Robert Jütte Samuel Hahnemann. The Founder of Homeopathy Translated by Margot Saar Copyright for the English translation: © Robert Jütte 2012 Originally published in German by dtv (Munich, 2005) Copyright for the English translation: © Robert Jütte 2012 Chapter 1 The Medical World in the Late Eighteenth Century 1792 Revolutionary France declared war on Austria. After the Battle of Valmy* the German poet Johann Wolfgang von Goethe wrote: “Here and now begins a new era in the history of the world.” The Habsburg Empire was in shock: the sudden death of the Austrian Emperor Leopold II, who had succeeded his brother on the throne in 1790, gave rise to rumours that he had been poisoned by Freemasons. Heated arguments ensued among physicians. Questions were raised as to the inadequate medical treatment received by the monarch. The man who had the audacity to hurl criticism at Vienna’s eminent imperial physicians for the excessive use of bloodletting was a then virtually unknown medical doctor from Saxony: Samuel Hahnemann, who would go down in medical history as the founder of homeopathy. In an article published in the journal Allgmeiner Anzeiger der Deutschen, Hahnemann charged the Emperor’s private physician with what we would today call medical malpractice and provoked a heated discussion about “right” or “wrong” therapies.1 He had, at this point in time, already discovered the similarity principle as the mainstay of his new system of medicine, but had as yet not tested it or presented it to a wider public. The medical case history just described is not only remarkable because of the prominent patient involved or the widely-noted appearance in the press of Samuel Hahnemann. It demonstrates how medicine was practised and experienced by patients at the end of the eighteenth century. The sensational occurrence is therefore an apt opening to the exciting life story of a “medical rebel” (Martin Gumpert) who was as much venerated and admired as he was mocked and criticized. Emperor Leopold II was 45 years old when he died in 1792. Due to the high infant mortality life expectancy averaged 33 years at the time. A person entering adulthood (at 15), having survived all the children’s diseases, could expect to reach the age of 55. Today, male youths in Germany have an average life expectancy of more than 75 years.2 So, even by the standards of his time, the Emperor died not only unexpectedly but “prematurely.” The month of his death, March, coincides with the annual mortality peak as indicated by historical demography for the respective age group in the eighteenth century. Among the ten most common causes of death, which were then named after the main symptoms, “chest complaints” ranked highest after “consumption,” “smallpox” and “stroke”. The “rheumatic inflammatory fever” to which Emperor Leopold II was said to have succumbed belonged to the “chest complaints” category. The contemporary medical literature reveals “catarrhs,” “rheumatisms” and “inflammatory disease” as the most frequently treated ailments. In the bi-annual medical reports solicited by the medical authorities of the Grand Duchy of Baden in the early nineteenth century “fever” was, at 20 per cent, by far the most common, clearly differentiated, diagnosis.3 The threshold of illness was generally very high: according to medical publications of the late eighteenth to early nineteenth century people rarely sought medical help before the third day, in most cases considerably later.4 Even membersCopyright for the English translation: © Robert Jütte 2012 of the upper classes stayed out of bed for as long as they possibly could because it was widely thought that “the bed […] drew you in and * At Valmy the allied Prussian and Austrian forces were – unexpectedly – defeated by the French army. (Translator’s note) 1 Chapter 1 promoted decline.”5 Driven, not least, by economic pressures, people tried to keep confinement to bed to a minimum. As a rule, patients remained at home. In-patient care in hospitals, which, around 1800, were still mostly refuges of the poor and needy, was generally reserved for the underprivileged.6 Leopold II was laid up at the Hofburg, Vienna’s imperial palace, and not, as one would expect today, on a private ward of Vienna General Hospital, although that particular institution was by then well on its way to becoming a hospital in the modern sense. How patients experienced and interpreted their illnesses can be gathered indirectly from the medical literature, but, more importantly, from the great number of autobiographical accounts we have at our disposal. Two interpretive patterns prevailed in the late eighteenth century: disease was either explained pragmatically as due to natural causes (wrong diet, living conditions etc.) and certain environmental factors (miasma theory) or it was ascribed to supernatural powers (god, demons, witches etc.).7 Regardless of whether one favoured the one theory or the other, or a combination of both, there was general consensus that it was the patient who was to blame: either God had sent the disease to punish him for his sins or nature avenged itself on his body because of his excessive and unwholesome lifestyle. As we now know from social history, the religious interpretation did by no means result in a fatalistic view of illness, neither in rural nor in urban settings. On the contrary: in the late eighteenth and early nineteenth century, even if illness was seen as a trial ordained by God, those afflicted would seek medical assistance – whether they belonged to the Protestant bourgeoisie of Northern Germany or the rural population of Baden in the South. They therefore would take active steps to look after their health (and use such means as venesection, specific health regimens etc.).8 Members of the middle classes who fell ill and were seen at home by their family physician expected him to supply a reliable diagnosis, ensure a speedy recovery and find the time for a bedside chat. No authority gap divided patient and physician, not even if the relationship was one of patronage as in the case of court physicians and emperors or other persons of high standing.9 It was different in hospitals. Hospitals were more like “proto-clinics” (Michel Foucault), an embryonic form of the institution with an ambiance reminiscent of the workhouse, gaol or poorhouse.10 Christoph Wilhelm Hufeland, the most prominent physician of Goethe’s time, described hospitals as places which were “cold, loveless and indifferent to patients”.11 Physicians looking after the poor and needy, often without remuneration, were frequently forced to comply with health police and health authorities in return for the opportunity for diagnostic and therapeutic research that hospitals certainly provided. The majority of patients would have found it a humiliating and undignified experience to “be at the mercy of a representative of the public welfare system”,12 while this would not have kept members of the lower classes in particular from making every effort (by writing petitionary letters, for instance) to secure one of the desirable places in an institution where they would be sure to receive care. Although patients had little or no choice when it came to treatment – whether in or out of hospital – it was customary for patients or their families to fully exploit the fact that it was possible to consult more than one physician. They had the option of either returning to self-medication, negotiating treatment with their physician or, equally, of obtaining a second opinion if they were not convinced by the advice they had received. If you fell ill in the eighteenth century an astonishiCopyright for the English translation: © Robert Jütte 2012 ng array of medical help would have been at your disposal. Financial considerations were secondary when choosing a healer. Neither in rural areas nor in the cities was the health market dominated by certified healers (surgeons, apothecaries, midwives) or even the much smaller group of academically trained physicians, despite an early movement, driven by the authorities, to establish a monopoly in their favour. 2 Chapter 1 Contemporary publications may have differentiated between officially licensed surgeons and “charlatans” or “quacks”, but that kind of division was in reality hardly discernible. More recent research has revealed that a clear differentiation between medical lay-practice and university-taught medicine did not yet exist in 1800. The concepts of illness and therapy held by the different groups might not always have coincided, but they often agreed that health problems or impairments had natural causes. Their ideas were derived from the Greek physician Galen’s doctrine of the four humours and their balance, or the lack of it, within the human body. Both groups also tended to use the same healing substances (especially in herbal medicine) and advertised, each in their own way, their “arcana” or secret remedies. In the late eighteenth and early nineteenth century academically trained physicians were in a different category from the surgeons, who acquired their skill partly as apprentices and partly as medical students. What distinguished both groups from the lay healers was not that they subscribed to a “rational” rather than empirical medicine. In their choice of therapist patients were primarily guided by a healer’s reputation, not their professional status. The reputation of a practitioner was based on the real or credible successes he achieved with his heterogeneous clientele, which was often made up of members of the upper, middle and lower classes in equal parts. It is therefore not surprising that well-to-do and educated citizens, who considered themselves enlightened, made the best possible – simultaneous or consecutive – use of the various therapies on offer. It is true nonetheless that lay medicine played a much more prominent part then than it does today.