1. Evacuation of the Stomach. This is an obvious and important indication for the use of emetics. indigestible food, irritant or poisonous substances from without, acid and acrid accumulations resulting from chemical changes in the gastric contents or from disordered secretion, regurgitating bile and possibly pancreatic juice, may one or more be present in the stomach, and occasion irritation of that organ in various modes, requiring relief by means of an emetic.

One of the irritative affections in which an emetic is often indicated, on this score, is severe spasmodic pain or cramp of the stomach. Whenever this phenomenon is presented, inquiry should be made as to the probable existence of some cause of the kind referred to, and, if there be reasonable ground for suspecting its presence, an emetic should be administered. One of the symptoms often present is some degree of nausea, but insufficient to bring about vomiting. One of the mildest emetics will generally be sufficient; and sometimes a tumblerful or two of warm water, or warm molasses and water, will answer the purpose, especially when occasional nausea is conjoined with the spasm. The relief from an emetic is often most prompt and complete, and the passage from intense suffering to ease most happy.

Another result of the same irritative agency is frequent retching, or ineffectual efforts to vomit, in which the patient may bring up a little bile, or acrid matter, showing the nature of the contents of the stomach, which, however, he is unable to empty completely. The suffering from the nausea, and racking of the fruitless emetic efforts, is often very great. This condition is not uncommon at the commencement, or in the course of fevers; in the former case, proceeding from undigested matters, which, in the disordered state of the digestive function incident to the febrile disease, the stomach is unable to dissolve; in the latter, from acrid secretion, particularly bile, which is sometimes produced in excess. if not relieved, the condition may end in positive gastritis, and may seriously aggravate the danger of the disease. I have not unfrequently met with it in the course of bilious remittent fever. Very gentle methods, as in the preceding condition, will here also answer a most excellent purpose.

i have repeatedly known a comatose state, simulating apoplexy, to result from irritation of stomach proceeding from acrid matters contained in it. One case of the kind I remember well, in which the condition apparently depended on a meal which the patient had made of cucumbers, ham, and I believe whortleberries. There are symptoms in these cases which usually serve sufficiently to distinguish them from true apoplexy. Though the attack may have been sudden, the face is not generally flushed as in congestion of the brain; there is no stertor, and the pulse is not specially full or strong. The patient, too, may exhibit some slight signs of consciousness if roused, and pressure in the epigastrium may occasion sensible uneasiness. An emetic will generally relieve the symptoms.

Urticaria frequently proceeds from this cause. The worst case of this disease I ever met with arose from eating raspberries, and ceased at once when the offending cause was discharged from the stomach. Other acute skin affections may sometimes have a similar origin, and be similarly relieved. By bearing this fact in mind, the young practitioner will not unfrequently be able to save himself much solicitude, and the patient great suffering.

Sick-headache is notoriously a frequent result of acrid or acid matter in the stomach; and may often be very advantageously treated by a mild emetic, given in anticipation, or aid of the spontaneous efforts of nature.

The indication for the use of emetics in cases of poisoning by the stomach is almost too obvious to require notice; but there are two or three points in connection with the subject which it may be proper to touch upon. The narcotic poisons, not possessed of very acrid properties, especially opium, are apt to produce great insensibility to the action of emetics; and it is sometimes necessary to select the most prompt and powerful in order to obtain any effect. it is common to use for the purpose sulphate of zinc, or even sulphate of copper, and to give these in doses twice or three times as great as would be required under ordinary circumstances. The point to which I wish particularly to call the attention of the student here, is the necessity for caution not to proceed too far with these acrid, and even corrosive substances. Should the first dose not vomit, it should not be indefinitely repeated, in order to obtain this effect. Though the stomach and nervous centres may be insensible to the emetic influence, the mucous membrane nevertheless suffers from the irritation, and, if too much of the emetic has been given, when reaction takes place, should the patient survive the immediate operation of the poison, violent gastric inflammation may be added to other sources of inconvenience or danger. it would, therefore, be best, in such cases, after the administration of one or two doses, to be content with the very free use of one of the milder emetics, which may be given safely in any dose. Under the head of poisoning from opium, the reader will find an account of the methods by which, in these cases, the insusceptibility of the cerebral centres to the emetic influence may be diminished, and the medicine be enabled to act. in the poisoning from mineral and other highly irritant substances, it may often be sufficient to wash out the stomach by means of warm drinks; but, if these should not vomit freely and thoroughly, one of the milder emetics should be administered.

2. Mechanical Compression of the Abdominal Viscera. in consequence of the contraction of the diaphragm and abdominal muscles, the whole of the viscera of the abdomen are powerfully compressed, and a tendency is given to the liquid matters contained in them to escape by every practicable passage. The blood of the vena portae and its radicals, throughout the abdomen, is thus hastened forward in its movement through the liver; and should congestion of this circulation have existed, it is for a time relieved. Hence emetics are useful in passive abdominal congestion, and its attendant disorders. Cases of this kind are not uncommon. in warm weather, especially, the liver not unfrequently becomes torpid, the capillary circulation through it is slow and languid, and the blood accumulates in the vena portae, producing various disorders of the stomach and bowels. One of the most common conditions is that often denominated bilious disorder. There is a feeling of oppression or weight in the abdominal region, the bowels are torpid, the appetite is impaired, the tongue is perhaps a little furred, there is a general uneasiness and often unaccountable depression of spirits, and not unfrequently, in the female, hysterical symptoms appear. This condition may be original, or may occur as an attendant on other diseases. An emetic often effectually relieves it by unloading the portal circulation.