Installment 13 of a series on case analysis
© Will Taylor, MD 2001 (bio)
Hahnemann's Contributions to the Healing Arts
Hahnemann's contributions to the development of a rational basis for healing are many. He was an early voice in disfavor of bloodletting as a routine adjunctive treatment. He was early among his colleagues in appreciating the infectious and contagious character of many diseases, and in drafting hygienic recommendations for these. His aphorisms 210-230 are an effective argument dismantling the Cartesian mind-body dichotomy that haunts conventional medicine, as well as many alternative approaches, to this day.
Although the observation of cure by similars predated him by at least 2,000 years, Hahnemann uniquely based a systematic and robust methodology of assessment and cure on this principle. And in large part, this latter was made possible by one of his greatest contributions to medicine - the systematic exploration of that thing which a cure by similars demands be similar to disease - the effect of medicinal substances on the healthy organism.
The medicine of Hahnemann's day relied on an awkward collection of rationales for its recommended therapeutics. Bloodletting, purging, cathartic and diaphoretic treatments, all were rationalized as necessary to balance theorized humors and eliminate theorized toxins from the body. Botanicals and heavy metals such as mercury were used in formulary combinations often better known to the apothecaries than to the prescribing physician, which did not permit accurate reflection on the curative effects of individual constituents.
Medicinal properties were often attributed to superficial features of a substance, hiding true explanation behind a smokescreen of supposed understanding. When one of the foremost physicians of Europe - William Cullen - published his pharmacology text in 1790, he attributed the curative effect of Peruvian Bark (Cinchona) in intermittent fevers to the simplistic, superficial observation that it was a bitter and astringent substance.
[Modern-day conventional medicine may look on such rationalizations humorously in its hubris, but it is instructive to ask how many depressed patients - treated with "selective serotonin reuptake inhibitors" - have had the serotonin levels in their brains measured or monitored. The answer should be obvious.]
Cinchona - the First Self-Proving
Hahnemann was, among many things, a chemist. He was also a master of many languages, and in the course of translating Cullen's work into German, he reflected that he could name at least a dozen things that were as bitter and astringent as the bark of the Peruvian Cinchona tree, which had no effect on intermittent fever.
He determined to experiment on himself with this substance, and in doing so, brought out upon himself the characteristic symptoms of intermittent fever - a syndrome which Cinchona was often seen to cure.
Hahnemann's Cinchona proving was remarkable for several reasons. It brought to full meaning Hippocrates' observation that "that which may poison, may also heal."
It suggested that we could functionally describe disease in terms of its carefully observed visible signs and symptoms, rather than labor at proposing a description of the invisible disturbance of the interior of the organism.
Finally, it provided a model for a method of systematically ascertaining the medicinal properties of a substance.
This may not seem remarkable to us today, in an era of investigational pharmacology and clinical trials, but it is important to recognize that Hahnemann's "provings" (Ger: experiments) were the first systematic drug trials performed in the history of Western medicine.
In 1798, eight years after his Cinchona self-proving, Hahnemann went public with his new ideas on medical assessment and cure, with the publication of his "Essay on a New Principal for Ascertaining the Curative Power of Drugs".
Seven years later, in 1805, he published his first collection of remedy provings, "Fragmenta de viribus medicamentorum positivis sive in sano corpore observatis" (Fragments on the Positive Powers of Drugs, - that is to say, their effects observed in the healthy body). This contained the pathogenic symptoms of 27 substances, which JH Clarke later described as "the first effort towards the reconstruction of the Materia Medica on a rational basis of pure experiment on the healthy human body."