For a general account of ipecacuanha, the reader is referred to the emetics (II. 465). As a diaphoretic it is very seldom given alone, and, when thus given, is not capable of producing any considerable effect, unless in doses which would discompose the stomach. I have, however, been in the habit of using it in cases in which, without producing copious diaphoresis, it is desirable to keep the skin in a soft, rather moist state. in the second stage of enteric or typhoid fever, commencing about the ninth day, when the mouth and surface of the body are disposed to be dry, and the secretions generally are deficient, and in analogous conditions in other fevers, I have found advantage in giving very small and frequently repeated doses, conjoined with small doses of the blue mass. One grain of the mercurial, with one-sixth or one-eighth of a grain of ipecacuanha, may be given every two hours, till some effect on the mouth is evinced, or occasion for its use ceases. The ordinary full diaphoretic dose is a grain, to be repeated every four, six, or eight hours. if it nauseate in this quantity, the dose may be diminished, and repeated more frequently.

Ipecacuanha And Opium

Conjoined with opium, ipecacuanha acquires great diaphoretic powers, which render this compound a most valuable medicine in numerous diseases. Some have supposed that but little of the power of this mixture is due to the ipecacuanha; the opium being, in their opinion, the main, or almost exclusive diaphoretic ingreclient. But I am convinced that this an error. Opium certainly will sometimes act with considerable energy as a diaphoretic; but it very often fails, and cannot alone be relied on. The addition of ipecacuanha is essential to the full diaphoretic effect; and powers are evolved by the combination which neither ingredient alone would exercise. This will be obvious when its method of operating is considered. Opium stimulates the capillary circulation, and has some excitant effect on the proper perspiratory function; ipecacuanha relaxes the coats of the vessels so as to keep them within the transuding point, while it also stimulates the proper function; if now warm drink be added to fill the blood-vessels, we have a combination of all the most powerful diaphoretic influences.

The stimulant and narcotic properties of the opium limit the employment of this combination. it is true that these properties are somewhat modified by the ipecacuanha, so as to render the preparation applicable where we might hesitate to employ opium alone; but still they are by no means annihilated; and it would not be proper to administer the medicine in states of the highest inflammatory excitement, with a full, strong pulse, nor in others in which there might be active congestion or inflammation of the brain. in all such cases, the excitement should be lowered by depletory measures, and the cerebral symptoms removed, before venturing upon this diaphoretic.

Therapeutic Application

The combination of opium and ipecacuanha is peculiarly applicable to inflammatory complaints, after the reduction of excitement. it operates beneficially by revulsion to the surface, depletion, the relief of pain, and the quieting of nervous irritation, which always forms an essential part of every inflammation. it is especially useful when the inflammation is complicated with typhoid phenomena. In all these affections, it is very often associated with calomel or other preparation of mercury; which is usually indicated, if at all required in the case, at the same stage.

It is unnecessary to particularize the several phlegmasiae in which the combination may be used. it may be given in all, with the exception of those of the brain, and of the bronchial mucous membrane, in which it is generally contraindicated, especially before free expectoration has taken place, by the effect of opium in checking the bronchial secretion. But thT)se to which it is most applicable are mucous enteritis, dysentery, and peritonitis. As a general rule, it may be given every night at bedtime, after the third day of the disease, if the patient has been duly depleted. in typhoid cases, it may be given earlier.

In acute rheumatism, it is one of the remedies most relied on. After a few days appropriated to the requisite depletory measures, a full dose may be given every eight, six, or four hours, so as to sustain a steady diaphoretic and anodyne effect. in this complaint, also, it is very advantageously associated with calomel with a view to mercurialism, if the disease do not show a disposition to enter into convalescence in eight or ten days.

In gout it is often useful, in the full dose, given at bedtime.

In the course of the idiopathic fevers, when associated with disordered nervous phenomena, especially want of sleep, it may often be advantageously given at night, when not contraindicated by too high arterial excitement, or vascular irritation of the brain. in these fevers, when of the low or typhoid character, it is an excellent remedy, exhibited as a stimulant and diaphoretic, in small doses, at regular intervals, through the twenty-four hours.

It is one of the most efficacious remedies in diarrhoea, after the bowels have been disembarrassed of any irritating matter, and in the various hemorrhages, especially the uterine, when not attended with arterial excitement.

In some cases of dropsy, which have failed to yield to diuretics and purgatives, recourse may be had to this combination, which, by the profuse perspiration it produces, promotes absorption. it should be given every four, six, or eight hours, so as to sustain a constant and powerful effect, which should, moreover, be aided by the hot bath. I have seen dropsy of the most obstinate character yield completely to this treatment.

Administration

The full dose is a grain, each, of ipecacuanha and opium; which, when the object is to sustain a constant impression, may be repeated every six or eight hours, or even more frequently. Sometimes advantage will be found from dividing the dose, and repeating it oftener. Very frequently the medicine is given only at bedtime; other remedies being used during the day. Sometimes, when the indication for its use is decided, but the stomach irritable, it may be exhibited in double the ordinary dose by enema. if given alone, or with calomel, the mixture is best administered in the form of pill; but a very frequent mode of exhibition is that of the powder of ipecacuanha and opium, or Dover's powder.