In therapeutics, as used generally by the great majority of physicians, we find even to-day that the very ancient empirical, trial and error approach is still the only method attempted. While this is so old that it goes back to the times of primitive medical men, it is constantly being refurbished in current technical language and offered as the newest thing in therapeutics. In emphasizing the great need for sound conceptual schemes, this led Dr. James B. Conant of Harvard University to comment as follows: +1.
I have suggested …..(the) need to enquire as to the degree of empiricism now present in any branch of science. The cases I quoted as examples were classical optics and chemo-therapy. In the former the conceptual scheme employed has wide validity, the degree of empiricism is very low. In the latter (chemo-therapy) the concepts are few and of limited application progress toward a new drug is still very much a “cut and try” after, the degree of empiricism is high, I would like to suggest that unless progress is made in reducing the degree of empiricism in any area, the rate of advance of the practical arts connected with that area will be relatively slow and highly capricious.
Another phase of the empirical, trial and error approach to therapeutic problems makes use of statistical findings. It is certain that no one therapeutic approach can honestly be rated as 100 percent effective. Always there is a varying per cent of cases in which even the most effective single measure fails us. This has always been so. Today, as 100 years ago, criticism of this statistical method by such a great mathematician and thinker as Comte +2 seems just as valid as ever. He is quoted:
I wish to speak of that assumed application of it (the numerical method) which is called the Statistics of Medicine, from which so many savants expect great things, and which from its very nature, can lead only to profound and direct degradation of the medical art (which would be reduced by it to a method of blind enumeration). Such a method…..it will tend to make al rational medication…..disappear from medicine, by (leading) the practitioner to make random trials of certain therapeutic measures with the object of noting down…..the numerical results of their application.
It is evident that the continual variations to which all organism is subject, are necessarily more pronounced n a pathological than a normal state, and as a consequence of this fact, the cases must be even less exactly similar, whence results the manifest impossibility of making a judicious comparison between two curative methods derived from data furnished by statistical tables alone independent of some sound medical theory.
As opposed to this, the oldest therapeutic method, we homoeopaths have been carrying on therapeutic experiments under a concept, the law of similars, Similia Similibus Curantur, for over a century. This concept remains so radically new that the dominant majority of physicians throughout the world have failed to be conscious of its real meaning.
These experiments begin with the administration of a drug to a group of reasonably healthy people of both sexes, in order that we may see what disturbances of health, if any, may be observed and recorded. Very wisely such disturbances are recorded in the language of the “prover.” During the past 150 years that these continuing experiments have been practised throughout the world, a great wealth of findings has accumulated about a great number of drugs. This experimental material has reached encyclopaedic proportions, so that he who would make the best use of it, must use a symptom index which we call a repertory.
As a result of decades of clinical experience with the above findings at the office and bedside, it has been found advisable to divide these symptoms into two great classes, which have come to be known as GENERALS: and PARTICULARS: those that apply to local areas and or organs and or parts of the sufferers body. It is only through these two groups that we can approach the study of our case by the use of the repertory (index).
The first question in the mind of the tyro is how do we determine which method of approach to use in the study of the case before us? The answer lies in the story (history) of all of the patients complaints and findings. When the patient has a few general symptoms, which are usually expressed by his use of the personal pronoun, as for instance, I am-feel-hate-love-crave- desire-am aggravated or ameliorated by, etc., begin the repertory differentiation with these rubrics, as experience has long shown them to be the very best for our purpose. This is not an arbitrary grading of such symptoms, but has been based on the practical therapeutic experience of generations of keen physician-observers. This approach in oftenest useful in treating patients who have a long and tedious medical history of a series of chronic complaints.
In acute cases, and in the young, we are often compelled to approach our differential diagnosis of the proper remedy by beginning with a particular symptom or rubric that describes a reaction of part of the body rather than the whole body. For instance, the head, chest, abdomen, extremity, throat, lung, stomach, joint, muscle, etc., because often in these cases the better method of the use of generals cannot be applied, as we are unable to observe such symptoms in these cases.
When reliable modalities applying to a particular symptom can be found we are justified in giving it the value of a general rubric. Often, too, a combination of both methods may be used as even in infants acutely ill for the first time some mental quick may be apparent. Sometimes what would only be a particular, such as epistaxis, when associated with purpura, easy ecchymoses, etc., becomes a general symptom and any remedy found under hemorrhagic tendencies may be called for.
It is these particular symptoms as modified by some outstanding association, amelioration and or aggravation that have come to be known as “guiding” by Hering; “Keynote” by Guernsey; “leaders” by Nash and “characteristic” by others. These terms apply to the same kinds of symptoms. Their greatest value lies in their memorability; they stick in the students mind and severe to attract attention when met with in the patients history. Such common symptoms as diarrhoea, headache, vertigo pain, fever-which in themselves are of no help in the differentiation of a curative remedy-take on great value when association are considered with them.
For instance diarrhoea that drives patient out of bed early in the morning becomes a keynote of Sulphur; headache that begins or is much worse every morning from 9 to 11 A.M. and passes off in the late afternoon is a leader for Natrum mur.; vertigo that occurs only with the eyes closed is characteristic of Theridion, Lach., and Thuja; pain relieved by continued motion is characteristic of Rhus tox., Caps., Puls. and Sulph.; fever with desire to be covered brings Bell., Hep., Pyrog., Nux v., and Rhus tox. to mind.
However, experience has shown it to be unwise for the physician to place too much reliance upon such “leading,” “keynote” symptoms in making his selection of the best indicated remedy. It will give an occasional brilliant cure, but much oftener failure follows. For example, in the rubric given above, desire for covering during heat with its five “characteristic” remedies, namely, Bell., Hepar., Nux v., Pyrog., and Rhus tox., nevertheless, when this symptom is met with in a case of sickness, no matter what the diagnosis, any other one of the thirty-six remedies listed under the rubric”aversion to uncovering with fever” may be the better remedy to use, depending upon the concomitant symptomatology. To over-simplify our therapeutics by senseless elimination of known and recorded findings is to lead us into unnecessary failure and frustration.
Another hint as to the importance of a given symptom in any case is its prominence in the suffering of the patient. Does the patient list it as an outstanding cause of his distress? From a diagnostic standpoint it may be of little or no consequence, but therapeutically experience has shown that any particularly trouble-some symptom, whether it be nausea, sweating, thirst, weakness, or fear takes on added therapeutic value when it is unusually prominent.
The known fact that the attempt to repertorize by long hand, so to speak, is time consuming has led various men to try methods that may retain the advantages but that will reduce the time consumed. Field, Boger, Welch & Houston, W.W. Young, Weiss, and Jiminez have all used punched strips and or cards to make quicker eliminations. Some are too incomplete or too expensive. This led me in 1950 to compile and copyright a Punch Card Spindle Repertory of 190 General symptoms from our homoeopathic repertories. Enough experience has been had with each of these general symptoms to justify the inclusion of 15 or more remedies.
Those generals that either include too great or too few a number of drugs have been omitted, not because they have no value, but because the spindle method has physical limitations, which make the inclusion of more than 190 rubrics either too awkward or too expensive. Experience with the first experimental editions also demonstrated that greater accuracy in selecting a compound rubric containing remedies having all the patients general symptoms would not be enhanced by including the very large rubrics and might be inaccurate and misleading if those containing too few were included.
