SELECTION OF RUBRICS FOR REPERTORIZATION. I have compared two methods of approach to therapeutic problems, namely the empirical without a broad general concept that tends to bring order out of its findings, and the homoeopathic which uses experiments upon human beings in health, records its findings in lay terms, thus avoiding the need to throw away all its experimental evidence with the next change in the interpretation of symptom complexes, and is operating under a broad concept of what we consider a law of nature. The unavoidable size of our task is emphasized and a method that saves tie tote busy physician is suggested.

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… 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.

Robert Farley