The Second Prescription

By Adolph Lippe MD

Excerpted from Lessons in Pure Homeopathy

This paper is supplementary to that great paper by the late Dr. von Boenninghausen on Hahnemann’s Three Precautions, published first in the Neues Archiv, and translated in the American Homoeopathic Review. It is addressed to such members of the medical profession who have accepted and appreciate his three precautions against these three errors, namely,

1. To suppose that the doses which, after many experiments, and compelled by experience, I have moderated even up to the present time, and which I have pointed out under each antipsoric remedy, are too small.
2. The improper selection of a remedy.
3. Hastiness in not allowing each dose sufficient time to develop and exhaust its action.

History repeats itself; Boenninghausen broke the silence imposed on the true homeopathicians by an ungenerous and ridiculous attempt made by Griesselich^[*] and Co. to ignore the teachings of the master and to adopt a pseudo-homeopathy which Rau taught in a pseudo-Organon,^[†] imposed on them by an erroneous belief that it was best to “let them alone,” and that opposition and exposure of their errors would only exasperate them and prevent their voluntary acceptance of the teachings of the master: this silence was broken because these misguided men became bolder and more abusive day by day.

We do not address ourselves at present to the adversaries of homeopathy as taught by Hahnemann, to those who deny the efficacy of dynamized drugs, who deny the universality of the law of the similars for the cure of the sick, who falsify history, abuse the master, and glory in their futile attempts to make truth and error coexist together. We address ourselves to our increasing number of healers who carefully select the truly similar homeopathic remedy and administer it in the truly homeopathic dose, and we do so because long experience has taught us that the most difficult task the healer has to perform is the proper and timely administration of the second dose; either of the remedy first administered or of another remedy; the most serious mistake we, as well as others, have made has been in not carefully following the third precautionary rule.

It is our aim to enlarge on this vital precaution. Hahnemann and Boenninghausen allude mainly to the treatment of chronic diseases, but the same hastiness in not allowing each dose sufficient time to develop and exhaust its action has its evil consequences as well in acute^[‡] as in chronic diseases the same mistake may bring about a fatal termination;^[§] and, if not, the case will become much protracted, and the recovery will hardly ever be a complete one. We shall, therefore, first dwell on “acute diseases.”

Among all the prevailing, grave and dangerous diseases which we are frequently called upon to treat, probably diphtheria stands at the head of the list, and in no acute disease is it so necessary to cling to these extended precautionary rules as in diphtheria. When we are called upon to treat this grave disease, we carefully note down all the symptoms of the patient, and, as homeopathicians, we select among the proved remedies the one most similar to the case. No silly assertion of any boasting croaker that he has found a specific for this or any other disease will induce the true healer to resort to such a remedy; he is fully aware that there is nothing in such boastful assertions; he, the true healer, knows the similar remedy, and now administers it in one single dose. And why? Because he can never a priori know when this single dose will exhaust its effects. The single dose has been administered, and the careful physician will again see the sick and, by close examinations, ascertain whether this one dose has produced an effect and, if it has, whether the effect has been exhausted.

There is rarely an acute case of a disease in which ominous^[**] symptoms do not appear almost immediately after giving a remedy, showing the close observer clearly that the dose of medicine administered begins to affect the sick. Frequently, the position of the sick at once becomes more natural, or sleep almost immediately follows, or the mental symptoms and the countenance of the sick change almost at once, or suppressed secretions are suddenly restored. If such ominous symptoms appear almost immediately after the administration of this one single dose, it is reasonably certain that its action, if not interrupted, will last for a considerable length of time, and it becomes absolutely necessary to wait until the effect of this single dose has been fully exhausted before another dose of any other or the same remedy is administered.

And why should more medicine [not] be given if the patient improves? What possible good could such an interference with the absolute beginning of a cure do? This single dose of the truly similar remedy, administered in what, to the individual judgment of the healer, appears to be in that individual case the minimum dose, will very frequently suffice to cure even a case of diphtheria, and we are not alone in here offering our testimony to this fact. Dr. George H. Carr says, in the United States Medical Investigator, that he treated, in the fall and winter of 1878 to 1879, one hundred cases of diphtheria, without any deaths; duration of illness, four to five days. He rarely had to repeat the dose and found that a single dose of a high potency acted as well in the most malignant as in the lightest cases, and his testimony carries with it a surprising conviction of its truthfulness when he adds to it the characteristic, well-described symptoms which indicate Lac caninum in this form of disease.^[††]

When a well-selected remedy has been administered in a single dose, and when the improvement is of short duration, the symptoms may either be the same as before or they may have changed, so that the same remedy is no longer indicated; then a second dose becomes imperatively necessary. If the same remedy is still indicated, it will generally be best to repeat it in a watery solution, and administer it by spoonfuls at shorter or longer intervals, until a decided improvement begins;^[‡‡] but if another remedy is indicated, it is best to administer this carefully-chosen remedy again in a single dose, and carefully note the results, never repeating it until its action is fully exhausted.

If the effects are short-duration, it is time enough to repeat them; that repetition, if possible, should be in a different potency from the one first given.^[§§] It has frequently occurred that the proper remedy was selected, and the minimum dose was administered at once, in a watery solution, in rapidly repeated doses, under the erroneous belief that a grave, acute disease required these frequent repetitions.

If, then, the patient appeared much worse after the lapse of some hours, did it not often show the healer that this aggravation was merely an artificial increase of the symptoms caused really by an overdose? If he became impressed with the true state of the case, he wisely discontinued the medicine, and was rewarded very soon by finding this artificial aggravation gives place to a permanent improvement. But, unfortunately, the healer would frequently become unnecessarily alarmed and suddenly and untimely, he would change after having blundered with this mistake that the disease was really developing most grave conditions. Such mistakes can hardly ever again be corrected.

It becomes obvious that a second dose should never be administered until the first dose has exhausted its effect. The mistake becomes decidedly more serious when a high potency is unnecessarily repeated than when the medicine is given in “appreciable” doses. In such cases as described, when in a grave case of disease repeated doses of various remedies have been administered injudiciously, but in really appreciable doses, a recovery may still follow when a well-selected remedy is administered in a high potency. We had an illustration of this proposition as early as 1846, and although the case has been reported before, it never was done in support of this proposition.

An elderly lady (over 60 years old) was attacked with Asiatic cholera. Her physician had exhausted all the remedies he knew of; Camphora, Arsenicum album, Veratrum album, Cuprum metallicum, Secale had been given often and at short intervals in tinctures and low potencies. Eighteen hours had passed, and the case grew worse rapidly. A careful examination of the totality of symptoms pointed to Veratrum album as the similar remedy; it had been given to no purpose.

With the consent of the now despairing, attending physician, a single dose of Veratrum album 200 was put on her cold tongue. In less than five minutes, the patient fell asleep, passed a large quantity of urine, the skin became hot, and a warm perspiration appeared. When she awoke, after more than four hours of sleep, she once more complained of cramps when another and last dose of Veratrum album was given, and the attack was entirely broken up.

If the proper remedy has been administered in the proper dose, and if an improvement has begun, new symptoms sometimes arise which were not present when the first dose was given. These new symptoms may belong to the remedy administered; they may be known to belong to it and will subside without further aid; or they are known not to belong to the remedy but are analogous to the well-known effects of it.

If they belong to the remedy, they will easily subside and should carefully be noted, and if the newly observed symptoms show an improvement in the pathological condition, for instance, pain in a paralyzed part of the body or restlessness and tossing about in a comatose patient, or cough with expectoration in a case of diphtheria, it will be necessary still further to wait for the action of the drug, or for the continuance of the improving pathological conditions.

On the other hand, if these newly arising symptoms do not belong to those here described but in reality manifest an increase of the disease, showing unmistakably a progressive development of the disorder, then we must administer at once a second dose, most likely of another remedy. The administration of another dose, or of another remedy, for the above-described new symptoms, not positively showing a progress of the disorder, is always followed by bad consequences; the interference with the work begun by the vis medicatrix naturae is always reprehensible.^[***]

For instance, a plethoric individual, addicted to spirituous liquor, is taken down with typhus fever; his wild delirium is finally followed on the seventh day by epistaxis. Should this new symptom be taken as an indication of a new remedy? Certainly not, and if a newly chosen remedy should check the nosebleed, will not the patient grow much worse otherwise? The nosebleed will most likely cease after a lapse of time, and during its continuance, the progressive improvement of the case shows clearly that it is beneficial to the sick individual.

Progressive knowledge of pathology enables the healer to judge correctly all newly arising symptoms in an acute disease; and once convinced of the unmistakable fact that the vis mediatrix naturae has been fully aroused by the medicine administered, even in that single but minimum dose, that the work of restoring the sick individual into his accustomed health has begun, the plain duty of the truly scientific healer is to “wait,” and if the health-restoring process is interrupted, and does not show any further progress, then a second dose becomes necessary; any attempt to hasten the once-begun health-restoring process by additional medication will invariably be followed by evil consequences;^[†††] the healer has enough opportunity to apply, even then, his individual judgment, by properly directing the general regime of the sick.

The same rules govern also the treatment of chronic diseases. There are cases in which a single dose of the similar remedy will cause a gradual improvement, lasting weeks, even months; the effect of such a dose lasts much longer in chronic than in acute diseases. If it becomes necessary to repeat the same remedy, it is always advisable to give another potency. In chronic diseases, it sometimes happens, just as it does in acute diseases, that the action of the remedy is of short duration; the second dose may then, at times, be given in a watery solution and be repeated frequently and for a very long time; in some cases, it becomes even necessary to continue this medicine for many weeks until the action of the remedy becomes apparent.

A priori, as we can never know with certainty how many doses of any medicine will be required to cure or improve the sick, it is therefore always safer to administer but one dose, or at most a few doses in quick succession. When the improvement has followed this first administration of a single dose of the medicine, homeopathic to the chronic disease, it not infrequently happens that this improvement, after continuing for weeks, is followed by a reappearance of the early symptoms of the chronic disease, never so severe or violent as they were at first, it is then advisable, and the closely observing Hahnemann so directs us, to wait a reasonable length of time (say, at least, one week), and not rashly administer a second dose until it becomes apparent that no further improvement can be expected from the first dose; that the second (late) aggravation continues and increases; and not until then should the carefully observing healer administer this second dose. The consequences of this rash interference are so grave that, in many cases, a cure may either be much retarded or become even hazardous. The aggravations following such a mistake may necessitate the administration of antidotes^[‡‡‡] and change the whole condition for the worse.

Carefully made provings with highly potentized drugs show the same results. A single dose, or a few doses in quick repetition, have been administered; in the course of time, generally in three days, hardly ever at an earlier time, the medicine generally begins to develop its effects, which often lasts for weeks, ending generally, as does a natural disease, in a so-called crisis, the latest symptoms almost always appearing on the surface of the body; but the proving does not end there at all.

After a long time, sometimes weeks, the same symptoms first observed by the prover from the effect of that remedy reappear again less violently, last a shorter time, and are really a mild repetition of the first proving. If, in this instance, the prover hastily concludes on the second day that the remedy taken will have no effect on him and then takes another dose of the same remedy, or, still worse, another remedy, he violently interferes with the already, to him, the unconscious sick-making effect of the remedy; in like manner, if he surmises that with the cessation of the first group of symptoms, the sick-making power of the remedy has exhausted itself, and he at once ventures on the proving of another remedy, he will not only not receive satisfactory results, but suffer unnecessarily from the combined effects of the sick-making power of two remedies. When we have gained this knowledge by actual experiment; when we have asked nature these questions and profited by the answer, we will better understand why we should be extremely cautious before we give a second dose for the cure of the sick.

The non-observance of Hahnemann’s three precautionary rules, to which this paper is only supplementary, has had its natural and evil results. The hastiness in administering a second dose before the first dose has had sufficient time to develop and exhaust its effect has caused many failures; cases have not been cured promptly, or not at all, on account of this hastiness; and these failures were generally attributed to an imaginary shortcoming of homeopathy as a healing art, or to the inefficacy of highly potentized drugs, or even to the inapplicability of the law of the similars. In all and every case of sickness, auxiliary and supplementary means of medicine have been demanded. Palliative treatment, such as has been demanded and defended on the grounds that homeopathic medicines, administered without regard to these precautionary rules, have failed.

The whole truth is that all and every departure from simple, pure homeopathy can be readily traced to the non-observance of the rules plainly laid down for the successful practice of this only healing art. A persistent demand is made that “the individual judgment” of the scientifically freedom-seeking physician must not be interfered with, that to be constrained by any rules is next to bigotry, etc. To all of whom we say that the departure-seeking spirits should honestly make the experiment, accept these precautionary rules, apply them practically, and if you then continue to fail to cure the sick, as you do now, just publish honestly your cases if such failures continue, draw the only sensible deduction from your failures, that it is your own fault, and try to do better.

First, read Hahnemann’s Organon of the Healing Art, then study the Materia Medica Pura; never touch Pharmacodymics^[§§§] or crude drugs, and then publish the results of your practical experiments in an honest homeopathic journal. There will be no more failures; there will be no longer a necessity to resort to any auxiliary and supplementary means, such as the ordinary health and life-destroying palliatives.

Lessons in Pure Homeopathy comprises the best of Adolph Lippe’s numerous writings, narrating a significant part of the yet unwritten story of pure homeopathy. Approaching homeopathy with Lippe as the guide is ideal for developing a clear, certain and deep understanding of the path that must be pursued to truly master homeopathy.  https://homeopathy.ca/product/lessons-in-pure-homeopathy-volumes-i-ii/

[*] Philip Griesselich (1804-1848) was the leader of the “scientific” and “anti-dogmatic” professed homeopaths.

[†] Gottlieb Ludwig Rau (1779-1841) of Giessen published his Organon of the Specific Healing Art in 1838, which was translated into English by Hempel in 1847. With this Organon, he intended to remove the imperfections of Hahnemann’s method, “to impart to the new doctrine a higher scientific character” and arrange “every new advancement in the medical sciences . . . into a more scientific system of therapeutics.” (p. 3-4)

[‡] It is interesting to note that Hahnemann emphasized the too-hasty repetition of the remedy, especially in chronic diseases. In his Chronic Diseases, he wrote regarding the third precaution, “The third great mistake which the homeopathic physician cannot too carefully avoid in the treatment of chronic diseases is the too-hasty repetition of the dose.” Lippe extended this rule equally to acute diseases.

[§] The editor has treated for over forty years patients with the most severe acute and chronic diseases, and he can’t recall many cases in which the patients repeated the remedy too often and very serious consequences followed. Of course, hypersensitive patients should only repeat the remedy with the greatest care; otherwise, they may begin to prove the remedy, and remedies can also be grafted onto them. This had occurred to Hering, who felt a constriction of his throat all throughout his life after he had triturated the venom of Lachesis. Also, Lachesis was grafted on the first wife of Kent after she had taken it too often.

[**] Ominous means pertaining to an omen. Today, the word “ominous” is generally understood as something menacing or threatening. However, it was formerly used both in a favorable and unfavorable sense. In the sense used by Lippe, the term “ominous symptoms” means symptoms presaging a favorable reaction to the homeopathic remedy.

[††] Here is an extract of Dr. Carr’s article referred to by Lippe, “January 13, 1879, I was called four miles into the country to see two little girls, one nine and the other five years of age. The symptoms in each case were as nearly alike as could be. Tongue yellowish, with bright red tip and edges and diphtheritic membrane well developed, thick yellow color, worse on the right side. Great swelling and enlargement of glands of the neck, starting on the right side first. Great thirst for cold water and could swallow only by little sips, as their throat was so full, and considerable salivation, which made their chin sore. Nose obstructed with thick yellow scabs and membranes, worse on the right side; great prostration and high fever; urine high colored and scanty; costive. As Mercurius iodatus flavus and nothing else was indicated, they each received one dose of Mercurius iodatus flavus CM, two pills No. 25, dry on the tongue, and Saccharum lactis ad libitum. To use their father’s words, ‘From that first dose, they began to gain, and both are eating, sleeping and getting well as fast as possible.’ No other dose was required, no other was given, no second visit was made, and today (January 23rd), these children are attending school and have been for nearly a week. Could one dose of Hahnemann’s 30th centesimal do any more or any better? Or would it, has it ever done so well? And furthermore, the higher the potency of Mercurius iodatus flavus, the better its effect is.

“This fall and winter, I have treated one hundred cases of genuine diphtheria in its various forms, from the lightest to the most malignant type. Loss none. Duration of illness: four to five days, rarely have I had to give more than one dose of the indicated remedy, and in some cases, complete casts of the membrane have been sloughed off and coughed up, and immediate recovery followed. And the single dose and high potency was just as good in the most malignant as the lightest case. Mercurius iodatus flavus and Lac caninum have been the main remedies in this epidemic. Skeptics may say what they will, but I can tell a case of diphtheria by the smell every time, and these were genuine.

“Lac caninum CM has always removed the following symptoms of the throat: false membrane, thick gray or slightly yellow or else dark and almost black. Throat worse at one time on the right, at another time on the left side, inflammation and swelling shift from side to side, most generally worse on the left side. In some cases, the membrane is white and glistening, almost like a mother of pearl, constant salivation and drooling. Fluids return by nose. Great sensitivity of throat to external pressure. Pricking and cutting pains when swallowing shoot up to ears and follow Lachesis excellently. I commend this to the notice of all and would further say that Lac caninum has been proved far enough to elicit 1,142 symptoms and nearly everyone genuine. True, the CM, 75M and 40M were used in the provings, and so, of course, it is no good. But if anyone will give it in diphtheria and give it a thorough trial based on the foregoing indications he will be amply repaid, and his patient cured. Cito tuto et jucunde.

And moreover, the skeptic should give one dose of Lac caninum CM in after-pains when they are very severe and shoot down into the thighs and in any form of uterine hemorrhage when blood is bright red and stringy. Only one trial will be necessary to convince him and set him to investigate.” (G. G. Carr. Every-day experience. United States Medical Investigator 1879; 9: 133-135.)

[‡‡] This passage is key to understanding Lippe’s approach to acute diseases. As long as there is improvement after the first dose, there is no need to repeat. However, if there is a relapse and the same remedy is indicated, then the remedy is given in water and repeated until there is a decided improvement. If the patient stops improving after two hours and relapses after four hours of the first dose, then the remedy can be repeated in water every two hours or so until there is a decided improvement.

[§§] Contrary to Lippe, the editor often prescribes the second dose in the same potency and in exactly the same way of administration, whether it was given as a single pellet, teaspoon, drop, or toothpick. The reason to give the second dose of the remedy in exactly the same way and conditions is to compare the patient’s responses to the two same doses. If the response to the second dose is more favorable than after the first one, it indicates that the remedy has a high degree of similarity and the remedy, potency and way of administration don’t need to be changed. On the other hand, if the response to the second dose is less favorable than after the first dose, it tends to indicate that the degree of similarity of the remedy is not high enough, and a remedy with a greater degree of similarity must be searched for. In this manner, less time is lost in order to verify the degree of similarity of the chosen remedy after the first dose.

[***] Indeed, when after a well-chosen homeopathic remedy, the patient develops new symptoms not related to the progression of the disease, there should not be any further remedial interference. The best thing to do then is to wait and watch.

[†††] The editor’s experience is contrary to the one of Lippe in both acute and chronic cases. As a rule, once the patient’s reaction to the remedy has been established, succeeding doses if properly administered, tend to enhance the healing process in the great majority of cases, especially when the degree of similarity of the remedy is high. However, when there is a decided reaction to the single dose of a remedy, no further dose should be given until this reaction ceases, at which point no time should be lost to administer it. Patients are instructed to pay attention to the first sign of a relapse in order to repeat the remedy on a timely basis, which prevents the loss of time that would occur in the eventuality of a full-blown relapse. Regardless, the basic rule for posology is the optimal posology, which is the individualization of the potency, repetition and way of administering the remedy at each visit with a patient. This subject is discussed in greater detail in Chapter 5, On Posology.

[‡‡‡] The editor has had to antidote the reaction to a homeopathically prescribed remedy only in a few cases in over forty years of practice, and two of these cases came from other physicians who had their patient overly repeat the prescribed remedy, and, in another case, a patient of mine, while self-medicating, kept repeating the remedy to antidote the aggravation to the previous dose. After the third dose, she became overly sensitive to the environment, which took two years for her to lose and return to baseline.

[§§§] Lippe is referring to the entire movement of pathological prescribing led by Richard Hughes (1836-1902) and his very popular Manual of Pharmacodynamics (1867-1899) that went through at least six editions.