Christian Theodore Herrmann (Hermann) 1773? – 1836? was a German physician, was a student and great nephew (by marriage) of Samuel Hahnemann, was one of only two homeopaths (the other was Matthias Marenzeller) to conduct State clinical trials on homeopathy across Europe, approximately 50,000 patients were involved in these studies.
Christian Theodore Herrmann was a physician in Sorau in the Niederlausitz (or Lower Lusatia in English, now part of Poland but at the time part of the Kingdom of Prussia), but by Feb. 1829 was in Russia.
Herrmann was the homeopathic physician of Tsar Nicholas I and his family, and the Countess Ostermann Tolstaya and her family, having attracted special attention of his patients and of the Tsar’s family, by his successful treatment of a bloody flux in Oranienbaum (a suburb of St. Petersburg). (See http://www.homeoint.org/books4/kotok/1000.htm The history of homeopathy in the Russian Empire until World War I, as compared with other European countries and the USA: similarities and discrepancies. Alexander Kotok, M.D. On-line version of the Ph.D. thesis improved and enlarged due to a special grant of the Pierre Schmidt foundation)
Christian Theodore Herrmann was a student of Samuel Hahnemann, and a member of Samuel Hahnemann‘s Prover’s Union, and he was a colleague of Ahner, Anton, Baehr, Becher, Clauss, Cubitz, Franz, Gustav Wilhelm Gross, Friedrich August Gunther, Gutmann, Friedrich Hahnemann, Ernst Harnisch, Carl Georg Christian Hartlaub, Frantz Hartmann, Haynel, Charles Julius Hempel, Hornberg, Simon Nicolaievitch von Korsakoff, Ernst Kummer, Christian Freidrich Langhammer, Lehman, Viet Meyer, Michler, Mockel, Admiral Mordwinoff, Mossadorf, Rock, Rosazewsky, Ernst Ferdinand Rueckert , John Ernst Stapf, Teuthorn, Tranz, Karl Friedrich Gottfried Trinks, Von Pleyel, Urban, Von Sonnenberg, Wagner, Walther, Wenzef, Wislicenus,
Christian Theodore Herrmann was born in Dresden, and he became the physician to the Countess?, and travelled to St. Petersburg with her entourage. In St. Petersburg, he successfully treated an outbreak of dysentry with homeopathic remedies, impressing Grand Duke Mikhail 1798 – 1848 (The British Journal of Homoeopathy. Robert Ellis Dudgeon, Richard Hughes. 1880. Page 307).
In 1829, Christian Theodore Herrmann petitioned the Military Hospital in Tultschin for the freedom to use homeopathy, but these first clinical trials of homeopathy were not successful, and Christian Theodore Herrmann was recalled to his military service.
Christian Theodore Herrmann conducted the first clinical trials with homeopathy on the intermittent fevers prevalent in Tulzyn in Podolia in 1830 at the direction of Tsar Nicholas I, where Christian Theodore Herrman found Thuja most efficatious (The North American Journal of Homeopathy, Volume 6. American Medical Union, 1858. Page 441).
Christian Theodore Herrmann wrote to Simon Nicolaievitch von Korsakoff, who said “Herrmann writes to me that he had to give up the treatment of cholera patients in the hospital, for all those who were sent to him were dying, and had already gone through the whole course of allopathic treatment. All methods are admissible here, only Homeopathy is persistently (useful).”
In 1832, homeopathy was banned in Russia.
In 1833, homeopathy was successfully sanctioned in Russia by Tsar Nicholas I.
A report submitted by Christian Theodore Herrmann to the Medical Department at the Ministry of Military Affairs in Russia, contained an article written by Carl von Seidlitz in the early 1830s (no exact year is noted) Über die auf allerhöchsten Befehl im St. Petersburger Militärhospitale angestellten homöopathischen Heilversuche, published in Heckers wissenschaftlichen Annalen der gesamten Heilkunde, Bd. XXVII, Heft 3, 153 as well as the report of Christian Theodore Herrmann in Latin, published in Annalen der homöopathischen Klinik von Hartlaub und Trinks, v. 2, pp. 381-390.
According to Carl von Seidlitz, during two months 128 patients were hospitalized in the homeopathic department. 65 of them recovered, 5 died and 58 remained receiving treatment. During the same period, in the allopathic department 457 patients were hospitalized; 364 of them recovered, 93 remained receiving treatment, while nobody died.
According to Christian Theodore Herrmann’s reports cited by Carl Bojanus, the experiment continued for some three months (April 5 to July 10, 1829). 164 patients were hospitalized, 123 of them recovered, 6 died, 18 improved their health conditions and were prepared to leave the hospital, whilst 18 remained receiving treatment.
While comparing the statistics by Carl von Seidlitz, to the statistics published by Christian Theodore Herrmann himself, Carl Bojanus concludes that
1. Carl von Seidlitz did not provide the reader with the true figures
2. Carl von Seidlitz’s assertion that “nobody died” during a period of 2 months can hardly be trustworthy.
3. The final statistics of the homeopathic department’s activity are splendid.
Moreover, referring to Christian Theodore Herrmann’s report written in Russian, Carl Bojanus informs us that many obstacles were put in the way of the right management of the treatment.
For example, according to Christian Theodore Herrmann, […] Many patients had long been treated, poisoned [sic!] and weakened allopathically; there was no supervision over patients, they were allowed to eat garlic, onion and horseradish [i.e., the food which is absolutely forbidden when receiving homeopathic treatment]; patients had caught cold going to the toilets, etc.
Fortunately, in the German version of his book, Carl Bojanus refers also to the detailed report of Christian Theodore Herrmann regarding the patients who were treated homeopathically by him.
This allows us to acknowledge the diseases.
Sixty seven patients […] were transferred from others hospitals, where they had been treated […] allopathically, including the giving of large doses of Quina bark, they thus were suffering both from their idiopathic and medicinal diseases […]. Six patients suffered from typhus, 3 of them were recognized by allopaths as incurable […]. Two patients suffered from tuberculosis […]. Eight patients suffered from rheumatic fever, one patient was hospitalized with diarrhea, one patient with gangrene, one with necrotic edematous scurvy, one with liver and spleen hypertrophy.
Of the 6 patients who died, 2 had been suffering from tuberculosis, 1 from typhus, 1 from diarrhea, 1 from gangrene and 1 from liver and spleen hypertrophy. It was not explained from which diseases suffered other patients.
The experiment was abandoned by the direct order of the Tsar Nicholas I.
Probably, Carl Bojanus was rather confused with the reasons that led to this decision.
He writes: “The medical authorities which observed the results of his [Christian Theodore Herrmann] activity, reported that homeopathic treatment has had no advantages over allopathic ones.
“The experiments of Christian Theodore Herrmann, which had been performed during three months, were stopped according to the Highest order. It is beyond any doubt that allopathic reports influenced the decision of Tsar Nicholas I to stop the experiment, despite the fact that Christian Theodore Herrmann himself submitted reports every month.
“Did Tsar Nicholas I distrust him? This would seem logical, if I did not know that Christian Theodore Herrmann was later proposed to continue with his treatment in St. Petersburg. I suppose that it was Christian Theodore Herrmann who initiated the decision that the experiment in Toulchin cease. I hope that some of the missing details of this story may be captured from the Russian archives later on.
“I can imagine the situation of Christian Theodore Herrmann in Toulchin. A foreigner, who had no common language with his patients, in a rather hostile professional environment, in some god forsaken small Ukrainian town (especially after St. Petersburg) – he found it difficult to continue his labors.
“At least I may assume that he turned personally to Tsar Nicholas I, insisting to be given a chance to prove the effectiveness of homeopathy in St. Petersburg. In any case, Christian Theodore Herrmann continued treating with homeopathy in the St. Petersburg Military hospital during a period extending from November 1829 to March 1830.”
Here Carl Bojanus has no “homeopathic” sources at all but only the above mentioned article by Carl von Seidlitz Über die auf allerhöchsten Befehl… and a report which was provided by Dr. Giegler, who had been in charge of the supervision over Christian Theodore Herrmann’s homeopathic treatments, without being himself involved in them.
Later this report was cited in the Conclusion of the Medical Council Regarding the Homeopathic Treatment published by the Medical Council in Zhurnal Ministerstva Vnutrennih del (Journal of the Ministry of Interior); this report is analyzed in the chapter Allopathy vs. Homeopathy.
According to Carl von Seidlitz, 431 patients were received in the homeopathic department, whilst 31 of them died. Other statistics were presented by Giegler: 395 patients were receiving the treatment, whilst 341 of them recovered and 23 died. 161 The interpretation of those results by the medical authorities is also found in the chapter Allopathy vs. Homeopathy.
Thomas Lindsley Bradford remarks: “Up to the year 1835, there were six public and formal trials of homeopathic practice undertaken by order of governments […]:
1. At Vienna in 1828, conducted by Matthias Marenzeller
2. at Tulzyn, Russia, in 1827 (by Christian Theodore Herrmann)
3. at St. Petersburg in 1829-30 by Christian Theodore Herrmann [sic]
4. at Munich in 1830-31 by Joseph Attomyr
5. at Paris in 1834 by Dr. Andral Jr.
6. at Naples in 1835 by order of the King by a mixed commission in the hospital of La Trinité.
“These were all made by allopathic physicians (not true!) and were not considered by members of the homeopathic school as fairly conducted.”
Unfortunately, Thomas Lindsley Bradford failed to stick to the facts. The experiment in Toulchin was in 1829, and not in 1827. Christian Theodore Herrmann (not Hermann) was not an allopath, and “members of the homeopathic school” never charged him for an “unfairly conducted” trial….
A special committee including several homeopaths (Drs. Adam, Carl Bernhard von Trinius and Christian Theodore Herrmann took part) should be established. After having had several meetings, the committee worked out a report and submitted it to the State Council. On September 26, 1833 the State Council accepted the following decisions concerning the future of homeopathy in Russia:
1. Homeopathic treatment may be applied […] by licensed physicians only.
2. Homeopathic pharmacies in St. Petersburg and Moscow are allowed to be established. These pharmacies have to provide all provincial pharmacies and homeopathic doctors in Russia. […].
3. The establishment of homeopathic pharmacies as well as their management, are allowed only to pharmacists licensed by the Board. […]. (According to the rules edicted in chap. 4, homeopathic doctors were also allowed to offer homeopathic medicines from their own kits in emergency, in two closed envelopes, (one – for the patient, the other – for future investigation in case of the patient’s death)).
4. Homeopathic doctors are allowed to prescribe homeopathic medicines to be obtained from allopathic pharmacies […] if these medicines are prepared there.
5. The price for homeopathic medicines shall be defined according to the Apothecary Rates.
6. Reports on the action of homeopathic treatment should be presented monthly to the Physikat and Medical Office [Meditsinskaia Kontora] in the main cities, and to the Medical Boards [Vrachebnye upravy] in the districts [gubernii] […].
7. The Physikat, Medical Office and Medical Boards are allowed to invite homeopathic doctors to be consulted regarding matters concerning homeopathy.
8. The supervision for carrying out these instructions, the help of the Physikat and Medical Office in the main cities and the Medical Boards in districts, should be enforced. […].
*Dean ME. ‘An innocent deception’: placebo controls in the St Petersburg homeopathy trial, 1829-30. Commentary on: Ministry of Internal Affairs (1832). [Conclusion of the Medical Council regarding homeopathic treatment]. Zhurnal Ministerstva Vnutrennih del 3:49–63….
Samuel Hahnemann, founder of the homeopathic school, began the systematic serial dilution and succussion of his medicines around 1814 (Samuel Hahnemann 1816). Since then the homeopathic materia medica has often been thought of as an elaborate collection of placebos, and it has long been known that placebo controlled tests of homeopathy took place as early as the mid 1830s (Reubi 1986).
A likely origin for this development in the history of clinical evaluation can be found in reports of two linked hospital based trials of homeopathy that took place in Russia a few years earlier.
The homeopath in both trials was a Christian Theodore Herrmann, who received a 1 year contract in February 1829 to test homeopathy with the Russian military (Ministry of Internal Affairs 1832, Lichtenstadt 1832).
The first study took place at the Military Hospital in the market town of Tulzyn, in the province of Podolya, Ukraine (Christian Theodore Herrmann 1831). At the end of three months, 164 patients had been admitted, 123 pronounced cured, 18 were convalescing, 18 still sick, and 6 had died.
The homeopathic ward received many gravely ill patients, and the small number of deaths were shown at autopsy to be due to advanced gross pathologies. The results were interesting enough for the Russian government to order Christian Theodore Herrmann to the Regional Military Hospital at St Petersburg to take part in a larger trial, supervised by a Dr Gigler.
Patients were admitted to an experimental homeopathic ward, for treatment by Christian Theodore Herrmann, and comparisons were made with the success rate in the allopathic wards, as happened in Tulzyn.
The novelty was Gigler’s inclusion of a ‘no treatment’ ward where patients were not subject to conventional drugging and bleeding, or homeopathic dosing. The untreated patients benefited from baths, tisanes, good nutrition and rest, but also:
“During this period, the patients were additionally subjects of an innocent deception. In order to deflect the suspicion that they were not being given any medicine, they were prescribed pills made of white breadcrumbs or cocoa, lactose powder or salep infusions, as happened in the homeopathic ward.” (page 56)
The ‘no treatment’ patients in fact did better than those in both the allopathic and homeopathic wards. The trial had important implications not just for homeopathy but also for the excessive allopathic drugging and bleeding that was prevalent. As a result of the report, homeopathy was banned in Russia for some years, although allopathy was not.
Within a couple of years of publication, placebo drugs became fashionable in clinical evaluation, sometimes in comparison with homeopathy, sometimes on their own, later as controls for allopathic treatments.
A well known opponent of homeopathy, Carl von Seidlitz, witnessed the St Petersburg trial and wrote a hostile report (Carl von Seidlitz 1833). He then conducted a homeopathic drug test in February 1834 at the Naval Hospital in the same city in which healthy nursing staff received homeopathically prepared vegetable charcoal or placebo in a single blind cross over design (Carl von Seidlitz 1834).
Within a few months (in fact 5 years later), Armand Trousseau and colleagues were giving placebo pills to their Parisian patients, perhaps in the belief that they were testing homeopathy, and fully aware they were testing a placebo response (Pigeaux 1834; Armand Trousseau and Gouraud 1834).
A placebo controlled homeopathic proving took place in Nuremberg in 1835 and even included a primitive form of random assignment – identical vials of active and placebo treatment were shuffled before distribution (Löhner 1835).
Around the same time in England, John Forbes treated a diarrhoea outbreak after dividing his patients into two groups: half received allopathic ‘treatment as usual’ and half got bread pills. He saw no difference in outcome, and when he reported the experiment in 1846 he added that the placebos could just as easily have been homeopathic tablets (John Forbes 1846).
In 1861, a French doctor gave placebo pills to patients with neurotic symptoms, and his attitude is representative: he called the placebo ‘orthodox homeopathy’, because, as he said, ‘Bread pills or globules of Aconitum 30c or 40c amount to the same thing.’ (Lisle 1861).
The interest in substituting placebos for active drug treatments in clinical evaluation from the 1830s onwards is well known. However, the extract from the St Petersburg report quoted above hints at a more complex story.
Apparently, ‘no treatment’ patients received placebos, ‘as happened in the homeopathic ward’. This mystifying phrase is not explained or mentioned again. Why did the homeopathic patients receive placebo, when homeopathy was being tested?
The answer can be found in Christian Theodore Herrmann’s report of his earlier trial (Christian Theodore Herrmann 1831). The Tulzyn patients were hard bitten Russian soldiers, who expected ‘heroic’ drugging and bleeding.
We are told they lacked confidence in the innocuous homeopathic powders and their scepticism was not reduced by the doses of unmedicated lactose Christian Theodore Herrmann prescribed in between the single doses of active medicine.
In using placebos as part of day to day homeopathic practice, Christian Theodore Herrmann was following Samuel Hahnemann‘s guidelines published between 1810 and 1830. Homeopaths were expected to prescribe placebo as a wash out when discontinuing allopathic medication, and at the beginning of homeopathic treatment, to identify ‘placebo responders’.
It was also frequently used in longer term case management, because the single rarely repeated doses of active medicines used in homeopathy were believed to produce misleading psychosomatic responses (Charles Gaspard Peschier 1835).
This little known aspect of homeopathic practice has been passed down in some form or other as part of formal training in the discipline until the present day. A detailed history of placebos in homeopathic clinical evaluation and practice can be found elsewhere (Dean 2000).
Methodologically, Samuel Hahnemann‘s guidelines seem closest to modern trials to determine optimal therapy in single patients (Cook 1996), although homeopaths gave placebos single blind, and without randomisation of treatment periods.
Whatever we may think of it now, the practice contrasts strongly with the traditional palliative use of therapeutic placebos when active treatments were unavailable or ineffective, and with the all or nothing placebos in parallel group clinical trials, where patients typically receive either placebo or active treatment, but not usually both.
The St Petersburg trial is probably the moment that homeopathic within treatment placebos began to be used as external controls, as became the norm in clinical trials more than a century later.