Page 6 - Autumn 12

Continued from page 3
‘stimulation’ in the system; from this it followed that illness was a state with an incorrect degree of stimulation present. Disease could thus be divided into two types: sthenia, where there was a state of over-stimulation present and asthenia, where under-stimulation was at the root of the problem. The essence of treatment was to counter-act these abnormal states either by ‘sedatives’ such as bleeding, cupping, cold applications and increasing perspiration, or ‘stimulants’ including hot applications, spicy foods, wine and exercise. Once an appropriate treatment had been selected, it was usually administered in excessively large amounts to ensure an adequate response. Hahnemann, of course, would have been well aware of this development and seen the results of its appli- cation. (Indeed, in 1801 he published a hard- hitting criticism of Brown’s theory. It is interesting to note that in a covering note to Hahnemann’s article, the editor of the journal describes him as ‘one of the most distinguished of German physicians’. It is clear that in spite of his controversial views Hahnemann at that time enjoyed the respect of some of his professional colleagues, although the article was published anonymously due to the possibility of physical violence on the author).
Although fully conversant with the methods of his contempories that did not mean that Hahnemann followed their lead in his clinical practice. His approach became much simpler, wherever possible avoiding strong medicine and concentrating on assisting nature rather than challenging her. His method came to involve principly attention to hygiene and clean- liness, considerations of diet and the minimal use of medicines wherever possible but still in material doses.
In 1789 his Instructions for surgeons respecting venereal disease was published in Leipzig. In this, among much else, he suggest- ed that although the treatment of mercury for syphilis was correct, the explanation that it acted by inducing excessive salivation was not; hence the massive doses used to induce the salivation were unjustified. His view was that mercury acted by setting up a ‘counter irrita-
tion’ in the body to the disease.
In September of the same year Hahnemann returned to the Leipzig area as it was a hub of the intellectual life, which he sought. Further study and translation work began to occupy an even greater proportion of his time, as his dis- illusionment with clinical medicine increased and he became convinced that the majority of treatments available caused more harm than good. However, his commitment to medicine as a healing art never wavered and his interest was maintained via his translations of medical texts. Hahnemann was never a ‘passive‘ trans- lator, merely reproducing a text in a different language. He invariably read the texts in an active way, using them as a means of additional study; and in a critical way as well, adding his own notes and comments to the translations.
Thus it was that in 1790 there arrived on his desk a copy of Treatise on Materia Medica by the Scottish doctor Cullen. It must be appre- ciated that at that time conditions in Western Europe were similar in many ways to the con- ditions now found in those areas of the world, where malaria is still endemic and so the treat- ment of ‘swamp’ or ‘marsh’ fever was of con- cern to all doctors. That, plus the venereal diseases would form a large part of the work- load of any practitioner. In the early part of the seventeenth century it had been found that the Quechua Indians of Peru were using the bark of a tree with success against the condition, and following its introduction into Europe by the end of the century ‘Peruvian or Jesuit Bark’ or just ‘Bark’ was known to be effective as a cure, although it was denounced in some quarters as quackery. One English doctor, Sir Robert Talbot dismissed it as a fraudulent treatment and advocated his own curative powder instead. He was successful in curing not only Charles II of England but also Louis XIV of France and the Queen of Spain and hence gained not only his knighthood but much influence. However, after his death in 1681 it was revealed that the major ingredient in his powder was the very bark he had spent many years denouncing – the machinations of ‘pharma’ are nothing new! (the name ‘quinine’ comes from the Peruvian word for the bark ‘Kina’ via the Spanish equivalent ‘quina’). Cullen was essentially an exponent of a variation of Brown’s theory, although he referred to ‘tone’ or ‘lack of tone’. Accordingly he supported the accepted explanation for the action of Bark that it acted via a ‘tonic effect on the stomach’. Hahnemann as is well known disagreed with this explanation and set out his objections in an extensive footnote in his translation:
“By combining the strongest bitters and the strongest astringents I can obtain a compound which, in small doses, possesses much more of these properties than the bark, and yet in all eternity no fever specific can be made from such a compound. The author [Cullen] should have accounted for this... I took, for several days, as an experiment, four drams (18 g) of
good china twice daily... Briefly, all symptoms usually associated with intermittent fever appeared in succession yet without actual rigor. To sum up: all those symptoms which to me are typical of intermittent fever... all made their appearance. This paroxysm lasted from two to three hours, and recurred when I repeated the dose and not otherwise. I discontinued the medicine and I was once more in good health”
Later in the same critique:
“If the author [Cullen] had detected that the bark had the power of producing artificial inter- mittent fever... certainly he would not have held so firmly to his mode of explanation”
and :
“Peruvian bark, which is used as a remedy for intermittent fever, acts because it can produce symptoms similar to those of intermittent fever in healthy people”.
Unsurprisingly, Hahnemann’s conclusions were challenged on a number of grounds, including lack of accurate diagnosis and the idea that Hahnemann had been infected with malaria whilst in Hermannstadt and was in fact in a carrier state, which was activated by his experiment. But for him the experiment was the final part of the emerging picture, he had been struggling with. Up to this point he had been dissatisfied with, and critical of, the convention- al system of medicine. However, he had been essentially a critic of aspects of the system rather than of the system itself, basically because he could offer no practical alternative. Now he could. He had found the key to his new method – Similia similibus curentur – let simi- lar be cured by similar. It was not, of course, a completely new idea. Hippocrates and other Greeks, plus Paracelsus and other more con- temporary writers had discussed the same type of ideas. What was new was that these thoughts were about to be harnessed and evolved into a complete and new medical discipline.
From this time onward Hahnemann became much more open in his attacks on pro- cedures such as bleeding, weakening diets etc, which he considered to be counter- productive (bleeding was considered to be both a curative and preventative procedure). One of his most virulent outbursts came in 1792 following the death of Kaiser Leopold II of Austria, who whilst ill had been subjected to repeated bleedings: the Kaiser subsequently, and in Hahnemann’s view consequentially, died and the ensuing controversy was largely of Hahnemann’s mak- ing. Allied to this more openly critical approach to the conventional wisdom Hahnemann began experimenting further (the first provings), ini- tially on himself and later involving others, who came to share his ideas. He gradually began to treat patients again including, due to a develop- ing interest in psychiatry, some mental patients. Around 1800 he resumed full time medical practice using only his new system.
All this resulted as well in a steady stream
4