BY AD. LIPPE, M.D., PHILADELPHIA.

In almost every work on Homoeopathy directions are given as to how much is required for a dose.

In the early publications in the Materia Medica Pura, 1811, by Samuel Hahnemann, first volume, he gives the dose only under Cina, and recommends per dose for a child of two years old three grains, for a child four years old six grains. In the second edition of 1822 we find under all medicines much smaller but different doses. In the third edition of 1830, he gives the smallest part of a drop of the 30th (centesimal) dilution as the most appropriate, and for all cases, sufficient dose.

These directions are found in all modern works on the practice of Homoeopathy, in the therapeutic pocket-book, in the published lectures of homoeopathic professors, in the various “Domestic Physicians,” (except in the “Domestic Physician,” by Dr. C. Hering) and in the Medical Journals.

All these recommendations are given with the assurance that they are the result of “Experience,” and are based upon observed facts.

While the advices so given are at great variance with one another, and while the opinions of different practitioners of Homoeopathy are not the same, it is undoubtedly time to endeavor to throw some light on this vexed question.

All parties who have given publicity to their opinions as regards the proper dose, are equally entitled to be heard, and their statements to be considered as the result of their honest individual investigation. The question of how much is required for a dose is no nearer solution now, than it was when first agitated. The reason why the various practitioners have arrived at so very different conclusions is simply this, that the solution of this question is the natural result of the adoption of previously established fundamental principles in the medical art. Why is it that Hahnemann, after an experience of twenty years, arrived at the conclusion that the 30th potency was sufficient in all cases, and that modern practitioners either reject the higher attenuations altogether, or admit that they will be occasionally serviceable? And how is it that Hahnemann, the older he grew, the less medicine he gave, while the modern young practitioners try really to excel one another in large doses and entirely deny the applicability of the higher dynamizations?

The reason for all this variety of opinion can only be found in the fact that the fundamental principles of Homoeopathy have not been accepted by those who differ with Hahnemann's experience, or that they may be unknown to them altogether. Whoever has accepted the fundamental principles of Homoeopathy must necessarily have attained similar, if not the same, results as did our great and good master, Samuel Hahnemann. In order that I may be better understood, I will give an historical development of the fundamental principles of Homoeopathy, to show what will be the universal result of the proper investigation of the question of “Doses,” and why different parties have arrived at different conclusions.

Hahnemann practically applied the principle “Similia Similibus Curantur” to the treatment of disease. The first question was to ascertain the positive action of medicinal substances on the human organism, and since Hahnemann found nothing of the kind in the, so-called, Materia Medica of the then prevailing school of medicine, save a few incomplete cases of poisoning with large doses, and the Materia Medica itself so faulty, so entirely arbitrary, based on speculative theory, not on experiment, that little benefit could be derived from or use made of it. He was the first physician who resorted to the simple but only possible course, i. e. to the proving of medicinal substances on the healthy. His friends, then a small but faithful number, began their investigations by first taking comparatively large doses of the crude substances; the very incomplete provings so obtained enabled Hahnemann to demonstrate the correctness of the law of cure; when the remedy, having similarity to the disease, was administered in comparatively large doses, there almost always followed a considerable aggravation of symptoms, which led Hahnemann first to give less medicine and to dilute the doses. The curative action of the medicines was not found to be diminished, but rather to be increased, and it was here that the light of potentization broke upon Hahnemann, and he discovered what modern men are pleased to call “the great mistake of a great man.” To this discovery, they, the modern wise men, follow him, and from that point judge Homoeopathy. Hahnemann did not rest content but prosecuted his researches, and discovered that some inert crude substances become curative agents, when their medicinal properties are developed by potentization, and that the provings on the healthy had to be made by potencies. His followers, who at first were bewildered when they beheld this theory of potentization, were compelled to be convinced by actual experiments of this great discovery of their master.

Hahnemann had called the attention of his pupils to the great medicinal powers of charcoal: charcoal was pulverized and taken in quantities, but no symptoms followed the increased doses, this was communicated to Hahnemann by Caspari who advised him to triturate one grain of charcoal with ninety-nine grains of sugar of milk, for the space of one hour, and this preparation should be taken: as no symptoms were observed by the prover, he advised them to take a grain of this first trituration and again triturate this grain with ninety-nine grains of sugar of milk for one hour; but few symptoms were observed: he again advised them to take one grain of this, the second trituration, and triturate this one grain with ninety-nine grains of sugar of milk for one hour, and take it. The provers now obtained most of the known symptoms of charcoal from this preparation, and this experiment gave rise to the doctrine of potentization, and settled also the pending question of the chemical and dynamical action of medicines, upon which question, from want of space, I abstain from enlarging, for the present. When Alumina was proved, symptoms was not observed until the sixth potency was taken.

Medicines already proved in large doses were now subjected to new provings and new and more decided symptoms were the result

The curative virtues of substances, formerly considered inert, were disclosed as in Alum. Natrum muriaticum, Lycopodium, Carbo vegetabilis and Silicea. The symptoms obtained from potentized doses, were the most reliable, as can easily be verified by comparing the first provings of Sulphur with the later. Invariably are the later symptoms only the result of provings with small doses, and these same symptoms are now the leading symptoms used by the practitioner every day. Nay even now is this assertion beautifully verified by the very valuable proving of Thuja, by Dr. Wolf — the result of high potencies only; this last Thuja proving not only confirms the former proving by Hahnemann, and later by the Vienna physicians, but more clearly defines the action of Thuja — defines the characteristic symptoms of this medicine. This is demonstrated more clearly by Arsenic: the symptoms produced by poisoning are but seldom of any use to the practitioner, they very much resemble the symptoms of disease when it approaches a fatal termination, and although Arsenic seems there often indicated, it is not able to cure.

Hahnemann found that the better he became acquainted with the action of drugs, the doses had to be diminished to avoid the frequent aggravation following the exhibition of the potentized medicine; he gave the medicine in smaller doses, and less often, in the same proportion as his knowledge of the action of medicines increased. No doubt in the eyes of the young or inexperienced “a great mistake of a great man.”

The three great fundamental principles consecutively developed by Hahnemann, were:

1. That the curative virtues of medicines can only be ascertained by provings on the healthy.

2. That the totality of symptoms constitute the disease.

3. That the curative virtues of medicines are developed by potentization.

On these three fundamental principles the structure of Homoeopathy was raised, and is continuing to be built, developing itself out of them. While these fundamental principles were fully established and confirmed by the experiments, the question was agitated “what is the proper dose to be administered for the cure of diseases.” Hahnemann himself, and such of his disciples who had fully mastered the Materia Medica, obtained more satisfactory results in the treatment of disease by diminishing the dose, while others contended that the smaller and smaller the doses became, they were not capable of removing the disease promptly, and preferred larger, and in many cases, very large doses of the crude drag, and so fell into the degradation of materialism.

It is further contended that although the most brilliant cures, and those too in persistent chronic diseases, when all systems and all doses had been uselessly tried, have resulted from the higher attenuations (200), they are objectionably high for practical use.

The followers of Hahnemann accepting the fundamental principles of Homoeopathy have from time to time given publicity to the results of their experience. and have all found themselves constrained to state that the most brilliant results were obtained from the higher attenuations, and that in some cases, where even the 200th potency was not sufficient to eradicate disease, the higher potencies were successfully administered; that it was essential never to administer a second dose of the same remedy or a dose of a new medicine, till the action of the former dose was fully exhausted, and that this action is often of long duration; that the lower doses never cure when the higher attenuations were administered without success; that the duration of disease is very much shortened if the higher attenuations are administered, and the occurrence of fully developed dangerous conditions of acute diseases decreased, in the same proportion as they had lessened the doses. While the curative action of the lower attenuations of the properly selected homoeopathic remedy has never been denied, the advocates of the lower attenuations have time and again been requested to prove their position by giving publicity to cases in which higher attenuations had at first been unsuccessfully administered and a permanent cure established by a lower attenuation. No such cases have ever been fairly stated; we have received nothing but vague assertions. Lower attenuations may palliate or suppress part of the symptoms, but they will never remove the disease, i e., the totality of the symptoms, after a higher attenuation has failed to do so.

In the flourishing Homoeopathic Clinic at Brussels high. potencies only are administered, and the results stand incomparable in the medical records. Vide the “Homoeopathic Belge.”

The materialists who deny the superiority of highly potentized medicines have not accepted the fundamental principles of Homoeopathy. They either neglect to ascertain the totality of the symptoms as taught in Hahnemann's anon, and instead, hold that pathological conditions, or names of diseases, indicate. the medicines, as for example, in their treatment of Intermittent Fever, (where they can see no difference in the great variety of symptoms in this or any other disease which depends so much on the epidemic character and the individuality of the patient) and they openly advise in text-books and lectures, the use of Chininum sulphuricum in crude and large doses, as the only remedy against Intermittent Fever. They entirely ignore even Hahnemann's first experiments, his proving of China officinalis, in order to ascertain what are the characteristic symptoms of China, and in what cases of Intermittent Fever it may be with certainty administered.

Entirely neglecting to consider the totality of symptoms, so varied in the same forms of disease by the character and individuality of the patient, they vainly look for specific medicines for specific diseases. In the present prevailing, so-called, Diphtheria, they pursue the same un-homoeopathic course, at one time administering Mercurius iodatus, in large doses and by ill success, driven from its use, they resort to Argentum nitricum, or tincture of Phosphorus, with no better success, because of the neglect of the first principles of Homoeopathy.

They entirely forget that the characteristic symptoms of the disease must also be characteristic to the remedy if a good result is sought to be obtained, and here I will give an illustration from my daily practice. I was called to prescribe for a lady, who was suffering from a true panaritium, all the bones of the index finger of the right hand were already involved. Symptoms — Burning pain, for which cold water dressings had been applied, pain worse from 10 o'clock to 4 in the morning, depriving her of all rest, and compelling her to walk up and down the room.

Apis had been administered without giving relief; I gave Arsenicum 200, but upon my visit in the morning I found the pain and distress increased. I again examined the case and found that warm poultices of bread and milk had been applied, but the warmer they were when applied the more severe the pain became; it now became evident that Arsenicum could not be the proper remedy, as this characteristic symptom of Arsenicum was deficient, “better from heat,” although all the other symptoms seemed to indicate it clearly. — I again compared the symptoms, and as the Lycopodium pains are always aggravated by wrapping up warmly, and as all the other symptoms were also to be found under the provings of Lycopodium, I administered one dose of Lycopodium 2000. The next night the patient was comparatively easier, the poultices could be applied warm, the improvement continued for four days, when Silicea became indicated, and one dose of it in the 200th potency was given, and the freely suppurating finger was gradually healed.

That class of Homoeopathists who acknowledge that the high potencies have cured cases that had yielded to no other preparations, but say that they are objectionably high for practical use, deride logic. They give evidence that they are capable of selecting, at times, the proper homoeopathic remedy, and have properly cured — but why not always? what is their objection to using them always? and why are the higher potencies not practically useful if they have cured?

The conflicting doctrines held by the various practitioners of medicine, calling themselves Homoeopathists, make it not only desirable, but imperatively necessary to determine the fundamental principles of Homoeopathy first, without determination of doses, as their adoption is clearly the result of an acknowledgment or denial of first principles. It is a duty we owe ourselves, the community, and the memory of Hahnemann to agree on positive fixed fundamental principles, and the vexed question of doses will solve itself. The community has a right to know, and should know, what constitutes Homoeopathy and a homoeopathic practitioner. The community which is to be benefited by a progressively developed art, finds conflicting, uncontradicted statements brought before it, with no support but the delusive or idle assertion of irresponsible individuals. As an historical fact we find that a professor of a Homoeopathic College, and in that capacity, testified at the trial of Dr. King, at Toronto, April, 1859, (the testimony is copied from the “Toronto Globe,” April 8th, 1859,) in open court, and under oath, when the question was asked as to what was a proper homoeopathic dose? “We endeavor to stop short of symptoms of poisoning.” The same witness says, “in homoeopathic treatment I have given as much as the 1-5th of a grain of Arsenic and have repeated that dose Horn twelve to fifteen times in the course of forty-eight hours!!!” These false assertions still remain on record against Homoeopathy, uncontradicted.

The witness remained a professor, and his text-books and published lectures, which are teeming with absurdities, are spread over the country under the name of Homoeopathy. While on the other hand the leading physicians on the continent of Europe, and in this country also, contend for the smallest doses and highest potencies, and the most astonishing results have followed their use for almost twenty years, nevertheless there are voices and pens enough in motion to contradict them, and warn the community not to trust to such ridiculously small doses, and even assert that an improvement on Homoeopathy, as taught by Hahnemann, has been accomplished by stopping where began “the great error of a great man.”

I have prescribed almost exclusively the higher potencies since 1846, and am perfectly convinced of their superiority over less potentized or crude medicines; at the same time I am far from willing even to endeavor to force my opinion upon any one, who from reasons, best known to himself, arrives at a different conclusion. Moreover I am content to strengthen and augment the testimony given by older and more experienced men than myself, that in the direction of higher and the highest potencies Homoeopathy is progressive. It is my firm conviction that the question of doses should not for the present be further agitated, as it is impossible, under existing circumstances, to arrive at any definite settlement. The doses being the result of previously established fundamental principles, we must first agree upon them.

The fundamental principles are:

1. That the curative virtues of medicines have to be ascertained by provings on the healthy, (and it has been shown by historical facts to be best by proving potencies).

2. That the totality of symptoms constitute the disease, (and by inference from this principle, Homoeopathy cannot acknowledge specific medicines for specific diseases).

3. That the curative virtue of medicine is developed by potentization, (and by inference from this doctrine, the administration of unpotentized medicine is not Homoeopathic, and therefore not admissible).

I am also convinced that those who fully acknowledge these fundamental principles of Homoeopathy, will find the smaller and smallest doses superior to the larger, and will find that Dr. v. Grauvogl, in his fundamental principles of “Physiology, Pathology and Homoeopathic Therapeutics,” is correct when he says, “he is the best physician who gives the smallest doses;” furthermore, all physicians who do not acknowledge these three fundamental principles are no Homoeopathists at all, and whether or not the so-called Allopathic school will receive them in their ranks — we as consistent Homoeopathists can have no communion with them.

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