THE USE OF EMETICS. 419 



If, on the other hand, disturbance of the circulation in the 

 centre be the cause of the vomiting, we must restore the 

 normal supply of blood by keeping the patient in the recum- 

 bent posture and insuring bodily rest, and stimulate the circu- 

 lation by Alcohol and food, if they can be retained in the 

 stomach. Nitro-glycerine, Nitrite of Amyl, and Chloral appear 

 to have been given with some success under these circum- 

 stances. 



When the cause cannot be removed we must reduce the irri- 

 tability of the centre by Opium or similar drugs. 



2. Defective Vomiting : Use of Emetics. The adoption of 

 vomiting as a therapeutic measure, and the selection of an 

 emetic from the list just given, are matters of the greatest 

 practical importance. The student must not think that in 

 inducing vomiting we are effecting a simple mechanical act 

 of evacuation ; he must appreciate the extent and degree of 

 physiological disturbance which we are setting up. If the 

 patient be very weak, the therapeutist may be alarmed to find 

 that his emetics or unsuccessful attempts at emesis are followed 

 by intense circulatory depression, faintness, and even threaten- 

 ing dissolution. The condition of the patient must be carefully, 

 if quickly, ascertained ; and if vomiting be considered a justifi- 

 able and proper method of treatment, a selection must be made of 

 one or other emetic, according to the patient's strength and other 

 circumstances. Fortunately, in most cases of acute poisoning, 

 where vomiting is urgently indicated, the patient is able to bear 

 the shock, and Sulphate of Zinc, twenty grains in two ounces 

 water, Sulphate of Copper, two to five grains in an ounce of water, 

 or a table-spoonful of Mustard in a cupful of hot water, should 

 be given without delay. Where blocking of the respiratory 

 passages by the products of croup or bronchitis calls for an 

 emetic, great judgment is required to estimate the patient's 

 strength and to select a proper emetic, if any. Vinum 

 Ipecacuanhae, in doses of 1 fl.dr. for children, or fl.oz. for 

 adults, is the best, because it is also an expectorant. Anti- 

 mony is decidedly more depressing, in doses of 1 to 2 gr. of 

 Tartarated Antimony, or \ fl.oz. of Vinum Antimoniale for an 

 adult. Carbonate of Ammonia is a suitable emetic in these 

 cases, being a stimulant to the heart and respiration. In acute 

 dyspepsia the mildest emetics are indicated, including tepid 

 water, Salt and water, warm nauseous infusions such as Chamo- 

 mile; and may be freely given. Apomorphia is at once the 

 most certain and generally applicable, whilst the least employed 

 of emetics, because rarely at hand. ^ gr. may be given sub- 

 cutaneously, or a dose of \ gr. by the mouth. It is frequently 

 necessary to follow an emetic by a stimulant, such as alcohol. 



