When, in the February and April numbers of this REview, (2 Ibid. 1863) vol. iii., 1863, we published Dr. J.R. Coxe’s article on Alternation, and our own modest objections to what we regarded as unsound argument and inaccurate statement on the part of Dr. Coxe, we had no idea that we were entering upon the discussion of a question, about the terms of which there could be any chance for a misunderstanding. Subsequent publications, from various quarters, have shown that all practitioners do not understand the same thing by the word alternation, as applied to the mode of prescribing homoeopathic remedies.
We think we shall be able to show that the practice which some writers defend, under the name of alternation, is not properly called by that name. But before entering upon the subject itself, we desire to make, once for all, two statements of general principles by which we are governed not only in the treatment of this question but of all questions that concern the practice of medicine; premising that we utterly disclaim any disposition to dogmatize or to speak as with authority on any question of medical practice. If the earnestness of conviction should betray us into too positive warmth of language, this is our misfortune; and none can disapprove it more decidedly than we regret it.
1. The business of the physician is to cure patient; this is the great practical object of his labor. We believe that nature is not always restricted to a single path-and that while some cases are so severe that there is but one way in which it is possible to cure them, there are often several ways in which it may be possible to effect the cure of some other case; each way having more or less widely, from the best way. Thus, we believe that Allopathy, with her heroic antiphlogistics, her revulsives (borrowed from the “circumlocution office”), and, still more frequently, with her blind and blundering misuse of specifics, does sometimes “cure” her cases, but this is not kind of cure that should satisfy the physician desires. It is neither to involve damaging sequelae), nor rapid, nor pleasant.
Thus, likewise, we know that Homoeopathists who mix medicines, whether in the tumbler or in the patient’s stomach (conglomerators or alternators), do often “cure” their patients. These cures, if our observations be correct, are neither so rapid nor so pleasant (free from sequelae) as cures might be; and we are confident that by these methods not nearly so large a proportion of the sick may be cured as by adherence to the simple, single remedy. Still, we admit that when a physician has cured a patient, by whatever method, he has, in so far as that patient is concerned, done the chief part of his duty. Though his method were not the chief part of his duty. Though his method were not not the best of known methods, he is not to be blamed without qualification.
2. But, although, from the ethical stand-point, we may concede that:
” ‘T is better to have” erred and cured
” Than never to have” cured “at all,” we think there is abundant reason for cautioning the practitioner to beware of confounding the misfortune of the error. with the good-luck of the cure.
As one to whom have been confided the interests of that individual patient, he may justly rejoice in the cure; but do his functions cease here? By no means. He is a man of science, to whose cure are to be instructed, every day of his active professional life, case after case of disease which he is to bend his energies to cure. What is it to be a man of science? It is to be one whose mind is stored with an array of facts carefully observed by others as well as by himself, and methodically arranged, in such wise that principles by virtue of which new observations may be arranged along with these facts-principles by the aid of which the facts which will result from operations observed to be in progress, or intentionally put into activity, may be accurately predicted, and, conversely, may be produced at pleasure.
Such is the scientific physician. Let us note the difference between the action of his mind and that of the patient, after a cure of of the latter has been accomplished by the former. The patient says to himself, “I was sick and now I am well. I will pay my doctor and then, to my work again!” This is all his sickness is to the patient.
The soliloquy of the doctor will depend very much upon the nature of the mental process by which he arrived at the mode of treatment that cured the patient. It may be:
1. “How can I ever be thankful enough for the lucky accident that made me give him Ledum! My I be as fortunate when I guess again!” or,
2. “When I gave Bryonia alone and Sepia alone, though each seemed to correspond pretty well, still the patient did not get much better. But when the happy thought of alternating them occurred to me, and I did it, she recovered. From this I shall learn that two remedies, each of which corresponds to part of case, may cure the case of given in alternation, when neither, if given singly, would cure it;” or.
3. “A year ago I should have given for such an angina as this, Belladonna and Mercurius in alternation, as Rummel recommends, and the patient would probably have gotten well in two or three days and I should have been satisfied; but since I have studied Lachesis, I find that remedy covers the whole case much better than Belladonna and Mercurius would do; and lo! he is well in twelve hours. From this, I learn to shun, more earnestly than ever, those expedients which, like alternation, are borrowed from the polypharmacy of the Old School and which, being opposed to sound principle, must be inferior in their results to some better way which accords with sound principles and which way I shall be most likely to find out if I make my practice follow principle. The case, then, gives me fresh zeal in my study of Materia Medica;” or.
4. “This case coast me much study. I saw that the symptoms of the abdomen and digestive canal as we as those of the lumbar of aggravation and amelioration corresponded admirably to Colocynth, but then, the patient had, in addition, an enlarged ovary (from which, possibly in some way, the other symptoms sprang), and I have never heard of Colocynth in connection with enlarged ovary. I might, therefore, have been tempted to alternate Colocynth with some remedy which is known to have cured and perhaps produced enlarged ovary, such as Lachesis, Apis, Graphites, Lycopodium, Staphysagria, etc., but for my aversion to disregard what seems to me the well-established principle: that maladies are not local affections, but general pervading the entire organism-that the individual man is not an aggregation of independent monads, each of which may be ill or get well ‘on its own hook,’ without its neighbour being thereby jostled, and against which may be discharged a corresponding load of medicinal monads each of which will find its own particular target without hitting and other-not this, but an individual being, whose functions and tissues are so intimately connected, that, “if one member suffers, all the members suffer,’ and conversely, if we get the key to the malady by finding the characteristic symptoms which will point us to the true remedy, we shall cure the entire suffering to whatever member we may address ourselves. In this faith, regarding the characteristic symptoms as calling unmistakably for Colocynth (there was nothing characteristic of any remedy in the ovarian symptoms-the ovary was enlarged, that was all), I give that remedy. And now, while in a few days the other symptoms which plainly called for Colocynth disappeared (permanently, as the event proved), in the space of two months the ovarian tumor had likewise disappeared, and the patient, who had been confined for six year to her room and couch, could now walk, drive, and go about the house as well as eve. (1 See “Observations on Colocynth.”) From this I learn the unity of disease, and by this I am strengthened in my belief that adherence to well-settled principles will, in the end, carry one father and faster, even over dark and uncertain ways, than any make-shift and irrational expedient would be likely to do;” or.
5. “In this case of dysmenorrhoea the symptoms of the head and eyes are very characteristic of Cyclamen. But, surely, the menstrual symptoms are too important to be overlooked in this case, and the remedy must correspond to these symptoms in order to cover the case. I looked for the symptoms of Cyclamen on the female sexual organ, s and lo! none are recorded in the Materia Medica Pura. It seems that there was not a woman among the early provers of Cyclamen. What was to be done? The menstrual symptoms corresponded pretty well with those of Pulsatilla, though the head and eye symptoms did not correspond. Should I alternate Cyclamen and Pulsatilla, which jointly cover the case? I should have high authority for such a course! But, I reflect, that the same kind of the human organism which, under some disease-producing influence, experiences, at one and the same time, the amenorrhoea and the head and eye symptoms of my patients-the same kind of human organism, I say, experienced also, when proving Cyclamen, head and eye symptoms exactly like those of my patient. Is it not fair to presume that, if this disease-producing cause and the specific properties of Cyclamen are so nearly alike as to produce identical symptoms in the head and eyes, they would have produced identical symptoms likewise in the female sexual organs, had the prover of Cyclamen been a woman? So strongly did probabilities seem to me to favor this presumption, that regarding alternation as an unsound and irrational expedient, I was about to take the risk of giving Cyclamen alone on the strength of this anticipated result of some future proving by a woman, when, chancing to meet with the new Austrian proving of Cyclamen, I found that provings by women are there recorded which confirmed my presumption in every particular. The case recovering speedily under Cyclamen, I learn from it that in many cases we are tempted to alternate because we cannot cover every feature of the case with either of the remedies which we think of alternating. But, in some of these cases, the symptoms which are really characteristic are fully met by one of these remedies, and there is ground for assuming, as clinical records show, that subsequent and more extended proving will demonstrate to us that this remedy, if fully proved, would really cover the entire case, characteristic and all. This experience fortifies me against a temptation to alternate, and leads me to rely more confidently on the indications furnished by characteristic symptoms.”
If we review these cases and analyze the operations of the physician’s mind, we shall see that, in number one, he confesses that he has been the “accident of an accident”, and he invokes his “good luck” to stand him in stead again. He does not exercise his reasoning faculties at all. Let him pass.
In the other cases, there is, besides a thanksgiving for succus, and effort of the mind to arrange the facts which the case presents in order, along with some other facts already stored there, and to infer from the aggregate store of facts some principle or plan of action which may be profitably brought to bear on some future case. It is thus and only thus that “experience teaches.” For, since no two cases are ever met with that are in every respect precisely alike, the experience acquired in treating one case can never be available in treating another, except through the intermediate application of the reasoning powers. We hear and observe facts, collect and arrange them analyze and reflect upon them, induce principles from them, and prepare ourselves to make practical application of these principles when a new case shall for it.
Now, what is this but theorizing? When we analyze a case in such a way as to suggest to our minds its proper mode or course of action, or to infer from it any principle that might help us in a future case, we form a “theory.” We cannot think, indeed, about collecting facts without theorizing.
Yet the defenders of alternation invite us simply “to look and see,” to “establish facts. These once fixed any theory which will perfectly account for them is good.” These are Dr. Hawley’s words. (1 American Homoeopathic REview, vol. v., p. 338). And the London Homoeopathic Review, vol. ix., p. 432, quotes Dr. Hawley’s words approvingly: “The homoeopathic system of medicine,” ** says DR. Hawley, “bases itself, not on theories but on facts as they observed in the world of man. It frees its disciples from all dogmas and simply asks them to look and see.” Well, being thus invited, we “look and see.” What do we see? Why we see Dr. Hawley giving Bryonia and Sepia in alternation in one chronic case and Arsenic and China in another case, and curing both in a way which satisfied him well. This is what we see. But what does DR. Hawley see when he look at these same facts? Why he sees something which prove to him that “for him, the use of remedies in alternation is better than the use of a single remedy.” And the London Review sees in the same facts something “which proved to him (Dr. Hawley) that the alternation of medicine is not only admissible, but that cases now and then occur which CAN ONLY BE CURED BY SUCH ALTERNATION.”
Is not this “theorizing” pretty strongly and on a rather slender basis? Our friends warn us against “Theory” and yet, from two facts, Dr. Hawley concluded that, “for him, the use of remedies in alternation is better than the use of a single remedy,” From the same two facts the London Review makes Dr. Hawley conclude that “cases now and then occur, which CAN ONLY BE CURED BY SUCH ALTERNATION.” This is a broad generalization on a very narrow foundation. But Dr. Hawley admonishes us that “we have not yet any such collection of facts as will warrant any generalization.”
For ourselves, we should not feel justified in drawing any such conclusions as these from DR. Hawley’s cases or from any of the case already narrated, cured by alternation. When adduced in evidence, we accepts them as facts and give them what we consider to be their full value. They prove to us that cases may be cured by alternated remedies, but they prove no more than that. They prove that two remedies in alternation cured a case which neither of those two remedies singly had cured. Beyond this they prove nothing. Assuredly they do not prove that a physician could not have cured each case more quickly with some other remedy, given singly. How could such evidence be held by us to justify such conclusions as Dr. Hawley and his reviewer draw from it, when our daily experience furnishes case after case which had been treated ineffectually by physicians who always alternate and which yields promptly to the single remedy. Evidence of this kind whether FOR or AGAINST alternation, will not settle this question.
These remarks, extended as they are, have been made for the purpose of showing that clinical experience is available as a means of improvement in medical practice only in so far as it is analyzed, thought about, and, in fact, “therorized” about; that those who deprecate dogmatism and would put off the formation of generalizations, do, themselves, dogmatize and theorize, and from the nature of the case they must do so in the act of reasoning about the evidence they bring forward.
If this be inevitable, then, it must be allowed us likewise to theorize and in what we have to say about alternation we shall hold ourselves justified in basing our argument on generalizations from a multitude of collated facts. We hold that the argument from theory is in order. And regarding a SCIENCE as being a connected and independent series of generalizations based on an analysis of methodically arranged and collated facts, we require the advocates of alternation to rest their cause, as we do our opposition to alternation, on such a generalization. Failing to do this, they have no claim for their method as a part of the SCIENCE of Therapeutics. Failing this, the facts which seem to justify alternation can be used in no other way than in the blind, empirical way of literal imitation, in which accuracy and certainty are quite out of the question. But our whole object in study and labor, beyond the direct need of our patients, is to complete the structure of our science, such as we have defined a Science to be, a means of attaining accuracy and certainty.
Some of the advocates of alternation have failed to perceive the necessity of raising their procedures to the level of a scientific method. They still rest on the rude empirical ground of unmethodized experience. Their argument is: “I have alternated remedies which, singly, had failed, and I cured. Henceforth I shall alternate.” Or, as the London Review varies the argument (9,432), “The practice of alternation of remedies is one so widely adopted that it would appear to have the sanction of very extended practical experience. ** Experience has proved abundantly that the alternation of remedies increases the rapidity of the cure,” etc. The same argument was used by Dr. Coxe, (1 American Homoeopathic Review, iii.59) who claims to have alternated for twenty-five years, and to have been successful. As we have before remarked, the same argument may be used by Allopathists, and by the advocates of every form of practice, whether pure, mixed, or wholly vicious. The same argument may be, and is, advanced by those who oppose alternation.
Others, however, have seen the necessity of basing their advocacy of alternation on some general principles, among them particularly Dr. Drysdale (1 Annals of British Homoeopathic Society) and Dr. Coc, (2 The American Homoeopathic Review, vol. v., April, 1865) and to these statements of principles we wish to devote some attention.
But, first, let us have a clear understanding of what is properly meant by alternation of remedies.
As we have stated, the term if used in different senses.
1. Dr. J.R. Coxe (loc.cit.) seemed to think that the opponents of alternation contend that each case of sickness should be treated with one single remedy, and that, if during an illness a change in the symptoms should compel a change in the remedy, this, by whatever name it be called, is, in fact, alternation. He scouts the idea of any real distinction between alternation and succession of remedies. Well, if this be all that alternation means, we have no reason to oppose it. But, what is a case of disease in this sense? Does it comprise all that may ail a man from the time that he takes to his bed to the time that he goes to his work again? Suppose a patient sick of dysentery, and recovering finely under the single remedy Mercurius corrosivus. When just convalescent he is seized with rheumatism, and requires Rhus toxicodendron. It is, “alternating” to give it to him? And then, suppose him safely over rheumatism; but just before he goes to work again, he has a return of dysentery, requiring Mercurius corrosivus. Is it “alternating” to give it, if the symptoms require if? And if, when cured of this relapse, he gets the measles and requires Euphrasia, is it “alternating” again to give him this remedy? Why, according to this definition, if you call this all one sickness, it has been a case of alternation. If you call it four sickness, perhaps not. To the patient, certainly, it is “all one,” whatever you call it? Now, suppose the symptoms in a case to have changed just as decidedly as in the case supposed above, but yet not so definitely as to induce you to give to the changes these nosological names of dysentery, rheumatism and measles. The medicines, Mercurius, Rhus and Euphrasia will have been just as clearly indicated by these successive changes, and just as imperatively required as though the patient were regarded as having had four successive disease. Is it “alternation” to give these remedies successively just as they become clearly indicated? We think it is not, but some say it is. We are sure it is sound practice.
2. Dr. Quin, of London, (1 Annual Address, Annuals of British Homoeopathic Society) calls the method of prescribing successive remedies in a case as the changes of symptoms may require them, “alternation a posteriori,” and sanctions and defends it. But he reprobates, under the name of “alternation a priori,” the practice which, it seems to us, is the only one which can properly by called “alternation,” viz.:
“Prescribing at the very outset of the treatment-at the very first visit and also, not unfrequently, almost at every subsequent visit, two or more medicines, to be alternated every quarter, half hour, or every two, three, or four hours. It is difficult to believe,” he continues, “that such practitioners are in the habit of carefully considering the cases under treatment, or have well studied their Materia Medica, or to divest one’s self of the idea that they resort to such slipshod practice in the hope that if one of the medicines does not hit off the complaint, some one of the others may. One meets with instructions for similar alternation laid down in popular books on Homoeopathy, showing that this a priori style of alternating remedies is, with certain practitioners, more a rule than an exception.”