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OBSERVATIONS ON DOSE.

BY W. P. ARMSTRONG, M.D.

1. In selecting a medicine for the cure of any disease or condition, I am now and ever have been guided by our well known law of similars; and not only do I find it the safe and true guide as concerns the cure of disease, but the similar remedy is in nearly all instances also the best palliative.

2. Whether in consequence of its homoeopathic relation or not, we find that a massive dose of the homeopathic remedy is likely to produce not only unpleasant, but often dangerous or even fatal results, thus retarding, if not altogether preventing a cure, and for this reason, if for no other, it is my habit to use an attenuated remedy; but a still more potent reason than this, is the fact that we find the attenuations to be possessed of greater curative powers than the crude drug. Yet there are exceptions to this rule, the most notable of which is the use of quinine and the other alkaloids of cinchona in intermittents. In my own practice, as well as in that of many others, when this drug is homœopathically indicated, it has been found by long experience in malarial districts, to act better in the crude form, this being, with the single exception of the matter of pleasantness, in every way more satisfactory, as the paroxysms are interrupted sooner, and are no more likely to return than after being stopped by a highly attenuated remedy. Do not, however, let me be understood as advocating its use in all cases of intermittents, but only in those cases in which it is homœopathically indicated by the totality of the symptoms. This it certainly has been in the majority of cases occurring in my practice.

Caulophyllum, a few drops of the mother tincture in water, barely sufficient to give it a slight taste, has many times, in my hands, prevented a miscarriage after the pains had set in. I give a teaspoonful of this mixture every ten minutes to every hour

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or two, according to the urgency of the case, but if it is too weak, or the patient receives too little of it, it produces no effect, as I have observed on two or three occasions.

Ustilago, in the same dose, has done me excellent service in the treatment of menorrhagia, to which it holds the homoeopathic relation.

Aconite, either in the tincture or first decimal dilution, a few drops in a wine glass full of water, of which a teaspoonful is given every hour, when homoeopathically indicated, will cut short the most violent cases of acute rheumatism in a very few days at most, while very often one day suffices to moderate the symptoms in a great degree. Such results can also occasionally be obtained by the medium and higher attenuations of the same medicine, but my experience teaches me that they are not to be expected as a rule.

In the first stage of pneumonia and capillary bronchitis, also, the first decimal attenuation has left little to be desired, but when I have given it in the medium and higher attenuations under the same conditions, I have generally had occasion to regret it. Yet in one epidemic of whooping cough cases complicated by pneumonia were of very frequent occurrence, and required and received with the best of effect, the thirtieth attenuation of Aconite. The tincture and the first and third dilutions were tried, but seemed to be totally devoid of all curative power. I have never been able to ascertain why the thirtieth should have been required in this epidemic, and the first in other and similar cases.

In view of the fact, then, that each attenuation has its own particular place to fill, varying, of course, with the different medicines, temperaments and conditions, it would be difficult if not impossible to say in general terms what attenuation is most efficient, although to say that one attenuation is more frequently useful than another, might be an easy matter.

3. As to the influence which age and sex should exert over the choice of the attenuation, I would say that in my own hands, the higher the attenuations have generally acted better on infants, the aged and the female sex, while the lower attenuations have acted better on persons between these periods of life, and on the male sex. Just how much the more highly sensitive, nervous or

ganizations of infants and females have had to do with it, I do not know, but certain it is that there are many exceptions to the rule.

Case 1.

A butcher, aged 48, weighing 240 pounds, and noted for the amount of whiskey he could drink without becoming intoxicated, had at a certain period every year an attack of supra-orbital neuralgia of the right side, lasting for two or three weeks, and continuing day and night, but worse in the forenoon and on rising up; the eye felt as if too large for the orbit; ocular conjunctiva considerably reddened. The present attack had been on for two days, and was producing intense agony, when he came to me and received a few powders of Spigelia 200th (Dunham) to be taken every hour. hour. A few hours only sufficed to relieve him, and the pain never returned while I knew him, which was for a period of several years afterwards.

Years ago was formulated the maxim that the lower attenuations should be used in acute affections, and the higher in the chronic, and in a measure, time has verified its correctness; but while true in the main, this also has its exceptions. Of these, the efficiency of Aconite 30th, in those cases of whooping cough complicated by pneumonia, already mentioned, was one.

The chief sphere of Chamomilla is in the treatment of acute and sub-acute affections, yet in my hands, at least, this remedy acts far better in the 200th, than in any lower attenuation, as it is not only more prompt, but more certain and permanent in its actions.

Case 2.

In the summer of 1869, my own child had had colic some portion of almost every day for two or three weeks. The attacks were generally worse in the evening, and would sometimes last for several hours. The chief characteristic was that she must be constantly carried. Every remedy that seemed in the least indicated, had been already given, and among the rest, Chamomilla, the mother tincture in water, and the 3d, 6th and 30th attenuations, but without the least apparent effect, until at last my wife, having, perhaps, more faith in the high attenuations than I pos

sessed, gave the child in the midst of one its attacks a dose of the 200th of the last named medicine, in a very few minutes after which, it was entirely relieved. It had only two or three attacks afterwards, and they were as quickly relieved in the same way.

Case 3.

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J. O., aged 10 months, daughter of a tuberculous mother; for four days has had enterocolitis, and has the appearance of being very sick. Three or four medicines have already been given, one after another, but without relief. There is a good deal of fever with thirst, stools green and frothy, mostly mucus, of unpleasant odor; every way worse in the evening; quite fretful, does not want to be looked at, must be carried. Chamomilla a single dose in the afternoon, with another next morning if not better; Sac. lac. every two hours, or every stool when more frequent than that. Ordered not to awaken her. She only had one more stool that day, slept well all night, and next day when I visited her, was playing on the floor. She had no more diarrhoea and was soon entirely well.

On several occasions I have removed in forty-eight hours the last vestige of facial erysipelas to which Apis was homœopathic, by means of the thirtieth attenuation of that remedy, a dose every hour.

On the other hand, Digitalis is much more frequently useful in sub-acute and chronic diseases than in the acute, yet no matter whether in chronic or acute disease, it in most instances acts better when given as low as the first decimal attenuation, or even in the crude form, several drops at a dose. I have also, in many cases, found the second decimal attenuation of Digitaline to be equally useful.

A prominent physician has suggested that the lower attenuations should be used when primarily homeopathic, and the higher when secondarily homoeopathic. This to me seems also to be true in the main, yet here, too, there are exceptions.

The homoeopathic relation of Coffea to sleeplessness is certainly primary, yet it acts better when given as high as the thirtieth than when given lower.

Chamomilla is certainly primarily homœopathic to the peculiar irritable mood so characteristic of it, yet it also acts better high than low.

The homeopathic relation of Rhus tox. to certain skin eruptions is primary, yet sometimes the high attenuations and some. times the low act best.

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4. In the treatment of chronic diseases, I usually repeat the dose from once or twice a day to every three hours, according to the urgency of the case, but always as far from meals as possible. Only exceptionally do I give a single dose and await the result. I have obtained good results in both ways, and have never yet seen that the continuation of a remedy after it had begun to produce an improvement in the symptoms, defeated the object to be attained, as long as proper limits were observed. When, however, the health line has been reached, as regards the symptoms for which the remedy has been administered, or the symptoms have so changed that it is no longer homoeopathic, it should certainly be discontinued. The continued action of a remedy after it has removed the symptoms which indicated it, tends to reproduce those symptoms.

5. In nearly all cases of acute disease, I repeat the dose every hour to three hours, according to the severity of the case in hand. Pneumonia, diphtheria and scarlatina are not exceptions to this rule. In treating rapidly recurring convulsions, or very severe neuralgic pain, I sometimes give a dose every ten to thirty minutes, until the patient is somewhat relieved, then less frequently. Yet, even in these cases I have sometimes given a single dose, which was followed by a most happy result. Whether my success would have been better had I followed the same method in other cases, instead of frequently repeating the dose, or not, I am of course unable to say positively, but it seems to me highly improbable. In pneumonia, I have always repeated the dose from every hour to every three hours; yet, in more than fifteen years practice, I have never lost a case of simple pneumonia, nor do I think it necessary. Most of these patients have been up in less than a week, and nearly, if not quite all, instead of having some portion of the lung left diseased, have made a complete recovery. 6. Many physicians have begun their practice by the use of

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