L’œuvre de Samuel
Hahnemann:
Étude de publications et de ses journaux de malades.
Par le Dr Bruno Laborier
The
role of patients
in Hahnemann’s patients’ diaries and publications
Summary :
Samuel
HahnemannWas it possible to grasp the role of patients through
Hahnemann’s writings?I studied part of Hahnemann’s publications and part
of his patients’ diaries. The publications set out precise indications
for medical practice and sometimes proposed an active role to the
patient. The patients’ diaries described part of the human limits of
the doctor-patient relationship.There was a continuity between the convictions
reported in the publications and the description of the patient’s
treatment in the patients’ diaries. The patient could take an active
part in the treatment of his illness. With a profound respect for human
beings, Hahnemann’s main concern dealt with the state of his patient’s
health.
Introduction :
In medicine, the role of the patients has always been
worth being taken into consideration.How did Samuel Hahnemann, the founder of homeopathy,
the great medical theoretician and outstanding doctor of his day, regard
the role of patients in his publications ? What role did he give to
the patient in his patients’ diaries ? Could one compare the
image of the patient in his publications with the one presented in the
patients’ diaries? Was there an overall significance in these
journals ?These were the main questions I tried to answer in
the present research.
1) APPROACH OF THE ROLE OF
PATIENTS FROM SOME OF SAMUEL HAHNEMANN’S PUBLICATIONS:I explored a part of all the publications by
Hahnemann, including the posthumous sixth edition of the Organon (1).
- The very role of patients:
The friend of health
(1792) (2) :
” To take ourselves to task about
our pernicious habits, to study ourselves, to follow the most
appropriate diet and way of life for our own constitution, and
heroically to deny ourselves everything that would tend to undermine our
own health, or that may already have done so… “” It would be a great mistake to imagine there are
different varieties of human beings.”
Cure and prevention of the Asiatic cholera
(1831) (2):
“… the camphor has to been given alone,
and always at the very beginning of the disease…”” Any person whose friend becomes ill because of
cholera, must immediately treat him with camphor, and not wait
for medical aid, which, even if it was good, would generally come too
late. “
Organon
, posthumous sixth edition
(1) :Paragraph 121 to 140:
“Mode of proceeding when making trial of
medicines on other persons than oneself.”Paragraph 127:
“The medicines must be tested on both males and
females, in order to reveal the alterations of health produced in the
sexual sphere.”The proving, tested on well-read or illiterate people
(paragraph 140) must be unpaid (paragraph 143) , practised on a great
number of medicines, and directed by Samuel Hahnemann or some reliable
young men (paragraph 145).
The doctor’s duty which
consists in allowing the patient to play a genuine role:
The medical observer
(a fragment) (1818)
(3):“The medical observer knows that the
observations relative to medical subjects must be written in a sincere
and dedicated way … and must be written with the inspiration of an
honest conscience, in order to communicate them to the world, knowing
that none of our earthly goods are more precious that the genuine
passion for the preservation of the life and health of our
fellow-men.”
Chronic diseases
(1835-1839) (4):
” Concerning diet and way of life, people who
want to be cured of a chronic disease have to endure some
restrictions.”“… for such a prolonged (psoric) chronic
disease, … the most suitable medical treatment, a very careful way of
life, an obedience from the patient do not suffice, much time and
patience are also necessary.”
Organon
, posthumous sixth edition (1):
Paragraph 84:
” The patient complains about the progression of
his pains, the relatives talk about his complaints, his behaviour, what
they observed about him; the doctor looks, listens, and notes with his
other senses what has changed and what is unusual about these
complaints. He notes everything, with the exact same expressions used by
the patient and his relatives. He lets them finish without interrupting
them (*) unless they stray from the subject…(*) Every interruption disturbs the flow of the
speaker’s ideas and they cannot remember so clearly what they started
out to say after that.”Paragraph 89:
– (except in simulated illnesses), the doctor must
mostly rely on the sensations experienced by the patient –Paragraph 261 :
” The most appropriate way of life in
chronic diseases while taking medication consists in removing all the
obstacles to the recovery of good health and sometimes adding the
necessary opposite conditions such as : innocent pastimes of soul
and spirit, outdoor activities, whatever the weather, (daily walks, some
manual work), the use of appropriate nourishing non medicinal food and
drink, and so on. “
Comments :
In The friend of health,
Hahnemann spoke of ” we “and
” I “, thus giving advice for himself and his
patients. He had therefore tested his ideas and hygienic advice on
himself, before proposing them to his patients. He considered all his
patients on an equal footing.In The medical observer,
Hahnemann demanded sincerity and honesty from people who wrote medical
observations. It was a preliminary in this investigation, before the
study of Hahnemann’s patients’ diaries.
Hahnemann proposed an active role to the patient when
one of his relatives was suffering from an early cholera.In the Chronic Diseases,
Hahnemann demanded from his patients rigorous hygienic rules, and a
great discipline; the doctor could sometimes give advice to the patient
about his living conditions.In the Organon, Hahnemann
proposed conditions for a good medical listening of the patient. Some
patients, healthy or sometimes ill, had an active role in the proving of
many remedies; many symptoms they collected, transcribed in the pure
Matiera medica of Samuel Hahnemann, and in the antipsoric remedies of
Chronic Diseases are still available for actual medical practise.
2) IMPORTANCE OF THE PATIENT
FOR SAMUEL HAHNEMANN WHEN WRITING HIS PATIENTS’ DIARIES :
Samuel HahnemannI have studied the first fives volumes available of
the diaries of Samuel Hahnemann’s patients in Paris : DF2, DF2A,
DF3, DF4, DF5.These volumes were written by hand by Samuel and
Mélanie Hahnemann. Their two handwritings were very dissimilar and easy
to tell from each other. I concentrated on Samuel Hahnemann’s work.These journals were read on microfiches published by
the Institut für Geschichte der Medizin of Stuttgart, with the help of
the publication of DF5 by Arnold Michalowski (5). This meant about 1500
pages whereas the French series contained 7000.The study of the patients’diaries revealed a direct
picture of the patient through the transcription of Hahnemann’s
consultations in his surgery, or a more indirect picture through the
transcription of his patient’s letters, or more indirectly still
through the transcription of the letters from the patient’s family if
the patient was not able to write himself (being a child or someone too
ill).
Extracts from the patients’
diaries written by Samuel Hahnemann :In accordance with medical secrecy, the identity of
the patients has not been revealed.DF2, page 21 to 23 : concerning a patient
suffering from ascites, Hahnemann wrote : ” must be
weighed “, and the patient’s weight in pounds was recorded
every week during five months.DF3, page 70 : ” pieces of small
yellowish strong smelling matter come out periodically from the left
tonsil. I take a sample of this matter and a piece of straw about this
size ————–”DF3, page 96 : May 4th ” …
cannot swallow or speak since yesterday morning. The problem is situated
in the lower gum as if a boil was forming causing continuous
pain. “DF3, page 116 : same patient July 10th
” … apart from two hours of sleep ( at 10 and 8 o’clock)
the attacks were uninterrupted. There is no more than six to eight
minutes between two attacks – he has been in agony for almost 24
hours.While eating, the pain was sometimes much stronger as
if the left side of his mouth was wounded and highly
inflamed. “DF3, page 123 : same patient, same year, August
26th ” at meal time a terrible aggravation as if
sharp instruments were violently being driven into an inflamed area /
the inside of his mouth and his tongue are extremely sensitive and the
gums are swollen and inflamed. “DF3 page 116 : même patient, 10 juillet
” …à l’exception de deux heures de
sommeil (à 10 et 8 heures) ces attaques n’ont pas discontinué. Il n’y
a pas plus de 6-8 minutes d’intervalle – voilà bientôt 24 heures
que cette agonie dure.En déjeunant le mal était parfois bien plus pénible comme si la
bouche à gauche était écorchée et fortement enflammée. “
DF3, page 124 : same patient, October 4th
” His suffering is unbearable – sleeps very little because
of the pain… He has been in pain since March – of the same quality… “DF3, page 201 : same patient April 11th,
following year : ” He is in agony “DF4, page 87 : description of a patient’s eye
troubles : ” … the small bright gold spots – the
difficulty and impossibility of reading. The eyes are stretched as if
they were being pulled out. Vision immediately blurred – outlines
disappear – then iron bar on the eyes specially on the forehead… ”
The circumferences of the pupils in the daylight and in the dark were
drawn four times on the observation.1838 February 5th ” can read
three pages at once … on the 30th of January he wrote and
read four pages. “DF5, page 60 : ” August 26th : must
have a warm foot bath for half an hour, then continue medication for
three more days.August 30th : has not taken a foot
bath nor medicine… “DF5, page 90: “she has taken by herself carbo
vegetabilis, calcarea carbonica, petroleum, sepia, lycopodium
clavatum.”DF5, page 113: “he has powered himself every day
with sulphur and drinks a decoction of savage pansy.”DF5, page 219 : … ” Within eight
days, he was poisoned by an enema containing one dram of Belladonne
which caused very dilated pupils – then a swollen tongue ; saw
thousands of things that did not exist and believed he was going to be
operated with a scalpel (he could not see real objets) memory loss,
drowsy, wanted to tear everything off, strong need to urinate
without success ; six hours later face very red and swollen ; he
recovered after a hot bath and could then urinate … “DF5, page 386 : ” October 7th : used
to smoke 10 to 24 cigars every day ;5 to 6 cigars just before my treatment ; has not
smoked any cigar since then ; I allow him one pipe.October 11th : smokes a great deal
according to his father’s letter – he denies this. “
Comments :
I found Samuel Hahnemann’s writing very precise,
and easy to read.Samuel Hahnemann had a clear perception of the
patient’s symptoms and his perception was easy for the reader to
understand.The self-treatment seemed to be very rarely recorded
in spite of Hahnemann’s usually careful research.The patients, through accidental or iatrogenic
poisonings, had sometimes a passive role in the collection of symptoms
of the remedies.In my opinion, the honesty of the transcription of
the observations was real, yet impossible to assert.
3) COMPARISON BETWEEN THE IMAGE
OF THE PATIENT IN SAMUEL HAHNEMANN’S PUBLICATIONS AND THAT PRESENTED
IN THE PATIENTS’ DIARIES :I found pieces of comparison in the chapter about the
doctor’s duty concerning the patient’s hygiene of life, the
observation of his symptoms and the follow-up of the patient.Extract of the patients’ diary (DF4 page 130)
concerning the hygiene of life, very similar to the way of
thinking found in the Friend of Health and the Organon
(paragraph 261) :” As it is never good to overtax one’s
strength, he must stop working at 10 o’clock ; then talk with a
friend for an hour and after taking his medicine, go to bed with his
head free from ideas from books or other intellectual work ; he
must walk for three quarters of an hour to an hour every day, but not
immediately after a meal, having to rest for three quarters of an hour
to an hour first. Without reading, without writing, without relaxing,
without indulging in leisure, it’s impossible for the chronically ill
organism to recover even with the most suitable remedies. “With regard to the observations of the patient’s
journals, Hahnemann gave a precise report of the patient’s sensations.
He probably wrote down sometimes the patient’s exact words or those of
his relatives and friends, or sometimes only what seemed important to
Hahnemann for the patient and his state of health, especially in the
transcription of the patients’ letters.Then, the follow-up of the patient was clearly
as conscientious as the initial observation, and indicated Hahnemann’s
great patience. To my knowledge, he never abandoned a single patient as
long as he or his relatives required his services.In conclusion of this chapter, the comparison
between the image of the patient in Hahnemann’s publications and that
presented in the patients’ diaries showed continuity. In other words,
Hahnemann practised what he recommended in his publications.
4) DID THESE PATIENTS’
DIARIES HAVE AN OVERALL SIGNIFICANCE ?This presentation of Samuel Hahnemann’s diaries can
not be considered as a faithful representation of all his work since I
studied only 1500 pages from the French series which contained more than
7000, knowing that the German series of the journals was even more
voluminous.Apart from this restriction, I found an overall
significance in these diaries for the patient, for Samuel Hahnemann, and
for the reader.
- Significance of these diaries for the
patient :
Through the accuracy with witch the patient described
his symptoms to the doctor, his respect of the doctor’s hygienic and
medicinal prescriptions, by regularly observing his symptoms, through
the patient’s loyalty to his doctor,the patient could become personally involved in his
state of health and occasionally even participate in the improvement and
cure of his illness. The family and friends of the patient sometimes
participated in this process.
- Significance of these diaries for Samuel
Hahnemann :
Samuel HahnemannHahnemann, through the strict non interpretative
recording of his observations, the clearness of his hygienic advice, the
apparent simplicity but nevertheless the enlightened choice of his
medicinal prescriptions, through his search to guarantee the respect of
his hygienic and medicinal prescriptions, the accuracy of his recordings
of the evolution of the symptoms, through Hahnemann’s faithfulness to
his principles concerning illness, the doctor’s role and homeopathic
treatment,I notice that Hahnemann’s main concern was with the
state of the patient’s health and not with his illness.
- Significance of these diaries for the
reader :
Hahnemann’s deep devotion to his work was clearly
shown to the reader of these journals. Finally, they helped the reader
to grasp part of the human limits of the doctor-patient relationship.
5) GENERAL AND PROVISIONAL
CONCLUSION :The role of patients in part of Samuel Hahnemann’s
publications and in part of his patients’ diaries could only be
partially apprehended.The publications gave quite accurate references for
medical practice. The patients could have an active role in the proving
of remedies, and in the treatment of cholera at its beginning.The patients’ diaries, accurately and meticulously
written, proved a great discipline in Samuel Hahnemnann’s work, and a
loyalty in his convictions.The self-treatment seemed rare.
The way Samuel Hahnemann presented his patients
revealed his profound respect for human beings.In my opinion, even though Samuel Hahnemann died more
than 150 years ago, Hahnemannian theories and practice are still
relevant, useful for the actual medical practice and deserve further
studies.REFERENCES
(1) Hahemann S.
Organon der Heilkunst. Textkritische Ausgabe der 6. Auflage.
Heidelberg : K.F. Haug, 1992.(2) Dudgeon R .E.
The lesser writings of Samuel Hahnemann. Reprint edition. New
Delhi : Jain, 1993; 156-753.(3) Hahnemann
S. Reine Arzneimittellehre von Samuel Hahnemann, vierter Theil.
Dresden: Arnold 1825; 22.(4) Hahnemann S. Die
chronischen Krankheiten, Band 1. Heidelberg: K.F. Haug , 1995; 134-170.(5) Hahnemann S. Krankenjournal DF5.
Transkription und Übersetzung von Arnold Michalowki.
Heidelberg : K.F. Haug, 1992Exposure presented in
Stuttgart, july 1999 for the second conference of the international
network for the History of homeopathy: homeopathy and his patients.Acknowledgements
Thanks to doctor M. Dinges for his advice on this
work.Thanks to the Institut für Geschichte der Medizin
der Robert Bosch Stiftung, Straussweg 17, 7000 Stuttgart, Germany for
the microfiches of Samuel Hahnemann’s patients’ diaries.
Résumé:
Pouvait-on appréhender le rôle des patients à
travers les écrits d’Hahnemann ?J’ai exploré une partie des publications et une
partie des journaux de malades d’Hahnemann. Les publications mettaient
en place des repères précis pour la pratique médicale, et proposaient
parfois un rôle actif au patient. Les journaux de malades rapportaient
une partie des limites humaines de la relation médecin-malade.Il existait une continuité entre les convictions
médicales exposées dans les publications et la prise en charge des
malades rapportée dans les journaux. Le patient pouvait participer
activement à la prise en charge de sa maladie. Hahnemann centrait ses
préoccupations sur l’état de santé des patients, avec un profond
respect de la personne humaine.Exposé présenté au congrès de la Société
hahnemannienne de Dauphiné-Savoie à Chambéry en novembre 1999, et
reproduit sur le site Internet <homeoint.org>
HDS ; congrès.
Textes Copyright ©
Dr Bruno Laborier 2002
html et illustration Copyright © Sylvain Cazalet 2002
