The following remarks upon the interesting, but, in our judgment, unsound paper on this subject by Dr. J.R. Coxe, jr., published in the February number of the current volume of the American Homoeopathic REview, (1 Vol. iii., 1863) may serve at least, it is hoped, to call attention to this very important approach to Polypharmacy in the customary method of prescribing, and, perhaps, to stimulate a discussion of its necessity and propriety.
In admitting that the alternation of remedies is incompatible with the theory of a true homoeopathic prescription, our colleague has granted all that the opponents of alternation could reasonably ask. That our practice has not yet come up to our theory, and that we are not yet fully possessed of the means and knowledge to bring it up to that degree of perfection, and that therefore some prescribers may feel constrained sometimes to alternate remedies, as it were under protest, may not be denied. But to urge that because our practice lags thus behind our theory, we are to rest satisfied with it, nay, to defend it and to conform our theory to it, is a position that would be fatal to all progress, and which we cannot think of conceding. Nor is the appeal to experience in the sense in which our colleague uses it valid. He “has alternated remedies in a practice of twenty-five years, and his practice has been generally successful.” We do not doubt this. But we believes his respected father practiced allopathy for a much longer period, and was a successful practitioner; would this fact be a valid argument in favor of allopathy?
Alternation and succession of remedies are not generally understood to be identical processes. By alternation, we think, practitioners generally understand the prescription, at one and the same time, of two or more remedies to follow each other at short intervals, the symptoms of these remedies taken altogether being thought to cover the symptoms of the case more completely than those of either remedy alone would do. The prescription is the result of one single examination of the patient and of one single comparison of the symptoms with the Materia Medica.
But when a succession of remedies is given, in either an acute or a chronic disease, the understanding, is that the first remedy, having been carefully selected, is allowed to exhaust its action alone, and then a collection of the symptoms the patient then presents is made, and the case is prescribed for afresh, almost as if it were a new case; and this process is repeated, each new prescription being the subject of a special study, until the case is cured. Such a process is equivalent to prescribing for a number of new and independent cases, and it is evidently not incompatible with the theory of a true homoeopathic prescription.
The very thoughtful article by Dr. Payne, to which reference is made by Dr. Coxe, contains nothing incompatible with these views. He instances cases in which a remedy which had covered all the symptoms acts well for a time, then cease to act, and leaves the case still uncured. He advises then a fresh study of the case, and especially a study of the previous history of the patient, and the prescription of a suitable antipsoric or antisyphilitic-in fact, a strictly homoeopathic prescription de novo. Now, in many such cases, acute though they appeared at the outset, if the prescriber had studied thus carefully at the very beginning, not only the present symptoms, but also the previous history of the patient, a single antipsoric prescriber at first might have sufficed for the case. For although chronic diseases may be incurable except by an antipsoric, antisyphilitic or antisycotic, yet these remedies may also be require in the very beginning of diseases that appear to be most acute. I can certainly testify, from repeated observation, to the efficacy of Sulphur (30) in most violent puerperal peritonitis, that remedy being all that was required to bring the cases to a speedy and favourable issue. This calls to mind Hahnemann’s admonition-Organon, aphorism 257.
The physician “should never lose sight of this great truth, that of all known remedies there is but one that merits a preference before all others, viz.: that whose symptoms bear the closet resemblance to the totality of those which characterize the malady.”
Be this as it may, Dr. Payne’s advice clearly contemplates a new study of the case for every new prescription, and, if this plan be pursued, the treatment will be strictly homoeopathic, even though a dozen remedies were required in succession before the case is cured.
Alternation, however, as generally understood and practiced, does not contemplate this new study of the cases before a second remedy is administered, or before every change of remedies; and herein it fails to come up to the requirements of a true homoeopathic prescription. And this is the kernel of the whole controversy.
Suppose a case of pleurisy. Bryonia covers all the symptoms. The patient improves for a time and then ceases to improve. The case is studied anew. Some symptoms are found to have vanished; some new ones have appeared. The physician studies the previous history of the patient more closely; he may or may not conclude that there is a psoric taint. At all events he perceives that Sulphur corresponds to the symptoms better than any other remedy. He prescribes Sulphur, therefore, just as though this were a new case that had just come under his treatment. This is an instance of succession of remedies. But each prescription is a strictly homoeopathic one, and in every respect commendable.
Suppose another case. A patient has acute tonsillitis. The physician collects his symptoms and prescribes “Belladonna, to be followed in four hours by Mercurius, and that again in four hours by Belladonna, and so on.” These two steady nags, so familiar to all, in this relation, are sometimes enlivened by the company of Aconite and Coffea (pro renata) where the prescriber has no scruples about driving m”four in hand.”
This is an example of alternation of remedies, and is objectionable on the following grounds: Suppose the first dose of Belladonna to have been a judicious prescription, and to have had an effect. How can the Prescriber know beforehand that this effect will be just such as to cause the totality of the symptoms at the end of four hours to correspond exactly to Mercurius, and, what would be still more wonderful, how can be foresee that the effect of the Mercurius will be just such as to cause Belladonna to be better indicated than any other remedy at the end of another period of four hours? The second remedy (a fortiori a third of fourth!) in such cases must always be prescribed without a preliminary study of the actual condition of the patient as modified by the action of the first remedy. It cannot, therefore, be an exact homoeopathic prescription.
Hahnemann has expressed himself fully on this subject in the Organon (1 Fourth edition, British translation) as follows:
Secale 272. “In no instance is it requisite to employ more than one simple medicine at a time.” (2 Experiments have been made by some Homoeopathists in cases where, imagining that one part of the symptoms of a disease required one remedy, and that another remedy was more suitable to the other part, they have given both remedies at the same time, or nearly so; but earnestly caution all my adherents against such a hazardous practice, which never will be necessary, though, in some instances, it may appear serviceable.
Secale 169. “It may easily occur, on examining a disease for the first time, and also on selecting for the first time the remedy that is to combat it, that the totality of the symptoms of the disease is found to be sufficiently covered by the morbific symptoms of a single medicine, and that two remedies dispute the preference as to eligibility in the present instance, the one being homoeopathic to one part of the disease, and the other still more so to another, It is, then, by no means advisable after using the preferable of the two remedies, to take the other without examination, because the medicine given as the inferior of the two, under the change of circumstances, may not be proper for the remaining symptoms; in which case, it follows, that a suitable homoeopathic remedy for the new set of symptoms should be selected in its stead.”
Secale 167. “In short, if the application of an imperfect homoeopathic remedy used, in the first instance, cause any accessory symptoms of some importance, the action of the first dose is not allowed to exhaust itself in acute disease; the altered state of the patient is then to be examined and the remainder of the primitive symptoms to be joined to those which have been recently discovered, to form of the whole a new image of the disease.”
Secale, 168. “A new remedy that is analogous may then be easily discovered among the medicines that are known, a single application of which will suffice, if not to destroy the disease entirely, at least to facilitate the cure in a great degree. If this new remedy is not sufficient to restore the health completely, then examine what yet remains of the diseased state and select the homoeopathic remedy that is most suitable to the new image that results from it. In this manner, the physician must continue until he attains his object-that is to say, until be has fully restored the health of the patient.
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.