Medical Essays, 1842-1882. Oliver Wendell Holmes

by heat. The snow may even be actually warmer than the part to which it is applied. But even if it were at the same temperature when applied, it never did and never could do the least good to a frozen part, except as a mode of regulating the application of what? of heat. But the heat must be applied gradually, just as food must be given a little at a time to those perishing with hunger. If the patient were brought into a warm room, heat would be applied very rapidly, were not something interposed to prevent this, and allow its gradual admission. Snow or iced water is exactly what is wanted; it is not cold to the part; it is very possibly warm, on the contrary, for these terms are relative, and if it does not melt and let the heat in, or is not taken away, the part will remain frozen up until doomsday. Now the treatment of a frozen limb by heat, in large or small quantities, is not Homoeopathy.

      The next supposed illustration of the Homoeopathic law is the alleged successful management of burns, by holding them to the fire. This is a popular mode of treating those burns which are of too little consequence to require any more efficacious remedy, and would inevitably get well of themselves, without any trouble being bestowed upon them. It produces a most acute pain in the part, which is followed by some loss of sensibility, as happens with the eye after exposure to strong light, and the ear after being subjected to very intense sounds. This is all it is capable of doing, and all further notions of its efficacy must be attributed merely to the vulgar love of paradox. If this example affords any comfort to the Homoeopathist, it seems as cruel to deprive him of it as it would be to convince the mistress of the smoke-jack or the flatiron that the fire does not literally “draw the fire out,” which is her hypothesis.

      But if it were true that frost-bites were cured by cold and burns by heat, it would be subversive, so far as it went, of the great principle of Homoeopathy.

      For you will remember that this principle is that Like cures Like, and not that Same cures Same; that there is resemblance and not identity between the symptoms of the disease and those produced by the drug which cures it, and none have been readier to insist upon this distinction than the Homoeopathists themselves. For if Same cures Same, then every poison must be its own antidote,—which is neither a part of their theory nor their so-called experience. They have been asked often enough, why it was that arsenic could not cure the mischief which arsenic had caused, and why the infectious cause of small-pox did not remedy the disease it had produced, and then they were ready enough to see the distinction I have pointed out. O no! it was not the hair of the same dog, but only of one very much like him!

      A third instance in proof of the Homoeopathic law is sought for in the acknowledged efficacy of vaccination. And how does the law apply to this? It is granted by the advocates of Homoeopathy that there is a resemblance between the effects of the vaccine virus on a person in health and the symptoms of small-pox. Therefore, according to the rule, the vaccine virus will cure the small-pox, which, as everybody knows, is entirely untrue. But it prevents small-pox, say the Homoeopathists. Yes, and so does small-pox prevent itself from ever happening again, and we know just as much of the principle involved in the one case as in the other. For this is only one of a series of facts which we are wholly unable to explain. Small-pox, measles, scarlet-fever, hooping-cough, protect those who have them once from future attacks; but nettle-rash and catarrh and lung fever, each of which is just as Homoeopathic to itself as any one of the others, have no such preservative power. We are obliged to accept the fact, unexplained, and we can do no more for vaccination than for the rest.

      I come now to the most directly practical point connected with the subject, namely,—

      What is the state of the evidence as to the efficacy of the proper Homoeopathic treatment in the cure of diseases.

      As the treatment adopted by the Homoeopathists has been almost universally by means of the infinitesimal doses, the question of their efficacy is thrown open, in common with that of the truth of their fundamental axiom, as both are tested in practice.

      We must look for facts as to the actual working of Homoeopathy to three sources.

      1. The statements of the unprofessional public.

      2. The assertions of Homoeopathic practitioners.

      3. The results of trials by competent and honest physicians, not pledged to the system.

      I think, after what we have seen of medical facts, as they are represented by incompetent persons, we are disposed to attribute little value to all statements of wonderful cures, coming from those who have never been accustomed to watch the caprices of disease, and have not cooled down their young enthusiasm by the habit of tranquil observation. Those who know nothing of the natural progress of a malady, of its ordinary duration, of its various modes of terminating, of its liability to accidental complications, of the signs which mark its insignificance or severity, of what is to be expected of it when left to itself, of how much or how little is to be anticipated from remedies, those who know nothing or next to nothing of all these things, and who are in a great state of excitement from benevolence, sympathy, or zeal for a new medical discovery, can hardly be expected to be sound judges of facts which have misled so many sagacious men, who have spent their lives in the daily study and observation of them. I believe that, after having drawn the portrait of defunct Perkinism, with its five thousand printed cures, and its million and a half computed ones, its miracles blazoned about through America, Denmark, and England; after relating that forty years ago women carried the Tractors about in their pockets, and workmen could not make them fast enough for the public demand; and then showing you, as a curiosity, a single one of these instruments, an odd one of a pair, which I obtained only by a lucky accident, so utterly lost is the memory of all their wonderful achievements; I believe, after all this, I need not waste time in showing that medical accuracy is not to be looked for in the florid reports of benevolent associations, the assertions of illustrious patrons, the lax effusions of daily journals, or the effervescent gossip of the tea-table.

      Dr. Hering, whose name is somewhat familiar to the champions of Homoeopathy, has said that “the new healing art is not to be judged by its success in isolated cases only, but according to its success in general, its innate truth, and the incontrovertible nature of its innate principles.”

      We have seen something of “the incontrovertible nature of its innate principles,” and it seems probable, on the whole, that its success in general must be made up of its success in isolated cases. Some attempts have been made, however, to finish the whole matter by sweeping statistical documents, which are intended to prove its triumphant success over the common practice.

      It is well known to those who have had the good fortune to see the “Homoeopathic Examiner,” that this journal led off, in its first number, with a grand display of everything the newly imported doctrine had to show for itself. It is well remarked, on the twenty-third page of this article, that “the comparison of bills of mortality among an equal number of sick, treated by divers methods, is a most poor and lame way to get at conclusions touching principles of the healing art.” In confirmation of which, the author proceeds upon the twenty-fifth page to prove the superiority of the Homoeopathic treatment of cholera, by precisely these very bills of mortality. Now, every intelligent physician is aware that the poison of cholera differed so much in its activity at different times and, places, that it was next to impossible to form any opinion as to the results of treatment, unless every precaution was taken to secure the most perfectly corresponding conditions in the patients treated, and hardly even then. Of course, then, a Russian Admiral, by the name of Mordvinov, backed by a number of so-called physicians practising in Russian villages, is singularly competent to the task of settling the whole question of the utility of this or that kind of treatment; to prove that, if not more than eight and a half per cent. of those attacked with the disease perished, the rest owed their immunity to Hahnemann. I can remember when more than a hundred patients in a public institution were attacked with what, I doubt not, many Homoeopathic physicians (to say nothing of Homoeopathic admirals) would have called cholera, and not one of them died, though treated in the common way, and it is my firm belief that, if such a result had followed the administration of the omnipotent globules, it would have been in the mouth of every adept in Europe, from Quin of London to Spohr of Gandersheim. No longer ago than yesterday, in one of the most widely circulated papers of this city, there was published an assertion that the mortality in several Homoeopathic Hospitals was not quite five in a hundred,