Having been honored by the President of the Society with an appointment to report on the Use of High Potencies in Chronic Diseases, I trust it may not be considered an unwarantable presumption if, for the following reasons, I venture to modify to a slight extent the theme assigned to me.
First The subject contemplates a report of a practical nature. But from the stand-point of practice, I think that a clear and well-defined distinction between acute and chronic diseases is not possible. If we attempt to base such a distinction upon the element of time alone, paying regard only to the duration of the disease, it cannot be made at the beginning of the treatment, and cannot therefore be of any practical value in determining the potency to be used.
If we base the distinction upon a pathological conception — that is upon the presumed existence in the patient of some dyscrasia, diathesis or miasm — it is equally impossible, at least in very many instances, to make it at the commencement of an illness.
It is a matter of common remark that cases which begin without any sign of miasmatic or dyscratic complication, often develop in their course unequivocal evidence of such complication, so that a case which would, in the outset, have been regarded as, in this sense, unquestionably acute, proves in its course to be unmistakably chronic.
Second. Furthermore, the subject as stated, involves a kind of petitio principii. To require a report on the “Use of the High Potencies in Chronic Diseases” is in some sort to imply that these potencies are especially useful and appropriate, if at all, in the treatment of chronic diseases as distinguished from acute diseases — an implication which it is true corresponds to a very widely received opinion among those physicians who have but little practical acquaintance with the action of the high potencies, but which, as we shall see, is not supported by the results of experiment.
No question connected with Homoeopathy has given rise to more vigorous controversy or to more earnest partisan feeling than that concerning the infinitesimal dose. The most bitter opposition of the Old School to Hahnemann was based on this question. It has been also the chief ground of division and contention among Homoeopathists themselves.
After an animated disputation covering a period of more than fifty years, there seems now, however, to be a cessation of hostilities between the advocates and opponents of the higher potencies. There seems to be a mutual disposition to suspend the discussion hitherto maintained chiefly on hypothetical grounds and to appeal in good faith to the “ultima ratio” — experiment. The times are favorable, therefore, for a quiet survey of the field and for a dispassionate estimate of the experimental knowledge of which the practical labors of our colleagues have put us in possession.
It is probable that Hahnemann was never what could be called an “heroic prescriber.” In his work on The Venereal Disease, published 1789, before he had discovered the homoeopathic law of cure, he portrays the evil effects of excessive doses of mercurial preparations, and speaks of radically curing some cases of syphilis by the use of a single grain of Mercury sol. in divided doses; and says that eight grains thus administered will often be sufficient to cure “very severe cases of syphilis,” Compared with the practice of his contemporaries, these are almost infinitesimal prescriptions.
In his first essays upon the homoeopathic law, Hahnemann advises the administration of doses but little if any smaller than those he had previously used. We first meet with the recommendation to use infinitesimal doses in the essays on “Scarlet Fever,” published in 1801, but referring to cases treated in 1799. He here advises Belladonna and Chamomilla to be given in preparations which correspond pretty nearly to the third centesimal dilution.
It pleases Dr. Dudgeon to suppose that “this sudden change,” as he calls it, from material to infinitesimal doses, was a matter of expediency and policy rather than of conviction on the part of Hahnemann, inasmuch as it coincided in point of time with the prosecutions of Hahnemann by the apothecaries.
But there is no evidence that the change was so very sudden as to require such an explanation. Even so short a period as one year spent in constant practice might be sufficient to satisfy so acute an observer as Hahnemann, that remedies given according to the homoeopathic law must be given in very small doses.
The whole career of Hahnemann is a consistent protest against the adoption or renunciation of any procedure connected with the practice of medicine, on grounds of mere policy or expediency. Hahnemann's long life was a continual sacrifice of ease and prosperity and highly-prized friendships to his convictions of truth. While therefore, during a period of twenty years he submitted to be driven from city to city rather than renounce the right of dispensing his own medicines, is it at all probable that he devised the method of diluting or potentizing remedies and insisted on the superiority of potentized remedies, simply, or in any degree from motives of expediency?
In subsequent essays Hahnemann advises still more distinctly the administration of potentized remedies, and in the first edition of the Organon, published in 1810, he says, “scarcely any dose of the homoeopathically selected remedy can be so small as not to be stronger than the natural disease and not capable of overcoming it.” About the same period he advises the use of the ninth dilution of Nux vomica and the eighteenth of Arsenic.
In the earlier volumes and editions of the Materia Medica Pura, Hahnemann recommends a particular dose for each remedy. Some remedies are to be given in the first dilution, some in the third, some in the ninth, some in the fifteenth, some in the twenty-fourth, some in the thirtieth.
In the latter years of his life he speaks of using with great success the sixtieth, one hundred and fiftieth and three hundredth dilutions, and it is well known that during these years he did not confine himself to a uniform dose, but used in some cases the lower potencies, and in some the very highest.
It is not unworthy of remark that as Hahnemann's practical experience in the treatment of disease increased, so did his estimate of the advantage and necessity of using higher dilutions, in at least many cases, likewise increase.
The promulgation of the dynamization theory by Hahnemann and his adoption of the practice of giving infinitesimal doses, were the occasion of the most violent denunciation of Homoeopathy by his professional opponents. Indeed, to this day, this really subordinate department of the method, is regarded by Allopaths as the essential feature of Homoeopathy; and to a superficial observer it would seem as if the infinitesimal dose were almost the only obstacle to a blending of Homoeopathy and the so-called Physiological School of Medicine.
The progressive advocacy by Hahnemann of the higher dilutions and, especially, the introduction by Korsakoff of what are technically known as the “high potencies” (the one hundred to fifteen hundredth) gave rise, as has been said, to a lively and bitter and decidedly personal controversy among Homoeopathists.
In every party or school which is still a minority, there are always Conservatives, who regret the necessity which compelled a separation from the party or school of the majority; who strive to make that separation as little decisive and marked as may be; who stoutly oppose any measure which would tend to increase the division or to make it irremediable; and who hail with delight almost any project of compromise or reunion. There are also Radicals, whose turbulent nature revels in the sensation of opposition; whose tendency it is to lay more stress on points of difference than on points of coincidence; who, having once separated from the majority, will not only entertain no thought of a reunion with them, but consider that fidelity to the principle on which their separation was based, requires that the separating chasm should be made continually wider. They seem to glory, not so much in the truth for the sake of which they separated, as in the mere fact of separation.
Among the followers of Hahnemann, the Radicals and the Conservatives were the respective parties to the contest about the potentization theory; and in weighing the arguments which each side brought forward, we must not lose sight of the respective tendencies of these two parties.
The law, Similia similibus curantur, which is the essence of Homoeopathy, was not an absolute novelty in medicine. Indeed, Hahnemann's first argument in favor of it, was drawn from the records of medicine. He showed that, in all ages, many cures had been made in accordance with it. He proved that his contemporaries, often unwittingly and sometimes consciously, applied it in treating the sick. To urge its admission as the universal law of cure, was, therefore, simply to advocate the recognition, as a universal truth, of that which was already received by medical men as, at least, a truth of partial and limited application.
Men of conservative tendencies might very consistently, at this time, become Homoeopathists; for it was not unreasonable to anticipate, at some period in the not distant future, a universal recognition of the homoeopathic law of cure and a consequent reunion with the dominant power.
But the dynamization theory was in irreconcilable opposition to all the notions of Hahnemann's opponents. It taught that doses inconceivably small were sufficient to effect radical cures in acute and dangerous diseases — that such doses were even more efficacious than larger ones. It taught that instead of the curative power of the drug being directly in proportion to its material quantity, there was reason for believing that, to some extent, at least, the converse was true.
There could be no such thing as a compromise on this question. Truth lay either with Hahnemann or with his opponents. It could not lie between them. To maintain this dynamization theory would be to make the separation between homoeopathists and the dominant school of medicine perpetual and irremediable.
It is easy to perceive what sort of a reception was likely to be accorded to the dynamization theory by the Conservative Homoeopathists. They could not regard it without unfavorable prepossessions. If compelled at last to admit its soundness, this would not be until irresistible testimony in its favor had been amassed — nor even then without regret for the fact and deprecation of the obstacles which it created in the way of a reunion with the old school. All their a priori assumptions would be unfavorable to its validity.
The Radicals, on the other hand, would receive with joy this additional element of difference from the old school of medicine. They would advocate it with enthusiasm. Their a priori arguments would lend it a vigorous support.
Thus in relation to a question that can be settled by experiment alone, and by a course of experiment requiring careful unprejudiced observation through many successive years, we have all the conditions requisite for an ardent controversy at the very outset, before any valid evidence could possibly have been gathered by either party.
We shall be less surprised at the vigorous opposition to the dynamization theory, if we recollect the condition of medicine and pharmacy at the beginning of the present century. The posology of that period was decidedly heroic. Drugs were given in the crudest forms. Pharmaceutical chemistry had not yet discovered the essential principles of drugs, the use of which at the present day has made doses of the one-fourth, one-eighth, or one-twentieth of a grain familiar even to practitioners of the old school. The microscope was still a rude and primitive instrument; quantitative chemical analysis had not attained any great development; much less was there any thought of applying, as is now done, the reactive susceptibility of the living organism to detect, through its specific affinities, particles of matter so small as to elude the microscopist and the chemist. In fact the doctrine of the extreme divisibility of matter rested, at that time, rather on the speculations of the metaphysician than on the demonstrations of the naturalist.
For this very reason, on the other hand, the speculations of the metaphysician had at that period the wider scope and the greater authority. And thus it was very easy for some of Hahnemann's more radical followers to erect on a figurative illustration used by him in the Organon a “ cloud-capped” theory of the transplantation of the medicinal force from the substance of the drug to the substance of the vehicle used for dilution, and upon the basis of this airy hypothesis to explain all manner of supposed action and reaction of drug spirit upon diseased force, etc., etc.
These considerations will, I think, justify us in passing over with scarcely a word of comment all that was so copiously written on the subject of the dose, from the date of Korsakoff's first publication to the date of Dr. Trinks' public letter to Dr. Stens in 1851.
2. The process of potentization which Hahnemann invented, develops a curative power in substances, which in the crude form, manifest no such power; and it increases the curative power of drugs which in the crude form do manifest a curative power.
Now, although these principles had been satisfactorily established, one would think, by the successful use of the third or sixth potencies, long before the controversy about the “high potencies” began, yet it will be perceived that almost all of the objectors who began to write after Korsakoff's publication and Hahnemann's cautious and conditional approval of it, derive their arguments from considerations of the probable quantity of the drugs which these high potencies might contain. Thus we are cautioned, even by those who admit that higher potencies have curative powers, that they are not to be trusted in acute diseases which have a rapid course, because, as Dr. Scott expresses it, “in these diseases the vital forces act with exaggerated energy and to act upon them, we require a greater amount of medicinal power, that is, a lower dilution” This statement, it will be perceived, regards the curative power as directly proportioned to the quantity of the drug, and begs the whole question at issue.
But when Hahnemann had shown that a more efficient curative power was exerted by the first dilution, or trituration, or even by drop doses of the mother tincture of drugs than by massive doses, as he had done to the satisfaction of all Homoeopathists, long before the higher dilutions were ever made, he had demonstrated that the curative power of drugs is not in the proportion of their material quantity, and had thus established the first principle of the dynamization theory.
When, furthermore, he showed to the satisfaction of all Homoeopathists, that substances which in their crude state exert no medicinal power, such as gold, charcoal, tin, common salt, etc., etc.. do, after dilution, trituration or potentization, come to possess a medicinal power, he demonstrated, in part, the second principle of the dynamization theory.
1. The curative power of a drug not being directly proportioned to the quantity of the drug, what relation does exist between this power and quantity What effect does a continued diminution of quantity exert upon the curative power of the drug?
2. It being admitted that the potentization process does develop the curative power, what are the limits of this development? What varieties in the nature and extent of this developed power, are produced by various degrees of potentization?
While the controversy on hypothetical grounds was being carried on by the Conservative and Radical Homoeopathists, reports of cases' were accumulating in the homoeopathic journals, which furnished indisputable testimony to the action of the higher potencies. Among those who published these records, the names of Gross, Stapf, Hering, von Boenninghausen, Aegidi and Nunez are conspicuous.
Their testimony was disputed on various grounds. Against some cases it was urged that they were inconclusive, since it was not clearly shown that the cure resulted from the remedy given and not rather from some hygienic prescription or restriction resorted to at the same time. Such criticism is legitimate, and cases to which it is fairly applicable must be excluded.
Against other cases it was urged that the data were not so fully recorded as to enable the reader to make sure of the diagnosis. I do not think such criticism as this is admissible, unless in a very few cases.
The value and authority of clinical records always depends on the reputation of the reporter for knowledge, accuracy and integrity. Now, whether, in reporting a case of alleged pneumonia, the reporter simply state that it was a case of pneumonia, presenting such or such characteristic symptoms, or whether he present a minute and elaborate detail of all the rational and physical signs of the patient, obtaining by the aid of auscultation, percussion, mensuration and chemical and microscopical analysis — in either case, we have nothing to depend upon but the scientific capacity and the integrity of the observer.
If he have these qualities in a sufficient degree to obtain with certainty the requisite physical and rational signs on which to base a trustworthy diagnosis of pneumonia, his statement of this diagnosis will be sufficient without the details. If he have them not, no details which he might pretend to give, would be deserving of the slightest confidence. These considerations annihilate the objection made by Dr. Watzke to cases published by Gross and Boenninghausen in the Archiv.
While cases demonstrating the value and efficacy of the high potencies were accumulating, a few cases were also published in which, the higher potencies having been used without effect, a lower potency or a crude dose of the same drug effected a cure. Dr. Black relates that in a case of headache Lachesis30 only produced symptoms of nervous disturbance, while Lach.6 effected a cure. Dr. Trinks records a case which had been treated by Hahnemann for nearly two years with Rhus in a higher dilution without effect, and which he himself cured within a few months by repeated doses of the mother tincture of Rhus.
The angry controversy was brought to a temporary close by Dr. Trinks' public letter to Dr. Stens,*[Published in 1859. The date was erroneously given above as 1851.] in which he states: “I was born a sceptic. As to the wonder-cures (cures by the high potencies) published in the journals, I can only say, I do not believe a word of them.” “Non credo quia impossible its,” seems to be the creed of Dr. Trinks — the impossibility consisting in a mere assumption, on his part, that such “preparations cannot possess any power. This same argument “non credo” — may, with equal force, be urged by the Allopathists against the first or third dilutions, which Dr. Trinks is in in the habit of using.
The argument proves too much. If Dr. Trinks may dismiss with “I don't believe it,” the testimony of those who advocate the high potencies, on the same grounds may these reject his accounts above referred to, of the cases in which he alleges that the lower potencies were efficacious where the higher had failed.
But the opponents of the high potencies were not content with seeking to invalidate the testimony of the advocates of these preparations. Some of them presented records of cases in which they had made unsuccessful trials of the high potencies. Of these, many were no doubt made in good faith, and must be accepted as evidence that there are cases in which the high potencies fail to cure. But the majority of these records are like those of Dr. Watzke, referred to by him, in the OEst. Zeitschrift, Vol. II, where he says, the patients on whom he tried the high potencies suffered for most part from diseases in which there was little reason to expect a favorable result from any remedy, in whatever dose, for, he says, they were cases of “dissolving. pulmonary cerebral tubercle, or fungoid tumor of the brain, of pulmonary and apoplexy, of spinal paralysis, of chronic hydrocephalus, valvular insufficiency of the heart, of fibrous tumor of the uterus, etc., etc.
Yet, no doubt, Dr. Watzke is one of those who would exclaim against the unfairness of Andral in pretending to test Homoeopathy in the Paris hospital, by giving a single dose of a homoeopathic remedy to a patient laboring under incurable disease!
Dr. Watzke, himself, though so bitterly opposed to the advocates of high potencies is constrained to state in the resume of the proving of Natrum muriaticum, in the fourth volume of the Austrian Journal, “I am, alas! I say, alas! for I would much rather have upheld the larger doses which accord with current views — I am compelled to declare myself for the higher dilutions. The physiological experiments made with Natrum muriaticum, as well as the great majority of the clinical results obtained therewith speak decisively and distinctly for these preparations.” This is strong language from an avowedly unwilling witness!
The conclusion to which an impartial estimate of the evidence concerning the high potencies, up to the year 1850, would lead, is well and justly expressed by a writer in the British Journal of Homoeopathy, Vol. V., p. 154:
During the last twelve years, a large mass of evidence of a most interesting and conclusive character has been accumulated on this subject. Of so much of this as was furnished by European observers, I proceed now to give a brief summary. Inasmuch as the question has been the subject of somewhat earnest personal controversy among ourselves and “scars may yet be tender,” I prefer to pass by, for the present, with a few trifling exceptions, all that has been contributed by American practitioners. I shall pass over also all endeavors that have been made to explain or to limit by hypothetical reasoning on physiological premises, the action of the high potencies. The question is purely a practical and experimental one.
It has been alleged that, admitting that an apparent development of curative power does result from the potentizing process in the case of some drugs at least, such as Silex, Gold, Natrum mur., etc., this is simply because this process renders soluble these substances which, in the crude state, are insoluble, or that it reduces the size of their particles to such an extent that these particles are capable of entering the smallest blood-vessels, and of thus coming into contact with the diseased tissue and of acting directly upon it. This curative power which is pretended to be developed by potentization is, they say, simply a facility of action produced by minute subdivision.
Hypothetical explanation does not alter facts. If, however, the above were the sole explanation of the action of potentized remedies, then it should result that the highest development of the curative power should be reached in that dilution, in which the particles have been reduced to a size appreciably less than that of a blood corpuscle. And, indeed, this ground has been taken by some writers. Now, arithemetical calculation as well as microscopic observation fix upon the third centesimal dilution, as that in which the above degree of subdivision has unquestionably been attained. If this view were correct, then, dilutions higher than the third should not display a curative power; or if they do display each power, it should not be in any case superior to that of the third dilution.
Now if it should chance to result from actual, incontrovertible experiment, that potencies higher than the third do display, with rare exceptions, a greater curative power than the third or lower potencies, this superiority must be directly attributable to the process of potentization.
I deem it right, therefore, to call all those potencies above the grade of that of which the action admits a mechanical explanation — “the higher potencies.“The term will apply, in this view, to all above the third centesimal.
In 1850 Drs. Wurmb and Caspar took charge of the Leopoldstadt Hospital, in Vienna. Their views on the subject of the dose were no Secret. They had no faith whatever in the higher potencies. They were physicians of much more than ordinary scientific attainments, and of great devotion; and Dr. Wurmb at least had few superiors in an exact and thorough knowledge of Materia Medica. In their “Clinical Studies,” published in 1852, they thus express the posological views with which they entered on the charge of the hospital:
We have given almost always the thirtieth decimal dilution, and only exceptionally a higher or a lower dilution. * * We propose to adhere to this dilution for two years longer, then to give another dilution for an equally long period, and finally to give for a similar period still another dilution. Such experiments as these are indispensable to the solution of the question of the dose, but manifestly they are valid only in the case of disease with regard to what the preliminary question What can Nature can do and what can Art? has already been definitely answered, and in favor of the latter?”
Here is the plan of an experiment which, if faithfully carried out, gives promise of some very conclusive data on the subject of the dose. Such questions as this require for their solution a multitude of instances such as can hardly be gathered in a private practice. But a hospital affords an appropriate and sufficient field for their collection. The hospital of Dr. Wurmb is the only one which has been devoted to such uses.
Before the expiration of the three periods, of three years -each, involved in the plan as above stated, Dr. Caspar was succeeded by Dr. Martin Eidherr, who has published in OEsterreichische Zeitschrift, for 1862, the result of the ten years' experiment.
It seems that in 1860 the Austrian Homoeopathic Society of Vienna proposed as a subject for consideration the question of the dose, inviting all Homoeopathists of all countries to take part in the discussion. A large number of responses, both verbal and written, were made to this invitation, some of which are published in the Austrian Journal, for 1862. Dr. Eidherr, the Editor of the Journal, remarks: “These discussions have, as is well known, led as yet to no positive result, because they rest exclusively on subjective grounds. While some record most brilliant cures effected only by the higher dilutions, others narrate similar cases cured only with the lower. Consequently, the society regards the question. as still an open one, and calls for further communications on the subject.”
At this point it was suggested that the material in the shape of clinical records which had been for ten years accumulating in the archives of the Leopoldstadt Hospital might, if collated, throw some further light on the subject.
Dr. Eidherr undertook the task. He resolved to confine his investigations to a single disease, pneumonia, which by the way is very prevalent in Vienna, for the reason that the diagnosis of this disease is easy, and that, by means of the physical signs, its course and progress and decline may be more accurately followed and observed than is the case with, many other acute diseases.
During the ten years, from 1850 to 1859 inclusive, all cases in the Leopoldstadt hospital had been treated for the first three years with the thirtieth decimal dilution, for the second period of three years with the sixth, and for the remaining four years with the fifteenth decimal dilution. It was proposed to compare the results of the treatment of pneumonia during these three periods.
But, in order to avoid a fallacy in drawing conclusions from this, comparison, it was necessary, first, to enquire whether the Genius Epidemicus was the same for these three periods, or, if not the same, how great an influence, and in favor of which period, did the difference exert?
To meet this preliminary question, Dr. Eidherr made a study, first, of those conditions which favor the origin and spread of pneumonia; and, second, of the prevalence and course of pneumonia in the great General Hospital of Vienna. during the same periods of time.
The first section of his treatise consists of tabular statements of the meteorological phenomena of the decennium in question, and of the relations of these phenomena to the prevalence of pneumonia as observed in the great General Hospital of Vienna.
The second section comprises short and succinct accounts of the cases of pneumonia treated in the Leopoldstad Hospital during the three periods into which, as already stated, the decennium was divided.
The third section contains a statement of the results of the treatment by the different dilutions used during the three. periods in question, taking into account the modifying influence of the different atmospheric conditions of these periods.
A careful estimate of the different meteorological conditions of these epochs, leads Dr. Eidherr to the conclusion that during the first epoch the atmospheric conditions were most favorable to the prevalence and severity of pneumonia, and therefore the least favorable for the treatment; during the second epoch least favorable for the spread and severity of pneumonia, and therefore the most favorable for the treatment.
Dr. Eidherr gives also a tabular statement of the average number of days during which each case of each group remained in hospital — that is the total duration of each case from its reception to its dismissal, as follows:
I now proceed to give as briefly as possible the conclusion to which Dr. Eidherr is led by this careful study of his statistics. Ho says, “this is the most extensive experiment that has ever been made, bearing on the question of the dose. Its subjects were 107 cases of pneumonia. Each case was the subject of careful investigation. Every imaginable care was taken to obviate every source of fallacy.” The experimenters were not radical Homoeopathists. Their prepossessions were rather against the high potencies. I can bear personal testimony to the fact that, in 1851, while the thirtieth dilution was the standard used in the hospital Dr. Wurmb frequently expressed himself, as believing that statistics would decide in favor of lower dilutions. It was not known how statistics had decided until Dr. Eidherr made the analysis from which I have quoted, and which shows that in every point of view the action of the thirtieth dilution, in so acute and dangerous a disease as pneumonia, is more certain and more rapid than that of the fifteenth or the sixth dilution, and that the fifteenth is preferable to the sixth dilution — or, to translate the decimal into the centesimal scale, the fifteenth is better than the seventh, the seventh than the third.
If we refer now to the points which were stated in 1850 as still requiring to be proved in relation to the high potencies, we find the third question satisfactorily solved by this experiment in the Leopoldstadt hospital. For the experiment proves beyond a doubt that the higher potencies are applicable and trustworthy in acute as well as in chronic diseases.
Let us now recapitulate the points at issue. I think we may safely state that, up to the present time, experience has established these facts: that the continued diminution of the material quantity of a drug through the process of potentization does not diminish the curative power of the drug when homoeopathically applied; that, on the contrary, the process of potentization does positively increase the curative power of a drug when homoeopathically used; that this increase of curative power is progressive, as far at least as the fifteenth centesimal dilution, and is demonstrated in the treatment of both acute and chronic diseases.
It was incumbent on the advocates of the higher potencies to demonstrate not only that these preparations are efficacious, nor simply that they are equally efficacious with the lower potencies, but that they are superior in efficacy.
This has been shown by the Vienna experiment up to a certain degree. The seventh centesimal has been shown to be superior in the treatment of pneumonia to the third, and the fifteenth to the seventh. There is a natural desire to find the limit of potentization. The Vienna experiment gives us no reason to suppose that this limit has been attained in the fifteenth potency.
Many most eminent practitioners assert for what are technically termed the “high potencies,” as great a superiority over the fifteenth and thirtieth as the latter have been shown to possess over the third. Cases are accumulating in our journals which go to corroborate these assertions. We can not refuse to believe these narrations. While they have not yet established a general superiority of the “high potencies” (sixtieth to two hundredth) over the fifteenth and thirtieth for the treatment of all cases, acute and chronic, they nevertheless prove beyond dispute that the rapid and permanent cure of both acute and chronic diseases is within their scope.
Among those who have long used the high potencies (in particular the two hundredth), Dr. von Boenninghausen stands pre-eminent. It is true that his practice lies chiefly among chronic diseases. Nevertheless many acute diseases are treated solely in accordance with his directions. He has for many years used exclusively the two hundredth potencies. His increasing fame and practice attest the validity of the services which he renders to those who consult him. The high character which he has always borne as an acute and sagacious observer of natural phenomena, the unblemished reputation which he has sustained throughout his long and eventful life, cause his observations and his statements to be received with implicit reliance and belief by all who are at all cognizant of his social position. He does not hesitate to express a decided conviction of the great superiority of the high potencies over the lower, in both acute and chronic diseases. Dr. Aegidi who, after having, on their first introduction, spoken favorably of the high potencies, retracted to some extent this good opinion, has recently announced as the result of a long course of experiment in his private practice, embracing the history of more than 4,000 cases, a clear and unequivocal preference for the high potencies in both acute and chronic diseases.
Dr. Aegidi who, after having, on their first introduction, spoken favorably of the high potencies, retracted to some extent this good opinion, has recently announced as the result of a long course of experiment in his private practice embracing the history of more than 4,000 cases, a clear and unequivocal preference for the high potencies in both acute and chronic diseases.
Dr. Battman has, within the last two years, published a series of cases of severe membranous croup, and of very dangerous acute pulmonary affections, cured in a marvelous manner with the two hundredth potency; and, basing himself on these narrations, he makes a warm protest against the irrational conduct of those Homoeopathists who, at the same time that they object to the illogical conduct of the Allopathists in refusing even to listen to any evidence in favor of Homoeopathy, obstinately close their own ears to all that is alleged in behalf of the high potencies.
Of six physicians of Austria and Hungary who presented written essays on the question of the dose to the Vienna society, none denied the curative action, often prompt and surprising, of the high potencies (one hundredth to the three hundredth) in both acute and chronic diseases. Only one expressed a doubt that they were in any case superior to the lower potencies. Two did not hesitate to claim such superiority for them in decided terms.
Dr. Wurmb, the head of the Leopoldstadt Hospital, states (OEst., Zeit., I. 158, 1862) that often remedies in the higher dilutions act, where the lower dilutions of the same remedy had failed to act. He gives an instance in which Bellad.100 effected a cure in chronic migraine, in which a lower potency of the same remedy had failed to do any good. The one hundredth and two hundredth potencies are now not infrequently administered in the Leopoldstadt Hospital. Dr. Wurmb remarks (loc. cit. 3, p 137) that “since he has had experience with the one hundredth dilution prepared by Dr. Eidherr and has satisfied himself of the wonderful effects which often result from them, he prescribes them in suitable cases with greater preference than the thirtieth or any other potency.” He does not state what he considers to be suitable cases.” It is probable that he does not consider his experience to be great enough, as yet, to justify him in laying down any general rules on the subject. It is likely that he decides for each particular case according to his view of probabilities, and that he cannot always give a clear reason for his preference of one potency over another. Each case, thus treated, may be regarded as in some sort an experiment contribution to that multitude of instances from an analysis of which we may hope to deduce, at some future time, a general law of posology.
If, after this general view of the evidence on the subject of the high potencies, it be appropriate for me, on such an occasion as the present, to state my own experience and methods, it may be done very briefly. Before I had fairly entered to any great extent upon the responsibilities of the practice of medicine, I had the advantage of observing the practice of some very eminent physicians and of listening to the counsel of others.
Not to mention American physicians, I heard in England chiefly the advocates of the low and the lowest potencies. The high potencies were at that time rarely mentioned in England except in terms of ridicule. And the contempt which the assumed non-material nature of these potencies inspired in the matter-of-fact mind of that taurine nationality whose devotion to the pound avoirdupois is even greater, if that were possible, than to, the pound sterling, was cordially extended to the intellectual acuteness and the scientific acquirements of all who believed in these potencies and who used them. Since that period the cause of the high potencies has been nobly advocated in England, by a few of those strong men, who are the true glory of the nation.
Passing from England to Westphalia, I enjoyed free and full and long continued opportunities to observe, the practice of Dr. von Boenninghausen who used the two hundredth potency exclusively. There was, certainly, in his practice, less parade of scientific auxiliaries than I had seen at the English hospitals or in the English dispensaries; but I do not think the diagnosis was less accurate on that account. I am very sure that the success of the treatment left but little to be desired. Though some acute diseases were here treated with high potencies under my observation, yet the majority were chronic cases, and, deeply impressed with the great responsibility involved in my judgments, I was hardly ready, from these observations, to conclude on the advantage of using high potencies in a general practice. Nevertheless, the effect of these observations was such as to satisfy me of the efficacy of the higher potencies in all forms of diseases. The question remained, “Are they superior to the lower?” Stapf, who was then living in retirement, counselled me to use the high potencies in chronic diseases, and thought the medium were all that could be desired in acute diseases. He had no statistics of comparative observations by which to justify his opinions.
In Vienna, Wurmb and Caspar were in the middle of the first epoch of the decennium of which Eidherr has given us the analysis. They were treating all diseases with the thirtieth decimal dilution. Their examinations of patients were minute and masterly, their prescriptions careful, their success very striking.
Fleischmann, at the same time, was giving the mother tincture or the lowest dilutions. His diagnosis was careless, his success neither rapid nor, except as compared with heroic allopathic treatment, very striking. His prescriptions were not accurate. He did not individualize his cases, but prescribed according to a coarse and rude generalization. On the subject of the potency his opinions, I learned from himself, were immovably made up. I perceived that he had ceased to be capable of learning, although he still lived; that, in knowledge, as in stature he had attained his growth; ossification was complete in his perceptive intellect no less than in his physical skeleton.
In Paris, Tessier was treating acute diseases in the hospital Ste. Marguerite with the sixth, twelfth and fifteenth dilutions. His success exceeded that of Fleischmann. It was inferior to that of Wurmb, but it was easy to perceive how inferior he was to that excellent physician in minute and comparative knowledge of the Materia Medica.
In Paris, Dr. Perry was prescribing at his dispensary the two hundredth potency, with but few exceptions, in all forms of disease. The reports indicated a very wonderful success, but, from the nature of a dispensary practice, this could not be made the subject of exact observation.
My conclusions from all these observations were favorable to the high potencies, so far as to admit their energetic action on acute as well as chronic diseases and their general superiority in the treatment of the latter; but I was not satisfied that they were so trustworthy, as a general rule, in the treatment of acute diseases as to be preferable to the lower potencies. I therefore began, in my own practice, with the use of the lower and medium dilutions (third to twelfth and fifteenth) in acute diseases. When very sure that my selection of the remedy was entirely correct and that the case would not suffer should my first prescription prove inert, I ventured, during the first few years of my practice, to give a high potency in acute diseases. I now look back on this period with wonder that the idea of a definite and direct relation between the curative power and the material quantity of a drug should have been so hard to eradicate from my mind.
Experience of the action of the higher potencies, on my own person, in very acute illness, first fully convinced me perhaps, because, in my own case I took the risk of trying the experiment more freely and fully than I had ever done in the case of others.
For the last five years I have used the high potencies (two hundredth), of ray own manufacture and of Lehrmann's, indiscriminately) in all forms of disease, that occur in a general practice. I am very sure that my practice has grown more successful ever year. While I trust that an increasing knowledge of the Materia Medica may have contributed greatly to this result, I cannot be mistaken in the belief that much is also due to my more and more frequent use of the high potencies.
I cannot say that every prescription has done everything I expected or hoped from it. Nobody's practice can be free from painful failures. In such cases, wherever I have been tolerably sure that my choice of remedy was correct, I have repeated the same remedy in a higher or lower potency as the case might be, and while I have collected from my practice many instances in which a high potency has acted promptly where a low had failed to act, I have noted only one case in which a high potency acted but inefficiently while a lower gave prompt and complete relief.
A gentleman who had suffered many years from necrosis of the femur was subject to acute attacks of periostitis. The twelfth potency of Asafetida was found to relieve his suffering, and repeated doses of it generally effected a cure within three or four days. After treating several attacks in this way, I gave him, at the commencement of a fresh attack, a dose of Asafetida200. The cure was effected in the space of six hours. A difference so remarkable was very obvious to the patient who, learning from me the difference between this and my former prescriptions, requested to be treated always thereafter with the two hundredth. Here, whatever cavils may be raised about the diagnosis or other points, the fact remains incontestible, that attacks which required for their cure several days and repeated doses of Asafetida12, were cured in six hours by a single dose of the two hundredth. Could it be that repeated treatment of these attacks had modified their severity and that the amelioration chanced to coincide, in point of time, with the change of potency? To satisfy myself on this point, I once reversed the experiment and without my patient's knowledge, gave the twelfth instead of the two hundredth potency. The attack came on with its ancient severity and persistence much to my patient's disgust, who was abundantly satisfied with the high potency but much ashamed of my want of confidence.
Even after I had become quite satisfied of the superiority of high potencies in most acute diseases, I yet hesitated to employ them in a malady so fearful and so rapid as croup. In this I still adhered to the low (the third) dilutions of Aconite, or Spongia, or Hepar, as the case might require or to the watery (first centesimal) dilution of Bromium or Iodine, if these remedies were indicated. Notwithstanding I had actually witnessed most surprising success in Dr. von Boenninghausen's practice with the two hundredth potencies in severe croup, I hesitated to use them. I argued to myself, “these low. potencies have served me well. The majority use them. I do not know that the high are better, even if they be as good. The success with them may be exceptional. I dare not risk the loss of time which would accrue from an unsuccessful experiment with them.”
Thus it turned out that I never used the high potencies until, three years ago, in the most severe case of membranous croup I ever saw, the low potencies in which I had always trusted, failed me utterly and I knew not what else to do. A resort to the use of the two hundredth potencies of Aconite, Hepar sulph. and Spongia saved my patient from this extremity of danger and satisfied me that a trial of the high potencies in the outset of an attack of croup, instead of involving a risk of wasting time, does in truth obviate such a risk from the employment of the lower potencies. From this time on, in the treatment of croup, I have uniformly begun with the two hundredth potency of whatever remedy was indicated. My success has been more uniform and much more rapidly attained than ever before.
My first use of a high potency of Bromine was accidental. Called to prescribe for a severe case of croup, in which that remedy was indicated, I found that the crude substance or a low dilution was not to be obtained. I had the two hundredth potency in my pocket case. I gave it with a result equally happy, and much more speedy than I had ever before witnessed. This was altogether contrary to my preconceived notions concerning Bromine, and it summarily upset a very pretty chemical theory I had formed.
As already remarked, I have sometimes met with facts of a contrary significance. In a case of chronic asthma, of great severity, I have recently found Glonoine of the greatest service. I first prescribed the sixth potency, having no other at hand. When the action of this dose was exhausted, I gave the two hundredth. The result was by no means satisfactory. The sixth again produced happy effects as before. Repeated experiments of this kind convinced me that in this instance the high potency did not act so favorably or so efficiently as the low. Whether this peculiarity should be accounted, for by assuming an idiosyncrasy on the part of the patient, or a peculiarity of Glonoine which renders it incapable of high potentization, or whether the* action of the Glonoine in this case will prove to have been only palliative and therefore temporary, is a question which can only be solved by a wider experience than I possess in the use of various potencies of this new but valuable remedy.*[The subsequent history of this case confirms the suspicion that the great relief afforded by Glonoine was palliative. After a few months the disease recurred with its original severity and no form of Glonoine (nor of any other remedy that I tried) availed to give relief.]
2. That, in both acute and chronic diseases, the preference, other things being equal, is to be given to the higher over the lower potencies. The experience of Wurmb shows that, in severe pneumonia, the fifteenth is to be preferred to the seventh and the seventh to the third (centesimal). I should go further and say that, in general, preference should be given to still higher potencies, even to the two hundredth.
3. Experience shows that, while the majority of cases both acute and chronic are cured more speedily by the high than by the lower potencies, yet, in some cases, the converse is observed. No explanation of this difference has been discovered, nor can its occurrence be foreseen in any case. While therefore the presumption, in every case, being in favor of the high potencies, the treatment should be begun with them, nevertheless, should no favorable result ensue, recourse should be then had to lower potencies, provided always there be a reasonable certainty that the remedy has been rightly selected.
|Source:||The American Homoeopathic Review Vol. 04 No. 05-07, 1863, pages 198-204, pages 251-263, pages 297-306|
|Description:||The Use of High Potencies in The Treatment of The Sick.|
|Editing:||errors only; interlinks; formatting|