Should we resurrect Richard Hughes?

ANTHONY CAMPBELL, MRCP, FFHOM

Mr President, Ladies and Gentlemen,

It is indeed a great honour to be invited to give the Richard Hughes Memorial Lecture, and I am extremely grateful for the privilege. At present we are beginning what promises to be a momentous decade, not only for the world at large but for that tiny corner of it which is homoeopathy. Below the surfaces of our lives many cross-currents of enormous power are at work, and we shall need to think care- fully about our future course if we are not to be shipwrecked.

It may seem strange that I should start by referring to the future when 1 have indicated by my title that I want to talk about the past. The usual practice of those who give memorial lectures is to begin with a polite bow in the direction of the departed luminary in whose name the lectureship was founded and then to pass on to matters of more immediate concern. In this case, however, I do want to talk about Hughes and his ideas, but my reason for doing so is not merely their historical interest. I believe that these ideas, largely neglected for almost 80 years, have the utmost relevance to the future of hom~eopathy today.

The neglect of Hughes's contribution over the years is hard to understand. When I first attended courses in homceopathy I heard Hughes mentioned once or twice, always disparagingly, as an advocate of "pathological prescribing". Cer- tainly no one suggested that I should read him, although in fact some of my eminent predecessors in this lectureship, for example Dr Foubister, had remarked on the importance and relevance of Hughes's ideas; and I do not know how long it would have taken me to discover Hughes for myself, had I not quite recently been called upon to help in the preparation of teaching material for students and so been led to go more deeply into the origins and history of homoeopathy.

Before I consider Hughes's main ideas and discuss their relevance for us today, let me remind you of some of his biographical details. He was born in 1836, and was thus a contemporary--just-----of Hahnemann. He died on a visit to Dublin in 1902, at the comparatively early age of 65, leaving a widow and two sons, the younger of whom was a doctor, though whether or not he followed his father's footsteps into the homoeopathic community I do not know.

Hughes was at one time on the staff of the London Hom~eopathic Hospital, but for most of his medical career he was in practice in Brighton, in partnership with

Richard Hughes Memorial Lecture, read to the Faculty of Homoeopathy on 21 February 1980

66 The British Homceopathic Journal

another prominent homceopath, Henry Madden. He contributed numerous articles on materia medica to the British Journal of Homceopathy from 1863 to 1884, when it ceased publication, and later he edited the Annals of the British Homceopathic Society. In 1881 he delivered the Hahnemannian Oration on "Hahnemann as a Medical Philosopher", and he organized the 5-yearly International Homoeopathic Congresses. But his main claim on our attention today is on account of his three major works: A Manual of Pharmacodynamics, The Principles and Practice of Homoeopathy, and the Cyclopaedia of Drug Pathogenesy. The first two- - tha t is, the Manual and the Principles and Practice--arose out of Hughes's work as Lecturer in Materia Medica under the auspices of the British Hom0eopathic Society. I mention this, because I want to make it clear that Hughes was not an isolated figure; on the contrary, his views were the hom~eopathic orthodoxy of his day, and were endorsed by his colleagues--notably by Dudgeon, the translator of the Organon and other Hahnemannian writ ings--as an authentic, up-to-date, interpretation of homoeopathy.

How comes it, then, that only a few years after the deaths of Hughes and Dudgeon, these books were apparently almost totally neglected and forgotten? Unfortunately it is almost impossible to discover the details. One reason is the lack of published material; for about ten years, from 1900 to 1910, the Society did not issue a journal, and even the (unpublished) Minutes of the Society, recently discovered in the cellars of Hahnemann House by our Secretary, Col. Barraclough, afford only a few tantalizing clues. Dr Bodman has very recently shed a little indirect light on the matter, and I shall return to this later. All we can say with certainty, however, is that between about 1902 and 1911, Hughes's ideas, and the books in which they were recorded, were allowed quietly to sink from view and were replaced by those with which we are familiar today.

I n the time available to me I cannot, of course, bring to your attention the whole scope of Hughes's thought. All that I can do is to indicate its general out- line, in the hope that those of you who have not yet chanced upon it for your- selves will be encouraged to explore it. At least I can assure you that reading Hughes is not tedious; although late Victorian prose style is not my favouri te-- too ornate and cumbersome by ha l f - -and though Hughes, who was a fine classical scholar, does have the habit of scattering Latin phrases that cause me, at any rate, to dig around in some pretty dusty cubby-holes of memory, he is a vigorous and sometimes witty writer who says what he means.

The clue to much of Hughes's thought, as I have already said, is that he takes a historical approach. Unlike some writers, he does not give you his own ideas bolstered up with selected passages from Hahnemann; instead, he considers critically what it was that Hahnemann actually said at various times. When he does differ from the Master - -and this is surprisingly seldom---he acknowledges the fact frankly. Reading Hughes, therefore, we always know where we are; he is a writer to be trusted.

I shall consider Hughes's work under three main headings: first, his discussion of Hahnemann's ideas, second his prescribing methods, and thi rd--what is probably his most important contribution--his revision of the materia medica.

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1 Hahnemann'sldeas The principal source of Hahnemann's ideas is of course the Organon, though Hughes also draws on Hahnemann's other writings, especially the Chronic Diseases. Throughout, he makes it clear that the portion of Hahnemann's career that mainly interests u s - - I mean the time when he was actually concerned with homceopathy--falls into two fairly distinct phases. The first, which may be considered to begin with the publication in 1805 of the essay called The Medicine of Experience, ends with Hahnemann's departure from Leipzig for Kothen in 1821, while the second covers his time at Kothen and Paris and ends with his death. These two phases in Hahnemann's career differ in many ways, and not only because by the time he reached Kothen he was an old man; they correspond in an interesting way with two sides of his character, the empirical and the metaphysical. In Leipzig he was surrounded by disciples, most of whom were young, he was actively engaged in general medical practice, and he was a univer- sity lecturer. In Kothen he lived virtually as a recluse, quite cut off from main- stream medicine, and his own practice was almost exclusively concerned with chronic disease. To the earlier phase belong the famous provings of the Materia Medica Pura, derived from scientific experiments on healthy subjects, whereas in the later phase Hahnemann's own contributions to the Chronic Diseases rely, as Hughes clearly demonstrates, almost entirely on the real or supposed effects of drugs--mainly in the 30th potency---on the sick.

The Organon, which Hahnemann revised extensively no less than six times in the course of his long life, also exhibits evidence of these changes in outlook. Hughes demonstrates that much of what is today thought to be intrinsic to homoeopathy--the concepts of vitalism and of dynamization, for example--are really quite late additions.

Hughes, it is clear, was much more strongly attracted to what I have called the empirical side of Hahnemann's thought than to the metaphysical aspects. Whether one agrees with him about this is ultimately, I think, a matter of temperament; but whichever view we take we should all be grateful to Hughes for his brilliant and scholarly documentation of the way in which Hahnemann's thought developed. It is naturally open to anyone to hold a different opinion from Hughes; but Hughes provides the historical facts which enable us to make up our own minds in an informed manner. This may be seen in his attitude to Hahnemann's vitalism, a doctrine whose evolution he traces through its various stages in the Organon. In the early editions there are no problems, and the idea is easily reconcilable with modern thinking. Later, however, Hahnemann adopted the theory that vitality is a "force", analogous to magnetism or electricity, which animates the body during life and leaves it at death. Disease is supposed to be due to derangement of this vital force, and the Organon contains ingenious and elaborate descriptions of the way in which homoeopathic medicines may be thought to act upon it.

Now, as Hughes rightly points out, it would be wrong to criticize Hahnemann for this view, which has been widely held in one form or another by very many people throughout history and which in Western philosophy derives from Aristotle. In Hahnemann's day it was held almost universally, but by the time

68 7"he British Homa, opathic Journal

Hughes wrote it was becoming unfashionable--a tendency that has gone even further today. At present there is hardly a single serious biologist or physiologist who would defend the vitalistic position; mechanistic explanations have won the day. Some of you may perhaps feel that the older view nevertheless has some- thing to be said for it. The point is, however, that the incorporation of such a theory into homoeopathy can only make the subject more difficult for anyone who has received a modern scientific education while it adds nothing to the practice of the art. I think, therefore, we should agree with Hughes's opinion that: "Either [theory] or neither may be wholly true; but one would have been glad if the Organon had kept itself clear of such questions, and had occupied only the solid ground of observation and experiment. ''1

Hughes adopts a similar attitude to the psora theory. By once more setting the theory in its historical context, he is able to defend Hahnemann from his more obtuse critics. To ridicule Hahnemann for not recognizing that scabies was due to the mite is, he says, a gross anachronism, for none of Hahnemann's contemporaries recognized this either; indeed, in this respect Hahnemann was wholly orthodox. But Hughes rejects the theory in the light of later discoveries and regrets that it was included in the Organon.

To my mind, Hughes's criticism of the psora theory, though valid, misses what is the real weakness of the idea, which is quite simply its near-universality. By advancing psora as an explanation for practically every form of chronic disease known to man, Hahnemann finally explains nothing at all.

As for dynamization, to which he devotes a good deal of space, Hughes finds himself in a quandary--as well he might--and I find his discussion of the subject less clear than it might be. On the practical level he admits that dilutions (he avoids the word potencies) as high as the 30th undoubtedly appear to work in his own experience, though it seems he seldom used them; and he accepts the testimony of respected colleagues as to the effectiveness of 200ths. However, he is very sceptical about the claims of the American high-potency school to have pro- duced genuine Hahnemannian dilutions of 1,000 or more; on the basis of simple arithmetical calculations of the number of bottles, amount of water, and length of time required, he thinks that these preparations cannot be what they purport to be, a suspicion that was reinforced by the unsatisfactory replies he received from the American manufacturers to whom he wrote for details. Still on the practical level, he disapproved of medicating tablets and pillules by adding a few drops of liquid to the container and shaking it; a method which, he said, introduces a fresh step of uncertainty into what is already an uncertain process.

On the theoretical level, he was troubled by the lack of any scientifically plausible explanation for the activity of dilutions higher than 12c. In this respect we do not seem to be noticeably better off today. And he rejects Hahnemann's late idea that serial dilution and succession actually enhance the effectiveness of the drugs. He writes: "By some of Hahnemann's followers, who are more imaginative than philosophical, this dynamization has been supposed to result from a transference of the whole thing from the realm of matter to that of spirit. I can only say that I know nothing of such conceptions as applied to natural things: they are to me alike uncongenial and unintelligible. ''2 He admits that

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Hahnemann's later writings seem to support this spiritual view of dynamization, but he thinks this is meant metaphorically. I doubt this myself; I think Hahnemann probably meant just what he said. As I say, I find Hughes's treat L ment of this subject not wholly satisfactory--but then, no one else's seems much better. The whole matter is decidedly obscure and much the most puzzling aspect of homoeopathy.

All the topics we have been considering so far are as alive today as they were in Hughes's time, and so is his treatment of them. In these respects he is a remark- ably modern writer, with a twentieth-century mind. Only, perhaps, in his rather lengthy and tedious discussion of the primary and secondary actions of drugs does he seem dated, and even here his conclusions are remarkably sensible. After reviewing all the argument then current about the correctness or otherwise of Hahnemann's explanation of the mode of action of homoeopathic drugs, he remarks that he himself finds all the proferred explanations unconvincing, but that this does not really matter provided they are not taken too seriously, so that homoeopathy stands or falls by them. Like Montaigne, Hughes was one of that relatively small band of thinkers who is ready to live with doubt rather than seek to grasp at makeshift theories; and I must say I respect him the more for it. What- ever may be the case in metaphysics or religion--and Hughes incidentally was a staunch churchman--totality explanations are, I am sure, out of place in science, where they should not be sought or expected.

2 Hughes's Preserib~,g Methods Hughes's empirical bent shows itself equally well in his attitude to prescribing. As we know, in recent years this has been the main focus for hostile criticism of Hughes; he has been accused of being a "pathological prescriber", which is regarded as the lowest form of homoeopathic life. Hughes himself, however, was unrepentant, and mustered an impressive list of citations from the Master to support the orthodoxy of his position. I shall not trouble you with these, however, but shall only give you the main prescribing features which he took into account. Orthodox or not, they seem to me soundly based on common sense.

If you are serious about the similimum idea, he says, you should take the following points into account in your prescribing.

The site of action: the drug chosen should have an effect on the organ or organs (including the skin) which are affected by the disease.

Kind of action: this, too, requires to be matched. If the disease produces fever, so should the drug, and similarly for inflammation, ulceration, and so on.

Causation: I find this the least helpful of Hughes's headings, owing to the changes that have occurred in our ideas of disease causation. However, from the examples he gives we could, I think, replace "causation" by "modality" and. arrive at the idea which he wished to convey.

Character of sensation: disease and drug should produce similar kinds of sensa- tion (pain, itching, and so on).

Concomitance: like Boenninghausen, Hughes regards the coincidence of two or

70 The British Homa, opathic Journal

more marked symptoms as important, on the common-sense grounds that unusual combinations of symptoms are unlikely to come about by chance and hence they help to characterize the remedy.

I think it will be evident even from this brief summary that there is a great deal more to Hughes's approach than mere reliance on pathology. Indeed, only the first two points (site and kind of action) could, I think, fairly be called patho- logical, and even they are surely implied in any scheme for finding the similimum. (If you doubt this, try to imagine how the effects of a drug could be "similar" to a disease picture without being similar in respect of site of action and kind of action.)

However, it would be fair to say that the scheme I have outlined is fairly general. Hughes admits that generalization is imperfect homoeopathy, but he thinks it is better than nothing. Here, I suggest, he was merely being honest about what nearly everyone does at times in practice. He writes: "By pursuing individualization you may strike your mark; but your weapon's point is so fine that, though it pierces deep when it hits, it is very liable to miss. Generalization gives a blunter point, but a broader one; your impression may be less incisive, but it can hardly fail to be made. ''3 Remember, too, that when Hughes was writing, homeeopaths were still largely concerned with the treatment of acute disease, as a glance at one of the journals of the day will show; and individualization is probably less important in acute disease. But, as he freely admits, it is often neces- sary to individualize; and he says that there are two methods for doing this.

The first is Hahnemann's, and consists in writing down all the symptoms of the case in the order of the schema of the Materia Medica Pura and then trying to match all of them, or most of them, or the most important of them, with the symptoms recorded for one of the drugs. In practice, this was difficult even for Hahnemann, and for us is nearly impossible; whence the growth of repertoriza- tion. Hughes accepts the practice, though he cautions his students that a reper- tory is only an index and is no substitute for the materia medica.

The second method is to base the prescription on the so-called characteristic symptoms. This idea, which at the time was being vigorously advocated in America by Hering (it forms the basis of his Guiding Symptoms), when pursued to its logical conclusion becomes the keynote system. Hughes has little trouble in demonstrating its inherent inconsistencies, and regards it as a gross and inaccurate over-simplification of the materia medica. He is, in fact, a confirmed adherent of the "totality" approach to prescribing, which we today consider so central to homoeopathy.

In addition to these methods of prescribing, Hughes introduces another way of looking at the art which seems to be wholly his own and which is, I believe, a most valuable contribution. What he points out is that the similimum concept should refer not merely to a static cross-section in time of the disease process and the provings, but to the way in which the symptoms develop over a period of time. Too often, he held, we think of the symptoms recorded in the materia medica as isolated in time and as unconnected with one another, whereas in reality they must have developed during the e~,olution of a clinical syndrome over a few hours or

Volume 69, Number 2, April 1980 71

days. The reason we do not realize this clearly is largely Hahnemann's unfor- tunate schematic arrangement of his materia medica--as Hughes wittily puts it, the student who attempts to read about Aconite begins with Vertigo and ends with Rage- -ye t the temporal evolution and interrelation of the symptoms, had we been given this information in narrative form, would be extremely relevant to the making of a true similimum.

J Hughes and the Materia Mediea This brings me to Hughes's work on the materia medica. I have already men- tioned the unsatisfactory basis of Hahnemann's contributions to the Chronic Diseases. In the course of a brilliant analysis of this material, Hughes shows how far Hahnemann fell short here of his own former high standards. Hughes concluded regretfully that the great bulk of the symptoms contained in the Chronic Diseases are not to be relied upon as genuine physiological effects of the drugs. That may shock you; but before you reject the idea as 16se-majestr, may I suggest that you read Hughes's discussion of the subject in his Manual? I will give you only one of the numerous instances which Hughes cites of Hahnemann's overcredulity at this time. One of the authors on whom Hahnemann draws describes a patient with advanced metastatic lung disease from carcinoma of the breast; not surprisingly, she coughs up pus before she dies. But, because she was receiving Conium, Hahnemann lists "purulent expectoration" and "pain shooting into the ulcers when coughing" as symptoms of Conium.

Let me make it clear, however, that in spite of these criticisms, Hughes did use the medicines described by Hahnemann in the Chronic Diseases, and he emphasized that his criticisms in no way apply to the symptoms of the Materia Medica Pura, which are in an entirely different category.

Yet another problem that was already becoming serious in Hughes's day was the wholesale incorporation into homoeopathic textbooks of clinical symptoms; that is, of symptoms recorded as having been cured by a medicine although they had not appeared in the provings of that medicine. In this category are included prescribing indications based on constitution and temperament, mental state, side of the body affected, modalities, and so on. Reliance on such indications had already led to the development of a new kind of materia medica, which Hughes links with the names of Jahr, Boenninghausen, Clarke, and others; the trend was of course taken even further by Kent, whom Hughes does not mention. As a true empiricist, Hughes was quite prepared to allow that these indications could be helpful in the choice of a remedy. However, he j ibbed--surely rightly--at the increasing practice of including them, without any indication of their origin, in published compilations of materia medica. For, as he pointed out, when we prescribe on such indications we may be prescribing a homoeopathic medicine, but we are not prescribing hom~eopathically. To claim that we are is to fall into the trap of circularity. The success of a prescription based on such indications can- not be adduced as evidence of the validity of the similimum principle.

You may say that this does not much matter, provided it works, and perhaps it doesn't, except to the purist. The problem is, however, that it causes chaos in the materia medica. These clinical symptoms appear in textbooks without any indica-

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tion of who observed them or in what circumstances, so that it is usually difficult or impossible to assess their reliability. I am sure Hughes was right in holding that the wholesale and uncritical incorporation of such material can only lead to a progressive deterioration of the materia medica.

In view of all these problems, Hughes concluded that there was an urgent need for a new, critical compilation of materia medica that would afford homoeopaths a sound basis on which to practice. He had earlier cooperated with Allen in the preparation of that editor's massive Encyclopaedia; but later he came to think that this monumental work, admirable though it was, contained far too much unreliable information, for Allen had included all published provings whatever his private opinion of their worth. The indefatigable Hughes therefore now embarked on a materia medica of his own, that should include all the reliable reports then available apart from Hahnemann's , which Hughes assumed every homceopath to possess already.

To me it seems almost incredible that anyone should even contemplate such a daunting task. (Admittedly, Dr. J. P. Dake is named on the title page as co-editor; but Dudgeon tells us that in fact the work was Hughes's alone.) In 1884 Hughes went to America to discuss the project with the American Institute of Homeopathy; at the meeting a number of guidelines were agreed on. Here are some of them.

All the provings were to be given in narrative s tyle-- i f necessary, by extracting the narrative element from the published schema. (This idea alone makes me quake in my editorial shoes.)

Some mention was to be made to relevant animal experiments even though many homoeopaths, from Hahnemann onwards, have objected to this. Hughes claims that animal studies can provide valuable confirmation of provings on human beings, and instances the finding of inflammation of serous membranes in animals taking Bryonia.

In every case the original source was to be consulted--another intimidating editorial prospect, but an unavoidable precaution if the enormous accumulation of errors that had crept into the materia medica was to be weeded out. As Hughes remarks, "no one who has not analysed a number of pathogeneses, as now exist- ing in Jahr and Allen, can have any idea of the number of errors there are to correct--~rrors resulting sometimes from haste or misapprehension, but most commonly from working with second-hand material. The fact is that all our book- makers have been copying one from another, and accumulating faults as they have gone on; so that our symptom-lists are made from shoddy instead of new cloth. ''4

In sifting his material, Hughes used a number of rules. Clinical symptoms were of course excluded, and so with few exceptions were symptoms reported as occurring from a drug administration to the sick. Symptoms recorded only once were also mainly omitted. As for the problem of provings carried out with infinitesimals, these were excluded above 6c unless confirmed by provings at lower dilutions. This last rule was accepted by all seven members of the Materia Medica Bureau in America, even though two of them were confirmed advocates of high potencies.

I/'ohtme 6 9, Number 2, April 1980 73

Furnished with these instructions, Hughes devoted 16 years to the four volumes of his Cyclopaedia of Drug Pathogenesy and then compiled a Repertory to the work. I have already indicated its scope; and, knowing what we do of Hughes's meticulous scholarship, we can be sure that it meets the exacting standards pro- posed for it. In view of this, the almost complete neglect of the Cyclopaedia by the homeeopathic community over the last 70 years seems to me nothing short of deplorable. What right do we have to claim that homaeopathy is based on the similimum principle, to chant the refrain similia similibus curentur, when we ignore by far the most comprehensive and scholarly compilation of the evidence for that claim that has come down to us? I do not know how many copies of the work are even still in existence; in the Faculty library there is only one, and the economics of present-day publishing make it out of the question that it could ever be reprinted. Yet it is, with the exception of Hahnemann's own writings, arguably the single most valuable contribution to the homoeopathic literature there has been. An obituary in an American journal of the time, the Hahnemannian Monthly, described it as "a work without parallel in all medical literature", and went on to say: "I t is a work - -we had almost said the work- - f rom which the future materia medica authority will compile all that is best and most reliable in his new textbook; and it requires no prophetic vision to foretell that its pages will be even more frequently explored at the end of the twentieth century than at its beginning."

Well, contemporary estimates of literary reputations are notoriously fallible, and this one certainly seems to be a case in point. Of course, we are not yet quite at the end of the twentieth century, so there is still time; but what are the reasons for the neglect of the Cyclopaedia up to the present?

Part of the explanation, I think, lies in something that Hughes himself refers to in his Introduction.

"I t seems to be the impression of some", he writes," that our Cyclopaedia is a mere luxury of pathogenesy, quite beyond the requirements of the student and the practitioner, and only really valuable to the teacher or writer on the subject. This view seems to us entirely mistaken. It shows how injurious has been the influence of the schemas which have hitherto reigned in the homoeopathic school, that when pure pathogenetic knowledge, in its primary form, is presented to the mind, there seems but little relish for it. ''5 (xv) But, he goes on to claim, the fight way to study the effects of drugs is to read narrative accounts of a series of cases illustrating their actions. This makes the materia medica interesting and alive.

Now, this argument is valid so far as it goes; but there is more to the story. Shortly after Hughes's death the matefia medica began to appear in quite a new guise: that of the so-called drug pictures of Kent and Tyler, which are based not merely upon provings and toxicology, but contain a large admixture of clinical symptoms. Moreover, being cast in dramatic form they are much more readable than the old-fashioned symptom lists that Hughes complains about, and indeed a r e - - a t least in Margaret Tyler's writ ings--more immediately appealing than those of Hughes himself.

But of course, it was not merely a new-style materia medica that was beginning to appear at about the time of the First World War. In a recent article in the

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British Homoeopathic Journal, Dr Bodman has given us a fascinating glimpse into the changes that occurred in the British Hom0eopathic Society at this time. From what he tells us it is fairly clear that the younger homoeopaths of the d a y - - especially Drs Tyler and Weir--fel t that Hughes and his ideas had dominated hom~eopathy for much too long--had, indeed, secured a stranglehold on homoeopathic th~nking and practice. Perhaps this was true. At any rate, the pendulum now swung back with a violence that nearly dislocated it from its hinge. In 1907 Dr Tyler and her mother, Lady Tyler, instituted a scholarship to send doctors to the USA to study under Kent, Dr Weir was an early beneficiary, and in 1909 he was appointed House Surgeon at the London Homoeopathic Hospital. Kentianism was thus becoming firmly established in London; while in Glasgow the new teaching had a powerful advocate in Dr Gibson Miller. Soon afterwards Dr Weir was appointed Compton Burnett Professor and Honorary Secretary of the Society. The victory of Kentianism was now assured.

These events happened a long time ago, before the professional lifetimes of even the most venerable living homceopaths. It is therefore not unreasonable to look at them afresh. I will do so in the words of Dr Charles Wheeler, who actual!y experienced both phases of homoeopathic development at first hand and main- tained, I believe, a balanced view of the matter.

Kentianism, he said, "in its essence . . , is an acceptance of the Hahnemannian doctrine, which is slightly contemptuous of any attempt to make terms with other medical knowledge, regarding, as it were, the teaching as something so transcendental that no reasoned explanations are likely to have any validity. Such interpretations, as it appears, have a certain attractive semi-mystical quality, and there is no question but thaf many minds today find satisfaction and peace there- in. The new things added by Kent are a refinement of the method of drug selec- tion, which goes in some ways beyond Hahnemann, though it is implicit, I think, in his teaching, and a confident use of the very highest potencies (and a lofty scorn of any others) which were in effect in the main rejected by Hahnemann. There is also the teaching of increased power with increasing potency, which is by no means always demonstrable, at least to my thinking.

"Now, it is abundantly clear that this conception of homoeopathy and the practice that ensues from it wins a fair number of converts, and those of the most enthusiastic and successful. But it is also fairly clear that it has but a limited appeal. Even in his own country, Dr Kent's followers are a minority; and in Europe, while they can claim, the highest quality of adherents, they leave the main body of the profession unconverted, even indifferent. Their response is that there can be no compromise with truth. They hold themselves to possess it in a unique degree: if the medical world cannot or will not see it so much the worse for them. To the elect there is no course but to go their way. If that means permanent loss to humanity the fault is not theirs. They are willing to pipe, and if the profession will not dance their consciences are clear. With those who would thus define their position there can be no argument, and heaven forbid that there should be any quarrel. ''6

These wise words come from Dr Wheeler's Presidential Address to the International Hom~eopathic Congress in 1936. Since then, Kentianism has made

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further advances, and now it is regarded as virtually the sole repository of ortho- dox Hahnemannianism. I think it is time that we considered seriously whether Kentianism has not suffered the fate of all revolutionary movements and hardened into a dogmatism that is as little conducive to original thinking as perhaps was the earlier dogmatism it replaced. And if, on reflection, we feel that this may be the case, what is to be done about it?

In my title I posed the question "Should we resurrect Richard Hughes?" My answer is a qualified "yes". Let me quote Wheeler again: "Hughes's brilliant expositions have never lost their value: admirable work has been and can be done on his lines; those who never consider his point of view will miss successes which they might have, and it is fair to remind the enthusiast for a more ethereal practice that in Great Britain it was the teaching of Hughes mainly, and the followers whom he won, that kept the flag of hom~eopathy flying in days far more difficult through persecution and ill will than any which we have to face now. ''7

It is, as I say, a qualified resurrection that I am advocating. It is not so much any particular ideas of Hughes that I recommend to you, so much as his general attitude. That attitude could perhaps be described as one of constant questioning, but questioning that is always constructive, not destructive, yet which takes nothing for granted and which, above all, tries always to set homo~opathic ideas in their historical context.

To put it a little differently, I would say that Hughes, far from being the "half- homoeopath" that he is sometimes pejoratively labelled, was actually one of the most informed and scholarly Hahnemannians there have been. However, he considered not just one period of Hahnemann's career-- the la tes t - -but all of it, and he founded his theory and practice on Hahnemann's earlier phase. I believe he had every right to do this. Kent, perhaps, could claim to be closer to Hahnemann's late, metaphysical, phase. Both Hughes and Kent went in certain respects beyond Hahnemann- -as , again, they had every right to do. But to debate which, if either, taught the "true" Hahnemannian doctrine is, I submit, futile. One might as well debate whether the true phase of a silkworm's life is spent as a moth on the wing or as a caterpillar spinning silk. Dogmatism about homceopathy--of any k ind- -can lead only to sterility; we must lay down no 39 articles to which everyone is to subscribe.

Certainly there can be no question of trying to convert people to this or that point of view. But anyone who feels that his or her results in practice are not wholly ideal, yet who is not convinced that the way forward lies in advancing further and further down the Kentian road, might, as Wheeler suggested, do well to look into Hughes's approach. Such people would be greatly helped if some part, at least, of the treasure store of the Cyclopaedia were made readily available to them; that is something which we as a Faculty should consider very seriously. It might, for example, be possible to go through this work and try to match some of the cases recorded there with modern clinical concepts. Hughes did this in his day in the Principles and Practice, But inevitably much of this is now out of date. We, I believe, would benefit immensely if we did it afresh.

Valuable though this would be, there is something even more important. I think we should seriously reconsider the way homoeopathy is taught. From the very

76 The British Homaeopathic Journal

outset, I believe, we should follow Hughes's example and set homoeopathy in its historical context, explaining frankly and without b i a s - - so far as that is humanly possible---how and why it has come to be where it is. Only one feature of the sub- ject should be stated to be an essential, defining characteristic, and that is the similimum principle; and even this should not be laid down as a scientific "law of cure" but only as what Hughes claimed it to be, a rule of art. This means that it does not have to be believed, or proved--indeed, it is not capable of proof or disproof; it is merely a guide to clinical practice which forms the basis of our discussion. Everything else--potency, theories of chronic disease, the importance or otherwise of pathology-- is secondary and inessential. All these things have been questioned in the past by the most eminent of homoeopaths, and we do wrong if we pretend otherwise. Of course there are differences of opinion among us on all these mat te rs - -why not? I believe that these differences should be presented fairly to students from the outset, by allowing them to come into con- tact with all the main trends in homoeopathy. Some of you may think that would be confusing. But we are teaching mature postgraduate doctors, not school- children; doctors these days are taught to think for themselves, to ask for evidence and to weigh it by accepted scientific criteria. And in the records of provings and toxicology~ especially as set out in the Cyclopaedia, we do have first-hand scientific evidence. Surely we should let our students read this material for them- selves, and see whether, as we claim, it provides clinical pictures similar to those of naturally occurring disease. I believe that it does; but we must be prepared to demonstrate it.

I know that this programme offers a great challenge. To meet it will require hard work and hard thinking, but I have no doubt that the effort will be very much worth while. Hughes's Cyclopaedia is a goldmine that was closed down and sealed up before its riches had been even touched, let alone properly exploited; we must re-open it.

What I am advocating, in short, is a return to the well-springs of homoeopathy; that is, to the sources of our materia medica. For too long we have been content to use secondary and even tertiary sources; we need to be go back to our origins. To carry out modern scientific research is important, but this activity is complementary to the historical recapitulation I am speaking of and cannot replace it. In the best of our materia medica we have a corpus of scientific observations which, though old, is still valid and capable of standing up to modern scientific scrutiny. If we establish hom~eopathy on this basis we shall find new paths opening before us through the manifold uncertainties, and opportunities, that await us in the future.

REFERENCES I Hughes R. The Principles and Practice of Homceopathy. London, 1902: 32. 2 Hughes R. ,4 Manual ofPharrnacodynarnics. 6th ed. London, 1912: 102-3. 3 Hughes R. Principles and Practice: 98. 4 Hughes R. A Cyclopaedia of Drug Pathogenesy. Vol. 1. London, 1886: xiii. 5 Ibid.: xv. 6 Wheeler CE. Principles and Practice. Br Horn J 1974: 63: 214. 7 lbid,:213.

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