The Dose of Medicine.
Selected writings of John M. Scudder.
Related entry: The Dose of Medicine
Heroic dosage was the rule and custom, in Eclecticism as well as the old school, when Dr. Scudder began practice. His studies and experience led him to a careful study of dosage, with a strong leaning toward the small and frequently repeated dose. This became more and more apparent in his teachings as the years passed and was one of the features of his medical philosophy which caused his antagonists to accuse him of Homeopathic proclivities. This charge he has fully met in a subsequent editorial. He ingeniously shows also that a large dose, when properly indicated, means less medicine in the aggregate.—Ed. Gleaner.
THE DOSE OF MEDICINE.—It would seem that but little could be said in regard to the doses of medicines, unless each individual agent was considered separately; it is, however, a very important subject for thought. Medicine has been given in too large quantities: this all will admit; but that as individuals we administer too much, each will deny. The general fact that an excess of medicine is used hardly needs proving, for every reader, if he reflects, will find that he frequently gives remedies when there is no positive advantage to be obtained from their use, and when he could not give a reason satisfactory to himself for their employment.
I tell my class that the rule which should invariably govern their action is, under no circumstances to administer medicine unless there is a well-defined indication for its use. There is no other safe course for the young physician, or for the old either, and surely no other for the patient. A strict observance of this rule will cause us to analyze disease more carefully, and study to better advantage our therapeutic resources and the value of remedies. In this way we will not only cease over-drugging our patients, much to their satisfaction, but will also attain much better success. It surely must be a source of extreme regret to every conscientious physician, to reflect that he has by the injudicious use of remedies arrested some natural process that was proving curative, or set up some morbid one that, if it did not lead to a fatal termination, would protract the disease.
We will do well to bear constantly in mind that at least eighty per cent of cases of sickness would recover without medicine, and that these we can not cure, our efforts being directed to shortening the duration of disease. If the mortality in our practice exceeds this, we had better use placebos, and abandon medicine; and inasmuch as it falls short of twenty per cent, there is a saving of life by our endeavors.
As regards my own experience, I find that I used as much medicine in my first year's practice as I did the fourth and fifth years, though my business had been more than quadrupled. Now I strictly adhere to the rule laid down, and find myself getting along with little medicine, even though my therapeutic knowledge has been increased a hundred-fold.
Large quantities of medicine are frequently given when a small quantity would answer a much better purpose. Take quinine, for instance; how often do we see it given to the extent of five or six grains daily, for weeks, in intermittent fever, and for many days in remittent. It is given in doses too small to do any good, and their repetition never increases the action of the remedy to such an extent as to get the desired influence. If we now give fifteen or twenty grains within four hours we will effect the desired results. Again, how frequently do we witness opium and morphia administered in broken doses to produce sleep, very large quantities being given without effect, when if given in one dose at the proper time, one-fourth of the quantity would have sufficed.
Some remedies exert a better influence in small doses, as of aconite, veratrum, gelseminum, belladonna, etc. Twenty to thirty drops of the tincture of aconite root to four ounces of water, in teaspoonful doses every hour, is much more efficient as a sedative than five drops every three hours, twenty drops of tincture of belladonna to four ounces of water, in teaspoonful doses every two hours, will relieve pain and irritation of the nervous system better than ten times the quantity. I do not desire to run this into Homeopathy and infinitesimal doses, but there is sufficient in it to demand the consideration of all practitioners. Sometimes, then, we find that we give less medicine by giving it in large doses, and at others by giving it in minute doses.—SCUDDER, Eclectic Medical Journal, 1864.