THE NEED OF AN INDEX TO THE MATERIA MEDICA


Everyone who has built up a repertory has rightly insisted that only confirmed symptoms be included. The Therapeutic Pocket Book is the finest example of this. Boenninghausen was uncannily accurate in his estimations. If we are to fit together the jigsaw puzzle of our patients symptoms, the parts must fit accurately.


This is a subject that I can write upon with feeling, not with the utmost of feeling because that would involve profanity and profanity is not euphonious; it is more expressive than instructive.

The literature of our school, as I have said on other occasions, is in a most untidy state. Our tools are all over and in many different shops. Some of them are hard to find at all. What should we think of a jeweller who kept shop as we do? Should we not get rather impatient waiting for our watch to be repaired? Then how about the poor soul who waits with utmost, suffering and humility while we must search and search to find something for his bellyache? It is not the pulling out of my repertory before the patient that embarrasses me; it is the fact that after patient and diligent search I remain as totally in the dark as before I cracked the book. “That is due to lack of skill in your use of it,” I can hear you say.

Many times, yes, but not always. I have seen a reputed master of Kent several times hard put to find what was wanted, only to make up an interpretation as a make-shift for what was sought. If homoeopathy is a science we can brook no makeshifts, at least by inexperienced hands and by novices. Naturally here is where the art comes in, but if we are to attract and hold newcomers, we cannot ask them at first to read between the lines and grab ideas out of a clear sky.

What is needed to work with the repertory is an index to the materia medica. The two would serve obviously different functions and would supplement each other. The purpose of a repertory is to enable one, by putting symptoms together, to find a group of remedies most likely to cover the case at hand. It is not primarily a source of information. It is primarily analytical and its contents somewhat dissected. An index would inform us where to look for everything butt would not necessarily give us a picture in the rough.

There are only a few fundamental material medicas, namely, the Materia Medica Pura, Chronic Diseases, Herings Guiding Symptoms and Allens Encyclopaedia of Pure Materia Medica. There is only one fundamental repertory and that is Boenninghausens Therapeutic Pocket Book. All other materia medicas and repertories are merely off-shoots of these, each gotten up to please the whim or definite idea of the author.

The index should be crossed to make it readily usable. Naturally this would be a lot of work, but so was the building of the Panama Canal, yet no one is sorry that he does not have to sail around Cape Horn. The various parts of a symptom should be crossed against each other. The parts that seem to me useful are the subjective or objective symptom, type, location, cause, modality, extension, precedence, concomitance, sequence and alternation. These should be indexed against each other. Abbreviations and references could be used to cut down space. The only other work that could be substituted for this is something on the order of Herings Analytical Therapeutics. It is a shame that this wonderful work was never completed. By means of an index we could readily find the information wanted.

Another difference would be that an index would not need to be as accurate as a repertory in that nonconfirmed symptoms could be admitted. It would need only to be suggestive, for an unconfirmed symptom might lead to a remedy for study and if that remedy fitted the case much time and suffering would be saved.

Everyone who has built up a repertory has rightly insisted that only confirmed symptoms be included. The Therapeutic Pocket Book is the finest example of this. Boenninghausen was uncannily accurate in his estimations. If we are to fit together the jigsaw puzzle of our patients symptoms, the parts must fit accurately.

Due to the incomplete functioning of repertories which makes an index, I would like to make a few remarks on the former.

Most of them suffer paradoxically from too much generalization and too much individualization, or better, analysis. In their super-generalizations they fail to distinguish between necessary shades. Knerr is least likely to err in this direction. Boenninghausen errs most because his is the most generalized. Kent starts at both ends and plays them against the middle. Another bad feature is the retention of obsolete terms. A glossary should be appended if these are to be retained. Kent had two very peculiar dreads. One was the inclusion of pathological terms and the other was his fear of the bogey-man of concomitants.

The latter has no place at all, the former has some reason for its existence. The arrangement is difficult to decide upon in a repertory because of overlapping parts, but that is no consolation to have the generals spread through 1400 pages. Only one man has attempted to make much use of synonyms at the head of his rubrics in the more condensed form of repertory for the enlightenment of his readers and that man is Boger. He has often put in present-day expressions. Knerr escapes the two “supers” by not breaking the symptoms into bits.

Kent criticised everybody who ever tried to build a repertory and then incorporated all the faults into his own. He criticised Boenninghausen for over-generalization and then over-generalized in rubric after rubric. He condemned the use of Boenninghausens modalities in so general a fashion, then failed to list modalities under particular parts and asked his readers to refer to the modality in general, a good old Boenninghausen custom. He became so analytical that symptoms are so mutilated in many parts of his book that the provers themselves could not identify them. His paper on writers cramp in his Lesser Writings shows this beautifully and one could build one of these new-fangled predigested houses while getting all the rubrics together for writers cramp.

He stressed in all his work the value of generals, yet he either omits many valuable ones or spreads others through the whole book. He devotes 280 pages to the extremities, which because of their vital importance stand at the end of the line, and only 175 pages to what he considered the very heart of the work. His fear of pathological terms we will pass by, for there is some solid reason for omitting them. Nevertheless he admitted many. His great stinginess in putting in concomitants was due to his view of them. If a person had a headache and a pain in the back at the same time, Kent wanted to know which was the concomitant.

If concomitance means merely occurring together, which I believe it does, then both are concomitants and the only thing that matters is that they occur together. Boenninghausens conception of this matter is the only one to take. You will find it in his Preface to the Therapeutic Pocket Book. Boenninghausen was not afflicted with bogeys. He was concerned with facts and accuracy as well as purity. I would not have devoted so much time to Kent, had he been less critical of others. For the information gleaned, one copy of Knerr is worth a dozen of Kent. As a parting shot, some concomitants were admitted into Kents, although I cannot figure out how he decided which was the concomitant.

Knerr is difficult because it is hard to find the modalities under the parts affected. The solid set up of his type is hard on the eyes. He is far more free with him concomitants and there is plenty of gold to be found in his masterpieces.

Gentrys Concordance should be splendid but for some reason or other does not seem to hold water. It seems mostly to lead in circles.

Medical literature suffers from being copies and recopies. It gives typical information and leaves out almost everything about the unusual which means much to the case before us. It is so voluminous that the Index Medicus was created to help the reader find what he wanted. Our literature is also large, especially that of our foundation subject, the materia medica. It has been copied and recopied, cut down and twisted and God knows what. A splendid general index was started by Drs. Eveline B. Lyle and Elizabeth Wright Hubbard but died from professional and financial indifference. If all the stuff turned out annually by the research grubbers of the Old School is worth an Index, should not our own materia medica be worth as much?.

TOLEDO, OHIO.

DISCUSSION.

DR. GRIMMER: I enjoyed Dr. Pulfords witty paper; it was pithy and to the point, but I find myself unable to agree with him about Kents Repertory. That is one of the most valuable works we have, in my estimation. It comes nearer than any other to being an unabridged repertory. It is far from perfect, nevertheless, when you know how to use it, it is of tremendous help. I couldnt do without it. I have worn out half a dozen in the last dozen years.

Boenninghausens Repertory is good. There can be no question about its value, and those of us who do not know how to use it may find it difficult and may be inclined to criticize it. If a work on a concomitance were added to Kents Repertory, I think we should come pretty nearly to having an ideal repertory. If the Doctor would study Kents Repertory along with the Hahnemannian concept of symptomatology, he wouldnt find it so difficult to use and get good from it. There is no question that it is cumbersome.

Dayton T. Pulford