Second Prescription

Evaluation of the patient after first prescription. Kent’s advise what should be kept in mind before making a second prescription?…

EDITORIAL NOTE-.What perplexing problems we often meet in practice! How we crave, at times, the advice of a master mind! We are so often the victims of prejudice, over-confidence or ignorance, and our patients suffer in consequence of this. Could we but understand the intricate laws governing the inner man, disease, and remedies, how much more wisely might we adjust ourselves to the far-reaching problems which endanger the life of a father, a mother, a noble son or an affectionate daughter. We would not then, as is so often done, impede or pervert the action of a carefully selected remedy by our impatience to get results, or by our impetuosity in hastening certain conditions which wilt not be hastened, or by our ignorance in so quickly changing remedies before one of them has had time for definite action. To help us in this noble work we reproduce below a masterly paper by Dr. J. T. Kent, read before the International Hahnemannian Association at Niagara Falls in 1888.-G. E. D.

What is more beautiful to look upon than the bud during its hourly changes to the rose in its bloom. This evolution has so often come to my mind when patiently awaiting the return of symptoms after the first prescription has exhausted its curative power. The return symptom-image unfolds the knowledge by which we know whether the first prescription was the specific or the palliative, i. e., we may know whether the remedy was deep enough to cure all the deranged vital wrong or simply a superficially acting remedy, capable of only a temporary effect. The many things learned by the action of, the first remedy determine the kind of demand made upon the physician for the second prescription.

Many problems come up to be solved that must be solved, or failure may follow,

How long shall I watch and wait? Is a question frequently asked but seldom answered.

Is the remedy still acting? Is the vital reaction still affected by the impulse of the remedy?

If the symptoms are returning, how long shall they be watched before it is necessary to act or give medicine?

Is the disease acute or chronic?

Why is the second prescription so much more difficult than the first?

Why is it that so many patients are benefited when first going to the physician and thereafter, drive no benefit?

I presume that most good prescribers will say: “We have often acted too soon, but never waited, too long.” Many physicians fail because, of not waiting, and yet the waiting must be governed by knowledge. Knowledge must be had, but where can it be obtained? To know that this waiting is right is quite different from waiting without a fixed purpose. This knowledge cannot be found where its existence is denied, it is not found with unbelievers and agnostics.

When the first prescription has been made, and the remedy has been similar enough to change the existing image, we have but to wait for results. The manner of change taking place in the totality of symptoms signifies everything, yet the manner of the return of the image, provided it has disappeared, signifies more.

First. If aggravation of symptoms follow;

Second. If amelioration of symptoms follow;

1. Aggravation of existing symptoms may come on with general improvement of the patient, which means well; but-

If aggravation of the symptoms is attended with decline of the patient the cure is doubtful, and the case must be handled with extreme care, as it is seldom that such patients recover perfectly.

2. If amelioration follow the prescription, to what does the amelioration apply?

It may apply to the general state or but to the few symptoms. If the patient does not feel the elasticity of life returning, the improved symptoms are the facts upon which to doubt recovery.

The knowledge that the disease is incurable often is obtained only in this way. In such cases every remedy may palliate his sufferings, but cure does not come. The symptoms that are the expressions of the debility are there, and hence the totality of the symptoms is not removed.

After the curative impulse has entirely subsided, the symptoms will appear one by one, falling into place to arrange an image of the disease before the intelligent physician for the purpose of cure. If the first prescription has been continuously given, there has been but little if any chance of a pure returning image of the disease, therefore this must be very unreliable.

When the remedy has been fully exhausted, then, and only then, can we trust the symptoms constituting, the picture.

If the first prescription was the similimum, the symptom will return-and when they return-asking for the same remedy.

Too often the remedy has been only similar enough to the superficial symptoms to change the totality and the image comes back altered, therefore resembling another remedy, which must always be regarded as a misfortune, by which the case is sometimes spoiled, and the hand of the master may fail to correct the wrong done.

Whenever the symptoms return the same image, calling for the same remedy, then it is that we have demonstrated, that-for a time, if the disease be chronic-we can but recommend the range of dynamics to cure this case. This rule is almost free from exceptions if the remedy is an antipsoric.

What must the physician do who has not the knowledge of dynamic medicines? He must sometimes see sick images come back without change of symptoms, though I believe it is seldom.

The symptoms may call for Phosphorus as strongly as when he began, and Phosphorus 6x has served and no longer cures. What can he do but change his remedy?

Can it be possible that man can be so ignorant of how to cure as to give a drug that is not indicated because the one that is indicated does not cure?

These ignorant mortals condemn the system of Homoeopathy and feel that they have performed their duty to the sick, forgetting that ignorance was the culprit.

I have observed in cases where a low potency had been administered in frequently repeated doses, that some time must elapse before a perfect action follow the higher potency; but where the dose had not been repeated after its action was first observed, the new and higher potency will act promptly.

When the symptoms come back-after prudent waiting-unchanged, the selection was correct, and if the same potency fail to act a higher one will generally do so quite promptly, as did the lower one first When the picture comes back unaltered except by the absence of some one or more symptoms, the remedy should never be changed until a still higher potency has been fully tested, as no harm can come to the case from giving a single dose of a medicine that has exhausted its curative powers. It is even negligence not to do such a thing.

James Tyler Kent
James Tyler Kent (1849–1916) was an American physician. Prior to his involvement with homeopathy, Kent had practiced conventional medicine in St. Louis, Missouri. He discovered and "converted" to homeopathy as a result of his wife's recovery from a serious ailment using homeopathic methods.
In 1881, Kent accepted a position as professor of anatomy at the Homeopathic College of Missouri, an institution with which he remained affiliated until 1888. In 1890, Kent moved to Pennsylvania to take a position as Dean of Professors at the Post-Graduate Homeopathic Medical School of Philadelphia. In 1897 Kent published his magnum opus, Repertory of the Homœopathic Materia Medica. Kent moved to Chicago in 1903, where he taught at Hahnemann Medical College.