Trick or Treatment (16 page)

Elsewhere in Europe, Hahnemann’s disciples spread the gospel of homeopathy with their master’s voice ringing in their ears: ‘He who does not walk exactly on the same line with me, who diverges, if it be but the breadth of a straw to the left or right, is a traitor and I will have nothing to do with him.’ Certainly Dr Frederick Quin, who had studied with Hahnemann in Paris, was no such traitor, for he established homeopathy in London in 1827 strictly according to Hahnemann’s principles. It soon became highly popular among the British aristocracy, and within half a century it was being practised across the country, with large homeopathic hospitals being founded in London, Bristol, Birmingham, Liverpool and Glasgow.

Although welcomed by many doctors and patients, this rapid growth was not without controversy. When William Henderson, Professor of General Pathology at Edinburgh University, began to support homeopathy in the 1840s, a colleague wrote: ‘The consternation manifested by the Medical Faculty in the University and by the College of Physicians was such as might be exhibited in ecclesiastical circles if the Professor of Divinity were to announce that he had become a Mohammedan.’

At roughly the same time, homeopathy was also establishing itself on the other side of the Atlantic. Dr Hans Burch Gram, a Bostonian of Danish descent, learned about homeopathy during a visit to Copenhagen and then brought the idea back to America in 1825. Just as had happened in Britain, homeopathy gained both ardent supporters and fervent critics. The result was that there were 2,500 practitioners and six homeopathic colleges by the outbreak of the American Civil War, but homeopaths were still largely denied the opportunity to serve in the army. A professor at the Homeopathic Medical College of Missouri argued that this infringed a soldier’s right to receive the medical care of his own choice:

In order to deal with their critics, homeopaths would often point to the successes they had achieved in dealing with major epidemics. As early as 1800, Hahnemann himself had used ultra-dilute Belladonna to combat scarlet fever; then in 1813 he used homeopathy to treat an epidemic of typhus spread by Napoleon’s soldiers after their invasion of Russia; and in 1831 homeopathic remedies such as Camphor, Cuprum and Veratrum were apparently successful in central Europe in tackling outbreaks of cholera, a disease that conventional medicine was unable to treat.

This success was repeated during a cholera epidemic in London in 1854, when patients at the London Homoeopathic Hospital had a survival rate of 84 per cent, compared to just 47 per cent for patients receiving more conventional treatment at the nearby Middlesex Hospital. Many homeopaths therefore argued that this was strong evidence in support of homeopathy, because it was possible to construe the results from these two hospitals as the outcome of an informal trial. The percentages allow us to compare the success rates of two treatments on two groups of patients with the same illness, and homeopathic remedies clearly did better than conventional medicine.

However, critics later pointed out three major reasons why these percentages did not necessarily mean that homeopathy was effective. First, the patients at the two hospitals had the same illness, but that does not necessarily mean that the two hospitals were competing on a level playing field. It could be, for instance, that the patients who attended the London Homoeopathic Hospital were wealthier, which would mean that they were in a better state of health before catching cholera and were better fed and cared for after leaving hospital – all of this, rather than the homeopathic treatment itself, might account for the higher success rate.

Second, as well as differing in the treatment that they offered, the two hospitals may have differed in other important ways. For instance, the London Homoeopathic Hospital might have had a higher standard of hygiene than the Middlesex Hospital, which could easily explain its superior survival rate. After all, we are dealing with an infectious disease, so clean wards, uncontaminated food and safe water were of the utmost importance.

Third, perhaps the higher survival rate at the London Homoeopathic Hospital was not indicative of the success of homeopathy, but rather it pointed to the failure of conventional medicine. Indeed, medical historians suspect that patients who received no medical care would probably have fared better than those who received the conventional medications given at the time. This might seem surprising, but the 1850s still belonged to the era of so-called ‘heroic medicine’, when doctors probably did more harm than good.

‘Heroic medicine’ was a term invented in the twentieth century to describe the aggressive practices that dominated healthcare up until the mid-nineteenth century. Patients had to endure bloodletting, intestinal purging, vomiting, sweating and blistering, which generally stressed an already weakened body. On top of this, patients would receive large doses of medications, such as mercury and arsenic, which scientists now know to be highly toxic. The extreme bloodletting suffered by George Washington, as described in Chapter 1, is a prime example of heroic medicine and its harmful impact on a patient. The label ‘heroic medicine’ reflected the role played by the supposedly heroic doctor, but anyone who survived the treatment was the real hero.

The richest patients were the most heroic of all, because they endured the most severe treatments. This observation was made as early as 1622, when a Florentine physician, Antonio Durazzini, reported on the recovery rates from a fever that was spreading through the region: ‘More of those who are able to seek medical advice and treatment die than of the poor.’ It was during this period that Latanzio Magiotti, the Grand Duke of Florence’s own doctor, said, ‘Most Serene Highness, I take the money not for my services as a doctor but as a guard, to prevent some young man who believes everything he reads in books from coming along and stuffing something down the patients which kills them.’

Although the desperate, wealthy and sick continued to rely on doctors, many onlookers openly criticized their practices. Benjamin Franklin commented, ‘All drug doctors are quacks,’ while the philosopher Voltaire wrote, ‘Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.’ He advised that a good physician was one who amused his patients while nature cured the disease. These concerns about medicine were also reflected by several dramatists, including Shakespeare, who in
Timon of Athens
has Timon advise: ‘Trust not the physician; His antidotes are poisons.’ Similarly, in
Le Malade imaginaire
, Molière wrote: ‘Nearly all men die of their remedies and not of their illnesses.’

Hence, if no treatment at all would have been better than conventional heroic medicine for cholera patients, then modern sceptics are not surprised that homeopathy was also better than conventional heroic medicine. After all, the sceptics feel that the homeopathic remedies were so diluted that taking them was the equivalent to having no treatment.

In short, we can conclude two things about a patient seeking treatment before the twentieth century. First, the patient would have been better off opting for no treatment rather than heroic medicine. Second, the patient would have been better off opting for homeopathy rather than for heroic medicine. The important question, however, was whether homeopathy was any better than a lack of treatment? Those who supported homeopathy were convinced by their own experience that it was genuinely effective, whereas sceptics argued that such dilute remedies could not possibly benefit the patient.

The arguments continued throughout the nineteenth century; and despite the initially positive response from the aristocracy and significant sections of the medical community, there was a gradual swing against Hahnemann’s ideas as each decade passed. For example, the American physician and writer Oliver Wendell Holmes accepted that conventional medicine had failed in the past (‘If all the medicine in the world were thrown into the sea, it would be bad for the fish and good for humanity’), but he was not prepared to tolerate homeopathy as the way forward. He called homeopathy ‘a mangled mass of perverse ingenuity, of tinsel erudition, of imbecile incredibility and of artful misrepresentation.’

In 1842, Holmes delivered a lecture entitled ‘Homeopathy and Its Kindred Delusions’, in which he reiterated why Hahnemann’s ideas did not make sense from a scientific point of view. He focused particularly on the extreme dilutions at the heart of homeopathy. One way to think about these dilutions is to consider the key ingredient being dissolved in ever greater volumes of liquid. Each time homeopaths dilute the active ingredient by a factor of 100, they are effectively dissolving it in a volume of water or alcohol that is 100 times bigger, and they do this over and over again. Holmes used a calculation by the Italian physician Dr Panvini to explain the bizarre consequences of such repeated dilutions when applied to a starting ingredient of one drop of Chamomile:

In the same spirit, William Croswell Doane (1832–1913) also took a swipe at homeopathy. As the first Episcopal Bishop of Albany, New York, he penned a piece of doggerel entitled ‘Lines on Homoeopathy’:

In Europe Sir John Forbes, Queen Victoria’s physician, called homeopathy ‘an outrage to human reason’, a view that was consistent with the entry for homeopathy in the 1891 edition of the
Encyclopaedia Britannica
: ‘Hahnemann’s errors were great…He led his followers far out of the track of sound views of disease.’

Part of the reason for homeopathy’s decline in popularity was that the medical establishment was transforming itself from heroic and dangerous into scientific and effective. Clinical trials, such as those that exposed the dangers of bloodletting, were steadily differentiating between hazardous procedures and effective cures. And, as each decade passed, there was an increased understanding of the true causes of disease. One of the most important medical breakthroughs took place during the previously mentioned 1854 London cholera epidemic.

The disease had first hit Britain in 1831, when 23,000 people died; this was followed by the 1849 epidemic, which killed 53,000. During the 1849 epidemic the obstetrician Dr John Snow questioned the established theory that cholera was spread through the air by unknown poisonous vapours. He had been a pioneer of anaesthesia and had administered chloroform to Queen Victoria during the birth of Prince Leopold, so he knew exactly how gaseous poisons affected groups of people; if cholera was caused by a gas, then entire populations should be affected, but instead the disease seemed to be selective about its victims. Therefore, he posited the radical theory that cholera was caused by contact with contaminated water and sewage. He put his theory to the test during the next cholera outbreak in 1854. In London’s Soho, he made an observation that seemed to support his theory:

To investigate his theory he plotted the location of every death on a map of Soho (see Figure 4) and, sure enough, the suspicious pump was at the epicentre. His theory was further backed by his observation that a local coffee shop that served water from the pump had nine customers who had contracted cholera. On the other hand, a nearby workhouse with its own well had no cases, and employees at the brewery on Broad Street had been unaffected because they drank their own produce.

A key piece of evidence was the case of a woman who died of cholera, even though she lived far from Soho. Snow learned, however, that she had previously lived in Soho and had such a fondness for the sweet pump water that she had specially asked for some Broad Street water to be brought to her house. Based on all these observations, Snow persuaded town officials to take the handle off the pump, which halted the supply of contaminated water and brought an end to the cholera outbreak. Snow, arguably the world’s first epidemiologist, had demonstrated the power of the new scientific approach to medicine, and in 1866 Britain suffered its last cholera outbreak.