When, in the February and April numbers of this Review, Vol. III, 1863, we published Dr. J. R. Coxe's article on Alternation, and our own modest objections to what we regarded as unsound argument and inaccurate statement on the part of Dr. Coxe - we had no idea that we were entering upon the discussion of a question about the terms of which there could be any chance for a misunderstanding. Subsequent publications, from various quarters, have shown that all practitioners do not understand the same thing by the word alternation, as applied to the mode of prescribing homoeopathic remedies. We think we shall be able to show that the practice which some writers defend, under the name of alternation, is not properly called by that name. But, before entering upon the subject itself, we desire to make, once for all, two statements of general principles by which we are governed not only in the treatment of this question but of all questions that concern the practice of medicine; premising that we utterly disclaim any disposition to dogmatize or to speak as with authority on any question of medical practice. If the earnestness of conviction should betray us into too positive warmth of language, this is our misfortune; and none can disapprove it more decidedly than we regret it.
1. The business of the physician is to cure his patient; this is the great practical object of his labor. We believe that nature is not always restricted to a single path - and that while some cases are so severe that there is but one way in which it is possible to cure them, there are often several ways in which it may be possible to effect the cure of some other case; each way having more or less of inconvenience attaching to it and of detriment resulting from it, in proportion as it differs, more or less widely, from the best way. Thus, we believe that Allopathy, with her heroic Antiphlogistics, her Revulsives (borrowed from the “circumlocution office”) and, still more frequently, with her blind and blundering misuse of specifics does sometimes “cure” her cases; but this is not the kind of cure that should satisfy the physician's desires. It is neither safe, inasmuch as it is debilitating in itself and is likely to involve damaging sequelae; nor rapid; nor pleasant. Thus, likewise, we know that Homoeopathists who mix medicines, whether in the tumbler or in the patient's stomach (conglomerators or alternators), do often “cure” their patients. These cures, if our observations be correct, are neither so rapid nor so pleasant (free from sequelae) as cures might be; and we are confident that by these methods not nearly so large a proportion of the sick may be cured as by adherence to the simple, single remedy. Still, we admit that when a physician has cured a patient, by whatever method, he has, in so far as that patient is concerned, done the chief part of his duty. Though his method were not the best of known methods, he is not to be blamed without qualification.
As one to whom have been confided the interests of that individual patient, he may justly rejoice in the cure; but do his functions cease here? By no means. He is a man of science, to whose care are to be entrusted, every day of his active professional life, case after case of disease which he is to bend his energies to cure. What is it to be a man of science? It is to be one whose mind is stored with an array of facts carefully observed by others as well as by himself, and methodically arranged, in such wise that principles have been and may be correctly inferred from them — principles by virtue of which new observations may be arranged along with these facts - principles by the aid of which the facts which will result from operations observed to be in progress, or intentionally put into activity, may he accurately predicted, and, conversely, may be produced at pleasure.
Such is the scientific physician. Let us note the difference between the action of his mind and that of the patient, after a cure of the latter has been accomplished by the former. The patient says to himself, “I was sick and now I am well. I will pay my doctor and then, to my work again!” This is all his sickness is to the patient.
2. “When I gave Bryonia alone and Sepia alone, though each seemed to correspond pretty well, still the patient did not get much better. But when the happy thought of alternating them occurred to me, and I did it, she recovered. From this I shall learn that two remedies, each of which corresponds to part of a case, may cure the case if given in alternation, when neither, if given singly, would cure it;” or,
3. “A year ago I should have given, for such an angina as this, Belladonna and Mercurius in alternation, as Rummel recommends, and the patient would probably have gotten well in two or three days and I should have been satisfied; but since I have studied Lachesis, I find that remedy covers the whole case much better than Belladonna and Mercurius would do; and lo! he is well in twelve hours. From this, I learn to shun, more earnestly than ever, those expedients which, like alternation, are borrowed from the polypharmacy of the old school and which, being opposed to sound principle, must be inferior in their results to some better way which accords with sound principles and which way I shall be most likely to find out if I make my practice follow principle. This case, then, gives me fresh zeal in my study of Materia Medica;” or,
4. “This case cost me much study. I saw that the symptoms of the abdomen and digestive canal as well as those of the lumbar region and of the hip and thigh and the general conditions of aggravation and amelioration corresponded admirably to Colocynth, but then, the patient had, in addition, an enlarged ovary (from which, possibly in some way, the other symptoms sprang), and I had never heard of Colocynth in connection with enlarged ovary. I might therefore, have been tempted to alternate Colocynth with some remedy which is known to have cured and perhaps produced enlarged ovary, such as Lachesis, Apis, Graphites, Lycopodium, Staphysagria, etc. - but for my aversion to disregard what seems to me the well-established principle that maladies are not local affections, but general, pervading the entire organism - that the individual man is, not an aggregation of independent monads, each of which may be ill or get well “on its own hook,” without its neighbor being thereby jostled, and against which may be discharged a corresponding load of medicinal monads each of which will find its own particular target without hitting any other - not this, but an individual being, whose functions and tissues are so intimately connected, that, “if one member suffers, all the members suffer;” and conversely, if we get the key to the malady by finding the characteristic symptoms which will point us to the true remedy, we shall cure the entire suffering, to whatever member we may address ourselves. In this faith, regarding the characteristic symptoms as calling unmistakably for Colocynth, (there was nothing characteristic of any remedy in the ovarian symptoms; the ovary was enlarged, that was all,) I gave that remedy. And now, while in a few days, the other symptoms which plainly called for Colocynth disappeared (permanently, as the event proved), in the space of two months the ovarian tumor had likewise disappeared, and the patient who had been confined for six years to her room and couch, could now walk, drive, and go about the house as well as ever. [See in a future number “Observations on Colocynth.”] From this I learn the unity of disease, and by this I am strengthened in my belief that adherence to well settled principles will, in the end, carry one farther and faster, even over dark and uncertain ways, than any makeshift and irrational expedient would be likely to do;” or,
6. “In this case of dysmenorrhea the symptoms of the head and eyes are very characteristic of Cycl. But, surely, the menstrual symptoms are too important to be overlooked in this case, and the remedy must correspond to these symptoms in order to cover the case. I looked for the symptoms of Cyclamen on the female sexual organs and, lo! none are recorded in the Materia Medica Pura. It seems that there was not a woman among the early provers of Cyclamen. What was to be done? The menstrual symptoms corresponded pretty well with those of Pulsatilla, though the head and eye symptoms did not correspond. Should I alternate Cyclamen and Pulsatilla which jointly cover the case? I should have high authority for such a course! But, I reflect, that the same kind of a human organism which, under some disease-producing influence, experiences, at one and the same time, the amenorrhoea and the head and eye symptoms of my patients - the same kind of human organism, I say, experienced also, when proving Cyclamen, head and eye symptoms exactly like those of my patient. Is it not fair to presume that, if this disease-producing cause and the specific properties of Cyclamen are so nearly alike as to produce identical symptoms in the head and eyes, they would have produced identical symptoms, likewise, in the female sexual organs, had the prover of Cyclamen been a woman? So strongly did probabilities seem to me to favor this presumption that, regarding alternation as an unsound and irrational expedient, I was about to take the risk of giving Cyclamen alone on the strength of this anticipated result of some future proving by a woman, when, chancing to meet with the new Austrian proving of Cyclam., I found that provings by women are there recorded which confirmed my presumption in every particular. The case recovering speedily under Cyclamen, I learn from it that in many cases we are tempted to alternate, because we cannot cover every feature of the case with either of the remedies which we think of alternating. But, in some of these cases, the symptoms which are really characteristic are fully met by one of these remedies and there is ground for assuming, as clinical records show, that subsequent and more extended provings will demonstrate to us that this remedy, if fully proved, would really cover the entire case, characteristics and all. This experience fortifies me against a temptation to alternate and leads me to rely more confidently on the indications furnished by characteristic symptoms.”
If we review these cases and analyze the operations of the physician's mind, we shall see that, in number one, he confesses that he has been the “accident of an accident,” and he invokes his “good luck” to stand him in stead again. He does not exercise his reasoning faculties at all. Let him pass.
In the other cases, there is, besides a thanksgiving for success, an effort of the mind to arrange the facts which the case presents in order, along with some other facts already stored there and to infer from the aggregate store of facts, some principle or plan of action which may be profitably brought to bear on some future case. It is thus and only thus that “experience teaches.“For, since no two cases are ever met with that are in every respect precisely alike, the experience acquired in treating one case can never be available in treating another, except through the intermediate application of the reasoning powers. We hear and observe facts, collect and arrange them, analyze and reflect upon them, induce principles from them, and prepare ourselves to make practical application of these principles when a new case shall call for it.
Now, what is this but theorizing? When we analyze a case in such a way as to suggest to our minds its proper mode or course of action, or to infer from it any principle that might help us in a future case, we form a “theory.” We cannot think, indeed, about collecting facts without theorizing.
Yet the defenders of alternation invite us simply “to look and see,” to “establish facts. These, once fixed, any theory which will perfectly account for them is good.” These are Dr. Hawley's words (American Homoeopathic Review, Vol. V, p. 338). And the London Homoeopathic Review, Vol. IX, p. 432, quotes Dr. Hawley's words approvingly: “The homoeopathic system of medicine,” * * says Dr. Hawley, “bases itself, not on theories but on facts as they are observed in the world of man. It frees its disciples from all dogmas and simply asks them to look and see.” Well, being thus invited, we “look and see.” What do we see? Why we see Dr. Hawley giving Bryonia and Sepia in alternation in one chronic case and Arsenic and China in another case, and curing both in a way which satisfies him well. This is what we see. But what does Dr. Hawley see when he looks at these same facts? Why he sees something which proves to him that “for him, the use of remedies in alternation is better than the use of a single remedy.” And the London, Review sees in the same facts something” which proved to him (Dr. Hawley) that the alternation of medicines is not only admissible, but that cases now and then occur which Can Only Be Cured By Such Alternation.”
Is not this “theorizing” pretty strongly and on a rather slender basis? Our friends warn us against “theory” and yet, from two facts, Dr. Hawley concludes that, “for him, the use of remedies in alternation is better than the use of a single remedy.” From the same two facts the London Review makes Dr. Hawley conclude that “cases now and then occur, which Can Only Be Cured by Such Alternation.” This is a broad generalization on a very narrow foundation. But Dr. Hawley admonishes us that “we have not yet any such collection of facts as will warrant any generalization.”
For ourselves, we should not feel justified in drawing, any such conclusions as these from Dr, Hawley's cases or from any of the cases already narrated, cured by alternation. When adduced in evidence, we accept them as facts and give them what we consider to be their full value. They prove to us that cases may be cured by alternated remedies, but they prove no more than that. They prove that two remedies in alternation cured a case which neither of those two remedies singly had cured. Beyond this they prove nothing. Assuredly they do not prove that a physician could not have cured each case more quickly with some other remedy, given singly. How could such evidence be held by us to justify such conclusions as Dr. Hawley and his reviewer draw from it, when our daily experience furnishes case after case which had been treated ineffectually by physicians who always alternate and which yields promptly to the single remedy. Evidence of this kind whether For or Against alternation, will not settle this question.
These remarks, extended as they are, have been made for the purpose of showing that clinical experience is available as a means of improvement in medical practice only in so far as it is analyzed, thought about and in fact “theorized” about; that those who deprecate dogmatism and would put off the formation of generalizations, do, themselves, dogmatize and theorize and from the nature of the case they must do so in the act of reasoning about the evidence they bring forward.
If this be inevitable, then, it must be allowed us likewise to theorize and in what we have to say about alternation we shall hold ourselves justified in basing our arguments on generalizations from a multitude of collated facts. We hold that the argument from theory is in order. And regarding a Science as being a connected and independent series of generalizations based on an analysis of methodically arranged and collated facts, we require the advocates of alternation to rest their cause, as we do our opposition to alternation, on such a generalization. Failing to do this, they have no claim for their method as a part of the Science of Therapeutics. Failing this, the facts which seem to justify alternation can be used in no other way than in the blind, empirical way of literal imitation, in which accuracy and certainty are quite out of the question. But our whole object in study and labor, beyond the direct need of our patients, is to complete the structure of our science, such as we have defined a Science to be, a means of attaining accuracy and certainty.
Some of the advocates of alternation have failed to perceive the necessity of raising their procedures to the level of a scientific method. They still rest on the rude empirical ground of unmethodized experience. Their argument is: “I have alternated remedies which, singly, had failed and I cured. Henceforth I shall alternate.” Or, as the London Review varies the argument (9, 432), “The practice of alternation of remedies is one so widely adopted that it would appear to have the sanction of very extended practical experience.* * Experience has proved abundantly that the alternation of remedies increases the rapidity of the cure,” etc. The same argument was used by Dr. Coxe (American Homoeopathic Review, III. 359) who claims to have alternated for twenty-five years, and to have been successful. As we have before remarked, the same argument may be used by Allopathists, and by the advocates of every form of practice, whether pure, mixed or wholly vicious. The same argument may be, and is, advanced by those who oppose alternation.
Others, however, have seen the necessity of basing their advocacy of alternation on some general principles, among them particularly Dr. Drysdale, (Annals of British Homoeopathic Society) and Dr. Coe (The American Homoeopathic Review, Vol. V. April, 1865) and to these statements of principles we wish to devote some attention.
1. Dr. J. R. Coxe (loc. cit.) seemed to think that the opponents of alternation contend that each case of sickness should be treated with one single remedy, and that, if during an illness a change in the symptoms should compel a change in the remedy, this, by whatever name it be called, is, in fact, alternation. He scouts the idea of any real distinction between alternation and succession of remedies. Well, if this be all that alternation means, we have no reason to oppose it. But, what is a case of disease in this sense? Does it comprise all that may ail a man from the time that he takes to his bed, to the time that he goes to his work again? Suppose a patient sick of dysentery and recovering finely under the single remedy Mercurius cor. When just convalescent, he is seized with rheumatism and requires Rhus tox. Is it “alternating” to give it to him? And then, suppose him safely over rheumatism; but just before he goes to work again, he has a return of dysentery, requiring Mercurius cor. Is it “alternating” to give it, if the symptoms require it? And if, when cured of this relapse, he gets the measles and Requires Euphrasia, is it “alternating” again to give him this remedy? Why, according to this definition, if you call this all one sickness, it has been a case of alternation. If you call it four sicknesses, perhaps not. To the patient, certainly, it is “all one,” whatever you call it! Now, suppose the symptoms in a case to have changed just as decidedly as in the case supposed above, but yet not so definitely as to induce you to give to the changes these nosological names of dysentery, rheumatism and measles. The medicines, Mercurius, Rhus and Euphrasia will have been just as clearly indicated by these successive changes and just as imperatively required as though the patient were regarded as having had four successive diseases. Is it “alternation” to give these remedies successively just as they become clearly indicated? We think it is not, but some say it is. We are sure it is sound practice.
2. Dr. Quin, of London, (Annual Address, Annals of British, Homoeopathic Society) calls the method of prescribing successive remedies in a case as the changes of symptoms may require them: “alternation a posteriori” and sanctions and defends it. But he reprobates, under the name of “alternation. a priori” the practice which, it seems to us, is the only one which can properly be called “alternation” viz.:
“Prescribing at the very outset of the treatment - at the very first visit and also, not unfrequently, almost at every subsequent visit, two or more medicines, to be alternated every quarter, half hour, or every two, three or four hours. It is difficult to believe” he coutiuues, “that such practitioners are in the habit of carefully considering the cases under treatment, or have well studied their Materia Medica or to divest oneself of the idea that they resort to such slipshod practice in the hope that if one of the medicines does not hit off the complaint, some one of the others may. One meets with instructions for similar alternation laid down in popular books on Homoeopathy, showing that this a priori style of alternating remedies is, with certain practitioners, more a rule than an exception.”
3. Dr. Drysdale defines alternation to be “the giving a second medicine while the sphere of action of the first is still unexhausted.“But Dr. Drysdale, while advocating alternation, in this sense, in certain specified cases, does not propose to give his second medicine except after a careful re-examination of the symptoms of the patient and a comparison of them with the Materia Medica. It is clear, then, that alternation as he defines and defends it, is not the same thing as the alternation a priori which Dr. Quin reprobates and to which we would restrict the term. Dr. Drysdale's definition seems to us very vague and impracticable. How are we to know when the sphere of action of the medicine is exhausted? By inferences from the proving? But we have reason to believe that the speed at which vital processes go on in sickness may be very different from that during a physiological proving. Reduced to a practical rule, Dr. Drysdale's reasoning would amount to this: If, on our second visit, symptoms shall be found to have arisen which seem to call for the second medicine, we should suspend the first and give the second, and then, if, at the third visit, the symptoms be found to have changed again, .so as to call again for the first medicine, we should give it. But this, he says, is ”alternation.“With certain qualifications we agree to his rule of practice, but we object to the name he gives it. And here names are important. It is of great consequence to avoid giving to two radically different procedures, one and the same name.
- We object to these, and to all kindred procedures, that they rest on hypotheses which are not warranted by the present possibilities of science. Dr. John Doe's first prescription of Aconite may be all right; the symptoms probably call for it. But the physician cannot know in advance that, in four hours, the symptoms will have so changed that, if he were present, he would perceive Belladonna to be indicated; and that, in four hours later, Aconite will be indicated again; and that the symptoms will go on, oscillating between these two series of indications, each oscillation consuming just four hours.
And “Dr. Busy,” by what wonderful gift could he foresee that seven days of Mercurius hydr. would bring his patient to a state requiring Sulphur, and seven days of Sulphur to a state requiring Collinsonia (whatever that state may be), and seven days of Collinsonia to a state calling for Podophyllum (and for just seven days of it too), and seven days of Podophyllum to a state of complex misery that calls for China and Ignatia in alternation (for just seven days likewise) and so on to the end of this long chapter!
These instances, and the comments upon them, comprise our definition of “alternation,” and our objection to it. It is a practice very prevalent in the United States and in England. It is exceptional in Germany, France, Spain and Italy.
The great law, Similia Similibus Curentur, teaches us to select a remedy the characteristic pathogenetic symptoms of which are very similar to those of the patient. This is a grand generalization, supported by a multitude of facts. We accept it. It takes no heed of names of diseases, nor of pathological theories of the seat and origin of diseases. Giving a broad and liberal signification to the word “symptom” so as to include everything abnormal about the patient, whether it be historical or actual, this law pays regard to the symptoms alone. It requires that the symptoms shall be collected and compared with the Materia Medica every time a prescription is made, and that the drug that has produced symptoms most similar to those of the patient shall be chosen and given. This is a true homoeopathic prescription. No matter how often during the sickness of a patient this process be repeated; no matter how many remedies be given in succession; no matter if the first remedy be recurred to after the second and the second after the first - if each prescription have been the fruit of a special collection of symptoms and comparison of them with the Materia Medica - call it ”alternation,” or by whatever other wrong name you please, it is a sound and defensible homoeopathic prescription, such as Hahnemann taught and practised and his followers adopted.
But the physician sometimes leaves a second remedy to be substituted for the first under certain specified contingencies. Is this alternation? By no means. In so doing, he makes the attendant his deputy, and describes the series of symptoms which, in his judgment, will be an indication that another remedy is required. He is merely instructing and empowering another person to make, in his stead, the study and selection of a remedy which should precede and be the basis of every new prescription.
And wherever, in his writings, Hahnemann has seemed to authorize or sanction alternation, his directions have been of this character. He has mentioned that a certain group of remedies is likely to be indicated in a certain disease, and although he has sometimes used the word ” alternate” (abwechseln), yet, in every case, he has specified the particular symptoms, or groups of symptoms, which would specially indicate and authorize the preference to be given to one, or another remedy of these groups.
In this Review, (April 1863,) we showed this to be true of Hahnemann's direction for the use of Spongia, Hepar and Aconite in croup, and also for Bryonia and Rhus in typhoid fever. The same is true of his directions touching cholera.
The London Homoeopathic Review (9, 432) says, “Those who combat 'Alternation' on the ground that it is opposed to the practice of Hahnemann, fall into a grave error.” In the introduction to Belladonna in his Materia Medica Pura, he advises the alternation of Aconite and Coffea cruda in purple rash, in these words: “Aconite and Coffea should be alternately given every twelve, sixteen or twenty-four hours, in proportion as one or other remedy is indicated.”
It is true that the above words are contained in the introduction to Belladonna, but they are not all the words contained in the sentence from which they are quoted. This sentence, complete, is as follows: “there (in the purple rash) Belladonna, naturally, does no good, and the other, common, charlatan treatment must also allow the most of the patients to die of it, whereas they might all be cured by the alternate use of Aconite and of the tincture of Coffea cruda, the former for the heat and the increasing restlessness and agonizing anxiety, the latter for over-excessive pains with a lachrymose humor; the Aconite in the 30th dilution of the juice and the tincture of Coffea cruda in the 3rd dilution, both in the dose of the smallest part of a drop, the one or the other every twelve, sixteen or twenty-four hours, according as the one or the other is indicated.“The two groups of symptoms which Hahnemann gives as indications, respectively, for the one or the other of these remedies, are omitted by the London Review. They are the essence of the whole matter. Following this advice of Hahnemann, it would not be possible for the practitioner on meeting a case of purple rash to begin with a blind a priori alternation of Aconite and Coffea. On the contrary, as we understand Hahnemann's direction, he should examine his case to see whether it presented the groups of symptoms “heat, increasing restlessness and agonizing anxiety,” in which case he would give Aconite; or whether the characteristics of the case were “over-excessive pains with a lachrymose humor,” in which case he would give Coffea. Suppose at his next visit, twelve, sixteen or twenty-four hours after, he should find, as might well happen, that the group of symptoms first observed had disappeared and had given place to the other group, he would, for this reason, change his remedy. Or, if he lived at a distance from the patient, he might make the nurse his deputy, and, instructing this deputy as to the distinction between the groups of symptoms, might direct her (as Hahnemann has directed us) to make changes in the remedies when corresponding changes in the symptoms should call for them. In this way there would be no assumption and no a priori “alternation.” The practice would be sound, fulfilling the conditions of a sound prescription, viz.: that each prescription be preceded by a fresh collection of the symptoms of the case and comparison of them with the Materia Medica.
Is it suggested that Hahnemann meant to intimate that these groups of symptoms might coexist in the patient at the same time and might make a “totality of symptoms” that would require these two remedies to cover it? But these groups are pathologically incompatible. No one conversant with the phenomena of sickness could conceive of a patient presenting, at one and the same time, “heat, increasing restlessness and agonizing anxiety,” and likewise over-sensibility to pain and a disposition to Weep and despond. No! patients in a waxing fever often swear; but they seldom pine and weep; they feel general anguish but make light of specific pains. But when the fever has waned, there often succeeds it a stage of over-sensibility and of proneness to weep; and this succession may be repeated again and again, and we suppose Hahnemann recommended these remedies to correspond to this succession. We cannot comprehend his words in the sense attached to them by the London Review. In the signification in which we have understood them, they correspond precisely to all of his other directions which have been quoted as favoring “alternation.”
But, now, suppose it conceded that, while Hahnemann's practical deductions from scientific principles were opposed to “alternation,” his practice sanctioned it. Is the argument from his practice all powerful against his principles? This reminds us of what the Chairman of the British Society calls Dr. Drysdale's” Socratic irony 'you all object to alternation, and, yet, you all alternate.'” We have seen that Dr. Drysdale's definition of alternation is such as to cover almost every actual case of treatment and is different from that of every other writer. But, the argument from the universality of a practice, in favor of its propriety, is a dangerous one to play with. Place it in the mouth of a theologian and see how it reads: You all condemn sin, and yet, you are all sinners! ”
Does the weight of this argument lie on the side of sin or on the side of the condemnation of sin! Does propriety necessarily follow from universality? Are the majority always right, just because they are the majority? If so, all hail, Allopathy!
The conditions of a true and defensible homoeopathic prescription require, in our opinion, that the symptoms of the patient, at the time of prescribing, shall be collected and compared with the provings in the Materia Medica, and that the drug whose symptoms correspond most closely with those of the patient shall be selected. Perhaps no Homoeopathician would object to this statement. But let us see what it requires.
First. It requires that before every prescription, the symptoms of the patient shall be studied anew. In some way or other, whether it be done by the physician or by a provisional deputy specially instructed for the case (as we have explained that the nurse may be), more or less perfectly, this must be done. We have seen that in the ordinary method of alternation (apriori) this is not attempted to be done and cannot be done: it is not proposed to do it.
Second. It requires that the aggregate of the symptoms Presented; by the patient be regarded as one malady, for which an analogue is to be found in the Materia Medica. We have no authority in science for arbitrarily dividing this aggregate of symptoms into groups, for each of which we are to find an analogue in the Materia Medica, and then giving these analogues, in combination, or in alternation. This requirement is perhaps the most difficult of all to fulfill. In collecting the symptoms, our utmost sharpness of insight and our deepest and most extensive learning in every department of physiological, psychological and pathological science will be talked to construct, from the patient's history and from his present condition, a complete picture of the morbid phenomena which he presents, from which the physiological idiosyncracies of his peculiar temperament and personality shall all have been eliminated, and in which his symptoms shall be duly arranged with regard to their mutual relations and dependencies. Then, furthermore, inasmuch as we cannot hope to find, in the proving of any drug, a duplicate symptom for every symptom of the patient, the rarest judgment and most extensive knowledge of semeiology are required to analyse the patient's symptoms and to detect those which are truly characteristic of that individual case, and for which an analogue must be found in the proving; and to set these characteristics apart from the other symptoms, the analogue of which it may be less imperatively necessary to discover. It is here, undoubtedly, that the greatest knowledge and ability are required of the physician and here that failures are most frequently made. It is, probably, from failures in this analysis of symptoms that the supposed necessity of alternation most frequently arises.
Third. It requires that a drug shall be selected which has produced, on the healthy subject, symptoms very similar to those of the patient. The substance given must have been proved in the same form (not necessarily the same dose) as that in which it is proposed to be given. If Hepar sulph. calcareum correspond to the case, this requirement is, by no means, fulfilled if' we give Sulphur and Calcarea carb. combined or alternated, on the ground that these substances are the constituents of Hepar sulph. calcareum. For, this involves the assumption that the Sulphur and the Calc. carb. have undergone no changes during the process which made, out of them, that third substance - Hepar sulph. No! Hepar sulph. was proved as such. If we select it, for the reason that the symptoms which it produced correspond to those of the patient, then we must give Hepar sulph., the very substance that was proved. Otherwise we plunge into a sea of speculation and hypothesis and forfeit that certainty which it was the sole object of our science (as of every science) to attain. In like manner, if the Iodide of Mercury had been proved on the healthy subject and its symptoms were most similar to those of our patient, it would not be a compliance with the demands of our science should we give, instead of Iodide of Mercury the very substance that produced these symptoms, the Mercurius vivus and the tincture of Iodine, assuming that, because Iodide of mercury is a compound of these two substances, therefore the conjoined or alternate action of the elements from whose union it sprang, must be identical with its own. From instances like these, it is clearly to be seen that we may not, consistently with the principles of our science, prescribe drugs in any other form or combination, than that in which they were proved. If drugs had been proved in alternation, we might then with propriety, perhaps, prescribe them in alternation. Until this is done, the method is a hap-hazard, chance operation - successful, no doubt, at times - but in such a way that success could never be foreseen or ensured, nor could the experience of the practitioner in any way serve to establish or confirm any principle of medical science.
A homoeopathic prescription, as we have defined it, is a deduction from a generalization, which has been established by induction from a multitude of instances. This is the law Similia Similibus Curentur, in accordance with which the remedy is selected, under the three requirements that we have specified. So well established is this law of nature, that if we are so fortunate as to be able, in any given case of disease, to comply closely with those requirements, and particularly with the second, we may with certainty predict, and in confidence await, the favorable result of our prescriptions. Such certainty of foresight and such confidence it is our great object to attain, and nothing but a scientific method can afford them.
But we have shown that alternation, as we use the term, and as we have described the process, is incompatible with this scientific method. It does not meet the requirements of the law. It does not take the aggregate of the symptoms as the single basis of prescription. It does not give the remedy, single and simple, such as it was used in the proving. But it permits itself to act on two assumptions - that the aggregate gate of the symptoms may be arbitrarily divided and separately prescribed for; and that two or more drugs which have been proved independently of each other may be used conjointly as a sort of composite analogue to the aggregate of the symptoms; and all this with equally good and sure results. These two assumptions are not even alleged to be based on any collection of facts. Their introduction deprives the proceeding of all claim to a strictly scientific process.
The advocates and defenders of alternation are naturally divided into two classes. The one frankly disavow any pretension that alternation is a scientific deduction from a general principle, and defend it on the simple ground of experience. They have alternated successfully in a case or cases like the present, and therefore they do it again.
Now, obviously, with this class we cannot discuss the question on scientific grounds. There is no reason in their method, because there is, in it, no reference to general principle, to natural laws: it gives no means of foreseeing and providing for future results; it is the simplest form of literal empiricism. We can do nothing more than show, as has been done, its unreasonableness and the precarious and contradictory and disappointing character of its results. We can only point out how far it falls below the standard of action to which practitioners of medicine should hold themselves, and how unworthy, in our judgment, such methods are, of reasoning and conscientious men.
The second class accept our definition of the requirements of a sound prescription, and our statement of the obligation of scientific men to abide by natural laws. But they claim that alternation does not necessarily, as we have maintained, contravene the requirements of such a prescription: and they claim that there are certain established principles in accordance with which we may, with scientific accuracy, determine when and how to alternate. This class defend alternation “on principle.“As the former class comprises some of our most conscientious and estimable colleagues, so does the latter embrace many of the most gifted and learned of our school. Their opinions are worthy of the most earnest and respectful consideration.
We have, in our last number, stated that some who defend alternation on principle designate by that name methods which, we think, ought not to be so-called, and which we do not find fault with; as, for example, Dr. Coxe; likewise Dr. Drysdale, in so far as his definition is concerned. Their methods do not always, of necessity, conflict with the requirements of a sound prescription. There are still other procedures, called “alternation,” but which are not always necessarily liable to the objections urged against “alternation,” properly so called, as we have defined it (a priori).
The occurrence of complications, and especially of traumatic complications, such as a burn of the hand, during the course of a pneumonia - a contused vulva simultaneously with a milk fever, are mentioned by Dr. Drysdale, as instances which may require alternation; as, for example, Urtica urens to the burned hand, while Phos. is being given internally for the Pneumonia, and Arnica to the vulva, while Aconite is given for the milk fever.
Now, of such cases as these it might perhaps be properly said, that they do not come under the scope of our inquiry, inasmuch as the burn and the contusion might be regarded as purely local, and not at all constitutional affections, and the respective applications might be viewed in the same light, and as not capable, when thus used, of affecting the general system, and of thus being, in fact, alternated with the remedy which the patient is taking internally. But, waiving this reply, we may say that the teaching of our own experience is, that, in such cases as these, the best way is to follow the one great rule which governs homoeopathic prescription; after the occurrence of the complication, collect and scrutinize the patient's symptoms anew. If the burn shall have been so slight as to make no impression on the general system, to produce no modification in the symptoms of the previously existing pneumonia, then there is no reason for doubting that simple protection from the atmospheric air will be all that is needed in the way of treatment for the burn.
If, on the other hand, the burn have been of a serious character, so as to produce constitutional disturbance, it will assuredly have modified the symptoms of the pneumonia, and we shall perhaps find, on taking the aggregate of the symptoms again, that some other remedy than Phos. is now indicated to meet the new state of things resulting from the pneumonia and the shock, of the burn combined, and that this new remedy will meet both troubles. For it must not be hastily assumed, as Dr. Drysdale seems inclined to intimate, that Urtica urens locally applied is always the best (or a good) remedy for burns. They are often (at least) best treated, as Boenninghausen has shown, by an internal remedy. Singularly enough, it once chanced to myself to meet the complication which Dr. Drysdale here supposes. The burn was severe, and the effect of the shock so modified the symptoms of the pneumonia that the resulting aggregate of symptoms called unmistakably for Arsenicum, which was given with most gratifying results, as regards both pneumonia and burn. The same may be said of the application of Arnica to contused vulva. Indeed, there is too great haste among us to recur to topical applications.
The second “principle,” upon which, according to Dr. Drysdale, “the practice of alternation rests,” is “the maintaining the susceptibility.” Dr. Drysdale says: “In disease we generally find that the susceptibility to the homoeopathic remedy is present from the nature of the case, and our great object should be to manage the doses and repetitions so that it shall not be exhausted before the natural period essential for a cure. This unfortunately, however, not unfrequently happens, in spite of varying the dilutions or originally having chosen the best. In this case the plan has been adopted of interposing doses of another remedy as nearly as possible homoeopathic to the case. This must of course be an antidote, but, as in the case of natural disease, it may tend to revive the susceptibility to the first remedy. * * * Without the use of occasional alternation and intermediate remedies, we should be almost deprived of the use of a large class of serviceable remedies in chronic disease, such as Opium in constipation, Lobelia, Lactuca, etc., in asthma, Coffea and Aconite in neuralgia, etc.”
This question of the propriety of alternating for the purpose of reviving the exhausted susceptibility may be treated in much the same way as the question of alternating to meet complications. When we have a case under treatment, we shall not be led to suspect an exhaustion of susceptibility, except by a change in the symptoms. Now, if the symptoms have changed, this very change furnishes us the basis for a new prescription. Why shall we not at once proceed, in accordance with the great rule of our art, to select a new remedy corresponding with these changed symptoms? Why should we prefer, to this certain method, the pathological hypothesis that the susceptibility to a remedy which we have assumed to be suited to the disease has become exhausted and needs a stimulant? This hypothesis may be correct, but can never be a certain basis for practice.
But let us take an example: Cases of dysentery not unfrequently occur in which Nux vomica or Mercurius seemed in the beginning to be very clearly indicated. The patient improves for a few days under the use of one of these remedies, and then ceases to improve. On a careful scrutiny of the case it appears that the prominent characteristic symptoms (most or them subjective, of course) have disappeared or become obscure. Even the evacuations have ceased to be characteristic of any remedy. The entire system is dull, languid, unimpressible. In such a case as this, we are told that the susceptibility of the patient has become exhausted; that a few doses of Opium will arouse it so that it will again respond to the appropriate remedy, and will be cured.
As a matter of fact we know this treatment does succeed, in many cases, but the rationale of the process is by no means satisfactory to us. And this is not a solitary instance of a successful practice following, through good luck, from a very faulty theory. If we analyse the case described we shall find, that when the patient ceases to improve under the Nux or the Mercurius which was first given, his symptoms changed in such a way that their totality furnished a satisfactory indication for Opium, and a capable prescriber would accordingly have selected Opium and cured his case, even though the notion of “exhausted susceptibility” had never entered his head. Simple adherence to the great principle of homoeopathic prescribing, viz., that each prescription is to be founded on a new collection of the symptoms, and a new comparison of them with the Materia Medica leads to success in all such cases, without the intervention of any pathological hypothesis whatever; at the same time it excludes all danger of appearing to sanction the bad habit of alternation.
As regards the use of Opium for constipation in chronic diseases, and Coffea in neuralgia, these being used as intermediate or alternated remedies, they, like topical applications in traumatic complications, are much abused, and often altogether needless if not hurtful. A single example will illustrate this point: A patient, not long ago, while under a friend's treatment, came under my observation. Her symptoms corresponded exceedingly well with those of Conium mac. It was a chronic disease of long standing. She had troublesome constipation, which was sometimes so bad that it seemed to completely neutralize the good effect which Conium was evidently producing. A dose or two of Opium30 would relieve the constipation, and the patient would seem for a while to improve again under the Conium. This might be called an illustration of what Dr. Drysdale refers to, as the necessity for alternated or intermediate remedies in either “complications of chronic diseases,” or “exhausted susceptibility.” It was not, however, satisfactory to my friend, nor to myself. He could not regard the regularly recurring constipation as a foreign complication. Believing in the unity of disease, he looked upon it as an integral portion of that patient's sickness and did not rest contented until he had found a single remedy which covered both the symptoms to which Conium corresponded and the constipation besides. This remedy was Alumina, under which the bowels became, and they have remained, perfectly regular. The patient's improvement, in other respects, was all that could be desired. In this case, as in most cases narrated of cures by alternation, the Opium and Conium, in alternation, seemed to work very well, and promised to effect or cure in the fullness of time. I doubt not that if, to all the other histories of cures by alternation, a sequel could be written, it would be found that each of these cases has, in the Materia Medica (actual or future), its own particular Alumina, which would effect a cure in as few days, as the most sanguine alternate would expect to accomplish it in months.
Having thus shown our belief that the alternation which Dr. Drysdale defends, for the purposes of “meeting complications,” and of “awakening susceptibility,” is not alternation a priori, not alternation properly so called, but is compatible with sound doctrine, although explained by the use of unsound pathological hypotheses, we shall pass, next, to the two general principles on which alternation, properly so called, is really based and defended
1. We have assumed that the propriety of Alternation can be argued about only by those who regard the practice of medicine as an art based upon scientific principles, by reference to which it is to be regulated and exercised. We have not considered it possible to discuss the question with those who make their practice a series of repetitions of individual experiences, without the intervention of general principles based on and inferred from a large number of individual instances.
No discussion can be sustained with this class of practitioners, for the reason that argument involves, in its very nature, an appeal to principle and the exercise of reason. When, consequently, an advocate of Alternation objects to our condemnation of his method, that he regards the subject from a practical point of view, while we persist in ignoring the practical, and in looking only at the question as one of science, we feel driven to the conclusion that, if excluded from the ground of scientific principle, we have no ground left on which to stand for the discussion of this or of any question of medical practice; and further than this we have nothing to say.
2. We have stated our belief that many writers have defended, under the name of Alternation, modes of practice which are, in our opinion, not properly called Alternation, and which certainly are not open to the objections that we entertain to what we have defined as Alternation, properly so called.
Dr. Coe (Am. Hom. Rev., Vol. V., p. 447), states: “It is an established principle in Homoeopathy, demonstrated by drug proving and clinical experience, that each drug has its own specific sphere and manner of action, hence that each remedy acts in a particular manner upon a particular organ or tissue, or upon a particular set of organs or tissues. Another recognized principle in Homoeopathy is that attenuated remedies act on the system only by virtue of their homoeopathicity to the disease by which the system is at the time affected; hence they are inert when taken by persons in health.” [One of our best provings of Natr. mur. on the healthy was made by Dr. Wurmb with the 30th decimal dilution!] * * * “But, supposing I find no single remedy that will complete the picture [corresponding to the picture of the disease]; some part is still defective, it either wants a head, a body, or a limb, what am I to do? What I do is this; I finish out the picture with something that will complete it. If the head symptoms are unmistakably Aconite symptoms, and nothing else, the chest symptoms unmistakably Bryonia symptoms, and nothing else, and the symptoms of the lower limps unmistakably Rhus symptoms, and nothing else,][ Humano capiti cervicem pictor equinam Jungere si velit, et varias inducere plumas Undique collatis membris, ut turpiter atrum Desinat in piscem mulier formosa superne, Spectatum admissi risum teneatis, amici? Horat. Epist. ad Pisones .] can finish my picture in no other way, nor can anyone else. * * * But the single remedy objector says, one of my medicines will modify the action of the other in such a manner that I cannot rely upon their doing what their pathogenesis would indicate. I think he is mistaken. If attenuated medicines only act homoeopathically, as we all hold, only act upon those organs and tissues which are affected by disease in a manner similar to the drug affection, then my Aconite, Bryonia and Rhus each goes to its own place, and performs its own office, without interfering or being interfered with by the others,”
Dr. Drysdale appears to agree with Dr. Coe, for he says (Annals of British Hom. Society, xvii. 375): “There are, therefore, no a priori physiological grounds for doubting that two medicines, whose physiological spheres are sufficiently dissimilar, can display their effects without interference, when given at intervals. Let us apply this to the treatment of complications in disease, and by this we may chiefly understand those symptoms or morbid states that are not necessarily dependent on one common proximate cause, but are connected merely by their happening to co-exist in the same individual;.” [We protest against this cool assumption that two or more “morbid states may co-exist in the same individual,” connected merely by their accidental co-existence!] “After exposure to cold we may be attacked with inflammation of the nasal, tracheal or bronchial mucous membrane, or parenchyma of the lungs or the pleura or the parietes of the chest or the liver or peritoneum, etc., according to the specific susceptibility of the tissues attacked; and each of these diseases may exist separately, and be attended with the appriate essential and sympathetic symptoms of the case. In such cases we ought properly to rely on one medicine, which may be reasonably expected to meet the specific susceptibility of the part primarily affected. But, on the other hand, from exposure to the same cause inflammation may be set up in several of those tissues at the same time, and thus several trains of morbid symptoms set up that have no necessary [would the author have better expressed his real meaning if he had said, 'pathologico-anatomical?'] connection, except that of occurring in the same individual. In that case, how can any one medicine be homoeopathic to the case which does not show its specific relation to all those different tissues in health? * * *
“Dr. Cate also brings forward inflammation of the mucous coat of the colon. When it extends to the peritoneal coat of the gut, he gives Merc. corr. in alternation with Sulphur, corresponding to their specific action on their (these) different tissues. Also in inflammation of the membranes of the brain, threatening effusion, he finds Bryonia, alternated with Hellebore, more efficacious than either singly. But this is already recognized in Homoeopathy, without stepping into the doubtful regions of pathology. ”
In discussing these statements, we desire to use great moderation of expression, conceding freely that they involve questions of pathology and pathogenesy, of which our knowledge is only, and perhaps can be only proximative, and concerning which, instead of absolute Facts, we have only Probabilities.
The tendency of the one class is to divide an independent group of phenomena, such as a sick man or a drug-proving presents, into elements each one of which it inclines to regard as independent of the others. To the researches of this character of mind we owe our knowledge of Histology, both physiological and pathological, and much else that is of inestimable value in medical science. The same disposition being carried into clinical investigation, the symptoms of the sick mall have been analyzed into the perversions of function of the various organs, and the alterations of the different tissues of the body, as well as the formation of tissues not found in the healthy body. As a result, we have the precious sciences of Pathology and Pathological Anatomy.
Based, as these analyses are, upon material changes of structure and of product, the danger to which those who engage in them are liable is this: that having their attention exclusively directed to material changes, or to visible and tangible results of material changes, they overlook two points to which it is equally important that observation should be directed.
1st. That inasmuch as healthy tissues exist, and healthy functions are performed, by virtue of an imponderable force, called, for lack of a better name, “Vital Force,” and which is inherent in each tissue, and gives to it its specific properties, there must have been a change in this force preceding every material change.
2d. That this force, though it seem to impart to each tissue and organ a susceptibility to stimulus peculiar to that tissue, yet so pervades and vivifies the entire organism, as to give rise to what is known as sympathy - a property of living organisms, by virtue of which there results, from the serious modification of any function or alteration of any tissue, a corresponding and definite modification of most if not all of the functions of the body, and an alteration of at least many of the tissues. It is by virtue of this property that each individual man is a living unit, and not a collection of independent monads, which merely chance to co-exist in one human form.
No physical research can detect this vital force, nor reveal the nature or modus operandi of this function of Sympathy, and hence it happens that those whose minds incline to rest upon the data of physical analysis are prone to overlook them, or, even though they admit them in their philosophy, yet to practically ignore or underestimate them. From this tendency results a disposition to regard the proximate cause of disease, that is to say the material change of tissue and product, as the essence of the disease, forgetting the modification of vital force, which must have preceded and been the occasion of this proximate cause - and a further disposition to look upon the alteration of function and tissue of each organ or system, of the body as a separate disease, thus easily admitting the idea of the co-existence of several independent diseases and of complicating diseases without number.
From the standpoint of this class of mind it is not easy to perceive the mutual relations and interdependencies of apparently remote groups of symptoms - such, for example, as ulceration of the Cerux uteri and chronic conjunctivitis, which, if they co-exist in any patient, would be likely to be regarded as independent diseases, and to be treated by independent courses of medication; whereas, in fact, they are so intimately connected that they are best treated by a single remedy.
Nothing is farther from our purpose than to make light of Pathology, which, as an aid in the investigation of disease, is of inestimable value. It is evident, however, that Hahnemann was right in warning his disciples against making it the basis of medical practice. Its investigations cannot, in the nature of things, go beyond material, changes. Yet disease begins in dynamic changes; and the connections of different groups of symptoms are dynamic, and beyond the reach of physical research.
And then, even where the subject is material and amenable to physical research, to base the prescription upon a determination of the organ or tissue affected by the drug and by the disease, is to go backward from the certainty afforded by a comparison of the symptoms to the uncertainty of a double hypothesis. For, as in the cases supposed by Dr. Drysdale, we have first to assume that the symptoms produced on the healthy subject by Merc. corr. and by Sulph. respectively; show that the one of these drugs acts especially on the mucous membrane of the colon, and the other on the serous covering of it; and, secondly, we must assume that, in the patient before us, the inflammation which began in the mucous membrane has extended to the serous membrane; and on this double assumption our alternation is to be based and defended. Suppose, that in its progress from within outwards, the disease also affected the muscular coat — should we give Nux vomica also? or the glands likewise? Shall we give a fourth remedy, say, Rhus? Then the vascular system of the gut is probably simultaneously affected — would this call for Hamamelis, or for Aconite for the Arteries and Hamamelis for the Veins? Here we should have six remedies to be alternated, the selection of each being based upon its ”specific relation to the tissue” affected, etc., etc. Now, what is all this but a revival of the old method, against which Hahnemann so earnestly protested, of prescribing upon the basis of an hypothesis of the nature and seat of the disease — an utter throwing overboard of the whole system of Inductive Philosophy, as so logically and so successfully applied to medical practice by Hahnemann?
It may be worth our while to dwell for a few moments longer on this very important branch of the subject, for it is a point on which very many practitioners have gone astray. Indeed, we have seen an attempt to reconstruct our entire Materia Medica pura, on the basis of the specific action of the drugs respectively upon certain organs and tissues of the body - almost all symptoms not anatomically explicable being excluded (the so-called “American Mat. Med.”)
The statement of a “general principle,” which we quoted, viz., “It is an established principle in Homoeopathy, demonstrated by drug proving and clinical experience, that each drug has its own specific sphere and manner of action, hence (!) that each remedy acts in a particular manner upon a particular organ or tissue, or upon a particular set of organs or tissues,” contains, it seems to us, a fallacy. While we admit, of course, that each drug has its own specific sphere and manner of action, it does not seem to us that this is equivalent to saying that each drug acts in its peculiar way on “a particular organ or tissue, or a particular set of organs and tissues,” leaving - (for this is implied in the statement, as the rest of the article from which we quote shows) - leaving the other organs and tissues of the body wholly unaffected by the action of the drug or disease, as the case may be. Yet it is necessary to assume this fallacy, in order to justify the practice of Alternation.
On the contrary, we have never met with, and we do not believe in, the possible existence of a case of sickness in which, as adduced by Dr. Coe, the head could be affected in one way, so as to unmistakably call for Aconite, and yet no organ of the body show Aconite symptoms; while at the same time the chest presented exclusively Bryonia symptoms, and the extremities Rhus symptoms. The uniform tendency of our own practical experience goes to satisfy us that, if any concrete case should present clear characteristic Aconite symptoms in any portion of the body, then not only would symptoms of disease be found in most of the other important organs or systems, but that these systems would present more or less well defined characteristics of Aconite: or even should they not present characteristics which we recognise as those of Aconite, the symptoms would nevertheless speedily disappear under the use of Aconite, if that drug were clearly indicated by characteristic symptoms in the other organs. So abundantly has our experience confirmed this view, that if we find clear characteristics of any drug in the symptoms of any organ of the body, no matter what symptoms may be presented by other parts of the body, and no matter how little these latter symptoms may seem to indicate this same drug, we never dream of alternating remedies. We are confident that a remedy, which is clearly indicated by characteristic symptoms, though they be but few in number, will cover the whole case, and will remove the entire disease. Nor do we, as is assumed by the alternators, expect to accomplish by ”succession” what they aim to effect by Alternation. We so thoroughly believe in the unity of disease as to be confident, that, in however many organs and tissues morbid symptoms may present themselves, they still spring from and depend upon one and the same unknown and inscrutable cause, just as the multifarious symptoms of a drug-proving depend upon the one cause, viz., the drug; and that though the characteristic symptoms which furnish the indication for the remedy may be observed only in the symptoms of one organ or system, yet the symptoms of all the rest of the body will be equally controlled by the action of this remedy. It is remarkable, however, to how great an extent, if we observe carefully and intelligently, we may recognize, in the various groups of symptoms affecting the various organs of the patient, the characteristic mode of action, and the conditions of that remedy, the characteristic indications for which we find in some one organ alone of the patient!
2. The tendency of the second of the classes of minds into which we divided medical philosophy is to Synthesis. They are, perhaps, in danger of underestimating those material changes of tissue which are the proximate cause of disease, because they are intent upon observing and tracing out that perversion of the vital force, which must have preceded and induced all the organic and material changes which the case presents, and which perversion they regard as essentially the disease itself. They study this perversion in its various manifestations, viz., the symptoms. They do not seek to analyze these groups of symptoms, for the purpose of forming a theory respecting the tissues affected, so as to select a remedy which affects, as they suppose, identical tissues, and in the same way. They do not thus admit hypothesis into their method. They study the groups of symptoms to get at their peculiarities and conditions. Profoundly impressed with the intimate connection of all parts of the body, through the all-pervading Vital Force (whatever it may be), and with the fact, observed every day, that change of function in one part of the body speedily brings about corresponding changes in almost every other part, they seek, by the light of one group of symptoms, to find in the patient other and corresponding groups. In these investigations Physiology and Pathology, which teach the relations and mutual dependencies of different organs, are of inestimable value, enabling the student to find in remote organs parallel groups of symptoms; the characteristic which determines his choice of a remedy being often in an organ very remote from that to which his attention was first called as being the seat of disease. Having thus been led, by his philosophy, to collect the various groups of symptoms presented by the entire body, as constituting one single disease, the practitioner surveys this collection in search of the characteristic symptom, or group of symptoms which shall point to his remedy. Ninety of the symptoms might be found among many remedies, ten perhaps may be peculiar to, and characteristic of, a single drug. This he selects, without hesitation, as his remedy for the entire malady of that patient.
Suppose the patient to have taken cold, and to present, in consequence, a malady which, anatomically, is made up of a pneumonia and hepatitis. It is all well enough, and doubtless important for the purposes of diagnosis and prognosis, to make this pathologio-anatomical analysis of the case. But when we come to regard the case from the standpoint of Therapeutics, we are not surely to follow the plan which Dr. Drysdale seems to sanction, viz., to look among the drugs which are shown by provings to act on the tissues of the lung, and select the best from among them, and then to look among remedies which act on the tissues of the liver, and select the best from among these remedies, and to alternate the two thus selected. What if, as would be likely in such a case, the pleura, likewise, were inflamed? Should we have a third remedy? Or the kidneys also? Should we have a fourth? ”Quousque tandem -?-“
On the contrary, we should collect the various groups of symptoms, as well those from which the Pathologist infers that the tissue of the lung is affected, as those from which he infers that the tissue of the liver is affected. All other symptoms likewise would be gathered. We should examine these symptoms, in the manner so often described, for the purpose of finding in them the peculiar characteristics of some particular drug. In thus dealing with the case, we should have this advantage over the Pathologist, that whereas his inferences may lead him astray, since the lung tissue may not be affected as he thinks it is - and likewise the tissue of the liver - we, on the other hand, taking into account only the obvious symptoms, avoid at least one very patent source of fallacy. Our own experience has altogether misled us if we do not find, in the case supposed, that if the lung symptoms give us characteristic indications for a remedy, the liver symptoms not only will not contradict this indication by affording one for some other remedy, but they will corroborate the indication, so as to give us no pretext for alternating.
But another case is supposed, viz., that a pneumonia is present, and a remedy has been well selected for it, and now a hepatitis supervenes to complicate the case. Here, we are told, is a new disease, which can have nothing to do with the previously existing pneumonia, and which must require a distinct treatment, in the way of alternation. This is in no way different from the complication of a bum, of which we have already spoken. If the complication is serious enough to produce constitutional symptoms (as a hepatitis would surely be), it would always (or our observation has uniformly deceived us) modify all existing symptoms. For example, a severe burn would give a typhoid character to an existing pneumonia. We must then make a new collection of the symptoms, and proceed as before to select a remedy.
Under any other plan - if we are to select our remedy according to correspondence of known drug-action and disease-action upon the tissues of the body - not only are we liable to errors already pointed out, but our scope is wonderfully restricted. How could we find remedies for changes of structure, such as we can never expect to see in drug-provings, such as cancer and heterologous growths of all kinds? How, for affections which do not depend on or involve any definite known change of tissue, as Intermittent fever, Epilepsy, Hysteria, and the host of chronic ailments?
The artificial disease intentionally produced by a drug, and the natural disease which results from the usual morbific predisposing and exciting causes may, for all purposes of argument, be regarded as identical. Principle No.1 might therefore, with equal propriety, be expressed thus. “A disease has its own specific sphere and manner of action; hence that disease acts in a particular manner upon a particular organ or tissue or upon a particular set of organs or tissues.”
A corollary of this proposition is, that, inasmuch as the drug and the disease respectively act in a particular manner and upon particular organs or tissues, they leave other organs and tissues of the body altogether unaffected, in their normal state and performing their healthy functions, and liable to be themselves attacked by some other disease, which may affect them in its own particular manner, and may run a simultaneous and independent course.
This is the argument for alternation which is constructed upon these principles: a certain disease affects in a peculiar way certain organs or tissues of the body, leaving the other organs and tissues in the fulfillment of their normal functions. Attenuated medicines may be administered to cure this disease. Attenuated medicines “act only by their homoeopathicity to the disease.” “They are inert” so far as action on the healthy organs or tissues is concerned. Homoeopathic medicines act only where, says Dr. Drysdale, they find that preternatural susceptibility to their action which inheres in organs or tissues diseased in a manner similar to the morbid state which those drugs can produce on the healthy.
These attenuated medicines then may be given for the case we have supposed. They will act upon the diseased organs and tissues, but will not affect the healthy ones at all. Now then, during the existence of this disease which, as stated, affects in a particular manner certain organs and tissues, and leaves all the rest undisturbed, a second disease may attack the individual (may we call one who may he thus divided up an individual?) acting in some other particular manner, upon some other particular organ or tissue.
To meet this new disease, coexistent with the original, it is affirmed that a. second remedy homoeopathic to it may be administered simultaneously with the former remedy. Or rather, since to administer it simultaneously might involve the risk of the chemical reaction of the drugs, the remedies may be alternated. It will not interfere with the former remedy, because attenuated medicines act only by virtue of their homoeopathicity to the disease (to which they are respectively homoeopathic). Thus each drug “will go to its own place,” like the respective members of a well-trained coach team when the winding horn announces that the coach is ready for the new relay!
Such is the argument for alternation succinctly, and, we think it will be conceded, fairly stated. In a former discussion of this subject we showed that, assuming natural disease and drug disease to be, for the purposes of this argument, substantially the same thing, it was proving too much to demonstrate that two or more diseases coexisting in the body could not and do not affect each other. This would render a cure of a disease impossible; for in the act of curing, we propose to cure a natural disease by creating in the body a drug disease which shall annihilate the natural disease and shall, in that very act, be itself annihilated. When a certain form of rheumatism exists in the body, we give Bryonia, and our intention is that Bryonia shall so act upon the body (producing therefore, virtually, a bryonia disease) as to cause the disappearance of the rheumatism and at the same time not to leave in its stead a bryonia disease nor any other disease. But if two diseases coexisting cannot react upon and modify each other, how could a cure take place? The proposition is evidently too broad; the argument proves too much.
Dr. Drysdale provides against this objection by limiting the alleged possible independent coexistence of diseases, to diseases which act in a dissimilar manner upon remote or unrelated organs and tissues.
According to this view, two diseases might coexist and not modify each other, if seated in organs distant from each other or, which is equivalent, a natural disease may exist, and a drug may be given which acts only upon organs remote from those which are the seat of the disease, and (if the doses be strong enough) may produce its peculiar drug disease without at all affecting the natural disease which is already present.
Dr. Drysdale and several other physicians hold these views, and appeal to their own observation and experience. If we may be allowed to draw an inference from Dr. Drysdale's remarks (Annals of British Hom. Soc., No. 17, p. 375), he believes that a hepatitis may supervene upon an already active pneumonia, and that each may run an independent course, and be treated independently by alternated remedies, without modifying each other or blending into one morbid state.
Our own experience has led us to very different conclusions, and we have on our side the names of colleagues, who, not having deviated from the modes of practice observed by Hahnemann's early disciples do not feel compelled to acknowledge and lament, as Dr. Drysdale does, that their practice is “not proportionally so successful as was that of Hahnemann's early followers.” (New Repertory, Introduction.)
How can this direct contrariety of inferences from observation be explained? We have altogether too profound a respect for the observing and reasoning powers of our dissentient friends, to set them a particle below our own! There must be an opposition in some of our methods of observation, or principles of inference. It will be found, we think, in the fact that to the word “disease” we respectively attach very different ideas. We mean by disease the aggregate of those symptoms presented by the sick man, which are characteristic of his particular deviation from a healthy state. The colleagues from whom we differ speak of disease as denoting a definite pathological and pathologico-anatomical change of the functions and tissues of some definite organ or system of organs.
In this latter view the patient might present evidence of those pathological changes in the organs and functions of respiration, to which the name pneumonia has been attached. Here then is one disease, pneumonia.
He may also present evidences of those pathological changes of function and tissue in the liver which give rise to the name hepatitis. And here would be another, coexistent disease hepatitis; and these two pathological and pathologico-anatomical conditions might, we freely admit, from the pathological and nosological standpoint, run their course to resolution or to destruction without so modifying each other as to coalesce or in any way blend or be confounded; for the lungs and the liver can never collide.
How would this case look from our standpoint? The patient has, we suppose, dyspnea, stitching pain in the thorax, hard, dry cough from tickling behind the sternum, scanty and occasionally bloody sputa - headache on the vertex, and sharp fever. He is worse at night; his pains are much aggravated by motion, and are relieved by repose and by warmth.
We have selected Bryonia for him - had previously diagnosticated pneumonia (physical signs aiding or confirming our diagnosis). Now he gets, in the hepatic region, sticking pains, fullness and tenderness; he has bilious vomiting and bitter taste. Ailed again by physical signs, we diagnosticate hepatitis, complicating the pneumonia; but the symptoms still indicate Bryonia, and so we continue that remedy.
But, we shall be asked, suppose the new symptoms do not indicate Bryonia, but, on the contrary, some other drug, will you not give that other drug for the liver and continue the Bryonia for the pneumonia!
To this we reply that in so far as our observation has taught us, in such a case the supervening of these new symptoms (of the liver namely) will have so modified the whole organism, including the diseased respiratory organs, that Bryonia will no longer be indicated by any symptoms; but the aggregate of characteristic symptoms of the entire sickness will now indicate some other remedy which will apply to and will cover the whole morbid state of that individual.
In the discussion which followed the reading of Dr. Drysdale's paper in the British Hom. Society, Dr. Russell took the same ground as Dr. Drysdale. He said, “that two morbid specific actions could occur simultaneously in the human body, and each pursue its course without arresting or modifying the other, is a proposition entirely at variance with the opinions of the old pathologists who flourished before the time of Hahnemann. * * It is of great importance to us to know whether this pathological doctrine be in accordance with the larger experience and observation to which we now have access.”
We could hardly have two diseases more specifically distinct than Typhus and Smallpox, yet, in the following narrative, we have a description of the two running their course, side by side, without either interfering with the other.” The case occurred in the London Fever Hospital, and is quoted by Dr. Murchison.
Dr. Russell proceeded to say: “There are many instances of a similar kind on record, and we must frame our theories so that they shall embrace this new category of cases. Suppose we encounter a case, and there are such on record, of a combination of scarlet fever and of typhus, how are we to deal with it? Are we to engage only one of the two destroying agents, and let the other alone until the first be entirely subdued? If we believe it is impossible for two medicinal actions to proceed pari passu in the animal economy, this is the rational course to pursue, and the one recommended by Hahnemann!” (This is an inexcusably lax statement. Hahnemann nowhere ever recommended that we should make only a part of the patient's ailment the basis of our choice of a remedy; he always strongly insisted on our considering the “totality of the symptoms,” and this would include both scarlet fever and typhus.)
“But, if two entirely different natural morbid processes can coexist in the human body without the one affecting the development of the other, what reason is there why there may not be two artificial simultaneous series of morbid phenomena, each equally independent of the other? If scarlet fever, or if smallpox, can each run its course, while at the same time typhus is doing so likewise, why may not Belladonna and Arsenicum each run their course when given in alternation?” (Annals British Homoeopathic Society xvii., p, 399 et seq.)
In reference to this last question, we may ask would Dr. Russell expect to get pure symptoms of any drug if it were proved simultaneously with another drug; would he believe that the two drug-diseases would run an independent, simultaneous course in a prover? Would he practically believe it by consenting to rely upon a materia medica pura made up in this way? Or, which is the same thing, would he trust to a materia medica composed of the results of an artificial (drug) disease running“ an independent course simultaneously” with “a natural disease?” In other words, would he trust proving made on sick persons?
We know he would not; for he is one of those who reject or suspect the provings of many of our most valuable drugs, because symptoms observed on the sick are included in the list, or because the provers were not careful enough to exclude other morbific or toxic agents while proving.
But, this inconsistency aside, let us take notice that in these remarks, and in this citation of a case of the coexistence of two diseases, Dr. Russell speaks altogether from the standpoint of the pathologist and nosologist, and not at all from that of the practical physician - the standpoint of therapeutics. He thinks he has proved his case if he has established, what nobody is disposed to deny, viz., that two nosological abstractions, called by distinct names (to wit, scarlet fever and typhus), may coexist.
Does he forget that nothing is more firmly established in homoeopathic practice than that the “name” which we may feel authorized to give to do sickness in “no wise determines our treatment of the sickness. Because we call the sickness typhus, we do not therefore, of necessity, give Arsenicum, or scarlet fever Belladonna! We may as often have to give Arsenic in a case that we should call scarlet fever, and Belladonna in a typhus.
What then guides us in selecting a remedy? Nothing save the aggregate of the characteristic symptoms. W e might divide and subdivide the symptoms and signs that the sick man presents (including under the designation “symptoms and signs” everything that distinguishes that sick man from himself when not sick) into a dozen nosological groups each having a distinct name, and yet the aggregate of these symptoms might (and we think it always would) point to one single remedy as corresponding to, and indicated by the entire morbid state of that sick man.
To prove his case by the argument and instances quoted, Dr. Russell must show that the symptoms of the scarlet fever and of the typhus, respectively, were incompatible in the case cited by him, and that they did not combine to present the characteristics of one common remedy.
For this is the point of the whole discussion. No matter how many of the pathological groups which are dignified by the names of distinct diseases, may coexist in a patient, if they be so blended and mutually modified as to indicate, in the aggregate, one single remedy, there can be no call for alternation.
Inasmuch as Dr. Russell rests his argument for alternation on the possible and frequent coexistence of distinct specific forms of disease, it is incumbent on him to show that these coexistent, distinct forms of disease, do not, by their coexistence, modify each other and blend into one harmonious aggregate of symptoms, the characteristic ones of which may be covered by a single remedy. In our experience this has always seemed to be the case, and we shall adduce other evidence to the same effect.
But before citing authorities, let us point out how far Dr. Russell's argument, even allowing it full force, comes short of being a defence of alternation, as it is actually practised here and in England! Dr. Russell allows it where “two distinct, specific forms of disease” coexist, such as scarlet fever or small pox and typhus - a phenomenon that no physician in ordinary family practice is likely to observe more than once a week! Yet how many times a day do a majority of our colleagues alternate? It is safe to say that, with very many, the giving a single remedy is the infrequent exception! Their case is exactly met by the following remarks of Dr. Russell, one of the champions of alternation:
“The objection usually urged against alternation, is that it leads to laxity of practice. True, if we give two medicines instead of one and let the system take its choice, as it were, to which it shall submit - if, in a given case, for example, we find two medicines pretty nearly indicated, and, instead of ourselves selecting the one and rejecting the other, we toss them both in, trusting that the right one will act, and the other be a nonentity or negative quantity. No One Who Deals Conscientiously With Himself Will Deliberately Approve of so Simple a Method of Evading the Difficulty of Choice.”
A few instances and citations may serve to recall to the minds of practitioners of medicine, the frequent instances in which two varieties of disease, coexisting, modify each other. A young person whose parents died of consumption, and who has himself had abscesses of the cervical glands and eruptions of the face and who takes cold readily — is feeble and pale - who, in short, has scrofulosis and is a predestined victim of consumption, gets an attack of enteritis or of pneumonia. Is it not notorious that the joint action and reaction upon each other, of this chronic scrofulosis and the acute enteritis or pneumonia, will be such that instead of the acute affections running the short and sharp course which they would follow in a robust subject, they will almost surely degenerate into tuberculosis of the mesenteric glands with colliquative diarrhea, and of the lungs, respectively? And would anyone dream of treating these acute affections in such a subject, just as they would treat them in a subject otherwise and previously healthy
When a patient has suffered from paroxysms of intermittent fever, and on the cessation of their regular recurrence he is still sallow, feeble, dyspeptic and full of malaise, there can be no question that he still suffers from the disease — the result of marsh miasm. If now this patient get a pneumonia or a neuralgia, here will be a second and a distinct and dissimilar disease coexisting with the former. So different, however, will be its course from what it would have been in a patient not laboring under miasmatic disease - so blended will it be, from the beginning, with the latter - that, though a wholly distinct “pathological form” of disease, it will require the identical treatment of miasmatic disease and will yield to nothing else. The same thing is eminently true of syphilis in the system.
“Syphilis, herpetism, scrofula, the marsh-miasmatic disease. ete., often appear under forms not habitual. * * * * We imagine that we are dealing with acute or chronic inflammations, and we treat them as such until, some day, changing our method, we see them recover, one under Mercury, another under Sulphur, another under Sulphate of quinine, another under Iodine, etc. Is there anything stranger than those observations in marshy countries, where pneumonias, fever, encephalo-meningitis, are cured by Quinine rather than by bloodlettings and by antiphlogistics?”
Another instance of the modifying power of two morbid influences, cooperating on the same individual, is furnished by the fact that when an epidemic prevails not only are almost all healthy persons, to some extent, affected by the epidemic influence, but the maladies of all sick persons, whatever their nature may be, are modified and changed into a greater or less conformity with the epidemic, whatever it may be.
Dr. David Hosack uses these words (Copland's Dict. Prac. Med., 2, 404, Note,): “The fact stated by Sydenham and other writers on epidemics, that the prevailing disease swallows up all other disorders; that is, that during the prevalence of an epidemic plague, typhus, dysentery or other diseases of this class, every indisposition of a febrile sort readily assumes the character of the prevailing disorder. We know this to be experienced in the diseases of other countries, and we see it daily exemplified in our own.” * * *
Homoeopathicians especially, since their observations are finer and are less exposed to fallacy from drug poisonings, have opportunity to make observations of this kind, and they have often noticed how, at one season and under one epidemic, a single drug or group of drugs corresponds to the most diverse pathological forms of disease, while at other seasons - and under other epidemic influences, very different groups of remedies are indicated by the same pathological forms of disease.
And we believe that most Homoeopathicians who have dealt much with chronic cases, must have fallen in with patients who labor under such a constitutional affection as herpes or cancer, and which, under favorable circumstances, is kept in a latent condition by the occasional use of some clearly indicated remedy. If these patients get an acute disease of whatever kind, this disease is almost sure to present, at an early period, symptoms which indicate this same remedy that suits their chronic malady. Does not this argument a posteriori show that these two independent, coexistent maladies blend and modify each other, at least in the view of the therapeutist?
The entire homoeopathic doctrine of chronic diseases, and the use and necessity of so-called antipsoric remedies, are based upon this same idea of the mutually modifying influence of two coexistent maladies.
Hahnemann says he found that in some persons acute disorders did not yield promptly to remedies which seemed indicated and which quickly cured them in others. On examining closely he found these patients presented, in the present or in the past, symptoms indicating their infection by certain miasms which he reduced (whether rightly or not is immaterial) to three miasms-psora, syphilis and sycosis. He sought for remedies which would meet the indications of these chronic miasms and the acute affections combined, and this led him to prove and use the remedies known as the antipsorics. Our success with those remedies might be taken as another a posteriori proof of the blending of two coexisting diseases.
“We have not a few examples where the patient has, through ignorance or design, unknown to us, taken large doses of heterogeneous drugs, such as Quinine or Opium or purgatives, and yet our higher dilutions have taken effect notwithstanding. On this subject Trinks confirms Kampfer's remark, that, in chronic diseases which have been long treated with excessive doses of allopathic medicines, we often find a great susceptibility to the action of homoeopathic medicine.”
Are these writers to be understood as maintaining that chronic drug poisonings, such as the mercurial, the sulphur, the iodine, the quinine, the iron or the opium cachexy, do not cause acute disease to be most difficult of cure? The contrary is notoriously the case, as the literature of physicians of every school abundantly shows. How can this be, unless the artificial chronic disease, viz., the cachexy, blend with and modify the supervening acute, natural disease!
These remarks might be extended to great length by multiplied instances. They suffice, however, to show distinctly the practical conclusions to which, what we conceive to be sound principles, as well as accurate observation, have led us. With them we conclude what we have to say concerning the alternation of remedies, taking our leave of the subject in the spirit of Bishop Chillingworth's declaration:
“I will take no man's liberty of judgment from him; neither shall any man take mine from me. I will think no man the worse man, * * I will love no man the less for differing in opinion from me. And what measure I mete to others I expect from them again.”
|Source:||The American Homoeopathic Review Vol. 06 No. 03, 1865, pages 81-96, pages 125-133, pages 166-177, pages 206-218|
|Description:||Alternation of Remedies.|
|Editing:||errors only; interlinks; formatting|