Locating hygienic medicine within the intellectual history of hygiene: cases of E. W. Lane and T. R. Allinson.

Nineteenth century hygiene might be a confusing concept. On the one hand, the concept of hygiene was gradually becoming an important concept that was focused on cleanliness and used interchangeably with sanitation. On the other hand, the classical notions of hygiene rooted in the Hippocratic teachings remained influential. This study is about two attempts to newly theorise such a confusing concept of hygiene in the second half of the century by Edward. W. Lane and Thomas R. Allinson. Their works, standing on the borders of self-help medical advice and theoretical treatises on medical philosophies, were not exactly scholarly ones, but their medical thoughts - conceptualised as hygienic medicine - show a characteristically holistic medical view of hygiene, a nineteenth-century version of the reinterpretation of the nature cure philosophy and vitalism. However, the aim of this study is to properly locate their conceptualisations of hygienic medicine within the historical context of the second half of the nineteenth century rather than to simply introduce the medical ideas in their books. Their views of hygiene were distinguished not only from the contemporary sanitary approach but also from similar attempts by contemporary orthodox and unorthodox medical doctors. Through a chronological analysis of changes in the concept of hygiene and a comparative analysis of these two authors' and other medical professionals' views of hygiene, this paper aims to help understand the complicated picture of nineteenth-century hygiene, particularly during the second half of the century, from the perspective of medical holism and reductionism.

Reductionism, Vitalism, and Holism.

The reductionist strategy, adopted by physics and chemistry, which was based on the effort to reduce the concepts necessary for the statement of scientific explanations to a minimum, was attractive to those who worked in the biomedical field. On the other hand, the vitalistic point of view opposed mechanism, believing that there were processes in living organisms that do not obey the laws of physics and chemistry. Finally, the holistic approach is focused on the evidence that the organized whole is almost always much more than the sum of its parts, and have led to direct attention to emerging qualities in a highly organized system which is a living being.

Vital spaces and mental health.

The impact of social and material conditions on mental health is well established but lacking in a coherent approach. We offer the concept of 'vitality' as means of describing how environments facilitate 'feelings of being alive' that cut across existing diagnostic categories. Drawing on the work of Stern, Fuchs, Worms and Duff, we argue that vitality is not solely a quality of an individual body, but rather emerges from attunements and resonances between bodies and materials. We use vitality as a lens to explore how movements within and between assembled sets of relations can facilitate or disable feelings and expressions of being alive. Building on extended discussions of both inpatient and community-based mental healthcare, we sketch out a research agenda for analysing 'vital spaces'.

New approaches within the history and theory of medicine and their relevance for homeopathy.

Conventional sciences have brought forth a wealth of knowledge and benefits, but they have not always been clear and precise about their legitimate scope and methodological limitations. In contrast, new and critical approaches in modern sciences question and reflect their own presuppositions, dependencies, and constraints. Examples are quantum physics, theory and history of science, as well as theory and history of medicine, sociology, and economics. In this way, deprecative dogmatism and animosity amongst sciences ought to be lessened, while the field opens up for each science to redefine its appropriate place in society. This would appear to be a chance for homeopathy, as new approaches, especially within the social and economic sciences, suggest that being a follower of Samuel Hahnemann (1755-1843) may have advantages and privileges that conventional medicine seems to be lacking and whose relevance was overlooked during the rise of economic thinking in the last two centuries.

Phenomenology and homeopathy.

There is a great overlap between the way of seeing the world in clinical homeopathy and in the technical philosophical system known as phenomenology. A knowledge of phenomenologic principles reveals Hahnemann to have been an unwitting phenomenologist. The ideas of phenomenology as applied to medicine show that homeopathy is the ideal medical system to fulfill the goals of coming ever closer to true patient concerns and experience of illness.

["Purified empiricism": Johann Christian Reil's (1759-1813) attempts at a foundation of medicine in relation to its tradition, kantianism, and speculative philosophy]. / "Geläuterte Empirie": Johann Christian Reils (1759-1813) Versuche zur Grundlegung der Medizin im Spannungsfeld von Tradition, Kantianismus und spe- kulativer Philosophie.

Johann Christian Reil's (1759-1813) importance lies in his theoretical approach to medicine. Following Kant in his early work, he attempts to combine medical experience with an underlying conceptual structure. This attempt is directed against both the chaotic empiricism of traditional medicine and speculative theories such as vitalism. The paper starts from his early reflections on the concept of a life force, which he interprets in the way of a non-reductive materialism. In the following, the basic outlines of his Theory of Fever will be shown. The Theory is a systematic attempt at finding a new foundation for diagnosis and therapy on the basis of the concept of fever, which is understood as modification of vital processes. The paper ends with a discussion of his later work, which has remained controversial so far. It shows that the combination of practical empiricism and scientific theory remained rather unstable in this early phase of the development of modern medicine.

The biopsychosocial model and its potential for a new theory of homeopathy.

Since the nineteenth century the theory of conventional medicine has been developed in close alignment with the mechanistic paradigm of natural sciences. Only in the twentieth century occasional attempts were made to (re)introduce the 'subject' into medical theory, as by Thure von Uexküll (1908-2004) who elaborated the so-called biopsychosocial model of the human being, trying to understand the patient as a unit of organic, mental, and social dimensions of life. Although widely neglected by conventional medicine, it is one of the most coherent, significant, and up-to-date models of medicine at present. Being torn between strict adherence to Hahnemann's original conceptualization and alienation caused by contemporary scientific criticism, homeopathy today still lacks a generally accepted, consistent, and definitive theory which would explain in scientific terms its strength, peculiarity, and principles without relapsing into biomedical reductionism. The biopsychosocial model of the human being implies great potential for a new theory of homeopathy, as may be demonstrated with some typical examples.

The concept of health - in the history of medicine and in the writings of Hahnemann.

The number of notions of health is not infinite. In the history of medicine we can only find a number of different conceptions or paradigmatic ideas of health, in a variety of references and combinations. Health was seen as: 1. harmonious balance between principles or entities, 2. result of a struggle against opposing forces, 3. continuous dialectical process, 4. hierarchy of components or functions, 5. potential to perform and to develop, 6. transcendence towards higher levels of being, 7. result of conscious autonomous action, 8. optimal causal functioning, or 9. public task and responsibility. Hahnemann's view of health, as reflected in his writings, utilized virtually all of these elements. They reappear for instance as: 1. harmonious tuning of the life force, 2. defeat of pathogenetic influences, 3. admittance of aggravations, 4. autocracy of the spirit-like life principle, 5. reference to a higher goal of human existence, 6. perfecting character of medical service, 7. concern about dietetics and life style, 8. utilization of causality and natural science, and 9. appealing to governmental provisions and medical police. These paradigms have been repeatedly recombined and applied. The theory of medicine is the attempt to analyze, adjust, and develop concepts that meet the demand of contemporary medical practice. Medical theory lies between the fields of observable facts and metaphysical convictions. Distinguishing the levels of practice, theory, and metaphysics could allow the open discussion of theoretical issues, such as the concept of health or disease, without raising purely theoretical objections to well-established practice.

How do parents of child patients compare consultations with homeopaths and physicians? A qualitative study.

OBJECTIVE: How do parents of child patients experience and compare consultations with homeopaths and physicians, and how do they describe an ideal consultation. METHODS: A qualitative study with interviews of parents to 16 children who had consulted both a homeopaths and a physicians. RESULTS: Comparing consultations with physicians and homeopaths, the parents experienced the homeopathic consultations to a greater extent to have a whole person approach, also described as a core factor in an ideal consultation. This approach included exhaustive questioning, longer consultations, more interaction with the child and looking for the underlying cause. CONCLUSION: The parents in this study perceived that the homeopathic consultation had a whole person approach while consultations with most physicians focused on the symptoms. The homeopathic consultation was said to be more in line with what the parents perceived to be an ideal consultation for their children than consultation with physicians. PRACTICE IMPLICATIONS: Treatment philosophy and the aim of the consultation are likely to play a larger part than the technical aspects in determining the form and content of a consultation. Training in communication could benefit from including discussions on how the practitioner's treatment philosophy influences the consultation behavior.

The concept of miasm--evolution and present day perspective.

This paper reviews the circumstances in which the concept of miasm evolved and how subsequent developments in medicine have improved our understanding of the cause of diseases. It concludes with an emphasis on the need to further refine the homeopathic concept of disease.

Believing in order to understand: Hahnemann's hierarchisation of values.

During the last 200 years, the social, scientific, and religious framework in which homeopathy is taught and practiced has changed tremendously. Various different forms of homeopathy have been advocated. To avoid being misled by the prevailing pluralism as a standard of reference for assessing new concepts, Hahnemann's original ideas and attitude toward medicine, philosophy, and ethics are discussed. Hahnemann's hierarchisation of values appears to consist primarily in striving for a world view in which he could conceive of himself as a spiritual and moral being, secondly in a yearning for scientific advancement, and thirdly in his need to earn a living. Homeopaths are challenged to match this hierarchisation and be aware that homeopathy comprises dimensions other than just science and economics.

Truth, proof and evidence: homeopathy and the medical paradigm.

The study and practice of medicine, in its most personal and intimate functions, its most sophisticated scientific and technological manifestations, and its philosophical and ethical ramifications, are central to our understanding of the human condition. Homeopathic medicine: its insights, the questions that it begs, and the scientific and philosophical challenges it presents, has a significant contribution to make to this process. To be actively and seriously engaged with homeopathy is an adventurous undertaking. It is to be engaged in exploring both human nature and the nature of the world we inhabit. And in that process we are also engaged in the pursuit of truth and the exploration of reality. This paper deals first with the layout of the playing field on which homeopathy has to compete to be taken seriously. It then discusses three concepts: reality, truth and knowledge, which are objectives for which we strive and principles that guide us in that striving. In the third part it introduces the concept of 'personal knowledge' as an essential ingredient of scientific discovery and the pursuit of truth. And finally it proposes that the homeopathic community in general, and the Faculty of Homeopathy in particular, must expand its vision with a definition of a new paradigm, the new model of healthcare and medical science to which the vision aspires.

The schism in chiropractic through the eyes of a 1st year chiropractic student.

Since its inception, the chiropractic profession has been divided along ideological fault lines. These divisions have led to a profession wide schism, which has limited mainstream acceptance, utilisation, social authority and integration. The authors explore the historical origins of this schism, taking time to consider historical context, religiosity, perpetuating factors, logical fallacies and siege mentality. Evidence is then provided for a way forward, based on the positioning of chiropractors as mainstream partners in health care.

[Claude Bernard - then and now]. / Claude Bernard ­ hier et aujourd'hui.

The early life of Claude Bernard - dreamer and frustrated playwright - reveals no indication of his future scientific aptitude. Cartesian doubt, a principle that he would adhere to lifelong, clouded a failed pharmacy apprenticeship that led to medical studies in Paris - but without great success. Research was his only aim, it was made possible only by a lucrative but unsuccessful arranged marriage. His passion for work and over-riding principles of truth and proof would ultimately allow him to stand out from his peers with recognition by multiple French professional societies - and the wider scientific world. In today's world, the two centuries-long practice of homeopathy illustrates his abhorrence of ''practice without proof'': a dominance by economic factors that is apparent in cancer chemotherapy, where new drug approval is often based on statistics rather than genuine clinical benefit. Bernard was indeed sceptical about the (ab)use of statistics - a caution even more necessary today. His experimental method stands out as a signal principle in research. This was cleverly taken out of context by Emile Zola, who used it to support his ideas on the literary naturalism that appeared in his Rougon-Macquart cycle of books - and that led him to dedicate his book, Le Roman Expérimental, to Claude Bernard himself.

Is homeopathy possible?

As a therapeutic intervention, homeopathy is the target of increased scepticism because in the main, its remedies are diluted and succussed (potentized) out of material existence. This puts homeopathy seemingly at odds with the paradigm of conventional science, in particular, that atoms and molecules are the fundamental building blocks of all matter. Accordingly, homeopathy cannot work, so that any reported beneficial effects must, at best, be due to the placebo effect. The purpose of this article is to challenge that conclusion and to suggest that there may well be conventional science-based explanations of how homeopathy could be possible. Homeopathy's key principles are first described. Then the double-blind randomized controlled trial (RCT), the chief means by which homeopathic remedies and prescribing are tested, is shown to be based on a linear reductionism that is too blunt an instrument with which to test the efficacy of complex interventions such as homeopathy The memory of water hypothesis, as a mechanism for how potentized remedies might work, is reviewed, along with some evidence for its existence. A possible rationale for the water memory effect is proposed in terms of a dynamic 'ordering' of water's constantly switching network of intermolecular hydrogen bonds, induced by the manufacturing process of homeopathic remedies. This could lead to a long-range molecular 'coherence' between trillions of mobile water molecules. However, the water memory effect is an essentially pharmacological explanation of homeopathy's putative efficacy. It is pointed out that healing also entails an interaction between consenting beings. From this point of view, an explanation of any therapeutic procedure should include an attempt to describe the nature of the patient-practitioner interaction. From this perspective, a quantum theoretical treatment of the therapeutic process, involving a form of macro-entanglement between patient, practitioner and remedy (PPR), is advanced as another possible explanation of the homeopathy's efficacy. This shows that the reason double-blind RCTs deliver at best only equivocal results on homeopathy's efficacy is because it effectively breaks the PPR entangled state. A comparison is made between the entanglement-breaking effect of double-blind RCTs and the wave-function 'collapsing' effect of observation in orthodox quantum theory. The article concludes by suggesting that the memory of water and PPR entanglement are not competing but most likely complementary hypotheses, and that both are probably required in order to provide a complete description of the homeopathic process. While awaiting experimental evidence of these hypotheses, it is suggested that observations of clinical outcomes would be superior to RCTs for further testing homeopathy's efficacy.