with ipecac. If for any reason there is difficulty of administration, apomorphia may be given subcutaneously.

When poison has been taken, the nearest emetic is the best, and those just mentioned, or mustard, if at hand, followed by large draughts of warm water and tickling of the fauces, are indicated. If a person is so thoroughly narcotized that emetics do not act, it may be possible, even by a temporary rousing by the cold affusion, pain, or the faradic current, to bring the nervous centres controlling the act of vomiting up to the point of responding for a moment to the stimulus applied.

In diseases of the respiratory passages, and especially in laryngitis (croup), where emetics enjoy a great popularity, there are several indications which are fulfilled. Removal of mucus from the fauces affords in young children, who are not able to clear the throat effectually, a measure of relief.

The long and deep inspiration preceding the act of vomiting, and the vigorous compression of the lungs by the muscular efforts involved, probably help to expel mucus from the bronchial tubes, and when false membrane is loosened and nearly detached, may finally dislodge it. It should always be distinctly remembered, however, that false membrane in place, and adherent to the inner surface of the larynx and trachea is very slightly, if at all, acted on this way.

The considerable quantities of mucus often thrown up by children with bronchitis, after the administration of an emetic, are not directly from the bronchial tubes, but have been mostly accumulated in the stomach by swallowing.

Probably all forms of laryngitis are attended by a certain element of spasm which produces temporary exacerbation of dyspnoea, and the relief often afforded by emetics is due to the muscular relaxation attending their action, in addition to the removal of mucus. It is obvious that the removal of mucus and the relief of spasm by the operation of an emetic cannot be looked upon as essential to a cure in a disease known to be so little dangerous to life as ordinary catarrhal laryngitis; and, on the other hand, it is unfortunately true, that only temporary relief is to be obtained by the same means in pseudo-membranous laryngitis.

The praises of various emetics as "cures for croup" have undoubtedly been based either on ignorance of this vital distinction or want of accuracy in diagnosis. There is no good reason to suppose that any emetic, or one emetic more than another, or any system of medication of which emetics form an important part, is either necessary to the cure of catarrhal or effectual in the cure of membranous croup.

In choosing an emetic to fulfil the indications mentioned above, the non-depressing ones should be chosen; and, although tartar emetic would, for its more long-continued action in producing muscular relaxation, be theoretically indicated, it is of

so much importance to husband the strength of the patient, that this drug is specially to be avoided. Sulphate of copper or zinc and ipecac make a list long enough for practical purposes.

In the bronchitis accompanying low fevers, a quick and nondepressing emetic may be of value in removing accumulated secretions and procuring freer respiration.

As among the means employed at the beginning of acute diseases, to break up, as it is called, a fever, emetics are of value only so far as morbific material may be present in the stomach, but as the presence of such material after the lapse of time during which symptoms are being developed in the stage of incubation is extremely improbable, the usefulness of the emetic may be considered equally so. Clinical observers, however, of high reputation, have thought that the course of a typhoid fever was materially shortened by a dose of tartar emetic during the first day or two.

Emetics, especially the tartrate of antimony, have been used to produce muscular relaxation in cases of dislocation and also of unyielding os uteri. They have, however, for both these purposes, become entirely obsolete, and superseded by anæsthetics.

SECTION IX.

CATHARTICS.

Kadapris, a cleaning; Kaðapós, clean.

These are drugs which increase the activity of the intestines, as shown by more frequent, more copious, and more watery discharges. These effects may be produced in two ways. Simple increase of peristalsis, especially in the large intestine, by hurrying along the intestinal contents, which arrive at the cæcum in a liquid condition, before they have had time to undergo the usual concentration by absorption of some of their water, may cause an apparent increase of secretion when such has not taken place. This increased rapidity is shown by the sensations of the patient, by observation of cæcal fistulæ, and by the chemical detection in the feces, of substances found, when normal peristalsis is taking place, only in the upper part of the intestines.

Increased secretion can be proved in the case of certain drugs by analysis of the intestinal contents and by observation in the lower animals of separate loops of intestine, one containing the cathartic while others are left empty for purposes of comparison.

Some catharties, when given with a considerable amount of water, prevent this water from being absorbed, and thus augment the amount of fluid in the intestines. While it is probable that all cathartics increase peristalsis more or less, it is only a portion which materially increase the secretion.

lu a general way it may be said that the mechanical catharties, resins, glucosides, and oils, especially affect peristalsis, while the salines, organic acids, and perhaps mercurials stimulate the

secretions.

No portion of the alimentary canal can be considered entirely independent of the rest. Mary emeties produce a certain amount of catharsis and the action of powerful catharties may interrupt digestion or provose nausea and vomiting.

The irritation of the lower part of the intestines undoubtedly causes increased peristals's from a point considerably above that to which it is dirty applied. This is the case with enemata and rectal supposterica

Absorption of a portion of some cathartics and elimination by other organs way take place, but the amount se slscrbed is

MECHANICAL CATHARTICS-FICUS.

101

usually slight. In the case of the salines, however, if they fail to act as cathartics, a very considerable portion passes into the urine. A few drugs produce slight cathartic effects when injected into the circulation, but never so promptly or easily as when placed in the intestinal canal. There is no drug which can be practically so used. The cathartic analogue of apomorphia is yet to be found. Tobacco, perhaps, approaches the most nearly to a specific cathartic, but has many obvious disadvantages.

The number of cathartics is very large. In the following list the attempt has been made to arrange them somewhat in the order of increasing activity, although this order is frequently departed from for the sake of bringing into the same group substances closely allied chemically or botanically.

MECHANICAL CATHARTICS.-Chiefly Laxatives.

[COARSE MEAL.] If the portion of the cereal grain nearest the outside is included in the flour, it is somewhat richer in gluten, and also contains a larger proportion of indigestible residue, which acts as a mechanical irritant. If such food does not have the desired laxative effect, its use should not be too long continued, lest there be an accumulation of the residue. Such meal may in some persons produce gastric disturbance more than sufficient to counterbalance the good it might do in the lower intestines. Oatmeal and Graham flour are the most common examples of this class. Hominy may be mentioned also. [FRUITS AND GARDEN VEGETABLES.] There are more or less indigested portions (cellulose) present in many fruits, and these, with the water and vegetable acids, tend to increase intestinal activity.

PRUNUM.-Prune.

Pflaumen, Zwetschen, G.; Prunes, Fr.

The (dried) fruit of Prunus Domestica (Nat. Ord. Rosacea, Amygdaleæ). Sweet, acidulous, containing 12 to 25 per cent. of sugar.

A well-known table fruit, used either uncooked or stewed. For medicinal purposes sometimes stewed with senna, when they are less disagreeable than might be supposed.

FICUS.-Fig.

Carica, Ficus Passa, Fici, Fructus Carica; Figue, Fr.; Feige, G.

The fleshy receptacle of Ficus Carica (Nat. Ord. Urticaceae, Artocarpeæ), bearing fruit upon its inner surface.

Contains fruit sugar (62 per cent.), and considerable indigestible matter, chiefly seeds. A well-known fruit, used in the dry state.

Already described. The seeds are used whole, in Doses of a teaspoonful.

[SHOT AND BULLETS] are said to have been used in a similar way.

HYDRARGYRUM. -METALLIC MERCURY,

when administered in considerable quantity, as is sometimes, though rarely, done, acts solely by its mechanical properties.

As important adjuvants to this class of cathartics, we should consider the effects of the habit of encouraging an evacuation of the bowels at a regular time every day, and of exercise, both active and passive. Those forms are naturally most valuable which bring into play the abdominal muscles and promote the circulation in the abdominal organs. Kneading of the bowels by the hands of the patient is of great value. The faradic current may also be used, directed either from one electrode in the rectum to the outside of the abdomen, or between two electrodes at different and changing portions of the surface.

ENEMATA are used either simply to wash out, soften, and lubricate fecal masses in the lower intestine, or, by exercising more or less irritating effect, to provoke the intestine to contraction. A small enema of cold water at a regular hour is often a sufficient provocative of a natural dejection. When larger ones are needed, warm water alone, or with the addition of soap or molasses, or salt, is generally employed. The patient should lie down upon the left side, and the fluid be allowed to enter gently without air, and not too rapidly. The force of gravity, as in the "fountain syringe," avoids jerkiness and the injection of air; but the same objects may, with some care, be accomplished with an ordinary elastic bulb syringe. The tube in ordinary use is a short one, but when it is desired to have the fluid go as high up as possible, a longer and flexible tube is to be used, made either of the woven and oiled texture specially employed for this purpose, or the still more flexible soft rubber. Each may have its advantages under special circumstances, but the latter can better follow the curves of the intestine, and with it it is almost impossible to do any injury.

Oil, either olive, cottonseed, or other, is often of value in this way. It is not worth while to attempt to mix it with water, but to give the oil, a pint or more, first, and then follow with water. Castor oil, or oil of turpentine, may be added, if it is desired to make it a little more stimulating.

pose

Suppositories may be introduced into the rectum for the purof exerting an irritant effect which is to be propagated to regions higher up. Soap is occasionally used in this way, especially with infants.