In prescribing for objective symptoms the larger doses of remedies are usually more generally requisite than in prescribing for subjective symptoms. For instance, very minute doses of the tincture of apis will relieve irritation and stinging of the urethra or external genitalia where there is nothing to be seen by the eye of the examiner, but larger doses act directly as a diuretic.
Again, asclepias tuberosa will relieve in quite small doses the pleuritic pains entirely subjective in character and resulting from a dry condition of the serous membranes involved; but give it in larger doses and the action is extended from the serous to the mucous membranes and finally to the skin itself. These actions, both in the small dose and in the large dose, are physiologic actions. There is no occasion to attach an element of mystery to the actions of remedies in small doses, nor is it necessary to elaborate any theories or systems covering such actions. That there are a large number of drugs possessing an action differing according to dose is a proposition that is never called in question.
It is agreed as well that in the ordinary doses of the books these remedies act physiologically; but when the small dose is considered, the mysterious "dynamic action" or the "remedial action" or "the specific action" is at once conjured into being.*
Table salt in large doses is emetic, and in continued excessive doses causes scurvy and a whole chain of devitalizing symptoms, yet we all know that in small amounts it possesses the most distinct physiologic usefulness. Many of our condiments are markedly irritant or emetic in large doses. There is no mystery connected with the actions of these substances in small amounts. We simply recognize the two kinds of action they possess and do not attempt to separate either one of them from physiologic laws. The man who smokes tobacco for the narcotic effect of the small amount of the weed absorbed into his system does not regard that action as extra-physiologic because a larger dose of the same thing would produce muscular relaxation, depression, and emesis.
The person who soothes a cough with wild cherry bark containing a minute amount of hydrocyanic acid, does not regard that procedure as extra-physiologic, because in large doses this acid is a powerful poison. Because the physiologists and pharmacologists have not yet worked out the physiologic actions of most of our drugs in small or minute doses, does not prove that there are no such physiologic actions. It only proves that these gentlemen have yet a lot of work before them.
There has been a great deal of contention between regular and sectarian physicians as to the poisonous action of drugs; many of the sectarians claiming that everything they recognized as physiologic action was really the toxic action as opposed to the remedial action. This contention has not led to anything practical and has been to the discredit of all involved in it. Pedantic and unscientific squabbles such as this are what divide the medical profession to-day.
A fair estimate of the views held by the Homeopaths may not be amiss. There are many such estimates scattered throughout medical literature, and we here reproduce an eclectic view taken from an authoritative eclectic textbook. the 15th edition of "Specific Medication," by Prof. John Scudder, M.D. It is probably fair middle ground.
"The Homceopathic law of cure, similia similibus curanter, is based upon the fact that many drugs have two actions in kind, dependent upon the dose-the action of the small or medicinal dose being the opposite of the large or toxic dose. Drug provings being done with toxic doses, the medicinal influence is the opposite of this, and if in disease we see the symptoms of the toxic action of a medicine. the small dose, giving the opposite effect, will prove curative. Homeopaths may twist and turn as they please, they cannot escape these conclusions. But as these opposite effects, dependent upon quantity. do not pertain to all drugs, and vary greatly with many, Homeopathy has a short leg and must go halt many times. In other instances the action of the drug is the same in kind both in small and large doses, and some of them are quite valuable remedies. there being no danger of mistakes from dose. Homeopaths employ the first class, but have little use for the second, as will be obvious to the reader."
The author of this book does not stand sponsor for the above views. but finds them suggestive. Rejecting personally the theories of Hahnemann after reading largely of his writings, yet it cannot be denied that his followers have discovered manv facts with reference to the action of remedies individually and have introduced into medicine many very valuable drugs.
The history of the Eclectic movement has shown much flexibility as to their theories which We need not consider except to state that they aim to use "specific remedies for specific indications, regardless of the names given to disease. Niederkorn says: "Specific medication does not teach that medicines will alleviate or cure certain diseases; that is to say. they will not cure an aggregate of symptoms arranged according to the much practiced nosology. Specific medication is the study by which we determine the direct action of remedies with special reference to their direct relation to pathological conditions, a study which determines a definite condition of disease, and points out the direct remedy for such conditions; a study which considers drug action as it relates to disease expression,"
Practically, the Eclectic of to-day superimposes what he finds of practical account in Homeopathic practice upon what he has learned from regular sources. He adds to this a specialized knowledge of botanic drugs. We must credit them with much earnest effort. They have done more in the last fifty years to develop our indigenous botanic materia medica than has the regular school. In pathology they have added very little to medical knowledge, but their more recent works upon materia medica and therapeutics would he a credit to any school of medicine.
It appears that the average mind has to have some little "cult" or shibbolethic formula. We all bow down to these things more or less, and so it may not be amiss to tentatively advance a proposition to the effect that in small and moderate doses we get the true physiologic action and in the large dose the Physiologic reaction.*
This proposition will at least serve to lock up current theoretical differences, and gives us opportunity in the following pages to classify all reasonable data and to gather together such facts in materia medica and therapeutics, in its wider field, as we can use in treating our patients.
* In disease manifestations, it frequently requires a very large dose to be toxic, as, for instance, the large doses of veratrum tolerated in puerperal convulsions, of chloral in mania, or of quinia in profound malarial paroxysms. Small doses of drugs must, quite naturally, be frequently repeated as a rule. Where small doses are used merely to meet the symptomatology there is usually a quicker response than when they are employed to combat established diseased processes.
As to large doses, it is imperative that we remember that antizymotics and febrifuges cannot take the place of the curette, with septic masses in the womb; that antineuralgic remedies are of little avail with a suppurating middle ear; that high colonic flushing will often do much more than intestinal antiseptics; that medication for catarrh will not remove polypi, and that abdominal pain may be due to appendicitis and require the surgeon. By all means, let us study our cases and treat our patients not merely by drugs, hut by every method properly adapted to the case. The study of drugs is important and is neglected, but there are other equally important branches in therapeutics. Don't indefinitely dose anyone with large quantities of drugs. Invariably, they will do more harm than good, and please don't give eight or ten drugs at the same time.