Now, obviously, with this class we cannot discuss the question on scientific grounds. There is no reason in their method, because there is in it no reference to general principle, to natural laws: it gives no means of foreseeing and providing for future results; it is the simplest form of literal empiricism. We can do nothing more than show, as has been done, its unreasonableness and the precarious and contradictory and disappointing character of its results. We can only point out how far it falls below the standard of action to which practitioners of medicine should hold themselves, and how unworthy, in our judgment, such methods are of reasoning and conscientious men.
The second class accept our definition of the requirements of a sound prescription, and our statement of the obligation of scientific men to abide by natural laws. But they claim that alternation does not necessarily, as we have maintained, contravene the requirements of such a prescription; and they claim that there are certain established principles in accordance with which we may, with scientific accuracy, determine when and how to alternate. This class defend alternation when and how to alternate. This calls defend alternation “on principle.” As the former class comprises some of our most conscientious and estimate colleagues, so does the latter embrace many of the most gifted and learned of our school. Their opinions are worthy of the most earnest and respectful consideration.
We have previously stated that some who defend alternation on principle designate by that name methods which, we think, ought not to be so called, and which we do not find fault with; as, for example, Dr. Coxe; likewise Dr. Drysdale, in so far as his definition is concerned with the requirements of a sound prescription. There are still other procedures, called “alternation,” but which are not always necessarily liable to the objections urged against “alternation,” properly so called, as we have defined it (a priori).
The occurrence of complications, and especially of traumatic complications, such as a burn of the hand, during the course of a pneumonia-a contused vulva simultaneously with a milk fever, are mentioned by Dr. Drysdale, as instances which may require alternation; as, for example, Urtica urens to the burned hand, while Phosphorus is being given internally for the pneumonia, and Arnica to the vulva, while Aconite is given for the milk fever.
Now, of such cases as these it might perhaps be properly said, that they do not come under the scope of our inquiry, inasmuch as the burn and the contusion might be regarded as purely local, and not at all constitutional affections, and the respective applications might be viewed in the same light, and as not capable, when thus used, of affecting the general system, and of thus being, in fact, alternated with the remedy which the patient is taking internally. But, waiving this reply, we may say that the teaching of our own experience is, that, in such cases as these, the best way is to follow the one great rule which governs homoeopathic prescription; after the occurrence of the complication, collect and scrutinize the patient’s symptoms anew. If the burn shall have been so slight as to make no impression on the general system, to produce no modification in the symptoms of the previously existing pneumonia, then there is no reason for doubting that simple protection from the atmospheric air will be all that is needed in the way of treatment for the burn.
It, on the other hand, the burn have been of a serious character, so as to produce constitutional disturbance, it will assuredly have modified the symptoms of the pneumonia, and we shall perhaps find, on taking the aggregate of the symptoms again, that some other remedy than phosphorus is now indicated to meet the new state of things resulting from the pneumonia and the shock of the burn combined, and that this new remedy will meet both troubles. For it must not be hastily assumed, as Dr. Drysdale seems inclined to intimate that Urtica urens locally applied is always the best (or a good) remedy for burns. They are often (at least) best treated, as Boenninghausen has shown, by an internal remedy. Singularly enough, it once changed to myself to meet the complication which Dr. Drysdale here supposes. The burn was severe, and the effect of the shock so modified the symptoms called unmistakably for Arsenicum, which was given with most gratifying results, as regards both pneumonia and burn. The same may be said of the application of Arnica to contused vulva. Indeed, there is too great haste among us to recur to topical applications.
The second “principle” upon which, according to Dr. Drysdale, “the practice of alternation rests,” is “the maintaining the susceptibility.” Dr. Drysdale says: “In disease we genial find that the susceptibility to the homoeopathic remedy is present from the nature of the case, and our great object should be to manage the doses and repetitions so that it shall not be exhausted before the natural period essential happens, in spite of varying the dilutions or originally having chosen the best. In this case the plan has been adopted of interposing doses of another remedy as nearly as possible homoeopathic to the case. This must, of course, be an antidote, but, as in the case of natural disease, it may tend to revive the susceptibility to the first remedy. ** Without the use of occasional alternation and intermediate remedies, we should be almost deprived of the use of a large class of serviceable remedies in chronic disease, such as Opium in constipation, Lobelia, Lactuca, etc., in asthma, Coffea and Aconite in neuralgia, ext.”
This question on the propriety of alternating for the purpose of reviving the exhausted susceptibility may be treated in much the same way as the question of alternation to meet complications. When we have case under treatment, we shall not be led to suspect an exhaustion of susceptibility, except by a change in the symptoms. Now, if the symptoms have changed, this very change furnishes us the basis for a new prescription. Why shall we not at once proceed, in accordance with the great rule of our art, to select a new remedy corresponding with these changed symptoms? Why should we prefer, to this certain method, the pathological hypothesis that the susceptibility to a remedy which we have assumed to be suited to the disease has become exhausted and needs a stimulant? This hypothesis may be correct, but can never be a stimulant? This hypothesis may be correct, but can never be a certain basis for practice.
But let us take an example: Cases of dysentery not unfrequently occur in which Nux vomica or Mercurius seemed in the beginning to be very clearly indicated. The patient improves for a few days under the use of one of these remedies and then ceases to improve. On a careful scrutiny of the case it appears that the prominent characteristic symptoms (most of them subjective, of course) have disappeared or become obscure. Even the evacuations have ceased to be characteristic of any remedy. The entire system is dull, languid, unimpressible. In such a case as this, we are told that the susceptibility of the patient has become exhausted; that a few doses of Opium will arouse is so that it will again respond to the appropriate remedy, and will be cured.
As a matter of fact we know this treatment does succeed in many cases, but the rationale of the process is by no means satisfactory to us. And this is not a solitary instance of a successful practice following, through good luck, from a very faulty theory. If we analyze the case described we shall find, that when the patient ceases to improve under the Nux or the Mercurius which was first given, his symptoms changed in such a way that their totality furnished a satisfactory indication for Opium, and a capable prescriber would accordingly have selected Opium and cured his case, even though the notion of “exhausted susceptibility” had never entered his head. Simple adherence to the great principle of homoeopathic prescribing, viz., that each prescription is to be founded on a new collection of the symptoms and a new comparison of them with the Materia Medica, leads to success in all such cases, without the intervention of nay pathological hypothesis whatever; at the same time it excludes all danger of appearing to sanction the bad habit of alternation.
As regards the use of Opium for constipation in chronic diseases, and Coffea in neuralgia, these being used as intermediate or alternated remedies, they, like topical applications in traumatic complications, are much abused, and often altogether needless if not hurtful. A single example will illustrate this point” A patient, not long ago, while under a friend’s treatment came under my observation. Her symptoms corresponded exceedingly well with those of Conium maculatum. It was a chronic disease of long standing. She had troublesome constipation, which was sometimes so bad that it seemed to completely neutralize the good effect which Conium was evidently producing. A dose or two of Opium (30) would relieve the constipation, and the patient would seem for a while to improve again under the Conium. This might be called an illustration of what Dr. Drysdale refers to as the necessity for alternated or intermediate remedies in either “complications of chronic diseases,” or “exhausted susceptibility.” It was not, however, satisfactory to my friend, nor to myself. He could not regard the regularly recurring constipation as a foreign complication. Believing in the unity of disease, he looked upon it as an integral portion of that patient’s sickness and did not rest contented until he has found a single remedy which covered both the symptoms to which Conium corresponded and the constipation besides. This remedy was Alumina, under which the bowels became, and they have remained, perfectly regular. The patient’s improvement, in other respects, was all that could be desired. In this case, as in most cases narrated of cures by alternation, the Opium and Conium, in alternation, seemed to work very well, and promised to effect a cure in the fullness of time. I doubt not that if, to all the other histories of cures by alternation, sequel could be written, it would be found that each of these cases has, in the Materia Medica (actual or future), its own particular Alumina, which would effect a cure in as few days, as the most sanguine alternate would expect to accomplish it in months.
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'.