Page images

through the mucous and cellular membranes, involving the muscular tissues, and not unfrequently attack the ligaments and cartilages themselves. But all these distressing results may generally be averted or overcome by judicious and prompt treatment.

CASE XXXIII. CONSUMPTION.-A lady aged forty, of slight make and scrofulous constitution, consulted me for a chronic cough, attended with extreme debility and emaciation. The patient stated that she had, in early life, two severe attacks of pleurisy, from the effects of which she had never quite recovered. Her general appearance entirely assumed the aspect of a consumptive patient, and the stethoscope afforded signs of pectoriloquism at the humoral extremity of the right clavicle, and on percussion the sound was found to be dull all over this portion of the chest. The pulse varied from 105 to 115; the animal heat 101°; she could not count more than seven without taking a breath; the inspirations thirty-one in a minute. The expectoration was profuse, and she occasionally suffered from night perspirations. The slightest change in the wind or temperature gave her cold, and made the cough almost unendurable: the tongue was coated; the appetite impaired; the bowels very loose; and she complained of want of sleep.

I prescribed a preparation of iodine and conium, to be inhaled twice daily, and a vesicating and iodine liniment to be applied over that portion of the chest where the pulmonary disease existed. The trisnitrate of bismuth was taken internally to overcome the diarrhoea. At the end of a fortnight a slight beneficial change had taken place both in the nature and quantity of the expectoration, and the cough was less frequent. The diarrhoea had quite ceased, and she expressed herself as feeling stronger and better in every respect. I now increased the strength of the inhalations, and prescribed the oleum morrhuæ (cod-liver oil) to be taken twice a day in an aromatic bitter. In six weeks the cough was overcome, and she was quite free from those violent paroxysms which

had formerly oppressed her, and the perspirations had ceased. Her flesh had increased in a more remarkable manner than I had ever before witnessed. The same treatment, modified according to symptoms and circumstances, was steadily persevered in for rather more than three months, by which period the cough had quite ceased, the pectoriloquism was changed for a mere resonance, and she was restored to average good health.

REMARKS. The above case (which, I was given to understand, had been pronounced a hopeless one) very strongly exhibits the curative influence of medicated inhalations, and also the beneficial effects of cod-liver oil in fattening the consumptive patient; and this is of very great importance in the treatment of those diseases where, by the wasting of their natural covering, the superficial vessels are exposed to the influence of every change of temperature in the air. The shielding of the vessels from the influence of cold, by an increased deposition of adipose matter, appears to be one of the chief objects gained by the use of the oil.

The great merit of cod-liver oil as a nutriment lies in the fact that it is an animal oil, so easy of assimilation as scarcely to require digestion. It is really doubtful whether it undergoes any material change in the stomach. It seems to be simply absorbed and deposited as fat in the cellular tissue beneath the skin, thereby forming an additional covering to the body, thick in some parts and thin in others, as nature requires to protect the sensitive and vital parts beneath.

The influence of a good covering of fat is strongly illustrated in the difference in the sensations experienced by fat and lean people on a cold winter's day. Fat people then become unusually blithe and gay, their eyes sparkle, their complexion is fresh and clear, and they show us in all their actions that they are in a congenial element. Thin, meagre, lean people, on the other hand, shrink up within themselves, the skin becomes blue, the teeth chatter, and every gust of

[ocr errors]

wind seems to make a ready passage through their attenuated forms. Reverse the weather, and we change instantly their condition. On a hot summer's day the "shadow of a man is in capital spirits, and ready for any enjoyment; while the fat man, per contra, puffs and blows and perspires like an overstrained engine.

This simple illustration will serve to show why cod-liver oil is so much more beneficial in cold than in hot weather, and why it benefits consumptives after the body has begun to waste, and not before. When the system requires the nourishing and protecting influence of the oil, it will generally agree; but I have never seen any good to result from its use until after the patient began to lose flesh. In the winter a covering of fat and a covering of flannel exert a similar influence they protect the superficial vessels from the impression of cold, and keep up the circulation of the surface.

Cod-liver oil is unquestionably a valuable nourishment in certain chronic diseases attended by wasting of the body, among which consumption is the most prominent and important. But I cannot regard it as a medicine. To do so would be to remove all distinctions between food and medicine. I believe, in fact, that it is wholly devoid of medicinal properties. Were not this the case, we should find it most beneficial in the earliest stage of consumption, yet we know it to be most beneficial in the third stage, after suppuration has commenced-and at that period of the year most favourable to the cure of this disease, viz., the summer and early autumn, when in reality experience establishes the very reverse to be


And yet, for several years, cod-liver oil has been almost the only medicine prescribed for the cure of pulmonary diseases. It has been emphatically THE GREAT REMEDY of the profession, and no nostrum was ever more empirically administered. In all stages and forms of consumption, and under every variety of circumstances which surround this disease, it has been given almost as a specific. Now what

are the results attained by its use? The bills of mortality show an increase in the number of deaths from pulmonary diseases equal to, if not greater than, the ratio of increase in the population. There has been no decrease in either their prevalence or their mortality. The sales of the oil have steadily decreased for several years, until it is questionable whether for every six gallons consumed three years ago one is consumed to-day. Then everybody hoped miracles from its use as a medicine-now comparatively few persons can be induced to take it even as a nourishment. From one absurd extreme we are fast verging to the opposite.

Now, clearly, all this is very foolish and very wrong. Cod-liver oil has certainly failed as a medicine, but it has firmly established its claims as an important article of diet in many exhausting diseases. Properly employed, and in suitable cases, it supplies the system with a peculiar nourishment required to counteract the waste going on, and at the same time saves the stomach from much labour in digestion. It is therefore an important dietetic aid to a proper and rational treatment of many cases of consumption, and should be so esteemed by the public and the profession.

CASE XXXIV. CHRONIC COUGH, WITH LOSS OF VOICE.The following interesting case came under my observation:


Liverpool, July 17th, 1846. "DEAR SIR,-Two friends of mine, Mrs. of this city, and Mrs. of Manchester (the former you will probably remember suffered under consumption, and the latter from severe asthma), assure me that they were perfectly restored by medicated inhalations to a state of health, after their cases had been considered as irremediable. From these very favourable accounts of your mode of practice, I am induced to lay my own case before you, which has hitherto baffled all treatment.

"I may mention that among other physicians who have professionally attended me, are included Drs.

place, and Dr.


of this of Manchester. All these gentlemen rank very high in this part of the country, and to each of them am I

indebted for much kindness and attention. Indeed, I am well convinced that, if the ordinary mode of treatment were capable of curing my ailment (which a sad experience now convinces me it can never do), I should have no cause to address you upon the present occasion.

"My age is forty-one, married, the mother of three children. I am of slight stature, fair complexion, but should say of an average good constitution. My parents are alive and have attained a good age, although neither of them ever looked very robust. I lost one child by croup, but the others are healthy.

"In the year 1840 I had a very severe attack of influenza, which confined me to the house for nearly two months, and ever since that time I have been subject to a 'winter cough,' attended with profuse expectoration, requiring long-continued and distressing efforts in its expulsion; palpitation of the heart; shortness of breath; and a peculiar wheezing or hissing noise in the throat, more especially when going up-stairs. All these symptoms have heretofore disappeared at this season of the year, but I grieve to say that I now feel worse, and suffer more inconvenience than I ever did, even in the winter months, for my voice is nearly gone (which never happened before), and I have a most painful difficulty in speaking, even in a whisper.

[ocr errors]

"I fear that my digestive organs were much impaired by the constant exhibition of cough medicines,' for ever since I abandoned the use of them (now about three weeks ago), I have gradually gained flesh and strength-all the functions of the system, indeed, now appear to be healthfully performed, with the exception of those allotted to the bronchial tubes. I feel, however, very nervous, which I chiefly attribute to loss of sleep at night from the urgency of the cough, and now write under great dejection of spirits.

"I shall be very glad to find that you can treat my case by correspondence; but my husband requests me to say, if a personal interview with me is indispensable, that he will gladly make an arrangement with you (as I cannot myself bear the fatigue of so long a journey) for paying me a professional visit.


Hoping that you will give this statement your earliest consideration, and anxiously awaiting your reply, I beg to subscribe myself, "Yours truly,



« ՆախորդըՇարունակել »