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.
