We observe larger objects first, gaining in power of discrimination by repeated looking. Trying to force facts into preconceived opinions and theories was, until quite recently, the way of the world, and very decidedly the way of medicine. Now, however, we are so engrossed in poring over minutiae, that we can barely see the great forest in which we are working. That devastating wars and the surgical holocausts should mark both periods simply show how bitter is the fruit of such thinking.
If, lacking a definite objective, we turn aside at every crossing, the end of our journey will never be insight. Presumably then propensity to wander implies a lack of definite ideals; a somewhat serious handicap, I imagine. Allow me to point out, here, that the lack of an unselfish devotion to the general good is the parent of most of our ills; especially those of the physician. For the public it is a case of where the ostensible needs to be made the obvious.
A look at the materia medica excites surprise that any one or even several persons should have ventured upon indexing it. It is also one of the reasons why our repertories fail to make the right, appeal to students! nor are they always easily worked, even by experts.
If it be really axiomatic to say that effectiveness is practically governed by simplicity of operation, then the great labour of properly collecting and developing clinical pictures and finally finding the similimum therefore, implies that our methods are still very crude. When doing this most of us try first one tack then another, until we develop the one best suited to our own mentality; thereby gaining a considerable efficiency and doing fairly good work. The result is just enough striking successes to hold our interest, and make us feel the near presence of much better and greater things, could we but fly grasp the situation.
As the different sciences bring first this then that fact in the scheme of nature to light, we note with keen satisfaction that they quite uniformly lean toward or tend to support the law of similars. Viewed from this angle the bearing of aetiology, anamnesis and heredity on disease aspects has been but imperfectly worked out, especially as concerns Homoeopathic practices. At most we have been content to observe the successive disease phases or the direct hereditary bias present in a given case, which is a move in the right direction, but of comparatively little real value because the investigation has not been carried far enough.
Associated individuals known as blood kin, invariably carry forward certain predilections to disease, so that by noting the ten or fifteen nearest blood relatives and their complaints, as accurately as possible, we are able to enumerate the relative proportions of the various tendencies present. Such findings show parental influences to be fifty per cent, basically active. Grandparents and children are the next most potent factors. The remainder include peculiarities descending from still earlier ancestors and are of a very persistent kind.
The actual symptoms of the patient are generally found to be an amplification of the hereditary findings, while a comparison of the two series usually points to such rubrics in the repertory as will quickly bring into relief the most similar remedies. It is especially helpful in those single symptom cases which Hahnemann called the most difficult of all. Working out a test case will exemplify the method. The patient had already improved marvellously for months after pulsatilla 12X given in three doses, twelve hours apart.
A careful examination showed sixteen points of morbidity in as many individuals of the nearest blood kin. Of these seven were of the rheumatic type, two typhoids, two pneumonias, two dysenterys, one sepsis and one each cardiac and haemorrhagic. A glance at the corresponding rubrics of the repertory gave phosphorus, pulsatilla and sulfur the first place. The indications upon which pulsatilla had been given are not regarded as characteristic by any means, yet in this scheme they become the individualistic, hence deciding ones.
Let me stress the scientific accuracy and speed of this method which begins with the self evident and objective, general findings and ends by using subjective sensations and mental symptoms for the final differentiation. Moreover it cuts a path of its own right through the repertory toward the deeply acting constitutional remedy of the patient.
DISCUSSION
Dr. Krichbaum: Suppose a man knows little about Homoeopathy, how is this going to come out?
Dr. Boger: If a man knows little about Homoeopathy this is the way to find out.
Dr. Krichbaum: It is a mechanical thing, is it?
Dr. Boger: No. The subjective sensations and mental sensations are used for the final differentiation.
Dr. Krichbaum: Do you rely entirely upon that, don’t you inject some of C. M. Boger into your remedies?
Dr. Boger: That is beside the question.
Dr. Krichbaum: No it isn’t beside the question. I will frankly say that I haven’t seen what you are driving at, and I am considered a fairly good prescriber and a fairly good Homoeopath.
Dr. E. M. Gramm: I think Dr. Boger has presented a matter that is of the greatest importance to Homoeopathic physicians who are accurate prescribers.
I am sorry to say that most of my friends who are accurate prescribers, when it comes to the matter of family history, take very much for granted. When I took charge of the dermatological department of Hahnemann dispensary, I entered it with the idea that most of our good Homoeopathic prescribers have, i.e., that disease manifestations upon the skin are “more or less evidences of heredity and welcomed the opportunity of investigating the matter; and there are very few of my friends among the so-called pure Homoeopathicians who, the moment they see a skin disease, do not say that child has inherited it. Our older. writings lead them to that conclusion.
Dr. Boger indicates the method by which to prove to ourselves that hereditary influences do or do not exist. In other words, by following his suggestion the assumption that inheritance is a factor in a given disease becomes a certainty when fads prove its truth. Prescribing on an assumption does not cover the totality of the symptoms of a patient. Dr. Boger gets his data from immediate consanguineous relatives; then he goes farther back to the preceding generation; then goes into the history of relatives of a lesser degree of consanguinity, etc. Finally, he focuses the information obtained’ on the patient in hand and does what rea1 Homoeopathicians must do—differentiate his remedy. His plan of getting the history of the case—getting the hereditary—is admirable. Following that plan will prevent us from doing what many of us do who try to practice Homoeopathy—imagine we know the hereditary when we see the disease.
Dr. Ords: I am wondering, in view of the fact that the history of the relatives of our patients may be very faulty, maybe the history that we get is partially false. We know that as a matter of diagnosis perhaps 40% or 50% of the diagnosis made are incorrect. Well, if that is the case, might it not also be so in these family histories, and the physician then would be basing his prescription on something that was partially false?
Dr. Lehman: I have worked along the line of Dr. Boger for a number of years and I find a great deal of helpful evidence will come out of almost every examination along that line. In connection with this method of examination, I have certified the conditions time after time by an examination of the eye, proving the hereditary trouble of the condition. I have a case under my observation now, of a young man about 18 years old, rather weakened in all his performances, and unable to do the usua1 amount of work and exercise of a boy of his age. An X-ray was taken of his lungs which showed a number of diseased areas. The diagnosis, of course, was tuberculosis, but in an examination of the eye there were no inflammatory areas, but it showed numerous streaks of lymphatic trouble hereditarily obtained, and showed that this had been healed practically in the prenatal condition. Now the diagnosis and a history of the patient all agreed, and it made quite a difference in the selection of a remedy when you know all these things have a bearing, because every remedy has a pathology, and if your lymphatic system is injured from the beginning and you know remedies that have their influence largely in this line of pathology you are at once helped to the keynote of a remedy. Then you can work it out backwards, and you will get your symptoms almost every time. It only helps us to find the remedy.
Dr. Custiss: I would like to ask Dr. Boger one or two questions, if he will illustrate a little, when he doses the discussion.
You say that you don’t use the repertory in the ordinary way of working, as ordinarily given. How then, are we going to try this method out and get at it—tell us how to get at it with the tools that we have to use.
Born in Western Pennsylvania, he graduated from the Philadelphia College of Pharmacy and subsequently Hahnemann Medical College of Philadelphia. He moved to Parkersburg, W. Va., in 1888, practicing there, but also consulting worldwide. He gave lectures at the Pulte Medical College in Cincinnati and taught philosophy, materia medica, and repertory at the American Foundation for Homoeopathy Postgraduate School. Boger brought BÅ“nninghausen's Characteristics and Repertory into the English Language in 1905. His publications include :
Boenninghausen's Characteristics and Repertory
Boenninghausen's Antipsorics
Boger's Diphtheria, (The Homoeopathic Therapeutics of)
A Synoptic Key of the Materia Medica, 1915
General Analysis with Card Index, 1931
Samarskite-A Proving
The Times Which Characterize the Appearance and Aggravation of the Symptoms and their Remedies