Kent's Method of Repertorizing

A good example of the working of an orderly mind is this discussion of Case I. in which Dr Hubbard demonstrates her approach to a difficult case, displaying her passion for thorough- ness. This case has been used as an example of the potential danger of improper prescribing of high potency homoeopathic medicines. Her handling of the severe aggravation is of special interest.—Ed. Mr E. W.. aged 60, complains of burning heat in the right thigh, which seems to be located in the skin, and which, during the past fifteen years, has spread to the right arm and hand and foot. It is present during sleep as well as in the daytime. There is an almost complete paralysis of his entire right side. He is slow and deliberate in his speech, of good intellect and in good spirits, although not a little suspicious, especially so of all doctors.

Some fifteen years ago he developed a series of ulcers on the groin, from one of which a sequestrum of bone discharged. He treated himself by a home remedy of chewed lead, which he prepared himself. Eighteen years ago he had typhoid but remembers no other disease. He denies venereal infection. He has no children and has been separated from his wife for more than ten years. He has a lack of facial expression but no Argyll pupil or Romberg, although the reflexes in the right extremities are lacking. He cannot repeat the words "Methodist". 'Episcopal', etc. There is very little atrophy of the muscles, although his strength on this side is gone. He has to eat with his left hand, and has a shuffling gait.

DISCUSSION

It is said that more than half the battle in any cure is a case well taken. We all know that the cases with few outstanding or characteristic symptoms (except pathological changes) are difficult to treat and of bad prognosis, and usually show a profound miasmatic disturbance. This case is so incomplete as to be impossible of a satisfactory solution. It may be that the individual actually shows no other symptoms and could give no more, but we should like to have a check-up. especially on the following:

Olher mentals, such as suicidal tendencies in the past, fears, whether the cheerfulness was euphoric or grandiose or merely normal, whether the suspicion was paranoid in trend or only the result of unfortunate experiences with physicians, and so on.

The general type of the patient, which is not mentioned, and many other little objective points such as tongue, ears, warts, moles, condition of nails, colour and character of discharges, if any; condition of the external glandular system, type of build, skin quality, warm-blooded or cold-blooded type, sweat in general, and sweat of affected parts in particular; sleep, conditions of aggravation and amelioration, time of aggravation, such as after sleep, morning, night, etc. The case as given presents no individual picture that might make the patient either a living entity or a drug entity to the physician. There is a conspicuous absence of Generals, no mention being made of reactions to wet weather or dry, heat or cold, position or motion, or to any of the desires or aversions in food.

Even from a general medical point of view the case is incomplete. One would like to know whether the groin ulcers followed buboes, whether at any time there was a urethral discharge whose venereal character was either unknown or unadmitted. This might be revealed by discovering what kind of treatment he had ever received. No mention is made of Wassermann tests or Neisserian smears. One would like to know the cause of the paralysis. From the brief description given little hint can be gained, but it makes an enormous difference in the choice of the remedy whether the paralysis is from a blood clot in the brain due to cerebral haemorrhage, or to a possible lead poisoning with resulting degeneration of nerve tissue, or to a luetic lesion in the cerebrospinal mechanism. Under the paralysis, is it progressive, as it would be if of syphilitic or lead origin, or is it stationary or retrogressive, as would be more likely in apoplexy?

The only really characteristic symptom in the whole case is the sensation of heat in the paralyzed part, although, being a particular, this should not be placed first. A careful inquiry is needed as to whether other symptoms throughout the life have been right-sided. We would call attention to the fact that the lesion in the brain, if any, is left-sided. Right-sided paralysis alone is not sufficient to give great weight to right- sidedness as a general symptom, although in so barren a case one clutches at straws.

The question of suppression of the ulcers, which may well have led to the paralysis, should be stressed. A check up of symptoms for lead poisoning, both in the gums, good and paralyzed side, should be gone

into. No mention is made of trembling, formication or numbness. In any case where there is a paucity of available symptoms it is important to get as clear a picture as possible of the childhood, whether fat or thin, rickety, amiable, with a tendency to glandular troubles, suppression of eruptions, foot sweat or discharges, susceptibility to frequent colds. In other words, the type of the child prior to any possible venereal, pharmacological or suppressive complications.

CHOICE OF RUBRICS