BY ADOLPH LIPPE, M. D.
Hahnemannian Monthly, Dec. 1867
The question of doses has been discussed for a long time, and many are the arguments and reasonings offered in the medical journals of our school; but the question is not any nearer a satisfactory solution than when it was first started.
the paper which I have the privilege of reading before my colleagues to-day proposes to show the reasons why this question has not been solved—why it cannot yet be solved and must remain an open question till the solution is made practicable by means not yet at our command.
In order to do this, let us first take a retrospective, historical view of this question of doses; dwell for a moment upon its present position; point out the reasons why the solution is an impossibility at present; indicate the preliminary steps which must be taken in order to enable us to come to a final conclusion; and, finally, show how we have to proceed to take these steps and so present the question as to make its solution a possibility.
When Hahnemann first established the correctness of the Homoeopathic law of cure, the law of similars, be employed in his first experimental trials crude medicines in comparatively very small doses, smaller than the common school of medicine were in the habit of prescribing; but he found these comparatively small doses, when applied in accordance with the law of similars, caused such violent aggravation of sufferings that he was compelled to seek for means to avoid this great difficulty, and for that reason only did he resort, at first, to what he then called “dilutions,” or rather a mere division of quantities. At a later period, while proving Carbo vegetabilis, he illustrated, by the practical experiment to bis followers, the theory of potentiation for the first time. The crude charcoal produced no effects on the provers, and then Hahnemann showed his pupils how to develop medicinal powers out of an otherwise inert substance, by trituration. And when the provers began to be affected by potencies of a substance which, in its crude state, had not developed any change of sensation in them, they became convinced of Hahnemann’s correct observations; and their conviction grew stronger in degree as they further found that symptoms obtained by them from the potentized charcoal were true and reliable guides, under the law of the similars, in the selection of that remedy for the cure of the sick. Hahnemann found further, by experiment, that all other medicinal substances gained curative powers by potentiation; caused fewer aggravations of already existing symptoms, and were more efficacious in curing the sick. Hahnemann gradually diminished the dose, and this diminution kept pace with his increasing knowledge of the medicinal power of drugs by proving them, and by administering them to the sick, guided by the law of cure and the provings. And when Hahnemann published the Chronic Diseases, be declared that we will find the thirtieth potency all-sufficient, provided the symptoms of the remedy correspond with those of the disease, or in other words, if the remedy is truly Homoeopathic to the case.
And even at that time there were found among his pretended followers men like Griesslich, who not only stubbornly refused to accept the small doses, but bitterly assailed the master on that account; and even then began the question of expediency against principle. This faction was wholly discarded by Hahnemann, and the most charitable construction we can possibly put on their conduct is this, that they imagined Homoeopathy, as a new school, would be more acceptable to the Allopaths if it could only come before them without the so objectionable and so ridiculous pellet.
Hahnemann was not the man to yield to expediencies; he continued to diminish the doses, and all the opposition and slanders could not check him, and his fame increased day by day. His cures became a greater certainty as he advanced in knowledge and as he decreased the doses; and we are informed by reliable persons that the last edition of the Organon, which Madam Hahnemann has for some time contemplated publishing, from his MS. in her possession, will show that he came to give still smaller doses than the thirtieth, as he advanced in experience. During Hahnemann’s time do we find Korsacoff carrying the potencies much higher than before; and later, Jenichen proposed to potentize medicines till he reached a point at which they would no longer retain curative qualities. He did this with fear and trembling, and the experiments made by him on himself, and by a few friends on themselves and others, revealed only the fact, that these, by him so called high-potencies not only retained their curative powers, but that diseased conditions were cured by them when lower potencies had produced no beneficial effects.
In our days, we find our colleague, Dr. Fincke, following up the experiment; and he has carried the potencies to a much higher degree than any one before him. And we are assured by the testimony of such physicians as have carefully tried them, that they not only cured patients, but it is asserted that they are by far the most curative agents ever employed. Not only have they been serviceable as curative agents, but the very highest potencies have been proved on the healthy, and the results obtained show the reliability of the experimental provings.
The opposition, which Griesslich & Co. began, (against the smaller doses) has continued ever since, and, while he and those who followed him made it a question of expediency, we find others governed by principles only. Admitting the honesty of purpose of all contending parties, their object being to advance our school, it is obvious to the close observer of history, that expediencies never accomplish what can only be obtained by a strict adherence to principles. The belief of honest and well meaning physicians that the common school of medicine will adopt Homoeopathy, if we only give up the theory of potentiation, is a grave error.
Again, we find, on the one side, those who are governed by the question of expediency not only give up one of the great principles, that of potentiation, but more or less other principles and most of the practical rules taught by Hahnemann. And, on the other side, we find those who have faithfully carried out the practical rules of Hahnemann, and are governed strictly by the principles taught by him, adhering to the smaller doses. On the one side, the small doses are entirely rejected; and on the other side, the question of doses is left open to the choice of the physician in each individual case. As a general thing, these latter prefer the higher potentized medicine, but hold that we have not yet found the law which must govern us in the selection of the dose in each individual case. And, while contending for the “minimum dose,” that is, the dose just sufficient to cure, they admit that it must still remain an open question, what that minimum dose is in each individual case.
The question of doses was generally understood to be the question whether larger or smaller doses, lower or higher potencies, were more preferable and more successful in the cure of the sick. And the very fact of asking such a question, implied the supposition that either the lower or higher potencies were more efficacious in all cases, and that we were striving to generalize one way or the other. But since such a generalizing solution of the question is outside of, and incompatible with, the avowed Homoeopathic principles of “individualizing,” the question so put never was satisfactorily answered, and never will be. The reflecting mind will seek a solution by a different mode of investigation. If we acknowledge the law of the similars as a fundamental principle in Homoeopathy, we must apply that law in the selection of the remedy for the cure of the sick, and individualize in each and every case. Under the guidance of this principle, we cannot possibly expect to find specific medicines for specific forms of dis-eases; and—which is the same thing—we cannot generalize. To be more explicit, we find that Belladonna is not a specific for scarlet fever, nor Pulsatilla for measles, nor China for intermittent fever; since our avowed principle compels us to individualize in the selection of the truly curative medicine in each and every case. And, if we admit this, does it not follow, as a logical conclusion, that we must likewisefind in each individual case the true minimum dose for that case? that we can as little generalize in the selection of the dose as we could in the selection of the remedy ?
And we must so much the more become convinced of the fruitlessness of the means hitherto resorted to, to solve a question which was not rightly put, if we look but for a moment at the unsatisfactory results obtained. To sustain this proposition, it is not necessary to dwell at length on the various articles published on the subject, for or against; the exclusive use of either the lower or higher potencies; they have not brought the question nearer solution, for the obvious reasons above shown.
And we only refer here to the experimental trials of doses as reported by Dr. Eidberr, in Vienna. These trials were made during ten consecutive years, from 1650 to 1660. All cases of pneumonia occurring in the Leopoldstadt Hospital, at Vienna, were treated for the first three years with the 80th potency; for the second period of three years with the 6th potency; and for the last four years with the 15th potency. The average time of sickness during the first three years, under the 30th potency, was 11.3 days: during the second three years, with the 6th potency, it was 19.5 days; during the third period of four years, under the 15th dilution, it was 14.6 days; showing conclusively that the results were in favor of the higher potencies and that, in the same ratio as the medicines were administered in higher potencies, the duration of the disease became shorter. And even this very elaborate report proved but little; the only deduction which can possibly be drawn from it is, that the higher potencies proved to be superior to the lower ones in the treatment of one acute disease. The report has met the same fate as did the relation of other scattered facts on record, showing that in some isolated cases the higher potencies bad been applied with great success. The adherents to the larger doses and opponents of dynamizationignored these reports, taking no notice of them, and, in some instances, they (vide Pope’s articles) unhesitatingly acknowledged their utter ignorance of the existence of the elaborate report above referred to, or of other similar facts published in the journals.
And, from the consideration of all these facts, it is apparent that the question of doses remains an open one at present; it must be left to the choice of the physician to select, in each individual case, the dose according to the best of his own judgment, and that the whole range of doses must be left open to his choice. And this is the doctrine of doses taught in the Homoeopathic Medical College of Pennsylvania for the last three years,—all the assertions to the contrary notwithstanding. It is true that, in the Dispensary and Public Clinic connected with this College, the patients have been exclusively treated with the higher and highest potencies. The results of this treatment will be laid before the profession. The journals are carefully kept by members of the class, and it will be an easy task to make an extract from them, and give a report, not with the intention of settling definitely the question of doses: far from it: the report can only show whether the higher and highest potencies are capable of curing diseased conditions, and in what time and to what extent, and it can show nothing more. The investigating physicians will be free to draw such deductions and conclusions from comparisons of this with other reports as the facts may warrant.
If it is admitted that the question of doses remains for the present an open one, that the modes of investigating it have not brought it to a solution, because they were all in themselves in opposition to the avowed principle of individualization, it follows, therefore, that another mode of investigating the question must be pursued. And it is now my object to propose a plan which may lead to this end. And if you will only follow me in my reasoning before adapting or rejecting the proposed plan, I hope you will accept it as the only feasible means of solving the question at issue.
When we wish to apply the law of similars to the cure of the sick, we seek for the truly Homoeopathic remedy in our Materia Medica; and the same great repository of the knowledge of drug-action may also be applied to for the solution of the vexed question of the dose. Our Materia Medica is composed of, and has been obtained by, provings of medicines on the human organism; these provings have been made with large crude doses and with various potencies; different provers with differing individualities, of different sexes, ages, and temperaments, at different times and in different localities, under varying circumstances, have responded similarly, but differently to different and various doses. So-called diseases also cause variously differing symptoms on different individuals, endowed with differing individualities, and their effects on each person are modified by the same conditions as are the effects of medicines on the provers. For instance, miasm and contagion will affect different individuals, either not at all, or similarly but differently: the altered conditions in both instance? are modified by the individuality of the subject exposed to either of them, that is, the medicine or the disease. If these propositions are correct, we can and must draw the conclusion from them, that we can neither find a specific for a disease nor a uniform dose for every person suffering from the influence of disease; that in either case we must individualize and not generalize. If these propositions and the conclusions drawn from them are correct, they also carry with them the means of solving the question of doses. In order to solve this question, we must know—
1. What symptoms composing our Materia Medica were observed from crude drugs, what from the lower, the higher, and the highest potencies.
2. What symptoms were observed from all of them, and what symptoms only from the one or the other preparation.
3. Do the symptoms observed from all of them yield to all doses, or do they yield sooner or more permanently to the one or the other dose, and to which dose do they most readily yield ?
4. Do the symptoms observed from large doses yield to the higher potencies?
5. Do the symptoms observed from higher potencies yield to lower potencies?
6. Do higher potencies cure cases which did not improve under lower potencies, or vice versa?
7. Must we ascend or descend in the scale of potencies, if the remedy has been truly Homoeopathic to the case, and if the dose administered did not cause any improvement?
In a small way, we might, even at present, make an effort to have these questions answered, as we are in the possession of provings with Apis, Sulphur, Thuya, Lachesis, Camphor, Lachnanthes, Gelseminum, in all known doses, and with such remedies as Theridion, only proved in the 30th potency. But in order to arrive at a satisfactory solution of all these questions, we must be in the possession of a complete Materia Medica, and if the results of the experiment have solved the proposed questions, we will be in the possession of such facts as will enable us to draw conclusions from them, and they again will further serve as an unerring guide in the selection of the similar dose in every individual case. Till we have a Materia Medica, as above indicated, the question of doses must remain an open one, and be left, as it always has been, to the judgment of the practitioner in each individual case.
And, if the above arguments are admitted, it becomes also obvious thai, as Homoeopathicians, we cannot admit a distinction, which persons who deny the efficacy and admissibility of higher potencies contrary to historical facts, have been diligently endeavoring to make,— I mean the distinguishing and division of members of our school into high and low potency men. All honest men will no doubt join me in the desire and aid in the effort to solve the pending question ; and till it is solved, till we have obtained practical rules derived from the experiments to be instituted, we must stand united and aid one another in this great work.
To show, in a familiar way, the utter absurdity of dividing our school into high and low potency men, you will please allow me to draw a timely comparison. And, for the present, I will only compare those so-called Homoeopathicians who totally reject and deny the efficacy of high potencies, and thereby wish to create a sect of their own and discredit those who admit the high potencies as n logical consequence of the fundamental principles of Homoeopathy with those of our fellow-citizens who, although living in the Republic and pretending to be members of the large body politic, deny the principle of equal rights and of manhood Suffrage as a logical consequence of the fundamental laws of our institutions.
And, in the lapse of time, I trust we shall hear the last of the silly pretence that we must drop a logical conclusion because the pellet will stink in the nostrils of our enemies,—the common school of medicine.—a school which carries within itself the germs of its own destruction, because not founded, as is ours, on the laws of nature,—a school without any principles at all, guided solely by expediencies, will be laughed to scorn; such pretences will avail as little as do the waitings of interested slave-drivers and enemies of the republic, who contend that equal rights and manhood suffrage would be offensive to the delicate nostrils of crowned heads abroad and to the tender sensibilities of an aping aristocracy at home!
The logical consequences must come. In the one instance they are already come ; in the other they must come also. And may I be spared the distasteful duty to follow my argument out according to strictly logical principles, to show what unenviable position the blind adherents toexpediency must necessarily occupy, as long, as a position is left them at all, which can be but a short time. And if this paper, which you have heard me read tonight, can persuade reflecting, honest men to discuss the question at issue impassionately, guided by facts and logic, I shall consider its preparation one of the happiest events of my life.