The second prescription, then, technically speaking, is the prescription after the one that has acted. You may administer a dozen remedies without having any effect upon the economy, and yet no prescription has been administered that has been specific. You may fool away much time in administering remedies that are not related to the case. The result is the same. Consider the first prescription the one that has acted, that one has effected changes, and subsequent to that the next prescription is the second.
The next thing we have to consider is the change of the remedy in a second prescription. Under what circumstances must we change the remedy? One instance I have mentioned, when striking new symptoms appear, and there is an entire change of base in the symptoms, so that the headache, perhaps, which has lasted a long time, disappears. After the administration of the medicine, when a new group of symptoms appears some where in the body relative to the patient, such as the patient has never had, this new group of symptoms means that a new remedy must be considered, and under such circumstances the change of the remedy will be the second prescription, and the second prescription in this case calls for a change of remedy.
We will suppose another instance where the remedy must be changed. A patient has been for years under treatment for a constitutional chronic disorder, and you have gone through the potencies ranging from the lowest to the highest, and they have acted curatively. You have administered the different potencies, repeating the same potency until it would not act any longer, and then going higher, until you have gone through the whole range of potencies. You can repeat that remedy many times on a paucity of symptoms, when you cannot give another remedy, simply because it has demonstrated itself to be the patient’s constitutional remedy. This remedy should not be changed so long as the curative action can be maintained. Even if the symptoms have been changed do not change the remedy, provided the patient has continuously, improved.
If the patient says he has improved continuously, and though it would be impossible for you, at this date, from the present symptoms, to select that remedy, hold on to that remedy, so long as you can secure improvement and good from it, though the symptoms have changed. Many physicians say: “If the symptoms change, I change the remedy.” That is one of the most detrimental things that can be done. Change the remedy if the symptoms have changed, providing the patient has not improved; but if the patient has improved, though the symptoms have changed, continue that remedy so long as the patient improves.
Very often the patients are giving forth symptoms long forgotten. The patient has not heard them, or has not felt them because he has become accustomed to them, like the ticking or the striking of the clock on the wall. Many of the symptoms that appear, and the slightest changes that occur, are old symptoms coming back. The patient is not always able to say that they are old symptoms returning, but finally the daughter or somebody in the house will delight you by saying that her mother had these things years ago and she has forgotten them. This is likely to be the case whenever a patient is proving.
So long as curative action can be obtained, and even though the symptoms have changed, provided the patient is improving, hands off. Whenever in doubt, wait. It is a rule after you have gone through a series of potencies, never to leave that remedy until one or more dose of a higher potency has been given and tested. But when this dose of a higher potency has been given and tested, without effect, that is the only means you have of knowing that this remedy has done all the good it can for this patient and that a change is necessary.
There is another instance to be spoken of, and that is when the second prescription becomes a complementary one. A second prescription is sometimes necessary to complement the former and this is always a change of remedy. Suppose a little four or five year old child, a large-headed, bright, blue-eyed boy, is subject to taking cold, and every cold settles in the head with flushed face and throbbing carotids, etc., you say give him Belladonna and Belladonna relieves, but it does not act as a constitutional remedy.
He continues to have these headaches, which are due to a psoric constitution, and the time comes when Belladonna will not relieve them; but upon a thorough study of the case, you find that when his symptoms are not acute, when he does not have this cold and fever, he does not have the headache and you see an entirely different remedy indicated. You study over the flabby muscles, and you find his glands are enlarged; that he takes cold with every change in the weather, like enough he craves eggs, and you decide that the case calls for Calcarea.
The fact that Belladonna was so closely related to him and only acted as a palliative further emphasizes it. It is a loss of time to treat more than the first or second acute paroxysm. Do not give Calcarea during the paroxysm, but after the wire edge has been rubbed off by Belladonna, give him that constitutional remedy that is complementary to Belladonna, which is Calcarea. Many remedies associate after this fashion.
Then there are series of remedies, as, for instance, Sulphur, Calcarea and Lycopodium. A medicine always leads to one of its own cognates, and we find that the cognates are closely related to each other, like Sepia and Nux Vomica. A bilious fever in a Sepia constitution is likely to call for Nux vomica, and as soon as that bilious fever or remittent fever has subsided the symptoms of Sepia come out immediately, showing the complementary relation of Nux and Sepia. If the patient has been under the influence of Sepia some time, and comes down with some acute inflammatory attack, he is very likely to run towards Nux or another of its cognates. The whole Materia Medica abounds with these complementary and cognate relationships.
The second prescriptions also takes into consideration the change of plan of treatment. The plan of treatment consists in assuming that the case is a psoric one, if looming up before the eyes, all the symptoms in the case and its history indicate psora. The treatment has probably consisted of Sulphur, Graphites and such medicines as are well-known to be anti-psorics. The symptoms have run to these remedies; but, behold, after you have made the patient wonderfully well, and you have effected marked changes in his system, so that the psoric symptoms have disappeared, he comes into your office with an ulcerated sore throat, with dreadful head pains and with the constitutional state and appearance that will lead you to say, “My dear sir, did you ever have syphilis?” “Yes, twenty or thirty years ago, and it was cured with Mercury.”
Now, the psoric condition has been subdued and this old syphilitic condition has come up. This, then indicates a second prescription. You have to adjust your remedies to an entirely new state of things. So it is also with regard to sycosis; these states may alternate with each other. When one is uppermost, the other is quiet, so you have to change your plan of treatment according to the state of the patient.
No prescription can be made for any patient except after a careful and prolonged study of the case, to know what it promises in the symptoms, and everything that has existed previously. That is the important thing. Always restudy your cases. Do not administer a medicine without knowing the constitution of the patient, because it is a hazardous and dangerous thing to do.
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.