The four medical theses of Samuel Hahnemann (1755

Abstract

Samuel Hahnemann, the founder of homoeopathy, over a period of 33 years wrote four medical theses at three different universities. The first, in 1779 at the University of Erlangen, Franconia, dealt with agents that allegedly induce spasms, granting him a MD degree. The second two theses in 1784 dealt with obstetrical matters and were imposed upon him by the University of Wittenberg, Saxony, for becoming a medical officer, a position he apparently aspired to mostly for financial reasons. The fourth thesis in 1812 at the University of Leipzig, Saxony, his most elaborate dissertation on a toxic plant, white hellebore, served as a habilitation, allowing him to hold university lectures in order to disseminate his new ideas.

Keywords

Samuel Hahnemann medical thesis university graduation Erlangen Leipzig Wittenberg

First: Doctoral dissertation of 1779 at Erlangen

Samuel Hahnemann (Figure 1) was born at Meißen, Saxony, on 10 April 1755 at a time when medical science was in its infancy, bloodletting a widespread practice and evidence-based approaches well-nigh unknown.¹ Knowledge based on experiments was scarce and anecdotal reports combined with reliance on personal authorities, who often grounded their firm beliefs on ancient concepts, prevailed. The first President of the United States, George Washington, died on 14 December 1799, his demise being accelerated by phlebotomy performed by a panel of high-ranking doctors who acted in line with contemporary concepts.²

Figure 1.

Samuel Hahnemann. Steel engraving by Leopold Beyer, Vienna, according to a painting by Schoppe, 1831. Courtesy: University Library at Erlangen collection of portraits.

Having graduated from the princely school of Saint Afra at Meißen in 1775, Hahnemann began his medical studies at the University of Leipzig (founded in 1409), registering there on 22 May 1775. Two years later he changed to the University of Vienna (founded in 1365) because he found medicine in Germany too theoretically oriented and he missed clinical experience.³ After nine months he became a librarian and personal physician to Doctor Samuel von Brukenthal, a Baron and Governor at Hermannstadt in Transylvania (now Sibiu in Romania). Hermannstadt had been founded as a Saxon colony in the 12th century, belonged for a long time to Austria and reached largely autonomous status in 1775. At that time, in 1494, it housed a very old apothecary but not a university. Brukenthal owned a vast library containing books that Hahnemann could use extensively and which presumably were instrumental in preparing his doctoral dissertation. It may have been there that he ran across a volume by Johann Pharamund Rhumelius (1597–1661), ‘Medicina Spagyrica tripartita’ (tripartite alchemist medicine), published in Frankfurt in 1648, where the seldom-used Hippocratic therapeutic principle of ‘similia similibus curantur’ is mentioned.⁴

Having worked there – presumably mainly for financial and secondarily for scientific reasons – from October 1777 until April 1779, he went to Erlangen in Brandenburg-Franconia (now Bavaria) whose university had been founded as recently as 1743 and he registered as a medical student. Costs of living seemed to be relatively low and there existed a small colony of Transylvanians and a freemasonry circle (Libanon zu den 3 Zedern), a congregation he had joined at Hermannstadt (Sankt Andreas zu den drei Seeblättern). Protestants could not graduate in Transylvania whereas most of the students at Erlangen were protestant.⁵ The matriculation book mentions him as ‘Samuel Hahneman’ [sic] from the University of Leipzig (‘ex academia Lipsiensi’), aged 24 years, on 12 April 1779.⁶ Already one day earlier, on 11 April 1779, ‘Samuel Hahneman Misenas’ [from Meißen] had registered as a promovendus [doctoral candidate]. He presented his doctoral dissertation Conspectus adfectuum spasmodicorum aetiologicus et therapeuticus [Aetiological and therapeutical consideration on spasmodic afflictions]⁷ which he must have prepared beforehand⁸ (Figure 2). In this rather sketchy attempt, he dwelled on the aetiological and therapeutic aspects of spasms by enumerating agents that allegedly induce or alleviate them.⁹

Figure 2.

Frontispiece of Hahnemann's first thesis of 1779 at the University of Erlangen. Courtesy: University Library at Erlangen collection of dissertations.

In 20 printed pages he divided his thesis as follows: (i) irritating agents; (ii) divine or climatic influences; (iii) emotion, sympathy and antipathy; and (iv) abundance or lack of powers and blood. He elaborated on specific agents that were believed to be helpful with convulsions and seizures, substances acting on nerves, narcotics, expelling and cooling agents, relaxants, roborants and corrigentia that ‘sweep up the tinder of spasms’. The remedies he recommended comprised a plethora of animal and herbal extracts, acids and salts, the bark of the China tree, tobacco and phlebotomy.¹⁰ This broad yet haphazard plethora of hints, suggestions and anecdotal observations were contained within the literature of that time. This was understandable since the neurophysiological basis and mechanisms of spasms were still unknown, but his paper was devoid of empirical data.

As a result a doctor's degree was granted him on 10 August 1779 after he had passed all academic requirements including the doctoral viva (tentamen [preliminary examination], examen rigorosum [final oral examination in a wider field] and disputation [scientific debate of the doctoral thesis]).^11–14 The documents are lost so we do not know the questions and answers but we do know that he was awarded the grade ‘rite’ (satisfactory), the lowest possible.¹⁵ The next semester he already spent at Leipzig studying chemistry and so he probably registered at Erlangen – a town he never returned to – only to obtain his MD which granted him an entrance billet into scientific circles, academic prestige and acknowledgment by other physicians and by patients.

As we learn from an investigation conducted at Tübingen,¹¹ many medical students registered at a university when aged between 17 and 18 years and studied for three to four years, the average age of the fresh medical doctors being 22–24 years. The minimum duration of medical studies at the University of Erlangen was six semesters and Hahnemann achieved this at two different locations abroad and fulfilled the academic requirements suo tempore.

Only a small percentage of all medical students underwent the costly procedure of a dissertation. It was not unusual that an inaugural thesis, which commonly contained between 16 and 60 pages, was not authored by the applicant himself but by his tutor. In this case, however, there is no doubt that Hahnemann himself was the author.¹⁶ His thoughts were consistent with prescientific, anecdotal and mystical thinking, never surpassing contemporary beliefs or traditional views. Some of his quotations – as with tobacco – were contradictory or frankly inaccurate. He restated and repeated in a loosely systematic way the philosophical and traditional thoughts of an era that had little medical empirical knowledge let alone scientific rigour. The views and conclusions expressed in Hahnemann's first thesis shed some light on the historical state of medical graduation and its requirements. Compared to other medical dissertations, his eclectic compilation was a philological labour of love testifying that the development that led him to part from contemporary medicine and to rely more on personal empirical observations must have started later in his life.

He must have noticed these shortcomings since he introduces in magnis et voluisse sat est (in great things it is sufficient to have shown goodwill) and concludes his dissertatiuncula (small dissertation) with humble remarks alluding to future scholars who should know better. He stated ‘If I will ever occasion to have the opportunity to augment and elaborate this laconic and aphoristic sketch, I shall do so’. But he never did.

Second and third theses of 1784 at Wittenberg

In the following year, 1780, Hahneman (as he spelled his name himself) opened his first practice at Hettstedt near Halle (Saxony-Anhalt) but already two years later, in 1782, he moved to Dessau where he married. He was to become the father of eleven children, eight of whom survived and for whom he was the only breadwinner. This may explain why he changed residence very often, translated medical and other scientific as well as belletristic texts and was keen on preparing the medication for his patients on his own.

The next station was Gommern in 1783, a small Saxonian town where he tried to obtain the position of an ‘Amtsphysikus’, comparable to a physician of a public health department or a medical officer.¹⁷ As was usual at that time, this was in addition to his private practice and mainly to increase his meagre income. The necessity derived from the fact that Gommern had neither many inhabitants nor facilities, keeping his salary low. On the other hand the local authorities seemed to be interested in having an officially employed doctor at hand.

When he already had assumed this position (presumably on 5 August 1783) the Prince-Elector of Saxony, Friedrich August (1759–1827), at the request of the medical faculty of Wittenberg (now the University of Halle-Wittenberg, founded in 1502), complained on 1 September 1783 that he had not undergone a tentamen as prescribed by the mandate of 13 September 1768 (the date on which Friedrich August's minority status ended) and was not sufficiently legitimised to perform this task because he had been promoted ‘abroad’, namely in Brandenburg-Franconia and so he was not academically legitimised. The title of a medical doctor was a prerequisite for becoming a medical officer.⁵ Nevertheless it was acknowledged that he had begun his studies at Leipzig in Saxony where his doctoral dissertation at Erlangen had already been acknowledged (‘nostrified’).

Hahnemann responded to this complaint on 18 November 1783 with a very submissive letter pointing to the difficult circumstances in which he lived and begged for dispensation from an oral examination, thus saving him money and travel expenses. Instead he offered to present a written thesis on a topic that was to be chosen at its discretion by the medical faculty of the University of Wittenberg (Leucorea) which was the closest to Gommern (about 60 km). He also asked for permission to confine the extent to a minimum, if still in keeping with the academic requirements.

In his answer to this request the decane Christian Friedrich Nürnberger (1744–1795), a physician and botanist, accepted his excuse and offered to refrain from having him travel to Wittenberg for the oral exam and to remit part of the fee but insisted on giving him some theses for written elaboration, which was agreed upon by Johann Gottfried Leonhardi (1746–1823), full Professor of Pathology and Surgery. Georg Rudolf Böhmer (1723–1803), physician and botanist and, while Vice-Chancellor, one of Nürnberger's teachers, opined that Hahnemann was to be treated as equal to a physician who had passed his exam at Leipzig. Interestingly, he considered it useful that Hahnemann would be permitted to perform his medical treatment methods ‘whom people were talking about but not always to his advantage’. This illustrates that at this point there seems to have emerged something new, unusual or contradictory, in his approach and the faculty was apparently interested in learning more about it and having him under close scrutiny.

After a copy of the approval, dated 18 April 1780, by the medical faculty of Leipzig of his first doctoral thesis at Erlangen, signed by Anton Wilhelm Plaz (1708–1784), physician and botanist, had been confirmed by a notary at Wittenberg, Hahnemann was given two obstetric themes, probably because childbirth was one of the important and frequent problems a public health physician had to face and Nürnberger himself had published extensively on matters of childbirth and lactation. Up to this time Hahnemann had not written anything about gynaecological matters and he rarely returned to this field thereafter.

The first thesis was entitled ‘An funiculi umbilicali deligatio in recens natis absolute sit necessaria et quale sit ejus de intermissione in foro ferendum judicium' (‘Whether the ligature of the umbilical chord in newborns is absolutely necessary and how its omission is to be judged from a legal point of view’). The second, hitherto virtually neglected and not mentioned in an eminent biography,¹⁵ read ‘An foeminis gravidis et puerperis vomitoria liceat propinare et quanam limitatione' (‘Whether it is allowed to give pregnant women and those who haven recently given birth emetic agents to drink and to what extent’). Both problems were being ventilated within the contemporary literature as is testified by books on forensic medicine.^18–20 Hahnemann was quick to perform this task and sent his handwritten Latin theses comprising altogether 18 pages (seven for the first, 11 for the second treatise) on 15 January 1784. They are not yet printed or edited and are not mentioned in a synopsis of Hahnemann's writings and publications.¹⁶ The originals are located at the university archives of Halle (Figure 3).

Figure 3.

Handwritten page of Hahnemann's third thesis of 1784 at the University of Wittenberg. Courtesy: Archives of the University of Halle-Wittenberg at Halle, UAH Rep. 1, Nr. 4911, fol. 52.

In these two specimina (specimens, examples of his theoretical knowledge), he opined that ligation of the umbilical cord was not absolutely necessary but safer in most cases and that its omission could possibly be a criminal offence since tearing-off and fatal haemorrhage was possible. At one point, however, he held that bleeding via the mouth of an umbilical cord could in rare cases be regarded as a substitute for venesection and therefore even be helpful. Thus he mentioned bloodletting as a possible and effective remedy for certain conditions in accordance with prevailing contemporary concepts. As for the second topic, he held that a mild induction of vomiting and gradual increase of emetic doses were permissible under close observation of the pregnant woman. He also pointed to the natural phenomenon of nausea and emesis accompanying pregnancy (hyperemesis gravidarum) and to the necessity – in certain specific cases – to liberate the stomach from noxious agents. He considered iatrogenic instalment of vomiting indicated when substances remaining in the stomach could possibly do more harm than the inconvenience caused by throwing up.

Again, contemporary knowledge is devoid of experimental data. There were similar theses in the 18th century that dealt with comparable topics, texts from which Hahnemann's papers did not essentially deviate. His first elaboration resembles an inaugural dissertation by Schael (de funiculi umbilicalis deligatione non absolute necessaria [on the assertion that the ligation of the umbilical chord is not absolutely necessary]) which had been presented to the medical faculty of the University of Göttingen (Lower Saxony, founded in 1737) and published on 1 November 1755.²¹ The second is similar to a case published within a collection of medical problems by Frederick (Friedrich, Fridericus) Hoffmann in 1723 at Halle/Magdeburg (Saxony-Anhalt).¹⁹ Thus, it may well be that Hahnemann, in his desire to fulfil the requirements for becoming a medical officer as fast as possible, drew from earlier sources. However, there is no hint at plagiarism or literal resemblance.

Both theses were written in Hahnemann's characteristic micrographic but readily legible script, ranged within the scope of the academic boundaries imposed upon him, and reflected the anatomical and therapeutic knowledge of his time. Other than with his first and last thesis, footnotes or references were missing. There was nothing novel or creative but the samples of his profound and widespread medical expertise served its purpose.

In his accompanying letter he took the chance to complain bitterly about the deplorable state of the local apothecary uttering derogative remarks on a specific person, insinuating that he himself could do better. He shied away from being visited or surveyed by this pharmacist because he feared his revenge. It is evident that he hoped that the personal preparation and sale of drugs could earn him additional money, an item that later on yielded fuel for heated conflicts.

As a result of his elaborations, accompanied by the dues of 10 Thaler, he received the filled-in admission form (Admissionsschein) enabling him further to perform the duty of a public health officer as testified by the decane on 16 January 1784. The instantaneous enactment one day after the submission without any further quibbles or discussion indicates the rather formal nature of this requirement and perhaps the necessity for the local health system to have a physician available apart from all academic agenda. It is unlikely that these theses, still not yet printed, had been assessed by the authorities in greater detail. Hahnemann left Gommern already one year later, at Easter 1785.

Fourth: Doctoral dissertation and habilitation of 1812 at Leipzig

Hahnemann authored a fourth thesis, a second and far more extensive doctoral dissertation, at the University of Leipzig (Saxony) 33 years after his first one at Erlangen and 28 years after his two for the medical faculty of Wittenberg (Figure 4).²² The reason was that, after having practised in many other – mostly smaller – locations (18 altogether!²³), he tried to become better known and to gain access to physicians and medical students alike in order to disseminate the new ideas on treatment he had developed and published in the meantime (Hahnemann 1810 [1921 [2006]).²⁴ He had been enrolled temporarily at the University of Göttingen in 1794 but had not pursued further scientific or academic goals there. At this point in his life Hahnemann felt he had a new mission to fulfill and planned to found a private institute for medical doctors but since nobody applied it was never opened.²⁵ By virtue of his second full dissertation, he strived to be allowed to hold academic lectures, starting with the winter semester of 1812/1813, which subsequently he did for more than nine years.

Figure 4.

Frontispiece of Hahnemann's second dissertation of 1812. Courtesy: University Library at Leipzig, Mat. Med. 2111.

To this end he underwent the process of habilitation, the working-out of an in-depth thesis on a special topic chosen by himself, that had to be defended against a panel of scholars, thus granting the proponent the ‘venia legendi’. We know from entries in financial documents that this procedure costed him 120 Thaler.

Leipzig was one of the first universities to introduce the process of habilitation for scholars who already had delivered a doctoral dissertation. The endowment to hold lectures and be appointed private lecturer (Privatdozent) was, however, dependent not only on scientific merits but also on personal, political and religious well-behaviour.²⁶ Hahnemann was never awarded this title nor that of full professor.

It is known that the elaboration of his printed and annotated thesis took him four months. The title was Dissertatio historico-medica de Helleborismo Veterum (Historical medical dissertation on the Hellborism in Ancient Times), comprising 163 paragraphs on 86 pages, published on 26 June 1812. Reference was not made to his earlier dissertation nor to his other two theses. The opponent in the oral discussion was his own son, Friedrich Hahnemann (born 30 November 1786), who was a magister artium and a Bachelor of Medicine too. To use an acquainted or related person was common practice at that time and not forbidden.

Friedrich is also of medical-historical interest since under his name a rebuttal of Hecker's critique^27,28 of Samuel's Organon²⁴ appeared in 1811,²⁹ believed essentially to have been initiated and written by Samuel himself. However, it is clear that Friedrich personally authored a philosophical dissertation, De somno naturali (On natural sleep) in 1811³⁰ as well as a medical dissertation De ulceris venerei cancrosi ortu et curatione (On the origin and treatment of Chancre) in 1812³¹ and so he was familiar with medical themes and was awarded an MD as well as a PhD.

The herbal and toxicological field seemed to intrigue Samuel Hahnemann because it dealt with plants of which he had considerable knowledge and the toxicological aspects had already been important for his first dissertation. He had praised the plant as ‘incomparable’ in a former paper³² and tried to revive ancient knowledge which according to his opinion was unjustifiably neglected. Veratrum album (White Veratrum), known as False Hellebor[in]e whose root is very poisonous, contains toxins including veratridine und protoveratrine.³³ In ancient times it was used for melancholy, pain, facial spasms, mental lethargy, sleepiness, unconsciousness, vertigo and paralysis. Besides inducing vomiting, Veratrum album may also cause severe diarrhoea, a feeling of coldness, muscle cramps, hallucinations, dyspnoea, collapse and death. Hahnemann had not explicitly mentioned the plant in his dissertation of 1779 but it may also cause some kind of spasm.

In more recent times, Veratrum album has been used against insects and lice and as an ingredient of sneezing-powder (now forbidden). Reports from the last decades confirm its toxicity since accidental or intentional intoxication has occurred repeatedly in adults and children. Hahnemann knew about the toxic effects and considered coffee an antidote. He claimed to have saved two children who were thought to have ingested fatal doses of the plant by oral and rectal infusions.³⁴ He also recommended Veratrum album against an epidemic of cholera.³⁵

The notion that a plant that may induce convulsions had also been used against epilepsy seemed especially to please him since it coincided with his new ideas (similia similibus). He elucidated the origin and use of ‘helleborism’ starting from ancient times, dwelling on historical Greek, Roman and Arabic sources, trying to prove that the plant that was used for this purgatory procedure was Veratrum album and not Veratrum nigrum (black false hellebore). In this monograph, apparently he attempted to obscure and to avoid mentioning his new medicine, homoeopathy, probably since he did not only face a group of ardent followers but mighty opponents as well; the term does not appear in the text.

He opined that the ancient use of helleborism was a ‘Herculean’ but not really dangerous treatment which – under certain conditions – should still be used, especially when small doses were applied and an individual approach chosen, namely when the plant and the disease ‘matched well’. He held that his fellow physicians had forgotten how to use this ‘excellent medication’. Contemporary homoeopathic repertory still recommends Veratrum in circulatory disorders (feelings of coldness, cold sweat, dizziness) and diarrhoea with vomiting.³⁶ The German pharmacopoieia³⁷ lists at least 10 homoeopathic preparations containing Veratrum album and the data bank PharmNet of the German ministry of health more than 300. However, it is not used in other fields, not even as a basis for artificial drugs or phytotherapy, and systematic scientific trials are lacking.

Having achieved his high-strung academic goal, it is known from contemporary sources that in his subsequent lectures, one of which he announced on 18 October 1814 as Institutiones artis morbos hominum sanandi (Introductions into the art of healing the illnesses of men), Hahnemann attacked the ‘old’ medicine whenever possible and assumed a rather religious and intransigent attitude concerning his new ideas. He now drew amply from his ‘Organon of the [rational] Healing Art’ published in 1810. Apparently he saw no more reason to conceal it and he mentioned it explicitly on his invitation posters. While his lectures, at times given at his private home, initially were attended by many curious students, listeners grew fewer and fewer until the end of the Winter semester of 1821 when he moved to Köthen (Saxony-Anhalt).

Hahnemann died on 2 July 1843. He was buried at Père Lachaise cemetery in Paris.

Conclusion

Hahnemann's first thesis of 1779 at Erlangen in Franconia was neurophysiologically oriented and dealt with spasmodic conditions and referred to bibliographical vintage material in order to support his collection which in no way surpassed the boundaries of contemporary beliefs. Its purpose was to gain access to the academic world and to establish himself as a medical doctor. No foreshadowing of his later controversial system was visible.

The second and third – gynaecological and obstetrical, respectively – theses of 1784 for the University of Wittenberg in Saxony were imposed upon him by the medical faculty as a prerequisite for performing his duties as a medical officer for the small town of Gommern. Their main purpose was to improve his income by assuming a position that assured him an additional salary. As can be judged from one of the accompanying letters by the Vice-Chancellor of the University, probably there was something new and controversial in his treatment methods. He was still recommending venesection for certain conditions in coincidence with contemporary beliefs.

The fourth thesis of 1812 at the University of Leipzig in Saxony was a fully fledged habilitation on the ancient use and possible actual usefulness of a specific toxic plant, White Veratrum (hellebore). This herb, having the potential to cause severe intoxication, is still part of the homoeopathic repertory. His aim was to be allowed to hold single-handed academic lectures, to create followers and to disseminate his new ideas. The plan to find an institute for this purpose failed. Hahnemann never attained the academic grade of private lecturer (Privatdozent) or full professor although he had achieved the important first steps. His novel system of treating patients by minute doses of individually selected agents which in healthy individuals were believed to elicit the symptoms to be treated, the ‘art of healing the illnesses of men’ as he grandiosely entitled one of his lectures, gained public awareness via other avenues.

Thirty-two years later Paulinus Ribbeck³⁸ used an almost identical title (De helleborismo veterum) as Hahnemann in his fourth thesis for his dissertation at the Friedrich-Wilhelm University of Berlin (now Humboldt University, founded in 1810) without mentioning him.

Footnotes

Acknowledgements

The author is very much indebted to several persons and organisations including the Library of the Friedrich-Alexander University of Erlangen-Nuremberg at Erlangen and its staff for substantial help and the permission to publish Figures 1 and 2. The Archives of the University of Halle-Wittenberg at Halle granted access to unpublished material, provided copies and permitted publication of Figure 3. The University of Leipzig supplied a copy of the last dissertation and allowed publication of . The Robert Bosch Stiftung at Stuttgart generously granted access to its collection of handwritten journals by Samuel Hahnemann. Professor Harald Popp, PhD, gave important hints and helped in regard to historical academic titles and procedures.

Author biography

Christoph JG Lang, MD, Dipl-Psych, was born in 1950 and studied medicine and psychology at Erlangen and Vienna. He worked in internal medicine and neurology and then studied neuropsychology in the United States. Currently he is Chief of the Outpatient Department at the Neurological Unit of the University of Erlangen-Nuremberg.

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Keller G von, Künzli von Fimmelsberg J. Kents Repertorium der homöopathischen Arzneimittel. [Kent's repertory of homoeopathic drugs]. 2nd corr ed. Stuttgart: Haug, 2011.

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Rote Liste® 2012. Arzneimittelverzeichnis für Deutschland (einschließlich EU-Zulassungen und bestimmter Medizinprodukte). 52nd Ed. Rote Liste® Service Gmbh, Frankfurt/Main, 2012.

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Ribbeck P. De helleborismo veterum. Dissertatio inauguralis historico-medica [quam consensu et auctoritate gratiosi medicorum ordinis in alma literarum universitate Friderico Guilelma ut summi in medicina et chirurgia honores rite sibi concedantur die XIII. M. septembris A. MDCCCXLIV. [13 September 1844] H. L. Q. S. [hora locoque solitis] publice defendet auctor Paulinus Ribbeck Marchicus {Mark Brandenburg}. Opponentibus: Maximiliano Wocke, med. et. chir. Dr. Julio Schultz, med. et chir. Dr. Vito Weiss, med. et chir. Stud.] University of Berlin, MD thesis, Schlesinger, 1844.

The four medical theses of Samuel Hahnemann (1755–1843)

Abstract

Keywords

First: Doctoral dissertation of 1779 at Erlangen

Second and third theses of 1784 at Wittenberg

Fourth: Doctoral dissertation and habilitation of 1812 at Leipzig

Conclusion

Footnotes

Acknowledgements

Author biography

References