[ Read before I.H.A., Bureau of Homoeopathic Philosophy, June 6, 1935.].
DAYTON T. PULFORD, M.D.
This is a subject that I can write upon with feeling, not with the utmost of feeling because that would involve profanity and profanity is not euphonious; it is more expressive than instructive.
The literature of our school, as I have said on other occasions, is in a most untidy state. Our tools are all over and in many different shops. Some of them are hard to find at all. What should we think of a jeweller who kept shop as we do? Should we not get rather impatient waiting for our watch to be repaired? Then how about the poor soul who waits with utmost, suffering and humility while we must search and search to find something for his bellyache? It is not the pulling out of my repertory before the patient that embarrasses me; it is the fact that after patient and diligent search I remain as totally in the dark as before I cracked the book. “That is due to lack of skill in your use of it,” I can hear you say.
Many times, yes, but not always. I have seen a reputed master of Kent several times hard put to find what was wanted, only to make up an interpretation as a make-shift for what was sought. If homoeopathy is a science we can brook no makeshifts, at least by inexperienced hands and by novices. Naturally here is where the art comes in, but if we are to attract and hold newcomers, we cannot ask them at first to read between the lines and grab ideas out of a clear sky.
What is needed to work with the repertory is an index to the materia medica. The two would serve obviously different functions and would supplement each other. The purpose of a repertory is to enable one, by putting symptoms together, to find a group of remedies most likely to cover the case at hand. It is not primarily a source of information. It is primarily analytical and its contents somewhat dissected. An index would inform us where to look for everything butt would not necessarily give us a picture in the rough.
There are only a few fundamental material medicas, namely, the Materia Medica Pura, Chronic Diseases, Herings Guiding Symptoms and Allens Encyclopaedia of Pure Materia Medica. There is only one fundamental repertory and that is Boenninghausens Therapeutic Pocket Book. All other materia medicas and repertories are merely off-shoots of these, each gotten up to please the whim or definite idea of the author.
The index should be crossed to make it readily usable. Naturally this would be a lot of work, but so was the building of the Panama Canal, yet no one is sorry that he does not have to sail around Cape Horn. The various parts of a symptom should be crossed against each other. The parts that seem to me useful are the subjective or objective symptom, type, location, cause, modality, extension, precedence, concomitance, sequence and alternation. These should be indexed against each other. Abbreviations and references could be used to cut down space. The only other work that could be substituted for this is something on the order of Herings Analytical Therapeutics. It is a shame that this wonderful work was never completed. By means of an index we could readily find the information wanted.
Another difference would be that an index would not need to be as accurate as a repertory in that nonconfirmed symptoms could be admitted. It would need only to be suggestive, for an unconfirmed symptom might lead to a remedy for study and if that remedy fitted the case much time and suffering would be saved.
Everyone who has built up a repertory has rightly insisted that only confirmed symptoms be included. The Therapeutic Pocket Book is the finest example of this. Boenninghausen was uncannily accurate in his estimations. If we are to fit together the jigsaw puzzle of our patients symptoms, the parts must fit accurately.
Due to the incomplete functioning of repertories which makes an index, I would like to make a few remarks on the former.
Most of them suffer paradoxically from too much generalization and too much individualization, or better, analysis. In their super-generalizations they fail to distinguish between necessary shades. Knerr is least likely to err in this direction. Boenninghausen errs most because his is the most generalized. Kent starts at both ends and plays them against the middle. Another bad feature is the retention of obsolete terms. A glossary should be appended if these are to be retained. Kent had two very peculiar dreads. One was the inclusion of pathological terms and the other was his fear of the bogey-man of concomitants.
The latter has no place at all, the former has some reason for its existence. The arrangement is difficult to decide upon in a repertory because of overlapping parts, but that is no consolation to have the generals spread through 1400 pages. Only one man has attempted to make much use of synonyms at the head of his rubrics in the more condensed form of repertory for the enlightenment of his readers and that man is Boger. He has often put in present-day expressions. Knerr escapes the two “supers” by not breaking the symptoms into bits.
Kent criticised everybody who ever tried to build a repertory and then incorporated all the faults into his own. He criticised Boenninghausen for over-generalization and then over-generalized in rubric after rubric. He condemned the use of Boenninghausens modalities in so general a fashion, then failed to list modalities under particular parts and asked his readers to refer to the modality in general, a good old Boenninghausen custom. He became so analytical that symptoms are so mutilated in many parts of his book that the provers themselves could not identify them. His paper on writers cramp in his Lesser Writings shows this beautifully and one could build one of these new-fangled predigested houses while getting all the rubrics together for writers cramp.
He stressed in all his work the value of generals, yet he either omits many valuable ones or spreads others through the whole book. He devotes 280 pages to the extremities, which because of their vital importance stand at the end of the line, and only 175 pages to what he considered the very heart of the work. His fear of pathological terms we will pass by, for there is some solid reason for omitting them. Nevertheless he admitted many. His great stinginess in putting in concomitants was due to his view of them. If a person had a headache and a pain in the back at the same time, Kent wanted to know which was the concomitant.
If concomitance means merely occurring together, which I believe it does, then both are concomitants and the only thing that matters is that they occur together. Boenninghausens conception of this matter is the only one to take. You will find it in his Preface to the Therapeutic Pocket Book. Boenninghausen was not afflicted with bogeys. He was concerned with facts and accuracy as well as purity. I would not have devoted so much time to Kent, had he been less critical of others. For the information gleaned, one copy of Knerr is worth a dozen of Kent. As a parting shot, some concomitants were admitted into Kents, although I cannot figure out how he decided which was the concomitant.
Knerr is difficult because it is hard to find the modalities under the parts affected. The solid set up of his type is hard on the eyes. He is far more free with him concomitants and there is plenty of gold to be found in his masterpieces.
Gentrys Concordance should be splendid but for some reason or other does not seem to hold water. It seems mostly to lead in circles.
Medical literature suffers from being copies and recopies. It gives typical information and leaves out almost everything about the unusual which means much to the case before us. It is so voluminous that the Index Medicus was created to help the reader find what he wanted. Our literature is also large, especially that of our foundation subject, the materia medica. It has been copied and recopied, cut down and twisted and God knows what. A splendid general index was started by Drs. Eveline B. Lyle and Elizabeth Wright Hubbard but died from professional and financial indifference. If all the stuff turned out annually by the research grubbers of the Old School is worth an Index, should not our own materia medica be worth as much?.
DR. GRIMMER: I enjoyed Dr. Pulfords witty paper; it was pithy and to the point, but I find myself unable to agree with him about Kents Repertory. That is one of the most valuable works we have, in my estimation. It comes nearer than any other to being an unabridged repertory. It is far from perfect, nevertheless, when you know how to use it, it is of tremendous help. I couldnt do without it. I have worn out half a dozen in the last dozen years.
Boenninghausens Repertory is good. There can be no question about its value, and those of us who do not know how to use it may find it difficult and may be inclined to criticize it. If a work on a concomitance were added to Kents Repertory, I think we should come pretty nearly to having an ideal repertory. If the Doctor would study Kents Repertory along with the Hahnemannian concept of symptomatology, he wouldnt find it so difficult to use and get good from it. There is no question that it is cumbersome.
As to his index for the materia medica. I think that is a fine idea, but I think he will find it even more cumbersome than Kents Repertory. Gentrys Repertory is somewhat along that very line. It involves too much, and I wonder who would have to take on his shoulders that task of giving us an index. It would be greater than any dictionary in existence. It would be valuable. I should like Dr. Pulford to undertake that task. I think he would be the man to do it.
DR. PULFORD: We are on our seventh copy of Kents Repertory, and we have worn out all but one of them, but I never yet have had a successful prescription by following the repertory alone. I want to cite just one case that illustrates why the Doctor wrote the paper. We had the patient, the head of a music conservatory come to our office. She had had a very annoying backache for a period of seven years. She had tried everybody, and on one could do her any good. Finally, she was recommended to us.
All the symptoms she could give to us was that she had a terrific backache on any exertion, and the only thing that would give her any relief at all was to get into a hot bath and have the parts rubbed. I went to Kent. I went to Boenninghausen, I went to Allens Repertory, and Dayton and I studied nearly everything we could get, but we could find nothing that even gave us a clue to the case. Finally, I made up my mind that the backache due to the least exertion might be Rhus tox., but I couldnt find anywhere where Rhus tox. was immediately relieved by a hot bath, or by rubbing.
We are trying to get all these good things together in a materia medica that we are trying to compile our own use. In running over that I found one remedy particularly that had complete relief from a hot bath. Well, the remedy was a close relation to Rhus tox. I gave her a single dose of Calc. fluorica 1M. and the backache vanished like dew before the morning sun, and has never returned. Now you figure it out.
DR. GRIMMER; Doctor, will you please state whether it was the relief of the backache or the relief of the patient generally.
DR. A. PULFORD: Relief generally.
DR. UNDERHILL: I came into the study of homoeopathy about a year after Kents Repertory was published, having studied old-school medicine prior to that time. I was initiated by George H. Thacher, of Philadelphia, who was a pupil of Kent, of course, Kents Repertory was the one I took up first. It was one of the most stupendous undertakings I think I ever attempted. Finally I made up my mind I would learn something about that repertory, and so I chased three remedies through from page one to the last page, and it took me a long time to do it. I took Lycopodium, Calcarea carb. and Sepia.
I took Lycopodium first, and beginning under MENTALS, under the mind on page one, wherever I found Lycopodium in the highest rate in bold-face type, I wrote down the symptoms, and went on, a little at a time, week after week, until I had been through the whole book; then I took Calcarea carb., and then Sepia. After I got through I knew more about those remedies and I learned how the repertory was built; and I learned many of the short-comings, which is important to know. If you are going to use an instrument, you have to know its shortcomings, and learn where to find things in it.
So now I can hunt up anything in Kent reasonably well. I finally did the same stunt with Boenninghausen on two remedies, and found that equally profitable. I use chiefly three repertories in my work– Kents. Boenninghausens and Bogers. I got a great deal of the help on learning to use Bogers Repertory by knowing Dr. Boger and getting acquainted with his viewpoint and his philosophy of life and philosophy of medicine. In that way I learned how to appreciate the values he has given in his repertory and in his Synoptic Key, which I can heartily recommend to all of you.
I think that the homoeopathic profession, the International Hahnemannian Association, should get together and produce a repertory free from error, or as free from error as possible. However, simply because we have no good repertory is no excuse for not using them, and if we check our repertory work with good knowledge of the materia medica, we dont stand much chance of going wrong.
DR. WAFFENSMITH: I think this discussion has been amply covered, but being a student of Dr. Kent, I cannot remain quiet without adding to it. As far as I am concerned, I think the repertory of Boenninghausen is a masterpiece in its way. When I was practicing in the Southwest in the saddle and carrying saddlebags, Kents Repertory was too cumbersome for me to carry. I carried a Boenninghausen, and used it many years, and I assure you that it was satisfactory; but as progress in all things moves on, so in homoeopathy repertorial progress has moved on. When I came to the centers of population where I didnt need to ride around on the back of a horse, I used Kents Repertory, and I have never yet in my work seen the time that I have failed to find and to work out from a repertorial standpoint any case that I have had, unless it was my fault primarily in taking the case.
Second, I have used the repertory from a mechanical standpoint; in other words, tried to judge the needed remedy for the patient through the mechanism of the repertory without taking in the dynamic constitutional desires and aversions and variations of the individual case that i was studying at that particular time. So I have felt that when I made an error or when I was unsuccessful in my work, it was not due to the repertory that I was using, but due to my own lack of thoughtfully, carefully and judicially taking the totality of the symptom complex of that particular case.
DR. FARRINGTON: We can make better progress in this discussion, and perhaps arrive at a better understanding if we consider two or three points. What is a repertory for ? It is in the nature of an index. It is only a help, and as Dr. A. Pulford has said, there are many cases that you have to prescribe for where your repertory will not help you.
I was a little surprised at our friends D. T. Pulford in lambasting Kent as he did, because I knew that he had used Kents Repertory. Perhaps we find time after time, as has already been stated, that it is not perfect; in fact, I could stand here and talk for fifteen minutes and tell you a lot of the imperfections that I in my own experience have noted. For instance, some of the terms used are peculiar. Rubrics that ought to be separated are combined, as, for instance, stinging and burning. There is a difference, and yet Kent, in almost all places, combines those two symptoms under burning. You will find under skin and one or two other places he does mention stinging. Then again, under subrubrics you are hunting for certain remedies, you will not find them, but often find them in rubric under the subrubric below, qualified by some other aspect of the symptom or some modality.
Then too, concomitants are almost entirely absent. I think one reason why that is so is because Kent knew if he once started to insert concomitants, he would have three big volumes of fifteen hundred pages, or whatever, it is, instead of one.
I grew up with Kents Repertory. Thirty-six years ago I took the first classic, and subscribed for each as it came out; I think I have about seven copies, including three copies of the first edition. I have, in the main, been successful in using it as a help in prescribing. When I was disappointed, I went to Boenninghausen; I went through others of the twenty or so repertories in my possession. The only one that I did not consult was the Cypher Repertory. If you delve into it you will find that it is a remarkable book. It seems based almost entirely on signs and hieroglyphics that are difficult to learn. The preface says they have made it easy. That is not so, butt it seems to me that it comes the nearest to an index of any repertory we have. The symptom is stated in Greek letters or Old English letters, and other signs indicate the qualifying features of the symptom as the nature of the pain, indicate the modality, indicate the concomitants, and you can get in one line there a whole syndrome pertaining to one symptom if you know how to use it, but it is too difficult.
Gentry is another that comes near to being an index but it is incomplete; in symptom of importance there are too few remedies given, and there is much repetition, because a symptom is given under different names or different synonyms of the same thing.
You have to interpret your symptoms in order to use any repertory. If you go to Kents first edition, you will find when you look for “stys” you have to hunt all through and find hordeola. That was changed in subsequent editions. There are other things I might mention along the same line. You have to learn how to use the repertory, and Kents may be easier than some others. In my estimation, it is, but evidently our essayist has not understood how to use it. It is full of gold nuggets, but as indicated by Dr. Pulford, they are scattered, and sometimes you have to search for them. However, who goes out and picks gold nuggets by the wayside?.
When the doctor closes the discussion, I would like him to give us some idea of what he means by an index of materia medica.
DR. A. PULFORD: May I be allowed to ask one question? I think it will be of interest to all. Is a patient who is relieved from a cold bath of necessity aggravated by a warm bath? I have not found it so, but if it is so, then Kent was justified in leaving that rubric out.
DR. BOGER: We might talk until this hall would be empty about repertories and wouldnt have settled anything.
There are two or three little facts about using repertories that I would like to call your attention to. That is, a symptom occurring in a single part is often general and the modifier of a symptom, heat or cold, or whatever it may be, in one part of the motor system is very often also general. That is, suppose you have a cutting pain in your little finger. Heat or cold, or some other modality will refer to any cutting pain that that patient may have in any part of his muscular system, and the modality for a cutting pain in the calf of the leg, which is highly special, will hold true for the back or the other leg. The modality of a cutting pain in the lumbar region will be just as good as for a cutting pain in the leg.
Kent often took the modality out of one symptom and applied it to another symptom, to a totally different symptom in the same region. Perhaps you never though of that. For instance, he will take a modality out of symptom 560 and apply that same modality to an entirely different symptom; maybe the symptom that he is talking about will be tearing pain, and he will apply it to a burning pain — pick the modality out of one symptom and apply it to another symptom in the same region.
Now, for that reason it is absolutely necessary to get a complete symptom picture of your case and not try to prescribe on two or three symptoms which unfortunately, we are sometimes compelled to do.
About concomitants, we must remember one thing about them, and that is concomitants occur in the materia medica text in rather a limited way as compared with the possibility of the number of concomitants we have. We may have any possible combination. They ought to be called coincidences and not concomitants. Coincidence is the right term. For that reason your concomitants can be only of minor value, unless you join them together otherwise.
When it comes to building repertories, the current repertoires are the only true and real repertorial way of doing things, because that does it the way it occurs and the way it goes through your mind, that is, you are continually occupied in trying to fit symptoms together. Isnt that what you are doing ? You are continually occupied in trying to fit that picture puzzle together. That is just exactly what you are doing with a card repertory, you are putting those parts together.
To make a card repertory feasible, you are compelled to reduce those large rubrics which you see in the Boenninghausen and Kent book to comparatively few remedies, but you clarify the matter while you are doing it. Every large rubric, and some contain more than 200 remedies, is an impediment for finding the similimum. To work up that large rubric into minor rubrics is not the work of a few minutes; that is the work of many hours. Then you come to the reverse process. You can take half a dozen of the minor symptoms and fit them together and see which remedies run through most of them. Those are two common ways of doing it.
I hold, and I think I have had a little experience in that, that a card repertory more closely simulates your way of thinking than all the repertories that we have, and prevents waste of time. Unfortunately, a card repertory is always limited in the number of cards that you can use, or will use, and the number of remedies on those cards. Whenever you have gone beyond a certain limit, you make a card repertory like the one here that our friend in New York built; it is just as hard to use it as other repertories, or a little harder sometimes.
DR. DIXON: I know you all think I am going to get up here to defend Kent, but I believe I will defend Pulford instead of Kent, because I know how much that boy thinks of Kent, and he, like everybody else, knows the shortcomings of a repertory, which, on the face of it, never can be complete. It has to be open to improvement all the while. Nobody knows that better than Dayton, so I am just going to speak a good work for Dayton on that.
I have studied repertories for years, and it always pleases me when somebody gets up and criticizes them, because I have always been full of criticism myself. I remember a few years ago Dr. Wright Hubbard, who is now present, decided she would write a new repertory. I havent heard a thing about it for about five years, isnt it, Dr. Hubbard?.
DR. HUBBARD: I have been writing a few other things in the interim. I am still on it.
DR. DIXON: It is an ambition that I feel like encouraging, but I hope some time somebody will be colossal enough to write a better one than Kents, and I think Kents is the best one still. They are all good, and all are needed.
The trouble we have with our repertorizing is better case taking. When I have trouble with a repertory case, I always feel the necessity of calling the patient back and retaking the case and picking up some loose ends that I had skipped.
Another word about indexes. I tell my patients that a repertory is an index. You have changed the thing you are looking for, instead of a symptom, into a rubric, that is about all the difference.
DR. LEWANDOWSKI: One of the most important things to consider in prescribing homoeopathically is the saving of time, and, unfortunately, that seems to be the biggest hindrance to the practice of pure homoeopathy. Given a long line of patients (this is an unusual occurrence in this present age of depression), how can you practice homoeopathy properly and dispense, with the number of patients that are waiting in your office, anxious to get out ? I have adopted a very peculiar method. Purchasing three books of Bogers Synoptic Key, I have taken the face of each printed page and pasted it in a little room off my office. The entire Synoptic Key is pasted on a side wall there. Each symptom has a number. This number corresponds to an index that I have on my desk.
A patient walks into my office and immediately on observation I class him, and without much trouble I pick out the number rather than write the symptom. I question him further. If I find that the patient is restless ( and it must be restlessness in the highest degree) I pick out this as an important symptom and jot down the number rather than the symptom. This saves time in writing out the full history of the patient, and if I want to go into investigative work, I look up the number to find out what it represents. Then the patient is given a thermometer in his mouth, and asked to walk into the next room.
I go into my room, with a checker in my hand, and with this history of numbers rather than symptoms, I jot down each number that is on that board. By that time I take the thermometer out of the patients mouth, read it, and ask him to undress for further examination. While he is doing that, I begin with the most important basic or outstanding symptom and check it, say, for instance, Pulsatilla, give it four checks, then go down to the next symptom, and on through, and then I write down “Pulsatilla, value of 25.” Then I go through the rest of the symptoms and complete my examination with the patient, and immediately I have the information.
Almost every case, whether acute or chronic is given the advantage of that sort of repertorial study. Unfortunately, many times the remedy that you are seeking, and you know is indicated, does not come out in the value in this examination. This probably is due to a faulty history taking. Then if I am faced with such a fact, I give the patient a placebo and wait until I can further study the case. I find this a very simple idea in doing a repertory study, without letting the patient know what you are doing. Although I have not used it very long and cannot quite the results I have received, I am confident that I am studying and practicing homoeopathy as nearly pure as it can be.
DR. UNDERHILL: It seems that we often think we have to hurry and prescribe for the patient the very first time he comes, or certainly the second time or the third time, whereas in chronic cases we have all kinds of kinds of time. At each interview we gather together data and get acquainted with the patient. In the meantime, you are doing something for him, and what are you doing? You are removing the obstacles to recovery, untangling and simplifying his life, correcting his diet, improving his daily routine, and helping him a great deal, and then when you are ready to give him the remedy, you have no particular obstacle to overcome except the disease itself.
DR. ROBERTS: Miss Wilson teaches the Boenninghausen system in Boston at the post-Graduate School, and I should like to ask if she has something to say.
MISS WILSON: There is not very much that can be said that hasnt already been touched on, excepting perhaps that every repertory system seems to have a definite set of principles underlying it. Kent has one set of principles underlying his; Boenninghausens, of course,is the totality of the case. It sometimes seems very hard to judge which is the most important and which is the least important symptom in a case. Therefore, if you follow Hahnemanns instructions and cover the totality of the case, you cant far wrong. It is a tedious system to work out. There isnt any question but that a thorough repertorization takes a great deal of time, but it isnt necessary for the physician to do that himself. Dr. Roberts has trained me to do his repertory work, and if he could train me, other physicians could have their help trained as well.
In Dr. Roberts office, although we use the Boenninghausen system as the main repertory, there are about forty there that are in active service. They are all in active service, I think excepting the Cypher Repertory that Dr. Farrington spoke of. It takes a whole post-graduate course to learn how to use the Cypher Repertory.
There are very many criticisms of Boenninghausens Pocket Book that are perfectly just. As far as Boenninghausen himself carried the work, it was very thoroughly and very carefully done. We might make a great many criticisms, perfectly just, of the Allen translation. What we have to do in using the Allen edition (which is the one that is most easily available at this time) is to know the mistakes and to work around them. We get good results in spite of them. Allens has suffered primarily from wrong translations. The translating has been very poorly done, or very carelessly done, or both, and the index in the back of the repertory is of no earthly use.
No repertory, of course, is fool-proof, because of several elements. One is the one who works the case, the one who uses the repertory; one, of course, is the taking of the case, and sometimes it is the patient himself.
DR. PULFORD: I have been attending meetings of this Association for many years, more or less ever since 1924, and I always have found that one of the best ways to get up a discussion was to get under the skin, so there was some method in my madness in writing the paper as I did. When the time comes to consider publishing the paper, I would publish the discussion and omit the paper.
I think in a way Dr. Underhill brought out the heart of the whole discussion in that it shows that we must know the limitations of our tools as well as their better points, and I think practically every one who has discussed the paper has merely emphasized that one point.
In answer to Dr. Farringtons question about the index, the purpose I had in mind chiefly with an index was to lead you to the information that you wanted, and the repertory alone doesnt serve quite that function. The whole function is to resynthesize from an analysis and not necessarily to lead you to all the minor points. I thought I brought that out about the matter of the index of an unconfirmed symptom. The unconfirmed symptom might be suggestive, but you wouldnt want to prescribe on that at any rate.