Modes of administering the remedy adopted by Hahnemann-His early external employment -Vehicles in which he gave it internally-He afterwards advises it to be always given dry-He introduces the globules- Various sizes used by him-His administration by olfaction, to supersede all other methods-Olfaction of the dry globule-Olfaction of the dissolved medicine-He returns to the giving of medicines in solution-Modes of preserving the solution- His endermic employment of medicines-His early employment of this method-His later mode of employing it-At one time he forbids its use-He afterwards recommends it strongly-Resume of Hahnemann’s methods-AEgidi proposes to give medicines in solution-Hering approves of AEgidi’s plan-He warns against stirring the solution too much-AEgidi approves of olfaction in some cases-Rau says olfaction is seldom useful-Rummel has seen it of use in certain cases-Perry advocates its employment-Gross approves of olfaction of the high potencies-Mure’s ingenious mode of giving his patients the benefit of olfaction without their knowledge- Drysdale’s mode of giving arseniuretted hydrogen-Kampfer alludes to the endermic method-Want of uniformity and rule in the administration of medicines-Practitioners generally guided by caprice or convenience- Dry vehicles for the medicine-Rotuli, pastilles, Norton’s pilules-Olfaction occasionally, useful-The endermic method-Its antiquity-Plistonicus, Dieuches, Diocles, Dioscorides, Rufus, Berengarius, Amatus-Classes of practitioners mentioned by Celsus-Lembert, Lesieur, Ahrensen on the endermic method-Madden’s experiments on the absorption of medicines- Solids-Fluids-Gases-Hering’s peculiar endermic method-Utility of the endermic method in certain cases-Mode of employing it- Inunction of medicines-The local employment of medicines- Hahnemann’s early denunciation of the local treatment of syphilis-His subsequent local treatment of other diseases-His local treatment of itch and cancer-He afterwards denounces all local treatment-Except of contusions and condylomata-Gross recommends local treatment in some cases-Schron also-Backhausen advises it in many cases-Griesselich, Veith, Koch, Mayrhofer, Segin, AEgidi, Patzack, employ it in certain cases-Trinks is not partial to it-Lippe recommends it in burns-Henriques also uses it in burns-Giving medicine by the mouth is often a local employment of it- The method is useful in some cases, but dangerous in others-Black’s ophthalmic ointment-Blake’s calendula lotion to the womb-Utility of a collyrium in ophthalmia neonatorum-Local employment of the remedy in toothache-In syphilis- In scabies-Homoeopathic pharmacy-Hahnemann’s early pharmaceutic innovations-His soluble mercury-A bad preparation- He afterwards abandons it-Want of uniformity in his first modes of preparing tincture of belladonna, opium, ipecacuanha, chamomilla, bryonia, rhus, and hyoscyamus-Lays down rules for the preparation of different substances-He occasionally deviates from these rules-He afterwards proposes a uniform process for all medicines-His mode of triturating-Hering proposes various proportions of the vehicle and drug-His economical and expeditious mode of preparing the dilutions-Vehsemeyer approves of the decimal scale-Gruner prepares medicines on this scale- Rummel suggests the proportion of 2 to 98-Relation of decimal to centesimal scale-Various works on homoeopathic pharmacy-Caspari’s dispensatory-Hartmann’s Latin translation-Buchner’s pharmacopoeia-Gruner’s pharmacopoeia-Schmid’s pharmacopoeia- Mure’s pharmaceutic propositions-His triturating machine-His apparatus for producing a vacuum-His succussion machine-Weber’s proposed to triturates all medicines up to 15-His dynamizator- Madden’s pharmaceutic suggestions-Hahnemann’s antiquated chemistry-Need of a new homoeopathic pharmacopoeia.
MODES OF ADMINISTERING THE HOMOEOPATHIC REMEDY LOCAL EMPLOYMENT OF MEDICINES HOMOEOPATHIC PHARMACEUTICS
HAVING with all due care selected the most appropriate homoeopathic remedy, and determined the magnitude of the dose, or potency of the dilution in which we deem it necessary to exhibit it, the next question that offers itself for consideration is this:- How is this medicine to be administration, in order that the patient shall derive the greatest amount of benefit from it? And we shall presently find the mode of administering a remedy admits of considerable variety, both in respect to the form in which it is given, and the part of the organism to which it is applied.
I shall now proceed to run over the modes of administration of remedies proposed and adopted by Hahnemann, and then go on to consider the variation on his modes proposed by others.
In the essay on Scarlet Fever, published in 1801, he makes mention of several mode of administering the remedy. Thus, for the fully developed scarlet fever he employed opium either externally or internally. If he resolved to give it externally, he laid upon the child’s epigastrium a piece of paper (according to the size of the child, from half to one inch in length and breadth), moistened with strong tincture of opium; and if he thought it advisable to give the remedy internally, be gave the dose mixed with from one to four tablespoonfuls of fluid, either water or beer.
At a later period, he rejected entirely these methods of giving the medicine, and he asserted, (Organon, 1st edition, Aphorism 252) that by its intimate mixture with a fluid the medicine obtained a great increase of power, as its volume was thereby increased; he now directed it to be given in the smallest possible volume, viz., a drop mixed with starch, or milk-sugar, or a sugar-globule imbibed with the dilution, to be lain upon the tongue and allowed to melt there; and he cautions against drinking anything for some time after taking the medicine, for fear or increasing too much its strength by its solution in the stomach in any considerable quantity of fluid. The introduction of sugar-globules into homoeopathic practice by Hahnemann seems to date from the year 1813 or thereabouts, if I may be allowed to judge from an expression of his in the fifth edition of the Organon, published in 1833, where he says, (Organon, Aphorism 288, note.) that his experience of the capability of globules to retain the medicinal power extends to eighteen or twenty years. Although he at first probably used globules of various sized (for he states that 10, 20, 100, (Ibid., Aphorism 288, note.) 200, (Chr Kr., i. 188.) or 300, (R.A.M.L., i., Int. to Belladonna and Aconite) may weigh sizes, ranging from a mustard-seed to a poppy-seed in size-the former chiefly for olfaction, the latter for ingestion; one drop of alcohol was, he tells us, sufficient to moisten 300, (Org. Aphorism 285, note.) 1000, or many more than 1000. (R.A.M.L., loc. cit). He was at one time very particular that this globule should not exceed a poppy-seed in size.
In the fourth edition of the Organon he alludes to the employment of medicines by olfaction, a procedure the subsequently grew very fond of; for in the fifth edition of that work he prefers it to every other mode of administering the remedy. He believed that a medicinal aura was always emanating from the globules without in the last impairing their strength, and he directs that one dry globule shall be place in small phial, and if a moderate dose is to be given, the patient is to inhale the medicinal emanation with one nostril; if a stronger dose is requires, he is to repeat the process with the other nostril. If the nostrils are stopped up from any cause, the inhalation may be effected by holding the phial to the mouth. This method, re reiterates, is preferable to every other made administering the remedy, and he states in this edition of the Organon that, for a year past, he had treated almost every patient in this way; and that he had found the action of the medicine just as powerful and as long by olfaction as by ingestion into the stomach.
As he had previously been particular in insisting on the ingestion of only one globule, so now he is particular about the olfaction of one only, but subsequently he was not so strict, but speaks of smelling at several in one phial; (Chr. Kr., 2nd edition, iii., preface.) and afterwards, as Croserio informs us, (N. Archiv, i. 2, 31.) he went back from his plan of smelling dry globules, and when he did practise olfaction, the globules were first dissolved in a mixture of water and alcohol.
However, the olfaction-process seems latterly to have fallen into disfavor, with its inventor, and in his last work, (Chr. Kr., loc. cit.) he restores to his first plan of giving the medicine dissolved in water, and in divided doses, for several successive days. In order to keep the solution sweet, he directs us to add a small quantity of spirits to it, or a few small pieces of hard-wood charcoal. The latter expedient is, however, attended with this disadvantage, that the solution becomes discolored in a few days, if much shaken.
I have already alluded to the circumstance that Hahnemann directs the potency of the solution to be altered by several shakes, before every successive dose of it is given.
To children, he observes, the medicinal solution should be given in this own ordinary drinking-mugs, sweetened, if necessary, with a little sugar. They suspect and refuse anything offered them in a spoon.
In the same preface to the third part of the Chronic Diseases Hahnemann described at length, and recommends the employment of medicines endermically. He had previously alluded to, but not pointedly recommended this method of exhibiting medicines. Thus, in the Medicine of Experience, (Lesser writings, p.531.) he says that the dynamic medicinal power is so pervading, that it is immaterial whether the dissolved medicine enter the stomach, merely remain in the mouth, or be applied to a wound or other part of the body deprived of skin. Nay, he says, the epidermis dose not present an insurmountable obstacle to the action of medicines on the sensitive fibres beneath it, for though dry medicines produce little effect, when dissolved and applied to a large surface of skin they act powerfully. Where the epidermis is thin, as it is on the pit of the stomach, the groin, the axilla, the bend of the elbow, the inside of the wrist, the popliteal space, etc., the medicine in solution acts readily, and its action is much increased by friction of the part to which it is applied. We have already seen that Hahnemann recommended so early as 1801 the application of tincture of opium to the epigastrium of children.
In the last edition of the Organon, (Page 206.) he states, that where the medicine cannot be given by the mouth, whether from incessant vomiting, inability to swallow, or other cause, it maybe applied to the epigastrium, but in that case it must be a stronger preparation of the medicine, and be applied on a large surface. Rubbing it in, he says, greatly increases its effect.
In the last edition of the Organon, (Aphorism 292, note.) however, he discountenances this procedure, an says that “homoeopathy never requires for its cures the rubbing-in of any medicine. ” His opinion respecting this technicality, however, subsequently underwent a complete revolution, for in the last edition of the Chronic Diseases (Vol. iii., preface.) he enjoins the endermic employment of medicines. He there says that the salutary action of the remedy will be much increased, if at the same time that it is being given internally its aqueous solution be rubbed on the skin of one or more parts of the body free from disease (whether exanthema, pain, or cramps). It is best, he says, to rub the medicine in thus:- one day on one part of the skin, and another on another part; and it is also best to employ this endermic mode on the days when we do not give the medicine internally. We must be careful not to apply the medicine to any portion of the skin where are ulcers or exanthemata. As usual, Hahnemann extols, this method, which he had but a few years before denounced, as having proved highly successful in his hands, and he now limits his formerly favorite and universal method of olfaction to weak irritable patients, and he no longer talks about the powerful and long action of the medicine even with them, for he directs that they should be made to smell at a few globules daily, once or twice with each nostril, and each time at a lower dilution; so that, supposing the patient began with the 30th dilution; and only went one degree lower every day, in a mouth he would be smelling at the mother-tincture, under this method.
Thus, then, we observe that Hahnemann’s modes of administering the remedy were –
1. He gave a certain portion of the alcoholic tincture mixed with water, or beer, or the ordinary drink of the patient. (That this mode of administering the medicine was not confined to his earlier career is evident from this, that in the treatment of lunatics he advises that the medicine should be mixed with the patient’s ordinary drink. (R.A.M.L., iii. p. 328, and Lesser Writings, p. 781.)
2. Subsequently his practice was to give the patient one globule dry on the tongue, with a caution not to drink any fluid soon afterwards.
3. Still later, for a short period, he recommended and practised almost exclusively the administration of medicines by olfaction.
4. He returned to his first plan of giving the medicine dissolved in a greater or smaller quantity of water, an employed, in addition.
5. The endermic method of exhibiting the medicines; directing a solution of them to be rubbed upon a sound portion of the skin, in the mode just described.
At that period of Hahnemann’s career, when his practice was to give the medicine dry, Dr. Aegidi, (Archive, xii. 2, 134.) ventured to dispute the advantage of so doing in all cases. A patient came under his care, affected with violent periodical headaches and many symptoms of dyspepsia. He was so excessively sensitive to the action of medicines, that any remedy administered in the usual way caused nothing but violent aggravations. Dr. AEgidi luckily bethought himself of giving the remedy indicated, which was phosphorus, in solution. He dissolved one globule of the 30th dilution in eight ounces of water, and gave of this a tablespoonful every morning. He was pleased to find that its action when thus administered was very beneficial, and the case, which has so long resisted the curative influence of the same and other remedies given in the usual way, rapidly improved when this method was had recourse to.
Subsequently, (Archive, xiv. 3, 78.) Dr. AEgidi, acting on a recommendation of Hahnemann, modified considerably his method of administering medicines in solution. He employed, for the purpose of dissolving the medicine, rain-water, and in cases of acute disease gave a certain quantity of the solution every two, three, four, or eight hours. In chronic diseases his method was quite different. One globule up to one drop (of the 1500th dilution down to the concentrated tincture, according to the nature of the case) was mixed, by means of strong shaking in a bottle, with a certain quantity of rain-water (from a cupful up to a quart and more); of this the patient was to drink, in the morning fasting, the smaller quantity all at once, but the larger in much the same way as mineral waters are usually drunk by the votaries of the healing streams, viz., a cupful (every quarter of an hour, a brisk walk in the open air (where that was possible) being taken after every cupful. Should the patient feel sleepy after his morning’s dose, he was to indulge his somnolent propensity. This plan, AEgidi tells, us, he found eminently successful in some cases, but not in all. Some were so irritable as not to admit of it; a few could only bear the method by olfaction.
Hering (Ibid., xiii. 3, 80.) says that, with Aegidi’s happy invention of administering repeated doses of the medicine dissolved in water, a new era in homoeopathy commences. It is especially useful in the case of very sensitive individuals, also in very painful affections, and in many of the diseases of children. Patients who could not bear the olfaction of a single globule without suffering from it, bore the medicine very well, and were rapidly cured when the medicine was administered according to AEgidi’s method. Hering states that a single globule should be mixed with four or six ounces of water, will stirred, and a spoonful of this given at a time. The dose of such a mixture might be repeated as often as every hour in some cases (or, in very acute cases, even every five or ten minutes). For instance, chamomilla and bryonia might be given every hour, in certain neuralgic affections. Care must, he says, be taken not to stir or shake the medicine in its vehicle too often in case of increasing its potency to too great a degree.
Hahnemann’s proposition to give medicine by olfaction has been much criticised by both the friends and the enemies of homoeopathy. Thus AEgidi (Archiv, xiv. 3.) states, that in some cases no other method can be substituted for it advantageously, but he does not point out what these cases are.
Rau (Werth d. hom., Heilv., 143.) says, however plausible the practice of olfaction may appear, he this in too many instances observed no effect whatever from its employment to put much confidence in it. Nothing, he says, can be expected from its employment in phlegmatic torpid subjects, but some advantages might attend its employment in cases of superlatively exalted sensibility, in neuralgia, in hysterical paroxysms, in versatile typhus fever. The chief indication for its use, he says, is a need for a rapid but transient short action upon the sensitive sphere. If patients are to be treated by this plan, Rau advises that the globules be freshly prepared, and not quite dry.
Rummel (Allg. hom. Ztg., vii., No.3.) says that although he rarely resorts the method of administering medicines by olfaction, he has seen it effectual in painful affections of the head and teeth, and in some disease of the respiratory organs. He is satisfied of the power medicines possess of acting in the form of vapour or emanations, for he has often been seriously affected by the medicine whilst preparing them. Nevertheless, (Ibid., ix., No.3.) he will not allow that it is a universally applicable method, as Hahnemann would have it, and he ridicules the notion of healing a chance by smelling at a tongue of mercurius 30.
Dr. Perry (Jour. de la Medorrhinum Hom., i. 48.) of Paris lately recorded a number of cases to prove the efficacy of olfaction. The diseases in which he has found it most serviceable are coryza, megrim, facial neuralgia, toothache, constipation. His mode of employing olfaction is to dissolve two or three globules of the medicine in a mixture of spirits and water in a small phial, and make the patient inspire the air in the phial through the nostrils. He finds, he says, this method very successful in constipation depending depending on inaction of the rectum. A patient so affected was made to smell at a solution of opium 6, at the period of the day when his bowels were generally moved, and if no effect resulted, to repeat the olfaction a quarter of an hour or half an hour afterwards. If no evacuation resulted, the olfaction was to be repeated in a few hours, or not till the next day.
Several homoeopathic practitioners have spoken in favour the occasional employment of olfaction, but few profess to think it a method suited for general application. The partisans of the high potencies, and among these more particularly Dr. Gross, profess to think highly of the olfaction of their favourite preparations, and possibly that may be the mode of administration best calculated to elicit the marvellous virtues of those transcendental remedies; but I do not know of any who habitually remedies; about I do not know of any who habitually employ the lower potencies who affect to believe that olfaction is ever preferable to ingestion, unless it be in some cases where the antidotal powers of camphor, nitrous ether, or smelling salts are requisite.
Dr.Mure (Doctrine de l’Ecole de Rio, p. 86.) speaks greatly in favor of the method by olfaction, but finding that in practice it caused great incredulity, he discovered, he says, a mode of securing the advantages of this method without shocking the prejudices of the patient. Over the uncorked phial containing the tincture of the required medicine in the appropriate dilution he reversed the patient’s empty bottle, and left it thus for thirty or sixty seconds, then he suddenly turned the latter bottle right, filled it with water, corked it quickly, and gave it to the patient to take. This method, he assures us, always succeeded admirably. I would receive this statement of Mure’s like his wonderful astronomical theory, cum grano salis.
Akin to the method of olfaction is the mode proposed and adopted by Dr. Drysdale, of administering arseniuretted hydrogen, which he adopted with apparently good results in the epidemic cholera that raged in Liverpool in 1849. He invested an apparatus for this purpose, of which a full description will be found in the British Journal of Homoeopathy, vol. viii., p. 152. A common milk-bottle, with a flexible tube provided with a mouth-piece inserted not its side aperture, is all the machinery required. The top aperture of the bottle is left open, to allow the free ingress of air, and into the bottle are put a few pieces of pure zinc, half an ounces of water, one drop of strong pure sulphuric acid, and five or ten drops of the 3rd dilution (aqueous) of arsenic. The hydrogen disengaged by the action of the acid on the zinc enters into combination with the arsenic in the drops, and the arseniuretted hydrogen thus formed is inhaled by the patient.
The method proposed by Hahnemann of rubbing in the medicines in solution, on sound portions of the skin, has excited very little attention among his followers. Kampfer n Allg. hom. Ztg., xxvi., No. 1 certainly alludes to it, but chiefly to claim for homoeopathy the cures performed by mineral baths, by tartar- emetic ointment in whooping-cough, by ranunculus-leaves in sciatica, by croton-oil in rheumatism, etc.