Hahnemann at first gave repeated doses-Instances of his repetitions-He afterwards attempted to regulate the repetition by the supposed duration of action of the medicine-Afterwards his rules was that the medicine should not be replaced as long as improvement went on-Difficulty of following Hahnemann’s rule-The medicine has not exhausted its action until improvement stops-He next allows the medicine to be repeated before it has exhausted its action-He allows the rapidity of the course of the disease to determine the repetition-The medicine when repeated must be given in a lower dilutions-He latterly allowed the medicine to be repeated very frequently, even in chronic diseases-But each time in a different potency-AEgidi asserts the advantage of more frequent repetition-Wolf advises more frequent repetition-Hering enumerates cases where repetition is useful-Gross and Kretschmar advise repetition in certain cases-Rau attempts to show when repetitions are useful, when hurtful-Kampfer’s rules for the repetition- Attomyr looks to the provings for the rules for the repetition-Attomyr’s un-Hahnemannic directions-Koch’s rules- Griesselich’s laudation of repetition-Circumstances in which it is to be employed-Periods of exacerbation of the disease ought to regulate the repetition-Trinks’s rules for the repetition- Arnold’s maxims-Attempt at a rule for the repetition in acute and chronic diseases-The exacerbations, periodicity, and rapidity of diseases should regulate the repetition-The dose cannot guide us in the repetition-Some homoeopathists contend for rare repetition, though Hahnemann latterly renounced the practice.
THEORETICALLY it might be inferred that the proper remedy having been discovered for the disease, and the appropriate dose having been found, all that remained for the physician to do was to place this dose of this remedy on the patient’s tongue, and this would amply suffice to effect the cure of the disease. Such a priori reasoning is encouraged by various parts of Hahnemann’s teachings, especially during the latter period of his life; thus his teaching in the Organon is that the dose of the appropriate medicine cannot be too small, so that it shall not be stronger than the disease to which it has a homoeopathic relation, and the logical inference from this of course is, that one single dose of one remedy is quite enough in acute as well as chronic diseases; and according we find this to have been Hahnemann’s doctrine and practice at one period.
But I am anticipating. This subject, like the others that I have in former lectures brought under your consideration, I shall proceed to consider historically, that is, I shall give you Hahnemann’s first practice, as far as that can be learned from his writings, and trace its gradual development in his mind, showing you the modifications his views and practice underwent with the growth of his system, and pointing out the circumstances that influenced his practice with respect to the repetition of the same medicine.
In the first essay he wrote announcing the discovery of the homoeopathic law in 1796, (Lesser Writings, p.295.) we find him giving the homoeopathic medicines–in considerable doses, as I formerly showed–very much in the same manner as the ordinary practitioners adopted, to wit, once or twice a day, in maladies of a chronic character. The case of colicodynia treated by him in the same year (Lesser Writings, p.353.) got the remedy also every day, but even at this period of his career he was conscious of what is called the cumulative action of certain medicines, such as digitalis and arsenic, and enjoined caution in their repetition. As regards the former of these medicines, he distinctly states (Ibid., p.328.) that its action lasts several days, and that therefore it might be attended with dangerous consequences to repeat the administration of even a small dose of it oftener than every two or three days, and he mentions a case where death ensued in consequence of giving only two grains of digitalis three times a day for three successive days; the effect in this case, he adds, in consequence of the long duration of the action of digitalis, was as if the whole eighteen grains had been administered at once.
In the two essays on intermittent and periodical diseases, published in the course of the following year 1798, (Ibid., pp.382,395.) no noteworthy difference is observable in his repetition of the medicines from what obtained and still obtains in the ordinary practice; thus six or seven grains of ledum, three times a day, is a prescription he used with success in a chronic affection remaining after the subsidence of a sort of remitting fever, and cinchona bark, half a drachm, twice a day, is what he gave in a case of intermitting asthma. It is not until we come to his treatment of scarlet fever that we find an attempt made to regulate the repetition of the remedy by its supposed duration of action. Thus the action of belladonna is supposed to last three days, (Ibid., p.437.) and its repetition for prophylactic as well as for curative purposes is enjoined to be made not oftener than every seventy-two hours as a general rule, excepting when the virulence of the disease is very great, when shorter intervals of repetition are recommended. That, however, Hahnemann did not yet consider the exhaustion of the action of the medicine should be waited for before giving another dose is evident from another passage in this essay on Scarlet Fever, where he directs a dose of belladonna every three hours, for the purpose of suppressing the disease when it first breaks out. (Ibid., p.441.)
It is not, however, till 1805 that we find a distinct enunciation of the rule of be observed in the repetition of the medicine. In the Medicine of Experience, published in that year, we find the following statement: (Lesser Writings, p.537.) “The repetition of the dose of a medicine is regulated by the duration of the action of each medicine. If the remedy acts in a positive (homoeopathic) manner, the amendment is still perceptible after the duration of its action has expired, and then another dose of the suitable remedy destroys the remainder of the disease. The good work will not be interrupted if the second dose be not given before the lapse of some hours after the cessation of the action of the remedy.”
But he adds, “the good effects of the medicine may be frustrated by its too rapid repetition–for this reason, because a dose prescribed before the cessation of the term of action of the positive medicine is to be regarded as an augmentation of the first dose,” in other words, the repeated doses accumulate in the system and act too violently. “After the expiry of the term of action,” he continues, (Ibid., p. 538.) “of the first dose of the medicine employed, we judge whether it will be useful to give a second dose of the same remedy.” And then he gives us the signs whereby we may know if the remedy was the proper one. We may be sure that the selection was correct if the disease have diminished in its whole extent, and it is probable that it was rightly selected if no new symptoms of importance have ensued, even though no perceptible amelioration should have occurred. In both these cases it is sometimes requisite, after the termination of the action of the first dose, to give a second or a third.
As regards the duration of the action of the medicines, Hahnemann had already, in his first essay On the Homoeopathic Principle, (Ibid., p.295) et seq. attempted to fix the periods of the duration of the action of several substances, at least of what he then called their direct or primary action; thus, according to him, the action of hyoscyamus lasted scarcely twelve hours; that of stramonium, in large doses, twenty-four hours, in small doses, only three hours; that of agaricus, from twelve to sixteen hours; that of aconite, from seven to eight hours; that of tobacco, in very large doses, twenty-four, in smaller doses, only a few hours; that of belladonna, twelve, twenty-four, or forty-eight hours; that of coffea, in large doses, two days, etc. etc.
In the first edition of the Organon, published in 1810, Hahnemann alters the rule he had given five years previously. Here the rule is, that the medicine should not be repeated as long as the improvement goes on, even though it be but slight; he says every new dose spoils the work of amelioration. This rule he considers much better and more important than his former one, because we do not know accurately the limits of the duration of the action of any medicine; some, for instance, exhausted their action in twenty-four hours (but he states this to be the shortest period of the action of any medicine he knows), whilst others continued to act for days and even weeks; the amelioration produced by the medicine also often continued perceptible after the action of the medicine was over.
The repetition of a medicine that had proved of use would, he tells us, only make the patient worse, if the amendment had not commenced on every point to stand still, thereby a medicinal disease would be added to the natural one; a disease when ameliorated presented a different group of morbid symptoms, and hence the same remedy was not again applicable. These directions, it will be observed, almost preclude altogether the repetition of any medicine, or, at all events, involve a contradiction that must somewhat have puzzled those who wished to act according to the exact directions of the Master; for, on the one hand, he says that a medicine is not to be repeated until the amendment the first dose produced becomes stationary, and again it is stated that any amendment will alter the morbid picture and indicate a totally different remedy.
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.