Discussion on what a physician may expect after administration of a remedy….

***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 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.

H.A. Roberts
Dr. H.A.Roberts (1868-1950) attended New York Homoeopathic Medical College and set up practrice in Brattleboro of Vermont (U.S.). He eventually moved to Connecticut where he practiced almost 50 years. Elected president of the Connecticut Homoeopathic Medical Society and subsequently President of The International Hahnemannian Association. His writings include Sensation As If and The Principles and Art of Cure by Homoeopathy.