The observation of the patient after the use of the first dose


- BENERJEE.P,
 Let us take for granted that the first prescription has been correct and that the prescribed medicine has been administered in the right potency. But what are we to expect now? When will the dose have to be repeated or a fresh selection made? How long are we to wait? Are there any indications for judging whether the patient will be cured?-These are facts that will engage our attention now. But let me, in the mean time, tell you once again that, if repeated doses of the first medicine have been given as prescribed by Hahnemann in the sixth edition of the Organon, then the medicine must be stopped, directly re-action begins to appear, that is to say, there must be no more repetition of doses when there has been some change in the symptoms of the patient. And we must consider all the several doses that have been repeated to be as good as one single dose, because, though in number the doses have been so many, the effect is cumulative, and as such, it is the effect of one single dose in fact. There has been only one single stroke dealt to the life-force. For the life-force the doses that have produced no re-action, are no doses at all. The life-force did not feel them, and as such, they are all non-entities for it. This is why it is to be understood that in cases begun with repeated doses, all the doses repeated till before the appearance of re-action are to be considered as one single dose. However, when the re-action has appeared, that is to say, when there has been some change in the patient's symptoms, we must stop the medicine forthwith and watch the character and progress of the changes.

 What are we to expect after the appearance of re-action on the use of the first dose?-We are to expect some changes e.g. ,-aggravation of disease symptoms or their amelioration, or their disappearance, or even a disorderly re-appearance of the old symptoms as distinct from their orderly re-appearance, which is always in the reverse order. Let us consider these different kinds of changes one by one.
 In case of aggravation of the disease symptoms, we have to carefully analyze the aggravation. As for example, what is it that has been aggravated, and of what type and character is this aggravation? There may be an aggravation of the symptoms but the patient may yet feel better in his interior-in his mind. There may hove been a rise in the temperature; the stools may have increased in number and even become worse in character, but yet, if the patient feels more at ease than before, it must be understood that the aggravation is a homœopathic aggravation and that the patient is therefore improving. This aggravation is only an unmasking of that portion of the malady that was masked (suppressed), and is therefore, to the benefit of the patient, and you must not be unnerved at it. Then again, the patient may at times be unable to realise his own condition after the aggravation, that is to say, whether he is feeling better in the interior, and may not therefore tell you whether he is better or worse. And in such a case, you have to watch him out carefully and understand for yourself if he seems to be comparatively less morose and pulled down than before. If you find him like this, take it that it is homœopathic aggravation, and there should therefore be no worrying over it. If however, instead of a homœopathic aggravation (i,e. aggravation of the symptoms of the disease with an amelioration of the condition of the internal being of the patient), there is an aggravation of the disease symptoms as also of the internal (the mind) of the patient, it must be viewed with distrust, as, such an aggravation does not indicate the process of cure. In the case of a true homœopathic aggravation, which indicates the process of cure, the patient must be better in the mind, in spite of the increase of his physical sufferings.

 But why are we to accept a homœopathic aggravation (aggravation of the physical symptoms of disease with an amelioration of the mental condition of the patient) as a favourable indication and the reverse of it as unfavourable?-The fact is that the really curative medicine will begin its process of work from the centre to the circumference, and if it begins its work first in the centre, in the mind, the effect will be manifested at once in the mind, and the patient will therefore feel better mentally first. But if, on the contrary, the medicine only brings about some improvement in the external symptoms without bringing about relief in the mind, it only means that the medicine is not acting from the centre to the circumference, and as such it is no process of cure. The only process of cure, as has already been explained before, is from the centre to the circumference, from the more internal to the less internal, from above downwards and not otherwise.
 Just here, I must make clear to you one very important fact. Before you use the first dose of your medicine in a chronic case, you must make sure that the patient has vitality enough to stand the homœopathic aggravation that will follow. Because, unless there is sufficient strength in your patient to bear the sufferings of a temporary homœopathic aggravation, he may altogether succumb under your medicine. This is a disaster that you must carefully avoid. In eases so deplorable, facts should be placed before the patient's guardian point blank, and no attempt should be made for curing the patient, and therefore no such deep-acting medicine as only can cure him should be given. Such cases are cases for palliation only, and superficially acting medicines as may be called for by the symptoms in hand, should only be used here. There is no help if no cure can necessarily be effected in such cases and the physician is not responsible in the least. If the patient had come to him earlier, that is to say, when he had yet vitality enough to stand the homœopathic aggravation, he might have been cured.

 Another word of caution please. Just as you must be cautious enough to avoid the disaster of a homœopathic aggravation in a hopelessly de-vitalised case, similarly, you must be cautious enough to avoid the mere palliation of a case in which there is yet vitality enough for a cure. It would be miserable, if you would wrongly condemn a case, in which the patient, though unable to stand a high potency like 1000th or more is yet able to stand the 30th or 200th. If you condemn such a case as past cure and only palliate the troubles, you would be making a deplorable mistake and would be sacrificing "Cure" for "Palliation". In such a case it is advisable to begin with a low potency like the 30th or 200th. As a matter of fact, I have learnt from my own experience that apparently desperate cases are brought round by the 30th or the 200th potency without any disastrous homœopathic aggravation. Such cases, after they have been brought round to some extent by the 30th or the 200th potency in the beginning, may possibly be cured by gradually increasing the potency as the patients progress and acquire greater and greater vitality. Just a word about homœopathic aggravation in passing. I have often observed that the aggravation that is at times seen in acute cases due to the repeated use of lower potencies is generally considered by many, as homœopathic aggravation. But this is a tremendous mistake. In acute cases, there should be absolutely no aggravation. The medicine and the potency should be so adjusted to the case as not to cause any perceptible aggravation at all. However, the aggravation referred to above, is not merely an aggravation of the external symptoms with an amelioration of the "internal" of the patient, but, as close observation will show, it is an aggravation of both the physical symptoms of the patient as also of his internal condition. It is an aggravation both of the disease and of the patient, and it indicates that the dose of the medicine has been materially large for the case, and that a still finer dose should have been used. Homœopathic aggravation is always due to the fineness of the dose, while the aggravation in question is always due to the largeness of the dose, and it is for this reason that it is called medicinal aggravation. The effect of homœopathic aggravation is cure, while a medicinal aggravation means only trouble and suffering to the patient.

 However, there is always some change after the use of the first dose of the correct medicine, and this change is of various kinds. In some cases, it is aggravation, in some it is amelioration and in others it is a disorderly return of old symptoms, and so forth. Let us now consider one by one these various changes, just to see what probable prognosis they make.
 (a) If, after the use of the medicine, there is an aggravation of the physical symptoms without any improvement of the mental condition, the prognosis is not very happy. An aggravation at the beginning is of course a good sign and as such the Homœopathic physician may have reason to hail it with delight, but when he will find that mental improvement is not coming on, but it is the aggravation only that is continuing and continuing, he will have reasons to be alarmed. Because the non-appearance of any mental improvement will at once indicate that it is the medicine only that is acting and that the patient is not reacting i.e. , is not responding to the medicine. This shows want of sufficient vitality in him and also that the medicine used, has been acting too deeply for his vitality. If it had been used earlier, i.e. , when the patient had sufficient vitality to stand such deep action of the medicine, he might have been cured. However, as the cage is, it is too late for him and he is fast marching to death in spite of anything. The certain prognosis in this case is bad.

 [Note:-In such cases as have not sufficient vitality, great care should be exercised at the beginning, and potencies higher than 30th, 60th, or 200th should not be generally used. With such low potencies in the beginning and going higher up gradually, even these cases may possibly be brought round.]
 (b) If in the above case, the medicine had been used long before i.e. , before the patient's condition became so desperate and he had yet sufficient vitality to respond to the medicine standing the homœopathic aggravation brought on by it, the prognosis might have been quite otherwise. In that case, the aggravation would have been almost the same, but it would have soon been followed by an amelioration of the mental condition, the physical aggravation gradually disappearing. The prognosis in such a case is good.
 (c) There may be a different kind of aggravation after the use of the selected medicine - different from what has been described above. In this, the aggravation is perhaps very severe, but it is lasting for a very short time only. And after this severe but short-lived aggravation, there is a mental improvement of the patient, and this mental improvement continues for a long time. In such cases any other medicine is not generally required, as the mental improvement continues and it then results in an all round cure of the patient. So that, in cases of severe aggravation quickly followed by a progressing mental improvement, the prognosis is certain cure.

 The above are the few types of aggravation and their respective prognoses. There are, however, certain cases in which there is no aggravation but other kinds of issues, and let us consider them one by one.
 (d) In some cases, that is to say, in cases in which the chronic disease has not progressed very far and has caused only functional derangements in the organs without yet bringing about any derangements in their structures, there is absolutely no aggravation after the use of the selected medicine but pure improvement resulting gradually in an all round cure of the patient-body and mind. This type of cure generally takes place in acute cases and it is very very rare in chronic cases. Though it is always desirable to have aggravation followed by improvement, as this only indicates the depth of the action of the medicine and thus leaves no room for doubting certain cure, yet this type of cure also is no less gratifying, because it subjects the patient to no sufferings, and besides, the physician can also understand from such cures that the selection of the medicine as also of the potency was perfectly correct and that the remedy fitted the case point to point. This may therefore be called a high class cure.

 (e) In certain other cases, there is amelioration in the beginning, but it is soon followed by an aggravation. These indicate that the amelioration in the beginning was only the result of the superficial action of the medicine and that the medicine has not acted deeply enough. This is certainly due to wrong selection, and the remedy in such cases of wrong selection is by no means easy, because, you have now to wait until the aggravation passes off and the patient presents his original picture again. And then you have to make your prescription afresh. If however, the aggravation continues and the original picture of the patient is not presented, but on the contrary, only a condition of complexities comes up, you cannot wait longer yet. You should then prescribe on the picture of complexities as you find it.
 Right here, let me tell you that, in all cases in which there is amelioration followed by aggravation as above, it should not be invariably concluded that the prescription was wrong. You should make sure from a re-study of the case whether your prescription was correct or not. If it still appears to be correct, the probable inference would be that the prognosis in the case is unfavourable. But why?-Because, the prescription being correct and there having been some favourable action from its use, the ceasing of the amelioration and the subsequent lasting aggravation can only be explained by saying that it is the depleted condition of the patient that is not allowing the action of the medicine to be permanent. It cannot be Psora, Sycosis or Syphilis that is hindering the cure, because the prescription was based on these miasms; it must overcome them and carry the patient on to cure. Now, if it is not any of these miasms, then it must be that some organ of the patient has been so damaged as not to admit of any repair. This is the only reasonable inference that we can make from a case in which amelioration is quickly followed by a lasting aggravation, and we may hold that the prognosis in such a case is undoubtedly unfavourable.

 (f) There is again another kind of amelioration, and it is lasting too for a long time. But unfortunately this amelioration is yet no amelioration at all. Because in it, there is only an amelioration of the external symptoms-the external disease-manifestations, without a corresponding improvement of the "internal" of the patient. In it, the disease-manifestations disappear but the patient does not feel better. It is no "cure" in our sense of the word. We already know that cure is not a mere disappearance of the disease-manifestations, but that it is something more,-it is a restoration of the sick man to the normal condition of health. However, when it appears that under the use of a deep acting miasmatic remedy in high potency, there is only an amelioration of the disease-manifestations without the patient feeling better, the prognosis is that the patient is incurable, even if the said amelioration is lasting for some time. The failure of the deep acting medicine to do anything in the mental plane of the patient (or he would have felt better) indicates a highly depraved condition-so depraved that it is refusing to be manifested outside. And unless there is manifestation outside of a latent depravity, there can be no cure. Such patients have, therefore, to be palliated only, and more serious endeavours, namely the use of still higher potencies for bringing out the latent depravity in such cases should not be made, as that might result fatally.

 Now, we have so far discussed as to what is indicated by aggravation and amelioration when they appear after the use of correct medicines in chronic cases; that is to say, what developments will indicate a favourable prognosis and what unfavourable. But, besides, changes in the shape of aggravation and amelioration, there are also other kinds of changes seen in chronic cases after the use of miasmatic remedies. Let us discuss them in details now, though they have already been discussed to some extent before.
 (g) There may be cases, in which after the use of the deep acting miasmatic remedy, there is neither aggravation nor amelioration but on the contrary some new symptoms are developed-new symptoms, such as have never before been experienced by the patient. Such cases would indicate that the prescription has been wrong, and the remedy lies in waiting and allowing the action of the wrong medicine to pass off. When these new symptoms have passed off after a sufficient wait, and when the patient appears to have regained his original state, a fresh selection should be made correctly. If, however, the new symptoms brought on by the wrong medicine do not pass off completely in spite of sufficient time having been allowed but on the contrary mix up with the original state of the patient and present quite a different picture, then the fresh selection will have to be made so as to fit this new picture and not the original picture of the case.

 (h) There is another kind of change again. In it, the external symptoms are ameliorated, but some internal part of the patient is attacked. I have myself had experiences of such cases. When in a case of eczema, I have selected and used a remedy as indicated by the external symptoms, I have seen the eczema disappearing but severe diarrhœa or neuralgia following. This has been certainly due to the whole patient (his external and internal) having not been taken into account while making the prescription or due to the prescription having not been miasmatic. Just see, how very dangerous it is to prescribe on external symptoms only and how very necessary it is to base the prescription on miasms in order that true cure may be effected. This will also make it clear to you that acute treatment, more or less, is ever therapeutic patch-work, as it is based on the external symptoms only-without the internal, the miasmatic basis of the patient having been sufficiently taken into account. As such, acute treatment cannot cure a patient in the sense in which Homœopathy understands cure. Acute prescription is only a prescription for the "disease" but not for the "patient".

 However, in the above case, the medicine acted, but in a wrong way owing to the defect in selection, and the flow of the action was from the outside to the interior-just the reverse of the true process of cure, which is always from the interior to the outside. This sort of flow of the disease from the external to the internal is called "Metastasis". But how to meet such unscientific metastasis?-The only way is to antidote the effect of the wrongly selected medicine at once. But, before this is actually done, facts should be explained clearly to the patient's guardians, as otherwise the re-appearance of the eczema under the use of the antidote (this re-appearance must necessarily be, in order that a true cure may be effected), may cause them alarm.
 In this connection, I should like to make a thorough and systematic statement of the full indications of the whole process of cure as it ought to happen in a curable chronic case after the administration of a correctly selected deep acting drug in high potency on the miasmatic basis. Full indications of this process have already been given, but I think only a thorough statement of the whole thing in a nut-shell can make my say complete:-

 In a few days of the use of the medicine, there will be either an aggravation of the external symptoms quickly followed by an internal relief, or there will be an external and internal relief straight. Alongside this aggravation or amelioration, as the case may be, the old symptoms that are no longer there in the patient, that is to say, that have been suppressed by this treatment and that, will gradually re-appear in the reverse order of their original appearance. It should be carefully noted that, it will be a reverse order of re-appearance and not a re-appearance in any other order, which is not order but disorder. Now, alongside this process the patient will gradually feel relief first of all in the interior, in his mind, and this relief will gradually be transmitted from the mind to the body, first in the internal parts of it, then gradually to less and less internal and last of all to the most external part of it-from within outwards. Then again, the appearance of the improvement in the parts of the body will be first perceived in the upper parts, and then this will spread gradually to the lower-from above downwards. These are the indications of a true ideal process of homœopathic cure-a cure that makes a new man of the sick man.

 There are some patients who are remarkably sensitive. They do not tolerate even potencies like 500th or 1000th., and when you try any such potency on them, they begin to prove the remedy instead of running on to a course of cure. It is difficult to cure such patients, and as such, their symptoms can only be palliated for a time with low potencies like the 30th or 200th at the utmost.
 There is another class of patients yet, who are only typical pictures of disorder-mind and body. Evidently, they have never been cured of any illnesses in their lives. Any illnesses have only been suppressed in them, by our scientific friends, and having now arrived at a pretty good old age, say 40 or 50, the system has become so hopelessly depraved as to have actually forgotten its different normal functions. When you take up records of their cases, you will find that, they give you pages of symptoms but never a "Case"-never a particular symptom that can land you on any one particular remedy. It is a pity that man should suffer and suffer till the end of his days, when he can be cured and made happy.

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