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en:ahr:dunham-c-the-dose-in-drug-proving-158-10436 [2012/07/12 10:56]
127.0.0.1 external edit
en:ahr:dunham-c-the-dose-in-drug-proving-158-10436 [2014/05/12 11:36]
legatum
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 {{anchor:​s41}}Thirdly:​ The susceptibility of provers to different preparations of the same drug is very various and apparently capricious. {{anchor:​s42}}One records characteristic specific symptoms from large doses of the crude drug, and is not affected by smaller doses; another is acted on by dilutions and not by any quantity of the crude substance. {{anchor:​s41}}Thirdly:​ The susceptibility of provers to different preparations of the same drug is very various and apparently capricious. {{anchor:​s42}}One records characteristic specific symptoms from large doses of the crude drug, and is not affected by smaller doses; another is acted on by dilutions and not by any quantity of the crude substance.
  
-{{anchor:​s43}}The relative power of a drug and susceptibility of the prover being altogether unknown until ascertained by direct experiment, the proving of a new drug is therefore a matter of pure experiment in every particular, and it might at first view be supposed to be a matter of indifference in what manner or with what doses the experiment is begun; which variety or sub-variety of symptoms is first developed, whether we take heroic doses and develop chemical symptoms or small doses and produce peripheral dynamic symptoms; Since in either case we should be able by subsequent experiments based on the first, to develop the complementary symptoms and thus complete our providing. {{anchor:​s44}}Experience ​teachers, however, that this supposition is not sound, and for the following reasons: Drugs vary not more in the intensity than in the permanence speedily to exhaust, sometimes by a single large dose, the susceptibility of the prover, so that no subsequent doses, whether large or small, produce any effect. {{anchor:​s45}}Of others again, a single large dose develops some one <span grade2>​generic or central specific</​span>​ symptom, and along with it includes such an exalted and distorted susceptibility that every subsequent dose, whether large or small, evokes straightway that one symptom or series of symptoms and none other. {{anchor:​s46}}Thus the proving is in either case partial and incomplete — we fail to get those symptoms which are the most valuable of all to us, as being those which clearly characterize the drug and enable us to distinguish it from all other drugs, viz.: — the <span grade2>​peripheral and central,</​span>​ <span grade2>​specific</​span>​ dynamic symptoms. {{anchor:​s47}}To illustrate this point, — it is well known that Mercury given in such doses as to produce <span grade2>​central specific</​span>​ symptoms, induces often so great a susceptibility of the organism to the action of this drug, that subsequent doses, even of tolerably high dilutions, provoke straightway a series of <span grade2>​central</​span>​ symptoms. {{anchor:​s48}}The same is true of Arsenic. {{anchor:​s49}}We have seen a case in which, generic and specific symptoms having once been produced by massive doses of Tartar emetic, the organism remained so sensitive to the action of this substance, that a few globules of the thirtieth dilution would at any time produce vomiting and diarrhea, with cold sweat and prostration. {{anchor:​s50}}It may be said that these are cases of very unusually great susceptibility to the action of the respective drugs. {{anchor:​s51}}This is true, but it is precisely such cases of great susceptibility that are of exceeding value to us, for in them, by judicious experimentation we could get most valuable peripheral symptoms, unalloyed by generic or by revolutionary effects.+{{anchor:​s43}}The relative power of a drug and susceptibility of the prover being altogether unknown until ascertained by direct experiment, the proving of a new drug is therefore a matter of pure experiment in every particular, and it might at first view be supposed to be a matter of indifference in what manner or with what doses the experiment is begun; which variety or sub-variety of symptoms is first developed, whether we take heroic doses and develop chemical symptoms or small doses and produce peripheral dynamic symptoms; Since in either case we should be able by subsequent experiments based on the first, to develop the complementary symptoms and thus complete our proving. {{anchor:​s44}}Experience ​teaches, however, that this supposition is not sound, and for the following reasons: Drugs vary not more in the intensity than in the permanence speedily to exhaust, sometimes by a single large dose, the susceptibility of the prover, so that no subsequent doses, whether large or small, produce any effect. {{anchor:​s45}}Of others again, a single large dose develops some one <span grade2>​generic or central specific</​span>​ symptom, and along with it includes such an exalted and distorted susceptibility that every subsequent dose, whether large or small, evokes straightway that one symptom or series of symptoms and none other. {{anchor:​s46}}Thus the proving is in either case partial and incomplete — we fail to get those symptoms which are the most valuable of all to us, as being those which clearly characterize the drug and enable us to distinguish it from all other drugs, viz.: — the <span grade2>​peripheral and central,</​span>​ <span grade2>​specific</​span>​ dynamic symptoms. {{anchor:​s47}}To illustrate this point, — it is well known that Mercury given in such doses as to produce <span grade2>​central specific</​span>​ symptoms, induces often so great a susceptibility of the organism to the action of this drug, that subsequent doses, even of tolerably high dilutions, provoke straightway a series of <span grade2>​central</​span>​ symptoms. {{anchor:​s48}}The same is true of Arsenic. {{anchor:​s49}}We have seen a case in which, generic and specific symptoms having once been produced by massive doses of Tartar emetic, the organism remained so sensitive to the action of this substance, that a few globules of the thirtieth dilution would at any time produce vomiting and diarrhea, with cold sweat and prostration. {{anchor:​s50}}It may be said that these are cases of very unusually great susceptibility to the action of the respective drugs. {{anchor:​s51}}This is true, but it is precisely such cases of great susceptibility that are of exceeding value to us, for in them, by judicious experimentation we could get most valuable peripheral symptoms, unalloyed by generic or by revolutionary effects.
  
 {{anchor:​s52}}There is no reason to believe, on the other hand, that small doses, so administered as to produce the peripheral specific symptoms, modify the susceptibility of the prover in any such way as to prevent his obtaining by subsequent larger doses, the central specific, the generic dynamic, or even the chemical and mechanical effects. {{anchor:​s53}}It follows from what has been said that, to obtain an exhaustive proving of a drug, we should begin with small doses, gradually increasing the quantity until unequivocal symptoms appear. {{anchor:​s54}}We shall thus, if we continue our experiments a suitable length of time, obtain peripheral symptoms; and these small doses will not have so influenced the system as to prevent our obtaining by subsequent larger doses the other varieties of effects. {{anchor:​s55}}Inasmuch as, in the nature of things, the peripheral symptoms, representing as they do, a cachexy, cannot be <span grade2>​speedily</​span>​ produced, a considerable space of time should be devoted to our first experiments with small doses. {{anchor:​s56}}Finally,​ after an interval of non-medication,​ larger doses should be taken until we have exhausted the whole dynamic action of the drug, and even obtained a fair picture of its chemical and revolutionary action, although this may in a measure be gained from records of <span grade2>​poisonings.</​span>​ {{anchor:​s52}}There is no reason to believe, on the other hand, that small doses, so administered as to produce the peripheral specific symptoms, modify the susceptibility of the prover in any such way as to prevent his obtaining by subsequent larger doses, the central specific, the generic dynamic, or even the chemical and mechanical effects. {{anchor:​s53}}It follows from what has been said that, to obtain an exhaustive proving of a drug, we should begin with small doses, gradually increasing the quantity until unequivocal symptoms appear. {{anchor:​s54}}We shall thus, if we continue our experiments a suitable length of time, obtain peripheral symptoms; and these small doses will not have so influenced the system as to prevent our obtaining by subsequent larger doses the other varieties of effects. {{anchor:​s55}}Inasmuch as, in the nature of things, the peripheral symptoms, representing as they do, a cachexy, cannot be <span grade2>​speedily</​span>​ produced, a considerable space of time should be devoted to our first experiments with small doses. {{anchor:​s56}}Finally,​ after an interval of non-medication,​ larger doses should be taken until we have exhausted the whole dynamic action of the drug, and even obtained a fair picture of its chemical and revolutionary action, although this may in a measure be gained from records of <span grade2>​poisonings.</​span>​
en/ahr/dunham-c-the-dose-in-drug-proving-158-10436.txt · Last modified: 2014/05/12 11:36 by legatum