In consequence of its general efficiency, comparative mildness, and entire safety, ipecacuanha is admirably adapted for those cases in which an emetic is called for, with the object of simply evacuating the stomach. These have been pointed out in the general remarks upon the subject of emetics. There is one condition, however, of this kind, in which its unaided powers cannot be relied on; that, namely, in which a poisonous dose of opium, or ether narcotic of similar powers, has been swallowed. in these cases, it is advisable to have recourse to one of the more powerful emetics; but even here, ipecacuanha should be used as an auxiliary, on account of the impunity with which very large doses may be taken.

Another condition in which ipecacuanha should be preferably employed, is when, at the same time that a mild effect only is desired; there is an indication Tor the frequent repetition of the emetic, and especially when the affection to be treated involves the respiratory passages. Hence it is applicable to cases of asthma, and to those of hooping cough, in both of which its simple nauseating influence is often of great advantage. in the paroxysm of spasmodic asthma, it may be given in the full dose requisite for vomiting, and afterwards in nauseating doses, so as to maintain a greater or less effect, according to the severity of the symptoms, until the dyspnoea subsides. in the more violent attacks of hooping cough, the same course may be pursued, but with greater reserve. A gentle emetic dose may be administered every two or three days, with smaller doses in the interval. in the early stages of infantile catarrh, an emetic of ipecacuanha will often also prove useful; and the same remedy is frequently employed in croup, though probably less efficacious than tartar emetic.

Still another condition, in which the mildness of ipecacuanha gives it a preference, is when emetics are employed to produce a local irritant influence on the stomach; as occasionally in dyspepsia, haematemesis, and cholera, in which the remedy has been recommended.

Generally speaking, in young children, in pregnant and puerperal women, and in persons debilitated by previous disease, ipecacuanha should be selected, for the same reason, when an emetic effect is desired.

There is one complaint in which ipecacuanha has long enjoyed peculiar credit, and in which it has been supposed to have peculiar powers. it was in the treatment of dysentery that the remedy was first brought into notice; and, though perhaps less employed than in former times exclusively for this purpose, it has never entirely lost its credit, and still enters into the general treatment of the disease, in combination with other medicines, especially calomel and opium. it has been given in two different methods in dysentery; in one, in large doses with a view to its full emetic effect; in the other, in smaller doses, repeated so as to sustain a nauseating impression, or operate on the bowels. According to the former method, a full emetic dose of twenty or thirty grains is administered, and repeated two or three times, at intervals of from six to twenty-four hours, according to the effects produced, and the severity of the symptoms. The remedy is applicable to any stage of the disease, provided the stools are still small, and bloody or mucous, without gan-grenous odour, and unattended with general prostration. in the second method, from two to five grains are given, at intervals of from one to three or four hours, until a purgative effect is produced; and the remedy is afterwards to be regulated by the state of the symptoms. Another method of using it, recommended by Mr. Playfair, is to give, at the beginning of the attack, from thirty to sixty grains of the powder with as many drops of laudanum. if it vomit, the dose is to be repeated. it is said that the remedy sometimes acts very promptly not only in the relief, but in the cure of dysentery; and by some it is looked on as almost a specific. it is unnecessary to resort to this supposition in explaining its operation. The diminished force of the circulation, the depletion, the derivation at the same time to the surface, through the perspiratory action of the medicine, and to the stomach, at the opposite extremity of the alimentary canal, through its local irritation; all these influences, with the increased secretion from the irritated surface, and the removal of the irritating feculent matters by catharsis, are sufficient by their cooperation to produce the results, without calling in the aid of any specific power.

The same method of treatment has been extended to diarrhoea; but in this affection the medicine is more useful in diaphoretic doses, of which more will be said hereafter.

As a nauseating agent, ipecacuanha has been much recommended in the hemorrhages, especially in that from the uterus; but it probably has no other effect than such as may depend on the depressed state of the pulse attendant on the state of nausea.

For meeting some of the other indications for emetics, ipecacuanha is inferior to other medicines of the class. Thus, when a vigorous compression and agitation of the abdominal viscera, or a strong general shock on the system, or great muscular relaxation and circulatory depression, are required, the object may be better obtained by tartar emetic; though ipecacuanha will often answer, when only a moderate amount of the effects referred to is indicated, and may often be advantageously conjoined with tartar emetic in doubtful cases.

Administration

The dose of the powder for the emetic effect is twenty grains, which may be repeated every twenty minutes until it operates. But the quantity required to vomit in different individuals varies exceedingly; and six, four, or even two grains will sometimes act. I formerly had a female patient whom a fraction of a grain uniformly vomited. For children the dose must be reduced proportionably with the age (see vol. i. p. 34); but the wine or syrup is more convenient of administration in the very young. The powder may be given suspended in a wineglassful of warm water, and its operation aided by draughts of warm water or chamomile tea.

Troches of ipecacuanha (Trochisci ipecacuanha, U. S.) are directed in the U. S. Pharmacopoeia, each of which contains one-quarter of a grain of the powder. They are, however, used as expectorants, and seldom if ever for the emetic effect.

An infusion, made with two drachms of the powder and six fluidounces of boiling water, may be given in the dose of a fluidounce, repeated as above.

As a nauseant, two grains of the powder, or a fluidrachm of the infusion may be given, and repeated every three or four hours, or at such intervals as may be necessary to maintain the impression.

The only officinal preparations of ipecacuanha, used for an emetic effect, are the wine, syrup, and fluid extract.

Wine of ipecacuanha (Vinum ipecacuanha, U. S., Br.) is of such a strength that one fluidounce contains the virtues of thirty grains of the root, admitting this to be wholly exhausted by the menstruum. The full emetic dose for an adult is one fluidounce, for an infant a year or two old, a fluidrachm, which may be repeated every fifteen minutes till it operates. This is a convenient emetic for children, and, if properly prepared from good root, is very efficient.

Syrup of ipecacuanha (Syrupus ipecacuanha, U. S.) is prepared by mixing two fluidounces of the fluid extract with thirty fluidounces of syrup. it differs from that of the Pharmacopoeia of 1850, both in mode of preparation and in strength. The former syrup was prepared by first exhausting the virtues of the root by means of diluted alcohol, then evaporating sufficiently, and adding sugar. it was only half as strong as the present syrup, of which a fluidounce should contain the virtues of thirty grains of the root. This preparation is peculiarly adapted to infantile cases. From half a fluidounce to a fluidounce for an adult, and from thirty minims to a fluidrachm for a child, may be repeated every fifteen minutes till it acts.

A Fluid Extract (Extractum ipecacuanha Fluidum, U. S.) was introduced into our Pharmacopoeia at the late revision. A fluidounce of it represents an ounce of the root, and the emetic dose is therefore from fifteen to thirty minims. it is, however, more used for preparing the syrup than for any other purpose.