1789, ý 273-284, 290-293, 614,
635, -[vide antea, p. 72, et seq.] wherewith, although they contradict themselves,
the other better writers agree, as Schwediaur, Hunter, Bell.




AND ITS ORDINARY IMPROPER TREATMENT.

737

foolish, nay, sinful, to destroy the chancre by external desiccative
and corrosive applications, seeing that thereby, not only is no part
of the venereal disease removed, but we deprive ourselves of this
conclusive sign of a perfect or imperfect cure, which should be our
guide during an internal mercurial treatment; nay, more, what is
much worse, we even cause the outbreak of the syphilis, which
had hitherto continued to lie latent and enchained in the interior,
and as long as the chancre existed could never burst forth, but
would have been for ever healed and destroyed had we medicinally
treated the disease solely by the use of the internal remedy, whilst
the chancre still existed until its cure was completed, that is to say,
until the chancre had disappeared without the aid of an external
remedy!
" But," say these medical men, " we give mercury internally
whilst we dry up or burn off the chancre."1
I would ask-in a sufficient or insufficient manner?    (It must
have been insufficient if the syphilis, as usually happens, breaks
out afterwards.)
"c Oh, we give it in a sufficient manner," they reply.
Possibly: but how can they tell during their treatment whether
their internally administered mercury sufficed for the cure, as it is
only the healing of the chancre that has remained untouched, under
the influence of internal remedies alone, that can give us the sole
certain proof thereof; but the chancre has been burnt off by them
before or during the treatment.
Had their employment of mercury sufficed for the perfect cure
of the internal venereal disease, they had not needed to burn off
the chancre, this would and must have disappeared2 at the same
time that the internal malady was eradicated without the simultaneous employment of any external remedy whatever!
But it is just because they know that their internal treatment
does not suffice for the extirpation of the internal malady, consequently also not for the spontaneous healing of the chancre; it is
just for this reason, that they burn off the chancre to give their
treatment the superficial appearance of having cured everything
I The worst kind of physicians advise nothing more to be done than destroying
the chancre, e. g. Girtanner, Treatise on the venereal disease. Gittingen, 1803, p. 215,
and Hecker, On the venereal disease, 2nd edit. pp. 67, 180, 182.
2 See Fritze and Hahnemann, op. cit.
3B




738

ON THE VENEREAL DISEASE

(the poor patient is deceived; he cannot help believing himself to
be cured); they give at the same time-if they wish to do the thing
thoroughly-mercury       internally   without knowing       (since  the
chancre, the guiding sign, is gone) how much or how long they
require to give it,' and this they do under the idea that even though
the patient may not be thereby thoroughly cured, they have at
least advanced the treatment of the disease as far as it will go.
But this is a mere delusion. For they torment the patient by
burning off his chancre, which is of no use, but is of the greatest
injury, as it is certainly followed by the breaking out of syphilis,
and they at the same time harrass him by giving him an indefinite
quantity of mercury by the mouth without avail. For the venereal
disease cannot be half or three quarters cured; it must either be
quite cured (and in that case not a trace of it is left), j it is
not at all cured; even though it be treated until it is almost cured
(but not perfectly eradicated) it is not at all cured; what has been
done for it is equivalent to nothing, for in the course of time it infallibly spreads round about again and reaches the same extent
and again plants itself just as firmly as if nothing at all had been
done for it.
Therefore what is the certain consequence of this local dryingup and often very tedious, often very painful burning off of the
chancre, whereby a portion of the genital organ is destroyed, and
of the blind employment of internal mercurial remedies? That the
patient is deceived into believing himself cured, and that his lesser
evil (chancre with latent internal venereal disease) is changed
into a greater! Now, either a bubo (a now much more trouble1 They often attempt to justify themselves by saying that they pushed the internal
administration of mercury until the appearance of the mercurial fever, whereby they
obtained a certainty of cure being effected. But what do they usually call mercurial
fever? Something that is not the least like it, and that affords no proof whatever of
an internal cure; looseness and falling out of the teeth, ulceration of the mouth,
swelling of the cheek and neck, violent pains in the belly, salivation? No! not every
violent assault with useless mercurial preparations as is now the fashion (calomel
with or without opium) can deserve that appellation; these remedies very seldom produce that peculiar febrile state which can still serve as the sign of the internal cure,
when some mischievous hand has burnt off the still more convincing chancre. It is
only the purest, most perfect, and hence most efficacious sesquioxyde of mercury that
produces it in venereal diseases, whereby the chancre (if it be still present) spontaneously heals without the aid of an external remedy, shewing that the internal
disease has been completely eradicated.




AND ITS ORDINARY IMPROPER TREATMENT.

739

some substitute for the indwelling venereal disease) or (where no
bubo has appeared, or if it have, has been driven off again) after a
few (3, 4, 6, 9) months syphilis breaks forth.
And if, after it has broken out, (as it inevitably must if the
patients were not assailed with unhelpful mercurial preparations so
violently that there was a struggle betwixt life and death, when if
they did not go the way of all flesh, some few of them were
thereby freed from their venereal disease) the physician be asked
if the ulcers on the tonsils, the bluish pimples on the face, extending even into the hairy scalp, the round copper-coloured spots
on the skin, &c. be not remains of the venereal disease that was
thought to be cured, he usually seeks to get out of the scrape by
alleging: "That he certainly had thoroughly cured him     on the
former occasion, there was then nothing more to be seen about
him " (he had burnt off the chancre and removed from sight the
proof of the existence of the indwelling disease; this he calls a
cure)-" the patient must certainly have caught a fresh infection
during these four, six, or nine months, whence this venereal ulceration of the throat, &c. has arisen."
Thus the poor betrayed sufferers must, in addition to their misfortune, bear the doctor's disgrace, because they know not how
syphilis can and must arise.
It can only proceed from the uncured indwelling venereal
disease, whose external substitute and suppresser (the chancre,
which, as long as it exists undisturbed, prevents the outbreak of
the syphilis) has been destroyed locally by the physician, and can
consequently no longer hinder its outbreak; and even though our
patient may be conscious of having had several suspicious connexions since the removal of his former chancre but got no
chancre therefrom, yet he has not been infected anew, and the
syphilis that has broken out must be derived indisputably from the
chancre that was formerly burnt off, consequently from the bad
treatment of his former venereal disease. For it has never occurred that syphilis has been produced without a previous (destroyed) chancre,i there is no authentic instance on record of such
a case having happened.
1 Hunter, op. cit., p. 487, says: " Probably not in one case out of 500," i. e. in no
case.
3s2




740

ON THE VENEREAL DISEASE

Did the patients, whose syphilitic symptoms the physician attributes to a new infection, know this, they having in the meantime
contracted no fresh chancre (which has been driven away), they
would know how to reply to the physician when he tries to transfer
his disgrace upon them, whose treatment he has bungled.
But as patients are ignorant on this subject, they alone have to
bear the injury and the disgrace; the doctor subjects them to a
new course of mercury, and if this be not pushed by him to a
much more violent and serious extent than the former one during
the destruction of the chancre was-if, I say, the patient be not
assailed until his life is endangered with the ordinary unserviceable mercurial preparations, a radical cure of the disease will not
be effected even with this second course; the patient gets rid
of his ulcers in the throat for example (for each of the. primary symptoms of syphilis is easily removed even by small
quantities of a bad mercurial remedy, whereby the disease is not
radically cured) but after a few, or after many months, a new
syphilitic symptom appears in their stead-and after a third and
a fourth similar, imperfect mercurial treatment, a third and a
fourth affection appear in succession, and at length the affections
of the joints and the agonizing nocturnal pains in the bones, for
which the useless mercurials, decoctions of woods and baths are no
longer of any avail; and the patient is left in the lurch, that is to
say, to suffer his tortures.
Thus, from an insignificant primary malady (for the original
venereal disease still accompanied by chancre may be readily cured
by the internal use of the best mercurial preparations), there arises
a succession of sufferings and morbid alterations of many years'
duration, often on account of the health-destroying treatments attended with danger to life, and all this-from the original local
destruction of the chancre which was designed by the beneficent
Creator to be the constant preventive of the breaking forth of the
syphilitic malady and the sure monitor of the physician as to
whether the internal treatment is complete (if it heals up of itself),
or the disease is not yet radically cured (if it remains unaltered on
its seat).
It is only by the discretion of the patients themselves that
physicians can ultimately be improved. Let every one that is
infected immediately dismiss the physician who wishes to com



AND ITS ORDINARY IMPROPER TREATMENT.

741

mence the destructive plan with him, of treating the chancre by
local remedies, though he bestow on the remedy he would employ
externally the mildest and most seductive of names, even though
he should call it cooling, sedative, alleviating, emollient, relaxing, descutient, purifying or healing; all these fine appellations
serve but to disguise the enemy. The chancre, being the most
important witness of what takes place within, must on no account
be touched or treated with any kind of external remedies by
whatever names they may be called.' The patient ought only to
be allowed to wash the genitals occasionally with tepid river-water
or warm cow's milk.
On the contrary, let him choose a physician, who, fully alive to the
extreme importance of the chancre, leaves this quite alone, and
understands how to conduct the internal treatment alone in a
masterly way; that is to say, eradicate it by means of the best
mercurial preparation that is capable of doing so, given internally without the production of salivation, in such a manner that
the chancre heals up of its own accord, without the aid of the
slightest external remedy.
Then and then only can the patient be sure that his disease is
cured.
The best mercurial preparation for effecting this, is the darkcoloured pure sesquioxyde of mercury, of which a small portion
rubbed with a drop of water on the palm of the hand by means of
the point of the finger, runs into minute globules of metallic mercury which are observable either with the naked eye or with a lens.
My mode of preparing it will be found in many books. This
only is the most innocuous and most powerful preparation where' And should the patient have allowed himself to be seduced and have permitted the
external driving off of his chancre, and should there arise, as usually happens, in
the place of it a bubo, let him remember that this has the same significance as the
chancre, and is a substitute for the internal malady, and that if allowed to stay there
undisturbed it also prevents the outbreak of the syphilis. Therefore he should not
allow this at least to be driven off by external remedies (inunctions of blue ointment
beneath the bubo, calledfrictions, and the application of many other things, which physicians term resolving the bubo), for after a few months the syphilis follows inevitably;
but he should rather let himself be only treated by the best mercurial preparation,
only inwardly, until the bubo, without the aid of external remedies and without
frictions, disappears spontaneously when the internal malady is cured; and it is only
thus that he can be certain of his complete recovery.




742

ON THE VENEREAL DISEASE, ETC.

with the venereal disease of all degrees may be cured, without
salivation, if the general state of the patient's health be not very
much broken up and weakened.
If, however, the patient have been mistreated by a physician
by having his chancre or the subsequent bubo driven off by
external remedies, and the syphilis have consequently broken out;
if it be already present, after several long-continued, fruitless treatments with bad mercurial preparations, in a high degree, the
general health that has been ruined by such violent treatment
must first be restored, and the accessory ailments usually present
must first be removed before the master in his art can employ
even the best mercurial preparation to effect the perfect cure.
In such master-pieces of treatment, where the malady has taken
such deep roots, and the chancre having been previously driven off
serves no more as a loadstar; there is nothing to shew that the
treatment has accomplished a perfect cure, but the closest observation for the arrival of the period, when, after the complete
restoration of the patient, some fresh symptoms present themselves
that are only peculiar to the action of mercury, but which are
quite new to the patient in the course of his venereal complaint,
and have scarcely ever been experienced before, but among which
neither salivation, nor toothache, nor ulcers of the mouth, nor
pains in the bowels, nor diarrhoea are to be found.




NOTA BENE FOR MY REVIEWERS.'
I have read several false criticisms on the second part of my
Pure Materia Medica, especially on the essay at the beginning of
it, entitled " Spirit of the HomoeopathicI2 Medical Doctrine."
Now I could easily settle them here after the traditional manner
of writers, and expose them in all their nakedness. But I shall
not do so. I do not wish to burden myself with the sin of immortalizing these follies and their perpetrators, and prefer not to
reveal the weaknesses of my contemporaries to an assuredly more
discerning posterity.
I shall only say this much in a general way.
I From the 3rd Part of the Reine Arzneimittellehre, dated February, 1817.
2 What an immense amount of learning do not my critics display! I shall only
allude to those who write and print homopathic and homopathy in place of hommopathic
and homaeopathy, thereby betraying that they are not aware of the immense difference
betwixt oi by and 'potov, but consider the two to be synonymous. Did they then
never hear a word about what the whole world knows, how the infinite difference betwixt /poovbatog and tpoyoio'ncg once split the whole Christian Church into two parts,
impossible to be re-united? Do they not understand enough Greek to know that (alone
and in combination) bybv means common, identical, the same (e. g. Eic 5gpbv Xixoc
sicavatalvot, Iliad 3.) but that 'ooLtov only means similar, resembling the object, but
never reaching it in regard to nature and kind, never becoming identical with it?
The homceopathic doctrine never pretended to cure a disease by the same, the
identical power by which the disease was produced-this has been impressed upon
the unreasonable opponents often enough, but, as it seems, in vain;-no! it only
cures in the mode most consonant to nature, by means of a power never exactly corresponding to, never the same as the cause of the disease, but by means of a medicine
that possesses the peculiar power of being able to produce a similar morbid state
(opotov irdOoc).
Cannot those persons feel the difference betwixt " identical," (the same) and
4" similar.?, Are they all homopathically labouring under the same malady of stupidity? Should not any one who ventures to step forward as a reviewer of the " Spirit
of the Homoeopathic Medical Doctrine" have at least a rudimentary idea of the
meaning of the word " Ilomcwopathy."




744

NOTA BENE FOR MY REVIEWERS.

Perversions of words and sense, incomprehensible palaver, which
is meant to appear learned, abuse and theoretical sceptical shakings
of the head, instead of practical demonstrations of the contrary,
seem to me to be weapons of too absurd a character to use against
a fact such as homoeopathy is; they remind me of the little figures
which mischievous boys make with gunpowder and set on fire
in order to tease people-the things can only fizz and splutter, but
are not very effective, are on the whole very miserable affairs.
By such tricks, the pitiful character of which recoils on their
authors, homoeopathy cannot be blown up.
My respected brethren on the opposition benches, I can give
you better advice as to how you should set about overthrowing, if
possible, this doctrine, which threatens to stifle your art, that is
founded on mere assumption, and to bring ruin upon all your
therapeutic lumber. Listen to me!
Your attempts against the systematic exposition of the doctrine,
entitled the " Spirit of the Homoeopathic Medical Doctrine," have
as you perceive, proved unsuccessful. You had better leave it
alone! Spirits such as this is, are no subjects for joking with. It
is said there are spirits whose appearance has left behind a life-long
disquiet in the conscience of the wicked and of those who act contrary to their knowledge of what is right and which nightly torment
them, for their neglect of acknowledged and yet neglected duties!
Mark this; otherwise you may not be able to silence the judge
within you, which has wakened to speak to you in unmistakeable
accents!
No! there is another and an infallible method of overthrowing
this doctrine, if that is possible to be done.
This doctrine appeals not only chiefly, but solely to the verdict
of experience-" repeat the experiments," it cries aloud, "repeat
them carefully and accurately, and you will find the doctrine confirmed at every step "-and it does what no medical doctrine, no
system of physic, no so-called therapeutics ever did or could do,
it insists upon being "judged by the result."
Here, then, we have homoeopathy just where Nve wished to have
it; here we can (come on, dear gentlemen, all will go on nicely)
give it the death blow from this side.
Take one case of disease after another, note it down according
to the directions given in the Organon, specially in respect of all




NOTA BENE FOR MY REVIEWERS.

745

its discernible symptoms, in so exact a manner that the founder of
homoeopathy himself shall be unable to find fault with the minuteness of the report (of course any case selected must be one for which
a homoeopathic medicine is to be found amongst those medicines
whose peculiar symptoms are known) and administer the most
appropriate homoeopathic medicinal substance that can be discovered, pure and unmixed, for the case of disease in question, in
a dose as small as this doctrine directs; but, as is expressly insisted
on, taking care to remove all other kinds of medicinal influences from
the patient, and if it do not give relief, speedy, mild and permanent relief, then, by a publication of the duly attested history
of the treatment according to the principles of the homoeopathic
system strictly followed out, you will be able to give a public
refutation of this doctrine which so seriously threatens the old
darkness.
But I pray you to beware of playing false in the matter!-all
roguery comes to light and leaves an unfavourable stigma behind it
as a warning.'
If then, following your conscientious example, every other equally
conscientious and careful medical experimentalist meets with the
same result-if all that the homoeopathic doctrine promises from being
faithfully followed out does not take place-then homoeopathy is as
good as lost, it is all up with homoeopathy if it does not shew itself
efficacious, remarkably efficacious.
Or, gentlemen on the opposition corporation benches, do you
know any other and more potent method for suppressing this
accursed doctrine, with its truths 2 that cut into the very soul of
1 As a warning example in point, I would refer to the notorious (exquisitely recorded) history of a disease which Kotzebue was said to have had, and of which he
was said to be miraculously cured by means of the excitement-theory method. It
was, however, as was soon shewn, a pure invention; invented in order to serve the
purposes of the excitement-theory of that time, and the disgrace of the deception is
still and will ever be attached to the name of its author.
2 The truth of this, the only rational doctrine of medicine, must seize upon the
convictions of these gentlemen if they possessed but a spark of reason, and it did so
to a certain extent, as we may observe here and there in their writings, from the
piteous lamentations caused by their apprehension of the speedy overthrow of the
antiquated edifice of their corporation.
But, see, they feel their brains so stuffed full of the hundred thousand fanciful
ideas, insane maxims, systems and dogmas, and the load of everlasting practical
trash, they are no longer capable of laying aside this useless furniture, in order then,




746

NOTA BENE FOR MY REVIEWERS.

the dogmatists of ancient and modern times, well-armed though
they   be-ignea inest illis vis et coelestis origo-which, as it is
asserted for certain, only needs to appeal to impartiality and sound
human reason, in order to find an entrance into the uncorrupted
understanding, and can point to the infallibly beneficial effects
that result from a faithful following out of its precepts, and is thus
enabled to triumph certainly over all obduracy;-do you, gentlemen, I repeat, know any more effectual mode of suppressing
this doctrine?
Yes! apparently you think you do.
Continue then to exalt the common-place twaddle of your school
to the very heavens with the most fulsome praise, and to pervert
and ridicule with your evil mind what your ignorance does not
pervert; continue to calumniate, to abuse, to revile:-and the
unprejudiced will be able plainly to comprehend on whose side
truth lies.
The improved (homoeopathic) medical doctrine will stand out in
with freedom of mind to practise impartially a system so simple as homcoopathy is,
for the benefit of mankind. They feel themselves, I say, so incapable of doing this,
that the ill-humour this causes distorts not only their mind, but also their features,
and can only find vent in impotent abuse of the better way that they can never
attain.
I am almost sorry for them; for the old falsehoods so often paraded before them as
truths hover incessantly before their memory as though they still were truths; the
fictions presented to them as articles of faith, and testified to by illustrious and great
names, have been so often dunned as important and proper things into their ears,
that they continue still to resound there; the illusory doctrinal maxims and the suppositions, a priori explanations, definitions and distinctions of the schools, offered to
them as axioms, have been so often read by them again and again in print, and custom
has habituated their whole mode of operations to such an easy-going routine readiness, that they are unable any longer to resist the pressure of those accustomed
things that have become their second nature, and they must, in spite of themselves,
continue to think and act in the same way- (at the very first view of the patient
some particular anatomical seat in the body occurs to them as the undoubted seat of
the disease, some nosological name for the disease presses itself upon them, they
already feel at their finger ends the elegant compound prescription, which they will
dash off upon the nearest piece of paper)-so that even if they wished seriously to
reform and lead a new medical life in simplicity and in truth, worthy of the Allseeing Maker of our mind that he has created to enable us to administer to the relief
of sick and suffering humanity, they are now incapable of doing so.
Such is the character of the self-styled critics of the reformed system of medicine
and their aiders and abettors; how can their criticisms be other than they are? God
have mercy on their poor souls!




NOTA BENE FOR MY REVIEWERS.

747

more prominent relief and appear to greater advantage against the
foil of this nonsense, and (-for who can entertain a doubt respecting the feeling for truth inherent in the better part of mankind?
-) will dispel the nocturnal darkness of antiquated stupidities, for
it teaches how to afford certain benefit in diseases, where hitherto
mere incomprehensible learned palaver, at the bed-side of the late
lamented, sought in vain to hide the damage done by pint and
quart bottles full of unsuitable mixtures of unknown, life-destroying drugs.
And what do you say when you see the author and first teacher
of homoeopathy, together with his genuine disciples, cure without
suffering and permanently, a much greater proportion of patients,
and such as are suffering from the worst, the most tedious complaints, with few, mild tasteless medicines?  Can your so-called
art do the like?   Does not such a result laugh to scorn your
miserable theoretical scepticism, and the impotent routine of your
cut-and-dry system?
If you really wish to do as well, imitate the homocopathic practice rationally and honestly!
If you do not wish this-well then, harp away-we will not
prevent you-harp away on your comfortless path of blind and
servile obedience in the dark midnight of fanciful systems, seduced
hither and thither by the will-o'-the-wisps of your venerated authorities, who, when you really stand in need of aid, leave you in the
lurch-dazzle your sight and disappear.
And if your unfortunate practice, from which that which you intended, wished and promised, does not occur, accumulates within
you a store of spiteful bile, which seeks to dissipate itself in calumniating your betters-well then, continue to call the grapes up
yonder, which party-pride, confusion of intellect, weakness or indolence prevents you reaching, sour, and leave them to be gathered
by more worthy persons.
Continue, if it so pleases you, enviously to slander the sublime
art, but know that envy gnaws in vain at adamantine truth, and
only consumes the marrow of the bones of its possessor.1

1 Aiova 3poroTc, Aeschyl., Eumen., 329.




EXAMINATION OF THE SOURCES OF THE COMMON
MATERIA      MEDICA.1
Next to a knowledge of what there is to cure in each particular
case which presents itself for treatment, there can be no more
necessary knowledge for a practical physician, than an acquaintance
with the curative implements, to know, namely, what each of the
remedies can certainly cure.
Twenty-three centuries have been spent in fruitless labour to
discover the way by which the end of this knowledge may be
reached; and not a step has been gained by all the efforts.
Had the millions of physicians who during this long space of
time occupied themselves with the subject, only discovered the way
to the knowledge of how this end (the discovery of the healing properties of each medicine) was to be attained, then had much, almost
everything, been accomplished; for then would this way have been
capable of being pursued, and the zeal and exertions of the better
class of physicians must have soon won a considerable territory of
knowledge, so that what still remained to be investigated would
also soon have been within our grasp.
But observe, that not one, as yet, ever trod the path that surely
and certainly leads to this end. All the paths hitherto trodden
were, consequently, as one century was forced to say of those of
another, mere ways of error. These we shall examine somewhat
more closely.
The first source of the Materia Medica hitherto extant is mere
guess work and fiction, which attempts to set forth the general
therapeutic virtues of drugs.
Exactly as the text ran in Dioscorides, seventeen centuries ago:
this or that substance is resolving, dissipating, diuretic, diaphoretic,
1 From the Reine Arzneimittellehre, part iii.




EXAMINATION OF THE SOURCES, ETC.

749

emmenagogue, antispasmodic, cathartic, &c.,-so runs it now in the
most recent works on Materia Medica. The same description of the
general virtues of particular drugs, which do not turn out true;
the same general assertions, which do not hold good when put to
the trial at the sick-bed. Experience declares, that such a medicine
very seldom performs, in the human body, what these books allege
respecting its general therapeutic virtues; and that when it does,
this happens either from other causes, or it is a merely palliative
passing effect (primary action), which is certainly followed by the
opposite, to the greater detriment of the patient.
If a medicine prized for its diuretic, diaphoretic, or emmenagogue qualities, when given by itself alone, had, in special circumstances, and in one out of many cases, seemed to have had this
effect, should it, on this account, be pronounced as absolutely
possessing these qualities, that is, would it deserve the title of an
unconditional diaphoretic, emmenagogue, or diuretic? In that
case, we should dignify with the name of an honest man, one who
only occasionally acted honestly; and on one who only lied on
rare occasions, we should bestow the honourable name of a truthful
man, a man of his word!
Are our conceptions to be thus perverted and reversed?
But these rare instances do not prove that a certain effect will
take place even in rare cases; for not in one case out of a hundred
were the substances given alone, but almost always in combination
with other medicines.
How few physicians are there who have given a patient but
one single simple substance at a time, and waited for its sole
operation, avoiding altogether the concomitant use of all other
medicinal substances! It is nothing but a mixture of various
medicines that ordinary practitioners employ! And if they ever
give a simple substance, for example, in powder, they are sure to
order also some herbal infusion (another kind of medicine), or
medicated clyster, or embrocation, or fomentation of some other
kind of herbs, to be used along with it. They never act otherwise.
This inherent vice clings like pitch to the ordinary practitioner, so that
he never can rid himself of it. He is in straits before and behind,
and he cannot rest, and is not at ease, if this and that, and a score
of other drugs, are not prescribed into the bargain.
And for this they have plenty of excuses.




750

EXAMINATION OF THE SOURCES OF THE

They maintain that this or that medicine (of the peculiar and
pure effects of which, however, they know nothing) is the principal
ingredient of their compound prescription, and that all the effects
must be attributed to it. The other substances were added for different objects, some to aid their principal ingredient, some to correct
it, others to direct it to this or that part of the body, or to give it the
necessary instructions on its passage (their own peculiar operation
being all the time unknown); as if the drugs were intelligent
beings, endowed with well-disposed wills and complaisant obedience, so that they would produce just that effect in the body
which the doctor ordered them, and not a particle more!
But do these accessory substances cease, on your command,
to confuse and to counteract, with their own peculiar and unknown medicinal influence, the action of your principal, and to
produce, in accordance with the eternal laws of their own inherent
nature, effects which cannot be surmised or predicted, and can
only be discovered and brought to our knowledge by pure experiment?
Is it not foolish to estimate the effect of one force, while other
forces of another kind were in action, which often contributed
mainly, though in common with the rest, to produce the result?
It would not be more absurd if some one were to try to
persuade us that he had discovered a good article of nutriment
in kitchen salt; that he had ordered it to a man half-starved, and
that he had no sooner eaten of it than he was invigorated, satiated,
and strengthened, as if by miracle; that the ounce of common
salt was the basis and chief ingredient of the nutritious receipt prescribed byhim,which he had caused to be dissolved, lege artis, in quantum satis of boiling water as the excipient and vehicle, then he had
added as a corrective, a good lump of butter, and, as an adjuvant,
a pound of fine cut rye-bread. This mixture (soup), after being
properly stirred, he caused to be taken at once by the famished
patient, and by it his hunger was completely appeased;-all the
latter ingredients were merely accessaries in the prescription, the
chief ingredient was the ounce of salt. This was prescribed by
him as the basis of the whole receipt; and see!-in his hands it
had, when prepared accurately according to these directions, always
exhibited the most beneficial results.
If, in the kitchen Materia Medica, the virtues of saturans,




COMMON MATERIA MEDICA.

751

analepticum, restaurans, reficiens, nutriens should, from  these circumstances, be ascribed to the article Sal culinare, it would
not be more childish and absurd than the conduct of the physician who should arbitrarily ordain one substance to be the
basis of his diuretic, then add two, three, or four other powerful
(unknown) medicinal substances (with the sage object, forsooth, of
serving as corrigens, dirigens, adjuvans, excipiens), and order the
patient to walk up and down the room while taking the mixture,
drinking in the meantime largely of warm sack-whey, made of Rhinewine well sweetened with sugar, and then publish triumphantly
the extraordinary success of the basis he had prescribed: "The
patient has passed more urine than usual." In his eyes the added
substances and the regimen are mere unimportant accessaries, and
innocent of the result, in order that he may be able to ascribe
to the substance which he has constituted the chief ingredient in
the receipt, and in which (he knows not why) he takes the deepest
interest, and whose fame he wishes to extend, the sole honour of
the effects produced. Thus it naturally happens, when, by such
arbitrary and wilful praise of a medicine which some one has taken
a fancy to, and to which he was determined to attribute some
definite curative property, the undeserved and surreptitious attributes of diuretic, emmenagogue, resolvent, sudorific, expectorant,
antispasmodic, are inscribed in the willing Materia Medica, where
they afterwards figure as truths, deluding those that trust to it.
Thus this rare effect must be attributed to the action of all these
medicines which were used at once! How small a part of the uncertain credit of being a diuretic, diaphoretic or emmenagogue, or
any other sort of medicine, falls to the share of each individual ingredient in the receipt!
Consequently, the general therapeutic virtues of drugs ascribed
to them by Dioscorides, and re-echoed by his successors, which
occupy the greatest share in Materia Medicas even of our own day,
as, for instance, that this or that medicine was diuretic, diaphoretic,
purgative, expectorant, or a purifier of the blood and humours, are
quite unfounded.1
1 When no other virtue could be attributed to a medicine, it must be at least an
evacuant: evacuant in some way or other; for, without an evacuation-without an
evacuation of the morbific matter which their grossly material conceptions of disease
led them to seek in all diseases, they could not imagine that a medicine could effect




752

EXAMINATION OF THE SOURCES OF THE

The assertion that this or that medicine is resolvent, discutient,
an exalter or depresser of sensibility, irritability, or the reproductive function, rests upon baseless hypothetical assumptions alone.
It was in itself a false and hypothetical assumption, destitute of
proof and of reality, that it was necessary directly to perform
these operations in diseases at all. How then, in the name of
reason, could it be ventured to ascribe these in themselves nugatory virtues to individual medicines, without proof, irrespective
altogether of the fact they were almost never prescribed singly,
but almost always only in combination with others?       Thus every
such assertion is a palpable lie.
What was ever seen dissolved or resolved in the interior of the
human body by medicines? By what facts was such a power of dissolving living parts of the organism proved to be possible by drugs?
Why is irrefragable evidence of the manifestation of this power by
some substance not brought forward?       Or why, since it is impossible to observe such mechanical and chemical effects of a drug in
the undiscovered and iindiscoverable penetralia of the organism,
has not a sense of shame restrained men from publishing such
inventions as truths and dogmas, and, with unblushing brow,
falsely ascribing such actions to medicines, since error in the most
serious and important of all earthly vocations, the healing of the
sick, must have the most grievous consequences; and falsehood
here is the greatest crime, being nothing less than high treason
against humanity?
And what is there, even in the hidden internal parts of the
living body, to dissolve or dissipate, which the human organism,
when acted on by medicine proper for its recovery, cannot itself,
when necessary, dissolve?
Is there anything actually present in the body to be dissolved
from without, as the opinion implies?     Has not our Sommering
a cure. Since, then, the generation and existence of a disease was due to this hypothetical morbific matter, they bethought themselves of all the conceivable exits from
the body by which this desperate matter could be driven out by medicines; and the
medicine had to do them the favour, to take upon itself the office of expelling this
imaginary morbid matter from the numerous vessels and fluids, and of clearing it
away by means of the urine, sweat, expectoration, or alvine discharge. These were
the principal effects they hoped and expected from their remedies: this was the part
all the medicines in the Materia Medica had to play.




COMMON MATERIA MEDICA.

753

proved that the swollen glands, which had hitherto always been
considered to be obstructed, had, on the contrary, their vessels
greatly dilated.  Has it not been established by experiment on
healthy peasants, that by the persevering use of Kimpf's clysters
there may be produced in and evacuated from their bowels the same
abominable evacuations which Kampf, on hypothetical grounds,
assumed to exist in the body of almost all patients affected by
chronic disease, in the form of stoppage, infarctus, and accumulations; although he had first, by his compound herbal decoction,
administered in the form of several hundred clysters, brought on
the unnatural condition of the bowels which produced these secretions, and then got them evacuated, to the horror of all beholders;
and, unfortunately, the rest of the profession were almost without
exception his followers, and in their mind's eye they now saw in
almost all patients nothing but obstructions of the smallest vessels
of the abdomen, infarctus and accumulations, took the senseless
herb-mixture of Kimpf to be really dissolving and dissipating, and
clystered the poor patients, for the sake of an hypothesis, with the
greatest vigour and perseverance, almost to death, so much so that
it was a sin and a shame.
Now, supposing that these imaginary cases were indeed real,
and that there could be something to dissolve and dissipate in the
diseased human body, who has ever seen this dissolution or dissipation effected by the direct action of the medicine when the patient
recovers, so that the vital force, which before presided over all
the operations of the organism, had remained, in this instance, a
passive spectator, and had allowed the medicine to work, unaided,
upon the supposed obstructed and indurated parts, as a tanner
operates on his hides?
By means of calomel, according to the history of a case,' a
chronic vomiting that occurred after meals was removed. The
cause of this vomiting was represented as nothing less than an
induration of the stomach and pylorus; this the narrator of the
case avers with the greatest effrontery, without adducing the
slightest evidence in support of his position, only that he might
attribute in this manner an unconditional resolvent power to
calomel, and assume the honour to himself of curing a disease
1 HIufeland's Journal, 1815, Dec., p. 121.
3c




754

EXAMINATION OF THE SOURCES OF THE

which is as rare as it is incurable. Another writer,1 rants in the
same imaginative strain about pressure on the stomach, cramps in
the stomach, eructation and vomiting in his patient being due to
some organic disease of the stomach, scirrhus, indurations and
tumours, and believes that as these were removed by drinking for
a length of time decoction of triticum repens (and at the same time
preserving a well-regulated diet and regimen?), that he has fully
established that this herb can cure scirrhus of the stomach, of the
existence of which in his case there was not the slightest proof.
But pressure of the stomach, eructation, and vomiting after meals,
even when of long standing, are by no means rare maladies, and
are often easily curable by an improved diet and regimen, and,
alone, afford no proof of induration or scirrhus of the stomach or
pylorus. This disease is accompanied by much more serious symptoms than pressure, eructation, and mere vomiting are.
This is however the highly commendable way in which a medicine is raised to the undeserved honour of being a resolving,
dissipating, &c. remedy, namely, by blind conjecture and bold
assumption of the presence of an important internal malady, never
seen or capable of being proved to be there.
The second source of the virtues of drugs, as ascribed to them in
the materia medica, has, it is alleged, a sure foundation, viz., their
sensible properties, from which their action may be inferred. We
shall see, however, what a turbid source this is.
I shall spare the ordinary medical school the humiliation of
reminding it of the folly of those ancient physicians who, determining the medicinal powers of crude drugs from their signature,
that is, from their colour and form, gave the testicle-shaped
Orchis-root in order to restore manly vigour; the phallus impudicus, to strengthen weak erections; ascribed to the yellow tumeric
the power of curing jaundice, and considered hypericum perforatum, whose yellow flowers on being crushed yield a red juice
(St. John's blood) useful in haemorrhages and wounds, &c.; but I
shall refrain from taunting the physicians of the present day with
these absurdities, although traces of them are to be met with in
the most modern treatises on materia medica.

1 In Hufeland's Journal, 1813, p. 63.




COMMON MATERIA MEDICA.

755

I shall only allude to what is scarcely less foolish, to wit, the
attempts, even of those of our own times, to guess the powers of
medicines from their smell and taste.
They pretended, by dint of tasting and smelling at drugs, to
find out what effect they would have on the human body; and for
this they invented some general therapeutical expressions.
All plants that had a bitter taste should and must (so they
decreed) have one and the same action, solely because they tasted
bitter.
But what a variety even of bitter tastes there are! Does this
variety not indicate a corresponding variety of action?
But how does the bitter taste obtain the honour awarded to it
by the Materia Medica and practical physicians, that it is a proof
of the so-called stomachic and tonic powers of drugs, and an evidence
of their similar and identical action, so that, according to this arbibitrary axiom, all the amara possess no other medicinal action but
this alone?
Although some of them have, besides, the peculiar power of
producing nausea, disgust, oppression of the stomach and eructations in healthy individuals, and consequently of curing, homoeopathically, an affection of a similar nature, yet each of them
possesses peculiar medicinal powers quite different from these,
which have hitherto been unnoticed, but which are often more
important than those ascribed to them, and whereby they differ
extremely from   each other.  Hence, to prescribe bitter-tasted
things without any distinction, the one in place of the other, as if
they all acted in the same manner, or thoughtlessly to mix them
together in one prescription, and under the name of bitters (extracta amara) to administer them, as if they were indubitably
identical medicines, having only the power of strengthening and
improving the stomach, betrays the most wretched, rudest routinism!
And if, as this dictatorial maxim of the authorities in materia
medica and therapeutics would have us believe, the bitterness
alone is sufficient to prove that everything that tastes bitter
(amara!) is absolutely and solely strengthening, and improves the
digestion, then must colocynth, squills, boletus laricis, the thickbarked, much-abused angustura, eupatorium, saponaria, myrica
gale, lupina, lactuca virosa, prussic acid, and upas-poison, all
3c2




756

EXAMINATION OF THE SOURCES OF THE

be entitled, as bitters, to rank among the tonic, stomachic medicines.
From this any one may easily see how irrational and arbitrary
the maxims of the ordinary materia medica are, how near they are
to downright falsehoods! And to make falsehoods the basis of
our system of treating the sick-what a crime!
Cinchona was found to have a bitter and astringent taste. This
was quite enough for them in order to judge of its inward powers;
but now all bitter and astringent tasting substances and barks
must possess the same medicinal powers as cinchona bark. Thus
was the action of medicines on the human frame determined, in
the materia medica, in the most unthinking and hasty manner
from their taste alone! And yet it must and ever will be false,
that willow bark, or a mixture of aloes and gall-nuts have the
same medicinal properties as cinchona bark. How many such
Chine factitice, which were to answer all the purposes of the true
cinchona bark, have been publicly recommended by celebrated
physicians, manufactured and sold, and administered with the
greatest confidence to their patients by other physicians!
Thus, the life and health of human beings were made dependent
on the opinion of a few blockheads, and whatever entered their
precious brains went to swell the materia medica.
In the same manner a number of inconceivably dissimilar smells
were jumbled together in one category, and all christened aromatics, in order that under this name a similar medicinal action
might conveniently be invented for them. Thus they were, without the slightest hesitation or consideration, one and all pronounced
to be exalters of the forces (excitants), strengtheners of the nerves,
deobstruents, &c.
Thus the most imperfect, the most deceptive of all the senses of
civilized man, that of smell,1 which admits of the expression by
words of so few perceptions of sensible differences-this should
suffice to determine the dynamic properties of a medicine in the
human organism, whilst all our senses together, employed with the
utmost care, in the examination of a medicinal substance with regard
to its external properties, do not give us any, not even the slightest
1 Precisely the most powerful medicines, belladonna, digitalis, tartar emetic,
arsenic, &c., have little or no smell.




COMMON MATERIA MEDICA.

757

information respecting this most important of all secrets, the
internal, immaterial power possessed by natural substances to
alter the health of human beings; in other words, respecting their
true medicinal and healing power, which is so extremely different
in every active substance, from that of every other, and which can
only be observed when it is taken internally, and acts upon the
vital functions of the organism!
Must mayflower, mint, angelica, arnica, sassafras, serpentaria,
sandal, coriander, chamomile, rosemary necessarily have the same
medicinal action, because, forsooth, it pleases the olfactory organ
of the respectable teachers of materia medica to discover that they
all have an aromatic smell?
Can a materia medica composed of such a jumble of dissimilar
medicines, all highly important from  the very variety of their
action, shew aught else than intemperate presumption, and dis.
honest, ignorant, self-complacency?
No art, be it ever so mean, has been guilty of such wanton
fictions with respect to the uses and powers of its materials and
tools. The agent to be employed was, at all events, always tried
upon smaller parts of the object it was intended to work upon,
in order to ascertain what alterations it was capable of effecting,
before it was employed on a large scale in the precious work,
where an error might be productive of serious injury. The cotton
bleacher tried the effects of chlorine, which is so destructive to
vegetable matters, in the first instance on a small portion of cloth,
and thereby avoided exposing all his stock of goods to danger.
The shoemaker had previously convinced himself of the properties
of the hempen thread, that it was stronger in the fibre, that,
when exposed to damp, it filled the holes in the leather by its
expansion more completely, and resisted putrefaction more powerfully than flax, before he preferred it to the latter for stitching all
his shoes; and that, after all, was but cobbler's work!
But in the arrogant medicine of the common stamp, the medicines
-the tools of the healing art-are employed without the least hesitation in the most important work which one man can perform for
his brother man-a work whereon life and death, nay, sometimes
the weal or woe of whole families and their descendants depends,
namely, the treatment of disease; and the acquaintance with these
remedies being derived solely from their deceptive outward appear



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ance, and from the preconceived notions and desultory classifications of teachers of materia medica, there is the greatest danger of
deception, of error, and of falsehood. But even then, as if to conceal the effect of each individual one, several remedies are given
mixed together in one prescription, with no anxiety as to the
inevitable result!
So much for the unfounded allegations respecting the general
therapeutic virtues of the several medicines in the materia medica,
which are all elevated to dogmas, on a foundation of blind guesswork, preconceived ideas, extraordinary notions and presumptuous
fiction. So much for this second impure source of the materia
medica, as it is called, hitherto in use!
Chemistry, also, has taken upon itself to disclose a source at
which the general therapeutic properties of drugs are to be ascertained. But we shall soon see the impurity of this third source of
the ordinary materia medica.
Attempts were made a century ago by Geoffroy, but still more
frequent have such attempts been since medicine became an art,
to discover, by means of chemistry, the properties of remedies
which could not be known in any other way.
I shall say nothing about the merely theoretical fallacies of
Baume, Steffens and Burdach, whereby the medicinal properties of
medicines were arbitrarily declared to reside in their gaseous and
certain other chemical constituents alone, and at the same time it
was assumed, without the slightest grounds, on mere conjecture,
that these hypothetical elementary constituents possessed certain
medicinal powers; so that it was really amusing to see the facility
and rapidity with which those gentlemen could create the medicinal properties of every remedy out of nothing. As nature, trials
on the living human organism, observations and experience were all
despised, and mere fancy, expert fingers and overweening confidence were alone employed, it is easy to conceive that the whole
affair was very soon settled.
No! I allude to the earnest aspirations, and the honest exertions of those of the present day, to arrive, by means of vegetable
and animal chemistry, at a knowledge of the real pure action of
medicines on the human frame, in which, as was deeply felt, the
materia medica up to that period, was miserably deficient.




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True it is that Chemistry-that art which reveals to us such
astonishing miracles, appeared to be a much more likely source for
obtaining information with respect to the properties of drugs, than
all the idle dreams, and learned salti mortali of ancient and modern
times, which we have just been considering; and many were infatuated with this expectation, yet, chiefly such as either did not
understand chemistry (and sought much more from it than it
could give or possessed), or knew nothing about medicine and
its requirements, or were ignorant of both the one and the other.
Animal chemistry can merely separate from animal substances
such inanimate matters as shew a different chemical action with
chemical reagents. But it is not these component parts of animal
tissues, separated by animal chemistry, on which the medicines act
when they derange the health, or cure the diseases of the living
organism, either through their elementary parts, as the chemist
would have us believe, or directly upon them. The fibrine, coagulable lymph, gelatine, organic acids, salts and earths, separated
from muscular substances by chemical operations, differ toto ccelo
from the living muscle, endowed with irritability in its perfect
organized state in the healthy and diseased individual; the matters
separated from it have not the most distant resemblance to the
living muscle. What information respecting the nature of the
living organism, or the changes which the different medicines are
capable of effecting on it when alive, can be derived from these
separated inanimate portions? Or is the process of digestion (that
wonderful transmutation of the most dissimilar kinds of food for
the purpose of promoting the perfect development of the living individual in all the variety of his organs and humours) rendered in the
slightest degree comprehensible from the discovery of a little soda
and phosphatic salt in the gastric juice? Can even the material,
not to speak of the dynamic, cause of a morbid digestion or nutrition be understood by what chemistry finds in the gastric juice,
so that a sure method of treatment could be founded thereon?
Nothing could be more futile than any expectation of this kind.
In like manner, in the chemical constituents shewn by vegetable
chemistry to exist in plants, even in such as possess the most
powerful medicinal properties, there is nothing either to smell or
taste which can express or reveal those so varied actions, which,
experience shews us, each of these medicinal substances is capable




760

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of performing, in altering the state of an individual, whether in
health or disease.
The water or oil, distilled from the plant, or the resin obtained
from  it, is certainly not its active principle; this only resided,
invisible to the eye, in those parts now extracted from it-the
resin, the oil, the distilled water; and is in itself perfectly imperceptible to our senses.  Its effects are manifested to our senses
only when this distilled water, this oil, this resin, or, still better,
the plant itself, is taken by the living individual, and when they
act dynamically on the susceptible spiritual-animal organism, in a
spiritual manner.
Moreover, what medicinal action do the other parts which
chemistry extracts from plants indicate, the vegetable fibrine, the
earths, the salts, the gums, the albumen, &c., which, with few exceptions, are found almost uniformly in all plants, even those most
opposite in their medicinal effects? Will the small quantity of
oxalate of lime which chemistry shews us to exist in rhubarb-root,
account for this medicine producing in healthy individuals such a
morbidly altered sleep, and such a curious heat of the body without thirst, and for its curing similar morbid states?
What information can all these parts, though analysed ever so
carefully by chemistry, give us, relative to the power of each
individual plant, virtually to alter the health of the living human
organism in the most peculiar and various manners?
The chemist, Gren, who knew nothing about medicine, in his
Pharmacology, which is full of the most reckless assertions, thus
holds forth to physicians: "The knowledge of the principles
contained in medicines, which chemistry gives us, can alone
determine the efficacy of remedies."
Knowledge indeed! And what knowledge does chemistry give
us with respect to the inanimate, speechless, component parts of
medicines? Answer: It merely teaches their chemical signification,
it teaches us that they act so and so with chemical reagents, and
hence are called gum, resin, albumen, mucus, earths and salts of
one kind or another;-matters of vastly little importance to the
physician. These appellations tell us nothing of the changes in
the sensations of the living man which may be effected by the
plant or mineral, each differing from the other in its peculiar
invisible, internal, essential nature; and yet, forsooth, the whole




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761

healing art depends on this alone!  The manifestations of the
active spirit of each individual remedial agent during its medicinal
employment on human beings, can alone inform the physician of
the sphere of action of the medicine, as regards its curative power.
The name of each of its chemical constituents, which in most
plants are almost identical, teaches him nothing on this point.
That calomel, for example, consists of from six to eight parts of
mercury, united by sublimation with one of muriatic acid-that
when rubbed up with lime-water, it becomes black, chemistry can
teach us; but that this preparation can cause in the human being
the well-known salivation with its peculiar odour, of this chemistry,
as chemistry, knows nothing; this no chemistry can teach us.
This dynamic relation of calomel to the human organism can only
be learned from experience, derived from its medicinal employment, and from its internal administration, when it acts dynamically and specifically on the living organism: and thus it is only
actual experiment and observation relative to the action of medicinal substances on the living human subject that can determine
their dynamical relation to the organism, in other words, their
medicinal properties; but this chemistry, in whose operations
merely inorganic substances are brought to act upon one another,
can never do.
Chemistry can indeed give us the useless information, that the
leaves of belladonna are very similar in their chemical composition
to cabbage and to a great many other vegetables, as they contain
albumen, gelatine, extractive matter, green resin, vegetable acid,
potash, calcareous and siliceous earths, &c.; but if, as Gren asserts,
the knowledge of the principal constituents, so far as they are
known to chemistry by means of its reagents, that is, chemically,
suffices to determine the medicinal properties of substances, it
follows that a dish of belladonna must be just as wholesome and
innocent an article of food as one of cabbage. Is that what the
chemist means? And yet the chemistry which presumes to determine
the medicinal properties of natural substances from their chemical
composition, cannot avoid asserting that the same medicinal powers
are possessed by substances which are proved by analysis to consist of the same constituents; it cannot consequently help declaring
cabbage and belladonna to be equally innocent vegetables, or
equally poisonous plants; thereby shewing, as clear as day, the




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absurdity of its presumption, and its incompetence to judge of the
medicinal powers of natural substances.
Do Gren and his followers not perceive that chemistry can only
give chemical information with respect to the presence of this or
that material component part of any physical body, and that these
are consequently to chemistry merely chemical substances? Chemical analysis can tell us their action with chemical reagents, and
this is its proper domain; but it can shew us neither in its dissolving nor digesting alembics, neither in its retorts nor yet in its
receivers, what dynamical changes any single medicine, when
brought in contact with the living organism, can produce.
Each science can only judge and throw light on subjects within
its own department; it is folly to expect from one science information upon matters belonging to other sciences.
The science of hydrostatics enables us to determine with precision the specific gravity of fine silver in comparison with that of
fine gold; but it presumes not to fix the different commercial
value of the one in comparison with that of the other. Whether
gold have twelve, thirteen, or fourteen times the value of its
weight of silver in Europe or in China, hydrostatics can never
tell; it is only the scarcity of and the demand for the one or the
other, that can determine their relative mercantile value.
In like manner, indispensable as a knowledge of the particular
form of plants is to the true farmer, and the power of distinguishing
them by their external appearance, which constitutes botany, yet
botany will never teach him whether a given plant is suitable or
the reverse as food for his sheep or swine, nor will it inform him
what grain or what root is best for making his horse strong, or
for fattening his ox; the botanical systems of neither Tournefort,
nor Haller, nor Linnweus, nor Jussieu, can tell him this; pure,
careful, comparative trials and experiments on   the  different
animals themselves can alone give him the requisite information.
Each science can decide on such matters only as are within its
own province.
What does chemistry find in the native magnet and the artificial
magnetic rod? In the former it discovers nothing but a rich iron
ore, intimately combined with silica and a small quantity of manganese; in the latter, nothing but pure iron. No chemical reagent
can discover, by the most minute chemical analysis, the slightest




COMMON MATERIA MEDICA.

763

trace of the mighty magnetic power in either the one or the
other.
But another science, natural philosophy, shews in its experiments the presence of this wonderful power in the native magnet
and magnetized steel, as also its physical relation to the external
world, its power of attracting iron (nickel, cobalt), the direction of
one end of the magnetic needle towards the north, its deviation
from the north pole in different decenniums and in different
regions of the globe, at one time towards the west, at another
towards the east, and the variety in its dip in different degrees of
latitude.
The science of natural philosophy, then, is capable of telling
something more respecting the magnet, and of discovering more
of its powers, than chemistry can, namely, its magnetic power in
a natural philosophical point of view.
But the knowledge of what is worth knowing about the magnet,
is not exhausted by chemistry and natural philosophy; neither of
these two sciences can detect anything in it beyond what belongs
to their own province. Neither the range of the chemical nor
that of the physical sciences can inform us, what mighty, what
peculiar, what characteristic effects the magnetic power is capable
of producing on the health of the human body, when brought into
contact with it, and what curative powers peculiar to itself it possesses in diseases in which it is suitable; of this chemistry and
natural philosophy are equally ignorant; this subject they must
both abandon to the experiments and observations of the physician.
Now, as no science can pretend to that which can only be
explained by another science, without rendering itself ridiculous, I
hope that medical men will gradually have the sense to see that
the proper province of chemistry is merely to separate the chemical
constituents of substances from each other, and to combine them
together again, (thus affording technical aid to pharmacy); I hope
that they will commence to see that medicines do not exist for
chemistry as medicines (i. e., powers capable of dynamically altering the health of an individual), but merely in so far as they are
chemical substances (i. e., in so far as their component parts are to
be regarded in a chemical light); that chemistry, consequently, can
only give chemical information with respect to medicinal substances,




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EXAMINATION OF THE SOURCES OF THE

but cannot tell what spiritual, dynamical changes they are capable
of effecting in the health of the human being, nor what medicinal
and curative powers each particular drug possesses, and is capable
of exercising in the living organism.
Finally, from the fourth impure source flowed the clinical and
special therapeutic indications for employment (ab usu in morbis),
into the ordinary materia medica.
This, the most common of all the sources of the materia medica
whence a knowledge of the curative powers of medicines was
sought to be obtained, is what is termed the practice of physic,
namely, the employment of medicines in actual diseases, whereby it
was imagined that information would be obtained with respect to
the diseases in which this and those in which that remedy was
efficacious.
This source has been resorted to from the very beginning of the
medical art, but has, from time to time, been relinquished, in order
to try and hit upon some more profitable mine for the knowledge
required, but it was always had recourse to again, as it appeared
the most natural method of learning the action of medicines, and
their exact uses.
Let us grant, for a moment, that this were the true way to
discover their curative virtues; one would, at least, have expected
that these experiments at the sick-bed would have been made with
single, simple drugs only; because, by mixing several together, it
would never be known to which among them the result was to be
ascribed. But in the records of medicine, we meet with few or no
cases in which this so natural idea was ever carried into execution,
viz., to give only one medicine at once in a disease, in order to
be certain whether it could produce a perfect cure in that disease.
It accordingly happened, that, in almost every instance, a mixture
of medicines was employed in diseases; and thus it could never be
ascertained for certain, when the treatment was successful, to
which ingredient of the mixture the favourable result was due; in
a word, nothing at all was learned. If, on the contrary, this medicinal mixture proved of no avail, or, as usually happened, did harm,
just as little could it be learned, from this result, to which of all
the medicines the bad result was attributable.
I know not whether it was an affectation of learning which




COMMON MATERIA MEDICA.

765

induced physicians always to administer medicines mixed together
in prescriptions as they are called, or whether it was their anxiety
which made them fancy that a single remedy was too powerless
and was not sufficient to cure the disease. Be this as it may, the
folly of prescribing several remedies together has prevailed from
the remotest antiquity; and immediately after Hippocrates' time
diseases were treated with a mixture of medicines, instead of with
one single medicine. Among the many writings falsely attributed to
Hippocrates, of which the greater part were written under his name,
shortly after his death, principally by his two sons, Draco and
Thessalus, as also by their sons, Hippocrates the third and fourth,
and among those works fabricated by the Alexandrians Artemidorus Capiton and his kinsman Dioscorides, in the name of
Hippocrates, there is not one practical treatise in which the prescriptions for diseases do not consist of several medicines, just as
in the prescriptions of their immediate followers, those of more
modern times, and those of the physicians of the present day.
But that from the employment of mixed prescriptions it cannot
be ascertained what each individual remedy is capable of effecting
in diseases, consequently, that no materia medica can be founded
thereon, was first commenced to be perceived by physicians of
later times, whereon several zealously set about prescribing in a
simple manner, in order to ascertain experimentally in what diseases this or that medicine was efficacious. They also published
cures which were said to have been effected by a single simple
remedy.
But how was the execution of this apparently rational idea
carried out?  We shall see.
In order to do so, I shall just run over what is to be found
on this subject in the three volumes of Hufeland's Journal for
1813, 1814 and 1815, and shall shew that the power of curing such
and such diseases has merely been attributed to single drugs, without their having been employed simply and alone.' Consequently,
It is true one single individual in all these three volumes, Ebers, instituted experiments with one single remedy only, in various diseases (Hufeland's Journal,
September and October 1813.)-With arsenic alone. But what sort of experiments?
Such as could throw no light on the curative powers of this substance. In the first
place, the cases of intermittent fever in which he employed arsenic were not minutely
described, and then the dose was such that it must have done much more harm than




766

EXAMINATION OF THE SOURCES OF THE

this is a new piece of fallacy in the place of the old one with its
acknowledged composite prescriptions.
That ulceration of the lungs has been cured by phellandrium
aquaticum is pretended to be shewn in the history of a case (Hufeland's Journal, August, 1813), whereby it appears (p. 110) that
tussilago, senega and Iceland moss were used at the same time.
With what right can the advocate for this mode of treatment
(which was so complex) exclaim, in conclusion:-" I am convinced
that the man owes the recovery of his health to this remedy
alone"?
Such was the sort of convictions that were produced by the impure source of the virtues ascribed to simple medicinal substances
in the materia medica!
In like manner (ibid., February, 1813), a case of inveterate
syphilis, which would not yield to various mercurial preparations,
(it was, in fact, a mercurial disease!) was cured in four weeks by
ammonia, along with which nothing, actually nothing, was employed-except camphor and opium!-Is that nothing?
An epilepsy (ibid., 1813, March) was cured in 14 months by
valerian alone, nothing else being used at the same time-but oleum
tartari per deliquium, tinctura colocynthidis, and baths of acorus
calamus, mint, and other aromatic substances (p. 52, 53).       Is that
nothing?
good. However, his candid acknowledgment of the harm it did is infinitely more
praiseworthy than the many alleged cases of cure recorded by others, in which
arsenic in the largest doses is said to have done nothing but good, and never the
least harm. Ebers affirms that the doses he administered were so small, that, in
most cases, they did not amount to one grain. To one patient he only gave 2/9ths of
a grain within the 24 hours (p. 55), and her life was put in danger, whereby it may
be perceived that even this minute dose is capable of producing the most fearful
effects. Honestly-observing physicians have long known this; but Ebers, led astray
by the materia medica, fancied that 2/9ths of a grain in 24 hours was a very small
dose of arsenic. Pure experience tells us it is a monstrous, a most unjustifiable dose
in diseases I When was it ever shewn that arsenic should be employed in doses of a
grain, or even of a tenth of a grain, in diseases? Many experiments with small and
still smaller doses (more and more diluted solutions) have shewn, that one drop which
contains the decillionth of a grain of arsenic in solution, is, in many cases, much too
strong a dose, even when arsenic is exactly suited for the case of disease. Had he
known this he would not have been astonished that his 2/9ths of a grain put his
patient's life in peril. Thus, from these trials, which are otherwise evidently very
honest, nothing can be learnt, not even what arsenic cannot cure; for the monstrous
doses effectually prevented any good effect from taking place.




COMMON MATERIA MEDICA.

767

In another case of epilepsy (ibid., p. 57) valerian alone effected
a cure, but there were employed, besides, an ounce and a half of
pomegranate leaves. Is that nothing?
Madness, with nymphomania, is said to have been cured by
drinking cold water alone (ibid. 1814, Jan.).   But infusion of
valerian and tinctura chince Whyttii (p. 12) were very prudently
administered along with it, in order that the action of the cold
water should be so completely masked as to be unrecognisable;
and the same happened in the case of another patient, who used
these powerful adjuvants only less frequently (p. 16).
Tymon (ibid., 1814, Aug., p. 38) professes to have found bleeding to syncope a specific in hydrophobia. But, see! he gives at the
same time 300 drops of laudanum, in clysters, every two hours,
and rubs in a drachm    of mercurial ointment every three hours.
Does this prove venesection to be the only true remedy for hydrophobia?
In like manner (ibid., 1814, April) a venesection, followed by
an hour of syncope, is said to have cured, solely and specifically, a
case of hydrophobia; at the same time (p. 102), however, there
were only administered strong doses of opium, James's powder, and
calomel till salivation was produced. Is that nothing?
If the case (ibid., 1815, July, p. 8-16) is to be a proof of the
efficacy of bleeding to syncope in already developed hydrophobia,
as the author would have it, cantharides should not have been
applied, and still less should mercurial ointment have been rubbed
in every two hours, and large doses of calomel and opium given
until violent salivation supervened. It is ludicrous when the author
adds (p. 20) that "the calomel was scarcely necessary."
This art of surreptitiously obtaining for a favdurite remedy the
merit of a cure, when the other equally powerful drugs employed
might at all events claim a share, is an established custom with
ordinary physicians; it being particularly requested that the courteous reader will shut his eyes, and allow the author to designate
all the secondary means employed inactive.
A case of tetanus is reported (ibid., 1814, Sept., p. 119) to have
been cured by cold water affusion alone. It is true opium was
at the same time employed; " as, however, the patient himself attributed the amendment to the affusion alone, to the affusion should the




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EXAMINATION OF THE SOURCES OF THE

cure be ascribed." This is what I call a pure source at which to
learn the virtues of drugs!
In a similar manner (ibid., 1815, Sept., p. 128) the healing
power of potash in croup is established; but along with it were
used other very powerful substances; for example, at the commencement of the (supposed?) disease two children were relieved
by salt of tartar in an infusion of senega root. Is what properly
pertains to two substances to be ascribed to the action of but one,
the potash?   According to what hitherto unheard-of system     of
logic?
In like manner, graphites (ibid., 1815, Nov., p. 40) is said to
have cured a large number of old fistulous ulcers, and yet corrosive
sublimate was in the mixture!  The explanation in the note, that
sublimate had already been tried in vain, is of no avail here: it
was not given alone, but in combination with opium, a quantity of
decoctions of various woods, and the favourite china factitia; it
was consequently greatly or completely destroyed by the astringent
parts of these accessory medicines, just as other metallic salts are
thereby destroyed and decomposed, and consequently it could not
develop its curative powers in such a mixture. Still less can the
apology, in the same note, for the addition of the mercurial to the
graphites be received, " that the sublimate was merely to serve as
an adjuvant here." Were this the fact, then must medicines act
agreeably to the commands of the prescribing physician, not
according to their natural powers, no! they must do exactly
neither more nor less than what the physician commanded and
permitted them to do. Can arrogance and presumption be carried
farther than this?  What man of sound intellect can attribute
such slavish obedience to medicinal substances, which act according to eternal laws? Did the author wish to see whether graphites
could prove efficacious by itself and to convince his readers of this,
he ought to have given it alone: but if he add to the graphites
corrosive sublimate, this must perform what corrosive sublimate
can and from its very nature must, not what the prescribing phyI One case, in which potash is said to have been efficacious when administered
alone was that of a child in the country, which the author did not see, and which,
from the description alone, he suspected to be this disease.




COMMON MATERIA MEDICA.

769

sician pleases that it shall or shall not do. Here again we have a
case from which nothing can be learnt. Graphites is represented as
having alone proved serviceable, and yet that tremendously powerful
medicinal substance, corrosive sublimate, was used along with it.
The cure of a case of florid pulmonary consumption by means of
charcoal powder is, if possible, still more unfounded. Here the
limewood charcoal was never employed alone, but always in conjunction with foxglove. So then the foxglove in the mixture has
no action?  None at all? and yet a medicine of such mighty
power! Do the authors of such observations deceive themselves,
or do they mean to make game of us?
Angelica root is said (ibid., 1815, April, p. 19) to have cured a
dropsy, properly speaking an unknown case of disease with swelling.  (The quid-pro-quo-giving pathology collects together all
diseases having the most distant resemblance in this respect under the name of "dropsy.")  But no! tincture of opium, cether,
and, finally, calamus, were used in addition to the tincture of
angelica. Can any rational man lay to the account of the angelica
alone the issue of this case?
No one will deny that the mineral water of Driburg has great
medicinal powers; but when the cures related in Hufeland's Journal, 1815, April, pp. 75, 80, 82, are ascribed to it alone, we must
declare these statements to be false, as so many other strong medicines were used along with it; nor can the pretended cure of a case
of cramp in the stomach with frequent vomiting by this water
(p. 85 to 93), nor that of hypochondriasis and hysteria (p. 94
to 97), prove anything in favour of the Driburg water, partly
on account of the ambiguity     and  vagueness of these two
names of diseases, but principally on account of the constant
employment of other medicines at the same time. Were we to
receive these cases as proofs of the efficacy of the mineral water,
we might, with equal justice, give to a single man the credit of
having alone lifted a large rock, without reckoning his many
active co-operators and the helpful machines employed. It would
be ridiculous to ascribe to one only that which was done by all
in conjunction.
These are a few samples from among the multitude I might
adduce from the writings of the more modern physicians, samples
of nominally simple treatment of diseases, each of which was said
3D




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to have been cured with one single remedy-in order to obtain at
last a knowledge of its true powers,-but along with which there
was always employed some medicine or other often more powerful
than itself; and although the physician should protest ever so vehemently that "that one medicine" to which he would fain attach all
the glory of the cure, "alone did it, he firmly believes," "the
" patient himself ascribed the good effects to this remedy alone,"
" to it alone he entrusted the cure," "he only employed the second
medicine as an adjuvant," or, "it had once before been employed
without effect;" yet all these shufflings will not avail to persuade
a rational man that the cure was owing to that medicine alone to
which the partiality of the physician would award the honour of
the cure, if any other-even one single other remedy-have been
used in the treatment. It must ever remain untrue that the cure
is due to this remedy alone; and the materia medica which shall
ascribe such a curative power to this remedy, on the authority of
such an impure observer as this, propagates falsehoods which must
inevitably be fraught with the most unhappy consequences to
humanity.
I will not deny that the cures of which I have just adduced
examples did approach towards simplicity. They certainly came
nearer, much nearer to the treatment of a disease with one single
remedy (without which mode of proceeding we can never be sure
that the medicine was the real instrument in effecting the cure),
than those of ordinary routine practitioners, who make it a glory
to administer to their patients several complex prescriptions, one
after the other, or even to prescribe daily one or two fresh mixtures.
But to have approached merely nearer to the administration of
single remedies implies that the true mark has been actually and
completely missed. Were it not so, then might we congratulate a
person on his good fortune whose number in the lottery differed
by a single cipher from that which won the highest prize; or a
sportsman whose shot has gone within a hair's breadth of his
game; or a shipwrecked mariner who would have escaped shipwreck had he been a single finger's-breadth farther from the fatal
rock.
What credence do the assertions in the ordinary materia medica
deserve with respect to the virtues of drugs ab usu in morbis?




COMMON MATERIA MEDICA.

771

What shall we say to the alleged powers of drugs in this or that
disease, when we know that the materia medica has obtained its
information thereupon from such observations; sometimes indeed
merely from the titles of the recorded observations of physicians
who scarcely ever treated with one single remedy, but generally
with a mixture of drugs, whereby as much uncertainty existed
as to which among them the result was to be ascribed to, as if, like
the routine practitioner, they had prescribed a great hotch-potch
of medicines?   What shall we say to the curative powers ascribed
with so much confidence by the materia medica to simple medicinal substances, seeing that these were almost never employed
singly?  We can say naught but this: among a thousand such
allegations and commendations, scarcely one deserves credence,
whether they refer to general therapeutical, or to clinical or special
therapeutical matters. Hence it is undeniable, that to ascribe any
powers to a medicinal substance which was never tested purely, that
is, unless along with others, consequently might as well have been
never tested at all, is to be guilty of deception and falsehood.
"What if all physicians were to agree from this time henceforth to
turn over a new leaf, and to prescribe in every disease only one single
simple medicine? Would we not, by this means, ascertain what
each medicine is capable of curing?"
This will never happen as long as a Hufeland lives, who considers the statements of the ordinary materia medica, though
derived from the impurest sources, to be truths, and seriously
defends the employment of a mixture of many medicines in diseases, imagining that " one medicine cannot suffice for all the
indications in a disease; several must be given at once, in order to
meet the several indications."
This statement, as pernicious as it is well meant, rests upon two
perfectly erroneous premisses, the first, whereby it is taken for
granted "' that the baseless declarations with respect to the virtues
of simple drugs in practical works, and in the materia medica
compiled from them, are well founded; and consequently, that
they were really capable of meeting the indications presented by
the case in which they were prescribed," (which, as we have shewn,
and shall again shew, is false);-the second, "that several medicines
should be prescribed at once in order to satisfy the several indicaS33




0 772

EXAMINATION OF THE SOURCES OF THE

tions in a disease, for this reason, because a single medicine can do
little more than respond to a single indication, but not to several
or many."
But what does the ordinary materia medica know about the
vast sphere of action of a simple medicinal substance, that materia
medica which, from impure observations of the result of the employment of several medicines in one disease, attributes to a drug
whatever powers it has pleased the physician to ascribe to a simple
ingredient of the mixture; which never subjected the powers of a
simple medicinal substance to a pure trial, that is, on a healthy
individual not affected with any symptoms of disease?  Does that
mixture of falsehood and truth which the materia medica has
scraped together from prescribers of compound medicines, in diseases of which merely the pathological name, but no accurate
description is given,-does this comprise the whole extent of the
sphere of action which the Almighty has bestowed on his instruments of cure? No! He has implanted in his healing instruments
undiscovered (but certainly discoverable) miracles of his wisdom
and goodness, in order that they may prove beneficial and helpful
to his beloved children of mankind, in a far greater measure than
was ever dreamt of by the short-sighted materia medica of the old
school.
But though it is certain that a single medicine at once is always
sufficient for the rational and appropriate treatment of a disease,
I am far from advising the medical world, on that account, to prescribe simply, that is, a single medicine in each disease, in order
to ascertain what medicine is useful in this, what in that, disease,
so that thereupon a materia medica, or treatise on the virtues of
drugs ab usu in morbis, should be formed.
Far be it from me to advise anything of the kind, notwithstanding that this idea might seem, and has seemed, to ordinary physicians, to promise the best results.
No! not the slightest useful addition can be either now or ever
made to our knowledge of the powers of drugs, with regard to their
usus in morbis, from observations on cases of disease even with
single medicines.
This were just as foul a source as all the others above mentioned,




COMMON MATERIA MEDICA.

773

hitherto employed. No useful truth, with respect to the curative
powers of each individual medicine, could flow from it.
I shall explain myself.
Such a mode of testing medicines in diseases were only possible
in two ways. Either a single drug must be tried in all diseases,
in order to ascertain in which of them it is efficacious; or all
drugs must be tried in a particular disease, in order to ascertain
which remedy can cure it most certainly and most perfectly.
And, first, with regard to the latter of these ways; and from it
may be inferred what reliance can be placed on the former.
By an infinite number of trials of all imaginable simple substances used in domestic practice, in a well-defined disease, which
shall constantly present the same characters, a true, certainly efficacious, specific remedy for the greater number of individuals and
their friends suffering from the same disease might certainly be
discovered, though only casu fortuito.
But who knows how many centuries the inhabitants of deep
valleys were forced to suffer from their goitres before accident,
after thousands of drugs and domestic nostrums had been tried in
vain, put it into the head of an individual, that roasted sponge was
the best thing for it; at all events it was not until the thirteenth
century that Arnault of Villeneuve notices its power of curing
goitre.
It is well known that for many years after its first invasion, the
venereal disease was treated in a most unsuccessful manner by the
physicians of the schools, by starvation, by purgatives, and other
useless remedies, which had been employed to combat the Arabian
leprosy, until at last, after many attempts and repeated trials of
an innumerable multitude of things by empirical physicians on
many thousands of patients who sought their aid, mercury was hit
upon, and proved itself specific in this dreadful scourge, in spite of
all the violent theoretical opposition of the pedantic physicians
of the Arabian school.
The intermittent fever endemic in the marshy regions of South
America, which has a great resemblance to our own marsh ague,
had long been treated by the Peruvians, probably after innumerable trials of other drugs, with cinchona bark, which they found to
be the most efficacious remedy, and which was first made known by
them as a febrifuge to Europeans in the year 1638.




774

EXAMINATION OF THE SOURCES OF THE

The bad consequences resulting from blows, falls, bruises and
strains were long endured, ere chance revealed to the labouring
classes who principally suffered from such accidents, the specific
virtues of arnica in such cases; at least Franz Joel was the
first who, in the sixteenth century, makes mention of its virtues,
and, in the eighteenth century, they were more particularly described by J. M. Fehr and J. D. Gohl, after they had become
generally recognised.
Thus, after thousands upon thousands of blind trials with innumerable substances upon, perhaps, millions of individuals, the
suitable, the specific remedy is at last discovered by accident. In
order to discover the remedies for the few maladies mentioned
above, there was no necessity for the employment on the part of
indolent man, of that reason and mature knowledge which the
Almighty has given to him, in order to enable him to free himself
from those inevitable natural and other evils involving his health
-the vast multitude of diseases;-in fact, no true medical knowledge at all was required. Mere experimenting with all imaginable
substances which might come into the head or hands was undoubtedly sufficient (to be sure after the lapse of perhaps hundreds
of years) to enable him to discover, by accident, a suitable remedy,
which never afterwards belied its specific power.
These few specifics in these few diseases constitute all the truth
which is contained in the voluminous materia medica in common use;
and these are, for the most part, I may say, almost entirely, derived
from domestic practice.
"But if specific remedies, which were always serviceable in the
above diseases, were discovered in this way, why could not some
remedies against all the remaining innumerable diseases be discovered by similar experiments?"
Because all other diseases only present themselves as individual
cases of disease differing from each other, or as epidemics which
have never been seen before, and will never be seen again in
exactly the same form. The constant specific remedies in these
few diseases were capable of being discovered by means of trying
every imaginable medicinal substance, only because the thing to be
cured, the disease, was of a constant character;-they are diseases
which always remain the same; some are produced by a miasm
which continues the same through all generations, such as the




COMMON MATERIA MEDICA.

775

venereal disease; others have the same exciting causes, as the ague
of marshy districts, the goitre of the inhabitants of deep valleys
and their outlets, and the bruises caused by falls and blows.
Had it been possible, by blind trials of all imaginable substances,
to discover accidentally the suitable (specific) remedy for each of
the innumerable other diseases, then must they all have been as
constant in their nature, have appeared always in the same manner
and in the same form, have shewn themselves to be always as identical in their character, as those few diseases we have mentioned.
Only for a want of a constant character can we suppose a supply
of a constant character.
That it was requisite, in order to find out empirically the proper
remedy, that all diseases, for which the specific was sought should
be identical and preserve an invariable fixed character, appears not
only to have been surmised, but to have been deeply felt by the
medical community of the old school. They imagined that they
must represent to themselves the various diseases of humanity in
certain fixed forms, before they could hope to discover for each a
suitable, trustworthy remedy, and this (as they knew no other
better-scientific-way of finding the fitting medicine in diseases)
by means of experimenting on them     with all possible drugs,-a
method which had succeeded so well in the few fixed diseases above
alluded to.
This undertaking, to arrange all other diseases in a certain fixed
classification, appeared to them at first certainly very plausible and
practicable.
In order to set about it, they conceived the idea of considering
all those from among the vast array of diseases, which bore any
resemblance to each other, as one and the same disease; and
having provided them with a name, and given them a place in their
nosological works, they were not deterred, by the constantly
occurring differences in their appearance, from declaring them to
be definite forms of disease, which they must always have before
them, in order thereby to be able to discover, as they flattered
themselves, a particular remedy for this disease.
Thus they collected the infinite variety of diseases into a few
arbitrarily formed classes of diseases, without reflecting that nature
is immutable, whatever false notions men may form of her. In
like manner, the polyhedrical kaleidoscope held before the eye




776

EXAMINATION OF THE SOURCES OF THE

arranges in one illusory picture a number of external very different objects, but if we look behind it into nature, we discover
a great variety of dissimilar elements.
It is no excuse to say that this arbitrary and unnatural amalgamation of diseases of nominally constant character was framed with
the good intention of thus discovering for each separately a sure
remedy, by means of trying on them the large number of known
drugs, or by accident. As was to have been expected, there were
found in this way no sure remedial agents for these artificially classified diseases; for we cannot imagine any real weapons to combat
figments and phantoms of the imagination!
All the uses and virtues, therefore, which the materia medica
ascribes to different medicines, in these surreptitious and fictitious
kinds of diseases, cannot make the slightest pretence to certainty.
What advantage has been gained in so many centuries, with all
the host of new and old medicines, over the artificial nosological
classes of diseases, and names of diseases? What remedies have
been found that can be relied on?     Is it not now as it was
long ago,-2300 years ago,-that by the employment of all the
various drugs in the innumerable cases of disease which occur in
nature, some are, it is true, much altered, generally, however, for
the worse, and but few are cured by them?   And was it possible,
even in this enormous space of time, that it could be otherwise,
that it could be improved, as long as the old system remained as
it was, with its imaginary thing to be cured, and imaginary virtues
of the instruments for effecting the cure, and its ignorance of their
true, pure action? How could really useful truths spring from the
employment of the latter against the former?
Let it not be alleged, " that not unfrequently many a severe
disease-which some called by one, others by a different pathological name-was cured as if by miracle, by a simple domestic
remedy, or by some medicine or prescription which accidentally
fell into the hands of the physician."
No doubt this sometimes happened; no well-informed man
would deny it. But from this we can learn nothing but what we
all know already, " that medicines can cure diseases;" but from
these casus fortuiti nothing is to be learnt; as yet they occupy an
isolated position in history, altogether useless for practice.




COMMON MATERIA MEDICA.

777

Our congratulations must only be bestowed on the sufferer who
reaped advantage from this rare godsend, and was cured quickly
(and lastingly?) by this accidental remedy. But from this wonderful cure nothing at all is learned; not the slightest addition
has thereby been made to the resources of the healing art.
On the contrary, these very chance cases of accidental cures,
when they have occurred to physicians, have done most to fill the
materia medica with false seductive declarations respecting the
curative actions of particular medicines ab usu in morbis.
For, as the ordinary physician seldom or never describes the
case of disease correctly, and, indeed, considers the circumstantial
description of a case of disease in all its symptoms as useless, if he
cannot bestow on it a pathological name (the illusory representation of a disease above alluded to), so he does not fail to apply
some illusory pathological name to his chance case, which, together with his prescription, or the single remedy in the mixture
to which alone he ascribes the cure, straightway finds its way into
the materia medica, which, moreover, is incapable of making use
of anything but mere pathological names of diseases in its account
of the uses of medicines.
He who, thereafter, is inclined to-regard a case occurring to himself as the same pathological species of disease (and why should he
not? the schools teach him to do so), has nothing to do but to resort
immediately to this magnificent receipt, this splendid specific, at
the bidding of its first recommender, or by the advice of the materia
medica.   But he certainly has, under the same illusory pathological name, a case before him vastly different in the detail of its
symptoms, and hence happens what was inevitable, the medicine
does no good; it does harm, as might have been anticipated.
This is the impure, this is the unhallowed source of all the declarations respecting the curative virtues of medicines ab usu in morbis
in the ordinary materia medica, whereby every imitator is led
astray.
Had the so-called observers-what they almost never did-communicated to the world those cases of lucky chance cures, only
describing minutely the case of disease, with all its symptoms, and
mentioning the remedy employed, they had at least written truth;
and the materia medica (finding no pathological name attached)
had not been able to glean any lies from them. They had, I say,




778

EXAMINATION OF THE SOURCES OF THE

written truth, which, however, would only have been useful in one
single way, namely, to teach every future physician the exact case
of disease beyond which the remedy, in order to prove useful,
should not be employed; and thus no false, and consequently
unsuccessful, imitation would have occurred. From such an accurate description it would have been evident to all future physicians
that the same, the exact same, case of disease never recurs in
nature, consequently could never again be cured miraculously.
Thus we would have been spared all the many hundred delusive accounts of the curative actions of particular drugs in the
ordinary materia medica, whose truthfulness and honesty has
hitherto consisted, and still consists, in this, that it has faithfully
re-echoed whatever authors have chosen to invent with respect to the
general therapeutical virtues of drugs, and has accepted, as genuine
coin, their alleged special therapeutic powers ab usu in morbis,
ascertained from accidental cases of cure, by associating the specific pathological name of a disease bestowed on his case by the
so-called observer, with, as the curative power, the presumed
single medicine to which, among all the drugs employed in the
compound prescription, the physician chose principally, if not
entirely, to entrust and ascribe the successful result.
So turbid and impure are the sources of the ordinary materia
medica, and so null and void its contents!
What a healing art, with such ill-understood medicines!
From the circumstance that constant remedies have already been
discovered for those diseases, few though they be,1 which have a
constant character, one might infer, that for all diseases of a constant character, constant (specific) remedies might be found.
And accordingly, since the only trustworthy way, the homoeopathic, has been pursued with honesty and zeal, the specific
remedies for several of the other constant diseases have already
been discovered.2
1 To be sure this was only effected by blind trials of all imaginable drugs; for
hitherto a scientific mode of making such discoveries has been entirely wanting in
medicine.
2 In this homoeopathic way, from a consideration of the symptoms of the smooth
scarlet fever, with bright erysipelatous redness of the skin, which formerly prevailed
in Europe from time to time, as a contagious epidemic (but has been almost totally
supplanted by thepurpura miliaris, which, in 1800, came from the Netherlands into




COMMON MATERIA MEDICA.

779

In order to treat successfully the other cases of disease occurring in man, and which, be they acute or chronic, differ so vastly
among each other, if they cannot be referred to some primary
disease which is constant in its character, they must each be
regarded as peculiar diseases, and a medicine which in its pure
effects on the healthy body shews symptoms similar to those of
the case before us, must be administered.
This improved healing art, i. e., the homoeopathic, draws not its
knowledge from those impure sources of the materia medica hitherto
in use, pursues not that antiquated, dreamy, false path we have
just pointed out, but follows the way consonant with nature. It
our country, and has been improperly confounded with scarlet fever, by physicians
who knew not the latter disease), I found the specific curative and prophylactic remedy
for this true, smooth scarlet-fever in the smallest doses of belladonna, which has the
power of producing a very similar fever, with a similar lobster-red colour of the
skin.
So, also, from a thorough consideration of the symptoms presented by the purpura
miliaris just mentioned, in the particular character of its purely inflammatory fever,
with agonizing anxiety and restlessness, I found that aconite must be the specific
remedy (occasionally alternately with raw coffee); and experience has confirmed
the truth of the remark.
The symptoms of croup are to be found in the pure materia medica, among the
symptoms produced by burnt sponge and hepar sulphuris; and, see! these two
alternately, and in the smallest dose, cure this frightful disease of children, as I
first discovered.
No known medicine is so capable of producing a state similar to that of the
epidemic hooping-cough as the sundew; and this disease, which, notwithstanding all
the exertions of allopathic physicians, either becomes chronic or terminates fatally,
is cured in a few days in a certain and safe manner, as I first shewed, by the smallest
portion of a drop of the decillionth dilution of the juice of drosera rotundifolia.
What physician before me, and before the publication of the " Pure Materia
Medica," was able to cure radically the constitutional and local sycosic condylomatous disease? They were content with removing the morbid growths by the cautery,
the knife, or the ligature, as often as they appeared externally, but none succeeded
in curing the disease. The symptoms of thuja occidentalis taught me, however, that
it must cure this disease; and, behold! a very small dose of its highly diluted juice
actually cures the internal disease, so that the external growths vanish also, shewing
the cure to be radical.
With an infinity of empirically chosen drugs the allopathist attacks the autumnal
dysentery, but with what miserable success I The symptoms of corrosive sublimate,
however (vide the " Pure Materia Medica"), resemble so closely those of this disease,
that this medicine must be its specific remedy; and experience convinced me, many
years since, that a single dose, consisting of a small portion of a drop of the
trillionth dilution of mercurius sublimatus corrosivus is sufficient to produce a rapid
and complete cure.




780

EXAMINATION OF THE SOURCES, ETC.

administers no medicines to combat the diseases of mankind before
testing their pure effects; that is, observing what changes they
can produce in the health of a healthy man-this is pure materia
medica.
Thus alone can the power of medicines on the human health be
known; thus alone can their true importance, the peculiar action
of each drug, be exhibited clearly and manifestly, without any
fallacy, any deception, independent of all speculation; in their
symptoms thus ascertained, all their curative elements lie disclosed; and among them may be found a signalization of all the
cases of disease which each fitting (specific) remedy is capable of
curing.
According to this improved system of medicine, cases of disease,
in all their endless variety of appearance (if they cannot be traced
back to some more profoundly rooted primary disease of constant
character), must be regarded in every instance as new, and never
before seen; they must be noted exactly as they present themselves, with all the symptoms, accidents and altered sensations
discoverable in them; and a remedy must be selected which, as
has been shewn by previous experiments of its action on perfect
health, is capable of producing symptoms, accidents, and altered
sensations most similar to those of the case under treatment; and
such a medicine, given in a very small dose, cures, as experience
teaches, much better and more perfectly than any other method
of treatment.
This doctrine of the pure effects of medicines promises no delusive, fabulous remedies for names of diseases, imagines no general
therapeutic virtues of drugs, but unostentatiously possesses the elements of cure for diseases accurately known (that is, investigated in
all their symptoms); and he who will take the trouble to choose the
remedy for a disease by the rule of the most perfect similarity will
ever find in it a pure inexhaustible source whence he may derive
the means for saving the lives of his fellow-men.
LEIPZIC, April 1817; and
COTHEN, January 1825.




ON

THE   UNCHARITABLENESS          TOWARDS     SUICIDES.1
The propensity to self-destruction always depends upon a disease
which is to a certain extent endemic in England, but in many
other countries it prevailed epidemically, so to speak, more some
time since than now, but it by no means affected the very worst
characters, but often otherwise honest, well-conducted individuals.
It is generally the friends of the individual-who do not pay attention to his corporeal disease, that often passes rapidly into this
mental disease-and his medical attendants, who know not how to
cure the suicidal-malady, that are to blame for the catastrophe.
By their unsteady, shy, anxious look, by the despondency they
display in their words and deeds, by their restlessness, that increases at certain times of the day, by their avoidance of things
that were formerly most agreeable to them, and sometimes by
their inconsolable lamentations over some slight corporeal ailments, the patients betray their internal malady. This most
unnatural of all human purposes, this disorder of the mind that
renders them aweary of life, might always be with certainty cured
if the medicinal powers of pure gold for the cure of this sad condition were known. The smallest dose of pulverized gold attenuated
to the billionth degree, or the smallest part of a drop of an equally
diluted solution of pure gold, which may be mixed in his drink
without his knowledge, immediately and permanently removes this
fearful state of the (body and) mind, and the unfortunate being is
saved.

1 From the Allgem. Anzeig. der Deutschen, No. 144. 1819.




ON
THE TREATMENT OF THE PURPURA MILIARIS.'
Almost all of those, without exception, who are affected by the
red miliary fever (falsely called scarlet-fever) that is often so fatal,
will not only be rescued from death, but also cured in a few days by
aconite given alternately with tincture of raw coffee. The expressed juice of the fresh aconite-plant should be mixed with equal
parts of alcohol, and diluted with a hundred times its quantity of
alcohol, until the last dilution is in the octillionth degree. Of
this a small portion of a drop is to be given for a dose when there
is increasing restlessness, anxiety and heat of the body, all acids
being carefully avoided; and when there are increasing pains (in
the head, throat, &c.) combined with a disposition to weep, a small
portion of a drop of the tincture of raw coffee diluted to the millionth degree.
The one will usually be necessary when the other has acted for
from sixteen to twenty-four hours.2 Not oftener.
Besides this nothing should be done or given to the patient-no
venesection, no leeches, no calomel, no purgative, no cooling or
diaphoretic medicine or herb-tea, no water compresses, no baths,
no clysters, no gargles, no vesicatories or sinapisms.
The patients should be kept in a moderately warm room, and
allowed to adapt their bed coverings to their own feelings, and to
drink whatever they like, warm or cold, only nothing acid during
the action of aconite.
But even should these remedies be prepared and administered
as directed, where is the practitioner who would refrain from
giving something or another from his routine system, thus rendering the treatment nugatory?
I From the Allgem. Anzeig. der Deutschen, No. 26. 1821.
2 [" Every twelve, sixteen or twenty-four hours, according as the one or the other
is indicated." (R. A. M. L., Introd. to Bell., pt. i, p. 15.)]




ON THE
PREPARATION AND DISPENSING OF MEDICINES
BY THE HOM(EOPATHIC PHYSICIAN.
I.   REPRESENTATION TO A PERSON HIGH IN AUTHORITY.1
"Non debet cui plus licet quod minus est non licere."
Ulpian., lib. 27, ad Sabinum.
The complaint of the Leipzic apothecaries " that by dispensing
my medicines I encroach upon their privileges," is untenable for
the following reasons.
My system of medicine has nothing in common with the ordinary medical art, but is in every respect its exact opposite. It is
a novum quid, to which the standard of measurement hitherto
applicable to the dispensing of medicines is completely unsuitable.
The old system makes use of complex mixtures of medicines, each
containing several ingredients in considerable quantity. The compounding of these prescriptions, which in general consist of several
medicinal substances, demands skilful, often laborious work and
time, neither of which the ordinary practitioner can devote to this
purpose, as he is occupied with visiting his patients, and does not
possess the skill required for compounding these various, often
heterogeneous, substances, and therefore must be glad to have at
hand an assistant in the apothecary,who relieves him of the toilsome,
time-wasting preparation of the medicines; in a word, who undertakes for him the dispensing business. For where the laws relative
to medical affairs speak of preparing the medicines2 and of dispensing,
1 Written in 1820, first published in Stapf's collection in 1829. [The subject of
this and the two following essays is not of so much interest to the English homceopathist, as his right to prepare and dispense his own medicines has never yet been
questioned, but the papers themselves are well worth perusal, and could not have
been with propriety omitted from this collection. The first is a remonstrance
addressed to the chief magistrate, in reply to an accusation, brought against him
by the Leipzic apothecaries, of dispensing his own medicines.]
2 When the medicinal laws speak of simple remedies, they make use of the words
simplicia and species, and by the expression, medicines and medicaments, they always
mean compound medicines.




784

ON DISPENSING BY THE PHYSICIAN.

they always and invariably imply thereby the compounding of several
medicinal substances in one formula or prescription. Nor can the state
medicinal regulations imply anything else thereby, for hitherto all
the prescriptions of doctors for their patients have been as a rule
compound recipes, that is, consisting of several medicinal ingredients mixed together; and up to the present day the treatment
of patients, as taught in our universities, colleges and hospitals,
consists solely in writing prescriptions, which are directions to the
apothecary relative to the different medicines he is to bring together in one formula, for hitherto patients as a rule have only
been treated with compound prescriptions, the compounding and
mixture of which was entirely left to the apothecary.
This right to prepare compound medicinal formulas for the physician was conceded to the privileged apothecary by the laws relating to medicine solely on this account, that none unconversant
with this work or having a bad stock of medicines might make a
bungle of the prescriptions, because the physician who is engaged
in practice would have often neither the skill to make these often
elaborate mixtures himself, nor the great time often requisite to
devote to their preparation.
All the royal mandates of this kind refer to this dispensing and
preparation of drugs (compound medicinal formulas) which exclusively appertains to the privileged apothecaries.
But their exclusive privilege is entirely limited to this, but does
not refer to the sale of the simplicia (simple drugs) otherwise there
could exist no druggists in the kingdom, for they are not prevented
by any law at present from selling simples to every one.
The only right and privilege belonging to the apothecary, exclusively to make up the mixtures ordered in prescriptions containing
several medicinal ingredients is not in the slightest degree interfered
with by the new method of treatment called homoeopathy, the
exact opposite of the ordinary medical art hitherto practised, for
this new system has no prescriptions that it could give to the
apothecary, has no compound remedies, but gives for every case of
disease only one single, simple medicinal substance, in an unmedicinal vehicle, therefore it does not compound, and consequently,
does not dispense. Its practice is, therefore, not included in the
prohibition to dispense contained in the laws regarding medicine.
Now, as every art admits of improvements in the course of ages,




I. REPRESENTATION TO A HIGH OFFICIAL.

785

which must be welcome to every civilized state, the medical art
also can and must advance farther on the way to perfection. If,
then, by the ordination by an All-wise Providence there arise the
art of curing diseases (more easily, surely and permanently) without compound remedies, without mixtures of medicines, and if
there be now physicians who know how to treat every disease efficaciously by means of one single, simple remedy (simplex), this
cannot be prevented by any privilege referring to-the preparation
of compound prescriptions; the new healing art advancing nearer to
perfection cannot thereby be obstructed in its beneficent progress,
for it is open to the physician for the purpose of curing diseases to
make use of every simple power in nature which is best adapted to
this end; for example, the employment by himself of electricity,
of galvanism, of the magnet, and so likewise of every kind of
simple agent; and in this the scientific physician has never yet been,
and can never be, fettered by any regulations of medical police.
For where is a syllable to be found in all the royal ordinances
relating to medicine that distinctly forbids physicians to administer
simplicia with their own hands to their patients?
And as long as no such distinct prohibition for the practitioner
exists in the laws, as long as no privilege granted to the apothecaries refers to their exclusive administration of the simplicia, as
long as it is allowed to the ignorant dealers in roots and herbs in
the weekly market to sell for money to those who seek their aid,
simplicia, medicinal roots and herbs, so long must it be allowed to
the scientific physician skilled in all the knowledge of nature, its
forms, and its phenomena, and intrusted with the care of human
maladies, to administer gratuitously to his patient the simple
remedy which he considers will prove most efficacious for the
disease, for this, as I shall shew, cannot be done by the apothecary.
Such is exactly the case with the new method of treatment of
which I am the founder, which is something quite different from
the ordinary mode of treatment. In my treatise upon the homoeopathic system, all prescriptions, all compound medicinal mixtures are
proscribed, and I inculcate that only one single, simple medicine at
a time is to be given in every case of disease,' and I never treat a
patient in any other way than this.
1 See the Organon of Medicine, 2d edit. 1819, 0 297, 298, 299- [vide fifth edition,
S272, 273, 274.]




786

ON DISPENSING BY THE PHYSICIAN.

According to this improved method of treatment, I require for
the cure of even severe diseases, that have hitherto been considered
incurable, only the smallest possible doses of simple substances,
either solutions of some minerals and metals in pure alcohol without the addition of any acid (preparations that are known to me
alone, but not to any chemists, consequently, not to any apothecary) or equally small doses of vegetable and animal substancesalways only one dose of a single, simple medicament-doses
which are so small that they are quite undetectable by the senses,
and by every conceivable chemical analysis, in their ordinary unmedicinal vehicle (sugar of milk).
This inconceivable minuteness of the doses of simple medicinal
substances in this new system of medicine quite sets aside all possible suspicion of a hurtful size of the dose of simple medicine
given to the patient.
Incapable of being taught that the great curative power of such
small doses of simple medicines, that shews itself in the beneficial
effects of their administration, depends upon a plan of selection for
the cases of disease for which they are adapted hitherto unknown
and peculiar to the homoeopathic art, whereof the ordinary system of
medicine never dreams, the apothecary ridicules the nullity of such
small doses, since all his senses, as well as the best chemical
analysis, cannot enable him to detect any medicinal substance in
the vehicle (sugar of milk).
If, then, even the apothecary, with all his jealous animosity
against the new healing art, cannot detect anything medicinal or
poisonous in the remedies of the genuine homoeopathic physician,
nor anything that could appear medicinal, not to mention too
strong or injurious, how completely satisfied may the government
which is concerned for the welfare and health of the community
be with respect to the effects of such efficacious remedies given in
such small, such inconceivable doses, as those homoeopathy administers to its patients! It may be infinitely more satisfied than
with respect to the trade of the apothecary, where the very same
medicines which the homoeopathic physician employs in such inconceivably small doses are unhesitatingly sold by the apothecary
in quantities upwards of a million times greater, to every one
(citizen or peasant), to persons who do not know what damage
these things may do when employed improperly; his only limitation




I. REPRESENTATION TO A HIGH OFFICIAL.

787

being that he shall not sell arsenic, corrosive sublimate, opium,
and a few other things, to strangers.
I take leave to draw the attention of the medical police of the
state to this subject.
Moreover, the homceopathic physician cannot employ the apothecary as an assistant in the practice of his new art. The medicinal
doses of such a physician are so minute, so imperceptible, that
if the apothecary had to put it into the vehicle alluded to
according to the directions of the physician (which the physician
himself can do in a minute without waste of time), the homceopathic physician, if he did not himself see the operation performed,
could not, either by the aid of his senses or by that of chemistry,
determine whether the apothecary gave the medicine he ordered,
or some other, or none at all.
This impossibility on the part of the homceopathic physician, to
exercise control over such an act of the apothecary, renders it
impossible for the physician of the new school to avail himself in
his treatment of an assistant, be he who he may. In this case he
can trust to himself only; he alone can know what he has himself
done.
And yet this uncommon minuteness of the dose of all dynamically-acting medicines is indispensably necessary in this new art,
which is excellent for the treatment of every disease, but which is
indispensable for the cure of the serious chronic diseases which
have hitherto been abandoned as incurable, and it is so indispensably necessary, that the cure of these diseases is impossible
without that minuteness of dose.
Now if the spirit of the laws relating to medicine is really directed
chiefly and before everything else to the salus publica, and if the
diseases most worthy of commiseration and hitherto abandoned as
incurable can only be transformed into health by means of this
new method, as, for instance, the cases I have cured testify, which
have roused to bitterness the envy of many of the ordinary practitioners, then it surely cannot be doubted that the sanitary police
will prefer the welfare of the suffering public to all unfounded
private claims, and will afford its protection to the new efficacious
healing art, but that it will not force upon the new system as its
assistant the art of the apothecary, which was originally instituted
for preparing the medicinal mixtures of the ordinary system, from
3E3




788

ON DISPENSING BY THE PHYSICIAN.

prescriptions containing many strong ingredients; such an act
could only be obstructive and never advantageous to homoeopathy.
I am correct in saying, "unfounded private claims," and I add
that these claims are "insignificant and unmeaning."    For how
much would an apothecary be entitled to if (as the homoeopathic
physician himself does without waste of time) to the vehicle of
three grains of sugar of milk he were to add, for example, one
drop of an alcholic solution of a grain of tin, rhubarb or cinchona
bark, diluted to more than the millionth degree?   According to
all scales of apothecaries' charges hitherto framed, which are
all calculated only according to the weight of the ingredients of
the ordinary formulas, and the trouble (which does not exist in
the new system) of compounding the ingredients, for making up
any such homoeopathic prescription, I say, he is entitled to justnothing.
If then for the preparation of homoeopathic medicine he were
entitled to nothing, it is to be feared that if the Leipzic apothecacaries still persist with their untenable proposition, there may be
some secret motive at work which determines them to force their
services, contrary to their interests, on the homoeopathic physician.
I would fain hope that this is not done with the intention of
throwing an insuperable obstacle in the way of the recently
developed and highly important new      healing  art, for which
nothing can be a substitute, as some of the practitioners who are
envious of its success would seem to wish.
The true homoeopathic physician, moreover, does not in the
least infringe on the rights of the apothecary as a dealer in drugs,
for he cannot charge the patient anything for such an inconceivably small dose of the simple medicine which no chemical
analysis can detect in the vehicle; he can only, as is proper, be
paid for the trouble he expends in investigating the morbid state,
and in choosing the most efficacious remedy, which is much
greater in this new beneficent system of medicine than under the
old system.
Now, as the new system has nothing in common with the
method of treatment hitherto practised, which consists in the
giving of compound prescriptions, for the preparation of which the
apothecaries are alone privileged; as the new system bears no
resemblance to this, seeing that it never treats with mixtures of




I. REPRESENTATION TO A HIGH OFFICIAL.

789

ponderous, massive doses of medicines, but with inexpressibly small
and subtle doses of always simple medicines prepared in a manner which is in some respects not attainable by the apothecaries,
regarding which, consequently, the art of the apothecary with its
old privileges, can have no privilege;1 I therefore make the following suggestion with all respect, but with a thorough conviction of
its justice:
"To keep the Leipzic apothecaries within the limits of their
privileges, and to notify to them, that their rights do not extend to
a new method of treatment which has never before been practised,
which, far from dispensing, that is, making up prescriptions of the
ordinary kind composed of several powerful medicines (the preparation of which belongs of right to the apothecary), or requiring
them for its treatment, on the contrary only requires inexpressibly
small doses of simple medicines (which the apothecary laughs at),
consequently only simplicia, which no ruler ever yet forbade scientific physicians to administer to their patients, and which consequently are, as we may naturally suppose, not prohibited in any
regulations of medical police."
This concession I look forward to with all the more confidence
and tranquillity, seeing that this new system has, on account of its
immense importance, already gained a public character, and already
in all countries where German is spoken, men are arising who
know how to estimate it as a great benefit for suffering humanity.
Finally, as regards what relates to my disciples,2 I must state
that I am in no way connected with them, and as the subject
is quite irrelevant I shall refrain from touching on it. I do not
consider any as my followers who, in addition to leading an irreproachable, perfectly moral life, does not practise the new art in
such a manner, that the remedy he administers to the patient in a
1 Pure human reason is the voice of God! No government ever yet permitted the
sock-mill to extend its right of monopoly to the person who can extract-what the
mill cannot do-pure starch from wheat without the employment of any machine
(the starch-maker); no government ever allowed the old privileges of the art of
printing to interfere with the development of divine lithography, which also multiplies a thousand-fold thoughts upon paper, and does this much more rapidly and
easily, but without the artificial composition of massive types.
2 [" In the very bitter and abusive complaint of the apothecaries, which was drawn
up by a Leipzic advocate," says Stapf, " malicious insinuations were made regarding
Hahnemann's disciples."]




790

ON DISPENSING BY THE PHYSICIAN.

non-medicinal vehicle (sugar of milk or diluted alcohol) contains
such a small subtle dose of the medicine that neither the senses
nor chemical analysis can detect the smallest absolutely hurtful
medicinal substance, indeed not the slightest trace of anything
medicinal at all, which pre-supposes a minuteness of dose that must
indubitably dispel all anxiety from all officers of state who have to
do with medical police.'
II.-THE HOM(EOPATHIC PHYSICIAN IS PREVENTED BY NO EXISTING
LAWS RELATING TO MEDICINE FROM HIMSELF ADMINISTERING
HIS MEDICINES TO HIS PATIENTS.2
No homoeopathic physician dispenses; according to the principles
of his art it is impossible for him to dispense.
To dispense means to mix together and to compound several
medicinal substances, as the apothecary does.
At the period when the word " dispense" was first used in a
medical sense, the pharmacopoeias under the name of dispensatoria
contained only compound medicinal formulas, as, for example, the
first dispensatorium  that appeared in    Germany, published      at
Niirnberg in 1551.
At the same time, the laws regarding medical affairs ordered that
the apothecary alone, and no one else, should compound the various
kinds of medicine according to the formulas of such a book (dispensatorium), or according to the prescription of the physician, into
a uniform mixture (to dispense), for the treatment of the sick.
In that alone consisted, and still consists, the apothecaries' privilege, and no apothecary has any other privilege.
The laws regulating medicine give to these mixtures of medicines the names of medicines, medicaments, and composita, but the
S[" And what," exclaims Stapf, "was the result of this representation which
Hahnemann addressed to a high personage in the state in consequence of a complaint
made against him by the Leipzic apothecaries regarding the dispensing his own
medicines?-The fatherland lost thereby one of its most illustrious sons! "]
2 Sent to the Authorities of State in 1821, first published in Stapf's Collection
in 1829.




II. THE HOM(EOPATHIST AND THE LAWS ON DISPENSING.      791
several medicinal substances and ingredients they do not term
either medicines or medicaments, but simplicia and species.
When therefore, the medicinal regulations forbid the physician
to administer himself medicines and medicaments to his patients,
in other words, to dispense, they cannot thereby mean anything
else than to prevent him compounding medicinal mixtures from
various medicinal ingredients; but they nowhere forbid him giving
simplicia to his patients.
They also forbid the apothecaries to dispense of themselves, or to
make up and give out medicinal mixtures (medicaments) for
patients, oithout the physician's prescription. Hence the apothecary
dare not prepare for patients without the doctor's prescription any
medicines (composita, medicinal mixtures, medicaments), but he is
permitted to sell to any one simple medicinal substances (excepting
those that act too violently in large dose), without the doctor's
prescription; whence we perceive that the giving of the simplicia
cannot constitute dispensing, otherwise the apothecary would not
be permitted to sell the simplicia.
But it is only permitted to the apothecary to sell simple medicinal substances; he has no privilege for this sale; otherwise there
would be no druggists, who also sell simple medicinal substances
to every one.
Therefore the apothecary is not justified in preventing the physician from administering, himself, a simple medicinal substance to
his patients.
The medicinal regulations never call the common sale by the
apothecary dispensing, consequently it cannot be said of the physician who administers a simple medicinal substance for the relief of
his patients, that he dispenses, because he does not compound for
them any so-called medicines and medicaments, in the legal sense,
that is, any composita consisting of several ingredients. In his unprivileged sale the apothecary gives to any one for money not only
the crude simple medicinal substance, but also the simple preparations therefrom: he gives the buyers tincture of rhubarb, anise
sugar, peppermint lozenges, &c., without let or hindrance, rightly
taking for granted that the alcohol used in preparing the tincture
and the sugar in the lozenges are not to be looked upon as medicinal substances, but as unmedicinal vehicles, in the former case for
the rhubarb, in the latter for the anise or peppermint oil, conse



792

ON DISPENSING BY THE PHYSICIAN.

quently that these simple preparations are not to be regarded as
medicinal mixtures, nor their sale as dispensing.
But to be consistent, he must allow that when the physician gives
a simple medicinal substance mixed with sugar to his patients, this
also cannot be considered dispensing.
Hitherto, however, this has almost never been the case.
From the most remote periods physicians were traditionally
directed by their teachers, by their colleges for instruction in the
art of prescribing, in their hospitals, and by their medical authorities, to treat their patients by prescribing medicines (composita)
in receipts from the apothecary's shop, and the apothecaries were
directed to compound those medicinal mixtures called medicines
and medicaments par excellence, from a variety of ingredients in
considerable quantities, which was called dispensing.
But there unexpectedly arose-since all that is imperfect in the
world gradually advances inevitably towards its perfection-an
entirely new system of medicine, called by its founder Homoeopathy,
and taught in the book entitled Organon of Medicine. This system of medicine, which, as the book teaches, is much more consonant to nature, and as its results shew, is much more successful, is
the direct opposite of the ordinary treatment. According to this
new system, medicinal substances are employed for diseases in
which the ordinary method gave exactly the opposite, but these
were never given as in the ordinary method, in mixtures, but a
single medicinal substance (simplex) only was always given for
each case of disease, and that in such an extremely small dose,
that the ordinary physician of the old school and the apothecary
regard it as an unimportant nothing, for the former was accustomed to employ in treatment only large doses of medicine, but
with entirely opposite aims, which could not do much good; and
the latter was accustomed to compound only large doses of several
medicinal ingredients, and to transform them into medicaments.
Whilst, for instance, the ordinary physician employs the tincture
of rhubarb in drachm doses, introduced into a formula along with
other medicines, for the purpose of causing purging, the homoeopathic physician gives a small part of a drop of the quadrillionth
dilution, and for the very opposite object, namely, for the cure of
morbid diarrhwoas, for which the old-school physician prescribes
large doses of opium, often in vain, whilst the homoeopathic phy



III. HOW MAY HOM(EOPATHY BE ERADICATED?

793

sician employs this same tincture of opium more appropriately for
the opposite state, and permanently removes continued constipation
with a small part of a drop of the billionth dilution.
With this new, much more beneficent healing art, the homoeopathic physician does not interfere with any apothecary's privilege,
nor does he break any existing medicinal regulation.
No medicinal law has ever alleged that the physician must not
give to his patient a single medicinal substance.
No privilege gives to the apothecary the exclusive right that he
alone shall sell, unhindered, to every one, simple medicinal substances in large quantities, at hap-hazard (often to the great injury
of the patient), whilst the physician dare not give to his patients,
with a scientific purpose, the same simple medicinal substances in
such small doses that the patient can only pay for the physician's
skill, not for the remedy, because the latter, on account of its
minuteness, has no commercial value, but on account of this incredible minuteness, must be given by the physician himself, and
cannot be left to any assistant.
According to the principles of his art, which prove the employment of any mixture of medicines whatever for the cure of disease
as contrary to sound reason,1 it is impossible that the homoeopathic
physician can ever administer a medicinal mixture to his patients,
consequently it is impossible that he can dispense, and so encroach
upon the apothecary's privilege.
III.-How MAY HOM(EOPATHY BE MOST CERTAINLY ERADICATED? 2
In no way more certainly than by the authoritative commandment, " Thou shalt not dispense."  I have only a few observations
to make on this subject. Although it were undoubtedly desirable
that there was a method of more certainly curing the sick than can
be done by the ordinary system of treatment, yet homoeopathy,
granting it fulfilled this desirable end, could not be tolerated,1 Organon of Medicine, 297-299, [vide last edition, ý 272 274].
2 From the Allgem. Anzeig. der Deutschen, No. 227. 1825.




794

ON DISPENSING BY THE PHYSICIAN.

First, because from its practice the apothecaries would suffer so
much;
Second, because the large number of physicians instructed
according to the old system would see themselves too strikingly
placed in the shade if homoeopathic treatment in their neighbourhood did much more than the prevailing system of medicine was
able to do.
These two classes of professional men endangered by homoeopathy, the apothecaries and the physicians who practise and teach
the old system of medicine, have consequently done all they could
in order to prejudice the public against this treatment; they have
tried to ridicule it, to malign it, and publicly to insult its practitioners in every way.
But as the fame of several remarkable homoeopathic cures of
diseases, hitherto incurable, spread among the public, and the
latter, as it always does, paid more attention to the facts than to
the calumnies respecting the new artbyits opponents, a different plan
was had recourse to. Those who sought relief for their maladies
at length no longer paid any attention to the invectives and pasquils, anonymous and otherwise, that appeared in the journals
that lent themselves to this purpose, they did not regard the bitter
attacks in Jorg's Critische Hefte, nor Heinroth's theoretical sophisms in his Anti-organon, nor Kieser's nor Sprengel's writingsthey looked to what had actually been effected here and there,
and in many places, and embraced with increasing fervour the new
healing art that did such great things.
All these manoeuvres did homoeopathy no harm; they were
unable to effect its suppression in the slightest degree. It raises
its head more joyfully than ever. Accordingly some persons gifted
with a greater amount of worldly wisdom have already abandoned
these useless counter-mines, and have hit upon the happier expedient of endeavouring to obtain its suppression by the laws of the
land, in order thereby to annihilate it.
It is a main point for the homoeopathic physician, in order that
he may undertake and accomplish the cure of serious diseases
with certainty, that he should himself select his remedies, prepare
them himself, and administer them to the patient with his own
hand, otherwise he is as little able to effect anything certain and
excellent of its kind as the caligrapher would be if he were not




III. HOW MAY HOM(EOPATHY BE ERADICATED?

795

allowed to select his own quills and cut them himself, or the
painter if he were forbidden to prepare his own colours, and was
obliged to get every tint he used prepared by a colour-mixing
institution established by government.
As little would the homoeopathic physician be able to perform a
masterpiece of cure, indeed he would not be able to cure at all, if
he were prevented preparing his own curative agents, the preparation of which demands so much care and such extreme delicacy,
but must let them be made by the apothecary, whose chief endeavour is and must be to annihilate a system of treatment that is
exciting such attention, which not only is unprofitable to him, but
as it undeniably demands infinitely fewer drugs for the accomplishment of the greatest cures, must one day open the eyes of the
world, and render his business, which is only profitable by the
amount of drugs disposed of to patients, useless.
Thus the homoeopathist would naturally not be able to do any
good with his medicines prepared by the apothecary, heaven only
knows how! for no supervision can be exercised over him (seeing
that one white powder of sugar of milk looks, tastes, smells and
reacts chemically exactly like another, whether it contain nothing
or whether it contain the minute homoeopathic medicine or some
medicine quite different), and he must naturally cease to be a
homoeopathic practitioner if he were to be prohibited and forbidden by law to prepare his own remedies.
This it is that the institute of apothecaries and those physicians
brought up in the old system who are not able to equal the homoeopathists in their cures, so earnestly desire for the new school, in
order to destroy the practice of the homoeopathists, consequently
homoeopathy itself, and they are, as we hear, attaining their
object, inasmuch as they prosecute legally the homoeopathists who
give their own medicines to their patients, on the strength of the
laws that forbid the physician to dispense his own medicines;
they avail themselves of the worldly arm      of the judge to
paralyse for ever the hand of the homoeopathist. In this they
were and are successful, for the judge, as a man not belonging to
the profession, acting upon the maxim cuilibet in arte sua credendum, imagines he must listen to the opinion of the medical
authorities on the subject, and make their reasons and deliverances
his own. It is only a pity that in this case he does not hear the calm,




796

ON DISPENSING BY THE PHYSICIAN.

well-weighed allegations of impartiality, but only the embittered,
fiery zeal of the adverse medical authorities, consisting of doctors
deeply imbued with the learning of the past, whose traditional
high position, together with that of their antiquated school,
must, as they are aware, decline if homoeopathists be at liberty to
exercise their art freely. This adverse party will undoubtedly win
the day if the judge does not perceive partisanship in their so-called
estimation of homoeopathy, or if he attends to the interested insinuations of his family physician, who as a physician of the old
school trembling for the renown of the time-honoured faculty,
takes great pains to join in the cry of the complainants and of the
medical authorities, " Crucify him, crucify him! "
If the judge, I repeat, do not estimate all this partisan talk at
its true value, and do not himself fulfil the sacred duty of a wise
impartial applicatio legis ad facta, do not himself examine the law
and its exact meaning with impartiality, then it is all up with the poor
homoeopathist,-he will be condemned, as a dispenser, of having
infringed upon the apothecaries' privilege, and he will be compelled
to abandon his profession. Such a verdict is as laudable as that
of the town magistrate, who, when his friends the inn-keepers of
the place, endowed with the exclusive right to feed guests with
dishes made in their kitchens, brought an accusation against a
man, "that he had encroached upon their privilege and fed
persons," condemned the latter to punishment and the costs, in
spite of all the representations of this benefactor to the effect,
"that there was a great difference betwixt the way he fed and that
in which the inn-keepers fed, and that though the latter might
have the exclusive right to dispense their composite dishes, and to
set them before their guests for money, yet that he had merely,
during a period of general scarcity, distributed gratuitously to
those who required it only simple articles of food, namely, bread
to him who stood in need of bread, meat to him who wanted meat,
or uncooked vegetables to him for whom they were suitable."
The homoeopathic physician is in the position of this benefactor.
In the midst of the dearth of relief for diseases, where allopathy
is of no use, he administers simple things, to cure one thing this,
to cure another that, whatever is most suitable for each, and this
he does gratuitously.
On the other hand the apothecaries' privilege runs as follows:




III. HOW MAY HOM(EOPATHY BE ERADICATED?

797

"that no one shall prepare medicines or medicaments, that is,
dispense them, except the apothecary, from the prescription of the
physician-therefore that the physician shall not dispense medicines, nor the apothecary prepare (dispense) medicine of his own
accord for patients, without the prescription of a legally qualified
physician."
But the words medicine and medicament are never employed in any
laws relative to medicine, except as signifying a medicinal mixture
composed of several medicinal ingredients, and the preparation of
this alone is exclusively entrusted to the privileged apothecary,
who is to prepare it according to the prescription of a legitimate
physician, that is, to dispense; and in like manner the physician
of the old school is enjoined to prescribe several medicinal ingredients in his recipe which are to be mixed together by the apothecary. Thus Professor Gruner in the preface to his Art of prescribing, says expressly, that a prescription must consist of several
medicinal ingredients to be united together, for a single medicinal
substance written down does not constitute a prescription,-and
for this reason every candidate for a medical degree must shew by
his certificates that he has attended the lectures of a professor on
the art of prescribing, and in order to shew that he is thorough
master of it, so as to be able to write prescriptions for a patient to
be made up at the laboratory, he must at the bidding of the
examiner write extempore prescriptions for any diseases named to
him; otherwise (and if he gives expression to his thought that
diseases may also be cured with simple things) he will be rejected, as has happened more than once.
Thus it is certain that according to law the prescription must
direct several medicinal ingredients to be united together, so as
that they shall constitute one medicament, in the dispensing of which
the apothecary's privilege solely and alone consists.
On the other hand, the homoeopathic physician gives his patient
nothing but one simple substance, he never mixes several together,
nor can he do so consistently with his doctrine and his conviction,
consequently he cannot employ in treatment any mixed by the
apothecary. It is therefore impossible that he can encroach on the
business of compounding medicines, in which alone the apothecary's
privilege consists, if he always gives his patient only a simple
medicinal substance. Then who could accuse the homoeopathic




798

ON DISPENSING BY THE PHYSICIAN.

physician of interfering with the right appertaining to the apothecary exclusively of preparing medicinal mixtures (medicines, medicaments), seeing that he has no medicinal ingredients to mix, and
that he mixes none himself, consequently he does not dispense?
Simple medicinal substances (species, simplicia) are not termed
medicines or medicaments by the medicinal laws of any land, on the
contrary these terms are used in contradistinction to one another.
Medicines or medicaments are, in the letter and spirit of these
laws, only compounds and mixtures of several medicinal ingredients
prepared from the physician's prescription by the apothecary, and
mingled together into a composite whole (called by the laws medicine and medicament), which is sufficiently obvious from this, that
the same medicinal laws that confer his privilegium exclusivum on
the apothecary, whereby he obtains the right to prepare medicinal
mixtures according to the physician's prescription, that is, to dispense
medicines (medicaments), and whereby he is at the same time forbidden to dispense medicines without the physician's prescription, that
is, to prepare of his own accord mixtures of several medicinal ingredients for the public-that the same medicinal laws, I say, allow him
to deal in simple medicinal substances, to sell to anyone that asks
for them-rhubarb, cinchona bark, jalap, aloes, castor, asafoetida,
valerian, and all other simplicia and species that are not dangerous
in small quantities-whence it is obvious that the laws which
forbid the apothecary to dispense medicines of his own accord, do
not understand by the term   "medicines" (medicaments), simple
substances, and do not consider that the giving of simple medicinal
things should be regarded as dispensing medicines; otherwise they
would not have allowed the apothecary to sell them. They, however, universally allow the apothecary to do this as a regular retail
seller of drugs, just as they appoint the druggist a wholesale dealer
in drugs.
But if, in order to suppress the homoeopathic physician, persecuted as he is by the old school of medicine and the apothecaries
-seeing that he cannot be accused of practising the apothecaries'
business of mixing medicines (dispensing)-it is sought to indict
him  as a seller of simplicia-an accusation that could not be
brought under the category of the prohibited dispensing (compounding simplicia into a medicament)--be it known that the
homoeopathic physician does not get paid by the patient for his
simple remedy (for medicines and medicaments in the sense of the




III. HOW MAY HOM(EOPATHY BE ERADICATED?

799

medicinal laws they are not, as we have shewn), nor can he be
paid for them, as they are so minute, so inconceivably delicate,
that it is impossible to attach a commercial value to them on
account of their incalculable minuteness! No! he does not get
paid for them, he can only justly demand for his skill and trouble
the fee that cannot be refused to any legitimate physician.
But in order to prevent his escape if possible, the apothecaries
and allopathic physicians sophistically allege, "that the homoeopath also makes up mixtures, and thereby encroaches on the
apothecary's privilege, seeing that he unites his medicinal substance (simple though it be) with sugar of milk."  But sugar of
milk is not a medicinal ingredient, it is a mere vehicle and recipient for the simple medicinal substance of the homoeopathic
practitioner, just like the cane sugar in peppermint lozenges, in
anise-sugar, in sugared worm-seeds and many other similar nonmedicinal things prepared and sold by the apothecary to the
public, which no medicinal regulations forbid him to sell on the
ground of their being mixtures of medicines or their sale coming
under the head of dispensing, and which, in spite of the sugar in
them as a vehicle, remain simple things (simplicia.)
Or shall the apothecary alone be allowed to give to the public a
medicinal substance mingled with sugar, but when the scientific
physician does the same for the purpose of curing disease, shall it
be forbidden, not allowed, punishable?    Is there a judge who
could pronounce such a sentence?
And is there a judge, who, after a careful consideration of the
above truthful representation, could, with the slightest semblance
of justice, so misapprehend and distort our medicinal regulations
that lay down so clearly and so accurately the definition of dispensing medicines, as to interpret them to condemn the homoeopathic physician, who gives his simple substance (never any mixtures) gratuitously in order to relieve his patient, of dispensing
and infringing on the apothecaries' privilege (which only refers to
the compounding of medicaments consisting of several ingredients)?
Could any impartial judge help acquitting him according to the
letter of these plain and unanimous laws?
Let any one point out to us a single passage in any code of medicinal laws which forbids the legitimate physician to administer a
simple medicinal substance in order to relieve his patient!




CONTRAST OF THE OLD AND THE NEW SYSTEMS
OF MEDICINE.'
As long as accurate observation, unwearied research, and careful
comparison have failed to demonstrate really constant original types
of disease for the amazing number of morbid phenomena and cases
of disease occurring in the human subject, which nature appears to
produce in endless variety and very dissimilar to one another, so
long will it be manifest that every single morbid phenomenon must
be homoeopathically treated, just as it presents itself, according to
the array of symptoms that shew themselves in every case, by which
means however they will all be infinitely better removed than by
all the routine treatment that has hitherto prevailed in ordinary
practice.
The adherents of the old school of medicine imagined that they
would best succeed with the treatment of that great variety of
morbid phenomena, if they arbitrarily drew up upon paper a list
of types of disease, which should represent and include within
them all the cases of disease that were met with at the sick-bed.
They gave the name of pathology to this work of theirs.
Seeing the impossibility of efficaciously treating every case of
disease according to its individuality, they imagined that their
business was to select from the apparently infinite variety of different morbid phenomena which nature displays, a number of
diseased states, all resembling each other in having some particular
prominent symptom in common, as fundamental forms, and,
having assigned to them general symptoms that were of not
unfrequent occurrence in diseases and bestowed on them special
names, to give them out for constant, distinct diseases, that always
From the Reine Arzneimittellehre, part iv, 2d edit. 1825.




CONTRAST OF THE OLD AND NEW SYSTEMS OF MEDICINE.         801
remained the same.      The collection of these forms of disease
manufactured by themselves, they asserted to constitute the whole
range of the world of disease, in other words, pathology, in order that
they might be able to lay down special modes of treatment for these
their imaginary morbid pictures, and this constituted the science of
therapeutics.
Thus they made a virtue of necessity, but they did not consider
the evil that must arise from this perversion of nature, they did
not reflect that this arbitrary procedure that did violence to nature,
after having grown old by being propagated through thousands of
years, would at length come to be regarded as a symbolical, unimprovable work.1
The physician who was called in to a case, to determine, as the
rules of his art enjoined, the nosological name of the disease his patient laboured under, must take for granted, in reference to some
symptoms that the pathological works describe as belonging to this
form of disease, that they are merely accidentally absent in his patient,
that they might very well be there, although they are not-the remaining often very numerous and serious sufferings and symptoms
which the patient was really affected with, but which do not occur
in the definition of the nosological name in the pathological work,
he must, so the rules of his art required, regard as unessential, as
accidental, as unimportant, as wild, exuberant offshoots, so to speak,
-symptoms of symptoms-which he need not pay attention to.
It was only by such extraordinary capricious adding-to the
actual morbid state, and equally capricious paring-down of it, that
the adherent of the arbitrary old school succeeded in concocting
the list of diseases recorded in nosological works, and in practice
demonstrating that his patient laboured under one of the diseases
in this nosological system, of which nature never thought when
she made him ill.
"What do we care," say the medical teachers and their books,
" what do we care about the presence of many other diverse symp1 It is only a pity that this fond dream is dispelled when we look at the various
systems of pathology with their different names and dissimilar descriptions of disease,
when we look at the hundred and fifty definitions of fever, and the very various
modes of treatment in the many works on therapeutics, which all lay equal claim
to infallibility. Which of all of them is right? Is not the unnatural, unreal, apocryphal character of all apparent?
3F




802

CONTRAST OF THE OLD AND THE NEW

toms that are observable in the case of disease before us, or the
absence of those that are awanting? The physician should pay no
attention to such empirical trifles; his practical tact, the penetrating
glance of his mental eye    into the hidden nature of the malady,
enables him to determine at the very first sight of the patient
what is the matter with him, what pathological form of disease he
has to do with, and what name he has to give it, and his therapeutic
knowledge teaches him what prescription he must order for it."
Thus then were prepared from that human piece of manufacture
termed pathology those deceptive pictures of disease which were
transferred lege artis to the patient, and falsely attributed to him,
and this it was that rendered it so easy for the physician to recal
to his memory without hesitation a couple of prescriptions which
the clinical therapeutics (of the prescription pocket-book) had in
readiness for this name.
But how did the prescriptions for these names of diseases originate?  Were they communicated by some divine revelation?
My dear sir, they are either formulas prescribed by some celebrated practitioner for some case or other of disease to which he
has arbitrarily given this nosological name, which formulas consist
of a variety of ingredients, known to him no doubt by name, that
came into his head and were put by him into an elegant form
by the aid of that important art which is called the art of prescribing (ars formulas concinnandi recteque concipiendi), whereby the
requirements of chemical skill and pharmaceutical observance were
attended to, if not the welfare of the patient;-one or several
receipts of this kind for the given case, under the use of which the
patient at least did not die, but-thanks to heaven and his good
constitution!-gradually recovered.    These are therefore receipts
taken from the writings of illustrious practitioners; or they are
formulas which, at the request of some publisher who well knew
how capitally prescription-manuals sell, were fabricated in a garret,
off-hand, for the pathological names, by some willing soul in
*         1 What honest man not endowed with clairvoyance could boast of possessing a
mental eye which should enable him to penetrate through flesh and bone into that
hidden essential nature-of things that the Creator of mankind alone understands, of
which mortal man would have no conception, for which he would have no words, if
it were laid open to him? Does not such pretension reach the climax of boastful
charlatanery and mendacious delusion?




SYSTEMS OF MEDICINE.

803

his pay, who was well skilled in the ars formulas concinnandi,
and who was guided in his labour by the account of the virtues
that the lying works on Materia Medica have liberally attributed
to the several medicinal substances.
But if the physician found the disease in his patient too unlike
any of the pathological forms of disease to permit him to give it a
definite name of this sort, it was admissible for him, according to his
books, to assume for the malady a more remote and concealed origin,
in order to establish a treatment thereupon (on this assumption).
Thus, supposing the patient at some former period had suffered
from pain (no matter what kind) in the back, his disease was
instantly ascribed to concealed or suppressed hemorrhoidsif he had had a tense abdomen, mucous excrements, anorexia
alternating with bulimia, or even only itching in the nose, his
disease was called a worm disease; or if he had occasionally
had pains (no matter what kind) in the limbs, his disease was pronounced to be concealed or immature gout, and against this fancied
internal morbific cause the treatment was directed. If there were
attacks of pain in the abdomen, spasm must be to blame for them;
if there was frequent determination of blood to the face, or if the
nose bled, the patient was decidedly too full-blooded; if the
patient grew very thin during the treatment, as he naturally
would, marasmus had to be combatted; if he was at the same
time of a very sensitive disposition, nervous weakness was the
enemy to be attacked; if he suffered from cough, then concealed
catarrh or a tendency to phthisis was in the back-ground; if the
patient sometimes felt pains in the right side of the abdomen, or
even only in the right shoulder, it was undoubtedly concealed inflammation or hidden induration of the liver that was to be taken
into consideration. An old cutaneous disease or an ulcer on the
leg must, in order that the treatment should be directed against
it, be attributed either to some herpetic humour or to some scrofulous virus, and a chronic prosopalgia must of course be ascribed
to the cancerous virus.  After having in vain treated first this
then the other fancied hidden morbid state according to the directions of the clinical books, and after all the mineral waters, which
are said to be useful in some indefinite manner for everything, had
been visited, nothing else remained but to view the case as one 6f
infarctus of the abdomen and obstruction of the minute vessels of
3  2




804

CONTRAST OF THE OLD AND THE NEW

that part according to the idea of the formerly celebrated Kimpf,
and to torture the patient, in Kampf's fashion, with injections into
the colon of hundreds of his absurd mixtures of vegetable decoctions, until he had got enough of them.
In consequence of the ease with which conclusions relative to
the essential nature of diseases were come to, there could, thank
heaven! never be any lack of plans of treatment whereby the
days of suffering of the patient might be fully occupied (for there
are prescriptions in plenty for all names of diseases), as long as
his purse, his patience, or his life lasted.
"But no! we can go to work in a more learned and sagacious
manner, and investigate and conjecture upon the maladies that
afflict mankind in the depths and concealment of abstract views of
life, as to whether, in the case before us, the arterial, the venous
or the nervous system, the sensibility, the irritability or the reproductive function suffer quantitively more or less (for we purposely
avoid considering the infinite variety of qualitive affections from
which these three expressions of vitality may suffer, in order not
to burthen ourselves to a still greater extent with the labour of
research and conjecture); we merely make a guess as to whether
these three expressions of vitality are in a state either of excessive
depression or excessive exaltation. If we are of opinion that the
first, second or third of them is suffering from one or other of
these states of too high or too low, we may boldly proceed to manoeuvre against it, according to the plan of the new iatro-chemical
sect, which found out, ' that nitrogen, hydrogen and carbon alone
constituted the souls of medicines, that is, the only active and
curative thing in them; that, moreover, carbon, nitrogen and
hydrogen could at pleasure regulate and screw up or screw down
(potentize and depotentize) the irritability, the sensibility and the
reproductive function, consequently (if the premisses are correct)
the whole vitality, and therefore they were capable of curing all
diseases.'-'Tis only a pity that they are not yet agreed as to
whether external agents act by means of their similarity or their
contrariety to the component parts of our organism!"
But in order that medicines should really contain these elementary principles, which, as far as was known, they had not hitherto
possessed, they were one holiday evening formally ascribed to
them at the desk, and, in a system of materia medica specially




SYSTEMS OF MEDICINE.

805

created for this purpose, it was decreed how much carbon, nitrogen
and hydrogen each medicinal substance should henceforth contain.
Could medical caprice go farther, or trifle more sinfully with
human life?
But how long shall this irresponsible playing with human life
still last?
After three and twenty centuries of such a criminal mode of
procedure, now that the whole human race seems to be awaking
in order powerfully to vindicate its rights, shall not the day
begin to dawn for the deliverance of suffering humanity which has
hitherto been racked with diseases, and in addition tortured with
medicines administered without rhyme or reason, and without
limit as to number and quantity, for phantoms of diseases, in
conformity with the wildest notions of physicians proud of the
antiquity of their sect?
Shall the pernicious jugglery of routine treatment still continue
to exist?
Shall the entreaty of the patient, to listen to the account of his
sufferings, vainly resound through the air unheard by his brethren of
mankind, without exciting the helpful attention of any human heart?
Or can the so remarkably different complaints and sufferings of
each single patient indicate anything else than the peculiarity of
his disease?  If not, what can this distinct voice of nature, which
expresses itself in terms so appropriate to the various symptoms of
the patient, what can it mean if not to render his morbid state as
cognizable as possible to the sympathizing and attentive physician,
in order to enable him to distinguish the very minutest shades of
difference of this case from every other?
Would beneficent nature, that makes such efforts for our preservation, by her extremely wise, simple, and wonderful arrangement for enabling the patient to reveal to the observer, by words
and signs, the great variety of his altered sensations and morbid
actions, have enabled him to do this so utterly in vain and without
object, and not in order to furnish a clear and accurate description
of his morbid state in the only conceivable manner so as not to
lead the practitioner astray? The disease, being but a peculiar condition, cannot speak, cannot tell its own story; the patient suffering
from it can alone render an account of his disease by the various
signs of his disordered health, the ailments he feels, the symptoms he




806

CONTRAST OF THE OLD AND THE NEW

can complain of, and by the alterations in him that are perceptible
to the senses. But the pseudo-wisdom of the ordinary physicians
thinks all this scarcely worth listening to; and even if they listen
to it, they allege that it is of no importance, that it is empirical
and expressed in a very unlearned manner by nature, that it does
not coincide with what their pathological books teach them and is,
therefore, not available for their purpose, but in place thereof they
put forward a figment of their learned reveries as the picture of the
internal (never ascertainable) state of the disease, in their folly
substitute this delusive pathological picture for the individual state
of each case of disease as nature faithfully delineates it, and direct
their medicinal weapons against this trumped-up phantom of their
imagination, the production of what they call their practical tact.
And what are these weapons of theirs?    Large doses of medicines; that is, be it observed, powerful substances, which, where they
do no good, must and really do injure the patient (seeing that the
peculiar and sole nature of all medicines in the world consists in
their capability, when brought in contact with the living sensitive
body, of morbidly deranging it, each in its own peculiar way),
which must accordingly make the patient worse, if they have not
been selected for remedial purposes with the utmost care that their
peculiar properties shall be adapted to the morbid state! These
medicinal substances, which in themselves are injurious, often very
injurious (and only useful in the cases for which they are suitable)
and which are unknown in regard to their peculiar, true action, were
so blindly resorted to, or in obedience to the mandates of the mendacious book called materia medica, mingled together (if the mixture
was not taken ready-made from the receipt-book) as though they
were drawn at hap-hazard from the wheel of fortune or rather misfortune, with no correct knowledge or rather no knowledge at all of
their true,peculiar effects, and they served but to increase the tortures
of the patient already suffering from his disease, with this barbarous
olla podrida full of disgusting smells and tastes (one spoonful to be
taken every hour!). Was such a procedure beneficial to him? oh
God! no, prejudicial to him. The usual result of such an unnatural and false mode of treatment pursued during every hour of
the day, must be visible aggravation of his state, aggravation which
the ignorant patient is made to believe is the malignant nature of
his disease. Poor, unhappy wretch! what else than to make bad




SYSTEMS OF MEDICINE.

807

worse can be done by such powerful noxious substances raked together according to the whims of the prevalent medical school,
taken at blind hazard and administered in an inappropriate place?
And in this homicidal manner have practitioners gone on acting
in despite of the truth that speaks trumpet-tongued for our information, because, since the remotest times, it has been the habit
with their profession to torture methodically suffering humanity in
this unnatural manner for their money-to their injury!
What human heart in whom the smallest spark of the Godimplanted monitor, conscience, still exists, but must shudder at
such abominable behaviour?
In vain, in vain dost thou seek to silence the audible, terrible
voice of the incorruptible judge in thy conscience, of that sacred
tribunal of God's justice that holds its seat in thy bosom, by the
miserable excuse that others do so likewise, and that such has been
the practice since the most remote ages; in vain dost thou seek to
stifle its still small voice by atheistical ridicule, wild pleasures,
and goblets of reason-obscuring, intoxicating drinks. The Holy
One, the Almighty lives, and eternal unchangeable justice lives
with him.
Now, as the internal operations and processes of the living
human organism cannot be inspected, and, as long as we are
merely men and not God, cannot be perfectly known to us, either
in the healthy or yet in the diseased state, and on that very
account all deductions from the exterior respecting the interior
are deceptive, and as the knowledge of disease can be neither a
metaphysical problem nor the product of fantastic speculation,
but is an affair of pure experience by the senses, because disease
as a manifestation can only be apprehended by observation; therefore every unprejudiced person must at once perceive that, as
careful observation finds every individual case of disease to differ
from every other,' no name borrowed from a pathological system
of man's fabrication which falsely alleges diseases to possess constant unvarying characters, should be attached to morbid states,
which in reality differ so much among themselves, and that there
' With the exception of such diseases as are caused by a miasm of constant
character, or by an always identical cause.




808

CONTRAST OF THE OLD AND THE NEW

can scarcely be any hypothetical representation which we can form
to ourselves respecting any one disease, that shall not be imaginary, delusive and untrue.
Diseases are nothing more than alterations of the healthy,
regular state of health, and as an alteration of this sort consists
merely in the occurrence of many accidents, morbid symptoms,
and perceptible divergences from the former healthy state, seeing
that after the removal of all these accidents and symptoms nothing
but health can remain; so there can be for the physician no other
true view of diseases which shall enable him to discover what
should be the aim of his treatment, and what there is to be cured,
save and except what is perceived by the senses of the observable
alterations of health in the patient.
The honest physician, therefore, whose conscience forbids him
with superficial haste to invent a delusive picture of the malady to
be cured, or to consider it as one of the forms of disease already
existing in pathological works; whose earnest desire it is, in one
word, to investigate the peculiar character of the disease before
him, in order to be able to restore the patient with certainty,-the
honest physician, I say, will observe his patient minutely, with all
his senses, will make the patient and his attendants detail all his
sufferings and symptoms, and will carefully note them down without
adding anything to or taking anything from them; he will thus
have a faithful genuine picture of the disease, and along with that
an accurate knowledge of all there is in it to be cured and removed; he will then have a true knowledge of the disease.
Now as diseases can be nothing more than alterations of the
healthy, regular state of health, and as every alteration of the health
of a healthy person is disease, therefore cure can be nothing than
transformation of the irregular state of health into the regular and
healthy state.
If, then, as cannot be denied, medicines are the agents for
curing diseases, they must possess the power of effecting an alteration in the state of health.
Now as there can be no other alteration of the sound state of
health than this, that the healthy person shall become sick, therefore medicines, inasmuch as they possess the power of healing,
consequently of altering the health of man, the healthy as well as
the sick, must, in their action upon the healthy, produce many




SYSTEMS OF MEDICINE.

809

symptoms, morbid sufferings, and divergences from the healthy
state.
Now admitting, what likewise cannot be denied, that, in order
to cure, the main business of the physician consists in knowing
beforehand the medicine from which a cure is most certainly to be
expected, he must, seeing that a cure by medicines takes place only
by reason of an alteration effected in the state of the health, above
all things know beforehand, what alterations in man's health the
several medicines can effect, before he selects one of them for
administration, if he do not wish to be guilty of a criminal inconsiderateness, and an unpardonable attack upon human life;-for if
every powerful medicine can make the healthy sick, an ignorantly
selected, consequently an unsuitable, medicine must necessarily
render the patient worse than he was.
The most zealous efforts of one who devotes himself to the cure
of diseases (a physician), must hence before all things, be directed
to obtain a foreknowledge of those properties and actions of medicines by means of which he may effect the cure or amelioration of
every individual case of disease with the greatest certainty, that is
to say, he must, before commencing the practice of physic, have
previously obtained a thorough knowledge of the peculiar alterations in the health of man the several medicines are capable of
effecting, in order to be able to select, in every case of disease, the
health-altering medicine most suitable for effecting a cure.
Now it is impossible that the alterations in man's health which
medicines are capable of producing, can be known and observed
more purely, certainly and completely, by any other method in
the world, than by the action of medicines upon healthy individuals; indeed there is no other way besides this conceivable,
in which it were possible to obtain experience that shall be at all
of an accurate character respecting the real alterations they are
capable of effecting in man's health. For the action they shew
with chemical reagents, reveals only chemical properties, which
are no clue to their power over the living human organism. The
alterations they produce when given to animals, only teach what
they can do to them each according to its nature, but not what
they would effect on man, endowed as he is with an organization
of a perfectly different character, and with very different powers
both of mind and body. Even when given in human diseases in




810

CONTRAST OF THE OLD AND THE NEW

order to ascertain their effects, the peculiar symptoms which were
solely due to the medicine can never be distinctly recognised, never
accurately distinguished, amid the tumult of the morbid symptoms
already present, so as to admit of our ascertaining which of the
changes effected were owing to the medicine, which to the disease.
Hence not the slightest claim to a knowledge of the true, pure
action of the various medicines can be made by the ordinary
materia medica, which has scraped together its fables respecting
the virtues of drugs, from the confused use of mixed medicaments
in diseases, its descriptions of which are often not more lucid than
the pathological names bestowed upon them.
The simple natural way alone remains for us, in order to ascertain clearly, purely and with certainty, the powers of medicines
upon man, that is, the alterations they are capable of effecting on
his health-the only genuine and simple natural way, viz., to
administer the medicines to healthy individuals who are attentive
enough to notice upon themselves what each individual medicine is
capable of producing in and on them of a peculiar morbid and
altered character, and to make a careful record of the complaints,
symptoms and alterations in their corporeal and mental state produced by its administration, as the peculiar alterations of man's
health this medicine may henceforth be expected to produce; for
whilst the action of a medicine lasts (provided violent moral
emotions and other injurious influences from without do not
intervene) all the symptoms that occur in a healthy individual
must be the effects of the medicine, seeing that its influence alone
dominates over our state of health at that period.
The physician must possess the most perfect knowledge possible
of the pure alterations in the health produced on the healthy
human body by the greatest possible number of single medicines,
before he ventures to undertake the most important of all vocations, namely, the administration of medicines to a sick person
for his disease, to a suffering fellow creature who appeals to our
most sacred sense of duty to relieve him, who demands all our compassion and all our zeal, to enable us to rescue him, for these
medicines if given improperly are frightful substances, and are
attended with injurious effects, and not unfrequently with danger
to life.
In this way alone will the upright physician act in the most




SYSTEMS OF MEDICINE.

811

important matter of conscience that can be, in gaining a knowledge
of the pure effects of medicines, and in investigating the case of
disease committed to his care, according to the distinct indication
and obvious requirements of nature, and in this way alone will he
act in accordance with the dictates of nature and conscience, even
though he know not as yet what morbid symptoms, artificially produced by medicine on the healthy individual, nature has destined
for the eradication of any given symptom in natural diseases.
This problem he cannot solve by any speculative a priori research, nor by any fantastic reveries-no! he can only solve this
problem also, by experiment, observation, and experience.
Now it is not merely one single observation, but all experiments
and observations carefully conducted demonstrate in the most
convincing manner (to every sensible individual who will be
convinced) that among medicines tested as to their pure effects,
that one alone, which can produce in the healthy individual a
similar morbid state, is capable of transforming a given case of
disease, rapidly, gently, and permanently into health, indeed, that
such a medicine will never fail to cure the disease. The place of the
natural disease in the organism is occupied by the artificial somewhat stronger medicinal disease, which now alone occupies the
vitality, and in consequence of the minuteness of the dose of the
medicine which produced it, runs but a brief course before being
extinguished, and the body is then left without disease, that is,
quite well and (homceopathically) cured.
If then, beneficent nature shews us, in the homoeopathic method
of treatment, the only sure and infallible way by which we can
remove easily and permanently the totality of the symptoms in a
patient, that is, his whole morbid state,' and by which we are able
to make him well at will; if every instance of treatment conducted
on this plan shews us the most unfailing cure; who could remain
so perverse, and neglect to such a degree the good of himself and
of humanity, as to refuse to tread in this path of truth and nature,
but stick to the indefensible, antiquated, purely imaginary phantoms of diseases and modes of treatment, to the ruination of the
sick?
1 After the removal of all his ailments, symptoms and the morbid changes in
his feelings, can anything besides health remain?




812       CONTRAST OF THE OLD AND THE NEW, ETC.
I know full well that it requires heroic courage in order to cure
ourselves of prejudices grown almost into mental infirmities, which
have become sacred to us on account of their hoary age, and that
it demands a very uncommon strength of mind to eradicate from
our memory all the absurdities that have been imprinted upon our
youthful susceptibilities as oracular deliverances, and to exchange
them for new truths.
But the oak-garland with which a consciousness of acting right
crowns us, rewards these victories over ourselves a thousand-fold!
Do old, antiquated untruths become anything better-do they
become -truths-by reason of their hoary antiquity?  Is not
truth eternal, though it may have been discovered only an hour
ago?  Does the novelty of its discovery render it an untruth?
Was there ever a discovery or a truth that was not at first novel?




THE MEDICAL OBSERYER.'
(A FRAGMENT.)
In order to be able to observe well, the medical practitioner
requires to possess, what is not to be met with among ordinary
physicians even in a moderate degree, the capacity and habit of
noticing carefully and correctly the phenomena that take place in
natural diseases., as well as those that occur in the morbid states
artificially excited by medicines when they are tested upon the
healthy body, and the ability to describe them in the most appropriate and natural expressions.
In order accurately to perceive what is to be observed in patients,
we should direct all our thoughts upon the matter we have in
hand, come out of ourselves,, as it were., and attach ourselves', so to
speak, with all our powers of concentration upon it, in order that
nothing that is actually present, that has to do with the subject.,
and that can be ascertained by the senses, may escape us.
Poetic fancy, fantastic wit and speculation must for a while be
suspended, and all over-strained reasoning, forced interpretation
and tendency to explain away things., m-ust be suppressed. The
duty of the observer is then only to take notice of the phenomena
and their course; his attention should be on the watch, not only
that nothing actually present escape his observation., but that
also what he observes be understood exactly as it is.
This capability of observing accurately is never quite an innate
faculty; it must be chiefly acquired by practice, by refining and
regulating the perceptions of the senses, that is to say., by exercising
a severe criticism in regard to the rapid impressions we obtain of
external objects, and at the same time the necessary coolness,
calmness and firmness of judgment must be preserved, together
with a constant distrust of our own powers of apprehension.
From the Reine Arzneimittellehre, pt. iv, 2nd edit. 1825.




814

THE MEDICAL OBSERVER.

The vast importance of our subject should make us direct the
energies of our body and mind towards the observation; and great
patience, supported by the power of the will, must sustain us in
this direction until the completion of the observation.
To educate us for the acquirement of this faculty, an acquaintance with the best writings of the Greeks and Romans is useful,
in order to enable us to attain directness in thinking and in
feeling, as also appropriateness and simplicity of expressing our
sensations; the art of drawing from nature is also useful, as it
sharpens and practises our eye, and thereby also our other senses,
teaching us to form a true conception of objects, and to represent
what we observe, truly and purely, without any addition from the
fancy. A knowledge of mathematics also gives us the requisite
severity in forming a judgment.
Thus equipped, the medical observer cannot fail to accomplish
his object, especially if he has constantly before his eyes the exalted
dignity of his calling-as the representative of the all-bountiful
Father and Preserver, to minister to His beloved human creatures
by renovating their systems when ravaged by disease. He knows
that observations of medical subjects must be made in a sincere
and holy spirit, as if under the eye of the all-seeing God, the
Judge of our secret thoughts, and must be recorded so as to
satisfy an upright conscience, in order that they may be communicated to the world, in the consciousness that no earthly
good is more worthy of our zealous exertions than the preservation of the life and health of our fellow-creatures.
The best opportunity for exercising and perfecting our observing faculty is afforded by instituting experiments with medicines
upon ourselves. Whilst avoiding all foreign medicinal influences
and disturbing mental impressions in this important operation,
the experimenter, after he has taken the medicine, has all his
attention strained towards all the alterations of health that take
place on and within him, in order to observe and correctly to
record them, with ever-wakeful feelings, and his senses ever on
the watch.
By continuing this careful investigation of all the changes that
occur within and upon himself, the experimenter attains the capability of observing all the sensations, be they ever so complex, that
he experiences from the medicine he is testing, and all, even the




THE MEDICAL OBSERVER.

815

finest shades of alteration of his health, and of recording in suitable
and adequate expressions his distinct conception of them.
Here alone is it possible for the beginner to make pure, correct,
and undisturbed observations, for he knows that he will not deceive
himself, there is no one to tell him aught that is untrue, and he
himself feels, sees, and notices what takes place in and upon him.
He will thus acquire practice to enable him to make equally
accurate observations on others also.
By means of these pure and accurate investigations we shall
be made aware, that all the symptomatology hitherto existing in
the ordinary system of medicine was only a very superficial affair,
and that nature is wont to disorder man in his health and in all
his sensations and functions by disease or medicine in such infinitely various and dissimilar manners, that a single word or a
general expression is totally inadequate to describe the morbid
sensations and symptoms which are often of such a complex
character, if we wish to portray really, truly, and perfectly the
alterations in the health we meet with.
No portrait painter was ever so careless as to pay no attention
to the marked peculiarity in the features of the person he wished
to make a likeness of, or to consider it sufficient to make any sort
of a pair of round holes below the forehead by way of eyes,
between them to draw a long-shaped thing directed downwards,
always of the same shape, by way of a nose, and beneath this to
put a slit going across the face, that should stand for the mouth of
this or of any other person; no painter, I say, ever went about
delineating human faces in such a rude and slovenly manner;
no naturalist ever went to work in this fashion in describing any
natural production; such was never the way in which any zoologist, botanist, or mineralogist acted.
It was only the semiology of ordinary medicine that went to
work in such a manner, when describing morbid phenomena.
The sensations that differ so vastly among each other, and the
innumerable varieties of the sufferings of the many different kinds
of patients, were so far from being described according to their
divergences and varieties, according to their peculiarities, the complexity of the pains composed of various kinds of sensations, their
degrees and shades, so far was the description from being accurate
or complete, that we find all these infinite varieties of sufferings




816

THE MEDICAL OBSERVER.

huddled together under a few bare, unmeaning, general terms,
such as perspiration, heat, fever, headache, sore-throat, croup,
asthma, cough, chest-complaints, stitch in the side, belly-ache, want
of appetite, dyspepsia, back-ache, coxalgia, hcemorrhoidal sufferings,
urinary disorders, pains in the limbs (called according to fancy
gouty or rheumatic), skin diseases, spasms, convulsions, &c. With
such superficial expressions, the innumerable varieties of sufferings
of patients were knocked off in the so-called observations, so that
-with the exception of some one or other severe, striking symptom in this or that case of disease-almost every disease pretended
to be described is as like another as the spots on a die, or as the
various pictures of the dauber resemble one another in flatness
and want of character.
The most important of all human vocations, I mean the observation of the sick, and of the infinite varieties of their disordered
state of health, can only be pursued in such a superficial and careless
manner by those who despise mankind, for in this way there is no
question either of distinguishing the peculiarities of the morbid
states, nor of selecting the only appropriate remedy for the special
circumstances of the case.
The conscientious physician who earnestly endeavours to apprehend in its peculiarity the disease to be cured, in order to be able
to oppose to it the appropriate remedy, will go much more carefully to work in his endeavour to distinguish what there is to
be observed; language will scarcely suffice to enable him to
express by appropriate words the innumerable varieties of the
symptoms in the morbid state; no sensation, be it ever so
peculiar, will escape him, which was occasioned in his feelings
by the medicine he tested on himself; he will endeavour to
convey an idea of it in language by the most appropriate expression, in order to be able in his practice to match the accurate
delineation of the morbid picture with the similarly acting medicine, whereby alone, as he knows, can a cure be effected.
So true it is that the careful observer alone can become a true
healer of diseases.




HOW   CAN SMALL DOSES OF SUCH VERY
ATTENUATED MEDICINE AS HOM(EOPATHY EMPLOYS
STILL POSSESS GREAT POWER P
This question is asked not only by the ordinary allopathic physician, who thinks he cannot go far enough with the huge
quantities of medicine he prescribes, but the beginner in homoeopathy also ignorantly puts the same question.
To doubt, if it be possible that they can have the requisite
power, seems to be of itself very foolish, because they are actually
seen to act so powerfully, and manifestly to compass the object
intended, and this they may be seen to do daily.
And what actually takes place must at least be possible!
But even when the hostile scoffers can no longer deny the
effect that lies before their very eyes, they seek, by means of false
analogies, to represent what is actually occurring, if not as impossible, at least as ridiculous.
" If a drop of such highly attenuated medicine," so they talk,
" can still act, then the water of the lake of Geneva, into which a
drop of some strong medicine has fallen, must display as much
curative power in each of its separate drops, indeed much more,
seeing that in the homoeopathic attenuations a much greater pro-,
portion of attenuating fluid is used."
The answer to this is, that in the preparation of the homoeopathic
medicinal attenuations, a small portion of medicine is not merely
added to an enormous quantity of non-medicinal fluid, or only
slightly mingled with it, as in the above comparison, which has
been devised in order to bring ridicule upon the affair, but, by the
succussion and trituration, there ensues not only the most intimate
mixture, but at the same time-and this is the most important
From the Reine Armneinittellehre, pt. vi, 1st edit. 1827.
3




818 HOW CAN SMALL DOSES OF SUCH VERY ATTENUATED MEDICINE
circumstance-there ensues such a great, and hitherto unknown
and undreamt of change, by the development and liberation of
the dynamic powers of the medicinal substance so treated, as to
excite astonishment.
In the above thoughtlessly adduced comparison however, by the
dropping of one drop of medicine into such a great lake, there can
be no question of even its superficial admixture with all parts of a
body of water of such extent, so as that every part shall contain
an equal portion of the drop of medicine.
There is not the slightest question of an intimate mixture in
such a case.
Even only a moderately large quantity of water, for instance,
a hogshead of water, if we attempted to impregnate it in its
entirety, in a mass, with a drop of medicine, could never, after any
length of time, or by any imaginable stirring about, be equally
mixed-not to mention that the constant internal changes and
uninterrupted chemical decomposition of the component parts of
the water, would have destroyed and annihilated the medicinal
power of a drop of vegetable tincture in the course of a few hours.
In like manner, a hundred weight of flour taken as one whole
mass, can by no mechanical contrivance be mixed so equally with
a grain of medicine as that each grain of flour shall obtain an equal
portion of the medicinal powder.
In the homoeopathic pharmaceutical operations on the contrary,
(admitting they consisted merely of a common mixture, which
they do not), as only a small quantity of the attenuating fluid is
taken at a time (a drop of medicinal tincture shaken up along with
100 drops of alcohol), there ensues a union and equal distribution
in a few seconds.
But the mode of attenuating practised in homoeopathy effects not
only an equal distribution of the medicinal drop throughout a great
proportional quantity of unmedicinal fluid (which is out of the
question in the above absurd comparison), but it also happens-and
this is of infinitely greater importance-that by the succussion and
trituration employed, a change is effected in the mixture, which is
so incredibly great and so inconceivably curative, that this development of the spiritual power of medicines to such a height by means
of the multiplied and continued trituration and succussion of a
small portion of medicinal substance with ever more and more




AS HOM(EOPATHY EMPLOYS STILL POSSESS GREAT POWER?         819
dry or fluid unmedicinal substances, deserves incontestably to be
reckoned among the greatest discoveries of this age.
The physical changes and development of power that may be
produced by trituration from substances in nature, which we call
matter, have hitherto only been surmised from some circumstances
-but the extraordinary effects in the way of developing and exciting the dynamic forces of medicines it can produce, have never
been dreamt of.
Now with respect to the development of physical forces from
material substances by trituration, this is a very wonderful subject.'
It is only the ignorant vulgar that still look upon matter as a
dead mass, for from its interior can be elicited incredible and
hitherto unsuspected powers.
All new discoveries of this sort are usually met by denial and
incredulity from  the great mass of mankind, who have neither
adequate acquaintance with physical phenomena nor with the
causes of these phenomena, nor the capacity to observe for
themselves, and to reflect upon what they perceive. They see, for
example, that when a piece of steel is strongly and rapidly rubbed
against a hard stone (agate, flint), an operation that is termed
striking fire, incandescent sparks fly off (and kindle the tinder or
punk they fall on); but how few among them have carefully
observed and reflected upon what really takes place there. All of
them, or at least almost all, go on thoughtlessly lighting their
tinder, and almost no one perceives, what a miracle, what a great
natural phenomenon thereby takes place. When sparks are thus
struck with sufficient force, and caught on a sheet of white paper,
then we may see, either with the naked eye or by means of a
lens, usually small pellets of steel lying there, which have been
detached in a state of fusion from the surface of the steel by the
smart collision with the flint, and have fallen in an incandescent
state, like small fire balls, in the form of sparks, upon the paper,
where they cooled.
1 [What follows appeared in 1825, in the AUlg. Anz. d. D., No. 194, and was intended as a reply to a correspondent of that Journal, who endeavoured to shew the
nothingness of homoeopathy by some of those calculations respecting the minuteness
of the dose, which to this day constitute the stereotyped arguments of the opponents
of the system. In the B. A. M. L. this is abridged, I have restored it to its original
form.]
3o3




820 HOW CAN SMALL DOSES OF SUCH VERY ATTENUATED MEDICINE
How! can the violent friction of the flint and steel (in the
operation of striking fire) cause such a degree of heat as to fuse
steel into little balls. Does it not require a heat of at least
3000~ of Fahrenheit's thermometer in order to melt steel? Whence
comes this tremendous heat?      Not out of the air, for this phenomenon takes place just as well in the vacuum of the air-pump I
therefore it must come from the substances that are rubbed
together; which is the fact.
But does the ordinary individual really believe that the cold
steel which he draws thoughtlessly from his pocket to light his
tinder, contains hidden within it (in a latent, confined, undeveloped state) an inexhaustible store of caloric, which the blow
only develops, and as it were, wakes into activity?    No, he does
not believe it, he has never reflected, and never will reflect, upon
the phenomena of nature.     And yet it is so.    And yet his steel,
which when at rest is cold, contains-whether he believe it or noan inexhaustible store of caloric, which can only be released by
friction. An inexhaustible store of caloric, I repeat, which is not
calculable by the cyphers of any of those arithmeticians who seek
to limit nature and render her contemptible, by applying their
multiplication table to the phenomena of her illimitable forces.
The great natural philosopher, Count Rumford,1 teaches us how to
heat our rooms solely by the rapid motion of two plates of metal
rubbing against one another, without the employment of any
ordinary combustible material whatever.       No further proof is
required to convince the reflective that natural bodies, and especially metals, contain an inexhaustible store of caloric concealed
within them, which however can be called into life only by means
of friction.
The effect of friction is so great, that not only the physical properties, such as caloric, odour,2 &c. are thereby called into life and
developed by it, but also the dynamic medicinal powers of natural
substances are thereby developed to an incredible degree, afact that
1 Count Rumford's treatise on caloric fills the first division of the 4th Vol. of his
works, which have been published by the Weimar Industrie- Comptoir.
2 Horn, ivory, bone, the calcareous stone impregnated with petroleum, &c., have of
themselves no smell, but when filed or rubbed they not only emit an odour but an
extremely fetid one, hence the last-mentioned substance has obtained the name of
&inkstone, though when not rubbed it has no smell.




AS HOM{EOPATHY EMPLOYS STILL POSSESS GREAT POWER.      821
has hitherto escaped observation. The founder of the homoeopathic
system was the first who made this great, this extraordinary discovery, that the properties of crude medicinal substances gain, when
they are fluid by repeated succussion with unmedicinal fluids, and
when they are dry by frequent continued trituration with unmedicinal powders, such an increase of medicinal power, that when
these processes are carried very far, even substances in which for
centuries no medicinal power has been observed in their crude
state, display under this manipulation a power of acting on the
health of man that is quite astonishing.
Thus pure gold, silver and platina have no action on the human
health in their solid state-and the same is the case with vegetable
charcoal in its crude state. Several grains of gold leaf, silver leaf or
charcoal may be taken by the most sensitive person without his
perceiving any medicinal action from   it. All these substances
present themselves to us in a state of suspended animation as far as
regards their medicinal action. But if a grain of gold leaf be triturated strongly for an hour in a porcelain mortar with one hundred
grains of sugar of milk, the powder that results (the first trituration)
possesses a considerable amount of medicinal power. If a grain of
this powder be triturated as strongly and as long with another hundred grains of sugar of milk, the preparation attains a much greater
medicinal power, and if this process be continued, and a grain
of the previous trituration be rubbed up as strongly and for as
long a time, each time with a fresh hundred grains of sugar of
milk until, after fifteen such triturations, the quintillionth attenuation of the original grain of gold leaf is obtained, then the last
attenuations do not display a weaker, but on the contrary, the
most penetrating, the greatest medicinal power of the whole of the
attenuations. A single grain of the last (quintillionth) attenuation
put into a small, clean phial, will restore a morbidly desponding
individual, with a constant inclination to commit suicide, in less
than an hour to a peaceful state of mind, to love of life, to happiness, and horror of his contemplated act, if he perform but a single
olfaction in the phial, or put on his tongue a quantity of this
powder no bigger than a grain of sand.1
1 [In connexion with this subject I may be permitted to adduce a few points bearing
on the question of the dose of gold. In the first place we learn from the 4th part of




822 HOW CAN SMALL DOSES OF SUCH VERY ATTENUATED MEDICINE
From this we perceive that the preparations of medicinal substances by trituration, the farther the development of their powers
is thereby brought and the more perfectly capable they are thereby
rendered for displaying their power, become capable of answering
the homoeopathic purpose in proportionately smaller quantities and
doses.
Medicinal substances are not dead masses in the ordinary sense
of the term, on the contrary, their true essential nature is only
dynamically spiritual-is pure force, which may be increased in
potency by that most wonderful process of trituration (and succussion) according to the homoeopathic method, almost to an infinite
degree.
In the same way liquid medicines do not become by their
greater and greater attenuation, weaker in power but always more
potent and penetrating.      For homoeopathic purposes this dilution is performed by well shaking a drop of the medicine with a
hundred drops of a non-medicinal fluid; from the bottle so shaken
a drop is taken and shaken up in the same manner with another
hundred drops of unmedicinal fluid, and so on. This result, so
incomprehensible to the man of figures, goes so far that we must
set bounds to the succussion process, in order that the degree of
attenuation be not over-balanced by the increased potency of the
medicine, and in that way the highest attenuations become too
the R. A. M. L. and the Chr. Kr. that this substance was proved upon healthy individuals in doses of from 100 to 200 grains of the first trituration (one to two grains
of pure gold). Then, with respect to the doses to be administered in disease, we find
it stated in the introduction to gold in the 2nd editions of both these works (published
respectively in 1825 and 1835, probably a repetition of what appeared in the 1st
edition of the R. A. M. L. published about 1820) that Hahnemann had cured several
(mehre) individuals suffering from suicidal melancholia with from 3/ooths to /iooths
of a grain of gold for the whole treatment. He also mentions in these places that he
had found a smaller quantity, viz., /ooooth part of a grain of gold not less powerful,
especially in caries of the nasal and palatial bones, from the abuse of mercurials. In
the essay of which our text is a translation (published in 1825) he states that a
quintillionth (15th dilution) was the preparation he then generally used; in the
same essay as it appears in the 6th part of the R. A. M. L. (published in 1827), and
in the introduction to gold in the R. A. M. L., (published in 1825) he recommends a
quadrillionth of a grain (12th dilution) for a dose. In the Chr. Kr., (published in
1835) he of course advises the decillionth (30th dilution) to be given in every case.
The following, then, was the state of Hahnemann's practice in reference to the dose
of this remedy at different periods. About 1820, 1st or 2nd attenuation; in 1825,
12th or 15th attenuation; in 1827, 12th attenuation; in 1835, 30th attenuation.]




AS HOM(EOPATHY EMPLOYS STILL POSSESS GREAT POWER?          823
active. If we wish, for example, to attenuate a drop of the juice
of sundewI to the decillionth, but shake each of the bottles with
twenty or more succussions from a powerful arm, in the hand of
which the bottle is held, in that case this medicine, which I have
discovered to be the specific remedy for the frightful epidemic
hooping-cough of children, will have become so powerful in the
fifteenth attenuation (spiritualization) that a drop of it given in
a tea-spoonful of water would endanger the life of such a child;
whereas if each dilution-bottle were shaken but twice (with two
strokes of the arm) and prepared in this manner up to the decillionth attenuation, a sugar globule the size of a poppy seed
moistened with the last attenuation cures this terrible disease with
this single dose without endangering the health of the child in
the slightest degree."
But these homoeopathic medicinal attenuations (-pity there is
no more appropriate word in any language to express what takes
place in the process, as this phenomenon was never heard of before
its discovery-) these attenuations are so far from     being diminutions of the medicinal power of this grain or drop of the crude
medicinal substance keeping pace with its extreme fractional diminution as expressed by figures, that, on the contrary, experience
shews them to be rather an actual exaltation of the medicinal
power, a real spiritualization of the dynamic property, a true,
astonishing unveiling and vivifying of the medicinal spirit.
But there are various reasons why the sceptic ridicules these
homoeopathic attenuations. First, because he is ignorant that by
means of such triturations the internal medicinal power is wonderfully developed, and is as it were liberated from its material bonds,
so as to enable it to operate more penetratingly and more freely
upon the human organism; secondly, because his purely arith1 Drosera rotundifolia, a plant, which, along with its various species, grows on
moist meadow-ground, and is very noxious to sheep.
2 [In the version of this passage as it stands in the R. A. M. L., the decillionth
attenuation prepared with twenty succussions to each bottle is spoken of as endangering the life of the hooping-cough patient, and from this circumstance and the
fact that it is not stated that such a preparation did endanger the life of any patient,
but only that it would (wiirde) endanger it, we are, I think, justified in inferring that
Hahnemann did not actually observe any such case, but that he merely supposed
that it would occur, which his theory of the increase of potency in homoeopathic
medicaments by the processes of trituration and succussion would lead him to do.]




824               HOW CAN SMALL DOSES, ETC.
metical mind believes that it sees here only an instance of enormous
subdivision, a mere material division and diminution, wherein every
part must be less than the whole -as every child knows; but he
does not observe, that in these spiritualizations of the internal
medicinal power, the material receptacle of these natural forces,
the palpable ponderable matter, is not to be taken into consideration at all; thirdly, because the sceptic has no experience relative
to the action of preparations of such exalted medicinal power.
If, then, he who pretends to be a seeker after truth will not
search for it where it is to be found, namely, in experience, he will
certainly fail to discover it; he will never find it by arithmetical
calculations.




ON THE IMPREGNATION OF THE GLOBULES WITH
MEDICINE.1
If we add to the mode of procedure recommended by the
esteemed author of this letter, that the globules, from 5 to 600 of
which should be in each little bottle, and fill it only about half full,
should be moistened with from three to four drops of the alcoholic
medicinal dilution, and not shaken in the corked up bottle, but
rather stirred about in it with a silver or glass pin, and the bottle
kept uncorked until by the evaporation of the alcohol they become
dry and no longer adhere to each other, so that each globule may
be taken out separately; in this way the homoeopathist possesses
indisputably the most convenient process for having his medicines
always of the same good quality and ready for immediate use.
The medicated alcohol that evaporates whilst the globules are
thus stirred for about an hour is no loss for the globules that are
thus dried in the bottle, seeing that, strictly speaking, for the
purpose of moistening 600 of the smallest globules a single drop
would suffice, and consequently in this desiccation by the evaporation of the superfluous medicated alcohol they do not undergo any
diminution whatsoever of their medicinal power, as I have been
superabundantly convinced by employing them in practice.
With this little alteration the process recommended by my
esteemed and patriotic correspondent deserves the thanks of every
homoeopathic practitioner, for it is the most perfect that has been
proposed, as my own experience convinces me.
1 From the Archiv der horn. Heilk., Vol. viii, pt. 2; p. 162. 1829. [This article
appears as a note appended to a communication from M. Korsakoff, a Russian
homoeopathic dilettante, suggesting the use of little tubes for holding the globules
ready made, such as those at present in almost universal use for pocket cases. He,,  ^
proposed that the globules should be saturated by pouring upon them two or three
drops of the medicinal dilution, and shaking the bottle several times strongly.]




826     ON THE IMPREGNATION OF GLOBULES WITH MEDICINE.
It is only in this form that the homoeopathic medicines can be
sent to the most distant parts without any alteration of their
powers, which is impossible to be done in their fluid form; for in
that case the medicinal fluid, which has already been sufficiently
potentized during their preparation (by two succussions at each
dilution), receives an enormous number of additional succussions
during the transport, and they are so highly potentized by a long
journey, that on their arrival they are scarcely fit for use, at least
not for susceptible patients, on account of their excessive strength,
as many observations go to prove.
The manufacture of little bottles from glass-tubes by means of
the blow-pipe, as our author directs, is a real improvement, as
they can be prepared in this way much more easily, neatly and
completely (with scarcely any constriction of the neck) than they
can be obtained in ordinary glass manufactories.1
1 [Hahnemann, as we learn from his writings, used globules of various sizes.
Those for administration by the mouth he usually describes as of the size of a
poppy-seed; he states them to be of the weight of 300 (Introd. to Belladonna and to
Aconite, R. A. M. L., pt. i) or 200 (Chr. Kr. pt. i, p. 188) to the grain, and he says
that 1000, many more than 1000 (R. A. M. L., loc. cit.) or 300 (Organon, c cclxxxv,
note) of them are sufficiently moistened by one drop of alcohol. Those for olfaction
he usually states to be of the size of a mustard seed (Organon, p. 9, note); and he
elsewhere (Organon,  cclxxxviii, note) states that 10, 20, or 100 may weigh a
grain. These globules were to be made by the confectioner, of sugar (Organon,
c cclxxxv, note, Chr. Kr., pt. i, p. 187), and his latest mode of moistening them
was to put them into a small glass or porcelain cup, to pour upon them a few drops
of the medicinal dilution, to let them stand thus a minute, and then to empty them
out on blotting paper, so as to dry them before putting them into a bottle for future
use.]




ALLOPATHY:
A WORD OF WARNING TO ALL SICK PERSONS.1
Allopathy, or the method of treatment of the old school of medicine, boasts, that for two and a half milleniums it has possessed the
art of removing the cause of the diseases entrusted to it, and thusin opposition to homoeopathy, which cannot do this-that it alone
effects cures of the cause, and heals in a rational manner.
If, however, the allopathists would remove the cause of chronic
diseases, which constitute much the greater number of all diseases,
it must previously be known to them. But it has in all ages been
completely unknown to them, and they went almost beside themselves, when the new discoveries of homoeopathy shewed them that
all chronic diseases depend solely and alone upon three chronic
miasms, whereof the whole of the old school of medicine had not
hitherto the most distant idea.
Now, as during all this long period they knew not the originating cause of all chronic diseases, it follows that hitherto they have
treated away at an unreal cause, that therefore they could not
remove the fundamental cause which was unknown to them, and
consequently, that they could not really cure chronic diseases.
The result also proved this; for if we except the diseases derived
solely from the venereal chancre-miasm, in which mercury, which
had been empirically discovered by non-medical persons, was no
doubt efficacious, the whole array of physicians of the old school,
with all their medicinal apparatus, could certainly aggravate all
other chronic maladies, and make them incurable, but they were
incompetent to restore to health one chronic patient. For, by
the force of medicine to transfer the patient from one chronic disease
into another and worse malady of different appearance, and then,
1 Published as a pamphlet. Leipzic, 1831.




828

ALLOPATHY:

as is usually done, to imagine that this took place accidentally,
and that the physician was perfectly innocent of the appearance
of this new sad state, is to delude one's self, and cannot be
termed curing, nor restoring to health, but deceiving and ruining
the patient.
The physician of the old school erroneously alleged the various,
often purely imaginary, characters and phenomena of chronic
diseases, to be their cause (whereas they are but the products
and expressions of that cause), and they treated now for a chill,
catarrh and rheumatism, anon for gout, congestion in the portal
system, hoemorrhoids, obstructions in the lymphatic vessels, indurations, morbid matters in the juices, impurities, excess of pituita
in the primpe viae, weakness of the stomach and digestive organs,
nervous debility, spasm, plethora, chronic inflammation, swelling,
and so on. They imagined these conditions to be the cause (causa)
of the chronic diseases, which had to be removed, and the diminution or suppression of these by means of the treatment hitherto
prevalent to be cures of the cause.
But when by the force of their medicines they succeeded in
diminishing or dispelling one of these characters or states, there
naturally always came in its stead another morbid phenomenon
(another product of the original cause). How then could the first
state have been the fundamental cause when its removal was
followed by no true cure, no restoration of health-when in place
of the one that had been driven away, another morbid phenomenon
and that always of a worse kind, made its appearance?  Whence
was originally derived the apparent morbid character and its
attendant phenomena? whence proceeded the patient's liability
to get cold, catarrh, rheumatism, gout, congestion of the portal
system, haemorrhoids, obstruction in the lymphatic vessels, indurations, mucosities and impurities in the primae viae, the apparent
acridity in the blood, the weakness of the stomach and digestive
organs, the febrile state, the nervous debility, spasm, plethora,
chronic inflammation, swelling, and so forth?  Whence did these
actually and originally come, since they are nothing more than
single glimpses of the probable character of the disease, and only
single expressions (symptoms) of the indwelling malady, the combatting of a single one of which (under the false title of cause)
with medicines, is truly nothing else than (blameworthy) symp



A WORD OF WARNING TO ALL SICK PERSONS.

829

tomatic treatment, which these gentlemen with unwarrantable pretension allege to be rational treatment of the cause? But what, then,
was the proper and real original cause of these varying, secondary
maladies and phenomena, whose removal would constitute a true
causal treatment, a radical, permanent cure, a real rational mode of
practice? Of all the many thousands of physicians of the old
school, none knew it, nor will they now deign to learn 1 it from
homoeopathy, but yet to this day they assert that their bungling
treatment, which never conduces to the advantage, but invariably
to the aggravation of chronic diseases, is rational treatment.
A more ludicrous pretension, and, as the universal, inevitable
result teaches, one more fraught with injurious consequences to
humanity, there never has been! In the first place, as regards their
treatment of diseases of a rapid course (acute diseases), experience
shews, that patients affected with such maladies, who, without any
allopathic interference, were left entirely to their unaided vital
force, recovered on an average much sooner and much more certainly than when they gave themselves up to the treatment of the
old 'school of medicine, under which many died who, without its
unhelpful operations, would have lived, and after which many long
remained in a wretched state, and usually at last died miserably of
the consequences of the fine treatment, who without these medicinal onslaughts on their lives, would much sooner have recovered
and would much more certainly have been preserved.
The reason of this was, that allopathy attributed a false character
to the acute diseases it had to cure, in order that they might conform to the plan of treatment once adopted for them. Thus we
see that in inflammations of the lungs and acute pleurisy, the
allopathists pre-supposed an excess of blood (plethora), of inflammatory blood, as the fundamental cause, and they did nothing but
draw off blood, and go on drawing off blood, from the veins, when
-as homoeopathy teaches and practises-they ought merely to have
removed the morbid irritation of the arterial system by means of the
few internal medicines suited for allaying it (and eradicating all the
inflammatory character of the blood), in order to extinguish the
entire, seemingly fatal disease in a few hours, without it being at all
requisite, according to their old destructive routine treatment, by
1 Is it much less shameful not to know a thing, than to refuse to learn it!




830

ALLOPATHY:

venesections and leeches, to rob the patient of this innocent, indispensable life's-juice, and, consequently, of all his strength, which
after this mistreatment he could either, as was most usual, never
regain, or only after a long indisposition.
It is incomprehensible how the allopaths can consider it a great
sin, if, in inflammatory diseases, e. g., pleurisy and inflammation of
the lungs, blood be not drawn off, and that repeatedly and in large
quantity, as they most injuriously, according to their stiff observances and agreeably to their art which has grown grey in gross
material notions, make it an invariable rule to do, and would
wish to make it the same for better physicians.
But if this is an efficacious sort of method, how can they reconcile it with the fact that of all that die in a year, a sixth part of
the whole number dies under them of inflammatory affections, as
their own tables prove! Not one twelfth of these would have
died had they not fallen into such sanguinary hands, had they been
but left to nature, and kept away from that old pernicious art.
Hundreds and thousands more die miserably every year-the
most promising youths of the country, in the bloom of their ageof wasting, consumption and suppuration of the lungs! You
have their death on your consciences! for is there one among
you that has not laid the seeds for it by your fine mode of treatment, by your senseless bloodletting and your antiphlogistic
appliances in a previous inflammation of the lungs, which must
thereby infallibly turn into pulmonary consumption, and prove
fatal?  This irrational, antipathic, barbarous mode of treating
inflammation of the lungs by numerous venesections, leeches and
debilitating substances (termed by you antiphlogistics), yearly
sends thousands to the grave, by fever from deprivation of the
forces (nervous fever), general swelling (dropsy), and suppuration
of the lungs! Truly an excellent, privileged mode of covertly
destroying wholesale the flower of mankind!
Can that be called curing, curing rationally, treatment of the
cause?
On the other hand, no patient cured by homoeopathy (often
with wonderful rapidity) from even the most severe inflammation of the lungs will be found who died thereafter of wasting and
suppuration of the lungs, for it cures the seemingly most fatal
inflammations of the lungs in this way only, by removing the




A WORD OF WARNING TO ALL SICK PERSONS.

831

dangerous morbid commotion of the circulating system, together
with the accompanying pains, by means of a few mild but appropriate internal medicinal agents, often within the twenty-four
hours, and allows the patient's strength to remain unaffected by
avoiding all evacuations of blood and all debilitating antiphlogistic
remedies; for it knows what the physicians of the ancient school
do not yet know, and, alas! do not wish to know, that violent
acute inflammations of the chest (and of other parts) are nothing
but explosions of an exanthematous miasm (psora) that lies hid in
the interior (no one free from psora ever gets inflammation of the
lungs!) and it knows how that, after subduing the inflammatory
excitement of the circulation, it has to take care that the psora be
cured without loss of time by means of appropriate antipsoric
medicines, so that it shall not establish its seat in the lungs which it
can so easily destroy; and this the homoeopathic curer of the acute
pulmonary inflammation may all the more readily accomplish,
since he has not wasted the vital forces (so indispensable for producing the reaction to the antipsoric remedy to be employed) by
tapping off the blood and by antipathic cooling remedies, as is
invariably done by the allopathist.
Moreover the allopathist does not treat the other diseases of
rapid course (acute) according to their several peculiarities, as the
homoeopathist does, but he treats them   according to the pathological denomination introduced in the old school, upon one and
the same plan of treatment that has once been laid down in the
book. Thus all epidemic intermittent fevers, differ they ever so
much among each other, are not cured by him with the medicine
specifically adapted for each individual intermittent fever, but are
invariably merely suppressed by strong, the very strongest doses
of cinchona bark, repeated often for weeks together; the patient,
however, does not get well; by this process he indeed loses all
the alternations of rigor and heat (this they call getting well), but
he becomes more ill, in another way than he was while he still had
the fever, with the insidious bark disease which has been forced
upon him, and which often lasts for years.
And in like manner these physicians, who arrogate to themselves the title of rational practitioners, have in their books ready.
made, fixed names for the acute diseases that attack mankind,
either singly (sporadic) or generally prevalent (epidemic) or infec



832

ALLOPATHY:

tious (contagious), and for each name they are pleased to bestow
on the prevailing disease they have also a certain defined plan of
treatment (only varied from time to time to suit the fashion),
which this fever, that is often quite unknown or that has never
appeared in the same form, must be content with, whether it do
good or harm. Those whom a giant's constitution does not help
through must infallibly succumb under such treatment.
Very differently does the homoeopathist act: he judges of the
prevailing disease according to its peculiarities and phenomena
(its individuality) without suffering himself to be led astray to a
wrong mode of treatment by any pathological systematic nomenclature, and by attention to the present state, complaints and
ailments of the patient, he generally, by means of the suitable
(specific) remedy, brings about the desired recovery.
But I must return to the immeasurably more numerous, longlasting (chronic) diseases of mankind, which, under the old system
of physic, have hitherto made the world a very vale of tears, in
order to shew how infinitely inferior, in such diseases also, the
injurious Allopathy is to the beneficent Homoeopathy.
Without knowing (from the earliest time till now) the true and
only cause of chronic diseases, Allopathy violently attacks the
patients with a number of medicines given in large doses in rapid
succession, often continued for a long time, in order-agreeably to
the misapplied saying of the common people, "much helps much "
-to conquer the disease by physical force. And by the power of
what medicines do they seek to accomplish this?     By such as
(although the old school physicians alas! know it not) invariably
have powers of quite a different kind, and produce effects on the
human health of quite another character than what are suitable
for the cure of the disease.
Hence the medicines they usually employ in these diseases are
appropriately termed allopathic (aMoax, aliena, ad rem non pertinentia, unsuitable), and their mode of treatment is justly denominated Allopathy.
But how did it happen that they could make use of such
inappropriate (&~ ora) medicines, to the injury of their patients?
Evidently from no evil design, but from ignorance! They employ
them because they know not their real properties and real effects




A WORD OF WARNING TO ALL SICK PERSONS.

833

upon the human body; and moreover, because it is a custom
introduced among them to administer them in such diseases,
because it stands so printed in their books, and because when
they were students it was long so taught them ex cathedra.
But how did it happen that in the employment of these medicines among patients during the many centuries that this system
of medicine has existed, they should not gradually have noted in
these medicinal substances what peculiarities each individually
possessed, and what were the effects of each upon the health of
man, so that at length they might have so gathered what each
was adapted to as a curative agent?
To this it will suffice to reply, that these physicians of the old
school possessed and do still possess a most approved method of
guarding and preserving themselves from the knowledge of the
peculiar mode of action of each individual medicine, and thereby
rendering it imperceptible to their eyes and observation.
Every one of their young physicians, namely, on undergoing his
examination for the high degree of Doctor of their art, must prove
by the certificates of the professors that he has diligently attended
the lectures on the art of prescribing, and must by the extempore
writing of prescriptions, that is to say, of recipes composed of several
different medicinal substances for the names of diseases given him
by the examiner (like conti finti), demonstrate that he is perfect
master of the noble art, essential to allopathy, of always prescribing
for the patient, lege artis, several medicinal ingredients, mingled
in one prescription, and, consequently, of carefully and entirely
eschewing the employment of a single simple medicinal substance.
Thus even to this day every prescription composed of several
different medicinal substances, betrays the prescriber to be without
dispute an allopathist, one of the many thousands belonging to the
unimprovable old school of physic!
Here I would ask my readers on their consciences to tell me,
how it were possible that these physicians, although during these
many centuries their numbers must amount to millions, could
detect and learn the peculiar properties of each of the single
medicinal substances while constantly using such mixtures of
drugs?
If we should give one of the mixtures according to their prescription
3H




834

ALLOPATIIY:

even to a quite healthy person, quite free from all morbid symptoms, would we from the effects that result from such a mixture,
even though it should consist but of two1 different ingredients,
ever be able to decide with certainty which of the effects that
ensue are to be attributed to the one, which to the other ingredient?   Never!-in all eternity, never!
Now, as even in trying a mixture of only two different medicinal substances upon a healthy person, we can never satisfactorily
observe the special effects of a single one of the two upon the
human health-since the mixture can           only manifest a middle
action of both the two together; how, I should like to know,
can it be otherwise than quite impossible to distinguish the peculiar powers and special action of each of the several ingredients
in an artistic prescription, when it is given to patients, that is to
say, to persons already suffering from a number of alterations of
health?
Who can fail to perceive from all this, that, besides that the
physicians of the old school never seriously set about making experiments with simple medicines on healthy individuals-who can
fail to perceive, I say, that they all, from  the remotest times until
now, must remain up to the present day perfectly and thoroughly
ignorant of the countless, special, pure, real effects and powers of each
individual medicine, consequently of all medicinal substances (if we
except the few most palpable phenomena of many medicines, that
they display even when mixed, and that cannot remain concealed
even from ordinary persons, e.g., that senna-leaves purge, opium
stupifies, mercury causes salivation, ipecacuanha excites vomiting,
1 According to that old so-called art of medicine, so repugnant to common sense, there
should be more then two, at least three, different things in an artistical prescription;
apparently, in order that the physician who prescribes lege artis, from the use of such
prescriptions for diseases, may be deprived of all chance of ascertaining which of the
different ingredients was useful or which did harm, and may also never see or be
taught by experience what particular effects each of the several ingredients of the
prescription, each simple medicinal substance therein produces on the human health,
in order to be able to employ it with certainty in diseases. Thus a bad job always
betrays itself by this, that its author seeks to keep us in the dark. When, however, now
and then the conscience of the good gentlemen was troublesome, when of late a ray
of the homoeopathic truth struck tpon their eyes, we have seen them put but two ingredients in their prescriptions, while they asserted that they now prescribed quite
simply; just as if a compound could ever make a simple!-In all eternity, never!




A WORD OF WARNING TO ALL SICK PERSONS.

835

cinchona bark suppresses the type of intermittent fevers, and a
few more of the same kind.)
This, therefore, is an art the professors of which have and wish
to have no knowledge of all their tools!
Among the very meanest of arts there does not exist one such
as this! The medical art of the old school alone gives an unheard
of example of the kind!
And yet these gentlemen boast so loudly, notwithstanding their
incredible irrationality, of being the only rational physicians, and,
in complete ignorance of the original cause of all the innumerable
chronic diseases not of a venereal character, of alone being able to
perform cures of the cause! Perform them-with what? With tools
whose pure actions are quite unknown to them, with medicinal
substances (prescribed in mixtures), from a special knowledge of
which they have introduced into their system, as I have shewn,
the most effectual arrangements for preserving themselves?
Was there ever a more ridiculous pretension? a more recherch6
piece of stupidity? a more complete negation of a curative system?
Of this stamp, dear sick people, are all the ordinary physicians.
Of such alone do the medical authorities of all civilized lands
consist.  These alone sit on the medical judgment-seat, and condemn all that is better, which, whatever advantage it may be of to
mankind, is opposed to their antiquated system!1 These alone are
the superintendents and directors of the countless hospitals and
infirmaries, filled with hundreds and thousands of patients pining
in vain for health! Of such alone are the body physicians of
princes and ministers of state. Of such only are the ordinary
professors of medicine in all universities!   With such routine
practitioners alone, of great and small degree, do our towns swarm,
from the celebrities who knock up two pairs of horses daily in
swift-rolling gilded chariots in order to pay visits of a couple of
minutes' duration to sixty, eighty, or more patients, down to the
crowd of low practitioners, who, in worn-out clothes, must exert
their legs to pester their patients with frequent visits and nu1 What wonder is it that they, with insolent pride in their principles transmitted
to them from the dark middle ages, zealously strive to suppress, by the worldly
arm of the lawgiver whose favoured house-physicians they are, the new medical art,
which by its deeds of cure surpasses all their medical promises, and leaves their antiquated system of treatment far behind!
3   2




836

ALLOPATHY:

merous prescriptions, with but scanty remuneration for their
fruitless and hurtful efforts, which are certainly much better paid
in the case of the high and mighty ones of their tribe.
If this innumerable host of doctors of the old school were merely
useless, and merely not profitable to their patients, even that would
be bad enough; but they are unspeakably hurtful and ruinous
to sick mankind. Without knowing it, without for an instant
dreaming of it-without even willing it, they produce incalculable
mischief (although in chronic diseases this is not so obvious) by
their furious assaults upon the patients with large doses of
powerful, almost invariably unsuitable drugs, which they continue
often for a great length of time, repeating them daily (often,
indeed, several times a-day), and when this naturally does no good,
they continue them in increasing quantities, and thus they not
unfrequently punish the patient without cessation for years, now
with this and now with that powerful medicinal mixture, unless
they procure for him (and for themselves too) a kind of respite
in the fine season, (which they term the bath-season) by sending
him to some mineral water or other, or still better to two in
succession, which may just then happen to be the most fashionable,
ordering him either to swallow daily no inconsiderable quantity
and even an increasing quantity, or to take daily at least one
bath of several minutes' duration, for weeks together. And yet
each draught of a mineral water, and each bath of it that is taken
is a strong dose of strong medicine!
What will the reflecting public say when they learn that the
physicians of the old school of medicine have never in twenty-five
centuries learned to know, that every medicinal substance, almost
without exception, taken in one single dose, requires several days,
sometimes even weeks to expend its full action on the human
body, as innumerable careful observations, experiences, and experiments have taught and satisfactorily proved to the accurate
observer of nature, the homoeopathic physician?  What will the
hitherto deluded world say to this, that the physicians of the old
school, as a proof that they yet know nothing respecting this most
indispensable truth, still go on to this day, giving their drugs to
patients day after day in several doses a-day, each dose of which
is disturbed in its action by the one that speedily follows it, so
that from their ignorance no dose is allowed one hundredth part of




A WORD OF WARNING TO ALL SICK PERSONS.

837

the time required for the completion of its action-an over-loading
of the body outside and in with the same medicinal mixture,
wherefrom only injury to the health can be effected, but never
anything good, appropriate, beneficial!
The reflective, unprejudiced reader will find a difficulty in
solving the riddle of how in all the world the great crowd of
physicians could for so many centuries stick to such a disastrous
treatment of chronic patients?
The ordinary hurtful mode of treatment of the old school physicians here alluded to would be incredible, did it not with them
depend on the grossest ignorance of the true process of nature, I
mean of what experience shews to be the relation between the
substances called medicines and the human body, that is to say,
did it not depend even at the present day on the wretched indefensible superstition of these men (called physicians), that drugs,
even in large, oft-repeated and increased doses, are one and all per
se and absolutely in all cases wholesome things.
The smallest approach to accuracy in observation, had they
been capable of it, would have convinced them that this was
radically false, and that the reverse of it only was true, namely:
that all things that can be termed medicinal are, per se, hurtful
substances, injurious in general to the health of man, which can only
become wholesome where each exactly corresponds in its injurious
power to the case of disease specially adapted for it, and where it is
given in appropriate dose and at the proper time.
This truth, so indispensable to enable us to cure, I was the first
to declare to the world.   The allopathists, taken by surprise,
seemed at first to admit it, just as if they had long been familiar
with it; but the result shewed that they still remained enchained
in their own blindness, and that this heaven-born truth could find
no entrance into their mechanical heads.
Had it been otherwise, it had been impossible that they could
persist to the present day in their quackish treatment of chronic
diseases, without endeavouring to ascertain the peculiar powers of
each several medicine in altering man's health, in cramming their
chronic patients, to their destruction, with a variety of these unknown drugs in admixture, in giving large, frequent and generally.
increasing doses of these important substances, continued for a
great length of time, happen what might, if they had known or




838

ALLOPATHY:

appreciated and kept in view this incontrovertible truth: that
medicines are in themselves hurtful substances, injurious in general to the health of man, and can only prove beneficial where each
exactly corresponds in its injurious effects to a case of disease
specially adapted to it, and where they are given in appropriate
dose and at the right time.
The mischievous effects to chronic patients that lie in this their
blind treatment, in this overloading of them with strong unknown
drugs, will be perfectly obvious to every reflecting, unprejudiced
person, who knows that every medicine is a disease-creating substance, consequently every powerful medicine taken day after day in
several and increasing doses will infallibly make any, even healthy
persons, ill,-at first obviously and perceptibly so, but when longer
continued their hurtful action is less apparent,' but all the more profoundly penetrating, and productive of permanent injury, in this way,
because the ever active life-sustaining power silently endeavours to
ward off the injury with which these frequent assaults threaten life
itself, by internal counter-operations by means of the construction
of invisible protections and barriers against the life-invading medicinal enemy,-by the formation of morbid alterations in the organs,
in order to exalt the function of one, and render it intolerably
sensitive and hence painful, and the others again insensible and
even indurated, whilst it deprives the other parts (that in their
healthy state were easily excited to action) of their irritability, or
even paralyses them; in short it brings about as many corporeal
and mental morbid alterations as were requisite for warding off
the danger to life from the hostile attacks of the constantly
reiterated medicinal doses; that is to say, it effects in secret innumerable disorganizations and abnormal organizations, so that a
persistent permanent derangement of the health of the body and
mind is the consequence,-for which there cannot be a more
appropriate appellation than chronic medicinal disease-an internal and external crippling of the health, whereby, if the powerful
drug have only been used some months, the nature of the indi1 Least of all perceptible if the doses be not increased, in which case the allopathic
physician seeks to persuade himself and his patient by saying, "his nature has
become habituated to this medicine, therefore the dose of it must be increased "'-a
radically wrong notion, leading to the patient's ruin!




A WORD OF WARNING TO ALL SICK PERSONS.

839

vidual is so permanently altered that even should all medicine
thereafter be discontinued, and the system be subjected to no
further loss of humours and forces, yet this morbid metamorphosis
in the interior cannot be again removed nor re-transformed into
health and the normal condition by the vital force under two or
three years.
Thus, for instance, the vital force of our organism, that is always
exercising a preservative function, protects the sensitive parts of
the palm of the hand of the pavier (as also of the worker among fire,
the glassblower and the like) against the scratching and lacerating
sharp angles and points of the paving stones, with a hard, horny
covering, to protect the skin with its nerves, blood-vessels and
muscles, from being wounded or destroyed. But should the man
from this time forth cease to handle rough stones, and take
nothing but soft things in his hands, at least a year must elapse
ere the vital force (for no surgical or other art can do this) brings
about the removal of this horny skin, which was formerly constructed by it on the workman's hands, for their protection
against the continued action of the rough stones.
Equally protective does our preservative power exert itself to
rescue life at least, if it can do no more, by the formation of
organic and dynamic barriers in the interior, against the injurious
and inimical assaults of long-continued doses of strong allopathic
medicines, that is, by the establishment of permanent alterations
of our organisms, which always form a persistent medicinal disease
that often lasts for years, that is not capable of being cured and removed by any human art, and that can only be changed back again
to the normal state in several years by the vital force itself, provided
all medicines are discontinued and the requisite strength of constitution still remains.
If, therefore, a psoric patient suffering from chronic non-venereal
affections, in place of being cured homceopathically in a gentle, rapid
and permanent manner, is assailed by physicians of the old school
by the long-continued use of a variety of strong drugs, incapable
of removing the chronic miasm, as the allopathic medicines are,
and, as usually happens, given in increasing doses during a long
period, as is the case in all their ordinary modes of treatment, we
may readily conceive into what a sad and at length incurable
state he must fall by such senseless attacks on his system, and




840

ALLOPATHY:

how relentlessly he must be assailed in order that, without the
very slightest diminution of his original psoric malady, permanent organic malformations and changes of the finest, most delicate parts of the organism, of those parts most indispensable for
life and well-being, may be developed, and, as a consequence of
them, new, permanent bark, opium, mercurial, iodine, prussic-acid,
arsenical, valerian, foxglove, and other nameless chronic medicinal
diseases, which all unite and become fused (complicated) into one
many-headed, intolerable monster of disease, for which there is
and can be no remedy on earth, no antidote, no restorative medicines in nature.
If, in addition to such bungling treatment to which the name
of rational is applied, powerful debilitating practices are employed,
as is usually the case when the old school physician imagines the
disease to lie in some corruption of the blood (dyscrasia) that must
be removed, or in full-bloodedness (plethora), (such treatment
he terms treatment of the cause), and he hence from time to
time taps off the blood (wherein the life of man chiefly resides) by
venesections and leeches, or reduces the system by repeated warm
baths, or when he, in his efforts for years to expel an imaginary
morbific substance (the favourite matter of the material mind of
allopathic physicians), robs the diseased body and utterly wastes
its most nutritive juices with so-called mild, blood-purifying (?) laxatives, then these insidious medicinal diseases produced secundum
artem by such admirable modes of treatment, become, on account of
this pitiless robbery of the vital force, so incurable, that recovery is
not to be thought of, and a miserable death can alone release
the patient from the maltreatment of his physicians and from
his nameless torments.
Be not too anxious, I advise you, to insist on the dissection of
the corpses of those you have done to death! You would not
do it did you know what you thereby revealed to him who knows
the truth! Besides some rare congenital malformations, and perchance some results of the deceased's dissipation, what of an
abnormal character do you encounter, that is not chiefly the product of your injurious operations, of your medical ignorance and
your therapeutic sins of omission and commission?  There is displayed not what was present before your treatment, as you would fain
persuade the relatives, but what was produced by your treatment
/ i




A WORD OF WARNING TO ALL SICK PERSONS.

841

the incurability of the deceased was not before but after your treatment. It avails you nothing, that you thereby gladly take the
opportunity of making a display of your subtle anatomical terminological learning, neither can it be concealed from those who
have any knowledge, that this is no test of ability to cure. The
result of such autopsies is not the enriching of pathological
anatomy, but the revelation of a hideous therapeutic anatomy,
to your disgrace-in spite of all your plausible sophistries!
But even should these last mentioned debilitating processes in
the treatment of chronic (psoric) diseases have been avoided,
yet the most perfect imaginable healing art can never remove
these chronic medicinal diseases produced from bad treatment
by the long-continued use of large doses of strong medicines
unsuitable for the disease, nor indeed those that are developed
by a single simple medicament employed for a length of time in
frequent, large doses; for where are remedies to be found that can
undo the organic mischief that has been effected?    But still less
can antidotes be thought of for persistent (chronic) maladies, the
consequence of medicinal mixtures. It is manifestly impossible
for the very best healing art to remove such vital injuries, for as
certainly as the preservative power alone can produce in us organic
permanent malformations and alterations for our protection and
delivery, be it from the chronic miasms1 or the inimical attacks of
large, long-continued doses of the strong, unsuitable medicines of
the allopathists, so certain is it that this life-preserving power alone
can again remove these malformations and alterations in our
internal parts that were first produced by itself, and restore again
the normal state, but it can only do this after years, and provided
the vital forces still suffice.
It is only in the case of a very robust, undebilitated, youthful
constitution, and under other favourable circumstances, that it is
possible for the vital force (alone), gradually (in two, three, four
years) to remove the organic degenerations which itself toilsomely
erected to ward off the attacks of inimical medicinal forces, and to
Those internal malformations, abnormal organizations and disorganizations produced by nature for our protection against the violence of chronic miasmatic disease
(psora), it can most rapidly remove and reconstruct with the assistance of the cure of
the psora by homoeopathy, but those caused by the injurious misuse of medicines, it
has much more difficulty in curing.




842

ALLOPATHY:

restore the healthy state, provided the psora that still remains at
the root of the evil be at the same time homoeopathically cured,
for this can never be overcome, never extinguished by our vital
force alone, and still less by the senseless bungling treatment of
allopathy that plumes itself upon its superlative wisdom.
But if the patient be already advanced in years, if his spirits be
depressed by sorrow, vexation, fear or want, or if in addition he
have been weakened by venesections, leechings, purgations and
the like, he can look for nothing with certainty but the sure
advance of death-the inevitable lot of those who can boast of
having employed many of the most distinguished physicians of the
old school and a variety of the mineral waters, foolishly prescribed
for them; none can ever help them more.
Subjectively it may be a more cruel deed to stab one's enemy in
the back from revenge, but objectively it is more cruel to undermine the system of a patient who sought our aid, and who might
easily and certainly have been relieved from his natural disease
by the appropriate remedies, so that life at length becomes intolerable to him, by secret instruments of destruction (wrong medicines, in scarcely legible prescriptions, forced upon him for half or
whole years together, in several, often increasing, doses daily), so
that he must hopelessly and irremediably drag out his wretched
existence in constant misery, without having the power to die, and
envying the poniarded Corsican his rapid death.
At the contemplation of this heart-breaking fact, of how difficult it is for a patient to escape from the destructive hands of
those quacks who foolishly pride themselves on their old false
art, and make a mighty display of incomprehensible pedantry, who
lie in wait for customers in order to entice them into their toils
by all manner of quackish expedients, I cannot forbear from affectionately beseeching my modest colleagues, the important, philanthrophic homoeopathists (0! multa mecum pejoraque passi durate
et vosmet rebus servate secundis!) to suffer for a short time the
unmerited pressure from above, but in the meantime not to
waste our divine art, so infallibly serviceable in natural unspoiled
diseases, on those irremediable patients who have been destroyed
to their very inmost marrow, not to receive at any price those
patients who have been injured to the verge of incurability by the
allopathic exterminating art, nor, by undertaking such impossibili



A WORD OF WARNING TO ALL SICK PERSONS.

843

ties, to expose themselves to the scornful laughter of the renowned
physicians of the old school, who have already taken the greatest
pains to make them utterly incurable for hard cash. First let
them be again restored by these high-titled destroyers of health
to the former state of natural disease they were in before these
medical onslaughts on their life were perpetrated, if they are able
to do it!
On the contrary I beseech my homoeopathic colleagues to be
contented for the present with patients who have not been
destroyed by the physicians of the old school, even though they be
the poorest among the people, and laden with the most severe,
chronic, natural diseases, and to be satisfied with the smallest
remuneration for their labour, if these poor people can prove to
them that their poverty has prevented them applying to other
(allopathic) physicians, and consequently being ruined by improper
drugs. Though their income may be small they will yet have the
unspeakable joy of certainly and rapidly re-establishing their
patients' health, and thus putting flaunting allopathy to shame,
which is incapable of curing, but can only aggravate diseases and
render them incurable with a wilderness of drugs-as a warning
to the befooled public. The homoeopathic medical art can alone
transform into health, as if by magic, all natural diseases not ruined
by allopathic art, provided there remain a tolerable amount of
vital force, and this it does without prating about rationality and
treatment of the cause.
Before homoeopathy, that gentle, safe healing art so consonant
with nature, was discovered, no well disposed and honest philanthropist could forbear pitying the innumerable crowd of old-school
physicians, as they groped about in midnight darkness with their
dreadfully learned ignorance, whilst their zeal in treating natural
diseases, in place of serving to benefit them or bringing about the
desired cure, only ruined them or rendered them incurable. For
who among them could unravel the confusion of so many (wouldbe profoundly learned) baseless hypothetical doctrines and unnatural therapeutic maxims and modes of treatment with drugs
whose peculiar action was unknown, given in senseless mixtures
and repeated large doses?-who among them could separate the
false from the true, and reduce their mode of practice to a method
of treatment that should be consonant with nature, and lastingly




844                     ALLOPATHY.
beneficial? They were then fully as much to be pitied as those
patients whom they injured and continue to injure to an infinite
degree with their antiquated unimproved method. But since the
light of the doctrine that is alone consonant with nature, of restoring health and well-being rapidly and certainly in unspoiled,
natural diseases by small quantities of properly prepared, mild
specific medicines, has appeared, and has shone throughout Europe
in marvellous deeds, those who paid no regard to it but contemned
and persecuted it are not to be pitied; they deserve for their
obstinate adherence to their antiquated homicidal mode of treatment nought but contempt and abhorrence, and unprejudiced
history will brand their names with a stigma on account of their
scornful rejection of the real aid which they might have afforded
their much-to-be-pitied patients, had they not impiously closed
their eyes and ears against the beneficent truth!




CURE AND PREVENTION OF THE ASIATIC
CHOLERA.1
Preliminary.
A receipt has been given to the world, which proved so efficacious
in Diinaburg in the Asiatic cholera, that of ten patients but one
died. The chief ingredient is camphor, which is in ten times the
proportion of the other ingredients. But not a tenth-nay, not
one in a hundred of the patients would have died had the other
ingredients, which were but injurious and obstructing, and the
venesection been left out, and the camphor been given alone and
always at the very commencement of the disease, for it is only when
given alone, and at the first invasion of the disease, that it is so
marvellously useful. But if physicians come, as usual, too late to
the patient, when the favourable time for employing the camphor
is past, and the second stage has already set in, when camphor is
useless, then they may use it in vain; their patients will die under
its employment. Hence every one, the instant any of his friends
take ill of Cholera, must himself, immediately treat them with
camphor, and not wait for medical aid, which, even if it were good,
would generally come too late. I have received many communications from Hungary from non-medical persons, who have restored
their friends, as if by magic, by giving camphor the instant they
became ill.
Where the cholera first appears, it usually comes on in the commencement in its first stage (with tonic spasmodic character); the
strength of the patient suddenly sinks, he cannot stand upright,
his expression is altered, the eyes sunk in, the face bluish and icy
cold, as also the hands, with coldness of the rest of the body;
hopeless discouragement and anxiety, with dread of suffocation, is
1 From the Archivf. horn. Heilk., vol. xi, 1831.




846     CURE AND PREVENTION OF THE ASIATIC CHOLERA.
visible in his looks; half stupified and insensible, he moans or
cries in a hollow, hoarse tone of voice, without making any distinct
complaints, except when asked; burning in the stomach and gullet,
and cramp-pain in the calves and other muscles; on touching the
precordial region, he cries out; he has no thirst, no sickness, no
vomiting or purging.
In the first stage camphor gives rapid relief, but the patient's
friends must themselves employ it, as this stage soon ends either in
death or in the second stage, which is more difficult to be cured,
and not with camphor. In the first stage, accordingly, the patient
must get as often as possible (at least every five minutes), a drop
of spirit of camphor (made with one ounce of camphor to twelve
of alcohol), on a lump of sugar, or in a spoonful of water. Some
spirit of camphor must be taken in the hollow of the hand and
rubbed into the skin of the arms, legs, and chest of the patient;
he may also get a clyster of half-a-pint of warm water, mingled
with two full teaspoonfuls of spirit of camphor, and from time to
time some camphor may be allowed to evaporate on a hot iron, so
that if the mouth should be closed by trismus, and he can swallow
nothing, he may draw in enough of camphor vapour with his
breath.
The quicker all this is done at the first onset of the first stage of
the disease, the more rapidly and certainly will the patient recover;
often in a couple of hours' warmth, strength, consciousness, rest
and sleep return, and he is saved.
If this period of the commencement of the disease, so favourable
to recovery and speedy cure, by the above indicated employment
of camphor, has been neglected, then things look worse; then camphor is no longer serviceable. There are moreover cases of cholera,
especially in northern regions, where this first stage, with its tonic
spasmodic character, is hardly observable, and the disease passes
instantly into the second stage of clonic spasmodic character: frequent evacuation of watery fluid, mixed with whitish, yellowish, or
reddish flakes, and, along with insatiable thirst and loud rumbling
1 There were cases of patients for whom camphor had not been employed, who
had apparently died in the first stage and were laid out for dead, in whom a finger
was seen to move; in these some camphor-spirit mixed with oil and introduced into
the mouth, recalled the apparently dead again to life.




CURE AND PREVENTION OF THE ASIATIC CHOLERA.

847

in the belly, violent vomiting of large quantities of the same fluid,
with increased agitation, groaning and yawning, icy coldness of
the whole body, even of the tongue, and marbled blue appearance
of the arms, hands and face, with fixed sunken eyes, diminution of
all the senses, slow pulse, excessively painful cramp in the calves,
and spasms of the limbs. In such cases the administration of a
drop of camphor spirit every five minutes must only be continued
so long as decided benefit is observable (which with a remedy of
such rapid action as camphor manifests itself within a quarter of
an hour). If in such cases decided benefit is not soon perceived,
then no time must be lost in administering the remedy for the
second stage.
The patient is to get one or two globules of the finest preparation of copper1 (prepared from metallic copper in the mode described
in the second part of my work on Chronic Diseases), thus cuprum
0,00 X, moistened with water, and introduced into his mouth every
hour, or every half-hour, until the vomiting and purging diminish,
and warmth and rest are restored. But nothing else at all must be
given beside; no other medicine, no herb tea, no baths, no blisters,
no fumigation, no venesection, &c., otherwise the remedy will be of
no avail. Similar good effects result from the administration of as
small a portion of white hellebore (veratrum     album, 0,00 X); but
the preparation of copper is much to be preferred, and is more
serviceable, and sometimes a single dose is sufficient, which is
allowed to act without a second being given, as long as the
patient's state goes on improving.2
The wishes of the patient of all kinds are only to be indulged in
moderation. Sometimes, when aid is delayed many hours, or
other and improper remedies have been administered, the patient
falls into a sort of typhoid state, with delirium. In this case,
1 If the dear and scarce (frequently falsified) cajeput oil be actually so serviceable
in the Asiatic cholera that out of ten scarcely one died, it must owe this quality to
its camphor-like property (it may almost be regarded as a fluid camphor) and to the
circumstance, that from the copper vessels in which it is imported from the East
Indies, it takes up some portion of copper, and hence, in its unpurified state, it is of
a blueish-green colour. It has, moreover, been found in Hungary, that those who
wore next the skin of their body a plate of copper, were exempt from infection; as
trustworthy intelligence from that country informs me.
2 Similar affections resulting from immoderate repletion of the stomach with
indigestible nutriment, are best removed by a few cups of strong coffee.




848      CURE AND PREVENTION OF THE ASIATIC CHOLERA.
bryonia ~ X, alternately with rhus tox. 0 X, proves of eminent
service.
The above preparation of copper, together with good and moderate diet, and proper attention to cleanliness, is the most certain
preventive and protective remedy; those in health should take,
once every week, a small globule of it (cupr. o X) in the morning
fasting, and not drink anything immediately afterwards, but this
should not be done until the cholera is in the locality itself, or in
the neighbourhood. The health of the individual will not be in
the least disturbed by this dose. I shall not, but any other
homoeopathic practitioner may, tell where the above medicines
may be procured, excepting the camphor, which, like the alcohol,
may be had at every chemist's shop.
Camphor cannot preserve those in health from cholera, but
only the above preparation of copper; but when the latter is taken
the vapour of camphor must be avoided, as it suspends the action
of the copper.'
COETHEN, 10th September, 1831.
I [In the first Vol. of the Bibl. Homeopathique we find the following extract of a
letter from Hahnemann to the Editor:
" Cuprum, as a prophylactic against cholera, has generally shewn itself efficacious
wherever it has been employed, and where its action has not been disturbed by gross
dietetic faults, or by the smell of camphor (which is its antidote). The best homceopathic practitioners have also found it indispensable in the second stage of the fully
developed disease, alternated, if the symptoms indicate this, with veratrum album X.
I have also advised the alternation of these two substances from week to week as a
preventive against the disease.
" I learn from authentic sources that at Vienna, Berlin and Magdeburg, thousands
of families, by following my instructions respecting the treatment by camphor, have
cured, often in less than a quarter of an hour, those of their members who were
attacked by the epidemic, and that so effectually, that their neighbours knew nothing
about it, and still less their medical attendants, who oppose with all their might this
treatment, so simple, so rapid, and so constantly certain in its effects."]




APPEAL TO THINKING PHILANTHROPISTS RESPECTING
THE   MODE     OF PROPAGATION       OF THE     ASIATIC
CHOLERA.
Two opinions, exactly opposed to each other, prevail on this
subject. One party considers the pestilence as only epidemic, of
atmospheric-telluric nature, just as though it were merely spread
through the air, from which there would in that case be no protection. The other party denies this, and holds it to be communicable
by contagion only, and propagated from one individual to another.
Of these two opinions one only can be the right one, and that
which is found to be the correct one will, like all truths, exercise
a great influence on the welfare of mankind.
The first has the most obstinate defenders, who adduce the
fact that when the cholera has broken out at one extremity of
the town, it may the very next morning be raging at the other
extremity, consequently the infection can only be present in the
air; and that they (the physicians) are in their own persons
proofs of the non-contagious character of cholera, seeing that they
generally remain unaffected by it and in good health, although
they are daily in personal communication with those dying of
cholera, and have even tasted the matter they ejected and the
blood out of their veins, lain down in their beds, and so forth.
This foolhardy, disgusting procedure they allege to be the experimentum crucis, that is to say, an incontrovertible proof of the
non-contagious nature of cholera, that it is not propagated by contact, but is present in the atmosphere, and for this reason attacks
individuals in widely distant places.
A fearfully pernicious and totally false assertion!
Were it the fact that this pestilential disease was uniformly
distributed throughout the atmosphere, like the influenza that

Published as a pamphlet. Leipzic, 1831.

3i




850

ON THE MODE OF PROPAGATION

recently spread over all Europe, then the many cases reported
by all the public journals would be quite inexplicable, where
small towns and villages in the vicinity of the murderously prevalent cholera, which, by the unanimous efforts of all their inhabitants, kept themselves strictly isolated, like a beseiged fortress,
and which refused to admit a single person from without-inexplicable, I repeat, would be the perfect exemption of such places
from the ravages of the cholera. This plague raged fiercely over
an extensive tract on the banks of the Volga, but in the very
middle of it, Sarepta, which had strictly and undeviatingly kept
itself secluded, remained perfectly free from the cholera, and up
to a recent period none of the villages around Vienna, where the
plague daily carries off a large number of victims, were invaded
by cholera, the peasants of these villages having all sworn to kill
any one who ventured near them, and even to refuse to permit
any of the inhabitants who had gone out of the villages to reenter them. How could their exemption have been possible had
the cholera been distributed throughout the atmosphere! And
how easy it is to comprehend their freedom from it, seeing that
they held aloof from contact with infected individuals.
The course followed by the cholera in every place it traversed
was almost uniformly this: that its fury shewed itself most virulently and most rapidly fatal at the commencement of its invasion
(evidently solely because at that time the miasm encountered
none but unprepared systems, for which even the slightest cholera
miasm was something quite novel, never before experienced, and
consequently extremely infectious); hence it then infected persons
most frequently and most fatally.
Thereafter the cases increased, and with them at the same time,
by the communication of the inhabitants among each other, the
quantity of the diluted miasm, whereby a kind of local sphere of
cholera-miasm exhalation was formed in the town, to which the
more or less robust individuals had an opportunity of becoming
gradually accustomed and hardened against it, so that by degrees
always fewer inhabitants were attacked by it and could be severely
affected by it (the cholera was then said to take on a milder
character), until at last all the inhabitants were almost uniformly
indurated against it, and thus the epidemic was extinguished in
this town.




OF THE ASIATIC CHOLERA.

851

Did the miasm only exist in the general atmosphere, the cases
could not be less numerous at last than they were at the commencement, for the same cause (said to be the general atmospheric
constitution) must have remained identical in its effects.
The only fact brought forward by Hufeland against my proofs
(viz., that on board an English ship in the open sea, about the
latitude of Riga, that had had no (?) communication with the town,
two sailors were suddenly seized with cholera) proves nothing, for
it is not known how near the ship came to the infected town,
Riga, so that the sphere of the miasm-exhalation from the town,
although diluted, might yet have reached and infected the sailors,
who were still unused to the miasm, especially if they, as is often
the case, were rendered more susceptible to it from intemperance.
The most striking examples of infection and rapid spread of
cholera take place, as is well known, and as the public journals
likewise inform us, in this way: On board ships-in whose confined spaces, filled with mouldy watery vapours, the cholera-miasm
finds a favourable element for its multiplication, and grows into
an enormously increased brood of those excessively minute, invisible, living creatures, so inimical to human life, of which the
contagious matter of the cholera most probably consists-on board
these ships, I say, this concentrated aggravated miasm kills several
of the crew; the others, however, being frequently exposed to the
danger of infection and thus gradually habituated to it, at length
become fortified against it, and no longer liable to be infected.
These individuals, apparently in good health, go ashore, and are
received by the inhabitants without hesitation into their cottages,
and ere they have time to give an account of those who have died of
the pestilence on board the ship, those who have approached nearest
to them are suddenly carried off by the cholera. The cause of
this is undoubtedly the invisible cloud that hovers closely around
the sailors who have remained free from the disease, and which is
composed of probably millions of those miasmatic animated beings,
which, at first developed on the broad marshy banks of the tepid
Ganges, always searching out in preference the human being to
his destruction and attaching themselves closely to him, when
transferred to distant and even colder regions become habituated
to these also, without any diminution either of their unhappy
fertility or of their fatal destructiveness.
312




852

ON THE MODE OF PROPAGATION

Closely but invisibly environed by this pestiferous, infectious
matter, against which, however, as has been observed, his own
individual system is, as it were, fortified by the long resistance of
his vital force to its action, and by being gradually habituated to
the inimical influence surrounding him, such a sailor (flying from
the corpses of his companions on board) has often gone ashore
apparently innocuous and well, and behold! the inhabitants who
hospitably entertained him, and first of all those who came into
immediate contact with him, quite unused to the miasm, are first
most rapidly and most certainly attacked without any warning, and
killed by the cholera, whilst of those who are more remote, such
only as are unnerved by their bad habits of life are liable to take
the infection. Those who are not debilitated, and who have kept
at some distance from the stranger who is surrounded by the
cholera-miasm, suffered only a slight attack from the miasmatic
exhalation hovering about in a more diluted form; their vital
force could easily ward off the weaker attack and master it, and
when they subsequently came nearer it their system had by this
time become somewhat habituated to the miasm, retained the
mastery over it, and even when these persons at length approached
nearer or quite close to the infected stranger, their vital force had
thus gradually become so fortified against it, that they could hold
intercourse with him with perfect impunity, having now become
completely uninfectable by the contagious principle of the cholera.
It is a wonderfully benevolent arrangement of God that he has
made it possible for man to fortify himself against, and render
himself unsusceptible to, the most deadly distempers, and especially the most fatal of them all, the infectious principle of cholera,
if he gradually approaches it ever nearer and nearer, allowing
intervals of time to elapse in order to recover himself, provided
always he have an undebilitated body.
When first called to a cholera patient, the physician, somewhat
timid as yet, as is but reasonable, either tarries at first in the antechamber (in the weaker atmosphere of miasmatic exhalation) or if
he enter the patient's room prefers keeping at some distance, or
standing at the door, orders the nurse in attendance to do this or
the other to the patient, he then prudently soon takes his departure promising to return again shortly; in the meantime he either
goes about a little in the open air, or goes home and has some




OF THE ASIATIC CHOLERA.

853

refreshment. His vital force, which at the first short visit at some distance from the patient, was only moderately assailed by the diluted
miasm, recovers itself completely in the meantime by this recreation,
and when he again comes into the patient's room and approaches
somewhat nearer to the patient, it soon by practice comes to resist
more powerfully the more concentrated infectious atmosphere that
exists closer to the patient, until at length, from frequent visits and
a nearer approach to the patient, it attains a mastery over the
assaults of the miasm, so that at last the physician is completely
hardened against even the most poisonous cholera miasm at the
bedside, and rendered quite uninfectable by this pestilence; and
the same is the case with the nurse who goes as cautiously and
gradually to work.
Both the one and the other then boast, because they can come
into immediate contact with the patient without any fear and
without any ill consequences, that they know better than to call
the disease contagious; it is not, they say, the least catching. This
presumptuous, inconsiderate, and perfectly untrue assertion has
already cost thousands their lives, who in their ignorance, and
quite unprepared, either approached the cholera patient suddenly,
or came in contact with these cholera physicians (who do not treat
with camphor) or the nurses. For such physicians and nurses,
fortified in this manner against the miasm, now take away with
them in their clothes, in their skin, in their hair, probably also in
their breath, the invisible (probably animated) and perpetually
reproductive contagious matter surrounding the cholera patient
they have just visited, and this contagious matter they unconsciously and unsuspectingly carry along with them throughout the
town and to their acquaintances, whom it unexpectedly and infallibly infects, without the slightest suspicion on their part of its
source.
Thus the cholera physicians and nurses are the most certain and
frequent propagators and communicators of contagion far and wide;
and yet amazement is expressed, even in the public journals, how
the infection can spread so rapidly the very first day, from the
first cholera patient at the one end of the town to persons at the
other end of the town, who had not come near the patient!
And thus the flame for the sacrifice of innocent persons breaks
out in all corners and ends of the town, lighted up by the sparks




854

ON THE MODE OF PROPAGATION

of the black death scattered in every direction by physicians and
their assistants! Every one readily opens the door to these plaguepropagators; allows them to sit down beside him, putting implicit
faith in their confidently declared assurance: "that it is ridiculous to
call the cholera contagious, as the cholera pestilence is only diffused
epidemically through the air, and cannot, therefore, be infectious"
-and see! the poor cajoled creatures are rewarded for their hospitality with the most miserable death.
To the very highest people of the town and of the court the
cholera angel of death obtains access, in the person of the physician who gives this evil counsel, enveloped by the fresh miasm; and
no one detects the concealed, invisible, but, for that reason, all the
more dangerous enemy.
Wherever such physicians and such nurses go (for what allseeing eye could perceive this invisible danger on these healthy
miasm-bearers?)-wherever they go, their presence communicates
the spark, and mortal sickness bursts forth everywhere, and the
pestilence depopulates whole towns and countries!
If physicians would but take warning, and, rendered uninfectable
by taking a few drops of camphorated spirit, approach (ever so
quickly) the cholera patient, in order to treat him at the commencement of his sickening with this medicine (pure, unadulterated camphorated spirit) which alone is efficacious, and which
most certainly destroys the miasm about the patient, by giving
him, as I have taught,1 every five minutes one drop of it, and in
the interval assiduously rubbing him on the head, neck, chest, and
abdomen with the same medicine poured into the hollow of the
hand, until all his giddy faint powerlessness, his suffocative anxiety,
and the icy-coldness of his body has disappeared, and given place
to reviving animation, tranquillity of mind, and complete return of
the vital warmth-if they would but do this, then every patient would
not only be infallibly restored within a couple of hours (as the most
undeniable facts and instances prove), but by the cure of the
disease with pure camphor, they would at the same time eradicate and annihilate the miasm (that probably consists of innumerable, invisible living beings) in and about the patient, about
themselves, even in the clothes, the linen, the bed of the patient
I Cure and Prevention of the Asiatic Cholera.- [See preceding article.]




OF THE ASIATIC CHOLERA.

855

(for these all would be penetrated by the vapour of the camphor if it were employed in this way) in the very furniture and
walls of the apartment also, and they themselves (the physicians
and nurses) would then carry off none of the contagious principle
with them, and could no longer infect persons throughout the
town.'
But these physicians, as we see, despise this; they prefer going
on killing their patients in crowds by pouring into them large
quantities of aqua-fortis and opium, by blood-letting, and so forth,
or giving the camphor mixed with so many obstructing and injurious matters, that it can scarcely do any good, solely to avoid
giving the simple, pure (efficacious) solution of camphor, because
the reformer of the old injurious system of treatment (the only one
they know), because I, from conviction, recommended it in the most
urgent manner in all countries of Europe. They seem to prefer
delivering over all mankind to the grave-digger, to listening to the
good counsel of the new purified healing art.
But who can prevent them acting so, as they alone possess the
power in the state to suppress what is good?
However, bountiful Providence has provided a beneficent remedy
for this state of things (for these physicians are protected, even in
their ill-deeds, by antiquated injurious laws).
Thus, the cholera is most surely and easily and almost miraculously curable, but only in the first couple of hours from the
commencement of the sickening, by means of the employment
of pure camphor, and that before the physicians in larger towns
that are summoned can attend. But on their arrival they may
even then, by the employment of unadulterated camphor-spirit, if
not cure the cholera completely (for the lapse of a few hours generally makes it too late to do so) yet annihilate the whole of the
contagious principle of this pestilence on and about the patient,
and adhering to themselves and the bystanders, and cease to
convey the miasm with them to other parts of the town. Hence
1 The sprinkling of suspected strangers on their arrival, and of suspected goods and
letters with camphor spirit, would most certainly destroy the cholera-miasm in them.
Not a single fact goes to prove that chlorine annihilates the miasm of cholera; it can
only destroy odorous effluvia. But the contagious matter of the Asiatic cholera is far
from being an odorous effluvium. What good then do the fumigations with chlorine,
which is here perfectly useless, and only hurtful to man's health?




856        ON THE MODE OF PROPAGATION OF CHOLERA.
the families of non-medical persons, by means of this employment
of camphor, cure the members of their families by thousands in
secret (the higher classes alone, must, on account of their station,
be under the necessity of calling in the physician, who, in defiance
of the philanthropic reformer of the healing art, and his efficacious
system of treatment, not unfrequently, with his improper remedies,
dispatches them to Orcus).
It is members of a family alone that can most certainly and easily
mutually cure each other with camphor spirit, because they are able
instantaneously to aid those taken ill.
Will physicians ever come to comprehend what is essential, and
what will at once put a stop to the devastation and depopulation
of two quarters of the globe?
Dixi et salvavi animam I
CiTHEN, the 24th October, 1831.




REMARKS ON THE EXTREME ATTENUATION OF
HOM(EOPATHIC MEDICINES.1
I. The essay of this intelligent and unwearied and honourable
investigator and promoter of our art, incontestably corroborates
the following truths that some observations of my own had already
hinted at, viz., 1, that the development of the powers of medicinal
substances by the process peculiar to homoeopathy, may be assumed
to be almost illimitable; 2, that the higher their dynamisation
(dematerialisation) is carried, the     more penetrating     and rapid
does their operation become; 3, that, however, their effects pass off
so much the more speedily.
All this is in strict accordance with my own experiments, though
I have not carried them so far; one of them I may only allude to,
namely, that once having prepared a dynamised attenuation of
sulphur up to XXX (90th dilution), I administered a drop of it on
sugar to an aged, unmarried lady, who was subject to rare epileptic
attacks (one every 9, 12, 14 months), and within an hour afterwards she had an epileptic fit, and since then she has remained
quite free from them.
1 [These remarks occur in the form of postcripts appended to a paper by Graf von
Korsakoff, published in the 11th and again in the 12th Vol. of the Archivf. horn. Heilk.
In this paper the author mentions that he had diluted medicines up to the 150th, 1000th
and 1500th attenuation, and that he had found them even at that degree of dilution
quite efficacious. He starts the idea that possibly the material division of the medicinal substance attains its limit at the third or sixth dilution, and that the subsequent
attenuations obtain their medicinal properties by a kind of infection or communication of the medicinal power, after the manner of contagious diseases, to the non-medicinal vehicle; and in corroboration of this notion he relates several experiments, in which
he says he communicated medicinal properties to large quantities of unmedicated
globules, by shaking them up with one dry medicated globule. He likewise remarks
that by diluting medicines highly, and by employing such infected globules, the
force of the primary action of the medicines, or their tendency to produce homoeopathic aggravations, declines, whilst the reaction of the organism, or the curative action
of the medicine, continually increases.]




858

REMARKS ON THE EXTREME ATTENUATION OF

The opponents of homoeopathy, obstinately attached to their old
system, who seem to have made a resolution not to allow themselves to be convinced of this wonderful development of the powers
of crude medicinal substances, which however manifests itself to
every unprejudiced person who honestly puts the matter to the
test, and which gives to the practice of homoeopathy that tranquillizing certainty and trustworthiness in the treatment of diseases
with highly dynamised attenuations of medicines in the smallest
doses, whereby it vastly surpasses every other method of treatment,
-our opponents, I say, on being informed of these extended
experiments and observations of the author of this treatise, who
has rendered such service to our art, can do nothing more than,
as they have hitherto done, remain standing in amazement below
the steps of the outer-court to the sanctuary of these health-bringing
truths, and announce by a sceptical smile their inability to avail
themselves of these beneficent revelations of the nature of things
for the welfare of their patients. They wore the same sceptical
smile when I some thirty and odd years ago pointed out the efficacy of the millionth part of a grain of belladonna in scarlet-fever;
they can now also do nothing more when they read of the dematerialisation of sulphur up to the thousandth potency, that it still
displays a powerful medicinal action on the human body. Their
Boeotian smiling however will not stay the eagle-flight of the new
beneficent healing-art, and in the meantime they remain as they
deserve to do, deprived of its blessings.'
However, it must be borne in mind, that the chief use of these
experiments, was to demonstrate how high medicinal attenuations
might be potentized without their action on man's state of health
being reduced to nothing, and for this, these experiments are
invaluable; but for the homoeopathic treatment of patients it is
advisable, in preparing all kinds of medicines, not to go higher
1 One might apply to these gentlemen Goethe's words:
" Daran erkenn' ich die gelehrten Hernn!
Was ihr nicht tastet, steht euch Meilen fern;
Was ihr nicht fasst, das fehlt euch ganz und gar;
Was ihr nicht rechnet, glaubt ihr, sei nicht wahr;
Was ihr nicht wigt, hat fiir euch kein Gewicht;
Was ihr nicht miinzt, das, meint ihr, gelte nicht."
(Faust, 2ter. Theil.)




HOMEOPATHIC MEDICINES.

859

than the decillionth attenuation and dynamisation (X), in order that
homoeopathic physicians may be able to assure themselves of
uniform results in their practice.1
II. I can scarcely believe that the carefully discriminating Graf
von Korsakoff can regard the subdivision and dynamisation peculiar
to homoeopathy as complete at the millionth and billionth development [3rd and 6th dilution], and incapable of any further disembodiment and spiritualization of their medicinal powers to an
even greater degree by further trituration of the dry and further
succussion of the fluid attenuations-the occurrence of which cannot
be doubted-or that he actually looks upon them as weaker, as he
seems to imply. Who can say that in the millionth or billionth
development the small particles of the medicinal substances have
arrived at the state of atoms not susceptible of further division, of
whose nature we can form      not the slightest conception?     For if
the living human organism shews an ever stronger reaction to the
more highly dynamised attenuations when they are used medicinally (as experience teaches, and as the author himself admits),
it follows that such higher medicinal preparations must be regarded
as stronger, inasmuch as there can be no standard for measuring
the degree of dynamic potency of a medicine, except the degree of
the reaction of the vital force against it.
Thus much, however, is deducible from his experiments, that,
1 [In 1829 he wrote to Dr. Schreter thus (Brit. Jour. of Hom., Vol. v, p. 398): " I
do not approve of your dynamising the medicines higher (as for instance, up to XII
and XX, [36th and 60th dilutions] ). There must be some end to the thing, it cannot
go on to infinity. By laying it down as a rule that all homoeopathic remedies be
attenuated and dynamised up to X [30th dil.], we have a uniform mode of procedure
in the treatment of all homceopathists, and when they describe a cure, we can repeat
it, as they and we operate with the same tools. In one word, we would do well to go
forward uninterruptedly in the beaten path. Then our enemies will not be able to
reproach us with having nothing fixed-no normal standard." In 1833 he speaks
more favourably of the higher attenuations, such as the 60th, 150th, and 300th dilutions (Organon, ~ ccLxxXVI, 2nd note), ascribing to them a more rapid and penetrating, but likewise a shorter action. Again in 1838 (Chr. Kr., part v, preface), he
speaks approvingly of the 50th dilution. As a rule, he seems to have used chiefly
the 30th dilution, still we find from the cases sent to Dr. Binninghausen, which I
give farther on, that he occasionally gave other preparations, and in the letter of
which a fac-simile is given in this work, he desires Dr. Lehmann to send him the 3d
trituration of certain medicines, whether for therapeutic use or fo#further dilution it
is impossible to say.]




860

REMARKS ON THE EXTREME ATTENUATION, ETC.

since a single dry globule imbibed with a high medicinal dynamisation, communicates to 13,500 unmedicated globules, with which
it is shaken for five minutes, medicinal power fully equal to what
it possesses itself, without suffering any diminution of power itself,
it seems that this marvellous communication takes place by means
of proximity and contact, and is a sort of infection, bearing a strong
resemblance to the infection of healthy persons by a contagion
brought near or in contact with them-a perfectly novel, ingenious
and probable idea, for which we are indebted to the Graf.
This communication or infection appears to take place by means
of the power which is perpetually spreading around, like an exhalation or emanation from such bodies, even though they are dry,
just like those globules the size of a mustard seed that had previously been moistened with a fluid medicine which we employ for
the cure of patients by olfaction. A globule of this kind, e. g., of
staphisagria X, which, in the course of twenty years, had been
smelt several hundreds of times after opening the bottle in which
it was, for a certain symptom that always recurred of the same
character, possesses at this hour medicinal power of equal strength
as at first, which could not be the case did it not continually
exhale its medicinal power in an inexhaustible manner.
The supposition of our author that dry globules that have been
impregnated with a certain degree of development of power can be
further dynamised and their medicinal power increased in their
bottles by shaking, or carrying about in the pocket, like medicinal
fluids further shaken, is not borne out by any fact, and will appear
to me incredible until it is supported by proper experimental
proofs.
On the whole we owe many thanks to this ingenious and indefatigable investigator for his present valuable communication.

C6TIIEN, 30th May, 1832.




CASES    ILLUSTRATIVE         OF   HOM(EOPATHIC
PRACTICE.1
Many persons of my acquaintance but half converted to homoeopathy have begged of me from time to time to publish still more
exact directions as to how this doctrine may be actually applied in
practice, and how we are to proceed. I am astonished that after
the very particular directions contained in the Organon of medicine
more special instruction can be wished for.
I am also asked, " How are we to examine the disease in every
particular case? " As if special enough directions were not to be
found in the book just mentioned.
As in homoeopathy the treatment is not directed towards any
supposed or illusory internal causes of disease, nor yet towards
any names of diseases invented by man which do not exist in
nature, and as every case of non-miasmatic disease is a distinct
individuality, independent, peculiar, differing in nature from all
others, never compounded of a hypothetical arrangement of symptoms, so no particular directions can be laid down for them (no
schema, no table), except that the physician, in order to effect a
cure, must oppose to every aggregate of morbid symptoms in a
case a group of similar medicinal symptoms as exact as it is to be
met with in any single known medicine, for this doctrine cannot
admit of more than a single medicinal substance (whose effects
have been accurately tested) to be given at once (see Organon of
medicine, ~ 271, 272).
Now we can neither enumerate all the possible aggregates of
symptoms of all concrete cases of disease, nor indicate a priori the
homoeopathic medicines for these (a priori.undefinable) possiI From the Reine Arzneimittellehre, pt. ii, 3rd edit. 1833. [The cases here given
originally appeared about 1817 in the first edition of the B. A. M. L., but the notes
and most of the preliminary matter are of the date we have given, and we may therefore consider the whole to represent Hahnemann's opinion and practice, with the
exception of the dose in these two cases, of the latter period.]




862

CASES ILLUSTRATIVE OF

bilities. For every individual given case (and every case is an
individuality, differing from all others) the homoeopathic medical
practitioner must himself find them, and for this end he must be
acquainted with the medicines that have till now been investigated
in respect of their positive action, or consult them for every case
of disease; but besides this he must do his endeavour to prove on
himself or on other healthy individuals medicines that have not
yet been investigated as regards the morbid alterations they are
capable of producing, in order thereby to increase our store of
known remedial agents,1 so that the choice of a remedy for every
one of the infinite variety of cases of disease (for the combatting of which we can never possess enough of suitable tools and
weapons) may become all the more easy and accurate.
That man is far from being animated with the true spirit of the
homoeopathic system, is no true disciple of this beneficent doctrine, who makes the slightest objections to institute on himself
careful experiments for the investigation of the peculiar effects of
the medicines which have remained unknown for 2500 years,
without which investigation (and unless their pure pathogenetic
action on the healthy individual has previously been ascertained)
all treatment of disease must continue to be not only a foolish,
but even a criminal operation, a dangerous attack upon human
life.
It is somewhat too much to expect us to work merely for the
benefit of such self-interested individuals as will contribute nothing
to the complete and indispensable building up of the indispensable
edifice, who only seek to make money by what has been discovered and investigated by the labours of others, and to furnish
themselves with the means of squandering the income derived from
the capital of science, to the accumulation of which they do not
evince the slightest inclination to contribute.
All who feel a true desire to assist in elucidating the peculiar
effects of medicines-our sole instruments, the knowledge of
which has for so many centuries remained uninvestigated, and
1 Before the discovery of Homoeopathy, medicinal substances were known only in
respect to their natural history, and besides their names nothing was known regarding them but their presumed qualities, which were either imaginary or altogether
false.




HOM(EOPATHIC PRACTICE.

863

which is yet so indispensable for enabling us to cure the sick, will
find the directions how these pure experiments with medicines
should be conducted in the Organon of medicine, ~ 118-142.
In addition to what has been there stated I shall only add, that
as the experimenter cannot, any more than any other human
being, be absolutely and perfectly healthy, he must, should slight
ailments to which he was liable appear during these provings of
the powers of medicines, place these between brackets, thereby
indicating that they are not confirmed, or dubious. But this will
not often happen, seeing that during the action upon a previously
healthy person of a sufficiently strong dose of the medicine, he is
under the influence of the medicine alone, and it is seldom that
any other symptom can shew itself during the first days but what
must be the effect of the medicine. Further, that in order to
investigate the symptoms of medicines for chronic diseases, for
example, in order to develop the cutaneous diseases, abnormal
growths and so forth, to be expected from the medicine, we must
not be contented with taking one or two doses of it only, but
we must continue its use for several days, to the amount of two
adequate doses daily, that is to say of sufficient size to cause us to
perceive its action, whilst at the same time we continue to observe
the diet and regimen indicated in the work alluded to.
The mode of preparing the medicinal substances for use in
homecopathic treatment will be found in the Orgaton of medicine,
~ 267-271, and also in the Chronic Diseases.     I would only
observe here, that for the proving of medicines on healthy individuals, dilutions and dynamisations are to be employed as high as
are used for the treatment of disease, namely, globules moistened
with the decillionth development of power.
The request of some friends, halting half-way on the road to
this method of treatment, to detail some examples of this treatment, is difficult to comply with, and no great advantage can
attend a compliance with it. Every cured case of disease shews
only how that case has been treated. The internal process of the
treatment depends always on those principles which are already
known, and they cannot be rendered concrete and definitely fixed
for each individual case, nor can they become at all more distinct
from the history of a single cure than they previously were when
these principles were enunciated. Every case of non-miasmatic




864.

CASES ILLUSTRATIVE OF

disease is peculiar and special, and it is the special in it that distinguishes it from every other case, that pertains to it alone, but
that cannot serve as a guide to the treatment of other cases.
Now if it is wished to describe a complicated case of disease consisting of many symptoms, in such a pragmatical manner that the
reasons that influence us in the choice of the remedy shall be
clearly revealed, this demands details laborious at once for the
recorder and for the reader.
In order, however, to comply with the desires of my friends in
this also, I may here detail two of the slightest cases of homoeopathic treatment.
Sch-, a washerwoman, somewhat above 40 years old, had been
more than three weeks unable to pursue her avocations, when she
consulted me on the 1st September, 1815.
1. On any movement, especially at every step, and worst on
making a false step, she has a shoot in the scrobiculus cordis, that
comes, as she avers, every time from the left side.
2. When she lies she feels quite well, then she has no pain
anywhere, neither in the side nor in the scrobiculus.
3. She cannot sleep after three o'clock in the morning.
4. She relishes her food, but when she has ate a little she feels
sick.
5. Then the water collects in her mouth and runs out of it, like
the water-brash.
6. She has frequently empty eructations after every meal.
7. Her temper is passionate, disposed to anger.-Whenever the
pain is severe she is covered with perspiration.-The catamenia
were quite regular a fortnight since...
In other respects her health is good.
Now, as regards Symptom 1, belladonna, china, and rhus toxicodendron cause shootings in the scrobiculus, but none of them only
on motion, as is the case here. Pulsatilla (see Symp. 387) certainly
causes shootings in the scrobiculus on making a false step, but
only as a rare alternating action, and has neither the same digestive
derangements as occur here at 4 compared with 5 and 6, nor the
same state of the disposition.
Bryonia alone has among its chief alternating actions, as the
whole list of its symptoms demonstrates, pains from movement and
especially shooting pains, as also stitches beneath the sternum (in




THE HOMCEOPATHIC PRACTICE.

865

the scrobiculus) on raising the arm (448), and on making a false
step it occasions shooting in other parts (520, 574).
The negative Symptom 2 met with here answers especially to
bryonia (558?)   few medicines (with the exception, perhaps, of
nux vomica and rhus toxicodendron in their alternating actionneither of which, however, are suitable for the other symptoms)
shew a complete relief to pains during rest and when lying;
bryonia does, however, in an especial manner (558, and many
other bryonia-symptoms).
Symptom 3 is met with in several medicines, and also in bryonia
(694).
Symptom    4 is certainly, as far as regards "sickness after
eating," met with in several other medicines (ignatia, nux vomica,
mercurius, ferrum, belladonna, pulsatilla, cantharis), but neither
so constantly and usually, nor with relish for food, as in bryonia
(279).
As regards Symptom 5 several medicines certainly cause a flow
of saliva like water-brash, just as well as bryonia (282); the others,
however, do not produce the remaining symptoms in a very similar
manner. Hence bryonia is to be preferred to them in this point.
Empty eructation (of wind only) after eating (Symptom 6) is
found in few medicines, and in none so constantly, so usually, and
to such a great degree, as in bryonia (255, 239).
To 7.-One of the chief symptoms in diseases (see Organon of
Medicine, ~ 213) is the "state of the disposition," and as bryonia
(778) causes this symptom also in an exactly similar mannerbryonir'is for all these reasons to be preferred in this case to all
other medicines as the homoeopathic remedy.
Now, as this woman was very robust, and the force of the disease
must accordingly have been very considerable, to prevent her by
its pain from doing any work, and as her vital forces, as has been
observed, were not consensually affected, I gave her one of the
strongest homoeopathic doses, a full drop of the pure juice of
bryonia root,1 to be taken immediately, and bade her come to me
again in 48 hours. I told my friend E., who was present, that
According to the most recent development of our new system the ingestion of a
single, minutest globule, moistened with the decillionth (f) potential development
would have been quite adequate to effect an equally rapid and complete recovery;
3K




866

CASES ILLUSTRATIVE OF

within that time the woman would be quite cured, but he, being
but half a convert to homoeopathy, expressed his doubts about it.
Two days afterwards he came again to ascertain the result, but the
woman did not return then, and, in fact, never came back again. I
could only allay the impatience of my friend by telling him her name
and that of the village where she lived, about three miles off, and
advising him to seek her out and ascertain for himself how she
was. This he did, and her answer was: " What was the use of
my going back?      The very next day I was quite well, and could
again commence my washing, and the day following I was as
well as I am still. I am extremely obliged to the doctor, but the
like of us have no time to leave off our work; and for three
weeks previously my illness prevented me earning anything."
W-e, a weakly, pale man of 42 years, who was constantly kept
by his business at his desk, came to me on the 27th December,
1815, having been already ill five days.
1. The first evening he became, without manifest cause, sick and
giddy, with much eructation.
2. The following night (about 2 a. m.) sour vomiting.
3. The subsequent nights severe eructation.
4. To-day also sick eructation of fetid and sourish taste.
5. He felt as if the food lay crude and undigested in his
stomach.
6. In his head he felt vacant, hollow and confused, and as if sensitive therein.
7. The least noise was painful to him.
8. He is of a mild, soft, patient disposition.
Here I may observe:To 1. That several medicines cause vertigo with nausea, as well
as pulsatilla (3), which produces its vertigo in the evening also (7),
a circumstance that has been observed from very few others.
To 2. Stramonium and nux vomica cause vomiting of sour and
sour-smelling mucus, but, as far as is known, not at night. Valerian and cocculus cause vomiting at night, but not of sour stuff.
Iron alone causes vomiting at night (61, 62), and can also cause
sour vomiting (66), but not the other symptoms observed here.
indeed, equally certain would have been the mere olfaction of a globule the size of a
mustard seed moistened with the same dynamisation, so that the drop of pure juice
given by me in the above case to a robust person, should not be imitated.




THE HOMiEOPATHIC PRACTICE.

867

Pulsatilla, however, causes not only sour vomiting in the evening (349, 356) and nocturnal vomiting in general, but also the
other symptoms of this case not found among those of iron.
To 3. Nocturnal eructation is peculiar to pulsatilla (296, 297).
To 4. Fetid, putrid (259) and sour eructations (301, 302) are
peculiar to pulsatilla.
To 5. The sensation of indigestion of the food in the stomach is
produced by few medicines, and by none in such a perfect and
striking manner as by pulsatilla (321, 322, 327).
To 6. With the exception of ignatia (2) which, however, cannot
produce the other ailments, the same state is only produced by
pulsatilla (39 compared with 40, 81).
To 7. Pulsatilla produces the same state (995), and it also causes
over-sensitiveness of other organs of the senses, for example, of the
sight (107). And although intolerance of noise is also met with in
nux vomica, ignatia, and aconite, yet these medicines are not homceopathic to the other symptoms and still less do they possess symptom
8, the mild character of the disposition, which, as stated in the
preface to pulsatilla, is particularly indicative of this plant.
This patient, therefore, could not be cured by anything in a more
easy, certain and permanent manner than by pulsatilla, which was
accordingly given to him immediately, but on account of his
weakly and delicate state only in a very minute dose, i. e., half-adrop of the quadrillionth of a strong drop of pulsatilla.1 This was
done in the evening.
The next day he was free of all ailments, his digestion was
restored, and a week thereafter, as I was told by him, he remained
free from complaint and quite well.
The investigation in such a slight case of disease, and the choice
of the homoeopathic remedy for it, is very speedily effected by the
practitioner who has had only a little experience in it, and who
either has the symptoms of the medicine in his memory, or who
knows where to find them readily; but to give in writing all the
reasons pro and con (which would be perceived by the mind in a
few seconds) gives rise, as we see, to tedious prolixity.
1 According to our present knowledge and experience the same object would have
been attained by taking one of the smallest globules of pulsatilla 7 (decillionth
potency) and with equal certainty a single olfaction of a globule the size of a mustard
seed of the same potency of pulsatilla.
3 K2




868                CASES ILLUSTRATIVE, ETC.
For the convenience of treatment, we require merely to indicate
for each symptom all the medicines which can produce the same
symptoms by a few letters (e. g., Ferr., Chin., Rheum, Puls.), and
also to bear in mind the circumstances under which they occur,
that have a determining influence on our choice and in the same
way with all the other symptoms, by what medicine each is excited,
and from the list so prepared we shall be able to perceive which of
the medicines homoeopathically covers the most of the symptoms
present, especially the most peculiar and characteristic ones,-and
this is the remedy sought for.




TWO CASES FROM HAHNEMANN'S NOTE BOOK.'
CASE I.
Julie M. a country girl; 14 years old; not yet menstruated.
12th September, 1842. A month previously she had slept in the
sun. Four days after this sleeping in the sun, the frightful idea
took possession of her that she saw a wolf, and six days thereafter
she felt as if she had received a great blow on the head. She now
spoke irrationally; became as if mad; wept much; had sometimes
difficulty in breathing; spat white mucus; could not tell any of
her sensations.
She got Belladonna,2 weakened dynamisation, in seven tablespoonfuls of water; of this, after it was shaken, a tablespoonful in a
glass of water, and after stirring this, one teaspoonful to be taken
in the morning.
16th.-Somewhat quieter; she can blow her nose, which she was
unable to do during her madness; she still talks as much nonsense,
but does not make so many grimaces while talking. She wept
much last night. Good motion. Tolerable sleep. She is still very
restless, but was more so before the Belladonna. The white of the
eye full of red vessels. She seems to have a pain in the nape of
the neck.
From the glass in which one tablespoonful was stirred, one teaspoonful is to be taken and stirred in a second glassful of water,
and of this from two to four teaspoonfuls (increasing the dose
daily by one teaspoonful) are to be taken in the morning.
20th.-Much better; speaks more rationally; works a little;
recognises and names me; and wishes to kiss a lady present. She
now begins to shew her amorous propensities; is easily put in a
passion, and takes things in bad part; sleeps well; weeps very
often; becomes angry about a trifle; eats more than usual; when
she comes to her senses she likes to play, but only just as a little
child would.
Belladonna, a globule of a higher potency: seven tablespoonSCommunicated by letter, dated 24th April, 1843, to Dr. Von Binninghausen, and
published in the Neues Archiv, Vol. i. 1844.
2 [Dr. B. tells us that whenever the dilution is not indicated, it is understood that
the 60th dilution was administered.]




870

TWO CASES FROM

fuls shaken in two glasses, 6 teaspoonfuls from the second glass
early in the morning.1
28th.-On the 22nd, 23rd and 24th, very much excited day and
night; great lasciviousness in her actions and words; she pulls up
her clothes and seeks to touch the genitals of others; she readily
gets into a rage and beats every one.
Hyoscyamus XO, seven tablespoonfuls, &c., one tablespoonful in
one tumblerful of water; in the morning a teaspoonful.
5th October. For five days she would eat nothing; complains
of belly-ache; for the last few days less malicious and less lascivious; stools rather loose; itching all over the body, especially on
her genitals; sleep, good.
Sacch. Lactis for seven days, in seven tablespoonfuls, &c.
10th.-On the 7th, fit of excessive anger; she sought to strike
everyone. The next day, the 8th, attack of fright and fear, almost
like the commencement of her illness (fear of an imaginary
wolf;) fear lest she should be burnt.   Since then she has become
quiet, and talks rationally and nothing indecent for the last two
days.
Sacch. Lactis, &c.
14th.-Quite good and sensible.
18th.-The same, but severe headache; inclination to sleep by
day; not so cheerful.
New sulphur (new dynamisation of the smallest material portion)
one globule in three tumblers; in the morning one teaspoonful.
22nd.-Very well; very little headache.
Sulphur, the next dynamisation in two tumblers.
She went on with the sulphur occasionally until November, at
which time she was and still remains a healthy, rational, amiable
girl.
CASE II.
O-t, an actor, 33 years old, married. 14th January, 1843.
For several years he had been frequently subject to sore throat, as
also now for a month past. The previous sore throat had lasted
six weeks. On swallowing his saliva, a pricking sensation; feeling
of contraction and excoriation.
[The meaning of these directions, which is not very obvious, seems to be that
the globule shall be dissolved in seven tablespoonfuls of water, and of this a tablespoonful is to be stirred in a second tumbler of water, and from this second glass a
teaspoonful is to be given for six successive mornings.]




HAHNEMANNJS NOTE BOOK.

871

When he has not the sore throat he suffers from a pressure in
the anus, with violent, excoriative pains; the anus is then inflamed,
swollen and constricted; it is only with a great effort that he can
then pass his faeces, when the swollen haemorrhoidal vessels protrude.
On the 15th January, he took, in the morning before breakfast, a teaspoonful of a solution of one globule of belladonna X~,
then the lowest dynamisation, dissolved in seven tablespoonfuls of
water, of which a tablespoonful was well stirred up in a tumblerful
of water.
15th.-In the evening aggravation of the sore throat.
16th.-Sore throat gone, but the affection of the anus returned
as above described; an open fissure with excoriative pain, inflammation, swelling, throbbing pain and constriction;-also in the
evening a painful motion.
He confessed having had a chancre eight years previously,
which had been, as usual, destroyed by caustics, after which all the
above affections had appeared.
18th.-Merc. viv. one globule of the lowest new dynamisation I,
(which contains a vastly smaller amount of matter than the usual
kind,) prepared in the same manner, and to be taken in the same
way as the Belladonna (the bottle being shaken each time), one
spoonful in a tumblerful of water well stirred.
20th.-Almost no sore throat. Anus better, but he still feels
there excoriation pain after a motion; he has however no more
throbbing, no swelling of the anus, and no inflammation; anus less
contracted.
One globule of merc. viv. (2/o) the second dynamisation of the
same kind; prepared in the same way, and taken in the morning.
25th.-Throat almost quite well; but in the anus, raw pain and
severe shootings; great pain in the anus after a motion; still some
contraction of it and heat.
30th.-In the afternoon, the last dose (one teaspoonful). On
the 28th the anus was better; sore throat returned; pretty severe
excoriation pain in the throat.
One globule in milk-sugar for seven days; prepared and taken
in the same manner.
7th February.-Severe ulcerative pain in the throat. Bellyache,
but good stools; several in succession, with great thirst. In the
anus all is right.




872

TWO CASES FROM HAHNEMANN'S NOTE BOOK.

Sulphur 2/o in seven tablespoonfuls, as above.
13th.-Had ulcerative pain in the throat, especially on swallowing his saliva, of which he has now a large quantity, especially
copious on the 11th and 12th.       Severe contraction of the anus,
especially since yesterday.
He now smelt here merc., and got to take as before, mere. v. 2/,
one globule in seven tablespoonfuls of water, and half a spoonful
of brandy.
20th.-Throat better since the 18th; he has suffered much with
the anus; the motion causes pain when it is passing; less thirst.
Milk-sugar in seven tablespoonfuls.
3rd March.-No more sore throat.         On going to stool a bloodless hvemorrhoidal knot comes down (formerly this was accompanied with burning and raw       pain), now with merely itching on
the spot.
To smell acid. nitri. and then to have milk-sugar in seven.
Almost no more pain after a motion; yesterday some blood
along with the motion (an old symptom). Throat well; only a
little sensitive when drinking cold water.
Olfaction of acid. nitri. (olfaction is performed by opening a
small bottle containing an ounce of alcohol or brandy wherein one
globule is dissolved, and smelt for an instant or two).
He remained permanently cured.1
1 [The following account of an illness with which Hahnemann was attacked,
which he gives in a letter to the same correspondent, dated 28th April, 1833, will be
read with interest.
" Although I kept myself very calm, yet the annoyance I received from * * * *
may have contributed to bring upon me the suffocative catarrh, that for 7 days
before and 14 days after the 10th of April [Hahnemann's birthday], threatened to
choke me, with instantaneous attacks of intolerable itching in the glottis, that would
have caused spasmodic cough, had it not deprived me of breath altogether; irritation of the fauces with the finger, so as to cause sickness, was the only thing that
restored the breathing, and that but slowly; there were besides other severe
symptoms-very great shortness of breath (without constriction of the chest), total
loss of appetite for food and drink, disgust at tobacco,, bruised feeling and weariness
of all the limbs, constant drowsiness, inability to do the least work, presentiment of
death, &c. The whole neighbourhood proved their great affection for me by sending
so frequently to enquire how I was, that I felt quite ashamed. It is only within
these four days that I have felt myself out of danger; I obtained relief by two
olfactions, of cof. cr. XO first, and then of calc.; ambra too was of use. And so the
Great Protector of all that is true and good will grant me as much more life upon
this earth as seemeth good to his wisdom."]




GENERAL INDEX.

Abscess of perinmum, 40; of labia, 45; of
antrum, 175.
Absorption of gonorrhoeal matter, 24.
Accidental discoveries of medicinal powers,
773.
Aconite, pathogenetic effects of, 339; therapeutic uses of, 339; in purpura miliaris,
550, 779.
Actions of medicines, primary and secondary, 312.
Acute diseases, terminate in recovery or
death, 471; allopathic treatment of, 829.
Adulterations of drugs, 551.
AEscuLAPIUS in the balance, 470.
Aesculus in asthma, 346.
Aethusa, pathogenetic effects of, 317; in
imbecility, 318.
Agaricus, pathogenetic and therapeutic
effects of, 351.
Aggravations, medicinal, 538, 539.
Agues, remedies in, 306; different kinds
of, 594.
Air, things that spoil the, 213.
Allopathy, on, 782, 827; derivation of the
word, 832.
Alterative treatment of syphilis, 137.
Ammonia, in gonorrhcea, 29; in syphilis,
147.
Anatomical school, the, 483.
Anatomy, uses of, to medicine, 484.
Anemone, pathogenetic and therapeutic
effects of, 340.
Animal magnetism, therapeutic uses of, 528.
Animal requirements, on the satisfaction
of our, 269.
Animals, dead bodies of, should be buried,
267; experiments on, value to therapeutics, 301, 809.
Anticyra, celebrated for its white hellebore,
660; and for its black, 692; sometimes
implied hellebore, 674.

Antidote for poison, there is no universal,
375.
Antidotes to some drugs, 374.
Apothecaries, attack on HAHNEMANN by
the, 783; privileges of the, 784, 797.
Apothecary system, origin of the, 490.
ARETAEUS, practice of, 381.
Arnica, in giddiness, 314; pathogenetic
effects of, 314; in dysentery, 315; dose
of, for children, 315; in glandular swellings, 316; vinegar the antidote to, 376;
case of poisoning by, 376; in continued
fever, 383; bad effects of, in a febrile
influenza, 392.
Arsenic, pathogenetic effects of, 336; therapeutic uses of, 336; in hydrophobia,
337; in a febrile disease, 638.
Asthma, case of spasmodic, 368.
Attenuation of medicine, on the extreme,
857; KORSAKOFF'S ideas respecting,
857; disapproval of excessive, 858.
Attenuations used by HAHNEMANN at different periods, 859.
Balsams in gonorrhoea, 32.
Bark, in syphilis, 145; production of ague
by, 314, 586; enormous consumption of,
399, 544, 552, 589.
Baths in gonorrhcea, 35.
Bed-sores, prevention of, 248.
Belladonna, in hydrophobia, 197, 320;
pathogenetic effects of, 320; therapeutic
uses of, 320; duration of action of, 322;
history of the discovery of its prophylactic
power in scarlet-fever, 431; dose of, in
scarlet-fever, 436; preparation of, 437;
dose of, as a prophylactic, 438; action
of, increased by acids, 439; probably
prophylactic of measles, 439; in the first
stages of scarlet-fever, 440; contra-indications for its use, 441; on the power of




874

GENERAL INDEX.

small doses of, 443; in paralysis, 447;
in scarlet-fever, 550, 778.
BELLOSTE'S pills, 140.
Bite of mad dogs, 194.
Bitters, observations on, 755.
BLACK'S mercurial preparation, 5, 142.
Bleeding, in syphilis, 154; bad effects of,
608.
Botanical affinities of plants no guide to
their therapeutic action, 303.
Bougies, in stricture, 61; elastic, 62; best
shape of, 62; horn, 64; medicated, 65.
Brandy in lying-in women, 211.
BROWN's Elements of Medicine, observations on, 405, 616.
Bryonia, in typhus, 712; preparation of,
713; symptoms it is indicated for, 713;
in the typhoid fever following cholera,
848.
Buboes, 94; non-venereal, 98; ordinary
treatment of, 98; treatment of, 104;
opening of, 106; in infants, 178.
Burials in churches, evils of, 263.
Burs, treatment of, 513, 527, 619, 704,
705, 716; DzoNDI on, 716; bad effects of
cold water in, 716; hot spirits and turpentine in, 717; BENJAMIN BELL on, 720,
723; RICHTER on, 720; KENTISH on, 721,
723;   SYDENHAM on, 723;    ANDERSON
oh, 724.
Butcher's shops, on the construction of,
266.
Cabinet-makers, deformity of, 219.
Calomel in syphilis, 135.
Camphor, in salivation, 157; pathogenetic
effects of, 343; therapeutic uses of, 344;
the antidote to opium, 375; case of poisoning by, 375; the antidote to cantharis and squill, 376; the antidote to cocculus, 377; the antidote to mezereum,
381; in febrile influenza, 390; in the
first stage of cholera, 845; fumigations
in cholera, 846; prophylactic and curative of cholera, 854.
Calculations of the quantity of medicine
in homoeopathic doses, 817.
Candles, danger of many lighted, 214.
Candidate for the degree of M.D., to a, 625.
Cannabis, pathogenetic effects of, 346.

Cantharis in gleet, 52.
Caries, venereal, 169.
Cases-of chancre in a woman, 86; of syphilitic phthisis, 117; of syphilis, 166; of
mercurial disease, 185; of colicodynia,
354; of spasmodic asthma, 368; of continued fever, 382; of remittent fever,
383; of febrile influenza, 385; of periodical and hebdomadal diseases, 395; of
hebdomadal hematuria, 396; of paralysis
cured by cold, 408, 526; of scarlet-fever
that led to the discovery of the prophylactic, 434; of scarlet-fever, 439; illustrative of homoeopathic practice, 861; of
gastrodynia cured by bryonia, 864; of
gastric derangement cured by pulsatilla,
866; of nymphomania cured by belladonna and hyoscyamus, 869; of venereal
sore throat and fissure in anus cured
by mercury, sulphur, and nitric acid, 870;
of suffocative catarrh cured by coffea,
calcarea and ambra, 872.
Cases,. mode of taking down, 506.
Catarrh, case of suffocative, 872.
Cause, treatment of the, 603.
Caustics in stricture, 65.
Certainty in medical practice, 358.
Cesspools, construction of, 262; cleansing
of, 262.
Chalk, why eaten by pregnant women, 224.
Chamomilla, pathogenetic effects of, 314;
in the after-sufferings of scarlet-fever,
442; in toothache, 641.
Chancre, 69; evil of burning off, 73, 729;
in the female, 83, 86; false, 87.
Charcoal fires, unwholesomeness of, 216.
Chemistry, value of, to therapeutics, 295,
485, 615, 758.
Cherry-laurel water, pathogenetic effects
of, 341; therapeutic uses of, 342.
Chlorosis combined with syphilis, 155.
Cholera, Asiatic, cure and prevention of,
845; camphor in the first stage of, 845;
cuprum in the second stage of, 846;
veratrum album in, 847; cajeput oil in,
847; copper plates in, 847; bryonia and
rhus for the consecutive fever of, 848;
preventives for, 848; success of homoeopathic treatment of, 848; mode of propagation of, 849; proofs of its -onta



GENERAL INDEX.

875

giousness, 850; miasm, probably] consisting of animated beings, 851 ';mode
of becoming habituated to, 852; camphor
prophylactic and curative of, 854; chlorine not destructive to, 855.
Chordee, 19; chronic, 47.
Chronic diseases, insufficiency of the old
system in, 474; the test of a system
of medicine, 705; allopathic treatment
of, 832.
Cicuta, pathogenetic effects of, 318.
Cinchona, in a hebdomadal disease, 395;
enormous consumption of, 399, 544, 552,
589; external employment of, 532; on
a proposed substitute for, 542; habitat
of, 515.
Citric acid the antidote to stramonium, 379.
Climate, 366.
Clinical experience as a means of ascertaining the powers of drugs, 764, 772.
Cocculus, pathogenetic effects of, 318; in
malignant typhus, 318; camphor the
antidote to, 377; case of poisoning by,
377.
COCKBURN on the seat of gonorrhoea, 16.
Coddling, bad effects of, 230.
Coffee, cure of uterine hemorrhage by, 224;
injurious effects of, on children, 275, 465;
pathogenetic effects of, 318; therapeutic
uses of, 318; antidote to opium, 318; bad
effects of, in nervous patients, 360; increases the action of camphor, 376; the
antidote to veratrum, 379; on the effects
of, 450; purely a medicinal substance,
451; primary action of, 453; headache
caused by, 454, 463; bad effects of, 458;
secondary action of, 460; removal of
bad effects of, 466; medicinal uses of,
467; palliative action of, 468; in purpura miliaris, 782.
Cold and heat, medicinal action of, 532.
Colicodynia, case of, 354.
Condylomata, venereal, 90.
Confectionery, unwholesomeness of, 275.
Conium, pathogenetic effects of, 316; in
indurated glands, 317; in cancer, 317.
Contrast of the old and new systems, 800.
Corpse-washers, uses of, 264.
Corrosive sublimate, in syphilis, 132; in
dysentery, 779.

Cow-pox, course of, 730.
Crocus, pathogenetic and therapeutic action of, 347.
Croup, burnt sponge in, 779.
Curative mode of treatment, the, 517, 588.
Cure, requisites to effect a, 505.
Cures, on wonderful, 477.
Dead, inspection of the, 264.
Debility, on direct and indirect, 414.
Diet, in gonorrhoea, 27; during mercurial
treatment, 162; conversation with my
brother on, 220; and regimen, 359, 541;
prevailing errors respecting, 361; bad
effects of a too rigid, 361; HIPPOCRATES
on, 365.
Dietetic regulations cannot be too simple,
365.
Dietetics, absurdities of modern, 221.
Digitalis, pathogenetic effects of, 327;
therapeutic uses of, 327; long lasting
action of, 328.
Diluents in gonorrhcea, 28.
Disease, good moral effects of, 220; increased susceptibility to the action of
medicines in, 528; definition of, 808.
Diseases, slight, do not require medicine,
536; with few symptoms, treatment of,
536.
Dispensatories, origin of, 490.
Dispensing by physicians, enactments
against, 491.
Dispensing medicines, on, 783; what constitutes, 784, 790.
Dissecting rooms, precautions respecting,
264.
Ditches, dangers attending the drying up
of, 259.
Doses, minuteness of the homoeopathic,
786; to be used in all cases of disease,
858; disapproval of excessive attenuation of the, 859; to be used in proving
drugs, 863.
Drosera, in catarrh and cough, 342; in
hooping cough, 779; increase of power
of, by excessive succussion, 823.
Dry gonorrhcea, 17, 38.
Dulcamara, in syphilis, 145; pathogenetic
effects of, 319; therapeutic uses of, 319.
Dynamic action of medicines, 529.
Dysentery, corrosive sublimate in, 779.




876

GENERAL INDEX.

DzoNDI, Professor, on burns, 716.
Electricity, medicinal effects of, 533.
Empyema cured by a sword-thrust, 219.
Enantiopathic system, 307, 703.
Epidemics, protection from infection by,
203; prevention of, 253.
Erysipelas combined with syphilis, 155.
EULER'S proficiency in mathematics promoted by his blindness, 220.
Examinations for the doctor's degree, nature of the, 833.
Exciting causes of disease, 502.
Experience, the medicine of, 497.
Experiments on the human body with
drugs, 304.
External appearance of plants, value of,
to therapeutics, 300.
Famine a source of pestilence, 265.
Favourite remedies, 602.
Fever, mercurial, 77, 163, 738; plans for
eradicating a, 243; on the treatment of
a, 628, 712.
Fevers, on continued and remittent, 382.
Field-hospitals, on the construction of,
257.
Fig-warts, 91.
Fish-markets, on the construction of, 267.
Flowers in a room, evils of, 213.
Food necessary to man, on the, 450.
Foreign drugs, scarcity of, 551; on substitutes for, 574.
FREDERICK HAHNEMANN, notice of, 278.
Friction, effects of, on steel, 819.
Frictions, mercurial, 130.
Friend of health, the, 189.
Frost-bite, treatment of, 527.
Fruit, danger of exhalations from, 215.
Fumigations, mercurial, 131; uselessness
of, 210.
GALEN'S system, 482, 669.
Gamboge, carbonate of potash the antidote
of, 378.
Gangrene of prepuce, 83.
Gastric derangement cured by pulsatilla,
866.
Gastrodynia cured by bryonia, 864.
General remedies, 596, 748.

Geum in intermittent, 341
GIRTANNER on venereal disease, 9 et seq.
Glands, effects of pressure on enlarged,
212.
Gleet, 49.
Globules, on the medication of, 825; various sizes used by HAINEMANN, 826.
Gold, in suicidal mania, 781, 821; powers
developed in, by trituration, 821; doses
of, employed by HAHNEMANN, 821.
Gonorrhoea, in the male, 15; in the male,
treatment of, 26; a local disease, 29; in
the female, 41; in the female, treatment
of, 43; secondary, in the male, 49; secondary, in the female, 55.
Good in hurtful things, 218.
Gourmand, picture of a, 271.
Gout combined with. syphilis, 155.
Grave, fatal results from opening a, 263.
Guaiac in syphilis, 144.
HAHNEMANN's discoveries, reception they
met with from the profession, 420.
HAHNEMANN'S son, notice of, 278.
HALLER, his services to medicine, 483; on
veratrum, 650.
Hardening the body, on, 230.
Health, things capable of deranging the,
503.
Heat and cold, medicinal action of, 532.
Hellebore, black, description of, 689; our
helleborus niger, 691; medicinal effects
of, 693; seeds of, 694.
Hellebore, white, our veratrum album, 651;
symptoms produced by, 657; habitat of,
659; best kind of, 661; best season for
collecting, 662; medicinal uses of, 662;
mode of administration of, 665, 676;
substances mixed with, 679; dose of,
677.
Helleborism of the ancients, 478; dissertation on the, 644; when it was practised, 667; ancient authors on, 667;
seasons for practising, 672; diseases
contra-indicating it, 672; diseases for
which it was indicated, 673; preparatory
treatment for, 675.
Helleborus niger, pathogenetic effects of,
340; therapeutic uses of, 340.
Hematuria, case of hebdomadal, 396.




GENERAL INDEX.

877

Hemlock in syphilis, 147.
Iepar sulphuris, for the bad effects of
mercury, 186; in itch, 512; in croup, 779.
HIPPOCRATES, dietetics of, 365; simple
practice of, 372, 480; homceopathic principle enunciated by, 524.
HOFFMANN'S theory of disease, 607.
Homceopathic doctrine, spirit of the, 696.
Homoeopathic principle, ancient hints respecting the, 524.
Homoeopathic system, first enunciation of
the, 311; explanation of the, 705.
Homoeopathy, HAHNEMANN'S account of
his discovery of, 582; derivation of the
word, 743; and homopathy, difference
between, 743; mode of disproving, if
false, 744; discovery of specifics by,
778; how it may be eradicated, 793.
Hooping-cough, drosera in, 779.
Hospital, on the construction of a fever,
245; fever, treatment of, 712.
HUFELAND, his opinion of HAHNEMANN,
405; letter to, 581; an opponent to simplicity in medicine, 771.
Humidity, bad effects of, on children, 273.
Humoral pathology, 608.
HUNTER'S experiments with gonorrhoea,
25; mode of treating stricture, 65.
Hurtful things, good in, 218.
Hydrocyanic acid, pathogenetic effects of,
341.
Hydrophobia, symptoms of, 194; nostrums
for, 195, 447; belladonna in, 197, 320;
kyoscyamus in, 197; cases of, 198; chronic, 199; proportion of bitten persons
affected by, 198, 448; arsenic in, 337;
not prevented by excising the bitten
part, 730.
Hyoscyamus, in hydrophobia, 197; pathogenetic effects of, 322; therapeutic uses
of, 323; duration of action of, 323; in
toothache, 642; in typhus, 714.
Ignatia, pathogenetic effects of, 327; therapeutic uses of, 327; vinegar the antidote to, 379; case of poisoning by, 379;
in continued fever, 383.
Infants, syphilis in, 176.
Infection, protection against, 203.
Influenza, an epidemic of febrile, 385.

Injections, in gonorrhoea, 27, 33, 43; in
gleet, 53.
Inoculation of gonorrhceal matter, 27.
Insane, on the treatment of the, 293.
Insanity, action of tobacco in, 325.
Instinct of the stomach in sickness, 445.
Inundations, treatment of, 259.
Ipecacuanha, therapeutic uses of, 328; in
scarlet fever, 433; external use of, 532.
Irritations, incompatibility of two similar,
510.
Itch, venereal, 113; treatment of, 512;
infection by, 731.
Joiners, deformity of, 219.
KAMPF'S clysters, 610, 753.
KEYSER's dragees in syphilis, 140.
Kitchen materia medica, 750.
KLOCKENBRING, insanity of, 287; curious
prescription for his own malady by, 290.
KORSAKOFF, his tubes for globules, 825;
his mode of saturating globules, 825;
his ideas respecting the transmission of
medicinal power, 857.
KOTZEBUE, satire of, against KLOCKENBRING,
288; pretended cure of, 745.
Lanes, evils of, 265.
Lead, pathogenetic effects of, 335.
LE DARAN'S bougies, 65.
Ledum, in syphilis, 145; pathogenetic
effects of, 330; therapeutic uses of, 330;
dose of, 330; in a febrile influenza, 394.
Liberality, on professional, 417.
Libertinism, folly of, 272.
Lightning, cure of paralysis by, 219.
Lime-water in gonorrhoea, 27, 44.
Lizards in scirrhous testicle, 49; in syphilis, 148.
Lobelia in syphilis, 145.
Lolium temulentum, pathogenetic effects of,
347; therapeutic uses'of, 347.
Lues venerea, 108.
Lunar caustic in stricture, 65.
LUTHER, comparison of HAHNEMANN with,
591.
Lying in state, evils of, 263.
Magnet, north pole of the, in toothache, 643.




878

GENERAL INDEX.

Man, on the reason of, 498.
Manufactories, regulations for, 268.
Marshes, on the drying up of, 259.
Masked syphilis, 111.
Materia medica, sources of the common,
487, 569, 748.
Medical observer, qualifications for a, 813.
Medicinal agents absolute in their power,
707.
Medicinal diseases, production of, 838; incurability of some, 841.
Medicinal substances used as food, 450.
Medicine of experience, 497.
Medicine, on the necessity of a regeneration of, 581.
Medicines, on the administration of, 370;
primary and secondary actions of, 452;
sources of their ascribed virtues, 487,
569, 748; not unconditionally wholesome, 467, 514; on the pathogenetic
effects of, 515; mode of ascertaining
their powers, 516, 809; their curative
powers, on what dependent? 700; the
homceopathic practitioner has a right to
administer his own, 790.
MELAMPUS, employment of veratrum by,
646.
MELANCTHON, HUFELAND compared with,
591.
Mercurial fever, 77, 163, 738.
Mercurial ointment, 125; uncertainty of,
127; on the rubbing-in of, 532.
Mercurial preparations, 121.
Mercurial treatment, on the ordinary, 737.
Mercurius solubilis, preparation of, 8, 184;
in syphilis, 161, 738, 741.
Mercury, to obtain pure, 7; effects of the
abuse of, 170; antidote to the effects of,
185; compared with syphilis, 332; pathogenetic effects of, 335; in the lead
disease, 335; conflicting opinions respecting the action of, 399; best preparation of, 738, 741.
Mesmerism, therapeutic uses of, 528.
Methods of treating disease, 553, 592.
Mezereum, in syphilis, 145; camphor the antidote to, 381; case of poisoning by, 381.
Miliary fever, different from scarlet-fever,
546; symptoms of, 547, 782; treatment
of, 782.

Millefolium, in hemorrhage, 316.
Mixed method of treating syphilis, 138.
Moderation, advantages of, 272.
Moisture, bad effects of, 215.
Morbific agents not absolute in their power,
706.
Name, treatment of the, 592.
Nasal bones, venereal affections, of, 120.
Nature, healing power of, 500.
Nature's processes for healing disease not
worthy of imitation, 500.
Nervous debility, on, 614.
Neutral salts, in gonorrhcea, 31.
Night-stools in a room, danger of, 216.
Nitrate of mercury in syphilis, 139.
Nitre in gonorrhoea, 31.
Nitre, spirits of, in typhus, 715.
Nodes, venereal, 119, 168.
Non-mercurial remedies for syphilis, 143.
Non-venereal gonorrhoea, 26.
Nostrums, for hydrophobia, 195, 447; for
toothache, 640.
Nota bene for the reviewers, 743.
Nursery, picture of an unhealthy, 273.
Nutmeg, pathogenetic effects of, 351; therapeutic uses of, 352.
Nux vomica, pathogenetic effects of, 325;
therapeutic uses of, 326; in a case of
spasmodic asthma, 369; in a febrile
disease, 637; in toothache, 641.
Nymphomania, case of, 869.
Obedience -of patients, 359.
Old clothes, regulations for dealers in, 254.
Oleander, in palpitation, 329.
Onychia, venereal, 113.
Ophthalmia, gonorrhoeal, 21, 40.
Opium, pathogenetic effects of, 330; palliative use of, 331; in mania, 332; in
the mercurial disease, 334; the antidote
to camphor, 375; in remittent fevers,
385; in scarlet-fever, 431; in sleepiness,
530.
Ordinary treatment, exposure of the, 598,
625, 748.
PALLAS on hellebore, 651.
Palliative mode of treatment, on the, 519,
589, 703.




GENERAL INDEX.

879

Palliatives, disadvantages of, 313, 520;
when they are to be used, 522.
Paper-mills, regulations respecting, 254.
Paralysis, case of, cured by cold, 408,
526.
Paraphymosis, 80.
Paris, in cramps, 318.
Pathology, uses of, to medicine, 561; definition of, 800.
Periodical diseases, cases of, 395.
PFEFFEL'S poetical talent increased by
blindness, 220.
PHILIP'S bougies, 65.
Philosophy, old-women's, 211.
Phimosis, 79; chronic,'87.
Phthisis, venereal, 117.
Physical properties of plants, value of, to
therapeutics, 300.
Physician, on the choice of a family, 278;
qualifications of a good, 283.
Physicians, portraits of fashionable, 280,
600.
Physiology, uses of, to medicine, 485.
PHYSON and SOCRATES, dialogue between,
240.
Phytolacca, pathogenetic effects of, 346.
Pimples, venereal, 113.
PLENK'S mucilaginous mercury, 140.
PLINY on hellebore, 650.
Post-mortem  examinations, what they
teach, 840.
Potash in gonorrhoea, 44.
Preface to the Thesaurus medicaminum,
398.
Preputial gonorrhoea, 23.
Prescriptions, absurdity of complex, 371,
400, 473, 487,566, 595, 833; apology for
complex, 372, 487, 594, 771; source of,
802.
Preservative operations of nature, 839.
Principle, on a new therapeutic, 295.
Principles of medicines, supposed active,
804.
Prisons, arrangement of, 253.
Privies, clearing out of, 262.
Prophylactic for scarlet-fever, JANI on the,
421; MUELLER on the, 422; history of the
discovery of the, 431.
Prostate gland, induration of the, 67.
Protection against infection, 203.

Proving of medicines, obligatory on all,
862; dilutions to be used in the, 863.
Proximate venereal symptoms, 112.
Prunus padus in ague, 342.
Psychical homoeopathy, 709.
Ptyalism from mercurial ointment, 128.
Pulsatilla, in toothache, 641; in a case of
gastric derangement, 866.
Purgatives, in gonorrhoea, 31; injurious
effects of, 228; on the treatment by,
609.
Purpura miliaris, symptoms of, 547, 782;
aconite in, 550, 779, 782; coffee in, 782;
treatment of, 782.
Pustula maligna, infection by, 731.
Rabies canina, 194.
Rag gatherers, regulations respecting, 253.
Red precipitate in stricture, 65.
Refutation of BROWN's doctrines, 405.
Regimen and diet in disease, 541.
Regimen for patients subjected to helleborism, 682.
Repetition of the dose, on the, 537.
Reviewers, nota bene for my, 743.
Rhagades, venereal, 113.
Rhododendron, pathogenetic effects of, 329;
therapeutic uses of, 330.
Rhubarb in diarrhoea, 352.
Rhus radicans in erysipelas, 343.
Rhus toxicodendron, in typhus, 714; preparation of, 714; in the typhoid fever
following cholera, 848.
RUMFORD'S mode of heating houses, 820.
Sabadilla, pathogenetic effects of, 351.
Salivation, prevention of, 156.
S'ambucus, pathogenetic effects of, 343;
therapeutic uses of, 343.
Sarsaparilla in syphilis, 144.
Scarlet fever, announcement of a prophylactic for, 421; prophylactic for, the
reception it got, 421; on the cure
and prevention of, 425; history of an
epidemic of, 427; persons chiefly liable
to, 427; PLENCIZ's description of, 428;
symptoms of, 428, 547; treatment of,
431; opium in, 431; ipecacunatha in, 438;
diet in, 433; prophylaxis of, 438; history of the discovery of the prophylactic




880

GENERAL INDEX.

for, 434; suppression of the first germs
of, by belladonna, 440; treatment of the
after-sufferings of, 441; observations on
the, 546; comparison of, with purpura
miliaris, 547; belladonna in, 550, 779.
Schools, promotion of infectious diseases
by, 268.
Scirrhus of the prepuce, 87.
Scorbutus combined with syphilis, 154.
Scrofula combined with syphilis, 154.
Seat of gonorrhoea, 17.
Sensible properties of medicines as a source
of the knowledge of their therapeutic
action, 300, 754.
Sequele of gonorrhoea, 46.
Sesamoides, 679.
Ships, regulations for, 260; diet for, 261;
ventilation of, 261.
Show, worth of outward, 240.
Sick, the visiter of the, 200.
Signature of medicines, 570, 754.
Signs of the times in medicine, 640.
Simplicity in medical practice, on, 358.
Single remedies should be given at a time,
371, 403, 531.
Small doses, on the power of, 443, 817.
Small-pox, communicated by foul linen,
249; and cow-pox incompatible, 511.
Smell, therapeutic action of drugs judged
of by their, 756.
SOCRATES and PHYSON, a dialogue, 240.
&olanum nigrum, pathogenetic effects of,
319; therapeutic uses of, 319.
Solvent remedies, on, 612.
Sore-throat, a stocking in, 212.
Sources of the common materia medica,
748.
Spanish collar, 80.
Speculative systems of medicine, value of,
556.
Spirit of the homoeopathic doctrine, 696.
Spoilt food, sale of, 268.
Squill, pathogenetic effects of, 348; therapeutic uses of, 348.
Stimulants, remarks on, 409.
Stomach, instinct of the, 220.
Stoves, proper regulation of, 217.
Stramonium, KLOCKENBRINO'S prescription
of, 290; pathogenetic effects of, 323;
therapeutic uses of, 324; vinegar the

antidote to, 379; case of poisoning by,
379.
Strangury, chronic, 46.
Stricture of the urethra, 56; persistent,
59; spasmodic, 59, 66; from calculus,
66.
Substitutes, objections to, 542, 574, 655.
Succussion, effects of, 817.
Suicidal mania, gold in, 781, 821.
Suicides, on the uncharitable feeling towards, 781.
Sword-thrust, cure of empyema by a, 219.
Sycosis, thuja in, 779.
Symptoms, treatment of, 478, 595; diseases
only discoverable by an observation of
the, 505.
Syphilis, 108, 332; diagnosis of, 108; produced by destroying the chancre, 736.
Syphon, HAHNEMANN'S injecting, for gonorrhoea, 27.
Systems of medicine, various, 482.
Tailoring, removal of deformity by, 218.
Taste, therapeutic action of drugs judged
of by their, 755.
Teething diseases, remarks on, 277, 612.
Testicle, swelled, 39; induration of, 48.
THEOPHRASTUS on hellebore, 649.
Theories in medicine, value of, 558.
Thuja in sycosis, 779.
Tobacco, pathogenetic effects of, 324; therapeutic uses of, 324.
Tonsillar ulcers, venereal, 115.
Toothache, nostrums for, 640; treatment
of, 641.
Town-walls prejudicial to health, 266.
Trees, unwholesomeness of, 216.
Tripper, origin of the word, 15.
Trituration, effects of, 817.
Typhus fever, odour of the miasm of, 248;
treatment of, 712.
UcAY'S mercurial preparation, 4.
Ulcers of the urethra, 22; venereal, 113.
Uterine hemorrhage cured by cofee, 224.
Uva ursi in urinary affections, 329.
Valerian in irritability, 316.
Vaugirard, treatment of syphilitic infants
at, 179.




GENERAL INDEX.

881

Venereal disease, infection by, 732.
Venereal diseases, treatise on, 1; observations on, 728.
Venereal sore-throat and fissure in the
anus, case of, 871.
Venesections in gonorrhoea, 30.
Veratrum album, pathogenetic of, 348, 657;
therapeutic uses of, 349; in a case of
colicodynia, 356; coffee the antidote to
379, 686; cases of poisoning by, 379;
in the water-colic, 605; the white hellebore of the ancients, 651; treatment of
bad effects of, 685; in cholera, 847.
Vienna Faculty, absurd decrees of, 574.
Vinegar not a universal antidote, 374; the
antidote to arnica, 376; the antidote to
stramonium, 379; the antidote to ignatia,
379.

Viola in skin diseases, 328.
Visiter of the sick, the, 200.
Wallachs, their treatment of syphilis, 131,
Walnut-husks in syphilis, 145.
Warm baths in gonorrhoea, 31.
Warts, venereal, 90, 167.
Water, supply of to towns, 260.
Water-colic, veratrum in, 605.
Weather, influence of, on disease, 366.
Workhouses, regulations for, 368.
Worm diseases, on so-called, 613.
Wounds in syphilitic subjects, 109.
Yew, pathogenetic effects of, 338; therapeutic uses of, 339.. THE END.

OCT4              fi*
ERRATA.
page 241, line 5 from bottom, for " beneficially" read "benignly."
page 342, line 3 from bottom, for " conciousness " read " consciousness "
page 422, line 16 from bottom, for " uniniated " read "uninitiated "
page 501, line 12 from bottom, for "GREG. MAG." read "GREG. NAZ."
page 579, line 12 from top, for "'partie hortense" read "partie hontese "
page 644, line 11 from top, dele "more "







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