In the adynamiae, emetics are of very extensive utility. They are of doubtful efficacy in syncope,when the disease arises from a topical affection of the heart and larger arteries, or when owing to debility, or an exhausted constitution. In many, perhaps the greater number of instances, fainting proceeds from accumulations in the stomach, and emetics are then absolutely-necessary. In dyspepsia, hypochondriasis, and chlorosis, they are remedies of the greatest importance.

The order styled spasmi is a group of diseases scarcely connected. Palpitatio, however, like syncope, more commonly depends on accumulations in the stomach and bowels than on any other cause; and asthma, with dyspnea, as we have seen, is greatly relieved by the operation of emetics, when not owing to any topical affection of the heart and arteries. If any medicine be useful in pertussis, it is occasional vomiting; but the pyrosis is a spasmodic complaint, and ultimately cured by a very different plan. Emetics are often useful as temporary palliatives. In colica, in cholera, and diarrhea, we have had occasion to point out their utility; but in hysteria, though sometimes necessary, they are of doubtful efficacy. In the other genera they are not employed, or only occasionally useful.

In the vesaniae, emetics are the most important remedies. When the disease is not connected with the stomach, Which generally happens, they are probably useful by the agitation formerly mentioned among their effects.

In the first order of the cachexia, the marcores, we find little foundation for their employment; yet, as in tabes the hectic fever is mentioned, they may appear to be indicated. But the fever, in this case, is from debility only, the exacerbation of the common evening paroxysm. It reminds us, however, of an omission, which we must supply, the utility of emetics in phthisis; a disease that has no appropriate place in the system of Dr. Cullen, which we have chiefly followed. Whether we consider the fever as a remittent, the bronchial glands as infarcted, or the existence of purulent matter in a concealed abscess, emetics appear to be medicines of the greatest utility. In fact, they are so; and could phthisis be ever cured, it would be by the joint action of emetics and blisters. No remedy is so generally useful as a slight emetic, frequently repeated; it checks the fever, relieves the burning heat, renders the respiration more free, and the cough more loose. Yet haeret, lateri lethalis arundo, emetics will not cure. In dropsies we have mentioned the occasional utility of natural vomiting, and stated that we have not yet been able to imitate it by art; but in hydrocephalus and

4 H 2 hydrothorax it is inadmissible. We find a few solitary cases where the water in hydrocele, a partial dropsy, has been evacuated in this way.

For the various genera of the order impetigenes we find little room for the use of this remedy. lf frambaesia, as Dr. Adams thinks (Memoirs of the Medical Society, vol. vi.), be an exanthema, emetics may be of service, as they very certainly are in icterus. Even where the pain at the pit of the stomach is violent, and the existence of a calculus unequivocal, though emetics may for a time increase the pain, the relaxation which they produce assists its passage. Neither in accidental nor in artificial vomiting have we ever found, in this case, any inflammation (the great source of alarm) follow. Emetics are of more importance in the last class of diseases, than from their local nature might be expected. In every caseof obstructed sense, where the cause is not so firmly fixed as to resist every power, these remedies are useful; in the caligo forinstance,amaurosis, dysaecia, and ageustia; in the greater number of depraved and deficient appetites; and in some of the depraved or irregular motions. In the apocenoses, the passive haemorrhages, or mucous discharges, they are certainly injurious. In the epischeses, if we except the amenorrhaea, and in the tumores, except the purulent ones, they are hurtful. The choice of emetics is a subject of some importance; but it is chiefly regulated by the quickness or the violence of their action. The most quickly operating emetic, in cases of emergency, is the white vitriol; the most violent is the turbith mineral. It is common to select the mercurial emetics in venereal cases; but this plan is not attended with peculiar advantages. We have often thought it singular that the squills are not more frequently employed for this purpose in asthma or pneumonia. They indeed produce a very permanent and distressing nausea, and are often employed as nauseating remedies; but we suspect that they might-be particularly useful if given in these cases so as to produce full vomiting. In such instances physicians seem to prefer the antimonial emetics, and it must be allowed that the squills are very uncertain in their operation.

Emetics are injurious when there is any original defect in the head, in the heart and larger arteries, or, perhaps, in the abdominal viscera, if we except the liver; in the aneurisms of the larger vessels, in the delicate and the weak, if particularly plethoric. If no plethora exists, debility is seldom so considerable as to contraindicate vomiting, should there be any foundation for thinking it may produce real good effect.

With respect to the administration, we have little to add to what we have already remarked. In cases of fever we prefer the evening; in asthmatic cases, the morning; in hectics, the period when the febrile accession is most strongly marked. In the other disorders there is little choice of time. The preferable form is a liquid; and were the preparation of the ipecacuanha wine to be always depended on, this would be the best form of a medicine almost universally employed as an emetic, since the powder, apparently entangled in the coats of the stomach, sometimes occasions a continuance of painful retchings. Those who have repeatedly taken this medicine often find even the smell or taste sufficient to excite vomiting; and, from what has been said, it will be obvious that such vomiting will be ineffectual.

To patients of this class it may be given in pills, or the tartarised antimony may be substituted.

Vomits, taken in the morning, should be allowed to produce their operation in bed. In the evening, if not taken in bed, the patient should immediately retire to it, without exposing himself to any chill. At any other period of the day, cold, after the vomiting, should be carefully avoided.

Any warm liquid may be employed to facilitate the action of the emetic; but the camomile, the carduus tea, mustard infusion, or whey, or the volatile alkali added to the bitter infusions, greatly facilitate it.