This section is from the book "A Practitioner's Handbook Of Materia Medica And Therapeutics", by Thos. S. Blair. Also available from Amazon: A Practitioner's handbook of Materia Medica and Therapeutics.
As we have drugs whose primary or direct actions in small doses cover a wide field, there is comparatively little occasion in routine practice to impose upon debilitated and chronic cases the large doses so useful in emergency and so often necessary when immediate results are imperative.*
Regarding the proposition that the vital action of drugs is qualitative rather than quantitative, the practical outcome is that the important matter in selecting a remedy for its vital action is to select the right drug. The dose should be the least amount meeting the indications adequately. Some of these doses will be large, but the majority need be but small.
The action of the fluids of the body upon drugs administered should ever be kept in mind. A great many are carried to the liver and destroyed or modified before they can influence the tissues at large to any appreciable degree; or they are detained in the liver and gradually escape into the system. This well-known fact suggests that nature is wiser than we are in the selection of remedies and expects the liver to nullify the effects of our misdirected medication, or that we should not administer in large doses the substances this organ intercepts. The study of the vital or the physiologic actions of drugs is one so involved as to present peculiar difficulties. Prof. Cushney tells us that "Pharmacology is the study of the changes induced in living organisms by the administration in a state of minute division of such unorganized substances as do not act merely as foods. . . or, the study of the organism rendered abnormal by drugs." *
* It is estimated that it is possible to physically divide one grain of a substance into one hundred million particles by solution or by long continued trituration; therefore, one grain of an 8x trituration can theoretically contain one particle of the drug. Division into molecules is not regarded possible by most physicists, either by solution or by trituration.
* In order to attain satisfactory results with remedies for their indications in small doses, very discriminating diagnosis is absolutely essential. When we give doses so small as to get only the primary action of a drug, we do not get the general effects upon the system noted in the action of large doses. In most instances, overwhelming drug action is not to be desired, but if one expects success with small doses he must weigh carefully the pathology and symptomatology of each individual case. It is not successful when one is prescribing at the flame of some disease, but the results are eminently satisfactory when the patient in ail his bearings is prescribed for and then carefully watched. Care should be taken in estimating the subjective phenomena not to lay undue emphasis upon pain. One needs to learn a good deal over again and attain familiarity with data to be elicited from careful inspection of the tongue, pulse, mucous surfaces, superficial vessels. eyes, the appearance of the skin. etc. It is well to learn how to use a few drugs for a few definite indications and then add gradually to one's stock of well-digested information.
It will soon surprise an erstwhile routine prescriber how soon he begins to note the little things in diagnosis and drug action and to relieve conditions in which he had previously failed.
* Arthur R. Cushney, M.D., "A Textbook of Pharmacology and Therapeutics." Lea Bros. & Co., Philadelphia.
The study of these changes is sometimes made with healthy men as the subjects, but usually the lower animals are employed. The data secured are principally objective. Homeopathic drug provings are practically studies in pharmacology, but they are made exclusively upon healthy human subjects and by the internal administration alone. The data secured are largely subjective, but in part objective. In both methods very material doses are employed. It is very much of a question just how far our therapeutics should be influenced by either one of these methods. Both are partial and may lead to equally fallacious reasoning.
In a laboratory it is very convenient to employ the lower animals for experimentation, and the data secured possess a certain scientific value, but it demands no argument to prove that additional experiments upon man are necessary before a clinical significance can be attached to them. Somewhat unfortunately, the pharmacologists convey the impression that only the more recent laboratory views of therapeutics are worthy of consideration, while the practical men in their round of visits get the impression that pharmacology is the science of destructive criticism as applied to drugs. Pharmacology is destined ultimately to place upon a more certain basis much of our practice, but as yet it is altogether too academic to ride roughshod over established therapeutic procedures rendered definite by the bedside observations of thousands of careful practitioners. The influence of a drug upon a sick man may be very different from the action of the separated active principle hypodermatically administered to a healthy frog or guinea pig.
On the other hand, pharmacology emphasizes one of the important sides of therapeutics practitioners are inclined to neglect, when it insists that we do not give drugs simply to influence diseased organs directly, but rather to influence healthy ones, since that action is the more certain one. In part, the idea is most excellent. In cardiac valvular lesions we cannot restore the valve, but we can influence the healthy heart muscle with our drugs; and in kidney diseases we can rest these organs by stimulating the skin; but we cannot make the intestines digest proteid, the medulla conduct the functions of cerebration, the spleen look after the glycogenic function, or the motor nerves conduct sensory impulses. As to the action of remedies themselves, we observe that most antipyretics reduce temperature in fever but not in health, the bromides inhibit convulsive action in epilepsy, but do not depress healthy brain tissue. Such data could be given quite in extenso, much to the discouragement of pharmacologic theories.
Homeoopathic drug provings possess more scientific value than is accorded to them in regular medicine. They are verified characteristics of drugs determined by most self-sacrificing investigation upon the part of many individuals of varying temperament. They are the complement of laboratory data upon physiologic actions of drugs. It takes both of these methods, tempered with the data secured from the ranks of the clinicians, to arrive at a working scheme of physiologic actions. Such a combination idea of physiologic actions is the real basis of most successful practice in all schools of medicine. After one has been for years engaged in active practice and has learned the more important end of therapeutics, an honest introspective inquiry will show to any physician other than a hopeless routineist, that he takes the subjective element into account nearly as much as he does the objective in prescribing for his patients. A successful man must do so.