The employment of drugs in ordinary or in large doses for their physical, chemic, or physiologic action is a procedure so well established in therapeutics, and so well borne out in the common experience of all ages, that a defence of such a rational use of remedies is not necessary.

The question of the natural limitations of such a line of therapy is a pertinent one, however. From time to time new theories have arisen, tending either to limit or to eliminate such a use of drugs. These theories or systems of therapeutics usually possess some degree of truth and one-sided merit, but they unite in a superlative elaboration of the symptomatology of disease processes as a guide in the selection of the indicated remedy, and they minimize the known physiologic actions as an indication towards the selection of the proper drug to meet the pathologic change underlying the symptomatology. Like the systems and theories of other branches of science, these well-meant efforts need not meet with pedantic condemnation, especially since certain abuses and\ overstatements have been corrected and our therapeutics tempered by reason of the discussions engendered by them. What, then, are the limitations naturally surrounding our use of remedies in the usual doses of the books and for their generally recognized physiologic actions?*

First, as regards the mechanical action of remedies little need be said, since there is substantial agreement as to such indications. The wonderful advances in surgery and mechano-therapy have rendered unnecessary many of the old procedures, and advances in drug therapy have largely eliminated mechanical emesis, bulky protective agents, demulcents, escharotics, and diluents.

Chemically considered, a wide field is opening up. The physiologic chemist has pointed the way to much of therapeutic value. Antacids, antilithics, and the oxidizing agents constitute the grosser chemic instances in therapy, but Rademacher, Grauvogel and the more recent investigators have been eager to give a chemic basis to much of therapeutic import.

The "Biochemic" theories of Schuessler open up a promising field worthy of more conservative investigation. At present, the studies he has made concerning the lack of various tissue salts in certain diseased conditions have been given a vitiated application by very "high potency" enthusiasts. Naturally, it requires a fairly tangible amount of any substance to supply a chemical deficiency, and even if the "law of similars" be admitted to apply in other directions, it is evident to any chemist that the tissue salts do not operate within such limitations.*

Schuessler is probably correct in some of his deductions, and the administration of material doses of his remedies constitutes an accessory to other treatment worthy of intelligent observation and studious employment. The various salts of calcium, potassium, iron, magnesium, sodium, and silica should have a well defined place as tissue foods.

The recent advances in chemic physics prompted by the investigation of radium and radioactive substances, and proving that molecules or atoms are not the ultimate subdivisions of matter, put us very much "at sea" as to some problems of vita chemistry. There may be many things undreamed of in our erstwhile chemic philosophy. If, after all, it is the electron and not the molecule that is active, we have been adding an excess of reagent to the human test tube in the reactions we endeavor to bring about by many of our drugs.

* The question of the natural limitations of the small dose is quite as important as is that of the large dose. It is to be hoped that all physicians who employ remedies for their actions in small doses may never be so attracted by the arguments in favor of such procedures as to neglect the rational and eminently necessary use of the large doses when they are indicated.

In view of the distressing emergencies confronting the practician so frequently and because of the marked sthenic character, or the malignancy of many cases of illness, it would be folly to uniformly depend upon small doses.

* The so-called "high potencies" are not based upon any tangible laws of physics, nor upon true chemical philosophy. "Potentizing" or "dynamizing" a drug through a line of attenuations is a theory at present given but limited application in the school of its origin. The author has given true Homeopathic 3X dilutions strictly according to their indications and compared results with his own admixture of I part of the mother tincture with 9'719 parts of alcohol. The therapeutic results have been identically alike. The same has been done with IX and 2X dilutions.

It is very rarely that any substance used in medicine will give tangible results in doses less than 1-1000 grain, or 1 grain of a 3X trituration. A 30X trituration in which one grain of the crude drug is contained would require of milk sugar sufficient to weigh eleven times as much as does the earth. Very few Homeopaths exceed the 6x with toxic drugs or the 3X with the ordinary run of drugs.

It is quite probable that an overwhelming dose of any remedy given for a chemic action is very seldom indicated except to antidote poison or to neutralize acids or alkalies. Iron, arsenic, phosphorus and other drugs act only in minute doses with any kindliness at all, and an excess is eliminated, unchanged, or but slightly changed. An excess of drug is liable to become an irritant and interfere with the elimination of the products of retrograde tissue metamorphosis. As an instance, it may be said that the salts of mercury induce the same general results, varying in the time element as regards their dissociability or according to the degree of minuteness of their absorbable particles.*

Many authorities claim that the chemic actions of drugs are much more prominent than their so-called vital actions. It is not always the more gross chemic action of acid and base, oxidation or interchange, but rather a certain affinity of the drug for some form of living protoplasm. When such drug action is sought, it is well to remember that in large dose most active drugs may be classed as poisons to a certain degree and that most poisons act upon a narrow area in minute doses but extend this area in large doses. This proposition cannot be too strongly emphasized, and certainly if our therapeutics is ever to become direct and definite, we desire drug actions limited to very definite and direct indications. Right here an important distinction must be made. The chemic action of drugs is quantitative rather than qualitative. while the vital action is qualitative rather than quantitative. As a general proposition, there are a few exceptions to this statement, but yet it very largely covers the case and applies to small dose therapy with peculiar force, in that when we give a remedy for its ultimate chemic action, the dose is a most important element and we must most carefully adjust that dose to the demands of the tissues we desire to reach and not give sufficient to overstep this narrow area and influence other tissues that might be harmed thereby. A small dose of a drug may act upon the medulla, but in larger dose extend its action to the cord and the cerebrum. Even protoplasmic poisons which paralyze any structure if exhibited in large quantity, yet invariably influence some special organ more particularly. This is a general rule in chemic reactions and cannot be safely deviated from in chemic therapeutics. Therefore, "a shotgun prescription" may contain only one substance if it is in too large dose and is consequently aimed at several organs instead of one.