such effect to its sedative agency. It is not always easy to separate these effects; which seem, indeed, to depend concurrently upon the same cause acting on the nervous system. But there is enough to show the sedative action to exist independently of this, in the fact that it occurs where the nauseating effect has either not taken place at all, or been removed.

The state

But there

It must be allowed that there are many singularities in the influence of this medicine as an emetic, and that we yet only partially understand the conditions which so variously modify this quality. The mode of administration is, doubtless, in part concerned; and particularly as regards the quantity of the fluid vehicle in which it is given. of the stomach itself is another of the conditions. is also an influence derived from the general state of the body at the time; attested, as I think, in the case of fever; where, according to my experience, there is less effect from given doses in producing sickness, than when this state is absent. The same conclusion seems to be justified regarding its employment in inflammatory disorders. And further, it is manifest that a habit is acquired as to the medicine, lessening or wholly removing effects that have occurred on its first use; so that vomiting or nausea, very harassing in the outset, may cease to disturb the patient, even though the same doses are continued as before.

The influence, indeed, of dose and manner of employment, curious and important in all cases, well deserves notice here. Our practice in England (limited, as I have said, by older views) seldom goes beyond such use of them in inflammatory disorders, as to sustain nausea for a time, and thereby repress the circulation; and even this intention is often made subordinate to the forcing of perspiration, as a means of relief. It is certain that the full value of the medicine is not thus

The latter circumstance might perhaps have been inferred, prior to all experience; but it is confirmed, as a fact in pathology, by instances exceedingly numerous, and often very remarkable. Besides those appertaining to the organs just named, we have many and striking examples in the urinary and generative systems, in the joints and muscular

tissues, in the secreting organs, &c.

And it may be to this

And it.

certain cases — as, for

principle we shall eventually refer instance, the singular metastases occasionally occurring in cynanche parotidea - which are wholly anomalous to our present knowledge, yet definite enough to prove a specific cause, the proper subject of future investigation.

The metastases whether in the form of inflammation, congestion, or other morbid action which are conjoined with, or depend upon, morbid states of the blood, are certainly amongst the most extraordinary phenomena of disease. Without repeating details, I may refer generally to what has been said in former chapters, regarding those translations in gout, scrofula, and other constitutional disorders, which, though they indicate simply various modes of development of the same cause of disease, come fairly under this denomination; and manifestly include many affections hitherto differently named, and ascribed to different causes. For, however varying in aspect or importance, we are not entitled to separate in principle those metastases which occur suddenly, from such as occupy a longer time in the transference of disordered action to another part. In each case the blood must be the medium of translation, and the difference of time is one merely of degree. This manner of regarding the subject is essential to the inquiry; and it will be found to confirm the inference, drawn from other sources, that the effects of a simple morbid matter, present in the

blood, may show themselves in forms greatly more varied than is yet presumed in the theory of disease.

-

Another point worthy of more notice than it receives, is the state of the body during what may be called the act of metastasis ; — that is, while the morbid matter, wholly or partially dislodged from one seat of its action, is in passage through the circulation to another part. It is certain, on observation of such cases, that during this time of transference, whether longer or shorter in duration, there is often a very notable disturbance of the heart, of the nervous system, and of various organs seemingly out of the ordinary course of the disease; which disappear, when the symptoms are again locally fixed. I find in my notes many curious examples of this fact; drawn not only from the familiar occurrences of gout, but from numerous other disorders, erysipelas, psoriasis and other affections of the skin, certain strumous swellings, &c. The phenomena of the exanthematous fevers, and of all translations between the skin and internal membranes, afford instances to the same effect. The general fact might have been anticipated, seeing the certainty that every such passage of morbid matter (whether foreign to the blood, or an excess of some of its ingredients) must be through the circulation alone, and that its influence cannot be wholly dormant during this time. But I wish to draw attention to it, as one well meriting further observation, and leading to inferences beyond those which appear on first view of the subject.

Closely connected with the same general view of metastasis, are those cases, equally numerous as remarkable, where the translation forms what has been termed a critical termination of the malady; of which the abscesses occasionally occurring in fevers, and towards the close of many other disorders, are

attained; and though we yet want proof of the efficacy or need of the large doses of emetic-tartar employed by some of the Continental physicians, it seems certain that those we use might beneficially be increased in relation to their sedative effect.*

The best test we have on this point is to be found in the objects for which we adopt the treatment; viz., the diminished action of the heart and arterial system, or the removal of some active irritation of the brain or other organ. In looking to this test, as well as on other accounts, it is very generally expedient to give the medicine under its simplest form. With a powerful agent of definite purpose in our hands, combination ought rather to be regarded as an exception than a rule of employment; enfeebling for the most part, the principle of treatment, and perplexing its results. I have elsewhere alluded to this maxim in practice, which, admitting all the needful qualifications, is still important enough to warrant a constant regard to it.

In the instance of emetic-tartar, its combination with opium is undoubtedly that which most merits notice. This seems a fair example of a compound acquiring powers, which do not equally belong to either of its component parts. Its value is attested by the observation of many physicians, particularly in cases of mania and cerebral irritation; and my own experience entirely concurs in this respect. In cases more strictly inflammatory in kind, whether pneumonia, bronchitis, rheumatism, or inflammation of the membranes of the brain, the same combination is often useful; but under more re

*The doses of those French physicians, whose practice is best authority (one or two grains, so repeated as to extend from 5 to 20 grains in the twenty-four hours), may be assumed as affording every scope to the beneficial use of the medicine in different cases. The maximum quantity here little exceeds what Rasori sometimes gave for a single dose.

serve, both as to the period of the disorder, and the propriety of bleeding as a previous remedy. The difference of opinion respecting the fitness of combining opium with the antimonial in such cases, arises probably from the different attention given to the latter points. Whether with or without emetictartar, it cannot safely be employed where bleeding is required. But allowing for its unfitness in these instances, I still believe the harm done to be less, than were it given, under the like circumstances, not so combined.

Reverting to the use of this combination in affections of the brain, it is remarkable how speedy and assured the effect often is. In the wild restlessness of delirium tremens this is

sometimes very strikingly seen. In fevers attended with much cerebral disturbance its employment has been attended with similar good. And in various forms of spasmodic

*

disease I have experience of the same kind; giving evidence of benefits which are not so readily or completely obtained by the use of opium alone.

It is probable that other applications of the tartar-emetic in the cure of disease will hereafter be ascertained; depending, it may be, upon other modes of agency than that to which I have chiefly alluded. For though employing the term sedative, thus far, in the most simple and practical sense in which we can understand it, it is obvious that much theory attaches to the subject; and that sedative action, so understood as merely opposed to stimulant, may occur not

* In a valuable paper by Dr. Graves (London Med. Gazette for July 8. 1837), this physician recommends the occasional use of emetic-tartar by enema; stating its effects to be the same as given by the mouth, and rightly commenting on the neglect of this means of administering various other remedies.

† In a late paper by Dr. Gemelle (Bulletin Général de Thérapeutique, Mars, 1838), cases are given of the successful treatment of synovial affections of the joints by the internal use of tartar-emetic.