Homepage Homeopathy History Cinchona Trial

Myth of the Cinchona Trial

Was the discovery of the principle of similarity a case of serendipity, i.e. an accidental unintended achievement?

The question of the beginning is peculiar to people. It is often answered with stories of initial experiences. These are memorable and are then taken for reality. But events and developments are usually much more complex than the stories about them. This also applies to Samuel Hahnemann's cinchona experiment.

The narrative

In relation to Samuel Hahnemann and homeopathy, the following narrative has prevailed:

As a young doctor and father of a family, Hahnemann had to keep his head above water financially for a while by translating. In addition to various chemical and pharmacological treatises, he also translated William Cullen's pharmacology from English. Critical as he was, he regularly added his own comments and reflections to his translations. His doubts about Cullen's assertion that the cinchona bark, which was commonly used at the time for the treatment of fever, was effective due to its stomach-strengthening effect, is said to have spurred him on to carry out an experiment on himself. When he then took about 15 grams of this substance twice a day for several days as a test, he noticed symptoms that resembled changeling fever. This experience is said to have led him to the similarity rule "Similia similibus curentur - treat similar things with similar things".

Like all stories, this one contains a kernel of truth. But it is and remains a story, a narrative that reduces complexity by breaking down a long process of knowledge into a memorable "aha" moment. In retrospect, it is hardly possible to reconstruct complex and multi-layered developments in detail. Besides, we humans like stories that present complicated facts in a simplified way. Thus, it has become accepted to present Hahnemann's cinchona experiment as the birth of homeopathy.

Figure 1 - Cinchona Peruviana. Wellcome Library, London (CC BY 4.0)

Attempt to reconstruct a process of cognition

Since Hahnemann left behind an extensive written legacy, one can try to trace the individual observations and considerations from which his views were formed on the basis of his early notes. This is the subject of the author Birgit Lochbrunner's work: Der Chinarindenversuch - Schlüsselexperiment für die Homöopathie? [1]. She examines the question of what significance the much-cited experiment had for Hahnemann's process of knowledge.

Figure 2 - Dosing vessel for quinine powder, Italy, 1801-1830. Science Museum, London. Wellcome Library, London (CC BY 4.0)

First of all, she points out that "neither with Hahnemann, nor with his direct pupils, nor in the following generations of homeopathic physicians, nor with the critics [...] did the cinchona bark test have a central significance". [translated by the author] (Lochbrunner, 2007, p.197)

Since Hahnemann developed the basic rules and requirements of the homeopathic drug trial only later, the trial cannot be considered a prototype of such a trial either.

Finally, she shows from various remarks in Hahnemann's early publications that the self-experiment was not the central milestone on the path of development of homeopathy, but that essential steps of knowledge preceded and followed it.

The fact is that Hahnemann, as a young doctor, had good reasons to criticise the medicine of his time. In particular, he disliked the prescribing of medicinal mixtures with many side effects as he saw fit. Out of dissatisfaction with the lack of concept and knowledge about medicines, he occupied himself mainly with medical literature and chemistry in the years 1780-1792. These extensive studies, along with his sobering treatment experiences, formed the basis for his new therapeutic system.

Figure 3 - Blue fluted glass arsenic bottle, Europe, 1701-1935 . Wellcome Library, London (CC BY 4.0)

In 1786, he published a paperÜber die Arsenikvergiftung, which reflected his own experiences at the bedside as well as insights into forensic medicine. Already here Hahnemann pointed out a similarity of symptoms between arsenic poisoning and alternating fever.

In 1787, his treatise Vorurtheile gegen die Steinkohlefeuerung, die Verbesserungsarten dieses Brennstoffs"(Prejudices against coal firing, the ways of improving this fuel) was published. There, too, he made a suggestion in the sense of the principle of similarity. (cf. Lochbrunner, 2007, p.30)

In 1789, in his textbook Unterricht für Wundärzte über die venerischen Krankheiten, he criticised the then common treatment of syphilis with massive administrations of mercury and tried a new milder and more effective formulation. He rejected the humoral-pathological and iatrochemical ideas of effect and explained the healing power of mercury through a counter-effect of the body (the so-called mercurial fever). Furthermore, he referred to the harmfulness of large and increasing doses.[1] Interestingly, he also described syphilis as a "minor fever" that can be cured with the "mercurial fever" artificially produced by mercury administration.

Figure 4 – Donald Monro's Arzneimittellehre (https://archive.org/details/BIUSante_38020x02)

Hahnemann's translation of Donald Monro's Chemisch pharmaceutische Arzneimitteltellehre [3] appeared in 1791.

In his usual manner, he also peppered this work with his notes. In a footnote (FN) to Mercurius solubilis he mentioned Mercurial fever once again. Here one finds the term similarity for the first time. For in his view, mercury ingestion leads to aggravation of venereal complaints, "because the ills of mercury have some resemblance to the venereal ones." (Hahnemann, 1791, p.181 (FN)) He also continued his reflections on the effect of cinchona bark in this work (Hahnemann, 1791, p.389 (FN)).

In addition, we learn here of his own changeling fever, which he treated with the usual tincture of cinchona:

"I took the like in Erlangen[2] against a recurrence of quartan fever and got rid of my fever by 6 quarts" [Trans. by the author] (Hahnemann, 1791, p. 396 (FN)).

In 1792 we find another very interesting remark in the publication Freund der Gesundheit. In an essay, Hahnemann recommends various precautions that doctors or nurses should take in the case of epidemic diseases in order not to infect their patients [4]. There he advises, among other things:

"Should one feel some approximate signs of the disease in oneself, immediately abstain from the sick person, and if one has not committed anything adverse in one's order of life, I recommend, as much as I try to avoid all medicinal prescriptions in these sheets, a home remedy, empirical if one will.

In such cases I have taken a quint of cinchona bark with wine every three quarters of an hour, until all danger of infection[3] (the disease might also be some kind of fever prevailing among the people) had completely disappeared again." [Trans. by the author] (Hahnemann, 1792, p.36)

This shows that Hahnemann already used cinchona bark as a remedy and preventive for incipient fever symptoms independently of malaria.

The principle of similarity was not discovered by Hahnemann, but was finally used systematically

In his later writings Hahnemann never tired of emphasising that in the past some physicians had already come to the conclusion, on the basis of their observations,

"that it is that [...] capacity of the [...] to excite (positive) symptoms analogous to the disease - it is by this means that they effect a true cure". [Trans. by the author] (Hahnemann, 1805, p.56)

As an example he quotes Hippocrates and then continues in the footnote:

"Thus even later physicians have now and then realised that the abdominal pain exciting property of rhubarb is the cause of their colic quenching, and the vomiting exciting power of ipecacuanha the reason for their vomiting quenching virtue in small doses" [Trans. by the author] (Hahnemann, 1805, p.64 (FN)).

He finds a wealth of analogous examples in the medical literature. He presents them in his essay Fingerzeige auf den homöopathischen Gebrauch der Arzneien in der bisherigen Praxis, which appeared in 1807 in Hufeland's Journal der practischen Arzneykunde [6].

Figure 5 - Photography Cinchona officinalis, Rubiaceae, Quinine Bark, bark. H. Zell 2009

It was the unalterable doctrine of medicine that "diseases are to be treated solely by means of counter-sanctimonious remedies (by palliatives)" that blocked a precise empirical analysis of all observations. The dogmatic adherence to the contraria principle thus prevented other principles of selection for remedies from being considered, tested and used at all. Hahnemann summed up:

"And even if now and then a wise man dared to contradict with a few quiet words and to propose: "Similia similibus", this objection was never respected and the basic dogma of all medical schools [...] remained [...] in undisturbed, mossy obsolescence, [...] uninterruptedly propagated to the present day." [Trans. by the author] (Hahnemann, 1807, p.6)

Hahnemann deserves credit for having finally made the principle of similarity systematically and practically usable, disregarding dusty dogmas and without regard to his reputation. His own bout with intermittent fever, his cure with tincture of cinchona, his subsequent experiment with cinchona bark and his repeated use of the remedy for fever symptoms are evidence of a multi-layered process of maturing knowledge. His practical experience confirmed what seemed conclusive to him from literature study and empirical observation.[4]

In 1796, Hahnemann first went public with the similarity rule in his essay "Versuch über ein neues Prinzip zur Auffindung der Heilkräfte der Arzneisubstanzen" [8]. The countless therapeutic experiences with homeopathy since then cannot be explained away as placebo effects (More on the placebo effect. More information on clinical research in homeopathy). But after 225 years of homeopathy, it is time to question the traditional myths and explanatory approaches, to clarify the terms and models and to describe the homeopathic-therapeutic principles on the basis of contemporary scientific findings.

[1] For experience shows "[...] that the smallest quantity of mercury, if it only excites a duly strong mercurial fever, can raise the highest degree of the most ingrained epidemic of lust". [Trans. by the author](Hahnemann, 1789, p.188f.)

[2] Hahnemann was in Leipzig and Vienna from 1775-1777 to study medicine; from 1777-1778 as librarian and personal physician to Baron von Brukenthal in Hermannstadt (Transylvania), where Hahnemann must have contracted an infection with the malaria endemic there; from 1778-1779 doctorate in Erlangen.

[3] Although microbes as pathogens could not yet be detected and made visible in Hahnemann's time, the term "contagion" had long been used in medicine. It is based on the observation that someone developed the same signs of illness after contact with a sick person. The Italian physician Girolamo Frascatoro (1478-1553) had already developed a theory of contagion as an explanatory model for the development and spread of epidemic diseases, but it was forgotten again. Luther (1483-1546) also used the term: "... especially the poison of a contagious disease, the contagion and the plague itself: the enemy has sent in gifft and deadly geschmeis to us through gottes verhengnis. Luther 3, 396b". By the 18th century at the latest, the term contagion was in general use in connection with the fight against smallpox and venereal diseases.

[4] "For how else could it be possible that the violent three-day and daily fever, which I cured four and six weeks ago, without knowing how it happened, with a few drops of tincture of quinine without afterpains, had almost exactly the series of coincidences which I perceive in myself yesterday and today, since I have, healthily, gradually taken four quarts of good quinine bark, for the sake of experiment!" [Trans. by the author] (Hahnemann, 1808, p. 494)

Literature

[1] Lochbrunner, Birgit (2007): Der Chinarindenversuch – Schlüsselexperiment für die Homöopathie?, Essen: KVC Verlag.

[2] Hahnemann, Samuel (1789): Unterricht für Wundärzte über die venerischen Krankheiten, nebst einem neuen Queksilberpräparate. Leipzig: Siegfried-Lebrecht Crusius.

[3] Hahnemann, Samuel (1791): Donald Monro's, Doktors der Arzneikunde, Chemisch pharmaceutische Arzneimittellehre welche die Londner Pharmacopöe praktisch erläutert - übersetzt und mit Anmerkungen von Samuel Hahnemann. Leipzig: Georg Emanuel Beer.

[4] Hahnemann, Samuel (1792): Verwahrung vor Ansteckung in epidemischen Krankheiten; Freund der Gesundheit, Bd.1, Heft 1. Frankfurt am Main: Wilhelm Fleischer.

[5] Hahnemann, Samuel (1805): Heilkunde der Erfahrung; Hufeland's Journal der practischen Heilkunde, Band 22, 3. Stück, S.5-100. Berlin: Wittich.

[6] Hahnemann, Samuel (1807): Fingerzeige auf den homöopathischen Gebrauch der Arzneien in der bisherigen Praxis; Hufeland's Journal der practischen Arzneykunde, 26. Band, 2. Stück, S. 5-43. Berlin: Wittich.

[7] Hahnemann, Samuel (2001): Gesammelte kleine Schriften; Auszug eines Briefs an einen Arzt von hohem Range, über die höchst nöthige Wiedergeburt der Heilkunde (geschrieben 1808, veröfffentlicht im Allg. Anzeiger der Deutschen, 343, S.3729-3741). Hrsg. v. Josef M. Schmidt u. Daniel Kaiser. Haug. Download available under https://zs.thulb.uni-jena.de/rsc/viewer/jportal_derivate_00263172/Reichsanzeiger_167367196_1808_02_0001.tif (8.6.2023)

[8] Hahnemann, Samuel (1796): Versuch über ein neues Prinzip zur Auffindung der Heilkräfte der Arzneisubstanzen; Journal der practischen Arzneykunde und Wundarzneykunst: hrsg. von C. W. Hufeland, 1796, 2. Band, 3. Stück S. 391-439 und 4. Stück S. 465-561. Jena: in der academischen Buchhandlung.

Authors: smi | Rev.: mnr | Ed.: pz | last modified June 29, 2023

This website uses only strictly necessary cookies that are essential for its operation. Further information can be found here:

Privacy Policy & Terms of Use