When, in the February and April numbers of this REview, (2 Ibid. 1863) 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 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 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 kind of cure that should satisfy the physician desires. It is neither 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 chief part of his duty. Though his method were not not the best of known methods, he is not to be blamed without qualification.
2. But, although, from the ethical stand-point, we may concede that:
” ‘T is better to have” erred and cured
” Than never to have” cured “at all,” we think there is abundant reason for cautioning the practitioner to beware of confounding the misfortune of the error. with the good-luck of the cure.
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 cure are to be instructed, 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 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 be 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 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.
The soliloquy of the doctor will depend very much upon the nature of the mental process by which he arrived at the mode of treatment that cured the patient. It may be:
1. “How can I ever be thankful enough for the lucky accident that made me give him Ledum! My I be as fortunate when I guess again!” or,
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 case, may cure the case of 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. The case, then, gives me fresh zeal in my study of Materia Medica;” or.
4. “This case coast me much study. I saw that the symptoms of the abdomen and digestive canal as we as those of the lumbar 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 have 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 neighbour 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 and 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 give 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 year to her room and couch, could now walk, drive, and go about the house as well as eve. (1 See “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 father and faster, even over dark and uncertain ways, than any make-shift and irrational expedient would be likely to do;” or.
5. “In this case of dysmenorrhoea the symptoms of the head and eyes are very characteristic of Cyclamen. 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 organ, s 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 the 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 Cyclamen, 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 proving will demonstrate to us that this remedy, if fully proved, would really cover the entire case, characteristic 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.”
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.