Page images

tions predicted that she would give birth to a male. To this opinion we were led by the difference we observed between the right and left uterine pulse. The first sensibly manifested its organic character, the latter not at all.” Dr. Rucco states that “the prediction was verified by the event,” and proceeds to give other instances, which need not be here adduced; but you may be interested to hear an example in which this physician considers that he detected the influence of a special mental emotion in modifying the pulse. “About three years since, the jaundice attacked a man of letters in consequence of a violent attachment to a young lady, whose parents would not consent to their union. The patient's pulse was low, concentrated, thin, tense, unequal. A small eminence arose between the index and middle fingers, and its smallness and concentration increased at the time the melancholy was deepest, so that it was clear, from the presence of the organic character of the hepatic pulse, that the action of the disappointment or negative he had received had made a morbose impression upon the vitality of the liver.”

You smile, not without reason, at the seeming pretension of this statement; but I would nevertheless advise you to refer to the works of such authors as Rucco, and compare their opinions with your own observations, and I am mistaken if you do not find that there is much to be ascertained from certain changes of character in the pulse, not susceptible of exact verbal description. Such conditions will aid you in judging of the vital energy in diseases, the issue of which may depend more on constitutional peculiarities than on organic change. Independently of the lessened influence of


posture, to which it has been one of the objects of this lecture to call your attention, let me repeat that, as a general rule, unnatural quickness of pulse sets in, often at a very early period, in phthisis, and increases with the progress of the disease ; that the earlier it is manifested the more, other things being equal, you would apprehend speedy aggravation, but that on the other hand a steady and gradual reduction of the frequency of the pulse would lead you to entertain hopes of important amendment, for under the influence of successful treatment the pulse loses its irritable character and becomes calmer, slower, and fuller. Whilst you will take care not rashly and hastily to pronounce a diagnosis from the state of the pulse alone, you will nevertheless rarely fail to derive considerable assistance from a sagacious regard to its condition.


Cod-liver oil-Superiority to any other single remedy in phthisis;

Illustrative instances of its value-Different kinds compared Collateral remedies sometimes useful, often unnecessaryEffect of its introduction into the system by friction-Mode of action-Important practical generalizations derivable from a knowledge of its mode of action—The appreciation and use of facts.

THE great object, gentlemen, of all our researches is to attain to the successful treatment of disease. With this conviction, I propose to devote the present lecture to the consideration of the effects of a remedy which you will have observed is very largely employed at this hospital, even to the extent of more than 600 gallons annually.

The records of the hospital give you an opportunity of comparing the effect of treatment conducted on general principles, irrespective of the use of this remedy, with treatment in which its administration has occupied an important place; and the more carefully you institute the comparison, the more you will be convinced of the value of this medicine in the treatment of phthisis, when appropriately administered, and combined with the use of such other measures as any special circumstances in the individual patient may require.

But you will like to see examples of its use. I first introduce M. A. F., a female aged thirty-two years. The expansion of the two sides of her chest at the upper part is not perfectly equal, although a practised eye may be required to detect the difference ; in the left subclavicular region inspiration is interrupted; in the right subclavicular region the expiratory murmur is prolonged. The disease is in a very early stage, and cod-liver oil has been given in the hope of improving her strength, and thus warding off further disease. Her progress is encouraging ; the pulse, during the last six weeks, having gone down from 116 to 80, and her weight increased five pounds.

The next patient, A. S., is a tailor, who has suffered much from confinement in close workshops. The principal physical signs at the time of his admission were, dulness on percussion, and extensive moist crepitation (clicking) over the upper half of the left chest. Softening of tubercular deposit was obviously proceeding rapidly, and this is the period in phthisis when the influence of remedies is usually least satisfactory. The patient looks very delicate. The pulse has remained about 100 for the last seven weeks, notwithstanding the administration of the cod-liver oil, and his general aspect is unpromising ; still, some good effect has been produced, and there is an addition of five pounds to his weight.

The next patient, L. D., a young woman aged twenty-one, came into the hospital on the 31st of October, with moist crepitation at the apex of the right lung, and gurgling in respiration and cough on the left ; phthisis existing in the second stage on one side, and in the third stage on the other. The pulse, as in the previous patient, remains as yet unaltered, but there is an improvement of strength, a subsidence of night perspirations, a regular state of bowels, which were previously relaxed, and, after the three months of her use of the oil, an increase of weight to the extent of six pounds. The local signs also indicate amendment. The expectoration is much diminished, and a dry, blowing respiration has taken the place of gurgling.

E. M., the patient now before you, under the judicious care of my colleague, Dr. Cursham, has acquired so ruddy a complexion that you would not suppose her an invalid, although there is cavernous respiration at the apex of one lung. Still, the cough is subdued; the expectoration, previously profuse, has ceased, and she has gained no less than fifteen pounds weight in about twelve weeks. It is right to mention that she has had spermaceti mixture, and compound hemlock-pill for her cough; and of late, in addition to cod-liver oil, an ounce twice a day of the following mixture : twenty-four grains of ammonio-citrate of iron; two drachms of spirit of nutmeg ; six ounces of infusion of calumba.

Here is another patient, S. G., aged twenty-five, who is fattening, and the catamenia, long interrupted, have returned,—a circumstance of great significance and promise. You find a little cavernulous rhonchus only, where there was formerly extensive gurgling; and a marked flattening in the subclavicular region indicates the process of contraction in a cavity.

Her weight, which was seven stone thirteen pounds on her admission, in July, has steadily increased; and now, at the end of February, it is nine stone, two pounds, and the

« PreviousContinue »