Family Name: Rubiaceae

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Notes from the Eclectic Physicians

Notes from the Eclectic Physicians

1874: J.M. Scudder
Preparation – Prepare a tincture from the root (a good article) 3viij. to Alcohol 76degree Oj. Dose from the fraction of a drop to gtts. v.

Ipecacuanha exerts a specific influence upon mucous membranes, relieving irritation, and arresting the inflammatory process. It also stimulates a better circulation and innervation, increases nutrition, and thus favors functional activity.

We employ it as a specific in most cases of cholera infantum. It allays irritation of the stomach, gradually checks the frequency of the discharges from the bowels, and restores tone and functional activity. In a large experience in the treatment of this disease, we have found nothing to equal it. It is usually prescribed in the following proportions: R Tincture of Ipecac, gtts. v. to gtts. xxx.; Water, 3iv. A teaspoonful every hour.

We employ it with very marked advantage in the treatment of infantile pneumonia, associated with Aconite and Veratrum. In some cases, the prescription of Ipecac alone will be sufficient to arrest the disease in two or three days, especially if given in the first stages. It is also employed with excellent results in diseases of the respiratory apparatus of the adult.

We prescribe it in all cases of muco-enteritis. If there is little constitutional disturbance, Ipecac is used alone; if there is some hardness and increased frequency of the pulse, it is given in combination with Aconite.

We employ it in Dysentery, especially in the sporadic form from cold. The simple prescription of Ipecac is frequently successful, but with much febrile action it is associated with a sedative.

In small doses we employ it as a stimulant to the entire digestive tract, associating it with the bitter tonics, or the restoratives. For this purpose, it will prove very valuable, especially where there is some gastro-intestinal irritation.

1883: Scudder
The root of cephaelis ipecacuanha ‑ Brazil .

Preparations: Powder, Tincture, Syrup, Emetina or Emetia. Dose: The dose of the powder will be from grs. x. to grs. xxx. every 10 or fifteen minutes with warm water, or some warm stimulant infusion; of the tincture gtt.x. to 3ss, every ten minutes with warm water or a warm infusion. Emetina is rarely used by hypodermic injection, the dose being one to two grains.

Therapeutic Action: Ipecacuanha is emetic, diaphoretic, expectorant, laxative and alterative. In full dose it is one of the mildest and most valuable emetics known. If it does not produce emesis, it generally soon proves cathartic. If administered in smaller doses, it acts as a stimulant, diaphoretic, expectorant, or laxative; and in still smaller doses, as a tonic and alterative. Its first effect upon the system, when administered, is that of a stimulant, or irritant to the mucous membrane of the stomach, and not until its active properties have been absorbed, does it cause nausea, depression and vomiting.

Hence it belongs to the class of specific emetics, ‑ those which produce emesis when introduced into the circulation from any part of the system. As an emetic the ipecacuanha does not depress the system like many other of the vegetable emetics. It may, therefore, be resorted to in cases of debility, when other agents would be inadmissible.

As a mild, effectual agent it may be prescribed whenever there is a foul state of the stomach, arising from a redundancy of mucus, or of the biliary secretion, or retained indigestible aliment. Its mildness and efficiency recommend it, when the object is simply to evacuate the stomach, or when a gentle influence of this kind only is desirable.

Its gentle action also renders it a very popular and highly valuable emetic, in numerous diseases of children. It is used in minute doses as an alterative, either alone or combined with other agents, as sulphur, cream of tartar, guaiacum, sarsaparilla podophyllin, sanguinaria, taraxacum, etc. In hepatic torpor, and where there was obvious derangement of the chylopoietic system, we have often combined it with the extract of taraxacum podophyllum and sanguinaria, forming the mass into pills, which have proved highly beneficial. In small doses it often proves valuable as a stimulant, tonic and alterative, in dyspepsia, and other diseases, combining it with some of the bitter tonics, the action of which it facilitates. It is sometimes combined with cathartics; two or three grains of it greatly facilitate the action of these agents, and even render small doses more efficient than large ones, when given uncombined. As an expectorant and diaphoretic it is often combined with the more stimulating agents, as the squill, senega, etc.

Specific Indication: Irritation of bronchial mucous membrane and air‑cells; irritation of stomach; irritation of small and large intestines.

Specific Uses: In acute bronchitis and pneumonia; in nausea, vomiting, and irritative dyspepsia; in cholera infantum, diarrhoea, dysentery, menorrhagia, and hemoptysis. In bronchitis, and especially in pneumonia, Ipecac in small doses takes a first place. As the pulse is frequent and the temperature increased, it is usually combined with Aconite.

In irritation of the stomach, especially if the pulse is frequent, and the temperature is increased, Ipecac is the remedy. In cholera infantum, Ipecac is suggested as a principal remedy. With frequent pulse and increased temperature of the abdomen, it is given with Aconite. With pallid or yellowish face, abdominal pain, pallid tongue, nausea and vomiting, it is associated with Nux. In the ordinary diarrhoea of irritation Ipecac is a very certain remedy. Give it with Aconite or Nux, as may be indicated.

In the common form of dysentery ‑ colitis, or simple inflammation of the large intestine ‑ Ipecac is as near a specific as we can imagine. In zymotic dysentery it may form a part of the treatment, but anti‑zymotics will take precedence. Dose: For these uses the dose will be small ‑ Tinct. Ipecac gtt. v. to gtt. xv., water 3iv; a teaspoonful every hour.

Antiemetic: As has been already noted, Ipecac in small doses (gtt. v. to gtt. x., water 3iv.) is an admirable remedy to relieve irritability of the stomach, and check nausea and vomiting. It is usually combined with Aconite.

1895: Watkins: IPECAC, SP MED
Intestinal irritation, diarrhoea, weakness and debility, cough, oppressed breathing, diminished expectoration, mucous rales, hypersecretion in bronchioles, elongated and pointed tongue, nausea, pain in stomach, pyrexia. Ten to twenty drops in four Ounces of water; teaspoonful every two hours.

1911: Fyfe
Irritation of the stomach, large or small intestines, irritation of the bronchial mucous membranes and air cells; irritation of the mucous membranes with increased secretion, when the tongue is narrow and pointed; profuse menstruation, passive hemorrhage; nausea and vomiting when the tongue is narrow and pointed, hoarseness following coughs and colds.

Ipecac, in small doses, is a frequently indicated remedy….ipecac and aconite are many times the only needed medication in cholera infantum, and the same prescription will cure most cases of ordinary summer diarrhea. fluid extract: one drop is medicinal-30 is emetic.

1911: LLOYD
The beginning of the history of ipecacuanha root and the first study of its virtues is clouded in mystery and fable. It is stated that the South American Indians were acquainted with the medicinal properties of the plant, having gained their experience from observing the habits

of animals (409).* A vague yet probably the first source of information on the subject of ipecacuanha root is found in a work published in London in 1625, named “The Pilgrims,” by Samuel Purchas (527), which in five volumes gives an account of many travels and the natural history of foreign countries. In Vol. IV, page 1311, where Brazilian plants and their uses are considered, the following passage occurs:

” Igpecaya or pigaya is profitable for the bloudie fluxe. The stalke is a quarter long and the roots of another or more, it hath only four or five leaves, it smelleth much wheresoever it is, but the smell is strong and terrible.”

The subsequent description of its medicinal virtues bears further evidence that we have here a plant at least closely related to official ipecacuanha. According to a printed note at the head of that chapter, the author is believed to be a Jesuit by the name of Manoel Tristaon (651a), who probably wrote the treatise in the year 1601.

The first definite information we have of ipecacuanha dates from the publication of a work by Piso and Marcgraf (511), called “Historia Naturalis Brasiliae,” Amsterdam, 1648, chapter lxiv being entitled “De Ipecacuanha ejusque Facultatibus.” Two species are described, a white and a brown species, the latter evidently being the true ipecacuanha plant. An illustration of the plant is added, which Merat considers quite a credtable reproduction of the true ipecacuanha. The entire chapter was reprinted with French translation, by Merat (422), and inserted in his “Dictionnaire,” as a testimony of the extreme exactness of the description given by Piso (511).

The root first came to Europe in 1672 through the agency of Le Gras (422), who sought to introduce it into medical practice. Keeping a stock supply in the care of an apothecary by the name of Claquenelle in Paris , he associated himself with J.A. Helvetius (309), a physician of German descent, who had graduated under the medical Faculty at Reims . However, the venture was at first a failure, owing to the employment of too large doses.

In 1680 a merchant by the name of Garnier in Paris , well acquainted with the medicinal virtues of the root, sent for a supply, obtaining 150 pounds from Spain . Through this gentleman, directly or indirectly, Helvetius (309) secured a new lot of the drug, which he skillfully managed to exploit by extensively advertising it as “radix anti-dysenterica”, the origin of which, however, he kept a secret. Finally the fame of the remedy came to the notice of Minister Colbert, who ordered that the remedy be given an official trial in the Paris municipal hospital.

*This fable has a parallel in the quaint description given by Clusius concerning the discovery of the healing virtues of nux vomica bark in cases of snake bite.

In 1688 Helvetius (309) obtained the sole license for the sale of the drug, which proved to be an efficient, or at least popular, remedy among the members of an aristocratic patronage, including no less a personage than the dauphin. King Louis the XIV then bought the secret from Helvetius for one thousand louis d’or, and made the remedy public property. He was induced to do so by the combined influences of his physician, Ant. d’Aquin, and of Franc. de Lachaise, confessor the king. Garnier, the merchant, however, brought suit in order to obtain his share of profit in the transaction, but was unsuccessful in his efforts.

After the use of the drug had thus been established in France , the remedy was introduced into other countries, e.g., by Leibnitz (378a) (1696) and Valentini (656b) (1698) into Germany , and 1694 by Fried. Dekker into Holland .

During the first part of the eighteenth century the drug was in frequent use in the various pharmacies of Germany , as is evidenced from its being mentioned in several old documents of that age. It is, for example, mentioned in the authoritative drug list of the Silesion town of Strehlen in 1724.

However, during the increasisng employment of the drug, in the latter part of the eighteenth century, much confusion arose as to its botanical origin, insomuch that it became the habit to designate as ipecacuanha any emetic plant, regardless of its botanical source. A long list of such plants is enumerated, for example, in Martius (409). In this manner the characteristics of the plant furnishing true ipecacuanha root became almost forgotten, other plants being substituted for it. Ray, for example, held it to be a species o f paris , and no less an authority than Linnaeus himself thought viola ipecacuanha now known as ionidum ipecacuanha (684), to be the true ipecaacuanha root.

In 1764, Mutis, a celebrated botanist in Santa Fe de Bogota, sent the younger Linnaeus a Peruvian emetic plant with description, which he thought was the true ipecacuanha root. Linnaeus fil. (385) accepted the statement of Mutis as correct and, moreover, believing the illustration given by Piso (511) of the true ipecacuanha plant to represent the specimen he received from Mutis, in 1871 gave it the name psychotria emetica, Mutis.

To Dr. Gomez (271, 272), who in 1800 returned from Brazil , is finally due the credit of having corrected this error. He re-established the nearly forgotten botanical character of true ipecacuanha in his memoir published at Lisbon in 1801, wherein he describes and figures the plant, and especially distinguishes it from Psychotria emetica, Mutis.

Having donated some specimens of the plant in his possession to his fellow countryman, F.A. Brotero (100), professor of botany, Coimbra , the latter published an account of it (1802) in the Trans. Linn. Soc naming it Calliocca ipecacuanha (100), but without giving credit to the source of his information, which chagrined Gomez considerably (422). Twelve years later Brotero left a copy of his article with a botanist by the name of Hectot,of Nantes who communicated it to M. Tussac (656a), and the latter, in publishing it, gave it the name Cephaelis ipecacuanha, also laying stress upon its distinction from Pyshotria emetica , Mutis perhaps without having had any knowledge of Gomez’s paper written twelve years before.

In 1820 A. Richard (550) again called attention to this distinction, but, as it seems, also without giving proper credit to Gomez, with the result that later authorities frequently quote the true ipecacuanha root under the name of Cephaelis ipecacuanha, A. Richard.

1905: Peterson
Properties: In minute doses tonic and stimulant;in large doses expectorant, diaphoretic and emetic.

Physiological action: Powdered ipecac applied to the skin will produce irritation, redness and pustulation. The powder when inhaled is an irritant to the mucous membrane and will caue in many, sneezing, asthmatic breathing;epistaxis,spitt ing of blood, and in some cases swelling of eyes, face, and throat. This may be counteracted with quebracho or uva ursi. In small it is a stimulant. In large doses a depressant. In small doses of one eighth to one queasrt of a grain it simulates slaivary and gastric secretion and has a fenral tonic effect on the stomach. In doses of one halt to one grain it is a good expecorant, whil in two grain doses it is diaphoretic. In larger doses of ten to twenty grains its firect effect is stimulating after which it will produce nausea snd vomiting. It is milder and llwer than other emtics but is less depresing. Ipecac has a marked effect on the pneumogastric nerve,. In many cases repreated emetic doses will produce a toleration of the stomach, the emetic affect beling lost, and it acts as a cathartic, the feces having a bilious color. Specific ipecachuana is preferable to the powder in most cases.

Indications: Persistant irritation of the mucous membrane with lack of secretion, especially in acute inflamatory condition. Irritation of digestive tract indicated by contracted elnogated pointed tongue with red edges. In all these cases it shoudl be iven in small doses. As an emetic in lare doses it is indicated where there is an accumulation in the stomach, with borad, flabby, pale and heavily coated tongue, showing inactivity. Nausea and vomiting with pale relaxed membrane, Taken in cold liquid in minute doses it is useful as a styptic, arrests nausea and vomiting and diarrhea. It is diaphoeritc, expectorant, and emetic. As an emetic it is slower than lobelia but is less depressing and often acts both as an emetic and laxative. Taking it in warm water makes its action more prompt in such cases. We think of it in acute bornichits, bronchitis in children. iN infantile pneumonia it is an excellant remedy. COugh with deficeint sevreion. I hemorrhage it is a useful remedy in good sized doses. In dysentery and diarhea it is one of our best agents, especially if combined with aconite. In croup, associated with sanguinaria, it is of great value. Its long contined use may cause a diarhea in some people and therefore discretion should be used, In minute doses it is one of our best remedies to excite the stomach to motor activity. Here is is given in small doses after meals. Syrup of ipecac is made of tincture ipecac 3/5i;simple syrup 3/5vii.Used as an expectorant.