No one thing in the method, practice and armamentarium of the strict homoeopathic physician has been more misunderstood than the repertory.
The repertory of the materia medica is peculiar to Homoeopathy; its employment, save in the crudest index form in any other school of medicine is impossible; the use of remedies in Homoeopathy being based upon provings, from which positive deductions and analyses may be made, whilst in other schools no such data are available.
The repertory has been decried as “taking too much time,” as being “mechanical,” as causing “neglect of the materia medica,” and in other ways spoken of with contempt. As is usual, this is done by those having little knowledge of or experience with it.
I except to show that it is not only useful, a thoroughly scientific procedure, and in the end a time-saver, but it also leads to-what is best of all- the more certain and rapid cure of diseases, because of the careful analysis and study of cases it necessitates, and the precision in the use of remedies it compels.
The word repertory means to find again, and it is, the dictionary tells us, an index or treasury in which things are disposed in an orderly manner, so they can be easily found. This is all that the first repertories of the homoeopathic materia medica were-indices or reference books-and while they were needed in the early days of Homoeopathy, we need them much more on account of the greatly increased size of the materia medica.
As time went on it was found that the utility of a repertory could be increased by making it not only an index, but analytic as well; so now we have two, kinds of repertories-the indexical and the analytical-these being commonly combined.
The index form is only valuable as a reference book or index. In it a symptom is given more or less in detail, with one or several appropriate remedies following little or no attempt at analytical arrangement being made. Examples of this class are Vol. III of Jahrs New Manual” and the repertory of Hulls Jahr”.
The analytical repertory is the result, so far as I know, of Boenninghausens genius, certainly in accuracy and completeness, though not including the latest remedies, no other repertory compares with it. It is the best general repertory extant and is both an index and analytic arrangement of remedies. With its aid Boenninghausen arrived at the remedy (simillimum) in a case with as much certainty as a chemist makes a chemical analysis.
Boenninghausen arranged drugs in classes, according as symptoms were emphasized in provings and (perhaps) more or less repeatedly verified in practice, by taking the Hahnemannian schema of the parts of the body and indicating under each rubric the different values of remedies by means of four distinct styles of type. For instance, in Allens Boenninghausen, which edition I take for illustration because of its more general use, in the medicines affecting the vertex are to be found Acon., Lach., PHOS., VERAT-A.; to these he gave numerical value. respectively, of 1, 2, 3 and 4.
Nor was this all. Boenninghausen observed that a complete symptom consisted of three parts:
1. The parts of the body affected, or location,
2. The kind of pain or discomfort experienced there, and
3. The modalities. i.e., the aggravations and ameliorations of time, temperature and weather, rest, position; motion, etc.; these three parts of the computer symptom being expressed by the words where, how, when.
In some cases of sickness a symptom-complex develops which is not to be found in the proving of any drug, but by following out this idea of the completed symptom of Boenninghausen a remedy may be discovered, by the aid of Boenninghausens Therapeutic Pocket Book, which will cure even though this remedy has not in its proving shown a similar symptom groups.
This is because the Therapeutic Pocket Book is based upon an analysis of the known general action of drugs which admits of more combinations than the provings have disclosed. Such a prescription is a synthetic one, as it results from the bringing together and harmonizing of what appear to be incongruous elements.
There are modern repertories arranged on the plan of Boenninghausens Therapeutics Pocket Book, the most recent being Kents which gives more details and sometimes symptoms in full. Lippes Repertory is to a limited extent analytical; on the other hand, Knerrs Repertory of the Guiding Symptoms, while it has the numerical value of the remedies indicated, is simply an index full of cross-references, but not well arranged for repertorial study.
The Repertory to Clarkes Dictionary of Materia Medica, while possessing novel and useful features, is only index, and not complete; the latter part of this statement is also true of the repertory of the Cyclopaedia of Drug Pathogenesy. Many other similar repertories are arranged on the Boenninghausen plan, and are correspondingly useful.
We may note, then, as the essentials of a good repertory completeness and accuracy, to which should be added analysis. It would seem, therefore, that the compiler of a repertory should not take upon himself, to decide as to the value of a symptom, nor the suitableness of a drug under certain conditions; everything should be incorporated; though he may point out symptoms which, in his opinion, are of questionable worth.
How can we make use of a repertory like the Boenninghausen Therapeutic Pocket Book? There are five necessary steps-four preparatory and one following the repertorial study.
The first, and most important, is the proper “taking of the case”, according to Hahnemanns instructions in the Organon(aphorism84 et seq). He tells us (aphorism 104) that “when all of the prominent and characteristic symptoms, collectively forming an image of a case of chronic, or of any other disease, have been carefully committed to writing, the most difficult part of the labor will have been accomplished”.
(2) The next step and one which may be made coincident with “taking the case,” is the selection of the symptoms useful for prescription purpose, according to aphorism 153 of the Organon, in which the two general types of symptoms are contrasted-(a) “the prominent, uncommon and peculiar symptoms,” sometimes called the idiosyncratic, hence the personal equation of the patient, useful in selecting the remedy, with (b)”the more general and indefinite common to every disease,” or diagnostic symptoms, of value, as a rule, only for indicating the nature of the affection.
Consequently for this reason alone, i.e. to be able to discriminate between these two kinds of symptoms, if for no other, the homoeopathic physician should be familiar with disease processes, familiar with disease symptoms, and skilled in the diagnosis of diseases.
(3) Third, is the decision as to the relative value of these prescription symptoms. Hering elaborates this is his comments on Hahnemanns Three Rules, which I abbreviate at discretion. He says “not only must the symptoms of the drug and disease be similar, they must also be of the same rank of value, as this often decides the selection of the curative remedy. To determine this “rank of value, ascertain, if possible, when examining the patient, the chronological order of appearance of symptoms, and give prominence to those which were the latest to appear, for to these especially must the remedy be similar,” i.e., to the complete disease picture.
“This holds good, also, in regard to patients who have been drugged; our antidotes to be most effective must be directed especially against those last given.” Many chronic cases require only careful antidoting in this way. Symptoms during the previous part of the illness should be, of course confirmatory and lead up to those last to appear therefore the development of the case will be in harmony with the unfolding of symptoms either in the pathogenesis of the remedy now needed, or in that of a remedy or remedies which would have preceded it sequentially.
When the symptoms which were the latest to appear are incomplete, for prescription purposes, we have to go back sometimes even to the childhood of the patient for sufficient data. The exception to this rule, of using the latest developed symptoms, is the
(4) Fourth requirement,-to discover, if possible, the origin or cause, exciting cause in many instances. The patient may know it, or, if not, symptoms may point to it. It is of use in both acute and chronic cases as it is the most satisfactory symptom to start with in the repertorial study, being the foundation many times upon which all the symptoms rest (Boger).
We have to consider, in general, two groups of causes:- the 1-External, as injuries of various kinds, effects of heat, exposure to sun or weather, etc.,- and the 2-Internal, as consequence of mental shock from fright, grief, etc., also effects of suppressions,- of emotions, of-discharges, not uncommon,-of eruptions, not less frequent and important,-of diseases from drugging, as intermittent with quinine or syphilis with mercury and potassium iodide. These are mostly to be found, in the Therapeutic Pocket Book, under “Aggravations” or in the section on the “Skin”.
