“The use of Complementary or Alternative Medicine should be placed within its historical context.” (Edzard Ernst, Healing, Hype, or Harm?: A Critical Analysis of Complementary or Alternative Medicine, 2008, p.12.)

In 1810, Samuel Hahnemann (1755-1843), a German physician and translator of medical texts, declared his discovery of two new medical 'laws'. The first of these principles-called 'the law of similars' after Hahnemann's famous phrase 'similia similibus curantur' (like treats like)-was, he asserted, based on his own careful observation and self-experimentation.

In fact there arethree, major pillars of homeopathy: the just mentioned law of similars, the potentisation of remedies, the working of the life force or dynamis.

All three of them find no basis in any known scientific theory.

Homoepathy thus also should be seen in what is in fact a hermetic context whose priciples are are as  follows :

1) principle of analogies

2) principle of polarity

3) principle of levels/layers of existence

4)  principle of unity

And how we find this mirrored in homeopathy:

1) analogy: as above so below – the law of correspondence and resonance in micro- and macrocosm

- in homoeopathy the law of similars

2) polarity: in all the manifested world there is duality; nothing exists without the simultaneous operation of its opposite

- in homoeopathy the law of first and secondary reaction

3) levels of existence: beside the physical level there is the level of the life force, the level of the psyche, of the rational mind and the level of the spirit – to name the gross ones; and these levels exist in micro- as well as in macrocosm

·         in homoeopathy the law of the working of the dynamis apart from the physical body, which is called an instrument of the spirit, dwelling in it

·         the possibility of potencies is based on the possibility of separating these levels from each other, i.e. to separate the spirit or entity of a remedy from its physical form (this has been shown by alchemy many times)

4) unity: everything in the world is one on the ultimate level of existence, everything is one and connected and related; and to achieve that unity and relatedness is the higher purpose of our existence, as seen by all mystics and religions.

- in homoeopathy "the higher purpose of our existence."

In the perspective of the development of European philosophical traditions, homoeopathy in fact is an heir of alchemy; though Hahnemann didn't mention this and even tried to exclude this perspective, since in his time it was not proper to discuss alchemy in decent circles.

- The idea of potentisation is clearly alchemical as a means of spiritualising matter – Hahnemann states this clearly enough. And nowhere else but in alchemy do we find this idea.

- The idea that there is a force inside matter that can be isolated and influenced and that this force is the important part of any material entity given.

- The whole background of thinking is the same as in alchemy, as shown above.

- Paracelsus is seen as an important forerunner of Hahnemann by most historians.

- Leading British homeopathist Kent’s idea of simple substance is what alchemy called prima materia – the substance before matter which has no specification but is linked to the working of the life force before it manifests. Kent picked this up from Swedenborg, a visionary whose picture of the world reflects all the characteristics of an hermetic "weltanschauung," as shown above. Kent’s system of potencies (30, 200, M, 10M) is also derived from Swedenborg‘s esoteric system of numbers.

Hahnemann nevertheless reported that those substances which caused the symptoms of a particular disease in healthy person would relieve those symptoms in their sufferers.

Essentially, Hahnemann (like many other physicians, before and since) believed that disease sprang not .horn a simple breakdown in the bodily mechanism which would demand similarly mechanical treatment: for example, purges to vent impurities, or emetics to remove blockages-but from disturbances of the body's ethereal vital force. Thus treatments needed to act on the metaphysical, rather than the corporeal, level. This rationale was, of course, not unlike that offered by mesmeric healers to explain that system's more than physical effects. Hahnemann argued that the therapeutic potency of a medicine in this metaphysical realm increased as the material medicinal substance itself was mixed, diluted, and refined:

For its own special purpose and by its own special procedure ... homeopathy develops the inner, spirit-like medicinal powers of crude substance to a degree hitherto unheard of, and makes all of them exceedingly, even immeasurably penetrating, active, and effective .... This remarkable transformation of the properties of natural bodies through the mechanical action of triturating and succession on their tiniest particles ... develops the latent dynamic powers previously imperceptible and as it were lying hidden asleep in them. These powers electively affect the vital principle of animallife.1

Hahnemann claimed to have derived his 'laws' and the therapeutic system built around them through reasoned experiment, rather than through either scholarly theorization or full-throttle speculative empiricism alone. However, his 'new science' was clearly attuned to ongoing debates in the medical community-debates with which his work as a translator of eighteenth-century medical texts would certainly have made him familiar. Most importantly, Hahnemann's system tapped into an increasingly widespread belief among medical professionals and consumers alike in the vis medicatrix naturae-the healing power of nature. In the Organon der rationellen Heilekund (first published in 1810, translated rapidly and widely, and generally referred to in English as the Organon if Rational Healing, or just the Organon), he argued that within all living bodies resided an innate healing power: 'In the state of health the spirit-like vital force (dynamis) animating the material human organization reigns in supreme sovereignty. It maintains the sensations and activities of all the parts of the living organism in a harmony that obliges wonderment)'2 Similarly, emerging models of disease as 'self-limiting' bolstered his system. These models proposed that diseases had a natural course through which they would inevitably progress, ending in a 'crisis' during which the patient's 'dynamis' or vital force would either be exhausted or be restored to a state of healthy balance.3

In combination, these two ideas suggested that the most effective therapeutic strategy was to strengthen the body for its inevitable ordeal, and to assist nature in reaching the 'crisis' before the body had been exhausted (a doctrine that would subsequently underpin the mid-nineteenth-century orthodox reformers' turn towards therapeutic nihilism). Hahnemann had no doubt that his method of treating like with like would surpass and supersede orthodox methods, which he termed 'allopathy'-'treatment with opposites'-and derided for opposing nature's own healing process and thus depleting the body. But he intended to go beyond merely assisting 'diseased nature' down her own 'very imperfect' path.4 Hahnemann reasoned that the artificial diseases reliably and briefly induced by his 'proven'-experimentally tested-medicines more powerfully engaged the patient's vital force. The strong symptoms thus artificially induced 'extinguished' the weaker (but more persistent) effects of the natural disease, then disappeared as the medicines left the patient's system: 'By giving a remedy which resembles the disease the instinctive vital force is compelled to increase its vital energy until it becomes stronger than the disease which, in turn, is vanquished.'5

Another area of heated debate among Hahnemann's medical contemporaries was the question of disease classification (or 'specific disease'). Could physicians distinguish with certainty one disease from another and treat it (in accordance with whatever explanation of its causation was then current) or could they be sure only of the individual patient's set of symptoms? In other words, did diseases exist as specific and knowable entities separate from the bodies in which they were expressed, or was every patient's disease experience unique and particular? The way in which a practitioner answered these questions had ramifications for every aspect of medical practice. If a practitioner believed in specific diseases, he (and in orthodox practice, it was all but inevitably a he) would strive to identify and treat that disease in increasingly standardized ways. However, practitioners dubious of specific disease identifications and standard treatments would tailor their treatments to individual patients and sets of symptoms. Men and women, adults and children, rich and poor, city-dwellers and country folk, sickly and hale, gluttonous and abstemious, pillars of virtue and slaves of the flesh-each would need slightly or radically different therapies. Since Hahnemann was suspicious of medical claims to be able to explain and identify diseases (although not necessarily of the notion of specific disease), he hedged his bets. His new medical system focused very closely on individual constellations of symptoms, rather than on what he regarded as largely speculative disease entities. Indeed, Hahnemann argued that the symptoms were the disease: 'Illness is the sum of its symptoms.'6

Given this assumption, it was imperative that homeopathic practitioners elicit from their patients a complete and detailed description of their entire disease experience. However, for any given constellation of circumstances and symptoms, homeopathy claimed that it could produce a proven specific remedy. Thus although homeopathy was based on two fairly straightforward principles, its practice depended on an elaborate complex of factors:

We only require to know, on the one hand, the diseases of the human frame accurately in their essential characteristics and their accidental complications, and, on the other hand, the pure effect of drugs; that is, the essential characteristics of the specific artificial disease they usually excite, together with the accidental symptoms caused by difference of dose, etc. and by choosing a remedy for a given natural disease that is capable of producing a very similar artificial disease we shall be able to cure the most obstinate diseases.7

Despite Hahnemann's blithe 'only', homeopathic practice clearly demanded a substantial burden of prior knowledge, especially as few known drugs had yet been tested on healthy individuals. In particular, homeopathic treatment depended heavily on a detailed patient history, and on precise patient-reporting of symptoms. Homeopathic practitioners could not rely exclusively on their own reading of the patient's body, because it was the patient's experienced illness (and personal circumstances) that determined the appropriate remedy. A homeopathic physician might spend several hours on the initial consultation, simply in taking the patient's history:

The patient details the history of his sufferings. Those about him tell of what they have heard him complain, how he has behaved, and what they have noticed in him. The physician sees, hears, and remarks by all his other senses what there is of an altered and unusual character about the patient. He writes down accurately all that the patients and his friends have told him in the very expressions used by them ... When the narrator has fmished what he would say of his own accord, the physician then reverts to each particular symptom and elicits more precise information.8

As with mesmerism, homeopathy's emphasis and dependence upon patient testimony presented a sharp contrast to trends in orthodox practice, where doctors were increasingly interested in uncoupling diagnosis from the 'subjective' experience of illness. Through technology and technique, regular medicine was struggling to declare independence from the patient; homeopathy instead reinforced the role of the patient as a partner-albeit often unwitting and in need of expert guidance--in the diagnostic process. Hahnemann explicitly notes that the patient's' own account of his sensations is most to be trusted' adding only the parenthetical caveat '(unless he is feigning illness)'.9

Homeopathy was also dependent on physicians' willingness to serve as their own experimental alembics (again, demonstrating a degree of comfort with subjective evidence which was disappearing from 'regular' practice); on the thoroughness and precision of their reports when 'proving' drugs; and on the continuous pursuit of such experiments. In this combination of attributes, homoeopathy united two already diverging strands of medicine--the rationalist system-building of learned medicine with its balance of universal 'laws' and individual experience; and the rising empiricism of' scientific medicine' with its hypotheses and experiments. It is perhaps this combination of familiarity and novelty that rendered homoeopathy so pernicious in the eyes of orthodox medical professionals----and so very attractive to medical consumers.

Like Hahnernann himself, medical consumers in the early nineteenth century were far from satisfied with the therapeutic offerings of the medical profession, and in particular with the prevailing fashion for dangerously emphatic treatments. Not only were their testimonies increasingly discounted, but their bodies-vulnerable sick bodies, at that-were subjected to newly punishing measures in search first of diagnosis, then of cure. 'A disgust of medicine' was hardly surprising when that medicine might entail (as, famously, in the case of George Washington's last illness):

two copious bleedings; a blister applied to the part affected; two moderate doses of calomel [a mercury-based emetic]; an injection ... which operated on the lower intestine another bleeding, when about thirty-two ounces of blood were drawn, vapors of vinegar and water ... ten grains of calomel ... repeated doses of emetic tartar ... blisters applied to the extremities and a cataplasm of bran and vinegar to the throat.'10

Patients were regularly bled to syncope (unconsciousness), cupped, and scarified. As well being bled through these general or local means, they were puked, purged, and poisoned; in some common diseases (for example, syphilis), patients were treated with mercury until their teeth loosened in their jaws. Medicated enemata offered another route to rebalancing the body's input and output, particularly in conditions such as hysteria, and disorders of the menses. And of course, there were the leeches. One American patient, Emily Mason, wrote to her sister of the treatment she was due to receive for facial pain: 'Today, I am threatened with leeching-Don't you envy me having those sweet little worms in my mouth?11

These harsh therapeutic tools formed the backbone of a rising medical trend: 'heroic medicine'. Although all of these methods and medications had long pedigrees in western medicine and were accepted by doctors and patients alike, the first third of the nineteenth century saw their usage taken to the very extremes of human endurance in search of medical 'activity'. In assessing the rationale behind such apparently horrific treatments, it is worth remembering that although orthodox doctors in this period knew considerably more about the internal structures and workings of the body than their predecessors, their new knowledge had not yet led to any novel therapies. Even Jenner's much lauded innovation of vaccinating with cowpox against the much more deadly smallpox did not constitute a cure, merely a far safer and often more effective preventive. So medical practitioners found themselves in the invidious position of making greater claims to authority based on their improved ability to describe the actions of disease upon the body, without being any better at explaining the origins of, or actually treating, disease. Moreover, their new knowledge, dependent as it was largely upon pathology, required investments at both the personal and professional level. Not only did individual practitioners have to spend both time and money acquiring pathological training (and moreover to do so at the risk of their own health, given the dangers of accidental self-contamination in the chamel house); but the profession too had to invest its capital as a humane art in the distasteful practices of human dissection (and while familiarity may have blunted our distaste for dissection, the controversy which has, as recently as 2003, greeted public exhibits of the dissected body-whether glossed as art or education-suggests that it remains just beneath the surface). Homeopathy represented an entirely different vision of medicine, then, in very fundamental ways. It was deliberate and gentle; it did not aim for or produce instantaneous or dramatic effects on the human body. It was, at least as framed by Hahnemann, profoundly anti-materialistic, and rooted its model of disease not in ever-more minute examinations of the physical body, but in attentive observations of the experiential one. Like mesmeric physiology, homeopathic knowledge was self declaredly rooted in the living body, not the dead--specifically the bodies of all its 'proving' practitioners.

From its origins as a critique from within the boundaries of elite German medicine, homeopathy spread rapidly to the rest of Europe, and accompanied the waves of German immigrants to the United States. In France and Britain, but especially in the United States, it found fertile soil, well prepared by the therapeutic excesses and monopolistic ambitions of orthodox medicine.12 Indeed, homeopathy-with its emphasis on mild, easily self administered, and highly portable drug therapies-was particularly well suited to the exigencies of a geographically dispersed, necessarily self-sufficient, and generally willful population. And Jacksonian American, culturally and politically marked by a rejection of elitism and professional claims to exclusive knowledge, was already shrugging off early attempts by its nascent medical profession to regulate the practice of medicine, and make it a preserve of the 'regularly trained'.

The chronology of medical regulation in America during this period demonstrates both the surging but often thwarted ambitions of medical practitioners, and the close relationship between culture, politics, and medical pluralism. Before the 1830s, medicine in the United States largely followed the professional model established in Britain. Medical societies were founded (the first, in Boston, in 1736), as were medical schools (beginning with the College of Philadelphia in 1765). Shortly thereafter, medical societies began to promote binding codes of practice which discriminated against 'irregulars' -lay and religious healers, itinerant practitioners, proponents of non-canonical medical systems, and anyone else claiming to practice medicine in the absence of training either through apprenticeship with an established doctor or surgeon, or in a medical school. By 1830, the United States had twenty-two medical schools, and thirteen states had passed laws which allowed local medical societies to license medical practitioners. Although these laws carried little force, they did raise the status of 'regulars' and gave them the exclusive right to sue for the payment of their medical bills. But these first steps towards an established orthodoxy were already being undermined by Jacksonian skepticism, by the continued proliferation of other medical systems-many rather better suited to the American context-and by the burgeoning industry of medical certification. New York journalist Mordecai Noah captured the changing mood of Jackson's America in 1830, when he stated bluntly: 'medicine like every useful science should be thrown open to the observation and study of all.' Meanwhile, medical degrees were becoming accepted as equivalent to the licenses issued by professional societies. This provoked a boom in highly profitable proprietary medical schools-essentially 'diploma mills', with low standards and even lower admissions requirements. Between 1830 and 1840 in the United States, 6800 new doctors graduated from such schools, to the disgust of their better-trained colleagues and medical consumers alike. As one critic writing in a medical journal complained:

It is very well understood among college boys that after a man has failed in scholarship, failed in writing, failed in speaking, failed in every purpose for which he entered college; after he has been dropped down from class to class, after he has been kicked out of college; there is ONE unfailing city of refuge-the profession of medicine.13

'Regular medicine' soon found itself caught in the proverbial cleft stick: on one hand, the mood of American society was staunchly anti-elitist, and equally strongly in favor of the dissemination of all useful knowledge and skills by every available means. On the other, the nascent educational institutions and regulatory systems that were intended to justify the privileges and authority claims of the medical profession were often themselves manifestly corrupt. Medical deregulation swiftly followed. Between 1830 and 1850, all but two states repealed their laws restricting medical practice to regularly qualified practitioners. Thus the United States carne to offer an untrammeled and unrestricted medical frontier to practitioners of all therapeutic stripes, and consumers were left free to assess the merits of competing systems and practitioners as they saw fit.

In 1847, elite US practitioners founded the American Medical Association (AMA) explicitly to combat the 'irregulars', who were rapidly gaining ground and establishing their own institutions and journals; and equally explicitly, to eradicate, regardless of system, all those who, as noted physician, Worthington Hooker, put it in 1849, practiced 'medicine as a trade instead of a profession, and [studied] the science of patient-getting to the neglect of the science of patient curing'. The AMA sought to restore the credibility of the 'regular' profession partly by closing the wounds caused by competition between orthodox practitioners. It regulated minimum fees, barred consultation with irregulars, and banned grubby advertising. However, the Association faced a long and uphill struggle. Its homeopathic opponents were often 'regularly' educated and better qualified-and they offered their well-heeled clients a far more palatable therapeutic course (an American journalist in 1848 was inspired to verse: 'The homeopathic system, sir, just suits me to a title I It proves of physic, anyhow, you cannot take too little').14 Meanwhile, for their poorer or rural adherents, homeopathists established homeopathic dispensaries and even mail-order homeopathy medicine chests-highly suitable for life on a frontier chronically underserved by medical practitioners of any system. These institutions and businesses alike persisted well into the twentieth century, despite major challenges like the 1910 Report on Medical Education in the United States and Canada, known universally as the Flexner Report after its author Abraham Flexner (a noted educational reformer, but not a doctor). Ostensibly Flexner's famous survey of American medical education supported no system, but only 'modern' medicine: 'Prior to the placing of medicine on a scientific basis, sectarianism was, of course, inevitable. Everyone started with some sort of preconceived notion, and from a logical point of view, one preconception was as good as another. ... Modern medicine has as little sympathy for allopathy as for homeopathy.' However, his findings set a new standard for medical education in which basic sciences, laboratory training, and hands-on clinical education reigned supreme. Few of the homeopathic medical schools (and indeed few 'regular' institutions) met this standard, or could raise the funds necessary to improve their facilities. Many went under; but the last surviving homeopathic medical school (the Hahnemann Medical College and Hospital of Pennsylvania) only finally severed its ties to the homeopathic system in the 1950S after over a century of teaching.

In Europe too, homeopathy was no short-lived fad; it was the system of choice for the British upper classes and gained royal patronage amongst Victoria's many offspring (patronage that homeopathy still retains today, with London's Homeopathic Hospital still operating under the Queen's warrant). As regularly trained William Kingdon (1789-1863) reported in an 1827 speech to his medical brethren, patient demand was essential to the spread of homeopathy-and perhaps the most important force in the creation of converts from within the medical profession itself.

My most profitable business is with gentlemen in the city, whose object it is to have their maladies attended to, if possible, without interference with their usual avocations-men whose minds are enlarged by education and occupations,-whose habit is industry, and whose fortune is the profitable occupation of their time, equally removed from the indolent and the luxurious, who readily catch at novelty for amusement, and the ignorant and unlettered, who are easily caught by any appearance of mysticism. Such men as these have been requiring me, for the last eighteen months, to try, as they call it 'Homeopathy,' at which I only smiled incredulously, and I fear, contemptuously. The reiteration of such applications, however, and from men in whose judgment and veracity I had confidence, seemed to demand from me some investigation of the subject; and desirous to set about it in the most fair way, I sought an introduction to Dr. Quin, of whom I had heard most honorable report.15

Conversions, or even speculative dabbling like this, were a blow to the heart of orthodoxy. Like the United States, nineteenth century Britain also suffered from proprietary medical schools, over competition among medical practitioners, and popular contempt for large portions of the orthodox profession. The luxuriant growth of British homeopathy was therefore no less threatening and loathsome to its orthodox profession. The pages of the Lancet and the British Medical Journal (BMJ) were filled with bitter diatribes against homeopathists, and indeed against their clientele-castigated as faddish, ignorant, deluded, self-indulgent, and of course, those old favorites, hysterical and hypochondriacally. And in this furnace of fear and loathing was the orthodox profession forged. The competition offered by the homeopathic system drove 'regular' practitioners previously absorbed by the internecine warfare between elite and general practitioners-to organize and identify as one profession. Moreover, homeopathy's commercial and therapeutic successes also forced major changes in orthodox medical practice. As the prominent and well-regarded physician SirJohn Forbes grudgingly noted in 1858:

The favorable practical results obtained by the homoeopathists-or to speak more accurately, the wonderful powers possessed by the natural restorative agencies of the living body, demonstrated under their imaginary treatment-have led to several other practical results of value to the practitioners of ordinary medicine.16

Despite scoffing at homeopathy's 'imaginary treatment', Forbes carefully enumerated the beneficial effects of inter-system competition:

[I]t has tended directly to improve their practice, by augmenting their confidence in Nature's powers, and proportionately diminishing their belief in the universal necessity of Art, thus checking that unnecessary interference with the natural processes by the employment of heroic means, always so prevalent and so injurious. It has thus been the means oflessening, in a considerable degree, the monstrous polypharmacy which has always been the disgrace of our Art-by at once diminishing the frequency of administration of drugs and lessening their dose.17

Even as he argued that homeopathy merely took credit for Nature's, own miracle cures, Forbes acknowledged the reciprocal weaknesses of orthodox practice: 'unnecessary interference' and 'monstrous polypharmacy'.18 Reviewers applauded Forbes's text, though few were as forthright as Forbes himself about the impact of homoeopathic successes on regular practice.

Homeopathists themselves were only too aware of their impact on orthodoxy. One homeopath observed allopathic borrowings with an air of amused superiority:

[T]he 'sweeping over us' of homoeopathic knowledge ... made pafients less tolerant of bloodletting, and so doctors had to give it up; and as they found that diseases did better without it, they had to alter the teachings of their text books accordingly, and they had to invent some other reason for their altered practice, and the 'sweeping over us of cholera' or 'the change of type of disease' served to save their dignity ... 24

Others expressed indignation at the allopathic pillaging of their pharmacopoeia, and unacknowledged 'plagiarism' of their practices of expectant medicine; and minute doses. Their hostility was only strengthened by continued attacks on homoeopathy from the allopathic camp. Naming prominent 'regular' names with abandon, one homeopath wrote, 'Black, Thorowgood and many others recommend bits of homeopathic practice without mentioning the hated word. Wilks filches from us while he abuses us. '20

In Britain and Germany, as in the US, medical professionals at the mid-century fought hard to re-establish a single orthodoxy and to imbue it with social, legal, and moral standing. As in the US, their efforts, beginning with organization (the British Medical Association was founded in 1832, and was intended, like its US counterpart, to fight orthodox corruption and quackery alike), self regulation and the raising of educational standards, and building on the successes of the emerging 'germ theory' did meet with considerable and growing success. However, homeopathy's powerful lay constituency and its elite corps of well-educated, well-organized (the British Homeopathy Society, for example, was founded in 1843, only a decade after the orthodox British Medical Association), and upper-class practitioners, if unable to resist some marginalization, nonetheless successfully prevented 'allopathy' from being enshrined in law as exclusively synonymous with 'medicine'. Indeed, homeopaths were able to force an amendment to the 1858 Medical Act (which established a regulatory body to supervise 'regular' medical education, and the annual publication of a Medical Register of qualified practitioners), which prevented medical licensing bodies and medical schools from discriminating against 'irregulars' so long as they were medically qualified. As in the US, the British government had no stomach for restricting the free trade in medical thought-or commodities.

Both homeopathy and mesmerism presented themselves initially as radical innovations within established medicine. Only as they were squeezed out by orthodox hostility did these systems reposition themselves as 'alternatives'-as challengers to the medical system they had intended to reform. The two systems shared not only a belief in imponderable forces or energies that could be turned to the task of curing; they also shared certain aspects of practice. Both, of course, were highly time-consuming, homeopathy because of its elaborate system of provings and detailed case histories, mesmerism because of the need to condition the patient to respond to the mesmerist's gaze and touch. Both also depended heavily on subjective, experirmential data, either from the mesmerized patient or from the homeopathist's experience of proving. Perhaps worst of all in the eyes of the orthodox profession, mesmerism and homeopathy both went around the medical establishment, to address the patients themselves. One well-known medical convert to mesmerism, James Esdaile bitterly protested the lack of a 'Free Trade in medical knowledge', after a paper describing his mesmeric practice in India, initially solicited by a respectable medical journal, was suddenly rejected.26 Denied the freedom of the medical press, Esdaile stubbornly published his article himself as a pamphlet. This fits well with his approach in a book-length version, in which he urged patients themselves:

to exercise their common sense and sober judgment in determining for the doctors the matter of fact; and if the community decides that it is really a remedy of great efficacy, that there is no resisting the proofs in support of it, that to know nothing about it is no recommendation to a medical man; then Mesmerism will assume its proper rank as a remedial agent ... 22

Esdaile was himself regularly qualified, and far from desiring a free medical marketplace; he wanted the practice of mesmerism to be firmly 'lodged in the hands of those who alone should practice it': other orthodox doctors and surgeons. 'Instead of doubting and dogmatizing about Mesmerism, I/would earnestly entreat my medical brethren to put it to the test by personal experiment.' What Esdaile in fact wanted was for consumer pressure to force the medical profession to change its stance on mesmerism-to render it orthodox. Unfortunately, although mesmerism could be smuggled into the private sickroom, it was harder to dismember than homeopathy; consequently, it could not be selectively (and by subterfuge) integrated with orthodoxy in the same way that homeopathy's most consumer-friendly attributes and practices had been.

Despite their shared features, homeopathy and mesmerism were far from similar in other ways, and produced quite different effects on the medical profession. In Europe, mesmerism perpetuated sexual hierarchies and in India, hierarchies of race, even as it challenged hierarchies of class. Homeopathy, on the other hand, was instrumental in opening the medical profession to women (and to a lesser degree, non-whites) particularly in the United States. This openness was not entirely disinterested. Doctors had long recognized that women were the family decision-makers in matters of health. Noting 'the growing aversion to large doses of strong and disagreeable medicine among the more liberal and progressive elements in society', one contemporary commented that 'many intelligent women had become tinctured with the heresy of Homeopathy and gave a preference to the physician who would prescribe or administer their milder and pleasant remedies'.23 As this American author (married to an early orthodox female physician) observed, this offered an opportunity for women of either medical sect: 'conformity to the demands for mild remedies gave the women doctors access to many families whose views were in accord with the reform movements that recognized the growing interest in enlarging the sphere of woman'.

JohnJames Garth Wilkinson's 1855 booklet War, Cholera and the Ministry of Health, 24 promoting the use of homeopathy in the British war effort in the Crimea, aptly illustrates the benefits that accrued to homeopathy by its radical inclusion of women as professional colleagues. As he argued for the special feminine suitability of the practice of medicine, Wilkinson sounded themes that would have been very familiar to his audience:25

In all respects one half of medical practice belongs to Homoeopathic woman. Only note her qualities. The first of these is intuition, the bird's eye of her ever busy love .... Were this intuition fixed and educated, it would readily pass into stable medical sight. Her fine sense animated by this, might soon eclipse the corresponding organism in the man in several fields of diagnosis ....26

Homeopathy had much to gain from recruiting women. For example, as he recited these stereotypes of femininity and invited women into the homeopathic profession, Wilkinson also claimed for homeopathy the purity that had become a 'feminine' trait. And by likening allopathy to slavery, he sought to harness the campaigning morality that had emerged as such a powerful weapon in abolitionism:

Woman… is the pillar of Homeopathy; she first saw the horrors of the old system in her own nursery among her loved ones; she has first experienced the blessing of the new. It was she that emancipated the slave: it will be she that ultimately rescues the Briton from the crooked and venomous darts of physic. She will then enter upon one of her own callings from which she has too long been excluded.27

In one area, the recruitment of women was in fact necessary: homeopathy, having marketed itself in particular to women as a means by which to spare themselves and their children from the horrors of heroic medicine, needed female bodies on which to 'prove' new homeopathic drugs for the treatment of 'female complaints'. By the standards of the profession, the provers of drugs had themselves to be trained and skilful observers: ideally, homeopathic doctors.28 Wilkinson also emphasized the status of homeopaths as 'an independent middle class' of healers, not a bad prediction of origins of the women in his target audience.29 And like many others in this period, he claimed for homeopathy the honor of effecting woman's emancipation from the domestic sphere: 'Hahnemann, without having that end in view, has done more than anyone else perhaps towards the emancipation of woman, by providing her with a field of the most humane and artistic usefulness, in which her beautiful powers can expand ... What then may we not augur for medicine when an entire better half is added to it?'30 Women too benefited: through sectarian medicine, particularly homeopathy, many of the first generation of female medical practitioners gained access to the medical profession as a whole.

Despite the challenges of 'scientific medicine' and the wholesale reform of the institutions and practices of orthodox medicine, homeopathy entered the twentieth century in strength. In Britain, it continued to have the support of the royal family and much of the social elite as well as a large middle-class following. British homeopathy differed from its US counterpart in its enduring reliance on medically qualified 'converts' as practitioners, and on a well-to-do client base. But eight cities had their own homeopathic hospitals, which treated charity patients as they trained generations of medical students. And the working poor could choose, in 1900, from thirty-five recognized homeopathic dispensaries, while homeopathic remedies were even more widely available for self-medication.

Although the number of homeopathic doctors continued to fall, their institutions survived and were indeed included first by the 1911 National Insurance Act (which insured all working men, and paid approved institutions and practitioners for their care) and subsequently the National Health Service (NHS).

The integration, finally, of homeopathy into orthodox medicine, under the auspices of the NHS was not without controversy, pain, or its own particular ironies. Many homeopathists were intensely skeptical of the intentions and outcomes of integration; the Scottish branch of the British Homeopathic Society adopted in 1941 a resolution expressing their anxiety about the effects of state control, and calling for the national society to 'ensure the right of medical men to independent judgment in matters of treatment' (though it is only fair to note that many non-homeopathic doctors were expressing exactly the same concerns about stat!: intervention in therapeutic decisions).31 Others were convinced that exclusion from the NHS was a far greater threat to the long-term survival of their beloved system. An editorial in the British Homeopathic Journal in 1944 took an accommodating approach:

There is a tendency for all minority movements, be they political or otherwise, to assume a self centeredness which is apt to result in the obscuration of the highest aim of general endeavour ... the homeopathic body one feels is not free from this taint .... [Some] wittingly or unwittingly adopt the very attitude which it would seem can but antagonize even those who are not unsympathetic to the homeopathic point of view ... The discoveries of medicine are free to all. So should the homeopathic view be proffered. Not with a superior air that this or that is 'the whole truth and there is not other!', but with a gentler assurance that we found this or that seems to give us better results and inviting enquiry and trial by experiment ... To shut one's eyes to the discoveries of chemotherapy ... is, one feels, foolishness. The 'pure' homeopath so called is a crank living in his own little cell. The complete physician is he who endeavours to know all, and knowing all, to choose what is best for the patient.32

Another correspondent took a slightly different approach to the process and goals of integration: 'I would view with regret any tendency to segregate Homeopathy more than is necessary for the preservation of our hospitals, because that is not the way of progress. Rather let us infiltrate into ordinary medical practice until Homeopathy (and I refer to the "pure" brand) is understood and given its proper place in the healing art.'33 The focus of homeopaths on the preservation of the remaining homeopathic hospitals, and the establishment of homeopathy as an independent specialty was effective-as far as it went. But homeopathy in general practice struggled from the outset to survive under the geographic limitation of patient pools, and time-constraints imposed by NHS practice, and many homeopaths chose to stay in their more lucrative and flexible private practices instead.34 In 1950, the Faculty of Homeopathy Act formally recognized homeopathic teaching, research, and practices, but homeopathic training-the lifeblood of any specialty-was denied public funding by the old enemy, the British Medical Association (through its offshoot, the British Postgraduate Medical Federation). In the end neither the sponsors not the skeptics of homeopathy on the NHS could have predicted the revival of homeopathy's fortunes and popularity of the 1970s and 1980s in part due to changes in the funding of entirely orthodox general practices. Not only was the system taken up eagerly by consumers and lay practitioners rediscovering the Organon-it also became once more the subject of clinical and scientific experimentation.

Medical consumers and providers often draw a strict division between orthodox medicine-in the West, typically high-tech, hospital-based, officially sanctioned and steeped in science-and 'alternative', 'complementary', or 'quack' therapies. But this distinction is fluid and contingent: the boundary between 'orthodox' and 'heterodox' must be actively policed by both lay and professional authorities if it is to remain stable. The cases of mesmerism and homeopathy illustrate how that boundary was established and sustained over time. Case study: From Hahneman to Rudolf Steiner Usage.

BBC television took up the challenge as part of its Horizon science documentary series, gathering together a team of scientists to oversee the project. They examined the effect of a homeopathically diluted histamine on cells, and compared this with the effect of pure water. Histamine is associated with allergic responses in cells, but would it still cause cells to react if it had been diluted to the extent that it was no longer present? Professor Martin Bland of St George's Hospital Medical School announced the final result: 'There's absolutely no evidence at all to say that there is any difference between the solution that started off as pure water and the solution that started off with the histamine.'

Acupuncture

While most people assume that acupuncture is a system of medicine that has its origins in China, in 1991 evidence surfaced indicating a European or Eurasian origine. In 1991 two German tourists, Helmut and Erika Simon, were hiking across an alpine glacier in the Otz valley near the border between Italy and Austria when they encountered a frozen corpse. At first they assumed it was the body of a modem hiker, many of whom have lost their lives due to treacherous weather conditions. In fact, they had stumbled upon the remains of a 5,000-year-old man.

Otzi the Iceman, named after the valley in which he was found, became world famous because his body had been remarkably well pre­served by the intense cold, making him the oldest European mummified human by far. Scientists began examining Otzi, and soon a startling series of discoveries emerged. One of the more unexpected avenues of research was a series of tattoos that covered parts of his body. These tattoos consisted of lines and dots, as opposed to being pictorial, and seemed to form fifteen distinct groups with 80 per cent of the points corres­ponding to those used in acupuncture today.

Various acupuncture experts agreed that the majority of tattoos seemed to lie within 6mm of known acupuncture points, and that the remainder all lay close to other areas of special significance to acupuncture. Allowing for the distortion of Otzi's skin in the past 5,000 years, it was even possible that every single tattoo corresponded with an acupuncture point. Bahr came to the conclusion that the markings were made by an ancient healer in order to allow Otzi to treat himself by using the tattoos as a guide for apply­ing needles to the correct sites.

The majority of tattoo sites are exactly those that would be used by a modern acupuncturist to treat back pain, and the remainder can be linked to abdominal disorders. In a paper published in 1999 in the highly respected journal Lancet, F. Bahr, L. Dorfer, and S. Suwanda, presidents of the German, Austrian, and Swiss academies of acupuncture, wrote: 'From an acupuncturist's viewpoint, the combination of points selected represents a meaningful therapeutic regimen.' Not only do we have an apparent treatment regime, but we also have a diagnosis that fits the speculation, because radiological studies have shown that Otzi suffered from arthritis in the lumbar. region of his spine, and we also know that there were numerous whip­worm eggs in his colon that would have caused him serious abdominal problems.

Earliest Chinese evidence for the origins of acupuncture has been found in prehistoric burial tombs, where archaeologists have discovered fine stone tools apparently intended for needling. One line of speculation is that such tools were fashioned because of the ancient Chinese belief that all disease was caused by demons within the human body. It may have been thought that the insertion of needles into the body could kill or release such demons.

The first detailed, description of acupuncture then appeared in the Huangdi Seijing (known as the The Yellow Emperor's Classic of Internal Medicine), a collection of writings dating from the second century BC. It presents the complex philosophy and practice of acupuncture in terms that would be largely familiar to any modem practitioner. Most importantly of all, Huangdi Neijing describes how Ch 'i, a vital energy or life force, flows though our body via channels known as meridians. Illnesses are due to imbalances or blockages in the flow of Ch'i, and the goal of acupuncture is to tap into the meridians at key points to rebalance or unblock the Ch'i.

Chinese medicine however emerged from a society that rejected human dissection. Unable to look inside the body, the Chinese developed a largely imaginary model of human anatomy that was based on the world around them. For example, the human body was supposed to have 365 distinct components, but only because there are 365 days in the year. Similarly, it seems likely that the belief in twelve meridians emerged as a parallel to the twelve great rivers of China. In short, the human body was interpreted as a microcosm of the universe, as opposed to understanding it in terms of its own reality.

The Ancient Greeks also had reservations about using corpses for medical research, but many notable physicians were prepared to break , with tradition in order to study the human body. For instance, in the third century Be, Herophilus of Alexandria explored the brain and its connection to the nervous system. He also identified the ovaries and the fallopian tubes, and was credited with disproving the bizarre and widely held view that the womb wandered around the female body.

In the case of  Ch'i, a core principle in Chinese acupuncture, different schools have evolved over the centuries and developed their own interpretations of how Ch'i flows through the body. For instance, some acupuncturists work on the basis of fourteen main meridians carrying Ch'i, while the majority support the notion that the body contains only twelve main meridians. Similarly, different schools of acupuncture have included additional concepts, such as yin and yang, and interpreted them in different ways. While some schools divided yin and yang into three subcategories, others divided them into four.

The emergence of new models of the body (and disease) also stimulated interest in acupuncture. These new hypotheses were based on increasingly materialistic interpretations of humouralism; they retained the assumption that the body was a system in a state of dynamic equilibrium, but anticipated and sought the physical substrates of that fluid system. Acupuncture's mysterious effects and mode of operation-taken in conjunction with its clear empirical success-raised questions to which experimentalists hoped their new models would provide answers. For example, could the Chinese and Japanese practice of treating certain conditions by performing acupuncture at sites far from the location of the pain be explained by the new imponderable fluid 'electricity'? If so, the ancient practice of therapeutic needling might point the way for a revolution in medicine. Such speculation placed acupuncture among the first therapies to be examined in terms of its electrical potential. Similarly, clinicians and experimentalists hoped that the strange power of the metal needles might finally provide a diagnostic test of whether a patient's ailment sprang from 'a disorder of the nervous system' or from somatic disease. This distinction had, of course, been made by earlier medical generations, but rose to prominence as a focus of medical interest in part because of increasing scepticism of patient self-reporting ('he [the patient] will seldom tell the truth, and perhaps never the whole truth', grumbled William Buchan in 1796 35). Berlioz himself pursued both of these interrogative strands, speculating that acupuncture 'acts by stimulating the nerves, or by restoring to them a principle of which they [were] deprived through the effects of the pain .... Very likely, the communication of galvanic shock produced by Volta's apparatus would increase the medical effects of acupuncture.36

As a vector for experimentation, and a site for testing broader medical hypotheses, acupuncture proved far more captivating to medical audiences than it had been as merely another exotic medical import. However, its origins were still too interesting to medical consumers (and too problematic for medical professionals) to be entirely erased. Berlioz responded to this dilemma by introducing acupuncture in terms of its exciting past, but simultaneously denying Chinese and Japanese physicians any intellectual credit for discovering or refining the technique:

The savage peoples living in the torrid and temperate zones were ... in the habit of marching almost nude when they went into combat. They [therefore] experienced the necessity of imprinting on their bodies some particular signs, which ... enabled them to identify "themselves. The operation which they practised to that end having been by chance done on injured parts, the resultant relief ensured its repetition in analogous circumstances. The need for signs graven on the skin having ceased with the progress of civilization, and the pricks seemingly procuring the cure only of a tiny number of maladies, the usage was lost in most nations. This remedy has been conserved only by the Chinese and the]apanese, their neighbors, where all the first institutions are sacred .... It is from these people that we take the method of acupuncture.37

As has often been the case when Europeans have borrowed medical or scientific expertise from non-western cultures, the Chinese were painted merely as chance discoverers and rote preservers of ancient knowledge, not its skilful creators. Berlioz and his cohort did not refer to or reproduce the Chinese body map; nor did they acknowledge or (publicly) experiment with its system of specific points.

In the absence of the perplexing body maps and explanatory notes so painfully translated by Ten Rhyne and Kaempfer, acupuncture was reintroduced to the western world by its Parisian exponents as a stand-alone technique. In other words, 'acupuncture' in this western incarnation ostensibly entailed no more and no less than puncturing the living body with a needle. While both lay and professional audiences continued to associate acupuncture with its Asian roots, these ties were ornamental. Acupuncture as practiced in Paris made no appeals to yin, yang, qi, or a system of channels and vessels linking the body's organs with its surface; nor did its supporters claim that acupuncture was a 'specific' for any particular diseases. Rather they pointed to its empirical success in individual cases, and in certain categories of complaint (particularly nervous and chronic pain). Framed in this way, acupuncture neither conflicted with nor challenged established understandings of the body and disease, even though it could not be fully integrated with them. Thus, although acupuncture's mechanism remained mysterious to western medicine-and indeed is unexplained in biomedical terms today-it was not dismissed as quackery. Even tentative analogies drawn between acupuncture and animal magnetism (another, more controversial 'imponderable fluid' of the day) did not drive the practice out of 'regular' hands (though proponents of the technique were active in disputing such explanations of its mode of action).

Although keen to explain the mechanism of acupuncture along the most 'modem' and 'scientific' lines, and thus to protect it from the tarnish of quackery, exponents of acupuncture were even more eager to spread the practice. They took to the rapidly expanding medical press, producing both case studies of its therapeutic successes and (even more copiously) experimental reports. Both types of account circulated widely, aided by the then-common practice in European and American medical journals of reprinting 'digests' of each other's more prominent articles. Perhaps even more effective in spreading information about the 'new' technique were the enthusiastic accounts of foreign medical students in Paris. Such first-hand descriptions of near-miraculous cures engaged personal as well as social networks, and helped to transmit the hands-on practice of acupuncture.

Investigations of the technique, particularly those driven by interest in electricity and its biological effects, spread across Europe. Trials took place in England, Scotland, Germany, France, Italy, the Low Countries, and the United States, as well as in more remote locations. Monographs, too, played an important role in propagating acupuncture. For example, the practice of acupuncture by the English-speaking profession was profoundly influenced by a single book: A Treatise on Acupuncturation, published by James Morss Churchill in 1822. Churchill's book, like Berlioz's text before it, introduced the healing needle through a disquisition on its 'Oriental' origins. Again like Berlioz, Churchill took pains to distinguish the practice of acupuncture in Europe from its practice in China, and to emphasize his own initial skepticism of Chinese claims for the technique:

I should not have taken the tales which are told of the wonderful cures effected by this operation amongst the original founders of it, as sufficient authority for recommending it, nor would I admit the fables which are promulgated by these people, as evidence of its efficacy, had not this efficacy been witnessed by European spectators on its native soil, and at length experienced in our own hemisphere; and even latterly, in our own country.38

Although he later gently chided his medical predecessors for their reluctance to adopt or even thoroughly test acupuncture, Churchill initially blamed that too on the Chinese themselves: 'It is probable, that the hyperbole in which it has been related, has induced the sober minds of our Northern soil, to treat these relations as the fictions of the Eastern imagination, and to reject them without examination, as fables.'39 So that 'gay luxurious imagination' crops up again, but this time clearly marked as a liability, rather than a lesser virtue.

Fictional or not, by the second decade of the nineteenth century, the British, French, and American medical presses had succumbed to the forces of curiosity and rising interest, and began to report on acupuncture. For twenty years, studies of acupuncture, and cases of its success (and later of its failure) peppered medical periodicals. Physicians and surgeons in private and hospital practice alike experimented with the technique, and speculated on the cause of its curious effects. As the US-based commentator Dunglison noted in a compendium of 'new remedies' of the 1840s, '[a]lthough acupuncturation is really an ancient therapeutical agent, attention to it has been so much revived of late years, and its use has been so largely extended, that it may be looked upon as constituting one of the novelties of therapeutics':

M. Jules Cloquet had much to do with reviving its employment in his own country and elsewhere, by his treatise on the subject published at Paris, in 1826, where it was for a long period a fashionable article in the hospitals; so much so, it is affirmed, that attempts were even made to heal a fractured bone by it without the application of any appropriate apparatus! and at one time, it is said, the patients in one of the hospitals actually revolted against the piqueurs medecins.40

Laymen and -women too played a crucial role in increasing awareness of the technique and promoting its use by medical professionals. Patients were amazed by acupuncture's efficiency in relieving pain that had, in many cases, plagued them for years. Mr A. W., 'a corpulent man' afflicted with lumbago Oower back pain and stiffness, such as that caused muscle strain or a slipped disc), was reported by his Fulham surgeon as 'expressing the greatest astonishment at what he termed the "magical effect of the needles"!!!' The same surgeon reported of another patient, a poor woman with 'six infant children' (and thus', unsurprisingly, a bad back):

Although perfectly freed from pain, it was enough to excite a smile to witness the woman's scepticism on the success of the operation; she could scarcely credit her senses, for when desired to turn on her back she obeyed with hesitation, and doubt, dreading lest she should encounter the 'pain' .... It was very gratifying to see the poor creature sit up; her countenance beamed with delight, equalled only by her astonishment and grateful thanks for the 'wonderful cure' I wrought her.41

Another patient, this time Churchill's own, wrote an account of his illness and cure, at his doctor's request. Sick with pain and weakness in his left hip, unable to walk any distance, and generally debilitated by 'a residence in a tropical climate, together with indulging too freely in excesses, which destroyed the digestive powers', C. Lindo of Margate sought Churchill's opinion on his case. Churchill regarded it as unsuitable for acupuncture, and Lindo instead 'visited the whole round of celebrated regulars, and irregulars', without success. 'As a forlorn hope, and at his earnest desire', Churchill agreed to try out the needles. Lindo concluded his account: '1 derived temporary relief from acupuncture, there is not the least doubt, and had I at the time, the advantage of country air, it is probable that a more beneficial result might have accrued ... ' .42 No miracle cure here, then, but after Lindo's unavailing round of treatments-including apparently, a caustic chemical rub that blistered him badly-his willingness to publicize a nearly painless, and at least temporarily beneficial, remedy is hardly surprising. Indeed one of the features most marked and discussed about acupuncture was that 'It would seem, that the operation is, as a general rule, most successful when it occasions the least pain.'43 The consumer appeal of this unusual attribute can be readily imagined ...

As had been the case for moxabustion (and as would be the case for homeopathy), socially prominent individuals played a crucial role in raising the visibility of acupuncture. In Britain, for example, one noble gout-sufferer-George O'Brien, Third Earl of Egremont, a noted patron of the racing world and member of the Prince-Regent's high-flying Brighton set-was cured of an excruciating, five-week bout of sciatica by acupuncture. In his relief, he paid the innovative surgeon a small fortune, renamed his favorite racehorse 'Acupuncture', and promoted the technique enthusiastically amongst his high-flying circle. As his well-rewarded surgeon recalled, 'There are no bounds to his Lordship's gratitude and delight: he went. .. to Brighton, a distance of thirty miles, to make it known amongst the nobility and faculty there.'44 As with moxa in the eighteenth century, it was the existence of and interactions between lay and professional networks--local, national, and international-that facilitated the spread of acupuncture in the early and middle nineteenth century.

Another version of the Earl of Egremont's miraculous cure, told post-prandially in the clubrooms of a London medical society some five years later, offers additional evidence of acupuncture's specific attractions for both patients and medical professionals. A surgeon named Dendy recounted the tale with some considerable gusto. Rich in detail, his version differed from earlier accounts in several ways: first, he told his medical audience much more about the Earl's case-and especially about its intractability to orthodox cures. George O'Brien was clearly nothing if not determined; by the time he heard of acupuncture, he had endured every orthodox measure and several well-known quackish ones at the hands of 'every medical man of note in London'. They had availed him nothing: 'he retired to his seat at Petworth, in despair'. It was upon his arrival at Petworth that the central importance of both lay and professional networks in propagating acupuncture becomes evident.

A friend of mine [Martin], who resided in Sussex at that time, happened to get an early copy of Mr. Churchill's little work on acupuncture, and tried the remedy therein advocated with perfect success on an old woman who was a protege of Lady Burrell, the daughter-in-law of the Earl. Her ladyship heard of the cure, and told the Earl what had been done; the result was, that the surgeon was sent for forthwith to try the new process on the peer.45

Martin, a surgeon, got his advanced copy because he and Churchill were acquainted in their student days at Guys and St Thomas's Hospitals. Sometimes, who you knew determined what you knew, and when. The Earl called Martin because of his daughter-in-Iaw's network of charitable patronage. And O'Brien in turn deployed his own elite social network in acupuncture's cause.

But Dendy's enthusiasm waned as he came to the close of his tale. He admitted that he had himself no very good news to tell of the technique: 'When first it was proposed, it certainly effected some singular cures, but, of late, success does not seem to have attended it ... As regards my own experience ... I have lately had three cases in which I have tried this remedy without advantage.46 Neither Dendy nor his auditors offered any explanation of acupuncture's declining efficacy. Other contemporaries agued that the needle's early success had encouraged too many practitioners to use it as a panacea in unsuitable or indeed incurable cases. Certainly, by the 1840s, acupuncture was typically tried by doctors on precisely those patients whose ailments had proven particularly intransigent. No longer novel, nor sufficiently 'miraculous', acupuncture disappeared from the medical press almost as quickly as it had appeared.

The practice of acupuncture, however, continued. Dendy's story and the social setting within which it was told offer substantial clues to the mechanism of acupuncture's survival after its media heyday. Rarely in the spotlight of the medical periodicals, local groups like the London Medical Society offered a convivial space in which medical gentlemen could quietly exchange news and trade tips on the practice of medicine (as opposed to the often more contentious issues of theory). These societies were shaped both by traditions of gentlemanly amateurism and by the newer demands of competition and professionalization. In the nineteenth century, science and experiment remained largely the province of the amateur, and doctors were prominent participants in scientific and technical innovation and debate. Medical men pursued both as matters of interest and in pursuit of gains tangible and intangible. With increased training in the 'allied sciences' of medicine, doctors considered themselves uniquely well able to evaluate mesmerism, galvanism, new drugs, the use of the stethoscope, and myriad other medical innovations of indeterminate worth-including acupuncture-and gathered together to do so in precisely these settings. Thus, although periodicals were a crucial mechanism by which to propagate a new technique, they were far from the only one.

Churchill himself had initially learned of acupuncture not from reading the published French reports of it, but from another surgeon, Mr Scott of Westminster. Churchill's interest was aroused by privately communicated and subsequently directly witnessed successes with needling. Even before he published his Treatise on Acupuncturation, Churchill was part of a growing nexus of British practitioners interested in or using acupuncture. And he tapped into the power of such personal networks himself as he struggled both to popularize and to standardize acupuncture practice. Churchill actively sought out acupuncture success stories and collected cases in which his adopted technique had procured long-sought health. He was not alone in this Endeavour; at least one prominent patient insisted that his doctors not only learn the technique (as propounded by Churchill), but that they report their successes back to him for further distribution. Another valuable tool for fostering acupuncture's credibility and inculcating its practice was eye-witnessing. Just as Churchill had been converted to acupuncture by seeing it in action, so others were brought into the fold. The act of witnessing was a frequent point of contact and potential transmission, and one that also illuminates (changing) contemporary structures of authority and its propagation. At the beginning of the century and for some considerable period, Churchill and his successors regularly listed the names of socially prominent observers who were in attendance upon successfully cured acupuncture patients, implying that their presence added weight to the reported results.47 But this model of authority was in decline within medicine. By the mid-century, it was slowly being replaced by statistics and by large-scale clinical observation.

This proved a stumbling block for acupuncture's proponents. Most of the men who publicly supported acupuncture depended on their practices for both livelihood and 'clinical material' (patients). In a second volume, presenting case studies proving the efficacy of acupuncture, Churchill complained that he could not perform the experiments necessary to establish acupuncture's active principle because his small practice threw up insufficient numbers of appropriate cases.48 This dilemma only worsened as the century progressed and the single case study lost its primacy in the periodical literature. Acupuncture supporters found themselves reporting on individual cases even after the multiple case study had become the norm for testing the efficacy of a medical practice or innovation. But what could they do? They often saw little chance of another suitable case appearing in their practices. Reporting late in the century on a solitary case in which acupuncture had relieved the pain of a man dying from cancer, one such practitioner prefaced his datum with the apologetic acknowledgement:

[O]ne case goes only a short way in establishing any method of alleviating or curing the pain of this formidable disease, but a long interval may pass before another presents itself in a small provincial town with a sparse surrounding population. Hence my reason for publishing a single case.49

As the balance in medicine tilted away from 'art' and toward 'science', the power of individual practitioners in private practice to significantly influence medical practice diminished. Often silent in the face of 'scientific medicine', such practitioners still had to satisfy their patients at the bedside, where doctors still struggled to establish themselves as the exclusive interpreters of the body. Day-to-day medicine remained a social art, and the laity, heterodox practitioners, midwives, and others still claimed the right to observe the body and pronounce upon it authoritatively. Patients demanded particular cures based on what they saw, and acupuncture's near invisibility in the medical press limited lay awareness of the technique as well. Acupuncture's proponents may have regarded a blandly empirical westernization as more readily assimilable, but it was hardly attention-grabbing. Certainly it lacked in drama, particularly as adversarial new systems like homeopathy emerged to offer formidable competition to merely orthodox alternatives, and controversy swept the medical and popular presses.

As an explicitly and vocally alternative medical system originating in a European context, homeopathy offers an excellent foil to acupuncture's non-European origins, and to its status as an apparently unthreatening stand-alone innovation. Moreover, where the history of acupuncture in Europe is cyclic and discontinuous, the history of homeopathy is continuous, illuminating the impact of changes in the institutions of biomedicine on medical systems which opposed it. So what can the history of homeopathy in the nineteenth century tell us about nineteenth-century responses to acupuncture?

First, it may be worthwhile to spell out the similarities between homeopathy and acupuncture as each emerged from the marketplace pluralism of the eighteenth century into the medical monopoly building of the nineteenth. Both homeopathy and acupuncture depended heavily-at least in theory-on subjective accounts of sensation and experience. Homeopathic doctors used their own experiences and sensations to 'prove' drugs. Homeopathic diagnosis relied heavily on patient self-reporting, and on the equally subjective accounts of the patient's friends and family. And certainly the mechanism by which homeopathic medicines produced their effects was mysterious: how could medicines composed almost entirely of water produce any effect on the sick body, much less a curative one? Neither was initially conceived as an 'alternative' in the sense in which we use the term today-as an either/or proposition. Acupuncture's proponents (like the advocates of mesmerism) wished to add new weapons to orthodoxy's armory in the battle against disease, while homeopaths expected their system to gradually displace by expansion the inferior techniques of allopathy, while absorbing its useful accumulated knowledge.

However, like orthodox medicine-or, as homeopathists rather polemically described it, 'allopathy'-homeopathy was, and was understood to be, a fully elaborated system of medical thought. In other words, both lay and professional responses to homeopathy took into account its theory and its practices as well as its material culture (the drugs themselves). Moreover, as we saw, over the course of the nineteenth century homeopathists developed their own professional journals, medical societies, research institutes, hospitals, medical schools, and even corporate pharmaceutical offshoots. Reactions to homeopathy from within the orthodox profession, although initially moderate and assimilative, rapidly became violently hostile (if still, surreptitiously, assimilative). And this hostility had a profound effect: rules like those of the AMA and BMA forbidding any consultation or cooperation between their members and 'homeopathists' and mandating the expulsion of any member caught 'dabbling' with homeopathy forced a unitary identity upon the wide range of healers who took up the system. Whatever their training, whatever the degree of their belief in Hahnemann's principles, all were equally 'homeopathists' in the eyes of their professional organizations. No such judgements or demands were made of regulars who chose to use acupuncture; one could easily take up the needle without taking up the title 'acupuncturist'-and indeed few if any even of acupuncture's most eloquent proponents would have defined themselves in terms of their use of the technique. Each of these differences played a crucial role in acupuncture's failure to thrive, or to challenge established medical models in the way that homeopathy did so successfully.

To render acupuncture assimilable by the 'regular' medical profession at the beginning of the nineteenth century, its proponents had relied on the pragmatism of the average practitioner and patient, and presented it as simply, empirically, an effective treatment for particular ailments. And at the beginning of the nineteenth century, good empirical evidence of success in particular cases was enough; a culturally challenging theory for which no material evidence could be found was considerably worse than no theory at all, at least in terms of rendering acupuncture acceptable. After the mid-century, however, this was no longer the case; pure empiricism (particularly when disconnected from even the possibility of a material explanation) was becoming a threat to the profession's aspirations to scientificity and the social authority that came with it. Empiricism was slipping back into the hands of the 'quacks'. But by then, western practitioners of acupuncture had become so habituated to trial-by-error needling in locus dolenti that its lost theoretical basis would in any case have been almost irrelevant.

By the same token, acupuncture users, lacking a unitary identity they were consultant surgeons and physicians, general practitioners, and very occasionally late in the century also followers of the new 'specialties’ such as neurology-and not excluded from the orthodox medical communion, felt no impulse to create their own institutions. In particular, they created no centers of training; individuals like Elliotson might mention acupuncture in lectures, or demonstrate it on teaching rounds should a suitable case be present. As long as acupuncture remained novel (and as long as its prominent practitioners remained orthodox!) such mentions could gain wide audiences: both lectures and notes on ward rounds were often serialized by the medical periodicals. But as acupuncture became familiar, its use-limited as it was to relatively minor and unexciting ailments-was no longer worthy of mention. Such essentially opportunistic efforts could not substitute for inclusion in a formal education programme, once the medical press turned its spotlight elsewhere. 01) the other hand, local cultures of acupuncture use persisted; for instance, it was 'for years a favorite traditional practice at the Leeds Infirmary' where three generations of Pridgin Teales used it as Surgeons to the Infirmary.50 But informal networks and family traditions were increasingly peripheral to the process by which innovations in medicine were diffused and entered the mainstream. Periodicals, textbooks, and formal medical education had, by the end of the nineteenth century, become the essential media for the transmission of medical knowledge. Homeopaths, precisely because of their formal exclusion from these venues, were well prepared for this shift, with journals, schools, and textbooks of their own, through which to propagate succeeding generations of homeopathic practitioners.

In fact, the case of homeopathy usefully illustrates both the benefits and the disadvantages of the 'alternative' position/posture. Clearly, homeopathists and supporters of homeopathy used the rhetoric of opposition to-and oppression by-medical orthodoxy to draw attention to the flaws of allopathic practice and the distinctiveness of their own. This in turn allowed them to build a strong and visible identity, which could be shared by professionals, amateurs, and consumers alike. However, by choosing to position homeopathy as an alternative to orthodox medicine, and by defining their therapy in part by what it was not, homeopathy's proponents left homeopathy open to being grouped with all the other self proclaimed 'alternatives', ranging from the medically respectable (such as osteopathy) to the downright disreputable (clairvoyance, for example). Similarly, by promoting homeopathy as an exclusive choice, they brought upon themselves the same set of disadvantages that faced allopaths in their battles to exclude homeopathy. The adversarial approach also encouraged dogmatism among homeopathic 'purists', which in turn reduced the flexibility of modernizers to incorporate popular new techniques or respond to challenging new doctrines, like germ theory. If acupuncture was rendered amorphous in the absence of theory, homeopathy was rendered brittle by an overly rigid theoretical structure.

And that brings us again to the question of culture, and the cross-cultural specificity (or not) of medicine. Were the different responses to and trajectories of acupuncture and homeopathy influenced by the fact that the former originated in China and the latter in Europe, and if so in what ways? Certainly, the separation of practice from theory in the case of acupuncture was intimately related to European perceptions of Chinese natural and medical knowledge as devoid of merit (beyond its antiquarian interest as an earlier stage of civilization). Those perceptions, as Floyer's diligent efforts of translation suggest, related not just to the factual content of that body of knowledge (on what side of the body the heart was lodged; the length of the intestines; the rate of circulation in the body) but to the cosmologies and epistemologies embedded therein (a non-dichotomous universe, a body internally legible through physical sensations, rather than auditory clues or direct inspection) and the manner in which the substance of each of these categories was expressed ('flowery', 'poetical' language). But perceptions of cross-cultural medical expertise were also influenced by far less arcane matters: for instance, the politics of international trade. Simply put, when Britain's political and economic relationship with China was, or was expected to be profitable, British attitudes towards China and all things Chinese tended to be buoyant. When that relationship soured, as it did after the failure of successive missions to China seeking more favorable trading terms, and in the period preceding and during the Opium Wars, so did attitudes towards other aspects of Chinese culture.

In the 1820s, when Churchill was first promoting the use of acupuncture in Britain, Lord Amherst had recently returned from a British ambassadorial mission to China in the years 1816 and 1817. The end of the Napoleonic Wars had allowed the re-expansion of British diplomatic and economic horizons, and the rigidity of the Canton Cohong system was again a focus for anti-Chinese sentiments. Moreover, the Country (private) traders were simultaneously pressing for the ending of the East India Company's monopoly of the China trade, and illicitly expanding their own ventures in East Asia. The embassy was ignominiously expelled from China without even a formal audience with the Emperor, much less any new agreement on trade terms. The embarrassing future of Amherst's mission contributed to growing (elite) British ~gust with China in general and the Chinese government in particular. In the popular press, the British public read tales of Chinese medicine and technology, set in the context of an obstinate and autocratic government. Perhaps even worse, at least for perceptions of Chinese medicine, they were told that Britain's generous attempt to negotiate had been blocked by a Chinese doctor.

China during this period gallingly persisted in regarding itself as self-sufficient, and culturally superior. Consequently, it did not seek to ally itself with or learn from European nations, and regarded its many foreign visitors and inhabitants as mere pilgrims to the shrine of a higher culture. Embassies from European powers were routinely referred to as 'tribute envoys' and required to follow long established schedules, routes, and rituals. The Amherst mission evaded these rules (arguing that it was not a tribute mission) and attempted to establish its own pace and precedents-or as the Chinese officials perceived it, stalled and prevaricated. On the Embassy's arrival in Beijing, Amherst was immediately summoned to the Emperor's presence. He declined, on the grounds of illness, and begged for rime to recover. The Emperor immediately offered the assistance of his own physician:

The Ambassador was immediately visited by the promised physician. This gentleman, who appeared to be something beyond the middle age, was dressed as a Mandarin. He felt His Lordship's pulse in both wrists; and having observed that his stomach was probably disordered from the use of a Chinese diet, recommended repose and an emetic, and retired. The report of this person to the Emperor, materially influenced, as it afterwards appeared, our subsequent treatment.

In other words, the imperial physician appears to have reported that Amherst was faking illness; as this was apparently the only reason given to the Emperor for the Ambassador's refusal to attend him, the Embassy was disgraced.49 Unsurprisingly, a considerable number of pages and column inches reporting and discussing the failed mission were expended on critiques of Chinese medical knowledge and theory, and the 'absurdities' of its practices. In particular, Chinese practitioners were criticized as 'entirely destitute of anatomical knowledge'.52 As the Lancet scoffed,
The knowledge of Anatomy among these primitive people is extremely slight and superficial .... The existence of the great viscera of the chest and abdomen is certainly ascertained, but the Chinese are profoundly ignorant of their relative position. The heart is thus supposed by them to be on the right side and the liver on the left.- There is scarcely an allusion made to the nervous, fibrous, and muscular structures .... In Physiology the Chinese are seen to scarcely less disadvantage.53

At first glance, this hostility seems to have had little effect on perceptions of acupuncture--after all, it was in the first flush of its British glory in the 1820s and 1830s-but of course, it does explain the urgency with which Churchill and other acupuncture supporters worked to cut acupuncture's ties with China, and to define their practice of acupuncture as anatomically based. Moreover, particularly in medical forums, they presented France, rather than China, as the immediate origin of European acupuncture, both in terms of its intellectual and its empirical antecedents. Obviously, Churchill and his counterparts knew that acupuncture was developed in China, but few traces of China persisted in the description and practice of acupuncture in Britain in the face of that nation's growing unpopularity. Even the needles themselves were domesticated and, westernized-this not only stripped them of undesirably 'Chinese' attributes, but powerfully illustrated the ease with which practitioners could construct their own apparatus to test the new treatment.

Contemporary observers were certainly aware of a close relationship between popular attitudes towards different cultures and public medical enthusiasms. Britain's victory over China in the Opium Wars enabled Britain to negotiate her own trade terms, punitive damages, and perhaps most importantly, healed British amour-propre, wounded by Chinese indifference to British trade and British culture. In its wake, orthodox medical practitioners contemplated the likely effects of increased exchange with the Chinese.54 Some even saw stirrings of a medical equivalent to the eighteenth-century chinoiserie craze, which had itself occurred during a period of greater openness in the China trade and correspondingly positive perceptions of China. In 1844, a scandalized but anonymous 'Medical Practitioner' scolded the government for its lax attitudes towards quacks in general, from mesmerists to dentists (for specialism-the notion that one could understand and treat one part of the human organism in isolation from its systemic context was itself seen as a sort of quackery until the late nineteenth century). In the midst of his tirade, the author singled out 'for its bare-faced impudence' the 'Chinese pills', as exemplifying all the frauds from which the Government should be protecting its citizens:

No sooner had the news of peace having been made in China reached us, then a 'most important discovery' was announced, and 'Chinese Pills' were placarded throughout the kingdom, recommended as a 'Universal remedy,' their virtues transcendently soaring above those of all other universal remedies hitherto known ... What, I ask, is the humble, unlettered, laboring man to think of these lies about the Chinese Physician's effectual means for contending with disease? He knows not but that all there stated may be true; he knows not that the Chinese theory and practice of Medicine is about as correct, in most of its principles, as the vain conceit of their own celestial relationship; that it is, in fact, the deepest in the dark, of all the intellectual pursuits of that singular people.55

Other authors were less perturbed, but nonetheless recognized that the forced opening of China was likely to bring new competitors to the medical scene. John Wilson, Medical Inspector of Naval Hospitals and Fleets, and recently returned from duty in China, mused in 1844: 'There is no saying whether, among the curiosities which will find their way hence to London, a celestial doctor may not be one.' Perhaps Wilson's complacency stemmed from his quite accurate view that Chinese medicine would compete far more directly with homeopathy than with orthodoxy:

He [the hypothetical Chinese practitioner] would possess pre-eminently the charm of novelty; and if to that he added the irresistible recommendation of boasting loudly, and boldly professing his power to cure all manner of disease, he might prove a formidable rival to the homeopathist. At any rate, he would be his fit antagonist, and a pretty race might be run between them for the popular favor. It is suspected, however, that the expounder of the pun-tsaow would be beaten, principally though the burthen of his big boluses, by the light weight of the disciple of Hahneman,; for the imaginative invalid who delights to toy with the immeasurable minute doses of the latter, would be frightened or disgusted by the drenches and balls of the former.56

In the end, if a 'celestial doctor' came to Britain in the decades after the Opium Wars, he or she left no traces on British medical culture. 'Chinese pills' and similar Orientalized patent medicines came and went. Acupuncture remained, albeit in its highly westernized form, embedded in local cultures and private practices. Its proponents occasionally grabbed the spotlight of the medical periodicals with unusual case studies, and more rarely, clinical studies in hospitals. One 'quack' practice associated itself with acupuncture: Baunscheidtism, used most famously to treat male sexual dysfunction and involving the use of a spring-loaded array of blades or needles and an irritating ointment applied to the site of puncture to create an eruptive rash. But in general, the practice of therapeutic needling stayed free from such taints, and firmly within (although peripheral to) orthodox practice across Europe and North America until the closing years of the nineteenth century.

As I and other historians have argued, the rise of homeopathy ended the reign of 'heroic medicine' and promoted the growth of a unified (and monopolistic) orthodox medical profession. Acupuncture certainly had no such profound effects, although arguably its advent and popularity did help to familiarize and domesticate the needle itself as a medical instrument. By the end of the nineteenth century, needles were commonly used to treat aneurism, to relieve various forms of edema, to introduce vaccine matter, and the hypodermic needle and syringe was being introduced; proponents of each of these innovations all harked back to acupuncture's relative safety and painlessness as evidence that they too were safe. In the first decades of the twentieth century, changes in medical education and in the structures of medical practice, and the rise of new therapies for the treatment of ailments like tetanus, rheumatism, neuralgia, gout, and sciatica-and perhaps most importantly, a rising sense amongst the orthodox medical profession of the power of the new scientific medicine-saw acupuncture drop out of western practice altogether. It would not return to its early nineteenth-century heights of popularity until the 1960s and 1970s.

In conclusion one should ad that physicians of Chinese medicine currently employ more than one hundred different diagnostic systems. At least seven methods of pattern differentiation are taught in today's universities and colleges. To these might be added a large number of other widely used methods, including biomedical diagnostics and methods derived from biomedicine but assimilated into Chinese medicine. There is no agreement between physicians about which method should be applied to a particular case, nor are there any established mechanisms to bring about convergence.

Today methods of diagnosis are often divided in classical/gudaide, traditional/chuantonde, modern/xiandaide, and new/xin. No unanimity exists, however, regarding the details of specific diagnostic techniques, the interpretation of diagnostic data thus obtained, or the relative value of various types. One can find, for instance, several different systems of pulse diagnosis on various sites of the body.

Treatment practices are equally varied, and the history of Chinese medicine is characterized by polemics between advocates of different schools of thought. Such polemics might concern theoretical issues or the correct interpretation of textual sources as much as the diagnostic and treatment techniques appropriate to a given case. The same acupuncture point is located differently by different physicians, and points are also selected on the basis of personal experience and stimulated by means of highly individualized needle techniques. That is, practitioners may use the same stylized terms taken from the canonical literature to describe a therapeutic intervention, but in practice they apply to it their own interpretations.

But if meridians and Ch'i are fictional, then what is the mechanism behind the apparent healing power of acupuncture?

Singh and Ernst in their book conclude:

1 The traditional principles of acupuncture are deeply flawed, as there is no evidence at all to demonstrate the existence of Ch'i or meridians.

2 Over the last three decades, a huge number of clinical trials have tested whether or not acupuncture is effective for treating a variety of disorders. Some of these trials have implied that acupuncture is effective. Unfortunately, most of them have been without adequate placebo control groups and of poor quality ­the majority of positive trials are therefore unreliable.

3 By focusing on the increasing number of high-quality research papers, reliable conclusions from systematic reviews make it clear that acupuncture does not work for a whole range of con­ditions, except as a placebo. Hence, if you see acupuncture being advertised by a clinic, then you can assume that it does not really work, except possibly in the treatment of some types of pain and nausea.

4 There are some high-quality trials that support the use of acupuncture for some types of pain and nausea, but there are also high-quality trials that contradict this conclusion. In short, the evidence is neither consistent nor convincing - it is border­line. (Simon Singh and Edzard Ernst, Trick or Treatment?: Alternative Medicine on Trial, 2008, p.84-85.)

One could ad that when medical researchers argue that the evidence seems largely to disprove the benefits of acupuncture, the response from acupuncturists often includes five main criticisms. We shall address them one by one:

1 Acupuncturists point out that we cannot simply ignore those randomized placebo-controlled clinical trials that indicate that acupuncture works. Of course, such evidence should not be ignored, but it has to be weighed against the evidence that counters it, and we need to decide which side of the argument is more convincing, much as a jury would do in a legal case. So let us weigh up the evidence. Is acupuncture effective for a wide range of disorders beyond all reasonable doubt? No. Is acupuncture effective for pain and nausea beyond all reasonable doubt? No. Is acupuncture effective for pain and nausea on the balance of probabilities? The jury it still out, but as time has passed and scientific rigour has increased, then the balance of evidence has moved increasingly against acupuncture. For example, as this book goes to print, the results have emerged of a clinical trial involving 640 patients with chronic back pain. According to this piece of research, which was sponsored by the N ationallnstitute of Health in America and conducted by Daniel Cherkin, sham acupuncture is just as effective as real acupuncture. This supports the view that acupuncture treatment acts as nothing more than a powerful placebo.

2 Practitioners argue that acupuncture, like many alternative therapies, is an individualized, complex treatment and therefore is not suitable for the sort of large-scale testing that is involved in a trial. This argument is based on the misunderstanding that clinical trials necessarily disregard individualization or com­plexity. The truth is that such features can be (and often are) incorporated into the design of clinical trials. Furthermore, most conventional medicine is equally complex and individualized, and yet it has progressed thanks to clinical trials. For instance, a doctor will ask a patient about his or her medical history, age, their general health, any recent changes in diet or routine and so on. Having considered all these factors, the doctor will offer a treatment appropriate to that individual patient - that treatment is likely to have been tested in a randomized clinical trial.

3 Many acupuncturists claim that the underlying philosophy of their therapy is so at odds with conventional science that the clinical trial is inappropriate for testing its efficacy. But this afcusation is irrelevant, because clinical trials have nothing to do with philosophy. Instead, clinical trials are solely concerned with establishing whether or not a treatment works.

4 Acupuncturists complain that the clinical trial is inappropriate for alternative therapies because the impact of the treatment is very subtle. But if the effect of acupuncture is so subtle that it cannot be detected, then is it really a worthwhile therapy? The modern clinical trial is a highly sophisticated, flexible and sensitive approach to assessing the efficacy of any treatment and it is the best way of detecting even the most subtle effect. It can measure effects in all sorts of ways, ranging from analysing a patient's blood to asking a patient to assess their own health. Some trials use well-established questionnaires that require patients to report several aspects of their quality of life, such as physical pain, emotional problems and vitality.

5 Finally, some acupuncturists point out that real acupuncture may perform only as well as sham acupuncture, but what if sham acupuncture offers a genuine medical benefit to patients? We have assumed so far that sham acupuncture is inert, except as a placebo, but is it conceivable that superficial and misplaced needling also somehow tap into the body's meridians? If this turns out to be true, then the entire philosophy of acupuncture falls apart - inserting a needle anywhere to any depth would have a therapeutic benefit, which seems highly unlikely. Also, the development of the telescopic needle sidesteps this question because it does not puncture the skin, so it cannot possibly tap into any meridians. Acupuncturists might counter by arguing that telescopic needles also offer therapeutic benefit because they apply pressure to the skin, but if this were the case then we would also receive benefits from a handshake, a tap on the back or scratching an ear. Alternatively, such pressure on the skin might sometimes detrimentally influence the flow of Ch'i, so such bodily contact might make us ill.
 

1.Samuel Hahnemann, Organon if Medicine: A New Translation, trans. Jost Kunzu, Alain Naude, and Peter Pendleton (London: Victor Gollancz, 1986), 188. Unless otherwise noted, all quotations from Hahnernann are from this translation of Hahne mann's sixth (and last) revised edition of his Organon, completed in 1842, just before his death.

2.Ibid. IS.

3.e.g. the flu might be said to progress through headaches, to swollen glands and body aches, to fever and nausea, to the breaking of the fever, to recuperation.

4.Hahnemann, Organon, 25.

5. Trans. Elizabeth Danciger, in The Emergence if Homeopathy: Alchemy into Medicine (London: Century Paperbacks, 1987).

6. Trans. Edward Hamlyn, The Healing Art if Homeopathy (Chicago: Keats Publishing, 1981), 19.

7.Trans. Danciger, Emergence if Homeopathy.

8.Trans. Hamlyn, Healing Art, 37-8.

9.Hahnemann, Orgjnon, 86.

10. 'News. From "The Times." A newspaper printed in Alexandria, dated in December', Medical Repository, 3 (1800), 3II-12, quoted in John Harley Warner and Janet Tighe, Major Problems in the History of American Medidne and Public Health (New York: Houghton Mifflin, 2001), 57-8. For a full and gory description of the full extent of ' heroic medicine' see Kaufinan, Homeopathy in America, esp. ch. I.

11.Emily Mason to Catherine Mason Rowland, 4 Nov. 1840, quoted in Kaufinan, Homeopathy in America, 12.

12.As we will see in Chapter 4, homeopathy proved equally adaptable to the political, cultural, and medical climate of colonial India/the Raj.

13.'American vs. European Medical Science again', Medical Record, 4 (1869), 183.

14.United States Magazine and Democratic Review, 22 (May 1848), 418, quoted in Kaufinan, Homeopathy in America, 30.

15.'Mr. Kingdon on Homeopathy', Journal of the Calcutta Medical and Physical Society, I (I July 1837), 404.

16.Sir John Forbes, QfNature and Art in the Cure of Disease, 2nd edn. (London: John Churchill, 1858), 162-3, cited in Nicholls, Homoeopathy, 165.

17.Forbes, Of Nature and Art, 162-3, cited ibid. 165-6.

18.Forbes, Of Nature and Art, 162-3, cited ibid. 166.

19.R. E. Dudgeon, Hahnemann, The FounderofSdentific Therapeutics (London: E. Gould and Sons, 1882),23-4, cited ibid. 169.

20.R. E. Dudgeon, The Influence of Homeopathy, 32-3 on General Medical Practice since the Death of Hahnemann (London: Turner & Co., 1874), cited ibid.

21.James Esdaile, The Introdudion of Mesmerism (with the Sanction of the Government) into the Public Hospitals of India (London: W. Kent and Co., 1856), 10.

22.This and immediately succeeding quotations from James Esdaile, The Introduction of Mesmerism, as an Anaesthetic and Curative Agent into the Hospitals of India (Perth: Dewar and Son, 1852),9.

23.Joseph Longshore, in a manuscript biography of his physician wife, Hannah Longshore. Quoted in Regina Morantz-Sanchez, Sympathy and Sdence: Women Physidans in American Medidne (New York: Oxford University Press, 1985), 59.

24.James John Garth Wilkinson, War, Cholera, and the Ministry of Health, and Appeal To Sir Benjamin Hall and the British People (New York: William Radde, and Fowler & Wells, 1855). Wilkinson was a regular MD, and author of another (rather curiously titled) work, The Human Body and its Relation to Man.

25.Morantz Sanchez, in Sympathy and Sdence, 5 and passim, has discussed these themes in great depth.

26.Wilkinson, War, 54.

27. Ibid, 53.

28.Anne Taylor Kirschmann, 'Adding Women to the Ranks, 1860-1890: A New View with a Homeopathic Lens', Bulletin of the History of Medicine, 73 (1999), 429-446, at 434-5.

29.Wilkinson, War, 56. 35.

30.Ibid. 54.

31.Thomas Robertson, 'Homeopathy and Post-War Reconstruction', British HomeopathicJoumal, 32 (1942), 117.

32. Editorial, British HomeopathicJoumal, 34 (1944),157-210, at 157-8.

33.Correspondence, ibid. 186.

34.Dr Manasse, 'Homeopathy and General Practice', British Homeopathic Joumal, 39 (1949), 186-7.

35. William Buchan, Observations Concerning the Prevention and Cure of Venereal Disease (London: Chapman, 1796), p. iv.

36. Berlioz, Memoires, 310-11.

37.Ibid. 296-7.

38.James Morss Churchill, A Treatise on Acupunauration (London: Simpkin and Marshall, 1822), 5.

39.Ibid. 10.

40.Dunglison, New Remedies, 45-6.

41.T. W. Wansbrough, as quoted inJames Morss Churchill, Cases fllustrative of the Effects of Acupuncturation, in Rheumatism, Lumbago, Sciatica, Anomalous Muscular Diseases, and in Dropsy of the Cellular Tissue, etc. (London: Callow and Wilson, 1828),73-5.

42.C. Lindo, quoted ibid. 39-43.

43.Dunglison, New Remedies, 48.

44.Churchill, Cases, 46.

45.'London Medical Society. March 18th, 1833. Mr. Kingdon, President. Rheumatism.-Elaterium. Acupuncture', Lancet (23 March 1833), 817-18, at 817.

46.Ibid.

47.See Steven Shapin and Simon Schaffer, Leviathan and the Air-Pump (see Chapter 3, n. I) for more on the emergence of the culture of the witness, the audience, and the performance in science.

48.Churchill, Treatise, 23-4.

49.William Craig, 'Art. VII. Acupuncture in a Case of Cancer', Edinburgh Medical journal, Combining the Monthly journal of Medicine and the Edinburgh Medical and Surgical journal, 14 (1869), 617-20, at 619.

50.T. Pridgin Teale, 'Clinical Essays, No. III. On the Relief of Pain and Muscular Disability by Acupuncture', Lancet (29 April 1871), 567-8, at 567.

51.Clarke Abel, Narrative of a journey in the Interior of China ... in the Years 1816 and 1817; Containing an Account of the Most Interesting Transactions of Lord Amherst's Embassy to the Court of Pekin (London: Longman, Hurst, Rees, Orme, and Brown, 1818), 107.

52. Ibid. 216.

53.'Medicine in China' Lancet, 1(1838--9),481-5.

54.The Opium Wars, also know as the Anglo-Chinese wars, were fought between 1839 and 1842, and 1856 and 1860, and as the name suggests, were sparked by China's decision to eradicate the highly profitable trade in opium dominated by the British. Opium, though known to be addictive and poisonous, was Britain's only successful export to China, and an effective ban would certainly have threatened Britain's balance in trade; however, Britain was anxious also to defend the right to free trade, and to eliminate the corrupt system under which Europeans were licensed to trade with China.

55.A Medical Practitioner, Quacks and Quackery: A Remonstrance against the Sanction given by the Government, the Press, and the Public, to the System of Imposture and Fraud Practised on the Ignorant and Credulous in the Quackeries of the Day (London: Simpkin, Marshall and Co., 1844), 30-1.

56.John Wilson, Medical Notes on China (London: John Churchill, 1846) 248.


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