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Sep 19, 2013

THE REPETITION OF THE DOSE Part 1 - By C W Butler

Published in 
THE
Medical Advance
A Homoeopathic Magazine
Vol. XXXI          CHICAGO, March, 1894.            No. 3

*SYMPOSIUM OF HOMOEOPATHIC PRESCRIBING


THE REPETITION OF THE DOSE

CLARENCE WILLARD BUTLER, MONTCLAIR, N.J.

Edited By: Dr. Ravinder S. Mann

Part 1
(For Part 2 Click Here

In the discussion of any scientific question a definite and certain terminology is of prime importance.  

It is probable that more energy has been wasted in profitless polemics from lack of precision and clearness in statement of the premises assumed than because of radical differences in opinion. It is well therefore that I should at the outset make plain my understanding of the terms used in the statement of the subject assigned to me. By a “dose” of medicine I understand any portion of a drug given for therapeutic purposes at a single imbibition; by repetition of doses I understand one or more additional portions of the same drug administered at practically appreciable intervals of time.

If, for example, a physician desires to administer three-eighths of a grain of morphine, and elects to give one-eighth of a grain every fifteen minutes until the whole quantity has been taken, I should say that he had given three doses of morphine of one-eighth grain each, and has repeated the doses every fifteen minutes; and this although the analgesic or hypnotic effect desired in this particular case might have been obtained, or even expected, only from the physiological effect of the total quantity  -  three eighth of a grain.

If a Homoeopathist puts one-half a grain of the third trituration of a drug into six spoonfuls of water and gives one spoonful every hour until all has been taken, I should consider each spoonful of the solution a dose, and would report this case of having received six doses of medicine at hourly intervals of repetition.

I have been thus particular to make my meaning in the use of these terms clear and unmistakable since there has arisen among certain physicians in recent years a fashion of speaking of the “divided dose” as if the total amount of the drug administered was the dose in each particular case. Now that medicines are given in different forms and at stated intervals, in portions smaller than the supposed remedial limit, evidences the fact that different effects are expected by the Therapeutist from these different methods of administration.

That this expectation had sound basis in general experience may be conceded I think, without argument.

This being true it follows inevitably that some result is expected from each portion given, however minute that portion may be, and for each such portion, for purposes of record and of communication, a definite name is surely required. We must therefore either coin a new one or accept that already recognized. But change in scientific terminology is only justified where the term in use involves ambiguity in expression, or implies an unscientific concept. In the case in question, despite the double meaning and inexact use in which it has been at times employed, the term “dose” does not seem open to either of these objections. I protest therefore against the change and modification of its meaning which the term “divided dose” interjects, because its inevitable effect must be ambiguity and confusion, where exactness and lucidity are imperative; and because it can serve so far as I can perceive no useful purpose.

Whether or not, with the present accumulation of facts any generalization may be made sufficiently wide to deserve recognition as a law for the repetition of the dose it is certain that no such generalization has been made and the question remains one of individual experience.

The opinions expressed, the theories advanced and the suggestions made in this paper, are then, of necessity personal, and for any and all of them the writer alone is responsible. By this statement it is not to be understood that originality is claimed not that any new thing may be expected. The paper is intended to be a practical, not an historical one, and while I gladly acknowledge my indebtedness in respect of the theories held and the practice advocated herein to many writers upon the subject from the time of Hahnemann to the present, any attempt to give due credit to particular individuals would necessitate a prolixity wholly inconsistent with its avowed purpose.

The methods is practice advocated will be first presented in the form of arbitrary rules and such remark or explanation as may seem necessary; together with the theories germane to the subject entertained by the writer, will follow. I desire first of all, however, to state with emphasis that these rules are based not upon the theories which will be presented, but upon many years watchful experience, --- are those relied upon daily in my professional work and for them I bespeak faithful and unprejudiced trial by all earnest practitioners of Homoeopathy.

RULES

I.                   Let the first prescription in each case be a single dose.
II.                Let the single dose of any remedy be given in its dry form.
III.             If no effect is produced by the single dose and the conditions remain the same, the remedy should be repeated.
IV.           When repeating the remedy if a higher potency be employed, a single dose of the new potency should be given dry.
V.              If a lower or the same potency be given, when repeating the remedy, these should be exhibited in a watery solution and the dose frequently repeated.
VI.           When drug action becomes manifest stop all medication and determine at once the character of the action. It will either be curative; or palliative; or it will change the disease type; or produce characteristic symptoms of the drug (a physiologico – pathological proving).
VII.        If a drug proving, i.e. the appearance of specific drug conditions, be in evidence, a new prescription will be called for.
VIII.     If the type of the disease is changed by the medication then too, a new prescription will be needed.
IX.            If the action be palliative, repetition of dose, or remedy (or change of drug or potency) is contra-indicated so long as the patient’s sufferings are thus mitigated.
X.               If the action be curative, under no circumstances may the dose be repeated (nor may remedy or potency be changed) as long as this action continues.
XI.            In all cases before repeating the dose, a re-examination equal in care with that required for any other prescription must always be made.

In stating his theories in respect of his subject and of matters more or less intimately connected therewith, the writer must of necessity encroach somewhat upon fields allotted to other contributors to this symposium. No injustice can be done them however, if it be borne in mind that, as has already been stated, the opinions here presented are his own and for them he alone is responsible. Stated as briefly as possible they are these.

The organized living body always endeavors to free itself from noxious influences. Whether such influences be “matter” or “motion” their elimination or annihilation is accomplished unaided, with much perturbation of the system, and in the animal economy with many discomforts and sufferings which are manifest to the skilled observer through recognizable signs (symptoms). From the practical standpoint the complex of these symptoms (signs) is the disease. The business of the Physician is to aid the system in its endeavors toward the elimination or annihilation of this sick making power with a minimum of discomfort, suffering and danger. This he accomplished in his office of Hygienist, or Sanatarian, by removing the aetiological factor when that is known, which is seldom the case; in his office as Therapeutist he attains the same end by the use of drugs. In the present state of human knowledge the appropriate drug may only be determined by the homeopathic law of selection. Such a drug, one homoeopathic to the case in hand, is curative and appropriately termed a remedy. The expression “homoeopathic remedy” is tautological; there is no other. The use of this term is justified however, by the frequent occurrence of the word “remedy” in all medical literature and indeed it may hardly be discared for the present.

That a drug homoeopathic to the case, does cure the patient by removing the cause and the disease is a fact abundantly proven; how it does this is not known.

Without striving to solve this problem we may safely assert that the drug itself is only indirectly the curative agent. The potent and only direct curative power is within the animal economy, and is its vital energy – that is, that portion of the universal energy appropriated by and acting through the organism at the time. As in the locomotive engine it is the steam which furnishes the motive power, not the lever, the proper adjustment of which admits the heated vapor to those appointed channels in the machine where its energy may be expanded in performing the desired work; as in an electrical apparatus it is the electricity which is effectual to the desired end, not the “switch” which directs the current, so in this wondrously complex machine, the living organism, the remedy is a factor in the cure only as it frees the vital energy and directs its only office, it is obvious that when this is accomplished further medication is superfluous.

All that the remedy can affect it has effected. Now experience teaches us that this effect may usually be had from a single dose of the appropriate drug.

Hence the first rule “Let the first prescription in each case be a single dose.” At two or three different times I have instituted series of experiments with the use of the single dose given in a watery solution, but they have been speedily abandoned, partly possibly, because favorable experience with the dry dose has prejudiced me in its favor, but mostly I think, because I saw nothing gained by this method and at times thought I marked distinct loss. I am free to confess however, that these experiments were never sufficiently exhaustive to form a reliable basis for a fixed rule of practice. But my experience with the method advocated has been so favorable that I have advised that (Rule II) the single dose of any remedy be given in its dry form.

I have said that curative action may usually be inaugurated by the single dose of the indicated remedy, and it is probable that this would be effected in all cases if in every instance we could choose exactly the remedy and the potency. So difficult is it to choose with certainty the most similar remedy even with the guidance of the unerring law of homoeopathy; so difficult is it to select the more appropriate potency since so little is known of the nice relations which should obtain between the drug energy and the vital energy, and no known law is here applicable. This ideal perfection of choice is often impossible to human and fallible judgment. Probably for these reasons, certainly for some reason, in a not inconsiderable number of cases the single dose will be followed by no appreciable modification of the conditions prescribed for. Under such circumstances and when the always imperative re-examination reveals the same conditions still present and by consequence the same drug called for, the remedy must be again exhibited. Rule III.

But this may not be done in any case until after a period of observation sufficiently long to leave no reasonable doubt of the failure of the former prescription. Unfortunately no rule, even approximate, can be given as to the proper period of observation, i.e. the time which one should await evidences of drug action. It is, and will probably always remain, a question of personal judgment in each individual case.

The nature and severity of the sickness, the constitution and temperament of the patient, the known promptitude in action of the remedy employed, are all factors which will enable the prescriber to form that basis or reasonable expectation upon which his action must depend. Acute suffering or imminent danger may call for frequent repetition, while in cases of long standing, especially such as depend upon or are modified by the deep-seated dyscrasia, (“Chronic miasms”), remedial action may only appear after days or weeks have elapsed, and the temptation to repeat the remedy or the dose must be religiously guarded against.

In cases of doubt always remember that the vis a tergo is toward the “fatal error” of rash precipitancy and in no case allow the judgment to be clouded by the restlessness of the patient, the insistence of his friends, nor your own anxiety. In therapeutics it is preeminently true that most wisely do “They also serve who also stand and wait.”

If, however, repetition of the remedy becomes necessary it may only be done in a higher, a lower or the same potency. The fact that the remedy in the form and strength of its original administration was impotent indicates that it should be repeated either in another power of the drug, or another method of exhibition.

If now the drug potency be changed, and this I earnestly recommend as the course usually most efficacious, that change should be marked and material. If your former prescription has been a very high potency, not only should you now give a lower, but a very much lower one; if a low or medium potency was first used, not only should you now use a higher, but a very much higher one – a change from a CM  to a 100 or vice versa.

Where it is practicable to make this marked change from a lower to higher potency, let this be done and a single dose dry, be given. (Rule IV). It will hardly be denied by the Therapeutist of experience that repetition of doses in these high powers too frequently induces troublesome aggravations or more troublesome complications in the way of drug symptoms and conditions.


Of these complications something further will be found in the discussion of Rule VII. 

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