In Search of the Later Hahnemann

Rima Handley, DPhil, FSHom

Beaconsfield

235pp £15.50

Reviewed by Ralf Jeutter, Ph.D.

At a time where homoeopaths argue, mostly to prove a point, whether Hanhemann was a rigid dogmatist, a shaman, or somebody who got it always 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 Hendley’s meticulously researched book In Search of the Later Hahnemann provides a good opportunity to compare our 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 fare 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 of looking into his workshop, and we can 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 cannot help but try to decide on these issues while reading the book. And it is exactly this aspect of the book which 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) and 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 J.T.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 fascinating 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 8 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 case books 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 Handely 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’ books is that he employed the whole range 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 a t least important and prominent symptoms. If tse 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 miasmatically it did not mean that his findings on 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 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, tsill 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 rnage of applicability has often evolved overd ecades and the use by 1000s of prescribers.

Another aspect of the anticipatory nature of Hahnmeann’s work is his development of homoeopathy as a constitutional medicine. Despite the clarity of para 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 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 life. Or aer we getting glimpses into a time of our profession where self-promotion was de rigeur yet?

Rima Handely 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 homoeopathy 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.