This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol2", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Syn. Tartar Emetic. Tartarated Antimony. Tartarized Antimony.
Tartar emetic is here to be considered only as an emetic. in its other relations it has already been fully treated of (see page 56), or will be hereafter. With perhaps the exception of ipecacuanha, it is the most valuable and most employed of the whole class, and has properties which render it, for certain purposes, superior even to that medicine, though inferior for others.
Effects and indications. Tartar emetic usually acts promptly and energetically, causing much nausea, and repeated and prolonged vomiting, with great general relaxation. in some instances, however, and in certain individuals, it operates as gently as any other emetic medicine. it is said to produce the same effects when injected into the blood-vessels, the serous cavities, or the cellular tissue, though with less certainty. Applied to the rectum, or the skin, it is little disposed to act as an emetic; yet in the former position it is asserted occasionally to vomit; and I have repeatedly noticed the same effect attendant on its external use as a pustulating agent. it is more apt to purge than most of the emetics ordinarily used.
Compared with ipecacuanha, it produces, as a general rule, more nausea, more frequent and protracted efforts at vomiting, greater muscular relaxation and arterial depression, and a stronger impression on the whole system. it is also more disposed to extend its action to the duodenum, and to cause bilious discharges.
From these qualities, the indications for its preferable use may be deduced. When the object is merely to evacuate the stomach, or to produce a gentle impression of any kind, or when it is necessary to repeat the emetic daily or at other shorter intervals, and always when vomiting is called for in an already highly irritated or inflamed state of the stomach, ipecacuanha should be selected. Tartar emetic is preferable when the object is to compress or agitate the abdominal viscera, to produce great muscular relaxation and circulatory depression, to supersede any particular morbid state by a shock upon the system, or to act energetically by revulsion.
in reference to the abdominal viscera, this is the most effective emetic in cases of portal and splenic congestion, torpor of the liver, and jaundice. in this last disease, it sometimes operates very energetically in bringing about biliary secretion, and may be resorted to when the liver refuses to respond to its ordinary excitants. in the course of bilious fever, portal congestion and deficient hepatic secretion sometimes occur, with aggravation of the symptoms, and may generally be relieved by a dose of tartar emetic, if the mucous membrane of the stomach is not already inflamed, or highly irritated; but it is at present much less used in such cases than formerly.
For the production of muscular relaxation, the medicine is extremely useful in croup, and of itself will often immediately check an attack of the catarrhal variety of that disease. There is reason, too, to suppose that, if employed early in the pseudomembranous variety, before the false membrane has formed largely, it will occasionally have the same effect. it is, however, frequently necessary to repeat the emetic once or oftener, and in quick succession, before the disease can be subdued; and its use should be accompanied with that of the warm bath at the same time. it might be supposed that the same property would render tartar emetic preferable to ipecacuanha in asthma and pertussis; and no doubt its immediate effects would be greater; but as, in these affections, there is usually occasion, when the emetic plan is adopted, for a frequent repetition of the medicine, ipecacuanha is on the whole preferable, as less liable to produce either serious gastric irritation, or general prostration of the system.
For producing the muscular relaxation, so much desired by the surgeon in obstinate cases of dislocation, tartar emetic is greatly preferable to ipecacuanha. it is here sufficient to obtain its full nauseating and relaxing effect; and it should be given with that view rather than to vomit, though it is not always possible to prevent the latter result.
For the same universal depression attendant on its nauseating operation, tartar emetic is often a most useful agent in subduing the violence of the maniacal paroxysm, of acute delirium, and of great hysterical disturbance, especially in the frequently recurring convulsions of the last-mentioned affection.
Through its powerful general impression or shock, it is peculiarly efficient in the interruption of paroxysmal diseases, whether remittent or intermittent, given so as to be in full action at the period for the recurrence of the paroxysm. Hence one of the indications for its use in intermittent and remittent fevers, and paroxysmal neuralgia. The same indication is offered in the forming stages of fever, when it is thought that a powerful shock will sometimes supersede the influence of the morbific cause altogether, or greatly moderate its violence.
From its energetic revulsive action, as well as its general depressing effect, tartar emetic is probably more successful in the subversion of inflammatory diseases, in their earlier stages, than any other emetic. Hence it has often been given at the commencement of ophthalmia, catarrhal inflammation, tonsillitis, laryngitis, and even pneumonia, with the effect of breaking up the disease; and is sometimes employed for the same purpose in swelled testicle, buboes, and synovial inflammation.
The same revulsive influence renders it peculiarly efficacious in various nervous diseases, as tic douloureux, obstinate headache, mania, and amaurosis.
It is often used, in small doses, in connection with purgative medicines, in order to increase their activity.
In doubtful cases, it should be combined with ipecacuanha, which gives it greater mildness and brevity of action, while the tartar emetic ensures efficiency.
It is contraindicated in debilitated states of the system, and an inflamed or irritated state of the stomach.
The medium dose of tartar emetic required for vomiting is two or three grains. But, from the variable degree of susceptibility to its action in different individuals, and under different circumstances of disease, it is usually deemed advisable to give it in doses of one grain, repeated every fifteen or twenty minutes till it acts, each dose being dissolved in a tablespoonful of water. if, after the administration of six or seven doses, it should produce much nausea and general prostration without vomiting, a dose of ipecacuanha may be administered, to produce the emetic effect.
When the two are given together, two grains of tartar emetic and twenty of ipecacuanha may be mixed, and divided into two powders, which may be given diffused in water; the second at an interval of fifteen or twenty minutes, if the first should not answer the purpose.
Antimonial wine may be given to an adult in the dose of a fluidounce, or, what is preferable, in half the quantity; repeated, if necessary, at the usual interval. it is, however, much more used as an emetic in children than adults. The dose for a child, one or two years old, is from twenty to forty drops. in the paroxysm of croup, this may be increased to forty or sixty drops.
By enema, from six to twelve grains of the salt may be administered; but it will seldom be found to vomit.
In cases of threatened death from food, or other solid body lodged in the oesophagus, relief is said to have been obtained, in several instances, by throwing a solution of tartar emetic into the veins. Two or three grains of it dissolved in two fluidounces of water, is the quantity usually employed, though as much as six grains are said to have been given. Emesis has been brought on, and the foreign body thus forced upward, and discharged.