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  • In Search of the Later Hahnemann

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Hahnemann's cases translated by Rima Handley. 
The story of Hahnemann's Parisian practice after being whisked off by his young wife Melanie.
Rima Handley had a background in teaching medieval literature at university level and also co-founded the Northern College of Homeopathic Medicine. This is the result of pouring over Hahnemann's casebooks archived in Stuttgart. We see Hahnemann experimenting, using higher potencies than before and also prescribing LMs.


Fascinating material indeed.


This book review is reprinted with permission from Volume 16, Summer 2003 Edition of Homeopathic Links.

Reviewed by Ralf Jeutter, Ph.D., UK

At a time where homoeopaths argue, mostly to prove a point, whether Hahnemann was a rigid dogmatist, a shaman, or somebody who always got it right and therefore needs to be emulated at all times, we maybe could do nothing better than to remind ourselves who he actually was and what he did. Rima Handley's meticulously researched book 'In Search of the Later Hahnemann' provides a good opportunity to compare the mental images we have of Hahnemann with the actual man.

For the author Rima Handley, this book is a second visit to a familiar scene: This time she looks less at the private Hahnemann and his relationship with Melanie, as she did in 'A Homeopathic Love Story', but takes a close look at the patient journals (housed at the Robert Bosch Institute in Stuttgart, Germany) of Hahnemann's last years in Paris from 1835-1843. The significance of her first -rate scholarly research for anyone interested in homoeopathy is evident in the sentence: 'So far we have had no clear idea how Hahnemann actually practiced, only what he put forward as his theory,. (p.11) Here now is a chance to look into his workshop, and to make up our own minds whether the Organon is a practical guide to run a busy practice, or whether it is only a statement of intent. Although it was not Rima Handley's expressed intention 'to take sides in the apparently endless

controversy between unicists and complexicists, classical and pathological prescribers' (p.15), the reader can't help trying to decide on these issues while reading the book. And it is exactly this aspect of the book that makes it so much more than a purely historical snapshot.

The individual chapters of the book deal with the different theoretical and practical facets of Hahnemann's practice in Paris. She outlines the 'Context' (chapter 1) of Hahnemann's move to Paris; we get lively images of the 'Patients' (chapter 2); she gives an overview of Hahnemann's 'Theory of Disease' (chapter 3) at this time; his routine use of Sulphur as a miasmatic remedy; we get a picture on what grounds Hahnemann chose the 'Remedy to follow Sulphur' (chapter 4); the 'Materia Medica' he had at his disposal (chapter 5); his understanding of the 'Venereal Miasms' (chapter 6); the 'iatrogenic diseases' he had to contend with (chapter 7); his 'experimentation with dosage and potency' (chapter 8), and his search for the 'ultimate attenuation' (chapter 9).

In the chapter on the 'Theory of Disease' Rima Handley outlines Hahnemann's miasm theory since 1828, which already included the well-known triad that miasm is a) an infectious disease, b) the consequences of suppression of infectious disease, and c) inherited disease patterns. It is fascinating to witness how ideas like genetic inheritance and microbiological organisms as transmitters of disease are slowly emerging without their full conceptualisation yet (which is a testimony to Hahnemann's correct intuition). Rima Handley gives a concise overview of the history of our understanding of miasms from Hahnemann, via H. Allen and IT. Kent to modern thinking 'to mean a tendency to chronic disease initiated by the acquired or inherited effects of psora, of venereal disease, of tuberculosis or cancer, or even of less apparently noxious diseases such as influenza'. (p.38) Particularly relevant to our time are the contributions by H. Allen and J-T. Kent and their moralistic and metaphorical understanding of the miasms as 'the separation from God', a type of thinking which is widespread in the homoeopathic community up to this day.

The most interesting aspects of this book concern Hahnemann's prescribing techniques. Hahnemann initially went to Paris as a 'private citizen, a retired doctor' (p.9), but then the last eight years of his life turned out to be one of the most productive and experimental phases of his life. The case books show 'the process by which he abandoned the use of the single unrepeated dry dose in favour of frequently repeated liquid doses'. (p.13) Often remedies were given daily. It seems to have been very important for him to constantly change the potency slightly to create a dynamic response to the disease. Once he started with higher potencies (beyond 30C - from mid 1838 onwards), he would use descending and later ascending scales, e.g. he would start with 100C (daily), a week later 90C (daily), then suddenly 185 C, then 199C, then 200C. He started the high potencies when he observed that the case plateaued on 30C. At this time Hahnemann became also more and more a miasmatic prescriber: '[...] whereas in the earlier years of his practice he had prescribed on the basis of what he had termed a "totality" of individual and characteristic symptoms, he now took to opening the majority of his chronic cases with Sulphur [...] it was common for him to prescribe Sulphur at the outset of a case, and to continue to do so, until other symptoms more characteristic of another remedy emerged'. (pp.40 and 44)

The casebooks make clear that Hahnemann prescribed often on 'very partial [...] indications' (p.66). Neither mental, nor dispositional factors seem to have been decisive for the choice of remedies in many cases, although they were taken into consideration occasionally. Psychological symptoms per se were not treated as more important, only if they were characteristic (as stated in Organon para 211). Rima Handley then makes the following point: 'The prominent place given to these (i.e. psychological symptoms) in modern homoeopathy seems to have originated with Kent and his followers, half a century later, when they equated illness with sin, and disease with willingly turning away from God. Seeing all disease as being primarily an affection of the inner man, they necessarily saw inner, psychological symptoms as causative'. (p.71) Here we get a glimpse of how important Rima Handley's book is beyond a specialised historical interest. By developing a historical perspective we can become aware of the one-sidedness of so much of modern homoeopathy (in favour of mental 'symptoms'), and the confusion which springs from that. We also might become aware of the hazards of treating disease as a metaphor, an expression of psychological or spiritual dynamics, instead of remaining inductive and analytical. In this context it is ironic that there is this image of Hahnemann as being rigid. What we can observe in the Paris patients' book is that he employed the whole ran e of prescribing techniques we are familiar with up to this day, all of them clearly outlined in the Organon: Miasmatic prescribing; prescriptions based on characteristic and distinctive symptoms - if these were not to be found in the case he would prescribe on at least important and prominent symptoms. If these were not present he was not adverse to rest his prescription on common symptoms, e.g. Opium or Plumbum for 'constipation'. He also employed remedies for certain pathological states, e.g. rheumatic remedies, paralytic remedies, respiratory remedies, urinary remedies, etc.

When he prescribed miasmatic ally it did not mean that his findings on totality and strict symptom similarity became obsolete. In extremis, when all possibilities were exhausted, he would also use unproven remedies, e.g. 'Auto', a remedy made from sputum of a tubercular patient. Reading the book one gets the impression that Hahnemann's development as a homoeopath mirrors the evolution of homoeopathy in general, and that dogmatism, as so often, is the prerogative of disciples. He employed many prescribing methods simultaneously, methods which many of us tend to see as exclusive to each other. On the other hand, this multipronged approach should not be confused with the empirical dictum of employing whatever helps. Rima Handley is very clear in her assessment of Hahnemann: 'Of course, Hahnemann still practices as we always thought he did, still does what he always said he did - on the whole. What is interesting, however, is to see how often he broke his own rules, as do all creative people'. (15) And she is candid enough to state in the beginning: 'Because I have been looking at Hahnemann's process rather than his conclusion I have singled out the examples of his rule breaking. [...].' (p.15)

This book can only increase our respect for Hahnemann, the physician, esp. when we appreciate the materia medica he worked with. In a sense, he was most of the time in the situation like we are now when proving a new remedy. We struggle with the 'understanding' of the remedy purely on the basis of the list of elicited symptoms without the backup of clinical experience. It is all the more admirable to see how 'complete' many of his provings are, although their full range of applicability has often evolved over decades and the use by 1000s of prescribers.

Another aspect of the anticipatory nature of Hahnemann's work is his development of homeopathy as a constitutional medicine. Despite the clarity of §5 regarding the importance of disposition, it is clear that Hahnemann only practiced it in rudimentary form. The full implications of a holistic and constitutional medicine were only developed after Hahnemann, although he was already able to stress the importance of this concept.

Hahnemann does not come over as the 'genius' prescriber (and how many we have these days in our ranks!), who produces one brilliant cure after the next. Rima Handley's assessment is sober in this respect: 'Of course he often failed. There are no miraculous transformations in these casebooks. No one emerges from the Hahnemanns' consulting room a fully realised human being with all the miasms cleared. People do often emerge, however, in better health'. (p.66) As a reader one wonders whether modern homoeopaths are so much better than Hahnemann was, or whether the Paris case books provide a further example of his integrity, which did not allow him to portray himself in a better light. Or are we getting vistas into a time of our profession where self-promotion was not 'de rigueur' yet?

Rima Handley has written a thought-provoking book. The book shows (without necessarily meaning to) that many of the oppositions in the current debate on the state of homeopathy are false oppositions, and that Hahnemann was much more versatile than his friends and foes might like to think. What also comes through is the importance of the time before Kent. It seems that in our pursuit of the MIND we have lost a few treasures on the way. This book, beautifully and professionally published by the excellent publishing house Beaconsfield, can possibly help to refocus our attention.

 

This book review is reprinted from The Homoeopath with permission from Nick Churchill of The Society of Homoeopaths.

I've written a number of book reviews that end, "This is a book every homoeopath needs on their shelf!" Rima Handley's new volume, In Search of the Later Hahnemann, is not one of those books.

This small volume has been a massive undertaking for Handley. It is a work that has been waiting almost a hundred years to be printed, and only because of Handley's unswerving dedication to the project has it become manifest. But the audience will be small. It is not the wonderfully told tale of A Homoeopathic Love Story, her last book. It offers no tips on how to practice. It has no therapeutics hints. It contains no materia medica. It is, for most homoeopaths, a book of no practical use.

So what is it? It is a short visit to an amazing historical record. When Dr. Richard Haehl uncovered the manuscript of Hahnemann's 6th Edition of the Organon, he also found Hahnemann's casebooks - 54 of them. The books, along with over 5,000 letters, were eventually given to the Robert Bosch Foundation in Stuttgart, where they have been carefully preserved.

The books contain the case records of all of Hahnemann's cases from 1801 until his death in 1843. When Hahnemann moved to Paris in 1835, lie began to practice with his wife, Melanie. The casebooks from this time are generally written in French, usually by Melanie, with comments and additions made by Hahnemann.

It was during this time that Hahnemann was also working on the 6th edition of the Organon. Ready for publication in 1842, it was not published until Haehl found the manuscript in 1920. Even then, with homoeopathy in decline, most homoeopaths were still practicing from the 5th edition that was written in 1833. Few looked at the changes that Hahnemann made in his last years. Handley's previous book tells us a bit about Hahnemann's practice in Paris. We read how he "opened his cases" with Sulphur, and how he experimented with various scales of potency. In this book the picture is fleshed out, and a strange picture it is indeed. Handley presents us with a precis of the last few years of Hahnemann's practice, as well as three complete cases from Hahnemann's casebooks. It is a fascinating record. Says Handley, "Until the very end of his life be 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."

I question this statement and wonder if this is a judgement on the part of Handley. Hahnemann, when presenting two cases in his Materia Medica Pura in 1833 said, "Many persons of my acquaintance but half converted to homoeopathy have repeatedly begged me to publish still more exact directions as to how this doctrine may be actually applied in practice, and how we are to proceed. I am astonished that after the very particular directions contained in the Organon more special instructions are wished for. I am also asked, 'how are we to examine the disease in each particular case?' As if special enough direction were not to be found in the book mentioned." And later he says, "The request of some friends, halting half-way on the road to this method of treatment, to detail some examples of this treatment is difficult to comply with, and no great advantage can attend a compliance with it. Every cured case of disease shows only how that case has been treated..." From MY reading, Hahnemann was hesitant to publish more cases because he was afraid that people would start seeing "this" remedy for "that" disease - something he did not want to encourage.

In Search of the Later Hahnemann introduces us to a parade of patients, including the rich and famous, with a catalogue of their ills. We see a sick population. Many had syphilis and/or gonorrhoea, and most had been victims of conventional allopathic medication. Among the patients we find Lord Elgin (of the Elgin marbles) who came for chronic neuralgia, Dr. Quin from England who came for his arthritis and asthma, Baron Rothschild who was seeking relief from his arthritis and neuralgia, the sculptor David d'Angers who came with rheumatism and gout, and the violinist Nicolo Paganini who came with a variety of complaints. Some of the patients had seen other homoeopaths before coming to Hahnemann. We see Hahnemann struggling with the remedies, most of which had only his provings to guide him. We see him using remedies that had minimal provings.

We see him, on occasion, using a remedy called "Isopath," made from the discharges of the patient. Says Handley, "Of course Hahnemann still practices as we always thought he did, still does what he always says he did - on the whole. What is interesting, however, is to see how often he broke his own rules, as do all creative people."

Put yourself in Hahnemann's position. You have devised a system of treatment. Sometimes it works, sometimes it doesn't. Where are you going wrong? Are you looking at the cases right? How much can you expect in the way of cure when the patient has been subjected to mercurial baths and has lost all her teeth? How do you use the few remedies you have available?

By the end of Hahnemann's life, he had only 201 remedies in his medicine case -, not all of them with full provings. Apis and Glonoine were still 10 years in the future. Syphilinum and Medorrhinum were about 40 years away.

Handley says it clearly in her introduction: "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 homoeopathy."

Because of a few of the cases in Handley's earlier work, many people are under the impression that Hahnemann, in his last years of practice, gave daily doses and started all his cases with Sulphur. The few cases in this book show quite the opposite. Although he often gave a series of doses, once lie saw strong action he gave placebos and waited and watched. He did not continue daily dosing for very long without a break. Similarly, he did not open "every" case with Sulphur- but he certainly did open many of his cases that way - and in the nature of the cases, many of them drug- suppressed active psora, it is an almost understandable tack to take.

One of the problems that exists with the notebooks is that Hahnemann's method is not spelled out clearly but expressed in his own shorthand. Sometimes his posology is clear and at other times we are not completely sure what he was doing. Handley says that "...the pattern is sufficiently clear to provide a reasonable degree of certainty in expanding the abbreviations", and she has taken the liberty of completing phrases within square brackets. So we have a prescription like this: "Lauroceras (potency not specified) in 10 [tablespoonfuls of water and half alcohol]. Put I tablespoonful in a glass and take 1 teaspoonful [of that daily]."

The frequent placing of the word "daily" in brackets on the notations of Hahnemann's prescriptions is problematic. Handley seems to assume that Hahnemann gave doses daily but offers no proof of her assertions other than the "reasonable degree of certainty" offered above. It is important to separate what is coming from Hahnemann and what is inferred by the author. At one point, commenting on Hahnemann's cases, she says, "He did not know what would happen and was often taken by complete surprise." Is this a judgement of the author, or a statement made, directly by Hahnemann?

Handley says: "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." This does not fit with what Hahnemann said in his writings, and I am surprised that Handley is continuing to foster the myths. The method of giving the single dry dose and waiting until there was a relapse of symptoms before repetition was mentioned in the 4th edition of the Organon (1829). By the time Hahnemann wrote the introduction to Boenninghausen's A Systemiatic Alphabetic Repertory in 1832 he had revised the single dry dose posology. The "main text" of 5th edition of the Organon (1833) clearly advocates the use of liquid doses in paragraphs 285 to 288 ("The action of the medicines in liquid form..."). By the 6th edition he introduced the use of the LM scale.

Through the few cases that are presented in this book we see Hahnemann "wobble and grope", - - going up in potency, going down in potency, trying one remedy after another. Often he seems to be chasing the symptoms. Using the analogy of illness as being "out of tune" Hahnemann seemed to be trying to "tune each note" before moving on. He rarely, if ever, seemed to find the elusive simillimum. He was working at the beginning of homoeopathy with a very sick population and with remedies whose usages were barely realised.

With a few exceptions as noted, the author has not inserted herself into the work. It is my understanding that she had writ- ten a final chapter discussing the implications of the work, but decided not to use it. All she says, in recognition of the import of the material presented is, "I have not been in any way concerned to take sides in apparently endless controversy between unicists and complexists, classical and pathological prescribers."

And, indeed, these controversies will continue. There are those - alternating remedies, switching remedies often, using isopathic remedies, going up and down in scales, starting with a nosode or with Sulphur- who will point to this work and say, "well, Hahnemann was doing it, so I am practicing like Hahnemann!"

The point is missed by those who say that Hahnemann was "breaking his rules" and therefore, they can too. Through this book we can follow a piece of a practice that was taking place in the first forty years of homoeopathy - when there were few remedies, little clinical experience, and no understanding of the potential of the remedies, nor the possible depth of the true simillimum.

Certainly Hahnemann, in his practice, "wobbled." Would any of us be any better having to face the same conditions with the same box of remedies? Perhaps current homoeopaths who are well versed in the Organon and have been practicing for a few years might be better homoeopaths than Hahnemann - were he to appear to us today -but, on occasion, they "wobble" too.

What we should not forget is that what Hahnemann gave us was the Organon; "the operating manual." In it, lie sets out the system as he believed it should be. His last revision of it was completed just a year before his death. When I read paragraph nine ("we use homoeopathy to let our patients achieve the higher purposes of their existence") I realise that this is the ultimate expression of what we should be doing and that Hahnemann was setting a goal much higher than he was ever able to personally achieve.

I recall reading a transcript of an inquest held for a little girl who died in Brooklyn, NY in the early 1850's. She had been under homoeopathic care. Her homoeopathic physicians were Carroll Dunham, A. G. Hull, John Gray, and P. P. Wells. Reading the transcript of the inquest lets you understand that these "grand homoeopaths" had NO idea of what they were doing. "We thought it was this, so we gave her that, and then we changed our mind, and gave her..." It was early in their careers. It reads, to us now, like terrible homeopathy. These homoeopaths were the proverbial "babes in the woods." Will homeopaths a hundred years from now look back and think the same of our work?

To sit and digest the material in Hahnemann's casebooks is a massive venture. The first obstacle is to decipher the handwriting of both Samuel and Melanie Hahnemann. The second is to translate it from the original French (with a smattering of German) into English. By undertaking this massive feat, Rima Handley has done a great service in bringing this information about Hahnemann's practice to our attention. It serves to show us how far homoeopathy has come in the last 150 years and to show us the daily . realities of practice by Hahnemann and his best pupil. It shows us the Emperor without his clothes. It serves to put it all into perspective and have us realise how clear was Hahnemann's vision, as presented in the Organon, even though he was generally unable to achieve that level of clarity in his own practice.

The Homoeopath
No. 68, Winter 1998

 

This book review is reprinted from the British Homoeopathic Journal Volume 87, January 1998, with permission from Peter Fisher, Editor.

Reviewed by Anthony Campbell

Most students of homoeopathy are familiar with the outline of Hahnemann's life and know that in 1834, in his 79th year, Hahnemann made a surprising second marriage, to a young Frenchwoman called Melanie d'Hervilly. At this time he was living in semi-seclusion in the little dukedom of Kothen, but soon afterwards he went with his wife to Paris, where he quickly established a successful and fashionable practice. However, it is not so widely realised that the homoeopathy he was practising at this time differed in important respects from what had gone before. One reason for this relative unfamiliarity with Hahnemann's later thought may be the predominance of Kent's view of homoeopathy. Kent died in 1916, but the sixth edition of The Organon, written while Hahnemann was in Paris, did not come to light until 1923; thus Kent was familiar with the fifth edition and based his practice on that, but the sixth edition differs in important respects from the fifth. Rima Handley has therefore performed an important service to homoeopathy by making this account of Hahnemann's late phase available to the homoeopathic community.

The publication of the sixth edition of The Organon was due to Hahnemann's chief biographer, Richard Haehl. Shortly after this Haehl died, leaving a vast amount of material unedited and unpublished. Fortunately, it survived the Second World War and has been preserved in a collection in Stuttgart. It appears to be of unparalleled importance for homoeopathy. There are, for example, 54 thick volumes containing the records of most of the patients treated by Hahnemann since 1801; this material is almost unknown though a few preliminary articles have appeared in German. Handley's book deals with only that part of the archives which relates to Hahnemann's Paris period, but though it is fairly brief this is a scholarly study well supported by notes and references. Handley is a historian by training and her general approach creates a feeling of confidence in the reader that she has got her facts right. I was therefore intrigued to find Melanie referred to as a Marquise; I have not seen this appellation applied to her previously and it is a pity that Handley does not elaborate on it.

We often hear or read references to something called 'classical homoeopathy'. This is usually taken to be synonymous with Kentian homoeopathy (reliance on the single dose, emphasis on the use of 'mentals' in prescribing, and so on). Anyone who has read the sixth edition of The Organon will already know that Hahnemann himself had departed considerably from this way of practising at the end of his life, and this book will make that even clearer. There is of course no mention of 'constitutional prescribing, which is a post-Hahnemannian innovation, but it is perhaps more surprising to find that there is nothing much about trying to cover the totality of the symptoms. Instead, Hahnemann lays great emphasis on the psora theory; almost all his patients are prescribed sulphur and some get only sulphur. Moreover, they don't get single doses, but prolonged courses of repeated daily doses. Usually the potency of successive doses is slightly altered by a technique similar to that known today as 'plussing'. The LM potencies are also used extensively, and we see Hahnemann just beginning to experiment with nosodes, though not the ones which we are familiar with today; he even tries some isopathic remedies.

For Hahnemann at this stage of his career, psora is virtually the key to disease and its treatment. Handley rightly identifies the theory as based on the notion of infection. Psora is thus in principle an acquired disease, although there is a glancing reference in a note in the sixth edition of The Organon which hints at the notion that psora might be inherited. It was later homoeopaths, especially in the USA, who made the question of inheritance an integral part of the theory. As Handley correctly remarks, 'Lamarckian' ideas of heredity were current at this time and it is a historical anachronism to project our own understanding of heredity onto Hahnemann.

One of the ways in which homoeopathy differs from mainstream medicine is the extent to which it is historically based, Newcomers are generally told that it is founded on the provings and on Hahnemann's writings. This is at best a half-truth; it would be more exact to say that it is founded on what various writers have said about these things. Few modern homoeopaths read the original proving material and The Organon, it has to be said, is not light reading. Nevertheless, I have long been convinced that it is impossible to understand homoeopathy in depth unless one does make the effort to come to grips with its historical foundations. I should therefore say that this book will be essential reading for any serious student of the subject. Handley is to be congratulated on making this material available in a scholarly but readable form. I hope that she will return to the Stuttgart archives to shed further light on the earlier development of homoeopathy.

British Homoeopathic Journal
January 1998


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