As a saline we may use sulphate of magnesia, or Friedrichshall, Pullna, Hunyadi Janos, or Carlsbad water; but, whichever saline we may choose, the use of one or other of them should on no account be omitted. One of the best salines is half a drachm of crystallized Carlsbad salts dissolved in a tumbler of hot water and drunk immediately after rising in the morning, and this may be used not merely in the morning after the mercurial, but it may also be employed every morning in cases where the bowels are constipated. The quantity of water is of considerable importance. Half a teaspoonful dissolved in a full tumbler is more efficacious than double the quantity of salt in half the quantity of water. Nor is this to be wondered at, for not only has the larger quantity of liquid greater power to wash out the intestine, but the increased amount of the water tends to increase the quantity of bile secreted, and this increase in bile is especially marked when the water is taken frequently in small quantities, as it is by persons undergoing the cure at Carlsbad, or who take the solution of Carlsbad salts at home by sipping it at intervals while dressing, instead of drinking it all off at once.
Zawilski found that when liquids were taken in this way not only was the bile secreted in greater quantity, but under a greater pressure, so much so that secretion still occurred when such an obstruction was opposed to its exit as would usually have caused the bile which had already been excreted to be reabsorbed.[1]
When the Carlsbad salts are employed after the mercurial, it is, I think, best to take them in single large draughts immediately on rising, but when used by themselves the solution should be sipped at intervals during dressing. When used alone, the Carlsbad water, warmed by standing the tumbler in a basin of hot water or in an ætna, is perhaps even better than the salts, which represent only a part of the normal constituents of the water. After the liver has been thoroughly cleared out in this manner by a mercurial purgative followed by a saline, vegetable cholagogues, such as iridin and euonymin, may be employed to assist the action of the Carlsbad salts, when these are found to be insufficient, even although they are taken with regularity. These cholagogues, the introduction of which into medicine, in this country at least, we owe to Professor Rutherford, are sometimes as useful, perhaps even more so than mercury, but, as a rule, I think the mercurial purgative is the best to begin with. Euonymin is the cholagogue most usually employed, but iridin is really the most powerful one, and is specially recommended by Dr. Rutherford.
Instead of trying to keep up the strength, as it is termed, by loading the stomach with food, the exhausted brain-worker should rather lean toward abstinence from food, and especially toward abstinence from alcoholic liquors. The feeling of muscular weakness and lassitude, which I have already had occasion to mention as frequently com-
- ↑ "Sitzungsber. der wiener Acad.," 1877; mat. nat. Abth., Bd. iv, p. 73.
