BY J. T. Kent, A.M., M.D.
As homoepathy includes both science and art, Repertory study must consist of science and art.
The scientific method is the mechanical method; taking all the symptoms and writing out all the associated remedies with gradings, making a summary with grades marked, at the end.
There is an artistic method that omits the mechanical, and is better, but all are not prepared to use it. The artistic method demands that judgment be passed on all the symptoms, after the case is most carefully taken. The symptoms must be judged as to their value as characteristics, in relation to the patient; they must be passed in review by the rational mind to determine those which are strange, rare, and peculiar.
Symptoms most peculiar to the patient must be taken first, then those less and less peculiar until the symptoms that are common and not peculiar are reached, in order, from first to last.
These must be valued in proportion as they relate to the patient rather than to his parts, and used instead of ultimates and symptoms pathognomonic.
Symptoms to be taken:
First – are those relating to the loves and hates, or desires and aversions.Next – are those belonging to the rational mind, so-called intellectual mind.Thirdly – those belonging to the memory.
These, the mental symptoms, must first be worked out by the usual form until the remedies best suited to his mental condition are determined, omitting all symptoms that relate to a pathological cause and all that are common to disease and to people. When the sum of these has been settled, a group of five or ten remedies, or as many as appear, we we are then prepared to compare them and the remedies found related to the remaining symptoms of the case.
The symptoms that are next most important are those related to the entire man and his entire body, or his blood and fluids: as sensitiveness to heat, to cold, to storm, to rest, to night, to day, to time. They include both symptoms and modalities.
As many as these as are found, also, in the first group, the mental summary, are to be retained.
There is no need of writing out the remedies not in the mental group ou summary; these symptoms, relating to the whole patient, cannot be omitted with any hope of success.
We must next look over all the record to ascertain which of that group are most similar to the particulars of the regions of the body; of the organs of the body; of the parts; and of the extremities.
Preference must be accorded to discharges from ulcers, from uterus during menstruation, from ears, and from other parts, as those are very closely related to the vital operation of the economy.
Next must be used the modalities of the parts affected, and frequently these will be found to be the very opposite of the modalities of the patient himself. A patient who craves heat for himself, generally, and for his body, may require cold to his head, to his stomach, or to the inflamed parts, hence the same rubric will not fit him and his parts. Hence to generalize by modalities of isolated particulars leads to the incorrect remedy or confounds values placed upon certain remedies.
There are strange and rare symptoms, even in parts of the body, which the experienced physician learns are so guiding that they must be ranked in the higher and first classes.
These include some keynotes which may guide safely to a remedy or to the shaping of results, provided that the mental and the physical generals do not stand contrary, as to their modalities, and therefore oppose the keynote-symptoms.
Any remedy correctly worked out, when looked up in the Materia Medica, should be perceived to agree with, and to fit, the patient; his symptoms; his parts; and his modalities. It is quite possible for a remedy not having the highest marking in the anemnesis to be the most similar in image, as seen in the Materia Medica.
The artistic prescriber sees much in the proving that cannot be retained in the Repertory, where everything must be sacrificed for the alphabetical system. The artistic prescriber must study Materia Medica long and earnestly to enable him to fix in his mind sick images, which, when needed, will infill the sick personalities of human beings. These are too numerous and too various to be named or classified. I have often known the intuitive prescriber to attempt to explain a so-called marvellous cure by saying: “I cannot quite say how I came to give that remedy but it resembled him.”
We have heard this, and felt it, and seen it, but who can attempt to explain it? It is something that belongs not to the neophyte, but comes gradually to the experienced artistic prescriber. It is only the growth of art in the artistic mind: what is noticed in all artists. It belongs to all healing artists, but if carried too far it becomes a fatal mistake, and must therefore be corrected by Repertory work done in even the most mechanical manner.
The more each one restrains the tendency to carelessness in prescribing and in method, the wiser he becomes in artistic effects and Materia Medica work. The two features of prescribing must go hand in hand, and must be kept in a high degree of balance, or loose methods and habits will come upon any good worker.
After all the symptoms of a patient have been written out the Repertory should be taken up. The beginner should not attempt to abbreviate the anemnesis, but should write out the full general rubric for exercise, if nothing more. If melancholy be the word, the remedies set to the word should be written down with all the graduations. If the melancholy appear only before the menses let a sub-rubric be placed in manner to show at a glance the number of remedies of the general class having the special period of aggravation. Many of the most brilliant cures are made from the general rubric when the special does not help, and, in careful notes of ten years, would bring down many of the general rubric symptoms, and furnish the best of clinical verifications. The longer this is done the more can the busy doctor abbreviate his case-notes.
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 Boenninghausen's Pocket Repertory is of the greatest service.
Take Minton's most excellent work, and we find menstrual agonies are ameliorated by heat, peculiar to Ars. and Nux., and by moist heat, to Nux-m. But the symptoms of one case are not like either of these remedies, and we must go farther into the Materia Medica. We can there form the anemnesis by analogy and make use of the general rubric, taking all the remedies known to be generally ameliorated by heat and warmth applied.
To be methodical, the general rubric should appear in the notes of the prescriber and the special below it. If this plan be carefully carried out, a comparison of ten years'work be a most instructive perusal. What is true of a remedy generally may often be true in particular, especially so in the absence of a contra-indicating exception, well established.
If this plan be followed by beginners, always reading up the Materia Medica with the anamnesis by the time business becomes plenty the work becomes easy and rapid. A young man can prescribe for a few patients a day and make careful homoeopathic cures, and he can gain speed enough to prescribe for twenty or thirty a day after a few years. Any man who desires to avoid this careful method, should not pretend to be a homoeopathic physician, as the right way is not in him, as the desire must precede the act.
The patient does not always express the symptom in the language that would best indicate the real nature of the symptom. Then it is that judgment is required, that the physician may gain a correct appreciation of the symptoms. So often is this true that the young man and often the old are led from the true expressions of nature, and he will make an inappropriate prescription. The task of taking symptoms is often a most difficult one. It is sometimes possible to abbreviate the anemnesis by selecting one symptom that is very peculiar containing the key to the case. A young man cannot often detect this peculiarity, and he should seldom attempt it. It is often convenient to abbreviate by taking a group of three or four essentials in a given case, making a summary of these, and eliminating all remedies not found in all the essential symptoms. A man with considerable experience may cut short the work in this way. I have frequently known young men to mistake a modality for a symptom. This is fatal to a correct result. The symptom is the sensation or condition, and the modality is only a modification. The symptom often becomes peculiar or characteristic through its modality.
When a sensation is looking up in the Repertory, all the remedies belonging to it should be written out, and individualization began by modalities.
I am frequently asked what is understood by peculiar as applied to a case. A little thought should lead each man to the solution.
A high temperature, a fever without thirst, is in a measure peculiar. A hard chill with thirst for cold water is peculiar. Thirst with a fever, with the heat, is not peculiar, because you can safely say it is common to find heat with thirst, and uncommon to find heat without thirst. That which is common to any given disease is never peculiar. This may seem too simple to demand an explanation, but let him who knows it go to the next page. Pathognomonic symptoms are not used to individualize by, and are never peculiar in the sense asked for.
I am asked what I mean when I say to beginners, treat the patient and not the disease. My answer always is about as follows: the symptom that is seldom found in a given disease is one not peculiar to the disease, but peculiar to the patient, therefore the peculiarities of the patient have made the disease differ from all the members of its class and from all others in the class, and make this disease, as affecting this patient, an individuality by itself, and can only be treated as an individual. This individuality in the patient manifests itself by peculiar symptoms nearly always prominent, and always looked for by the true healer. The man who gives Acon. for fever knows nothing of the spirit of the law or the duties of the physician. The same is true of Colocynth for colic, Arsenicum for chill, etc.
“What shall we do when we find several peculiarities in the same patient and one remedy does not cover them all?” Here is where the astute physician will pick up his Repertory and commence the search for a remedy most similar to all, and if he has been a student for a few years he need not go about asking foolish questions. The lazy man has spent his days in the folly of pleasures, and the man of limited belief has shot out so many valuable things that he is constantly up in public asking foolish questions and reporting cases with symptoms so badly taken that he reveals the whereabouts of his past life. He has not made use of the Repertory, and shows a complete ignorance of the rubrics and the usual formality of taking symptoms as taught by Hahnemann. It is a blessed thing that they are not responsible for all their ignorance. Where shall the responsibility rest, and who shall “throw the first stone?”
It is so easy to wink at the sins that we ourselves are guilty of that is seems impossible to find judge or jury before whom to arraign the first law-breaker.
The cry for liberty has been a grievous error, as liberty is and has been most shamefully abused. It means a licence to violate law, and only a modest elasticity is necessary and full eclecticism is the product. It is liberty that has driven out of use, or limited the use, of the Repertorythat all the old healers so much consulted. If Boenninghausen used a Repertory with the limited remedies there proved, how much more do we need to consult it.
Ever since the appearance of my Repertory in print many of my friends who use it have urged me to write out my own method of using a Repertory. I realize that it is a most difficult undertaking, but shall attempt to explain my method. I doubt not but most careful prescribers will find that they are working in a similar manner.
The use of the Repertory in homoeopathic practice is a necessity if one is to do careful work. Our Materia Medica is so cumbersome without a Repertory that the best prescriber must meet with only indifferent results.
After the case has been properly taken according to Hahnemann's rules it is ready for study. I do not intend to offer in this manner the ordinary rubrics, because all know them so well. A case that is well taken and ordinarily full will show morbid manifestations in sensitiveness to many surroundings, such as weather, heat and cold, also in the desires and aversions, mental symptoms and the various regions of the body.
When I take up a full case for study, I single out all the expressions that describe the general state, such as the aggravations and ameliorations of the general state of the patient or of many of his symptoms. I next consider carefully all his longings, mental and physical, all the desires and aversions, antipathies, fears, dreads, etc. Next I look for all the intellectual perversions, methods of reasoning, memory, causes of mental disturbances, etc. All these I arrange in form together, in order to set opposite each one all remedies in corresponding rubrics as found in the Repertory. By the cancellation process it will soon be seen that only a few remedies run through all these symptoms, and therefore only a few are to be carefully compared in order to ascertain which one of all these is most like the particular symptoms not yet lined up to be considered as the first ones have been considered. Hahnemann teaches in the 153rd paragraph that we are to give particular attention to such symptoms as are peculiar and characteristic. He teaches also that the physician must pay his earnest attention to the patient. Now if these two things are duly considered, it will be seen that Hahnemann's idea was that a characteristic symptom is one that is not common to disease but one that characterizes the patient. All the first lot of symptoms singled out for a more comprehensive view are such, as characterize the patient, and are predicated of the patient himself. By treating a portion of the symptoms in this way we have reduced the list of possible remedies to a few or perhaps only one. As it is necessary to consider the totality of the symptoms for a basis of the homoeopathic prescription, it is now necessary to examine all the rest of the symptoms in order to ascertain how these few remedies correspond with all the particulars.
It may be said that the above is only routine work and everybody does it just that way. True, but after so much has been accepted the more intricate problems come up. To work out a well-rounded case is the simplest part of Repertory work, but when one-sided cases appear and when the patient states his symptoms in language that cannot be found in provings the case is far different. The record of the patient should stand as nearly as possible in his own language. From an extensive correspondence and many years of teaching graduates, I have come to the conclusion that it is a difficult matter for many to know when the record of symptoms contains the possibilities of a curative prescription. Many cases are presented with no generals and no mental symptoms – absolutely no characterizing symptoms – only the symptoms common to sickness. When a successful prescription is made on such symptoms it is scarcely more than a “lucky hit”. It cannot be classed as scientific prescribing. Many records are presented with pages of vague description and one keynote that has served as a disgraceful “stool pigeon” to call forth a failure from many doctors.
Unless the symptoms that characterize the patient are brought out in the record the physician should not be surprised at a failure. The remedy must be similar to the symptoms of the patient as well as the pathognomonic symptoms of his disease in order to cure. To show something about the requirements of Repertory work, I will try to bring out hypothetical groups of symptoms such as come to every man. In a well-rounded case, or as an isolated group, we frequently meet with what is called “writer's cramp”. This must be divided into many elements before it can be properly put on paper as a work-out case or fragment of a case. If we should take “writer's cramp” and say no more about it, we would have only a limited number of remedies to look to for cure. But our resources are unlimited, as well be seen. “Writer's cramp”, when examined into, will be found to mean cramp in fingers, hand or arms, or all three. Sometimes numbness and tingling of one or all three; sometimes sensation of paralysis in one or all three; sometimes tingling of fingers and hand, and all of these conditions from writing or worse while writing.
Cramp in fingers while writing: Brach., Cocc., Cycl., Trill., Mag-ph., Stann.Cramp in hand while writing: Anac., Euph., Mag-p., Nat-p., Sil.Numbness in fingers while writing: Carl.Numbness in hand while writing: Agar., Zinc. Paralytic feeling in hand while writing: Acon., Agar., Chel., Cocc.Cramp in wrist while writing: Amyl-n., Brach.
The above brings out all that can be found in the Materia Medica on this subject, and failure often follows owing to the scanty clinical and pathogenetic records to which we have access; but we have just begun to consider that vexatious group of symptoms. It is true that sometimes the above scanty showing presents just the remedy required. But oftener it does not, and then we may proceed as follows:
Cramp in the fingers, hand and wrist or such parts as are affected: use the general groups on pages 971, 972 & 973 of my Repertory.
Numbness of fingers and hand: pages 1038 and 1039, using also the general group.
Sensation of paralysis of hands and fingers: use the general groups, pages 1176 and 1179.
After these have been carefully written out, turn to the general rubric in Generalities, on page 1358, “Exertion”, and write out such of these remedies as are found in the complex symptoms from exertion. Writing is nothing else but prolonged exertion. When this simple lesson is learned the physician will see at once that the same process will show the remedy in those who have lost the power of the hand and fingers, or have cramps, etc., from playing stringed instruments or playing the piano or the prolonged use of any tool or instrument. It is using in proper manner a general rubric.
Furthermore, after cures have been made with remedies selected in this way, such remedies may be added to the scanty list of particulars first referred to, and in this manner will our Repertory grow into usefulness. This is the legitimate use of clinical symptoms. It is the proper application of the general rubric to the end that our scanty particulars may be built up. The new Repertory is the only one ever found that provides a vacant space for annotating just such information. If the large number of correct prescribers in the world would join in this extension, we could soon have a Repertory of comparatively extensive particulars. Our generals were well worked out by Boenninghausen and much overdone, as he generalized many rubrics that were purely particulars, the use of which as generals is misleading and ends in failure. The success coming from Boenninghausen's Pocket-book is due to the arrangement whereby generals can be quickly made use of to furnish modalities for individual symptoms, whether general or particular. This feature is preserved in my Repertory, as all know who use it. But it is the generals that can be used this way. A large rubric made up of promiscuous particulars, none of which are predicated of the patient is a “hit or miss” when applied in general and usually a miss. For example, “aggravation from writing” is a rubric of particulars. In no instance is there one wherein the patient himself is worse from writing, but the eyes, the head, the hands, the back (from stooping), etc., make up this rubric. It is useless to resort to aggravation from writing when a headache is the symptom and find the remedy refers to a complaint in some other part wholly unlike headache. To make use of this modality for mental symptoms when it is applied to complaints of the hand is perverting the uses of circumstances. Aggravation from writing should be limited to the symptoms that are worse from writing and kept with them, as it is not a general. It is so done in my Repertory. This is wholly different in the great rubric “motion”. If we study Bryonia from that rubric, and from the Materia Medica, we will see that such a large number of particular symptoms is aggravated by that remedy that it appears that the very patient himself is worse from motion.
Hence, it will be seen that motion is a rubric that must show the extent of aggravation in relation to the general bodily state by general and particular, and it must be retained in the generals. Any rubric that modifies so many particulars that the very patient himself seems to be so modified must be classed as general. Many wonderful cures have been made from the use of Boenninghausen and many wonderful failures have followed, and it is from the above cause. The new Repertory is produced to show forth all the particulars, each symptom with the circumstance connected with it. It is in infancy and may remain so very long, unless all who use it unite to preserve their experience in well-kept records and furnish the author with such. The author is devoting his life to the growth and infilling and perfecting of this work, and begs all true workers will cooperate by noting errors and omissions, and, above all, noting such modalities of particulars as have come from generals and been observed in cures.