For the preparation 10,000 you take one grain of the degree 100 and add to it thirty-three grains of sugar of milk. Stir up this mass for a moment with the spatula and proceed in the same manner so that such a third is triturated twice for six minutes and after each trituration of six minutes it is scraped up (perhaps after four minutes) before the second third is added, and (after this has been treated in a similar manner and scraped up) before the last third of sugar of milk has been mixed it is also triturated twice for six minutes and then scraped and stored in a well-corked glass vial marked 10,000 as containing a medicinal substances which has been diluted or potentised 10,000 times.
In a similar manner we proceed with one grain of this powder (marked 10,000)if we wish to bring our potency up to 1, the potency of a millionth dilution.
In order to obtain a uniform preparation of the homoeopathic and particularly of the anti-psoric remedies in the form of powders, I advise, as I usually do myself, to prepare all these medicinal substances, neither higher nor lower than the millionth potency, and from these make a solution from which the necessary potencies can be prepared.
The trituration must be made with force but not so vehemently that the sugar of milk powder adheres too firmly to the mortar, so that it could not be scraped up within four minutes.
In a special annotation (page 182) he deals with dried vegetable substances and the triturations prepared from juiceless plants:
Vegetable substances which can only be obtained dry for instance Cinchona bark, Ipecacuanha, etc., are triturated in a similar way. The millionth triturations may be dissolved like all the other substances either in water or alcohol without losing any of their peculiar power. In this state they may be preserved better and for a longer period than the common tinctures, which easily spoil. Of the juiceless vegetable substances, such as, Oleander, Thuja, Mezereum, etc., you may take one grain and a half of the fresh leaves, bark, roots, etc., and reduce them by trituration with three hundred grains of sugar of milk to the millionth trituration. You take one grain of this trituration and continue the process of potentising from vial to vial with water or alcohol to the necessary degree, to its full strength by shaking each vial twice. The same process of trituration may be resorted to with the recently obtained medicinal juices. Squeeze the juice out of the plant, triturate one drop of it with the necessary quantity of sugar of milk to obtain the millionth trituration. Of this you take one grain, dissolve it in a mixture of half water and half alcohol in order to further develop its strength by diluting it through the process of the twenty-seven small alcohol vials to bring it to the necessary degree of potency, shaking it twice each time. The latter (the fresh juices) seem to develop their virtue better than by simply mixing the juice with alcohol without previous trituration and passing it through the thirty vials with alcohol by means of two shakes. I know this from experience.
For certain medicinal substances such as Phosphorus, Causticum, and others, Hahnemann gives special instructions which we will not mention here.
In 270 of the “Organon,” instructions are given which differ in some of the less important details from those of the “Chronic Diseases”; he also gives special directions for the preparation of the small globules, and for potentising the “medicaments aux globules” (see Vol. I, Chapter XXIV), as also for the necessary shoggings (percussions), etc.
The care he wished to see employed in handling the necessary implements for this work so that no contamination of the sensitive medicinal substances could take place, he describes in an annotation on page 183 of “Chronic Diseases.” He considered it indispensable that after the three hours trituration of each medicinal substance, the mortar, pestle and spatula should be scalded several times with boiling water, and in between washed clean and dried, so that no suspicion of any contamination should remain for any further medicine that was to be triturated. To satisfy the most exacting mind that there was not even a suspicion remaining of the last medicine that had been triturated, the mortar, pestle and spatula could be exposed to a red heat after the cleaning.
OPINION OF AN EXPERT ON HAHNEMANN’S TEACHING ON THE PREPARATION OF MEDICINES.
Dr. Willmar Schwabe, who founded the Homoeopathic Central Pharmacy of Leipsic, which is known throughout the world, has advocated most strongly the accurate adherence to Hahnemann’s instructions for the preparation of medicines, has repeated Hahnemann’s tests at great expenditure of time and money, by following his instructions, and has drawn up a pharmacopoeia so thorough that it has not yet been equalled (it has now been published in several languages). He says regarding this branch of Hahnemann’s life’s work and the necessity of accurately following all instructions of the master, (“Internat. hom. Presse,” 1872, Vol. I, page 328):
It is to the credit of Hahnemann that he has been the first to put applied pharmacodynamics on a firm basis, and all true disciples of homoeopathy are called upon to further develop it. The corner-stone of this foundation is the Law of Similars, and the physiological proving of the medicinal substances upon the healthy organism. The key notes is the introduction of the method for preparing the medicines, given by the founder of homoeopathy. Both are capable of further perfecting and improving, but never on the lines of hypothetical speculations, as have always been customary in allopathy. The sphere of action of the medicinal substance is revealed clearly upon the healthy human organism, more or less so, according to the reaction from the stimulus. This has been shown by the repetition of certain of Hahnemann’s provings. They have brought to light some new points; but they have also shown that some of the symptoms accepted by the prover in his tabulation of symptoms, are untenable. But it has also shown Hahnemann to be the most accurate observer, of the symptoms which appeared, of all who have undertaken the proving of medicines. His provings are far in advance and more classical than those of his followers.
His doctrine of the medicinal stimulation and of the specific action of simple medicinal substances upon the diseased tissues, is his own invention. The medicinal stimulation is caused by medicinal substance, the preparation of which Hahnemann has prescribed in a very definite form. The disease picture presented by the symptoms of Hahnemann’s provings and those of the original provers form the basis for the manuals and books of homoeopathy used for the treatment of patients. An enrichment of these is constantly taking place. The structure of homoeopathy has been pre-eminently erected upon the ground of pharmaco- dynamics and it cannot easily be denied that there is still much work to be done. But the condition is that the provings must be carried out with medicinal remedies prepared in the same manner as those of Hahnemann. In this we must be conservative. Hahnemann’s words “imitate me, but imitate accurately” must be written in letters of fire in his works, especially for those who deal with the preparation of medicines-a living “mene mene tekel.” An error only harms two people at the bedside; the patient and the physician; the rage for improvements as far as it strives to alter the kernel of Hahnemann’s teaching for the preparation of medicines harms the whole of homoeopathy. The carrying out of Hahnemann’s rules is, therefore, the chief condition for the pharmacist, not the “desire to improve”. That, in conclusion, the tincture, etc., prepared according to Hahnemann’s prescriptions, are considered the best is probably most easily proved by the active business carried on in those establishments which work according to his ideas. The same applies to the preparation of potencies.
In his closing remarks Schwabe says of the duties which the homoeopathic pharmacist should fulfil in the preparation of homoeopathic remedies (page 334):
Homoeopathic pharmacy allows of no arbitrary methods because the preparations which it produces are used according to principles which are totally different from the method of treatment of their opponents.
Homoeopathic pharmacy must be conservative; it can only progress when the activity of a remedy has, owing to renewed thorough proving, been altered by some different mode of preparation.
That homoeopathic pharmacist who sets himself firmly upon Hahnemannian ground and rejects all innovations which have not been tested and established by physiological provings, is not a reactionary.
The Kernel of Hahnemann’s teaching, in spite of all the advances in chemistry, remains simplicity, durability, and uniformity of the contents of medicinal preparations-this trinity alone gives uniform results in the experiments made on the healthy organism, when the precautions defined in homoeopathic provings have been observed, as well as practised, at the bedside (page256).
OFFICIAL DIRECTIONS FOR THE PREPARATION OF TUBERCULIN.
The Prussian Government published on April 7th, 1902, a Ministerial Decree concerning the preparation and dispensing of Koch’s “tuberculin.” It says in a passage which we quote from the “Hom. Monatsblatter,” 1902, page 192:
The dilution required for the use of tuberculin can only be prepared correctly by means of sterilised measuring-tubes and pipettes which every physicians does not possess but which are usually found in all chemists’ shops, therefore, tuberculin in the future may be dispensed by them in the diluted conditon. As tuberculin, when diluted quickly deteriorates unless a method is adopted to check this development in the dilution, and for this the best is a weak carbolic solution, therefore I decree that the dilutions shall only be made with 0.5 per cent. of carbolic acid solution and, as a rule, be prepared shortly before the remedy is required, and that it should not be kept in stock longer than four weeks. Then by mixing one part of Koch’s tuberculin with nine parts of 0.5 per cent. of carbolic acid solution a ten per cent. tuberculin solution is prepared which can be used as a stock solution for further dilutions. The receptacle must be labelled with the strength of the tuberculin solution and bear the date of preparation. The stock solution, however, must not be kept longer than four weeks.
Further dilutions must be prepared by taking one part of the stock solution and nine parts of 0.5 per cent. carbolic acid solution, and with the solution thus obtained one part is to be mixed with nine parts of 0.5 per cent. of carbolic solution and so forth.
The “Homoopathische Monatsblatter” remarks on this:
By this our homoeopathic doctrine of dosage receives official recognition, because it is of secondary importance whether spirits of wine or 0.5 per cent. carbolic solution is used.. It is particularly noteworthy in this Decree that the dilution of the Tuberculin is termed “necessary,” and that its activity is not only found in the first, second and third decimal solution, but from the additional words” and so forth,” it can be deduced that the higher dilutions are considered effective.
OPINIONS OF CONTEMPORARIES OF HAHNEMANN ON THE HOMOEOPATHIC DOSAGE PRINCIPLE.
In contrast to the majority of his contemporary colleagues, Hufeland recognised the efficacy of highly diluted remedies from the earliest days. This he did for the first time when Hahnemann was attacked on account of his Scarlet Fever remedy. He vindicated his colleague who had been attacked and wrote (“Hufeland’s Journal,” Vol. VI, page 2):
I was sorry that a man, whose services for our sciences are so incontestable, should have been so badly treated when he introduced his prophylactic for Scarlet Fever, and I do not deny that I myself was averse to the infinite smallness of the dose of Belladonna employed. In any case it (Hahnemann’s Essay-R.H.) contains excellent indications of the better effect of medicines and of the modifications which they produce through the different conditions of the organism; these are better than those of the usually neglected preparations and their descriptions. Certainly we have here secrets which the ordinary practitioner and pharmacist had never conjectured, and the voice of a man who for ten years has occupied himself with the preparation and administration of narcotics and other poisonous remedies should be listened to with the greatest attention. I am, at least, convinced that the ordinary proportion of the ingredient cannot be conclusively accepted as the correct principle for ascertaining their effects, and that some times, one grain under certain conditions, and in certain combinations, may do more than a quantity ten times as large, and even that the smallest dose may produce results which we would never obtain with a large one.
Then in the year 1826 he expressed his opinion on the homoeopathic preparations of medicines in his “Journal” (Part-I):
As regards the purely dynamic effect of remedies as accepted by homoeopathy, no one could be more, convinced of it than the author, who has long expressed this in his writings and accepted it.-That every action upon the living, and thus the effect of every remedy, is an actio viva, has always been my axiom. Moschus shows us that with some highly volatile remedies a division can take place which goes almost into infinity and beyond all ponderability, and yet retain its active power. One grain of musk will permeate the air of a large room to such an extent that the whole room smells of musk, which must therefore be present, and although this may go into a trillionth of a particle, the musk does not lose weight. In Ipecacuanha we have long recognised that the smallest doses, one-twelfth and one-sixth of a grain triturated with sugar, contain very great, yes, even new activities. May not other volatile remedies, especially the narcotic ones, be capable of a similar almost infinitesimal division, and yet retain their action upon the organism?-This is indeed a problem which deserves investigation.
To have increased the activity by increasing the points of action, by dissolving with fluids, or by long continued trituration is undoubtedly a service for which we ought to thank Hahnemann, since he first drew our attention to it.
And Professor Riecke of Tubingen says:
Although from every chair we hear the words; simplex veri sigillum, yet at the bedside no one (as Goethe says) can resist man’s inborn mania for mixing, soiling and adulterating. The receipt books which are being multiplied show best how little consideration the physicians give to simplicity in their prescriptions. The harm which incapable physicians cause daily, by their mad compounds-and all Hahnemann’s accusations regarding this “malpractice and humdrum routine, about these bungled treatments and this bragging of pseudo-scientific quackery” which allopathy contains, even if exaggerated, unfortunately hold a good deal of truth. It is true that the human organism and its diseases are complicated and we might think that compound remedies should be suitable for the purpose. Yet it passes far beyond our power of insight to recognise correctly the nature of these complications and then prepare suitable compounds ad ex tempore. But upon the duration of the effects of the medicine he remarks:
An equally important idea of homoeopathy is that of letting the smallest dose of medicine quietly act before a second dose is given to the patient. The thoughtless humdrum practice demands a “one tablespoonful every hour” mixture. Even excellent practitioners cannot pay a visit to a patient without writing a new prescription, although the medicine they had ordered yesterday is only half finished. They drown their patients in a flood of medicines; and these pets of the apothecaries never think in their unfortunate activity of a dissemination of a general disease due to medicines. This mania for medicines pursues the unfortunate to his death-bed, and he is not allowed to quit this earth without this medicinal evil. Many a dying person could say with real earnestness: “If I had not taken it, I would have escaped.”
Regarding the question of dosage itself, Dr. Riecke says with insight “that it is not even closely united to the system of homoeopathy,” but that it is “the real stumbling-block, the object of general derision and the reason for manifold persecutions.” In criticising it, he of course still runs along the old lines when he states that even the most skilled mathematician could not have a real conception or understanding of the actual largeness or smallness of the Hahnemannian decillion, when, in writing it down, sixty noughts had to be added to the unit. He tried to picture this in the usual manner by adding up the amount of water required in order to prepare the one decillion dilution of a grain of opium. For this purpose naturally the sun and the size of the earth had to be drawn into it again. It is obvious that Riecke also did not know Hahnemann’s answer to the “Truth-Seeker” or has not thoroughly thought it out. Then he raises, as a further objection, the power of attraction of the glass walls and the penetration of the medicinal fluid into the pores of the glass, but overlooks that in this respect only the whole mass of the diluted remedy could come into consideration, and that nothing essential could be altered in the composition of the fluid as such, therefore neither the potency nor its strength. Then he reminds us himself that a billionth part of a grain of gold could be traced; that the millionth part of a grain of Arsenious iodide could be made visible by means of reagents; that water in which quicksilver had been boiled was efficacious for the treatment of worms although medicinal particles could no longer be traced in it; that Spallanzi in the decillionth part of a grain of frogs’ spawn could still fructify the eggs of the frog. And after having recognised the wonderful delicacy of our organs of sense and the impossibility of weighing odours he continues:
The system of dilution may have been carried too far and made too general by homoeopathy, but no limit has hitherto been set to the sensitiveness of the living patient and it can hardly be further doubted that Hahnemann has here touched upon a gigantic if as yet still incomprehensible discovery; only time will define the value of this discovery; only public homoeopathic clinics can decide this matter.
He finally points out the economic importance of the smallness of homoeopathic remedies by saying:
Considering the smallness of the homoeopathic doses a whole medicine chest containing a hundred remedies could comfortably be put in a letter-case, and as this complete chest would hardly contain one grain of substances and therefore be materially almost valueless, the homoeopathic physician finds himself in the pleasant position of administering to his patients immediately and free of charge the remedy prescribed which does not offend the senses. This is the most brilliant issue of homoeopathy from the point of view of State Science, because with one grain of China it can cure all the intermittent fevers of the whole human race from the time of Adam to the Day of Judgment, and thus a nation that had faith in homoeopathy could save the whole expenditure of medicaments, an expenditure which in Wurtemberg could be estimated at one million.
Dr. Griesselich, however, writes in the year 1848 (Manual of “Homoeopathic Therapy,” 121, page 185):
If we cast a glance upon Hahnemann’s whole conception of potentisation the unsolvable contradiction is to be found in the fact that on the one side he says natural disease requires only the smallest possible dose of medicine in order to be affected, and on the other hand he assumes an increase of the medicinal power which, if the first assumption is correct, is not only unnecessary but must be avoided, so that the artificial illness produced by the disease could not attain appreciable dimensions.
OPINIONS OF PRESENT DAY HOMOEOPATHIC PHYSICIANS ON THE THEORY OF DOSAGE.
Emil Schlegel of Tubingen asserts in his “Reform der Heilkunde,” page 45:
Hahnemann has-certainly to his own surprise-been carried very far on purely experimental lines into the refining of medicinal substances. We can assert to-day that the sciences of Chemistry and Physics in their progress have followed him to a large extent by discovering with their best and finest methods the proof of the possibility of an unusual splitting up of substances and other material, which still remains traceable. Professor Ostwald of Leipsic has followed up this question at the Homoeopathic Laboratory of Schwabe, and with his apparatus (see also Supplement 232) has arrived at the conclusion that for certain substances the billionth particle and even a further dilution could be traced with certainty. But Hahnemann who saw the human organism- the finest reagent as v. Grauvogl once said- saw also the reaction of substances which have been much further sub-divided; this is confirmed day by day. The question is difficult because on the one hand it is frequently hard to determine the turning point in a disease process and also because it leaves the possibility of spontaneous action open. On the other hand it is this turning-point which constitutes the proof of the reality of the dose of medicine; we, therefore, cannot deny that great caution is required. But I can assure you that the facts of experience are so palpable that they can leave no doubt in a normal intellect which has become acquainted with them. The efficacy of very high, inconceivably high, homoeopathic medicinal preparations is no longer subject to doubt for me and for many experienced physicians who have to deal with them.