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Diseases are cured, not by eloquence, but by remedies well and duly applied, of which, if any sage and discreet man, though he have no tongue, know well the proper usage, he shall become a greater physician than if, without practice, he ornament well his language. -- Cornelius Celsus (21 B.C.-50 A.D.).
If scientific medicine today is withstanding nonchalantly the assaults of a myriad of systems, cults, and quackeries, it is merely repeating the history of other periods. The eighteenth century, for example, was predominantly a time of revolutionary systems and theories in medicine. There was the dynamico-organic system of Stahl, who believed that the soul was the supreme principle of disease. There was the mechanico-dynamic system of Hoffman teaching that life expresses itself in motion, and that all manifestations within the body are controlled by nervous spirit. The school of Montpellier taught that various organs possess individual life. Mesmer, prince of imposters, claimed that magnetic fluid poured from the hand, and the Brunonian system asserted that it was only necessary for a cure to determine the grade of disease in accordance with the strength or weakness of the active irritation, and to adjust the right proportion of strengthening or weakening medicines to the case. Further, there remained from previous centuries phlogistic and antiphlogistic theories, the view that all disease was caused by the impaction of debris and obstruction of the intestines, and half a dozen other assorted hypotheses.
At the end of the century, scientific medicine had little of its own to offer. Pasteur had not discovered the bacteria, Lister had not given us asepsis, chemistry was only beginning to be a science, and the other fundamental medical sciences -anatomy, pathology, biology, and physiology-had just begun to sort out their facts from a welter of hypotheses. Drugs were known in abundance, but there was nothing comparable to the scientific pharmacology of today. All sorts of mixtures and combinations were used without reference to the effects that the ingredients of a mixture might have upon one another. When a positive action was obtained it was credited to the mixture and not to the individual ingredient responsible. Such was the scene just before 1800. Upon this stage there stepped a remarkable figure, Samuel Christian Friedrich Hahnemann, born at Meissen in Germany in 1755.
After studying at Leipzig and Vienna, Hahnemann graduated in medicine at Erlangen in 1779, but he became dissatisfied with the practice of his profession and retired for reflection and study. In 1790 there came into his hands a materia medica written by William Cullen of Lanarkshire. Cullen was professor of medicine at Glasgow and Edinburgh and founder himself of a system of medicine which emphasized the importance of the nerves, and assumed that the brain was indissolubly united with the soul. Cullen, however, was a practical man; his therapeutics were simple and he deplored the excessive bloodletting which was a feature of the medicine of the time. It had already been attacked by Le Sage in Gil Blas, by Moliere, and by many others Hahnemann read in the book by Cullen that Peruvian bark, the source of quinine, would cure malaria. This was true; quinine does cure malaria. But what did Hahnemann do with the observation? Unfortunately, he did not know that malaria is caused by a plasmodium which gets into the blood through the agency of the mosquito; the plasmodium was not discovered by Laveran until November 6, 1880. So Hahnemann evolved the theory that perhaps quinine cured malaria because it would produce symptoms like those of malaria if given to a healthy man. He tried it on himself and it did. With this idea fixed in his mind, he returned to the practice of medicine in 1796, and his remarkable hypothesis became the basis of the system called homeopathy, expressed in the phrase similia similibus curantur, "like cures like."
This idea was not really original; it was essentially a revival of the old Paracelsian doctrine of signatures -- like cures like -- except that Paracelsus directed his attack toward the cause of the disease rather than at the symptoms. There are, in fact, some who assert that Milton, in his preface to Samson Agonistes, was alluding to the same thing as practiced in his time:
(Tragedy is) therefore said by Aristotle to be of power, by raising pity and fear, or terror, to purge the mind of those and such like passions; that is, to temper and reduce them to just measure with a kind of delight, stirred up by reading or seeing those passions well imitated. Nor is Nature wanting in her own effort to make good his assertion: for so in physic, things of melancholic hue and quality are used against melancholy, sour against sour, salt to remove salt humors.
The idea, therefore, was not new.
After his return to practice, it became Hahnemann's chief interest in life to propagate his theory. He began at once to write extensively, and it is significant that he did not confine his propaganda to the medical profession but addressed the public as well. Furthermore, it is a fact that he received all students, all applicants for knowledge of his methods, whether or not they had been previously trained in medicine. Then in 1810, he presented to the world the homeopathic bible, Organon der Rationellen Heilkunde.
The Hahnemannian system of disease and its healing, as presented in this book, involved three main tenets: first, that diseases or symptoms of disease are curable by particular drugs which produce similar pathologic effects upon the healthy body; second, that the dynamic effect or force of drugs is increased by giving them in very small doses, even diluted to a decillionth of their original strength, and lastly, that chronic diseases are a manifestation of a suppressed itch or "psora."
Hahnemann seems to have known practically nothing of, or to have been unwilling to recognize, the existence of those definite changes in the human body that are associated with disease, and that are now included under the science of pathology. To him disease was chiefly a matter of the spirit. "Diseases," he said, "will not cease to be dynamic aberrations of our spiritlike life, manifested by sensations and actions." This spiritual theory, in which Hahnemann believed so implicitly, dominated subsequent homeopathic literature. The "dynamis" not only lay at the bottom of disease; it was also responsible for the power exerted by drugs in working cures.
Hahnemann's theory of "psora" or itch was essentially so preposterous that it began to be deserted even by confirmed homeopathists almost immediately. The "psora" was a miasm or evil spirit which pervaded the body and ultimately manifested itself on the surface in the form of an eruption, or as a nodular growth, or as some other form of skin disturbance. It was Hahnemann's idea that the outward manifestation was a salubrious mechanism for the relief of the inner condition.
The Organon said:
The only really salutary treatment is that of the homeopathic method, according to which the totality of symptoms of a natural disease is combated by a medicine in commensurate doses, capable of creating in the healthy body symptoms most similar to those of the natural disease.
By administering a medicinal potency chosen exactly in accordance with the similitude of symptoms, a somewhat stronger, similar, artificial morbid affection is implanted upon the vital power deranged by natural disease; this artificial affection is substituted, as it were, for the weaker Similar natural disease against which the instinctive vital force, now only excited to stronger effort by the drug affection, needs only to direct its increased energy; but owing to its brief duration it will soon be overcome by the vital force, which, liberated first from the natural disease, and then from the substituted natural disease, and then from the substituted artificial (drug) affection, now again finds itself enabled to continue the life of the organism in health.
In simpler terms, the conception was that the drugs induced a condition which was substituted for the actual disease, and that the body could easily get rid of the substitute. That, in brief, was the pharmacologic doctrine of homeopathy.
It will be remembered that Hahnemann arrived at his method of treatment by observing the symptoms caused by a dose of Peruvian bark. In 1771 Albrecht von Haller had first suggested the method of testing the virtues of drugs by trying them on healthy human beings. The method was revived by Hahnemann, and called "proving a drug." Not only did medical men test drugs upon themselves under this proving system, but all sorts of other proving tests were made by all kinds of more or less qualified individuals. The results, as might be expected, were remarkable. One decillionth of a grain of table salt was found by an imaginative prover to produce on himself 1,349 symptoms. And while the dosages of the early homeopaths often reached the heights of futility, the preparations they used were sometimes of a highly poetic and romantic nature. In a catalogue of homeopathic remedies appeared such strange substances as lachryma filia, the tears of a young girl in great grief and suffering, used for great grief and suffering in young girls. Then there was flavus irides, the yellow ray of the spectrum, there were extracts of three kind of pediculi, or lice, and anticipating the modern gland craze, there were extracts of all of the body glands then known. The strength of the drugs used may be estimated from the fact that a child in Gloucester County, Virginia, took $8 worth of homeopathic medicine at a single sitting, the entire supply of the family for a year, and, not knowing that anything ought to happen, didn't have a symptom!
The physicians who were attempting to follow the wavering path of scientific medicine through the mass of medieval superstitions which beset it at that time suddenly found themselves placed on the defensive. Compared to the general medical practice of the age, the system of Hahnemann, though quite fallacious, had two things in its favor: it replaced mixtures of powerful drugs in large doses by small doses of simple ones. Thus a widely used prescription was Rush's Thunderbolt, developed by Benjamin Rush, signer of the Declaration of Independence. It gave ten grains of jalap and ten of calomel at a single dose. A patient who had just tried it thereafter craved weak medicine. Moreover, homeopathy carried with it, as any new and revolutionary system always does, a powerful appeal to the lay imagination. Professors Meyer-Steinheg of Jena and Sudhoff of Leipzig, two of the world's greatest medical historians, assert that the influence of Hahnemann was, on the whole, certainly for good. He emphasized the individualization of the patient in the handling of disease, he stopped the progress of half a dozen or more peculiar systems of treatment based on a false pathology, and he demonstrated the value of testing the actual virtues of drugs by trial. It is probably true that any criticisms which might be brought against him in the light of later and better knowledge apply equally well against a large part of the other medicine of his time. Moreover, we must not hold against him the vagaries and exaggerations into which some of his disciples drifted.
What was the immediate success of homeopathy? In 1821, in Leipzig, the first homeopathic journal was published, the Archives of the Homeopathic Method of Curing Disease. In Austria, where homeopathy appeared in 1819, it was forbidden by an imperial decree, but it nevertheless made progress and the decree was revoked in 1837. It reached Italy and Denmark in 1821. Quinn, a physician, introduced the method into Great Britain in 1827, but shortly thereafter medical opposition became strong and practitioners of homeopathy were denied the right to practice. This prohibition, after a long contest, was revoked, and by the eighties homeopathy was prospering. A homeopathic hospital was opened in 1887 in Liverpool on an endowment by Henry Tate, a sugar refiner. The first homeopathic dispensary had been opened in 1841, the second in 1867. In 1885, it was reported that the English dispensaries treated 78,881 patients, or 1,516 a week. At the dedication of the hospital in 1887 a conference of homeopathic practitioners was held, and the hope was expressed that a homeopathic surgeon would soon arrive to take care of work referred by homeopathic practitioners.
But nowhere did homeopathy flourish as it did in the United States. It was apparently brought to this country in 1825. The first homeopathic medical college was organized in Philadelphia in 1848, the next in New York in 1858. About 1880 the homeopathic practitioners were at the height of their influence. Many tales might ' be told of the battles within the medical fraternity to determine whether the homeopathic or the regular party should control. Indeed, there are whisperings of a session of the American Medical Association at which a phalanx of homeopathic practitioners assaulted the platform and dragged the speakers bodily from their perch. Homeopathic schools appeared in abundance. In 1880 there were in the United States, 72 regular medical colleges, 12 homeopathic colleges, and 6 eclectic colleges. In 1890 there were 93 regular, 14 homeopathic, and 8 eclectic. In 1900, there were 121 regular, 22 homeopathic, and 10 eclectic. And in 1900 the homeopathic practitioners, assembled in Washington, D. C., dedicated a monument in granite and bronze to:
But from that year the influence of homeopathy began to decline steadily, its schools to close their doors or to merge with regular medical schools, and its practitioners to practice in increasing measure what they called "allopathic" medicine. What happened to bring about this remarkable and sudden change? Undoubtedly two influences, both brought to bear on medical education, induced the ultimate collapse.
The first educational number of The Journal of the American Medical Association was published on September 21, 1901. It listed the medical colleges in the United States, the type of education and preliminary entrance requirements enforced in each school, and its provisions for didactic and clinical teaching. It showed that there were 124 regular medical schools, 10 eclectic schools, and 21 homeopathic schools, and it pointed out their qualities and their deficiencies. The poor schools began to wilt and fade-and many of the homeopathic schools were poor ones. By 1905 their graduates were fewer in number than in any year since 1880. In 1907, there were but seventeen homeopathic schools left; in 1908, but sixteen; in 1909, fourteen; in 1912, ten; in 1915, eight; in 1921, five; and in 1925, there remained but two, and one of these carried a low classification. Altogether during 1923, there were just forty-nine homeopathic graduates.
At the end of 1931, homeopathic medicine continued to be taught only in the New York Homeopathic Medical College and Flower Hospital of New York, and in the Hahnemann Medical College and Hospital in Philadelphia. In the former institution 348 students were registered, and there were 77 men and 3 women graduates. In the Philadelphia institution there were 502 students and 93 graduates for the year. However, in these institutions the medicine that is taught is not homeopathic medicine in the old sense of the word, but modern medicine with some reflection of the history of homeopathy.
In the meantime, gatherings of homeopaths view with interest attempts made abroad to read into the knowledge of the present the homeopathic theories of the past. The demand among young men for opportunity to study medicine is far greater than the number of places available in American medical schools. Hence institutions that give reliable four-year courses are bound to be crowded with students regardless of any strange notions that they may teach, provided they, at the same time, have complete qualifications in medical science. When the homeopathic graduate takes his place in the community he practices regular medicine.
Publicity is a powerful tool. Students who observed the gradual decline of homeopathy began to seek regular schools; in fact, many a young man who had been doctored in his early youth by a homeopathic physician was advised by that very physician not to enter a homeopathic college. The fact is, indeed, that homeopathy died from within. The very disciples of Hahnemann, and most of the more enlightened practitioners of homeopathy since Hahnemann's time, when they came into practice, found their system unavailing in the face of serious illness. They then availed themselves of the right of every practitioner of medicine to use any treatment that may be for the good of his patient. They informed themselves of scientific medicine and prescribed drugs in doses that would work. The American Institute of Homeopathy, the official organization, finally adopted the definition: "A homeopathic physician is one who adds to his knowledge of medicine a special knowledge of homeopathic therapeutics and observes the Law of Similia. All that pertains to the great field of medical learning is his, by tradition, by inheritance, by right." This was essentially a desire to allow homeopathic practitioners to prescribe "old school" drugs in old school doses. It was a confession of inadequacy and failure.
While homeopathy, as a school, though not the individual homeopathist, had stood still and clung to its law of similars and to Hahnemann's unprovable theory, scientific medicine had been sweeping onward with steady, sure progress. Before such a fact as the inevitable response of the heart to an adequate dose of digitalis, any theory of dynamics and vibrations which called for splitting that dose into decillionth parts was bound to evaporate. Before the rapid effects of the satisfactory administration of mercury and "606," measurable by a Wassermann test, theories of "psora" and similars could not exist. The effects of efficient dosages are, as Celsus asserted, positive, sure, visible, convincing. They need no argument, they speak for themselves. Thus, by 1900, all that remained of the original homeopath was the law of similars and the method of using them. Otherwise homeopaths were prescribing diphtheria antitoxin and forgetting belladonna; they were practicing surgery; they were using full doses of drugs when they wanted to get action. It came down to this: that a homeopath was just like any other physician, except that he gave what were essentially nothing but placebos in minor conditions. When the regular medical schools began to raise their standards, the homeopathic schools had to do the same or confess their inferiority. And when they did the same, they lost their students, who had been attracted chiefly by their lower standards, and had to close their doors anyway.
Thus passed the homeopathic system. Thus, in fact, pass all systems in the practice of medicine. Scientific medicine absorbs from them that which is good, if there is any good, and then they die. Perhaps osteopathy has taught us something by its stress on massage; perhaps even Eddyism has made itself valuable by showing the value of suggestion in conditions affecting the mind. Others, such as chiropractic and Abramsism, teach only the ease with which delusions may be foisted on the public. The history of homeopathy is distinct and peculiar. It records the propounding and acceptance of a theory which, in itself wrong, nevertheless influenced the steps of a beginning science into paths that were right.
Dr. Fishbein, who served for 25 years as editor of the Journal of the American Medical Association, was probably the most vigorous crusader against quackery who ever lived. The above passage appeared in 1932 in the homeopathy chapter of his book Fads and Fallacies in Healing: An Analysis of the Foibles of the Healing Cults, with Essays on Various Other Peculiar Notions in the Health Field, published by Blue Ribbon Books in New York City.