| paper read before the International Hahnemannian
Association at Niagara Falls, 1888
What is more beautiful to look upon than the bud during its hourly
changes to the rose in its bloom. This evolution has so often come
to my mind when patiently awaiting the return of symptoms after
the first prescription has exhausted its curative power. The return
symptom-image unfolds the knowledge by which we know whether the
first prescription was the specific or the palliative, i.e., we
may know whether the remedy was deep enough to cure all the deranged
vital wrong or simply a superficially acting remedy, capable of
only a temporary effect. The many things learned by the action of
the first remedy determine the kind of demand made upon the physician
for the second prescription.
Many problems come up to be solved that must be solved, or failure
may follow.
How long shall I watch and wait? Is a question frequently asked
but seldom answered.
Is the remedy still acting? Is the vital reaction still affected
by the impulse of the remedy?
If the symptoms are returning, how long shall they be watched
before it is necessary to act or give medicine?
Is the disease acute or chronic?
Why is the second prescription so much more difficult than the
first?
Why is it that so many patients are benefited when first going
to the physician and thereafter derive no benefit?
I presume that most good prescribers will say: "We have often
acted too soon, but never waited too long." Many physicians
fail because of not waiting, and yet the waiting must be governed
by knowledge. Knowledge must be had, but where can it be obtained?
To know that this waiting is right is quite different from waiting
without a fixed purpose. This knowledge cannot be found where its
existence is denied; it is not found with unbelievers and agnostics.
When the first prescription has been made and the remedy has been
similar enough to change the existing image, we have but to wait
for results. The manner of change taking place in the totality of
symptoms signifies everything, yet the manner of the return of the
image, provided it has disappeared, signifies more.
First. If aggravation of symptoms follow;
Second. If amelioration of symptoms follow;
1. Aggravation of exiting symptoms may come on with general improvement
of the patient, which means well; but --
If aggravation of the symptoms is attended with decline of the patient
the cure is doubtful, and the case must be handled with extreme
care, as it is seldom that such patients recover perfectly.
2. If amelioration follow the prescription, to what does the amelioration
apply?
It may apply to the general state or but to the few symptoms. If
the patient does not feel the elasticity of life returning, the
improved symptoms are the facts upon which to doubt recovery.
The knowledge that the disease is incurable often is obtained
only in this way. In such cases every remedy may palliate his sufferings,
but cure does not come. The symptoms that are the expressions of
the debility are there, and hence the totality of the symptoms is
not removed.
After the curative impulse has entirely subsided, the symptoms
will appear one by one, falling into place to arrange an image of
the disease before the intelligent physician for the purpose of
cure.
If the first prescription has been continuously given, there has
been but little if any chance of a pure returning image of the disease,
therefore this image must be very unreliable.
When the remedy has been fully exhausted, then, and only then,
can we trust the symptoms constituting the picture.
If the first prescription was the similimum, the symptoms will
return - and when they return - asking for the same remedy.
Too often the remedy has been only similar enough to the superficial
symptoms to change the totality and the image comes back altered,
therefore resembling another remedy, which must always be regarded
as a misfortune, by which the case is sometimes spoiled, and the
hand of the master may fail to correct the wrong done.
Whenever the symptoms return the same image, calling for the same
remedy, then it is that we have demonstrated, that - for a time,
if the disease be chronic - we can but recommend the range of dynamics
to cure this case. This rule is almost free from exceptions if the
remedy is an antipsoric.
What must the physician do who has not the knowledge of dynamic
medicines? He must sometimes see sick images come back without change
of symptoms, though I believe it is seldom.
The symptoms may call for Phosphorus as strongly as when he began,
and Phosphorus 6x has served and no longer cures. What can he do
but change his remedy?
Can it be possible that man can be so ignorant of how to cure
as to give a drug that is not indicated because the one that is
indicated does not cure?
These ignorant mortals condemn the system of Homoeopathy and feel
that they have performed their duty to the sick, forgetting that
ignorance was the culprit.
I have observed in cases where a low potency had been administered
in frequently repeated doses, that some time must elapse before
a perfect action will follow the higher potency; but where the dose
had not been repeated after its action was first observed, the new
and higher potency will act promptly.
When the symptoms come back - after prudent waiting - unchanged,
the selection was correct, and if the same potency fail to act a
higher one will generally do so quite promptly, as did the lower
one first. When the picture comes back unaltered except by the absence
of some one or more symptoms, the remedy should never be changed
until a still higher potency has been fully tested, as no harm can
come to the case from giving a single dose of a medicine that has
exhausted its curative powers. It is even negligence not to do such
a thing.
Proper Time to Change
When the demonstration is clear that the present remedy has done
all it is capable of doing - and this demonstration can not be made
until much higher potencies than usually made have been tried -
then the time is present for the next prescription.
To change to the next remedy becomes a ponderous problem, and what
shall it be?
The last appearing symptom shall be the guide to the next remedy.
This is so whenever the image has been permitted to settle by watching
and waiting for the shaping of the returning symptom-picture. Long
have I waited after exhausting the power of a remedy, while observing
a few of the old symptoms returning; finally a new symptom appears.
This latest symptom will appear in the anamnesis as best related
to some medicine having it as a characteristic which most likely
have all the rest of the symptoms.
It is not supposed that this later appearing symptom is an old symptom
on its way to final departure, for so long as old symptoms re-appear
and disappear it is granted that no medicine is to be thought of.
It is an error to think of a medicine when a symptom-image is
changing. The physician must wait for permanency or firmness in
the relations of the image before making a prescription.
Some say, "I must give the patient medicine or he will go
and see someone else." I have only to say that it were better
had all sick folks gone somewhere else, for these doctors seldom
cure but often complicate the sickness.
The acute expressions of a chronic disease have a different management
from the acute disease, e.g., a child suffers from bronchitis in
every change of weather. It may grow worse if treated with the remedy
for the acute symptoms.
The miasm that predisposes the child to recurrent attacks must
be considered.
One recently under my care had received Antimonium tart., Calcarea,
Sulphur, Lycopodium, etc., in such indiscriminate confusion that
the child was not cured. The waiting on Sac.-lac. through several
attacks permitted the drug-effects to pass off, and the true image
of the sickness was permitted to express itself through several
of the exacerbations taken as a whole.
When western ague is complicated with a miasm, a single paroxysm
does not fully express the totality, but several must be grouped
and the true image will be discovered. If the acute disease be complicated
with a miasm the indicated remedy will wipe it out "cito, tuto
et jucunde."
Avoid Haste
All things oppose haste in prescribing. In very grave diseases
haste is a common error, more frequently with the second prescription
than the first. Many doctors suppose that a diphtheria demands a
medicine immediately because "something must be done."
This is an error; many a life has been saved by waiting and waiting.
For example:
A little girl was suffering from a severe attack of diphtheria and
the mother had treated it four days with Mercurius 3x, and Kali
bich. 3x, in alternation. She was poor, and therefore I did not
refuse to take the case which was then in a very bad state: nose,
mouth and larynx full of exudate.
After a long study the child received Lycopodium cm., one dose,
dry, which cleared out the exudate from nose and fauces, but did
not touch the larynx.
I dare not tell you how long I watched that child before I saw
an indication for the second remedy which it would have needed had
the Lycopodium been given when the child first took sick. I waited
until the poor child was threatening dissolution when I saw a little
tough yellow mucus in the mouth. Kali bich., cm., one dose, cleared
the larynx in one day and there was no further medication necessary.
The first prescription is made with the entire image of the sickness
formed. (People usually send for the doctor after there can be no
doubt of the sickness to be treated.)
The doctor watches the improvement of the patient and the corresponding
disappearance of the symptoms under the first prescription, and
when the case comes to a standstill he is uneasy, and with increasing
fidgetiness he awaits the coming indication for the next dose of
medicine.
The fidgetiness which comes from a lack of knowledge unfits the
physician as an observer and judge of symptoms; hence we see the
doctor usually failing to cure his own children. He cannot wait
and reason clearly over the returning symptoms.
While watching the prescriptions of beginners, I have observed very
often the proper results of the first prescription. The patient
has improved for a time, the ceased to respond to any remedy.
Close investigation generally reveals that this patient improved
after the first dose of medicine, that the symptoms changed slightly
without new symptoms, and the new "photo" seemed to call
for some other remedy, when, of course, the remedy was changed and
trouble began. Constant changing of remedies followed until all
the antipsorics in the Chronic Diseases had been given on flitting
symptom-images, and the patient is yet sick. This is the common
experience of young Hahnemannians trying to find the right way.
Some of experience make lesser blunders and some make few, but how
many have made none? All of these blunders I have made, as I had
no teacher, until I blundered upon the works of the great Master.
Wait and Observe
The first prescription may not have been well chosen medicine,
and then it becomes necessary to make a second effort.
As time brings about the re-examination of the patient, new facts
are brought out in relation to the image of the sickness, indicating
that the first medicine had not been suitable; perhaps several weeks
have passed and the re-examination finds no change in the symptoms.
Shall I compare all the facts in the case to reassure myself of
the correctness of the first prescription, or shall I wait longer?
Yes, to the former, of course, and if the remedy is still the
most similar to all the symptoms, wait, and watch, and study the
patient for a new light on his feelings to which he has become so
accustomed he has not observed.
Commonly the new study of the case will reveal the reason why
the first prescription has not cured: it was not appropriate.
If it still appears to be the most similar remedy the question
arises: "How long shall I wait?"
At this point it should be duly appreciated that the length of
time is not so important as being on the safe side, and "wait"
is the only safe thing to do. It may have been many days, but that
matters not, wait longer.
The finest curative action I ever observed was begun sixty days
after the administration of a single dose.
The curative action may begin as late as a long-acting drug can
produce symptoms on a healthy body. This guide has never been thought
of by our writers, but it is well to be considered. Why not?
It is the practice for some to go lower if a high potency has
failed.
This method has but few recorded successes but should not be ignored.
The question next to be considered is the giving of a dose of
medicine in water and divided doses. This has at times seemed to
have favor over the single dry dose. This is open for discussion,
requiring the testimony of the many, not of few, to give weight.
The best reports are made from both methods, and both are in harmony
with correct practice.
Improper Action
The next important step to be considered is when the first prescription
has acted improperly, or without curative results. Then it becomes
necessary to consider a second prescription. The first prescription
sometimes changes the symptoms that are harmless and painless into
symptoms that are dangerous and painful.
If a rheumatism of the knee goes to the heart under a remedy prescribed
for the one symptom, the remedy has done harm. It is an unfortunate
prescription and must be antidoted. In incurable diseases when a
remedy has set up destructive symptoms, an antidote must be considered.
If the remedy changes the general symptom-image, and the general
state of the patient is growing worse, the question then comes up,
was the prescription only similar to a part of the image, or is
the disease incurable? Knowledge of disease may settle this question.
If the disease is incurable, the action of the remedy was not expected
to do more than to change the sufferings into peaceful symptoms,
and the second prescription is to be considered only when new sufferings
demand a remedy.
But suppose such a change of suffering comes after the first prescription
and the disease is undoubtedly curable, then the conclusion must
be that the first prescription was not the true specific, and that
the true image has not been seen.
Wait until the old image has fully returned is all there is to
do.
It is hazardous practice to follow up rapidly all the changing
symptoms in any sickness, with remedies that simply for the moment
seem similar to the symptoms present. The observing physician will
know by the symptoms and their directions, whether the patient is
growing better or worse, even though he appear to the contrary to
himself and his friends.
The complaints of patient or friends constitute no ground for
a second prescription.
The greatest sufferings may intervene in the change of symptoms
during progress of permanent recovery, and if such symptoms are
disturbed by a new prescription or palliated by inappropriate medicine,
the patient may never be cured.
The object of the first prescription is to arrange the vital current
or motion in a direction favorable to equilibrium, and when this
is attained it must not be disturbed by a new interference. Ignorance
in this sphere has cost millions of lives.
When will the medical world be willing to learn these principles
so well that they can cure speedily, gently and permanently?
There can be no fixed time for making the second prescription;
it may be many months.
The second prescription must be one that has a friendly relation
to the last one or the preceding. No intelligent prescription can
be made without knowing the last remedy. Concordances in Boenninghausen
must not be ignored. The new remedy should sustain a complementary
to the former.
Remedies Suitable to Follow
In managing a chronic sickness the remedy that conforms to an
acute experience of the illness is worth knowing, as very often
its chronic may be just the one that conforms to its symptoms.
Calcarea is the natural chronic of Belladonna and Rhus;
Natrum mur. sustains the same relation to Apis and Ignatia;
Silicea to Pulsatilla;
Sulphur to Aconite;
When Pulsatilla has been of great service in a given case and
finally cures no more, while the symptoms now point to Silicea,
the latter will be given with confidence as its complementary relation
has long been established.
On the other hand Causticum and Phosphorus do not like to work
after each other, nor will Apis do well after Rhus.
How physicians can make the second prescription without regard
to the experience of nearly a century, is more than man can know.
These things are not written to instruct men of experience in
the right way, but for the young men who have asked so often for
the above notes of our present practice.
I am told almost daily that this kind of practice is splitting hairs,
but I am convinced of the necessity of obeying every injunction.
Careful Records
You should have no confidence in the experience of men who do
not write out faithfully all the symptoms of the patient treated,
and note carefully the remedy, and how given. Especially is this
necessary in patients likely to need a second prescription.
The physician who has in his case-book the notes of every illness
of his patients has wonderful hold of any community. He has the
old symptoms and the remedies noted that cured, and he can make
indirect inquiry after all the old symptoms long ago removed.
The pleasure is not small found in consulting such a case-book.
Experience soon leads the close prescriber to note all the peculiar
symptoms and to omit the nondescript wanderings indulged in by sick
people; however, it is important to be correct in judgment.
Many physicians make a correct first prescription and the patient
does well and cheers up for a while, but finally the test is made
for the second and then all is lost. Homoeopathy is nothing if not
true and, if true, the greatest accuracy of detail and method should
be followed. It is fortunate that the physicians who repeat while
the remedy is acting are such poor prescribers or their death-list
would be enormous.
|