Origin

Ipecacuanha consists of the roots of a small shrubby plant, growing in the forests of Brazil, where it is said to be collected chiefly by the aborigines. The same plant grows also in New Granada. The root is brought in bags or bales, chiefly from the ports of Brazil; but I have seen parcels which were said to have come from Caracas.

Sensible and Chemical Properties. As in the shops, the root is in pieces from two to four inches long often much contorted, somewhat vol. ii. - 30 smaller in thickness than a goose-quill, and extremely rough from circular unequal rings, set close together, with fissures between them, generally deep, but in one variety rather superficial. There is often attached to the proper root, or mingled with it in mass, a portion of the underground stem of the plant, which is easily distinguished by its smoothness, and, being inert, should be rejected. The colour of the root is usually dark-brown or blackish-gray, but sometimes brownish with a reddish tint, and still more rarely light-gray or ash-coloured. The powder is of a light grayish-fawn. The root is, when whole, inodorous, but in powder has a faint, peculiar smell, which in some individuals produces violent attacks of dyspnoea, resembling the paroxysms of spasmodic asthma. The taste is bitter, acrid, and nauseous. The sensible properties and virtues of the root are extracted by water and alcohol. They are said to be impaired by long boiling. Galls and other vegetable astringents produce precipitates with the infusion.

Active Principles

The principle upon which ipecacuanha mainly depends for its effects on the system is an organic alkali, called emetia, emetina, or emetin, which is probably combined with a peculiar acid named ipecacuanhic acid, at one time mistaken for the gallic. Emetia when pure is very powerful, sometimes operating as an emetic in the dose of half a grain. Both in a pure and impure state, it was at one time prepared and kept in the shops, under the impression that it might be substituted for ipecacuanha; but its violence, and the danger from over-doses have, with other causes, led to its entire abandonment; and it is now seldom or never heard of as a medicine. For further information in relation to it, the reader is referred to the U. S. Dispensatory. Besides emetia, there is a minute proportion of a volatile principle, upon which the odour of the root and probably its acrid taste depend; for the emetia is stated simply to have a slight bitter taste This volatile ingredient is said to possess no emetic power.

Effects on the System

Locally, ipecacuanha is an irritant of considerable powers. Applied to the skin, it is capable of producing inflammation, and a vesicular eruption. The dust in contact with the eyes, occasions redness and high irritation. When air in which particles of the powder are floating is inhaled by certain individuals, it causes severe irritation of the air-passages, exciting in some violent sneezing, and in others a complete paroxysm of asthmatic dyspnoea, followed by copious expectoration. The case of a medical gentleman has been reported to me, in whom it occasions severe inflammation of the mucous membrane of his mouth, fauces, and respiratory passages. Pereira quotes a case in which the effects of the powder were so severe as even to endanger life. The assistant of a druggist, engaged in powdering the root, incautiously inhaled the dust for a period of three hours. He was attacked with vomiting, followed by tightness of the chest, and afterwards with constriction of the throat, and a feeling as of suffocation; and had a pale and deathly appearance. Measures were employed for his relief with temporary success; but another attack came on, in which there seemed to be imminent danger of suffocation. A strong decoction of uva ursi with extract of rhatany was administered, with the apparent effect of giving almost immediate relief; but he continued to suffer several days with difficulty of breathing. {Mat. Med., 3d ed., p. 1596.) The experiments of Bretonneau show that the powder, introduced into the stomach or rectum of animals, may produce severe inflammation of these parts. (Trousseau et Pidoux, ae ed., i. 602.)

When swallowed in very minute doses, ipecacuanha appears to act as a tonic, increasing the appetite, and facilitating digestion; effects which are probably owing to a very gentle exercise of its irritant property. it probably also promotes the gastric secretion. in doses somewhat larger, it acts as a diaphoretic and expectorant, appearing to have a special tendency to the pulmonary apparatus. Still larger doses nauseate; and, if the quantity be merely within the vomiting point, the medicine is very apt to purge. in the full medicinal dose, it acts as a rather prompt and efficient emetic, generally vomiting within twenty minutes, with considerable antecedent nausea, though less than that produced by certain other substances belonging to the class. The vomiting, though efficient, is not often violent; the powder being usually thrown off by one or two efforts; but occasionally the action is more prolonged, especially when the doses have been small, and several times repeated. in consequence of the facility with which the whole, or nearly the whole of the powder is discharged from the stomach, ipecacuanha is a very safe emetic, and may be given in very large doses, with little more effect than from the ordinary full dose. However large the quantity, the stomach usually discharges it by one or two acts of vomiting. Even when operating as an emetic, the medicine sometimes also proves laxative; but it is less apt to do so than tartar emetic. I shall here treat of the applications of ipecacuanha only as an emetic and nauseant. As a diaphoretic, expectorant, and local irritant, there will be occasion to consider it hereafter.

Therapeutic Application

The remedial virtues of ipecacuanha were known to the aborigines of Brazil. The first published account of it was by Pison, about the middle of the seventeenth century, who spoke of its virtues in dysentery. A physician named Legras afterwards endeavoured to introduce it into France, but with little success. it at length became generally known through a young physician named Helvetius, who used it as a secret remedy in Paris, and, having been very successful with it in the treatment of dysentery, and cured the Dauphin among others, received honours and a large reward from Louis XIV.