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.”
3. Dr. Drysdale defines alternation to be “the giving a second medicine while the sphere of action of the first is still unexhausted.” But Dr. Drysdale, while advocating alternation, in this sense, in certain specified cases, does not propose to give his second medicine except after a careful re-examination of the symptoms of the patient, and a comparison of them with the Materia Medica. It is clear, then, that alternation as he defines and defends it, is not same thing as the alternation a priori which Dr. Quin reprobates, and to which we would restrict the term. Dr. Drysdale’s definition seems to us very vague and impracticable. How are we to know when the sphere of action of the medicine is exhausted? By inferences from the proving? But we have reason to believe that the speed at which vital processes go on in sickness may be very different from that during a physiological proving. Reduced to a practical rule, Dr. Drysdale’s reasoning would amount to this: If, on our second visit, symptoms shall be found to have arisen which seem to call for the second medicine, we should suspend the first and give the second, and then, if, at the third visit, the symptoms be found to have changed gain, so as to call again for the first medicine, we should give it. But this, he says, is “alternation.” With certain qualifications we agree to his rule of practice, but we object to the name he gives it. And here names are important. It is of great consequence to avoid giving to two radically different procedures one and the same name.
Now, what do we mean by “alternation?” Let us give a practical answer. We have before us a prescription label filled up by Dr. John Doe. It reads thus:
“No. 1, Aconite (3); No. 2, Bellad, (6); of each, twelve powders. Take the powders alternately as numbered, every four hours.”
We have another paper containing directions prepared by Dr. Busy, for a chronic patient:
“Take as follows: Mercurius hydriod., first decimal trituration, every night for seven nights:
“Then Sulphur (3), every night for seven nights;
“Then Collinsonia (1), every night for seven nights;
“Then Podophyllum pelt. (2), every night for seven nights;
“Then Ignatia (3) and China (1), alternately every night and morning, for seven days;
“Then Aurum met. (1), every night for seven nights;
“Then Pulsatilla, (1), every night for seven nights;
“Then Phytolacca dec.(1), every night for seven nights.”
We object to these, and to all kindred procedures, that they rest on hypotheses which are not warranted by the present possibilities of science. Dr. John Doe’s first prescription of Aconite may be all right; the symptoms probably call for it. But it physician cannot know in advance that, in four hours, the symptoms will have so changed that, if he were present, he would perceive Belladonna to be indicated; and that, in four hours later, Aconite will be indicated again; and that the symptoms will go on, oscillating between these two series of indications, each occillation consuming just four hours.
And “Dr. Busy”, by what wonderful gift could he foresee that seven days of Mercurius hydrargyrum would bring his patient to a state requiring Sulphur, and seven days of Sulphur to a state requiring Collinsonia (whatever that state may be), and seven days of Collinsonia to a state calling for Podophyllum (and for just seven days of it too), and seven days of Podophyllum to a state of complex misery that calls for China and Ignatia in alternation (for just seven days likewise) and so on to the end of this long chapter!
“Oh, was some power that gift gave us!”
These instances, and the comments upon them, comprise our definition of “alternation,” and our objection to it. It is a practice very prevalent in the United States and in England. It is exceptional in Germany, France, Spain and Italy.
The principles which govern the selection and administration of homoeopathic remedies are very simple.
The great law, SIMILIA SIMILIBUS CURANTUR, teaches us to select a remedy the characteristic pathogenetic symptoms of which are very similar to those of the patient. This is a grand generalization, supported by a multitude of facts. We accept it. It takes no heed of names of diseases. Giving a broad and liberal signification to the word “symptom,” so as to include everything abnormal about the patient, whether it be historical or actual, this law pays regard to the symptoms alone. It requires that the symptoms shall be collected and compared with the Materia Medica every time a prescription is made, and that the drug that has produced symptoms most similar to those of the patient shall be chosen and given. This is a true homoeopathic prescription. No matter how often during the sickness of a patient this process be repeated; no matter how many remedies be given in succession; no matter if the first remedy be recurred to after the second that the second after the first-if each prescription have been the fruit of a special collection of symptoms and comparison of them with the Materia Medica-call it “alternation,” or by whatever other wrong name you please, it is a sound and defensible homoeopathic prescription, such as Hahnemann taught and practiced, and his followers adopted.
But the physician sometimes leaves a second remedy to be substituted for the first under certain specified contingencies. Is this alternation? By no means. In so doing, he makes the attendant his deputy, and describes the series of symptoms which, in his judgment, will be an indication that another remedy is required. He is merely instructing and empowering another person to make, in his stead, the study and selection of a remedy which should precede and be the basis of every new prescription.
And wherever, in his writings, Hahnemann has seemed to authorize or sanction alternation, his directions have been of this character. He has mentioned that a certain group of remedies is likely to be indicated in a certain disease, and although he has sometimes use the word “alternate” (abwechseln), yet, in every case, he has specified the particular symptoms, or groups of symptoms, which would specially indicate and authorize the preference to be given to one or another remedy of these groups.
In a previous paper (1 American Homoeopathic Review, April, 1863) we showed this to be true of Hahnemann’s directions for the use of Spongia, Hepar and Aconite in croup, and also for Bryonia And Rhus in typhoid fever. The same is true of his directions touching cholera.
The London Homoeopathic Review (2 Vol. ix., p.432) says: “Those who combat ‘Alternation’ on the ground that it is opposed to the practice of Hahnemann, fall into a grave error. In the introduction to Belladonna in his Materia Medica Pura, he advises the alternation of Aconite and Coffea cruda in purple rash, in these words: ‘Aconite and Coffea should be alternately given every twelve, sixteen or twenty-four hours, in proportion as one or other remedy is indicated.'”
It is true that the above words are contained in the introduction to Belladonna, but they are not all the words contained in the sentence from which they are quoted. This sentence, complete, is as follows: “There (in the purple rash) Belladonna, naturally, does no good, no the other, common, charlatan treatment must also allow the most of the alternate use of Aconite and of the tincture of Coffea cruda, the former for the heat and the increasing restlessness and agonizing anxiety, the latter for over-excessive pains with a lachrymose humor; the Aconite in the 30th dilution of the juice and the tincture of Coffea cruda in the 3d dilution, both in the dose of the smallest part of a drop, the one or the other every twelve, sixteen or twenty -four hours, according as the one or the other is indicated.” The two groups of symptoms which Hahnemann gives as indications, respectively, for the one or the other of these remedies, are omitted by the London Review. They are the essence of the whole matter. Following this advice of Hahnemann, it would not be possible for the practitioner, on meeting a case of purple rash, to begin with a blind a priori alternation of Aconite and Coffea. On the contrary, as we understand Hahnemann’s direction, he should examine his case to see whether it presented the groups of symptoms “heat, increasing restlessness and agonizing anxiety,” in which case he would give Aconite; or whether the characteristic of the case were “over-excessive pains with a lachrymose humor,” in which case he would give Coffea. Suppose at his next visit, twelve, sixteen or twenty-four hours after, he should find, as might well happen, that the group of symptoms first observed had disappeared and had given place to the other group, he would, for this reason, change his remedy. Or, if he lived at a distance from the patient, he might make the nurse his deputy, and, instructing this deputy as to the distinction between the groups of symptoms, might direct her (as Hahnemann has directed us) to make changes in the remedies when corresponding changes in the symptoms should call for them. In this way there would be no assumption and no a priori “alternation.” The practice would be sound, fulfilling the conditions of a sound prescription, viz.: that each prescription of the case, and comparison of them with MAteria Medica.
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'.