(A.) - Extract from the Author's Work on "Loss of Weight, Blood-Spitting, and Lung-Disease," Etc., 2nd Ed.

Oil, even when it agrees and passes into the blood, does not completely represent the solid fats of the natural food, and therefore cannot permanently take their place. As a temporary substitute for natural fats introduced by the natural route, it answers admirably; but, sooner or later, in some cases very soon indeed, the portal system becomes choked and refuses to absorb more oil, the oil disagrees with the stomach, it rises, it spoils the appetite, and thus not only ceases to do good, but does positive harm by preventing the patient from taking as much food as the stomach might otherwise call for and digest.

None of these disadvantages occurs with well made pancreatic emulsions of solid fat. The consequence is that an artificial supply of natural fat by the natural route can be kept up for an indefinite time, if required, while the appetite is usually improved and the digestion also; and, at the same time, a very large quantity of amylaceous food is rapidly converted into dextrine and sugar by the pancreatic action of the emulsion, and thus a most important assistance in the economy of fat is given, by the increased supply of carbon from the carbo-hydrates, at the same time that fat is being thrown into the blood by the emulsion.

From the date of its first introduction in 1863, up to 1872, at the Royal Hospital alone, I had prescribed the emulsion in more than 6,000 cases, and since that time I have prescribed it in all suitable cases of consumption or of wasting from defective assimilation of fat that have come under my care, both at the Royal Chest Hospital and in private practice, and I have had numerous opportunities of witnessing its effects, when prescribed by my colleagues at the Hospital, and by other medical men, who have communicated to me their opinions on the subject or sought my assistance in consultation.

The general results of my thus extended experience have been confirmatory of the statement of my opinion, extracted at page 225 from the report which I published in 1867.

Happily to my own experience may now be added that of thousands of my professional brethren in different parts of the world, by whom pancreatic emulsion and pancreatine are daily prescribed, and from whom I constantly receive testimony of its value.

I am informed on the best authority, that as much as sixty thousand pounds weight of the emulsion (made in London) have been consumed within a single year.

While there are certainly a few persons who cannot possibly take or assimilate the emulsion, although able to take cod liver oil, they are but very few indeed, now that the emulsion has been made so perfect a preparation; whereas the number of persons who can take and assimilate emulsion, but not cod liver oil, is very large. In either case - the rejection of cod oil or the rejection of emulsion - it is necessary not to be too easily persuaded by our patients to desist from prescribing the remedy.

I frequently find that patients, who assert that they cannot possibly, and never could, keep down the oil, will manage to do so when informed that it is the only thing that will stay the progress of their disease, and when assisted by being instructed in the variety of ways in which the oil may be disguised, and its assimilation facilitated. I may here point out that the addition of a dose of pancreatine to each dose of oil will, in a large number of cases, at once get oyer the difficulty in keeping it down - when that difficulty is that it eructates for some time after it is taken and is then rejected, not that it comes up directly. Many persons who have long taken quantities of oil without difficulty, but with scarcely any good effect, will gain flesh, and obtain all the advantages which assimilated cod liver oil can give, if they add the pancreatine to their dose.

With the emulsion - patients, who after a first trial say they cannot take it, will nearly always find out that they can, when it is explained to them that there is nothing but pancreatic emulsion and cod liver oil which can really stay the progress of their wasting; and when they are assisted by being shown the best way of taking the remedy and by having any faults in their primary digestive functions set right. The usual defect in primary digestion with such patients, is the combination of an excess of acidity with a feeble stomach, and this should be corrected by an effervescing draught of potass and soda, with citric acid, quinine and strychnia; or where there is much flatulent distension as well as epigastric pain soon after food, by a stomachic powder of bicarbonate of soda, bicarbonate of potass, powdered ginger, and powdered calumba, in half a tumbler of water, a quarter of an hour before the meal.

At the same time it is frequently necessary to unload the bowels, and to relieve the portal system, which has often been long over-loaded with cod liver oil olein, absorbed by the veins. It is to be remembered that, whereas olein is, in some measure at least, taken up by venous absorption, the solid fats have to pass by the lacteal route; and thus, when substituted for oil, in the form of pancreatic emulsion, they relieve the tax upon the choked-up venous system.

Then, the period after a meal at which the emulsion is taken may be varied, to meet the differences in the rapidity with which different stomachs dispose of their contents. Many who cannot keep the emulsion comfortably down when taken two hours after food, can do so if they take it from half an hour to an hour after. This particularly applies to young children. They generally manage it best within half an hour of a meal; and when their diet consists of farinaceous foods and milk, it is best to mix it with a portion of the food.

With regard to menstruum: - milk is certainly the nicest and best, where milk agrees with the stomach and taste; but many persons have an old-standing aversion to milk, or have long ceased to be able to digest it comfortably. In such cases it is absurd to insist on the emulsion being taken in milk. The best substitute for milk, and indeed one of the best menstrua for pancreatic emulsion, is thin water-arrowroot, or barley-water. The emulsion mixes well with it, and by converting the starch into glucose, gives it a pleasant, nutty sweetness. Some patients declare that coffee is the best of all things to take it in. Many persons, however, prefer the emulsion mixed in water to about the consistence of new milk, and then flavoured with wine, especially Tokay, ginger wine, or orange wine. In whatever menstruum it is mixed, it should not be made much thicker than new milk, and I advise a sufficient quantity of wine, brandy, rum, orange-brandy, ginger-brandy, or clove-brandy, to be added, to give it a decidedly cordial character both to the palate and to the stomach.

One of the most important points in getting the emulsion well taken, is to have it smoothly mixed in the menstruum; this is easily done by putting the emulsion first into a cup, or glass, and then adding the menstruum little by little, and beating them together with a spoon; till the whole is made of about the consistence of oil, or of good cream; after which any quantity of fluid may be mixed by simple stirring; but if the emulsion is put in a lump into the menstruum, it may be difficult afterwards to get it smoothly mixed, especially in cold weather. The mixing may be facilitated by having the cup or glass made warm, or the chill taken off the menstruum, but it is not well to make it decidedly hot.

Some patients have asked to be allowed to take the emulsion 'as it is' with some brown sugar over it, and declare that they like it in that form. This is better than not taking it at all, but I prefer its being mixed into a more fluid state. A good many mothers have told me that their children take it spread on bread, instead of butter, and sugared. This is not a bad way of giving it, because in masticating it with the bread it gets well mixed with the food and saliva; I may mention also, that treacle posset, after it has cooled, is a very good menstruum, and pleases children when they are fond of sweets.

One more detail is worth alluding to, viz., to order a biscuit or a piece of bread to be eaten after the dose, so as completely to clear the palate of its taste and influence.

It is of the utmost importance to impress upon patients that cod liver oil and pancreatic emulsion are not to be regarded as medicines, but as articles of diet - Medicinal foods - without which they, in their state of health, will as surely starve as persons in health would do if deprived of the most nutritive part of their food. They should be ordered to be weighed whenever they leave off either the oil or the emulsion, and to weigh every week, to see if they lose or gain. So long as they do not lose any weight they may desist from their dose, but must at once return to it if there is the slightest diminution in weight. I always order patients, on leaving off either oil or emulsion, to make an equivalent increase in the quantity of fat they eat, and to see whether by this means their weight can now be maintained, and thus to learn whether the power of digesting and assimilating a sufficiency of fat without artificial assistance has been restored.