Dr Rajitha K Nair
James Tyler Kent, physician and author of several valuable medical works Is a native of the town of Woodhull, Steuben countryNew York ,born In 1849 as the son of Mr: Stephen Kent and Caroline Tyler. His elementary and secondary education was acquired In Franklin academy. He was educated in medicine in ecletic medical institute Ohio graduating there in 1871.
Dr. Kent began his professional carrier in St: Louis as a physician of the eclectic school and at the same time being activelyconnected with several eclectic Journals in the capacity of a writer and also took an earnest part in council of Eclectic Medical College,St: Louis.
During this time his attention was forcibly directed to Homoeopathy through the serious illness of his wife whose case refused to yield to the treatment of either of his own Eclectic or allopathic school practitioners but was subdued by Homoeopathic treatment He then became a careful student of Hahnemann’s organon and other works of the new school which resulted in his complete conversion to Homoeopathy. For more than 35 years Dr: Kent has been a conspicuous figure in the medical circle and for more than 25 years in teaching and practicing under the law of similia. He was looked upon as one of the ablest teachers and exponents In the Homoeopathic school in America.
His contributions to the literature of the profession are known by their strength rather than their length and include more prominently his Repertory, Materia medica and Homoeopathic philosophy. He was born on 31st March 1849 and died on 6th June 1916. He was married to Dr: Clara Louis Kent
History and evolution of Kent’s repertory
Kent’s repertory belongs to the classification of logical utilitarian type became it has a logic behind its construction and has a utilitarian function. In the latter half of 19th century there developed two prominent schools of philosophers as Puritan group and Boenning Hausen’ s school. Both groups had their own merits and demerits.
Puritan group – They were rigid types . According to them repertory is merely an Index of materia medica. In these repertories symptoms are obtained as narrated by the prover while proving. There is no distortion of the provers words or symptoms and there is no breaking up of symptoms. Symptoms are represented in the repertory as it was recorded in proving. Hering, Hempel ,Jahr, Knerr , Gentry etc belongs to this school. Demerit of these repertories is that reportorial analysis Is not possible with these repertories.
This school was represented by Boenning Hausen . Their idea was not mere Indexing of symptoms. These repertories aid in clinical practice for the selection of the similimum. Here the symptoms are broken up into different components like sensation location modality and concomitants and are kept separated.
By the last quarter of 19th century there was flooding of the field of repertories by a large number of small books as regional orclinical repertories. Thus the number of repertories increased upto 120. This clearly shows that the profession was not satisfied with the existing type of general repertories. Puritan group was so rigid that It Is Impossible for these repertories to be used for reportorial analysis while Therapeutic pocket book would lead to unwarranted combinations which gave no confirmations to any materia medica .
Thus a need was felt for a new repertory that could combine the better aspects of these contrasting Ideas. First step in this direction was the repertory to the more characteristic symptoms of our materia medica by Constantine Lippe. In this repertory modalities were given In detail. The concept were broadened and put to maximum benefit In Kent’s repertory . In the beginning Kent used Therapeutic pocket book but was soon dissatisfied with Its philosophy and he started to go through the repertories published up that time. He liked the plan and arrangement of Lippe’s repertory. Dr: Kent had a thorough knowledge of materia medica and he found that many medicines are lacking in lippe’s repertory. So he added notes to each symptom or rubric. This was interleaved many times. He got into contact with Dr: Lippe. Dr.Lippe wanted Kent to work along with Lee who was preparing a 3rd edition of Lippe’s repertory. By this time Dr.Kent has prepared a repertory of urinary organs ,chill, fever, sweat etc.
Taking help from Dr: Kent Lee started working and compiled a repertory on Mind and Head. But the compilation was based on Boenning Hausen idea of generals end modalities were given at the end. Dr: Kent was not satisfied with this work and when lee became blind Kent rearranged It according to his plan.
Kent then started working on e repertory. In his opinion all the repertories had e common source, which are drug proving reports materia medica end clinical verifications. According to Dr: Kent verified symptom in any repertory has immense value. Therefore he asked his students to copy the symptom end remedies already collected in other repertories. He was helped In this endeavor by Drs: Milton Powell , Mary Ives, Arthur Allen end F.E. Gladwin.
Kent’s original plan was to :-
- Gather and compile all the materil that has appeared in the existing repertories
- To add into this compilation the notes he made over years To obtain from the Materia medica more symptoms and remedies for adding Into the compilation.
- To add only those clinical symptom which were found not contradictory with their proving but consistent with their nature.
- To check and recheck everything. For this he had gone through all the repertories. But soon he found out that there were a lot of mistakes in the existing repertories. He found many omissions, missing, or over emphasis of symptoms
- Therapeutic pocket book -over Importance to concomitants. Kent said that these concomitants are against the principles of Hahnemann. There Is generalisation of particular modalities or mixing up of general modalities , imaginative and guess work and also breaking up of symptom.
- Lippe-symptoms confused with modalities.
- Jahr -too much emphasis on clinical symptoms
- Hempel -symptom retained in the words of prover and this may lead to confusion.
- Knerr -Clinical symptoms, toxicological extracts , observations from old school etc are included.
- Gentry -symptoms recorded many times causing confusion.
So Kent discarded all the compilations and started working on a blank paper. He took no help from any of his students. He and his wife together worked out a new format of repertory. After the completion of the work Kent started using it in his clinical practice. On demand from the profession it was taken up for publication. But the cost of publication was too high which was estimated to be $ 9000 and was refused by Boericke and Tafel due to the huge outlay involved. So it was decided to publish the book in sections and subscriptions were sought from the profession. 200 subscriptions were obtained at $30.
At last the first edition of repertory came out In loose sheet form In 1897. By the time of publication of 2nd volume 90 withdrawn subscription. Repertory was issued in the book form for the fist time in 1899.
2nd edition -was published by Dr. Kent white he was In Lancaster.
3rd edition—Or: Kent at the time of his death left three handwritten and corrected copies for the 3rd edition of his repertory. In the preface of this repertory he writes about this work as ‘’ The 3rd edition completes my life work , I have brought up to date , I have rearranged and made numerous corrections In addition to adding of many new remedies. I have verified every symptom in the book .You will find aft remedies of any value contained herein and the book is complete”. He corrected and perfected the 3″‘ edition mostly during 1906- 1909. Of these 3 handwritten copies of the 3rd edition ,one was with Dr:F.E.GIadwln , Dr: J.S-Pugh and other one was with his wife DrClara Louis Kent. Dr :Ehrhart with the help of F.E .Glodwtn and J.S.Pugh published the 3rd edition in 1924. It can be seen that the 3rd edition published after Kent’s death has some glaring mistakes when compared to Kent’s manuscripts for the 3rd edition and then mistakes ware carried over to the present edition. Kent’s corrected manuscript was with F.EGladwin and she noted the mistakes and published it in Homoeopathic recorder volume Xlll February 1928.
4th edition – Published in Chicago in 1935 by Ehrhart and Karl wtth the help of Clara Louie Kent , F.E.Giadwin and J.S.Pugh.
5th edition -This edition of Kent’s repertory was planned in 1939. But due to the outbreak of the war it was considered unwise to attempt such a large undertaking. Some how It was published In 1945 before the end of war by Dr:Clara Louie Kent
6th American edition -was published In 1957
1st INDIAN EDITION-CAME OUT IN 1961.
It can be seen that the 3rd edition published after Kent’s death has some glaring mistakes when compared with Kent’s manuscripts for the third edition and these mistakes were carried over to the present edition. One copy of Kent’s original manuscript was with F.E.Gladwin and she noted the mistakes and published the corrections In Homoeopathic recorder volume Xlll-Feb 1928
Dr.Gladwin gave her copy of Kent’s manuscript of 3rd edition to Dr.Austin who In turn passed it to Dr: P. Schmidt along with the golden diamond ring which Dr Kent wore during his lifetime. Dr P.Schmidt assisted in revising 3rd, 4th and 5th editions.
Dr:Schmldt discovered many mistakes in the American and Indian editions. There were omissions wrong Insertions, mistakes in alphabetical order, spellings incorrect placing of rubrics and sub rubrics, error in grading etc. Unfortunately this corrected manuscript which was ready for printing was stolen by a selfish person. And he asked for help to publish the repertory, Dr.C.S.Saandhu got in contact with him and he was given a portion of the manuscript to be copied down. But In the beginning Dr:Sandhu was not knowing that he was seeing Kent original manuscripts. It was decided to bring out the repertory in sections. Two volumes were published which contained Mind and Vertigo in the Ist volume and head ,eye ^vision In the 2nd volume.
At the same time on request from Dr: P. Schmidt ,Dr-.Diwan Harish Chand got in touch with the person who had stolen it and managed to obtain the manuscripts which were in a mutilated form. He got this after prolonged and continuous persuasion. At last it was published in 1974. This edition is supposed to be the 7th edition of Kent’s repertory but the same repertory Is now termed as Kent’s final general repertory of Homoeopathic materia medica.
In the early part of the 20th century Dr.C.M.Boger added a lot of rubrics to Kent’s repertory. Additions were also made by Dr.Vithoulkas.
- Dr.R.P.Patel published a corrected and Improved Kent’s repertory
- Expanded by DrSivaraman.
- DrJost Kunzhli made additions /corrections and published Repertorium Generale.
- Synthetic repertory -Generals of Kent worked out into 3 volumes by Barthel &l Klunker.
During the last decades of 20th century Kent’s repertory formed the foundation for
- Synthesis -By Friedriche Schroyens
- Homoeopathic medical repertory -Robin Murphy
- Complete repertory -Roger Van Zandvoort
- Kent’s comparative repertory -Dockx & Kokelenberg
- Chronic miasms In Homoeopathy -R.P.Patel.
Philosophical background of Kent’s repertory
Dr; Kent was not satisfied with the repertories available during his time. He severely criticized the faulty method of giving Importance to parts and overgeneralising of symptoms and favored the selection of symptom on the basis of generals. As a master of materia medica he noticed that particulars do not fall in line with generals in all cases and he emphasized the importance of generals. He said that in order to understand a person his expressions at the level of generals must be noted and relied upon.
So the emphasis should be given to study the expression of sick person as a whole I.e whilst approach according to which the disease starts in the core. We should know the pattern of disease occurrence, awareness of its origin and progress is essential. Mental symptoms are most important because disease primarily deranges the core or mental domain. After that it may cause some effect on the physical level producing physical symptoms touching the patient as a whole, at last disease gets localised and produces particular symptoms. The symptom noticeable at the level of parts should be considered only after mental generals end physical generals. Dr: Kent says “man Is prior to organs and the home In which he lives Is his body. What is expressed in parts is always preceded by a deviation in the state of health of the person. Such a deviation can be known only through expressions at the general level.
Kent’s repertory is based on the philosophy of DEDUCTIVE LOGIC. So here generals are dealt with in detail followed by particulars and minute peculiars. If a case is worked out from particulars only frequent failures may result This Is due to the fact that the particular direction in which the remedies In general rubric has not been observed and thus to depend upon a small group of remedies is to shut out other remedies which may have that symptom although not yet observed. In each the general symptom should be considered first and then particularise. In many cases particulars alone wont give a complete picture.
By working out a case in the other direction I.e. from generals to particulars the general rubric will include all the remedies that are related to the symptom and if after having done this ,the particulars are gone Into and the remedy which run through the general rubric Is found to have the particular symptom. This will aid in the choice of the remedy to be prescribed.
The medicine selected should cover the patient and should rover the pathognomonic symptom. For this find the strange rare and peculiar symptom, see that no generals are contradicting. It will be the similimum. This method was adopted by Kent. So under the chapter mind mental generals are given. They contain rubrics related to will /understanding and memory. The physical generals are mostly listed under the chapter generalities and a few in other chapters. Both these chapters are full of generals and these alone can be useful In finding out the similimum In some cases.
Kent made use of earlier materia medica and clinical observations but rejected numerous symptoms and drugs which were Insufficiently confirmed. Thus his repertory contains only 648 drugs.
Evaluation of remedies
He used three varities of typography to indicate the gradation of remedies unlike the 5 gradations of Boenning Hausen and Boger
Bold -3 marks-1st grade -felt strongly by all provers of majority of provers ,frequently confirmed and verified.
Italics -represents 2 marks, 2nd grade symptoms brought out by few provers, have not been confirmed but occasionally verified.
Roman -represenst 1 mark, 3rd grade , verified by curing patients so accepted as clinical symptom.
According to Dhawale—3 mark of Kent is similar to 5 mark of Boenning Hausen , 2mark of kent similar to 4&3 of Boenning Hausen and 1 mark to 2&.1 of Boenning Hausen .
Plan and construction of Kent’s repertory
Kent’s repertory has a uniform plan which provides scope for indefinite expansion so that remedies can be added from time to time whenever confirmed or verified.
Kent’s repertory started from Lipper’s repertory of the more characteristic symptom of our materia medica published in 1879.Lipper’s repertory inturn took its material from.
Repertory to the Allen town manual published in 1838 by Constantine hering which is the first repertory and materia medica published in English language.
Selections from Boenning Hausen’s works
Adolph Lippe’s materia medica
Works of Guernsey ,hering and Jahr.
Repertory is divided into 37 chapters spanning into 1423 pages arranged in double columns. The repertory starts with mind chapter, which has been given prime importance. Last chapter is on generalities which contains physical generals and physical general modalities. These 37 chapters can be classed into 3 sections as • Mentals-mind mental complaints sensations dispositions and attributes.
Particulars-30 chapters arranged in Hahnemannian schema.
Almost all of these chapters are dealing with anatomical locations. it also includes chapters on discharges like stool and urine, local pathology-cough and expectoration, physiological functions-respiration, vision, hearing& steep.
Symptoms not localised to any particular organ like vertigo sleep chill, fever, perspiration and generalities.
Number of medicines -648. An index of medicines with their abbreviations are given in the beginning of repertory although other drugs were known during his time. He rejected numerous symptom and drugs which were insufficiently confirmed.
Evaluation of remedies
He used three varieties of typography to indicate the gradation of remedies unlike the 5 gradations of Boenning Hausen and Boger.
Bold -3 marks-1st grade -felt strongly by all provers or majority of provers, frequently confirmed and verified.
Italics -represents 2 marks, 2nd symptoms brought out by few provers, have not been confirmed but occasionally verified.
Roman -represents 1 mark, 3rd grade , verified by curing patients so accepted as clinical symptom
The plan followed through out is from generals to particulars.
i.e. general rubrics containing all the remedies which have produced all the symptoms followed by particulars like side ,time, modalities and lastly extensions.
Up to 6th edition ,Kent’s repertory contains 37 chapters. In the 7th edition or Kent’s final general repertory by Pierre Schmidt contain 39 chapters where he gave independent status to smell and voice which under the earlier editions were put under nose and larynx respectively. In Kunzli’s repertorium generale by Jost Kunzli he reduced the total number of chapters into 27 by putting vision under eyes, external throat under throat ,bladder, kidney ,prostate, urethra and urine under urinary organs and chill, fever and perspiration under one section. So for a question about the no: of chapters in Kent’s repertory one may answer that upto 6th editions there were only 37 sections including the 5 sections on urinary organs and in Kent’s final general repertory by Pierre Schmidt contains 39 chapters and Kents repertorium generate by lost Kunzli contains 27 chapters.
In every chapter arrangement of rubrics is in alphabetical order except in some situations,e.g. Vertigo- Vertigo is the first rubric, then time modalities and only after this we can find the anatomical arrangement. The plan followed through out is from generals to particulars. Each rubrics starts with a general group of remedies. After that, sides of body, time, different sensations and circumstances are arranged.
Type of rubrics depends on the chapter.
Anatomical region- if the chapter is an anatomical region conditions referable to that part will be given as rubrics and they will be arranged In alphabetical order. e.g.-in head, abdomen , chest etc.
Physiological function-disorder of that particular function will be given as rubrics. E.g.- Hearing- Impaired. Vision- dim, Respiration – irregular.
Pathological condition – hare general remedies and modifications will be given as rubrics. E.g.- Vertigo- vertigo , chill-chill.
Local pathologies-here modifications by time and circumstances will be given as rubrics. E.g.- Cough-Morning
Mind-mental conditions, dispositions and attributes will be given as rubrics
Generalities -rubrics related to time, conditions, modifications and circumstances. Conditions can be diagnosis like paralysis agitans or pathological conditions like haemorrhage
Rubric presentation or type of rubrics
Expression of a state -Anger/ fear /restlessness
Expression of a sensation-coldness/heal/numbness
Expression of a condition-atrophy/ catarrh/ flatulence
Expression of a location-side/left
Expression of a modality-time- day time/noon/11 am, seasonal-summer/winter, circumstances-lying,bed on.
Expression of diagnosis-epilepsy,gangrene,hydrocele
Expression of a causation
Arrangement of sub-rubrics under every rubric is based on the principle of generals to particulars. General rubric include all those medicines where the prover reported a symptom with several modifications. In such cases medicine will be seen under the general rubric and also under the particular rubric. It also includes symptoms without any modifications, symptoms of an undefined kind or nature and also some symptoms with undefined modalities as for e.g.-pain in arm.
Particular rubric- from the level of general rubric he further individualized or particularized as side, time, modalities, extensions, localizations, kind and nature. In some cases even sub-locations can be seen. Finest and minutest shades are modifications further modified. A symptom at each level becomes a general in relation to the succeeding levels. i.e., from broad undefined symptom groups and going to the minutest particulars. Thus the extremities chapter became very large and received many criticisms. In this chapter he used sub-locations up to the level of fingertips, nails and even phalanges.
We can find this pattern of arrangement in Allen’s Symptom register. Here each symptom is followed by its cause then modalities and then peculiarities.Here the arrangement is strictly alphabetical. Key word or RUBRIC is kept close to the margin line and is printed in CAPITALS of heavy block type. Modifications or sub-rubrics are placed two spaces to the right of the margin line. Remedy line is four spaces to the right. Every sub-rubric to placed two spaces to the right of one above.
Arrangement of sub rubrics -arrangement of sub rubrics is always in a fixed pattern, i.e. side, time, modalities and extensions.
This S T M E Arrangement was brought forward by Julia Minerva Green, a disciple of Kent. This arrangement is mainly seen for subjective sensations like pain, numbness etc. but in objective symptoms like discharges, eruption, discoloration etc we do not find this STME arrangement instead sub rubrics are presented here mainly in the form of characters and locations as they are more important. Circumstances and time are placed as peculiarities under character. In these type of rubrics there will be no time and modalities under the general rubrics. E.g.:- Head-Eruption, margins of hair, occiput, character, modalities.
So each rubric is modified by six factors following the same order following the same order all through the different headingswith some exceptions in some chapters. They are
Sides or laterality (first right then left)
Time of occurrence
Modifications (modalities – conditions and circumstances are given in alphabetical order)
Character of pain or sensations.
It is important to note that all these modifications need not necessarily be present under every general rubric as only those symptoms which have been recorded during the proving are compiled in this repertory.
Explanations for STME arrangement
SIDE-whenever a rubrics can be divided into sides the general rubric is followed immediately by side first right and then left except in chapters on generalities, perspiration etc where SIDE is given as a rubric within the alphabetical arrangement. In certain chapters SIDE is considered as a sub location. E.g.- chapters on Head, Abdomen, Chest, Teeth. If the rubrics cannot be divided into sides as in chapters on Mind, cough etc naturally side will not find any place. In some chapters where Side cannot be given or are not given Time immediately follows the general rubric.
TIME-time is given in most of the rubrics. In the arrangement of time also he followed the logic of generals to particulars. Arrangement is from general period of time to particular point of time. If any symptom is aggravated during the daytime the general rubric or side is followed immediately by daytime. In Kent’s repertory almost all rubrics are arranged in alphabetical order but time rubrics are given according to their order of appearances. The general periods of time are arranged as day time, morning, forenoon, noon, afternoon, evening, twilight, night, midnight, midnight before and midnight after.
Each period of time is further divided into particular points of time like 8 am 9 am 4-8pm etc. any other peculiarities associated with time are given as sub rubrics. E.g.:- Cough-Paroxysmal-evening -bed in. within the general periods of time the corresponding clock timings are given. In the chapter on chill TIME is given as a separate rubric within the alphabetical order (lam-12pm.), if one division of time is not given, the next division follows. E.g.:- the rubric anxiety is followed by the sub-rubric day-time, where as anger is followed by morning because day time as a sub-rubric is not given under anger.
Modalities- this section follows time. Aggravations and ameliorations are mixed together and arranged in the alphabetical order. Modalities include different factors, which influence the symptom. In case of aggravation only the circumstances will be mentioned. If there is amelioration from the same condition it will be given as sub-rubric and following the sub-rubric the term amel will be added to it. Large number of sub-rubrics constitutes this area. This part is a mixture of concomitants and character apart from aggravations and ameliorations. E.g.:- Head pain-catarrhal, hammering, paroxysmal, pulsating. E.g.:- for concomitants- head pain- coryza with, head pain- pain in neck with. So this section is a mixture of 3 C as Circumstances, Characteristics and Concomitants. Alternation with a particular complaint to pieced within the alphabetical order among the alphabet ‘a’, e.g.: respiration- asthmatic alternating with skin eruptions but extensions are given after all modalities.
Extensions - This is the fourth modification of a symptom and is mainly found under the pain rubric. Here It may be remembered in regard to extent ion that the points from which a certain symptom extends to the one under which the symptom will be found and never under the part to which it extends.E.g.: Head Pain -extending to eyes. This symptom must be looked for under the rubric Head Pain and not under Eye Pain.
Locations—- After extension sub location of the main location will be arranged in alphabetical order. Under each of these sub-locations the above mentioned STME arrangement can be seen, .for e.g:- head chapter includes many sub-locations like Brain, Forehead, Temples, Occiput etc. These modifications are especially found under pain rubric.
Character of pains or sensations- this section of symptom is usually seen under subjective symptoms like Pains, noises in the ears etc, here also the character of pain or sensations will be given in the alphabetical order like – aching, burning, catching, drawing etc. Under each type of pain Time Modalities and Extensions are given.
The above order STMELC is generally followed in each rubric and sub-rubrics. Since generalities chapter deals with certain states of the person and also aggravations and ameliorations the above order is not possible in this chapter. This order has been slightly modified according to the rubrics here and there.
Skin, Fever, Perspiration, sleep etc do not follow this arrangement. But in these chapters also we can find an alphabetical arrangement from generals to minute particulars.
Chapters are arranged in anatomical after Mind. Discharges such as stool, urine, expectoration etc are given as separate chapters. Generals are found under Mind, Generalities and Sleep although some generals are found scattered in other chapter also. Some conditions like Vertigo, Cough, Chill, Fever, Vision and hearing are given as separate chapters. In this repertory systems are not given separately but symptoms related to them are given under parts.
25 Larynx &Trachea
Reference : Introduction to Repertorisation – Dr Munir Ahammed
Dr Rajitha K Nair BHMS,MD(Hom)
Govt. Homeopathic Medical College. Trivandrum. Kerala
Email : email@example.com