A Note on Hahnemanns Approach to Medical Problems
"I marvel at the transcendent acuteness his wonderful perceptive powers, his almost miraculous instinct in perceiving the characteristic symptoms, the grand pathological states producible by medicines Hahnemanns own doings are tenfold as great and important as all the labours of all his predecessors and all his followers.
It is convenient to divide Hahnemann's life into four phases. The first phase concerns his study and practice of allopathic medicine. The second phase covers the period when he abandoned medical practice altogether in frustration and disgust and fell back upon translation work as his main income. Third comes a phase when he addressed and gradually solved all the problems he confronted in the allopathy of his training and began to construct a new medical system through provings and tests.  The final phase is when homeopathy as a system was up and running and he then practised and perfected it for the rest of his days.
The crucial second and third phases appear to us like 'crucible years' in which his whole spirit was plunged into the fires of despair and his intellect was pitted against apparently insurmountable obstacles which he finally overpowered. And in both these phases he wandered helpless and forlorn with his growing family, all over
Wherever we find Hahnemann deviating from the regular medical practices of his dayand we find that he does this very oftenwe can have some confidence in deducing that he does this for two main reasons. First, that he has tried out the regular approach for himself and found it deficient and unsatisfactory in some important respect. Second, that he has devised, through his own experimentation, a new method, which he has exhaustively tested and which he has found to be superior. This series of developments he ascribes to 'experience'  and thus they reveal him as a perpetual innovator, a pioneer, and experimentalist  who accepted nothing at face value, who questioned everything, and who then proceeded endlessly and tirelessly to improve every method he had been given, even including those methods he had devised himself. Very largely then, it becomes clear that his objections to traditional methods were NOT based upon any theory, or theoretical concerns in general, but upon practice. They are rooted in practice and acute observation. 
A good example of this tendency is shown when we consider his use of small doses. Homeopathy is famous for its small doses, but we even see him at the very beginning of his medical career giving smaller doses of Mercury in Syphilis than those of his contemporary colleagues.  Why is this? It seems likely that even at this early stage he was critical and questioning of traditional approaches and when he encountered a problem, a shortcoming, he sought out ways to correct it. On this basis we must assume that he saw for himself the unsatisfactory nature of strong drugs.  He must have seen for himself from an early stage that large doses tend to have an overwhelming effect upon the organism, that they do not induce a good healing response in the patient, but tend instead to overexcite, to overstimulate and so cause more damage than good. Trying for himself smaller doses on patients, he then began to see that they do indeed have a gentler action, do not swamp the vital powers with excess stimulus, but evoke a gentler, milder and more curative reaction, with fewer adverse effects.
He must have approached this problem, as with all others, from a critical, practical and experimental position, not on the basis of some theory. In doing so, he moved from the practice of his contemporaries to a new position, revised by him through observation and experiment. This was always his method of working. He used it in all his work from start to finish. We can also apply this view to how he dealt with all other aspects of medical practice that came under his critical gaze, such as mixed drugs, contraries, purging, bleeding and all the other techniques handed to him in his training. He rejected each of them because he had personally tested them and found them to be unsatisfactory and so sought out and found ways to improve them. 
Such an appraisal of the man and his method of working is indispensable as it allows us to gain a much richer understanding of his life and work. This perspective gives us important information, because it shows that in spite of his vast theoretical knowledge of medical systems and his awesome linguistic skills, his principal concern was always firmly grounded in practical medicine. In no sense, therefore, did he construct homeopathy as a theoretical medical system  or let his theoretical knowledge in any sense 'get in the way' of his pure empirical work. It shows that he was indeed the empirical experimentalist as he is commonly portrayed, and not primarily a theoretician as some would prefer to have him seen. 
Regarding contraries versus similars,  and single versus mixed drugs,  the same method is at work, his acute observational skills and his provisional views, firmly embedded in personal medical practice, come to the fore in deciding which direction he chooses. Having directly observed at firsthand the suppressive effects of mixed drugs in strong doses and of contraries, he thus had little option but to experiment with single drugs and to use them on the basis of similars. In every sphere of his experimentationwhich formed the groundwork on which homeopathy was to be basedthe same basic process underpinned his approach. He starts with a practice he has problems with, he analyses the nature of the problem, he tries some alternatives and then finally selects the method that offers the best chance of improvement with little or no harm. His method is always rooted in direct medical practice, in acute observation and in conducting his own experiments. Furthermore, we can then also see that he continues to find ways of improving even the best method. Indeed, he never ceases from devising new ways of improving any good method he chances upon in his search. This is especially apparent in the exhaustive and unending changes he made regarding dosage or potency scales. 
Once he had realised the superior path of using small doses of single drugs based on similars, he never ceased until his dying day of improving the methods of preparing and administering such drugs. So we see his desire to improve his clinical methods repeatedly and unceasingly exemplified in his life's work.
 Robert E Dudgeon, Lectures on the Theory and Practice of Homeopathy,
 This covers the period 1775-1784 during which time he resided at
 This mostly covers the period 1784-1793.
Recognising "the insufficiency of medical science," (Richard Haehl, Samuel Hahnemann His Life and Works, 2 volumes, 1922,
 After the Cinchona proving of 1790, others followed and were collected in the Fragmenta de viribus of 1805, a small volume in Latin containing 27 drug pictures. The contents consisted mostly of symptoms he had collected from ancient medical literature combined with some from partial provings he had made himself. Having rejected the authorised allopathic "Materia Medica based on conjectures and compound prescriptions," (Samuel Hahnemann, The Organon, combined 5th/6th Edition, 1841, Edited by Boericke and Dudgeon, Jain Reprint, §54) Hahnemann sought to create a new one founded solely on the bedrock of pure symptoms induced in healthy persons, in other words, via proving drugs on the healthy. "This spirit-like power to alter mans state of health (and hence to cure diseases)...lies hidden in the inner nature of medicines." (Organon, §20) Medicinal substances, when taken in their crude state by the experimenter do not exhibit nearly the full amount of the powers that lie hidden in them which they do when they are taken on an empty stomach, daily from four to six very small globules of the thirtieth potentised dilution of such a substance, moistened with a little water, and let him continue this for several days. (Organon, §128) Sometime after the Cinchona experiment of 1790, Hahnemann "contented himself with hunting up in the works of the ancient authors for hints respecting the physiological action of different substances," (Dudgeon, xxii) and "in this way he collected together a tolerable pathogenesis of many powerful substances, and on this basis he endeavoured to practise." (Dudgeon, xlvii) But the results of this endeavour "were inadequate to afford him sufficiently accurate pictures of morbid states corresponding to the natural diseases he had to treat," (Dudgeon, xlvii) and "were so vague and indefinite...(comprising) slovenly detailed cases of poisoning...(which) would never do to found a method of treatment on." (Dudgeon, 178-9) Up to 1798, "I should say his knowledge of medicines was entirely derived from the records of poisonings in allopathic literature, and a few desultory and unmethodical experiments on himself and friends." (Dudgeon, 52) He therefore was left with no option but "to test the medicines and poisons accurately and systematically upon the healthy individual." (Dudgeon, xlvii) He therefore undertook careful and more detailed "experiments with different drugs on himself and various friends." (Dudgeon, 49) The "ten volumes of provings he has left us are an eternal monument to his energy, perseverance, conscientiousness and self-sacrifice." (Dudgeon, xlvii)
 Such "men of authentic genius are necessarily to a large degree destructive of past traditions
always transform, upset and destroy." (Sir Isaiah Berlin, The Sense of Reality - Studies in Ideas and Their History, London: Pimlico, 1996, 70) Such rebels are "bound to subvert, break through, destroy, liberate, let in air from outside." (Berlin, 1996, 67) Like William Harvey, Hahnemann professed to learn "not from books
not from the tenets of Philosophers, but from the fabric of Nature." (Roy Porter, The Greatest Benefit to Mankind A Medical History of Humanity, New York: Norton, 1998, 215). Like Paracelsus, Hahnemann "thought he could learn more medicine by travelling and observing than from any library." (Roger French, Medicine before Science: the Business of Medicine from the Middle Ages to the Enlightenment,
 He wandered around Saxony roughly from 1786 to 1805 when he finally settled first in Torgau (1805-11), then in
 In his construction of homeopathy, Hahnemann gives "pure experiment, careful observation and accurate experience alone," (Gumpert, 144) as the sole determining factors, the sole forces that shaped his new system. Hahnemann "cast tradition aside, and had recourse only to the medicines he had learned, tested and confirmed." (Gumpert, 67) in all these discoveries Hahnemann was guided by experience, to which he trusted solely." (Dudgeon, 49-50) He had no respect for theories except those "in consonance with nature and experience. (Organon, 1) What Hahnemann terms "...'experience' is equivalent to investigation; 'sciences of experience' are the same as what are now called the 'inductive sciences'...or 'empiricism'." (Ameke, 133) This refers to where Hahnemann says things like "true medicine is from its very nature a pure science of experience," (Ameke, 134) that medicine "should rest only upon pure facts," (Ameke, 134) and that medicine should be rooted in "pure experience and observation...and not venture a single step beyond the sphere of pure, carefully observed experience and experiment." (Ameke, 134) Hahnemann was, "in all essentials, a flawless experimenter." (Introduction to the 2nd Organon, xxiv) Most of Hahnemanns work can be ascribed to "the scrutiny of reason guided by experience." (Dudgeon, 137) Medicine is a science of experience: its object is to eradicate diseases by means of remedies." Samuel Hahnemann, The Medicine of Experience (1806), reprinted in The Monthly Homoeopathic Review,
 Hahnemann "one of the most distinguished physicians of
 Hahnemann was "one of the best observers." (Dudgeon, 77) He especially "surpassed his mixture-loving contemporaries in the gifts of observation and investigation." (Ameke, 85) Everything he deduced "from pure experience and observation." (Ameke, 134) By his own admission, his medical views were solely based only on accurate observation of nature, on careful experimentation and pure experience, (Organon, §52) and what multiplied experience and careful observation have led me to adopt. (Organon, §270)
 Hahnemann "advocated ever more definitely the administration of small doses." (Gumpert, 96) In his Essay On a New Principle of 1796, Hahnemann "does not yet talk about diminishing the dose, but insists on the necessity of administering but one medicine at a time
in all these discoveries Hahnemann was guided by experience, to which he trusted solely." (Dudgeon, 49-50) In 1797, he says that for several years since I never administered anything else but one single remedy at a time. (
 Hahnemann manifested a definite "tendency of his mind to rebel against the enormous doses of ordinary practice." (Dudgeon, 392) His doses of Mercury in syphilis were for his time a very minute dosage, (
"This celebrated chemist...this meritorious physician...the meritorious Hahnemann...whom chemistry has to thank for many important discoveries."(Ameke, 41) "Science derives its knowledge of life from a consideration of the facts of observation and experience," (Stuart Close MD, Lectures and Essays on Homeopathic Philosophy, Philadelphia: Erhart & Karl, 1924, 11) Dr. Krauss candidly states in his Introduction to the 2nd Organon: "Hahnemann was, in all essentials, a flawless experimenter." (Organon, xxiv) "The era of scientific medical experimentation begins with Hahnemann and nobody else. Scientific to the core, Hahnemann experimented scientifically for scientific observation." (Organon, xxvii) Homeopathy was "founded and developed into a scientific system...by Hahnemann...under the principles of the Inductive method of science as developed by Lord Bacon." (Close, 16-17) Dudgeon notes that "his diligence must have been something extraordinary," (Dudgeon, xxii) points to "the power of his great genius," (Dudgeon, 64) and lauds "the brilliant discoveries of his genius." (Dudgeon, 560) His "Essay on a New Principle" emerged in 1796 "after six years of patient observation and research." (Dudgeon, 49) Hobhouse points to the relentless thoroughness with which Hahnemann set himself to any task. (Hobhouse, 64)
 In Aphorism 6, he bemoans the, "futility of transcendental speculations which can receive no confirmation from experience." (Organon, p.32) He "was committed with all his mind to the observational method...he rejected in its entirety the clap-trap of medieval traditions and he made out an eloquent case for the pharmacological experimental method." (Charles S Cameron, Homeopathy in Retrospect, Trans. Stud. Coll. Phys. Philadelphia., 27, 1959, 28-33; quote from, 32) Hahnemann's clear understanding of the dismal value of 'medical systems' is yet further illustrated by the following quotes: "anon came the alchymist with his salt, sulphur and mercury; anon Silvius, with his acids, biles and mucus...our system-builders delighted in these metaphysical heights, where it was so easy to win territory; for in the boundless region of speculation every one becomes a ruler who can most effectually elevate himself beyond the domain of the senses." (Aesculapius in the Balance, 1805, Hahnemann's Lesser Writings, edited by Dudgeon, London: Henry Turner & Co, 1895, 421-2) Numerous such scathing comments clearly reveal Hahnemanns disdain for medical theories. He rejected Claudius Galen for "inventing a subtle system (rather) than consulting experience. Disdaining to learn the powers of medicines by instituting experiments, he gave the bad example of generalizing and framing hypotheses." (Samuel Hahnemann, On the Helleborism of the Ancients, 1812, in Hahnemann's Lesser Writings, 592) He dismissed generations of medical theorists for making a "display of the most fantastic, often most self-contradictory, hypotheses, explanations, demonstrations, conjectures, dogmas, and systems, whose evil consequences are not to be overlooked," (Samuel Hahnemann, On the Value of the Speculative Systems of Medicine, 1808, in Hahnemann's Lesser Writings, 489-90) for employing mostly "sophistical whimsicalities," (Samuel Hahnemann, Aesculapius in the Balance, 1805, in Lesser Writings, 420) and for "looking only through the spectacles of hypothetical conceits, gross mechanical explanations, and pretensions to systems." (Hahnemann, 1805, 426) Hahnemann's numerous derogatory comments about the dangers of medical theories and systems, illustrate his own detailed and intimate knowledge of them; that he rejected such theories; that he held theoretical medicine in general in utter contempt; and that as a physician he was grounded primarily in practical medicine, that is in what cures sickness: all Hahnemanns views and doctrines were made subservient to his therapeutics. (Dudgeon, 243)
 A typical example of this prejudicial and wholly erroneous nonsense: "Hahnemann had cast homeopathy in substantially the same eighteenth century mould that had given shape to the systems of Cullen, Brown and Rush; as regular physicians assessed it, homeopathy offered an unambiguous example of extreme rationalism informing a dogmatic system of practice with dire consequences." (John H Warner, The Therapeutic Perspective, Medical Practice, Knowledge and Identity in America 1820-85, Harvard: Harvard Univ. Press, USA, 1986, 52-3)
 "The primary characteristic of homeopathic medicine was the law of similia." (William G Rothstein, American Physicians in the 19th Century from Sects to Science, Baltimore: John Hopkins Univ. Press, 1972, 165-6) "One should apply in the disease to be healed...that remedy which is able to stimulate another artificially produced disease, as similar as possible; and the former will be healedsimilia similibuslikes with likes." (Haehl, I, 66) Homeopathy then "is exclusively the science and art of the investigation and application of the similia similibus curentur phenomenon." (O E Guttentag, Trends toward Homeopathy Present and Past, Bull Hist Med, 8.8, 1940, 1172-1193; quote from 1176) He declared that "diseases should be treated by agents capable of producing in the healthy symptoms similar to their own," (Dudgeon, 46) thereby rejecting medical contraries saying that "persistent symptoms of disease are far from being removed...by opposite symptoms of medicines." (Organon, §23) From a vast array of instances, collected from the writings of various authors, and his own experience, he demonstrates the value of treating diseases with medicines that have the power of developing symptoms similar to those of the disease. (Dudgeon, 49)
 "Hahnemann insisted that only one remedy be given at a time and continually belaboured his allopathic colleagues for their multi-ingredient prescriptions." (Coulter, II, 390) "Then let us...agree to give but one single, simple remedy at a time, for every single disease." (Samuel Hahnemann, Are the Obstacles to Certainty and Simplicity in Practical Medicine Insurmountable? 1797, in Lesser Writings, 320). He rebelled against "the irrationality of complicated systems of diet and regimen, and complex prescriptions," (Dudgeon, xxiv) in common use in his day. In Konigslutter, 1795-9, he "had now abandoned the complicated medication of ordinary medical practice...(and) the absurdity of giving complex mixtures of medicines." (Dudgeon, xxiv) In his preface to his translation of the Edinburgh Dispensatorium, which he translated in 1800, he described the prescriptions in common use as "a confused jumble of unknown drugsmostly poisonsmixed together." (Dudgeon, xxviii) He "was a most passionate opponent of mixed doses that contained a large number of ingredients." (Gumpert, 96) Hahnemann "was the first to raise his voice against the compounding of prescriptions, holding that the effects of compounds on disease could never be known precisely." (Coulter, II, 335) He condemned the "employment of the many-mixed, this pell-mell administration of several substances at once...these hotchpotch doses." (Samuel Hahnemann, On the Value of the Speculative Systems of Medicine, 1808, in Lesser Writings, 489-90; quote from 498) He was very "outspoken in his contempt for every mixture of medicines," (Haehl, I, 308) revealing his "rejection of compound medicines." (Haehl, I, 308) He objected to the awkward and often chemically ridiculous polypharmacy, (
 Hahnemanns "discovery of the principle of potentisation came about gradually as he experimented in the reduction of his doses, in order to arrive at a point where severe aggravations would not occur." (Close, 190) His "idea at first was simply to reduce the "strength" or material mass of his drug, but his passion for accuracy led him to adopt a scale, that he might always be sure of the degree of reduction and establish a standard for comparison." (Close, 216) He progressively reduced his doses in order to relieve and eliminate the toxic effects of drugs on the patient, such that over time his "doses became more and more refined and attenuated." (Dudgeon, xlv) The objective was to administer "doses smaller than those capable of producing morbid symptoms in the healthy." (Dudgeon, 46) It was "the homeopathic aggravation, that is the increase of all important disease symptoms which followed upon the administration of the 'specific remedy'... (that) induced him to gradually decrease the dose." (Dudgeon, 311) With regard to dosage it was "the aggravation after strong doses," (Dudgeon, 315) that drove him ever further into drug dilution. He denounced larger doses which, "he says, cause medicinal aggravations." (