Having learned how to select the remedy and the potency,and in how many does to give it, the next state; is to know how to watch your case. The physician must be able to determine whether the remedy given is acting at all, and, if so, whether favorably and what prognosis may be expected. He must know how do determine the length of action of his remedy in each individual case,m in short, having started the journey to cure,he where to change. Two things help hi mainly in these decisions and both are determined by careful observation based on seeing the patient, for what the patient will tell you is often misleading. The first sign-post to guide you is the aggression. A discussion of this is best given in chapters 34 and 35 in Kents Lectures on Homoeopathic Philosophy, from which we have taken much of what follows.
The types of aggravation which may be observed are as follows.
1.A prolonged aggravation with subsequent decline of the patient. this means either that the patient is incurable or that he has been overwhelmed but the turmoil ensuing on too highs potency. This usually occurs in cases of marked pathology, yet whose fatality is able termite symptoms. Under the second prescription we will take up what to do in such exigencies, but the doctor must be sure before resorting to a second prescription that doctor must be sure before resorting to a second type doctor must be sure before resorting to a second prescription that he truly has an aggravation of the first and not the second type.
2. This second type is a long aggravation followed by slow improvement., This means a serious case on the border of incurability but caught just in time.
3. The third type of aggravation is quick,brief and vigorous, followed by speedy relief of the patient. This type is much to be desired and is a sign that the improvement will be of long duration,and that structural changes are in non-vital organs. Abscesses and suppurating glands appear at times in these cases as part of the aggravations. This is a good sign and should not be interfered with.
4. The fourth type is where there is practically no observable aggravation and yet the patient recovers steadily. This is ideal and shows that there is no great organic disease and that the potency chosen exactly fitted the case, especially if during recovery the symptoms follow Herings laws,which will be discussed later.
5. The fifth type is where brief amelioration comes first and aggravation afterwards. this means either that your remedy was only palliative and did not touch the true constitutional state of the patient, or else that the patient was incurable, or else that some the indicated remedy (or dye,to follow our our simile) to take hold. For example, a Silica case of ours would be markedly ameliorated fro a week often days and then slip back, nor did a change of potency hold longer ; however Tuberculinum took hold and kept it, and since than other remedies hold.
6. Another type of aggravation is where the symptoms developed turn out to be a proving of your remedy. This may be due to an idiosyncrasy to the particular drug on the part of your patient or the appetite may be an over sensitive who proves everything given him. These patients need the medium low potencies and are often incurable.
7.Another apparent form of aggravation is where new symptoms appear after the administration of a remedy. This suggests that the prescription was incorrect and will be dealt with under the second prescription.
8. There is type of aggravation in which the individual symptoms stand out clearer while the patient himself feels better. This is often followed by old symptoms repairing in the reverse order of their coming (see Hering;s laws of cure) this is highly favorable. the physician must note the direction of the reappearing symptoms. If they go wrongly, i.e., from without inward, it is dangerous, if from within outward it is favorable.
Another variant which is without actual aggravation is too short relief of symptoms without any special aggravation. This is very similar to the fifth and causes the physician to cast about for a miasmatic remedy.
Sometimes there is a fulltime amelioration of symptoms without any special relief of the patient himself. This show a case that is only open to palliation, the vital force cannot make the grade to cure.
An unnecessarily severe aggravation is used by too high or too low potency. A well chosen potency will given as above, either by aggravation in a quick short one. Too prolonged an aggravations after high potencies,such as CM in curable cases,the patient feels distinct better even during the aggravation, as it is the characteristic symptoms and not the disease or the patient which are aggravated.
A very feeble vitality may not be able to throw out an aggravation and such must be given a single dose of a really high potency and watched for the minutes signs. On the other hand a strong vitality may have marked tissue changes which will produce a violent aggravation so that the physician must bear in mind the two factors, the vitality of the whole and the pathological changes,and balance theses carefully in his choice of potency.
If there is no aggravation in cases of vigorous vitality it is probable that your remedy was only partially similar (the ideal cases of recovery without perceptible aggravation are usually not those with especially married vitality). In acute diseases an amelioration without a slight initial aggravation often means that your remedy is not deep enough and another dose of it will probably be needed.
THE SECOND PRESCRIPTION.
Kent defines the second prescription as “the one after one that has acted”. this means that a bungling prescriber may have given four or five remedies and the sixth, if it really takes hold, should be classed as the first prescription. Granted that according to the above observations on aggravation. Granted that occurring to the above observation on aggravation your remedy was well chosen and has acted let it alone. “Watch and wait.” Before making and second prescription restudy the case. According to Kent there are possibilities for the second prescription, either repetition, antidoting or complementing.
The prime indication for the second prescription which is a repetition is the return of the original symptoms of the patient they have been better,with or without aggravation,and then they tell you, and you observe,that the original symptoms have at reappeared,whether identical,less severe or more severe than at first. This calls for repetition in the same potency after you are sure they have returned to stay.
It should here be added that if the patient returns telling you that their general sense of well not yet returned you should wait as often improvement goes in tell you that they them selves feel worse, wait and watch for the even if the symptoms change, but the patient feels and seems will of the wisps to do so and you would ruin your case. While well being increases,wait; when it comes to a standstill, wait. If the general state is worse end the symptoms have changed then consider a new second prescription as follows:
The prime indication for a change of remedy of the second prescription is where new symptoms croup after your first prescription, without amelioration in the general well being of the favorable and you must antidote it. The selection was unfavorable and you must antidote it. ?The selection if this antidotal second prescription is based on the original symptoms plus the new symptoms with more emphasis on the new ones. This second prescription, then, should wipe out the new symptoms and modify the old.
The prime indication for a change of remedy of the second prescription is where new symptoms crop up after your first prescription, without amelioration in the general well being of the patient, and remain. This means the first prescription was unfavorable and you must antidote it. The selection of this antidotal second prescription is based on the original symptoms plus the new symptoms with more emphasis on the new ones. This second prescription, then, should wipe out the new symptoms and modify the old.
The prime indication for a change to a complementary remedy is where your first prescription, especially in acute disease or if it was not a deep acting remedy, does not seem to have fathomed the case. Here a complementary remedy will take deeper hold on the life. For instance, in a n acute throat Belladonna may have been the similimum, but after the acute attack passed a chaser was needed to prevent recurrence, to eradicate predisposition, and, if the symptoms agree, your second prescription would be the chronic complement of Belladonna, which is Calcarea.
There is another indication which goes deep into the philosophy, for a change of remedy in your second prescription. This is likely to be a remedy from a different miasmatic group and it entails a change in the plan of treatment, consequent to the cropping up of a different miasm after the clearing away by the first prescription of the miasm which was at first on top of the case.
This subject of the second prescription was to me the most difficult in homoeopathy. Every beginner should read and reread his Kents Philosophy, restudy his cases, and above all “watch and wait”.
NEW YORK CITY.
A homoeopathician speaks with the highest veneration of Hahnemann, of his writings, acquirements, genius and honest uprightness; of his superior gift of observation, and success in applying his new method of cure with far better results than his pupils through his most intimate knowledge of the materia medica which he created. The older the student the more be admires the genius of the master, for he knows him better and trusts him more the longer he associates himself with his writings, gradually becoming identified and enabled to follow him by experiment.
The non-homoeopathist speaks disdainfully of Hahnemann; he calls him a man of straw, a visionary; declares him unreliable in his observations, his materia medica a mass of chaff, perfectly useless unless well sifted; his system he terms unscientific and ridiculous, in need of being modified, remodeled, or exploded. The less he knows of it the more fault he finds with it.