In Search of the Later Hahnemann
OverviewA study of Hahnemann's cases and prescribing methods in Paris, during the final phase of his life.
The material is drawn from his hitherto unknown casebooks of that period.
235 pp pb
Beaconsfield Publishers, Ltd.
DetailsThis book is the story of Samuel Hahnemann's practice of homeopathy in Paris during the last years of his life.
It is based on his actual casebooks, which up till now have been left substantially unexamined in a German library. It was to Paris that Hahnemann had moved with his young second wife, Melanie, and here that he completed the second edition of his Chronic Diseases and the final revision of his major theoretical work, the Organon.
We see him putting into practice the implications of his thinking on chronic disease, experimenting with some of the new remedies being developed by himself and others, and pushing his conception of the infinitesimal dose to undreamed-of lengths in the LM potency.
The whole range of his Paris patients appears in these pages, many of them famous, others obscure, and still others who had traveled from elsewhere in Europe and the Americas to seek his help.
We see him grappling with the scourges of the time, such as consumption and the consequences of venereal disease, as well as with conditions that had been caused or further complicated by previous treatment. Some of the cases are quoted at length, and there are nine double-page facsimile spreads of case notes made either by Hahnemann alone or else in conjunction with Melanie.
There are successful cures, but we also see him making mistakes, improvising, getting stuck and lost in his cases, yet always trusting in the process he had himself formulated. We see him as a whole person and witness the process of the learning and making of homeopathy.
From the BookIntroduction
All homeopaths are familiar with the story of Samuel Hahnemann's early life, its trials and vicissitudes, his piece-by-piece formulation of the principles of homeopathy and their painstaking verification in practice, as well as with the story of his success and failure in Leipzig followed by his self-chosen exile to Kothen in 1821.
We are not, however, so familiar with the story of his later years, the years in which, having married a rich young French wife, the Marquise Melanie d'Hervilly, he moved to Paris. At the age of eighty he once again set up a successful homeopathic practice, publicizing homeopathy from the capital of the fashionable world in a way he could never have done from the small Saxon town where he had been living for the previous fourteen years.
It was in Paris that Hahnemann achieved his greatest renown and where he was, at last, honoured, as he always should have been for his remarkable achievements. It was in Paris that he completed the second edition of his Chronic Diseases and his final revision of the Organon.
It was in Paris that he put into practical effect the implications of his theory of chronic disease, the miasm theory, as it has come to be known. It was in Paris that he experimented with high potencies and pushed his conception of the infinitesimal dose to undreamed-of lengths in developing the LM potency.
This book is the story of Hahnemann's practice of homeopathy during the last years of his life in Paris, a period hitherto little studied and much misunderstood. The story is based for the first time on Hahnemann's actual casebooks, up till now left substantially unexamined in a German library. These reveal a rather different Samuel Hahnemann from the apparently confident master with whom we have become familiar through the pages of his published works.
We see here the private experimentation that underpinned the assurance of his public utterances. We see him literally 'practicing' homeopathy, obliged to try numerous different methods of prescribing with his complex Parisian patients, guided not by any dogma but by the spirit of enquiry which had always informed his own learning.
These last casebooks show how Hahnemann adopted a new method of prescribing in the wake of his discovery of the psoric miasm. He no longer prescribed solely on the 'totality of symptoms' he had advocated for so long, but often prescribed miasmatically, usually clearing the psoric miasm at the outset of a case, before proceeding with any more individual prescribing.
He also prescribed in the higher potencies, about which he had first written in a note to the fifth edition of the Organon (Paragraph 287), changing his methods to accommodate them, prescribing in liquid doses frequently repeated, abandoning the familiar practice of giving one dose and waiting for its action to cease before considering any repetition.
We see him tentatively moving towards what he considered to be his ultimate achievement in releasing spirit from matter: his discovery of the LM potency. We see him making successful cures, of course, but we also see him making mistakes, improvising, getting stuck and lost in his cases.
We see him trying different ways of coping with the responses to remedies, especially with aggravations. We see him developing his materia medica from the fifty or so remedies which he had at the beginning of his practice to the nearly two hundred which he had by the end of his life. We see him prescribing new and unusual remedies, nosodes, poorly proved and even unproved substances, in his attempts to wrest his patients from the jaws of disease. Above all we see him experimental, tentative, enquiring, trusting the process he had himself formulated, trusting that if symptoms were indeed the only expression of disease, then removal of the symptoms must result in removal of the disease.
If the remedy chosen did not remove the symptoms, then he chose another remedy. If the symptoms aggravated, he often saw the aggravation as an indication for another remedy.
If the symptoms disappeared he often put a double exclamation mark in the margin. It seems that surprise at the fact that homeopathy works is something that never leaves even the best prescribers!
We see here the real Hahnemann, Hahnemann at his everyday work. As the existential psychotherapist Irvin Yalom has written:
'In their everyday work, therapists, if they are to relate to their patients in an authentic fashion, experience considerable uncertainty . . . The capacity to tolerate uncertainty is a prerequisite for the profession. Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal, such is rarely the case: instead, therapists frequently wobble, improvise, and grope for direction.
The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy.'*
To read Hahnemann's cases is to see him 'wobble, improvise and grope for direction' a great deal, It is to see him as a whole person and to share in the process of the making of homeopathy. R.H.
* Yalom, I. D.
Love's Executioner and Other Tales of Psychotherapy
Bloomsbury, London 1989
The Beginnings of Homeopathy
Conflicts with Colleagues
New Developments in Homeopathy
Love and Marriage
The Robert Bosch Institute
THE THEORY OF DISEASE
Consequences of the New Theory
Cases: Mr Campbell, Mme Leloir
CHOOSING THE REMEDY
Frequent Change of Remedy
Remedies in Tandem or Alternation
HAHNEMANN'S MATERIA MEDICA
Early Period - to 1828
Middle Period - 1828 to 1839
Late Period - after 1839
THE VENEREAL MIASMS
Syphilis and Sycosis
Case: Mme Leloir (continuation)
Electrotherapy and Magnetism
DOSAGE AND POTENCY IN THE EARLY DAYS
THE ULTIMATE ATTENUATION
Higher Centesimal Potencies
Experimenting with the Scale
The LM Potency
APPENDIX I: FURTHER CASES
APPENDIX II: THE MANUSCRIPTS
The American Homeopath, 1999
Reviewed by David Little In the 5th and 6th editions of The Organon of the Healing Art (1833 & c. 1843), Samuel Hahnemann claimed his new revised techniques could speed the time of homeopathic cure to 1/2, or less, the time it took with the methods of the 4th Organon (1829.)
What could have led the Old Master to make such a profound statement? What is the difference between the methods of the 4th, 5th, and 6th editions of the Organon, and what innovations did the Founder introduce during the last 10 years of his life?
One of the major changes was the replacement of the ordinary dry pellet dose with a succussed aqueous solution. Hahnemann used a full range of potencies from 6c to 200c with his liquid delivery system and introduced a completely new potency range called the 50 millesimal remedies (L.M.) The LM potencies are made with a 1 to 50,000 dilution ratio and are administered in gradually ascending potencies marked LM 0/1, 0/2, 0/3, up to 0/30.
These new methods greatly expand the therapeutic range of homeopathy by offering a new, flexible posology system which is applied to two complementary potency ranges (Cs and LMs.) For these, and other reasons, I have always found the last 10 years of Hahnemann's life and works fascinating.
In 1984, while in Nepal, I began a careful study of Hahnemann's final methods through The Organon, The Chronic Diseases, eyewitness accounts, letters to colleagues, and a few of Hahnemann's cases from 1843.
With these resources I reconstructed the Founder's revised methods, and for a 12-year period I put these techniques through an extensive trial while running free clinics in North India. The results of this experiment confirmed Hahnemann's postulates that his new posology techniques offer definite advantages over his older methods.
With this as a basis, I was excited to hear of Rima Handley's publication, In Search of the Later Hahnemann, as it offers a view of the casebooks from the Paris epoch.
First of all, I would like to thank Ms. Handley for her extensive study of Samuel Hahnemann's casebooks. She has done a fine job of painting a portrait of the time period, the people, the places, as well as the diseases they suffered.
I would recommend that all serious homeopaths read her work, as it gives us insight into how our science first developed. Between the years 1833 to 1843, Samuel Hahnemann began a series of radical experiments with the goal of perfecting homeopathic methodology.
This makes a historical review of this critical period important because it sheds light on Hahnemann's revised views on homeopathic posology. Unfortunately, the casebooks are very cryptic, especially to those who are not familiar with the use of the medicinal solution or the LM potency.
For this reason, I have obtained from the Robert Bosch Institute the microfiches of Hahnemann's cases between 1840 and 1843 so that I may review the material related to the LM period personally. This has allowed me to corroborate the nature of the material and confirm a few fundamental mistakes in Ms. Handley's text through a study of the original sources.
The casebooks from this period are the records of Hahnemann's sizable practice in Paris. Due to the great number of clients, Samuel and Melanie were only able to devote a limited time to each patient. For this reason it is not surprising that the case notes only contain the chief complaints of the individuals and the treatment undertaken.
These cases were used as concise records of their clients rather then a complete record of all of Hahnemann's thoughts and observations. The cases were recorded by Melanie and then passed to Samuel, who would often record repertory rubrics and write out the chosen remedy, potency (LM or C), and dose of the medicinal solution.
Hahnemann gave birth to homeopathy and the following generations of homeopaths have nurtured this infant to full maturity. Nevertheless, modem homeopathy still has a lot to learn from the methods Hahnemann employed, especially in his last 3 years. The fruits of his experiment are recorded in the 6th Organon, but for the most part, the methodology remains a mystery. This is beginning to change.
Understanding Hahnemann's Legacy
Ms. Handley has done a great work, but she has developed one of her central themes on a misconception of what is actually published in the various editions of the Organon. This is particularly obvious in the following quote:
By the time Hahnemann came to Paris he had considerably modified his previous practice with regard to dose and potency; he had stopped prescribing in single dry doses repeated very infrequently (the way of prescribing advocated in the main text of the 5th edition), and had begun to prescribe the centesimals in liquid.
Throughout the Paris period he prescribed his remedies in liquid doses repeated frequently, either every other day, daily or several times a day. He also made considerable use of the method of olfaction, or inhaling of remedies.
Ms. Handley includes in this theme the idea that Hahnemann's private practice was considerably different from his published works because he kept his new experiments secret:
Until the very end of his life he continued to observe and experiment. However, a life of continuous opposition had made him secretive and he allowed little to be published of the results of these last years practice. This book is an attempt to uncover its true nature.
In truth, all of the methods Ms. Handley mentions above were placed in the public domain by Hahnemann rather than kept private. The Founder introduced the liquid delivery system in aph. 286, 287, and 288 of the 5th edition (1833), well before he went to Paris with Melanie in 1835.
He first discussed the method of olfaction in the introduction to Boenninghausen's repertory (1832), and the most detailed explanation of olfaction is found in the 5th Organon.
All of Hahnemann's revised methods depend on the correct use of the medicinal solution. The last time Hahnemann recommended the use of the single unit dry dose was in aph. 242 of the 4th Organon. If the homeopath is still using the dry pellet dose, they must abide by the rules of the 4th Organon (1829) and the first edition of The Chronic Diseases (1828.) I call this the 'single dose wait and watch' method. This is the most common form of classical homeopathy.
In the 5th Organon, the Old Homeopath proposed a *new posology method which utilizes a single dose when there is a striking remedy response (§245), and the repetition of the remedy at suitable intervals to speed the cure in slowly or moderately improving cases (§246.) He called his **new posology the "middle path" because it represents the balance point between the exclusive single dose and the systematic repetition of homeopathic remedies.
< b class="sub">>Posology Questions
Ms. Handley also maintains that Hahnemann gave his remedies "daily" and she notes this in brackets on every case from his notebook. A study of the casebooks shows this is incorrect. In the 1837 edition of The Chronic Diseases, the Old Master suggested the use of a series of doses daily, or every other day, followed by placebo when necessary. Even the example cases Ms. Handley presents demonstrate a series of liquid doses followed by a period of placebos rather than daily doses.
In the 5th Organon, Hahnemann recommended that any striking response to a single dose of a remedy completely contraindicates the repetition of the remedy. In the 6th Organon he points out that a remedy may be given daily, IF NECESSARY! If it is not "necessary" to speed the cure, such a dosage schedule will only slow down the cure and lead to aggravations. The idea that Hahnemann gave all his doses daily is a false representation.
Hahnemann's casebooks show that the Old Master constantly experimented with his methodology. In the cases from 1840 to 1843 we find Hahnemann giving a remedy and placebo in medicinal solution to the same client. He did not mark down exactly how many times he gave the remedy nor how many times he gave the placebo. Some of these doses may have been single doses while in others they could have been a series of doses or in alternation with a placebo. To understand just how he gave his dose we must also study the eyewitness accounts of those who were with him in the last years.
Dr. Croserio, whom Ms. Handley calls the foremost homeopath in Paris, was an eyewitness to Hahnemann's work and an inner confidant during these last years. In the Neues Archiv der Hom. Heilkunst vol. 1, no. 2, 1844, he published a testimonial of Hahnemann's practice in Paris in the last LM period. This letter can be found in Boenninghausen's Lesser Writings in an article called 'Hahnemann's Doses of Medicine.' Croserio clearly states:
Only in rare cases he would give daily a tablespoonful or coffeespoonful of the first solution in 8 to 15 tablespoons of water. If he gave a powder to be taken at once in a tablespoon of water, this was never anything else then sugar of milk.
In chronic disease he would in no case allow the patient to smell at the medicine oftener than once a week, and would give nothing but sugar of milk besides; and in this way be would make the most admirable cures, even in cases where we others had not been able to do anything.
The period just before and after the 5th Organon was one of radical experimentation and constant transformation. Due to the limited number of proven remedies it was sometimes very hard to find a remedy that fit the totality of the symptoms.
For this reason, in the 1830s Hahnemann performed trials with double remedies, remedies in tandem, remedies in alternation and remedies in series. As the materia medica expanded he did not need to use tandem remedies, alternations, or change medications as often. By the 1840s his casebooks show that for the most part, Hahnemann left these former methods behind as he found more successful methods. These methods center on the medicinal solution and the high potencies, centesimal, and LM potency.
The cases from the final period show Hahnemann using 6c, 12c, 24c, 30c, and 190-200c as well as a wide range of LM potencies (0/1 to 0/24) in the manner suggested in the 6th edition of The Organon. The new posology methods were applied to the centesimal remedies in the exact same manner as the LM potencies. This is what Dr. Croserio saw Hahnemann doing, and the method he learned from him personally.
He never prescribed two different remedies, to be used in alternation or one after the other, he always wanted to see first the effect of the one remedy, before he gave another, and this even with the patient who he treated at a distance of two or three hundred miles.
Nor would he change. Even in acute disease it was a rare case to see him allow the patient to take more than one spoonful in 24 hours.
Now, this eyewitness account of the LM period paints quite a different picture of Hahnemann's practice in his last years than Ms. Handley's book. This is because she does not really differentiate between the mid-1830s where he used more tandem prescriptions, alternations and series of remedies from his more perfected methods of the last 3 years.
The cases in my possession from 1840-1843 correspond to the testimony of Dr. Croserio and reflect the methods published in the 6th Organon. It would be wrong to think that the cases from 1835 are the same as the cases from 1843 where the Paris experiments reach their conclusion.
The Minimal Dose
Another area where Ms. Handley is mistaken is where she speaks of Hahnemann making medicinal solutions from drops of the 30c stock dilution. She incorrectly translates Hahnemann's notation "./x in 7 cab" as 1 drop of liquid of the 30c potency in 7 tablespoons. She suggests that the period (.) stands for the one drop.
This notation actually stands for the use of one small poppy seed size #10 pellet in 7 tablespoons. From the time of the 4th Organon (1829), Hahnemann prepared his homeopathic remedies by placing one drop of the stock potency on 500 hundred tiny pellets. In the 5th Organon (1833) and The Chronic Diseases (1837 edition), Hahnemann suggested the use of 1, or more rarely, 2 pellets to make the medicinal solution. Again we can look to Dr. Creserio's letter for confirmation:
But I can assure you that he was most fully convinced that it was not necessary in any case, or under any circumstance, nor even useful, to give drop doses of the medicines, and that he from day to day more clearly saw the injury of giving larger doses.
The entire movement toward the higher potencies was accompanied by a corresponding reduction of the size of the dose to the tiny pellets. In Hahnemann's advanced methods, one of these tiny pellets is used to make a medicinal solution of at least 3_ oz. The most explicit instructions on how to make and apply a medicinal solution are found in the 6th Organon.
The following is an extraction from a letter composed by Reverend Everest, a close personal friend of Hahnemann's to a Dr. Luther. It was published in The Times in 1853 and records his observations of the Master at work:
His next experiment was to dissolve three, two or one globule in a glass of water, and then, after carefully stirring, to put a dessert or teaspoonful of this into another glass.
All of Hahnemann's experiments with the liquid delivery system revolve around the use of 1, or rarely, 2 tiny #10 pills. Ms. Handley confuses the instructions related to the different pharmaceutical methods for manufacturing centesimal and LM potencies with the instructions on how to prepare the medicinal solutions for the patient.
Hahnemann called the centesimal potencies "medicament au la goutte" (medicines of the drop) in juxtaposition to the LM potency which he called "medicament au globule" (medicines of the pellet.)
The centesimal potencies are medicines made from a "drop," while LMs are medicines made from a "Pill." The centesimal potencies of the 5th Organon were produced by taking one drop of the remedial agent and diluting it with 100 drops of alcohol and then giving 10 succussions. The LM potency is made by taking one tiny #10 pill of LM1 and diluting it with 100 drops of alcohol and applying 100 succussions. This then makes a LM2 potency of which one drop is placed on 500 #10 pills.
Normally only one small pill of the centesimal or LM potency is dissolved in a minimum of 3_oz in a glass bottle. This bottle is then succussed from 1 to 12 times depending on the sensitivity of the individual constitution. From this bottle 1, 2, or 3 teaspoons are taken and stirred into 4 oz of water in a glass, and 1, 2, or 3 teaspoons are given to the client. In order to put these new posology concepts into practice one must study the 6th Organon of the Healing Art very closely with someone who has put the methods into practice for some years.
Hahnemann sent his 6th and final edition of the Organon to his publisher before he left for his heavenly abode on July 2, 1843. Unfortunately, the publication was not completed and the manuscript was returned to the Hahnemanns.
Mrs. Hahnemann took possession of the document after the departure of her revered husband but was unable to publish it due to a number of practical and personal reasons. It was not until 1921 that an English version of the Dudgeon-Boericke translation of the 6th Organon was published.
The O'Reilly edition, called The Organon of the Medical Art, has offered homeopaths a new, excellent translation. Our generation of homeopaths has just begun to understand the true depth of this masterpiece.
There are those who say that Hahnemann's private practice was completely different then his published works like The Organon. They say that Hahnemann used combination and tandem remedies and point to Ms. Handley's work as proof.
This is certainly not fair to Rima's foundational research work, which portrays a series of experiments extending over 8 years (1835-1843.) She clearly says that in his final years Hahnemann become more conservative with his remedies and gave more placebos.
The dual remedy experiment was between 1832-1833 before Hahnemann left for Paris, which Rima does not cover.***
As to the dual remedy experiments, Hahnemann wrote that from the "many attempts" with the dual remedies, only "one or two have been successful," which was insufficient for the "establishment of the new rule." The dual remedy experiments failed to produce sufficient results, and for this reason was abandoned by Hahnemann, Boenninghausen and Aegidi its originator.
We have others who profess the so-called homogenic teachings of Hahnemann which treats "disease irritations not the symptoms." They are followers of sequential therapy, which uses combinations of high potency remedies chosen by a reductionist view of etiology and isopathic relationships.
"Tolle Causum" (remove the cause), they cry, just like the allopaths of old school. They still cling to the idea that the proximate cause of a disease is the disease itself and do not understand that the cause of the thing or event can not be, at the same time, the thing or event itself.****
Hahnemann reminds us that such understanding is just sound common sense. The true healing art removes both the etiology (proximate cause) as well as the symptoms (event) with a similar remedy.
To learn Hahnemannian homeopathy properly, one should study its methodology with those who have tested its principles in the field for years. Experience with the method is golden. This is what the pretenders lack.
Hahnemann's last 10 years were ones of great transformation as he worked to perfect his homeopathic system. One cannot get the complete picture from the casebooks in isolation. They must be complemented by the corresponding editions of the Organon and The Chronic Diseases, as well as eyewitness accounts and personal letters.
Our study shows that the cases from Hahnemann's last 3 years are in perfect harmony with the techniques he recorded in the 6th edition of the Organon and eyewitness accounts.
The Organon is the text in which Hahnemann sets out the lofty goals of homeopathy. It is a vision of De Medicina Futura, the medicine of the future. The old doctor pointed in the direction he wanted his new system to go and left valuable advice for his students.
Much of his hopes for homeopathy were beyond his grasp, but the principles which make homeopathy unique remain the key to the system. I'm sure the old homeopath would have been happy to see the expansion of the materia medica and repertory. Nevertheless, the advanced posology methods of his last 3 years (1840-1843) are still little understood.
Ms. Handley has done a great service by opening up the field and calling on her colleagues to go deeper into the subject. She acknowledges that such a grand undertaking as translating Hahnemann's casebooks is bound to contain inaccuracies. It is always easy to be a critic but very hard to do the work.
I have made several mistakes over the years yet they always helped my understanding to grow. Rima opened up the subject and we are grateful for her works.
As to experiments with the medicinal solutions Kent once said:The question next to be considered is the giving of a dose of medicine in water and divided doses. This has at times seemed to have favor over the single dry dose. This is open for discussion, requiring testimony of the many, not of few, to give weight. The best reports are made from both methods, and both are in harmony with correct practice.
We are slowly building the testimony of the many and the weight of our experience is building. In the 5th and 6th Organons (1833 & 1843), Samuel Hahnemann claimed his revised methods could speed the time of homeopathic cure to _, _, or less, the time it took with the methods of the 4th Organon (1829).
It is for classical homeopaths who have mastered the 4th Organon methods to take up the challenge and begin new experiments. Only they have the background and depth of experience necessary to really test Hahnemann's "new methods" in the field.
*Organon of Medicine, 5th edition by Dudgeon & 6th by Boericke, page 122 and 123
**note to §246, 123
***Refer letter, Hahnemann to Boenninghausen, October 16th 1833,
Samuel Hahnemann, his Life and Works, Richard Haehl, page 253
****Organon, O'Reilly edition, page 10 of the Introduction
Reprinted with permission from the
National Center for Homeopathy