MEDICINE BEFORE HAHNEMANN

 Linn J. Boyd. M.D.

 

With the present abundance of elaborate and exhaustive treatise, it may at first sight appear unduly presumptions for the writer to offer an epitome of medical history. However the available annals and chronicles are unable to serve the particular purpose for which these statements have been written, that is, to assist one in obtaining the proper historical perspective of homoeopathy. Scholarly volumes have been compiled with a general review of medicine as their text.

Homoeopathy being only a single event in a long, complicated and slowly moving story, must necessarily be dismissed in a few lines in books dealing with the general significance of various events and discovers in the entire field of medicine. As a rule these brief considerations consist of biographical sketches. of Hahnemann and a chronological account of his announcements, without a satisfactory evaluation of the relative importance of his ideas and a summary dismissal of all of his practices.

Special histories of homoeopathy have also been written, but are equally useless for the discussion at hand. Few in number, old in years, dealing at length with many irrelevant details, they were penned in a period characterized by bitter animosity between protagonists and antagonists. They represent propaganda and prejudice rather than history, fiction rather than fact, attack and defense rather than calm unheated discussions based upon sober reflection. For these reasons, among others, the writer has deemed it imperative to recall briefly certain salient features of medicine, since it is axiomatic that a subject which has had over one hundred years development can only be grasped when its history is known.

Recognition of the importance of the proper historical orientation and realization that this is essential to the correct critical attitude leads me to the belief that this resume may not be amiss, even though it barely outlines in the most elementary fashion a most complicated picture. Incidentally the possession of the appropriate attitude has other advantages. With such material, there can be inquiry into remote origins of the essential idea, reflection upon the effect on medical practice, building theories with some justification dealing with reasons for announcing the homoeopathic principle at the particular time in medical history, and whether or not evidence tends to show that the publication has resulted in advance.

In the following pages it will be occasionally necessary to inject personal theories into the discussion, but an endeavor will be made to subordinate them. The reader must always understand that these represent working hypotheses, never to be taken as proven statements, but merely as the most reasonable interpretation and explanation after an extensive sorting of all the available material. Critics may complain that the projection of personal ideas invalidates rather than mellows the text, but a report replete with refurbished antiques has only the value of a second-hand garment.

It is hoped that these introductory remarks may show that a review of certain pertinent phases of medical history is a necessary preamble to an intelligent discussion, as well as reveal the desirability of occasionally arriving at conclusions based on the data presented. I have despaired of citing authorities because the debt is too great, but let the original authors accept the compliment that imitation implies.

A general unanimity exists among those best qualified to have opinions upon the medical practice of primitive peoples. They appear agreed that the treatment of illness or injury consisted for the most part in instinctive reactions, that is to say, either crude mechanical devices directed at stopping the flow of blood from a torn vessel, or pristine pharmacological procedures.

It is equally elementary to state that medical practice at a slightly later period, practically at the dawn of recorded history, was based largely upon a demonology invented by our remote superstitious ancestors. In a world teeming with demons man quite naturally regarded disease as a visitation by some supernatural agency, and treatment consisting of procedures designed to render the new habitat of the evil spirit as unpleasant as possible seemed sufficient. Among the methods then in vogue were pommelling (a precursor of present day massage), fumigation with evil smelling stuffs which chased the demon beyond the Nile, or ejection by emetics.

Fraser, in his charming book, “The Golden Bough,” has devoted a large section to the consideration of “homoeopathic magic,” suggesting the psychological origin of the idea that likes may be treated by likes. It should be read by all interested, although it may not appeal to some.

In the translations of the Vedas the interested may read how the demon was entreated to pass into some more pleasant abode, and that the demon of jaundice was asked to depart into the body of a yellow bird, while the demon of the chilly ague was offered the cold body of a frog is quite significant. These citations are suggested as the earliest examples of the doctrine of Signatures and faint indications of the idea that likes may be treated by likes. Even some ancient Chaldean prescriptions were homoeopathic in implication, directing that the bitter (gall bladder?) be cured by the bitter.

Early Greek literature furnishes additional illustrations of ancient theory. The reader may recall that the happiness of Ulysses at the sight of land was compared to the joy of sons seeing their father recover from a long illness with which an angry god had assailed him. The howling, Cyclops was reminded that illness came from Zeus and was therefore unavoidable. Supernatural factors in the etiology of disease were accepted in both of these instances.

During the dominance of the demonological concept of disease treatment was entrusted to priests and from the time of Sehektanch on, the priesthood guarded the bodies of their charges as well as the soul. The defecation of Aesculapius was followed by the establishment of numerous temples devoted to healing the sick and shows a similar theological notion of disease among the Greeks. The following quotation from Oslers “The Evolution of Internal Medicine,” presents a picture of the period in unmistakable words.

“Like other departments of philosophy, medicine began with an age of wonder. The accidents of disease and the features of death aroused surprise and stimulated interest and a beginning was made when man first asked in astonishment Why should these be? Surrounded everywhere by mysteries, he projected his own personality into the world about him, and peopled Heaven and earth with Powers, responsible alike for good and evil who were to be propitiated by sacrifices or placated by prayers. Satisfying the inborn longing of the human mind for an explanation these celestial creatures of his own handiwork presided over every action of his life.

For countless ages man regarded diseases as a manifestations of these powers the evil eye and the demoniacal possession, the murrain on the cattle, and the sickness that destroyeth in the noon day had alike a supernatural origin. Crude and bizarre among the primitive nations, these ideas received among the Greeks and Romans practical development worthy of these peoples. There have been systems of so-called divine healing in all great civilizations, but, for beauty of conception and for grandeur of detail in the execution all are as nothing in comparison with the cult of Apollo, son of Aesculapius,the God of Healing”.

As indicative of a period of transition mention should be made of Pythagoras who taught a system of dietetics and stressed the curative power of music in diseases of the mind. Empedocles referred to fire, earth and water and ether in the fragment of the the poem “On Nature.” By substituting air for ether we have as corresponding qualities heat, cold, moisture, and dryness. These soon became the equivalents of the four humors, blood, phlegm, black and yellow bile, in short, the humoral pathology which dominated Greek and other medical theories for centuries.

Hippocrates and his contemporaries inaugurated three innovations which revolutionized medicine.

1. They attached great importance to prognosis.

2. They made detailed observations of disease.

3. They rejected the supernatural in disease.

The first and second propositions although obviously important need no discussion here but the acceptance of the third announced the arrival of a new era in medicine. So long as man believed disease to be an affliction resulting from incurring the anger of an offended god little progress in medicine was possible except in so far as propitiating practices might accidentally favorably influence the course of disease and this is, at best, a remote possibility.

With an absolute rejection of the supernatural in disease advance in medicine became, not only a possibility but an actuality, although the divorcement of religion and medicine was accomplished in tortoise fashion and only within our own age has the separation been sufficiently marked as not to impede progress.

At all events the Hippocratean tenets lead to a materialistic or realistic theory of disease and maladies originating from lesser factors than divine maledictions could be dealt with in a direct manner. Like all new truths non-essential, irrelevant and even erroneous corollaries were attached and it was unfortunate that disease became a something to be purged, drained, “let,” or sweat out of the body, for it has taken centuries to evaluate this “something”.

Beginning as a premature generalization, possessing considerable truth and resulting in improvement in treatment or at least an attenuation in the severity of disease, the practice of medicine was based upon the assumption that disease was a something added to the body which could be cured by elimination through natural or artificial openings. Centuries have come, each bringing varied methods having as their goal the removal of hypothetical toxins. Centuries have gone, each writing Tekel to many of these practices until one by one they have gradually become obsolete and archaic. Of the panaceas, bleeding and emesis have practically disappeared and because of a natural reaction to their frequent failure are now avoided, even when indicated. Of the ancient tripod of cure, purges remain partly as a verity, mostly as a heritage.

This materialistic concept of disease is more important in a consideration of the origin of homoeopathy than the discovery by Hippocrates that like may be treated by like. In one of the works usually attributed to Hippocrates entitled “On the Places of Man,” the author makes the admission that although the general rule of practice is contraria contraris, the opposite rule also holds good in some instances, that is, similia similibus curentur. He illustrates this statement by several examples among which are the following: Substances which cause strangury, cough, vomiting or diarrhoea will generally cure these same diseases. Warm water which when drunk generally excites vomiting, will also put a stop to it by removing the cause.

“Give the patient a draught from the root of mandrake in a smaller dose than will induce mania,” he well counselled for the treatment of suicidal mania. The author of De Morbus Popularibus (Hippocrates?) gave us the following formula, “dolor dolorem solvit,” which may be rendered, one pain cures another. In the 46th aphorism we note “of two pains occurring together, not in the same part of the body, the stronger weakens the other”; also that “the cold stomach delights in the cold things.” In one place he states that cold water causes convulsions, tetanus and rigor (Aphorisms, v. 17), while in another that cold water in tetanus will restore natural warmth. In aphorism 21 we note that cold things such as snow and ice cause haemorrhages, yet cold water is curative in haemorrhages.

In De Internis Affectionibus we read that in the summer after a long walk dropsy is produced by the hasty drinking of stagnant or rain water, still the best remedy is for the patient to drink himself full of the same water for this increases the stools and urine. In De Morbo Sacro he states that most epilepsies are curable by the same means as caused them. A homoeopathic morsel can be found in the Epistles of Hippocrates “Hellebore given to the sane pours darkness on the mind, but it is wont greatly to benefit the insane.” It is therefore quite reasonable to assume that Hippocrates was well aware of the existence of more than a single therapeutic rule and that among others he thought and taught the dogma of similia. How different this concept is from Hahnemanns but still an inkling of a general therapeutic method! As a matter of record the writer should state that he is not prepared to defend the accuracy of all of Hippocrates views.

The Dogmatists should be mentioned as the successors to Hippocrates. Believing that physicians should be philosophers they indulged in endless and largely useless speculations, yet with the idea that progress in medicine rested in physiology and understanding of disease in “perverted vital function” they might have made noteworthy advances had it not been for the court physicians and the philosophy of Plato.

The Empirics of Heraclides represented a reaction against the Dogmatists. This school had for their main proposition the idea that the chief duty of the physician consisted in discovering what particular drugs will remove particular symptoms. This removal was accomplished as the result of.

1. Observation, experiments, autopsy;

2. Learning from contemporaries;

3. Analogy;

4. Epilogism inferring preceding events from the present.

Before leaving Greek medicine and passing on to a brief consideration of Roman medicine one more interesting, though at present hackneyed quotation, may be cited:.

“Take the hair, it is written

Of the dog by which you are bitten.

Work off one wine by his brother,

And one labor with another”.

-Antiphanes, 401, B.C.

In considering Roman medicine we may profitably omit mention of Cato the Censor, whose panacea was cabbage, and arrive at Asclepiades of Prusa. Utilizing the atomic theory of Democritus and Epicurus, this reformer taught that the body was composed of atoms between which were pores. Disease was due to alternations in the relationship between the atoms, especially blocking of the latter. His treatment may be summarized in the statement that he did not believe the function of the physician was to amuse the patient while Nature cured the disease, but that Nature was capable of doing harm.

Among his followers was Themison who conceived the idea of abolishing all the conflicting theories of medicine by combining the good features of each. His eclecticism is clearly displayed by the desire to supplant the practice of distinguishing diseases by their symptoms (Empirics) and searching for the causes of disease (Dogmatists) by merely observing what symptoms diseases had in common. The observer would then discern that all ailments were manifested by either an increase or diminution of secretions depending upon variations in the size of the pores, that is to say, constriction or relaxation (Asclepiades).

Treatment was based upon the principle of contraria contrariis, that is, astringents or laxatives. The greatest of the latter class was bleeding. After an interval the tenets of this self-styled Methodic school were perfected by Thessaulus of Tralles by the introduction of the alterative method of treatment, an idea which remains, somewhat modified, in medicine today. The great importance of this school from the standpoint of our discussion is that it followed a single therapeutic rule or guide contraria contrariis curentur which with the Brunonian doctrine, forms a replica of Hahnemanns similars.

Before presenting Galen to our readers, we owe a few lines to Nicander who recognized the homoeopathic or isopathic principle in his poetical materia medica. The treatment of viper bites consisted of the head of the viper or the liver of the reptile macerated in wine or river water. The cooked flesh of frogs was recommended in the therapeutics of toad poisoning. Even Xenocrates, flourishing long before Galen, was tinctured with a sort of homoeopathy in advising the use of goats blood in the treatment of hemoptysis. Ecchymosis of the eyes was best treated by the local application of pigeons blood according to this authority. Other therapeutic gems were the treatment of asthma by pulverized frogs lungs, affections of the liver by dried wolf liver, diseases of the spleen by roasted bullock spleen, hydrophobia by the saliva found under the tongue of a rabid dog, or by the internal use of its liver. Varro advised a patient bitten by an asp to drink his own urine.

Galen, the most prolific of ancient writers, was the next great figure in medicine. To him the foundations of medicine rested upon two pillars, anatomy and physiology, while Diseases were of three kinds-.

1. Those affecting simple tissues, as muscles.

2. Those affecting compound tissues as liver.

3. Those affecting the body generally, but especially the four humours.

The third are the dyscrasiae in contrast to eucrasia, the normal harmonious mixture of humours. Even in eucrasia there may be a preponderance of some humour resulting in particular temperaments as sanguine, bilious, phlegmatic, and melancholic.

The causes of disease are three.

1. Procatartic or exciting.

2. Proegumenic or predisposing.

3. Synergestic or proximate.

Symptoms are of three classes

1. Altered functions (actions leases).

2. Vitiated qualities (qualities vitiatas).

3. The results of both of those especially morbid excretions and retentions.

His therapeutic doctrine is best exemplified by “indication,” meaning whatever enables us to draw conclusions as to treatment apart from experience. His first indication is to remove the cause of disease or prevent its action. A second class arises from symptoms. If these are against Nature treat by contraries, but if they are in accordance with Nature treat by similars. Other indications which need no discussion are the temperament of the patient, the seasons of the year, dreams, etc. Some drugs are specifics, i.e., purgatives, but they must act through one of the elementary qualities heat, cold, dryness and moisture. Each of these is divisible into degrees according to its intensity. Thus Opium is cold to the fourth degree and pepper hot to a similar extent, a division carried to a ridiculous degree in the subsequent centuries. A few homoeopathic ideas found in Galen are mentioned here.

Similia similibus Deus adjungit (De Thera ad Pison).

Simile ad sibi similie natura fertur (De Semine ii).

Simile ad suum simile tendit naturaliter (De Util Resp).

Simile est congruum et amicum (De Inaeq.Intemp).

It should be mentioned in passing that Galen influenced medical practice for several hundred years.

Christianity exerted a definite influence upon medicine and being altruistic, the good outweighs the bad. Comment must be made upon three unfortunate effects:.

1. It helped restore primitive theories of diseases.

2. It imposed restrictions upon free thought and investigation.

3. It aroused controversies that practically absorbed the intellectual minds of the day.

The Bishop of Cesarea pointed out that diseases are sent by God as punishments (I. Cor. xi, 30), and that instead of going to physicians, people should await the chastening of the Lord until he sees fit to remove them (Micah vii, 9). Further, that diseases may be caused by Satan with the permission of God (Job ii, 6,7). As indicative of the period, reference can be made to the story of Theodore of Alexander who dreamed in the Church of SS. Cyrus and John that eating an asp would cure him of poison that he had taken.

Without relating the entire anecdote. Theodore quaintly concludes, “Thus saints are cured not contraries by contraries, but likes by the use of likes.” The Arabian school which came into existence at this time rendered an invaluable service to medicine by describing new diseases, new remedies, and writing the first pharmacopoeia. No time will be spent on this important group although the theory of Psora, which is discussed in another paper necessitates calling attention to them.

The school of Salerno is the sole outstanding light of the Dark Ages. For our purpose it is sufficient to observe an item found in the commentaries on the Salernitan pharmacopoeia. “If a man is bitten by a mad dog immediately put some of its hair upon the bite” thus this idea of similars returns to medicine after one thousands years.

The revival of medicine began in the thirtieth century with Arnald of Villanova, seeker for an universal remedy, and Peter the Disputant, and passes through the period of intellectual ferment at the close of the fifteenth century when all things new and extravagant attracted men. The era of Chemical Mystics is the next period which compels us to pause.

Of Basil Valentine, the father of Medical Chemistry, a few words will suffice. “Likes must be cured by their likes and not by their contraries as heat by heat, and cold by cold, shooting by shooting; for one heat attracts another to itself, one cold to the other as the magnet does the iron. Hence prickly simples can remove diseases whose characteristic is prickly pains, and minerals which are poisonous cure and destroy symptoms of poisoning when they are brought to bear upon them. Although some- times a chill may be removed and suppressed, still I say as a philosopher and one experienced in Natures ways that similar must be fitted with similar whereby it will be removed radically and thoroughly if I am a proper physician and understand medicine.”-(De Microcosmo).

Paracelsus, an outstanding figure of medical history, must also have consideration. To him medicine rested upon four pillars.

1. Philosophy not the vulgar type but of the circle of sciences. A division of this pillar is anatomy, not of dissection but the anatomy of essence, an imaginary analysis of man into mystical elements or ingredients salt, sulphur and mercury.

2. Astronomy as exemplified by the fact that some diseases are due to exhalations of the stars.

3. Alchemy an attempt to improve upon natural substances, a foreshadowing of the search for active principles.

4. Virtue of the physician.

Diseases are caused by and cured by the action of the macrocosm (universe) upon the corresponding parts of the microcosm (man). There are five kinds of jaundice, five kinds of dropsy, etc. The duty of the physician is to distinguish the Entry. The immediate cause of disease is not alternation of the humours but in the mystic elements, salt, sulphur and mercury.

From the therapeutic angle there are several important points to be noted. Every disease has its specific arcanum or remedy. Drugs are chosen upon the Doctrine of Signatures. “As a woman is known by her shape, so the medicine,” and the arcanum is recognized by form and color. Thus topaz and celandine are useful in jaundice, but yellow substances are also useful in diseases of the heart, yellow being the color of the sun which rules that organ. The action of the remedy does not depend upon the amount but upon its virtue. (When an attempt is made to trace the origin of the Doctrine of Signatures so many obstacles are encountered as to render this almost impossible and we must be content with the mention of some examples).

Euphrasia, also called eyebright, looks like the iris of the eye, therefore it is useful in diseases of that organ, especially dimness of vision. Orchid root bears a slight resemblance to the testes and is esteemed in the treatment of impotence. Hypericum perfoliatum yields when crushed, a blood red juice and is therefore specific in haemorrhage. The color of turmeric and berberis secured for them a reputation in the treatment of jaundice as did chelidonium. The poppy is shaped like a head (even possessing a crown), therefore its usefulness in diseases of the head.

Ranunculus and scrophularis have roots which resemble haemorrhoids, so that their use is apparent. The red dye from madder is used to promote menstrual discharge while Cassia fistula is shaped like an inflated bowel and is useful in intestinal diseases. Lemon is shaped like a heart. The bile tastes bitter so does gentian. The mushroom, phallus impudicus, was a promoter of fecundity. The branch of the elder tree has a pith like the spinal cord. Lichen pulmonarius looked like a lung, cyclamen like a stomach. Lithospermum possessed stony hardness, therefore its use in stone in the bladder. Examples numbering several hundreds are available but unnecessary for our purpose.

It is impossible to avoid comparing Paracelsius and Hahnemann. The former classed doctors into five classes.

1. Naturales,

2. Specifici,

3. Characterales,

4. Spirituals,

5. Fideles.

The first class corresponds closely to Hahnemanns enantiopathic and the second class resembles the homoeopathic. Paracelsus differed from Hahnemann in that the former thought that the enantiopathic and other classes may cure, that each sect is capable of curing all and the educated physician may choose whichever he likes, while Hahnemann denied this.

Both Hahnemann and Paracelsus were on bad terms with the apothecaries. Paracelsus wrote “So shamefully do they (the apothecaries) make up their medicines, that it is only by a special interposition of Providence that they do not more harm; and at the same time they charge so extravagantly for them and so much cry up their trash, that I do not believe any persons can be met with who are greater adepts in lying”.

Both Paracelsus and Hahnemann used the invective against poly- pharmacy. Like Hahnemann he laughed at the notion of attempting to reduce the diseases to a certain number of genera- “You imagine that you have invented receipts for all the different fevers. You limit the number of fevers to seventy and what-not that there are five times seventy.” Hahnemann said: “The Homoeopathic physician, who does not entertain the foregone conclusions devised by the ordinary school (who have fixed upon a few names of such fevers, besides which mighty nature dare not produce any others so as to admit of their treating these diseases according to some fixed method), does not acknowledge the names goal fever, bilious fever, but treats each according to their several peculiarities.

(Note to the 73d Aphorism). Paracelsus resembles Hahnemann in that he recognized the primary and secondary actions of remedies, for speaking of vitriol he says that as surely as it relaxes in its first period, so surely does it constrict in its second period. They also resemble each other in minute doses. Paracelsus in his “On the Causes and Origin of Lues Gallica (lib. v. cap. 11), states the following:.

“As a single spark can ignite a great heap of wood indeed, can set a whole forest in flames, in like manner can a very small dose of medicine overpower a great disease. As the spark has no weight so the medicine given, however small be its weight, should suffice to effect its action.” Hahnemann states that the dose of the homoeopathically selected remedy can never be prepared so small that it shall not be stronger than the natural disease, and shall not be able to overpower, extinguish and cure it, at least in part, as long as it is capable of causing some, though slight, preponderance of its own symptoms, etc.

(Aphorism 279). Paracelsus also anticipated Hahnemann in the use of medicines by olfaction “They have many rare powers and they are very numerous; there is one, for instance, the Specificum odoriferum, which cures diseases when the patients are unable to swallow the medicine as in apoplexy and epilepsy.” (Parac. Op. Vol. III, pt. vi, page 70, 1589).

We should note before leaving the subject that Paracelsus pointed out that he who will employ cold for heat, moisture for dryness does not understand disease (Paramirum, page 68). “What makes jaundice that also cures jaundice and all its species. In like manner the medicine that shall cure paralysis must proceed from that which causes it; and in this way we practice according to the method or cure by arcana” (Archidoxis, Vol. III, pt. v. page 18).

In retrospect let us recall that the idea of similars prevailed from the earliest times as in the Vedas. Similars were sanctioned by Hippocrates, for his doctrine of vis medicatrix implies that if the symptoms are due to the efforts of Nature to cure, it is the duty of the physician to promote these efforts by drugs which produce similar symptoms. Averroes wrote “Nature has so arranged that diseased organs are benefited by parts similar to them.”

“In diseases of the stomach the stomach of animals, especially fowls, are useful and for disorders of the lungs use the lungs of the fox.” Albertus Magnus related that it is no secret how every like aids, confirms, loves and acts upon and embraces that which is like it. Arnald of Villanova directed wounded soldiers to drink pepper water since that plant had a stalk and flower which were reddish and leaves are spotted as if with blood. Asarum and Cyclamen resembled the ear and were prescribed in aural diseases, Valentine had taught that diseases like poison may be driven out by contraries or drawn out by similars.

Paracelsus stated “So heart cures heart, spleen spleen, lung lung, not sows heart, not cow spleen, not goat lung, but member corresponding to member of the greater and inner man (macrocosm and microcosm). “The leaves and kernels of the peach are good for wounds, for see now on the fruit of the peach, it is pressed by the finger hollow places remain, so also severe wounds leave hollow places behind, Lizards are good for anthrax and carbuncle as is proved by the color, and the frog is specific for plague, for as plague is disgusting so is the frog.” And thus the similia similibus curantur or vomitus vomitu curantur of Hippocrates became the simile sui similecrat of Paracelsus.

Before passing to the others of the group of the Chemical Mystics, there is one observation I desire to record, which may be valueless but appears interesting to consider. There is one trait of Hahnemann upon which all are agreed. He was an inveterate reader and probably had a wider acquaintance with the literature of his time than any of his contemporaries. In spite of all of the similarities, it is remarkable that Hahnemanns literary researches should have absolutely failed to encounter Paracelsus who possessed so many identical characteristics of ideas and methods.

One cannot be positive and state that there is an undiscovered relationship between the ideas of Hahnemann and Paracelsus, for only a coincidence may exist, but it is at least peculiar that in spite of Hahnemanns erudition, he should have lived totally unaware of Paracelsus.

After Paracelsus came Agricola who, in relating the inability of his fellows to cure cancer, lupus, fistula, or leprosy, said: “If the subject be viewed in its proper light, it must be confessed that a concealed poison is at the root of such diseases, and this poison must be of an arsenical nature or character, this poison must therefore be expelled by means of the same or similar poison.” He goes on to say that if a realagar disease is present it must be cured with a realagar remedy, and with none other.

Arndt (1621) observed “And as physicians sometimes cure contraria contrariis, opposites with opposites, but sometimes the doctors cure similia similibus, likes with likes, poison with poison”.

The third of the group of Chemical Mystics is John Baptist van Helmont. To him all nature is alive. There is no dead matter, but in animals this material life assumes an almost personal form called archeus. Every body structure has a local Archeus and the whole organism is directed by the Archeus influus which resided in the stomach and is connected with the sensitive and rational soul. Disease is not a lesion of structure of function but since disease affects life or Archeus it must have its seat in life or Archeus.

Disease is a morbid idea conceived by the Archeus either through weakness or from harmful agents which cause him to depart from his normal course. There are innate diseases, as epilepsy, as well as diseases due to external causes such as witchcraft. Dropsy is not due to disease of the liver but to the anger of the renal Archeus who has lost his temper and refuses to work. Both contraria contraris and similia similibus are wrong. Treatment is simple and consists of removing the harmful products of disease and pacifying the Archeus by the use of specific medicine.

The seventeenth century developments in medicine are largely reactions to mysticism and partly the result of the teaching of Bacon and Descartes. The latter held that the universe contained two distinct things, matter and mind, a dualism which dominated medicine then as it does in many quarters today. Two schools developed as the result, the iatrochemical and iatromechanical. A typical exponent of the first is Sylvius who taught that bile after being secreted by the cystic artery passed to the heart where it meets the acid lymph brought in by the thoracic duct and vena cava.

The combination produces fermentation, the cause of body heat and the diastole of the heart. If the acidity or alkalinity becomes greater the fermentation increases and fever results, that is to say, diseases are due to acridities. Treatment may be vital, curative, etc., but actually consisted of the correction of the acidity or alkalinity and narcotics. Sylvius deserves mention because he is the last of the great Galenists. The iatromechanical school began with Sancto Sanctorius who discovered “insensible perspiration” and needs no consideration here.

The eighteenth or philosophic century is one of interest since it touches directly upon our topic. The vitalistic system of medicine can be divided into two classes the metaphysical and the scientific. The first held that the body is composed of dead material which is inhabited by an immaterial being called “life” which acts upon the body from without and separates from it at death. The animists identified life with soul while the vitalists maintained the existence of a second “vital principle”.

Stahl exemplifies one group. He taught that life resists putrefaction by keeping the blood in motion. Motion is immaterial and presupposes an immaterial agent, the soul. By keeping the blood, the most putrescent part, in motion and by expelling whatever is beginning to corrupt by secretions and excretions putrefaction is prevented. The proof of this is found in Seneca “You die not because you are ill but because you are alive.” The duty of the physicians is to watch and assist the soul. The school is mentioned here for several reasons, among which is the thought that this represents the beginning of the metaphysical period and the close of the materialistic so far as reactionaries are concerned.

Barthez may be chosen as an example of vitalism. Medical science has nothing to do with the essence of things but is the study of the phenomenon in health and disease. Without discussing the manner in which he arrived at his conclusions, it can be stated that the theory demands the existence of another being than the soul or body, a vital principle. Disease is the effort of the vital principle to resist harmful agency, or it is due to a morbid idea manifesting itself by alterations of sensibility in those abnormal acts which regulate the chemical constitution of humours. Treatment is of three types, the first of which is important for our purpose.

1. Natural assisting nature (or vital principle) in her efforts by giving an emetic in nausea or a purgative in diarrhoea. The physician is to employ this method where the termination of disease is favorable.

2. The analytic due to the fact that most diseases are composed of elementary affections.

3. Empire.

(a) method perturbatrice (Sydenham and Boerhaave);

(b) method imitative by which the vital principle is directed into the path by which Nature usually cures similar diseases;

(c) remedies that have been found useful in certain diseases.

Among the other very important features of this system is the concept of disordered vital spirit. This idea either reduces the number of therapeutic possibilities or necessitates following Stahl in assuming that medicines contain semi-spiritual or “Dynamic” powers enabling them to be brought in direct contact with the immaterial sources of life and disease. We will later have an occasion to note that Hahnemann held that drugs contain dynamic spiritual powers brought to life by dynamization (rubbing and shaking) that rubbing and shaking may penetrate fully into the essence of the drug and so free its more deeply seated medicinal powers, so that they may act in a spiritual manner and cure diseases which are solely spiritual derangements of the spiritual vital force which animates the body.

Having briefly reviewed a few of the more important phases of medical history, we may arrive at a conclusion.

The Treatment of Disease by Similars, Likes May be Treated by Likes, is Actually a Therapeutic Method Long Suggested to Medicine.

Owing to the fact that this conclusion is subject to several interpretations the writer feels the necessity of injecting his own interpretation. The evidence submitted above and which could be amplified many times, proves beyond all peradventure of a doubt that the method of treating disease by similars was a practice which existed in a variety of forms in all ages. Each century witnessed the intrusion and partial acceptance of the theory just as each hundred has seen its importance wane and nearly die with the extinction of its chief promoter. But even the regular appearance in a comet-like fashion is suggestive of a persistent attempt to force medicine into a different mode of practice and represents pioneer work in the discovery of a great and fundamental truth.

For surely this idea recurring in various guises and under different roles, discovered by workers in scattered countries and in different periods, cannot be entirely fallacious for, like the phoenix, it rises again from its own ashes, although displaying a new plumage of terminology and explanation. Although analysis of the different “similar methods” of treatment fail to show more than a very superficial resemblance, it appears to the writer that Hahnemanns discovery is a rediscovery, but that the particular manner in which it was utilized is new with Hahnemann.

A deduction frequently made from epitomes of medical history is that, just as Hahnemanns ideas may be regarded historically as a truth long known to medicine, so are his other theories a combination of sixteenth century vitalism and mysticism. Although I do not wish to closely analyze this hastily drawn conclusion, I am compelled to interject an allied thought. How frequently are the terms vitalism and mysticism used and how rarely are they defined and applied or criticised in the light of our present knowledge?.

A digression may be allowable to illustrate a slightly different angle of the situation. In the beginning Hahnemann offered a method of treating the sick by a substance capable of provoking a similar illness. In the ensuing years of his long life he elaborated upon many themes absolutely irrelevant to his first proposal. It is quite true that he sought to make his essential theory more plausible and more practical by attaching many dubious theories, but it must be emphatically stated that this patchwork, for it is no more, is denominated crude mysticism and vitalism in their unrefined sense. The error into which many appear to fall is to make Hahnemann greater than homoeopathy rather than the reverse.

To be more exact, homoeopathy is a method by which likes may be treated by likes (there are other interpretations and renderings); but it is this and no more, and many of Hahnemanns theories have little or nothing to do with the essential idea of similars. In fact, many were merely announced by the same man while others represent futile attempts at explanation, or hazy conjectural concepts which defy every attempt at co-ordination with his original idea.

Having so distant a connection it seems reasonable to assume that the vitality of any one of his ideas does not depend upon the validity of any other, nor in fact even of the truth of his offered explanation. May I add that he offered them only as working hypotheses to be cast aside if found insufficient; or would it be more apropos to ask should he be reproached for the failure to offer a satisfactory explanation for his phenomena when we cannot do so in spite of 125 years of advance in basic sciences.

To successfully deny a kinship in the presence of so close a historical connection with the doctrine of signatures, sympathy and similars requires a repudiation which the writer is not able to manufacture, and likewise the frequent mention of vital force in the later works of Hahnemann together with the doctrine of dynamization shows a close relationship to vitalism. But what of it? Let us clarify the situation by clearly distinguishing between what is homoeopathy and what are explanations of its modus operandi. In short each hypothesis is a complete chapter in itself and the truth or falsity of homoeopathy cannot be measured by the validity of the theory of psora or what not.

With the disposition of these two propositions we may profitably turn our attention to another item intimately allied to the historical angle. The opening paragraphs intimated that by reviewing medical history it might become possible to theorize with some basis as to why homoeopathy was announced at the particular time. Dismissing the possibility of divine revelation it is rational to proceed from the very reasonable assumption that a certain group of conditions must have existed in order for anyone to feel the necessity for deviating from the usual path.

If it is possible to show that the practice of medicine was in a very highly unsatisfactory state, in fact, almost unbelievable state, our problem becomes simplified. It is equally apparent that the new method would be at divergence with the accepted. We have then only the necessity to show that there was a need for him or some other radical to realize how unwarranted, unscientific, even disastrous the treatment was and the stage is set for the opening of a new school of thought.

We recall that the period of demonology was succeeded by an era when the supernatural factor was dethroned and materialism placed in high esteem. Diseases became realistic somethings and treatment proceeded upon a quantitative basis. Man was affected by a definite quantity of disease and energetic treatment was directed at the removal or dilution of real and hypothetical toxins. Whatever advantages this theory may possess the fact remains that it had many abuses.

Hahnemann appeared to object to treatment whereby fever is resolved by epistaxis, sweating and mucous expectoration, other diseases by vomiting, diarrhoea, bleeding from the anus, or articular pains, by ulcers upon the legs, inflammation of the tonsils, by salivation. Therapy by diuretics and diaphoretics, applications of mustard, horse- radish, blisters, setons, issues, noxa, tartar emetic ointment, actual cautery, roborantia, nervina, tonica, do not seem to have met with his approval. Extremely large doses of mixtures containing fifty or more ingredients, the action of no one of which was understood, aroused his ire.

It would be exceedingly difficult to successfully maintain that a theory of violent ill-advised measures irrationally applied did more good than harm. These ill-conceived measures had increased both in the number of misunderstood drugs, and in an incomprehensible dosage until a period shortly preceding Hahnemann. Then came an inevitable and too long postponed reaction, a series of deviations from the accepted mode of practice. Materialistic medicine, by which we mean a quantitative therapy, had reached an apogee and it is significant that each mutation assumed a meta-physical aspect and made onslaught against the traditional method, until it can be said that an era of metaphysical medicine tended to dominate the field.

Hahnemann came onto the field when the background was a crumbling but still inhabited castle of empirical medicine crowded with vague, fanciful and speculative notions. It seems easy to predict what some of Hahnemanns reactions would be. First he would attempt to complete the devastation of the castle, secondly he would rebuke the surviving combatants for their irrational and disastrous treatment and offer a new method tinctured with current trends in medicine.

In this fashion we may arrive at an interesting conclusion. From the psychological stand-point any method offered by Hahnemann would be influenced by reaction to the unwarranted unscientific treatment of his day. If his explanations utilized the foremost knowledge of his time it is obvious that they would consist of statements tinctured with the terminology of mysticism and vitalism.

The following is indicative of the substitution he offered:.

“Homoeopathy sheds not one drop of blood, administers no emetics, purgatives, laxatives or diaphoretics, drives off no external affections by external means, prescribes no warm baths or mentioned clysters, no setons, no issues, excites no pytalism, burns not with moxa or red hot iron to the very bone and so forth, but gives with its own hand preparations of simple, un- compounded medicines with which it is accurately acquainted, never subdues pain with opium, etc”.

This quotation is offered as a partial substantiation of the writers statement that some homoeopathic practices may represent in part a psychological reaction to the prevailing practice of the time. I am not at this time speaking of their value but of a possible origin. This reaction, begun before Hahnemann in the very thought of mysticism and vitalism, reaches an apogee in Hahnemann and is continued by Bichat, Morgagni and the entire line of pathologists. In order to show what Hahnemanns contemporaries thought of their own therapeutics, I quote from the famous Parisian, Bichat:.

“An incoherent assemblage of incoherent opinions it is perhaps of all the physiological sciences that which best shows the caprice of the human mind. What do I say? It is not a science for the methodical mind, it is a shapeless assemblage of inexact ideas, of observations often puerile, of deceptive remedies and of formula as fantastically conceived as they are tediously arranged”.

In short Hahnemann lived in a changing age and viewing the period just before and just after him we see many alterations and reforms in medical practice. In these reforms he played a great part, but deserves neither the sole credit as his followers would have it, nor the ridicule his detractors would cast upon him.

“Tut man! one fire burns out anothers burning,

One pain is lessened by another anguish.

Turn giddy and be hop by backward turning;

One desperate grief cures with anothers anguish

Take thou some new infection to the eye

And the rank poison of the old will die”.

-Romeo and Juliet.

In physics things of melancholic hue are equality used against equality, sour against sour, salt to remove salt.

-Samson and Agonistes.

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