Repetition of the Dose


Advice on Repetition of homeopathic medicine by Dr. Fortier Bernoville in his book WHAT WE MUST NOT DO IN HOMOEOPATHY….


Almost all homoeopaths have a tendency to prescribe for a long time the same remedy in spite of the amelioration obtained. We have tried much to fight against this habit. We may have to deal with an acute or a chronic case. We treat it for a given period and it is very difficult for us to tell the patient when he will begin to have amelioration. It is also necessary to lengthen the interval between the doses and to stop it totally when there is complete amelioration of the symptoms. Thus, if the patient is left alone to his own initiative he may either stop the remedy earlier before the amelioration has become manifest or he may fall in deep uncertainty. On the other hand we must also take care to consolidate the amelioration obtained. But it is necessary as Hahnemann has said, to decrease the frequency of doses as soon as their actions have become evident.

(This is a very delicate point in homoeopathic practice. As a rule we must stop repeating as soon as we have effect from the medicine applied. But how long should we wait for the desired effect? No rule can be laid down in answer to this question. On the one hand, the doctor is not sure whether his medicine is acting or not and on the other hand the patient becomes impatient because you cannot assure him when he is going to have amelioration. This is really a dilemma in homoeopathy. I venture to suggest a method, which I have seen very often useful during my long years of experience. (Repeat the dose in however high dilution it may be at short intervals until its action becomes apparent or give a high dilution and intercalate it with a lower one and stop the medicine as soon as its action is manifest and as long it continues to act. If the amelioration is not complete, repeat in the same way, R.M.)

Only homoeopaths who have very long experience, do not commit such errors (in repetition). We should also try to avoid a second error which will consist in stopping the medicine too soon. We must know to place ourselves on the borderline of these two dangers. To stop the medicine too soon is to cause the patient to fall back on his diseased condition. The first error is generally committed by very pusillanimous patients, while the second, which is generally done by the doctors, is to prescribe the same medicine for a very long time. In most of the patients this kind of continued prescription of the same medicine has practically no ill effects because their sensitiveness is of medium nature. But this kind of prescription has very great importance in hypersensitive patients who are rather exceptional. In such patients, the repetition of doses will cause in them not a stimulation but will bring an extreme depression resulting out of too frequent medicinal excitations. It is the question of rhythm In such cases we cannot fix well the rhythm which suit him. In such cases you may take the help of a method in order to check this medicinal excitation. It is to tell your patient not to take the medicine all the days of a week, to take it as for example for 5 days after an interval of seven, or not to take any medicine at all till the day of his next visit. In this way we may check the medicinal excitation; if not, we have the chance to fall in that extremely disagreeable situation which is as follows: The patient has begun his first prescription; he has great amelioration. He continues his medicines and telephones you that he is going much more worse. Then you change the medicine because you find new symptoms, but the patient goes from bad to worse. If you persist in your error, you give continually some new medicines till one day you stop all remedies and the patient feels immediately better.

Against this danger the Unicists and the adepts of Anglo- American school have found out a system which consists in giving their “Placebo” for “Saccharum Lactis” or “Inertia”. The patient knows not that what he is taking day after day contains no trace of medicine, that it is nothing but sugar of milk. The patient is not told that he is taking only sugar of milk to avoid all auto-suggestions. But in France we have not this habit.

In patients who are not very sensitive when the amelioration is very great and it can no more be increased, the continuation of the treatment does not ameliorate any more, neither it does any harm. The patient who continues the treatment will have no further benefit because he has reached the optimum, but at the same time there will not be any ill-effect. This is what happens at the end of a well-conducted treatment of a chronic disease. But from time to time we have to deal with hypersensitive patients. There hypersensitiveness is so intense that whatever medicine we may apply will cause an aggravation and they do not feel well until all medicines are stopped. Only then they are freed from all medicinal excitations. It is also possible that they may continue to feel well because some medicines taken previously may act at that time in a very delayed way.

We have already seen while speaking about the duration of the action of remedies that we should not repeat a medicine until the previous dose has ceased acting. The superiority of homoeopathy had been established from the very beginning by Hahnemann who had discovered that we are capable of knowing the duration of action of the medicines by diluting and dynamising it. We have thus an immense superiority over the official school. We can measure the duration of the action of our medicines. It is now up to us not to fall in an inverse error of becoming more of a homoeopath than Hahnemann himself and by repeating the medicines very often. We know that in a general way we apply lower dilutions, often in repeated doses in acute cases, while in chronic cases we use, while in chronic cases we use high dilutions repeating very rarely. Naturally it becomes a question of real technique, variable with each patient. We know also that in urgent cases, as for example a case of haemorrhage, we are authorised to repeat our medicines at an interval of five or even three minutes: e.g. China 6, in dangerous epistaxis, or Silicea or Naja in metrorrhagia should be repeated very frequently.

In acute case we know also that the 3rd and the 6th dilutions are applied every hour every two hours or every three hours. But let us remember always,.

1. That we must avoid repeating a medicine for a long time when the amelioration is apparent and consolidated. But let us also remember at the same time that we should not stop the medicine until the amelioration is really consolidated.

2. That we must avoid repeating a medicine until it has completed its action.

As the evolution is much more rapid in acute cases, the homoeopaths in general and the beginners in particular may commit the error of repeating the remedies too long a time. When you treat cases of whooping cough, measles, mumps or bronchitis, when the symptoms are yielding, the temperature is falling down, you will know well that the medicine is to be stopped. It is in chronic cases where amelioration is often insidious, when it is feared that the patient may fall back it is quite possible to make the error of continuing the prescription for a long time. MEDICINAL AGGRAVATION

A second important point is this: How to check the aggravation from the high dilutions?

All the medicines may be prescribed in high dilutions without danger but on the condition that we know how to administer them. The beginners in homoeopathy are according to their temperament divided into two groups: the audacious and the timorous. Fortune favours the audacious and they advance very soon but will meet many failures. Professor Marage, who was entrusted with some lectures in the University of Sorbonne, I think took of Homoeopathy though he did not believe in it because a Homoeopathy gave him Sulphur and an eczema appeared on his body. Chavanon took up Homoeopath because he bought a book by Chiron and was terribly aggravated as a consequence of taking different Homoeopathic medicines in frequent intervals.

Before knowing if it is necessary to check the aggravations, it is necessary to put to oneself the following questions: Is it really necessary to check them or not? They are some American and English homoeopaths who systematically look for aggravation. They are satisfied only when they get an aggravation while treating a chronic case.

In think that with the French temperament and character we cannot act in the same way with our patients. On the other I believe that the Latin people who react much sooner to remedies than Anglo-Saxons tolerate much less well the aggravations and are not at all made to note down regularly their symptoms. A Scotch and a Scandinavian will accept willingly to pass through a a phase of aggravation that may last long, as for example for the cure of a case of Asthma. A Frenchman will accept it rarely. It is always necessary to take into consideration the desire of the patients because it is they who know what will suit them. So far as we are concerned we follow the teachings of Dr. Nebel who has made researches throughout his practice in order to check the aggravation caused by the high dilutions and from him has generated the idea of applying the antidote to cause a drainage. DRAINAGE

You know that in the materia medica we have some short lists of remedies which are named as antidotes to some other medicines. In fact they are not the antidotes of medicines considered toxic. Nebel, by antidotes, understands that the medicines called antidotes are complementaries and satellites. Thus when Pulsatilla is indicated as antidote of Nux Vomica, it means that when Nux vomica will finish acting it is necessary to apply Pulsatilla. Therefore in the place of “Antidote” it is better to use the word “Satellite’ or “Complementary” and by so doing we will know to check the aggravation of such medicines called antidotes. In the way Nebel has come to drainage. He began to observe in tuberculous patients that the most indicated remedy aggravates and that aggravation may not be dangerous for a patient who resists well or who has become ill very recently, but it may be terrible in patients in whom cavities are already formed. His first research on drainage was carried out on the aggravation caused by Calcarea Carbonica in high dilutions. We have therefore, continued like him to try to check aggravation caused by the high dilutions.

We have several means to check the aggravation. The first means is that of Dr.Nebel, afterwards taken up by Dr. Chiron. Chiron systematically drains the patient during the first eight days i.e. to say he does not give high dilutions when he starts the treatment. He gives first of all some drops or some globules of a functional remedy (that which has an elective action on a particular organ). The medicine for the constitution is applied after a week.

The second process is applied by the Unicists themselves who always look for an aggravation. It is Doctoress M. Tyler of London who first used this method which has been taken up by Dr. Renaud in France. This process consists in fractioning the high dilution. Instead of giving 200th once, it is broken into 3 parts and is applied every hour, i.e. to say the complete dose is taken in two hours and in three times. It is a case of medical excitation. The medicine will cause diminution of its intensity by antidoting itself partially.

A third process is that which I practise myself. I have often noticed that when a medicine is applied for a long time before or after the meals it acts much more deeply but it may cause some aggravation if the patient is very very sensitive. Therefore apply a medicine in the middle of a meal in hypersensitive patients. They will manifestly have an amelioration. This process is used by the doctors of the thermal stations. At Vittel Evian and at Capvern, the water does not act well but when taken in the morning during fasting and people are quite astonished that the water also acts well when taken at table. It is because the water acts mildly when taken with meals.

Lastly the process of Dr. Cahis of Barcelona which consists in mixing of dilutions. This method is in my opinion remarkable and I must emphasise this method. When you have a medicine, which systematically causes aggravation, in such and such case, specially in very well characterised diseases, apply first of all a mixture of the high and a low dilution: Arsenicum M/6 (1M plus 6th). You will have at the same time a rapid action of the 6th and the intensity and prolonged action of 1M. This process should besides be applied according to a precise technique for each disease, because it adapts to the disease rather than to the patient.

I will tell you something of a fifth method which has also been indicated to us by Dr. Nebel. It is that the drainage remedies should be applied in high dilutions, specially in the beginning of the treatment of a chronic case. It is a proved fact that the application from the very beginning of a high dilution may cause very injurious and prolonged aggravation and a very delayed amelioration. The observation of a patient by the unicists are extremely instructive in this respect for us, because these cases give us the experience of the application of a single remedy. I have known a homoeopath who allowed a case of gonorrhoea to become chronic with increase of flow during a very prolonged treatment. But it is possible that the blennorrhagias treated during two years check a prostatic infection and some late aggravations which we do not relate to their real cause. To establish in a patient who has gonorrhoea a kind of sinus flow continued for two or three years may not be a bad thing for the general health as well as for avoiding the diseases of the late years, but we must not fall into an inverse error and we must be able to understand the inconveniencies of such a method.

TIME OF APPLICATION OF DOSES

We are now going to see the errors that we may make regarding the time of the application of doses.

Medicinal aggravations are very often caused by applying the doses at the wrong moment. The time of action of the remedy is extremely important and it is also sometimes very difficult to fix the proper time. He who knows the proper time of the application of medicines can get rapid results. In other cases, on the contrary, if the application is untimely, there are aggravations and the diseased condition of the patient is prolonged. Untimely application of doses is a common error as regards the hour, season, and in woman during menses.

The time of application of remedies and the application of remedies in proper time as regards the menses in woman are very easy to fix. We know very clearly the time when some medicines aggravate which indicates to us precisely the hour of drainage. For functional remedies it is better to apply them one or two hours before the time of aggravation. As for example, we know that in homoeopathy all the hepatobiliary medicines have an aggravation from 4 to 8 P.M., with a summum towards 5 to 6 P.M. This is true for Lycopodium, Chelidonium, Sepia. Pulsatilla, Myrica, China, Chionanthus. This rule is also applicable to Ricinus Communis. Apply the medicine at 4 P.M. at the end of the stomach digestion and you will have an amelioration. Ricinus Communis, in the case of cholecystitis acts towards 4 P.M., if the patient has taken his meal between noon and 1 O’clock. This is the moment of the elimination of urea in the urine which is very important. If you establish a curve of that elimination you will find that the maximum is towards 5 P.M. This is what explains the aggravation of Lycopodium.

For China this is not always true. This remedy often acts better when it is given in the evening because it has an aggravation between 2 to 5 P.M., in children when they wake up in the morning. The aggravation of Natrum muriaticum and Gelsemium is due to the solar influence. The patients suitable to these medicines have an aggravation during the day. The solar activity is the greatest between 10 A.M. and 3 P.M. If you make a graph you will find that from 10 A.M. to 12 noon the solar influence is at its highest. Natrum muriaticum and Gelsemium, of which the symptoms follow the solar activity, are to be applied during that time. There are other remedies, that have aggravation before storm. As for example Rhododendron and Phosphorus. These medicines are to be applied before the storm. Sometimes they are also applied earlier when great heat precedes storm. If you apply them during the storm, during the fall of the barometer, they will not act very well. Fergie-Woods of London has shown that the barometer on the one hand and the season on the other give very valuable indications about the marked action of a remedy specially in children. He said that the month of June is the month of Sulphur, whereas the month of Phosphorus is July. These remedies of “Burning” are really useful at a time when the days are the longest during the year.

For seasonal aggravations we have two medicines: Lachesis and Natrum sulphuricum. The same rule is to be followed here. Do not be too late or too early to apply these medicines. Apply 15 days before their seasonal aggravation. An asthmatic or rheumatic who has terrible aggravation of his disease each year in the month of March, must begin his treatment from the beginning of February. A hay fever should not be treated from the 15th March when the patient has already his attack of the disease. He should be treated from the month of January with Lachesis, Allium, Sabadilla etc.

This rule is also very true for the Tuberculines. Very often asthmatic and rheumatic aggravation may be checked down by diluted tuberculines specially by T.R. and also by Lachesis when there is aggravation in extreme conditions, in great cold or in great heat.

In amenorrhoea and in hypermenorrhoea, Sulphur, Graphites, Pulsatilla, Kali carbonica form the quarto of remedies. Apply high dilution of Sulphur 8 or 10 days before the period. If you apply it at a time nearer to the period it will not bring back the menses which is delayed.

For the sea-sickness the same rule applies : Cocculus, Tabacum, Ignatia, are the three medicines given 4 days before embarkation. If you apply it on board the result will be nil or insignificant, Generally Ignatia 1M, is to be applied 4 days before embarkation and it should be repeated after 8 days if the crossing is very long. In very troublesome cases, apply Cocculus or Tabacum 30. once a day on board the ship also. I have got some beautiful results in sailors who were suffering for 10 or 12 years from sea-sickness. One never becomes habituated to this disease. It is according to one’s temperament that one suffers or does not suffer from sea-sickness.

In dangerous hypermenorrhoea or metrorrhagia, apply the ground remedies 7 or 8 days before the possible date.

In simple cases of hypermenorrhoea, apply only in the beginning of the menses. When it is the question of a case where there is ground for fear of a strong action or the stoppage of the flow apply it only towards the 4th day. There are some women for whom every thing is normal up to the 3rd or 4th day, but who from the 5th day begin to be haemorrhagic. They are types of Pulsatilla. In such cases you can apply China, and Arnica, which will give you good results. The question of time in menstrual disorders is very important.

Mauritius Fortier-Bernoville
Mauritius (Maurice) Fortier Bernoville 1896 – 1939 MD was a French orthodox physician who converted to homeopathy to become the Chief editor of L’Homeopathie Moderne (founded in 1932; ceased publication in 1940), one of the founders of the Laboratoire Homeopathiques Modernes, and the founder of the Institut National Homeopathique Francais.

Bernoville was a major lecturer in homeopathy, and he was active in Liga Medicorum Homeopathica Internationalis, and a founder of the le Syndicat national des médecins homœopathes français in 1932, and a member of the French Society of Homeopathy, and the Society of Homeopathy in the Rhone.

Fortier-Bernoville wrote several books, including Une etude sur Phosphorus (1930), L'Homoeopathie en Medecine Infantile (1931), his best known Comment guerir par l'Homoeopathie (1929, 1937), and an interesting work on iridology, Introduction a l'etude de l'Iridologie (1932).

With Louis-Alcime Rousseau, he wrote several booklets, including Diseases of Respiratory and Digestive Systems of Children, Diabetes Mellitus, Chronic Rheumatism, treatment of hay fever (1929), The importance of chemistry and toxicology in the indications of Phosphorus (1931), and Homeopathic Medicine for Children (1931). He also wrote several short pamphlets, including What We Must Not Do in Homoeopathy, which discusses the logistics of drainage and how to avoid aggravations.

He was an opponent of Kentian homeopathy and a proponent of drainage and artificial phylectenular autotherapy as well.