The questions contained in the following letter, recently received, represent a class of queries that are frequently propounded both orally and in correspondence. It has appeared not inappropriate to publish a general reply to these and similar questions:
“1. In what form do you use these potencies, in the shape of pellets or liquids?
“2. Do you use the decimal or the centesimal scale in the preparation of the high potencies?
“3. Do you repeat the high potencies in rapid succession in acute diseases, as you do the low preparations?
“4. If you use pellets, do you consider them perfectly reliable? and how many, as a general rule, constitute a dose, either dry or taken in water?
“5. Do you alternate the high potencies, or do you rely upon the single remedy?
“6. Do you believe that the high potencies, from your own experience in the use of them and from what you have beheld in the practice of others, are far superior, in all respects, to the low preparation as remedial agents?
“Some of these questions may seem in themselves to be insignificant, but I do not consider them so, for in making my first trial I wish to start right, that the experiment may be made fairly, with a sincere desire to know the truth, the whole truth, and nothing but the truth.
“In conclusion, let me say that you may rest assured your answers to this communication will be kept perfectly private, and no publicity (as coming from you) given them.
“Permit me to repeat that it is only a sincere desire to seek out and find the truth that has led me thus to trouble you.”
We heartily respect our correspondent’s earnest desire to get at the “whole truth,” and to “start fair” in his experiment; and we respect his hesitation to use the high potencies until he should have a reasonable assurance that in so doing he would not be hazarding the interests of his patients. We take this public manner of replying to his questions, partly with a view of convincing him that we have no wish that our “answers to this communication” should be glad to have “publicity (as coming from us) given them.” For they are expressions and as cautious and complete experiments as we have up to the present time been capable of making. They express our present opinion, those views in accordance with which we shape our daily practice.
But we hold ourselves bound by them only so long as they shall continue to be our honest convictions. Should further observation and more extended experience satisfy us that any of our present positions are untenable we shall gladly abandon them for others, and shall then, likewise, be not only willing but anxious to have “publicity (as coming from us) given” to these new views. The object of our professional life is to find out the truth and to shape our practice accordingly. Consistency to this object is true consistency; while consistency to any form of opinion or doctrine that may at one time have been supposed to be the truth and proclaimed by us as such, consistency to such opinion merely because we may have once publicly uttered it, this is the basest and most ignoble bigotry and cowardice.
In the article (1 The Use of High Potencies in Treatment of the Sick”) to which our correspondent refers, we had no object but to express frankly and plainly the views which govern us in the practice of medicine. We would call his attention to the fact that the greater part of the article consisted of citations of the opinions and experience of other practitioners whose conclusions were but corroborated by our own.
1. In what form do you use these potencies, in the shape of pellets or of liquids?
As a matter of fact, we use them in the form of pellets. As a matter of faith, we know no difference between pellets, pills, triturations or liquids. The pellet is merely a convenient means for dividing a drop of liquid into a number of equal parts, and it is for this object that we use them. We have been in the habit of buying unmedicated pellets or globules at Smith’s Pharmacy, and medicating them with liquid potencies of our own preparation. Pellets thus medicated we find retain their remedial powers for several years at least, exactly how long we cannot say. They are so much more portable and more convenient to administer than liquids, that this furnishes us a sufficient reason for preferring them to the liquids form of prescriptions.
A writer in the British Journal of Homoeopathy, some years ago, published an essay on the Globule versus the Pillule, making out a very bad case for the unlucky globule as calculated to bring Homoeopathy into contempt in the eyes of persons not indoctrinated. There is something laughable, if it were not deplorable, in this argument, the pith of which is this: “We give small doses, to be sure, but let us not, by using the pellet, appear to give small ones; let us use as big a pill as anybody that we may not seem to give a small dose, and may not rudely jostle the prejudices of our patients.” But surely, if contempt would have damaged Homoeopathy, this luckless science, despised, scorned, ridiculed, and, scores of times, extinguished by Homeric laughter, should have been done for long ago! To adopt and defend this much condemned science, and yet to shrink from the obvious smallness of a pellet-dose- is not this “to strain at a gnat and swallow a camel.”
Nothing will gain the confidence of a patient so surely as success! His confidence, once gained by success, cannot be shaken by the form of your dose! Yes, it may though! If he sees that while your doctrines requires you to give small doses, you yet dissemble and juggle, and, by using large pills and lozenges and mixtures, try to make it appear that you are giving as large doses as your Old-School neighbor, he will suspect that your faith in the system you profess is not really strong, and he will have doubts of both you and your system. The sick man who feels that you are curing him, cares not a straw for the logical improbabilities of your doctrines, nor for the scientific difficulties attending the explanation of the action of your little dose. LArge or small, much or nothing, if, under your auspices, his health return, he will have faith equally in yourself and in your methods.
We have been amazed at much that has been said and written on this subject. Our own patients have rarely remarked, one said to us, “Do you really hope to cure me with those tiny pills?” “Yes, certainly.” “I should not believe they could possibly have any power.” “Why? Because they are so fine and small for pills? “Yes.” “Then, my dear sir, instead of regarding them as ‘fine pills,’ consider them to be very coarse granular powder, and you cannot fail to be impressed, a priori, with their immense power!” He perceived the absurdity of his objection, which was to the outward form and not to the inherent power. The success of the prescription satisfied him of the virtue of little pills.
Another patient objected to the very small vials of my pocket-case. I replied they were a matter of convenience to me, but if he would be better satisfied I would, next day, bring his dose in a quart bottle and pour out the same quantity (pellets). He also perceived that his objection was frivolous, and was content.
2. Do you use the decimal or centesimal scale in the preparation of the high potencies?
As matter of fact, we use the centesimal scale in preparing the high potencies and all the potencies which we use, and have used since we began to practice medicine. As a matter of opinion we see no reason to prefer the decimal. It does not insure a more uniform gradation as has been claimed. The use of it leads to confusion and is to be regretted. We prefer adhering to Hahnemann’s scale. It is easy to convert the one into the other in reporting cases or in reading reports. If our correspondent will refer to the article which prompted his letter, he will note that in the treatment of pneumonia Wurmb and Eidherr used potencies prepared on the decimal scale, which fact we there stated and we reduced their numbers to the corresponding ones of the centesimal scale. In general in this country where the facts are not specially stated, it is understood that the centesimal or Hahnemann scale is intended.
Our own preparations were made in strict accordance with Hahnemann’s directions and so are the high potencies of Lehrmann, as we have learned from Dr. von Boenninghausen, who directed their preparation, and from Lehrmann, himself.
3. Do you repeat the high potencies in rapid succession in acute diseases, as you do the low preparations?
How shall such a knotty question be unraveled? It involves two assumptions, two beggings of the questions, viz: 1. That we do repeat the low potencies in rapid succession in acute disease; and, second, that we make any such distinction between acute and chronic diseases, as to admit of a radical difference in our principle of prescribing.
1. We recognize but one rule touching the repetition of the dose. It was laid down by Hahnemann and is as follows: Do not repeat the dose of the remedy given until the effects of the previous dose shall have ceased to be evident. Our most grievous failures have come from a violation of this rule. Our most brilliant and complete successes have coincided with a strict observance of it. If we are sure that our remedy has been rightly selected, we sometimes direct, particularly in cases that have been actively treated by allopathic physicians before we were called, and in which we apprehend a sluggish response to remedies, a repetition of the dose every few hours, until some amelioration or decided aggravation appear, but we always order a suspension of the remedy as soon as either is manifest.
2. We know of no clear distinction between acute and chronic disease on which to base a difference in treatment. Indeed no difference whatever, unless it be one analogous to that which Hahnemann laid down viz.: that chronic diseases are based on the awakening of miasms that had hitherto lain dormant in the system.
For instance, is scarlatina an acute disease? Assuredly it is so regarded. Yet, on the third day, scarlatina often shows that it has awakened and ingrafted itself upon the scrofulous (or psoric?) taint in the patient’s constitution and then, surely, it becomes typically chronic. This is an example of what we see happen in all forms of disease. It prevents an available distinction between acute and chronic diseases.
We can assure our correspondent that it is safe and advantageous to strictly follow the Hahnemannian rule about the repetition of the dose in acute no less than in chronic diseases. But let us anticipate a possible confusion in his mind. Some writers Dr. Drysdale we are surprised to see among them-seem to think that Hahnemann, when he said, “Wait till the first dose shall have exhausted its action,” meant to say, “Do not repeat the dose until that period shall have elapsed which I have indicated in the Materia Medica as the duration of action of each drug.” This period for some drugs is several days, for others several weeks or even months. We do not so understand him. The duration of action of a remedy on the healthy subject (prover) furnishes no criterion of the duration of its action on the sick. Again, the duration of its action on one sick person furnishes no criterion of the duration of its action on another sick person. Surely the vital processes are much more rapid in acute pneumonia than they are in tuberculosis. Is it not probable that the duration of action of a dose of medicine would be shorter in the former than in the latter?
We suppose Hahnemann meant as follows: “If amelioration follows a dose of medicine, do not repeat the dose until the amelioration ceases to progress, Then, if the symptoms be the same as before, though mitigated in severity, repeat the dose. If the symptoms be different, study the case anew and make another selection of remedy.” It is in this sense that we have understood and the we apply Hahnemann’s rule. Not pretending that we do not often, through errors of judgment, infringe it, we are sure that whenever we do so, misfortune follows, and that in proportion to our faithfulness, so is our success.
In respect of the repetition of doses, as well as the form of the prescription, we have no difficulty with our patients. Patients are like soldiers; they believe in a man who believes in himself. We say this in all humility, for, in a matter of science, belief in one’s self is faith in the laws one has under-taken to carry out in practice. And if the physician show confidence in his methods, his patients will yield themselves implicity to his guidance. The prejudice in favor of large and m any doses is a relic of past ages, when the practitioner was paid, not for his skill and personal services, but for the medicines he furnished, a barbarous usage, which, along with slavery, we received from our British progenitors. Unlike them, we have discarded the former but not the latter.
4. If you use pellets, do you consider them perfectly reliable? Assuredly, or else we would not use them. We medicate them ourselves.
And, how many constitute a dose? If, properly medicated, one is as good as one hundred. As there is a possibility that, in medicating several thousands at one operation, a pellet here and there may fail to get saturated, we usually give about four to six. We use the smallest pellets as most easily and surely medicated.
5. Do you alternate the high potencies, or do you rely upon the single remedy?
Here again our friend confounds a principle and quantity. If it be right and advantageous to alternate the low, it is right and advantageous to alternate the high potencies. But, in fact, we do not alternate at all. We always rely on the single remedy at one time. Dr. Drysdale says that everybody alternates, and, therefore, there must be some necessity for the practice. But his illustrations are so far fetched, and his definition of alternation is so contrary to the conceptions which all other homoeopathicians, from Hahnemann down, have had on the subject, that, notwithstanding our respect for Dr. Drysdale, we must repeat, in the very face of his learned paper, that we do not alternate.
Our understanding of the practice of alternation, and our objections to it were stated, as well as we are able to state them, in the American Homoeopathic Review, June, 1863, vol. iii., No. 12. (1 1See “Alternation of Remedies,” in this book.).
We are opposed to it in theory, and we adjure it in practice. It is an abominable heresy. As a shot-gun maims where the rifle would kill, so alternation may change and modify and main the disease, but it never does nor can effect the clean, direct and perfect cure that a single remedy, exactly homoeopathic, will accomplish. As a relic of the polypharmacy which has been the stumbling-block of the Old School, we loathe it. As a refuge of the careless prescriber and slothful student, we despise it. As an anomaly in homoeopathic practice, a fatal obstacle to progress in the clinical portion of our Materia Medica, we deplore it.
6. Do you believe that the high potencies, from your own experience in the use of them, and from what you have beheld in the practice of others, are far superior in all respects to the law preparations as remedial agents?
An affirmative answer is involved in the statement that we use the high in preference to the low preparations. For details we refer again to the article which prompted our correspondent’s letter. Personally we have suffered, and do now suffer, from chronic organic disease, and from occasional very violet acute attacks. We always use the high potencies in these cases, preferring them to the low. We use them in our family and among our friends. We use them in general practice. Many of our friends and patients, non-professional persons, know the fact and freely say that they and their children are more speedily cured by the high than by the low potencies.
N.B. The imaginations of our friends aforesaid are not more lively than those of the average of other people. Indeed, they are plain, matter-of-fact persons, possessing much common sense, but, for the most part, no genius. They prefer high potencies.
And now, having replied in detail to the queries of our correspondent, let us add a few remarks which we beg him to receive in good part.
To change the aspect of a case, to cause the original symptoms to be supplanted by other symptoms, this is no more a cure than “a strategic change of base” is a “victorious campaign.” Yet this may be effected by repeated doses of a drug in a low potency, whether the drug be strictly homoeopathic to the case or not. And a succession of such changes and supplantings may be effected, day after day, until finally the patient gets well or nearly so. Meanwhile the patient may be amused by the varieties which each day brings forth, and if he know nothing of a true homoeopathic cure, but have heretofore had only the heroic treatment, he may fancy he has been doing finely.
Now, in this way, with low potencies, a practitioner may do quite a business on a very slender capital of knowledge.
Not so if he use the high potencies. With these no change is effected in the case unless the remedy have been strictly homoeopathic to the case. They are like the rifle-ball if they hit, they kill; if not, there is no record of the shot. There can be no good luck from scattering.
Now it will be perceived that the question of cures with high and low potencies is not merely a question of potencies, and our friend’s trial will not be a fair one unless he make sure that his selection of the remedy in each case in which he tries the high potencies is strictly homoeopathic. If he make sure of this
and be correct in it, then let him go on in confidence with his experiment. We bid him God-speed.