Volume 84, Number 2, April 1995 113

the offer. George Vithoulkas was invited to a conference in California in 1978. This is said to have been a key event. He was greeted with religious fervour by medical and non medical homoeopaths. What was most sur- prising was the number of practitioners pre- sent in the audience. H o m o e o p a t h y had remained underground and survived. There has been a d ramat ic growth of sales of h o m o e o p a t h i c med ic ines i n the USA. Grossinger ends the book with an appendix containing an account of his daughter's treat- ment at the hand of allopathy and homoeopa- thy.

I found the book enjoyable and informa- tive. Moreover i t 's reasonably priced and affordable.

HAGEN RAMPES

The P r a c t i c a l and F i n a n c i a l G u i d e to Private Practice. Gillian K. Elliott. London: Gillian K. Elliott, 42 Cheryls Close, Bagleys Lane, SW6 2AY. ISBN 0952339404. s or s for newly-qualified doctors

This manual is prepared in A4 format with a main section covering practical considera- tions of starting in private practice and small- er sections on legal requirements, taxation and insurance. This manual is written for pro- fessions allied to medicine, including com- plementary medical practitioners, but previ- ously to this manual the author produced a similar manual for medical consultants, and for 12 years ran an advisory service giving general f inancial and practical advice to newly-appointed consultants and general practitioners, as well as acting as a medical practice manager. Some of the considerations for non-doctor practitioners are different, i.e. such as advertising. For doctors who are unsure about starting in private practice this guide will provide a valuable check-list, as well as ind ica t ing the neces sa ry skil ls required to organize and administer a private practice.

The limitation of this guide, along with other guides and books on the subject, is that many of the skills and much of the confi- dence needed to run a successful private practice are difficult to acquire solely from this format. (The exception possibly being some of the book-keeping and accountancy skills, where written guidance can be very

helpful.) Guides such as this are generally helpful in

reviewing what you know and can, with the support of colleagues and professional advi- sors, provide the information to develop the skills to efficiently manage a private practice.

DAVID OWEN

Divided Legacy. A history of the schism in medical thought. Volume IV: Twentieth cen- tury medicine: the bacteriological era. Harris L Coulter. North Atlantic Books, Berkeley, California. $50.

Throughout its history homoeopa thy has been characterized by two divergent trends. Some homoeopaths, such as Richard Hughes, were concerned to build bridges to orthodox medicine and were reluctant to accept the more 'extreme' homoeopathic doctrines of vitalism, miasms, and ultra-high potencies; and others, such as Constantine Hering and James Tyler Kent, accepted these ideas enthusiastically and ignored conventional medicine or rejected it outright.

Hahnemann ' s own career exhibits this ambivalence. He did not publish any system- atic description of homoeopathy until The Medicine of Experience in 1806, when he was 51. Soon after this he moved to Leipzig, where he remained until 1821, and during these 15 years, which saw the publication of the early editions of The Organon and the Materia Medica Pura, his approach was more or less that of a medical scientist, albeit an eccentric one. He was lecturing at the uni- versity and was thus exposed to the medical ideas of the day, even if he rejected them, and he was treating patients with acute as well as with chronic diseases.

In 1821, however, he was driven by the hostility of the Leipzig apothecaries to move to the little principality of Koethen, where he was pretty well cut off, not only from main- stream medicine, but even from most of his own disciples, while his practice became largely confined to the treatment of chronic diseases. It is to this period that the an- nouncements of his potency and miasm theo- ries belong. Thus those of his ideas that have proved most contentious in later years were produced after the age of 66 and at a time when he was relatively isolated. This does

114 British Homoeopathic Journal

not of course invalidate them but the setting in which they were arrived at does need to be kept in mind in trying to evaluate them.

Not all homoeopaths regarded these devel- opments as improvement either at the time or subsequently. Certainly they tended to give rise to inconsistencies, apparently unnoticed by Hahnemann. Take, for instance, the miasm theory. Hahnemann had always maintained that the mechanisms of disease production are unknowable. Yet the miasm idea is essen- tially a pathological theory. It postulates that the vast ma jo r i ty of chronic d iseases is caused by one of three miasms, and especial- ly by one of these, psora. Hahnemann did not offer any suggestions about what the miasms might be in themselves, but to a modern read- er his description inevitably calls to mind the concept of infection. And indeed, although Hahnemann did not explicitly state that the chronic miasms might be caused by microor- ganisms he did make this suggestion in con- nection with cholera.

The miasms are supposed to enter the b o d y - - t h r o u g h the skin, in the case of psora--and there remain latent for months or years before giving rise, later in life, to innu- merable forms of chronic disease. What can this be but a theory of disease mechanism?

Because Hahnemann ' s writings exhibit such inconsistencies it has been open to his successors to emphasize different aspects of homoeopathy while claiming to be authentic homoeopaths. But there have often been bit- ter disputes among the faithful, and it was this that led to the downfall of homoeopathy in the USA in the nineteenth century. At that time American homoeopathy was divided into a large number of ' low-potency ' pre- scribers on the one hand and a smaller but vocal body of 'high-potency' homoeopaths on the other. The high-potency group held out for what they regarded as the pure doc- trine of homoeopathy, while the low-potency majority were prepared to mix their homoeo- pathic medicines, to use allopathy at times, and generally to make compromises with the conventional medicine of the day. Eventually there ceased to be any real d i f f e rence be tween l ow-po tency h o m o e o p a t h y and allopathy, and the great majority of American homoeopaths quietly ceased to identify them- selves as such. The high-potency enthusiasts held on for a time but eventually they died

out and were not replaced. In the end all the homoeopathic hospitals and colleges were closed by the Government as being 'not up to s tandard ' , and homoeopa thy pret ty well ceased to exist in the USA; until, that is, it was revived in recent years.

In his lengthy historical survey of medical history, of which this is the fourth and final vo lume , Coul te r has been concerned to defend one side in this dispute. He is a pas- sionate advocate of the way of thinking that insp i red the ' h i g h - p o t e n c y ' school in America in the nineteenth century and in the twent ie th came to domina t e Br i t i sh homoeopathy under the influence of Margaret Tyler, John Weir, and others.

Coulter labels the 2 approaches 'rational- ism' and 'empiricism'. This is a rather con- fusing terminology, somewhat reminiscent of the mediaeval philosophical schools of nomi- nalism and realism. Probably many readers will identify empiricism with holism, and rationalism with reductionism, although this is not the terminology that Coulter uses him- self.

For Coulter, empiricism is good and ratio- nal ism is bad. Rat ional ism, we are told, explains the functioning of the body by the laws of chemistry, physics and mechanics, whereas empi r i c i sm does not a t tempt to explain it or to generalize but deals with the individual. Homoeopathy is of course empiri- cal, allopathy rational.

Coulter 's book looks at the fairly recent history of medicine from this point of view. The first few chapters consider the work of nineteenth-century medical scientists such as Pasteur, Koch, Erlich and Metchnikoff. There fo l lows a long chap te r exp l ic i t ly on homoeopathy , and indeed the underlying theme of the book is that homoeopathy is the one true embodiment of empiricism. But even within homoeopathy itself Coulter identifies heroes and villains. The chief homoeopathic villain is, predictably, Richard Hughes, iden- tified as the world leader of the low-potency school of homoeopathy in the later decades of the nineteenth century. The heroes include, again predictably, Constantine Hering, Kent and Margaret Tyler; G. Vithoulkas is cited as a latter-day inheritor of this 'correct' under- standing of homoeopathy. Other twentieth- century figures who receive Coulter's seal of approval include Sir John Weir and the late

Volume 84, Number2, April 1995 115

Dr Margery Blackie, whom Coulter oddly describes as Lady [sic] Margery Blackie.

There is no doubt that Coulter 's study is based on a prodigious amount of research. The numerous quotations are fully referenced and the bibliography takes up 42 pages. All this scholarship might lead the unwary reader to suppose that he or she was being offered a reasonably objective view of the subject. But this is not the case.

It is of course undeniable that every writer, no matter how much he tries to be objective, will inevitably introduce his own bias into what he writes, but Coul ter ' s approach is frankly tendentious. Kent and his supporters and followers are represented as exponents of something called 'classical' homoeopathy.

In the twentieth century the spirit of strict Hahnemannian homeopathy has been represent- ed by [Kent's] Repertory, and the degree to which practitioners in any country abide by Hahnemann's empirical legacy is defined by how closely they follow the Kentian method.

This claim is quite unequivocal: Kent is the one true interpreter of homoeopathy for the twentieth century. But this is a serious and mi s l ead ing o v e r - s i m p l i f i c a t i o n . It neglects or even wilfully ignores two impor- tant strands in the Kentian system that have no connection with homoeopathy.

We know that Kent , in c o m m o n with Hering, Boericke, and most if not all of the other high-potency homoeopaths in America in the nineteenth century, was a deeply com- mitted Swedenborgian; indeed Kent himself states this explicitly. Swedenborgian ideas appeared to these people to offer an ideal philosophical and mystical complement to homoeopathy; conversely, homoeopathy was seen by the numerous Swedenborgians of the day as the ideal system of medicine for them. Much of the structure of Kent's Repertory-- in particular the great emphasis it places on the ' M e n t a l s ' - - d e r i v e s from Swedenbor- gianism. One would therefore natura l ly expect that Coulter would at least discuss the influence of Swedenborg on nineteenth-cen- tury American homoeopathy, even if only to discount it. But not so; Swedenborg does not even appear in the index, and Swedenbor- gianism receives only a glancing and dismis- sive reference in the text.

It is inconceivable that Coulter did not know about Swedenborg's impact on nine-

teenth-century American homoeopathy, so why does he so carefully avoid discussing it? It is difficult to avoid the suspicion that he does so because it does not fit neatly into the picture he wants to paint. To have introduced Swedenborg at this poin t would have required a long digression, since few modern readers know anything about him; and it would have introduced a frankly mystical element into Coulter's semi-scientific treat- ment of his material. Nevertheless, in omit- ting any discussion of Swedenborg he has left out one of the chief formative influences on Kentian homoeopathy.

Another important influence on Kent came from his early training in the medical system known as ' e c l e c t i c i s m ' . This has been emphasized recently by Matthew Wood (The Magical Staff: the Vitalist Tradition in Western Medicine [1994]). It was a tenet of John M. Scudder, Kent's teacher, that the life force of the physician played an important part in the therapeutic process; Kent imported this idea into homoeopathy, but it was, Wood says, a homoeopathic heresy. Coulter has a poor opinion of eclecticism and consequently downplays its influence on Kent.

There are numerous other instances where Coulter 's enthusiasm for a particular inter- pretation has led him to present a one-sided view of his material. He states (p. 256) that Hahnemann's miasmatic doctrine was 'in due course accepted by all [sic] homoeopathic physicians...'. This is manifestly not the case; it was not accepted, for example, by Richard Hughes or Robert Dudgeon (but possibly Coulter would not admit that Hughes was a truly homoeopathic physician).

Some of Coulter's criticisms of 'allopath- ic' medicine are well taken if perhaps a little hackneyed (thalidomide, chloramphenicol, streptomycin). In fact, nearly all his refer- ences to conventional medicine are 20 or more years old. This leads him into some dubious arguments.

His dismissal of the 'allopathic' treatment of hypertension is a good example. The rau- wolfia alkaloids are obsolescent if not frankly obsolete as a treatment for hypertension; there is therefore little point in devoting a page to detailing their unwanted effects. And, like many critics of 'allopathy', he entirely fails to suggest a plausible alternative to the treatments he pillories. It is true that there is

116 British Homoeopathic Journal

no drug treatment of hypertension that is wholly satisfactory or without unwanted effects. But what follows from this, given that numerous trials have shown the efficacy of the available drugs in reducing the incidence of strokes and heart attacks? Are we sup- posed to give up using them? Coulter seems to imply this, although he does not say so in so many words; nor does he offer any alterna- tive.

His remarks on diabetes are even more unsatisfactory. Here we are offered the sur- prising statement that 'Juvenile diabetes, an autoimmune disorder, is often generated by the whooping cough vaccine...'. The rubella vaccine is also alleged to have this effect; the reference produced in support of this alarm- ing statement is an article by one R. M. Henig in The New York Times Magazine of 20 March 1988. We are then told that insulin and hypoglycaemic drugs are practically useless and that 'The best treatment for diabetes today remains proper adjustment of the diet.' This ignores the modem studies which make it clear that good diabetic control undoubted- ly reduces the incidence of diabetic complica- tions. Claims such as these are potentially dangerous because the book will doubtless be read mainly by non-medical people, who will probably take its pronouncements at face value. Conceivably, if you suffered from hypertension or diabetes and were already unhappy about taking 'allopathic' medica- tion, reading Coulter might just persuade you that it was all right to stop your treatment. Non-medically-qualified homoeopaths may well also draw the same conclusion and advise their patients accordingly.

But the book is also misleading in another

way: it seems to me that it does a disservice to the cause it purports to defend. Coulter has done an enormous amount of bibliographical research and he has a valid point to make: namely, that there has been a strong tendency for doctors to concentrate on technology while neglecting the personal and individual aspects of patients. A lot of the popular enthusiasm today for homoeopathy and other kinds of complementary medicine arises from dissatisfaction with this impersonality. But Coulter protests too much; he overstates his case to such an extent that it is difficult to take it seriously. For him, those whom he places on the side of the empiricists can do no wrong, while the blinkered and bigoted 'rationalists' are totally misguided. This rigid separation of people into sheep and goats is something that has charac ter ized many homoeopa th ic writers, start ing with Hahnemann himself; Coulter's mentor Kent was another such. On the other hand, Richard Hughes, the execrated 'rationalist traitor' within the homoeopathic camp, was a model of tolerance. Perhaps there is a message there somewhere?

It would be going too far to dismiss this book as valueless. It brings together a lot of historical information that most people would probably not find easy to track down without the resources of a large library, and, if read se lect ively , it could provide a useful overview of the way in which medicine developed between about 1850 and 1950. But its view of modem therapeutics is so distorted and one-sided as to be misleading and even dangerous to readers who come to it without a prior knowledge of the subject.

ANTHONY CAMPBELL