The Revision of our Materia Medica
It was to the great Constantin Hering (1800-1880) to found the American Institute of Homoeopathy in 1844. He did this for one major reason, and that was the revision of the materia medica. Why did that seem necessary to him in an early stage of homoeopathy more than one and a half centuries ago? Because even in those days with a very limited number of provings and clinical experiences no practitioner had access to all these data brought forth in homoeopathy. Clinical symptoms available from case-histories and provings were spread over a vast number of monographs and periodicals. There was no central work for the practitioner containing everything.
Can you imagine the situation of today? Later about that - we will proceed step by step in chronological order.
What was available regarding primary source material on materia medica in 1844? The term "primary source material" refers to the very first publication of provings as well as of clinical symptoms. It is not used for any short-cut extractions of proving or clinical symptoms. The latter are called secondary, and to give an example for these we could mention the "Synoptic Key" of Boger, the "Lectures on Materia Medica" by Dunham, Farrington or Kent, the "Keynotes" of Allen, Guernsey or Nash, the "Comparative Materia medica" of Gross or Roberts, and many others. Of course all of them have their place in homoeopathy: They are valuable for the student, for acquiring a basic knowledge of materia medica, and to the advanced prescriber for a synopsis of characteristic symptoms of the various remedies.
In regard to the revised materia medica we always refer to primary sources. Going back concerning those to the time of Hering in 1844 - what was available to him? Regarding monographs we find Hahnemanns "Materia Medica Pura" first published exactly 200 years ago, his "Chronic Diseases", and the "Materia Medica Pura" of Hartlaub (1895 - 1939) and Trinks (1800 - 1868) in three volumes. Furthermore periodicals containing provings and clinical cases started their circulation. To mention the first with the date of their start of distribution they were
• in Germany the "Archives of the Homoeopathic Healing Art" (1822),
• in Italy the "Effemeridi di Medicina Omiopatica" (1829)
• in Switzerland the "Bibliothèque Homoéopathique" (1832),
• in France the "Journal de la Médecine Homoéopathique" (1833),
• in the United States the "Correspondenzblatt" in German language and the "American Journal of Homoeopathy" (both in 1835).
Up to 1844 almost 50 different periodicals were distributed in various countries. Some were continued for only a few years but others for 20 years or more, covering from 200 to more than 500 pages annually. As all of them contained a large number of provings and clinical observations, Hering was facing the following problems:
• No practitioner had access to all these works;
• But even if a physician had most of them in his library he would have to consult many of these works for even one patient, because many remedies had more than one proving.
• Nobody could gather and use clinical confirmations or pure clinical symp-toms, because they were hidden in thousands of reported clinical cases. And even if one attempted the immense effort to find these clinical symptoms for even one remedy in all the available periodicals, these periodicals often lacked proper indexes. So this undertaking was impossible.
Therefore Hering decided
• to collect everything from its primary sources as mentioned before,
• to arrange the symptoms properly, and
• to publish everything in many volumes for the use of the practitioner.
To cut a long story short: Hering failed in this just as T.F. Allen (1837 - 1902) did when he founded the Materia Medica Association together with one of the Wesselhoeft´s in 1889 for the purpose of revising the materia medica. Of course both, Hering and Allen, had published a collection in ten volumes each: "The Guiding Symptoms of Our Materia Medica" (1870 - 1891) and "The Encyclopaedia of Pure Materia Medica" (1875 - 1879). Unfortunately both have their disadvantages:
• They were incomplete even in the year of publication regarding enclosed pro-vings;
• Both have their mistakes in regard to translation;
• The "Guiding Symptoms" contain short-cuts of the proving symptoms cau-sing many mistakes;
• The "Encyclopaedia" is lacking clinical experiences.
So what is the present position of homoeopathy concerning its materia medica? Is there a fundamental difference for the practitioner of Hering´s time and today? No there is not, in spite of many more publications and even in spite of many different software systems. The number of homoeopathic periodicals worldwide increased from about 50 in 1844 to more than 700 nowadays. They include hundreds of thousands of clinical cases and many provings as well. Furthermore a great number of books containing provings and clinical cases have been published. Who can make use of all that information and have quick access to it in daily practice? Nobody.
Why not? Because no practitioner has at his disposal a library covering all this. And even if he would have, how could he find the proper information immediately to solve a case at hand? One could reply pointing to the different software programs available. Of course they could assist well when one has unlimited time to study. Then an extensive search through the included books and periodicals can be done to find the original symptoms. But in daily practice? Here one has to have the required symptoms at once at his disposal. Therefore a properly arranged extensive standard work of our materia medica is required. It has to include all reliable proving and clinical symptoms published worldwide from the beginnings of homoeopathy until the present time.
In the younger days it was to the late Georg von Keller (1919 - 2003) of Tübingen, Germany, to take up this task. He collected a large homoeopathic library and started to extract all proving and clinical symptoms of a certain remedy from monographs and periodicals. Of course he used primary source material only, because all secondary materials contain short-cuts, omissions, alterations and mistakes. The first monograph he published was about Kreosote in 1973. 13 more monographs followed until 1987 - finishing with Kalium carbonicum covering 523 pages.
Being a disciple of Keller beginning in 1978 he taught the speaker all about the procedure in compiling his work. Consequently a project was started by the orator in 1982 listing all homoeopathic journals worldwide from the beginnings of homoeopathy until the present time. This was published under the title "Bibliotheca Homoeopathica" in 1984. The idea was to establish an overview regarding the periodicals that had to be checked for provings and clinical cases. By doing so the planned revision of our materia medica would be comprehensive and all-inclusive in its basis.
In the following years four main steps were done:
• To build up a homoeopathic library having direct access to all necessary sources. To my own collection were added the collections of Keller, Ellithorp (1946-2004) and P.S. Krishnamurty. At present it totals about 9.000 volumes.
• To develop a proper scheme of arrangement of the symptoms, a system for references and a lay-out for print.
• To index monographs and periodicals with the names of remedies for the purpose of localising required provings and case-histories.
• To verify the accuracy of this procedure to index and arrange the collected symptoms. The drug chosen for that was Dulcamara being of middle size. By the way it probably was the first homoeopathically prescribed drug in India for the cure of Maharaja Ranjit Singh of Lahore by Johann Martin Honigberger (1795 - 1869) in 1839.
The first public announcement of the project was done 20 years ago at the Liga Congress in Cologne, Germany, with a speaker´s paper entitled "The State of the Homoeopathic Materia medica". Making the international homoeopathic community aware of the problems of our tools and the consequences in daily practice was difficult. In those days the belief in the infallibility of our instruments was great. One even had the impression almost nobody at all considered the question whether there might be mistakes for example in our repertories leading to wrong prescriptions. But anybody following the advice of Hahnemann properly should not rely upon repertories exclusively for prescriptions but compare the symptoms of the patient carefully with the primary text of provings or clinical symptoms. To cite from Hahnemann´s "Chronic Diseases" (p. 121): "With great consciousness [...] the Homoeopath [...] should investigate first the whole state of the patient [...] and then he should carefully find out in the work on Chronic Diseases as well as in the work on Materia Medica Pura a remedy covering in similarity [...] and for this purpose he should not be satisfied with any of the existing repertories - a carelessness only too frequent; for these books are only intend to give light hints as to one or another remedy that might be selected but they can never dispense him from making the research at the first fountain heads. He who does not take the trouble of treading this path in all [...] diseases, [...] but contents himself with the vague hints of the repertories in the choice of a remedy [...] does not deserve the honourable title of a genuine Homoeopath, but is rather be called a bungler."
Here we have to remember Hahnemann´s intention in regard to therapy: He was in great despair concerning the state of traditional medicine because with its instruments it was impossible in any given case to predict the result. The uncertainty of old school treatment affected Hahnemann deeply and finally led him to the discovery of homoeopathy. Regardless of all opinions and theories in the end, one has to find the remedy covering the patient´s symptoms as exactly as possible. Therefore the practitioner has to rely upon tools being as reliable as possible.
The project of the revision of the homoeopathic materia medica is realized at the Glees Academy of Homoeopathic Physicians. Furthermore this institution is dedicated to the post-graduate teachings of homoeopathy for beginners as well as for the advanced. Drawing mainly from this group, about 20 colleagues is putting this project into effect. The steps that have been done and are to be done for each remedy are the following:
• A listing was made containing mainly those remedies included in Bönninghausen´s "Therapeutic Pocket Book" or having a good ranking in the speaker´s statistics of successfully prescribed remedies in his clinic. By doing so there was an outcome of about 120 remedies. Using them about 95 per cent of prescriptions in an average clinic is covered. This is the first group of remedies to be tackled, studied, and revised in the first step of the project. Each co-worker is free to take up the remedy he wants.
• In the library of the academy several assistants collect the source material. They have to check a great many indexes for each remedy to locate all its provings and clinical cases. These primary publications are photocopied, affixed with bibliographic references and collected in a document file - one for each remedy. Depending upon the remedy this procedure requires many weeks or even months. Finally the document file is handed over to the colleague who selected that remedy for revision.
• Every colleague has been provided with the software specially written for our project. Furthermore he got an introduction how to put the symptoms into the data base. While doing so colleagues get continuous support by e-mail or telephone as most of them live in Germany.
• When completed, proof-reading is done three times - by the colleague who put in the data, by another colleague, and finally by myself. Then it goes to print.
Generally one volume is dedicated to one remedy. Exceptionally two remedies are put into one volume if each of them consists of a small number of symptoms only.
The arrangement of the symptoms follows the tradition of the head to toe scheme. It starts with mind, which is followed by sensorium, internal and external head, and it ends with sweat, fever and pulse. Many chapters have subdivisions such as internal head being further divided into brain, sides, forehead, temples, vertex and occiput.
The symptoms in each chapter or sub-chapter are alphabetically arranged and numbered in sequence. In this way symptoms can be easily located using the marginal list of numbers counted in groups of five which is the way Hahnemann numbered symptoms in "Materia Medica Pura" and "Chronic Diseases".
Each symptom has abbreviated bibliographic references. In this way every symptom will show its precise source in the literature.
Symptoms of clinical origin are put into square brackets. Consequently the practitioner can make his decision as to which class of symptom - proving or clinical - he likes to base his prescription on.
In the second part of each monograph an extensive bibliography points to the literature used and that which has been considered but not used with comments.
To give an idea of the number of symptoms of certain remedies: Agaricus - 2.257 (three times more than in "Chronic Diseases"); Causticum 3.355 (more than double that in "Chronic Diseases"); Mezereum - 1.854 (three times more than in "Chronic Diseases").
At present 33 remedies have been published with a total number of about 42.000 symptoms. 17 are in preparation at this time. Simultaneously a so-called hand-book is composed dividing all symptoms into their elements regarding the idea of a complete symptom. This is the basis of the new repertory which is in outline form currently. It will be published when the first step is completed, that is when about 120 remedies are finished. After that the second step will cover again about 120 remedies of somewhat less importance, and so on.
One day the revised materia medica will also be available as software program fulfilling the requirements of our age.
Summarizing it can be said: The revised materia medica includes all accessible and reliable symptoms from provings, toxicological sources and clinical cases found in the international homoeopathic literature from the beginnings of homoeopathy until today. The arrangement of the symptoms serves the needs of the practitioner, and the exact bibliographic references allow checking any entry. This compilation can grow as the homoeopathic materia medica grows. This standard work can be used for further elaborations concerning special repertories or materiae medicae. Up to now the work is available in German language only. But the speaker is confident the international homoeopathic community can participate one day using a translated English edition.
I am thankful to the Family-Ernst-Wendt-Foundation of Germany for supporting the revision.