James Tyler Kent

Kent's concept of totality

Kent also emphasized the detailed study of the expressions of the whole person which must be given primary importance to understand the nature of the disease. He studied all symptoms to understand the disease, which proceeds from center to circumference, from inward to outward. The totality of a case is formed by Mental Generals, Physical Generals and Characteristic Particulars.

Kent's Totality of Symptoms is erected by the following hierarchy:

STRANGE, RARE AND PECULIAR SYMPTOMS

These may occur among mentals, generals, or particulars and must therefore be of varying importance and rank !

1.      MIND

Will

     Understanding

     Memory

2.      PHYSICAL GENERALS

Things affecting the whole body.

Ailments from, agg. and amel.

Symptoms related to sex, appetite, desire and aversion to food, weather, positions, food aggravations and amelioration's, reactions to heat and cold, etc.

3.      PARTICULARS

      Symptoms related to the parts. (These must be qualified.)

From Generals to Particulars

Kent argues that „the whole problem, like any other scientific problem, must be gone into and followed from generals to particulars“, what is in correspondence with his rule of government from center to circumference. There is one center that rules, controls and is supreme. All true diseases flow from center to circumference and the order of repair in the economy is also from center to circumference.

J.T.Kent in Lectures on homeopathic philosophy

The homeopathic physician must use discrimination, must individualize things dissimilar in one thing and yet similar in other ways. This is done by the Generals, for without Generals of a case, no man can practice homeopathy; without these he will not be able to individualize and see distinctions. Kent points out that „in ninety-nine cases of a hundred you can leave out the particulars, for the particulars are usually contained within the generals“[4].

Kent argues that the method of working out a case from Generals to Particulars is the most satisfactory. However, if a case is worked out merely from the particulars it is more than probable that the remedy will not be seen due to the fact that the particulars may not have been observed yet. Thus to depend upon a small group of remedies relating to some particular symptom is to shut out other remedies which may have that symptom, although not yet observed.

Particulars (local symptoms) are common to many remedies and patients and cannot help us at all to differentiate remedies. Being "scanty", i.e. incomplete, they cannot be given the highest rank. Yet Kent did not ignore them provided they were qualified by modalities of aggravation or amelioration or by concomitants.

Kent, Repertory of the homoeopathic Materia Medica, p.vii

The importance of the MIND

Among the Generals the symptoms of the Mind are of prime importance based on the assumption that disease has its origin in the mind, and on Swedenborg's philosophy, in which Mind was seen to occupy a higher position than the physical body, and in the hierarchy extending from the dynamic plane to its ultimation in physical disease.

On the Value of Symptoms[5]

Kent classified disease symptoms into three main categories whose value is classified into three grades:

General Symptoms

Particular Symptoms

Common Symptoms

Symptoms are classified into generals and particulars to evaluate their importance and „upon correct generalizing depends all successful work as a homeopathic prescriber“[6]. Both kind of symptoms can be either common or uncommon. All symptoms must be judged as to their value as characteristics, in relation to the patient, and "the student and physician must work to settle the generals, common symptoms and particulars to the fullest extent, if he wants to save work"[7].

Kent has developed a more sophisticated hierarchy of symptom-values which takes more time and greater application in understanding the various shades of differentiation of symptom-values and then to utilize the same for the repertorial analysis. It is to emphasize that each individual case and its symptoms requires evaluation according to its own requirement. "When you have taken a case on paper you must settle upon the symptoms that CANNOT be omitted in each individual"[8].

He gave very definite guidelines regarding the value of symptoms. In his evaluation of symptoms, Mentals occupy the highest place, followed by Physical Generals, and lastly the Particulars (particulars must be qualified by modalities).

Strange, rare and peculiar symptoms belong to the highest generals "because strange, rare and peculiar must apply to the patient himself"[9]. Hence, these must take a high place in the search for the remedy. But Kent also says, "Get the strong strange, peculiar symptoms, and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT", as to prescribe on them exclusively is easy, but often fatal. "They may put you straight on to your drug (if the rest of the case fits!) - they may put you straight off it "[10], if they have never been recorded as having evoked. "When looking over a list of symptoms, first discover three, four, or five or six (or as many as may exist) symptoms that are strange, rare and peculiar: work these out first. These are the highest generals, because strange, rare and peculiar must apply to the patient himself. When you have settled upon three, four or six remedies that have these first generals, then find out which of this list is most like the rest of the symptoms, common and particular."[11]

General symptoms relate to the patient as a whole. They characterize the patient and are therefore of higher value than the particulars which affect only a given organ. With generals the patient refers certain symptoms or conditions of symptoms to himself, inner consciousness and ego, by saying „I am...“, „Me..“  or „I feel...“ or „I do“  thus and so  etc. The highest rank of all belongs to those symptoms, that are not only peculiar, but also general. They are broadly classified in mental and physical generals.

All mental symptoms are classified as Generals as they reflect the inner self and individuality of the patient, the subconsciousness or involuntary action of the mind. Kent regarded Mentals as belonging to the highest grade as they express the inner-most of the patient most absolutely and the symptoms around which other symptoms revolve - hence, they are most characteristic of the individual. They, if they are marked, dominate the case. If a mental trait is marked, and especially if it denotes change from patient's normal, it is of the utmost importance to the case, and must be in the same type of rubrics as in the patient, i.e. if the symptom is very marked, the remedy you are in search of must be among the remedies in that rubric. They are of highest value in case taking and are frequently the key to the whole case.

But even the Mental Symptoms are graded. Of the highest importance are those that relate to the will. Of second grade, those that affect the understanding, and of the third grade, those that relate to the memory. Will and emotions deal with excitements, determinations, weaknesses, loves and hates, moods and temperaments, traits, suspicion, fear, jealousy etc. These are of the highest importance among the mentals. Understanding deals with perversions of understanding, intelligence, perceptions, illusions, delusions, dreams, loss of sense of proportions etc.

Physical generals are an expression of the reaction of the patient to the environment. They stand next to mentals and deal with the body as a whole under various physical conditions or circumstances, like disorders of sexual function, cravings and aversions of food and drink, menstrual state, sleep, symptoms caused by external influences like heat, cold, weather, climate, motion, time, position, posture  etc. Kent also writes, that „modalities, or conditions of aggravation and amelioration applying to the case as a whole or the patient himself, are generals of high rank“[12].

Particulars express the disturbance and suffering of some part, organ or function of the body, indicating the concentration of the disease in a certain part of the body. They can be qualified by location, sensation, modalities and concomitants. In these symptoms the patient speaks of „My“. They assume importance in cases where generals point to more than one remedy or are not well marked or when particulars are characterized by outstanding peculiar locals, sensation, modalities or concomitants.

Common particulars may in certain circumstances assume a comparatively high rank when two common symptoms appear associated, i.e. when two symptoms, insignificant otherwise, combine. Then they can be the differentiating factor, even when the components  were observed by quite different provers.

Generals are sometimes made up of particulars. If there are certain symptoms running through several particulars then these symptoms have become generals as well as particulars.

Kent writes, that „nothing in particulars can contradict or contra-indicate strongly marked generals, though they may appear to do so...“[13] because the whole is greater than it’s parts. General symptoms rank higher simply because they relate to the man as a whole that, and if it is a strong and well marked one, it can overrule any number of even strong particulars. On the other hand, a number of strong particulars must not be neglected or under-estimated on account of one or even more weak generals. It is this question of the rank of symptoms that is the chief objection to the numerical method of selecting the remedy and all the mechanical methods are to end in failure for quality will ever be of more importance than mere quantity.

How to work out a case

First, differentiate the symptoms between generals and particulars, common and uncommon symptoms. As Kent gives more importance to Generals these should be found out in the first instance.

In the introduction to his repertory Kent offers the following suggestion:

J.T.Kent, Repertory of the homoeopathic Materia Medica, p.vii

All cases should be worked out according to Kent's above hierarchy, using the uncommon, characteristic, rare and peculiar symptoms. Thus, first work out the Mental Generals, then Physical Generals and finally the Particulars.

Write out all the Mental Symptoms and all the symptoms and conditions pertaining to the patient himself, and search the repertory for the symptoms that correspond to these. Then we are advised to search for such Physical Symptoms that include the whole being, i.e. Physical Generals, as are predicated of the blood, color of discharges, bodily aggravation and amelioration, as well as desire for open air, desire for heat, cold air, for rest, motion which may be only a desire or a general feeling of amelioration. Circumstances that make the whole person feel better or worse is of much greater importance than when only a part is affected, and these are often quite opposite. The case is further individualized by using the Particular Symptoms predicated of the organs, functions and sensations, always giving importance to their modalities, especially the time of occurrence of every symptom, until every detail has been examined.

Then the symptom picture has to be examined collectively and individually, and lastly the closest fit remedy or remedies have to be studied in the Materia Medica until there is no doubt about the most similar remedy. In each case one must necessarily refer to the Materia Medica to confirm the choice of the remedy. You will generally find, that one drug stands out more and more pre-eminently, it may not be in all the rubrics, "but is has got to be in all the important ones, i.e. those best marked in the patient and of highest grade"[14].

Using eliminative rubrics

This standard method can be bypassed by the use of Eliminative symptoms, which are expected to contain positively the indicated remedy. Only the remedies  covering this symptom are taken into account for further elimination. It is usually a short rubric and belongs to the highest ranks in Kent's evaluation. A marked mental symptom that cannot be omitted can be used as an eliminating symptom, to compare with all the subsequent rubrics you consult. With this strong eliminating symptom you can go through the rubrics of the patient's symptoms in their order, i.e. mentals, first, then generals, then particulars with modalities - taking from each list only the remedies that appear in this first rubric. In this way you can work down, till you are satisfied that the remedy is found that fits the patient as a whole. But to eliminate with safety you must be sure that the symptom is real and marked and actually expresses the patient.

Dr.Gibson Miller used "Hot and Cold Remedies" as eliminative rubrics to work out the case (see appendix).

These principles also apply for "Kent's Final General Repertory of the Homoeopathic Materia Medica", written by Dr.Pierre Schmidt, as well as "Kent's Repertorium Generale", written by Jost Künzli von Fimmelsberg. Both are revised editions, taking the effort to complete and correct Kent's repertory.

Some notes on Kent and Constitutional prescribing

Kent also mentioned a time component which is to be considered in the evaluation of symptoms. He writes that symptoms persisting from childhood are of high importance and can point to possible causation's for the developing pathology and to the indicated remedy. However, the pathological result itself is not of much help in selecting the simillimum.

When treating a patient constitutionally (this refers to the innate constitution) he laid emphasis on the "character" of the patient and viewed disease on the background of the constitution. Here, also those symptoms have to be included which were present before the chief complaint. But it is an often misunderstood conception that Kent treated patients exclusively based on their "constitution". He also applied the procedure more similar to Hahnemann, and where the symptoms are used which appear since the occurrence of the chief ailment and refer to the actual layer. Nor did he always apply the "constitutional" remedy in acute diseases but the indicated remedy according to the symptoms, which may differ from the "constitutional" remedy.