D MJL [j{)! R^E PORT BY HORACE DOHELL, M.TX, I'IIYSTOIaV ro TIIK KOTAI. HOSPITAL POK disfvasfs op' TUB CHEfT •) » "i " "• C9 / v'^/'l/Cv Tile following Editorial note appeared in the "f^rr??rc/, Nov. 17, 1866:— "THE DIETETIC VALUE OF PANCREATED FATS. '" It would be interesting to know to what extent the experience of those medical men who have used the ' pancreatic emulsion' of fat, accords with that which Dr. Dobell has now recorded in our col- umns in about two hundred cases of consumption. Several thousand pounds weight of this new medical agent have, we believe, been sup- plied by the makers to the order of medical men in this and other countries ; and we think, therefore, that the time has arrived when some perfectly impartial evidence should be added to that of the ingenious author of this treatment. The remedy has been placed fairly before the profession, the author reserving to himself no pecuni- ar}' interest or advantage whatever; and if the utility of the remedy bears any proportion to the large demand which has arisen for it, we ought to know this clearly, and to understand and appreciate our obligations." With the sense and justice of this suggestion I entirely agreed, and in order to assist in carrying it out, I obtained from Messrs. Savory and, Moore the names of some of the principal places from which they had received orders for Pancreatic Emulsion, and then posted to the leading medical men in those places the following letter and Schedule of questions. I had no other means than this of ascertaining who had used the Emulsion. But it is evident that in this way I must have sent to many who have not used it, and must have failed to reach a large number of those who had obtained it through other wholesale chemists than Savorv and Moore, through provincial chemists, and other indirect channels. [See Vast page.] } REPORT TABULATED SIGNATURE. ADDRESS. Henry Gibbons, M.R.C.S. 28, Stafford Street. Wol- verhampton. John Fox, M.D., Ardgowan Sq., Greenock. J. Swift Walker. M.D., Hanley, Staffordshire. Henry S. Purdon, M.D.. College Square, Belfast. 1—In how many cases of Consumption have yon prescribed thePancret- tic Emulsion prepared by Savurv and Moore ? Two cases. About twenty-four. About thirty. 2—In what dose, at what interval after food, and for how long a time did yon administer it in each case ? One teaspoonful onehnur after food for two months. One teaspoonful one hour after each meal. Not continued long, owing to the expense. A teaspoonful three times a day, about ten hours after food. In teaspoonful doses. after food, administered in milk. 3—What is your opinion of i;s effects upon :—1. Digestion ? 2. Nutri- tion ? 3. Weight of the patient ? 1. No effects. 2 Good. 3. Increase. 1. Nearly all the patients stated thai it improved digestion. 2 & 3 cannot answer. 1. Increases appetite and promotes digestion. 2. Increases. 3 Increases. 1. Promotes digestion. 2. Patient appears to grow in weight" and in flesh. 3. Duto. R. Gutteridge, M.D. London Road, Leicester. C. Glenn Bott, M.f)., 2. Eyre Street, Sheffield. H. S. Leverton, M.R.C.S.,&c. Truro, Corn- wall. John Skaife, M.R.C.S., &c, Northampton Square, London. One case. A case of general atrophy. Case of disease of stomach, &c, &c. Six cases noted, several others not noted. Not stated. Half a teaspoonful in milk three times a day, half to three-quarters of an hour after food. According to the printed directions. One teaspoonful twice a day, one hour after food, rora two weeks to three months. The patient rapidly gained both flesh and strength. The result would be to encourage my continu- ing to use it. It decidedly assists di- gestion and nourishes the body. Digestion and nutrition are improved. Weight is increased. FROM SCHEDULES. 4—Have you found that patients can take the Emulsion when they cannot take Cod-liver Oil? Yes, far better. Yes, occasionally. Yes. Yes. After the second bottle she took such a dislike to the flavor that she would not resume it. In eight cases out of nine it agreed. Most decidedly in two or three well marked ruses. 5—What is your opinion of the effects of the Emulsion in :—1. The true first stage of Con- sumption Pre-tubercu- lar? 2. The stage of Tuberculization ? 3. The stage of Softening ? 4. The stage of excava- tion? I GENERAL REMARKS. 1. Very good. 2. Very good. 3. Very good. 4. No effects. 1. Certainly useful. 2, 3, 4. All the patients stated that they were benefitted by its use. 1. Very good ; much superior to Cod-liver oil. 2. Ditto, ditto. 3. No effect. 4. No effect. 1. In one case a boy aged 12, attacked by first Btage of phthisis, the effects of the remedy were amazing ; and at the present time no symptoms of consump- tion remain. 3. One case, a man, age 40 stage of softening, derived much benefit from the Emulsion and has gained in strength and flesh. One case only a few months under treatment. Second stage, rapid in- crease in flesh and strength. Not answered. I intend to try the Emul- sion thoroughly in cases of phthisis The general plight of the body is improved in every stage. Very far superior to Cod-liver Oil The only objection to its general use being the price. Wherever price is alluded to in this report, the price in England is ment. The American preparation is only one half the English in London. Have not had time to warrant me in giving a decided opinion on its merits. I must say, however, that I am favorable to it, and would willingly continue its use if permitted by the Directors of this Infirmary. In cases of old standing bronchitis and also in debility, after a severs attack, is superior to any ether remedy. The first case was in Be!last Charitable Society Infirm- ary. The reason I have not tried the Emulsion more frequeutly is, that its expense is rather too much especially in hospital and dispensary practice. I have used the Emulsion in one case, second stage, with considerable success It strikes me, if the flavor could be varied, or if it could be sent out without flavor, it would be a very great improvement. I am sorry I have not sufficient data to reply to all your questions. I was only able to use th« Emulsion for a short time, in a few cases, about twelvemonths ago, while House Surgeon to the Leeds Dispensary. In cases of debility wasting, &c, from any cause, this is a most valuable remedy. The Emulsion invariably agrees, unless there is some special stomach derangement. REPORT TABULATED SIGNATURE. ADDRESS. J. P. Cassells, M D., 419, St. Vincent Street, Glasgow. C. B Garrett, M.D., Hastings. John Firth, M.R.C.S. Macclesfield. A. Mercer Adams, M.D.. Edin., Boston, Lincoln- shire. A. C. Clifton. M.RCS., Abingdon Street, North- ampton. G. T. W. ATugliston, M. D Maryland Point, K. 1—In how many oases of Consumption have you prescribed the Pancrea- tic Emulsion prepared by Savort and Mooeb 1 2—In what dose, at what interval after food, and for how long a time did you administer it in each case ? In a very large number Dr. Cassell writes again, July 23, 1867: '• Since my last re- port I have had a run of cases suitable for the use of the Emul- sion, and in wh ch I have prescribed it very largely, with much benefit, so in- creasing the favora- ble opinion I have already expressed.'1 About fourteen. Seven cases. Thirty-two. Five cases. From 1 drachm to \ oz. about one hour after food. In some cases it was used for abo ut twelve days, in many for some months and in one (1st stage) for about eight months using i oz doses with the most marked benefit., Indeed, I am inclined to re- gard it as having effected a cure. A dessert spoonful three times a day. almost directly after meals. One teaspoonful two hours after food, in two cases for three months, in four cases for one month. One hour after food, twice a day. A teaspoonful half hour after food, in four- teen cases for one month, in lour for fourteen days, in four for ten weeks, in eight for two months. One teaspoonful one hour after meals, three times a nay in water, milk, or bran- dy and water 3—What is your opinion of its effects upon :—1. Digestion ? 2. Nutri- tion ? 3. Weight of the patient ? Improvement in most cases 2 & 3. In those cases in which I have pre- scribed it for a long time it has improved the nutrition and in- creased the weight of the patient. 1 Agrees well. 2 & 3. Adds to weight and strength. 1. Did not disagree. Appetite improved. 3. Improved 3 Apparently increased in all. Not weighed. I found it most service abie. The patieut could not take oil. Was in last stage of consumption. Ral- lied for a time by using it. Digestion improved and w eight increased. In a few eases itap peared te improve di- gestion. In other cases it was nil. In all but three cases the patients improve 1 in nutrition and weight. 1. Assist* digestion. 2. Improves nutrition. 3. In one case the pa- tient gained 3>£ lbs. in Six weeks. FROM SCHEDULES. 4—Have you found that patients can lake the Kraulsinn when they cannot tane Cod-liver Oil? Yes, in every case. Yes, generally, though 'omo preferred Cod- liver Oil. Yes. 5—What is your opinion of the effects of the Emulsion in :—I. The true first stige of Con- sumption Pre-tubercu- lar? 2. The stage of Tuberculiiawon ? 3. The Btage of Softening? 4. The stage of excava- tion? I, 2. When it can be borne by the stomach benefit has in mom case, followed,using large doses. 3, 4. A decided opinion cannot be given, for the reason that in these stages I have not been able to pre- vail upon patients dr their Iriends to con- tinue it* u-e for-a lenirth of time mffl- cient to t >t its prop- erties. 8. 3. Good in both. 1. In two ca*es the pa- tients are now quite well. 2. Two still tinder treat- ment. In the last stages. Three dead. I have only experience of its use in the sof- tening stage. But I should think it very useful in the earlier periods and shall not fail to make a trial of it. 1 Decidedly.beneficial. 2. do. " do. 3. Nil, except in three cases, which were benefitted. 4. NU. 1. Not had the oppor- tunity of trying it. 2,3, 4. It improves the strength and renders the expectoration more healthy and less copious, GENERAL REMARKS. I have found it equally beneficial iu cases of wasting in poor children. And in one case of malignant disease of the pancreas—female, aged forty-five— where large masses of fatty-looking matter passed in the stools and there was great wasting of the body, the patient improved much in general con- dition under the use of the Emulsion, and the fatty matter ceased to pass in the stools in a rapid manner. I think it a splendid invention I consider Emulsion a valuable addition to the nu. tritive agents required in the treatment of phth- isis, and it is specially useful in cases where Cod liver Oil cannot be ta ken. No remarks. The Pancreatic Emulsion seema to give general satisfaction and benefit, which is a £rreat consider- ation, iiecause there are many persons who cannot take Cod-liver Oil. I have recommended its use in three cases in second stage (softening.) (1.) Mrs ---, thirty five, had two children ill two years. After taking Emulsion six weeks, gained 3^ibs. cough and other Kymptoms much improved. (2.) Mis*---, twenty-eight, ill one year and a half has taken Emulsion two months, with diminution of coughs and expectoration. (3.) Miss---, stiMinous abscesses, and softening of both lungs; loss of strength, appetite, and weight Has taken Emulsion eight weeks, with decided advantage over Cod-liver Oil. All symp- toms better. Intends to continue Emulsion. 4h case. Mrs.---, twenty-seven ; five children ; could not take Cod-liver Oil,; it deranged diges- tion. Has taken Emulsion one month, with great benefit; increase of weight and bulk. Cough much better and feels stronger. 5th case. Mr. W---, the most marked of all (stage of excavation,) after a long course of Emulsion, he now attends regularly to his duties, as foreman in the fitting-shop of the Great Eastern Railway. REPORT TABULATED SIGNATURE. ADDRESS. Charles F. Lewis, L.R.CP., Edin. (Exam), Henfield, Sassex. A. E. Sansom, M.D., Lond., 29 Duncan Terrace, Loudon. Julius Althaus, M.D., 18, Bryanstone Street, Portman Square. Henry Colley Marsh, M.B. Lond. &c, Rochdale, W. Alexander, M.D., M.R.C.P., Senior Phy- sician, Halifax Infirmary, Halifax. 1—In how many cases of Consumption have you prescribed the Pancrea- tic Emulsion prepared by Savoki and Mooee ? At present only two. I have notes of only five cases in private prac- tice. When Physician to the Royal Infirmary, I pre- scribed it in about twenty cases of tuber- cular phthisis, where Cod-liver Oil did not agree. Very numerous. Probably a dozen. 2—In what dose, at what interval after food, and for how long a time did you administer it in each case ? One teaspoonful two hours afie.' breakfast and dinner ; three months one case twelve months the other, and Btill taking it. To adult3, two teaspoon- fuls in milk soon after meals. From 2 drachms to ^ oz. twice a day. Sometimes a teaspoonful after food four times a day, sometimes a tablespoonful half hour after breakfast and after dinner, during many months when bourne. A tablespoonful, with usually Almond Emul- sion, tc adults, a des- sert spoonful for chil- dren, in the intervals of food-taking. 3—What is your opinion of its effects upon :—1. Digestion ? 2. Nutri- tion ? 3. Weight of the patient ? In both cases appetite very much improved. In one case nutrition and weight increased ; the other remains much in the same way. 1. Tendency to improve digestion, certainly not to impair it. 2. In some cases marked improvement. 3. Not noted. 1. Much improved. 2. Much improved. 3. No data. 1. Often improves it— sometimes produces biliousness. 2. When digestion is im- proved, nutrition is improved. 3. When nutrition is im- proved, the weight in- creases. 1. The stomach has usually tolerated it well 3. It seemed to arrest emaciation. FROM SCHEDULES. 4—Have you found that patients can take the Emulsion when the.v cannot take Cod-liver 0.1? Yes, in one case the patient was unable to take Cod-liver Oil, in the other both Emul- sion and Oil ; and when the supply of Emulsion was exhausted, missed it very much. Yes this is the general rule Yes, it agreed with all but one. Yes, and vice versa. According to their own statements, yes; and when the stomach is deranged. 5—What is your opinion of the effects of the Emulsion in:—1. The true first stige of Con- sumption Pre-tubercu- lar? 2. The stage of Tuberculization ? 3. The stige of Softening ? 4. The stage of excava- tion ? 1. Have not tried it. 2. Ditto. 3. Marked benefit in one case. In both cases all moist sounds quite dis- appeared. 2. In one case of consoli- dation of left upper lobe, after the use of F.mulsion one month, there was marked im- provement, and dul- ness could not be de- tected. 3, 4. In ' a case of rapid formation of tubercle, Emulsion seemed inert. When the sounds are very moist at com- mencement of observa- tion. Emulsion, seemed to cause only slight improvemt nt. Not having kept notes of the case, cannot give exact information ; hut it seemed to act best in what you call the 2nd and 4th stages. 1. Most excellent. 2. Very excellent. 3. Doubtful. 4. Very doubtful 1. Not employed in this stage. 2. No marked effects. 3. Allays the gastric ir- ritability. 4. Aids nutrition, and thus prolongs life. GENERAL REMARKS. I have no hesitation in saying that in the two cases in which I have given the Emulsion, it has quite ex- ceeded my expectations. In one patient when she commenced the Emulsion, the left lung was in the stage of excavation, and the right in the stage of softening, which has been arrested, and the moist sounds in the left lung cleared away. I am now giv- ing it in a third case, but has only been taking it five days, so cannot report upon it at present. When the sounds were tolerably dry. the formation of tubercles slow, the Emulsion seemed to exert a marked protective influence. I have now uuder my care two cases of the stage of excavation. In one case, twelve months, in the other, five months have passed without the slightest increase of the signs, as evidenced by physical examination. In both the sounds remain re- markably dry. I have prescribed Emulsion in a number of cases of ner- vous disorders, especially hystera associated with anaemia, and paralytic affections connected with mal- nutrition. In all of these cases Emulsion was well borne, and appeared to be of considerable benefit in improving assimilation and general condition of the patient. I have often found that Cod-liver Oil in capsules is bet. ter borne than in any other form. I give one capsule immediately after each meal for a week, then two for a fortnight ; then stop a week, and begin with two, and go on to three. Those patients who have failed to take the Emulsion have taken these very well. [LETTER.] "84 Harley Street, March, 1867. "Dear Sir :—Allow me to direct your attention to the accom- panying Editorial note which appeared in the Lancet, Nov. 17, 1866. "It is clearly impracticable for any medical journal to publish separate reports of all the cases in which the Pancreatic Emulsion has now been used by different medical men. "I have, therefore, drawn up the enclosed questions to facilitate the collection of impartial evidence, as suggested by the Lancet, in a form in which it can be systematically arranged for publication within a limited space. "If you will kindly fill up the enclosed schedule at your leisure and send it within one month from this date to the Royal Hospital for Diseases of the Chest, addressed to the Hon Secretary, I will see that the results are fairly tabulated and published as soon as a suffi- cient number of reports has been received. "I am, dear Sir, yours faithfully, " Horace Dobell. " On a careful examination it will be found that the experience of the effects of the Pancreatic Emulsions of Fat, as expressed in this report by a number of perfectly independent observers, corresponds in a remarkable degree with the results of my qwn investigations and experiments already published.* It will also be observed—and it is an important fact—that the greatest confidence in the remedy is ex- pressed by those who have given it in the largest number of cases. 1Q«**S£evZfttff*'Sei^ 10th-1864; June 10th. 1865; Nov. 11th and 18th, 1863 ; British Medical Journal, Jan. 20th, nnd Feb 20th 1866. " On Tuber- culosis; its Nature, Cause, and Treatment," Churchill, 1866. "On the true JMrst btage of Consumption," Churchill, 1867. C^The foregoing pages constitute about one half of Dr. Dobell's original report. ClIARi.ES .KXIIEHIDGE, PRINTER, Franklin-Pt., near Kent. Greenpoint, X. Y.