On the Repetition of Medicines



5. If a large dose be given shortly after a small one the action of the latter is thereby increased.

6. If a large dose be given a long time after a small one the action of the latter is thereby neither increased nor repeated.

From the repetition of the medicinal doses therefore only two different kinds of action are observed-1, increase, or 2, repetition of the medicinal action; the former by the renewal of the doses at short intervals, the latter by their renewal at long intervals. The Homoeopathic therapeutic principle can derive no service from the increase of the medicinal action; the repetition of the medicinal action at long intervals is the only kind of repetition which seems to be required by the present state of things, as far as practice is concerned. The repetition of the medicine is, he contends, not an improvement or perfectioning of the art, but a mere pis-aller shift, occasioned by defective knowledge of the active sphere of action of most medicines; by the innumerable complications of most diseases; by the frequent selection of the improper remedy; by the improper dose; by dietetic disturbances of the medicinal action, etc., etc.

The Materia Medica must be referred to, to ascertain what is a long, what a short interval. We have short and long-acting medicines. In all medicines some parts of their action come on quickly and last but a short time; others appear late and last longer. The duration of action varies from one hour to several weeks, or even months. In like manner, the morbific agencies produce at one time a shorter, at another a longer lasting disease, and the health-restoring agencies-the medicines- must, by the different duration of their actions, resemble this property of the diseases.

It would, he contends, be contrary to the principle of similarity to give slow-acting medicines and doses in rapid diseases, and equally opposed to this principle would it be to give slow and long-acting medicines at short intervals, and vice-versa. it betrays, he alleges, but a scanty acquaintance with Hahnemann’s doctrines to say that the smallness of the dose does not appertain to the essentials of homoeopathy, for the homoeopathic therapeutic principle is not capable of being carried into practice without both smallness of the doses and rarity of their administration. (This is going a little too far, as homoeopathic cures, it is admitted on all hands, were effected before Hahnemann or small doses were known.) The force of habit is a powerful enemy, continues Attomyr, to repetition, the organism becomes in time blunted even to the action of poisons. It was an experience of this that first led to the introduction of inter-current remedies. It has, Dr. Attomyr remarks, been stated that the size and the repetition of the dose are to be determined by the age, sex, temperament of the patient, the character and duration of the disease, and so forth. But all this appears to him erroneous. The repetition is determined by the size of the dose. As the action of large doses-so he says, contrary to the opinion of homoeopathists- lasts- but a short time, they may be repeated at short intervals. The 30th of aconite cannot be repeated every hour, even in an acute pneumonia, but the 3rd may: the treatment of this disease with large doses often repeated corresponds, he thinks, more to the homoeopathic principle than with high potencies at long intervals. I need hardly remark that in all this Attomyr, who is reputed Hahnemannist, is quite at variance with Hahnemann, who directs that the acutest diseases shall be treated with the 30th dilution repeated frequently, in some cases as often as every five minutes. Hahnemann also ascribed to the higher dilutions a more transitory action.

When, says Attomyr, we are about to prescribe for a patient, the first question is-What medicine according to the homoeopathic principle? the next-In what dose according to the homoeopathic principle? The answer to the second question determines the question of the repetition. If we determine for a larger dose, this involves the necessity of more frequent repetition, and vice versa.

Dr. Attomyr appears to me to be a framer of pretty hypothesis, which, however, like the houses that children build of cards, require but a very superficial inspection to convince us of their hollowness, and need no very vigorous assault to overthrow them completely.

Dr. Koch, in his work On Homoeopathy, (Die homoeopathie, 587. so often referred to in the course of these lectures, thus formulizes what he has to say respecting the repetition of the medicines.

1. The more similar the medicinal agent, the less requisite is its repetition. Repetitions in very small quantities is its repetition. Repetitions in very small quantities not only do no harm, but on the contrary, are essential to the certainty of the cure.

2. The less similar the medicine, the oftener must the dose be repeated.

3. The more extensive the morbid process, the oftener is the repetition of the medicine required.

4. The more acute the morbid process, the more frequent must be the repetition; the more chronic the morbid process the more rare must be the repetition.

5.The more similar the medicine, the more hurtful is the repetition of large doses.

Dr. Griesselich (Handbuch, 258.) subjects the recorded opinions of Hahnemann and his followers upon the repetition of the medicines, to a searching criticism distinguished by his usual sarcastic and genial talent. He says it is impossible to give fixed rules to give rules for the repetition of the dose for all cases; the characteristics of each case must be well considered, and must be our guide upon the subject. It is, says he, absurd to speak of the duration of the action of a medicine, we can only speak properly of the duration of the action of a dose; to say that arsenic, for example, acts for thirty or forty days is incorrect; we might just as well say it acts for ten minutes or for five years. In cases of cholera, arsenic may be given every ten minutes and still action of the former dose be explained before the next is given, whereas a slow arsenical poisoning may last for years. There is, he says an incontrovertible rule for the repetition, and that is this: the dose of the properly selected remedy should not be repeated as long as a beneficial action is observed to continue from its administration. The repetition of the medicine, he says, is a real and important improvement in the method of administering it. The object of repetition is to retain the diseased organism in the state necessary to allow it to effect the cure. The repetition of the medicine renders its impression more lasting. The repetition of the medicine often repairs the error of a too feeble dose, it frequently effects what might have been accomplished by a first, more appropriate and more powerful dose.

In chronic diseases, when we are sure our selection has been correct, if within a certain period, to be determined by the urgency of the symptoms, no amendment is perceptible, we should repeat the medicine; but if the amendment is going on, we may advantageously leave the patient without medicine for days, and even for weeks; and give him unmedicated powders in the meantime. As a rule, the intervals between the doses may be longer in chronic diseases, and shorter in acute. In the latter, too frequent repetition is not so apt to do harm; whereas, by waiting too long, we may do positive injury, for to lose time in such cases is to lose everything. Change of dose is very requisite even in acute diseases.

In acute diseases the periods of exacerbation must be our guide for the repetition of the medicine: thus in dysentery, vomiting, and cholera, we should repeat the dose after every evacuation; in colic, intermitting faceache, toothache, and such-like pains, the dose should be repeated at every attack; and if the dose acts no longer, we should change the dose, which is a better plan than changing the medicine. A medicine may be its own antidote, as many observation show. Hence, in many cases the success of a well-chosen of a well-chosen remedy may be destroyed by too frequent repetition.

Dr. Trinks, who was one of the first to insist on the necessity of repeating the medicine in both acute and chronic diseases, at a time when such advice was considered by the Hahnemannic purists little better than high treason, considers the subject of the repetition of medicines again at length in his Materia Medica. He says, if after one dose of a medicine the symptoms become altered in their character, the same medicine must not be repeated; but if the symptoms are merely altered in degree, this is an indication for repeating the medicine, and it should be repeated as long as it exercises a beneficial influence on the disease. It is, then only the alteration and diminution in degree of the violence of the symptoms that, according to Trinks, can give a rational empirical indication for the repetition of the same medicine in a disease. Dr. Trinks says, that as no one dose of a medicine, even of powerful action, is capable of producing all its effects on the organism, so one dose is never sufficient to eradicate a deeply -rooted disease, albeit a superficial slight affection, even though it may have lasted some considerable time, will often yield to one dose. The rule Trinks gives for the period of the repetition is, that a second dose should not be given until the improvement effected by the first becomes stationary; and this rule, he says applies to acute as well as chronic diseases. The more the safely of the organism is threatened by the disease, the more rapid should be our repetition of the medicine; in the acutest forms of disease we shall have to give the medicine every four, three, or two hours, or one, half, or quarter of an hour, or even every ten or five minutes; and continue to give it in this way until the danger to life is past. In chronic diseases, he says, we shall much oftener have occasion to repeat the same medicine than in acute, for the changes in the latter are usually so rapid as to demand a change of remedy. In chronic diseases we should continue to repeat the medicine that we are certain is indicated, until either an alteration is effected or we are convinced that no improvement will follow its continuance. In these diseases it is not necessary to give the medicine oftener than every twelve, twenty- four, forty-eight, or seventy-two hours; for in them the medicines act more slowly than in acute diseases, and the frequency of the repetition must also be determined by the nature of the medicine, in regard to its being one of longer or shorter action.

R.E. Dudgeon
Robert Ellis Dudgeon 1820 – 1904 Licentiate of the Royal College of Surgeons in Edinburgh in 1839, Robert Ellis Dudgeon studied in Paris and Vienna before graduating as a doctor. Robert Ellis Dudgeon then became the editor of the British Journal of Homeopathy and he held this post for forty years.
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.