Ipecacuanha

Volume III — Main text

CepAaeUs Ipeeaauaika, Rich. Nat. Ord., Ruhiacea,

1. Provings. — ^t, Hahnemann, ^uf. ^^r^. Pirr^, vol. iii of original, vol. i of translation. Contains 146 symptoms from self, 46 ^tn 3 fellow-observers, and 41 from authors.

2. Bock took Ip. for 2 d. at intervals of 2 h. ; ^ gr. caused after \ h. eructations, nausea, increase of saliva, then agreeable warmth in stomach and rumbling in bowels, at same time slight pinching^ burning of upper lip and tongue, frequent yawning, feeling of weight and pressure in head, vertigo, pressure in head and forehead, as though the brain were compressed by two boards ; pains in eyes like those in head, eyeballs seemed forced out of their sockets, and objects appeared in a mist. I gr. taken 2 h. later caused increased headache from forehead to crown, at same time sleepiness, pinching pains, distension of abdomen. 2 gr. caused after J h. inclination to vomit, pain in bowels, distension of abdomen, dryness of fauces, pressure on chest, laziness and diminished thinking power. After 4 gr., violent pinching in stomach, distension of belly, great inclination to vomit, pressive and spasmodic pains in r. patella and 1. arm, increased by touching, pinching pains in 1. hip from crista ilii to trochanter major, then some stitches in r. tibia, feeling as if ants were running in calves, weariness of lower extremiAs. 8 gr. caused colic pains with rumbling in bowels and feeling of warmth extending to chest and sometimes accompanied by shooting. Inclination to vomit, burning pains in forehead, increased by touch. In larynx dryness, burning, and scraping. 15 gr. caused same symptoms in a greater degree, especially those of stomach, till in ^ h. vomiting ensued, thereafter great drowsiness. {Diss, de rad, IpeCy in A. h, Z., xxxii, 68.)

3. Lembke took, Sept. 14th, 7 a.m., \ gr. rad. Ip. Soon, rumbling in stomach, warmth in stomach, increased flowof saliva, empty eructations. 7.30 a.m., same d., \ gr. Increased saliva, loathing, dazed head, chilliness, boring frontal pain, pain in umbilical region increased b; pressure,^ great low of saliva, with much loathing and feeling as if b would vomit, abdomen distended and pains constant, feet fee) knocke off (abgeschlagen). Inclination to urinate, though he had done so 6 a.m. and drunk nothing since, hands ccid and moist, very wes lazy, dull, and chilly. 8 a.m., inclination to vomit, pinching bellyac much sneezing and thin discharge from nose, much thin saliva m be spat out, boring frontal pain, paleness, sunken features, repr attacks of desire to vomit, with freedom from sickness in betr frequent chills. 8.45, weary, but feels better, good appetite, afterwards soft stool, the 2nd to-day — unusual. {A, h, Z., x: 125.)

11, Poisonings. ^^i, A man engaged in pulverising ipec. ror was suffering from slight cough and coryza, inhaled during quantity of the dust, which caused him to vomit three times ar him oppression of the chest. Thereupon he left off pound

ti

drug, but after i h. he had the most violent attack of suifocation, constriction of windpipe and throat, earthy cadaveric complexion^ the most frightful anxiety during the sufFocative attack ; these symptoms increased every instant. Many remedies were tried with partial relief, but the symptoms recurred in an aggravated degree after 5 h., and he thought he should be suffocated. After taking a strong decoction of uva ursi leaves and rhatany root he was almost instantaneously relieved, and in i h. could breathe freely, but the respiratory symptoms lasted several d., though in a more moderate degree. (Prieger, Rust's Mag,y xxxii, pt. I, 182 ; Franks Mag.^ i, 548.)

3, Mrs. S — , act. 26, at occasional intervals after her marriage to a medical man, was affected with a very troublesome shortness of breathing, attended with a remarkable stricture about her throat and breast, and with a particular kind of wheezing noise. The fits came on very suddenly ; were often so violent as to threaten immediate suffocation ; and generally went off* in 2 or 3 d, with spitting of a tough phlegm of a disagreeable metallic taste. It was at last discovered that these attacks occurred whenever Ip. was being powdered or put up. By keeping her out of the way when this occurred she remained clear of the fits for 7 or 8 years together, but one e. her husband, having received a quantity of the powder, without considering opened it out and put it into a bottle. His wife, not being far off^, immediately called out that she felt her throat affected, and was seized with the 'Stricture upon her chest, and difficulty of breathing. She was exceedingly ill all n., and when I saw her between 2 and 3 a.m. she was gasping for breath at a window, as pale as death, her pulse scarcely to be felt, and evidently in the utmost danger of suffocation. Bleeding and laudanum had but little effect. After some sleep between q and I ( she got up, her breathing still very difficult and her eyes looking red and a little inflamed. There was some abatement of the distress from this time till e., when it returned in force and continued all n. ; and this history was repeated without change for 8 d., and in a mitigated form for 6 d. more. She had a slight appearance of the menses about 4 or 5 d. after the accident occurred, although it was about the middle of the interval; coughed up at times some small quantities of blood, and had also some mixed with her stools and urine. (Scott, Phil. Trans, for 1776, part i, p. 168.)

1. In October, 1824, being much lowered by over-exertion, while putting up a dose of powdered Ip., I was suddenly seized with a violent attack of asthma, attended with the most distressing dy^pncea and oppression at the praccordia. In spite of bleeding and active cathartics the attack lasted 5 or 6 d., and was several times repeated before I could convince myself that it was due to the drug. After a long change and rest, during which I was quite free from asthma, I resumed work in 1826, and, having occasion to take an emetic, chose Ip. wine. From the moment I swallowed it I felt in throat and stomach a sensation totally indescribable but as intolerable as if I had drunk melted lead. I leaped out of bed and rolled over the floor from side to side of the room« At length I drank copiously of warm water, which produced some vomiting and some mitigation of my intense sufferings. The di^ixesfe ^iXa^V^

subsided, and settled into one of my worst attacks of asthma. From this time forward I became subject to them whenever exposed to this drug or to the fumes of burning sulphur, the paroxysms always beginning with a feeling of irritation of the nasal mucous membrane, which rapidly spread along the bronchial ramifications. To diminish its sensibility I practised snufF-taking, and for the last 7 yean have been free from a severe attack. But about 3 years ago I put my tongue to some liquid in a vial to ascertain its nature ; and in an instant the peculiar burning, indescribable feeling came on in the mouth, rapidly extending to the fauces, and down the trachea and bronchise ; and for 2 h. I suffered greatly and had considerable dyspnoea, all of which gradually disappeared.

h. I observed in some of my attacks a very curious sequela. When expectoration became free, in the mornings mouthfuls would be thrown up which any person at first sight would have pronounced to be a mass of small nearly transparent worms. On close examination I discovered it to be thickened mucus, which had collected in the small bronchiae during sleep, and was now thrown off as casts of these tubes, often in such quantity as to surprise me that sufficient air could have passed through the lungs while sleeping for the purposes of life. (Robertson, Jmer, Journ. of Mtd. 5«., N, S. vii, 252.)

1. a, I inherited from my mother's family, with a slender constitution, a strongly-marked nervous temperament ; and, with advancing years, dyspepsia developed itself. In my 25th year I was the subject of an attack of pneumonia (autumn of 1822). After my recovery, which was rapid, my he^ilth continued as formerly, until the sprine following, during which and the succeeding summer I had repeated and severe attacks of spasmodic asthma ; arising, as I then supposed, from the exposure incident to my duties. The paroxysms usually came on suddenly, preceded by tickling in the nostrils, and sneezing, and continued from 3 d. to 3 weeks, during which I was unable to remain in a recumbent position. During a paroxysm, the dyspeptic symptoms were usually mitigated considerably. In the autumn following, more than 6 mo. after the first attack, I was led to attribute these parox)rsms to the irritating properties of Ip. when inhaled. I was in the habit of using the drug freely in my practice, carrying it with me and dealing it out at the bedside. My attention once properly directed, 1 soon established the ^ct beyond all doubt by actual and painful experiment. Yet so new and singular was the ^ct that it was a long period before I could convince myself that even a single grain floating in the atmosphere of an ordinary room was capable of inducing a violent paroxysm of asthma, continuing weeks, reducing the strength as rapidly as an ordinary fever, and only terminating by cough and expectoration.

b. Early in the spring of 1825, 1 took ^ss of the powdered root ir tepid water, taking the precaution to have it weighed and mixed in part of the house remote from my own room, not dreaming that ai other form than dry powder would affect my breathing. In about tl usual time for an emetic to operate, there seemed to be a simultanec effort to breathe, cough, and vomit, while neither of these funcf* was performed in any degree of perfection — producing a state of su

'3

ing totally indescribable by words. The whole muscles of chest and abdomen seemed in a state of violent irregular spasm — every effort to vomit being interrupted by an attempt to cough ; and notwithstanding a cold March wind was blowing, it became necessary to open the windows and support me in an erect position for nearly an hour to prevent immediate suffocation — an event momentarily expected by my friends. At the end of about an h., without any previous mitigation of symptoms, 1 was almost instantaneously and completely relieved, md at my own request was laid upon the bed. Breathing was free and natural, but weakness was extreme ; at the same time a burning heat was diffused over the whole surface of the body, which, on examination, was found to proceed from a kind of erysipelatous eruption covering every portion, similar to what is seen after exposing the naked skin to a burning sun. The patches were circular, and varied from the size of sixpence to that of the palm of the hand — considerably elevated, with thick rounded edges, and of a fiery colour. I soon fell into a profound sleep, which lasted till m. ; and there was no recurrence of dyspnoea. On two subsequent occasions 1 took a laxative pill containing a grain of Ip. ; and in both instances, after 8 — lO h., a severe paroxysm of asthma followed, continuing several d. (Uriah Turner, M.D., Bose. Mtd. and Surg, yourn.y xxix, 229.)

1. rt. (After relating a similar experience to the foregoing, the writer adds). It is astonishing, I had almost said incredible, how small a quantity of Ip., inhaled, will produce the most sudden and violent paroxysms. A clerk in my drug store scattered a small quantity of Ip. on the counter, which he brushed off; the doors and windows were open, and a current of air had passed through the store for 4 h. before I entered it ; in 2 m. after my arrival 1 was seized with a violent sneezing, followed almost immediately with a paroxysm of asthma, which entirely disabled me for the d. Again, a young man in my office was directed to transfer a quantity of Ip. from a paper to a jar; I left the office for i h. On my return I was almost instantly attacked with one of the most fearful paroxysms I have ever experienced ; the extreme sense of suffocation, oppression at the pr;ecordia, a most exhausting nausea, convulsive but totally ineffectual efforts to vomit, attended with simultaneous spasms of the diaphragm and muscles of the chest and abdomen, produced altogether a state of suffering which defies description. In each of these instances the quantity of Ip. inhaled must have been infinitesimally small.

h. That these effects of Ip. do not depend invariably on the irritating properties of the powder when inhaled, but on idiosyncrasy, seems established by the following circumstances. In the summer of 1 84 1, I had a long course of bilious fever. The attack was marked by no particular symptom of disease of the lungs ; but as soon as I commenced the use of Ip. or of Dover's powder as a febrifuge, I had a convulsive and harassing cough and dyspnoea j every effort to speak was interrupted by a spasm of the muscles of respiration, and a sense of sinking and oppression of the prsecordia which constituted, in my opinion, the climax of human suffering. (Patterson, Ihid,^ p, 41 1.)

1. M. M — , pharmacien, has never been able to pass through his

shop when the Ip. drawer is open without feeling himself strangely suffocated. He is nevertheless strong and vigorous, not subject to asthma, and his pulmonary organs in good condition. So great is hit susceptibility that when in his study, separated from the shop by a sitting room and a good-sized garden, he is yet conscious of the opening of the drawer containing the powder, and feels the asthmatic effect for several d. (Imbert-Gourbeyre, Mvm, sur t Ipt'cacuanha^ Paris, XK69.)

1. M. B — , pharmacien, is obliged to leave his house, though occupying the third floor, whenever Ip. is powdered in the cellar, lest he should die of suffocation. Once, purchasing some articles of a wholesale druggist, he felt his usual dyspnoea on the opening of a certain bag, and had to leave the shop for a time. On his return some h. later he assumed that the bag contained Ip. The druggist denicu that it was so, but one of his assistants recognised the bag as having some d. previously contained this substance, though subsequently it had been employed for another purpose. (A/V.)

2. A hospital attendant, xt. 32, strong and healthy, passed through a room in which a bag of Ip. powder was being emptied into a vessel. He was immediately seized with dryness of ^uces and sense of constriction of glottis. Face became red, conjunctivae injected, thorax arrested in expiration, speech and cough impossible. In his anguish he rushed into open air, where he was able to take an inspiration, and sneezing occurred, and cough without expectoration. In 5 m. ^cial redness was somewhat lessened. Conjunctivae were still injected, and he had violent headache, sore feeling in pharynx, and some hoarseness. Mucous membrane of velum and pharynx were much injected, and showed many small haemorrhagic points. Breathing regular, 24, difficult without aid of auxiliary muscles, and noisy. Sharp vesicular respiration all over lungs, with loud whistling and r>[c5. Expectoration of a moderate quantity of viscid lemon -coloured phlegm in balls, with traces of blood. No nausea ^ pulse 112 j temp, normal. On 5th d. expectoration was purely catarrhal. Then followed a violent bronchial catarrh, with great exhaustion. After 14 d. he was well. (Ide, J, h, Z., civ. No. 23.)

3. a. On June 20th, 1856, 1 was asked early in m. to visit B-« as soon as possible. He was employed in pounding at one of the city druggists, and had suddenly lost his sight, with horrible pain in eyes. Patient was 30, of pretty strong constitution ; had served his time in the army, and had never been seriously ill, save for 13 weeks of intermittent fever in 1851. On arriving, I found him on a sofa uttering loud cries from pain and loss of sight. He said he had gone to bed quite well, and slept till 3 a.m. ; he was then awakened by a dreadful pain in both eyes, especially the r. He could not sleep any more, the pillow was soaked with constant and copious lachrymation, and when daylight appeared he found to his horror that he was blind. Present condition, — features expressing pain ; eyes closed, lids slightly swollen, especially r. He complains of acute tearing pains, which especially affect the r. eye and scarcely reach the forehead. On separating r. eyelids a gush of tears escaped. Ocular conjunctiva is congested in a circle, rosy-red, and infiltrated ; so is that of lids, but in lesser degree.

IS

Tunica vaginalis swollen ; cornea dull and infiltrated, and on closer examination studded here and there with thickened patches, as if at these points the tissues were too closely united to be penetrated by the serum. Iris seemed dull and softened ; pupil was contracted and gave little or no reaction, but it was of a pure black, and without any trace of obstacle to light, — yet sight was quite gone, L. eye presented same symptoms, but to much less degree ; its sight was little a^ected. At tirst patient had experienced chills followed by heat, and, at last, after the pains had raged for some time, perspiration. No other symptoms.

Although patient spoke of having pounded Ip. the e. before, I could not trace the attack to this fact ; and in absence of other exciting causes considered it the dSut of a masked intermittent. Treating him accordingly, pains first abated, then sight returned, so that by noon he could sec and count my fingers held before his r. eye, and in afternoon he could distinguish the hands on a time-piece. Swelling and redness continued some time longer, but by e. his condition was very tolerable, and by the 26th he was well.

h. About H weeks after this I was called up for the same cause. The same phenomena had reappeared, only this time it was the 1. eye that was most affected, and there was also nausea and vomiting. There seemed no cause for the attack, save that again on the previous c. he had pounded Ip. Inquiring now more closely into this matter, I found that only once before the last occasion had the patient been occupied with this drug, viz. in January i and he remembered then having experienced similar symptoms, especially in the r. eye; they had been ascribed to the entrance of a foreign body. This time I gave an emetic and ordered entire rest. The symptoms diminished regularly and without trouble and he resumed his work.

c. On March 2nd next year B — came to me very early with his r. eye bound up. He had again, the previous d. at noon, been pounding Ip. In ^ h. he had felt a slight pricking and pressive pain in the eyes ; in e. he could not read because the light blinded him j 5 or 6 times he saw flames before his eyes, whilst the pains kept on increasing. The conjunctiva began to redden, but there was little perceptible swelling. He went to bed at his usual h. and slept quietly till 2, when he awoke in violent pain with the pillow quite wet. At 3 he could no longer stay in bed. The r. eye was the worst, it was quite blind ; with the I. he often saw iridescent rings of fire; the pain was incessant and momentarily aggravated by bright light. The other symptoms were as before. (TamhaYN, Jmrn. /, Pharm., i^c.^ i**^;, from Imbert-

GOURBEYRE, Op. ett.)

1. In small or nauseating doses Ip. produces malaise, with shuddering, chilliness, yawning, flow of saliva, and eructations. In somewhat larger doses it occasionally gives rise to uneasiness and rumbling in bowels, and sense of emptiness there, increased secretion of saliva and mucus, constriction of chest, irritation of throat, dry cough, occasionally spitting of blood or epistaxis, nausea, and inclination to vomit. Very soon after it is taken in full doses it excites vomiting, which is neither very severe nor frequently repeated, nor attended with

the same degree or even kind of sinking and prostration which tartar emetic occasions. In all doses it is apt to relax the bowels, if they are in a healthy state. (Stillk, op. at,)

II. A native student of the Campbell Medical School^ aec. 23, took, Nov. 26th, 1874, at 6.15 p.m., about 35 gr. of powdered Ip. as an emetic for acidity of stomach. 6.30, griping in abdomen with a little vertigo and nausea ; had a thin natural motion. Nausea and vertigo increased, and he felt hot inside. About 7 nausea was so great and distressing that he induced vomiting by finger in throat; ejected matters tasted sour, and consisted of some undigested rice mixed with a large quantity of mucus, no sign of drug. Vertigo and nausea relieved, but griping continued and increased. 8, large stool of watery character with some fsecal matter i felt very weak and lay down on bed y griping less. 8.45, another loose stool. Felt excessively weak; griping again increased, and within 15 m. he passed another copious stool on floor, being too weak to walk to closet \ stool was greenish yellow, and spotted over with little bits of thready white mucus. Griping after this became much less, but patient grew weaker and lay prostrate on bed. 10, cramps in fingers of both hands \ slight general perspiration. !0.30, suddenly screamed out, complaining of drawing pain in r. great toe, which was tieen spasmodically flexed. Immediately after, 1. toe was in same condition, then feet, then calves. Now and then there was some stiffness in neck, especially in sternomastoids. After this spasmodic contractions went on irregularly in both upper and lower extremities, but more frequently and more severely in the latter, proving a severe torture to patient. li>30, much restlessness \ slight general perspiration ; extremities somewhat cold ; pulse soft, weak, slow. (Ginger frictions were applied to extremities, with hot bottles, and a draught of chloric ether and ammonia administered.) 12, pulse slightly better, but no relief to spasms; griping increased, and he passed a large watery stool, greenish in colour, with white mucus floating over it. Within 10 m. another stool of same character. Spasms became more severe \ voice depressed ; slight nausea and occasional retching. Another draught was given at i a.m. j several watery stools were passed unconsciously in bed ; could not perceive whether he passed any water. No sleep ; spasms constant. 2, chlorodyne, 30 min., was given. Another loose stool, of greenish colour and containing mucus, was passed. After an h., another dose of chlorodyne. After this patient felt very drowsy, and spasms began to come at longer intervals i they were also of shorter duration and less severe. Stools (foetid) were all the time being passed unconsciously in small quantity into bedclothes. At 5 a.m. a severe spasmodic contraction took place in r. foot, and immediately it was followed by a copious watery stool, with white mucus floating in it. After that (6 a.m.) bedclothes were changed and there were no more stools ; no marked spasms -y no vomiting, only a slight nausea, almost constant for 2 h. more. (Sircar, Calcutta yourn, of Med.^ vii, 447.)

ill. Experiments on animals. — I. Dr. Polichronie (These de Paris^ 1 874) has made a series of researches for the purpose of discovering

the mode of action of Ip. and of craciinc. His conclusions are as

follows :

a. Emetine is the really active principle of Ip,

h. Emetine is a very toxic substance. It kills animals in two ways, sometimes by the prostration of the nervous system which it causes, sometimes — when given in small doses — by the mtcnse enteritis which it brines on.

c. Emetine brings on vomiting only at the moment of its elimination by the gastric mucous membrane, as proved by the delay of the sickness, and even more frequently its entire absence, after section of the two vagi ; in this respect it acts quite differently from apomorphia and tartar emetic, these causing vomiting as quickly when the nerves are cut as when they arc intact.*

^. Emetine has no vaso-constrictor action. (Lond, Med, Record,

i'ii 59-)

1. PccHOLiER, in his experiments, employed emetine as well as the drug itself. The animals selected for experiment were rabbits and frogs, — the former because they do not vomit. The following are the results of the inquiry :

a. I. considerably diminished the number and energy of the pulsations of the heart in rabbits.

b. It notably reduced the number of respirations in these animals, as well as the afflux of blood to the lune. Indeed, the pale and exsanguine state of the pulmonary tissue displayed after death was remarkable ; it was a veritable depletion of the lung.

c. In animals under its influence the temp, of mouth, axilla, and ear was lowered, while that of rectum remained stationary or rose.

d. In the digestive sphere, Ip. produced efforts at vomiting, hyperzmia of alimentary canal, and disappearance of sugar from liver.

e> The action on the nervous system was investigated in frogs. It reduced promptly the energy of the nervous system, and determined considerable collapse. The paralysis induced by it showed itself chiefly in the sensory system ; motor nervous power and muscular irritability were merely diminished and not wholly abolished. (Lancet^ April 25th, 1863.)

1. My experience of the effects of emetine is at variance on some points with that of M. Pecholier. In my cases the respiratory movements were increased in frequency, and the cardiac action was not less rapid than in health. In the lungs there was always, post mortem^ more or less engorgement with blood, and in one case even lobular pneumonia was set up, (Dyce Duckworth, St. Barth, Hosp, Rep., v, 220.)

• The same results have been obtained by Chouppc (^Gaz. Mid. di Paris, Aug. ist, 1874).— Eds.

Volume IV — Appendix

U. 12. a. Early in m. of April 25th, 1888, Chas. E. A., jet. 18, r*'*'e to my office in great distress. Both eyes were tightly bandaged, , ^ad hung down, and he was led in by his father. On d. previous, ^ "^d pulverised about 28 oz. of Ip. in an open iron mortar. He had g *^c to bed feeling as well as usual, but was awakened about i a.m. ' 'n tense pain in both eyes. There was profuse lachrymation and ^ ^t photophobia ; and therewith constant nausea but no vomiting.

IPECACUANHA.

(See Tol, iii, p. i o.)

This state of affairs had continued from that time until I saw him.

1 found slcin of lids and parts about eyes dusky red; margins of lids reddened ; conjunctivae slightly injected, particularly on lids ; fwDt circumcorneal redness ; great photophobia and copious lachrymation, especially when lids were separated. I rides were somewhat contracted, not mobile, and apparently darkened in colour. Pain was constant and severe : it seemed to localise itself just over eyes, beneath brows, and was much worse over 1. eye. There was also slight dull hod' ache in frontal region, just above inner canthus ; and sensation of a foreign body being in eye. Nausea was constant, and appetite gone.

b. Cocaine was instilled several times, without efFcct on fain or upon pupils. Atropine solution was equally powerless ; and ailuti few atropine crystals were placed in the conjunctival sacs. Even thea dilatation was slow : 1. pupil was more sluggish than r. As loonu

[>upils were dilated, photophobia and lachrymation was sotnewlut essened ; and during d. all symptoms gradually abated a little. Antr

2 d. they had disappeared. (Harold Wilson, Hahn. Mathlft Nov. 1 888.)