(Tartar Emetic; Tartrated Antimony.)

Origin. - Antimony trioxide is mixed with acid potassium tartrate and water to the consistence of a paste, allowed to stand for twenty-four hours, boiled in water, and crystallized.

Description and Properties. - Colorless, transparent crystals of the rhombic system, becoming opaque and white on exposure to air, or a white, granular powder, without odor and having a sweet, afterward disagreeable, metallic taste. Soluble in 15.5 parts of water and in 3 parts of boiling water, but insoluble in alcohol, which precipitates it from its aqueous solution in the form of a crystalline powder.

Dose. - 1-2 grains (0.06-0.12 Gm.) as an emetic; 1/2-1 grain (0.03-0.06 Gm.) as a cardiac depressant; 1/20-1/4 grain (0.003-0.01 Gm.) as a diaphoretic and expectorant [1/10 grain (0.005 Gm) as an expectorant; 1/2 grain (0.03 Gm.) as an emetic, U. S. P.].

Official Preparations

Syrupus Scillae Compositus - Syrupi Scillae Compositi - Compound Syrup of Squills (Hive Syrup). - Formula: Fluidextract of squill, 80; fluidextract of senega, 80; antimony and potassium tartrate, 2; sugar, 750; purified talc, 20; water, to 1000.

Dose, - 5-60 minims (0.3-4.0 Cc).

Vinum Antimonii - Vini Antimonii - Wine of Antimony. - Formula: Antimony and potassium tartrate, 4; boiling distilled water, 65; alcohol, 175; white wine, to 1000.

Dose. - 5-60 minims (0.3-4.0 Cc.) [15 minims (1 Cc), U. S. P.].

Antagonists and Incompatibles. - Opium, alcohol, and the cardiac stimulants and antispasmodics generally are antagonistic. Tannic and gallic acids and the lead salts are incompatible.

Synergists. - Emetics, cathartics, and cardiac depressants promote the action of tartar emetic.

Physiological Action. - Externally and Locally. - Tartar emetic is a powerful irritant when applied to the skin, producing a follicular inflammation followed by a papular eruption, becoming vesicular, and later forming pustules with a central umbilication, desiccation finally occurring, the pustules closely resembling those of small-pox. Necrosis and ulceration may follow prolonged application.

Internally. - Digestive System. - Upon the mucous membrane of the gastro-intestinal tract, as upon the skin, antimony and potassium tartrate acts as a powerful irritant. Small doses, occasioning only a sensation of warmth in the stomach, soon produce an increased secretion of saliva and gastric juice, as well as of secretions from the intestines, liver, and pancreas, more or less nausea frequently accompanying these symptoms.

A little larger dosage excites vomiting, due to the irritating action of the drug upon the mucous membrane and nerves of the stomach. After absorption, it is thought that, antimony has a direct action on the medulla, causing vomiting, but the evidence is not conclusive. Full or large doses irritate the intestines, producing diarrhea, the discharges, if the dose has been excessive, being very loose and watery. Severe cramps and epigastric pains accompany the foregoing symptoms.

Circulatory System. - Tartar emetic is a powerful cardiac depressant, even in small doses slowing and weakening the heart's action, and simultaneously lowering arterial pressure by direct depression of the heart muscle.

Poisonous doses of the drug profoundly depress the heart, which is finally arrested in diastole.

Nervous System. - Antimony and potassium tartrate in small doses and under certain conditions exerts a sedative influence upon the brain. Indeed, its action is that of a depressant to the entire nervous system, particularly the spinal cord, small doses depressing the sensory side, while poisonous doses depress both the motor and sensory centers of the cord. The intense prostration is probably a result of the circulatory depression acting on the nerve-centers rather than a direct nerve-cell involvement.

Under the administration of antimony, therefore, reflex excitability is diminished and the muscular system is depressed, the drug acting as an antispasmodic, probably by its influence both upon the muscles and the nervous system.

Respiratory System. - Very small doses have no effect upon the respiratory movements, but increase the secretions from the bronchial mucous membrane. Full doses depress the respiratory movements, shortening the inspiration but prolonging expiration. Toxic doses render the breathing extremely irregular and greatly lengthen the pause between inspiration and expiration, while there is an enormous increase in the bronchial secretion.

Absorption and Elimination. - Tartar emetic rapidly enters the blood, and is eliminated by many channels, principally by the bowels, but also by the bile, milk, sweat, and urine. The drug is an active diaphoretic, expectorant, and cholagogue.

Temperature. - Small doses do not affect temperature perceptibly; large doses lower bodily heat, chiefly by depressing the circulation.

Untoward Action. - The untoward manifestations produced by medicinal amounts of tartar emetic in individuals having a marked susceptibility to the drug do not differ essentially from the symptoms of poisoning next described.

Poisoning. - Tartar emetic produces all the symptoms of an irritant poison - severe burning sensation in the esophagus and stomach and violent and repeated vomiting, the ejecta, in addition to undigested food, containing mucus, bile, and frequently blood.

These symptoms are attended with severe colicky pains in the abdomen and serous purging, the discharges resembling those of cholera, the analogy with the latter disease being rendered the more striking by the presence of cramps in the extremities - a characteristic feature of poisoning by tartar emetic.

Together with these gastro-intestinal symptoms there is extreme prostration, accompanied by an irregular, weak, almost imperceptible pulse, great muscular relaxation, depressed respiration, pinched and livid countenance, cold, clammy skin, reduction of temperature, and scanty and bloody urine. Death may be preceded by stupor, wild delirium, or convulsions. Fatal dose of tartar emetic has been 2 grains (0.1 Gm.) - although much larger quantities have been taken. The prompt emesis has served to prevent poisoning.

Treatment of Poisoning. - If the poison has not been entirely ejected in the act of vomiting, the stomach should be immediately washed out with a solution of tannic acid, after which strong coffee should be administered, together with demulcent drinks, anodynes, and respiratory and cardiac stimulants should they be necessary.

Therapeutics. - Externally and Locally. - Tartar emetic was formerly used as a rubefacient, being still so employed to some extent. The tendency of the drug, however, to produce extensive papular eruption and destruction of tissue renders its external use unsafe. Hebra considers that the external use of tartar emetic is a "useless, injurious procedure, and occasionally even dangerous to life."

Internally. - The medical uses of tartar emetic are constantly becoming more restricted. Because of its slow and depressing action the employment of the drug as an emetic has been practically abandoned. It is still used as a sedative in various acute inflammations. It is beneficial in the early stages of acute laryngitis and bronchitis, but its administration should be discontinued after a free secretion of bronchial mucus is established.

The remedy is given by many practitioners in the early stages of acute lobar pneumonia.

The compound syrup of squills is a useful expectorant, being a popular and efficient remedy for spasmodic affections, particularly spasmodic laryngitis.

Administration. - As an emetic the action of the drug is facilitated and enhanced by associating it with ipecacuanha, the remedies together being given in powdered form.

As a diaphoretic and expectorant small doses of the wine of antimony are preferable, repeated every two or three hours.