Methods Of Administration

Many patients can take perfectly pure, well-clarified cod-liver oil better than the emulsions and preparations in which it is offered in the market, while others prefer it in the form of the so-called emulsions with hypophosphites of lime, soda, or iron, or with other substances. Some of these emulsions are rendered almost tasteless, while others are flavoured with winter-green, ginger, or some other aromatic.

Emulsions are seldom as good as the pure oil, and are only to be preferred when the latter is not digested or when the taste proves too nauseous. They usually do not contain above 50 per cent of the oil, and often only 33 per cent; hence the dose is unnecessarily bulky. Moreover, they rapidly deteriorate with age, so that if emulsions are to be used they should be freshly made with yolk of egg and glycerin or mucilage of tragacanth.

Dr. James Stewart, of Montreal, gives excellent formulae for this purpose as follows:

Cod-liver oil.......................................... 6 ounces.

Oil of wintergreen.................................... 1 drachm.

Chloroform........................................... 3 drachms.

Glycerin, yolk of egg, each............................. 5 "

Orange-flower water, sufficient to make.................. 12 ounces.

M. Dose, one tablespoonful.

This is not too thick.

Cod-liver oil.......................................... 6 ounces.

Oil of wintergreen (or any essential oil).................. I drachm.

Mucilage of tragacanth................................. 2 ounces.

Orange water, sufficient to make......................... 12 "

M. Dose, one tablespoonful.

This emulsion is somewhat thicker than the preceding one.

Oil of bitter almonds may be used in the proportion of three drops to the ounce, instead of the wintergreen oil.

Lefaki recommends an emulsion made with an equal part of lime water flavoured with lemon sirup or vanilla. This can be prescribed when diarrhoea exists. Another method is to add two ounces of finely chopped and strained fresh pancreas to the gallon of oil to produce an emulsion.

Stewart suggests rinsing the mouth before taking the oil with undiluted brandy or whisky and two or three drops of oil of peppermint. Children may be given a peppermint lozenge. If preferred, the dose of pure oil may be poured upon the surface of some fluid, such as orange or ginger bitters, strong black coffee, lemon juice, weak brandy and water, or even ale or beer. Pains should be taken to float the oil in the centre of the surface of the fluid, so that it is to some extent coated by it and does not come in contact with the glass or cup and produce a lingering, disagreeable taste in the mouth. Ringer suggests adding a few drops of catsup to disguise the taste, or the use of a mixture of equal parts of the oil and fresh aqueous solution of gum acacia with two minims of oil of lemons added to each ounce. A little salt taken in the mouth before and after each dose may neutralise the taste. He also refers to the use of a cod-liver-oil jelly containing 70 per cent of the oil. This disguises the flavour.

The oil is sometimes given with different preparations of meat juice.

In this country cod-liver oil is extensively used in the form of capsules of gelatin which are shaped like an olive, and which some patients can swallow with ease, although they are rather bulky and not always reliable. A child of ten years came under my observation who for some time previously had been given four or five of these capsules daily, each containing a teaspoonful of cod-liver oil. She had developed an exceedingly irritative stomach cough, for which a variety of sedatives had been administered without any effect. To my astonishment, she at one time vomited seventeen of the undissolved capsules, which represented four or five days' dosage.

The oil is sometimes administered in the form of "oleochyle," in which it is claimed it has been predigested and rendered easier of absorption.

Claude Bernard, to whom we are indebted for much valuable research upon the physiology of digestion, first showed that ether given by the mouth acts as a stimulant to the secretion of the pancreas and the glands of Brunner which aid the digestion of fat, and that it increases the absorption of fats. Acting upon this suggestion, Dr. Balthazer Foster found that pure ether added to fats and oils in the proportion of five or six minims to a drachm of the oil would often insure its digestion, whereas previously it had excited nausea and vomiting, and this method has proved of service in the hands of others. The ether itself disguises somewhat the taste of the oil, but I have sometimes found it to produce disagreeable eructations. In fact, in some hospitals a "malingerer's mixture" has been employed composed of a disagreeable combination of ether, oil, and asafcetida, which has the result of causing eructations and maintaining an exceedingly disagreeable taste in the mouth. Lime water is sometimes added to cod-liver oil to produce a temporary emulsion, and it may prevent nausea.

Cod-liver oil is advantageously combined with malt, and when not so sweet as to be disliked by the patient it proves a very serviceable food. Cod-liver oil is added in the proportion of 30 per cent to maltine, or 50 per cent to malt extract.

In very hot weather it is usually best to suspend the administration of oil, as it is liable to disagree, even if it does not become rancid.