I give a brief summary of two cases treated during the past winter to illustrate in part some advantages in repertory usage. While the chronic background undeniably was present and calling for a remedy, each presented itself as an acute condition rather than the so-called chronic case to which we too frequently, I believe, limit repertory study.
CASE I.
In March I was called to Florida to see Mrs. S., age 72, duration of illness four weeks in bed, temperature 102.6, pulse irregular, poor quality, and prostration marked. She had contracted la grippe, I was told, and then relapsed with severe throat and laryngeal symptoms. She now presented severe and almost continuous pain and stiffness in the neck. This condition was worse at night, worse from touch, worse from turning. There was slight relief from constant heat, also from firm pressure. A week before cough had been raspy with cringing on swallowing even saliva. The cough was now loose and rattling, no expectoration. She was unable to sleep, and perspired a good deal at night, the head, upper chest, neck and arms in particular.
She was greatly depressed, mood variable, restless, sensitive to the least draft, and irritable, more noticeably in the morning. I could elicit no other symptoms. The family and patient were worn with the month;s siege and were expecting speedy relief. Repertorizing brought out for study Bryonia, 14/23: Mercurious, 13/28; Sulphur, 13/28; Rhus tox. 13/34; Calcarea carb. 11/26; and Silica, 9/23. Bryonia 200x gave not relief in twenty-four hours. Bryonia 1M quickly relieved the acute neck condition.
The temperature went to normal, and the pulse improved, but the stiffness in the cervical muscles, and the general symptoms of sensitiveness to draft, depression, and irritability in the morning showed little change. After waiting forty-eight hours i gave Calcarea carb. 1M, with such improvement that I was able to return to Boston five days later. The patient gained steadily, returned north two weeks later, and remains well.
Observation: While Bryonia covered each of the five generals chosen 1-2-3-1-1 respectively and all the particulars, Calcarea covered the generals in rubric value 3-3-33-2 but failed to cover five of the ten particulars. Note, however, the strength of the Calcarea generals as compared with the prominence of these symptoms in the patient.
CASE II.
Mrs. A., age 45, started flowing Oct. 17th last. This continued off and on until Feb. a. From that time to the date of my visit Feb. 24th, she flowed almost continuously. Several days in bed had given no relief. Characteristic of the metrorrhagia were as follows: active, red, clots, worse from emotional excitement, sudden gushes, intermittent painless, paroxysmal,profuse and sudden. Her general health and appetite remained unaffected. Repertorizing, I added the following generals: Anxiety about health, wants sympathy, lack of vital heat, worse hot, stuffy rooms, thirstless, averse fats. Now see if the remedy that occurs to you comes through.
Using as particular metrorrhagia, soreness of the mammae before menses, and possibility of fibroids the following values were found: Sulphur, 8/14: Calcarea, 7/14; Phosphorus, 7/14; Pulsatilla, 6/14: Cocculus, 6/9; BElladonna, 5/8. Testing the various characteristic of the bleeding, i.e., the active flow, red color, clots, sudden rush, aggravation from emotional excitement, gushing, intermittent, painless, paroxysmal, profuse, and sudden onset the following numerical result was found: Sulphur, 3/5: Phosphorus, 6/16; Pulsatilla, 6/11; Calcarea, 6/11; and Belladonna, 10/22.
Accordingly Calcarea carb. 200x was sent from the office. The flow ceased in twelve hours. There has been no return to date. Examination for fibroids was negative. Patient is improved in general health recently, adjusting herself bravely to the sudden loss of a favorite brother.
Observation: The generals were apparently outranked by the strong particulars. These favored Belladonna, but considering the duration of her difficulty the complementary Calcarea which also well covered the generals was chosen.
The late Dr. J.H. Clarke of London stated: “It is impossible to practise homoeopathy as it should be practised without the aid of repertories, and the best repertory is the fullest.” The use of a repertory is appalling to many physicians. Only by constant use can any repertory become a companion and a helper. In emphasizing repertory advantages, understand that it cannot take the place of materia medica study, and is never intended to so do. The repertory is our chief instrument of precision, but there must be equal faithfulness and intelligent use of both repertory and materia medica as well. The pathogenesis of the remedies, their sick making powers as shown in the provings, is our court of last appeal.
The repertory is a valuable index of the symptoms of the materia medica, but to many it is a maze of material more confusing than the detail of provings. However, the materia medica is so cumbersome that the advantages of repertorizing, in spite of sacrifices for an alphabetical system, puts a premium on careful work. Those who fail to use a repertory because they think of symptoms in pathological terms must remember in fairness that the simple language of the proves, who were mostly laymen, has been the saving grace of homoeopathy. We are trying of fix in our minds sick images of remedies which correspond to the morbid manifestations in the patient as shown by his sensitiveness to time, weather, heat and cold, in short, all circumstances, desires, aversions, aggravations, amelioration, changed mental states, and all that is shown symptomatically of the reaction of his vital force to the morbific agent which disturbs.
It follows that the proper taking of the case becomes an imperative first premise to repertory success. Immediately we face the need to clearly perceiving homoeopathic philosophy. Quoting, “All that a physician may regard as curative in disease consists entirely in the complaints of the patient, and the morbid changes of his health perceptible to the senses; that is to say it consists entirely in the totality of the symptoms through which disease expresses its demand for an appropriate remedy.” So we make a record not of the disease, but of the individually diseased patient. Individualization of each case regardless of its diagnostic label must precede proper repertory study. We are gauged not so much by the soundness of our teaching as by our thought and accuracy in practice. The repertory is an effective check on alternation or polypharmacy, for there is nothing in the provings to justify either habit.
We must know the laws governing homoeopathic treatment and the cure of disease as given in the Organon and the Chronic Diseases. It is ludicrous to expect the results of master prescribers unless we follow Hahnemann explicitly and whole heartedly. His strict inductive method outranks the sometimes conventional or appealing idea to think of remedies in connection with disease in the treatment of which they have been frequently useful. There is not place for empiricism in the teaching of Hahnemann. Remember, our remedies as powerful curative agents regardless of disease labels or laboratory findings, so far as selection is concerned. Characteristic symptoms characterize the patient, not the disease.
The use of a repertory checks the inspirational or psychic prescription. It demands a reasonable consideration of the complete totality to the greatest possible detail. There will be one-sided cases, and some in symptoms stated in language not found in the provings. These are challenges to the accurate observer, his art in questioning; his patience in waiting. Again, to repertorize we want all the deviations from health, all the disturbance of mind, body and soul that we can get without influences on our part. Each case must be open and met without prejudice, or preconceived leanings toward s suspected remedy.
Persistent use of the repertory avoids the overworking of favorite remedies. I believe it was Dr. Hayes of your Society who once suggested, “Try prescribing one week without using your ten favorite remedies.” A few examples. Take throbbing pains. The first thought of many men is Belladonna. But turning to the repertory rubric you see how Aconite, Calcarea carb., Phosphorus, Pulsatilla, and Sepia and have this characteristic pain to a higher degree than the overworked Belladonna. Individualize for example as to the time of the throbbing pains, say after midnight, and note the prominence of Bryonia, Calcarea, phosphorus, Sulphur, and Sepia.
Or, take aggravation from motion. How quickly we think of Bryonia. But what of Arnica, Arsenicum, Apis, Belladonna, Carbo veg., Colocynth, Digitalis, Gelsemium, Hepar, Ipecac, Lachesis, Mercurius, Nitric acid, Nux vomica, Phosphorus, Sulphur, Silica, Veratrum and Zinc? Some of these are aggravated as prominently as our first thought, Bryonia. One other example, tearfulness. This will suggest Pulsatilla to many. But we overlook Aconite, Apis, Antimonium tartrate, Belladonna, Bryonia, Calcarea, and many others if we overwork the Pulsatilla bottle. This overworking or habit forming use of a remedy is well offset by reference to the repertory.
