Importance of clinical repertories with an overview of the prescriber by JH Clarke

 Dr Prathibha Angya M

Abstract
The clinical repertories were born out of the need of the profession and the genius of the great homoeopathic practitioners. They are fruit of many years of labour and contain the hidden treasure of homoeopathic literature. There are many repertories which are time proven but few of them become popular and remain in mind of a physician. Few repertories are useful treasure in homoeopathic literature. One of them is “The Prescriber by J.H. Clarke”. The immense usefulness in certain cases cannot be ruled out. This article is to remind us one of such repertory and is an attempt at encouraging the use and study of clinical repertory.

Keywords: clinical repertory, prescriber, construction, scope and limitation. 

Introduction
Medical men have got to study human beings as a group as well as individuals, in health and in disease. Physicians have to face both concrete realities with scientific abstraction. So the method of study should be based on phenomenology through sense perception.

Observations of the physician are bound to be clinical. As homoeopathy is a specialized system of drug therapy; for homoeopath the diagnosis does not mean the treatment of nominal entity, but diagnosis of patient with respect to drug reaction, which would restore his vital equilibrium.

When characteristics of a remedy are marked in a case, the name of the disease becomes insignificant and in such cases, clinical repertory should not be resorted to, the last court of appeal being Materia Medica. Broadly speaking, we have two types of symptoms. The subjective symptoms– as the ability to experience & describe these symptoms is not same in all parts, so they should be interpreted by physician to a large extent especially in hysterical and young children. And the objective symptoms where physician can ascertain by means of senses- aided or unaided. These symptoms may not be especially diagnostic of disease or pathologic state but are important for prescribing. Those which are pathognomic of certain disease help us to point to a class of remedies and excluding others which may be otherwise superficially related.

Any general repertory i.e. Kent, Synthesis due to their large volume are very difficult for a physician to carry to the bedside and moreover these repertories do not have any Materia Medica part combined with them. BBCR, Boger Synoptic Key, Materia Medica by W. Boericke with O.E Boericke’s Repertory etc. are the examples of such type of books where both Materia Medica & repertory are combined. It is said that O. E. Boericke’s repertory is one of the important general clinical repertory.

Clinical repertory is an index of remedies applicable to various more or less fixed symptom syndromes to which nosological labels can be given. It can be a general clinical repertory (e.g. Boericke’s and Clark’s repertory), disease oriented clinical repertory (e.g. The Therapeutics of Intermittent Fever, Repertory of Leucorrhoea, Bell’s Diarrhoea,) or an organ based clinical repertory (Minton’s Uterine Therapeutics, Berridge Repertory of Diseases of Eye). Great numbers of published small clinical repertories are present in the old homoeopathic journals. Their non-availability and thus disuse has also played a role in the slow progress of our system.

The concept of clinical repertories
These sorts of repertories contain clinical symptoms/conditions with their corresponding group of medicines. They are not commonly used for the purpose of repertorization. However, these repertories can be used for repertorization of cases where clinical conditions mask the characteristic symptoms of the patient. In such cases the physician finds the prominent common symptoms/clinical conditions with few modalities and concomitants. In spite of emphasis on individualized prescription based on characteristic expressions, the emergence of clinical repertories could not be prevented in homoeopathic practice even in Hahnemann’s time. 

The grouping of the medicines according to the name of diseases, though discouraged by many stalwarts, has given birth to several clinical repertories. 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 Compton Burnett. He expresses it as – “The fact is, we need any and every way of finding the right remedy, the simple simile, the simple symptomatic similimum and the furthest reach of all the pathological similimum, and I maintain that we are still within the lines of Homoeopathy that is an expensive, progressive science”. Dr. Burnett in his writings, has given examples of different cases i.e. Like “Diseases of the Liver”, “Organ diseases of Women” etc. From where we can understand that he has preferred certain medicines for certain clinical conditions. For example- He has treated many cases of jaundice, enlargement of liver, tumour of liver by Chelidonium majus; for traumatic uterus he had used Hypericum, Arnica, Bellis per, Kali chlor, cuprum acet., Cedron etc. Dr. J. Compton Burnett advocated more in favour of such practice but he could not compile a separate repertory for that purpose and the credit for compiling the first useful clinical repertory goes to Dr. J. H. Clarke. J. H. Clarke in the introduction of his clinical repertory has written- “Certain diseases come to have certain remedies arranged to them and all the patients who are found to be suffering from any given disease must be denoted with one of the remedies credited to it.”

Clinical repertory of J. H. Clarke is based on his dictionary of Materia Medica. Though Clarke’s Clinical repertory was popular at that time but O. E. Boericke’s repertory gradually takes upper hand in popularity probably due to its arrangement of rubrics in different anatomical section, which is more practical and useful. There are many useful regional clinical repertories which help the practitioners to find a similar remedy.

Utility of Clinical repertory
Clinical repertories are those repertories which contain symptoms or condition and corresponding group of medicines.

These repertories facilitate the selection of remedy on the basis pathological similarity, causation, modalities and concomitants.

They are not commonly used the purpose of Repertorization however these repertories can be used for Repertorization of cases where clinical conditions mask the characteristics of the patients in such cases physician finds modalities and concomitants. These cases need the help of clinical repertories for selecting similimum.

Scope and limitations of clinical repertories
Though Clinical repertories have not been put to their fullest utility, this can be very useful too if the scope and limitations are properly understood and implemented in practice.

Scope–

1. Clinical repertories can be used in the study of Homoeopathic therapeutics as well as Materia Medica.

 2. They help us to repertorize the following types of cases-

 a) Cases lacking in mental symptoms and physical general symptoms.

 b) Cases with clinical diagnosis

 c) Cases with a few symptoms 

3. They are used as quick reference books while in doubt and confusion at bedside. Not only that it also helps to reduce the number of probable medicines for a given disease condition bearing a nosological label.

 4. Clinical Repertories contain some rubrics, which are not found in other general repertories; therefore, they can become a good companion in the study of such rubrics.

5. Clinical repertories help us to find the most appropriate palliative medicines in incurable cases.

6. Regional repertories help in finding out the most similar medicine in a specific clinical condition. 

7. In acute cases it helps best as the patient usually does not say all his symptoms during sufferings except particular symptoms.

Limitations-Clinical Repertories are based on nosological terms and clinical conditions, which are the results of clinical observations; hence their use is limited to particular type of cases. They are mainly used for reference work.

Need of pathology in prescribing
It helps to understand the symptom in context with the whole; with respect to natural history of disease and place each symptom in proper relative importance. They are important to prescribe the truly homoeopathic remedies, not the seemingly homoeopathic ones.

Overview of “The Prescriber” by J.H. Clarke.

Name of the book: The Prescriber 

Author: John Henry Clarke, M.D (1853-1931)

Dr. John Henry Clarke was born in 1853. He was one of the most eminent homoeopaths of England, who devoted his whole life for the advancement of Homoeopathy. He took his degree at Edinburgh University in 1875 as gold medallist in several subjects, followed it up with the M. D. and further academic successes and appointments in 1877.

He became a keen follower of Dr. Compton Burnett who was himself in the direct hierarchy of Ruddock. In April 1885, Dr. Burnett edited his last volume of The Homoeopathic World and the next month, May 1885, Dr. Clarke commenced as editor. He was editor of ‘The Homoeopathic World’ for twenty-nine years. He was also a consulting physician to the London Homoeopathic Hospital.

He had the credit of introducing many remedies into the Homoeopathic Materia Medica. He introduced Pertussin, Carcinosinum, Epihysterinum, Morbillium, Parotidinum, Bacillinum testicum, Scarlatinum, Scirrhinum into Materia Medica.

Politics.

Clarke was a leading advocate of anti-Semitism. Anti-Semitism (also known as Judeophobia) is prejudice against or hostility towards Jews. He served as chairman of ‘The Britons’ from its formation in 1919 until his death as an associate of Henry Hamilton Beamish. He wrote several articles on Christianity that has a militant bent.

WORKS OF J.H. CLARKE
Clarke was keen in his writing and it is even said that he had a desk in his carriage. For many years, he was the editor of The Homeopathic World. He wrote many books, his best known were Dictionary of Practical Materia Medica and Repertory of Materia Medica (i.e., the Clinical Repertory).

LIST OF BOOKS BY CLARKE

• Dictionary of Practical Materia Medica, 3 volumes
• The Prescriber – A Dictionary of the New Therapeutics with an essay on ‘How to Practice Homoeopathy’
• Clinical Repertory to the Dictionary of Materia Medica with Repertories of Causation, Temperaments, Clinical Relationships and Natural Relationship.
• A Dictionary of Domestic Medicine
• A Bird’s Eye view of Hahnemann’s Organon
• The Principles of Cure
• ABC Manual
• Constitutional Medicine
• Homoeopathy Explained
• Revolution in Homoeopathy
• Diseases of the Heart and Arteries, their Causes, Nature and their Treatment
• Rheumatism and Sciatica
• Indigestion – Its Causes and Cure
• Cholera, Diarrhoea and Dysentery
• Catarrh, Colds and Grippe
• Whooping Cough
• Non-surgical Treatment of Diseases of Glands
• The Cure of Tumours
• Therapeutics of Cancer
• Haemorrhoids and Habitual Constipation
• Gunpowder as a War Remedy
• Therapeutics of Serpent Poison
• Radium as an Intercurrent Remedy.

Publication: it was first published by firm of Messrs. Keene and Ashwell. Later by B. Jain Publishers (P) Ltd.

• It was first published in 1885
• Updated by Clarke in 1925-1940
• Third Edition published in 2006
• 30^th impression 2009.

 Number of medicines: 428

Preface to Second Edition
In his initial days of practice of Homoeopathy Dr. J.H. Clarke found difficulty to select similimum on the basis of the knowledge of Materia Medica alone. He used to refer Clinical Index of Dr. Ruddock’s well-known Vade Mecum. He found limitations while referring the book and began to interleave his own experiences in the book. This led to the compilation of The Prescriber. In the compilation and additions of The Prescriber the role of Drs E.A. Neatby and T. Miller Neatby, author of A Manual of Tropical Disease and Hygiene for Missionarie is very appreciable. Mr W.H. Knight, the literary executer of late Dr. Leopod salzer of Calcutta also supplied some information which were incorporated in this book.

THE PRESCRIBER deals with the treatment and the directions instead of dealing with generalities and minute particulars for ready application to any case of any disease.

Plan and Construction 

Macro-Structure: 

The whole book can be divided into two main sections –

1. Introduction to the prescriber
2. The Prescriber.

The first section:

–The introduction to the Prescriber is divided into four parts.

The Part-I deals with how to practice Homoeopathy and it throws light on the following topics.

1. Necessary implements
2. The comparative value of symptoms. “The Prescriber” and The “Clinical Repertory”. Cases in point.
3. The dictionary of practical Materia Medica.
4. Boenninghausen “Pocket Book”. 
5. The scope of clinical repertories.
6. Kinds and degrees of similarity.
7. Hahnemann’s doctrine of chronic disease.
8. The genius epidemicus
9. The homoeopathic Materia Medica.
10. Symptom repertories

The Part-II deals with Case Taking and it throws light on the following topics.

1. A suggested form.
2. “totality of the symptoms” and the invisible nature of disease.
3. “treating symptoms”. Hahnemann’s case. 
4. Indications from heredity and history.
5. The value of the names of diseases.

The part-III deals with the Plan of – The Prescriber, and How to use it and it throws light on the following topics.

1. The plan.
2. Rules of prescribing.
3. Examples of prescriptions.

The part –IV contains the list of remedies, abbreviations and signs.

The second section:

–The Prescriber

This is the main part which deals with treatment of diseases arranged alphabetically.

Micro-Structure:

The plan of the work is simple. 

The names of the diseases are given in alphabetical order. The cross-reference is used for the similar conditions or different names of the diseases. e.g. Page 81, Arteries, DISEASE OF see Aneurism.

The name of the medicine or medicines mostly useful in the particular disease is given under each heading (rubric). e.g. Page 203, Hysterical vomiting –kreas.3, 1h.

The most commonly indicated medicines are mentioned along with the attenuation, doses and repetitions schedule. 

1. Attenuation (potency) – is given after the name of the medicine. when several attenuations are believed to be efficacious, the numbers of the lowest and the highest are given, and a bar is placed between them. E.g. “Acon.1-3” would mean Acon 1,3x,2, or 3, can select any one. 

When choice lies between two only, the two numbers are joined by an “or”. e.g. “Cham.1or6”

When no sign or figure follows the name of a medicine the pure substance is meant.

 e.g. “Kali i.gr.ii.” means two grains of the iodide of potassium itself.

2. Dose-in all cases where no mention of dose is made, one drop of the tincture, or one pilule or tablet is indicated.

when trituration is intended, it is indicated by the number of grains for a dose following the number of the attenuation. e.g. “Silic.3, gr.iii.” means three grains of the third trituration of silica.

3. Repetition of dose– the times of the repetition of the dose are given in terms of hours (h) and minutes (m), after the name of a medicine with its attenuation, “1h” means that medicine to be given every hour; “2h” every two hours; “6h” every six hours or four times a day; “8h” every eight hours or three times a day; “10m” every ten minutes.

When more than one medicine is named, it is found to be prefixed with each symptoms which would lead the prescriber to choose that in preference to the rest. e.g. page 203, Hystero-Epilepsy-During the attack, Moschus 3, every five or ten minutes. During the intervals, Zinc.valer.3,4h.

Where no such differentiating symptoms can be given, the medicines are named in the order of their general applicability, and numbered; in an intension that the prescriber shall use them in that order; if there are no other symptoms in the case pointing to one more than the other. e.g. Page- 156, Enchondroma– (1) sil.3, gr.iii.8h. (2) calc. fluor.3, gr.v.8h. 

Where a number of symptoms are given as belonging to one medicine, these will be found separated either by commas or semicolons. All those only separated by commas belong to a single group, and this must all be present in order to indicate the medicine. e.g. Page- 280, under Sciatica will be found, “pains made worse by sitting, relieved somewhat by walking, entirely by lying down; sensation as if hamstring muscles were too short. Am.mur.3x, 2h.” this means that ammonium muriaticum is indicated when the pain of sciatica is marked by all these characters. If in any case the pain were noted as being “relived somewhat by walking”, without the other two, the medicine would, probably not be appropriate. Again under the same heading we have “In the old and debilitated; purely neuralgic; paralysis, Ars.3, 2h.” this means that Arsenic is likely to benefit all cases that are of a purely neuralgic kind, as opposed to inflammatory or rheumatic; also sciatica in patients suffering from paralysis, also sciatica in old and debilitated patients.

Each characteristics is sufficient in itself to indicate the medicine, and this the semicolons are intended to show; should two of the characteristics, or all three, be found in the same patients, the medicine would be still more strongly indicated.

Some characteristic conditions which are not in themselves constitute disease are given under headings, such as Tongue, Taste, Smell etc. these occur as symptoms in various diseases and as a result of the action of certain drugs, these help in determining the choice of medicine, if that medicine is in relation to the case as a whole. e.g. If in doubt which of two medicine to give in a case of dyspepsia, a reference to the heading tongue shows which of these medicines is capable of producing a condition of tongue most like that present and determine the choice.

An elaborate repertory of remedies is given on “Toothache”.

The rubrics like diet, constitution, chronic diseases help a physician to expedite the recovery of the patient.

The clinical rubric usually begins with a little description of the clinical conditions and the names of the medicines follow the indications. This arrangement is very useful for any practitioner.

EXPLANATION OF SIGNS USED.

m. = minute. 

h. = hour. 

r. = one rising. 

h.s.s. = at bed-time. 

gl. = globule. 

gtt. = drop. 

gr. = grain. 

1 drachm. = one drachm, or one teaspoonful. 

2 drachms. = two drachms, or one dessert-spoonful. 

4 drachms. = half an ounce, or one table-spoonful. 

One ounce. = one ounce, or two table-spoonfuls. 

Oi. = one pint. 

< = worse, or aggravation. 

> = better, or amelioration.

HOW TO REFER THE PRESCRIBER?

Refer the clinical condition for which the medicine is sought for. The cross-references can also be used for the similar names. The whole content under the appropriate rubric should be gone through to select the most appropriate remedy along with its indications, doses and repetitions.

Scope and limitations

Scope and limitations is similar to all the clinical repertories.

scope

An elaborate repertory of remedies is given on “Toothache”.

The rubrics like diet, constitution, chronic diseases help a physician to expedite the recovery of the patient.

The clinical rubric usually begins with a little description of the clinical conditions and the names of the medicines follow the indications. This arrangement is very useful for any practitioner.

The most commonly indicated medicines are mentioned along with the attenuation, doses and repetitions schedule.

Limitations

However valuable a clinical repertory may be, it can never be paramount in homoeopathy.

Therefore, the physician should use his/her discrimination while using this repertory for working out a case. 

Conclusion
The importance of clinical repertories in homoeopathy cannot be neglected, (Considering FN §235 of Organon of Medicine, 5^th ed.) though Master Hahnemann has criticized treatment of so called “disease entities” as it is a personal event to an individual; but it is impossible to build a science merely by compiling a great number of individual observations. It is a “prima facie” method of reducing the number of probable similar drugs for a diseased condition bearing a nosological label. The Clarke states, “I only offer it as one, and that the most elementary, of the methods by which the similar, that is to say, the Homoeopathy remedy may be found”.

Reference:

1. Siju PV. A reference to repertories for homoeopathic students. Reprint ed. B. Jain Publishers (P) Ltd. 2007; New Delhi.
2. Shashi Kant Tiwari. Essentials of Repertorization. Fourth edition. B. Jain Publishers (P) Ltd.2005; New Delhi.
3. J. H. Clarke. The Prescriber. Third edition. B. Jain Publishers (P) Ltd.2006; New Delhi.
4. http://www.academia.edu/7440649/IMPORTANCE_OF_CLINICAL_REPERTORIES_WITH_AN_OVERVIEW_OF_BOERICKE_REPERTORY.

Dr. Prathibha Angya M
PG Repertory part II
Government Homoeopathy Medical College and Hospital, Dr. Siddaiah Puranik Road, BasaveshwaraNagar, Bengaluru-560079.
Email: prathibha.angya@gmail.com
Under guidance of  Dr. MUNIR AHMED R, M.D (HOM.), M.B.A (Edn. Mgt.)