The Complete PG Works of Oliver Wendell Holmes, Sr.

O >> Oliver Wendell Holmes, Sr. (The Physician and Poet not the Jurist) >> The Complete PG Works of Oliver Wendell Holmes, Sr.


2. That drugs should be shown to be always capable of curing those
diseases most like their own symptoms.

3. That remedies should be shown not to cure diseases when they do not
produce symptoms resembling those presented in these diseases.

1. The effects of drugs upon healthy persons have been studied by
Hahnemann and his associates. Their results were made known in his
Materia Medica, a work in three large volumes in the French translation,
published about eight years ago. The mode of experimentation appears to
have been, to take the substance on trial, either in common or minute
doses, and then to set down every little sensation, every little movement
of mind or body, which occurred within many succeeding hours or days, as
being produced solely by the substance employed. When I have enumerated
some of the symptoms attributed to the power of the drugs taken, you will
be able to judge how much value is to be ascribed to the assertions of
such observers.

The following list was taken literally from the Materia Medica of
Hahnemann, by my friend M. Vernois, for whose accuracy I am willing to
be responsible. He has given seven pages of these symptoms, not
selected, but taken at hazard from the French translation of the work. I
shall be very brief in my citations.

"After stooping some time, sense of painful weight about the head upon
resuming the erect posture."

"An itching, tickling sensation at the outer edge of the palm of the left
hand, which obliges the person to scratch." The medicine was acetate of
lime, and as the action of the globule taken is said to last twenty-eight
days, you may judge how many such symptoms as the last might be supposed
to happen.

Among the symptoms attributed to muriatic acid are these: a catarrh,
sighing, pimples; "after having written a long time with the back a
little bent over, violent pain in the back and shoulder-blades, as if
from a strain,"--"dreams which are not remembered,--disposition to mental
dejection,--wakefulness before and after midnight."

I might extend this catalogue almost indefinitely. I have not cited
these specimens with any view to exciting a sense of the ridiculous,
which many others of those mentioned would not fail to do, but to show
that the common accidents of sensation, the little bodily inconveniences
to which all of us are subject, are seriously and systematically ascribed
to whatever medicine may have been exhibited, even in the minute doses I
have mentioned, whole days or weeks previously.

To these are added all the symptoms ever said by anybody, whether
deserving confidence or not, as I shall hereafter illustrate, to be
produced by the substance in question.

The effects of sixty-four medicinal substances, ascertained by one or
both of these methods, are enumerated in the Materia Medica of Hahnemann,
which may be considered as the basis of practical Homoeopathy. In the
Manual of Jahr, which is the common guide, so far as I know, of those who
practise Homoeopathy in these regions, two hundred remedies are
enumerated, many of which, however, have never been employed in practice.
In at least one edition there were no means of distinguishing those which
had been tried upon the sick from the others. It is true that marks have
been added in the edition employed here, which serve to distinguish them;
but what are we to think of a standard practical author on Materia
Medica, who at one time omits to designate the proper doses of his
remedies, and at another to let us have any means of knowing whether a
remedy has ever been tried or not, while he is recommending its
employment in the most critical and threatening diseases?

I think that, from what I have shown of the character of Hahnemann's
experiments, it would be a satisfaction to any candid inquirer to know
whether other persons, to whose assertions he could look with confidence,
confirm these pretended facts. Now there are many individuals, long and
well known to the scientific world, who have tried these experiments upon
healthy subjects, and utterly deny that their effects have at all
corresponded to Hahnemann's assertions.

I will take, for instance, the statements of Andral (and I am not
referring to his well-known public experiments in his hospital) as to the
result of his own trials. This distinguished physician is Professor of
Medicine in the School of Paris, and one of the most widely known and
valued authors upon practical and theoretical subjects the profession can
claim in any country. He is a man of great kindness of character, a most
liberal eclectic by nature and habit, of unquestioned integrity, and is
called, in the leading article of the first number of the "Homoepathic
Examiner," "an eminent and very enlightened allopathist." Assisted by a
number of other persons in good health, he experimented on the effects of
cinchona, aconite, sulphur, arnica, and the other most highly extolled
remedies. His experiments lasted a year, and he stated publicly to the
Academy of Medicine that they never produced the slightest appearance of
the symptoms attributed to them. The results of a man like this, so
extensively known as one of the most philosophical and candid, as well as
brilliant of instructors, and whose admirable abilities and signal
liberality are generally conceded, ought to be of great weight in
deciding the question.

M. Double, a well-known medical writer and a physician of high standing
in Paris, had occasion so long ago as 1801, before he had heard of
Homoeopathy, to make experiments upon Cinchona, or Peruvian bark. He and
several others took the drug in every kind of dose for four months, and
the fever it is pretended by Hahnemann to excite never was produced.

M. Bonnet, President of the Royal Society of Medicine of Bordeaux, had
occasion to observe many soldiers during the Peninsular War, who made use
of Cinchona as a preservative against different diseases, but he never
found it to produce the pretended paroxysms.

If any objection were made to evidence of this kind, I would refer to the
express experiments on many of the Homoeopathic substances, which were
given to healthy persons with every precaution as to diet and regimen, by
M. Louis Fleury, without being followed by the slightest of the pretended
consequences. And let me mention as a curious fact, that the same
quantity of arsenic given to one animal in the common form of the
unprepared powder, and to another after having been rubbed up into six
hundred globules, offered no particular difference of activity in the two
cases.

This is a strange contradiction to the doctrine of the development of
what they call dynamic power, by means of friction and subdivision.

In 1835 a public challenge was offered to the best known Homoeopathic
physician in Paris to select any ten substances asserted to produce the
most striking effects; to prepare them himself; to choose one by lot
without knowing which of them he had taken, and try it upon himself or
any intelligent and devoted Homoeopathist, and, waiting his own time, to
come forward and tell what substance had been employed. The challenge
was at first accepted, but the acceptance retracted before the time of
trial arrived.

From all this I think it fair to conclude that the catalogues of symptoms
attributed in Homoeopathic works to the influence of various drugs upon
healthy persons are not entitled to any confidence.

2. It is necessary to show, in the next place, that medicinal substances
are always capable of curing diseases most like their own symptoms. For
facts relating to this question we must look to two sources; the recorded
experience of the medical profession in general, and the results of
trials made according to Homoeopathic principles, and capable of testing
the truth of the doctrine.

No person, that I am aware of, has ever denied that in some cases there
exists a resemblance between the effects of a remedy and the symptoms of
diseases in which it is beneficial. This has been recognized, as
Hahnemann himself has shown, from the time of Hippocrates. But according
to the records of the medical profession, as they have been hitherto
interpreted, this is true of only a very small proportion of useful
remedies. Nor has it ever been considered as an established truth that
the efficacy of even these few remedies was in any definite ratio to
their power of producing symptoms more or less like those they cured.

Such was the state of opinion when Hahnemann came forward with the
proposition that all the cases of successful treatment found in the works
of all preceding medical writers were to be ascribed solely to the
operation of the Homoeopathic principle, which had effected the cure,
although without the physician's knowledge that this was the real secret.
And strange as it may seem, he was enabled to give such a degree of
plausibility to this assertion, that any person not acquainted somewhat
with medical literature, not quite familiar, I should rather say, with
the relative value of medical evidence, according to the sources whence
it is derived, would be almost frightened into the belief, at seeing the
pages upon pages of Latin names he has summoned as his witnesses.

It has hitherto been customary, when examining the writings of authors of
preceding ages, upon subjects as to which they were less enlightened than
ourselves, and which they were very liable to misrepresent, to exercise
some little discretion; to discriminate, in some measure, between writers
deserving confidence and those not entitled to it. But there is not the
least appearance of any such delicacy on the part of Hahnemann. A large
majority of the names of old authors he cites are wholly unknown to
science. With some of them I have been long acquainted, and I know that
their accounts of diseases are no more to be trusted than their
contemporary Ambroise Pare's stories of mermen, and similar absurdities.
But if my judgment is rejected, as being a prejudiced one, I can refer to
Cullen, who mentioned three of Hahnemann's authors in one sentence, as
being "not necessarily bad authorities; but certainly such when they
delivered very improbable events;" and as this was said more than half a
century ago, it could not have had any reference to Hahnemann. But
although not the slightest sign of discrimination is visible in his
quotations,--although for him a handful of chaff from Schenck is all the
same thing as a measure of wheat from Morgagni,--there is a formidable
display of authorities, and an abundant proof of ingenious researches to
be found in each of the great works of Hahnemann with which I am
familiar. [Some painful surmises might arise as to the erudition of
Hahnemann's English Translator, who makes two individuals of "Zacutus,
Lucitanus," as well as respecting that of the conductors of an American
Homoeopathic periodical, who suffer the name of the world-renowned
Cardanus to be spelt Cardamus in at least three places, were not this
gross ignorance of course attributable only to the printer.]

It is stated by Dr. Leo-Wolf, that Professor Joerg, of Leipsic, has
proved many of Hahnemann's quotations from old authors to be adulterate
and false. What particular instances he has pointed out I have no means
of learning. And it is probably wholly impossible on this side of the
Atlantic, and even in most of the public libraries of Europe, to find
anything more than a small fraction of the innumerable obscure
publications which the neglect of grocers and trunkmakers has spared to
be ransacked by the all-devouring genius of Homoeopathy. I have
endeavored to verify such passages as my own library afforded me the
means of doing. For some I have looked in vain, for want, as I am
willing to believe, of more exact references. But this I am able to
affirm, that, out of the very small number which I have been able, to
trace back to their original authors, I have found two to be wrongly
quoted, one of them being a gross misrepresentation.

The first is from the ancient Roman author, Caelius Aurelianus; the
second from the venerable folio of Forestus. Hahnemann uses the
following expressions,--if he is not misrepresented in the English
Translation of the 'Organon': "Asclepiades on one occasion cured an
inflammation of the brain by administering a small quantity of wine."
After correcting the erroneous reference of the Translator, I can find no
such case alluded to in the chapter. But Caelius Aurelianus mentions two
modes of treatment employed by Asclepiades, into both of which the use of
wine entered, as being "in the highest degree irrational and dangerous."
[Caelius Aurel. De Morb. Acut. et Chron. lib. I. cap. xv. not xvi.
Amsterdam. Wetstein, 1755.]

In speaking of the oil of anise-seed, Hahnemann says that Forestus
observed violent colic caused by its administration. But, as the author
tells the story, a young man took, by the counsel of a surgeon, an acrid
and virulent medicine, the name of which is not given, which brought on a
most cruel fit of the gripes and colic. After this another surgeon was
called, who gave him oil of anise-seed and wine, "which increased his
suffering." [Observ. et Curat. Med. lib. XXI obs. xiii. Frankfort,
1614.] Now if this was the Homoeopathic remedy, as Hahnemann pretends,
it might be a fair question why the young man was not cured by it. But
it is a much graver question why a man who has shrewdness and learning
enough to go so far after his facts, should think it right to treat them
with such astonishing negligence or such artful unfairness.

Even if every word he had pretended to take from his old authorities were
to be found in them, even if the authority of every one of these authors
were beyond question, the looseness with which they are used to prove
whatever Hahnemann chooses is beyond the bounds of credibility. Let me
give one instance to illustrate the character of this man's mind.
Hahnemann asserts, in a note annexed to the 110th paragraph of the
"Organon," that the smell of the rose will cause certain persons to
faint. And he says in the text that substances which produce peculiar
effects of this nature on particular constitutions cure the same symptoms
in people in general. Then in another note to the same paragraph he
quotes the following fact from one of the last sources one would have
looked to for medical information, the Byzantine Historians.

"It was by these means (i.e. Homoeopathically) that the Princess Eudosia
with rose-water restored a person who had fainted!"

Is it possible that a man who is guilty of such pedantic folly as
this,--a man who can see a confirmation of his doctrine in such a
recovery as this,--a recovery which is happening every day, from a breath
of air, a drop or two of water, untying a bonnet-string, loosening a
stay-lace, and which can hardly help happening, whatever is done,--is it
possible that a man, of whose pages, not here and there one, but hundreds
upon hundreds are loaded with such trivialities, is the Newton, the
Columbus, the Harvey of the nineteenth century!

The whole process of demonstration he employs is this. An experiment is
instituted with some drug upon one or more healthy persons. Everything
that happens for a number of days or weeks is, as we have seen, set down
as an effect of the medicine. Old volumes are then ransacked
promiscuously, and every morbid sensation or change that anybody ever
said was produced by the drug in question is added to the list of
symptoms. By one or both of these methods, each of the sixty-four
substances enumerated by Hahnemann is shown to produce a very large
number of symptoms, the lowest in his scale being ninety-seven, and the
highest fourteen hundred and ninety-one. And having made out this list
respecting any drug, a catalogue which, as you may observe in any
Homoeopathic manual, contains various symptoms belonging to every organ
of the body, what can be easier than to find alleged cures in every
medical author which can at once be attributed to the Homoeopathic
principle; still more if the grave of extinguished credulity is called
upon to give up its dead bones as living witnesses; and worst of all, if
the monuments of the past are to be mutilated in favor of "the sole law
of Nature in therapeutics"?

There are a few familiar facts of which great use has been made as an
entering wedge for the Homoeopathic doctrine. They have been suffered to
pass current so long that it is time they should be nailed to the
counter, a little operation which I undertake, with perfect cheerfulness,
to perform for them.

The first is a supposed illustration of the Homoeopathic law found in the
precept given for the treatment of parts which have been frozen, by
friction with snow or similar means. But we deceive ourselves by names,
if we suppose the frozen part to be treated by cold, and not by heat.
The snow may even be actually warmer than the part to which it is
applied. But even if it were at the same temperature when applied, it
never did and never could do the least good to a frozen part, except as a
mode of regulating the application of what? of heat. But the heat must
be applied gradually, just as food must be given a little at a time to
those perishing with hunger. If the patient were brought into a warm
room, heat would be applied very rapidly, were not something interposed
to prevent this, and allow its gradual admission. Snow or iced water is
exactly what is wanted; it is not cold to the part; it is very possibly
warm, on the contrary, for these terms are relative, and if it does not
melt and let the heat in, or is not taken away, the part will remain
frozen up until doomsday. Now the treatment of a frozen limb by heat, in
large or small quantities, is not Homoeopathy.

The next supposed illustration of the Homoeopathic law is the alleged
successful management of burns, by holding them to the fire. This is a
popular mode of treating those burns which are of too little consequence
to require any more efficacious remedy, and would inevitably get well of
themselves, without any trouble being bestowed upon them. It produces a
most acute pain in the part, which is followed by some loss of
sensibility, as happens with the eye after exposure to strong light, and
the ear after being subjected to very intense sounds. This is all it is
capable of doing, and all further notions of its efficacy must be
attributed merely to the vulgar love of paradox. If this example affords
any comfort to the Homoeopathist, it seems as cruel to deprive him of it
as it would be to convince the mistress of the smoke-jack or the flatiron
that the fire does not literally "draw the fire out," which is her
hypothesis.

But if it were true that frost-bites were cured by cold and burns by
heat, it would be subversive, so far as it went, of the great principle
of Homoeopathy.

For you will remember that this principle is that Like cures Like, and
not that Same cures Same; that there is resemblance and not identity
between the symptoms of the disease and those produced by the drug which
cures it, and none have been readier to insist upon this distinction than
the Homoeopathists themselves. For if Same cures Same, then every poison
must be its own antidote,--which is neither a part of their theory nor
their so-called experience. They have been asked often enough, why it
was that arsenic could not cure the mischief which arsenic had caused,
and why the infectious cause of small-pox did not remedy the disease it
had produced, and then the; were ready enough to see the distinction I
have pointed out. O no! it was not the hair of the same dog, but only of
one very much like him!

A third instance in proof of the Homoeopathic law is sought for in the
acknowledged efficacy of vaccination. And how does the law apply to
this? It is granted by the advocates of Homoeopathy that there is a
resemblance between the effects of the vaccine virus on a person in
health and the symptoms of small-pox. Therefore, according to the rule,
the vaccine virus will cure the small-pox, which, as everybody knows, is
entirely untrue. But it prevents small-pox, say the Homoeopathists.
Yes, and so does small-pox prevent itself from ever happening again, and
we know just as much of the principle involved in the one case as in the
other. For this is only one of a series of facts which we are wholly
unable to explain. Small-pox, measles, scarlet-fever, hooping-cough,
protect those who have them once from future attacks; but nettle-rash and
catarrh and lung fever, each of which is just as Homoeopathic to itself
as any one of the others, have no such preservative power. We are
obliged to accept the fact, unexplained, and we can do no more for
vaccination than for the rest.

I come now to the most directly practical point connected with the
subject, namely,--

What is the state of the evidence as to the efficacy of the proper
Homoeopathic treatment in the cure of diseases.

As the treatment adopted by the Homoeopathists has been almost
universally by means of the infinitesimal doses, the question of their
efficacy is thrown open, in common with that of the truth of their
fundamental axiom, as both are tested in practice.

We must look for facts as to the actual working of Homoeopathy to three
sources.

1. The statements of the unprofessional public.

2. The assertions of Homoeopathic practitioners.

3. The results of trials by competent and honest physicians, not pledged
to the system.

I think, after what we have seen of medical facts, as they are
represented by incompetent persons, we are disposed to attribute little
value to all statements of wonderful cures, coming from those who have
never been accustomed to watch the caprices of disease, and have not
cooled down their young enthusiasm by the habit of tranquil observation.
Those who know nothing of the natural progress of a malady, of its
ordinary duration, of its various modes of terminating, of its liability
to accidental complications, of the signs which mark its insignificance
or severity, of what is to be expected of it when left to itself, of how
much or how little is to be anticipated from remedies, those who know
nothing or next to nothing of all these things, and who are in a great
state of excitement from benevolence, sympathy, or zeal for a new medical
discovery, can hardly be expected to be sound judges of facts which have
misled so many sagacious men, who have spent their lives in the daily
study and observation of them. I believe that, after having drawn the
portrait of defunct Perkinism, with its five thousand printed cures, and
its million and a half computed ones, its miracles blazoned about through
America, Denmark, and England; after relating that forty years ago women
carried the Tractors about in their pockets, and workmen could not make
them fast enough for the public demand; and then showing you, as a
curiosity, a single one of these instruments, an odd one of a pair, which
I obtained only by a lucky accident, so utterly lost is the memory of all
their wonderful achievements; I believe, after all this, I need not waste
time in showing that medical accuracy is not to be looked for in the
florid reports of benevolent associations, the assertions of illustrious
patrons, the lax effusions of daily journals, or the effervescent gossip
of the tea-table.

Dr. Hering, whose name is somewhat familiar to the champions of
Homoeopathy, has said that "the new healing art is not to be judged by
its success in isolated cases only, but according to its success in
general, its innate truth, and the incontrovertible nature of its innate
principles."

We have seen something of "the incontrovertible nature of its innate
principles," and it seems probable, on the whole, that its success in
general must be made up of its success in isolated cases. Some attempts
have been made, however, to finish the whole matter by sweeping
statistical documents, which are intended to prove its triumphant success
over the common practice.

It is well known to those who have had the good fortune to see the
"Homoeopathic Examiner," that this journal led off, in its first number,
with a grand display of everything the newly imported doctrine had to
show for itself. It is well remarked, on the twenty-third page of this
article, that "the comparison of bills of mortality among an equal number
of sick, treated by divers methods, is a most poor and lame way to get at
conclusions touching principles of the healing art." In confirmation of
which, the author proceeds upon the twenty-fifth page to prove the
superiority of the Homoeopathic treatment of cholera, by precisely these
very bills of mortality. Now, every intelligent physician is aware that
the poison of cholera differed so much in its activity at different times
and, places, that it was next to impossible to form any opinion as to the
results of treatment, unless every precaution was taken to secure the
most perfectly corresponding conditions in the patients treated, and
hardly even then. Of course, then, a Russian Admiral, by the name of
Mordvinov, backed by a number of so-called physicians practising in
Russian villages, is singularly competent to the task of settling the
whole question of the utility of this or that kind of treatment; to prove
that, if not more than eight and a half per cent. of those attacked with
the disease perished, the rest owed their immunity to Hahnemann. I can
remember when more than a hundred patients in a public institution were
attacked with what, I doubt not, many Homoeopathic physicians (to say
nothing of Homoeopathic admirals) would have called cholera, and not one
of them died, though treated in the common way, and it is my firm belief
that, if such a result had followed the administration of the omnipotent
globules, it would have been in the mouth of every adept in Europe, from
Quin of London to Spohr of Gandersheim. No longer ago than yesterday, in
one of the most widely circulated papers of this city, there was
published an assertion that the mortality in several Homoeopathic
Hospitals was not quite five in a hundred, whereas, in what are called by
the writer Allopathic Hospitals, it is said to be eleven in a hundred. An
honest man should be ashamed of such an argumentum ad ignorantiam. The
mortality of a hospital depends not merely on the treatment of the
patients, but on the class of diseases it is in the habit of receiving,
on the place where it is, on the season, and many other circumstances.
For instance, there are many hospitals in the great cities of Europe that
receive few diseases of a nature to endanger life, and, on the other
hand, there are others where dangerous diseases are accumulated out of
the common proportion. Thus, in the wards of Louis, at the Hospital of
La Pitie, a vast number of patients in the last stages of consumption
were constantly entering, to swell the mortality of that hospital. It
was because he was known to pay particular attention to the diseases of
the chest that patients laboring under those fatal affections to an
incurable extent were so constantly coming in upon him. It is always a
miserable appeal to the thoughtlessness of the vulgar, to allege the
naked fact of the less comparative mortality in the practice of one
hospital or of one physician than another, as an evidence of the
superiority of their treatment. Other things being equal, it must always
be expected that those institutions and individuals enjoying to the
highest degree the confidence of the community will lose the largest
proportion of their patients; for the simple reason that they will
naturally be looked to by those suffering from the gravest class of
diseases; that many, who know that they are affected with mortal disease,
will choose to die under their care or shelter, while the subjects of
trifling maladies, and merely troublesome symptoms, amuse themselves to
any extent among the fancy practitioners. When, therefore, Dr.
Mublenbein, as stated in the "Homoeopathic Examiner," and quoted in
yesterday's "Daily Advertiser," asserts that the mortality among his
patients is only one per cent. since he has practised Homoeopathy,
whereas it was six per cent. when he employed the common mode of
practice, I am convinced by this, his own statement, that the citizens of
Brunswick, whenever they are seriously sick, take good care not to send
for Dr. Muhlenbein!