Homeopathy In Perspective
A Critical Appraisal
Smashwords Edition
Copyright 2009 Anthony Campbell
Smashwords Edition: Licence Notes
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The picture on the cover is of the Hahnemann Memorial at Scott Circle, Washington DC.
About the author:
I was a consultant physician at The Royal London Homeopathic Hospital for over 20 years. This is the largest hospital for the study and practice of homeopathy and other forms of complementary medicine in Britain; it is a NHS hospital. I am a former editor of the British Homeopathic Journal (now Homeopathy). All the staff who work at the hospital are conventionally qualified in their own fields as well as in complementary medicine.
From a review by Dr John Floyd:
Thank you for clearing up my fog re homeopathy. I had generally grouped it with herbalism and the other "alternative" therapeutic offerings, but without knowing much about it.
Contents
PART I ORIGINS AND DEVELOPMENT
Chapter 2 Hahnemann's Discovery
Chapter 3 Hahnemann's Later Ideas
Chapter 6 Early English Homeopathy
Chapter 7 Homeopathy in America
Chapter 9 The Twentieth Century
Chapter 10 The Occult and Mesmer
PART 2 HOMEOPATHY TODAY
Chapter 11 Can We Prove Homeopathy
Chapter 12 Assessing Homeopathy
Appendix A Books cited in the text
Appendix B Reviews and meta-analyses cited
Appendix C Modern provings cited
Appendix D Clinical trials cited
Appendix F Potency studies cited
Preface
This is is a book about homeopathy: what it is, how it developed, where it stands today. It is written for people with questioning minds; anyone who has adopted a fixed opinion in advance about homeopathy, either for or against, may receive the odd shock.
No prior knowledge of homeopathy is assumed, but this doesn't mean that the book is meant only for beginners. Even if you have read a good deal about homeopathy previously you may, I believe, find that you view it in a different light after you have finished. What I try to do here is to look at homeopathy as squarely as possible and to provide the facts as I see them. What you then make of them is up to you. I think this is worth doing because the material I present is not well known even to many homeopaths, yet it's essential for anyone who wants to make an informed judgement about homeopathy. These facts are not, to my knowledge, easily available anywhere else; it certainly took me a long time to learn them.
The book is in two parts. Part I explains the origins of homeopathy and how it came to be where it is today. It provides explanations for some of the more outlandish ideas in homeopathy and sets them in their historical context, without which it is not really possible to form an adequate idea of the subject. Part II is concerned with homeopathy now and considers the evidence for its effectiveness. I do this by looking at the research evidence and also by describing my own experience, over 24 years, of actually using the treatment.
If you want to get a proper understanding of homeopathy you should read both parts. If you are mainly interested in evaluating it from a scientific and clinical point of view you could start with Part II, though you may need to refer back to Part I if some of the ideas and terminology are unfamiliar to you.
I thought it best not to burden the text with footnotes in the style of a scholarly monograph, but the appendices provide references and reading lists for those who want to take their study of the subject further.
PART I ORIGINS AND DEVELOPMENT
Chapter 1 Introduction
Homeopathy is under attack today, at least in Britain. There is nothing new about this, of course; throughout its 200-year history it has been repeatedly criticised as inherently absurd and useless, yet it has survived. The main difference now is that the National Health Service currently funds five homeopathic hospitals and, in a time of limited resources and ever more expensive conventional treatments, it is becoming increasingly difficult to justify the outlay on homeopathy, at least in the view of critics. True, there is still a lot of demand for this form of treatment from patients, but funding health authorities are asking for evidence of efficacy and this is not easy to provide. The media, which until recently were pretty uniformly sympathetic to homeopathy, are beginning to be less so or even downright hostile. All this is likely to seem puzzling to people who know little about the subject. In this book I try to present the facts as opposed to the rhetoric.
A brief overview of the territory
Homeopathy is a system of medicine that was introduced in the early nineteenth century by a German physician, Samuel Christian Hahnemann (1755-1843). It was based on the idea of “like curing like”. Later, Hahnemann also introduced the use of very small doses, which he came to believe were actually more effective than larger ones; this is the feature that has most strongly captured the popular attention.
Homeopathy spread widely in Europe in the 19th century and was brought to England and also to the USA, where it became very successful after the Civil War. In the USA it took on a different character, when it was coloured by ideas derived from the Swedish mystic Emanuel Swedenborg. Towards the end of the nineteenth century an American homeopath and Swedenborgian, James Tyler Kent, was very influential and his ideas were brought to Britain, where they became the dominant homeopathic orthodoxy after the First World War.
Kentian homeopathy subsequently was exported all over the world and is still widespread today. It is characterized by hostility to orthodox medicine, the use of very dilute medicines (“high potencies”), and emphasis on the psychological and “spiritual” characteristics of patients. Many of the more extreme features of modern homeopathy can be ascribed to Kent. Other forms of homeopathy do however exist: for example, “complex homeopathy”, much used in Germany, where it tends to shade off into herbal medicine (phytotherapy).
There is a sense in which homeopathy could be thought of as a kind of medical coelacanth, a survival from an earlier age. Still, it has had to move with the times and this means accepting the need to test the treatment objectively by means of controlled trials. These have been done to some extent and have given mixed results. In spite of continuing uncertainty about its efficacy, homeopathy answers a need felt by many people and for this reason alone it is likely to continue to be used in the twenty-first century.
A typical homeopathic consultation
A homeopathic consultation generally differs quite a lot from what goes on in a conventional doctor’s surgery. Suppose you go to see your GP with what you suspect is arthritis. She will ask you a number of questions with the aim of reaching a diagnosis. She will want to know how long you have had the symptoms, how they began, which joints are affected, and so on. She will examine your joints and probably your other systems as well – heart, lungs, skin, for example. She will arrange for some blood tests. At the end of this process she will reach a diagnosis, perhaps rheumatoid arthritis. She will then prescribe some treatment or, if necessary, refer you to a rheumatology specialist for a further opinion.
What has been happening throughout all this is a process of elimination. The doctor is excluding other causes for your symptoms until she is left with rheumatoid arthritis as the only reasonable conclusion. This is quite similar to what a detective does in solving a crime – putting together facts, making hypotheses, testing them to see if they are valid. The science or art of making a diagnosis in this way is one of the main things taught at medical school.
A homeopathic consultation, in contrast, is not concerned with diagnosis in this sense, although if the homeopath is medically qualified she will have made a conventional diagnosis in addition. But the essence of homeopathy is said to be individualization. Instead of seeking to place you in a class (the rheumatoid arthritis class in this case) the homeopath is interested in those features that distinguish you from other patients with broadly similar symptoms. This is in many ways the opposite of what happens in a conventional consultation.
For example, she will ask about things that make your pain better or worse – heat, cold, movement, and about your emotional reactions to your symptoms – whether you get irritable, weepy, fearful, or worried. She will also ask a range of general questions about your appetite, sleep, reactions to weather, food likes and dislikes, and other things that have nothing directly to do with your complaint. Here she is using the homeopathic concept of “constitution”; many though not all homeopaths believe that patients can be classified in a number of groups according to their personalities and that this may give an important clue to the kind of medicine, or remedy, they require.
Obtaining all this information can take a long time – up to an hour or even longer. Armed with it the homeopath will now try to decide on the right medicine for you. In the past this often entailed referring to a large book, called a repertory, in which various symptoms are listed according to the remedies that correspond to them. As there are often hundreds of these for a particular symptom a lot of complicated sifting and cross-referencing is called for, and the task has been computerized to make it easier and quicker. Several programs are available for this purpose and many homeopaths now make use of them.
Having decided on what she hopes will be the right remedy the homeopath will prescribe it in one of several forms. It may be a liquid, tasting of alcohol; a sugary powder, to be dissolved on the tongue; or little globules of sugar. You may be asked to take just a single dose of the remedy, though this may be split in three to be taken over twenty-four hours, or you may be given a number of tablets to take once or twice daily for several weeks; other ways of taking the medicines are also possible. In any case, you will probably be asked to return in a few weeks to report progress.
You will probably be warned that your symptoms may become worse at first; this is the so-called homeopathic aggravation, which is generally thought to be a good sign – the right medicine has been chosen. You may be advised to avoid coffee and tea and told to keep the medicines away from strong light or scent. If you ask how homeopathy works you will be told that it stimulates the body to heal itself and that it is “getting at the root” of the problem.
When you return for your second consultation you will be asked how you got on. The homeopath will be particularly interested in any changes in your mood, appetite, and particularly your general sense of well-being. Depending on what has happened she will decide whether to repeat the remedy, change to a different one, or do nothing. The last possibility may well surprise you but the homeopath will explain that it is a principle of this form of treatment not to repeat the treatment until its effects begin to wear off. Many homeopaths believe that remedies can continue acting for weeks or even months. Homeopaths warn their patients that treatment of chronic disease is likely to be lengthy and quick results are often not to be expected.
The description I’ve just given applies to chronic disease, such as rheumatoid arthritis. Homeopathy originally developed as a treatment for acute disease, however, and in this case the consultation need not be so long or so detailed. An acute sore throat, for example, is often treated with one of a quite small range of remedies and the homeopath may be satisfied to prescribe on just a few presenting symptoms in these circumstances.
If you are encountering homeopathy for the first time you will probably feel that you have received a gratifying amount of individual attention but you are also likely to find it pretty mystifying. That was certainly my experience.
My background in homeopathy
I first became involved with with homeopathy in 1974, when I began working and studying at The Royal London Homeopathic Hospital (RLHH), which is the largest of the five National Health Service homeopathic hospitals in Britain. At the time I had just completed a period of intensive study to obtain membership of the Royal College of Physicians and was looking about for a new direction professionally. Even so, I knew nothing about homeopathy and would not have thought of taking it up, were it not for a friend whose opinion I respected and who told me she had found it to be impressively effective.
In part, homeopathy appealed to me because it was different. Conventional medicine in the early 1970s seemed not to be going forward very fast. Little new was happening and medical advances, such as they were, consisted mainly in ringing the changes on the existing antibiotics and antidepressants. If homeopathy really worked, as my friend assured me from her own experience it did, it seemed to offer a new and potentially exciting alternative.
I therefore registered to take an introductory course at the hospital. Here I quickly found myself floundering in unknown waters. The names of the medicines were nearly all unfamiliar and I thought I must have misheard when a lecturer mentioned casually that she had used a more dilute preparation in order to obtain a bigger effect. These things were disturbing enough, but what really worried me was the feeling that taking up homeopathy might be a little like undergoing a religious conversion. At least some of the speakers seemed to feel themselves to be in possession of a sacred Truth that had to be preserved at all costs; one man reacted quite angrily when someone in the audience expressed a degree of scepticism about something he had said.
Fortunately, not all the homeopaths I met were so closed-minded. And there were definitely career prospects available to someone like me, for the homeopathic community was in a state of crisis at this time. A few months earlier several of the most prominent homeopaths in Britain had been killed in an air crash when taking off from Heathrow on their way to a conference in Brussels. Although the victims had not included any of the consultants at the hospital, at least two of these were close to retirement and there was deep concern about the need to find replacements. As I had the higher medical qualification needed to be appointed as a National Health Service consultant I was a potential recruit to the homeopathic banner.
The RLHH at that time was a small general hospital, with a very busy outpatients service and well over a hundred inpatients, though more of these were surgical than medical. There were several surgeons working at the hospital and they were in no sense homeopathic, although surgical patients sometimes asked for a consultation with one of the homeopathic physicians.
On the medical side the hospital had a slightly old-fashioned air, which was accentuated by the fact that several of the physicians were elderly. However, there were also some younger staff members and all of them, old and young, gave the impression of being good doctors as well as good homeopaths. In fact, they were doctors first and homeopaths second, which was definitely reassuring, though this is not to say that homeopathy was unimportant to them. It seemed clear to me that, as they claimed, practising this form of treatment entailed listening to patients in a way that the patients themselves appreciated and that had to some extent died out in mainstream medicine.
In view of the succession problem the hospital had recently set up a training scheme for future consultants which combined clinical work and study. I was appointed to this scheme along with another doctor a few years younger than I. In 1977 several consultant vacancies arose owing to retirement and resignation, and a colleague and I took over as consultants. I remained at the hospital until my retirement twenty-one years later.
My opinion of homeopathy naturally evolved and changed over the years I was at the hospital. After an initial period of enthusiasm it became gradually more questioning and ultimately more critical. Early successes were not repeated and I increasingly began to suspect that the responses I did occasionally see were due to the placebo effect or other things rather than to the medicines. I attended talks or read articles in which people described their successes with various homeopathic remedies but they never seemed to work for me.
When I first encountered homeopathy I was taught what is often called “classical homeopathy”. For reasons I shall explain in the course of the book, I think this is a misleading term, but at the beginning I didn’t realize that there were other ways of practising homeopathy. Nevertheless I was puzzled by many of the ideas I encountered, some of which seemed quite bizarre. Where did these come from? This never seemed to be explained. Many homeopaths assumed that they all originated in the nineteenth century with the founder of homeopathy, Samuel Hahnemann, although they also attributed great importance to a later American writer called James Tyler Kent. But most were busy working physicians with little interest in delving into the origins of their discipline; most were content to rely on hearsay and secondary or even tertiary sources.
One of my tutors, however, was an erudite and widely read doctor called Ralph Twentyman. He told me that Kent had been much influenced by the eighteenth-century mystic Emanuel Swedenborg, and this remark made me aware of the need to go back into the origins of homeopathy in order to try to understand it better. In the 1970s and 1980s I began to read the writings of British nineteenth-century homeopathic physicians such as Robert Dudgeon and Richard Hughes. These authors revealed to me a picture of homeopathy that was significantly different in many ways from that with which I was familiar. In their books I found explanations for many aspects of homeopathy that seemed eccentric or outlandish, and I began to publish my discoveries in papers and, later, in book form.
The book, which I called The Two Faces of Homeopathy, came out in 1984. It sold reasonably well and stirred up quite a bit of controversy, but it is now out of print. Since then new facts have come to light and my own ideas about homeopathy have developed further, so this book is a very substantial update of the earlier work. But one thing has remained the same. In both books my approach is mainly historical. This requires a few words of explanation. Why this interest in history? Isn’t present-day homeopathy what really matters?
The importance of history
One of the main ways in which homeopathy differs from conventional medicine is in the importance of history for understanding it. In conventional medicine, the history of the subject is fairly unimportant; it has a cultural value but medicine changes so fast that the ideas of the past have little relevance to the present. For homeopathy it is otherwise. I’d go so far as to say that you can’t understand homeopathy in any depth unless you have a fair idea of its history. Yet this fact is not always recognized by newcomers to the subject, who in consequence find themselves more confused than they need be.
Like many other forms of unorthodox medicine, homeopathy is largely static, fixed in the past; most of the ideas still current today have altered little from when they were first formulated in the nineteenth century. The main textbooks still in use today were written at that time. For homeopaths this is not usually thought of as a disadvantage – rather the opposite. Believers in unconventional medical systems often regard their perceived antiquity as a merit. In the case of homeopathy there are claims that it has ancient roots, even as far back as Hippocrates.
Important though the history of the subject is, however, homeopathy is still a living form of treatment and the book would be incomplete if it were merely a historical study. In Part II, therefore, I look at homeopathy today and consider the all-important question: does it work? For reasons I shall explain, this is actually quite difficult to answer, in part because of the lack of good-quality research. But I shall do my best to offer a balanced assessment, based partly on research but also on first-hand experience.
To anticipate my conclusions, the verdict will have to be the cautious one permitted in Scottish law courts: not proven. Although there is a fair amount of research to support the claims made for homeopathy, its quality is uneven and it is still possible of critics to dismiss it as invalid. Moreover, homeopathy continues to suffer from one very serious liability: the lack of any plausible explanation for how it might work. For these reasons it remains possible that all the alleged effects of homeopathic medicines are due to the placebo response and other factors unconnected with the medicines themselves.
The practical issue: should I try homeopathy?
This brings me to a difficult but important question, which was raised by a perceptive reviewer of an earlier draft of this book. What if you, the reader, want to know whether you should try homeopathy yourself?
In her critical and witty book Sleeping With Extraterrestrials the sceptical writer Wendy Kaminer begins by admitting that she consults a homeopath. She is embarrassed by this, but nevertheless she finds that, for whatever reasons, homeopathy has helped her.
"When I go to my homeopath maybe I’m following one of the precepts of the recovery movement that I’ve always derided: I’m thinking with my heart and not my head. Or maybe I’m acting rationally after all. Believing in homeopathy may be irrational, but not using homeopathy if it works would be even more irrational. I care only if medicine works, not why. (I have the vaguest understanding of antibiotics.)
"So I don’t listen to scientists eager to tell me why homeopathic remedies can’t possibly work, because they violate the laws of chemistry. Assuming that the scientists are right, and the remedies I’ve taken are mere placebos, why would I want to start doubting – and diminishing – their effectiveness? Why not be susceptible to placebos?£
Kaminer surely has a valid point here: it may be rational for an individual to use homeopathy, even if the benefit is due to the placebo effect. But, as she goes on to point out, it would be irrational for anyone else to take her belief in the efficacy of homeopathy at face value; she might be mistaken, deluded, or even dishonest: "If you’re intrigued by my report, you should ask me to substantiate it, with some objective evidence. You should try to duplicate my experience."
It is, I find, remarkably difficult to find much “objective evidence” about homeopathy; frequently what we get instead is emphatic assertions with few supporting facts. In this book I try to present the available evidence as fairly as I can; it is for you, the reader, to make of it what you will.
Chapter 2 Hahnemann’s Discovery
There is a prevailing view of the origins of homeopathy that is partly based on legend: it might be called “homeomythology”. The legend goes something like this.
Samuel Hahnemann, the founder of homeopathy, was a medical genius whose thought was far in advance of his own time and even ours. He started out as a conventional doctor but became disillusioned with the orthodox approach, which he called allopathy, and cast about for something better. As the result of an experiment on himself using quinine he was led to formulate the homeopathic “law of similars”. He also discovered the principle of using small doses.
In the light of these two ideas he carried out a vast number of experiments on himself and others (using tiny doses, naturally) – the so-called “provings”. These are the basis of his system. Modern homeopathy still relies on the provings carried out by Hahnemann and his successors down to our own day. It is often also believed that Hahnemann introduced the idea of prescribing on the basis of the patient’s character or “constitution”.
Like most legends, this one is based on fact but it also contains fantasy, and it incorporates ideas that were not part of Hahnemann’s own doctrine but were introduced from other medical or even mystical belief systems of the time. However, although the commonly accepted idea of how homeopathy originated contains much that is legendary, in one respect at least it is accurate: its originator, Samuel Hahnemann, is at centre stage. If, as has been said, Western philosophy is a series of footnotes to Plato it is even more true that homeopathy is a series of footnotes to Hahnemann. My first task, therefore, must be to present an outline of Hahnemann’s life and thought.
Samuel Christian Hahnemann was by any standards a glorious eccentric, and his restless life story is mirrored in the turbulent history of the medical heresy that he fathered. In order to understand him and his views we must set him in his historical context, for his life and career span a critical period in the development of European medical and scientific thought, in which ways of looking at the world and at human beings that still owed much to classical and mediaeval ideas were giving way to those with which we are familiar today. This is reflected in Hahnemann, who at times seems almost modern and at others appears to be living in a conceptual universe so remote from our own as to be scarcely comprehensible.
Life
Hahnemann was born at Meissen, in south-east Germany, on 10th April 1755, at approximately midnight. So, at least, Hahnemann himself always maintained; but the entry in the church register at Meissen records the birth as having occurred on the morning of 11th April, and this later date was adopted by some homeopaths and gave rise to disagreement about the right day to celebrate the Master’s birthday. It is curiously appropriate that the inventor of homeopathy should have arrived in this world already equipped with a future occasion for controversy.
Hahnemann’s father was a craftsman who worked in the famous Meissen porcelain trade. He was not very well off, so as a boy Samuel was briefly put to work for a Leipzig grocer, and it was with some difficulty that he persuaded his father to allow him to become a medical student. But in 1775 he entered the University of Leipzig, where he quickly became self-supporting by means of teaching and translating. Growing dissatisfied with the standard of medical education at Leipzig, however, and already showing signs of a characteristic restlessness, he departed in 1776 for Vienna, but before completing his studies there he left to take up a post as librarian and family physician to the Governor of Transylvania, Baron von Brukenthal, at Hermannstadt.
It was at this time that he became a Freemason. It has been claimed that the library at Hermannstadt held esoteric alchemical works, including those of Paracelsus, and that it was dipping into these that planted the seed of homeopathy in Hahnemann’s mind. This is certainly possible, but no evidence to support the speculation exists.
In 1779 Hahnemann left his employment with von Brukenthal to complete his medical education at the University of Erlangen, where he was finally awarded his doctorate in medicine in August 1779. We don’t know what Hahnemann did in the year after qualifying, but in 1780 he established his first medical practice in the small mining town of Hettstedt, where he recorded his disillusionment with the medical treatments of his day, especially blood-letting.
Soon afterwards he moved to Dassau, where he began to take an interest in chemistry. This was an momentous period for chemists. In Hahnemann’s lifetime the phlogiston theory of combustion was disproved, a number of gases were identified, the compositions of air and water were discovered, and the atomic theory was placed on a surer footing. Hahnemann felt the excitement of this atmosphere of discovery and carried out some chemical research of his own, though he doesn’t seem to have heard about the atomic theory.
The sense of intellectual excitement was not confined to chemistry. At this time German writers and philosophers were developing the ideas of “Naturphilosophie” – a semi-mystical view of science and the world that underlies, for example, much of Goethe’s thought. It is almost certain that the young Hahnemann would have encountered these ideas at university, and though he does not refer to them explicitly in his writings their influence can be detected in his religious and metaphysical outlook. Naturphilosophie, as expounded by its leading philosopher, Schelling, is based on a sense of the Divine as underlying the manifest universe and as giving form to it, but the nature of truth is to be apprehended by thought and intuition rather than through revelation.
Naturphilosophie, therefore, is deistic rather than theistic, pagan rather than Christian. Hahnemann, likewise, though a deeply religious man who believed himself to be God’s chosen instrument for the healing of mankind, was hardly a Christian: nowhere in his writings does he refer to Christ or Christianity. His religion is essentially a matter of faith in, and devotion to, the Father. This religious attitude found itself at home in Freemasonry; Hahnemann preserved his interest in the Craft all his life, though he was not always an active member.
In 1782 he married Johanna Kuchler, an apothecary’s daughter. A year later their first child, a daughter, was born – the first of a large family. Still Hahnemann did not settle down but continued to move about. In 1785 he was in Dresden, where he worked as locum tenens for the Medical Officer of Health. On the death of the incumbent Hahnemann applied for the substantive appointment, but he was unsuccessful and set off once more on his travels.
He seems then largely to have abandoned medical practice for a time and to have concentrated his energies on translating, by which he supported his family and himself for a number of years. He also continued his chemical research; he published a test for the fraudulent adulteration of wine with lead which was officially adopted in Prussia, and he described a method for detecting arsenic in forensic material. It is said that while in Dresden he met the famous French chemist Lavoisier, later to be guillotined during the Revolution.
In 1789 Hahnemann and his family moved to Leipzig. This was Hahnemann’s third sojourn in that city. He did not practise medicine there but continued to write, translate. and study. His family now consisted of six persons, and he found himself hard pressed financially.
There is a touching story that gives a vivid picture of the tribulations undergone by the Hahnemann family. At one time money was so short that Hahnemann used to weigh out a portion of bread daily for each member of his family. When one of his daughters fell ill she was unable to eat her ration, and so stored it away in a box until she should recover. But she began to feel worse rather than better, and fearing she would die she called her favourite sister and handed over to her the store of dried-up bread as a legacy so that it should not be wasted.
To have grown up in the Hahnemann household seems to have been something of an ordeal in various ways and it left its mark on those who underwent the experience. The family was dogged by tragedy. Two daughters were probably murdered and three were divorced, while the elder son Friedrich seems to have been half-mad. He deserted his wife and child; his ultimate fate is unknown, but there is a curious story of a wild-looking man called Hahnemann who appeared in America during a cholera epidemic, cured a large number of people, and then vanished into the far West, never to be seen again; this was probably Friedrich.
Hahnemann’s other son died as an infant in 1799, when Hahnemann was forced to leave Koenigslutter owing to the hostility of the pharmacists of that town (a harbinger of things to come). On the way to Hamburg the carriage in which the family was travelling was overturned; Hahnemann’s son received fatal injuries and one of his daughters broke a leg, so that the party had to interrupt the journey for over six weeks.
The role of Frau Hahnemann amid all these vicissitudes is uncertain. No doubt she had a difficult life, but there are suggestions that she was something of a Xanthippe to her philosophical husband. In the circumstances it is perhaps hard to blame her.
Between 1789 and 1805 the Hahnemann family lived in literally dozens of places in eastern Germany. Hahnemann was unable to settle anywhere, but was driven on by his restless spirit and the need to make a living. All this travelling was a more difficult, indeed hazardous, affair then than it would be today. The roads were bad and often unsafe, and moreover the period was one of continual civil unrest. Hahnemann’s youth was marred by the Seven Years’ War between Prussia and Austria, while later, at Leipzig, he was to find himself caught up in the Napoleonic Wars.
Although Hahnemann was not practising medicine at this time he still had strong views on the subject, which he repeatedly expressed forcibly in print. The prevailing medical theories of his day were based on crude mechanical and hydraulic analogies as explanations of physiological processes. Thus diseases were classified in terms of tonicity or relaxation (our use of the word “tonic” derives from this theory) or were ascribed to supposed intestinal inflammation. There is no need to discuss these long-discredited theories in detail but it is important to notice their practical implications for medical treatment.
The main resources of orthodox physicians in Hahnemann’s day were large doses of drugs, habitually given in complicated mixtures, and blood-letting, often carried to horrifying lengths – indeed, to the point of almost complete exsanguination, so that the final drops had to be squeezed from the unfortunate patients.
Hahnemann rejected both the theories and the practices of orthodox medicine. It was, he held, inherently impossible to know the inner nature of disease processes and it was therefore fruitless to speculate about them or to base treatment on theories. As for complex drug mixtures and blood-letting, both were dangerous and unjustifiable.
Hahnemann had not yet thought of homeopathy but he was a firm advocate of environmental measures to promote health – fresh air, good food, and exercise. In these opinions he was certainly in advance of his time, and the same is true of his enlightened ideas about the right way to treat the mentally ill.
In Hahnemann’s day the practice was to treat “lunatics” with great harshness; they were given purges and emetics and were tied up, starved, and flogged if they complained, soiled themselves, or became violent. Hahnemann strongly attacked this crude form of behaviour therapy and instead advocated kindness and patience. In 1792 he had an opportunity to put his ideas into practice, for he was invited by the Duke Ernst von Sachsen-Gotha to come to Georgenthal to manage an asylum for the insane. The Duke magnanimously placed part of his hunting-castle at Hahnemann’s disposal for the purpose.
Unfortunately only one patient was ever admitted. This was a Hanoverian government minister named Klockenbring. Hahnemann left his patient free and gradually built up a rapport with him; he also gave him medication though we do not know much about this. Under this treatment Klockenbring recovered and was discharged, though he relapsed and died two years later. After this no new patients were forthcoming and the experiment came to an end. There is a suggestion that Hahnemann, always a difficult man to get on with, had fallen out with his patron the Duke. He had certainly gained a reputation as an eccentric: the Sheriff of Georgenthal, when asked how many patients Dr Hahnemann had in his institution, replied drily: “One – himself.”
Hahnemann therefore recommenced his wanderings. His family now consisted of ten persons and financial pressures were greater than ever. He tried to support himself by admitting mental patients to his home, but this was not a success and he had to fall back on his old trade of translating.
He also made two unwise attempts to remedy his fortunes by other means. In 1800 he published an announcement of his discovery of a cure (belladonna) for scarlet fever, which he promised to reveal to anyone who paid a gold piece for his book on scarlet fever; and in 1801 he mistakenly believed that he had discovered a new chemical compound of possible medicinal value, details of which could be obtained on payment of a fee. It proved to be common borax. These unprofessional announcements earned Hahnemann a good deal of derision and opprobrium.
Up to this time Hahnemann had done scarcely enough to earn even a footnote in medical history. By now he was into middle age and it might have seemed likely that he would never again have anything to do with practical medicine. but in fact his real medical career was about to begin.
The discovery of homeopathy
The germ of homeopathy had been planted in Hahnemann’s mind by an experiment he carried out in 1790. It was suggested to him by translating the Materia Medica of the Scottish physician Cullen. Among the herbs described by Cullen was the Peruvian bark cinchona (quinine), already in use as a treatment for malaria.
Cullen followed orthodox opinion in attributing its effectiveness to its “tonic effect on the stomach”. Hahnemann (who was never content to remain a mere translator but frequently added his own opinions in notes) attacked this idea, on the reasonable grounds that the taking of much more astringent substances than cinchona did not cure fever; hence the therapeutic effects of cinchona must be produced in some other way. Not content to leave the matter at the level of theory, Hahnemann proceeded to experiment.
"I took for several days, as an experiment, four drams of good china (cinchona) daily. My feet and finger tips, etc., at first became cold; I became languid and drowsy; my pulse became hard and quick; an intolerable anxiety and trembling (but without a rigor); trembling in all the limbs; then pulsation in the head, redness in the cheeks, thirst; briefly, all those symptoms which to me are typical of intermittent fever, such as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb, disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body – all made their appearance. This paroxysm lasted for two or three hours every time, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once more in good health."
Critics have objected that quinine does not in fact produce the symptoms of malaria, but this seems rather beside the point. What matters is that Hahnemann believed that it had done so in his case and that this suggested the idea of homeopathy to him. (The clinical thermometer had not been invented in his day, so the diagnosis of “intermittent fever” was necessarily based entirely on the symptoms.)
Nevertheless, many years were to elapse before the germ of homeopathy grew into a full therapeutic system. Not until 1796 did Hahnemann publish anything on the subject, and even then the essay he wrote was theoretical rather than practical and it seems that he had not yet had much opportunity to try his idea out on patients.
In 1805, after several more moves, Hahnemann settled for a time in Torgau, on the Elbe, where he remained for an unwontedly long time – nearly seven years. We know little about his life at this time, but it seems he was practising medicine according to his new system. His finances now improved and he was at last able to give up translating and concentrate on his own writing. Numerous articles by him appeared, the most important of which was an essay, The Medicine of Experience, which came out in 1806 and was the forerunner of his definitive theoretical work, The Organon.
The Medicine of Experience was published, like many of Hahnemann’s writings, in The Journal of Practical Medicine, edited by Hufeland – an eminent physician who, though he never became a homeopath, was sympathetic to Hahnemann’s ideas. Although Hahnemann did not use the word homeopathy in print until the following year, we find set forth in this essay the main features of his method, which may be summarized as follows.
1. Medicines are to be chosen on the basis of the patient’s symptoms, without reference to the supposed disease process underlying them. For Hahnemann the symptoms are the disease, and once they have gone the disease is cured.
2.The effects of drugs can be known only by means of experiments on healthy people. It is no use relying on what is found in patients because the symptoms of the disease will be difficult to distinguish from those of the drug.
3. Medicines must be chosen for the similarity of their effects to the symptoms of the patient. This “similia principle” is of course the kernel of the homeopathic method.
4. Medicines are to be given in single doses instead of complex mixtures.
5. Medicines are to be given in small doses to prevent “aggravations”. (Hahnemann believed that a correctly chosen medicine would always produce some slight worsening of the patient’s condition, no matter how transient; this could be reduced to a minimum by judicious reduction of the size of the dose.)
6. Medicines are to be repeated only when recurrence of the patient’s symptoms indicates the need.
These principles constituted homeopathy as it stood when first formulated by its originator. As a system it was very different from the orthodox medicine of the day but from a modern point of view it could fairly claim to be more scientific and certainly a lot safer. At any rate, it quickly brought success to Hahnemann, who was henceforth not to find himself again penurious. What is remarkable is that he had taken some fifty years to arrive at his system, and he was to go on adding to it almost up to his death in his eighty-ninth year. He was indeed a late developer.
As well as The Medicine of Experience, Hahnemann published while in Torgau a book, in Latin, on pharmacology. In it he described 27 drugs, giving the symptoms they produced in the healthy body. It seems he had already tested the drugs on himself and on his long-suffering family and the book is therefore the first published record of “provings” (the testing of drugs on healthy people).
Unfortunately he gave no details about the doses he used or the manner of administration, a reticence that was to characterize all his later writings and to detract from their value. Among the drugs described by Hahnemann were Aconite (monkshood), Arnica (leopard’s bane), Belladonna (deadly nightshade), Chamomilla (chamomile), Nux vomica (poison nut), and Pulsatilla (windflower), all of which are still widely used in homeopathy today.
In 1810 Hahnemann published the first edition of his major theoretical work, The Organon of Rational Healing (later retitled The Organon of the Healing Art, and today often referred to simply as The Organon). Further editions of this continued to appear at intervals throughout his long life, while the sixth and last did not come to light until 1920.
The Organon is the Bible of homeopathy and anyone who wants to study the subject seriously must read it with close attention – a somewhat daunting task. It is arranged in numbered paragraphs, to which are often appended voluminous footnotes. The style is difficult – long involved sentences that the most authoritative English version, that of R.E. Dudgeon, does not render wholly pellucid.
In the course of his life Hahnemann was to have second and third thoughts about many of the ideas in The Organon; these he incorporated in the text of each successive edition, though without always cancelling what he had written previously, so that self-contradictions occur. Coming to terms with Hahnemann’s thought therefore involves the reader in some fairly detailed textual criticism, and it is not surprising, if regrettable, that many later homeopaths have shirked the task and consequently have had an over-simplified view of what the Master actually taught.
The Organon initially excited rather little interest, either hostile or friendly. Perhaps this was because of distractions from public events, for the Napoleonic Wars were now raging. Napoleon himself entrenched outside Dresden in the winter of 1810-11 and constructed fortifications at other towns, including Torgau, further down the Elbe. Feeling understandably unsettled by these preparations for war, in 1811 Hahnemann decided to move to Leipzig; an unwise choice as it turned out, for Leipzig was to become the site of one of the most decisive battles of the war.
This was the fourth time that Hahnemann had stayed in Leipzig; the first time had been as a grocer’s boy, the second as a medical student, and the third as a struggling physician. None of these visits was a happy precedent, but on this occasion – at least to begin with – things went better for him.
Fame at last
Hahnemann’s first venture was to try to set up an Institute for the Postgraduate Study of Homeopathy, but no physicians enrolled for the course and he therefore applied to be allowed to deliver lectures at the university. Candidates for this honour were expected to present a dissertation and to defend their thesis in the mediaeval fashion against a “respondent”. With unwonted tact Hahnemann avoided the contentious subject of homeopathy and instead presented a learned paper designed to prove that the white hellebore of the ancients was the same as the modern Veratrum album. The respondent was his son Friedrich. The subject proved acceptable, the occasion went off well, and Hahnemann was free to begin his lectures.
In the same month Napoleon began his calamitous retreat from Moscow. By August 1813 he was back in Saxony with a new army; he defeated the allies at Dresden and then moved north-west to Leipzig, where he encamped outside the city accompanied by his unreliable ally the King of Saxony.
On the 18th October Napoleon fought a major battle against the Allies, who were commanded by Prince Karl Schwarzenberg. Next day Napoleon’s Saxon allies turned against him; he was defeated and had to leave Germany, never to return. Leipzig celebrated the defeat of the French but the city was full of wounded men. Hahnemann took part in treating the casualties and the victims of the epidemic that broke out in the city.
Gradually life in Leipzig returned to normal and Hahnemann was able to resume his lectures. At first these were packed, large numbers of students turning out for what they expected would be a rag occasion. Hahnemann himself took matters with extreme seriousness but even his closest friends and disciples felt that the solemnity of the setting left something to be desired.
Hahnemann, his few remaining white hairs carefully curled and powdered, and wearing formal clothes that belonged to a bygone era, would sit down ceremoniously, take out his watch and lay it before him on the table, and after clearing his throat read a passage from The Organon. He would then dilate upon the ideas it contained, becoming more and more excited and flushed, until at last he broke out in a “raging hurricane” of abuse against orthodox medicine and orthodox practitioners. This, of course, was what his audience was waiting for.
Once the entertainment value of the lectures had been exhausted, however, attendance dwindled and soon Hahnemann was reduced to lecturing to a few devoted disciples. But his lack of success was not due solely either to his subject matter or to his eccentricities of dress and delivery; he was the target of serious opposition from the Professor of Medicine, and even those students who would have liked to come over to the new system of therapy found it unwise to do so.
Yet if Hahnemann failed to make his mark as a lecturer his sojourn in Leipzig was immensely fruitful in another way, for it was at this time that he carried out his main series of “provings” with the help of his few disciples.
The little band of enthusiasts was worked hard by the Master. Not only did they have to try out the various drugs on themselves and record the results with extreme conscientiousness; sometimes they had to collect the substances, especially the herbal ones, themselves, learning to recognize them in the field and to prepare the tinctures for proving.
Hahnemann did not leave us any details of the doses he used or the manner of giving the drugs, but from chance remarks elsewhere in his writings and from the accounts of his provers we have a pretty fair idea of what went on.
All the provings at this time were carried out with mother tinctures (extracts) of herbs or, in the case of insoluble substances, with “first triturations” (one part of substance ground up with nine parts of sugar of milk). That is, Hahnemann used actual material doses for the provings. I emphasize the point because it is often believed by homeopaths that he used high dilutions (“potencies”). In fact, he did not do so until much later.
His usual practice seems to have been to give repeated doses until some effect was produced; the actual amount was calculated on the basis of his own previous experience. The provers were expected to record their symptoms with the utmost care, and on presenting their notebooks to Hahnemann they had to offer him their hands – the customary way of taking an oath at German universities at that time – and swear that what they had reported was the truth. Hahnemann would then question them closely about their symptoms to elicit the details of time, factors that made them better or worse, and so on. Coffee, tea, wine, brandy and spices were forbidden to provers and so was chess (which Hahnemann considered too exciting), but beer was allowed and moderate exercise was encouraged.
The results of the Leipzig provings were published between 1811 and 1821 in a major six-volume work usually referred to as The Materia Medica Pura. As he had done earlier, Hahnemann supplemented his researches with reports of poisoning and over-dosage, and the resulting compilation was a unique contribution to pharmacology; nothing like it had been attempted before, and the information it contains (together with that in The Chronic Diseases, which I shall discuss later) still forms the basis of homeopathic practice today.
Not many modern homeopaths, however, make use of The Materia Medica Pura directly; instead they rely on secondary or tertiary sources. This is because Hahnemann unfortunately chose to present his findings in a way that makes them virtually unreadable. Instead of giving narrative descriptions of the provers’ experiences he recorded their symptoms in an anatomical scheme of his own devising, so that what we are left with is a series of disconnected snippets that cannot be put together in the mind to yield a whole picture. As the nineteenth-century homeopath Robert Dudgeon remarked, it is as if a portrait gallery of family pictures were arranged by features – all the noses in one place, all the eyes in another, and so on. For this reason Hahnemann’s original provings are seldom referred to today.
A further problem from our point of view is that Hahnemann’s method of conducting his provings, though extremely meticulous and painstaking, did nothing to eliminate the effect of suggestion. The subjects knew what medicines they were taking (indeed, they had often gathered the herbs themselves) and they therefore knew what effects they might experience.
It is unfair to criticize Hahnemann for not recognizing the importance of suggestion, for this was not properly understood until many years later, yet it has to be kept in mind in assessing his findings. Another difficulty with the provings is that all the provers were men (although it is likely that Hahnemann had earlier tried the medicines on female members of his family). But in spite of any reservations one may have there is no doubt that Hahnemann’s Leipzig provings are a fascinating piece of work and represent a serious scientific attempt to investigate the properties of drugs.
It would be reasonable to expect that this achievement would represent the summit of Hahnemann’s career and that he would now remain in Leipzig, surrounded by his small but devoted band of followers, while his own fame and that of his system spread ever farther and won new converts. After all, he was now in his sixties and he had made a name for himself professionally; it was hardly likely that he would now contribute any new ideas. And yet, much still lay in the future.
Departure to Köthen
Hahnemann’s very success made him the target of much hostility, not only from doctors but also from his old enemies, the apothecaries, who resented the fact that he made up his own medicines and advised his disciples to do likewise. For a time their criticisms were silenced by the arrival in Leipzig of the victorious Prince Schwarzenberg, the hero of the battle of Leipzig, who came for the express purpose of being treated by Hahnemann.
Unfortunately, after an initial improvement the Prince died, and there was no lack of voices to accuse Hahnemann of having precipitated his demise. The apothecaries now obtained an injunction to prevent Hahnemann from dispensing his own medicines, and since they were unwilling to keep them themselves his practice could not continue. He was therefore forced to leave Leipzig.
The Duke of Anhalt Köthen, a small principality some 36 miles away, was an ardent admirer of the new system, and he offered Hahnemann the post of court physician in the tiny capital of his dominions. Hahnemann had no choice but to accept.
The move to Köthen took place in 1821. A considerable change came over Hahnemann in his new home. He was now virtually cut off, not merely from mainstream medicine but even from his own disciples. He became in effect a reclusive, hardly venturing outside his house. But he was by no means inactive; patients suffering from various forms of chronic disease came to him from all over Europe, and he continued to think, write and develop his system, which now began to take on new characteristics.
While he was in Köthen he published a third, fourth and fifth edition of The Organon, and also a second and third edition of The Materia Medica Pura. It was in Köthen, too, that he elaborated his famous notion of dynamisation and also announced his theory of chronic disease, both of which I shall discuss in the next chapter.
The hostility that homeopathy evoked from orthodox physicians and from apothecaries is easy to understand, but matters were undoubtedly made worse by Hahnemann himself. It may be the case that, had he not been so eccentric and obstinate, he would not have thought of homeopathy in the first place or have had the determination to defend and propagate his ideas in the teeth of opposition. But this independence and prickliness were to create needless difficulties for the new movement, which took on many of the attributes of a religious sect.
As so commonly happens in such sects the most virulent controversy occurred, not with outside critics, but within the ranks of homeopathy itself. For much of this dissent Hahnemann was himself responsible. From his seclusion in Köthen he continued to cause confusion in Leipzig. He dissolved the newly formed Homeopathic Society in Leipzig on the grounds that some of its members were not fully committed to the new doctrine, and his intolerance for deviation eventually became so extreme that he used to say: “He who does not walk exactly the same line with me, who diverges, if it be but the breadth of a straw, to the right or the left, is an apostate and a traitor and I will have nothing to do with him.”
Soon after Hahnemann’s departure a homeopathic hospital was established at Leipzig by private subscription and a Dr Müller was put in charge and gave his services for nothing. But Hahnemann took exception to Müller for his independence, and had him replaced by a salaried director. This man in turn was replaced by a bogus homeopath appropriately named Fickel, who took the job with the intention of discrediting homeopathy, and the consequent fiasco led in 1842 to the closure of the hospital.
As the years went by and Hahnemann aged he grew increasingly out of touch with general medical thought, but this did not prevent him from engaging in acrimonious disputes with the most eminent medical authorities, whom he treated with undisguised contempt. It has to be said that his arguments were by this time almost invariably superficial and irrelevant, for he was so utterly convinced of his own rightness that any attack, however well reasoned, seemed to him an expression of pure prejudice and ignorance.