Again, we are told (1 “The Dose,” by E.M. ale, M.D., N.A.J., ix.265) that coldness, a condition corresponding to the chilly stage of fevers, is the
primary effect of Aconite, and that a state corresponding to the hot stage of fever is the secondary effect of that drug. Let us hear Hahnemann. In the introduction to Aconite (1 Mat, Med, 1st ed) he says: “Aconite is one of a few drugs whose primary action consists in several alternating conditions of chill or coldness and heat.” And now let us study the day-books of the Austrian provers of Aconite.
Rothausl took tincture of Aconite in doses regularly increasing from six drops daily to fifteen drops daily for nine days, when, feeling powerful effects, he ceased taking it and noted his symptoms.
From the second to the eighth day inclusive, he had the following constantly recurring symptoms: restlessness at night; bad dreams; unnatural heat of body; rawness and increased secretion in the larynx; cough; vertigo; headache. On the ninth day, after midnight, severe chill in paroxysms of shivering, starting from the praecordia, lasting two hours, followed by burning, dry heat, with frequent, feverish pulse; and this followed by moderate sweat.
For the next six days he has various troublesome symptoms affecting the chest and limbs, and on the sixteenth day of the proving he had again, at night, a febrile paroxysm consisting of chill, heat and sweat, the first less severe, the last more abundant than on the ninth day.
On the seventeenth day, at night, a similar febrile paroxysm. Then for seven days symptoms of increasing severity in the head and chest, ending with haemoptysis on the nineteenth day, and finally, on the twenty-fourth day, a very severe and well marked and defined neuralgic head and face ache.
How can be ingenuity of the most ambitious law giver find a pretext for dividing the symptoms (especially the febrile symptoms) of this excellent proving into primary and secondary? A febrile paroxysm occurred on the ninth, the sixteenth and the seventeenth days’ before it and after it were well-marked symptoms of the chest and extremities. Which shall be primary and which secondary if date of occurrence determine the question? Which, if nature or if rank determine it?
Certainly, if lateness of occurrence stamp a symptom as secondary, then the neuralgic head and face ache, the very last symptom reported by Rothausl, must be classed as secondary. Not so fast, however? In the proving of Aconite by Zlatorovish with the second decimal, which he took in increasing and very large doses for seven days without effect, the very first symptom was a violent neuralgic head and face ache, almost identical with that described by Rothausl on his twenty-fourth day.
It appears, then, that Rothausl’s last symptoms was Zlatarovich’s first. If the time of occurrence determines the class, we must rank Rothausl’s headache among the secondary, and Zlatarovich’s identical headache among the primary, and thus we have the same symptom in each class, which is a reductio ad absurdum.
It will be noticed that these identical symptoms, produced at different times in different provers of Aconite, were produced by different doses. The opposite symptoms of Argentum nitricum in different provers resulted from different
doses.
Prof. T.F. Allen has shown how greatly the results of different doses vary. Dr. Sharp shows that, in the same prover, Aconite has four different kinds of action on the heart, as shown by the radial pulse, depending on the dose, and that in only two of these is one series of symptoms followed by an opposite series.
Hahnemann, who, it must be remembered, had an immense experience as a drug- prover, and who brought to the work a devotion and powers of observation and analysis rarely equaled, was well aware of the fact that the appearance of apparently contradictory symptoms in a proving is greatly dependent on the dose, as appears from aphorism 66 of the Organon (4th ed.), in which, for this reason, he recommends the use of small doses in proving.
Passing for a moment to the second division of the subject, the value of primary and secondary symptoms as guides in selecting the remedy, there are many drugs which, having certain constant characteristic symptoms, have also series of alternating symptoms relating chiefly to the secretions. Among them we may mention Veratrum album, which has (122-124) “Thin stool passing unnoticed with flatus. Frequent liquid stools. Liquid stools unnoticed with flatus. Diarrhoea of acrid faeces, etc.” And also (127-139), “Constipation from thickness and hardness of faeces. A desire and compulsion to stool in the upper abdomen, and yet no stool, or a very difficult one, as if from inactivity of the rectum, and as if the rectum took no part in the peristaltic motion of the upper intestines.” Also Hahnemann quotes from Greding, “Diarrhoea with copious sweat” and “long continued constipation.”
The efficacy of Veratrum in the treatment of diarrhoea of an appropriate character is universally conceded in our school. And in my own practice, Veratrum has for many years been a frequently used and highly valued remedy for constipation in persons of all ages, but especially in infants and young children, in whom digestion appearing to be well performed, the evacuation of faeces appears nevertheless to be impossible because of the inertia f the rectum-a fact demonstrated by the circumstance that a healthy stool can be procured almost at will by irritation of the rectum, as by the common practice of introducing into the anus a piece of soap or an oiled paper, or a rubber bougie. We have here the apparent anomaly of the same remedy equally efficacious in diarrhoea and constipation.
Nux vomica furnishes a similar example. Its efficacy in certain forms of constipation as well as of dysenteric diarrhoea is well known.
Let us now, for a moment, examine a little more closely the nature of the functions affecting which the alternate series of opposed conditions, which have been called primary and secondary, are mostly observed in drug-proving. 1st. They are such as in the nature of things are periodic, and not continuous; characterized by periods of repose and activity, and susceptible of quantitative and qualitative correlative interchange among themselves. Thus sleep is periodic, and capable of being supplemented to a degree by other forms of repose to the nervous system. The intestinal canal, the genito-urinary apparatus, the skin, in so far as secretion and excretion are concerned, have periods of activity and repose; and the inactivity of one may be made up by increased activity of another. And thus the function of any one of these apparatus may vary widely at different times without a conditions of opposition being established. For this reason, then, the mere quantity of one of the excretions, or the degree in which any one of these periodic and convertible functions is performed, does not rank first among he indications on which any one of these periodic and convertible functions is performed, does not rank first among the indications on which the selection of a drug is to be based. If we now analyze the prescriptions of Veratrum and Nux vomica referred to, we shall find certain constant phenomena characterizing both the constipation and the diarrhoea, and which would determine the prescription almost without reference to the excretion.
The Veratrum diarrhoea is uncontrolled and almost unnoticed by the patient, liquid faeces escaping with the flatus. Here we have a paretic and anaesthetic state of the rectum and sphincter. The Veratrum constipation exists solely because the rectum does not perform its expulsive function, and is not, as normally it should be, irritated thereto by the presence of faeces. Here likewise is a paretic and anaesthetic conditions. But Veratrum is not fully indicated in either case without the characteristic general symptoms: general depression of vitality; predominant coldness of the body; pallor and cold sweat of the forehead, or of the whole body, on slight emotion or exertion, as, for example, on having a diarrhoeic stool, or making the ineffectual effort to have a stool, if constipated.
Both the constipation and the diarrhoea of Nux vomica are characterized by increased but uncoordinated activity of the intestine, evinced by tormina and tenesmus, and frequent insufficient stools; so that the condition of intestinal action is the same, whether there be, as in one case a minus, and as in the other, a plus of excretion; and, indeed, in the Nux vomica patient these conditions often alternate. These remarks and instances will sufficiently illustrate my conclusions, viz.:
That the appearance or non-appearance of opposed series among the symptoms of a drug depends chiefly, if not altogether, upon the dose in which the drug was proved; and that the question of the constant and necessary appearance of such series cannot be determined until experiments with a uniform and the least possible dose shall have been made by many provers with the same drug, and in the case of many drugs, and therefore that, 1st, Although in our Materia Medica, as it now exists, pathogenesis do present certain series of symptoms more or less opposed, nevertheless (excluding the symptoms of the agony which are not available in practice), inasmuch as these series of symptoms occur in different orders in different provers according to dose or idiosyncrasy, no sound practical distinction can be drawn between them, based on assumed difference of nature, by virtue of which they can be designated respectively as primary and secondary.
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'.