Hahnemann
by Ameke: a Sound and Reliable Witness.
by Peter Morrell
Dream of Egypt, 1995 – Peter Morrell
This
short piece brings to the attention of others the useful work of Wilhelm
Ameke from his little known book ‘A History of Homeopathy.’
Being out of print for over a century and hard to obtain, this useful
text illuminates Hahnemann’s life in a fresh and masterful way. This
is an interim piece I compiled recently for some lectures, and which
will be extended as time permits. In due course, it is hoped that the
full text of Ameke might be placed online where all can admire its many
gems. This selection mostly focuses upon Ameke’s description of
Hahnemann’s views on many clinical matters and snippets regarding the
origin of homeopathy. It also highlights what is unusual, important and
remarkable in his character as a physician.
***************
Although
Hahnemann retained enormous affection and respect for his teacher at
Vienna, Dr von Quarin, it remains certain that von Quarin “was
an advocate of bleeding till the day of his death,” [Ameke, 59]
in 1812. Hahnemann stated, “I owe to him whatever there is of
physician in me.” [Ameke, 58] Although Hahnemann “employed
bleeding…but he always applied it cautiously.” [Ameke, 67]
Though as early “as 1784 he contended…against bleeding,”
[Ameke, 67] yet “he still bled in 1797…and [even as late as]
1800 he was not an absolute opponent of it.” [Ameke, 67] But he
always felt it was abused and used to excess by most physicians. He “was
a great enemy of coffee, but a great advocate of exercise and open air…change
of climate and residence at the seaside.” [Ameke, 60] On the
therapeutic use of cold water “Hahnemann writes at length…and
gives exact instructions.” [Ameke, 62] He always gave “only
one remedy at a time, and carefully watched its effects.”
[Ameke, 74] For every addition of a “second or a third [remedy]
only deranges the object we have in view.” [Ameke, 86] Giving
only one drug, we must “wait till its action is exhausted before
giving another.” [Ameke, 87] Once he was convinced of something
“he enunciated it with the greatest precision, and did not
easily allow himself to be turned from it.” [Ameke, 63]
Even as a young physician, Hahnemann seems to “have
been unaffected by the prevalent belief in authority,” [Ameke,
59] preferring instead to formulate his own medical views, very largely
based upon his powers of reflection and his very keen observational
powers.
Tendencies Hahnemann condemned
In
1808 Hahnemann sharply condemned the main method of “treating
most diseases by scouring out the stomach and bowels.” [Ameke,
94] This is also the “method which regards the diseased body as
a mere chemically decomposed mass,” [Ameke, 94] and which
regards diseases as having “no other originating cause but
mucosities…[inspiring treatments that seek the] combat of
putridity.” [Ameke, 94] Such a view also pretends that only by “the
strength of the doses of most powerful and costly medicines,”
[Ameke, 94] can such disease ever be subdued or cured. Hahnemann bemoans
the “search into the internal essence of diseases,”
[Ameke, 95] which he regards as an utterly futile endeavour. He also
condemns this system as one that respects only “the mechanical
origin of diseases…[and] which derives diseases from the original form
of the parts.” [Ameke, 95] Such a view he regards as too
simplistic, too mechanistic and not sufficiently holistic in its
perception of the living organism.
Hahnemann condemned those medical systems that
claimed “most diseases were produced by impure and acid humours
which were to be expelled from the body,” [Ameke, 42] or which
claimed that “most illnesses resulted from gastric impurities,
especially bile,” [Ameke, 43] and which therefore believed that
“the removal of these matters by emetics and purgatives was the
principal means resorted to.” [Ameke, 43] As far as Hahnemann
was concerned, such medical systems incorrectly concluded, “purgatives
and emetics demonstrated the truth of these theories.” [Ameke,
43] One such idea was “infarcts…an unnatural condition of the
blood vessels…distended in various places by ill-concocted, variously
degenerated, fluid-bereft, inspissated, viscid, bilious, polypous and
coagulated blood…” [Ameke, 43] Hahnemann had nothing but
contempt for such theories and regarded them as entirely imaginary
concepts and dangerous fantasies with no reality whatever. Therefore, he
was equally dismissive of the methods employed such as “clysters…to
which various appropriate drugs were added…employed to disperse these
infarctus.” [Ameke, 44] This treatment with clysters [enemas] “was
much in vogue among physicians, patients and even healthy persons, for
many years.” [Ameke, 45]
Hahnemann was as dismissive of clysters and the
theories of infarcts as he was of the strong mixed drugs also in vogue
at the same time. Such remedies as “senna, spirits of wine,
dandelion, rhubarb, sal-ammoniac, mercury, dog’s grass and antimony…which
were supposed to cleanse the tubes and passages of the human body from
their foul accumulations.” [Ameke, 45] Hahnemann simply did not
believe the monstrous theory that every patient had these mythical
obstructions and poisons. He was therefore wholly opposed to the idea
that they must all be “sweated and purged, puked, bled and
salivated,” [Ameke, 45] back to health by these heroic
measures.
It is no surprise therefore that he roundly condemned
and dismissed on instinct “bleeding, cold, emetics, purgatives,
diaphoretics.” [Ameke, 46] He denounced the “vomiting,
purging and sweating,” [Ameke, 46] view that “inflammatory
matters, impure fermenting substances, acridities and degenerated
bile,” [Ameke, 91] were the causes of disease or that they
should be “energetically evacuated,” [Ameke, 91] in
order to cure the patient. All such talk he depicts as merely a “euphemism
for emetics and purgatives,” [Ameke, 92] and indeed, for “the
lancet, tepid drinks, miserable diet, emetics, purgatives…[which]
threatened to destroy our generation.” [Ameke, 96]
He denounced the use of “blisters, baths,
fomentations, anodynes, and repeated enemata,” [Ameke, 68] just
as he maintained that “refrigerating and laxative salts, watery
drinks, and bleeding act as poisons. Emetics and blisters do harm.”
[Ameke, 68] To most practitioners it must have been “very
tempting to utilise the great chemical discoveries in the treatment of
disease,” [Ameke, 50] but Hahnemann [almost alone] successfully
resisted this temptation. Most physicians were “too impatient to
utilise,” [Ameke, 50] new discoveries, too eager “to
reap when they had barely finished sowing.” [Ameke, 50] They
dismally failed to “observe how the functions of their patients
were carried on.” [Ameke, 53] Even at this early stage, one can
see that Hahnemann was cautiously and judiciously trying to work out
precisely why the medicine he had been taught did not work and one can
detect his endeavour to find a harmless yet efficacious
therapeutic method.
In the early 1790s, he “gave one remedy at a
time, and carefully watched its effects.” [Ameke, 74] This sums
up his approach very accurately. He also “succeeded in achieving
many splendid cures by his simple method of treatment…[soon having]
the reputation of a careful and successful practitioner.”
[Ameke, 74-5] His basic powers of patient observation were truly
remarkable. Not only did he want to know “what is hurtful or
irrational,” [Ameke, 87] in the medicine of his day but why and
how one can proceed to escape from such a useless muddle. In medicine,
he despised whatever was harmful and what did not make sense, usually
both together. “That is the essence of science: ask an
impertinent question, and you are on the way to a pertinent
answer.” [Jacob Bronowski (1908–1974), The Ascent of Man,
ch. 4 (1973)] Hahnemann had the immense audacity and conviction to “prescribe
one single, simple medicament and nothing more,” [Ameke, 97]
and then simply wait and observe. This was the essence of his approach
for the reform of medicine.
Other influences were also at work in their impact on
medicine. One problem that reared its head was “the whirligig of
natural philosophy” [Ameke, 48] which had taken hold of many
people, most of whom were “suffering from the spirit of the age.”
[Ameke, 48] None of this brought any benefit to medicine, according to
Hahnemann. It just gave the signal and increased the tendency to invent
more wild theories. Yet, in therapeutics, disease was increasingly
regarded as a “departure from normal form and composition, that
is, anatomical and chemical change.” [Ameke, 49] Consequently, “one
theory was superseded by another,” [Ameke, 53] and people
frequently switched sides many times. As a result, “dogmatism
and a persecuting spirit,” [Ameke, 57] became the dominant
spirit, just as if religious sectarianism were breaking out in medicine
and inspiring many unnecessarily “embittered disputes.”
[Ameke, 58] Eighteenth century medicine was crisis-torn, with rival
theories pitched against each other in an unseemly battle for supremacy.
As early as 1784, he “speaks contemptuously
of fashionable physicians.” [Ameke, 76] He also tried to “direct
the attention of his fellow-practitioners to the many absurdities of the
day.” [Ameke, 77] Why? because he wanted them to be more
critical. A good example is when he says, “we must forcibly
sever ourselves from these deified oracles if we wish to shake off the
yoke of ignorance and credulity.” [Ameke, 77] He rebelled
against any deference to medical authority [because so and so says this]
as a means of validating a method or concept. He insisted on thinking
for himself and experiment as a superior path. He infinitely preferred
consulting “nature and experience,” [Ameke, 126] to any
medical theory.
Hahnemann was taught the medicine of mixed strong
drugs, which he confessed, “clung to him more obstinately than
the miasma of any disease.” [Ameke, 78] Although in the first
few years of his practice he adhered to this approach, “he was
gradually emancipating himself from this bad system.” [Ameke,
78] It did not work, in spite of his best efforts. As early as 1784, “he
advocates a simple method…instead of the farrago of contradictory
prescriptions.” [Ameke, 78] In the year 1798, “he
inveighs against the physicians who love prescriptions containing many
ingredients…[regarding it as] the height of empiricism…the
employment of mixtures of strong medicines.” [Ameke, 81] He was
realising that the chief problems were mixed drugs, strong doses and
damaging methods like blood-letting, purges and enemas. Nothing in the
medicine of his day was either curative or gentle.
Instead of mixed drugs he would increasingly “give
only one simple remedy at a time…[Ameke, and so] in these simplest
maladies he gave single simple remedies out of the store of existing
drugs which was then small.” [Ameke, 80] His careful and
methodical approach reveals just “how earnest was his striving
after truth and how great his anxiety for the improvement of
therapeutics.” [Ameke, 85] He especially “surpassed his
mixture-loving contemporaries in the gifts of observation and
investigation.” [Ameke, 85] Hahnemann confidently declares
that, “using several drugs at once…is the true sign of
charlatanism. Quackery always goes hand in hand with complicated
mixtures…[which is] so far removed from the simple ways and laws of
nature.” [Ameke, 86]
In 1805, he states “a single simple remedy is
always…the most beneficial…it is never necessary to give two at once.”
[Ameke, 86] He denounces “drugs…which must fight against
diseases,” [Ameke, 87] as deriving from a misunderstanding of
sickness with such doctors viewing patients “through glasses
tinged with ideal systems,” [Ameke, 87] which are utterly
useless means to cure sickness. They did this rather than investigate
matters for themselves, as he was doing. They obstinately clung to
theory and eschewed the spirit of empiricism Hahnemann loved and which
was the guiding beacon of his life. No physicians other than Hahnemann “preached
this important truth with such energy and such conviction.”
[Ameke, 87] He “attacked deference to authority in therapeutics
as early as 1786 and 1790.” [Ameke, 87]
It
is perfectly true that “no physician since Paracelsus had dared
to expose with such frankness and boldness the miserable condition of
the medical treatment of the period…[and] that requires a thorough
reform from top to bottom.” [Ameke, 98] Is modern medicine
really any better? Is it less harmful, more logical or more curative?
Which, if any?
In therapeutics, Hahnemann regarded the many who
became “involved in gossamer subtleties,” [Ameke, 97]
as fools, because such was “a misdirection of mental energy,”
[Ameke, 97] that might be much better employed for the more serious task
of observing patients and using single drugs in small doses. Rather than
do that, they foolishly preferred to use “sweetening, diluting,
purifying, loosening, thickening, cooling and evacuating measures,”
[Ameke, 95] that would not cure the patient anyway. Therefore, in his
view, patients faced “the wretched and hopeless choice of one of
the numerous methods, almost all equally impotent…[with] no fixed
therapeutic principles of acknowledged value.” [Ameke, 99] In
medicine, such was the outrageous state of affairs in the early years of
the 19th century.
Good Reputation
Hahnemann “acquired a great reputation for
his improvements in the practice of medicine, in pharmacology, and
especially in hygiene.” [Ameke, iv] Hufeland, for example, “never
lost respect for Hahnemann’s genius and services to medicine.”
[Ameke, iv] As a translator Hahnemann always “intercalates
various improvements and inventions.” [Ameke, 12] He was widely
regarded as “a writer who has improved and perfected,”
[Ameke, 14] any text translation he undertook. This was no chance
comment. Numerous examples exist of this observation. Numerous honours
and accomplishments in chemistry and pharmacy preceded his discovery of
homeopathy, what Ameke calls “his pre-homeopathic labours.”
[Ameke, x] Various writers refer to “Hahnemann’s
superiority,” [Ameke, 18] or to this “very valuable
book by my esteemed friend, Dr Samuel Hahnemann.” [Ameke, 18]
These comments mostly allude to his innumerable minor
discoveries and embellishments to the art of chemistry, or to the value
of his translation footnotes all completed before the emergence of
homeopathy. For example, “in 1788, Hahnemann discovered the
solubility of metallic sulphates in boiling nitric acid.”
[Ameke, 28] Another is “the test for wine invented by Dr
Hahnemann [which] has especially pleased me.” [Ameke, 29] Or “Hahnemann’s
mercury, an excellent and mild preparation, the usefulness of which has
been proved.” [Ameke, 32] He is variously described as “a
capable physician,” [Ameke, 75] and “one of the most
distinguished physicians of Germany…of matured experience and
reflection…a man rendered famous by his writings.” [Ameke,
75]
In 1799 one writer alludes to Hahnemann by calling
him “a man who has made himself a name in Germany both as a
chemist and a practitioner [who] deserves especial recommendation,”
[Ameke, 37] and adds that “every article gives evidence of
having been written with the greatest care.” [Ameke, 37]
Another critic expresses his admiration for “a man who has
conferred so many benefits on science…by his valuable
translations…that are faithful and successful…[who has] added
precious notes which expand and elucidate [the original]”
[Ameke, 40] such that “he has thus enhanced the value of the
work.” [Ameke, 40] So highly regarded were Hahnemann’s
translations “which he has enriched with his own notes.”
[Ameke, 40] These “great many explanatory and supplementary
remarks…give the translation a great advantage over the
original.” [Ameke, 40]
Such writers could clearly appreciate the “thoroughness
of his emendations…his short notes…[which] serve to explain the
text…and which is enhanced by the translator’s notes.”
[Ameke, 40-41] Such comments reveal the clear and unambiguous
recognition which he received for his “thorough pharmaceutical
knowledge and industry…this celebrated chemist…this meritorious
physician…the meritorious Hahnemann…whom chemistry has to thank for
many important discoveries.” [Ameke, 41] He is unanimously
applauded as one who “has won for himself unfading laurels,”
[Ameke, 42] for his contributions to science. Hahnemann was “so
much respected and renowned for his valuable services,” [Ameke,
90] that he did not require to “to make himself more popular
with the German public.” [Ameke, 90]
When
Hahnemann correctly stated that “Arsenic does not contain
muriatic acid…[this showed] Hahnemann’s superiority,”
[Ameke, 18] in points of chemistry. In all his translations, “accuracy
prevails everywhere,” [Ameke, 22] and reflects the “extreme
care he employed in his labours.” [Ameke, 22] As early as 1784,
“Hahnemann advocated the crystallisation of tartar emetic.”
[Ameke, 24] It was in the fine details of his corrections and footnote
additions that he earned his reputation as a meticulous, highly
knowledgeable, diligent and thus reliable scientific translator. In
time, he garnered a similar reputation for his work reforming pharmacy,
for example, “the regulation and sale of poisons,”
[Ameke, 34] the “preservation of odoriferous substances,”
[Ameke, 34] and the “evaporation of extracts over water baths.”
[Ameke, 34] Ameke also lists many pages of examples of his contributions
to pharmacy and examples of his recommended small doses for drugs of all
types.
In such innumerable ways Hahnemann was considered to
have “enriched our therapeutic thesaurus.” [Ameke, 35]
In every case, they all prove “how thoroughly Hahnemann had
studied the subject,” [Ameke, 34] in question, whether it was
botany, pharmacy or chemistry. It meant that when he made a statement “every
page shows that the well informed author speaks from experience,”
[Ameke, 37] it shows his great diligence, that he composed work of more
than “an ordinary character,” [Ameke, 37] that he
always produced “useful work,” [Ameke, 38] and that “he
surpassed most of them in knowledge of the subjects,” [Ameke,
38] on which he expounded. Such factors considerably enhanced his
scientific credentials.
Dose Reduction
Hahnemann “even wished to see the names of
diseases abolished.” [Ameke, 116] Though he recognised the
obvious convenience of disease classification schemes, he “always
advocated individualisation and taught it systematically.”
[Ameke, 116] He felt that giving diseases names was a highly misleading
habit that inevitably led to disreputable rote prescribing, and to
viewing a sickness as an actual thing. Though he did use crude drugs
throughout the 1790s, he developed a peculiar method of administering
the drug “in very small but continually increasing doses, till
some severe symptoms manifest themselves.” [Ameke, 119] He
later called this the ‘primary toxic action’ of a drug. Then the
dose was abruptly stopped and beneficial results awaited. He later
called this the ‘curative secondary reaction’ of the vital force
elicited by a drug [see Organon §57, 59, 63, 64-6, 69, 112,
114-5, 130, 133, 137-8, 161 for primary and secondary effects of drugs].
He gradually diminished the doses he used throughout that decade. He
always used smaller doses than his contemporaries, and experimented a
great deal in achieving good results from the tiniest doses. These
trials obviously flowed from his conviction that large doses were
intrinsically harmful and felt it was his duty to find a saner, more
rational and less damaging approach to the whole question of dosage of
drugs. He soon saw the reform of drug dosage as absolutely crucial for
any reform of medicine itself.
Mercury in syphilis is probably “the only
instance after 1799 in which he recommends stronger doses.”
[Ameke, 121] His method “began with small ones and gradually
increased them up to the point of slight toxic action.” [Ameke,
121] In this manner he aimed to transform himself into “the
zealous, careful observer, the conscientious physician.”
[Ameke, 121] Though he had not as yet “raised the smallness of
the dose to a general therapeutic principle,” [Ameke, 121] yet
this practice of unrelenting dose experimentation “was peculiar
to him, and distinguished him from all his colleagues.” [Ameke,
121] He also “noted accurately the duration of action,”
[Ameke, 121] of drugs that he used. No-one else was doing this. And all
the while these experiments formed an essential part of “his
laudable endeavours to attain to simplicity of treatment.”
[Ameke, 121]
In recommending smaller doses for numerous drugs,
Hahnemann was basing his view on direct observations of the actions of
drugs on the body. Repeatedly, he grounds his medical views not in
high-faluting theories but through consulting “nature and
experience,” [Ameke, 126] as his chief guides in all that he
says. In the footnotes to Cullen [1790], Monro [1791] and the Edinburgh
Dispensatorium [1797], he disagrees with almost every dosage listed by
the original author, concluding always that “large doses…must
do harm.” [Ameke, 126] Instinctively, he rebelled against large
doses as harmful.
In every case, therefore, he recommends “an
incredibly small quantity,” [Ameke, 127] of the drugs he
discusses, because the large doses “multiplied experience will
not allow me to advise.” [Ameke, 127] The results “of
the zealous and careful researches of our genial investigator forced
upon him…the conviction that the doses…accepted as normal, were much
too large.” [Ameke, 127] History records “no instance…of
a physician ever having attempted to determine the question of the
suitable dose with such zealous endeavour as the clear-sighted,
indefatigable and thoughtful Hahnemann.” [Ameke, 127]
Severing
his link with tradition, and basing his views solely upon direct
observation and experience, he “proceeded still further in the
diminution of the dose.” [Ameke, 128] Nor did he recommend
drugs on the old basis. He did not aim “to produce emesis,
purgation, or narcosis; neither did he employ them to cleanse the blood
of acridities…cutting the phlegm, softening of indurations, or
destroying parasites.” [Ameke, 128-9] What such low dose
preparations he used did, was to “favourably influence the
curative process.” [Ameke, 129] This means they assist the
natural healing powers. This was a radically new therapeutic concept.
Furthermore, he found that small doses of the best
remedy would create “as great an impression as if they were
infants at the breast.” [Ameke, 129] By this he meant, “the
sensitiveness of the human body to medicines…transcends all belief.”
[Ameke, 129] He especially means sensitivity to similar medicines.
He himself was “astounded at his discovery.” [Ameke,
129] He too regarded as incredible “the results obtained by a
millionth, a billionth, etc, part of a grain of medicine.”
[Ameke, 129] As is now well known, he soon went on to obtain “results
which could not be obtained with the crude substances.” [Ameke,
131] Drugs, which obviously contained no detectable substance, still “possessed
great healing power.” [Ameke, 131] They heal by their
similarity to the case totality and by stimulating the innate
self-healing powers.
This breakthrough in dose reduction and medicine
preparation also meant that many previously “highly poisonous
substances,” [Ameke, 131] could now be brought into harmless
use as healing agents. They could indeed be “converted into…powerful
remedial agents in the hands of a skilful physician.” [Ameke,
131] Dismissing the views of his “dogmatical and credulous
predecessors,” [Ameke, 133] whose theories and “deductions
ran counter to the maxims of experience,” [Ameke, 133]
Hahnemann, as “a practical physician,” [Ameke, 133]
grounded his medical views solely in the “science of experience.”
[Ameke, 133] He roundly condemned the “imaginings of physicians,”
[Ameke, 133] which he felt to have no place in any rational healing art.
What he also called “speculative refinements, arbitrary axioms…dogmatic
assumptions…[and the] magnificent conjuring games of so-called
theoretical medicine.” [Ameke, 134] Instead, Hahnemann had
respect solely for “a science of pure experience…knowledge of
the disease to be treated and the actions of drugs.” [Ameke,
134] These, he insists can only be deduced “from pure experience
and observation,” [Ameke, 134] rather than from signatures or
‘old wives tales,’ which he despised.
Appearance
In
his own house “he liked to wear a brightly-flowered
dressing-gown, yellow slippers and black velvet cap.” [Ameke,
157] His long pipe “was seldom out of his hand, and this
indulgence in tobacco was the only relaxation from his abstemious mode
of life…his food extremely frugal.” [Ameke, 157] When seeing
patients, instead of a bureau, “he used a large plain square
table on which three or four huge folios lay, in which he had entered
the histories of the maladies of his patients…[and] in which he wrote
down their cases…with the exactness which he recommends in his Organon.”
[Ameke, 157]
Source
Wilhelm Ameke, History
of Homœopathy, with an appendix on the present state of University
medicine, translated by A. E. Drysdale, edited by R. E. Dudgeon,
London: E. Gould & Son, 1885.