Having selected the indicated remedy, having decided upon the medium in which it should be given; having decided upon the repetition of the dose and potency; having prepared the channels, the next step in its administration is to give such direction as well secure the confidence of the patients. These directions apply not only to the remedy, but to auxiliaries to the remedies such as diet, exercise habits, etc.
My experience has taught me that it requires as through a knowledge of the records of the day books of our drug provers; as good a knowledge of human nature; as good a memory; as much tact, and as wide experience as it did to select the remedy; for in addition to deciding the potency of our remedy, the size and repetition of the dose, we must consider the channels through which to administer it and the auxiliary treatment. To illustrate my meaning concerning tact, let me relate two cases by Prof. S. Lilienthal and one by Prof. N. H. Dickinson.
Case I. A wealthy woman living on Fifth Avenue, New York, who took great pleasure in telling all her friends that she was a chronic invalid, had been unable to walk, in fact, even dress herself, for over a year; she did not suffer much, but was ” so weak, so weak!” One morning Professor Lilienthal’s wife asked him to go with her to look at a clock in one of the leading New York stores. From there Lilienthal went to see his patient. Her report was that for the past twenty-four hours there had been no improvement. She was so weak that it took her maid two hours to help her bathe that morning. Professor Lilienthal then described a clock he had seen at the store in the morning. He used all the adjectives of which he was a past master, to describe that clock, and informed his patient that the clock would be on exhibition again at 2 o’clock that afternoon.
He then gave the patient some Placebo and told her that he was sure that would strength her; that it was a new remedy that he had read about the night before. At 2 o’clock he was in his carriage on the street opposite the store and, as he expected, his patient soon appeared to examine the cloak. From that date on she had no neurasthenia.
Case II. This time a case of hysteria; also a Fifth Avenue patient whose husband paid Professor Lilienthal 1000.00 a quarter to take care of his wife. It was her habit to call Professor Lilienthal between midnight and three o’clock. ON this occasion he found her suffering most excruciating pain in the stomach. She was turning in bed, first in one position and then in another, exclaiming, ” Do something, do something.” In her contortions she happened to turn into the knee and chest position and Professor Lilienthal brought his hand down upon her buttock with a sound that could be heard all over the house. The patient at once turned over, sat up, and pointing, said to Lilienthal,”There’s the door.” The Professor went. The husband, however, paid his 1000.00 a quarter for three years afterwards.
Case III. Professor W. H. Dickinson was the most tactful man I ever associated with. Let me give you one illustration of his tack. We had held a long consultation over a patient – a woman, aged forty-five, who had a long, large chin, with heavy jaws, and thin lips, which closed with a snap and remained closed. She had told us what was the matter with her and what she wanted us to do. Dr. DIckinson put up the remedy agreed upon and said, “Take five, just fifteen minutes BEFORE, now remained before, each of your three meals.” When we got outdoors Dickinson said to me: ” I noticed the surprise on your face when I said before meals. You see, I know her. The only way to get her to do what you want her to do is to tell her to do the opposite. She will take the medicine fifteen minutes after each meal, as I want her to do.”
The Potency and Repetition of the Dose
Having decided upon the indicated remedy, we still find two very important and difficult questions confronting us. The first is : In what potency should it be given? The second one is : If more than one dose, at what intervals should the dose be repeated? Let us take up these two questions.