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.
It is otherwise with respect to disease of a fixed course and character; such for instance, an many acute diseases, where our medicines are employed rather for the sake of moderating the violence of the different stages of the disease, than with the hope of cutting short the entire malady. We know of some affections, for instance, where after the febrile stage has subsided, certain other symptoms will inevitably set in, and we are quite justified, even by Hahnemann’s rules, in prescribing one remedy adapted to the febrile condition, followed by another more specifically suited to the other symptoms, and if the febrile disturbance should have a tendency to recur at any stage of the disease, our antipyretic may be again interposed with advantage.
The alternation of remedies is also justified in those cases where we have previously had experience of the course the disease will take, and of the benefit to be derived from different medicines at different periods. For instance, we know of some diseases, from experience, that a certain medicine will bring them a certain length on the road to cure; but that this medicine is advantageously followed up by such another medicine, and the first medicine is useful after a certain action of the latter. The utility of experience is shown by our being able to predicate beforehand the effect one medicine and then another would have; but I confess such cases occur but rarely, especially among chronic diseases; and therefore the prescription of medicines in alternation is very seldom to be justified. As a rule, the safer, better, and more scientific plan is, in every case where that is possible to take a fresh survey of the case after the administration of every medicine, before we think of proceeding to the prescription of another medicine; for it may and often does happen that after the patient has taken our first medicine for some time, the symptoms still indicate the repetition of that medicine, or are so far altered as to demand quite a different remedy from the one we though at first would rightly follow that we first prescribed.
The case, however, is different where we feel pretty well assured that in the course of the disease some symptoms of a fixed character will arise that will indicate the employment of another and totally different medicine; e.g., when, in the case of females, the menstrual function is certain to be accompanied by a definite array of symptoms, which we know will require to be treated with some particular medicine. The alternation of a medicine and its antidote, as proposed and performed by Constantine Hering-in this way, viz., giving a globule of colocynth 30, and a teaspoonful of black coffee alternately -seems certainly to be highly unscientific, but he claims for it a success which, if authenticated, would undoubtedly justify its employment; possibly there is truth in his allegation that a stronger medicine acts through its weaker antidote.
Hahnemann has advised in the Organon the occasional alternation of medicines that have a very similar action, such as sulphur and hepar sulphuris, but this was at the time when he entertained the idea that a medicine could not bear to be repeated in two or more successive doses; and we may conceive that these directions were annulled by his subsequent admission that a medicine might be repeated an incalculable number of times, not only without bad effects, but with great advantage. In diseases of such frightful rapidity as cholera, where the symptoms change from minute to minute, it is often imperative to give the most appropriate medicines in alternation. In cases of disease attended constantly or intermittently with some febrile action, almost every practitioner has seen the benefit of alternating aconite with the more homoeopathic specific, and the results of practice show the absurdity of the fears of our clerical censor, to the effect that by such a procedure we would destroy the specific relation of the disease to the latter medicine.
The illustration he gives, if I remember rightly, is this: that belladonna is the homoeopathic specific for scarlet fever, but if we take away the fever by means of aconite, we leave the scarlet only, for which belladonna is not specific. But might make himself perfectly easy on this head, for we cannot take away the fever without destroying the specific malady on which the fever depends, and if this can be done by means of the alternation of aconite and belladonna better than by belladonna alone, the practice is good; for we are not concerned in our treatment of any disease, to vindicate the claims of any particular medicine to be the specific of that disease but to cure the patient. A fact or two however, is worth all the speculation in the world, and therefore I may call your attention to the statement of Dr. Bechet, in his recent work on Purulent Meningitis, to the effect that when he ceased to give the suitable medicines in alternation the disease became aggravated. (Opium cit., p. 196.)
Hahnemann mentions several substances as suitable when given successively in chronic diseases; thus he states that calcarea follows sulphur well, and lycopodium calcarea, that mercurius, belladonna, and iodium are a good series, and that sepia and natrum muriaticum succeed each other well. Whether it was merely experience, or the certain symptomatic relationship the medicines in these series bear to each other, that led Hahnemann to recommend them in succession, I am unable to determine, but it is certain that he did not intend either series to be given absolutely, but only if on investigation the symptoms of the disease admitted of their administration.
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.