The Use Of Repertory


Success with the repertory depends upon the ability of the physician “to take the case” properly and make correct deductions therefrom. The repertory should not be looked upon as necessarily a time saver at first, but rather as an aid to accuracy, the economy of time coming in the later management of the case, as a result of the complete primary study, and ultimately in its more rapid cure.


As one case has been studied, with the aid of Boenninghausens Therapeutic Pocket Book, it will not be time wasted to examine the repertory itself for a few minutes. Boenninghausen introduced it about 1830, it then included one hundred and twenty-five remedies; in the new American edition by Dr. Timothy Field Allen, Published in 1891, several remedies were unwisely, I think, omitted while about one hundred and seventy- five were added, many being but imperfectly noted.

The Boger translation of 1905 consists of Boenninghausens Characteristics of the Materia Medica and the Repertory. The latter is large, somewhat different in arrangement and much more complicated than the Allen edition, but extremely useful as a reference book and analysis, containing one hundred and forty remedies.

The Allen Boenninghausen, in spite of inaccuracies and unwarranted changes in rubric headings, is on the whole the best in size, arrangement and conciseness for use at the bed side. The first 140 pages cover “all parts of the body”, i.e. gives the remedies affecting those parts. It is most general in the arrangement, e.g. the “mind” and “Intellect” are covered in thirty-six rubrics, so it can be seen that particulars have no place, and yet all mental variations are included in these six and thirty headings.

After the parts of the body, in Boenninghausen, follows 50 pages of “Sensations”, then short sections on “Glands” and “Bones”, and 35 pages devoted to “Skin” symptoms Next “Sleep and dreams” 10 pages, “Circulation and Fever” 20 pages, and last in this part 40 pages of “Aggravations” and 10 pages of “Ameliorations”.

After the 160 pages are devoted to the “Concordances” or relationship of remedies, an important and valuable part of the work, as Boenninghausen tells us “useful not only for the selection and confirmation of the remedy but also for judging of the sequence of remedies especially in chronic diseases”.

The second case is one I reported in the Hahnemannian Advocate, Feb, 15, 1900, under the title “Guiding Symptoms”; and here is the part germane to this lecture. a letter from a brother physician, portions of which were as follows.:

“Dear Doctor:-I send you the bearer, Mr. X., for treatment. The trouble is chronic gonorrhoea of two years duration. He has had, at different times, Sulphur, Pulsatilla. Sepia, Thuja, Mezereum, and Belladonna. He is married and claims the gonorrhoea came from his wifes leucorrhoeal discharge. However that may be he is desirous of getting well. He has used about all the injections that were recommended and has been under all sorts of treatment, before he came to me. Every thing from patent medicine and quacks to the family doctor. He makes no attempt to conceal anything, therefore you will have no trouble in obtaining both history and symptoms”.

Sincerely.

Mr. X was of medium height, of full habit, with brown eyes and brown hair. Had been married four years, no children. His wife had been married before and had one miscarriage, before she became Mrs. X. He had had quinsy, colds, etc., but never any severe illness. The gonorrhoea (?) came on two and a half years ago, and about six months later there was swelling of the right testis with soreness, fever, etc. The discharge has been growing less, and is now very slight only a drop in the morning; color grayish white.

Micturition of normal frequency, never in the night. Meatus a little irritated, and lately, burning while urinating.

Appetite and sleep are very good, craves fat meat.

Coldness of glans penis in the afternoon, also of the perinaeum, especially in bed.

Has had the cold sound passed twice; the first time with relief, the second with increase of the discomfort.

Since last April has had soreness and feeling of pressure in the perinaeum and tuberosities of the ischia, which is:

Worse when standing,

Better walking about,

Better lying down, i.e. the pain and soreness,

Better on walking in the morning, but soon the pain comes on and increases during the day, while he stands, and is relieved as soon as he sits or lies down.

There is soreness to touch or pressure on sitting or form pressure of the clothes.

Frequent ineffectual urging to stool.

Mr. X works in a shoe factory and has to stand all day with one foot on the treadle of a machine.

Taking the present, i.e. last symptoms of the case especially into consideration, I looked up Perinaeum as the “part affected.” in Boenninghausens Therapeutic Pocket Book, Allens edition on page 93, where there is a list, under that “location,” of thirty-nine drugs.

Which is the simillimum? We are assisted in the choice by the difference in the remedies as indicated in the repertory by the various sizes of the type. Thus under Perinaeum the six most prominent ones are Agn., Alum., Carbo-an., Carbo-v., Cyc., Sul., and while originally I worked this case out in full, by using the first two rubrics to begin with, which is the only proper and safe way for any one to do in their first studies, I will now, for the sake of making the explanation shorter, take only these six medicines for this illustration.

On turning to the next group-the kind of discomfort-and taking the soreness (external), page 181, we find that the first drug of the six, Agn., does not occur, so it can be dropped. The second, Alum., and Sul., also, are in the next to the highest type, while Carbo-v. and Cyc. occur in the third size, and Carbo- an. in the fourth or lowest. Consequently the value of these six remedies under the two symptoms would stand as follows, reckoning four for the highest type, three for the next lower, and so on: (Agn. 4), Alum.7. Carbo-an.5, Carbo-v.6, Cyc. .6, Sul. .7.

The third symptom, feeling of pressure, is really the last half of the second group, as it still further explains how the part is affected. In the repertory it is found as pressing in muscles, page 174, and in this list some of the remedies are wanting, so after adding to each the figure representing its value, under this symptom, there results Carbo-an. 8, Cyc. 10, Sul.9.

Now we come to the last group, the modalities, and take, first, aggravation when standing, page 301, and following the same process, secure Carbo-an.9. Cyc. 14. Sul. 12; and the next symptom-part amelioration walking, page 320, gives Cyc. 18, Sul.

16.

Having reduced the list of remedies to two a reference to the materia medica will aid. The pathogenesis of Sulphur gives little in the perineal symptoms that agree with the case; only:

“Constantly bearing down (toward anus); forcing down after sitting. Itching in perinaeum, with soft stool”.

Neither did the case present any of the general symptoms of Sulphur, so it is set aside.

There remains Cyclamen, and its proving contains:

“Drawing pressive pain in and about anus and perinaeum, as if a spot were suppurating, when walking or sitting”.

Not exactly the same as the case, and yet as the general conditions of the drug coincide, i.e. the relief from walking, the aggravated when standing, and the fact that the part affected the way it was involved were particularly prominent under Cyclamen, it was given on Jan. 20, 1898. He then received Cyclamen 50m. (F), three doses, dry on the tongue, one at once, the next morning, the third the following night.

Jan. 31, 1898, he reported: “Have been growing gradually better the last few days, though my work has been unusually hard and have been standing constantly.” No medicine.

Feb. 24., not much better than at last report; the bearing down has been about the same; it has been worse for the last two days. Urethra sore to touch, with dysuria. Cyclamen 50m, two doses dry.

March 15, urinary symptoms better, less discharge, dysuria less, urethral soreness less, except last two days. Has had an attack of spasmodic contraction of rectum which waked him at night. Soreness of perinaeum generally less; also coldness of glans and perinaeum. Sweat sticky, without odor, on scrotum and perinaeum. Is working very hard. On account of the condition being worse the last two days, I repeated Cyclamen 20m, one dose dry.

April 4, perinaeum very much better, some days no discomfort, but the last day or two a little, before a night. Very little bearing down in rectum, no rectal spasm. Discharge about the same, also urethral soreness. Sweat less about the parts. Is working overtime and very hard. At this time he had a felon around the nail of the right index finger, caused by running a straw under the nail; as it was very painful, and the local symptoms called for it, I gave him Hepar 1m (F), three doses dry.

April 25, the felon improved at once soon after the last prescription. Had a sore throat and took various things for it, as tincture of iron and gargle of peroxide of hydrogen, also took quinine for the fever, etc. All the perineal symptoms are worse again (naturally), they are not as much relieved by walking about, are better after stool. Symptoms of urethra are also worse. Two rectal spasms have occurred. Cyclamen 50m, two doses dry.

May 3, has been better the last four or five days. Soreness and bearing down are both less. Still some scalding in urethra, discharge slight. No rectal spasms. No medicine.

May 16, all symptoms better, except there is still some urethral soreness, with slight milky discharge; as the length of time the remedy usually acts had nearly expired, I repeated Cyclamen cm (S), one dose dry.

June 6, very much better, especially the last week; before that no improvement, but was worse. Urethral soreness and discharge less. No rectal spasms. Perineal soreness much less. No medicine.

June 21, received a letter from him saying: “I have not been feeling nearly as well for the past week, but am not so bad as I was before.” Cyclamen cm. two doses dry.

July 2, very much improved. Soreness not all gone, but can stand much better. Less bearing down. Urethral discharge and soreness much less. No medicine.

As he was going away for a month I gave him two powders of Cyclamen cm. to take in case there should be an aggravation. Aug. 22, reported that he was worse about Aug. 3rd and 4th and took the Cyclamen powders with relief so that now he is feeling well. Had a spasm of rectum. He noticed, he said, that he did now have a return of the trouble as often and when it did come back it did not last as long. Had an attack of cholera morbus two nights ago and a few loose stools since. I gave him two powders of Cyclamen cm, as on July 2d, to use when necessary.

Oct. 6 1898, reported that about ten days ago, Sept. 26th, was worse again and took the powders of Cyclamen. The soreness, discharge, bearing down, etc., all came back only much less than the time before. No rectal spasm. Is gaining right along now.

I have not heard from him personally since, but have seen the physician, who sent him to me that Mr.X. was perfectly well and that if the perineal trouble returned he would see me at once. This was over a year later.

The time that elapsed between the repetitions of the drug are interesting. Starting with Jan. 20th, 1898, he then went for 35 days then 21 days, then 41, then 21, then 36, next 43, and lastly 54 days, bringing it to Sept. 26th, 1898. The duration of action of Cyclamen is given as two or three weeks; in this case the effect never passed off in less than three weeks and between the last two prescriptions of Cyclamen was nearly eight weeks.

Case III is a chronic one. Mrs. L., 60 years old, who had passed the menopause without incident, thought she had always had “liver trouble” though the first attack of icterus occurred in the spring of 1896. The next fall she was again jaundiced for six to eight weeks. Through the the following winter her health was poor and in May 1897 chills began, first with intervals of seven days, later quotidian and finally irregular. In June considerable quinine was given to her which for a time controlled, apparently, the chills as only slight ones occurred in the summer, but in September she had two severe ones and two more at the beginning of November just prior to my seeing her in consultation.

The symptoms of the last paroxysms, the “latest symptoms to appear,” were:

Time-4 to 6 p.m. generally near 6 oclock, an afternoon and evening paroxysm.

Exciting cause-Any slight irregularity in diet.

Prodromes none.

Chill-Began “all over.”

Feet and hands very cold as if dead.

Wanted to be wrapped up, without relief, though if she uncovered was no chiller.

No thirst.

Chill lasted from twenty to sixty minutes.

Heat-Generally slight, though temperature rises from.

1* to 4* according to severity of paroxysm.

Moderate thirst.

Apathetic, very drowsy, lies, with eyes closed.

Face bluish.

Pulse full and slow.

Desire to uncover.

Sometimes wishes to be fanned.

Sweat -Generally begins by 8 or 9 p.m.

Cold sweat, general, not profuse.

She then goes to sleep, and usually does not wake till morning. Apyrexia-Clear, though slightly icteric.

Other symptoms-Has been constipated for years and takes laxatives, stools natural color.

Liver normal size.

Spleen can be felt.

Digestion easily upset, but clean tongue and no bad taste.

Has lost twenty-five pounds the past year, is emaciated, pale, sallow.

Remedies already given: Nat-m. 30 and 200; Ph-ac. 30; Sul. 200 (last spring); Gel 3x recently.

No quinine for two months.

The useful symptoms were:

1. Cause-(a) drugging with quinine, p, 295 (as it partly suppressed the chills and modified them.)

“Our antidotes to be most effective must be directed especially against those (drugs) last given.”

–Hering, Hahnemanns Three Rules.

(b) Exciting cause of paroxysm “aggravation disordered stomach,” p. 277.

And next the characteristics of the paroxysm complete picture,” including:

2. Time (a) “aggravation afternoon” (4 to 6). p. 269, and (b) “aggravation evening,”p. 270.

3. “Chill without thirst,”p. 255.

4. “Heat with thirst,” p. 259.

5. “Desire to uncover in heat,” p. 259.

6. “Sweat cold,” p. 263.

Taking the first two rubrics together, to shorten the work, we have:

Nineteen remedies Abuse Agg. Agg Chill Heat

result from first quinine after evening without with

two rubrics. Agg. dis noon. thirst. thirst.

ordered

stomach.

Ant-t 5 1 4 3 1

Ars 6 3 3 4 4

Bry 5 3 4 2 3

Calc-c 5 2 3 1 4

Caps 3 1 4 2 1

Carbo-v 7 1 2 1 1

Cham 3 1 3

Cyc. 2 1 4 3

Fer. 5 2 3

Ip. 8 2 3 2 1

Nat-m 5 2 3 1 3

Nux-v 5 3 1 3 1

Phos. 3 3 4 4 1

Puls 8 4 4 4 3

Sep 5 4 4 2 2

Stan 2 2 4

Sul. 5 4 4 3 4

Sul-ac. 3 1 4

Verat-a. 5 1 1 1 2

Desire to Sweat Totals.

uncover in cold.

heat.

Ant-t

Ars 1 4 25

Bry 1 3 21

Calc-c 3 1 19

Caps

Carbo-v 1 2 15

Cham

Cyc.

Fer.

Ip.

Nat-m

Nux-v 1 2 16

Phos. 2 1 18

Puls 4 4 31

Sep 1 2 20

Stan

Sul. 2 3 25

Sul-ac.

Verat-a. 3 4 17

Now the materia medica was consulted. In such cases assistance is obtained from Dr. H.C. Allens work “Therapeutics of Fevers,” and full confirmation of Pulsatilla for this case can be found either in that book or in Herings “Guiding Symptoms, Vol. VIII, pp. 634-8.

Nov. 9, 1897, she was given, during the apyrexia, Pulsatilla cm (F), five doses in water.

Nov. 17, slight chill at 6 p.m.

Nov. 18, severe chill, then heat, no sweat, between 2 and 3 p.m.

Nov. 20, Pulsatilla 1 mil. (F), three doses in water.

Two weeks elapsed and then a very slight chill, none after. Bowels regular, doses not have to use laxatives.

The last report, April 19, 1905, seven and one half years later, was that she had no return and was well.

Case IV. As an illustration of rapid work with the repertory at the bedside let me offer the following:

A man, forty years old, was taken suddenly in the afternoon with pain in the scrobiculus, a severe griping and also sticking pain which extended to the back. For relief he either bent backward or lay on his abdomen. The site of the pain was sensitive to touch, there was no flatus, and no history of dietetic or other indiscretion. When seen the attack had been going on some two hours.

On taking the symptoms in proper order the first who rubrics “pit of stomach,” p. 81, and “griping pain,” p. 161, together, using only the remedies in the two largest sizes of type occurring in both, gave six remedies, as follows: Bell. 6 Bry. 7, Calc-c.7 Cocc. 7, Lyc. 6, Puls.7.

Rubric No.3, “sticking inward,” p. 184, gave four remedies with the following totals: Bell.8. Bry. 10, Calc-c. 10, Cocc.8.

From the fourth rubric, “aggravation from touch,p. 304, there resulted: Bell. 12, Bry. 14. Calc-c.11, Cocc.10.

The fifth symptom part, “amelioration bending backward,” p. 311, cut out two, leaving only: Bell. 17 and Cocc. 13 and lastly the “relief lying on abdomen,” i.e., amelioration pressure, external,” p. 317: Bell. 17, Cocc. 16. The full working out of the case, the only safe way, and which I did at the bedside, gives the same result.

It required but a glance at the pathogeneses of the two remedies to confirm the choice of Belladonna, and one dose of the 200th relieved in fifteen minutes so he was free from pain; but in about an hour he tried to get up, when the pain returned, and as it persisted and grew in intensity another dose was given, with prompt and permanent relief.

Case V is one more instance of quick repertory work and results.

A pneumonia of the middle and lower lobes of the right lung, in a woman about seven months pregnant, yielded rapidly to Phosphorus, but after the crisis the cough developed much more severely, and premature labor seemed unavoidable. Phosphorus repeated did not act. There was no fever; pulse 90 to 100 and regular; cough short, hacking, almost constant, worse from 4 to 6 in the afternoon; expectoration whitish mucus, sometimes bloody; no thirst; short breath; most relief lying on the back; much abdominal flatus.

What medicine would help and how could it be found?

It was probable that a remedy which related to or followed well after Phosphorus should be selected, and I turned to the “Relationship” under that remedy on p. 437. Here the rubric “Other Remedies” seemed to give the desired list;l of these we will take the two highest types yielding twenty-five medicines, among which is doubtless the one needed.

The rubrics should be used in the following order:

1. Other remedies, p. 437.

2. Cough with expectoration, p. 115.

3. Expectoration white, p. 119.

4. Expectoration bloody, p. 117.

5. Aggravation afternoon, p. 269.

6. Amelioration lying on back, p. 316.

7. Respiration rapid, p. 113.

8. Flatulence in general, p. 83.

After these may be taken or not, as one likes:

9. Expectoration mucous (slimy), p. 118.

10. No thirst, p. 66.

The following is the working out in this way; the original study, with the first rubric taken in full, gaves the same result, but I give cut down to save time and space:

Only the two Other Cough Expect, Expect. Agg

highest styles remedies. with whitish. bloody. After

of type used expect. noon

here.

Aloe. 3 2

Apis. 4 3

Arg-n. 4

Bap. 3

Bell. 3 1

Bry. 3 3

Cact. 3

Calc-c. 3 4

Cannab-i. 3

Cimic. 3

Crotal. 3

Gel. 4

Glon. 3

K-bi. 3

Lit-t. 3

Lyc. 3 4 4 3 4

Merc. 3 2 2 3 3

Nux-v. 3 2

Pod. 3

Puls. 4 4

Sang. 3

Sep. 3 4 4 3 4

Sil. 3 3 1 2 4

Sul. 4 3 2 4 4

Verat-v. 3

Amel Respi. Flatulent Totals. Expect.

Lying on rapid mucous.

back general

Aloe.

Apis.

Arg-n.

Bap.

Bell.

Bry.

Cact.

Calc-c.

Cannab-i.

Cimic.

Crotal.

Gel.

Glon.

K-bi.

Lit-t.

Lyc. 3 4 4 29 4

Merc. 2 3 4 22 1

Nux-v.

Pod.

Puls.

Sang.

Sep. 1 4 3 26 2

Sil. 1 3 4 27 2

Sul. 2 4 4 27 2

Verat-v.

No thirst. Totals.

Aloe.

Apis.

Arg-n.

Bap.

Bell.

Bry.

Cact.

Calc-c.

Cannab-i.

Cimic.

Crotal.

Gel.

Glon.

K-bi.

Lit-t.

Lyc. 1 34

Merc. 1 23

Nux-v.

Pod.

Puls.

Sang.

Sep. 3 31

Sil.

Sul. 2 31

Verat-v.

Though Lycopodium, Sepia and Sulphur ran close together there was no difficulty, when their provings were consulted, in deciding between them.

Lycopodium cm. (S) was given in water, four doses at two hour intervals, beginning at 10 a.m., to develop as rapid action as possible. The cough was much less that afternoon and by the next morning was gone. Seven weeks later the baby was born; both mother and child are alive today.

Case VI. This is not an unusual one but an instance of harmonizing of what seem to be incongruous elements in a case so that one prescription will cover, also illustrating the proper order in which to use the different groups of symptoms, and the assistance and confirmation the second group may give.

Maurice Worcester Turner