Marketplace of the Marvelous (Beacon Press, 2013) illustrates a fascinating period in America's history, when many would-be patients fled from the induced vomiting and "medicinal" bleedings to a plethora of burgeoning practices that promised new ways to cure their ills. Author Erika Janik offers an entertaining introduction to the "quacks, snake-oil salesman, and charlatan" that arose in such a cultural climate as this. While many of the fads were defrauded, some of those notions still exist in our accepted medical curricula. The following is excerpted from the fourth chapter, "Dilutions of Health," and traces the origins of homeopathy.
For Elizabeth Cady Stanton, homeopathy felt like nothing less than liberation. Even better: this freedom could be purchased through the mail. “Dear me, how much cruel bondage of mind and suffering of body poor woman will escape,” wrote Stanton to her friend and fellow women’s rights advocate Lucretia Mott, “when she takes the liberty of being her own physician of both body and soul.” Stanton had first heard about homeopathy from her brother-in-law Edward Bayard in the 1830s. Diagnosed with heart disease, Bayard had received a discouraging prognosis from his New York City doctor. Dismayed by the news, Bayard tried homeopathy at the urging of his wife. Bayard’s recovery under the care of homeopath Augustus P. Biegler, using concoctions of diluted drug treatments, so astonished Bayard that he gave up his law practice to devote himself to the study of homeopathy.
Bayard’s miraculous turnaround also convinced Stanton to give homeopathy a try. “I have seen wonders in Homeopathy,” she reported to her cousin Elizabeth Smith (she of hydropathic wet-dress fame), and “I intend to commence life on Homeopathic principles.” She purchased a home homeopathy kit and began doctoring her family, friends, and neighbors in Seneca Falls, New York. Stanton found taking charge of her health incredibly powerful, and she expressed great pride in her self-reliance. She nursed her children through malaria, whooping cough, mumps, and broken limbs with homeopathic therapies. She described the 1852 homeopathic birth of her daughter as an “easy” fifteen-minute labor with a quick recovery. Practicing do-it-yourself homeopathy, Stanton joined the tens of thousands of lay practitioners who, along with formally trained homeopaths, made homeopathy a real and formidable contender to radically reform the practice of medicine.
Despite its egalitarian leanings, homeopathy did not share the populist origins of Thomsonism and hydropathy. Instead, like phrenology, the origin of homeopathy began with a regular doctor. Homeopathy developed from the experimental pharmacology of disillusioned German physician and scholar Samuel Christian Frederick Hahnemann. Born in Meissen, Germany, in 1755, Hahnemann exhibited a remarkable aptitude for languages from a young age, mastering eight foreign tongues by the age of twenty-four. He used his language skills to finance his medical education in Leipzig, Vienna, and Erlangen, teaching German and French and translating medical, historical, and philosophical works. But by the time of his graduation from the University of Erlangen in 1779, Hahnemann had begun to question the effectiveness of the existing medical system. The medicine he had learned seemed to lack the scientific rigor found in other fields, founded more on superstition than reason. A doctor trying to find a cure for intermittent fever, explained Hahnemann, would logically “turn his attention solely to learn what medicines the experience of bygone ages has discovered.” He searches “and to his amazement discovers that an immense number of medicines have been celebrated in intermittent fever. Where is he to begin? Which medicine is he to give first; which next, and which last? He looks round for aid, but no directing angel appears.” And even if one remedy did emerge as the clear favorite, Hahnemann complained that the same prescription sent to ten pharmacies resulted in ten different preparations. So the doctor “must hope for the best, and trust to good luck!” He examined common medical treatments for arsenic poisoning and psychiatric disorders and found them far from adequate. Contemporary medicine, declared an exasperated Hahnemann, was far too uncertain to be scientific, “founded upon perhapses and blind chance” rather than anything demonstrably provable. Hahnemann became so appalled by the practice of medicine that he abandoned it completely in 1782 and turned to writing and translating scientific texts full-time. He also studied botany, pharmacology, and chemistry, searching for the answers that regular medicine had failed to provide him.
One book seemed to offer a possibility. While translating Scottish physician William Cullen’s A Treatise on the Materia Medica into German in 1790, Hahnemann became intrigued by Cullen’s explanation of how cinchona bark healed malaria. The dried bark of a South American tree, cinchona contained quinine and had been used in Europe since the sixteenth century. It also had the rare distinction of being one of few drugs in common usage with an unquestioned and demonstrative therapeutic value. Cullen claimed that cinchona also strengthened the digestive system, but Hahnemann’s own experiences taking cinchona had left him nauseated and sick. Skeptical of Cullen’s claim and curious by nature, Hahnemann decided to experiment on himself. Hahnemann hoped his experiments might provide a scientific and rational explanation for how and why this particular drug worked for malaria, which he believed regular medicine sorely lacked.
For several days, Hahnemann ingested large doses of cinchona, taking careful note of its effects on his stomach. The cinchona left him feeling chilled, feverish, weak, and without appetite. He reported that his “feet, finger ends, etc., at first became cold. I grew languid and drowsy; then my heart began to palpitate and my pulse grew hard and small, intolerable anxiety, trembling (but without cold rigour), prostration through all my limbs.” The once healthy Hahnemann now appeared to have all the symptoms of malaria. When he stopped his daily dose, the symptoms disappeared. His observations soon led him to conclude that “substances which excite a kind of fever . . . extinguish the types of intermittent fever.” Cure a fever with a fever, or like cures like. This epiphany led Hahnemann to articulate what he called the law of similars, or Similia similibus curantur. It became the first law of his new system, one that he and later his followers hoped would revolutionize medicine.
An approach to healing based on similars was not new. Hahnemann himself likely knew about it already. Ancient Romans advised the consumption of a raw liver from a rabid dog to cure rabies, and colonial Americans used yellow mustard seeds to ward off yellow fever and jaundice. Even today, the “hair of the dog” after a night of hard drinking could be construed as a homeopathic remedy for a hangover. Heroic medicine, however, saw no necessary correlation between disease and treatment. Most regulars treated fevers with bloodletting and laxatives that produced strong bouts of nausea. Rather than reproducing symptoms, regular therapy sought to eliminate—or, more often, change—the symptoms. Hahnemann argued that this “heterogenous” method attacked healthy organs and weakened the whole system rather than directly targeting and extinguishing the original disease with a similar one “in a prompt and rapid manner.” Mimicking the symptoms would cause the body to push out the original disease and substitute the artificial one.
Although Hahnemann had first discovered his theory by swallowing large amounts of cinchona, he wondered if a smaller dose might actually be better. He worried that standard doses magnified a sick person’s symptoms to a potentially life-threatening degree. “In illness the body is enormously more sensitive to drugs than in health,” asserted Hahnemann. Hahnemann began testing smaller and smaller doses and found that he could still emulate the disease but without aggravating symptoms. In fact, it seemed that the less he gave—even doses as small as a millionth of a gram—the better he could produce an artificial disease with curative effects.
But doses this small could barely be seen much less handled. Hahnemann found a solution in dilutions, or what he later called the law of infinitesimals, in which he dissolved one grain of drug in ninety-nine parts water, alcohol, or lactose. This mixture would then be combined and mixed again, and then combined and mixed again, and so on to the thirtieth dilution, at which point the mixture theoretically contained only 1/10^60 grain of the active substance. Hahnemann believed that this small dose gave the body enough ammunition to reproduce the symptoms of disease but not so much that the body could not quickly rid itself of both the drug and the sickness.
Hahnemann was not the only one to suggest the healing power of small doses. In 1796, English physician Edward Jenner demonstrated that a small amount of cowpox given to otherwise healthy people appeared to produce immunity to smallpox. Hahnemann praised Jenner’s breakthrough as an excellent homeopathic example of how a similar disease could prove effective in destroying the original disease. Jenner’s method was not exactly homeopathic since it had not undergone dilution and cowpox was a preventative measure rather than a cure for an active disease, but Hahnemann nonetheless saw smallpox vaccination as an affirmation of homeopathic ideas. Despite Hahnemann’s approval of the practice, though, vaccination would later prove a divisive and controversial issue among homeopaths wary of the consequences of giving non-dilute diseases to otherwise healthy people.
Hahnemann published his initial findings and theory in “Essay on a New Principle for Ascertaining the Curative Power of Drugs, with a Few Glances at Those Hitherto Employed” in 1796. The paper clearly laid out his central idea: “In order to cure diseases, we must search for medicines that can excite a similar disease in the human body.” Hahnemann named his new system homeopathy from the Greek root homoios (like) to emphasize its focus on similars. He had a new name for regular medicine, too: allopathy, from the Greek root allos, meaning different. Nonhomeopathic irregulars soon adopted the name as well, and allopathy became the common irregular sobriquet for regular medicine.
Reflecting his insistence on scientific discipline, Hahnemann went to painstaking lengths to ensure that his findings and drug trials were rigorous. His procedures presage much of what is standard in clinical trials today. Rather than rely on the superficial comparisons of common origin or physical appearance (yellow mustard for yellow fever, for example) that had informed ancient healing practices based on similars, Hahnemann found matches between the drug and disease through extensive experiments that he called provings, from the German word Prüfung, for test. He chose the word carefully. Hahnemann wanted to be sure the name illustrated his care in providing the truth to patients. For homeopathy to work, the action of all medicines had to be determined, and the only way to do that, Hahnemann believed, was to test them on healthy people. Hahnemann moved from first testing remedies on himself to testing them on his neighbors. Only after he was absolutely sure of the effects of a substance did he use it on sick patients. This method is now standard in modern medical trials, where new treatments are first used on healthy people to evaluate safety and then the sick to evaluate efficacy. Every substance was tested singly because compounds of two or more ingredients made it impossible to know the effects of the individual substance. To assist in the proving, Hahnemann recruited volunteers and required that they take careful and voluminous notes on every twitch, twinge, and change they experienced during the trials. He advised one of his provers testing Helleborus niger to take it “any day when you are well, and have no very urgent business, and have not eaten any medicinal substance (such as parsley) at dinner.” He directed him to “take one drop of this to eight ounces of water, and a scruple of alcohol (to prevent its decomposition), shake it briskly, and take an ounce of it while fasting; and so every hour and a half or two hours another ounce, as long as you are not too severely affected by what you take.” Because every person was different, many individuals needed to test each remedy and record their symptoms—mental, emotional, and physical—to create a full and accurate proving of all possible effects. “Provers” had to stick to a moderate diet free of spices and alcohol, aside from the scruple used in mixing, and to avoid extreme physical or mental exertion. Each symptom received careful attention as to whether “eating, drinking, talking, coughing, sneezing, or some other bodily function” altered its form. Based on his initial experiments, cinchona became Hahnemann’s first remedy.
Testing remedies was an enormous task. Hahnemann and his followers ingested common herbs and minerals, plants, fungi, barks, and shellfish. They examined hops, toadstools, oyster shells, poison ivy, and ragweed. Nearly everything homeopaths added to their healing catalog had been known and used medically for centuries. In every case, they used small doses. Hahnemann came to believe that no substance was poisonous if taken in the proper—tiny—quantity.
Hahnemann published the first compilation of his drug provings, listing medicines and symptoms caused by each, in his 1811 Materia Medica Pura. A Latin term, materia medica means the body of collected knowledge of substances used for healing—in homeopathy’s case, all of the provings. While not specific to any one form of healing, the term is widely used in homeopathy to mean all of the homeopathic remedies. Even as he released the book, Hahnemann emphasized that the testing would never be finished. Hahnemann wanted the homeopathic medicine chest to continue to grow and improve with new discoveries and time. By the end of the nineteenth century, more than seven hundred remedies had been studied and catalogued.
Many regular doctors saw homeopathy as nothing less than absurd. Some took issue with Hahnemann’s provings. They claimed his results invalid because he did not compare the reactions of his provers with a control group not taking drugs. That no such tests likely existed for most if not all heroic therapies appears not to have bothered most regulars, who often demonstrated a hypocritical blindness to the unscientific and speculative nature of their own techniques. Regulars prescribed drugs and performed treatments without the kinds of detailed observations and studies done by homeopaths, and almost certainly did not employ control groups to determine the efficacy or benefit of their depletive methods. Hahnemann’s precise methods of observations and exactness in accumulating data, while lacking the randomization and blinding of trials today, provided a level of testing virtually unheard of in eighteenth- and nineteenth-century medicine, and made homeopathy appear far more scientific than contemporary regular medicine.
Others ridiculed the symptom lists in the Materia Medica Pura with its pages describing “yawning and stretching,” “easily falls asleep when reading,” and “an excessive liability to become pregnant.” Other remedies seemed to produce contradictory results. What was a doctor to do when faced with several drugs causing both constipation and diarrhea, impotence and excessive sexual desire? The extraordinary detail given to each symptom required an almost superhuman degree of self-awareness. Not to mention that not all provers reported the same symptoms from the same substances. The flowering plant aconite, also known as monkshood, for instance, could produce headaches that felt like your eyes might fall out or ones that felt like your brain was being moved by burning water—both headaches but with very different feelings that could be difficult to identify. It also caused “distraction of the attention when reading and writing,” and “dryness of the upper eye lids.” Each remedy produced a staggering number of symptoms, from ninety-seven on the low end to more than a thousand on the other extreme. To Hahnemann, though, the details that regulars found so ridiculous distinguished the homeopathic approach and provided the keys to its efficacy. Regular medicine was far too general to be helpful, he argued, lacking the crucial details that made each sick person’s case unique and ultimately, treatable.
If the symptoms struck regular doctors as ridiculous, the homeopathic dilutions made them virtually apoplectic. They argued that dilutions of these magnitudes made it statistically improbable that any of the original substance even remained in the dilution. The law of infinitesimals seemed to defy Avogadro’s number, which set the point in the dilution process where a molecule in any given substance could no longer theoretically exist. “Either Hahnemann is right, in which case our science and the basis of our thinking is nonsense, or he is wrong, in which case this teaching is nonsense,” declared German physician T. Jurgensen. It comes as no surprise that the astute Oliver Wendell Holmes questioned the rationality of anyone who believed that a man with a mortar and pestle could “take a little speck of some substance which nobody ever thought to have any smell at all, as, for instance, a grain of chalk or of charcoal, and that he will, after an hour or two of rubbing and scraping, develop in a portion of it an odor, which, if the whole grain were used, would be capable of pervading an apartment, a house, a village, a province, an empire, nay the entire atmosphere of this broad planet upon which we tread.” Those who subscribed to such views, Holmes declared, were simply “incapable of reasoning.” Regular physician Eli Geddings was a little more generous, expressing his skepticism that small doses would work but concluding that homeopathy could prove a blessing for lessening upset stomachs.
Small doses also jarred against a culture that expected a big effect from drugs. Regulars frequently prescribed drugs by the spoonful, not by the fraction of a gram. If patients didn’t bleed, vomit, or blister, how would they know they were getting better? Hahnemann and his followers took the radical position of arguing that healing didn’t have to hurt. They advocated for treatments that gave patients little or no feeling of physiological or physical change because healing, they argued, had nothing to do with the physical material of the remedy. Nor was disease a physical entity.
Homeopathy, like many other eighteenth- and nineteenth-century medical theories, including regular medicine, was a vitalist system. Advocates believed that disease resulted from an imbalance or blockage of the body’s invisible but powerful life force. Symptoms were “the product of the disease itself,” but they were not themselves the actual disease. “There does not exist a single disease that can have a material principle for its cause,” wrote Hahnemann. “On the contrary, all of them are solely and always the special result of an actual and dynamic derangement in the state of health.”
Reprinted with permission from Marketplace of the Marvelous: The Strange Origins of Modern Medicine by Erika Janik and published by Beacon Press, 2013.