Some gentlemen of the fleet informed me that they found oil of almonds a useful addition to the purgative. Others as well as myself made a practical comparison of the saline purgative with that composed of rhubarb and calomel, as recommended by Sir John Pringle, and we gave the preference to the former, as more easy, speedy, and effectual in its operation, especially in the first stage. Cases may occur, however, in which the other may be more advisable; for where there is a sense of weight about the stomach, which most probably arises from the biliary organs being clogged with bile, and where emetics have failed to remove it, or the weakness of the patient may render them improper, then calomel has the best effect: for it was formerly observed, that it tends to loosen the secretions, and to stimulate the more distant excretories, such as the biliary ducts. It is very important to caution young practitioners concerning the employment of opium in all stages of this disease, but especially in the beginning; for though it is an excellent remedy when seasonably and judiciously employed, it is very liable to abuse, particularly in the hands of the inexperienced, who may be tempted to give it improperly from an anxiety to relieve; but as more harm may arise from an unseasonable administration of it than could be compensated by the best-timed use of it, it is best to err on the side of caution and omission. The principal caution to be observed with regard to this remedy is, to premise suitable evacuation, such as blood-letting, if necessary, but more especially purging. It is always pernicious to give it in its pure state during the _tormina_, so common in the first days. By these I mean the abdominal gripings, which denote inflammation, and are entirely different from the _tenesmus_, which is a more constant and characteristic symptom of the disease, and seems to arise from irritation and spasms of the rectum and colon. It was in this disease that I first observed the good effects of a small quantity of neutral salt in taking off the inconveniencies attending opium, such as the feverish heat and confusion of the head, which it is apt to produce in many constitutions; and as the administration of the anodyne coincided with the evening dose of ipecacuana, I was led to adopt a form similar to that of Dover’s powder, but with only half the quantity of opium; or, it was given in a liquid form, by combining twenty drops of thebaic tincture and a drachm of ipecacuana wine, with nitre from five to ten grains, in any simple vehicle in form of a draught. There is a very observable difference, in some cases, between opium given in a liquid and in a solid form; and the former is much more certain in its effect when the intention is to procure speedy and effectual ease.