The friend of health (Hahnemann, 1791) – Part i – 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 exhalations in cellars in which a quantity of yeast or beer has fermented, is soon removed by throwing in fresh slaked lime.
The vapour developed in manufactories where much 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 protective means against poisonous vapours, after we had discovered, by means of chemistry, the exact nature of these exhalations.
But it is quite another thing with the contagious exhalations from dangerous fevers and infectious diseases. They are so subtle that chemistry has never yet been able to subject them to analysis, and consequently has failed to furnish an antidote for them. Most of them are not catching at the distance of a few paces in the open air, not even the plague of the East; but in close chambers these vapours exist in a concentrated form and then become injurious, dangerous, fatal, at a considerable distance from the patient.

Now as we know of no specific antidotes for the several kinds of contagious matters, we must content ourselves with general prophylactic means. Some of these means are sometimes in the power of the patient, but most of them are solely available by the nurse, the physician, and the clergyman, who visit the sick.
As regards the former of these, the patient, if not too weak, may change his room and his bed every day, and the room he is to occupy may, before he comes into it in the morning, be well aired by opening the doors and all the windows. If he have curtains to his bed he may draw them to, and let the fresh air circulate once more through his room, before the physician or clergyman comes to visit him.
The hospitals used by an army in a campaign, which are often established in churches, granaries, or airy sheds, are for that reason much less liable to propagate contagion, and also much more beneficial for the patients than the stationary hospitals, which are often built too close, low, and angular. In the latter, the nurses, physicians, and clergymen often run great risks. And what risks do they not constantly run in the half underground damp dwellings of the lowest class of the people, in the dirty cellars of back courts and narrow lanes that the sun’s reviving rays never shine in, and the pure morning air never reaches, stuffed full with a crowd of pauper families, where pale care, and whining hunger seem for ever to have established their desolating throne!
During the prevalence of contagious diseases the poisonous qualities of the vitiated air are concentrated in such places, so that the odour of the pest is plainly perceptible, and every time the door is opened, a blast of death and desolation escapes. These are the places fraught with greatest danger to physician and clergyman. Is there any mode whereby they can effectually protect their lungs from the Stygian exhalation, when the crying misery on all sides appeals to them, shocks them, and makes them forgetful of self? And yet they must try to discover some preventive! How are they to do so?
I have said above, that we may gradually accustom ourselves to the most poisonous exhalations, and remain pretty well in the midst of them.
But, as is the case with accustoming ourselves to every thing, the advance from one extreme to the other must be made with the utmost caution, and by very small degrees, so it is especially with this.

We become gradually accustomed to the most 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 the most dangerous typhoid fevers, or even have suddenly died by venturing near them, whilst the prisoners themselves, having been gradually accustomed to the atmosphere, enjoy a tolerable health.
In like manner we find that physicians who see patients labouring under malignant fevers rarely and only occasionally, and clergymen whose vocation only requires them to pay a visit now and then, are much more frequently infected than those who visit many such cases in a day.
From these facts naturally proceeds the first condition for those who visit such sick-beds for the first time, “that they should in the commencement rather see their patients more frequently, but each time stay beside them as short a time as possible, keep as far away as possible from the bed or chamber utensil, and especially that they should take care that the sick room be thoroughly aired before their visit.”
After these preliminary steps have been taken with proper caution and due care, we may then, by degrees, remain somewhat longer, especially beside patients with the slighter form of the disease, and of cleanly habits, we may also approach them sufficiently close to be able to feel their pulse and see their tongue, taking the precaution when so near them, to refrain from breathing. All this can be done without any appearance of affectation, anxiety, or constraint.
I have observed, that it is usually the most compassionate, young physicians, who, in epidemics of this sort, are soonest carried off, when they neglect this insufficiently known precaution, perhaps from excessive philanthropy and anxiety about their patients; that on the other hand, the hard hearted sort of every-day doctors who love to make a sensation by the large number of patients they visit daily, and who love to measure the greatness of their medical skill by the agility of their limbs and their rapidity, most certainly escape infection. But there is a wise middle path (which young clergymen who visit the sick are counselled to adopt), whereby they may unite the most sensitive and warmest philanthropy with immunity to their own precious health.

The consideration “that a precipitate self-sacrifice may do them harm but cannot benefit the patient, and that it is better to spare one’s life for the preservation of many, than to hazard it in order to gratify a few,” will make the above first precaution acceptable, viz.-by very gradually approaching and accustoming ourselves to the inflammatory material of the contagion, to blunt by degrees our nerves to the impression of the miasm (morbid exhalation) otherwise so easily communicable. We must not neglect to impress the same precautionary measures on the attendants of the sick person.
The second precaution is “that we should, when visiting the patient, endeavour to maintain our mind and body in a good equilibrium.” This is as much as to say, that during this occupation we must not permit ourselves to be acted on by debilitating emotions; excesses in venery, in anger, grief and care, as also over-exertion of the mind of all sorts, are great promoters of infection.
Hence to attend either as physician or clergyman a dear friend sick of the prevalent fever is a very dangerous occupation, as I have learnt from dear-bought experience.
We should endeavour moreover to preserve as much as possible our usual mode of living, and whilst our strength is still good we should not forget to take food and drink in the usual manner, and duly apportioned to the amount of hunger and thirst we may have. Unusual abstinence or excess in eating and drinking should be carefully avoided.
But in this respect no absolute dietetic rules can be laid down. It has been said that one should not visit patients when one’s stomach is empty, but this is equally erroneous as if it were to be said, one should visit them with an empty stomach. One who like myself is never used to eat anything in the forenoon, would derange his digestion and render himself more susceptible of infection were he, following the old maxim, to eat something for which he had no appetite and visit his patients in this state; and vice versa.
On such occasions we should attend more than ordinarily to our desires for particular articles of diet, and procure if possible that for which we have most appetite, but then only eat as much as will satisfy us.
All over fatigue of the body, chills and night-watchings, should be avoided.

All over fatigue of the body, chills and night-watchings, should be avoided.
Thus we become gradually habituated to the occupation of tending patients suffering from malignant fevers, which is fraught with so much danger and cannot be compensated by any amount of pecuniary remuneration, until at length it becomes almost as difficult to be infected at all as to get the small-pox twice. If under all these circumstances we retain our courage, sympathizing compassionate feelings, and a clear head, we become persons of great importance in the state, not to be recompensed by the favour of princes, but conscious of our lofty destiny and rising superior to ourselves, we dedicate ourselves to the welfare of the very lowest as well as the highest among the people, we become as it were angels of God on earth.
Should the medical man experience in himself some commencing signs of the disease, he should immediately leave off visiting the patient, and if he have not committed any dietetic or regiminal error, I would recommend, notwithstanding I have endeavoured in this book to avoid anything like medicinal prescriptions, the employment of a domestic remedy, so to speak, empirically.
In such cases I have taken a drachm of cinchona bark in wine every three quarters of an hour, until all danger of infection (whatever kind of epidemic fever the disease might be) was completely over.
I can recommend this from my own experience, but am far from insisting upon the performance of this innocuous and powerful precaution by those who are of a different opinion. My reasons would be satisfactory if I could adduce them in this place.
But as it is not enough to protect ourselves from infection, but also necessary not to allow others to come in the way of danger through us, those who have been engaged about such patients should certainly not approach others too nearly until they have changed the clothes they had on when beside the patients for others, and the former should be hung up in an airy place where no one should go near them, until we again need them to visit our patients. Next to the sick-room, infection takes place most easily by means of such clothes, although the person who visits the patient may not have undergone any infection.
A highly respectable and orderly individual who for years had never walked anywhere, but only to his office at the fixed hours, had a female attendant with whom he was on very friendly terms, an old good-natured person, who without his knowledge employed all her leisure hours in making herself useful to a poor family living about a hundred yards from his house, who were lying sick of a putrid fever, the prominent character of which was, a malignant typhoid fever. For a fortnight all went on well; but about this time the gentleman received some intelligence of a very annoying and depressing character, and in a few days, although to my certain knowledge he had seen no one affected with such a disease, he got, in all probability from the clothes of his attendant who was often very close to him, exactly the same kind of malignant fever, only much more malignant. I visited him as a friend with unreserved sympathy as I ought, and I fell sick of the same fever, although I had been already very much accustomed to infection.

This case, together with many other similar ones, taught me that clothes carry far and wide the contagious matter of such fevers, and that depressing mental emotions render persons susceptible to the miasm, even such as are already used to its influence.
It would appear that the lawyer who draws up a will, the notary and the witnesses would, on account of not being habituated to such impressions, run much greater risk of being infected in these cases. I do not deny it; but for them there are modes of escape which are not so accessible to the other persons of whom we have spoken.
Where there is nothing, the sovereign has lost his rights, there is no will to be made. But when wealthy persons wish to make their last will and testament on their sick bed, there are two circumstances in favour of the lawyer and his assistants. As in the formalities of a legal testament, the patient’s bed often cannot remain in its usual situation, and as moreover it is essential for such a testament that the testator should be in full possession of his intellectual faculties, it follows that for those patients who are not absolutely poor another room and another bed may be got ready, thoroughly aired and free from infectious atmosphere. They do not need to remove thither until all this has been properly performed a short time before.
The weakness of the intellect in such patients generally keeps pace with their corporeal weakness, and a patient who possesses sufficient strength of intellect to make his will would not allege that he is too weak to be removed to another bed and room.

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

When a physician or clergyman enters an unfumigated chamber he can at once tell by his sense of smell whether his needful order to air the room has been obeyed or not. All sick people make a disagreeable smell about them. Therefore the freedom from smell of a chamber is the best proof that it has previously been aired, but if fumigations have been had recourse to, the latter becomes doubtful and suspicious. Neither the physician nor the clergyman, neither the sick-nurse nor the patient, require perfumes when they have to think and speak seriously concerning a matter of life and death. They should never be used!