(This is a somewhat dissident review to the 'empirical' perspective articulated by Coulter)

Divided Legacy. 
A history of the schism in medical thought. Vol. I 
The patterns emerge: Hippocrates to Paracelsus. 1975. Vol. II 
Progress and regress. 
J. B. van Helmont to Claude Bernard. 1977. 
By Harris L. Coulter. 
Wehawken Book Cc,.: Washington D.C. $17.50 each.
[Editor's note: As of September 1996 Minimum Price Books' price is $50.00-Vol. I, and $50.00-Vol. II]

The homoeopathic literature to date has lacked a satisfactory assessment of homoeopathy's place in the history of medicine. Harris Coulter's work comes closer to remedying this situation than any previous work. In it Coulter outlines what he sees as the split between Empirical and Rational elements in the history of medical thought. He places homoeopathy at the end of a more or less continuous stream of empiricist development, while modern allopathic medicine is seen largely as the child of the rationalist school.

Empiricism, according to Coulter, is based upon the subservience of theory to practice, while rationalist medicine places more importance on a theoretical framework from which to understand the individual case. This leads to a reliance of rationalist practice on a doctrine which emphasizes causes and diseases, holds a static mechanistic concept of the patient, and treats by contraries. Empiricism on the other hand emphasizes the total symptom picture, the individual patient, and holds a dynamic view of the, organism whose inherent self-heating powers are to be encouraged by the administration of similars. Rationalism is thus able to establish a sophisticated jargon which serves to "unite" physicians with one another while at the same time isolating the patients and simplifying the practice. The empirical physician has no such doctrine and is consequently more vulnerable to outside criticis and this, combined with the greater efforts his technique requires, has, according to Coulter, served to keep empirical medicine in its relatively subordinate position.

The book opens with a consideration of the Hippocratic writings which Coulter divides into two schools, one representing the empirical, and the other the rationalist pole. He then outlines the thought of some of the major figures in medicine up to the end of the nineteenth century, classifying them according to the predominance of one or the other trait in their writings.

At times this classification does not ring true, as with Paracelsus, whom Coulter places in the Empirical camp. While this classification may well be broadly justified, Paracelsus himself emphasized the importance of a mode of perception which transcended mundane empiricism, relying instead on an inspirational element in treating his patients. In thus subordinating the individualism of Paracelsus to his general thesis, one wonders whether Coulter may not himself be guilty of an over-rationalistic approach to the history of medicine. It is also unfortunate that he does not discuss Greek temple healing. One gets the uneasy feeling that this, together with his refusal to examine the importance of "spiritual/psychological" factors in both Paracelsian and homoeopathic medicine may be because these do not fall neatly into line with his thesis.

Many homoeopaths would object to their school with its "law of similars" and miasmatic theory being classed as empirical, an epithet which has traditionally been used in a derogatory sense to describe medical practitioners. Hahnemann himself was, of course, at pains to describe his Organon as the "Rational Art of Healing". It is possible that a division into individualized and generalized schools of medicine would have been more plausible, but with some reservations I personally feel that Coulter has provided a fruitful approach from which to view medical practice. In particular I feel that in terms of understanding the process whereby the responsibility for health has been gradually taken out of the patient's own hands and placed in the "expert" hands of the physician, his general thesis is valuable. It is unfortunate perhaps that the excessive length and dry style of these, books will inevitably limit their readership. They will, however, remain of interest to the academic historian of medicine.

R. J. WITHERS

British Homoeopathic Journal 
Volume 67, Number 1, January 1978