By M. D. Coe, M. D., St. Charles, Ill.

Much has been written of late on the subject of the alternation of remedies, and as it is a question which must be decided by experience, as must every other question of medical practice, no dogmatism will satisfy or bring together those differing in opinion. I conceive that the discussion in the February number of the Review does not cover the whole ground, nor does Dr Hawley touch some reasons which have most influenced me to alternate. I purpose in this article to give some of the principles which have governed me in my practice.

Specific action pertains to every organ and tissue of the human system. Each gland, each membrane has its specific office, selecting and secerning from the blood or the cast off elements, its own appropriate secretion. In each tissue are arrested by some elective process, just such elements as are necessary for its growth or maintenance. The avenue is closed to all other unless some toxical agent is thrown in which has power to arrest the normal process.

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 upon 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.

When I visit a patient, I endeavor to get a perfect impression, or image, if you please, of the disease, of its symptoms and pathology. Then applying my governing law “like cures like,” I endeavor to find a pathogenetic picture which will exactly correspond to, or be a likeness of the image of the disease. If in searching my drug-provings, I find in the pathogenesis of a single remedy a picture which is a perfect likeness, I administer that remedy alone. When I lay the picture upon the image, it exactly covers it. But supposing after exhausting my pathogenetic lore, I find no single remedy that will complete the picture; 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 limbs unmistakably Rhus symptoms and nothing else, I can finish my picture in no other way, nor can anyone else. Now in this case what is to be done? If I use only one remedy, I move only one group of symptoms at a time and they must be taken in succession, while if 1 alternate, I act upon all at the same time. 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 remedies 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.

The objector may ask, “Why not then combine your remedies and administer them all at once after the manner of the old school? Because they might chemically affect each other, and effect a change of substance, so that we should be administering something different from the original remedies. If we could be certain in any case that there was no chemical union, no modification of the substance, but simply a mixture, I am satisfied that we might administer combined remedies, upon the basis of their individual pathogenesis, and trust to the animal economy to do its own selecting and appropriating. But as we cannot be satisfied that there is no modification of substance, we cannot be certain of effects until we have provings of combined medicines. “But,” says the objector again, “may not your remedies administered at short intervals chemically combine and produce a change of substance after they are taken?” No, for each does its part, by making its specific impression upon the nerves which it specifically affects, and this nerve force or impression is communicated to the cells specifically adapted to receive it; and that force or impression for which they have no specific affinity cannot affect them. I, therefore, have always preferred, when I could not find a drug whose symptoms completely covered the symptoms of disease, to use two, and i have even used three in alternation. If we had a Materia Medica so perfect, that a perfect likeness of each abnormal condition of the animal economy could be found and in the pathogenesis of distinct drugs, then I should have no controversy with the advocates of the single remedy system, and in fact the only reason why I practice alternation, is this want of perfection.

To exemplify a little further our meaning, we will change the figure. I find my patient being preyed upon by a disease in the form of a double-headed monster, each head, as far as I can discern, possessing independent vitality. My patient asks to be delivered from its power. Being anxious to relieve him as soon as possible, I seize a club in each hand, determined to deal a blow to each head at the same time. Just as I have raised my clubs to strike, my arm is arrested and I hear a voice frantically exclaim, “Hold, Dr.! What in the name of science and the master are you about to do?” I reply: “You see that double-headed monster prying upon the vitality of my patient. He asks me to rescue him and I am taking the shortest method of doing so.” ” But,“ says my interrogator, “you make an awkward appearance with a club in each hand, you cannot strike scientifically with two clubs at once, and then the master always taught that you should only use one, and after that was used up to take another. I would use one club, on one head, until I had killed it, then I would take the other and kill the other head.” In reply I tell him that by using two clubs at once, I can kill both heads in the same time that he would require to kill one, and as the relief of my patient is my only object, not caring how it is done, I shall not hesitate to use both clubs at once even if my attitude be not as graceful and my procedure as scientific as you could desire. I practice homoeopathically. Feeling conscience-striken because I have kept my patient so long in waiting, I fall to belaboring both heads of the monster by using both clubs simultaneously; and after I have dispatched him, I turn round and see standing behind me one of the editors of the Review, with sorrow depicted in his countenance and exclaiming, “You are not a Homoeopathician.”

REMARKS. - This article very justly affirms that the question of alternation, being a practical one, “must be decided by experience;” that no dogmatism will satisfy those differing in opinion. The writer then straightway proceeds to dogmatize, on the basis of two assumptions, which he claims to be “established principles in Homoeopathy,” but which very few will concede in the terms in which he has expressed them.

Having referred the question to experience, he makes no appeal to experience, whether his own or his neighbors. If he have experience which can throw light on this question, it ought to be comparative experience. He ought to be able to say, “for a certain period of times I avoided alternation, selecting my remedies as Hahnemann directs; then, for a period, I alternated. My success under the latter method was the greater.” Such a statement as this would carry weight. But we gather from this article that Dr. Coe has always practiced alternation, deriving his ideas of its propriety and necessity from the assumed “established principles” upon which he bases his arguments, and upon the assumed imperfections of the Materia Medica.

If our conjecture be correct, then his experience, being confined to the practice of alternation and not bearing upon the opposite method, can have only a negative value. It merely shows that a measure of success does attend this faulty form of practice, a point which was freely conceded to Dr. Hawley. But inasmuch as no advocate of alternation claims invariable success, the question remains, “might not the success have been greater if alternation had been avoided?“Not having any comparative experience by the light of which to answer this question, the alternator-ab-iuitio, could not reply.

Our editorial note to Dr. Hawley's paper expressly referred to Hahnemann's experience, and to the experience of the writer, as being of this comparative character and as therefore bearing on this question, and as showing, so far as they go, that the results of adherence to the single remedy are more satisfactory than those of alternation.

Some of the points touched by Dr. Coe are too important to be treated in this annotation. They will be discussed in a future number of the Review.

Suffice it now to say that, when he states that “the only reason why he practises alternation is the want of perfection of the Materia Medica,” - he concedes, if he will allow us to add one other analogous reason, viz., ” want of perfection in the knowledge, possessed by practitioners, of the Materia Medica which we already have,” all that the opponents of alternation contend for. For this position admits that alternation is wrong in principle and is only necessitated by a temporary emergency, we contend that the emergency instead of being common, is rare, if not altogether imaginary and we appeal to our practice.

How dangerous it is to discuss a question of science with rhetorical figures!

Dr. Coe makes merry over his imagined double-headed monster, for each head of which he provides a club, and he grows happy at the thought that by his two-handed energy he will have destroyed this figurative disease much more quickly than the luckless editor could do it, whom he restricts to the use of a single club to be applied to but one head at a time.

Now we have always supposed that the efficacy of an armament depended not so much upon the number of efficient weapons as upon the skill with which the weapons existing were used, and one club in a vigorous right hand might do more execution even on a double-headed monster, than two clubs even in the hands of our ambidexterous correspondent. But why restrict the monster to the “two-headed” form? If we are to admit the dual or multiple independent co-existence of disease, why not liken it to do centipede, each foot “possessing independent vitality.” With what armament now will our friend cope with his antagonist? Shall he call Briareus in consultation and arm him with one hundred clubs? We do not believe in the multiple co-existence of disease. Leaving out of view traumatic affections which may supervene during idiopathic sickness, as Drysdale shows, we believe in the unity of disease and we expect to find one remedy of which the characteristic symptoms cover the whole case.

The figure of the two-headed monster is, therefore, in our view, defective. But, admitting the figure, why must we use clubs at all? In the days when brute force reigned supreme they were well enough. But surely, in this day of enlightenment ”clubs are not trumps.“

Hercules was the embodiment of brute strength as distinguished from intellectual acuteness and skill. Surely his subjugation of the Lernean Hydra should not serve us as an example in treating disease. We cannot afford to spend so much time as the club-treatment requires; for both the experience of Hercules and that of our Irish friends at Donnybrook fair, prove that the breaking of heads by clubs is a tedious and uncertain affair. We decline to enter into competition with our friend in the use of his favorite therapeutic agent, the club, whether he use it single, double or a hundred-fold. But, if he insist on a mechanical figure, we will suggest that, while he is counting the heads of the monster and is casting about in his club-room for a bludgeon adapted to each head, and is fitting his hands for the arduous effort and is so getting his balance, as to make sure that the complex wielding of his numerous weapons shall not trip him up, we shall humbly survey the monstrous form with the intent to study the controlling characteristics of its anatomical structure, and when we shall have learned to what type it belongs and what are its characteristics as an individual, then with one single weapon (a slender sword, it may be, or a bodkin, or a drop of Prussic acid) we shall touch the vital part (the heart, or the medulla, or a delicate mucous membrane), on whose integrity depends the life of all the heads and all the rest — and presto - before the ponderous clubs have time to fall on those devoted heads” belaboring them simultaneously“ — the work is done.

Multiplicity in armament is generally inconsistent with simplicity and efficiency and is characteristic of a barbaric age or race.

Thus the double-club array is known as the ”Indian clubs.“

The Japanese wear two swords, and yet cannot stand a moment before the single rapier of the Frenchman.

The savage of the Southern States glories in his belt full of six-shooters, and his boot legs bristling with bowie-knives. Before the single purpose of the Northern farmer, he is rapidly passing into the realm of history. [Eds.