In Catarrh which mainly affects the stomach, ipecacuanha can also prove very useful, but it needs to be employed with more precaution. Anything like the emetic, or even the nauseating doses, would be almost sure to aggravate the inflammatory tendency and produce gastritis of an unmanageable kind. But in the smaller doses (five to ten minims of the wine) ipecacuanha is highly beneficial; in many cases of chronic catarrhal dyspepsia, and indeed in atonic dyspepsia which is independent of any catarrhal cause, this remedy is most valuable. In children, even acute catarrh is much benefited by ipecacuanha.

In Vomiting of several kinds, ipecacuanha is demonstrated to be an excellent medicine; but it here requires to be taken in very small doses. One minim of the wine (equal to 1/32 grain) is taken in water and repeated at short intervals till a decided effect is produced. It is now well established that this effect of ipecacuanha is especially, if not solely, produced in cases where the vomiting is sympathetic in character. It is seen very remarkably in the sickness of pregnancy, for which there is probably no antidote of equal value; and in the morning sickness of chronic alcoholism it is scarcely less useful. On the contrary, it is useless in sickness arising from organic affections of the stomach, such as cancer, chronic ulceration, etc.

As an Arrester of Haemorrhage, ipecacuanha possesses considerable energy; a fact which is the more curious because in poisonous doses it has frequently produced haemoptysis and other forms of bleeding.

The best doses to employ are those which just stop short at the production of slight nausea; one grain repeated frequently enough to produce a very gentle effect. To produce absolute emesis is to run a grave risk of heightening the very mischief which we are treating. In the haemoptysis of early phthisis, ipecacuanha may dispute with ergot of rye the reputation of being the most valuable styptic we possess. In the passive haemorrhages from merely engorged bronchial mucous membrane, it is equally effective. In haematemesis it is of value when the haemorrhage is vicarious of menstruation. In menorrhagias it is scarcely worth while to mention it as a remedy fit to be put in competition with ergot of rye and several others.

In Dysentery, ipecacuanha has of late years proved itself more than worthy of the old reputation, implied in the name "radix antidysenterica," under which Leibnitz introduced it to Europe. In acute tropical dysentery there is now a vast amount of Indian experience to show that the bold use of large doses is most successful. At the earliest opportunity twenty-five or thirty grains of powdered ipecacuanha are given in a very small quantity of fluid; some physicians order a full dose of laudanum or a few doses of chloroform half an hour previously. The patient is kept quite still in bed, and may suck a little ice or take a tea-spoonful of water, if thirsty. Mustard or turpentine is applied to the belly.

It is surprising how seldom either vomiting or any considerable amount of nausea occurs; and in eight or ten hours the remedy can be repeated in diminished dose. Under this treatment the purging of blood and slime, the abdominal pain, and the tenesmus soon disappear, the motions becoming feculent; and there is often a profuse sweat, followed by refreshing sleep. The smaller doses of ipecacuanha are continued for some days, taking care to keep intervals free for the administration of food. Even when the motions have become healthy, ten or twelve grains should be given at bedtime for two or three nights.

This treatment is applicable to the great majority of patients, but even in dysentery we sometimes meet with evidence of the greater sensitiveness of some persons than of others; and in such exceptional cases two or three grain doses, with opium and gray powder, will often prove very successful.

The general utility of the large doses above described is conclusively shown by Dr. Maclean, who ably sums up the modern evidence, including his own large experience, in his article on Dysentery in Reynolds' "System of Medicine," vol. i. The credit of reintroducing the plan is due to Mr. Docker.1

It is very interesting to notice that while ipecacuanha is, par excellence, the treatment for acute dysentery of the ordinary type, which so commonly alternates, epidemically, with outbreaks of intermittent and remittent fever, the other great cinchonaceous drug, cinchona (with its alkaloids), is equally successful in that variety of dysentery which is actually complicated with the symptoms of genuine malarial poisoning. In the latter case large doses of quinine perfectly replace the ipecacuanha treatment.

In Diarrhoea, more especially when dependent on nervous irritation, and hence particularly in the diarrhoea of young children, ipecacuanha is a powerful remedy, especially when there is also vomiting or retching.

1 Lancet, vol ii., 1858.

Vinum ipecac. in three-minim doses every two or three hours, will quickly put a check to the disorder, even when it has begun to take on pseudo-dysenteric characters with blood and slime.

In various spasmodic Diseases of the Respiratory Organs ipecacuanha is of great value. In the paroxysms of nervous Asthma it was especially praised by the late Dr. Salter, who gave it, however, in one large emetic dose at the outset of the paroxysm. I myself prefer to give repeated five or ten minim doses of the wine every ten to thirty minutes during two or three hours, or until substantial relief is obtained, and this will often happen, even in intense cases, very quickly. In Whooping-cough, doses of one minim for children under five years, or two minims for older patients, may be given every one, two, or three hours with the greatest relief.

In simple Inflammatory Croup and in simple Pneumonia, ipecacuanha has only a comparatively limited value; it does not so quickly produce nauseating effects as tartar emetic; it is also inferior to the latter as a diaphoretic, while both are inferior to aconite.

In concluding the general estimate of the therapeutic powers of ipecacuanha, it is necessary to give a caution respecting the extreme inconvenience which may be occasioned by giving this drug, even in very small doses, to patients possessed of the unfortunate idiosyncrasy of suffering irritative catarrh or asthma whenever they take it. If any sick person declares from past experience that he is liable to this, the practitioner (whatever his desire to administer ipecacuanha on any particular occasion) should pause before venturing to give even the minutest dose; for so great is the misery which it causes to such persons, and so keen often is their annoyance, that he may suffer great discredit for his persistence in prescribing it.

(The following is from R. and V., Brit. Med. Journ., June 9, 1877:

"1. Sixty grains of powdered ipecacuan, mixed with a small quantity of bile, and placed in the duodenum, powerfully stimulated the liver. Even three grains had an effect on a dog weighing 6.8 kilogrammes, very nearly as great as the effect of sixty grains on a dog weighing 27.2 kilogrammes, the amount of bile secreted per dog being nearly the same in both cases. 2. The bile secreted under its influence was of normal composition as regards the biliary matter proper. 3. No purgative effect was produced, but there was an increased secretion of mucus in the small intestine. The composition of the bile did not afford any evidence of an increased secretion of mucus in the small intestine. The composition did not afford any evidence of an increasd secretion of mucus having taken place from the glands of the bile-ducts.

"The increased biliary flow that followed ipecacuan could not in these experiments be ascribed to any relaxation of spasm of the bile-ducts; for that no such thing existed was clearly shown by the free flow of the bile before the substance was given. Nor could it be owing to contraction of the gall-bladder, for the cystic duct was clamped. Nor can it be ascribed to contraction of the bile-ducts, for the increased flow was far too pro-longed to be attributable to any such cause. It is therefore certain that this substance, like the others, has the power of stimulating the secreting apparatus of the liver. This being now proved as regards the dog, it can scarcely be doubted that the modus operandi is the same in man. The results of these experiments will, therefore, lead to new speculations regarding the pathology of dysentery; for every step towards greater accuracy of knowledge regarding the modus operandi of any therapeictic agent is certainly calculated to advance our knowledge of the true nature of the pathological condition that is relieved or cured by it.")

Preparations and Dose. - Ipecacuanha, gr. j - xxx (.06 - 2.); Pulv. Ipecac. Co., gr. x. - xv. (.65 - 1.); Extract. Ipecac. Fluid., mj. - xxx. (.06 - 2.); Syrup. Ipecac, mxv. - 3 ij. (1. - 8.); Vinum Ipecac, mxv. i - 3 ij. (1. - 8.); Trochisci Ipecac, p. r. n.

Besides the officinal members of the Cinchonaceas, there is one plant, Coffee, which is of great importance, and cannot be passed over in a treatise on therapeutics. On account of the identity, or close relationship, of their active ingredients, I must also notice the tea-plants, Paraguay Tea, and Guarana, though these belong to different orders.