adapted to dry bronchitis with the sibilant râle, and like states, because of its power to promote mucous secretion; but there are, up to the present, hardly sufficient data to warrant a clinical conclusion. It would not be strange, however, if variability of action here, also, should interfere with the effectiveness of the application.

It would appear, therefore, that Apomorphia is appropriate to the exceptional case, and not to a class of cases, and to the exceptional case in the double sense of that which is of rare occurrence, and also of what is of frequent occurrence, but resists the usual remedy. The fact that it is the only emetic agent of convenient and of preferred exhibition by the skin carries with it a large part of its practical value. Thus employed, it may prove, e. g., the only effectual resource in a case of impaction of a foreign body deep in the throat.* Ringer's suggestion of its value in some hysterical affections, and report of its success in persistent hiccough which had resisted other remedies, are also instances in illustration. Doubtless, a like trial with Apomorphia is to be made in a case of coma, where evacuation of the stomach is indicated and the patient cannot take the usual emetic in the usual way; but we cannot justify the conclusion, although sanctioned by such eminent authority as Trous. and Pid.-viz., that "this medicament is particularly indicated in such as have been poisoned,

* Thus, M. Verger reports a success in a child with plum stone lodged in the œsophagus; ipecac had failed, but a second injection of Apomorphia secured its extrication.

in children and in patients attacked with delirium or with coma.*

Administration.-Dose by the stomach, grain ; by the skin, grain. This is Bartholow's rule and is definite and safe; but the fractions are smaller than those ordered by many other writers and will sometimes prove inadequate. Whether infancy may show the same singular susceptibility to Apomorphia, that is shown to all natural thebaic preparations, has not been adequately determined; but great care should be taken in ordering this active neurotic remedy with the young. Kohler claims to have shown in his experiments, that a smaller dose will vomit, received per rectum, than as given by the mouth; solutions of the salt rubbed into the thighs and introduced into the vagina of dogs remained without effect. If the small fraction of a grain, required by the skin, be freely diluted, there will be little smarting and no subsequent irritation. The solution is seldom quite clear, and it has been proposed to clarify by adding a few drops of dilute hydrochloric acid; but this makes the vehicle more irritating and secures no advantage. The proposal to add glycerine is objectionable for the same reason. As already said, the solution for exhibition by either method must be freshly prepared, and the salt used must have been previously well kept.t

* Italics our own.

† Of other possible artificial alkaloids derivable from opium, apocodeine in particular has received attention. It is a much more stable body than Apomorphine, has the same emetic properties but less energetic, but has not been obtained in crystalline form.

TOPICAL OR IRRITANT EMETICS.

These are such as provoke vomiting solely by virtue of an irritation brought to bear upon the interior of the stomach. Obviously, they are not absorbed ; it is because they are too irritant to admit of absorption that they perform this service; their emetic operation, therefore, is singularly prompt and limited in action. The materials usually applied to this purpose are, with one exception, of mineral origin. The most familiar are the sulphates of zinc and copper, the yellow sulphate of mercury, alum and mustard.

Rabuteau has established the rule that salts of the metals which have an atomic weight inferior to that of zinc do not provoke vomiting when received into the stomach,—i. e., of course, with the exception of minerals like arsenic, which are essentially toxic. But it is otherwise with salts of metals having an equal and superior atomic weight; and the derivatives of copper and mercury are familiar illustrations. The salts of cadmium are emetic, and so are those of iron, unless diluted and used with care.

ZINCI ET CUPRI SULPHAS.

Known commercially as the White and the Blue Vitriol. The white or Zinc-Sulphate is less energetic; but its emetic action is less likely to be followed by inflammation of the stomach. White vitriol was used by Paracelsus, and blue vitriol by Dioscorides, and

both these materials were relatively in much more common use, prior to the discovery of the emetic properties of soluble preparations of the toxic mineral antimony and the introduction of ipecac into Europe. The emetic dose of the Zinc salt is twenty to thirty grains, and of the Copper salt, ten to fifteen grains, in two to three ounces of warm water; to be repeated in fifteen minutes if vomiting does not occur. Doubtless, as already suggested, the green vitriol, or iron-sulphate, might often be substituted with advantage for the more poisonous vitriols.

HYDRARG. SULPH. FLAVA,

Or Turpeth mineral, the most convenient of all irritant emetics, on account of small dose and slight taste, is everywhere familiar-at least, to American physicians through its suggested employment in croup. Dr. Barker, of New York, whose name is always associated with this application, has received both the thanks and the rebuke of the profession for such contribution to therapeutics. Mercury, like antimony, is an actively toxic mineral, and a considerable dose, given for prompt emetic effect, which should chance to be retained and, in part at least, absorbed, may do a serious harm. It should be the province of the physician alone to direct its action, and to guard against the latter result. It must be remembered, moreover, that the disease for which it is proposed is a most serious affection; that the patient is generally a child, and so a difficult subject for the exhibition of bulky and offensive remedies.

The timely dose of Turpeth mineral may save—as it doubtless has saved-from the graver necessity of tracheotomy, and even from death by suffocation. But it is far too energetic and uncertain a material to be prepared beforehand in form of "croup powders," as some of the books have proposed,—and entrusted to the family for use at discretion.

The usual dose is three to five grains, to be added to a little sugar and swallowed with water. It should vomit within fifteen minutes; if not, it must be repeated. Action is almost sure to follow the second. dose, if not the first; but in the rare case where it fails, emesis must be made sure by resort to some other material. Rightly applied, the value of this emetic in croup is unequaled, and danger is remote and improbable.

ALUMEN.

Powdered Alum ought to be erased from the list of topical emetics. Its comparative safety is its only recommendation. It must be taken in large bulk, is very offensive to the patient and is slow in operation, often requiring thirty minutes. It has had frequent application in croup, but the claim that this salt may exert some especial action in dissolution or detachment of the membrane is hardly any longer maintained. The usual dose is a full teaspoonful, made into a partial confection with syrup or honey.*

*The author will never forget his effort to crowd this disgusting emetic down the throat of his own child; nor the efforts of the little sufferer at resistance, frightened by the unprecedented harshness of treatment, and in a frantic struggle for air at every breath. It was a final experience with an Alum emetic in children.