In July 1986 an 'Open Letter' by Dr M. S. Rao was publ ished/ I do not wish to deal with most of the points raised. These were answered in the same edition of this journal. However there is one statement in that letter which requires discussion. Dr Rao states: 'May I suggest that we put our house in order by believing in the philosophical system inherent in homoeopathy and preaching it without too much compromise.' It can be argued that philosophy is not inherent in hom0eopathy and that the only inherent idea is similia similibus curentur. But if the statement were true, to which philosophy does it refer: that of Hahnemann, of Hering, of Kent? However, it is probable that the idea behind Dr Rao's plea would find sympathy among many homeeopaths, so that it should not merely be dismissed. If we assume that the philosophy referred to is that of Hahnemann, we cannot attempt to judge its value unless we understand what he meant when he spoke of vital principle, of miasm and of the evolution of skin diseases which he regarded as an essential part of chronic disease. In this respect it must be remembered that Hahnemann was essentially a being of the eighteenth century. By the time he published The ~Medicine of Experience he was fifty years of age. Although he produced ideas which differed from those of his contemporaries, it would be ridiculous to assume that he was not a man of his time and that his thinking was not, primarily, that of an eighteenth-century doctor. In order, therefore, to understand and judge his philosophy we have to understand his medical background. Until the seventeenth century medicine was based on a mixture of folklore and the ideas of classical physicians, of whom the most important was Galen. Medicine was concerned more with the condition of the sick man rather than specific conditions. Pathological theory concerned itself with body fluids or humors, or with constricted or relaxed conditions of the solid parts (solidism). Because of Galen humoral pathology was more popular and even in the mid seventeenth century physicians concerned themselves with the humors rather than particular diseases. However a few conditions such as smallpox and leprosy were recognized. During the seventeenth century science began to make great strides with the work of Galileo, Newton and Boyle. Medicine followed with a reaction against the vitalism of Galen. Harvey described the circulation of the blood. Sydenham began to distinguish between the individual and his symptom picture and thus described entities such as measles, syphilis and gout. Andreas Vesalius (1514-64) had already, by human dissection, corrected the anatomy of Galen which was based , in part, on animals. Three years after the death of Harvey, Marcello Malpighi (1628-94) demonstrated the capillary circulation and used the new microscope of Anton van Leeuwenhoek to lay the foundations of histology. Progress continued at what must have seemed a fi'ightening rate. At Leyden, Boerhaave, at the beginning of the eighteenth century, introduced bedside teaching and correlated clinical with post mortem findings. His pupil, Albrecht von HaUer (1708-77), preached empiricism and scientific experiment. Cullen, whose book led Hahnemann to commence his experiments, listed hundreds of diseases. But the problem was that while all these new facts were being discovered knowledge was still too limited to make sense of them. Doctors could not, therefore, resist the temptation to speculate. Georg Ernst Stahl (1660-1734) 2 proposed that life is an activity of the soul (anima), disease coming because of the soul's misdirection. A condition was either tonic or plethoric, requiring bleeding or balsamic pills. Frederick Hoffman, a contemporary, considered the vital principle to be like ether which spread to the tissues via the nerves. Disease was alteration of the nature of the vital principle. Acute disease, being spasmodic, required sedation, chronic disease was atonic and needed stimulation. In France, Theophile de Borden came close to endocrinology
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