{"id":45313,"date":"2019-08-09T15:33:55","date_gmt":"2019-08-09T14:33:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45313"},"modified":"2019-08-16T15:09:11","modified_gmt":"2019-08-16T14:09:11","slug":"jeffrey-aronson-when-i-use-a-word-nothing-is-not-a-poison","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/08\/09\/jeffrey-aronson-when-i-use-a-word-nothing-is-not-a-poison\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . &#8220;Nothing is not a poison&#8221;"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\" alt=\"\" width=\"127\" height=\"159\" \/><\/a>Paracelsus was a Swiss physician, alchemist, and astrologer, born Philippus Aureolus Theophrastus Bombastus von Hohenheim in about 1493. He died in 1541, and his <\/span><i><span style=\"font-weight: 400\">Sieben Defensiones<\/span><\/i><span style=\"font-weight: 400\">, written in 1538, were published posthumously in Cologne in 1564 in Swiss-German, and translated into Latin, as <\/span><i><span style=\"font-weight: 400\">Septem Defensiones<\/span><\/i><span style=\"font-weight: 400\">, in 1566. In the third defence (<\/span><i><span style=\"font-weight: 400\">Die dritte Defension wegen des Schreibens der neuen Rezepte<\/span><\/i><span style=\"font-weight: 400\">), Paracelsus wrote his now much quoted text: \u201cWas ist das nit gifft ist? alle ding sind gift und nichts ohn gifft. Allein die dosis macht das ein ding kein gifft ist.\u201d In English: \u201cWhat is there that is not a poison? Every thing [<\/span><i><span style=\"font-weight: 400\">sic<\/span><\/i><span style=\"font-weight: 400\">] is a poison and nothing is not a poison. Only the dose determines that a thing is not a poison.\u201d A Latin translation appeared in the margin of the 1564 edition (below).<\/span><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/08\/Jeffrey-Aronson-nothing-is-not-a-posion-fig-1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-45315 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/08\/Jeffrey-Aronson-nothing-is-not-a-posion-fig-1.jpg\" alt=\"\" width=\"625\" height=\"557\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/08\/Jeffrey-Aronson-nothing-is-not-a-posion-fig-1.jpg 625w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/08\/Jeffrey-Aronson-nothing-is-not-a-posion-fig-1-300x267.jpg 300w\" sizes=\"auto, (max-width: 625px) 100vw, 625px\" \/><\/a><\/p>\n<p><span style=\"font-weight: 400\">The words \u201calle ding\u201d (\u201cevery thing\u201d) are ambiguous. Instead of the traditional medical philosophy, based on the four humours, the four elements, and Aristotle\u2019s four qualities, Paracelsus proposed a tripartite system, reflecting the Trinity and threefold human nature, consisting of soul, spirit, and body. The three educational pillars on which he thought his system should be built were astronomy, natural philosophy, and alchemy, reflecting the heavens, the earth, and human biology. Seeking a name for the elements of his new philosophy, and wanting to avoid the word \u201celements\u201d itself, he rejected words such as the Latin terms corpora (bodies), essentiae (essentials or essences), and species (classes), and the German words ersten (first things), and st\u00fccke (pieces), and finally settled on \u201cdingen\u201d, literally just \u201cthings\u201d.<\/span><\/p>\n<p><span style=\"font-weight: 400\">At a time when most medicines were herbal, Paracelsus\u2019s tripartite scheme involved the use of mercury, sulphur, and salt as therapeutic principles, or arcana (secret remedies), which he called \u201cdrei dingen\u201d (\u201cthree things\u201d) and which he considered to be the prime sources of all the matter in the universe, the causes of diseases, and at the same time possible cures. By \u201csalt\u201d he meant what we would nowadays call metallic salts, such as those of antimony, arsenic, copper, iron, lead, magnesium, mercury, and potassium, particularly potassium nitrate (sal nitri, nitre, or saltpetre).<\/span><\/p>\n<p><span style=\"font-weight: 400\">Paracelsus wrote <\/span><i><span style=\"font-weight: 400\">The Third Defence<\/span><\/i><span style=\"font-weight: 400\"> in response to herbalists\u2019 criticisms of his treatment of syphilis. Read in isolation, as it is usually quoted, \u201calle ding sind gifft\u201d, cannot be clearly interpreted: he might have been specifically referring to his therapies, the drei dingen. However, elsewhere in <\/span><i><span style=\"font-weight: 400\">The Third Defence<\/span><\/i><span style=\"font-weight: 400\"> he stated that all therapeutic substances are indeed potential poisons. His reply to those who criticized him for using poisons in his therapeutic practice takes the line that there are poisons in nature, but that God put them there, and when used properly they do not have to be poisonous. \u201cWhy should a poison be denounced?\u201d he writes. \u201cHe who denounces a poison does not understand its composition.\u201d Take purgatives, for example. \u201cWa[s] ist ein Purgatio?\u201d he asks, and the answer, in the marginal Latin translation, is \u201cOmnis purgatio venenum, si non servetur dosis\u201d; \u201cEvery purgative is a poison if the dose is not heeded\u201d (Figure 1). Theriac, he points out, used as an antidote to poison, was itself obtained from the venom of poisonous vipers. Even food and drink is poisonous, he suggests, if taken in too great quantities. Then he adds, \u201cThe main point is that the dose should not be too large or too small. He who uses a middling dose will not cause poisoning.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">It would be surprising if Paracelsus had not recognized that too little of anything, or at least any thing, would be ineffective. His view that the same things could both cause and cure diseases was not Hahnemann\u2019s homoeopathic view that \u201csimilia similibus curantur\u201d. Paracelsus appreciated that a dose might be too small to be effective and that too large a dose would be poisonous. It therefore seems likely that he would have thought it logical that there must be a dose in between that would be both effective and not poisonous. This description may even have been seen as according with his more general tripartite theory. Perhaps he fully understood the complete nature of the graded dose\u2013response curve, but we cannot be sure from the evidence of his text.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It took a further 300 years before the proper nature of dose-responsiveness started to become fully appreciated.<\/span><\/p>\n<p><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Paracelsus was a Swiss physician, alchemist, and astrologer, born Philippus Aureolus Theophrastus Bombastus von Hohenheim in about 1493. He died in 1541, and his Sieben Defensiones, written in 1538, were [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/08\/09\/jeffrey-aronson-when-i-use-a-word-nothing-is-not-a-poison\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-45313","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I Use a Word . . . &quot;Nothing is not a poison&quot; - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/08\/09\/jeffrey-aronson-when-i-use-a-word-nothing-is-not-a-poison\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jeffrey Aronson: When I Use a Word . . . &quot;Nothing is not a poison&quot; - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Paracelsus was a Swiss physician, alchemist, and astrologer, born Philippus Aureolus Theophrastus Bombastus von Hohenheim in about 1493. 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