Dr Jubin BHMS,MD(Hom)
They are those repertories which contain clinical symptoms or conditions and corresponding group of medicines. They facilitate the selection of a remedy on the basis of pathological similarity, causation, modalities and concomitants. They are not commonly used for the purpose of repertorization. However these repertories can be used for cases where clinical conditions mask the characteristics of the patient. In such cases the physician finds the prominent common symptoms with a few modalities and concomitants. These cases need the help of clinical repertories for selecting the simillimum.
Origin Of The Concept Of Clinical Repertories :
In spite of emphasis on individualization and prescription based on characteristic expressions, the emergence of clinical repertories could not be prevented in homoeopathic practice as early as Hahnemann times. The grouping of medicines according to the name of diseases, though discouraged by many stalwart gave birth to clinical repertories. The greatest modern exponent of this practice is the late Dr. J. Crompton Burnett, who has brought once more to light the vast therapeutic treasures which had been forgotten in the works of our great masters. The use of nosological correspondence is one method by means of which a similar, if not the most similar, remedy may be discovered.
All ways of finding indications are open to practitioners and the clinical avenue is one of them. J.H.Clarke has described it like this “ Certain diseases come to have certain remedies assigned to them and all patients who are found to be suffering from any given disease must be dosed with one of the remedies credited to it”. Master Hahnemann was certainly not happy with such kind of practice, he described it as , “Treating the names of the diseases with names of therapeutic actions”. Such a kind of practice was much favoured by Dr. J. Crompton Burnett. He expre3sses it as “ The fact is, we need any and every way of finding the right remedy, the simple simile, the simple symptomatic simillimum and the furthest reach of all—the pathological simillimum, and I maintain that we are still within the lines of Homoeopathy that is an expansive, progressive science”.
As early as in 1869 Bell’s diarrhoea and 1873 Berridge’s Eye, two very useful clinical regional repertories were published. Though the concept of such practice was conceived by Burnett he could not compile a separate repertory for that purpose and hence the credit of authoring the first clinical repertory goes to J.H.Clarke.
There are many clinical repertories available these days, but two of them are well known as General Clinical Repertories. They are A Clinical Repertory by J.H.Clarke and Materia Medica with Repertory by O.E.Boericke. There are many useful regional repertories which help the practitioners to find the similar remedy.
Scope and Limitation
Though they have not been put to their fullest utility, these are very useful too of the scope and limitations are properly understood and implemented in practice.
1. Clinical repertories can be used in the study of Homoeopathic therapeutics as well as Materia Medica.
2. They help to repertories the following types of cases
a. Cases lacking in mental generals and physical generals but rich in common symptoms.
b. Cases with clinical diagnosis.
c. Short cases with very a few symptoms.
3. They are used as quick reference books at the bedside.
4. Clinical repertories contain some rubrics, which are not found in other general repertories, so they can become a good companion in the study of such rubrics.
5. Clinical repertories help us to find the most appropriate palliative medicine in incurable cases.
6. Regional repertories help in finding out the simillimum in a specific clinical condition.
Clinical repertories are bases on nosological terms and clinical symptoms, which are the result of clinical observations hence their use is limited to particular type of cases. They are mainly used for reference work.
A Clinical Repertory To The Dictionary Of Practical Materia Medicatogether With Repertories Of Causation Temperaments Clinical Relationships Natural Relationships By John Henry Clarke, M.D
This was published in 1904.. He asks his readers to give more attention to the preface both general and introductory notes to each separate division. This work is more useful for the study of Materia Medica no less than an instrument in finding out indicated remedies. Homoeopathic practice demands unlimited practice in knowledge of Materia Medica and knowledge how to use it. This demands unlimited patience and application in the study of drug comparisons. The author described his repertory as beneficial. It enables the practitioner to compare any remedy with any similar remedy in five different points, all of great importance in practice.
The basis of this work is Dictionary of Practical Materia Medica where every remedy is described from a number of different points of view. The clinical point of view is one of these, and under the heading “CLINICAL”in which it has been found most frequently indicated in practice. Later he prepared an Index to enable the reader to find at a glance all the remedies which can cause a particular clinical condition. The clinical repertory constitutes the Index.
Under next section, remedies are described under the heading of “ CAUSATION”. This tells how the remedies are related to conditions due to definite causes. An alphabetical list of causes is added. Under anyone will be found all drugs which have been observed curative in condition produced by it.
Another index deals with TEMPERAMENTS. The last section deals with RELATIONSHIPS both NATURAL AND CLINICAL.
There is a Dedication, Preface and List of remedies with Abbreviations then list of Abbreviations with Remedies. The number of medicines given in this repertory comes under 1065. First a list of remedies with abbreviations are given then a list of abbreviations and their remedies. In making these abbreviations the author has followed Cipher Repertory. The object aimed at the selection has been to choose a combination of letters which shall at once suggest a remedy and that alone. Then he used the letter ‘X’ to signify Acid. Every medicine name begins with a Capital letter. When the name of medicine has 2 parts, The second part always begins with small letter. In between 2 parts there will be a full stop.
There is alphabetical arrangement of rubrics and sub-rubrics. There is no grading of remedies. Almost all rubrics consists of a general group of remedies followed by sub-rubrics. Cross- references are given wherever necessary and at the end of rubrics.
Eg: Asthma. After the sub-rubric it is given that See also Cardiac asthma and Miner’s asthma.
A Symptom Repertory to the Dictionary is a different matter and a very difficult undertaking. Clinical Repertory serves the purpose for which it is given. It is given complete in itself within the range of its aims.
I. Clinical Repertory :
Most important part of the repertory. Here a number of clinical conditions with corresponding remedies in alphabetical order are given. The list is not regarded as inclusive or exclusive but rather as suggestive. But the list serves several purposes.
1.It saves lot of space. The main indications of a remedy are the same in any disease and the fine indications will be found on referring to the headings under which they occur in the Schema.
2.The name of the remedy printed in Italics or ordinary roman, does not represent in grade in evaluation, but when a remedy appears in Italics, it signifies that the same remedy occur under the same heading in the Prescriber.
Eg: In the rubric, gastric affections (P-68) Ulcers- Atro appears in Italics. It indicates that under the same heading Gastric Ulcer it is given in the book Prescriber.
3.Finally it affords a convenient basis for compiling a Clinical Index.
The Dictionary was linked to the Prescriber in the clinical section of the former.
That link is preserved in the Clinical repertory. Instead of the names of the diseases being italicized as in the clinical headings, the names of the remedies are italicized in the Clinical repertory. The sixth edition of Prescriber is used as a reference for the occurrence of the name of the remedy and that was prepared in the interval between the appearance of the first and second volumes of the Dictionary. Under the heading of the any disease show that in its general action it has a correspondence with the most marked features of that disease. So we can make a comparison of remedies. In selecting a remedy first the Clinical Repertory, then the Prescriber and lastly the Dictionary will have to be referred for any case then if any striking Causation or Temperament is there it will help more. General rubrics are followed by sub-rubrics.
Rare rubrics :
Many of the clinical rubrics which are difficult to find in other repertories are found here – eg: Bazin’s disease, Chagre’s Fever, Cynanche Cellularis etc.
Another method of attaining similimum by ascertaining the similarity is the seat of action. Some drugs have a predominant affinity for certain organs and that drugs will often relieve a great variety of affections seated in or arising from disease of particular organs. So here we get rubrics like Heart affections, Gastric affections. The work of Paracelsus and his disciple Rademacher deals largely in Specifics based on the Homoeopathicity of organ affinity. The greatest modern exponent of this practice is Dr. Compton Burnett who has brought to light vast therapeutic treasures which lie forgotten.
The remedy appearing in brackets signify that the particular affections under which it appears does not occur in the Dictionary of Practical Materia Medica under the clinical heading but has been added to the copy since Dictionary of Practical Materia Medica was published.
Rare rubrics with meanings :
1. Adipsia – Absence of thirst or abnormal avoidance of drinking.
2. Adrenal neuralgia – Pain near or upon the kidney.
3. Angina Faucium – Sore throat from any cause, severe constricting pain.
4. Antrum of Highmore – Maxillary sinus.
5. Arachnitis or Arachnoiditis – Inflammation of arachnoid membrane and its subjacent space.
6. Ardor urinae – Ardor is the old term for hot or burning so hot urination.
7. Balanorrhoea – Balanitis with discharge or Purulent balanitis.
8. Bazin’s disease – Erythema induratum
9. Bereavement – Deprivation causing grief and devolation especially due to a death of a loved one. The period of grief and mourning following bereavement resembles clinical depression.
10. Blenorrhagia – Discharge from mucus surfaces.
11. Blepharopthalmia – Gonorrhoeal opthalmia.
12. Bronzed skin – Darkness in Addison’s disease.
13. Brow ague – Intermittent supra orbital neuralgia.
14. Catheterism – Passage of a catheter
15. Catheter fever—Urinary fever.
16. Chagre’s fever—Virus of Bunyaviridae, an agent causing bunya virus encephalitis.
17. Clairaudience – Hearing illusions of.Able to hear not discernable by ordinary means, a type of extraordinary perception.
18. Clumsiness – Awkwardness.
19. Consumptiveness – Wasting disease especially Tuberculosis.
20. Cynanche cellularis – Sore throat.
21. Decemetitis – Inflammation of Decemet’s membrane.
22. Dysmenia – Dysmenorrhoea.
23. Farcy – Cutaneous glanders, the more chronic and constitutional lymphatic form of glanders with thickening of superficial lymph vessels.
24. Fidgets –Restless.
25. Frowning – Wrinkled aspect of brow, expressing disapprobation or severity occasionally of deep thought or perplexity. Habit of expressing disapprobation.
26. Hospital Gangrene – Decubitus ulcer.
27. Innutrition – want of nutrition.
28. Knock- knee—Genu valgum.
29. Levitation – Hallucinatory sensation of floating or rising in air or Support system for severe burn victims, consists of bed in the form of inflatable chamber containing numerous outlets through which humidified warm sterile air is released at pressure sufficient to raise patient so that he is supported in sterile air environment.
30. Lisping – Parasigmatism or Imperfect pronunciation of s and z sounds.
31. Lithaemia – Excess of uric acid or its salts in blood or hyperuricaemia.
32. Melanosis – Disorder caused by disturbance in melanin pigmentation or melanism.
33. Mendacity – Quality of being mendacious or habitual lying, deceiving or falsehood.
34. Mendicity – Practice of begging.
35. Mental Alienation – Alienation refers to the condition with lack of meaningful relationship to others, sometimes resulting in depersonalization and estrangement from others.
36. Metritis – Inflammation of the uterus.
37. Mycosis – Any disease caused by fungus.
38. Panaris – Panaritium , Whitlow, Paronychia.
39. Phlegmon – Acute suppurative inflammation of the subcutaneous tissue.
40. Pining boys – Low spirited boys, lacking boyish go.
41. Psilosis or Sprue – Falling of hair.
42. Reveries –
1. Rejoice, wildness or rage
2. Violent or rude language.
3. Fantastic or fanciful unpractical or purely theoretical notion or idea.
4. Day dreaming or lost in thought.
43. Rhinorrhoea cerebrospinalis – Discharge of cerebrospinal fluid through the nose
44. Rhinoscleroma – Granulomatous disease in mhich hard patchesn or nodules form on nose and nasopharynx due to Kleibsella rhinoscleromatis. Occur in Egypt, Eastern Europe, Central and South America.
45. Rumination – Physiological process in ruminant animals where they chew the cud and material gets regurgitated from their rumen for rechewing. eg: cow, sheep, antelope, deer etc,
n Disorder of infancy with repeated regurgitation of food with weight loss, failure to thrive which develops after a period of normal functioning.
n Periodic reconsideration of the same subject.
46. Sausage – A preparation of comminuted beef, pork etc or a mixture of these either fresh, salted, pickled, smoked with salt, spices, flour and stuffed into a container made from an intestine or other animal tissue.
47. Scleriasis – Diffuse symmetrical scleroderma.
48. Scurf – Dandruff.
49. Spavin – Disease of tarsal joints of horse.
50. Steatoma – Steato denotes fat.
51. Tic convusif – Facial spasm.
52. Ticklishness – Titillation or peculiar disaggreeable sensation by light stimuli of skin accompanied by laughing.
53. Uric academia – Hyperuricaemia.
54. Vaccinia – Infection primary, local limited to site of inoculation in man by inoculation with small pox.
55. Varioloid – Resembles small pox and it is a mild form of small pox.
56. Veta – Mountain sickness.
57. Xerostomia – Dry mouth from arrest of salivary secretion.
II. REPERTORY OF CAUSATION.
Almost all remedy have relations to some kind of various accidents or conditions of ordinary life. These symptoms are made worse or better by heat or cold, rest and motion, by night or by day or other circumstances or conditions. This is not the same thing as aggravation, though allied to it and sometimes identical with it. For instance Arnica removes morbid conditions(apart of course from surgical injuries such as broken bones) caused by falls; Ruta relieves the effects of bruised bones. It is not correct in either case to describe these as aggravations and so he arranged such relationships under a separate heading in the Dictionary. These he had indexed and repertorised in the subjoined list.
Although Causation and Aggravation are not the same, they are closely allied. Rhus is related to the effects of damp weather and appears in the list of remedies having this Causation ; but it also has its symptoms, when not caused by damp, aggravated in a supreme degree of conditions of damp. So the Prescriber who uses this list of Causes as a rough list of Aggravations also will not go far wrong, and may find no little help from it in some of the cases.
The name of the few remedies have been added which do not occur in the Dictionary of Practical Materia Medica. These for the most part is enclosed in brackets. When a cause is associated with a particular effect, the effect is placed in brackets and precedes the name of the remedy which responds to it. Washing clothes causes ill effects to which certain remedies respond. Phosphorus corresponds to headache resulting from washing clothes. In the list of remedies it is marked thus : “(headache) Pho.”. When in a list of remedies one of them has a qualifying word or phrase thus prefixed to it, the qualification must be understood to apply to that remedy only, and not to those which follow.
Eye overexertion – Phos, Ruta,(Sulph) This indicate that this condition is not mentioned under Sulphur in Dictionary of PractiCal Materia Medica.
III. REPERTORY OF TEMPERAMENTS, DISPOSITIONS, CONSTITUTIONS AND STATES.
In the Preface it is mentioned by Dr.Clarke that acute observers from the time of Hahnemann have noticed that some remedies act well on some persons and at all well in some others. The respective types of Nux vomica and Pulsatilla are well known but many other remedies have preferences marked more or less well marked for particular temperaments. These are mentioned in the Dictionary under then heading “Characteristics” as the types or constitutions the particular remedy is specially “suited” to. But under “Suited to” are included not constitutions, temperaments ands persons only, but also occurring in persons of particular age and type, sot his becomes a complement of the Clinical repertory.
The user who may not find the remedy he is in search of in the Clinical Repertory may possibly find in the Repertory of Temperaments under the heading of the complaint the patient is suffering from. Here remedies which are found to act most beneficially on certain types of persons, temperaments, sex and age are given. Complaints and conditions of particular type of persons or constitutions are arranged. Various types of temperament like bilious, lymphatic, leuco-phlegmatic, sanguine etc are given. Here we get remedies which act most beneficial in certain types of persons.
Eg : Sore throat public speakers.
Remedies for peculiar constitutions eg: Carbo-nitrogenoid, Hydrogenoid etc. In the Dictionary of Practical Materia Medica these are given generally in the section “Characteristics” under the description “SUITED TO”..
IV. REPERTORY OF CLINICAL RELATIONSHIPS.
This section is given in tabular form the clinical relation of all the remedies in Materia Medica. They are included under the following headings.
b. Remedies Follow Well.
c. Remedy is followed Well by.
e. Incompatible Remedies.
f. Remedy Antidotes.
g. Remedy is Antidoted by.
h. Duration of action of Remedies.
The term “Compatible” is a generic term and includes all the remedies of the first three columns but Compatible is included as some remedies have been noted as compatible with others without further qualification.
The source of this section is the table published by Dr. Gibson Miller in the Homoeopathic World in 1902.. Under Complimentary – Certain food materials which enhance the action are given.
Eg: Artimesia when given in wine is more effecting than in water.
V. REPERTORY OF NATURAL RELATIONSHIPS.
In the Preface it is told that the aim of Homoeopathy is to individualise and this must be with most possible completeness. Grouping can be of utmost value in the study and use of the Materia Medica. When individualisation is mastered grouping becomes an important event in practice. Dr.Cooper grouped Lobelias and Dr.Burnett grouped some of the Conifers. The Homoeopathic Materia Medica consists of anything and everything in the universe. Man himself epitomizes the Universe and nothing in the universe is unrelated to him. Thus he has developed some of the applications of the substances and the methods by which they are to be prepared and applied. This section provides knowledge at a glance the place in Nature of any remedy in questions etc, mineral, animal, vegetables etc.
First we can find the alphabetical list of all the natural order and under each section is given in alphabetical list of all the remedies included in the Materia Medica.
There is also given a list of natural or evalutionary order. Here a number is given for each order and same number is in alphabetical order. This knowledge is important because there is a therapeutic likeness and between the members of same group. This section of the repertory is divided into 5 sections.
1. Metals or elements.
2. Vegetable kingdom.
3. Animal kingdom.
1.Metals or elements.
First an alphabetical list of elements are given each with its symbol and atomic weight. Prefixed to each name is a number. This number shows its position in the succeeding list, which gives the elements in the order of their atomic weights. In addition to this, distinguishing number in the second list is affixed to the letter “G” and a Roman numeral. This refers to a third list—a list of the Mendeleffian groups; and the numeral shows in which of these groups any given element is to be found.
2.Vegetable kingdom :
There are 2 lists given in this section – a list of natural orders in alphabetical order, and a list of natural orders in systematic or evolutionary order. In the first or alphabetical list, under the name of each order, all the remedies of the order are given, also alphabetically. The alphabetical list is distinguished by the numbers which correspond with the numbers of the systematic list, so that the place of any remedy in each list can at once be found.
For example that it were desired to find out all the relations of Belladonna in the Materia Medica. On consulting to the Dictionary it belongs to Solanaceae,
Looking for Solanaceae in the alphabetical list we find 20 other remedies belonging to the same order. Affixed to the name of the order we find the number 69.Turning to the systematic list we find Solanaceae bracketed with Convolvulaceae (68), Boraginnaceae (67), Hydrophyllaceae (66) and followed by Scrophulariaceae (70) etc. Under each of these orders in the alphabetical list all the members will be found. Thus the relation of Belladonna to any or all of them may be traced.
3. Animal kingdom :
Of the animal kingdom as similar arrangement has been adopted—an alphabetical list distinguished by numbers corresponding to numbers in the succeeding systematic list. In arranging the latter he has been governed by Francis. P Pascoe’s “Zoological Classification”. In the Dictionary and the authorities it has been relied, no very definite distinction between “Orders” and “Families” has been observed in describing the place or the various animals ; but he do not think this will occasion any difficulty in tracing any animal remedy and its natural relations.
4. Sarcodes :
They are medicines prepared from healthy animal tissues and organs. They are “flesh” remedies. They are remedies of great importance and there is the list of remedies and the supplementary list of remedies derived from altered tissues and secretions as Urea and Uric acid from Urine, Thyro-iodin from Thyroid glands.
Nosodes are remedies derived from morbid tissues and secretions containing the specific virus of the diseases. A list of these remedies, the importance of which is becoming daily more recognized concludes this section.
1. Number of medicines given under each rubric is very few, even in general rubric as compared to other repertories.
2. There is no grading of remedies, so we cannot find most important remedy for each condition.
3. Most of the remedies used are rare and the curative effects of which are to be proved.
4. Many medicines given in sub-rubrics are not included in general rubric. Eg : Asthma – hysterical – Nux mosch.
5. This repertory can only be used for quick reference and not for good systematic repertorization.