Thursday, June 21, 2012

Putting Homeopathy In A Historical Context: Part 2

In last week’s entry, I set the scene onto which homeopathy burst. It was a world in which science and reason were ascending, but very unevenly – where some disciplines were charging forward, many were lagging. Medicine, unfortunately, was one of those that lagged. This uneven development both frustrated and inspired, as we’ll soon see.

Samuel Hahnemann

Samuel Hahnemann got off to rough start as a physician. He transferred his studies between several medical schools, including Leipzig and Vienna, before finally finishing his education in Erlangen. Despite a circuitous course, he ultimately graduated with honors, and was by all measures a very bright man – in addition to his medical training, he was an astute learner of languages, and in addition to his native German was proficient in English, French, Italian, Latin, Greek, and Arabic.

However, I said it was a rough start, and rough it was. He took a physician’s position in a mining town in Saxony, but soon found that the same discontent that drove him to pursue his education at three different universities drove him to be discontented with his chosen career. Hahnemann felt that the practice of medicine was so disorganized, and its medicines so poorly understood, that the treatments sometimes did more harm than good to patients, and so he gave up his practice only a few years after starting it, much to the chagrin of his wife, who thought he was neglecting his young children (he would eventually have eleven children).

Hahnemann wasn’t entirely off-base with his criticisms of medicine. As I’ve said, in Hahnemann’s time, the practice of medicine often involved on the one hand harmful procedures and toxic substances, and on the other a convoluted system of herbs based largely on ancient texts and the notion that herbs’ use could be determined by their appearance. Clinical trials didn’t really exist at this point in time, and so the individual effects of a given herb or treatment were largely unknown – medicines were applied based on theory and opinion, rather than on documented effects. Hahnemann was but one of many people around Europe who felt that there wasn’t nearly enough order and reason in the world around him, and his first response was to throw up his hands and give up.

Der prüfung

In order to support his young children, he fell back on his linguistic skills and got a job as a medical translator. It was in the course of translating William Cullen’s A Treatise on the Materia Medica that Hahnemann came across a passage relating to the treatment of malaria. Cullen stated that cinchona bark was effective against malaria because it was both astringent and bitter, and those properties were what cured malaria (cinchona bark has since been shown to contain quinine). Hahnemann, being the skeptical reader he was, thought this was nonsense. Why should astringency and bitterness make cinchona bark effective against malaria? Weren’t there a whole host of other herbs that were both astringent and bitter, but were of no use against malaria? Hahnemann felt this was symptomatic of medicine in his time – no one knew what any of the individual herbs or chemicals they were using did, they were just guessing.

Hahnemann’s next move was somewhere in the grey zone between madness and genius. It was genius in that Hahnemann was one of the first people in history to test the effect of a single drug in order to determine its use, but it was also mad in that Hahnemann decided to test the effect of Cinchona bark by consuming large quantities of the herb himself. Hahnemann called this experiment a ‘prüfung’, or test, a quite normal word which would eventually be corrupted into English as the obscure ‘proving’, adding to homeopathy’s somewhat anachronistic language.

While the first randomized control trial of a medication wouldn’t be published until 1948, by Hahnemann’s time, there had been some early medical experiments that laid the groundwork for later drug trials – James Lind’s experiments which showed that citrus fruits were an effective treatment for scurvy took place in 1747. Even so, though physicists were learning the laws of force and causality that caused a billiard ball to move after being struck by another billiard ball, this type of thinking – that a unique cause had a unique effect – was only just beginning to enter into medicine (after all, the proof that linked unique germs to unique diseases wouldn’t appear in the medical literature until the 1860’s). In his experiment, Hahnemann was trying to determine causal effect in medicine in a way that was relatively novel. That said, taking a Herculean dose of Cinchona bark was a brave way to go about it.

Some may know this story, others not, but here’s how things panned out for this particular experiment. Hahnemann took a large amount of Cinchona bark, most likely to the great frustration of his long-suffering wife, and found that it made him chilly, drowsy and anxious, made his heart palpitate, and caused him to become slightly feverish. Hahnemann associated these symptoms with those of malaria itself, the very disease Cinchona was meant to cure.

We now know that the quinine in Cinchona bark kills Plasmodium falciparum, the parasite that causes malaria, but Hahnemann, working as he was before germ theory was elucidated, came to a different conclusion. His conclusion was that somehow, something about the fact that the symptoms of cinchona poisoning were so similar to the symptoms of malaria was what caused Cinchona to cancel out or annul malarial symptoms. Somehow, by overlapping, by being similar, the one disease was cured by the other. From this, Hahnemann derived what is called ‘The Law of Similars’, that being that diseases are cured by substances which cause symptoms similar to the disease itself. Hahnemann was working from ideas that had been around since at least the time of Hippocrates, but these ideas had never evolved into a full theory prior to Hahnemann’s experiment.

Medicine at the time worked with the theory that if a patient was hot, to cool them down, and likewise a cool patient should be warmed up, a theory which has become significantly more advanced in the past two hundred years, but which still bears that primary approach – as Dr Andrew Weil says, consider how many classes of drugs start with the phrase ‘anti’, and you’ll get a sense for medical philosophy in practice. Hahnemann’s theory was different – that a cool patient should be given something cool, and then his/her body would warm itself up. Hahnemann rejected the thinking of his time as unscientific and unreasoned, and through trial and experimentation arrived at at his theory.

Next week, we’ll tackle one of homeopathy’s most challenging concepts – dilution of medicines.