Marketplace of the Marvelous (20 page)

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.
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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.
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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 nondilute diseases to otherwise healthy people.
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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.”
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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.
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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.”
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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.
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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.
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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.
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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.
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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.
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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.
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“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.
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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.”
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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.
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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.
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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.”
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Hahnemann did not believe that the body could defeat disease and restore its balance on its own. He, like many of his regular contemporaries, discounted the body's natural healing power, believing it crude and imperfect. Setting aside nature, Hahnemann claimed that the body's “native army” could only defeat the “enemy” with the firepower
of the homeopathic remedy he called the “auxiliary troops.” “It is the organic vital force of our bodies which itself cures natural diseases of all kinds,” declared Hahnemann, “whenever, by means of the proper homeopathic medicines, it is placed in a position to conquer, which, indeed, it never could do without the auxiliary force.” In other words, the homeopathic remedy gave the vital spirit the firepower to defeat illness. Small doses, Hahnemann argued, so small the material substance may not have even existed anymore, did not matter. What mattered was the remedy's spirit-like dynamic energy that bolstered, mingled, and restored the body's own invisible vital force, this energy being the most effective means of reaching and acting on the energy of the body.

Dilution alone could not activate a remedy's energy. Hahnemann's experiments led him to conclude that a medication must be shaken, rubbed, and banged against a leather pad to transform from its crude form to one energized by its “inner medicinal essence.” Only then would it be ready to work with the body's vital force. Hahnemann referred to this process of dilution and strengthening as “dynamization.” So even as the effectiveness of the diluted remedies seemed to defy logic, homeopaths believed that the solution “remembered” its former self, which gave it a liquid potency that made healing possible.
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Hahnemann's firm belief in the unlikely power of small doses led him to call these extreme dilutions “high potencies.”
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Patients could not sit idly by and wait for homeopathy to marshal the body's native army alone. Hahnemann expected patients to be familiar with homeopathic theory and to have read his 1810 homeopathic manual
Organon of the Rational Art of Healing
. Composed in 271 aphorisms, the book fully laid out his principles and theories, gave directions for use, and offered guidance for doctors on how to detail their cases. Proper homeopathic prescribing relied on patients' awareness and articulation of their illness experiences, including their emotions. For many women, this attention during their exam was the first time medicine validated their feelings and experiences of their own bodies.
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Patients also followed certain protocols before, during, and after treatment for best results. Diets received particular attention as Hahnemann believed that certain foods could adversely affect the medicine's power. “It may be readily conceived that everything which exercises a medicinal influence on the patient should be removed from his regimen and mode of life,” counseled Hahnemann,
“in order that the effects of such minute doses may not be destroyed, overpowered, or disturbed by any foreign stimulant.”
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Acute diseases had very specific rules, while those suffering from chronic illnesses followed more general guidelines largely aimed at the elimination of foods that kindled disease. Forbidden foods included smoked meat and fish, duck, turtle, sausages, pastries of any kind, sugar, cinnamon, and alcohol. And if anyone needed a reminder to not eat rotten food, rancid cheese and butter were also prohibited.
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