Richard Hughes Memorial Lecture FRANK
BODMAN,
r~.D., D . P . M . , F . F . H O M .
Emeritus Consultant Psychiatrist, Bristol Homteopathic Hospital Mr. President, Fellows and Members, I t is a great honour to be invited to give the Richard Hughes Memorial Lecture and I am most grateful to the Faculty for affording me this opportunity to discuss the contribution made to Homceopathy by this remarkable doctor. W h a t at first sight is so astonishing is t h a t within thirty years of his death, Richard Hughes was virtually forgotten. Margaret Tyler in her first Editorial of the new journal Homoeopathy lists four homceopathic heroes but omits Hughes. Even Dr. Blackie confessed that apart from once dipping into his Pharmacodynamics t h a t this was the extent of her knowledge of him. Dr. Priestman nearly declined to give the Memorial Lecture as she had never read any of his books. And yet Hughes had held every office in the British Homceopathic Society: Secretary, Editor, Vice-President, President. He had been Permanent Secretary of the International Homceopathic Congress for m a n y years. He had been the author of scores of papers for English and American journals, and he had published massive textbooks which had gone into m a n y editions, been translated into several languages and sold in their thousands. In fact, he had for thirty years, dominated the homceopathic world. And yet thirty years later, none of Hughes' books were in stock at the British Homoeopathie Association, though they advertised the works of Allen, Clarke, K e n t and Wheeler. W h y then this sudden lapse into oblivion? This is the question I would like to discuss with you this evening. To understand Hughes' objectives, we need to know something of the climate of opinion in the times when he began his career, the kind of medical problems he encountered in day-to-day practice, the influential figures in Homceopathy when he started work, and the goals he set himself. Far be it from me to a t t e m p t to improve on m y dear friend, the late Douglas Ross's magnificent account of Richard Hughes' life and work. I f I dot the i's and cross the t's, it is to develop m y argument. Hughes was born in 1836, a year before Queen Victoria came to the throne. He qualified as a doctor at Edinburgh with an L.R.C.P. At the beginning of his medical career he was associated with his father-inlaw, a Mr. Amesbury who was a specialist in the treatment of scoliosis, an allopath to the backbone. Hughes says of himself that he was an allopath in 1859, but his first acquaintance with Homceopathy was in the following year, 1860. How this came about he does not say. But for the next year he struggled to master the principles of Homceopathy and was elected a Member of the British Homceopathic Society in 1861. Read to the Faculty of Homceopathy on 26 March 1970
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The tussle to learn Homceopathy made am indelible impression on Hughes. As he wrote later, his first impression was of utter confusion and discouragement. I t began with vertigo and ended with rage. One thing t h a t stuck in his mind was that there was tremendous drudgery associated with such learning. Many would-be students would be repelled and m a n y beginners would drop out. Later in his hfe he referred to some of the authors as obsolete, belonging to the dark ages of Homceopathy. I n particular, he was upset by the disconnected nature of Hahnemarm's schema in the Materia Medica and the Chronic Diseases. These books were available in English translation as well as French, and Hughes was fluent in both French and German. Current English advice was to read as well Jahrs' Manual; it was considered the English translations of H a h n e m a n n ' s works were not very reliable. In addition there were available Dr. Dudgeon's printed lectures on Homceop a t h y which had been dehvered in London in 1851. But apart from this course of lectures, there had been a few irregular lectures b y Dr. Quin and Dr. Russell. I n effect, then, Hughes was self-taught in Homceopathy. He brought to this study the attitude of an Edinburgh student, trained to recognize specific diseases and fresh from the teaching of the new pathology of Virehow, and the physiology of Phillips. The principle of similia similibus was simple enough to grasp, but its practice appeared to Hughes laborious, hazardous and tentative. Here was scope for reform. I think most of us, as we embark on a new profession, tend unconsciously to select from among our mentors a model with whom we identify, and whose attitudes and values have a long-lasting influence on our career. I n the case of Richard Hughes, his exemplar was Professor Henderson, Professor of Pathology at Edinburgh. Professor Henderson was a brilliant young man who was expected to follow the famous Abercrombie on his retirement. He had already published original papers on cardiac disease, had reported on the pathology of lobar pneumonia, and identified molluscum contagiosum for the first time b y microscopic studies. He was elected Professor of Pathology at Edinburgh in 1842. Soon afterwards, a student at Edinburgh directed his attention to Homoeop a t h y and with Abercrombie's encouragement, he began to investigate the practice in his wards at the Infirmary. When he announced that he was convinced of its value, he was boycotted by his colleagues, forced to give up his Chair of Clinical Medicine, resign his appointment at the Infirmary and his membership of the Medico Chirurgieal Society. I n spite of these attacks he persisted in his general medical researches and was the first to distinguish relapsing fever from the typhus-like fevers, and later to differentiate typhus from typhoid. His enemies tried to depose him from his Chair of Pathology, but were unsuccessful. From 1845 onwards Professor Henderson was the leading Homceopath in Great Britain in Hughes' opinion. Henderson contributed m a n y papers to the British Journal of Homceopathy from 1845 to 1851. He took a prominent share in raising up what Hughes terms a rational and scientific school of homceopathics. As an objective pathologist he did not believe in the existence of a separate vital principle.
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I n spite of his unhappy experiences at the Infirmary and the University, Henderson was against the assumption of the word "homoeopath" as a sectarian and distinctive designation, and it is to be noted that Hughes in his lifetime never used the word " H o m c e o p a t h y " in the titles of his various textbooks. Hughes defended him from the criticism t h a t Henderson only used objective signs rather than subjective symptoms in selecting the remedy, but there certainly was this tendency developing in this so-called rational school. One student claimed t h a t it m a y be safely asserted t h a t none ever listened to Henderson as a teacher who did not before long come to love him as a friend. Professor Henderson then was probably the greatest influence on the young Hughes. At 25 Hughes was elected a member of the Homceopathic Society and here he was to meet the senior figures in the British Homceopathie world. First and foremost was Dr. Quin, the founder of the Homceopathie Society; but he was coming to the end of his active life. Still the President of the Society as long as he lived, his poor health prevented his attendance at the Society meetings and his last signature in the Minute Book was inscribed in the following year, i.e. 1862. But another member of the six founders of the Society was Dr. Dudgeon who was to continue to be a powerful figure for m a n y years to come, who was to outlive Hughes, indeed to pronounce his funeral oration. Dudgeon, born in 1821, qualified in Edinburgh at the same time as Madden, but he was too young to receive his degree and went abroad for two years and, together with Madden, studied Hom0eopathy at Fleischmaun's famous little hospital in Vienna. I n the same year t h a t he joined the Homceopathic Society, he also joined the Pathological Society of London and in 1904 was still a member. He was the first Editor of the British Journal of Homoeopathy and continued to edit it until publication ceased in 1884, thirty-six years later. In the following year 1849, he translated the Organon of Hahnemarm into English, and two years later produced his Pathogenetic Cyclopaedia. In 1853, he was lecturing on Homceopathy at the H a h n e m a n n Hospital in London and in the next year published his lectures in book form. I n these lectures he was critical of Hahnemann's psora theory and of dynamization. Three years later he had translated H a h n e m a n n ' s lesser writings and at the age of 48 he was appointed Assistant Physician to the London Homceopathie Hospital, while his friend Madden was elected full Physician. He retired from out-patient practice five years later, was Vice-President of the Society the two following years, and when Dr. Quin died in 1878 was elected President, and re-elected twelve years later. He continued with his translations and turned his attention to H a h n e m a n n ' s Materia Medica in 1880, and in 1894 translated Hahnemann's Therapeutic Hints. But this is only a part of his activities. He had been a private in the London Scottish Regiment. He could look back to the family doctor of his youth, who treated measles by venesection with a consequent high mortality. He was an inventor; and in the days before the sphygmauometer and the electrocardiogram, invented a pocket sphygmograph, an instrument which strapped to the wrist, recorded the pulse in waves on a strip of smoked paper. While these records were not labelled P Q R S T like an ECG, a great deal of information about the heart's action could be read from the tracing. Dudgeon himself had an intermittent pulse. I can remember as a small boy being fascinated b y this little instrument
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and the curious smell of the smoked paper. The sphygmograph was widely used b y orthodox physicians. He investigated the mechanism of accommodation in a series of experiments and another invention was a set of underwater glasses for vision under water. Dudgeon was a keen swimmer, and at the age of 49 reported that he had personally tried out all twenty of the public swimming baths in London. I t was typical of his experimental attitude t h a t on a walk in the country, he plucked a cone from a Thuja tree and chewed it, and as a consequence developed a urethritis. But Dudgeon was not just a berlin working in his library. He had a busy private practice. And it is hard to realize the conditions of practice one hundred years ago. A call to a maternity case six miles away at 3 a.m. meant t h a t the horse had to be saddled and harnessed, usually at that hour by the doctor himself. And afterwards on the return home, the horse had to be rubbed down, watered and fed, before the doctor could get any rest himself. Dudgeon himself described a case of typhoid in an old lady of 72. He saw her every two hours and slept at the patient's house until she was over the worst. At one stage, when he thought the physicians were becoming a little precious, he described a day in his practice and detailed fourteen patients for whom he syringed ears, removed a foreign body from the eye, prescribed new shoes for one, ordered gymnastics for another, manually removed impacted faeces, painted a sore throat, and indeed only prescribed medicine (in homceo pathie potencies) for five patients! Physician, pathologist, inventor, translator, lecturer, author, nevertheless he found time to play golf one afternoon a week. Within a year of Hughes joining the Society, Dudgeon recognized his potential and recruited him as third Editor of the Journal. W h a t were Dudgeon's beliefs and how did they influence Editorial policy'~ First, he regretted that the word "Homceopathy" had ever been coined ant he declined to accept the nickname of "homceopath". He believed we were physicians before homceopaths, and bound to do the best for our patients. He did not believe t h a t Homceopathy was the final trut[ in medicine; that to define too strictly the limits of legitimate homceopathi( practice would transform the Homceopathic Society into a clique and a sect Secondly, he thought the doctrine of the vital force had been dead anc buried half a century. He was shocked at any a t t e m p t to resurrect it. Thirdly, he distrusted the theories built round dyaamization. Finally, Dudgeon believed that it was greatly in the interests of Homceopaths t h a t it should have a scientific pathological basis. But besides Dudgeon, fifteen years Hughes' senior, there was another Edito: who perhaps acted as something of a counterbalance, Dr. Drysdale. Drysdale, a son of a Lord Provost of Edinburgh was born two years afte: Waterloo, and educated in France. He read medicine at Edinburgh and was pupil of Fletcher, a progressive physiologist who discussed the theory o: Homceopathy in his lectures. He graduated at the age of 21 as M.D. and then set off with his friend Russel (later to become a homceopath) to Germany and Austria; they visited Leipzi~ and then moved on to Vienna where Drysdale attended daily at Fleischmann'; homceopathic hospital for two years. I t was here in Vienna he met Dudgeon not yet converted to Homceopathy. He returned to England in 1840 and begat what was to be a very successful practice in Liverpool, and in the followin~
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year opened a Homceopathic Dispensary which became very popular. I n the same year he edited Elements of General Pathology by his old teacher Fletcher, and uncompleted because of the Professor's early death, and in the following year inaugurated the British Journal of Homeeopathy. I n 1849, a cholera epidemic hit Liverpool. He treated 175 patients with a mortality of 25 per cent., while the general mortality in Liverpool was 45 per cent. His successes roused the envy of his allopathic colleagues, and he was expelled from the Liverpool Medical Institute. He realized the need for a repertory, but recognized that such a work would be very bulky and to save space devised a cypher; this was ingenious but most physicians found t h a t learning the cypher was equivalent to learning a new language, and it never became popular. I n 1868, he applied for a post in the Children's Hospital at Liverpool, hoping to demonstrate the homceopathic method in an orthodox hospital, but the antagonism of the allopathic physicians was too great and his election was defeated. At this time, too, he was interested in the origin of life and spent eight years with Dallinger on microscopic research on primitive unicellular organisms, proving to his satisfaction after a prolonged study of their life cycle that there was no evidence for spontaneous generation. Having failed to have charge of beds in an orthodox hospital, he had the satisfaction twenty years later of appointment as physician to a homceopathie hospital in Liverpool, thanks to the generosity of a member of the Tare family. He read his last paper to the Bournemouth Congress at the age of 77 and died two years later. Drysdale remarked t h a t the earlist converts to Homceopathy among men of m a r k in the medical world were outstanding pathologists. He was an earnest advocate of critical revision of the Materia Medica. He recommended that one cannot be too scrupulous or too severe in refusing the admission of doubtful symptoms and advised rejection of all symptoms recorded from sick persons. For Drysdale, the totality of symptoms included not only the subjective symptoms, but all possible means of physical and chemical diagnosis; t h a t it was desirable to find the pathological simile. In his experience it was the exception to cure any given case with a single remedy; one must give a succession of remedies or at times alternate. He was of the opinion that the concept of a single remedy was an ideal. I n 1867 he maintained that the selected remedy must be one t h a t acted on the affected part. But he also pointed out the extreme significance of apparently unimportant and trivial symptoms, and compared them to the value of the microscope in arriving at a pathological diagnosis. "We must not quarrel with apparently unmeaning and unconnected symptoms, they correspond to the unconnected and apparently unmeaning signs of dorm a n t disease." A curious contradiction appears at this stage in his outlook. He complains t h a t H a h n e m a n n was not emancipated from a belief in a vital principle. In Drysdale's view the supposed vis medicatrix naturae had no existence; organized matter was held together by a special affinity quite different from chemical affinity; there was no resemblance between the vital and the chemical forces, and he did not believe any chemical action whatever took place in living organized matter. Would he have accepted enzymes and the double helix? He did not accept the germ theory of disease.
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Drysdale kept abreast of developments in organic chemistry, in physics, and followed Virchow's cellular pathology. Nevertheless he pointed out that therapeutic specificity was not dependent on physiological specificity. A dilated pupil was not necessarily an indication for homceopathic potencies of Belladonna. For Drysdale vitality was a property of organized matter, and he laid stress on the degree of organization. But of the causes of this organization, he admitted logic and science could tell us nothing, we were up against a blank wall. But in the last year of his life he was still maintaining t h a t there was only one t r e a t m e n t - - b a s e d on pathology; the symptomatic approach ought to be merely the pathological carried out to a far more minute degree than the condition recognized by coarse, morbid anatomy. There spoke the microscopist. As far as dosage was concerned, Drysdale had to admit t h a t high dilutions sometimes worked: for his part, low dilutions did best and he found no advantage above the 3rd decimal. Dudgeon and Drysdale, these very influential homceopaths were on the lookout for a third Editor of their journal, the official organ of the Homceopathic Society. But before I describe the incidents t h a t decided them to appoint Richard Hughes, I would like to describe the conditions which faced a general practitioner in the 1860s. Hughes had settled down in Brighton where there were already seven other homceopaths, and as far as I can ascertain, never had charge of hospital beds. He treated his patients in their homes and in the Brighton dispensary and he had to be prepared to cope with very serious infectious illnesses. Typhoid was a serious problem--attacking all classes, even the Prince of Wales was a victim in the 70s. There were 100,000 cases in England a year, with 20,000 deaths, and a high incidence in the middle classes. Smallpox outbreaks occurred from time to time. One homceopath in Leicester had eighty cases with only four deaths, and a Bristol homceopath, Dr. Williams, Medical Officer to Muller's Orphanages, had 300 cases of smallpox on his hands at once. Relapsing fever was not unknown, and Dyee Brown, a Scottish homceopath with experience of an epidemic in Aberdeen, travelled to London to give the benefit of his advice to his London colleagues faced with this problem. Diphtheria was a new disease, first called the Boulogne throat; it arrived from France and the first cases were identified in the late 50s. There was no immunity to this new infection and the mortality was alarming; one thinks of the analogy of measles killing off the South Sea Islanders. Hughes lost his first three eases, and ten of his next t w e n t y eases died. More t h a n one child in a family might be lost in a few days. Puerperal fever was another bugbear. Semmelweis had only just published his researches in 1861. And venereal disease was rife. The incidence of syphilis in the A r m y in 1863 was 25 per cent. and in the naval port of Devouport there were 2,000 prostitutes. Last but not least, tuberculosis was a scourge, though its cause was still debated and would be for some time to come. There were no trained nurses to help the doctor. The Nightingale School for Nurses at St. Thomas's had only just been opened in 1860 and the District Nurses queen's Institute did not function for another quarter of a century. B u t such a demanding type of practice was not going to absorb the energies
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of our young doctor. I n the year of his election to the Society he contributed a paper on the present state of the physiology and pathology of the nervous system; it was a r6sum6 of recent orthodox research by Brown Sequard and Claude Bernard. This made no reference to Homceopathy; but the next year he corrected this omission with a seminal paper on the indications afforded b y physiology and pathology for the selection of homceopathic medicines, and the need of a scientific pathogenesy and the means for its attainment. The Journal printed this revolutionary paper, but a footnote was added b y Quin himself advising readers to be cautious in accepting these new ideas. The footnote read: 'The Editorial Committee publishing this first paper must beg to guard themselves against being supposed to coincide with his views; wider experience and mature thought will convince Dr. Hughes of the soundness both of I-Iahnemann's doctrine and of his practical rules for the selection and administration of remedies. signed, Quin, Russell, and u Hughes was convinced of the truth of the homceopathic method and he stated it was the object of his life to maintain this t r u t h and put it into practice. He saw himself as a scientist who must keep abreast with the advances in physiology and pathology; only in this way would it be possible to enlist the interest of the old school practitioners. While he realized t h a t the best textbook would be obsolete in ten years, he set about writing a homceopathic pharmacology, a task which employed all the leisure left him b y a laborious practice. His Manual of Pharmacodynamics was published in 1867. His main object was to set forth in a connected way the sphere of action of each remedy in a way that would appeal to doctors trained in the orthodox school, and to elucidate the physiological and pathological actions of each drug. He hoped to make Homceopatby scientific b y linking it to pathology and physiology. He believed in maladies as concrete entities. He did not agree with the French aphorism, il n ' y a pas de maladies, i] n ' y a que des malades: and so he expected ultimately to fmd a specific remedy for es eh specific disease. With characteristic Victorian optimism, he felt pathology was advancing so rapidly t h a t the chaos of disease was steadily being organized and classified and as each new disease was recognized, it would be for the homceopaths to discover the specific remedy. Treatment must be methodized, scientific, based upon principle. Hahnemann, he said, had discovered the best and only plan of finding true specifics, but Hughes believed that these specifics would be found to act in strict accordance with the laws of physiology. Halmemann's method depended on proving medicines on healthy subjects. But had he always kept to this principle? Hughes had his doubts and embarked on a lengthy process of tracing t t a l m e m a n n ' s sources, checking all the references in a variety of languages. He found him guilty of using symptoms derived from the treatmejat of sick persons and resolved to purge the Materia Medica of all such symptoms ab usu ex morbis. He admitted too t h a t in his early studies of Homceopathy he had often speculated on the probability t h a t m a n y of the minute particulars had no real connection with the disease process at all. He was a generalizer, not an individualizer, what the botanist would call a "lumper", not a "splitter". He pro-
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ferred objective signs to subjective symptoms for it was difficult to understand the cause of these symptoms and he had, like all orthodox physicians, been brought up on the motto "Tolle causam"--find the cause. He was doubtful too about the provings with the 30th potency in Halmemann's Chronic Diseases and was, therefore, prepared to dismiss some of the provings there of Calcarea, Hepar sulph., Carbo veg., Lycopodium, Sepia and
Silica. Further there were too m a n y remedies. The list must be reduced, remedies found useless must be omitted. One hundred remedies should be adequate and then their symptom-list should be winnowed and what he called "frivolous" symptoms expunged. After all, the symptoms were only the phenomena, but it was the prerogative of science and a necessity of the human intellect to pierce beyond phenomena and ascertain the laws and even the ultimate causes. The Manual of Pharmacodynamics was a success from the start. I t was translated into French, German and Spanish; and a second edition appeared three years later, third and fourth editions at intervals of five years. He wrote especially to interest practitioners of the old school. I t was quoted extensively both in Great Britain and in America, reviewed in an orthodox medical journal, and in ten years this book had achieved a world-wide reputation. I t was considered the most readable book in the English homceopathic literature. A quarter of a century later it was still considered the best introduction for the inquirer. Many later homceopathic physicians, including his critics, admitted they were trained on Hughes' Manual. I t was even recommended to American students as a standard work, the best book to put into the student's hand as an introduction. At 27, Hughes became the third Editor of the British Journal of Homoeopathy and continued as Editor until 1884, twenty-one years later when the journM ceased to exist. Hughes revived the Journal in 1893 as the Journal of the British Homveopathic Society and died in a Dublin street in 1902 with the proofs of the forthcoming number in his pocket. He says t h a t from his youth he had a eacoethes scribendi, an itch for scribbling. H e set about improving the journM. He published abstracts each quarter from the homceopathic journals of France, Belgium, Germany, Spain, I t a l y and America, and exchanged in all thirty-one journals. His motto printed at the top of his summaries was a quotation from the gospel account of the miracle of loaves and fishes--' 'Gather up the fragments t h a t nothing be lost". But he was unsparing in his reviews, both of English and foreign colleagues. Though unsigned, the style is unmistakable. Of Jahr, one of the first disciples, he deplores the imperfection of his medical education, his ignorance of French medicine; long past out-of-date, his writings "nonsense made difficult". Of Gross---he considered his well-known work "a monument of misdirected industry". Could he have foreseen t h a t in later years his own Cyclopaedia would be open to the same criticism? The Americans did not fare better. Even of Hering, the introducer of Lachesis, he could not feel sure of his judgment: he was critical too of Lippe. He started to edit Allen's Encyclopaedia but gave up his commentary as he found Allen's compilation disclosed so much t h a t was faulty. He could be very sarcastic about his own colleagues' efforts and was patronizing in donnish style about Compton Burnett's useful little essays, condemned his slipshod
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style, his crabbed translations and his tendency to appeal ad populum; add discouraging about Cooper's introductions of new remedies. The next crucial event in Hughes' career was his visit as official delegate to the first World Convention of Homceopathy at Philadelphia in 1876. Hughes had hardly endeared himself to the American homceopaths by his fearless criticisms of their textbooks and articles. He continually protested against the indiscriminate blending of so-called curative symptoms with those of pure provings, and Lippe, and Hering, who had introduced Apis and Glonoine, as well as Lachcsis, came in for urffavourable comment, and so did Hempel who was accused of Swedenborgian mysticism. Hering's Guiding Symptoms were described as a vast ella podrida of fact and fancy, of wheat and chaff, with an obvious preference for the fancy and the chaff. He followed this up at the Convention by criticising the veteran Hering in a paper Hughes read on materia mediea as a science. He also contributed a paper on the value of Hydrocyanic acid in epilepsy. Not a very convincing essay, as Hughes saw a similarity in the terminal convulsion of cyanide poisoning with the epileptic attack. The American Carrel Dunliam in his address to the World Congress warned the Convention against pathological prescribing: it would be prescribing for a class, not an individual. But the message seems to have been lost on Hughes who described Dunham as having none of the contempt for nosology and pathology so often paraded by exclusive colleagues. Hughes stayed with Dunham at this Convention and was distressed when Dunham died shortly after the Congress, killed by overwork for this great occasion. Hughes could not fail to be impressed by the flourishing state of Homceopathy in the United States. There were over 3,500 homceopaths, and seven colleges devoted to homceopathic medicine. At least eight homceopathic journals. But while he inveighed against the American school who would banish nosology and pathology, nevertheless he dedicated his second edition of his Manual of Therapeutics to his American colleagues, doubly endeared, he wrote, by his memories of 1876. Later he was awarded Honorary M.D.s by three American homceopathic colleges. He came back from America, dissatisfied with the lack of progress in Britail), determined t h a t the next World Congress should be held in London, t h a t a school of Homceopathy should be established in London; he was appointed secretary to organize the London Congress and expressed the view t h a t in ten to twenty years' time Homceopathy as a distinct sect might have ceased to exist in Europe. And a few years later, he came to the conclusion t h a t there was no likelihood t h a t Homceopathy would be dominant in medicine. I t s practice is too refined, too difficult, too laborious, for the mass of practitioners and the generality of mankind. The organizers of the proposed school of Homceopathy ran into difficulties at first, but eventually a group of physicians, including Hughes, gave a series of lectures. In the first course, there were only two students, both graduates, Dr. Goldsborough and Dr. J o h n Clarke, who ironically subsequently became Hughes' chief rival and opponent. The organizers were disappointed t h a t no undergraduates attended; and some of them favoured an all-homceopathic university, but it was soon realized t h a t this was impracticable.
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A t the end of five years, Hughes was no longer teaching, but published his last year's course of lectures as the third edition of his Pharmacodynamies. But another great project was occupying Hughes' mind. The year before the Philadelphia Congress, Hale, an American homceopath, had published his New Remedies which he had compiled from indigenous plants used by the Red Indians, the common people, and the herbalists, who called themselves in the USA botanic practitioners, and so introduced for the first time such valuable remedies as Actaea, Aesculus, Baptisia, Caulophyllum, Collinsonia, Gelsemium,
Hamamelis, Hydrastis, Iris, Phytolaeea, Sanguinaria. Hughes became aware that behind the scenes there was a proposal for a new encyclopaedia incorporating these new drugs, and that Dr. Allen was organizing a t e a m to work on this scheme. At this Congress he met an American, Dr. Dake, who shared Hughes' views on the unscientific nature of m a n y of the symptomlists in the provings old and new. Hughes offered Allen his help in editing and purging the undesirable and doubtful symptoms from Hahnemann's Chronic Diseases and made a start on this, for he "was compelled to the conclusion t h a t the great bulk of the s y m p t o m lists in the Chronic Diseases were not to be relied on as genuine physiological effects of the drugs" and he considered no clinical symptoms should be admitted. But evidently disagreement arose between Hughes and Allen, and Hughes, after completing his sifting and winnowing of Hahnemann, abandoned his share in Allen's Encyclopaedia which was finally published in 1880. Dr. Dake, however, continued with propaganda for Hughes' reconstruction of the materia mediea and at a meeting of the American Institute of Homceopathy, which Hughes attended, Dake and Hughes were jointly appointed editors of a Cyclopaedia of Drug Pathogenesy. Hughes had high hopes of this work. "I m a y be sanguine", he wrote, " b u t I hope t h a t the fortress of intolerance and prejudice is being undermined and will, ere long, come down with a crash." But he was disappointed b y its languid reception in America; very few journals noticed it, and very few workers referred to it in their articles, indeed he reported attempts to discredit it. He, as Chairman of the H a l m e m a n n Publishing Society, tried to get the society to back it financially, but the committee for once refused him. Even at society discussions, he was pained t h a t no reference was made to the data he had so laboriously collected. The Cyclopaedia was published in parts and the final part appeared in 1892, a marathon effort lasting ten years, embodying a very great deal of research and unremitting industry. However, it was criticized as a book suitable for students rather than for practising doctors, as it was not an easy book for reference, it was too voluminous. Other physicians spoke of a wholsesale massacre, only half the remedies in Allen's Encyclopaedia appeared in Hughes' Cyclopaedia. Hughes had claimed for his work it contained the truth and nothing but the truth, but was it the whole truth? H a d he not been too fierce? too puritan? too iconoclastic? :Nevertheless, Allen generously recommended Hughes' work to would-be students. Goldsborough, one of Hughes' first students, now President of the Society, pronounced it a classic, but isn't it the fate of classics to be respected but not read ?
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Hughes defended his work as sufficient for ideal practice; it was intended for the working practitioner in actual practice; but I think he assumed t h a t the average doctor was prepared to work as obsessionally as he, the perfectionist, was; and the general opinion was t h a t the Cyclopaedia was a magnificent work of reference. Hughes by this time was at the top of the homoeopathic establishment. He had been Vice-President and President of the British Homceopathie Society, Permanent Secretary of the International Congress, Vice-President at the Paris International Congress, President of the Medical Reform Union, Chairman of the H a h n e m a n n Publishing Company. But there was an underground movement which had begun as far back as 1876 and at t h a t first International Congress in Philadelphia. I t was an ironical twist of fate t h a t the initiator of the backlash was a Dr. Skinner. We must have a flashback to the 40s and Professor Henderson's struggle to convince his Edinburgh colleagues of the validity of Homceopathy. His chief persecutor was no less than the famous Dr. J a m e s Simpson, the introducer of chloroform anaesthesia. His favourite student at t h a t time was young Dr. Skinner, whom he recruited as his private assistant in his obstetric practice. Skinner identified himself with his chief's attitude to Homceopathy. Skinner moved on to Liverpool where he enjoyed a large consulting practice. But in his late thirties he had a "breakdown", what we would call nowadays a depressive illness. He was hors de combat for some three years, until he met a Dr. Burridge, a homceopathic physician who prescribed a very high potency of Sulphur. The result was a rapid restoration to normality. Skinner now studied Homceopathy in earnest, severed his connection with the orthodox Liverpool Institute and began to build up a new practice, and two years later published a small book, Homeeopathy and Gynaecology,in which he took farewell of his former colleagues. Cured b y a high potency, he advocated their use and so was challenged by the Liverpool homceopaths, who were low potency men, to produce a case cured b y a high potency where low potencies had failed. He presented a case of tuberculosis of the spine with psoas abscesses which he cured with Syphilinum in high potency. The n~w recruit travelled as an unofficial delegate to t h a t first International Congress in Philadelphia t h a t Hughes attended as official representative. There he met Hering, Lippe, Allen and Swan, all authors whose works you m a y remember had come under Hughes' scornful criticism. At this Congress, Skinner lobbied Lippe and Swan and they agreed jointly to produce a new journal which they named the Organon to be published simultaneously in England and America. The policy was to attack Hughes' pathological Homceopathy which the Editors regarded as a serious departure from H a h n e m a n n ' s original teachings. Their justification was to return to the practice of individualization by a study of the symptoms and their modalities of each separate patient. At the end of three years, Skinner was s out of pocket and the enterprise had to be abandoned. Instead Dr. Skinner moved to London where he carried on a large consulting practice for a quarter of a century. Here he met Dr. J o h n Clarke, of Prescriber fame. J o h n Clarke, sixteen years younger t h a n Hughes, was going to be his chief opponent. I n 1875 after graduation as M.D. of Edinburgh, the young Clarke was at a loose end, and it was a relative, not a doctor, who suggested that he should look
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into Homceopathy. Clarke visited the Liverpool Dispensary, where an active group of homceopaths were working, including Drysdale, who had made provings of Kali bichrom., and the Haywards, who had proved the venom of the rattlesnake. (An orthodox medical journal commented on this research-"Now the serpent was more subtle than any of the beasts of the field but he was not subtle enough for the homoeopaths of Liverpool.") From Liverpool, he went to the London Homoeopathic Hospital as houseman, and joined the London School of Homceopathy, where Hughes was one of the lecturers. Indeed Clarke was one of the only two students in that year and won the prize offered at the end of the course. At the end of his period as house physician, Clarke moved to Ipswich in general practice as an assistant to a homceopath. Here he had some practice in journalism and contributed a series of reformist articles to a local left wing paper. But as early as'this, Hughes and Clarke clashed. Hughes quoted Clarke as a recent and valuable accession to our ranks but criticized him for reporting t h a t anathema a clinical symptom. Two years later Clarke was back in London in private practice and was assigned the job of reporting on the Jubilee meeting of the British Medical Association, which afforded him the opportunity of ironical comment, a talent he later exploited to the full. Having passed this test satisfactorily, Hughes recrl~ited Clarke as a junior Editor of the British Journal of Homceopathy. But this arrangement only lasted two years when Clarke resigned to take over the Editorship of the Homeopathic World from Dr. Burnett, a journal more orientated towards the laity. A few years later Dr. Dudgeon joked t h a t Dr. Clarke was a homoeopathic Atlas sustaining on his unaided shoulders the whole homceopathic world. I n tiffs same year of 1885, Clarke issued his first edition of the Prescriber, a pocket-book on treatment which went into eight editions in the next forty years. I t was about this time that he came across Skinner's Homeeopathy and Gynaecology and was very impressed by the success of high potencies, and as he wrote, "on the principle that it is never wise to waste time, or trouble, in doubting or believing anything when it is possible to know", (what a contrast to the sceptical Dudgeon and Hughes!), he wrote off at once to America for a set of 500 and 1M potencies and put them to the test. Gratified by the results he contacted Skinner who by this time had been in consulting practice in the West End for five years. In the discussions at Society meetings Clarke insisted on the importance of the symptoms as guides, rather than the pathology and claimed that I-[ahnemann depreciated pathological indicators for detection of the remedy. Finally in 1890 Clarke threw down a challenge to Hughes in a paper to the Society, "The Two Paths in Homoeopathy". Here he let his hair down and bared his teeth. He began by paying a tribute to his venerated teacher Dr. Hughes. He admitted t h a t Dr. Hughes' textbooks were readable, readily utilizable and did not shock unnecessarily one's allopathic feelings. But Clarke had found the homceopathic family less united than he had expected. He summed it up t h a t there are two paths which diverge at a point and lead in widely opposite directions. The parting of the ways lies in the relative importance given to p~thologieal
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states and names of diseases on the one hand, and on the other hand, to symptoms and appearances when diagnosing the remedy. He went on to say t h a t symptoms were the only definite facts in our knowledge of disease and drug action. But morbid anatomy, pathological theories, nosological terms were a foundation of shifting sand. And to support his argument Clarke quoted in detail one of H a h n e m a n n ' s records of a case of dyspepsia. You will not be surprised to hear t h a t Dr. Hughes listened to this paper with very mingled feelings--accused Clarke of belonging to an old-fashioned minority which would soon be extinct, and as for the peculiar and mental symptoms they were of secondary importance. Dudgeon admitted t h a t Clarke had given them a shock by resurrecting from the t o m b the long buried doctrine of the vital force. I t was after this lecture t h a t Clarke gra~iually withdrew from Society meetings and a few years later resigned his appointment as physician to the London Homoeopathic Hospital. He joined forces with Dr. Skinner, the high potency exponent and, together with Dr. Cooper and Dr. Burnett, formed a Dining Club, later known as the Cooper Club where they met regularly. Burnett, you will remember, had been harshly criticized b y Hughes, and Cooper had fared little better at his hands. Hughes continued to give post-gr~luatc lectures in 1895 and attacked Clarke in this course for his use of clinical symptoms in prescribing. The only concession Hughes would make was t h a t clinical symptoms were reluctantly admitted as necessary in this rough workaday world, but it was not a matter of pride but a concession to weakness. Did he imply t h a t Clarke was weak? Clarke, however, was busy on his Dictionary of Materia Medica; the first volume was published in 1900. Clarke's Dictionary was designed to present the picture of each remedy so t h a t it m a y be recognized. He used clinical symptoms, and felt objections to them were academical rather than practical. For those who had scruples about using clinical symptoms, he dismissed them to study Hughes' Cyclopaedia. He was also working behind the scenes to establish a Chair of Homceopathy for his friend Dr. Burnett. But Compton Burnett died in 1901. Hughes in his obituary notice dismissed him as an eclectic in practice, and not a pure hom0eopath. Nevertheless, a Compton Burnett course of lectures in Homceopathy was later established. Hughes was only to outlive Burnett a year. He died suddenly in Dublin in 1902 and a special meeting of the Society was held to honour his memory. Clarke paid a graceful tribute, pointing out t h a t everyone in the room, except the very senior Dr. Dudgeon, owed it to Dr. Hughes t h a t he was there. This was very generous, as Clarke had been denied office in the Society; apart from the short term as Editor at the beginning of his career, he was never elected Secretary, Vice-President or President, and when the Interaational Congress was held in London in 1911, the foreign members were shocked t h a t he had not been elected President. J o h n Clarke retired from discussion in the Society for nearly a quarter of a century, but Hughes' reputation faded into an oblivion for nearly fifty y e a r s - Was this deserved? After all, as a keen young doctor, convinced of the truth of Homceopathy, he had sought to bring it up to date with the orthodox scientific teaching of his day; to make it more acceptable to his orthodox colleagues he was prepared
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to prune the materia medica of its excrescences and extravagances, as he saw them, and to abolish Hahnemann's arbitrary schema. Dudgeon had described the schema as though an artist should paint a family group, arranging all the eyes of all the members of the family in one part of the picture, all the noses in another, the ears all together and so on. Hughes, therefore, was the first English writer to construct a drug picture: true, it was a limited picture, heavily shaded with pathology--but from this first sketch evolved a more eolourful drawing by Clarke until we have the detailed portraits of Kent and the fine outlines of Dr. Margaret Tyler. De Bone in his Use of Lateral Thinking states that "in working up through an orthodox organization the new ideas man m a y be more of a hindrance than an asset".
"Drive, energy, singlemindedness are much more effective qualities and as such are the ones rewarded." Hughes had these qualities and he earned his reward. "But singlemindedness, drive and determination are not characteristic of the ideas man." And here was Hughes' weak spot. He was a man of few ideas, and was not receptive to new ideas, so that interested in pathology as he was, he failed to keep up with developments in his lifetime. His fellow members could hardly believe their ears when he claimed the prostate gland was part of the urinary system, not the sexual system. I n spite of Pasteur's researches, he was very reluctant to accept what he called the germ theory of disease and not until 1900 would he admit that phthisis was a bacterial disease, and he doubted that influenza was infectious. As for diabetes, Hughes recommended uranium nitrate; experiments on dogs had produced glycosuria; but at this time, there were m a n y views on the organ responsible for diabetes--one school named the kidneys, others the liver, some the blood, others the brain, but no one had thought of the pancreas. What better demonstration of the futility of linking the selection of the remedy to the organ that was supposed to be malfunctioning? As for the high potencies, he was forced to admit that the 30th potency sometimes was effective, but it worried him that there was no scientific explanation, and so he admitted that he had great difficulty in believing in them. Indeed in a discussion of a paper on high potencies, his criticism of the reader of the paper was so savage that the President took him to task for his severe strictures. Sir Mortimer Wheeler has commented that: "The scientific revolution of the middle decades of the nineteenth century had isolated science and materialism as a way of life, and had placed it upon an intellectual pedestal which was in fact g r o s s l y . . , out of scale. " I n this exaggerated insularity, science became Science (with a capital 'S') with an overall detachment which excluded those sorts of thinking that are not susceptible to tangible proof." But the old argument between the vitalists and the materialists is still open. The proceedings of the Serbelloni symposia demonstrate that there are two groups of scientists with opposing views. "On the one hand there are the scientists who claim that to all intents and purposes we do understand the secret of life and its origins; that molecular biology which now knows the chemical structure of the most imortant constituents of living cells has explained in principle how life works . . ."
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B u t quite a lot of other scientists, a p p a r e n t l y equally intelligent a n d e m i n e n t , claim t h a t these "answers" are n o t answers at all, a n d t h a t the real p r o b l e m still exists. W e do n o t u n d e r s t a n d , t h e y say, either how life works or how it evolves. N i n e t e e n t h - c e n t u r y H u g h e s took one side down one path. Clarke who lived on into the t w e n t i e t h c e n t u r y took the other side, t h e other p a t h , a n d in this c o u n t r y we have followed h i m a n d K e n t , Tyler a n d Sir J o h n Weir. B u t in his a t t e m p t to make H o m c e o p a t h y more acceptable to his orthodox colleagues, he rendered a great service i n m a k i n g a difficult subject m u c h easier to learn, a n d recruited m a n y doctors to our faculty. As Dr. Clarke commented, " P e r h a p s he worked too well." Requiescat in pacem. LITERATURE British Journal of Homeopathy, vols. xviii-xli, 1860-1883. Monthly Homazopathic Review, vols. xxxii-xlvi, 1888-1902. Journal of the British Homveopathie Society, vols. i xi, 1893-1903. Blackie, M. British Homveopathic Journal, 49, 79. April 1960. Bodman, F. British Homveopathic Journal, 50, 73-82. April 1961. Bono, E. de. The Use of Lateral Thinking. London, 1967. Burford, G. British Homv~opathic Journal, 116-24, 1932. Clarke, J. H. Thomas Skinner M.D. London, 1907. Clarke, J. H. Dictionary of Practical Materia Medica, vol. 1. London, 1900. Clarke, J. H. A Clinical Repertory. London, I904. Davy, J. Observer, 15 February 1970. Dudgeon, R. Lectures on the Theory and Practive of Homeeopathy. Manchester, 1854. Dudgeon, R. Foreword, Hughes' Principles and Practice of Homceopathy. London, 1902. Goldborough, G., British Homeeopathic Journal, 126-9, 1932. Hughes, R. A Manual of Pharmacodynamies, 4th edition. London, 1880. Hughes, R. A Manual of Therapeutics, 2nd edition. London, 1877. Hughes, R., and Dake, J. P. A Cyclopaedia of Drug Pathogenesy. London and New York, 1886. Hughes, R. A Repertory. London and New York, 1897. Hughes, R. Trans. World. Homeeopathic Convention of 1876, vol. ii. Philadelphia, 1880. Hughes, R. Principles and Practice of Homceopathy. London, 1902. Priestman, K. British Homozopathic Journal, 54, 77. April 1965. Ross, D. British Homceopathle Journal, 47, 14-27. January 1958. Tyler, M. Homeeopathy, vol. i, p. 2. 1932. Wheeler, M. Alr~ for Oblivion. London, 1966. Winter, G. A Country Camera. London, 1966.