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It may therefore be regarded, not so much as an equivalent as a rival to the cod-liver oil. Where cod oil fails, sperm or whale oil would probably be useless, but the failure of the oleum jecoris aselli is no proof that the oleum bubulum may not be administered with the hope of advantage, and from its greater cheapness and less penetrating odour it might be largely tried in the way of in-unction. Either oil may sometimes be advantageously substituted for the other, and although that of the cod will in the majority of cases prove most effectual, I think you are now in possession of facts showing that the neat oil is likely to prove a useful addition to our medical resources, and that both these oils probably act similarly, in combining with albumen and assisting in the supply of the chyle granules which enrich the blood.
After impressing on you the remarkable efficacy of animal oils, when appropriately administered, it may be right to guard you against expecting too much from their administration, in cases not presenting circumstances requiring their use; and here a little of the wisdom of our ancestors, as it found expression in a work published more than a century since, may be suitably introduced.*
“Scaramouch: I take that discovery of the benefit of oil and its application to have been the greatest that hath for a long while been made in the medicinal art, and yet you would fain make it ridiculous and useless.
“ Harlequin : Indeed Scara’, it is he that makes it ridiculous and useless by promiscuously giving oils in all cases. Their use is as old as physic, and physicians
* A Serious Conference between Scaramouch and Harlequin, by Momophilus Carthusiensis. London, 1719, p. 25.
e were a
in all ages have taken care to let us know when they are of benefit and when noxious. Dr. Woodward alone has made oil a panacea, and I never yet saw any pretensions to a universal medicine where there were any to common sense.”
I must not conclude this lecture, without impressing on you the importance of the persevering use of animal oils when they are found appropriate. We must give them, sometimes alternated with steel or other tonics, even for many years, if we would overcome the liability to a return of the symptoms. The necessity and advantage of such a plan are well portrayed in a letter, now in my hand, from a patient, who was under my care during the summer of 1848, affected with vomica. In spring, 1849, he resumed work, and, with an interval rendered necessary by an attack of bronchitis, has continued working in a manufactory till the present time.
He gained twenty pounds in weight during his stay in the hospital. The longest period, during the last three years, that he has omitted the oil, was nine weeks, during which he lost ten pounds’ weight, but on resuming it, he gained three quarters of a pound in weight every week for a considerable period. He writes, “I sometimes give the stomach a rest from the oil for a fortnight, but whatever diet I then take there is a falling off. When I have a false appetite an hour after a meal, a good dose of oil upon ginger wine fails not to remove it.” He adds, “I get the oil both pure and cheap. Mr. H., my surgeon, provides it, and a benevolent lady, Mrs. B., pays the bill.” Is not this one of the best kinds of self-supporting dispensary ?
The statement made in this lecture regarding vege
table oils requires an important qualification in consequence of experiments which I have made during the first eight months of the present year (1853) with oil of cocoa-nut, which appears to me to possess medicinal properties similar to those of cod-liver oil. The results in the first thirty patients to whom I administered it bear comparison with those obtained in the first thirtyseven patients for whom I prescribed cod-liver oil, chiefly in the year 1845, as related to the Medical Society of London, and briefly described in some of the medical journals.* Amongst the patients to whom cocoa-nut oil was given, there were some instances of arrested phthisis, as decided as any I have been accustomed to attribute to the use of cod-liver oil, over which it possesses advantages in reference to economy and palateableness; and it is interesting to remark that its efficacy was experienced by some who had previously taken cod oil uselessly, and by others who had discontinued it on account of nausea.
Transact. Prov. Med. Assoc. New
* Lancet, June 27, 1846. Series, vol. iii. p. 182.
Urine — Importance of the office of the kidneys- Edema of
lungs from albuminuria—Renal disease rare in consumptive patients—Altered proportions of uric acid to urea in phthisis -Probable cause and remedy—Proportion of solid contents as influenced by the disease and the treatment Conditions of the urine as an aid to diagnosis.
You are well aware, gentlemen, of the great importance of the office of the kidneys in separating from the blood certain nitrogenous materials which are no longer fit for circulation. If the function of these organs be for a hundred hours altogether suspended, death is almost an invariable result. Disturbed function of the kidneys is, however, more frequently the consequence of some altered condition of the blood, than of any inherent fault in these organs. For example, a superabundance of lithic acid in the urine does not prove that there is a faulty condition of the secreting apparatus. We might support this assertion by various examples. For instance, gout appears to depend mainly on the presence of uric acid in the blood, and the occurrence of this acid in excess in the urine is not, under such circumstances, an evil, but rather indicates and promotes the abatement of the disorder. Again, the disease called diabetes, is no
proof of faulty kidneys. Maitland, Rees, and others, have shown the existence of sugar in the blood in connexion with this malady, and the removal of that substance, through this outlet, is, under such circumstances, natural and necessary. There is, however, one common and important change in the condition of the urine-namely, that in which albumen is precipitated from it on the application of heat or nitric acid, which, when long-continued, is for the most part found associated with renal disease. The relation of this condition of urine to dropsy was observed by Cruikshank, Darwin, Wells, and Blackall, but it was reserved for our eminent contemporary, Dr. Bright, by a happy generalization, to establish the fact, that certain organic changes in the kidney are usually associated with albuminuria, whilst they also tend to modify the phenomena, and overrule the course of various other disorders. It is important you should be aware that persons affected with Bright's disease sometimes die rather suddenly with oedema of the lungs. Such a case occurred not long since at this hospital, and I regret that I cannot show you the kidney of the patient, but I will relate another case which will serve more completely to illustrate the subject.
Some time since I was requested to visit a young man, aged twenty-one, whose breathing was extremely oppressed. There was slightly more dulness on percussion over the right than the left side of the chest, but no bronchophony, and the only important physical sign, was a delicate, sub-crepitant rhonchus (small bubbling rhonchus) over the whole chest. The patient's hands had a pale wax-like appearance; the bites of