The Homoeopathic Aggravation

When the chronic disease has not ultimated itself in tissue changes, you may get no aggravation at all, unless, perhaps, it be a very light exacerbation of the symptoms, and that slight exacerbation of the symptoms is of a different character….

A disease that is of no very long standing ordinarily yields without any great degree of suffering to the first dose of this remedy,” which is to say that in acute disease we seldom see anything like striking aggravation unless the acute disease has drawn near death’s door, or is very severe, unless it has lasted many days, and breaking down of blood and tissue is threatened, or has taken place. Then we will see sharp aggravations, great prostration, violent sweating, exhaustion, vomiting and purging following the action of the remedy I have seen most severe reaction which seemed to be necessary to recovery.

Such a state in acute disease where it has gone many days without a remedy and a great threatening is present will be to an acute disease what many years would be to a chronic disease of long standing. Long standing means as a matter of progress, if we say a disease of much progress, or of considerable ultimates, we understand it better. If the disease has ultimated itself in change of tissue, then you see striking aggravations, even aggravations that cannot be recovered from, such as we find in the advanced forms of tissue change, e.g., where the kidneys are destroyed or the liver destroyed, or in phthisis, where the lungs are destroyed.

A disease ought always to be well considered as to whether it is acute or chronic. Where there are no tissue changes, where no ultimates are present, then you may expect the remedy to cure the patient without any serious aggravation, or without any sharp suffering, for there is no necessity of reacting form a serious structural change. Where there is a deep-seated septic condition, where pyaemia must be the result, you will find sometimes vomiting and purging. As a reaction of the vital force of the economy when order is established, this order, which is attended by reaction, as it were, commences a process of house cleaning.

It does it itself, the drug does not do it; if a crude substance is used it is the action of the drug, of course, but the action of the dynamic drug is to turn the economy into order. So it is with chronic disease. When the chronic disease has not ultimated itself in tissue changes, you may get no aggravation at all, unless, perhaps, it be a very light exacerbation of the symptoms, and that slight exacerbation of the symptoms is of a different character.

It is the establishment of the remedy as a new disease upon the economy instead of the reaction which corresponds to a process of house cleaning. Elimination must take place, as we know, probably from the bowels, or stomach, by vomiting, by expectoration, or by the kidneys, in those cases where everything has been suppressed.

It may look like an aggravation when you have had for years a limb paralyzed from a neuritis. Suppose, after you administer a remedy that goes right to the spot, that is in the very highest sense homoeopathic, or truly specific, that paralyzed limb commences to tingle and creep like the crawling interiorly of ants, tingling sometimes from which he cannot sleep for days and nights. This is due to the reaction of the nerves of the part. They are called into new life, into activity.

I have seen this in paralysis. You take, for instance, a child who has lain in a stupor for a long time, from inaction of the brain, the tingling that comes in the scalp, in the fingers and toes is dreadful, the child turns and twists and screeches and cries, and it requires an iron hand on the part of the doctor to hold that mother from doing something to hush that cry, for just so sure as that is done that child will go back into death.

That is a reaction, so that all over the benumbed parts, or where the blood begins to flow into parts where the circulation has been feeble, where the nerves take on sensation again, we have reaction, which is but the result of that turning into order. That part has been benumbed and dead, and when circulation takes place in the part in order to repair its tissue we have reaction, which is attended with distress. If the physician cannot look upon that and bear it, he will have trouble. If he thinks it is an indication for another remedy he will spoil his case.

We must discriminate between that which is reaction and that which calls for a remedy. These things are only seen in Homoeopathy, never in any other practice. Sometimes the physician will be driven to his wit’s end in dealing with these reactions. It is sometimes a dreadful thing to look upon, and the physician may be turned out of doors. Let him meet it as a man; let him be patient with it, because the ignorance of the mother or the friends can be no excuse for his violence of principle, even once.

A disease of very long standing sometimes fails to yield without this aggravation and disturbance and turmoil in the economy, and the deeper it is the more tissue change you have to contend with, and the more wonderful and distressing and painful is this reaction. When a patient comes back after every dose of medicine with violent reaction, with violent aggravation of the disease, with violent aggravation of the symptoms, you know then that there is some deep-seated trouble.

There is a difference between the ultimates of disease and absolute weakness of the vital force. There is such a state as weakness of the economy, and there is such a state as activity of the economy, with much tissue change. In feeble patients you may expect feeble reactions, or none at all after your remedy, but in the feeble cases they are of such character that you have few symptoms, and you can very seldom find a remedy truly specific.

For example, say you get a patient that is destined to go into consumption, a merely suspicious case. You administer the right remedy and a violent reaction comes, a foreshadowing of what he will go through years from now if he is not cured by the remedy. A shocking condition will come upon him; he may be frightened and come back and tell you that that was an awful dose of medicine, poison, etc. That is the remedy disease, those are the symptoms of the remedy foreshadowing the future of that case, because if that remedy was not similar enough to him it could not do such things, and it is because of the similitude of his state; and he may only have those symptoms in shadow.

But the remedy cannot give him symptoms that he has not. It cannot give him symptoms that are not related to him except in those cases that are called oversensitives. Oversensitives, you know, are such as are capable of proving everything that comes along. You must know whether the patient is oversensitive and proving the drug, or whether he has a vigorous constitution and is getting an aggravation. The remedy will be exaggerated in oversensitives and sometimes in those of weakly constitution, especially those with a very narrow receding chin, those who have sunken eyes, those who have senility marked in the eyes.

The next paragraph continues this one to a certain extent. Par. 155. “I say without any degree of suffering, because when a perfect homoeopathic remedy acts upon the body, it is nothing more than symptoms analogous to those of the disease laboring to surmount and annihilate these latter by surping their place.” This is only speaking from experience. Whenever Hahnemann makes such a remark he does not place any value upon it, because it is a matter of opinion.

You will find as a general thing in acute diseases, that if a slight aggravation of the symptoms comes in a few minutes, you will hardly ever think of giving another dose. The remedy is so similar and searches so thoroughly that it is hardly ever necessary to repeat it. Now there are circumstances when it is necessary to repeat, but this is so difficult to teach, and so difficult to lay down rules for, that the only safe plan is to begin cases without repetition, to give a single dose and wait, and watch its effects. I very commonly give in vigorous, typhoid fever patient medicine in water, because it is a continued fever; but I watch and wait, giving it several days, and the slightest sign of the action of the remedy causes me to stop it always. I never vary from that. In a fever where the patient is feeble, to gain an immediate reaction that should never be done.

In a remittent fever the reaction may come in a very few hours and the one dose should be the rule, while in a typhoid the reaction will seldom come in a few hours. It is a matter of a few days, and hence the repetition is admissible. In typhoids that are somewhat delicate never do such a thing. The more vigor there is in a constitution the more the remedy can co-operate with that vigor to bring about a safe and quick action.

The more feeble the patient the more cautious you should be about using the smallest dose you can give. In many chronic disease it is possible to bring about a reaction in the first night, hence the danger if repeating the remedy. If the delirium subsides, or a moisture comes upon the skin, and he slumbers placidly, the medicine should never be given beyond such a state. There are times in diphtheria when the repetition of the remedy will kill, and there are times when repetition will save life. I hope some day to be able to discover the principles.

158.This trifling homoeopathic aggravation of the malady during the first few hours, the happy omen which announces that the acute disease will soon be cured, and that it will, for the most part, yield to a first dose.” That a natural disease can destroy another by exceeding it in power and intensity, but above all things by its similarity, is the whole truth and nothing but the truth. So that when this slight aggravation occurs you will seldom, if ever, have to give another dose in an acute disease. When this aggravation does not come, when there is not the slightest aggravation of the symptoms, and the patient appears to be gradually better after the remedy, then it is that relief may cease in the case of an acute disease, and when that relief ceases the reaction has ceased and then another dose of medicine is correct practice.

Relief that begins without any aggravation of the symptoms, does not last so long in an acute disease as when an aggravation has taken place. A slight action of the remedy over and above the disease is a good sign. Again, you will find if your remedy was not perfectly similar you will not get an aggravation except in oversensitive patients, and then it is a medicinal aggravation.

When you find that you get no aggravation of the symptoms in a good vigorous constitutions, none at all, very often your remedy has been only partially similar and it may require two or three of such partially similar remedies to finish the case. If you will observe the work of ordinary physician, you will notice they give two or three remedies to get their patients through where a master gives but one.

159.The smaller the dose of the Homoeopathic remedy, the slighter the apparent aggravation of the disease, and it is proportionately of shorter duration.” This was written at the time of Hahnemann’s experience with what might be called small doses, ranging from the lower potencies to the 30th and seldom much higher. He had had ample experience with the 30th, and occasionally with 60th, but not with tremendous turmoil that comes from the very highest attenuations.

It reads in the correct translation of this (this is incorrect here) : “The smaller the dose is of the homoeopathic medicine, the less and the shorter is the aggravation in the first hours.” It might be considered to mean an apparent aggravation, or an apparent aggravation of the disease. Now Hahnemann observes, as you will find amongst several of his writings, that the disease itself is actually intensified and made worse by the remedy, if the remedy be precisely similar, but if we pass away from the crudity of the medicines, ranging up towards the 30th potency, we get a milder action, and it has a deeper curative action, and the smaller the dose of the homoeopathic medicine the less and the shorter is the aggravation. The idea is that there is an aggravation in the first hours; that is a matter that the paragraph itself admits, and it is this aggravation that Hahnemann is talking about.

It is sometimes true that after the third or fourth potencies of Belladonna in a violent congestion of the brain, the aggravation is violent, and if the medicine is not discontinued the child will die. The disease itself appears to be aggravated, the child seems to be so susceptible to Belladonna that it appears as if were to be added to the disease, but with the 30th potency, as Hahnemann observes, this aggravation is slight and of short duration. Now, in this we get an outside aggravation. It is the drug disease of the remedy added to the natural disease, an aggravated state of the disease caused by the drug. It is true sometimes, in spite of this aggravation, that the patient says somehow or other he feels better.

This aggravation is unnecessarily prolonged by giving too low potencies; it is also prolonged by a repetition of the dose. I recently observed a state that occured from repetition. I sent a very robust young woman, twenty years old, a dose of Bryonia, to be taken dry on the tongue. However, she dissolved it in water, and was taking it at the end of the second day, when I was sent for, at which time she seemed to be going into pneumonia. She had a dry, harsh cough. “What is the matter with my daughter, doctor, is she going to die?” She was proving Bryonia. I stopped the Bryonia, and next morning she was well. This has been seen a great many times when the medicine was similar. If the medicine is not very similar, only partially similar it yet may be similar enough to cure, but you will not see the results that I am now speaking of; but when you make accurate prescriptions, and are doing your best work, you will see these things in the very best constitutions.

Of course, the explanation is that the patient is as sensitive to the medicine that will cure her as to the disease that she has. Diseased states, then, are made worse by unnecessary repetition and by the dose not being small enough, that is, by the dose being very crude. The third, fourth and sixth are dangerous potencies, if you are a good prescriber, If you are a poor prescriber, you will demonstrate but little of anything. You will naturally go to the higher and higher potencies for the purpose of departing from what seems to be a poisonous dose.

This action differs from the aggravation of a c.m. potency, during the latter the patient feels decidedly better. It is short, it is decisive, and only the characteristic symptoms of the disease are aggravated. The disease itself is not aggravated; the disease itself is not added to, and is not intensified, but the symptoms of the disease stand out sharply and the patient says, “I am getting better.” The symptoms sometimes are a little alarming, but intermingled with this is a ray of light that convinces the patient from his innermost feelings that he is getting better. “I feel much better this morning,” says the patient, though the symptoms may have been sharpened up.

160. We are accused nowadays of having departed from Hahnemann. Hahnemann wrote of the 30th potency in one of the stage of his life, as sufficiently high and sufficiently low. We can easily see that it was in the earlier period of his investigations that he made the remark that potentizing must end somewhere. we are accused of departing from Hahnemann, because we give different doses from what Hahnemann gave. Now I want to show you that this is not so.

Read paragraph 279: “It has been fully proved by pure experiments that when a disease does not evidently depend upon the impaired state of an important organ the dose depend of the homoeopathic remedy can never be sufficiently small so as to be inferior to the power of the natural disease which it can, at least, partially extinguish and cure, provided it be capable of producing only a small increase of symptoms immediately after it is administered.

Now, if we go to the 200th potency and find that that will aggravate, if we go to the 50m. and find that that will aggravate, if we go to the cm., the mm., etc., and find that they will aggravate that they still have the power to intensify the symptoms, the remedy has just the same curative power in it. If we have the potency so high that it is not capable of producing an aggravation of the symptoms, we may then be sure that there is no medicinal power left. We are up to the 13mm. and the end is not yet.

Now we have never made the claim that every potency will suit everybody. The potency must correspond to the state of the patient. If we ever find a person who will be aggravated in his symptoms in the most positive and definite fashion, that potency will be verified. We have not departed from Hahnemann, but have acted in accordance with his doctrines.

280.This incontrovertible axiom, founded upon experience, will serve as a rule by which the doses of all homoeopathic medicines, without exception, are to be attenuated to such a degree, that after being introduced into the body they shall merely produce an almost insensible aggravation of the disease. It is of little importance whether the attenuation goes so far as to appear almost impossible to ordinary physicians whose minds feed on no other ideas but what are gross and material. All these arguments and vain assertions will be of little avail when opposed to the doctrines of unerring experience.

Now, can there be any doubt of what Hahnemann meant when he speaks of the smallest dose? Can there be any doubt but that he means attenuation, and attenuation up and up until we reach that point in the attenuation that we do not observe a slight aggravation of the symptoms? In the note to paragraph 249, he says, “All experience teaches us that scarcely any homoeopathic medicine can be prepared in too minute a dose to produce perceptible benefit in a disease to which it is adapted. Hence, it would be an improper and an injurious practice when the medicine produces no good effect or an inconsiderable aggravation of the symptoms, after the manner of the old school to repeat or increase the dose under the ideas that it cannot prove serviceable on account of its minuteness.

So the senses have no relation whatever to the minuteness of the dose. The medical man is inclined to measure doses from the standard of a poisonous dose. He will measure off a little less than that which would poison, and call that a dose. It must be seen, it must yet be visible. This is not the test that Hahnemann offers. He offers the test of the dose as one capable of producing a slight aggravation of the symptoms. We see he does not limit attenuation, but he practically teaches it is unlimited, and the end has never been found.

There is a generally prevailing idea all over, not among strict Hahnemannians, but among modern homoeopaths in general, that the dose of medicine laid down by Hahnemann is too small to cure. It is a fatal error. An increase of the dose cannot make it more homoeopathic. The similarity of the remedy is first, and the dose is second. But that the dose of medicine laid down by Hahnemann is too small to cure is a fatal error. We must see by the experience in the clinics, and by considering the wonderful things that we have gone over in the doctrines, that we have really very little to do with the dose, that there is a wonderful latitude in dosage, and that we cannot lay down any fixed rule as to the best potency to use.

It ought to be distinctly felt, from all we have gone over, that he 30th potency is low enough to begin business with in any acute or chronic disease, but where the limit is no mortal can see. We want to follow up the series, so that we may get the very internal states that exist in degrees in the medicine. The different potencies are distinct from each other, some are very far apart, yet invariably connected. It is a mistake for any homoeopath to start out with the idea that the dose of medicine laid down by Hahnemann is too small to cure.

James Tyler Kent
James Tyler Kent (1849–1916) was an American physician. Prior to his involvement with homeopathy, Kent had practiced conventional medicine in St. Louis, Missouri. He discovered and "converted" to homeopathy as a result of his wife's recovery from a serious ailment using homeopathic methods.
In 1881, Kent accepted a position as professor of anatomy at the Homeopathic College of Missouri, an institution with which he remained affiliated until 1888. In 1890, Kent moved to Pennsylvania to take a position as Dean of Professors at the Post-Graduate Homeopathic Medical School of Philadelphia. In 1897 Kent published his magnum opus, Repertory of the Homœopathic Materia Medica. Kent moved to Chicago in 1903, where he taught at Hahnemann Medical College.