A standard official preparation, containing 50 per cent. of cod-liver oil. It may be flavored to suit the taste, with oil of gaultheria, oil of bitter almond, etc. Dose. - Average dose: 2 fluidrams (8 Cc), U. S. P.

Emulsum Olei Morrhuae cum Hypophosphitibus -Emulsi Olei Morrhuae cum HypophosphitibusEmulsion of Cod-liver Oil with Hypo-phosphites. U. S. P.

Similar to oleum morrhuae, but containing the hypophosphites of calcium, potassium, and sodium.

Dose. - Average dose: 2 fluidrams (S Cc), U. S. P.

Physiological Action. - Externally and Locally. - It possesses emollient properties, and may be applied to the skin and mucous membranes without causing irritation. It slightly reduces temperature in fever when applied to the body.

Internally. - Fat is a normal and necessary constituent of the body. It is the fuel used to supply energy, and those tissues and organs which are the most active require the most fat. Consequently, nerves, muscles, and glands are more abundantly furnished with fat than cartilage, and in cases of starvation those structures demanding the greater supply must have it, at the expense of the less highly organized and active tissues - as is seen in the great emaciation preceding the decline of mental powers. The blood contains about one-half of 1 per cent. of fat; the muscles, 3 per cent; the brain, 8 per cent.; and the nerves 22 per cent. In order, therefore, that the various cells of the body may possess sufficient vitality to withstand by physiological resistance the encroachments of disease and the invasion of pathogenic microorganisms, this equilibrium must be maintained. Yet this necessary food, fat, is more frequently deficient than any other, from the difficulty either of obtaining a supply or of digesting and assimilating it.

Before oils or fats can enter the various cells and act as food, and consequently be a source of power, they must be digested and assimilated by the body. The value of an oil is based upon: (1) Its rate of absorption; (2) its rate of oxidation; (3) its agreeable taste.

Cod-liver oil, while to many persons repugnant in taste, is more readily absorbed and oxidized than any other fat. It has already been prepared by the liver, and therefore partly elaborated, and, owing to the biliary salts which it contains, it passes more readily through animal membranes. Moreover, Naumann has shown that cod-liver oil is more easily oxidized than any other oil, rendering this substance almost an ideal ready-made food. Its actions upon the several systems are here considered.

Digestive System. - Large doses disturb the stomach and may even occasion vomiting, but in medicinal doses alone, or in the form of an emulsion, it may be taken usually without discomfort, in some cases even increasing the appetite. In the stomach cod-liver oil is unaffected, but in the intestines it meets the pancreatic juice, which resolves a portion of it into glycerin and fatty acids, the latter combining with the alkalies of the bile and the intestinal juice to form soaps, while the remaining, and larger, portion is emulsionized by the alkaline secretions of the intestines.

Circulatory System. - The number of red corpuscles is increased, and the quality of the blood is greatly improved.

Nervous System. - This shares, with the other tissues of the body, the general amelioration, the drug being a food and tonic to the brain and nerves.

Respiratory System. - No special action is noticeable other than the natural improvement in the respiratory power incidental to better blood and an increased functional activity of the nerves and muscles.

Absorption and Elimination. - Cod-liver oil can be absorbed only after it enters the intestines. The glycerin and fatty acids formed by the pancreatic and the intestinal juices, together with the soaps produced by the action of the bile, are readily absorbed by the mucous membrane.

The oil remaining, as has been stated, is emulsionized - that is, it is subdivided into minute globules, each enclosed in an envelope composed of alkaline albuminate and soap, which has a great affinity for the mucous membrane and carries the oil through the columnar epithelium of the intestinal villi into the lymph-spaces. The osmosis inward of the oil-emulsion is rendered still easier by the action of the bile with which the mucous membrane is bathed.

It will be seen that much of the oil taken into the system is oxidized, being subsequently excreted as carbonic acid and water.

Temperature. - When taken internally the temperature is unaffected, but, as has been observed, when applied to the epidermis the bodily heat is reduced.

Untoward Action. - In addition to disturbances of digestion sometimes occasioned by moderate doses, cod-liver oil at times produces a vesicular eczema which may spread over the entire body. This eruption is probably caused by the volatile fatty acids which the oil contains. At times it may cause a diarrhea.

Poisoning. - Cod-liver oil possesses no poisonous action.

Therapeutics. - Externally and Locally. - Cod-liver oil is much used by dermatologists in diseases of the skin, being especially serviceable in softening the crusts of eczema. It has been applied to the skin to allay irritation and for the reduction of temperature in the exanthemata.

Daily inunctions are beneficial in chronic scaly skin diseases, while a local application to the chest has seemed at times to influence favorably the course of pertussis.

Internally. - For two or three centuries cod-liver oil has been used both externally and internally for chronic rheumatism, but it is only since 1841 that it has been employed in the treatment of tuberculosis. While to-day it does not receive the enthusiastic support which attended its introduction in the latter disease, it is nevertheless a standard and highly efficacious remedy in the various forms of the disorder. It is equally valuable in scrofulous affections, and even more potent in rachitis. Chronic bronchitis is perhaps more frequently relieved by its use than by any other internal remedy. Diseases resulting in anemia are usually more benefited by cod-liver oil than by other remedial agents. Chronic arthritis, fistula and abscess in the neighborhood of the joints, have been greatly improved by its use. Atheroma of the arteries and many cutaneous diseases, particularly the strumous variety, and syphilo-dermata yield to its alterative and nutrient properties.

Probably no single drug is employed in nervous diseases with effects so markedly beneficial as those of cod-liver oil. While possessing no specific action, it increases the strength and vitality of the patient, enabling him to resist morbid tendencies more successfully, and, by improving the condition of the nerves, lessens the liability to nervous derangement.

Diabetes mellitus and Brights disease, with anemia yet unattended by marked digestive disturbance, are decidedly improved by the administration of cod-liver oil.

Should no gastric disorder supervene, this remedy should invariably be given in the last-named diseases. It certainly serves to maintain the general health, and is singularly efficacious in prolonging the lives of the afflicted patients, enabling them to profit by hygienic measures, upon which great reliance should be placed. The tonic and nutritive properties of the drug have been strikingly shown in the rapid improvement of patients convalescing from acute diseases. In catarrhal conditions, especially in ozena and otitis following measles and scarlet fever, it is of marked benefit.

Without entering upon specific considerations other than the above, it will be seen that cod-liver oil is indicated whenever there is defective activity, whether inherited or acquired.

Contraindications. - It is to be remembered that cod-liver oil is a food and not a medicine: it is therefore contraindicated in all diseases where it proves detrimental to the appetite, causing eructation, heartburn, diarrhea, etc. It is usually contraindicated in fevers, owing to the suspension of the secretions and impairment of digestion characteristic of acute febrile disorders.

Administration. - In the early use of cod-liver oil it is advisable to prescribe small doses, that its toleration by the stomach may be gradually acquired. To many patients, however, it is extremely distasteful, and the repugnance is increased rather than lessened by continued use. In such cases it is better, if possible, to disguise the taste and smell in some manner rather than to abandon so valuable a remedy when clearly indicated. Various means have been employed for this purpose. An emulsion may be made which obviates its disagreeable qualities. There are in the market soft capsules containing this oil that serve an excellent purpose, being easily swallowed and disguising completely the taste and odor of the drug. Administration should occur ordinarily some time after meals, that the oil may reach the intestines as soon as possible.