The Methods of the 4th, 5th and 6th Organon
The 4th, 5th and 6th Organon represent the progression of Samuel Hahnemann’s clinical methods from 1829 to circa 1843. The 4th Organon (1829) presented the single dose method and recommends that a homoeopathic remedy should not be repeated until there is a complete standstill of any amelioration in every direction. This is called the "wait and watch method", which states that a remedy should not be repeated until the duration of the previous dose has ceased. This method is usually performed by administering the medicine as dry pellets although Hahnemann was already experimenting with olfaction and medicinal solutions.
In aphorism 245 of the 5th Organon (1833) the Hofrath presented what he considered to be the "middle path" in regards to the single dose and the repetition of the remedy to speed the cure. The Founder recommends that in cases where there is a perceptibly progressive and strikingly increasing amelioration the remedy should be allowed to act alone as long as this state lasts. In aphorism 246 the Founder now suggests that in cases where there is only a slowly progressive amelioration that may take 40, 50 to 100 days for the remedy to accomplish all it can do, the remedy should be repeated at suitable intervals to speed the cure before the amelioration comes to a complete standstill.
In the footnote to aphorism 246 Hahnemann says that in order to use this "true middle path" the homoeopath must be guided by the nature of the remedy, the physical constitution of the patient, and the magnitude of the disease. This means that if one understands the nature of the remedy, the patient and the disease state it is possible to repeat the remedy to speed the cure. For example, Hahnemann wrote that in chronic diseases Sulphur 30C can rarely be repeated with advantage, even in robust patients with fully developed psora, sooner than every 7 days. In patients that are weaker and more sensitive it is more normal to give the remedy every 9, 12 or 14 days. This example gives one an idea of the baseline suggestion for repeating the 30C in chronic diseases. When using the 200C or 1M the time period between repetitions of the remedy must be lengthened accordingly.
With the 5th Organon’s middle path method it is no longer necessary to wait until the complete duration of the remedy ceases as witnessed by a complete standstill of any improvement. For this reason, the homoeopath is able to speed the cure of slow moving chronic diseases to one half or one quarter of the time it took with the 4th Organon’s wait and watch method. This method is still valid for the application of the C potency in dry pellets, by olfaction, and in liquid solutions. The wait and watch method forms an important basis for all of the posology methods developed in the 1830s and 1840s. If the homoeopath does not know when to wait and watch they become prone to overmedicating their patients, causing aggravations, and slowing down the cure.
At the time of the 4th and 5th editions Hahnemann stated his preference for the use of remedies in liquid solution but had yet to work out the most effective delivery system. This lacuna in the system was filled in 1837 when he introduced the use of the medicinal solution prepared in a bottle and preserved by brandy. This preparation was most suitable for his new method which included "divided doses" measured in teaspoons. The Paris casebooks of this period show that the Founder was already using a 7 to 8 tablespoon medicinal solution with the addition of a dilution glass. This method was later presented to the public in the 6th Organon, which was completed in 1842. By this time, the Founder had developed a new dynamization system called the 50 Millesimal potency.
The Lost Teachings of Samuel Hahnemann
There has been quite a bit of misunderstanding about how Hahnemann actually administered the LM potency in the clinic. Some people seem to think that he gave most of his patients the daily dose for months on end in some mechanical fashion. This misapprehension arose because it is very difficult to understand how to give the LM potency just from reading the Organon without the guidance of experienced teachers who know the method.
Hahnemann was grooming Boenninghausen for the role of teaching the LM potency in 1843, but after Samuel’s passing, Melanie Hahnemann dissuaded the Baron from sharing this new information until she published the 6th edition. Unfortunately, Madame Hahnemann was unable to publish the 6th edition before her death so all those with knowledge of the new method had passed away by the time the manuscript was published. The first German edition appeared in 1920 and the English translation in 1921. By this time the lineage of living teachers of the LM potency was broken and the actual methodology of the 50 Millesimal potency became a lost teaching of Samuel Hahnemann. Only Samuel, Melanie and Baron von Boenninghausen (and to a lesser degree Reverend Everest) had full knowledge about the LM potency. Dr. Croserio witnessed how Hahnemann gave the LM potency but was not privy to the exact method of their manufacture.
The only way to reconstruct how Samuel Hahnemann really used the LM potency is to carefully study the 6th Organon and compare it with the Paris Casebooks and letters on the subject written by Hahnemann, Boenninghausen, Reverend Everest and Dr. Croserio. I have been fortunate to be supplied with microfiches of the original Paris Casebooks by the Robert Bosch Institute and have been given permission to share this information. These documents contain a record of how the Founder actually gave the C and LM potency and help to fill in holes in the information supplied in the 6th Organon. On this basis, I have been able to reconstruct Hahnemann’s final methods and test them in a clinical trial spreading over a 10 year period. For the first 10 years of my LM experiments I did not have a full understanding how the Founder administered his remedies in the 1840s. Now after around 25 years of testing the LM potency I have also added my own experience to the pool of knowledge.
Posology and Case Management in the 6th Edition
Aphorism 246 of the 6th Organon offers the most precise details on how to give the LM potency and must be put in context with the statements in aphorism 248 about the daily and alternate day dose. In the first sentence of aphorism 246 Hahnemann clearly says "every noticeably progressing and conspicuously increasing improvement is a state which, as long as it persists, generally excludes any repetition of the medicine..." The reason for this is that the medicine being used is still "hastening toward completion". This is not the time to repeat the dose as it may spoil this dramatic reaction by causing aggravations or a relapse of the symptoms.
This reflects what Hahnemann said in aphorism 245 of the 5th Organon on the single dose. Some persons are under the illusion that what Hahnemann says in the first sentence of aphorism 246 of the 6th edition only refers to the method of the 5th Organon. They act as if this statement has nothing to do with the LM potency. How can this be? The last time Hahnemann spoke about giving the exclusive single dose and waiting until there was a complete standstill of the improvement before repeating the remedy was in the 4th Organon in 1829 not the 5th edition. Experience shows that to ignore the first sentence of aphorism 246 of the 6th edition is a grand mistake.
After speaking about the single dose Hahnemann says, "On the other hand" there are many cases that only show a "slow, continuous improvement based on one dose of an aptly selected homoeopathic medicine (taking 40, 50, 60 100 days to complete the cure, depending on the nature of the medicine) but this is very seldom the case" Then he goes on to state how important it is to "foreshorten this period" to 1/2, 3/4 or less the time so that a more rapid cure is attained. This reflects what Hahnemann said in aphorism 246 of the 5th Organon on repeating the remedy to speed the cure. Although this information is not completely new the data is expanded into new regions and applied in a more effective manner.
In aphorism 246 of the 6th edition Hahnemann makes it rather clear that there are two possible reactions to a remedy that must be treated differently.
A. A "noticeably progressing and conspicuously increasing improvement". In this instance he says to leave the single dose to act without repetition as long as this state lasts. It also implies that any time during treatment that there is a dramatically increasing amelioration on a series of doses to stop the remedy. I would like to report that my colleagues and I have seen many cures of chronic diseases with single and infrequent doses of the LM potency. For example, a patient with a 9 year old disease of the eyes was given a single test dose of Causticum 0/1 and all the symptoms disappeared in a few days and have never returned!
B. A "slow continuous improvement" where a single dose could take up to 100 days to produce significant results. This, however, is seldom the case as most of the time this slow improvement just ceases at some point and the patient relapses. This is quite common in protracted long lasting chronic diseases. In this case, one should repeat the dose at suitable intervals to speed the cure. One can repeat the dose to speed the cure only if one meets the 5 conditions noted at the end of the paragraph.
1. The remedy is perfectly homoeopathic (not a wrong remedy or a partial simillimum).
2. The remedy is potentized and dissolved in water (not the dry dose).
3. The remedy is given in a small dose (1 pill in at least a 7 to 8 tablespoon medicinal solution given in a split-dose, etc.)
4. The remedy is given at suitable intervals based on what experience has shown to be the most suitable (individualization).
5. The degree of potency must be changed on each dose (the medicinal solution must be succussed prior to ingestion.).
There is a GREAT difference between a "noticeably progressing and conspicuously increasing amelioration" and a "slow continuous improvement" where the patient usually relapses. The different nature of these responses offers a very important differential prognosis on the action of the remedy. When the patient is already hastening toward cure after a single dose or a short series of rapid doses they do NOT need the cure to be sped! One can not speed up that which is already progressing as fast as possible. The rapid repetition of the remedy in such cases only leads to aggravations, accessory symptoms and relapses of the disease state. This is all due to overmedication, which is the bane of good homoeopathic treatment.
Hahnemann notes that single dose cures are quite common in acute diseases although it is much rarer in long term chronic cases. Nevertheless, the author has witnessed a good number of cases in which the patient only needs a single dose or infrequent repetition of the LM potency. The statement about the daily dose in the footnote to aphorism 246 says the LM may be given daily WHEN NECESSARY. It does not say that one must give the LM potency daily to everyone. If it is NOT NECESSARY the LM potency will only slow down the cure in the long run.
All the statements about the daily and alternate day dose that follow in aphorism 248 are about how to speed the cure of SLOW moving cases. These are the cases where we need to be "foreshorten this period" to 1/2, 3/4 or less so that a more rapid cure is attained. If the patient is experiencing a strikingly progressive increasing amelioration on a single dose, infrequent doses, or a short series of doses, the repetition of the remedy is counter indicated. If the patient is only slowly improving then one must use the techniques like those suggested in aphorism 248 to speed the cure. This is the best of both worlds!
Dr. Croserio’s Eyewitness Account
Dr. Croserio was a very close colleague of Samuel and Melanie Hahnemann. He and Jahr were invited to Hahnemann's death bed to see the Founder lying in state and he helped Melanie in her practice after the Founder passed away. He also defended Melanie in court when she was charged with practicing without a license. For these reasons, I call him "faithful Dr. Croserio". Hahnemann sent two LM cases by letter to Boenninghausen in 1843. Boenninghausen wanted more clarifications so he asked Croserio for an eyewitness account of how Hahnemann actually used the LM potency. This letter can be found in Boenninghausen's Lesser Writings under the title Hahnemann's Doses of Medicine.
Dr. Croserio noted in his eyewitness account that Hahnemann "frequently" gave single doses by olfaction followed by 7 days of placebo. The Paris casebooks confirm the fact that the Founder certainly did often use single doses (often by olfaction, but sometimes through the oral solution) and gave the patient placebo for at least 1 week! Some patients got almost exclusive olfactions of single doses and placebos. Hahnemann did not always use the daily or alternate day dose. Sometimes in his cases he noted that he gave the remedy every three days, etc. The Founder’s method was artistic not mechanical and was individualized according to the time and circumstances.
Dr. Croserio's letter also stated that as soon as Hahnemann saw definite medicinal action he either diminished the dose or stopped the remedy and the patient was given placebo. The Paris casebooks confirm this perfectly. Sometimes he gave a single dose followed by at least 7 days of placebo while he waited and watched. At other times, he gave a short series of 3 to 7 doses over a 7 day period and had the patient come back in one week. At this time, he would re-evaluate the case and make adjustments if necessary. He might repeat the remedy or he might give placebos and have the patient come back in another week. If there were strong medicinal actions he would follow the series of doses with a series of placebos. Hahnemann constantly interpolated and followed his medicinal doses with placebos at different intervals. In many cases he gave almost as much placebo as medicine.
The Paris Casebooks show that Hahnemann never gave the daily dose or alternate day dose for very long periods without stopping the medicine and giving placebos for at least 1 week! Some patients were on placebo for 7, 14 and even 21 days or more if necessary. This "on again - off again" method was used with all his patients. I have not seen 1 case in the microfiches of the Paris casebooks between 1840 to 1843 (the LM epoch) where Hahnemann gives the daily or alternate day dose for months without stopping the remedy and giving placebos. This is true in the Casebooks like DF-10, 11, 12, 13, 14, etc., which have ample LM prescriptions. This information shows that the remedy should be stopped whenever there is a conspicuously progressive and strikingly increasing amelioration, an aggravation or any confusion about the direction the case is going. This period of waiting and watching is essential to good homoeopathic prescribing.
Hahnemann’s Letter Case Sent to Boenninghausen
The following record is one of the LM cases which Hahnemann sent to Boenninghausen in 1843. This case is found in Boenninghausen’s Lesser Writings, in an article called Three Precautionary Rules of Hahnemann. Warning: The Smallness of the Dose. This record has been double checked with a work by Hanspeter Sailer called, Di Entwicklung von Samuel Hahnemann's aertzukcger Praxis, Verlag, Haug, 1988, which investigates the same case from the record in the casebook. This case was taken just months before the Founder become fatally ill so it shows his final methods.
On Jan. 14, 1843 the patient was complaining of sore throat alternating with an anal fissure. Hahnemann gave him Belladonna in C potency in a 7 tablespoon medicinal solution which aggravated the throat and brought out the anal fissure. This was most likely a daily dose. On Jan. 16 the patient confessed he had suppressed a syphilitic chancre with corrosives and Hahnemann gave him Merc. 0/1 in 7 tablespooons. Here is a list of prescriptions.
1. Jan. 14, 1843. Belladonna C potency in a 7 tablespoon solution.
2. Jan 16. Merc. 0/1 in a 7 tablespoon solution.
3. Jan. 20. Merc. 0/2 in a 7 tablespoon solution.
4. Jan. 25. Sailer says Hahnemann gave 2 placebos.
4. Jan. 30. 7 days of placebo in medicinal solution.
5. Feb. 7. Sulphur 0/2. in a 7 tablespoon solution.
6. Feb 13. Merc 0/2 olfaction.
7. Feb 14. Merc 0/2 in a 7 tablespoon medicinal solution.
8. Feb 20. Placebo in 7 tablespoon medicinal solution.
9. March 3. Single dose olfaction of Nitric Acid. (17 days on single dose olfaction).
10. March 20. Second single dose olfaction of Nitric Acid. (Patient cured).
This example case is typical for the repetition of remedies followed by placebos as well as single dose olfactions. In a period of around 65 days (a little over two months) the patient spent around 39 days without any medicinal doses! In this case Hahnemann gave nearly as much placebo as medicine. The patient was off medicine more than he was on medicine even though this was a serious case of syphilis! The idea that Hahnemann gave the daily dose for endless weeks, months and years is a total myth!
Personal Experiences in the Clinic
I would also like to say that the LM remedies cannot be treated like a low potency system. One cannot compare the C and LM potency solely by the amount of the original substance left in the dilution. There is a great difference between a mathematical and dynamic equivalence. The LM 0/1 of 1 pill in an 8 tablespoons solution has around the same amount of medicinal substance as the 9C but its power is much, much greater due to its 1/50,000 dilution and 100 succussions per dilution. In over 20 years of comparing the LM with the C potency (I use both side by side) I would say that the LM 0/1 acts like a higher potency than the 30C. To think the LM is the equivalent of the low potency C is a great mistake. Boenninghausen personally tested the LM potency and wrote that they act like the high and highest C potencies!
All things equal, I would say the LM 0/1, 0/2 and 0/3 act with a similar depth to the 60C to 200C or higher although the duration of the remedy may not be as long as the ultra high C potencies. The LM potency will cause strong aggravations when misused. I have seen it, my colleagues have seen it, and I have received countless letters from patients who were greatly aggravated by receiving the LM potency daily in a mechanical fashion. Many times they felt very, very good in the first week or so (strikingly progressive amelioration) and then got worse and worse because the dose was never slowed down or stopped. These are clinical facts. It is a great mistake to completely jettison the wait and watch philosophy. In truth, Hahnemann’s new methods are a perfect balance of knowing when to wait and watch and when to act and observe. A good homoeopath needs to know how to do both.
I have found that overmedication either causes the patient to become unresponsive to the remedy due to overexposure or it causes aggravations that make them oversensitive to the remedy. Sometimes this can make it hard to use even the correct remedy later in the case. The cases that are often spoiled are those which only needed a single dose or infrequent doses, or only a short series of doses, but were never given the time they needed to respond. What should be the "best case scenarios" become the "worst case situations" because the remedy was given when it was not needed. One must be very careful with the LM potency because overmedication will cause aggravations, accessory symptoms or adverse counter actions of the vital force if abused. Like all homoeopathic potencies, the medicinal powers of the LM potency must be treated with the greatest respect.
Hahnemann spoke about raising the LM potency every 7 to 14 days in aphorism 248 but the Paris casebooks show that this was only a baseline example. He would sometimes raise his potencies more quickly before the bottle was finished, and in other cases he would keep the patient on the same potency interspersed with or followed by placebo for longer periods. Sometimes he would move up to find a better potency, and at other times he would move downward because of aggravations. There was no rigid protocol or fixed rule in posology. The time for raising the potency was dependent on several factors. This includes the time the medicine was consumed, how much placebo was given, and the nature of the symptoms and circumstances.
I know that some homoeopaths give all patients the daily or alternate day dose and only stop if and when they see aggravations. This does reflect one aspect of Hahnemann's method but it does not take into account what he says in aphorism 246 and its footnote. It also does not coincide with the Dr. Croserio's eyewitness account or what is found in the Paris casebooks. Sometimes Hahnemann gave a single dose and placebos and other times he gave a series of split-doses at intervals like daily, alternate days, every third day, every fourth day, etc. It all depended on the nature of the disease state and the response of the patient to the first test dose or doses. Hahnemann constantly alternated series of medicinal doses with placebos and periods of waiting and watching. He used so many different methods that one simplistic mechanical approach cannot embrace his artistic methodology. As Croserio said,
"It would be impossible for me to give in a letter all the shadings of his treatment. By your constant correspondence with the learned sage you have had abundant opportunity to learn to appreciate his rare powers of observation, and you will therefore easily see that his mode of action was not always the same".
Hahnemann customized the adjustments of the dose, the time of repetition, the use of placebos, and the raising of the potency based on what the individual needed. He used single doses and infrequent repetition interspersed by placebo as well as frequent repetition daily, every other day, etc. All his patients were not treated identically because "his mode of action was not always the same." Everything Hahnemann did was individualized according to the symptoms, time and circumstances.
I have presented quotes from the Organon, a case from the Paris casebooks, and an eyewitness account that all show similar facts. Although I have many other cases and more documentation I have used examples that are in the public domain so they can be confirmed by interested parties. I hope this opens the doors to some deeper research.
A Detailed Review of Hahnemann’s Letter Case
I would like to clarify some points brought up in Part One of The LM potency and the Paris Casebooks. Hahnemann sent Baron von Boenninghausen two LM cases by letter in 1843, just before the Founder left for his Heavenly Abode. The Baron shared these cases with his colleagues in the Neus Archive f.hom, Heilkunst Volume 1 number 1, 1844, page 69 (Stapf's Archives). Dr. Stapf raised a number of questions as it is impossible to understand all the potential ramifications raised by these 2 cases just by looking at the extracts. In order to answer these questions Boenninghausen sought help from Dr. Croserio, who was very close to Samuel and Melanie Hahnemann. Dr. Croserio responded with a letter written on Jan. 28th, 1844 which was published with Boenninghausen's commentary in the Neus Archive f.hom, Heilkunst Volume 1 number 12, 1844.The Baron wrote:
"In order to be quite sure as to the matter I applied to those homeopaths in Paris, who were most intimate with Hahnemann, visited him almost daily, and in consequence, were best informed as to his practice during the "last times", namely, to Dr. Croserio, from whom I had before had a very friendly communication, could therefore also feel sure that he would give me as detailed an account as possible."
Hahnemann’s Paris Casebooks contain only personal notes of the Founder's practice and leave many questions unanswered. He rarely wrote down exactly how he was giving his remedies. Boenninghausen understood this, and for this reason he sought an eyewitness account to fill in the details. Dr. Croserio's letter is a very valuable testimony because it gives insights as to how Hahnemann really practiced in the clinic. Dr. Croserio wrote:
"As to his [Hahnenmann's] mode in which he prescribed the medicines to be taken I am able to give you all the information that you may wish, as I have quite frequently been witness of it"
Croserio confirmed that Hahnemann was dissolving 1, rarely 2, tiny pills into 8 to 15 tablespoons of water and taking a tablespoon of this solution and stirring it into a tumbler of water.
He notes that Hahnemann would start with 1 spoonful of the solution and increase this on successive doses, if necessary,
"until he observed some action."
"Then he [Hahnemann] would diminish the dose or would stop the medicine."
This is a very important detail that does not come through clearly in the 6th Organon. Hahnemann frequently either slowed down the remedy or stopped the repetition of his remedies and gave placebos while he waited and watched. To this Boenninghausen commented.
"This passage in the communication of Dr. Croserio gives the most clear and complete exposition of the mode practiced by the closely observing Master of the art during the last times, on his patients, and explains most satisfactorily what might have appeared obscure in the two cases lately reported. The addition "until he felt an effect" is of the greatest importance, and must always be closely observed, in order that nothing may be spoiled afterwards by giving too much or too often"
Dr. Croserio also notes:
"In order to pacify the patients or their relatives he frequently allowed them to take simple sugar of milk"
Hahnemann often repeated the dose at suitable intervals to speed the cure. In slowly moving cases of protracted diseases this repetition could be daily or on alternate days. The exact intervals, however, are rarely marked in the Paris Casebooks. Nevertheless, the pattern of giving a single dose or a short series of doses and having the patient return in 7 days was quite common, especially at the beginning of treatment. In some serious cases he would have the patient return every 3 or 4 days if necessary. After stabilizing the posology he might have some patients come back after 14 days. The idea of giving a patient a daily dose and having them return in 1 month is not found in the Paris Casebooks. The Founder observed his cases much more closely than this so he could make careful, timely and skillful adjustment to the treatment plan. The case of O-T demonstrates this method clearly.
Hahnemann dictated this example case to a secretary and sent it to Boenninghausen. Some details have been clarified from the Paris casebooks from the sources quoted in The LM Potency and the Paris Casebooks, Part 1.
1. Jan. 15, 1843. Belladonna C potency in a 7 tablespoon solution.
The patient came with a sore throat that alternated with an anal fissure. The first dose made the throat worse by evening.
2. Jan 16. Mercury 0/1 in 7 tablespoon solution.
The throatache was gone but the fissure returned immediately! This shows these conditions were related. The patient then revealed that eight years before he had a syphilitic chancre destroyed by corrosives. All his problems started after this. He was immediately given Mercury 0/1. This fissure and chap were very painful. How often he gave the dose is not noted. It could be a daily dose.
3. Jan. 20. Mercury 0/2 in 7 tablespoons.
The patient returned for his check up 4 days later. This shows how closely Hahnemann was following a serious case at the start. There are no "take this daily for one month" in his casebooks. The patient's throatache returned slightly. The anus is better although there is still soreness during stool. At this time, Hahnemann raised the potency! The journal says: "One pellet of the Mercuries 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" a 7 tablespoon medicinal solution would not be finished yet. Nevertheless, Hahnemann immediately raised the potency to 0/2. He did not wait for the bottle to be finished.
4. Jan. 25 Sailer says Hahnemann gave 2 placebos.
The 0/2 continued to improve the throat but there was severe lancinations in the anus. 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 understood because Hahnemann wrote on Jan. 30th that the patient had taken the last dose of medicine that afternoon. He only had 7 doses and that was 11 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 for very long.
4. Jan. 30th. 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. There was no particular aggravation yet Hahnemann decided to give placebos for 1 week and wait and watch. He must have figured he had enough medicinal action for the time being so he stopped the remedy and waited and watched. Then he changed his tactics.
5. Feb. 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 can cause psora to obstruct the cure. At this time, Hahnemann gave Sulphur 0/2 as an intercurrent remedy. Exactly how often it was given 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. Feb 13. Mercury 0/2 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! There was also some constriction in the anus which started the day before. Rather than two symptoms alternating the symptoms were both present at once. Now the patient was given an olfaction of Mercury 0/2. Hahnemann did not raise the potency even though the other bottle of Mercury 0/2 was completely consumed. Sometimes Hahnemann did not wait until a bottle was finished before he raised the potency and at other times he continued to use the same potency after the first bottle was finished. This shows that Samuel was individualizing the case management procedures not following a rigid protocol.
7. Feb 14. Mercury 0/2 in 7 tablespoon medicinal solution.
Hahnemann now gave the patient a medicinal solution of Mercury 0/2. This was to be taken "as before". The last doses appear to be administered on alternate days. He kept the patient on the same potency for around 25 days, which shows that the suggestions in aphorism 248 of the 6th edition are only baseline suggestions not a rigid protocol.
8. Feb 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 enough medicinal action so Hahnemann again waited and watched for around 11 days. The placebo had to be given on alternate days to last this long. This shows that the patient was most likely taking Mercury 0/2 on alternate days. He was already used to taking the remedy (hence the placebo) every other day.
9. March 3. Single dose olfaction of Nitric Acid. (17 days on single dose olfaction)
Now the throatache was cured, and the strong anal symptoms ceased, although a hemorrhoid vein was extruding during stool. Hahnemann says "I let him smell of Ac. Nitr." Hahnemann frequently gave single doses by olfaction although he also sometimes gave them in oral solutions. In some cases he would wait and watch for longer periods than 7 days like 14 or even 21 days. There are many such prescriptions in the Paris casebooks between 1840 and 1843.
Dr. Croserio confirms in his letter that Hahnemann frequently gave single doses by olfaction followed by a period of placebos. He wrote:
"In chronic diseases he [Hahnemann] would in no case allow the patient to smell at the medicines oftener than once a week, and would give nothing but sugar besides; and in this way he would make the most admirable cures, even in cases where we others had not been able to do anything."
10. March 20. Second single dose olfaction of Nitric Acid. (Patient cured)
Now Hahnemann wrote that there was hardly any pain after stool, the throat was well, although the patient feels some sensation on drinking cold water. 17 days later Hahnemann says "Now he is allowed to smell of Ac. nitr." This means that before this and since March 3rd he was not allowed to smell Nitric acid! This illustrative case confirms that Hahnemann frequently gave single doses and did not give the remedy daily to everyone. There are many of these that are documented in the Paris casebooks. How long the remedy acted one cannot tell from the record because he only wrote "His health was permanently restored".
Learning by Example
What can we all learn from this case? How does it clarify what is written in the 6th Organon? First of all it shows that Hahnemann individualized his posology and case management strategy according to the symptoms, time and circumstances. Secondly, it shows how he would interpolate and/or follow his medicinal doses with placebos while he waited and watched. This method is confirmed throughout the Paris Casebooks between 1840 and 1843 (the LM epoch). Hahnemann’s case examples and Dr. Croserio’s letter offer a true picture of how the Founder was actually giving his remedies in Paris in his last days. Over the years I have reviewed many of Hahnemann’s case histories that show a similar pattern.
Hahnemann did not speak out on 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. Most people do not realize that Hahnemann was often using the "on again - off again" method when he was giving a series of rapid doses to speed the cure.
As Dr. Croserio said, when Hahnemann observed a visible medicinal action he would diminish the dose or stop his repetitions and give a series of placebos. It appears that in some cases he did this every once in a while just to wait and watch so he wouldn't overmedicate his patients. Many also do not realize that Hahnemann was continuing to use the single dose, especially by olfactions. This balance of single doses and infrequent repetitions and split-doses at more rapid intervals to speed the cure offers a wide range of methods in the clinic. The idea Hahnemann gave the daily dose to everyone has been proven wrong by the Paris Casebooks and eyewitness accounts.
It becomes apparent from a deeper study that the suggestions found in the 6th Organon are a baseline protocol from which to make adjustments according to the patient, symptoms, time and circumstances. Every patient must be treated as an individual and the posology and case management strategy individualized to suit the nature of the situation. Individual patients very so greatly in the nature of their constitutions, temperaments, vitality, and sensitivity, that no one method suits all patients all the time under all circumstances. Disease states vary so greatly in their nature, stages and magnitudes that the potency, the size of the medicinal solution, the number of succussions, and the size of the dose must be carefully adjusted. Patients respond so differently to single doses, infrequent doses, and a rapid series of doses, that no one schedule can suit all persons all the time. For this reason, it is important to understand that individualization is a cardinal principle that cannot be overlooked no matter what method one is using.
The 4th Organon is the foundation of all good homoeopathic prescribing. If the practitioner does not understand how to apply the single dose wait and watch philosophy, they are not qualified to use the more advanced methods of the 5th and 6th Organon. One must understand when it is time to wait and watch and when it is time to act and observe the repetition of the remedy. One must understand when a single dose or a short series of doses is sufficient, and when it is more prudent to use more rapid doses to speed the cure. One must understand that it is important to slow down the repetitions as the patient improves to avoid aggravations in the middle and at the end of treatment. One must also know when it is time to stop the remedy to see if the cure is complete or the patient still needs medicine but at longer and longer intervals. To think that one can just give the daily or alternate day dose to everyone for months on end is a grand misnomer that is counter productive in the end.
During the 1840s Hahnemann used both the C and LM potency side by side in the clinic in medicinal solution. The same general rules apply to both potencies. In cases where there is a strikingly increasing amelioration, allow the remedy to act without repetition. In cases where the remedy action is tardy or too slow, repeat the remedy at suitable intervals to speed the cure. This method is the same in the 5th and 6th Organon when using both the C and LM potency. From 1833 to 1843 Hahnemann suggested this middle path in regard to the single dose and repetition of the remedy before the duration of the action ceases. If the 5 conditions attached to aphorism 246 are met, one may speed the cure of slow moving cases dramatically with both the C and LM potency.
Some persons do better on the C potency and some do better on the LM potency. Others seem to do better on both given at different stages in the case. It is not a matter that one must either use the C potency or the LM potency. It is my experience that the C and LM potency are complementary opposites that greatly expand the therapeutic horizons of the homoeopathic pharmacy. Why think in terms of being for or against either when the truth is that both have their place in contemporary practice. Hahnemann’s advanced methods open the door to a more artistic method of using Homoeopathy than is possible with the single dry dose wait and watch method. Nevertheless, knowing when to wait and watch is still an integral part of the case management strategy.
I hope this information is useful to the homoeopathic community. There are simply too many people who think they can give the LM potency daily for long periods in a mechanical fashion. While Hahnemann would stop the repetitions of the remedy quite frequently and wait and watch, these persons continue rapid repetitions for long periods. Some practitioners suggest the daily dose for 1 month rather than carefully testing the remedy and treatment plan at the onset of administration. Others are calling the aggravations produced by such mechanistic methods a "cleansing crisis" and telling patients to continue the medicine regardless of the discomfort. More than one case has been spoiled and the cure delayed in this fashion. These mistakes have their basis in a superficial understanding of what is actually written in the 6th Organon and how Hahnemann actually practiced in the clinic.
It is not surprising that some persons have stated that they saw more aggravations when they used the LM potency than the high potency Cs! Why is this when the LM potency is supposed to be so gentle it can be given daily to everyone? The truth is that the LM potency is very powerful and is only gentle when it is used properly in accordance with the time and circumstances. The idea that one can give the daily dose for months is often separated from the words WHEN NECESSARY found in the footnote to aphorism 246. I have yet to see one LM case in the Paris Casebooks where Hahnemann thought it was "necessary" to do such a thing! In truth Hahnemann used almost as much placebo as medicine. As Hahnemann said, "Dare to Know!"
Sincerely, David Little