The symptoms which drugs produce upon the healthy organism vary according to the dose. They may be :
1/ CHEMICAL — depending on the chemical affinity which exists between the drug and the tissues of the body, and independent of vitality : or,
2/ MECHANICAL (or revolutionary), consisting chiefly in violent efforts on the part of The organism to eject from its cavities the offending substance : or,
3/ DYNAMIC, contingent upon vitality and resulting from the relations of the peculiar properties of the drug to the susceptibilities of the living, healthy organism. These dynamic effects may be :
A/ Generic — such as are common to all the members of a certain class of drugs and which serve to distinguish this class from others, but do not furnish means of distinguishing' between different individuals of the same class. For example, Arsenic in certain doses produces vomiting and diarrhea, with cold sweat and cramps of the extremities.
These are dynamic effects of Arsenic but they are generic, since other members of the class to which Arsenic belongs, viz.: Cuprum, Veratrum, Tartar emetic, etc., in certain doses, produce identical symptoms : and were these remedies proved in such doses alone, it would be impossible to distinguish the pathogenesis of one of them from that of any of the others.
B/ Specific — such as results from the dynamic action of the drug and are peculiar to it. They serve to distinguish a given drug from all others. For example, Arsenic, taken in different doses from those which produce the generic dynamic effects, produces vomiting and diarrhea or tendencies thereto : but these phenomena are accompanied and characterized by conditions quite different from those which accompany the similar symptoms of Cuprum, Veratrum, etc., and are thus distinguishable from the effects of these drugs.
The Specific-dynamic symptoms may be again sub-divided into Central and Peripheral.
The Central symptoms appear speedily after the drug is taken, are generally the result of comparatively large doses and, in the case of many drugs, are confined to the alimentary canal and to the organs immediately connected with it.
The Peripheral symptoms appear more tardily, are generally the result of comparatively small doses, taken repeatedly or allowed to act without interruption for a long period, and appear in the bones, skin, glands, etc., and in the coordinated phenomena of life. They are often the manifestations of a dyscrasia or cachexy.
Doses which produce central symptoms do not generally produce the peripheral (or at least not until after a long period has elapsed) and vice versa. For example, Mercury, in certain doses, produces well-marked and characteristic action upon the alimentary canal and its appendages. In smaller doses it produces, instead of these effects, a series of symptoms in the skin, bones, glands, etc. — the Mercurial cachexy. The former are what we mean by central specific dynamic symptoms.
The latter are the peripheral symptoms. Arsenic, again, furnishes, according to the dose, examples of all of the above varieties of symptoms. In certain doses it develops chemical and revolutionary effects. In smaller doses, as we have seen, generic dynamic : in still smaller doses, specific dynamic symptoms of the central variety. In yet smaller doses, it produced peripheral specific symptoms, which are those of the so-called "gradual poisoning :" as for instance in poisoning by exhalations of Arsenic from green wallpaper, in which the phenomena of vomiting and diarrhoea or the central specific symptoms do not appear, but instead of these we have evidence of a distinct cachexy, in the skin and glandular symptoms, marasmus, etc.
Such are the varieties of symptoms produced by corresponding varieties in the dose. It is hardly necessary to say that they are not always to be distinguished with precision : but the facility with which we are able to recognize them is in proportion to the completeness of our proving.
It unquestionably behooves the homoeopathic physician to have an exhaustive knowledge of the whole sphere of action of his drugs : but, as a prescriber, he must be familiar with the varieties and subvarieties of dynamic effects which we have specified. This knowledge is to be attained in the first place only by drug-proving. The proving of drugs must then be so conducted as to produce in the greatest possible completeness and clearness, each of these varieties and sub-varieties. This, as has been shown, is to be accomplished by a skillful selection and succession of doses. It is not so simple and easy a matter as it might at first view appear to be : fort
First : The doses by which the corresponding varieties of symptoms are produced, differ widely in different drugs. For example, a half grain of crude Nitrate of silver or of Sulphuric acid produces chemical symptoms, while a half grain of Lycopodium or of Silicea produces probably no symptom at all. A grain of Arsenic produces generic dynamic symptoms, while ten grains of Natrum muriaticum may be inert. Forty drops of Bryonia tincture may excite a fair show of specific dynamic symptoms, while forty drops of tincture of Opium will produce generic dynamic symptoms or full narcotism.
Secondly : The susceptibility of different provers to the same drug is very different, and the degree of susceptibility which each prover possesses is to be learned only by experiment. For example, one prover will take five hundred drops of Thuja without any effect : another, taking twenty drops, experiences violent specific symptoms.
Thirdly : The susceptibility of provers to different preparations of the same drug is very, various and apparently capricious. 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.
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 subvariety 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.
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 of their action upon the organism. Some drugs appear 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. Of others again, a, single large dose develops some one generic or central specific symptom, and along with it induces 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.
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 peripheral and central specific dynamic symptoms. To illustrate this point, — it is well known that Mercury given in such doses as to produce central specific 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 straight-way a series of central symptoms.
The same is true of Arsenic. 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 diarrhoea, with cold sweat and prostration. It may be said that these are cases of very unusually great susceptibility to the action of the respective drugs.
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.
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. 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.
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. Inasmuch as, in the nature of things, the peripheral symptoms,, representing, as they do, a cachexy, cannot be speedily produced, a considerable space of time should be devoted to our first experiments with small doses.
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 poisonings.
But, in this relation, what are the "small doses" with which we are to begin our proving? The term is comparative. Are they drop doses of the tinctures, or are they high dilutions ?
They are such doses as have, in the proving of some previous drug, shown themselves capable of producing unequivocal symptoms. We must search the records of provings, therefore, for our standard initial dose.
What, this is at present we shall soon see : as our experience increases, this standard may from time to time be altered.
It is evident that the method of conducting a proving is a matter of great importance, and should not be left to caprice or accident. The completeness of our Materia Medica, and consequently our ability to cure disease, depend upon our selection of a happy method. This important subject has received the attention of the American Institute of Homoeopathy, to which the Central Bureau of Materia Medica has presented a report on Drug-Provings.
The majority of the Bureau repeat Hahnemann's directions for proving as contained in the Organon : and as regards the dose, they recommend "the prover who makes use of potencies" to make a trial of the high potencies first, and afterward, if necessary, to take the lower dilutions and triturations, or the crude substance or tincture, if satisfactory results are not obtained with the attenuations.
This recommendation accords with our deductions and corresponds with the spirit of Hahnemann's directions. Hahnemann's instructions differed at different periods of his life.
One essential idea, however, pervades them all — a small dose is to be taken at first, and the dose is to be increased until unequivocal symptoms manifest themselves. In the last edition of the Organon he adds, as the result of his extensive observation, that "The most recent experience has taught that medicinal substances, when taken in the crude state, do not for a long time display the full extent of their virtues, as they do when taken in higher developments.
Thus any one, even of those medicines whose virtues are considered weakest, is now found to be most advantageously studied if four to six globules of the thirtieth dilution be taken every morning for several days."
In this statement, Hahnemann does not contradict the spirit of his former directions, for he adds, "Should the effects of such a dose be weak, it may be daily increased." He further adds, "The more moderate the dose, the more are the primitive effects developed, which are the most important to be known." We see nothing in Hahnemarm's writings which shows that he ever thought of restricting the dose in proving to the thirtieth dilution, as some have stated : he simply assures its that unless proving with so high a dilution were made, the prover would fail to get all of the symptoms which the drug is capable of evolving.
In the Minority report of the Central Bureau, [ Am. Hom. Review, vol. I., p. 575.] Dr. Hempel differs from the majority in so far as the proving with dilutions is concerned. He would propose that "all such provings should be rejected rather than encouraged :" and he "is convinced in his deepest soul, that it is owing to the incorporation of such provings in our Materia Medica that all the confusion and uncertainties with which it is now tainted, are presenting immense and almost insufferable difficulties to the inexperienced student of our science."
We trust that it is unnecessary to say that in commenting freely, as we shall do, on Dr. Hempel's report, we are :actuated by no unworthy feeling toward our colleague, whose unceasing and very arduous labors in the cause of Homoeopathy command our highest respect, and deserve the grateful recognition of every English and American Homoeopath. We speak of him only because, by his report, he stands forth as the representative of certain opinions, which seem to us unsound and unsupported by the evidence on which they are supposed to rest.
His report may be reduced to the following propositions :
1/ Drugs should not be proved with attenuated substances.
2/ The middle and higher potencies do not produce reliable symptoms, unless the system has been previously saturated with massive doses of the original drug. Corollary: the saturation of the system by massive doses of a drug renders it susceptible to the action of the middle and higher potencies.
3/ In exceptional cases a peculiar idiosyncrasy may enable the organism to develop symptoms from the higher potencies : but "it is unreliable to commence the proving with these potencies." The sequence of this conclusion is not very clear. We suppose Dr. Hempel to mean that symptoms developed, where an idiosyncratic susceptibility to drug-action exists, are not so reliable as those developed where there is no idiosyncrasy.
It is much to Dr. Hempel's credit that he has not left these propositions to stand in his report as bare unsupported
assertions.
Recognizing the experimental nature of the question, he has referred for corroboration of his views to the experience of those who have made our provings, and has called to the witness-stand the great body of our drug-provers in the following terms : "All the splendid provings of the original provers of the Materia Medica, and of the Austrian Provers Union, of the Provers Society of Prague, and of any other Provers Society, whose provings are accepted with universal acclaim and confidence, have been instituted with massive doses of the strongest preparations of the drug : the higher and middle potencies were invariably tied after the former."
If this statement were literally correct, if, indeed, none of these provers ever began their, provings with potencies, then they are incompetent witnesses for Dr. Hempel's purpose — they are incapable of testifying as to the action of dilutions when lot preceded by massive doses, since, Dr. Hempel says, they never tried them. If this were so, then the second proposition of Dr. Hempel's report would rest unsupported save by the one witness whom, we neglected to say, Dr. Hempel cites, first of all, in these words : "Dr. Hempel has never been able to elicit any reliable symptoms by means of the middle or higher potencies, unless the organism had been previously saturated with massive doses of the original drug."
On this one point of negative evidence, then, this important proposition stands — "Dr. Hempel has never been able." But perhaps others have been able. Perhaps the very witnesses whom Dr. Hempel has called have been more successful than he. We will cross-examine them.
First, then, we call upon the "Original Provers of the Materia Medica," by which we suppose Dr. Hempel means Hahnemann's "Materia Medica Pura" and "Chronische Krankheiten."
Of these provers, the "Great Original" was Hahnemann himself.
His pupils and friends adhered strictly to his directions and method. What Hahnemann’s opinion was as to the propriety of commencing a proving with small doses we have already seen..
After thirty-five years experience in drug-proving, he sums up his observations in the advice to begin with the thirtieth dilution. But what was his practice ? What doses did he actually take ? It has been generally supposed that he did not as a rule record the doses with which his provings were made.
Dr. Hempel, however, seems to have had access to some sources of knowledge on the subject that are not open to the general reader, for he tells us without qualification, that "all the splendid provings of the original provers of the Materia Medica were made with massive doses of the strongest preparations, etc."
Those who have not enjoyed these unusual means of information, gather from a few observations, scattered through Hahnemann's writings, the following facts :
Silver was proved by Hahnemann in the first trituration.
The Nitrate of Silver, of which he gives a few symptoms, in the fifteenth dilution. Carbo vegetabilis was proved in the third trituration. In a letter in the Neues Archiv. (1813), he directs Stapf to prove Helleborus thus : "Add a drop of the tincture to eight ounces of water and one drachm of alcohol : shake well, and take an ounce every hour and a half or two hours until some decided effects are produced."
And camphor, thus : “ Dissolve two grains in a drachm of alcohol : shake this well with eight ounces of water, and take in from four to six doses during the day.
In the first publication of the proving of Natrum muriaticum (1830), Hahnemann tells us that a great part at least of this proving was made with thirtieth dilution, and he adds, that "it is only in such a highly potenized form that this and all other drugs display the whole of their power to alter the condition of the organism."
This was Hahnemann's conclusion after thirty years of active experience in drug-proving. As a voucher he gives us the proving of Natrum muriaticum, the value of which is attested by the clinical experience of the last thirty years, and confirmed as we shall see by the Austrian re-proving.
In the same volume of the Chronische Krankheiten, Hahnemann published the proving of Kali carbonicum, and large additions to the previously published provings of Carbo vegetabilis, Causticum, Conium and Sulphur.
It is but reasonable to conclude that the symptoms of Kali Carbonicum, and many at feast of those of the other dings above named, were produced by the thirtieth dilution as well as those of Natrum muriaticum.
In view of these facts, it is hardly correct to say, as Dr. Hempel does, that "all the provings of the original provers of our Materia Medica were made with massive doses of the strongest preparations, etc."
Second, we call upon the Austrian Provers Union. This society conducted in the years 1842 to 1848, a series of re-provings of certain of the drugs proved by Hahnemann, in the hope of discovering the pathological connection of the symptoms which in Hahnemann's scheme are disconnected.
Conceiving also that some of Hahnemann's symptoms were vague, because produced, as they supposed, by small doses, they pushed their provings with massive doses, in many cases to extreme poisoning. With these views we could hardly expect from them much testimony, either positive or negative, on the subject of proving with potencies : but, in that which they do furnish, we should expect them to be unfavorable witnesses for our views, since their proclivities are almost uniformly against the use of potencies in proving or in therapeutics.
Dr. Hempel says, "All these splendid provings, etc., were instituted with massive doses : the middle and higher potencies were invariably tried after the former." Let us examine the records.
In the proving of Aconite, sixteen provers made in all thirty-seven experiments. Six of these were made with dilutions from the first to the twelfth centesimal, and-symptoms were observed in all but one.
In five of these cases, large doses of the tincture had been taken before the dilution. In one case the prover began with the first centesimal dilution and got symptoms.
In the proving of Bryonia, fourteen provers made twenty-nine experiments, of which ten were with dilutions from the first decimal to the 203d.
In two of these, the provers began with the dilutions, viz : with the tenth and the thirtieth, and got in one case very graphic symptoms : in the other, symptoms unequivocal though less numerous.
In the eases in which dilutions were used after massive doses of the tincture had been taken, considerable intervals were allowed to elapse after the last symptoms from the tincture-proving disappeared before the dilutions were taken, e. g., forty-one days before the 203d dilution was taken, and yet this dilution appears to have produced decided symptoms.
It is true that the propriety of ascribing these symptoms to the Bryonia is called in question by the. Editor of the Austrian Journal, but with scarcely sufficient grounds, since a subsequent proving with the 203d dilution evoked them again.
Here then, in the only two cases in which dilutions were taken before the tincture, symptoms were obtained (while in one case in which they were taken after the tincture, no symptoms were observed, shows that the corollary to proposition No. 2 is at least not universally, true).
In the proving of Silver we find that the drug was taken by one prover each in the first, second, and third triturations, and in the fourth, fifth, arid sixth dilutions, and valuable symptoms were obtained by each. The Editor calls attention to the great correspondence between these symptoms and those of Hahnemann, obtained, as we know, from the first trituration.
In the proving of Nitrate of Silver, the Editor remarks : "Between the experiments a sufficient time elapsed to insure against the effects of one experiment being complicated by those of a preceding one, two years being consumed in the proving."
The proving was begun with the first decimal trituration, and subsequently in succession the second, sixth, and thirtieth dilutions were used. The effect of each dose was allowed to expend itself before a new experiment was instituted : symptoms clear and characteristic, and covering a period of six to nine days, were obtained from a single dose of the thirtieth dilution.
Here, it is true, the dilutions were preceded by low triturations, yet the Austrian provers were of opinion that in these cases the lower preparations did not influence the susceptibility of the system to the higher potencies.
In proving Kali bichromicum, in only two cases was a dilution higher than the third employed. In both of these the twelfth was used and symptoms were obtained. In one, that of Dr. Wachtl, the symptoms from a single dose give a complete picture of the subjective and objective effects of this drug in the pharynx and neighboring organs. In neither of these cases had the drug been previously taken in massive doses.
In the proving of Colocynth, fifteen prover made twenty-five experiments. Ten were made with dilutions, and in nine, symptoms were obtained. In three of these, the third dilution was used and no other preparation of Colocynth had previously been taken.
In proving Thuja, twenty-three provers made fifty-nine experiments." Seventeen were made with dilutions, and, in thirteen, unequivocal symptoms followed.
Nine began their provings with dilutions and got symptoms. Four began their provings with dilutions and got no symptoms. But, on the other hand, seven conducted their provings with massive doses of the tincture without obtaining any unequivocal symptoms. It is evident, then, that negative testimony on this subject is of little value.
In proving Cochineal, four provers began their experiments with the hundredth dilution, one with the sixtieth and one with the thirtieth dilution, and all got valuable symptoms. One prover, on the other hand, began with the 200th dilution and gradually descended, getting no symptoms until he took massive doses.
In the proving of Natrum muriaticum, thirty-nine provers took part. Fourteen began with dilutions varying from the sixth to thirtieth, — the majority beginning with the thirtieth, twelve obtained symptoms of which some are of great value, lasting and recurring for many days after the last dose.
Thus, in twelve cases out of thirty-nine, dilutions were taken before "the system was saturated with massive doses of the strongest preparations, etc.," instead of dilutions being "in, variably tried after" such massive doses.
We may remark that in every case in which we ascribed symptoms to the dilutions, except the case of the 203d of Bryonia, they have been so admitted by the Austrian provers themselves.
In conclusion, was may, obserye that with Natrum muriaticum the record of the Austrian provings closes.
In his concluding remarks- on that drug, Dr. Watzke uses the following language : "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 attained therewith, speak decisively and distinctly for these preparations.
Several of our most cautious provers have obtained unquestionable characteristic Natrum muriaticum symptoms from them." It is remarkable that as Hahnemann was evidently led by experience to recommend that in drug-provings dilutions should be used as well as crude preparations, in like manner, the Austrian prover should, as the result of his experience, express himself as above.
Watzke further remarks : [ Oest. Zeitschrift, vol. III., p. 64, note.] "I am very far from regarding a stormy method of proving as the only proper and useful one, and I recognize the conditions of an all-sided knowledge of the remedy, in the free, unrestrained method we have adopted : experiments being made with large, small, an smallest doses according to the disposition, judgment and good pleasure of the prover."
And again, in reply to a critic, "My friend says, 'I have Proved all my remedies in strong and some in the strongest doses : with many I have also made provings with the higher, even with the thirtieth dilution — Have I then done otherwise ?"
In a recent number of the Allg. Zeitung, it is stated that a member of the Old Austrian Provers Union has begun to prove, Quassia amara with the thirtieth dilution, and has obtained valuable symptoms. Experto crede.
In view of these facts, we think Dr. Hempel is hardly correct in stating that "all the provings of the Austrian Proven Union were made with massive doses, etc. — the middle and higher potencies being invariably tried after the massive doses."
The records of the Austrian Union not only prove that dilutions may evoke trustworthy symptoms in a majority of tie cases in which they are employed, but they also give us the means of forming a judgment on the propositions which form the substance of Dr. Hempel's report.
1/ "Drugs should not be proved with attenuations. — Now, since it has been shown that attenuations produce, reliable and valuable symptoms, we submit that they should be used and for these reasons :
a/ Because attenuations have produced symptoms which have not also been produced by massive doses, and which have been confirmed by clinical experience. In the proving of Natrum muriaticum, the only distinct picture of periodic fever was induced in Dr. Wurmb while proving the thirtieth and twenty-fifth dilutions.
Dr. Schreter, proving the thirtieth, got symptoms which no prover with massive doses presents. In the proving of Thuja, certain symptoms affecting the vision were produced in Dr. Huber by the sixtieth dilution, and in Prof. Zlatarovich by the twelfth, which no other provers have recorded.
In the proving of Colocynth, the third dilution produced symptoms not recorded by any prover who took massive doses, and yet corroborated by a second prover with the third.
b/ Because some provers are susceptible to the action of dilutions or small doses, and not to that of massive doses of the crude substance. For instance, Dr. Wurmb got decided and persistent symptoms from dilutions (thirtieth to sixth) of Natrum muriaticum. From lower dilutions and from the crude substance, even in half-ounce doses and repeated frequently, he got no symptoms. Was this because his system was saturated ?
We think not : for on recurring to the dilutions, he again got symptoms as at first. Now, had the provings been confined to the crude substance, we should, not have Dr. Wurmb's proving of Natrum muriaticum, the most complete and reliable single experiment that we possess, and which we could hardly consent to give up, notwithstanding Dr. Hempel's opinion that "potency-provings should rather be rejected than encouraged."
The same thing is observed in the provings of Aconite, Thuja and Colocynth.
2/ "Potencies do not produce reliable symptoms unless the system has been previously saturated with massive doses of the crude substance : and Corollary, massive doses render the system susceptible to the action of smaller quantities."
We have shown that in repeated instances, symptoms which Hahnemann and the Austrian provers regarded as "reliable" have resulted from potencies not preceded by massive doses — symptoms confirmed by other provings and by clinical experience. On what grounds does Dr. Hempel question their reliability ?
Again, we have no conclusive evidence that massive doses, as a rule, render the system more sensitive to small doses. In some cases they appear to do so. In others they have the opposite effect.
In the records, we find the utmost variety as regards the susceptibility of provers to various doses. Some, like Dr. Wurmb, are susceptible to dilutions alone of a given drug, others to massive doses alone. Many obtain symptoms at first from comparatively small doses of the crude substance, but find it necessary to steadily increase the dose, until finally, after taking in some cases several hundred drops or grains, they get no symptoms at all from any preparation.
This looks like a blunting of the susceptibility rather than an exaltation. We are not always justified in assuming that, where dilutions were taken after massive doses, the symptoms were due to the massive doses and, not to the dilutions. In the majority of these cases a sufficient period elapsed between the experiments to prevent all possibility of the one complicating the other.
In a few cases no such period elapsed, and in these it may be that the symptoms ascribed to the dilutions were really due to the previous massive doses, yet even in these cases we cannot be certain of this : for in one of them, that of Prof. Zlatarovich, who, after taking in the aggregate several thousand drops of, the Thuja-tincture, changed without delay to the twelfth dilution, a symptom was observed which had not occurred to him or to any one else while proving the tincture, but only to Huber while taking the sixtieth.
In conclusion, we see in the Austrian records more reason to suppose that massive dose, as a rule, blunt than that they exalt the susceptibility, although in some cases they unquestionably have the latter effect.
As these cases .cannot be recognized in advance, it is clear that in the case of an individual drug or prover, nothing positive on this head can be assumed as a basis on which to plan a proving,
3/ It is said that "idiosyncrasy" determines the action of potencies, and that provings having this origin are not reliable.
The word "idiosyncrasy" is used in two senses. Properly, it signifies an abnormal sensibility to drug-action : or such a relation to a special drug as that the drug produces in the prover symptoms that occur to no other prover, and which bear no analogy at all to the symptoms which others experience. Such symptoms as these must always be regarded as suspicious until verified by clinical experience. Such an idiosyncrasy is exemplified by persons who have "hay asthma," "rose catarrh," etc.
But, as most frequently employed, the word "idiosyncrasy" is synonymous with "susceptibility," implying an unusually acute, but not abnormal, sensibility to the action of the drug, and a prover who shows a marked susceptibility to the action of a drug is said to have an idiosyncrasy which favors its action.
This susceptibility is similar to that which individuals exhibit for natural diseases — some being prone to one kind of disease, others to another, just as one prover is especially susceptible to Thuja, another to Aconite.
Now what pathologist would think of objecting to a case of pneumonia that t was not a reliable picture of the disease, because it could be shown that the patient had a great susceptibility to, the disease, and took it on the slightest provocation ?
A certain susceptibility to the action of a drug is absolutely necessary to a good proving. Hahnemann speaks of it in his Organon as a necessary condition.
What the Austrian provers think on the subject may be gathered from the following remarks of Watzke (Dr Wurmb proved Thuja five times, — four times in massive doses and once in dilutions : result very meager) : "We may observe that the proving of a drug, is not so easy an affair as it seems to be.
The individuality of the prover as well as of the drug plays here so important a part, that a successful proving is often an entirely accidental piece of good fortune of the susceptible prover, while the boldest, but unsusceptible prover, with the best good-will and the greatest devotion may obtain only a scanty and one-sided result."
This susceptibility may be to the drug in general or to particular preparations of it. Wurmb was acted on only by dilutions of Natrum muriaticum. Watzke only by immense doses of the crude substance. Watzke was sensitive to very small doses of Thuja, while Wurmb and Reisinger were almost insensible to every preparation of it.
Obviously, then, a prover's susceptibility varies with the drug and with the preparations, and can be learned only by experiment with all preparations.
From the general tenor of Dr. Hempel's report, one night infer that while the middle and higher potencies produce symptoms only in very exceptional cases, massive-doses of the strongest preparations act always.
The records of the Austrian provings hardly warrant such an assumption. Of the thirty-one experiments made with tincture of Aconite : six were not followed by any trustworthy symptoms. Of the thirty-six made with large doses of tincture of Thuja, seven were without result. Of fourteen made with large doses of crude Colocynth, one was without result. Of the fifteen provers of Bryonia, one at least took very large doses of the tincture without observing any symptoms.
Several who took large doses of crude Natrum muriaticum were insensible to its action. It is obvious, then, that the development of symptoms is not of necessity copious and satisfactory in the ratio of the dose.
The Austrian records abound in editorial remarks, intimating that provers have defeated their object by taking too large doses, and by repeating the dose too frequently.
We have seen, then, that potency-provings may be trustworthy and that they are indispensable to a complete and exhaustive proving. It is to be observed that even the few Austrian potency-provings which we have, were not, generally, conducted in such a way as to demonstrate the full value of such experiments.
In very many cases, only a few days were allowed for the development of symptoms before a larger dose was taken. In the few cases in which a different course was pursued, as in Wurmb's proving of Natrum muriaticum, clear and persistent and most valuable series of symptoms were obtained.
In order to obtain a perfect proving, the prover should ever bear in mind certain fallacies to which he is liable. These fallacies differ according to the dose which he is employing : they are equal for either extreme of dose. If he use the higher dilutions, he is in great danger of confounding "imaginary" symptoms with real subjective drug symptoms. If he employ massive doses, he is in equal danger of including in his record chemical and mechanical symptoms.
Either error is a source of confusion and uncertainly, but he is greatly mistaken who thinks, to avoid introducing confusion and uncertainly into the Materia Medica by simply rejecting potency provings. They can be avoided only by the constant analysis of the symptoms (whether produced with potencies or with large doses), by frequent repetitions of the provings on one's self and others, and by clinical verifications of the symptoms.
The Austrian records give an example of the latter fallacy. The symptoms are so intermingled with chemical and revolutionary effects, that one cannot use too great caution in basing a prescription upon them.
In conclusion, we may assume the following points to be established by induction and by direct experience :
In order to obtain an exhaustive proving :
1/ We must prove the drug both in dilutions and in massive doses.
2/ The proving should be commenced with dilutions : and high dilutions should be employed until satisfactory evidence is obtained that the prover is not susceptible to their action. We thus obtain one of the unknown quantities of our problem, viz., the measure of the susceptibility of the prover.
3/ Where a keen susceptibility is found to exist, the greatest care must be exercised to avoid blunting or perverting it.
With this view, repeated experiments should be made at long intervals, with high potencies, until no new varieties of symptoms are evoked.
Then, after a long period of non-medication, the prover should take lower potencies and then small doses of the crude substance repeated at intervals, and finally after another long period of repose, large doses of crude substance. 4 thorough proving after this fashion may require years for its completion — but it will have an advantage over most of our recent provings, in the fact that it will be thorough, and that it will be of permanent and certain use to the practitioner.
4/ In proving with dilutions, as well as with massive doses, a long period of time should be occupied in testing each preparation, in order that the full effect may be seen in the production of dyscrasias, etc.
5/ The greatest care should be exercised in verifying symptoms by repeated experiments, in order that "imaginary" symptoms on the one hand and chemical and mechanical symptoms on the other may be excluded.
The fashion, which has become very prevalent of late, of including in the pathogenesis every sensation which occurs during the proving, without distinction or verification — and which may be called the Pre-Raphaelite method. of proving — cannot be too strongly rebuked.
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