The second prescription
by James Tyler Kent, M.D.
Presented by Sylvain CazaletEDITORIAL NOTE : What perplexing problems we often
meet in practice ! How we crave, at times, the advice of a master mind !We are so often the victims of prejudice,
over-confidence or ignorance, and our patients suffer in consequence of this.Could we but understand the intricate laws governing
the inner man, disease, and remedies, how much more wisely might we adjust ourselves to the
far-reaching problems which endanger the life of a father, a mother, a noble son or an
affectionate daughter.We would not then, as is so often done, impede or
pervert the action of a carefully selected remedy by our impatience to get results, or by
our impetuosity in hastening certain conditions which will not be hastened, or by our
ignorance in so quickly changing remedies before one of them has had time for definite
action.
To help us in this noble work
we reproduce below a masterly paper by Dr. J. T. Kent, read before the International
Hahnemannian Association at Niagara Falls in 1888.- G. E. D.What is more beautiful to look upon than the bud
during its hourly changes to the rose in its bloom.This evolution has so often come to my mind when
patiently awaiting the return of symptoms after the first prescription has exhausted its
curative power.The return symptom-image unfolds the knowledge by
which we know whether the first prescription was the specific or the palliative, i.e., we
may know whether the remedy was deep enough to cure all the deranged vital wrong or simply a
superficially acting remedy, capable of only a temporary effect.The many things learned by the action of the first
remedy determine the kind of demand made upon the physician for the second prescription.Many problems come up to be solved that must be
solved, or failure may follow.
How long shall I watch and wait ?
Is a question frequently asked but seldom answered.
Is the remedy still acting ?
Is the vital reaction still affected by the impulse of the remedy ?
If the symptoms are returning, how long shall they be watched before
it is necessary to act or give medicine ?Is the disease acute or chronic ?
Why is the second prescription so much more difficult than the first
?Why is it that so many patients are benefited when first going to the
physician and thereafter derive no benefit ?I presume that most good prescribers will say :
“We have often acted too soon, but never waited
too long.”Many physicians fail because of not waiting, and yet
the waiting must be governed by knowledge.Knowledge must be had, but where can it be obtained ?
To know that this waiting is right is quite different
from waiting without a fixed purpose.This knowledge cannot be found where its existence is
denied; it is not found with unbelievers and agnostics.When the first prescription has been made and the
remedy has been similar enough to change the existing image, we have but to wait for
results.The manner of change taking
place in the totality of symptoms signifies everything, yet the manner of the return of the
image, provided it has disappeared, signifies more.
First, if aggravation of
symptoms follow ; second, if amelioration of symptoms follow;1. If aggravation of the symptoms is attended with decline of the
patient the cure is doubtful, and the case must be handled with extreme care, as it is
seldom that such patients recover perfectly.2. If amelioration follow the prescription, to what does the
amelioration apply ?It may apply to the general state or but to the few
symptoms.If the patient does not feel the elasticity of life
returning, the improved symptoms are the facts upon which to doubt recovery.The knowledge that the disease is incurable often is
obtained only in this way.In such cases every remedy may palliate his
sufferings, but cure does not come.The symptoms that are the expressions of the debility
are there, and hence the totality of the symptoms is not removed.After the curative impulse has entirely subsided, the
symptoms will appear one by one, falling into place to arrange an image of the disease
before the intelligent physician for the purpose of cure.If the first prescription has been continuously
given, there has been but little if any chance of a pure returning image of the disease,
therefore this image must be very unreliable.When the remedy has been fully exhausted, then, and
only then, can we trust the symptoms constituting the picture.If the first prescription was
the similimum, the symptoms will return (and when they return) asking for the same remedy.Too often the remedy has been only similar enough to
the superficial symptoms to change the totality and the image comes back altered, therefore
resembling another remedy, which must always be regarded as a misfortune, by which the case
is sometimes spoiled, and the hand of the master may fail to correct the wrong done.Whenever the symptoms return the same image, calling
for the same remedy, then it is that we have demonstrated, that (for
a time, if the disease be chronic) we can but recommend the range of dynamics to
cure this case.This rule is almost free from exceptions if the
remedy is an antipsoric.What must the physician do who has not the knowledge
of dynamic medicines ?He must sometimes see sick images come back without
change of symptoms, though I believe it is seldom.The symptoms may call for Phosphorus as strongly as
when he began, and Phosphorus 6X has served and no longer cures.What can he do but change his remedy ?
Can it be possible that man can be so ignorant of how
to cure as to give a drug that is not indicated because the one that is indicated does not
cure ?These ignorant mortals condemn the system of
Homoeopathy and feel that they have performed their duty to the sick, forgetting that
ignorance was the culprit.I have observed in cases where a low potency had been
administered in frequently repeated doses, that some time must elapse before a perfect
action will follow the higher potency ; but where the dose had not been repeated after its
action was first observed, the new and higher potency will act promptly.When the symptoms come back (after
prudent waiting) unchanged, the selection was correct, and if the same potency
fail to act a higher one will generally do so quite promptly, as did the lower one first.When the picture comes back unaltered except by the
absence of some one or more symptoms, the remedy should never be changed until a still
higher potency has been fully tested, as no harm can come to the case from giving a single
dose of a medicine that has exhausted its curative powers.It is even negligence not to do such a thing.
I. Proper time to change
When the demonstration is clear that the present
remedy has done all it is capable of doing (and this demonstration
can not be made until much higher potencies than usually made have been tried)
then the time is present for the next prescription.To change to the next remedy becomes a ponderous
problem, and what shall it be ?The last appearing symptom
shall be the guide to the next remedy.This is so whenever the image has been permitted to
settle by watching and waiting for the shaping of the returning symptom-picture.Long have I waited after exhausting the power of a
remedy, while observing a few of the old symptoms returning ; finally a new symptom appears.This latest symptom will appear in the anamnesis as
best related to some medicine having it as a characteristic which most likely have all the
rest of the symptoms.It is not supposed that this later appearing symptom
is an old symptom on its way to final departure, for so long as old
symptoms reappear and disappear it is granted that no medicine is to be thought of.It is an error to think of a medicine when a
symptom-image is changing.The physician must wait for permanency or firmness in
the relations of the image before making a prescription.Some say :
“I must give the patient medicine or he will go
and see someone else.”I have only to say that it were better had all sick
folks gone somewhere else, for these doctors seldom cure but often complicate the sickness.The acute expressions of a
chronic disease have a different management from the acute disease, e.g., a child suffers
from bronchitis in every change of weather.It may grow worse if treated with the remedy for the
acute symptoms.The miasm that predisposes the
child to recurrent attacks must be considered.One recently under my care had received Antimonium
tartaricum, Calcarea carbonica, Sulphur, Lycopodium clavatum, etc., in such indiscriminate
confusion that the child was not cured.The waiting on Saccharum lactis, through several
attacks permitted the drug-effects to pass off, and the true image of the sickness was
permitted to express itself through several of the exacerbations taken as a whole.When western ague is complicated with a miasm, a
single paroxysm does not fully express the totality, but several must be grouped and the
true image will be discovered.If the acute disease be complicated with a miasm the
indicated remedy will wipe it out :“cito, tuto et jucunde.”
II. Avoid haste
All things oppose haste in prescribing.
In very grave diseases haste is a common error, more
frequently with the second prescription than the first.Many doctors suppose that a diphtheria demands a
medicine immediately because :“Something must be done.”
This is an error ; many a life has been saved by
waiting and waiting.For example:
A little girl was suffering from a severe attack of
diphtheria and the mother had treated it four days with Mercurius solubilis 3x, and Kalium
bichromicum 3x, in alternation.She was poor, and therefore I did not refuse to take
the case which was then in a very bad state : nose, mouth and larynx full of exudate.After a long study the child received Lycopodium
clavatum cm., one dose, dry, which cleared out the exudate from nose and fauces, but did not
touch the larynx.I dare not tell you how long I watched that child
before I saw an indication for the second remedy which it would have needed had the
Lycopodium clavatum been given when the child first took sick.I waited until the poor child was threatening
dissolution when I saw a little tough yellow mucus in the mouth :Kalium bichromicum, cm., one dose, cleared the larynx
in one day and there was no further medication necessary.The first prescription is made with the entire image
of the sickness formed.(People usually send for the
doctor after there can be no doubt of the sickness to be treated.)The doctor watches the improvement of the patient and
the corresponding disappearance of the symptoms under the first prescription, and when the
case comes to a standstill he is uneasy, and with increasing fidgetiness he awaits the
coming indication for the next dose of medicine.The fidgetiness which comes from a lack of knowledge
unfits the physician as an observer and judge of symptoms ; hence we see the doctor usually
failing to cure his own children.He cannot wait and reason clearly over the returning
symptoms.While watching the prescriptions of beginners, I have
observed very often the proper results of the first prescription.The patient has improved for a time, the ceased to
respond to any remedy.Close investigation generally reveals that this
patient improved after the first dose of medicine, that the symptoms changed slightly
without new symptoms, and the new “photo” seemed to call for some other remedy,
when, of course, the remedy was changed and trouble began.Constant changing of remedies followed until all the
antipsorics in the Chronic Diseases had been given on
flitting symptom-images, and the patient is yet sick.This is the common experience of young Hahnemannians
trying to find the right way.Some of experience make lesser blunders and some make
few, but how many have made none ?All of these blunders I have made, as I had no
teacher, until I blundered upon the works of the great Master.
III Wait and observe
The first prescription may not have been well chosen
medicine, and then it becomes necessary to make a second effort.As time brings about the re-examination of the
patient, new facts are brought out in relation to the image of the sickness, indicating that
the first medicine had not been suitable ; perhaps several weeks have passed and the
reexamination finds no change in the symptoms.Shall I compare all the facts in the case to reassure
myself of the correctness of the first prescription, or shall I wait longer ?Yes, to the former, of course, and if the remedy is
still the most similar to all the symptoms, wait, and watch, and study the patient for a new
light on his feelings to which he has become so accustomed he has not observed.Commonly the new study of the case will reveal the
reason why the first prescription has not cured: it was not appropriate.If it still appears to be the most similar remedy the
question arises :“How long shall I wait ?”
At this point it should be duly appreciated that the
length of time is not so important as being on the safe side, and “wait” is the
only safe thing to do.It may have been many days, but that matters not,
wait longer.The finest curative action I ever observed was begun
sixty days after the administration of a single dose.The curative action may begin
as late as a long-acting drug can produce symptoms on a healthy body.This guide has never been thought of by our writers,
but it is well to be considered.Why not ?
It is the practice for some to go lower if a high
potency has failed.This method has but few recorded successes but should
not be ignored.The question next to be considered is the giving of a
dose of medicine in water and divided doses.This has at times seemed to have favor over the
single dry dose.This is open for discussion, requiring the testimony
of the many, not of few, to give weight.The best reports are made from both methods, and both
are in harmony with correct practice.
IV. Improper action
The next important step to be considered is when the
first prescription has acted improperly, or without curative results.Then it becomes necessary to consider a second
prescription.The first prescription sometimes changes the symptoms
that are harmless and painless into symptoms that are dangerous and painful.If a rheumatism of the knee
goes to the heart under a remedy prescribed for the one symptom, the remedy has done harm.It is an unfortunate prescription and must be
antidoted. In incurable diseases when a remedy has set up destructive symptoms, an antidote
must be considered.If the remedy changes the general symptom-image, and
the general state of the patient is growing worse, the question then comes up, was the
prescription only similar to a part of the image, or is the disease incurable ?Knowledge of disease
may settle this question.
If the disease is incurable, the action of the remedy
was not expected to do more than to change the sufferings into peaceful symptoms, and the
second prescription is to be considered only when new sufferings demand a remedy.But suppose such a change of suffering comes after
the first prescription and the disease is undoubtedly curable, then the conclusion must be
that the first prescription was not the true specific, and that the true image has not been
seen.Wait until the old image has fully returned is all
there is to do.It is hazardous practice to follow up rapidly all the
changing symptoms in any sickness, with remedies that simply for the moment seem similar to
the symptoms present.The observing physician will know
by the symptoms and their directions, whether the patient is growing better or worse,
even though he appear to the contrary to himself and his friends.The complaints of patient or friends constitute no
ground for a second prescription.The greatest sufferings may
intervene in the change of symptoms during progress of permanent recovery, and if such
symptoms are disturbed by a new prescription or palliated by inappropriate medicine, the
patient may never be cured.The object of the first prescription is to arrange
the vital current or motion in a direction favorable to equilibrium, and when this is
attained it must not be disturbed by a new interference. Ignorance in this sphere has cost
millions of lives.When will the medical world be willing to learn these
principles so well that they can cure speedily, gently and permanently ?There can be no fixed time for making the second
prescription ; it may be many months.The second prescription must be one that has a
friendly relation to the last one or the preceding.No intelligent prescription can be made without
knowing the last remedy.Concordances in Boenninghausen must not be ignored.
The new remedy should
sustain a complementary to the former.
V. Remedies suitable to follow
In managing a chronic sickness the remedy that
conforms to an acute experience of the illness is worth knowing, as very often its chronic
may be just the one that conforms to its symptoms.Calcarea is the natural chronic of Belladonna and
Rhus toxicodendron ; Natrum muriaticum sustains the same relation to Apis mellifica and
Ignatia amara ; Silicea to Pulsatilla ; Sulphur to Aconite.When Pulsatilla has been of great service in a given
case and finally cures no more, while the symptoms now point to Silicea, the latter will be
given with confidence as its complementary relation has long been established.On the other hand Causticum and Phosphorus do not
like to work after each other, nor will Apis do well after Rhus.How physicians can make the second prescription
without regard to the experience of nearly a century, is more than man can know.These things are not written to instruct men of
experience in the right way, but for the young men who have asked so often for the above
notes of our present practice.I am told almost daily that this kind of practice is
splitting hairs, but I am convinced of the necessity of obeying
every injunction.VI. Careful records
You should have no confidence in the experience of
men who do not write out faithfully all the symptoms of the patient treated, and note
carefully the remedy, and how given.Especially is this necessary in patients likely to
need a second prescription.The physician who has in his case-book the notes of
every illness of his patients has wonderful hold of any community.He has the old symptoms and the remedies noted that
cured, and he can make indirect inquiry after all the old symptoms long ago removed.The pleasure is not small found in consulting such a
case-book.Experience soon leads the close prescriber to note
all the peculiar symptoms and to omit the nondescript wanderings indulged in by sick people
; however, it is important to be correct in judgment.Many physicians make a correct first prescription and
the patient does well and cheers up for a while, but finally the test is made for the second
and then all is lost.Homoeopathy is nothing if not true and, if true, the
greatest accuracy of detail and method should be followed.It is fortunate that the physicians who repeat while
the remedy is acting are such poor prescribers or their death-list would be enormous.Copyright © Sylvain Cazalet
1999