Volume 83, Number 4, October 1994 October 1994, Vol. 83, pp. 240-244

Homoeopathic prescribing in the late 19th century BERNARD LEARY, MRCGP, FFHOM

Summary The discovery of the records of the London Homoeopathie Hospital dating from 1889 to 1923 has given the opportunity to study pre- s c r ib ing m e t h o d s in the pre- and pos t - Kentian periods. In particular, it has given a detailed insight into late 19th century ideas which has not been available before. A pilot study has demonstrated the common reme- dies employed and their potencies. Further research is needed to determine, if possible, the reasons for selection of remedies and the relative efficacy of the 2 contrasting systems of prescription.

Background It is the claim of every homoeopath that he prescribes in accordance with the principles laid down by Hahnemann. It is questionable whether this is true at the present time or indeed whether it was ever true. Even in the early stages of Hahnemann ' s work his fol- lowers were q u e s t i o n i n g his ideas. The Master, unable to brook crit icism, fought back with the result that there was a schism in homoeopathy in Germany from the very early days.

The Central Society was founded in 1830 in Leipzig but was attacked by Hahnemann in November 1832 (A summons to half the homoeopaths in Leipzig) because it admitted anyone who was interested: 1, 2

No man of this kind ought to occupy any of the sacred offices of our divine art in this hospital; for, strictly homoeopathically, you may depend upon it I shall raise my honest and influential voice and warn the world, already tired of deception, in all the public papers, of such falsi- fication and which deserves to be shunned. My fatherly exhortation for the present, in this

paper, shall be limited to Leipzig, hoping that you will reform.

This caused uproar so that from then on there were virtually two societies. When the Chairman, Moritz Mtiller, called a meeting in Leipzig, Hahneman called one in Koethen. In order to solve the quarrel Mtiller resigned in 1834 in favour of Schweikert. 3 Hahnemann laid down strict observance of similia sim- ilibus curentur. He demanded avoidance of all antipathic treatment, rejection of all heroic remedies e.g. b loodle t t ing , purging , and avoidance of stimulation which resulted in later weakening. The Central Society met in Koethen but only Hahnemann's friends were present. There was a move to abolish the Cen t r a l S o c i e t y and open the S a x o n Provincial Society. It is recorded that even his closes supporters breathed a sigh of relief when Hahnemann moved to Paris in 1835.

The most popular ideas were summarized by Paul Wolf (1795-1857) who prepared 18 theses that were accepted by the Central Society. These were published in Archives of Homoeopathic Medical Art, 1837, vol 13. The following is a r6sum6:

- -Str ic t acknowledgement of similia. - - I n order to employ law of cure it is neces-

sary to study the materia medica for years. - - T h e homoeopathic method does not con-

sist in mere comparison of symptoms, nor does it favour empiricism and lack of gen- eral medical education; but on the other hand it accep t s those par ts o f the old school which are known to be useful.

- -Unde r the totality of symptoms the scien- tifically educated homoeopathist compre- hends the pathological condition.

240

Volume 83, Number 4, October 1994 241

- - T h e homoeopathic law of cure not only demands that there be a similarity between the symptoms, but also a similarity of the disease and the comparison of the former is only an expedient to recognise the latter. The homoeopathic physician, therefore, makes sure whether the existing similarity be simply between the symptoms or also between the natural and the medicinal dis- ease as regards character, nature and seat.

- - T h e homoeopathic physician must know the meaning, the importance and the cause of several symptoms in order to judge which he may safely ignore and which he may safely consider to be the peculiar fea- ture of the disease.

- -Homoeopathy gratefully acknowledges the facts of pathological anatomy, etc., that the old school has discovered in the past but it considers the dynamic features of a disease process to be more important than the material, in that it is more susceptible to treatment. By the nature of the disease which, accord ing to Hahnemann , the physician could not or need not know, is especially understood the dynamic or vital part of the causal action, and not the mater- ial, the organic substratum of the complex of symptoms.

- - I t is not the business of the homoeopathist to remove simply the present complex of symptoms, but to abolish permanently the totality of both the symptoms and disease. It influences the choice of remedy but does not serve as the only indication.

- - H o m o e o p a t h y considers the totality of symptoms and not merely single annoying and secondary ones. Therefore it is not s imply a symptomat ic treatment in the base sense of the word.

- - T h e homoeopathic practit ioner, just as much as those of the opposi te school, requires all of the auxiliary sciences of medicine; none are unnecessary for him. The psora theory of Hahnemann is only of conditional importance in practice, as he put forth a great many antipsoric medi- cines and not a single one only.

- -The homoeopathic materia medica, though offering much assistance in making practi- cal and reliable prescriptions, is not per- fect, but needs to be developed; and reli- able reprovings should be made.

- - A n y medicament is homoeopathic as soon

as it occupies its relation to a certain dis- ease according to the main principle of homoeopathy, be it used in the 30th poten- cy or not at all diluted in grain, scruple or even larger doses. If Hahnemann later con- s idered the d i lu t ing of med ic ines as absolutely augmenting their action, and unconditionally believed that when thus diluted they are capable of affecting the healthy organism as well as the diseased, we must protest against it, and the more definitely on account of the attempt that has been made to draw practical conclu- sions from this theory which must be con- sidered objectionable, e.g. that the 30th potency is in all cases a sufficient and suit- able dose.

- -The principle to allow a medicine to act as long as improvement is perceptible is rea- sonable and practical. The duration of its effect, however, cannot be predicted; for the action does not mean a steady and per- manent effect, but a persisting of the vitali- ty, from the impulse given it by the medi- cine, for the restoration of health.

- - W e consider palliatives, as employed in the old school, allowable when the danger- ous effects of a disease must be instantly removed.

- - W e oppose the views of Hahnemann that diseases can only be cured by the assis- tance of art and not by the vis mediatrix naturae.

- -The writings of Hahnemann can no longer be considered as expressing the standpoint of homoeopathy of the present day, either theoretically or practically; for however great may be our veneration of his genius and for his discovery of the fundamental law of cure, we are not willing to subordi- nate our convictions to his authority or to humble ourselves for the derision of our opponents. Being convinced of the truth of the fundamental principles of homoeopa- thy, similia similibus curentur, we shall ardently endeavour to develop it, together with its genuine scientific elements, viz. to use one medicine at a time; to enrich the knowledge of medicinal agents by prov- ings on the healthy organism; to give the system a rational basis; to add other practi- cal rules which have been approved by experience; to test everything that has been added for the demonstration of certain the-

242 British Homoeopathic Journal

ories and suppositions which have no con- nection with the principles of homoeopa- thy.

British background These ideas were similar to those of British homoeopaths lead by Dudgeon and Hughes until the end of the century. They contrasted with those of Frederic Quin who was proba- b ly the only Bri t ish homoeopa th who had actually met Hahnemann. He said that:

He very seldom used tinctures. Most medicines he gave in high dilutions and very seldom had occasion to descend. Some medic ines he prescribed in lower attenuations. Thus in gonor- rhoea he gave Cannabis in globules saturated with the Mother Tincture and he never prescribed higher than 3. But Nux vomica, Bryonia, Belladonna and the antipsorics he gave in the 30th and he had no reason to be dis- pleased with the results of his practice. 3

Hughes recognized the need to reduce the dose of powerful poisons and that many emi- nent p rac t i t ioners used high d i lu t ions and praised their efficacy. But

We seem, therefore to have effected all reason- able ends, even with the most potent poisons when we have reached the thousandths and mil- lionths of which I have hitherto spoken...Unless some evidence should be brought before us to prove that we actually develop power, as we go on attenuating after the Hahnemannian method, reason must certainly frown upon the higher potencies. 4

Early in the 20th century the opinions of James Tyler Kent took over with emphasis upon mental symptoms and the use of high potencies. They first appeared on the scene when Dr Octavia Lewin presented a paper en t i t l ed ' C a s e s i l lus t ra t ing Cons t i t u t i ona l Treatment' .5 Dr. Lewin was a London gradu- ate who had obta ined her MD in Chicago. She raised the possibil i ty of curing a patient by studying the generals rather than the par- ticulars. It is interesting that in only 1 of the 5 cases were the mentals ment ioned. Al l the p a t i e n t s were t r e a t e d w i th M p o t e n c i e s . Dudgeon, who was present at the meeting, raged against the whole idea. As far as he was concerned the very high potencies were not what was c la imed . But others p resen t egged on by J. H. Clarke welcomed the new ideas, although there was some discussion of

wha t a ' c o n s t i t u t i o n ' a c t u a l l y was. Tha t e v e n i n g m u s t have been s w e e t m u s i c to Clarke whose own ideas were very far from those of Hughes. He had been the outs ider who used the 30th and 200th potencies. As a result, despite his seniority, he at that t ime had h e l d no p o s t w i t h i n the B r i t i s h Homoeopa th i c Society . Now he was to be vindicated.

Results Most homoeopaths are familiar with the out- line of this story but without any real details of the prescribing method in use prior to the change to Kentian ideas. The discovery of the r e c o r d s o f the L o n d o n H o m o e o p a t h i c Hospital dating from 1889 to 1923 gives an opportunity to examine the changes in pre- scribing methods during this important time. S p o n s o r e d by the h o s p i t a l , Dr M a r i a Lorentzon, late Research Officer, and myself have been fortunate in having obtained fund- ing f rom the W e l l c o m e I n s t i t u t e for the H i s to ry of M e d i c i n e for this r e sea rch for which we are most grateful.

The method of prescr ibing at the turn of the century is surprising to the modern physi- cian. It has of course to be remembered that although chronic cases, including rheumatic fever and its cardiac sequelae, tuberculosis and gastric ulcers, were admitted, their treat- ment tended to be for an acute episode. In addi t ion stays in hospital were longer than those today. If one excludes admiss ions of nurses with tonsillitis or influenza for 3 or 4 days, admissions could average 40 days, and s tays of 3 or 4 months were not unusual . During this t ime patients could receive 5, 10 or even 20 d i f fe ren t h o m o e o p a t h i c medi - c i n e s . S o m e o f t h e s e a re e x p l i c a b l e as t reatment for intercurrent episodes but it is d i f f icul t to avo id the f irst impress ion that medic ines were p resc r ibed on an arbi t rary basis. There is no evidence in the records that a r e p e r t o r y o f any k i n d was u sed in the pre-Kentian period.

The choice of medicament was limited to no more than 2 dozen. A preliminary exami- n a t i o n o f 500 r e c o r d s ou t o f a p o s s i b l e 30,000 suggests that by far the most common medicine used was Bryonia. The next com- monest were Arsenicum and Arsenicum iod. Others were Belladonna, Aconite, China, Ignatia, Chamomilla, Nitric acid and Nux

Volume 83, Number 4, October 1994

vomica, Veratrum both album and viride, Hydrastis, Ant. tart., Rhus tox., and Berberis. All of these were prescribed in low potency, usually lx or 3x but mother tinctures were used regularly. These were given at short intervals of 1-4 hours, 2 being the most fre- quent. High potencies were not used at all. Occasionally a 30th was given, particularly of Sulphur, but this was given repeatedly rather than in the single split dose of modern times. No other centesimal potencies were prescribed and it is noticeable that medicines requiring high potency for effect such as Natrum mur., were seldom prescribed.

Quantity seems to have had importance. If a medicine was ineffective the dose might be increased rather than the medicine or the potency being changed. Many medicines were given in liquid form in 3 or 5 minim doses. The solid dose is more difficult to determine, with g, possibly referring to glob- ules. It does not appear to mean grains since when such a dose was administered the con- ventional gr was used. The number given varied from 1 to 3 and could be altered dur- ing treatment.

Alternation of medicines was common- place, particularly Bryonia which was usually prescr ibed 2-hour ly , a l ternately with Arsenicum or Aconite. Neither was there reluctance to use conventional together with or instead of homoeopathic medicines. Iron was given for anaemia although sometimes as a lx potency. Potassium iodide, a common medicine of the time, was prescr ibed a l though its purpose is not obvious . Morphine was used for pain relief in 1 case when there appeared to have been no attempt to relieve the symptoms homoeopathically, but it is difficult to be certain from the notes whether or not this was justified. Diphtheria antitoxin was used, but not, it seems, as a routine, possibly because of the expense rather than on medical grounds. Most volun- tary hospitals could not afford it.

Kent's influence But by 1910 there had been a complete change. It is of special interest to examine the notes of patients under the care of Dr Washington Epps which cover the whole of the first decade of the century. In 1902 his patients received the treatment described above, but by 1910 Kent and his followers

243

appear to have had a strong influence. Medicines were now prescribed in single doses and almost always in the 200th poten- cy. Low potencies seem to have been reserved for the sort of pathological condi- tions where we would use them today. Alternation had virtually disappeared. The choice of drug did not alter to a great extent although it is noticeable that Bryonia was only prescribed twice for 36 patients. This is not surprising since most case papers now included a note of repertorization. Perhaps old habits died hard and the importance of the mental symptoms had not yet been fully appreciated thus limiting the choice of drug. Perhaps also it may be that Dr. Epps, although admissions covered the full spread of diagnoses, seems to have specialized in rheumatic fever and its sequelae so that indi- cated medicines tended to be the same in sev- eral cases.

Another aspect of the study must be the efficacy of the therapy. This will be difficult and will require comparisons with conven- tional results. Most patients were discharged with the letters 'VMI': very much improved. It is far from clear in many cases what this meant. There are no miracles. Heart murmurs do not disappear with 1 high potency as was claimed in some of the 19th century litera- ture. As to deaths, they were infrequent (Dr Moir in 1889 had only 1 death in 74 patients) and most seem to have been inevitable. Causes included heart failure, the last stages of TB, bronchiolitis in an infant and carcino- ma.

Surgery played a major part in the activi- ties of the hospital and the methods used appear to have been similar to those in other hospitals. Most of these surgeons were homoeopathic practitioners but they do not seem to have used potencies to alleviate the effects of surgery itself. While Hepar sulph. might be given for sepsis, or Belladonna in fever, no attempt seems to have been made to prescribe Arnica or Staphysagria to promote wound healing. In fact many patients admit- ted for surgery received no homoeopathy at all.

It is hoped that a detailed examination of the records will throw clear light on the dif- fering methods of homoeopathic prescribing over the 50-year period they cover. The rea- sons for the choice of potency and of timing

244

of dosage may become clearer. It would be pleasant to think that the relative efficacy of the 2 methods of prescribing could be estab- lished but it is unlikely that it will be possible for any definite conclusions to be made. However if we can add to our knowledge of prescribing methods it may help to give a more satisfactory answer to the continually recurring question about ideal methods of selecting a homoeopath ic medicine and potency.

Further research on these records will need to be directed towards discovering: - -How remedies were chosen. - -How potencies were selected.

British Homoeopathic Journal

- -The frequency of dose. - -The use of alternation. - - A n y indication of the relative efficacy of

methods.

References 1 Pulman (3. Transactions of the World Homoeopathic

Convention June 1876, Volume 2, History of Homoeopathy: Germany. p20. Philadelphia: Sherman 1880.

2 Ibid p23. 3 Minutes of the British Homoeopathic Society 1855. 4 Hughes R. A Manual ofPharmacodynamics, p103. New

Delhi: Jain 1980. 5 Lewin OMS. Cases Illustrating Constitutional Treatment.

BrJHom 1903, 131-9.

Dr Bernard Leafy Windycroft Brimington Chesterfield, Derbyshire $43 lAX