This section is from the book "An Experimental History Of The Materia Medica", by William Lewis.
Pharm. Lond. & Edinb.
Hipecacuanna; Radix braziliensis. Psycbotria emetica Linn*(a) Ipecacoanha: a slender root, brought from the Spanish Weft Indies, in short pieces, variously bent and contorted, full of wrinkles and deep circular fissures, which reach quite down to a small whitish woody fibre that runs in the middle of each piece: the cortical part is compact, brittle, and looks smooth and resinous on breaking. Two sorts of this root are met with in the shops, one brought from Peru, the other from Brazil; usually denominated from their external colour, the first whitish, grey, or ash-coloured, the other brown ipecacoanha.*(b) The first is generally preferred, being found to operate with the greatest certainty and mildness.
A root has been brought over under the name of white ipecacoanha, which has little or nothing of the virtues of the two foregoing: this is readily distinguished by its yellowish white colour, woody texture, and having no siffures or wrinkles. More dangerous abuses have sometimes been committed, by the fubfti-tution or mixture of the roots of an American apocynuniy which have been found to operate with great violence both upwards and downwards, and in some instances, as is said, to prove fatal: these may be known by their being larger than the true ipecacoanha, the fissures more distant, the intermediate spaces smoother, and more particularly by the colour of the medullary fibre, which in the poisonous roots is a deep reddish yellow, in the true ipecacoanha a whitish or pale greyish.
*(a) This is the name given it in the supplement to Linnaeus; it was formerly reckoned by him a species of Lonicera.
*(b) Both kinds have been found in the neighbourhood of Rio di Janeiro. Lond. Med, Jourtt. ix. 69.
Ipecacoanha has scarcely any smell, unless during its pulverization or infusion in liquors, in which circumstances it emits a faint nauseous one: in chewing, the wrinkled cortical part proves bitterish and subacrid, and covers the tongue as it were with a kind of mucilage; the medullary woody fibre is nearly insipid, and gives out to menstrua very little active matter. Geoffroy observes, that in pulverizing considerable quantities, the finer powder that flies off, unlefs great care be taken to avoid it, is apt to affect the operator with a difficulty of breathing, a pitting of blood, a bleeding at the nose, or a swelling and inflammation of the eyes and face, and sometimes of the throat; and that these symptoms go off in a few days, either spon-taneoufly, or by the assistance of venaesection. *In the Philosophical Transactions, vol. lxvi. part I. is a remarkable case of violent asthmatic fits in a lady caused by the effluvia of powdered ipecacoanha.
This root is the mildest and safest emetic that has yet been discovered; and may be ventured on almost in the lowest circumltances where the slomach requires to be unloaded. The common dose is from ten grains to a scruple and upwards: in the medical observations and inquiries published by a society of physicians in London, a great number of cases are mentioned, in which two grains operated sufficiendy: in con-stitutions which bore vomiting ill, and which were greatly ruffled by the usual doses, two or three grains operated with great ease. Where it fails of operating upwards, it commonly purges, and sometimes considerably: in this intention it may be employed, in several cases, to advantage, in conjunction with other purgatives, to determine its action downwards: I have found fifteen grains of jalap, with two or three of ipecacoanha, purge more than twice the quantity of jalap by itself.
The ipecacoanha was first introduced, about the middle of last century, as a specific in dysenteries; and repeated experience has consirmed its efficacy in this distemper, not only when used as an emetic, but likewife when given in such small doses as scarcely to affect the grosser emunctories. In common dyfenteric fluxes, it frequently performs a cure in a very short space of time; not by its exerting an astringent power, as some have suppofed, for it does not appear to have any real astringency; nor by its mucilaginous subftance covering the intestines and incraiffating thin humours, as others with more plausibility, have inferred both from its mucilaginous taste, and from the ropiness and slimi-nefs which it maniseftly communicates to the contents of the stomach; but apparently by promoting perspiration, the freedom of which is in these cases of the utmost importance, and an in-creafe of which, even in a state of health, is generally observed to diminish the evacuation by stool. In common dysenteries, the skin is for the most part dry and tense,. and perspiration obstructed: and indeed this obstruction, and the conversion of the perspirable matter upon the intestines, is very frequently the immediate cause of the disease. Most of the common diaphoretics pass off, in these cases, without effect: but ipecacoanha, if the patient, after a puke or two be covered up warm in bed, brings on a free diaphorefis or a plentiful sweat, by which I have often known the distemper terminated at once.
In putrid or malignant dysenteries, or where the patient breathes a tainted air, it has not been found equally successful: it requires here to be continued for several days, or repeated as an evacuant, with the further assistance of rhubarb, cordial antiseptics, and mild opiates or astringents. Where plentiful evacuation is ne-cessary, or the offending matter lodged deep, and the operation can be borne without inconvenience, the ipecacoanha, as Dr. Pringle ob-serves, is moil advantageoufly given in small quantities at a time, and repeated at proper intervals, till a vomiting or purging comes on.
* In the spasmodic asthma, Dr. Akenside remarks, that where nothing contraindicates repeated vomiting, he knows no medicine so effectual as ipecacoanha. In violent paroxyms, a scruple procures great and immediate relief. For habitual indisposition, from three to five grains every morning, or from five to ten every other morning, may be given for a month or six weeks. It is equally useful where it does not vomit, as where it does. The relief seems owing to its general antispasmodic or relaxing property, of which its emetic operation is probably a particular consequence (a).
*In the Stockholm acts 1770, are several cases of uterine haemorrhages cured by one third or half a grain, rubbed with sugar, given every four hours or oftener. In one case, the haemorrhage returned on discontinuing the medicine, and ceased on repeating it. These small doses had good effects in catarrhal coughs, even in those which attend consumptions; and if not beneficial, are at least: not hurtful, in bloody coughs, in which vomiting has several times been observed to come on, without any increase of the haemorrhage. They may be useful in peripneumony and pleurisy, in which cough is often the most troublesome symptom, and in which Seneka root (which in increafed dofes proves also emetic) has been so much recommended.
(a) Med. Transact. i. 93.
The emetic virtue of ipecacoanha resides in its refinous parts. By digesting the root in fresh quantities of rectified spirit, and inspissating the filtered tinctures, a resinous extract is obtained, to the quantity of about three ounces from six-teen, which, by itself, vomits strongly, and with great irritation: the residuum yields to water nearly four ounces of a soft tenacious mucilage, which has scarcely any sensible operation. If only a part of the refin be extracted, by slight digestion in a little highly rectified spirit, the remaining root proves more gentle, and rather purgative than emetic: in this state it is recommended by some in dysenteries accompanied with a considerable fever, where the root with its natural quantity of resin might irritate too much; but as small doses of the root itself operate with all the ease and gentleness that can be wished for, this precarious method of weakening it does not appear advisable.
By boiling it in water, a part of the refin is taken up with the mucilage; the extract amounting to about six ounces from sixteen, and proving mildly emetic. The best men-struum for extracting the entire virtue of the root appears to be a mixture of one part of pure spirit with two or rather three parts of water: after sufficient digestion in this men-struum, neither water nor spirit took up any thing considerable from the remainder. In the shops wine is employed: an ounce of the root is macerated or digested in a pint† or fifteen ounces of mountain ‡. These tinctures, in doses of from half an ounce or less to an ounce and upwards, prove mildly emetic.