- Email: [email protected]
Was Dudgeon right?
I hope I have demonstrated that hom~eopathy is a rational approach to the treatment of the sick, using naturally occurring laws. The spiritual approach has no more reference to homoeopathy than to any other field of treatment and tends to distract attention from the specific homo~opathic approach.
To conclude Our cures are neither sudden nor dramatic, but they are so natural the illness 'melts away', surely the 'hall-mark' of good treatment. REFERENCES 1 Boyd HW. Are we poles apart? Br Hom J 1968; 57:2. 2 Mauriot A. Biography of Sir A. Fleming. Jonathon Cope 1969. "I realize that every living thing m u s t . . , have an effective defence mechanism; otherwise.., the bacteria would invade and destroy it." 3 Hahnemann S. Organon paragraph 64. 4 BrJ lnd Med 1968; 23:136. 5 Inglis B. Through the Time Barrier. Pp. 123-4. Paladin Books.
Was Dudgeon right? A discussion of the theories of Hahnemann BERNARD LEARY, MB, MRCGP, DTM&H, MFHOM The odd thing about homoeopathy is the devotion shown to Hahnemann, its founder, who died one hundred and fifty years ago. In theory all our actions are based upon his theories and methods and every student is referred to the Organon which is supposed to be his mentor and guide. Not that there have not been criticisms of his ideas. Anthony Campbell has revived our interest in Richard Hughes who, commenting upon the Materia Medica of Hahnemann, pointed out many of the symptoms in Hahnemann's later provings were derived from tests upon the sick rather than the healthy. Hughes answer to this was that we should take note of the earlier work and regard with suspicion later ideas which could be blamed upon the Master's age. "To make" he says ~ "the Hahnemann of 1830-1843 our guide is I think to commit ourselves to his senility". We must all have encountered eminent physicians who were masters of their craft but whose powers began to fail and who became increasingly sensitive to criticism as they got older. It seems the A paper read to the British Homceopathic Congress at Great Yarmouth in April 1985.
194
The British Homoeopathic Journal
view of Hughes that this is the picture we could expect of Hahnemann, many of whose theories date from his old age. This is a comfortable idea because it allows us to discard almost anything we do not like. But have we any evidence? During his lifetime none of his disciples seem to have criticized him in this way. Of course there could be reasons for this. Trying to fight a hostile establishment, they would be likely to close ranks, at least in public. Indeed his closest followers do not seem to have been the most critical of men. With Gros, Hering, Boenninghausen and so on one must sometimes wonder if they ever had their feet on the ground, despite their great contributions to homoeopathy. But if we look at Hahnemann himself we do not get a picture of senility. After his second marriage he did not retire gracefully to be looked after in his old age. Instead he goes to Paris, opens a new successful practice, starts, for the first time in years, visiting patients at home, and leads a gay social life. We must also take note of von Boenninghausen's comments upon the letter he received from Dr Croserio in 18442 concerning Hahnemann's dosages. "Such a statement as to the size of dosages made by man to whom no one has denied a most rare faculty of observation, made at the conclusion of his earthly career, has at least for me a greater importance than all the bald assertions and contradictions with which his opponents have flooded us". No suggestion here that the Master is to be regarded as senile. The picture we get is that most of his cerebral arteries were functioning. Should we not expect this? Are we to assume that he did not make use of his own remedies? Because of these contradictory views of the man I find Dudgeon of interest. Now Dudgeon did not know Hahnemann personally, but his lectures given eight years after Hahnemann's death seem to be one of the first collected criticisms of his ideas. Dudgeon's opinion was that Hahnemann was a brilliant observer but a hopeless theorizer. 3 In fact he .accepted none of these theories and gave logical reasons for not doing so. We do not need to concern ourselves with the ideas he put forward in their place. But we still claim to rely upon Hahnemann's hypotheses and Dudgeon's analysis of them would serve as a useful basis for their examination. One of the difficulties, as Dudgeon states, 4 is the reluctance of Hahnemann to discard an idea even when it had been overtaken by another. His writings are therefore full of apparently contradictory statements. This does not seem to worry some doctors who pick quotations from whichever paragraph or edition suits their argument while ignoring those which maygive a contrary view. But quite a number of our practices do not seem to derive from his teaching. So I pose two questions: How much of Hahnemann's views do we accept? and How much should we accept? Provings
Let us first consider provings, which have already been mentioned. Our claim is that we base our methods on a knowledge of the symptoms produced in a healthy individual by the remedy concerned. Dudgeon quotes the first detailed account of how these should be obtained which are given in 'The Medicine of Experience'.5 He points out that even here, so early, Hahnemann let in the idea of the sick when he said: "How, even in diseases amid the symptoms of the original disease, t h e medicinal symptoms may be d i s c o v e r e d . . , must be left solely to masters in the art Volume74, Number 4, October 1985
195
of observation." In a letter to Stapf in 1813 he wrote: "An increase by a medicine of symptoms that had previously been present most probably indicates that the medicine can of itself also excite such symptoms.'6 In the late Organon he allowed such symptoms to be listed. 7Clinical experience had gradually crept in. Many of the later provings were conducted using the 30th potency and certainly some of the symptoms are suspect, as they seem to derive from the sick. Hughes tried to establish purity by restricting symptoms in his Cyclopaedia to those from provings on the healthy and using potencies no higher than 12x. s But there are problems here. Many of our common remedies are prescribed as much, if not more, because of mental symptoms. It can be very difficult to find these in Hughes. Even in Hahnemann they may not be there. Of course with something like Natrum tour. you would not expect these symptoms from material doses. But when we try to reproduce provings, particularly using the 30, but even with lower potencies, we seem to have the greatest difficulty in finding anything like the conventional drug picture. Whatever we would like, we have to accept that a large part of our materia medica is based on clinical experience rather than on scientific sounding provings.
Theory of cure With regard to the theory of cure, Dudgeon traces the development from the first essay "On a New Principle" of 1796 to the final edition of the Organon. In summary, a weaker dynamic action will be suppressed by a stronger if the two are similar but only suspended if dissimilar. Medicines excite artificial diseases which are stronger than natural diseases but which can be more easily overcome by the vital force. 8 Every real medicine 9 acts at all times, under all circumstances and produces the symptoms peculiar to it. Dudgeon points out that there is no proof that a medicine is stronger except that it happens to cure. Indeed taking Hahnemann's own examples, the cook who burned his hand cures it with heat but a much lesser degree of heat than that which caused the burn.l~ Frostbite is cured by cold but again a lesser not a greater degree than that which caused the original damage. As to medicines acting all the time, Dudgeon gives, I think, some rather unsatisfactory examples to combat this argument but from our own experience I think we can say that the usual result of taking a potency which is not the similium or very dose to it is for nothing to happen at all. This again brings us to high potency provings but we seem to have little evidence for these.
Homo~opathic aggravation The question of homceopathic aggravation can be summed up in two quotations. First from the 'Medicine of Experience': n "If we have not only selected the right remedy but have also hit upon the proper dose, the remedy causes within the first few hours after the first dose has been taken, a kind of slight aggravation which the patient imagines to be an increase of his disease but which is nothing more than the primary symptoms of the medicine which are somewhat superior in intensity to the disease and which ought to resemble the original malady as to deceive the patient himself." The second is from the Organon. 12"Every aggravation by the production of new 196
The British Homwopathic Journal
symptoms invariably proves unsuitability on the part of the medicine given in the case of disease before us". The first, as Dudgeon points out, inevitably follows from the idea of a stronger disease overcoming a weaker. But the question is: Does the homeeopathic aggravation really occur? Let me give you a few examples from the minutes of the Allegheny County Homceopathic Medical Society.13 A Dr J. F. Cooper described a case of sore throat to which he administered Bell 3x. Soon after the patient was struggling for breath and almost collapsed. This was cured with camphor. Dr Hoffman described a case of whooping cough which went into violent aggravation lasting several days after the patient took a whole bottle of Drosera 3x. Dr Martin gave a case of cerebral irritation which went into convulsions after Bell 3x. All these are put forward as examples of the homoeopathic aggravation, but they could equally fit the second type, that of unsuitable medicine. However, there seems no reason why the disease should not have been progressing in its usual way. Certainly we all know of cases where patients seem to have got worse before they got better, but we also have patients who improve without any sign of aggravation. The frequency of such an occurrence, as Hahnemann suggests, is at least doubtful.
Theory of Chronic Disease The theory of Chronic Disease was one which really provoked Dudgeon's criticism, not least because he saw it as departing from the doctrine of the similium. I do not need to go here into any detailed exposition of the theory. You are all familiar with it. But it is worth recalling his summary of the essentials as he saw them? 4Thus we shall find it requires us to believe - - T h a t seven eighths of all chronic diseases are the consequence of an infection with a skin disease that has been driven off or removed by external treatment. - That this skin disease is identical with what we call itch, though it presents itself under many different forms. - - That every infectious chronic skin disease is scabies or a degeneration of it. - - That none of these seven eighths of all chronic diseases are curable save by the use of a certain set of medicaments that were mostly unknown or unused before Hahnemann's time, consequently that no such chronic diseases were ever cured before the promulgation of his doctrine in 1828. - That itch, properly so called, and all the varieties of skin diseases Hahnemann includes under that term are only safely curable by internal remedies and that their treatment by external remedies is fraught with the greatest danger to the patient. The question of the importance of skin disease I leave to the individual. Certainly, I personally have never seen a case of suppressed skin disease which convinced me. I exclude here the asthma/eczema relationship which is an alternation of essentially the same allergic process. Campbell criticizes the theory because it is so general. I think there are two other important points. First, the idea that by implication no chronic disease was ever cured before 1828. This is absurd. Hahnemann himself makes claim to hom0eopathic cures before that, using medicines that are not antipsoric. Second, as Dudgeon points out, Hahnemann's complete omission of Volume 74, Number 4, October 1985
197
hereditary disease. If we leave the theory's correctness on one side for a moment, do we in fact act upon it? The answer is surely no. The antipsorics are used regularly in the same way as other remedies, purely on a similium basis. Many doctors could probably not tell you which medicines are listed in Chronic Diseases. And when we give Sulphur we explain it as trying to produce a reaction, not that we think the patient is psoric. Our idea of the miasm seems to be totally different from Hahnemann. We pay great attention to the family history, with the suggestion that there may be a hereditary diathesis for which the nosode is the remedy. Admittedly we also recognize the effects of acquired disease in the past, but once more it is the nosode rather than the antipsoric that we prescribe. For most of us this theory has no place in everyday practice.
Dynamization One theory that we all would probably claim to follow is that of dynamization. Historically it seems likely that Hahnemann reduced his doses to avoid aggravations and side effects, no doubt spurred on by his quarrel with the apothecaries. In his essay on scarlet fever of 180115 he lays stress on the intimate mixture of the tincture with the diluting water. There is no claim to power, although he does say that it only comes with brisk, long continued stirring. By 1810, in the first edition of the Organon, he started to suggest an increase in power, but it was not really until 1825, in the essay "How can small doses of very attenuated medicines as homceopathy employs have any action on the sick? ''16 that he definitely stated that there is an undreamt-of change by the liberation of dynamic powers. By 1828 he is warning that succussion must be limited because of the increase in strength it produces, although he changes his mind in the second edition. 17 Dudgeon could not accept this theory, 18feeling the need for a material dose. He thought there was absolutely no evidence on which to base it. He thought it ignored individual susceptibilities when considering medicinal strength. He decried Hahnemann's attempts to lay down an arithmetic scale of strength with such statements that a drop of the decillionth of Nux vomica produced nearly half the effect of a drop of the quintillionth. How could he tell? Thus we have a theory that stands on very shaky ground. But we go further. Taking ideas from Korsakov and Hering we talk of containers absorbing potencies and requiring heat treatment to clear them. (How do we know?) We gaily seed our medicine bottles. Is it any wonder that trials produce results no better than placebo?
Posology Hahnemann first of all seems to have used conventional doses, but in the Scarlet Fever essay of 180119 he suggested infinitesimal doses and over the years made reference to the power of these. In the eighteen twenties, in the Materia Medica Pura, he gives specific instructions 2~for various medicines to be used in differing dilutions, Squilla in the 1st, Chamomilla in the 12th, Stannum in the 9th. But with the advent of the Psora theory he settled upon the 30th as the standard for all conditions. 198
The British Homoeopathic Journal
However, he does not seem to have stuck to this himself. Dr Chapman's description in the Homoeopathic Times of Hahnemann's pocket case gives an account of all potencies from 3rd to 30th. 2~On the other hand Dr Croserio, in the letter previously referred to, states that Hahnemann only used the 30th, although Boenninghausen, in a note to that letter, insists that he also used the 60th. 22We are therefore in doubt as to what he believed, but whatever it was it does not seem to relate to our practice. The very high potencies were not of course available to him. Modem prescribing habits vary but probably approximate to the idea that with a clear picture and good mentals we go high but with a less clear picture or marked pathological change we use a low potency. This does not fit with Hahnemann either in theory or practice. Frequency of dose As you know, we are repeatedly exhorted to repeat a medicine only when the first dose has completed its action. However in the second edition of Chronic Diseases 23 and again in the sixth edition of the Organon we have an instruction to repeat frequently in acute disease and every day or two in chronic. Since the vital principle does not accept unchanged doses without resistance the medicine is to be given 8, 10, or 12 succussions before each dose to alter the potency. This can then be continued for months. In contrast, Dr Croserio 24 states that even in acute cases it was rare for Hahnemann to allow the patient to take more than one spoonful in 24 hours and in chronic conditions he would not allow the patient to smell the medicine more than once a week. Once more we seem to be in confusion over theory and practice.
To me, one striking point about Dudgeon's lectures is that my edition runs to some 550 pages. Of these, rather less than a third is devoted to Hahnemann's writings. Most of the rest consists of other doctors' opinions. On any point he seems to be able to find up to a dozen doctors, each with his own ideas. Admittedly it was much easier then to have an opinion since there were fewer restrictions by the rules of science. But if Dudgeon were standing here today, how many doctors would he find with an original thought on the theory of homoeopathy? Hughes had his ideas. Dudgeon had his ideas, Hering produced volumes of ideas, but in this century theory seems to have been frozen. Whatever one may think of Hahnemann's theories they are based on eighteenth century and early nineteenth century ideas of pathology, physiology and philosophy. Written in the German of that time and translated without change of style, they are difficult to read, let alone judge. Further, printed as they are without comment and often without date, the student gets no idea of the historical evolution of a theory. Someone said, a few years ago, that we must drag hom~eopathy into the twentieth century. But this is 1985 and the twenty first century is on the horizon. Should we not be sitting down and deciding, never mind what was said in the past, deciding what we believe today. Perhaps there would be no change. Perhaps we would finish up with the simple statement that we do not have any theory but we are homceopaths because it appears to work. That at least would be honest. Before I get shot I should make it clear that I am not here to attack Hahnemann Volume 74, Number 4, October1985
199
who was obviously a doctor with an extraordinary brain. In any case there are enough doctors in the audience who can produce evidence of the value of many of his observations. But we all believe in the circulation of the blood, yet how many of us have read William Harvey. What is more to the point, are medical students required to read him for 1st MB? Surely our explanations of what we do and what we believe should be as far as possible accurate. ~2ertainly we should not claim to believe one thing and actually believe another. ~t is better to have no theory than one for which there is no substantial eviderlce. Any theory we do have should be put forward in twentieth century language and not based either in eighteenth century metaphysics or nineteenth century scientific ideas. Many of Hahnemann's ideas are factual observations. On the other hand many of his theories appear to have no supporting evidence. The first can be stated as facts. Should not the latter be discarded? Many people have a philosophical approach to hom0eopathy. Others opt for the scientific. But whatever it is, homceopathy is not a religion. There is therefore no need for a high priest. To quote Dudgeon again: 25"Hahnemann was a great man, but not a prophet; his works are full of wisdom, but they are not revelations. And yet there are some of his disciples who think it almost blasphemy to dispute any of his sayings". Has not the time come--and here comes the heresy--with great reverence and respect but with great firmness to consign the eighteenth century Hahnemann and indeed the nineteenth century Kent to the historical museum and library and to teach our students a twenty first century philosophy? REFERENCES 1 Hughes R. Manual of Pharmacodynamics, Sixth Edition, p. 91. New Delhi: Jain. 1980. 2 Bradford TL. The Lesser Writings of CMF yon Boenninghausen, Indian Edition, p. 216. New Delhi: Jain. 1979. 3 Dudgeon RE. Lectures on the Theory and Practice ofHomceopathy p. 77. New Delhi: Jain. 1980. 4 Dudgeon RE. Lectures, p. 219. 5 Hahnemann S. Lesser Writings. p. 447. New Delhi: Jain. 6 Dudgeon RE. Lectures, p. 184. 7 Hahnemann S. Organon, Translated Boericke, p. 198. Calcutta: Roy. 1970. 8 Hahnemann S. Lesser Writings. p. 447. 9 Hahnemann S. Organon, p. 108. 10 Ibid. p. 85. 11 Hahnemann S. Lesser Writings, p. 455. 12 Organon, p. 257. 13 Aggravation after Dose and Repetition of Dose, Homoeopathic Heritage, 1984; 9: 12:576. 14 Dudgeon RE. Lectures, p. 289. 15 Hahnemann S. Lesser Writings, p. 375. 16 Hahnemann S. Materia Medica Pura, p. 43. New Delhi: Jain, 1980. 17 Hahnemann S. Chronic Diseases, p. xx. New Delhi: Jain, 1981. 18 Dudgeon. Lectures, p. 242-249. 19 Hahnemann S. Lesser Writings, p. 375. 20 Materia medica pura. 21 Dudgeon. Lectures, p. 407. 22 Von Boenninghausen. Lesser Writings, p. 215. 23 Organon, p. 253. 24 Von Boenninghausen. Lesser Writings, p.213. 25 Dudgeon. Lectures, p. 137.
200
The British Homveopathic Journal
To conclude Our cures are neither sudden nor dramatic, but they are so natural the illness 'melts away', surely the 'hall-mark' of good treatment. REFERENCES 1 Boyd HW. Are we poles apart? Br Hom J 1968; 57:2. 2 Mauriot A. Biography of Sir A. Fleming. Jonathon Cope 1969. "I realize that every living thing m u s t . . , have an effective defence mechanism; otherwise.., the bacteria would invade and destroy it." 3 Hahnemann S. Organon paragraph 64. 4 BrJ lnd Med 1968; 23:136. 5 Inglis B. Through the Time Barrier. Pp. 123-4. Paladin Books.
Was Dudgeon right? A discussion of the theories of Hahnemann BERNARD LEARY, MB, MRCGP, DTM&H, MFHOM The odd thing about homoeopathy is the devotion shown to Hahnemann, its founder, who died one hundred and fifty years ago. In theory all our actions are based upon his theories and methods and every student is referred to the Organon which is supposed to be his mentor and guide. Not that there have not been criticisms of his ideas. Anthony Campbell has revived our interest in Richard Hughes who, commenting upon the Materia Medica of Hahnemann, pointed out many of the symptoms in Hahnemann's later provings were derived from tests upon the sick rather than the healthy. Hughes answer to this was that we should take note of the earlier work and regard with suspicion later ideas which could be blamed upon the Master's age. "To make" he says ~ "the Hahnemann of 1830-1843 our guide is I think to commit ourselves to his senility". We must all have encountered eminent physicians who were masters of their craft but whose powers began to fail and who became increasingly sensitive to criticism as they got older. It seems the A paper read to the British Homceopathic Congress at Great Yarmouth in April 1985.
194
The British Homoeopathic Journal
view of Hughes that this is the picture we could expect of Hahnemann, many of whose theories date from his old age. This is a comfortable idea because it allows us to discard almost anything we do not like. But have we any evidence? During his lifetime none of his disciples seem to have criticized him in this way. Of course there could be reasons for this. Trying to fight a hostile establishment, they would be likely to close ranks, at least in public. Indeed his closest followers do not seem to have been the most critical of men. With Gros, Hering, Boenninghausen and so on one must sometimes wonder if they ever had their feet on the ground, despite their great contributions to homoeopathy. But if we look at Hahnemann himself we do not get a picture of senility. After his second marriage he did not retire gracefully to be looked after in his old age. Instead he goes to Paris, opens a new successful practice, starts, for the first time in years, visiting patients at home, and leads a gay social life. We must also take note of von Boenninghausen's comments upon the letter he received from Dr Croserio in 18442 concerning Hahnemann's dosages. "Such a statement as to the size of dosages made by man to whom no one has denied a most rare faculty of observation, made at the conclusion of his earthly career, has at least for me a greater importance than all the bald assertions and contradictions with which his opponents have flooded us". No suggestion here that the Master is to be regarded as senile. The picture we get is that most of his cerebral arteries were functioning. Should we not expect this? Are we to assume that he did not make use of his own remedies? Because of these contradictory views of the man I find Dudgeon of interest. Now Dudgeon did not know Hahnemann personally, but his lectures given eight years after Hahnemann's death seem to be one of the first collected criticisms of his ideas. Dudgeon's opinion was that Hahnemann was a brilliant observer but a hopeless theorizer. 3 In fact he .accepted none of these theories and gave logical reasons for not doing so. We do not need to concern ourselves with the ideas he put forward in their place. But we still claim to rely upon Hahnemann's hypotheses and Dudgeon's analysis of them would serve as a useful basis for their examination. One of the difficulties, as Dudgeon states, 4 is the reluctance of Hahnemann to discard an idea even when it had been overtaken by another. His writings are therefore full of apparently contradictory statements. This does not seem to worry some doctors who pick quotations from whichever paragraph or edition suits their argument while ignoring those which maygive a contrary view. But quite a number of our practices do not seem to derive from his teaching. So I pose two questions: How much of Hahnemann's views do we accept? and How much should we accept? Provings
Let us first consider provings, which have already been mentioned. Our claim is that we base our methods on a knowledge of the symptoms produced in a healthy individual by the remedy concerned. Dudgeon quotes the first detailed account of how these should be obtained which are given in 'The Medicine of Experience'.5 He points out that even here, so early, Hahnemann let in the idea of the sick when he said: "How, even in diseases amid the symptoms of the original disease, t h e medicinal symptoms may be d i s c o v e r e d . . , must be left solely to masters in the art Volume74, Number 4, October 1985
195
of observation." In a letter to Stapf in 1813 he wrote: "An increase by a medicine of symptoms that had previously been present most probably indicates that the medicine can of itself also excite such symptoms.'6 In the late Organon he allowed such symptoms to be listed. 7Clinical experience had gradually crept in. Many of the later provings were conducted using the 30th potency and certainly some of the symptoms are suspect, as they seem to derive from the sick. Hughes tried to establish purity by restricting symptoms in his Cyclopaedia to those from provings on the healthy and using potencies no higher than 12x. s But there are problems here. Many of our common remedies are prescribed as much, if not more, because of mental symptoms. It can be very difficult to find these in Hughes. Even in Hahnemann they may not be there. Of course with something like Natrum tour. you would not expect these symptoms from material doses. But when we try to reproduce provings, particularly using the 30, but even with lower potencies, we seem to have the greatest difficulty in finding anything like the conventional drug picture. Whatever we would like, we have to accept that a large part of our materia medica is based on clinical experience rather than on scientific sounding provings.
Theory of cure With regard to the theory of cure, Dudgeon traces the development from the first essay "On a New Principle" of 1796 to the final edition of the Organon. In summary, a weaker dynamic action will be suppressed by a stronger if the two are similar but only suspended if dissimilar. Medicines excite artificial diseases which are stronger than natural diseases but which can be more easily overcome by the vital force. 8 Every real medicine 9 acts at all times, under all circumstances and produces the symptoms peculiar to it. Dudgeon points out that there is no proof that a medicine is stronger except that it happens to cure. Indeed taking Hahnemann's own examples, the cook who burned his hand cures it with heat but a much lesser degree of heat than that which caused the burn.l~ Frostbite is cured by cold but again a lesser not a greater degree than that which caused the original damage. As to medicines acting all the time, Dudgeon gives, I think, some rather unsatisfactory examples to combat this argument but from our own experience I think we can say that the usual result of taking a potency which is not the similium or very dose to it is for nothing to happen at all. This again brings us to high potency provings but we seem to have little evidence for these.
Homo~opathic aggravation The question of homceopathic aggravation can be summed up in two quotations. First from the 'Medicine of Experience': n "If we have not only selected the right remedy but have also hit upon the proper dose, the remedy causes within the first few hours after the first dose has been taken, a kind of slight aggravation which the patient imagines to be an increase of his disease but which is nothing more than the primary symptoms of the medicine which are somewhat superior in intensity to the disease and which ought to resemble the original malady as to deceive the patient himself." The second is from the Organon. 12"Every aggravation by the production of new 196
The British Homwopathic Journal
symptoms invariably proves unsuitability on the part of the medicine given in the case of disease before us". The first, as Dudgeon points out, inevitably follows from the idea of a stronger disease overcoming a weaker. But the question is: Does the homeeopathic aggravation really occur? Let me give you a few examples from the minutes of the Allegheny County Homceopathic Medical Society.13 A Dr J. F. Cooper described a case of sore throat to which he administered Bell 3x. Soon after the patient was struggling for breath and almost collapsed. This was cured with camphor. Dr Hoffman described a case of whooping cough which went into violent aggravation lasting several days after the patient took a whole bottle of Drosera 3x. Dr Martin gave a case of cerebral irritation which went into convulsions after Bell 3x. All these are put forward as examples of the homoeopathic aggravation, but they could equally fit the second type, that of unsuitable medicine. However, there seems no reason why the disease should not have been progressing in its usual way. Certainly we all know of cases where patients seem to have got worse before they got better, but we also have patients who improve without any sign of aggravation. The frequency of such an occurrence, as Hahnemann suggests, is at least doubtful.
Theory of Chronic Disease The theory of Chronic Disease was one which really provoked Dudgeon's criticism, not least because he saw it as departing from the doctrine of the similium. I do not need to go here into any detailed exposition of the theory. You are all familiar with it. But it is worth recalling his summary of the essentials as he saw them? 4Thus we shall find it requires us to believe - - T h a t seven eighths of all chronic diseases are the consequence of an infection with a skin disease that has been driven off or removed by external treatment. - That this skin disease is identical with what we call itch, though it presents itself under many different forms. - - That every infectious chronic skin disease is scabies or a degeneration of it. - - That none of these seven eighths of all chronic diseases are curable save by the use of a certain set of medicaments that were mostly unknown or unused before Hahnemann's time, consequently that no such chronic diseases were ever cured before the promulgation of his doctrine in 1828. - That itch, properly so called, and all the varieties of skin diseases Hahnemann includes under that term are only safely curable by internal remedies and that their treatment by external remedies is fraught with the greatest danger to the patient. The question of the importance of skin disease I leave to the individual. Certainly, I personally have never seen a case of suppressed skin disease which convinced me. I exclude here the asthma/eczema relationship which is an alternation of essentially the same allergic process. Campbell criticizes the theory because it is so general. I think there are two other important points. First, the idea that by implication no chronic disease was ever cured before 1828. This is absurd. Hahnemann himself makes claim to hom0eopathic cures before that, using medicines that are not antipsoric. Second, as Dudgeon points out, Hahnemann's complete omission of Volume 74, Number 4, October 1985
197
hereditary disease. If we leave the theory's correctness on one side for a moment, do we in fact act upon it? The answer is surely no. The antipsorics are used regularly in the same way as other remedies, purely on a similium basis. Many doctors could probably not tell you which medicines are listed in Chronic Diseases. And when we give Sulphur we explain it as trying to produce a reaction, not that we think the patient is psoric. Our idea of the miasm seems to be totally different from Hahnemann. We pay great attention to the family history, with the suggestion that there may be a hereditary diathesis for which the nosode is the remedy. Admittedly we also recognize the effects of acquired disease in the past, but once more it is the nosode rather than the antipsoric that we prescribe. For most of us this theory has no place in everyday practice.
Dynamization One theory that we all would probably claim to follow is that of dynamization. Historically it seems likely that Hahnemann reduced his doses to avoid aggravations and side effects, no doubt spurred on by his quarrel with the apothecaries. In his essay on scarlet fever of 180115 he lays stress on the intimate mixture of the tincture with the diluting water. There is no claim to power, although he does say that it only comes with brisk, long continued stirring. By 1810, in the first edition of the Organon, he started to suggest an increase in power, but it was not really until 1825, in the essay "How can small doses of very attenuated medicines as homceopathy employs have any action on the sick? ''16 that he definitely stated that there is an undreamt-of change by the liberation of dynamic powers. By 1828 he is warning that succussion must be limited because of the increase in strength it produces, although he changes his mind in the second edition. 17 Dudgeon could not accept this theory, 18feeling the need for a material dose. He thought there was absolutely no evidence on which to base it. He thought it ignored individual susceptibilities when considering medicinal strength. He decried Hahnemann's attempts to lay down an arithmetic scale of strength with such statements that a drop of the decillionth of Nux vomica produced nearly half the effect of a drop of the quintillionth. How could he tell? Thus we have a theory that stands on very shaky ground. But we go further. Taking ideas from Korsakov and Hering we talk of containers absorbing potencies and requiring heat treatment to clear them. (How do we know?) We gaily seed our medicine bottles. Is it any wonder that trials produce results no better than placebo?
Posology Hahnemann first of all seems to have used conventional doses, but in the Scarlet Fever essay of 180119 he suggested infinitesimal doses and over the years made reference to the power of these. In the eighteen twenties, in the Materia Medica Pura, he gives specific instructions 2~for various medicines to be used in differing dilutions, Squilla in the 1st, Chamomilla in the 12th, Stannum in the 9th. But with the advent of the Psora theory he settled upon the 30th as the standard for all conditions. 198
The British Homoeopathic Journal
However, he does not seem to have stuck to this himself. Dr Chapman's description in the Homoeopathic Times of Hahnemann's pocket case gives an account of all potencies from 3rd to 30th. 2~On the other hand Dr Croserio, in the letter previously referred to, states that Hahnemann only used the 30th, although Boenninghausen, in a note to that letter, insists that he also used the 60th. 22We are therefore in doubt as to what he believed, but whatever it was it does not seem to relate to our practice. The very high potencies were not of course available to him. Modem prescribing habits vary but probably approximate to the idea that with a clear picture and good mentals we go high but with a less clear picture or marked pathological change we use a low potency. This does not fit with Hahnemann either in theory or practice. Frequency of dose As you know, we are repeatedly exhorted to repeat a medicine only when the first dose has completed its action. However in the second edition of Chronic Diseases 23 and again in the sixth edition of the Organon we have an instruction to repeat frequently in acute disease and every day or two in chronic. Since the vital principle does not accept unchanged doses without resistance the medicine is to be given 8, 10, or 12 succussions before each dose to alter the potency. This can then be continued for months. In contrast, Dr Croserio 24 states that even in acute cases it was rare for Hahnemann to allow the patient to take more than one spoonful in 24 hours and in chronic conditions he would not allow the patient to smell the medicine more than once a week. Once more we seem to be in confusion over theory and practice.
To me, one striking point about Dudgeon's lectures is that my edition runs to some 550 pages. Of these, rather less than a third is devoted to Hahnemann's writings. Most of the rest consists of other doctors' opinions. On any point he seems to be able to find up to a dozen doctors, each with his own ideas. Admittedly it was much easier then to have an opinion since there were fewer restrictions by the rules of science. But if Dudgeon were standing here today, how many doctors would he find with an original thought on the theory of homoeopathy? Hughes had his ideas. Dudgeon had his ideas, Hering produced volumes of ideas, but in this century theory seems to have been frozen. Whatever one may think of Hahnemann's theories they are based on eighteenth century and early nineteenth century ideas of pathology, physiology and philosophy. Written in the German of that time and translated without change of style, they are difficult to read, let alone judge. Further, printed as they are without comment and often without date, the student gets no idea of the historical evolution of a theory. Someone said, a few years ago, that we must drag hom~eopathy into the twentieth century. But this is 1985 and the twenty first century is on the horizon. Should we not be sitting down and deciding, never mind what was said in the past, deciding what we believe today. Perhaps there would be no change. Perhaps we would finish up with the simple statement that we do not have any theory but we are homceopaths because it appears to work. That at least would be honest. Before I get shot I should make it clear that I am not here to attack Hahnemann Volume 74, Number 4, October1985
199
who was obviously a doctor with an extraordinary brain. In any case there are enough doctors in the audience who can produce evidence of the value of many of his observations. But we all believe in the circulation of the blood, yet how many of us have read William Harvey. What is more to the point, are medical students required to read him for 1st MB? Surely our explanations of what we do and what we believe should be as far as possible accurate. ~2ertainly we should not claim to believe one thing and actually believe another. ~t is better to have no theory than one for which there is no substantial eviderlce. Any theory we do have should be put forward in twentieth century language and not based either in eighteenth century metaphysics or nineteenth century scientific ideas. Many of Hahnemann's ideas are factual observations. On the other hand many of his theories appear to have no supporting evidence. The first can be stated as facts. Should not the latter be discarded? Many people have a philosophical approach to hom0eopathy. Others opt for the scientific. But whatever it is, homceopathy is not a religion. There is therefore no need for a high priest. To quote Dudgeon again: 25"Hahnemann was a great man, but not a prophet; his works are full of wisdom, but they are not revelations. And yet there are some of his disciples who think it almost blasphemy to dispute any of his sayings". Has not the time come--and here comes the heresy--with great reverence and respect but with great firmness to consign the eighteenth century Hahnemann and indeed the nineteenth century Kent to the historical museum and library and to teach our students a twenty first century philosophy? REFERENCES 1 Hughes R. Manual of Pharmacodynamics, Sixth Edition, p. 91. New Delhi: Jain. 1980. 2 Bradford TL. The Lesser Writings of CMF yon Boenninghausen, Indian Edition, p. 216. New Delhi: Jain. 1979. 3 Dudgeon RE. Lectures on the Theory and Practice ofHomceopathy p. 77. New Delhi: Jain. 1980. 4 Dudgeon RE. Lectures, p. 219. 5 Hahnemann S. Lesser Writings. p. 447. New Delhi: Jain. 6 Dudgeon RE. Lectures, p. 184. 7 Hahnemann S. Organon, Translated Boericke, p. 198. Calcutta: Roy. 1970. 8 Hahnemann S. Lesser Writings. p. 447. 9 Hahnemann S. Organon, p. 108. 10 Ibid. p. 85. 11 Hahnemann S. Lesser Writings, p. 455. 12 Organon, p. 257. 13 Aggravation after Dose and Repetition of Dose, Homoeopathic Heritage, 1984; 9: 12:576. 14 Dudgeon RE. Lectures, p. 289. 15 Hahnemann S. Lesser Writings, p. 375. 16 Hahnemann S. Materia Medica Pura, p. 43. New Delhi: Jain, 1980. 17 Hahnemann S. Chronic Diseases, p. xx. New Delhi: Jain, 1981. 18 Dudgeon. Lectures, p. 242-249. 19 Hahnemann S. Lesser Writings, p. 375. 20 Materia medica pura. 21 Dudgeon. Lectures, p. 407. 22 Von Boenninghausen. Lesser Writings, p. 215. 23 Organon, p. 253. 24 Von Boenninghausen. Lesser Writings, p.213. 25 Dudgeon. Lectures, p. 137.
200
The British Homveopathic Journal