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cite a number of previous writers, who had observed these pains in persons exposed to lead, but the word gout is never mentioned. Of the 752 sufferers from arthralgia who came under his personal ken, 168 were house painters, the very class in which Dr. Garrod has so often observed gout in this country. As the mode of life and habits of the French operatives are less calculated to provoke gout than those of English workmen, and as gout is not encountered in France amongst individuals suffering from marked lead poisoning, the question as to whether or not lead predisposes to the disease may safely receive a negative

answer.

I add here a final remark. I have said that P. K. probably died at last of what Todd called "gouty kidney." Basham, in his work On Dropsy, p. 214, narrates the case of a painter, who inherited gout from his father, and had the first seizure in his seventeenth year. No mention, however, is made of lead symptoms. There were chalky deposits on the joints of the right hand. Whilst convalescing from the gouty attack for which he was under treatment, and probably after drinking beer or exposure to cold, the urine was found to contain albumen in considerable quantity and various renal products. Nevertheless, whether P. K.'s albuminuria was, or was not, dependent upon structural disease of the kidney inflicted by his gout, there is a form of albuminuria produced by the action of lead on the blood, or on the kidneys. Ollivier was the first to point this out.* In chronic lead poisoning, he says, the kidney lesion and albuminuria are both attributable to a cachexia, or general alteration of nutrition produced by the metal, whilst the acute form of poisoning gives rise primarily to a local lesion, determined directly by the elimination of the lead, and that the kidneys, once altered, permit an albuminous drain. Renal elements were discovered in the albuminous urine of men and animals poisoned by lead, and on examination

* De l'albuminurie saturnine; also his Essai sur les albuminuries produites par l'élimination des substances toxiques. Danjoy's brochure, entitled, De l'albuminurie dans l'encéphalopathie et l'amaurose saturnine, is also well worthy of perusal.

after death, epithelial desquamation and obstruction of the tubuli uriniferi. Other observers, however, maintain that the albuminous principles of the blood are changed in chemical composition* in the very first instance by lead, whether the process of poisoning be slow or quick a view which has the merit of placing all the forms of toxic albuminuria on the same pathological level as regards the initial alteration.

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REPERTORIES.

By Dr. HERBERT NANKIVELL, M.D., M.R.C.S.

THE necessity of a repertory, or index to the symptoms contained in the homoeopathic Materia Medica, is apparent even to those who content themselves with abridgments of the drug-symptoms; it is doubly apparent to those who are in the habit of consulting the records of the actual provings. The purpose of a repertory is to enable the physician to discover, rapidly enough, and with the smallest possible amount of searching, the drug or drugs which reproduce with the greatest similarity the group of symptoms he is treating. More than this it cannot do, and the provings themselves must be consulted before it can be determined whether there be a true similarity between the range of action of the drug, and the diseased state under observation.

The question arises then, In what manner can these requirements be most completely satisfied? The answer to this is, "By placing every symptom in full in every place in which it can possibly be searched for." It is not sufficient merely to put in the name of the drug under one particular heading, without all the rest of the symptom in connection with it; because in this way, as we shall afterwards see, a repertory loses nearly all its value. For convenience' sake

* According to Bucheim (Lehrbuch der Argeneimittelehre) the lead becomes a soluble albuminate.

such a work would be divided into chapters, in correspondence more or less with the divisions of Hahnemann's schema. Then in each chapter, under each substantive heading, e. g., "pain," "weariness," or "weight," should be written down each drug which produces that symptom, with the rest of the symptom affixed. Perhaps a drug may produce both "pain," and "weariness," then it must be found under each of these heads, and also under a special heading "pain and weariness:" in all the places, its conditions, e. g., at "evening," and "during walking," and its concomitants go down as well. Then it must also be found in full in the list of "conditions," under its proper headings, and in the list of "concomitants" likewise. If, then, a drug-symptom supplies two substantive headings it goes down in three places; and if it possess two conditions and one concomitant, it goes down further in nine other places, thus making a total of twelve entries. Now, as a symptom becomes longer and more complicated, it contains, and goes down under a greater number of headings. The size of the book increases, therefore, in something like geometrical progression, and Jahr's calculation that such a repertory would fill forty-eight of his big volumes does not seem an exaggerated one. Our model repertory would thus become a model of perseverance; but as a help in practice it would never be used. Yet theoretically this standard is a true one, whereby to weigh the merits of a repertory, and any work that falls seriously short of it becomes a more or less fallacious guide to the practitioner.

At present there are in the hands of English-speaking homœopathists, four different repertories: viz., Jahr's, whether according to Hull, or Curie; Buck's Regional Symptomatology and Clinical Dictionary; Hempel's Repertory; and that now in course of publication by the Hahnemann Society, which is distinguished from all others by the employment of symbols. We shall proceed to com

pare the respective merits and demerits of these works, and also to discover how nearly any of them approach the theoretical standard, for this will be the best test of their respective usefulness.

To begin with Mr. Buck's repertory. The first section of the Regional Symptomatology contains those symptoms relating to "taste, appetite, vomiting, &c." This section fills eighteen pages, and gives in an abridged form the symptoms of 57 drugs. It is supplied with по special index at the end for any of the symptoms, and therefore becomes all but useless for rapid reference. It is in fact a mere collation of symptoms. Turning now to the Clinical Dictionary, one finds under 'Appetite' (p. 738) the following sections: (1) Lost; 25 drugs, 18 of these are simply named, while 7 contain more particular indications. (2) Voracious; with 12 drugs, merely named, 6 of which have already appeared under the first section. (3) Very soon satisfied; 1 drug, Podophyllum. (4) Constant hunger; Staphysagria only. Under 'Appetite,' then, we can only depend on the 7 particularised drugs under sect. 1, and on the 2 last-named; other drugs may be indicated, but we cannot tell which, without turning back some 250 pages, to the Symptomatology. Turning to 'Taste' (p. 777), we find under (1) Lost; 9 drugs, name only; (2) Acid; 8 drugs, two of which were in sect. i. (3) Bitter; 8 drugs. No other variety of Taste' is given. Under Vomiting' (p. 782) are given 9 drugs; of 'Bile,' 8; of 'Food,' 8; 'During Pregnancy,' 4; with 'Diarrhoea' 6 drugs. By means of this dictionary it would be a matter of difficulty to hit on a symptom containing three such heads, as reference must be made in three separate pages to find a drug, and then back to the Regional Symptomatology to endeavour to verify the conditions and concomitants. Moreover, the simplicity of the work, and its small range of drugs, must in some cases prevent altogether the discovery of the right medicine.

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We shall take Hull's Jahr, a book which has passed through four American editions, as a specimen, more or less correct, of repertories according to Jahr. Chap. xiv contains the symptoms of Appetite, &c. Sect. 1 is taken up with clinical observations, and the indications of a few special drugs. The repertorial part proper commences with sect. 2; under Loss of Appetite,' 128 drugs are given,

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followed by a list of indications for 41 drugs; reference is also made to 'Disgust,' with 28 drugs, besides further indications for 16; and to Satiety,' under which 21 drugs are grouped, with 6 under a further indication. Comparing this with Buck's work, its greater fullness is at once seen, vet its defect in the amount of drug indication makes the long list of names a puzzle to the practitioner, and the real power of selection conferred by either work is not so different as one would at first suppose. Under Loss of appetite' but 13 adjuncts, conditions, and concomitants are placed, defining but 41 drugs out of 128; and we could not by this work cover such a symptom as the following"Loss of appetite at dinner, with nausea, faintness, and sweat on the forehead." Lycopodium produces this, but it only figures here as one out of the 128 beneath 'Loss of Appetite.' Sect. 3 includes all the symptoms which occur during or after the reception of food or drink into the stomach, and filling, as it does nearly six pages, would appear to be very complete. The defective arrangement of the concomitant symptoms, however, deprives this section of much of its value. For instance, under 'During a meal,' one observes the following succession of symptoms:"Nausea," "odontalgia," and "oesophagus (pressure in)." No one would expect to find toothache in such company. Among the sufferings after meals, 56 drugs are given under 'Stomach' (pains, pressure, &c., in the); but we are not told which produce the pains, which the pressure, or which both; there is no information given as to the quality, comparative violence, duration or direction of the pains; and we are left in entire ignorance as to what the '&c.' refers. So that one is not a bit further on in the search after the required drug in this way, for it is quite impossible to go hunting up all the stomach-symptoms of 56 drugs in practice. Neither Jahr then, nor Buck, come up to the admitted requirements of what a repertory ought to be; the one overburdens the practitioner with a long list of undefined drugs, and the other supplies him with only a scanty list of polychrests.

Hempel's repertory takes rank considerably above the

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