When the attending physician has “taken the case” of the patient for whom he must prescribe and has chosen the remedy, how shall he decide on the potency to be used? shall it be a matter of routine? Because he generally givens the two hundredth or the thousandth shall be begin with that? Shall he not rather consider how acute the condition is and how the patient is reacting to the attack?
If the condition is chronic and the suffering not too great, would it not seem wise to begin with the two hundredth potency and watch its action? Even here, however, the remedy itself must be taken into consideration because some drugs act so much more quickly than others and some do better in a higher, some in a lower potency.
Suppose the physician has given the two hundredth potency with good results, but finally improvement seems at a standstill and the same remedy is still indicated. Shall the same potency be repeated or is it better to go higher to the five hundredth or one thousandth?
Again, it seems to me that circumstances must decide. If the reaction to the first dose has been prompt and very decided, it wound seem probable that the same potency might well, be repeated; but if the reaction to the remedy was rather slow in the first place, the second dose should be in a higher potency.
Supposing that the same remedy has been repeated several times in ascending potencies and now a new remedy is indicated, what potency of that should be used? If A was last given in the ten thousandth, should one feel that the patients system has been brought to the level of that potency and would react best to that in the new remedy, B, or would it be better to begin lower again, hoping in that way to interfere less with what had already been accomplished ? Is it not possible that a remedy acting on a different plane from the last one given might reach symptoms or conditions that the former had not touched?
Here we come up against the theory of the simillimum which, of course, should fit the patient in every detail and require neither repetition nor change, but so many times we cannot attain to such perfection and have to do as well as we can with a similar.
Far be it from me even to suggest alternation of remedies, but I have one patient who has occasional attacks of gas which make it exceedingly hard for her to breathe. Lycopodium, Kali carb. and Sulphur given for the totality of symptoms have all served to put her in better condition and lessen the frequency of attacks; but when one comes, if it does not yield to drinking hot water, she has permission to take one tablet of Carbo veg. 12x., which generally relieves her in ten or fifteen minutes and the improvement lasts for some time. It seems inexcusable that I havent found a remedy to cure the condition entirely. Carbo veg. in high potency does not do it. The patient elderly and takes life rather hard, two reasons which make prescribing more difficult.
Another question of potency: Mr. A is treated for an acute condition-say a sore throat, a coryza or an acute sinus-and responds promptly to a remedy in a certain potency. Later, perhaps in two or three years, he comes back with the same symptoms and apparently needing the same remedy. Should it be prescribed in the same potency as before ? I think it would be logical to go higher, although sometimes the same potency works well. Can we make any rule about it?
These ordinary problems must be faced every day and answers decided on I should be grateful for a discussion of them.
DR. HUBBARD: We cannot let great silence follow the potency question.
I would like to ask Dr. Stevens if she feels, when she has a patient on chronic high potency of 50M., if some condition comes in where she has to give acute remedy, that she should carefully keep away from the 50M. I gathered from the Carbo veg. 12x. that she keeps as far away as possible from the constitutional remedies.
DR. GRIMMER: I am sorry I missed hearing the paper; I just came in. But there is one thing; she spoke about alternation. There is a broad law or manner of approach that Dr. Kent mention in his philosophy about remedies that have to be given in a complementary series. Where there is a mixture of miasms in chronic conditions, very often one remedy, an antipsoric, for instance, will act favorably for quite a while, and then, in spite of change of potency or anything else, there is a deadlock and you come to a stone wall.
In that case the remedy that corresponds to the complicating miasm will act well for a while, and then will come up the other group of remedies and an antipsoric or antisycotic, whichever it may be. There have been many cases that required that procedure in order to effect a cure.
DR. SAGER : I would like to ask a question. Dr. Stevens is giving a high potency and here comes an acute condition. and she gives another remedy. Is that going to interfere with the action of the high potency?
DR. QUACKENBUSH: To me the question that Dr. Stevens has brought up is a question of judgment. That is the thing which distinguishes the homoeopathic physicians, let us say, from the amateur prescriber. We all hark back to first principles, and having been taught that the high potency is the activator, the thing which carries the chronic case along, and that if an acute condition really requires something more than a placebo, it would seem better to give the low, as Dr. Stevens has done in her 12x.
The interruption-that is, the change in the sequence-is almost infinitesimal, because we have another fundamental chronic thing, which is recognized by all the masters. Hering particularly states the law again is that in acute condition the chronic symptoms remain in abeyance, and when the acute condition subsides, aided and abetted materially by the low potency, back again comes your chronic condition, and you are able to judge and carry on with your high potency as before.
DR. BOND: I remember reading in the Recorder some time ago an article along that same line by Dr. Underhill. I wonder if he would mind reviewing that a little for us.
DR. UNDERHILL, JR.: As a rule, in chronic conditions I attempt to treat whatever symptoms are uppermost at the time that I see the patient, the first contact with the case. The patient who has never been seen before needs perhaps to be sold on homoeopathy, and I have not started anything as far as chronic trouble is concerned. Therefore, if he has a cold or an acute digestive upset, I feel it is perfectly justifiable to attack that directly.
However, if he has come for a chronic condition, or if, after such a patient has been placed on a chronic remedy, he then comes with an acute conditions, I try to determine whether or not it is going to run away with him. If it does not, we will let it ride with placebo, and the arousing effect of the constitutional remedy on his vitality will in all probability see him through.
Once in a while, however, threatening conditions do arise, and then it is a problem just what to do. There comes in your point of fine discrimination, and I do not know that I can give a final word as to what procedure is best. I have tried both ways, doing was Dr. Stevens has done, giving a relatively low potency for the acute condition, but have been, on the average, more disappointed in its than I have when I have stepped in with a high potency of the acute remedy.
After the acute condition has worn off, the plan ins to wait as long as possible before repeating or stepping in again with a chronic remedy and before doing so being careful to look over the case very critically to see whether or not the same remedy or some other remedy is indicated.
DR. MOORE : Dr. Underhill, about what potency would you use ordinarily, on the average, at the start in an acute case?
DR. UNDERHILL : I usually try to give a different potency from what I give in the chronic case.
DR. MOORE : If there has been no chronic, do you run lower, and about what do you mean by low potency?
DR. UNDERHILL: Anything above the thirtieth centesimal we consider high. Anything below the 30th is low potency. We usually start with about the 200th in acute conditions, and when the remedy no longer holds after sufficient amelioration to demonstrate the homoeopathicity of the drug, we then step it up to the 1M. potency.
DR. DIXON: That brings up a little remark that was put to me since we assembled this morning. A party who is on a high potency dose complained about a cough, that the cough was distressing and it was thought something ought to be done for the cough. Something like that comes up so often, and I always try to evade breaking out on another remedy. I talk philosophy to those people. I say, “Get an idea of values. When you have a chronic remedy to cure a chronic condition, it seems futile to break in on a big program like that just to give relief from a cough or a cold or a runny nose or something of the sort.”
It is surprising how many people you can carry though a distressing aggravation of some acute trouble if you just spread a little philosophy there and show them what real values are. It will often work. Those acute conditions will subside. They my be distressing or aggravating for a while, but if you evaluate real values, I think it is well worth while to go through it, rather than to break in on a well-selected chronic remedy.
Another point I wanted to speak about is the one Dr. Stevens brought up, about the patient who comes back two or three years afterwards and whats another dose of the same remedy. I find the same remedy that worked two or three years before, or six months before, will carry that case usually very nicely when they come back, in the same potency. I always select that and always tell them, “That remedy did good work for you six months or two years ago, and it is entitled to repetition.” I dont think many times I have to change that.
DR. GRIMMER: I hope you will pardon my speaking twice, but there is a thought that I think might help. Dr. Dixon spoke of handing the patient plenty of the philosophic side of our work. That is good, but you get food patients sometimes that know nothing at all about homoeopathy. They come to us because some other grateful patient has sent them, knowing just that it is the doctor that cured them, without inquiring about homoeopathy or anything. It is a little heard to put those patients on philosophy along. I always give them plenty of placebo, as well as the philosophy. I think it helps to back it up.
DR. HAYES: Mr. Chairman, when a patient has been through a session with Dr. Dixon, I imagine his morale is much better forever after.
The question of potency, of course, is an individual problem, but one should not forget a simple outlook from which we can estimate it at least, and that is, How much work in medicine do you have to do be or can you do with a certain patient? If a great dela has to be done it is better in a chronic case to begin with low potency, and the 30th is a wonderful potency, if there is a great deal of chronicity in the individual.
With a young person with a great deal of vitality, you can often give high potency to the CM. even at once, and get permanent results. Where the more chronic and long standing conditions, especially where pathology has taken place which is more or less obscure, are apparent, then low potency, ranging up from that, is the best way to use it.
DR. BOND: That brings up a case I had just before coming to Cleveland. I have given a woman Lycopodium 10M. about three months ago, with very marked relief. She kept me after some medicine for a cough that had just recently occurred. Not having her case history with me, and being a little bit busy, I told her I would have to go home and bring her back some medicine.
The next time I came to see another member of the family, I had forgotten her medicine. I made the excuse again and said this time I would have to send it to her. It happened that the very next day I was in town and thought I would go around and see her anyhow. By the time I got there to give her medicine, she was well of her cough, so I guess my delay was beneficial in the end.
The chronic remedy, Lycopodium, had carried her through cough as well, without having to give her any acute remedy.
I wonder how many of you have noticed people developing acute colds after the chronic remedy has been given. It has been an observation on my apart quite often. I would like to hear from some other member on that part of it, too.
DR. STEVENS: In reply to Dr. Bonds question, about the development of what seems an acute cold, I think it is very common where a deep homoeopathic remedy is given to have what seems to be an acute coryza develop, and if you can simply keep the patient quite and content for a few days it usually turns out very well. Sometimes in case of a cough where I want the patient to keep quiet on the remedy, I advise, especially at night, a wet pack; that is, a very thin, wet linen covered by a dry flannel, so the evaporation relieves the congestion in the larynx, if it is that.
Sometimes I even allow glycerin lozenges, which are absolutely unmedicated. Pine Brothers glycerin lozenges with honey flavor I think are perfectly safe. They have no medical value, but they are very soothing to a dry throat and help to bridge over the acute stage until the remedy has time to act.
In reference to Dr. Hubbards question, I have tried very hard never to interfere with the action of a high potency. I either give plenty of placebo or, if it seems absolutely necessary, as it does in the cases of which I spoke, I give a very low potency which will act on a different plane and not cut into the action of the high potency.