Proving of medicines the inevitable corollary from the law similia similibus curentur-Little known of the positive action of medicines when the homoeopathic law was discovered-That little in favour of homoeopathy-Hahnemann did not at once commence to prove medicines-He appeals to his colleagues to assist him. His appeal is neglected-He exposes the weakness of the system of his colleagues-And thereby renders himself obnoxious to them-He publishes his first provings-His first directions for proving- He rejects homoeopathic aggravations as a pathogenetic source-His final directions for proving-His provings with globules of the 30th dilution-His pathogenetic sources-Various with globules of the 30th dilutions-His pathogenetic sources-Various doses used by Hahnemann in his provings-What has the old school done in the way of physiological provings? The empiricists-Heraclides- Mithridates-Attalos Philometer-Nicander-Matthioli’s and Richard’s poisonings-Haller’s recommendation to prove-Alexander’s experiments-Experiments on the lower animals despised by Hahnemann-Jorg’s proving society-Its labours appropriated by Hahnemann- Wedekind’s and Martin’s efforts to induce others to prove-The provings of the allopathic society of Vienna-The provings of Rademacher’s followers-Pereira’s approval of provings-Resolution of the Strasburg scientific congress-Forbes’s recommendation of proving-Of what use are proving to allopathists? They are only available by homoeopathists-Piper’ rules for proving-Schron’s direction for proving-His disapproval of provings with the 30th dilution-His proposal for arranging the pathogenetic effects-Griesselich’s rules and cautions-Names of the most distinguished provers-Hering approves of proving with the 30th dilution-And practises it-He proposes to prove medicine in the high potencies-His list of pathogenetic sources-A society in Thuringia established to prove 30th dilutions-Watzke’s reasons for re-proving Hahnemann’s medicines-Drysdale’s remarks on provings-Trinks disapproves of proving with high dilutions, and rejects symptoms obtained from patients-Curtis’s proposal for negative provings-Absurd substances that have been proved-Mure’s provings of hides, diseased potatoes, guano, lice, etc, -Hering’s doubtful medicine-Wurzler’s pudding-How provings should be conducted_Medicines should be proved in small doses, but not in high dilutions only-Patients an impure source for drug-symptoms- Poisoning of lower animals useful-Duty of all homoeopathists to prove.
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 pathogenetic actions of drugs, but was composed almost entirely of supposititious accounts of the virtues of drugs, principally derived from the empirical employment of these drugs in disease. If you would read a masterly exposure of the weaknesses of the ordinary Materia Medica, I cannot be better than refer you to two essays of Hahnemann’s, which you will find in the collected edition of his Lesser Writings. These are the essay on The Three Current Methods of Treatment, (Lesser Writings, p. 592.) and that entitled Examination of the Sources of the ordinary Materia Medica. (Ibid., p. 748).
It is sufficiently obvious that the inevitable corollary from the axiom “that to cure diseases we must select medicines capable of causing similar diseases” is, “in order to be practise successfully, we must ascertain what morbid states the different medicinal substances produce.” Hahnemann accordingly, after viewing the subject in every possible light, and examining carefully every method that had been proposed for ascertaining the action of drugs, came at last to the conclusion that the only way to do this is “to test the medicines singly and alone on the healthy human body”.
Hahnemann now began to search diligently all the records of medicine, to see if he could find examples where the various medicines had been so tested, and try them on this own person, in a desultory and unmethodical manner however, as the results he has recorded of his researched and experiments for the next six years show. (Essay on a New Principle.) The conclusion to which Hahnemann came, that medicines must be tested on the healthy body before; they can be properly applied in disease must have been attended with feelings almost akin to despair, when on examining the records of medicine of medicine he found so little of a positive nature was known concerning the pure action of drugs, and when he become convinced that the whole business of testing medicines on the healthy had yet to be done. We can well imagine the feeling if despondency that must have taken possession of him when, after ransacking the archives of his art, he found absolutely nothing that could avail him in practice.
How can one man’s life, he would naturally think, suffice to construct a pure Materia Medica according to the only principle upon which such a work can be formed? Will not the experiments that must be performed for this end completely ruin the health of him that undertakes them? What number of medicines can be tested in this way within a moderate period of time? How are diseases to be treated at all until a considerable number of medicines are thus proved? In searching through the records of medicine I find, from the accounts of cases of poisoning by various medicinal substances, many facts which strengthen still more the convictions I have acquired; but will these accounts of poisonings suffice to guide me to the selection of the remedies for the diseases I meet with?
I shall arrange what I can collect on this important point, and add to the symptoms detailed in the records of poisonings the results of those desultory experiments I have myself performed, and see what pictures of diseases these can afford me. Thus I find it recorded of arnica, that it causes nausea, uneasiness, anxiety, peevishness, headache, oppression of the stomach, empty eructations cuttings in the bowels, and frequent scanty evacuations, with straining. Now in this autumn season we have an epidemic dysentery very prevalent, which presents just these symptoms of arnica. Let me see what arnica will do for its cure. As I expected, arnica proves itself specific, and cures the disease without requiring any other medicine whatsoever, in doses of from four to fourteen grains, according to the age of the subject. Arnica is therefore the specific remedy for this dysentery, and that by virtue of its power to cause a similar affection. (Essay on a New Principle, Lesser Writings, p. 314.)
Here is a patient suffering every morning on waking from an anxious feeling in the stomachic region, which, in the course of a few hours, involves the chest, causing tightness there, sometimes amounting to complete loss of breath; in the course of a few hours the affection attacks the larynx, and suffocation becomes imminent (swallowing solids or fluids being impossible); and as the sun declines it leaves those parts, and becomes confined to the head, with timorous, hopeless, suicidal thoughts, till about ten o’ clock, when he falls asleep, and all the morbid symptoms disappear. This case reminds me forcibly of the effects of veratrum, as noticed in the cases of poisoning by that powerful drug. Veratrum therefore is evidently the remedy for this case, and see! a few grains of it given every morning, suffice to cure this annoying complaint in a very short time. (Ibid., p. 349.)
And thus he went on for some time, attempting to find parallels for the diseases that presented themselves in the records of poisonings by medicines, endeavouring from these same records to determine a priori what morbid states they would be useful for; occasionally, when doubtful of the exact action of the drug, eking out its pathogenetic action by swallowing an uncomfortably large dose himself, and observing what symptoms resulted.
However, after going on in this way for some years, occasionally making lucky hits in finding exact parallels of medicinal and morbid actions, he at length discovered that, after all his trouble, the symptoms he could cull from the cases of poisoning were so vague and indefinite, that at the best he should by this plan never be able to arrive at anything better than an approximation to a certain choice of the specific drug; that, in a word, these slovenly detailed cases of poisoning, most of which had been disturbed and deranged by the administration of equally violent so-called antidotes, would never do to found a method of treatment on. He saw clearly that there was nothing for it but to test each medicine individually on the healthy body, and carefully notice the exact morbid picture or pictures it developed, that so parallels might be obtained, not only for striking and simple general morbid forms, but also for every variety of disease that presented itself in actual practice.
If, thought Hahnemann, I can induce a number of my medical brethren to join me in testing medicines on our healthy bodies, there will then be some chance of our being able to obtain in a reasonable space of time a considerable number of well-known curative tools with which work upon diseases. Acting on this thought, he wrote some earnest essays in Hufeland’s Journal, setting forth his new opinions and forcing them on the attention of the profession by the most conclusive arguments and the most striking illustrations. He urgently entreated them to join him in his proposed reform and perfecting of the Materia Medica, and appealed to them to assist in the glorious work with the utmost confidence of their ready response. (Essay on a New Principle, etc., Lesser Writings, p. 295; and On the Obstacles to Certainty and Simplicity, etc., ibid., p.358).
Alas! for the boasted zeal and earnestness of the members of the medical profession, Hahnemann’s appeal met with nothing but derision and contempt from his colleagues. None, not one, saw the utility of putting himself to inconvenience for the purpose of ascertaining the powers of the instruments he was hourly called upon to use in cases of life and death. One and all were perfectly satisfied with the traditional system they and their ancestors had practised; all were content stare super vias antiquas. Again and again did Hahnemann appeal to them, and again and again did he receive the same supercilious treatment.
Hahnemann, whose whole soul was fired with enthusiasm for his profession, and whose only aim was so to perfect his art as that it should be means of curing diseases more perfectly, effectually, and speedily than it had hitherto done, could not understand this apathy. (In later years he was so well aware of the fruitlessness of hoping for anything from the zeal of the great body of medical men, that when his disciple Stapf proposed to appeal to the profession at large to assist in the proving of medicines, ” Your plan,” says he, ” is well meant but impracticable. We should be laughed at for our request, or even treated with contempt. Which of our every-day colleagues would undertake such laborious trials? when he can tap on his well filled prescription-book and exclaim, ‘Thou art my comforter! I am never at a loss to prescribe when I have thee.
However things may turn out with the patient I am safe : these are prescriptions of the great masters; I prescribe them, no one can blame me.’ In all eternity you would never succeed in elevating these gentry to our pure views,” etc. (N. Arch., i.1, 161.)). Do these men, thought he, really believe that the system they and their ancestors have pursued from time immemorial is a rational, an efficacious one? I shall soon show them their mistake. With that he wrote an essay (AEsculapius in the Balance, Lesser Writings, p. 470) pointing out the glaring inconsistencies and absurdities of the old system, and showing clearly what must be done in order to render the art a certain and successful one, in place of a scientific deformity as it was. Simple-minded Hahnemann, better had it been for your own peace of mind had your held your tongue altogether than thus attack time-honoured system.
Joe Miller tells a story of a lady who received with wonderful equanimity all kinds of abuse until the abuser the abuser ventured to call her ugly. This fair lady did not resent the insult with greater bitterness than did the aggrieved partisans of Galenic medicine that offered to them by Hahnemann. Hahnemann had dared to expose the ugliness of their system, the foul-mouthed calumniator! No quarter must be given him. Hahnemann was not a little surprised to find that the sole reply vouchsafed to his scientific criticisms was abuse, scorn, contumely. He could not understand it- Dear Master,
” How green are you, and fresh in this old world.”
He attributed the outcry against him to jealousy of his discoveries. That it was not, but rage that he had exposed the deformity of his enemies in all its hideous nakedness. This could never be forgiven him; Hahnemann was henceforward a marked man. Luther might advance his own peculiar theological opinions, comparatively little notice was taken of him, but when once he began to expose the weaknesses of Rome, the whole thunder of the Vatican was directed against him; and so it was with Hahnemann. Paul was wiser in his day and generation. Had he blasphemed the great goddess Diana, it is doubtful if the unadorned eloquence of the worthy town-clerk would have saved him begin torn to pieces by the incensed Ephesians.
Hahnemann’s assaults on ancient medicine had rendered him thoroughly distasteful to his colleagues; he was now no more to be trusted, and was henceforth regarded as an outcast and a Pariah, whose companionship was to be shunned for evermore. He now saw full well that he must not look to his medical brethren for assistance in his great aim, but he did not despair; on the contrary, this very oppositions of his colleagues made him more resolute in his determination to carry out his plans alone, or with what casual assistance he could procure from non- professional friends.
Accordingly he set himself to his task con amore, and in a few years more he was able to give to the world a tolerable array of medicinal substances whose pure pathogenetic action he had ascertained by experiments on himself, his family, and a few friends. He did not, however, give these results as anything like complete, and indeed merely styled them Fragmentary Observations relative to the Positive Powers of Medicines on the Human Body. This work was merely an earnest of what was to come; it was published in 1805. Later in the same year he published his celebrated essay called The Medicine of Experience, (Lesser Writing, p. 497.) and in this essay he details at length how experiments with medicinal substances are to be conducted in order to ascertain their pathogenetic effects. I shall now give you the substance of what he there says. (Ibid., 515.)
“Every simple medicinal substance, “causes a peculiar specific disease-a series of determinate symptoms, which is not produced precisely in the same way by any other medicine in the world. As every species of plant differs in some way from every other species of plant, and as every mineral and salt differs from every other mineral and salt, so do they all differ among themselves in their medicinal properties, that is to say, in their morbific powers; each of these substance effects an alteration in our state of health in a peculiar determinate manner. Medicinal substances manifest the nature of their pathogenetic power, and their absolute true action on the healthy human body in the purest manner, when each is given singly and uncombined. Many of the most active medicines have already occasionally found their way into the human body, and the accidents they have given rise to have been recorded (e. g., poisonings accidental and intentional, and their histories). In order to follow up still farther this natural guide and to penetrate more profoundly into this source of knowledge, we administer these medicines experimentally, the weaker as well as the stronger, each singly and uncombined, to healthy individuals, with caution, and carefully removing all accessory circumstances capable of exercising an influence. We note down the symptoms they occasion precisely in the order in which they occur, and thus we obtain the pure result of the form of disease that each of these medicinal substances is capable if producing, absolutely and by itself, in the human body.
“In order to ascertain the effects of less powerful medicinal agents in this manner, we must give only one pretty strong dose to the temperate healthy person who is the subject of the experiment, and it is best to give it in solution. If we wish to ascertain the remaining symptoms which were not revealed by the first trial, we may give to another person, or to the same individual, but only to the latter after the lapse of several days, when the action of the first dose is fully over, a similar or even a stronger portion, and note the symptoms of irritation thence resulting in the same careful and sceptical manner. For medicines that are still weaker we require, in addition to a considerable dose, individuals that are healthy, it is true, but of very irritable delicate constitutions.
“The more obvious and striking symptoms must be recorded in the list, those that are of a dubious character should be marked with a sign of dubiety, until they have frequently been confirmed. In the investigation of these medicinal symptoms all suggestions and leading questions must be carefully avoided. It must be chiefly the mere voluntary relation of the person who is the subject of the experiment-nothing like guesswork, nothing obtained by dint of cross-questioning,, that should be noted down as truth, and still less expressions descriptive of expressions that have been suggested to the experimenter. But how,” he add, and this observation has more significance than we might at first sight suppose, “how, even in diseases, amid the symptoms of the original disease, the medicinal symptoms may be discovered, is a subject for the exercise of a higher order of inductive minds, and must be left solely to masters in the art of observation.” I think it a pity, for the sake of the purity of the Materia Medica, he had not for ever retained the opinion he expresses some years previously regarding this same giving of medicines to unhealthy subjects for the purpose of ascertaining their effects; for we find in the Essay on a New Principle (Lesser Writings, p. 309.) the following statement. After saying that the only way to ascertain the effects of drugs is to test them on the human body, he writes :- “The necessity for this has been perceived in all ages, but a false way was generally followed, inasmuch as they were only employed empirically and capriciously in diseases. The reaction of the diseased organism, however, to an untested or imperfectly tested remedy, gives such intricate results that their appreciation is impossible for the most acute physician. Either nothing happens, or there occur aggravations, changes, amelioration, recovery, death-without the possibility of the greatest practical being able to divine what part the diseased organism, and what the remedy played in effecting the result. They teach nothing, and only lead to false conclusions.”Ten years later, as I have shown, Hahnemann thought he was in a condition to determine what share the disease and what the remedy had in the result brought about by the administration of a medicine in disease, but I confess myself more disposed to agree with him in his former than his latter opinion.
It appears that some of his disciples sought to excess Hahnemann’s limitations respecting the trustworthiness of symptoms produced in patients, by putting down as the pathogenetic action of the drug those symptoms of the disease which were aggravated after its administration, for in a letter to Stapf, dated Sept. 1813, he thus expresses himself:-
“You are right in supposing that the increase by a medicine of symptoms that had been previously present, most probable indicates that the medicine given can of itself also excite similar symptoms. Still we must not include such symptoms in the pure positive effects of the medicine, at least not in writing. All we can do is to bear them in mind, in order that we may pay proper attention to them when once they occur purely (that is, never having been present before) during the use of the same medicine.” (N. Arch., i. 1, 156). We shall presently see that in the last edition of the Organon he allows such symptoms to be registered among the pure effects of medicines.
Such then, as I have detailed them to you, were the principles on which Hahnemann acted in the commencement of his arduous undertaking of constructing a totally new Materia Medica. As years advanced, his mode of proceeding became altered to a certain degree, and I now propose to lay before you his notions as to how the remedial agents should be proved (as we term it), in order to ascertain their pathogenetic powers. I shall give you his latest and most matured ideas on the subject as they are to be found in the Organon; but as it would occupy too mush time, and probably exhaust your patience, were I to read all that he has said upon the subject, I think it best to lay before you a condensed view of the most material points, referring you to the last edition of the organon, from Aphorism cv. to cxlv., for more ample details on the subject.
Every medicine differs in its action on the human frame from every other. The stronger medicines developed their action sooner than the weaker on robust individuals is small doses. Weaker medicines must be given in larger powers, and the very weakest only show their action on every irritable subjects. We should take care that the medicines we employ for our provings are genuine and unadulterated. Indigenous plants should be taken in the form of fresh juice mixed with alcohol; exotic vegetable substances as powder or tincture, made when they were freshly gathered; salts and gums should merely be dissolved in water just before being taken. If we can only get the plant dry, and if it be weak, we should take it in the form of infusion, swallowing it while warm. The diet of the experimenter should be regulated, all medicinal and stimulating beverages avoided, and also over- exertion of the mind and disturbing passions. Both males and females are required for experiment. Recent experiment show that medicines do not exhibit nearly all their powers when given in the crude state, but that they do so when duly triturated and succussed. The best plan of proving medicines, even such as are deemed weak, is to give the experimenter, on an empty stomach, daily from four to six very small globules of the 30th dilution of the substance we wish to test, and continue this for several days, until an effect os produced. As, however, many people are affected by a very small quantity, it is best to commence with the smallest dose, and it is a great advantage when one dose takes effect at first, for then we can learn better the sequence of the symptoms, which we cannot do if it is requisite to give several successive doses of the medicine. If, however, we do not care about the sequential order of the phenomena, but merely wish to know what symptoms the drug produces, then the best plan is to give it every day in increasing doses. When we experience any sensation, we should try what effect change of position, walking, the open air, the close room, eating, drinking, coughing, sneezing, etc, have on it, and note the times of the day when it occurs. All the symptoms a medicine can produce are not observable on one person, so we require to test it on many, in order to ascertain them. The more moderate the dose used for our experiments, the more distinctly are the primary actions of the medicine developed. Too large dose give rise to disturbing secondary actions. All the phenomena that arise during the action of a medicine are solely derived from this medicine, and must be registered as its symptoms, even though the experimenter has observed the occurrence of similar symptoms a considerable time previously, as arising spontaneously. If the physician does not perform the experiments on himself, he should closely superintend the experiments of the person he employs for this purpose, but the best plan is for the medical man to make his experiments on himself; if he dose so he gains a great advantage in the accuracy of the symptoms, in acquiring habits and powers of observation, and his health, far from suffering, in the long run will be much benefited by the trials.