The Second Prescription
NATIONAL JOURNAL OF HOMOEOPATHY 1999 Mar / Apr VOL VIII NO 2.
Dr Adolph Lippe
Dr Von Boenninghausen in his "Lesser Writings" had drawn the attention of Homoeopaths about Dr Hahnemann's precautions to be observed in practice against the following three errors. They are:
- To presume that the doses of potentised remedies are too small.
- Improper selection of the remedy.
- Hastiness in not allowing each dose sufficient time to develop and exhaust its action.
Long experience has taught us that the most difficult task the healer has to perform is proper and timely administration of the second dose, either of the same remedy or of another remedy. The most serious mistake a Homoeopath often makes is in not following the third precautionary rule quoted above. The same caution is to be exercised both in acute and chronic cases. While in chronic diseases the mistake may be possibly corrected in course of time, in acute cases the same mistake may bring about a fatal termination or the case may be protracted with the cure never complete.
Waiting Is The Best Policy
In an acute case after carefully noting the symptoms and analyzing the same, one may administer the most similar remedy in a single dose. He can never know when this single dose will exhaust its effect. There is rarely an acute case where the symptoms do not appear almost immediately after giving the remedy showing the close observer the effect of the remedy. Frequently the condition of the sick become more natural or sleep almost immediately follows or the mental symptoms or countenance of the sick person change or suppressed secretions are suddenly restored. If such symptoms occur almost immediately after the administration of the single first dose, it is reasonably certain that its action, if not interrupted, will last for a considerable length of time. It, therefore, becomes absolutely necessary to wait till the effect of this single dose has been fully exhausted, before another dose of the same or another remedy is given. Why at all more medicine should be given if the patient is improving and the single dose is sufficient to cure? We are not alone in offering this testimony to this fact. .Dr G H Carr said that he treated in 1878 and 1879 one hundred cases of diphtheria , which is a very difficult acute disease to handle, without any deaths . He rarely had to repeat the dose and found that the single dose acted as well in the most malignant as in the lightest cases.
Second Dose In Plussing
When a well-selected remedy has been given in a single dose and when the improvement is of short duration the symptoms may either be the same as before or they may have changed., so that the same remedy may no longer be indicated; then a second dose becomes imperatively necessary. If the same remedy is still indicated, it will generally be best to repeat it in watery solution and administer it in spoonfuls at shorter or longer intervals till a decided improvement begins.
If, however, another remedy is indicated on the basis of presenting symptoms, it is again best to administer the new remedy in a single dose and carefully note the results., never repeating it till its action is fully exhausted; if its effects are of a short duration it is time enough to repeat it but in a different potency.
It has been frequently seen that the proper remedy was selected and the single dose was administered in watery solution but in rapidly repeated doses under the erroneous belief that a grave acute disease required such frequent repetitions. If then, as a consequence, the patient appeared much worse after the lapse of some hours did it not show that this aggravation was merely an artificial increase of the symptoms caused really by an overdose of the remedy? If the physician wisely discontinues the medicine he will soon be rewarded by the fact that this artificial aggravation gives place to permanent improvement. If in the event of such an aggravation, the doctor becomes unnecessarily alarmed and suddenly and untimely changes the remedy he will find that this mistake will lead to the gravest conditions. Such mistakes can hardly ever again be corrected. The mistake becomes more serious when a high potency was unnecessarily repeated than when the patient was given appreciable doses of the remedy in same potency in water.
When in an acute case repeated doses of various remedies have been administered injudiciously, a recovery will still follow when a well -selected remedy is given in high potency. We have an illustration of this proposition.
Case: An elderly lady was attacked with Asiatic cholera. Her physician exhausted all the remedies he knew of; Camphor, Arsenic, Cuprum and Secale-cor were given often in short intervals and in low potency. Her condition deteriorated. A careful evaluation of the totality of the symptoms pointed to Ver-alb as the similar remedy. A single dose of that remedy in 200 potency was placed dry on the tongue of the lady. In less than five minutes the patient fell fast asleep, passed a large quantity of urine, skin became hot and a warm perspiration ensued. When she awoke, after more than 4 hours of sleep, she once more complained of cramps when another dose of Veratrum-alb was given and the attack was entirely broken up.
Another Situation: If an improvement has begun after the administration of the remedy, new symptoms sometimes arise, which were not present initially. These new symptoms may belong to the remedy and if so, will subside without further aid. They should be carefully noted and if these symptoms show an improvement in the pathological condition, as, for instance, pain in a paralyzed part of the body or restlessness and tossing in a comatose patient, or cough with expectoration in a case of diphtheria, it will be necessary to wait still further for the action of the drug or for the continuance of the improvement in the pathological condition.
On the other hand, if these newly arising symptoms do not belong to those described above but in reality an increase in the disease, then we must administer at once a second dose, most likely another remedy but caution is needed that such a course is not adopted when the new symptoms do not point to deterioration in the disease condition as it will lead to bad consequences. Full knowledge of pathology will enable the healer to judge correctly the arising symptoms in an acute disease and to realize that the curative process has begun and he has to wait. Second dose will be warranted only when the healing process has halted and does not show any further progress.
The same rules apply to chronic cases. There are cases where a single dose of the remedy will cause a gradual improvement, lasting for weeks or months. If it becomes necessary to repeat the same remedy it is always advisable to give in another potency. In chronic cases, it sometimes happens, just as in acute cases, that the action of the remedy is of short duration; the second dose may then be given in watery solution and be repeated frequently and for a long time; in some cases it becomes necessary to continue this medication for many weeks till the action of the remedy becomes apparent.
Not infrequently it happens that after the first dose there is improvement which continues for weeks where after it is followed by reappearance of the early symptoms of the chronic disease, but never so violent as before. It is desirable to wait for a reasonable period say a week or ten days before thinking of giving a second dose. Otherwise there will be grave consequences as the progress of the cure will be retarded and may necessitate antidoting the second dose and it may change the disease condition for the worse.
When we have gained this knowledge by actual experiment and when we ask these questions and profit by the answers while practicing, we will appreciate why we should be extremely cautious in administering the second dose.
First read the Organon of the healing art, then study the Materia Medica. Observe the above rules in practice and publish the results. There will be no more failures and there will be no need to resort to any auxiliary and supplementary measures.
Editor's Note: Obviously the article was based on the previous edition (5th) of Organon. Under Aph 246, he says that in chronic cases, in order to effect improvement in a shorter period of time the highly potentised medicine ( ie his new potency) should be dissolved in water and given in proper small dose that experience has taught us as the most suitable in definite intervals with the precaution that degree of every dose deviates somewhat from the preceding and following in order that the vital force which is to be altered to a similar medicinal disease be not aroused to untoward reactions and revolt as is always the case with unmodified and especially rapidly repeated doses. He adds in a footnote to this Aphorism "During the last four or five years all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely, after the lower degree of potency has been used for one or two weeks in the treatment of chronic diseases advance is made in the same way to higher degrees ( beginning with the lowest degrees).
Dr P Schmidt admirably summarises the changes in his pamphlet "The Hidden Treasures Of The Last Organon":
- The choice of the remedy shall be strictly determined in accordance with the law of Similars.
- It shall be administered in an infinitesimal potency
- After being extensively diluted and highly dynamised.
- Absorbed dissolved in water
- Administered in general in very small quantities (1 coffee-spoonful)
- Repeated at intervals which experience has proved suitable to effect as speedy a cure as is possible
- Taking great care, however, in repeating to vary the potency so that dose should differ slightly from those preceding and following
- In acute cases where no improvement is observed, the dose is to be repeated with modified potency as above and (this is quite new) in chronic cases, where the treatment has proved effective, then, in order to speed up the cure, the remedy may be given daily and for months, if necessary. In Aph 247 Dr Hahnemann clearly gives the reason- that it is unwarranted to repeat the same unchanged dose of the a remedy once or more as the vital force does not accept such unchanged doses without resistance in view of the fact that the former dose has already accomplished the expected change in the vital force and a second dynamically wholly similar unchanged dose of the same medicine no longer finds, therefore, the same conditions (derangement) of the vital force. The patient may be made more sick by such repetition .But if the succeeding dose is changed slightly every time and somewhat higher, then the vital force may be altered without difficulty by the same medicine and thus the cure brought nearer.