***ONE of the first things required of a homoeopathic physician is that his powers of observation shall be highly developed. His powers of discrimination should be very keenly attuned, first, that he may observe the patient in the analysis of the symptoms and the selection of the remedy, and second, that he may have the keen perception of the import of the symptoms after the remedy has been carefully selected and administered. After the administration of the *simillimum some action should result. It is upon the development and interpretation of the action of the remedy, or the reaction of the vital energy to the remedy, that successful prescribing very large depends.
What are we to expect after the remedy has been administered? According to Hahnemann, the nearer similar the remedy the more reaction we may expect (*Organon, 154, 155.) If the exact *simillimum is found we are apt to get a slight aggravation before relief comes. On the other hand, if no changes take place, too long patient waiting is useless, for it is evidence that the *simillimum has not been found; but the nearer the symptoms of the patient are to the symptoms of the remedy, the more sure we are to have some reaction. It is for us to determine what the reaction means and to interpret it in prognostic terms. We must be able to listen to the patient’s report and from it and our powers of observation to determine what the remedy is doing. We know that when the remedy acts the symptoms will change, in either character or degree. There may be a disappearance of the symptoms, amelioration of the symptoms or increase of the symptoms, and these changes are the manifest action of the remedy on the vital force; and it is these manifestations we must study.
Among the most common reactions after the remedy has been administered is aggravation or amelioration. Now…..there are two types of aggravations, either of which may be manifest. There is the aggravation which is an aggravation of the disease condition, in which the patient grows worse. There may be a very different type of aggravation, in which the symptoms are worse, but the patient is growing better. He will say, “I feel better, Doctor, but such-and-such symptoms are worse.” The aggravation from the diseased state is an indication that the patient is growing weaker, and therefore the diseased state is growing stronger while his vital energy is ebbing. On the other hand, the aggravation of the symptoms while the patient reports himself as feeling better is an indication that his vital force is being set in order, but individual symptoms may show aggravation.
We must also observe how the aggravation or amelioration occurs and the duration of these periods. In this connection we must always bear in mind that it is the patient’s welfare we are seeking, and it is for us to determine whether he is improving or declining. Sometimes he will say that he is weaker, yet on analysis of the symptoms you will find this is not true. The story of the symptoms is often of greater importance than the patient’s opinion. After we have assured him of the amelioration of his condition and called his attention of the particular instances of improvement, he will feel better immediately.
The aggravation when the patient is growing actually weaker is a sure indication that the symptoms are taking on a more internal phase and the vital organs are more affected. In other words, it is an illustration of the reversal of the order of cure. In these states the patient may sometimes declare himself better, because of the absence of some trying symptoms, yet the careful homoeopathic observer will know he is worse because the natural course of cure is reversed and the disease condition is attacking more vital parts. By these differentiations we know whether the patient is progressing or retrogressing. In many of these cases there is corroboration between the patient and the symptoms in the mind of the patient himself; and just in so far as there is this corroboration, the truth of his observation is valuable. We should find whether the symptoms are tending toward the exterior and away from the inner parts. In other words we should know whether there is a peripheral tendency, or a tendency in the reverse order.
The aggravation of the diseased state may come from an incurable state which is stirred to its foundations by the potentized remedy, and unless the remedy is counteracted the disease will become worse and more rapidly approach a fatal termination. In borderline cases, cases bordering on fatal termination, the use of extremely high potencies may react on the vital energy so deeply as to cause an aggravation of the disease, whereas a more moderate potency (say the 30th or 200th) would not give such dangerously powerful effects. However, no fatal aggravation will occur unless it is already foreshadowed by the symptoms manifest in the patient. The potentized remedy will never produce a fatal aggravation, or a destructive aggravation, that would not have been possible and even probable from the symptomatology; but it may, and often does, when used without discretion, speed the case to a fatal termination. In other words, a single dose of the high potency will not produce disease conditions; it has the power to develop conditions that are already present if it is used carelessly or ignorantly. More careful study might reveal the indications for a less deeply acting remedy, which when administered would greatly mitigate much of the fatal suffering.
You must remember that we are warned in the *Organon to discern what is curative in medicine, and also what is curable in disease. This point cannot be too greatly stressed: that in profound states we must be very careful not to stir the vital energy to its depths. There should be more time allowed to attempt at a gradual restoration, as there has likewise been a gradual decline. Very often less deeply acting remedies will react and palliate incurable diseases because they act more superficially. They act upon the sensorium and do not act upon the deep recesses of the vital force itself, and yet make the patient much more comfortable by relieving the symptoms annoying through the sensorium.
We can know, then, whether changes are occurring from the depths of the vital force or whether the patient may recover. The direction taken by the symptoms is the sure indication.
In this connection, the first observation is often a prolonged aggravation and a final decline of the patient. Now just what has happened? Possibly there has been too deep an antipsoric administered and it has set in motion the vital energy and develop a destructive process. In these profound states of incurable case. In such cases as these profound incurable conditions we should avoid giving a high potency of the remedy; by administering a lower potency we may be able to go on and develop the case gradually until later it may possibly react favourably to a higher potency. This is well illustrated in advanced cases of tuberculosis, where it is never safe to give a very high attenuation of the exact *simillimum. It is probably wiser not to use an antipsoric in these conditions. However, this applies only to those who are profoundly ill with chronic troubles.
In cases where there is not so profound a disturbance, after the remedy has been administered, the aggravation may be long and severe, yet the final reaction and amelioration comes. Sometimes in these states the aggravation may even last for weeks, yet improvement is general is continually taking place and then comes the amelioration and a slow but sure recovery, so that the second observation would be a long aggravation but final although slow improvement.
In these borderline cases there has already been established some marked organic changes, and where pathological changes have actually taken place the period of aggravation will be longer, but the general improvement in health in the curable cases will be manifest.
Then there is another reaction, where the aggravation is quick and short and strong, with rapid improvement of the patient. When you find such a reaction to the remedy you will always find rapid improvement. The reaction is vigorous and there has been no structural change of the vital organs. If there have been structural changes they have been of a superficial nature and near the surface and not of the vital parts, such manifestations as furunculosis or abscess formations on the surface. These are surface changes and are not comparable to the effects of the changes.in the deeper organs, like the kidneys, the heart, or the brain.
It is well to take note of the difference between organic changes that take place in the vital organs that sustain the economy, which we cannot do without, and those that take place in less vital parts of the body and are not vital to life itself.
An aggravation that is quick, short, and strong is to be desired, because we know that improvement will be rapid.
Again, there is another class of indications where we find no aggravation whatsoever. There is no organic change; there is no tendency to organic disease. The chronic condition causing disturbances to which the remedy is applicable is not of very great depth, it belongs to the functional conditions, exhibiting its effects in the nervous manifestations and the relations of the patient to his surroundings and to tissue changes. There are changes in the vital force that are so profound as to cause many symptoms that are very trying to the patient and yet so slight that with all the instruments of precision we do not observe any pathological changes. It is in these conditions that we sometimes get considerable suffering, yet cures will come without any aggravation. In these cases the single remedy in a moderate potency and the remedy are correct.
Then we have some cases with amelioration coming first and aggravation coming afterward. This amelioration comes on to last usually for three or four days; the patient seems to be better but at the end of a week or ten days all the symptoms are worse than when he first came to you. These are usually cases that have a great many symptoms. We find that, in spite of what we thought at first was a favorable reaction, the ultimate condition is unfavorable. Either we selected too superficial a remedy, that could act only as a palliative, or the case is incurable and the remedy has been somewhat similar but not completely so. In order to determine the cause of the reaction we must examine the patient and find out whether the symptoms related to the remedy or to the disease. Sometimes you will find the remedy was in error. You will find usually in these cases that the remedy was similar to the most pronounced symptoms but it did not cover the whole case, and therefore did not strike at the constitutional state of the patient. Here in evaluating the symptoms we missed the essential concomitants, and we based our prescription on the generals only. It may be that we have an incurable patient. It will be fortunate for such cases if the symptoms come back exactly as they were when you first saw the case, but the symptoms often come back changed. Then we must wait, and this will require patience on the part of the physician and co- operation on the part of the patient. It may be necessary to take the patient into your confidence, if he evinces sufficient intelligence to warrant it.
The higher potencies will set in motion in the vital force curative functions which will act a long time, because oftentimes in these chronic conditions it takes a long time to establish order, and the vital energy takes its own time to cure. During this process no medicine should be given.
In cases that are proceeding to a perfect cure, if the improvement continues for some times and then suddenly comes to a half, find out if the patient has been doing something that is against the rules of health or has interfered with the continuation of the curative action of the remedy. This will often be found to be the cause of too short a period of relief from the symptoms.
In the third observation you will remember there was a quick aggravation followed by a long amelioration. Note the difference here. You have just considered the amelioration, that was of too short duration. In instances where you have an aggravation immediately after the administration of the remedy, and then a quick rebound, you never see too short amelioration of the remedy. If there is a quick rebound, the amelioration should last. If it does not last, it is because of some condition that interferes with the action of the remedy. It may be something that he is doing deliberately and intentionally. A quick rebound means everything to the case. It means that the remedy is well chose, that it covers the condition of the vital economy; and if everything goes without interference, it will bring ultimate recovery.
There is this to remember: some remedies have an aggravation immediately after administration, and some have a sharp aggravation some little time after administration. For instance, *Phosphorus may have a sharp aggravation, but it rarely occurs under twenty-four hours after administration, and it may be forty-eight hours or longer, and it may last for some little time.
A word about the acute cases in conditions where you get a quick rebound and amelioration lasting for a few hours, only to have another aggravation, when the action of the remedy on the vital force is exhausted. The action of the remedy is much more quickly exhausted in the rapid pace of acute diseases than in the more moderate progress of chronic manifestations, and more frequent repetitions of the remedy may be demanded. The most satisfactory amelioration in acute cases is where amelioration comes gradually and takes an hour or two after the administration of the remedy before it is markedly manifest.
If amelioration is too short in chronic diseases it means that structural changes are taking place and have destroyed or threatened to destroy the proper functions of the patient. It takes close observation to discern these changes from the reaction of the remedy. However, one may acquire much help from careful observation of these indications in detecting the course and progress of the case.
Once in a great while you will find a full period of amelioration of the symptoms, yet no special relief of the patient. This you will encounter in cases where you have structural changes, where the patient will improve on the remedy for some time and then improvement will cease. They can improve only to a certain point, and then improvement can go no further. We meet these conditions where organs like the liver or kidneys are partially involved and can function only in part. The remedy may keep the patient comfortable, however; and by careful repetitions of the remedy at infrequent intervals the patient may be kept comfortable for a considerable period of time even though you will not be justified in expecting a cure.
There is another reaction that we find in some patients, and that is purely hysterical. They seem to prove any remedy you may give them and get an aggravation from it. This may be because of an idiosyncrasy for the remedy or because of too sensitive reaction of the vital energy. It may be almost impossible to do anything with them in a curative way, but it may be of inestimable help in proving a remedy. Before a remedy is used the constitutional condition of the patient should be very carefully noted. Write down the peculiarities of the patient in as much detail as possible, and then these observations should be deducted from the proving.
In a case where the symptoms found by careful questioning seem to be entirely adequate to cover the case and to warrant a good selection of the *simillimum, we may note a reaction where a great number of symptoms appear after the administration of the remedy. If these are a return of former symptoms that have been forgotten, it is an indication that we are on the right road to recovery and it is a truly homoeopathic action. Old symptoms reappearing we know to be a step in the right direction, because we know the condition is being solved in the homoeopathic manner, and by the law of the direction of cure: ***CURE TAKES PLACE FORM WITHIN OUTWARD, FROM ABOVE DOWNWARD, FROM THE IMPORTANT ORGANS TO THE LESS IMPORTANT ORGANS; AND SYMPTOMS DISAPPEARS IN THE REVERSE ORDER OF THEIR APPEARANCE.
If, however, these are actually a number of new symptoms, it is an unfavourable sign. Old symptoms reappearing are a step in the right direction, as we know; therefore a group of entirely new symptoms appearing after the administration of a remedy is evidence that we have made a decided step in the wrong direction. We have probably mixed the case.
We occasionally find another class of reaction after the administration of the remedy. In these cases, too, we find the appearance of new symptoms after the administration of the remedy, but in the first place these cases offered few symptoms for an adequate prescription. It is usually possible to get a complete symptomatic picture of the case if we take the necessary amount of care in taking the case, but we do occasionally meet cases where there is little presented in the way of symptoms, or the symptoms presented have little in the way of modifications as to modalities and concomitants upon which to base a satisfactory analysis of the case. Hahnemann deals with such cases in the *Organon, Paragraph 172-82. In these conditions where event he most careful case-taking fails to reveal an adequate basis for prescription of *simillimum, we may yet find that if the few symptoms are sufficiently well marked a remedy may be selected which will either eliminate the marked symptoms found in the first consideration of the case, with consequent general improvement, or there will be a development of more symptoms.
If there has been a general improvement, the first remedy was homoeopathic to the case, and not alone to the few symptoms presented on our first consideration. In the second instance, the first remedy was probably one of a group of similars, and it has severed to bring to light the other formerly hidden symptoms which were a definite part of the case. It has unfolded the case to us. In this instance, then, the closely related remedies to the one first administered will probably contain among them the *simillimum which will be the remedy to cover and assist most in curing the complete case.
Even in these observations we must be very careful to consider whether we have administered a similar remedy that has unfolded the case to us, or whether our selection has been so far from the similar that we have merely mixed the case.
Diseased states are progressive, ever developing deeper and deeper manifestations. Disease is destruction; cure is constructive development. Cure is always centrifugal, as growth is always centrifugal.
By careful observation of the symptoms before selecting the remedy and by careful observation of the reaction after the administration of the remedy, we may have the assurance that comes from intelligent comprehension of our work, and we can know when we are making satisfactory progress in each individual case.
What is the most necessary attribute of the homoeopathic physician? (*Answer: His sense of perception.)
What are we to expect after the administration of the remedy?
What are the most common reactions? (*Answer : worse and better.)
What do we infer when the patient feels better, but the symptoms are worse?
What do we infer when the patient is weaker, but the symptoms are better?
When there is actual aggravation of the diseased state, after the administration of the *simillimum, what is our prognosis?
Does the homoeopathic remedy ever produce a fatal aggravation,
When actual aggravation of a diseased state gives a prognosis of a deep-acting disease after a deep-acting remedy has been administered what can we do to help the patient?
(*Answer: Sometimes a complementary remedy, of less depth of action, will actually assist the patient to a place where cure may be carried out by the deep-acting *simillimum; or it would surely palliate the dangerous and distressing symptoms if no cure were possible.)
What is the sure guide for our prognosis?
What is the most desirable reaction after administration of the remedy? (*Answer: A short, quick, strong aggravation, with closely following amelioration and recession of the symptoms in the order of cure.)
What do we infer when we find first a strong amelioration, then (<)? In cases seemingly proceeding to a perfect cure, when amelioration comes suddenly to a halt, what is our next step? (*Answer : Find out if the patient is doing something to interfere with the action of the remedy, or if it is just a cycle of the disease symptoms.)
What is the difference between an aggravation occurring immediately after administration of the remedy, and one occurring two or three days after its administration?
If we find too short an amelioration after administration of the remedy in chronic disease, what is our prognosis?
What do we infer from the patient who seems to prove any remedy that may be given him?