Divison I. Class I. Emetics.

Related entry: Emetics as diaphoretics

Emetics are a class of remedial agents which by producing a specific impression upon the sentient nerves of the stomach, or upon the nervous centers, are capable of exciting vomiting. Emetics may be divided into two classes, according to their mode of action: the first class prove emetic by their irritant effect upon the mucous membrane, and sentient extremities of the nerves of the stomach; the second, by being absorbed into the blood either affect the nerve centers, or by having a specific affinity for the mucous membrane of the stomach act there upon the terminal branches of the pneumogastric nerve.

Action of Emetics.—The action of both of these classes of emetics is similar in some respects; that is, in both the impression is transmitted to the pneumogastric uerve, or to the medulla oblongata, from which it arises; this excites the sensation of nausea, which is referred to the stomach. The reflex action is transmitted downward through the spinal cord to the muscles concerned in the process of evacuation, calling into action the muscles of the larynx, the diaphragm, and the abdominal muscles. The act of vomiting may be thus described: the patient first draws a quick, deep breath, the rima-glottidis is spasmodically closed to prevent the egress of the air, and thus prevent the diaphragm from being forced upward. The muscle of the stomach itself contracts, and the pylorus is at the same time forcibly closed; the abdominal muscles contracting press the stomach against the diaphragm, but being unable to act upon it, the stomach, which endures the pressure, is forcibly emptied of its contents.

The action of a specific emetic is not dependent upon the quantity, the nauseating taste, or the unpleasant smell of the article: some of the most energetic emetics will act very efficiently in minute doses, while the same article may have but little taste, and be entirely devoid of offensive odor.

A like result follows from injecting them into the veins, or into the rectum, and not unfrequently from their external application; showing most conclusively that emesis is induced by the specific influence which they exert upon the nervous centers.

Specific emetics always produce more or less nausea and relaxation of the system, whether their action is carried to emesis or not; while on the contrary, irritant emetics produce but little nausea, but merely a feeling of discomfort in the stomach.

The susceptibility to the influence of emetics is extremely variable in different persons, and a difference not unfrequently manifests itself in the same person at different times, depending upon the character of the disease, and a variation in the gastric sensibility of the patient. A dose that will scarcely affect one, may produce hyper-emesis in another, or in the same person at another time.

Therapeutic Indications.

Emetics are employed in a diversity of diseases, and to fulfill a great variety of indications. They make a very powerful impression upon the system, and often effect important changes in the pathology of disease. Emetics are often valuable, and even very important agents when no specific disease exists, as well as in the opposite condition. When a train of morbid sensations, and an extensive chain of perverted sympathies exist, emetics are important agents in revolutionizing the whole system, and breaking up that concatenation of depraved sympathies.

We shall next proceed to notice, in detail, the various indications which emetics are capable of fulfilling, and their adaptation to the treatment of different diseases.

I. Evacuation of the Stomach.—They are valuable for the purpose of evacuating the stomach when that organ is overdistended with indigestible articles of food that oppress it, and thereby disturb the normal condition of the system. They are also useful when a redundancy of acid, or mucus is generated in the stomach. The nausea and vomiting which take place in such cases, pain in the stomach or head, or the "sick-headache," are often relieved by their use. When from an inverted peristaltic action of the duodenum, acrid, bilious matter is thrown into the stomach, when any vitiated accumulations take place in that organ, or when poisons, particularly those of the narcotic kind, are lodged in the stomach, emetics are pre-eminently useful for the purpose of ejectiug the offending matter.

II. Action in Febrile Diseases.—Emetics are valuable therapeutic agents in the treatment of febrile diseases in general. During the early stages of many attacks of lever, the employment of emetics is of unquestionable importance. In the various forms of intermittente, and bilious remittents in particular, this class of agents may be administered with much advantage. They are also found useful during the early stages of typhus, typhus icterodes, continued, and synochal grades of fever.

1st. In the intermittent and bilious remittent fevers, and even in other types, when there are evidences of a morbid biliary secretion being thrown into the stomach by the inverted action of the duodenum, or in any case where there are vitiated materials accumulated in that organ, producing irritability, nausea, and a morbid eensibility, emetics are exceedingly valuable for the purpose of quieting that irritability, removing those vitiated materials, and for preparing the stomach for the reception and retention of other medicines, which would be rejected if it were not for this preparatory treatment. The removal of the vitiated seeretious of the stomach, and such food as may be undigested, is of the first importance in all cases, for if not removed in this mannet they are excreted by the bowels, and in their passage mort or less is absorbed and conveyed into the circulation, thus vitiating the blood-fluid. They are not only of use in checking nausea and vomiting, which often prevent the use of the necessary remedies, but by their cleansing and exciting influence on the mucous membrane, they promote the ready absorption of agents which are administered after their action.

2d. By their mechanical action they compress the liver and abdominal viscera, they remove visceral congestions, overcome obstructions in the liver and portal circle, stimulate the chylopoietic viscera and glands of the intestines to action, give a powerful shock to the nervous system, and break up the morbid associations and diseased sympathies which often sustain and keep up the recurrence of the febrile paroxysms.

3d. The shock which they give to the nervous system is very frequently the means of arresting the disease, and restoring the patient to health, if resorted to before the system becomes prostrated, or the disease fully seated. They break the chain of pathological associations, substituting their own impression for that of the existing disease, and break up or counteract the periodic tendency.

4th. An emetic given a short time before the expected attack of the cold stage of ague, in order to have it in full operation at the time of the paroxysm, not unfrequently arrests it; and should it not, it renders it much milder—the cold stage is of shorter duration, and the reaction is comparatively feeble. They also prepare the system for the reception of tonics, whose remedial powers seem to be materially augmented by premising their administration with an emetic.

5th. They promote the secretion and remove congestion of the lungs, and thus aid in decarbonizing the blood; they also increase the renal, gastric, biliary and pancreatic secretions, and by their mechanical effects upon the abdominal viscera, and their influence over the hepatic secretions they often produce copious alvine evacuations. They thus prove depurative, removing from the blood the products of disintegration and chemical change, the presence of which is often as we have already seen a proximate cause of these diseases.

6th. By nauseating and relaxing the system, they most effectually overcome that spasmodic and constricted condition of the cutaneous exhalents which attends fever, and thus lessen the exalted action in tbe cutaneous capillaries, and consequently the abnormal generation of caloric which attends their increased activity.

7th. They act indirectly as sedatives, depressing the vascular and nervous excitement, thereby promoting diaphoresis. The cutaneous exhalation acts indirectly as a refrigerant, by the evaporation which takes place from the surface, in this way counteracting the abnormal generation of caloric.

These influences properly carried out, tend in a very powerful manner to lessen the intensity of the excitement, and to hasten the supervention of convalescence.

8th. By increasing the secretions in general, but particularly those of the lungs, liver, kidneys and skin, they act as depletives; and in this way supersede the necessity of resorting to the lancet. During the period of nausea and relaxation, they serve to depress the vascular and nervous action, and exert a sedative influence over the circulation; thus again, just as surely, and much more safely, fulfilling those indications for which the lancet is said to be alone adequate.

9th. They exert a revulsive influence, by making the stomach the center of an artificial fluxion, and thus detracting from the inflammation or congestion existing in some other organ. This influence is one of great importance in the treatment of all diseases, but particularly those of an inflammatory character; since by counteracting local congestions by virtue of thoir strong centrifugal influence over the circulation, they aid in a very powerful manner in equalizing the circulation and nervous excitement.

III. Action in Diseases of the Respiratory Apparatus.—Emetics are very important remedies in the various forms of pneumonia: in pleuritis, in pneumonia biliosa, in peripneumonia or in pneumonia proper, frequent gentle emetics will be found of great utility. Some have objected to the use of this class of remedial agents in the treatment of pneumonic inflammation, in consequence of the mechanical compression attending emesis. It has been asserted that they aggravate the sufferings of the patient, and the intensity of the disease; but experience has fully convinced us that the objection urged against their use in this respect is not valid, especially when the mild vegetable agents to which we resort, are snbstituted tor the poisonous minerals in common use in the old system of practice.

1st. In the most violent forms of pleuritic inflammation emetics administered in nauseating doses, for some time before full vomiting is desired, aided by copious draughts of warm diaphoretic infusions, will in a very short time produce a general relaxation, and a free perspiration; and when the system is thus brought under the influence of emetics, vomiting, instead of aggravating the sufferings of the patient, will generally give prompt and in many cases entire relief. The violence of the pain, and the respiratory suffering will be speedily mitigated, and will not be attended with a subsequent recurrence.

2d. In the various forms of pneumonia the smaller bronchial tubes and air-cells of the lungs will be found obstructed or loaded with a viscid tenacious mucus, unless the intensity of the inflammation has arrested the secretion. If it is arrested, emetics by their sedative influence upon the system, will diminish the inflammation and restore the secretion. If the secretion has not been arrested, and the bronchial tubes and air-cells are loaded with it, an emetic will be found ceedingly valuable in removing the obstruction. They likewise exert many other salutary influences upon the system in the treatment of these diseases. They are important expectorants, they are valuable as diaphoretics and revulsives, they equalize the circulation, they act as depletives, they depress the vascular and nervous excitement, and exert a very powerful influence in subduing the inflammation.

They are equally applicable in the treatment of the various forms, and different stages of pneumonic inflammation, unless there is extreme prostration.

3d. Emetics are by no means an unimportant class of agents in the treatment of the various forme of cynanche, especially so in that form designated as croup. The speedy relief which they often afford in that disease is truly surprising. In cases where the patient is threatened with immediate suffocation, from the accumulated mucus in the larynx, trachea and bronchia, or from the pseudo-membranous formation which is the result of the inflammatory action in the larynx, an emetic will frequently give prompt relief. In order to secure the full advantages which this class of agents is capable of affording in this disease, it becomes necessary to repeat them frequently, and in some cases, much advantage will be gained by giving them so as to keep up a constant nausea and occasional vomiting for several hours.

4th. Asthma is another disease in which emetics are prominent remedies. They invariably give temporary relief, if taken during the asthmatic paroxysm; and if the patient is young, or the disease not too firmly seated in the constitution, an energetic and persevering course of emetics, assisted by suitable expectorants, together with auxiliary means both dietetic and medicinal, will do much toward effecting a radical cure. They are also valuable in hooping-cough, nervous-cough, chronic bronchitis, and the various catarrhal diseases occurring during the cold and variable seasons of the year.

IV. Action in the Exanthemata.—They are very useful in the exauthematous diseases, as measles, scarlatina and smallpox, especially in the early stages. When the pharynx and contiguous parts are ulcerated, inflamed, and swollen to such an extent as to impede respiration and deglutitiou, emetics will lessen the inflammation and swelling, cleanse the ulcers, remove the viscid secretions, establish a new action in the parts, equalize the circulation, act as diaphoretics; and if there is oppression of the lungs, which is frequently the case, especially in measles, they will remove it. They fulfill many other indications in these diseases. Thus, during the early stages of these complaints, if the eruption is tardy in making its appearance upon the surface, or when it has appeared, and a retrocession has taken place, emetics, by producing a determination to and relaxation of the skin, will bring it again to the surface.

V. Action in Rheumatism.—Emetics are occasionally employed in gouty and rheumatic affections with much advantage. When an arthritic habit obtains, a dyspeptic state of the stomach is generally present, in many cases a redundancy of acid being generated, in which event a course of mild emetics will do much toward arresting the paroxysms; and used in conjunction with proper restoratives, they will very materially aid in eradicating the arthritic habit. In inflammatory rheumatism, and even in the chronic form of this complaint, emetics, if given to keep up a constant nausea and diaphoresis, and to such an extent as to occasionally produce emesis, will recommend themselves as effective agents. They remove any morbid secretions from the stomach, subdue inflammatory action by their sedative and diaphoretic influence, and by acting as revellents, equalize the circulation.

VI. Action in Hepatic Affections.—In chronic hepatic affections, in torpor of the portal circle, in visceral obstructions, and in diseases of the glandular and lymphatic systems, emetics are useful in removing the torpor, and restoring the various organs implicated to a normal performance of their functions. The influence which they exert upon the sympathetic system of nerves, and the shock which they impart to the whole system in the act of vomiting, by the severe compression of the abdominal viscera, and by exciting a new action in the nervous, vascular and lymphatic systems, tends to prepare the patient for the reception of tonics and alteratives, when their influence will be doubly appreciable. In jaundice, experience decides in favor of their employment. If the biliary ducts are obstructed by calculi, producing jaundice, or if it arises from hepatic torpor, or functional derangement of that organ, emetics are valuable for removing the obstruction, by compressing the liver in the act of vomiting, and in arousing and restoring the healthy secretory functions of that organ.

VII. Action in Dyspepsia.—Gentle emetics are very useful in the treatment of dyspepsia, dependent upon debility or functional derangement of the stomach. Frequent mild emetics remove the morbid accumulation of acid and mucus from the stomach, and counteract the tendency to their generation; they remove the oppressed state of the stomach, induced by the presence of these morbid accumulations. In such conditions, the digestion is impaired, the gastric juice it vitiated, and its solvent properties weakened, chymifica-tion is imperfect, and the chyle is unhealthy. The intimate sympathetic relations existing between the digestive apparatus and the brain, are manifestly deranged by this unhealthy state of the stomach. Emetics are important for the purpose of counteracting this condition of the stomach, and the morbid sympathies which arise from it.

VIII. Action in Hypochondriasis.—Hypochondriasis is another disease in which emetics frequently prove beneficial. They often arouse the mental and physical energies of the hypochondriac, and dispel those gloomy forebodings which are essential characteristics of that disease; they also increase the susceptibilities of the system to other remedies. In this disease there generally exists a congestion of the portal circle, and a torpid and deranged state of the digestive organs, and a morbidly sensitive state of the brain and nervous system; in these conditions we have often witnessed the salutary influences of emetics.

IX. Action in Mania.—Emetics are also administered with much advantage in mania, arising from intemperance. In such cases the extreme insensibility of the stomach, sometimes requires that they should be administered in unusually large doses. In ordinary intoxication, they will evacuate the stomach, lessen the cerebral oppression, arouse the sensibilities of the nervous system, and restore the inebriate to a state of sobriety and consciousness more speedily than any of the ordinary remedies with which we are acquainted. If mania has arisen from the too free use of alcohol, an emetic not only evacuates the stomach, and thus removes the exciting cause, but it acts as a sedative, revellent, and an antispasmodic; it equalizes the nervous energy and excitement, and in many cases subverts the morbid habit.

X. Action in Diseases of the Brain and Nervous System.—In relation to their employment in apoplexy, a contrariety of views prevails. When apoplexy attacks a patient while the stomach is in a state of engorgement, the use of an emetic is of primary importance; but as a general rule their use is highly improper, and often dangerous. In this disease, as well as in all others in which the brain and nervous system are deeply involved, much larger doses will be required to accomplish the desired object.

Congestion, irritation and inflammation of the brain, or a morbid erythism of the nervous system, will require enlarged doses to secure their ordinary effects. The same is the case when there is a lack of the due oxygenation or aeration of the blood, as in asthma, croup, bronchitis, asphyxia, etc. The venous blood is oppressive to the brain, paralyzing the sensibilities of the nervous system, and thus deadens the susceptibility of the stomach to the influence of emetics. In such cases very powerful emetics are required, and their ordinary dose should be doubled or even quadrupled.

Emetics have also been used in amaurosis. If the stomach is disordered, they may be employed with a prospect of some advantage, but in most cases their use will not result in much benefit.

In epilepsy emetics are occasionally beneficial, although a contrariety of sentiment obtains relative to their utility in this disease. When the disease arises from a disturbed condition of the digestive organs, evidenced by nausea, flatulence, and other symptoms of indigestion, and in those forms of epilepsy assuming a periodic character, they frequently prove serviceable, and a persevering course of long duration has in some cases prevented a recurrence of the epileptic attack. They should be administered every third or fourth day, and in those forms which assume a regular periodicity a short time before the expected uttack. Dr. Smith of New York asserts that they are more effectual in epilepsy and hysteria than any of the ordinary remedies used.

They are often used with great advantage in the different forms of hysteria. In the convulsive form of this disease, we have found them more speedy in arresting the convulsions than any other agents we have been in the habit of using. In those cases simulating syncope, emetics will arouse the patient and restore her sensibilities in most cases, as soon, as they have produced nausea and full vomiting. In the chronic form of the disease, they are regarded by some of the most eminent physicians as being more effectual in removing the morbid state of the nervous system, upon which this disease is supposed to depend, than any other class of medicinal agents. The shock which they impart to the whole system, but particularly to the nerves, seems to prepare it for the reception of antispasmodics, tonics and alteratives, which agents are found doubly efficient where preceded by, or alternated with, an occasional emetic.

In spasmodic and convulsive affections they are preeminent. By nauseating and relaxing the system, they often exert a very powerful influence over the spasm; in these cases they are given not only by the mouth, but also used as enemata.

XI. Action in Amenorrhea.—Wherever amenorrhea arises from a sudden check of the menstrual secretion, in persons of a plethoric habit, by exposure to cold, a spasm or constriction of the extreme uterine vessels is the result; when emetics, accompanied by warm diluents, pediluvia and fomentations, will in many instances speedily remove the constriction and restore the secretion. The nauseating, relaxing, sedative and diaphoretic influences in such cases are very desirable. In other cases, induced by any sudden mental excitement or emotion, or by any of the depressing or exciting passions, such as excessive anger, fear, joy or grief, causing a sudden abstraction of the vital and vascular afflux from the uterus and concentrating it upon the brain, or any other organ, they will not unfrequently be found valuable auxiliaries in equalizing the excitement, and restoring the catamenia.

In chlorosis arising from retention of the menses, when there is a languid circulation, with a depraved and variable appetite, emetics, in conjunction with chalybeates and tonics, will be found important in breaking up the chlorotic habit. In many cases it will be found that restorative agents will have but little if any effect, the digestive organs being so obstructed and weakened that those agents which are indispensable to the restoration of the normal quantity and quality of the blood can not be absorbed. In these cases we find more or less nausea, loss of appetite and loaded tongue. In such cases we have seen removed from the stomach by the action of ar emetic, such quantities of offensive mucus and vitiated secretion, that we could not be surprised that our iron and tonics had proven ineffectual; in such cases as these the careful administration of an emetic is the first step toward a cure.

In dysmenorrhea, repeated emetics, the hip-bath and fomentations, aided by anodynes and antispasmodics, will prove of much advantage in subduing the morbid sensibility of the uterus and removing the spasm. We do not speak of their employment alone, because a combination of influences will be found more effectual than any one class simply.

XII. Action in Dropsy.—Emetics are frequently prescribed with great advantage in the various forms of dropsy, but particularly in ascites and anasarca. Their action promotes the activity of the absorbent system; vascular excitement retards absorption; emetics, therefore, by lessening vascular excitement, and producing depletion, favor this process, and prove of great utility in dropsical cases.

The full advantages of these agents can not be so effectually secured when the patient is permitted to drink freely of diluents during their operation. When given in this manner, the fluid furnishes the material for absorption; consequently the vessels are kept in a state of repletion, and the reabsorption of the exhaled fluid goes on slowly, if at all, and they fail to prove beneficial. When, however, a dry emetic is given—that is, an emetic with but a small quantity of fluid—it nauseates longer, proves more decidedly sedative, acts more effectually upon the lungs, kidneys, skin and intestinal exhalants, and thus more effectually depletes, at the same time that it facilitates the process of absorption. A very eminent writer relates a case in which a single emetic so effectually excited the mucous membrane of the stomach as to cause the patient to vomit six pints more than he drank during its operation.

They also act as revulsives, and while increased exhalation is taking place in the alimentary canal, and the other great I munctories of the system are active, the dropsical effusion must be lessened, and occasionally it has been entirely arrested, and a speedy cure has been the result. It is, doubtless, in these various ways that emetics increase the action of the absorbents, and effect the removal of the effused fluids.

XIII. Action in Glandular Diseases.—In diseases of the glandular system, such as enlargements of the glands, buboes, scrofulous tumors, hernia humoralis, etc., they not unfrequently disperse them with great rapidity, owing probably to their revolutionizing influence over the absorbent system. They may be used in many of the cachetic habits of body with much advantage. Mild emetics may precede or accompany the use of alteratives and general restoratives, in many of those depraved and vitiated states of the system characterized by cutaneous eruptions, and foul and ill-conditioned ulcers. The influence of alteratives and corroborants seems to be more decidedly sanative when they follow emetics, or when emetics are occasionally prescribed during the course of their administration, than when the important influences of this auxiliary class of agents are omitted.

XIV. Action in Phthisis Pulmonalis.—In the early stages of phthisis pulmonalis, gentle emetics are of great importance. They expel the mucus from the bronchial tubes and air-cells of the lungs, lessen the dyspnoea, and act very beneficially as expectorants. They lessen the irritation and congestion in the lungs, and equalize the circulation, diminish arterial excitement, and relieve laborious respiration; and in a short time, if early resorted to, will frequently effect a cure. In some cases we have administered them every morning, or every other morning, in nauseating doses, until they had relaxed the system, and then increased the dose until gentle emesis ensued; and this course, if persevered in for several weeks, aided by demulcent expectorants, and such agents as will improve the quality and quantity of the blood, will be followed by the happiest results. It checks the cough, allays the irritation of the lungs, mitigates the urgent symptoms, and is often of itself attended with an increase of strength. An occasional emetic, throughout the whole course of the disease (if there is not too much debility), will give great temporary relief; in the advanced stages of the disease they are too debilitating, and should rarely be prescribed.

XV. Action in Diabetes.—Emetics are found to be very useful in diabetes. In several cases in which we have used them, they seemed to exert a very happy influence. Others speak very favorably of their use, and cases are recorded in which a single emetic has effectually arrested the disease. They equalize the circulation, stimulate the digestive apparatus, promote the secretions of other organs, and probably in this way lessen the burden imposed upon the kidneys, giving them time to recover their tone.

XVI. Action in Ophthalmia.—Ophthalmia is another disease in which emetics are found to exert an important influence. Much authority might be adduced in favor of their administration in this affection, when there is a deranged condition of the digestive organs, and acidity of the stomach; which is by no means an unfrequent occurrence, both in the acute and chronic form of the disease. In acute ophthalmia, their depletive, revulsive and sedative influence over the disease is very conspicuous.

XVII. Action in Dysentery.—In dysentery they are often resorted to with great advantage. This disease is often connected with, or dependent upon a redundancy of vitiated bile, or other irritating materials accumulated in the primae viae. When this is the case, emetics are indispensable; their tendency to equalize the circulation and promote diaphoresis, renders them especially valuable.

XVIII. Action in Hemorrhage.—Emetics are occasionally employed in the various forms of hemorrhage. With regard to their use in hemoptysis, some discrepancy of opinion exists. When administered in nauseating doses, for some time before emesis is effected, they diminish the momentum of the circulation by their sedative influence, relax the system, and equalize the circulation; and may be occasionally prescribed with safety and advantage. But as a general rule, we conceive that their mechanical influence would be hazardous; the impetus which they give to the pulmonary circulation renders their indiscriminate employment objectionable, and in many cases dangerous. In active hemorrhages they should be used with much caution. If administered in small doses and not often repeated, their equalizing, revulsive and sedative influences counteract any bad effect that might otherwise occur. In passive hemorrhages from the lungs, and in those witnessed in the incipient stages of phthisis pulmonalis, mild emetics are valuable auxiliaries to expectorants and other pectoral agents.

The same objection does not rest against their use in uterine hemorrhages; an equal amount of mechanical force is not exerted upon the uterine vessels in emesis; neither, in like cases, is the same impediment presented to interrupt the uterine circulation, as is the case in hemoptysis. Emetics cause contraction of the uterus, and thus the orifices of the bleeding vessels are closed, and many cases are reported in which they have proved efficacious.

Haematemesis is often owing to visceral engorgement, or torpidity of some of the abdominal viscera, producing irregular congestions, and hemorrhages. Emetics remove the venous congestions, and by the pressure which they cause to be exerted upon the diseased viscus, the exhaling vessels are compressed, and the hemorrhage is arrested.

Specific Indications for their Use.

The tongue is broad, full, dirty, and especially coated at its base. There is sometimes nausea, disgust for food and drink, and everything taken seems to stop at the stomach. The patient complains of sensations of weight and oppression at the epigastrium.

Conditions Contraindicating their Use.

1. They are contraindicated in apoplexy, phrenitis, cerebral congestions, in short in all cases where a great determination to the brain exists.

2. They are improper in advanced stages of pregnancy, in hernia, aneurisms of any of the large vessels, hypertrophy of the heart, or ossification of the arteries or valves of the heart; we might say in any disease of the circulatory system.

3. They are improper in all cases of extreme debility, as in the more advanced stages of febrile and inflammatory disease, etc.

4. In gastro-intestinal irritation or inflammation, their ordinary use is very improper.

As a general rule emetics are inadmissible in the above cases, but we can lay down no infallible rule for their employment, as circumstances may occur in such relations to the usual contraindications, as to justify their use.

In febrile affections, where there is great excitement, if no danger would result from a delay, emetics should not be administered until the fever abates. If they are prescribed during the exacerbation they do not operate so kindly and effectually as they do during the declination or stage of apyrexia. Not only so, but largely increased doses are required to produce the same effect. During the hight of the fever, every fiber is tense, and the exalted erythism of the nervous and vascular systems lessens the susceptibility to their influence. They should be administered, at first, during the pyrexial stage, in nauseating doses, to relax the system; and this influence should be aided by warm infusions of eupatorium, or chamomile; when there is sufficient relaxation, and perspiration is induced, the dose may be increased, and repeated every twenty or thirty minutes, until the stomach is thoroughly evacuated, and the whole system is brought under their influence.

Another rule pertaining to the administration of emetics (and one not to be rejected as unimportant), is the avoidance of cold drinks during their operation. It is improper for them to be given even when the mildest emetics are prescribed, but especially so during the use of tartrate of antimony. When the stomach is relaxed by the emetic, and large quantities of warm fluids, cold drinks often produce violent (and in some cases fatal) spasms of that organ. The shock is powerful, and its effects not unfrequently irremediable, even when the most potent stimulants and antispasmodics are speedily used. Dr. Eberle notices two cases of sudden death caused by drinking cold water, soon after taking a dose of tartar emetic.

Another rule, never to be violated, is the use of simple, digestible and unirritating diet for twenty-four hours after an emetic. Emetics produce a temporary relaxation of the muscular fiber of the stomach, and lessen its digestive powers; hence the necessity for time to enable it to recover from this enervation, before being taxed with the elaboration of even a small portion of most of the ordinary indigestible articles of diet in daily use.

Recapitulation.

1st. Emetics serve to expel any morbid or vitiated matter, whether undigested food, secretion, or poison from the stomach.

2d. They serve to promote general relaxation, equalize and lessen the momentum of the circulation, counteract congestion, excite the liver and other glands to action, promote diaphoresis, and act as depletives, deobstruents, and eliminatives.

3d. The shock which they impart to the nervous system is often productive of much good in the early stages of fever, and likewise in many chronic diseases, arresting the disordered action by supersession.

4th. Emetics are often productive of much good in spasmodic or convulsive action, being by virtue of their action on the brain and nervous system, powerfully antispasmodic.

5th. In many chronic affections of the chylopoiëtic viscera, and glandular system, they prove beneficial by newly exciting those organs, promoting absorption and the various secretions and excretions—thereby subverting morbid action.

6th. They promote the bronchial secretion, and facilitate expectoration, and therefore are of great importance in diseases of the respiratory organs, such as croup, asthma, pertussis, bronchitis, pneumonia, etc.

7th. From their supersedent, sedative, depletive, revulsive, relaxing, deobstruent, depurative and equalizing effects, they often exert a revolutionizing influence upon the entire system, thereby breaking up perverted associations, and in many instances completely subverting existing morbid sympathies, and effecting permanent cures.

In these various ways they serve as valuable auxiliaries to the use of tonics, alteratives, etc., co-operating with, and materially facilitating their curative action.

Anti-emetics.

Following the consideration of remedies which produce emesis, we will briefly study the remedies and means which check nausea and vomiting. In some cases these remedies act upon and through the nervous system, being sedative in one case, stimulant in another, in other cases the action is topical upon the mucous membrane of the stomach. In others it is chemical, comprising acids, alkalies, and antiseptics. In still others the action is upon a different part, with which the stomach is in sympathy. The nausea and vomiting being sympathetic, it is relieved when the original disease is removed.

The American Eclectic Materia Medica and Therapeutics, 1898, was written by John M. Scudder, M.D.