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The Science of Homeopathy – page 239

1. The pathological diagnosis. A severe pathological diagnosis does not in itself signify incurability, but it is one factor to be considered.
2. The strength of the patient’s constitution, especially prior to the original homeopathic treatment. Younger patients with strong consti- tutions initially have a much better chance of recovery than elderly or weakened patients.
3. The nature of the response to previous remedies. To determine this, the entire history of the case must be reviewed. Perhaps the patient has had some response to, say, half of the remedies, and no response at all to the rest. The mere fact that there has been some response is not in itself an encouraging sign. If the responses were merely temporarily palliative, the prognosis is adverse. If there have been distinctive ag- gravation followed by lasting ameliorations, then the prognosis is more favorable.
4. The clarity of the image of the remedy in the moment. Often, a homeopath treating a case simply has never studied the remedy which is needed. In these cases, another homeopath may see the image very clearly. This prognosis would be more favorable.
5. The strength or weakness of the ancestors of the patient.

These factors must all be combined to form a judgment which, again, cannot be absolute or final. It is a difficult decision to arrive at, but it is of more than mere academic value. Depending on the curabil- ity or incurability of the case, the goals and approaches to treatment will differ.
Let us first consider the situation in which the case is judged to be relatively “incurable” after having many homeopathic remedies over a period of years. It is important to avoid routinely prescribing the rem- edy which last produced an amelioration. Incurable cases in general tend to change images very rapidly. It is quite unusual in such cases for a medicine to be needed twice in succession. Therefore, the case must be carefully re-taken at each visit, and whichever remedy is given must fit the image in the moment. For example, suppose an incurable case suffered a month ago from loss of urine upon straining or cough- ing; later, it turns out that the patient has a strong aversion to sweets. Causticum would naturally come to mind, but the chances are that the original stress incontinence has already disappeared and become replaced by another symptom which fits more precisely, say, Graphites. Each prescription must be based solely upon the current image.
In incurable cases, the goal is to find the remedy which will produce an immediate amelioration of symptoms. Of course, such an amelio- ration will quite likely be followed by relapse after a relatively short