Of The Repetition Of The Medicament... Contd
From all this, it is evident that homoeopathists do sometimes differ with regard to the dose, and its repetition. But of what prejudice can that be to the principle?
The experience of Hahnemann has taught him that medicaments operate very favourably at the 30th attenuation: some of his disciples insist upon much lower dilutions, such as the millionth, the billionth, &c. Hahnemann recommends that the repetitions should be rare; others insist that they should be frequent.
Are not these differences of opinion explained by the fact that the law requires the dose to be increased or diminished, both in strength and frequency, according to the case and state of the patient.
Had not the physicians, to whom we are alluding, a variety of of cases to treat? the very same men who prescribe such strong doses, have often succeeded, under other circumstances, with much weaker doses; and those who, in certain cases, insist on frequent repetitions, have succeeded in curing many diseases with a single dose, or at least with very few repetitions of it. The contrary fact has also occurred; and many who recommend high attenuations and few repetitions, have been obliged to have recourse to more powerful and more frequent doses.
The opponents of homoeopathy vainly flattered themselves that these divisions were a certain proof of the downfall of the art; their opinion only served to show that they were totally ignorant of our doctrine; for if homoeopathist disagreed as to the repetition of the doses, or even as their strength, no difference has ever existed as regards the law, which indicates the choice of the remedy. All homoeopathists, without a single exception, when treating a patient, prescribe for him a medicament which harmonizes with the symptoms of the complaint they have to subdue; they are all orthodox, since they obey the fundamental law.
It seems to me that the preceding observations prove that what we said in the beginning is true; and consequently, that great care should be taken with respect to strength or repetition, that the dose should therefore be adjusted to the intimate nature of the case, to the constitution of the subject, and finally that it, as well as its repetition, should be determined by the aid it has lent to the symptoms.
The study of the laws which regulate life, the study of the law which directs us in the choice of the remedy, every thing concurs in persuading us to adopt this opinion; and, after all the practical experience of Hahnemann, of Stapf, of Gross, of Hering, of Aegidi, Hartmann, Rummel, etc., every day convinces us more and more of the truth of our opinion.
The practical experience of all those men, who have devoted themselves to homoeopathy, and of many others which I might name, but above all the long experience of Hahnemann himself, rescues us from many perplexities and difficulties as to the repetition and increase of the dose. For by them we know that generally minute doses are much more favourable than stronger ones, so that, with high dilutions, we cure without encountering those painful aggravations which frighten when they occur, and which are the result of strong doses.
Thus, in the case of vomitings, a prevailing symptom in certain gastric affections, the stibiated tartar which is prescribed, with the greatest propriety, will save the patient in a few hours, if administered in minute doses, but often occasions the greatest suffering if given in powerful doses, such as a few grains at a time.
So that, in making choice of the dose, the difficulty is far more apparent than real, since the experience of many practitioners during a course of years, informs us, that we ought to choose the dose from among the dilutions prescribed by Hahnemann, that is, between the hundredth, the millionth, or the decillionth of a grain. It is obvious that this scale is sufficiently extended, since we can, without any hazard, according to the sensibility of the patient, take one or other of these dilutions; always remembering that the most extended ought usually to be preferred, or at least until we have ascertained the patient sensibility, and the degree of susceptibility with which he receives the impression of the medicaments.
As regards the repetition of the medicament, the same may be said as of the dose; experience teaches us that it ought to vary in frequency according to the case.
Let all these remarks, which have been the result of observation, be constantly present to the mind of the practitioner; let him lay them down and arrange them formally as precepts; but let him, at the same time, never consider himself as the mere mechanical observer of the fundamental law and its secondary precepts. The whole of his mind must be employed in the scientific practice of the art.
Undoubtedly, it would be fortunate for the patient if, by means of our fundamental and infallible basis, the physician could, without effort, without inconvenience and without hesitation, always discover the best remedy; undoubtedly it would be fortunate for the patient if the physician could tell before-hand that, for a given case and with a given remedy, he had nothing to do but repeat mechanically, two, three, or four doses, more or less, to bring about the cure of a disease. But we shall never be able to establish such invariable and positive rules; for in order to obtain a similar result, it would be necessary not only that two cases should be completely identical, but that the patients' constitution should be absolutely alike, that all accidental causes, both physical and moral, affecting the patient, should exactly correspond; in short that which cannot be found would be required.
Thus then, instead of attempting to determine the number of globules and the frequency of their repetition, let us confine ourselves to the collecting of results provided by experience, and let us endeavour to ascertain what are the data by which the physician ought to be governed.
In this pursuit, the physician ought above all things to feel that, in dispensing homoeopathic medicaments, it is intended to aid the healing power of nature as evidenced in the symptoms, in order that this may subdue the evil which is oppressing life, and consequently restore the equilibrium to the functions.
It is evident, therefore, according to this reasoning, that the remedy must be prescribed in a dose sufficiently strong to lend this aid, and that we ought to avoid as much as possible the giving more of the remedy than may be required; for doses too strong and too frequent carry the vital reaction to too high a pitch, and produce a dangerous commotion in our functions.
Thus by experiments repeated a thousand times, we know that minute doses are best adapted to assist vital re-action, and it is therefore among this number that the physician will have to select his dose. Clinical experience teaching us every day the respective activity of each and every remedy, this datum also comes to our aid in fixing the dose. Finally, we possess the data furnished by the patient himself, from whom we learn that he is endowed with a lively sensibility, and great susceptibility to impression; or else that he is almost insensible to the action of medicinal and other agents.
According to the sum of all these various data, we have to settle the power of the dose, which can never be absolute, but constantly variable, according to the nature of the complaints, the activity of the remedy, and the age, sex and constitution of the patient.
Dispense, therefore, homoeopathic remedies by beginning at the highest attenuations, in order to learn the susceptibility of the patient: choose accordingly the 30, 24, 20, 16 or lower dilutions: experience will inform you whether the doses ought to be kept up at the same dilutions, or whether you will have to replace them by stronger or weaker doses.
In the repetition of the doses, the primitive action of the remedy, and the vital reaction, will serve for our guides.
As to the sequel of our procedure, I cannot do better than quote some views of Aegidi:
After the taking of the medicament, one of these two cases must ensure:
The alteration in the state of the patient comprehends three cases:
1. Alteration in the group of the symptoms affecting the patient.
2. Improvement.
3. Aggravation.
A. Sometimes it is seen, that in spite of the best selected medicaments, and the most proper doses, the state of the patient evinces no change; which might induce the belief that the system is devoid of all susceptibility to homoeopathic agents.
In this case, we must repeat the dose at greater or less intervals, according to the susceptibility of the patient to the medicament, until we have produced a sensible homoeopathic aggravation, which will be followed by marked improvement, or else until we perceive other symptoms, proper to the medicament, which had not before declared themselves among the symptoms of the disease. This process does certainly complicate the state of the patient; but improvement will succeed it: in the contrary case, the sign of an ill chosen medicine is evinced.
We sometimes meet in our practice with patients who are but ill-adapted to receive the influence of medicaments. In such cases, one dose of Opium and another of sulphur will be found every effectual in preparing the system to yield to the action of the curatives. And this course is preferable to that of attempting to effect a cure by sudden and hasty repetitions of any one medicament.
Jahr states a case in which medicaments ought to be frequently repeated: it is in complaints which should a paucity of symptoms, such as barrenness, chilblains, wens, certain chronic exanthem, and all local diseases, which are perfectly inactive, and manifest themselves only by one striking symptom. The same may be said of all general affections of the body and the mind, which do not assume appearances sufficiently distinct to warrant the choice of a medicament.
Now, assuming in this place that every remedy attacks the system on its weakest side, and that the manifestations thence proceeding are always a the same time so many signs of the latent disease, I should prescribe either tincture of sulphur or some other medicine still more obviously suggested, at the dose of a single globule of the thirtieth attenuation, every two or three days, until there is sufficient signs of every kind elicited. Then I should immediately dispense another remedy, capable of covering, not only the first evil, but likewise all the new signs thus obtained, and this I would leave to operate until the improvement it produced had become stationary, or else I would repeat it, or change it, according to the persisting symptoms.
This rule of conduct derived from Hahnemann, and advised and successfully practised by Jahr, appears very rational, and I do not hesitate to recommend it in similar cases.
Electricity has been employed in these cases with equal success, and after its application the system has become very fit for impression from the action of homoeopathic remedies. (Footnote: Hahnemann has already recommended electricity, in slight shocks, for inveterate local diseases, especially for those pertaining to the organs of sense. Experience has proved to Aegidi that the use of electricity is useful not only in those cases which have been cited by Hahnemann, but in others far more general. [Still] he never obtained any great consequences from electric shocks, whilst he succeeded much better by submitting the patient, in an isolated position, to an electric draught every second or fourth day. The diseases for which he found this practice beneficial were, bad eyes, sore ears, chronic ulcers, obstructions in the glands, paralysis, scrofula, &c. Medicines which were before ineffectual, are found to act with efficacy after the employment of electricity, which is continued as long as it may be deemed necessary.)
B. 1. In the first case, the change in the group of symptoms, is a proof that the medicament has not been well selected: it must, therefore, be speedily replaced by a better.
2. In the second case, the medicament is seen to act in a salutary manner, and it would be very unwise not to wait for the term of this improvement without giving it another dose. If its action were to continue through several weeks, the slow progress of the improvement would not be a reason for giving anything new, for we should only obtain an injurious effect from the first result. It not unfrequently happens that the first dose of a well selected medicament produces a complete cure. This will take place when the disorder is not very serious, and especially when the patient has not been subjected already to the baneful influence of potent medicinal mixtures.
So long, then, as the first action of the remedy is visibly manifest, without being too strong, do not interrupt it. So long as the vital reaction, the specific result of the remedy, is favourable and strongly marked, let this repairing power work out its good effects, and do disturb its salutary action.
3. In the third case, the state of the patient is apparently worse; the characteristic symptoms have become more intense without changing their form: this is called homoeopathic aggravation.
It must not, however, from the use of the word aggravation, be supposed that the disease has received an accession of intensity: it is the symptoms that are aggravated - not the disease.
Patients, after having taken a homoeopathic medicine, frequently observe that the organs where the disease is lodged, and even other parts which before appeared in perfect health, betray symptoms of pain, of visible alteration, or functional disorder. These symptoms are the result of the powers of the medicine, and shew that it has begun to act on the diseased parts, and on other parts of the constitution in order to ensure the curative reaction.
This medicinal action is therefore very different from an aggravation of the disease. To affect the removal of the latter, would require the assistance of an appropriate remedy; whilst the former, far from inducing such a necessity, terminates in the relief of the patient.
This medicinal action operates in proportion to the strength of the dose, the age of the patient, and his susceptibility. Hence the stronger the dose is made, the more this action will be seen; and the more the patient is youthful and open to impressions, the more remarkable it will appear.
This action need not be very perceptible to be salutary; consequently, we should always endeavour to produce it in as mild a degree as we can; and it frequently happens that, by largely diluting medicines, as by mixing them with water, this homoeopathic aggravation is not felt at all.
From what I have just said, it will be foreseen by the reader, that, in cases of acute diseases, the medicinal action, homoeopathic aggravation, must be very speedy in showing itself, and equally prompt to disappear. Often indeed, in a few minutes after the ingestion of the remedy, the patient begins to feel its effects; but soon afterwards, especially when pain has caused suffering, a light and peaceful sleep declares the curative action of the remedy; and the patient, especially if a child, awakes in a state of improvement, which promises an early recovery.
In chronic diseases, the action of the medicine is much slower; it often takes several days to enable you to perceive that the remedy is acting; and in general it is only by the same slow degree that the salutary effects or reaction of the medicine is made apparent.
Enough has now been said to explain that what is called homoeopathic aggravation is merely an aggravation of the symptoms, and by no means of the disease itself - a very material point to be rightly understood, that the physician may not confound the actual disease with the action of the curative agent.
This action, though too great, may be left to die away, unless it be too violent or too continuous; and in the latter case, the proper antidote pointed out in the materia medica must be given.
By following this course, the physician will have the pleasure to bring about the cure of his patient in a much shorter time, more certainly and more effectually than it was possible to effect at the commencement of homoeopathic practice, in which, very frequently, it happened that the physician, bewildered by doubts of most perplexing solution, had not the experience and the rules since acquired to point the way.
"I made experiments," says Hering, "on the repetition of the doses, guided by the old rule: I repeated the doses at wider and wider intervals; the remedy not acting at all, or producing merely aggravation, it was repeated until reaction had become apparent. But in administering it after that period, which is the case when the patient resides far from his physician, notwithstanding his contrary prescriptions, the result in general was unfavourable.
When the reaction does not continue, or is of short action, viz., appears to be but palliative, it is allowed to repeat the doses; and the fittest medicament is then the one which has already produced benefit. A second dose, administered the following day, is sufficient in most cases. It may, however, in this case be given not only a second time, but be repeated as often as any satisfactory result shall continue to be obtained. Aegidi says he found that, in most cases, it was proper to give a dose every seventh day, and that by this means patients very speedily recovered. There are likewise cases in which it is requisite to repeat the dose every fourth and even every second day.
Hering says, he performed numerous experiments with much success, repeating the doses according to the following rule: the first dose being allowed one day to act; the second dose two days; the third three days, and so on; lengthening the interval by one day for each repetition; that is to say, giving the remedy the fist, second, fourth, seventh, the eleventh, the sixteenth day, till the reaction or new symptoms appear. After this, it is right to wait until the reaction is over, when we may give another medicine adapted to the remaining symptoms.
It may often be observed that the first dose not produce any action on the first day; that the second dose, on the second day, produces only a slight action, which disappears the next day; that the third dose produces, on the fourth day, an action longer and often more permanent; and, when this does not appear, the same result is obtained from the fourth dose on the seventh day.
Sometimes the intervals between the repetition of the doses must be longer that those above mentioned; that is, instead of giving the medicine on the first, second, the fourth, the seventh and the eleventh days, it is necessary to give it only on the first, the second, the fifth, the ninth, the fifteenth, and so on. This point cannot be decided at first: we must always proceed until adequate reaction takes place before we can settle these intervals.
The nature of the malady will be a better guide that the usual duration allotted to these intervals. In very violent and active diseases, ten or fifteen minutes are the space observed for remedies of short action, and a few hours of those of long action. In less violent disorders, it may be one day; in those which are very slow, several days; and the subsequent intervals must be prolonged to the utmost possible extent.
It is only when it is seen that the remedy hitherto made use of ceases to produce improvement in the state of the patient, that a substitute is chosen, the use of which must be submitted to the same conditions.
Another kind of repetition proposed by Hering, is that in which no one medicine cover the whole of the symptoms, and which takes place after a single intermediate remedy: it is called alternate repetition. It appears to him that this kind of repetition has been but very imperfectly studied hitherto; and is yet far from being insignificant.
In the beginning of my practice, in 1822, says Hering, "I cured a liver complaint, with jaundice, with alternate use of Ruta tincture and Ignatia , prescribing those medicaments alternately, every three or four days: a permanent cure followed in a few weeks.
"At a later period, when I found a remedy of short action and another of long action, each corresponding with some of the morbid symptoms, I alternated the use of those medicines with the greatest success.
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