The Use of Tartar Emetic in Large Doses in inflammation. The remarks hitherto made refer to the use of tartar emetic in the ordinary doses of from one-twelfth to one-quarter of a grain every hour or two hours. I should not be doing justice to the subject, without directing the attention of the reader to the method introduced by Rasori, and advocated by Laennec and many other eminent physicians, of using it in very large quantities, so as to make a profound impression on the system, and of relying mainly upon this impression for the cure.

When there is no urgency in the case, from four to eight grains may be given during the first period of twenty-four hours, in doses of half a grain or a grain at regular intervals; and this quantity may be gradually increased, as the stomach is found to bear the medicine, up to twelve, or, if required by the severity of the disease, to twenty-four, or even thirty grains, in the same period of time; and the latter quantity has often been greatly exceeded. Should the case, however, be threatening at the commencement, or considerably advanced before coming under treatment, one grain may be given every two hours from the outset, and continued till amendment takes place, with gradual increase to two or two and a half grains, should the violence of the symptoms require it. Each dose should be given dissolved in a wineglassful of water, or sweetened water, or weak mucilaginous solution. Should severe vomiting be produced, the intervals between the doses may be increased until the stomach becomes reconciled, and then diminished as before. if the bowels are much disturbed, five drops of laudanum may be added to every other dose until the diarrhoea is checked. it is asserted that it is in pneumonia that this method of treatment has been found most efficacious; and, from the testimony in its favour from the highest sources, there can be no doubt that it exercises an extraordinary control over that disease; often curing the most threatening cases without the intervention of any other remedy. Some employ bleeding conjointly; but others consider that this interferes with the efficiency of the antimonial, and avoid it altogether. it is probable that tartar emetic is useful in the disease, not only by reducing the quantity, quality, and motion of the blood, and diminishing respiration, but also by acting revulsively from the lungs towards the alimentary canal, and, as supposed by Laennec, by favouring the absorption of the exuded matters of the consolidated lung. Trousseau does not think that the spontaneous supervention of vomiting and purging in pneumonia should prevent the use of the antimonial, as he has repeatedly found these affections to subside under its use; but an old diarrhoea, upon which the pneumonia has itself supervened, as when this inflammation occurs in the course of typhoid fever, is incompatible with the remedy.

* Dr John Seibert, of Milwaukee, Wisconsin, in a letter to the author, states that he has found great advantage from combining tartar emetic with hydrocyanic acid, in the treatment of pneumonia, and other febrile and inflammatory diseases. He dissolves four grains of the antimonial with thirty-two minims of officinal diluted hydrocyanic acid in four fluidounces of water, and gives a teaspoonful four times daily. [Note to the second edition.) there are few cases in which the stomach does not become tolerant of the medicine by the second day, even when much disturbed at first. But, should threatening symptoms be produced, with prostration, cramps in the extremities, or white stools, it should be suspended, and measures resorted to for relieving the excessive vomiting and purging. if, after tolerance has been established, the disorder of stomach and bowels return, the plan of treatment should be abandoned altogether; as the occurrence would evince an irritability of the alimentary canal, which might lead to serious consequences. it is highly important, for the success of the measure, that the diet should be reduced; and, in acute cases, only farinaceous liquids should be employed, and these not taken very frequently. indeed, for the first day or two, water alone, or mucilaginous drinks will be sufficient. Acidulous fruits should be avoided. When the febrile symptoms subside, the quantity of the medicine should be diminished; but it ought not to be suspended abruptly, even upon the supposed commencement of convalescence. Sometimes the symptoms return when the antimonial is too hastily withdrawn. it should be continued, therefore, in gradually diminishing doses, for some time after the fever has disappeared.

Other inflammations have been treated upon the same principle. in acute rheumatism, particularly the articular variety, the remedy sometimes displays great powers, curing the disease very promptly; while in other cases it seems to exercise little control. inflammation of the joints with synovial effusion, whether of rheumatic origin or otherwise, sometimes yields to it very speedily. in pleurisy and the cardiac inflammations, it has been found useful, but much less efficient than in pneumonia. Severe bronchitis will sometimes yield to it; and the remedy has been highly recommended in meningitis, which, it is asserted, has sometimes been cured by it in two or three days. The same has been said of its efficacy in phlebitis.

But, while acknowledging the favourable results obtained by the method of Rasori in pneumonia and other acute inflammations, I am bound to express my own conviction, that the practice is, on the whole, not to be recommended. The objections to it are various. Whatever may have been said of the safety of the remedy, the simple fact that tartar emetic has repeatedly proved fatal in quantities less than those often employed in this method of treatment, is sufficient to satisfy us that these statements should be received with some allowance. We hear of successful results; but those of a contrary character are probably not always published to the world; and the practitioner himself may be deceived; as it is very easy for the strong advocate of a remedy to see in its fatal effects, especially when occurring through his own instrumentality, only the effects of the disease. A latent gastric or intestinal inflammation might be roused by the excessive doses of the medicine into fatal activity. The violent effects often produced on the alimentary canal, with the attendant prostration, though capable of being checked, if seen at their very commencement, may do irreparable mischief in the absence of the practitioner; and he never can be positively certain that they may not come on at any moment. When the patient is always under watchful superintendence, as in a hospital, there may be little danger; but, in the ordinary course of practice, when the case is necessarily left, in the intervals of the visits of the practitioner, in unskilful hands, death may occur almost without the suspicion of danger; and, as before stated, I myself was once accidentally the witness of such a result; nor did the parents, or, so far as I know, the physician himself, ever suspect the real cause of the fatal issue. it is by no means certain that, independently of the vomiting and purging, the blood may not be fatally disorganized by the immense quantities of the antimonial introduced into it. The prostration thence resulting might readily be mistaken for that of the disease. Nor is this mere conjecture. The late Dr. Peebles, of Petersburg, Va., recorded several cases, in which patients, who had been cured of pneumonia by this method, died soon afterwards of an irrepressible hemorrhage, induced, as he believed, by the state of the blood poisoned by the antimonial. {Am. Journ. of Med. Sci., N. S., xv. 338.) Nor is the remedy at all essential in these enormous doses. The danger is peculiarly great in children; and, though their pectoral inflammations yield to the treatment with a facility corresponding to the greater danger; yet it seems to me that this does not authorize us to incur the hazard of destroying life by the direct instrumentality of the means employed; especially as a moderate use of the remedy will probably answer quite as good, if not a better purpose, in conjunction with other measures.