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It is interesting to observe how master clinicians CM Boger, JH Clarke, JT Kent, DM Borland through various philosophical concepts, gave us guidelines on remedy choice and remedy response for homeopathic management of acute and emergency situations. These include, an understanding of pathogenesis of remedies; correlating this with the pathological presentation of the case; differential diagnosis of remedies in the materia medica which is essential prior to making a prescription; understanding the characteristics available from pathological particulars; and the significance of laboratory investigations. Boger (1915), Boenninghausen (1846), Clarke (1925) and Boericke (1927) also developed the Materia Medica of remedies to support an appropriate choice in such situations. Discussed below is an evaluation of approaches to the materia medica that have been useful in some emergency situations.

 

1.  Dr. CM Boger, a master clinician, was considered the dean of the homeopathic profession. He treated complicated cases with advanced pathology, for over 25 years before he articulated his PATHOGENETIC TOTALITY in his Synoptic Key (Boger, 1915).

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Boger discovered the art of carefully fitting the pathogenetic expression of remedy to clinical symptoms. He encouraged each one to develop a special aptness in grasping the essential points of symptom images, supported by knowledge of the Materia Medica and a skilful use of reference books.

“One perceives remedies by their general expression or genius. We learn our remedies by their air or personality; an every changing composite effect, but always reflecting the same motive.”

Boger, 1915

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There is a strain, a pattern that runs through every pathogenetic symptom complex. This he termed the "GENIUS" of the remedy. The arrangement of symptoms in every remedy in his Synoptic Key brings this idea into greater prominence. After the patient tells his story, the pathogenetic symptom complex can be “amplified and more accurately determined” by structuring the totality of various characteristic expressions of a case in a predetermined format. But this remains flexible to the balance of characteristics in individual cases. This clinical totality will be discussed later.

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2. Dr. JH Clarke (1925) in the fourth preface to the Dictionary of Practical Materia Medica in 1893 intended that this book would be a form of “materia medica companion to The Prescriber” that he had already conceived of before this project began.  In the plan of this materia medica, he adopted the Schema suggested by Hahnemann. The sources of symptoms were from Allen’s Encyclopedia (1874-1879) which in turn included all symptoms from the Materia Medica Pura  (1994) and Chronic Diseases (1896) of Hahnemann; and from Hering’s Guiding Symptoms (2000) which includes various clinical symptoms confirmed by Hering from reliable sources. The important aspect of Clarke’s Dictionary is that it includes clinical symptoms that were observed and verified by him. If there was any opposition to this inclusion, he put his argument very clearly in favour of clinical symptoms very clearly.

 

In the preface, he says a remedy could demonstrate its clinical scope not only through a proving by producing new symptoms, but also when old symptoms disappear in the prover. The scope of the remedy is also observed clinically when conditions are cured under the effect of a remedy. Besides this, new proving symptoms could be observed when a simillimum was prescribed. The ability must be developed in a homeopath to perceive and recognize drug symptoms (medicinal) during the process of cure, after a remedy was prescribed. These symptoms do not indicate that change of remedy was needed, since cure was already in progress. Clarke felt that a practitioner who could not recognize clinical symptoms and drug symptoms during case management lost the best materia medica teacher he was ever likely to find, and he could end up spoiling many cases by “supposing them worse”, based on inaccurate interpretation of remedy response following appearance of these medicinal symptoms. When the patient was actually already doing well on the right remedy one simply needed to stop the dosing or else partially antidote it with an indicated remedy if medicinal symptoms were troublesome. (Clarke, 1925:v).
 

The clinical section in the materia medica of every remedy description had a list of clinical conditions indicating its scope. These conditions were neither inclusive nor exclusive, but suggestive. The diagnosis was one common indication, while individualization proceeded based on the materia medica. This clinical list created a relationship between The Prescriber (Clarke, 2003) and the Dictionary, with the Clinical Repertory (Clarke, 1904) which contain more remedies that were not mentioned in The Prescriber. His emphasis in the Dictionary was on characteristic remedy pictures (generals, modalities, and concomitants seen clinically), causations, relationship of remedies, and symptoms along with objective observations.

He also sought to offer to the practitioner different “grades of similarity” for a homeopathic prescription. He sought to supply through this book the materials needed for the “application of the Law of Similars in any of its modes” (Clarke, 1925: ix). By this he meant, that while keeping one’s attention “steadily on the plane of phenomena of disease”(Clarke, 1925: ix) he sought to portray every feature of drug activity that was likely to be found “in correspondence to the manifestation of disease”, as was his own personal experience of disease. By this he meant, similarity could be observed at the level of organ affinity or coarse tissue changes, finest sensations or characteristic symptom similarity.

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Clarke echoes the words of Hahnemann and all successful homeopaths; nothing short of hard work could make a good homeopath. With this, he gives us a treasure of clinical experiences, along with various manifestations of remedy expressions and applications in the Dictionary. This is a very helpful perspective for emergency management, as it builds on a strong foundation of materia medica from provings to which are added documented clinical symptoms, cured clinical conditions and confirmed remedy characteristics.

3. Dr. William Boericke in 1927 presented the 9th edition of Pocket Manual of Homeopathic Materia Medica with Repertory in a condensed form for practical use. The Repertory by his brother Dr. Oscar Boericke, was first added to the 3rd edition, but continued to be updated and remodeled as well. Boericke’s materia medica contains well known and clinically verified symptoms of the remedies including less important symptoms. In addition it contains new remedies and essentials of published clinical experience. Dr. Boericke included clinical suggestions of many drugs obtained from their toxicological effects available in early medical literature. These remedies were not yet proved completely but he included them as he wanted to offer an opportunity to experiment with these drugs, and in the future discover their distinctive use through provings, thus enlarging the homeopathic remedy armamentarium.

He was aware of the difference of opinion regarding the inclusion of remedies whose information was either obsolete or in some minds illusory. But he thought it important not to leave out information about any natural substance that had already received attention for clinical application from various reliable sources in the past. He found support in Dr. Constantine Hering, who favored the introduction of all remedies capable of producing a reaction in the body which could guide to their medicinal employment. The investigation of remedies includes their action on the healthy, the sick, animals or plants. Over time, he knew, useless information would be eliminated as accurate physiological and pathological knowledge about them developed.

He also used disease diagnoses in remedy descriptions and nosological names in the repertory. But this was not intended to suggest specific remedies for specific disease conditions, but rather to give an idea of the clinical depth and scope of various remedies. These are also included into a Therapeutic Index, a practical handbook for everyday service. He felt that any aid for finding a curative remedy needed to be utilized. He quotes Dr. J. Crompton Burnett, who stated that one needed any and every way of finding the right similimum remedy, right from the simply symptomatic, to the farthest reach of all, the pathological simillimum. Dr. Boericke, though, cautions that his work on the Materia Medica remains but an introduction to the larger books of reference and records of provings, like Allen’s Encyclopedia(1874-1879), Hering’s Guiding Symptoms (2000) and Materia Medica Pura (1994).
 

Dr. Boericke’s Materia Medica remains one of the most studied and referred- to index of remedy symptomatology, for its scope in various clinical diagnoses.  For emergencies, it remains an important book for quick reference.

4. Caroll Dunhamn (1877) wrote a paper on the importance of Diagnosis in Homeopathic Therapeutics in 1852. His perception of clinico-pathological correlations made between remedy choice and clinical diagnosis is worth understanding. He considers diagnosis to be very important to understand the significance of each symptom included in the totality of symptoms for prescription. We need to distinguish which of these are “primary or idiopathic” and which are “reflex or sympathetic”. These symptoms help us to determine the ‘seat of disease’ and further to “form a just notion of the pathological conditions of that organ and tissue”. This evaluation is necessary before a prescription is made because this must be similar to the pathogenesis of the remedy chosen. In other words we need to know what the drug disease a remedy is capable of causing and hence curing.

It is necessary that for a remedy to be a true simillimum, the idiopathic symptoms of the patient should correspond to the idiopathic symptoms (i.e. primary sphere of action) of the remedy AND the pathology of its sympathetic (secondary) symptoms as well. The remedy chosen is one that can develop a pathological condition similar to the disease in the patient.

Dr. Dunham gives the following examples to explain this perception: “We may want to choose a remedy which affects the nervous centers idiopathically as Belladonna or its analogues, while in another case one may want to choose a remedy that acts idiopathically on the vegetative sphere and affects the nervous system only sympathetically as Cina. Neglect to distinguish between the central sphere of action of the two has led compilers of manuals to recommend Cina in hydrocephalous, which is an error.
 

Again tenderness in the coxofemoral region, pain on moving the limb and on pressing the greater trochanter in toward the acetabulum, may have its seat in the tissues of the joint, or in the nerves that supply that region. And we have drugs that affect the tissues of the joint and others that affect the nerves in question. We must select the former if the joint and the latter if the nerves be affected; and in order to make the selection we must previously make the twofold diagnosis so often urged. Neglect of this has led to the erroneous recommendation of Colocynth in hip joint disease.”

A twofold diagnosis, one correlating the remedy to the clinico-pathological seat of disease (differentiating idiopathic sphere of action from sympathetic, secondary effect) and the other correlating the homeopathic remedy to the characteristic totality, is then a necessary preliminary to a properly conducted homeopathic management.

In emergencies, this becomes a vital perception to develop – both in the understanding and study of remedies, as well as in the clinico-pathological correlation required in the patient’s totality. Dr. CM Boger’s approach is quite similar and in agreement with Dr. Carol Dunham.

 

5. Dr. Douglas Borland (1946) in his book on Emergencies has the following to say:
 “All these emergency cases fall roughly into two main groups - the patient who a dying, and the patient who is in great pain. You sometimes get the two combined. There is a third problem - Is the case medical or surgical ? - and that is always at the back of one's mind.”

One’s general medical skill helps decide between surgical and medical intervention. But dealing with morbid conditions and acute pain require homeopathic skill. Dangerous cases, according to Borland “from a drug point of view is to look on them under three headings:
 I, the cases with acute cardiac failure;
2, the case in which there is a gradual cardiac failure with a tendency to dilation; and

3, the case of acute cardiac attack of the anginous type.”

 
Categorizing pain as an emergency presentation is more difficult. Borland says: “I thought probably the most helpful way would be to consider the cases of acute pain which one meets with in general practice, and these I think one can classify to a certain extent. One gets acute neuralgias, acute inflammation of one of the serous membranes, and acute colic.”

 “from the prescribing point of view one takes the character of the pain and the circumstances which make it better or worse, and to a lesser extent its situation...
Working on these lines it is possible to take up the three groups and give the indications for the leading drugs which you must have at your finger ends.”

Here we see Borland following Boenninghausen’s totality, the complete symptom in location, sensation, modality and concomitant, for an acute prescription. But in addition, he suggests the need for a homeopath to have the characteristics of the commonly indicated remedies in various clinical presentations at one’s “finger-ends” (or one’s finger-tips). This would be vital expertise to develop in an emergency-homeopath.

 

6. Dr. J.T.Kent (1956): Kent’s Lectures on Homeopathic Materia Medica, describe remedies in with their scope of morbidity described in vivid pictures based on their characteristic spheres of actions along with characteristic sensations and modalities. Emergency presentations come alive in his descriptions.

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