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Let's Discuss About "Pathological Generals"

The Pathological General is the concept of Dr. Cyrus Maxwell Boger.

Pathological Generals are the expressions of the person which are known by a study of the changes at the tissue level. Certain types of constitutions are prone to certain pathological changes to different levels of the system or organs.

An individual may respond to constant unfavorable stimuli through pathological changes in different tissues, but a common propensity might still persists. This common changes at different tissue levels show the behavior of the whole constitution which is important to understand the individual. This common changes are called Pathological Generals.

Suppose a patient comes to the clinic with cellulitis, pneumonia as well as conjunctivitis or osteo-arthritis. Dr Boger warned us about the patient's affinity towards a particular pathology i.e. INFLAMMATION at different tissue levels. Why don't we give importance to inflammation ( although it is a mere pathology ), as it is the tendency of the individuality of the patient to react in that manner against any external stimuli, when other patients are not responding in the similar way? So although it is a pathology but still it deserves the highest priority.

Dr Boger was such a modern minded person. He was a person of few words. That is why we see all of his writtings are not very voluminous. Most of his writtings are initially hard to crack, but when they are understood they are the gems.

This is my understanding about the Pathological Generals. Please share your views in this regard.

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Comment by Hans Weitbrecht on May 26, 2010 at 2:57pm
Dear Sajjad, ear members

i referred to Bogers cases which he presented at meetings of the AHA. Those cases are printed in Bannan's compilation.

I used Bogers synotic Key and the BB1 to see, if the information he gave would reflect in the repertories. In 70% of his case presentations they did not.

I did the same with Kent and the result was even worse -- about 85%.

I did the same with Boenninghausen, -- I took the first remedy he prescribed and had a fail rate of 10%. At the time I was unable to verify his second prescriptions, as I was not fully familiar with the use of the remedy relationships. Remember, Boenninghausen handed out 3 to 4 different remedies to be taken in fairly quick succession,-- but that is a different topic.

All of this is no reflection of my own clinic, nor on homeopathy in general.

Phatak was a follower of Boger, to the point, that he copied much of Bogers into his own Materia medica (never gave Boger the credit for it). I have a feeling, that Phatak was involved in the production of Boger's fifth edition of the synoptik Key. Maybe someone on the board has more precise information on that.

Hans Weitbrecht
Comment by sajjadakram on May 26, 2010 at 7:57am
Dear Hans,
Dr Phatak of India was confident about Boger’s synoptic key. Throughout his life he used this repertory. According he him it is most reliable.
While an experience and learned homeopath like you is getting wrong result in 70 cases then homeopath like us will obviously get 100% wrong result.
Can you please guide what to do?
Comment by sajjadakram on May 26, 2010 at 7:23am
Dear Hans,
Please explain what is right and what is wrong.TPB is said to be the most reliable repertory.According to you it does contains 50%proved and 50% clinical wsymptoms.I came to the conclusion that allopathy is best of all because every thing is open there.
Comment by Hans Weitbrecht on May 26, 2010 at 5:06am
Dear members
We could star a separate Boger discussion, there would be a lot to say.
Here are a few pointers.

earlier around a Bb rubric and a Kent rubric were compared. Their similitude comes as no surprise as both authors used the SRH or the TT and copied the rubrics into their repertories. Kent made more mistakes, - so his rubrics are further apart from the original.

An in-debt study of Boger's articles and books reveals, that Boger was in the same line as kent. there is no difference in the way they see cases.

This becomes even more clear when we see, that Boger was the editor of Boenninghausen's works, bringing them together, but he is not the author of the work.
BTW. it was Anna his second wive who did the donkey work.

As to the Synoptic Key / general analysis -- they are bogers own compilations, and reflect the result of his clinical experience. boger realized the importance of the CCE's (cure combinable elements), as explained by me in my homeopathy study guide.

Boger does not give us clear instructions how he arrived there, -- be it by analysis, or intuition --.

His findings regards the polychrests match in many cases the results of my analysis.
yet there are less used remedies portrayed, --often not found in his repertorial part--, where his analysis seems to have no basis in provings and my clinical experience.

Sadly he had a clinic fire, which destroyed almost all papers, so that we don't have a lot of his case work to go by.

I tried to repertorize his case presentations with his own tools, but failed in more than 70% of cases to even get near the remedy he selected. This questions the usefulness of such presentations, other than to blow ones ego.

Hans Weitbrecht
Comment by Katja Schütt on April 5, 2010 at 1:24pm
I agree that it was Boger who introduced the use of Pathological Generals (and Clinical Rubrics), although they are not necessarily of highest priority !

At Boger's time, both the Boenninghausen and Kentian schools were popular. Boger studied both but accepted Boenninghausen's way of working out a case, convinced that the basic principles, plan and construction of Boenninghausen's repertory were sound, comprehensible and practicable. He accepted Boenninghausen's approach to the totality of the patient with emphasis on Physical Generals, Modalities and Concomitants.

But he was also aware of the difficulties faced by homeopaths while using the Therapeutic Pocket Book as well as the criticism leveled against its principles and methodology (generalization). Boger was of the opinion that it was better to include main rubrics with subrubrics that carry further particularization. Thus his repertory includes all the generalizations and particularizations in order to minimize the error of Grand Generalization and his work is seen as an attempt to bridge Boenninghausen and Kent. His appreciation of time-dimension, causative modalities, tissue affinities and pathological generals give a new vista in understanding the case.

Boger has favored the understanding of the whole case on the levels of constitution, diagnosis and ongoing pathology. He emphasized the complete study of the case and also advised against giving more importance to a single symptom, even if it might be a key-note one. He expressed the importance and hierarchy of the various types and parts of the symptoms and that every symptom should be valued as per the condition. Boger too subscribed to the principle of totality of symptoms and was fully in agreement with the idea of what constitutes a complete symptom, which is studied in relation to location, sensation, modalities (and concomitants).
He also stressed the importance of uncommon symptoms for the choice of the indicated remedy and advised against the great error of regarding a numerically large mass of symptoms that are common in their character, but do not individualize the case, as a sufficient guide in choosing the remedy.

He emphasized General Symptoms as the middle path between the mental symptoms and the particulars. He wrote that in ordinary practice generalization is least understood and very often neglected to the detriment of good work. He generalized symptoms when they were found in more than three parts or organs, i.e. when three regions manifest the same sensations or modalities this symptom can be generalized. (Boenninghausen however generalized each single symptom as he predicated it to be a symptom of the whole.) But Boger was aware of the danger of over generalization and carried out the process of generalization in his works very carefully.

Boger went further to seek general changes in the tissues and parts of the body as he was not satisfied by merely following the principle of complete symptoms. He regarded Pathological Generals as representing the tendency of the whole constitution and stressed their value as opposed to the diagnostic pathology. He argued that these are the pathological conditions which become characteristic of the patient and affect him in many parts. Pathological Generals tell the state of the whole body and its changes in relation to the constitution. Certain types of constitutions are prone to certain pathological changes in different levels of systems and organs, showing the behavior of the whole constitution, which is important to understand the individual.

Boger also appreciated the use of Clinical Conditions in grouping medicines and their use in selecting a remedy in absence of characteristic symptoms. Though they should be put to a limited use, they may help the physician in cases of advanced pathology (gross tissue changes) where the physician is left without a clear symptom picture. They help mainly in finding out a palliative drug, or a drug which is suitable in helping to overcome the present crisis, and especially to start the treatment of one-sided diseases - following the instructions given by Hahnemann in § 173 ff. Organon. These rubrics are helpful to arrive at a group of remedies, which can be further narrowed down with the help of modalities and concomitants to select the most similar remedy.

To work out a case the symptoms have to be arranged depending on the availability of data and peculiarity of symptoms. Each outstanding symptom is followed by the next strongest. Depending upon the availability of data and value of symptoms cases are to be repertorized using the following scheme:

Causative Modalities (ailments from)
Other Modalities: aggravations and ameliorations
Physical Generals
Location and Sensations
Pathological Generals
Clinical Rubrics

If the case has definite Causative modalities these should be used in first place. If the case does not present with causative modalities, but has other general as well as particular modalities these should be used in the first place. If the case does present with clear concomitants these can be used first. If the case shows changes in the tissues at different locations in a person, which follow a pattern and therefore express the deviation in the constitution, then Pathological Generals should be included.
Diagnostic rubrics can be used for repertorization when the case does not have any other choice and lacks in characteristic expressions. Mental symptoms are used for final differentiation.

It is obvious that the success of repertorization depends on the ability to deal with symptoms. Based on a different conception of the Totality of Symptoms there are different repertorization methods. It is important for a homeopath to be familiar with the subtle differences so that he may apply them depending upon the prescribing data elicited from the patient, and to use the one best suited to the case in hand.

As for Boger, his repertorization method is best used for cases rich in particulars, with marked modalities and concomitants, pathological generals, clinical symptoms, one-sided diseases (if the totality of the state can be filled out), objective symptoms and pathological symptoms (with absence of characteristic symptoms), cases without many mental symptoms, fever cases, and to get related remedies by working on the chapter on Concordances.
Comment by Dr. Rahul V. Jadhav on March 30, 2010 at 3:44am
even needs more inputs on importance of objective symptoms.... which were always advocated by Dr boger.......
Comment by Dr. Rahul V. Jadhav on March 30, 2010 at 3:38am
Dr. Boger was a busy practitioner and it is been said that he used to treat so called end stage, pathological cases with an ease he used to get all sort of advanced pathological cases and used to treat them with an ease... why??? how???? remains a big question!!!!..... what in those cases he used to see, which we could not .... even today???..... why his synoptic key is so difficult to understand??? ... "precision".... only word which can answer all these questions..... " collected works of Dr boger by Bannam" is probably the book which can help us understand him better........ need more inputs from dr dutta on this .....:)
Comment by Dr. Wequar Ali Khan on March 17, 2010 at 12:45pm
Dr Dutta,very interesting topic.The more we learn, more feeling that we have to know more;

From what you have quoted from Boger's article,i will request you to take up a case and guide us(me in particular;)how those points in the form of rubrics under "--individualistic symptom into one group", " --disease manifestations into other" and then "finding the remedy in both--" can be applied.This will enable us to study any case keeping Boger's approach in mind.
"The final analysis of every case resolves itself into the assembling of the individualistic
symptoms into one group and collecting the disease manifestations into another, then
finding the remedy which runs through both, while placing the greater emphasis on the
former. This method applies to repertory making just as fully as it does to case taking and
prescribing. Therefore the over large rubrics of our repertories are likely to be more useful
for occasional confirmatory reference, than for the running down of the final remedy.
Comment by DR. ARINDAM DUTTA on March 17, 2010 at 2:45am
Like the other mainstream homoeopaths Dr. Boger also gave utmost importance to the uncommon individualistic symptoms for making homoeopathic prescriptions, but at the same time unlike others he also emphasized on the pathology of the diseases our patients suffering from.

I am quoting here from one of Dr. Boger's mastermind article- "GRADING OF SYMPTOMS"

"......Illness may present any possible combination from among many thousands of
symptoms, although as a matter of fact such extreme variability of disease expression is the
exception; were it otherwise the problem must remain, practically unsolvable. Most of its
symptom groups are referable to particular diseases, organs and individuals. The two former
remain fairly constant, at times, how-ever, exhibiting very pronounced disease phases,
thereby beclouding the diagnosis and leading to organopathic, pathological or diagnostic
prescribing of a makeshift nature; ultimately a most pernicious thing.

"Of far greater importance are the individualistic symptom groupings, for they generally
show forth the real man, his moods, his ways and his particular reactions. Occurring singly,
in small groups or at indefinite intervals, they often seem to lack distinctive support, hence
are more difficult to link together and interpret. This encourages palliative medication as
well as makes real curing much harder. On the other hand cases presenting very numerous
symptoms are hard to unravel, especially when brooded over by an active imagination.

"The final analysis of every case resolves itself into the assembling of the individualistic
symptoms into one group
and collecting the disease manifestations into another, then
finding the remedy which runs through both, while placing the greater emphasis on the
former. This method applies to repertory making just as fully as it does to case taking and
prescribing. Therefore the over large rubrics of our repertories are likely to be more useful
for occasional confirmatory reference, than for the running down of the final remedy."

PS- The bolds are mine.
Comment by DR. ARINDAM DUTTA on March 16, 2010 at 10:21pm
Dear GZ & others,

We must not forget apart from pathology, Dr. Boger put much stress upon-

1) the concept of CAUSATIONS


2) the importance of TIME MODALITIES.

They were also great contributions of DR. C. M. B.

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