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OBSERVATIONS ON THE COD-LIVER OIL.

OBSERVATIONS ON THE OLEUM JECORIS ASELLI, OR COD-LIVER OIL;

ITS NATURE, PROPERTIES, MODE OF PREPARATION, &c.

BY JOHN SAVORY,

MEMBER OF THE SOCIETY OF APOTHECARIES, LATE PRESIDENT OF THE ROYAL PHARMACEUTICAL SOCIETY OF GREAT BRITAIN, &c. &c.

LONDON: JOHN CHURCHILL, PRINCES STREET, SOHO. 1849.

LONDON: G. J. PALMER, PRINTER, SAVOY-STREET, STRAND.

ON COD-LIVER OIL.

The introduction of a new therapeutical agent into general practice cannot fail to interest the medical profession and the public, and, profiting by the experience attained in a consideration of the manner in which former remedies have been brought into notice, extolled for their efficacy, persevered in for a time, and then gradually permitted to fall into disuse, and finally sink into oblivion, it will doubtless be useful to review the circumstances attendant upon the proposal now so generally entertained of the administration of the cod-liver oil for a variety of diseases and disorders.

Dr. Percival remarks, that it was so largely dispensed at the Manchester infirmary, that "near a hogshead of it was disposed of annually;" yet its employment was almost solely confined to the relief of cases of chronic rheumatism, sciatica, and those contractions and rigidities so frequently the consequences of exposure to damp and cold. In these cases it was considered as superior to all other remedial means that had been used, and its beneficial effects were strikingly apparent. The operation of the oil in the first instance was mostly to increase the pain sustained by the afflicted, but this was soon succeeded by a gradual subsidence of the severity of the symptoms. It occasioned, particularly in irritable habits, an acceleration of the pulse, and diffused a glow of warmth over the whole frame of a very agreeable description. It promoted the secretions of the skin, and occasionally acted on the bowels. It was observed, that when its use had been persisted in for a few weeks the tongue became foul and the appetite impaired, so that an emetic was found to be necessary. It was, however, given in large doses, varying from one to three table-spoonfuls twice, thrice, or four times daily. It was also employed extensively as a liniment to the stiffened joints or limbs; but if soreness existed its use was forbidden; it was also never exhibited internally when fever was present.

The oil employed at the Manchester Infirmary was obtained from Newfoundland, and brought thence in barrels containing from 400 to 520 pounds in weight; it was obtained by the putrefaction of the livers of the fish, which were heaped together for the purpose. The oil so procured was, however, found to be exceedingly nauseous and offensive, both as regards smell and taste, so that but few stomachs could bear it, although a variety of means were resorted to to disguise its unpleasant character.

Notwithstanding this, Dr. Bardsley remarks, that where it could be persisted in, such was the power of habit, that a relish for its flavour succeeded to its use, and what before was taken with such extreme disgust became pleasurably received. Dr. Percival says, the oil left upon the palate a savour like that of putrid fish, and that the perspiration of those taking it was strongly tainted with it. The oil, however, was not solely obtained from the livers of the cod-fish, but also from the ling . So offensive was it found to be, that it was, in many instances, rendered necessary to combine it into the form of a liquid soap, and it is not too much to assert, that the efficiency of it as a remedy must have been, in no inconsiderable degree, impaired by the formulae to which it was reduced.

Mr. Darbey, the house surgeon of the infirmary, in a letter to Dr. Percival, states the discovery of the effects of cod-liver oil to have been accidental, and to have occurred in a patient who, using it externally, was induced also to take some of it internally. She recovered the use of her limbs, and in a few weeks was dismissed. No particular attention was directed to the circumstance until her return to the infirmary, in the course of 12 months, on account of a renewal of her complaint with considerable violence, which, however, soon subsided by the employment of the same means of relief. Dr. Kay, one of the physicians of the infirmary, remarked upon the case, and wished to test the character of the remedies in similar cases, and found the practice to succeed beyond his most sanguine expectations. It is worthy of remark, that the instances in which it was found to be most serviceable were those in which the perspiration was gradually promoted. Those who had been cripples for many years were found, after persisting in its use for a few weeks, not only to be able to quit their seats, to which they had been confined, but also to walk even without the aid of crutches or a stick. The effects were so remarkable, that application was made to the infirmary for the oil in all kinds of lameness, and an expenditure of not less than 50 or 60 gallons annually was the result. This practice was commenced about the year 1772, and continued for many years afterwards.

One of the great evils attendant upon the introduction of a new remedy is the universality of its application to cases, often of very dissimilar nature. Its inefficiency to such a variety of purposes thereby speedily becomes apparent, and those disorders to which it may be beneficially applicable cease to be subjected to its operation: the novelty is gone; a prejudice against its use is created, and some new proposition speedily serves to banish it from a position it might probably, with advantage, have held in the Materia Medica.

Dr. Bardsley, writing in 1807, however, gives his testimony to the efficiency of cod-liver oil in cases of chronic rheumatism, and says, "In some instances, where every other means have proved unsuccessful, it has operated in a manner so decidedly beneficial as to excite astonishment." In many cases, however, of a mild description, it has not been of any advantage. In the chronic rheumatism of aged persons, in whom the muscles and their tendons have acquired great rigidity, so that the joints have become almost inflexible, it was found to be most serviceable. In females, also, whose powers had been much depressed by frequent parturition, and in whom debility towards the decline of life prevailed to a great degree, it has served to produce the happiest effects. And, in all the cases, in which it has been attended with benefit, it has uniformly been remarked that the consequences produced by the exhibition of the oil have been to occasion an increase of power, size, and general fatness. Its operation was far from being uniform, for whilst in some instances it produced increased action of the bowels and promoted the alvine discharges, in others it had a tendency to induce constipation. In some it occasioned increased perspiration, and in others an addition to the secretion of the urine. In some it produced an eruption of the skin, attended with a sense of prickling heat. In some few cases, none of these sensible effects were to be observed. When it proved serviceable, its beneficial effects were found to be apparent in the course of a fortnight, and if at the expiration of that time no good resulted, little was to be expected from a continuance of its use; it was, however, remarked, that when it began to be useful its progress was observed to be gradual, and it became necessary, in order to insure a cure of the patient and to guard against a renewal of the attack, to continue its daily exhibition for a period extending to not less than six or eight months.

The observations of these enlightened physicians have been confirmed by more modern practitioners. Corroborative evidence has been adduced against its employment in acute cases, or those attended by active inflammatory action, and for its employment in chronic cases attended by a low inflammatory condition, or in those cases where want of power and diminished strength are most apparent.

It is not a little remarkable, that after the able and valued testimony just alluded to, an agent of such therapeutical properties should have been allowed to fall into utter neglect in this country. Much praise is due to the physicians of Germany for investigating the subject, and practically testing its efficiency. It would be out of place here, and foreign to my purpose, to call attention to the various trials to which the remedy has been submitted and its efficient powers confirmed; these are to be found in the medical periodical literature of Germany and France, and have been translated and transferred to the pages of our own journals.

The cod-liver oil has been found principally efficacious in rheumatic, gouty, and scrophulous cases, with their accompanying manifestations of cutaneous eruptions and neuralgic pains. Whenever a deficiency of tone is apparent in the system, its employment has been found of benefit. Where, as in pulmonary cases, it cannot be looked upon as curative, it nevertheless tends to the general support of the frame, and may probably serve to give time for the employment of other remedies more especially directed to the existing disease.

One of the greatest objections to its use was, as already stated, the exceedingly unpleasant savour it possessed, and the consequent disgust to its exhibition produced in persons of delicate stomach. This has in some measure originated from the introduction of a spurious article, or from the manner in which the original has been introduced. What could be expected otherwise than a most loathsome material, from livers heaped together by thousands sent over from Newfoundland, to deposit their oil by a course of putrefaction? The livers of other fish have also been found to have accompanied those of the cod, hence, probably, deteriorating the effect of that of the cod, or introducing an article calculated to produce no good result. At Berlin it is known that a spurious oil was introduced into the hospital, and the failure in its operation had well nigh superseded its use altogether. A genuine oil was however happily obtained, and the value of the remedy established. Various modes of adulteration have been detected. It has been found to be mixed with whale oil, the oil of the seal, &c.; and its offensive character may easily be estimated. The price at which the oil is to be obtained may probably, in some measure, serve as a clue to the discovery of these attempts, than which nothing can be more reprehensible. It is melancholy to reflect that in nothing more, or perhaps equally so, is adulteration practised than in medicinal articles. The public have little means of detecting these fraudulent proceedings, which ought, however, when brought to light, to be subjected to the severest censure and punishment.

It is questionable how far these adulterations may be detected by the operation of the oil, since the principles of its immediate action in various diseases is far from having been satisfactorily ascertained. Its nutrient properties are known, and must be admitted in common with all adipose substances, and a knowledge of their constituents and action upon the human frame; but beyond this, namely, the specific qualities as adapted to counteract scrophula, rickets, rheumatic or gouty inflammation, neuralgia, pulmonary disorders, &c. is unknown. The well-ascertained effects of iodine in the relief of scrophulous diseases point out that substance as the immediate agent affording relief in those cases, but it has been ascertained that the quantity of iodine in the cod-liver oil is exceedingly small, being much beneath that which is ordinarily given in the treatment of scrophulous disorders, and without effect in those cases; still this small quantity may perhaps by nature be so incorporated in the composition of the oil, that although of diminished proportions, it may yet possess an increased power of action, as in the case of natural mineral waters. It may probably be truly averred, that no fictitious mineral waters, however admirably prepared, and however accurately constituted, according to the proportions of the several ingredients as ascertained by chemical analysis, are capable of producing the same effects as those by the water derived from the original spring. This may perhaps be the result of some electric or galvanic agency operating in its constitution, the place of which cannot be supplied by any substitute to be found in the laboratory of the chemist. Nature here manifests her decided superiority to the efforts of art, though ably directed by the hand of science. Dr. Pereira has suggested bromine to be the active principle in the oil, and others have attributed its efficiency to various phosphoric compounds. Dr. Williams refers its agency to some biliary principle; in short, nothing certain is known upon the subject: the cause may here be said to be occult, but the effect is apparent. Mons. Bretonneau asserts that he has obtained effects just as markedly beneficial to result from the use of the common whale oil, as from the cod-liver oil, although we know the power to be but very partially obtained from the liver of the cetaceous tribe.

As, however, cod-liver oil is admitted to be an important medical agent, and as so many eminent medical practitioners have given their decided approbation to its employment, it is of the greatest consequence to have the article in the most perfect state of purity. Under this impression I have for a considerable time been engaged in various methods to accomplish this end, and without occasioning any change in its constituent properties, or altering the relative proportion of the several substances which enter into its formation, I have at length been enabled to obtain the oil from the fresh livers in a state of purity and comparative sapidity which I flatter myself will be universally approved. Its clearness and transparency is equal to that of any other oil even of a vegetable nature; its taste is such that it needs no admixture to disguise it, and it is therefore freed from the suspicion of being, by any combination, deprived of its essential and curative properties. It may be taken, not in the large doses previously administered in the Manchester Infirmary, of one, two, or three table-spoonfuls, two, three, or four times daily, but in that of one, two, or three tea-spoonfuls twice a day, and may, without fear of counteracting its medicinal quality, be agreeably taken in a small quantity of milk, or coffee, or beer. Infusion of orange-peel is a convenient and agreeable vehicle for its administration. Peppermint-water is also a convenient and proper means. If it be employed in the form of an emulsion, care must be taken that no syrup be employed into the constitution of which acid enters, as it would be incompatible with the alkali necessarily used to form the mixture.

If the oil be pure and freed from all extraneous matters, and the livers from which it is procured be in a recent and not in a putrid state, there is little apprehension as to any disagreeable effects following its exhibition; in some cases, however, it has been found to disorder the bowels in a slight degree upon commencing its use, but that speedily subsides, and has rarely required the aid of remedies to counteract such effects.

Externally it may be used by itself, or in combination with ammonia, or camphor, spermaceti, wax, &c., according to the intention with which it is employed, and which it is hardly necessary to say should be under the direction of a professional adviser.

LONDON: G. J. PALMER, PRINTER, SAVOY STREET, STRAND.

A COMPENDIUM of DOMESTIC MEDICINE, and COMPANION to the MEDICINE CHEST. Comprising Plain Directions for the Employment of Medicines--their Properties and Doses--Brief Descriptions of the Symptoms and Treatment of Diseases--Disorders incidental to Infants and Children--Directions for restoring Suspended Animation--Counteracting the Effects of Poison--A Selection of the most Efficacious Prescriptions and various Mechanical Auxiliaries to Medicine.

Transcriber's Notes:

--Text in italics is enclosed by underscores .

--Obvious punctuation and spelling inaccuracies were silently corrected.

--Archaic and variable spelling has been preserved.

His heart came into his mouth. He gulped it down, and, with what was perhaps a judicious sacrifice, jumped the remainder of his testimonials.

When the stranger heard how he had been tracked through the streets, he put his head to the side to think.

It was a remarkable compliment to his abstraction that Andrew paused involuntarily in his story and waited.

He felt that his future was in the balance. Those sons of peers may faintly realise his position whose parents have hesitated whether to make statesmen or cattle-dealers of them.

"I don't mind telling you," the stranger said at last, "that your case has been under consideration. When we left the Embankment my intention was to dispose of you in a doorway. But your story moves me strangely. Could I be certain that you felt the sacredness of human life--as I fear no boy can feel it--I should be tempted to ask you instead to become one of us."

There was something in this remark about the sacredness of human life that was not what Andrew expected, and his answer died unspoken.

"Youth," continued the stranger, "is enthusiasm, but not enthusiasm in a straight line. We are impotent in directing it, like a boy with a toy engine. How carefully the child sets it off, how soon it goes off the rails! So youth is wrecked. The slightest obstacle sends it off at a tangent. The vital force expended in a wrong direction does evil instead of good. You know the story of Atalanta. It has always been misread. She was the type not of woman but of youth, and Hippomenes personated age. He was the slower runner, but he won the race; and yet how beautiful, even where it run to riot, must enthusiasm be in such a cause as ours!"

"If Atalanta had been Scotch," said Andrew "she would not have lost that race for a pound of apples."

The stranger regarded him longingly, like a father only prevented by state reasons from embracing his son.

He murmured something that Andrew hardly caught.

It sounded like:

"Atalanta would have been better dead."

"Your nationality is in your favour," he said, "and you have served your apprenticeship to our calling. You have been tending towards us ever since you came to London. You are an apple ripe for plucking, and if you are not plucked now you will fall. I would fain take you by the hand, and yet--"

"And yet?"

"And yet I hesitate. You seem a youth of the fairest promise; but how often have I let these impulses deceive me! You talk of logic, but is it more than talk? Man, they say, is a reasonable being. They are wrong. He is only a being capable of reason."

"Try me," said Andrew.

The stranger resumed in a lower key:

"You do not understand what you ask as yet," he said; "still less what we would ask in return of you."

"I have seen something to-day," said Andrew.

"But you are mistaken in its application. You think I followed the man lately deceased as pertinaciously as you followed me. You are wrong. When you met me in Chancery Lane I was in pursuit of a gentleman to whose case I have devoted myself for several days. It has interested me much. There is no reason why I should conceal his name. It is one honoured in this country, Sir Wilfrid Lawson. He looked in on his man of business, which delayed me at the shop-window of which you have spoken. I waited for him, and I thought I had him this time. But you see I lost him in the Strand, after all."

"But the other, then," Andrew asked, "who was he?"

"Oh, I picked him up at Charing Cross. He was better dead."

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