In the routine practice, whether the patient submit to the law of contrary remedies, and therefore, have recourse to narcotics, or sanguine evacuations, or whether he adopt the perturbative or revulsive method, and consequently employ emetics, purgatives, bloodlettings, blisters, or other irritating remedies, the difficulty of applying them has always been acknowledged. In like manner, the repetition of the purgatives, emetics, and bloodlettings, and the proper time and frequency of their use, have always been considered by medical men as among the most delicate and critical points in the art.
Now, in homoeopathy, although we have no longer to dread the perplexities of the old school respecting the method of treatment, we cannot shut our eyes to the numerous difficulties which belong to the proper application of medicaments. In this respect, our task is no longer that of studying in books the disease, or even the medicaments; we must observe the operation of the medicament on the diseased organs, and practice accordingly; and hence it will be easy to conceive the difficulty of regulating that administration of medicaments which, in homoeopathic language, is called the repetition of the doses.
In his first edition of the Organon, Hahnemann recommended to his pupils, to let the action of one dose of a homoeopathic remedy be completely exhausted before giving another remedy, or a second dose of the first. He indeed proscribed repetition; observing that one large dose or several smaller ones, given at short intervals, did not allow the vital power to re-act in a proper degree; for the disturbance occasioned to the constitution by large doses, or by repeated small ones, of the best selected medicament, becomes in a manner permanent, or is renewed each time that the vital strength recovers its tone and reacts; so as to render it impossible to obtain a happy result.
These reasons induced Hahnemann to reprove in the severest terms some homoeopathic physicians, who had advised the prescription of doses much more powerful than those prescribed by himself; whilst he, on the contrary, assured us that the highest dilution, such as thirty, and the smallest doses of this dilution, were those which ought to be prescribed, allowing them entirely to exhaust their effort.
I must observe, however, that though it should appear in practice that, in some slight cases of sickness, one of these small doses is enough to produce almost all the effects expected from the medicament, especially in the case of very young children, or of older persons of very sensitive and irritable constitutions, yet it is equally certain, that, in many cases, and indeed in most cases, whether in serious acute, or in chronic diseases which have lasted for a long time, and the very nature of which has been subverted by improper medicines, so small a dose of the medicine can never suffice to effect all that may be expected of its curative influence; but, on the contrary, several doses will be required to raise the vital re-action to its requisite power.
It was Dr. Aegidi who first observed that, in many cases, the repetition of the doses was required in order to accelerate and establish a cure. Wolff afterwards advised the repetition of the doses as essentially useful in many chronic maladies; and this drew attention of physicians to the subject. Hartmann was the first to cite a cure of psoric disease by means of repeating the same dose seven times. Finally, the cholera provided us with most valuable data regarding the repetition of the doses; and it was in consequence of the experience gained by the treatment of this scourge, that the venerable founder of Homoeopathy was led to modify some of his former ideas.
Hahnemann, therefore, who has always been guided by experience, found, after a time, the necessity of repeating the medicament. He felt that, in order to distinguish the correct practice from among the different practices, of non-repetition and frequent repetition, it was necessary to be guided as well by the nature of the various medicaments as by the patient's constitution and the nature of his complaint.
In pure syphilitic diseases, Hahnemann has often found that a single dose of metallic mercury was sufficient; but that not unfrequently two or three doses were required, when, in these diseases, the least trace of psora was observable.
The opinion of Hahnemann, which I have just announced, was published in 1833 by Boenninghausen, at the head of his repertory of chronic diseases; and I believe that this practical decision is very generally received at present.
I know that Hahnemann often prescribes his medicines to be dissolved in water; the patient repeating the dose every day, though by fractions of globules. Thus he dissolves one or more globules in six, eight or even fifteen spoonfuls of water, and orders the patient to take a spoonful of this potion every day. But up to the present time, he has not publicly declared his adoption of this mode of administering the medicament: experience alone will show us whether it is to be adopted to the exclusion of other methods.
In his instructions as to experiments on remedies at the tenth dilution, Hahnemann has himself furnished the grounds for the practice of repetition by repeating several globules every third day.
The repetition of Bryonia and Ignatia after twelve or twenty-four hours, when a rapid but short improvement has taken place, the repetition of the magnet, of Veratrum in malignant fevers, and probably of Belladonna , opened the way for the repetition of medicines of more durable action, such as Silicea , Causticum , Carbo vegetabilis , &c., which have all been practised with success.
In acute diseases, the proper time for repeating a remedy which has been rightly chosen, is determined by the greater or less progress of the disease; in so much that when the case is urgent, the remedy is given every twenty-four, eighteen, twelve, eight or four hours, and even less, if the remedy does good.
This repetition is not even quick enough for the rapid and dangerous advance of some acute diseases. Thus, in a most speedily fatal disease which we know of, the cholera, at the beginning of the disease, we must administer, every five minutes, one or two drops of a mild solution of Camphor , in order to secure prompt and certain relief. When that disease has developed itself, the proper medicaments, such as Cuprum , Veratrum , Phosp., Arsenic , Carb. veg. , &c., are given every two or three hours.
In the case of intermitting diseases, which prevail in a sporadic or epidemic manner, we find that each attack or paroxysm is equally composed of two alternate and contrary states, cold and heat, or heat and cold; and most frequently of three states, cold, heat and perspiration. It is therefore necessary that the remedy which is chosen for these diseases, and which is mostly selected from a class of apsorics, shall be capable of exciting in healthy persons, these similar successive states, or at least that it should have the faculty of exciting that one of the two or three states, which is the strongest and most marked by all the accessory symptoms.
However, it is chiefly according to the symptoms of the state of the patient during apyrexy, that the physician must be guided in selecting the homoeopathic curative.
The time of administering this, consists in giving the medicine immediately, or atleast every soon after the fits. Thus administered, it has time to produce in the system all the effects which depend on it for the restoration of health, without violence or disturbance; whilst, if it were given at once, before the paroxysm, its effect would coincide with the renewal of the disease, and would excite in the system such a struggle, so strong a reaction, that the patient would lose a great part of his strength, and his life might be in danger.
If the time of the apyrexia is very short, as in some serious cases of fever, in which it is marked by circumstances connected with the preceding paroxysm, the homoeopathic medicine must be given as soon as the sweating, or other symptoms indicating the termination of the fit, begin to decline. (footnote: When an intermittent fever, not sustained by march emanations, does not entirely give way to the proper remedy, this failure has arisen from the patients being affected with some chronic disease more or less latent; antipsorics should then be resorted to, in order to make the cure a more certain event.)
In chronic diseases, to cite an instance of the use of sulphur, Hahnemann thinks of the mildest dose of this substance, in most cases, cannot be repeated with good effect above once in seven days, a period which must be lengthened in proportion as the patients are more delicate or excitable; and, when these latter are to be treated, it will be advisable to give such a dose but every nine, twelve, and fourteen days, continuing it until the remedy ceases to be efficacious.
It may be further observed of sulphur, the medicine affording the present illustration, that, in chronic diseases, it will be found that four, six, eight, or ten such doses given in succession, will almost always be sufficient to destroy every part of the chronic affection, which sulphur possesses the property of curing. But I am all along supposing that there has been no abuse of sulphur in the treatment, for otherwise, the most minute dose of sulphur would be extremely injurious to the patient.
From the first year of my homoeopathic practice, I had been so strongly impressed with the law "similar similibus curentur," on which the homoeopathic doctrine is founded, that I did not hesitate to look upon this law as not only the best guide for discovering the remedy itself, but as the surest for making known the rules of that remedy's application.
This proposition requires a little explanation to be clearly understood. According to this law, the remedy ought to excite, in a man of sound health, phenomena analogous to those found in the diseases it is known to cure. But, to fulfil this condition, it will be necessary that the remedy be adapted to each individual, as well with respect to the symptoms as with respect to the strength of the dose and its repetition. Each case must be studied by itself; each must be treated distinctly; and the nature of each must lead to the discovery of the remedy, the dose, and the repetition.
It is thus that the physician must display his most enduring attention, and give proof of his practical talent; and thus the reader will understand why hitherto so much doubt and indecision have pervaded the opinions of homoeopathic physicians on this subject.
"When, indeed," says Rummel, "we consider the opinions which different homoeopathists have expressed on the repetition of the doses, we are led to believe that great uncertainly prevails in homoeopathic medicine.
"On one side, the founder of homoeopathy and the sagacious Gross give their authority to uphold high dilutions. The latter, however, admits the propriety of more concentrated doses of certain medicaments; as, for instance, of Dulcamara in diarrhoea. He prescribes, of most substances, a few globules of the 30th dilution to the dose, and he cures a vast number of patients.
"At the head of the opposite party, that is, of the advocates of the lower dilutions, is Trinks, who is supported by Griesselich, &c. This method has been very favourably received by practitioners; and Aegidi has lately declared for it.
"If I select at random from cases treated by an extensive practice of homoeopathy, through a course of ten years, I find that I have cured a chronic disease in a robust man with only two globules of Sepia 10, which, without any other auxiliary, displayed their curative action for six successive weeks. But, I likewise find that a child, a few months old, took several globules of Arsenic 4, repeated every fourth day; that I have cured acute diseases, attended with great uneasiness, with Aconitum 3, and Ipecacuanha 3, repeated every two and six hours, in entire drops of the dose; that Nux vomica was found beneficial at the dose of one drop of tincture not diluted, or at the 100; and that I have often been obliged to use 100 or a 10,000 of mercury to effect a rapid cure of syphilis, whilst there have been other cases in which mercury 5, and rarely repeated, produced the cure of inveterate pseudo-syphilitic affections.
"Every honest homoeopathist will, no doubt, be able to recall to his mind similar cases, of which I could produce many other examples, if there were any conclusion to be deduced therefrom, save this, that we are still very much in the dark as to the dose most proper to be given.
"The result, therefore, may be stated thus: cures are effectual with all kinds of doses, with decillionths as well as with drops not diluted, when the right medicine is used; but the cure is rendered more speedy in proportion as the dose is well adjusted to the excitability of the patient. In this nice point, it is that the talent of the physician reveals itself, a talent which can neither be imparted nor reduced to any final rules, but which must be acquired by experience and observation.
"If we desire to submit our practice to rules more and more defined in this respect, we ought especially to observe the following points:
"1st. Do strong doses produce homoeopathic aggravations, and are these necessarily pernicious, or rather are they not merely transient, and serving only to shackle the cure?
"2d. Do high dilutions always suffice, in all cases; or rather are there not circumstances in which, after having vainly had recourse to high dilutions, lower dilutions produce the cure?
"After solving that problem, we shall dispel the numerous contradictions which are to be met in the works of homoeopathists.
"Griesselich has hit with a rude hand this sore and tender place, and has very naturally given pain. But it is nevertheless true, and there is a contradiction in saying that a substance is at once attenuated and rendered more potent by dilution, and likewise in attributing a longer and more lasting action, sometimes to the 8th and sometimes to the 1st dilution. This contradiction would possibly disappear by admitting that there is an essential difference between developing the virtue of a drug, and making this virtue manifest.
"A medicament, inert in itself, will acquire an evident virtue by trituration and succession, which divides in parts and renders it not only capable of being dissolved in other vehicles, but likewise more assimilable to the system. 'Coropa non agunt, nisi soluta,' is an old adage, which certainly ought not to be less considered in the natural history of organic bodies than in chemistry. But whether operations do or do not raise the power of such medicines, is still a matter of doubt, which the facts hitherto collected do not enable us to determine.
"Attrition and succussion are indispensable to render many substances soluble in a vehicle. But solubility is also a condition in which the development of strength continues feeble or dwindles to nothing.
"Experience alone can decide how far attenuation may correct, without doing injury to the manifestation and development of power; and, for that reason, I must oppose the affectation of assigning to decillionths the degree of dilution most proper at all times and for all cases. The various degrees of power, indeed, with which unpounded medicaments act on the body, protect against this pretence of marking any general limit according to mere whim, and on no ground but supposition.
"Beyond the point within which there is a necessity for attenuating a particular remedy, in order to unfold its properties, these properties must of course decline; and this is proved by impartial observation. [Still] we cannot deny that there are systems sensitive enough to perceive very extended dilutions, when they correspond with the nature of such a sensibility. But no exception must be received as a rule; and it is not fair to reproach us, as our opponents have unjustly done, with doing nothing, because they do not happen to perceive the motives of our acts.
"But let us return to the questions which I have put, and to the second of which is referable what had just been said.
"In the opinion of most homoeopathists, the highest dilutions are not sufficient in all cases; and, though several of these practitioners have limited this admission to acute disease, the reader has seen that it is more easy to perceive the efficaciousness of a remedy in an acute, than in a chronic, affection. In relation to Aconite , I possess substantial proofs that the third attenuation has obtained speedy relief, where the twenty-fourth has been unsuccessful, after several trials. I can say as much of mercury for chancres; and I could easily produce similar evidence relating to other means, did it not appear unnecessary to prove that everybody is acquainted with.
"The first question, that is, whether stronger doses produce more sensible aggravations, is more difficult for solution; for the continual progress of the disease, which the means does not resist, is often mistaken for an aggravation of the disease by the remedy.
"But even though cases of this kind were excepted, others would still remain. The most impartial observer must certainly admit the effect of aggravation by the medicament, inasmuch as the course of the disease attests it, and because the improvement which soon becomes apparent in a morbid state, which had long persisted without exhibiting any change, will not allow any doubt as to the action enforced by the medicinal substance.
"This fact may, above all, be witnessed most positively in cases of exanthems and in chronic ulcers. I remember a case which was lately presented to my observation, in which, after a few doses of sulphur given to a robust young girl, an itching and watery exanthem broke out all over her body, though for a long time previously the patient had only tetters on the arm.
"But this effect is not always the consequence of large doses; it is seen to follow the most various dilutions, and it is not of frequent occurrence. It is therefore an exception to the rule, and an event seldom pernicious.
"My observations have not enabled me to determine whether in such a case it is better to interrupt the use of the medicine and to abandon the cure to the mediating power thus called to life, or to continue to raise the reacting energy of the body by fresh doses, in order to accelerate the cure by this means.
"There are facts to support both opinions. I must not conceal, however, that in some particulars, the result of the second method was not a perfect cure, but rather a return to the state of health in which the patient had been, before this means had been employed; and I am therefore persuaded, that too much reliance ought not to be placed on it, or more than one failure would ensue.
"According to my own observations, the repetition of the doses has frequently prevented the necessity of descending to inferior dilutions. However, the method adopted by a great many homoeopathists, and which consists in giving each time a different dilution, deserves to be carefully considered.
"I have made it a rule to descend at all times to a lower dilution, when higher dilutions do not effectuate a favourable re-action, and when I am convinced I have chosen the right remedy.
"The result of our examination may be stated to be, that we already posses some rules relative to the strength and repetition of the doses; but these rules are far from being sufficient to direct the practitioner in every case.
"As we cannot teach the painter what thickness he ought to give the colours, in every particular case, in order to attain the greatest possible effect, as we must leave this to his own judgement and skill as an artist, in the same manner, the strength of doses, in the greater number of cases, must be left to the appreciation of the medical man, to his estimation of the excitability of his patient, and to his practical skill.
"If we reflect again that frequently the greatest and most obstinate complaints give way with surprising rapidity to an extremely minute dose of the exact remedy, it becomes more and more evident, that circumstances are frequently mere accessories, with the medicament has been properly selected; but that they acquire more importance, when the analogy is less decided between the medicament and the disease, and that stronger doses are then required to bring about a cure.
"But if we employ, as is frequently the case, these strong doses in cases where this means is not necessary, they frequently do mischief, and give rise to obstinate disorders, which require a length of time for relief, more especially when the physician is as stubborn as he is ignorant."
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