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Moreover, some of the symptoms of Antimony lead me to infer that it may be of use in certain cases of lupus, namely, when the suppurative destruction and loss of substance is not far advanced; at least, prominent among the symptoms of Antimony we find the obstinate lumps, boils, and pimples so characteristic of lupus, and not less so the disposition to discoloured gangrenous suppuration of the upper connective tissue. I have not at the present moment any clinical experience of the efficacy of Antimony in such affections, but I shall employ it whenever an opportuuity presents itself.
As regards the treatment of lupus it is not altogether without favourable results. Arsenic and Mercurius are sometimes strikingly efficacious, sometimes, however, not at all. I have given Kali bichrom. and Condurango too seldom to be justified in forming conclusions respecting them. For about seven months I have had under treatment a girl of seventeen who has had this horrible disease for ten years, and in whom it has already produced the most cruel devastation. The left eye, the nose, and the upper lip are completely destroyed; the lower lip is so far destroyed that the incisor teeth are laid bare to their roots and are quite loose. Since the employment of Mercury the destructive process in the orbit and the root of the nose has come to a stand and become almost dry, and the pains in the lower lip have almost ceased.
In order to show how numerous are the cases of exanthematous disease in our dispensary I subjoin a- tabular resume of the cases treated in 1872 and the results of the treatment.
I should mention that in the third column (" improved ") all those cases which did not present themselves in the dispensary after their complete cure must he included; and in like manner under the head of "discontinued" there must always be a considerable proportion of cured, as, indeed, we are often made aware when they subsequently present themselves for other affections.
The case of elephantiasis occurred in a man of sixty, in whom, in consequence of chronic ulcers of the legs of many years' standing (originating in eczema), there was developed immense infiltration of the whole surrounding skin with considerable thickening and desquamation, so that the whole leg and foot formed a thick shapeless mass, which certainly justified the above diagnosis. Under the use of Sulphur and Arsenic marked improvement took place; unfortunately the patient ceased attendance after some time.
THE CYPHER REPERTORY.
The appearance of a fresh instalment of the Repertory of the Hahnemann Publishing Society,* for which we are indebted to the industry of Dr. Herbert Nankivell, induces me to say a few words on the subject of repertories in general, and of this one in particular.
It must be obvious to any one who considers the subject, that there are two conceivable modes of working the homoeopathic method, of following the rule "Let likes be treated by likes." The one may be called the a priori mode, the other the a posteriori. The former infers from the pathogenetic action of any substance what will be the morbid conditions in which it should prove curative. It tests the inference by practice, and gains therefrom additional indications for the distinctive choice of the remedy. It finally obtains a specific, i. e. a medicine definitely related to a certain form or stage of a known malady, which when it encounters it will certainly modify or extinguish. The a posteriori mode, on the other hand, begins with disease instead of drugs. It is that which we adopt when, having examined a case, we consult our pathogenetic records to see what medicine has caused similar symptoms in the healthy. Our future progress here may be as in the former way of proceeding; but, more commonly, the fre
* A Repertory; or, Systematic Arrangement and Analysis of the Homoeopathic Materia Medica. Part VI, containing Stools and Rectum. By Dr. Herbert Nankivell. London: Turner. New York: Boericke and Tafel.
quent adoption of this plan results in its exclusive use, to the disregard of the other mode of working.
I have myself been an habitual follower and advocate of the it priori mode of homoeopathising; and what work I have been able to do in the field of Materia Medica has been directed towards its furtherance. Nor do I cease to maintain that it is, whenever practicable, the best manner of proceeding. It sends the student forth ready equipped for his work without cumbersome apparatus of books of reference. It harmonises with all advance in physiology and pathology, for it tends to make of pharmacodynamics a companion and analogous science. Nor need it be deficient in the individualisation which is the special merit of the other plan. If only the medicines be studied in their minute detail as well as their broad outline, they may be a priori adapted not only to genera but to species, not only to species but to individuals. As a matter of fact, nearly all our best specifics—the remedies which are the glory and the power of homoeopathy—have been gained in this way.
But it is nevertheless true that such a plan alone does not suffice for the exigencies of practice. The chief difficulty in working it arises from the form of our Materia Medica. The a posteriori method was evidently Hahnemann's ideal; and the arrangement of his pathogeneses in the form of a schema of disconnected symptoms had view thereto. If every case is to be treated by writing down its symptoms in anatomical order, and then finding what medicine has produced all, or the greatest number, or the most characteristic of them, then the form adopted answers every purpose. That it is impossible to form any a, priori notion of the medicine, or to see in its effects any true pictures of disease, is of no consequence upon this system. The only faculty to be exercised upon the Materia Medica is that of memory. Now, as we know many of our medicines only from the pathogeneses with which Hahnemann and his like-minded followers have furnished us, we can work with them only upon his plan. We should never use them a priori; but when seeking for a simile to fit a given case, every now and then we come upon them.
It is for this latter purpose that repertories are indispensable. A repertory, as its name implies, is a means of finding that to which it belongs. It is simply an index to the Symptomen-Codex, which shall save us the turning over every page in search of that which we want. But an index may be a good or a bad one. It is good in proportion as it is copious, as by repeating each topic in every element of which it consists it insures immediate success in consulting it. Dr. Nankivell himself has, years ago, demonstrated the superiority in this respect of the Kepertory of the Hahnemann Publishing Society over the others available to English readers.* I would refer those interested in the subject to his article, and it is needless to repeat his arguments here. One, however, may be added. The other repertories (Hempel's, and Hull's and Curie's Jahr) date some twenty years back; and hence contain none of the medicines which have been added to our stock since that time. The English Repertory, as it has fairly been called, adopts all new remedies as it goes on. Its first list (1850) contained 323 medicines; its second (1859)—some being omitted—301; and now Dr. Nankivell has added (mainly from Hale's and Mure's collections) eighty-two more. >
As this work is hardly so well known as it deserves to be, a brief account of its history and progress may be given with advantage.
The Hahnemann Publishing Society was founded in 1848. Its object was to supply to physicians practising homoeopathy works of real value, the expense of whose publication would be too great a risk to be undertaken by private enterprise. Dr. Dudgeon at once offered to prepare for it "a systematic arrangement of the homoeopathic Materia Medica." This offer being accepted, there appeared from his pen in 1850 a volume of some 600 pages, entitled The Pathogenetic Cyclopaedia; a systematic arrangement and analysis of the Homoeopathic Materia Medica. * Brit. Journ. of Bom., xxiv, 278.