Kurtz prefers the lower dilutions-Veith acknowledges the necessity of various dilutions-Kammerer prefers the higher dilutions, but gives stronger doses in acute diseases–Schmid always gives substantial doses-Watzke prefers the lower dilutions-His rules for the dose-He condemns the Jenichen preparations-Trinks lays down rules for the dose. The doses vary with the character of the remedy-And of the disease-Trinks practically an adherent of the lower dilutions-Schron prefers the lower dilutions-Ridicules the Jenichen potencies-Elwert prefers the lower-Helbig condemns an exclusive adherence to high or low dilutions-He gives large doses to drunkards-Vehsemeyer uses the lower dilutions-Schuler gives larger doses to drunkards-Noack condemns exclusivism-Goullon says the dose is to be regulated by the reactive power of the organism and the quality of the medicine-Lietzau recommends the pure tincture-Schneider opposes the exclusive use of the 30th-Wable prefers medium doses-he recommends much succussion-Kampfer prefers the lower and medium dilutions-He gives different medicines in different doses-He considers drunkards very sensitive to small doses-He gives massive doses in typhus-Hartmann does the same-J.O. Muller opposed to a uniform dose-Condemns the high potencies-Attomyr endeavours to find rules for the dose in the provings-Hering also looks to the provings for rules for the dose-Black is disposed to do so also-Koch makes the dose depend on similarity, susceptibility, and intensity-Stens prefers the higher dilutions- Griesselich prefers the lower dilutions, especially for acute diseases-Arnold thinks it is never necessary to go beyond the 6th decimal dilution-Mure claims the merit of the discovery of a posological rule-He lays down many rules for the dose-Nunez prefers the dilutions above 2000 for acute and chronic diseases- Cruxent’s grand astronomical rule for the dose-Scott’s rules for the dose-Great latitude of the remedial dose-Rarity of one dose curing where another had failed-Hahnemann erred in fixing on a uniform dose-Various circumstances determine the suitable dose- come diseases demand larger doses- Some medicines require to be given in larger doses.
IN continuation of the subject of homoeopathic posology, commenced in my last lecture, I now proceed to lay before you some few, more of the opinions broached on the subject by the most distinguished and influential of Hahnemann’s disciples. I should be taxing your patience too much to give a complete detail of all that these gentlemen have written on the subject, so I shall content myself with the briefest of outlines, in order to put you au courant with the ideas of the most eminent among the homoeopathic writers on the subject of the dose, so that, knowing what has already been written on the point, you may be spared the trouble of painfully excogitating afresh ideas that have already been thought out by others, or arrived at by a lengthened and careful experience.
The first of those who have written on the dose question who stands on my list for this evening, is Dr. Kurtz, (Hyg., iv.239; Jahrb. f. Hom., i. 83.) favourably known for several powerful and effective articles on homoeopathy of a valuable practical character. For him the dose is comparatively a very indifferent matter. It is the quality and not the quantity that produces the curative effect; it matters little, he thinks, what the quantity is, provided it is not so great as to overpower the vital dynamism by its too great medicinal or by its chemical action. In most cases he thinks it is safer to stick to the lower dilutions; he cannot deny that he was often seen the efficacy of the higher dilutions, but as often their total inefficacy; he will not deny the occasional occurrence of medicinal aggravations, but they do not seem to depend on the dose given, as they occur just as often from the high as the low dilutions. He believes that the aggravations, when they follow the administration of the higher dilutions, occur in consequence of the vis medicatrix being only excited by them to feeble reaction.
Dr. J.E. Veith (Hyg., v.432.) acknowledges the perfect necessity of the dilutions and triturations; the appropriate remedy, when minutely subdivided, acts much more excellently and is much more suitable to the functions of the capillary and nervous systems than the medicine in the grosser material forms. The impulse of the medicinal actions ought not to be more powerful than the vitality demands for its critical actions. The dilutions still retain their medicinal power in very high potencies. In his practice, the 18th is the highest dilation he uses. Dulcamara, sarsaparilla, sambucus, tinct. sulphuris, cannabis, ledum, rhododendron, rheum. etc., he gives in the pure tincture or 1st dilution; much, he says, may be done with sepia, calcarea, silicea, etc., in pretty high dilutions, even with the regulation 30th dilution.
Dr. Kammerer (Ibid., iv.488.) takes up the other side of the question, and shows himself an ardent admirer of the smaller doses. He thinks it our duty to show, in contrast to the allopathic school, with how small and with how large doses we can cure diseases; and he says that this very contrast will make out opponents reflect and abandon their method of treatment. It is a fact, he says, that homoeopathic medical men who employ the larger doses often take weeks to cure diseases, or perhaps are unable to cure them at all, whereas they are readily cured by means of the higher dilutions. It would be difficult to prove this fact of Kammerer’s as we do not often find cases so exactly alike as to afford proper grounds for making a comparison; moreover, the precise converse of this statement has often been made by other equally trustworthy homoeopathic observers. Still Kammerer is not such an enthusiast for the higher dilutions as to wish to reject the lower ones, or even the pure tincture; each,. he says, is suitable in its proper place and at its proper time.
There are, he believes, no general rules for the dose yet discovered. He generally prefers for acute diseases the larger doses, for chronic diseases the smaller ones, but the choice of the dose in these cases must always depend in some measure on the individuality of the patient and the reactive power of the organism. He says he has never succeeded in curing an important organic disease by means of large doses or frequent repetitions of the dose. Much as Kammerer speaks in favour of the high dilutions in this essay, we learn from others of his works, especially an article on the metaphlogosis of the cellular tissue of the neck, and another upon typhus fever, (Hyg., v.257 and xv.1.) that he employed occasionally the lower dilutions with great effect; that in the last-mentioned essay he speaks of giving the remedies in from the 1st to the 6th dilution, in drops — calc.5, phos.6, arsen.6, and so forth. The success of his treatment was, he tells us, very great. In another essay, (Ibid., xi. 289.) Kammerer tries to bring about a union betwixt the advocated of the large and small doses; each party, he says, possesses a portion of the truth. A consideration of the degree of the sensitiveness of the diseases organs and their power of reaction will, he imagines, explain all the apparent contradictions of the posological question.
At the furthest material terminus of the posological scale stands Dr. Georg Schmid, who from the very commencement of his homoeopathic career showed himself an opponent of the hyper micro-posology of Hahnemann’s later years, and a defender of the material doses of his earlier practice. In 1846 he published in a special work (Arzneibereitung and Gabengrosse) the results of his experience with the larger doses which his convictions led him to employ. In the fifth volume of the British Journal of Homoeopathy you will find the cases given in that work translated, and a perusal of them will show you what can be effected by material quantities of medicines homoeopathically selected, and by the success of G. Schmid’s practice you will be, I think, convinced of the superlative folly of those puritans of the Gross and Boenninghausen school who denounce all who employ ought approaching to sensible quantities of our medicines as allopathists in disguise, and seek to brand them with other recherche epithets.
By some strange fatality, it has very frequently happened that those who have thought it incumbent on them to use the high dilutions only in their practice, seem at the same time to deem in requisite to employ their own natural common sense in infinitesimal quantities also, when judging of the posological question. But to return to Dr. Schmid. He says that we have no reason to dread the use of the larger doses, that real medicinal aggravations are much rare than they are by many side to be, what have been called by that name have generally been mere phases of the natural aggravations of the diseases; and so far are the real medicinal aggravations from being to be dreaded when they do occur, that they are to be regarded as only an increase of the reaction of the vis medicatrix against the disease, and this increase in general only leads to the more rapid and successful dispersion of the disease; of course it is requisite that the selection of the remedy should be correct, in order that this should happen.
He makes the size of the dose dependent on the condition in which the medicinal substance is; he admits that the process of trituration is effectual in awakening the latent powers of some substances, such, for instance, as sulphur; so far he acknowledges the dynamization-theory. Thus, oddly enough, we find, Dr., Schmid the advocate of the most material and massive doses, holding, as I have shown you in a former lecture, the most ultra dynamical notions respecting the morbid and curative processes, and adopting this other dynamical notion of Hahnemann’s respecting the dynamization of drugs by the pharmaceutic processes to which they are subjected. To be sure, his belief in dynamization does not go very far, for he considers that it attains its utmost limit in the 1st trituration. The doses recommended and administered by Schmid are certainly not large compared with those given by the allopathic school, consisting only of drops and fractions of grains of the medicament. He seldom gives a medicine in the diluted form; but veratrum he makes a special exception to this rule, and he states that he never gives it in the pure tincture, as he has often seen severe aggravations ensue from its use in this form. Arsenic is another remedy that he gives in comparatively small doses, usually about the 2nd trituration. He enters into a long defence of his doses, and argues at great length in favour of their being still within the limits of homoeopathy; but arguments in proof of this are only necessary for those who believe that homoeopathy is identical with infinitesimal doses. The exclusive employment of massive doses, as practiced, by Dr. Schmid, is equally absurd with Dr. Gross’s exclusive employment of high dilutions, and by adhering to either extreme the advantages obtainable by a variety of dose are lost.
Dr. Watzke of Vienna — the late learned editor of the Austrian Homoeopathic Journal, which effected more for homoeopathy in its brief career of four years than any other homoeopathic journal in ten — has furnished us (Hom. Bekehrungsepist., i.81.) with the results of his experience and reflections on the subject of the dose question. He says the proper selection of the remedy is the first thing in point of importance; to this the size of the dose is quite subordinate, but it is by no means a matter of indifference. He says that he himself has gone through both extremes of our homoeopathic posology. At one time he gave nothing but 30th dilutions, at another nothing but the 3rd, 2nd, 1st attenuations or pure tinctures; he hovered, as he expresses it, at first in the ether of decillionths, and then descended into the lowest depths of the material substance. From these two extremes he gradually lapsed into a happy medium, usually the 3rd to the 6th attenuation, prepared according to the decimal scale, without, however, altogether rejecting the higher and lower preparations. Supposing that the smaller doses would always effect all that the larger ones can do, still he prefers the latter; 1st, because it is of importance to divest our doctrines and practice as much as possible of the appearance of the paradoxical, the marvellous, and the incredible; 2nd, because he does not wish to pay dearer for what he may obtain cheaper; 3rd, because he can be more certain of the purity and genuineness of the preparations in the larger doses. He lays down as maxims -1, that the size of the dose must depends on the receptivity and on the sensitiveness of the patient, and of the affected organ or system, on the kind and magnitude, the course and the stage of the disease, as also on the character of the medicine; 2, that the dose must be the larger, the more rare, difficult, and tedious the cure of the disease is by nature alone, and vice versa. He gives examples of the beneficial action of the smallest doses, viz., the 30th dilution. On a subsequent occasion (Oest. Ztsch., i, 3, 236.) he details examples of the power of larger doses in an epidemy of measles. The doses were aconitum, in the 1st and 3rd, and belladonna and pulsatilla in the 3rd dilutions. In another place (Ibid., ii.1,133.) he gives us examples of the treatment of chronic diseases also with the larger doses. One dose consisted of a whole drop of oil of sabina, which caused no medicinal aggravation and indeed Watzke talks very little about such aggravations; and in a whole array of cases treated by the larger doses there is no instance of such aggravations having ensued. He inveighs against the high potencies of Jenichen, and states that he tried them repeatedly and carefully, without the slightest benefit. He does not, however, condemn the higher dilutions of the Hahnemannic scale; on the contrary, he believes there are some diseases for which they are indispensable, and he believes that by confining ourselves, as Schmid dose, to the massive doses we shall lose many advantages. In his proving of natrum muriaticum, he says, ” I regret to say I am forced to declare myself in favour of the higher attenuations.”
Dr.Trinks, so favourably known to homoeopathists by his valuable additions to the Materia Medica, as also by his recent complication of an abridged Materia Medica, handles the posological question with his usual ability, in the introduction to the last-named work. (Einleitung, p. xxxvi.) He says, that notwithstanding the vast quantity that has been written on the subject, and the incessant controversies the dose has given rise to in the homoeopathic camp, it cannot be said that a satisfactory solution of the problem has yet been arrived at. It is a question that a very extensive experience can alone decide, and it cannot determined, as hahnemann well remarked, by subtle reasoning or hair-splitting refinements of casuistry. In the present position of the question, the following, he says, seem to be a few of the maxims that experience, when honestly consulted, has determined: —
1. Acute diseases require the lower and middle attenuation.
2. Chronic diseases requite higher and often the highest attenuation, because they generally need for their cure such medicines as only attain their full development of power by means of repeated subdivision.
3.There are many exceptions to this — many chronic diseases requiring low dilutions, and even the mother tincture.
4. Many observations go to prove that he higher dilutions are of use in diseases, not only of a purely dynamic but also of a material or organic character.
5. Many medicines appear only to develop their full powers by long-continued trituration and succussion.
6. Many other medicines seem to possess their full powers in the original tincture or crude state, and all the subsequent processes, to which they are subjected seem but to diminish those powers.
The proper dose must be determined–
1.By the peculiar nature and essential character of the medicines. Their physiological provings throw all the light we possess upon their energy, intensity, extensity and duration of action. Among the medicines which, even in large doses, display great energy and intensity along with a short duration of action, are, aconitum, chamomilla, camphor, moschus, ignatia, ipecacuanha, hyoscyamus, coffea, stramonium, laurocerasus, sambucus, opium, etc. Those that have a less violent, but more intensive, penetrating, and longer-lasting action, are almost all the mineral medicines, the mineral acids, and not a few vegetable substances. The most energetic and intensively acting medicines and intensive medicines in the medium dilutions; the least energetic and intensive in the lowest dilutions and crude substance. The first class includes all our so-called heroic medicines; such are, belladonna, bryonia, arsenicum, calcarea, kali, lachesis, lycopodium, mercurius corrosivus, natrum muriaticum, phosphorus, sepia, silicea, sulphur, rhus, etc.
The second class, which should generally be used in the medium dilutions, included cannabis, china, euphrasia, coffea, arnica, asafoetida, agnus, bismuth, capsicum, chamomilla, chelidonium, crocus, dulcamara, digitalis, gratiola, hepar, ipecacuanha, laurocerasus, ledum, mezereum, phosphoric acid, nux moschata, oleander, opium, rheum, sabina, secale, senega, spigelia, squilla, tabacum, thuja, veratrum, etc.
The third class, which generally require to be used in the lower dilutions and crude substance, comprehends ferrum, verbascum, camphor, moschus, castoreum, viola odorata and tricolor, taraxacum, trifolium, chelidonium, etc.
The second determining circumstances is the nature and character of the disease to be cured. Diseases that display in all their phenomena great energy and intensity, rapidity of evolution, attack the most important organs, betray much malignancy, and threaten the integrity of the whole organism, or of certain parts of it, demand an energetic and rapid medicinal influence. To this category belong almost all the acute diseases, inflammations, gastric, bilious, catarrhal, rheumatic, typhus, and putrid fevers. Nervous fevers and nervous rheumatisms, on the contrary, demand the higher dilutions. Chronic diseases demand, as a rule, the higher dilutions, but there are exceptions to this, in the case of those diseases, namely where, along with inveteracy and long duration, there is torpor of the ganglionic system, as in the case of hypochondriac diseases, where the patient has led a dissipated life. In hysteria also the smaller doses can often not
be borne, especially in those cases where in some parts the irritability is abnormally increased, in others abnormal torpidity is present. In those cases we sometimes find that neither the high nor the low potencies do any good. In other cases of hysteria we sometimes observe the best effects from the high dilutions. Where there is great irritability of the cerebro- spinal system, there is often little susceptibility to medicinal influences, and, on the contrary, a high degree of susceptibility often co-exists with great torpor and even partial paralysis of the nervous system. Disturbances of the mental state of a chronic character often demand the utmost caution in the choice of the dose. Often the smallest dose suffices to restore the lost balance of harmony of the most chronic description, in other cases large and repeated doses are required.
Diseases of the mucous membranes of the alimentary canal, of the uropoietic and sexual organs, and of the respiratory passages, may be treated at once with the medium dilutions, and the lower dilutions may be had recourse to where there is great atony and torpor, especially if this has lasted long.
Neuralgias and spasmodic affections sometimes requite high, sometimes low dilutions.
Syphilis and its various developments demand the lower dilutions and stronger doses of the appropriate medicine; but the most inveterate cases never require the mercurials in the crude state.
Chronic gout demands great circumspection in the selection of the dose; the smallest doses often cause intolerable aggravations.
Chlorosis requires iron in large and repeated doses, but other medicines in the highest dilutions.
The medicinal dyscrasias caused by the abuse of such medicines as mercury and iodine require a cautious administration of their antidotes, but the cinchona disease and the lead-poisoning require larger doses of their antidotes.
The other determining circumstances in the selection of the dose detailed by Trinks I shall only briefly enumerate; they are–
3. The individuality of the patient.
4. The constitution.
5.The sex. The female is most susceptible, and therefore requires the smallest doses.
6. The temperament. The melancholic, sanguine, and choleric temperaments display the greatest susceptibility, the lymphatic the least.
7. The manner of life of the patient.
8. His idiosyncrasies.
9. The epidemic and endemic influences.
10.The influences of climate. The inhabitants of warm climates seem to possess a greater susceptibility for medicinal influences than those of more temperate and colder climates.
Dr. Trinks has many other very valuable directions and, maxims respecting the choice of the doe, which are well worth a careful study, but which time would fail me to detail in this lecture. We find from the Materia Medica which he published conjointly with Dr. Noack and Muller, that practically he is an adherent of the lower dilutions and triturations, and that he often prescribes the pure medicine. He is of opinion that many diseases are curable by stronger doses, whereas the smaller and smallest doses often merely irritate without producing any curative reaction.
Dr.Schron (Hauptsatze, p.63.) was one of the first who combated Hahnemann’s views on the subject of posology. He is, however, no bigoted defender of the more massive doses, on the contrary, he relates a case where spongia 6 caused an extraordinary aggravation, whilst spongia 45 diminished the symptoms, in a remarkable degree. He says he acknowledges the undeniable efficacy of such small doses, and seeks for an explanation of this efficacy in the delicate power of reaction of the organism, and not in any dynamization or increase or power in the medicinal preparations; the smaller and smallest doses are not, he says, to be regarded as essential to homoeopathy, since the properly chosen medicine will display its curative powers in the larger doses also. What to give? is the first question to be determined. How to give it? is the second and secondary consideration; and yet, notwithstanding that this is invariably the distinct declaration of all the advocates of the lower dilutions, their unthinking opponents, the partisans of the exclusive treatment with globules of the highest potencies, allege that the quantity prescribed by their opponents is meant to make up defective quantity, in other words, that the large dose is intended to be a substitute for an imperfect and erroneous selection of the drug; than which nothing can be more unfounded. It would perhaps be nearer the truth to assert that the high dilutionists are much more intent on giving a medicine in a high dilution than in attending to all the circumstances connected with the disease that could determine the choice of the remedy. In another place, (Naturheilprocesse., ii.200.) Dr. Schron says that many observations have shown that the more massive doses have produced the desired effect, where the very small ones were of no avail. If, he continues, we take into consideration the face that homoeopathic aggravations occur very rarely, that what have been termed medicinal aggravations are generally to be ascribed to the natural course of the disease, and that an occasional aggravation is not to be avoided though we use the smallest doses, it is not easy to see why we should waste precious time by the administration of the smallest doses, which sometimes have no effect whatever. We cannot, however, he goes on to say, deny that there are certain cases, especially in very irritable patients, or diseases of a very excited character, where we may with the greatest advantage employ the high dilutions, and, in fact, where we cannot dispense with them; but in the generality of cases it will not be necessary to go beyond the 3rd or 6th dilution, whilst there are many medicines which can be advantageously employed in the pure tincture or 1st attenuation. In spite of giving such doses, he asserts he has never witnessed any so-called homoeopathic aggravations. He ridicules (Hyg., xxi.1.) the absurdity of the high potencies of Jenichen, and will not waste time by testing them at the sick-bed.