Ipecac

“ More recently, the manufacturers of Alcresta Ipecac have been advising its use in conditions which were not contemplated by the Council when the preparation was accepted for New and Non­official Remedies. They now claim that ipecac alkaloids have been shown to be useful in the treatment of typhoid fever, flatulence, diarrhea and constipation and that Alcresta Ipecac has these properties. ”

“ The feet should be kept warm and the head cool, but don't put cold water on a child's head. [Pg 57]
Asthma.
If an attack comes on from sudden cold, take Aconite and Ipecac every hour for a day, and if any symptoms remain, in place of the Aconite use Copaiva, Arsenicum and Phos. Acid with the Ipecac, giving them in rotation, a dose every hour.
In Chronic Asthma, where the patient is liable to an attack at any time, great benefit will be derived from taking these four in rotation about two hours apart for a day or two, at any time when symptoms of an attack begin to appear. ”

“ Uses.—According to Mooden Sheriff, the root bark is an efficient emetic in doses of 3 grams. In smaller doses it is febrifuge and produces nausea. The bark is extremely bitter; its reputation in the treatment of skin diseases is undeserved. It is a good substitute for ipecac, having given good results in all conditions in which the latter is indicated, with the exception of dysentery. ”

“ Dissolve a teaspoonful of salt in water and give to the patient, or administer a teaspoonful of ipecac every few minutes to a child, and a tablespoonful to an adult. Follow the dose with a glass of water and then insert the forefinger in the throat. One who has taken opium does not vomit easily and strenuous efforts should be made to produce vomiting. ”

“ Recent experiments have proved the accuracy of the clinical observations which recognized the cholagogue property of ipecac, and hence the emetic effect of this remedy is aided by its power to promote the discharge of bile. Emetics are of course contraindicated when jaundice is due to an impacted calculus, to malignant disease, to echinococci or other kinds of tumor. If there is much irritability of the gastro-intestinal mucous membrane, as shown in vomiting and diarrhoea, small doses of calomel (1/12 to 1⁄4 grain) three or four times a day are highly useful. ”

“ Another plan is to give about six grains of ipecac, and to repeat the dose several times, at intervals of an hour or less, in conjunction with purgatives and warm fomentations. Turpentine has also been used internally and by enema, but seems to have accomplished little good. Perhaps the most frequent plan after bleeding, is to rub one or two drachms of Mercurial Ointment well on the skin, over the abdomen, every two or three hours, sometimes for several days regularly; eight or ten grains of Calomel being also given daily, at the same time. ”

“ For the after pains it may be given in alternation with Ipecac or Aconite if there is flooding, or with Pulsatilla when the flooding is not troublesome, a dose once in half an hour, until the pains are checked.
For Rigidity of the soft parts and severe, retarded and long protracted labor, where the pains are strong and irregular, and great pain and exhaustion is experienced on account of the unyielding condition of the parts, Lobelia Inflata given in drop doses of the tr. ”

“ When the difficulty of expectoration is excessive an emetic may be resorted to. It is true that infants and children vomit with less straining and difficulty than adults, but, still, the practice of flinging emetics around is too common. The unpleasantness of getting up in the night because of a pseudo-croup in a distant patient's baby is not a correct indication for encouraging the indiscriminate use of emetics. When they are required, antimonials ought to be excluded from the list. Ipecac, sulphate of zinc, sulphate of copper, turpeth mineral are preferable. ”

“ Repeated small Doses of the Ipecacuana, from four to six Grains, operated both as an Emetic, and kept up a Purging; but they made the Men so sick, that we could not prevail upon them to continue their Use. Mr. Francis Russel told me, that, in the Year 1756, he found a few Grains of Rhubarb added to each Dose, made it operate more as a Purgative, and did not make the Men so sick.—Dr. Akenside proposes giving the Ipecacuana in so small Doses as one or two Grains every six Hours, in a Draught made of Mint-water, and Half a Drachm of confectio cardiaca ”

“ Emetics are certainly more efficient when composed of Ipecacuan united with Tartarized Antimony, or Sulphate of Zinc, than when they simply consist of any one of such substances in an equivalent dose. ”

“ It consists, in the main, of administering, as early in the disease as possible, 25 to 30 grains of Ipecacuanha, in as small a quantity of fluid as possible, premising half an hour previously 25 to 30 drops of Laudanum. The patient should keep perfectly still in bed, and abstain from fluids for at least three hours. If thirsty, he may suck a little ice, or may have a teaspoonful of cold water. It is seldom, under this management, that nausea is excessive, and vomiting is rarely troublesome, seldom setting in for two hours after the medicine has been taken. ”

“ A different climate, different regimen, and different habit of body or exercise, may surely so far alter the operation of a drug as to make it have a different effect in Africa from what it has in Europe. Be that as it may, still I say bark is a purgative when it is successful in this fever; but bleeding, at no stage of this distemper, is of any service; and, indeed, if attempted the second day, the lancet is seldom followed by blood. Ipecacuanha both fatigues the patient and heightens the fever, and so conducts the patient more speedily to his end. ”

“ The best medicine in the day time we found to be small doses of ipecacuana alone twice or thrice a day; and if there should be fresh collections of bile, small doses of the saline purgative will be necessary. Ipecacuana in this intention, may be given in the dose of two grains in athletic constitutions, such as those of seamen; but in the more delicate constitutions, such as are commonly met with in private practice, one grain is a sufficient dose. I have found manna and tamarinds a good addition to this medicine in the earlier stages of the disease, 477 where there was much bile ”

“ The chief interest in the composition of such medicines, however, centres in the presence or absence of more potent remedies, such as preparations of opium, ipecacuanha, etc.; and here the analyst is on surer ground. The extraction of minute quantities of alkaloids from complex mixtures containing large quantities of saccharine and “extractive” matters is, however, a matter of much difficulty, and their identification is complicated by the great similarity in the behaviour of morphine and the alkaloids of ipecacuanha towards the various reagents used in their recognition. ”

“ In this latter variety subcutaneous or intravenous injections of a polyvalent antiserum (Shiga's or Lister Institute) should be administered, together with aperient salines. Until a microscopical examination of the stools has been made it is difficult to prognosticate in any given case whether ipecacuanha, or its alkaloid, is likely to prove the more effective drug, or whether the sulphates or calomel will answer better. In every case one or the other ought to be exhibited at once; one failing after a fair trial, the other, unless manifestly contraindicated, should get a chance. ”

“ In the woody column they are obvious; the prevailing tissue consists of short pitted vessels. The cortical parenchyme and the medullary rays are loaded with small starch granules. Some cells of the interior part of the bark contain however only bundles of acicular crystals of oxalate of calcium.
Chemical Composition—The peculiar principles of ipecacuanha are Emetine and Ipecacuanhic Acid, together with a minute proportion of a fœtid volatile oil. The activity of the drug appears to be due solely to the alkaloid, which taken internally is a potent emetic. ”

“ Small proportions of other drugs having no well-marked characters might possibly also be present; there was no evidence of any further ingredients, but in the presence of so large a proportion of treacle small quantities of indifferent substances it would not be possible to detect.
About 1 per cent. by volume of alcohol was present; assuming liquid extract of ipecacuanha and tincture of opium to have been the preparations of these drugs used, the formula is approximately:
Estimated cost of ingredients for 32⁄3 fluid ounces, 3⁄4d. ”

“ The ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases will rapidly effect a cure. I have in a preceding Conversation given you a prescription for the ipecacuanha wine mixture. Let a teaspoonful of the mixture be taken every four hours.
If in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise; and put on the chest a tela vesicatoria, prepared and applied as I recommended when treating of inflammation of the lungs. ”

“ In some constitutions Antimony has been known to produce a ptyalism; Dr. James assured Sir George Baker that he knew six instances of it, although the patients thus affected had neither their teeth loosened, nor their breath made offensive. The peculiar susceptibility of certain individuals to the effects of particular plants is also 189very singular: Murray relates that unpleasant symptoms have been experienced by merely keeping Aconite for some time in the hand, or on the bosom. I am acquainted with two persons in whom the odour of Ipecacuan always produces a most distressing dyspnæa ”

“ As fragments of the root grow most readily, complete extirpation of the plant in any one locality does not seem probable. The more intelligent poayeros of Matto Grosso are indeed wise enough intentionally to leave small bits of root in the place whence a clump has been dug, and even to close over the opening in the soil.
Cultivation—The importance in India of ipecacuanha as a remedy for dysentery, and the increasing costliness of the drug, [1385] have occasioned active measures to be taken for attempting its cultivation in that country. ”

“ True Expectorants.—The action of Antimony and Ipecacuanha upon the secretion of bronchial mucus is of so specific a character as to render it highly probable that these medicines add to their neurotic influence a true eliminative agency. We are as yet unable to decide whether or not they are ever secreted by these mucous glands, because not only is the analysis of the mucus a matter of difficulty, but hitherto no investigation of the matter has been made. Squill also is probably an Eliminative Expectorant.
Many of the true Expectorants are volatile and odorous in nature. ”

“ Ipecacuanha, a small shrubby plant of the natural order Rubiaceae. It is a native of Brazil, growing in clumps or patches in moist shady forests from 8° to 22° S., and is also found in New Granada and probably in Bolivia. The drug of commerce is procured chiefly from the region lying between the towns of Cuyaba, Villa Bella, Villa Maria and Diamantina in the province of Matto Grosso, and near the German colony of Philadelphia, north of Rio Janeiro. Ipecacuanha, although in common use in Brazil, was not employed in Europe previous to 1672. ”

“ Lefort (1869) has shown that the New Granada drug is a little less rich in emetine than the ipecacuanha of Brazil.
Mr. R. B. White, of Medellin in the valley of the Cauca, New Granada, near which place the drug has been collected, has been good enough to send us herbarium specimens of the plant with roots attached; they agree entirely with Cephaëlis Ipecacuanha.
Microscopic Structure—The root is coated with a thin layer of brown cork-cells; the interior cortical tissue is made up of a uniform parenchyme, in which medullary rays cannot be distinguished. ”

“ Leaves and flowers possess the same virtues. It is very seldom used by females in the United States. This herb should be in every collection; an excellent regulator in all urinary difficulties, where the evacuations are scant, or too profuse; strengthens the kidneys and bladder.
BITTER ROOT, OR AMERICAN IPECACUANHA.
Grows in wood bogs, and on low, sandy land; is emetic, and an excellent hydragogue, causing the water to pass off freely; is diaphoretic, possessing the same virtues as the English Ipecacuanha, but I prefer it as it is rather milder. It is the bitterest root we have it Botany. ”

“ As an excipient for vegetable powder it answers well, and for other substances on which it can exert a partially solvent action it is eminently useful. Among these are such salts as valerianate of zinc, 4 gr., which with 1 of the glycerin mass forms a good pill.
Quinine, 3 parts, with 1 of the glycerin mass, P. B. strength, works well. Compound powder of ipecacuanha, 5 gr., with 3⁄4 gr. of the mass, makes a good pill. Oxide of zinc, too, 4 gr. with 1, makes a good mass.
But for most mineral and insoluble powders it is too moist, and will not form with them a firm mass ”

“ Uses.—This plant is not used medicinally in the Philippines, but is very common in India. Dr. G. Bidie, of Madras, states that the expressed juice of the leaves is in great repute, wherever the plant grows, as an emetic for children and is safe, certain and speedy in its action. Like ipecacuanha it seems to have little tendency to act on the bowels or depress the vital powers, and it decidedly increases the secretion of the pulmonary organs. Probably an infusion of the dried leaves or an extract prepared from the green plant would retain all its active properties. ”