Ipecacuanha

[CEPHAELIS EMETICA. NATURAL ORDER, RUBIACE^.]

We obtain this drug from the provinces of Rio Janeiro, Bahia and Pernambuco, whence it is imported in bales, barrels and bags. The stem of the plant from which this root is obtained, is from two to three feet high, and has rarely more than four or six leaves. The roots are gathered at all seasons of the year, though more frequently from January to March, inclusive. The farmers, residing in the neighborhood of the villages where it grows, and Indians carry on considerable trade with this plant.

The root is also denominated annulated ipecacuanha, to distinguish it from other roots of the same species.

The root of cephaelis ipecacuanha occurs in pieces of three or four inches long, and about the size of a small goose-quill, variously bent and contorted, simple and branched. It seems to be composed of rings strung upon a central ligneous cord. This arrangement gives it a knotty appearance, the knots being still rendered more promi-

204 IPECACUANHA.

nent by circular fissures penetrating the bark to about a line in depth.

For medicinal purposes the dark, brownish -looking root should be chosen. It has an acrid, aromatic, slightly bitter taste, and a some- what nauseous and peculiar odor. From this root we obtain a deep- yellow tincture.

The active principle of this root is emetine, which was obtained by Pelletier and Caventou in 1820 ; this is an alkaloid of a white color, powder form, not affected by exposure to the air, little soluble in water, and forming salts in combination with acids; it forms a greyish-white precipitate with an infusion of galls (tannate of eme- tine, an inert substance) ; hence galls are an antidote to poisonous doses of emetine.

Ipecacuanha seems to affect primarily the solar plexus and the pneumogastric nerve; it irritates these centres spasmodically ; inci- dental to this irritation is vascular erethism ; hence it is useful for haemorrhage, for inflammatory irritation of the bronchial tubes, All of Magendie's animals exhibited signs of inflammation in the air- tubes. It is suitable for feeble, slender persons with sensitive temperaments. According to Sachs, who ridicules homoeopathy, ipecacuanha possesses a specific medicinal relation to periodical diseases, if the paroxysms occur in the night.

It is only one, acquainted with this property of ipecacuanha, who is capable of doing justice to the great vifto.es of this drug. Years before Sachs, Hahnemann taught this doctrine, when he recommended ipecacuanha as a remedy for paroxysmal asthma.

Some persons are wonderfully sensitive to the action of ipecacu- anha. The merest atom of dust will interfere with their breathing. Dr. Eoberts writes in a communication to Pereira: "If I remain in a room where the preparation of ipecacuanha is going on — for instance, making the pulvis ipecacuanlicB composUus, I am sure to have a regular attack of asthma.

In a few seconds dyspnoea comes on in a violent degree, attended with wheezing and great weight and anxiety about the praecordia. The attack generally remains about an hour, but I obtain no relief until a copious expectoration takes place, which is invariably the case. After the attack is over, I suffer no further inconvenience. I have always considered that the attack proceeds from the minute particles of the ipecacuanha floating in the atmosphere acting as an irritant on the mucous membrane of the trachea and the bronchial tubes." To this communication Pereira adds the important remark that, in some cases "the mere odor of

IPECACUANHA. 205

the root seems sufficient to excite difficulty of breathing, with a feel- ing of suffocation."

A druggist's assistant, while engaged in the process of powdering ipecacuanha, was poisoned by the incautious inhalation of the dust. This case is mentioned by Dr. Priegher in Rust's Magazine. The patient who was suffering from catarrh and cough, inhaled during three hours the dust from the root ; in consequence of which, vomit- ing came on, followed by a tightness on the chest.

An hour after this, he complained of a most violent sense of suffocation and con- striction of the trachea and throat; his face looked cadaverous: he had the most frightful paroxysms of oppression and anxiety. The physician who was called in, bled him and gave asafoetida and bella- donna with temporary relief ; but in five hours a fresh attack came on, with the most imminent danger of suffocation. A strong decoc- tion of uva ursi, with the extract of rhatany, was administered with almost immediate relief, and in an hour his breathing was much freer.

He was able to leave the house in two days, but suffered several days with difficulty of breathing.

This case shows the immense power possessed- by ipecacuanha, of spasmodically irritating the ramifications of the pneumogastric uerves, and causing a variety of conditions of the respiratory and gastric organs, which find in ipecacuanha a sure and energetic remedy.

CEPHALIC GKOUP.

The provings of ipecacuanha which Hahnemann bequeathed to ns, are short, but exceedingly characteristic and instructive. We find that ipecacuanha causes : a fine stinging pain in the head and fore- head, excited and aggravated by contact. Headache, as if the brain and skull had been incised, with nausea.

HEADACHES. — These kinds of pain may characterize rheumatic and bilious headaches, caused by exposure, over-eating, etc. In

HEMICKANIA, with stinging pain and soreness, nausea, etc., ipe- cacuanha will be found useful, especially in paroxysmal hemicrania.

FACIAL GKOUP.

EPISTAXIS. — Ipecacuanha causes spasmodic sneezing, and bleeding at the nose. In a case of haemorrhage from the nose, ipecacuanha arrested the bleeding at once. The patient was a lady of about sixty years. All sorts of appliances had been resorted to, to stop the bleeding, but in vain. The patient was almost dying from loss of blood. Half a grain of the powder of ipecacuanha arrested the haemorrhage promptly and permanently.

206 IPECACUANHA.

Ipecacuanha causes : flat taste iu the mouth ; nausea, preceding from the stomach ; feeling of qualmishness, emptiness and flabbi- ness about the stomach ; nausea with aversion to all food ; constant nausea and inclination to vomit; flow of watery saliva; vomiting with thirst and distention of the abdomen ; violent pinching pains in the stomach ; spasmodic pains in the hypochondria ; cutting pains in the umbilical region. Feeling of excessive distention of the abdomen.

GASTRIC DERANGEMENTS Ipecacuanha is an important

remedy in gastric derangements characterized by constant nausea, vomiting, accumulation of saliva in the mouth, flow of saliva from the mouth, sensation as if the stomach were "hanging down loose." Frequently, such attacks recur in regular paroxysms.

An old lady was suddenly attacked, without any apparent cause, by vomiting. At 2 A. M. she experienced distressing nausea, followed by spasmodic vomiting, with expulsion of large quantities of tenacious white mucus. The paroxysms lasted two hours.

During the vomiting she was cold, turned pale and suffered a good deal of oppression and anguish, with palpitation of the heart. She had five paroxysms of this kind in five successive nights, each succeeding paroxysm becoming more violent and more obstinate, when my aid was requested. I gave the lady one globule of ipecacuanha200, after which she slept soundly the following night and never again had even the shadow of an attack.

VOMITING OF PREGNANCY, when the nausea is almost con- stant and the act of vomiting not painful, is often cured by ipecacuanha.

HiEMATEMESIS. — Ipecacuanha may excite vomiting of blood ;

hence we use it in hasmatemesis with gastric derangements, pinching

pain in the bowels, especially about the umbilicus, with small, weak

pulse, pale sunken face, coldness of the skin, cold sweat, difficult

breathing. The flow is bright-red (or black and clotted).

A girl, aged twenty-three years, blonde and heretofore in excellent health, was taken, in consequence of grief, with a continuous pressure in the stomach, loss of ap- petite, frequent nausea and, a week later, after violent anger, sudden vomiting of clotted and then liquid blood amounting to about two pounds. She was deathly pale, almost pulseless and nearly unconscious. While I was present she vomited again, losing about half a pound of dark blood. Prescribed ipecac.1, one dose every half hour.

Soon after the second dose, vomiting of blood, followed by a sensation of relief; after this the pulse increased somewhat in volume, and breathing became easier; an hour later, vomiting of blood and mucus, and two hours later, vomiting of mucus only. On the next day she was well, with exception of exhaustion from the loss of blood. (Goullon in HirscheFs Zeitschrift, ii., 156.)

After slight gastric derangements, hasmatemesis set in, repeated three times in six or seven days. The first time the blood was dark and clotted; later, clear and liquid ; the vomiting was followed by bloody stools. A renewal of the attack was now threatening. There was extreme exhaustion, repeated fainting, dimness of vision, the slightest motion or hacking caused nausea; the tongue was dry, brown; tormenting thirst, stubborn constipation.

For several years past, the patient has suf- fered from bleeding piles and from gout. Ipecahuanha in repeated doses cured the heematemesis. (Nunnez in Ailg. Horn.

Zeitg., xliii., 93.)

IPECACUANHA. 207

DYSPEPSIA.— Ipecacuanha is useful in dyspepsia with anorexia, oppression after eating, flow of watery saliva, qualmishness, bad taste in the mouth, want of tone in the stomach.

CARDIALGIA, accompanied by retching and vomiting. A tear- ing-pinching in the abdomen as if the bowels were grasped with the hands, so that the fingers spread apart, making a sharp impression into the bowels ; the pain is moderated during rest, but intensely aggravated by the least movement.

COLIC. — Flatulent colic, with diarrhoea. Umbilical colic. Greatly aggravated by motion.

Ipecacuanha has caused : diarrhceic stools, as if fermented ; bloody stools ; green and foul-smelling stools. These symptoms, accom- panied with the characteristic nausea, gastric disturbances and pain in the bowels, justify the use of the drug in

BILIOUS DIARRHOEA and simple intestinal catarrh with loss of appetite, qualmishness, white-coated tongue and the symptoms so repeatedly described.

CHOLERA INFANTUM with nausea, vomiting and purging at the same moment, the stools look fermented, difficult breathing, pallor of the countenance, coldness of the body. Flatulence.

HEMORRHAGE FROM THE BOWELS, in profuse bleed- ing from the haemorrhoidal vessels, with a» totality of symptoms pointing toward the remedy.

UKINARY AND SEXUAL GEOUP.

Ipecacuanha has caused frequent urging to urinate with scanty urinary discharge, bloody urination. Hence it may be used in ex- ceptional cases of

DYSURIA and of licematuria with difficulty of voiding urine, urging to urinate, spasmodic retention, qualmishness at the stomach, etc. Of course, the totality of symptoms alone will decide the choice of the remedy.

Ipecacuanha does not exert a marked effect upon the sexual organs of men ; upon women it causes : premature menstruation with bearing-down pains ; haemorrhage from the uterus. We find this remedy useful in

HEMORRHAGE FROM THE UTERUS with bearing-down pains, sickness at the stomach, pallor of the countenance, coldness of the feet and other characteristic symptoms. The blood is bright red, and is discharged with a gush.

208 IPECACUANHA.

RESPIRATORY GKOUP.

We find recorded ■ over-sensitiveness of the lining mucous mem- brane of the larynx -and trachea ; frequent dry tickling cough with expectoration of thick mucus ; cough with bloody sputa ; rattling noise in the air-passages during respiration ; cough with inclination to vomit ; haemoptysis. We use ipecacuanha in

SPASMODIC COUGHS and in

WHOOPINQ COUCH with spells of threatening suffocation, especially in children. The patient's countenance becomes blue, purplish, convulsed ; the child becomes stiff ; nosebleed ; discharge of blood from the mouth. The cough is frequently brought on by sickling in the larynx.

HAEMOPTYSIS with characteristic indications.

Ipecacuanha causes an asthmatic constriction of the chest; and 's an excellent remedy in

SPASMODIC ASTHMA with suffocative spells, anguish, deathly pallor of the countenance, apprehension and dread of death. Fre- quently these paroxysms recur with regularity at certain hours of the night, a strong additional indication for the remedy under con- sideration.

PEVER GROUP.

INTERMITTENT FEVER. — Ipecacuanha is a prominent

remedy in intermittent fever, if the gastric symptoms are very

marked, the tongue is coated with a thick, grayish slime, loss of

appetite, scanty and loose stool, nausea and vomiting ; the patient

feels chilly, although the skin is not very cold to the touch, thirst

moderate. There is no marked regularity of the different stages of

the paroxysms ; the chill is accompanied by great lassitude and

weariness. The hot stage lasts long, with anxious, oppressed

breathing and dry, hacking cough. The sweat is sour, becomes

profuse after the abuse of quinine. The gastric symptoms of

ipecacuanha are clearly marked and constant nausea is one of the

most reliable indications for its use in intermittent fever. The

greatest prostration occurs during the chill.

Miss A. B., aged eleven, black hair and eyes, had long been subject to attacks of ague, for which quinine had been successfully given, without preventing recurrence of paroxysms with every new provocation. Chill every other day, she shivers awhile, then shakes for twenty minutes. Headache ; hands first cold.

Nausea as the chill goes off; nausea all the time. No thirst with the chill. Heat following the chill, thirst with the heat. Perspiration when the fever passes off.

Found her covered upon the sofa shaking with a chill when I visited her. Prescribed ipecacuanha iM to take at bedtime. Was in bed next day most of the time; following day at play. Cured.

(Dr. J. H. P.

Frost in Hahn. Monthly, Oct., 1874.)

IKIS VERSICOLOR 209

F. V., aged thirty-five, has had annual attacks of fever and ague for eighteen years. Has also suffered severely from chronic diarrhoea with watery stools, umbilical colic, great flatulency, pallor of the countenance, prostration. Present condition : diarrhoea as described.

Paroxysms every second day, at irregular intervals, are ushered in by a "feeling of internal chilliness, great lassitude and purplish color of the countenance. The cold stage lasts for one or two hours and is followed by intense heat of the entire body, severe blinding headache, nausea, absence of sweat and thirst. The apyrexia is marked by lassitude, loss of appetite, expression of dullness amounting to stupidity, heaviness of the eyes ; nausea. Cured in three days by ipecac'

EXANTHEMATOUS GROUP.

IPECACUANHA causes pricking pains here and there, termin- ating in burning pains. This symptom may be a valuable indication in other affections to which ipecacuanha is homoeopathic ; in gastric derangements, for instance, this symptom may occur.

MENTAL GROUP.

Ipecacuanha causes apathy of mind, impatience, fretfulness. These symptoms are only valuable as indications for the use of ipecacuanha in other affections, such as gastric derangements, head- ache, fever, etc.