CLINICAL CASES - Dr. C. Lippe, M. D.,

Case I.—A lady had for several days frequent diarrhoeic stools, commencing in the morning on rising, sudden urging, gushing, accompanied with flatulence, the stool spattering all over the vessel; the frequent movements had produced considerable prostration. A single dose of Natrum sulphuricam was given in the CM potency of Fincke. The frequent movements gradually ceased during the day, and no more medicine was given. The following morning the loose evacuations did not return, and the patient, with the exception of a little feeling of weakness, as well. Sulphur and Aloes have the morning diarrhea, but the patient is compelled to arise from the desire to evacuate. The Sulphur patient has colic before a loose evacuation; Aloes, rumbling of flatulence before stool.

Case II.—The patient complains of a sore throat; on examination, find ulcer on both tonsils more on the right side, with external swelling of that side of the throat; j^ainful to touch; of course there is considerable inflammation and difficulty of swallowing. The history of the case informed me that the pain commenced on the left side and progressed to the other side. On the experiment, found that cold liquids were easier swallowed than warm fluids. Lachesis CM (Fincke), was given one dose; the following day the patient reports no better, but is no worse; no medicine; the following day much better; in a day was well. This was a clear case for the remedy, and the indications have been verified many times during the winter, especially the easier swallowing of cold fluids. Lycopodium has the swelling, pain, and ulceration commencing on the right side, extending to the left, and the greater facility of swallowing warm liquids. 

In these acute cases, when the proper remedy has been selected, and just enough, sufficient for that patient has been administered, it is often found that in the first twenty-four hours there is no improvement. If an improper (non-homoeopathic) remedy had been administered, the case would progress from bad to worse; if too much medicine, or in too often-repeated doses, there would likely be an aggravation; but finding the case apparently in status quo my judgement was that the proper remedy had been given, and just enough, and the next day proved this view correct. In giving one dose and watching the case, experience has taught me that my cases convalesce more rapidly. In case of a progress of the disease after being twenty-four hours stationary, the symptoms being similar to the previous condition, then a powder of a different generally higher) potency might be dissolved in water, a teaspoonful given every one or two hours, for four or five hours, and the result waited for; if an improvement follows, no matter how slight, let the remedy act until its action has been exhausted.

THE REPETITION OF THE DOSE - Dr. E. B. Nash, M. D.

One would naturally suppose that but little that is new can now be said on this subject. The three cardinal principles, viz:—the similars; the single remedy, and the minimum dose, are generally accepted by Homeopathists and this subject of the repetition of the dose is embraced in the latter. If it be true that the minimum in one case is not the minimum in another, or in other words, it is necessary to use the tincture in one case (as did Hahnemann;, and the CM in another; then why is it not likely to be true, that undue or too frequent repetition would be as much out of place as prescribing the 3rd when the 200th was the minimum and vice versa?

It is well understood that the primary effect of a drug prescribed homoeopathically, acting in the direction of the disease as it does, must be to cause (even though it be so slight as to be imperceptible) a temporary aggravation. Hahnemann teaches that the dose must be large enough to produce this aggravation in order to be curative (§279 and 280).

Again, it is well understood, that it is the secondary effect or reaction that cures. This being true, the violence and duration of the primary effect, of course, must pass away before the cure begins. What, then, would be the result if the dose were too large, or too frequently repeated? Evidently, in the first case, unnecessary suffering from too intense aggravation ; in the second, hindered reaction or cure. These truths seem self-evident.

Then it seems to me that there can be but one correct rule, and that is, to repeat the dose when reaction (curative action) ceases. How frequently the dose must be repeated on account of expended reaction, must depend upon both the individual and the disease with which we have to do.

As some individuals are more susceptible to drug action than. others, and require the small or smallest dose to affect them, so some are possessed of stronger reactive power, and the response to the proper remedy will be more lasting. Violent, acute diseases, attacking persons in full vigor and progressing rapidly, call for more frequent repetition of the remedy than chronic diseases. Hahnemann speaks in the paragraph above referred to of the proper dose being able to cure a portion of the disease. Every dose just sufficient is followed by reaction if it is administered after reaction ceases, or where disease action is in the ascendency. If administered in sufficient doses to impress either in health or during reaction, its effect is primary, in the first condition (health) causing disease action, in the latter (reaction) hindering the cure.

It may take more than one dose, especially if the first dose is not large enough, to get the impression that always resides in the homeopathic remedy ; but just as soon as that impression is obtained, the remedy should be discontinued so long as improvement continues.

A remedy may, and often has been repeated after sufficient has been administered to set up curative action, and the result is, the case is either made worse, held in statu quo, or recovers more slowly than it would have done if the remedy were properly given. The habit of doing something, so long as the patient is not quite well, even though he may be convalescent, is often productive of harm. 

Sac. Lac. is the remedy when reaction is fully established, and every physician should have plenty of it and use it.

It requires as much skill to know when not to give medicine, as when to give.

In very acute diseases it may be necessary to repeat very often

until an effect is evident. In chronic diseases, improvement once begun, may continue from a single dose even for months, or until cure. We should always remember that reaction cures our patient; not the primary action ; primary action is always in the direction of the disease; while reaction only is in the direction of health.

The allopath gives large doses of Mandrake or Rhubarb or Jalap in constipation for its primary action, and reaction is always defeating him, and reaction in his case is still in the direction of disease as before. And this reaction of which we talk, is nature's effort in the direction of health, whether opposed to drug or natural disease, if there is such a thing as natural disease.

Drugs are poisons, and just as sure as you introduce one into the organism, unless the dose is so large as to completely overpower nature, she immediately brings all her forces into action to repel the intruder, and she will continue to strive until entirely overpowered by the drug or until health is established.

Now, a much smaller dose will excite this reaction in disease, when administered homoeopathically, than in health, simply because the disease renders the part acted upon more susceptible to the drug. 

In regard to the modus operandi of the homeopathic remedy in curing disease, I can do no better than refer you to aphorism 282 of the Organon (Wesselhoft's translation).

You remember the case of colicodynia reported by Hahnemann. It was cured by Verat. alb. in 4 gr. doses. The aggravation was so intense that, to use the patient's own expression, he " wrestled with death," covered with cold sweat, and almost suffocated. The remedy was homoeopathic and a cure resulted, but it might just as surely and more promptly have followed the minimum dose, and saved the terrible suffering. Hahnemann learned a lesson from the case, and was forced, as we are, to accept the fact that, to perform the safest, quickest, and pleasantest cure, we must seek to administer a dose just sufficient, "simply this and nothing more;" and repetition has as much to do with it as the size of the single dose or the potency.