The Diagnosis, Pathology, and Treatment of the Diseases of the
Chest. By W. W. Gerhard, M. D., Lecturer on Clinical Me-
dicine to the University of Pennsylvania, one of the Physicians
to the Pennsylvania Hospital. Third Edition, Revised and En-
larged. Philadelphia: Ed. Barrington & Geo. D. Haswell.
1850.
7	. ■ •
Those who acknowledge the importance of physical diagnosis
in diseases of the chest—and who does not 1—will hail with pecu-
liar pleasure this new edition of a popular work from the hands of
a “ master in Israel.” The name of its author is closely associated
with this subject as one who has done much in its elucidation.
This edition contains a variety of new matter,’besides a more full
development of many portions of the former one. A statement of
the effects of cod liver oil in the treatment of consumption is among
the novelties introduced. In regard to the question whether cod liver
oil ever cures phthisis, the author remarks, that he has “ never yet
met with a case in which the physical signs, as well as the general
symptoms, have entirely disappeared. Indeed, in most cases of
the disease, we -do not find that the physical signs diminish as de-
cidedly as the general symptoms.” The author remarks that
sometimes they even increase while the patient is gaining flesh,
and his fever is considerably lessened. In these cases the depo-
sition goes on, while the patient becomes less sensible to its effects,
and thus even gains flesh. He (the author) therefore concludes
that cod liver oil is not a specific against phthisis; it simply in-
creases flesh, notwithstanding the disease; and sometimes may
indirectly bring about a permanent cure in cases in which the tu-
berculous tendency has been ameliorated, and is therefore readily
removed. He thinks, too, that cod liver oil will be more certainly
useful in those cases in which patients are evidently disposed to
consumption, and have inherited a strong tendency to it, although
it is not yet developed. Under these circumstances, “ where the
patient is already thin or slightly emaciated, he directs it to be
taken as an article of food rather than as a medicine.” In these
conclusions we entirely agree, as we have elsewhere in this num-
ber, it not yet having fallen to our lot to meet with more than
improvement in the general health, in any case of decided phthisis
in which we have used it. The following are the results obtained
in the Pennsylvania Hospital during a trial of six months; the
statement was prepared by Dr. Levick, one of the resident phy-
sicians ;
“ 1st. Of the Oil.—That the light colored oil can be taken with-
out difficulty by patients whose stomachs have steadily rejected
the brown oil.
2d. Of the mode of administration.—That a few of the patients
have taken the oil without any adjunct to disguise its taste. That
its nauseating properties are corrected by its administration with
milk; but that its taste is most effectually disguised by the froth
of porter.
3d. Of the time of its administration.—That as a general rule
it has been taken before meals, but that in four instances where it
was not tolerated before meals it was readily taken after meals.
4th. Of diarrhoea as a contraindication to its use.—That the ex-
istence of diarrhoea is not a positive contraindication to its use.
In three instances in which patients were thus affected, no increase
of the symptoms was produced by its use, and no diminution by
its abandonment. In a fourth instance, when the diarrhoea had
previously existed, the discharge appeared to be increased by the
exhibition of the oil, and abated with its withdrawal.
5th. Of its effects in cases of phthisis pulmonalis.—That patients
using the oil have increased in flesh, in weight, and strength. That
while using the oil, their cough and expectoration have diminish-
ed ; that with some, hectic and rigors have entirely disappeared.
That six of them have been so much benefitted as to leave the
hospital and resume their former occupations. That in one in-
stance, a patient who entered the hospital with cough, copious
purulent expectoration, extreme emaciation, inability to leave his
bed, and with the physical signs of a cavity under the left clavicle,
after six months use of the oil left the hospital weighing 140 lbs.,
with little or no cough, no hectic or rigors, and with an almost
entire absence of expectoration: the physical signs having greatly
diminished.
6th. Of the physical signs.—That the improvement of the phy-
sical signs is not coincident with that of the general symptoms.
7th. Of its use in general scrofula.—That in scrofulous diseases,
where there was no reason to expect the existence of pulmonary
tubercles, the improvement of the patient’s health has been very
decided.
8th. Of congestion of lungs as produced by cod liver oil.—That
there has been no decided evidence of such a result following the
use of the oil in the preceding cases. [Two patients of the twenty
while using the oil had severe attacks of haemoptysis, but there
was no reason to refer them to the use of the remedy.]
9th. That in those cases which have terminated fatally, the ap-
petite, the nutrition, and strength of the patient appeared for a time
to be decidedly increased; that the life of the patient appeared to
be in this manner temporarily protracted; but that for a few weeks
immediately preceding death the remedy seemed to have entirely
lost its value.	'	-.	>	$
10th. Length of time, <^c.—That to be of any decided perma-
nent benefit its use must be steadily persisted in. It should be
continued even after the most striking symptoms of the disease
have in a great measure disappeared.”
A short supplement on Spirometry concludes the work, a mode
of exploration discovered by Dr. Hutchinson, and of which a brief
notice wasgiven in a review of Kirkes & Paget?s Handbook of Phy-
siology in this Journal, and which seems destined to throw light
on the subject of physical diagnosis, eveti in cases where auscul-
tation and percussion fail, as was seen in the case of Freeman,
reported by Dr. Hutchinson, in which the Spirometer revealed
disease not discoverable by the ordinary means of exploration.
The profession owes a debt of gratitude to Dr. Gerhard for the
excellent work with which he has presented them, a feeling which
we hope will be substantially manifested in the rapid sale of the
present edition.