a. If it is necessary to afford speedy relief, we must give large doses; if not, small.
b.If it is necessary to give transient relief, we must give large doses; if not, small.
c. If it is requisite to afford intensive relief we must give large doses, if extensive, small doses; hence acute diseases demand large, chronic diseases small doses; the principle of similarity demands this.
Thus Attomyr seeks to carry out the principle similia similibus with regard to the selection of the dose as well as of the remedy, and he considers it inappropriate to give for an acute disease a preparation that only commences to act after a considerable time, that has a long duration of action, and that acts extensively. But in order to be able to apply these rules of Attomyr, it is, as he justly observes, requisite to understand what are chronic, what acute diseases; and what are large, what small doses. As regards the doses. One grain of arsenic is a large dose, and one grain of verbascum a small dose, in respect to the healthy individual; it is otherwise with the sick. Hahnemann, says Attomyr, gave at first large doses, but finding their action too violent, he diluted until he came to the 30th, and finding that certain medicines acted best in this dilution, he inferred that the 30th dilution was the best for all medicines. Experience, however, shows that the 30th dilution is not the ultimate limit of the efficacy of all medicines. With many medicines the dilution may go still higher. Dr. Attomyr now sails away upon the wings of speculative day-dreaming into the mystic region of the dynamization-theory, whither I shall not at present follow him. In another place (N. Archiv, iii.2.) he again reverts to this subject, and repeats that the Materia Medica is the only place where we can discover rules for the dose. The size of the dose is, he says, not to be determined by the age, the temperament, the sex, etc., but by the disease. A patient who is affected in the same way as a large dose of arsenic affects a healthy person, must get a large dose of arsenic for his cure; one who has the symptoms occasioned by small doses must get small doses; and again, one who has symptoms similar to those produced by the high potencies, will be cured by high potencies of arsenic only. Now, independent of the primary difficulty that meets us at the very threshold of this posological maxim, viz., that in Hahnemann’s Materia Medica we have no information respecting the various doses that cause the different symptoms, methinks it would be rather a dangerous plan to give a patient labouring under-say gastritis, a dose of arsenic sufficient to cause that disease in the healthy, or to a patient affected with pneumonia the quantity of phosphorus sufficient to develop that disease in a healthy person.
Dr. Hering of Philadelphia has on more than one occasion given us his ideas on the subject of the dose. Latterly he has published a paper, (Ibid., i.3, 161.) endeavouring to lay down rules for the selection of the dose. The course of the medicinal disease must, he says, correspond with that of the disease to be cured. He rejects the idea of the secondary action of drugs being owing to the reaction of the organism. Primary and secondary actions are both owing to the direct agency of the medicine. In proving medicines in larger doses, there occur first the primary violent effects of the medicine, and afterwards a series of symptoms are observed that last for a long time, as long as weeks or months, and gradually diminish in number and intensity. These secondary symptoms are often the very opposite of the primary ones. When medicines are proved in the higher potencies, only these latter, the secondary symptoms, are observed, and there is no opposition perceptible betwixt the symptoms produced during the last and the first days of the medicine’s action. The practical rule he deduces from these remarks is as follows:-“Have we chosen our remedy from the symptoms of a case of disease on account of the perfect correspondence of the chief characteristics in disease and remedy, we have only to note whether the symptoms of the case correspond with the primary action of the drug, when we give the lower dilutions, or with the secondary symptoms, that is, with those got from the provings with higher potencies, in which case we give the higher.” Now, in order that this rule should have any practical value, we should require to know what symptoms are primary, what secondary in the Materia Medica, which I have on a former occasion shown we do not, or at least, what symptoms were produced by stronger, what by weaker preparations of the medicine, which we must ever remain ignorant of as far as Hahnemann’s provings are concerned.
Dr. Black, in an excellent paper on posology, in the seventh volume of the British Journal of Homoeopathy, is disposed to think more hopefully of Dr. Hering’s plan than, I confess, I do. I must refer you to that paper, as it is well worth an attentive perusal. (He has since, however (British Journal of Homoeopathy, x.692), stated that he no longer entertains this favourable opinion of Hering’s plan, and thinks it was an over-hasty conclusion, but there are many other points in his first paper that render it worthy of attention.)
Dr. Koch, in his great work On Homoeopathy, (Die homoeopathie, p.586.) has recorded at length the thoughts that had long occupied his mind with reference to posology, and which he had partially expressed on several occasions. The following are the practical rules he lays down for the dose:-
1. The more similar the remedial power (the pathogenetic effects of the medicine) to the disease, the more certain will be the cure, and the smaller, within certain limits, should be the dose.
2. The less similar the medicine, the larger should be the dose, but the cure is not so certain.
3. The more similar the medicine, the more hurtful is a large dose.
4. The greater the susceptibility, the less should the dose be, and vice versa.
5.The more intensive the exciting cause, the more similar and stronger, quantitatively speaking, must the medicine be.
6. The more intensively, rapidly, and energetically the morbid process goes on, the more necessary is it to select the remedy accurately and to give a larger dose, whilst in morbid processes of less intensity and rapidity a smaller dose is necessary.
Dr. Stens (Allg. hom. Ztg., xl.11.) of Bonn lays down the following rules for the dose:- 1. High potencies (betwixt 12 and 30) are in general the most appropriate, and in most cases capable of being substituted for the others. 2. In recent diseases that have more of a local character and appear to be limited in extent, the lower potencies are to be preferred. 3. In very chronic, deeply rooted maladies, even when they appear locally, the higher, and especially the so-called high potencies, are vastly superior to the lower.
Griesselich (Handbuch, 242 et seq.) subjects the whole posological controversy, to the searching glance of his acute critical mind. It is refreshing to read the observations of one endowed with a fine mainly common sense, after the inanities and platitudes that are so frequently indulged in by many of the eccentric followers of Hahnemann, whose great aim seems to be, like that worshipful magistrate Mr. Dogberry, to write themselves down asses. Into Dr. Griesselich’s criticism I have not time to enter, so I shall content myself with briefly giving the conclusions to which he arrives. He gives the decided preference to the lower dilutions, more especially in the case of acute diseases. In such dangerous cases it is always safer to give a little too much than too little of the medicine; and in chronic diseases, where there is plenty of time, there can be no objection to feeling our way with small, and even the smallest doses. The fear of the larger doses is, says Griesselich, as unfounded as that of the smaller doses; both are useful, and such is the great susceptibility of the organism and such its power of neutralizing any excess of the remedial agent, that the range of doses applicable for any disease is much greater than is commonly supposed. Dr. Griesselich sets his face entirely against the mystery-monger Jenichen and his ridiculous preparations.
The opinion of Dr. J. W. Arnold, one of the most distinguished of Hahnemann’s disciples, whether we consider his reputation as a physiologist before he became a convert to homoeopathy, or his untiring zeal in labouring to advance scientific and rational medicine since that time, is entitled to great weight, and I have accordingly much pleasure in quoting entire from his latest work (Das rationell-specifische oder idiopathische Heilverfahren, p.320.) the results of his long experience. “After I was convinced,” he writes, “of the truth of Hahnemann’s law of cure, I deemed it my duty to listen to the repeatedly expressed desire of the Reformer and repeat his experiments exactly. As far as the doses were concerned, I did this with the greatest unwillingness and with complete scepticism as to the result. Nevertheless, I saw not a few cases recover after the administration of medicines in the 10th, 20th, and even 30th centesimal dilutions. I observed not only the speedy cure of acute diseases, but also frequently a remarkable change, and finally the complete cure of chronic cases. I readily grant that many of the cures which encouraged me in the commencement of my homoeopathic experience were not due to the small doses of medicine exhibited; but that all the results are to be ascribed to the healing powers of nature alone, I can by no means convince myself, even with all the force of scepticism. I saw in not a few cases which had resisted the most different modes of treatment, a cure take place after a small dose of a carefully chosen homoeopathic medicine, which could not possibly be ascribed to any other influence than that of the medicine. In not a few cases, however, I waited in vain for a curative result from the small doses; but still distrusting myself rather than the dicta of Hahnemann, I at first sought the cause of the failure, not in the insufficiency of the dose, but in some error in the choice of the medicine. This gave me no little trouble and anxiety, until I found myself compelled to descend to low dilutions. I was soon convinced that these yielded much more certain results without the so much dreaded dis- advantages. In this manner, guided by experience, I arrived step by step at the maxim that it is never necessary to administer medicine in any dilution or trituration higher than the 6th decimal, and I have never had to complain of any hurtful collateral action or any primary action that disturbed the cure. But, in addition, I have to say that it is only very seldom, and with very powerful medicines, and in very susceptible patients, that I ever go so high as the 5th or 6th decimal dilution–that is general I confine myself to the 1st or 2nd dilution or trituration, though not unfrequently I find it necessary to go up to the 3rd or 4th decimal dilution, on account of the irritability of the patient, the violence of the acute disease, or the energetic action of the medicine. In the six lowest decimal dilutions and triturations, I consider we possess a scale adequate to afford the suitable dose for all known diseases. In a period of ten years I have never found it necessary to go above the 6th decimal dilution, but I have often been obliged to give the specific remedy in stronger doses, such as several drops of the pure tincture, or a quarter, one, or even several grains of the original preparations. The employment of these medicinal doses gives me the satisfaction of knowing that I operate with demonstrable quantities of medicinal matter. It also satisfies me, because I have learned by experience that by such a choice of doses we can easily give the quantity sufficient to excite the curative action, without injuring the patient through excess.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.