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.”
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.