בונינגהאוזן ושיטת ה-LM – חלק 2: ניתוח ניהול מקרה של הנמן

Hahnemann Sends LM Cases to Boenninghausen

Hahnemann sent Baron von Boenninghausen two LM case histories in 1843, shortly before he left for his Heavenly Abode.  The Baron shared these cases with his colleagues in the Neus Archive f. hom, Heilkunst (Stapf’s Archives) Volume 1 number 1 1844, page 69. These cases can be found in Boenninghausen’s Lesser Writings in an article called, Three Precautionary Rules of Hahnemann, in the section called, 1. Warning, the Smallness of the Dose. These cases were very instructive as they show how the Founder administered olfaction as well as the oral medicinal solution of the C and LM potency.

The following case history has been checked with the original case found in the Paris Casebooks. This information was presented in an article by Hanspeter Sailer called Di Entwicklung von Samuel Hahnemann’s aertzukcger Praxis, Verlag, Haug, 1988. The Baron noted that Hahnemann dictated the example cases to a secretary and dated and signed the letter in his own hand. This was the last letter he received from his honored teacher.

On January 14, 1843 a patient referred to as O-T came complaining of sore throat alternating with an anal fissure. Sailer noted that the patient’s name was Varlet. For several years the patient had a sore throat but the present attack had lasted for one month. The last time he had a sore throat it lasted for six weeks. The patient reported that when he swallowed saliva he feel a pricking sensation with constriction and soreness. When he was not suffering from the sore throat he experienced a fissure of the anus with violent pains as from a chap. At this time, the anus was inflamed, swollen and constricted. The patient could only discharge his stool with great exertion with swollen, extruding hemorrhoidal veins.

1. January 15, 1843 – Belladonna in a 7 tablespoon solution.

Hahnemann prescribed Belladonna for sore throat on the 14th but told the patient to take the remedy the next morning on an empty stomach before breakfast. The potency was not noted in his letter to Boenninghausen but Sailer confirmed that it was the LM 0/3 from the original casebook. The patient was instructed to put one tablespoon of the medicinal solution into a glass of water, stir it well and take one coffeespoon as a dose.

2. January 16 – Merc. 0/1 in a 7 tablespoon solution.

The throat ache was gone but the fissure returned immediately! This shows that these conditions were related. The patient then revealed that eight years earlier he had a syphilitic chancre that was destroyed by corrosives. All his problems started after the suppression of the syphilitic miasm. Hahnemann immediately prescribed Mercury 0/1, his cardinal anti-syphilitic remedy. The fissure and the chap were very painful. How often he gave the dose is not noted. This may be a daily dose as the symptoms were in an acute-like crisis. The Mercury 0/1 was to be prepared and taken in the same way as the Belladonna.

3. January 20 – Merc. 0/2 in 7 tablespoons.

The patient returned for his check up 4 days later. This example shows how closely Hahnemann was following this rather serious case at the start. There are no “take this daily for one month” prescriptions in his casebooks. The patient’s throat pain returned slightly and the anus was better although there was still soreness during stool. At this time, Hahnemann raised the potency! The journal says: “One pellet of the Mercurius viv., 2 dynamization, prepared and taken in the same manner in the morning”. If the patient took the Mercury 0/1 in the “same manner in the morning” the 7 tablespoon medicinal solution would not be finished yet. Nevertheless, Hahnemann immediately raised the potency to 0/2.  This shows that the Founder raised the potency when he considered it necessary and did not always wait for the bottle to be finished.

4. January 25 – Sailer says Hahnemann gave 2 placebos. This is not in Boenninghausen’s text.

The 0/2 continued to improve the throat but there was severe lancination in the anus. This may have been a similar aggravation caused by the remedy. The patient was then given 2 placebos. It seems these two placebos were alternated with the remedy so he was now taking the alternate day dose.  This can be deduced because Hahnemann wrote on Jan. 30th that the patient had taken the last dose of medicine that afternoon. He only had 7 doses and this was 10 days later so he could not be taking the remedy daily. The Mercury 0/2 was taken daily for 4 days and then slowed down to alternate days interspersed with placebo. This shows Hahnemann slowing down the remedy, which is an important method used to prevent overmedication. The daily dose of Mercury was not continued.

4. January 30 th – 7 days of placebo in medicinal solution.

The anus was now better but the throat was worse. This shows the alternation of the symptoms still continuing although the symptoms are a little better in general. There was no particular aggravation yet Hahnemann decided to give placebos for 1 week and wait and watch. He must have observed enough medicinal action so he stopped the remedy. This prescription demonstrates how the Founder alternated periods of active doses with periods of placebo and waiting and watching.

5. February. 7 – Sulphur 0/2 in 7 tablespoon solution.

The anus was still well but there was severe pain as if an ulceration in the throat. Hahnemann wrote in The Chronic Diseases that the suppression of syphilis could cause a flare up of psora that obstructs the cure. On this basis, Hahnemann gave Sulphur 0/2 as a chronic intercurrent remedy. It was his hope that this anti-psoric remedy would assist the action of his anti-syphilitic remedy in removing the complex miasmic disorder. Exactly how often the remedy was administered is not noted. Just because the patient returned in one week one cannot assume it was a daily dose but it may have been.

6. February 13  – Mercury olfaction.

The Sulphur brought out clear Mercury symptoms on the 11th and 12th. The throat felt ulcerated and the saliva was increased and now was in great quantities! This was a sign that the anti-psoric intercurrent had an effect on the overall symptom pattern. There was also some constriction in the anus from yesterday. Rather than alternating, the symptoms were both present at the same time. At this time, the patient was given a single olfaction of Mercury, potency not noted.

7. February 14 – Merc 0/2 in 7 tablespoon medicinal solution.

Hahnemann now gave the patient a medicinal solution of Merc. 0/2. This was to be taken “as before”. Hahnemann kept the patient on the same potency as given on January 20th, around 25 days previously. In this case he did not raise the potency every 7 or 14 days as suggested by the example in aphorism 248 of the 6th Organon . This shows that the paragraph is only offering a baseline example, not a rigid predetermined schedule. Hahnemann individualized all these procedures. In one prescription he raised the potency before the bottle was finished and in others he kept the patient on the same potency for longer periods.

8. February 20 – Placebo in 7 tablespoon medicinal solution.

The throat was better since the 18th but there was much suffering at the anus. There seemed to be strong aggravation so Hahnemann waited and watched for around 11 days.

9. March 3 – Single Dose Olfaction of Nitric Acid.

After the aggravation passed the symptoms of the patient improved. The sore throat was now ameliorated. On going to stool a hemorrhoidal vein still extrudes although it did not cause as much pain as before. Now there is only a bit of itching in that spot. Hahnemann wrote, “I let him smell of Ac. Nitr.” Sailer confirms that this prescription was a single inhalation of the remedy. In this example, Hahnemann is using this method to give a gentle but deep dose toward the end of the treatment in an effort to complete the cure without aggravation.

10. March 20 – Single Dose Olfaction of Nitric Acid. (Patient cured)

Now there was hardly any pain after stool, throat well, although he feels some sensation on drinking cold water. Hahnemann wrote, “Now he is allowed to smell of Ac. nitr.” This means that before this and since March 3rd the patient was not allowed to smell Nitric acid! This dose was allowed to act over a period of 17 days. How long the second olfaction acted one cannot tell from the record because Hahnemann only wrote, “His health was permanently restored”. The prescriptions in this case show the following pattern.

1. Jan. 14, 1843. Belladonna in LM 0/3 in a 7 tablespoon solution.

2. Jan 16. Merc. 0/1 in 7 tablespoons medicinal solution.

3. Jan. 20. Merc. 0/2 in 7 tablespoons medicinal solution.

4. Jan. 25. 2 placebos to be alternated with final doses of the Mercury.

4. Jan. 30. 7 days of placebo in medicinal solution.

5. Feb. 7. Sulphur 0/2 in a 7 tablespoon medicinal solution.

6. Feb 13.  Merc. olfaction.

7. Feb 14. Merc 0/2 in a 7 tablespoon medicinal solution.

8. Feb 20. Placebo in a 7 tablespoon medicinal solution.

9. March 3. Single dose olfaction of Nitric Acid (17 days on an olfaction).

10. March 20. Second single dose olfaction of Nitric Acid (Patient cured).

What does this case tell us? First of all, Hahnemann’s prescriptions were individualized according to the cause, symptoms, miasms and attending circumstances. He did not use preconceived schedules over long periods of time. He responded to each change in the symptoms and customized his case management methods according to the time and circumstances. Secondly, this case shows how the Founder often interpolated and followed his medicinal doses with a series of placebos. In this example the patient spent around 37 days on placebos over a period of 64 days! The idea that Hahnemann gave the daily dose for weeks, months and years on end is a complete myth!

Hahnemann’s case examples offer a true picture of how Samuel Hahnemann actually practiced in Paris in the 1840s. Over the last 8 or so years I have reviewed scores of LM cases that show a similar pattern. Hahnemann used single doses (usually by olfaction) followed by placebos as well as a series of oral doses interpolated with and/or followed by placebos. Hahnemann did not speak about his liberal use of placebos in the 6th Organon. This may have been because he did not want to state this in a public work, as the placebo was his “secret simillimum”.  If the public found out it could have caused problems.

Hahnemann never gave the daily dose or alternate day dose for long periods without stopping the medicine, giving placebos and waiting and watching. Some patients remained on placebo for 7, 14 , 21 or even more days at times. This “on again – off again” technique was used with all of his patients. I have not seen a single case in the microfiches of the Paris casebooks between 1840 to 1843 where Hahnemann gave the daily or alternate day dose of the LM potency for months without stopping the remedy and giving placebos. This is true in the Casebooks DF-10, 11, 12, 13, 14, etc., which are replete with LM prescriptions

Any time there is a noticeably progressive and strikingly increasing amelioration the LM potency should not be repeated as long as this state lasts. These cases may be cured by a single dose or infrequent repetitions of the remedy. If the patient is only slowly improving, the remedy should be repeated at suitable intervals to speed the cure. Any time during the treatment that there is a sudden strikingly increasing amelioration, or an aggravation or strong accessory symptoms, the dose should be stopped as long as the state lasts. In the case of light to moderate similar aggravation it is usually best to wait and watch for the expected amelioration. In the case of strong aggravations, obstructive accessory symptoms, and the appearance of new troublesome symptoms, the situation should be rectified by skilful intervention to regularize the symptoms.

As long as the patient is improving at a reasonable rate the remedy should be repeated at suitable intervals to speed the cure. In “protracted diseases” the remedy may be repeated daily or on alternate days, if necessary, to speed the cure in otherwise long drawn out cases. The more frequent repetition may be used as long as the patient is improving and there are no aggravations or new symptoms. As the patient improves over time it is best to slow down the repetition of the remedy as the potencies are increased to prevent aggravations.

If there is an aggravation toward the end of treatment when the patient is well in most respects this is a sign of that the cure is reaching completion. To test this scenario one stops the medicine, gives placebo if necessary, and waits and watches. If the aggravation is followed by a period of amelioration and then a relapse of symptoms, the remedy should be again administered but at longer durations until the cure is complete. If the aggravation is followed by the complete restoration of health the remedy is no longer needed. This is the case management method of the 6 th Organon in a nutshell.

 

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