Hahnemann’s early notions on primary and secondary actions-He says some medicines have only a primary action-The importance he attached to distinguishing between primary and secondary actions- On it he founds his division of medicine into curative and palliative-Latterly he ascribes the primary action chiefly to the influence of the medicines, the secondary chiefly to the reaction of the vital force-Examples of the two actions-Secondary actions not noticed after small dose, or even after moderate doses on the healthy-Examples from the Materia Medica of primary and secondary actions-These two actions rarer in the later editions-Afterwards termed alternating actions-Finally not distinguished by a special appellation-Hahnemann seems practically to have abandoned the distinction-Hahnemann’s self- contradictions-His alternating action-Examples of it-Probable reasons for the adoption of the term-Hering combats the notion of primary and secondary actions- Piper disapproves of the distinction-Helbig rejects it-Watzke ideas on the subject- Attomyr’s notions directly opposed to Hahnemann’s Kurtz rejects the division-Trinks does the same-Schron would retain the division and use it to prune the Materia Medica-Arnold dissents from Hahnemann-Hirschel agrees partially with Hahnemann-Drysdale accepts Hahnemann’s division-Gerstel proposes the division into active and positive and negative symptoms-Griesselich repudiates Hahnemann’s division-The division into primary and secondary untenable-Hahnemann’s original notions had a bad influence on his mode of recording symptoms-Faults of the Hahnemannie schema- Example of a complete picture of a medicinal disease-Hahnemann’s Materia Medica is little more than an index- Reductio ad absurdum of the primary, secondary, and alternating actions-Great preponderance of subjective symptoms in the Materia Medica- Hahnemann’s provings fall short of his original standard-We ought to strive to bring them up to this standard-Notwithstanding all faults, Hahnemann’s Materia Medica is a wonderful work-His earlier provings are especially valuable.
Primary Secondary Alternating actions of medicines
HAVING in my last lecture endeavoured to explain to you how we ought to interrogate the organism in reference to the pathogenetic powers of drugs, I shall now attempt to ascertain the exact signification of the answers we receive.
And first let us hear what Hahnemann says on this subject. In his first essay to often alluded to he has the following (Lesser Writings, p. 312):-
“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 vegetable substances act.” As an example of these two actions he instance the effects of opium, which, in its primary direct action, causes a fearless elevation of spirit, a sensation of strength and courage, and imaginative gaiety; but in its secondary indirect action, which occurs from eight to twelve hours afterwards, there ensue relaxation, dejection, diffidence, peevishness, loss of memory, discomfort, fearfulness.
“A few medicines are exceptions to this rule, continuing their primary action uninterruptedly of the same kind, though always diminishing in degree, until after some time no trace of their action can be detected, and the normal condition of the organism is restored. Of this kind are the metallic and other mineral medicines, such as arsenic, mercury, lead, etc.”
In the Medicine of Experience he has the following observations on the same subject (Ibid., p. 517):-
“In the action of simple medicines on the healthy human body there occur, in the first place, phenomena and symptoms, which may be termed the positive disease, to be expected from the specific action of the medicinal substance, or its positive primary (first and principal) effect. When this is past, there ensues in hardly appreciable transitions the exact opposite of the first process (especially in the case of vegetable medicines), then occur the exact opposite (negative) symptoms, constituting the secondary action.”
In the first edition of the Organon he distinguishes the two actions by the terms primary and secondary symptoms.
The discrimination of the primary and secondary action was a point of some importance according to Hahnemann, as the choice of the homoeopathic specific medicine was dependent upon it; for, as he says in the Medicine of Experience, (Lesser Writings, p. 517.) it is the symptoms of the primary action of the drug that should correspond to those of the disease, in order that the drug should be a positive or curative remedy, and not a mere palliative.
Thus by his doctrine of primary and secondary actions he divides medicines into homoeopathic-which alone are the curative ones-and palliative, which are those generally employed in the old system. A palliative medicine, he tells us in the Medicine of Experience, (Ibid., p. 519.) is one whose positive primary action is the opposite of the disease. This, he elsewhere informs us, is the enantiopathic or antipathic method-that founded on the principle contraria contrariis curantur.
In the last edition of the Organon we have a still fuller explanation of the primary and secondary actions of medicines, which I shall now read to you:-
“Every agent that acts upon the vitality, every medicine, produces more or less change in the vital force, and causes a certain alternation in the health of the individual for a longer or shorter period. This is termed primary action. Although a product of the medicinal and vital powers conjointly, it belongs principally to the influencing power. To this influence our vital force endeavours to oppose its own energy. This reaction belongs to our preserving vital force, of which it is an automatic action, and it is termed secondary action or counter-action.
“During the primary action of the artificial medicinal agents (medicines) on our healthy body, our vital force seems to conduct itself merely in a susceptible (receptive, as it were passive) manner, and appears, so to say, compelled to permit, the impressions of the artificial power acting from without to take place in it, and thereby alter its state of health; it then, however, appears to rouse itself again to action, and to develop (a) the exact opposite condition (counter-action, secondary action) to this effect produced on it (the primary action), if there be an opposite to it, and that in as great a degree as was the the effect (primary action) of the artificial morbific or medicinal agent on it, and in proportion to its own energy; or (b) when there is not in nature a state exactly the opposite of the primary action, it appears to endeavour to recover its lost balance, that is, to make its superior power available in the extinction of the change wrought in it from without (by the medicine), in the place of which it substitutes its normal state (secondary action, curative action).
“Examples of a are frequent enough. A hand bathed in hot water is at first much warmer than the other hand that has not been so treated (primary action), but when it is withdrawn from the hot water and again perfectly dried, it becomes in a short time cold, and at length much colder than the other (secondary action). A person heated by violent exercise (prime action) is afterwards affected with chilliness and shivering (secondary action). To one who was yesterday heated by drinking much wine (primary action), to-day every breath of air feels too cold (counter-action of the organism, secondary action). An arm that has been kept long in very cold water is at first much paler and colder (primary action) than the other; but removed from the cold water and dried, it subsequently becomes not only warmer than the other, but even hot, red, and inflamed (secondary action, re-action of the vital power).
Excessive liveliness follows the use of strong coffee (primary action), but torpor and drowsiness for a long time afterwards (reaction, secondary action), if this be not always again removed for a short time by imbibing fresh supplies of coffee (palliative). After the deep stupefied sleep caused by opium (primary action), the following night will be still more sleepless (reaction, secondary action). After the constipation produced by opium (primary action) diarrhoea ensues (secondary action); and after purgation with medicines that irritate the bowels, constipation and costiveness of several days’ duration ensue (secondary action). And in like manner it always happens, after the primary action of an agent that produces in large doses a great change in the health of a healthy person, that its exact opposite, when, as has been observed, there is positively such a thing, is produced in the secondary action by our viral force.
(Organon, Aphorism 1xiii., ixiv., ixv).
In the next paragraph of the Organon, he seems to imply that in his experiments with medicines only the primary action was produced.
“An obvious antagonistic secondary action, however, is, as may readily be conceived, not to be noticed from the action of quite minute homoeopathic doses of the deranging agents on the healthy body. A small dose of every one of them certainly produces a primary action that is perceptible to a sufficiently attentive observe; but the living organism employs against it only so much counter-action (secondary action) as is necessary for the restoration of the normal condition.” (Ibid., Aphorism 1xvi).
And this opinion is more decidedly expressed in a subsequent paragraph, (Ibid., Aphorism cxii) where we find the following statement:-
“In the older descriptions of the often dangerous effects of medicines ingested in excessively large doses, we notice certain states that were produced, not at the commencement but toward the termination of these sad events, and which were of an exactly opposite nature to those that first appeared. These symptoms, the very reverse of the primary action, or proper action of the medicine on the vital force, are the reaction of the vital force the organism, its secondary action, of which there is seldom or never the least trace from experiments with moderate doses on healthy bodies, and from small doses none whatever.”
And in another paragraph he has these words:-
“In experiments with moderate doses of medicine on healthy bodies we observe only their primary action.” (Organon, Aphorism cxiv).
He reiterates this statement with still greater force in another place:-
“The more moderate, within certain limits, the doses of the medicine used for such experiments, the more distinctly are the primary actions developed, and these, which are most worth knowing, occur alone, without any admixture of secondary actions or reactions of the vital force. When excessively large doses are used, on the other hand, there occur not only a number of secondary actions among the symptoms, but the primary actions also come on in such hurried confusion and with such impetuosity that nothing can be accurately observed.” (Ibid., Aphorism cxxxvi).
In Hahnemann’s Materia Medica we find various instances of primary and secondary action noticed. Thus in the pathogenesis of china we find the following observation in a note:- “The constipation of cinchona bark is secondary action or reaction of the organism against the great tendency of this medicine to cause diarrhoea in its primary action.” Of chamomilla he says, “All symptoms of constipation of the bowels are secondary action, i.e., reaction of the organism against the effort of chamomilla to produce diarrhoea in its primary action.” In his remarks on digitalis, he states that the diminution of the velocity of the pulse is primary action, but that after a few days the pulse becomes increased in velocity and smaller, and this is counter- action or secondary action. Again of squilla, he says that in its primary action it causes great diuresis, but in its secondary action there ensues diminished secretion of urine. Of sarsaparilla he states that the diuresis it causes is secondary action, but in the same medicine, as it stands in the Chronic Diseases, this symptom is recorded without any such damning expletive, and therefore we are to conclude that he looked upon it as primary action, as indeed we observe it to be in the provings of other individuals; at least, it occurs very shortly after the ingestion of the medicine. Of opium, he says it weakens the muscular force in the secondary action, whilst in the primary action it exalts the same force.
Although in the earlier editions of the Pure Materia Medica the designation of certain symptoms as primary and secondary actions is very frequent, we observe, as we trace Hahnemann through the later editions of his works, that what he would formerly have denominated by these names he subsequently calls alternating actions, and it will be found that in his last works we very seldom meet with either designation; and even in the case of medicines the original provings of which appeared in the Materia Medica, many symptoms of which were marked as secondary actions, as they stand in the Chronic Diseases the epithet secondary action is either altogether omitted or only very rarely inserted, and in the new medicines, although exactly similar symptom abound, the term secondary action is seldom or never applied to them. This fact seems to indicate that Hahnemann’s mind underwent some important change in reference to his original idea of primary and secondary actions of medicines; indeed, he seems to have almost if not quite abandoned it, and to have admitted all the symptoms that occur during the action of the medicine as available for therapeutic use, which we have seen was not the case whilst he divided the symptoms into primary and secondary actions; for the distinctly states that the disease must resemble the primary action of the medicines, in order that the latter should be a positively curative agent. (Medicine of Experience, Lesser Writings, p. 517).
Indeed, from the passage I quoted just now from the 112th paragraph of the Organon, it is quite obvious that he latterly regarded all the symptoms whatsoever that occurred during the proving with moderate and still more with small doses, as primary action, though it is manifest, if we look into the earlier editions of the Materia Medica, that he then frequently met with secondary actions. My own opinion, judging from all these facts, is, that Hahnemann latterly gave up altogether the notion of primary and secondary actions, but that he did not exactly like to recant actually his dogmatically expressed notions on the subject, and so he contented, himself with doing so virtually, by alleging that in his provings only the one kind of action was observed. It is very obvious that the distinction of primary and secondary actions, which Hahnemann at first regarded of so much importance, was subsequently nearly if not altogether neglected by him. We may, then, conclude that the doctrine of primary and secondary actions of drugs is not a cardinal point in Hahnemann’s system, and we may therefore freely criticise it, without fear of incurring the censure of the self-constituted champions of pure Hahnemannism.
But though Hahnemann, as we have just seen, denied that the moderate or small doses which he administered in order to test the physiological action of drugs could produce what he denominated secondary action, or the exact opposite condition of that first produced, he found that even his moderate or small doses often produced states directly antagonistic to each other. At first, as we have noticed, the last of these was denominated secondary action, and held to be useless as a therapeutic guide, and therefore undeserving of being recorded as an effect of the medicine in the Materia Medica, unless accompanied by the warning epithet of “secondary action, ” as the Humane Society warms us off unsafe part of the Serpentine by labelling them “dangerous,” but whether Hahnemann found that if he excluded all the antagonistic symptoms he would thereby greatly curtail the dimensions of each schema, or whether it was that experience taught him that some antagonistic against actions are serviceable in a therapeutic point of views, as, for example, nux vomica, pulsatilla, sulphur, etc., are capable of producing but certain it is that secondary action became a much less frequent expletive in his pathogenetic records, and its place was for a while taken by a new expression, viz., alternating action. Without revoking formally his previously expressed notions of primary and secondary action, Hahnemann states that he applies this new expression to designate “the alternating condition of the different paroxysms of action of the primary action,” (Organon, Aphorism xxv.) and he virtually excludes the secondary action from his provings, though he still retains the notion in his Organon.
It cannot escape any student of Hahnemann’s works that an idea once entertained or an opinion once broached by him is rarely entirely abandoned or formally rejected in his works, even though it is virtually superseded by another idea; and the consequence is, that in his writings, and more especially in the Organon, and particularly the later editions of it, we find statements side by side almost diametrically opposed to each other. He seems unwilling to efface that he had previously written, but retains the order notion, though the more recent one virtually extinguishes it. Of this we shall see frequent examples as was advance, but I may merely remind you to certain anomalies and contradictions I hinted at in my last lecture. Thus, in one place, he describes minutely the mode of testing remedies in their crude state, and lays down dogmatically the rules that should guide us in giving the medicine in tincture, powder, infusion, or solution, and the various quantities in which which stronger or weaker drugs should be ingested in order to develop symptoms; and a few paragraphs further on he lays down as a rule that all medicines should be proved in globules of the 30th dilution, for in that state they are best adapted to develop their peculiar effects, the stronger as well as the weaker. The former of these notions was his first one, but though he virtually does away with it by his later opinion, he retains both. Again he states in one paragraph that it is a useless and uncertain plan to test medicine on patients-this being his original opinion. A few paragraph further on he says it is quite a commendable and proper plan to test medicines on the sick- apparently forgetful that he had ever denounced it. Though, as we shall hereafter see, Hahnemann does occasionally solemnly recant an opinion he previously held, yet he generally evinces an insuperable repugnance to do so, and shows a great dislike to cancel any opinion he had previously expressed, diametrically opposed though it may be to his later views.
Knowing this peculiarity of Hahnemann’s mental organization, we have less difficulty in understanding his virtual abandonment of the doctrines of secondary actions, whilst it still retains a place in the systematic exposition of his doctrines.
Having thus seen that Hahnemann after a time ceased to employ the term secondary action (or rather after-action, for that is the exact meaning of the word nach-wirkung, which I have hitherto rendered secondary action), and that the expression alternating action became for a time a frequent epithet attached to certain symptoms in his schemas, let us for a moment look to a few examples of this alternating action, expressly indicated as such by himself. Thus among the symptoms of arsenic in the Materia Medica, we have the following:- “Bitter taste in the mouth after eating,” and this is said to be an alternating action with another symptom, “bitter taste, without having ate anything.” In the same medicine, the symptom “adypsia” is said to be an alternating action with “thirst.” In the pathogenesy of aurum there are some symptoms marked “alternating action” that in former years would inevitably have been called secondary or curative action. These symptoms are “gaiety and good humour,” in opposition to “melancholy and low spirits,” the latter being the most characteristic action of gold, and indeed the moral state that chiefly influences us in our employment of it as a therapeutic agent.
In the pathogenesy of digitalis, “retention of urine” is stated to be a rare alternating action of that medicine, but this would probably have figured in Hahnemann’s earlier career as a secondary, action, and therefore useless in a curative point of view.
In stannum, “extravagant gaiety” is stated to be an alternating action, whereas mere “good humour and sociability” are denominated secondary or curative action; it is obvious that these two states are merely different degree of the same moral condition, and it is difficult to conceive why the lesser should be unfit for therapeutic use while the greater is.
I might multiply these examples also ad infinitum, but I think I have adduced instances enough to convince you that the so-called alternating action latterly usurped the place of secondary action in Hahnemann’s system. This alternating actions as regarded by Hahnemann as quite available for the purposes of therapeutic indication and the epithet, when it occurs after a symptom, is not to be understood as diminished the value of that symptom in the slightest. It would almost seem as though Hahnemann and invented the term in order to preserve from annihilation many symptoms of his provings, which in his earlier days he would have left out altogether or only inserted with a qualifying epithet that would have diminished their value to the homoeopathic practitioner; as though he had in his later years become so avaricious of every symptom that presented itself whilst taking the medicine, and for weeks or even months afterwards (for to such a length of time do some of his observations refer),. that he could not bear the thought of expunging one of them. Or more probably, he found that hat he was an first disposed to reject as secondary symptoms were equally available for curative purposes with those he termed primary symptom; and he therefore found it necessary, as far at least as his own physiological experiments went, to modify his theory of primary and secondary actions accordingly he limited the occurrence of the latter to the consequences to the ingestion of enormous doses of the medicament, whilst he at the same time contended that moderate or small doses could only produce primary actions; and aware that these were often apparently of an antagonistic character, the invented the expression alternating actions for these contradictory symptoms, an expression which involves an altogether new theory of the action of drugs. But it seems soon to have become apparent to Hahnemann, that having abandoned the notion of the occurrence of secondary actions after the moderate doses in which he proved the medicines, it was not necessary to indicate by any particular term the antagonistic symptoms that presented themselves in his provings. Every symptoms that occurred after the administration of a medicine to a healthy person, in the smallest dose, he registered as medicinal action, therefore as indicative of curative power; and the length of time that might elapse after the ingestion of the medicine, before the observation of the symptom, was something incredible in his alter proving; ten, twenty, thirty, forty, or fifty days being no usual period. Accordingly we find that the expression alternating action becomes very rare in the medicine treated of in the chronic Diseases, and even many or these every symptoms of a medicine, which in the Materia medica were stated be alternating actions, a are simply recorded in the Chronic Disease without any such qualifying epithet. Thus the symptoms I have just cited from the Materia Medica belonging to arsenic, there stated to be alternating action, are not so designated in the Chronic Disease. The same is the case with the symptoms of stannum I have alluded to, and I might quote many other similar facts to show that as Hahnemann had previously abandoned the secondary action in his provings, so also he gradually dropped the alternating action. How very different Hahnemann’s notions on the subject were at different times will be most strikingly observed if we compare his first Essay on a New Principle, where for every medicine mentioned the primary and secondary actions are carefully noted, with his later provings in the Materia Medica and Chronic Diseases, where eat first the secondary action becomes modified into alternating action, and afterwards both expressions are quietly consigned to the tomb of all the Capulets.