Dr S K Tiwari
““Probably there has never been a more thorough student of Boenninghausen than the late Dr. Cyrus M. Boger -Herbert A Roberts
Boger’s views on finding the similimum
Being a practical man Boger emphasized on the detail study of a case in order to find out similimum. He stressed over the complete study of the picture and advised against giving more importance to a single symptom even if the symptom might be a key-note one.
He says “Running after key-notes while paying scant attention to the general harmony of the picture has spoiled many a case and leads to polypharmacy.”
He has always given importance to the general picture compare to the key notes “It is f better to be able to see the general picture and use the key-note as a differentiating point just as we would use a modality.” He further adds “Unless we can think of the human economy as a unit of force whose amplitude of action moves back and forth incessant between health and sickness, we can have no true conception of what the curing of disease actually implies.” “The symptoms which belong to the patient are .all important ones and far outrank those of the disease. It should be the business of the prescriber to trace out if connection that exists between the two kinds, always keeping in mind their relative age and sequence; in no other way can we unravel what seems all a tangle at first sight.”
Criticizing the key-notes prescriberes he states “The common way of eliciting well-known key-notes and prescribing accordingly is a most pernicious practice, which has earned deserved odium and is no improvement upon the theoretical methods of. the old school.”
Boger felt that subjective symptom though they have importance in selection of the remedy are liable to be altered by the provers, patient as well as by the physicians while interpreting. Whereas the objective symptoms are the fact hence more reliable and concrete. He says “Objective phenomena, being exempt from self — interpretation and allowing the largest scope to the acumen of the examiner are withal the least deceptive and should receive our first and best attention.” He further reminds the physician not to neglect these while taking the case. In his words he puts it as “As patients present themselves it the first duty of the physician to observe them closely, noting the facial expression, manner, mode of action, habits, and all external without asking a single question.”
About the dependence on clinical symptoms he says “To be ruled by clinic observations and pathological guesses is a most disastrous error which limits our action and only obscures the wonderful power of which the true similimum is capable.”
He favors the study of full picture for the purpose of prescribing “To do the best work, nothing must prevent a full, free and frank presentation of the symptoms as they are, without bias, and although their comprehension necessarily involves judgment, the more clearly they follow the text.”
About the new and old symptoms in a case he advocates that the last symptom in the disease is the most important clue for the similimum — “The most expressive new symptom is usually the key to the whole case and directly related to all of the others, and is often expressed by a change of temper or mental condition. Such apparent trifles reveal the inner man to the acute observer and have proven the undoing and insufficiency of liberal Homoeopathy.”
“Here it may not be amiss to point out that nature tries to attract our attention to the most important things, by developing them last of all; putting them right under our noses, as it were.”
Even in a confusing presentation he states that one should be guided by the recent man symptom. In his own word “Occasionally no one remedy corresponds to the whole picture; then we must prescribe for the most recent phase first and for the earlier one when it is ease again uncovered.”
Regarding the mental symptom he accepts its hierarchy but at the same he expresses and difficulty in eliciting them without any alteration. “No effort should be spared to learn the nature of the mental change which has overtaken the victim, for it epitomizes the whole patient”.
“Conditions which modify or excite mental symptoms are not exceeded in importance by any others. To these belong the influence of the emotions, of fright, grief, solitude or company, thinking of the disease, consolation, vexation, etc., on the mind”.
“Mind mirrors itself with great accuracy in the different modes and manners of physical e expression. The interdependence of mental and physical states is so great that we can while never afford to overlook it entirely. They, moreover, always clarify every other symptom; and often in a decisive way.”
“If the physician can get at the patient’s mode of thinking, his involuntary ideas, he can t build up a picture of his mental process. This is often difficult. The psychoanalyst takes hours and weeks to do it, the physician rarely has so much time at his disposal.”
He has also emphasized on the understanding of the constitution type and general tendencies which play a great role in selection of the right remedy. “Histories which do not reveal the constitutional bias or leaning are badly deficient”.
“The ruling feature of every case puts the stamp some particular type, such as bilious, hemorrhagic, etc., upon it, and when we select remedies, which in their action and order of development conform to the presenting type, we say that the genius of the drug corresponds to that of the disease.”
Regarding type and hierarchy of symptoms he clearly states “All symptoms are reactions, be general or particular. The mental ones are the most illuminating as well as interacting fully with all the others, hence they deserve the highest rank. General sensereactions to heat, cold, light, noise, touch, posture, motion, etc., are all distinctly related to the comfort of the patient, hence also of great value. Subjective sensations are ideographic expressions, useful for interpretation by the examiner and may have any value whatsoever.:
Their true worth is best ascertained by their purity and definiteness as fully expressed by the patient who invariably gives them a mental slant not otherwise obtainable. This has value in so far as it leads away from the machine methods of the schools. Every symptom picture shows three phases, constitutional, general conformation and the peculiarities. The basic factors with the rules of procedure are the constants, while the symptoms are the variables. All three must be well met before the simillimum can be seen.”
He was against the mechanical use of repertories. He sounds precaution by stating, “T mechanically assemble the remedies which run through all or most of the rubrics having the closest resemblance to the symptoms of the patient is a method much in use, but one that tends to obliterate the finer shades of expression on both sides, and after all, even with the aid of the mental symptoms, only approximates the choice. Much of Hahnemann’s greatness lay in his faculty of expressing every symptom and process in its natural language.”
“To depend wholly upon a numerical concurrence is indeed fallacious, arid yet every use of the repertory implies the presence of this fact, to some extent; but it is greatly overshadowed by the relative standing of the individual symptoms.”The above views of Boger undoubtedly indicates towards his holistic approach of treatment where in he considers sick man as a unit who expresses the turmoil at the level of generals and particulars.
To summaries his views one must note the instructions given by him clearly about the best indicated remedy “The best indicated remedy is the one holding the closest similitude thereto in location, origin, modality, mental condition, concomitants, peculiarities and time.”
Evolution of Boger’s concept
Dr. C.M. Boger was a leading practitioner of United States in the early decades of twentieth century. As a practical man he well understood the difficulties faced by the practitioners of his days in finding out a correct correspondence in Materia Medica in the shortest possible time. The perceptive mind of this German physician soon discovered that, in spite of the availability of a plethora of literature and clinical experiences, the burning question was how best those could be put to use. In his time, both the Boenninghausen and Kentian schools were popular. Boger made a study of both but accepted Boenninghausen’s way of working out of a case. Finding that the practitioners had to depend on the existing faulty translations of Repertory of Antipsoric Remedies, he embarked upon the task of translating it in 1900.
In the course of his translation work, he was further convinced that there was a need for a repertory and Boenninghausen’s basic principles, plan and construction were sound, and that the book was comprehensible, and hence practicable. Boger was also aware of the difficulties faced by the practitioners while using the Therapeutic Pocket Book as well as criticism leveled against its principles and methodology.
Boger also undertook another major work of rewriting Boenninghausen’s repertory. This he did by adding aggravation, amelioration and concomitant in a detailed manner at the end of every chapter. The outcome was a more useful work enriched with many new chapters,new rubrics and medicines. It was published by Borick & Tafel in 1905. Even thereafterBoger continued to work on the repertory; however, death snatched him away before he could give the final version.
He was a busy practitioner hence in spite of his great desire to compile a better repertory he could not afford and to spend the required time. However, he frequently lectured before scientific audiences at the Pulte Medical College in Cincinnati and was a teacher of philosophy, materia medica and repertory in the American Foundation for Homoeopathy Post Graduate school from 1924 until his death.
In 1915 he authored ‘ Synoptic Key of Materia Medica’ wherein he has arranged symptoms as per his concept of understanding the sickness as well as the medicines i.e.the location, modalities, physical and pathological, generals, mental generals and particulars with modalities and concomitants. His views and concept becomes more and more clear as his other works were published.
In Times of remedies and Moon phases’ as well as in ‘Synoptic Key’. The importance is given to causation, concomitant and modalities. The sensations and complaints are generalized after analyzing each symptom of the patient to arrive at a ‘central idea’ so that the physical generals as well- as pathological generals of the patient along with the particulars are understood clearly.. His concepts clearly denotes that all the symptom (general and particular) can be splitted into its component and with the of help of these splitted components of various symptoms a comprehensive picture can emerge if arranged properly and perceived carefully. Thus the whole picture would present the image of the sick person.
He has worked with 186 medicines in Moon phases. 420 medicines in Times of Remedies 489 medicines in Synoptic key and 250 in Index Card Repertory. His ‘Boenninghausens characteristics and Repertory’ has 464 medicines.
His interest grew more and more in the field and because of his devotion he could work on additions to Kent Repertory. He found that many rubric and subrubrics did not have even prominent remedies, which he found very effective in his practice. He did 3202 additions in various sections of Kent’s Repertory. This was his last work, which he could give to the profession.
Dr C M Boger favored the idea of understanding each symptoms completely by analysis in relation to its location , sensation, modalities and concomitants and also in relation with the origin, duration and progress. Certainly, he was not satisfied only with the mechanical division of each symptoms but went one step ahead to explore and understand the Cause and Effect phenomenon in totality so that not only the details but also the central thread would be available. He worked hard from 1905 till he lived to prepare a repertory on this line which was published as BBCR in 1937 posthumously.
Boger’s concept of totality
Boger indeed helped the profession by pulling all his experiences in the evolution of ‘Portrait of Disease’ (natural as well as artificial). He re-emphasized the following seven points to appreciate the whole picture of the disease.
1. Changes of personality and temperament 2. Peculiarities of disease 3. The cause
4. Modalities 5. The seat of disease 6. Time. 7. Concomitants
It is obvious that Boger has favoured the understanding of the whole phenomenon at the levels of Constitution, Diagnosis and on ongoing Pathology. Boger’s appreciation of time dimension, causative modalities, tissue affinities and pathological generals gave a new vista in understanding the case. In his article “Some Thoughts on Prescribing he instructs physician to first try to elicit the evident cause and course of the sickness down to the late symptom and effect of such influences, time temperature, open air, posture, being alone motion, sleep eating; drinking, touch, pressure, discharges, etc. Second comes the modalities and consideration of mental state in order of importance. Third entire objective aspect or expression of the sickness including the state of secretions (sensations).
Lastly, the part affected must be determined which also brings the investigation in touch with diagnosis. He further states that by going over the above rubrics in the order name the contour of the disease picture would be pretty clearly outlined and would point fairly, well towards the similimum and the prescriber has only to keep in mind that the actual differentiating factor may belong to any rubric.
From the above, it is obvious that Boger has given importance to Causation, Modalities General sensations and pathology. Location is given the last place in the order of hierarchy.
About the importance of the Causation he says, the causation come from without or arise from within, the homoeopathic simillimum cannot be chosen with safety without taking them into account” and about Modalities he states, “They individualize and define every sickness as well as every drug, hence the most suitable medicine cannot be chosen while they remain unknown.”
Mind is given adequate importance, and for selecting a drug it becomes imperative that the remedy selected is always in agreement with the mind. He wrote in the article “How shall I find the remedy?” “The Inter-dependence of mental and physical states is so great that we never afford to overlook it entirely. They, moreover, always clarify every other Symptom often in a decisive way.” He has emphasized that, “In a general way drugs effect the similar tissues bear a certain relation to each other and are differentiated through the mental sphere and the modalities.”
Boger had expressed the importance and hierarchy of the various types and parts of the symptoms, which can be applicable in different conditions in formation of the totality. He advocates that every symptom should be valued as per the condition. He has stressed on the fact, “If every symptom is a little picture reflected from the central disturbance, a composite picture will most nearly depict the whole. This is what we mean when we speak on the symptom complex or the totality of symptoms.
Some of the works done by this great repertorian in the field of the repertory has been discussed below
Card Index Repertory
It was published in 1928 (Some put is as 1931)
The Rubrics are arranged alphabetically. The first card is ACHING and last one YELLOW
The total number of cards is 305, Dr L.D. Dhawale puts it as 339
Four types of letter are used to indicate the grades e.g. NUX.V., Nux.V., Nux. V Nux.V. Cards are punched.
Total number of medicines used is 250.
Most of the cards have rubrics which shows a general character or some particular complaints.
Most of the rubrics are similar as mentioned in synoptic key. Even the number of medicine and grades are same at times.
The rubrics are taken f ‘Condition of Aggravations and Amelioration’ and ‘Generalities’ from Synoptic key.
The card repertory became out of use because his other repertories ‘Synoptic Key’ and
B.BCR have more number of medicines for the same rubrics and also more sub rubrics.
However even now the better cards can be prepared based on his card repertory.
A comparative study of a few rubrics —
Alternating effects — card repertory — (24 remedies)
Synoptic Key – (13 remedies)
B B C R – (6 remedies)
Emaciation Card repertory – 17
Synoptic key – 21
Separate chapters are given for the different parts in BBCR and synoptic key.
I) In Card index repertory the time is given in combination of 4 hrs e.g. 4.00 a.m. to 8.00 a.m., 8.00 a.m. to 12.00 noon etc.with out any sub rubrics
II) In Times of remedies — It is given in detail on hourly basis. Even the hour rubric has many sub rubrics. Every main rubric has sizable number of medicines. It is given on the basis of weather as well as on broad division of time and complaints
III) In Synoptic key it is given as hourly basis. But the number of medicines is less under each rubric compare to the Times of remedies.
IV) IBBCR it is given as, morning, noon, and evening, night and at some places time of hour is also mentioned.
There are some difficulties noticed in following the abbreviations of remedies used in card repertory e.g phosphoric acid — Phos-a/pho-a Thuja occ — Thuya/thu etc
Working out a case
Cards should be arranged as per the hierarchy of the symptoms, worked out by Boger’s method. They are arranged one after another. Look for hole against light. The indicated medicine or the group of medicines would emerge automatically.
The times of the remedies
It is based on Boger’s long experience in observing various symptoms in relation to in his clinical practice. He was of opinion that the particular time when a medicine manifests its full therapeutic action is often of decisive importance.
This work appeared first time as an article in The Zeistschrift des Berliner Vereines Homoeopatischer Aerzte (Vol XXV). Subsequently it was improved and published independently.
Boger has emphasized the importance of time factor and this work is truly a great help for the prescribers who give importance to the ‘time factor’ as well as various modalities.
The total no. of medicines used in this book is 420
Construction and arrangement
The different chapters are as follows
Time — various hours:
General rubrics starts with I AM followed by various sub rubrics. It is followed by 2 AM, 3AM 12 midnight
Weather — spring, summer, autumn, winter
Fever — chill, Heat
Periodicity — In general
Mind Larynx Neck
Sensorium Stomach Extremities
Head Abdomen Skin
Eyes Stool Sleep
Nose Genitals Fever
During day — in general
(Followed by sections as above)
Morning (4 am — 9 am) followed by all the sections
Forenoon (9 am to 12 noon) ”
Afternoon (12 noon to 6 p.m.) ”
Evening (6 p.m. to 9 p.m.) ‘
Night (9 p.m. to 4 am) ,,
This work was published along with the ‘Times of the remedies’ in 1931. The total number of remedies used in this work is —186. Dr Boger has emphasized the importance of ‘Moon phases’ in the action of a drug. It is rather a new method of application of remedies developed from an extensive research work carried on by this indefatigable worker in the cause of advancement of the homoeopathic science and it is due to his tireless energy and hard work that a new angle of vision in prescribing remedies has been brought out. It is presented in the form of table of moon phases — first quarter, full moon, last quarter, and new moon. The table consists of an enumeration of the time, at which a particularly successful prescription has been made; thereby accentuating the importance of the time period in which the remedy has been found more useful. Whenever a patient reported with striking relief in the symptoms, the time was marked in the phase of moon.
This research was undertaken to find out whether there was anything in this question of ‘times of remedies as related to phases of moon. The number mentioned in the table denotes the number of cases where the remedy (against which the number is written) was successful in bringing out results. The results are entirely clinical. This table is a strong confirmatory symptom evaluator in the final decision, as to the remedy to be chosen. One can almost use it to start the search of simillimum.
In Boger’s word:
“When a new patient comes to you, you ask him, “When are you worst ?“ “Well, I was worst in the middle of last week”. “Is that about when you are usually worst?” “Yes, about that time”.
Open up your almanac and see what quarter the moon was in, then took down your list of remedies and see which remedies are most prominent in that quarter. He further says, “I am glad to say is showing good and exclusive results in quite a large number of remedies”.
A Synoptic Key Of The Materia Medica
Though this repertory and materia medica was published long back and it can not be classified under the modern repertories, its contents and utility is such that no practitioner of the rational healing art should neglect this book
The fifth and final edition of A Synoptic Key of the Materia Medica was published in 1931 by C. M. Boger.
The aim of this book is to simplify the use of the Homoeopathic Materia Medica so that the truly curative remedy may be worked out with greater ease and certainty in a given case. For this purpose the synoptic key has been presented as a combination of the analytic and synoptic methods.
The analysis of any case to clearly outline the disease picture would follow the following schema:
Modalities Sensations Parts affected
Mind Objective aspect
The above arrangement would fairly well point towards the simillimum, and the prescriber has only to keep in mind the fact that the actual differentiating factor may belong to any rubric whatsoever.
Plan and Construction
This book is presented in the following three parts:
The first part ‘Analysis’ is a short repertory containing:
- The periods of aggravation
- Conditions of aggravation and amelioration
- Generalities i.e. Consideration of drug affinities for the entire organism
- Regional repertory
The number of medicines mentioned under the repertory section is 489.
The second part ‘Synopsis’ contains the general expression or genius of each re arranged alphabetically. C. M. Boger emphasizes that we must learn to know our remedies just as we do our friends by their air or personality; an ever-changing composite effect, but always reflecting the same motive. The ‘Genius’ of the drug means the strain; which runs through every pathogenic symptom complex.
This part contains an exposition of the important and characteristic features of the important remedies of the Homoeopathic Materia Medica, with their physiological spheres activities, modalities and relationships. Three hundred and twenty three (323) remedies discussed in this part.
The third part comprises of the following
1. Table of the Approximate Duration of Action of remedies: The duration remedies is given by weeks. The number of week/weeks is written on the top of the remedy towards the end e.g.: Zinc It means the minimum duration of action of Zincum is 4 weeks.
2. Complimentary remedies: Here the remedies are written alphabetically complimentary remedies are mentioned against them.
3. Antagonistic remedies: Here the inimical medicines i.e., those who do not follow well are mentioned against the remedies.
4. Supplementary reference table: The rubrics are arranged alphabetically, contain the page number against them. The additional sub rubrics and medicines mentioned in this section should be combined referred to with analysis part.
5. How to refer the repertory:
One should be familiar with the construction and arrangement of sections rubrics. The rubric, which one needs to refer, should be looked into the related section of analysis and also in supplementary reference table. The combined rubric should be made use for all the practical purpose.
Boenninghausen’s characteristics and repertory
Perhaps one of the greatest pieces of homoeopathic literature left by Dr. Boger is the Boenninghausen’s Characteristics and Repertory. Boger”s Repertory is “the combined observations and logic of’ Boenninghausen and the wide and wise observations garnered by Boger from long years of study and practice.” This is the high tribute that Dr. H.A. Roberts paid to Boger
This repertory was published in 1905
The manuscripts for the second edition were published posthumously with the assistance of wife, by Roy & Co., India in 1937.
This, the second edition, proved very useful in successfully working out cases. It contains characteristics of medicines in the first part and repertory proper in the second. Hence the title Boenninghausen’s Characteristics and Repertory. The work is an attempt to bridge Boenninghausen and Kent.
Dr. Dario Spinedi who wrote a foreword to ‘Complete Repertory’ writes, “I discovered that Oger’s Boenninghausen’s repertory is a real gold mine for all kinds of symptoms
Boger’s work Boenninghausen’s characteristics and Repertory based on the following fundamental concepts:
1) Doctrine of complete symptom and concomitants 4) Clinical rubrics
5) Evaluation of remedies
2) Doctrine of pathological generals 6) Fever totality
3) Doctrine of causation and time 7) Concordance
Most of the sections in the book start with the rubric In general. This rubric groups those prominent medicines, which are capable of producing different types of symptoms in relation that Organ/Location. Clinically, these medicines have affinity towards the organs. This grouping may not help us in the process of systematic repertorization, but it can be of much help to know the affinity towards the parts. It suggests organ remedies, which may be useful finding out a drug for palliation when only a few prescribing symptoms are available in case.
Location rubrics are followed by further sub-divisions of parts, with each part having rubrics ‘side’ and ‘extending to.’ After the Location, different sensations are arranged in an alphabetic order. The end of Location and beginning of Sensation is marked by a horizontal line “———-“.“ Each sensation is a general rubric, which is followed by a group of medicines. It is divided into sub-rubrics under which parts are mentioned (mostly abbreviations). Rubrics for the pain is mentioned as various types of pain i.e aching, ping etc Usually, these sub-rubrics arc too specific and have less number of medicines. Thus these sub-rubrics are too specific and less useful in repertorization
The rubrics for Location and Sensation are mixed and there are no separate heading given for them, but it is easy to understand because there is an order, i e, after Location,
Sensations are arranged in an alphabetical order. Time, Aggravation, Amelioration Concomitant and Cross-reference follow this.
Methods of repertorization
1. Using causative modalities in the first place 5. Using diagnostic rubrics
2. Using Modalities in the first place 3. Using concomitant in the first
4. Using pathological generals 6. Following Roberts’s( B.T.P.B.) method
Use of Concordance chapter
This chapter deals with the relationship of remedies. The chapter can be used following the same method, which is used in working out of “Relationship of Medicines” Boenninghausen’s Therapeutic Pocket Book.
1. It can be used for studying the relationship of remedies at various levels — mind, parts sensations, modalities.
2. It helps to find out a close running medicine, which can be thought of in future follow-ups if picture changes.
3. To find out a second medicine, if the first one (though — indicated), does not meet the expectation in given time.
4. Sometimes a deep acting medicine, though indicated, should not be given so as to avoid unwanted precipitation of adverse symptoms; in those cases an analogue can be four out with the help of this section.
5. This section helps us to study various relationships of remedies. Kent has suggested close study of sub headings and medicines listed against them. A remedy, which runs throughout in higher marks, bears a definite relationship with remedy, like Aconite and Sulph, Puls with Sil. and Kali sulph.Boger, for his dedicated work to the cause of the homoeopathy, will be remembered as long as this rational system of medicine continue to cure effectively suffering humanity. His work should not be studied only for academic interest but it has to be experienced in treating the patient to know the utility of the authentic and genuine work done by Boger