The Form of Medicine.
The common action of many medicines obtained in the old practice is the poisonous action. The agent is given in such large closes and is so nauseous, that the human body in self-preservation is forced to act upon and expel it. Thus, an emetic forces the stomach to an act of expulsion, and we have emesis; a cathartic influences the intestinal canal in like manner and we have catharsis; and so with diaphoretics and diuretics. A different class, which may be represented by mercury, antimony, and arsenic, obtain entrance to the blood, and depressing this, they depress every manifestation of life until they are finally slowly removed.
It we desire to obtain these grave influences of medicine, the form is not particular, neither is the size of the dose—if the patient can stand it. But if we desire that slow, insensible, but direct action that I have spoken of, we want our remedies in such form that they will be kindly received and have a kindly action upon the organism.
We have also to take into consideration the preservation of the article, uniformity of action, pleasantness to the sick, portability, and ease of prescription. These hold a secondary place, yet are very important.
A class of remedies may be regarded as chemicals, and these we desire in greatest purity, and only purchase such as bear the names of the best manufacturers. Such are Quinia, Morphia., Sulphite of Soda, Phosphate of Soda, the Bromides, etc.
The largest class is obtained from the vegetable world, and are products of nature's laboratory. These we wish unchanged by art, as nature has prepared them, simply reducing the bulk, and using a vehicle to preserve them.
Very certainly the best menstruum for all vegetable remedies is alcohol and water in varying proportion. There is no vegetable product that does not yield its medicinal properties to these, in a very concentrated form, the alcohol being in sufficient proportion for preservation. Not only so, but with modern apparatus for percolation, the fluid may easily represent the strength of ounce for ounce, giving sufficient concentration to make it portable.
The tincture thus prepared is miscible with water, which is undoubtedly the best vehicle for the introduction of a remedy into the blood. In using a hypodermic injection, we employ water as a vehicle for the medicine, and not simple syrup, syrup of lemon or ginger, an extract of quassia or other nasty substance, and so in introducing remedies into the circulation we will find water decidedly the best vehicle.
Remedies in pura naturalibus are not offensive, it is the covering them up, and mixing them that makes them unpleasant. Doctors' potions are proverbially nasty, and the public mind has been cultivated to believe that a mixture in a bottle must be an offence to smell, taste and stomach. The thoughts of such medicines are enough to make some sick.
My prescriptions are uniformly made with water as a vehicle, the tincture being added to it in such proportion that the dose will be a teaspoonful. If the tinctures are carried in the pocket case, we add them to a glass of water in proper proportion, and renew the medicine at each visit that it may be fresh.
In the treatment of diseases of children this extemporaneous dispensing is especially desirable. Children are naturally adverse to anything unpleasant, and one ordinary drugging is sufficient to "put them against medicine." It is very unpleasant to be required to force medicine upon a child against its wishes, still more to throw it down, hold it forcibly, and grasping its nose make it swallow the mixture. No wonder parents turn from such practice to Homoeopathy.
It has been my practice to have the little patient see all the operations of preparing the medicine. It sees the pocket case, inspects the bottles, and is convinced that everything is clean and there is nothing objectionable. The glass of water is placed before it, and the few drops of medicine added, and to the request, "My dear, taste this and see if the medicine is not good," it offers no objection, is satisfied, and you have obtained the little patient's confidence, and will never lose it until you abuse it.
The Dose of Medicine.
As a rule, the dose of medicine should be the smallest quantity that will produce the desired result. The proper dose, or that which gives the best result, is very much smaller than one who has been used to the large doses of indirect medicine would suppose possible. Yet it is not infinitesimal, as our Homoeopathic friends would have us believe. It is difficult to state what the dose should be as yet, but I believe those named in connection with the remedies are the maximum.
A few examples may serve to illustrate this. In the olden time we thought the dose of a strong tincture of Macrotys was from half to one teaspoonful, repeated every two or three hours, until "the head felt like bursting." I now find the remedy much more certain in the proportion of ʒj. of the tincture to water ℥iv. a teaspoonful every two hours. The common directions for using Veratrum (Norwood's Tincture) were to commence with a dose of three drops every three hours, increasing one drop each hour, until its full effect was produced. Now the dose is always less than one drop. Aconite was formerly given in doses of drops, now in fractions of drops.
The dose will vary in different cases, and with different practitioners. If it falls below the grass or poisonous action of the drug, it will have specific influence, and the diagnosis being right, will accomplish the object of the prescriber. I am satisfied that the size of the dose does not make such difference as has been thought, and that the essential element of success is to get the right remedy.