The double remedy experiments of 1833

- Following in hahnemann's footsteps : the the definitive years 1833-1843 (D. Little)

The method of combining two homoeopathic remedies in mixture originated with Dr. Aegidi, who forwarded Hahnemann 233 cases of his method. Aegidi found a confidant in Baron von Boenninghausen, who used his influence with the Founder to support the new method. The Hofrath was so impressed by the enthusiasm of his disciples that he promised to refer to the double remedies in the 5th Organon, even before trying them! He wrote from Coethen on June 15, 1833:
 "Do not think that I am capable of rejecting any good thing from mere prejudice, or because it might cause alterations in my doctrine. I only desire the truth, as I believe you do too. Hence I am delighted that such a happy idea has occurred to you, and that you have kept it within necessary limits; 'that two medicinal substances (in smallest doses or by olfaction) should be given together only in a case where both seem homoeopathically suitable to the case, but each from a different side.' Under such circumstances the procedure is so constant with the requirement of our art that nothing can be urged against it; on the contrary, homeopathy must be congratulated on your discovery."
 Hahnemann had not yet tried Aegidi's method but he was very hopeful that it would prove a benefit to his new healing art. For this reason, he promised to take up testing the hypothesis in the clinic as soon as possible. His letter continues:
 "I myself will take the first opportunity of putting it into practice, and I have no doubt concerning the good results. I think too, that both remedies should be given together; just as we take Sulphur and Calcarea together when we cause our patients to take or smell Hepar sulph, or Sulphur and Mercury when they take or smell Cinnabar. I am glad that von Boenninghausen is entirely of our opinion and acts accordingly. Permit me then, to give your discovery to the world in the fifth edition of the Organon which will soon be published."
 Many of Hahnemann's critics say that the Founder was close-minded, dogmatic, and against any innovations to his new medical system. The above letter puts such myths to rest. He was so optimistic that he offered to refer to Aedigi's method in the 5th Organon before he tried it in the clinic. He began his first experiments with the olfaction of a double remedy on June 17, 1833. What was the outcome of the Founder's four months of clinical trials? He wrote the following to Boenninghausen from Coethen, on October 16, 1833:
 "Easily your eloquence would have defeated me, if I were in the same case as you, that is, if I had already been as convinced by several and by so many experiences of the utility, even preference/superiority of the giving of a double remedy as you supposedly had been. But from several trials in this manner only one or two turned out well, which isn't sufficient for the apodictic [irrefutable] proposing of a new theorem." [Emphasis added]
 Hahnemann's experiments with the double remedies proved a failure because they did not work as well as the single remedy. He was critical of the double remedies because he could see their limitations in the clinic. The second half of his letter to Boenninghausen offers more information about his conclusions:
 "I was therefore in this practice still too far behind to proceed with full conviction. Therefore it required only a slight moment to induce me to a change of these passages in the new Organon, which results in this, that I concede the possibility that two well-selected, different remedies can be given simultaneously [together] with advantage in some cases, but that this seemed to be a difficult and critical [serious/delicate] procedure." [Translation from the German by Gaby Rottler]
 In the beginning, Hahnemann hoped to have "some good results" with the double remedies (his letter of June 1833 to Boenninghausen). In a later letter, dated September 17, he wrote Boenninghausen to say that they were "never, as we know, absolutely necessary." In the end, as he wrote in the letter of October 16, he found "only one or two" of his experiments "turned out well." It was the Founder's experience that one single remedy alone, or in alternation, or as a series of remedies, worked much better than combinations.
 The Hofrath had listened pensively to his disciples Aegidi and Boenninghausen, but with increasing reservation. He was now caught between his own inner convictions and the enthusiasm of his two students for a simple but less effective method. The meeting of the Central Society on August 10, 1833 offered the Founder a perfect way out of this difficult position. He brought the subject of the double remedies to the floor for a discussion of their ramifications. Bradford reported in his Life and Letters of Hahnemann, page 488:
 "Dr. Aedigi proposed to Hahnemann to administer a mixture of two highly potentized remedies each corresponding to different parts of the disease. In the potentized state the medicines thus mixed would be incapable of chemical reactions, but would each act separately in its own spheres. Dr. Boenninghausen approved of the idea and Hahnemann was induced to present the matter to the meeting of the Central Society in 1833. Hahnemann was persuaded that this would probably lead to the polypharmacy of the old school, and he decided to exclude this doctrine from the new edition of the Organon."
 Although Bradford highlighted the political aspects of the situation, Hahnemann's later letter to Boenninghausen in October shows that, in fact, the failure of his double remedy trial was a major factor in the withdrawal of his support at the meeting. All present at that meeting unanimously agreed to remove the passage from the 5th Organon-because the failed method was a political liability that would be abused by the polypharmacists. One month later, Hufeland was given a copy of the passage on the double remedies from the printer calling for quick action by the homoeopaths. At that time, the passage was replaced with a strong caution, in which the Founder called the double remedy trials a "hazardous experiment." Vide aphorism 272 of the 5th Organon:
 "In no case is it requisite to administer more than one simple medicinal substance at one time. 2(a)
 Footnote 2(a): Some homoeopathists have made the experiment, in cases where they deemed one remedy homoeopathically suitable for one portion of the symptoms of a case of disease, and a second for another portion, of administering both remedies at the same time; but I earnestly deprecate such a hazardous experiment, which can never be necessary, though it sometimes may be of use."
 This footnote expresses the same thoughts Hahnemann wrote in his letter to the Baron in October 1833. He still did not wish to say that Aegidi and Boenninghausen never got any results, but he knew that a homoeopathician could do better with one single remedy at a time. He also realized that there were inherent hazards in giving a double remedy. Since he wanted everyone to be very careful with their patients, he advised against the method. Was this because he had noticed side effects after several months of observation? There was also the concern that those who used double remedies would never learn how to use a single remedy correctly; the method would thus become self-defeating to homoeopathic education. For all of these reasons, all reference to the double remedies were removed and the aphorisms on the single remedy were strengthened even further in aphorism 273 of the 6th Organon:
 "In no case of cure is it necessary to employ more than a single simple medicinal substance at one time with a patient. For this reason alone it is inadmissible to do so. It is inconceivable that there could be the slightest doubt about whether it is more in accordance with nature and more reasonable to prescribe only a single simple, well known medicinal substance at one time in a disease or a mixture of several different ones. In homoeopathy-the only true and simple, the only natural medical art-it is absolutely prohibited to administer to the patient, at one time, two different medicinal substances."
 Many have pointed to the radical nature of Hahnemann's Paris period, but in truth, his most controversial experiment took place before the publishing of the 5th Organon, while Hahnemann was living as a widower in Coethen. Indeed, as the Paris casebooks progress to 1843, the Founder uses even less alternations and changes of remedies than he did in 1833. In 1837, he was still mostly using C potencies up to 30C, but by 1843, he had a much bigger pharmacy of around 130 remedies ranging from 30C to 200C, and he had even tested the 1M. He also utilized a full range of the complementary LM potencies, 0/1 to 0/30. This new higherpotency pharmacy had an immediate effect on his case management strategies. The Paris casebooks from the period of the 6th Organon [1840-1843] correspond very well to the eyewitness accounts of faithful Dr. Croserio, who practiced with Melanie after Samuel's death. The 6th edition is the Founder's last will and testament and a guidebook to the medicine of the future.