I. A young man woman complained by phone of a steady ache and tenderness to touch on the right rib an inch or so from the 4th or 5th costosternal articulation with the desire to stretch the torso backward, and thus relieve it. She had it some years ago, she said. Then I remembered having treated her for a moderate scoliosis and anaemia with scanty symptoms fifteen or so years before which, I see by looking up her record, was corrected with Med. 200, Bac. 200 and Puls. 1000. The other symptoms now present, although not necessarily associated with this chest pain were;
Cough every half hour.
Scratchy throat (takes cigarettes on formal occasions only): scanty, stringy, tenacious expectoration.
Easily flushed from hurry, exertion or excitement.
Desire flushed from hurry, exertion or excitement.
Desire for deep breath.
O, these little cases that have such slight characterization to interest one! I suppose almost any remedy might be given and doctor and patient get on together somehow. Yet the patient wants relief; and the prescriber likes to feel some certainty of good selection, especially when he may feel lacking in spiritual perception. So this time out came Boger’s concentration of Boenninghausen, the Cards and General Analysis, to see what they would do.
The synthesis; figure taken from the General Analysis.
Cards show three Larynx Voice Cough
Sticky Redness Exertion. Excitement Respiration Bones
remedies Phos. 3 3 3 3
1 1 3 2 1 9-19.
Puls. 1 1 3 2
2 3 2 1 7-15.
Sul. 1 2
32 1 3 3 7-15.
Enumeration, Phos. largest; value of symptoms, Phos. greatest; missing symptoms, Phos. least; characterization, Phos. strongest; effect on prescriber, good; time consumed, 7 minutes. Phosphorus 30 4 d., 1 every two hours, cured.
II. Single girl of 27, a tall, slim, talkative blonde; the report by telephone. She described the condition as white lumps of pin-head size coming around the vulva, so I understood. These itched much; she was wont to dig them out, leaving bleeding sites which soon healed normally. The lumps were rubbery, not easily crushed.
Menstruation was dark, offensive and protracted. No other symptoms were obtainable, it seemed.
Merc. sol. 10M. was given, the only excuse being “itching pimples on the (female) genitals.” (Knerr). Nevertheless, several weeks later the girl reported that although she had thought that she was feeling well before, that she had been feeling still better since taking the medicine. But the lumps were still erupting.
By questioning (over phone) I found that they had now assumed a cauliflower appearance at the apices and that they were situated about the orifice of the vagina. The same menstrual symptoms persisted and the patient did not feel as bright mornings as before. Of course experience would have pointed out the right remedy, which the reader probably knows already.
However, just that experienced had not come to me and probably the darkness was worse because of the scanty phone report. So I made a list of the fourth and fifth grade remedies from External Genitals in the Boenninghausen Pocket Book, seventeen in all. Then I became tired, so I selected five from Condylomata and played up the menstrual symptoms for a throw. Here is the result:.
Exter. genitalia Condylomata Menses dark. Menses
long. Menses off. Aggravation Morn.
Ars. 4 4
Calc. 4 4 2
Nit. ac. 4 5 4
Sep. 5 4 3 4
Thuj. 5 5 2
Nitric acid looked queer there without a tendency to flow. However, Hahnemann and Hering give metrorrhagias of sorts, besides its known haemorrhagic capacity. Not being satisfied with the result, I looked at Orifices, General Analysis, Boger, and found Calc. not there, Sepia low and Nit. ac. very high. Now the curtain was aside and the peculiar, striking and characteristic recognized. Of course Nitric Acid made a clean sweep: the 10M. used.
This provides the background for a little play:.
Scene, nowhere. (Enter two nonexistents who for want of designation may be called Doctor Socrates and Dr. Plato).
Dr.Socrates(yawning):We;;, I tried to humanize it.
Dr.Plato (rather tartly): It cannot be done. It is all very interesting but tell me this’ what proposition goes off into the far spaces of error as that of the mechanician” What misses the vital essence more completely than the manipulations of the calculator?.
Dr.S.(rousing himself): My dear Doctor Plato, you do not appear to be in your usual good form this morning. Do you appear to be in your usual good form this morning. Do you realize that you have descended from the pure reason to which we are accustomed to the uncertainties of mere analogous evidences” But
I will couple on to your thought although to me it appears to be clothed with exaggerations. Of course the answer to your question must be, in all these categories, yes. As you have guard so jealously, be found wrapped up in a synthesis? and may it not be unfolded by the presentation to the eye of the values of its components and also, though less so, of the totals of the competing remedies?.
Remember, Doctor Plato, that the wise prescriber does not necessarily award the judgment to that remedy having the largest figures per se, but (a) one’s knowledge of and experience with materia medica and practices and (c) to the qualifications gained from the texts of provings.
In this way the remedy blossoms out just as it does in the clear cut schema which does not need the repertory.
Dr.P; You have missed my point entirely. It is not the process that I object to, it is the thing itself. It is my contention that the repertories serve the part of a baby walker. Instead of studying materia medica for dear life, extracting the genius and the categories out of each remedy, the student, who often is also the physician, scuffs about with the repertory under his arm like a crutch and feels that he must depend on it at every step or whenever he comes to a title rough ground.
Dr.S: But it does not act that way : I have explained that already.
Dr.P.: I contend that it does.
Dr.S.: It does not.
Dr.P.: It does.
Dr.S.: You are crazy.
Dr.P.: So are you.
Dr.S.: Now see here; we have gained some reputation for accurate dealing with causes and effects; we must preserve that reputation. The thing to do is to submit this question to the I.H.A.; and if there is anything left of the I.H.A. after the members get through with the question, we may come to a settlement.
Dr.P.: All right, all right! But you will see that it will re4solve to nothing.
Exeunt subito. (A loud noise is heard outside).
DR.W, E.LEONARD; Your Socratic-Platonic dialogue is an excellent portrayal of the struggle that often goes on in the mind of the homoeopathic prescriber. A between natural indolence and the vain desire to be able to generalize upon our experience with remedies, there is always the demonstration by the repertory, mathematical and perfect, if you please, provided you
could be sure of the validity of all the rubrics. Granting always a lack of thoroughness in collecting ALL the symptoms, I have as often fallen down with the repertory as without it.
Therefore I would side with Plato in regarding the repertory as more or less of a crutch.
An old medical friend of mine made it a practice to read over at least one whole remedy per diem. The result was an uncanny skill in using them.
DR.GRACE STEVENS: The use of the repertory is often overdone. Real success with it depends, after all, on the right selection of symptoms to form the schema and the power to choose the right one from the several remedies which appear in the study. The knowledge of Materia Medical is the thing!.
DR. ADRIAN A. POMPE: It is very seldom indeed that I ever make a prescription without restoring to Kent’s Repertory. On trips out, I always carry the 2nd edition since I have the third in my office. I refer to it as my consultant to the patient. Some appreciate it and some think one doesnt know much, which is no doubt correct. The repertory is a crutch, but often sufficient in itself with a little use of gray matter.
DR. ALFRED PULFORD: What a wonderful world this would be if we could only supply a complete workable replica of the brain with the transfer of knowledge, if any.
It is like making calls at night. Dr. D.T. can just smell the house where he is to go and make a call and go right to it, no matter how dark the night. While I could reach Europe or S.A. on the same trip more easily than I could find that home in the dark. Dr. Hayes is imbued with that same sense in finding the right remedy and in using the repertory. His successful work demands and commands the admiration of us all.
Dr. Pompe thinks a man should be fortunate to have so many repertories, yet I do not feel so. With the most full card repertory yet attempted, it has failed me more than once, even when the case was so “well taken” that it ran down to a single drug.
The longer I live and the more accurately I try to practice real homoeopathy the more convinced I am that unless we touch the constitution with our drug, we are only removing or suppressing symptoms.
To me the Repertory has always pointed not to the ACCURATE drug, but to the most similar remedy, and that usually means the most similar remedy, and that usually means the most similar to the symptoms at hand, whether they truly relate to the drug’s true pathogenetic group or not. I find very few of the “evaluate” symptoms so evaluated as to conform to each drug’s true pathogenesis, many of whose symptoms appear in insignificant type.
With the grand characteristic of each drug, and its essential primary pathogenetic group, which together form the SYMPTOM TOTALITY of that drug, a work of that kind, together with a copy of Kent’s Repertory, or Knerr’s would be worth more to me
than all the materia medica and repertories, card or otherwise, combined. For no drug will or possibly can remove a pathogenesis unless it can directly produce a counterpart.
DR. DAYTON T. PULFORD: My ideas as to the value of repertories are still in a nebulous state, I must admit. At Boston I had drills in Kent’s by a reputed master of the repertory, the late Dr. Gladwin. We were taught to read between the limbs. I must confess that I have often found no lines to read between. Kent’s has been the cause of more profanity in my life than any other book.
A quite logical scheme is badly balled up by spreading things all through it which should be in more logical places. Fine distinctions are not drawn in places where they are needed in spite of the voluminous going from Generals to Particulars. Then the old problem of Concomitants which were a bogey man for Kent. Just to read some of his jugglings, e.g. writer’s cramp, in his Lesser Writings, is enough to show that no young man who can ill afford at least a clerk, let alone a secretary, could make more than a dollar a day.
Back of the repertory lies the inability at times to get the nature of the case and to know what to pick out if we have got it. Somewhere in the patient’s condition lies a group of symptoms, a few in number, that form the basis of the rest of his story. If we can find these the others may be disregarded. Here is where what might be called a physiological diagnosis would be of use, might also add for an alternative a mental or psychological diagnosis. It would give us the heart of the whole situation.
Sleeplessness from indigestion might call for a different group of remedies than sleeplessness from a heart condition. This together with the most important part, the patient, would clinch the remedy. The patient with a bad heart, preceded by a rheumatic trouble, which in turn was preceded by quinsy, would need our attention to the original trouble. One with pain in the knee might need us to attend to the hip. The maze is endless. Even a sinner may note sin in a church, and even a remedy may be arrived at in unorthodox fashion.
The Therapeutic Pocket Book is to my mind the most reliable and the nearest approach to a mathematical repertory that we have. Were I to pick the triumvirate of homoeopathy I would choose Hahnemann, Boenninghausen and Hering. They did the most fundamental and progressive work in homoeopathy of all. We can only progress upon their firm foundation.
Dr. Macfarlan hit the nail on the head when he spoke of Kent as a compiler. We have had so much compiling and deleting that homoeopathy has become much like the Christian religion, both unrecognizable to their founders We must keep Hahnemann as our goal and not attempt to usurp his place until we can qualify to do so.
DR. HARVEY FARRINGTON: Success in using Boenninghausen, Boger Lippe, Kent or the card repertories depends almost as much upon familiarity with the place and phraseology of the certain repertory, as it does in the ability to select proper symptoms for the schema. Boenninghausen (and Boger’s modifications of it) are to this day without doubt the best for obscure cases of those with paucity of symptoms. Pompe sticks to Kent; so do I for the most part. But this is reality because I grew up with Kent and never had expert advice in the use of Boenninghausen. It must be
admitted that Boenninghausen contains some indications which are “particular” according to Kent’s rating. But Boenninghausen was meticulous in his recording of remedies and their rating But Boenninghausen was meticulous in his recording of remedies and their rating as to degrees of importance and where his experience was limited he put over the remedy in small or ordinary type leaving it to others to raise their value. So there are doubtless many remedies in the low rating which should be marked in higher degree, and who knows? Many of Boger’s indications which Kent would consider “particular” may prove to be “general” characteristics.
DR. JOHN HUTCHINSON: In case I my attention is arrested by the modality introducing it. I am so lazy minded that whenever such a thing as a modality cries out in the wilderness I pin all my attention to it and fry out of it all. the fat possible. But Dr. Hayes is thorough and marshals his whole army to get the fat. Isn’t that what makes our Council interesting? We don’t all travel on the same highway, but “All roads lead to Rome”.
In case I, I should, or rather, would have chosen another one of the remedies shown in the picture, and probably failed and so zig-zagged along to the similimum if ever.
No. III is a literary fortress. If any of us can select either Socrates or Plato without choosing both he is some analyst.
I sometimes wonder what Dr. Hayes is-a philosopher, a materia-medicist, an artist, a wizard, or an all-round Hahnemann, and let it go at that. His mind seems equal to the dissection of any problem, and not only its dissection but its distinguished solution. This is not intended to be personal at all.
It is only to show that rugged individualism is the thing, and we are most lucky whenever our members-or any one of them- will exhibit it so forcefully that he makes out his case, wins his point, and so convinces and inspires us with the logic of his results.
I use the repertory in a very imperfect and desultory way. With an intricate case I may go to it simply to refresh my memory as to the names of remedies. Those names that are illuminating I take to the materia medica and read their text. It seems impossible for me to introduce into the performance any branch of mathematics.
DR. MAURICE TURNER:I’ve brought myself up on Boenninghausen, and had to dig out the concordances, i.e., the use of them, and altogether have had more satisfaction from the Therapeutic Pocket Book than from any other repertory.
I like the paper of the kind Dr. Hayes has given us and thank him.
DR. HAYES: Ha! Ha! Ha! I did not expect to hook out such a bagful of professional skeletons, confessions and sundry complexes as have come to the surface here. Nevertheless, I know that they do not exist without good reason. The discussors may be depended on for that. The discussion has such good points that it is almost an impertinence to meddle with them but I will
permit myself to call out a few of them.
Dr. Farrington remarks that in the older days of the Pocket Book practice the prescribers had to be good materia medica students. I like the way he said that. He did not say that they knew a lot of materia medica nor what they carried around a caput full of keynotes. There is a difference! Which the reader may apprehend without further hint of mine.
On second thought, though, I will point out that the remarks of Dr. A. Pulford do imply, if not intentionally at least by the genius of his motive, this same difference; and in favor of remedy genius of his motive, this same difference; and in favor of remedy genius rather than symptomatic chatter. I wish that the same Dr. Pulford might present a diversified series of successful cures demonstrating his mental processes from the “taking of the case” to the final decision. I do not mean that he should intend to demonstrate any theory of his, not at all, but just his own natural processes. Can he do that?.
Wise is Dr. T. Puldford! “Back of the repertory lies the inability at times to get the nature of the case and know what to pick out-.” “Some-where in the patient’s condition lies a group of symptoms, few in number, that form the basis of the rest of his his story.” Would that this entire paragraph might be posted on the front door of every homoeopathic college and tattoed on the breast of every student, to be kept washed and shaved, of course.
Dr. Turner is excused from more discussion especially as I remember with interest his demonstration of the use of Boenninghausen which were published several years ago and which were exceedingly instructive.
I note Drs. Leonard, Stevens and Farrington’s remarks as to the necessity that every rubric selected for repertory calculation shall be valid. I approve of Dr. Leonard writing “provided” in italics. Dr. Stevens speaks of “seeing the picture of the remedy in the patient.” In my opinion nothing in the art of prescribing can equal that.
I think that Dr. Hutchinson could give a more excellent reason for not “repertorizing,” a reason that it would be well for students and teachers to consider. He is an investigator of materia medica highways and byways and topography too, and has an uncanny insight into sick human nature.
At first I was rather amused at his reference to some of my alleged peculiarities. Then I thought, “Well! can it be posed-?” I looked up at my picture of Hahnemann; then I rushed to a mirror- horrors! Never mind, he meant well so we will let it pass this time.
There is so much that might be said not only for or against repertory practice but in consideration of a number of associated influences that it would need another paper to bring the material out. This I may do sometime if no one else does. Meanwhile I will leave my real feelings about it in the air. That is where the question will always stay anyhow, no matter what individuals decide about it.