■*■'■ ■'■$&&? A'*- .!:;.'r-'*-.-':'i yvl: -BfowlM-^Slfev,.. \i AN INAUGURAL DISSERTATION O N T H E THEORY AND PRACTICE O F EMETICS. SUBMITTED TO THE EXAMINATION OB the Rev. 10HN EWING, S. T. P. Provost, the TRUSTEES and MEDICAL PROFESSORS of the UNIVERSITY of PENNSYLVANIA, For a Degree of Doctor of Medicine, On the 8th Day of May, 1793. A: & BY HENRY WILKIN S, OF ANNAPOLIS, MARYLAND—MEMBER OF THE AMERICAN MEDICAL SOCIETY. ----RES ARDUA, VET.USTIS NOVITATEM DARE, NOVIS AUCTORITATEM---- Plin. Hift. Nat. Pref. , -^r/^*' PHILADELPHIA: PRINTED BY TAKRX HALl, N° I49, CHESNUT STREET; BETWEEN FOURTH AND FIFTH STREETS. M.DCC.XCIII. THE THEORY. X O treat on any fubjeft advantageoufly, it is not only peceffary to begin a radice, but alfo to produce or call forth to our affiftance, whatever may appear ufeful to enlighten our fub- jeft, or the conception of our readers ; and this is more efpeci- ally proper, when we better underftand the auxiliary, than we do the fubjeft under treatment. For the above reafon, I intend, before proceeding to treat of irregular aftions, to touch upon the regular aftions or phyfiology of the ftomach ; having pre* mifed as much of the anatomy as our fubjeft requires. Of the Stomach. The ftomach is formed by feveral coats ; the internal part may be called its furface, (which is formed by what is called the vil- lous coat) from its analogy in property to the cutis, the univer- fal furface of our body. Like the cutis, it is a defenfive cover- ing to more delicate parts over which it is fpread. It is full of papilla? and pores, which tranfmit or fecrete a fluid; and it is fpread upon a cellular membrane. Beneath this cellular mem- brane, mufcular fibres run, chiefly in two direftions, longitudinally and circularly ; thefe fibres appear to originate from the cefopha- gus ; they form a coat which is enveloped in the manner of the other abdominal vifcera by the peritoneum, which forms the laft coat of the ftomach. As our fubjeft does not require great accuracy about the fliape or fituation of the ftomach, it will fuffice to fay, that the fto- mach is of a curved conical figure, the bafis of which lies about the left hypochondrium ; and the loweft part (which is not the apex) with the apex in the epigaftrium, thus having a diagonal fituation. The cardia and pylorus, the two orifices of the ftomach, are fituated on the fmall or fuperior arch of the ftomach, at about three-fifths of the ftomach's length diftant from each other. The conftant contents of the ftomach, viz. air and gaftric fluid, together with the neceffary ingefta, and the aftion that thefe indireftly produce, are the exciters of aftion proper to the fto- mach : heat is common to every part. The air is a ftimulus by its diftending power, efpecially as it antagonizes the preflure around ; and if we may judge from the cffcfts of air admitted into wounds; or Datura! cavities of the body^ [ 4 ] body, we fhall furely conclude it to be a ftimulus in its intrinfic quality. The gaftric fluid is too fmall in quantity to give diftention to the ftomach, but by its quality"it gives a ftimulus, which is prov- ed by the fenfation of hunger depending much upon the fecreti- on of it, as well as by its effects when applied to an ulcer. Our ingefta when well chofen (taken aggregately) aft as a ftimulus both by body and quality, and the aftion of the ftomach ferves to perpetuate itfelf by difturbing the ftate (viz. reft) which is beft fuited for the nerves to retain their fubtle moveable con- tents. These powers, though they are not inftruments of motion, yet they are as neceflary to the producing motion in the ftomach, as blood is to the continuance of the aftion of the heart. In an anonymous effay which I publifhed laft fall, on animal motion, I endeavoured to define the property of that principle which we call life in the moving ftate, and from its property being to con- denfe or.contract, and fuch a power being a fufheient agent for every aftion in the fyftem, (for every aftion may be reduced to contraftion and relaxation, the latter the effeft of an efcape of" that principle which produced the former) I concluded that the vital principle was the fole agent of motion, and that every other power in the fyftem, as far as they concerned motion, was only for the regulating or condufting the principle of life or motion. Hence the aftion of every part, caterisparibus, is juft equal or agreeable to the quantity of vital principle determined into it, as the determination is equal to the ftimulus applied. These things I have thought neceflary to mention, becaufe, upon fuch principles I mean to explain my fubjeft. By the operation of the ftimuli, a quantity of the vital principle is de- termined into the coats of the ftomach, fufheient for its aftion, which does not confift in the fimple contraftion and then a re- laxation of the whole ftomach, but in what is called a periftaltic motion, which is thus performed : Some of the upper circular fibres contraft, and then thofe inferior to the flrft, whilft the firft give way ; during this aftion in the circulars, the longitudi- nals contraft and then relax again. Such an aftion is well adapt- ed to expel the contents of the ftomach into the inteftines. In a ftate of health, when the fyftem is well regulated, I fup- pofe the diftribution of the vital principle to the ftomach to be exactly anfwerable to what the animal ceconomy can fupply, without depriving other organs of their due, and equally well fuited to what the ftomach requires. With this I finifh what I have to fay on regular motion, and now proceed to irregular aftion, or Vomiting. This appears to be the immediate effeft of an overplus of the moving power determined into the mufcular coat of the ftomach, the [ 5 ] the abdominal mufcles, and the diaphragm; with thefe many other mufcles are convulfed alfo, as thofe about the throat; but, they rather retard than promote vomiting. By the violent contraftion of the fibres of the ftomach, the pylorus is perfeftly conftrifted for a while, fo as to deny any paffage that way, and alfo hinder the defcending motion proper to the ftomach and inteftines, whilft at the fame time the dia- phragm is contracted to a plane and the abdominal mufcles are drawn into a concavity. By this violent prefiure which the fto- mach now fuftains, the contents, if any, are urged fo as to over- come the conftriftion of the cefophagus; this afcending directi- on of the contents, together with the conftriftion of the pylorus, effeftually invert the natural aftion, fo that now it aflifts in ex- pelling the contents. It is fomewhat difficult to fay how the mufcles fhould be convulfed by medicines applied to the ftomach, and efpecially thofe in particular which affift in vomiting. But if we confider the great connection of the nervous fyftem, and the mobility of its contents, with the eafe that an aftion can be excited in many parts, efpecially in the mufcular fyftem, it will appear almolt impoflible to excite a folitary aftion : and as to thefe particular mufcles it may be obferved, that they are fome of the moft ca- pable of aftion of any in the body; that their unceafing natural aftion fhew them to have, or require, a large, free, and conftant fupply of the principle of motion ; and laftly, that being both voluntary and involuntary, they muft have a very ready, eafy determination to them : hence they are not only excited by me- dicines applied to the ftomach, but alfo by irritations applied to the noftrils, the trachea, or the lungs, as in freezing and coughing. The exhibition of an emetic appears to carry the fyftem through three ftages, in the following order: I. A state of languor and liftleflhefs. 2. A state of irregular excitement: and 3. A state of general, equal, deficient excitement or tem- porary relaxation. As I am treating of the Theory, I look upon it to be my du- ty to give fome explanation of the above appearances, which I lhall do in the following correfponding numbers. I. A state of perfection in the fyftem does not depend alone upon a found and fufheient fet of folids and fluids, but alfo up- on proper diftributions of the moving principle. This proper distribution produces fuch actions in the animal, vital, and natural organs, as taken together we term Health," from common fenfe or idea of fuch a ftate : As then fome parts of our fyftem are more fuited for aftion than others, fome more neceflary to the immediate welfare of the animal ceconomy, and finally, fome more dependant than others ; it follows of courfe, that a preternatural diftribution of the moving power, without any incrcafe or deficiency of it (elf or of ftimuli, may fhew or produce [ 6 ] produce a ftate of lefs or more general excitement than is to he obferved at the point of health. In the ftage under confideration, there appears a lefs general excitement, even with the addition of ftimuli, admitting the emetic to be of the ftimulant clafs. The vital principle appears to be with-held from the furface : hence the languor, a common fymptom of a relaxed cutis and feeble pulfe ; hence the difcharge of faliva from the relaxation extending over the tongue and fauces; and hence the palenefs which is dependant upon the action of the extreme arteries ; thefe having fuffered with the cutis, with which they are inti- mately connefted. II. This ftage depends upon a proceflion of the fame unnatu- ral diftribution of the vital principle as the firft ftage, but now the ftomach, the diaphragm, and the abdominal mufcles are car- ried from a predifpofition into excefhve aftion. By the above means, a confiderable mechanical preflure is given to the venous fyftem, which keeps up the languifhing heart during the effort of vomiting, and immediately that is over gives it a temporary jncreafe of aftion. The rednefs of the face that attends violent itraining is not owing to any increafe of aftion in the arteries at that time, for their aftion is almofl fufpended, but to the preflure of the muf- cles about the neck, hindering the return of blood by the jugu- lar veins. III. When the ftimulus is removed that caufed the above ftates, then the natural ftimuli receive each their proportional demands of the moving power, and of confequence a natural dif- tribution is made; but as exceffive aftion exhaufts the principle of motion in an uncommon degree, there will be a proportional deficiency throughout the fyftem : hence the general relaxation and temporary lofs of excitement which conftitutes the third and laft ftage. By attending to the above, we may know how to apply our emetics to more advantage, as fome difeafes indicate one ftage, and not the others to be applied. It is by inducing thefe dif- ferent ftages, that the ufe of emetics is fo extenfive. Of the Powers that produce Vomiting. They are, ift. Medicines that aft varioufly on the ftomach. 2dly. Mechanical diftention and friftion. 3dly. Various pow- ers that aft primarily upon fome other part : this I have added to the two former, rather to make the fubjeft complete, than becaufe it is ufed. Of Medicines. It is very certain that all emetic medicines do not have their effect by an identical modus operandi, for medicines of quite oppo- fite qualities are found to have this fame effeft. Although I am unable to diftribute emetic medicines into their proper claffes, yet [ 7 3 yet I think there is a fufheient foundation for making three dif- ferent claffes: as, the Irritating,—the Stimulating,—and the Sedative :—on each of which I mail fay a few words. Of the Irritating. Under this clafs I confider fuch medicines as determine the vital principle, to the parts which we difcover to be principally excited in vomiting, with great celerity, compared with the na- tural determination : their effefts are, quick and powerful vo- miting. This determination they may bring about by having an immediate attraction for the vital element, or by having an attraction for the components of the ftomach, (as efcharotics have) which will not fail to have a powerful effect on the nerve* there inferted. Of the Stimulating. To this clafs belong fuch emetics as have but little more at- traction for the vital element than fome of the natural ftimuli have : they produce aftive, though not harfh vomiting, at fome diftance of time after being taken. Such an effeft they may have from the fame caufes as the former, only being milder; efpecially in the latter cafe, for thefe never deftroy the folids though they may have a tendency, and thus have confiderablc power on the nerves. Of the Sedative. Such medicines have a place in this clafs which have no di- reft tendency of themfelves to excite the vital principle, yet by an indireft means they produce vomiting : as by relaxing the in- ternal coat of the ftomach, and thus allowing the natural ftimuli to act upon fuch parts as they were naturally excluded from, and thus produce an uncommon determination that way. Such medicines may relax by having a power to folve the folids, as for inftance, warm water, oils, &c. and probably there arc other means which are not fo well underftood. Mechanical Diftention and Friction. As motion in all parts of the fyftem exhautts the moving power, it is evident that it alfo mult keep up an afflux of that fame power to the different parts. As that then is the cafe, it is eafily conceived how diftention (which in faft is the fame operation) fhould be attended with a like effeft, and caufe a determination equal to its degree: bo- dies of water are what we generally apply for the purpofe: over-eating afts this way. Friction differs little from diftention in its mode. In this the diftention affects the whole fibres immediately; in that only the eminentias are diftended which communicate their action to the [ 8 ] the parts in conjunction. Friction, though it is fometimes appli- ed accidentally to the ftomach, yet it feldom or never is applied purpofely for vomiting to any other part than to the cefophagus. Of the various Powers that act primarily on fome other Part. These I think may be juftly divided into two claffes ; i. Such as induce or confift in an evident increafe of aftion in fome con- tiguous, connected or fympathizing part; 2. Such as confift in adefeft of aftion over a large fhare of the fyftem. Of the firfl: clafs are inflammations, fpafms, or irritations in different parts of the fyftem, which by foliciting an increafe of the moving power to themfelves, do it alfo to other parts which being more capa- ble of aftion, fhew the effefts more evidently than the primary affected parts; this niay be done either by contiguity, or by affect- ing the nerves leading to the ftomach and parts concerned in vo- miting. Of the fecond clafs are, great debility, violent fnocks, fear, difguft, &c. all of which induce a ftate of debility over the cor- poreal fyftem ; by which means vomiting is produced, in the fame manner, as is done by fedative medicines. In fuch cafes as the above, the ftomach or the arterial fyftem conftantly re-aft, as being more fuited or capable of re-aftion than any other parts. With this I conclude what I have to fay on the Theory. THE PRACTICE. I. A SHALL begin with the mbft fimple, and probably the molt original ufe of emetics, which is to evacuate fuch fubftan- ces as will prove noxious in the ftomach. When fuch a fubftance has been taken, and it be advifeable to ufe vomiting, we are to proceed to it immediately. If an inftantaneous evacuation is required, we had beft try fric- tion to the cefophagus with a feather, but it it admits of delay, we may ufe ipecacuana, which may be given on any fubftance and with any antidote, without fear of a decompofition. How- ever, there are fome cafes which require rather more fpeedy eva- cuation than ipecacuana is fuited to give ; in fuch cafes the zin- cum vitriolatum may frequently be ufed to advantage. The dofe of zinc. vit. is from two grains to thirty. The dofe of ipecacuana from ten grains to thirty.' II. Inflam- [ 9 1 II. Inflammatory Fever. Such a fever in its higheft degree, uncombined with topical affeftion, is a rare diforder in this country ; and in fuch cafes, probably, emetics might not have a place ; but in thofe of lefs magnitude, and efpecially when children or youths are the fub- jeft 5 of it, as is moft commonly the cafe, emetics are proper me- dicines, and fhould in general be ufed with or without bleeding, as the circumftances of the patient's age and degree of affeftion may direft. For this we have the advice of many eminent practitioners. Anti monium tartarizatum is one of the beft ; and to render its effefts permanent and more general, it fhould be given in do- fes of about one third of a grain, every eight or ten minutes, and continued till it vomits fufficiently. As the tafte of it is dif- agreeable to fome people, it may be diffolved in apple-water, which effectually deftroys the tafte. By this medicine, the primae viae is excited ab ore ufque ad anum ; the furface is relaxed; and often a permanent fweat is produced, by which a perfeft victory is gained over the fever. III. Putrid Fever. Although vomiting is frequently fpontaneous at the begin- ning of moft putrid fevers, yet it does not contra-indicate eme- tics ; for it is the product of a debilitated primee via;, excited by a quantity of offending fordes; to difcharge which, excite the ftomach to a proper aftion, and roufe the vital fyftem, eme- tics are properly fuited. They fhould be given at the com- mencement of the difeafe. Only the gentler kinds are to be uf- ed, as ipecacuana ; vinum ipecac, from a dram to half an ounce, vinum antimouiale, from twenty to one hundred and twenty drops ; or a combination of ipecacuana and tartar emetic ; as eight grains of the former, with half a grain of the latter ; thefe are feldom or never to be repeated. IV. Nervous Fever. This fever appears to have a greater claim to obftruftions, as a caufe, than any other : to remove which, break the peculiar actions which conftitute the diforder, and roufe the aftions of the fyftem, emetics are well adapted. For this purpofe a gen- tle emetic of ipecacuana is often of fervicc when {riven in th^ beginning. V. Remittent Fever. In fome cafes of this fever it becomes neceflary to flop the fpontaneous vomiting. In fuch cafes it would not be advifeable to exhibit an emetic ; but in moft cafes, where there is only naufea and vomiting that is troublefome from continuance, ra- ther than excefs, a gentle emetic, properly adminiilered, will B be L 10 ] be found to put a period to it, by evacuating the bile, and re- mitting the violence of the fever. James's powder, in dofes of five or fix grains, every twenty minutes, repeated according to events, or fulph. au. ant. in dofes of two grains every hour, are fuch as have proved ufeful. VI. Intermittent Fever. The ftated returns of intermittents, adpim£tum temporis, clear- ly difcover to us, that an identity in the ftate of the fyftem, is requifite to their recurrence, and the continuance of them after the removal of the remote caufes that induced them, as plainly fhew the power that habit has in their returns and continuance. Under thefe circumftances, I may enquire what promifes fo fair, and at fo little expenfe to the fyftem, to interrupt that peculiari- ty, break in upon a wrong habit, and relax the fpafm that forms the firfl ftage, as emetics ? Reason and experience both concur in direfting the emetic at the acceflion of the cold ftage. The antimon. tart, given in the manner directed in II. is the moft eficctual, and fhould be preferred except in very irritable ftomachs, where ipecacuana will be fufheient. VII. Cynanche Tonfillaris.. We fhould not expeft, a priori, that emetics would be either ufeful or admiflible in this affeftion, but experience fpeaks the contraty. In the beginning is the time of adminiflering the e- metic. By it, a free perfpiration is opened, upon the obftruftion of which the diforder is founded, and by the aftion of the fto- mach a determination is made to that, and confequently from the feat of the diforder, whilft the fmall aftion of the mufcles about the throat is infufficient to counteraft the falutary aftions of other parts. The emetic fhould be more or lefs powerful, and continued, according to the neceffity of the cafe, and the patient's habit. VIII. Cynanche Trachealis. This is almoft peculiar to children, and in fome meafure, from their inability to difcharge the collefting mucous from the trachea. To throw off this, to give the fecretions another de- termination, and to excite the torpid primae viae, emetics are fo ufeful and flrongly indicated, that many phyficians ufe nothing more. From the great infenfibility, powerfuland repeated emetics are requifite. Scarce any lefs than four grains of tartar emetic can be expected to operate fufficiently on a child of two or three years old ; and when this is given we may proceed to fomething e'fe, if requifite. Fcr a fecond medicine the zincum vitriolatum may [ II ] maybe ufed, one grain every fifteen or twenty minutes for four or fix times. IX. Peripneumonia Notha. Doctor Cullen recommends emetics in this diforder. They certainly are indicated to loofen and difcharge the tough phlegm with which the patient's lungs are generally oppreffed ; and they will be ufeful in putting an end to the naufea with which the ftomach is much affefted. From the ftate of patients affefted with this diforder, the vomiting fhould be gentle and of fhort duration ; hence ipecacuana, vin. ipecacuance, vin. ant. and ox- ymel of fquills are thofe in ufe. The latter is preferred by fome, but upon no fubftantial reafon. The dofe is from half a dram to two drams, and that of the powder of fquills from one to three grains. X. Gout. Emetics are prefcribed as an incipient medicine to remove the dyfpeptic fymptoms, which often return, and are very trou- blefome to thofe who have been much afflicted with the gout. The gentle ftimulating kinds are fuch as are ufed : none aniwers better than vinum ipecacuance. XI. Scarlatina. Some would have this diforder to proceed from the fame caufe as the cynanche maligna, and it is poflible that it may; but it differs from that in fymptoms, nearly as much as this does from the cynanche tonfiilaris. By the fcarlatina, I mean a diforder that has nv.ich more inflam- matory aftion, lefs putrefcency, and a {lighter affeftion of the throat than that affeftion which conftitutes a cynanche maligna. Some have directed bleeding as an incipient prescription, whilft others order the bark immediately ; but probably, a better way than either is to begin with a gentle emetic j for the ratio of which I refer to what I have faid in III. and VII. XII. Phthifis Pulmonalis. The ufe of emetics in phthifis is pretty well known. It is only the incipient phthifis that indicates them ; and even here they are not always admiflible, which is to be directed from a knowledge of the caufes. Dr. Reed, who has written on this diforder, fpeaks highly of them. I cannot adopt his theory of the diforder or the cure ; but had rather fuppofe, that the afti- on of the ftomach induced by vomiting, interrupts or fufpends the morbid aftion of the lungs. Ipecacuana in dofes of eight or ten grains repeated feveral times, is a proper medicine. If it be cczitiaucd in very long, it will [ I* ] will be apt to do more injury to the ftomach than good to the lungs. XIII. Menorrhagia. When this is of the aftive kind, it is always fupported by a particular determination to the affefted parts. In fuch cafes, emetics in naufeating dofes fhould have a place; as being medicines extremely well fuited to take off that determi- nation, and relax the arterial fyftem. Either antimonials or ipecacuana may be ufed, as the colla- teral fymptoms may indicate one or the other. XIV. Amenorrhcea. When this depends upon a checked perfpiration, or what is termed taking cold, emetics are proper. By them the heade.ch, naufea, fluggifhnefs, and every bad fymptorn is removed, together with the obftruftion on which it nYpends. Such an emetic fliould be ufed as will prove aftive, and yet not operate rough: as eight grains of ipecacuana with a, grain of tartar. XV. Catarrh. There are two fpecies of catarrh; one proceeding from con- tagion, ufually called influenza, the other from uncommon ex- pofure to cold, efpecially after being heated. The former ap- pears in fuch different ftates, that what is requifite in one cafe would be pernicious in another; that is, with refpeft to reduc- ing the fyftem. But in all cafes emetics may be fafely employed at one time or another ; and in general they fliould be the firft prescription, I am a witnefs of their good effefts. They per- fectly interrupt the morbid fecretions or determinations, and they put a period to the moft difagreeable fymptoms and fenfa- tions of the diforder. In the Edinburgh commentaries, where emetics are highly fpoken of, a combination of the ipecacuana and tartar emetic is recommended. In many cafes of common cold they are ufefij to the fame end as above. Here fome prefer oxymel of fquills; but their ufe does not warrant a better effeft than is to be obtained from ipecacuana. XVI. Dyfentery. In this diforder, the fyftem labours under a confiderable py- rexia, fuperadded to a topical affeftion of a part of the intelti- nal canal; but although that be the cafe, the ftomach is ufually in a collapfed ftate, and hence, in the early ftate of dyfentery is ufually affefted with naufea. By giving fmall dofes of emetics and repeating them according to the neceffity, the aftion of the prima? vis is rendered more equal, and cleared of its offending , contentsj [ 13 1 contents ; whilft the fever, which adds much to the affeftion, is counteracted, and reduced by the fame medicine and at the fame time. This practice beft fuits the beginning of the difeafe, when it is moft plainly indicated. Some are in favour with the cuftom of giving one, two, or three grains of ipecacuana twice a day; while others direft three or four grains of tartar emetic to be diffolved in a quart of warm water, and taken in fmall portions, fo as to be confumed in the courfe of a day. James's powder in fmall dofes is alfo a favou- rite medicine. XVII. Apoplexy. Emetics have been prefcribed by fome in this diforder, par- ticularly by Dr. Fothergill. It is the apoplexia ferofa that they are ufed in. They muft operate by their equalizing properties; and as having fuch properties, they may have a like good effeft in the apoplexia atrabiliaria, and apoplexia cataleptica of Dr. Cullen. An emetic of quick and confiderable aftion fhould be thrown down at once; for which end twelve grains of zincum vitriolatum may be given at once, diffolved in a little warm wa- ter : or any other proper emetic. XVIII. Palfy. The caufes of palfy are numerous ; fome admit of no remo- val, others have no indications for fuch changes as emetics could produce : but there are fome few cafes that are faid to depend upon fuch obftruftions, as are removeable by a proper agitation of the fyftem. In fuch cafes, it will in general be prudent to try the effefts of vomiting. To this end, half a dram or a dram of milliard may be given, which promifes to give an additional fti- mulus to that of vomiting, and if its effefts are favourable, let it be repeated pro re nata. XIX. Epilepfy. There are fome cafes of epilepfy, which depend upon a ps- culiarity of conftitution that admits of a repetition of the parox- yfm upon very flight changes. The flight changes that the lu- nar revolution effefts, are fuppofed to be fufficient to excite them. If it is not, it admits of no doubt that they are apt to return at nearly ftated periods, and hence when we difcover the predifpo- fition, a clear indication is offered to make fome change in the fvftem, to interrupt the morbid procefs, which a fmart emetic at that time is found to do, with the advantage of fubverting the threatening paroxyfm, and doing the fyftem no injury of itfelf. By this means an opportunity is gained Of altering that ftate of the fyftem upon which the diforder depends, XX. Chorea. [ 14 1 XX. Chorea. Vomits are here prefcribed, both to break up that determi- nation of the nervous principle which conftitutes the proximate caufe of the diforder, and to reduce the fyftem which is laid down as an indication to check the predifpofition. The emetic fhould not be rough, but fuited to the age and habit of the patient. XXI. Afthma. I have known a gentle emetic, given at the accefiion of a fit of the afthma, fo to interrupt it, that a flight fit of half the ufual length was the confequence. It is perfeftly fafe, and Scarce ever fhould be omitted when the predifpofition takes place. XXII. Dyfpncea. There are feveral fpecies of dyfpncea where emetics may be ufeful, and fome where they may be hurtful. The dyfpncea catarrhalis appears to indicate them more clear- ly than any of the other fpecies, whilft there is no place for them in the dyfpncea pinguedinofa, the dyfpncea thoracica, or the dyfpncea extrinfeca. XXIII. Hooping Cough. Almost every praftitioner prefcribes emetics in this com- plaint, for the ratio of which I refer to what I have faid in XX. They fliould be of the gentler kinds, and repeated frequently j The quantity is to be adjufted to the patient's age. XXIV. Hyfteria. An irregularity in the primae viae, which depends upon a col- lapfed ftate of it, appears to be the foundation of hyfteric fymp- toms. To put an end to them fpeedily is a defirable objeft ; and I am informed from good authority, that a dofe of ipecacuana, or any other fuitable emetic, will have that effeft. As white vitriol is a proper medicine in thefe cafes, exclufive of its eme- tic property, and alfo afts very fpeedily as an emetic, it is pro- bable that a few grains may be better adapted to this cafe than any other emetic. XXV. Mania. Emetics have been prefcribed in mania, with benefit. It is the mania corporea of Dr. Cullen that indicates them. It is certain that mania fometimes alternates with other affeftions of the fyftem ; and hence it is poffible that it may yield to an infli- cted inoffenfive aftion. XXVI. Dropfy. [ 15 1 XXVI. Dropfy. From the fuccefs of Dr. Home (vide Clin. Exp.) in feveral cafes of anafarca hydrothorax and afcites, with emeti cs, they are well worthy of a trial. The peculiar circumftances of the cafe are to direft us in the ufe of them. No benefit can be expefted in a cafe of hydatides ; nor can we hope for much more in that fpecies termed hydrops facca- tus. Emetics give a determination of aftion and fecretion to the ftomach, and thus at once may aim at the caufe, (if that be ex- cefs of aftion) and the diforder. Dr. Home ufed fquills, but they may not be better than ipecacuana. XXVII. Jaundice. In that fpecies of jaundice called ifterus calculofus, it is pro- bable that emetics may be often Serviceable to expel the calculus from the duft into the duodenum ; but in cafe they do not effeft that, they may prove hurtful by urging the calculus into or along the duft, falter than the duft can yield, and thus bring on an inflammation, to the great difadvantage of the patient. As we can never know, a priori, the fize of the obftruftion, we fhall al- ways be at fome rifque ; and therefore fhould try only the gentle emetics. XXVIII. Hernia Humoralis. Mr. Falc, who has written exceedingly well on the gonor- rhoea and its attendants, recommends in this cafe an emetic of ipecacuana and calomel, as a fpeedy and fure relief. Many other phyficians have alfo recommended them. Swedeaur has fhewn, that it will alternate with the affection of the urethra, and why may it not yield to any Other aftion ? XXIX. Ulcers. The blue vitriol was fome time paft ufed among the common people as an univerfal noftrum. It was tried for old ulcers, and certainly proved ufeful in fome defperate cafes. They took from ten to eighteen grains at a dofe ; and from their own informati- on given me, it always proved a gentle emetic, vomiting with- out producing the common antecedent naufea, as other emetics. However, I fhould never recommend above two or three grains. In venereal ulcers the gratiola has been greatly praifed, which generally vomited: Its dofe is from ten to thirty grains. XXX. Anorexia. In the anorexia humoralis, as well as in the anorexia atonica, emetics are an excellent remedy ; their ufe is fo well known, that the patient? generally propofe the medicine themfelves : a gentle emetic [ 16 ] emetic is fufheient. By the aftion of vomiting, the ftomach re- gains its due aftion; the lofs of which is the foundation of the complaint. Here I beg leave, to prevent feeming contradiction, to infert v ,.tt appears to be a law in animal motion ; which is, that when any organ below a due excitement, not depending upon a primary laxity of the folids, is thrown into a confiderable aftion, it ufu- ally retains a confiderable fhare of aftion compared with what it did before ; but when an organ poffefling its proper aftion is preternaturally excited, it is left in a ftate of lower excitement than natural, provided it has not been carried to an inflammati- on or fpafm. With this I choofe to condude my Thesis, left I fall into the common error of ftraining the fubjeft ; trutling, that I have omitted few cafes where emetics are plainly indicated ; or, where though not plainly indicated, yet have been found ufeful from experience.