A STUDY OF KENT’S REPERTORY ” By DR. MARGARET TYLER
With acknowledgments to DR.R.GIBSON MILLER, DR.WEIR (from whose lectures this is mainly reproduced), and DR.BORLAND.
WHEN one thinks of the bewilderment and despair of the uninitiated, engaged in a first tussle with Kent’s stupendous Repertory, one is haunted by the old-rime story in his chariot, reading as he journeyed, to whom a stranger joined himself with the pertinent question, “Understandest thou what thou readest?” and the prompt reply,”How can I, except some man should guide me?”
“How can I, except some man should guide me ?” There are mazes yet that badly need the “silken clue”.Kent’s Repertory is such a maze. Once the thread in hand, you can penetrate with ease its deepest recesses. But without the clue, you are hopelessly lost.
It is a question whether men trained from the start. in Homoeopathy can at all appreciate the difficulties of those who were never trained, but who have had to pick out everything for themselves. They hardly realise the almost insuperable difficulties presented by such a work to those who lack the very simple clue, in the scheme on which, from end to end, the Repertory is complied. Once master the scheme, and it is simplicity itself. You can turn up, in a moment, what you want.
But, what do you want?. You have got to learn that too ! For without the knowledge of what you do want, without the all important grading of symptoms (i,e, the realisation of their comparative value) life is too short, even when you have mastered its construction , to use the Repertory as your habitual guide in prescribing. And unless you to do use it, and commonly work out your cases, you will be unable to use is, or to trust it in emergencies, when you would give your very soul for a drug that could save.
For my part, I can sympathise and understand; because I so well remember my own difficulties. Until I first heard Dr.Weir’s lecture on the subject, three years ago, in spite of having worked with quite a number of repertories for years, comparing them in the effort to deduce from them something simple and quickly workable, I must say that I groped hopelessly in Kent; especially in the pain sections; and had not the haziest notion how to find just what I wanted. Rubric after rubric, at the interval of a few pages, seemed to have almost the same heading, and yet a different list of remedies. The same ground seemed to be covered again and again, with a different result. How has I to choose my exact rubric, and be sure of my drug?
Therefore, remembering my own experiences, as one of the great uninitiated, and the illumination that came to me in what I then thought one of the most important if an important series of lectures, when the call came recently, in two urgent requests, one in this country and one in America, to put this paper into shape, I felt that I must answer it; must try to reproduce, in part anyway, the subject-matter of that lecture; so that others too may grasp the idea, and he made “free” of the Repertory.
To be asked to pronounce and teach under the very eye of critics and experts is not a little alarming.(* Yet I have a feeling that I may be able to deal with the question more helpfully than even the highest authority of all, or the men he has trained who, in their turn, taught me all that I know*), simply because I am unique among them in having experienced the difficulties of the uninitiated. They have not! Therefore to the uninitiated I offer this attempt at help; trusting that in the discussion that follows, the critics and experts may be able to point out any errors or fallacies; and that Dr. Kent himself will be moved to endorse or refute what is here put forth. the subject is URGENT, if Homoeopathy is to reign. Nothing will count, in these days, but the best work.
But before considering where to look for what we want, let us pause for a moment to consider what we want to find. For to quite know what we want to find will simplify our work, and greatly limit our labours.
What we want to find, is, of course, the homoeopathic remedy. That is what we go to the Repertory to discover.
But what is the homoeopathic remedy? Why, the homoeopathic remedy is always that drug which, in its pathogenesis, exhibits the morbid symptoms of the actual patient we desire to cure.
The actual patient, to begin with ! It is the symptoms of the patient; not necessarily the symptoms of the disease for which the patient consults us.
Hahnemann says that the physician must realise that he is concerned not with diseases, but with sick persons. In a patient we must see a person who is suffering; an individual who deviates from the normal of the race, and from his own-normal; a mortal out of tune, to some extent, with environment, physical or mental, and therefore distressed.
If you are treating merely a case of some named disease, and attempt to hunt that disease through Repertory and Materia Medica, you are very unlikely to discover the curative remedy. To begin with, drugs have seldom been pushed far enough to produce pathological lesion; and if your work is based on pathological changes, you are done. Again, supposing many drugs had been pushed so far as to produce Pneumonia, for instance, each would produce not only a pneumonia with symptoms peculiar to itself, but would also elicit symptoms peculiar to individual provers, so that you would still need to individualise, in order to cure. Pathologists know that drugs produce pneumonia or sciatica; what they do not know is that they produce a modified sciatica or pneumonia.
What you have to discover is, the remedy needed by the patient himself; the remedy that corresponds to him, body and soul-and more especially soul! You need his individual remedy; the remedy for which his symptoms (symptoms inherent in himself, not dependent on his pathological lesions,- his “obvious morbid anatomy,”) cry.
So you may find that there are a great many symptoms, very pressing to the patient, that you may discard at once, since they will not help you one scrap in your search for the remedy. A patient with ankylosis is necessarily stiff. The stiffness appeals to him; and on account of that stiffness he appeals to you; since it limits his movements, and cripples his activities. But stiffness will not help you in your search for a remedy for that patient! It is a common, an inevitable symptom in ankylosis, accounted for by the pathological changes.
Dyspnoea, with an enlarged thyroid, in part impacted behind the clavicles, would be intensely distressing to the patient; but it would not be an important symptom, unless qualified, so far as repertory work was concerned. It would be a “common” symptom. with such a lesion, dependent on a mechanical cause. The drug, unless it had been pushed to produce just such a lesion, would not need to have Dyspnoea in black type! Dyspnoea, on the contrary, with nothing grossly mechanical to account for it, might lead to the consideration of certain remedies, especially if qualified by some modality, as “worse in wet weather-on waking-during sleep.” Or again, frequency of micturition , with a morbid growth impacted in the pelvis, would not help you in the choice of a remedy. It would be a symptom secondary to gross pathological change; not a symptom expressing the patient herself, but a symptom merely dependent on mechanical pressure; promptly relieved by the removal of the tumour.
Symptoms, then, dependent on mechanical cause, do not express the patient, and are useless for homoeopathic prescribing. They may, it is true, lead to the exhibition of a more or less palliative remedy-palliative to the pressing distress; they are useless for the selection of the curative drug.
So, before you ever open your repertory, or plunge into the vertex of drugs, you can discard all the symptoms dependent on gross lesions,and so cut down a little your work.
Which means,. always examine your patient with care before you start with the repertory.
Be sure that the symptoms you take are peculiar to, and characteristic of the patient himself, and not merely secondary to disease. But remember! you cannot eliminate symptoms dependent on a disease which you have n0t diagnosed !
Besides pathological symptoms, there are COMMON SYMPTOMS; and these again will not help you greatly; qualified. But they will cause you an immense amount of work, if you elect to start on them.
Common symptoms are of two kinds, symptoms common to the disease, which are merely diagnostic, and do not show how the patient reacts to this particular “morbific agent,” as Hahnemann puts it; and therefore useless for the selection of one remedy- such as diarrhoea, vomiting, excessive sweating, headache. Common symptoms do not serve to distinguish, and you need to distinguish, if you are to pick out THE drug. Take the question of thirst; your patient has fever, and is extremely thirsty. This is a common symptom; doubly common as a matter of fact, for thirst is common to every many remedies, and to most fevers. You must have something more, something that distinguishes and qualifies to make the symptom of the slightest use to you:- and yet the symptom of the slightest use and, as concerns the patient, urgent. Enquire further, and see if you cannot make it useful. Supposing you find that the thirst is at one particular hour; or only during the cold stage, or before it; or that it is for large quantities, or small; or that there is thirstlessness during the period of high temperature only; or a ranging thirst with no desire to drink; why, these things are peculiar to individual patients and to fewer drugs, and are therefore of importance. Underline them. They are distinctive. You will be able to use them to help to find the remedy. You see how a common and useless symptom may be transformed into one of Kent’s “strange, rare and peculiar, therefore general symptoms-because strange, rare and peculiar must apply to the patient himself.
So with all common symptoms, whether general to the patient, or particular to his parts-diarrhoea,vomiting, localised pain, headache-the very ailments for which the patient comes to you for help ! See what long rubrics, with almost every drug in them ! They will not help you one scrap.
Never start on these. They are absolutely useless unless you can get something that qualifies, that distinguishes, that is peculiar to THIS patient with diarrhoea, or headache; if so, a common symptom, qualified, may help you in your work.
But if we may not take the ailments complained of by the patient, and if we may not take the urgent and distressing symptoms dependent on a lesion, what in heaven’s name are we to take? What are the symptoms that do denote the patient? What are the symptoms on which we may start? And how are symptoms to be graded, as to their relative importance?
Kent (closely following Hahnemann in this, as in all things) is most definite as to the symptoms of first grade; the symptoms of supreme importance to the case, as expressing most absolutely the patient. These are the MENTAL symptoms. They, if they are marked, dominate the case
You may find that a patient is intensely jealous, or suspicious, or tearful, or indifferent to lived ones, or reserved and intolerant of sympathy and consolation. In sickness these things come out. Often in sickness the very nature seems to change; the rash and reckless become timid for themselves and others; the good tempered, snappy; the irritable and restless, patient. If a mental trait is marked, and especially if it denotes change from the patient’s normal, it is of the utmost importance to the case; and you know that it must be in the same type in rubric as in patient; which means that only remedies in the higher types are likely to fit the case. If the symptom is not very marked, beware how you use it to eliminate drugs; if the rubric is very small, take it, but take a larger rubric with it, that more or less includes the trait. Do not risk missing your remedy for an ill-marked mental, or a very small rubric. But if it is very marked mental, or a very small rubric. But if it is very marked, you know that the remedy you are in search of must be among the drugs in that rubric; so here again you may be able to limit your work.
Kent says, “When you have taken a case on paper you must settle upon the symptoms that CANNOT be omitted in each individual.” Such a marked mental-mental being of the highest grade! would be one of the symptoms that you CANNOT omit for this individual; therefore your remedy must be here. And therefore you can use it as an eliminating symptom, to compare with all the subsequent rubrics you consult; from which you can often discard the drugs that do not appear in this first essential list. With this guide, this strong eliminating symptom, straight from “the heart of the patient’s heart,” as it were, you can go through the rubrics of the patient’s symptoms in their order (i.e., mentals first, then generals, then particulars with modalities), taking from each list only the remedies that appear in this first rubric, (insane jealousy, or whatever it be), but taking all these jealous remedies from every subsequent list. In this way you can work rapidly down, till you are satisfied that you have found the remedy that fits the patient as a whole.
But this means much! To eliminate with safety, you must take symptoms seriously, not lightly. You must be absolutely sure that your symptoms are real and marked; that they do actually express the patient. You will have to ask many questions in order to elicit a few telling symptoms: and you must be quite sure that you and your patient mean the same thing. There are many pitfalls !
But even the mental symptoms are graded. Of highest rank in importance are those that relate to the WILL. with loves and hates, suspicions and fears. she hates her child-is jealous-fear of disease-of solitude-these are among the highest mentals.
Of second grade, those that effect the UNDER STANDING, with delusions, delirium; loss of the sense of proportions, with exaltation of trifles, delusions of grandeur, or persecution. Of third and lowest mental grade, those that relate to MEMORY.
Then those symptoms, as Kent puts it, “strange, rare and peculiar, therefore among the highest generals; because strange, rare and peculiar must apply to the patient himself.”
These must take a high place in the search for the remedy; but a place depending perhaps on their grade; for a peculiar mental would rank higher than a mere peculiar local symptom. Many of them are indicative of one or two drugs only. Write them down high in your list, but use them with care. As Kent says, “the great trouble with keynotes is that they are missed. The keynotes are often characteristic symptoms: but if the keynotes are taken as final,and the generals do not conform,then will come the failures.” As a matter of fact. wiping out a symptom, and curing a patient, are not synonymous.
A drug in its provings can only evoke in each case what was there already, latent in the prover-even as disease brings out weak points, and therefore does not affect two patients exactly alike. It requires many provers of different types, and different defective resistances, to bring out the whole picture of a drug pathogenesis. Had more drugs been more extensively proved, many more “rare, peculiar and distinctive” symptoms would probably have seen the light. A patient’s own individual remedy, prescribed on mental and general symptoms, will often wipe out peculiar symptoms that it has never been recorded as having evoked and which are the striking keynotes of some other remedy. Therefore beware how you take rare and peculiar symptoms, with only one or two drugs to their credit, as eliminating symptoms. This is easy, but often fatal. they may put you straight on to you drug (if the rest of the case fits!)- they may put you straight off it! You dare not use them, ever, to throw out drugs; though where there is nothing in the generals to contradict, they afford a strong reason for the exhibition of a remedy that has been known to produce and cure them. They are invaluable often to giver the casting vote.
As Kent says, “Get the strong, strange, peculiar symptoms, and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT.”
But there may be no very marked mental symptoms, but the patient may be a very chilly patient, utterly intolerant of cold. In such a case you may limit your labour often, by throwing out from each rubric the hot remedies, intolerant of heat, as you work down your list. Or conversely, if the patient is a hot patient, and intolerant of heat in every form, why only the hot remedies in each rubric need to be considered: you can throw out the chilly ones. But to be safely used, such symptoms must, of course, be general to the patient as a whole, not particular to some part (for general and particular symptoms are often flatly contradictory), and they must be very marked. If too lightly used, there is always the risk of throwing out the remedy you need from the very start. It is this dread of missing the remedy that leads some of us to expend such an the remedy that leads some of us to expend such an enormous amount of labour on our cases, and to use methods that Kent describes as “hard and arduous, entailing an enormously larger amount of work than he does in his cases.” This he stigmatises as “working uphill.”
Besides hot and cold remedies, Kent has a smaller rubric of remedies affected by both heat and cold. It us useful where patients are intolerant of both extremes of temperature. You will observe that there are both hot and cold remedies in this list. It occurs on p.1312 of the Repertory.
And here, with a plea for criticism and pronouncement, I will insert a list of grades, as we more or less understand them; for Kent says in a private letter from which I have been quoting, “The student and physician must work to settle the generals, common symptoms and particulars to the fullest extent, If he wants to save work”. And a realisation of the relative importance of the marked symptoms of a case is essential for the best and quickest work.
WILL; with loves, hates fears.
UNDERSTANDING; with delusions, delirium.
STRANGE, RARE AND PECULIAR: These may occur among mentals, generals or particulars,a nd must therefore be of varying importance and rank.
PHYSICAL : Sexual perversions (loves and hates, physical) or those referred to stomach, as desires and aversions for foods; for hot and cold foods and drinks; appetite; thirst. PHYSICAL GENERALS;
Reactions to HEAT AND COLD
Damp and dry
Oxygen and carbon di-oxide.
To position, gravitation
Pressure, motion, with train-sickness,
Food aggravations and ameliorations.
CHARACTER OF DISCHARGES.
PARTICULARS; (relating to a part, and not the whole;qualified, always).
Of these last Kent says, :Do not expect a remedy that has the generals must have all the little symptoms. It is a waste of time to run out all the little symptoms if the remedy has the generals. Nothing disturbs me so much as the long letters I get from doctors who show how they have wasted time on useless particulars. Common particulars are generally worthless.”
“Get the strong, strange, peculiar symptoms,” (it will bear repeating!) “and then SEE TO IT THAT THERE ARE NO GENERALS IN THE CASE THAT OPPOSE OR CONTRADICT.’
And again he says, ” When looking over a list of symptoms, first of all discover three, four, or five or six (or as many as may exist) symptoms that are strange, rare and peculiar: work these out first. these are the highest generals, because strange rare and peculiar must apply to the patient himself. When you have settled upon three, four or six remedies that have these first generals, then find out which of this list is like the rest of the symptoms, common and particular.
“When you have taken a case on paper, you must settle upon the symptoms that CANNOT be omitted in each individual. If he is worse from motion, you cannot omit that, unless it is common, which means if due to inflammation. (Every inflamed and swollen joint is worse from motion, hence in that case, aggravation from motion is not worth much). Worse from consolation, she hates her mother, shed hates her children. she is worse from music, she is sad before the M. Period, she is chilly during menses, during stool, during urination., Eliminate these from, she is always too warm, worse in a warm room, craves cool air, all symptoms come on when she is dressed too warmly, etc., etc. Then see how many remedies you have; perhaps only three or four, perhaps only one. Notice whether there is anything in the case that opposes this one., If there is nothing, then give it. If you see the keynotes of Arsenicum, next see to it that the patient is chilly, sensitive to air, fearful, restless, weak, pale, must have the pictures on the wall hung straight, and Arsenicum will cure.
“Or if the keynotes look like Pulsatilla, see to it that she is not chilly, that she likes the windows open, wants she is not chilly, that she likes the windows open, wants to walk in the open air, is better from motion. tearful, gentle. The great trouble with keynotes is that they are misused. The keynotes are often characteristic symptoms; but if the keynotes are taken as final, and the generals do not conform, then will come the failures.” And now, at last, to the REPERTORY! We know what we want; let us see where to find it,
In the Repertory it is a question of Alpha and Omega, the beginning and the end, the first and the last the MENTALS in the first section of the book, the GENERALITIES, (or GENERALS) at the end, in the last section. These are what most import us. Many a chronic case may be worked out on mentals and generals only, and the particulars will be found to fit in, in a marvellous way.
Observe that in the Mentals at the beginning, in the Generals at the end, and in all the intermediate sections, from cover to cover, the same arrangement holds; so that we can master it at once, and for all.
Everywhere it is the same
Next, CONDITIONS IN ALPHABETICAL ORDER.
Then, when it is a question of pain, LOCALITY, CHARACTER, EXTENSION.
Take a mental symptom from the first section of the book; take anxiety.
First, always, TIME, ANXIETY; morning. afternoon, at night; at some special hour.
Then, conditions under which anxiety has been observed, in alphabetical order ANXIETY; in open air, in bed; as of a guilty conscience; during fever; for others; before menses; about salvation; on waking, and so on
Now turn to the last section of the Repertory, the Generalities, or GENERALS. Here we have the aggravation, ameliorations and reactions of the patient as precisely the same arrangement is found.
First, in regard to TIME. the patient is generally worse in the morning, at noon, at night, at such hour. (Where nothing is specified, aggravation is always understood. “On waking”. mean worse on waking. It is normal to be ameliorated by sleep. We do not repertorise the normal !)
Then, after time, come the general conditions of the patient as a whole, in alphabetical order. these always apply to the patient generally. (The aggravations of his various parts, head, skin, stomach, limbs, occur earlier in the book, each in its own section.)
Among these Generalities at the end of the book we find worse and better from bath and washing; from cold; from wet and dry; from position, motion, pressure, eating, sleep, and so on. Here also, inserted alphabetically among the rest, you will find nearly all that there is of pathology in the book, and that is not much. Also certain conditions in their alphabetical place, such as faintness; convulsions; fullness; pain in general-its onset, gradual or sudden; and its disappearance in the same way, and their combinations; its character,burning, pressing, shooting, etc.., and its direction, pains that shoot up, down, inwards, outwards , across.
(Elsewhere under different headings, in their different sections we must look for particular pains, located in head, limb, joint or organ.)
But under these broader headings, such as faintness, convulsions, you will again find qualifications, aggravations and ameliorations; and in all of these, down to smallest sub- sections, the same order reigns, down to first, then CONDITIONS, alphabetically. (AS FAINTNESS morning; after morning after midnight; at such an hour; during fever; before or after eating; on exertion; after M.P.; while standing, and a host of others.)
But there are also a few Generals scattered through the earlier sections of the book, and we must know where to look for them.
Desires and aversions in regard to foods are to be found in the section STOMACH, with hunger and thirst -these latter with their modifications and qualifications in regard to time, first, and the other conditions in alphabetical order. Observe that while hunger and of diet are placed in the section STOMACH, the aggravations and ameliorations from eating, drinking, and from different kinds of food and drink are found (most of them under the heading food) among the Generals at the end of the book.
In the same way, while the general aggravation and amelioration in regard to the menstrual function are placed in the Generalities, as we saw; all the important menstrual conditions are to be found in the section GENITALIA-FEMALE. While particulars with menstrual modifications will be found scattered from end to end of the book, as for instance, various headaches modified by menses in the section HEAD. Stomach or abdominal distresses modified by menses in the section STOMACH or ABDOMEN.
Everywhere and in everything the self-same arrangement holds The better and worse of the patient as a whole occurs always under the Generalities: the better or worse of a part or organ (the particular) is always found in its appropriate place, whether under HEAD, STOMACH, CHEST, EXTREMITIES.
Between the MENTALS at the end, the intermediate bulk of the book, with these few exceptions, is concerned with PARTICULARS; that is to say, not with the patient as a whole, but with his various parts.