4. AMELIORATION COMES FIRST AND IS SOONER OR LATER FOLLOWED BY AGGRAVATION. This signifies still more, but not necessarily incurable, pathology. A slow, tedious recovery may be expected.
5. A LONG SEVERE AGGRAVATION WITH FINAL DECLINE OF PATIENT. Extensive and incurable organic lesions and advanced pathologic changes. (An antidote in such a case may sometimes be necessary.).
6. PALLIATION IN MANIFESTLY INCURABLE TERMINAL CONDITIONS. The remedy producing euthanasia but not in any way hastening the termination of life.
7. A PROVING OF THE REMEDY OCCURS. Either the patient is exceedingly sensitive or there is perhaps a tuberculous or a sycotic background. A suitable nosode if indicated, or a deep antipsoric, may be required to arouse the vitality and turn the case in the right direction.
8. A NEW REMEDY PICTURE SOON PRESENTS ITSELF WITHOUT ANY ESSENTIAL PROGRESS TOWARD RECOVERY. Such cases often have a tuberculous background and a suitable nosode or antipsoric remedy may be required to steady the picture and stop the oscillation.
9. CURATIVE ACTION FOLLOWS ONE OR MORE OF THE THREE NORMAL DIRECTIONS:– from above downward (e.g., complaints shifting from head to back), from within outward (e.g., skin eruptions substituted for digestive symptoms), and finally the disappearance of recent and the return of old, perhaps even long- forgotten symptoms. Full recovery is indicated by any or all of these curative directions following the prescription of the wholly similar remedy.
10. THE SYMPTOM PICTURE CLEARS IN THE WRONG DIRECTION. Physical improvement with progressive mental warping, always unfavorable and unless checked may lead to insanity, sometimes occurs in tuberculous, syphilitic, and sycotic cases and the suitable antipsoric, antisyphilitic or antisycotic remedy should be presented. The corresponding nosode will sometimes turn the case even in the face of confusing and apparently conflicting symptomatic indications.
11. TOO SHORT RELIEF OF SYMPTOMS. This may mean any of several things: — (a) Too low a potency of the remedy; (b) A similar but not the exact similimum may have been prescribed; (c) Poor case management, failure of the physician to discover the obstacles to recovery, or failure of the patient to cooperate with his medical advisor and to actually live up to his part of the necessarily mutual undertaking.
In observing the action of the indicated remedy the kind of improvement is worthy of consideration. If the remedy is acting as it should there will be objective evidence unmistakable to the watchful physician, something in the step, the tone of voice, the manner of greeting, the expression and color of the face. Something has happened, a change has taken place.
The statement of the patient may or may not agree with the objective symptoms and signs of betterment. The chief complaint, the particular outstanding symptom, may perhaps be no better, may even be aggravated; and with his attention focussed on this the general constitutional change may be more or less overlooked. In such a situation, if the patient is questioned regarding each recorded symptom there should be ample evidence of remedial action, enough to satisfy both physician and patient.
Improvement that is general is of tremendous value, that which is particular is much less encouraging. The kind of improvement desired must include betterment in the mental sphere, more ambition, more energy and at least some of the objective signs and symptoms as noted above.
Remedial action which does not include several of these essentials must be regarded with some misgivings as to the actual homoeopathicity of the remedy prescribed.
After the first prescription in chronic cases three very important questions generally sooner or later present themselves:.
When should the remedy be repeated? When should the potency be changed? When should a new remedy be prescribed?.
Much of success and failure in homoeopathic practice is involved in the correct or incorrect solution of these problems.
There is undoubtedly a very strong tendency to make all three errors: to repeat too soon, to change the potency without rhyme or reason and to prescribe a new remedy prematurely without adequate symptomatic justification.
If the first prescription was in error the sooner the mistake is recognized and corrected the better. But suppose the similimum has acted favorably, when will it cease to act and require repetition?.
Any table to list the duration of action of a list of remedies is to be regarded with suspicion. Such a time table fails to take into account the wide potency range employed in homoeopathic practice, the varying degrees of pathological resistance which the remedy must encounter and the constitutional reaction of each individual patient.
Improvement under the action of the remedy in chronic cases is almost never a straight shot up a hill or inclined plane. As day alternates with night so does amelioration alternate with aggravation during the recovery process. This oscillation or rhythm is a normal and natural phenomenon and careful observation will enable the physician to detect it in the vast majority of cases coming under constitutional treatment. Do not allow the ebb and flow of the tide to confuse you as to the general direction the case is taking.
Careful observation along these lines will act as a check against hasty action which might cut or divert the remedial process.
The Hahnemannian who employs the single remedy in the single dose and in moderately high potency, having removed the obstacles to recovery, is in a most fortunate and opportune position to truly observe and accurately evaluate the results of his labors.
PHILADELPHIA, PENNA.
Eugene passed away at his country home on Spring Hill, Tuscarora Township, Bradford County, PA. He had been in ill health for several months. His wife, the former Caroline Davis, whom he had married in Philadelphia in 1910, had passed away in 1961. They spent most of their marriage lives in Swarthmore, PA.
Dr. Underhill was a member of the United Lodge of Theosophy, a member of the Philadelphia County Medical Society, and the Pennsylvania Medical Society. He was also the editor of the Homœopathic Recorder.