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Cod-Liver Oil in Phthisis. Dr. Ranking's InquiriesAuthor(s): Jesse LeachSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 13, No. 13 (Jun. 27, 1849), pp.356-359Published by: BMJStable URL: http://www.jstor.org/stable/25500854 .

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356 COD-LIVER OIL IN PHTHISIS.-DR. RANKING'S INQUIRIES.

COD-LIVER OIL IN PHTHISIS. DR. RANKING'S INQUIRIES.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR,-I am happy to find,through the medium of your

excellent Journal, that the active literary abilities of

Dr. Ranking are enlisted in the investigation of the

therapeutic efficacy of cod-liver oil in the treatment of

phthisis. Any voluntary effort from so distinguished a

.ournalist as Dr. Ranking undoubtedly is, must willingly

gain the zealous co-operation of every member of the

Association to so praiseworthy an undertaking. Having used the oil with considerable advantage in eleven

cases, which I subjoin, I will briefly give you the

result of my experience of its palliative and curative

effects in the treatment of this formidable affection, which has annually swept away more people than any other disease. Like every other remedy for the cure

of disease, the cod-liver oil has already divided the

opinions of the profession; whilst some are extolling its virtues, others are as busily engaged in condemning it to the Tombs of the Capulets. I believe these con.

flicting opinions arise from a simple cause, which I

will endeavour to explain. The druggists are at present

filtering the oil through charcoal to free it from colour,

taste, and smell, which process in a great measure it

accomplishes, but not without depriving the oil of some

of its best principles. This I am led to believe from

having found that this oil is not so valuable as the oil

,that has not undergone filtration. The colour of the oil which I first used with considerable advantage in a

hopeless case of phthisis, was of a yellow brown, and was

obtained from Mr. Wooley, of Manchester. The second

supply which I received was colourless, and much more

pleasnt to the eye, taste, and smell. I soon, however,

discovered, the advantages which my patient had

derived from the use of the yellow brown oil were

gradually lost during the use of the colourless oil.

This naturally convinced me the second supply could

not be genuine. I saw the druggist from whom I had

obtained it, and found out that the colourless oil was

the yellow brown oil filtered through charcoal. I

placed my patient under the use of the yellow brown

oil, and her condition soon resumed an improvement. Since then I have heard surgeons express the same

views, which more firmly impresses me with the belief

that the opinion I had arrived at was not a mere fancy of the imagination. I would therefore strongly advise

those gentlemen who have used the colourless oil and

found it not answer their expectations, to give the

yellow brown oil a proper trial before they prematurely condemn what I consider to be a great addition to our

remedies in the treatment of phthisis. Should the

subsequent experience of others prove the reality of a

valuable medicinal principle of the oil to be lost in its

filtration through charcoal,.which I have every reason to believe will be the case, the just inquiry which will

be made, will be, what principle does the oil lose in

.passing through charcoal I do not profess to know

myself, and only advance a surmise which chemistry

can demonstrate. By a simple parity of reasoning,

important conclusions may be arrived at, should future

investigation prove that the oil does become chemically

acted upon by charcoal, and lose some important con

stituent of its component parts by passing through charcoal. Long before iodine was discovered, sub.

stances containing iodine in very minute quantities were given for the cure of bronchocele, but from the

uncertainty of their action, were doomed to disuse

until iodine, which forms the richest discovery in the

annals of modern medicine, was made known and

proved a safe and easy agent in reducing this unsightly

disease. Who can say, after a proper trial, that the

cod-liver oil does not possess the best safeguard in the

treatment of phthisis, assisted by other means to suit

urgent symptoms, that we know of and practice; and if

so, what elementary constituent of the oil confers upon us such important powers over what science already knows t Iodine, as I have before said, was, in minute

quantities in substances, used and abandoned for the

cure of bronchocele; yet, iodine was discovered, and

was the remedy for bronchocele. The cod.liver oil

must contain some principle which has an influence In

subduing tubercles. I hope we shall see the period when

this principle will be known, and tubercle as control

lable under its influence as bronchocele is by iodine.

The dose of the oil which I have given is from .

tea spoonful to a table spoonful three times a day, with

the addition of a few grains of powdered orange-peel, or two drops of lemon-juice to each dose. Buttermilk,

raspberry vinegar, or rasped potatoes, disguise the taue

and smell. The endermic use of the oil has ofea bee

combined with compound soap liniment or spirits of

turpentine. The unpleasant odour arising from its

evaporation when endermically employed, offers a

strong objection to its endermic use.

The therapeutic action of the oil is to add increased

power to the assimilative powers of the system, which

counteracts and keeps in check the insidious ravages of the disease; in one case it granulated an ulcerated

cavity in my practice. Whether it will absorb tuber

cular deposits or not, subsequent experience will

demonstrate. It diminishes the secretion of pus, and

proportionately increases the secretion of mucus. It

heals mucous apthous ulceration of the mouth, and

perceptibly cures hectic. I have not generally found

it to aggravate the diarrhoea in the last stages of

phthisis. In some it fattens, in others it does nbt

increase the weight of the patient. In all cases it

does good by prolonging the life, and mitigating tle

sufferings of the patient, as the subjoined cases iwiR show. The first two cases will be given more fully in

order to identify them as tubercular disorganization; the remaining nine will be compressed in their narrative, so as to suit them to the pages of a journal.

CASE I.-Mrs. B., aged 34, became seriously

indisposed about two months since, after an attack of

influenza, which was then prevailing in the neighbour.

hood, to which succeeded bronchitis and suppreedo catamenia. Phthisis supervened, and at the timi te

oil was first used, the lung had an extensively ulcesoed

cavity.

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COD-LIVER OIL IN PHTHISIS.-DR. RANKING'S INQUIRIES. 357

September 1st, 1848.-Extreme emaciation of body aWd pectoral muscles; breathing hurried under slight

exertion; cough troublesome; expectoration pus;

apthous ulceration of the mucous membrane of the

mouth; diarrhea; confirmed hectic; the brick-dust

streak over the alveolar mucous surface; dulness on

pe0tussion from the left clavicle to the margin of the

tiMrd rib; garguilement, with pectoriloquy. Pulse

140, weak, and thready. Commenced the use of a

tablespoonful of cod-liver oil, with two drops of lemon

juice three times a day. Five grains of the extract of

benbane at bed-time; generous diet. Wine negus to

relieve sickness when required.

September 28th. Has increased in weight; apthous ulceration improving; expectoration easier, the same

in quantity and quality; improved appetite. The'

state of the cavity the same.

November 8th. The condition of the lung as before;

improved appearance; hectic much abated; diarrhea

not so troublesome. On placing the expectoration under the microscope, there was a great change since

the use of the oil. The quantity expectorated was

about the same; but the quality was different. In

place of pus there was a viscid flaky mucus, holding in solution patches of pus.

December 15th. Can walk about the house, and

ascends the stairs with greater ease. A much improved

appearance; the cavity as before; the expectoration still mucuS and pus; will not take any more oil.

January 10th. Has left off the oil three weeks, and

has now dyspnea in the morning. The cavity the

same; lost flesh; expectoration contains more pus and less mucus; hectic returning; care-worn counte

nance; diarrhea. Mustard poultice over the chest;

super-acetate of lead and opium, to suppress the

diarrhmoa; brandy and water.

February 4th. Does not appear likely to survive

miiy days; evidently diminished vital energy, with

increased tubercular symptoms. Has to lie with only onesheet upon her after five in the morning, the

hectic is so distressing. After much difficulty, have

succeeded in persuading her to take the oil again. March 10th. Diarrhea not so troublesome. Two

evacuations in the morning, and one in the evening.

-lspiration easier; more buoyancy of spirits; the

condition of the lung and hectic not improved.

April 17th. Her condition does not improve; says she feels less oppression in her breathing since she took the oil for the second time.

May 1st. Pulse 142; extreme debility of body; ghastly aspect; distressing cough, with profuse muco

purulent expectoration. The physical signs bespeak no diminution in the size of the cavity. Is again

becoming tired of using the oil; still she says it gives her the most relief. Continuing its use.

Caes II.--John Riley, aged 50, manager at a cotton

mill. About three months before my visit has been

suffering from a weight and pain in the left side, with a hacking cough, which occasionally brought up a

little phlegm, streaked with blood. His bodily strength has gradually diminished; has not been able to take

his accustomed amount of food. Took on his own

account a nourishing food, wine, with an aperient pill,

thinking he should find relief thereby, but found his

sufferings increased under this treatment. On the 12th

September, 1848, I first saw him. Much emaciation

of the body and pectoral muscles; dulness on per cussion beneath the left clavicle. Pectoriloquy very distinct, with the cavernous rAle; distressing cough;

expectoration pus, and nearly half a teacupful in

the twenty-four hours; hectic. Ordered the temperature of the room to be 60? Fahrenheit, and not to exceed

65?; an infusion of bran with honey as a drink; a

table-spoonful of cod-liver oil three times a day, with

two drops of lemon juice; three grains of the extract

of henbane at bed-time. A liniment of equal parts of

the oil and spirits of turpentine to be well rubbed over

the chest twice a day.

September 18th. Does not experience much improve ment as vet. Patches of flaky mucus appear mixed

with the expectorated pus. To persevere.

November let. The cavity is now perceptibly smaller; hectic diminishing; pulse 96. The muco-purulent

expectoration less by one half, and streaked with blood,

tongue clean, and secretions healthy. Ordered him to

take a little fowl, and as much beef as hecaan bear.

To continue as before.

'January 5th. Has gained 401bs. in weight since the

first of November. Appearance much improved; hectic gone; cannot perceive the cavernous r&le, or

any entrance of air into that portion of the lung where

the cavity was. Some few specks of pus, mixed with

a slaty-coloured mucus. Enjoys his food, and wishes

for some table beer, which I have allowed.

April23rd. He is now free from cough or expectora

tion, and feels, with the exception of debility, perfectly well. Resumes his duties as manager. Discontinues

the oil, and allowed any quantity of nutritive food

which he can bear, with table beer.

The remaining cases I will be as brief as possible with.

CASE III.-Miss B., aged 22, has been under an

eminent physician, in Manchester, and takes the

colourless oil, from which she has received no benefit.

Tubercles are formed in the axillary region. No cavity or hectic. Began the use of the yellow-brown oil on

5th of November, and continued to use it until the

25th of February, when she lost her cough, and gained in weight. Recommended her to Devonshire for a

more genial climate.

CASE IV.-B. G., aged 36, resembles, in every par

ticular, the case No. 1. January 28th began the use

of the oil.

April 28th. Hectic much relieved; expectorates more freely; more mucus and less pus. Takes his

food better; apthous ulceration nearly gone. The

cavity does not improve. Continuing the use of the oil.

CASE V.-Mr. B. has been under the treatment of

an eminent surgeon, and taken the pale oil, and by him

pronounced consumptive. December 25th began the

use of the oil, and on the 1st of April discontinued it.

Is perfectly free from cough. I did not see this case,

but was consulted by letter from a distance. This.

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358 COD-LIVER OIL IN PHTHISIS.-DR. RANKING'S INQUIRIES.

gentlemen was a friend of the lady (Case 3,) whose

cure produced a desire from him to undergo the same

treatment.

CASE VI.-Mr. T., aged 24, has been under the

treatment of his medical attendant about two months, and gradually became worse. Has not taken the oil; has

a large cavity beneath the left clavicle; hectic; apthous ulceration of the mouth. Began to use the oil on the

26th of January. The temperature of the room to be

strictly watched, with the same treatment as in Case 2.

April 26th. Have received word his hectic is dimin

ishing. He improves in appearance. From an ex

amination of the sputa which I have received, there

is more mucus and less pus. He continues to use

the oil.

CASE VII,-Mrs. J., aged 46, about three months

before my visit had influenza, subsequent to which a

small cavity of the upper part of the right lung super

vened, with hectic. Has now taken the oil about two

months, with a diminution of her cough and expectora tion. Is improved in'strength and appearance. Con

tinues the oil.

CASE VIII. -Mr. J., aged 19, a large cavity in the

right lung, and hectic. Has taken the oil about four

weeks with some advantage. This is a hopeless case.

CASE IX.-Mr. R., aged 23, with a small cavity beneath the left clavicle, and hectic. Has taken the

oil four months, with considerable advantage. The

diameter of the cavity diminishes. The quality of the

expectoration better, there being more mucus, with a

few specks of pus, and occasionally a tinge of blood.

CASE X.-Miss W., aged 20, dulness from the left

clavicle to the margin of the third rib; contracted

vesicular rale; troublesome hacking cough, with mucous

expectoration, sometimes mixed with blood. Cannot

detect a cavity. Has buried a father and three sisters

from phthisis. Has taken the oil three months, with

considerable relief. Her aspect is much improved. She is continuing the oil.

CASE XI.-Mr. H., aged 39, has a small cavity in the left axillary space. Has used the oil four months.

With the exception of a diminution of the expectoration, I see no improvement, either in his appearance, or

physical symptoms.

REMARKs.--Case 1 fully exemplifies the palliative effects of the oil in hopeless cases of phthisis. In

December, when the oil had produced an apparent influence in mitigating the most prominent fatal

characteristics of the complaint, at the urgent request of the patient, it was discontinued. Six weeks elapse, a fatal train of bad symptoms supervene, and she is

obliged to resume the use of the oil to prevent an

apparent fatal issue, when her symptoms became

mitigated in severity, but she does not regain her wonted

constitutional vigour. Throughout these periods I

watched the increase and diminution of mucus and

pus by the aid of a powerful microscope, and found, to

my satisfaction, when the system became impregnated with the oil, the pus diminished, and mucus increased.

Nevertheless, no diminution in the size of the cavity took place; she still survives, without any hope of an

ultimate recovery. Case 2, from its unexpected suc

cessful termination, furnishes a proof of the value of

the oil, aided by other means, which no other medicine

in my practice ever accomplished. The man had every

physical symptom of a tubercular cavity in the left

lung; notwithstanding he recovered, after using the

oil internally and endermically for five months. The

cavity is healed, and he is in the enjoyment of good

health, and free from every vestige of a tendency to

relapse. He is now heavier than he was before his

sickness. Case 3 recovered from tubercular depositions. This case may relapse, and precaution has been used

in sending her to a warmer climate to prevent this

occurrence. She took the colourless oil under the

advice of an eminent practitioner, without any benefit.

The yellow-brown soon produced an improvement. Cases 4, 6, 8, 11, are likely not to be permanently benefitted by the oil. Case 5 I never saw, and there

fore cannot say with a certainty whether the case was

phthisis or not. Case 7 appears, from her present

physical and general symptoms, likely to rocover.

Case 10 is no doubt one of tubercularisation of the

lung. How far her present favourable symptoms may

continue, time alone can reveal; delusive hopes may, as they often have been, the omnious harbingers of

an ultimately fatal termination in this case. The

majority of the cases continue under treatment, the

issue of which it would be difficult and impolitic to

premise. The only just conclusion to be arrived at

is, that the use of the oil has diminished the advent of

ulceration, where it had not already taken place before

its use; and where the ulcerative process was fully

established, it seems to have prevented its further

progress. The secretion of pus is substituted for that

of mucus when the oil is suspended, and vice versa.

The most satisfactory proof of its efficacy is, that

under favourable circumstances and cases, it does

cicatrize cavities. Whether this is suspended action

only for a time, to be afterwards developed in a fatal

issue, time will be the best Judge. I do not think it

would be wise to abandon other valuable auxiliaries

with the oil. When there is a necessity for leeching, counter-irritation, tartar emetic, or sedatives, it is the

bounden duty of the surgeon to conjoin each or every one with the oil, as cases may require. Too great a

caution cannot be used in having the temperature of

the room where the patient lives as equable and

temperate as possible. I have generally adopted from

60 to 65. Diet also forms an excellent link in the

treatment; an infusion of bran, with cream or honey, I have found to agree with patients as a beverage; it

combines nutritive with demulcent properties, and

relieves the apthous mucous ulceration in the ulcerative

stages of phthisis. Lastly, too much cannot be said

in favour of examining the sputa under the eye of a

powerful microscope. This instrument reveals the

condition of a cavity or diseased bronchial tube as

clearly as could be wished; the quality and quantity of pus secreted can be noted as accurately by its powers, and the pathological inference thereby deduced as

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SUFFOLK BRANCH MEETING. 359

correctly as the physical signs furnish to an expert

stethoscopist; without it the practitioner cannot measure

improvements; it is like the rudder to a ship, or a

compass to a mariner; it furnishes ocular demonstration

of facts which to unaided vision would, at the best, be only problematical. With these remarks I shall

conclude a very imperfect account of the use of cod

liver oil in my practice, hoping the experience of

others more competent to judge may reconcile the con

licting opinions of its efficacy into a standard of

worth, and that this may confer a boon on suffering

humanity. I am, Sir,

Your obedient servant, JESSE LEACH.

Heywood, Lancashire,

May, 1849.

Protee ing0 off ocettiet.

MEETING OF THE SUFFOLK BRANCH

OF THE PROVINCIAL MEDICAL AND SURGICAL

ASSOC I ATION.

The Anniversary Meeting of the Suffolk Branch of the Association was held at the Town Hall, Hadleigh, on Friday, the 15th of June. The following members were present:

Dr. Baird, Dr. Durrant, and Mr. Ranson, Ipswich; Dr. Ranking, Norwich; Dr. Bedingfield and Mr.

Bree, Stowmarket; Dr. Duncan, Mr. Nunn, Dr.

Clarke, and Mr. Waylen, Colchester; Mr. Jones, Melford; Mr. Growse, Mr. Mudd, and Mr. Growse, jun., Hadleigh; Mr. Munn and Mr. Gurden, Boxford;

Dr. Kirkman, Mellon; Mr. Martin, Holbrook; Mr. R.

Growse, Bilderton; Mr. Jeaffreson, Framlinghamn 'Mr. H. L. Freeman, Saxmundham; Mr. Fenn,

Nyland; Mr. Rodick, Halstead; Mr. F. Manning, East Bergholt.

At two o'clock the chair was taken by Mr. Growse, who said that he had much pleasure in receiving the

members of the Association, at Hadleigh, and felt honoured in being selected to fill the office of President for the ensuing year. He would not occupy their time

by any lengthened observations, as there were many communications to be brought before the meeting. He could only assure them that he entered most cordially into the objects of this great and excellent Association,

and he should always entertain a most sincere pleasure in furthering its interest to the utmost of his ability. (Cheers.)

Mr. Bree then read several letters from members, who were unable to attend.

Dr. Durrant then read a paper upon " Latent and

Circumscribed Pleurisy, with Effusion."

A discussion ensued on the comparative value of the

different methods of counter-irritation, in which Mr.

Nunn, Mr. Jeaffreson, and Dr. Ranking took part, the

opinion of the meeting appearing to be favourable to the use of flying blisters in chronic inflammation of the pleura, instead of either open blisters, tartar-emetic

ointment, or croton oil. Dr. Durrant's paper also led to some interesting remarks upon the difficulty of the differential diagnosis in circumscribed pleurisy.

Dr. Duncan then read a most excellent and elabo rate paper upon "Tuberculous Deposit in the Kidney."

The paper was illustrated by numerous drawings, fresh

preparations, and the pathology of this form of disease was well shewn, after the meeting, by various micro

scopical preparations. An abstract of this paper will he published in the Journal.

Mr. Jeaffreson, of Framlingham, then detailed an

interesting " Case of Lithotrity," which was followed

by a paper from Dr. Bedingfield. Mr. Nunn of Colchester, then read two most interest.

ing cases, in one of which a puff-dart" was accidentally drawn into the trachea, and in the other a compound dislocation and entire loss of the astragalus occurred.

The last paper read was a most valuable contribution

upon "The use of Cod-liver Oil in Phthisis, Tabes

Mesenterica, Morbus Coxarius, &c.," by Dr. Clark, of Colchester.

This paper was handed over to Dr. Ranking to assist him in his inquiries upon this subject, and, with the others, will be published in the next number of the

Journal.

Dr. Ranking expressed much pleasure in hearing the paper of Dr. Clark. He had taken much interest in the inquiry of the therapeutical value of cod-liver oil in phthisis pulmonalis, and after several years' trial was induced to consider it the very best remedy hitherto

brought forward in the treatment of this disease. Dr.

Ranking urged upon the meeting the importance of the members of the Association assisting him in his

investigations. Mr. Martin had seen much of the use of cod.liver

oil, but he regretted that he, too, frequently lost sight of his patients, as they got their oil at the druggists and treated themselves. He believed it to be a medicine of great value.

Dr. Clark exhibited a specimen of the oil made

by himself, by subjecting the liver to a heat of 190 for some hours, and then straining. The prepara tion was straw coloured and clear. He had tried all the kinds of cod-liver oil, and gave the preference

infinitely to that similar to the specimen exhibited. He spoke highly of its remedial effects in tabes meseF

terica, and hoped much from its use in phthisis pul. monalis in the early stages, though he had no doubt

that we should be disappointed if we expected too much

from this or any other remedy, in the advanced forms

of the disease. Dr. Clark handed round Yonge's elaborate analysis of the various kinds of cod-liver oil.

The following resolutions were then proposed:

Proposed by Dr. Ranking, seconded by Dr. Baird, -", That this meeting expresses its deep and sincere

regret at the great loss which the Association has

sustained in the death of its Secretary, Dr. Streeten; and it is desirous of recording in its proceedings the

high estimation and respect in which it holds the

memory of one who devoted so much of his time and talents to serve the interests of the Association." .

Proposed by Dr. Durrant, seconded by Dr. Chevallier, -- That the place of meeting of the Suffolk Branch of the Provincial Medical and Surgical Association for

1850, be at Woodbridge, and that Dr. Kirkman be

requested to preside." Proposed by Dr. Kirkman, seconded by Mr. Martin,

-" That the best thanks of this meeting be presented to those gentlemen who have read papers and cases.

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