Ipecac: This drug contains emetin which is an expectorant, emetic, and protoplasmic poison.

Ipecac affects the following tissues: mucous membrane of the alimentary and respiratory tracts. "The stomach presents a picture of severe inflammation. There is present an infiltration of round cells throughout the mucosa, and portions of the submucosa are involved. The surface layer of the mucosa may be necrosed and in places undergo sloughing. The blood vessels in the muscularis mucosa are congested." Nausea and vomiting are observed, this being due to local gastric irritation.

"The trachea undergoes acute inflammation; the muscular layer just inside the cartilage is intensely congested. The blood vessels are distended with blood and there is an extravasation of blood between the muscle fibres. The mucous membrane is apt to be denuded and badly swollen. The lumen of the trachea is filled with strings of mucus, epithelial cells, leucocytes, fibrin and blood.

"In the lung a picture of lobular pneumonia is produced. The walls of the terminal bronchioles and alveolar passages are somewhat swollen. The alveolar septa show round celled infiltration especially about the blood vessels, which are distended and tortuous. Many of the alveolar spaces and air sacs are obliterated by the collapse of the septa and by the mass of exudate, consisting largely of emigrated leucocytes, red corpuscles, mucous and epithelial cells. The bronchi and the bronchioles contain a secretion of mucopurulent material.

"The kidney may be involved in the physiological action of Ipecac. It has produced great congestion with extravasation of blood into the tubules and beginning parenchymatous degeneration and nephritis. A diapedesis of blood elements into the tubules, with the formation of blood casts, has been observed. There are other changes, but these are the most striking.

"In addition to the foregoing, the following facts, with reference to the action of Ipecac are pertinent. Sweating of reflex origin is a probability. The blood pressure may be raised by perivascular constriction, but it may fall during the nausea. A bloody diarrhea may ensue, accompanied by depression of the heart action. Capillary paralysis is produced by Ipecac, which is accountable for its hemorrhagic symptoms. Locally, the drug is an irritant; pustular eruptions have appeared upon the skin and when applied to the eye conjunctivitis results."

"Emetin is a powerful amebicide, but is not a bactericide. Emetin is not a specific in pyorrhea as has been claimed, but is an aid in conjunction with dental surgery and proper antisepsis, in clearing up cases."

Therapeutics

Ipecacuanha or Ipecac, in larger doses will cause nausea and vomiting, but will allay these symptoms if given in minute doses; hence the drug is useful in any gas-•tric or intestinal disturbance when nausea is predominant, particularly when the tongue is clean. A clean tongue with nausea, is a guiding indication for Ipecac under any circumstances.

Bright red hemorrhages, when accompanied by nausea, will require this medicine. This is particularly so in hemateme-sis or in hemoptysis, for which condition the remedy is of value.

In bronchitis or in bronchopneumonia, especially in infants or children, Ipecac is a very important remedy and will be indicated by a loose, rattling, choking cough, with fine or coarse rattling throughout the chest. The severity of the coughing often induces bluish redness of the face, as well as nausea and vomiting. Hence in spasmodic cough such as pertussis, Ipecac is of frequent use also. Asthma will often require this medicine, when together with nausea, there is a sense of oppression and anxiety about the chest, dyspnea and threatened suffocation. The cough is choking or gagging and causes vomiting of strings of white mucus. At the same time, the chest seems filled with mucus, which it is difficult to raise.

In the enterocolitis of infants, Ipecac will be indicated by grass-green, fermented stools or by green mucous stools, together with nausea and vomiting. The mouth seems filled with saliva, when this remedy is indicated, necessitating frequent swallowing.

In some cases of intermittent fever, which have tolerated quinin badly and have failed to improve thereby, Ipecac will be required; especially when a short chill, but long hot stage with thirst and followed by sweat, are present. Nausea throughout the paroxysm is a characteristic accompaniment. Irregular cases, after quinin, when nausea is marked, may need this remedy.

Characteristic Symptoms Of Ipecac

1. Headache, as if the brain were bruised, all through the bones of the head, and down into the root of the tongue, with nausea.

2. Distressing nausea and inclination to vomit, with almost all complaints.

3. Stooping causes him to vomit.

4. Distressed sensation, as though the stomach were hanging down relaxed.

5. With every movement, a cutting pain in the abdomen almost constantly, running from left to right.

6. Stools as if fermented; green as grass, with nausea and colic.

7. Hemorrhage from the uterus, blood bright red, profuse, clotted, with heavy oppressed breathing.

8. Suffocation threatens from constriction in the throat and chest.

9. Loses breath with cough, turns pale and becomes rigid; worse from the least motion.

10. One hand cold, the other hot.

11. Backache, short chill, prolonged fever; mostly heat with thirst, headache and nausea; cough and sweat last.