BY J. R. COXE, JR., M. D., PHILADELPHIA, PA.

The alternation of remedies in the treatment of disease is now, and has been for a long period, a very fruitful source of controversy among the best and most distinguished physicians of the homoeopathic school. It is, confessedly, a subject of very great importance and demands our most serious attention.

The general philosophy of Homoeopathy, its law — Similia Similibus Curentur — plainly indicate that each individual case of disease ought to be attacked and conquered by one remedy. Hahnemann says, “In each and every case of disease, before the remedy can be selected with confidence of success, the totality of the symptoms, a perfect image of the disease, is to be obtained, and the homoeopathic remedy is that drug capable of producing a similar totality — an exact image. This great truth is the foundation stone of Homoeopathy and reasoning, a priori based upon it leads irresistably to the conclusion that a single remedy is all sufficient for the end we have in view.”

Thus, theoretically, the question appears to be settled, but in a practical point of view, in such cas esas we are daily called to treat, how does this question stand? We are all of us perfectly aware that the cases of any disease, acute or chronic, where a cure is effected by one single medicine are rare indeed, in fact somewhat like angels visits. We have to use during the progress of the disease two or more remedies, in alternation or in succession, before we are able to effect a cure, and this is the case even in the acute form of nearly every disease, at least such is ray experience after an extensive practice of twenty-five years. Now, how are we to reconcile this discrepancy, or, can it be reconciled? If not, then, assuredly must theory yield to facts. Our illustrious founder has made a very clear and marked distinction between the nature and the origin of acute and chronic diseases. He ascribes the origin of all chronic diseases to Psora, Syphilis and Sycosis, and he produces an amount of evidence in its favor, certainly sufficient to satisfy any impartial man, though parts of the evidence may be defective in logical strength or may even be denied in toto.

It is well known to all physicians of every school, that when Psora or Syphilis are once well developed in the system they will continue, unless removed by the attending M.D., during the whole life of the individual, in this they differ from many acute diseases which are often, I may say very often, cured by nature alone — vis medicatrix naturoe; and, as Dr. Forbes very truly remarks, the physician receives the credit, thus defrauding nature.

By his psoric theory, Hahnemann did not mean the Itch as certain ignorant physicians have asserted; on the contrary he calls it the multiform Psora, and says it includes all the scaly, papular and herpetic eruptions described by Willan and others. The itch theory is an old medical dogma, and was very prevalent long prior to the birth of Hahnemann. It was very strongly supported by Autenrieth, and by Schonlein the celebrated allopathic professor in Berlin.

The psoric theory was not original with Hahnemann; on the contrary it was also an old medical dogma and was strongly advocated by many eminent physicians before he was born. This is clearly proven by his quoting a very large number of his predecessors in medicine, and all that he claimed was that he furnished additional proof of its truth, and of its value to the physician in his treatment. I, therefore, do perfectly coincide with the opinion of Professor Henderson, of Edinburgh, who states, “This psoric hypothesis is, substantially one of the most incontrovertible doctrines of modern Pathology. It was held by nearly all the distinguished predecessors of Hahnemann, is now held by a vast number of learned allopathic physicians and by them only is it held as an itch doctrine. We have now all the essentials of Hahnemann's psoric pathology in the doctrines of his allopathic successors. It is nearly identical with the Dyscrasic pathology of the present day which recognizes a morbific admixture, taint, or poison of some kind, as the cause of a vast number of chronic diseases, and this is, in fact, all that Hahnemann contends for.”

It is a merciful provision of the Almighty that the more acute and potent forms of disease are, in general, removed from the central portions of the body to the circumference where there is less danger to life. The bones, the skin and the muscles bear far better, and for a longer period, the disorganizing effects of disease than the heart, the lungs, etc. When, then, these effects of Psora, or Syphilis, are suppressed and driven inwards by lotions, etc., as is yet done by the Allopaths, they invariably have a strong tendency to attack some one of the central and vital organs, in very many instances producing sudden death, and this is the experience of every medical man of every school for hundreds of years, and these different diseases thus thrown inwards were, as a rule, transmitted from parent to offspring from generation to generation with as much certainty as mental peculiarities, and thus became far more difficult to eradicate or cure. All medical men agree that Phthisis, Schirrus, Epilepsy, cum multis aliis, are hereditary, and nearly all chronic diseases are said by numerous very distinguished men to pursue the same course. The disease, whatever it may be, when thus hereditary, is aroused from its latent and quiescent state by various circumstances, in fact, by whatever has a tendency to disturb the normal functions of life.

It is this state of mankind, it appears to me, as it has appeared to many others, which, absolutely, compels the physician to alternate his medicines, to give two or more, as in his judgement may be necessary at intervals varying from five minutes, as in Croup, to five hours. Dr. Boenninghausen gives three remedies in croup at short intervals. He is an experienced man and he cannot be called an half Homoeopath, at least he ought not so to be; Hering, certainly in my estimation the most distinguished of American Homoeopaths, cured a case by the alternate use of Ruta tinct. and Ignatia. Would any man call him an half Homoeopath? Hahnemann cured a case by the alternate use of Bryonia tincture, and Pulsatilla. Was he an half Homoeopath? I could mention many more distinguished physicians who find it absolutely necessary to alternate their remedies, in fact they could not cure the case without alternating; yet some of these men say they do not alternate, but merely give different remedies in succession — Pooh, pudor! Here is a distinction without a difference,“ a rose by any other name would smell as sweet,” and I can use either word to express the same idea.

In an article written by our worthy Colleague, Dr. Payne, of Bath, and published some years since in the Philadelphia Journal of Homoeopathy, Vol. II, June, Sept. and Oct. 1853, upon the alternation of remedies, he establishes, in my opinion, the absolute necessity of alternation. I would call the attention of the profession to this essay of Dr. P.; it is well worthy of republication and of attentive perusal.

Payne says, “The alternating remedy in acute diseases is for the purpose of holding in check the hereditary or acquired latent disease, either psoric or syphilitic, or in both combined, as is often the case, until the acute disease can be overcome. In this consists the importance which Hahnemann attaches to the history of the case, or, in other words, the history of the abnormal manifestations, both mental and physical. All the symptoms in a given case may be acute, and we may readily find a remedy which completely covers them. The symptoms are for a time ameliorated, but eventually they increase. We repeat the remedy with no result. What are we now to do? Many of the Lest homoeopathic physicians tell us to give Sulph.³⁰ and then repeat the former remedy. We do so; if Sulphur is the remedy we succeed, if not, we fail; ultimately some of the more noble organs are attacked, perhaps Phthisis or some other equally dangerous disease is developed and the case becomes hopeless. In the commencement if we had carefully enquired into the previous history of the patient and also of his parents, as Hahnemann advises us always to do, and had selected the remedy which covered the abnormal condition thus found as an alternating medicine, we might, and probably would have succeeded in preventing the fatal termination.”

Aye, say hundreds and thousands of the best homoeopathic physicians, alternate and save your patients. No, say, those who disapprove of alternation, a very trifling minority, go on with the medicine, don't alternate, no matter what may be the result — no one but a half Homoeopath will ever alternate. Payne also thinks that the alternating remedy should be an anti-psoric and in this, as a general rule, I fully agree with him, though I have found the exceptions in my practice somewhat frequent.

We may all say, and I believe we do all say, that a single remedy is sufficient for the cure of a single case of disease, that is, when uncomplicated and when there is neither a Syphilitic nor a Psoric taint. I have no doubt every one of us would fully agree in this, but of such uncomplicated cases, how many do any of us see in the course of one year? For my own part, I can safely say, not more than three or four, and I doubt whether any general practitioner sees more. From this I conclude that we are ex necessitate rei compelled to alternate our remedies and in this opinion, I am happy to say, I am fortified by the approval of so distinguished a man as our colleague Dr. Payne, as well as many, very many others, the opponents of alternation being not, as I believe, more than five or six percent of the whole number of homoeopathic practitioners throughout the civilized world.

We must, however, never forget that there is a very important distinction and a very great difference between acute and chronic diseases. Acute diseases arise from outward impressions and are never transmitted, being frequently cured by the vis medicatrix naturae alone. While chronic diseases are in general inherent and are born with the individual, having been transmitted, in numerous instances, from his ancestors, and are never cured without medical aid. Now Hahnemann alone has furnished the profession, by his theory of chronic diseases, with a key to this difference, and he alone has given us the exact direction in which we must look for the origin of most, if not all, of the chronic diseases which afflict the human race.

In conclusion then, I protest in the name of Homoeopathy against the charge brought against nine-tenths of the profession of being half Homoeopaths. This charge too brought by a very small minority who seem to suppose that they are Popes or Dictators, and that their dicta are to be adopted under the penalty of anathema maranatha, while they forget that their equals, at least in our ranks, after as long an experience as their own, differ from them toto coelo. In medicine as in most other pursuits, nothing is so abhorrent to the human mind as dictation or an attempt at coercion, and in this day and generation it will never be submitted to or endured.

Personalities, or generalized personalities, ought never to be admitted into the pages of a scientific review, they invariably do far more injury than benefit and I earnestly recommend their discontinuance.

Note. — In a preceding article our colleague has given some views adverse to the alternation of remedies. As the subject is one of great importance we shall continue it in a subsequent number.

Eds.