HOMOEOPATHY (from _____, a similarity of feeling or condition) as a distinctive system of medicine owes its origin to Hahnemann, a German physician (see HAHNEMANN). It is customary to regard homoeopathy as a mere system of therapeutics, having reference only to the question how and on what principle is disease to be treated. But a careful student of Hahnemann or of his Organon will soon discover the system with which his name is fundamentally associated is one nor merely therapeutics but of pathology, and that any complete exposition of it must embrace an account of Hahnemanns views of the ultimate nature and cause of disease, as well as of the remedies by which it is to be combated, and the principles or principles on which these are to be selected.
Hahnemann taught that disease is to be regarded as consisting essentially of the symptoms of its as experienced and expressed by the patient, or as detected by the physician; in other words, that the chief symptoms, or the "totality of the symptoms," constitute the disease, and that disease is in no case caused by any material substance, but is only and always a peculiar, dynamic derangement of the health. "Diseases" (Introduction to the Organon, p. 17) "will not cease to be spiritual dynamic derangements of our spiritual vital principle." He says on page 3 of the Organon, "For as far the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses," and at page 18, referring "to small-pox, a disease accompanied by almost general suppuration," he asks, "is it possible to entertain the idea of a material morbific matter being introduced into the blood?" He held that the psoric miasm, of which the itch it the outward and visible and comparatively harmless sign, was at the root of nearly all chronic disease, viz., of all chronic disease that was not due to syphilis or sycosis. He tells us in a note to the 80th section of the Organon that he spent twelve years in the investigations which led to the discovery of that great source of chronic disease and of its remedies (antipsoric remedies). It Was a very essential part of Hahnemanns teaching that nature is a bad physician, and not to be much trusted; that drugs are the real curative agents provided by the beneficence of the Almighty; that drugs given to healthy persons have a power of producing symptoms of disease. The ascertainment of the symptoms produced by drugs in healthy persons is called technically "proving," and the record of such provings constitutes a large part of the literature of homoepathy. This power of drugs he perpetually refers to as their "pathogenetic power." His great therapeutical doctrine, for formulating which his followers call him, with doubtful taste, "the Messiah of Medicine," was to this effect, that there is a correspondence between the symptoms produced by any given drug administered to a healthy person and its power of curing any given disease, and that the remedy for any given disease, that is, for any set of symptoms "in their totality," is that drug which, given to any healthy person, will produce the most perfect imitation of the said set of symptoms; in other words, Similia similibus curantur. Further, the dose of medicine is to be so attenuated as to cure the disease without hurting the patient. This attenuation of medicines constitutes, not only the most popular note of the system of Hahnemann, but that feature of it which is most characteristic of his own views and practice, and which in well-known words he declared to be established beyond the reach of cavil from feature experience either of allopaths or of practitioners of the "new mongrel system made up of a mixture of allopathic and homoeopathic processes." He gives minute directions as to the processes by which this attenuation is to be achieved, the principal of which are trituration, succession, and dilution. These processes developed what he called the spiritual power which lies hid in he inner nature of medicines" (20th section of the Organon). Hahnemann held that medicines became, for curative purposes, more powerful as they became more attenuated; in his last edition of the Organon (1833), and in its last pages, he gave the most expressive evidence of his belief in the virtue of attenuation by saying that he could scarcely name one disease which in the last year he and his assistants had not treated with the most happy results, solely by means of "olfaction"; and he added that a patient even destitute of the sense of smell may expect an equally perfect action and cure from the medicine by olfaction. He condemned strongly the administration simultaneously of a number of medicines, and insisted that only one should be given at a time. Finally, it would be unjust to him not to bear in mind that he claimed to base his views and practice on experience and sound experiment. Some points of his system were borrowed by Hahnemann from previous writersas, indeed, he himself, though imperfectly, admits. Not to mention others, he was anticipated by Hippocrates, and especially by Paracelsus (1495-1541), in his doctrine of Similia similibus curantur, if not in its exclusive application. These identical words occur in the Geneva edition (1658) of the works of Paracelsus, as a marginal heading to one of the paragraphs; and in the "Fragmenta Medica," Op. Omnia, vol. i. 168, 169, occurs the following passage:
Simile similes cura; non contrarium.
"Quisquis enim cum laude agree Medicum volet, is had nugas longe valere jubeat. Nec enim ullus unquam morbus calidus per frigida sanatus fuit, nec frigidus per calida. Simile autem suum simile frequenter curavit, scilicet Mercurius sulphur, et sulphur Mercurium; et sal illa, velut et illa sal. Interdum quidem cum proprietate junctum frigidum sanavit calidum; sed id non factum est rationne frigidi, verum ratione naturae alterius, quam a primo illo omnino diversam facimus."
It is very remarkable that in Hahnemanns enumeration of authors who anticipated him in regard to the doctrine of Similia, he makes no mention of the views of Paracelsus, though the very words seem to be taken from the works of that physician. The other point in Hahnemanns doctrinethat medicines should be tried first on healthy personshe admits to have been enunciated by Haller. Roughly it has been acted on by physicians in all ages, but certainly more systematically since Hahnemanns time, though the result is often not such as t support his theory in regard to the action of medicine on the diseased as compared with the healthy body.
In the most characteristic feature of Hahnemanns practice"the potentizing," dynamizing," of medicinal substanceshe appears to have been original. It has been generally affirmed that he was led to adopt his doctrine of "attenuation" by the fact that the medicines he administered produced similar effects to those of the disease, and that in any gross quantity, as he admitted, they would aggravate matters. But another and a chief reason is to be found in his views of the "spiritual," "immaterial," "dynamic" origin of disease, and his resentment against the old modes of practice of medicine.
The followers of Hahnemann are true to him in making light comparatively of pathological fact, and giving their main attention to therapeutics. They are still concerned mainly with medicines, and one very large American encylopaedia is devoted exclusively to a record of "Provings"; it is edited by Dr Timothy Allen, professor of material medica and therapeutics in the New York Homoeopathic Medical College. For some years Hahnemanns disciples continued pretty faithful to the doctrine of Similia similibus curantur, but they were not long in making some changes in it. We can only notice a few of the leading deviations, Dr Sharp, of Rugby, who has striven hard to overcome objectors, while admitting the doctrine of Similia, requires that it have regard not to mere symptoms, but to the seat and pathology of the case; that the drug used to be one which shall affect the organ at fault. Homoeopathy cannot become a science till it is founded on what he calls Organopathy, or a much more careful consideration of the seat of disease than is involved in Hahnemanns views, who, he complains, passionately rejected pathology and morbid anatomy. Recently a leading homoeopathist has published a book, the very title of which contradicts the doctrine of his master. Hahnemann maintains that cures never were effected in any other manner than by means of medicines of homoeopathic power (Organon, p. 100), and that, whenever cures were wrought by those who did not understand homoeopathy, it was in virtue of the homoeopathic law, "the only law consonant to nature." But in 1878 Dr Kidd, the leading consultant among homoeopathic practitioners in London, published a book on the Laws of Therapeutics. It is true that he does not carry the pluralizing far: he only substitutes two for Hahnemanns one law; but it is not the less a very remarkable departure. He is still faithful to the idea of a relationship between the action of medicines on the healthy and their curative value in sickness; but the law of Similia is sadly compromised. "In most cases that relationship is either of similarity or of contrariety." "Looking," says he, "to the observation of facts apart from theoretic speculations, two primary laws of therapeutics unfold themselves. These two laws of therapeutics may well be called Galens law, founded upon the rule of contraria contrariis and Hahnemanns or the homoeopathic law, founded upon the relationship of similars." This is certainly a comprehensive if a rather unphilosophical generalization. The practice of Hahnemann as to the use of highly attenuated doses of medicine is evidently not more closely adhered to than his doctrine of Similia. This fact is the subject of complaint in homoeopathic journals. The Medical Investigator, in 1876, says reprovingly: "How many claiming to be homoepaths are daily entirely disregarding the law of Similia. It is getting to be quite a rare thing to hear of a homoeopathic practitioner conducting a serious case form beginning to end without using as such cathartics, sudorifics, diuretics, &c., in direct opposition to our law; not only are these drugs used in this way, but thee are some also go so far to say that they cannot be dispensed with." Dr Wyld, the vice-president of the British Homoeopathic Society, in a letter to Dr W. B. Richardson, published in the Lancet of June 2, 1877, arguing for an abolition of the schism of the profession on this question, thus sums up the admissions which he as a somewhat representative man was prepared to make:"First, that the views expressed by Hahnemann are often extravagant and incorrect; Secondary, that Hahnemann are often extravagant and incorrect; Secondly, that Hippocrates was right when he said some diseases are best treated by similars and some by contraries, and therefore it is unwise and correct to assume the title of homoeopathist; Thirdly, that although many believe that he action of the infinitesimal in nature can be demonstrated, its use in medicine is practically by a large number in this country all but abandoned." It must not, however, be supposed that there are not many true believers in Hahnemann;s doctrines both of Sikmilia, &c., and of infinitesimal doses, extending even to olfactions. In fact, one recent writers goes beyond Hahnemann. In the Homoeopathic Observer, after many years of anxious experimenting, he claims to have discovered decided results from olfaction, or the smelling of medicines, but more especially by means of medicines contained in closed vessels held in the hand. Mons. Granier, of Nimes, carries the dynamic theory of Hahnemann farther than its author. "Medicines," he says, "are fluidic powers, they are being (êtres) that man may create at his will. I wish I could say they are occult powers, forming t he chain of fluidic connection between the world and the tomb; but I am convinced in my own mind that, placed on the limits of fluidic dynamism, our observation might cast its scrutinizing glance into the unseen world."
Homoeopathy has a considerable number of adherents in Great Britain, in the United States, and on the continent of Europe. In order to ascertain the esteem accorded to it in the land of its origin, inquiries have been made of neutral and unbiased authorities, and the general result is that it has no scientific recognition, but that many of the public believe in it, and consult practitioners who profess to practice it. The system has no place in any of the universities of Germany, nor does it seem to have a single school of its own in the entire German empire. It is universally condemned in Germany by men who have anything to do with biological science, and even in the lectures on therapeutics it is not mentioned at all. In Great Britain the Medical Act of 1858 gives power to the Privy Council severely to prohibit attempts by any examining body to impose restrictions as to any theory of medicine or surgery on candidates for examination. There is a homoeopathic hospital with 100 beds in London, to which is attached a homoeopathic school (see Dr Wyld in Lancet, June 2, 1877). Homoeopathy is not strong in England. There are said to be 105 homoeopathic practitioners in London. In Great Britain and Ireland, with a population of thirty-five millions, there are but 275 homoeopathic physicians. Liverpool and Glasgrow, each with about half a million of population, have respectively fifteen and five homoeopathic doctors. The somewhat weak and failing condition of homoeopathy in Britain is thus contrasted by a writer in the monthly Homoeopathic Review for January 1880 with its condition in America; in four chief American cities there are 462 homoeopathic doctors, in four English towns 139; in New York city the homoeopathic physicians are to the allopathic as 1 to 6, in London the proportion is 1 to 20. The writer attributes the lower condition of homoeopathy in England to the fact "that it has ceased to be a novelty, that it has revolutionized orthodox medicine, and that many of our own men (homoeopathic practitioners) abjure the minute doses which served so well in the hands of Hahnemann and many of his earlier disciples." But all these facts or factors must obtain equally in America. It is probable that the different system of medical education and qualification in the two centuries has something to do with the difference. In the United States homoeopathy has naturally had freer scope than in Europe. Some have estimated the proportion of homoeopathic practitioners in the State as being one-eight of the whole number of legally qualified practitioners. Every State determines for itself the conditions of qualification in medicine; and there is thus a vast number of separate medical schools giving both education and diplomas. Consequently there is a serious inequality in the severity of medical education and examination. In some States, as in that of Michigan, the legislature has engrafted on the university a department for teaching its youth the principal and therapeutics of homoeopathy; and very lately the same legislature has provided a hospital for the homoeopathic treatment of disease.
In all countries the doctrine of homoeopathy is still without broad scientific recognition; and certainly in England its chief representatives are anxious to cease their existence as a distinctive school, and have, by their avowed departure from Hahnemanns law of Similia, and his mode of attenuating and administering medicines, brought themselves under the severest condemnation of their masters few faithful followers, amongst whom are still included men of high character. We need not discuss in detail the individual doctrines of Hahnemann, especially those just referred to, as they are scarcely fought for by those who now represent what remains of the homoeopathic school. Hanhnemanns fundamental views of disease deserve more attention. He dispersed any deep study of disease, and theorized about it instead. Had he carefully inquired into the nature and natural history of disease as Hippocrates did, or as he himself inquired into the sensations of those who took infinitesimal doses, he would have done more for the word and his own reputation. Hahnemann was easily captivated by theories, and not very sound in his reasoning. But underlying all his system, as we have seen, was the idea that the causes of disease were impalpable, immaterial, spiritual dynamic. And this great foundation was rotten. Modern medicine is doing some of its best work in showing the material and the visible character of the causes of many of the commonest diseases, and suggests this in many cases where it has not as yet been demonstrated. The cause of many diseases is shown to be a living germ or particle which can be discerned under the microscope , can be carried on a lancet or in a tube, and inserted under the skin so as to produce its peculiar disease. This is true of small-pox, Hahnemann notwithstanding. The germ can be preserved or it can be killed, and thus disease can be propagated or prevented. The close air of workshops, which generates consumption in such amount, can be shown to be full of impurities, chemical or organic. The causes of other diseases are often, not merely visible under a microscope, but coarsely visible. We have been lately told on high authority that to produce certain forms of blood-poisoning one or two ounces at least of septic fluid are necessary. So with other forms of common disease. Alcohol does not destroy a liver or kidney in any dynamic or immaterial form, but in coarse quantities diligently repeated. The lead which paralyses the painters wrist is not a "spiritual" thing. It is an accumulation of matter in the wrong place, and enters his body in palpable quantities, and, what is more, can be recovered in similar quantities from his body. SO with the uric acid or its salts in the blood of a person who has inherited his fathers gout, and perhaps his port wine. It is not a "spiritual" affair at all, but can be demonstrated chemically and under the microscope. The itch, to whose mysterious workings Hanhemann attributed two-thirds of the internal diseases of the body, including mania, cancer, gout, &c., is easily demonstrated to be dependent on an ugly crab-like insect, which can be destroyed in a few hours with sulphur, when there is an end both of it and of the itch. We are aware of the euphemistic form which is given to Hanhemanns views of the psoric or itch disease; and we are partly disposed to admit, with the late Professor Henderson, the ablest and wisest of Hanhemanns supporters in England, that Hahnemann was unfortunate in the exposition of his own views of this subject. But Hanhemanns fine but fundamental theories about the spiritual and dynamic origin of disease are all exploded by the revelations of modern pathology, and their demolition only completes that of his therapeutical theories which rested on them.
Still it does not follow that homoeopathy has been of no use. Hahnemann deserves the credit of being the first to break decidedly with the old school of medical practice, in which, forgetful of the teachings of Hippocrates, nature was either overlooked or rudely opposed by wrong and ungentle methods. He was so dissatisfied with this system that he gave up practice. We can scarcely now estimated the force of character and of courage which implied, eighty years back, in abandoning the common lines of medicine. More than this, he and his followers showed results in the treatment of disease which compared very favourably with the results of orthodox practice. But they entirely missed the right conclusion from their experience. Let us take, for example, the statistics of the treatment of the lung (pneumonia), adduced, not by Hahnemann,for it is one of his very weak points that he did not record cases,but, after his death, by Dr Fleischmann of Vienna. Dr Henderson quotes these and other homoeopathic statistics with great satisfaction, and undoubtedly and properly they produced a great effect, showing a mortality of 1 in 21 cases only, which was a much higher percentage of success than under the ordinary treatment. But these statistics have since been entirely eclipsed by the minute and historical record of cases treated in the Edinburgh Infirmary, where the late Dr Hughes Bennett treated 105 cases of acute pneumonia, extending over sixteen years, without one death. Still we must admit that Fleischmanns results were greatly better than the old ones, and that but for the homoeopathic practice, which most practitioners regarded as a negation, tantamount to leaving the disease to nature, the emancipation from traditional methods of treatment would have been much slower than it was.
Besides this, homoeopathy may be credited with two other services. It has given prominence to the therapeutical side of medicine, and has done much to stimulate the study of the physiological action of drugs. No doubt Hahnemann completely erred in despising nature, and in magnifying medicines in the cure of disease. But his very methods showed, unintentionally on his part, what nature could do; and his devotion and that of his school to therapeutics has acted as a somewhat deserved rebuke to those physicians who get so absorbed in the study of disease as to forget that the great interest of mankind in it is to have it cured with as little delay as possible. It may be admitted that homoeopathy has done some service in directing more special attention to various powerful drugs, such as aconite, nux vomica, belladonna, and to the advantage of giving them in similar forms than were common before the days of Hahnemann.
Hahnemanns errors were great. His doctrine of specifics was highly retrograde and unscientific, and his disparagement of the principle of tolle causum and of those who aimed at discovering the causes of disease (Organon, p. 3) was unphilosophical. He was fanciful and theoretical to a very high degree. He led his followers far out of the track of sound views of disease and the methods by which it can best be prevented and cured. But, with all his defects, it must be admitted that he had the great merit of disturbing and discrediting indefensible modes of practice. (J. G. G.)
FOOTNOTES (page. 126)
1 An ancient English metrical homiliarium exists in the library of the university of Cambridge, of which earlier versions have existed, and a portion of perhaps the earliest copy, dating from about the middle of the 13th century, was published in 1862 by Mr J. Small, librarian to the university of Edinburgh.
The above article was written by James Grey Glover, M.D., L.R.C.S; Direct Representative of the Profession in the General Medical Council; Member of Council of the Metropolitan Hospital Sunday Fund; contributor to the Lancet and the Practitioner.