====== THE QUESTION OF THE DOSE.====== 

{{anchor:s2}}REMARKS BY CARROLL DUNHAM, M. D., NEW YORK.

{{anchor:s3}}In a report to the Homoeopathic Medical Society of the state of New York, on the "Use of High Potencies in the Treatment of the Sick," published in the November, December and January numbers of this Review, current volume, I stated, page 303, "that I have noted only one case in which a high potency acted but inefficiently, while a lower gave prompt and complete relief;" and, again, "that a general law for the <span grade2>a priori</span> selection of the potency suitable for a concrete case, if such a law be possible, is yet to be discovered;" and, again, "this fact that a low potency succeeded where a higher had failed, together with similar facts reported by other practitioners, must have a bearing upon general conclusions."

{{anchor:s4}}The question of the dose is manifestly an open one. {{anchor:s5}}Experience must be accumulated before we can hope to discover a law for our guidance on the subject. {{anchor:s6}}Every fact bearing on the question should have our candid and careful study.

{{anchor:s7}}In the report alluded to, a portion of the evidence in favor of the high potencies was detailed. {{anchor:s8}}The following cases present evidence on the other side and deserve particular attention. {{anchor:s9}}They are published by Dr. Arnold of Heidelberg in the <span grade2>Homoeopathische Vierteljahrschrift,</span> January, 1864, together with some very fair and ingenuous remarks by Dr. Arnold, who, it may be remarked, is in the habit of using only the lowest potencies or massive doses.

<span grade2>{{anchor:s10}}Psoriasis Guttata cured by Arsenic.</span> {{anchor:s11}}— The power of the preparations of Arsenic to cure psoriasis is so well known that I should not publish this case, were it not that it furnishes, in addition, a striking evidence of the fact, that even in chronic diseases we are often obliged to give strong doses even of the very heroic remedies if we would accomplish cure.

{{anchor:s12}}A lady, eighteen years old, whose childhood had been healthy and who had never had any sickness worth naming, who felt perfectly strong and well, and had a blooming appearance, and in whom no predisposing cause for any skin disease could be discovered, observed several years ago, on certain parts of the body, isolated, red, somewhat elevated spots, on the surface of which small scales were visible. {{anchor:s13}}Inasmuch, however, as she felt well and the spots had spared the face and neck, she did not think it necessary to seek medical advice. {{anchor:s14}}Gradually the spots became more numerous, their dimensions also increased and although the patient had no other complaint, she was yet induced to seek the advice of a physician on account of the itching which was often troublesome, especially at night.

{{anchor:s15}}Purgatives and the so-called blood-purifying tea (species lignorum) had no result. {{anchor:s16}}In the spring of 1861 she came to me. {{anchor:s17}}The eruption was over the whole skin with the exception of the face and hands; the spots were large and confluent. {{anchor:s18}}I gave her at first one grain daily of the sixth decimal trituration of Arsenic. {{anchor:s19}}But as no change had occurred in fourteen days, I changed to the fourth decimal trituration of which a grain was taken every forenoon. {{anchor:s20}}In fourteen days I found a slight improvement, in that certain spots seemed to be less red and did not itch so much at night. {{anchor:s21}}I now intermitted the use of Arsenic for three weeks, and after this period found again the old evil condition. {{anchor:s22}}One grain of the third decimal trituration of Arsenic, which was now given daily for fourteen days, wrought a more striking improvement, as well in relation to the development and size of the spots, which were much less, as also in respect to the itching at night which had almost altogether ceased.{{anchor:s23}}' But inasmuch as, after a pause of fourteen days, this improvement had again partly disappeared, I felt myself obliged to resort to a still stronger dose of the remedy in order not to put the patience of my client to too severe a test. {{anchor:s24}}She now received, once every day, two grains of the second decimal trituration, that is one-fiftieth of a grain of Arsenions acid. {{anchor:s25}}The action of this dose resulted after two weeks in a very striking improvement, which moreover maintained itself during a suspension of the remedy for the next two weeks. {{anchor:s26}}I therefore allowed the patient to continue the remedy for two weeks longer, taking daily a two grain dose of the second decimal dilution. {{anchor:s27}}The cure was complete and permanent; for a half year afterwards I had an opportunity of seeing the lady, and was assured that the recovery had been lasting.

{{anchor:s28}}On the subject of the homoeopathic relation of Arsenic to psoriasis, scarcely any physician who is familiar with the effects of this remedy can entertain a doubt. {{anchor:s29}}I must confess too that I have often seen a cure result from the use of the sixth, but still more from the fourth decimal trituration of this drug. {{anchor:s30}}Even in the case just related, the amelioration might have proceeded to an enduring cure if the use of the fourth trituration had been continued for a longer time. {{anchor:s31}}But inasmuch as the patient had borne the Arsenic very well and not a single symptom of its pathogenetic action had been apparent, even after a daily dose of two grains of the second trituration, there was no reason for losing time in the use of small doses. {{anchor:s32}}In any case, this is a new evidence that in chronic diseases even very heroic remedies must sometimes be given in very large doses.

<span grade2>{{anchor:s33}}Natal Polypus cured by Calcarea.</span> {{anchor:s34}}— A lady, aged fifty-five, of respectable position in society, pale, of delicate constitution, small and rachitic from childhood but never seriously ill, perceived, several years ago, in the right nostril an impediment to respiration. {{anchor:s35}}An examination by a physician readily disclosed the presence of a mucous polypus. {{anchor:s36}}Various remedies were administered during a long period without perceptible effect. {{anchor:s37}}Neither Mercurius dulcis., used as a snuff, nor Corrosive sublimate in solution, to be inhaled, had a noteworthy or enduring effect. {{anchor:s38}}The patient thought the slight changes noticed were rather to be ascribed to the weather, and especially to the dryness or moisture of the atmosphere than to the remedies used.

{{anchor:s39}}Under these circumstances, the operation being proposed, I was asked whether a cure was possible without operative procedures. {{anchor:s40}}I declared that a cure by means of internal remedies not only might succeed, but that it would have a much more enduring result than the mechanical removal of the growth could have; and furthermore, that an operation in case it should prove necessary <span grade2>after</span> an internal treatment, would be more certain and more lasting in its result, than one without the previous use of corresponding remedies.

{{anchor:s41}}Having seen from Calcarea carbonica in several similar cases a very striking and unmistakable curative action, I prescribed the fourth decimal trituration of this remedy and ordered at first one grain daily, and after eight days two grains daily to be taken. {{anchor:s42}}After two months, the patient appeared and reported that she had taken the remedy four weeks and then intermitted it for four weeks, and that no change in her condition was observable. {{anchor:s43}}And I could myself perceive neither increase nor decrease of the polypous excrescence. {{anchor:s44}}This determined me to give the second decimal trituration of Calcarea, one grain daily. {{anchor:s45}}After fourteen days, the nostril having become more permeable and a diminution in the size of the polypus being perceptible, although very trifling in degree, I allowed a pause of four weeks in the use of the remedy. {{anchor:s46}}After this lapse of time, the tumor had regained its former size; the lady was more than ever inclined towards the operation.

{{anchor:s47}}I concluded to wait upon her a few weeks longer and gave her the officinal lime water, a teaspoonful twice daily in milk. {{anchor:s48}}Four weeks later, the lady came again to me; a most careful investigation revealed no trace of the polypus. {{anchor:s49}}She informed me that there was amelioration after the very first doses of lime water, and that after a fortnight the nose had felt entirely free and since that time there had been no aggravation.

{{anchor:s50}}The improvement has already lasted more than a year without any further administration of the remedy. {{anchor:s51}}Repeated examinations have failed to enable me to discover any trace of the polypus.

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====== DOCUMENT DESCRIPTOR ======

^ Source: | The American Homoeopathic Review Vol. 04 No. 12, 1864, pages 545-549 |
^ Description: | The Question of The Dose. |
^ Author: | Dunham, C. |
^ Year: | 1864 |
^ Editing: | errors only; interlinks; formatting |
^ Attribution: | Legatum Homeopathicum |