§ 232. These latter, alternating diseases, are also very numerous,¹ but all belong to the class of chronic diseases; they are generally a manifestation of developed psora alone, sometimes, but seldom, complicated with a syphilitic miasm, and therefore in the former case may be cured by antipsoric medicines; in the latter, however, in alternation with antisyphilitics as taught in my work on the Chronic Diseases.

§ 233. The typical intermittent diseases are those where a morbid state of unvarying character returns at a tolerably fixed period, whilst the patient is apparently in good health, and takes its departure at an equally fixed period; this is observed in those apparently non-febrile morbid states that come and go in a periodical manner (at certain times), as well as in those of a febrile character, to wit, the numerous varieties of intermittent fevers.

§ 234. Those apparently non-febrile, typical, periodically recurring morbid states just alluded to observed in one single patient at a time (they do not usually appear sporadically or epidemically) always belong to the chronic diseases, mostly to those that are purely psoric, are but seldom complicated with syphilis, and are successfully treated by the same means; yet it is sometimes necessary to employ as an intermediate remedy a small dose of a potentized solution of cinchona bark, in order to extinguish completely their intermittent type.

§ 235. With regard to the intermittent fevers,² that prevail sporadically or epidemically (not those endemically located in marshy districts), we often find every paroxysm likewise composed of two opposite alternating states (cold, heat—heat, cold), more frequently still of three (cold, heat, sweat). Therefore the remedy selected for them from the general class of proved (common, not antipsoric) medicines must either (and remedies of this sort are the surest) be able likewise to produce in the healthy body two (or all three) similar alternating states, or else must correspond by similarity of symptoms, in the most homœopathic manner possible, to the strongest, best marked, and most peculiar alternating state (either to the cold stage, or to the hot stage, or to the sweating stage, each with its accessory symptoms, according as the one or other alternating state is the strongest and most peculiar); but the symptoms of the patient’s health during the intervals when he is free from fever must be the chief guide to the most appropriate homœopathic remedy.³

§ 236. The most appropriate and efficacious time for administering the medicine in these cases is immediately or very soon after the termination of the paroxysm, as soon as the patient has in some degree recovered from its effects; it has then time to effect all the changes in the organism requisite for the restoration of health, without any great disturbance or violent commotion; whereas the action of a medicine, be it ever so specifically appropriate, if given immediately before the paroxysm, coincides with the natural recurrence of the disease and causes such a reaction in the organism, such a violent contention, that an attack of that nature produces at the very least a great loss of strength, if it do not endanger life.⁴ But if the medicine be given immediately after the termination of the fit, that is to say, at the period when the apyretic interval has commenced and a long time before there are any preparations for the next paroxysm, then the vital force of the organism is in the best possible condition to allow itself to be quietly altered by the remedy, and thus restored to the healthy state.

§ 237. But if the stage of apyrexia be very short, as happens in some very bad fevers, or if it be disturbed by some of the after sufferings of the previous paroxysm, the dose of the homœopathic medicine should be administered when the perspiration begins to abate, or the other subsequent phenomena of the expiring paroxysm begin to diminish.

§ 238. Not infrequently, the suitable medicine has with a single dose destroyed several attacks and brought about the return of health, but in the majority of cases, another dose must be administered after each attack. Better still, however, when the character of the symptoms has not changed, doses of the same medicine given according to the newer discovery of repetition of doses (see note to § 270), may be given without difficulty by dynamizing each successive dose with 10-12 succussions of the vial containing the medicinal substance. Nevertheless, there are at times cases, though seldom, where the intermittent fever returns after several days’ well being. This return of the same fever after a healthy interval is only possible when the noxious principle that first caused the fever, is still acting upon the convalescent, as is the case in marshy regions. Here a permanent restoration can often take place only by getting away from this causative factor, as is possible by seeking a mountainous retreat, if the cause was a marshy fever.

§ 239. As almost every medicine causes in its pure action a special peculiar fever, and even a kind of intermittent fever with its alternating states, differing from all other fevers that are caused by other medicines, homœopathic remedies may be found in the extensive domain of medicines for all the numerous varieties of natural intermittent fevers and, for a great many of such fevers, even in the moderate collection of medicines already proved on the healthy individual.

§ 240. But if the remedy found to be the homœopathic specific for a prevalent epidemic of intermittent fever do not effect a perfect cure in some one or other patient, if it be not the influence of a marshy district that prevents the cure, it must always be the psoric miasm in the background, in which case antipsoric medicines must be employed until complete relief is obtained.

§ 241. Epidemics of intermittent fever in situations where none are endemic, are of the nature of chronic diseases, composed of single acute paroxysms; each single epidemy is of a peculiar, uniform character common to all the individuals attacked, and when this character is found in the totality of the symptoms common to all, it guides us to the discovery of the homœopathic (specific) remedy suitable for all the cases, which is almost universally serviceable in those patients who enjoyed tolerable health before the occurrence of the epidemy, that is to say, who were not chronic sufferers from developed psora.

§ 242. If, however, in such an epidemic intermittent fever the first paroxysms have been left uncured, or if the patients have been weakened by improper allopathic treatment; then the inherent psora that exists, alas! in so many persons, although in a latent state, becomes developed, takes on the type of the intermittent fever, and to all appearances continues to play the part of the epidemic intermittent fever, so that the medicine, which would have been useful in the first paroxysms (rarely an antipsoric), is now no longer suitable and cannot be of any service. We have now to do with a psoric intermittent fever only, and this will generally be subdued by minute and rarely repeated doses of sulphur or hepar sulphuris in a high potency.

§ 243. In those often very pernicious intermittent fevers which attack a single person, not residing in a marshy district, we must also at first, as in the case of acute diseases generally, which they resemble in respect to their psoric origin, employ for some days, to render what service it may, a homœopathic remedy selected for the special case from the other class of proved (not antipsoric) medicines; but if, notwithstanding this procedure the recovery is deferred, we know that we have to do with psora on the point of its development, and that in this case antipsoric medicines alone can effect a radical cure.

§ 244. The intermittent fevers endemic in marshy districts and tracts of country frequently exposed to inundations, give a great deal of work to physicians of the old school, and yet a healthy man may in his youth become habituated even to marshy districts and remain in good health, provided he preserves a faultless regimen and his system is not lowered by want, fatigue or pernicious passions. The intermittent fevers endemic there would at the most only attack him on his first arrival; but one or two very small doses of a highly potentized solution of cinchona bark would, conjointly with the well-regulated mode of living just alluded to, speedily free him from the disease. But persons who, while taking sufficient corporeal exercise and pursuing a healthy system of intellectual occupations and bodily regimen, cannot be cured of marsh intermittent fever by one or a few of such small doses of cinchona—in such persons psora, striving to develop itself, always lies at the root of their malady, and their intermittent fever cannot be cured in the marshy district without antipsoric treatment.⁵ It sometimes happens that when these patients exchange, without delay, the marshy district for one that is dry and mountainous, recovery apparently ensues (the fever leaves them) if they be not yet deeply sunk in disease, that is to say, if the psora was not completely developed in them and can consequently return to its latent state; but they will never regain perfect health without antipsoric treatment.

§ 245. Having thus seen what attention should, in the homœopathic treatment, be paid to the chief varieties of diseases and to the peculiar circumstances connected with them, we now pass on to what we have to say respecting the remedies and the mode of employing them, together with the regimen to be observed during their use.

§ 246. Every perceptibly progressive and strikingly increasing amelioration during treatment is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hastening towards its completion. This is not infrequently the case in acute diseases, but in more chronic diseases, on the other hand, a single dose of an appropriately selected homœopathic remedy will at times complete even with but slowly progressive improvement and give the help which such a remedy in such a case can accomplish naturally within 40, 50, 60, 100 days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily affected, as recent and oft-repeated observations have taught me under the following conditions: firstly, if the medicine selected with the utmost care was perfectly homœopathic; secondly, if it is highly potentized, dissolved in water and given in proper small dose that experience has taught as the most suitable in definite intervals for the quickest accomplishment of the cure but with the precaution, that the degree of every dose deviate somewhat from the preceding and following in order that the vital principle which is to be altered to a similar medicinal disease be not aroused to untoward reactions and revolt as is always the case⁶ with unmodified and especially rapidly repeated doses.

§ 247. It is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition (and at short inervals in order not to delay the cure). The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those similar to the disease to be cured, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homœopathic to the original disease, hence no step towards cure can follow, only a true aggravation of the condition of the patient. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher (pp. 269-270)) then the vital principle may be altered without difficulty by the same medicine (the sensation of natural disease diminishing) and thus the cure brought nearer.⁷

§ 248. For this purpose, we potentize anew the medicinal solution⁸ (with perhaps 8, 10, 12 succussions) from which we give the patient one or (increasingly) several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener. Thus in chronic diseases, every correctly chosen homœopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success. If the solution is used up (in seven to fifteen days) it is necessary to add to the next solution of the same medicine if still indicated one or (though rarely) several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one more homœopathically related medicine must be chosen in place of the last and administered in the same repeated doses, mindful, however, of modifying the solution of every dose with thorough vigorous succussions, thus changing its degree of potency and increasing it somewhat. On the other hand, should there appear during almost daily repetition of the well indicated homœopathic remedy, towards the end of the treatment of a chronic disease, so-called (§ 161) homœopathic aggravations by which the balance of the morbid symptoms seem to again increase somewhat (the medicinal disease, similar to the original, now alone persistently manifests itself). The doses in that case must then be reduced still further and repeated in longer intervals and possibly stopped several days, in order to see if the convalescence need no further medicinal aid. The apparent symptoms (Schein-Symptome) caused by the excess of the homœopathic medicine will soon disappear and leave undisturbed health in its wake. If only a small vial say a dram of dilute alcohol is used in the treatment, in which is contained and dissolved through succussion one globule of the medicine which is to be used by olfaction every two, three or four days, this also must be thoroughly succussed eight to ten times before each olfaction.

§ 249. Every medicine prescribed for a case of disease which, in the course of its action, produces new and troublesome symptoms not appertaining to the disease to be cured, is not capable of effecting real improvement,⁹ and cannot be considered as homœopathically selected; it must, therefore, either, if the aggravation be considerable, be first partially neutralized as soon as possible by an antidote before giving the next remedy chosen more accurately according to similarity of action; or if the troublesome symptoms be not very violent, the next remedy must be given immediately, in order to take the place of the improperly selected one.¹⁰

§ 250. When, to the observant practitioner who accurately investigates the state of the disease, it is evident, in urgent cases after the lapse of only six, eight or twelve hours that he has made a bad selection in the medicine last given, in that the patient’s state is growing perceptibly, however slightly, worse from hour to hour, by the occurrence of new symptoms and sufferings, it is not only allowable for him, but it is his duty to remedy his mistake, by the selection and administration of a homœopathic medicine not merely tolerably suitable, but the most appropriate possible for the existing state of the disease (§ 167).

§ 251. There are some medicines (e. g., ignatia, also bryonia and rhus, and sometimes belladonna) whose power of altering man’s health consists chiefly in alternating actions—a kind of primary-action symptoms that are in part opposed to each other. Should the practitioner find, on prescribing one of these, selected on strict homœopathic principles, that no improvement follows, he will in most cases soon effect his object by giving (in acute diseases, even within a few hours) a fresh and equally small dose of the same medicine.¹¹

§ 252. But should we find, during the employment of the other medicines in chronic (psoric) diseases, that the best selected homœopathic (antipsoric) medicine in the suitable (minutest) dose does not effect an improvement, this is a sure sign that the cause that keeps up the disease still persists, and that there is some circumstance in the mode of life of the patient or in the situation in which he is placed, that must be removed in order that a permanent cure may ensue.

§ 253. Among the signs that, in all diseases, especially in such as are of an acute nature, inform us of a slight commencement of amelioration or aggravation that is not perceptible to every one, the state of mind and the whole demeanor of the patient are the most certain and instructive. In the case of ever so slight an improvement we observe a greater degree of comfort, increased calmness and freedom of the mind, higher spirits—a kind of return of the natural state. In the case of ever so small a commencement of aggravation we have, on the contrary, the exact opposite of this: a constrained, helpless, pitiable state of the disposition, of the mind, of the whole demeanor, and of all gestures, postures and actions, which may be easily perceived on close observation, but cannot be described in words.¹²

§ 254. The other new or increased symptoms, or, on the contrary, the diminution of the original ones without any addition of new ones, will soon dispel all doubts from the mind of the attentively observing and investigating practitioner with regard to the aggravation or amelioration; though there are among patients persons who are either incapable of giving an account of this amelioration or aggravation, or are unwilling to confess it.

§ 255. But even with such individuals we may convince ourselves on this point by going with them through all the symptoms enumerated in our notes of the disease one by one, and finding that they complain of no new unusual symptoms in addition to these, and that none of the old symptoms are worse. If this be the case, and if an improvement in the disposition and mind have already been observed, the medicine must have effected positive diminution of the disease, or, if sufficient time have not yet elapsed for this, it will soon effect it. If, now, the improvement delay too long in making its appearance, this depends either on some error of conduct on the part of the patient, or on other interfering circumstances.

Notas

Two or three states may alternate with one another. Thus, for instance, in the case of double alternating diseases, certain pains may occur persistently in the legs, etc., immediately on the disappearance of a kind of ophthalmia, which latter again appears as soon as the pain in the limbs has gone off for the time— convulsions and spasms may alternate immediately with any other affection of the body or some part of it—in a case of threefold alternating states in a common indisposition, periods of apparent increase of health and unusual exaltation of the corporeal and mental powers (extravagant gaiety, extraordinary activity of the body, excess of comfortable feeling, inordinate appetite, etc.) may occur, after which, and quite unexpectedly, gloomy, melancholy humor, intolerable hypochondriacal derangement of the disposition, with disorder of several of the vital operations, the digestion, sleep, etc., appear, which again, and just as suddenly, give place to the habitual moderate ill-health; and so also several and very various alternating states. When the new state makes its appearance, there is often no perceptible trace of the former one. In other cases only slight traces of the former alternating state remain when the new one occurs; few of the symptoms of the first state remain on the appearance and during the continuance of the second. Sometimes the morbid alternating states are quite of opposite natures, as for instance, melancholy periodically alternating with gay insanity or frenzy. ↩
The pathology hitherto in vogue, which is still in the stage of irrational infancy, recognizes but one single intermittent fever, which it likewise termed ague, and admits of no varieties but such as are constituted by the different intervals at which the paroxysms recur, quotidian, tertian, quartan, etc. But there are much more important differences among them than what are marked by the periods of their recurrence; there are innumerable varieties of these fevers, some of which cannot even be denominated ague, as their fits consist solely of heat; others, again, are characterised by cold alone, with or without subsequent perspiration; yet others which exhibit general coldness of the surface, with a sensation of heat on the patient’s part, or whilst the body feels externally hot, the patient feels cold; others, again, in which one paroxysm consists entirely of a rigor or simple chilliness, followed by an interval of health, while the next consists of heat alone, followed or not by perspiration; others, again, in which the heat comes first, and the cold stage not till that is gone; others, again, wherein after a cold or hot stage apyrexia ensues, and then perspiration comes on like a second fit, often many hours subsequently; others, again, in which no perspiration at all comes on, and yet others in which the whole attack consists of perspiration alone, without any cold or hot stage, or in which the perspiration is only present during the heat; and there are innumerable other differences, especially in regard to the accessory symptoms, such as headache of a peculiar kind, bad taste in the mouth, nausea, vomiting, diarrhœa, want of or excessive thirst, peculiar pains in the body or limbs, disturbed sleep, deliria, alterations of temper, spasms, etc., before, during or after the cold stage, before, during or after the hot stage, before, during, or after the sweating stage, and countless other varieties. All these are manifestly intermittent fevers of very different kinds, each of which, as might naturally be supposed, requires a special (homœopathic) treatment. It must be confessed that they can almost all be suppressed (as is often done) by enormous doses of bark and of its pharmaceutical preparation, the sulphate of quinine; that is to say, their periodical recurrence (their typus) may be extinguished by it, but the patients who suffered from intermittent fevers for which cinchona bark is not suitable, as is the case with all those epidemic intermittent fevers that traverse whole countries and even mountainous districts, are not restored to health by the extinction of the typus; on the contrary, they now remain ill in another manner, and worse, often much worse, than before; they are affected by peculiar, chronic bark dyscrasias, and can scarcely be restored to health even by a prolonged treatment by the true system of medicine—and yet that is what is called curing, forsooth! ↩
Dr. von Bönninghausen, who has rendered more services to our beneficent system of medicine than any other of my disciples, has best elucidated this subject, which demands so much care, and has facilitated the choice of the efficient remedy for the various epidemics of fever, in his work entitled Versuch einer homöopathischen Therapie der Wechselfieber, 1833, Münster bei Regensberg. ↩
This is observed in the fatal cases, by no means rare, in which a moderate dose of opium given during the cold stage quickly deprived the patients of life. ↩
Large, oft-repeated doses of cinchona bark, as also concentrated cinchonic remedies, such as the sulphate of quinine, have certainly the power of freeing such patients from the periodical fits of the marsh ague; but those thus deceived into the belief that they are cured remain diseased in another way, frequently with an incurable Quinin intoxication. (See § 276 note.) ↩
What I said in the fifth edition of the Organon, in a long note to this paragraph in order to prevent these undesirable reactions of the vital energy, was all that the experience I then had justified. But during the last four or five years, however, 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 disease, advance is made in the same way to higher degrees, (beginning according to the new dynamization method, taught herewith with the use of the lowest degrees). ↩
We ought not even with the best chosen homœopathic medicine, for instance one pellet of the same potency that was beneficial at first, to let the patient have a second or third dose, taken dry. In the same way, if the medicine was dissolved in water and the first dose proved beneficial, a second or third and even smaller dose from the bottle standing undisturbed, even in intervals of a few days, would prove no longer beneficial, even though the original preparation had been potentized with ten succussions or as I suggested later with but two succussions in order to obviate this disadvantage and this according to above reasons. But through modification of every dose in its dynamization degree, as I herewith teach, there exists no offense, even if the doses be repeated more frequently, even if the medicine be ever so highly potentized with ever so many succussions. It almost seems as if the best selected homœopathic remedy could best extract the morbid disorder from the vital force and in chronic diseases to extinguish the same only if applied in several different forms. ↩
Made in 40, 30, 20, 15 or 8 tablespoonfuls of water with the addition of some alcohol or a piece of charcoal in order to preserve it. If charcoal is used, it is suspended by means of a thread in the vial and is taken out when the vial is succussed. The solution of the medicinal globule (and it is rarely necessary to use more than one globule) of a thoroughly potentized medicine in a large quantity of water can be obviated by making a solution in only 7-8 tablespoonfuls of water and after thorough succussion of the vial take from it one tablespoonful and put it in a glass of water (containing about 7 to 8 spoonfuls), this stirred thoroughly and then give a dose to the patient. If he is unusually excited and sensitive, a teaspoonful of this solution may be put in a second glass of water, thoroughly stirred and teaspoonful doses or more be given. There are patients of so great sensitiveness that a third or fourth glass, similarly prepared, may be necessary. Each such prepared glass must be made fresh daily. The globule of the high potency is best crushed in a few grains of sugar of milk which the patient can put in the vial and be dissolved in the requisite quantity of water. ↩
As all experience shows that the dose of the specially suited homœopathic medicine can scarcely be prepared too small to effect perceptible amelioration in the disease for which it is appropriate (§§ 275-278), we should act injudiciously and hurtfully were we when no improvement, or some, though it be even slight, aggravation ensues, to repeat or even increase the dose of the same medicine, as is done in the old system, under the delusion that it was not efficacious on account of its small quantity (its too small dose). Every aggravation by the production of new symptoms—when nothing untoward has occurred in the mental or physical regimen —invariably proves unsuitableness on the part of the medicine formerly given in the case of disease before us, but never indicates that the dose has been too weak. ↩
The well informed and conscientiously careful physician will never be in a position to require an antidote in his practice if he will begin, as he should, to give the selected medicine in the smallest possible dose. A like minute dose of a better chosen remedy will re-establish order throughout. ↩
As I have more particularly described in the introduction to “Ignatia” (in the first volume of the Materia Medica Pura). ↩
The signs of improvement in the disposition and mind, however, may be expected only soon after the medicine has been taken when the dose has been sufficiently minute (i. e., as small as possible), an unnecessarily larger dose of even the most suitable homœopathic medicine acts too violently, and at first produces too great and too lasting a disturbance of the mind and disposition to allow us soon to perceive the improvement in them. I must here observe that this so essential rule is chiefly transgressed by presumptuous tyros in homœopathy, and by physicians who are converted to homœopathy from the ranks of the old school. From old prejudices these persons abhor the smallest doses of the lowest dilutions of medicine in such cases, and hence they fail to experience the great advantages and blessings of that mode of proceeding which a thousandfold experience has shown to be the most salutary; they cannot effect all that homœopathy is capable of doing, and hence they have no claim to be considered its adherents. ↩