3. Apparently quite suddenly the doses of some medicines he prescribed fell down to a point where they ceased to be cognizable by the senses or by chemical tests. This sudden fall was simultaneous with the commencement of the persecution of the apothecaries. As yet, however, he did not apply the homoeopathic law to the treatment of all diseases, and in cases where he employed the ordinary treatment he used large, and the very largest, doses.
4. As he extended the law to the treatment of all diseases, his doses become all small, but not uniformly so; for he allowed himself a range betwixt a drop of the pure tincture or a grain of the 1st trituration, and a portion of a drop of the 30th dilution of the centesimal scale.
5. After his invention of the psora-theory he fixed the uniform standard fore the dose of all remedies at a globule of the 30th dilution. Almost the only exception to this is in the case of camphor for cholera, which he advised to be given in drops of the saturated spirit.
6. In the last years of his life he again allowed himself a grater range of dose, chiefly by extending the scale of dilutions upwards as high as the 60th, 150th, and even 300th dilutions, but also downwards to the 24th, and occasionally also much lower.
It is hardly possible to contemplate these frequent changes by Hahnemann of his views and practice respecting the dose, and the contradictions he involves himself in, without coming to the conclusion that he often formed his general deductions from very insufficient data, and that the question of the dose within certain limits is one of very minor importance compared with that of the selection of the remedy.
However, I must not anticipate the judgment which I trust you will form with me, after a careful survey of the principal opinions on this point that have been expressed by the most notable of Hahnemann’s followers.
Dr. Hartlaub, (Arch., vii.19.) was one of the first to touch upon that subject of the homoeopathic posology, and to question the property of Hahnemann’s directions relative to the minuteness of the dose and the infrequency of the exhibition of it. The substance of his paper is as follows:– He believes that, as regards acute diseases, the very smallest dose, once given, may suffice to overcome the malady, but that for deeper-seated chronic diseases larger doses, more frequently repeated, may be necessary, and he relates the case of a scrofulous girl, affected with an eruption on the head, on whom a great number of medicines failed to produce any good effect, or even to prevent the malady spreading; but conium in the mother-tincture and 1st dilution speedily effected a permanent cure.
Dr.P. Wolf, (Archiv, xii. 2, 37.) early called in question the property of fixing the dose at the 30th dilution for all diseases and all remedies, and thought that the range of dose should not be limited betwixt smelling at a globule of the 30th and taking a drop of the same dilution. He considered that the range should rather be betwixt the pure tincture and the 30th, and that the different susceptibilities of different individuals and different diseases might demand different doses of a medicine.
Dr. Rau, (Werth, etc., p. 168.) in the work so often quoted from, says that the best guide for determining the dose is the maxim that the susceptibility of the organism for homogenous irritation is in the direct ratio of the violence of the disease. Thus the more violent and acute the diseases, the smaller must be the dose of the remedy, and the larger must it be, the longer the disease has lasted and the more chronic its character is. In cases of the latter description, he alleges it may often be necessary to give a whole drop of some very active medicine, whereas in recent and very acute diseases a small portion of a drop of the 30th dilution will often bring about strong reaction. Some practitioners, he remarks, have stated that the antipsoric in the 30th dilution often act too violently in acute diseases, and have therefore recommended lower dilutions; but he has generally noticed that in these diseases the more massive doses produce too long -continued and intense reactions, and that the 30th and higher dilutions, or even the mere smelling at a high dilution, will often suffice for the cure of acute affections. For chronic diseases, on the contrary, it often happens that a small dose of the proper medicine will not act, but a larger dose is required. However, he does not believe it possible to lay down any general rules for the dose, and recommends a careful observations of nature. At a subsequent period (Hyg., iv. p. 297.) he again treats of this subject, and repeats the same views. He states that he has been particularly successful in the treatment of chronic skin diseases by means of graphites in substance, dulcamara tea, decoction of sarsaparilla, etc., without any bad consequences resulting from these comparatively large doses. Similar views are also expressed by him in his last work, entitled Organon of Specific Medicine.
Dr. Werber (Ibid.i. 180.) says, medicines present two sides, a qualitative and quantitative, which have an intimate relation to the quality and quantity of the vital forces. As the excitability is different and variable, the medicines must exhibit a variable amount of action on their influence upon the vital force. He admits the efficacy of small doses in the cases for which they are suitable, but says that it is an untenable dogma to employ only the small and smallest doses, and he adduces many cases where he effected a cure with larger doses, in which no homoeopathic aggravations ensued, and the patients made as good recoveries as they could possibly have done had they only sniffed the most delicate medicinal aura; and yet he pathetically remarks, these fine cures of his were attacked by the purists in the most bitter fashion. The same views are repeated by him on a subsequent occasion. (Ibid., 229.)
Dr. Aegidi (Ibid., ii.201.) contends that the remedies often disappoint us in the high dilutions usually prescribed, and that they ought to be given in stronger doses. He says that since he has employed the medicines in more massive quantities he has been much more successful than before; among other effects produced by these larger quantities, he observes that the accessory effects of the medicine sometimes come out very prominently, more so even than in the pure provings of medicines on the healthy, and this he considers of great importance in determining the characteristic action of the drug. He allows all potencies to possess a power of influencing the organism, from the pure tincture up to the 1500th dilution. He will not, however, admit the successive dilutions to be dynamizations in Hahnemann’s sense of the word. (Arch., xiv. 3.)
On a subsequent occasion (Allg. h. Ztg., xxvii., No.9.) he states that experience has proved that under certain circumstances the higher subdivisions, such as the 30th, 60th, 100th, and upwards, show a decided power of action; but he contends that there must be a point in the continued subdivisions of the medicinal substance where the medicinal power becomes so weak as no longer to possess the power of acting on the organism. He considers it an advantage to have at our command the whole scale of dilutions; we cannot, he says, effect everything we desire with the highest or with the lowest dilutions exclusively; undiluted medicines even are sometimes necessary; the essence of homoeopathy does not, he says, consist in the administration of infinitesimals. He contradicts the assertion that has been often made, that the lower dilutions are more adapted for acute, the higher for chronic diseases, for he had often succeeded in curing very acute diseases with the higher dilutions, after employing, without effect, the low potencies; and he has often found even undiluted medicines useful in bringing about healthy reaction in chronic diseases. Finally, he declares himself opposed to the practice of giving but one globule dissolved in a large quantity of water. He ridicules a religious adhesion to this mode of practice.
Dr. Rummel has on several occasions given us his opinion on the subject of posology. In one article on the subject, (Ibid., xxvii., July,1835.) he lays it down as a maxim that we sometimes require the higher dilutions, sometimes the lower, even undiluted medicines. For him the right selections of the medicine is the main point; that being made, ” we cure the quicker,” says he, “the better we understand to adapt our doses to the special excitability of the patient.” He declared himself decidedly opposed to making the 30th dilution the normal standard, “although,” he says, ” this dilution does often act, we should beware of constituting the exceptions the rule, and thus meriting the reproach of doing nothing, which our enemies are so fond of bringing against us”. He has often observed low dilutions act well, when high dilutions had no effect. As to the comparative frequency of medicinal aggravations from high and low dilutions, he is unable to say that the one produces them more frequently than the other; they only occur exceptionally, and at least as often after the high as the low dilutions; at the same time he observes, what are called aggravations are frequently merely the natural course of the disease. On another occasion (Griesselich, Sachenspiegel, 119.) Rummel expresses himself to much the same effect. He says that the dilutions from 3 to 15 are generally sufficient for all cases, and that they act without producing any injurious consequences. With regard to some medicines, such as Ipecacuanha, euphrasia, crocus, etc., he is disposed to reject altogether their higher dilutions, they do not seem to have any curative effect; the cures observed sometimes after their employment he thinks may safely be reckoned amongst the triumphs of the expectant method. He further alleges that Hahnemann himself had returned to the administration of larger doses than before, and that at the very time when he was advocating the exclusive employment of the very smallest doses. At a subsequent period, (Allg. h. Ztg., xxi., No.12.) Dr. Rummel again reverts to the subject of the dose. He admits that medicines are still efficacious in the 30th dilution; but the advocates for the larger doses also declare that the organism is more rarely susceptible for the higher than the lower dilutions, or, as he stated in a former article to which I have alluded, the appropriateness of the 30th dilution is the exception not the rule. “There must, ” he says, ” be some limit to the power of action of homoeopathic preparations, because the hindrances to the divisibility, or the development, or dynamization, as it is called, must always be increasing. “An admission of the efficacy of the 30th dilution does not, he alleges, involve a denial if the greater efficacy of the 3rd or 10th dilution, the most that can be said is that in some cases the higher dilutions seem to possess certain advantages. Should it be proved that No. 10 always acts better than No.20, or even that No, 3 or 6 is better than No., 10, it by no. means follows that No.1 or the undiluted tincture must necessarily be better than No.3; indeed the reverse seems frequently to be the case. Still he by no means denies the efficacy of many medicines in the undiluted from, but their general use he believes is less appropriate for homoeopathic purposes than that of diluted medicines; in some cases he admits that he has succeeded with higher dilutions when the lower ones failed. From what he says, the only inference is that cures may be effected with doses of all kinds, from the another-tincture upwards. The practical rules we gather from this paper are as follows: — In diseases where the nervous system generally or the abdominal nerves are specially affected, the higher dilutions are the best; in acute diseases the lower dilutions are more generally serviceable. It is advisable not only to proceed from the smaller to the larger doses, but often also from the small to the still smaller, up to the very highest dilutions. After either kind of doses a homoeopathic aggravation often occurs without being followed by any amendment. He gives a good many instances of such aggravations. On the introduction of the high potencies of Jenichen into practice, Rummel again (Allg. h. Ztg., xxix., Nos.2 and 3.) gives utterance to his ideas on the posological question. He states that the dilutions he commonly employs are those betwixt 3 and 30. He cannot pretend to lay down any general rule for the proper dose, but he alleges that he obtained comparatively the least favorably results when he, for the sake of experiment, confined his practice exclusively to the lower attenuations only, though even then cases sometimes occurred which seemed to speak in favour of the superior efficacy of such dilutions under certain circumstances. He replies in the affirmative to the question — “Do medicines still act in the 200th dilution?” Even in that state of attenuation he alleges that they can develop their peculiar accessory symptoms, and cause a transient aggravation of the disease; ” indeed,” he adds, “it appears to me very probable that in many cases they do more good than the attenuations hitherto in use.” I may mention that the high dilutions Rummel employed were what they professed to be, having been prepared after the Hahnemannian fashion by a conscientious chemist of the name of Petters, and they were not the transcendental potencies of our horse-breaking friend Jenichen. As regards the cases brought forward by Rummel to prove the power of the higher potencies, I may, however, remark, that Griesselich subjects them to a critical examinations in the (Hygea, Hyg., xxi. 62.) and proves to his own satisfaction that in scarcely one instance is there evidence that the medicines acted at all, still less that they acted better than the ordinary dilutions.
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.