C.M. Boger, M.D., Parkersburg, W.Va.
Most repertory making is the compiling of a working index of the materia medica, and because of its magnitude has long ago passed beyond the power of a single mind. Even major works of this kind soon fall behind developments, so we now use a form of analysis which assembles the most salient and useful points into rubrics, which are then arranged in a flexible and easily grasped schema.
Illness may present any possible combination from among many thousands of symptoms, although as a matter of fact such extreme variability of disease expression is the exception; were it otherwise the problem must remain practically unsolvable. Most of its symptom groups are referable to particular diseases, organs and individuals. The former two remain fairly constant, at times, however, exhibiting very pronounced disease phases, thereby beclouding the diagnosis and leading to organopathic, pathologic or diagnostic prescribing of a makeshift nature; ultimately a most pernicious thing.
Of far greater importance are the individualistic symptom groupings, for they generally show forth the real man, his moods, his ways and his particular reactions. Occurring singly, in small groups or at indefinite intervals, they often seem to lack distinctive support, hence are more difficult to link together and interpret. This encourages palliative medication and makes real curing much harder. On the other hand, cases presenting very numerous symptoms are hard to unravel, especially when brooded over by an active imagination.
The final analysis of every case, therefore, resolves itself into the assembling of the individualistic symptoms into one group and collecting the disease manifestations into another, then finding the remedy which runs through both, while placing the greater emphasis on the former. This method applies to repertory making just as fully as it does to case taking and prescribing. Therefore, the over-large rubrics of our repertories are likely to be more useful for occasional confirmatory reference, than for the running down of the final remedy.
By eliminating all but the highest two grades of remedies in the large general and including all the confirmed ones in the smaller rubrics, we bring to the fore the largest possible number of characteristics. Each case, of even the same disease, presents a slightly different alignment of symptoms, particularly in its latest and most significant development, which is usually but an outcropping of another link in the chain of individualistic symptoms belonging to the life history of the patient. This way of looking at the matter presupposes the taking of a pretty thorough case history, but furnishes a key to almost every sickness for long periods of time.
While the grading of symptoms largely depends upon their discovery and the extent of subsequent confirmation obtained for every one of them, their sphere of action is also of vast importance and may not be safely left out of the calculation, because it goes far toward making certain the choice of the remedy. To depend wholly upon a numerical concurrence is, indeed, fallacious, and yet every use of the repertory implies the presence of this factor to some extent; but it is greatly overshadowed by the relative standing of each symptom in each case. In the abstract the same symptom may have the highest standing in one case and the lowest in the very next, all depending upon the general outline of the case, as delimited by the associated symptoms. Viewed from this standpoint, symptom grading, as found in the repertories, is unsatisfactory as well as of lesser importance, and yet has some value. The relative value of a given symptom depends almost wholly upon its setting, therefore changes from case to case and is only finally determined as to its raptorial value by numerous clinical trials. If I apprehend the matter rightly, the original pathogenetic symptom is really only a hint of what it may possibly develop in the future, as determined by successive tastings. A case in point: Intolerance of clothes about the neck occurs in a good many proving’s, but it remained for Herring’s Lachesis to who that it leads them all and has only a few straggling followers.