(1 Suggested by a contribution by Dr. H. to the American Homoeopathic Review, vol. v., February, 1865)
I.
We publish with great pleasure articles which, like the above, though they seem to favor a practice which we deprecate, are, nevertheless, honest expressions of the earnest conviction of men of close observation and faithfully study.
Nothing could be farther from our intention than to undertake to dogmatize on this question, which we admit to be an open question, and on which men of eminence entertain opinions at variance with our own. It may be allowed us, nevertheless, in all courtesy to our contributor, to signify the points on which we take issue with him.
I. We assuredly do entertain the belief that “two or more medicinal forces (or, we prefer to say “morbific forces”) cannot together act upon the economy without so modifying each other that neither shall produce the effect it would if only one were acting.” This belief has prevailed among medical men from the earliest ages. It is the foundation of the practice of polypharmacy in all its varieties, from the complex prescriptions of the seventeenth century to the alternations of our own colleagues. For we hold, with Dr. Sorge (by no means a Hahnemannian, let us add), that “the practice of alternation, as it exists among homoeopathicians, is only another form of mixing remedies with the intention of getting an effect compounded of the action of the two or more drugs that are alternated.”
We say, this belief is the foundation of polypharmacy. The rationale of a compound prescription we take to be the following: the drug which is regarded as the one chiefly indicated possesses, let us suppose, certain properties which would be hurtful to the patient. Another drug is conjoined with it for the purpose of antidoting those hurtful properties. Again, it lacks the power to produce certain effects which are deemed desirable. Another drug is added to supplement this deficiency, and so on, ad infinitum. This entire procedure rests on the belief that these medicinal forces will so modify each other in the economy that neither shall produce the effect it would if only one were acting.
As an example, we mention calomel and opium, a very familiar combination. Certainly the object of giving the opium is that it may modify the action of the calomel, and in a way which conforms to the known action of opium when given alone.
If there were no reason to believe that “two or more morbific force (a drug is a morbific agent exciting a morbific force) could not together act upon the economy, without so modifying each other that neither shall produce the effect it would it only one were acting,” how could we ever cure disease? The morbific force which constitutes the disease is acting upon the economy,, and we bring to bear upon the economy another morbific force, viz., a drug Now, if the latter be properly selected with reference to the former, we know that these forces will so modify each other that, on the one hand, the drug will not produce pathogenetic symptoms as it would on the healthy subject. This statement rests on the basis of such “facts” as our friend invokes. On what other theory than the mutual modification of morbific forces acting together upon the economy could it be explained?
On what other theory could we explain the action of antidotes as homoeopathicians understand and employ them? How else could we explain the action of Belladonna, in large doses, in antidoting poisonous doses of morphine (1 American journal Medical Science, January, 1862) as well as mutual antidoting powers which allopaths have recently discovered, many of the cerebro stimulants and spinant alkaloids to possess? How else, finally could we explain the efficacy claimed for the practice of alternation in general and for certain instances of it particular, such as the cases related by Dr. H., and which we fully credit, where Belladonna and Bryonia in alternation accomplished what neither could do singly, and where Arsenic and China in alternation cured a case which neither alone had cured? How else but by conceding that two or more medicinal forces cannot act together upon the economy without so modifying each other, that neither shall produce the effect it would if only one where acting?
The fact that medicinal or morbific influences must be avoided when we are engaged in proving drugs is universally admitted; even Dr. H. assented to it. But on what other grounds than the belief already stated?
That persons long accustomed to use tobacco or coffee are not easily affected by drugs is accounted for, probably, by the fact that long habit has, in so far as those persons are concerned caused tobacco or coffee to cease to be “medicinal forces.” Use has become “second nature.” That is persons not accustomed to the use of coffee, a dose of it will modify the action of another morbific, or medicinal, force is demonstrated by the effect of coffee antidoting opium, Nux vomica, alcohol, as yell as in neutralizing the beneficial curative action of many drugs, as our clinical observations often satisfy us that it does. The same statements apply to tobacco.
2. We think we may then assume, as conceded, the fact that “two or more medicinal forces cannot at the same time act upon the human system, without mutual modification.” It is now asked, whether granting this modification, we may not avail ourselves of it to derive, from the alternate use of drugs which modify each other, good effects that we have attained no other way? There can be
not doubt of the possibility of this being done, no doubt that it has been done with advantage; as, indeed, Dr. H. shows by two instances.
But, in the present state of our science, it would be impossible for any one lay down rules for the selection of remedies to be given in alternation, with the view of gaining any desired modification of the action of each. Nor can we conceive of the possibility of arriving at any such law. The rule of the ancient polypharmacy, viz., to select remedies according to the effects which they produce singly, and to combine them with reference to the effect desired, does not always work well in practice. For example, calomel and opium produce a combined effect, which is clearly a modification of the known action of each drug. But on the other hand, the combined action of opium, ipecacuanha and the sulphate of potash in Dover’s powder is quite distinct and different from that of either constituent alone, and is such as could hardly be anticipated from what we know of these constituents.
Arsenic and China produced a combined effect which cured an ague that neither singly would cure. Now, if this fact were to be taken as a guide in selecting a combination for a case of uterine disease, for example, in which we were at a lose of uterine disease, for example, in which we were at a loss to decide between Sepia and Pulsatilla, it might lead us to alternate those two remedies. But it is not three months since one of us took charge of a case in which this alternation, on this very ground, had been employed, but the patient had not recovered. We were led to the conclusion that the Sepia was really the remedy indicated-that it did good, but that its effects were constantly antidoted by the Pulsatilla. We omitted the Pulsatilla, gave Sepia judiciously, and the patient promptly recovered.
When, in addition to this difficulty arising from the fact that alternated drugs do not always produce a morbific action which can be predicated in advance from their known single action, we consider that the various degrees of susceptibility of the organism to drugs indicated with different degrees of accuracy, will cause the modifications by drugs of each other’s action to be different in each individual case, we clearly see that we can never be in a position to predicate, in advance, the effect of the joint administration of several drugs. We can never, therefore, have a scientific indication for such a combination or alternation. If we make it, it must always be the result of “guess-work” of “feeling our way along,” just as Dr. H. did in the cases he relates.
But we claim superiority for Homoeopathy in that it gives us the means of selecting our remedies with a reasonable certainly of their effects, and we rightly claim that medicine should not rest content with anything short of a method which, given the symptoms of a disease, points us to certain remedy if our materia medica contain it; or, given the pathogenesis of a drug, indicates to us, a priori, the complex of symptoms which the drug will remove.
But the method of alternation throws us back from all-such certainty-back to the field of unmethodized clinical experience-back to the trackless wilderness of polypharmacy and allopathy.
For the reasons, briefly and imperfectly stated, from the stand-point of science we hold that homoeopathic medicine cannot countenance nor tolerate alternation. And we have such a faith in the unity of nature as to believe that what sound reasoning shows to be erroneous, accumulated facts will prove to be mischievous and unnecessary.
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'.