BOENNINGHAUSEN’S THERAPEUTIC POCKET
BOOK
First Edition: 1846
Modified by Dr. Timothy Field
Allen
Introduction: Dr. H. A. Roberts and Dr. Annie C Wilson
Year of Publishing: 1935
TPB is a logical utilitarian repertory.
HISTORY
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.
TPB was the culmination of years
of diligent and laborious work done by Boenninghausen. During the initial days
of compiling a repertory Hahnemann himself was supervising the efforts of
Stapf and Ruckert. At the same time Hartlaub and Trinks and Weber were also
involved in compiling a repertory, on being called upon by Hahnemann.
Boenninghausen took the task of compiling a repertory. He meticulously went
through the reports of original provings and compared them with reports of
clinical verifications.
It was with the encouragement of
Hahnemann, that Boenninghausen developed his first repertory: Repertory of
Antipsorics (1832). In 1835 he published Repertory of medicines which are not
Antipsoric; in 1836 - Attempt at showing the relative kinship of Homeopathic
medicines and in 1846 he published, Therapeutic manual for Homoeopathic
physicians. BTP is a combination of all these four books.
After his death T F ALLEN added
sides of the body (1853) to the text.
The original book was written in German language, which was first time
translated to English by a homoeopathic physician whose name is not known. A
short time afterwards Hempel translated these books. The literature was handled
by Okie, CM. Boger and T F Allen and lastly edited by H. A. Roberts and Annie C
Wilson.
T F Allen made a lot of additions
and deletions. He added the sides of the body and 120 remedies and deleted 4
remedies (126-4+220=342). This book is known as T. F. Allen’s Boennninghausen’s
Therapeutic Pocket Book, because he has left more lasting impression up on his
book.
PHILOSOPHIC BACKGROUND
BTP is based upon the following fundamental concepts:-
1. Doctrine of analogy and
doctrine of grand generalisation
2. Doctrine of concomitant
3. Evaluation of Remedies
4. Concordances
DOCTRINE OF ANALOGY
Boenninghausen observed that, even
with best possible case taking the case record is often left incomplete, one of
the elements of symptom - Location, sensation, modality or concomitant may be
missing. He collected all such symptoms as they appeared in the cases, which
came to him for treatment. Every case was examined symptomatically with the
purpose to make every symptom as complete in itself as possible. Later he
learned that, symptoms that existed in an incomplete state in some part could
be completed by observing the conditions of other parts of the case. This is called the doctrine of Analogy.
DOCTRINE OF GRAND GENERALISATION
He also discovered that, condition of aggravation or
amelioration is not confined to a particular symptom, but is applicable to all
symptoms of the case. So he raised them (i.e. Particulars) to the level of
Generals - It is called the doctrine of
grand generalisation.
It is the patient who is sick, not
his head, nor his eyes nor his heart. Every symptom that refers to a part may
be predicated of the whole man. The symptoms of disease are often broken up and
scattered through different parts of a patient. These scattered parts must be
found and brought together in harmonious relation according to a typical form.
Boenninghausen has designed his pocket book in such a way that, it would enable
the physician to bring the symptoms together and complete one part by another.
DOCTRINE OF CONCOMITANT
Boenninghausen emphasized more on completing the symptom with all their
components; i.e.
LOCATION - Which includes parts, organs, tissues, systems as well as directions
and extensions.
SENSATION - Kind of pain, suffering and complaints, and also functional or
organic changes characterising the morbid process.
MODALITY - This includes
conditions of aggravation or ameliorations. Factors which cause, excite,
increase or decrease or modify a symptom are included in the modality.
CONCOMITANT - Symptoms appear and disappear with the main complaints; but they
does not have any pathological relationship with the main complaints.
Boenninghausen, identified in each case a group of symptoms along with the main
complaint; such symptoms were generally overlooked by the patient, and un
noticed by the physician. He emphasized that, in all cases such a group of
symptoms does exist, and they are missed, because of inadequate observation.
They appear to be unrelated to the main complaint; but are quite crucial in
individualizing the case as well as the remedy.
EVALUATION OF REMEDIES
on account of the large number of remedies under nearly every
rubric, Boenninghausen found it indispensable to distinguish their relative
value by means of various types
So, he made 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)
Boenninghausen 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.
CONCORDANCES
Boenninghausen'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 Boenninghausen 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. It 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.
NUMBER OF
MEDICINES
Boenninghausen had 125 remedies in his original edition. Allen dropped out four
remedies that appeared in Boenninghausen'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 poli ambo
Magnetis poli articus
Magnetis polus australis
Allen added 220 remedies so that
the number now appearing in Allen’s 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.
Section on relationship deals with
148 remedies.
PLAN AND CONSTRUCTION
The Introductory part of TPB is
work is written in nine sections
·
Preface - written by H. A. ROBERTS in 1935
·
Life and works of Boenninghausen
·
Repertory uses
·
Art of physician in taking the case
·
Philosophical background
·
Construction of repertory - contains parts which are
descriptions about the 7 chapters in his repertory
·
Limitations of repertory
·
Adaptability of repertory
·
Uses of analysis
Allen's Preface to the new American
edition
Boenninghausen's original Preface
MACRO CONSTRUCTION
The repertory is divided into 7distinct compartments in the earlier
editions. One cannot find these divisions in later editions.
·
Mind and intellect (original edition-mind and soul)
·
Parts of body and organs
·
Sensation and complaints in general, glands, bones, skin
·
Sleep and dreams
·
Fever
·
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.
·
Relationship of remedies
Though each chapter can be as a
whole by itself, it 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.
MIND AND INTELLECT
TPB 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.
TPB - 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.
Boenninghausen 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 realized
that the most careful observer may at times get only a clouded picture of the
mental symptom.
Boenninghausen included 17 rubrics under aggravations emotional excitement.
His first repertory, Repertory of Antipsorics
contained large number of rubrics under mind section when compared to
Therapeutic pocket book.
PARTS OF BODY AND
ORGANS
This part of TPB constitutes 42 chapters and follows the anatomical
schema of Hahnemann beginning with head and proceeding downwards to the mouth,
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 TPB, he
added many eye symptoms
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.
SLEEP AND DREAMS
This part of the book
is divided into three sections as
Sleep; Positions during sleep; Dreams
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.
FEVER AND CIRCULATION
In the older editions of Boenninghausen's original work there were
seven subsections. In Allen's edition the subheadings given by Boenninghausen
are removed but the general outline is followed with some minor changes.
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
Aggravations
Ameliorations
RELATIONSHIP OF REMEDIES
Basis of this section is Boenninghausen's work on relationship of
remedies - An attempt at showing the relative kinship of Homoeopathic medicines,
published by Boenninghausen. 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.
USES
·
Can be used for studying the relationship of various
remedies at various levels
·
Helps to find out the close running remedies that 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.
·
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.
·
Comparative study of materia medica becomes easy
ADAPTABILITY OF TPB
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
·
Cases with confusing symptoms many or few when the remedy
likeness is reviled - It is useful to get related remedies by working on the
last chapter.
LIMITATIONS OF TPB
TPB was the ultimate attempt of
Boenninghausen to index the symptoms of Materia Medica according to the
instructions given by Hahnemann; it was the first valuable repertory for
bedside practice.
But soon many practitioners found
it difficult to use it in daily practice. Many criticized the principles of
analogy and raised voice against the use of associated complaints as
concomitant symptoms. Apart from over generalization and difficulty in
comprehending true concomitants, the presentation itself had some problems.
As time passed, newer repertories
emerged and some of its deficiencies were noted.
·
Originally TPB contained only 126 remedies. Allen dropped
out 4 medicines and added 220 new medicines. Hence the total number came to
342. Even after Robert's edition, the book deals with only 362 medicines.
·
The rubrics given in the book are not many. The limited
rubrics cannot be used for many of the symptoms
·
Though, in the location part large group of medicines are
mentioned under most of the rubrics, but in other sections there are many
rubrics that 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.
·
In Boenninghausen method, though mind is not given
importance in finalizing 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 appear under this heading, which is not useful in practice. Even medicines
like Thuja don't find any place in this group. 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
incorporation of sides of body is not done smoothly. TPB 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 rubric, then one is not
sure whether the medicine 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 that
confuse the beginners.
·
Vague and nonspecific sensations don't find any place. In
practice majority of patients do not specify the sensation.
This book has not been updated and so it lacks
information about sarcodes and nosodes that have become an essential part of
practice today and without the knowledge of these medicines physician is
handicapped to a great extent.
DR. SUMIT GOEL M.D. (Hom)