(From The Science of Therapeutics).
THE symptoms which drugs produce upon the healthy organism vary according to the dose. They may be:.
1. CHEMICAL-depending on the chemical affinity which exists between the drug and the tissues of the body, and independent of vitality; or.
2. MECHANICAL (or revolutionary)-consisting chiefly in violent efforts on the part of the organism to eject from its cavities the offending substance; or.
3. DYNAMIC-contingent upon vitality and resulting from the relations of the peculiar properties of the drug of the susceptibilities of the living, healthy organism. These dynamic effects may be:.
(a) Generic-such as are common to all the members of a certain class of drugs and which serve to distinguish this class from others, but do not furnish means of distinguishing between different individuals of the same class. For example, ARsenic in certain doses produces vomiting and diarrhoea, with cold sweat and cramps of the extremities.
These are dynamic effects of ARsenic, but they are generic, since other members of the class to which Arsenic belongs, viz. Cuprum, Veratrum, Tartar emetic, etc., in certain doses, produce identical symptoms; and were these remedies proved in such doses alone, it would be impossible to distinguish the pathogenesis of one of them from that of any of the others.
(b) Specific-such as results from the dynamic action of the drug and are peculiar to it. They serve to distinguish a give drug from all others. For example, Arsenic, taken in different doses from those which produce the generic dynamic effects, produced vomiting and diarrhoea or tendencies thereto; but these phenomena are accompanied and characterized by conditions quite different from those which accompany the similar symptoms of Cuprum, Veratrum, etc., and are thus distinguishable from the effects of these drugs.
The Specific dynamic symptoms may be again subdivided into Central and PEripheral.
The Central symptoms appear speedily after the drug is taken, are generally the result of comparatively large doses and, in the case of many drugs, are confined to the alimentary canal and to the organs immediately connected with it.
The Peripheral symptoms appear more tardily, are generally the result of comparatively small doses, taken repeatedly or allowed to act without interruption for a long period, and appear in the bones, skin, glands, etc., and in the co-ordinated phenomena of life. They are often the manifestations of a dyscrasia or cachexy. Doses which produce central symptoms do not generally produce the peripheral (or at least not till after a long period has elapsed) and vice versa.
For example, Mercury, in certain doses, produces well-marked and characteristic action upon the alimentary canal and its appendages. In smaller doses it produces, instead of these effects, a series of symptoms in skin, bones, glands, etc., the Mercurial cachexy. The former are what we mean by central specific dynamic symptoms. The latter are the peripheral symptoms. Arsenic, again,furnishes, according to dose, examples of all the above varieties of symptoms. In certain doses it develops chemical and revolutionary effects.
In smaller doses, as we have seen, generic dynamic; in still smaller doses, specific dynamic symptoms of the central variety. In yet smaller doses, it produces peripheral specific symptoms, which are those of the so-called “gradual poisoning”; as for instance in poisoning by exhalations of Arsenic from green wall-paper, in which the phenomena of vomiting and diarrhoea, or the central specific symptoms do not appear, but instead of these we have evidence of the distinct cachexy, in the skin and glandular symptoms, marasmus, etc.
Such are the varieties of symptoms produced by corresponding varieties in the dose. It is hardly necessary to say that they are not always to be distinguished with precision; but the facility with which we are able to recognize them is in proportion to the completeness of our proving.
It unquestionably behoves the homoeopathic physician to have an exhaustive knowledge of the whole sphere of action of his drugs; but, as a prescriber, he must be familiar with the varieties and sub-varieties of dynamic effects which we have specified. This knowledge is to be obtained in the first place only by drug- proving. The proving of drugs must then be so conducted as to produce in the greatest possible completeness and clearness, each of these varieties and sub-varieties. This, as has been shown, is to be accomplished by a skillful selection and succession of doses. It is not so simple and easy a matter, as it might at first view appear to be: for.
First: the doses by which the corresponding varieties of symptoms are produces, differ widely in different drugs. For example, a half-grain of crude Nitrate of silver or of Sulphuric acid produces chemical symptoms, while a half-grain of Lycopodium or of Silica produces probably no symptom at all. A grain of Arsenic produces generic dynamic symptoms, while ten grains of Natrum muriaticum may be inert. Forty drops of Bryonia tincture may excite a fair show of specific dynamic symptoms, while forty drops of tincture of Opium will produce generic dynamic symptoms, or full narcotism.
Secondly: The susceptibility of different provers to the same drug is very different, and the degree of susceptibility which each prover possesses is to learnt only by experiment. For example, one prover will take five hundred drops of Thuja without any effect; another taking twenty drops, experiences violent specific symptoms.
Thirdly: The susceptibility of provers to different preparations of the same drug is very various and apparently capricious. One records characteristic specific symptoms from large doses of the crude drug, and is not affected by smaller doses; another is acted on by dilutions and not by any quantity of the crude substance.
The relative power of a drug and susceptibility of the prover being altogether unknown until ascertained by direct experiment, the proving of a new drug is therefore a mater of pure experiment in every particular, and it might at first view be supposed to be a matter of indifference in what manner or with what doses the experiment is begun; which variety or sub-variety of symptoms is first developed, whether we take heroic doses and develop chemical symptoms; since in either case we should to able by subsequent experiments bases on the first, to develop the complementary symptoms and thus complete our proving.
Experience teaches, however, that this supposition is not sound, and for the following reasons: Drugs vary not more in the intensity than in the permanence of their action upon the organism. Some drugs appear speedily to exhaust, sometimes by a single large dose, the susceptibility of the prover, so that no subsequent doses, whether large or small, produce any effect. Of other again, a single large dose develops some one generic or central specific symptoms, and along with it induces such an exalted and distorted susceptibility that every subsequent dose, whether large or small, evokes straightaway that one symptoms or series of symptoms and none other.
Thus the proving is in either case partial and incomplete-we fail to get those symptoms which are the most valuable of all to us, as being those which clearly characterize the drug and enable us to distinguish it from all other drugs, viz., the peripheral and central specific dynamic symptoms. To illustrate this point-it is well known that Mercury given in such doses as to produce central specific that Mercury given in such doses as to produce central specific symptoms, induces often so great a susceptibility of the organism to the action of this drug that subsequent doses, even of tolerably high dilutions, provoke straightaway a series of central symptoms.
The same is true of ARsenic. We have seen a case in which, generic and specific symptoms having once been produced by massive doses of Tartar emetic, the organism remained so sensitive to the action of this substance, that a few globules of he thirtieth dilution would at any time produce vomiting and diarrhoea, with cold sweat and prostration. It may be said that these are case of very unusually great susceptibility to he action of the respective drugs. This is true, but it is precisely such cases of great susceptibility that are of exceeding value to us, for in them, by judicious experimentation, we could get most valuable peripheral symptoms, unalloyed by generic or by revolutionary effects.
There is no reason to believe, on the other hand, that small doses, so administered as to produce the peripheral specific symptoms, modify the susceptibility of the prover in any such way as to prevent his obtaining by subsequent larger doses the central specific, the generic dynamic, or even the chemical and mechanical effects. It followed from what has been said, that to obtain an exhaustive proving of a drug, we should begin with small doses, gradually increasing the quantity until unequivocal symptoms appear.
We shall thus, if we continue our experiments a suitable length of time, obtain peripheral symptoms; and these small doses will not have so influence the system as to prevent out obtaining by subsequent larger doses the other varieties of effects. Inasmuch as, in the nature of things, the peripheral symptoms, representing, as they do, a cachexy, cannot be speedily produced, at considerable space of time should be devoted to our first experiments with small doses.
Finally, after an interval of non medication, larger doses should be taken until we have exhausted the whole dynamic action of the drug, and even obtained a fair picture of its chemical and revolutionary action, although this may in a measure be gained from records of poisoning.
But, in this relation, what are the “small does” with which we are to begin our proving? The term is comparative. Are they drop doses of the tinctures, or are they high dilutions? They are such doses as have, in the proving of some previous drug, shown themselves capable of producing unequivocal symptoms. We must search the records of the provings, therefore, for our standard initial dose. What this is at present we shall soon see: as our experience increases, this standard may from time to time be altered.
It is evident that the method of conducting a proving is a matter of great importance, and should not be left to caprice of accident. The completeness of our Materia Medica, and consequently our ability to cure disease, depend upon our selection of a happy method. This important subject has received the attention of the American Institute of Homoeopathy, to which the Central Bureau of Materia Medica has presented a report on Drug-Provings.
The majority of the Bureau repeat Hahnemanns directions for proving as contained in the Organon; and as regards the dose, they recommend “the prover who makes use of potencies” to make a trial of the high potencies first and afterwards, if necessary, to take the lower dilutions and triturations, or the crude substance or tincture, if satisfactory are not obtained with the attenuations.
This recommendation accords with our deductions and corresponds with the spirit of Hahnemanns direction. Hahnemanns instructions differed at different periods of his life. One essential idea, however, pervades them all-a small dose is to be taken at first, and the dose is to be increased until unequivocal symptoms manifest themselves. In the last edition of the Organon he adds, as result of his extensive observation, that “The most recent experience has taught me that medicinal substances, when taken in the crude state, do not for a long time display the full extent of their virtues, as they do when taken in higher developments.
Thus any one, even of medicines whose virtues are considered weakest, is not found to be most advantageously studies if four to six globules of the thirtieth dilution be taken every morning for several days.” In this statement Hahnemann does not contradict the spirit of his former directions for he adds, :should the effects of such a dose be weak, it may be daily increased.” He further adds, “The more moderate the dose, the more are the primitive effects developed, which are the most important to be known.”
We see nothing in Hahnemanns writings which shows that he ever thought of restricting the dose in proving to the thirtieth dilution, as some have stated: he simply assures us that unless provings with so high a dilution were made, the prover would fail to get all the symptoms which the drug is capable of evolving.
(DR. DUNHAM proceeds to discuss work by Dr. Hempel and reprovings of drugs in Austria. They are very interesting but too long to reproduce. So we will merely give his summary and conclusions, which contain all that is really important).
In conclusion we may assume the following points to be established by induction and by direct experience. In order to obtain an exhaustive proving:.
1. We must prove the drug both in dilutions and in massive doses.
2. The proving should be commenced with dilutions; and high dilutions should be employed until satisfactory evidence is obtained that the prover is not susceptible to their action. We thus obtain one of the unknown quantities of our problem, viz. the measure of the susceptibility of the prover.
3. Where a keen susceptibility is found to exist, the greatest care must be exercised to avoid blunting or perverting it. With this view, repeated experiments should be made at long intervals, with high potencies, until no new varieties of symptoms are evoked. Then, after a long period of non-medication, the prover should take lower potencies and then small doses of the crude substance repeated at intervals, and finally after another long period of repose, large doses of crude substance. A thorough proving after this fashion may require years for its completion but it will have an advantage over most of our recent provings, in the fact that it will be thorough, and that it will be of permanent and certain use to the practitioner.
4. In proving with dilutions, as well as with massive doses, a long period of time should be occupied in testing each preparation, in order that the full effect may be seen in the production of dyscrasias, etc.
5. The greatest care should be exercised in verifying symptoms by repeated experiments, in order that “imaginary” symptoms on the one hand and chemical and mechanical symptoms on the other may be excluded. The fashion, which has become very prevalent of late, of including in the pathogenesis every sensation which occurs during the proving, without distinction or verification and which may be called the Pre-Raphaelite method of proving cannot be too strongly rebuked.