There has always been much speculation regarding the proper method of using the Boenninghausen “concordances.” While Boenninghausen gave suggestions in the preface of the Therapeutic Pocket – Book for the use of the concordances, yet he did not give full directions. Consequently, as these suggestions are meagre, they have been overlooked and so the use of the concordance has languished.
Nevertheless, while some Homoeopaths have made use of the concordances they have usually, at the same time, felt that there was something, in or about them, that they did not understand, which, if explained, would be of inestimable help.
Let us see what Boenninghausen says in regard to the concordances and possibly, from that, we, may be able not only to understand the scope of this part of the Therapeutic Pocket – Book, but also, by its help, be able to make use of the concordances in therapeutic case study.
In speaking of his concordances Boenninghausen says: “In studying the materia medica, which I consider the fountain – head of Homoeopathy, these concordance have been of the most decided importance to me, as they have not only led me to understand the genius of the medicines, but also to select with more certainty the proper remedies, and to determine the order of their successive exhibition, particularly in chronic diseases.”
Here, then, are three applications of the concordances. First, the grasp of the genius of the medicines; second, greater certainty in selection, and, third, sequence. These three uses can best be comprehended if one first recalls how Boenninghausens repertory is constructed. Therefore, I will briefly outline its arrangement.
In the Therapeutic Pocket – Book there are seven separate and, at the same time, related sections. They are:
First. Mind and Soul, whose rubrics, though few, cover all moral and intellectual variations.
Second. Parts of the Body and Organs or “Location.”
Third. Sensation and Complaints, comprising those in
a-External and Internal parts of the body in general.
c-In Bones, and
d-Of the skin and external parts, which are thus grouped under one general heading and not divided into four separate parts as in Dr. T.F. Allens Boenninghausen.
Fourth. Sleep and Dreams.
Fifth. Fever, including
a-Circulation of the blood.
b-Cold stage (chilliness).
g-Compound fevers. Sixth. Alterations of the State of Health, that is
a-Aggravation according to time.
b-Aggravation according to Situation and Circumstance, and
c-Amelioration by Position and Circumstances, and, lastly,
Seventh. The Concordance of the Medicaments, to use the old phraseology.
These sections are not all as clear – cut as the names seem to indicate, but, for the sake of completeness, encroach on each other. Thus the second – “Parts of the Body” – contains details in the way of “Sensation,” which properly belong in that, the third, section, but could not be given as well there.
In each “concordance” these seven sections are represented and the harmonious relation of the remedy to others is given under each section.
Now the three applications of the concordances, of which Boenninghausen tells us, and a few words more, further along in the same preface, is all we have in the way of instruction concerning the use of the concordances. What help can be derived from these brief directions?
First. “The grasp of the genius of the medicines.” Boenninghausen puts it that in studying the materia medica the concordances were of decided importance to him, as they, among other things, led him to understand the genius of the medicines. This we also can do. The basis of such study is the help afforded by the concordance in comparing the remedies. Certainly one way, and, perhaps, the most satisfactory way, to study materia medica is by comparison.
This brings us to the second use, “to select with more certainty the proper remedies,” which would be a logical result of the comparative study of the materia medica.
So far we can, in both ways, follow Boenninghausens suggestions and thus gain all the benefit from remedial comparison and increased certainty of selection that the concordances offer. There is nothing obscure nor difficult to follow here.
The third application of the concordances may be summed up in the one word, “sequence,” that is, the sequence of the remedies. Boenninghausen says “particularly in chronic diseases,” yet we find the concordances useful also in pointing out the next remedy in acute affections.
This, the sequence of the remedies, is the most important of the three uses of the concordances, and possibly the one which has seemed obscure, but as to there being anything hidden, I feel that is a mistake. The concordances are to be used in this regard, that is, to find the “next remedy,” in the ways I shall soon point out. The almost always satisfactory result obtained from using one of them in indicating the remedy to follow is due to the wonderfully accurate and comprehensive manner in which they are compiled and not to there being anything concealed or esoteric. The hidden thing is the knowledge of the simplicity of the method of using them.
How many physicians are non – plussed when it comes to the selection of the following, that is, the “next” remedy!
Having selected the first medicine for a case with accuracy and worked out its action in various potencies, or if the symptoms change substantially, new ones developing, – either case demanding a change of remedy,- it is here that the difficulty comes.
To meet these new and trying conditions there are the instructions in the Organon, or Herings advice in regard to the importance of the new symptoms that have appeared; and, besides, the suggestions at the end of each remedy in some of the materia medicas, notably in the Guiding Symptoms, as to following remedies, and elsewhere, all of which is very helpful.
Yes, it is all helpful, but it is not as specific as are the concordances in this respect and besides it takes much less time to use the concordances, as I hope to show, an time often is of importance in a case.
Truly we cannot have too much help in this matter, and as it was with special references to the sequential relation of remedies that the concordances were constructed we frequently find in them the assistance we need and which we have sought for, unavailingly, elsewhere.
To my mind this is the great use to which the concordances may be put; in fact, as I have said, for which they were made, and this help may be obtained by using them, without undue waste of time or effort.
Take, for example, the arrangement of the concordances of two remedies, Aconite and Belladonna. Here almost, at a glance, one can see the careful way in which the relation of these remedies, to each other, was noted.
These medicines, Aconite and Belladonna, have many points of contact, but it will be seen, on examining their concordances, that while under Aconite the sequential relation of Belladonna is shown, yet in the concordance of that drug there is little if any indication of such relationship – sequential – of Aconite to belladonna, which we know seldom if ever occurs.
The concordances of both Aconite and Belladonna show distinctly that relation to the remedies which bear to them respectively a chronic relationship, that is, to Sulphur and Calcarea. And so it is throughout this part of the Therapeutic Pocket – Book, in regard to remedial relationship.
Incidentally there are two things in the concordances to which I wish to call attention. The first is in the way of correction. In the Allen edition of Boenninghausen the sixth section of each concordance has been changed. Originally this sixth section or rubric was in two parts.
This is the rubric corresponding to the sixth part of the main body of the Therapeutic Pocket – Book covering the “State of the Patient According to Time and Circumstance.” In the original the first part of this rubric related to “Aggravation According to Time,” and the second to “Aggravation According to Circumstances and the Ameliorations.” Dr.T.F. Allen put these two parts together. Certainly they are more useful in the original form, that is, separated.
The second matter is that in each concordance in section seven, which Allen has called “Other Remedies,” we have in reality a concordance of that particular concordance as section seven, in the divisions of the whole work, is the section of the “Concordances of the Medicaments.” Thus in each concordance of the concordance there is a resume of what has gone before in that particular concordance. This rubric is often of great help and may be the only one to be used.
How are the concordances to be made use of in relation to the sequence of remedies?
That depends upon the case and so, unfortunately, no hard and fast rules can be given. Something may be said, however. For example, the concordances may be used either with or without assistance from the first part of the Therapeutic Pocket – Book, as the case requires.
Generally a concordance is to be used alone, taking, as the first rubric, the one which covers the “part affected.” Thus if it be a mental case “Mind” is used first, or if the part be elsewhere in the body then the rubric of “Localities” is first taken, and so on. I use the rubric headings, in reference, as given in the Allen Boenninghausen.
The following is an illustration: In the study of a case in which Silicea had helped, the concordance of Silicea was used, together with the first part of the Therapeutic Pocket – Book. The rubric of “Localities,” in the Silicea concordance, was taken, then the various “Sensations” presented by the case, and, lastly, the special “Aggravations” in the case. These gave Calcarea as the remedy to follow. Not only did the materia medica, when consulted, confirm this, but also on exhibition, it proved to be the simillimum.
In another case with mental symptoms of Hyoscyamus, in which that remedy helped for a time, but finally failed to improve the case further, the concordance of Hyoscyamus assisted when used as follows:
The first rubric taken was “Mind.” Here Belladonna, Cannabis Indica, Stramonium and Veratrum album are the leading remedies, with Glonoine, Lycopodium and Opium next. As a skin efflorescence had recently developed the rubric of “Skin” was next consulted. These two rubrics gave Arsenicum 4, Belladonna, 6, Lycopodium 5, Phosphorus 2, Rhus 2, Sulphur 3.
Further study, in the materia medica, showed Lycopodium to be the remedy. it not only cleared up the eruption in proper order, that is, first, but soon the mental state also.
Another illustration of the use of the concordance is one in which lachesis was helping a joint case, but, after being exhibited in rising potencies, at last the patient failed to respond. Then in the Lachesis concordance “Localities” was taken. After that rubrics for the “Sensations,” “Modalities,” and “Concomitants,” that were present in the case then, were selected from the first part of the Therapeutic Pocket – Book. The resultant remedy – Pulsatilla – took hold at once and cured.
This was successful, of course, but the study could have been much shortened by taking just three rubrics in the Lachesis concordance, that is, “Localities,” “Sensations,” and “Aggravation, Time and Circumstances,” to use the rubric headings, as altered, in the T.F. Allen Boenninghausen. This gives Pulsatilla ahead of any other remedy – based upon the analytic value – as expressed by the different type.
I give this example in both ways because it shows the simplicity and rapidity with which the concordance can be used and also indicates how accurate the result may be.
There remains, then, to speak of those cases in which one makes use of the seventh rubric – tenth in Allen – which, as I have said, corresponds to each concordance as a whole and which I have called the concordance of the concordance.
In certain ill defined cases, that is, partially developed symptomatically, which may be said to have failed to localize, it is often the only rubric to use. One may yet enough suggestion from it alone, or it may have to be helped out, as it were, by other rubrics in the concordance or even, exceptionally, by the first part of the Therapeutic Pocket – Book, in a way similar to that I have already indicated.
The key to the special concordance to be used in a case consists in the name of the remedy last effective in that case. It matters not how this remedy was selected – whether by Boenninghausen, by some other repertory, or in some other manner or even as to the potency in which it was exhibited – the deciding point being that the remedy affected the case favorably, that is, it was homoeopathic.
Take a case coming from old school hands that has had, for example, either Ferrum or Colchicum (Colchicine). It may or may not be evident that the remedy has worked out its usefulness. It isnt necessary always to give one antidote, in such an instance, though that is one of the things to be considered. As the medicine has helped it is possible that if it be given in potency that there will be a further responses to it. If when the remedy be thus exhibited there is no reaction the concordance of that medicine may be of help.
Therefore in such a case there is a choice between these three procedures – that is, antidote, repetition in a different potency, or reference to the concordance.
From what has been said I hope it is clear that a concordance may be used in several ways. Particularly is it of value in selecting the “following remedy,” which it does with accuracy and with the minimum expenditure of time and effort. Also, because of its comprehensive grasp of the sequential relation of remedies, it is quite likely to suggest, in its workings, a medicine, to follow, which would not be thought of, without the aid of the concordance, except after laborious study, and which will be found, in the large majority of instances, to be the desired simillimum.
Those who use the Therapeutic Pocket – Book and, likewise, make use of its concordances, should add, if they have not already done so, the use of the eighteen groups of “concomitants.” They, too, are included in the Therapeutic Pocket – Book. These help to increase the accuracy of the remedy selection and decrease the time and effort required for its discovery.
As a paper of mine, in this subject, has already been printed, in the medical Advance, I will give only a short example here:
Take the case of an unmarried woman of thirty, whose menstrual flow comes too early, is scanty, bright, and without clots. All the associated symptoms – concomitants – which are hardly characteristic, occur before and after the flowing. During the flow, and in the interval between periods, she is free from symptoms.
The relief during the flow suggests a small group of remedies – a half dozen. Note, please, that in the working out the remedy, finally selected is one of the six, though the modality of amelioration during menses was not used in the study except infrequently. While Bovista (15), Phosphorus (17), and Sepia (15), cover this syndrome in Boenninghausen, Phosphorus most markedly, yet a reference to the materia medica shows Sepia to be the “most similar,” which is therefore given. The concomitant rubrics here are “before” and “after” menses.
This use of the concomitant rubrics makes available symptoms which would otherwise, from their commonness, be difficult to find in the repertories and which, if found, would, for the same reason – because they are common symptoms – be valueless for prescription purposes.
These common symptoms are available because of what may be called their mass, or concomitant, value. When grouped in this way under “concomitant symptoms” they thus collectively indicate a remedy, that is, a remedy which is more or less likely, as the case may be, to develop extraneous symptoms associated with various morbid states. The concomitant or mass value of each remedy, as estimated by Boenninghausen, is indicated in the concomitant rubrics, as is the remedy value in the rest of the Therapeutic Pocket – Book, by the different size of the type.
Boenninghausen speaks in regard to the rubrics of “Concomitant Complaints,” as follows: “Convinced of the importance of the symptoms which occur simultaneously with others, and form with them a group of symptoms, I have increased for a great many years the secondary symptoms in the Materia Medica Pura, by adding to them every secondary symptom occurring in my own experience, as well as in that of others, and their number has increased so incredibly, that I have been able to abstract from them general rules.
By these rules it is proved with great certainty that one remedy inclines much more than others to certain secondary complaints: that these last do not take exclusively this or that form, but that in general every kind of complaint which is at all related to the sphere of activity of the remedy, may be its attendant, although its true characteristic secondary complaints, attend it most frequently.
This discovery, proved by long experience to be true, has led me to bring the “Concomitant Complaints” together under one head, where the order of the remedies has again been pointed out by means of a different point; and whenever those secondary complaints require to be taken into consideration in the treatment of a case, they will have to be looked for among the peculiarities of the remedies, which are simultaneously indicated, in a greater or lesser number.”
It would seem that this explanation is as full and clear as could be desired.
The following list of these “concomitant” rubrics may be helpful, as they are renamed in the Allen Boenninghausen and many of them are, therefore, unrecognizable. The page number and the rubric heading under which they are given in the Allen edition follow in form thesis:
Mental – Concomitant Complaints (Drugs which have Concomitants of Mental Symptoms, p. 23).
Nose – Concomitant Complaints (Accompanying Symptoms of Nasal Discharges, p. 49).
Stool – Complaints Attending (Troubles Before Stool, – During, – After, p. 90).
Urine – Concomitant Complaints (Troubles Before. – At Beginning of, – During, – At Close of, – After, p. 100)
Menstruation – Concomitant Complaints (Troubles Before. – At Beginning of, – During, – After, p. 109).
Leucorrhoea – Concomitant Complaints (Accompanying Troubles of Leucorrhoea, p. 111).
Breath – Concomitant Complaints (Respiration, Accompanying Troubles of, p. 114).
Cough – Concomitant Complaints (Troubles Associated with Cough, p. 120).
Yawning – Concomitant Complaints (Associated Troubles, p. 240. See Aggravation, Yawning, p. 310).
Complaints Preventing Sleep (Sleep Prevented by Various Symptoms, p. 240).
Waking – Concomitant Complaints (Waking, Associated Symptoms p.241. See Aggravation, Waking, p. 306).
Sleepiness in the Daytime – Concomitant Complaints (Sleepiness During the Day, Associated Symptoms, p. 243).
Sleep – Concomitant Complaints (Associated Symptoms, p. 245. See Aggravation, Sleep, During, p. 300).
Sleeplessness – Complaints Causing (Symptoms Causing Sleeplessness, p. 246).
Fever, Cold Stage – Concomitant Complaints (Symptoms During Chill, p. 256).
Heat – Concomitant Complaints (Heat, Associated Symptoms, p. 259).
Perspiration – Concomitant Complaints (Sweat with Associated Symptoms, p. 265.)
Compound Fevers – Concomitant Complaints, Before, – During, – After the Fever (Compound Fever, – Before, – Before, – During, – After, p. 268).
These concomitant rubrics, as well as the concordances, appeared originally in the Therapeutic Pocket – Book. They were, unfortunately, either unappreciated or soon forgotten – probably both.
No other repertory contains anything that approaches them. Partial rubrics of this kind, in other repertories, have been evidently copied from Boenninghausen.
Being unique, practical and accurate, it would seem that the help of both the concordances and concomitants should be invoked, when possible, – first, because of the saving of time their use insures; second, because of the accuracy their use adds to the prescription, and, lastly, because the precision derived from their use also adds a scientific element to the prescription which is, unfortunately, too often lacking.
Those physicians who are able to elicit characteristic symptoms in every case, at whatever stage the case may be, have, of course, no need nor use for either the Boenninghausen concordances or concomitants.
Many of us, on the other hand, have to cure, if possible, chronic, and sometimes, acute, diseases occurring in patients whose symptoms are devoid of characteristics, no matter how carefully we examine or question them, either at the first scrutiny or later, when the action of the remedy has ceased. At such times the concomitants or the concordances may be of great help.
There seems to be no valid reason for avoiding these aids in prescribing, which have, by Boenninghausens genius, been worked out and arranged and which are available for our use and assistance. All that is required of us is to learn how to make use of them.
I trust that what I have given here may help some one in the use of both the concordances and concomitants. The aid given by them is too valuable to be ignored, too important to be neglected. While they are not needed in every case yet the accordances and concomitants in those cases to which they are suited is something which every physician longs for and for which every physician should strive.
With these prescription aids in Boenninghausen at hand, and a knowledge of the ease with which they may be applied, it is one step nearer to that ideal simplicity in prescribing which all in the profession desire.