C. VON BOENNINGHAUSEN

PREFACE TO THERAPEUTIC POCKET BOOK

IT is now more than fifteen years since I first introduced my "Repertory" of the homoeopathic remedies, which has proved eminently useful to the profession, and enjoys an extensive circulation, either through the original editions of the work itself, or the manuals of our indefatigable Jahr, by whom it has been adopted without any material alteration.

The work havinig been constantly used, an opportunity has been afforded of appreciating its advantages as well as of pointing out its defects; and the publication of similar works which has been continued up to the present day, and their ready sale, clearly show that they meet the demands of our art. It is undoubtedly true, that the diligent and careful study of the "Materia Medica Pura" cannot be fully supplied by any Repertory whatever; nor have I ever had the intention of making that study unnecessary; on the contrary, I am of opinion that all works having such a tendency unquestionably do a great deal of harm.

On the other hand it cannot be denied, that the homoeopathic physician can only devote himself to such studies in his hours of leisure, which are few indeed, and that in his practice his memory should be assisted by a work, containing an abridged account of the symptoms, which he will easily be able to look over, and where the characteristic symptoms of the remedies are pointed out, so that he may, in every case of illness, select the homoeopathic agent with certainty and without too great a loss of time, from among those remedies which are generally indicated for that case.

In my opinion, the defects of all existing Repertories consist principally in confining themselves to the symptoms contained in the Materia Medica Pura, to which - certainly not without a careful examination - the results which have been obtained in practice are added; but these two classes of symptoms have never been combined and arranged in such a manner as would enable the practitioner to determine the curative value of every single symptom, to complete those symptoms which have remained incomplete, and to fill up the numerous vacancies in the pathogenetic effects of our drugs, which the practitioner meets at every moment in practice.

If a great many symptoms should remain incomplete, either because the part of the body or the sensations are not clearly indicated, or - which often happens - because it is not stated whether time and circumstances had made the case worse or better, the difficulty to determine the curative value of the symptoms increases, for reasons which are self-evident: The characteristic curative power of a remedy is never revealed by a single symptom, be it ever so complete; the peculiar bias and feeling of the examining agent may have a considerable influence on the examination, which may mislead his judgment; secondary effects and alternate symptoms of an inferior order may be allowed to slip in as characteristic symptoms of the higher order; and, after all, the greater or lesser value of most of the symptoms can only be determined by a laborious comparison of all the symptoms together, which cannot be accomplished at the sick-bed by means of the Materia Medica Pura, and requires great preparatory study. In the old manuals, many of the more or less important symptoms have been split up, and the fragments dispersed under different heads, besides leaving a great many vacancies, or symptoms which occur in disease without any corresponding symptoms having been obtained by our provings, and which the old manuals do not afford the means of supplying by analogy. The uncertainty arising from the splitting up of the symptoms, and the dispersion of their fragmentary expressions under different heads, together with the prolixity which every homoeopathic practitioner complains of in the old manuals, has induced me to think of and prepare an arrangement which would do away with the above mentioned defects, so far at least as this is possible in the present state of our science. It affords me pleasure to acknowledge with gratitude and reverence the excellent advice which my late friend and master, Hahnemann, has given me in relation to my plan, in an uninterrupted correspondence.

In order to avoid the inconvenience of splitting up and dispersing the symptoms farther than had been done hitherto, and which has been so frequently complained of, it was at first my intention to retain the form and arrangement of my original Repertory, which Hahnemann had repeatedly assured me he preferred to all others: at the same time I intended to condense it into one volume, to define every part of it with greater accuracy, and to complete it as much as possible, from Analogy as well as from Experience. After finishing about one-half of the manuscript, it had, contrary to my expectation, grown to such a size, that I relinquished my plan, the more willingly as I discovered that the same object might be attained in a more simple and even more satisfactory manner, by arranging and combining the remedies in such an order as would point out their relative value in the treatment of disease; thus opening a hitherto untrodden path into the extensive field of a combination of symptoms into groups.

In order to avoid encumbering the homoeopathic literature with a useless work, I first arranged a work like the present, but confined only to polychrest medicines. Finding that the plan worked well, and to the satisfaction of our late master, who pronounced it excellent and eminently practical, I did no longer hesitate to finish the work, which I now present to the homoeopathic public, requesting them at the same time to excuse its inevitable defects and errors.

The object of this Pocket-book, as it has been stated on its title-page, is a double one, viz., to aid the memory of the practitioner at the sick-bed in the selection of the remedies, and to serve the student of the Materia Medica Pura as a guide, by which he is enabled to find his way, to determine the greater or lesser value of every symptom, and to complete and express the symptoms with greater accuracy.

As a great number of remedies are mentioned for almost every symptom, it has been deemed indispensable to point out their relative value by means of a different print, as I had done in my former Repertories, and which Hahnemann had repeatedly declared to be requisite. The reader will find the remedies divided into five classes, distinguished throughout the whole book by the print. The four principal ones occur in the first part (Mind and Soul), under the head "Covetousness," and may serve as an example. The word PULS., given in capitals, takes the first, the most prominent place. It is followed, in a descending order, by the words ARS. and LYC., printed in small capitals, as being less distinguished, but still characteristically indicated for the symptom to which they belong, and having been found useful in practice. Of a still inferior order are the words natr. and sep., given in italic letters, and the last place with regard to the value of the remedies takes calc., which is printed in Roman letters. The fifth order contains the dubious remedies, which require to be more closely ascertained, and occur the least frequently: they are inclosed in parentheses; as for example, on p. 61, the word (cham.), on page 63 (puls.), and some others.

It is evident that the limits of these classes, which it was neither easy, nor seemed convenient or necessary to multiply, could not be fixed with any thing like mathematical certainty. I have not even been able to determine whether and how far the remedial power of the remedies contained in one class inclined to the remedies contained in the class next before or after; but this inclination never reaches one half of the difference allowed between every two successive orders or classes of remedies. Without presuming to maintain that I have marked off the curative limits of the remedies in every instance with infallible precision, I may, however, be allowed to say, that no assiduity, no care, no circumspection, has been wanting on my part, to avoid errors as much as possible.

The arrangement of the work is easily understood; a few explanations will therefore be sufficient. It is divided into seven distinct parts, in each of which the systematical and the alphabetical order have been united as much as possible, in order to facilitate the use of the book. Although every section may be considered as a whole in itself, it nevertheless contains only a portion of a symptom, which is completed in the other parts. In the case of toothache, for instance, the seat of the pain is to be found in the second section, the kind of pain in the third, the increase or decrease of the pain according to time and circumstances in the sixth; and whatever of secondary symptoms may be necessary to complete the picture of the disease, and to select with certainty the suitable remedy, is in a like manner to be found in the different sections.

With regard to the first section, it is necessary to observe that our Materia Medica Pura contains nowhere a greater number of consecutive or secondary effects than among the symptoms of the mind; and that on the other hand most beginners misapprehend or very often overlook this part of a complete picture of the disease. I have therefore deemed it advisable to give only the most essential and predominant symptoms under as few heads as possible, in order to facilitate the business of looking for the symptoms and finding out the remedy. The chapter "Intellect" has been simplified in a great measure; many symptoms, such as the different shades of madness, having been more particularly defined in other parts of the work.

The second section, " Parts of the Body and Organs," has been condensed as much as possible, as it is the tendency of the whole work to explain one part by another. In this section will be found several symptoms, which have proved of importance in practice - for instance, under "exterior head, face, cough" - which would in vain be looked for in any other work. This section points out the medicines which have a greater or lesser specific influence on the different tissues and organs, and it is only to a few particular organs that some pathogenetic symptoms have been annexed, which are merely confined to these, and for which no suitable place could be found elsewhere.

The third section contains, in an alphabetic order, all the sensations and complaints:
1, in general, and then in particular;
2, of the glands;
3, of the bones; and
4, of the skin and exterior,
and is intended to show, more or less, the characteristic nature or form of the complaint, as the preceding section points out the part of the body which is principally acted upon by the drug.

The fourth section treats of sleep and dreams, the fifth of fever, the essential character of both the sleep and fever being minutely distinguished and indicated in every instance.

With regard to the second, fourth, and fifth sections, the following explanation of the chapter "Concomitant Complaints" will be necessary. Convinced of the importance of the symptoms which occur simultaneously with others, and form with them a group of symptoms, I have increased for a great many years the secondary symptoms in the Materia Medica Pura, by adding to them every secondary symptom occurring in my own experience, as well as in that of others, and their number has increased so incredibly, that I have been able to abstract from them general rules. By these rules it is proved with great certainty, that one remedy inclines much more than another to certain secondary complaints; that these last do not take exclusively this or that form, but that in general every kind of complaint which is at all related to the sphere of activity of the remedy, may be its attendant, although its true characteristic secondary complaints attend it the most frequently. This discovery, proved by long experience to be true, has led me to bring the "Concomitant Complaints" together under one head, where the order of the remedies has again been pointed out by means of a different print; and whenever those secondary complaints require to be taken into consideration in the treatment of a case, they will have to be looked for among the peculiarities of the remedies, which are simultaneously indicated, in a greater or lesser number.

The sixth section, containing the changes in the state of the patient according to time and circumstances, is not less important than any of the preceding ones; in referring to it the greatest precaution is required. One has particularly to avoid considering as an aggravation of the malady, what is only a consecutive (or alternate) effect of the remedy, even though the state of the patient in general should be worse. Diarrhoea for instance, appearing only in the morning, is very often cured by Bryonia, although obstruction and evening exacerbation characterize the primary action of this remedy. Such phenomena, which are called consecutive or alternate effects in the proving of drugs, occur very frequently in natural diseases, where a state developes itself, which, though opposed to the original complaint, is not the less a state of suffering, and may easily mislead the ignorant in the choice of the remedy. In another respect, the connection existing between the aggravation or amelioration of single symptoms and the whole complaint, is by far greater than is generally supposed; this aggravation or amelioration is never limited exclusively to one symptom or another: on the contrary, the choice of the right medicine very often depends principally upon one or the other of these conditions. I will give a single instance as a proof. During my absence from home, my patients are always given over to a friend of mine, Dr. Lutterbeck, of this place. I had cured one of them of a deeply rooted phthisis tuberculosa, and in order to remove some remaining complaints, amongst which a disagreeable smoothness of the teeth, with a good deal of slime on them, was particularly troublesome, and which became worse for two successive days, every time he shaved, my friend gave him Carb. An. 30, with the most decided and lasting effect, although the only skin-symptom of the face (152), which had been observed by Dr. Adams, did not exist, and could not, therefore, lead to the selection of that agent. The experienced homoeopathist will therefore easily find, that I have bestowed a particular care upon this section, and that I have given in it many of the results of my own experience, which will be looked for in vain either in the Materia Medica Pura, or any where else.

The seventh and last section gives under the head "Concordances", the results of a comparison of the effects of all the medicines in use: 1st, with reference to the preceding sections, marked with the corresponding number; an 2dly, comparing the different remedies with reference to the symptom, and pointing to their relative value by the different print adopted throughout the work. This laborious work - which it has required a good deal of time to complete, and by means of which my knowledge of the Materia Medica has been considerably improved - is to supply the place of the "Relations or Affinities" (Verwandschaften), which I published in 1836; imperfect as they were, yet my critic (Hygea, IV. p. 369 ff.) has acknowledged their usefulness by copying them literally with all their defects and errors, and with few, for the most part faulty additions, in his " Manual of the Homoeopathic Materia Medica" (Leipsic, Schumann), without naming the source from which he had taken them, and which he had ridiculed before his book was out.

I trust that nobody will consider this section useless and superfluous, now that it has been improved and freed, as much as possible, from errors. In studying the Materia Medica which I consider the fountain-head of Homoeopathy, these Concordances have been of the most decided importance to me, as they have not only led me to understand the genius of the medicines, but also to select with more certainty the proper remedies, and to determine the order of their successive exhibition, particularly in chronic diseases. A certain familiarity with the Materia Medica Pura, it is true, is indispensable to the proper use of these Concordances; but this use is greatly facilitated for the beginner by the polychrests, which are full of symptoms and present a great many points of contact, wherefore an intimate acquaintance with the latter will enable him to use the Concordances with great ease and advantage. At the end of every remedy I have given the known Antidotes (Antid.), as well as the noxious remedies (Noc.). I have to observe, that the same reasons which induced me, in 1835, to omit, besides Osmium, several other remedies, still continue, and that I did not wish to mix up the certain and tried with the uncertain and doubtful.

It may be necessary to add a few words respecting the use of this Pocket-book, for beginners in homoeopathy, for whom it is principally intended.

In studying the Materia Medica Pura, I have found it the most simple and most expeditious way, to mark with a pencil - according to the order of this Pocket-book - all the characteristic symptoms which have been indicated by the different print, either in the original works, or in one of the Repertories, and to add those symptoms which were wanting: this requires but little time and trouble, and affords at the same time an easy survey, which may be completed as its defects are perceived in practice. In this manner, one not only acquires a thorough knowledge of the most important symptoms, and of the genius of every single remedy, but also a lasting written collection of every thing necessary to be known, which, becoming deeply impressed upon the memory, may afterwards be referred to in difficult cases, and will frequently be of the greatest use in selecting the proper remedy.

The facility with which this work may be used at the bedside of the patient, greatly depends upon the fact whether the practitioner is a mere beginner, or more or less versed in the homoeopathic art of healing. Every beginner ought to make a careful search for every symptom without exception. The more one knows, the less he will have to look for, and is only here and there required to assist his memory. This may be best shown by an example. I have chosen for that purpose a case from my latest practice, where the choice of the remedy was, indeed, not difficult, on the contrary, appeared quite easy to me, though through want of attention the right one might have been missed. It will at the same time afford an opportunity to many a beginner of trying his own skill.

E. N., of L., a gentleman about fifty years of age, of a healthy, almost too florid complexion, generally of a cheerful temper, except during severe attacks of pain, when he broke out into fits of passion, and his nerves became exceedingly irritated, had been cured, by external alloeopathic applications, of a rheumatic pain, as it was called, in the right eyehole. The drugs which had been used could not be ascertained. For the last months he had been suffering with a peculiar kind of violent pain in the lower part of the right thigh, comprising all the muscles of the back part of it, viz., from the calf down to the heel, with the exception of the joints of the knee and ankle. The pain itself he described as a very acute, crampy, jerking, tearing one, often intermingled with stitches, proceeding from the inner parts: in the morning, however, the pain was upon the whole much less, but digging, and the patient felt as if beaten all over. It increased towards evening, and when in a quiet state - particularly when sitting or standing after movement, and more especially during a walk in the open air. During the walk itself, the pain often wandered from the right calf to the upper part of the left arm, and again became insupportable when the patient put his hand into his pocket or bosom, and kept the arm quiet: by moving the arm the pain was lessened, and often quickly returned to the right calf. He found the greatest relief by walking up and down in the room, and rubbing the affected part. The concomitant complaints consisted in sleeplessness before midnight, frequent attacks of flushes of heat, with thirst in the evening, without any previous shuddering, a disagreeable, greasy taste in the mouth, with nausea in the throat, and an almost continual, pressing pain in the lower part of the chest and the pit of the stomach, as if something were forcing its way through.

No homoeopathic physician, who is familiar with the effects of his remedies, having so complete and so accurate a picture of the disease before him, will long be in doubt as to the most suitable remedy in this case, as all those symptoms together correspond only to one remedy homoeopathically: the beginner, on the contrary, will be obliged to look for almost every single symptom, and will find the right remedy only after a long investigation. Between the two extremes, of knowing and not knowing, there are numerous degrees of half-knowledge, which require a more or less frequent reference to the Manual.

One, for instance, knows that those pains which fly from one part to another, being worse towards evening and in repose, the greasy taste in the mouth, sleeplessness before midnight, and some others of the symptoms, which have been mentioned, are pre-eminently the effects of Pulsatilla; he is not sure, however, whether the rest of the symptoms belong to it, and wishing to act conscientiously, he will not mind the trouble of referring to the Materia Medica, when he will soon find that Pulsatilla is not the right homoeopathic remedy, as many of the symptoms, besides those of the mind, are not similar to Pulsatilla, and are even directly opposed to it.

Another has studied more particularly the peculiar character of pains, and distinctly recollects that the principal effects of China are laming, crampy, tearing pains, pains as if beaten, stitches shooting from interior towards exterior parts, as well as pains flying from one part to another; - he knows, moreover, that other symptoms, as sleeplessness before midnight, aggravation in rest, amelioration by moving and rubbing, flying heat with thirst, are caused by China: but with regard to the other symptoms he is not sure, and he is therefore obliged to consult a Repertory, where he will soon meet with counter-indications, showing that China is not a fit remedy in the present case.

Now neither of them will think of making a trial, and of giving the patient a remedy, the effect of which in this case is so uncertain; but, as conscientious homoeopathic physicians, they will consider and compare, and with the assistance of this Pocklet-book they will soon find without a great deal of trouble, what is the only fit and truly homoeopathic remedy in the case.

But, suppose there was a third, who understood enough of homoeopathy, to know at once that Pulsatilla, China, and other concurring remedies are not the right medicines, but who does not sufficiently know Valeriana, which corresponds to the principal symptoms, and therefore is doubtful as to the fitness of this remedy, which is not as frequently used as other medicines: he will only have to verify some symptoms, about which he is in doubt, to convince himself that this must be the best among all known medicines, which was proved by the result, as after a single, highly potentized, very small dose, dissolved in water, the principal complaint, with all the conicomitant ones, was completely removed within three days. The uninformed practitioner, who is only willing to consult authorities, and refuses every sort of Repertory, would probably not have thought of looking for this remedy, which is seldom used in similar complaints, in the second volume of the "Archiv," and would waste much time and labor in comparing other remedies, before discovering the true one. And even, if it should at last occur to him to refer to the Archiv, he would still meet with doubts and uncertainties which he could not overcome without assistance. Valerian corresponds, it is true, to the symptoms of our case; but the correspondence can only be perceived by him who has made himself acquainted with the inmost curative character or genius of the remedy, by careful study and observation. The uncertainty is moreover increased by several typographical errors in the notes, and by the fact that several alternate effects have not been marked out as such, and are not easily recognized.

But it is by far more difficult still for the less experienced homoeopathic physician to cure, without a Repertory, a disease with few symptoms, for which a great many remedies are indicated. In this district, for instance, a malignant whooping-cough is at present raging among the children, and it is only in single exceptional cases that the well known symptoms for Drosera present themselves, the remedies which are usually given for whooping-cough being never indicated. However, in the beginning of the cough a remarkable puffiness and swelling are present, not so much of the face, as of the part immediately above the eyes, between the lids and eyebrows, where it often appears like a thick little bag, a symptom which has hitherto been observed only in Kali Carb. (219); and indeed, in the beginning of the present epidemy, this was the only quick and sure remedy. Only in the last period the disease took another form, which required Veratrum alb., on account of the cold perspiration on the forehead during vomiting.

This is not the place to speak about the magnitude and repetition of the doses, a subject on which opinions are still divided. I think it necessary, however, to direct the attention of the English and American homoeopathic physician to what we have experienced in this respect within the last two years. Several practical physicians of the highest order have ascertained by a number of the most careful experiments, that the high dynamizations, such as 200, 400, 800, so far from being inefficacious, not only continue to act with sufficient power to cure every kind of disease, but that the power of the medicines generally, and the number of their characteristic symptoms, are developed in a more perfect manner by the high dynamizations, and that very often a disease is cured with high dynamizations which had been attacked in vain with the lower potencies of the same remedy.

Convinced of the truth of this most important discovery, I have used those high dynamizations for two years past, and I am so entirely satisfied with the results, that during the last year I have scarcely used any other preparations; since then, my practice, which has always been a successful one, has become still more so, and all those who have taken my advice are enthusiastic in their approbation of this progress.

There are some who pretend to have found - more by reasoning than by experience - that the high dynamizations, though capable of curing some kinds of disease, particularly those of the sensitive sphere, are not applicable to the diseases of the vegetative system. For my part, I deem myself authorized, by a number of incontestable facts, absolutely to deny this assertion. It is precisely in the diseases of the skin, of the glands, and of the bones, that I have observed the most surprising effects from dynamizations of the highest degree, and my journals contain a great many perfect cures, particularly of those kinds of diseases which had for a long time resisted the larger and often repeated doses of the same remedy. Caries, osteomalaxy, exostosis, curvature of the spine, as well as the different species of cutaneous eruptions, of tetters and ulcers, are not less curable with high dynamizations, than, the different kinds of mania, epilepsy, and all the other natural diseases, provided one is experienced enough in homoeopathy to choose the remedies which, under all circumstances, are the most suitable, and firm enough to allow them to act as long as that action will last. Every homoeopathic physician, who is able to select the right medicine, and who avoids the great fault of precipitation, which is always injurious, will soon perceive that the high dynamizations, when given at long intervals and without repetition, are generally preferable to larger doses, which are repeated or changed too frequently.

Nothing now remains, but to recommend this work, which is the fruit of about three years' labor, to the just, unprejudiced, and friendly criticism of all those, who, like myself, are determined to devote their lives entirely to homoeopathy and to suffering humanity.

C. VON BOENNINGHAUSEN. Munster, October, 1845.

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