Organon of the rational art of healing

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EVEPvYMAN^S LIBRARY
EDITED BY ERNEST RHYS

SCIENCE

ORGANON OF THE RATIONAL

ART OF HEALING, BY SAMUEL

HAHNEMANN. TRANSLATED BY

C. E. WHEELER, M.D.

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ORGANON
@ @ OF THE
RATIONAL

ART OF «
HEALING
BY SAMUEL
HAHNEMANN

LOM D ON: PUBLI SHED
byJ-MDENT &SONSHP
AND IN NE'W YORK
BY E'P- DUTTON^CO

CONTENTS

PART I
translator's preface ....
introduction .....

author's PREFACE .....

translator's note

organon of the rational art of healing

PAGE

ix

xi

. xxvii

. xxviii

I

PART II

PREFATORY NOTE

PROTECTION AGAINST INFECTION IN EPIDEMIC
DISEASES .

PLANS FOR ERADICATING A MALIGNANT FEVER .

SUGGESTIONS FOR THE PREVENTION OF EPIDEMICS
IN GENERAL, ESPECIALLY IN TOWNS

iESCULAPIUS IN THE BALANCE ....

Ill

126

141
163

Vll

TRANSLATOR'S PREFACE

The original suggestion that Hahnemann's
Organon was worthy of a place in Every-
man's Library came from the late Mr. James
Speirs, and was supported by the British
Homoeopathic Association, of whose Council
Mr. Speirs was a member. Mr. J. M. Dent
looked favourably on the proposal, but was
naturally anxious to make clear that the Organon
is put forward here as a piece of history rather
than as a contribution to polemics. For this
reason the original edition of 1810 was selected
for presentation, as it both constitutes a land-
mark in medical history and is less controversial
than the later editions. The name of Robert
Dudgeon is inevitably bound up with the render-
ing of Hahnemann's works into English, but
inasmuch as Dr. Dudgeon worked from the
latest and fullest edition, another translator had
to be sought for this, the original edition. The
association of Dr. Dudgeon with Hahnemann is
maintained, however, in Part H of this volume,
for the translations of the essays contained
therein are from his pen. His version of the
Organon has also been for me a court of appeal
and constant help in difficulty, and it remains
by far the most valuable record for any one

X TRANSLATOR'S PREFACE

desirous to test the truth of Hahnemann's
propositions.

In preparing my translation I have had the
advantage of the co-operation of Mr. James
Speirs, until his sudden and untimely death,
and the invaluable assistance of my friend, Dr.
T. Miller Neatby, M.A., who has constantly
criticized the work both as physician and as
writer, giving a value to this version which it
would otherwise have lacked. To him I render
my most hearty and grateful thanks : indeed, I
am deeply conscious that his aid will count for
no small proportion of any acceptance which this
volume may win.

C. E. Wheeler.

35, Queen Anne Sf., W.
March, 27, 19 13.

INTRODUCTION

The Organon of Samuel Hahnemann is one
of those books whose effect upon the world has
been, in its intensity, out of all proportion to
the extent to which its pages have been read.
It is the foundation upon which the structure of
Homoeopathy has been built. Its successive
editions (five in Hahnemann's lifetime) embodied
the ripe experience and confident beliefs of its
author, and old-fashioned as its phraseology
sounds to-day, and out of date as many of its
conceptions appear, it is not too much to say
that the principles of Homoeopathy, and even the
most effective art of applying those principles,
are expressed in the Organon in a way that
might easily be modified in the phrasing, but
must remain unaltered in the essence for any
who wish to test this method of practical thera-
peutics. But the storm of anger and opposition
that broke over Hahnemann and his method
was the very worst atmosphere for the calm dis-
passionate enquiry which he eagerly desired,
but which he and^his followers have longed for
in vain. Individtials have granted the enquiry
(thus, indeed, has the system made its converts),
but the Profession, never. Consequently less
than five per cent, of the practitioners of medicine
at any time have had even a remote acquaint-
ance with the Organon, with the result that its
undoubted effect has been exerted indirectly and
Hahnemann has lost much honour that should
have been his. The difference between the

xi

xii INTRODUCTION

orthodox medical practice to-day and the practice
of a century ago (tiie first edition of the Organon
appeared in 1810) is very great. Pasteur and
Lister and their followers have revolutionized
surgery, but the therapeutics of drugs (the sphere
of Homoeopathy) have also changed exceedingly,
and practices like bleeding and blistering and
drastic measures of that order have almost dis-
appeared. Yet to Hahnemann's contemporaries
these drastic procedures seemed the only way
of salvation, and though founded on the wildest
theories, which in their turn were supported by
hardly a shred of evidence or experiment, they
were yet persisted in with that blind optimistic
confidence which has seldom been found lacking
among the descendants of ^sculapius. Gradu-
ally from 1 8 10 up to the present time the scene
has changed, and although physicians still de-
plore the lack of method shown in giving medi-
cines, and although many of the most famous
of them express an almost universal scepticism
of the value of drugs, they have at least learnt
caution and the powers of recovery that belong
to unaided Nature, and seldom to-day do they
load the balance against the patient after the
authentic fashion of their predecessors. The
march of science, that is of exacter knowledge,
through the century has counted for much in
this change of attitude, but tlrc influence of the
constant presence of even the small minority of
believers in Homoeopathy has been a force that
cannot be overlooked. While bleeding and
salivation and purgation and drastic methods of
counter-irritation were confidently proclaimed as
essential to the treatment of disease, there was
always after 1810 a remnant that refused these
methods and demonstrated to all who would see

INTRODUCTION xiii

that patients recovered more surely and more
speedily in the hands of those who used only
minute doses of simple remedies.^

Granted that many cures attributed to Homoeo-
pathy may have been really due to natural
powers of recovery working unhindered, what
more damning indictment of the older methods
could possibly be presented? If it be held (as
many hold who admit the effectiveness of
Homoeopathy), that its work was purely to
demonstrate the recuperative powers of Nature
unimpeded by the physician, that negative
achievement of Homoeopathy would yet suffice
to place the name of Hahnemann among those
who have benefited mankind.

Therefore, as an historical work, the Organon
may be offered to every man as a book of great
interest, a book whose effects, negative and
positive, have reached many to whom its contents
have been unknown and to whom the name of
its author has been only a synonym for crazy
theorizing and unprofitable speculation. But
there is another claim to attention which may
be urged on behalf of the book, a claim that will
be better realized if it is approached through a
brief account of Hahnemann and of the nature
of his work.

Hahnemann was born at Meissen in Saxony

^ Of the superior results obtained by Homoeopathy while
the drastic means of treatment were still in popular use there
can be no doubt whatever. Everywhere the official influence
of the Profession was used to decry and suppress the heresy,
and it was only through the conviction of state-governing
bodies that Homoeopathy's results were so good, that its
adherents obtained leave to practise. The clause in the
English Medical Act which ensures the status of Hahne-
mann's followers was directly due to. the vastly superior
results obtained by them in treating cholera in London.

xiv INTRODUCTION

in the year 1755. His parents, though poor, were
filled with a sense of the value of knowledge and
obtained for him such education as they could.
By dint of great natural aptitude and diligence
he made the most of the opportunities so obtained;
and he was able, in process of time, not only to
complete his medical studies and obtain his
degree, but also to become an erudite man. His
knowledge of languages was unusually exten-
sive, including besides his native German, Eng-
lish, French, Italian, Greek, Latin, Hebrew,
Arabic and Spanish. Therefore in all his
voluminous studies of the medical wisdom of
the past he w^as able to consult each author in
his own tongue. But his bent was ever to
science rather than to literature. He was deeply
religious and the Bible has left its mark upon
his style of writing; but there are few or no
traces in his works of the great political and
literary movements that synchronized with parts
of his long life. The Organon exhibits a pas-
sionate desire for exact and clear statements, a
desire which, at any rate to the English mind
seems at times to conflict with the structural exi-
gencies of the German tongue. Indeed, his
desire for clarity leads him into repetitions which
end in confusion, and the Organon is hardly to
be recommended as a model of style. But
throughout it is at least w^orkmanlike, clear in
thought, arduously painstaking and full of pas-
sionate conviction, yet withal moderate and
argumentative through all its apparently dog-
matic utterance. No unprejudiced person can
rise from its perusal without a respect for Hahne-
mann, and what is true of the Organon in this
respect is true of all the other writings of this
great physician.

INTRODUCTION xv

Up to the year 1790, that is until he was thirty-
five, he worked at his profession and at other
branches of science, especially at chemistry. In
this last field he was responsible for much
admirable work, and witness to his ability is
furnished by the great Berzelius, who said of
him, "The man might have been a great
chemist " : testimony the more to be valued as
Berzelius had no fraction of interest in or sym-
pathy with Hahnemann's medical opinions.
As a physician Hahnemann was recognized by
1790 as one of the best in Germany. Hufe-
land, the leader of the German medical pro-
fession at this time, spoke thus of him, and
retained a staunch regard for him and a
high opinion of his abilities, though he never
followed him into Homoeopathy, nor even, as
far as appears, submitted it to any practical
examination.

As a physician Hahnemann made several most
competent and valuable contributions to general
medicine; among them may be specially men-
tioned his rational and humane teaching with
regard to the treatment of the insane, and his
practical hints on the management of epidemics,
in both of which matters he was much in advance
of his contemporaries and virtually anticipated
all the modern points of view. But in spite of
his standing in the world of medicine, he was
profoundly dissatisfied with the art of medicine.
The smallest knowledge of the treatment that
was current and orthodox in his day is enough
to explain his dissatisfaction, for dangerous
practices were then deduced from almost base-
less theories to an extent nearly incredible, and
although Hahnemann's caution and sound sense
kept him from the worst pitfalls, he was left in

xvi INTRODUCTION

the helpless state of having no alternative method
to supply the place of all that his reason rejected.
By 1790 he had almost withdrawn from practice
and was earning his living by translating
medical works. At this time he was engaged on
Cullen's Materia Medica, and being dissatisfied
with Cullen's explanation of the action of cin-
chona bark in relieving and curing ague, he
took the scientific and rational course of personal
experiment in order to test the matter. It is
needless to state that the treatment of ague by
cinchona was one of the few really satisfactory
pieces of treatment in Hahnemann's day, and,
not unnaturally, speculation was rife as to the
reason of this definite curative relation between
drug and disease. Hahnemann's experiment
consisted in taking a large dose of cinchona
bark while in good health and noting its effect
upon his own healthy body. To his surprise he
found reproduced upon himself all the chief
phenomena (and even many of the minor symp-
toms) of a paroxysm of ague. When the attack
passed off, a second dose produced a second
paroxysm, and Hahnemann was presently face to
face with the fact that this drug, which so often
cured ague was capable of reproducing in his
own healthy body the phenomena of ague. Like,
in fact, cured like. Cinchona bark does not
invariaLly produce this effect on the healthy,
even in large doses, but the general truth of
Hahnemann's observation, though sometimes
questioned, has been amply confirmed ; and Pro-
fessor Lewin, the great German authority on
Materia Medica, who has no leanings to Homoeo-
pathy, not only quotes this experiment of Hahne-
mann, but endorses it as illustrating a genuine
result of the drug, and confirms it with similar

^ ^ INTRODUCTION

xvii

cases. There are always individual reactions to
individual drugs, but it may be taken as estab-
lished that cinchona bark tends, at any rate, to
produce phenomena similar to those which it can
cure, although the extent of the tendency varies
in different experimenters.

This experiment was a ray of light to Hahne-
mann, for it suggested a possible clue to curative
relations between drugs and cases of disease, a
clue which he eagerly followed up. Those, and
they are not a few, who are ignorant of his
life and work, and yet brand him as a shallow,
crackbrained dreamer or designing charlatan,
are apt to think of him as rushing forth into
the world with a complete system of medicine
erected on the foundation of one doubtful ex-
periment. The truth is far other than this. As
soon as the cinchona experiment suggested to
Hahnemann the possibility that the principle of
like to like might prove a general Law of Heal-
ing, he began a systematic study of the records
of medicine in the search for instances. He
soon found numbers, many of which were men-
tioned in a preface to the Organon, which in
this edition is summarized shortly, as its interest
is technical and professional only. But over and
over again Hahnemann found that a drug pre-
scribed empirically had proved itself capable of
curing conditions similar to those which it could
produce. The records of medicine, in fact, gave
plenty of encouragement to his now dawning
belief that similia similihus was a genuine Law
of Cure. But he did not neglect present experi-
ment while searching out past experience. He
returned to medical practice, and as opportunity
offered he prescribed drugs for the diseases
whose symptoms they could counterfeit, and

xviii INTRODUCTION

noted his results. Having interested a few
friends in his experiments, he now began to lay
the foundations of his vast work on Pure Materia
Medica, his reason being that, in order to pre-
scribe homoeopathically, that is, on the basis of a
similarity of symptoms between drug and dis-
ease, it is necessary to have a full knowledge of
drug-symptoms. Such knowledge was largely
to seek, because in spite of the work of a few
previous experimenters like Haller and Stoerck,
the effects of drugs upon the healthy, apart from
cases (comparatively rare) of poisoning, could
only be known from records of over-dosing in
sickness, records wherein drug-symptoms and
disease-symptoms were intermingled and con-
fused. In order to gain a knowledge of pure
drug action "provers" had to be enlisted,
healthy and devoted persons who would take
drugs in sufficient quantities to produce clear
symptoms, and by recording these symptoms
would begin the task of constructing clear
symptom-pictures of remedies for comparison
with the symptom-pictures of cases of disease.
Hahnemann and a few of his friends attacked
this herculean task and continued it year after
year, until a mass of exact knowledge was avail-
able with regard to the effects of drugs such as
had never existed before; knowledge which re-
mains the more important part of the homoeo-
pathic Materia Medica, although a century of
continued experiment and clinical experience has
added to it and clarified it.

In research and in experiment six years
passed, and in 1796 Hahnemann felt justified in
publishing a first statement of his beliefs. This
appeared in Hufeland's Journal, the leading
medical periodical of that day. In the article

M

INTRODUCTION xix

Hahnemann stated his theory, and adduced in
its favour the evidence of the past as well as
the results of experiment. While this article is
the presentation of a case by a man who believes
in it, it is not a dogmatic assertion so much as
a plea for further experiment. The plea was
denied, as virtually all the pleas of homoeopathy
to be tested before it is condemned have been
denied. The first stirrings of the storm of
obloquy and hatred which it was the fate of
Homoeopathy to rouse were already audible, but
Hahnemann returned to his experiments un-
deterred. In 1805 appeared the first collection
of drug symptoms, the forerunner of Materia
Medica Pura which appeared in instalments
between 181 1 and 1827; and in 1806 another
essay on the general theory of Homoeopathy
which formed a kind of preface to the Organon.
Ten years more of unwearying experiment have
passed by, and Hahnemann can at least claim
that he has shrunk from no effort to establish
the truth by the only means known to science,
experiment and observation. But between 1796
and 1806 appeared various essays on points
related to the lawswii/fa similibus curentur ("Let
likes be treated with likes "), a law which after
sixteen years of labour he felt justified in pro-
claiming. In 1801, for instance, appears the
first hint of that practice which, more than any
other, is associated in the mind of every man
with Homoeopathy, the practice of administering
drugs in minute and, ultimately, in infinitesimal
doses. Though to many this practice is of the
essence of Homoeopathy, it is, strictly speaking,
an unessential addition to the central law. The
law of Hahnemann and of Homoeopathy governs
only the choice of the remedy, and when a drug

XX INTRODUCTION

is given to cure a disease the symptoms of which
it can counterfeit when given to the heahhy,
then, consciously or unconsciously, Homoeopathy
is practised, be the doses large or small or in-
finitesimal. Unconscious Homoeopathy is not
uncommon, and instances now and then appear
in orthodox journals. Seeing that by the
homoeopathic law drugs are chosen that act
similarly to diseases, it would seem only reason-
able to use them with caution lest the condition
be aggravated, but the precise amount necessary
for any particular case is a matter for the
physician to decide from his own experience.
Hahnemann and his followers appeal always to
experience and experiment. They say in effect :
"We have made certain experiments and we
find a certain constant relation to exist between
drugs and diseases. Of this we are so confident
that we cannot admit an adverse opinion not
founded on experiments equally painstaking.
But among ourselves we find considerable
divergences as to the best dosage for individual
cases. JNIost of us have found drugs active in
quantities minute or infinitesimal, but we can
lay down as yet no law of dosage comparable
to the law of selection of the remedy. We sus-
pect that just as there is an optimum remedy for
any given case, so there is an optimum dosage.
Our experiments universally lead us to dosage
much smaller than that customary with non-
homoeopathic physicians, but the exact range of
it should, we think, be a matter of individual
experience and experiment." This at least
would sum up fairly the present position among
homoeopathists with regard to the question of
the dose. It is entirely secondary to the choice
of the remedy, and it is that choice and not the

INTRODUCTION xxi

amount of the drug actually administered that
stamps a treatment as homoeopathic.

In 1 8 10 appeared the first edition of the work
before us, The Organon of Rational Medicine,
which is here translated as it stands, with the
omission only of such notes as have a purely
technical interest. Exactly twenty years of
arduous experiment and close observation had
passed since the first gleam of a possible law-
flashed on Hahnemann's mind. Right or wrong,
at least he cannot be justly accused of haste or
scanty consideration. All that he could do
scientifically to test his case he has done, and
he rightly speaks now with confidence and some
scorn of any who should (and actually did) con-
demn his conclusions without any enquiry into
those experimental bases upon which his con-
clusions rest. Although the first edition went
oflf but slowly, five editions in all were published
in Hahnemann's lifetime, and the work became
and has remained the chief foundation-stone of
Homoeopathy. Hahnemann never ceased to
observe and to test, and the later editions of the
Organon contain a good deal of additional
matter embodying his later experience, but
nothing that conflicts with the essential prin-
ciples laid down in the first edition. Especially
he came to develop views concerning the origin
of chronic diseases and the best method of
treating them homoeopathically, which modify
some of the paragraphs here set forth and add
a good deal of fresh material. With those
views we have here little to do. The Organon
is presented in this edition as a work of profound
historical interest and value, not as a polemic
in favour of a cause. Though a day should
come when Hahnemann's views are proved

xxii INTRODUCTION

erroneous (and that day is not yet), the Organon
would still retain an historical and personal in-
terest which makes it unnecessary to preface it
with any full controversial argument. It will
suffice to say of Hahnemann's views on chronic
diseases that although his theories have by no
means found universal acceptance among his
followers, the practice he founded upon them
has proved itself of real value, and those who
have accepted the theoretical basis and built
their practice on it most definitely are generally
those who have proved most successful in deal-
ing with chronic diseases. In this, the first
edition of the Organon, insistence is only laid
upon the law of treating likes with likes. That
is now, as then, the central law of Homoeopathy
to which the small dosage of remedies and the
theories of chronic diseases are accessory but
not essential. Hahnemann died in 1843 full of
years, having won the enthusiastic respect and
honour of a large number of the laity and the
no less earnest hatred and scorn of most of his
profession. Homoeopathy has never been the
faith of more than a small minority of medical
men, but it has spread all over the world and
can count its adherents and its hospitals and
dispensaries everywhere. In Europe, inasmuch
as the ban of official medicine has been pub-
lished against it, and its followers have been
denied all chance of holding teaching posts or
influential positions, it has had to strive against
great odds and make its way in the teeth of an
opposition none the less powerful because
founded chiefly on ignorance and prejudice.
Still it has held its own and gained ground.
Governments have refused to join in the pro-
fessional attack upon it, and although in Europe

INTRODUCTION xxiii

there are no homoeopathic schools, and although
every convert has to be won from the ranks of
those who have been officially taught to regard
it as folly or charlatanism, still it makes its
converts. The minority hold to it because they
have tested its claims and found them valid.
The majority decry it because (in almost every
case) they have little or no knowledge even of
its aims, and still less experience of its practical
application. In America, less hampered by
tradition, it has had a fairer field, and though
even there the faith of a minority, it neverthe-
less numbers its doctors by the thousand and
possesses its own schools and colleges.

General medical science has enormously ad-
vanced since the days of Hahnemann, for, thanks
mainly to Pasteur and Lister, surgery is a great
beneficent force, and although leaders of medi-
cine still bewail the lack of exact therapeutic
methods, yet their art is now fairly free from
the reproach of doing active harm. The early
results of Homoeopathy were contrasted with the
results of men whose methods were dangerously
drastic, while modern medicine is sceptical of
its power to heal, but careful not to hurt, and
this is a great gain. Homoeopathy as an art is
concerned only with the use of drugs in diseases.
All that pertains to surgery and to the accessory
branches of medicine is as much within the
power of the followers of Hahnemann as of any
others, and they have not been slow to avail
themselves of these gains of knowledge. But
they retain the faith that, in the sphere of the
application of drugs to diseases, the law of
similars is a weapon potent to relieve and cure
with swiftness and certainty w^henever its in-
dications are clear. Moreover,^ certain advances

xxiv INTRODUCTION

of modern science give them confidence that
they have in Homoeopathy a genuine law of
tissue reaction. For the study of protoplasm
has led to the formulation of certain biological
laws, universally accepted, concerning its re-
action to stimuli; and the fundamental law of
such reactions applying to all stimulating agents,
whether chemical (as e. g. drugs), electrical,
mechanical or other is that the same agent which
in relatively large doses can damage or destroy
life activity, can in a relatively smaller dose stim-
ulate it. Whence it follows that if by experiment-
ing with drugs upon the healthy we have learned
the tissues which these agents have it in their
power to injure (and we deduce this from the
symptoms exhibited), and if we find these same
tissues manifesting by similar symptoms the
injurious effects of disease, then we can con-
fidently administer small doses of the drugs
which we have independently found to have the
power of damaging those tissues, knowing that
the STYiall dose will act as a stimulus to those
very cells that need a stimulus ; and this is to all
intents the homoeopathic law. This approxima-
tion to the law has been worked out by biologists
untainted with the heresies of Hahnemann, and
has led at least one distinguished teacher of
Materia Medica, Professor Hugo Schuiz of
Greifswald, to conclusions which he is suffici-
ently open-minded to admit resemble those of
Homoeopathy. This admission has prevented
most of his orthodox colleagues from studying
his work and has brought a certain amount of
obloquy on his head.

But now Bacteriology (which was a sealed
book to Hahnemann, though he gained a pre-
scient glimpse of some at least of its contents

INTRODUCTION xxv

when he met with cholera) comes upon the scene
to make a practical application of these biological
laws, and from them to develop the modern
"vaccine " treatment. This treatment is founded
upon the observed facts first that certain micro-
scopic organisms (bacteria) are by their multi-
plication in the body the specific agents of certain
diseases; second, that the body elaborates
specific defences and offences by which to resist
and overcome them; and third that when this
defensive and offensive mechanism is insuffi-
cient it can often be stimulated to sufficiency by
the administration of a remedy manufactured by
growing the specific causal germ or germs out-
side the body, and from these ''cultures " making
a preparation known as a vaccine. In other
words the germ (somewhat modified) is the
remedy for the disease that the germ itself pro-
duces. And if this is not Homoeopathy it is
difficult to know by what other name to call it.
The growth and success of vaccine treatment
has actually been a great encouragement to
homoeopathists, and many great bacteriologists
have in recent years come to speak with less
acerbity of Homoeopathy, and the general pro-
fessional bitterness has largely abated. Add to
this the newest theories of physics and the dis-
covery of the powers of radium, which render
the action of the infinitesimal at least more
credible, and it must be admitted that the lapse
of a hundred years has made the fundamental
dogma of the Organon not less, but more de-
serving of the test of experiment. Enormously
as some of the great scourges of mankind have
been brought under control, there are few in-
habitants of the civilized world that are not at
one time or other in need of a physician. It

xxvi INTRODUCTION

concerns every man that no avenue of possible
help should be left unexplored. Now it is un-
deniable that from a variety of reasons, easily
explicable, the theories of the Organon and the
practice founded on them have not received
the bare justice of a satisfactory testing. In the
main the few who have tested them have come
to believe in them, and have been willing to
endure ostracism and ill-will for their faith, but
the many have been content with a scornful
denial of statements which they have never
troubled to investigate. There is no room here
for a consideration of personal rights and
wrongs; the issues of life and death, health and
disease, are too grave. It would not be worth
while to perpetuate a difference even in order to
win justice for Hahnemann as neither dreamer
nor charlatan, but a great physician. But until
this possible source of strength to medicine is
amply tested and once for all confirmed or dis-
proved there must be an uneasy feeling of a
possible waste of power and some smouldering
rancour and ill-will. There is no adequate test
but that of personal experiment, patient and
oft-repeated, but before experiment must come
curiosity and a desire for conviction positive or
negative. This curiosity and this desire hardly
exist, but no one sufficiently scientific to avoid
prejudice could read the Organon without first
wondering and then testing. Out of the multi-
plication of experiments should come at last a
full and fair conviction.

AUTHOR'S PREFACE

Truth for which all the eager world is fain,
Which makes us happy, lies for evermore
Not buried deep but lightly covered o'er.
By the wise Hand that destined it for men.

Gellert.

The testimony of all ages is in nothing more
unanimous than in maintaining that the art of
healing is an art of conjecture (ars conjecturalis) :
no art therefore has less right to refuse a search-
ing enquiry into the soundness of its basis than
this art upon which health, the dearest earthly
possession of man, is founded.

I count it to my credit that in recent days I
have been alone in subjecting it to a serious
impartial investigation, and that I have laid
before the world in signed or anonymous pub-
Ucations the convictions which have resulted
therefrom.

Through this enquiry I found the road to
truth, upon which I have to tread alone, a road
far removed from the common highway of
medical routine. The further I advanced from
truth to truth, the further did my conclusions
move from that ancient structure which, having
been built out of opinion, is now only main-
tained by opinion, although I allowed no single
one of my conclusions to stand unless fully con-
firmed by experiment.

The results of these convictions are stated in
this book. It remains to be seen whether
physicians who intend to deal fairly with their

xxvii

xxviii AUTHOR'S PREFACE

consciences and with humanity can open their
eyes to the health-giving truth, or whether they
will continue to abide by their baleful tissue of
arbitrary conjectures.

This warning at least I would give at the
beginning, that indolence, desire for ease, and
obstinacy make service at the altar of truth
impossible, and that only freedom from pre-
judice and tireless zeal avail for the most holy
of the endeavours of mankind, the practice of
the true art of healing. But the physician who
works in this spirit follows close after God, the
Creator of the world, whose creatures he helps
to uphold, and whose approval makes his heart
thrice blessed.

TRANSLATOR'S NOTE

In the original edition, between the preface
and the body of the work, Hahnemann inserted
an introduction, devoted mainly to a record of
applications of the homoeopathic law made un-
consciously by other physicians and recorded by
them. This introduction is therefore mainly of
a technical interest and is here omitted, but some
idea of the care and thoroughness of Hahne-
mann's investigations can be formed from the
fact that he quotes nearly two hundred and fifty
instances of unconscious Homoeopathy, most of
them not isolated cases, but records of repeated
experiences; and supports them by the evidence
of no fewer than four hundred and forty physi-
cians mentioned by name, with a reference to
the source from which each opinion is derived.

BIBLIOGRAPHY OF S. C. F. HAHNEMANN

Original Works. — Inaugural Thesis {Conspectus affeduum
spasmodicoru77i cctiologicus et therapeutiais, qiiem dissertatione
inaugurali medica . . . submittit S. H.), Erlangen, 1779; Direc-
tions for Curing Old Sores and Ulcers {Anleitung alte Schdden nnd
faule Geschwiire grilndlich zu heilen), Leipzig, 1784; On Arsenical
Poisoning, its Treatment and Judicial Detection ( Ueber die Arsenik-
vergiftjcng, ikre Hiilfe und gerichtliche Ausmittehmg), Leipzig,
1786; Instructions for Surgeons concerning Venereal Diseases,
with a New Mercurial Preparation ( Unterricht fi'ir Wunddrzte iiber
die venerischen Krankheiten, nebst eijtemnezien Qtieksilberprdparaie),
Leipzig, 1789; Pharmaceutical Lexicon {Apothekerlexicon), in 4
vols., Leipzig, 1 793-1 799; Preparation of the Cassel Yellow
{Bereitung des Casseller Gelbs), Erfurt, 1793 ; Essay on a New
Principle for Ascertaining the Curative Power of Drugs ( Verstuk
iiber ein neues Princip zur Auffindung der Heilkrdfte der Arzneisub-
stanzen), from Hufeland's Journal der Praktischen Arzneykunde,
1796 ; Cure and Prevention of Scarlet Fever {Heilung imd Verhii-
tung des Scharlach-Fiebers), Gotha, 1801 ; reprinted, 1844 ; The
Effects of Coffee {Der Kaffee in seinen Wirktingen), Leipzig, 1803 ;
trans, into French by E. G. von Brunnow, 1824 ; into English by
Mrs. E. Epps, 1855 ; Fragmenta deviribiis medicanientorurupositivis
sive in sano corpore hujnanis observatis, Leipzig, 1805 ; Organon
of Rational Healing {Organon der rationellen Heilkunde), 1810 ;
2nd ed., 1819 ; 3rd ed., 1824; 4th ed., 1829; 5th ed., 1833;
6th ed., 1865 ; trans, into French by E. G. von Brunnow, 1824 ; by
Dr. A. J. L. Jourdan, 1832 ; into Spanish by Lopez Pinciano, 1835 ;
into English by R. E. Dudgeon, 1849 ; Materia Medica Pura
{Peine Arzneimittellehre\ in 6 vols., Dresden, 1811-1821 ; 2nded.,
1822-1827; 3rd ed., 1830-1833 ; trans, into Italian by Dr. F.
Romani, 1825 ; into Latin by E. Stapf, G. Gross and E. G.
von Brunnow, 1826- 1828 ; into French by A. J. L. Jourdan, 1834 ;
into Spanish by Lopez Pinciano, 1835 ; into English by R. E.
Dudgeon, 1880 ; Chronic Diseases, their Nature and Homoeopathic
Treatment {Die chronischen Krankheiten. ihre eigenthilmliche Natur
und hombopathische Heihmg), in 4 vols., Dresden and Leipzig,
1828-1830; 2nd ed., in 5 vols., 1835-1839 ; trans, into French
by A. J. L. Jourdan, 1832 ; into English by Dr. G. M. Scott,
1842 ; into Spanish by R. de T. Villannera, 1849 ; The Lesser
Writings of S. H., collected and translated .by R. E. Dudgeon,

xxix

XXX BIBLIOGRAPHY

1 85 1 and 1852 ; H.'s Therapeutic Hints, collected and arranged
by R. E. Dudgeon, 1894.

Biography and Criticism. — Das Leben und Streben S. H., by
J. Muehlenthor, 1834; Ein Blick auf H. und die Homoopatkik, by
E. G. von Brunnow, 1844; trans, into English by J. Norton, 1845 ;
A Biographical Monument to the Memory of S. H., by C. Fischer,

1852 ; H. : a Biographical Sketch, by R. E. Dudgeon, 1852 ; Die
Homoopathik H.'' s oder die Heilkundeder Erfahrung, by C. Hencke,
1861 ; On H.'s Merits, Errors and Critics, by M. Roth, 1872 ; Dr.
A H.'s des Begrunders der Homxopathie , by F. Albrecht, 1875 ;
Ecce Medicus ; or, H. as a man and as a physician, by J. C. Burnett,
1881 ; H. as a Medical Philosopher, The Organon, etc., by R.
Huges, 1882 ; A Bird's Eye View of H.'s Organon of Medicine, by
J. H. Clarke, 1893 ; The Life and Letters of Dr. S. H., by T. L.
Bradford, 1895 5 The Influence of the Therapeutic Teaching of H.
in 1796 upon the Study and Practice of Medicine in 1896, by A.
C. Pope, 1905; Knaves or Fools? by C. E. Wheeler, 1908.

ORGANON OF
THE RATIONAL ART OF HEALING

BY

SAMUEL HAHNEMANN

TRANSLATED FROM THE FIRST EDITION

AND EDITED BY

C. E. WHEELER, M.D., B.S., B.Sc.

TOGETHER WITH

FOUR ESSAYS BY SAMUEL HAHNEMANN

TRANSLATED BY

R. E. DUDGEON, M.D.

I

ORGANON OF TOE RATIONAL ART OF HEAL-
ING, ACCORDING TO THE LAWS OF
HOMCEOPATHY.

The physician has no higher aim than to make
sick folk well, to pursue what is called the Art of
Healing.

2

The highest ideal of cure is the speedy, gentle
and enduring restoration of health, or the re-
moval and annihilation of disease in its entirety,
by the quickest, most trustworthy, and least
harmful way, according to principles that can
readily be understood, (the Rational Art of
Healing).

3
If the physician clearly perceives what it is in
disease in general and in each case of disease
in particular that has to be cured (knowledge of
disease, knowledge of the requirements of disease
or disease-indications) : if he clearly perceives
what is the healing principle in medicine
generally and in each medicine in particular
(knowledge of the powers of medicines) : if in the
light of clear principles he can so adapt the
healing virtue of the drug to the illness that is
to be cured that recovery must follow, and if he

B

2 ORGANON OF THE

has the abihty not only to select the particular
remedy whose mode of action is most suitable
for the case (choice of the remedy or indicated
medicine), but also to choose the exact quantity
of the remedy required (the suitable dose) and
the fitting period for its repetition, if, I say, he
knows all these things and in addition recog-
nizes in every case the hindrances to lasting
recovery and can remove them, then truly he
understands how to build up his work on an
adequate basis of reason, and he is a rational
practitioner of the healing art,

4
He is also a maintainer of health, if he knows
the causes that may disturb health and excite
disease and how to remove them from healthy
persons.

5
It may be granted that every disease must
depend upon an alteration in the inner working
of the human organism. This disease can only
be mentally conceived through its outward signs
and all that these signs reveal ; in no way what-
ever can the disease itself be recognised.

The invisible disease producing alteration in
the inward man together with the visible altera-
tion in health (the sum of the symptoms) make
up that which is called disease : both together
actually constitute the disease.

Author's note. — Therefore I do not know how
that morbid change in the Inward of the body
which occurs in disease could have been re-
garded as a thing existing by itself and outside

RATIONAL ART OF HEALING 3

the disease, as a condition of the disease, as its
inner, immediate primal cause {prima causa),

A thing or a condition demands a first proxim-
ate cause only in order to come into existence;
where the thing or condition actually exists it
requires no further originating, no first and
proximate cause, for its continued existence.

Thus a disease, once established, endures
independently of its proximate, exciting, primal
cause : endures without further need of its
cause : endures even if its cause no longer
exists. How, then, can the removal of the cause
be held to be the principal condition of the cure
of the disease ? It is impossible that the primal
cause of its flight should cleave to a flying
bullet, and the alteration which we can perceive
in it is only an altered kind of existence — an
altered state, and it would be more than absurd
to maintain that this state could not be funda-
mentally removed, that this bullet could not be
brought again to rest, except by an investigation
into the prima causa of its flight and then by
the removal of the prima causa thus meta-
physically ascertained, or as (others would ex-
press it) by the removal of those alterations in
the inner being of the bullet upon which its
flight is dependent.

In no wise ! A single impulse of equal power
exactly opposed to the flight of the bullet, brings
it at once to rest, without impossible meta-
physical inquirings into the inner being of the
bullet in flight.

All that we need to know are the symptoms
of the flight of this bullet, that is to eay the force
and the direction of its motion, in order to set
against it a counter-force of equal strength in a
direction exactly opposed, and so at once compel
it to immobility.

B 2

4 ORGANON OF THE

This is also (it may be said in passing) an
example of the way in which alterations can
naturally be made in abnormal conditions of
physical things, namely, through their exact
opposites. Thus boiling water can be swiftly
reduced to a moderate temperature by the addi-
tion of a certain quantity of snow; an acid loses
its acidity and becomes a neutral salt through
the action of an opposing alkali ; the over-
stretched material strives to contract ; the com-
pressed to expand; the over-dry substance to
absorb moisture from the air, and so on ; and
in this way most alterations of abnormal con-
ditions in the physical world are effected by
Nature by means of their opposites. But the
living organism of animals must obey widely
different laws for the removal of the altered con-
dition which is the result of disease; here the
law of opposites which is adapted to the altera-
tion of non-living physical nature is of no avail.

7
There must be a curative principle present in
medicine; reason divines as much. But its
inner nature is in no way to be perceived by us;
its mode of expression and its outward effects
alone can be judged by experience.

S

The unprejudiced observer, knowing the
worthlessness of abstract speculation which can-
not be confirmed by experience, is unable, how-
ever acute he may be, to take note of anything
in any single case of disease, except the changes
in the condition of the body and soul which are
perceptible by the senses, the so-called disease
phenomena, symptoms in fact; in other words,

RATIONAL ART OF HEALING 5

he can note only such falHngs away from a
former state of heahh as are recognizable by the
patient himself, the friends in attendance, and
the physician. All these perceptible signs make
up together the picture of the disease.

9
As, then, in disease there is nothing to lay
hold of except these phenomena, the disease can
be only related to the required remedy through
the symptoms, by means of which, in fact, it
both makes known the need of the patient for
help and points to the kind of help that is
required. And thus this symptom-complex, this
outward reflection, which is a representation of
the inward being of the illness, is the only means
whereby it is possible to discover a remedy for
it, the only means which can indicate the most
appropriate agent of cure.

10

A disease in its whole range is represented
only by the complex of morbid symptoms.

Author's note. — i. All exact observation
teaches that a serious illness requiring treatment
practically never consists of one single symptom,
and that a single serious symptom seldom if
ever occurs alone. Almost always there are
several notable signs of disease and deviations
from the normal health simultaneously present
in the patient, which make up the unity of the
morbid condition, however little at first sight
some of them seem to be related to one another.
A single slight symptom is not an illness calling
for treatment.

Author's note. — 2. Formerly physicians, not
knowing how otherwise to render help in cases
of disease, sought to combat by remedies one

6 ORGANON OF THE

single symptom out of several and if possible to
suppress it — a one-sided proceeding which under
the name of "symptomatic treatment " has justly
aroused general condemnation, because thereby
not only was no benefit gained, but much
damage was inflicted. One single symptom is
no more the actual disease than one foot is the
whole man.

II
It is not conceivable, nor can any experience
in the world establish it, that there should
remain, or could remain, anything but a state
of health when all the symptoms of disease (the
whole complex of perceptible phenomena) are
removed, or that the disease-causing alteration
in the inward of the organism should in that
event continue unextinguished.

12

The invisible disease-producing change in the
inward man and the complex of outwardly per-
ceptible symptoms are consequently determined
by one another reciprocally and inevitably ; both
together make up the disease in its entirety, that
is, constitute such a unity that the latter must
stand or fall simultaneously with the former,
that they must exist together and disappear
together, so that whatsoever is able to call out
a group of definite symptoms, must have caused
in the body that corresponding inward morbid
change which is inseparable from the outward
appearances of disease. Otherwise the appear-
ance of the symptoms would be impossible :
and similarly whatever removes permanently
the complex of outward signs of disease must
simultaneously have removed the inward morbid
change, because the banishing of the former

RATIONAL ART OF HEALING 7

without the disappearance of the latter is incon-
ceivable.

Author's note A foreboding dream, a super-
stitious fancy, a solemn prophecy that death
must infallibly occur on a certain day and at a
certain hour, have not seldom produced all the
symptoms of commencing and progressive ill-
ness and of approaching death and have even
caused death itself at the hour predicted. Now
this would not have been possible without the
simultaneous setting in motion of an inward
change corresponding to the outward and visible
symptoms; hence in such cases all the signs of
approaching death have frequently been dis-
pelled, and a state of health suddenly restored,
by some skilful deception or contrary conviction,
and this again could not occur without the
removal of the inward alteration which was
threatening life.

13

Now since, when cure is effected through the
removal of the whole range of the perceptible
signs and symptoms, the inward change which
caused the symptoms is also removed (that is,
the totality of the disease), it follows that the
physician has only to clear away the entire
symptom-complex in order also to get rid of
the inward alteration — in other words, to remove
the whole disease, the disease itself, a feat which
must always be the only aim of the rational
healer; for the essence of the art of medicine
consists in compassing the restoration of health,
not in searching for the change in the inward
and hidden things, a quest which can tend to
nothing but fruitless speculation.

Author's note. — It is only through a misuse
of the desire to reach the eternal, sown in the

8 ORGANON OF THE

spirit of man for nobler purposes, that these im-
pudent attempts have been made upon the realm
of the impossible, those speculative broodings
over the essential nature of the medicinal powers
of drugs, over vitality, over the inner invisible
working of the organism in health and over the
changes of this hidden inner working which
constitute disease — in other words, over the
inner nature and essence of illness.

All that mankind has apprehended of animal
magnetism, galvanism, electricity, attraction and
repulsion, earth magnetism, caloric, phenomena
of gases, and other objects of chemical and
physical enquiry, is far, far wide of the compre-
hensive, clear, and fruitful explanation of even
the smallest function in the living organism,
whether healthy or diseased. What innumer-
able unknown powers and their laws may be
involved in the regulation of the living organs,
powers and laws of which we know nothing and
for whose recognition we should need infinitely
more and infinitely finer senses than we have !
When the physician maintains that research
into such things is necessary, then he shows a
misconception of the capacities of men and a
misunderstanding of the requisites for the work
of healing.

The more that profound intelligences devoted
themselves to this "research into the secrets of
Nature," the more did fruitless hypotheses come
to birth, full of contradictions. All history
teaches this, and so also teaches the judgment
of the best informed among healthy minds.

If only it had served the practice of medicine
in the slightest degree — if all this subtle investi-
gation had revealed the true remedy for the least
of diseases, it might yet pass for desirable !

Listen to the wise and upright Sydenham :

RATIONAL ART OF HEALING 9

"Quantulacumque in hoc scientiae genere acces-
sio etsi nil magnificentius quam odontalgias aut
clavorum pedibus innascentium ciirationem,
edoceat longe maximi facienda est, prae inani
subtilium speculationum pompa, — quae fortasse
medico ad abigendos morbos non magis ex usu
futura est, quam architecto ad construendos
aedes music^e artis peritia."

Yet behold ! All imaginable theories con-
cerning the functions, the inner form, and com-
position of the living brain in health and in dis-
ease, all the countless speculations concerning
the nature of inflammation, all hypotheses as
to the nature of water and caloric, never availed,
in the world's historv, to furnish a hint or an
indication of the specific remedy for the phrenitis
caused by sunstroke ! Loflfler discovered it
accidentally to consist in sprinkling the skin
with hot water, and the rational (homoeopathic)
system of medicine can easily and swiftly by
its simple laws find this and other specific
remedies, without metaphysical racking of the
brains and without the need of waiting for the
happy chance which mav be delayed for a
thousand years.

14
Inasmuch, then, as in disease nothing that
expresses the need for assistance can be dis-
covered by observation except the complex of
symptoms, it follows that it is precisely the
totality of the perceptible symptoms, and that
alone which must afford the significant indica-
tion in disease for the selection of a remedy.

15

Again, since the healing principle of medicine
cannot itself be actually perceived, and since in

10 ORGANON OF THR

pure experiments by the most acute observers
nothing can be determined in drugs which con-
stitutes them medicines except their power to
bring about distinct changes in the health of the
human body and to excite, especially in the
healthy, various unmistakable symptoms of dis-
ease ; it follows that, if medicines act as remedies,
they only make known their inner healing
principle and bring their remedial power into
play through this ability to cause symptoms.
And it follows also that, when we wish to decide
which among several remedies is the most appro-
priate for any individual case of illness, we can
put our confidence only in those disease-pheno-
mena which medicines produce in healthy
bodies ; for these form the only evidence of their
inherent tendency to cure.

16

If, then, disease has nothing to show by re-
moval of which it can be changed into health,
save the complex of its symptoms, and if, further,
medicines can show nothing of their power of
healing except their tendency to excite disease-
symptoms, it follows that medicines, to be true
remedies, must uproot and remove the symp-
toms of illness by the power of the symptoms
which they themselves can excite.

If, now, experience should show (and indeed
it does show) that a given disease-symptom is
only removed by the very medicine which has
produced a similar symptom in a healthy body,
then it would be probable that this remedy is
able to uproot that disease-symptom by virtue
of its tendency to call forth a similar one.

RATIONAL ART OF HEALING it

18

If, further, it should be shown (and, indeed,
this also is shown) that the very medicine which
has given rise in a healthy body to all the
symptoms shown by the illness which it is
desired to cure, can remove by its medical use
the whole complex of disease-symptoms (that is,
the whole existing disease), and change the con-
dition to one of health, then it cannot be doubted
that the law has been discovered whereby this
medicine has brought recovery to this disease,
namely, the law: "Similar symptoms in the
remedy remove similar symptoms in the
disease."

19
Now as experience shows incontestably in
regard to every remedy and every disease, that
all remedies without exception cure swiftly,
thoroughly and enduringly, the illnesses whose
symptoms are of like order with their own, we
are justified in asserting that the healing power
of 'medicines depends on the resemblance of their
symptoms to the symptoms of disease: or in
other words, every medicine which, among the
symptoms which it can cause in a healthy body,
reproduces most of those present in a given
disease, is capable of curing that disease in the
swiftest, most thoro^igh, and most enduring
fashion.

20

This eternal, universal law of Nature, that
every disease is destroyed and cured through
the similar artificial disease which the appro-
priate remedy has the tendency to excite, rests
on the following proposition : that only one
disease can exist in the body at any one time,

12 ORGANON OF THE

and therefore one disease must yield to the
other.

Author's note, — The few examples which have
been brought forward to the contrary are all too
much under suspicion of possible misinterpre-
tation to be taken for clear and indubitable
observations.

21

To every disease the organism reacts in a
special and individual way. Since its nature is
bound fast to unchanging laws of unity, it can-
not react to a new disease or receive it unless
indeed it ceases to react to the first disease. If
the later disease is unable to remove the earlier
and is forced upon the organism too long, then
both combine to make a single third disease,
which is called a complicated disease. These
propositions are based on the following facts.

22

A natural ^ chronic disease present in the body
resists the appearance of a new chronic disease,
unless at least the later be a miasmatic or
endemic disorder and the body remain unduly
exposed to it over a considerable period of time.
In such a case, as usually the two diseases are
dissimilar, the later cannot extinguish the earlier
homoeopathically, and either the former, if it is
a weaker disease, is suspended as long as the
latter endures (as Schoepf saw an itching skin
eruption disappear when the patient was attacked
by scurvy, to return, however, after the scurvy
was cured), or the two disorders combine into
one so-called complicated disease; which,
though complicated, always presents a single

1 /.e. not artificial. See note to S. 25.

RATIONAL ART OF HEALING 13

disease-picture, intermediate between the disease-
pictures of the two disorders, and can be treated
and cured homoeopathically by the totality ol
the newly united symptom-complexes just like
a simple disease. From the time of the second
infection up to the time of the combination of
both into a third single but complicated disease,
the first infectio^i is latent.

But incomparably more frequent than the
blending and consequent complication of natural
diseases, are the artificial disorders, produced
when unsuitable remedial measures are applied
for a long time to bodies attacked by chronic
disease. For such remedial measures, having no
impulse similar to that of the disease for which
they are given, are unable to remove it and cure
it homoeopathically ; but on the contrary they
attack the body over a long period of time in a
dissimilar way, and thus gradually bring about
an inner reaction of a dissimilar kind, in short,
an artificial chronic disease, which unites with
the original chronic disease and so builds up a
new monstrous disorder, a complicated malady,
which is often of a very obstinate kind..

Author's note, — Many cases published in
medical journals with requests for suggestions
as to treatment are of this kind, as are also many
chronic disease-histories related in medical
works. Of a like order are the numerous cases
where venereal disease is not cured by lengthy
treatment with unsuitable preparations of
mercury, but combines with chronic mercury-
poisoning to make a horrible blend of compli-
cated disease (masked venereal disease), which
can now no longer be cured with mercury (the

14 ORGANON OF THE

remedy for syphilis), but must be treated with
liver of sulphur (the remedy for mercurial
poisoning).

24

If, on the other hand, when chronic disease is
present, the patient is attacked with a new, more
local, and therefore less severe disease, which has
no resemblance to the first and therefore cannot
cure it homoeopathically, then usually the chronic
disease is suspended as long as the local disorder
endures.

25

If a long-standing chronic disease, whether
natural or artificial, is present, it will, being the
stronger, repel from the organism a new acute
natural disease of a different kind, and often also
an acute disorder artificially induced.

Translator's note. — Here and elsewhere Hah-
nemann means by artificial diseases those affec-
tions which are the result of drug-taking, or
procedures like vaccination, or the use of blisters,
setons or issues, all of which were very frequently
and drastically used in his day. For instance,
in a note to this aphorism he quotes Jenner as
maintaining that rickets prevents, vaccination
from "taking," and that even regular coffee-
drinking is apt to render vaccination ineffective.
The former would be an instance of a natural
chronic disease repelling an acute artificial dis-
ease, the latter of an artificial chronic disease
(coffee-poisoning) having the same effect.
Neither of Jenner's statements would be im-
plicitly accepted to-day, but the effect of one
disease on another is a subject upon which it
is still difficult to dogmatize, and Hahnemann's
general propositions seem to be borne out, at

RATIONAL ART OF HEALING 15

any rate in some instances. In any case, in
reading these and the next few aphorisms it is
important to remember that Hahnemann is now
seeking for an explanation of certain facts which
he had observed concerning the relations between
drugs and diseases. His explanations and his
examples from natural diseases have not all the
power of conviction which they seemed to have
in his day, but the facts which these aphorisms
attempt to explain remain founded on experiment
and observation, and can only be confuted by
further experiment and observation. Hahne-
mann claimed that "likes are the best means of
treating likes." Only experiment can show
whether this is a true statement, and if experi-
ment confirms Hahnemann, we can doubt or
reject his explanation as to the 7nodus operandi
of his law without impugning the law's validity.

26

But if, when the organism is suffering from a
chronic illness, a new and acute disease attacks
it and proves stronger than the first disease, but
does not resemble it, then the chronic disorder
gives rise to no symptoms (lies latent) while the
acute disease runs its course, but reappears after-
wards unchanged.

27

When the organism suffering from an acute
disease becomes infected with another acute dis-
ease of a dissimilar kind, the disorder which is
the weaker of the two gives way, but is not
destroyed, only remaining latent until the
stronger has run its course.

Author'' s note. — An eruption^ of measles will
disappear as soon as small-pox papules become

i6 ORGANON OF THE

visible, and wlien these are healed, the eruption
of measles, latent till then, appears again and
runs its ordinary course. 1 have seen the swell-
ing in a case of parotitis (mumps) disappear
when vaccination took effect, and only when the
cow-pox had run its course did the swelling and
fever characteristic of mumps reappear and run
thereafter their usual course. Again, a case of
scarlet fever with tonsillitis was interrupted and
suspended for four days while cow-pox vesicles
developed (Jenner).

28
But if, on the contrary, an acute infection
attacks an organism already suflfering from a
similar acute disease, then the stronger infection
uproots the weaker entirely and removes it
homoeopathically.

29

Two acute diseases meeting in the same
organism never blend into one; the cases
hitherto cited in evidence are only apparent
examples of such a fusion.

30

Further, if a chronic disease is already present,
and a very similar acute disorder attacks the
patient, the chronic disease is destroyed by the
acute and homoeopathically cured.

Author's note. — Leroy saw a very chronic and
obstinate ophthalmia in a boy disappear per-
manently after an attack of small-pox, a disease
\vhich has itself the power to cause violent in-
flammation of the eyes.

An obstinate ophthalmia was cured by Dezo-

RATIONAL ART OF HEALING 17

teux by inoculation of small-pox. Other similar
cases have been observed.

31
The great homoeopathic Law of Cure rests on
this law of man's nature, revealed by experience,
that diseases are only destroyed and cured by
similar diseases. The homoeopathic law may be
thus formulated : that a disease can only be
destroyed and cured by a remedy which has the
tendency to produce a similar disease, for the
effects of drugs are in themselves no other than
artificial diseases.

The tincture of an ounce of cinchona-bark
mixed with a couple of pounds of water and
swallowed in the course of twenty-four hours
will certainly produce a cinchona fever of several
davs' duration. A warm foot-bath of an arsenical
solution or the application of an arsenical oint-
ment to the scalp ^ will no less certainly bring
about an arsenical fever lasting at least a fort-
night, than residence in a marshy district in
autumn will cause intermittent fever. A girdle
of mercurial plaster round the loins will cause
mercurial poisoning no less quickly and surely
than wearing the shirt of a person affected with
the itch will produce an attack of the itch. A
strong infusion of elder flowers or a few berries
of belladonna are just as much disease-producing

1 Arsenic in Hahnemann's day was used in doses which
now seem terrifying, and most preparations of it were far
stronger than any now employed. Symptoms of arsenical
poisoning would not be produced by the external use of
modern pharmacopocial preparations except in patients of
extraordinary susceptibility to the drug.

i8 ORGANON OF THE

forces as inoculated vaccine-matter, or a viper-
bite, or a great shock, and every one of these
influences, just because it has the po^ver to pro-
duce disease, can become a remedy and a force
to counteract disease, as soon as it is opposed
to a similar disorder already existing in the body.
So that all that we call medicine is no other
than the power to produce disease, and all true
remedies are no other than substances capable
of arousing in the organism an artificial disease
similar to the natural disease which it is thereby
able to destroy and to remove.

When, by the laws of rational therapeutics we
have found the medicine which is best adapted
for curing a given disease and have applied it
as a remedy, it is clear that the sick organism
is, as it were, inoculated with a new- disease
(counter-disease) by virtue of the disease-force
in the drug; but it must be owned that this
artificial counter-disease possesses unusual ad-
vantages over all natural counter-diseases.

34

The invisible influences whereby the ordinary
diseases of mankind are produced are all too
little known, and are all too little under our
command, for us to use them for the production
of diseases at our will, and thus as remedies
against diseases of longer standing.

Translator's note. — The "influences" invisible
to Hahnemann are many of them visible enough
to-day in bacteriological laboratories, and are
used as remedies in a way quite comparable to
that which Hahnemann suggests in this and the
following paragraphs.

RATIONAL ART OF HEALING 19

35

Even the miasms, which might conceivably be
inoculated for the removal of certain diseases,
are too few in number to be used even to a
limited extent as remedies.

Translator's note. — In these days before
bacteriology, a miasm corresponded to what
would now be called a bacterial disease. Years
afterwards, when Hahnemann came in contact
with cholera, he conceived the agent of that
disease to consist of "animalcul^e " invisible to
any means of sight that science then possessed,
and his suggested rules for dealing with epi-
demics are not only extraordinarily sound, but
owe their soundness to the fact that Hahne-
m^ann's conception of the mode of transmission
of infection was not far from the truth.

36

Even if we were able to produce various
natural diseases artificially and at will, they are
either not sufficiently analogous to the disease
under treatment, and therefore not helpful, or
they are of longer duration than the original
disorder, and hence, even when they have over-
come it, they frequently remain a considerable
time in the body, seldom disappear of them-
selves, and usually require artificial remedies
before they are defeated and finally removed.

37

On the other hand, the disease-producing
powers usually termed "drugs" or "medicines"
can be used for purposes of cure, with infinitely
greater ease, far more certainty and with a range
of choice almost unlimited; we can give to the
c 2

20 ORGANON OF THE

counter-disease thereby aroused (which is to
remove the natural disease that we are called to
treat) a regulated strength and duration, because
the size and weight of the dose lies at our com-
mand; and as every medicine differs from every
other and possesses a wide range of action, we
have in the great multitude of drugs an unlimited
number of artificial diseases ready to hand, which
we can oppose with decisive choice to the natural
course of the diseases and infirmities of mankind,
and so, swiftly and surely, remove and extinguish
natural disorders by means of very similar dis-
eases artificially produced.

38

As it is now no longer doubtful that the dis-
eases of men consist merely of certain groups of
definite symptoms, and may be destroyed and
changed into health (which is the order of pro-
ceeding in all genuine cures) by a medicine truly,
but only by such a medicine as can artificially
excite similar disease-symptoms, it follows that
tlie art of cure is comprised in finding an answer
to these three questions —

1. How can the physician discover what he
needs to know of the disease in order to cure it?

2. How can he discover the individual disease-
producing powers of medicines which are to act
as counter-diseases for the cure of natural
diseases ?

3. How can he most efficiently turn these arti-
ficial disease-producing powers (medicines) to
account for the cure of natural diseases ?

39
As to the first point, the enormous number
and variety of diseases might easily persuade us

RATIONAL ART OF HEALING 2t

into a conviction that they cannot possibly be
individually considered or even retained in the
memory ; and that they cannot be cured unless a
comprehensive survey be first made of them and
a separation effected, (upon the basis of certain
common characteristics,) into a few small classes,
each of which may then with comparative ease
be treated as one disease by a common method.

40
Diseases, infirmities and illnesses present,
however, appearances so endlessly various that
such a forcible grouping into separate divisions,
however apparently necessary, can hardly serve
any useful purpose from the point of view of
cure.

41

The division of diseases into general and local
seems to have been commonly observed.

42

But the human body is, in its living state, a
unity, a complete and rounded whole. Every
sensation, every manifestation of force, everv
inter-relation of the material of one part, is
intimately concerned with the sensation, force-
manifestations and inter-relations of all the other
parts; no part can suffer without involving all
the rest in suffering (greater or less) and in
alteration.

43
This oneness of life forbids the idea that any
bodily disease can remain completely and abso-
lutely local so long as it is not confined to a part
of the body entirely shut off horn all the rest.
The remainder of the system simultaneously
suffers more or less, and betrays its suffering in

22 ORGANON OF THE

this or that symptom. Every powerful medicine
produces amongst other actions an effect upon a
disease apparently local, even when applied to a
distant part or taken internally, and the remedy
specifically fitted for the general disease (of which
the local manifestation is always but a part or
symptom) relieves also the local affection which
is far removed and apparently isolated.

44

A second division of diseases into febrile and
afebrile, though highly esteemed, labours under
a similar disadvantage. There is no general
agreement as to which characteristic signs and
symptoms should be included in the definition
of fever, and which should be rejected; and
among the greater number of theories and de-
finitions of fever there is none that does not
include symptoms which are also found more or
less in diseases which are universally considered
among the most afebrile. The most febrile pass
over into the most afebrile by imperceptible
degrees, a fact which shows that a sharp division
between the two is only artificial and not natural.

TransJator^s note. — Hahnemann wrote long
before the days of clinical thermometers. But
even with that absolute means of estimating
fever, the presence or absence of a rise of tem-
perature would still by itself be an insufficient
basis for the classification of diseases.

45
The nomenclature or classification of the
countless varieties of disease, even if it could
be accomplished with tolerable accuracy and
completeness, would serve the physician only
as a natural historian, in the way that the classi-

RATIONAL ART OF HEALING 21,

fieation of other natural phenomena and natural
objects is of value in general natural history.
In other words, it would aid his historical per-
ception by means of a tabulated and ordered
survey. But for the physician as a practitioner
of the art of medicine it would be of no value
whatever. For the true art of treating disease
cannot rest content with such simple one-sided
resemblances as suffice for the classification of
diseases into genera and species. On the con-
trary, it must make the most complete survey
of every single case of disease that comes to be
treated before it can select the remedy exactly
suitable thereto, that is, before it can deservedly
be called a well-founded and rational art of cure.
Translator' s note, — Increased knowledge of the
outside causes of disease, such as is afforded by
bacteriology and the allied sciences, has now
given at least a partial classification of the great-
est value to the physician, both in the prevention
of disease and in the diagnosis and prognosis
of individual cases. But it still remains as true
as when Flahnemann insisted on it, that the
treatment of each case must be an individual
treatment, and such classifications as w^ere pos-
sible a century ago only tended to obscure that
fundamental fact with which the physician has
alwavs to reckon.

46

Nature has no nomenclature or classification
of disease. She produces individual diseases,
and insists that the true physician shall not
treat in his brethren the systematic combination
which makes up a genus of disease (a kind
of confounding together of different diseases),
but shall always treat the individuality of each

24 ORGANON OF THE

individual case of disease. And she forbids the
therapeutic treatment of groups of diseases con-
structed merely in the imagination of men, for
such treatment is a crippling of the divine work
of healing; on the contrary, she enjoins the
treatment of individual disease, which she has
wisely created as distinct entities.

Author^ s note. — Huxham, deserving of honour
for his acute insight no less than for his tender
conscience, says {Op. Phys. Med.) : "Nihil sane
artem medicam pestiferum magis unquam irrepsit
malum, quam generalia quaedam nomina morbis
imponere, iisque aptare velle generalem quandam
medicinam."

47
The rational nature of the art of medicine
manifests itself pre-eminently in the rejection
of all systematic and other prejudices, in the
refusal to act without good grounds, in the
adoption of every possible measure to achieve
the desired action, and in confining attention
as much as possible to that which can be de-
finitely ascertained. Correspondingly the char-
acteristic of the rational and thorough physician
is, pre-eminently, attention to the divergences
and differences of diseases, and also of drugs or,
in other words, the careful investigation of the
individual signs of every single disorder and
of the individual mode of action of every single
remedy.

48

Every disease epidemic in the world differs
from every other, excepting only those few which
are caused by a definite unchangeable miasm.
Further, even every single case of epidemic and
sporadic disease differs from every other, those

RATIONAL ART OF HEALING 25

only excepted that belong to the collective dis-
eases noted elsewhere. Therefore the rational
physician will judge every case of illness brought
under his care according to its individual char-
acteristics. When he has investigated its in-
dividual features and noted all its signs and
symptoms (for they exist in order to be noted), he
will treat it according to its individuality (i, e.
according to the particular group of symptoms
it displays), with a suitable individual remedy.

Such a direct, unprejudiced and rational pro-
cedure will demonstrate wherein he differs from
every physician who does not trouble to investi-
gate the case of disease thoroughly, but (to suit
his own convenience) generalizes regarding it,
labels it according to the conjectural system
which he affects, and models his treatment en-
tirely on this conjecture.

49
Certain diseases are caused by a special agent
of contagion (an individual miasm of a suffi-
ciently definite kind), for instance, the plague
of the Levant, small-pox, measles, true smooth
scarlet fever, venereal disease, the itch of wool-
makers, as well as rabies, whooping-cough, plica
polonica, etc. These diseases seem to. be so
definitely distinguished in their course and char-
acter that, whenever they appear, they can be
recognized by their persistent signs as old
acquaintances. Therefore it is possible to give
each of them a definite name and to attempt to
establish for each of them a regular and staple
method of treatment.

50
It may well be that there are yet other diseases
attributable to a "miasm" which we cannot yet
demonstrate, besides those that belong to certain

26 ORGANON OF THE

localities and climatic conditions and those that
are endemic in certain scattered regions: e.g.
autumnal marsh-fever, yellow fever, sea-scurvy,
framboesia (yaws), pellagra, etc. Further, there
are a few diseases arising either from a single
uniformly acting cause or from a combination
of several definite causes acting simultaneously,
which can readily be classed together to some
extent, as, for instance, gout, and possibly also
membranous croup and Miller's asthma. These
diseases are little less deserving of their special
names because the symptom-group remains
tolerably constant, on the whole, for each of
them, and therefore each is adapted to a definite
and almost established treatment.

51

But the case is very different when we con-
sider a number of other diseases probably arising
from the concurrent effect of several pathogenic
causes which do not unite in the same w^ay for
the production of the disorder. These diseases
often differ from one another in regard to several
important symptoms, and hence cannot ever be
treated all with the same remedies.

To this class of disease belong the widely
differing varieties of epilepsy, catalepsy, tetanus,
chorea, "pleurisy, phthisis, diabetes, angina pec-
toris, prosopalgia, dysentery, and other condi-
tions represented by names which the schools
have given to disease-states that often differ
fundamentally and only resemble one another in
a few symptoms. By maintaining an alleged
identity it was possible to establish for them an
identical treatment, but the very different results
obtained by the pursuit of this method are alone
enous^h to refute the supposed identity of disease

RATIONAL ART OF HEALING 27

upon which the method is founded. As col-
lective names they may have a certain value, but
none as the special names of identical disease-
conditions : for then they lead the physician
astray into a uniform empirical medicinal treat-
ment, to the detriment of his patients.

Author^ s note. — Thus, for instance, there are
several varieties of diabetes, that is, several dis-
eases essentially different classed together under
this one name. At the first casual glance thev
seem to resemble one another in one or more
Symptoms, but to maintain therefore that they
represent cases of one and the same disease is
erroneous. If the individual cases are carefully
examined it will be found in almost every one
of them that there are symptoms differing widely
from those present in other cases, and svmptom's
present in some and absent in others. Even the
urine often varies much in its character, although
the inventors of the name diabetes attached a
very great importance to their discovery of a
special character therein ; sometimes it passes
rapidly into vinous or acetous fermentation, at
other times it only becomes mouldy, and so forth.
If one kind of diabetes can be cured with am-
monium sulphate, many other kinds will fail to
respond to this remedy. Alum would seem to
be of advantage in a few cases, and again in
others neither alum nor ammonium sulphate
w^ould appear to be of any use. How can these
be cases of one disease which differ so much in
their svmotoms and require such varving treat-
ment ? These manifold disease-conditions mav
indeed be called kinds of diabetes^ but not simplv
diabetes, lest the false impression be created bv
this name that they are all cases of one simple
well-defined disorder. He who has cured one case
of facial neuralgia with mercurial ointment will

28 ORGANON OF THE

soon find three or four cases for which this oint-
ment will not in the least avail, although he will
call them all by the same name. If each of these
names only stood for diseases which were always
identical in character, then it would be impossible
that the remedy which succeeded once should
ever fail, for if the diseases are identical they
must yield to identical treatment. But as mani-
festly they do not so yield, they clearly demon-
strate that in spite of bearing the same name
they are essentially different disorders, wherein
insufficient pains have been taken to discover the
distinguishing symptoms. Certainly these vari-
ous disease-states might be called kinds of facial
neuralgia, for they are not all of them always
one and the same disease. And so it is with the
other diseases mentioned, and yet others of a
similar sort.

52

And so, finally, with regard to other diseases,
the greater the variety of morbid conditions
embraced under one name (conditions distantly
resembling one another in respect of one or two
symptoms, but differing widely in the vast
majority of their phenomena and peculiarities),
the more unsuitable does the name become and
the more dangerous the tendency which the name
encourages towards empirical treatment. Such
ambiguous names as ague, dropsy, consumption,
leucorrhoea, haemorrhoids, melancholia, mania,
etc., can be taken as examples.

Author's note. — What myriads of so-called
agues there are, differing widely from one
another, having in common at most the pheno-
mena of chills and heat and something of an
intermittent type, and often not even that !

RATIONAL ART OF HEALING 29

Closer investigation of their other symptoms
reveals that almost every one of these differing
kinds is a disease sui generis. With what right
are many most different diseases classed under
the one name of jaundice, when all their symp-
toms but one are different, and that one, yellow-
ness of the skin, depends on a disturbance of
bile-excretion which may arise from very differ-
ent causes ? So also among the symptoms of
countless very dissimilar illnesses there is found
oedema; but who would classify under the com-
mon name of dropsy all these most different
diseases as if they were one, on account of a
single symptom, very conspicuous it is true, but
not therefore always important, often indeed not
important at all ? And likewise with the other
examples cited.

53
How, with any appearance of reason, can
diseases be grouped under general names when
they have often only a single symptom in com-
mon, and how can such a classification justify
their similar medicinal treatment ? And if the
medicinal treatment is not to be identical in all
the cases — as it cannot be without detriment to
the patients — what is the use of identical names
which imply an identical treatment? These
names, therefore, are so misleading, useless, and
harmful that they ought to exercise little in-
fluence upon the treatment of a rational physi-
cian. He, at least, knows that he has to form a
judgment on diseases and to cure them not on
the basis of a vague similarity in a single
symptom, but under the guidance of the whole
complex of signs and symptoms presented by
each individual patient, whose sufferings he must

30 ORGANON OF THE

investigate exactly to the exclusion of mere
hypothesis and conjecture.

54
Even those far-reaching diseases which may
be spread abroad by infectious material during
an epidemic, the great number of so-called
putrid, bilious, nervous fevers (hospital, jail or
camp fevers), or other contagious fevers, are very
different in their characterand their course at every
time of their occurrence. Every fresh epidemic,
for instance, of the so-called putrid fever appears
in many of its most striking symptoms unlike
all previous epidemics of the same name, because
there is a different miasm at the root of each
epidemic. It is counter to all logical exactitude
to give to this very different disorder the old
name and thus to be misled by the misuse of a
name into employing the same medicinal treat-
ment for this epidemic as for former epidemics
of the same designation.

55
In the case of such epidemic or sporadic dis-
orders we can only consider as similar, for the
purposes of curative treatment, the various cases
that occur in each separate outbreak, which in
this respect is fitly called a collective disease.
These cases we can treat on similar lines, with
due regard to the greater or lesser variations
from type w hich appear in each single case.

56

For every epidemic includes a number of very
similar cases of disease ; but different epidemics
differ very markedly one from another and can

RATIONAL ART OF HEALING 31

neither be rightly called by the same or a similar
name, nor treated indiscriminately with the same
remedy.

57
These epidemics, to which no constant and
universally suitable name can be given (since at
every fresh appearance among the nations they
present an altered form and different groups of
signs and symptoms), are best considered as
collective diseases. But under this designation
they should be grouped with that extensive class
which is made up of all other diseases, illnesses,
and disorders which arise from the concurrence
of causes and forces differing wddely in their
number, strength, and kind. Indeed, these in-
fluences are of an infinite variety, and hence
arises the infinite diversity of the diseases from
which the great race of man has suffered and
still suffers in the w^orld.

58

All things that have any individual influence
(and their number is legion) can affect our
organism and bring about changes therein, be-
cause our organism stands in relation to all parts
of the universe in a constant action and reaction.
And every such influence produces a distinct
change of its own in virtue of its own distinct
and unique nature.

59
How different then, may I not say, how in-
finitely different, must those diseases be, which
result from the action of these innumerable
forces ! Often the forces are inimical in the
highest degree w^hen they affect our bodies with

32 ORGANON OF THE

more or less of simultaneity, or in succession in
different qualities and varying strengths. And
in addition our bodies vary so much in so many
external and internal individualities and peculi-
arities and the conditions of life are of such
manifold variety that no human being exactly
resembles another in respect to any imaginable
point.

Author's note. — Some of these influences,
which predispose to disease or produce it, are
the countless number of emanations, more or
less harmful, given off from organic and in-
organic substances ; the many different kinds of
gas, each with a different irritative power, which
disturb or alter our nervous systems in our
dwellings and workshops, or stream out against
us from water, earth, animals and plants; the
lack of sufficient nutriment for the maintenance
of full vitality or of pure, fresh air; excess or
deficiency of sunlight or of electricity; varying
atmospheric pressure and varying dampness or
dryness of the air ; the properties and possible
ill effects, as yet unknown, of high mountain
regions and of low-lying lands and deep valleys ;
the peculiarities of climate and situation in great
plains, in deserts without water or plant life, on
the sea coast or near swamps, on hills, in woods
or in places exposed to various prevailing winds;
the influence of very changeable weather or of
long-continued unchanging weather; the in-
fluence of storms and other meteorological con-
ditions; exposure to air that is too hot or too
cold ; the effect of too much or too little artificial
warmth, either from clothing or heated rooms;
the hampering of limbs by certain forms of
dress ; the habitual taking of food or drink which
is too hot or too cold; hunger, or thirst, or ex-
cessive eating, or excessive drinking; or the

RATIONAL ART OF HEALING 33

power to injure the body medicinally which some
articles of diet possess, such as wine, brandy,
beer adulterated with more or less harmful herbs,
impure drinking water, coffee, tea, indigenous or
foreign spices; or the unknown but possibly
injurious effects of certain plants and animals
used for food; or injurious properties that
articles of diet may acquire through careless pre-
paration, spoiling, substitution or adulteration ;
want of cleanliness of person or clothes or dwell-
ings; harmful substances that get into food
through uncleanliness or carelessness in pre-
paration or storage; the inhaling of injurious
vapours in sick rooms, mines, stamping-mills,
stations for the roasting and smelting of ore;
the dust which may surround us from stuffs
made in factories and workshops laden with
many dangerous substances; neglect of various
police-regulations for the safety of the common
weal ; excessive bodily exertion ; overworking of
one or other organs of body or mind; various
unnatural postures acquired in various occupa-
tions; want of use of certain parts of the bodv
or general laziness; irregular times of rest, of
meals, of work; excess or deficiency of sleep at
night; especially excessive mental exertion, or
mental work of an unpleasant and compulsory
nature, or such as excites or wearies certain
faculties of the mind; or violent uncontrollable
passions, such as anger, fear and vexation, etc.

60

Hence arises the unimaginable number of
different diseases of body and mind; diseases
so different that, strictly speaking, it is hardly
too much to say that each has only existed once
in the world. Therefore (except for those few

34 ORGANON OF THE

diseases caused by a definite unchanging miasm,
and probably a few others) every epidemic or
sporadic collective disease is to be regarded and
treated as a nameless, individual disorder, which
has never occurred before exactly as in this case,
in this person and in these circumstances, and
can never in this identical form appear in the
world again.

6i

Since Nature herself produces diseases of so
individual a kind, no rational medical art can
exist which does not strictly individualize each
case of disease — that is, which does not regard
each case of disease as distinct and unique,
which in truth it is.

62

This individualizing examination of each case
of disease as it appears demands from the
physician nothing but freedom from prejudice,
sound sense, attention in observing and exact-
ness in tracing the picture of the disease.

63

The patient relates the course of his suffer-
ings ; those in attendance on him tell of his com-
plaints and his general condition ; the physician
sees, hears, and observes by his other senses,
what is altered and unusual in the patient. He
writes down all that the patient and his friends
have said, using their exact expressions. Keep-
ing silence himself, he allows them to say all
they wish, if possible without interruption. At
the outset the physician requests them to speak
slowly so that he can commit to writing as much
as he wishes.

RATIONAL ART OF HEALING 35

Author's note. — Every interruption breaks the
train of thought, and the speakers thereafter
seldom or never express themselves exactly as
they would otherwise have done.

64

Every statement of the patient or his friends
is written in a separate paragraph, so that all
the different symptoms are ranged one below
the other. In this way the physician can make
additions to any record which at first was too
vague or inexact.

65

When patient and friends have said all they
wish to say, the physician examines each symp-
tom more closely in the following way. He
reads over the symptoms one by one as they
were related and asks for further details about
each one; for instance, he asks, "At what time
did this symptom appear?" "Before taking the
medicine ? whilst taking the medicine ? or only
some days after leaving off the medicine ? "
"Exactly what kind of pain was it?" "What
was its exact position ? " " Did the pain come
in paroxysms at different times, unaccompanied
by any other symptom ? " " How long did it
last?" "At what time of day or night was it
at its worst, and at what hour did it cease ? "
"What was the exact character, in plain words,
of this or that symptom or circumstance ? "

66

In this way the physician obtains more exact

knowledge of each symptom, but he never frames

his questions in such a way that-the patient can

answer with a simple "Yes" or "No" (that is,

D 2

36 ORGANON OF THE

he never suggests the answer). If care is not
taken in regard to this, the patient will be misled
into giving an affirmative or negative answer
that is untrue or half true or inexact, in order
to save himself trouble or (as he thinks) to please
his questioner, and therefrom a false disease-
picture and an unsuitable treatment will neces-
sarily result.

Author's note. — For instance, the physician
should never ask either patient or friends such
questions as "Did you not observe this or
that ? " " Is it not a fact that the condition was
so and so ? " since such suggestions lead to false
information.

67

If in the course of these voluntary statements
nothing has been said of certain parts or func-
tions of the body, the physician enquires con-
cerning those parts and functions ; but he always
uses general expressions, so that his informants
are compelled to speak in detail.

Author's note. — Thus, "What is the character
of the stools ? " " How freely does he pass
urine ? " " How does he sleep by day, and how
by night?" "What is his disposition?"
"What about thirst, or any special taste in the
mouth ? " "What kinds of food and drink does
he like, what does he most dislike ? " " Has
each kind of food its natural taste or an altered
one ? " " Is there anything to say about his
head, his limbs, or his abdomen ? "

68

It is upon the patient that most reliance must
be placed in regard to his sensations, except in
cases of malingering. When, therefore, the

RATIONAL ART OF HEALING

v5/

patient has given the physician the necessary
information either voluntarily or at least without
prompting, so that the disease-picture is toler-
ably complete, then the physician may ask more
detailed questions.

Author's note, — For instance, "How often do
the bowels act, and what is the exact character
of the stools ? " " Is defecation painful ? " " Of
what did the vomit consist? " "Is the evil taste
in the mouth bitter, or sour, or putrid, or of what
character ? " " How does he behave when
asleep ? " " Does he moan or cry out or speak ? "
"Does he lie only on his back?" "If not, on
which side ? " "When did the rigor come on ? "
" How long did the cold stage last ? " " And the
hot stage ? " " How great was the thirst ? "
"When did he sweat?" etc.

69

When full notes have been taken of all these
particulars, the physician records what he him-
self has observed in the patient and ascertains
whether all or part of this is characteristic of the
patient w^hen in health.

Author's note — For instance, the physician
observes how the patient behaved during the
visit; whether he was morose or sad; whether
he was drowsy or in any way dull of under-
standing; whether his voice was hoarse or low,
or how otherwise he spoke ; what was the colour
of his face, of his eyes, and of his skin generally ;
the state of his tongue, of his breath, of his
special senses; whether his pupils were dilated
or not; and how swiftly they reacted to light;
how he lay, and what efforts he made to raise
himself; and anything else in his condition
which may strike the physician as noteworthy.

38 ORGANON OF THE

70

The symptoms and sensations of the patient
during a course of medicine do not furnish a
pure picture of the disease. On the contrary,
those symptoms and sensations from which he
suffered before the use of the medicine or some
time after he has ceased to take it give the true
fundamental conception of the original form of
the disease, and the physician must take par-
ticular note of these. Indeed, if the disease is
chronic and the patient has been taking medicine
up to the time when he is seen, he should be
left some days entirely without medicine, and
the physician should defer the exact examination
of the disease-symptoms until the permanent
features of the old disease appear unaffected in
their purity by treatment, and a faithful picture
of the original disorder can be constructed.

71
But if the threatening character of an acute
disease admit of no delay, and if he cannot dis-
cover what symptoms were present before the
treatment was begun, the physician must content
himself with the observation of the diseased con-
dition, altered though it is by medicines, in order
that he may at least combat the existing disorder
with a suitable remedy.

72

If the disease has any striking and obvious
cause, the patient (or, at least, his friends when
questioned privately) will mention it, either
voluntarily or in answer to careful questioning.

Author's note — Any cause of a disgraceful
character, which patient or friends may not will-

RATIONAL ART OF HEALING 39

ingly confess, demands skilful questioning on
the part of the physician or else private informa-
tion. Such causes, for instance, are poisoning,
attempted suicide, debauchery, over-indulgence
in wine or spirits, over-eating, and venereal dis-
ease; and in another sphere disappointed love,
jealousy, domestic unhappiness, grief, ill-usage,
baulked revenge, or injured pride. Or again
some physical defect may be concealed, such as
rupture or prolapse, etc.

73
When enquiring into the condition of a patient
suffering from a chronic disease, the physician
must investigate and weigh carefully the cir-
cumstances of the patient in regard to his
ordinary occupation, his customary mode of
living, his diet, his household surroundings, and
so forth, so that any factor that is exciting or
maintaining the disease may be discovered and
removed.

74
In chronic diseases the investigation of the
signs of disease mentioned above and of all
others must be as careful and detailed as possible
and must take note of the most minute peculiar-
ities. This last is necessary, partly because
these minute peculiarities are specially character-
istic of chronic diseases and least resemble the
features of acute illnesses, and therefore for the
purpose of cure cannot be too exactly noted ; and
partly because patients become so accustomed
to their prolonged sufferings that they pay little
or no heed to the lesser accessory symptoms,
which are none the less characteristic and often
have a very important bearing on the choice of
the remedy. Indeed, they almost look upon

40 ORGANON OF THE

these symptoms as a necessary part of their con-
dition, almost as a state of heahh ; for after five,
ten, or twenty years of suffering they have all
but forgotten the sensation of genuine health
and can hardly believe that these lesser or greater
departures from the normal have anv relation to
their principal malady.

75

Further, patients differ so widely one from
another that some of them (especially hypo-
chondriacs so-called and other hypersensitive
persons impatient of suffering) set forth their
complaint in too vivid a light, and describe their
symptoms in exaggerated language in order to
make the physician more anxious to relieve them.

Author's note. — Pure invention of symptoms
is never met with in hypochondriacs, even in
the most impatient. A comparison of the symp-
toms they complain of at various times, as when
the physician gives them nothing at all, or gives
them only a placebo, demonstrates this. Only
something must be deducted on the score of
hyperbolic language and the use of superlatives,
or at least the strength of their expressions must
be attributed to their hypersensitiveness. From
this point of view the very exaggeration that
marks the descriptions of their symptoms be-
comes an important feature in the picture of the
disease. It is a different matter when we are
dealing with the insane or with rascally
malingerers.

76

Other patients, of an opposite type of character,
omit to mention a number of symptoms, partly
from indolence, partly from misplaced modesty,
partly from lack of intelligence, or else they

RATIONAL ART OF HEALING 41

describe them vaguely or assert that some of
them are of little consequence.

77
Now surely, on the one hand, the physician
must listen most carefully to the patient's de-
scription of his symptoms and sensations, and
especially must he be prepared to believe the
actual expressions which the patient himself
uses to explain his sufferings, because they are
frequently altered and incorrectly stated by
friends and attendants. But as surely, on the
other hand, in all diseases and especially in
chronic diseases, the discovery of the true and
complete disease-picture and of its individualities
demands particular insight, scepticism, know-
ledge of human nature, wariness in enquiry, and
patience of the profoundest kind.

78

On the whole the physician will find the in-
vestigation more easy in acute diseases or those
of short duration, because both patients and
friends have recent and vivid memories of all
symptoms and departures from the health which
has been so lately lost. Here, too, the physician
requires to know all that can be known ; but he
has less occasion for enquiry since the know-
ledge which he desires is for the most part
spontaneously given.

79
In the investigation of the symptom-complex
of epidemic or sporadic diseases it matters no-
thing whether or no anything similar has
appeared in the world before under this or that
name. The novelty or strangeness of an illness

42 * ORGANON OF THE

makes no difference either to the examination or
to the cure of it; for in any case the physician
must look upon the clear picture of any prevail-
ing disease as a thing new and unknown, and
he must give it a thorough individual examina-
tion, if he wishes to be a rational practitioner of
medicine. For him no conjecture can take the
place of truth, nor dare he consider that he
knows, in whole or in part, any case of disease
brought to him, unless he has carefully studied
all its manifestations ; the more so as every pre-
vailing illness (as exact investigation reveals) is
in many respects a distinct phenomenon, very
different from all previous diseases of a similar
name. Epidemics due to a miasm that remains
constant, as, e. g. small-pox, measles, and so
on, form exceptions to this rule.

80

It may well happen that in the first case of an
epidemic the physician will not obtain a complete
picture of the disease at once; for such a col-
lective disease only reveals the totality of its
symptoms and signs to the exact observation of
several cases. Nevertheless, the physician who
examines with care can often arrive so near to
the true position, even with the first or second
case of an epidemic, that he forms a character-
istic picture of it in his mind and thereby even
at that early stage discovers a suitable counter
disease-force for it, a remedy adapted to its
requirements.

81

In the course of recording the symptom-com-
plex of several cases of this kind, the disease
picture, at first only sketched in, becomes stead-

RATIONAL ART OF HEALING 43

ily more complete; not longer and more wordy,
but almost always shorter, more easily recogniz-
able, more characteristic, including more of the
totality of this collective disease. Then the
general symptoms of little importance and in-
dividuality (such as malaise, weariness, want of
sleep, want of appetite, and so forth) retreat into
the background, and the more striking and
peculiar symptoms, belonging to few diseases
and of rarer occurrence, began to stand out and
to make up the characteristic picture of this
illness.

Author's note, — If the physician has found
for the earlier cases a remedy approximately
suitable, and still more if he has found the
almost specific remedy, he will either find the
later cases confirm the suitability of his first
choice (selected upon a true, albeit incomplete,
conception of the disease), or he will find himself
led to a more suitable remedy, and finally to
the most suitable, the specific, remedy.

82

When once the whole complex of symptoms,
the picture of any particular kind of disease, is
exactly drawn out, then the most difficult part
of the physician's task is finished. Then he has
it always before him ; he can study it in all its
details, in order to discover an effective opposing
force, an artificial counter disease-force, similar
to the existing disorder, chosen out of the
symptom-lists of all the medicines which are
known to him ; and when in the course of treat-
ment he wishes to learn the effect of the remedy,
he need only remove from the original complex
of disease-symptoms those that have been ameli-
orated, and add any new symptom that has
appeared.

44 ORGANON OF THE

83
The second point in the task of a rational
practice of medicine concerns the choice of the
homoeopathic remedy. This is that artificial
disease-producing power whereby the patient can
be, as it were, inoculated with a similar illness,
an artificial counter-disease which by the resem-
blance of its symptoms can overcome and ex-
tinguish, and thus radically cure, the disease
from which the patient suffers.

84

To this end individual remedies must be
known in all their power as disease-exciting
agents. That is, as far as possible, all the
disease-symptoms and alterations in the body
which various remedies have the power to pro-
duce must be known before any one remedy can
be chosen to combat the natural disease under
treatment.

85

If, in order to discover this, a medicine is
given to a sick person, little or nothing of its
pure effects is seen, because the effects which it
is especially desired to observe, namely, the
alterations in the state of the body resulting
from the medicine, are so mingled with the
symptoms of the existing natural disease that
they can be recognized only doubtfully or not
at all.

86

To avoid this and to discover what distinctive
alterations, symptoms and signs various medi-
cines could produce in the health of body and
mind, in other words, what elements of disease
they tended to arouse, there was no course more

RATIONAL ART OF HEALING 45

natural than to administer them experimentally
to healthy people in moderate doses.

Author's note, — The great Albrecht von
Haller recognized this necessity long ago (in
the preface to Pharm. Helvet.) : Nempe primum
in corpore sano medela tentanda est, sine pere-
grina ulla miscela : odoreque et sapare ejus
exploratis, exigua illius dosis ingerenda et ad
omnes, quae inde contingunt, affectionum ex-
cretiones adtendendum. Inde ad ductum phae-
nomenorum, in sano obviorum, transeas ad
experimenta in corpore aegroto," etc.

87

As soon as I undertook this task with resolu-
tion, not a few powers of artificial disease were
revealed to me in the course of an observation
conducted at no small sacrifice and with the
greatest possible care. These can now^ be em-
ployed with exact certainty for arousing counter-
diseases, that is, as homoeopathic remedies for
natural disorders.

88

Many lists of symptoms recorded in older
writings also came to my notice, which furnish
examples of the ill effects of powerful substances
when swallowed by healthy persons in large
quantities.

Author's note, — It was never suspected that
the first foundation of a knowledge of drugs had
been laid by these histories of drug-diseases.
Hitherto this knowledge had remained almost
entirely conjectural, that is, had hardly existed
at all.

89
The agreement of my observations on the real
effects of medicines with these older records

46 ORGANON OF THE

(albeit the latter were not recorded for purposes
of therapeutics), and even the agreement of these
accounts with others of a similar kind, must
readily convince us that drugs produce morbid
alterations in the healthy human body in accord-
ance with established, unalterable laws, and that
each has power to excite its definite, individual,
invariable symptoms of disease.

90

In those older descriptions of the effects, fre-
quently dangerous, produced by the swallowing
of over-doses of medicines, it is often noticeable
that symptoms of a kind entirely opposed to
those which were first observed appear in the
later stages of these melancholy occurrences.

91
I also in my own early experiments observed
such late-appearing symptoms fairly frequently
(though far less often than in the older accounts
referred to, because I did not experiment with
such immoderate doses) ; but I found in con-
tinuing my experiments that, as surely as I used
smaller doses, so surely did these late symptoms
appear but rarely, while the early symptoms were
observed in far greater number and with no
less clearness, especially when I redoubled my
care in observation and avoided everything
which could possibly hinder the exactness of the
experiment.

92

The fact that the frequency of these later
symptoms (which may be called ''negative" or
"secondary") is greatest when large doses are
given, and diminished in exact ratio to the
diminution of the dose, shows that the secondary

RATIONAL ART OF HEALING 47

symptoms are only a kind of after-disease due
to large doses following upon the cessation of
the early symptoms ("positive" or ** primary"
symptoms). It is a kind of opposite or reactive
condition, analogous to the customary process
of life wherein everything seems to go on by a
series of alternating states.

Author^s note. — As sadness usually follows
upon excessive joy, liveliness upon sleep, heat
upon chill, and vice versa,

93

After the administration of every powerful
medicine a considerable number of different
symptoms appear, a whole series of occurrences
and signs of disease, which are all primary
symptoms if the experimental dose was not
excessive. These more frequent primary
symptoms are the chief effects of the medicines
viewed as artificial disease-producing forces.

94
Among these there are not a few symptoms
which are partly, or in some circumstances en-
tirely, opposed to other symptoms which have
appeared earlier or may appear later. These
are not therefore to be regarded as secondary
symptoms or the after-disease produced by the
medicine, but only as the alternating phase of
the paroxysms of the positive (or primary) drug-
action.

95

When medicines are administered to the

healthy, some symptoms follow more often, some

less often, and some only appear very seldom.

The most unusual symptoms and those which

48 ORGANON OF THE

appear most regularly are the most valuable as
indications.

Author's note, — Idiosyncrasies are often no
more than these rare but real effects of drugs on
persons who, although healthy, possess a special
sensitiveness to the action of special substances.
Thus the handling of some kinds of sumach
causes skin-eruptions in certain people, and eat-
ing mussels causes erythema and urticaria in
others. Again, some horses and cows have been
suddenly killed by eating leaves of yew, while
other animals of the species are affected but
little.

96

Every medicine produces special effects which
are never exactly counterfeited by any other.

97

As every species of plant differs from every
other species in its external form, in its in-
dividual mode of life and growth, in its taste
and in its smell, and as every mineral and every
salt is certainly different from every other in
external appearance as well as in its inner
physical and chemical peculiarities (whereby any
confounding of one with another should surely
have been prevented), so assuredly are they all
different in their power to produce disease (and
therefore also in their power to heal). Each
substance effects alterations in the health and
condition of the human body after its own dis-
tinct and definite fashion, a fashion which for-
bids the substitution of any other substance for
itself.

Author's note. — Whosoever exactly knows
and rightly values the extraordinary difference
between the effects of one. drug and those of any

RATIONAL ART OF HEALING 49

other, can easily see that from a therapeutic point
of view there can be no equivalent remedies, no
surrogates. Only those who do not know the
pure and definite effects of different medicines
can be guilty of such substitutions. Thus the
minerals wherein a later and more cunning
chemistr}^ has discovered new and individual
metals, differing widely from all others, were
held by our ignorant ancestors for stones and
earths of no value; thus, too, children confound
things essentially most different because they
hardly know their external appearances, far less
their true worth and their inner and most vary-
ing peculiarities.

98

Substances belonging to the animal and vege-
table kingdom are most powerful as medicines
in their crude state.

Author's note. — Those plants and animals
which are used for food have the advantage
over others of possessing a larger proportion
of nutritious material, and differ from the
others in that their medicinal powers in the
raw state are either not so strong or, when they
are strong, are lessened and destroyed by dry-
ing (as those of the arum and peony root) by
expression of the poisonous juices (as of cas-
sava), by fermentation (as of sour gherkins),
by smoking and by the action of heat (in roast-
ing, frying, baking, boiling), or are antidoted
and rendered harmless by the addition of salt,
sugar, and above all vinegar (in sauces and
salads). Even most medicinal plants lose some
or all of their power by such procedures. The
juice of the heroic plant is often reduced to an
inactive pitch-like substance by the heat com-
monly used in making an extract. The expressed

50 ORGANON OF THE

juice of the most deadly plants in their fresh
state, if allowed to stand for only one day in a
moderately warm place passes into complete
alcoholic fermentation and is deprived of much
of its medicinal strength ; but if it is left to
stand for another one or two days till the acetous
fermentation is complete, all specific medicinal
power vanishes ; the deposit is then quite harm-
less and resembles wheat-starch.

99
In order to examine the effects of medicines
it must be remembered that strong drugs (so-
called "heroic") will display their effects when
given in quite small doses, in healthy, even
robust persons. Those of lesser power must be
given in more material quantities for the purpose
of these experiments, but the weakest drugs can
only be tested upon such subjects as are free
from disease, but at the same time are delicate,
excitable and sensitive.

100

The physician planning these experiments,
upon which hang the welfare of generations of
men, should choose no medicines but those which
he knows well and of whose purity and potency
he is entirely convinced.

lOI

Each of these medicines must be administered
in a perfectly simple and unadulterated form,
in powder, or alcoholic tincture, or (if they are
salts and gums) in watery solution, so as to
procure only individual effects of each substance.
As, however, infusions of plants in water and
fresh plant-juices are spoilt by fermentation
within a few hours, drugs belonging to these

RATIONAL ART OF HEALING 51

classes must either be administered without
delay as soon as they are prepared, or fermenta-
tion must be delayed by the addition of a little
spirit of wine, or avoided by the use of a larger
quantity of alcohol.

102

For the purpose of these experiments every
drug must be given alone and quite pure, without
admixture of any foreign substance ; and nothing
of a similar kind must be taken either at the
same time or shortly before or after the dose
of medicine.

103

The healthy person who is the subject of the
experiment must take, while fasting, about such
a dose as is commonly used in medical practice.
It is best given in solution, and no food should
be taken for some hours afterwards. The sub-
ject must be willing to pay strict attention to his
condition without losing his mental tranquillity.

104

If (as is best) the effects of this single dose
are to be observed over a period of several days,
the diet must be strictly regulated. As far as
possible it should be of a simple nutritious char-
acter without condiments ; and green vegetables
and fresh roots should be avoided as they all
have some disturbing medicinal action in what-
ever v/ay they are prepared. The drinks should
be those usually taken, as little stimulating as
possible.

105

The subject must refrain from any kind of
excesses, especially sexual excess.

E 2

52 ORGANON OF THE

io6

If no result follows the first dose, or at least
nothing clear and definite, a second dose of
double the quantity should be given on the
second day, and if this also produces no effect,
then a still stronger dose on the third day.

107

This repetition, however, will seldom be re-
quired if both the experimenter and the physician
are equally observant. To obtain a pure result,
at least as regards the regular succession of
the symptoms, it is far better to see whether
the experiment cannot be carried through by the
administration of a single dose, and only to
give another dose of the same drug after (say)
some w^eeks; or better still, after a considerable
time, to administer a single dose of a different
medicine.

108

In this way the order of appearance of the
drug-symptoms can be better observed than
when a second dose of the same medicine is
given soon after the first; also the duration of
the action of a drug on the human body is more
certainly determined by the administration of a
single dose than by any other method.

109

When, however, it is desired to investigate
the symptoms themselves, especially those of a
medicine of little power, without regard to dura-
tion of action or succession of symptoms, then
the preferable method is to give it every day
in an increasing dose or several times a day in
the same dose. In this way the powers of even

RATIONAL ART OF HEALING 53

the weakest drug, as yet perhaps unknown, will
come to light.

no

All the individual symptoms of a drug do
not appear in any one person selected for experi-
ment, nor do they all appear at once or on the
same day, but some appear in one person and
some in another, and yet in such a way that
some or many of the symptoms will be found
in a fourth or tenth prover which appeared
earlier in the second or sixth or seventh ; more-
over, they will not all appear precisely at the
same hour.

Ill

The number of disease-elements which a
medicine can produce is only brought near com-
pleteness by repeated observations on many
suitable persons.

112

In conducting such an experiment with a
definite medicine the smaller the doses, up to a
certain point, the more surely (within limits)
will the primary symptoms, unmixed with
secondary, appear conspicuous in the proving;
provided always that the observation is con-
ducted with the most minute attention and aided
by the choice of a prover who is in every respect
temperate, self-observant and sensitive.

113
When over-large doses are employed, not only
do the secondary symptoms play a large part,
but the primary sym.ptoms appear in so con-
fused and sudden and precipitate a manner that
they cannot be exactly observed ; to say nothing

54 ORGANON OF THE

of the danger, which cannot be a matter of
indiflerence to any one who cares for his fellows
and regards the least of mankind as a brother.

114

The subjects of the experiment must be able
to express their sensations exactly and clearly.

115

In the investigation of these drug-symptoms
all suggestion must be as rigidly avoided as in
the examination of the symptoms of disease.
The greater part of what is recorded as the
genuine result of experiment must be the volun-
tary statements of the prover; nothing must be
conjectural, nothing guessed at, and as little as
possible should consist of answers to formal
questions ; least of all should the record contain
expressions relating to sensations with which the
prover has been previously prompted, or the
results of questions that suggest the answers
"Yes" or "No."

116

In order to render these important state-
ments as accurate as possible it is a good plan,
as soon as any symptoms or sensations of the
prover are written down, to make him repeat his
description, so that, when his second account is
identical with the first, it may be recorded in
that form, and when the accounts vary he may
be confronted with both and invited to choose
and confirm the statement which is nearest to
the truth, and thereby render true, pure and
striking the picture of the drug disease which
has been discovered through his aid. The
physician who is observing the experiment adds

RATIONAL ART OF HEALING 55

to the description whatever alterations in health
he has himself observed in the prover.

117

The record of the more definite and striking
symptoms must be accompanied by a note of
the time that elapsed between the giving of the
dose and the appearance of the symptoms, the
time of day at which they appeared, their dura-
tion, and all contingent circumstances; those
symptoms that are observed more often in the
same way should be underlined, and the doubt-
ful ones followed by a mark of interrogation or
enclosed in brackets until perhaps the doubt
concerning them is removed by the confirmation
of other experiments.

118

The w^eightiest experiments in drugs remain
those conducted by the closely observing and
unprejudiced physician upon himself.

119

Even in diseases, especially in chronic dis-
eases, the symptoms of a remedy can sometimes
be discovered beneath the symptoms of the
original disorder. But it is a subject. for the
higher art and should be left to masters of
observation alone.

120

If we have thus tested on healthy persons a
number of medicines, and have carefully and
faithfully recorded all the disease-elements and
symptoms which as artificial disease-producing
forces they are able to arouse^ then we possess
a Materia Medica, a collection of the genuine

56 ORGANON OF THE

positive mode of action of simple medicines, a
codex of Nature wherein is registered a con-
siderable list of the individual symptoms and
disease-elements of each powerful and tested
drug just as the observation of the experimenter
discovered them. Among these are to be found
the elements of many natural diseases which can
be cured through the likeness herein established.

121

In such a Materia Medica there is nothing
conjectured, asserted without proof, imagined,
invented; but all is the pure reply of Nature to
careful questioning.

122

Truly only a considerable supply of medicines
thus accurately known in their positive modes
of action can serve our turn, and enable us to
discover a remedy for every one of the innumer-
able natural cases of disease.

Author's note, — When thousands of exact and
tireless observers, instead of one as hitherto,
have laboured at the discovery of these first
elements of a rational Materia Medica, what
will it not be possible to effect in the whole
extent of the endless kingdom of disease ! Then
the art of medicine will no longer be mocked
at as an art of conjecture lacking all foundation.

123

Nevertheless even now there are but few cases
of disease for which, even out of this small
supply of provings,^ a suitable analogue of
counter disease-force (i. e. a remedy) cannot be

^ " Fragmenta de viribus medicaminum positivis." — Hah-
nemann, 1805.

RATIONAL ART OF HEALING S7

found which will bring about a restoration ot
health gently, swiftly and enduringly without
any marked perturbations. This fact depends
on the manifold variety of symptoms and the
abundance of disease-elements which every one
of the powerful medicines hitherto tested has
already displayed in its positive action on the
healthy body. In spite of the limited choice of
remedies (even now not completely known),
incomparably more and better cures can be
achieved by this method than by the so-called
general methods or any other of all the irrational
non-homoeopathic ways of treatment.

124

Whenever in the provings of one or other of
these medicines, tested in their positive action by
observations on the healthy body, we find a
symptom-complex analogous to that of a given
natural disease, that medicine will, nay, must,
be the most suitable counter-force for the de-
struction and extinction of that natural disorder ;
the specific, or completely suitable, remedy is
discovered in that medicine.

125
If now the counter disease-force (the drug) is
entirely suitable by its likeness of symptoms
(that is, if it be selected on the ground of its
homoeopathicity), and if, further, it is admin-
istered properly, then the natural disease, how-
ever threatening or severe, however encumbered
with many symptoms, will depart almost un-
noticed in a few hours, provided it has not been
of long duration. If it is of longer standing, it
will be a few days before it disappears. In either
case practically none of the pathogenic symptoms
of the drug, that is, of the artificial counter-

58 ORGANON OF THE

disease will be observed. In rapid and hardly
noticeable sequence, there comes only health ;
the natural and the artificial disease both swiftly
and gently vanish, without perceptible reaction ;
there has been a true dynamic annihilation.

126

Here we arrive at the third point in a rational
system of therapeutics, the most suitable method
of administering the homoeopathic remedy in
cases of disease.

127

If a patient complain of one or two trivial
symptoms, which have but recently appeared,
the physician should not look upon this as a
complete disease requiring therapeutic aid. A
slight alteration in diet and mode of life will
usually be enough to make an end of such an
illness. But if the patient complain only of one
or two violent symptoms, the physician will
generally find, on examination, other, though
lesser, symptoms, which make up a complete
disease-picture. This is generally the case with
chronic disorders, of which more hereafter.

128

The more severe an illness is, the more omin-
ous and striking usually are the symptoms of
which it consists. But thereby the more surely
also is a suitable remedy discovered for it, if a
sufficient number of medicines, tested in their
positive actions, is at our disposal. Among the
symptom-groups of many drugs it is not as a
rule difficult to find one whose particular disease-
elements and symptom-complex present a very
similar picture to those of the natural disease,

RATIONAL ART OF HEALING 59

thereby constituting it a suitable counter disease-
agent ; this is the desired remedy.

129

In this search for a specific homoeopathic
remedy, that is, in this comparison of the totality
of the symptoms of the natural disease with the
symptom-lists of available medicines, the more
striking and unusual of the characteristic symp-
toms of the disease should especially be kept in
view; for it is precisely to these symptoms that
analogues must be found among the disease-
symptoms of the drug which is to be the most
suitable remedy. On the other hand the general
signs, like loss of appetite, weariness, discom-
fort, disturbed sleep, and so forth, are of little
significance when unaccompanied by more pre-
cise indications, because they are found in the
symptomatology of most drugs as of most
natural diseases.

130

If, then, the counter disease-picture, con-
structed from the symptom-list of the remedy
held to be most suitable, contains in the greatest
number and closest resemblance, these striking
and characteristic symptoms of the disease that
is to be cured, then this medicine affords the
most apt artificial counter-disease for this case
of illness, and is, in short, the specific remedy.
The disease will be removed and extinguished
without any disturbance, often even within the
period of action of the first dose.

131

I say, without disturbance. For in employing
this most suitable counter disease-force, only

6o ORGANON OF THE

those drug-symptoms are called into play which
correspond to the disease-symptoms (and the
first destroy the second) ; the other and often
very numerous symptoms found in the symptom-
list of the suitable remedy remain entirely latent
because they find nothing to correspond to them
in the disease-condition. Nothing of them will
be noted in the condition of the patient, which
will improve from hour to hour; presumably
because the whole power of the specific remedy
is concentrated on those disease-symptoms which
resemble its own and is entirely devoted to the
destruction of these similar symptoms.

Author's note. — Yet there is no homoeopathic
remedy, however suitably chosen, which may not
in the course of its action on a very excitable
and sensitive patient, cause at least one, prob-
ably very trifling, unwonted disturbance, a little
new symptom. For it is almost impossible that
medicine and disease should cover each other in
their symptoms as exactly as two triangles with
equal angles and equal sides cover each other.
But generally these unimportant differences are
readily adjusted by the individual energy of the
living organism, and only patients of unusual
sensitiveness are aware of them ; recovery goes
steadily forward, unless prevented by errors in
the conduct of the patient's life or by excitement
of the passions.

Translator' s note — In more modern phrase-
ology it might be said that drugs have an indi-
vidual power, in sufficient doses, of affecting
certain body-tissues, often indeed a large number
of tissues. When these tissues are affected by
disease in a way resembling the action that the
drug exerts upon them, they, being rendered
more sensitive by disease, will respond to the
stimulus of a smaller dose of the homoeopathic

RATIONAL ART OF HEALING 6i

remedy than was originally required to call out
symptoms in the healthy provers. But the
smaller dose, which can affect the diseased and
thereby sensitized tissues and can probably
cause amelioration, is not strong enough to
arouse symptoms in tissues which have remained
normal, in spite of the fact that the drug pos-
sesses a distinct relation to these tissues. Con-
sequently symptoms due in the provers to dis-
turbances of these tissues (w^hich ex hypothesi
remain normal in this particular patient) do not
appear as a result of administering the drug,
unless in unduly sensitive subjects, and then
only to a small extent.

132

But although it is certain that a suitably
selected homoeopathic remedy gently destroys
and removes disease, without arousing such
special symptoms of its own as are not present
in the patient, that is, without exciting sufferings
of a new and serious kind, yet it usually causes,
as it W'Cre, a slight aggravation of the patient's
condition in the first hour or two after its admin-
istration. This aggravation so closely resembles
the original disease that it seems to the patient
to be a real worsening of his symptoms. But it
is in reality no more than the onset of a very
similar medicinal disease rather more powerful
than the original disease. This slight homoeo-
pathic aggravation during the first hours (which
is, in fact, a very good prognostic sign that the
acute disease will probably yield to the first
dose), is quite as it should be; for naturally the
drug-disease must be somewhat stronger than
the illness if it is to overcome arid extinguish it;
even as an analogous natural disease can only

62 ORGANON OF THE

remove and destroy another when it is the
stronger (S. 28). The smaller the dose of the
homoeopathic remedy, the less will be this
aggravation of symptoms appearing in the first
hours. ^

Yet the dose of a homoeopathic remedy can
hardly be made so small that it will not over-
come and ameliorate its analogous disease, in-
deed completely cure and banish it (S. 244). It
is, therefore, easily to be understood why even
the very smallest dose of a homoeopathic remedy
always causes a small homoeopathic aggravation
of this kind, albeit a very mild one, in the first
hours after its administration.

Author's note — This aggravation, an exalta-
tion of the drug-symptoms over the analogous
disease-symptoms has been observed by other
physicians when by chance they have employed
a homoeopathic remedy. The use of viola
tricolor at first caused an aggravation in the
skin-eruption which it ultimately (homoeopathic-
ally) cured (Leroy, Heilk, fur Mutter).

133
Since the number of medicines exactly tested
in regard to their positive action is as yet only
moderate, it sometimes happens that only a
smaller or greater part of the symptoms of a case
of disease can be found in the symptom-register
of the most suitable medicine. Consequently
this incomplete counter-disease force must be
employed for lack of a complete one.

^ This corresponds to the experience of the use of vaccines
and the "negative" and "positive " phases of Sir Almroth
Wright.

RATIONAL ART OF HEALING 63

134
In such a case a complete undisturbed cure
by this drug is naturally not to be anticipated.
After its use many more symptoms may appear
in the patient than were previously present as a
result of the disease. These will not prevent the
uprooting of a considerable part of the disorder,
nor the establishment of a fair commencement of
a cure; but nevertheless, complete cure may be
impeded by these accessory symptoms.

135
The small number of homoeopathic symptoms
shown by the best-selected medicine is little or
no hindrance to cure, if these few symptoms for
the most part correspond to the characteristic
and specially striking features of the disease. In
such a case cure follows the use of the remedy
swiftly and almost undisturbed.

136

If, however, few of the outstanding character-
istic symptoms of the disease can be paralleled
in the symptomatology of the chosen drug, and
if it corresponds to the disease chiefly in such
general symptoms as nausea, weariness, dis-
turbed sleep, discomfort, and so forth, and in
little else; then, if no remedy more exactly
homoeopathic can be found among such agencies
of counter-disease as are known, the physician
can promise himself but little immediate favour-
able result from the use of the drug.

137
Such a case, however, is rarq even with the
number, as yet small, of medicines known in
their positive actions; and the bad effects of

64 ORGANON OF THE

administering such a remedy are lessened as
soon as another, more suitable, medicine can be
chosen.

138
Thus, if accessory symptoms of some moment
occur after the use of the first selected medicine,
which is not exactly homoeopathic, this first dose
should not be allowed to exhaust itself and
expose the patient to the full duration of its
action ; but the altered disease-state should be
freshly examined, and a new disease-picture
made from the combination of the remaining
original symptoms with those that have just
appeared.

139
We shall then more easily find among our
known medicines an analogue to the new disease-
picture just presented, and a single dose of this
remedy, if it does not entirely destroy the dis-
ease, will bring recovery much nearer. And if
even this drug is not enough to achieve a com-
plete cure, we proceed similarly with the repeated
examination of the disease-condition and the
repeated selection of the most suitable homoeo-
pathic counter-force till our object is achieved
and the patient is completely restored to health.

140

If on the first examination of a disease and
the first choice of a remedy it is found that the
symptom-complex of the illness cannot be effect-
ually covered from the symptom-register of a
single medicine (owing to the insufficient num-
ber of medicines which are known) ; and if
further it is found that tw^o medicines contend
for preference, the one corresponding more

RATIONAL ART OF HEALING 65

closely to one part of the symptom-complex and
the other more closely to another part; then it
is not desirable to give one medicine after the
other without further close examination, nor to
administer both together, for no one can foresee
how the one may hinder and perturb the action
of the other (S. 235, 256).

141

It is far better first of all to give only the one
which on the whole seems more suitable. It will
certainly ameliorate the illness in part, but will
on the other hand bring out a new range of
symptoms.

142

When this happens, the homoeopathic law
allows no second dose of the same medicine to
be given. But at the same time the other remedy,
which seemed suitable upon the first indications
for the second half of the symptoms, must not
be given without consideration and a further
enquiry into the condition left after the use of
the first medicine.

143
Far rather in this case, as always when a
change has come about in the disease-condition,
the present remaining symptom-complex must
be considered anew and without regard to the
second remedy which at first seemed partly suit-
able, in order that the counter-force most adapted
to the present new condition may be selected
without prejudice.

144

It seldom happens that the medicine which
at first appeared the second best will now be

66 ORGANON OF THE

indicated. But if, indeed, this very remedy ap-
pears after the new examination at least as suit-
able as any other, then it deserves the more con-
fidence, and should be straightway administered.

145
It is only in cases of long-standing chronic
disease, not subject to any notable change, which
possess definite stable fundamental symptoms,
that sometimes two medicines almost equally
homoeopathic can be used with advantage in
alternation ; ^ and even that is only to be toler-
ated as long as amongst the number of proved
remedies there is none that offers a group of
symptoms altogether or almost parallel to those
of the chronic disease in question. If there
should be such a remedy, then it alone and un-
aided will do all that is required, and will cure
swiftly and enduringly and without perturbation.

146

A similar difficulty in the art of healing arises
in cases where the number of disease-symptoms
is too limited. This contingency demands the
most careful attention ; for if the difficulty which
it creates is now removed, then almost all the
difficulties which hinder the therapeutic art are
disposed of, except the lack of remedies
homoeopathically known.

147
The only diseases which seem to have but few
symptoms, and are therefore more troublesome
to cure, are those which may be called incom-
plete, since they present only one or two leading

1 Hahnemann never regarded this procedure as other than
a make-shift, and in later years ceased to recommend it.

RATIONAL ART OF HEALING 67

symptoms, and these obscure almost all the rest.
They belong for the most part to chronic
diseases.

148

Their principal symptom may be either of an
external character or may affect an internal
organ ; as, for instance, headaches of years' dura-
tion, long-standing diarrhoea, cardialgia, and so
forth. The first class are usually termed local
diseases.

149

In incom.plete diseases of the second kind, it
is often due to the physician's want of obser-
vation that the symptoms which are actually
present and which make up the complete dis-
ease-picture, are not fully discovered.

150

There are, nevertheless, a few illnesses which,
after all preliminary examinations (S. 63-81,
S. 178-182), present but one or two marked and
violent symptoms and leave all others only
vague and shadowy.

151
To deal successfully with such rare cases the
first procedure is to choose the counter disease-
force which is best indicated by these few
symptoms.

152
Sometimes, indeed, it will happen that this
remedy, chosen most carefully in accordance
with the homoeopathic law, albeit from few
symptoms, will actually prove to be the exact
counter-force required to destroy the existing
F 2

68 ORGANON OF THE

disease. This is the more Hkely to occur, the
more striking, strange, and characteristic are
the few disease-symptoms present.

153
But more often the medicine so selected will
prove only partially suitable, since there was no
complex of many symptoms to guide to a
decisive choice.

154

In this case the medicine, which has been
chosen as exactly as possible, but is neverthe-
less not completely homoeopathic, will cause
accessory symptoms while counteracting a dis-
ease to which it is only partially analogous. A
similar sequence of events has been already
noted as likely to occur when the choice of a
remedy is incomplete from lack of sufficient
counteracting forces, i, e, lack of exact know-
ledge of a sufficient number of medicines. The
accessory symptoms and phenomena, which
appear in these circumstances out of the symp-
tomatology of the drug, are intermingled with
those of the patient's condition, but are at the
same time themselves to be regarded as symp-
toms of the disease, although they were not
experienced before the administration of the
medicine. Entirely new symptoms will appear,
or symptoms hardly perceived before will become
more marked.

Translator's note. — That is to say, the effect
of a drug on a diseased body is, to a large
extent, influenced by the nature of the disease,
and forms, as it were, a commentary upon it,
from which more knowledge of the disease can
be acquired.

RATIONAL ART OF HEALING 69

155
The accessory phenomena and newly appear-
ing symptoms of disease must not be attributed
entirely to the medicine. They originate from
it, but they are always and only such symptoms
as this particular disease had the latent power
to produce in this particular body, symptoms
which the medicine, as an agent having a similar
tendency, merely elicited and caused to appear.^
In a word, the entire symptom-complex now in
evidence is to be regarded as that of the disease
itself, as its actual existing condition, and as
such it is to be treated.

156
Thus the choice of the remedy, which was in
this case almost unavoidably imperfect, yet
serves to make the symptom-complex complete
and so to facilitate the discovery of a second
homoeopathic counter disease-force which shall
be more exactly adapted to the needs of the case.

157
Therefore, after the action of the single dose
of the first medicine is completed (unless the
violence of the newly appearing symptoms de-
mand more speedy aid) a new examination of
the disease must be undertaken ; the status
morbiy as it now is, must be exactly noted, and
a second homoeopathic remedy chosen according
thereto, which shall be exactly suitable to the
immediate condition. This is the more readily
and exactly done, because the group of symptom's
has become more numerous and more complete.

^ Except when they usher in the final-death agony, or can
be traced to some error in the mode of living, outbreak of
violent passion, etc.

70 ORGANON OF THE

iS8
Among incomplete diseases (S. 147) the so-
called local disturbances take an important place.

159
These local diseases, unless they have arisen
a short time previously from an external lesion,
always depend upon an inner malady extend-
ing throughout the whole organism ; and the
medicinal treatment of them must, therefore, also
have regard to the whole organism, if it is to be
reasonable, consistent, and effective.

161

No so-called local malady arising from internal
causes and persisting in a definite region can be
thought of as produced without the consent (as
it were) of the rest of the general health, and
without the participation of the other sensitive
and irritable parts of the body and the other
living organs. Thus the amelioration and even
complete cure of maladies which appear isolated
on the most distant parts of the skin, by means
of a small dose of a remedy homoeopathically
chosen, placed on the tongue or introduced into
the stomach, can only be explained by the
general acute sensitiveness to medicinal powers
and the ready, alert response to drug-force which
permeate all parts of the living organism.

162
Such cures are best effected when the physician
takes into account all noticeable alterations in
the patient's general condition, and thus finds
himself in a position to draw a complete outline
of the disease-picture before seeking among the
medicines known to him for a clearly marked
counter-force to the whole complex of symptoms.

RATIONAL ART OF HEALING 71

general as well as local. In this way a choice
can be made which is completely homoeopathic.

163

By means of this medicine employed intern-
ally (not externally) the general disease-condition
of the body is removed simultaneously with the
local disorder, and the first and the last are cured
together. This proves that the local malady
depends on a disease of the body as a whole, and
is only to be regarded as one of the most
important symptoms in a general disease.

164

This is so true that, when any remedy locally
applied has cured without other aid and has
restored health (as it has occasionally done), it
has only been able to do so by exercising
homoeopathically a healing influence upon the
inward disease-condition, and it would have
cured equally well had it been administered only
internally and not externally at all.

Author's note. — Thus some eczemas are re-
moved by the external use of cantharides and
some other eruptions by a similar use of mer-
curial preparations; but none of them are cured
so that general health ensues, unless these ex-
ternal remedies have also the power to remove
the inseparably associated inner disease-con-
dition and have, therefore, affected the whole
organism with their healing power.

165

It would seem, indeed, as though the cure of
such a malady would be hastened, if the remedy
recognized as truly homoeopathic to the whole
disease complex were not only administered

72 ORGANON OF THE

internally but also applied externally; seeing
that the local affection usually strives to isolate
itself (although it can never do this completely
in the living organism), and that it is true that
medicines act more speedily on the part to which
they are applied than to more distant regions.

Author's note. — If cherry laurel water is in-
jected into the bowel of an animal, its spasmodic
action first appears in the lower limbs and later
in the upper, while this order is reversed if the
drug is swallowed.

1 66

Nevertheless, this simultaneous use of a
remedy externally and internally in diseases
where the local symptoms are the more marked,
has this great disadvantage, that through the
local application these principal symptoms (/. e.
the local affection) will be destroyed before the
internal disease is destroyed. Consequently
through their disappearance it becomes difficult
or even impossible in many cases to decide
whether in addition the whole disease has been
abolished.

Translator's note. — The belief that grave
symptoms might ensue if skin diseases were sup-
pressed was shared by most physicians in
Hahnemann's time. This belief is not now
widely held. The subject is a difficult one and
hardly ripe for dogmatism. What Hahnemann
fears in these paragraphs is the grave danger
that the patient may seem to be cured with the
disappearance of the skin eruption and so pass
out of observation before he has really recovered.

167

A similar but, if possible, greater disadvantage
generally follows the practice of using an active

RATIONAL ART OF HEALING 73

remedy (even if homoeopathic) only in local
application to the local disease (in other words,
the principal symptom), unless it has been pre-
viously administered internally to bring about
the entire destruction of the general disease.
For then it is even more unlikely that the remedy
when only locally applied should have simul-
taneously acted so powerfully and completely
on the inner organism as to remove and destroy
the total disease as well as its local symptoms.
This favourable result will only occur in the
very rare cases in which the inner disease is but
slight and the external affection is so extensive
that the topical application will have been made
over a considerable area of the body.

168

In all other cases the simple external appli-
cation of a small quantity of the remedy will
not exert upon the inner organism an action
nearly powerful enough to destroy the inner and
often chronic and deep-seated disease. Even
if its proportionately more rapid curative action
promptly avails to remove the local lesion, which
is merely the most prominent symptom of dis-
ease, the inner malady still remains and the case
has become more serious than before.

169

For if the local affection is made to disappear
by this local incomplete treatment, then the in-
ternal treatment necessary for the complete cure
of the total disease remains in vague obscurity;
for now only the other and ill-marked symptoms
remain, symptoms which are not so constant
and persistent as the local symptoms, and often
are not characteristic enough to enable a clear

74 ORGANON OF THE

and comprehensive picture of the disease to be
constructed.

170

The physician in his search for a suitable
internal treatment must remain in doubt whether
the homoeopathic remedy apparently indicated
has entirely destroyed and removed the whole
disease; for the most important and persistent
symptom (the local lesion) has already vanished.
He will have to work in semi-darkness, and thus
will either give too much or too little of the
remedy, or he will employ it too long or not
long enough for complete cure; and thus the
patient suffers.

171
If the remedy which is completely adapted to
the disease has not been discovered before the
local symptoms have been removed either by the
knife or by some destructive or desiccating local
application, the case necessarily becomes more
difficult on account of the uncertain and in-
sufficiently characteristic nature of the remaining
symptoms. For the external and principal
symptoms, which would have led most surely to
the choice of the exact remedy and would have
confirmed the choice by responding to its in-
ternal use, have been removed from observation.

172

If the external phenomena were still present,
then their failure to disappear would show that
the inner treatment was not yet complete ; if, on
the contrary, they disappeared under internal
medication alone, that would constitute a con-
vincing proof that the disease was uprooted and
that the desired recovery from the whole disease
was achieved — a priceless advantage.

RATIONAL ART OF HEALING 75

173
The disappearance of local symptoms as a
result of local treatment is almost always com-
pensated in Nature by the increase and develop-
ment of the other symptoms, hitherto virtually
latent although recognizable, and by the appear-
ance of new disease-phenomena. That is to
say, there is a heightening of the remaining
symptoms that make up the general disease.
This result of a local application is usually
wrongly called a driving inward of the external
disorder upon the nerves or the "humours."

174
In some diseases this awakening of the other
symptoms, after removal of the local manifesta-
tions, only takes place gradually, so that the
aggravation of the patient's condition is only
perceived after some lapse of time.

175
On the other hand, some other diseases pre-
senting local symptoms show a sudden acute
development of their remaining and generally
internal symptoms when the important local
manifestation has been removed by topical
applications. This acute aggravation of the
disease may be most alarming, and often ends
rapidly in death. Here the local phenomena
not only serve the end of hindering the develop-
ment of the internal symptoms, as in chronic
and sluggish cases of disease, but also seem to
be raised to the position of the chief symptom,
the symptom which, as it w^ere, for the time
absorbs the intensity and danger of the other
symptoms and prevents their perilous develop-
ment. The most melancholy experience teaches

76 ORGANON OF THE

how irrational it is in these cases, as well as in
the others, to abolish the relatively beneficent
local symptoms by a purely local treatment.

176

Fortunately the life-activity of the organism
itself sometimes causes the return of the local
symptom which has been artificially abolished;
it is less desirable to attempt to do this by
artificial means. Even inoculation is frequently
unsuccessful, because as a rule the local disease
inoculated is not the original one, but another
which bears only a superficial resemblance to
the first.

177

The rational cure of all such diseases depends
entirely on the internal administration of a
medicinal force, suitably adapted by its homoeo-
pathy to the whole symptom-complex, whereof
the local symptom is but the most characteristic
sign among a number of others. If this remedy
is given internally, and if in addition a suitable
regimen is ordered, the local application of the
specific medicine will hardly ever be found
necessary.

Author^s note. — Different diseases require
different rules of treatment in this respect. For
some, local applications of the indicated remedy
are most dangerous, for others, harmless or
beneficial.

178

The difficulty of effecting a homoeopathic cure
of these incomplete diseases (among which the
local diseases, so-called, should be mostly
classed) depends principally, as has been already
said, on the fact that they so seldom present

RATIONAL ART OF HEALING ^^

more than one outstanding symptom. The
remaining symptoms, which with the local
manifestation complete the disease-picture, re-
main in the background and escape the attention
of most observers.

179

This difficulty can only be overcome by more
searching and careful observations and inquiries.

180

To this end, if the patient complains only of a
few severe symptoms and can furnish no others
at the first examination, the physician does best
to defer his judgment as to the curability of the
disease and its curative treatment. These dis-
eases are nearly always chronic and will not
suffer permanently from a delay of several days^
during which all deviations from health in the
patient, great or small, can be more carefully
investigated until every one, even of the trivial
and hitherto unnoticed symptoms, has been
elicited and exactly noted.

Author's note. — Local symptoms are hardly
ever acute except when they are "metastases." ^

^ A metastasis is a severe localized symptom which appears
naturally in acute diseases, apparently as an attempt to
transfer them to an outward and less vital part of the
organism, and so to save the inner life from the danger that
threatens it. In such cases, although the local symptom at
the moment masks the others, yet the remaining symptoms
are more easy to discover owing to the phenomena which
preceded the metastasis, and by taking these together with
the local appearances, the entire symptom-complex and
disease-picture can be obtained and a suitable homoepathic
remedy selected ; cure then proceeds rationally and radically.
In these cases it is especially dangerous "to attack the local
symptoms with topical applications alone.

7^ ORGANON OF THE

i8i

In a chronic case of this kind the physician
will encourage the patient to divert his attention
from his local ailments and to take note of the
accessory signs and symptoms however small.
In this way special symptoms will be elicited
which the patient had hitherto overlooked on
account of the insistent nature of the more
obvious malady.

Author's note. — If the patient stubbornly de-
clines to make any further observations and
insists on treatment without delay, it is advisable
to treat him for a few days with some un-
medicinal preparation instead of a drug, in order
to gain time for the discovery, by further exact
investigation, of all morbid changes in his con-
dition. It is a harmless deception which will
bring to light most of the special symptoms of
his disease.

182

These other peculiarities of the patient, both
the greater and the less, will aid the physician
to obtain a complete view of the disease as a
whole ; and careful inquiries into the state of
various bodily functions, a close observation of
the manner and appearance of the patient, to-
gether with any information furnished by friends
and asked for, if necessary, in secret, will add
to the tale of facts already obtained all the
additional information necessary for successful
treatment.

183

In this way the physician will seldom fail to
discover the entire symptom-complex of any
chronic disease however obscure. Then from
the disease-elements found among the remedies

RATIONAL ART OF HEALING 79

that have been tested on healthy persons he can
select the counter-force most similar to the
natural disorder, that is, the exact homoeopathic
remedy. Here also the most special and char-
acteristic symptoms of the disease must above
all others be found in the remedy which is to
prove appropriate.

184

If the drug first chosen actually corresponds
to the disease in its entirety it must cure it.
But if, owing to the insufficient number of fully
proved drugs and the consequent restriction of
our choice, the medicine selected is not exactly
homoeopathic, then it will arouse new symptoms
which will in their turn point the way to the
next remedy likely to prove serviceable.

185

Mental diseases appear to supply the next
class of malady which is troublesome to cure.
But actually they are not much more difficult to
deal with than other incomplete diseases, among
which they may be reckoned.

186

Indeed, they are in no wise really an excep-
tional class of disease, though often sharply
separated off from others in classification. For
in every other kind of disease the condition of
the mind and of the disposition is invariably
altered in some w^ay, and the disposition and
mental characteristics of the patient form symp-
toms of prime importance in all cases which the
physician has to treat. Such symptoms must be
included in the totality of disease-phenomena if
a rational homoeopathic cure is to be achieved.

8o ORGANON OF THE

187

This point is of such importance that it is not
too much to say that the mental symptoms of a
patient often form the determining factor in the
choice of the medicinal counter-force. They are
the characteristics which the observant physician
can least of all afford to overlook.

188

The creator of medicinal virtues has had
particular regard to this important feature of
disease, namely, alterations in the mental and
moral condition ; for there is no drug in the
world of any power which does not produce in
healthy persons very marked mental and moral
changes, which are different for every different
medicine.

189

We shall, therefore, ne\er learn to cure
rationally or homoeopathically, unless we con-
sider in every case of disease these alternations
in mind and disposition, and choose as a
counter-force the remedy which is capable of
causing similar alterations.

Author's note. — Thus aconite will never bring
about a speedy or lasting cure in a patient of
quiet, equable disposition ; nux vomica is as
little serviceable to gentle phlegmatic patients,
Pulsatilla as little to the gay and happy, ignatia
as little to those who are imperturbable and dis-
inclined either to fear or to vexation.

190

Thus all that there is to say concerning the
cure of diseases of the mind and spirit can be
compressed into a few words. They can be

RATIONAL ART OF HEALING 8i

cured, like all other diseases, by those remedies,
and those alone, which possess a counter-force
most nearly resembling their own, a counter-
force which has been displayed in symptoms
produced on the mind and body of healthy
people.

191

The so-called mental and emotional diseases
are, for the most part, no more than diseases of
the body wherein the characteristic symptoms
of disturbance in mind and disposition have
more or less swiftly increased, while the bodily
symptoms have more or less swiftly diminished,
until finally a most striking disproportion is
attained, almost like the disproportionate ap-
pearance of a local disease.

192

Cases occur not infrequently where a so-called
bodily disease which is threatening to life (a
disease of one or other of the important organs
or an acute dangerous disease) becomes changed
into melancholia or mania by an increase in
psychical symptoms which have been present in
lesser degree from the first. Then all the bodily
symptoms lose their threatening character, de-
creasing to such a degree that their obscured
but persistent existence is only to be detected
by the persevering physician who is also gifted
with fine powers of observation. In a word,
they assume the form of incomplete diseases,
local diseases, as it were, in which the mental
symptoms w^hich at first were mild and un-
important increase until they are the chief
svmptoms. Then they take the place, to a large
extent, of the other symptoms, which they
palliate by their own intensity; this is a process

S2 ORGANON OF THE

which we have already noted in considering
local disorders.

Translator's note. — These were the days when
instruments of exact physical examination
(stethoscope, thermometer, etc.) and the aids of
the laboratory were nearly all unknown. Ap-
pearances can never again be as misleading even
to the careless as they often were in Hahne-
mann's day to the most careful.

193
Therefore in dealing with these diseases, as
with those of sections 180 and 181, the investi-
gation of the symptom-complex demands the
greatest perseverance, fine observation, most
careful discrimination and a detailed enquiry if
we would discover the bodily symptoms in dis-
eases of the mind. The exact appreciation of
the particular characters of each individual
change in mind and disposition is, of course, of
the first importance, and when combined with a
knowledge of the bodily symptoms will lead
to the discovery of the remedy appropriately
homoeopathic both in its mental and bodily
symptomatology, and so will lead to the ex-
tinction of the disease.

194

For the determination of the non-mental
symptoms the greatest aid is derived from a
clear description of all the phenomena of the
previous bodily disease which, through the one-
sided exaggeration of its mental and emotional
symptoms, developed into a mental disease.

195
The comparison of these earlier symptoms
with the existing symptoms will show that the

RATIONAL ART OF HEALING 83

first have persisted, although obscured and
now hardly perceptible ; and a characteristic
symptom-picture of the disease can thus be
better constructed.

196

If the mental disease is not fully developed
from a bodily disorder, and if it remains doubt-
ful whether it has not resulted from faults of
education, evil habits, perverted morals, super-
stition or ignorance, the decisive criterion will
be that disorders due to the latter causes yield
to careful remonstrances, reasonable representa-
tions, consolation or serious advice, while true
mental diseases speedily grow worse, melan-
cholia becomes more melancholy, spiteful mania
becomes more exasperated, and the nonsense of
the fool becomes even more devoid of reason.

197

Nevertheless there are certain diseases of the
disposition which have not simply developed out
of bodily diseases; but, on the contrary, with
but slight implication of the body, originate and
endure from emotional causes, such as continued
anxiety, worry, vexation and exposure to terror
or fright. In time this kind of emotional disease
affects the bodily health, often very adversely.

198

Emotional diseases of this order, originating
in the mind, are precisely those which can be
rapidly transformed into health, both of mind
and body, by psychical means, such as a display
of confidence, friendly remonstrance, sensible
advice, and often by well-concealed deceptions.
Their cure by such measures, however, can only
G 2

84 ORGANON OF THE

be achieved while they are yet recent and the
bodily conditions little disturbed by them.

Aidhor's note. — Mental and emotional dis-
eases arising from bodily causes, which can
only be cured by suitable homoeopathic remedies,
demand also and always a careful and appro-
priate psychical demeanour towards the patient
on the part of attendants and physicians ; a
helpful kind of mind-regimen, as it were. To
furious mania there must be opposed quiet fear-
lessness and cool resolution ; to doleful lamenta-
tion a mien of silent sympathy ; to imbecile
chattering, silence, but not inattention ; and of
disgusting behaviour and foul speech no notice
whatever should be taken. Destructive acts and
injuries must be prevented without reproaches
to the patient, and everything must be arranged
to avoid any corporal punishment. For as in
mental disorders there can be no sense of wrong-
doing, so by all human justice there should be
no punishments. Contradiction, eager explana-
tions, violent correction and harshness are as dis-
astrous to the mind and soul of such patients as
timid yielding at the wrong time. Above all, con-
tempt, deceit and fraud exasperate these patients,
and aggravate their condition. A semblance
must always be maintained of treating them as
reasonable beings. On the other hand, all kinds
of disturbing external influences should be re-
moved. When for any case of disease of mind
or disposition an exact homoeopathic remedy has
been chosen according to the truly delineated
picture of the disease-condition (and this is the
easier from the unmistakable character of the
mental symptoms, which are the most important
ones), then even the minutest dose will bring
about the most striking improvement in a very
short time, an improvement denied to the

RATIONAL ART OF HEALING 8s

^

strongest doses of all unsuitable drugs, though
repeated even to an extent dangerous to life.
I affirm that the superiority of the homoeopathic
over all other imaginable methods is nowhere
shown in so triumphant a light as in the relief
of long-standing mental and emotional diseases
which have originated from bodily diseases or
developed simultaneously with them.

Translator's note, — Hahnemann, apart from
homoeopathy, was one of the earliest pioneers
in the humane treatment of insanity, and de-
serves a credit for his theories and practice in
this regard which is too seldom accorded to him.
In the time of the Organon the ordinary routine
treatment of the insane was as barbarous and
revolting as it was ineffective.

199

No other diseases require any special direc-
tions for their cure. They obey, all of them,
the eternal law of homoeopathy, to which there
is no exception.

200

Hitherto, then, we have reviewed those cir-
cumstances of the disease which have the great-
est bearing upon the choice of the homoeopathic
remedy. Now we pass to the special laws of
rational treatment in the mode of employing the
remedy.

201

Every improvement in an acute or a chronic
disease, however small it be, provided it is
definitely progressive, is a condition which
absolutely forbids any further administration of
any medicine as long as it lasts. , This is because
the good is not yet exhausted which the dose
of medicine already taken can effect, and any

86 ORGANON OF THE

fresh dose of any medicine would disturb the
process of inriprovement.

202

This admonition is the more important because
the exact time-Hmits of the action of remedies
is hardly known with certainty in any single
case. Therefore, so long as improvement con-
tinues, so long must we assume that, at least in
this case, the period of action of the remedy is
not exhausted.

Author's note. — Some remedies seem to ex-
haust their power in about twenty-four hours,
but not many; others take a few days or a
number of days, some even weeks, to complete
their effects.

203

Hence it follows that, when the remedy is
exacdy homoeopathic in its action the ameliora-
tion will persist even after the time of action
of the drug is expired. The good work will
not be interrupted even if a second dose is not
given until several hours (or, in chronic diseases,
actually days) have elapsed after the period of
remedial action has ended. The part of the
disease already destroyed will not be renewed,
and improvement will remain remarkably evident
even without the administration of another dose.

204
When the continuous improvement that
follows the first dose of the remedy homoeo-
pathically appropriate to the disease does not go
on to the complete restoration of health (as it
often will), the stationary period that ensues
indicates generally the limit of action of the
given remedy. Before this time it is needless

RATIONAL ART OF HEALING ^7

and unreasonable, nay, it may be positively
harmful, to repeat the dose.

205

Even the remedy which has proved so helpful
may do nothing but harm if repeated before
improvement has come to a standstill in all
respects; because until then the counter-force is
no longer necessary in such measure as a new
dose would supply. Indeed, in a disease which
is easily influenced and not chronic, the first
dose of the best selected medicine will have
already caused in the course of its own active
period all the good, all the desired alterations
which the physician can achieve for the moment
— all the health attainable for that time, in fact;
another dose of the same drug given before the
period of action of the first is ended would alter
this advantageous condition, and therefore must
do harm, causing a medicinal disease to be
mingled with the remaining natural symptoms,
causing, in fact, both a change and an aggrava-
tion of the disease.

Author's note. — Failure to observe this rule
is punished by an aggravation of the disease,
which either becomes more threatening or slower
to recover.

206

When there comes an end to the improvement,
which has gone steadily forward though not to
complete recovery, a precise examination of the
present improved aspect of the disease will show
a small and altered symptom-group, to which a
second dose of the former medicine would no
longer be suitably homoeopathic. Another
counter-force is required, more^ adapted to the
remaining phenomena of the disease.

88 ORGANON OF THE

207

If, consequently, the dose of a remedy that
has been chosen with all care cannot complete
the restoration to health within the period of its
activity (as in most cases of recent disease it
can), obviously nothing better can be done
for the remaining, though much ameliorated,
malady than to give a dose of another remedy
chosen for its exact suitability to the symptoms
still unremoved.

208

Only when a disease of a threatening type
shows no improvement, or still more when the
condition has grown slightly worse, must a dose
of another remedy exactly adapted to this
stationary or aggravated state of disease be given
before the end of the active working-time of the
first medicine, which has shown by its failure
that it was not homueopathic to the case.

209

Even more certainly the keen-sighted physi-
cian who has a clear perception of the disease
condition, as soon as he realizes that he was
mistaken in the choice of the remedy last given
(this in urgent cases will be evident after six,
eight or twelve hours), and observes the state
of the patient growing clearly, even though only
slightly, worse from hour to hour, is not only
permitted, but compelled by his duty, to correct
his error by the choice of a new remedy which
shall be not only tolerably suitable, but abso-
lutely the one best adapted to the existing state
of disease.

RATIONAL ART OF HEALING 89

210

Even in chronic diseases it is seldom really
desirable to give the same medicine a second
time, even after the active period of the first dose
has expired, and this is particularly true at the
commencement of treatment.

211

When a single thoroughly suitable specific
medicine cannot immediately be found it is
generally best to give as intercurrent remedies
one or two medicines chosen on the ground
of the characteristic original disease-symptoms.
These drugs, used alternately with the principal
remedy, although insufficient in themselves to
achieve a cure, yet forward it more surely than
does the repetition once or twice of the original
medicine, wdiich, being chosen in accordance
with the fundamental disease-symptoms, was
reasonably held to be the most suitable, and yet
proved not so completely adapted to the case as
to cure it without further aid.

212

If, however, it should be found that the best
result follows the continued administration of the
first-selected medicine (as may be the case when
the counter-force is remarkably similar to the
chronic disease-force), then, while each succes-
sive dose is left to act for the whole period of
its effective power, a smaller quantity should be
given each time, so as not to disturb the process
of the improvement, but rather to take the case
along the shortest path to the desired end of

recovery.

213

So soon as the chronic disease (a disease, say,
of ten, fifteen or twenty years' standing) has

90 ORGANON OF THE

yielded to a single completely suitable (or
specific) remedy, or to a remedy as nearly
adapted to the case as possible (aided perhaps
by the intercurrent use of the next most appro-
priate medicine), then after three or six months
the principal remedy must again be given at
intervals first of one week and later of several
weeks, each successive dose being smaller than
its immediate predecessor, until all tendency of
the organism to relapse into its chronic disease
has been extinguished.

214

The careful observer recognizes the exact
moment for the repetition of the dose when one
or other of the original disease-symptoms re-
appears in a mild degree.

215

But if it is found that this procedure is not
thoroughly effective, and that the patient is only
kept from a relapse by the use of doses as big
as, or bigger than, the first dose of the remedy,
then, although these doses are still followed by
good results, we have a sure sign that the cause
that produced the disease is still at work, and
that there is some circumstance in the mode of
life or the surroundings of the patient which
must be changed before a permanent cure can
be made.

216

Among the signs which give evidence in all
diseases (especially in acute diseases) of a slight
improvement or worsening not perceptible to
every one, the surest and most illuminating are
those that concern the condition of the patient's
mind and his demeanour. In the case of even

RATIONAL ART OF HEALING 91

a very slight change for the better there appears
a greater sense of ease, increasing calmness and
freedom of spirit ; a kind of return of the natural
healthy state. On the other hand, the signs of
the slightest change for the worse are exactly
opposite ; a more constrained, uneasy, self-pity-
ing condition of mind and spirit, of the whole
demeanour, and of all the postures and actions,
a condition noted by close observation more
easily than it can be described in words.

217

The other new symptoms, either of improve-
ment or the contrary, soon leave no doubt in the
mind of the observant and attentive physician
of the course the disease is taking. But there
are patients who are either unable or unwilling
to give an account, whether of improvement or
worsening, so that their mere statements are of
little value without other evident signs.

218

But even with such persons conviction is
easily attained when we realize that, if no new-
signs of disease appear after the use of the
remedy, and if the patient complain of no new
symptoms hitherto unexperienced, then the
medicine must either have brought about a
thorough change for the better, or be about to
cause such a change when more time is allowed
to develop it. On the other hand, if the patient
relates this or that new occurrence or important
symptom (the sign that the exact homoeopathic
remedy has not been chosen), then, although he
may assure us in a good-natured way that he
feels better, we must not put any confidence in
this assurance, but must regard his condition as

92 ORGANON OF THE

a more serious one, and the evidence of this fact
will before long be forthcoming.

219

As certain symptoms of medicines, when
tested on healthy human beings, appear several
hours or even several days later than other
symptoms, so they cannot remove the corre-
sponding symptoms in disease except after a
corresponding lapse of time, however speedily
they destroy symptoms of a different order, a
fact which need not surprise us.

Author'' s note. — Thus the tendency of mercury
to cause deep circular. ulcers with inflamed and
tender margins does not show itself in the prov-
ings for some days or even weeks. Similarly it
will not cure such ulcers in the first few days.

220

If we have the choice we should prefer for the
cure of chronic diseases medicines of long dura-
tion of action ; and medicines of a short active
period for the rapid acute cases, that is, diseases
which tend to frequent changes of condition.

221

The reasonable physician will take pains to
avoid making favourite remedies of those which,
from being frequently indicated, have chanced
to be frequently useful to him. For if he does
so he will often neglect some rarer remedies
which would in certain cases have served him
better.

222

Further he will not from a mistrustful weak-
ness of judgment despise any remedies, because
they have failed him when given without suitable

RATIONAL ART OF HEALING 93

indications. He will not avoid them without
good reasons, being mindful of the truth that
only that remedy deserves respect and preference
among the counter-forces of disease which corre-
sponds most exactly to the symptom-picture of
any given case, and that no paltry prejudices
should influence his serious choice of the best
medicine for his purpose.

223

If we bear in mind the necessary and desirable
smallness of the doses required in homoeopathic
practice it is easy to understand that during
treatment every substance in the diet which
might act in any medicinal way must be for-
bidden, so that the minute dose shall not be
overpowered or extinguished by some artificial
irritant.

224

This careful enquiry into possible hindrances
to cure is the more important in chronic diseases,
because such disorders commonly originate, at
least partly, in the harmful influences just men-
tioned and in other errors in the mode of life
which, though unrecognized, are often harmful.
When they do not so originate they are all the
more difficult to treat.

Translator's note. — Here follows a long list of
articles of diet and circumstances of life that may
be harmful. Coffee and tea rank high in Hahne-
mann's judgment as noxious influences.

225

The most appropriate regimen to accompany
the medicinal treatment of chronic diseases con-
sists in the removal of such hindrances to re-
covery and the prescription of such opposite

94 ORGANON OF THE

conditions as are necessary ; exercise in the fresh
air; simple, suitable and unspiced food and
drink; surroundings uplifting to the spirit, etc.

226

In acute diseases, on the other hand (except
conditions of actual delirium), the subtle and
unerring perceptions of the life-instinct which
are then aroused speak so clearly and definitely
that the physician need only warn nurses and
attendants to offer no opposition to this voice of
nature either by refusing the patient anything
that is strongly desired, or by persuading him
to take anything that his instinct may reject.

227

Certainly the desires of the patient suffering
from an acute disease are chiefly for such food
and drink as give palliative relief ; they are not,
as a rule, of a medicinal character, and they
merely supply a kind of need. Any slight
hindrance to the radical removal of the disease
which the moderate gratification of these desires
might cause is easily counteracted and overborne
by the suitable homoeopathic remedy and by the
life-force thereby liberated.

228

The reasonable physician must have to his
hand the strongest and most genuine medicines
before he can have confidence in them as counter-
forces (remedies). He must convince himself of
their genuine character.

229

It should be a matter of conscience with him
to assure himself without any doubt, in every
case, that the patient receives the correct and
genuine medicine.

RATIONAL ART OF HEALING 95

230

The medicinal powers of indigenous plants or
of those that can be obtained in a fresh state are
obtained most completely and certainly, when
their freshly expressed juice is immediately
mixed with an equal part of spirits of wine;
such preparations retain their strength, wholly
and always, unimpaired if they are kept in a dark
place in well-stoppered glass bottles.

Author^s note, — Although equal parts of
alcohol and freshly expressed juice form the best
preparations for effecting the precipitation of
albuminous matter and preventing all possible
fermentation and deterioration, yet for plants
which contain much thick mucus or a superfluity
of albumen (e. g. Symphytum, viola tricolor,
sethusa cynapium, solanum nigrum, etc.) a
double quantity of spirit of wine is commonly
desirable. When this has stood in a close-
stoppered bottle for a day and a night the pre-
cipitated albuminous material can be filtered off
and the clear preparation kept for therapeutic
use.

231

Other plants, w^hich are exotic, or cannot be
obtained in a fresh state, should never be taken
on trust in a powdered state. The reasonable
physician will convince himself of their genuine-
ness by handling them in their untouched whole
condition before he makes any use of them as
medicines.

Author's note. — Certain precautions are neces-
sary in order to keep these drugs in the state of
powder. The whole and untouched plants even
when fully dried always retain a certain quantity
of water, not sufficient indeed while the substance
remains whole and unpowdered to impair its

96 ORGANON OF THE

dryness and promote decomposition, but far
more than sufficient when the substance is in
its fully divided condition. When powdered
they will decompose and become mouldy unless
this moisture is driven off. Animal or vegetable
drugs, stable enough in the entire state, w411 not
furnish a stable unchangeable powder unless this
extra moisture is got rid of. This is best done
by drying the powder over a water-bath till all
the small pieces of it are as easily separated as
fine sand and readily fall to dust. In this con-
dition it can be kept for ever in sealed bottles.
All vegetable and animal preparations not pre-
served in air-tight vessels gradually lose more
and more of their medicinal power.

232

As every medicine acts most definitely and
effectually in solution the wise physician will
administer all medicines in this way, except
those whose nature requires that they be given
in the powdered form. All other preparations
but these make the comparison of observations
difficult and the estimation of the dose of every
powerful medicine uncertain.

233
Metals, salts, and other preparations of this
kind, whose purity cannot be recognized without
elaborate tests, should only be used by the
rational and responsible physician when they
have been prepared under his own eyes.

234
In no case is it necessary for cure to use more
than one single simple medicinal substance at a
time.

RATIONAL ART OF HEALING 97

235
It is difficult to conceive how there could ever
be the smallest doubt that it is more logical
and reasonable to prescribe a single tested medi-
cine for a disease than a mixture of several.

236

For the rational physician finds at once all
that he can desire in quite simple medicines
given singly, artificial disease-producing powers,
which by their homoeopathic might can over-
come, extinguish and radically cure natural
diseases. Therefore he will always act accord-
ing to the general maxim : " Quod fieri potest
per pauca non debet fieri per plura"; and he will
never use as remedies anything but single
simple medicines. It is wholly unknown how
two or more medicines mixed together may
hinder and alter one another in their actions on
the human body ; on the other hand, a simple
medicine used in diseases whose symptom-com-
plex is exactly known, will cure, if it is exactly
and homoeopathically adapted to the case; and
at the worst, if it is not rightly chosen and can-
not therefore be of service, its use can yet add
to our knowledge of drugs, because the new
symptoms excited by it in such a case afford
confirmation of those which the drug has already
shown in experiments on the healthy.

237
If a medicine is exactly and specifically chosen
and fully homoeopathic to a case of disease, then
it will affect the original disorder favourably,
even if given in too large a quantity; but there
will be an unnecessary and ovqr-powerful im-
pression made on the organism through the
excessive size and intensity of the dose.

H

98 ORGANON OF THE

238

For if the change in the organism produced
by the overdose of the remedy, homoeopathic as
it was to the original disease, be too violent,
then besides the increase in the homoeopathic
aggravation (S. 132) there follows an unnecessary
weakening of the patient after the active period
of the drug has ended. Further, if the dose was
very excessive, then after the increased primary
drug-symptoms (S. 132) there ensue symptoms of
its secondary action, a kind of medicinal after-
disease of an opposite character to the first.

239

As at the present date hardly any medicine
can be found that is so completely homoeopathic
to a case of disease as to correspond to it exactly
and mathematically in each and every point
(S. 131, note), so the new symptoms, which were
unimportant when a small dose was given, are
aggravated into severe maladies of many kinds
when the dose is too considerable.

240

For these and many other reasons the reason-
able physician (who always follows the best
method in practice because it is the best, and
refuses to depart from it at the bidding of blind
custom) will choose only the most suitable dose
of the indicated remedy, so that hardly a sign
of aggravation of the disease will be aroused
(S. 132); that is, will choose a dose which as a
counter-force only just exceeds the disease-force
against which it is directed.

RATIONAL ART OF HEALING 99

241

This apparent aggravation and increase of the
existing disease which resuhs from the use of
the homoeopathic remedy should be hardly per-
ceptible, and then only in the first hour or two
after its administration.

242

One of the chief laws of homoeopathic thera-
peutics is the following : the counter-force
chosen as exactly as possible for the removal
of a natural disease-force should be so calculated
that it will only just attain its object and will do
the body no harm in any way through unneces-
sary strength.

243
Now, as the smallest quantity of medicine
naturally disturbs the organism least, we should
choose the very smallest doses, provided always
that they are a match for the disease.

244

Universal experience has shown that the very
smallest doses of drugs chosen for their homoeo-
pathicity to diseases are a match each for the
corresponding disorder. For if the disease does
not manifesdy arise from a serious morbid
change in some important organ, hardly any
dose of the homoeopathically selected remedy
can be so small as not to be stronger than the
natural disease and so overcome it.

245
The ordinary observer has no conception how
extraordinarily sensitive the body becomes to
drugs when it is diseased, and especially to drugs
chosen homoeopathically.
H 2

loo ORGANON OF THE

246

Therefore every patient is in the highest de-
gree susceptible to suitably applied medicinal
forces. There is no person, however robust,
even though only suffering from a chronic or
so-called local disease, who will not soon feel
the desired change in the affected part if he
takes the helpful and homoeopathically chosen
medicine even in the smallest dose imaginable —
who will not, in a word, be much more affected
thereby than would a day-old but healthy infant.

247

This being the case, the true physician will
pursue the rational course and give the chosen
homoeopathic remedy in just so small a dose as
will overcome and destroy the existing disease
without further ado. A dose so small will reduce
to its lowest limits any possible harm that might
result from a failure to select the exact remedy
at the first choice, a possibility that must always
be reckoned w-ith since human abilities may
easily err. At the worst, even if the wrong drug
be administered, the smallness of the dose will
render it far too weak to resist the natural energy^
of the body and the swift opposition of the more
exactly adapted homoeopathic remedy, by the
use of which the mitial mistake will be recti-
fied, and any small ill effects of that mistake
extinguished.

248

The fact that one dose, or a little more, of a
certain homoeopathically chosen medicine usually
overcomes and destroys the analogous disease,
and that every dose which is unnecessarily
powerful affects the body more than is required,
explains the following important observation.

RATIONAL ART OF HEALING loi

which holds good in most cases : namely, that
a certain quantity of a remedy has a more power-
ful effect when given at intervals in divided
doses than when given all at one time.

249

Eight drops of almost any medicinal tincture
given in one dose have only a quarter of the
effect of eight drops of the same tincture given
every four hours or every two hours in drop
doses.

250

If dilution is also employed (whereby the dose
gains a greater power of expansion), an exces-
sive effect is easily produced. But there is no
small difference in the effects of a dilution which
is, as it were, only superficial and a dilution
which is so intimate and uniform that every
smallest part of the fluid medium contains a due
proportion of the dissolved medicine ; the former
is much less powerful than the latter.

251
Thus the intimate mixture produced by adding
a single drop of a tincture to a pound of w^ater
and shaking vigorously, if administered in doses
of two ounces every two hours, will produce
more effect than a single dose of eight drops of
the tincture.

252

From the experience last mentioned, that the
power of a medicine in solution is much in-
creased by intimate mixture with a large volume
of fluid, it follows undeniably that, in order to
make the dose of the homoeopathic remedy as
small as is possible and necessary it must be
given in the smallest possible bulk.

I02 ORGANON OF THE

253

Moreover, the strength of action of a dose
does not vary in exact proportion to its quantity.
Eight drops of a tincture given in one dose do
not produce four times the effect of two drops,
but only about twice the effect. A mixture of one
drop of a tincture with ten drops of an un-
medicated fluid, given in drop doses, will not
produce ten times the effect of drop doses of a
mixture ten times as dilute, but only about (or
scarcely) twice the effect, and so on in the same
ratio, so that even a drop of the highest dilution
must possess, and does in fact show, a very
considerable power.

254

The action upon the living human body of
the remedial counter-force which constitutes a
medicine is so profound and spreads from those
sensitive areas well supplied with nerves, to
which it is first applied, throughout the whole
organism with such inconceivable rapidity and
completeness that this action must be called
spirit-like. It is almost as spirit-like as the
action of vitality itself, by which its power is
reflected on the organism. Drug-action borrows
a kind of life from the power of response to
specific impressions, the sensitiveness, and irri-
tability, possessed by living bodies.

255
Every part of our bodies that possesses the
sense of touch is able to receive the influence
of medicine and distribute its power all over the
other parts of the organism.

256

The tongue, mouth and stomach are certainly
the parts most sensitive to medicinal impressions.

RATIONAL ART OF HEALING 103

and drugs applied to these regions, especially in
solution, act with greater power and rapidity on
all points of the body.

257

The interior of the nose, and the rectum, as
well as parts denuded of skin, wounded or ulcer-
ating surfaces, permit an action of medicines on
the whole organism which is nearly as penetrat-
ing as if the drugs had been taken by the mouth.

258

On the other hand, the external surfaces of
the body covered with epidermis are less adapted
to receive the action of medicines. The most
sensitive parts, it is true, allow a certain amount
of drug power to pass to the nerves and from
them to the whole body, but far less than the
amount that so passes when the drug is taken
by the mouth or injected into the rectum.

259

Therefore in certain cases, where the need-
ful medicine cannot be given by the mouth
(although, even if it cannot be swallowed, the
mere taking of the drug into the mouth cavity
often produces the full medicinal effect), and
where it is not convenient or desirable to give
it by the rectum, in such cases, I say, if the
patients are quick of response to medicines, the
mere external application of the drug in solution
to the most sensitive external parts {e, g. the pit
of the stomach, or the lower abdomen) will often
achieve a result not much inferior to that ob-
tained when the drug is given internally. But
the medicine must for this purpose be used in a
stronger form and spread over a large surface;

I04 ORGANON OF THE

and, if this proves not enough, it should be
rubbed in, or administered (in still stronger
solution) by means of baths to the whole or part
of the body.

Author's note, — Rubbing in seems to heighten
the action of medicines by making the skin more
sensitive to the medicinal force which is thence
communicated to the whole body. If friction
be used to the under part of the thigh, then the
mere subsequent application of mercurial oint-
ment is as effective as if the ointment itself had
been rubbed in.

260

Among causes which have given rise in
general practice to the use of large doses the
employment of drugs as palliatives ranks
highest.

Author's note. — How exactly opposite are the
methods of using drugs as palliatives and using
them homoeopathically, is shown by the fact that
in the first method as much of the drug is needed
as can be borne, and in the second as little as it
is possible to give consistently with producing
the desired effect.

261

By the palliative use of drugs, which is the
exact opposite of the homoeopathic art of heal-
ing, the attempt is made to overcome certain
symptoms of disease by means of certain known
symptoms of medicines.

262

As by means of medicines so used the con-
dition produced is not in the least similar to that
of the disease (as it is with the homoeopathic
method), but the exact contrary ; so there ensues

RATIONAL ART OF HEALING 105

on such drug-administration not the least initial
(apparent) aggravation, but on the contrary an
almost immediate improvement in the patient's
symptoms. In the first hour after receiving a
palliative the patient feels himself much relieved,
a sensation that practically never occurs after the
administration of the homoeopathic remedy.

263

Under the homoeopathic remedy the whole
disease-condition is quickly vanquished, extin-
guished, and destroyed (not in the first hour
certainly, but later on in gradually increasing
measure) by the counter-force of the specific
medicine. But with a palliative, given according
to the law, contraria contrariis ciirentur^ only
one single symptom of the disease is relieved,
quickly, by the exactly opposed symptom of the
drug; perhaps because the opposites by a kind
of mutual fusion neutralize one another dynamic-
ally (though only for a time), and in this way
the disease-symptom loses its influence on the
organism as long as the power of the opposed
medicinal symptom lasts.

264

The original malady seems to disappear at
once at the beginning of the palliative treatment.
But it is not removed, not extinguished ; as soon
as the opposed action of the palliative is ex-
hausted and ceases to work (which takes place
in a few hours or days), the malady returns, with
an intensity actually increased by the addition
of the after-effects (''secondary" symptoms) of
the palliative, which (being opposed to the
"primary" symptoms) are very like the original
disease-symptoms and thus seriously and per-
manently aggravate the patient's condition.

io6 ORGANON OF THE

265

Palliative treatment follows a course quite con-
trary to that of homoeopathic treatment in that
the patient is most relieved in the first hour after
receiving the medicine, less in the second hour,
still less in the third, and so on, until with the
cessation of action of the primary opposite drug-
symptoms the tendency to secondary action sets
in and the patient becomes worse than he was
before the palliative was administered.

266

Now, in order to renew the deceptive improve-
ment, it is necessary to increase the dose of the
palliative continually, often to give very large
doses of it, because each successive dose has to
cover up not only the natural disease-symptoms,
but also the aggravation of the disease-condition
which results from the secondary action of the
previous dose.

267

Unless the dose of the palliative is increased,
the temporary improvement becomes continu-
ously less, and finally imperceptible, and there
follows an increased aggravation of the disease.

268

Every medicine is a palliative (antagonistic
and contrary in action to a principal symptom
of disease) when it only relieves in doses which
have to be continuously increased.

Author's note, — The irrational character of
palliative treatment is self-evident, for the patient
requires a radical cure, not a temporary, illusory
improvement which ends in a strengthening of
the original malady. Such treatment is also

RATIONAL ART OF HEALING 107

mistaken, because by it only one symptom is
attacked and that often only the twentieth part
of the disease and of its whole complex of pheno-
mena. In other words palliative treatment is
treatment which is symptomatic and not
remedial. It was fortunate that so little was
known of the individual symptomatology of
drugs ; otherwise too frequent a use might have
been made of them for the purpose of combating
opposite conditions. There remained but few
actions of this kind available. Coffee was given
for a tendency to drowsiness ; the primary power
of opium to constipate was used for diarrhoea,
even of a chronic kind; its action in causing a
heavy stupefying sleep was used for chronic
wakefulness, and the state of insensibility and
stupor which it can extend over the whole
sensorium was employed to relieve every imagin-
able kind of pain ; the tendency to constipation
was treated with large doses of irritating purga-
tives and laxatives that caused frequent evacua-
tions; a deficiency of body-heat and so-called
weakness of the stomach were remedied by
stimulating spices and alcoholic drinks ; inflam-
mation by cooling substances; heat of the body
by blood-letting; even chronic cases of almost
complete paralysis of the bladder were energetic-
ally attacked with the powerful irritant action of
cantharides, etc. But experience showed, often
too late, how seldom health was thereby restored,
and how frequently increased disease or worse
ensued.

269

Only in the emergencies most threatening to
life, e, g. asphyxia, coma from lightning-stroke
or suffocation, freezing, and so forth, is it per-
missible and desirable to restore, at least as a

io8 ORGANON OF THE

preliminary measure, the sensibility and power
of response to stimuli (the physical life) by
means of strong coffee, or gentle electrical
shocks, or some stimulating strong-smelling
application, and so gain time until, if necessary,
a homoeopathic remedy can be chosen for the
condition. To this category belong also the
different antidotes to acute poisonings.

270

Further, a homoeopathic remedy is not to be
regarded as unsuitably chosen if a few of its
symptoms are only palliatives {antipathic) to
some of the less important minor symptoms of
the disease, provided only that the other, and
especially the well-marked, individual and
characteristic principal symptoms of the disease
are met and covered by the same remedy homoeo-
pathically, i.e. through resemblance of drug to
malady.

271

In such a case none of the ill consequences
are seen which generally follow the one-sided
palliation of a single disease-symptom. Com-
plete recovery ensues without accessory symp-
toms or after-troubles, but in such a way that
those symptoms which were here attacked only
by the opposed (palliative) symptoms in the
sphere of action of the medicine, usually do not
disappear until the drug's action is entirely
completed.

Translator's note. — Here follows a long note
of Hahnemann's, explaining another method of
treatment often adopted in his day, which de-
manded large doses of drugs. It consisted in
administering remedies calculated to act not
directly against the disease-symptoms, but on

RATIONAL ART OF HEALING 109

other parts of the body. Thus skin-diseases
would be treated with purgatives and all the
class of counter-irritants. Blisters, setons and
bleeding belong to this category of remedies.
Hahnemann points out that, although the
disease-symptoms are sometimes lessened at
first by this method, they usually return as
soon as the ''revulsive" treatment so-called is
superseded.

Author's note. — Employing the homoeopathic
method, the rational physician will very seldom
find it necessary to employ the drastic method
of evacuations, upwards or downwards, except
when quite indigestible or foreign or poisonous
substances have been taken into the stomach or
bowels.

Sometimes the use of some undynamic (non-
homceopathic) remedies is useful. Such are
fatty substances which mechanically or physic-
ally loosen the compactness and solidity of
fibres : tannin which thickens living fibres almost
as much as it does dead ones ; charcoal which
lessens the evil odour of unhealthy parts of the
living body just as it destroys that of dead
things : chalk, alkalies, soap, and sulphur, which
can chemically decompose and so neutralize and
render harmless corrosive acids and metallic
salts in or on the human body ; acids and
alkalies, which may influence concretions in the
bladder; the actual cautery and caustics of
various kinds. The use of blood-letting, or of
leeches, which as a rational procedure is rarely
indicated, need not be expounded here.

PREFATORY NOTE TO PART II

Hahnemann was a ready and prolific writer,
and his own works, apart from his numerous
translations of medical works, form a long list.
From the lesser writings, as collected by Dr.
Robert Dudgeon and translated by him into
English, I have selected four as a kind of
supplement to the Organon. The first three
appeared in The Friend of Health, of which two
parts were published, the first in 1792 and the
second in 1795. They have a very real value
even to-day, and that in two ways. First of all
they testify strongly to the keen observation,
the shrewdness and the essentially practical
nature of Hahnemann, a man as far removed
as possible from the dreamer or impostor for
which he is sometimes ignorantly taken. In
days when the science of public health did not
exist, when Bacteriology and all the light which
it throws upon infection and immunity was
unknown, careful observation and shrewd deduc-
tion alone led Hahnemann to formulate these
suggestions (far too much in advance of his age
to be accepted), of which it is not too much to
say that by far the greater part of them would
hold good to-day, and in a cou^ntry where the
latest resources of civilization are unavailable

III

112 PREFATORY NOTE

most of his plans could be followed with nothing
but advantage.

But these three essays have another interest,
and that is an historical and sociological one.
For both by the things Hahnemann recommends
and the things he discountenances, and by the
conditions he assumes, we catch glimpses of the
state of society at the end of the eighteenth cen-
tury, the manner of life and the daily surround-
ings of the German people, which are both
deeply interesting to the curious and valuable
to the sociologist. The fourth essay, Aesculapius
in the Balance y was written in 1805, and forms
an admirable preface to the Organon, inasmuch
as it gives more than a hint of the chaotic state
of medicine into which the Organon attempted
to bring some order. It, too, has its sociological
value, especially in its glimpses of the relations
of doctors and apothecaries and of the methods
of ordinary treatment ; but beyond this it throws
a light on one great reason for the ill-will which
Homoeopathy aroused, by clearly showing how
powerful were the vested interests directly
threatened by Hahnemann's theories and prac-
tice. Vested interests inevitably fight for sur-
vival and attack those that come into conflict
with them with rancour and persistence. It was
not the least of the misfortunes of Hahnemann
that, by their very nature, his doctrines aroused
this opposition ; but it is not altogether to the
credit of the judgment of later generations that
the rancour which arose from a threatened
monopoly should remain to cloud and prejudice

PREFATORY NOTE 113

a reasoned enquiry, long after the monopoly was
overthrown. The essay Mscidapius in the
Balance, therefore, will always retain more than
merely an historical interest. The translations
are those of the late Robert Ellis Dudgeon,
M.D., whose long life was a constant endeavour
to honour the memory of Hahnemann and ex-
tend the scope of his doctrine, and to whose
memory I should wish to dedicate this reprint
of some of his work.

C. E. W.

PART II

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 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 ex-
halations 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 quicksilver 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 pro-
tective 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 conta-
12 115

ii6 PROTECTION AGAINST INFECTION

gious 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 air circulate once more through
his room, before the physician or clergyman
comes to visit him.

The hospitals used by an army in a cam-
paign, 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 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 con-
stantly run in the half-underground damp

IN EPIDEMIC DISEASES 117

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 desola-
tion 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 w^ell in the midst
of them.

But, as it is the case with accustoming our-
selves to everything, that the advance fro7n one
extreme to the other must he made with the
utmost caution^ and hy very sm^all degrees, so
it is especially with this.

We become gradually accustomed to the most
unwholesome 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

ii8 PROTECTION AGAINST INFECTION

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 in-
fected than those who visit many such cases in
a day.

From these facts naturally proceeds the first
condition for those who visit such sick-beds for
the first time, "that they should in the com-
mencement rather see their patients more fre-
quently, 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, specially
beside patients with the slighter form of the dis-
ease, 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 epide-
mics of this sort, are soonest carried off, when
they neglect this insufficiently known precau-
tion, perhaps from excessive philanthropy and
anxiety about their patients; that on the other

IN EPIDEMIC DISEASES 119

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 clergy-
men 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 gradu-
ally approaching and accustoming ourselves
to the inflamniatory 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 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 clergy-
man a dear friend sick of the prevalent fever is
a very dangerous occupation, as I have learnt
from dear-bought experience.

120 PROTECTION AGAINST INFECTION

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 in-

IN EPIDEMIC DISEASES 121

fected at all as to get the smail-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 superior to ourselves,
w^e dedicate ourselves to the welfare of the very
lowest as well as the highest among the people,
and 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, notwith-
standing 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 cin-
chona 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 experi-
ence, but am far from insisting upon the per-
formance of this innocuous and powerful pre-
caution 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

122 PROTECTION AGAINST INFECTION

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
w^ho 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 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 sym-
pathy 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 sus-
ceptible to the miasm, even such as are already
used to its influence.

IN EPIDEMIC DISEASES 123

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 impres-
sions, 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 circum-
stances in favour of the lawyer and his assist-
ants. 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 weak-
ness, 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 ap-
proach 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

124 PROTECTION AGAINST INFECTION

miasm, for example the bloody flux, the nerves
remain for a considerable time, often for years,
to some 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 precau-
tion, 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 oppor-
tunity of rendering a service to my fellow-
creatures. But as the spoiled (phlogisticated,
foul, fixed, etc.) 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, w^hose
essential nature is quite unknown to us and not
perceptible to our senses, can be weakened.

IN EPIDEMIC DISEASES 125

neutralized, or in any other manner rendered
innocuous by these fumes, it would be foolish,
I would almost say unjustifiable, by recommend-
ing such fumigations for the supposed purifica-
tion 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 repre-
sentation 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 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 un-
fumigated 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 !

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 cer-
tainly be cut off by it. Should it, as soon will
happen, once penetrate into the damp dirty
houses of the poor, who are already often ren-
dered liable speedily to catch the disease, by
unhealthy, miserable fare, by sorrow and depres-
sion, 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 con-
venient 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

126

A MALIGNANT FEVER 127

they will flee, but they are indifferent to a mur-
derous 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 separa-
tion 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, do not leave it to the
caprice of the possessor of the house to extin-
guish the fire in the way he thinks fit, but them-
selves make the necessary arrangements, and
erect 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 in-
finitely more than the property of an individual
— in like manner, I assert it ought not to be left
to the individual's caprice to nurse his relatives
affected with infectious disorders, in his house,

128 PLANS FOR ERADICATING

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 ex-
pressible in figures, can compensate for the Ufe
of one, not to speak of many famiHes, fathers,
mothers, husbands, wives, children, endangered
by him.

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 pro-
tecting 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

A MALIGNANT FEVER 129

requisite, provided with straw mattresses 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 after-
wards 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 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?).

I30 PLANS FOR ERADICATING

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 mad-
man, a murdering quack-doctor, an incendiary,
a robber, a poisoning courtesan, etc. They
belong to the state until they are rendered in-
nocuous. Salus publica periclitatur is the simple
standard for determining all the wholesome regu-
lations 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 wc 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, 1 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 pre-
vent 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
pent! 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, etc..

Dr. H.

A MALIGNANT FEVER 131

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,
rigour, 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 in-
fection, 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 nar-
rower 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

^ If this remuneration be considerable (about a thaler
[3J. 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 saved and
in the smaller sum required, will be the manifest result.

K 2

132 PLANS FOR ERADICATING

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, ^ 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
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 in-
haling the patient's breath,^ whence the con-
tagious principle spreads farthest and most
powerfully.

When the patient has a clean tongue,^ 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.

^ When the disease is particularly malignant in its char-
acter, 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.

- 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.

^ This disease was chiefly a gaol-fever without anything
in the first passages.

A MALIGNANT FEVER 133

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 mix-
ture of vinegar and water for the purposes of
ablution.

Each bed should be provided with a linen
mattress well stuffed with straw,^ over which is
spread a linen sheet, and on this a piece of oil-
cloth,^ 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 courtyard, or
beneath a shed only covered at top. They should
first be washed clean in merely tepid water with
soap, and subsequently 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.^

1 Mattresses 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 these often fatal
bed-sores {sphacelus a decubitii) so often met with in
malignant fevers.

■^ By its smoothness it prevents the formation of bed
sores, and catches the f?eces that often pass involuntarily in
patients seriously ill. They may be easily removed without
soiling the bed linen or mattress, which has a very bad
effect on the purity of the air.

2 A washerwoman in America had to wash some dirty

134 PLANS FOR ERADICATING

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.^

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, etc.,
until she is gradually habituated to the miasm.

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 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 apt to be volatilized by it ; but this danger is only to
be apprehended from the employment of hot water,

^ 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 nourish-
ment 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.

A MALIGNANT FEVER 135

The state of the heahh of the whole household
should be every day carefully investigated by
the physician, even though they consider them-
selves 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 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 Imen 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 when
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.

136 PLANS FOR ERADICATING

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 w^ages 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, con-
tent, comfort, etc., 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, etc.

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 patient is pushed
through the trap-door. The physician instructs
him how near and in what manner he may
approach the patient.^

When a patient dies he must be immediately
pushed through on his bed into the passage, and
left there until the physician has convinced him-
self of his decease. The corpse is then to be
covered with straw, and carried out on his bed
into the courtyard or dead-house, where he is to
be put, along with the clothes in which he died,

^ By incautiously approaching the beds of such patients, I
have frequently seen the most promising young clergymen
infected and die.

A MALIGNANT FEVER 137

into a coffin well stuffed with straw; the corpse
should be covered with straw and, in the pre-
sence 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 up on
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 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 w'ell 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 courtyard, in the presence of
the physician,^ and finally he is to be accom-
panied home by the physician and surgeon.

Whenever a patient has recovered or died, the
wooden close-stool he has used must be burnt
in the open air, and the pot de chamhre broken
and the fragments thrown into the fire.

After the epidemic has been subdued, the male
attendants should not be dismissed until they

1 Too much care cannot be taken to secure the destruc-
tion 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.

138 PLANS FOR ERADICATING

have whitewashed the whole of the interior walls
of the house, not only the sick ward, but every
other room, and the temales 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 100° 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
120° 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 mattresses (after taking out
the straw), the towels, sheets, etc., should also

1 The pestiferous miasmata which have become attached
to clothes, linen, beds, etc., can according to my observations
be expelled from such things and destroyed by no means
more certainly than by a heat of upwards of 100° 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.

A MALIGNANT FEVER 139

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 of the mattresses, the accumulated
sweepings, rags, bandages, scrubbing clothes,
brooms, and other articles of small value, should
be burnt in the courtyard 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 attend-
ants, with his wife, being allowed to live in it
gratuitously as housekeepers. Their business
would be to see that the 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 popu-
lation, and might be the means of preserving
many useful citizens to the state.

There might be a few beds kept there per-
manently for the reception of all sick journey-
men, 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

I40 PLANS FOR ERADICATING

at the same time he should receive an adequate
(not paltry ^) remuneration for each patient who
recovers, when he leaves the house.

^ 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).

SUGGESTIONS FOR THE PREVENTION
OF EPIDEMICS IN GENERAL, ESPE-
CIALLY IN TOWNS

A WELL-ORDERED policc should take care that
rag-gatherers are not allowed to live anywhere
but in isolated houses near the paper-mills/ 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, 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 courtyard, 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 lit 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 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

^ Which should never be built close to t^wns and villages.

141

142 SUGGESTIONS FOR PREVENTION OF

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 covered shed, open on
all sides.

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 shown
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 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 visitors are pre-

1 Should it be feared that such an article of clothing,
probably worn by a sick person, miojht 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.

EPIDEMICS IN GENERAL 143

maturely 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 imprison-
ment is for life and to those gaols where prisoners
guilty of capital crimes are kept until the termina-
tion of their trial (often for several years), the
visitation or inspection of which is not unfre-
quently 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
except 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 intention with such prisons.

If then the gaol even for capital offenders can
and ought to be nothing but a means of depriv-
ing 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

144 SUGGESTIONS FOR PREVENTION OF

windows, while they are sufficiently narrow,
should be always so long as to allow the free
access of fresh air. Where two windows oppo-
site 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 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 carry-
ing 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

^ The exhalation from these wretched creatures, that con-
stantly 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.

EPIDEMICS IN GENERAL 145

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 120° Reaum.), and then the
sieve snould 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, pass-
ing 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 animal poisons,
the virus of the most fatal pestilence, is gener-
ated. Police authorities, be humane !

I scarcely need to remark, that the (often long-
continued) imprisonment of debtors who are fre-
quently 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, etc., 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 author-
ities, if they have it in their power to act, should
take care that an epidemic is not thereby brought
into the country.

146 SUGGESTIONS FOR PREVENTION OF

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, etc., outside the
town, to make them lie undressed on straw mat-
tresses, keeping them warmly covered in winter,
and in this manner retaining them until their
march can be renewed.^ 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 mlitary 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 townsman, if they bring pestilence
along with them, as they usually do, very few
means of preserving the life and health of him-
self 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 com-
munication with the sick, with infected houses,
and even with those who frequent such houses.
If they bring him anything 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

^ 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.

EPIDEMICS IN GENERAL 147

plunged them into hot water mingled with
vinegar, in the open court, or thoroughly fumi-
gated them with sulphur. Should it be articles
of food/ let him not partake of them before pre-
paring them on the fire, or otherwise heating
them.

Infectious diseases have even been communi-
cated 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 ;

^ 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, etc. 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.
L 2

148 SUGGESTIONS FOR PREVENTION OF

this ceremony should be omitted when the
danger is so imminent; as also drinking out of
another's glass.

At such times we should never bring second-
hand furniture ^ 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 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 pesti-
lences.^

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.

^ 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.

- 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 putrefied
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 cesspools which have not been, cleared out
for thirty years or more. Of this more hereafter.

EPIDEMICS IN GENERAL 149

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 con-
stantly exhaling, there is no better time for
removing it than in severe cold. The mud which
* is 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 w^eather.

After great inundations on fiat land, the spon-
taneous drying up of which cannot be expected
to take place m 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 windmills 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 a fertile source of epidemic
diseases (see Klockhoff). 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

I50 SUGGESTIONS FOR PREVENTION OF

unacknowledged) benefit of a sufficient supply
of fresh flowing water, in place of which the in-
habitants 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 disad-
vantages might not be obviated by the construc-
tion of artificial aqueducts on no very expensive
scale, or of (very deep) w^ells ; but I am con-
vinced 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 gradu-
ally 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
w^ood charcoai should be thrown, which, accord-
ing 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 de-

EPIDEMICS IN GENERAL 151

structive ^ diseases. Among these are the mode
of feeding the crew so much in vogue, with often
half-decayed, dried, and saUed meat, with un-
wholesome 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 pesti-
lential foetor ; 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; sauerkraut;
sometimes brown sugar in place of oil ; brandy
for strengthening ; meat-soups boiled dow-n and
dried, in place of kept meat; malt-liquor to drink
in addition to w^ater; 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 w^alls 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

^ 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.

152 SUGGESTIONS FOR PREVENTION OF

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 con-
ducting leaden pipes into all parts of the ship
which all terminate in the kitchen fireplace, 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 w^et sailcloth,
and cover it with unravelled pieces of old moist-
ened tow.

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 ana
animals can be carried off without doing any
harm, covered cesspools 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 pos-
sible, 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 to-

EPIDEMICS IN GENERAL 153

gether, 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, north-east, 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 in-
stances in which the exhalations from old privies
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 ex-
halation from their clothes, that many of those
approaching them have been cut off by typhus
fever.

In order to avoid the pestilential poison pro-
ceeding 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

154 SUGGESTIONS FOR PREVENTION OF

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 atmo-
spheric air occupies the place of the fire-extin-
guishing 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 work-
men ; 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 emana-
tions.^ Hence alterations and building opera-

1 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.

EPIDEMICS IN GENERAL 155,

tions in the floor of such churches are fraught
with manifest danger to the life of the workmen
and the congregations in tlie 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 per-
formed 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 prevails, in-
fectious 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 Ouenstadt 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 pro-
pagated to others from this house. I succeeded
in this for five months, until this girl died and
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 ; ;

156 SUGGESTIONS FOR PREVENTION OF

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 there-
after all those that had been guilty of this action,
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 person-
ages in the state called inspectors of the dead
and corpse-washers, w^hose 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, nor 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, w^hich can
no longer teach us anything. Examples are not

EPIDEMICS IN GENERAL 157

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 ren-
dered more contagious and more murderous, in
the small low old houses situated close to the
town-walls, 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
hov\^ 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 con-
stantly 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

158 SUGGESTIONS FOR PREVENTION OF

my face away from them and to keep my
compassion to myself.

If, however, the inmates of them be not with-
out 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 feartul 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 by establishing corn-granaries
and flour-magazines against seasons of scarcity.
I must make the general observation belong-
ing to this place, that most of our towns are not
adapted, nor 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 pre-
venting 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 courtyard and a garden as
broad and twice as long as the house. In this

EPIDEMICS IN GENERAL 159

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/ 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, etc., possess !

The handsome, roomy high and airy butchers*
shops we meet w^ith in some towns (e. g, Dres-
den) 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.

The shops for the sale of stock-fish and her-
rings 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 ware-
houses of the butchers, soap-boilers, parchment-
makers, catgut spinners, glue-boilers, and all
other trades that are engaged with animal sub-

^ The deteriorated air in closely built towns with high
houses is especially injurious to children, and skives 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 readilv notice the large number of these
pitiable little monstrosities in closely built towns, partly
iDecause 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.

i6o SUGGESTIONS FOR PREVENTION OF

stances 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. 1 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.- If, as

1 It is curious that in almost all lan£,mages the same
expressions are applied to the most horrible as well as to
the most revered things — schaudervoll^ sacer, aiuficl, are
instances in point.

- Does this custom originate in the vanity of man, who
thinks to vindicate his right to the title of sole lord of crea-
tion by assuming to be alone worthy of the high honour of
being buried beneath the ground, and to show 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
graze?

EPIDEMICS IN GENERAL i6i

is assuredly the case, all putrefying animal sub-
stances 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 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 foody
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 pur-
chased 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 complaint,
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 work houses where
the workpeople live in the house, those who fall
ill should, whenever they commence to complain,
be immediately separated from the healthy work-
men, 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

i62 PREVENTION OF EPIDEMICS

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 (whooping-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 pre-
vented. 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 con-
gregations, not to come to church 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 in-
firmarieSy 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 re-
spects much too vast to be dismissed here with
a few words.

^SCULAPIUS IN THE BALANCE^

Ars autem tarn conjecturalis cum sit (praesertim quo nunc
habetur modo) locum ampliorum dedit non solum errori
verum etiam imposturae. — Baco de Verulam, Augin.
Scienf.

After I had discovered the weakness and errors
of my teachers and books, I sank into a state of
sorrowful indignation, which had nearly alto-
gether 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 re-
solved 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 I with how many
difficulties have you to contend at every step, in
order to maintain a bare existence, if you would
avoid the bypaths that lead astray from moral-
ity. 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 ! how great and God-like thy destiny !

^ Published at Leipzic in 1805.
M 2 1^3

i64 ^SCULAPIUS IN THE BALANCE

how noble the object of thy Hfe ! Art thou not
destined to approach by the ladder of hallowed
impressions, ennobling deeds, and all-penetrat-
ing knowledge, even towards the Great Spirit
whom all the inhabitants of the universe wor-
ship ? Can that Divine Spirit who gave thee
thy soul, and winged thee for such high enter-
prises, have designed that thou shouldst be
helplessly and irremediably oppressed by those
bodily ailments which we call diseases ?

Ah, no ! 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 pos-
sible, 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 dis-
turbance of the health was so great that no other
termination than a miserable death seemed pos-
sible? 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 ascrib-
able, either to the force of youth overmastering
the disease, or to the unreckoned influence of
various fortunate circumstances, than to the
medicines employed ! 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

^SCULAPIUS IN THE BALANCE 165

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 w^e
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 obstruct-
ing 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,
wdthout 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

i66 ^SCULAPIUS IN THE BALANCE

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 wTong. What pre-
sumption 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 restora-
tion 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 per-
sons 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 im-
perious instinct impelling him to commit all

^SCULAPIUS IN THE BALANCE 167

sorts of dietetic paradoxes. Pork, sauerkraut,
potato-salad, herring, oysters, 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 regula-
tions for the arrest of pestilential epidemics, by
cutting off communication with the affected dis-
trict, by separation and removal of the sick from
the healthy ; by fumigation of the affected abodes
and furniture with nitric and muriatic acid, etc.,
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 particu-
lars of the disease, in order that- we may imitate

i68 ^SCULAPIUS IN THE BALANCE

•the procedure when such a case recurs ? Alas I
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, etc., each composed
of a number of different medicinal substances.
Heaven knows which of them all did good.^
"The patient also drank an infusion of a variety
of herbs; the composition of this I do not recol-
lect, 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 imi-
tators are deceptive ; the whole fact is lost for
posterity. All we see is, that cure is possible;
but how it is 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,

^ Let it not be asserted "that all the substances only did
good because of their combination, that naught must be
added to, nothing taken from, it to enable us to repeat
the fact." 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 from what it was to-day,
according as one ingredient was added sooner than the
other, more fully pulverized, or rubbed-up more strongly with
the other ingredients, according as the atmospheric temper-
ature 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 circum-
stances may occur to mar human calculations.

^SCULAPIUS IN THE BALANCE 169

amid the hurry and bustle which infectious dis-
eases 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 pro-
cedure in the hands of ordinary practitioners),
speaks with a compassionate air of the unfavour-
able season and inclement w^eather, 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 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 can-
not give. At one time he wishes to remove the

I70 ^SCULAPIUS IN THE BALANCE

asthenia by internal or external stimulants; at
another fortify the tone of the muscular fibre with
a multitude of bitter extracts,^ whose effects he
knows not, or strengthen the digestive appar-
atus 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 ob-
served obstructions in the glands and minute
vessels of the abdomen ; or by means of purga-
tives 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 gonorrhoea; 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 with-
draws 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,
m.ental affections of many kinds, and I know not
how many other chronic diseases.

1 We often read in the histories of cases, even of distin-
guished 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 !

^SCULAPIUS IN THE BALANCE 171

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 aflfiicted sufferer steals on his melan-
choly way, borne down with miserable suffering,
and, despairing in human aid, seeks a solace in
religion.

"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 com-
fort 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 noonday 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 constitu-
tion, 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 All-wise, did not design these com-
plexities of our civic constitution and our arti-
ficial 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 great

172 ^SCULAPIUS IN THE BALANCE

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 moun-
tains, 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 highlander with his oatmeal
cakes ?

I am ready to admit that the contest of con-
flicting 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 im-
potent against the water-colic of the peasant of
lower Saxony, the tsbmer of Hungary and
Transylvania, the radesyge of Norway, the
sihhens of Scotland, the hotme of Lapland, the
pelagra of Lombardy, the plica polonica of
certain Sclavonic tribes, and various other dis-
eases prevalent among the simple peasantry of
various countries, as it is against the more aris-
tocratic 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 !

^SCULAPIUS IN THE BALANCE 173

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 aston-
ishes half the world about him, and not less
himself; but among the many medicines he em-
ployed 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 here-
after. His experience in this case, remarkable
though it seemed, will hardly ever 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 Pferdekuren
[horse cures]), which, however great the noise

174 ^SCULAPIUS IN THE BALANCE

they might make, are not of a character to be
imitated, salti niortali, madly desperate attempts
by means of the most powerful drugs in enor-
mous doses, which brought the patient into the
most imminent danger, in w^hich life and death
wrestled for the mastery, and in which a slight
unforeseen preponderance on 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 un-
criminal, and almost imparts to them the lustre
of a good action, the saving of a life.^

This cannot be the divine art, that like the
mighty working of Nature should effect the
greatest deeds simply, mildly, and unobservedly,
by means of the smallest agencies.

The ordinary practice of the majority of our
practitioners in their treatment of diseases re-
sembles these horrible revolutionary cures.
They partially attain their object, but in a hurt-
ful 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

1 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.

^SCULAPIUS IN THE BALANCE 175

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 w^hat 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 lien-

tery, 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 dis-
ease, 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.

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 metror-
rhagia. After some time I am greeted by a
shout of triumph: "Excuse m€ ! I have also

176 ^SCULAPIUS IN THE BALANCE

succeeded in putting a stop to the uterine
haemorrhage."

But do you not see how, on the other hand,
the skin lias 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 develops 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 arti-
ficial 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 commence-
ment 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 circum-
stances of the case — in all these instances a cure
may occur.

In like manner, mistakes of the chemist re-
specting 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

^SCULAPIUS IN THE BALANCE 177

are to be found in the chemist's shop, with an
alteration of the diet, secundum artenij to one of
a very extraordinary, very meagre character.
"The patient must first be powerfully affected
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, etc.,
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 spar-
ing in his use of violent remedies in enormous
doses.

The schools of both the former and the latter
class authorize 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 yEsculapius lived, this so indis-
pensable art of medicine has made so little pro-
gress? What was the obstacle? for what the
physicians have already done is not one hun-
dredth 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
acquired its practice from a caste who called

N

178 ^SCULAPIUS IN THE BALANCE

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 Hippo-
crates. This attentive, unsophisticated observer
sought Nature in Nature. He saw and described
the diseases before him accurately, without addi-
tion, 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 applica-
tion. 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.

^ 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 anything about such matters.

^SCULAPIUS IN THE BALANCE 179

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, Aretaeus,^ excepted.

Sophistical whimsicalities were pressed in to
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 theriacaj composed of an innumerable
multitude of ingredients, and more lately the
niithridaticum, and similar compounds, cele-
brated 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 neg-
lected. 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 them. Galen devised
a system for this purpose, his four qualities with

^ 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 modern pathologists do it.
N 2

i8o ^SCULAPIUS IN THE BALANCE

their different degrees; and until the last hun-
dred 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 everything by
the shape of the smallest parts, their weight,
pressure, friction, etc. ; 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

itSCULAPIUS IN THE BALANCE i8i

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 stupend-
ous castles in the air concealed their poverty in
the art of healing.

"But, since the discovery of printing, the pre-
liminary sciences of the physician, especially
natural history and natural philosophy, 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 know-ledge 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 or another or of a third intes-
tine; 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 fila-
ment to serve as a bridge for the transportations
of a disease from one part of the body to another,

N 2

i82 ^SCULAPIUS IN THE BALANCE

or some other unfruitful speculations of the same
kind. After the absorbents were discovered,
anatomy immediately took upon herself to in-
struct physicians in what way medicines must
permeate them, in order to get to that spot of
the body where their remedial powder 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 exist-
ence 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 pheno-
mena of the human body upon sensible observa-
tion and truthful experience alone. Little has
been 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

.^SCULAPIUS IN THE BALANCE 183

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 dis-
eased 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 physio-
logical and pathological phenomena, and how
much it has distinguished itself by authorizing
this or that medicine. Gren, Tromsdorff, and
Liphardt may serve as warning examples of this.

It is, I repeat, a matter for most serious re-
flection, 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, not-
withstanding, they have had no marked bene-
ficial influence on the treatment of disease.

Let us consider how this has happened.

Anatomy shows 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

i84 ^SCULAPIUS IN THE BALANCE

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 out-
side of organs, we see only their grosser sub-
stance; but into the innermost depths of their
being, and into the connection of their secret
operations no mortal eye can ever pierce.

By means of pure observation and unpre-
judiced reflection, in connection 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 pheno-
mena in what is called a healthy body remain
pretty constant, and hence can be observed fre-
quently 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 hum-
bling 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 ex-
planation 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 w^hen we attempt to
regard the state of the disease physiologically,

^SCULAPIUS IN THE BALANCE 185

there drops before our previously clear light of
physiology a thick veil — a partition which pre-
vents all vision. Our physiological skill is quite
at fault when w^e 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 trans-
ference 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 differ-
ent 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 suitable-
ness or worthlessness of medicines, for it is
altogether out of its sphere of vision to determine
what is properly healing or hurtful, and it pos-
sesses 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

i86 ^SCULAPIUS IN THE BALANCE

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 inter-
mittent fever; and turn his attention solely to
learn what medicines the experience of bygone
ages has discovered for intermittent fever, be-
sides 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 in-
spiration 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 mixed together in

^SCULAPIUS IN THE BALANCE 187

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 con-
siders it better to mix together many than
few ; ^ 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 power-
ful 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 ! "

Periculosce plenum opus alece! What are we

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 pre-
scriptions must have an orthodox form, a basis (fundamental
medicine), a corrective (something added in order to correct
the faults of the basis), aji adjuvant (an auxiliary substance
to support the weakness of the basis), and a7i 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 ?

i88 ^SCULAPIUS IN THE BALANCE

to think of a science, the operations of which are
founded upon perhapses and bhnd 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 sub-
stances alone and uncombined in intermittent
fever ?

"Oh no! Some give authorities, or quote
other works on 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

.^SCULAPIUS IN THE BALANCE 189

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 com-
municated 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 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 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 un-
combined in this disease, frequently with good

^ This is the general but most unjustifiable procedure ot
our medical practitioners : to prescribe nothing by itself— no^
always in combination with several other things in an artistic
prescription ! " No prescription can be properly termed
such," says Hofrath Gruner in his Art of Prescribifig^
"which does not contain several ingredients at once" — so, in
order to see clearer, you had better put out your eyes !

I90 ^SCULAPIUS IN THE BALANCE

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 administra-
tion of medicine to the sick, the order of apothe-
caries was instituted, — a guild which depends for
existence on the complicated mixtures of drugs.
Never will the complicated formulae cease to pre-
vail, as long as the powerful order of apothe-
caries maintains its great influence.

Unlucky period of the mediaeval age, which
produced a Nicolaus the ointment-maker (Myrep-

^SCULAPIUS IN THE BALANCE 191

sus), from whose work the Antidotaria and
Codices Medicamentarii were compiled in Italy
and Paris ; and in Germany at first in NUrnberg,
about the middle of the sixteenth century, the
first Dispensatorium was written, by the well-
meant zeal of the youthful Valerius Cordus.
Before these unhappy events, the apothecaries
were merely unprivileged vendors of crude
drugs, dealers in simples, druggists. (At the
utmost, they might have some theriac, mithri-
date, 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 pre-
vented him from giving them to his patients in
their simple and uncombined state.

But from the time when the authorities intro-
duced dispensatories — that is, books full of com-
pound medicines, which were to be kept ready
made — it became necessary to form the apothe-
caries into a close corporation, and to give them
a monopoly (on condition that they should have
always a stock of ready prepared medicinal mix-
tures), 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 authorizing 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

192 ^SCULAPIUS IN THE BALANCE

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 numer-
ous commendations given of its virtues. By
this the young physician was led to employ these
compositions in preference to the simple medi-
cines, especially as the former were authorized
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 huge
folios (the Vienna, Prague, Augsburg, Branden-
burg, Wiirtemburg, etc., dispensatories). And
now there was no known disease for which the
dispensatory had not certain ready-made com-
pounds, or, at least, the formulas for them,
accompanied by the most eulogistic recommenda-
tions of them. The professor of the healing art
was now prepared, when he had such a receipt-
book in his hand, — full of receipts for every
disease sanctioned by the highest authorities in
the land ! What does he want more to make
him perfect as a healer of disease? How easy
has the great art been made to him !

It is only quite lately that a change has taken

^SCULAPIUS IN THE BALANCE 193

place in the matter. The formulas in the dis-
pensatory 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 of magisterial formulae
remain.

The spirit of the advancing age had at length
expunged from the list of drugs the pearls and
jewels, the cosdy bezoar, the unicorn, and other
things, which were form.erly 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 mix-
tures to the apothecaries, and thus, in some
measures, to impose restrictions on the physi-
cians. 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 direcdy 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: —

ist. Was it owing to the notorious ignorance
of the physicians of the present day, which

1 For example, the Constitutiones Fredericill Imperatoris,

194 ^SCULAPIUS IN THE BALANCE

rendered them unable to prepare a tolerable com-
bination of drugs, or even to measure out the
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 dread-
ful supposition !) how could they write a pre-
scription, that is, directions for combining a
variety of substances in the most proper manner,
if they themselves were not masters of the opera-
tion which they described?

2nd. Or were they made in order to enrich the
apothecaries, whose incomes suffered by the
physicians themselves dispensing their medi-
cines? If the whole system of medicine existed
for the benefit of the apothecaries alone, — if
people fell sick solely for the profit of apothe-
caries— 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.

:^rd. 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 chemic-
ally 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

^SCULAPIUS IN THE BALANCE 195

and consistent directions at all,' until at length
he gives directions for compounding that are
full of contradictions, and make him the laugh-
ing-stock 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, from his
want of acquaintance with pharmaceutical mani-
pulations, 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 pre-
scribed, some brown powder, smelling of cam-
phor. Or the physician, perhaps, writes a pre-
scription for hemoptysis, consisting of alum and
kitchen-salt rubbed together. Now, although
each of these substances, separately, is dry, yet
out of the triturated combination no powder
results, but a fluid, which the physician, not

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.

196 ^SCULAPIUS IN THE BALANCE

♦ 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 pre-
paration 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 combina-
tion, a problem, w^hich, when vegetable sub-
stances 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 know-
ledge, 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 dis-
pense, the apothecary's income is secured in the
most satisfactory manner. What regulations
respecting the prices of drugs can check his over-
charges? And even if the prices of the drugs
are fixed by law, his conscience often does not
prevent him from employing a cheaper substitute
(quid pro quo), instead of the expensive one that
is prescribed. Many apothecaries have carried

^SCULAPIUS IN THE BALANCE 197

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 /Ze/ot
avnPaWofjiSvcov ; and the multitude of books which
treat of the adulteration of drugs and deceptions
practised by the apothecaries, constitute of them-
selves 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 ! The latter gets fourpence
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) pre-
scriptions; 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 pre-
scriptions, 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 mes-
senger), it seems to me that the result is not
commensurate with the arrangement. The
physician becomes a mechanical workman, his

198 ^SCULAPIUS IN THE BALANCE

occupation becomes a labour that requires the
least reflection of all trades; he writes pre-
scriptions (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 by the state to
another (the apothecary), who also is not answer-
able 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 con-
cerns 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 medi-
cines 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

^ 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 promises 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 !

^SCULAPIUS IN THE BALANCE 199

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 instrun>ents (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 physician who should wisely
wish to avoid that injudicious mode of prescrib-
ing 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 apothe-
cary's purse; he must take his choice of either
being harassed to death or of abandoning it and
again writing compound prescriptions. In this

^ 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. "

200 ^SCULAPIUS IN THE BALANCE

case what course would ninety-nine doctors out
of a hundred choose ? Do you know ? I do !

Therefore adieu to all progress in our art !
Adieu to the successful treatment of the
sick !

Richard Clay <5r» Sons, Limited, London and Bungay.

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