Wednesday, 1 September 2010

The contribution of homeopathy to medicine in the UK

Homeopathy was brought to London by an Edinburgh-educated physician, Dr Frederick Quin M.D.. He had been treated by an Italian physician and homeopath for an illness while on tour as the physician to an aristocratic party. Convinced by the efficacy of this new therapeutic approach, Quin set about learning more about it. When he set up his homeopathic practice in 1832 he attracted a significant clientele of the well-to-do, including dukes, duchesses and archbishops. By 1849 he had established the British Homeopathic Society (whose membership was almost entirely limited to qualified physicians), The British Journal of Homeopathy and established the London Homeopathic Hospital, which continues to tarnish Great Ormond Street to this day. Quin despised lay homeopathic quacks, whose unscrupulous behaviour (e.g. parading ‘cured’ patients in public) he felt brought this new system of medicine into disrepute. His reputation was such (he was a close colleague of Hahnemann himself) that he was able to limit the activities of the growing number of lay homeopaths, and close down their hospitals, by merely refusing to be associated with them. Thus, homeopathy began in the UK – as on the continent – as a serious medical development that was available only to those who could afford to engage proper physicians.

By carefully competing for the same patients, and on the same terms, Quin quickly became the enemy of regular physicians. Quin was despised by the Royal College of Physicians, who sent him several letters reminding him that practicing medicine in London without being a member of their hallowed society was an illegal act. Members of the RCP also snubbed him socially, working in unison to blackball his attempts to join the better St James’ clubs. Later, after the formation of the BMA, this august organisation refused membership to homeopathically-inclined doctors and banned its members from associating with them:
A medical man has no right, under any circumstances whatever, to attend the call of a homoeopath, or knowingly to meet him at the bedside of the sick.
- British Medical Journal (1862)
The Lancet vociferously called for the removal of the few homeopaths who infiltrated medical schools, and campaigned against further such atrocities. During the years of medical reform in the late 1850s, the BMA and other medical societies and colleges called on parliament to pass acts preventing homeopathic physicians from practicing at all.

In the face of this much resistance, how could an educated physician contemplate practicing this despised quackery?

As any doctor will tell you, and a great many controlled studies have shown, many diseases and ailments will resolve on their own. Furthermore, placebo treatments can accelerate the resolution of symptoms. At the time that Quin was building his practice, though, most physicians were prescribing quite violent treatments to their patients. These may have had no more effect on the body than sugar pills, and in some cases may have positively worsened symptoms. Bleeding was commonplace for any ailment, as is generally known. Pharmacological interventions of the day mostly fit into the category of ‘heroic’; all had obvious and theatrical effects on the body. [See for example counter-irritation, cupping, strychnine and arsenic, all  in vogue at the time.]. This was the era when drugs that made you pee, poo and vomit were considered to cleanse the body and balance the humours – all considered dangerous nonsense today. Many pharmacopoeias instructed certain drugs to be administered in increasing doses until such effects occurred. Some patients would be very suspicious of a course of treatment that merely made them well. Some of the wealthy clients of the physicians enjoyed experimenting with their health and demanded tangible results. Similarly, physicians were highly sceptical of the homeopathic approach and its lack of obvious effect on the human body (in addition to its general implausibility).

Regular physicians accused their homeopathic colleagues of exclusively treating patients who required no medication, or who would get better eventually without any treatment. Naturally, the homeopaths countered with the argument that if this were the case, then regular physicians should stop unnecessarily poisoning their own, similarly afflicted patients. Homeopathy had been introduced by a trained medic, who had attracted a following of similarly-educated physicians. Quinn and his colleagues all had well to do patients, who voted with their feet. They saw the effects of homeopathy to be as miraculous as the homeopaths themselves did. Despite the vigorous opposition of the RCP, the BMA and the GMC, homeopathy flourished so long as it attracted such custom.

Much like regular medicine, Homeopathy was a popular parlour game for rich hypochondriacs in the 19th century. There was money to be made, and homeopathically-inclined patients would not be put off by the opinions of The Lancet, the RCP and the BMA, so long as their physician was properly qualified, and not some fairground quack. Many patients probably enjoyed the adventure of being treated by rebel physicians. Those adopting the unorthodox practice genuinely believed (as many deluded lay practitioners do today) that it worked, and was more than a mere placebo. As a system of medicine homeopathy was more than the handing out of sugar pills. A complex philosophy governed what treatments should be used for what ailments, as was the case for regular medicine at the time.

Finally, although regular physicians lobbied parliament to pass acts to prohibit the practice of homeopaths, the most significant of these acts (The Medical Act of 1858) utterly failed in this objective. Then, as now, homeopaths had too many friends in high places who could ensure that their business could always operate within the law. The best the regular physicians could achieve was to restrict the legitimacy of post-graduate homeopathic qualifications; they managed to do for a century.

Over the course of half a century dedicated to opposing homeopathy, regular physicians learned a valuable lesson from their competitors: many ailments can self-resolve with adequate care and without a theatrical pharmacological sideshow. In the face of the success of sugar pills as therapeutics at the hands of homeopaths, medicine slowly became less heroic, and more introspective. It began to question practices and call for evidence of efficacy. By the end of the 19th century, homeopathy was in serious decline (in parallel with its aristocratic support base) and, having learnt its lesson, medicine was advancing on its way towards the modern discipline we know today. Although we can confidently denounce homeopathy as nonsense today (sometimes dangerously so), we should acknowledge the important role its historical proponents played in steering regular medicine away from some of the practices that we prefer to now overlook.

Further reading:
Phillip A Nicholls' Homoeopathy and the medical profession (1988) is probably the best academic exploration of homeopathy in the UK.

Rants from lay homeopaths will be deleted.