Volume 6

The cyclopædia of practical medicine. Comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc. etc / Edited by John Forbes, Alexander Tweedie, John Conolly.

Date:
1833-1835
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopædia of practical medicine. Comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc. etc / Edited by John Forbes, Alexander Tweedie, John Conolly. Source: Wellcome Collection.

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    missible in the advanced stage of pregnancy. The spontaneous vomitings which attend the early stage of pregnancy are sufficient guaran- tees of their safety at that period. In diseases of debility, and in weak and delicate subjects, emetics, especially those which nauseate, should be carefully avoided. Experience has also proved that the frequent employment of emetics 1S injurious, producing general debility, and such an irritable state of stomach that it isexcited to vomiting by the most trifling causes, even by changes in the nature of the food ; indeed no means are so likely to induce dyspepsia as ,the custom of taking frequent emetics.* With respect to the period of the administer- ing emetics, much must depend on the circum- stances of the case which demand their employ- ment. Imfthere be no immediate urgency, the evening is the best time; for as the body is always more or less exhausted by the operation of an emetic, the tendency to sleep which su- pervenes can then be readily indulged. Atten- tion to the period for administering emetics is particularly requisite in febrile affections. Thus when they are necessary in continued fever, the time of day for administering them with most advantage must not be overlooked. In almost every continued fever there is a mid-day and ang an evening exacerbation. These are not always very obvious; the evening one, how- ever, is the most so; and its approach is marked by increase of pulse, thirst, headach and dry hot skin. Itis immediately prior to this acces- sion that emetics will be found most useful, sometimes checking it altogether, at other times at least diminishing its violence. In reference to the operation of emetics, we may remark that the dose of the emetic sub- stance should be sufficient to produce full vo- miting, otherwise nausea and restlessness, in- stead of vomiting, will follow the administra- tion of the medicine. It is the custom to order warm water to be freely drunk during the ope- ration of an emetic. ‘This certainly promotes its action if the fluid be taken after each time of vomiting ; but it is requisite to be cautious that too much is not taken at once. The sto- mach, when oppressed with water, does not yield to the action of the muscles which are ex- cited to produce vomiting, thence it is in danger * This remark is, apparently, at variance with the custom of the Romans. Emetics were daily taken to enable them to relish the enjoyments of the table; and so far did the Romans carry this custom that they sometimes excited vomit- ing to eject from the stomach what they had eaten in one course, that they might be the more ca- pable of enjoying what was to follow. According to Seneca, ‘‘ they vomited that they might eat, and ate that they might vomit.”? They employed emetics before meals that they might be able to eat more plentifully ; and they often concluded a feast with an emetic to prevent the consequences of gluttony. In one of Cicero’s epistles to Atticus, he describes a visit which he made to Cesar, at his villa near Rome; and states that his dignified host paid him the compliment of taking an emetic before dinner when he understood that Cicero intended to spend the day with him. + Some of the old writers, Stoll in particular, re- gard the period of the day as a matter of indiffer- ence. Rat. Med. 11. of laceration. There are several instances on record of this having occurred ; but it may be questioned whether rupture ever happened, un- less the organ was previously diseased? The quantity of fluid for an adult should not exceed two thirds of a pint at a draught; it should be tepid, and, if the stomach be weak, some bitter infusion, as, for instance, that of camomile flowers, or a few drops of liquor ammonia in tion of the emetic. If the vomiting be severe and long-continued, it may be checked by solu- tions of neutral salts; sulphate of magnesia for example, or citrate of potassa, formed with the carbonate of potassa and fresh lemon-juice, given in a state of effervescence ; or a teaspoon- ful of magnesia may be given in a glass of sherry ; or solid opium or hydrocyanic acid may be administered in small doses.* All substances employed to excite vomiting may be arranged in two classes—direct and indirect emetics. I. Direct emetics are substances which cause vomiting by an immediate impression on the nerves of the stomach. It may be asked how can this take place, if the stomach be a passive agent in the act of vomiting? We reply, that by the term passive agent we do not mean to assert that the stomach is insensible to the sti- mulus of all emetic substances; on the con- trary all irritants, whether chemical or mecha- nical, are capable of stimulating the stomach to vomiting ; but, nevertheless, in this operation, the stomach is not the active agent. This seem- ing inconsistency may be thus explained. When the stomach is in the performance of its natural function, the digested food is pushed forward to the pyloric orifice; but if the chymification be not complete, it is again thrown back into the fundus, and occasionally into the pharynx, producing eructation; a circumstance, how- ever, which occurs only when the secreted juices of the stomach are in a morbid state; and, under this condition, the ejectment resem- bles in every thing but degree that produced by emetics. In a similar manner, when a large dose of sulphate of zinc, for instance, is swal- lowed, its immediate application to the nerves of the fundus of the stomach, produces a spas- modic contraction there, which throws the whole contents of the viscus mixed with the sulphate upon the pylorus; but these are as rapidly re- turned, even before the relaxation which must follow the spasmodic contraction have taken place; and by this means, the emetic substance being applied to the nerves of the cardiac por- tion of the stomach, the muscles and every other part necessary for effecting vomiting are simultaneously called into operation, and vo- miting takes place. This is the opinion of the writer of this article, and he conceives that it is the only theory capable of explaining the imme- * Many other means may be employed to check vomiting; as, for instance, the administration of subnitrate of bismuth, infusion of calumba, strong coffee, tincture of capsicum diluted with water, in that induced by pregnancy and sailing ;—a large dose of calomel, and dry cupping on the epigas~ trium.