Hahnemann's
FRAGMENTARY OBSERVATIONS ON BROWN'S ELEMENTS OF MEDICINE
From Hufeland'sJournal der pract. Arzneykunde, Vol. v. Pt. 2, p. 52, 1801.
[Hufeland himselfputs the following note to this masterly criticism.--"Theseobservations are from the pen of one of the most distinguished ofGerman physicians, who, however, as he himself expresses it, 'aslong as literary chouanerie makes the highways unsafe,' will notpermit his name to appear, which, in my opinion, is a good planin cases where reason and not the authority of names are todecide; I must, however, observe that the author has read nothingeither for or against the Brunonian system, therefore we may beall the more certain that we have here the unprejudiced opinionon this subject of a practical physician of matured experienceand reflection."]
In section XVIIIhe politely apologises for being obliged to make use of thephrases, deficient, exhausted, consumed, accumulated, superfluousexcitability, owing to the novelty of the doctrine and thepoverty of common language. But this is no excuse for the man whoboasts (CCCXII) of having now reduced the art of medicine to anexact science which will at no distant day receive theappellation of Doctrine of Nature (note to DCLXXVII), and ofbeing the first who has made it a demonstrated science (see endof the Preface). He who would teach a new science for which hemust employ new ideas, ought to employ for them new, appropriate,unequivocal terms, or make use of the old words, attaching newmeanings to them, for the new expressions. But as Brown employsthe old expressions unexplained and without attaching to them newmeanings, he must permit the reader to understand them in theirold signification, and when we read, that excitablity, a certainquantity or certain energy of which has been assigned to everybeing upon the commencement of its living state (XVIII.), may beworn out by stimuli (CCCIX) and yet afterwards be drawn forth bynew stimuli, he must not be offended if we believe that we haveread nonsense.
XXI. z,h,"Emetics and purgatives, fear, grief, &c., diminish thesum-total of excitement, and are debilitating; – but from noother reason, not because they are other than stimulating agents,– they are stimulants but are debilitating, that is, weaklystimulant, owing their debility (he should have said,debilitating power) to a degree of stimulus greatly inferior tothe proper one."
If allexcitement, all the conditions of life and health, are owing tostimulus, and to no other cause (XXII.) no stimulus is of itselfcapable of diminishing the excitement. Either the externalcondition for life and health does not solely depend upon what istermed "stimulus," or if it do, then a stimulus, be iteven a weak, an insufficient one, cannot debilitate. It is only(but Brown does not make this proviso) when it is the solestimulus acting upon the body for a long time, all other greaterstimuli being in the meantime excluded, that a debilitatingeffect can be produced, not, however, in consequence of thesmallness of the acting stimulus, but in consequence of theabsence of the greater (accustomed) stimuli. If it wereotherwise, a man in good health, who would feel still moreenlivened by drinking four ounces of wine, would be tremendouslydebilitated if at that time in place of four ounces he shouldtake but four drops in his mouth, and would be debilitated fourtimes as much if he took only one drop.
An addition tothe condition of life, be it ever so small (a weak simplestimulus), can never become a minus, can never debilitate. If,however, it do debilitate (as purgatives, fear, grief, and soforth do), whilst the sum-total of the usual means requisite forsustaining life (heat, food, &c.) remains undiminished, inthat case its debilitating power must be owing to quite adifferent cause than the smallness of the stimulating power.
Who can fail toperceive the justness of these conclusions?
A healthy,excitable girl, in the full possession of all stimuli requisitefor health, dies instantaneously on suddenly hearing the tragicalintelligence that her lover has been stabbed. If this was merelya simple but only a small stimulus, it must have, been just asmall addition to the not defective sum of all the other stimuli.How could this small addition do harm, how could it destroy life,and that instantaneously, if it merely acted as a simple stimulusand in no other manner.
Who can fail toperceive the correctness of these inferences?
He carries outhis delusion so far as to assert (XXI,h), that fear and grief areonly lower degrees of confidence and joy." Were I to dare tomake such allegations, I could make anything out of everything,for it is very easy to be a scholastic sophist. No, my dearfriend! there are two scales; at the top of the one standsindifference, and below that come vexation, grief, despair. Theother scale has indifference at its lowest part, whence it mountsup to confidence, to joy, to rapture.
If it is allowedto Brown to infer from identity of effects, identity of causes,we may be permitted to infer from opposite effects, oppositecauses, and to consider cold and grief, warmth and joy, asopposite powers (because they exhibit opposite (effects), yet insuch a way as that the strengthening property of the latter, likethe debilitating property of the former cannot depend on theircommon attributes as stimuli, but must depend upon attributes,that in the former are of a directly opposite nature to those inthe latter.
In XX and XXIBrown reckons poisons and typhus contagions among the abovepowers (whose debilitating power depends on the smallness of thestimulation that they produce on the body.
Well now, if aman in the full possession of all the health-sustaining externalstimuli (the sum-total of which is from 3000 to 3010 daily)should choose, after drinking his last glass of wine, to get intoa pit filled with carbonic acid, and if in ten minutes thereafterhe is brought out dead, irrecoverably dead, what is it in thiscase that prevents the continuance of life? Is it the addition ofthe too small and therefore debilitating stimulus of the fixedair? Let us compute the sum of its stimulating energy at 1, or ifyou will at 1/1,000,000th, in that case the sum of all thestimuli that have acted upon him during the last twentyfourhours, inclusive of the carbonic acid inspired, will amount to3001 or 3000 1/1,000,000th. He has been acted on every precedingday by as many (more or fewer) stimuli, there has occurred inthis last day neither diminution nor increase of the stimuli upto the moment of his death. What then prevented him living? It isevident that it was an agent that proved so excessively injuriousto him, not in consequence of the smallness of its stimulatingenergy, but on account of its enormous power of quite a differentnature.
He tries to getover the difficulty (XXI, z) by saying that the debilitatingstimuli produce their debilitating effects partly by means of adisagreeable relation to the excitability, or by their causing adisagreeable sensation. But he is very inconsistent to boast inone page that he has reduced physiology and pathology to one ortwo principles, and in the next page quasi aliud agendo, to put acouple of qualitates occult¾ in the corner, which, in case ofnecessity, when the defects of the vaunted chief supports of hissystem are exposed, he may bring forward as already establishedprinciples, and attach to them, according to his fancy, anymeaning they may be required to bear. But through all these partsassigned to auxiliaries, accessory springs of action, andaccessory agents, the boasted simplicity of his so-called systemvanishes into nothing. Now all the specific effects of poisons,contagions, &c., when it suits the purpose of Brown and hisfollowers, and the omnipotent words, "stimulants, weaklystimulant," will not do, can be referred to discordantcombination of powers," and the specific remedial powers ofthis or that medicine, sometimes to the "agreeable relationthat the exciting power bears to the excitability,"sometimes to an "agreeable sensation;" and thus hisretreat is covered! How artful! but at the same time howdisingenuous!
To hisoverstrained objections to cold in asthenic diseases –(CCXCII) "In diseases of great and direct debility, coldmust be most carefully avoided, as it is always of a directlydebilitating operation, and never of service but in sthenicdiseases, and those that are in a progress to indirect debility"–which is repeatedly alluded to, I must oppose myexperience, which is the same as that of many others, that duringmany years when I was still ignorant of any specific remedies forold chronic diseases, I have frequently combatted themsuccessfully solely with cold washing, cold foot-baths, and alsowith immersion for one minute at a time in water of from 50¡ to60¡ Fahr. One case however among many others is so remarkablethat I cannot refrain from detailing it. A man somewhat advancedin years, but still possessing considerable strength, had had forfive years from unknown cause a paralytic affection of his leftarm. The movements he could perform with it were very weak andsmall, and the sensibility of it also was much diminished. Onceupon a time when he was on a visit to a relation, and there wasno one to fetch the fish for the supper out of a frozen tank, hegets up quietly, breaks the ice, leans over it and passes nearlyone hour with both arms in the ice-cold water before be can getout the required number of fish. He comes and brings them to thegreat delight of his host, but immediately complains of pain's inthe affected arm, which in the course of a few hours, inflames,The following day the pain and inflammation were gone, and hisarm had acquired its healthy sensibility and all the powers ofhealth. The paralysis was cured and remained so. Should he haveremained uncured to support Brown's erroneous maxims?
Brown, like allshort-sighted, unpractical physicians, always looked only to theprimary and incipient action of the remedy, but not to the aftereffect, which is, however, the chief thing.
CCXCVIII."In spasms and convulsions, in the internal, in the externalparts, in bleeding discharges, in the direful delirium of feversand other very violent diseases, in asthenic inflammation: whenthose stimuli, which have a more permanent influence, fail, oract to no good purpose; the virtue of the diffusible stimulants,the principal of which is opium, is eminent." What a generalway of speaking, and how empirical! What an immense deal the mancan do with opium! I only wish I could do the like. To cureinternal and external spasms with opium better than with anyother remedy, any one else would find somewhat difficult.
CCXCIX."When the action of all the other powers by which life issupported, is of no effect, they (that is, wine, brandy, opium.)turn aside the instant stroke of death." No one took themmore copiously and more variously than the Master who wrote this;how is it that they did not turn aside the stroke of death fromhimself (at his moderate age), and so avert the stigma from hisdoctrine?
CCCI. "Ahigher place in the scale is claimed by musk volatile alkali,camphor;– however, in every respect the preparations ofopium are sufficient for most purposes of high stimulating."According to this, opium ought to be quite adequate for the cureof most chronic diseases, and of others that he ascribes to ahigh degree of debility, as poisonings of all sorts, &c. Inthat case it would be a real panacea, and we should scarcelyrequire any other remedy. He could certainly have seen andtreated but few chronic diseases, and assuredly no cases ofpoisoning with white hellebore, arsenic, &c., otherwise bewould not have asserted such falsehoods.
According to thisparagraph, camphor should possess the same powers as opium, onlyin a somewhat less degree; and yet actual experience shows thattheir effects are exactly opposed; the one removes the effects ofthe other. How little Brown knew about the things where of hespeaks so confidently!
CCCII. "Indiseases depending upon great debility [consequently according tohim, in acute typhus, putrid and bilious fevers, the Levantineplague, &c.] animal soups should be given." But animalsoups are utterly abhorred by them; will he in spite of thedisgust they occasion force them upon the patients? They wouldagree with them admirably!
CCCIII. In thecase of a convalescent in whom stimulants should be continued, herecommends that "in his movements he should first usegestation." The old school profoundly ignorant of nature,with whose fables Brown, the reformer of medicine, is still sochokefull, also considered riding without succussion as comingunder the category of strengthening remedies, and ranged thispassive motion alongside the active ones (such as walking,digging, and other manual exercises), and yet the former actsantagonistically to the latter, and is antiphlogistic,antisthenic, debilitating (at all events in its primary effect),greatly diminishing the pulse, causing vomiting and nausea,&c. The reader will easily perceive how opposed this is totruth and nature.
CCCVII, f,"The remedies of asthenic diathesis, to whatever part theyare applied, stimulate that part more than any other." Thisis also one of his maxims that carries us away by its god-likesimplicity. Pity that it is fundamentally false–that it iscompletely opposed to all true experience. Tincture of opiumapplied to the pit of the stomach causes no sensation on the spotto which it is applied, but speedily relieves hystericalvomiting. When applied there, or to the neck, or to any othersensitive part of the, body, it checks (in a palliative manner)some diarrh¾as, removes the apoplectic death-like coldness,stiffness and unconsciousness caused by large doses of camphor,the abdominal pains produced by belladonna, and the sopor oftyphus, though at the seat of its application no perceptiblechange is observable. And I could adduce a hundred other examplesopposed to the generality of the maxim "that medicines actmore strongly at the part where they are applied thanelsewhere." This is a pure invention of his own.
CCCVIII."Inanition of the vessels (penury of blood) takes place inasthenic diseases in an exact proportion to their degree."In pestilential typhus fevers, where sometimes only a few hourselapse in the transition from health to death, or in the suddenfatal cases caused by cherry-laurel water, by carburettedhydrogen, by exposure to the exhalations from cesspools, by thevapour of charcoal, by carbonic acid, by fright, where theinterval betwixt health and death often scarcely amounts to acouple of minutes, how could such an enormous deficiency of blood"in an exact proportion to the degree of these asthenicdiseases" have occurred in such a short time? Whither hasthe blood gone? It would be ridiculous to expose still furtherthe absurdity of this assertion on which he prides himself somuch.
According to thisparagraph he considers the most efficacious remedy for asthenicdiseases to be (artificial) filling of the vessels with blood!Just as if healthy blood could be prepared in a diseased body,just as if blood could be manufactured all at once by means ofopium, wine, and forced-down animal soups, in such diseases, inthe same way as butter is made in a churn, or beer in a brewingvat! What sort of blood? How different is chlorotic blood fromthat of plithisical subjects! Ast parva non curat philosophus.
CCCIX. "Whenthe excitability is worn out by any one stimulus, any newstimulus finds excitability and draws it forth, and therebyproduces a further variation of the effect." The fact is nodoubt true, that a second medicine again acts when the one justgiven no longer does any thing. But the cause of this phenomenon,what is it? It is impossible that it can be as Brown says.
If stimulants donot differ among each other in kind, but only in degree andstrength (an unconditional main dogma of Brown's, CCCXII,CCCXIII), then it is impossible that the second stimulant couldact anew, after the first stimulant has ceased to be able to act.An increased dose of the first must necessarily effect all thatcould be expected from the second stimulant, if they differedfrom each other only in degree and strength; but the first, evenwhen given in a stronger dose, now does nothing more, whereasthe, second acts anew, consequently they cannot differ merely indegree, they must differ in kind (modo). If however, this be thecase, the whole Brunonian system falls to the ground.
Moreover, how canthe second stimulus still find excitability it forth, as he hereasserts, when it has been already worn out by the first? Whencecame the new excitability? from his fancy, or from the resourcesof the animal economy, whose existence he will not acknowledge?Tertium non datur. If it come from the latter source, then indeedit may sometimes flow more slowly and with greater difficulty,sometimes too quickly and impetuously. But then the second andonly remaining mainstay of his system breaks down. Behold there amore natural origin of diseases, which these words of his betrayagainst his will. Had he wished or been able to be consistent, hewould not have ventured to touch this ticklish point, which giveshim a slap in the face.
That all thisnonsense is his actual meaning, is evident from the followingassertions in
CCCXII, CCCXIII."The effects of all external powers upon us do not differamong themselves; they produce life, activity, health anddisease, by the same operation, by the same stimulus. Hence itfollows that things which restore health cannot act otherwisethan by one and the same stimulus."
"Severalthings that produce the same effect are then identical with eachother, are one and the same thing."
This is far frombeing the case when the action is complex; for even according toBrown, the medicines do not establish health in the system sovery immediately, so unconditionally, so independently of thecorporeal powers, so entirely without previous reaction, as theapple-tree lets the apple fall on the grass.
But if the effectbe brought about by composite actions, the prime agent on whichthe action depends may certainly be very different.
Windmills,horse-power, steam-engines and capstans worked by men, may allempty a reservoir of water; the dry atmospheric air also thatextends over the reservoir empties it; but does it thereforefollow that wind, horses, fire, men and the dry atmosphere areone and the same thing? There are also many powers that exercisea double action, a primary and a secondary, and several amongthem that resemble each other in their primary action, and not afew that do so in their secondary action. If then the carelessobserver looks only to the resemblance of the primary action ofsome powers (as Brown often did), or only to their secondaryactions, or to similarity of actions, be they primary orsecondary, be may often be misled to infer an identity of causefrom some similarity of these one-sided actions, as usuallyhappened to Brown. In making deductions from similar falsepremises, I might with equal justice say, that a watery vegetablediet, and strong animal soups were one and the same thing, forthey both (in their primary action on the body) cause satiety.The same effects have the same cause, therefore watery vegetablenutriment and beef-tea are one and the same thing. And thus thefalse scholastic deduction, is made.
CCCXIV. "Inasthenic diseases the administration first of diffusiblestimulants, for the purpose of bringing back the appetite [evenin every diseased body ?] for the greatest remedy, food, as wellas keeping the food on the stomach and assisting in the digestionof it [will they do so in every diseased body?], then theapplication of heat, then the use of less diffusible and moredurable stimulants: as animal food, without and with seasoning,wine, gestation, gentle exercise, moderate sleep, pure air,exertion of mind, [can the mind of one affected with melancholiabe exerted?] exertion in passion and emotion, [even in idiots andraving maniacs?] an agreeable exercise of the senses; all thosereproduce health, by no other operation but that of onlyincreasing excitement."
This then sums upall Brown's therapeutics for diseases of, and accompanied by,weakness! That kind nature and youth will, assisted by such anappropriate regimen, (for it is nothing more) and even by itself,cure diseases having far other pro-ducing causes than deficiencyand excess of excitability, is a phenomenon daily witnessed bythe unprejudiced observer, which, however, must be explained awayor denied by Brown in order to support his scholastic system.
But withoutreckoning this divine power and granting that all these diseasesdepended on a morbid degree of excitability, and could only beremoved by the remedies indicated by him (but which were usedlong before his time), what becomes of the myriads of diseasesthat cannot be cured by these remedies? It avails us little thathe ascribes them all also to deficiency or excess ofexcitability. All that we want is that he should cure them. Weshall see if by this regimen, the large number of mentaldiseases, the epilepsies, the venereal lues, the mercurialwasting, the pellagra, the plica polonica, (I reject the name oflocal diseases, the refuge of the Brunonians, for theseaffections) will be cured. Hic Rhodus ! hic salta!
Or will thisregimen, whose curative effect cannot be looked for under aconsiderable time, cure asthenia which often kills healthyindividuals in a few hours or even minutes (the bad kinds oftyphus fevers, the Levantine plague, apoplexy, the accidentscaused by laurocerasus, azotic and carbonic acid gas, carburettedhydrogen, veratrum. album, arsenical vapour, &c.)?
DCLXXVII."As it now happens, that either direct or indirect debilityproves hurtful, hence we have a third case given, where we haveto combat both sorts of debility."
Who could havebelieved that a scholastic pedant who plumes himself so much onhis logical forms, who reckons for us in figures on a scale ofhis own exactly the degree of the exciting power andexcitability, would have so far forgotten himself, as MasterBrown does here at the end of his immortal work? How! both kindsof debility conspiring to make one disease in one body?
In the firstplace, I should like to know, as he (notes to XLVII and LXXXII)fixes the standard of health at 40 degrees of excitability –the predisposition to direct debility in the degrees below 40down to 25,-- complete and extreme direct debility from 25 to0,– the predisposition to sthenia in the degrees from 40 to55,-- sthenia itself in the degrees from 55 to 70,– andindirect debility in the degrees from 70 to 80;–I shouldlike to know in what part of this scale (which he is so proud of)he could place the mixed form of debility he speaks of, by whatfigures he would expound this supposed excitability? Here he saysnothing about the figures of his table, which he is so fond ofputting forward elsewhere.
Here he prudentlyignores them and attempts in a note, by means of mere words, Iknow not whether I should say to conceal or to increase thehiatus. He brings forward many examples where in one diseasedirect debility occurs along with indirect, indirect with directdebility. Granted that the man whom he there supposes to beaffected with typhus had got thereby a direct debility of 10 (30degrees below 40) that is 40-30, but in the meantime, by means ofgreat corporeal motion, had contracted an indirect debility of 70(30 degrees above 40) that is 40 + 30, can the man thereby haveaggravated his state and be now labouring under indirect and atthe same time direct debility? If Brown's excitement theory benot entirely false and his scales not the mere offspring of hisfancy, must not instantaneous health or the degree of 40 ensue,since 40 minus 30 and plus 30, gives 40, the sum of excitability?
If this be notthe result of the meeting of the two opposed debilities, I shouldlike to know what it is then? What part of his excitability-scaleis not already occupied ?
Either there isnot a spark of truth in his excitement theory or his scale ofexcitability, or the man must, although already affected bytyphus, be instantly restored completely to health or nearly soby the added corporeal exertion, according to Brown's wholetheory and his vaunted scale. But if, as must naturally happen,the man visibly aggravates his malady by this fatigue, as Brownhimself confesses, this circumstance overthrows his whole system.
If theextraordinary accumulation of excitability in a case of typhus,imagined by Brown, can and must be aggravated by corporealexertion, as experience teaches and as he here admits, theneither the corporeal motion cannot remove the excitability,otherwise in this case health would ensue or almost ensue, orthere can be in typhus no accumulation of excitability. Plus andminus cannot co-exist without mutually annihilating one another.
It is impossiblethat a state of accumulation of excitability can be aggravated bya power that diminishes excitability (according to his wholetheory), therefore the aggravation that ensues is a refutation ofhis whole beautiful excitement theory and his tabularly expressedaccumulation and exhaustion of excitability to which, accordingto him, all the conditions of life may be referred.
Brown gives us noinformation as to the state (and degree) in which we must supposethe excitability to exist when the two debilities meet together.That he himself did not know how to conceive this state isobvious from his extraordinary and ambiguous assertions relativeto this point.
Thus, as thedirect debility of the man affected with typhus must amount to atleast 70 degrees of accumulation of excitability, to what heightdid the degrees rise since his state was aggravated by corporealexertion? The degrees of the accumulation could certainly not bethe least diminished, otherwise the disease had not beenaggravated, at all events it had been transformed into a sthenicdisease (at 60); the state must then have sunk suddenly and farbelow 40 into indirect debility, in order to be able to expressthe great aggravation that has ensued at least by the degree 10.In the former case, seeing that for the commencement of thetreatment of the simple direct debility Brown prescribes tendrops of laudanum, he must prescribe for its cure eight drops orless ; in the latter case, however, as he orders for thecommencement of the treatment of the simple indirect debility 150drops, he must for a worse degree have administered 200 drops andupwards. But no! his vaunted consistency forsakes him here.
"When theaffection," he says (DCLXXXVI)," is more a mixture ofboth sorts of debility, these proportions of the doses must beblended together."
Though this ispurposely worded so as to be incomprehensible, it can only havethis one meaning, that we should from the two select anintermediate number betwixt the dose increasing from a few dropsand that decreasing from many drops. Therefore a mediumproportion betwixt an increasing and decreasing pro-gression.Very strange! In this case, from the beginning to the end (ifboth debilities were pretty equal in point of strength) 80 dropsshould be given uninterruptedly, which is contrary to his othermodes of treatment and opposed to the nature of the thing. Andhow if the direct debility or indirect debility, was greater thanthe indirect the latter greater than the former, what state ispresent, what is to be done for it? He himself does not actuallyknow what he should direct to be done for cases which he can makeclear neither to himself nor to others, and what would he adviseto be done in this dilemma? He prudently forbears giving anydetailed information on the subject, and merely in the note toDCLXXVII cunningly says, (possibly in order to escape observationin the confusion?) "A judicious physician will find plentyof scope for the exercise of his judgment in these mixedstates." In a word, be leaves us, with a bow to the reader,in the lurch, not only here but in the treatment of allasthenias, "because," as he assures us in thisparagraph, "there is scarcely any asthenic disease wheresuch. a mixed state is not present," So almost all asthenicdiseases consist of an unknown mixture of both debilities whereofhe knows not how to impart any information in reference to thechange therefrom resulting in the body, and to the accompanyingstate of excitement and excitability, nor to give us any adviceon the subject! Heaven help us! throughout the whole transparentwork he has dazzled as with a flaring straw fire, here it sinksdown into ashes, and he leaves us, with a smile, surrounded by abowling wilderness in the darkness of night.
from the LesserWritings of Samuel Hahnemann. Jain, New Delhi, 1989.[p350-361]