Repertorising
by Dr. Margaret Lucy Tyler and Sir John Weir
Presented by Sylvain Cazalet
Sir John WeirEvery Art and every Science has its
own jargon, and the art of Repertorising is no exception. Let us get straight to terms.Success in Repertorising depends on
ability to deal with symptoms ; and this has to be taught ; it is not innate. People all the
world over are wasting their lives, working out cases at enormous expenditure of time and
minutest care, for comparatively poor results : and all for want of a little initial help.
The key to the enigma, which they lack, is the GRADING OF SYMPTOMS… The grading of
symptoms in such-wise as to economise labour without compromising results ; and, in the
cases where all the more-or-less-indicated remedies lack some symptom or other of the
totality, to know which symptoms are of vital importance to the correct prescription ; and
which are of less importance, and may therefore probably be neglected ; and also which may
be safely used as eliminating symptoms, to throw out remedies by the dozen from the
very start ; and which cannot be safely used to throw out any remedies at all, on pain of
perhaps losing the very drug one is in search of – the curative simillimum.To begin with, symptoms are of two
orders : (a) those general to the patient as a whole (Kent’s GENERALS), and (b)
those particular, not to the patient as a whole, but to some part of him (Kent’s
PARTICULARS).
THE GRADING OF SYMPTOMS
Among the Generals, the symptoms of
the first grade are, if well marked, the MENTAL SYMPTOMS. These take the highest rank
; and a strongly marked mental symptom will always rule out any number of poorly-marked
symptoms of lesser grade. (For these may never have appeared in the drug-pathogenesis –
perhaps for lack of a sufficiently drastic proving ; and yet, time and again, the drug will
clear them up). The Mental symptoms, always provide that they are very definite and
well-marked, are the most important symptoms of the case.But for the mental
symptoms particularly, it is well to go constantly through the Repertory (Mind-section),
and to master all that is presents ; and to make cross references ; and to be sure that
you get the correct rubric ; and often combine two rubrics that practically amount to the
same thing, and yet do not give quite the same list of drugs. As, for instance, aversion
to company and better alone may not be quite the same thing ; and yet it is
often difficult to sort them. Again, worse in the dark, and fear of darkness are
difficult to fix correctly in many cases, while the elements fear of robbers, fear of
ghosts – of apparitions, etc., may come in : so here you have at least four rubrics
which you may have to combine on pain of missing something. Many of the rubrics must be
considered in company, and all with intelligence and some elasticity, or there is great
danger of eliminating the very drug you are in search of. And – the better you know your
Repertory, the more rapid your work will be, and the better your results. Never grudge
turning its pages !
Second in grade, after the
mental symptoms, and his reactions to mental environment, come, if well marked, such
general symtoms of the patient as his reactions, as a whole, to bodily environment
: – to times and seasons, to heat and cold, to damp and dry, to storm
and tempest, to position, pressure, motion, jar, touch, etc. But they have got
to be in capitals or in italics in the patient as well as in the Repertory, to take this
rank ; or to be safely used, some of them, as eliminating symptoms. (“Some of
them”, because there are perhaps only half-a-dozen symptoms which it is at all safe
to use in this way ; and then only, of course, if strongly marked).And, once again, be
sure that you have your very rubric ; and if necessary combine two rubrics that work out
practically as synonyms, and yet do not present quite the same list of drugs. A doctor was
driven to despair over a case of melancholia by using better for open air instead
of desire for open air. The symptom was so intensely marked that it was used
without hesitation as an eliminating symptom, ruling out Sulphur (which has desire
for open air), but which had every other big symptom of the case in capitals and which
promptly cured. You have got to know your Repertory from cover to cover, if you are to
have the best results : and you have got to use it with brains and imagination.The third-grade General symptoms are
the CRAVINGS AND AVERSIONS. But to be elevated to such rank, they must not be mere likes and
dislikes, but longings and loathings: in big types in the Repertory, and in
the patient – in corresponding types, anyhow !In corresponding
types everywhere and all through : and this is most important. As, for instance, if
your patient is only a little restless, Ars. and Rhus., superlatively
restless remedies, will, of course, be rather contra-indicated. Big types in the Repertory
will never help you, unless the symptoms are big type in the patient too. In first taking
the case, it is well to vary the type as you set down the symptoms ; to put those poorly
marked in brackets, and to underline the intensely marked symptoms : for that will help
you to match them correctly.
Then next in importance
comes, in women, the MENSTRUAL STATE, i.e., general aggravation of symptoms before,
during and after the menses. Of lower rank comes the question of menses early,
late, and excessive – and this last of course only where there is nothing such
a polypus, fibroid, menopause, to account for it.And now, at last, you come to the
PARTICULARS – the symptoms that bulk so largely for the patient, and for which he is as a
matter of fact, actually consulting you. You will have taken them down first, with
the utmost care and detail, listening to his story, and interrupting as little as possible ;
but you will consider them last : for these symptoms are really of minor importance
from your point of view (certainly in chronic cases) because they are general to the
patient as a living whole, but only particulars to some part of him. In a great railway
system, for instance, a strike that raises the price of fuel for a few weeks, an accident on
the line that means compensation to the repair of few yards of permanent way, are less vital
to the Company than the brain quality of its General Manager, of the force, competence and
activity of the Chairman and Board of Directors. Make the executive of the Company
efficient, and it will deal in the best way with details. In like manner, put your patient,
as a whole, in order, and he will straighten out the disorder of his parts. You have got to
get at him ; and you can only get at him through his general and mental symptoms.
Start for the Particulars, and see where they land you ! In the body politic, where the
executive is not sound, you deal with lax discipline here, with peculation there, with
incompetence, and disorder, and slackness, and inefficiency. There is rottenness at the core
; and you will find that as fast as you clear up one mess ; the system breaks down at a new
part. Go for the Management ; put that right ; and let it act. So with your work : –
start treating an eczema, per se, and “cure” it, to find yourself
confronted with – say asthma ; prescribe for that, and the wretched patient comes back
presently with a brand-new disease – Rheumatism : tinker with that – and the heart gives
out. Go for the executive – for the patient himself ; – the patient who was all along
capable of eczema – asthma – rheumatism : go for the patient as a live entity, revealed
by his general and mental symptoms in chief ; deal with him according to the Law of
Similars, and he will do the rest. Always provided that the thing has not gone too far, that
the tissue changes are not too gross, he will even undo the rest, step by step
backwards, to the reproduction of the initial lesion on the skin. The whole is greater than
its part. Never juggle with “Particulars” at the expense of the life of the whole.But, in their right position of
secondary importance, you must go into the particulars all the same, and with great care (if
only to confirm your choice of the drug) ; and it will amaze you to find how they fall into
line, when the choice is correct. More than that, when the drug has been chosen on general
grounds, the patient will return and tell you, not only “I’m better”, and that the
trouble for which he consulted you is better, but he will volunteer, “My knees are
better too, all the swelling has gone” ; and referring to your notes you discover that
you had never heard of his knees before ! and he will go on and tell you that his back (of
which you hear now for the first time) is much less painful : and the constipation, which he
had not previously mentioned, is a thing of the pasts. (This was a Nitric acid case
!).Among the PARTICULARS, your
first-grade symptoms will always be anything peculiar, or unusual, or unexpected,
or unaccountable. You now want to know not only how your patient, as a whole,
reacts to environment, but how his head, his stomach, his lungs, his muscles and joints
stand heat and cold, damp weather and dry, react to stuffy atmosphere or draughts, desire or
resent movement and jar. You will find one headache being banged against the wall ; while
another has to be nursed with such extreme care that the sufferer dare not move a finger,
and would swear, if the movement of his lips were not agony, when you clumsily lurch against
his bed. Or another headache will demand a bolt-upright position ; while for a fourth the
only thing is to kneel up, while it is pressed low into the pillow, or against the floor.Now, to get the terms clearly… A
GENERAL SYMPTOM, OR A GENERAL, IS ONE THAT REFERS TO THE PATIENT HIMSELF, AS A WHOLE, AND OF
WHICH HE CAN SAY “I”, instead of “My”. “I feel the cold
frightfully : ” “I dare not move hand or foot in a thunderstorm ; and I simply
couldn’t be alone.” “This heat is knocking me all to pieces – I just can’t stand
it !” – these are Generals. In these the patient expresses himself. Remember, he is the
sum of many lives, building up many tissues, and organs of diverse function. Through the
Generals the Dweller-in-the-House speaks – through the Mentals and Generals : – the Life
which is the sum of the lives, and something beyond that : – the Life “in which they
live and move and have their being” ; and with whom, whatever their individual life and
vigour, they perish. Truly the whole is greater than its part. Surely it is scientific to
deal with the whole first, as a Whole ?But where your patient says
“My” instead of “I”, there you have a Particular. “My headache is
awful in the house : the only thing for it is to go out and walk about. It often drives me
out of bed at 2 or 3 a.m., to walk the Common for hours.” (These are not exaggerated
statements : we are giving you, all through, actual words of actual patients ; and the magic
drug for the last was Puls.).But the Generals and the Particulars
may not only be quite different, but they may be flatly contradictory in the same patient :
so you see how imperative it is to get them clearly, and to know what value to give to
each. Arsenicum is worse from cold : Ars. stands in the list of
“predominantly cold remedies” in capitals. And yet the headache of Arsenicum
is better from cold. Ars. has been described as only comfortable when “rolled
in blankets up to his chin, with his head out of the window.” Lycopodium is a warm
remedy in the main, and often cannot stand heat : yet his stomach symptoms, which are a
great feature of the drug, are ameliorated by hot food and drinks. Of these the
patient says not “I”, but “My”, therefore they are particulars. He may
say, “I cannot stand heat”, (a General of the highest importance, and one of the
most safe and useful of eliminating symptoms – if strongly marked !) – “I cannot
stand heat, but my indigestion” (a particular of the greatest importance to the
patient, and on which he lays the greatest stress) “is better for hot food and
drinks. Cold things always disagree with me”, (meaning his stomach). Again, Phosphorus
stands in capitals as a very cold person –If you are to be a
good prescriber, by the way, your drugs have got to be people for you, with whims, fancies
and terrrors ; with tempers and idiosyncrasies and characteristics : you have got to see
them stalking about the world, speaking and moving and halting, with the
bodies-minds-souls of men. You have got to travel with them in tram or train, and they
will betray themselves, buttoned up and shrinking together, or loose and jolly and open ;
fidgety, restless, fearful ; dull and inert ; quarrelling for an open window, growing at
the draught with windows closed. You have got to dine with them, and they will reveal
themselves in their relation to food and drink, and in the mental revelations such
convivial moments of relaxation call forth. You may spot them, standing for preference, or
sinking always into the nearest seat ; stoop shouldered and drooping, or erect and full of
“go” ; depressed and querulous ; restless and anxious, as their deeply lined
faces testify ; smooth and smug ; dirty complexioned and careless of appearance ; chalky
faced and flabby of superlative tissue : compact and hard as nails ; fault-finding –
affectionate and mild – responsive to every wave of sentiment and emotion – dull and
indifferent. Look for them everywhere, and learn them, and they will betray themselves at
every turn ; and you will often save yourselves hours of solid work, by spotting them as
they enter your consulting room.So, to hark back… Phosphorus
is a very cold person, but his stomach is better for cold drinks. When
that is sick he craves for cold water, which is vomited, however, so soon as it gets
warm in the stomach. This is a particular, true, but a priceless one, because it is
peculiar to Phosphorus. And here we have a new term – a “PECULIAR” symptom,
strongly diagnostic of one drug. These peculiar symptoms are especially useful in
acute diseases where you are more likely to meet them, and where they often provide a
brilliant short-cut to the drug, saving time and toil. And see how these peculiar
unaccountable, contradictory symptoms help you – how unexpected they are, and how
diagnostic ! here you have the superlatively chilly Phosphorus : and yet his pains
are often of the most intensely-burning description : and though, as a whole, he
cannot tolerate cold, yet his sick stomach craves for icy drinks, which it cannot even
retain when they get warm ! Take your Generals and Particulars mixed-up and awry and
just-anyhow, and you might land in giving such a patient Lycopodium ; for both are
worse for heat, and worse for cold ; only the Generals and Particulars are exactly
reversed ! For Lycopodium is in the main, intolerant of heat, which his stomach
craves ; while Phosphorus detests the cold which his sick stomach demands with
vehemence. See how all-important it is to get your Generals and Particulars right ! This
is where we fail, and blame Homœpathy.Then, besides Kent’s Generals
and Particulars, you have COMMON SYMPTOMS. A symptom may be common to all cases
of a certain disease, and therefore of no great use in picking out the individual remedy for
a particular case of that disease ; or it may be common to a very great number of drugs, and
therefore indicate one of a large group of remedies only ; and so of very little use in
repertorising. Take thirst, a general symptom of the patient, though in the Repertory
relegated to the section “Stomach” : – “I’m terribly thirsty.” If
there is nothing to account for the thirst, it may be an important symptom ; though
common to a great number of drugs ! But if the patient is running a high temperature, or
suffering from diabetes, or if his work keeps him in the heat of a bakehouse or an
engine-room, or if the weather is suddenly and unusually hot, the symptom becomes a Common
symptom, and almost valueless. Don’t waste life in writing down that awful list of remedies
“Thirsty”. Absence of thirst under conditions where you would expect it, on
the contrary, becomes a very important symptom, as absence of thirst with a very high
temperature – Kent has a rubric for that. Remember – THE MORE UNCOMMON A SYMPTOM IS, THE
MORE VALUABLE : THE LESS YOU CAN ACCOUNT FOR A SYMPTOM AND THE MORE INTENSELY PERSONAL IT
IS, THE MORE IMPORTANT. In inflammation, for instance, worse from pressure is what
one would expect, and of little value – so many drugs and most inflammations have it ! But better
from pressure, under these circumstances, is priceless, and leads you to a small group
of drugs, such a Bryonia. Frequent micturition with a fibroid impacted in the pelvis
is not a symptom that will help you in working out your case ; it is a Common symptom and
amply accounted for… and this leads one to insist on the absolute necessity for correct
diagnosis before you even open your Repertory. Remember, the priceless symptoms for
success are the strange, the rare, the unaccountable ones ; those that flatly contradict
preconceived ideas, and head off straight for a limited number of drugs.
“ELIMINATING” SYMPTOMS
This is a new word, but expresses
what we all desire in repertorising, and what we have got be very chary of using too
rigidly, lest we lose the remedy we are looking for.Instances best reveal meanings. Take
one. Say your patient complains of dyspepsia, with burning pain in the stomach, and the
frequent vomiting of sour fluid. He pours you out particulars, which he has at his
finger-tips ; since they are just the symptoms that impress a man’s memory, by intruding
themselves on his consciousness in a very realistic way. You jot them down till you have got
the case as fully as most people go, with all its modalities (i.e. the conditions as
to heat and cold, movement and rest, position, hours of day and night, relation to food
and drink, etc., of the stomach condition complained of). You have assured
yourself, by careful examination, as to whether the trouble is likely to be organic or
functional ; or whether some of the symptoms have got to be discounted, as secondary to some
gross lesion. And now it is your turn. You have to elicit the general symptoms of
your patient ; you have got to switch him off the siding “my”, and on to the main
line “I”. And you now find that he cannot stand heat – whatever his stomach may do
; that he is ill if long out in the sun : that he wants a cool room, prefers cold weather
and a cold climate : that he never goes near the fire : and you noticed when he came in
that, though the weather was cold, he was not buttoned up, or thickly clothed. It is not
closeness or stuffiness so much that affects him (you have got to be careful between these!)
but heat. He is one of Dr. G. Miller’s “predominantly hot-remedy people”. There
is an eliminating symptom for you ! You know at once, whatever his stomach condition may
be (its particular symptoms might perhaps be equally well-met by Ars., Phos., Nux, Lyc.,
Nat-mur., or a host of others) ; but with that temperament, that warm personality, it
would be useless for deep and curative work to think of giving him Ars., Phos., Nux or
Sep. He is a hot patient, and these are predominantly cold remedies. You can strike
them out at once. For even if one of them, aptly fitting the exact stomach symptoms only,
gave temporary relief to the immediate condition, the patient would relapse again and again.
It could not hold. It would act as a palliative, not a curative drug. It might provide a
temporary organ-stimulus : it could never be the stimulus of the organism. And here you see
well the difference between deep and superficial work – between curative and palliative. The
people who get their honest triumphs in similars, and see at least brilliant
temporary results in superficial and acute conditions, and believe honestly that these are
the very best attainable by medicine, scout the idea of the lasting triumphs of the simillimum.
They know well, from years of experience, their own limitations ; and it seems to them
outrageous that other people should make larger claims. As a matter of fact, when you get
the real simillimum, the odds are that, instead of palliating the stomach condition, you
will aggravate it a thousandfold – for the moment ; aggravate it, once and for all, to cure.
And if you do not know your work, you will think that you have got the wrong medicine and
antidote or change it ; and your patient will be, so far as you are concerned, incurable.
But it may be your ignorance only that makes him so !So now, down all the rubrics,
mental, general, and particular, you will carry that great eliminating symptom, WORSE FROM
HEAT, and ruthlessly cut out all the remedies that are chilly, and therefore deeply help
chilly people. None of these you need write down at all. Using Dr. G. Miller’s list, which
we will give in a moment, you can go on to any other General, and especially to any marked
mental symptom, and often get a pretty correct idea of the exact remedy before you ever
start to tackle the particular and immediate suffering for which the patient comes to you.
Now supposing you discover that he is liable to fits of depression, and yet cannot endure
any attempt at consolation ; that he becomes a very fiend if anyone attempts to cheer him up
– even to enquire what is amiss : the people have learnt to let him severely alone, when his
moods are upon him ; why, with these two important symptoms alone, worse from heat, and
worse from consolation, which have got to be in equal type, remember, in the patient and
in the drug, you have reduced your area of search to Lil-tig., Nat-mur., and Plat.
(for Lyc. and Merc. come through the “< consolation test" in the lowest type only, which is hardly good enough for such a marked loathing of consolation as this !) Or, if your patient had been as predominantly chilly and worse for cold as this one was for heat, and the aggravation from consolation test came out as strongly, you would have found yourself at the start of your work with Ars., Bell., Calc-ph., Ign., Nit-ac.,
Sep. and Sil., with two or three others to play with in brackets – lowest type.
If you can get such marked eliminating symptoms to begin with, see what a comparatively
small number of drugs you have to carry down through all the rubrics, and how much easier
and quicker it is to get your remedy, and how much greater confidence you have in the result
of your search. You will generally find, as you work down, that one drug stands out more and
more pre-eminently : – it may not be in all the rubrics, but it has got to be in all the
important ones, i.e., those best marked in the patient, and of highest grade. And
presently you throw down your pen : you are convinced ; and it is a mere waste of time to go
further.Now take the same case and start,
instead, on the marked symptoms complained of by the patient – the Particulars, and just see
what work you have cut out for you ! Begin with the rubric Vomiting, and write it out
for the last time, and see what it entails. And write all the drugs, in all the types, lest
you should miss any. Take his particular symptoms, one by one, and write, and write, and
write.Vomiting, 162 drugs.
Vomiting water, 108 drugs.
Vomiting sour, 89 drugs.
Burning pain in the stomach, 186 drugs.
Pain in the stomach p.c., 110 drugs, etc.It may be easily such a list, of which this
is but the merest beginning : – no wonder that people get “Repertory funk !” – for
remember that people are actually doing this, at this moment, in all quarters of the world :
for they are sending us their beautifully-neat, conscientious and exhaustive work to show,
as they ask for a better way : and it is their cry for help that has caused this article to
be compiled. Sheets and sheets of paper you will cover. One that lies before us now has all
the drugs in forty-nine different rubrics, some if immense length, as Stools
offensive, Burning urine, Stools pasty, Yellow stools. Why, before you ever come down to
such symptoms, you should have three of four drugs only in hand : – and they are symptoms of
the lowest grade, and Common symptoms ; hardly worth glancing through for confirmation of
the drug. Moreover, there is the possibility that you may accidentally omit the very drug
you want from some of the long lists you are so slavishly copying : and the odds are, that
when they are all complete, without the aid of eliminating symptoms some half-a-dozen drugs
will come out pretty near one another when you count up at the end, and that your travaux
d’Hercule will leave you unconvinced and still in doubt.Copyright © Sylvain Cazalet
1999
