PRACTICAL HINTS IN THERAPEUTICS


Theoritically there is no difficulty in understanding the spirit of his statements but we often come across with tremendous difficulties in the actual field. He has mentioned about repetition of drugs at proper intervals both before and after the commencement of the action of a drug but he has not definitely pointed out how to know those proper intervals; how long to wait after administering the first dose of a well selected drug?


(Question of repetition of drugs)

The selection of a proper Similimum is essential and the question of repetition of the same is no less essential.

As regards the question of repetition Hahnemann in his organon points out thus.

(1) “Perceptible and continued progress of improvement in an acute or chronic disease, is a condition which as long as it lasts, counter – indicates the repetition of any medicine whatever.” (Art no. 245)

(2) ” … A speedy cure may actually be obtained by repeating the finest dose of an accurately selected medicine at proper intervals, such as are proved by experience to be most conductive to a speedy cure and timed so as to prevent an injurious and revulsive counteraction of the vital force, whose action is to be tempered and modified in accordance with the morbific power of the medicine.”

(3) “Under these conditions … medicine may be repeated at intervals of fourteen, twelve, ten, eight, or seven days. In chronic diseases assuming an acute form and demanding greater haste these spaces of time may be obliviated still more but in acute diseases the remedies may be repeated at intervals of twenty four, twelve, or four hours and in the most acute diseases of intervals varying from an hour to five minutes. These periods etc.”

(4) The dose of the same medicine is to be repeated several times if necessary but only until recovery occurs or until the remedy ceases to produce improvement.

Theoritically there is no difficulty in understanding the spirit of his statements but we often come across with tremendous difficulties in the actual field. He has mentioned about repetition of drugs at proper intervals both before and after the commencement of the action of a drug but he has not definitely pointed out how to know those proper intervals; how long to wait after administering the first dose of a well selected drug?

It has been found many a time that injudicious waiting has been, in acute diseases particularly of infectious nature, the cause of loss of life. In chronic cases however it does not matter so much if some delay is made in giving a second dose of the medicine.

Injudicious repetitions on the other hand, always interferes with the smooth action of a drug. Only the minimum administration of a drug in order to produce a “definite and tangible impression” is what is aimed at.

Under such circumstances, I always follow the following rule and almost always do get very satisfactory results if the selection of the drug is correct.

I have been observing for a long time that there is a clear relation between the time which a disease takes to develop and the time which it takes to disappear although there have been exceptions to this general rule.

This led me to think that there must be also the same kind of relation between the rate at which a disease – process progresses and the time which a well selected drug takes to produce a tangible impression in the same; that is there must be some proportionality between the two.

A chronic disease for instance, which takes, say, 10 years to assume a particular shape cannot be expected to show any impression in a few days, so in this case repetition of a drug before a fortnight will have no meaning.

Pneumonia, cholera, diphtheria and other infectious diseases form instances in which a symptom complex progresses rapidly and if a well selected drug be administered to a particular case, the rate of the symptoms to vanish may thus be expected to be equally rapid.

In these cases repetition of a drug every one or two hrs. will not be unjustified, till a definite impression is obtained. In a very very urgent case of cholera morbus a drug may have to be repeated every fifteen to thirty minutes as we have already seen in art 247.

Another difficulty often creeps in. Suppose in an acute case we administer a drug. Improvement sets in, but when to stop the drug? I generally go on repeating the drug at distant intervals in these cases, until a definite tangible impression that is an allround amelioration in all the symptoms sets in.

I do this particularly in cases of acute toxaemia or bacterial infections until a considerable portion of the toxin in the system is neutralised or in bacterial infections, the activity of the bacteria is controlled completely. Because if we stop medicine before an allround impression sets in, it is generally associated with a flaring up of the disease process.

One or two practical illustrations will not be, I think out of place here.

(1) Pt. a child of 2 yrs. when seen presented the following complaints.

(a) Temperature – continuous for 6/7 days, ranging from 104 to 105 degree.

(b) Much dyspnoea – Respiration rate about 90 per. wt. while the pulse rate is 132, R/P ratio about 1 to 1.4 degree.

(c) Much rattling in chest.

(d) Abdomen distended (e) Tongue coated white. (f) Patient much irritable.

There was no difficulty in choosing out the Similimum. It was Antim tart. But the difficulty lay in the question about repetition. It was a very bad type of broncho – pneumonia the condition of the patient was gradually going worse. Question of time was of extreme moment. so Antim tart 30, 4 doses were given, one dose to be taken every 4 hrs. In such urgent cases there is no harm if some unnecessary over dosage he made but an underdose which is not sufficient to evoke the vital force and means loss of life.

Next morning temperature came down to 100 with amelioration of all other symptoms. But the infection was not yet fully controlled as evidenced by the slight temperature and the little dyspnoea which still persisted. So again Antim tart. 30 2 doses were given morning and evening. Next day temperature fell to normal and there was no respiratory trouble.

Here it should be noted that with the gradual diminution in the bacterial activity the interval of repetition of the drug was also prolonged.

The following is another case which shows the right field for repetition.

Patient, a lady of 48, came with the following complaints:-

1. Daily pain in abdomen, for about 4 months (Rt. hypochondrium about 2 hrs. after meals, relieved by take hot water with lemon juice- occasionally this pain becomes very severe.

2. Occasional burning in throat.

3. Liver enlarged, gall bladder enlarged.

4. History of malaria. 5. Chronic tendency to loose motions. 6. Much Rumbling in abdomen. Evidently it was a case of chronic cholecystitis – The acute pains being due to gallstones.

According to symptoms China 6 twice daily for 8 days were prescribed. Eight days after report came that there was much amelioration in the intensity of the daily pain. Again China 6 was prescribed twice daily for 2 days, then once daily for another 4 days.

6 days after it was reported that she had mild pain only once during the week. Kept better in every other respect.

Again China 6 was prescribed twice daily for 2 days, then once daily for 4 days.

This repetition was made inspite of the patient gradually getting well; because it is my personal experience that in gall bladder cases particularly in gallstones, repetition should be made so long as the dyspeptic symptoms continue and tenderness and a palpable mass persists in the gall bladder region; otherwise in most cases there has been a relapse.

In this case, though the patient was improving but the disease was not completely controlled, as she had an attack though of much less intensity during the week and the infection was persisting. So repetition was made. In gall bladder cases, a tangible impression can only be said to have occurred when there will be cessation of pain for at least 3 months.

Here a word of caution is necessary. We should be very careful about repetition of drug in cases where the parenchymatous tissue of any vital organ is severely damaged; as in cases of advanced pulmonary tuberculosis, in advanced cases of nephritis, in advanced heart diseases etc.

Repetitions in these cases, will evoke the vital force vigorously and the little healthy parenchymatous cells that are left will not be able to act harmoniously in response to the vital force. They will naturally fail and failure of a vital organ means death. In these cases if the drug be given cautiously at distant intervals, the parenchymatous cells which are damaged but not actually dead, will be slowly brought to life again and then an all round cure may be expected.

Individual idiosyncrasy is also a factor which often troubles us. Some people are peculiarly sensitive to certain drugs. In them the repetition of drugs should be made very carefully otherwise serious aggravations are sometimes met with. So in each and every case the result of each administration should be carefully observed.

Lastly I would conclude by drawing the readers attention to the fact that there are some diseases which are called allergic diseases, as well as there are certain drugs where the question of repetition should be thought of very carefully; These diseases are tuberculosis, particularly in later stages, various kinds of coughs in which the allergic manifestations are very prominent e.g. whooping cough, various kinds of skin eruptions – urticaria, certain types of scabies etc.

Besides these diseases, effect of drug aggravation has been to my experience not very significant and repetition of drugs can be undertaken with more courage.

As regards drugs, which when repeated injudiciously causes aggravation of symptoms; Lachesis, Lycopodium, nosodes in general in high potencies, phosphorus particularly in T.B. Drosera particularly in whooping cough are worth mentioning.

Sanyal I B