The peculiar sedative effects of the antimonial on the circulation and respiration are certainly produced through absorption; as they are not apt to occur when vomiting and purging ensue, except in so far as they may result from the mere nauseating influence; while, if the medicine be given so as not to occasion these effects, they are not only induced, but often continue for several days after its use has been suspended. Whether it acts on the heart through the organic nervous centres, or by a direct influence upon the organ itself, or by some deteriorating change produced by it in the blood, has not been determined; but I have little doubt that it has an important influence on the blood itself; as it produces effects in inflammation greater than can be ascribed to a mere reduction in the rapidity and force of the circulation, and much greater than can be obtained from an even more powerful sedative effect on the pulse, resulting from digitalis.

3. Indications And Contraindications

The medicine is indicated, whenever there is a call for reducing arterial excitement, and at the same time lowering the quality of the blood. Through the former of these effects, it promotes absorption, and may, therefore, be employed for removing effused liquids, and for the discussion of indolent swellings. it is contraindicated by a depressed condition of the circulation, a depraved state of the blood, and the existence either of positive irritation or inflammation of the stomach and small intestines, or a strong tendency to it. From what I have before said, it may be inferred that tartar emetic is not a medicine which can be carelessly administered with impunity. At a meeting of the College of Physicians of Philadelphia, wishing to elicit the experience of the members present, I inquired what had been the results of their observations upon this point. Several of the members stated that they had been cognizant of fatal results from its abuse. I have no doubt that serious consequences sometimes occur of which we hear nothing; but this is only an argument for caution, not for an abandonment of so valuable an auxiliary to the lancet.

4. Therapeutic Application

Tartar emetic was first brought into public notice by Mynsicht in 1631. it is at present among the medicines most extensively employed, and fully merits its reputation. As a direct arterial sedative it is used in inflammations, local vascular irritations, and fevers; jointly in the same capacity and as an alterative, in cutaneous and scrofulous affections; and, for the relaxation attendant on its nauseating influence, in paroxysms of nervous excitement or irritation.

1. inflammations. in all cases of acute inflammation, especially when attended with fever, tartar emetic may be advantageously used, with due attention to the contraindications before mentioned. After bleeding, if required, and a thorough purgation, it is probably the most efficient remedy at our command in the earlier stages, when the indications are to diminish the activity of the circulation, and lessen the stimulating quality, or the richness of the blood. When the skin is hot and dry, in such cases, it may be conjoined with one of the refrigerant diaphoretics, as citrate of potassa or nitre; and, when there is a coexisting indication for the mercurial impression, with the latter of these medicines and with calomel, in the form of the nitrous powders. (See Nitrate of Potassa.) A slight degree of nausea or laxative effect produced by it will not generally interfere with its beneficial operation; but it should be kept within the vomiting point, and should not be permitted to occasion griping pains, or an irritating diarrhoea. These inconveniences may often be corrected by conjoining it with a little morphia, when this may not be contraindicated; but if it should still act as an irritant, it should be reduced in quantity, or, if necessary, suspended. Should suppuration occur, with a disposition to sweat copiously during sleep, and other evidences of debility, the antimonial should be omitted. From one-twelfth to one-quarter of a grain may be given every hour or two hours during the day; but, as it is generally desirable that the patient should sleep at night, the medicine may be suspended at bedtime, and in its place a combination of opium, ipecacuanha, and calomel administered, when not opposed by some contraindication, or unnecessary from the moderate character of the affection.

It is not as a substitute for depletion, but as an adjuvant, that I would recommend tartar emetic in inflammation. if mainly relied upon, it must, in serious cases, be given much more freely than as above advised. The plan of treating inflammation exclusively by large doses of the antimo-nials, or of regarding them as the main remedy, though practised upon from time to time ever since the medicine first came into vogue, was never extensively adopted, or regarded as a distinct antiphlogistic method, until brought into notice, in the year 1800, by Rasori, Professor of Clinical Medicine at Milan, and the famous advocate of the contrastimulant system of therapeutics. Upon this method of using tartar emetic I shall dilate directly, merely premising that, as the result of my own observation and experience, I prefer the ordinary antiphlogistic plan of depletion by bleeding and purgatives; the antimonial being employed simply as an adjuvant, or, if as the chief remedy, only in those mild cases which do not require the lancet, and to which moderate doses of the medicine are adequate.

There is scarcely one of the phlegmasiae, in which this antimonial may not be usefully employed, with the exception of those in which its tendency to irritate the stomach and bowels might prove hurtful. it is, however, especially adapted to the pulmonary inflammations, in which its expectorant property adds to its efficiency. Mild cases of bronchitis may be trusted to this remedy, conjoined with demulcents, a saline cathartic, and low diet; and, in the severe cases, it is the best adjuvant of the lancet in the early stage. Later in the disease, it may be usefully associated with the milder stimulant expectorants, as squill and seneka. in pneumonia there is probably no remedy, with the exception of bloodletting, more efficient in the early stages. During the period of high inflammatory excitement, the patient should be kept constantly under its influence, care being taken to restrain it within the vomiting point; not that a little vomiting would prove injurious in itself, but that it unnecessarily incommodes the patient, and might interfere with the continuance of the remedy. in the advanced stage of the disease, should it not show a disposition to yield, I prefer the treatment by calomel and opium, so as to induce a slight mercurial influence; as I believe that it is even more efficacious, and less prostrating than the antimonial. in pleurisy the medicine is less useful; as its influence on the bronchial secretion is here of little avail; and the same may be said of it in pericardial and endocardial inflammation. But in all these pectoral affections, it has the advantage of diminishing the movement of the inflamed organs, and thereby, in some degree, obviating one of the aggravating influences in the disease. The fewer the pulsations and respirations, the less, of course, is the motion of the heart and lungs. it is quite unnecessary to enumerate every particular local inflammation in which the medicine may be usefully employed. I would simply repeat that it is applicable to all, without exception, when attended with a vigorous and accelerated pulse, and not complicated with irritation of stomach and bowels, or a tendency to this condition. in consequence of their frequent association with vomiting, the antimonial is less adapted to peritonitis, hepatitis, and nephritis, than to some other local inflammations. in peritonitis, especially, the chances of evil from the disturbance of the stomach are so great as probably to outweigh any good from the antiphlogistic properties of the medicine; and, on the whole, it might be - best not to employ it in that complaint. The same objection exists to its use in meningitis, which is often attended with vomiting; but, when this complication does not exist, and the pulse is excited and tolerably strong, it may be used with propriety. To gastritis and enteritis it is, of course, quite inapplicable. The same might be supposed of dysentery; but, as it is probably absorbed before reaching the colon, it would not be liable to irritate that bowel directly; and experience has shown that it is sometimes useful in the febrile forms of this disease. in the earlier stages of acute rheumatism with fever, tartar emetic is almost always indicated. To acute gout it is less appropriate; and the liability of retrocession to the stomach should, indeed, forbid its use; as it has not, like colchium, any specially alterative influence over the disease; while, by irritating the stomach, it might make that a centre of afflux to the irritative tendency, and thus cause a hazardous translation.*