concurrent symptoms of vomiting, palpitation, and oedema, with which this patient was for a time harassed, have entirely disappeared. In addition to cod oil, she has had syrup of iodide of iron, and counterirritation has occasionally been established by the application of a liniment made according to the following prescription: Take of iodine, and of iodide of potassium, each an ounce; of rectified spirit, two ounces; mix.

I must have the satisfaction of introducing one more patient, whose case is highly gratifying. This young woman, M. B., is, I am informed, the only remaining member of a large family, all of whom have died of phthisis. She was admitted five months since, with dull percussion at the right apex; at the left, gurgling in respiration, and cough. Her case was examined and recorded by two other medical gentlemen before I explored her chest, and my account corresponded with theirs as to the existence of cavity in the left side. To-day two of my colleagues have examined her, and agree with me in the opinion that no sign of cavity can now be detected in that situation. Let me describe the progress of her improvement: the extent of the gurgling gradually lessened, then dry cavernous respiration was the principal sign; this was superseded by blowing, and then bronchial breathing, and at present I detect nothing wrong except a little flattening of contour, slight dulness on percussion, and wavy inspiration. The catamenia have returned; the pulse has sunk from 112 to 80. Her weight five months since was seven stone twelve pounds and a quarter; we will try it again it is now nine stone five pounds and a quarter.*

* This patient continues, at the present time (August, 1853), in a state of apparent health.

It will be observed that this patient gained twenty-one pounds in weight during the space of twenty-one weeks; and it is worthy of notice, that the quantity of cod-liver oil administered during that time was considerably less than three pints; a fact strongly opposed to the opinion that the oil is useful only in the way of nutritive material. Our usual plan is to give one or two drachms twice a day at first, gradually increasing the quantity to half an ounce three times a day, and I have seldom found any advantage accrue from going beyond this limit. Dr. Pollock has informed me of some experiments made at his suggestion on the fattening power of coarse cod-liver oil on pigs. and oxen, from which it resulted that two ounces daily was the best quantity for pigs; four ounces for oxen. It was ascertained from butchers, unacquainted with the experiments, that when more than two ounces had been given to pigs, the flesh of the animals was objected to, as having a disagreeable flavour.

You may wish to form an opinion regarding the comparative efficacy of the different kinds of cod-liver oil. In my early trials of the remedy, six years since, forty or fifty cases were treated with the coarse kind, resembling what is used in preparing leather, and, the average benefit derived did not materially differ from that effected by the purest varieties subsequently employed. At a later period I had the curiosity to try these different kinds, combined with liquor potassæ and peppermint oil, giving alternately the coarse and the purified cod oil, and recording the report of the patients; and it is a curious fact, that the majority actually gave the preference to the mixtures in which the coarser oil

was introduced. Objections have been made to this combination, as complicating the treatment with the addition of a medicine by some persons supposed to be inappropriate; but my experience is favourable to the use of liquor potassæ, especially in the early stage of phthisis, and theoretical arguments might be advanced in its favour. In scrofulous affections, if Dr. Hughes Bennett be correct in his hypothesis, there is probably undue acidity of stomach, unfavourable to the solution of albuminous materials. The alkali of the salivary and pancreatic fluids, being neutralized, fails to fulfil its proper office. The lungs, not having enough carbon to excrete, local congestions arise; the blood is overcharged with albumen, and the albuminous exudation being deficient in fat, elementary molecules are not formed so as to constitute nuclei capable of development into cells, and tubercular corpuscles are the natural result.

Cod-liver oil probably tends to obviate the series of derangements just described, by combining with the albuminous element of chyme, so as to form the healthy chyle-granules which feed the blood; and, for the reason above named, is probably more advantageously introduced in scrofulous subjects when combined with an alkali. It is a curious fact that when, about seventy-five years since cod-liver oil was largely used at the Manchester Infirmary, chiefly in the treatment of rheumatism, the medicine was ordinarily given combined with alkali; Dr. Percival's favourite prescription being twelve minims of soap lixivium, an ounce of cod-liver oil, and half an ounce of peppermint water. The practice of administering a little lemon-juice afterwards would not neces

sarily interfere with the action of the alkali; and is worthy of incidental notice in connexion with the recent valuable suggestions of Dr. G. O. Rees on the treatment of rheumatism with the juice of lemons. Occasionally, although not frequently, the stomach rebels against the oil however purified, and in whatever combination ; and I have been accustomed in consequence, under such circumstances, to introduce the oil endermically.

Three years since I was requested to see a gentleman from the country, confined to his bed, emaciated, hectic, and apparently failing rapidly, with a cavity at the apex of the right lung. There was considerable diarrhoea; and thinking the internal use of cod oil unseasonable, I ordered an ounce, combined with oil of lavender, to be rubbed into the chest night and morning. This gentleman gradually rallied, and returned to the country, where he advanced much in strength and weight, and rode about on horseback. I examined him last year; and, judging from the physical signs, found the size of the cavity materially reduced.

J. S., a female patient under my care for the last two years, with softened tubercle in the left lung, notwithstanding the adoption of a tonic regimen, and the internal administration of cod oil, got gradually worse, and in four months preceding August, 1850, her weight was reduced from 105 pounds to 97. I then prescribed, as a liniment, three ounces of cod oil; an ounce of aromatic spirit of ammonia; half a drachm of oil of lavender ; and five grains of opium; half to be rubbed in night and morning. In a fortnight improvement commenced, and in two months her weight had increased to 104 pounds.

M. A. W., a patient lately in the hospital, with cavernous respiration at the summits of both lungs, and who

for twelve weeks had lost on an average a pound in weight every week, rallied, gained a little weight during the first month of using the same liniment, and left the hospital somewhat improved. But I will not multiply examples. It is enough to say that satisfactory results have been sufficiently frequent to authorise the measure, sometimes as an auxiliary to the internal use of the oil, but more especially as a substitute, when the stomach revolts at its internal administration.

I am indebted to Dr. Glover, of Newcastle, for a reference to some observations of Dr. Klencke, of Brunswick, confirmatory of the results just described. In a memoir on the Therapeutical History of Cod Oil, Dr. Klencke says, "I shaved some young dogs, and rubbed them with cod-liver oil twice daily for three weeks. At the end of this period they were in as good condition as dogs to whom oil had been internally administered; their bile was found as rich in fat, and their chyle equally charged with corpuscles without nuclei." Klencke adds, that similar changes were observed in the bile and chyle of a cat bathed twice a day for some time in the same remedy, and that some oil was discovered in the urine of the animal, proving its free absorption by the skin.

You will naturally ask me whether there are any disadvantages incident to the use of so valuable a remedy; and you may repeat questions which I have occasionally heard, Does it often produce diarrhoea? Does it tend to increase hæmoptysis? As respects the latter question, it might be sufficient to mention that the average frequency of the occurrence of hæmoptysis, as recorded by Louis and other observers, was fully as great in phthisical cases before cod-liver oil was introduced, as it