The Dose of Medicine.
Selected writings of John M. Scudder.
Related entry: The Dose of Medicine
Again does Prof. Scudder make a plea for smaller and more definite dosage. See also previous editorial on "The Dose of Medicine."—Ed. Gleaner.
THE DOSE OF MEDICINE.—The question of dose is one of very great importance to the physician, and it is well for each one to give it careful consideration. We find that most drugs vary in action according to the size of the dose, and with many the action of the small dose is directly the reverse of the large. It is upon this fact, to a considerable extent, that the Homeopathic practice is based. But it will not do to say that for each drug there is a large and a small dose, and two effects which are the opposite of each other, for this is not true of all, and is but a portion of the truth with regard to any. The facts are that many effects may be obtained from a single drug by simple variation of the dose.
The large dose is common to the Old-School and Eclectic branches of the profession, and the effects obtained are gross and unpleasant. It may be said with truth that the large dose is always poisonous, in that it produces effects contrary to the conditions of normal life. We get a better idea of this from giving the drugs to a healthy man. For instance, I give you half a grain of Podophyllin every three hours, and you are not long in finding out that its action is not conducive to health and comfort. It makes your bowels sick. If I give you freely of Comp. Powder of Lobelia, or of Jalap, you undergo a similar experience. Suppose we take the ordinary diaphoretics and diuretics instead; they are much milder, yet you find that even these cause disease. We change our program and give you Quinine, or even Hydrastis, and yet these tonics render you sick as well. Suppose we try Veratrum, Gelsemium, Aconite, etc., and still you get sick on the medicine, in place of increasing your health. We say that all medicines, used in large doses, will make you sick.
What answer will you make? That we cure disease by producing disease? Possibly not, though it is a well-known fact that diseases thus artificially produced will replace natural ones, and after a time, these subsiding, the patient will recover.
But I desire to call attention to the fact that most drugs used in large dose must of necessity do a wrong to some function or part, or to the entire life, and the effect is necessarily unpleasant. The sufferings from this gross drugging are fearful to think of, and in all probability will exceed the natural suffering from disease, and will many times exceed any other suffering to which civilized man is liable. If you are not able to realize this by looking at the sick, refer to some such sickness in your own person, and to your knowledge of the action of drugs upon your own body.
I do not wish to be understood as saying that this gross drugging will not cure disease, or that in some cases it is not the very best means at our command; but I do wish to say that in large dose drugs should be used with a great deal of care, and only when the effect is clearly known.
It will be noticed further that the statement made was, "that most drugs used in large dose must of necessity do a wrong to life." The exceptions are not very many, yet it is well to notice them. For instance, in certain affections the drug is antagonized by the disease, and even the large dose produces no unpleasant symptoms. Thus, in certain cases of periodic fever, a patient may take ten, fifteen, twenty, thirty grains, or even a larger quantity of quinine, without a single cerebral symptom. There are cases in which Tinc. Gelsemium may be given in half-teaspoonful or teaspoonful doses, and in cases of tetanus I have thus repeated it for days without unpleasant effects. In a case of angina pectoris, a patient will take without unpleasantness doses of Tinct Lobelia that under other conditions would not be tolerated. There is a condition of disease in which Opium or Morphia may be used in large dose without the slightest tendency to narcotism. The reader will have noticed these cases, and may have come to the conclusion from them that large doses are not injurious. Yet any one taking a second thought will see that it is only when the drug and the disease oppose one another accurately that this is the case.
Small doses influence the life as well as large ones, though of course the action is not so gross and decided. Even in small doses drugs will impair the life, though of course to a more limited extent. Thus in the use of the small dose there is less danger of doing the, patient an injury rather than a good. Small doses of drugs, if curative, must be selected with care, having reference to the location and kind of disease. That drugs are curative in small doses, is certified by thousands of the most accurate observers, and I conclude that the evidence is sufficient to satisfy the most incredulous.
The small dose is pleasant in form, and does no wrong to the sense of taste or smell, or to the stomach through which it must be absorbed. It does not increase the unpleasantness of disease, but on the contrary, being selected for its opposition to, it relieves the unpleasantness of sickness.
The small dose must act directly and specifically, if it acts at all. Any good from counter-irritation, revulsion, or the production of medicinal disease, is not possible. Indeed, the remedy is so opposed to the disease that the influence is wholly lost in its amelioration.
What is the small dose that I am speaking of? Let us say in gross, and with reference to a large majority of the strong tinctures of our vegetable materia medica, that it will be five to ten drops to four ounces of water; dose a teaspoonful. In acute disease we usually direct frequent repetitions of the medicine; in chronic disease it is not given so frequently. To unbelievers in this small dose, I advise some experimentation—not on the sick, but on yourselves. Add of Tinc. Aconite (root) five drops to four ounces of water, and take a teaspoonful every hour for a day, and see whether at the end you would like it stronger. Try Rhus Toxicodendron in the same dose, and see at the end of two or three days if more Rhus poisoning would be desirable. Try Tinct. of ! Nux in same small dose, and see if you would want any addition to the old-fashioned belly ache that grows from it. Try Tincture of Podophyllin, continued for ten days, and see if you would want it stronger. There is nothing like a personal experience in these things, to prove that our small dose is quite large enough.
But what shall we say of the infinitesimal dose of the Homeopathist? It is best to say nothing more than that we believe our small dose will give better satisfaction than the Homeopathic dose. It is not the part of wisdom to say that it has no curative action, for the testimony in its favor, both in character and numbers, is quite as good as our own. It is quite easy to say, "You lie, you rascal, you lie!" But there is no argument in it, and your opponent may retort with equal justice, "You lie, you ignoramus, you lie!"
"There are many things in nature not accounted for in my philosophy," but my experience in the practice of medicine for eighteen years proves to me that the dose of medicine should be the smallest possible quantity that will cure disease, and that it should be pleasant in form, direct in action, and as little capable of harm as is possible. If I were giving advice to the physician, it would be in Scriptural language— "Be ye therefore wise as servants, and harmless as doves."—SCUDDER, Eclectic Medical Journal, 1874.