The Homoeopathic Aggravation

Gross (Arch., i.2, 25) says that the homoeopathic aggravations appear and disappear quickly in proportion to the suitability of the medicine and the suitability of the dose, i.e., its smallness. He alleges that it is only quite small doses of medicine that produce a rapid homoeopathic aggravation, larger doses produce their action much later. This is true to a certain extent; that is to say, massive doses often act as irritants, and are expelled as such, and therefore do not develop their specific action so decidedly as smaller doses that cause no irritation in the primae viae; but it is not true, as a rule, in respect to different infinitesimal doses beyond a certain point.

G. Schmid (Hom. Arzneibereitung, 204) asserts that if the doses be sufficiently large, no so-called homoeopathic aggravation will occur, and that it is met with only when the dose is too small, where-by imperfect excitation ensues, that not being sufficiently maintained, exhausts itself in vain efforts and struggles. This explanation, I must confess, is not very satisfactory, for if a small dose causes these intermittent curative struggles, presenting the appearance of an increase of the disease, a fortiori a larger dose should produce greater or more prolonged struggles. Schmid, it is well known, is a great advocate for the larger and more material doses, and doubtless he will observe that they act more mildly and efficaciously than the smaller and more infinitesimal ones. It is quite possible he may never see any aggravations from the use of his massive doses, whilst the timid globulist is constantly observing them; but I do not think his explanation of the fact is correct, as I shall hereafter show. He also states that the homoeopathic aggravation must often be looked upon as the result of a fear for larger doses of medicine, and is generally ascribable to the spontaneous exacerbation of the disease, or to the so-called perturbatio critica, or crisis.

Kampfer (Allg. h. Ztg., xxiv, 231) admitting the occurrence of the homoeopathic aggravation, distinguishes two kinds of it, one of a critical, the other of a non-critical character; the former being followed by amelioration, the latter not. This may be true or not, but unless we are enabled to discriminate the two kinds, the division is without practical value.

Hirschel,(Die homoeopathie, 86) while denying that the homoeopathic aggravation is necessary for the cure, admits four different kinds of it.

1. Where there is great irritability of the whole organism, or of particular organs and systems, there may occur, even from comparatively small doses, certain accessory actions of a quite superfluous character.

2. Where medicines are administered which are not accurately adapted to the case of disease, some particular symptoms may be increased by this improperly-selected medicine, without the removal of the disease supervening.

3. The morbid process may on the whole be increased without any advantage, no curative effect following; or, lastly–

4. The specific remedy may excite and hasten the morbid process, with a good result for the recovery.

None of these aggravations, with the exception perhaps of the last, resembles, that described by Hahnemann, and even the last Dr. Hirschel takes pains to tell us is not the same as Hahnemann’s, for Hahnemann’s aggravation was but a momentary affair and a medicinal action, whereas this is the real morbid process increased in rapidity and running a definite course.

Whilst we may readily admit the first three forms of aggravation described by Hirschel, the last requires a little more consideration. The examples he gives of it are these: it occurs, he says, in hyperaemia, in the catarrhal process, in inflammation, and in neuralgia. I cannot precisely tell what he means by hyperaemia, but I cannot see how it should be necessary, nor does my experience teach me that it is the case that any such aggravation, with acceleration of the morbid process, occurs in catarrhs or inflammations. On the contrary, the truly chosen homoeopathic remedy seems generally to diminish these diseases at once. With respect to neuralgias and nervous affections, no doubt an aggravation is often observed before the malady is removed; but the mere hastening on of a paroxysm of tic or epilepsy cannot be considered to be an aggravation, unless the paroxysm be of more than usual severity.

Trinks (Handbuch, p.lxi.) says, that both homoeopathic aggravations and the pathogenetic action of medicines occur occasionally after strong, moderate, and very small doses of medicine cannot be denied. The accessory medicinal effects are most frequently noticed from the stronger doses, or from the administration of inappropriate medicines. Both the aggravation and the medicinal perturbation are seen most frequently in very susceptible, nervous, or hysterical individuals; much more frequently in chronic than acute diseases. There are, however, many cases in which neither are observed, even after continuing the medicine for a long time. Many cases are cured without any aggravation, and many cases are aggravated without any cure being effected. He likewise believes that many medical men have asserted they have seen aggravations where there really were none, or which were merely the natural crises of the disease. When the aggravation occurs it is best, he says, to wait till it has exhausted itself, after which the disease generally advances rapidly towards a cure; or if the aggravation is too violent or long continued, we may repeat the medicine, which will then act as an antidote, or give the real homoeopathic antidote indicated. The medicinal perturbation may arise either from continuing the medicine too long or from giving an improper one; in the former case it should be discontinued. in the latter we should substitute for it a better selected remedy. All very good directions, doubtless, but Dr. Trinks does not inform us how we are to distinguish the medicinal aggravation from the natural increase of the disease, nor the medicinal perturbation in consequence of too long use of the drug from that caused by an improper choice; so that we are left as much in the dark as before.

Schneider (Allg. h. Ztg., xxv.245) denominates Hahnemann’s homoeopathic aggravation “a phantom,” and he describes the states that have had this appellation bestowed upon them by authors. They are–1, a one-sided medicinal action upon particular systems, produced by a too powerful dose; 2, the spontaneous increase of the disease; 3, the excitation that sometimes precedes a crisis; 4, a merely apparent aggravation of certain symptoms; or, finally 5, the homoeopathic aggravation is, he says, “a psychical effect of the homoeopathic theory,” in other words, fancy. He has never seen a homoeopathic aggravation, even from comparatively large doses of the homoeopathic remedy.

Dr. Romano (Allg.h. Ztg., xxxiii. 314) is a firm believer in the Hahnemannic doctrine of homoeopathic aggravations, which he considers to be of frequent occurrence. It is, he admits, of the greatest importance to be able to distinguish, when an aggravation occurs, whether it is due to the action of the medicine or whether it is owing to an increase of the disease; the former being a matter of congratulation, for the expiry of which we may tranquillity wait, knowing that it will be followed speedily by amelioration; the latter being an object of dread and, in many cases, of danger to the life of the patient. He thinks he has discovered the touchstone for distinguishing the two. If, says he, during the aggravation the pulse is slower or not quicker than it was before, it is a medicinal aggravation; if quicker, it is an exacerbation of the disease. It is evident if the disease, as is frequently the case with acute diseases, is principally indicated by the violent action of the circulatory system, this test, if correct, would not be applicable. I need hardly say that Romano’s notion has not been confirmed by any other observer.

Rau (Hyg., iv.296) says that the action of a homoeopathic remedy very suitable for the case is often felt very soon after its ingestion, not in the way of an exact homoeopathic aggravation, as described by Hahnemann, but the patient feels a sort of formicative crawling or searching throughout the body, but especially in the affected parts, sometimes amounting to a shooting and jerking, accompanied not unfrequently by a feeling of general prostration, faintness, or excessive sleepiness. So many of his patients, he says, spoke of these sensations, that he came to the belief that they were certain signs of the appropriateness of the remedy; and where they did not occur, he imagined that the medicine was not properly selected. Now, though it is doubtless true that such symptoms are confessed to by many patients after the administration of a medicine, I must from my own experience allege, contrary to Rau’s opinion, that they by no means always follow the ingestion of the appropriate medicine, and that we sometimes find them to occur in patients where no good result is obtained from the medicine administered. The symptoms Rau describes as occurring after the ingestion of the remedy can but be considered as equivalent to Hahnemann’s homoeopathic aggravation, or, at all events, they are only a variety of it.

Griesselich (Handbuch, etc., 54) was, when first he became a convert to the homoeopathic system, thoroughly impressed with the reality and essentiality of the homoeopathic aggravation. He happened to be affected one day with headache, for which he took two globules of the 30th dilution of nux vomica, and the aggravation he anticipated was not long in making its appearance; and in this way, to wit, by the force of imagination only, he believes many beautiful instances of aggravation are perceived. He has often seen them occur in patients who knew something of homoeopathy, and who firmly believed that an aggravation must occur, when he had given them nothing but milk-sugar. Thus also Brand v Bull. de la Soc. de Medorrhinum Hom., 1846, p. 243. observed aggravations to occur from the patient taking water only, which he believed to be medicine. The imagination, says Griesselich, has played no insignificant part in homoeopathy; the extreme credulity of many of its adherents as regards the post hoc being proper hoc having led many to believe that all the phenomena they noted in the course of the disease were due to the medicines they administered, just as in the old school all the phenomena that occur are ascribed to the morbid process, and the disturbing action of the medicine is but seldom taken into consideration. There is no doubt, Griesselich observes, that there is a kind of superstitious credulity on the part of the patient, which we may avail ourselves of in order to cure his disease. By persuading the patient that he must expect a certain action from a certain substance administered, we may often succeed in bringing about such action, even although we only administer some perfectly innocuous substance. Not only aggravations but cures may be effected by this means; and there is little doubt that many homoeopathic cures with large and small doses and with inappropriate medicines are effected in this manner. The cures effected by relies, holy water, sympathy, etc., are all of this class and no doubt also many of the cures effected by inappropriate though may be powerful allopathic medicines.

He thinks, however, that there is something real at the bottom of the homoeopathic aggravation, as described by Hahnemann, though he denies that it assists him in his theory at all. The aggravation Griesselich admits as occurring is, however, rather the accessory disturbance caused by the medicine in a sensitive individual than Hahnemann’s true homoeopathic aggravation. Thus, he observes, there are persons so sensitive that they will have slight traces of ptyalism from a dose of the 4th or 6th dilution of mercury. Such phenomena are signs of what is called idiosyncrasy, and may occur both when the medicine is suitable to the disease and when it is quite unsuitable. In diseases which occur in paroxysms also it frequently happens that after the administration of the homoeopathic medicine a strong paroxysm occurs, and then the malady ceases. The crises that often occur after the termination of the proper morbid process are also, he asserts, often unjustly denominated aggravations, which they have no claim to be. All that we can say is that homoeopathy does not always prevent their occurrence, but they certainly are not more frequent under it than under the old system, or when diseases are left to themselves.

Dr. J. W. Arnold (Idiop. Heilverf., 207, et seq.) has the following remarks upon the homoeopathic aggravation:-“After the administration of a homoeopathic remedy we frequently observe an increase of the symptoms already present. They become not only stronger but increases in extent, become thus more perceptible and more distinctly cognizable. Along with them are frequently conjoined symptoms which had been previously present, but had ceased for some time. Besides these we observe symptoms which had never before troubled the patient, but which stand in a certain genetic or organic connection with the primary disease. All these effects of the medicines may be termed homoeopathic aggravations, but not so many symptoms that occur during the use of the medicines, and which must be looked upon as the immediate effects of the latter. The thick-and-thin adherents of Hahnemann, who are too frequently in the habit of thinking they see homoeopathic aggravations, often consider as such the pure medicinal symptoms, and often also an increase of the symptoms depending upon the natural course of the disease. On the other hand, there are sceptics among the homoeopaths who assert that an aggravation of the disease unmistakably produced by the medicine administered is extremely rare, that a great deal too much is said about it, and its importance altogether over-estimated. If we distinguish the true homoeopathic aggravation from other kinds of medicinal action and from the natural increase of the disease, we certainly shall seldom have an opportunity of observing the former, especially if the dose be right….. Although,” he continues, “the homoeopathic aggravation is often followed by amelioration, yet this is not always the case, especially in very irritable and delicate patients; and also in incurable diseases we often observe an increase of the disease after the medicine, followed by no amelioration, or, at all events, no cure. In these cases the homoeopathic aggravation may be compared to the efforts at a crisis in incurable diseases, where the crisis is never attained”.

For my own part, I think that the homoeopathic aggravation of Hahnemann was a necessary deduction of his from his theoretical explanation of the mode in which the homoeopathic medicines, acted, viz., by the stronger expelling the weaker. It is part and parcel of this theory, and nothing more. It is very obvious that if it were a fact and not a theoretical fancy it would constantly be occurring, more especially if the dose given were at all greater than what would barely suffice to overcome the disease; but in Hahnemann’s own recorded practice we have only one instance of its occurring decidedly, and that in a case where the dose was quite sufficient to produce the same symptoms in a perfectly healthy individual. In the practice of those who usually give their medicines in much larger doses than the regulation 30th dilution of Hahnemann, we find that true homoeopathic aggravations are seldom or never met with, whereas they should be of constant occurrence; and it is chiefly those who give the highest dilutions and preparations of the medicines, diluted a long way beyond what Hahnemann ever dreamed of, who profess to be constantly seeing these homoeopathic aggravations. The chief foundations for the belief in homoeopathic aggravation are, I conceive, these:-1. Imagination or expectoration on the part of the patient. 2. Ignorance of the march of diseases, of their natural remissions and exacerbations, of their crises and critical discharges. 3. Above all, however, by observers having confounded the two sorts of aggravations described by Hahnemann together, and talking of the medicinal perturbation, as Dr. Drysdale (British Journal of Homoeopathy, vi.24.) has termed it, as though this were Hahnemann’s homoeopathic aggravation. We find it is chiefly those who pride themselves on being pure Hahnemannists who make this mistake; such gentlemen do not thereby show much knowledge of the writings of him they acknowledge as master, for Hahnemann distinctly says that when these medicinal perturbations occur they are a sign that the medicine has been improperly selected; whereas to read the writings of those I have alluded to, it would seem that the more violent the medicinal perturbation the more certain the consequent cure. There is no doubt that such medicinal perturbations do sometimes occur, and that from doses of all sizes, from the smallest as well as the largest. The cause seems to be idiosyncrasy on the part of the patient, and I do not believe they are always indicative of a false choice of the remedy, for we by no means rarely find that after their occurrence the disease declines, though at the same time I am bound to admit that they are often followed by no good result. The distinction betwixt Hahnemann’s homoeopathic aggravation and the medicinal perturbation cannot be too forcibly insisted on. The latter is by no means uncommon, and is of no value in a therapeutic point of view; the former is rare, and is almost confined to neuralgic and paroxysmal diseases, as far as my own observation teaches me, and in such cases it is often, but by no means always, nor I might even say generally, a favourable sign.

The following, then, are the conclusions at which I have arrived relative to the homoeopathic aggravation:-

1. That the true homoeopathic aggravation of Hahnemann, or increase of the actual morbid symptoms shortly after the administration of the medicine, is of rare occurrence.

2. That it does not always depend upon the magnitude of the dose administered, for it may occur from a small dose as well as from a larger one, and is more dependent on the kind of the disease or the susceptibility of the patient than on the magnitude of the dose.

3. That whilst it may undoubtedly be sometimes avoided by diminishing the dose, it is equally certainly often avoided by increasing the dose.

4. That it is sometimes the precursor of a cure, but not always, for cases are observed, e.g., of neuralgic affections, where many medicines aggravate but none relieve the disease.

5. That it has been confounded with several other things.

a. With the natural paroxysms of the disease.

b. With the natural increase of the disease before its decline.

c. With the so-called crises or critical discharges at the termination of the original morbid process.

d. With the transformation of the disease requisite to effect a cure, e.g., the suppuration of warts and other tumours, the natural opening of abscesses, etc.

e. With the effects of imagination or anticipation on a highly excitable patient.

f. With the pathogenetic effects of medicines administered for a curative purpose in susceptible individuals, termed by Drysdale and others medicinal perturbations.

6. That these medicinal perturbations occur from doses of all sizes.

7. That they are not always, as Hahnemann has said, indicative of an erroneous choice of the remedy, but rather of a preternatural susceptibility on the part of the patient.

8. That they are not desirable, as, if strong, they may interrupt the cure and require to be subdued by an antidote.

9. That they sometimes occur after the first dose or two of the remedy, but on repeating the same remedy cease to show themselves.

10. That effects very similar to them are often excited by the mere influence of the imagination or anticipation, even after the administration of a totally inert substance.

I have dwelt thus long and entered thus minutely upon the subject of the homoeopathic aggravation because I believe no harm but only good can result from the most rigid critical examination of all the tenets inculcated by Hahnemann, and none can deny that this doctrine of his has occupied rather a prominent place in the Hahnemannic system, and its importance has been very much exaggerated by many of those who consider themselves as the purest of Hahnemann’s disciples. On reading some of the cases recorded by these latter gentleman, we are astonished to perceive the amazing power they attribute to their medicines and the terrible effects they sometimes witness from their administration, even in the very smallest doses. Every increase of the disease after a medicine has been given is at once regarded as a homoeopathic aggravation, demanding the immediate suspension of the medicine in order to allow it, as the phrase is, to exhaust its action, though often the increase observed may have nothing earthly to do with the medicine given, but may be solely ascribable to the advance of the disease. It is a remarkable fact and at the same time a very significant one that aggravation are most frequently observed by those practitioners who do not avail themselves of the modern methods of physical diagnosis, who reject pathology and the study of pathological anatomy, who give habitually the smallest doses, and who have been bitten by the Jenichen delusion, whilst these aggravations are rarely, if at all observed by those who have kept pace with the modern advances in diagnosis and pathology, and who prefer the lower scale of dilutions as a rule.

I have pointed out how necessary a corollary the homoeopathic aggravation is to the Hahnemannic theory of the stronger medicinal disease expelling the weaker natural disease; but you will notice that from the explanation I offered of the mode of action of remedies no aggravation whatsoever ought to ensue, for the curative agent does not act by virtue of its superior strength over the diseases, but it acts as a stimulus to the morbid part, which is in a state of under-stimulation.

R.E. Dudgeon
Robert Ellis Dudgeon 1820 – 1904 Licentiate of the Royal College of Surgeons in Edinburgh in 1839, Robert Ellis Dudgeon studied in Paris and Vienna before graduating as a doctor. Robert Ellis Dudgeon then became the editor of the British Journal of Homeopathy and he held this post for forty years.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.