The name and practice of Hahnemann, Boenninghausen and Hering have been adduced in support of alternation. Hahnemann’s views on the subject we have already quoted from the Organon. The case to which Dr. Coxe refers, as cured by Hahnemann by “the alternate use of Bryonia tincture and Pulsatilla,” has escaped our notice, and we should esteem it a favor if Dr. Coxe would inform us where-abouts in homoeopathic literature it is recorded.
Hahnemann published very few cases. In vol. ii. of the Materia Medica Pura, third edition, 1838, he related two cases, one of which was cured by a single dose of Bryonia tincture, and the other by a single dose of Pulsatilla. May Dr. Coxe have, possibly, referred inaccurately to these cases and, by a fault of memory, blended them?
It is often stated, however, that Hahnemann used Bryonia and Rhus toxicodendron alternately in his very successful treatment of the typhus or hospital fever which prevailed so extensively in northern Germany, in 1813-14, after the French invasion. A reference to this article on the “Treatment of the Typhus or Hospital Fever at present prevailing,” originally published in the Allgem. Anzeig, der Eutschen, number six, 1814, and translated by dr. Dudgeon among “Hahnemann’s Lesser Writings,” (1 will show how erroneous this statement is.
He says, “this fever has two principal stages”, of which he gives the distinguishing symptoms; the first stage being characterised by “pains and consciousness,” the second stage by “delirium and mania.”
“In the first stage,” he continues, “two vegetable substances are of use and generally quite remove the disease at the commencement-the Bryonia alba and the Rhus toxicodendron.”
He proceeds to give the special indications for each of these remedies. “If the patient complains of dizziness, shooting (or jerking-tearing) pains in the head, throat, chest, or abdomen, etc., which are felt particularly on moving the part- in addition to the other symptoms, the haemorrhages, the vomiting, the heat, the thirst, the nocturnal restlessness, etc. we give a single drop of Bryonia. (12) Improvement takes place in the course of four and twenty hours, and as long as the improvement goes on, we give him no other medicine, nor even repeat the same dose.
“If now the amendment produced by the single dose of Bryonia goes off in the course of two, three or four days, that is to say, if the patient then complains of shooting pains in one or other parts of the body whilst the part is at rest; if the prostration and anorexia are greater, if there is harassing cough or such a debility of certain parts as to threaten paralysis, we give a debility of certain parts as to threaten paralysis, we give a single drop of Rhus toxicodendron (12) and no more nor any other medicine so long as the improvement is manifest and continued. ** Of, if the symptoms i have just described occur at the very commencement of the attack, we give at its very commencement a drop of Rhus toxicodendron (12).”
“The whole disease will generally be removed by a single dose of the first of the second medicine (according as the one or the other is indicated, without the addition of any other).
“If, notwithstanding, the disease should pass into the ‘second stage’ of delirium and mania, then Hyoscyamus niger meets all the indications of the case.”
These detailed directions for the treatment of an epidemic disease give a perfect picture of a true homoeopathic treatment. They state, in substance, that the generic symptoms of the disease are always accompanied in the commencement by one or the other of two groups of characteristic symptoms. Accordingly, as one or the other of these groups is present, Bryonia or Rhus is to be given. When the consequent amelioration ceases, then the case is to be examined anew, and according to the characteristics then found to present themselves, a new remedy is to be selected, and thus the practitioner is to go on until the case is cured. But alternation is now where advised or allowed.
Hahnemann’s brief and very general hints relating to the treatment of croup are of the same general character. In the introduction to Spongia, (1 Materia Medica Pura, vol. vi., second edition, Dresden, p.199) he says: “Homoeopathy has found, in symptoms 145 and in other symptoms, the most remarkable applicability of Spongia to that terrible acute disease-membranous croup-provided, however, the local inflammation has first been diminished or subdued by a very small dose of Aconite. The additional use of a small dose of Hepar sulphuris will rarely be found necessary.” Nothing is here said or in any way intimated concerning alternation.
In giving general directions beforehand for the treatment of this disease, which usually present a very uniform group of symptoms, he shows that the symptoms, while the local inflammation is still raging, call for a very small dose of Aconite; that when this has acted, it will generally be found that the local inflammation is subdued, leaving a group of symptoms which correspond best to the symptoms of Spongia; that sometimes there may be such a modification as to call instead or subsequently for Hepar sulphuris.
When a physician has it in his power to visit his cases frequently, and to watch their course, he has no excuse for deviating from the methods of a true homoeopathic prescription. If it prove necessary to give a succession of remedies, he is bound to make each successive prescription the subject of a special study, both of the symptoms of the patient and of the provings in the Materia Medica, and to select on each occasion the remedy which corresponds best to the symptoms of the cease.
But where, as sometimes happens, the physician is unable to see the case at all, or where he is giving general directions for the treatment of case which it is supposed may, at some future time, occur, this accuracy is impossible. His duty is then to describe to his client the symptoms which will probably be present in each stage of the disease, if it appear in the ordinary form and follow the ordinary course; to point out the indications for the appropriate remedy in each stage; and to instruct his client to give only one medicine at a time at each stage, and never to repeat the dose, or to give any other remedy so long as amelioration is manifest. This is the best the physician can do when treating disease under the disadvantage of never seeing the patient. This is the method adopted by Hahnemann with reference to hospital typhus. It is the method of Dr. Boenninghausen in treating croup.
It is well known that Dr. Boenninghausen does not visit his cases, but prescribes chiefly in his offices. He knows that the first symptoms of croup are almost uniformly combined with a local inflammation which, along with all the other symptoms, forms a group to which Aconite corresponds better than any other remedy. His first powder, therefore, is Aconite. And his instructions are explicit. The second powder is never to be given until the amelioration, consequent on the first, shall have ceased, and so with the remaining powders. The recipients of “Croup powders” are especially and carefully instructed under what circumstances alone it is proper to give any or all of the subsequent powder. This is as near an approach to a new study for each change of remedy as is possible when the physician does not see the patient.
It does not really amount in most cases even to a succession, much less an alternation of remedies, for in a large majority of cases the Aconite alone not regard cures the patient.
That Dr. Boenninghausen does not not regard this method as an “alternation of remedies” is shown in vol. ii., p. 561, of the American Homoeopathic Review.
Indeed, in theory and in practice Dr. Boenninghausen is as decidedly opposed to alternation as we have shown that Hahnemann was.
We believe we could say that Dr. Hering’s views are similar to those we have expressed, but we prefer to await a statement from his own vigorous pen of those arguments, both theoretical and practical, which none could give so well as he.
In conclusion, we hope it is hardly necessary to add, that inasmuch as offensive language and odious epithets lend no strength to argument nor sweetness to persuasion, we entirely agree with our colleague in his closing paragraph. Nay! for that very reason, he will allow us to say, we could almost wish his own expressions had been a very little less emphatic.
(1 American Homoeopathic Review, 1865.).
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'.