Medical Essays, 1842-1882. Oliver Wendell Holmes

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      I wish to state, for the sake of any who may be interested in the subject, that I shall treat it, not by ridicule, but by argument; perhaps with great freedom, but with good temper and in peaceable language; with very little hope of reclaiming converts, with no desire of making enemies, but with a firm belief that its pretensions and assertions cannot stand before a single hour of calm investigation.

      II.

      It may be thought that a direct attack upon the pretensions of HOMOEOPATHY is an uncalled-for aggression upon an unoffending doctrine and its peaceful advocates.

      But a little inquiry will show that it has long assumed so hostile a position with respect to the Medical Profession, that any trouble I, or any other member of that profession, may choose to bestow upon it may be considered merely as a matter of self-defence. It began with an attempt to show the insignificance of all existing medical knowledge. It not only laid claim to wonderful powers of its own, but it declared the common practice to be attended with the most positively injurious effects, that by it acute diseases are aggravated, and chronic diseases rendered incurable. It has at various times brought forward collections of figures having the air of statistical documents, pretending to show a great proportional mortality among the patients of the Medical Profession, as compared with those treated according to its own rules. Not contented with choosing a name of classical origin for itself, it invented one for the whole community of innocent physicians, assuring them, to their great surprise, that they were all ALLOPATHISTS, whether they knew it or not, and including all the illustrious masters of the past, from Hippocrates down to Hunter, under the same gratuitous title. The line, then, has been drawn by the champions of the new doctrine; they have lifted the lance, they have sounded the charge, and are responsible for any little skirmishing which may happen.

      But, independently of any such grounds of active resistance, the subject involves interests so disproportioned to its intrinsic claims, that it is no more than an act of humanity to give it a public examination. If the new doctrine is not truth, it is a dangerous, a deadly error. If it is a mere illusion, and acquires the same degree of influence that we have often seen obtained by other illusions, there is not one of my audience who may not have occasion to deplore the fatal credulity which listened to its promises.

      I shall therefore undertake a sober examination of its principles, its facts, and some points of its history. The limited time at my disposal requires me to condense as much as possible what I have to say, but I shall endeavor to be plain and direct in expressing it. Not one statement shall be made which cannot be supported by unimpeachable reference: not one word shall be uttered which I am not as willing to print as to speak. I have no quibbles to utter, and I shall stoop to answer none; but, with full faith in the sufficiency of a plain statement of facts and reasons, I submit the subject to the discernment of my audience.

      The question may be asked in the outset,—Have you submitted the doctrines you are professing to examine to the test of long-repeated and careful experiment; have you tried to see whether they were true or not? To this I answer, that it is abundantly evident, from what has often happened, that it would be of no manner of use for me to allege the results of any experiments I might have instituted. Again and again have the most explicit statements been made by the most competent persons of the utter failure of all their trials, and there were the same abundant explanations offered as used to be for the Unguentum Armarium and the Metallic Tractors. I could by no possibility perform any experiments the result of which could not be easily explained away so as to be of no conclusive significance. Besides, as arguments in favor of Homoeopathy are constantly addressed to the public in journals, pamphlets, and even lectures, by inexperienced dilettanti, the same channel must be open to all its opponents.

      It is necessary, for the sake of those to whom the whole subject may be new, to give in the smallest possible compass the substance of the Homoeopathic Doctrine. Samuel Hahnemann, its founder, is a German physician, now living in Paris, [Hahnemann died in 1843 at the age of eighty-seven years. In 1796 he published the first paper containing his peculiar notions; in 1805 his first work on the subject; in 1810 his somewhat famous “Organon of the Healing Art;” the next year what he called the “Pure Materia Medica;” and in 1828 his last work, the “Treatise on Chronic Diseases.” He has therefore been writing at intervals on his favorite subject for nearly half a century.

      The one great doctrine which constitutes the basis of Homoeopathy as a system is expressed by the Latin aphorism, “SIMILIA SIBILIBUS CURANTUR,”

      or like cures like, that is, diseases are cured by agents capable of producing symptoms resembling those found in the disease under treatment. A disease for Hahnemann consists essentially in a group of symptoms. The proper medicine for any disease is the one which is capable of producing a similar group of symptoms when given to a healthy person.

      It is of course necessary to know what are the trains of symptoms excited by different substances, when administered to persons in health, if any such can be shown to exist. Hahnemann and his disciples give catalogues of the symptoms which they affirm were produced upon themselves or others by a large number of drugs which they submitted to experiment.

      The second great fact which Hahnemann professes to have established is the efficacy of medicinal substances reduced to a wonderful degree of minuteness or dilution. The following account of his mode of preparing his medicines is from his work on Chronic Diseases, which has not, I believe, yet been translated into English. A grain of the substance, if it is solid, a drop if it is liquid, is to be added to about a third part of one hundred grains of sugar of milk in an unglazed porcelain capsule which has had the polish removed from the lower part of its cavity by rubbing it with wet sand; they are to be mingled for an instant with a bone or horn spatula, and then rubbed together for six minutes; then the mass is to be scraped together from the mortar and pestle, which is to take four minutes; then to be again rubbed for six minutes. Four minutes are then to be devoted to scraping the powder into a heap, and the second third of the hundred grains of sugar of milk to be added. Then they are to be stirred an instant and rubbed six minutes,—again to be scraped together four minutes and forcibly rubbed six; once more scraped together for four minutes, when the last third of the hundred grains of sugar of milk is to be added and mingled by stirring with the spatula; six minutes of forcible rubbing, four of scraping together, and six more (positively the last six) of rubbing, finish this part of the process.

      Every grain of this powder contains the hundredth of a grain of the medicinal substance mingled with the sugar of milk. If, therefore, a grain of the powder just prepared is mingled with another hundred grains of sugar of milk, and the process just described repeated, we shall have a powder of which every grain contains the hundredth of the hundredth, or the ten thousandth part of a grain of the medicinal substance. Repeat the same process with the same quantity of fresh sugar of milk, and every grain of your powder will contain the millionth of a grain of the medicinal substance. When the powder is of this strength, it is ready to employ in the further solutions and dilutions to be made use of in practice.

      A grain of the powder is to be taken, a hundred drops of alcohol are to be poured on it, the vial is to be slowly turned for a few minutes, until the powder is dissolved, and two shakes are to be given to it. On this point I will quote Hahnemann's own words. “A long experience and multiplied observations upon the sick lead me within the last few years to prefer giving only two shakes to medicinal liquids, whereas I formerly used to give ten.” The process of dilution is carried on in the same way as the attenuation of the powder was done; each successive dilution with alcohol reducing the medicine to a hundredth part of the quantity of that which preceded it. In this way the dilution of the original millionth of a grain of medicine contained in the grain of powder operated on is carried successively to the billionth, trillionth, quadrillionth, quintillionth, and very often much higher fractional divisions. A dose of any of these medicines is a minute fraction of a drop, obtained by moistening with them one or more little globules of sugar, of which Hahnemann says it takes about two hundred to weigh a grain.

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