BY P. P. WELLS, M. D., BROOKLYN, N. Y.

The attempt to cure diseases by the use of drugs was first made many centuries ago, and from that time to the present these have been the favorite agents in the hands of men who have devoted their time and talents to curing the sick. In many generations they have constituted almost the entire arsenal from which this class of men have drawn the resources demanded by the duties of their special calling; and in all time, since they were first brought into use, they have been largely the majority of all the means employed in the art of healing. In their use, with patients and their friends, there has always been a kind of mystery, which carried with it a peculiar charm, which sanctified and made tolerable, the otherwise intolerable disgust inseparable from the common experience of their administration and effects. While on the other hand, with the profession, this mystery has been cherished and magnified as an object dear to the heart, and a means of exalting the estimation of the importance of the functions they were supposed to be executing. The association of mystery and ignorance is no new compact, neither has it been a novelty, for many centuries, when affectation of the one has been made to serve as a cover for the other.

This is as old, and has been as common, as the substitute of arrogant assumption for positive knowledge. But, has mystery in the use of the drugs been made a cover for ignorance of their nature and effects? Let the experience of any, man, well-informed in the premises, answer. Is not the continued experience of thirty centuries, of the use of drugs in the treatment of the sick, a sufficient answer to the charge, or suspicion, of ignorance of their nature and effects, on the part of those to whom they are still chief favorites, and a principal reliance in this treatment? Let the current treatises on Materia Medica, of the old school of medicine, stripped of their unacknowledged borrowings from that of the new, answer. It may be affirmed without fear of contradiction, that beyond a few of the most obvious generic effects of drugs, the ignorance of their actions on the living organism has been most complete, through the centuries in which they have been so liberally employed. And further, that the medical profession, while content with a hypothetical philosophy of diseases, was also so far satisfied with this ignorance of the nature and action of the agents it employed for their cure, as to have taken no measures, worthy of respect, for its removal. A few writers, in all this time, more enlightened than their fellows, were alone conscious of the disabilities arising from this state of things, and had slight and occasional glimpses of the measures to be taken for its removal; but not one of these even, put forth an earnest effort to realize his own conceptions of the needed reform. It was not until the discovery of the law by which diseases are cured by drugs, that there was any conception of the extent or importance of drug actions on the living organism; much less of the necessity of an exact knowledge of them, in order to an intelligent use of these agents for the cure of the sick. This discovery disclosed the necessity of an exact and exhaustive knowledge of drug action, and imposed the obligation of serious and continued efforts to attain it. This necessity was first observed, and this obligation first acknowledged and obeyed, by the discoverer of this law of cure; and the knowledge, when gained, he called the proving of the drug. They are both now fully recognized by the adherents of the school of practice he inaugurated, and with them the only question now is, how, and by what means, is this knowledge to be gained? or, in other words, what is necessary to obtain an answer to the two following questions:

What is a drug? and, what is it to prove that drug?

In order to a clear understanding of the true answer to the first question, we must go back of it and ask another – What is life? Answer: The continued action of those forces, through and upon the organs of the body, which preserve it from decay. This is life. And health is that balanced action of these forces which preserves the integrity of all its parts. In this balance is the conservatism of the whole, without this, destruction of parts more or less is the result, the value of which is determined by the importance and number of organs or functions involved.

A drug is any material agent the ingestion of which is capable of so disturbing this balanced action of the vital forces, that the functions of one or more of the organs of the body are no longer executed in the manner the best welfare of the whole requires; and all material agents capable of so acting on the living organism, are drugs. Hence drugs are destructive. The difference, and the only apparent difference between drugs and food, is that of destruction and conservation.

To prove a drug is simply to ascertain what disturbances of this balance it is capable of producing. What are the organs it invades, and what are the modifications of function it produces? Answers to these questions, when ascertained and recorded, are the proving of that drug.

How are these answers to be obtained? In the first place, they can only be gained satisfactorily, in circumstances I which make the problem a simple one. Any circumstance which complicates the inquiry diminishes or destroys the value of the answer. These are to be guarded against chiefly: First, in the quality of the drug. It must be pure, i. e., it must possess all its active properties, and be free from mixture with other drugs. Second, in the state of the prover. He must have in himself that balance of the action of the vital forces which we call health, and which we propose to disturb by the drug; and, third, in the circumstances which surround the prover. These must be such as are not liable of themselves to produce disturbances which may be put to the account of the drug.

Having, so far as possible, secured these necessary conditions, how shall we proceed to prove a drug? It is pure, the prover is healthy, and of such intellectual and moral character as to qualify him for the great work, and his circumstances such as to warrant a reasonable freedom from complicating disturbances, and now what shall the prover do?

In the first place, he shall not depart in any way from any of his ordinary habits of life, with a view to avoid modifying influences, because his life is based on those habits and conformed to them, and any important change in these, must result in changes more or less important, which may be put to the account of the drug. His food, drinks, sleep and exercise must be such as he has been accustomed to. His common pursuits should not be departed from, and every circumstance and act the nearest possible to those of his common daily experience. And, then, to be a prover of the drug, he must possess such susceptibilities to its action as will admit of developing in him the specific results of its use.

All men and women are not equally good provers, neither is any one equally a good prover of all drugs. Most persons have some peculiar susceptibilities to the action of some drugs, of which they are consequently good provers. And if others fail of realizing results which verify their experience, this is not therefore to be rejected. Peculiar susceptibilities make the knowledge of peculiar facts possible, and their possession of the greater value, because peculiar. He must not only have the requisite susceptibility, but also that intelligence of subjective phenomena which will enable him rightly to appreciate and record them intelligently. In this there is a wide difference in men and women, both in the perception and description of such phenomena.

Every practitioner of much experience has found difficulty in obtaining from some patients an intelligent account of their sufferings, not because they did not suffer, but because of this deficient power of perception and expression. Such persons can never be good provers. A good prover must also honestly record all experienced facts, after the commencement of his experiment, and be equally scrupulous in avoiding skepticism, imaginary phenomena, and undue coloring of those which are real. It has been too common with some excellent men to receive all facts, at first, with suspicion, and to regard this as a duty and function of superior wisdom, never realizing that a fact suspected is more than half rejected, and that whether suspected or rejected, it is a fact still, and its value in no wise affected by this absurd mistake. Such persons can never be good provers, if indeed, they can be provers at all. A prover, at the beginning of his experiment, must be in that degree of physiological equilibrium which is not subject daily and hourly to abnormal sensations and disturbance of functions, which would invalidate or complicate his observations.

These most requisite preliminaries being secured, and having determined to make the experiment of proving a drug, what is the object to be sought? We answer, principally to ascertain those facts which place the given drug in the series of curative agents; by which also it is related to diseased conditions, and by which those conditions may be cured. But are not all disturbances of the vital forces, such as have been stated in the outset of these observations, alike so related? Nothing is more certain, than that all symptoms of drug action have not an equal value in this respect. And while all are the proper subjects of record by the prover, all are not equally curative, and some probably not curative at all. The proper object of the prover is to ascertain those which cure. Or, in other words, those which are peculiar to the drug, and which distinguish its action from that of other drugs; the power to cure having been fixed in these, and not in those symptoms which are common to it and other drugs. If it had been otherwise ordered, the impossibility of finding a curative in a given case of disease, by any distinctive signs, would have necessitated the giving the series of drugs successively to which the symptoms in common belong, till the right was found, till which time the sufferings of the patient would remain unrelieved, and perhaps his safety be compromised. The proper object then of the prover of a drug is to ascertain its characteristic symptoms, and to distinguish them from those common to other drugs. This can only be done by recording all the facts observed, and then comparing this record with the records of the ascertained effects of other drugs, and noting the resemblances and differences, the proving of a drug, then, consists of two parts, the observation and record of its actions, and the analysis and comparison of them with the recorded observations of the actions of other drugs.

Having complied with all the requisites for a true proving and having a clear view of its proper object, what course shall be taken to secure it? This is made up of two parts. The dose – how much, and in what state; and the repetitions; how. often it shall be taken? First of the dose. It may be of the crude drug, or of a low or high potence of it. Which is preferable? In a given case, the answer to this will depend, first, on the nature of the drug; and, second, on the susceptibility of the prover. Those drugs which in their natural state affect the organism but slightly, as Carbo veg. and Silicea, require to be potentized in order to the development of their characteristic effects on the prover. While those which are prompt in their action, as Ipecac., may be proved in the crude state or in low potencies; but if the drug be actively poisonous, as Merc. cor., it can be proved only in the potencies.

The object of the proving is a knowledge of what is peculiar to the drug – its characteristics. In those drugs which. are comparatively inert in their natural state, these are rarely developed after crude doses. So that most of the so-called provings of such substances, in such doses, are comparatively valueless. The same is, to a great extent, true of such provings of active poisons. The one class is expelled from the system without ever coming into active relation to the forces of life, with a manifestation of few or no symptoms; the other, by the violence of its action, causes its speedy expulsion, with few symptoms, and these such as are common to the drugs of its class, and are therefore of little or no practical value. The disturbances of functions are such as might have been the result of almost any drug of its class and there-fore are generic and not characteristic; and for this reason, not curative; and so are no answer to the problem before the prover. This is probably the true explanation of the poverty of the provings of Tartar emet, Corrosive sublimate, and some others. The second element in determining the state of the drug to be taken, and its quantity, is the susceptibility of the prover. The greater this, the less the dose, as a general rule. If the organism be powerfully impressed suddenly, it may so revolt against the dose as to expel it at once, with only generic symptoms, and the prover fails of his object. If the prover be of only moderate impressibility, he may realize valuable results from larger doses. If very obtuse, he is but poorly fitted for his work. In a word, he is to take the drug in such doses as will admit of and secure the pervasion of his organism by it, so that its effects may be“ developed in the functions of the various organs of his body. This can generally be better done by its gradual than sudden introduction; as in this way we avoid those violent functional alarms, which, when they occur in a proving, work our certain defeat. Hence, in those provings where a first dose is followed by no marked results, it is better to repeat it, and if necessary, many times, till symptoms arc developed, than to begin to increase the dose with each repetition, as the manner of many has been. This method usually results in a few generic symptoms, and these consequently are not worth the pains they cost By the gradual introduction of the drug, the organs become pervaded by it, tolerate it and respond to its specific impression, and its characteristics are secured. Hence the great error of those who have questioned the value of provings with high potencies. If the attempted proving with these, owing to the unimpressible nature of the prover, or from any other cause, produces no results, it can in no way invalidate the truth of those obtained from the provings of others better endowed for the work. From the very nature of the case, symptoms so obtained, which are genuine, must possess the highest value.

In regard to the repetition of doses by a prover, it is to be governed by the nature of the drug, and the results already obtained. Drugs of slow action, as Causticum, Lycopodium, etc., are to be taken at longer intervals than such as are quick, as Aconite, Arnica, Ipecac., etc. This is the general rule, which, if it be remembered, with this one other, to repeat no dose while symptoms are being realized from those already taken, the prover can hardly make a mistake. This last is equivalent to that rule in practice which forbids the repetition of doses while those previously taken are still active, and in all provings, is of imperative authority. The reason for this is that, from the nature of the case, the total symptoms of a drug are produced in sequences, some earlier and some later in the series, and while these are being developed, a repetition of the dose only sets the prover back to the beginning again, and by continued repetition of this process, he may never reach those later and more valuable symptoms which a better method might have secured.

The second and not the least important duty of the prover is, to record the symptoms of the proving as they occur – First, in the order of their appearance; and, second, with all their attending circumstances. It is important that the natural order to preserved, because all symptoms in the series are not of equal value, and one of the elements which enables us to determine the value of symptoms is the date of their occurrence after the taking of the dose producing them. The more remote from the taking of the dose, the greater the value of the symptom. The prover is to be explicit, in recording pains experienced, to state their exact locality and quality. It is not enough to know he had pain, he must state of what kind it was. If shooting, in what direction it passed. If it appeared first on one side and then on the other, to note carefully that first attacked, so that it may be known whether the symptoms passed from right to left, and the reverse; and if the course were from within outward, or the reverse, and also of any symptom whether its course of progress were from above downwards or the reverse. In these peculiarities are found the characteristics of many drugs. He will also note most carefully all the circumstances of the appearance of a symptom, and also all those which cause its aggravation or mitigation; such as time of day, morning, forenoon, afternoon, evening, night, before midnight, after midnight, or better still if possible, the exact hour, as many valuable symptoms of valuable drugs are characterized by this fact, as those of Lycopodium which appear at four, p.m., and of Kali carb. at three, a.m. He must note the position of the prover when the symptom appeared, and also those positions by which the symptom is aggravated or relieved. Was he standing, walking, sitting, lying; on the right or left side, or back; how it is affected by motion or repose; how by particular motion, if at all; how by eating, drinking and sleep, and how after these; how, if at all, by the presence and acts of others, and whatever other modifying acts of himself or others, or whatever other circumstances may have favored the appearance, or increased or diminished the intensity, of the symptom. This part of the duty of the prover should be insisted on the more earnestly, because many extensive records of the effects of drugs, when these have been omitted, have been made and published, which are by the omission rendered nearly useless in practical medicine. They are only records, they are very far from being provings, and provings only can have practical value. The extent to which our Materia Medica has suffered at the hands of ignorant translators and condensers by the omission of these facts of the original record, can only be understood after comparison of the original provings of the earlier Homoeopathists and their associates with the translations and abridgements of these gentlemen, which have appeared as “Manuals” and “Codices” These latter are only like an attempt to produce a living man without a soul. These elements are the very life of a proving.

Then, as has been already stated, he is faithfully to record all the facts. He is to judge no one too insignificant for note. How many sufferers have been relieved by Kali carb. by the intelligent student of the Materia Medica, who knew this peculiarity of its cough at three in the morning, who would have been unrelieved had this fact been omitted by the prover. And what fact in its record of symptoms appears more unimportant to him who is no student? If the prover is in doubt as to whether any fact be the result of the action of the drug, let it be recorded as a fact still in question, but on no account omit it. In deciding whether it be of the drug, he must refer to his ordinary past experience, when not subject to drug action, and also inquire whether it can more reasonably be referred to any other agent, and then, if possible, verify the fact by subsequent observation. In his record he is to remember that skepticism is a curse; and imagination a lie; and that the truth has no part with either.

Objective phenomena make but a small part of the record of past provings, and especially of those of the early provers. It can hardly be necessary to say that all such appearances should be carefully noted, though the value of many of them as indicia for the selection of a curative drug may be well called in question, and the exact importance which may belong to any of them, for this purpose, may not yet be well settled. Still if no greater good comes from their careful record and study than to establish this value, and to give them their proper place, whatever it may be, in the elements to be considered in prescribing for the sick, it will not prove a labor in vain. At first glance it would certainly seem that these phenomena should occupy the first place among those which decide a prescription, but a careful study of those great cures which have been recorded and published for our instruction, by the early masters of our art, will disclose the fact that they play but a small part in their prescriptive decisions. And, at the present time it may not, perhaps, be going too far to anticipate, that when the truth is finally and undoubtedly disclosed, which answers that most important query,”What is the 'like' which cures? objective phenomena will occupy quite a subordinate place in that curing similarity. In my own past experience it is not difficult to remember many disappointed expectations of success based on these great uncertainties, nor to recollect that in my observation of the practice of others, those who have most relied on these phenomena, and have sought to be mainly controlled by them, have not been the most successful physicians; and that some such, after years of struggling in their great endeavor to make this a basis of a successful practice, have finally, in their disappointment, seemed to apostatize from a faith they never either cherished or comprehended, and to have abandoned a practice they had never adopted. Such memories are instructive, if not decisive of the possibility of erecting a successful practice on this uncertain foundation.

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