2d: That symptoms, apparently opposed (not including those of the agony), occurring in a drug-proving are equally available as guides in the selection or remedies.
Coming now to the special subject of this paper, I justify the length at which the preliminary subjects have been discussed by the suggestion that, if I have shown that there is now basis for a division of drug-symptoms into primary and secondary, I have thereby shown the impossibility of a law of dose based on such a division. Or, if admitting that in pathogeneses there to appear groups of symptoms apparently opposed, I have shown that these refer only to certain functions, and by no means embrace, or could be made to include, the symptoms of the entire organism. I have thereby shown that an alleged law of dose based on the existence of these groups, must necessarily be partial, and therefore devoid of that generality of application to the entire pathogenesis which alone would justify the appellation “LAW,” and I claim to have shown these things.
In 1844, Dr. C. Hering in a letter to the German Central Verein in session at Magdeburgh (N. Archiv., 21, 3, 166) rejects Hahnemann’s explanation of primary and secondary symptoms. He admits that there are in every proving primary and secondary symptoms, in the sense that some symptoms appear earlier and others later in the course of the proving, but affirms that although these may appear of the proving, but affirms that although these may appear to be opposed to each other, they are all to be regarded as drug- symptoms, and as such are to be made the basis of prescriptions. He gives instances of such prescription in the cases of Conium, Opium, and Mercury. Indeed, he says that the longer-lasting, more permanent and more opposed to the earlier these later symptoms are, the more useful are they in practice. He says further, that “the course of the drug- disease (in proving) must correspond with that of the disease to be treated.” Hearing further states that “all symptoms which arise in provings of the higher potencies are similar to the later effects of the lower or so-called stronger doses, and are not like the first effects of strong doses.” He adds that the great characteristics of remedies (as we have seen in the cases of Nux vomica, Veratrum, etc.) accompany both the earlier and later symptoms, e.g., the burning of Arsenic.
From these consideration, Hering deduces the following law of dose:
“Having chosen the remedy according to the symptoms of a case from the complete correspondence of the characteristics in disease and drug, we have only to consider whether the symptoms of the case generally have more resemblance to the earlier (primary) symptoms of the drug, and then we give the lower potencies; or more resemblance to the later (secondary) effects, that is, to the symptoms produced by the higher potency provings, and when we give the higher.”
It may be said that this is simply saying: Prescribe doses analogous to those which produced, in the proving, the symptoms presented by the case under treatment. But it amounts to a great deal more, for by showing that the symptoms produced in provings by small doses correspond with the later effects of large doses, it enables us to infer the effects of small doses in cases where provings have been conducted with large doses only.
In 1860, Dr. E.M. Hale published an elaborate article in the N.A.F. of H., vol. ix., on “The Dose,” in which he expresses the belief that he has discovered the long-desired law by which “the proper dose for each case may be selected with as much certainty as the proper remedy,” as follows:
“In any case of disease we must select a remedy whose primary and secondary symptoms correspond with those of the malady to be treated,” and.
“If the primary symptoms of a disease are present, and we are combating them with a remedy whose primary symptoms correspond, we must make the dose the smallest compatible with reason; and if we are treating the secondary symptoms of a malady with a remedy whose secondary symptoms correspond, we must use as large a dose as we can with safety”
These propositions rest on the assumption that all drugs produce, and all diseases present, two series of symptoms, primary and secondary, and that in one or other of these classes is embraced every symptoms of drug or disease. I have expressed my dissent from this view, and given reasons for thinking that a distinction between primary and secondary symptoms, if ever justifiable, is, at most, applicable to but a portion of the symptoms of each drug. It cannot, if I am correct, be made the basis of a general law.
Dr. Hale illustrates his meaning by referring to Aconite, the primary symptoms of which, he says, “correspond perfectly with the chilly stage of all fevers,” while the secondary symptoms of Aconite “correspond with the hot stage of fever.” He therefore recommends a small dose of a dilution of Aconite during the chilly stage, and large doses of the tincture or 1st decimal during the hot stage, and relates results of such treatment, which seem to have satisfied him, but would hardly have satisfied me.
Again, he tells us that the primary symptoms of a group of remedies, of which cinchona, Ferrum, Conium, Nux vomica, and Ignatia are members, are such as to denote that these drugs first “increase the tone and strength of the muscular or nervous system, impart vitality and vigor to the functions of the vital organs;” and that their secondary effects are to cause “a peculiar atony, a condition of deficient vitality, and a cachexia of a more or less obstinate character.” And, stating further, that an outbreak of intermittent fever is always preceded by “an era of good feeling,” a condition of exalted muscular and nervous tone and vigor, he regards this as the primary stage of that disease, to be treated, when recognized, therefore, by small doses of Cinchona. The outbreak, therefore, by small doses of Cinchona. The outbreak of paroxysmal fever is regarded by Hale as belongs to the secondary series of symptoms, and therefore to be treated by as large doses of Cinchona as may safely be given.
In a paper presented to this Institute in 1874, Dr. Hale reiterates these views in substance and re-affirms this alleged “law of dose.” He illustrates the two alleged series of symptoms of disease, called primary and secondary, by the instance of inflammation of the urinary passages, in which congestion and arrested secretion with fever and pain appear first, and are succeeded by profuse secretion or suppuration, prostration and cessation of pain, etc. And he affirms that the group of cognate drugs, of which Cantharis may be the representative, presents similar series of primary and secondary symptoms.
Considering, first of all, the last illustration, it is true that the process of inflammation consists of several successive steps, “accelerated and increased circulation, followed by retarded and diminished circulation, exudation of liquor sanguinis, emigration of leucocytes and stasis,” and it is true that the earlier steps are prior to the later, but they are equally successive and necessary steps in a uniform and definite process, and nothing justifies the drawing a line anywhere in the belongs to a different and opposite series to that which lies in front of it. Nor can I recognize in drug-provings any such opposed series. Neither Hahnemann’s provings of Cinchona and Ferrum, nor Hahnemann;s and Harley’s provings of Conium, nor Hahnemann’s provings of Nux vomica and Ignatia seem to me to support the allegations of Dr. Hale.
Alluding now to Hale’s remarks upon aconite, I refer to my quotations of Hahnemann, Rothausl, Zlatarovich and Sharp, which show that Aconite does not produce a distinct chilly stage first, followed by continued heat, but, as Hahnemann says, “alternating conditions made up of shivering or cold and heat, and recurring frequently or at longer intervals.” So that while I will not deny that Dr. Hale prescribed as he says he did, and with the results which he described, I do affirms that the pathogenesis of Aconite affords no grand for the theory on which he says he acted, or which he deduced from his action.
And, if I may deviate for an instant from the subject strictly under discussion, these statements about Aconite and its application suggest the fact that many prescriptions professedly homoeopathic are really made ex usu in morbis, and are not based on a strict individualization of the case, and a selection of the drug whose symptoms correspond to it. Aconite, having early acquired a reputation as a remedy in febrile conditions, is too often given in routine fashion, “in all fevers” (to use Dr. Hale’s Phrase), and therefore in many case in which the symptoms do not at all indicate it. For, as even Hahnemann warned us, “its is not every case presenting febrile symptoms that Aconite is homoeopathically indicated;” and therefore it cannot truly be said to correspond to the “chilly” or any other “stage of all fevers.” Given when the patient is quiet, lies still, is tranquil in mind and hopeful or patient, it will not remove the symptoms as a Homoeopathically selected remedy would do. Nor is it indicated by a similarity of symptoms in any save a small minority, if in any, of the intermittent, remittent or continued fevers which so often prevail in different parts of our country, nor in the febrile condition which persists when parenchymatous inflammation is established in any important organ.
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'.