The dried root of CephaŽlis Ipecacuanha. Brazil.

Fig. 203.   Ipecacuanha, two thirds the natural size.

Fig. 203. - Ipecacuanha, two-thirds the natural size.

Characters. - In pieces about the size of a small quill, contorted and irregularly annulated. Colour brown, of various shades. It consists of two parts, the cortical or active portion, which is brittle, and a slender, tough, white, woody centre. This hard centre and the annulated appearance of the cortex give to the root the appearance of a number of brown beads strung on a white thread.

Composition. - The woody centre is inert. The cortical part contains an alkaloid, emetine, and an acid, ipecacuanhic acid, which is a glucoside allied to tannic acid.

Dose. - Of the powdered root, as emetic, 15-30 gr.; in dysentery, 20-30 gr. in a bolus.

Preparations.

B.P.

Dose.

Pilula Conii Composita (vide p. 522)......................................................

5-10 gr.

Pilula Ipecacuanhae cum Scilla (vide p. 522)........................................

5-10 gr.

Pulvis Ipecacuanhae Compositus............................................................

5-14 gr.

Trochisci Ipecacuanhae (1/4-gr. in each)................................................

1-3

Trochisci Morphinae et Ipecacuanhae (1/36-gr.morphine, 1/12-gr. ipecac.)......................................................................

1-6

Vinum Ipecacuanhae (as an emetic).......................................................

3-6 fl. dr.

,, ,, (as an expectorant).............................................

5-40 min.

U.S.P

Extractum Ipecacuanhae Fluidum (as expectorant)...............................

5 min.

,, ,, (as emetic).....................................

25 min.

Pulvis Ipecacuanhae et Opii .................................................................

5-15 gr.

Trochisci Ipecacuanhae (1/4-gr. in each)...............................................

1-4

Trochisci Morphinae et Ipecacuanhae (1/40-gr. of morphine,

1/2-gr. ipecac.).............................................................................

Tinctura Ipecacanhae et Opii.................................................................

4-15 min.

Syrupus Ipecacuanhae (as expectorant).........................................................

2-30 min.

,, ,, (as emetic)............................................................

1/2-l fl. oz.

Vinum ,, (as expectorant) ...................................................

3-5 min.

,, ,, (to relieve vomiting)............................................

half a drop

Pulvis Ipecacuanhae Compositus. Compound Powder of Ipecacuanha, B.P. Pulvis Ipecacuanhae et Opii. Powder of Ipecac and Opium, U.S.P. (Dover's Powder). - Ipecacuanha, 1; opium, 1; sulphate of potassium, 8, B.P. Ipecac, 10; powdered opium, 10; sugar of milk, 80, U.S.P.

Physiological Action. - In frogs small doses of emetine cause irregularity of the heart, with final stoppage in diastole and loss of irritability of the cardiac muscle. Larger doses paralyse the central nervous system and diminish the contractile power of the muscles (p. 128).

Locally applied to the skin or mucous membranes, it acts as an irritant and may produce a pustular eruption. In some persons it has a peculiarly irritating action on the respiratory tract, so that almost infinitesimal quantities of the powder cause running at the nose, and sometimes asthma. When taken internally, it is an irritant to the mucous membrane of the stomach, and acts as a prompt emetic. This is partly due to the local action of the drug on the ends of the vagus in the stomach, and, when absorbed into the blood, to its action on the vomiting centre in the medulla.

Emetine produces in dogs, both when injected under the skin and when administered internally, diarrhoea, which is sometimes bloody. The intestinal mucous membrane is swollen, red, and ecchymosed as in poisoning by arsenic, antimony, platinum, iron, or sepsine.

When injected either subcutaneously or into the veins it produces death by cardiac paralysis. It paralyses the vessels first, and then the heart, so that the blood-pressure sinks nearly to zero while each cardiac pulsation is still powerful and produces a considerable wave in the blood-pressure tracing.

The lungs are often congested, oedematous, or in a state of red hepatisation, especially in rabbits.

In medicinal doses it increases the secretion from mucous membranes often very markedly, and is hence used to increase the expectoration and render it more fluid in bronchitis (p. 255). It is slightly diaphoretic, independently of the effect produced by its nauseating qualities.

Uses. - Ipecacuanha is used as an emetic in cases of poisoning and in overloaded conditions of the stomach; to clear out the trachea and larynx in croup and diphtheria (1 teaspoonful of vinum ipecacuanhae every 1/4-hour, in a child, till vomiting occurs); to empty the bronchial tubes in chronic bronchitis when choked up with mucus.

In jaundice depending on catarrhal conditions of the bile-ducts, it is useful to lessen the viscidity of the mucus; also in jaundice depending on the presence of a small calculus.

As a diaphoretic it is given in suddenly suppressed menstruation, and in rheumatism, muscular or acute, in the form of Dover's Powder; also in catarrhs. In small doses it is often useful in vomiting from various causes, e.g. vomiting of pregnancy.

As an expectorant (p. 255) it is very useful when the bronchial secretion is scanty, tough, and difficult to expectorate. Ringer strongly recommends the spray of ipecacuanha wine in winter cough and bronchial asthma.

Ipecacuanha is very useful as an anti-dysenteric, especially in the acute dysentery of the tropics; large doses (30 gr.) must be given on an empty stomach, preceded by a dose of laudanum half an hour before, to still the stomach and prevent vomiting. No water must be taken with it, and the patient must lie down with his head low.

Precautions. - Large doses must not be given to pregnant women, or to old people with atheromatous arteries. The wine is apt to lose its power by keeping, and hence it is best to preserve it in small sealed bottles.

Caffea. Coffee. Not officinal. - The seed of Coffea arabica.

Composition. - Unroasted coffee contains caffeine and a kind of tannin called caffeotannic acid. During roasting a part of the caffeine is volatilised and an empyreumatic substance called caffeon is developed.

Action. - The action of coffee is somewhat like that of caffeine (p. 871), but differs from it in some respects, inasmuch as the caffeon increases the peristaltic movements of the intestine, and causes, indeed, tetanic contraction of it, while caffeine does not alter peristaltic movements. Caffeon quickens the pulse, dilates the vessels and lowers the blood-pressure, and produces a sensation of warmth on the surface. In some persons coffee produces a feeling of weight in the abdomen and a tendency to haemorrhoids. As tea has not this action, or has it only to a comparatively slight extent, it is probably due to the combined action of the caffeine and caffeon.

Use. - Coffee is used chiefly as a remedy in headache and as a stimulant in cases of opium-poisoning.