VI.
REPERTORIZING.
As no one person can carry all the symptoms of all the remedies in his mind, a concordance or index is needed. We term a symptom index a repertory. There are about half a handed of these, general or special, based on different systems of studying the case. The two most vital to know are the basic ones of the two main methods, the Kent Repertory and the Boenninghausen.
THE KENT REPERTORY; ITS CONSTRUCTION.
The Kent Repertory is a compilation of materia medica, certain prior repertories, such as Lippes and clinical symptoms verified. In order to successfully search in the Kent Repertory for the symptoms of your case as evaluated in accordance with our last lecture you must be thoroughly familiar with the plan of the book, it rationale, and also its inconsistencies. The plan of the book is to work from generals to particulars,m a general rubric first in most instances. The book is based on anatomical divisions, (see Table of Contents, p. VII), with certain exceptions such as the first section on MIND; the last one,GENERALITIES; discharges,m such as STOOL,SWEAT, URINE and EXPECTORATION,which appear as separate sections next to the anatomical region producing them; and certain general conditions,such as VERTIGO, COUGH, SLEEP, CHILL and FEVER,which are also separate.
Under each anatomical section the rubrics run in alphabetical order regardless of whether they are pathology, sensations,modalities, or objective symptoms (such as “bores head in pillow”, page 108) Each such main heading is followed by modifiers,(if there by such) in the order following: ?Time, circumstances in alphabetical order, extensions (the point from which a symptom extends is the one under which it will be found, not the point to which it extends), location with its time, circumstance and extension modifiers,and lastly, sensation with its modifiers.
For instance, the main section HEAD is anatomical, but under that you will not find an anatomical section for occiput, rather must you look under the sensation in the occiput, as for instance, COLDNESS or PAIN, OCCIPUT, in.
It is to be noted that certain anatomical regions have no corresponding section in this Repertory, for instance, NECK, which is found under THROAT, EXTERNAL THROAT, and BACK, EXTERNAL THROAT contains the rubrics pertaining to the anterior neck,such as goitre,glands, torticollis, etc., and BACK contains nape and posterior cervical region. Furthermore, lungs, heart, aorta, axillary glands, breast and milk appear under CHEST; posterior chest appears under BACK; impulse under GENERALITIES; head sinuses are divided between NOSE and FACE; salivary glands are found under FACE instead of under THROAT; lips under MOUTH; oesophagus is found under Stomach and liver under ABDOMEN.
There is no section for the circulatory, glandular or nervous systems, as this book is not based on systems, (Boerickes Repertory is in part), but the parts of these systems are found scattered throughout the book under allied anatomical headings. Many symptoms which one would expect to find under the nervous system appear under GENERALITIES as they indicate a tendency of the whole organism, such as ANALGESIA, CHOREA, CONVULSIONS, PARALYSIS, TREMBLING, etc. Twitching of the parts appears under the anatomical part, such as FACE, EXTREMITIES. Nervous symptoms having to do with the spine appear under BACK. such as OPISTHOTONOS. Meningitis appears in two places, under HEAD, INFLAMMATION, meanings of,and BACK, INFLAMMATION, cord, membranes of.
Similar or allied rubrics often appear in two or more different places, as for instance: Dysmenorrhoea under GENITALIA, FEMALE,MENSES painful: ABDOMEN, PAIN, hypogastrium, in, menses, during; and ABDOMEN, PAIN,menses, during.
It must be noted that many rubrics which appear as particulars under the proper anatomical sections or main headings also appear in the last section, GENERALITIES, in their relation to the body as a whole, for instance, under GENERALITIES, MENSES, comes aggravation or amelioration of the whole person before, during or after menses,while under GENITALIA FEMALE appears the type and circumstances of the menses, or, so to speak, the particulars. Similarly under GENERALITIES, PERSPIRATION, appears amelioration or aggravation of the body as a whole from sweat,whereas under the section PERSPIRATION are given the quality, occurrent and modalities of the discharge itself.
Sweat of any especial apart is found under the anatomical section in which the part is located, such as, ABDOMEN, PERSPIRATION on. Perception of the scalp is not under HEAD, scalp, perspiration of, but under HEAD, PERSPIRATION, scalp of. General amelioration by, or distress from, the act of eating appears under GENERALITIES, EATING; and under GENERALITIES, GOOD, are the aggravations and ameliorations from the different articles of food, but under the section STOMACH,aversions and desires for special articles of food appear.
Pathological diagnoses are found frequently in GENERALITIES and occasionally as hazings under other sections but more often as sub headings under the CHEST, INFLAMMATION, pleura of, and appendicitis under ABDOMEN, INFLAMMATION, appendicitis. On the other hand empyema is found under CHEST, EMPYEMA, directly, and goitre under EXTERNAL THROAT, GOITRE. Certain pathological states which re symptoms rather than diseases,such as CHOREA, CONVULSION, CYANOSIS, DROPSY, ETC., APPEAR UNDER generalities. Objective symptoms are scattered all through the book and are often small unclassified rubrics, such as BRITTLE NAILS, GESTURES under MIND, BITING under MIND,and red lips under FACE, DISCOLORATION, red, lips.
THE KENT REPERTORY; ITS USE.
This Repertory is built to work the cases from general symptoms to particular symptoms to particular symptoms. We have already spoke in our lecture on the evaluation of symptom of Kent;s method of grading, MENTALS being the most important, and GENERALS next. Most chronic cases and many acute ones can be worked out by the Repertory on the MENTALS and GENERALS alone to within three to five remedies., The beginner should take at least eight of these symptoms,although expects often solve the case on three to five.
The beginner must be very sure that these MENTALS and GENERALS are really true of the patient, and that he has not warped the symptom in translating the patients colloquial expressions into the language of the rubrics. Moreover a symptom must have the same mass of importance in the patients case as is assigned to it in the symptom hierarchy. If an important symptom can not be found in the Repertory it can often be found under a synonymous rubric. It is to be understood that the headings in the under GENERALITIES WHICH are not pathological and not marked “ameliorated by.” of otherwise explain,d and which are not sensations or conditions, mean aggravation from.,” for example, EATING,before,mens worse before eating, COITION,after, means aggravated after coition, etc.
Many of the ameliorations are omitted and you must look for them under aggravation under their opposites,for instance, there is no better in summer. This is considered equivalent to worse in winter. Sometimes two or more rubrics must be combined in order to be equivalent to a given symptom. If the rubrics are very small it may be worse to add all the remedies.
If at least one of the rubrics is large and the others fair size, only such remedies as run through all the component rubrics of he is symptom should be taken. Certain symptoms have so large z group of remedies that they are almost useless except as eliminating symptoms. Such a one is cold bloodiness of the patient,which appears under GENERALITIES, HEAT, lack of vital, and would serve to eliminate any markedly hot blooded remedies which had otherwise come through the generals high in a given case.
The student will recall from out previous lecture that the common symptoms, or the unqualified big,main rubrics, such as SADNESS, VOMITING, etc., are of little or no use on repertorizing,and that among both GENERALS AND PARTICULARS, a strange,rare and peculiar symptom ranks high. A strange rare and peculiar general would be “during cold state craves cold,.” or “during hot stage craves heat”, as in Camphor a strange, rate and peculiar particular would be “a thirst for ice water only during chill” Eup. per.).
We have said that the beginner should locate in the Repertory his eight or more main GENERALS AND chart the remedies appearing under each of these, putting 3 for the bold face (heavy black type), 2 for italics and 1 for to man (plain type), this being done for all the fraction being the numerical totality of the remedy grades and the denominator being the number of symptoms in which the remedy appears.
Now the PARTICULARS come interplay, beginning with the most peculiar one, and case should be taken knot to use too small rubrics. In fact it is safer to use a more general, medium sized rubric than the more exact particular rubric. The occurrence of these particulars in the few remedies which have stood highest in the GENERALS, and in these only,being taken. you can now see which few remedies are fairly similar to the GENERALS of your case,and which few of those most resemble the PARTICULARS of the case., Add the particular title general fraction and reduce your list tot he three to five remedies which stand highest in their grand to,al. If one remedy totals 16/7 and another 15/8, the former is to be preferred.
