Repertory Development

A brief historical outline, focusing on the principal dichotomy to emerge in repertory development – the inclusive vs exclusive approach to symptom indexing. (This outline originally formed part of the Repertorium Universale Guide.)

Baron Clemens F M von Bönninghausen, James Tyler Kent and Constantine Hering

As early as 1834 when Bönninghausen’s first repertory had been available for just 2 years (though already into its 2nd edition), and Jahr’s, which was based on Bönninghausen’s model, published only months before, Hahnemann homed in on the major stumbling block the repertory presented to practitioners. In a letter to Bönninghausen, he complained that even if homeopaths can see that the repertories alone aren’t sufficient to find the remedy, with a repertory in their hands they’re nevertheless lulled into believing there’s a good chance they can dispense with the literature altogether (1), a point no less valid 170 years further on. Paradoxically, the better a repertory becomes, the more its essential limitations need to be underlined.

Although it may seem to be stating the obvious, the repertory is an index, the back pages of the materia medica. There are different ways to index material, some intrinsically better than others, some a matter of personal preference. Some indexes are more accurate than others. There’s also no doubt that a good index is a valuable complement to its source material, but it can never replace it any more than the index at the back of a reference book could stand in for its contents.

The homeopathic repertory (from Latin repertorium, an inventory) emerged as a concept around 1817 when Hahnemann started cataloguing all the symptoms gathered from the growing number of provings he was by then conducting. His alphabetical list of symptoms (Symptomenlexikon) grew to 4 volumes but was never published. It was 15 years before the first repertory finally appeared in print – Bönninghausen’s Repertory of Antipsoric Medicines – in 1832.

The best way to structure and organise the indexing of the materia medica occupied many minds at the time, and debate about the advantages and disadvantages of each schema continued throughout that 15-year period and for many years after. The debate crystallised around a single critical issue – that of how to index a symptom without losing the features which made it characteristic of the remedy. Opinion diverged on this.

Exclusivity vs inclusivity

Some (notably Hering) favoured preserving each symptom in its entirety and proposed an index biased towards exclusivity. Such an index results in a large number of very specific rubrics (from Latin ruber, red: a heading or title) containing relatively few remedies. It has great precision because the symptom is recorded exactly as the prover experienced it, narrowing down the choice of possible remedies very effectively. But this makes it somewhat inflexible, not to mention an unwieldy size. It’s of less use if the symptoms of the case in hand don’t precisely match what’s already recorded and as a result it’s much easier to miss potentially appropriate remedies. (Knerr’s 1936 Repertory of Hering’s Guiding Symptoms is probably the clearest exposition of this repertorial perspective. Knerr was Hering’s son-in-law.)

Others (notably Bönninghausen) realised that for any one remedy there were certain qualities or aspects of symptoms – their characterising dimensions – that were not confined to single symptoms but ran right through the remedy expression (eg. burning in Arsenicum, stitching pains in Asafœtida, ball/lump-like sensations in Lilium tigrinum). So these dimensions, once established as being characteristic of the remedy, could legitimately be separated from their precise context and indexed in their own right. Such an index is biased towards inclusivity. It results in a smaller number of less specific partial rubrics containing relatively large numbers of remedies. Complete symptoms can be constructed from the sum of their parts to match the case in hand, with the final differentiation being made between the remedies which appear in all (or the majority of) the rubrics. It’s less precise and produces a larger number of potential remedies to differentiate between, but is enormously flexible and less likely to miss an appropriate remedy. The most economic and elegant distillation of this method, which Hahnemann pronounced "excellent and eminently desirable", is found in Bönninghausen’s 1846 Therapeutic Pocketbook (2). (The Introduction to T F Allen's 1897 edition of the Therapeutic Pocketbook, including Bönninghausen’s original introduction, can be accessed from the Articles page.)

Many more repertories followed from a variety of authors, many of which were published as small specialist volumes devoted to a particular part of the body or a particular condition. Others reflected different approaches to finding the remedy.

Kent's compromise

Kent, whose 1897 compilation repertory forms the basis for most of the repertories in common use today, achieved a certain amount of compromise between the exclusive and inclusive perspectives. He agreed with indexing the characteristic qualities of symptoms in their own right (3) and included much of Bönninghausen’s Therapeutic Pocketbook in his own work, particularly the Generalities section. The view widely held today, that Kent’s approach is somehow opposite to Bönninghausen’s, is inappropriate for this reason. Despite the fact that Kent later set himself up in opposition to Bönninghausen and focused some of his criticisms on the latter’s principles of generalisation (4), the root of the difference between them lies elsewhere. It lies in Kent’s concept of a symptom hierarchy, which is absent from Hahnemann’s and Bönninghausen’s viewpoint.

Kent’s imposition of his Swedenborgian vision of a symptom hierarchy onto Bönninghausen’s non-hierarchical schema led him into a conceptual impasse when it came to dealing with individual symptom modalities (Kent’s “particulars”) which were the opposite to more general modalities (Kent’s “generals”) – eg. a painful shoulder worse for movement while the patient is generally ameliorated by walking about. In Kent’s view, a modality which turns out to be generally characteristic of the state is not a “particular” but a “general”, and once it’s a “general” it can’t be “particular”. He couldn’t marry Bönninghausen’s approach (which allowed for such eventualities eg. Aggravation; motion of affected part, and Amelioration; walking) with his viewpoint which constrained him to create this notional separation between “generals” and “particulars” in a hierarchical ranking. Kent’s blind spot – in some way confusing a generally applicable particular modality with a general modality for the person as a whole – led to him publicly criticising Bönninghausen’s work and perpetuating that view in his influential teachings. This also had the effect of isolating the Therapeutic Pocketbook from its context within the spectrum of Bönninghausen’s works and creating an artificially polarised perspective of the two approaches which is not supported by detailed study of the work of either man.

So it was the constraints of Kent’s hierarchy, rather than any fundamental disagreement with the principle of indexing characterising dimensions in their own right, which inevitably biased the structure of Kent’s repertory towards Hering’s (another Swedenborgian) exclusive viewpoint.

One of the greatest strengths of Kent’s repertory lies in his development of symptoms in the mental and emotional sphere, an area which Bönninghausen only indexed in the most brief and essential terms in the Therapeutic Pocketbook because of the greater specificity of symptoms within the Mind section and the greater potential for error in their interpretation. (The Mind section of Kent’s repertory has been substantially improved through each edition of the Complete Repertory.)

Modern repertories

Computer repertorisation programs first appeared in the late 1980’s and it was Kent’s structure which was initially adopted in the various digital repertories accompanying them. Two major repertory projects have since evolved. Synthesis has continued to develop along Kentian lines, informed to a large extent by the Hering viewpoint. Its most recent edition (version 9) includes Bönninghausen’s and Boger’s material, with (in version 9.1) some restructuring of subrubrics to permit a change in emphasis in the generalisation of characterising dimensions, but with no overall integration or updating. The Complete Repertory, on the other hand, in its original and subsequent (Millennium) editions has progressively moved towards the integration of Bönninghausen’s inclusive approach with Hering’s exclusive one. For the Repertorium Universale, the addition of all Bönninghausen’s repertories were completed, the Bönninghausen-specific rubrics were updated with most if not all post-Bönninghausen material and the Kentian foundation finally gave way to a structure allowing an even balance between flexibility and precision. While the Kentian foundation continues at present to be the structure of choice for most homeopaths, the elegance and power of Bönninghausen's approach continues to inform the development of the Complete Repertory in equal measure.

Towards an integrated approach

The strengths of various different methodological approaches, each of which spawned their own repertories, have traditionally led to a prevailing wisdom which stipulates that certain types of case are best suited to certain methods and repertories. For example, a case consisting of mainly mental/emotional and general symptoms suits Kent’s approach, a case of physical generals well defined by modalities and concomitants, Bönninghausen’s, and a case with lots of physical generals, but not many individualising features, Boger’s or Phatak’s. The major drawback for modern practitioners using a variety of methodologies in this way is that few of the repertories have been updated with new provings and ongoing clinical confirmations since their original publication. Although all these repertories are generally included in the modern compilation repertories, they’re effectively lost in the Kentian structure which restricts all but the most limited application of methods other than Kent’s.

The information in a Kentian-style repertory has the quality of uniqueness, but is more or less limited to complete symptoms drawn from provings, while the information in a Bönninghausen-style repertory is more generalised and not constrained to complete proving symptoms. Prevailing dogma dictates that one should use either one method or the other, but in practical terms there seems little reason why that should be the case or why both approaches – and many others – shouldn’t be incorporated into a single repertory, doing away with the artificial polarisation evident in the perception of different methods. This allows the advantages of the exclusive perspective (specificity, precision) to be freely combined with the advantages of the inclusive perspective (combinability, completeness) and both views to be used interchangeably as and when appropriate. It also means that the disadvantages of each perspective – too great a degree of exclusivity and lack of differentiation – can be minimised.

The inclusive approach does have one significant conceptual advantage over the exclusive one. Its flexibility allows for the creation of a virtually infinite variety of complete symptoms, more than can ever be represented in any Kentian-style repertory. (Homeopaths today are still working with Bönninghausen’s Therapeutic Pocketbook – the size of the Complete Repertory 4.5’s Mind section alone – for just this reason.) The specificity of the Kentian rubrics can, in most situations, be recreated from the Bönninghausen rubrics since the remedies in the Kentian rubrics are nearly always contained in the larger Bönninghausen partial rubrics. In combining the partial rubrics to reconstruct the complete symptom, the Kentian remedies are automatically included, but usually with the addition of further remedies which wouldn’t have come into the picture using Kentian rubrics alone.

Working with the Bönninghausen approach also encourages a different perspective on the literature – patterns and themes are emphasised, which works well with the latest trends in analytical technique.

The prominence given to Kent’s teachings in the English-speaking world and the prevalence of his repertory structure in modern repertories has tended to dictate the dominance of his method, commented on by Ian Watson, in his A Guide to the Methodologies of Homeopathy: “In Great Britain and the United States the Kentian method is now so widely taught and practised that many are misled into believing that it is the only way to practise homeopathy. If the existence of other methods is acknowledged, the Kentian method is often elevated by its proponents to the status of pure homeopathy, classical homeopathy or even Hahnemannian homeopathy (!). This need by some to be seen as the sole bearers of truth has, in my opinion, created greater disagreement and division amongst homeopaths than anything else.” (5) Perhaps it’s just that the characterising dimensions of Kent’s repertory – “hierarchy” and “exclusivity” – are generally symptomatic of the Kent gestalt, and find sympathetic resonance in all sorts of places!

Notes and References

(1) “Even if the homœopathicians perceive that the repertories are insufficient for finding the best remedy [aid] for every case of disease, nevertheless they calm down when they have such an overview in their hands, and then believe (with some probability) to be able to dispense with the sources and don’t buy and don’t use them.” (Hahnemann to von Bönninghausen, December 26 1834. Translation © Gaby Rottler, 2000.)
(2) “There is no doubt that a diligent and comprehensive study of the pure Materia Medica cannot be thoroughly accomplished by the use of any repertory whatever. I have not intended to dispense with such a study, but rather have considered all works of such intent positively injurious. Still, it is not to be denied that a homeopathic physician can only devote himself to such studies in his leisure hours (which are, indeed, few enough), and that he needs in his practice, to aid his memory, a work which is abridged, easily consulted, and which contains the characteristic symptoms and their combinations, to enable him, in any individual case of sickness, to select from the remedies generally indicated the one suitable and homeopathic, without a too great loss of time.” C M von Bönninghausen. Introduction to Therapeutic Pocketbook for Homeopathic Physicians for use at the Bedside and the Study of Materia Medica Pura. 1846. Translation from T F Allen edition.
(3) “Many of the most brilliant cures are made from the general rubric when the special does not help … The special aggravation is a great help, but such observations are often wanting, and the general rubric must be pressed into service. Again, we have to work by analogy. In this method Bönninghausen’s Pocket Repertory is of the greatest service.” James Tyler Kent. How to Study the Repertory in Repertory of the Homeopathic Materia Medica. 1897. 6th edition, B Jain, New Delhi. pXX.
(4) “Nothing has harmed our cause more than books that generalise modalities, viz: by making a certain aggravation or amelioration fit all parts as well as the general bodily states. Cold air may aggravate the patient but ameliorate the headache. Stooping seldom aggravates headache, backache, cough and vertigo in the same degree, yet Bönninghausen compels you to look in one place for all of them, and they are marked with the same gradings. The patient is often better by motion, but his parts, if inflamed, are worse from motion.” J T Kent. The View for Successful Prescribing. Homeopathician: 1(1912)140-143 in K-H Gypser (Ed). 1987. Kent’s Minor Writings on Homeopathy, B Jain, New Delhi, p645. (Note how easy it is to interpret Kent’s comments about degree as if he were talking about intensity.)
(5) Ian Watson. 1991. A Guide to the Methodologies of Homeopathy. Cutting Edge Publications, Kendal. p20