was no doubt thought unnecessary to spend time in proving homoeopathic relationships to those already convinced of the rule of sirnilia similibus and willing to take those relationships for granted. The suggested use of the drug goes in most instances far beyond the strict application of its pathogenesis and pre-supposes a reference to a schema and repertory which include many purely clinical symptoms. An attempt is also made to define the type of constitution for which a given drug is most suitable, following the example given by Hahnemann when he differentiated between the pulsatilla and nux vomica class of patient. Evidently the author considers this a point of great importance, and we fully agree with him, but for the sake of accuracy in prescribing, the characteristics of the drug disease would be required to be most carefully defined in a large number of instances or by many observers before they could be accepted as indicative for patients.

The book is illuminating and most valuable to the clinician, but it will be seen that it is not meant for everybody. It would not be a suitable work to place in the hands of a student who is tentatively finding his way from the allopathic to the hom~eopathic methods of treatment. He would miss the homeeopathic connection between drug and disease. It would be far better to give him a volume of Dr Hughes' Pharmacodynamics where the pathogenesis of each drug is displayed and its homeeopathicity to its clinical applications clearly demonstrated. Hughes should be the text-book for the beginner, Kent will be invaluable as a supplement to the advanced student and the practitioner. Perhaps some day we shall have a materia medica which will combine the good qualities of each, but we may have to wait long, since its production will require a union of different orders of mind.

Reprinted from The British Homceopathic Journal 1912; 2: 28-29.

Initial impressions of homoeopathy BEVIS M. H E A P

Drawing conclusions about homoeopathy after an elective lasting only a few weeks is difficult. In the hospital setting, both as in and out patients, patients tend to have chronic problems such as asthma or low back pain for which they have received numerous treatments elsewhere, without success, before attending the homoeopathic hospital. This means that successful treatment takes a long time and patients often did not return during the time of my personal study.

Another reason for the difficulty is the multiple prescribing which occurs in

Mr Heap is a fourth-year medical student at Leicester University

226 The British Homceopathic Journal

hospital. If a patient does get better it is difficult to decide which remedy gave rise to the improvement or, if the patient is on conventional drugs as well, if the homaeopathy had any effect at all.

General practice presented problems with regard to whether hom~eopathy works or not in that those patients who do get better do not return to the surgery until the next time they are ill. In my experience patients coming with a new p rob- lem fairly often remarked that the homoeopathic treatment received when last ill had helped.

Studies in homceopathy do not totally resolve the question either. The Glasgow Homaeopathic Hospital project on the treatment of rheumatoid arthritis made several striking claims, such as some patients not needing conventional treatment at all and others needing less of conventional treatment than previously. The study may be criticized, however, as it was not a double blind trial and homceopathic and conventional therapies were carried out by different physicians. The trial report acknowledged this and plans have been made for a double blind trial to take place.

The use of double blind trials in homoeopathy is questioned by many within the discipline, for to a hom0eopath every patient is different, has a different set of symptoms, and receives different treatment. What also makes trials difficult is that if the patient is seen early in his illness a diagnosis may not be made.

Another claim to success in homoeopathy is in the cholera epidemic in London in 1854 in which the London Homceopathic Hospital had a death rate of 16.4 per cent against that of the other hospitals which was 51.8 per cent. However, the L.H.H. dealt with small numbers of patients compared with the total and may simply have provided better overall care of patients; it is difficult to say.

There are many anecodotal records of success, but when these are quoted no- one mentions the number of patients who did not respond to treatment. The GP with whom I studied had made a study of his patients during an outbreak of measles and found that in those treated homoeopathically there was a lower rate of complications than in those who received conventional antibiotics, but the numbers were small.

The research into the effect of various potencies on the growth of plants is inter- esting. The results so far seem to show a variation in activity of the various potencies which follows a sinusoidal curve, some potencies enhancing growth, some inhibiting it. The application of these results to clinical practice is slight, but it does show that liquids which contain no material other than diluent do vary in activity, and it also seems to bear out one of Hahnemann's observations that certain drugs act best at certain potencies.

Despite the criticism one may level at research into homoeopathy and the scepticism as to the effectiveness of a solution so dilute that no solute is likely to be contained in it, there are two observations which lead one to be a little less sceptical. These are the exacerbations of symptoms which can be seen after the administration of high potencies of a remedy, such as the patient I saw who was given a 200 of House dust and proceeded in the next few hours to become markedly more broncho-constricted and needed emergency treatment.

The other observation about the effectiveness of homoeopathy is that patients

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come back for further homoeopathic treatment after their initial illness which brought them into contact with homoeopathy. There is a growing interest in homceopathy among patients, partly because of the supposed lack of side effects, which may not be quite true, as some of the exacerbations aRer a remedy is given can be severe, and since the drugs were "proved" in healthy subjects they must be capable of producing symptoms. The public interest is shown by the articles found in popular magazines and the fact that both the BBC and Anglia TV are making documentaries about hom~eopathy at present.

This leads one to ask why, if homceopathy is effective, it is not more widely accepted in conventional circles and the reasons for this are complex. It is a case of "six of one and half a dozen of the other". The early homoeopaths-- Hahnemann and later the American Kent--were very dogmatic about hom~eopathy and scathing about conventional therapies; predictably the practitioners of these therapies reacted against this and condemned homoeopathy.

As medicine is, in general, a conservative profession this feeling has carried over to the present day, and the phrase "a homteopathy dose", meaning one so low as to have no therapeutic action, is found in literature from time to time.

The lack of scientific evidence for homoeopathy is another reason for it to be shunned, but as I stated above, some attempts are being made to rectify this.

The milder attitude of today's homoeopaths, to whom homoeopathy is a system of therapeutics and not a panacea for all ills, may ease its recognition in con- ventional circles.

Part of homaeopathy's bad name came from the ignorance of those outside it as to its nat ure,_which I do not feel is a good reason to condemn it.

Where homoeopathy fits into modern medicine is a debate which exists mainly among those who practise it. The hospitals exist not simply as treatment centres but also as teaching establishments. There are, however, those who feel that homceopathy is more suited to general practice and here it does seem to offer a lot. The possibility of follow-up of acute cases is more feasible than in hospital and there is less acute disease seen in hospital anyway. If a patient is not ~mproving he has easier access to his GP. Private practice is also thriving and, with the greater time available, prescribing is more accurate overall than in an NHS setting.

Conclusion My own feelings about homceopathy are ambiguous. I am unsure as to its efficacy, but would like to try to keep an open mind about it. The box of remedies given to those of us who attended the short course, along with the directions as to their use in acute prescribing, will give me an opportunity to follow up homoeopathy in a practical way which may make the problem clearer.

While anecodotal evidence is strong for homoeopathy, it is, as stated above, not satisfying alone and it could be that in the cases referred to, hom~eopathy is simply an elaborate placebo. This in itself does not seem satisfactory in view of the cases quoted being pneumonia etc., with very little psychological component, and also the cases in which animals are successfully treated.

228 The British Homwopathic Journal