As preliminary to an intelligible discussion of this question, we must briefly define primary and secondary symptoms respectively, and state how, in our judgment, the discrimination between them bears upon the selection of the remedy. And this, notwithstanding these questions have been elaborately and lucidly discussed by other members of this bureau. For it will not have escaped the reader’s observation that these terms are used with different significations by different writers.
Symptoms may be called primary as being first in order of occurrence, in comparison with others which, occurring at a later period, are, with reference to time, secondary to them.
Or, symptoms may be called primary as being, in a sense, the exciting cause of other and apposing symptoms, which are then secondary to, as being contingent upon, the former.
Or, symptoms may me styled primary as being of greater importance or significance than others called, therefore, secondary.
The distinction, then, may be based on considerations of time, of opposition in nature, or of rank. And it is important not to confound or combine these ideas in our discussions.
Since most of our traditional notions on this subject originated in Hahnemann’s utterances upon it throughout his writings, I will briefly repeat his views before stating my practical conclusions.
In an essay entitled Suggestions for Ascertaining the Curative Powers of Drugs, published 1796 (S.W., 312), Hahnemann says: “Most medicines have more than one action; the first a direct action, which gradually changes into the second (which I call the indirect secondary action). The latter is generally a state exactly the opposite of the former. In this way most vegetables act. But few medicines are exceptions to this rule, e.g.; metals and minerals.” He illustrates what he means by the secondary action in the following note: “Under Opium, for example, a fearless elevation of spirit, a sensation of strength and high courage, an imaginative gaiety, etc., are part of the direct primary action of a moderate dose; but after eight or twelve hours an opposite state sets in- the indirect secondary action; there ensue relaxation, dejection, diffidence, fear, loss of memory, etc.”
In the preface of the Fragmenta de Vir. Medorrhinum Pos., etc., 1805, Hahnemann says: “Simple drugs produce in the healthy body symptoms peculiar to themselves, but not all at once, nor in one and the same series, nor all in each experimenter; but to-day perhaps these, nor all in each experimenter; but to-day perhaps these, to-morrow those; this first one in Caius, the third in Titus, but so that on some other occasion Titus may experience what Caius felt yesterday.
“A certain drug evokes some symptoms earlier and others later, which are somewhat opposed and dissimilar to each other; indeed may be diametrically opposed. I call the former primary, or of the first order, and the latter secondary, of the second order.
“For each individual drug has a peculiar and definite period of action in the human body, longer or shorter, and when this has passed, all the symptoms produced by the drug cease together.
“Of the drugs, therefore, the effects of which pass over in a brief space of time, the primary symptoms appear and disappear within a few hours. After these the secondary appear and as quickly disappear. But the exact hour in which any symptoms may be wont to show itself cannot be positively determined, partly because of the diverse nature of men, partly because of different doses.
“I have observed some drug the course of whose effects consisted in two, three or more paroxysms, comprising both kinds of symptoms, both the primary and the secondary; the former, indeed, as I have stated in general terms, appeared first and the latter second. And, sometimes, it seems to me i have seen symptoms of a kind of third order.
“Under the action of moderate or small doses, the symptoms of the first order come chiefly to view; less frequently those of the second order. I have chiefly preserved the former, as most suitable to the Medical Art and most worthy to be known.”
Finally he speaks of a class of symptoms which he denominates “reliquias,” generally the effects of very large doses, and which seem to indicate or depend upon more or less permanent alterations of tissue, including the symptoms of the “agony” in fatal cases.
As illustrating these views, I quote remarks prefixed or appended to the symptomatology of several of the drugs mentioned in the Fragmenta.
In a note a Aconite, Hahnemann says: “Through the whole course of action of this plant, its effects of the first and second order were repeated in short paroxysms, two, three, or four times before the whole effect ceased (eight to sixteen hours).” And he describes these effects as follows:
“Alternating paroxysms (during the third, fourth, and fifth hours); general sense of heat, with red cheeks and headache, worse on moving the eyeballs upward and laterally, then shivering of the whole body with red cheeks and hot head; then shivering and lachrymation with pressing headache and red cheeks.”
In a note to Chamomilla, Hahnemann says: “The course of its action is run in paroxysms of several hours’ duration, comprising symptoms of each order, free spaces of remissions being interjected, so, nevertheless, that in the earlier paroxysms, the symptoms of the first order, in the latter, those of the second order predominate.”
In a note to Ignatia, he says: “Ignatia is wont to display the curriculum of its operations in several paroxysms comprising both orders of symptoms, and repeated at intervals of several hours,” and concerning the mental symptoms: “Inconstancy, impatience, vacillation, quarrelsomeness, wonderful mutability of disposition, now prone to laughter, now to tears,” he says: “There mental symptoms are wont to be repeated at intervals of three or four hours.”
Hahnemann’s teachings on this subject in the Organon (in which all the editions substantially agree) have been so fully given by Dr. C. Wesselhoeft in the preceding section of the report of this bureau, that I am spared the necessity of quoting them.
It appears that Hahnemann, in the Fragmenta and the Organon, teaches that among the symptoms of a drug, there appear series which are opposed to each other in different degree of diversity, from being “somewhat opposed” to “diametrically opposite;” and that, of these series, that which occurs first in order of time, is to rank among the primary, and the occurring subsequently among the secondary symptoms. But he calls attention to the fact that there are some kinds of symptoms in every proving, to which there can be no series of an opposite nature, i.e., to which an opposite cannot be predicated; for, he says, “Our organism always bestirs itself to sep up in opposition to this effect (first drug action), the OPPOSITE, condition, WHERE SUCH A CONDITION CAN EXIST.” (1 Organon, 2d and 3d ed., aphorism 74; 4th ed., aphorism 63.
In his definition of primary and secondary symptoms, therefore, Hahnemann blended the elements of time and of causation or nature (viz., that these classes were opposed in their nature). The secondary symptoms were not an independent series, but were secondary by virtue of their relation of opposition in nature to a series of preceding symptoms. And such symptoms as did not in their nature admit of an opposite condition (as, for example, pain, cutaneous eruption, etc.) could not be called primary, because, in the nature of things, they could not be followed by an opposite class of symptoms. Nor could they be called secondary, because, in the nature of things, they could not have been preceded by an opposite series, which could stand to them in the relation of primary symptoms. Hahnemann, then, appears to have recognized in the pathogenesis of drugs, symptoms which being opposed in nature could be arranged into series of primary and secondary, and other symptoms not susceptible of such arrangement.
He distinctly tell us (1 Organon, 2d and 3d ed., aphorism 59; 4th ed., aphorism 152) that the primary or positive symptoms of drugs are those on which we are to base our prescriptions.
These statements in the Organon, as quoted by Dr. Wesselhoeft, embrace not only a description of various classes of symptoms as observed by Hahnemann in drug- proving, but also a theory of the nature and genesis if these various classes. A man’s observations of natural phenomena, if he be a keen and accurate observer, as Hahnemann unquestionably was, are generally correct. His theoretical explanation of them is pretty sure to be tinctured with the philosophy of the period in which he wrote, and is not likely to be accepted without qualification by men of a subsequent period. And, at the present day, few would accept Hahnemann’s explanation of the genesis of primary and secondary symptoms as representing respectively a state of passivity followed by a state of intensified activity on the part of the vital force; this conception of a vital force, in the sense in which Hahnemann used the term, being one which, itself, has been discarded by most physiologists. But the rejection of the explanation offered by Hahnemann does not involve the rejection of the observations to which he attached it.
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'.