IPECACUANHA (Cephaelis Ipecacuanha).
   The root of (1) Cephaelis Ipecacuanha (Brotero), A. Richard, or of (2) Cephaelis acuminata, Karsten (Nat. Ord. Rubiaceae). Brazil and other parts of South America. Dose, 1 to 20 grains. Common Names: Ipecac, (1) Rio Ipecac, (2) Cartagena Ipecac. Principal Constituents.—The alkaloids emetine (C30H44N2O4), cephaeline (C28H33N2O4), cephaelic (ipecacuanhic) acid, volatile oil, tannin, etc. Preparations.-1. Pulvis Ipecacuanha, Powdered Ipecac. Dose, 1 to 20 grains. (Usual emetic dose, 10 to 15 grains.) 2. Specific Medicine Ipecac. Dose, 1/30 to 20 drops (for specific purposes the fractional dose is employed). 3. Syrupus Ipecacuanha, Syrup of Ipecac. Dose, 1 to 20 minims (expectorant); 2 to 4 fluidrachms (emetic). 4. Alcresta Ipecac. Dose, 1 tablet daily. Specific Indications.—Irritation with long and pointed tongue, with reddened tip and edges, and accompanied by nausea and vomiting, with or without fever; irritation with increased secretions; irritation of stomach, bowels, bronchial tubes, bronchioles, and pulmonic air cells, and nervous system; irritative diarrhoea; dysentery, with the ipecac tongue; acute bowel disorders with increased secretion; hypersecretion of bronchial fluid with mucous rales (minute dose); diminished expectoration (medium doses); irritative cough, with or without dyspnea; hoarseness from coughs and colds; hemorrhage; menorrhagia (medium doses); as an emetic when the stomach is overloaded or in foul condition, with broad, flabby and slimy tongue (full doses). Action.—Ipecac, in material amounts, is irritant to the skin and mucosa. Applied by inunction it excites irritation, and produces vesicular and pustular eruptions and sometimes ulcers. When inhaled it causes heat and violent sneezing. In susceptible individuals the powdered drug excites pronounced attacks simulating asthma, the chief symptoms being great dyspnea, with wheezing respiration and cough, and marked anxiety and prostration. This is often accompanied by violent and prolonged sneezing and spitting of blood, and followed usually by a free expectoration of mucus. In doses of less than 1 grain, ipecac is a gastric tonic and hepatic stimulant. Large doses (15 grains or more) are emetic. If emesis fails catharsis may result; or both emesis and purgation may be produced by it. Ipecac feces are peculiar-bilious and mush-like. From 3 to 10 grains of the powdered drug will cause nausea, with more or less depression of the pulse, languor, diaphoresis, and increase of mucous secretion. As an emetic it is fairly slow (15 to 20 minutes), active and thorough, causes much nausea and muscular straining, and the ejection of a large quantity of mucus. A state of tolerance may be established by the prolonged use of ipecac. Though said to have no appreciable effect upon the circulation, the therapeutic action of small doses seems to controvert this statement, a stimulating effect accepted in Eclectic therapy as special sedation resulting. Emetine has produced death by gastro-intestinal inflammation and cardiac paralysis. Therapy.—The field of therapeutic activity of ipecac is restricted chiefly to the digestive and respiratory tracts, and to some extent to the blood vessels, acting as a hemostatic. It is decidedly irritant to mucous surfaces, particularly that of the nasal passages, and in some individuals will precipitate an attack simulating spasmodic asthma. It increases biliary activity, is expectorant in small doses, and emetic in full doses, and there is evidence that it possesses antiseptic qualities. Ipecac is used chiefly for five great purposes: (1) In full doses as an emetic; (2) in small doses as a nauseant expectorant; (3) to check active hemorrhage; (4) to check vomiting; (5) and as employed mostly in Eclectic therapy, to control irritation and inflammation of the mucous passages of alimentation and respiration. The chief specific indications are: (1) The full, broad tongue, heavily coated, with constant nausea or vomiting. Here it should be used in full doses as an emetic; (2) irritation of digestive tract, with long, pointed, reddened tongue and tendency to nausea, vomiting, diarrhea or dysentery; (3) scanty expectoration, with irritative cough and hoarseness; (4) active hemorrhage. The conditions demanding the specific use of ipecac are those showing irritation, capillary engorgement, and hypersecretion. As an emetic ipecac is not suited for emergency cases, such as poisoning, if other more suitable and more rapid emetics can be procured. Zinc sulphate or apomorphine is more prompt and more certain in poison cases, especially narcotic poisoning. But for the purpose of relieving the stomach of its contents when overloaded, or when food is fermenting and undergoing faulty digestion, and the tongue is heavily coated, the breath foul, and nausea, or vomiting imminent, a full emetic dose of ipecac is justifiable and efficient. In this way it often relieves gastric distress and pain, being of very great value in acute indigestion, and checks bilious attacks with sick headache due to the causes mentioned. One of the therapeutic facts long ago recognized by those whose eyes are not otherwise open to the utility of specific medication is that ipecac (though a common emetic), in very small doses, is one of the best of antiemetics. This is most easily accomplished when the tongue is red and pointed and shows evidence of irritation. There are other cases, however, in which the nausea depends upon foul accumulations in the stomach. The tongue is then broad, flabby, and slimy, and nausea is pronounced. In such instances a full emetic dose may be given, and if nausea and vomiting then persist it may be followed by minute doses. This usually is effective. Ipecac in small doses is one of the recognized agents of value in the nausea and vomiting of pregnancy. Ipecac is often lost sight of as a remedy for active hemorrhage. Of course, it operates best where the quantity of blood lost is small. We have seen most excellent r¹