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The two faces of homoeopathy 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 for a second time. On the previous occasion that you did me this honour I reviewed the main features of Hughes's: teaching and concluded that there was much that we could gain from reconsidering some of his ideas. In the intervening years ! have given some more thought to these, and this evening ! should like to lay before you some of the conclusions I have reached.

You may perhaps recall that one of the most surprising things about Hughes is the contrast between the esteem in which he was held by British homoeopaths in his lifetime and the complete eclipse that his reputation suffered almost immediately after his death. Many reasons can be adduced for this, but I think that the essential clue to the mystery is to be found in a quotation which I should like to read to you. Hughes was always concerned with attempting to build bridges between homoeopathy and orthodox medicine, and he appealed to orthodox doctors to bring their scientific knowledge and expertise to bear on homoeopathy. And he went on, in a most remarkable passage, as follows:

"Do our brethren know what would be the result of such generous policy? We should at once cease to exist as a separate body. (My italics.) Our name would remain only as a technical term to designate our doctrine; while 'homoeopathic' journals, societies, hospitals, dispensaries, pharma- copoeias, directories, under such title, would lose their raison d'etre and cease to be. The rivalry between 'homoeopathic' and 'allopathic' practitioners would no longer embitter doctors and perplex patients. ''1

Now, in writing this, Hughes was really letting a very large cat, indeed a potential tiger, out of the bag. And I believe it was sentiments such as these, rather than his views on pathological prescribing and the rest, that led to his posthumous ostracism by the majority of hom~eopaths. However this may be, it is the implica- tions of Hughes's view of the desirable relationship between homoeopathy and orthodox medicine that I should like to examine this evening, because it seems to me that this question is vital to the future development of our subject.

The thesis I want to lay before you is that there are two faces or aspects of homoeopathy, and that many of the problems we confront today arise because the existence of these two faces is not generally recognized. The different forms of homoeopathy may conveniently be labelled scientific and metaphysical.

The existence of these two aspects goes right back throughout the history of hom~eopathy to Hahnemann himself, who in fact combined them more

The Richard Hughes Memorial Lecture 1984.

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completely than any subsequent homoeopath has succeeded in doing. However, he did this not simultaneously but sequentially, for his life falls into separate sections that do not have a great deal of connection with one another. In order to bring this out, let me remind you of the main events of his career that are relevant in this context.

It was some fifty years before Hahnemann even began to practise or write about the medical system that he was later to christen homoeopathy. If we take the publication of "The Medicine of Experience" as the starting point, this occurred in 1806. Shortly afterwards he moved to Leipzig for the fourth and last time, and remained there for ten years (1811-21). During this time he wrote the second, third, and fourth editions of the Organon and also carried out the pharma- cological research that resulted in the publication of the Materia Medica Pura. Whatever one's reservations about this research, there is no doubt that it was in conception scientific. That is to say, it was intended to produce new knowledge about the effects of drugs, and it was designed to eliminate as far as possible sources o f error. During this period, moreover, Hahnemann was involved in the treatment of acute disease, he was surrounded by disciples, nearly all of whom were much younger than he, and he was lecturing at the university and therefore in contact, even if hostile contact, with orthodox medical ideas.

In 1821, however, everything changed. The hostility of the Leipzig apothecaries forced him to leave the city and move to the tiny principality of K6then, where he was almost completely isolated not only from orthodox medicine but even from his own disciples. His practice, too, changed, becoming almost exclusively concerned with the treatment of chronic disease. It is perhaps not surprising that his ideas changed as well. It is in fact to this period that belong several of the theories and practices that are today often thought to be the most characteristic of homoeopathy. Thus, while he was at K6then, he incorporated the doctrine of vitalism into the Organon, he propounded the theory of dynamization or potentization, and he announced his discovery of the cause of chronic disease-- the miasm theory.

That the theory of vitalism is metaphysical does not, I think, require much argument to prove. Hahnemann did not invent the idea, of course, but merely took sides in a debate that was centuries old and would continue long after his death; but in linking homoeopathy so decisively to the concept of the dynamis or vital force he introduced a strongly metaphysical element. By definition the vital force cannot be seen or weighed or measured; it cannot be detected by the senses or with instruments. It remains a mere theoretical construct, and is no more accessible to scientific investigation than is the soul or the ether.

It may not be so immediately obvious why I classify the theories of dynamiza- tion and miasms as metaphysical. I should explain at this point that I am using Karl Popper's terminology, according to which a theory is "metaphysical" if it cannot be tested, z For a theory to be scientific, it must make "risky" predictions. It must forbid certain things; that is, there must be some events or observations which, if they occur, will invalidate the theory or at least require that it be modified. If a theory covers every conceivable eventuality it can never be disproved, but by the same token it is not scientific but metaphysical. (Note that

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this does not necessarily mean it is of no Value.) Popper instances Freudian theory as metaphysical, since any conceivable behaviour can be explained in Freudian terms.

The miasm theory is, I believe, a metaphysical theory of this kind, even though it might at first glance appear to be a scientific theory of pathology. If you read Hahnemann's account of the manifestations of psora, you will see that they include almost every imaginable symptom and disease. Ask yourself what form of chronic disease is not due to psora, and you will see the difficulty; by explaining everything, the theory really explains nothing. It is hard to avoid the suspicion that the miasm theory was adopted by Hahnemann as a face-saver, a psycho- logical expedient for avoiding an intolerable conclusion.

Hahnemann 's biographer Haehl quotes some very revealing passages, written by Hahnemann before he thought of homoeopathy, in which it is clear that he was impelled by an almost mystical desire to relieve suffering and by a deeply held conviction that a benevolent Creator would not have left mankind without a means of achieving this end.

"Would He, the Father of all, coldly survey the torments of disease of His dearest creatures? Would He leave no way open to the genius of mankind---otherwise so infallible--no easy, certain, and dependable way of regarding disease from the right angle, of determining the use and the specific, safe and dependable results obtainable from the medicines?

Before I would have given credence to this blasphemy, I should have forsworn all the school systems of the world...-3

The answer to his dilemma was, of course, homaeopathy, and it is essential to understand that for Hahnemann homoeopathy always had this kind of divine sanction. This helps to explain his fierce intolerance of criticism in later years, and his ruthless suppression of the slightest real or fancied heresy on the part of his disciples. When, therefore, it became evident from both his own experience and that of others that homoeopathy was not an answer to every problem, this posed an intolerable psychological threat. He escaped from it by taking refuge in an unassailable theoretical for t ress-- the miasm doctrine, which thenceforth became for him an integral part of homoeopathy.

The theory of dynamization or potentization appears suddenly and without real explanation in Hahnemann 's writings. At an earlier stage in his career he acknowledged that diluting medicines did weaken them, but not nearly so much as might be expected. Now, however, in reply to a critic who asserted that homceopaths were, in effect, throwing a teaspoonful of medicine into Lake Geneva and using the lake water for treating patients, Hahnemann claimed that the analogy did not hold good, because it omitted the role of trituration and succussion. These techniques, which he described for the first time, actually enhanced the activity of the medicines, he said, to such an extent that they could be diluted almost limitlessly without losing their efficacy--indeed, the more they were dynamized the more powerful they became.

Now, this too may at first seem to be a scientific idea, but if we look a little deeper its metaphysical nature becomes apparent. Hahnemann offers no evidence in support of his claims, but once they have been made he insists on them with his usual obstinacy. It would take too long to go into all the reasons that led him to

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the theory, but they seem to have been closely bound up with his conversion to belief in vitalism. A potentized medicine could be said to be the vital force trapped in a bottle, like a jinn. This is certainly a metaphysical, almost mystical, idea, and it was recognized as such by at least one hom~eopath of the time, named Veith, who compared it (somewhat inaccurately) to the teachings of Zoroaster.

Homoeopaths sometimes represent Hahnemann as a medical scientist, far in advance of his own day, but I think that this is a serious over-simplification that greatly distorts his thinking. It is quite true that he was a scientist in some respects--in his emphasis on experimentation as the only means to sure knowl- edge of pharmacology, for example, and in his interest in chemistry--and he was also forward-looking in such matters as the need for good food and fresh air and in his enlightened attitude to mental disease. However, there are also echoes of much older ideas. The resemblance between his views and those of Paracelsus has often been remarked on. Paracelsus was steeped in the alchemical tradition, and Hahnemann's later ideas have a good deal in common with alchemy, too. For example, the notion that a tiny quantity of a potentized medicine has an enormously powerful effect reminds us of the Philosopher's Stone, a minute frag- ment of which could transmute many times its own weight of base metal into gold or cure all known diseases; and again, the Philosopher's Stone as universal panacea finds its parallel in Hahnemann's view of homoeopathy as a universal answer to disease. And the Paracelsian Doctrine of Signatures has been put forward as a primitive form of homoeopathy.

These curious resemblances have never been satisfactorily explained. It seems that late in life Hahnemann claimed never to have heard of Paracelsus, and he dismissed the Doctrine of Signatures as childish. However, as a young man Hahnemann became a Freemason, and he preserved his interest in the Craft all his life. German Masonry in the late eighteenth century was affected by Rosicrucianism, which in turn had close links with Paracelsus and alchemy, so it seems unlikely that Hahnemann would not have encountered these ideas. Perhaps, therefore, his later denial of having done so is an example of Freudian "forgetting".

To summarize, then: I am suggesting that the period of Hahnemann's life that is concerned with homoeopathy falls into two fairly distinct phases. In the earlier period he was primarily a scientist, in the later a metaphysician. Much of the history of hom0eopathy since Hahnemann's death has been concerned with the interaction, and sometimes conflict, between these two ways of looking at the subject.

The later evolution of these ideas In Britain in the nineteenth century, Dudgeon, Hughes and their followers were very much on the scientific wing of homoeopathy. They rejected vitalism, miasms, and the potency concept; most British prescribing was of what we would now call low potencies. They also made use of the new ideas in medicine that were beginning to come in during the second half of the nineteenth century, and, as we have heard, Hughes wished to minimize the differences separating homoeopathy from orthodox medicine.

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This description holds good of the main stream of British hom~eopathy, though I should point out that there was also a minority movement in the opposite direction at this time, towards metaphysical and even occult ideas. Thus, the Hermetic Order of the Golden Dawn, that extraordinary magical society of which the poet W. B. Yeats was a prominent member, included fourteen medical men of whom most--perhaps all--were homceopaths.

In the USA, meanwhile, hom~eopathy was evolving very differently. Two distinct schools developed: a low-potency wing, which in the end was absorbed by orthodox medicine, and a much smaller but ultimately more influential group of high-potency prescribers. The best known of this second group today are Constantine Hering and James Tyler Kent.

The high-potency school laid great emphasis on vitalism and the miasm theory and extended these ideas in important respects. It is to them, for example, that we owe the idea that the miasms are hereditary influences, and it was Hering and his followers who invented the nosodes. They claimed to be upholders of "pure Hahnemannian homoeopathy", but this claim is only tenable if we confine our- selves to Hahnemann's late metaphysical period. In any case it ignores one most important fact: namely, that the high-potency school was deeply influenced by the ideas of the Swedish mystic Emanuel Swedenborg.

Swedenborg died in 1772. He was a respected scientist and statesman who from middle age onwards led an amazing double life, continuing to be a practical man of affairs, but at the same time 'maintaining continual communion with the spirit world. His mystical activities led him to produce a new interpretation of Christianity which, though original, has much in common with Neoplatonic ideas. Swedenborg did not found an organization to support his teachings, but after his death, in England, a New Church was set up for the purpose. By 1784 Swedenborg's doctrines had reached America, where they quickly became very successful.

Strong links between Swedenborgianism and homeeopathy were forged very early. Almost all the leading high-potency hom~eopaths were Swedenborgians, while the firm of Boericke and Tafel, which published homoeopathic books, also published Swedenborg's works. The connection between Swedenborgianism and homceopathy was stated quite explicitly be Kent and others, but has been quietly ignored by a number of later writers on homoeopathy. However, for anyone who has even a nodding familiarity with Swedenborg's ideas, their influence on the high-potency school in America is completely evident, and indeed I would go so far as to say that it is not possible to understand Kent fully unless he is seen in the light of Swedenborg's teachings.

For Swedenborg, the idea that there is a mystical correspondence between the spirit world and our own was fundamental. Like the alchemists, Swedenborg taught that the form and function of man (the microcosm) is modelled on, and reflects, that of Heaven (the macrocosm). Whatever happens in the spirit world must have its counterpart here on earth. This idea of correspondence fitted in with the similia principle, and of course it was natural for the Swedenborgians to regard this as a divinely ordained law of nature.

Vitalism, likewise, was wholly congenial to the Swedenborgians. Swedenborg

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held that the essential nature of a man is determined by his "will" and "under- s tanding"-- that is, by his basic spiritual impulse. This teaching could be directly equated with Hahnemann's notion that disease is caused by derangement in the vital force. The Swedenborgian homoeopaths maintained that disease always begins at the inmost, spiritual, level, and disease is therefore always a moral as well as a physical problem. It follows that the homoeopath must not treat the body alone but also the patient's mind and inner spiritual essence. This belief explains the preponderance of "Mind" in Kent's Repertory.

The Swedenborgians gave a definite moral twist to the miasm theory. For Hahnemann, the miasms had been acquired "infections", but for the Swedenborgians they were moral taints passed from generation to generation, and psora in particular took on some of the characteristics of Original Sin, a feature that was picked up by contemporary critics.

The story of the subsequent spread of these ideas among homoeopaths is too well known to require recounting in detail. In the early years of the twentieth century Margaret Tyler went to America to study under Kent. On her return, full of enthusiasm for the new teaching, she instituted, together with her mother Lady Tyler, a scholarship to send doctors to the USA. An early beneficiary was Dr (later Sir) John Weir, who soon after his return to England in 1909 was appointed Compton Burnett Professor and Honorary Secretary of the British Homoeopathic Society. Under the influence of Tyler and Weir in London and of Gibson Miller in Glasgow, Kentianism made rapid progress towards becoming the prevailing hom~eopathic orthodoxy in Britain. The Hughesian Old Guard were not converted, but they were getting old; before long they died out, and by the end of the First World War the change was virtually complete.

The result was the almost complete isolation of British homoeopathy within the British medical scene. Vitalism, high potencies, and miasms were all unacceptable to orthodox doctors and in reading the writings of homoeopaths of the time, it is difficult to avoid the suspicion that most of them were quite indifferent to this. There are some notable exceptions, such as Charles Wheeler, but many hom0eopaths of the day seemed positively to rejoice in the differences between themselves and their orthodox colleagues. It is easy to understand how strongly they would have disagreed with the sentiments expressed by Hughes in the passage I quoted earlier.

The new attitude was not evident only on the level of theory, but also found expression in the materia medica produced by Margaret Tyler and her colleagues. Hahnemann's materia medica is unreadable. Hughes presented the materia medica in narrative form in the Cyclopaedia, but it remains hard work to read. Then came Kent, with his "dramatization" of the remedies (an idea he borrowed from Hering). And now Margaret Tyler took this trend to an extreme. Read her celebrated description of Sepia, for example, and you find yourself far removed from the language of science. 4 For better or worse, what she produced was more like an art form, in which the remedy protraits have an almost Dickensian flavour. Small wonder that they have proved so popular among lay hom~eopaths.

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The position today So much, then, for a very brief historical review of how we came to be where we are today. Now I would like to look at certain aspects of our present position and to draw out some of its possible implications for the future.

Perhaps the central question that we face is our relationship to the lay practice of homoeopathy. Like osteopathy and acupuncture, homoeopathy is practised today by a tiny minority of doctors and a large and growing body of lay practitioners. These two groups tend to have different views of their subject.

In the past, the majority of British medically qualified homoeopaths were Kentians. Today there seems to be a greater diversity of views, some hom0eopathic doctors still being Kentians, while others are closer to what might be called a neo-Hughesian position. The essentials of the neo-Hughesian position might be outlined in the following terms: 1 The similia principle is not to be regarded as a law of nature, but simply as a

rule of thumb that has given rise to some medicines that seem to work in practice.

2 The potency idea is something to be investigated scientifically and accepted, modified, or rejected according to the evidence that turns up.

3 Vitalism, psora, and other metaphysical ideas do not form an essential part of homceopathy.

4 Modern medical and scientific knowledge should be incorporated into homoeopathy where relevant and should be taken into account in prescribing. (Notice that this may entail a reappraisal of the materia medica, including the provings.) A version of homaeopathy on these lines would probably appeal to some

homoeopathic doctors, although others would probably feel that it omitted much of what makes homeeopathy distinctive, and this I am sure would be the view of nearly all lay homoeopaths. The fact is that from Hahnemann onwards many hom0eopaths have tended to see in their subject more than a mere medical system and have attributed to it strongly metaphysical overtones. Thus, in the nineteenth century we find Hempel, the American translator of The Chronic Diseases, writing as follows:

"In proportion as man's spiritual nature becomes developed and purified, the psoric miasm will be diminished, and will finally be completely removed from the life of humanity. This complete physical regeneration of human nature will necessarily be attended with great changes in all the external rela tions of man, education, mode of labouring, living, etc. etc. ''5

In this remarkable passage homoeopathy has become a form of millenarianism, for it is destined to bring about a total transformation of human life. Now let me match it with a passage from a contemporary lay writer on homoeopathy, George Vithoulkas.

"One can say that contemporary people are demanding a way to regain their lost psychosomatic equilibrium in order to face the challenges that technological civilization has imposed on them. It is my strong belief and my experience that homoeopathy can effectively help ailing humanity in this endeavour and be an invaluable asset for a speedy spiritual evolution of mankind. ''6

The millenarian character of this passage is evident, not only in the overt reference to spiritual evolution, but in the implied reference to an Adamic Golden

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Age in which people once lived in "psychosomatic equilibrium". This may strike some of you as extreme, but I think that if you listen to what your patients are saying, you will find that ideas of this kind, though less explicitly worked out, underly many of their attitudes.

When homoeopathy first arrived in this country its patients were largely aristo- cratic or upper middle class, and this remained true until comparatively recently. Today, however, its appeal seems to be at least in part to younger people of all classes who are suspicious of science and scientific medicine and who are looking for an alternative life style. Such people are specifically attracted by the meta- physical aspects of hom~eopathy.

Whether we like it or not, therefore, homeeopathy finds itself linked in the popular mind with other forms of alternative or complementary medicine. It is therefore important to look at what these kinds of therapy have in common. What they have in common, I suggest, is a rejection of scientific materialism and reduc- tionism.

Orthodox medicine, in contrast, is founded on materialism. This is not to deny, of course, that individual doctors may hold religious beliefs just like anyone else, but it is no part of a medical training to inculcate students with any kind of religious or spiritual view of human nature. Indeed the usually unspoken premise of the modern scientific outlook is that human beings are complicated physio- logical mechanisms and nothing more.

This assumption yields brilliant advances in technological medicine but is worse than useless when it comes to dealing with the psychological and emotional problems that make up so much of most doctors' work. Doctors have to help their patients to cope with suffering, both physical and emotional, and ultimately with death. A major problem here is that our society lacks any kind of agreed meta- physical or religious framework within which to encounter these crises, so that the doctor has to treat each situation as it arises as a new and unique event.

In the past, medicine and religion were closely linked, and indeed priest and physician were often one and the same. Today, when medicine has become secular, the physician finds himself the uneasy heir to two quite different tradi- tions. On the one hand he or she is trained as a scientist, uses scientific tech- niques, with tools and medicines provided by science, and indeed his patients expect him to be a scientist. On the other hand he is also expected to be a healer, an initiate of ancient mysteries who can provide answers to the deepest questions of life and death. Obviously no one human being can combine these roles fully, and indeed the second role probably cannot be adequately filled by anyone today.

Our society lacks any agreed metaphysical basis. In this it resembles the Graeco-Roman world at the beginning of the Christian era, which was likewise a time of great uncertainty and doubt. Then people were rejecting the mythologies of the ancient world; today we have rejected the spiritual dimension. The world is a cosmic accident, man is a jumped-up ape, and no meaning of any kind can be assigned to human life and suffering. I have no doubt that a powerful element in the appeal of the alternative medical systems is the fact that they are usually based on a different set of assumptions.

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What of the future? Predictions are notoriously risky, and never more so than today, when the very survival of our society is seriously at risk. Given that we do survive, however, what is likely to happen to hom0eopathy?

I think that for the foreseeable future the two forms of homoeopathy will continue to coexist, probably rather uneasily. However, in so far as research supports homoeopathy, it will tend to encourage the move towards what I have called neo-Hughesianism, and it seems possible that eventually the distinction between medical homoeopathy and orthodox medicine will disappear, very much as Hughes hoped it would.

But would this result in the disappearance of metaphysical homoeopathy? I don't think so. I believe that popular enthusiasm for this version will ensure its survival, at least among lay practitioners. Scientifically minded homoeopaths may find this regrettable, but the psychological need for metaphysically tinged medical systems is real and they need to come to terms with it.

In describing the two forms of homoeopathy I have tried to clarify rather than to make a value judgement. It would be wrong to conclude, however, without offering some personal reactions, which you may of course agree or disagree with as you think fit.

Conclusion Hahnemann was a physician not a philosopher, and it shows; as an abstract thinker he can hardly be taken seriously. To be fair to him, he had few preten- sions in this direction; it was his followers, especially in America, who imposed that role on him after his death. As a psychologist, too, Hahnemann was hardly an innovator, and while it would be unfair to criticize him for not producing a new view of human nature like Freud or Jung, the fact remains that the psychological categorization of much homceopathic prescribing seems crude and antiquated today.

These remarks apply with even greater force to Kent. The Swedenborgian ideas that he and other American homeeopaths grafted onto homoeopathy had a profound effect on its later development, all the stronger for being unknown to many modern homoeopaths. It is very questionable how acceptable the Sweden- borgian metaphysical and psychological framework is today, and the attempt to apply it in practice seems at times to be not very successful.

In my view, therefore, as a metaphysical system homoeopathy is unsatisfactory. The fact remains, however, that several generations of able and compassionate physicians have found hom0eopathic metaphysics a good basis from which to work, and certainly on the practical and humanitarian level they have done at least as well as their orthodox contemporaries. Besides, the fact that a healer is attached to a particular system does not necessarily oblige him to accept all its dogmas uncritically. Indeed the best practitioners often seem to be those who are not bound rigidly by the theories of their system, but use them as a convenient peg on which to hang their own individualities. It is usually the second-rate who set great store by "the system".

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Although metaphysica l homceopathy has serious shortcomings, therefore, the fact that it fills a psychological need seems to me to be significant. I doubt whether humani ty can tolerate the psychological vacuum of a complete lack of meta- physical assumptions, and in the absence of such assumptions there is a tendency to seek refuge in i r r a t i o n a l i s m - - a t rend that is only too obvious in many places today. As T. S. Eliot wrote, " H u m a n k i n d cannot bear very much reali ty."

The doctor , of course, is not apar t from society, but faces the same dilemmas and contradict ions as everyone e l s e - - i ndeed perhaps with unusual acuteness. The subject has been finely discussed by the psychiatr is t J Dominian in an article in the B r i t i s h M e d i c a l J o u r n a l last Chris tmas called "The Doc to r as Prophet" , v which I s trongly recommend to your attention. There are no easy answers, but it is vital that we face up to the questions, which face all doctors, whether homoeopaths or not.

REFERENCES 1 Hughes R. The Principles and Practice ofHomoeopathy p. 186 London: 1902. 2 Popper KR. Conjectures and Refutations p. 36-37. London: RKP, 1972. 3 Haehl R. Samuel Hahnemann, His Life and Work p. 64-65. London: 1922. 4 Tyler M. Homaeopathic Drug Pictures p. 739. London: London 1942. 5 Hahnemann S. The Chronic Diseases Vol. 1 tr. Hempel C J, p. 211. New York: 1845. 6 Vithoulkas F. The Science ofHomo~opathy p. 14. Athens: 1978. 7 Dominian J. The Doctor as Prophet. Br MedJ 1983; 287:1925.

Twenty years ago The British Homaeopathic Journal, January 1965

NOEL J. PRATT, MRCS, LRCP, FFHOM

This issue began with the Presidential Address by Dr Stuart McAusland, entitled "Fu tu re Possibilities". He quoted Sir Rober t (later Lord) Platt, who had said that some of the best minds in medicine have blown away the cobwebs of medical humbug, and made an appeal "agains t a new climate of opinion . . . . jus t as rigid and stereotyped as the o l d . . , in w h i c h . . , only one kind o f science is recognized, and all other values in medicine are in danger of being lost, or are played down in importance". Dr McAus land said that the Facu l ty is the guardian for homoeopathy against certain threats; even in 1965 there was a threat of closure of the Roya l London Homaeopathic Hospital , on the grounds that it was too expen- sive. On a more positive note he mentioned an article by Dr F. A. Nash published in the P r o c e e d i n g s o f the R o y a l S o c i e t y o f M e d i c i n e , in which he stated that the task of logically selecting diseases capable of causing a part icular group of symptoms could not be done infallibly without paper , pencil, and leisure. Dr McAus land commented that this sounded strangely like repertorization.

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