Abstract: Richard Pitcairn writes on simplicity in homeopathy, the principles of homeopathy, the development of the homeopathic materia medica, and the contributions C. M. Boger made to homeopathy. He illustrates several cases using different repertories.
â€”The greatest obstacle to cure is human imaginationâ€”
This presentation is about the possibility of simplicity in your homeopathic practice, and is a focus on the work of homeopath C. M. Boger as one who moved in that direction during his career.
What is meant by simplicity in homeopathy? This talk will attempt to explain that idea in terms of the evolution of practice over the last two centuries.
Homeopathy was a new development in medicine, a radical one, but it did start with one basic idea – that of using similar medicines as stimulants to cure. It is perhaps difficult for us to appreciate what an extraordinary challenge this was to medicine of the time (and now). The chief system of medicine in both Hahnemann’s time and ours, the allopathic system, is based on completely different, even opposite, concepts. Allopathic medicine has developed from its basic premises to be extraordinarily big and complex – much of it as a result of increasing fragmentation of the patient. The tendency towards specialization and more complicated technology requires more of everything involved in doing this work.
If we consider the huge medical complexes of today, it may be easier to understand the significance of Hahnemann’s action if we could see these large hospital structures as ones dedicated to blood-letting (as an imaginative exercise). Imagine if the entire use of these was the teaching, research, and actual practice of blood-letting of patients. Then along comes someone who says “blood-letting is not helpful, in fact it harms patients and should not be used.” Can you imagine the upset, the resistance? Suddenly these buildings are not needed in that way (condos?), the faculty is irrelevant, the technique to be discarded.
Hahnemann was saying something similar but it is more difficult for us to see that because part of our mind still accepts the validity of the allopathic framework that he so soundly rejected. In declaring how drugs could be used in a new way, a way opposite of the accepted wisdom, he was saying something similar to the critique of blood-letting. Looking at these pictures can you see how radical it is to declare that these edifices no longer have any use? Hahnemann’s stance struck so much at the foundation of medicine of his day it was like positing that the world was round instead of flat. It upset a lot of thinking, a whole lot of planning that was going on.
What I want to point to here is how the one idea of how medicines act by being similar was a simplification of medicine, bringing a tremendous amount of complexity having to do with use of medicines, dosing, administration, expectation of medicine action, evaluation of patient’s response – all of that – into a position of irrelevance. Perhaps you can get a feeling as to why homeopathy is not readily embraced.
What was it that Hahnemann was saying? That out of all the theories about how medicines could be used, what actions they can have, what medicines actually do to the patient – all of this was reduced down to this one idea: that medicines can stimulate healing if they can produce more or less the same symptoms the patient already has. Full stop. All other ideas about it, even as we see today about drugs doing this and that, he discarded as not correct, as erroneous ideas. So, in one swipe he discarded the accumulated complexity of drug use and substituted a simple principle – the use of the similar medicine.
So homeopathy started in simplicity, but what has happened to it since that time? Like any new discipline it has gone through early stages, then through a process of development during which the limits of the method were explored, but, with more time, it has also diverged in two general directions.
Let’s look first at how homeopathy developed and defined itself the first 100-200 years. Early on, while Hahnemann himself was working with homeopathy, he added to the basic principle of using similar medicines with this further guidance:
1. Don’t give the medicine in too crude a form or it causes unnecessary suffering.
2. If the medicine is diluted and triturated or succussed, it becomes more effective in treatment, more “potent.”
3. Disease is not physical but starts from an energetic level, what he called the “life force” of the patient.
4. There is a group of patients that are ill in a different way, what he came to call “chronic disease.”
5. Chronic diseases are quite different than other types of illness in that the patient never recovers on his or her own. The condition is life-long.
6. There are three forms of chronic disease; the most common and important he called psora, which in essence is a type of skin disease characterized by itching.
7. The successful treatment of the chronic disease patients requires the use of a selected group of remedies (as outlined in his book The Chronic Diseases).
8. Treatment of chronic disease patients with remedies not suitable for this condition (not using the anti-psorics primarily) results in disease not cured but becoming latent at best.
This is pretty much what Hahnemann defined during his 50 years of clinical experience. Let’s look next at how subsequent practitioners developed it further.
These were the major steps.
1. Use of nosodes (lyssin, psorinum, tuberculinum, variolinum, & others).
2. Use of higher potencies (primarily the influence of Boenninghausen & Kent).
3. Additional provings (like Hering’s proving of Lachesis).
4. Identification of the polychrest remedies.
I would like to focus especially on these two things: the addition of new remedies and identification of the polychrest remedies. When homeopathy was first being used, and new medicines were being tested and used clinically, it was a time of expansion of materia medica, as one would expect. The underlying question was “Are new remedies needed? Do we have enough?” – reasonable questions to ask. Hahnemann had already stated his opinion in relation to treatment of chronic disease. In addressing the problem of successfully treating chronic disease patients, Hahnemann says that early on the idea was that maybe “we don’t have enough remedies”; in other words there are remedies out there to discover that will do the job. However, with more experience, he rejects that idea with these words:
“Whence then this less favorable, this unfavorable, result of the continued treatment of the non-venereal chronic diseases even by homoeopathy? What was the reason of the thousands of unsuccessful endeavors to heal the other diseases of a chronic nature so that lasting health might result? Might this be caused, perhaps, by the still too small number of homoeopathic remedial means that have so far been proved as to their pure action (note added: too few remedies so far known)? The followers of homoeopathy have hitherto thus consoled themselves; but this excuse, or so-called consolation, never satisfied the founder of homoeopathy – particularly because even the new additions of proved valuable medicines, increasing from year to year, have not advanced the healing of chronic (non-venereal) diseases by a single step, while acute diseases (unless these, at their commencement, threaten unavoidable death) are not only passably removed, by means of a correct application of homoeopathic remedies, but with the assistance of the never-resting, preservative vital force in our organism, find a speedy and complete cure.” (1)
Yet we, today, know there have been a significant number of very valuable remedies added since Hahnemann’s time – ones like Lachesis & Apis. How can we sort this out? One way to understand it is to realize that as remedy provings accumulated there were a lot of duplications. We may identify a new substance that has significant symptoms but does it add something to the existing materia medica? In other words, the “new” remedy may just do what another one is already doing.
We can understand the possibilities like this:
1. Some remedies will produce a large number of symptoms, ones common to illness.
2. Other remedies will produce symptoms, but the range of their action is not large and what they do is already available with other remedies.
3. A third group will produce few symptoms but some that are very unusual, specific or peculiar.
The issue is with groups 1 and 2. We can see that practical experience would gradually define what remedies are most useful. Yes, there are more remedies to choose from (if we have increasingly larger numbers in the materia medica), but out of these choices there are some that give the best coverage. The others remaining duplicates. Do some of these duplicate remedies give us something extra? Do they have an advantage or do they just burden us with more to learn?
Following this thought there are two ways this can go. One is to gradually accumulate larger and larger numbers of remedies, just adding them to the materia medica & then trying to make fine differentiations between them. The other is to focus down on the most useful remedies and discard the others. One is the path of complexity, the other a distilling to simplicity. In this talk we will be considering the latter path, one taken by several people but most eloquently presented by C. M. Boger. So if we study the progression of homeopathy through its development up to present times, we can see these parallel trends – movements towards complexity and also towards simplicity.
Let’s look at the former first, complexity. Here are some of the more prominent modifications of practice that add more choice, make decision making less simple:
1. Enlarging our materia medica & repertories to include hundreds of additional medicines. For example, remedies from a variety of animals, birds, and modern substances like coca cola, cell phones. Added to this are also quite a number of unproven remedies from chemistry – the periodic table of the elements and new substances never seen in this universe – like positrons. Many of these are being used to treat patients with chronic disease instead of following Hahnemann’s advice on using the antipsoric medicines.
2. Re-introduction of the Doctrine of Signatures that Hahnemann rejected as a basis for determining the action of medicines. In modern times we know it as the “Kingdoms of Nature” prescribing. (2,3)
3. Basing the prescription on the patient’s personality rather than the symptoms of illness. Hahnemann, Kent and others all warned against this approach yet it has become a common extension of contemporary homeopathic work. (4)
4. Grouping remedies together if they are from related plants or animals, assuming that they will have characteristics in common. (5) A keyword for this is using “themes” or “families”.
Though all of this can be very fascinating we can see that it does make the practice of homeopathy a more complicated one. Let’s look at the other direction, that of simplifying homeopathy. As part of this approach is an implied definition of what homeopathy can accomplish. Hahnemann tells us that the cured patient will have their suffering relieved but that their personality will stay the same. Much of contemporary homeopathic practice now assumes that successful treatment will make the person “better” in terms of personality – in their work, relationships, and general life experience – so what we are saying from the view of simplicity is that the limit of homeopathic work is the relief of suffering from illness. Beyond that it does not go. Homeopathy does not have the ability to “make a person better.”
Secondly we make the assumption that there is a practical limitation to the different ways that illness can manifest. Put another way, how an animal can be sick is not infinite – at least in terms of the patterns of characteristic symptoms we need for our homeopathic work. There is presently much concern about the possibility of a severe flu disease, yet if we consider what is most typical of flu – the fever, aching, vomiting or diarrhea – then that pattern would set the parameters for what we would call flu (not as a diagnosis exactly but as a symbolic word that communicates the illness in a general way). Within this parameter there are a number of patterns possible. One person may have more emphasis on fever, headache, pains while another has more the vomiting and diarrhea. How many patterns can there be? It is not unlimited. One way of presenting what is possible is like this, from the repertory:
Generalities; Influenza (27): Aconite, arn., Arsenicum, bapt., bell., bry., camph., Causticum, chel., chin., cimic., EUP-PER., gels., ip., MERC., NUX-V., phos., phyt., puls., Rhus-t., sabad., sang., sil., spig., squil., stict., verat-v.
This is from the Boenninghausen repertory and we see here 27 different ways that influenza has been recognized over the last century or two. Could there be other patterns? Well, yes and no. If a pattern is really different than this we certainly could work it up, but might not consider it as fitting within our general classification. The allopathic world may still call it “flu” if they are able to identify a particular virus involved, however, we might call it “typhoid fever” or “catarrhal fever” or some such which better fits our repertory work. Remember that these disease names are just convenient symbols for our use and have no inherent reality of their own.
The significant point here is that there are only so many ways of being sick and what this suggests is that there will correspondingly be a limited group of remedies that most fit these possible patterns. To try to make this more clear, if we start working with a group of say 100 remedies that we think fit influenza, with enough clinical experience we can identify a much smaller group that is most fitting and that basically cover the problem adequately. We might find that our experience with the 100 takes us down eventually to the 27. Is it possible there is another remedy out here very good for treating flu? Sure. But is it necessary? If we have it covered, then we don’t need it.
This idea has to do with the recognition, over time and with clinical experience, of finding the most useful remedies for the expression of disease. The ones we want are those that cover all the possible manifestations and when we find them, we have what we need. This process has been a continuing one for the last 200+ years. And what do we call those remedies we have found as most suitable? We call them the polychrests.
C. M. Boger, MD, the focus of this talk, was a master of this process. It is not that he did not know how to work with considerable detail. After all he put together the Boeenninghausen repertory from several smaller ones that Boeenninghausen had published in his life and then reorganized and added to it – quite a feat. The Boger-Boeenninghausen repertory is considered by some as one of the best ever made.
Who was C. M. Boger?
This brief introduction will not do justice to a life that was so full. (6) He was born in 1861 in Western Pennsylvania, received his elementary education in the public schools of Lebanon, PA, and graduated in pharmacy from the Philadelphia College of Pharmacy and later in medicine from Hahnemann Medical College of Philadelphia. He settled in Parkersburg, West Virginia in 1888, where he had a very large practice for a long time, with patients consulting him from neighboring states and from distant states and countries.
His ambition was to devote all his time to teaching and writing, but he never reached the point of giving up his practice. He frequently lectured before scientific audiences at the Pulte Medical College in Cincinnati and was a teacher of philosophy, materia medica, and repertory study in the American Foundation for Homeopathy Postgraduate School since its third year in 1924. He served as the IHA president in 1904.
Dr. Boger knew the homeopathic literature well. He had access to the original provings and writings, for he was a German scholar. He also was a devoted follower of the Boeenninghausen method of repertory study, as all of his published words show.
His publications include:
Boeenninghausen Characteristics and Repertory
Boger’s Diphtheria (The Homeopathic 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.
He died September 2, 1935, at age 74 from food poisoning, after eating some home-canned tomatoes. On becoming ill he drove himself to the hospital but died shortly after arriving. He is buried in the Lutheran Cemetery in Lebanon, Pennsylvania.
Throughout his career, he was known as one who was extremely accurate with his prescriptions and he was quite familiar with several repertories. He used four large repertories in his office as well as his own large list of observations, which later went into the making of the Synoptic Key. He used Kent’s repertory, Jahr’s and Possart’s repertory, Welsh’s – which was an old repertory even then – and of course Boeenninghausen repertories.
In the Synoptic Key, Boger takes the concept of generalizing as near to its practical limit as possible. This work was inspired by Lippe’s attempts to develop a Synthetic Materia Medica. Boger developed this repertory over many years and added new rubrics with caution, only when his personal work needed them. This made it more practical and guarded against including less pertinent rubrics. He made a serious attempt to unite analysis and synthesis in each rubric, expressed usually as one or two words. In this way the unavoidable clumsiness inherent in repertory use is streamlined to a great degree.
The Card Repertory (7)
Boger’s latest work, the Card Repertory of the General Analysis, was a further development of his line of thinking. It is especially suitable for the chronic case in which we are limited to the general trends of the illness and the locations affected. As much as possible we add to this any modalities and concomitants. It is typical of chronic cases presented to us that they are sort of “smudged” after other treatments have been done, but usually we able to still see what sort of illness it is (e.g., fever, edematous, inflammation, eruption, etc.) and also what parts of the body are affected. The General Analysis matches this sort of case and the rubrics also have the same distillation down to the most essential features, so that they will have the most general application. We will see some examples of that in a moment.
Boger describes the strategy of his card repertory by first discussing the two most popular methods of repertory analysis that were done in his time. He describes them this way:
1. To pick out a central symptom and associate all other symptoms with it, then taking this to materia medica to find a pattern match.
2. The opposite approach – which is to collect all the symptoms (the totality) and work them up as to numerical value (grading) and then making a more fine differentiation.
In a letter sent to a colleague 6 months before his death he says, “In my card system I have taken a middle ground by finding the anatomical sphere wherein a symptom arises or occurs, modifying this by the modalities first, and then reducing the number of remaining remedies by noting discrete symptoms as found in Kent. This soon reduces the drugs to a small number, when the mental outlook as given in the pathogenesis (e.g., in the proving) will decide.”
What he is saying here is that he starts by emphasizing the location of the disease in the body, brings in modalities, and then with this smaller list of remedies, goes to a repertory like Kent to work out the particulars. The final decision is based on the mental/emotional state of the patient to which the final remedy must correspond. Thus, “according to Boger, the preliminary choice of remedies should be limited by the rubric pertaining to locations and pathological generals.”
Strangely enough Boger’s most developed work, the General Analysis Card Repertory, went through six editions yet was not very popular. In a talk by homeopath Royal E. S. Hayes, MD, he says “Boger’s Synoptic Key in the form of cards and accompanying General Analysis in my opinion is by far the best of repertories. It seems strange that it has not come into popular use. It has been mentioned in the literature only casually. Some writer in the Pacific Coast Journal mentioned it a year ago or so as his preference, but that is the only instance of its use known to me. I have its operation to three or four – they nodded and went their way. I had a short illustrative account in the Homeopathic Recorder for February 1993 and the writer was prepared to follow this with a series of case illustrations showing various ways to use it, but as for some reason only the first was published and the project was abandoned. I recall, however, that Boger himself was much pleased with what had been worked out and said that it had suggested to him still further ways to manipulate this repertory.” (8)
Hayes further states “Chopping up symptoms and regions (of provings) and laying the pieces up in piles to the extent that Kent did does not help analysis in the philosophical or homeopathic sense. Boger made a serious attempt by selecting and theoretically consolidating influences or conditions that hold sway over sick individuals, to unite analysis and synthesis in one rubric, usually expressed in one or two words. His degree of success in this, as the unavoidable clumsiness of repertory procedure goes, is one of the items that help to make his repertory superior. Boger’s repertory is the quickest, usually requiring less than 10, sometimes 5 minutes for a solution. And it is, in my opinion, the safest in that it is more likely than any other to include the desired remedy in the final group. The best remedy is likely to be included at the start and less likely to be dropped out on the way.”
Let’s look at some examples of this repertory. What I will show here are comparisons of cases worked with the larger repertory of Kent and also with the General Analysis.
Here, for example is one of Hahnemann’s cases:
Case: The Washerwoman (9)
S., a washerwoman, somewhere about 40 years old, had been more than three weeks unable to earn her bread, when she consulted me on the 1st September, 1815.
1. On any movement, especially at every step, and worst on making a false step, she has a (shooting pain) in the pit of the stomach, that comes, as she avers, every time from the left side.
2. When she lies she feels quite well, then she has no pain anywhere, neither in the side nor in the pit of the stomach.
3. She cannot sleep after three o’clock in the morning.
4. She relishes her food, but when she has eaten a little she feels sick.
5. Then the water collects in her mouth and runs out of it, like the water-brash.
6. She has frequent empty eructations after every meal.
7. Her temper is passionate, disposed to anger.
8. When the pain is severe she is covered with perspiration.
9. The catamenia were quite regular a fortnight since.
In other respects her health is good.
Next Hahnemann works through the case, symptom by symptom, doing something like an elimination process eventually coming to the prescription. (I am skipping this detail as not being relevant to our discussion.)
Now, as this woman was very robust, and the force of the disease must consequently have been very considerable to prevent her by its pain from doing any work, and as her vital forces, as has been observed were not impaired, I gave her one of the strongest homeopathic doses, a full drop of the undiluted juice of Bryonia root, to be taken immediately, and bade her come to me again in 48 hours. I told my friend E., who was present, that within that time the woman would assuredly be quite cured, but he, being but half converted to homeopathy, expressed his doubts about it.
Two days afterwards he came again to ascertain the result, but the woman did not return then, and, in fact, never came back again. I could only allay the impatience of my friend by telling him her name and that of the village where she lived, about a mile and a half off, and advising him to seek her out and ascertain for himself how she was. This he did, and her answer was,
“What was the use of my going back? The very next day I was quite well, and could again go to my washing, and the day following I was as well as I am still. I am extremely obliged to the doctor, but the like of us have no time to leave off our work; and for three weeks previously my illness prevented me earning anything.”
Here is how this case is worked up using the Kent repertory, using “all remedies”, and the analysis structured so the remedies ordered by grading:
We see that Bryonia does come up for consideration in the top group of remedies, so this is a perfectly fine analysis. Let’s compare this with using the General Analysis.
In contrast to the analysis done with Kent’s repertory, we see, first of all, that only 3 rubrics are used. Also the rubrics chosen are more “general”. For example we can read the first one to mean: “Any condition or symptom that has focus in the stomach or bowels”. Obviously to accurately represent the case the stomach condition has to have some prominence. It would surely throw us off if the stomach discomfort was a minor or occasional symptom. In this case, the stomach of the woman is what is affected and so much so that she cannot work and must lie down.
The second and third symptoms are modalities and they are not modalities that affect the part, the stomach, but rather modalities of the patient. It is prominent, again, that she is made much worse by motion and also so relieved by lying down that she has no pains at all!
So this analysis brings us to 3 remedies to consider and reference to the materia medica would easily identify Bryonia as the best choice.
Just as an exercise, let’s put in one more rubric and see how this narrows even more.
By adding in that she is a washerwoman and made worse from working with water (bending over, arms and hands constantly wet, inhaling watery vapors) then we narrow it down to just 2 remedies. It is best in using the General Analysis not to use too many rubrics, often 2 or 3 are adequate but it is interesting here to see how the remedy carries through even with four.
Case from Harvey Farrington (10)
This is the authentic history of a young woman of twenty, who contracted malaria while traveling with her family in Italy. Massive doses of quinine, prescribed by an Italian physician, stopped the chills and she was able to continue her tour. Not long after her return home she required a dose of Bromine, her constitutional remedy. Later, whether from the action of the Bromine or otherwise, the chills reappeared. Arsenicum alb. was prescribed by a local homeopath without result. The symptoms became alarming, and he gave quinine in massive doses, this time with only temporary palliative effect.
In prescribing for malarial patients homeopathically, the exact similimum must be found, if a cure is to be expected. Since Arsenicum had been prescribed by a man of many years’ experience, and the case presented a number of Arsenicum indications, the physician who was called at this juncture worked the case out with great care, using Kent’s Repertory.
The symptoms were as follows: Chill daily at 6 or 6:30 p. m.; beginning between the scapulae, as though ice water were dashed down the back; preceded by faintness and yawning; accompanied by intense thirst, great restlessness with tossing about, coldness, numbness and aching of the extremities, cold buttocks, and a sensation as though a wind blew on the feet and legs. The chill was worse from drinking cold water and from the least movement under the covers. Fever without thirst was accompanied by throbbing headache, faintness, nausea, moaning, oppression of the chest, gasping and restlessness. The face was flushed, the skin hot and dry, and there was chilliness from lifting the covers. The temperature during the heat rose to 104. 5 F. Restlessness was the most marked mental characteristic; therefore, it was given first place in the repertory study.
Let me list these symptoms in a more accessible form.