Dr.Hughes accepts Dr. Hale’s view as to what is primary and what secondary in the action of drugs, and also that “in any case of disease we must select a remedy whose primary and secondary symptoms correspond with those of the malady to be treated,” always adding the proviso, “that there be such a succession of opposite states in either or both which does not by any means hold good in all cases.” He objects to making a difference in dose according as the primary or secondary stage of the disease is present and calling the practice Homoeopathic in both cases.
A medicine may be Homoeopathic to two apparently opposite, conditions, but no different of dose is necessary in the two spheres of action; at least, no such difference as advised by Dr. Hale, who Dr. Hale, who, Dr. Hughes declares, is plainly practicing antipathy when he uses doses sufficiently large to induce primary effects to remove conditions like the secondary reactions which are observed in drug effects.
Dr. Dunham so clearly expresses my own views in relation to this whole subject that I will conclude with quotations from a paper, written in 1875, entitled Primary and Secondary Symptoms of Drugs as Guides in Determining the Dose.
“The very terms primary and secondary,” as illustrated by Hahnemann in the Fragmenta, Organon, and Materia Medica Pura, “seem to imply a succession of symptoms, more or less opposed in character, and all of them differing from the equilibrium of function which we recognize as health. The instances given, and, indeed, the only possible instances of which a “more” or “less,” or an “opposite.” may be predicated, as, for example, temperature, sleep, certain mental conditions, and the secretions and excretions generally.
Thus we may have an unnaturally prolonged sleep or wakefulness, gaiety or despondency, and a plus or minus of sweat, alvine discharge, urine, etc. But how could we have an opposite condition to any specified pain or subjective sensation, to parenchymatous deposit, cutaneous eruption, etc. The absence of these phenomena would be protanto a state of health; it would not be an opposed morbid condition or sensation.
The possibility, then, of classifying symptoms into primary and secondary on the basis of the relative nature of the symptoms, is not coextensive with symptomatology; it is partial, confined to a moderate number of conceivable morbid phenomena.
Shall we, then, in the second place, base the distinction on the element of time, and call the symptoms which first occur primary, and those which come later secondary? Where, then, shall we draw the line? How many hours or days shall we allow or the development of primary symptoms? In view of the immense difference in the rapidity with which the curriculum of action of different drugs is run, it is obvious that special rule must be established for each drug. Nor is this the only difficulty.
The results of different doses on the same provers, and of different doses or even the same dose on different provers, are so various, that, first, as Hahnemann intimates in the preface to the Fragmenta, the symptoms which appears in one prover to-day will not appear for several days in another prover; and, secondly; a very small dose may produce only one series of symptoms; a larger dose two series of opposed symptoms; a still larger dose two series differently opposed; and a very large dose again, only one series.
On looking over the register of symptoms of Argentum nitricum, we find reported as occurring early in the proving, irritation of the bladder and urethra, and increased frequency and quantity of urine, and as occurring later in the proving, diminution in frequency of micturition and in the quantity of urine. Surely, one might pronounce the former to be primary, and the latter secondary symptoms. But on examining the provers’ day- books, we find that the majority of the provers (being those who took large doses) report the former, and not the latter symptoms.
It was the prover who took the 30th who reported diminished urine, and he did not report any increase at any time. These symptoms, therefore, which appear in the register to be opposed, and properly distinguishable as primary and secondary, did not bear to each other any relation of opposition or correlation, as they might have done had they occurred in the same individual. They are different, unrelated, independent effects of different doses in different individuals.
Most of the provers o Tellurium taking the 3d trit. had, on the first and subsequent, days, symptoms of the general sensibility of sweat, of the skin, of the bladder, etc. But one prover who took the 4th trit, had no symptoms at all until the 14th or 15th day when cutaneous symptoms affecting the ear appeared, and were very persistent and troublesome. Were these symptoms secondary because they came later then other symptoms in other provers? And secondary to what?
How can John’s lumbago be secondary to James’s toothache? But during the second month this same prover, his ear symptoms having vanished, had symptoms referred to the dorsal spine. Were these secondary to the ear symptoms because they came later? Certainly as regards time they were secondary, because later; but being in nature wholly unrelated-neither opposite nor similar-they cannot be called secondary as regards nature nor as regards rank or value. Both have been repeatedly verified in practice.
Again, we are told that coldness-a condition corresponding to the chilly stage of fever-is the primary effect of Aconite, and that a state corresponding to the hot stage of fevers is the secondary effect of that drug. Let us hear Hahnemann. In the introduction to Aconite he says: “Aconite is one of a few drugs whose primary action consists in several alternating conditions of chill or coldness and head.” And now let us study the day- books of the Austrian provers of Aconite.
Rothausl took tincture of Aconite in doses regularly increasing from six drops daily to fifteen drops daily for nine days, when, feeling powerful effects, he ceases taking it and noted his symptoms.
From the second to the eighth day inclusive, he had the following constantly-recurring symptoms: restlessness at night, bad drams, unnatural heat of body, rawness and increased secretion in the larynx, cough, vertigo, headache. On the ninth day, after midnight, severe chill in paroxysms of shivering, starting from the precordia, lasting two hours, followed by burning, dry heat, with frequent, feverish pulse, and this was followed by moderate sweat.
For the next six days he had various troublesome symptoms affecting the chest and limbs, and on the sixteenth day of the proving he had again, at night, a febrile paroxysm consisting of chill, heat and sweat, the first less severe, the last more abundant, than on the ninth day.
On the seventeenth day, at night, a similar febrile paroxysm. Then for seven days symptoms of increasing severity in the head and chest, ending with haemoptysis on the nineteenth day, and finally, on the twenty-fourth day, a very severe and well-marked and defined neuralgic head and faceache.
How can the ingenuity of the most ambitions lawgiver find a pretext for dividing the symptoms (especially the febrile symptoms) of this excellent proving into primary and secondary? A febrile paroxysm occurred on the ninth, sixteenth and seventeenth days; before it and after it were well-marked symptoms of the chest and extremities. Which shall be primary and which secondary if date of occurrence determine the question? Which, if nature or if rank determine it?
Certainly, if lateness of occurrence stamps a symptom as secondary, then the neuralgic head and faceache-the very last symptom reported by Rothausl-must be classed as secondary. Not so fast, however! In the proving of Aconite by Zlatarovich with the second decimal, which he took in increasing and very large doses for seven days without effect, the very first symptom was a violent neuralgic head and faceache, almost identical with that described by Rothausl on his twenty-fourth day.
It appears, then, that Rothausl’s last symptoms was Zlatarovich’s first. If the time of occurrence determines the class,. we must rank Rothausl’s headache among the secondary and Zlatarovich’s identical headache among the primary, and thus we have the same symptom in each class, which is a reduction ad absurdum.
It will be noticed that these identical symptoms, produced at different times in different provers of Aconite, were produced by different doses. The opposite symptoms of Argentum nitricum in different provers resulted from different doses….
There are many drugs which, having certain constant characteristic symptoms, have also series of alternating symptoms relating chiefly to the secretions. Among them we may mention Veratrum album, which has “Thin stool passing unnoticed with flatus. Frequent liquid stools. Liquid stools unnoticed with flatus. Diarrhoea of acrid faeces, etc.” And also, “Constipation from thickness and hardness of faeces. A desire and compulsion to stool in the upper abdomen, and yet no stool or a very difficult one, as if from inactivity of the rectum or as if the rectum took no part in the peristaltic motion of the upper intestines.” Also Hahnemann quotes from Greding: “Diarrhoea, with copious sweat,” and “long-continued constipation”.
