Single Drugs, Small Doses, Similars – Peter Morrell

Single Drugs, Small Doses, Similars

by Peter Morrell

Crete, 23-4-2000

“…in the period in question, Hahnemann seems to
have been pretty well assailed on all sides by many difficult and unresolved medical
problems at the same time…and this, probably explains the relatively slow pace of his
progress between 1782 and 1799. Like a military commander besieged and fighting on
several active fronts at the same time he could only devote a small amount of his time,
energy and intelligence to any one problem at a time…it really is a testament to his
inventive genius that he did settle all these complex problems in less than two
decades.”[Morrell, 1999, NEJH 8.2, p.108]

——oOo—–

In our attempts to understand Hahnemann’s early work and the events
that lay behind the origin of his new system, we need to consider a range of central
themes, which he himself had unravelled, and which repeatedly bedevilled his progress
1783-1800. In outline terms, these themes include large vs. small doses; signatures vs.
provings; contraries vs. similars; primary and secondary actions of drugs; their toxic and
therapeutic effects; the ability of diseases to displace one another; single vs. mixed
drugs; and his accumulation of data from the literature about the actions of drugs in
health and disease.

These themes constituted a dense mass of problems that Hahnemann
confronted. Slowly and systematically, and with considerable difficulty, he patiently
worked his way through them all; the fruits of his labours eventually being homeopathy,
based, as it is, upon the four central principles: similars, provings, single drugs and
small doses. To some extent, Hahnemann must have derived these principles from the
underlying but opposite principles of Old Physic: contraries, signatures, mixed drugs and
large doses.

We need to consider the processes by which he seized upon these four
principles and the manner of his disengagement from Old Physick. The facts being mostly
unknown, we must try to piece these ideas together ourselves through ‘thinking aloud’.
This essay attempts precisely that.

Having already attempted to account for the origin of provings and the
small doses of homeopathy [see The Proving, Potentisation and The Law of Similars,
Resonance, USA, June 1998; >From Poisonings and Provings to Holism, Similia
11.2, Australia, Dec. 1998; Hunter, Hahnemann and the Origin of Homeopathy, New
England Journal of Homeopathy, Jan 2000, USA; Some Reflections On the Origin of
Hahnemann’s Ideas, Feb 2000, online], I have recently been contemplating the manner in
which Hahnemann began to focus upon single drugs and similars, during his studies of the
1780s. One useful approach, for example, is for us to consider why he reduced his doses:

‘We cannot fail to be struck by the sudden transition from the
massive doses he prescribed in 1798 to the unheard-of minuteness of his doses only one
year later, and we can but guess the causes for this abrupt transition.’ [Dudgeon,
1853, pp.395-6]

It is very difficult to conceptualise why Hahnemann wished in 1798-9 so
suddenly to reduce the doses of his drugs. In order to set that problem into its right
context, it is helpful to review all his previous work with drugs during the 1780s and
1790s.

In his researches into the actions of drugs, Hahnemann was engaged in a
monumental struggle to generate some new order and light out of the great chaos and
darkness of many years standing. Yet, it is very hard to convey all of this material
clearly and concisely to the interested reader. Eventually, it was all neatly laid out in
the Organon [especially aphorism 59], but it started out very much as a tangled
mass of complex material, of ‘work in progress’. Some was derived tentatively from his
historical researches, and the rest came in profusion from his own observations of drugs
and how they function.

The starting point was his decision, around 1784, to reject the use of
opposites and strong doses. This momentous turning point was arrived at because he had
been repeatedly frustrated to observe that strong doses always produce toxic effects. Such
an example is provided by the use of Mercury in Syphilis, in which he had long
taken an interest.

That he was also translating medical texts from other languages might
be seen as an important side-issue that kept him abreast of medical developments in
general, but which only earned him a meagre living to support his growing family [see
Nicholls, p.11; for details of his translations see Morrell, 1998, Haehl, pp.511-15 and
Bradford, pp.515-21].

However, what seems truly important about his translation work, and by
no means a side-issue in his development, was his gradual accumulation of therapeutic
hints and tips about drugs. Arguably, that formed the basis for his early experimentation,
as it enabled him to accrue a vast and unique catalogue of information about the actions
of drugs on various occasions, in health and disease, as reported by various authors, from
around the world, and for many diverse medical conditions.

To illustrate how centrally important the period of his translations
was to him, it is useful to remind ourselves that every time Hahnemann had to labour to
argue a point, whether in his minor essays, in the Organon, or in the Chronic
Disease, you will notice that he always fell back on the firm bedrock of numerous
examples, which he had hewn from his studies of the great medical texts of antiquity and
those of his contemporaries. Truly, times without number he used such examples to pepper
his writings. On virtually every page of his writings, they appear. That shows how
important they were to him.

In bringing together this large mass of information – maybe out of idle
curiosity in the first instance – it did not take Hahnemann long to notice that it
contained distinct and meaningful patterns. It was probably this information, which
triggered his new interest in single drugs and similars, and turned him away from mixed
drugs and contraries. It must have been this new data that suddenly changed his focus from
being a merely passive translator, to wanting to become an experimenter. This change in
his attitude in the period 1784-90 was critical, as it paved the way for his provings:

‘Then let us…agree to give but one single, simple remedy at a
time, for every single disease…’ [Are the Obstacles to Certainty and Simplicity in
Practical Medicine Insurmountable?, 1797, in Lesser Writings, p.320]

‘Hahnemann was the first to raise his voice against the compounding
of prescriptions, holding that the effects of compounds on disease could never be
known precisely.’ [Coulter, Vol. 2, p.335]

‘I have no hesitation in asserting that whenever two medicines are
mingled together, they almost never produce each its own action on the system, but one
almost always different from the action of both separately – an intermediate action, a
neutral action, – if I may be allowed to borrow the expression from chemical
language.’ [Are the Obstacles to Certainty and Simplicity in Practical Medicine
Insurmountable?, 1797, in Lesser Writings, p.320]

While translating medical texts in Dresden [1784 on] he started to
collect records of poisonings and records of cures by drugs. Having abandoned allopathic
medical practice in 1784, on his move to Dresden [see Bradford, p.36, Cook, pp.46-7], he
was working as a translator of medical texts [see Morrell, 1998]:

‘From 1782 until 1796 Hahnemann earned a meagre living through work
as a translator, writer and chemical researcher…’ [Nicholls, p.11]

‘But the Dresden period was only a prelude to the man’s real
individual work in later decades. It becomes evident that he recognized the
insufficiency of medical science and of the therapeutic methods of those days, which
he denounced with undaunted energy and eloquence of speech like the old prophets.’
[Haehl, Vol. 1, p.33]

‘[He]…moved to Leipzig at the end of September 1789…which
included the years from 1789 until the summer of 1792…it was only a continuation of
his Dresden mode of living. Here, also he gave up his medical practice…’ [Haehl,
vol. 1, p.34]

It seems likely that what Hahnemann noticed in the growing mass of
data, he had obtained from the literature, soon became glaringly obvious to him; that
single drugs throughout the ages had repeatedly shown themselves able to “cause what
they can cure” and to “cure what they can cause”. Furthermore, he
identified a similar pattern in the records of examples of poisonings by drugs, from
throughout medical history [see Organon pp.159-79, for numerous examples of
involuntary cures by similars; see also Dudgeon, 1853, pp.4-7 and 22-26]. The actual
discovery of this pattern must have been a momentous breakthrough in his thinking, and
arguably, one that was infinitely more cataclysmic and important than his joy at the first
proving. These enormous and resounding implications must have seemed critical to him. In
effect, what he had at last unearthed were two primary and fundamental fault-lines within
allopathy and which comprised the reasons why it was so useless: first, mixed drugs and
second contraries.

‘In Hahnemann, new and great ideas were coming to birth. His whole
intellect was in a state of ferment; he was in a condition of complete internal
revolution. Dissatisfied with the old teaching which he had hitherto received and
acquired, he was almost repelled by it, although he had not yet arrived at a clearly
recognized, firmly established and irrefutably sound basis for a new teaching…he was
distracted by mental labours, which drove him restlessly from place to place.’ [Haehl,
Vol. 1, p.48]

‘From the years 1790 to 1805 his new system of treatment was slowly
coming to birth. We have a first slight intimation of its arrival in 1790; in 1796, we
see the first definite form in the fight against the mixing of drugs in use at that
time; in the following years it unfolded itself further, and attained its first
complete form in the ‘Organon’ in the year 1810.’ [Haehl, Vol. 1, p.48]

This breakthrough in his understanding of the underlying reasons why
allopathy was ineffective, must have lifted his troubled spirits enormously, and must have
been the inspiration that set him on the road to undertaking experiments with single
drugs. The thought that drove his actions was his dream of creating a new medical system.
It was this thought that inspired the experiments. Thus, we can see that only in harness
together, can thought and experiment yield the desired results. The experiments were
conceived to test and confirm his ideas, and, arguably, would not have even taken place at
all, if he had not conceived the ideas behind them.

Once he could clearly see before him a repeating pattern within his
data, then he must have become much more optimistic and confident that he was working
along the right lines and on the point of elucidating a new system; he was buoyed up and
carried along with a new joy. This lift to his spirits must also be measured against the
profound depth of his prior disappointment, almost to the point of despair, at giving up
the practice of medicine in the 1780s.

‘The future looked very dark to the honest seeker after truth. He
had lost his faith in medicine. Of this time, he writes: ‘Where shall I look for aid,
sure aid? sighed the disconsolate father on hearing the moaning of his dear,
inexpressibly dear sick children. The darkness of night and the darkness of a desert
all around me; no prospect of relief for my oppressed paternal heart.” [Hahnemann in
Hufeland, Lesser Writings, p.513, quoted in Bradford, p.51]

“Hahnemann was so disillusioned with the state of medical
practice and knowledge that, soon after his marriage in 1782, he totally refrained
from practising medicine…so deep was his belief that the tools he had been given
would do more harm than good.” [Danciger, 1987, p.5]

‘Had he wished he could have remained in Gommern [1781-84], for
means for his ample living were assured. According to the statements made by his
contemporaries and by himself, he had become disgusted with the errors and
uncertainties of the prevalent methods of medical practice, and wished earnestly, to
seek for some better method. He reduced himself and his family to want for conscience
sake.’ [Bradford, p.36]

“After I had discovered the weakness and errors of my teachers
and books, I sank into a state of sorrowful indignation, which had nearly altogether
disgusted me with the study of medicine.” [Opening lines of Aesculapius in the
Balance, 1805, in Lesser Writings p.410, Jain Edition]

“For 18 years I have departed from the beaten track of
medicine. It was painful to me to grope in the dark, guided only by our books in the
treatment of the sick…In an 8 years’ practice, pursued with conscientious attention,
I had learned the delusive nature of the ordinary methods of treatment…” [From
Letter upon the Necessity of a Regeneration of Medicine, 1808, in Lesser Writings
pp.511-3, Jain Edition]

Hahnemann in the early 1780’s “…was becoming disenchanted
with his chosen profession” [Cook, 1981, p.52] and gave up the practice of
medicine at an early stage in his career, both out of severe disappointment with its
results and to make sufficient cash from translating to support his large and growing
family:

‘The old teachers of materia medica have been copied up to the
most recent times, together with their shallowness, their indecision, their fairy
tales and their untruths by everybody (with few exceptions) and neither the old
originators nor their weak followers deserve to be spared. We must tear ourselves
violently away from these idealised authorities, if we desire to shake off the yoke of
uncertainty and superstition in one of the most important branches of practical
medicine. It is now high time.’ [Hahnemann, in his translation of Cullen’s Materia
Medica, quoted by Haehl, Vol. 1, p.273]

Thus, it is clear, that the main motivation, which led him into
experimentation was that of profound unhappiness and disappointment with allopathic practice
– his growing rage against the blunders of allopathy – on the one hand, combined with his
desire to construct a new system that worked, on the other. Seemingly, all he had to do was
to start taking drugs himself in small dose, to investigate in finer detail their effects on
health, and he would then be able to construct a completely new materia medica, based upon
the true effects of single drugs. This also combined his desire to test his ideas about
similars, single drugs and small doses, and to test the general effects of drugs on the
healthy organism. Thus, the proving technique replaced the inaccurate and woefully fuzzy
technique of ‘signatures’, which he had for so long detested as a reprehensible form of
‘medical guesswork’:

‘Hahnemann definitely rejected [the law of signatures]…in his
Materia Medica Pura we read under Chelidonium…’the ancients imagined that the yellow
colour of the juice of this plant was an indication (signature) of its utility in
bilious diseases…the importance of human health does not admit of any such uncertain
directions for the of medicines. It would be criminal frivolity to rest contented with
such guesswork at the bedside of the sick.’’ [Hahnemann quoted in Hobhouse, 1933,
pp.137-8]

This new approach gave him an essentially practical method of testing
drugs and with which he could build a system of medicine, based solely upon experiments,
using similars and single drugs, rather than upon contraries and mixed drugs. His final task
was investigating a range of dosage patterns in order to find the doses able to produce the
most beneficial results. Thus, he would then have a system based upon similars and single
drugs, provings and minimum dose. Rather than relying on signatures, he could fine-tune
through provings and experimentation the use of smaller, safer doses.

‘It is not probable that when he commenced upon ‘Cullen’ Hahnemann
had any particular theories, but only a growing disgust for the medical fallacies of the
day.’ [Bradford, p.43]

In his conception of a gentle and healing system, which would not cause
any harmful effects, he naturally wanted less harm but more healing than old allopathy could
muster. He wanted an essentially gentler approach. It was undoubtedly in this manner, that
he was pulled towards smaller doses in general. He was not primarily drawn towards small
doses because of any dogma or preconception on his own part, but due to pragmatic attempts
to reduce the toxic effects of drugs, while retaining their healing powers. Increasing doses
and thus increasing the harmful effects – as he had seen in the case of Mercury and
Syphilis, was clearly not a viable option. We have now accurately summarised what he was
doing in the whole period from 1783 to 1800. He was trying to formulate a new system of
medicine, in accordance with the known actions of drugs, such that primary or toxic effects
would be avoided or greatly reduced, while the secondary or healing effect was retained or
enhanced.

In regard to opposites, Hahnemann could see from his own medical practice
the disastrous folly of their use. While they brought relief to start with, but then an even
worse situation soon afterwards ensued. In the case of constipation, for example, things
were initially improved when laxatives like Liquorice or Senna were given, but
soon afterwards, patients ended up even more constipated than before. Thus the ‘cure’
that laxatives offered to the constipated, was an illusion – as it did not last and would
cause more harm than good in the medium term: people became addicted to their use. He
observed much the same principle in the effects of Coffee on sleep. In crude dose [or
in its primary action] it causes sleeplessness, while in small dose [or in its secondary
action], it induces sleep [see Organon, Aph. 60].

‘Every agent that acts upon the vitality, every medicine, deranges
more or less the vital force, and causes a certain alteration in the health of the
individual for a longer or shorter period. This is termed primary action.’ [Organon,
Aph. 63]

Thus, it might have been the ‘contrary nature’ of the laxative or
maybe also the high doses, which caused the problem, but either way, these effects were too
violent and disruptive for him to consider them acceptable for use in a gentle healing art.
Through many observations of this type, he was, therefore, pretty well forced to conclude,
and from an early stage, that strong doses and opposites were completely unsuitable as
principles for a gentle and truly curative form of medicine. They were neither gentle nor
curative. I think this survey adequately covers the reasons for his abandonment of
contraries and strong doses of drugs.

‘At this time [1797] Hahnemann was habitually depending on the single
remedy…he was in the habit of preparing and dispensing his own medicines independent
of the apothecaries. By all his writings at this time, he endeavoured to induce his
professional brethren to try the plan of simple remedies given according to a precise
law. But it was in vain, they became jealous of his success, for he was now engaged in
active practice.’ [Bradford, pp.59-60]

‘[In his ‘Essay On a New Principle’ of 1796] Hahnemann does not yet
talk about diminishing the dose, but insists on the necessity of administering but one
medicine at a time…in all these discoveries Hahnemann was guided by experience, to
which he trusted solely…’ [Dudgeon, 1853, pp.49-50]

‘I have no hesitation in asserting that whenever two medicines are
mingled together, they almost never produce each its own action on the system…’ [Are
the Obstacles to Certainty and Simplicity in Practical Medicine Insurmountable?, 1797,
in Lesser Writings, p.320]

‘A single simple remedy is always calculated to produce the most
beneficial effects without any additional means…it is never requisite to mix two of
them together.’ [The Medicine of Experience, 1805, in Lesser Writings, p.469]

‘…we must only give one single simple substance at a time.’ [ibid.,
p.469]

‘An equally important reason for prescribing only the single remedy
was that all the provings were of single substances – not of mixtures.’ [Coulter, Vol.
2, p.391]

‘Hahnemann insisted that only one remedy be given at a time and
continually belaboured his allopathic colleagues for their multi-ingredient
prescriptions…’ [Coulter, Vol. 2, p.390]

With regard to the idea of different diseases, he often noticed that one
disease would disappear when another came along, and he found reference to this displacement
of one disease by another, in the literature. In this sense, he decided that only one
disease could exist in the body at any one time. Numerous examples, from the medical
literature, could also be adduced of one disease displacing or curing another [Reference to
diseases displacing each other can be found in the Organon Aph. 34-36 and Aph. 40-46
along with numerous examples; see also Aph. 38, 47-9, 50 and also Dudgeon, 1853, pp.66-7].

‘Many examples might be adduced of diseases which, in the course of
nature, have been homeopathically cured by other diseases presenting similar symptoms…’
[Organon, Aph 46]

He noticed that the more similar these two diseases were, the more
closely they would cure or displace each other, and that this would in many cases be
permanent. On the other hand, dissimilar diseases only displaced each other temporarily,
imperfectly or in an uncurative manner. Thus, he must have realised, in this manner, that
the similars principle was always superior to that of opposites. He tus made it his business
to spend much time collecting from the annals of medical history, examples of such
phenomena. He also collected examples of similar drugs curing similar diseases.

‘In 1792 he published a cure of a case of colicodynia after the usual
means of cure had failed, by means of medicine producing very similar morbid symptoms
[Veratrum album].’ [Bradford, p.59]

He noticed how the effect on the system of any drug, acts much like a
disease, transiently producing certain types of symptoms and affecting certain organs and
systems, regularly and predictably. For example, Onion [Allium cepa], in crude dose can
induce sneezing and coryza. Thus, its use for hayfever or a cold, is a good example of how
the ‘artificial disease’ induced by the drug can be used to displace the symptoms of a
broadly similar disease. This ‘artificial disease’, produced by the remedy, is
reproducible in many different people and thus comprises a therapeutically controllable
entity or ‘tool of cure’. At that time, these were all completely original observations
in medicine. He was making it his business to create order out of chaos, and was working
very much at the cutting edge of a new medical frontier.

To all this complex and confusing data, he also added many completely new
observations about the impacts drugs make upon the organism. He explored the primary and
secondary effects in great detail, and also realised that these were fundamentally toxic and
therapeutic effects, respectively. A good example is alcohol, which, amongst many other
effects, in its primary action it dulls the senses, but in its secondary effects greatly
increases sensitivity to light and sounds. Having noted that the primary effect of a drug is
generally toxic, and that the secondary action is like the reactive [or homeostatic] power
of the body’s healing force [innate vital force], he therefore chose the latter as gentler
and more curative than the former. He noted that primary and secondary effects are often
opposite to one another, such as constipation and diarrhoea in the case of Opium and Chamomilla;
drowsiness and wakefulness in the case of Coffee and Opium; stupor and
activity in Opium and Cannabis; shivering and sweating in the case of Camphor.
In this manner, he amassed numerous examples of the actions of drugs [see Organon,
Aph. 63 and Dudgeon, 1853, p.212 et seq]. And, all this information was vital to his task.

‘…after the primary action of a medicine that produces in large
doses a great change in the health of a healthy person, that its exact opposite, when,
as has been observed, there is actually such a thing, is produced in the sedondary
action by our vital force.’ [Organon, Aph.65]

He noticed that though the primary effect is not very useful
therapeutically [causing bad aggravations], yet it could be regarded as the true basis for
what old allopathy and all its dismal practices. He therefore had to obtain a method of
using smaller doses, which would mimic the secondary effect without the primary. In other
words, he wanted a dosage strategy for a drug which would increase its healing effect, but
which would reduce or dispense with its primary, poisoning action. It is safe to conclude
that his attempts to reduce doses stemmed, in large part, from his observations of the
primary and secondary actions of drugs.

Here are some examples, which he adduces of this very matter:

‘In Hahnemann’s ‘Materia Medica’ we find various instances of primary
and secondary action noticed. Thus in the pathogenesis of China we find…’the
constipation of Cinchona bark is secondary action or reaction of the organism against
the great tendency of this medicine to cause diarrhoea in its primary action’. Of
Chamomilla, he says ‘all symptoms of constipation of the bowels are secondary action,
i.e. reaction of the organism against the effort of Chamomilla to produce diarrhoea in
its primary action.’ In his remarks on Digitalis, he states that the diminution of the
velocity of the pulse is primary action, but after a few days the pulse becomes
increased in velocity…’ [Dudgeon, 1853, p.216]

Numerous other examples can be cited [see Dudgeon, pp.212-221]. They are
found in detail in Aphorism 59 of The Organon. They are also found in the ‘Fragmenta
de viribus…’, the ‘Essay On a New Principle’ of 1796 and finally in all
the provings listed in his ‘Materia Medica Pura’.

It must be said, en passant, however, that there is some confusion in his
comments about primary and secondary effects. Initially, he states that the secondary
effects are due to the reactive power of the organism, which is still the predominant view
among most homeopaths, but in later editions of the Organon, he talks of ‘alternating
effects’ and he did not hesitate to place all drug effects into the drug pictures. Thus,
we might say, that he accepted even secondary effects as somehow belonging to the drug, even
though they resembled the opposing reactions of the vital force to the primary effects [see Organon,
Aph. 114-5]:

‘…in experiments with moderate doses of medicine on healthy
bodies, we observe only their primary action…wherewith the medicine deranges the
health of the human being and develops in him a morbid state of longer or shorter
duration.’ [Organon, Aph. 114]

He observed a seesaw action relating to opposites and similars, and also
relating to primary and secondary actions.

‘ ..close inspection of the action of medicinal substances on the
healthy led to a major discovery the biphasic action of drugs.’ [Coulter, vol. 2, p.363;
see also Nicholls, p.78]

A seesaw action was also apparent in relation to dosage – high doses
being toxic and having a primary action, while low doses mimicking the secondary action and
thus stimulating a healing reaction. This can be summarised as follows:

Placing the mass of his data together, he soon noticed that when using
single drugs, many writers had reported that the effects of poisonings and cures were more
often rooted in similarities than in differences. Arguably, this singular fact must have
stood out and set alarm bells going off in his mind.

‘Does bark, then, he asked, produce the same symptoms as it removes?
Does it alike produce and cure Ague? It is called a specific. Is the specific curing
power of drugs founded in such a principle? Do they all uniformly excite a counterfeit
disease to that which they remedy? Drug after drug, specific after specific was tested
on himself and on healthy friends with one unvarying result – each remedy of recognized
specific power excited a spurious disease resembling that for which it was considered
specific.’ [Dudgeon, 1875, Biography of Hahnemann, Homeopathic World, 10, p.234, quoted
in Bradford, p.46]

Thus, what seems to have dawned on him was that the ‘similia principle’
was always the fundamental underlying principle of cure when a single drug is used alone.
From this observation he must have realised that similars and single drugs work together,
just as mixed drugs and opposites work together in allopathic treatment. Then he started to
experiment with single drugs. This then led him to the discovery of the toxic and
therapeutic actions and the primary and secondary effects of drugs i.e. provings [1790 on]
and, finally, dose reduction in 1798-9. The exact sequence he followed started first at the
level of theory and then discovery and then experiment. Repeatedly, he followed this same
sequence, zigzagging back and forth from theory to experiment the whole while. We can
clearly see from all this, that Hahnemann was making sense and creating order out of a large
mass of conflicting data, drawn partly from the literature and partly from his own
experiments.

From all such information, he began to conceptualise a new system of
healing which would use similars, small doses and thus stimulate the secondary [healing]
actions of drugs, as opposed to old allopathy, which relied entirely upon opposites, large
doses and thus the primary actions of drugs. This harks back to something that Gumpert said:

‘He…strove to do away with the blind chimney-sweeper’s methods of
dulling symptoms.’ [Gumpert, p.99]

As stated previously, some of this new information, which he had created,
came from his historical researches, while the rest came from his experiments with drugs and
the first provings from 1790 onwards. Therefore, we might accurately depict Hahnemann up to
1790, as undertaking mostly historical research and collecting [from the literature] many
examples of the actions of drugs in health and disease; then, after 1790, he became a
practitioner again and undertook numerous experimental studies of drugs on the healthy
organism. This second phase was clearly designed to test, correct and confirm the ideas
which had become established in his mind from the first phase. He wished to confirm and
corroborate the ideas he had formulated, so as to mould them into a more workable system.
The result of all this was twofold. First, came the synthesis of techniques into a new
practical system of medicine, based on proven drugs – homeopathy. Second, came the Organon,
into which he compressed all the observations he had made, the principles that underpinned
them, and their implications for medicine as a whole. The first might be seen as the ‘what
and when’ of the new system of therapy, but the latter was the ‘how and why’.

He also noticed that the vital force is a very useful concept to explain
the actions of drugs and diseases, whether of primary or secondary actions; whether toxic or
therapeutic [see Organon, Aph. 9-10]. He conceived disease as being fundamentally
caused by defects [later to be called ‘miasms’] in the vital force, which rendered its
operational control of the organism imperfect. The aim of his new system of therapy would be
to correct or remove these defects and so restore the vital force to much better and more
harmonious control of the organism.

In 1790, while translating Cullen’s Materia Medica there came the
great breakthrough he needed:

“…which was to him what the falling apple was to Newton, and
the swinging lamp in the Baptistery at Pisa was to Galileo.” [Dudgeon, 1853, p.xxi]

“From this single experiment [with Cinchona] his mind appears to
have been impressed with the conviction that the pathogenetic effects of medicines would
give the key to their therapeutic powers.” [Dudgeon, 1853, p.xxi]

‘Hahnemann having, by his simple and rational experiment with
Cinchona bark in 1790, conclusively established the great therapeutic law, that to cure
diseases medicines must be used which possess the power of exciting similar diseases, at
once perceived that the whole edifice of the old Materia Medica must be rebuilt from the
very foundation, as that Materia Medica furnished nothing positive regarding the [true]
pathogenetic actions of drugs.’ [Dudgeon, 1853, p.176]

From his provings, it became clear that the ‘artificial diseases’,
which drugs can induce, can be applied to the unhealthy organism, and so can be used as a
therapeutic tool to displace real diseases, when employed along the principle of similars.
Thus, he sought to use his newly proven drugs, just like the diseases of old, which had
occasionally shown themselves able to displace and cure similar diseases. This, in essence,
reveals very clearly the manner of his approach.

‘…Hahnemann neatly and conscientiously assembled and numbered his
observations of the symptoms excited in himself and his children by the most varied of
medicines.’ [Gumpert, p.114]

‘Day after day, he tested medicines on himself and others. He
collected histories of cases of poisoning. His purpose was to establish a physiological
doctrine of medical remedies, free from all suppositions, and based solely on
experiments.’ [Gumpert, p.92]

‘…most of the virtues of medicinal bodies were discovered by
accidental, empirical experience, by chance; often first observed by non-medical persons…’
[Essay On a New Principle, 1796, in Lesser Writings, p.258]

‘…medicines [in 18^th century Old Physic] are almost
never prescribed singly, but usually in a mixture with others, thus depriving such
investigations of value.’ [Coulter, vol. 2, p.326]

In fact, it is very hard to separate the many elements within his
investigations, as these also include primary and secondary effects of drugs and their toxic
and therapeutic actions. As we previously stated, all these topics were intermingled and
blended together in his search.

‘Hahnemann very carefully argues the question of the new law; he
adduces many results of poisonings by drugs, gives his experiences in the uses of
medicines…and records the symptoms that certain medicines produced on himself and
others.’ [Bradford, p.58]

It was probably the single drug, which he picked on first in his search,
and, like the master string, it pulled everything else along with it. It is well known that
the provings came third [after 1790] and small doses fourth [after 1798, see Dudgeon], and
therefore it seems logical that single drugs and similars came first.

‘Hahnemann, the physician, recognized more and more the complete
insufficiency and unreliability of the science of treatment of his day…therefore he
withdrew, more and more from medical practice, which gave him no inward satisfaction,
and accorded him no substantial profit for himself and his growing family.’ [Haehl,
Vol. 1, p.40]

During the period up to 1790, and the first proving with Cinchona,
some of his ideas and thinking at that time, give us a good insight into his next moves. By
around 1786, Hahnemann was probably left in little doubt that single drugs and similars held
the greatest promise for his future studies. This must represent a remarkable change in his
thinking on the whole subject.

‘…he transferred his residence to Dresden; but with the exception
of taking for a year the post of physician to the hospital, during the illness of Dr.
Wagner, he does not seem to have done much in the way of practice here.’ [Dudgeon, 1853,
p.xx]

Though he had more or less given up the practice of medicine, while
living in Dresden, he still kept alive the hope that his painstaking researches would one
day enable him to dissect and lay bare those fundamental errors which made it so
ineffective:

‘In his work as a translator he could not restrain himself from
giving outspoken expression of his divergent views. In 1798, for example, in translating
the ‘Edinburgh Dispensatorium’, he availed himself of a footnote to mock at the
multi-compounded prescriptions…’ [Haehl, Vol. 1, p.307]

‘In marginal notes and comments he criticized and tore to pieces the
works he translated…with an iron consistency, Hahnemann revealed the gaps and
fallacies in medical treatment, and his ever-increasing knowledge of medicines stood him
in good stead.’ [Gumpert, p.59]

‘Hahnemann published during this period [1790-1805] over 5,500
printed pages – original work, essays in medical journals, and translations, among these
were works of fundamental importance, which deserve special attention.’ [Haehl, Vol. 1,
p.48]

He also nurtured a hope – nay, a profound yearning – that he would one
day be able to unravel some new medical principles, which could be moulded into a new
system, infinitely more efficacious, safe and predictable than Old Physick. Though
temporarily an outcast from medicine, his big dream was to return and be welcomed back like
a prodigal, a saviour:

‘He could only wait for the moment, as inevitable as the Day of
Judgment, which would see him revealed as the apostle of a pure and true doctrine of
medicine.’ [Gumpert, p.59]

‘So it is only outwardly that he appears to be estranged from the art
of healing; in reality the whole of this period [1790s] was only a continuation of his
years of study and a further, more stern and serious preparation toward the special life
task for the years still to come.’ [Haehl, Vol. 1, p.40]

As we have seen, Hahnemann’s experiments with single drugs also
revealed to him many new insights into the nature of the organism in health and disease and
a host of new information about how drugs operate. Such as their primary and secondary
effects and the holistic nature of their actions.

‘Like all other Empirics before him, therefore, Hahnemann insists
that therapeutic theory arises out of therapeutic practice. Practice is always prior to
theory.’ [Coulter, vol. 2, p.351]

It is, perhaps, tempting to believe that Hahnemann formulated homeopathy
in his mind as a fourfold grand plan during the 1780s, which he then merely tested and
confirmed in the first provings of 1790-96. Alluring though it is, there is scant evidence
to support this notion. What we do seem to find, however, is only the gradual formulation of
the main elements of homeopathy as he abandoned the principles of allopathy or Old Physic
during the 1780s. It seems likely that single drugs were the first [around 1784], and that
this led him to more deeply contemplate similars during his translation work of the 1780s
and 1790s.

Thus, it seems fairly clear, that even by 1789, Hahnemann was carrying
with him only similars and single drugs as potential, but still unconfirmed, new medical
principles, which he instinctively believed to be superior to the contraries and mixed drugs
of Old Physick. He certainly detested strong doses and signatures from an early stage, but
not until the following decade was he able to confidently and unambiguously replace them
with something more reliable. Therefore, he had not moulded them into a new system before
the first proving of 1790.

What we have also seen, therefore, is that his system evolved gradually
and in a fairly haphazard and piecemeal fashion; that the sequence: single drugs ->
similars -> provings -> minimum doses is what occurred; that experimentation with the
provings of drugs was undoubtedly a major turning point, as they substantially and
unambiguously confirmed to him the superiority of three central new principles: single drug,
similars and provings, and therefore allowed him to boldly and confidently brush aside
forever mixed drugs, contraries and signatures – old Galenic axioms which he had detested
since the early 1780s. Without doubt, it was his experiments that confirmed or demolished
every idea he formulated. Thus, it was experimentation – the very spirit of his age – that
was the single most important force that created homeopathy from a mass of doubts, hunches
and perhapses.

SOURCES

Bradford, Thomas L, 1895, Life and Letters of Hahnemann,
Philadelphia, USA

Cook, Trevor, 1981, Samuel Hahnemann Founder of
Homeopathy, Thorsons, UK

Coulter, Harris L, 1975, Divided Legacy, The Schism in
Medical Thought, Volume 2, Wehawken Books, Washington, USA

Danciger, Elizabeth, 1987, Homeopathy Alchemy into
Medicine, Unwin Collins, London

Dudgeon, Robert E, 1853, Lectures On the Theory &
Practice of Homeopathy, Jain Reprint

Dudgeon, R E, 1875, Biography of Hahnemann, Homeopathic
World, Vol. 10, p.46 et seq.

Gumpert, Martin, 1945, Hahnemann – The Adventurous Career
of a Medical Rebel, L B Fischer Publ. Corp, New York, translated from the German by Claud W
Sykes.

Haehl, R, 1922, Samuel Hahnemann His Life and Works, 2
volumes, Jain reprint

Hahnemann, Samuel, 1841, The Organon, combined 5th/6th
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Morrell, Peter, 1998, From Poisonings and Provings to
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Morrell, Peter, 1999, Hunter, Hahnemann and the Origin of
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Morrell, Peter, 2000, Some Reflections On the Origin of
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Morrell, Peter, 2000, Clarke’s ‘Hahnemann and
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