COD-LIVER OIL- ITS MODES OF ACTION. 343 from the alimentary canal. This may depend on its containing some biliary principles; it often has a marked effect in increasing the secretion of the liver, and if this is sufficiently carried off by the several processes of combustion and elimination, no tendency to sickness results from its use. It is, therefore, not surprising that codliver oil can be administered in larger quantities and for a longer time in cold seasons than in hot; to persons who take exercise than to the sedentary; and especially to those whose bowels act regularly and sufficiently. With many weakly persons it assists the digestive process by promoting the biliary secretion; and, in not a few instances, I have found it effectual in improving and rendering more fluid this secretion in persons liable to gall-stones, or obstructions from inspissated bile. On the other hand, it is apt to disagree in cases of inflammatory dyspepsia, especially that affecting the duodenum; in those of hepatic congestion, with fulness and tenderness of the hypochondria; and in all states of high fever or inflammation. All such affections should be relieved by saline effervescing draughts, mild mercurial aperients, and such means, before the oil is given; and, in case of persons prone to these disorders, they may be required occasionally during its use. Thus we have an oily matter, well borne by the stomach, easily diffused by emulsion through the alimentary mass, readily absorbed by the lacteals, where it contributes to form a rich molecular base' in the chyle; apt to saponify with the basic salts of the blood; and, when diffused in this fluid throughout the capillaries of the body, capable of penetrating to all the textures, and of exercising its solvent and softening action on the solid fats of old deposits, whilst it affords a rich pabulum for the living sarcophytes and bioplasm of the blood, tissue-cells, and lymphatics. Its superior penetrative and suppling properties render cod-liver oil valuable in the process of currying leather, and previously to its introduction into medicine, this was its chief commercial use. Its fluidity and divisibility enable it to pervade all tissues of the body, and to penetrate even into caseous and imperfectly organised deposits, and so to dissolve their solid fats and soften their concrete sarcophytes, as to render permeable and supple their whole mass, and open them to the immigration of new and active bioplasm, by the operation of which their vitality and nutrition may be improved and maintained, or if incapable of such improvement, their substance may be gradually dissolved and carried off. If we call to mind also the large share which fatty transformation seems to have in the processes of resolution and suppuration which terminate inflammation and clear away its products (as explained in Chap. vii.) we can see why the administration of cod-liver oil proves so eminently beneficient in promoting these salutary results. For that very process of fatty transformation which is so injurious and fatal when it affects vital organs, as the heart, or when it spreads destruction in the caseation of a lung, is salutary and conservative when it helps to soften and carry off the obstructing and irritating products of inflammation. We can thus understand why under the use of the oil the cough becomes softened, and the expectoration easy, being thereby fattened and ripened (sputa concocta, crachats gras, cuits). Much more might be said respecting the action and valuable qualities of this wonder working agent; but we cannot afford space here, and must refer to the 'Principles of Medicine,' (3rd Ed. p. 484 et seq.) for further particulars, and for its history and the best mode of taking it. I would only add here that longer experience has further convinced me of its value as a remedy, and has proved that there COD-LIVER OIL-CONSTANT USE REQUIRED. 345 need be less limitation to its use than formerly was thought necessary. For instance, it was, and often still is, said that it ought not to be given in warm weather, or in hot climates, or during the existence of any fever, inflammation, or hæmorrhage. We now have abundant evidence that it may be taken throughout the summer, in the East and West Indies, in Madeira, and in other tropical climates. Under these circumstances, it is generally expedient to reduce the dose or the frequency of its exhibition: and the same moderation may be required in continuing it during feverish or inflammatory attacks; but, as before stated, it may commonly be given after a morning meal, long before the attack has subsided, and it may contribute not a little to their removal. So soon as a patient is able to take and digest solid food, he may take a little oil after it. With respect to hæmoptysis, so long as the discharges of blood are so large or frequent as to require the constant exhibition of styptics, there is no time for the oil; neither ought solid food to be taken which fits the stomach for it; but I have found no reason to suppose that the oil has any tendency to increase the hæmorrhage; whereas it certainly promotes the healing the phthinoplastic ruptures which produced it. But in such a case the oil may be given in conjunction with a styptic, and a mixture containing sulphuric, tannic, or gallic acids, separate or combined, or tincture of perchloride of iron, or liquid extract of ergot, with judicious flavouring, may be made an agreeable vehicle for the oil. A most important point to be observed in order to obtain the greatest benefit from the oil, is that its use should be persevered in regularly, and for a sufficient length of time. Neither the public, nor the profession, is sufficiently aware of this, and it is the more necessary to insist strongly on it. To prove truly remedial, it must be taken in quantities sufficient so to diffuse it through the system that it may affect the nutrition of every part. This cannot be effected by giving unlimited doses, as these would be either not retained or not absorbed. The doses must be moderate, and therefore they must be steadily continued for an indefinite length of time; not only until there is an amelioration in the symptoms-even although such an amelioration may amount to the patient thinking himself quite well, which is a common case,-but until all signs or symptoms of the existence of phthinoplasms are removed, and the nutritive functions are restored to a healthy state. Doubtless, it will be objected, in that case, many persons once seriously affected must continue to take the oil all their lives. So they must, I reply. It is the staff of life to them, and it is a great boon thus to have a life, otherwise despaired of, prolonged and made enjoyable at the trifling inconvenience of taking daily a dose of oil with one or two of their meals. The cases requiring this perpetual oil-preserving are chiefly those in which phthinoplastic matter has already formed to such an extent, chiefly in the lungs or lymphatic glands, that although it may have become quiescent for the time, trifling causes may bring it into activity, and spread its infecting influence through the frame. This phthinoplastic influence may be exerted, not only locally-producing crepitus, cough, expectoration, &c.—but also constitutionally, by impairing the nutrition of the body, and causing a general decline of its powers. So, even without cough, a person in whom consumption has been arrested, may go into a decline, wasting and dwindling, without any obvious increase of local disease. This decline may commonly be counteracted by the oil, aided by suitable tonics and generous living and healthy air: but all these latter are of little avail without the oil. A similar declining state of general health sometimes COD-LIVER OIL COUNTERACTS DECLINE. 347 precedes the development of pulmonary consumption, which may supervene at any time on the application of an exciting cause. If we endeavour to examine more closely in what this general decline consists, we find loss of flesh a prominent feature. The nutrition of the body is at fault; and in the absence of any cause in the supplies, or in the digestive or assimilating organs, we are led to suspect the bioplasm itself to be wanting in quantity or quality, or both: it lacks some of those wonderful vital properties of action, motion, growth, and multiplication, by virtue of which it normally renovates and sustains the tissues of the body in the wear and tear of life. Here is what may be called predisposition to consumption, whether hereditary or acquired; whether the result of conformation, or arising from the operation of some depressing or deteriorating agency. As yet there may be no local development of disease. There is a general phthisis, but no phthinoplasm to begin the decay of an organ. But this soon follows. The first cold taken excites an inflammation, with its proliferating sarcophytes, and these partaking of the declining vitality of the general bioplasm, form concrete and decaying products, beginning with obstruction, and ending in destruction, of the part. Or it may be some blighting influence conveyed by damp or impure air, which palsies the sarcophytes of the lym phatics in the glands or in the lungs, and thus localises the work of consumption. Now it is manifestly most desirable to prevent this destructive work before it attacks an important organ; and, in reference to our present subject, the use of codliver oil, here is a case for its most appropriate application in conjunction with other invigorating measures. A general wasting or falling away of flesh may be sufficient to mark the decline in question; but we may be confirmed by the appearance of swellings of the submaxillary |