1. In childhood and infancy, emetics are generally well borne, and prove highly serviceable in the diseases of early life. In them, generally speaking, Ipecacuanha is preferable to Tartar Emetic; the latter occasionally causing great depression. Sydenham reprobates the use of antimonial emetics before the eighth year.

2. Emetics Differ Much In The Rapidity Of Their Action

Thus the Sulphates of Zinc and Copper act almost immediately after they have been swallowed, and should, in consequence, be employed whenever it is of importance to unload the stomach rapidly, as in cases of poisoning. Tartar Emetic acts more slowly than these substances, but quicker than Ipecacuanha or Mustard; but it should be remembered that a great difference exists in individuals, with regard to the facility with which vomiting is induced.

3. The relative amount of subsequent depression which the various emetics induce, is a point of practical importance. Of the whole range of emetics, Tobacco produces the greatest and most permanent depression; so much so, indeed, that nothing but extreme circumstances can justify its employment. Tartar Emetic is more depressing in its action than Ipecacuanha; and this, in its turn, more so than the Sulphates of Zinc or Copper, and Mustard. The last, indeed, hardly produces any perceptible depression, and is consequently well suited for debilitated subjects, in atonic gout, drunkenness, &c.

4. The degree of nausea and depression which certain emetics produce is not proportionate to their emetic effect. This is very evident if we compare the operation of Tobacco with that of Mustard, or Tartar Emetic with the Sulphate of Copper.

5. The Amount Of Diaphoresis Which They Produce Merits Attention

Tartar Emetic and Ipecacuanha cause copious perspiration, whilst the Sulphates of Zinc and Copper excite comparatively little.

6. An habitual use of emetics is highly injurious, rendering the stomach so susceptible that ordinary diet cannot be retained, and debilitating the system generally. No means are so likely to produce dyspepsia. It is a practice which cannot be too strongly condemned.

7. The period of the day best adapted for their administration is the evening, when the tendency to sleep which supervenes can be readily indulged. If, however, the urgency of the case requires it, there is no period of the day when they may not be given.

8. When the vomiting is too violent or too long continued, the means best adapted for checking it are effervescing draughts, with a few drops of T. Opii, or Hydrocyanic Acid, or Crea-sote. (Dr. Joy.) A mustard plaster to the epigastrium is sometimes effectual.

3102. Therapeutic Uses

Fevers. In Intermittent Fevers, an emetic given at the commencement of the cold stage, was formerly regarded as a sure means of cutting the disease short. Though they will not do this, emetics, when not otherwise contra-indicated, appear to exercise a beneficial influence in mitigating the subsequent severity of the attack, not only unloading the stomach of crude and ill-digested food, but lowering the vascular excitement, and determining to the skin. Their use is almost entirely limited to the outset of the fever, and should, on no account, even then, be employed, if there be any great amount of gastric irritation. The same remark applies to Remittent and Continued Fevers; but in Yellow Fever, the experience of the best authorities agrees in condemning their employment. In all fevers the great danger which attends the use of emetics is, that they may induce an irritable state of the stomach, which is but little under the control of medicines. In the severe fevers of the Mediterranean, Sir William Burnett* found them highly injurious. When employed, Ipecacuanha should be preferred. In Typhus Fever, an emetic, observes Dr. Murchison. is often of undoubted service in relieving symptoms during the first five or six days of the disease. Its good effects are often most marked in mitigating or removing the headache and general pains, in reducing the temperature, quenching the thirst, and quieting any gastric disturbance. It is only contra-indicated when the patient is unusually weak, or when the disease has advanced beyond the first week. The same remarks apply to Typhoid {Enteric) Fever. Here they ought never to be given after the twelfth day; for when the peritoneum is laid bare by intestinal ulcers, the act of vomiting may induce perforation.

* On the Mediterranean Fever, 2nd ed., p. 33.

On Fevers, &c., 1862, p. 263.

3103. In Gastric Remittent Fever, if the child is seen early, and there is reason to suppose that improper food has been the cause of the attack, an emetic will often be found at once to relieve the symptoms. It is only applicable to the earliest stage. (Dr. Locock.*)

3104. In Scarlet Fever, at the commencement of the disease, an emetic may be administered with great advantage. It appears to exercise a favourable influence on the course of the fever subsequently. Drs. Withering, Willan, Burns, Bateman, Tweedie, &c, agree in approving of emetics in the early stage. They prove more efficacious in children than in adults.

3105. In Puerperal Fever, emetics are advocated by Doulcet, Richter, Tonnelli, Cruveilhier, and others. Dr. Ferguson considers that the cases in which they are chiefly useful are those in which the liver is implicated, and biliary derangement is a prominent symptom. Dr. Gooch advises caution when the face is pale, the skin cool, and the pulse small and weak. When used, they should only be as auxiliaries, and their utility is chiefly confined to the earliest stages. They entirely failed in the hands of Dr. Dewees and Dr. Clarke.

3106. Disease of the Brain, &c. In Insanity, emetics are advised by Esquirol, Bush, Foville, Cox, Wake, and others. They are undoubtedly useful when derangements of the stomach exist. Dr. Prichard observes that emetics are sometimes useful during a state of furious excitement, and produce calmness and a mitigation of violence. Sometimes, under these circumstances, he adds, their exhibition is followed by a restoration of sleep and tranquillity. Maniacs bear large doses of antimony without effect. Considerable judgment is necessary in selecting cases in which emetics may be administered with safety. In Puerperal Insanity, when gastric disorder exists in a marked manner, Dr. Mackenzie:]: considers that an emetic may be given with safety and advantage.