MEDICINE BEFORE HAHNEMANN


MEDICINE BEFORE HAHNEMANN.
 Linn J. Boyd. M.D.

 

With the present abundance of elaborate and exhaust…


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hippocrates and his contemporaries inaugurated three innovations which revolutionized medicine.

1. They attached great importance to prognosis.

2. They made detailed observations of disease.

3. They rejected the supernatural in disease.

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

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

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

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

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

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

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

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

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

1. Observation, experiments, autopsy;

2. Learning from contemporaries;

3. Analogy;

4. Epilogism inferring preceding events from the present.

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

“Take the hair, it is written

Of the dog by which you are bitten.

Work off one wine by his brother,

And one labor with another”.

-Antiphanes, 401, B.C.

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

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

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

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

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

1. Those affecting simple tissues, as muscles.

2. Those affecting compound tissues as liver.

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

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

The causes of disease are three.

1. Procatartic or exciting.

2. Proegumenic or predisposing.

3. Synergestic or proximate.

Symptoms are of three classes

1. Altered functions (actions leases).

2. Vitiated qualities (qualities vitiatas).

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

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

Similia similibus Deus adjungit (De Thera ad Pison).

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

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

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

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

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

1. It helped restore primitive theories of diseases.

2. It imposed restrictions upon free thought and investigation.

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

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

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

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

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

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

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

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

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

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

Linn J. Boyd