Published in
THE
Medical Advance
A Homoeopathic Magazine
Vol.
XXXI CHICAGO
*SYMPOSIUM OF HOMOEOPATHIC PRESCRIBING
THE REPETITION OF THE DOSE
CLARENCE WILLARD BUTLER, MONTCLAIR , N.J.
Edited By: Dr. Ravindra S. Mann
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.
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