The philosophy of repertorisiation

Dr Jeena Aslam

A brief study of the repertory of Dr. Kent, Dr. Boenninghausen and Dr. Boger

The word ‘repertory’ means a store house, a store or collection especially of facts or information. The word originated from the Latin word REPERTORIUM or (REPERTIRE) which means “an inventory, a table or a compendium where the information is so arranged that it is easy to find. But the word “REPERTIRE” in French means a company store house.

“The meaning of repertory given in certain book as store house or inventory is a misnomer”, Benedict D’ Castro. According to him the word originates from the latin word REPERTORIUM. Repertorium is again derived from the Latin word REPERTUS, means reproduction. Repertory is an index of symptoms of materia medica, the record of scientific proving which is reproduced and artistically arranged in a practical form, indicating the relative gradation of medicines to facilitate the quick selection of the indicated medicines.

“Repertory is an index to the homoeopathic materia medica, which is full of informations collected from toxicology, drug proving, and clinical experience”, says Dr. Tiwari. Repertory bridges the gap between materia medica on one hand and the disease on the other.
Thus the study of repertory helps us to understand the patient and the materia medica. Materia medica and repertory are complement to each other.

The various philosophical approaches to find the totality of symptoms and similar remedy through repertorization and the technique used in the construction of repertories by Boenning hausen, Kent and Boger as follows.

Boenning Hausen’s concept of totality: – In his concept totality of symptoms comprises following seven points.

• Quis   Personality, the individuality
• Quid   Disease, its nature and peculiarity
• Ubi   Seat of the disease
• Quibus auxilis   Accompanying symptoms.
• Cur   Cause of disease
• Quomodo   Modification, agg. and amel.
• Quando   Time

Philosophical background of Boenninghausen’s repertory rests on the following.

1. Doctrine of Analogy
2. Doctrine of concomitance
3. Evaluation of remedies
4. Concordance

Doctrine of analogy: -According to Boenninghausen one can make order out of chaos by combining the scattered symptoms by making use of analogy. To complete a symptom local maladies and sensations pertaining to one part should also be applied to other parts. Thus he raised local symptoms to a general level which could be used for the whole person this is called doctoring of grand generalization. He also evolved the concept that ‘what is true to the part is also true to the whole person’. Boenninghausen’s approach was that proving are not complete and can never be really complete. He says that to make things comparatively more complete, so as to make the best of what can be found out; he wanted to complete the case by analogy as learned from actual experience and practice.

Doctrine of concomitant: – The word concomitant means existing or occurring together; or attendant. They are the unreasonable attendants of the case. Boenninghausen identified in each case a group of symptoms which have no relation to the leading symptom from the standpoint of theoretical pathology, yet they have actual relationship with the case in that they exist in same person at the same time. Concomitant is the differentiating factor in any case. The foundation of the TPB lies in it.

Evaluation of remedies: – Boenning Hausen was the first to grade the remedies, there are 5 gradings

CAPITALS- 5 marks FIRST GRADE
BOLD 4 marks SECOND GRADE
ITALICS 3 marks THIRD GRADE
ROMAN 2 marks FOURTH GRADE
ROMAN ( PARANTHESIS) 1 mark FIFTH GRADE

This gradation is based on frequency and intensity of the appearance of symptom in provers.
5 marks Symptom frequent, confirmed and verified
1 mark Symptom not verified, not confirmed

Concordance: – In the earlier edition the headings is concordance of remedies, by changing Allen makes this more comprehensive. This chapter is divided into sections, each begin with a section devoted to a remedy in alphabetical order.
Each of these remedy section is subdivided into rubric Mind, Localities, Sensation, Glands, Bones, Skin, Sleep and Dreams, Blood; Circulation and Fever, Aggravation: Time and circumstances, Other remedies, Antidotes, Injurious. Other remedies mean general relationship of remedies. Other remedies also cover these symptoms which do not fit into the above said rubrics.

BOGER’S CONCEPT:–
Dr. C.M. Boger in his book “Studies in the philosophy of healing” gives a scientific procedure for “choosing the remedy”. According to him the characteristic symptom comprises following seven points
1. Change of personality and temperament: – To be particularly noted when striking alterations occur.
2. Peculiarity of disease:- e.g. Stepladder pattern in typhoid
3. Seat of the disease:- Every drug acts more definitely upon certain parts of the organism; right, left, diagonally etc. e.g.:- Sepia cures stubborn abscess of fingers and toes.
4. Concomitance
5. Cause
6. Modalities
7. Time
A, Periodicity
B, Hour of the day when they are better or worse

Boger’s work Boenninghausen’s characteristics and repertory is based on the following fundamental concepts

1. Doctrine of complete symptom and concomitant
2. Doctrine of pathological general
3. Doctrine of causation and time
4. Clinical rubrics
5. Evaluation of remedies
6. Fever totality
7. Concordance

Doctrine of complete symptom and concomitant: – A complete symptom is that which consists of location, sensation, modalities and concomitants. Boger borrowed this idea of complete symptom from Boenninghausen’s method of erecting totality, but he improved it by relating sensation and modalities to specific parts, thereby he fairly and squarely met the criticism.

In the book, the complete symptoms are well arranged. Concomittnats are given greater importance by Boger in relation to parts.

Doctrine of pathological general: – Pathological generals tell the state of the whole body and its changes in relation to the constitution. They help us to concentrate on more concrete changes to select the similimum. The chapter in the book “sensations and complaints in general” is full of examples of pathological generals, which include discharges, structural alterations, constitutions, diathesis etc.

Doctrine of causation and time:– From his point of view, causation and time factors are more definite and reliable in cases as well as in medicines. Each chapter in the book is followed by time aggravation. The section on aggravation also contains many causative factors. In the chaper ‘choosing the remedy’ he gives importance to the miasmatic cause, as well as exciting cause.In his hierarchy of evaluating symptoms he gave more importance to causation and general modalities .

Clinical rubrics:-Boger mentioned several clinical rubrics in his repertory. These rubrics help the physician in cases of advanced pathology. These rubrics are useful to arrive at a group of medicines, which can further be narrowed down, with the help of modalities and concomitants to select finally the most similar remedy.

Evaluation of remedies:-He introduced the grading of symptoms into five ranks by the use of different topography such as

• Capital 5
• Bold 4
• Italic 3
• Roman 2
• Roman in parenthesis (1), rarely used.

The gradation is based on the frequency of the appearance of symptoms in the provers. Thus five mark medicines are most important and one mark medicines least important.

Fever totality:-This is the unique contribution of Boger. The arrangement is self explanatory. Each stage of fever is followed by time, aggravation, amelioration and concomitant. Thus they help to repertorize any simple as well as complicated cases of fever.

Concordance:-By including this chapter Boger has made the philosophy clearer and practical. It deals with the relationship of 125remedies.

KENTS PHILOSOPHY:-
Kent’s repertory is based on philosophy of deductive logic. I.e. from generals to particulars. Generals are dealt within depth followed by particulars, and minute particulars. Under chapter mind mental generals are given. The physical generals are mostly listed under generalities, and a few in other chapters.

Kentian method: – Dr Kent has classified the symptoms into three main categories:-
1. General
2. Particular
3. Common

General symptoms: – All the symptoms that the patient predicate of himself or of which he uses the first person pronoun are general symptoms. E.g. I am weak, I am thirsty. As the general symptoms affect the patient as a whole they are of higher value.

General symptoms subdivided into two groups

• Mental generals
• Will and emotion
• Understanding
• Intellect

2. Physical generals:-

• Perversion of sexual sphere and effects of coition
• Symptoms pertaining to appetite, food desires and aversions, thirst
• Things affecting the entire body
• Weather
• Food
• Position
• Motion
• Symptoms of special senses

3. Particular symptoms:-
They refer to the symptoms related to a particular part of the body of the patient

• First grade particular: – those that are rare and unusual e.g. inflammation without pain.
• Second grade particular: – Particular symptom with marked modalities.
• Third grade particulars: – Particular symptoms without modality.

Common symptoms: – this symptom is common to a particular disease or is found in several patients as a common factor. They do not play much role in the selection of similimum unless they have peculiar modalities.

Kent’s repertory contains 648 drugs and he has used three varieties of topography indicating the gradation of remedies.
Bold letter 3 marks First grade
Italics 2marks Second Grade
Ordinary 1 mark Third grade.

Provers Reproved Verified
First grade symptoms ++++ ++++ ++++
(All provers) (Reproved) (Verified)

Second Grade ++ ++++ ++
(Few) (Reproved) (Occasionally verified)
Third grade + ——- +
(Occasionally) (Not seen) (Clinical symptom)

Though all the three are important, its relevance depends on the nature of the case

Dr.Jeena Aslam BHMS,MD(Hom)
Medical Officer,Department of Homeopathy. Govt.of Kerala