The title of the paper is “Do You Repertorize?” and I think
I can give the answer which is that some of you do repertorize and some of you do not. This rather rambling discourse which I am about to give is pointed to those who do not.
A repertory is an index of symptoms arranged systematically. They can be arranged alphabetically, or schematically according to the parts of the body, or arranged according to certain guiding principles. The purpose of a repertory is as a reference and guide in looking up a particular symptom leading to a similimum, or that may make a distinction between two or more remedies in a given case.
Another purpose is for careful study of all symptoms in chronic case. It is not meant for use in cases with clear indications for the similimum, because in those cases close questioning may confuse the issue. I am referring to the average acute condition which we see all the time in run-of- the-mill cases. Those cases very seldom have to be repertorized nor should they be repertorized.
If you sit down and question and question, and listen and listen, you will obtain a set of symptoms in a very simple acute case that will be so confusing that you won’t hit the remedy; and, since nature gets them well anyway, you have wasted your time and your patient’s money. So, in a general way, in acute cases a repertory is not necessary, although it can be used as a quick reference to verify leading symptoms in an acute case, or to give leading indications of a remedy, or to differentiate between one, two, or three remedies that appear to have a bearing on the particular acute case.
In chronic cases, where there are many symptoms, and where the symptoms are very confused, and where several remedies appear to be indicated, I believe a repertory is absolutely necessary. I think that there are very few homoeopaths, no matter how skilled and how well-versed in the basic principles of this art, who can take a complicated chronic case and, at the end of the time say, “That is the remedy.” There may be a few who can do it and I should like to meet them and learn how it is done. These chronic cases show so many inherited tendencies, and many of them have ……..
been marred by mismanagement and overeager prescribing-even homoeopathic prescribing in a chronic case can complicate itself- that the final task of reaching the similimum is very difficult.
We must have a means of eliminating and of reaching the point where one or two remedies clearly stand out as suitable and appropriate to the particular individual who is ill.
There are several different types of repertory. There is a repertory based on general and particular symptoms, such as Kent, and Lippe, and Lee.
Another class of repertory is based on the totality of symptoms-an example of that is Boenninghausen’s Therapeutic Pocket Book-totality of symptoms as to particular points: the location or locations of the complaint, the sensations or complaints, the conditions of aggravation as to time and circumstance; of amelioration, as to time and circumstance; and concomitants.
Then there are what we call the concordance repertories, in which symptoms as developed by the provings and clinically have been broken into parts and so listed, and these repertories are very excellent for reference, but not so good where you have to work out a remedy.
Examples of a concordance repertory are: Knerr’s Repertory of Hering’s Guiding Symptoms, Allen’s Symptom Register, Boenninghausen’s Repertory of the Antipsorics, and Gentry’s Concordance, a massive work in ten volumes.
Then a fourth class of repertory consists of what we call clinical repertories, which cover the whole or a part of the body, for instance, Lee and Clark, on Cough and Expectoration; that is a clinical repertory and covers just those particular manifestations of illness, cough and expectoration. It is very excellent as a reference. Then there is Bell, on Diarrhea, which is, without doubt, an extremely useful repertory of a particular type of diseased state; and Morgan’s volume on urinary disorders; and Lutze’s Neuralgias.
Then there are the card system type of repertory of which Field’s Card Repertory is a leading example. Dr. Marcos Jimenez, formerly of Monterey, Mexico, has devised one which he demonstrated at the convention in Pasadena. The spindle type of repertory falls into this classification, e.g. Farley’s Punch Card Repertory.
There are certain repertories not devoted to disease states or parts of the body; for instance, Sensations As If, by Holcombe, by Dr. Roberts, and by the late Dr. James Ward; Sides of the Body compiled by Boenninghausen, and Illustrated Repertory, by Gray, which illustrates the directions of pains, and it could be very useful in certain types of cases.
So we have quite a number of different types of repertories, all of which are useful. The one most commonly in use today is Kent’s, which is a repertory based on general and particular symptoms.
My personal preference is for Boenninghausen’s Therapeutic pocket Book, because that was the first one I learned how to use, and its use was taught me by my preceptor, the late Dr. H.A. Roberts. Boenninghausen’s method of repertorization is a little bit different from Kent’s and in the minds of many Kentians is a sort of “screw-ball” method of arriving at a similimum. I know Kent didn’t think very much of it-naturally, he wouldn’t -but there are some Boenninghausen men who don’t think very much of Kent either-and, naturally, they wouldn’t. But it is not my purpose to compare repertories. I just want to discuss Boenninghausen’s and cite a case worked out according to Boenninghausen’s method.
As we noted above, Boenninghausen emphasizes four points – and a symptom is not clear to usable unless it has these four points-as follows:.
1. Location of the complaint.
2. Actual sensation or complaint.
3. Aggravations and ameliorations as to:.
Now, Boenninghausen reasons that if a single symptom is complete, it must meet these four requirements. It must have location, sensation, it must have aggravation as to time and circumstance, and amelioration as to time and circumstance, and a concomitant; therefore the total symptom picture must have these four characteristics. This simplifies things because we often get many incomplete symptoms.
If an man says he has a pain in the head and can describe the pain, which is worse when lying and better from heat, and he gives no other modality in any of his symptoms, we can reason by analogy that that modality applies not only to that locality and the character of the pain in the head, but also will apply to the individual as a whole, because the head is a part of the whole, and the whole is equal to the sum of its parts.
Providing one symptom is complete, it is conceivable that the correct remedy might be found-one single symptom, a pain of a definite character, in a definite locality, a condition of amelioration or aggravation, and a differentiating factor, which is the concomitant, and the remedy can be found.
I have a case to show that that is so. The remedy was found and the patient was cured on a single symptom. Sometimes the condition of an aggravation or amelioration may be the differentiating factor or concomitant. Sometimes it is a symptom which apparently has no bearing on the case at all, but which really has because it occurs in this particular patient. It may seem insignificant and unimportant, but it is important because the individual who is ill, whom we are considering, has expressed it. That is the concomitant, and it is really a little bit difficult sometimes to recognize what are the concomitants.
If, in a page of fragmentary symptoms, those four elements, locality, sensation, aggravation and amelioration, and concomitants-if these four elements can be found and brought together to make a complete symptom, there is hope of finding a remedy. The location, sensation and conditions are not enough; the concomitant must be added, the peculiar or added feature which always exists in every totality, by which it is differentiated from every other remedy, and that is the strange, rare, or peculiar symptom Hahnemann spoke of. The concomitant symptom is to the totality what the condition of aggravation or amelioration is to the symptom. That is Dr. Roberts’ interpretation of a concomitant symptom.
A woman in the 7th or 8th month of her fourth pregnancy complains of pain in a spot below the right breast which gradually becomes worse until it is a tearing and raw sensation. The pain runs from the right hypochondriac region over the epigastrium to the left hypochondrium. After lying down in bed the pain becomes so severe she has to get up and walk about for relief, which comes about 12 p.m. Aggravation lying on painful side.
” in for part of the night.
” after lying down.
” when quiet.
” slight touch.
Amelioration moving about.
Now, this case really represents a single symptom which refers to a particular type of pain. It sounds as if there were a lot of symptoms there, but, according to Boenninghausen, this is a single symptom, and the remedy was arrived at on that basis.
The first thing to look for is location, which is the right hypochondrium. Although the pain goes from the right hypochondrium to the left, use the place where it originated.
Now for the sensation and complaints: There are two, one of tearing and one of rawness. It was stated that the pain was a tearing and raw sensation. Under the Boenninghausen system, we are obliged to use two rubrics. One is tearing and one is rawness, but since they are both referred to the inner portion of the body, they are both referred to the inner portion of the body, they are tearing internally and rawness internally. We have now met two portions of the requirements, location and sensation.
Now we have to meet the conditions of aggravation and of amelioration; as to time and as to circumstances. The pain is worse before midnight. Translating this into repertory language, we use the rubric “aggravation in the forepart of the night.” The pain is also worse when lying down, from lying on the painful side, and from slight touch, all of which cover aggravation as to circumstances. Amelioration as to circumstances is covered by the rubric, “amelioration from walking”.
The fourth requirement for a complete symptom is a concomitant. Now, where is the concomitant in this case? Is it not the fact that the woman was pregnant? While there appears no relation between the symptom discussed and pregnancy itself, the occurrence of the complaint during pregnancy makes the fact of pregnancy in this instance important. Therefore, we use the rubric “pregnancy ” as the concomitant.
We have now “blocked out” the case. That is, we have translated into repertory language the language of the patient, have indicated what rubrics are pertinent to the symptomatology of the patient, within the structure of Boenninghausen’s system, keeping in mind the four important requirements of location, sensation, modality and concomitancy.
We are now ready to proceed to the next step, namely, a consideration of remedies which present a symptom picture similar to that of the patient. Among these the similimum will be found.
These simplest procedure in a simple case showing a single symptom is to choose a leading rubric then to select from that rubric all the remedies ranking 5 and 4 against which to run all the other rubrics of the case. In this instance we have chosen all the remedies under the rubric “right hypochondrium,” having a value of 5 and 4. These are: Aconite, Baryta carb., Ammonium carb., Belladonna, Bryonia, Chelidonium, Kali carb., Lycopodium, Nux vom., and Sepia. The remaining rubrics are now run against these remedies, the value of the remedies in relation to the particular rubric being set down opposite the remedy as shown in the accompanying diagram:
Acon. 5 3 3 4 4 3 4 3
Barc.c. 5 3 2 2 5 5 2 2
Am.c. 5 2 3 3 4 2 2
Bell. 5 5 5 2 4 3 3 5 5 9/37
Bry. 5 5 2 4 4 4 4 4 4 9/36 Lyc
Chel. 4 4 2 2 2 4 Bell
Cocc. 5 3 4 2 2 5 Sep
K.carb. 5 3 3 3 2 3 2 2 2 9/25 Bry
Lyc. 5 5 2 5 5 4 5 4 3 9/38
Nux v. 5 5 5 4 2 4 4 3
Rhus 3 2 4 5 4 4 2 5 4 9/33
Ruta 3 3 4 4 5 4 4
Sepia 4 5 4 4 4 3 3 4 5 9/36
Page 82 188 175 289 271 290 294 320 294
1. Right hypochondrium
2. Tearing internal
3. Rawness internal
4. Worse lying
5. Worse forepart of night
6. Worse lying on painful side
7. Worse pressure external
8. Ameliorated walking
A further glance at the diagram, which represents the repertorial workout, will show that only five remedies come through in the highest degree, i.e. covering all the rubrics and having the greatest numerical values. These are Lycopodium 9/38, Belladonna 9/37, Bryonia 9/36, Sepia 9/36 and Kali carb. 9/25.
The decision to prescribe Lycopodium was based not only upon the fact that it had the highest value, repertorially speaking, but also upon the characteristic direction of the pain, i.e. from right to left. The potency used was the 3x which cured.
The repertorial principle and method outlined form this simple case composed of a single symptom can be applied successfully to those cases exhibiting many symptoms or fragments of symptoms. The procedure is somewhat more complicated than for the case cited and takes considerable time but the results are comparable and consistently accurate. a word of warning to those not skilled in the use of the repertory must be added here: No repertory chooses the similimum; it simply eliminates those remedies which do not and can not cover the case. The court of last resort is always the Materia Medica.
80 MAIN STREET,
DR. EDWARD C. WHITMONT (New York, N.Y.): I asked Dr. Sutherland especially to speak on Boenninghausen because I admit I am at a loss about it, and it would be a great help if the different indications for Kent and for Boenninghausen could be brought out now.
DR. A.H. GRIMMER (Chicago, Ill.): Of course, I am in favor of anything that brings us to the remedy, and those who are used to working with one system will work better with that system, and I would advise them to stick to the way they have been trained and the way they have worked and gotten their results, but, as the Doctor has shown us here, if we analyze, we will se there isn’t such a vast difference, after all.
He takes the one symptom, but in his analysis of it, the demands that Boenninghausen makes for modalities, that is, the time and circumstance, and so forth make that symptom a fact, and there can be no question but that it is a genuine indication and that is brought out by Boenninghausen’s demands; also, that when you have a thing like that, you have what is termed generally a one-sided case; that is, it is only related to the one thing that that patient is complaining of, and otherwise the patient is well. Of course, that covers the whole case and becomes a very high grade general, because it is the patient, so, after all, they come down to the final analysis, and they come down to about the same principle.
DR. ALLAN D. SUTHERLAND (Brattleboro, Vt.): It is interesting that in comparing the results gained from Boenninghausen and Kent, you come to the same group of remedies. Now, we were at Forest Hills in Boston in 1946 with the Foundation Postgraduate School, and we had a nice class down there. There were one or two doubters, especially doubting Boenninghausen’s method. They all knew Kent and couldn’t see how boenninghausen was worth a dime and stated so in no uncertain terms.
One of them particularly, who was an Indian, was in a continual turmoil and state of argument with me over the effectiveness of Boenninghausen, so he handed me a case that he had already repertorized by means of Kent’s Repertory, which I didn’t know at the time, and said, “I wish you would repertorize this. We have been trying to help this man.” So I spent quite some time one evening and worked it out and brought in the list of remedies.
Remember, you very seldom come to any one single remedy in any repertorial study. You have eliminated all but three, four, or five, and have to go to the Materia Medica in the last analysis to determine which of them you will use for the patient.
I brought in a list of three or four remedies which had come through with Boenninghausen, the remedies which we had to compare with the patient, and with the Materia Medica to get the true similimum. Then he hauled out the sheets on which he repertorized according to Kent’s method, and he said, “Now, we will see,” and we did see. We had the same group of remedies in the Boenninghausen. One might have had the highest value in Kent and it might have had secondary value in Boenninghausen. Sepia might have been at the head of the list instead of Lycopodium, but the same remedies were there.
DR. GRIMMER: In the final analysis, the repertory will give you several, from which you have to choose the right one.
DR. SUTHERLAND: You will never hit the similimum if you depend entirely on the repertory.
DR. GRIMMER: Right! It never was intended for anything but to bring it down to a few remedies.
DR. WHITMONT: Boenninghausen is more suited for cases where you have a few symptoms or a symptom, rather than a broad constitutional state.
DR. SUTHERLAND: From a theoretical point of view, I wouldn’t say Boenninghausen was more suited, but just as well suited for a case with few symptoms as for a case with a lot of them, and this is an example of what I mean. This case had very few symptoms, as we usually understand symptoms, and so far as Boenninghausen’s method was concerned, it had just one symptom, because one symptom is comprised of four parts under Boenninghausen’s method: location; sensation; aggravation as to time and circumstance, amelioration as to time and circumstance; and concomitants. That group of four is a symptom.
DR. WHITMONT: Did you have two or three main symptoms, and the concomitant may be a symptom-either a symptom may be a concomitant or a sensation?.
DR. SUTHERLAND: Sometimes a sensation is a concomitant; sometimes a condition of aggravation or amelioration is a concomitant. A location rarely is a concomitant.
DR. WHITMONT: He has something on the nose and something on the foot. Would you not consider that “something” as a concomitant?.
DR. GRIMMER: The associated symptoms.
DR. SUTHERLAND: The concomitants are more or less associated symptoms, but sometimes it would be that you would consider aggravations as concomitants, and while you would still have a listing under the section “aggravation and amelioration,” you would save some of those to go under the concomitant. It depends a little on a little experience with the use of the repertory. You can’t get it all at a session like this. There are a lot of angles I have left out because if you are going to discuss Boenninghausen’s Repertory, you can sit down and discuss it for years on end, as you can with Kent.
DR. ROBERT H. FARLEY (Philadelphia, Pa.): How many remedies does Boenninghausen consider?.
DR. SUTHERLAND: Three hundred forty-two.
DR. FARLEY: How many does Kent have?.
DR. SUTHERLAND: About six hundred and Kent, true enough, considers remedies which are very useful and that you would never arrive at by Boenninghausen’s method. That is one of the failings, but it is not a failing in the method; it is a failing in the compilation. I think it was Dr. Roberts’ purpose, had he continued to be in health, to enlarge the number of remedies compiled under Boenninghausen.
DR. WHITMONT: In Kent only, polychrests are completely carried through. If you take a case on generals, you usually end up with a polychrest.
DR. FARLEY: That has also been my experience. That is one of the reasons why sometimes your most carefully worked out remedy fails to produce results.
DR. SUTHERLAND: That is correct.
DR. FARLEY: That has been recognized in homoeopathy for many years, ever since there has been homoeopathy.
H.C. Allen used to teach the use of nosodes, and where the best homoeopathic remedy fails to produce your result, why shouldn’t it be just possibly that of all the sickness-causing substances in the world, those that are going to cure this particular patient have not yet been investigated? We haven’t anywhere nearly proved all the things that can cause sickness. Perhaps it is one we have not investigated or have incompletely investigated, so you can’t expect perfection from any method that we use.
DR. SUTHERLAND: I think that is very true, and that is one reason why provings need to be continued, because, as you say, we meet cases where there has been no proved remedy to meet that particular disease state in that particular patient. There isn’t a remedy which we know anything about which would suit that patient.