This is a new word, but expresses what we all desire in repertorising, and what we have got to be very chary of using too rigidly, lest we lose the remedy we are looking for.
Instances best reveal meanings. Take one. Say your patient complains of dyspepsia, with burning pain in the stomach, and the frequent vomiting of sour fluid. He pours you out particulars, which he has at his finger-tips; since they are just the symptoms that impress a man’s memory, by intruding themselves on his consciousness in a very realistic way. You jot them down till you have got the case as fully as most people go, with all its modalities (i.e. the conditions as to heat and cold, movement and rest, position, hours of day and night, relation to food and drink, etc., of the stomach condition complained of). You have assured yourself, by careful examination, as to whether the trouble is likely to be organic or functional; or whether some of the symptoms have got to be discounted, as secondary to some gross lesion. And now it is your turn.
You have to elicit the general symptoms of your patient; you have got to switch him off the siding “my”, and on to the main line “I”. And you now find that he cannot stand heat-whatever his stomach may do; that he is ill if long out in the sun: that he wants a cool room, prefers cold weather and a cold climate : that he never goes near the fire: and you noticed when he came in that, though the weather was cold, he was not buttoned up, or thickly clothed. It is not closeness or stuffiness so much that affects him (you have got to be careful between these!) but heat.
He is one of Dr. G. Miller’s predominantly hot-remedy people”. There is an eliminating symptom for you! You know at once, whatever his stomach condition may be (its particular symptoms might perhaps be equally well-met by Arsenicum, Phosphorus, Nux vomica, Lycopodium, Nat.-mur., or a host of others); but with that temperament, that warm personality, it would be useless for deep and curative work to think of giving him Arsenicum, Phosphorus, Nux or Sepia He is a hot patient, and these are predominantly cold remedies. You can strike them out at once. For even if one of them, aptly fitting the exact stomach symptoms only, gave temporary relief to the immediate condition, the patient would relapse again and again. It could not hold. It would act as a palliative, not a curative drug. It might provide a temporary organ-stimulus: it could never be the stimulus of the organism. And here you see well the difference between deep and superficial work- between curative and palliative.
The people who get their honest triumphs in similars, and see at least brilliant temporary results in superficial and acute conditions, and believe honestly that these are the very best attainable by medicine, scout the idea of the lasting triumphs of the simillimum. They know well from years of experience, their own limitations; and it seems to them outrageous that people should make larger claims. As a matter of fact, when you get the real simillimum, the odds are that, instead of palliating the stomach condition, you will aggravate it a thousand-fold-for the moment; aggravate it, once and for all, to cure. And if you do not know your work, you will think that you have got the wrong medicine, and antidote or change it: and your patient will be, so far as you are concerned, incurable. But it may be your ignorance only that makes him so!
So now, down all the rubrics, mental, general and particular, you will carry that great eliminating symptom, WORSE FROM HEAT, and ruthlessly cut out all the remedies that are chilly, and therefore deeply help chilly people. None of these you need write down at all. Using Dr. G. Miller’s list, which we will give in a moment, you can go on to any other General, and especially to any marked mental symptom, and often get a pretty correct idea of the exact remedy before you ever start to tackle the particular and immediate suffering for which the patient comes to you.
Now supposing you discover that he is liable to fits of depression, and yet cannot endure any attempt at consolation; that he becomes a very fiend if anyone attempts to cheer him up-even to enquire what is amiss: that people have learnt to let him severely alone, when his moods are upon him; why with these two important symptoms alone, worse from heat, and worse from consolation, which have got to be in equal type, remember, in the patient and in the drug, you have reduced your area of search to Lil-tig., Nat.-mur. and Platina (for Lycopodium and Mercurius come through the “(<) consolation test” in the lowest type only, which is hardly good enough for such a marked loathing of consolation as this!) Or, if your patient had been as predominantly chilly and worse for cold as this one was for heat, and the aggravation from consolation test came out as strongly, you would have found yourself at the start of your work with Arsenicum, Belladonna, Calcarea-ph., Ignatia, Nit.-ac., Sepia and Silicea, with two or three others to play with in brackets-lowest type.
If you can get such marked eliminating symptoms to begin with, see what a comparatively small number of drugs you have to carry down through all the rubrics, and how much easier and quicker it is to get your remedy, and how much greater confidence you have in the result of your search. You will generally find, as you work down, that one drugs stands out more and more pre-eminently:- it may not be in all the rubrics, but it has got to be in all the important ones, i.e., those best marked in the patient, and of highest grade. And presently you throw down your pen: you are convinced; and it is a mere waste of time to go further.
Now take the same case and start, instead, on the marked symptoms complained of by the patient-the Particulars, and just see what work you have cut out for you! Begin with the rubric Vomiting, and write it out for the last time, and see what it entails. And write all the drugs, in all the types lest you should miss any. Take his particular symptoms, one by one, and write, and write, and write.
Vomiting, 162 drugs.
Vomiting watery, 108 drugs.
Vomiting sour, 89 drugs.
Burning pain in the stomach, 186 drugs.
Pain in the stomach p.c., 110 drugs, etc.
It may be easily such a list, of which this is but the merest beginning:-no wonder that people get “Repertory funk!”-for remember that people are actually doing this, at this moments in all quarters of the world: for they are sending us their beautifully-neat, conscientious and exhaustive work to show, as they ask for a better way: and it is their cry for help that has caused this article to be compiled. Sheets and sheets of paper you will cover. One that lies before us now has all the drugs in forty-nine different rubrics, some of immense length, as Stools offensive, Burning urine, Stools pasty, Yellow stools.
Why, before you ever come down to such symptoms, you should have three or four drugs only in hand:-and they are symptoms of the lowest grade, and Common symptoms; hardly worth glancing through for confirmation of the drug. Moreover, there is the possibility that you may accidentally omit the very drug you want from some of the long lists you are so slavishly copying: and the odds are, that when they are all complete, without the aid of eliminating symptoms some half-a-dozen drugs will come out pretty near one another when you count up at the end, and that your traveaux d’ Hercule will leave you unconvinced and still in doubt.