The word repertory brings hazy thoughts to physicians of something mysterious, difficult, something better left alone. To others the value of repertory study is clear but the amount of work necessary to enable one to use a large repertory to advantage is appalling. So all the earlier works are out of print, every edition is small; it is hard to persuade a publisher to undertake the many difficulties of printing; the cost of the student remains high and the danger of typographical error great.
Yet the repertory to the homoeopathic materia medica is its key; it unlocks the treasure house of provings and makes them available for practical use.
1 – REPERTORY MAKING.
In order to understand any repertory it is necessary to consider how the different general ones were made. By general repertory I mean one which aims to cover the whole field in distinction from the repertories of special symptoms or special diseases. The general repertories,so far as I know them, will be considered in this paper and the special repertories listed as an addition to it. I am indebted to Dr. F.E. Gladwin for her clear presentation of repertory making and to an editorial by Dr. H.A. Roberts in the November 1930 Recorder fro the fullest list of special repertories I have seen.
Repertories were started as soon as provings became so numerous and bulky that ones mind could not retain the characteristic symptoms. One student after another cast about for some satisfactory method of cataloguing symptoms so that the remedy might be found without reading the whole provings. Naturally each compiler chose a method suited to his own needs; therefore the methods are different and it becomes necessary to search for the framework on which each repertory is built before we can use it intelligently either for remedy study or for compiling new repertories.
The first repertory in America was a Repertory to the Manual published in Allentown, Pennsylvania, in 1838 by Constantine Hering and the faculty of the Allentown College. This is not in existence now, so far as I know, hence its plan or method cannot be stated, though undoubtedly it influenced the work of later compilers, especially that of Constantine Lippe.
Boenninghausens Therapeutic Pocket Book came out in 1845. It has had several editions and translators and is still in daily use, a masterpiece in generalizations. Each translator was likely to add a few remedies from his own observation and experience, some thoroughly proven and some included on clinical ground only.
Boenninghausen showed his plan for a repertory to Hahnemann and secured his approval when the work was far larger than it finally became in the much condensed Pocket Book. The idea of generalization controlled his work more and more, so we finally have a book small enough to carry in ones pocket with enough suggestion all through its generalizations so that a student whose mind works the same way can read much between the lines and reduce the remedies similar to the case in hand to a small group, which is all any repertory can do.
A symptom is general, according to Boenninghausen is one without modification. No matter what the modification may be as to time, place or circumstance, any remedy having the symptom should be placed under that symptom in general. Also location is very strong in the Therapeutic Pocket Book. Therefore the parts of the body are leading headings and under each is listed all the remedies having anything to do with that part. For instance, head in general has under it all remedies that produce any kind of symptom in any part of the head. Then parts of the head are listed with their symptoms in general. Some symptoms of parts are given under these general headings and these in turn are generalized. A few of the large headings or departments close with a group called accompanying symptoms, as “accompanying troubles of respiration”, “troubles associated with cough”, etc.
The requirement that each case be individualized is met by the mental symptoms in general at the beginning of the book divided into Mind and Intellect, by the full list of Sensations and the sections called Aggravations and Ameliorations. These three sections are also done with emphasis on the part affected and done in general.
To study a case with the Therapeutic Pocket Book one must look up the part or parts affected with any general groups under them pertinent to the case, combine these with Sensations noted, circumstances of Aggravation and Amelioration and anything characteristic that can be found under Mind, Hunger and Thirst and the “accompanying troubles” groups.
The remedies are given in five kinds of type to grade their values in the symptom groups. Therefore, the student can find those remedies running through these general headings which have the highest values. The Pocket Book then furnishes him further aid. The last third is given over to “Relationships of Remedies”. This is an alphabetical list of remedies with the same general headings for each and under each heading related remedies printed in the four types to show the degree of relationship.
The headings here follow the same thought as the first part of the book, stressing location, sensation, aggravation. Under each of these remedies is a heading called “Other Remedies”. This gives the student the remedies related to the one under discussion, also in the four grades of relationship. Some advanced students, who know the materia medica quite well, make great use of this last group, often seeing there at once the remedies most closely related to the case in hand and going from there directly to the provings to make the final choice.
To Quote Dr. C.M. Boger:.
I have nearly all the card indices, but could not use them to advantage, so I slowly worked out one to suit myself. It was first printed in book form for pocket reference and later transferred to punched cards to insure greater facility in use. The production of these cards was very troublesome until I found a firm that gets out statistical card indices for the government. It agreed to print my rubrics on their forms and punched them accurately as per sample. the continued use of these cards slowly evolved a system which depends upon a three fold classification of symptoms; first, fundamental, constitutional or life time effects; second, the present display which is a fresh or acute outburst of the deeper lying tendencies; and third, the modalities. As you see its basis is essentially that of the philosophy of the Organon.
Obviously, every mind has more or less of its own point of departure from which it views the symptom image. Boenninghausen originally followed the regional-general-continual method as found in the Pocket Book; in his later life he picked out the essentials, found their concomitants and conditions and added the weight of clinical confirmation. All this is very plain in his Aphorisms of Hippocrates published shortly before his death.
A controversial subject concerning the Boenninghausen repertory is this, to quote from a lecture by Dr. Gladwin:.
For an illustration let us take the sensation of “Intolerance of Clothing”. Under this rubric are the remedies that have intolerance of clothing about the neck only; about the stomach only; about the abdomen only; and the remedies that are sensitive to clothing everywhere.
This arrangement makes it look as though Boenninghausen believed what was true of a part was also true of a whole and what was true of a whole was true of all of the parts, viz., if a remedy had one kind of a pain in the head, it was likely to have any kind of pain in the head; if it had nausea or one kind of pain in the stomach, it could have distension or any kind of pain in the stomach; if it had an aggravation in one part, it could have the same aggravation in any part or all of its parts.
Logic teaches that what is true of a whole is true of its part, but it does not teach that what is true of a part is necessarily true of the whole.
However, Boenninghausen selected so well and grouped so well that the Pocket Book seldom fails the careful student.
Next we come to Jahrs Repertory as translated into English from the French by Curry. This is the second part of Jahrs New Manual of Homoeopathic Materia Medica. Jahr did what many teachers are trying to do in these days. he sought to meet his students on the ground of their previous instruction and lead them into homoeopathic thinking.
He wanted to make a repertory that such students would understand, so he listed remedies for disease, then he listed remedies for symptoms of diseases, then finally he gave the symptoms of the patient, general symptoms modified and lastly particular symptoms with their modifications. He emphasized in his preface that the symptoms of the patient were the most important and must be sought before a curative remedy could be found. Therefore this repertory is really two, a repertory of disease and a repertory of the patient.
Later in translating his work into German (his Hand Book) he endeavored to call groups of symptoms diseases and asked his students to prescribe for as many of these diseases as possible, in this way hoping to lead them to consider the patient as an individual.
Jahrs idea of symptom in general was very different from Boenninghausens. To Boenninghausen this meant a symptom without modification, any symptom that had been produced in the part. To Jahr it meant the indefinite symptoms, those with nothing to pin them to anything; it meant also the symptoms having quite a number of different modifications. Jahrs particular symptoms are those modified in one particular.
Next consider the Hempel Repertory, being the third volume of the Symptom Codex published in 1853. When Charles J. Hempel had finished translating the Symptom Codex, he wanted a repertory of the symptoms contained in it. He did not believe in dividing or changing symptoms; they must be kept in the words of the prover, so he copied the symptoms as given, repeating each time the wording was different even with no change in meaning, e.g., “burning in stomach”, “burning pain in stomach”, “vertigo when rising from a chair”, “vertigo when rising from a seat”.
So Hempel thought mostly in particulars; the symptoms rarely have more than one remedy and with a change in just one word, but often no change in meaning, the remedy is different.
Calvin B. Knerr, son-in-law of Constantine Hering, published his Repertory to the Guiding Symptoms in 1896. He uses the same form throughout as found in the Guiding Symptoms, even to gathering the “relationships” at the end of the book and giving the remedies the four lines of grading. It makes a book that is bulky without being useful in every day study. As a reference repertory for comparative research it takes its own place.
Constantine Lippe published his Repertory to the More Characteristic Symptoms of the Materia Medica in 1880. He patterned it after the Allentown repertory of 1838 and added selections from the works of Boenninghausen, Adolph Lippe, Bell, H.N. Guernsey, Hering and Jahr. He follows the order of parts of the body as given in the Materia Medica Pura and ends with a section called Generalities with which all previous sections are to be compared. Like Boenninghausen he used the indented lines with dashes at the left to show the dependence of the indented symptom on the one above. In other words, the full line symptoms are headings or leading symptoms and those which are indented are modifications of them.
Unlike Boenninghausen, Lippe uses only two kinds of print to show grades of symptoms; Boenninghausen uses five.
Lippes Repertory is well put together, but poorly printed on poor paper. It is difficult because the great majority of rubrics have so very few symptoms that combinations of them lead nowhere. The book needed to be enlarged; students could not find enough in it.
James Tyler Kent, when he wanted to develop further the general symptoms with their modifications, began to write notes on remedies and symptoms into Lippes Repertory. When the little book was full of notes, he began on an interleaved copy. When this was full he made loose leaves useful for additions. The further development of Kents Repertory would best be told in the words of Dr. F.E. Gladwin who studied with him at t he time he complied it.
Dr. Kent held that all repertories were but compilations at best and the verified symptoms of a remedy were the property of all. This being the case, it would save much time if he began where the others left off. So to save time he asked his students to copy the symptoms and remedies already collected in the other repertories. Dr. Milton Powel and Dr. Mary Ives copied a goodly portion. Dr. Arthur Allen was given the Eye symptoms. He asked me to copy Thirst. He then gathered in the various copies and began to add his notes. In so doing he found such symptoms as “pain in head after meals”. To his mind this logically belonged under Head but his copy compelled him to put it in Complaints After Meals.
Things that logically belonged under Throat, were under Fauces, Pharynx and OEsophagus. Appetite, which logically belonged under Stomach and Taste, which logically belonged in Mouth, were in a chapter called Appetite and Taste. Eructation, Nausea and Vomiting which logically belonged in Stomach were in a chapter by themselves.
Dr. Kent thought it would be more logical and would save time in working a case, to group all of the kinds of pain together in each of the parts instead of arranging them alphabetically, that is, Aching pain under A, Biting pain under B, and so on as Lippe had done.
The more he worked upon the Repertory, the more he discovered that he couldnt follow Lippes form, and when he had a voluminous manuscript – it looked to me like a very large repertory already finished – he put it all aside and began again. All of his work to that date and the work of the students counted for naught excepting to show him that if he was to make a logical repertory from beginning to end, he must start at the beginning and rearrange.
In copying the symptoms in general from Boenninghausen he found that Boenninghausens symptoms in general did not follow the idea of the symptoms in general that had been followed by Jahr and Lippe. This taught him that he could not combine the rubrics of different repertories; he must verify every one that he copied to make sure that all of the remedies under his symptoms in general belonged there. This meant much sifting out, for he agreed with Lippe and Jahr in what a symptom in General should be. In this kind of work his students could not help, so the Kent Repertory as it stands today, represents years of work by one man.
In Dr. Kents mind location seemed of chief importance in finding a remedy, therefore all of the symptoms affecting a part were placed in alphabetical order in the chapter of that part. If it affected the whole, then it was placed in whichever chapter of a whole that it belonged. The arrangement of the chapters followed the order of parts that Hahnemann used in his provings.
The mental generals (controlling symptoms), with the exception of a few found in Sleep, are in the first chapter which is called Mind. The physical generals (controlling symptoms), those that can be predicated of the patient as a whole, are found in the chapters on Sleep, Chills, Fever and Generalities. The symptoms of the part run through the other chapters, each containing all the symptoms of that part.
In the Kent Repertory the general symptoms are the mental symptoms and those that affect the patient as a whole. These are found in five chapters but the symptoms in general are found in every book in the Repertory.
What general symptoms and symptoms in general are must be remembered in the analysis of the case for each must be taken to each in the Repertory. For instance, if the patient had headache worse in the morning on rising, if nausea and his rheumatism are worse when he first gets out of bed and his catarrhal symptoms are worse at the same time, he has a general aggravation in the morning on rising and it should be looked for in the chapter of Generalities.
The symptoms which make up this general are also placed under the parts in which they occur. If he has headache from bathing, from blowing the nose, from riding in a boat, etc., he has headache in general and it should be looked for under that rubric in the chapter on HEAD. If there had been several aggravations of the headache in the morning then it would have been headache in general in the morning and be looked for under that rubric. Knowing these things shortens the working of a case.
In each chapter throughout the book the arrangement of the symptoms is the same. In this arrangement the alphabetically first, symptom in general of the whole part stands first. This is followed by its modifications. If there are two of the part as the ear or eye, or if the part is divided as in forehead, the first modification is Side and the second modification is Time but if there is only one of the part and the part is not divided then in both cases the modifications by Time comes first; these are followed in alphabetical order by the modifications, by the conditions or circumstances under which they occur; when the symptom is modified by extending somewhere: extending, instead of being placed in its alphabetical order, is placed at the end of the alphabet after W. After all of the modifications of the part as a whole have been considered the parts of the part are taken up in like manner – symptoms in general first followed by its modifications by sides, time, circumstances, or conditions and extending.
Wherever the prover reported “boring in the head”, “burning in the stomach”, “shooting in the extremities”, etc., Dr. Kent said boring, burning, shooting, etc., are pains and should be classified as characteristic of pain instead of as as individual symptoms, therefore instead of placing boring as a symptom under B he placed it under the characteristic of pain. The characteristic of a symptom always follows the modifications by circumstances or conditions. Under the characteristic of pain in the head, boring pain comes first and it is treated just as pain in general was treated. This is followed by the different kinds of pain in alphabetical order each treated in the same way.
Dr. Kent shortened his Repertory by the use of synonyms. In the materia medica stabbing and sticking pains often appear; in the Kent Repertory stabbing and sometimes lancinating pains become cutting and sticking becomes stitching. The materia medica and the patient have throbbing headache but in the Kent Repertory it is pulsating and is found under pain in general of the whole head and pulsating under pain in general of the parts of the head. There is also a painless pulsating in the head. This, instead of being a modification of a symptom, is a symptom in itself therefore falls in its proper alphabetical order of symptoms.
When a symptom cannot be found in the Repertory, look of its synonym. Hammering pains, pulsating pains, radiating pains, spasmodic pain, wandering pain are found in alphabetical order among the modifications of pain in general of the part instead of under the character of the pain.
The Kent Repertory came out first about 1900 in paper fascicles, one for each major section of the book. Now we have it in its third edition with poorer paper than the second edition and many more typographical errors. This third edition was printed by Ehrhart & Karl in 1924, eight years after Dr. kents death, from notes made by him in the second edition.
It is a colossal work, the only general repertory yet compiled which works out modifications logically to great detail. To the student who learns its method and works through it constantly the book is dependable and satisfactory.
Students should learn the Boenninghausen method and the Kent method of repertory study. Some minds are more at home in one and some in the other. Some use Boenninghausen for generals and Kent for particulars. Everyone should know Kent thoroughly and everyone who knows it will use it more or less every working day.
So much for the making of the general repertories in book form; one might mention in passing Gentrys Concordance built on the key-word theory. This is in six volumes and is absolutely worthless on account of bulk and repetition without useful method.
Several times one of our physicians has attempted to make a card repertory by placing a symptoms on a card with the remedies having the symptom below it and punching with different shaped holes to indicate the grading of the remedies. The idea is to select the cards related to the case in hand, place them over each other in front of a good light when the punching will make those most closely related shine through. This saves writing the list of remedies for each case. Another way to save writing has been devised in slip sheets, each sheet containing a printed list of most remedies and a system of squares opposite each remedy in which to write the grading of symptoms in numbers. The remedies are listed vertically and the symptoms written in horizontally. It is similar to mathematical plotting.