Dr Rajitha K Nair
After Hahnemann’s materia medica pura was written it became more and more apparent that some method should be used that would make it possible to find the similimum more easily and quickly. Records of symptoms developed through proving reached so bulky proportions that medicines were prescribed after referring pages and pages of materia medica. Even Hahnemann who conducted many provings and who himself proved many drugs prescribed medicines after much reference to the materia medica. This was a stupendous task even to Hahnemann and he compelled a short repertory of leading symptoms which were printed in Latin. Later he developed the repertory idea still further but these later repertories are still in the manuscript form.
After recovering from purulent tuberculosis In 1828 Boenninghausen developed a firm belief in homoeopathy. He started working on the new healing art and came in contact with several physicians and tried to know more and more about Homoeopathy. Soon he came in contact with Hahnemann in 1830. At that time repertory was a new adventure in the Homoeopathic literature developing under pressure of necessity in indexing many provings that had accumulated or to Index the ever enlarging materia medica.
Boenninghausen took up the task of compiling a Repertory on being requested by Hahnemann himself. He meticulously went through the records of original provings and compared them with reports of clinical verifications. In this process he even discarded some medicines which could not stand his scrutiny.
In the modern version Boenning hausen’s repertory encompassed only those medicines that were listed in Hahnemann’s chronic diseases as antipsorics. He published his first repertory in 1832 and It is called as the REPERTORY OF ANTIPSORICS with a preface by Hahnemann. In spite of the systematic productions of Hartlaub and Trinks and Weber and Peschler whose alphabetical index was also prepared by Boenninghausen, the practitioners preffered Boenning hausen’s repertory. They found it more practical and urged Boenning hausen to make it more useful. To make this book more comprehensible Boenning hausen later on added more more antipsoric medicines that were nearly proved.
His second repertory the REPRTORY OF MEDICINES WHICH ARE NOT ANTIPSORICS was made available to the profession in 1835. In 1833 he published a book named THE SUMMARY VIEW OF CHIEF SPHERE OF OPERATION OF ANTIPSORIC MEDICINES and their characteristic peculiarities as an appendix to the repertory and also another work AN ATTEMPT AT HOMOEOPATHIC THERAPY OF INTERMITTENT FEVER.
In 1836 the book named AN ATTEMPT AT SHOWING THE RELATIVE KINSHIP OF HOMOEOPATHIC MEDICINES was published.
Lastly after 10 years of clinical experience published his Therapeutic pocket book in 1846 wherein he incorporated all informations from his earlier works as well as his rich clinical experience. It was named by Boenning Hausen as THE THERAPEUTIC MANUAL FOR HOMOEOPATHIC PHYSICIANS FOR — USE AT SICK BED AND IN THE STUDY OF MATERIA MEDICA PURA.
Source books of Therapeutic pocket book
- Repertory of antipsoric medlclnes-1832
- Summary view of chief sphere of operation of anti- psoric remedies and their characteristic peculiarities as an appendix to the repertory -1833
- An attempt at Homoeopathic therapy of Intermittent fever-1833
- Repertory of medicines which are not antipsorics-1835
- Relative kinship of Homoeopathic medicines-1836
The difficulty to cure the chronic disease caused Boenning Hausen to think of expedients which would make suitable remedy easier and more certain by bringing the symptom of each one more clearly in view. At first the repertory was limited to the remedies named in the first three volumes of chronic diseases.
The Therapeutic pocket book attained instantaneous popularity among practitioners. Even today this work is Invaluable. Dr: Hahnemann himself used Boenning Hausen’s Therapeutic pocket book in his practice and preferred it to jahr’s compilation. This Therapeutic pocket book contained the principles and general method of construction set forth in former volumes, much amplified and perfected as the fruit of constant observations over a period of several years and yet so compactly constructed that it avoided the cumbersome features of jahr ‘s and other earlier repertories.
About 2 years after Boenning Hausen first published his Therapeutic pocket book an English edition was published in Munster.Translators name has not been given for this edition but the translation was done as Boenning Hausen says in his preface that by one of the most eminent German Homoeopathic physicians who is perfectly acquainted with English language and literature but who does not care to be known. This edition is not practical for present day use because the translator used many phrases which are now obsolete
A French translation was made by Boenning Hausen himself
A short time afterwards It was translated by Hempel in around 1847. A careful comparison of several editions and comparison with materia medica convince us that of the older editions Hempels edition is more nearly correct in Its original form and more practical than any other early editions available at that time. translated by Boger and Okle in 1847.
Later it was translated by T.F-Allen where he made many changes in the form of additions of rubrics medicines and even some changes in the structure but the basic outline remained the same. he incorporated the two sides of human body published by Boenning Hausen in 1851. This incorporation was not done smoothly, so there are many difficulties .Allens edition has suffered from faulty translation to a marked degree. Along with these mistakes in translation and rearrangement of headings has decreased the usefulness of what would have been the most valuable edition of Therapeutic pocket book.
At last in 1935 H. A. Roberts a stalwart in the field brought out a new edition of Boenning Hausen’s Therapeutic pocket book with a few minor changes and carrying an elaborate Introduction which facilitated the understanding and practical use of the book. With his vast experience and contribution to the Homoeopathic literature he was perhaps the fittest person to write such a learned and useful introduction
Boenning Hausen’s Therapeutic pocket book is the result of his long years of his Indefatigable labour , the fruit of all his professional studies, the sum total of all his vast experience and a perfected type of mechanism by which the principle of Homoeopathy are made practical of application. Allen rearranged the book by changing the titles also.
Use of repertory
The physician need in his practice to aid in his memory a work which is abridged , easily consulted and which contains the characteristic symptom and their combinations. This is to enable him in any individual case of sickness to select from the remedies generally indicated , the one suitable and Homoeopathic without a too great loss of time. In his repertory construction Boenning Hausen was supported and advised by Dr: Hahnemann.
Philosophical background of therapeutic pocket book
The principle of repertorisation on Boenning Hausen’s Therapeutic pocket book is based on inductive reasoning. The essence of reportorial preparation is a generalisation or proceeding from particulars to generals.
Boenning Hausen proceeds on Hahnemannian theory that it is the patient who is sick and not his body nor his eyes. every symptom that refers to a part may be predicted of the whole person.
The symptoms are classified according to the elements of a symptom. The disease expressions are segregated under the four categories as location sensation, modalities and concomitants.
The school of philosophy that determines the principles of repertorisation is called Boenning Hausen’s school of philosophy. It is based on the premises of inductive reasoning. The basic principle for repertorisation is the process of generalisation or proceeding from particulars to generals. Thus the presence of particular symptom may Indicate the selection of Therapeutic pocket book provided that those particulars can be aggregated to form a general symptom on the basis of Inductive reasoning.
While studying the symptomatology in Homoeopathic materia medica , Boenning Hausen realised many difficulties with regard to symptoms. With the best possible case taking , the record is often left in an incomplete or fragmentary state where sometimes location, sometimes sensation and at other times modalities may be missing.
He secured the difficulties encountered by physician in securing a complete image of the case and his comparison of case records and the records of provers convinced him of the fact that the same lack of observation existed in provers as existed in
patients. He emphasised more on completing the symptom with all their components. Boenning Hausen held that a symptom should be complete before it fits into the totality. A complete symptom consists of sensation , location, modality and concomitants.
In constructing Therapeutic pocket book , Boenning Hausen based his grouping of symptom on Dr: Hahnemann’s teaching , It is imperative that the Homoeopathic physician should prescribe on the totality of the case. He proceeded on the hypothesis that this totality was not only the sum total of all the symptom but in itself was one grand symptom , the symptom of the patient. Whether the individual part or grand symptom Is considered 3 factors areimportant as
Location implies part, organ or tissue involved in the disease process. Majority of symptoms can be easily related to parts.
It includes the kind of pain sensation ,functional or organic change characterising the disease process. Sensation can be subjective or objective sensation or complaint. Patient generally mentions this component of the symptom. The change in normal function alters the sensation which is first noticed as a complaint. The exactness of the sensation helps the physician to understand the complaint and to differentiate drugs.
Every symptom is qualified by factors which modify them. In most of the expressions the increasing factor is identified by the patient and the factor that gives relief are hardly noticed. For completing the symptom both aggravations and ameliorations are important. Modalities include the circumstances which are causing, exciting, Increasing or affording relief of the sufferings. This also Includes causation and exciting and maintaining factors.
This is not an essential component, but its presence would immensely help us to individualize the case along with the other three components there exits some expressions which are not directly related to the symptom but such expressions appear and disappear with the complaint. These are the expressions of the individual and they deserve prime importance in the study of symptom and diseases. Very often patient forgets to mention concomitant because they do not consider them worthy of being mentioned.
BoenningHausen subscribed to the principles of generalisation. The brilliance of his focus is on particular symptom and the need to obtain all the four elements of a symptomatic expression to complete a symptom. As the ideal state may not always be achievable he introduced the principles of inductive reasoning for attempting generalisation. Under this two major premises included were the doctrine of analogy and doctrine of concomitance.
Boenning Hausen’s attempt was to complete the symptom but in practice he found it difficult to do so. Thus he evolved the concept that what is true to the part is also true to the whole person. The following fundamental concepts forms the bedrock of Therapeutic pocket book as
- Doctrine of analogy
- Doctrine of concomitants
- Evaluation of remedies
Doctrine of analogy
This refers to the concept of evolving a general expression from among the particular features. When a sensation is prevalent at more than two locations with the modifying factors being the same and having a common concomitant for all the affected regions that sensation have a pivotal role to convert the whole complex of expression into a meaningful unit that is a general symptom.
e.g :- If a person is having pricking pain in chest, teeth and knee joint, pain is aggravated by breathing and wearing warm clothes,. Toothache is worse from chewing and relieved by holding warm water in mouth, knee pain is aggravated by walking and there is some relief by applying a hot fomentation. Whenever this complaint affects this person he becomes homesick , sticking pain becomes a general sensation with modalities worse by movement and better by warmth, the concomitant being homesickness and parts affected being teeth, chest and knee. In certain situations this ideal may not be present. There may be some deficiency in the data either due to masking of data in the patient or due to non observation by the patient or due to physicians inability to access the whole data. In such an event basing on the principles of Gestalt’s school of psychology we are able to complete the symptom by using the available data.
Boenning Hausen referred to this plan as the doctrine of analogy. In the light of this plan , the generalisation of the symptom is achieved by the harmony perceived among the expressed features. While adopting to the doctrine of analogy one has to be careful to avoid falling prey to the trivialisation of the principle by overstreching it. The symptom complex thus obtained is called a grand symptom.
Boenning Hausen’s analytical mind came to the conclusion that to complete the symptom local modalities and sensations pertaining to one part should also be applied to other parts. Thus he raised local symptom to a general level which could be used for the whole person. This is called the doctrine of grand generalisation.
Boenning Hausen considered sickness as an expression of the whole person and not the part. Sickness is expressed through different parts of the person. Thus all modalities which are noted in one part but absent in other part should be taken as an expression of the whole person.
This approach solved many difficulties encountered in completing the symptom and for a long time majority of physicians followed this approach. Even today some physicians adopt this method. However this approach may not serve those cases in which different parts expresses different modalities which do not correspond to the person’s characteristics.
The combination of subjective and objective symptom constitutes the case. We often find that it is impossible to secure from the patient a clear cut picture of his difficulties in spite of the best art the physician may exercise.
Boenning Hausen recognized that even with the best possible case taking the record is often left in an incomplete or fragmentary state. In some instances the localities are not clearly mentioned , In others the sensation or affection is indicated in an intelligible manner. Most frequently the conditions of aggravations and ameliorations of the particular symptom or the patients general condition could not be stated because of patients lack of observation. Perhaps the patient could not state what relation the symptom the symptom had to each other as to time place and persons if there are alternating symptom groups. In these modifications of symptom such as aggravations and ameliorations lie the keys that unlock the similitude of remedies to the individual case.
Boenning Hausen comprehended the difficulties encountered by the practitioners in securing a complete picture of the case and comparisons of case records convinced him of the fact that the same lack of observation existed in provers as in patients. Later every case was examined symptomatically with this purpose always in view to make every symptom as complete as possible covering the specific points of locality, sensations ,modalities and concomitants or co-existence of other symptoms under the same circumstances.
He learned that symptom which existed in an incomplete form in some part of the given case can be reliably completed by analogy by observing the conditions in other parts of the case. If it is unable to find the condition which aggravated or ameliorated a particular symptom of the case patient would readily express a condition of amelioration of some other symptom. The condition of aggravations or ameliorations is not confined to that particular symptom but they apply to all the symptom of the case. In reality the patient is not expressing many symptoms but only parts of very few complete symptoms which the examiner must bring together and complete. Boenning Hausen so defined the Therapeutic pocket book that It would enable the physician to bring together these symptom and complete one part by another.
The perceptible symptom of the disease are often broken up and scattered through the different parts of the patients organism. These scattered parts must be found and brought together. Boenning Hausen applies the principles of concomitance , when in an obscure case he brings order out of chaos by combining the scattered fragments of symptom into one or more typical symptoms by fixing a locality in one part, taking the characteristic or sensation from symptom expressed by the patient In some other parts. But these symptom are not chosen at random they must all bear a definite relation to each other in the matter of time circumstances , even though they have a seeming irregularity in grouping.
Doctrine of concomitants
This is the most celebrated contribution that Boenning Hausen has made to the understanding of the totality of symptoms.the trigger factor of this discovery may be found in Dr:Hahnemann’s observations. While expanding the individualising features in relation to the accompaniments. Boenning Hausen constructed these factors as an addition to the concomitant factor and he developed this idea into an integral part of the complete symptom theory.
The verb concomitance means existing or occurring together, attendant. The noun means attendant circumstances. The concomitant thus becomes the factor which coexist with the primary suffering or the main complaint. The concomitant symptom cannot have an independent existence. In nearly every case we find one or more concomitant symptom, we often find that the concomitant symptom are not only co existent but they are those symptom that indicate the remedy.
In constructing Therapeutic pocket book Boenning Hausen based his grouping of symptom on Hahnemann’s teaching that it is imperative that the physician should prescribe on the totality of the case. He proceeded on the hypothesis that Oils totality was not only the sumtotal of the symptom but in itself was one grand symptom,the symptom of the patient. And that whether the individual part or symptom were considered in the totality 3 factors are important as location, sensation and modality.
Symptoms naturally occur in groups, some of which are marked and prominent and some are subsidiary. These are always the leading symptom and these chief symptom may be defined as those symptom for which there are clear pathological foundation or the symptom that are marked, prominent and clearly recognizable or symptom which first attract the attention of the physician and which causes the most suffering. It Indicates chiefly the seat and nature of the morbid process. If some symptom appear with some relation of time to the outstanding symptom group such as alternating summer and winter symptoms , they should be taken into consideration. In most cases we can find one or more concomitant symptom and we often find that the concomitant symptom are not only co existent but they are those symptom that seemingly have no relation to the leading symptom from the stand point of theoretical pathology.
Other important points regarding concomitant symptom are
We can find no reason for their existence in the individual under consideration
They exist at the same time in the same patient They must not be overlooked nor undervalued because they cannot be made to confirm to the theories of the traditional medicine.
According to Boenning Hausen concomitants are the differentiating factor. In all cases with location, sensation and modalities the concomitant must be added, the peculiar or accidental feature that exists in every totality. In both the patient and the remedy by which it is differentiated from every case or remedy.
The concomitant symptom is to the totality what the condition of aggravation and amelioration is to the single symptom it is the differentiating factor.
Boenning Hausen first identified in each case a group of symptom along with the main complaint which in practice were generally overlooked by the patient and unnoticed by the physician. In all cases such a group of symptom does exists and and they are totally missed due to inadequate observation. Such group of symptom even appear unrelated to the main complaint and they are very crucial in Individualising the case as well as the remedy.
Master Dr: Hahnemann had also stated the importance of striking singular rare and characteristic symptom which Boenning Hausen described as concomitant. Infact the idea of concomitant came from Dr: Hahnemann’s instructions on case taking where he emphasised the importance of enquiring into the symptom before, during and after the main complaint.
Evaluation of remedies
On account of the large number of remedies under nearly every rubrics Boenning Hausen FOUND IT INDISPENSABLE TO DISTINGUISH THEIR RELATIVE VALUE BY MEANS OF VARIOUS TYPES
So there will be found five classes distinguished by 5 types.
The grading of medicines in various editions
Grade marks original evaluation Allens edition
- 1st 5 spaced italics CAPITALS
- 2nd 4 simple italics bold
- 3rd 3 spaced roman italics
- 4th 2 simple roman roman
- 5th 1 (roman) (Roman)
Boenning Hausen was the first person to grade the remedies. Importance of this grading of remedies is that many drugs produce same type of symptom but with difference in frequency and intensity. This grading he indicated in terms of 5 ranks by different typography. the gradation is based on the frequency and intensity of the appearance of symptom in provers. 5 mark remedies are frequently confirmed and verified and 1 mark are doubtful remedies which require further confirmation by reproving, critical study and which occur most rarely in the book. these are mainly seen in the relationship section. The gradation of remedies signifies the varying importance of symptom in relation to the various drugs related.
Boenning Hausen’s keen and observant mind noticed that a relationship existed among remedies so he introduced a chapter on relationship of remedies. It is actually the book which Boenning Hausen published in 1836. In the earlier editions of pocketbook, he refers to this chapter as concordance of remedies but Allen returned to the earlier and more easily comprehensible title for this chapter.lt Indicates the comparative value of symptom in relation to particular symptom groups. The concordance has been of extreme importance not only for the recognisation of the genius of the remedies but also for testing and making sure of its choice and for judging the sequence of various remedies in especially in chronic diseases.
This chapter discusses the relationship of medicines under different headings as
- Sleep and dreams
- Blood, circulation and fever
- Other remedies
Plan and construction of therapeutic pocket book
During Boenning Hausen’s time repertory was a new adventure in the field of Homoeopathic literature developed because of the pressure of necessity in indexing the various provings that have been accumulated. He developed a repertory which was more convenient, more elaborate and which is at the same time more compact, comprehensive and easy to use when compared to the other existing repertories.
One of the important features of Therapeutic pocket book is that he used the five variations in type that indicated the individual evaluation of each remedy to the given rubrics. The existing repertories were largely defective in that they were largely constructed upon concordance plan which breaks every sentence or idea into component words or parts which scatters them throughout the work in an alphabetical order. once scattered according this plan they can never be brought together again.
So he thought of classifying and arranging the rubrics or symptom in such a way that they could be found easily and brought together in consistent and logical form. This Is done without separating or breaking up them too much. They must be separated but only in such a way that would not destroy their individuality and they must be capable of being reassembled when needed.
The plan must be elastic enough to allow the separated parts of a remedy to be brought together in such forms as would correspond to any group of symptom that might arise in practice.
NO: OF medicines
Boenning Hausen had 125 remedies in his original edition. Allen dropped out four remedies that appeared in Boenning Hausen’s work. These remedies are Angustura vera-because of the difficulty at that time in securing the true bark and the false had been sold for the true to such a degree that severe poisonings had occurred from the use of crude forms and Germany has forbidden its sale.
Magnetis poly ambo
Magnetis poly articus
Magnetis polus australls
Allen added 220 remedies so that the number now appearing
In Allens edition is 340.
H. A. Roberts had added 20 remedies so that the number of medicines now appearing after his correction is 364.
Index of remedies is not given, so that if certain medicine is not found under a rubric one is not sure weather the medicine is not included in the repertory or is not well represented in the book.
The remedies that Allen added appears in comparatively few rubrics and is found in location rubrics. And those rubrics dealing with functional symptom than in subjective and modifying symptoms.
Section on relationship deals with 148 remedies.
The present edition which we are using now is PRINCIPLES AND PRACTICABILITY OF BOENNINGHA– USENS THERAPEUTIC POCKET BOOK FOR HOMOEOPATHIC PHYSICIANS TO — USE AT BED SIDE AND IN THE STUDY OF MATERIA MEDICA PURA-EDITED BY Dr: T F ALLEN CORRECTED BY H.A- ROBERTS.
This Allen’s edition corrected by Homoeopathy .HA.Roberts and Annle.C.WiIson is arranged in two parts as
1. Part 1-Introductory part
2. Part 2-Repertory proper
PART 1 -INTRODUCTION
The introductory part of this work is written in nine sections
1. Preface-written by BY H.A. ROBERTS in 1935
2. Life and works of Boenning Hausen
3. Repertory uses
4. Art of physician in taking the case
5. Philosophical background
6. Construction of repertory -this section contains parts which are descriptions about the 7 chapters in his repertory as
Mind and Intellect
Parts of body and organs
Sensation and complaints
Sleep and dreams
Fever and circulation
Alterations of state of health
Relationship of remedies
7. limitations of repertory
8. adaptability of repertory
9. uses of analysis
II.Allen’s preface to the new american edition
III. Boenning Hausen’s original preface
PART II-REPERTORY PROPER
Allen had removed the general headings from mind to ameliorations and all thes in allen’s edition appears as chapters.
Name of section is printed in the top of each page
465 pages including relationship section
Index of symptom -21 pages
It comes under the classification of logical utilitarian repertory
evaluation of remedies -5 grades
The whole data in the repertory is segregated into 7distinct compartments in the earlier editions. We cannot find these divisions in later editions . the seven parts are
1. mind and intellect (original edition-mind and soul)
2. parts of body and organs
3. sensation and complaints in general,glands,bones,skin
4. sleep and dreams
Boenning Hausen’s edition
- Circulation of blood
- Cold stage
- Compound fever
- Concomitant complaint
- Blood and circulation
- Compound fever
- Concomitant complaints
- Febrile symptom -sides,signs and symptoms
6.alterations of the state of health
Aggravation according to time
Aggravation according to situation and circumstances
Amelioration according to position and circumstances
Allen had removed the headings of these subsections and the title was given as aggravations and ameliorations.
7. Relationship of remedies
Though each chapter can be as a whole by itself each chapter gives only one element of a symptom.the other elements may have to be obtained from other chapters. e.g:- headache-location of pain is found in second section, nature of pain in the third section and whatever concomitants that are found in the relevant sections.
In all sections as far as possible a systematic order has been united with an alphabetical arrangement is seen.
Therapeutic pocket book is the culmination of years of diligent and laborious work done by Boenning Hausen. During the initial days of compiling a repertory Dr: Hahnemann himself was supervising the efforts of stapf and ruckert. At the same time hartiauband trinks and Weber and Pesschier were also involved in compiling a repertory on being called upon by Dr: Hahnemann. Boenning Hausen took the task of compiling a repertory on being called upon by Dr: Hahnemann. He meticulously went through the reports of original provings and compared them with reports of clinical verifications.
This deals with the arrangement of rubrics under different sections of the repertory.
Mind and intellect
Therapeutic pocket book has two separate sections under mind as mind and intellect. In the older editions these were given as mind and soul.
Chapter on mind contains rubrics in relation to emotions and Intellect contains rubrics in relation to understanding and memory.
This is the least elaborate of all sections in Therapeutic pocket book.mind section contains 18 rubrics and so also in intellect section including the rubrics on vertigo. Apart from these we can find 18 rubrics in the chapter on aggravations under the head excitement-emotional. These are all general rubrics without any sub rubrics. They are too general and vague in nature to merit more elaboration for any practical utility.
It is indeed surprising to find few rubrics under mental domain while Boenning Hausen was an ardent follower of Dr: Hahnemann and was in close correspondence with him for many years. It is a well established fact that Dr: Hahnemann advocated that the measure of a man’s personality and his deviations from normal lay largely in his mental and spiritual reactions. In the light of this Boenning Hausen’s decision to waterdown the mind factor stands prominent.
A deeper study of the objectives that set out for his repertory clears the mist surrounding confusion. Boenning Hausen based his work on the concept of whole man placing the balance of his emphasis on the value of concomitants and modalities.
It was not his intention to reflect the picture of man through his mental reactions alone because he realised that the most careful observer may at times get only a clouded picture of the mental symptom. Beginners are apt to make mistakes or very often overlook this part of the complete picture of the disease. It was his stand that the solid basis of his four square foundation was the only basis for securing the totality of the case.
Boenning Hausen included 17 rubrics under aggravations emotional excitement. Dr: Hahnemann held that the emotional causes of disturbed functions was an important factor in repertory establishing a state of equilibrium and Boenning Hausen’s experience led him to the same conclusion . disturbed emotional sphere manifests in a long and varied train of symptom varying in accordance with to the circumstances and conditions of environment, training and conviction. The consequence of these disturbed emotional states are so deep and permanent that they do not always manifests themselves clearly in the mental sphere and for curing the Homoeopathic physician should take into consideration these initial emotional disturbances.
So we assume that the rubrics under aggravations that deals with emotional causes of functional disturbances are closely related to that part dealing with mental and emotional symptom. Moreover considering the fact that Boenning Hausen based his repertory on inductive reasoning which means that the analysis of symptom has to proceed from generals to particulars, the mental symptom cannot be given prominence. Thereafter Boenning Hausen was justified in not according pre eminence to the mind factor in his repertory.
Misplaced rubrics that should be moved to mind section
1. All rubrics under aggravation -emotional excitement
2. Sensation-excitement nervous
3. Sensation-hysteria and hypochondriasis
4. Sensation-looked at aversion to being
5. Sensation-Touch Illusions of
6. Sensations -Water dread of
8. Aggravation-Alone when
10. Aggravation- Narrating her symptom
13. Aggravation-Strangers when among
14. Aggravation-talking of other people
15. Aggravation-talking about disagreeable things
16. Aggravation-thinking of his disease
17. Aggravation-thinking of something else
20. Amelioration-attention paying
21. Amelioration-carrying the child in arms
22. Amelioration-exerting mind
24. Aggravation weeping
25. Sensation- Carried desires to be
26. Sensation -Clumsiness
27. Sensation-comfortable sensation
His first repertory , repertory of antipsorics contains large number of rubrics under mind section when compared to Therapeutic pocket book.
Meanings of rubrics
1. Intellect-ability to reason ,understand or perceive
2. Amative -Incline to love more of sexual love
3. Avarice-too great desire to have wealth or greed for riches
4. Despair- hopelessness
5. Excitement- to arouse the feelings
6. Fretfullness-lrritable,discontended and peevish
7. Haughtiness-having or showing great pride in oneself contemptt or pride, arrogant
8. Mischevious- Injurious or harmful. Incline to annoy or vex with playful tricks
9. Mistrust-lack of trust or confidence, In doubt, they have no trust or confidence in themselves Intellect section
1. Befogged-to make obscure mild or confusion
2. Comprehension-capacity of understanding Ideas or facts
3 Delerium-a temporary state of extreme mental excitement characterised by restlessness confused speech and hallucination. It may sometimes occur during fever or in insanity.
4. Ecstasy-a state of being overpowered by emotions or joy, grief or an extreme emotional exaltation usually intense and delight that overpowes the senses and lifts one into a trance like state.
5.Imbecility-a mentally retarded person equal to a child between 3-8 years old , very foolish and stupid person
6. Stupefaction-stunted amazement of utter bewilderment
1. Mortification-wounded pride, something causing shame or humiliation
2. Reproaches-to accuse and blame for a fault, so as to make feel ashamed
3. Scorn-extreme often indignant contempt for something or someone or to refuse or reject as disgraceful
4. Vexation- something which cause annoyance or distress
Comparison with kent
Rubrics are much less compared to that given in Kents repertory .sub rubrics are not given for any of the mental symptoms.
Therapeutic pocket book Kent
Alternative mood Mind-moods alternating
Fretfulness Mind- Irritability
Comprehension difficult Mind-difficult
Aggravation -excitement-emotional Mind-excitement emotional
Aggravation -contradiction Mind-contradiction Intolerant
Aggravation -fright Mind-fright ailments from
Aggravation – grief and sorrow Mind-grief
Aggravation -jealousy Mind-jealousy
Aggravation -joy Mind-joy a/f
Aggravation -unhappy love Mind-love ailments
Aggravation -mortification Mind-mortification
Aggravation -reproaches Mind-reproaches
Aggravation -rudeness of others Mind-rudeness ailments from
Aggravation -scorn Mind-scorn
Aggravation -vexation Mind-anger ailments from
PART II – Parts of body and organs
This part of Therapeutic pocket book constitutes 42 chapters and it follows the anatomical schema of Dr: Hahnemann beginning with upper parts like head and proceeding downwards to the mouth, then following alimentary tract down with its functions and symptom. Then follows urinary organs and functions , sexual organs and functions, symptom related to respiration and then respiratory organs , external throat, neck, chest, back upper and lower extremities.
When Allen translated Boenning Hausen’s Therapeutic pocket book he added many eye symptom and also Boenning Hausen’s work on two sides of the human body. This section begins with a chapter on internal head followed by a chapter on external head which deals with scalp, hair and also one or two rubrics on sensations on external head. Again internal head and external head chapters are present which are only dealing with sides of head right and left side. By arranging so we can find medicines having affinity to particular locations.
In dealing with any location that have a definite function especially of senses we first finds locations with its modifications followed immediately by a section devoted to symptom of function.
Eg:- eye-vision, ear-hearing In dealing with the chapter on eye we can find that this chapter deals with various locations of eye and is followed by a chapter on vision. Although this part of the book is dealing with locations we can find sensations and complaints also in these chapters as squinting, staring, cataract, discharge from nose, stopped nose, and some rubrics on concomitant or accompanying symptom. Vision, Ing nad smell chapters are dealing with various abnormalities of Its function.
Face-while dealing with face we can find some locations which are given as sub rubrics. eg:- eruption-cheeks, chin swelling-between lids, brow,
Teeth – begins with a rubrics toothache generally which should have been given under sensations according to the general plan. This is followed by different locations as Incisors , molars etc. some symptom like grinding of teeth, teeth covered with mucus , sordes are also given. Gums are given as location in teeth chapter. Sides are included in the same chapter
Mouth-It contains sub rubrics relating to breath, (hot and cold) saliva (increased, decreased) tongue and hard palate ans soft palate. taste is given as a separate chapter after one on hunger and thirst.
Throat-contains only two locations, throat Internal and tonsils. Chapter on external throat is given after air passages.
Mouth and faces is dealing with only sides of throat such as right and left sides.
Hunger and thirst-this chapter deals with rubrics on appetite, thirst, hunger, desires and aversions. Intolerance or aggravation from particular articles of food is given in chapter aggravation but one draw back of this chapter is that many important medicines are missing in many rubrics.
E.g. desires salt-nat mur absent Taste deals with various perversions of taste like bad bitter, burnt. In Kent’s repertory this is included in the chapter on stomach.
Nausea and vomiting-deals with rubrics on these conditions and also about the character of the vomits Abdomen-locations on abdomen are given under 5 sections and these sections are dealing only with location except the rubrics on hernia. The sections dealing with abdomen are
- Internal abdomen
- External abdomen
- Abdominal rings-sides
Internal abdomen deals with various Internal organs and also locations like hypochondria, epigastria etc, diaphragm is given as a location in this chapter (kent-chest). Stomach is included in this chapter (kent-separate chapter). External abdomen deals with locations Iike inguinal glands ,mons veneris. Flatulence-deals with different rubrics related to flatus like odour, cold ,hot, Increased flatus, borborygml etc.eructation, beiching and heartburn is given as section before nausea and vomiting.
Stool-chapter on stool is important in the sense that it contains many location rubrics like rectum anus and perineum. Many conditions or complaints like diarrhoea, constipation, haemorrhoids, worms and also rubrics related to the character of stool are also present . There is no definite order for arrangement of rubrics but sub rubrics are arranged in alphabetical order. Concomitants are given as troubles before during and after stool Urinary organs , urine and micturition-In Therapeutic pocket book 3 chapters are given in relation to urinary organs and its symptom of function. The section on urine deals with colour, odour, constituents and sediments of urine and also its quantity. Mictiuration section deals with symptom of urination and also some concomitants. It contains rubrics like dysuria, retention and concomitants as troubles before, during and after Mictiuration.
Sexual organs, menstruation, leucorrhoea-both male and female sexual organs are dealt with in chapter on sexual organs. The order of arrangement is first male organs in general followed by particular locations like penis ,glans etc.this is followed by female organs in general. Then labour pain , Its character and after that symptom related to sexual functions. Sides are incorporated in the same chapter.
Section on menstruation includes rubrics related to menstruation, character of menstrual discharge, abortion, menorrhagia etc. these rubrics can be considered as aggravations also.
Section on leucorrhoea deals with character of leucorrhoeal discharge and concomitants or accompanying troubles of leucorrhoea.
Respiration, cough and air passages-here symptom of respiration are given first consideration. So before locations symptom of respiration are given as arrested. Irregular, oppressed. after respiration comes a section on cough which include both rubrics on cough and expectoration. locations are given last under the heading air passages which include larynx and trachea. Voice rubrics are also given in this chapter.
External throat and neck, neck and nape of neck-this sections include only locations the most important ones are cervical and sub maxillary glands and the thyroid gland, (neck is not given as a chapter in Kent’s repertory instead we have to look for rubrics related to neck in two chapters for anterior neck- external throat and for posterior neck- back-cervical region). neck and nape of neck deals with only side rubrics.
Chest -this section deals with both Internal and external chest, heart and its region, sternum and its region, mammary glands nipple etc.the order of arrangement is at first internal organs and its locations followed by symptom produced by them like palpitation. Then comes locations on external chest, mammary glands and nipples followed by milk its quantity and quality. sides of chest are included in the same chapter.
Back-this section includes only location rubrics likescapula, dorsal region, lumbar and sacral region and coccyx. Boenning Hausen makes 4 divisions of back namely
- Back in general
- Kraus-part of back between hips corresponding to the region of the sacrum
- Steiss-region of coccyx
He has no separate division for small of back which we understands to be as the lumbar region I.e extending from the hips to ribs. Here the symptom in materia medica which we include under small of back are given under sacrum and lumbar region.
Upper extremities-This chapter contains only location rubrics. The order of arrangement is from above downwards anatomically from shoulder to nails-axilia is included under upper extremities-(kent–chest). Then joints of upper extremities are given in general followed by each individual joint from above downwards from shoulder joint to finger joints and then bones of upper extremities in general. Sides are included in the same chapter.
Lower extremities-here also same arrangement as that seen in upper extremities. Locations are arranged in anatomical order from above downwards from loin to nails. then joints of lower extremities in general followed by individual joints as hips to toe joints and then bones of lower extremities in general. Sides are included in the same section.
Under these chapters devoted to parts of body and organs we find a few aggravations and an occasional rubrics that might have been listed under concomitants.
Chapters where sides of body are added
1. INTERNAL HEAD
2. External head
6. Face-locations of sensation
8. Mouth and fauces(separate chapter)
9. Abdomen (separate chapter)
10. hypochondria(separate chapter)
11. Abdominal rings
12. Sexual organs
13- Neck and nape of neck
16. Upper extremities
17. lower extremities
Chapters where concomitants are given
Concomitants are those symptom accompanying the main complaints which have no direct pathological relation to the main complaint. Concomitants are the second differentiating factor according to Boenning Hausen and boger.
Some remedies are more inclined to produce concomitant symptom and these may not be always particular symptom but it includes every sort of complaints which lies in the sphere of the remedy. So these remedies which have a tendency to produce concomitants. The chapters where concomitants are added are
1. Intellect -drugs which have concomitants of mental symptom
2. Nose-accompanying symptom of nasal discharges
3. Leucorrhoea -accompnying troubles of leucorrhoea
4. Respiration -accompanying troubles of respiration
5. Cough-troubles associated with cough
Some troubles which can be considered as aggravation can be included concomitants.
Eg – troubles before during nad after stool
Micturiton -troubles before during and after
Menstruatin -troubles before during and toes
Chapters in parts of body and organs-comparison with kent
Internal head, external head, Internal head sides, external head sides in Therapeutic pocket book -included under one chapter head in kent repertory Eyes, vision, ear, hearing in Therapeutic pocket book – same as in kent
Nose, smell-one chapter nose in kent Face and face-locations of sensation- one chapter in kent Teeth , mouth, throat, mouth and fauces sides-In Kent’s repertory mouth chapter is given before teeth. In kent
throat is followed by a chapter on external throat. In Therapeutic pocket book external throat is given after air passages.
Hunger and thirst, taste , eructation, nausea and vomiting-except taste which is given under mouth. In kent’s repertory all these sections are given in stomach chapter. In Therapeutic pocket book stomach is given as a rubrics under Internal abdomen.
Abdomen Internal, abdomen external, abdomen sides, hypochondria, abdominal rings, flatulence- together given under one chapter in Kent repertory
Stool-preceded by a chapter rectum in kents repertory which includes diarrhoea, constipation, dysentry, haemorrhoids, worms etc . In Therapeutic pocket book all these complaints and locations like perineum anus and rectum are given in the section stool.
Urinary organs, urine, micturition-given as 5 chapters in Kent’s repertory and the arrangement is alphabetical as bladder, kidney, prostate , urethra and urine.ln kent symptom of micturion is included under bladder. Sexual organs-In Kents repertory two separate chapters male and female genitalla Menstruation- this section is included under genitalla in kent repertory. Leucorrhoea-Included under genitalla female in kent’s repertory
Respiration, cough and air passages-in kent air passages or larynx and trachea are given first consideration then respiration, cough and expectoration are given as separate chapters
External throat and neck-follows immediately after throat Neck and nape of neck-new chapter Upper extremity, lower extremity-together constitute a single big chapter
PART III – Sensations and complaints in general
In Allen’s edition the title of this chapter is given as sensation but it should be read as sensations and complaints as given in his original repertory .the next three sections as glands bones and skin should be considered as subchapters of sensations and complaints in general, this can be considered as sensations and complaints in glands bones and skin,
In this chapter we get an alphabetical grouping of subjective and objective symptom . It Includes rubrics related to
Locations- mainly generalised like side rubrics as side right, left, crosswise
Complaints or conditions eg: apoplexy
This section forms the most important and the most vital part of the book.
Subjective symptom or sensations given in this section
Desire for open air
Aversion to open air
Intolerance of clothing
Inclination to lie down
Aversion to motion
Sensitiveness to pain
Inclination to sit
Illusions of touch
Dread of washing
Dread of water
Examples of objective symptoms
Cracking of joints
All sensations and complaints related to glands. for location of these complaints we have to refer to the parts of body and organs Tonsillitis-Internal throat-tonsils + glands-Inflammation
Bones : All complaints related to bones like caries of bones but mostly subjective symptom are given.
Skin – In this chapter we get rubrics related to skin hair and nails
PART IV-SLEEP AND DREAMS
This part of the book is divided into three sections as
2. Positions during sleep
Sleep section contains rubrics related to yawning and waking. positions in sleep includes various positions which the patient assumes during sleep. It also includes sleepiness and sleeplessness with their modalities. In these chapters only the most essential and the most clearly defined symptom are given.
PART V- Fever and circulation
In the older editions of Boenning Hausen’s original work there were seven subsections. In allen’s edition the subheadings given by Boenning Hausen are removed but the general outline is followed with some minor changes.
- Original edition allens edition
- Circulation of blood blood and circulation
- Cold stage Chilliness
- Coldness heat
- Heat Perspiration
- Perspiration Sweat
- Compound fever compound fever
- Concomitant complaints concomitant complaint
- Febrile symptom -sides
These are not actually given as separate sections in allen’s edition.In this edition the headings are removed and we cannot find the chapter name in the beginning.
Section on circulation deals with rubrics related to aneamia, diseases and symptom related to blood vessels and character of pulse.
Immediately after the rubrics related to circulation cold stage begins with rubrics chillness in general and is followed by its different modifications.
In Boenning Hausen’s original edition third stage is coldness. But in Allen’s edition the third and fourth stages are reversed so that coldness is given after the heat stage. So in Allen’s edition we can find symptom of fever following immediately after the chilly stage or cold stage.
Coldness or cold stage-the cold symptom or coldness is given after the heat stage.
Perspiration deals with symptom related to sweat or sweat in any special parts. In this section, character of sweat, odour of sweat etc are mentioned . so this stage should be considered as a general section, most of the sections contain a rubrics devoted to concomitant complaint. Compound fever-here the different stages alternating as chill, then heat, then sweat etc are given.
Concomitant complaints-3 rubrics are devoted to this as before fever, during and after fever. Other than this most of the above sections is followed by the rubrics associated complaints. Febrile symptom -sides-this section was not given in Boenning Hausen’s original edition.
PART VI – Alterations of the state of health
Original edition contained three chapters as Aggravations according to time Aggravation according to situation and circumstances Amelioration according to situation and circumstances
Allen’s edition contains only 2 sections
Time is arranged according to the day timings and situations and circumstances are given in alphabetical order. Aggravation is a large section whereas amelioration contains only small number of rubrics and does not include time ameliorations. Clock timings are not given in Therapeutic pocket book.day timings are followed by a rubrics on periodicity. Situational aggravation include seasons, fullmoon, new moon (not given in Kent) injury burns etc.some mental rubrics are also given in aggravation section.rubrics on climacteric, peurparium, women, children, stages of life are also included in aggravation section.
PART VII- Relationship of remedies
Basis of this section is Boenning Hausen’s work on relationship of remedies called as an attempt at showing the relative kinship of Homoeopathic medicines published by Boenning Hausen in 1833. In the earlier editions of Therapeutic pocket book the title was concordance of remedies This section deals with relationship of 141 remedies. among these 148 medicines were present in original Therapeutic pocket book and 21 were added by Allen. This gives a comparative value of remedies in relation to particular symptom groups.
Chapter on relationship of remedies is divided into sections, each section being devoted to remedy in the alphabetical order.
Each of these remedy section is divided into rubrics here rubrics are not individual symptom groups like mind ,sensation location etc, as are found in the first part of the book.
So the rubrics in relationship section are
- Sleep and dreams
- Blood and circulation
- Other remedies
One rubrics which is commonly present in remedy section are other remedies. Some remedies don’t fall within the section grouping like mind localities but it covers all those symptoms that do not fall to such regular groups. So the rank of remedies in this rubrics represents a general relationship of these remedies to the remedy under consideration.
In the rubrics injurious and antidotes comparatively few remedies are given. In the earlier editions instead of injurious, the term noxious was given.
- Can be used for studying the relationship of various remedies at various levels as mind, locations,
- Helps to find out the close running remedies which can be thought of in future follow ups.
- Helps to find the second prescription in an acute case after the action of the first remedy is over to complete the cure in a case where the outstanding complaint is related to gland bones or skin, we must select our remedies from those rubrics under the remedy that has served well at first in acute stage.
- Treatment in a chronic case with a partial similimum. Here some benefit has been secured from the remedy selected as the similimum but a complete a cure. This can be can be due to several factors such as Incompleteness of our materia medica due to lack of complete provings our incomplete knowledge of materia medica Imperfect case taking due to these reasons we have been unable to select a similimum. So inorder to make a complete cure we can find a related remedy with the help of this section
- In chronic diseases with advanced pathology in serious conditions like advanced pulmonary tuberculosis we cannot give the indicated remedy if it is deep acting, but a remedy should be given which will not produce any adverse effects. Here the complimentary remedy can be given which may lead the patient into a condition where he can tolerate the deep acting remedy.
- To form the therapeutic programme
- Comparative study of materia medica becomes easy
METHOD OF WORKING
Under the medicine given as the first prescription refer the subheading in which the main complaint of the patient and use it as the first rubrics
First rubrics can be taken as the eliminating symptom , only these medicines should be taken further which covers the first rubrics. Only 3, 4 and 5 mark medicines need be taken .add up the marks and take the remedy with maximum marks. If the patients outstanding symptom is skin eruption then the first rubrics need not be mind but skin. Demerits of this section is that No: of remedies in relationship section is less compared to that used in other sections
Adaptability of therapeutic pocket book
From the philosophy and construction of Therapeutic pocket book It is obvious that the book can be used for the repertorisation of following types of cases.
- Cases with complete symptom
- Cases with prominent sensations and modalities in some parts but vague in other parts
- Cases with prominent concomitants
- Cases with paucity of symptom with scattered modalities and no characteristics
- Cases where generals are lacking
In addition cases where there are confusing symptom many or few when the remedy likeness is reviled we can refer to Therapeutic pocket book
It is useful to get related remedies by working on the last chapter.
Limitations of the repertory
Therapeutic pocket book was the ultimate attempt of Boenning Hausen to index the symptom of materia medica according to the instructions given by Dr: Hahnemann, It was the first valuable repertory for bedside practice. But soon many practitioners found it difficult to use it in daily practice. its construction was also found to be defective.
The Therapeutic pocket book underwent many editions but nothing could make it free from defects. Many criticized the principles of analogy and raised voice against the use of associated complaints as concomittant symptoms. Apart from over generalisation and difficulty in comprehending true concomitants the presentation itself has some problems. Being one among the earliest and pioneering works the attempt of Boenning Hausen is commendable.
As time passed newer repertories emerged some of its deficiencies were noted. They are No: of medicines:- originally the Therapeutic pocket book contained only 126 remedies but Allen who edited the book dropped out 4 medicines and added 220 new medicines. Hence the total no: comes to 342. Even after Robert’s edition the book deals with only 362 medicines which fall short of various pictures available in practice.
No : of rubrics – the rubrics given in the book are not many. The limited rubrics cannot be used for many of the symptoms
Rubrics and medicines :- though in the location part large group of medicines are mentioned under most of the rubrics, but in other sections we find many rubrics which do not contain well known and important medicines. Eg:- desire for salt NAT MUR is not mentioned and desire for smoked meat CALC PHOS is not mentioned. Some of the medicines are repeated often and are given undue importance. This can be modified if the book is used carefully and analytically. For Eg:- In mind section almost all rubrics contain VER ALB in high ranks
Mind section-In Boenning Hausen method though mind is not given importance in finalising the medicines from a repertorial group, we find that mind section is not well presented in the repertory .there are only 18 rubrics under mind and 17 under intellect section. These rubrics are too general and cannot be used for any purpose other than reference.
Concomitants of mental symptoms-a group of medicines appears under this heading which is not useful in practise.even medicines like thuja don’t find any place in this group. Concomitants – though prime importance was given to concomitants , concomitants are not given separately
Defects in construction and compilation-the book has undergone many modifications and editions. The incoporation of sides of body is not done smoothly. Therapeutic pocket book is based on the philosophy of complete symptom but the book itself does not follow the principle . very often location and sensation cannot be strictly divided and they are mixed at many places Indexing of medicines has not been attempted. As a result if certain medicines are not found under a rubrics then one is not sure whether the medicines is omitted or not well represented in the repertory.
- There is no fixed order for the arrangement of rubrics
- Number of medicines in relationship section is too few.
- There are many misplaced rubrics
- There are many similar rubrics under different sections which confuse the beginners.
- Vague and nonspecific sensations don’t find any place. In practice majority of patients do not specify the sensation.
- In Therapeutic pocket book there is no general rubrics for pain , only specific types of pains are mentioned.
This book has not been updated and so it tacks information about sarcodes and nosodes which have become an essential part of practice today and without the knowledge of these medicines practitioner is handicapped to a great extend
In spite of all criticisms leveled against the book its contribution to the profession is unique. It is still useful in working out specific types of cases.
Dr Rajitha K Nair BHMS,MD(Hom)
Govt. Homeopathic Medical College. Trivandrum. Kerala
Email : [email protected]