Hahnemann at first allowed the alternations of medicines in certain cases- He afterwards altogether condemns it -Cases in which he continued to practises it. His intercurrent remedies- Hering advocates the alternation of long and short acting medicines-He denies the propriety of alternating cuprum and veratrum-He advises the alternation of a medicine and its antidote-Gross recommends alternation-Rummel approves of it- Hartmann speaks favourably of it-Aegidi advises it in many cases- Hirschel practises rapid alternation rapid alternation-Kampfer looks upon it as a make shift-He disapproves of it, but says it is necessary in some cases- Griesselich only allows it in cases where the choice between two medicines is impossible-Trinks disapproves of it, but says it is allowable in certain rare cases-Marey recommends it in certain cases-Beilby denounces it is pleurisy-Horner advises it in pleurisy-The practice is reprehensible in chronic diseases-The practice of prescribing a course of several medicines in succession is akin to it- Alternation allowable in diseases of fixed course, where we can predict the symptoms that will occur-Cases in which it is justifiable-Bechet’s proof of its necessity in some cases- Hahnemann’s successions of medicines-Reasons for Hahnemann’s intercurrent medicines-Is it ever necessary to mix medicines?- Hahnemann’s early denunciations of mixtures-Liedbeck proposes to give the chemical compound of two indicated medicines-His mistake about the proving of iron-He accuses Hering of plagiarism- Aegidi’s proposal to mix medicines-Schron disapproves entirely of the practice-Molin proposes to prove mixtures -Griesselich condemns it- Simultaneous exhibition of two medicines externally and internally- Roux, Panthin, and Gauwerky propose to mix different dilutions-The mixture of medicines not allowable-Is occasionally practised-Omnium gatherum-Auxiliaries to homoeopathic treatment-Hahnemann recommends antipathic, palliative, and chemical remedies in certain cases- His employment of electricity, pitch-plasters, mesmerism, cold water- Hydropathic measures in great favour with some homoeopathists- Starke’s homoeopathic theory of hydropathy-Kurtz, Brutzer, Hampe, Ott, Russell, on the water-cure-Bloodletting approved by some- Kretschmar, Hering, Muller, Rummel, Rau, Henderson, Charge, advise it occasionally-Arnold, Elwert, Schubert, Ruckert, condemn it- Dietl proves its hurtfulness in pneumonia-Are purgatives ever allowable?-Cases in which they are-Black on their use-Are derivatives ever required?-Thirst alleged use in suppressed exanthemata-Cases in which stimulants are required-Certain useful non-homoeopathic the auxiliaries-Hot sponge in croup-Kinesitics- Galvanism-Burq’s chains-Junod’s hemospastic apparatus-Dry cupping-Mesmerism-Reichenbach’s magnetic meridian-Schroth’s thirst cure-Many non-homoeopathic auxiliaries employed by all practitioners.
ALTERNATION OF MEDICINES ON THE ADMINISTRATION OF MORE THAN ONE MEDICINE AT A TIME AND ON THE EMPLOYMENT OF AUXILIARIES
THE subjects that will occupy our attention this evening have given rise to much wordy warfare among the disciples of Hahnemann, attended by a good deal of unnecessary bitterness on the part of those who pretend to be the Elishas of homoeopathy- the sole inheritors of the prophetic mantle of our great Master.
In the first edition of the Organon Hahnemann has the following remarks on the subject of the administration of medicines in alteration:-
“It is only in some cases of ancient chronic diseases which are liable to no remarkable alterations, which have certain fixed and permanent fundamental symptoms, that two almost equally appropriate homoeopathic remedies may be successfully employed in alternation.” The reason he gives for this procedure is that the supply of thoroughly proved medicines is not yet sufficient to enable us to find among them one which shall exactly correspond to some cases. He regards this technical operation as a mere makeshift until better times-that is, until our Materia Medica shall be richer. In the later editions of the Organon (Fifth edition, Aphorism ). he sets his face against this practice, on the ground that the number of remedies we know the physiological actin of is no longer small, but suffices to meet every case, and also on this ground, that we cannot tell what alterations the first remedy will have effected in the morbid condition, so as to render the selection of an entirely different remedy imperative.
In some diseases, especially acute diseases of fixed character, however, he advised, from experience of its advantage, the alternation of two or more remedies.
Thus, in a peculiar kind of typhus fever, (Lesser Writings, p. 712.) he advised the alternation of bryonia and rhus. In an epidemic of purpura miliaris (Ibid., p. 781) he counselled the alternation of aconite and coffea. In croup he advised the alternate or rather sequential employment of aconite, spongia, and hepar sulphuris. (R.A.M. L., vi., 19e.)
In the last edition of the Organon (Org., p. 292, note.) he says:-“When for other diseases also we may consider it requisite, as far as we can calculate, to give eight, nine, or ten doses of tinct. sulphuris, it is yet more expedient in such a case to interpose after every, or every second or third dose, a dose of another medicine, which in this case is next in point of homoeopathic suitableness to sulphur (usually hepar sulphuris), and to allow this to act for eight nine, twelve, or fourteen days before again commencing a course of three doses of sulphur.” He also immediately afterwards states that it is necessary occasionally to interpose a dose of nux or pulsatilla betwixt the doses of sulphur in such a course, if sulphur symptoms make their appearance. Again, he mentions with approval the suggestion of Dr. Griesselich, to the effect that when we find that sulphur is not well borne by the patient we may interpose a dose of mercurius metallicus, when we shall find that after the action of the medicine the sulphur will be well borne by the patient. For the prophylaxis of cholera he advises the alternation of cuprum and veratrum.
In the Chronic Diseases (Vol.i. p. 165, note.) he mentions, inter alia, that he had cured some cases of intermittent fever, or rather some epidemics, of that disease, with aconite alternated with ipecacuanha, cina alternated with capsicum, arnica alternated with ipecacuanha, etc.; and he further states that some kinds of marsh-ague can only be cured by china combined (alternated) with antipsoric medicines.
Dr. Hering (Arch., xiii. 3.) was one of the first who wrote at length upon the technicality of the alternation of medicines He says, that a very short time after he first became. acquainted with homoeopathy, in 1822, he cured a liver complaint with jaundice by the alternate administration of ruta O, and ignatia 12, every third or fourth day. Afterwards he found it a good plan to alternate a long and a short-acting remedy, both of which correspond to a portion of the symptoms. He mentions that Dr. Ihm of Philadelphia cured a case of dropsy in a child by alternating bryonia and pulsatilla. It is, he says often useful to give an acute remedy speedily after a chronic one; as aconite after sulphur, hepar after silicea or zinc, nux after arsenic. By so doing, he asserts, we do not put a stop to the action of the first remedy. In all such cases, he observes, there occurs a third action, corresponding to those symptoms in which both remedies differ from each other. Hence, says he, in the teeth of Hahnemann’s advice, it is not advisable to give as prophylactics two such remedies as cuprum and veratrum alternately for cholera, for they will be unable in the very least to give protection against what they possess in common.
Relying upon this third action just alluded to, he has often given in chronic diseases two antipsorics, which each covered a portion of the symptoms, in rapid alternation. Thus to a liver case he first gave kali carbonicum, and followed it up by carbo vegetabilis in a few days, with wonderful success. In perfectly similar cases, neither the one nor the other remedy given alone was able to effect a like cure.
Hitherto, he says, he has generally given those antipsorics that act more briefly and slightly (such as carbo vegetabilis, aurum, argentum, platina, cuprum, conium, colocynthis, dulcamara, belladonna, rhus, clematis, anacardium, staphysagria, thuja, sabina, sabadilla, moschus) after the more powerful antipsorics (such as causticum, phosphorus, natrum muriaticum kali carbonicum, natrum carbonicum, calcarea, alumina, magnesia, silicea agaricus, bovista, lycopodium, sepia, bulimus (?).
The administration of a remedy in alternation with its antidote he commends. He learnt this technicality, he says, in the dry bellyache of the West Indies. Colocynthis, which he found to be the specific for this disease, in some cases caused frightful aggravations, for which he gave black coffee by teaspoonfuls; and he found this such an excellent plan, that he went on with it and treated numerous cases in this way. A similar plan he has adopted in reference to conium and coffee, sepia and vinegar, and occasionally phosphorus and opium. This practice is, he remarks, useful in the treatment of violent paroxysms of gout. He is of opinion that there are no such things as antidotes that completely do away with the action of a medicine; the stronger medicine always continue to act through the weaker. Camphor is, he says adapted for alternation with very few medicines. In the alternation of remedies attention must, he insists, be paid to the symptomatic relationships of the remedies.
Dr. Gross soon afterwards expressed himself favourable to the alternation of remedies. We have no reason to be embarrassed, he says, if we find that our patient’s case is only partly covered by one remedy and partly by another, in that case we must give the two remedies in alternation; and he relates a case where he gave belladonna and pulsatilla every ninety-six hours alternately, with the most perfect success.
On a subsequent occasion (Allg. h. Ztg., xvii., No. 6.) he again alludes to this technicality. Aconite and belladonna in alternation, he asserts, mutually complete their respective spheres of action; the same with belladonna and lachesis, and with belladonna and sepia.
Dr. Rummel, in a note to Dr. Gross’s paper, corroborates this observation; he commends the alternate administration of belladonna and mercurius in quinsy, of china and the appropriate homoeopathic remedy in masked intermittent fever, of ipecacuanha and antimonium in gastric affections, of belladonna and graphites in lupus.
Dr. Hartmann expresses himself in favour of the alternation of remedies in certain cases. He has seen excellent effects from the alternation of chamomilla and ignatia, ipecacuanha and ignatia, aconite and coffea. In h is Therapeutics (Vol. i. p. 78.) he insists on the rationality of alternating two different remedies; in cases, for instance, where there is a complication of two different diseases, as scarlatina and purpura miliaris: belladonna corresponds to the former, aconite to the latter; and these two remedies may be given alternately every three hours, to the great advantage of the patient. Dulcamara and belladonna may, he says, be advantageously alternated in sore-throat. In phthisis, where there is an almost constant febrile state, it is, he says, good practice to give, in alternation with the principal specific some apyretic remedy, as aconite, acidum hydrocyanicum, or laurocerasus. He also alludes to the necessity of alternating the remedies in croup, a practice which we have seen Hahnemann himself advises.
Dr. AEgidi (Archiv. xiv. 3, 82.) says that in very painful diseases, such as toothache, where the selection of the appropriate remedy is often difficult, and must yet be made quickly, he found himself forced, in order not to lose his patient, to give him several remedies, perhaps three or four, and let him take one every hour or every two hours. He found this plan so successful that he fell upon the idea of extending it to the treatment of other diseases, where several remedies seemed to be equally indicated. He was gratified to find that his new plan proved most successful. In acute diseases, where three or four remedies were equally indicated, he gave them successively every two or three hours. In chronic diseases, under the same circumstances, he gives a different remedy morning and evening, or he changes only every day or every two days, and after the patient has finished the course he allows him to wait without medicine, in acute diseases twenty-four or forty or forty-eight hours, in chronic, four, eight, or fourteen days, in order to give time for the reaction to take place. This practice is of course entirely exceptional, and only to be adopted where the difficulty of selecting anyone from among three or four remedies, all equally indicated, is insurmountable.
Dr. Hirschel (Allg. h. Ztg., v., No. 16) expresses his opinion of the rapid administration of several different remedies in alternation, and he states that the most careful observation has convinced him of the inestimable value of this technicality; he gives several cases where he gave chamomilla 12, followed in half an hour by dulcamara 30, which was repeated in twelve minutes; in another quarter of an hour he gave pulsatilla 30, and then arsenicum 30. Such a confused succession of different remedies gives us no high opinion of Dr. Hirsch’s carefulness, either in observation or in selecting the right remedy, for it is very probable that he would have cured his case much better had he devoted more time and study to the selection of the one right remedy.
Dr. Kampfer (Allg. h. Ztg., xxiv., No. 16) looks upon the alternation of remedies as a makeshift indispensable in practice, in consequence of our inability in every case to determine which of two or more remedies is the best adapted for the case. He believes that when we succeed with this practice, our success depends on the antidotal relation of the medicines to each other. Where two remedies seem to be equally suitable, he believes it would be better practice to give first one of them in repeated doses, and watch what effect it produced before giving the other; about which I think there can be no doubt, only the cases in which it seems necessary to have recourse to the alternating practice are precisely those where we cannot afford to waste several hours without doing all in our power to relative the patient.
Under certain circumstances, he admits the necessity of giving several remedies in rapid succession, but he says, contrary to the dictum of Hering, that the symptomatic relationship of the medicines among each other should not be our guide for their alternation or successive administration, but that the morbid picture should alone influence our choice. He gives a case of a very severe attack of croup, where he gave first arsenicum 30, then phosphorus 30, then spongia 6, and lastly, hepar 4, each in the dose of a drop in water, and the last three at intervals of a quarter of an hour; in two hours the danger was over. he does not hold this up as a model cure; in fact, he says he gave the remedies in this rapid succession, because he did not know which of the remedies was the most indicated, and the case was so desperate he could not wait till each had expended its action before giving the next. I suspect these simple reasons alleged by Dr. Kampfer are, in nine cases out of ten, the real reason of most practitioners for adopting such a practice, and any other reasons that have been offered are generally put forward to conceal these real ones.
Where, says Griesselich, (Handbuch, 266) it is impossible to find the right remedy, then it is not only allowable but imperative to give in alternation two remedies of allied mode of action; but this, he says, is very different from that slovenly practice which would not take the trouble to ascertain which of two remedies was most indicated, but give two or more remedies in alternation, in order to save trouble.
Dr. Trinks (Handbuch, Einleitung, lvii.) says, that the practice of alternating two medicines is adopted nominally in those cases in which among the list of proved medicines the most appropriate one cannot be accurately discovered. But he quietly hints that this may not be always the true reason for the practice, but that it may be sometimes owing to a subjective want of thorough acquaintance with the Materia Medica. It is, he says, strictly speaking, contrary to the principle of homoeopathy, which allows of the employment of but one remedy at a time; and another remedy ought not to be given until the action of the first is carefully noted, for it may effect such a change in the morbid picture as to cause the second medicine to be no longer indicated. Although, he says, many cases have been cured by the alternation of two remedies, it is not a practice worthy of imitation.
Homoeopathy demands the greatest carefulness in the selection of the remedy, and cannot sanction such a procedure, the less so as the supply of well proved medicines is now so great as to render it almost an impossibility that we should fall to discover amid the recorded pathogenetic symptoms the counterpart of the disease only we have to treat. As a makeshift in certain cases the practice may be allowed; for two remedies given in alternation do often seem mutually to support each other’s action, and perhaps we may grant that in certain cases such mutual support is necessary, but these cases are, at the best, exceptional; we know as yet no certain rules nor guiding principles for having recourse to the alternation of two remedies, and in our employment of this technicality we can be guided by experience only. There is no doubt that it tends to obscure our knowledge of the action of medicines. The alternation of three or four medicines, as recommended and practised by some physicians, smacks of the mixture loving propensities of the old school, and is not to be tolerated or countenanced.
Dr. Marcy (Theory and Practice, p. 121.) says: ” In all cases of urgent acute disease, in which we can find no single remedy which corresponds to the prominent symptoms, it is necessary to select a second remedy which shall cover the remaining symptoms, and administer it in alternation with the first. Pneumonia is often accompanied by cerebral inflammation, typhus fever by serious disorder of the intestinal canal, the lungs, the brain, and nervous system; intermittent fever by enlargement of the liver, jaundice, cough, etc.; and other maladies by affections in other parts of the body, which are not strictly connected with the original complaint. In examples of this kind, the alternation, of remedies is both proper and necessary; at the same time it must be remembered that it is far more desirable that a single medicine should be chosen which covers all the symptoms of the disease.”
In this country. Dr. Beilby (Brit. Jour. of Hom. vol. x.) has recently denounced the alternation of medicines in disease in general, and in pleurisy in particular, whereas, Dr. Horner (N. Arch., i. 2, 15) is just of an opposite opinion, and he states that aconite does not act nearly so well in inflammation of the lungs when given alone, as when alternated with bryonia.
As regards chronic diseases, I cannot help regarding the reason generally alleged for employing this technicality, viz., that the symptoms of the disease are not sufficiently covered by the pathogenesy of one medicine, but that they are by two, as utterly insufficient, and there are much more powerful arguments for its total abandonment in such cases. For instance what a blind and unthinking enumeration of symptoms does it not imply to say that the deficient symptoms of the one medicine may be eked out by the effects of another. Thus, suppose we find a medicine that corresponds to a case of disease in every respect, except that it has not among its recorded pathogenetic effects some particular stomach-ache or other pain that the patient complains of, and which is to be found in the pathogenesy of another medicine, which we shall suppose only corresponds to the case in this particular symptom, would it not be to set all science at defiance to give the first medicine and help out its action by the subsequent administration of the stomach-ache medicine?
This practice is a relic of the barbarous compound prescriptions of the allopathists, and the reasons alleged for it are identical with those given in justification of this hotch potch practice. But though it is a practice to be reprehended and avoided, I fear it is one that obtains pretty extensively amongst homoeopathic practitioners in relation to chronic diseases; and the excuse often given is, that patients with these affections are seen at such long intervals that it is requisite to provide them with a course of medicine, and as it is unlikely they will be cured by one medicine, the next best is prescribed to follow or to be taken in alternation with the first. The more frequent private reason for alternation, in such cases is the uncertainty in the practitioner’s mind as to which is the proper medicine-an uncertainty that must often exist even with the most skilful of us; and the rationale of the practice is the same as though a bad shot should put two or three bullets into his, rifle, on the chance that if one missed the other might hit, though it is obvious that a good shot would be much more certain of hitting his mark with one bullet than more, as the presence of others might deflect the best-directed bullet from its course by their mutual concussions.
The practice, by no means uncommon among the more slovenly practitioners of homoeopathy, of giving in chronic diseases two different medicines of long action, one in the morning, the other in the evening, is in no way to be justified, though, as far as my experience goes, the alternation, at not very remote intervals, of a long and a short-acting medicine in chronic diseases is often highly successful. As a rule, however, in chronic diseases we should always wait for the effect of one medicine before administering the next; as by the action of the first the disease may have become so much altered as no longer to indicate the use of the second medicine.