In the diarrhoea which precedes epidemic cholera, the same absence of bile in the passages may often be noticed, and should be treated, in the same way, with the minute doses of calomel and opium frequently repeated. A more energetic use of the same remedy is, I believe, indicated in the earlier stages of the fully formed cholera, in which the utter want of biliary secretion is one of the most prominent symptoms, and its return one of the most favourable signs. The combination of calomel, opium, and acetate of lead, which I had long used habitually in the profuse colourless diarrhoea above mentioned, I was induced to resort to, upon a larger scale, in the first cases of cholera which occurred to me, and had every reason to be satisfied with my success. in this complaint, it is important to make an immediate impression. instead, therefore, of the very minute doses given in the less rapid and dangerous affection, I prescribe half a grain or a grain of opium, a grain or two of calomel, and from two to four grains of acetate of lead, at the first dose, and repeat the combination every half hour or hour afterwards, in one-quarter or one-half the quantity, until some impression has been made on the disease; a large sinapism being at the same time applied to the abdomen, and an anodyne enema administered.

Not unfrequently this deficiency of bile in the passages is associated, as an accidental accompaniment, with other diseases. Whenever it so happens, there is the same indication for the alterative use of mercury; and calomel, or some other mercurial, should be associated with other remedies in the treatment. This indication is often presented in the course of the idiopathic fevers, and various phlegmasiae, and the same rule as to the regulation of the dose may be observed as in the former cases; that is, if there is a tendency to irritation of stomach and bowels, the medicine may be given in small and often repeated doses; otherwise, in a larger dose at bedtime. I have been very much in the habit, under the latter circumstances, of associating from one to three grains of calomel, with the opium and ipecacuanha, often indicated to procure rest at night. in dysentery, in which the secretion of the liver is generally diminished, this treatment is prominently indicated, even when there may be no intention to exhibit the calomel with reference to its antiphlogistic influence.

2. instead of simple deficiency of bile, there is often a perverted secretion, as shown by the altered colour of the passages, which are now dark-coloured, brown, or black, and sometimes acrid, causing much uneasiness in the bowels. The colour may be distinguished from that of hemorrhage by the absence of any shade of redness when the stools are diluted. I have repeatedly noticed that this darkness of the stools is the first step towards their decolorization; implying that the action of the liver is deranged before being suspended; and a very gentle interference by mercury, under these circumstances, is often sufficient to correct the disorder. As in the preceding condition of the secretion, there may be attendant upon this either a constipated or loose state of the bowels; in the latter case, forming a disease which has often been confounded with true melaena. The treatment is exactly the same as for deficient bile; the larger dose at bedtime being given in the cases with torpid bowels; the smaller doses, distributed at short intervals through the day, in those attended with diarrhoea, b. Therapeutic Application connected with full Mercurialism.

3. Singular as it may seem, an excessive secretion of bile by the liver will generally yield with great facility to the same treatment, proving that it is not merely a stimulant influence which the mercury exerts on the liver, but that its action is really alterative. in cholera morbus and bilious diarrhoea, both characterized by excessive discharges of bile, the treatment which in my hands has always acted most kindly, is that of the small doses of calomel and opium, repeated at very short intervals, as above described. in cholera morbus, after the stomach has been washed out by free draughts of chicken water, or some other demulcent beverage, let one-sixth of a grain, each, of calomel and opium be given every half hour, while a strong sinapism is applied over the abdomen, and the disease will, I think, be generally found to yield speedily. if any one be disposed to smile at the minuteness of these doses, let him try the plan, and afterwards decide as to its efficiency.

The foregoing are the chief uses of the mercurials, so administered as to produce no other observable effect than alteration from a morbid to a healthy state in the hepatic and digestive functions. That they may be beneficial, in the same doses, in those affections in which they are ordinarily exhibited so as to produce ptyalism, is highly probable; nay almost certain; as we constantly witness the desired result, though they may fall short of salivating, as they often do, when given with that object. They are, indeed, not unfrequently administered purposely in such affections in purely alterative doses; but it would be waste of space to enumerate such applications of the remedy under this head; as they are to be considered immediately in connection with its sialagogue operation.

The uses to which mercury may be applied, in this relation, may be arranged under 1. its sialagogue property, 2. its property of stimulating the secretions, 3. that of promoting absorption, 4. its general stimulant property, and 5. that of changing the condition of the blood and the tissues, which may be designated as its revolutionizing property, under which may be ranked its antiphlogistic, febrifuge, and antisyphilitic effects.