Dose in Drug Proving

The Central symptoms appear speedily after the drug is taken, are generally the result of comparatively large doses. 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….

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 to 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. There are dynamic effects of 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 given drug from all others. For example, Arsenic, taken in different doses from those which produce the generic dynamic effects, produces 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 sub-divided 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 coordinated 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 until 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 the 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 the dose, examples of all of the above varieties of symptoms. In certain doses if develops chemical and revolutionary effects. In smaller doses, as e have seen, generic dynamic; in still 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 wallpaper, in which the phenomena of vomiting and diarrhoea or the central specific symptoms do not appear, but instead of these we have evidence of a 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 nor 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 subvarieties of dynamics effects which we have specified. This knowledges is to be attained 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 subvarieties. This, as has been shown, is to be accomplished by a skilful 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 produced, differ widely in different varieties of example, a half grain of crude Nitrate of silver or of Sulphuric acid produces chemical symptoms, while a half grain of Lycopodium or of Silicea produces probably no symptoms at all. A grain of Arsenic produces generic dynamic symptoms, while ten grains of Natrum muriaticum may b 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 be learned 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 record 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 matter 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 subvariety of symptoms is first developed, whether we take heroic doses and develop chemical symptoms or small doses and produce peripheral dynamic symptoms; since in either case we should be able by subsequent experiments based 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 others again, a single large dose develops some one generic or central specific symptom, and along with it induces such an exalted and distorted susceptibility that every subsequent dose, whether large or small, evokes straightway that one symptom 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 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 straight-way 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 the thirtieth dilution would at any time produce vomiting and diarrhoea, with cold sweat and prostration. It may be said that these are cases of very unusually great susceptibility to the 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 follows 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 influenced the system as to prevent our 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, a 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 poisonings.

But, in this relation, what are the “small doses” 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 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 or 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-Proving. The majority of the Bureau repeat Hahnemann’s 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 afterward, if necessary, to take the lower dilutions and triturations, or the crude substance or tincture, if satisfactory results are not obtained with the attenuations.

This recommendation accords with our deductions and corresponds with the spirit of Hahnemann’s directions. Hahnemann’s 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 the result of his extensive observation, that “The most recent experience has taught 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 those medicines whose virtues are considered weakest, is now found to be most advantageously studied 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 Hahnemann’s 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 proving with so high a dilution were made, the prover would fail to get all of the symptoms which the drug is capable of evolving.

In the Minority report of the Central Bureau, (1 Am.Hom. REview, vol. i., p.575) Dr. Hempel differs from the majority in so as the proving with dilutions is concerned. He would propose that “all such provings should be rejected rather than encouraged;” and he is convinced in his deepest soul, that it is owing to the incorporation of such provings in our Materia Medica that all the confusion and uncertainties with which it is now tainted, are presenting immense and almost insufferable difficulties to the inexperienced student of our science.” We trust that it is unnecessary to say that in commenting freely, as we shall do, on Dr. Hempel’s report, we are actuated by no unworthy feeling toward our colleague, whose unceasing and very arduous labors in the cause of Homoeopathy command our highest respect, and deserve the grateful recognition of every English and American Homoeopath. We speak of him only because, by his report, he stand forth as the representative of certain opinions, which seem to us unsound and unsupported by the evidence on which they are supposed to rest.

His report may be reduced to the following propositions:

1. Drugs should not be proved with attenuated substance.

2. The middle and higher potencies do not produce reliable symptoms, unless the system has been previously saturated with massive doses of the original drug. Corollary: the saturation of the system by massive doses of a drug renders it susceptible to the action of the middle and higher potencies.

3. In exceptional cases a peculiar idiosyncrasy may enable the organism to develop symptoms from the higher potencies; but “it is unreliable to commence the proving with these potencies.” The sequence of this conclusion is not very clear. We suppose Dr. Hempel to mean that symptoms developed, where an idiosyncratic susceptibility to drug-action exists, are not so reliable as those developed where there is not idiosyncrasy.

It is much to Dr. Hempel’s credit that he has not left these propositions to stand in his report as bare unsupported assertions. Recognizing the experimental nature of the question, he has referred for corroboration of his views to the experience of those who have made our provings, and has called to the witness- stand the great body of our drug-provers in the following terms: “All the splendid provings of the original provers of the Materia Medica, and of the Austrian Provers’ Union, of the Provers’ Society of Prague, and of any other Provers’ Society, whose provings are accepted with universal acclaim and confidence, have been instituted with massive doses of the strongest preparations of the drug; the higher and middle potencies were invariably tied after the former.” If this statement were literally correct, if, indeed, none of these provers ever began their provings with potencies, then they are incompetent witnesses for Dr. Hempel’s purpose-they are incapable of testifying as to the action of dilutions when not receded by massive doses, since, Dr. Hempel says, they never tried them. If this were so, then the second proposition of Dr. Hempel’s report would rest unsupported save by the one witness whom, we neglected to say, Dr. Hempel cites, first of all, in these words: “Dr. Hempel has never been able to elicit any reliable symptoms by means of the middle or higher potencies, unless the organism had been previously saturated with massive doses of the original drug.” On this one point of negative evidence, then, this important proposition stands “Dr. Hempel has never been able.” But perhaps others have been able. Perhaps the very witnesses whom DR. Hempel has called have been more successful than he. We will cross-examine them.

First, the, we call upon the “Original Provers of the Materia Medica,” by which we suppose Dr. Hempel means Hahnemann’s “Materia Medica Pura” and “Chronische Krankheiten.” Of these provers, the “Great Original” was Hahnemann himself. His pupils and friends adhered strictly to his directions and method. What Hahnemann’s opinion was as to the propriety of commencing of proving with small doses we have already seen. After thirty-five years’ experience in drug- proving, he sums up his observation sin the advice to begin with the thirtieth dilution. But what was his practice? What doses did he actually take? It has been generally supposed that he did not as a rule record the doses with which his provings were made. Dr. Hempel, however, seems to have had access to some sources of knowledge on the subject that are not open to the general reader, for he tells us without qualification, that “all the splendid provings of the original provers of the Materia Medica were made with massive doses of the strongest preparations, etc.” Those who have not enjoyed these unusual means of information, gather from a few observations, scattered through Hahnemann’s writings, the following observations.

Silver was proved by Hahnemann in the first trituration. The Nitrate of Silver, of which he gives a few symptoms, in the fifteenth dilution. Carbo vegetabilis was proved in the third trituration. In a letter in the Neues Archiv. (1813), he directs Stapf to prove Helleborus thus: “Add a drop of the tincture to eight ounces of water and one drachm of alcohol; shake well, and take an ounce hour and a half or two hours until some decided effects are produced.” And camphor, thus: “Dissolve two grains in a drachm of alcohol; shake this well with eight ounces of water, and take in from four to six doses during the day.”

In the first publication of the proving of Natrum muriaticum (1830), Hahnemann tells us that a great part at least of this proving was made with the thirtieth dilution, and he adds, that “it is only in such a highly potenized form that this and all other drugs display the whole of their power to alter the condition of the organism.” This was Hahnemann’s conclusion after thirty years of active experience in drug-proving. As a voucher he gives us the proving of Natrum

muriaticum, the value of which is attested by the clinical experience of the last thirty years, and confirmed as we shall se by the Austrian re-proving. In the same volume of the Chronische Krankheiten, Hahnemann published the proving of Kali carbonicum, and large additions to the previously published provings of Carbo vegetabilis, Causticum, Conium and Sulphur. It is but reasonable to conclude that the symptoms of Kali carbonicum, and many at least of those of the other drugs above named, were produced by the thirtieth dilution as well as those of Natrum muriaticum.

In view of these facts, it is hardly correct to say, as Dr. Hempel does, that “all the provings of the original provers of our Materia Medica were made with massive doses of the strongest preparations, etc.”

Second, we call upon the Austrian Provers’ Union. This society conducted in the years 1842 to 1848, a series of re-provings of certain of the drugs proved by Hahnemann, in the hope of certain of the drugs proved by Hahnemann, in the hope of discovering the pathological connection of the symptoms which in Hahnemann’ scheme are disconnected. Conceiving also that some of Hahnemann’s symptoms were vague, because produced, as they supposed, by small doses, they pushed their provings with massive doses, in many case to extreme poisoning. With these views we could hardly expect from them much testimony, either positive or negative, on the subject of proving with potencies; but, in that which they do furnish, we should expect them to be unfavourable witnesses for our views, since their proclivities are almost uniformly against the use of potencies in proving or in therapeutics. Dr. Hempel says, “all these splendid provings, etc., were instituted with massive does; the middle and higher potencies were invariably tried after the former.” Let us examine the records.

In the proving of Aconite, sixteen provers made in all thirty-seven experiments. Six of these were made with dilutions from the first to the twelfth centesimal, and symptoms were observed in all but one. In five of these cases, large doses of the tincture had been taken before the dilution. In one case the prover began with the first centesimal dilution and got symptoms.

In the proving of Bryonia, fourteen provers made twenty-nine experiments, of which ten were with dilutions from the first decimal the dilutions, viz: with

the tenth and the thirtieth, and got in one case very graphic symptoms; in the other, symptoms unequivocal though less numerous. In the cases in which dilutions were used after massive doses of the tincture had been taken, considerable intervals were allowed to elapse after the last symptoms from the tincture-proving disappeared before the dilutions were taken, e.g., forty-one days before the 203d dilution was taken, and yet this dilution appears to have produced decided symptoms. It is true that the propriety of ascribing these symptoms to the Bryonia is called in question by the Editor of the Austrian Journal, but with scarcely sufficient grounds, since a subsequent proving with the 203d dilution evoked them again. Here, then, in the tincture, symptoms were obtained (while in one case in which they were taken after the tincture, no symptoms were observed, shows that the corollary to proposition No.2 is at least not universally true).

In the proving of Silver we find that the drug was taken be one prover each in the first, second, and third trituration, and in the fourth, fifth, and sixth dilutions, and valuable symptoms were obtained by each. The Editor calls attention to the great correspondence between these symptoms and those of Hahnemann, obtained, as we known, from the first trituration.

Carroll Dunham
Dr. Carroll Dunham M.D. (1828-1877)
Dr. Dunham graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York. While in Dublin, he received a dissecting wound that nearly killed him, but with the aid of homoeopathy he cured himself with Lachesis. He visited various homoeopathic hospitals in Europe and then went to Munster where he stayed with Dr. Boenninghausen and studied the methods of that great master. His works include 'Lectures on Materia Medica' and 'Homoeopathy - Science of Therapeutics'.