On the Repetition of Medicines



The transient exaltation of the symptoms, often produced by too large and too often repeated doses of the medicine, may often be allayed by giving repeated smaller doses of the same medicine, and per contra the exaltation produced by small doses may be subdued by larger ones. In chronic diseases the susceptibility of the organism is often blunted by giving very frequently repeated doses of the same medicine, but occasionally the reverse happens, and the susceptibility is increased by repeated doses. In the former case we must give stronger doses, in the latter we must descend to smaller and still smaller doses.

Dr. Arnold, in his recent work on homoeopathy, (Idiop. Heilv., 325) gives the following maxims as the deductions from his observations on the subject of the repetition of the remedy:- 1. The smaller the dose is, so much the sooner is an other necessary. This, however, is only true, he says, with respect to a certain strength of dose. Very massive doses are often soon expelled from the organism in consequence of the irritation they produce, and hence their action may be very transient.

2. The shorter the duration of action of a medicine is, the more rapid must be its repetition; the longer its action, the slower must its repetition be. The duration of action of a medicine is very various in different individuals and in different diseases. It is shorter in persons of lively nature, longer in those of a torpid nature; it may run its course in a few hours in acute diseases, while it may last days in chronic maladies.

3. The duration of the action of a medicine is different in the same person in health and in disease. It is generally shorter in the diseased than in the healthy body. The more rapid the course of the disease is, the more frequent must the repetition be, and vice versa. In acute diseases the dose must be repeated till crises appear; in chronic affections, until symptoms of reaction occur.

4. When anything occurs to disturb or stop the action of the medicine administered, the more frequent repetition of the medicine will be demanded. The more strict the diet, the more rarely is it requisite to repeat the medicine, and vice versa. It is a good plan to give two or three strong doses of a remedy and then a dose of its antidote, in cases of deeply-rooted diseases and little excitability of the organism.

There are many others whom I might have cited as having written with more or less learning on the subject of the repetition of medicines, but I believe I have, in what I have read to you, detailed the principal opinions that have been broached on the subject; and it would be a useless waste of your time to give you the details of those recorded opinions of other homoeopathists of less note, which would be mostly mere repetitions of what you have already heard. I shall therefore bring this lecture to a conclusion by making a few observations on the subject of the repetition of the dose; a question, only second (if second) in importance to that of the selection of the dose itself.

It is evident to my mind that Hahnemann was influenced entirely by the theoretical notions he had adopted relative to the supposed curative action of the homoeopathic agent, in the advice he at one time gave to administer one, and only one, dose of the medicine. His theory was, as you are aware, that the disease yielded to the medicine in virtue of the medicinal disease being the stronger of the two; and further, such was his opinion of the enormous superiority of the medicinal disease in point of strength, that he held that the medicine could not possibly be given in so small a dose as that it should not possibly be given in so small a dose as that it should not be more powerful than the natural disease. Holding these views, it is evident that he must consider more than one dose as not only superfluous but injurious, as apt to disturb the operations of the medicinal disease already set up by the first dose. His direction not to give another dose before the action of the first is expended, which was the next modification of his teaching on the subject of the repetition, was also founded in error, or at least led to an almost impracticable practice, owing to his belief in the absolute duration of the action of the various medicines. It is certainly possible that a dose of calcarea will in some cases act for forty or sixty days, or even longer; but we can readily conceive cases where its action will not last longer than as many hours, or even minutes. Hahnemann did not at first take into consideration that the duration of the action of a medicine was entirely relative and conditional; and here again we find the great individualizer of disease dealing in the most extensive generalizations, in defiance of his own injunctions to individualize all cases of disease. As well might it be said that each medicine could only cure a disease of a certain duration. The repetition of the medicine cannot therefore be said to be determinable by the supposed duration of the action of the remedy. Hahnemann, indeed, practically abandoned this notion in his later years and prescribed the repetition of the medicine, irrespective of its supposed duration of action. The standard he then fixed was one of a very arbitrary character The duration and intensity of the disease was to be our guide. It seems to have been some practical acquaintance with that most fearful and intense of diseases, cholera, that first led him to break through his former rule; for the whole duration of the disease, from its invasion to its termination by death or recovery, often did not amount to one-tenth part of the supposed duration of the action of the medicine; accordingly, the medicine was to be prescribed in some cases as often as every five minutes.

It seems to me that no rule for determining the repetition of the medicine can be deduced, either from the supposed duration of the medicine’s action, or from the intensity of the disease, or from the so-called potency of the medicinal preparation as some have proposed. I believe, it will ultimately be found that the repetition of the dose will be determinable by the periods of exacerbation of the disease. In chronic diseases, I believe, if we attend to their manifestations, we shall observe a certain amount of periodicity in them all. Some, for example, have regular periods of exacerbation and intermission; others there are which still exhibit exacerbations or intermissions, but these are of an irregular character. Others, again, though not presenting any complete intermissions, will be found to offer at least remissions, corresponding it may be to different periods of the day, of the week, or even of the lunar month. I think our repetition of the medicine in chronic diseases should be in a manner regulated by this periodicity of the disease. In regularly intermitting diseases we should give our medicine at some fixed period, anterior to, during, or subsequent to the fit, whichever experience shall determine to be the most appropriate time. When the fits of disease are irregular, as for instance, in many cases of neuralgia, the medicine should be given during the attack. When there are merely remissions and aggravations at certain periods of the day, as is the case in most chronic diseases, our remedy should be given at some time having a stated relation to the period of the exacerbation, to be determined likewise by experience. In acute diseases, the frequency of our repetition of the dose must be determined by the rapidity of the disease, or by the danger attending it, or by the irregular exacerbations that occur in it; thus it is a good plan in diarrhoea to repeat the medicine after every evacuation; in whooping-cough to give a dose after every fit, and so forth. (Similar ideas respecting the repetition of the medicine are expressed in a paper by Dr. Scott, which I have perused in manuscript while these sheets were going through the press. As this lecture was first delivered nearly two these sheets were going through the press. As this lecture was first delivered nearly two years ago, the views expressed in it similar to those entertained by Dr. Scott were not suggested to me by his essay; in fact, I have merely followed up the hints given by Griesselich (v. antea, p. 467)). By this plan, as regards both the chronic and acute diseases, we shall make the action of the medicine bear a certain relation to the disease, not only in point of homoeopathic character, but also as regards the periods of the development of the medicinal influence.

I cannot see how the dose of the medicine can influence us in regard to its repetition, although this has been adduced by some homoeopathists as a determining motive. Thus Attomyr states that the smaller the dose the rarer must be its repetition; whereas, as the object of repetition is only to supply the deficiency of power in the original dose, we should naturally be induced to draw an exactly opposite conclusion from that given by Attomyr. and rather say with Arnold, the smaller the dose the weaker it must be, and the more occasion, must there be for eking out this want of power by frequent repetition. True, practically, we almost all act upon Attomyr’s rule, and we generally repeat the smallest doses more rarely than the largest, but the reason of this is not that given by Attomyr, but this-viz., that we usually prescribe the smallest doses in the most chronic diseases, where frequent repetition is inapplicable for other reasons, and we give the larger doses in acute diseases, and by repetition increase the power of the medicine. Thus we observe that Hahnemann, who had a uniform dose for all diseases, did not hesitate to prescribe the 30th dilution as often as every quarter of an hour in very acute diseases.

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.