Hence, if no treatment at all would have been better than conventional heroic medicine for cholera patients, then modern sceptics are not surprised that homeopathy was also better than conventional heroic medicine. After all, the sceptics feel that the homeopathic remedies were so diluted that taking them was the equivalent to having no treatment.
In short, we can conclude two things about a patient seeking treatment before the twentieth century. First, the patient would have been better off opting for no treatment rather than heroic medicine. Second, the patient would have been better off opting for homeopathy rather than for heroic medicine. The important question, however, was whether homeopathy was any better than a lack of treatment? Those who supported homeopathy were convinced by their own experience that it was genuinely effective, whereas sceptics argued that such dilute remedies could not possibly benefit the patient.
The arguments continued throughout the nineteenth century; and despite the initially positive response from the aristocracy and significant sections of the medical community, there was a gradual swing against Hahnemann’s ideas as each decade passed. For example, the American physician and writer Oliver Wendell Holmes accepted that conventional medicine had failed in the past (‘If all the medicine in the world were thrown into the sea, it would be bad for the fish and good for humanity’), but he was not prepared to tolerate homeopathy as the way forward. He called homeopathy ‘a mangled mass of perverse ingenuity, of tinsel erudition, of imbecile incredibility and of artful misrepresentation.’
In 1842, Holmes delivered a lecture entitled ‘Homeopathy and Its Kindred Delusions’, in which he reiterated why Hahnemann’s ideas did not make sense from a scientific point of view. He focused particularly on the extreme dilutions at the heart of homeopathy. One way to think about these dilutions is to consider the key ingredient being dissolved in ever greater volumes of liquid. Each time homeopaths dilute the active ingredient by a factor of 100, they are effectively dissolving it in a volume of water or alcohol that is 100 times bigger, and they do this over and over again. Holmes used a calculation by the Italian physician Dr Panvini to explain the bizarre consequences of such repeated dilutions when applied to a starting ingredient of one drop of Chamomile:
For the first dilution it would take 100 drops of alcohol. For the second dilution it would take 10,000 drops, or about a pint. For the third dilution it would take 100 pints. For the fourth dilution it would take 10,000 pints, or more than 1,000 gallons, and so on to the ninth dilution, which would take ten billion gallons, which he computed would fill the basin of Lake Agnano, a body of water two miles in circumference. The twelfth dilution would of course fill a million such lakes. By the time the seventeenth degree of dilution should be reached, the alcohol required would equal in quantity the waters of ten thousand Adriatic seas. Swallowers of globules, one of your little pellets, moistened in the mingled waves of one million lakes of alcohol, each two miles in circumference, with which had been blended that one drop of Tincture of Camomile, would be of precisely the strength recommended for that medicine in your favorite Jahr’s Manual, against the most sudden, frightful, and fatal diseases!
In the same spirit, William Croswell Doane (1832–1913) also took a swipe at homeopathy. As the first Episcopal Bishop of Albany, New York, he penned a piece of doggerel entitled ‘Lines on Homoeopathy’:
Stir the mixture well
Lest it prove inferior,
Then put half a drop
Into Lake Superior.
Every other day
Take a drop in water,
You’ll be better soon
Or at least you oughter.
In Europe Sir John Forbes, Queen Victoria’s physician, called homeopathy ‘an outrage to human reason’, a view that was consistent with the entry for homeopathy in the 1891 edition of the Encyclopaedia Britannica : ‘Hahnemann’s errors were great…He led his followers far out of the track of sound views of disease.’
Part of the reason for homeopathy’s decline in popularity was that the medical establishment was transforming itself from heroic and dangerous into scientific and effective. Clinical trials, such as those that exposed the dangers of bloodletting, were steadily differentiating between hazardous procedures and effective cures. And, as each decade passed, there was an increased understanding of the true causes of disease. One of the most important medical breakthroughs took place during the previously mentioned 1854 London cholera epidemic.
The disease had first hit Britain in 1831, when 23,000 people died; this was followed by the 1849 epidemic, which killed 53,000. During the 1849 epidemic the obstetrician Dr John Snow questioned the established theory that cholera was spread through the air by unknown poisonous vapours. He had been a pioneer of anaesthesia and had administered chloroform to Queen Victoria during the birth of Prince Leopold, so he knew exactly how gaseous poisons affected groups of people; if cholera was caused by a gas, then entire populations should be affected, but instead the disease seemed to be selective about its victims. Therefore, he posited the radical theory that cholera was caused by contact with contaminated water and sewage. He put his theory to the test during the next cholera outbreak in 1854. In London’s Soho, he made an observation that seemed to support his theory:
Within 250 yards of the spot where Cambridge Street joins Broad Street there were upwards of 500 fatal attacks of cholera in 10 days. As soon as I became acquainted with the situation and extent of this eruption of cholera, I suspected some contamination of the water of the much‑frequented street‑pump in Broad Street.
To investigate his theory he plotted the location of every death on a map of Soho (see Figure 4) and, sure enough, the suspicious pump was at the epicentre. His theory was further backed by his observation that a local coffee shop that served water from the pump had nine customers who had contracted cholera. On the other hand, a nearby workhouse with its own well had no cases, and employees at the brewery on Broad Street had been unaffected because they drank their own produce.
A key piece of evidence was the case of a woman who died of cholera, even though she lived far from Soho. Snow learned, however, that she had previously lived in Soho and had such a fondness for the sweet pump water that she had specially asked for some Broad Street water to be brought to her house. Based on all these observations, Snow persuaded town officials to take the handle off the pump, which halted the supply of contaminated water and brought an end to the cholera outbreak. Snow, arguably the world’s first epidemiologist, had demonstrated the power of the new scientific approach to medicine, and in 1866 Britain suffered its last cholera outbreak.
Other major scientific breakthroughs included vaccination, which had been growing in popularity since the start of the 1800s, and Joseph Lister’s pioneering use of antiseptics in 1865. Thereafter Louis Pasteur invented vaccines for rabies and anthrax, thus contributing to the development of the germ theory of disease. Even more importantly, Robert Koch and his pupils identified the bacteria responsible for cholera, tuberculosis, diphtheria, typhoid, pneumonia, gonorrhoea, leprosy, bubonic plague, tetanus and syphilis. Koch deservedly received the 1905 Nobel Prize for Medicine for these discoveries.