Oleum jecoris aselli

Volume I — Special Symptomatology

{Cod-liver Oil.)

Description. — Oleum Morrhuse, or Cod-liver oil, is obtained from the liver of the Gadus Morrhua and other species of the Gadus. The livers of the Cod are put into a large vessel and heated by steam applied to the outside. The liquid is drained off, allowed to stand, and the oil is finally skimmed off as it rises to the top. The finest brands of oil are prepared by forcing currents of steam at high pressure through the mass of livers, tearing them in this way to pieces and melting out their oil.

The oil should be perfectly limpid, yellow, thick, and free from rancidity, and possessing the peculiar fishy taste.

The brown and black oils are rancid, nauseous, disgusting, and unfit for administration.

Cod-liver oil is a very complex substance, containing, according to Dr. Jorgh, glycerine, oleic, magaric, butyric, and acetic acids; also iodine, bromine, phosphorus, phosphoric acid. The iodine is in proportion of about one part in two thousand; or, according to Dr. Jorgh, four-hundredths of a grain in one hundred grains of the oil.

Officinal Preparations. — (1) The pure oil; (2) triturations of the oil ; (3) tincture. (Dr. Neidhard recommends a tincture made by digesting 3 i to 1 1 of strong alcohol, and dilutions from this tincture.)

[For the best methods of administration, and the size of dose, see "Therapeutics," Vol. II.]

Analogues. — Ampelopsis ( ?), Alnus { ?), Arsenicum, Bromine, Baptisia ( ?), Calcaria, Cistus, {Glycerine,) Iodine, Phosphorus, {Hypophosphites of soda, lime, etc.,) Spongia, Sulphur.

[The following pathogenesis is prepared from Neidhard's provings and clinical experience, and arranged by Dr. Fairbanks. All the symptoms, not otherwise credited, belong to Neidhard.]

Mind.

Fretful temper.

Talks about himself in the third person. 0 Sensation as if out of her mind.

Head.

Dull aching pain in the forehead, also in the vertex. Giddiness, everything turns black.

Headache in the forenoon, with vomiting and constant retching. Steady aching pain from left to right temple. ° Dry coryza and sneezing.

0 Fluent coryza, hoarseness and rawness of the chest. 0 Pain from occiput to forehead, with nausea. ° Bursting headache after coughing, as if it would split open. 0 Aching pain about inner part of right eyebrow, as if in the periosteum.

Eyes.

A flow of tears when walking in the open air, worse in the left. Heaviness over the eyes; eyelids so heavy she can hardly raise

them ; swelling of the lids. Blackness and blindness before the eyes, with disposition to

shut them — during chill. 0 Aching pain in right eye, when using it. 0 Scrofulous ophthalmia. {Hale.)

Ears.

0 Fetid discharge from the ears.

° Marked deafness in left ear, and abscess in the right.

Nose.

° Dry coryza, cough and sneezing

0 Bleeding of nose when stooping, with amenorrhea.

° Chronic catarrh and ozoena. {Hale.)

Face.

Flushed face; burning of the face.

A growth of thin, short hair on chin and upper lip, where she had none previous to use of 01. Jec. (2 months.) Mouth.

Tongue coated yellow.

Parched feeling in mouth; constant thirst. Soreness of the tongue after using the oil.

Throat.

Soreness in the throat.

Tickling in throat pit, after dinner, with cough, (vwv.) ° Great hoarseness, (chronic.) ° Slight hoarseness in evening, worse next day. ° Choking and oppressed feeling when lying down. ° Chronic sore throat relieved, with expectoration of yellow mucus.

Taste and Appetite.

Loss of appetite, could not taste milk. (w. twice verified.) Nausea with thirst, and loss of appetite, (w.) Vomiting with bitter acid taste.

Stomach and Abdomen. Great nausea and sickness of stomach, (vw.) Weight and oppression in pit of stomach, (v.) Heat in region of stomach, (v.) Pressive tensive pain in stomach.

Acid vomiting, and purging with pain in stomach, (v.) Vomiting of bile and mucus, with bitter and acid taste— after a chill.

Soreness and heaviness in region of liver, worse from pressure

or exercise, (ww.) Beating pain in region of spleen, with bearing down pain in

the side, (vv.)

Jerking, drawing pain in region of spleen, worse when breathing or coughing, (v.) S]jasmodie pain in umbilical region. ° Tabes mesenterica. (Hale.)

Stool and Anus.

Diarrhoea in the night and early morning.

Constipation, (vw.) with burning of hands and feet (v.)— at

times with cold feet.

Urinary Organs.

Urine reddish, with pink sediment. Soreness in region of kidneys.

Sexual Organs.

c Discharge of yellow matter from the womb, with weak back

oooo jv£enstmation obstructed, from taking cold.

0 Menstruation premature or copious.

0 Soreness of both ovaries; dysmenorrhea.

Respiratory Organs. Shortness of breath, with heavy beating of heart, (v.) Asthma continually increasing in violence, (v.) Pain in right side, above and below scapula, arresting the

breath, (vvvv.) Pain in left side of chest, through to back, with cough and

shortness of breath, (vvvv.) Pain at apex of (left?) scapula.

Sharp stitch in left side, (w.) lasting some minutes. Oppression and heat in chest, (vv.)

Stitch in right side during a long breath, lasting all day. (vv.) Rheumatic pain in region of heart, also in muscles of chest, (vv.) A sudden stitch in the heart. Oppressive anxious beating of heart, (v.) Soreness in chest and stomach, with cough — verified many times.

Weakness in the chest, with hard coughing spells in the morning, (vv.)

Sensation of excoriation in left chest, extending to the back, (vvv.)

Dry hacking cough, (vvv.)

Cough all night; palpitation of heart, (v.)

Tickling cough, in middle of upper chest, (trachea?) with palpitation of heart, (v.)

Case 1. — Mrs. O., 36. A long-continued cough, with emaciation, loss of strength and appetite. After many other remedies had failed, there was excessive weakness, with expectoration of heavy bloody mucus. Teaspoonful doses of Oleum Jec, pure, three times a day for three months, cured.

Case 2. — Mrs. F., 30. Severe cough, following exposure to cold, damp weather, with yellowish expectoration at times. At other times, dry and hacking, after ineffectual use of Calc. Hypophos 2x, and other remedies. IJ Oleum Jec. 1 x (well shaken). Drop doses three times a day cured in a few days.

Back and Neck.

Soreness all around the body to the back, (w.) Weakness and dull aching in sacral region, relieved by pressure, (vv.)

Soreness in region of kidneys, after exercise, (v.)

° Soreness from back to chest.

° Sharp heavy aching pain in lower spine.

c Spinal irritation, sore to the touch.

° A sensation of fluttering commences in region of sacrum, and gradually ascends to the occiput. As it rises it affects the abdomen and chest, so that she can move neither hand or foot.

Expectoration of yellow mucus, (vwv.)

Expectoration of tough greenish-yellow phlegm, with saltish taste. (By continuing the oil it became white.) (vvv.)

Expectoration of tough thin mucus in the morning, (vvv.)

Expectoration of thick white phlegm, with hard cough, (vv.)

"White expectoration, with pain in side, worse when bending side inwards.

Spitting of blood, (v.)

00 Pain in upper part of chest when coughing.

°° Violent cough, with retching; night and day.

00 Burning heat in left chest through to back, with cough.

° Loose cough, with yellowish expectoration.

0 Cough on raising the arm, with stitches.

0 Weakness in chest and back ; more in left.

0 Haemoptysis. (Cured three cases.)

0 Soreness in centre of chest, with barking cough and aching between the shoulders.

Fever.

Flushes of heat, (v.)

Fever and heat over the whole body, (vwv.)

Pulse very frequent, varying from 100 to 120. (vv.)

Great thirst; constant thirst.

Chill every evening (v.) for four days, with acid vomiting and

diarrhoea. (Relieved by Iris.) A creeping sensation all over the body, with a rush of blood

to the heart.

A. tertian intermittent fever, returned four times, receding two hours each time, and lasting two hours; chill passed down the back and around abdomen. Relieved by Eup. perf.

Fever for two hours in the night, followed by a violent perspiration; mainly on upper parts.

Flushes of heat with red face, heat in stomach, and fever all over to ends of toes ; lasting eight or ten hours.

Perspiration every night (v.) or all the time.

Chills and hectic fever, with beating pain in spleen.

Chilly at bedtime, followed by fever, oppression and heat of the chest.

Chill at three a.m., lasting one hour, followed by fever; pulse

from 100 to 120. Chill in evening, afterwards fever and palpitation of heart. 0 Cold perspiration the whole day.

Case. — Lady, age 30, spare. Was constantly chilly, feeling as if she was continually taking cold. A few drop doses of Oleum Jec. 1 x cured.

Upper Extremities. Burning heat in the palms of the hands, mostly at night.

(verified by many provings.) Hands dry and parched, with heaviness over the eyes. 0 Continued aching and sore pain in the elbow and knee joints.

Lower Extremities. Cold feet (ever since taking the oil). Soreness of the feet; abscess on left thigh. 0 Rheumatic pain in left foot. 0 "White swelling of knees; scrofulous hip disease.

Sleep.

"Wakefulness and vivid dreams from the fever and excitement. Less sleepy than usual, with night sweats. Sleeplessness after 3 a. m., with general prostration. ° Dreams of seeing objects in the room during sleep.

Skin.

Boil on right side of chest. Abscess on the left thigh.

Generalities.

A decided increase in strength and natural health, (wo ) She looked fatter and healthier in the face than before.

General lassitude and prostration of whole system, (v.)

She feels miserable, with great nervous irritation. (After

tablespoonful doses for weeks.) The hot air is disagreeable to him.

0 It influences favorably the constitution of the blood; pale, anaemic patients become, while taking it, rosy and plethoric. (Hale.)

° It is especially useful in that condition of the system in which, with generally lowered tone, there is a tendency to cellular hyperplasia, to the formation of "exudations," composed of imperfectly developed cells, which, in the majority of cases, from the very beginning are incapable of development into perfect entities, having only one potential quality, that of dying. (H. C. Wood.)

° Scrofulosis, i. e., a tendency to increase in the lymphatic glands; to multiplication of their cellular elements, and the formation (1) of cheesy deposits, a slow, fatty degeneration, with dessication; or, (2) a rapid, fatty change, with abundance of moisture, resulting in pus and abscesses.

° A condition of cellular hyperplasia, affecting the mucous membrane of the air-passages. The patient, on the slightest occasion, suffers from catarrh, until, finally, a multiplication of cells occurs so rapidly, as to fill up a greater or less number of the air vesicles of the lungs, generally those of the apex, causing one of those conditions known as "consumption." (H>.)

0 In nearly all diseases, where we find combined, a condition marked by weakness, emaciation, and anosmia. (Hale.)

° Diseases of the bones; scrofulous; chronic inflammations of the joints; caries; necroses; abscesses, etc. ( Wood.)

° Defective nutrition, especially in children, where there is pallor, loss of strength, emaciation, etc. (Hale.)

° Chronic rheumatism,, in cachectic, broken down constitutions.

° Nervous affections, neuralgia, sciatica, lumbago, in emaciated and anaemic persons, with deficiency of animal heat. (H.) Conditions.

Chill passes down the back and around the abdomen.

Pains move from before backwards, and from below upwards.

Pains are worse after exercise, in either side, predominantly

the left, through to the back. Pains move from right to left, and from thence through to the

back.

Cough worse when lying down, when laughing, or from a draught of air. (C. D. Fairbanks.)

Volume II — Special Therapeutics

The formal introduction of the Cod-liver oil into homoeopathic therapeutics was due to the venerable Dr. Neidhard. When his papers relating to this medicine first appeared in the “United States Medical and Surgical Journal/’ they were received with indifference by some and incredulity by many.

It had been suggested by a few in our ranks that the fact of the presence of some of the “ antipsorics ” in Cod-liver oil, in very minute quantities, was what gave it its real value in certain diseases of a chronic (psoric) character. It cures the same class of diseases for which we prescribe Iodine, Bromine, Phosphorus, Phosphoric acid, and Calcarea, and the oil is said to contain all these substances. The quantity of each substance is so minute that the oil may be said to represent a high potency of them. Even the Iodine never exceeds one part in two thousand.

It has been taught by allopathists that the oily principle alone was what gave it its value, for they asserted that the medicinal constituents are too minute in quantity to be of any value in disease. But many experiments, made with great care, have proved that no other oil, or even Glycerin, has the same curative action in disease. They may fatten, but the disease itself goes on unchecked.

The same failure to cure diseases occurs with Cod-liver oil when it is given indiscriminately. If the diseased organism does not call for its constituents and the oil, it will not cure.

In other words, it must be selected according to the law of similia.

The totality of the symptoms for which it is prescribed, must be covered either by the Iodine alone, or by Iodine and the other remedies it contains.

It is not the oil alone that corresponds to the emaciation, which is said to be one of the keynotes for its administration. The emaciation must bear a resemblance to that caused by Iodine and Phosphorus.

If it is asked, could we not successfully imitate Cod-liver oil, by adding to Glycerin, or some oil, the medicines above named? I reply, No, for this contains many acids, besides certain biliary principles, which make it a very complex substance, which it would be almost impossible for the chemist to imitate.

Dr. Neidhard, following the fundamental law of our school, instituted provings of Cod-liver oil, and watched closely its effects on the sick, even when given in small doses.

The results of his investigations prove that it should be treated as any other remedy, namely, selected according to one law, and given in small doses.

I will try and give you some general indications for the selection of Cod-liver oil. After which I will mention certain diseases in which it has been found useful. For the special symptomatic indications I refer you to the pathogenesis in the first volume.

One of the most important indications for the use of Cod-liver oil is the presence of anaemia, under which term I include all conditions of the blood where there is a deficiency of red globules.

This anaemia must not be the result of losses of blood, or that chlorotic anaemia which is accompanied by an anasarcous condition, or without emaciation. I doubt if the oil will prove of any benefit in leucocythcemia.

We are therefore restricted in the use of the Aselli to those cases of anaemia not due to haemorrhages, cancer, renal diseases, or chlorosis. The anaemia must be caused by (1) want of proper nutriment; (2) conditions which prevent nutriment from being converted into healthy blood (diseases of the liver, digestive apparatus, stomach or intestines, especially mesenteric diseases); (3) conditions which tend to deteriorate the blood, namely, scrofulosis, tuberculosis, etc.

It has been shown by eminent authorities that the proportion of red globules is materially increased in patients to whom the oil is given for any length of time. In speaking of the dose I shall refer to this fact again.

Another important general indication for the use of Cod-liver oil is that condition of system in which, with general lowered tone, there is a tendency to cellular hyperplasia; to the formation of exudations composed of imperfectly developed cells, which, in the great majority of cases, from the very beginning are incapable of development into perfect entities, having only one potential quality, that of dying. There are various types of this diathesis or condition of the system. In one of them there is a tendency to increase in the lymphatic glands, to multiplication at the expense of development of their cellular elements, i. e., to the formation of numerous imperfectly developed cells, and, finally, to the destruction of them. The death of the cells is partly due to their inherent qualities, and is partly the result of the pressure which they exert on one another, and upon their sources of foodsupply. If they undergo a slow fatty degeneration, with desiccation, cheesy deposits are formed ; if a rapid fatty change, with abundance of moisture, pus and abscesses are produced ; in either case ulceration is the final result.

This is the so-called scrofulous diathesis — scrofulosis.

In another of this group of diatheses, the tendency to cellular hyperplasia affects the mucous membranes of the air-passages, and the patient, on the slightest provocation, suffers from catarrh, until finally a multiplication of cells occurs so rapidly as to fill up a greater or less number of the air-vesicles of the lungs, generally

those of the apex, and “consumption” results; or else an attack of pneumonia being produced by some exposure, the exudation is cellular rather than fibrinous, and catarrhal pneumonia, ending in the majority of cases in a more or less rapid phthisis, occurs.

It is asserted that the general experience proves that the oil is more valuable in affections of the internal than in those of the external lymphatic glands.

There is one point upon which all allopathic observers agree, namely, “ that in proportion as the local scrofulous disease affects a person who has been subjected to bad hygienic influences, and especially to the use of coarse and innutritious food, does the action of the oil appear to be prompt and decided. When, on the other hand, it has become developed in spite of favorable external conditions of living, and when the digestion is very feeble and imperfect, the oil is seldom tolerated, and rarely produces good effects.”

But the latter class of cases are just the ones in which the small (similimum) doses are suitable, and will bring about curative results without causing indigestion or gastric irritation.

Baehr, in his Practice, admits its value in scrofulosis. He says :

Cod-liver oil is decidedly useful if the digestion is impaired ; if the stomach seems disinclined to retain food, and if ft-equent diarrhceic discharges set in ; if, moreover, nutrition is impaired, the body is emaciated and destitute of animal juices. If the appetite is good, the digestion regular, and there is a marked disposition to adiposis, the oil is decidedly hurtful.

H. C. Wood makes the following excellent remarks, viz. :

The value of Cod-liver oil in what is very often called the “ pretuberculcir stage of phthisis,” has already been alluded to, but is so important that it will bear reiteration. There can be no doubt that consumption often commences with catarrh, and is often developed slowly, as the result of frequently “catching cold.” Whenever a patient is feeble, pale, somewhat anaemic, complains of his liability to catch cold on the slightest exposure, even though no local disease exists anywhere, or rather because no local disease exists anywhere, there is cause for alarm, and it is of the most vital importance that the patient be put upon a tonic treatment whose basis is Cod-liver oil, be fed upon a nutritious diet, and have the hygiene of his daily life regulated, especial care being taken to avoid any exposure to cold. In the advanced stage of chronic phthisis, the remedy is less efficacious, in that it much more rarely effects a cure than in the pretubercular stage ; yet it does more good than all the other remedies of the Pharmacopceia combined — alleviating the cough, increasing the strength, weight, and general health of the sufferer, often retarding or even arresting the pulmonic disorganization, almost always greatly prolonging life, and sometimes, in conjunction with other measures, effecting a cure.

If you will consult the provings of the oil, as given by Neidhard, you will find that it causes the same “ tendency to catch cold upon the slightest exposure,” so strongly dwelt upon by Wood. Neid hard’s clinical experience proves the correctness of this indication, and he gives many illustrative cases of its power, in attenuated doses, of preventing this tendency.

Among the diseases for which Cod-liver oil is specially indicated is chronic catarrh , whether occurring in the nasal, laryngeal, or bronchial passages, or the intestines.

When you have thoroughly tried Hepar sulphur, Hydrastis, Copaiva, and other remedies, and the patient is not rid of the discharges, and is, moreover, anaemic, thin, and catches cold easily upon the slightest exposure, and thinks he “ would get well if he did not catch a new cold every few days,” in such cases you will find the oil a specific. It will restore the general tonicity of the patient, and prevent the susceptibility to catching cold, and a cure will result. An extensive experience in the treatment of catarrhal affections incident to a residence near the Great Lakes, proves to me that Cod-liver oil is the best radical remedy we possess for that disease.

Chronic Rheumatism. — It was in this disease that the oil first gained its reputation. It will not cure, however, unless the general indications for its use are present.

It remained for Dr. Muller to point out distinctly the two kinds of chronic rheumatism.

(1.) Musculo-fibrous rheumatism, arising in a state of abject poverty, and produced by crowded dwellings, insufficient air and light, an originally feeble and impaired constitution, a scrofulous constitution, and inherited proclivity to this disease.

This form of rheumatism begins with dull pains in the limbs, extending gradually to the spine, and as high as the neck, producing stiffness and more or less permanent rigidity of the muscles of the trunk and limbs. It presents no inflammatory phenomena, but is accompanied with oedematous swelling without redness, and may terminate in paralysis.

(2.) Fibrous rheumatism, produced by protracted residence in damp and cold

localities, and differing from the first variety in being confined to the joints. It, however, gradually exhausts the strength and impairs the nutrition of the patient.

In these two forms only of rheumatism did Dr. Muller find the oil of any service. In other words, Cod-liver oil is not a remedy for rheumatism as such, but for a cachectic state of the body which sometimes sustains and protracts indefinitely the rheumatic disorder.

Stille says that in such cases the oil at first aggravates the 'pains. He explains it thus :

It is only at a later period, when the oil has begun to improve nutrition, that it triumphs over the state of morbid sensibility by enabling the system to get rid of its cause.

I would explain it differently. All homoeopathic remedies, if given in too large doses, at first aggravate. So with Cod-liver oil, which, if given in smaller doses, will cure more promptly and without the aggravation.

I have alluded to its use in scrofula. It has been observed that in scrofulous enlargements of the parotid, thyroid, and submaxillary glands, and of those seated in the neck, axillae, and groin, Cod-liver oil was of little use. But when, with such swellings, caries of the bones exists at the same time, the caries is rapidly cured, while the glands remain unaffected. It is in caries and strumous osteitis that Cod-liver oil has made its most brilliant cures. Swelling, softening, and disintegration, with ulceration of contiguous soft parts, external abscesses, hectic fever, and marasmus, have all disappeared after the use of the oil. The more chronic and torpid the disease, the more efficacious does the oil appear to be, and it always improved the general health before the general affection.

It is most useful when the caries attacks the epiphyses of the long bones, and less so in caries of the shafts of these and of the flat bones.

It is of doubtful value in necrosis and vertebral caries. In hipjoint disease it has cured a large proportion ; but it is said to be more valuable when the disease originated in the bone itself than in the synovial membrane.

It is more successful in the cure of fistulce and abscesses around the joints than in affections of the joints themselves. Chronic arthritis of the ankle-joint is oftener benefited than is arthritis of the hip-joints.

In rachitis its curative power is often wonderful. Trousseau found it useful in children with imperfect ossification of the bones, enlargement of the cranium with persistence of the fontanels, tardy or premature dentition, enlargement of the liver, and abdominal dropsy. Sometimes, after four or five days of treatment, the pains in the limbs ceased, and at the end of a fortnight bones which before were flexible acquired a good degree of firmness.

In softening of the bones in adults the oil produces equally surprising cures.

Not only in ulcers and softening of the bones is it useful, but in ulcerations of the glands. Although the oil may fail to benefit swollen glands, so soon as those glands are attacked by scrofulous abscesses and ulceration , or when an indolent ulcer with excoriated edges remains, or one extending under the skin and beneath the muscles, nothing promotes a cure so certainly as Cod-liver oil. This curative power is signally manifested in cold abscesses; the serous is replaced by a purulent discharge, healthy granulations cover the indolent surface of the sore, and cicatrization ensues.

Tabes mesenterica is often relieved and sometimes cured by this remedy. The children are pale, cachectic, greatly emaciated, with large, tumid abdomen, enlarged liver, and swollen mesenteric glands.

I have cured several such cases, when inanition seemed inevitable, by the administration of Cod-liver oil (with and without Phosphate of lime), in doses not exceed mg fifteen drops three times a day, assisted by the inunction of a few teaspoonfuls into the abdominal cutaneous surface.

If, however, the glands are greatly enlarged and evidently tuberculous, it is doubted if the oil will cure.

Diseases of the skin are often benefited by this medicine if they are engrafted on a scrofulous or cachectic state of the system. If an inflammatory element prevails, it is worse than useless, unless used in the high potencies.

Lupus is more apt to be cured by the oil than any other. Emery treated seventy-four persons affected with this disease; of these, twenty-eight were cured, and all greatly benefited. Other authorities give as favorable reports. The doses used varied im-

I

mensely. Some prescribed a pound or two a day for months ! Others a teaspoonful three times a day. The small doses cured as readily as the large, showing that it was the medicinal action of the constituents of the oil, rather than the nutrient, which effected the cures.

The only other cutaneous disease which is as promptly cured by the oil is ichthyosis.

Two English physicians report cases cured in a short time by the oil, used internally and externally. I have cured two cases in children by giving small doses internally, and its inunction into the diseased surface.

It is in phthisis or pulmonary consumption that the Cod-liver oil has been most extensively used — and abused. The amount that has been poured down the throats of the unhappy victims of this disease is simply incredible !

Like all new remedies for consumption, its powers and virtues were once lauded to the skies.

An immense experience, both in public and private practice, during the last thirty years, has greatly modified the early and extravagant estimate of its value. It is estimated that when judiciously given (in allopathic practice) about eighteen per cent, are cured; sixty per cent, benefited; while the balance are injured, or indifferent to its action. It is known, however, that the deathrate from consumption has certainly diminished since its use.

In homoeopathic practice it has not been used sufficiently to enable me to give you any statistics of its value when prescribed according to our law. Owing to prejudice, lack of confidence, or what is more probable, ignorance of the special indications for its use, our school have rarely prescribed it in phthisis. The time has come when we should ascertain definitely its sphere of action, and the characteristic symptoms and conditions calling for it.

We can attain this knowledge by (1) a careful study of the experience of trustworthy and honest allopathic practitioners ; (2) a study of the symptoms of its constituent elements in health and disease ; and (3) a record of its effects when prescribed in small doses.

The homoeopath who will not prescribe Cod-liver oil in tuberculosis because it is abused in allopathic practice, is unworthy the

name of physician. If it cures, it does so because its constituents are homoeopathic to the disease , aided by its powerful nutrient qualities.

Some of our authorities are liberal enough to advise its use in appropriate cases. Baehr, after giving the special indications for Iodine, Phosphorus, etc., says:

As regards Cod-liver oil, even the physiological school admits that it acts well in phthisis. The Iodine it contains being present in only a small quantity the boldest conclusions were resorted to for the purpose of substantiating the theory that the oil alone was the curative agent. That this theory is erroneous, can easily be shown by some other oil being substituted for Cod-liver oil — the same effect will not be obtained. The small quantity of Iodine is sufficient for the homoeopath to account for the action of the oil. That it should be used with caution has already been stated at the conclusion of our chapter on scrofulosis. The same maxims that were laid down on that occasion are likewise applicable to phthisis, so much more as it is decidedly injurious to phthisicky patients to have their appetite and digestion interfered with. The dose should likewise be carefully measured ; a teaspoonful in the morning is sufficient. It is decidedly improper to prescribe a spoonful morning and evening. A morning dose is sufficient. In the evening the oil disagrees with most persons. No other medicine should be given with the oil.

I do not agree with Baehr in relation to dose, nor his prohibition of other medicines. I think three small doses a day are better than one large one.

Dr. Mayhofer, of Nice (see “ Diseases of the Respiratory Organs,” vol. i), says:

Cod-liver oil justly merits the high reputation which it has acquired in correcting those deficiencies of nutrition commonly comprehended in the terms scrofulosis and tuberculosis. But, on the other hand, there is perhaps no remedy which has been so much misused, and thereby effected so much harm, as this animal oil. Ask any adult, afflicted with a scrofulous disease, how many medical practitioners have been consulted for him in his childhood, and the answer will be that if their number was great their unanimity was still more marvellous, as they one and all recommended Cod-liver oil as a ne plus ultra for his complaint. The quantity of oil that many of these unfortunate children are made to swallow is often truly amazing, yet a great number of them are not only none the better for it, but, on the contrary, all are worse. Some reflection on the two principal types (irritable and torpid) of the scrofulous diathesis, and the all-important physiological part which fat plays in the animal economy, would have prevented these sad results.

In patients exhibiting a strumous diathesis, of a slender and lean figure, and thin, transparent skin, we generally find combined a frequent pulse, great excitability of the nervous system, with high specific gravity of the urine — all signs of an accelerated metamorphosis. It is in this condition that the action of Cod-liver

oil has obtained its antiscrofulous fame. In a short time after its use the angular forms acquire more roundness, and the general susceptibility, as well as the morbid phenomena, gives way to its influence. Scrofulous individuals, however, who exhibit a fatty, puffy, leucophlegmatic body, swollen nose and upper lip, slowness of the cardiac contractions, defective irritability of the nervous system, and low specific gravity of the urine, far from being benefited by Cod-liver oil, are the very victims who have been made to swallow it by quarts, and to no purpose. The reason of this is obvious : fat requires nearly double the amount of oxygen for its combustion (100: 292.14) to that demanded by albumen (100: 153.31 ), and as it evinces a greater tendency to the generation of acid than the latter, acts, when introduced into the organism, the part of a moderator to the metamorphosis of nitrogenous substances. On the other hand, that part of the oleaginous matter which has not furnished its share toward the production of animal heat by combustion, does so by its accumulation under the cutaneous surface, or enters as a necessary element into the formation of cells. It is thus evident that Cod-liver oil can only be of service when the destructive nutritive process prevails over the constructive one, and that otherwise its agency must rather increase than diminish a lymphatic tendency of constitution.

But the virtues of this animal product are, by a great number of physicians, attributed in a measure to the Iodine contained in it. There can be no doubt as to the salutary influence exercised by this metalloid over some special scrofulous affections ; but this does not destroy the fact that Cod-liver oil, like any other fatty substances (the fat of dogs is a popular remedy in Germany for scrofula and phthisis), produces its best effects on lean persons, who, as physiology teaches, consume more oxygen and excrete more CO2 and bile than fat ones ; while on those who show a disposition to the formation of adipose tissue, it effects a contrary result to that which is desired, in spite of the Iodine which it contains. Cod-liver oil is a specific only in a limited number of morbid conditions. In the majority of instances it derives its importance from its value as a nutritive agent arresting a preternatural waste.

We now turn to the best testimony, relating to its use in phthisis, afforded by the allopathic school.

The great and enlightened experience of Dr. Walshe led him to conclusions which we will now proceed to quote. You will observe that while he concedes to the oil all of the nutrient qualities which have been claimed for it, he is not prepared to regard it in any sense a cure for tubercular consumption. He asserts :

(1.) That Cod-liver oil more rapidly and more effectually induces improvement in the general and local symptoms than any other known substance. (2.) That its power of curing the disease is undetermined. (3.) That the mean amount of permanency of the good effects of the oil is undetermined. (4.) That it relatively produces more marked effects in the third than in the previous stages. (5.) That it increases weight in favorable cases with singular speed, and out of all proportion to the actual quantity taken ; that hence it must in some

unknown way save waste and render food more readily assimilable. (6.) That it sometimes fails to increase weight. (7.) That in the great majority of cases, where it fails to increase weight, it does little good in other ways. (8.) That it does not relieve dyspnoea out of proportion with other symptoms. (9.) That the effects traceable to the oil in the most favorable cases are : increase of weight, suspension of colliquative sweats, improved appetite, diminished cough and expectoration, cessation of sickness with cough, and gradual disappearance of physical signs. (10.) That in some cases it cannot be taken, either because it disagrees with the stomach, impairing the appetite (without itself absolutely nourishing) and causing nausea, or because it produces diarrhoea. (11.) That in the former case it may be made palatable by associating it with a mineral acid ; and in the latter prevented from affecting the bowels by combination with astringents. (12.) That intrathoracic inflammation and haemoptysis are contraindications to its use, but only temporarily so. (13.) Diarrhoea, if depending on chronic peritonitis or secretive change, or small ulcerations in the ileum, is no contraindication to the use of the oil. Even profuse diarrhoea, caused by extensive ulceration of the large bowel, is not made worse by it. (14.) That the beneficial operation of the oil diminishes, coder is paribus, directly as the age of those using it increases. (15.) That the effects of the oil are more strikingly beneficial when a small extent of lung is implicated in an advanced stage, than where a relatively large area is diseased in an incipient stage. (16.) That where chronic pleurisy or chronic pneumonia exists on a large scale, the oil often fails to relieve the pectoral symptoms. (17.) That it often disagrees when the liver is enlarged and probably fatty. (18.) That weight may be increased by it, the cough and expectoration diminished, nightsweating cease, the strength which has been failing remain stationary under the use of the oil, and yet the local disease be all the while advancing.

“Singular proof,” says Dr. Walshe, “of the nutritive power of the agent,” and, we may add, of its inefficiency as a medicine.

This admirable exhaustive summary of the knowledge which is possessed of the subject to which it relates, confirmed, as it has been, by the conclusions of competent observers, shows a wide difference between the anticipations which were indulged respecting the virtues of Cod-liver oil and the sober realities of experience. But enough remains to prove that among all the remedies that have been proposed for pulmonary consumption, none can be compared with this in efficacy. More than any other it mitigates the symptoms of the disease, and delays its march ; while in some cases it appears permanently to arrest the degeneration of tubercles already deposited, and so to improve the nutrition as to prevent the formation of new ones. — Stii/le.

Dr. Anstie has called attention to the usefulness of this medicine in the treatment of chronic convulsive diseases, namely, paralysis agitans, simple epilepsy, mercurial tremor, and chorea. Doubtless, if the general condition of the patients was such as called for the oil, they would be benefited by it.

The second formula I shall give at the close of this lecture is very highly praised by many physicians noted for their successful treatment of nervous diseases. It is useful in insanity, dementia, hydrocephaloid states, cerebral exhaustion, spinal exhaustion, neuralgia, etc., if the general conditions of low vitality indicate it.

Dr. Holcombe once reported an interesting case of chronic diarrhoea, caused, as he supposed, by ulceration of the mucous membrane, which he cured with Cod-liver oil in teaspoonful doses. He thought the local soothing effect of the oil partly contributed to the cure. But its specific action was probably as important. I have stated that diarrhoea, unless inflammatory, was no contraindication for its use. I have cured with the oil several cases of chronic diarrhoea in adults, with great emaciation, poor digestion, and depressed nutrition, after Arsenicum, Nitric acid, and Phosphorus had been used unavailingly.

The Dose. — The usual quantity of the oil prescribed by the allopathic school is rarely less than a tablespoonful three times a day. This amount is sometimes doubled and trebled. The result of these massive doses is the same as follows the administration of large doses of any drug. Pathogenetic effects are caused, and the disease instead of being benefited is often aggravated to a serious degree. It seems to be a rule with that .school that the dose must be as large as possible, without doing serious injury. It is this disregard of the disease-producing effect of the oil, that has driven it into disuse in some quarters, and led to its abuse everywhere.

I have previously stated that it increases the proportion of red globules in anaemia. This increase, under the use of large doses, may become abnormal. Stille admits that “ the continued use of the oil may sometimes predispose to parenchymous congestions,” and quotes Benson, who found “ a consolidated and congested condition of the lung frequent in consumptives treated with the oil.” He also quotes Gluge and Theirnesse, who “produced pneumonia artificially in certain animals by feeding them exclusively on Cod-liver oil. The lesions found were hepatizations of

the lung, accumulation of fatty fluid in the parenchyma of the lungs, liver, kidneys, and in the blood.” It is not strange then that such acute observers as Stille and Wood should caution against its use in “ some cases of phthisis.”

Does it not seem strange that they did not think of decreasing the dose in all cases, instead of advising to “ use it (in large doses) with caution ? ”

There is abundant proof, and you will meet with such proof frequently in your practice, that abuse of Cod-liver oil will cause haemoptysis, inflammation, fever, and many unpleasant symptoms, which tend to hasten the death of patients, instead of curing them or prolonging life.

If the Cod-liver oil is homoeopathically indicated, a drachm three times a day should be the maximum dose for an adult. In a -certain class of cases, when its constituents are closely indicated, the dose should be very small ; a few drops of the pure oil, or the lower triturations or dilutions. Dr. Neidhard uses a tincture made by adding §ix Alcohol to 5j of the oil. This he prescribes in drop doses, when it is “closely affiliated.”

I prefer the triturations of the brown oil, because it is the richest in medicinal constituents, and I have seen excellent effects in infants suffering from marasmus, from the 2X and 3X. I rarely prescribe over fifteen drops to young persons, and this dose should not be repeated oftener than three times a day. In these doses, especially if given in the form of emulsion or in capsules, it rarely disagrees with the stomach, and the disagreeable symptoms of gastric irritation it often causes in large doses are avoided.

It is not always necessary that the oil should be administered internally.

You may find some patients with stomachs so sensitive that a few drops will nauseate and cause gastric disturbance.

In such try the triturations or dilutions, but if you see no good effects, and you feel sure that this is the remedy, do not hesitate to try the inunction process.

It was proven by Polloch and Klenke that animals who are rubbed with the Cod-liver oil daily (on the shorn skin) increase in weight as fast as when administered internally. In some of the hospitals of England and this country this process has been

adopted with good results. In the case of children, especially, this plan is productive of excellent cures.

For many years I have treated those cases of marasmus which occur in children under five years of age, with the 2* and 3X trituration internally, and inunctions of the oil on the abdomen and stomach. In very young infants I rely upon the inunction alone.

I can recall to memory several infants who had been given over to die by eminent physicians of both schools, but who recovered in a few months under the patient and regular daily inunction of half an ounce.

Adults become tired and disgusted with the odor, and it is difficult to get them to persevere; but children rarely seem to be discommoded by it. It is well known that young children rarely object to the taste of the oil ; they even become fond of it.

Many methods have been devised to disguise the taste and smell of the oil. The enormous doses prescribed by other schools have seemed to make this necessary, although, as has been stated, children do not generally object to it.

Given in the small doses which are used in our practice, the necessity of such disguise is not so important. We shall, however, be obliged in many cases to recommend various devices for that purpose.

A few drops, or the first trituration, is as offensive to some as a teaspoonful.

The best method of taking the pure oil is to drop it into a little table beer or 'porter .

If the juice of a lemon is sucked just before and after the dose, a teaspoonful or less can be readily taken by most patients. It is said that chewing a piece of smoked herring is the best expedient.

I strongly protest against the use of whiskey or brandy for such purpose. When it is taken in equal or double the amount of the oil, as a disguise, or a stimulant, it soon creates a taste for the liquor, which will grow into a necessity, and you make a drunkard of your patient before either he or you are aware.

Many emulsions have been made with the oil. They all contain lime water, Phosphate or Hypophosphite of lime, and are flavored with Oil of bitter almonds. Wilbour’s oil is the most popular, although many other manufacturers imitate it.

One of the most palatable, and I will say the most useful, of all these emulsions is made after the following formula :

R. Hypophosphite of lime, Aqua calcis,

Oleum aselli morrhuae, aa Syrup, balsam Peru, Mucilage acacia, aa Oleum amygdala amara,

• 33

• Iviij

• Sj

. gtts. v. — M.

Of this the dose is a teaspoonful or less — rarely a dessertspoonful, even to adults. It rarely disagrees with the most sensitive stomachs. The objection to its compound character may frighten a good many purists, but it is hardly more complex than the oil itself, and when the life and health of our patients are at stake, we should not be too stringent in our ideas of “ the single remedy and the minimum dose.”

Another formula, which has

been called the Phosphoric acid

emulsion, is very popular with physicians who specially treat insanity, nervous diseases, and cerebral exhaustion :

R. Cod-liver oil,

. 5iv

Glyconin,

Jamaica rum,

. oh

Dilate Phos. acid,

. 3h

Oil bitter almonds,

. . . . gtts. x. — M.

Glyconin is made by thoroughly triturating Glycerin and yolk of egg, equal parts. Add to this Glyconin the Oil of almonds, drop by drop, slowly, stirring it vigorously. Add the Cod-liver oil to the Glyconin. Then add the Hum and Phos. acid. Dose, 15 to 60 drops.

It is generally recommended that the oil be taken after meals, or midway between ; but my experience and observation go to show that small doses, at least, are better borne if taken just before sitting down to meals.

In treating patients constitutionally with the oil, we can adopt the same rules in regard to intercurrent remedies as when we are giving an antipsoric, i. e., if any remedy seems indicated by symptoms which spring up and require attention, the indicated remedy may be prescribed without suspending the oil.

The presence of fever, a bilious -coated tongue, or decided gastric derangement calls for the suspension of the oil until these conditions disappear. Rarely does diarrhoea, unless it is inflammatory, contraindicate the use of the oil. On the contrary, some of the worst forms of diarrhoea have been cured by it.