1641. Diseases Of The Abdominal Viscera

In some forms of Dyspepsia, particularly where the liver appears to be torpid and inactive, and the biliary secretion is of a vitiated character, Ipecacuanha, in doses of gr. 1/4 - gr. 1/2, daily, in the form of pill, with Ext. GentianAe, Pil. Rhei Co., or Taraxacum, proves highly serviceable. Its mode of action is obscure, but under its use the urgency of the symptoms subsides, the tone of the digestive organs improves, and the evacuations assume a healthy character. It may, in some instances, be advantageously conjoined with a mild mercurial, but, under all circumstances, it requires to be persevered with in order to obtain its full influence. In functional derangement of the Liver, Ipecacuanha often proves highly serviceable when given in small and long-continued doses.

1642. In Dysentery, Ipecacuanha was first employed as a remedy by Piso,§ who brought it from the Brazils, and gave it in drachm doses, and in the form of infusion. But it was not until Helvetius, who had come from Holland to Paris, gave some of it, with a knowledge of its virtues, to the physician of Louis XIV., who employed it successfully in the case of the Dauphin, then dangerously attacked by Dysentery, that it came generally into use. Marais,* and soon afterwards Sloane, Heister, Vater, &c, further demonstrated its good effects. (Copland.) Since that date, it has been employed by the highest authorities; and in modern times we find Annesley, Twining, Ainslie, Geddes, Mortimer, Ballingall, Playfair, Balmair, and Fergusson, recording their testimony as to its value and efficacy in this disease. My own experience fully bears out the eulogiums which have been passed upon it; and, indeed, there can be but one opinion, that when given in such doses as to establish and keep up a gentle moisture on the skin, together with a slight degree of nausea, its operation is most beneficial. I have never observed any advantage from inducing vomiting by its means in this disease; the most benefit appearing to accrue, when a slight degree of nausea is kept up, without producing its more powerful effect. Mr. Twining§ trusted to it alone (gr. vj., combined with Ext. Gentian.), repeating it twice or thrice daily. He premised a full blood-letting, and employed Pulv. Jalapae Co. 3j. as a purgative. Mr. Annesley's formula is very serviceable, and one for a long period very generally employed: -1641 Diseases Of The Abdominal Viscera 151 Pil. Hydrarg. gr. ij. - iij., Pulv. Ipecac. Pad. gr. j. - ij., Opii gr. 1/4, ft. pil. 4tis vel 5tis horis sumend. When the acute stage has subsided, it may be combined with great advantage with the Nitrate of Silver. There is no form or stage of the disease in which it does not prove beneficial, either alone or combined with Opium, or other medicines. Its beneficial operation is probably due to its power of diminishing morbid arterial action, and determining to the skin. (See Pulv. Ipecac, cum Opio.) The treatment of Dysentery by large doses of Ipecacuanha (gr. xxx. - gr. lx.), uncombined with other remedies, has been re-introduced by Mr. E. J. Docker, || who remarks that the action of these large doses is certain, speedy, and complete. "In all constitutions, robust as well as delicate, under all circumstances the result is the same. In the very worst cases, when the strength of the patient is almost exhausted, after the whole range of remedies has been tried in vain, the disease running its course swiftly and surely to a fatal issue, 90 grs. of Ipecacuanha have been given, and forthwith the symptoms have entirely changed, the disease itself being literally cured." Of fifty-three cases thus treated, he lost only one, and that was complicated with Abscess in the Liver. This treatment has been extensively tried in the Madias Presidency and other parts of the East, and the results form the substance of an excellent paper by Dr. W. R. Cornish.¶

* Guy's Hosp. Reports, No. x.

Lectures, vol. ii. p. 67.

Cyc. Pract. Med., vol. i. p. 118.

§ De Med. Brazil, lib. ii. Amst. 1658.

* Ergo Dysent. Affect. Radix Bra-siliensis, Paris, 1690.

Philosoph.Trans., No. ccxxxviii.

Dict. Pract Med , vol. i. p. 731, from which the preceding sketch is extracted.

§ Clin. Illus. of Diseases of Bengal, vol. i. p. 69.

|| Lancet, July and Aug. 1858. ¶ Madras Med. Journ., Jan. 1861, p. 41.

The treatment consisted of administering powdered Ipecacuanha in doses of gr. xxx. - gr. xl. - gr. lx., according to the severity of the case, and repeating the dose every fourth or fifth hour till amendment was manifest. To enable the stomach to bear these doses, Mr. Docker precedes them with f3ss. of Tr. Opii, and applies sinapisms to the stomach. Others, including Dr. Arthur, whose experience is great, omit these means, considering that the vomiting is attended with the most salutary effects, and that without it Ipecacuanha would lose half its efficacy. In recent cases the disease generally begins to yield in one or two days, and the medicine is then given at longer intervals. In convalescence the Ipecacuanha is omitted, and small doses of Blue Pill with Opium once or twice daily, or the mineral acids, are substituted. To sum up, it appears - 1. That acute dysentery is more successfully and speedily treated by large doses of Ipecacuanha than by other means. 2. That it is more effectual in the acute than in the chronic forms. 3. That large doses, such as those mentioned above, may be given with perfect safety, without any fear of hyper-emesis or other ill effects. 4. That, as a general rule, it is less successful with natives than with Europeans. The reader will do well to consult Dr. Ewart's valuable paper on the subject in the eighth volume of the "Indian Annals of Medical Science" (1863), p. 396. The Ipecacuanha treatment in Infantile Dysentery has been tried with success in the Children's Hospital, London, by Dr. Hillier.*

1643. In Diarrhoea, Ipecacuanha proves very serviceable, often effecting a cure when other medicines have proved ineffectual. It has been praised by LinnAeus. Fothergill, Sir G. Baker,§ and others. It may be combined with Rhubarb, Hydrarg. c. Cret., Argent. Nit., Plum. Acetas, &c, according to the circumstances of each case. When it fails in small doses, a full dose, to produce emesis, often proves effectual.