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.
