William Cullen (1712-90), John Brown (1735-88)
It remains to speak of two systematic writers on medicine in the 18th century, whose great reputation prevents them from being passed over, though their real contribution to the progress of medicine was not great -- Cullen and Brown.
William Cullen (1712-90) was a most eminent and popular professor of medicine at Edinburgh. The same academical influences as surrounded the Dutch and German founders of systems were doubtless partly concerned in leading him to form the plan of a comprehensive system of medicine. Cullens system was largely based on the new physiological doctrine of irritability, but is especially noticeable for the importance attached to nervous action. Thus even gout was regarded as a "neurosis." These pathological principles of Cullen are contained in his First Lines of the Practice of Physic, and extremely popular book, often reprinted and translated. More importance is to be attached to his Nosology or Classification of Diseases. The attempt to classify diseases on a natural-history plan was not new, having been commenced by Sauvages and others, and is perhaps not a task of the highest importance. Cullen drew out a classification of great needless complexity, the chief part of which is now forgotten, but several of his main division are still preserved.
It is difficult to form a clear estimate of the importance of the last systematizer of medicine, John Brown (1735-88), for, though in England he has been but little regarded, the wide though short-lived popularity of his system on the Continent shows that it must have contained some elements of brilliancy, if not originality. His theory of medicine professed to explain the processes of life and disease and the methods of cure, upon one simple principle, -- that of the property of "excitability," in virtue of which the "exciting powers," defined as being (1) external forces and (2) the functions of the system itself, call forth the vital phenomena "sense, motion, mental function, and passion." All exciting powers are stimulant, the apparent debilitating or sedative effect of some being due to a deficiency in the degree of stimulus; so that the final conclusion is that "the whole phenomena of life, health as well as disease, consist in stimulus and noting else." Brown recognized some diseases as sthenic, others as asthenic, the latter requiring stimulating treatment, the former the reverse; but his practical conclusion was that 97 per cent of all diseases required a "stimulating" treatment. In this he claimed to have made the most salutary reform because all physicians from Hippocrates had treated diseases by depletion and debilitating measures with the object of curing by elimination. It would be unprofitable to attempt a complete analysis of the Brunonian system; and it is difficult now to understand why it attracted so much attention in its day. To us at the present time it seems merely a dialectical construction, having its beginning and end in definition, the words powers, stimulus, &c., being used in such a way as not to correspond to any precise physical conceptions, still less to definite material objects or forces. One recommendation of the system was that it favoured a milder system of treatment than was at that time in vogue; Brown may be said to have been the first advocate of the modern stimulant or feeding treatment of fevers. He advocated the use of "animal soups" or beef tea. Further he had the discernment to see that certain symptoms, such as convulsions and delirium, which were then commonly held always to indicate inflammation, were often really signs of weakness.
The fortunes of Browns system (called, from giving been originally written in Latin, the Brunonian) form one of the strangest chapters in the history of medicine. In Scotland, Brown so far won the sympathy of the students that riotous conflicts took place between his partisans and opponents. In England his system took little root. In Italy, on the other hand, it received enthusiastic support, and naturally, a corresponding degree of opposition. The most important adherent to Browns system was Rasoir (1763-1837), who taught it as professor at Pavia, but afterwards substituted his own system of contra-stimulus. The theoretical difference between this and the "stimulus" theory need not be expounded. The practical difference in the corresponding treatment was very great, as Rasori advocated a copious use of bleeding and of depressing remedies, such as antimony. Joseph Frank, a German, professor at Pavia, afterwards of Vienna, the author of an encyclopaedic work on medicine now forgotten, embraced the Brunonian system, though he afterwards introduced some modifications, and transplanted it to Vienna. Many names are quoted as partisans or opponents of the Brunonian system in Italy, but scarcely one of them has any other claim to be remembered. In Germany the new system called forth, a little later, no less enthusiasm an controversial heat. Girtanner first began to spread the new ideas (though giving them out as his own), but Weikard was the first avowed advocate of the system. Röschlaub (1768-1835) modified Browns system into the theory of excitement (Erregungstheorie), which for a time was extremely popular in Germany. The enthusiasm of the younger Brunonians in Germany was as great as in Edinburgh or in Italy, and led to serious riots in the university of Göttingen. In America the system was enthusiastically adopted by a noted physician, Benjamin Rush, of Philadelphia, who was followed by a considerable school. France was not more influenced by the new school than England. In both countries the tendency towards positive science and progress by objective investigation was too marked for any theoretical system to have more than a passing influence. In France, however, the influence of Browns theories is very clearly seen in the writings of Broussais, who, though not rightly classed with the system-makers, since his conclusions were partly based upon anatomical investigation, resembled them in his attempt to unite theory and practice in one comprehensive synthesis. The explanation of the meteoric splendour of the Brunonian system in other countries seems to be as follows. In Italy the period of intellectual decadence had set in, and no serious scientific ardour remained to withstand the novelties of abstract theory. In Germany the case was somewhat different. Intellectual activity was not wanting, but the great achievements of the 18th century in philosophy and the moral sciences had fostered a love of abstract speculation; and some sort of cosmical or general system was thought indispensable in every department of special science. Hence another generation had to pass away before Germany found herself on the level, in scientific investigation, of France and England.
Samuel Hahnemann and Homoeopathy (Homeopathy)
Before the theoretic tendency of the 18th century was quite exhausted, it displayed itself in a system which, though in some respects isolated in the history of medicine, stands nearest to that of Brown, -- that, namely, of Samuel Hahnemann (see HOMOEOPATHY). Hahnemann (1753-1844) was in conception as revolutionary a reformer of medicine as Paracelsus. He professed to base medicine entirely on a knowledge of symptoms, regarding all investigation of the causes of symptoms as useless. While thus rejecting all the lessons of morbid anatomy and pathology, he put forward views respecting the causes of disease which hardly bear to be seriously stated. All chronic maladies result either from three diseases psora (the itch), syphilis, or sycosis (a skin disease), or else are maladies produced by medicines. Seven-eights of all chronic diseases are produced by itch driven inwards. (FOOTNOTE 814-1) (It is fair to say that these views were published in one of his later works.)
In treatment of disease Hahnemann rejected entirely the notion of a vis medicatrix naturae, and was guided by his well-known principle "similia similibus curantur," which he explained as depending on the law that in order to get rid of a disease some remedy must be given which should substitute for the disease an action dynamically similar, but weaker. The original malady being thus got rid of, the vital force would easily be able to cope with and extinguish the slighter disturbance caused by the remedy. Something very similar was held by Brown, who taught that "indirect debility" was to be cured by a lesser degree of the same stimulus as had caused the original disturbance. Generally, however, Hahnemanns views contradict those of Brown, though moving somewhat in the same plane. In order to select remedies which should fulfil the indication of producing symptoms like those of the disease, Hahnemann made many observations of the action of drugs on healthy persons. He did not originate this line of research, for it had been pursued if not originated by Haller, and cultivated systematically by Tommasini, an Italian "contra-stimulist;" but he carried it out with much elaboration. His results, nevertheless, were vitiated by being obtained in the interest of a theory, and by singular want of discrimination. Hahnemanns doctrines met with much opposition on that part of the medical profession, and he was hence led to state his case to the "lay" public as a sort of court of appeal; and thus matters of science were made the theme of much popular controversy. This expedient, in which Hahnemann had been in a small degree anticipated by Brown, contributed largely to the success of his system. The appeal flattered a prevalent belief in the right of private judgment, even in technical and learned subjects. Hahnemann was thus able to take up the position (and not without justification) of a victim of professional prejudice. The anomalous position into which professional scorn and extra-professional popularity brought him produced a distinct deterioration in the character of his work. In his second period he developed the extraordinary theory of "potentiality" or dynamization, -- namely, that medicines gained in strength by being diluted, if the dilution was accompanied by shaking or pounding, which was supposed to "potentialize" or increase the potency of the medicine. On this extraordinary principle Hahnemann ordered his original tinctures to be reduced in strength to one-fiftieth; these first dilutions again to one-fiftieth; and so on, even till the thirtieth dilution, which he himself used by preference, and to which he ascribed the highest "potentiality." It is hardly necessary to point out that even the lower dilutions involve quantities which no analysis can weigh, measure, or even recognize. The still greater eccentricities of Hahnemanns later works need not be recounted. From a theoretical point of view Hahnemanns is one of the abstract systems, pretending to universality, which modern medicine neither accepts nor finds it worth while to controvert. In the treatment of disease his practical innovations came at a fortunate time, when the excesses of the depletory system had only partially been superseded by the equally injurious opposite extreme of Browns stimulant treatment. Hahnemanns use of mild and often quite inert remedies contrasted favourably with both of these. Further he did good by insisting upon simplicity in prescribing, when it was the custom to give a number of drugs, often heterogeneous and inconsistent, in the same prescription. But these indirect benefits were quite independent of the truth or falsity of his theoretical system.
814-1 The itch is really on affection produced by the presence in the skin of a species of mite (Acarus scabiei), and when this is destroyed or removed the disease is at an end.
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