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There are only three instances calling for a variation from the common standard of scales of diluting, but they would have to be increased many times to adapt them to different drugs to be classified according to their powers; but this is avoidable and unnecessary when we revert to the fundamental principle, that is, development of force by expansion of surface. This is the principle to be held fast; the scale, to which too much importance has been attached, is not the principle, and should be varied according to the substance to be expanded. This is the only method by which a very minute and safe amount of drugmatter can be made to accomplish all that can be accomplished by medicine when used for the purpose of developing the specific effect, and this effect may be expected, provided we do not transcend the limits of possibility.
How, then, shall we best utilize this principle of potentiation if the old scale proves inadequate? Change the scale, is my answer. But, it may be asked, would not a multiplicity of scales become necessary and create confusion? This is easily avoided without violating any principle or without becoming in the least inconsistent: It is to adopt a scale which shall obviate enormous intervals by a slower rate of progression. Such a scale would be in the proportion of 1:1, 1:2, 1:3, etc.
This would answer best for the drugs of medium power as well as for those which in their crude form are practically inert. It is easy to adapt it to the wet and dry dilution potencies. If, e. g., coffee or chamomilla is diluted in the proportion of 1:1, the first would be of the strength of the tincture; the second, of ; the third, of $ of the original substance with a proportionate degree of power. The power, though reduced in equal ratio with the quantity, is not lost so soon as it would be in the decimal or, much more certainly, in the centesimal scale. By this method we simply preserve the intermediate degrees of potentiation which are absolutely lost in the use of the usual scales. As we are unable to determine for drugs in general, or for any drug in particular, the ratio of increase of strength, and only able to assume by generalization that expansion of surface increases and develops molecular drug-power, we are equally unable to determine at what stage of potentiation a potency may cease to be practically useful before the substance reaches the point of extinction, which is reached somewhere between the twentieth and twenty-fourth decimal. At all events, long before the thirtieth centesimal. Hence, to make sure that we are not simply losing the beneficial effects of a chosen remedy by too rapid progression, we should seek every opportunity of testing, in cases of disease, those intermediate grades of potencies which have hitherto been unused; for instance, the possible
grades between the third and fourth decimal, representing all fractional parts of substance and power between to and ito. In potencies of the centesimal scale, the difference between probably very efficacious fractional parts; for instance, between the third and fourth centesimal, or between any other two numbers, is vastly greater than is the decimal scale, and hence the probability of loss of therapeutic value and opportunity is much greater.
This is easily obviated by the employment of scales of less rapid progression, of which that of the proportion of 1:1, 1:2, and 1:3, are advisable, although scales of still less rapid progression readily suggest themselves.
The application of this proposition in the scale of progression to very active substances, might be just the same as with substances of less easily-liberated power. With poisons the object of dilution is not potentiation, but depotentiation. If, e. g., we desire to use a very poisonous substance as a medicine, our first object should be to reduce it in quantity and power. Now, the proportion of 1:1 might be too slow. For example, grain of sulphate of morphia is far too bulky for our therapeutic purposes; # gr. would be so still, and so would $ gr., especially if expanded in surface, as it would be at that stage of our proposed new scale. Hence, to obviate repetition, it is an easy matter to reduce all known dangerously active substances by the decimal, centesimal, or even any other scale of much more rapid progression, to the second or third decimal or centesimal potency, after which progression should be much slower, as would be the case in the scale of 1:1 or 1:2, because, after the third or fourth decimal the intermediate grades should not be lost, because they may lose us our patient.
But how does this apply to practically inert substances, charcoal, graphite, silica, etc. If much of our knowledge of the development of physical and toxic properties of drugs of known active nature, rests on assumption and, to say the most, on working theories, we must, one and all, freely admit that our knowledge of the laws of development of toxic and therapeutic powers of inert substaeces is much more deficient. But, if we may assume that the toxic properties of charcoal, for instance, are increased tenfold by a tenfold subdivision,* we must also take it for granted that in the process of potentiation it will share the same fate as active substances, namely, that its power will diminish in exact proportion with the substance; but we must
This means either that a quantity of charcoal has been expanded by grinding to ten times its original surface, or it may mean also that nine molecules of a medium (alcohol, sacch. lact.) have been interposed between every two molecules of charcoal. The latter is the case in an ideal, but practically unattainable trituration.
also bear in mind that its original latent force, whatever this may be, is very small as compared with the energy of very active drugs; and that hence it will be lost much more quickly than in the case of drugs of free energy which has to be controlled. And yet, it is to be hoped that some of our time-honored “antipsorics may prove much more satisfactory when a scale is adopted which, while developing latent powers in one step, does not waste them in the next; but which acts as a slow and conservative method of retention.
One more explanatory remark brings me to the close. It would be an easily-refutable error to suppose that this method would lead away from the good old ways of high potentiation. Any one is free to continue this as heretofore, and he may consider himself perfectly safe in the use of the new scale, which is as endless as the older ones, and will surely lead to the remotest part of the universe if continued long enough.
I have used this scale for three years whenever I feared that my medicines were either too strong or too weak. Like other physicians, I felt that I was leaping or, rather, flying between extreme points ; while, by adopting a rate of slower progress, I felt my way along cautiously, from point to point, without losing sight of intermediate ground, and without so much danger of missing therapeutic opportunities, which in the system of leaping progression, are hopelessly lost.
SOME SYMPTOMS PERTAINING TO THE SKIN, GLEANED FROM THE CYCLOPÆDIA OF DRUG PATHOGENESY; WITH
OCCASIONAL REMARKS THEREON.
BY JOHN L. COFFIN, M.D., BOSTON, MASS.
APIS MELLIFICA. Prover No. I a. Dose, I drop (1). — After two days, small elevations of the skin, like ants' bites, appear over the external end of the eyebrow; pain as if raw, and very sensitive to pressure.
b. 2 dr. of ist dilution. — Transient, smarting itching over the right eyebrow. Pricking itching in left eye, on the lids and round about the eye, mostly in the inner canthus. Burning like fire on small, well-developed spots on hands for several mornings. Itching of right eyelids, in fits, during the day.
d. 2 dr. ad dilution. — Itching of the eyelids. Painful vesicle, as tender as a boil, with red areola, suppurating in the middle, on the left side of the hairy part of the pubes, remains painful for several days. (This symptom occurred on the tenth day after taking the drug, and is the only symptom, with one
exception, showing any vesiculation in the whole pathogenesis. I should doubt its value very much. J. L. c.)
e. 6 dr. 6th dilution. — Some pricking in the palms, back of hands, face, forehead, underneath eyes, and on the body, at sharply-defined small spots.
f. Dose not stated. - Swelling of the lips, and swollen feeling for several days, followed by a slight eruption round about them, and dryness and exfoliation of the lower lips. Burning of toes, with redness and heat of them, whilst the feet are cold.
Prover No. 3. Poison of one bee. - After two and a half hours, itching on palms, worse on the left side, in small, burning spots. Burning itching here and there, especially severe on left thigh, posteriorly. Burning places here and there on the back, which itch also.
Prover No. 4. From quite constant exposure to the poison. — Pricking itching round the eyes, on eyebrows, lids, and eyes themselves, worse on left, especially the inner canthi, with inclination to press or rub the eyes strongly. A quantity of vesicles and small, sore, red places on tip and left border of the tongue.
Prover No. 9. From (1). — Pricking all over body, most on palms and back of hands, face, and forehead, chiefly at circumscribed spots.
Prover No. 10. From 1). — On fifth day, at night, on removing boots and socks, feet were found highly swelled, with sensation of weight and stiffness; upper part of feet bright red; felt rigid and itched. Soles and balls of toes had painful sensation of fulness, and in walking gave sensation as if cushioned.
Prover No. 11 3rd dilution. - Itching pricking of the skin in different parts.
Prover No. 13. 10 drops 2 x.- Soon itching of scalp, extending to face and neck. After repeating dose, itching extended to thighs and hands.
Poisoning No. I a. From the sting: -Skin extremely sensitive to contact, painful to the slightest touch ; could not bear the shirt upon him. Red and white blotches over the body and extremities, like nettle-rash.
b. Same man stung again. - A condition simulating collapse was followed by hot fushes, nausea, vomiting, watery diarrhoea, twitching of the muscles, rash, red blotches, with great sensitiveness of the skin to contact. This sensitiveness of the skin extended all over the body.
Poisoning No. 2. From sting. — Body covered with large wheals, slightly raised, and quite white, interspaces being scarlet.
Poisoning No. 6. Boy was stung. - On undressing saw eruption of nettle-rash all over, which itched much.
Poisoning No. 8. Girl stung in the neck. — On undressing her, forty to fifty minutes after, she was found covered with red spots, size of a hand, as though they had been scalded.
Poisoning No.9. Boy stung on commissure of the mouth. — At once a feeling of general numbness, and after a few minutes a most violent itching, like needle-pricks; had to rub the whole body with cloths to allay it. After rubbing he was observed to be covered from head to foot with small white spots, as after gnat-bites.
Poisoning No. 10. Man stung on tip of nose. — He suddenly felt an indescribable sensation through the whole body, with a prickly feeling, and white and red spots on the palms, arms, and legs.
Poisoning No. 12. A man stung by a bee on testicle. Part swelled to such an extent there was scarcely room for it in the scrotum, with tensive feeling, and the most violent itching. Soon afterwards the whole left side of body swelled, first in the joints, where lumps appeared, which looked somewhat inflamed, and itched violently.
Poisoning No. 13. Woman stung on temple. — Followed by urticarious rash all over the body, and profuse perspiration.
Poisoning No. 14. Robust man stung on top of head. — The whole body was covered with wheals, but without change of color; indeed, the wheals were whiter than the rest of the skin.
Poisoning No. 15 b. From sting. - Entire skin was covered with a red rash, very much resembling scarlatina, only, if any. thing, of a less bright color, and somewhat rougher to the feel than the common type of that exanthem.
Poisoning No. 15. Boy stung by a "yellow-jacket.” — Immediately commenced itching and burning all over, and when he reached home was "all broke out.” He was found covered, from head to foot, with elevated circular and oblong patches, which soon ran together, forming an entire blotch over back, arms, and legs. Eruption, on its first appearance, was white, but on rubbing the parts would become pinkish. It was accompanied with intense burning, itching, and stinging, causing continual scratching and rubbing.
From these symptoms, viewed collectively, it will readily be seen that this drug causes a general cutaneous irritability, manifested by maculæ and wheals appearing all over the body, but more especially about eyes, hands, face, neck, and extremities. Urticaria evidently is the condition in which we should expect the best effect from its homeopathic application, and clinical results have not disappointed such expectations. It is, however, more applicable to those cases of urticaria accompanied with