MUCH confusion exists among medical men for want of a proper comprehension of our subject; and false claims as to principles of selection and the modus operandi of cures are often made when primary and secondary symptoms of drugs are used as guides in determining the seize of the dose.
This is not strange, however, since the terms primary and secondary, as applied to drug-action, are susceptible of different interpretations, and are used with different significations by different authors.
Of the picture of primary and secondary effects of drugs which we find in the works of Old-School writers, and which have been made the basis of the “law of the dose” by some writers of the Homoeopathic School, I quite agree with the late Dr. Dunham’s estimate, that “they are composite pictures made up from a variety of observations on patients and from cases of poisoning, and bear no more resemblance to a pathogenesis on a single individual than the composition of an artist which has the mountains of Ecuador covered with the forests of Oregon and decked with the flowers of Java presents to a faithful landscape from nature.”.
Let me rehearse what the writers of the Homoeopathic School have said concerning the subject under consideration.
Hahnemann, in his essay, “Suggestions for Ascertaining the Curative Powers of Drugs,” published in 1796, and which you can read in the Lesser Writings, says: “Most medicines have more than one action; the first a direct action, which generally changes into the second (which I call the indirect secondary action). The latter is generally a state exactly the opposite of the former.
In this way most vegetables act.” He illustrates his meaning thus: “Under Opium a fearless elevation of spirit, a sensation of strength and high courage, an imaginative gaiety are part of the direct primary action of a moderate dose on the system; but after the lapse of eight or twelve hours an opposite state sets in, the indirect secondary action, and there ensue relaxation, dejection, diffidence, peevishness, loss of memory, discomfort, fear.”
It must be noted here, however, that Hahnemann admitted qualifications as to his general statement as to the opposite primary and secondary action of medicines and specified metals and minerals which “continue their primary action uninterruptedly, of the same kind, though always diminishing in degree, until after some time no trace of their action can be detected, and the natural condition of the organism is restored”.
In the preface of the Fragmenta, published in 1805, Hahnemann further says: “Simple drugs produce in the healthy body symptoms peculiar to themselves, but not all at once, nor in one and the same series, nor all in each experimenter…..
A certain drug evokes some symptoms earlier and others later, which are somewhat opposed and dissimilar to each other; indeed, may be diametrically opposed. I call the former primary, or of the first order, and the latter secondary, or of the second order.
For each individual drug has a peculiar and definite period of action in the human body, longer or shorter, and when this has passed, all the symptoms produced by the drug cases together.
Of the drugs, therefore, the effects of which pass over in a brief space of time, the primary symptoms appear and disappear within a few hours. After these the secondary appear and as quickly disappear. But the exact hour in which any symptoms may be wont to show itself cannot be positively determined, partly because of the diverse nature of men, partly because of different doses.
I have observed some drugs the course of whose effects consisted in two, three, or more paroxysms, comprising both kinds of symptoms, both the primary and the secondary; the former, indeed, as I have stated in general terms, appeared first and the latter second. And sometimes it seems to me I have seen symptoms of a kind of third order.
Under the action of moderate or small doses, the symptoms of the first order came chiefly to view; less frequently those of the second order. I have chiefly preserved the former, as most suitable to the medical art and most worthy to be known.”.
The illustrate his views he prefixed or appended to the symptomatology of the drugs mentioned in the Fragmenta the following remarks:.
Under Aconite: “Through the whole course of action of this plant, its effect of the first and second order were repeated in short paroxysms two, three or four times before the whole effect ceased. These effects were as follows:.
Coldness of the whole body and dry internal heat; chilliness; sense of heat, first in the hands, then in the whole body, especially in the thorax, without sensible external heat. .
Alternating paroxysms (during the third, fourth and fifth hours), general sense of heat, with red checks and headache, worse on moving the eyeballs upward and laterally; then shivering of the whole body, with red cheeks and hot head; then shivering and lachrymation, with pressing headache and red cheeks”.
Under Chamomilla: “The course of its action is run in paroxysms of several hours’ duration being comprising symptoms of each order, free spaces or remissions being interjected, so, nevertheless, that in the earlier paroxysms the symptoms of the first order; in the later, those of the second order, predominate”.
Under Ignatia: “Inconstancy, impatience, vacillation, quarrelsomeness, wonderful mutability of disposition-now prone to laughter, now to tears. These mental symptoms are wont to be repeated at intervals of three or four hours”.
Commenting on these quotations from Hahnemann, Dr. Carroll Dunham has truly said: “In his definition of primary and secondary symptoms, Hahnemann blended the elements of time and of causation or nature (viz., that these classes were opposed in their nature.) The secondary symptoms were not an independent series, but were secondary by virtue of their relation of opposition in nature to a series of preceding symptoms”.
Hahnemann pointed out they clearly, however, that there are symptoms in every proving to which there can be no symptoms of an opposite nature. He says: “Our organism always bestirs itself to set up on opposition to the first drug-effect the opposite condition, if such a condition can exist.” In other words, such symptoms as in their nature did not admit of an opposite condition (as, for example, pain, cutaneous eruptions, etc.; could not be called primary, because,in the nature of things, they could not be followed by an opposite class of symptoms; nor could they be called secondary, because, in the nature of things, they could not have been preceded by an opposite series which could stand to them in the relation of primary symptoms.
Hahnemann also recognized symptoms occurring occasionally which he denominated contradictory, which were not secondary, but how to distinguish them from the secondary symptoms we are not told. In the Organon he gives instances of what he regards as secondary symptoms, viz: “the gaiety which follows the use of coffee is a primary symptom; the subsequent drowsiness and lassitude are secondary symptoms. The sleep which follows Opium is a primary, and the subsequent insomnia a secondary symptom. The purging of cathartics is a primary, and the subsequent constipation a secondary symptom. The constipation of Opium is a primary, and the subsequent diarrhoea a secondary symptom”.
According to the rules laid down in the Organon, we are to use the primary symptoms in prescribing, nerve the secondary.
In the Materia Medica Pura, however, we find Hahnemann to deviate from his definitions and illustrations in the Organon. In the preface to Belladonna he says: “There is no known drug of long action which expresses itself in so manifold (two and three- fold) alternate conditions….Of none of these alternate conditions (Wechselwirkungen) can it be said that they are beyond the primary action.” The symptoms referred to are:.
Contracted pupils and dilated pupils.
Abdominal pains, compelling to bend backward and to sit still; to move forward, and not admitting of motion.
Suppressed stool and urine, and involuntary stool and micturition, and constant tenesmus.
Sleeplessness and deep slumber.
In the preface to Nux vomica, Hahnemann says: “The symptoms of a single dose of Nux vomica are wont to recur several days in succession at the same time of day, even at the same hour, or every other day. Hence the usefulness of this drug in some typical diseases when the symptoms otherwise correspond. Besides this periodicity of the symptoms, and besides the alternation of heat and cold, there follow also upon one another, here and there (as is the case also with other drugs), symptoms which differ very much from one another, and appear to be opposed to each other, although they all belong to the primary action of the drug. We call these alternate actions (Wechselwirkungen)”.
Other Nux vomica symptoms referred to, are:.
Anorexia and great appetite.
Constipation with tenesmus, and diarrhoea with desire and tenesmus.
