Definition. - The dried root, to which may be attached a portion of the stem, not more than 7 Cm. in length, of Cephaelis Ipecacuanha (Brotero) A. Richard, known commercially as Rio, Brazilian, or Para Ipecac, or the corresponding portion of C. acuminata Karst, known commercially as Carthagena ipecac, yielding not less than 2 per cent. of ipecac alkaloids.

Description and Properties. - The older roots of Rio ipecac are in pieces of 2 to 6 inches (5-15 Cm.) in length and about 1/6 inch (4 Mm.) thick, mostly simple, contorted, dull grayish-brown or blackish, finely wrinkled, closely and irregularly annulated and often transversely fissured; bark thick, brittle, brownish, easily separated from the thin, whitish, tough, ligneous portion; odor slight, peculiar, nauseous; taste bitterish, acrid, nauseating. When ipecac is sound and free from mouldiness its quality is proportionate to the thickness of the bark and the thinness of the ligneous portion.

Carthagena ipecac is similar to Rio and about one-half thicker.

The active principles of ipecac are emetine and cephaeline, of the former of which there is present I to 2 per cent. The drug also contains ipecacuanhic or cephaelic acid, starch, resin, etc.

Dose. - As an emetic, 15-30 grains (1.0-2.0 Gm.); as an expectorant, 1/2-2 grains (0.03-0.12 Gm.).

Official Preparations

Fluidextractum Ipecacuanhae - Fluidextracti Ipecacuanhae - Fluidextract of Ipecacuanha.

Dose. - As an emetic, 15-30 minims (0.2-0.5 Cc.); as an expectorant, 1/2-2 minims (0.03-0.12 Cc.) [as an emetic, 15 minims (I Cc); as an expectorant, 1 minim (0.05 Cc), U. S. P.].

Pulvis Ipecacuanhae et Opii - Pulveris Ipecacuanhae et Opii - Powder of Ipecac and Opium. (See Opium.)

Syrupus Ipecacuanhae - Syrupi Ipecacuanhae - Syrup of Ipecac. - Formula: Fluidextract of ipecac, 70; acetic acid, 10; glycerin, 100; sugar, 700; water, to 1000.

Dose. - As an emetic, 2.6 fluidrams (7.39-22.50 Cc); as an expectorant, 5-30 minims (0.3-2.0 Cc.) [as an expectorant, 15 minims (1 Cc.); as an emetic, 4 fluid-drams (15 Cc), U. S. P.].

Tinctura Ipecacuanhas et Opii - Tincturas Ipecacuanhas et Opii - Tincture of Ipecac and Opium. (See Opium.)

Vinum Ipecacuanhae - Vini Ipecacuanhas - Wine of Ipecac (10 per cent.). -Dose. - 1-60 minims (0.06-4.0 Cc.) [15 minims (1 Cc), U. S. P.].

Antagonists and Incompatibles. - The gastric sedatives and narcotics generally hinder the emetic properties of ipecac. The incompatibles are tannic acid and vegetable infusions containing it, metallic salts, and caustic alkalies.

Synergists. - The emetics, sedative expectorants, warm drinks, are synergistic, and opium aids the diaphoretic properties of the drug.

Physiological Action. - Externally and Locally. - Ipecac is a powerful irritant to the mucous membranes of the respiratory tract when the powdered drug is inhaled. The prolonged application of ipecac to the skin occasions much irritation, even producing vesication, pustulation, and ulceration. Ipecac also possesses some antiseptic properties.

Internally. - Digestive System. - In small doses ipecac acts as a stimulant to the stomach. The salivary and gastric glands are stimulated, the action of very small doses of the drug resembling that of vegetable bitters.

Large doses are powerfully irritant and emetic, the emesis being the result of both a local irritation upon the stomach and perhaps some slight action on the vomiting center. The vomiting is preceded by and attended with but little, if any, nausea, although there is usually a marked increase in the secretion of bile and intestinal mucus, full doses of the drug acting not only as an emetic, but as a purgative and cholagogue.

Circulatory System. - Except in occasioning the ordinary depression incident to the act of vomiting, ipecac in moderate amounts has no influence upon the heart. Enormous doses, however, particularly if injected into the jugular vein, have destroyed the life of dogs by cardiac paralysis.

Nervous System. - Save in slight stimulation of the medulla oblongata and a slight diminution of the reflex activity of the spinal cord, ipecac has no important action upon the nervous system.

Respiratory System. - So far as the respiratory movements are concerned, they are unaffected by moderates doses of ipecac. The bronchial mucus membrane is stimulated, augmenting the secretion of bronchial mucus, and therefore reflexly stimulating coughing.

Absorption and Elimination. - The active principles of ipecac are rapidly absorbed, being eliminated chiefly by the gastro-intestinal mucous membrane, although the other secretions share in the excretory process, the skin being especially affected by this drug, which acts as a mild diaphoretic.

Temperature. - Under medicinal doses the temperature is unchanged. Poisonous doses reduce temperature.

Untoward Action. - Rarely, in persons peculiarly susceptible to the drug, intense cutaneous irritation and conjunctival inflammation, accompanied by neuralgia of the face and scalp, have been produced. Even soiling the hand with a few drops of the tincture of ipecac has occasioned unfavorable results.

Poisoning. - There is violent vomiting and purging, the ejecta containing bile and frequently blood. Among the graver symptoms are abdominal pain, marked cardiac depression, muscular weakness, and greatly diminished reflex irritability. The skin is cold and bathed in perspiration.

Treatment of Poisoning. - Tannic acid should be given as the chemical antidote. Opium, belladonna, and cardiac stimulants may be necessary.

Therapeutics. - Externally and Locally. - Troches of ipecac and spray inhalations of wine of ipecac are used to allay the cough and expectoration in acute bronchitis and obstinate "winter coughs

Internally. - Ipecac in proper doses is a very efficient emetic, and is frequently employed as such, particularly when it is desirable through the act of vomiting to empty the air passages, as in spasmodic laryngitis, bronchitis, tracheitis, and the early stages of diphtheria. The action of the drug is so tardy, however, that it is not the most desirable emetic to use when it is necessary to empty the stomach quickly, as in cases of poisoning.

When the stomach contains a quantity of undigested food, causing pain, headache, etc., ipecac is a valuable emetic, since the drug occasions little marked nausea or depression.

Minute doses of ipecac, such as 1 to 4 minims (0.06-0.2 Cc.) of the wine or 1/10 to 1/4 grain (0.006-0.01 Gm.) of the powdered drug, act as an efficient gastric sedative and stomachic, frequently arresting vomiting when other drugs have failed. The statement, however, that minim doses of the wine of ipecac allay the nausea and vomiting of pregnancy is probably apocryphal.

Ipecac in small doses is an excellent adjuvant to other chola-gogues to relieve the distress of hepatic dyspepsia. The drug is equally advantageous in atotric dyspepsia, attended with flatulence, depression of spirits, etc.

The notoriety and pecuniary profit which Helvetius secured in connection with ipecac - or Radix antidysenterica, as it was originally named by its propagator - were due to its apparent specific action in dysentery.

The drug is peculiarly efficient in dysentery. Whatever the form of dysenteric attack may be, ipecac is the more efficient the earlier it is administered.

The drug, in order to exert any beneficial influence in bilious dysentery, must be given in large doses - 60 to 90 grains (3.88-5.83 Gm.) in a single dose, or 20 grains (1.29 Gm.) every four hours. These doses, of course, will at first produce emesis, but the repetition of them tends to establish a tolerance of the remedy, an early attainment of which is most desirable.

Various methods have been employed to aid the stomach in retaining the drug, such as the administration of opium or other gastric sedative, a sinapism placed upon the epigastrium, etc.

Ipecac has been highly recommended in infantile diarrhea. It has been successfully employed in hematemesis and uterine hemorrhage, it being customary in the former complaint to give at first an emetic dose, succeeded by smaller and nauseating amounts.

Like other emetics, ipecac has proved efficient in expediting labor by relieving rigidity of the os uteri.

The drug has been found beneficial in relieving hemoptysis, and it is of unquestioned value in many affections of the lungs and bronchial tubes. In pneumonia, particularly in the congestive and declining stages of the disease, it has proved serviceable.

In bronchitis and phthisis, especially when the secretion is scanty, and in chronic bronchitis with much cough and but a moderate amount of expectoration, ipecac is a valuable remedy. It has been found valuable in spasmodic asthma.

Ipecac is an important adjuvant to quinine in the treatment of remittent and intermittent fevers, the latter disease having been cured, it is claimed, by ipecac alone in doses of 1 or 2 grains (0.06-0.12 Gm.), given every three or four hours.

Contraindications. - Ipecac is not permissible for patients suffering from aneurism, hernia, prolapse of uterus or rectum, etc.

Administration. - The drug is notoriously uncertain in its action, probably because of the variation in the percentage of emetine, the freshly powdered root being ordinarily more reliable.

As a diaphoretic the powder is also preferable, though in any case the fluidextract may be substituted for the powdered form. As an expectorant the syrup and wine are the preparations usually employed.

Children are very tolerant of ipecac, the syrup being the preparation usually given to them.

Emetine, represents the crude drug fully, and may be administered as an emetic in doses of 1/12 to 1/6 grain (0.005-0.01 Gm.), and in correspondingly small doses when a diaphoretic or expectorant action is desired. It has been found extremely difficult to prepare it free from other substances.