The Second Prescription

The second prescription may be a repetition of the first, or it may be an antidote or a complement; but none of these things can be considered, unless the first examination, and all the things that have since arisen, have been carefully restudied….

The second prescription may be a repetition of the first, or it may be an antidote or a complement; but none of these things can be considered unless the record has been again fully studied, unless the first examination, and all the things that have since arisen, have been carefully restudied that they may be brought again to the mind of the physician. This is one of the difficulties to contend with when patients change doctors, and one of the reasons why patients do not do well after such a change.

The strict homoeopathic physician knows the importance of this and will try to ascertain the first prescription. If the former physician is strictly a homoeopathic physician, he is most competent of all others to make the second prescription. It is often a hardship for a patient to fall into the hands of a second doctor, no matter how much Materia Medica he may know.

The medicine that has partly cured the case can often finish it, and that medicine should not be changed until there are good reasons for changing it. It is a very common thing for patients to come to me from the hands of good prescribers. I tell them to stay with their own doctor. I do not want them. Such changing is often a detriment of the patient, unless he brings a full record, and this is especially true in relation to a case that has been partially cured, where the remedy has acted properly.

If the patient has no reasonable excuse to leave the doctor, it is really a matter of detriment to the patient for a physician to take another’s patients at such a moment. It is not so much a question of ethics, it is not so much a question of the relation of one doctor to another because friends can stand all that, but it is only after a tedious inspection of all the symptoms that an intelligent physician is capable of making a second prescription. As a general thing, if the first prescription has been beneficial it ought not to be left until it has done all that it can do. How is the second physician to know that? Then the duty of the physician is first to the patient, and to persuade the patient to return to his first doctor.

The rule is, after the first correction and homoeopathic prescription, the striking features for which that remedy was administered have been removed, a change has come, and the guiding symptoms of the case have been taken out, and only the common and trivial symptoms remain. It is true if the physician would wait long enough he would see the return of those symptoms, but usually when a patient walks into a doctor’s office the doctor is in a hurry to make a prescription and does not wait until the proper time.

He at once prescribes on the symptoms that are left, and this is one of the dangers to be avoided, a hurried second prescription. The patients are to be pitied that fall into the hands of such homoeopaths. Many patients are wonderfully benefited by the first prescription; they have said to me “Dr. So and So benefited me wonderfully for a while, and them, he did not seem to be able to do me any good.” the fact was that the first prescription was a correct one, having been properly chosen, and after that first prescription the doctor administered his medicine so hastily and so indiscriminately that nothing more was accomplished in the case.

The trouble was that he did not wait long enough. It makes no difference whether the physician is so extremely conscientious that he does not want to give Sac lac or whether he is so ignorant that he does not know how to give it, the result is the same. the early repetition of the medicine and the continued giving of the same medicine, will prevent anything like an opportunity for the making of a second prescription.

If the doctor administers a well-chosen remedy, and repeats it too soon, he never gives the symptoms a chance to come back and call for a second prescription; but they come intermingled with drug symptoms, so that the rational second prescription cannot be made. The second prescription presupposes that the first one has been a correct one, that it has acted, and that it has been let alone.

If the first prescription has not acted curatively, or has not been permitted to act the full time, it is impossible to get a second observation. The second observation is made when the case comes to a standstill, for after the first prescription has been made changes occur; there is a coming and going of symptoms, and while these changes are occurring no rational observation can be made of the case; if a second prescription be made during this time, it will be likely to spoil the whole case. If the patient is not given a perfect rest, if medicines are not kept out of the case, we will have no opportunity to make a rational second prescription.

But if these precautions are observed, then we can really make an observation upon the return of the original symptoms, which is the first thing to be considered. Perhaps they are not so marked, but that is always the first thing to be looked for, the return of the original symptoms. While the confusion is going on after the administration of the remedy, while internal order is being established in the economy, we do not have the return of the original symptoms. This may be a matter of days, or weeks, or months, but if the return of symptoms is not observed what is there to be done?

Without symptoms what can the homoeopathic physician do? No matter what state the patient is in, what can the physician do without symptoms? There is no earthly guide to the remedy except by signs and symptoms. So that it is the duty of the physician to wait for the return of the original symptoms. If the symptoms return somewhat as they were, differing slightly in their intensity, increased or decreased, it is good.

If the patient has not had these present symptoms for some time, if there has been a relief caused by the first prescription, and then the symptoms return somewhat as in the original, this one of the reasons for believing that the first prescription was a good one. If, after an interval of two or more months, the original symptom return, we need very little information beyond this to know that the first prescription was a good one. In such a case when the symptoms return when the patient has the same general and particulars as formerly, it means that the first prescription was a good one, that the case is curable, and that the second prescription must be a repetition of the former.

Another reason for making a second prescription is the appearance of a lot of new symptoms taking the place of the old symptoms; the old symptoms do not return, but new symptoms come in their place. The patient says: “Well, doctor, you have cured me of those symptoms I had, but now I have these.” The doctor, after examining carefully these new symptoms, immediately looks up the pathogenesis, and it is possible that he will find these symptoms in the drug that he has administered and then it looks like a proving.

He asks the patient if he ever had these symptoms before. “Never to my recollection, doctor.” Cross- examine him carefully to see if he is not mistaken, until it seems that they are really new symptoms. If so, the remedy has not acted properly. It was not homoeopathic to the case; and yet it was an unfortunate prescription, because it has caused the disease to progress in another direction, developing another group of symptoms.

This coming up of new symptoms means that they must be antidoted, if it is possible. The new symptoms combining with the old ones must be again studied and the second remedy must correspond more particularly to the new than to the old. It may cause the new symptoms to disappear and possibly have an effect upon the old ones. Any subsequent prescription takes into account all the things that have preceded it, all the conditions that have arisen, and, the third, fourth, fifth or sixth prescriptions have the same difficulties to surmount that are to be surmounted in the second. If the first prescription was an unfortunate one, then all the others are made with difficulty and fear.

It is rarely the case that a new prescription become necessary when the case merely comes to a standstill. The first prescription has been made and the symptoms commence to change in an orderly way; they change and interchange and new symptoms come up, but finally the symptoms go back to their original state, not marked enough to be of any importance, without any special suffering to the patient, and the patient has arrived at a state of standstill. The patient says, “I have no symptoms, yet I am not improving; I seemed to have come to a standstill position.” He says this as to himself, not as to the symptoms. He has come to a standstill.

It is the duty of the physician then to wait, and wait a long time, but if after many months no outward symptoms have appeared, no external tendency of the disease, it is true that another dose of the same medicine will not do harm and the same remedy is the only one that can be considered. A new one cannot be entertained, because there is no guide to it; but another dose of the same medicine can cause the patient to be jogged along the way of feeling better, but there should never be any haste about it. Wait a long time when patients come to a standstill; but when, as in the first instance, the return of the original symptoms is observed, then you have some guide to the administration of the medicine.

James Tyler Kent
James Tyler Kent (1849–1916) was an American physician. Prior to his involvement with homeopathy, Kent had practiced conventional medicine in St. Louis, Missouri. He discovered and "converted" to homeopathy as a result of his wife's recovery from a serious ailment using homeopathic methods.
In 1881, Kent accepted a position as professor of anatomy at the Homeopathic College of Missouri, an institution with which he remained affiliated until 1888. In 1890, Kent moved to Pennsylvania to take a position as Dean of Professors at the Post-Graduate Homeopathic Medical School of Philadelphia. In 1897 Kent published his magnum opus, Repertory of the Homœopathic Materia Medica. Kent moved to Chicago in 1903, where he taught at Hahnemann Medical College.