What would Hahnemann Do ?

WWHD (What would Hahnemann do?

Faced with our current COVID-19 pandemic, it feels reasonable to ask, What would Hahnemann do?

Of course, he’s not around to ask;

Let me break this down into 3 categories:

Homeopathic treatment & homeoprophylaxis; it seems obvious that, were he around today, he’s be curious about investigating the individual & collective expressions of this pandemic disease and prescribing on the basis of these.

We need to look carefully into his assertion, in aphorism 102 of the Organon, that “To be sure, all those afflicted by the epidemic at that time have the same disease, flowing from one and the same source.” This appears to be at variance with his earlier (aph. 13) statement that “Disease is not to be considered as an inwardly hidden Wesen (Entity) separate from the living whole, from the organism and its enlivening dynamis.”, i.e., that Disease is the organism’s response to an insult.

Hahnemann was operating in an era when the causes of disease were as yet poorly understood. Although he presaged modern germ theory, the dance of and relative roles of pathogen & host were (still are) poorly appreciated. In aphorism 102, he appears to attribute disease to its inciting (pathogenic) influence, at variance with the concept of disease in his dynamist philosophy.

This puts into question the role of a “genus epidemicus,” a remedy for the collective disease uniformly attributable to a given epidemic insult.

We need to understand that the concept of the “genus epidemicus” was developed empirically, in Hahnemann’s management of epidemic scarlet fever in 1798; and that, in the context of its use at the time, it is a valid construct. Hahnemann employed his genus remedy for that epidemic (Belladonna) successfully in homeoprophylaxis and in the treatment of early, undifferentiated cases (really the same thing), but did not use a genus remedy to treat all cases encountered in that epidemic, as revealed in his monograph, Cure and Prevention of Scarlet Fever. Aphorisms 100-102 can be overinterpreted to suggest that everyone affected in a given epidemic has “the same disease” and consequently needs the same (genus) remedy, a proposition that has not been upheld in epidemics in or beyond Hahnemann’s day.

“Non-pharmacologic” transmission mitigation measures – Hahnemann wrote extensively about these in his 1792 essay A Friend of Health. It’s clear that he would support adoption of quarantine, facemark use, distancing, and restrictions on indoor gatherings in the face of an epidemic to limit epidemic spread.

Vaccination

Now here’s a tricky place. Contemporary homeopaths generally find themselves opposed to vaccination dogmatically, often without clear understanding of the basis for this objection, but believing it erroneously to be foundational in homeopathic philosophy.

Some contemporary “homeopathic” practices assume vaccination to underlie many of the diseases of humankind, and purport to “de-tox” clients from the effects of these, approaches which need to be seen as revisionist; I do not wish to debate the validity of these, but they cannot be attributed to Hahnemannian teachings.

Objections of contemporary homeopaths to vaccination are perhaps in part due to its association with “conventional medicine,” to which homeopaths often feel in general opposition; and in part due to the writings of some of our homeopathic authors more recent than Hahnemann.

Hahnemann did offer wholesale objection to the conventional medical practices of his day, but notably, these were to the dogmatic practices of 18th-19th-century medicine, in the tradition of Hippocrates & Galen, and to the nascent iatromechanical philosophy & practice of his day; his objections cannot be broadly applied to the practices of contemporary conventional medicine, although we might find opportunity to critique conventional pharmacologic practices according to the principles he generated.

Concern regarding the practice of vaccination in the homeopathic community can most clearly be traced to James Compton Burnett, who in 1897 published his booklet Vaccinosis and its cure by Thuja. It needs to be emphasized that Burnett’s concerns applied specifically to Jenner’s Smallpox vaccination, a highly unhygienic practice which involved the arm-to-arm transmission not only of Vaccinia (“cowpox”) virus, but also of other pathogenic agents that might be present in the human or livestock donor, which we now recognize to have included tuberculosis, syphilis, hoof & mouth disease, staphylococcus, &c. Boenninghausen had previously pointed to the observation that Vaccination was responsible for the “disquieting spread of scrofulous diseases” (“scrofula” refers to the extra-pulmonary expressions of Tuberculosis, a disease whose nature was not appreciated until the 1880s).

A careful read of Boenninghausen’s & Burnett’s concerns reveals that these authors were not particularly concerned re the use of disease agents in the manner used in contemporary vaccination, but specifically in the unhygienic practice of Jenner’s smallpox vaccine, which promoted the spread of a number of unrelated diseases, most prominently scrofula (tuberculosis).

Edward Jenner introduced the practice of vaccination (inoculation with “cowpox,” Vaccinia virus, in 1796, roughly contemporaneous with Hahnemann’s development of homeopathy, and Hahnemann considered Jenner’s vaccine to provide an example of cure by similars.

Hahnemann does tell us, in aphorism §30 – “The human body seems to allow itself (in its condition) to be more effectively altered in its tuning by medicines than by natural disease irritants (partly because dose adjustment is in our power),” suggesting preference for the use of medicinal substances over natural disease in effecting cure by similars. Although he did describe the practice of homeoprophylaxis in the management of epidemic disease using medicinal substances, this involves the treatment of early as-yet symptomatic cases following exposure or closely proximate to exposure, and is not at all an equivalent to vaccination in the long-term prevention of illness. Contemporary innovators do often confuse homeopropylaxis with “homeopathic vaccination,” a contemporary practice which does not have its roots in Hahnemannian practice.

Although Hahnemann in part presaged our contemporary appreciation of germ theory (most clearly in his description of the Asiatic cholera, but also in his description of the chronic miasmatic diseases), our contemporary appreciation of infectious disease has its roots in the works of Pasteur and Koch, dating to the late 1800s, well past Hahnemann’s era. Our appreciation of immunology is even more recent, developed in the 20th century, in the works of Élie Metchnikoff, Robert Koch, Emil von Behring, Paul Ehrlich , Macfarlane Burnet, et.al.; Edward Jenner was “flying blind,” operating only under the empirical observation that those previously exposed to smallpox, or the apparently similar diseases “cowpox” or “grease” were protected from subsequent smallpox infection.

In his Organon (aphorism 38 in the 6th edition), Hahnemann references Jenner’s use of vaccination. It’s clear he was aware of the practice; Voltaire had introduced the use of Jenner’s vaccine to the Prussian court in 1728; Empress Maria Theresa of Vienna encouraged the development of vaccination in 1768 under the guidance of her personal physician, Gerard van Swieten, who was one of Hahnemann’s medical school professors in Vienna, and had her 4 children vaccinated. Louis XVI of France received Jenner’s vaccine; Vaccination, and the preceding practice of variolation, intentional exposure to smallpox itself, via arm-to-arm transmission of pustular secretions, were both well-known in Hahnemann’s day.

In his Organon, (aph. 46) Hahnemann wrote “cow-pox when near maturity does, on account of its great similarity, homoeopathically diminish very much the supervening smallpox and make it much milder.”

and in a footnote to aph. 46,

“This seems to be the reason for this beneficial remarkable fact namely that since the general distribution of Jenner’s Cow-Pox vaccination, human smallpox never again appeared as epidemically or virulently as 40-50 years before when one city visited lost at least one-half and often three-quarters of its children by death of this miserable pestilence”

and in aphorism 56,

“Universal vaccination put an end to all epidemics of that deadly fearful smallpox to such an extent that the present generation does no longer possess a clear conception of the former frightful smallpox plague.”

  • these seeming endorsements unaccompanied by any expressed criticism of the practice.

further, in a letter to to Dr. Schreeter, of Lemberg, on December 19, 1831, Hahnemann wrote: “In order to provide the dear little Patty with the protective cow pox, the safest plan would certainly be to obtain the lymph [infectious material] direct from the cow; but if this cannot be done (children are also made more ill by it, than from the matter obtained from human beings), I would advise you to inoculate another child with the protective pox, and as soon as slight redness of the punctures shows it has taken, I would immediately for two successive days give Sulphur 1-30, and inoculate your child from the pock that it produced.” Here appearing to address the concerns Burnett later brought up regarding arm-to-arm inoculation.

Some early proponents of homeopathy enthusiastically embraced the practice of smallpox vaccination, considering it an example of cure by similars. Hughes wrote (in The Principles and Practice of Homeopathy, 1902):

“Let me begin by saying that as regards vaccination we are, as a body, entirely at one with our brethren of the old school, though we have individual dissidents in our ranks as they have in theirs. Statistics at large demonstrate the extensive immunity from the disease secured by this invaluable prophylactic; and no one who has had the opportunity of comparing the unmodified small-pox with that form of it which ordinarily appears in vaccinated subjects can do otherwise than bless the name of Jenner.”

If we leave off concerns re the unhygienic practice of arm-to-arm inoculation and the various diseases that might be transmitted by this practice, I can find no criticisms of vaccination as we today understand this practice in our classical homeopathic literature.

The contemporary practice of vaccination has its roots in Pasteur, who in 1879 introduced the use of weakened cultures of chicken cholera to successfully “vaccinate” chickens against this disease. Although the term “vaccination” refers specifically to “Vacca,” (Proto-Indo-European for cow, in reference to Jenner’s use of cowpox as his source material), Pasteur adopted this term and generalized its use to his new “vaccines” in honor of Jenner. Pasteur later went on to develop “vaccines” for Anthrax in cows & sheep, for Swine erysipelas, and along with Émile Roux, for rabies in dogs & humans, using live attenuated preparations of infectious material.

Advances in our understanding of microbiology, & of immunology, have permitted the development of our contemporary collection of vaccines. These individually require our careful consideration re safety & efficacy, and impact on individual & public health, beyond the industry stamp of “safe and effective” and opposing criticisms which too often take on the specter of the 3rd horseman of the apocalypse. And any concerns need to be weighed carefully against the real and unembellished risks of disease, from both the individual & public health perspectives. Sadly such a discussion appears nearly impossible to engage in today, with violently polarized beliefs belittling each others’ positions.

It has not helped this discussion that the manufacture of vaccines has become tremendously financially lucrative, and is entirely protected from legal liability in much of the world by governmental policy. Aside from any actual vaccine risk, this positions vaccine manufacturers, in the eyes of much of the public, as able to leverage their protection from liability for financial gain. This opens a can of worms I’ll sidestep for the moment, to focus on the medical issues, but at some point in this discussion, it needs to be addressed. I recall the origins of the U.S. National Childhood Vaccine Injury Act of 1986 & the National Vaccine Injury Compensation Program, late in my years as a medical resident; there was great concern among primary care physicians regarding their legal liability for adverse reactions to the Pertussis component of the existing DPT vaccine, leading the CDC to first develop standardized informational materials for parents in order to solicit informed consent; the first round of materials was so detailed & technical in character that concern was raised that no parent in their right mind would sign after reading; and that those who did sign must not have actually read it through. The 2nd round was a simple card stock form, one side with an illustration of a teddy bear with bandaid on its shoulder, saying “protect your teddy;” physicians’ attorneys rightly rejected this as meaningless. The CDCs next strategy culminated in the federal government taking on all liability for adverse vaccine reactions, with the establishment of a national reporting system, and absolving vaccine manufacturers, physicians, all medical staff & institutions from any liability related to vaccine adverse reactions.

The development of our current round of COVID-19 vaccines has come under further criticism, as vaccine development, and subsequently deployment, has been heavily subsidized by the U.S. & other national & regional governments, absolving manufacturers of both legal & financial risk in development & implementation.

These aside (& again, they need to be taken up at some point), the purely medical risks & benefits of contemporary vaccination practices, alongside the risks & benefits of their associated natural diseases, are deserving of careful consideration. & those considerations cannot be assessed evenly across the board.

The apparent successes of Smallpox and Polio vaccination are often used to support the practice of vaccination more generally. These deserve great scrutiny, and we can easily discover that they’re not quite what they appear to be at first glance. Smallpox is considered to have been “eliminated” from the globe, existing now only in petri dishes in virology laboratories, where the peculiarities of this complex virus hold the fascination of researchers. Yet the disappearance of Smallpox as a circulating disease cannot be solely, or even substantially, attributed to the practice of vaccination. The last case of naturally-acquired smallpox, in 1977 in Somalia (of Ali Maow Maalin), was actually a case of the related disease, Alastrim, due to the closely related Variola minor virus, with appears to have evolved in West Africa under the selection pressure of variolation, inoculation with smallpox pus, an ancient practice that predated Jenner’s use of Vaccinia. The elimination of smallpox may be in part related to vaccination, but the widespread transmission of the antigenically-related Alastrim resulting from the West African slave trade was likely a more significant factor, along with improvements in Dickensian living conditions contributing to disease transmission & severity.

Elimination of Polio from the developed nations of the world again may have had something in part to do with vaccination interrupting the chain of transmission in the 1950s; but with its continued absence despite current use of a vaccine that can prevent disease but not transmission, greater credit is clearly due to quarantine & clean water standards for this fecal-oral-transmitted disease.

The heroic role of vaccination questioned for these “big 2,” we might engage in a more fruitful discussion of the true role of vaccination in personal & public health. I discuss these issues individually in several of my courses, including my Measles, Mumps, and Influenza courses.

Coming back to the current SARS-CoV-2 pandemic, it’s important to weigh any risks & benefits of vaccination against those of natural exposure. This is a disease that has now (23. March 2021) claimed nearly 3 million deaths worldwide, over 1/2 million in the U.S. alone, disproportionately affecting the elderly & BIPOC populations. And results in chronic disease following acute infection in 10-20% across all demographic groups. We cannot equate vaccination against COVID-19 with that against relatively benign diseases such as chickenpox, or against diseases that exact a minuscule toll on the population of developed countries such as diphtheria or tetanus.

I cannot answer for Hahnemann, and would contradict any who might attempt to; but I find nothing in his teachings that could be used to argue against the utility of vaccination in this pandemic.

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