Chapter XIII — Homoeopathic Posology

By posology (from the Greek, posos, how much) we mean the science or doctrine of dosage.

Small doses and homœopathy are commonly regarded as synonymous terms. If they who have such an idea of it are favorably inclined toward homœopathy, it is as likely to be because they have heard that the medicines are "pleasant to take" as for any other reason. While such an impression, taken with what, it involves, is not altogether undesirable, it is to be regretted that a broader basis of judgment has not been furnished by those whose duty it is to instruct the public in the principles of homœopathy. Had this been done such a juvenile conception would not exist, and homœopathy would be more widely appreciated.

It is not to be denied that the subject of the dose in homœopathy is a very important one. The three essential elements of the system are the principle, the remedy and the dose;-and the three are of equal importance. Posology, and the related subject of Potentiation were the subjects of so much misunderstanding, discussion and controversy in the early - days of homœopathy that the profession, after being divided into two opposing camps grew tired of the subject. It came to be regarded as a kind of "Gordian Knot," to be cut by each individual as best he could with the instrument at his disposal. Hahnemann himself at one time, almost in despair of ever being able to bring his followers to an agreement on the subject, cut the knot by proposing to treat all cases with the thirtieth potency. Following this suggestion others tacitly adopted a dosage confined to one, or a very limited range of potencies. The materialistically minded restricted themselves to the crude tinctures and triturations, or the very low dilutions, ranging from 1x to 6x. Others ranged from the third to the thirtieth potencies, while another small class of metaphysical tendency used only the very high potencies, ranging. from the two hundredth to the millionth, each according to his personal predilection.

Such a state of affairs is unfortunate. Assuming that there is a difference in the action of the various doses of medicines, and that a series of potencies or preparations of the different medicines has been available for use; it follows that the entire series should be open to every practitioner, and that each man should be competent, willing and ready to use any potency or preparation of the remedy indicated in a given case, without prejudice. If he confines himself to one or two potencies, be they low, medium, or high, he is limiting his own usefulness and depriving his patient of valuable means of relief and cure.

Under homœopathic principles any potency may be required in any case. It is as unreasonable to expect to cure all cases with any two or three potencies as it is to expect to cure all cases with any two or three remedies. In either case, those who follow such a course are governed more by the love of ease and their prejudices than they are by their desire for efficiency.

The selection of the dose is as much an integral part of the process of making a homœopathic prescription as the selection of the remedy, and often quite as important. A well selected remedy may fail utterly, or even do injury, because of wrong dosage. Dose as well as remedy must be adjusted to the patient's need.

The homœopathic doctrine of dosage, like the law of cure, was based upon the discovery of the opposite action of large and small doses of medicine. It is another application it medicine of, the Law of Mutual Action - the third Newtonian law of motion - "Action and Reaction are Equal and Opposite." Every one at all acquainted with the action of drugs knows, for example, that Ipecac in large doses causes nausea and vomiting and in small doses, under certain conditions, will cure the same; that Opium in large doses will cause a deep sleep or narcosis, arid in small doses, under certain, conditions, will cure the same.

Closely allied to this is the so-called primary and secondary action of drugs, in, which we see many drugs, in the first or primary stage of their action producing one group of symptoms, and in the second stage a directly opposite set of phenomena; as when the deep sleep of the primary action of Opium is followed by a much longer lasting wakefulness; or where the diarrhea induced by a cathartic is followed by a longer lasting constipation. This applies, of course, only to drugs given in tangible form and considerable quantities, in what are called "physiological doses."

Although the physiological antagonism between large and small doses is an illustration of the homœopathic law of posology, the use of drugs in "physiological doses" has nothing to do with their homœopathic use, because homœopathic remedies are never used in "physiological doses." This statement is true, even in those cases where the low reacting power of the patient some-, times requires material doses of the homœopathic remedy. It would be more accurate to say that homœopathic medicines are never used for their "physiological effect."

It is necessary to a clear understanding of the subject that a distinction be made between three terms, physiological, therapeutic, and pathogenetic, used by the two schools of medicine to express the nature of the action of the drugs. There is a demoralizing tendency even in the homœopathic school to use these terms without discrimination.

The word "physiological" as currently used in medicine in relation to drug action and dosage is misleading and inaccurate, The Word has a reassuring sound, pleasantly suggestive of something normal and healthy. Its use tends to obscure, or keep in the background, the fact that the kind of drug action so designated is essentially a toxic action and therefore really painful and injurious.

The "physiological action" of a drug is not its therapeutic or curative action. It is exactly the opposite of a curative action., and is never employed in homœopathic practice for therapeutic purposes. The use of the word "physiological" in connection with drug action and drug dosage tends to mislead the unwary and justify the use of measures which would otherwise be regarded as illegitimate. In one word, is it a euphemism. Inasmuch as the action of the '.'physiological" dose and the purpose for which it is given is avowedly to produce drug symptoms, in, a direct and positive manner, that fact should be clearly expressed in the name,' in order that there may be no misunderstanding.

The homœopathic school has recognized the wisdom and justice of taking this position, and has complied with the requirements of scientific accuracy in nomenclature by the adoption and use of the word "pathogenetic" (Gr., pathos, suffering, and genesis origin, "producing suffering") as properly describing the character of such drug action. The "suffering" of the organism produced by the drug is expressed in symptoms, which are the language of disease. In homœopathic parlance, therefore, these are termed "pathogenetic symptoms," a term which is preferable because it is accurate and truthful.

Therapeutic means curative, healing, alleviating. A pathogenetic action is never curative. The action of a drug may be pathogenetic (toxic), or therapeutic (curative), depending upon the size and strength of the dose, the susceptibility of the patient and the principle upon which it is given.

In the homœopathic treatment of disease a drug is never given for its pathogenetic action. Pathogenetic doses may be given, however, for experimental purposes to a healthy person, in making what are called provings. In treating disease homeopathically the object is not to produce symptoms but to "remove them. By means of the similar remedy in the minimum dose it is possible to do this in a direct manner without producing symptoms. It is not necessary to resort to the indirect, antipathic or allopathic method of producing drug symptoms in one part to remove a disease of the same, or any other part, and therefore it is not necessary to use "physiological" or pathogenetic doses. The homœopathic cure is obtained without suffering, without the production of any drug symptoms, in a positive and direct manner, by the action of sub-physiological or sub-pathogenetic doses; in other words, by the minimum dose, which is a dose so small that it is not capable of producing symptoms when used therapeutically. Homœopathy requires that the therapeutic dose must be capable only of producing a slight temporary aggravation or intensification of already existing symptoms, never of producing new symptoms. Only the similar remedy, in the. smallest possible dose, is capable of bringing about this highly desirable result. By this means the patient's strength and vitality are conserved, his suffering quickly reduced to the lowest possible degree and a true cure brought about, if the case has not passed beyond the curative stage. It is not to be understood that infinitesimal doses are not capable of producing symptoms in healthy susceptible persons; for that is not true. Infinitesimal doses will produce symptoms in certain highly sensitive persons, and many of our most valuable provings have been made with more or less highly potentiated medicines. Indeed, no remedy can be regarded as having been thoroughly proven until it has been proven in the potencies as well as in crude form.

In ordinary usage a physiological dose means a dose of a drug, empirically selected, of sufficient quantity and strength to produce a definite, predetermined effect or group of symptoms. Practically it amounts to the maximum dose consistent with safety. A physiological dose of Atropine or Belladonna, for example, is one sufficient to produce dilatation of the pupils, dryness of the mucous membranes and flushing or turgescence of the skin. The action of the drug is carried to this point irrespective of any accessory symptoms that may be produced, or as to whether it is curative or otherwise. No other kind of action is looked for or expected and, as a rule, it is not recognized if it occurs. The intent is to produce a direct definite drug effect. That other effects not desired nor needed are produced incidentally, does not matter. They are left to take care of themselves, and it is not considered that they complicate or prejudice the case if they occur.

In attempting to predetermine arbitrarily the size and strength of the physiological dose, allowance is made only for difference in the age of the patients, who are roughly divided into two classes, infants and adults. If a patient is unable to take the established or usual doses without serious results, it is considered to be a case. of idiosyncrasy or hypersensitiveness and some other drug is substituted.

Unlike the homœopathic physician, the allopathic practitioner is not trained to observe the finer, more delicate action of drugs upon the living organism and he does not, therefore, recognize the symptoms expressing such actions when they occur. From this point of view such symptoms, so long as they are not serious, are of no importance and have no use.

In considering the reasons why the dose of the medicine chosen homeopathically is necessarily smaller than the physiological dose of antipathic or allopathic prescription, we meet first the fact of organic resistance.

Every living organism is endowed with an inherent, automatic power of reaction to stimuli. By means of this power the organism offers resistance to everything which tends to injure or destroy its integrity or disturb its normal functioning. Resistance is manifested by suffering pain, fever, inflammation, changed secretions and excretions, etc.

This power is displayed when drugs are administered because drugs are inimical to health, in proportion to their power and the size of the dose. In order for a dissimilar drug to produce its so-called physiological effect, therefore, the dose must be large enough to overcome first, this bodily resistance; and second, to produce its characteristic symptoms.

When the similar or homœopathic drug is administered in disease, little or no resistance is encountered because the sphere of its action has already been invaded and its resistance overcome by the similarly acting disease producing agent. The affected organs or tissues are open to attacks from without. Susceptibility to the similar drug is therefore greatly increased.

The homœopathic drug acts upon the identical tracts involved in the disease process, in a manner similar to the action of the disease producing cause itself. In order that the suffering of the affected organs may pot be increased and the patient injured, a much smaller dose must be given.

The homeopathic dose, therefore, is always a sub-physiological or sub-pathogenetic dose; that is, a dose so small as not to produce pathogenetic symptoms; for we desire, not to produce more symptoms, but only to remove and obliterate symptoms already existing. It must also be given in a dose so small, as not to produce a severe aggravation of the already existing symptoms.

Another reason for the small dose lies in the fact that disease renders the affected parts abnormally sensitive, as we see in an inflamed eye, which is painfully sensitive to a degree of light to which it reacts, normally in health..

A third reason is that the homeopathic drug is always given singly, so that its action is complete and unmodified by other drugs.

Homœopathists do not say, vaguely, that medicines in infinitesimal doses cure disease unconditionally. The proposition is that medicines act curatively in infinitesimal quantities, when given in cases to which they are homeopathic And they still further qualify this statement by laying down three, necessary requirements for such action:

1. The development of special virtues in medicine by a peculiar process of preparation, or potentiation.

2. The increased susceptibility to medicinal impression produced by disease.

3. The selection of the symptomatically similar remedy.

They affirm and stand ready to demonstrate that an infinitesimal dose of medicine has power and that it acts as a force; but in order that the force should be medicinal, or curative, a condition of application is necessary; namely, that it be applied in accordance with the homœopathic law.

Force, to be effective, must be supplied not only in proper amount, but in the proper direction and at the proper time.

The proper amount of a drug to be administered in a given case can never be settled by a priori reasoning, but only by experience; and thus it has been settled. Those who hesitate to try the infinitesimal doses of homœopathy on the ground of improbability, should be reminded that an infinitesimal quantity is a quantity. It cannot be thought of as nothing. Hear Hahnemann's reply to those who railed at the infinitesimal dose as "Nothing," and "Absurd."

"How so? The smallest possible portion of a substance, is it not an integral part of the whole? Were it to be divided and redivided even to the limits of infinity, would there not still remain something,-something substantial, - a part of the whole, let it be ever so minute? What man in his senses would deny it?

And if this be in reality an integral part of the divided substance, which no man in his senses can doubt, why should this minute portion, as it is certainly something, be inactive, while the whole acted with so much violence?"

Hahnemann's final views and practice in regard to the dose were arrived at gradually, through long years of careful experiment and observation; at first, even for some time after the promulgation of the law of similars and the method of practice based upon it, he used medicines in material doses and in the usual form. His discovery of the principle of potentiation came about gradually as he experimented in the reduction of his doses, in order, to, arrive at a point where severe aggravations would not occur. Gradually, by experience, he learned that the latent powers of drugs were released or developed by trituration, dilution and succussion. Thus he arrived at his final conclusion that the proper dose is always the least possible dose which will effect a cure.

Having now a general view of the principles underlying the question of the dose, and a general standard by which to test results, it is desirable to try to formulate some rules, based upon experience, to govern us in the selection of the proper dose for a particular case.

The question seems more complex now than it was in Hahnemann's day, but really it is not so. The same principle applies now as then. For the greater part of his life Hahnemann had only what we now call the lower potencies; namely from the first to the thirtieth; although in his later years he was enabled to procure and use some of the higher potencies. Bœnninghausen wrote that Hahnemann had repeatedly stated to him that he generally used the sixtieth dilution, and that he often used much higher ones with great satisfaction. Bœnninghausen also states that Hahnemann, in correspondence with him, was much interested in the experiments of Bœnninghausen and Gross with the high potencies and heartily Approved of the same. It was repeatedly stated that Hahnemann would deal with this subject in the forthcoming sixth edition of the Organon, a work which unfortunately never saw the light until 1922.

Since Hahnemann's day the potency makers have been busy and we now have potencies ranging up to the millionth centesimal, and ever higher. Men with the confidence, courage and zeal to experiment with these altitudinous preparations and publish their results have not been lacking. Physicians of unquestioned honesty, ability and experience have testified that, they obtained curative results from the use even of the very highest potencies. It is not just for us to question this testimony until we have put the matter to the test. In the light of experience and of recent revelations in other departments of science of the power of the infinitesimal, there is nothing inherently improbable about it, and it is unquestionably to our advantage to have as large an armamentarium as possible.

The great bulk of the work of the profession, however, is done with the lower and medium potencies and these, if accurately prescribed and wisely managed, will give satisfactory results in the great majority of cases. The third, sixth, twelfth and thirtieth potencies with a set of the two hundredths to "top off with" gives a general working range. When the young practitioner can afford to add to these a set of BOERICKE & TAFEL's hand made five hundredths and one thousandths, he will be well equipped indeed. The rest is "velvet;" but if anybody should offer him a set of Fincke's, Swan's or Skinner's fifty thousandths and one hundred thousandths, he should not let his modesty nor his prejudices prevent him from accepting and trying them. Hundreds of practitioners, including the writer, have used them with great satisfaction.

Choosing the Potency

Now is there any teaching which will help us to choose the best potency for a given case? There is little teaching but many opinions. Practitioners who publicly boast of their liberality on this subject, will too often be found, on more intimate acquaintance, to practice an obstinate exclusivism in the use of some particular potency, generally a very low or a very high one; and to harshly criticize those who differ with them. This is unfortunate, because such practitioners undoubtedly deprive themselves and their patients of many agents of cure which are easily within their reach.

The series of potencies has been compared to the gamut in music, "A skillful artist may indeed construct a harmony with the various vibrations of the same chord; but what a more beautiful and perfect harmony might he construct by a proper combination of all the sounds that can be elicited from his instrument." (Guernsey.)

In general it may be stated that any curable diseases may be cured by any potency, when the indicated remedy is administered; but that the cure may be much accelerated by selecting the potency or dose appropriate to the individual case

Five considerations influence us in the choice of the dose:

1. The susceptibility of the patient. 2. The seat of the disease. 3. The nature and intensity of the disease. 4. The stage and duration of the disease. 5. The previous treatment of the disease.

Susceptibility of the Patient

This is generally and rightly regarded as the most important guide in the selection of the dose. It is important to have some means of gauging, at least approximately, the susceptibility of a patient.

Susceptibility to medicinal action is only a part or phase of the general susceptibility of the organism to all stimuli. By analogy, as well as by experience, we are led to a consideration of the main factors -which modify and express susceptibility in general.

Susceptibility varies in different individuals according to age, temperament, constitution, habits, character of diseases and environment.

The susceptibility of an individual to a remedy at, different times also varies. Idiosyncrasy may exist as a modifying factor. Homeopathicity must always be considered.

The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy, and the higher the-potency required.

The "Indefatigable Jahr" has very lucidly and beautifully illustrated this point. He remarks an essential difference between the action of the low and high potencies, which consists, not in their strength or weakness, but in the development of, the peculiarities of the remedy, as we rise in the scale of potencies. This is based on the well known fact that provings of the tincture and lowest potencies of a drug, -as a rule, produce only the more common. and general symptoms of the drug, not very sharply differentiated from other drugs of its class. It is in the provings of the medium and higher potencies that the special and peculiar character of the drug is revealed by its finer and most characteristic symptoms. Jahr illustrates this by a geometrical figure, consisting of a number of concentric circles, with radii drawn to represent remedies in different stages of potentiation.

In the first to the third potency, as shown in the innermost circle where the radii he close together, similar or related remedies like Arn, Rhus, Bry and Sulph have a great many symptoms in common; but the higher they progress in the scale of potentiation the more the radii recede from each other, so that each appears more and more distinctly in its peculiar and characteristic features.

All narcotics, like Bell, Stram or Opium, for example, in crude and massive doses act in a manner equally stupefying, causing death by apoplexy or paralysis; all drastics produce vomiting and purging, etc. It is only in small or potentiated doses that their most characteristic differences of action become apparent.

"By continual diluting and succussing," says Jahr, "remedies get neither stronger nor weaker, but their individual peculiarities become more and more developed;" in other words, their sphere of action is enlarged, as represented by the concentric circles.

The practical bearing of this on the selection of the potency or dose, according to Jahr, is as follows: - In a given case, where the symptoms are not clearly developed and there is an absence or scarcity of characteristic features; or where two or three remedies seem about equally indicated, susceptibility and reaction may be regarded as low. We give, therefore, the remedy which seems most similar, in a low (third to twelfth) potency. But, when most symptoms of a case clearly indicate one remedy, whose characteristic symptoms correspond closely to the characteristic symptoms of the case, we give the high potencies - thirtieth, two hundredth, thousandth, or higher, according to the prescriber's degree of confidence and the contents of his medicine case.

We may slightly modify Jahr's advice by suggesting; the clearer, and more Positively the finer, more peculiar and more characteristic symptoms of the remedy appear in a case, the higher the degree of susceptibility and the higher the potency.

This rule covers more points of the requirements to be stated later than appears at first glance. The class of cases (to be described later) which require low potencies for their cure, do not as a rule present the finest and most characteristic shadings of symptoms which characterize the cases requiring high potencies, so that we may pretty safely judge the degree of susceptibility of the patient by the character and completeness of the symptoms.

Allowance should be made, however, for the varying ability of examiners. One man, keen of perception, accurate, painstaking, conscientious and well trained, will see many things in a case which another not so endowed will fail to see.

Susceptibility is Modified by Age

Generally speaking, susceptibility is greatest in children and young, vigorous persons, and diminishes with age. Children are particularly sensitive during development, and the most sensitive organs are those which are being developed. Therefore the medicines which have a peculiar affinity for those organs should be given in the medium or higher potencies.

Susceptibility is Modified by Constitution and Temperament

The higher potencies are best adapted to sensitive persons of the nervous, sanguine or choleric temperament; to intelligent, intellectual persons, quick to act and react; to zealous and impulsive persons.

Lower potencies and larger and more frequent doses correspond better to torpid and phlegmatic individuals, dull of comprehension and slow to act; to coarse fibered, sluggish individuals of gross habits; to those who possess great muscular power but who require a powerful stimulus to excite them. Such persons can take with seeming impunity large amounts of stimulants like whiskey, and show little effect from it. When ill they often require low potencies, or even sometimes, material doses.

Susceptibility is Modified by Habit and Environment

It is increased by intellectual occupation, by excitement of the imagination and emotions, by sedentary occupations, by long sleep, by an effeminate life. Such persons require high potencies.

Susceptibility is Modified by Pathological Conditions

In certain terminal conditions the power of the organism to react, even to the indicated homœopathic remedy, may become so low that only material doses can arouse it. A common example of this is seen in certain terminal conditions of valvular heart disease, where Digitalis is the indicated remedy, but no effect is produced by any potency. The patient will respond, however, to tangible doses of the pure tincture or, a fresh infusion of Digitalis and sometimes make a good recovery from a condition that seems hopeless. Although such doses, judged only by their amount, might be regarded as "physiological" or pathogenetic doses, the nature of the reaction in such cases is clearly not pathogenetic but dynamic and curative, as many have witnessed. The form of the reaction complies perfectly with the requirements of cure as to order and direction of the disappearance of the symptoms and nature of the result.

Quantity alone does not constitute a pathogenetic dose. Quality, proportionality and the susceptibility of the patient are also factors. What would be a large, injurious or perhaps dangerous dose f or- a highly susceptible patient, would have no effect whatever upon one whose power to react was very low by reason of the existence of gross pathological lesions, or of long existent, exhausting chronic disease and much previous treatment. It is solely a question of approximating the quality and quantity of the dose to the grade or plane of the disease, according to the law of similars. If the grade of the disease is low, and the power of reaction low, the remedy must be given low. Thus we find, in such cases, that the symptoms of the patient are usually of a low order; common, pathological symptoms; organ symptoms; gross terminal symptoms; symptoms that correspond to the effects of crude drugs in massive toxic doses. The finer shadings of symptoms belonging to acute conditions, in vigorous sensitive patients, do not appear. Potentiated medicines will not act. The case has passed beyond that stage, and the finer symptoms with it. Yet the symptoms remain and the almost hopeless conditions they rep resent, are still within the scope of the homœopathic law; and they sometimes yield to its power, when the related law of posology is rightly understood and applied.

So-called "pathological symptoms," when they exist alone, are as significant and characteristic in their way and may be as clearly indicative of a remedy, homeopathically, as the earlier, finer grades of symptoms. Whether they are as useful to the homœopathic prescriber or not depends upon the existence of similar symptoms in the Materia Medica. We can only prescribe for symptoms which have a counterpart in the Materia Medica. From the records of poisonings, over-dosing, and some extreme provings, as well as from clinical -experience, we have knowledge of some drugs whose symptoms thus derived, correspond very closely to the class of pathological symptoms under discussion. In the list of such drugs we may find one which fits our case. If that is not possible a study of the early symptoms from the history of the case, if they can be elicited, may lead directly or by analogy, to the remedy needed. When a case has reached a stage where none but gross pathological or organ symptoms are present, it is usually incurable; but it is not necessarily beyond help by medicines homœopathically selected, even if no results follow the use of the ordinary small doses or potentiated medicines.

In terminal conditions, therefore, when the patient does not react to well selected remedies, nor to intercurrent reaction remedies given in potentiated form and small doses, resort to the crude drug and increase the dose to the point of reaction.

When reasonably sure of the remedy give the tincture, or a low trituration, first in moderate, then in increasing doses until the dosage is found to which the patient will react,, even if it be the "maximum dose" as set down in the books. The "maximum dose" may be the "minimum dose" necessary to bring about reaction sometimes. It takes more power to. drive an automobile up a bill than it does on the level; and if the hill is very steep the driver may have to go backward on the road a ways and take "a running start," in order to gain momentum enough to carry him up. When he gets to the top of. the hill he can shut off power and coast" down the other side. That is what the homœopathic prescriber has to do sometimes, in the kind of cases under discussion.

This does not in the least degree invalidate nor violate the principle of the minimum dose in such cases, The principle of similia as applied in the selection of both remedy and dose is eternally and universally true. It is as true in terminal conditions in chronic diseases marked by gross pathological lesions and symptoms as it is in any other kind of cases. The homœopathic physician fails and falls short of his duty if, at such a crisis, he throws tip his hands and lets his patient die or pass into other hands; or if he weakly yields, abandons the principle of similia and resorts to the routine measures of allopathic practice, based upon theoretical assumptions. Occasionally an allopathic physician is called in who gives so-called physiological doses of some common drug and restores the patient. He merely does what the homœopathic physician should have the discernment and common sense to namely give the drug that is really homeopathic to the case, but give it in the stronger doses required at that stage of the case to excite the curative reaction. He does what the homœopathic physician is perhaps too timid, too ignorant or too prejudiced to do. Result: the allopath gets the honor, the family and the emolument; the homœopath "gets the laugh;" and homœopathy "gets a black eye." The occasional successes of allopathic physicians in such cases are nearly always accomplished with drugs which are essentially, although crudely, homœopathic. The homœopath who habitually uses high potencies is apt to forget or overlook the fact that a terminal case may reach a point where the symptoms call for material doses because the susceptibility is so low that it will react to no other, but will react to them.

Such a case occurred in the practice of the writer. It was a case of valvular heart disease of many years' standing, which had reached the stage of fibrillation. In a previous crisis it had responded to potentiated medicines. In this instance, however, potentiated medicines, selected with the greatest care, had no effect. An effort was made to arouse the dormant reactivity with intercurrent remedies, also in high potency. Laurocerasus, Carbo vegetabilis, Tuberculinum and Medorrhinum were given, as recommended by homœopathic authorities. All efforts failed and the case rapidly progressed toward dissolution. Tachycardia, arrhythmia, œdema, ascites, hydrothorax, passive congestion of the brain and liver, delirium, suppression of urine and coma foretold the rapid approach of the end. For a period of over three weeks the symptoms had positively and unmistakably demanded Digitalis; but doses ranging from forty thousandth down to drop doses of the tincture produced no favorable change.

At this point, by advice of an eminent allopathic specialist who was called in at the request of the family, full doses of a special preparation of Digitalis and a salt-free, liquid-diet were given. Within thirty-six hours the patient was passing over one hundred ounces of urine, in twenty-four hours, brain, lungs and liver rapidly cleared up and the case which had appeared absolutely hopeless progressed steadily to a good recovery.

The action of the Digitalis was clearly curative. No pathogenetic symptoms of any kind appeared, for the copious urine was distinctly a curative symptom. Only six doses of the drug were given, at intervals of twelve hours, and it was discontinued as soon as its full therapeutic action was established.

About one month later, it was necessary to repeat the medication in smaller doses a few times for a slight return of some of the symptoms, due to over exertion.