The essence of the change was a rebellion against orthodox
medical science as taught and practised in the teaching hospitals, and the
introduction of a series of radically different but all-embracing beliefs on
the nature and treatment of disease. The empirical quack continued in the
background and still exists today, although in an attenuated form. But the new
irregulars—the literate ‘book-reading’ practitioners—were usually educated men
and often medically qualified.
They were therefore not so much quacks (although frequently
derided as such) as practitioners for whom the terms ‘alternative’ or
‘complementary’ is more appropriate. Indeed, supporters of CAM have good reason
to object to the term ‘quackery’ being linked in any way with such practices as
homeopathy, osteopathy, chiropractic, acupuncture and herbalism. It would be
impossible to review the history of all the current forms of alternative
medicine, so I am confining this paper to one of the earliest and still the
most frequently used unorthodox system: homeopathy.
HOMEOPATHY
While it can scarcely compare in antiquity with Chinese or
Indian medicine, homeopathy is the longest established CAM to have arisen in
Europe.7 It was founded by Samuel Hahnemann (1755-1843), who grew up in Meissen
in Germany, received his medical degree in Erlangen in 1779, and died a millionaire
in Paris in 1843. During his first fifteen years as a physician Hahnemann
struggled desperately to make a living. One day, however, he made a discovery.
He started to take regular doses of cinchona or ‘the bark’ (i.e. quinine).
This, he said, produced all the symptoms of intermittent fever (malaria) but to
a mild degree and without the characteristic rigors of that disease. This led
Hahnemann to an idea which was published in 1796 as Essay on a New Principle
for Ascertaining the Curative Power of Drugs, which was followed in 1810 by his
famous work The Organon of the Healing Art.1
Hahnemann believed that if a patient had an illness, it
could be cured by giving a medicine which, if given to a healthy person, would
produce similar symptoms of that same illness but to a slighter degree. Thus,
if a patient was suffering from severe nausea, he was given a medicine which in
a healthy person would provoke mild nausea. By a process he called ‘proving’,
Hahnemann claimed to be able to compile a selection of appropriate remedies.
This led to his famous aphorism, ‘like cures like’, which is often called the
‘principle of similars’; and he cited Jenner's use of cowpox vaccination to
prevent smallpox as an example.
The differences between orthodox medicine and homeopathy
could hardly be more vivid. From its beginning homeopathy always began with a
long consultation, lasting at least an hour, in which all aspects of the
patient's illness and life were discussed—homeopaths like to stress that they
practise ‘holistic medicine’—and the appropriate treatment chosen. In contrast,
during the first half of the nineteenth century, when homeopathy was becoming
established, orthodox medicine was immersed in the belief that advances in
understanding disease could only come from a detailed correlation of symptoms
and signs of the sick patient on the ward, and the findings at autopsy:
clinico-pathological correlation. As Bichat famously put it put it at the very
end of the eighteenth century:
‘For twenty years from morning to night you have taken notes
at patients' bedsides... which, refusing to yield up their meaning, offer you a
succession of incoherent phenomena. Open up a few corpses: you will dissipate
at once the darkness that observation alone could not dispel.’8
Clinico-pathological correlation demanded the understanding
of a very long and complex collection of diseases accompanied by heated debates
between the contagionists and the anti-contagionists. This was way beyond the
comprehension of the general public. Moreover, medical treatment was to a large
extent crude and ineffective, consisting largely of potentially dangerous
polypharmacy, purging, and profuse blood-letting.
Hahnemann showed no interest in detailed pathology, and none
in conventional diagnosis and treatment. He was only interested in the
principles of homeopathic medicine which he used to name the illness.2
Classical homeopathy was therefore seen by its supporters as an attractively
safe system, simple, easy to understand, and centred on the patient as a whole
and not on pathological lesions. This goes a long way to explain why homeopathy
was popular.9
But there was one aspect of homeopathy which, from the time
it was first announced in about 1814, led to open warfare between orthodox
medicine and homeopathy. This was the result of Hahnemann's belief that drugs
should be given in a dose which only just produced the slightest symptoms of
the disease which was being treated. To achieve this aim, Hahnemann diluted his
medical preparations to such an astonishing extent that if one assumes that
that the substance he employed was completely soluble, by only the fourth
dilution the ratio of the medicine to the solution would be 1:100 000 000. The
physician and poet Oliver Wendell Holmes (1809-1894) in the USA, always a
master of ridicule, said that Hahnemann's dilution would take ‘the waters of
ten thousand Adriatic seas.’1 But Hahnemann insisted that homeopathic medicines
retained their therapeutic power provided you shook the preparation violently
during the process of dilution—a process Hahnemann named as ‘potentization’ by
which every homeopathic medicine not only retained or even increased its
therapeutic power, but persisted as a ‘dematerialized spiritual force’. To
orthodox practitioners this was sheer nonsense.10 Hahnemann claimed that by his
methods he could cure all or nearly all acute diseases. To make matters worse,
he announced in 1828 that all, or nearly all, chronic diseases were caused by
‘the itch’ (scabies).
Whereas Hahnemann claimed that homeopathy could cure all or
virtually all diseases, his followers modified these claims in the hope of
becoming accepted by orthodox medical practitioners. One of the first
institutions devoted to homeopathy was the American Institute of Homeopathy,
founded at the end of the nineteenth century, when it seems that ‘a
rapprochement between homeopaths and conventional physicians gradually
unfolded. Homeopaths adopted new orthodox treatments... while allopaths
[regular orthodox physicians] borrowed homeopathic remedies... In 1903, after
long antagonism, the American Medical Association... invited homeopaths to join
[the Association].’9 The Food, Drug and Cosmetic Act of 1939 in the USA allowed
homeopathic medicines to be sold openly on the market. Five homeopathic
hospitals were founded in Britain, the two largest (in London and Glasgow)
having in-patient units. Today the ten most common diseases treated by
homeopaths are (in order of frequency) asthma, depression, otitis media,
allergic rhinitis (hay fever), headache and migraine, neurotic disorders,
non-specific allergy, dermatitis, arthritis and hypertension.
There seems little doubt there has been a remarkable revival
of homeopathy since the 1960s and 1970s in many countries, but especially the
USA where, in 2002, it was estimated that the number of patients using
homeopathic remedies had risen by 500% in the previous seven years, mostly by
purchasing over-the-counter remedies. In the USA patients seen by homeopaths
tended to be more affluent, more frequently white, present more subjective
symptoms, and to be younger than patients seen by conventional physicians.9 In
Britain a survey by the BBC in 1999 found that 17% of 1204 randomly selected
adults had used homeopathy within the past year (this includes homeopathic
remedies bought over the counter) and another survey in 1998 estimated that
there were 470 000 recent users of homeopathy in the UK. It is likely that most
patients in the UK who use complementary medicine are largely middle class and
middle aged.11 One of the well known features of homeopathy is that from the
nineteenth century to today it has been firmly supported by royalty and the
aristocracy. Edward, Prince of Wales was the patron of the London Homeopathic
Hospital, while the Duke of York, later King George VI, gave the title ‘Royal’
to the hospital. He also named one of his race-horses ‘Hypericum’ after a
homeopathic remedy. He entered it for the Thousand Guinea Stakes at Newmarket
in 1946 and it won.12