Therapeutics of Respiratory System by MW Van Denburg

Book review by Dr Annapoorna H 

TITLE – Therapeutics of respiratory system, cough and coryza, acute and chronic.

Repertory with index

Materia Medica with index

by M W Vandenberg A.M., M.D.

Publishers Boericke and Tafel, Philadelphia in 1916.

INTRODUCTION:
This is a clinical repertory on the respiratory system by Van Denburg. He has constructed this repertory with the primary objective of saving time and to render the work of the physician more efficient by enabling him to select the drug with greater precision. This repertory saves time by bringing together all the drugs applicable to a given case. This book comprises of both repertory and material medica pertaining to the respiratory system.

Materia Medica : Foundation of the materia medica: all the 10 volumes of herrings guiding symptoms have been carefully consulted and the most PQRS of every drug are noted as well as those that most strongly indicate the drug.

Following paragraphs in Herrings guiding symptoms have been carefully reviewed in the construction of this book.

1. mind 
2. nose 
3. mouth 
4. palate and throat 
5. larynx and bronchi 
6. respiration 
7. cough 
8. inner chest and lungs
9. Heart, pulse and circulation.

None of the drugs with respiratory symptoms have been omitted. Materia medica of this book has been condensed and only the characteristics of the remedy have been mentioned.

Repertory: Gradations has not been used for the remedies in this repertory as the author has found unmarked symptoms of Herring’s guiding symptoms are more effective than the heavily marked symptoms.

Cross references have been given to avoid too many repetitions of the same symptoms.

Planning of the repertory: There are many categories involved in the materials that have to be entered in such a work, and the best way to include all the signs and symptoms with concomitants is to arrange the repertory in the alphabetical order. Even though the arrangement doesn’t follow any logic, it is very practical and easy.

As construction of this repertory doesn’t follow any logic, the alphabetical arrangement of rubrics will require every prominent descriptive word or phrase to be given importance and this might include too many pages as a result. Therefore, for the construction of this repertory, author has carefully selected the most obvious words and phrases from the symptoms to represent the whole. 

Introduction is followed by INDICES – General Index and shorter index. Shorter index has been given to assist beginners who are not familiar with the use of a repertory. Frequent use of the shorter index should lead to the exclusive employment of General Index when one has become more familiar with the book. Indices comprises of rubrics, sub-rubrics with page numbers. 

Method of using this repertory:  The author gives 7 points which helps the physician to find the similimum for the case before him.

a) Firstly, turn over the index for the leading symptoms manifested by the patient.

b) Then, consult the repertory at the place indicated.

c) If not satisfactory, try another leading symptom of the patient in the same way beginning from the index. 

d) In case, further details of the remedy indicated are desired, turn to the condensed materia medica, finding the remedy in the index.

e) If wider knowledge of the remedy is desired, consult the same remedy in herring guiding symptoms

f) Finally, to learn a drug as completely as possible, the nature and action of the drug, consult the cyclopedia of drug pathogensy.

7) In the estimate, much help maybe derived from lectures and essays of Dunham, Farrington, Hughes, and others.

A word to the beginner: we know that a person is sick by the way they report their sensations or feelings, by their changed appearance, by the physiological changes, by the physical changes and all of these changes give peculiar symptoms.

2) Drugs, poisonous and those more or less deleterious, are capable of producing such changes as these in healthy persons.

3) Experience has taught that when a drug sickness is closely similar to so called natural sickness, when administered properly will be beneficial to the patient.

4) Experience has taught that similar drug is likely to strongly affect the patient for ill if given in large doses or even at times in appreciable doses.

5) The size and frequency of the dose is strictly subjected to empirical tests, and in this fact lays the skills of the physician.

Drug that increases the symptoms will usually benefit if given in sufficiently reduced doses.

Source: The symptoms here given have been derived from drug proving and clinical symptoms. In any case, these symptoms are subjected to further experiment and observations.

REPERTORY PART

Construction:

On top of the page, the word ‘repertory’ and the last rubric of that page has been mentioned with the page number. Presentation of the rubrics and the remedies in this repertory are as follows;

1. RUBRICS: 

• Alphabetically arranged
• Given in capital bold
• Followed by colon (:)
• main rubric is repeated 

Ex: ABDOMEN:

2. SUBRUBRICS:

• Given below the main rubric with space towards right.
• Given in roman bold
• Followed by colon (:)

Ex: ACRID:

             Acrid coryza:

3. SUBORDINATE RUBRICS: Few rubrics have subordinate rubrics and further subordinates.

• First subordinate rubric to the sub-rubric is mentioned in bold roman beside the sub-rubric with a colon.
• Further subordinate rubrics (if any) are mentioned in italics and are followed by colon.
• These are mentioned alphabetically.

Ex: ACRID:

            Acrid coryza : thick : Abundant:

4. DESCRIPTION AND REMEDY: After the subordinate rubrics, detailed symptom description is given which is followed by the indicated remedy. Mostly every detailed description is followed by single remedy, but at places, few remedies have been mentioned within the brackets.

• Description may contain any of the following; 

Sensations (ex. Coldness, suffocative, constriction)

Location (ex. between shoulders, nose front, nose back)

Character (ex. Acrid, corroding, offensive)

Discharges (ex. Watery, profuse, fluent, thick, colour)

Time modalities (ex. AM, PM, day, night, evening, morning)

Onset (ex. Acute, sub-acute, chronic)

Situation/ circumstantial modalities (ex. Worse in open air, better indoors, better washing in cold water)

Concomitants (ex. Coldness between the shoulders)

• Alphabetical order has been followed in accordance to the remedy given after the description.
• Symptom description is given in roman.
• Remedy is given in italics.
• Remedy doesn’t have any gradations.

ACRID:

Acrid coryza : thick : abundant :

Thick, yellow, acrid and corrosive discharge; nose stopped, Arum triph.

Acrid, purulent discharge; nostrils sore, especially left (chronic catarrh), Uran. Nit. 

5. CROSS REFERENCES: 

• Confirmatory cross reference is given right beside the main rubric.

Ex:  ACRID COUGH:   See “Sputa, Acrid”  “Acrid chest”  “Rawness chest”.

• Comparative cross reference has been given within the brackets after the remedy is mentioned.

All the rubrics in this repertory has been categorised into sections for better understanding;

• • Location: nose, throat, larynx, chest, epiglottis, clavicle,  oesophagus, Eustachian tube, frontal sinuses, glandular swelling, lachrymal duct, mouth, palate, posterior nares, roof of mouth, root of nose, uvula, sternum, stomach, ears, eyes, face.
  • Throat: hawking, hoarseness, itching, lump, larynx and throat given in detail, pustules, rising in, singer’s sore throat, speaker’s throat, voice. Throat has been separately mentioned as a main rubric.
  • Sputa: abundant, adhesive, black bloody, bloody taste, difficult, flies out, gluey, little bit of, lumpy, offensive, purulent, scanty, saliva – no sputa, slimy, viscid. Sputa  and discharges(mentioned as a main rubric also)
  • Discharges: abundant, acrid, bland, passive abundant secretions, thick discharges( mentioned as a main rubric also), thin discharges(mentioned as a main rubric also), vicarious blood.
  • Coryza: alternating, bland, bloody, colour, acrid, exhausting, offensive, painful, purulent, sneezing, snuffles.
  • Cough: asthenic cough, awakens from cough, belching, bloody, bursting, constant, constriction, croupy, dry, deep, difficult, distressing, explosive, frequent, habitual, hacking, hard, harsh, heart cough, hollow, hysterical, loose, loud, nervous, obstinate, occasional, offensive, ovarian cough, painful, painless, penetrating, rattling, reflex, ringing, short, spasm, sympathetic, tea drinkers, tingling, tormenting, tube sounding, uterine cough, pregnancy cough, violent, wind instrument cough, worm cough.
  • Sensations: burning, rawness, constriction, crumb feeling, crawling, cord feeling, drops falling, dropping in throat, dryness, dust feeling, emptiness, fly to pieces, fullness, fur feeling, hair feeing, heat and cold, heaviness, hollowness, irritation, membrane feeling, oppressed, peculiar sensations – throat, larynx, chest lungs, stomach; prickling, shocking, worm sensation.
  • Respiration: breathing, cough; breathing – deep, difficult, dyspnoea, paralysis; choking and gagging, dyspnoea, suffocation, violent.
  • Senses and Functions: smell; smell and taste; taste; tasteless; swallowing.
  • Onset: acute, chronic cough, chronic coryza.
  • Time modality: 

Time – morning, day, forenoon, afternoon, evening, night, midnight, 2to 4 AM, 3AM, 4AM.

Alternating time – 

Coryza – dry day, fluent night

              – dry AM, fluent PM

              – dry night, fluent night

Coryza – stopped in, fluent out

              – stopped out, fluent in

Coryza – stopped night, free day;  stopped night, free morning.

Alternating times – dry cough, loose cough.

• • Modalities: better – air, position, bathing, busy, drinking, eating, motion, electrical storms, foggy weather, fresh cold, inhaled air. Sides – left side, right side; lying down, sleep and cough; warm, water in mouth, wet weather. WORSE , BETTER (mentioned as main rubric)
  • Constitution: aged people, children, drunkards, old people, rachitic children, scrofulous children.
  • Mind rubrics: anguish, depressed, drowsy, irritable, noise sensitive to. Few mind rubrics have been mentioned under main rubrics worse and better.
  • Clinical rubrics: asthma, dyspnoea; casts, fibrinous; aphonia; oedema of lungs; foreign body in; hiccough; hay fever; hydrothorax; paralysis of breathing, throat, lungs; tuberculosis; ulcers; whooping cough.
  • Others: angina pectoris, anorexia, backache, bones ache, between shoulders, constipation, dentition, diarrhoea, eruptions, headache, hip pain, involuntary stool, flatulence, genitals, liver troubles, spleen, trembling, twitching, veins enlarged, vomiting.
  • Generalities: chills, chilliness, cold and coldness, fever, night sweats, dropsy, debility, shock, emaciation, flesh, pulse, sleep and cough, thirst, urine, weakness.

MATERIA MEDICA PART
Repertory is followed by Materia Medica which has been constructed considering PQRS from Herring’s guiding symptoms.

This part starts with an Index which contains names of the drugs with page numbers. Starts from Aconitum Napellus and end at Zizia.

Total number of remedies: 296

Arrangement: Symptoms of each remedy has been mentioned under sub headings. Note that not all the sub headings are mentioned under all the remedies. Following are the sub headings under which symptoms have been mentioned;

Coryza:

• Dry
• Fluent
• Sensations – under nose, throat, headache
• Discharges
• Pharynx
• Aliments from
• Worse /Better 
• Acute/chronic
• Temperament / appearances.

Cough: 

• Dry 
• Sputa
• Worse /better
• Larynx and voice – larynx, voice, croup, throat.
• Chest and respiration
• Sensations and pains
• Pulse / fever and pulse
• Temperaments / mind / appearances
• Peculiar states/ special symptoms
• Concomitants
• Acute/ chronic
• Special diseases(clinical conditions)
• potencies

Dr Annapoorna H
PG scholar, Department of case taking and repertory,
Government Homoeopathic Medical College and Hospital, Bengaluru.