Euphorbia ipecacuanha. Ipecacuanha spurge.

Pl. 52. Euphorbia ipecacuanha. From the specific name given to this vegetable we infer, that before the true origin of the officinal ipecacuanha was known, this plant, among others, was for a time considered the source of that drug. The Pharmacopoeia Danica was one of the works in which this reference was made, and Linnaeus undoubtedly paid some respect to the opinion in assigning the specific name.

Nearly all the species of Euphorbia appear to possess the power of acting with violence on the stomach and alimentary canal. This power particularly resides in a milky juice which they exude on being wounded. Of the species which have been most extensively submitted to experiment are Euphorbia officinarum, esula, helioscopia, dulcis, peplus, exigua, Cyparissias, palustris, and Characias. Professor Murray has collected details respecting the operation of most of these, from various medical authorities. It appears that they all excite vomiting or purging, and in large doses bring on violent burning pains of the stomach and bowels, heat and thirst, followed by great prostration of strength, cold sweats, and in some instance, death. In small quantities, however, they have been used as medicines with safety, although some of them are uncertain in regard to their dose, and difficult to manage in their operation. [Note B.]

[Note B. Sponte jam patet, internum Euphorbii usum periculo plenum esse. Sed confirmant id infortunia, specialibus casibus subnata. Obiit quidam cui empiricus illud imprudenter exhibuerat, dysenteria eodem die. Virgo venusta seni decrepito, se invita, desponsata ad mortem sibi conciliandam pulverem Euphorbii ingessit, unde dolores ventrjs atrocissimi, hypercatharses cum vomitionibus frequentissimis, singultu, ardore ventnculi et faucium sitique inextinguibili, tandem sudores frigidi et animi deliq*ia: ex quibus atigustus tarnen arte emersit. Nihilomimus tarnen quidam illud praecipere ausi sunt, et instar drastici, quod pituitam, sed potentius aquam, subduceret in iis, quibus venter nimis contra alia mitiora torpet, vel ut loqui amant, friget, in hydropicis praecipue admiserunt. lta ;Etius, Actuarius et Arabes non nulli. Galenus et Dioscorides tacent de vi ejus purgante, ömnes tarnen, qui ore captum concedunt, cautionem summam injungunt, et connubium, cum iis, quae acrimonium ejus frangere valent, vel praegressam mitigationem desiderant. Hanc ipsam tentarunt oleo amygdalino, sueco Citri, phlegmate Vitrioli, Mastiche, Croco, Tragacantha, Melle aliisque bene multis secundum varium de ejus natura conceptum. Sed ejusmodi correctiones vel non sufficiunt, vel, si sufficiunt, ipsam vim medicaminis destruunt. Minuere dosin vel rite illam diluere, aliis exemplis artis est. Ast nondum comprobata vera dosis est. Ad grana decern permittit Sennertus, alias non ineptus subdolse Euphorbii vis judex; a grano uno ad octo cum semisse concedit Heurnius; a granis duobus sex vel octo Geoffroy. Omnibus hisce audacior et Fallopius, qui prseceptoris sui Machesii auctoritate et propria experientia ductus, non dubitavit Euphorbii vetusti drachmam unam, rarius scrupulos quatuor, dare. Mixtum Cassia mitius deprehendit quam solutum, qua forma sitim intolerabilem et evacuationem largiorem creavit. Sed praestat usum internum eiusdem omnino negligere.
Murray Apperatus Medicaminum sub Euphorbia officinarum.]

The genus Euphorbia comprises a vast number of species, of different habit, size and mode of growth. The flowers are frequently minute, very complex, and difficult of examination. They have a calyciform involucrum with four or five segments like petals, and the same number of interior segments like nectaries. Stamens twelve or more. Filaments articulated. Fertile flower solitary, stipitate, naked. Styles three, bifid. Capsule three seeded.

The species Ipecacuanha is procumbent, with opposite, obovate, oblong or linear leaves; peduncles axillary, one flowered, elongated.

The genus was placed by Linnaeus in the class Dodecandria, order Trigynia. Michaux, considering as separate male flowers, the bodies of stamens which correspond, in number, to the nectaries or lacinulae, has referred the genus to Monoecia, Monadelphia. In this he has been followed by various American botanists.

In natural arrangements this genus is among the Tricoccae of Linn, and Euphorbiae of Juss.

The Euphorbia ipecacuanha is a low, tufted plant, growing in sandy soils in the Middle and Southern states. Michaux remarks, that the plants are sometimes buried in the sand. It is a polymorphous vegetable both in its shape and colour, the leaves continually differing in their outline, even in contiguous plants; and the colour varying from green to crimson.

The root is irregular and fleshy, very large in proportion to the plant it bears, running deep into the sand, sometimes, as Mr. Pursh informs us, extending to the depth of six feet. The stems, from one root, are numerous, erect or procumbent, forming large bunches on the surface of the ground. They are smooth, regularly dichotomous, and jointed at the forks. The leaves are inserted at the joints, opposite, sessile, smooth, having most frequently an oblong shape though different plants possess every intermediate variety in the form of the leaf, from circular to linear. Their size and colour are likewise variable. The flowers are solitary on long peduncles from the forks of the stem. Calyx spreading, divided into five obtuse segments. Inner segments or nectaries five, small, gibbous. Stamens numerous, in five parcels, appearing, at different times, two or three together, with double anthers. The fertile flowers have a large, roundish, drooping, pedicelled germ, crowned with six revolute stigmas. Capsule three celled.

The dried root of the Euphorbia ipecacuanha is of a greyish colour outside, and white within. It is light and brittle and has about the hardness of cork. To the taste it is sweetish and not particularly unpleasant.

I subjected some portions of the root to chemical examination and obtained the following results.

Sulphuric ether digested on the powdered root dissolves a part of it; and this ethereal solution gives a precipitate, if alcohol is added to it.

Alcohol alone takes up another portion of the root, and assumes a pearly turbidness after water is added. Both the ethereal and alcoholic solutions, evaporated to dryness, leave a residuum which is fusible and inflammable. The decoction gives no precipitate with gelatin or sulphate of iron. With alcohol it gave out a white precipitate which rendered the solution turbid, and subsided in flocks. The cold infusion exhibited the same phenomena in a smaller degree. From these appearances we may infer that the root contains caoutchouc, resin, mucus and probably faecula.

The Euphorbia ipecacuanha has long been known to possess the same property, which is so frequent in its genus, of exciting the stomach powerfully as an emetic. The appropriation of its specific name seems even to imply that such a property had been recognised in this species in a more eminent degree, than in the rest. It does not appear, however, that it has ever continued long in use, this being prevented, probably, by the suspicious character of the race of plants to which it belongs. The late Dr. Barton mentions this vegetable among his indigenous emetics, but considers it too violent and uncertain to be depended on as a safe medicine.

Within a few years the plant has been attended to by some medical gentlemen in Philadelphia, who report more favourably of its powers and mode of operation; and consider it as a safe, certain and manageable emetic, applicable to most of the cases in which medicines of this kind are called for.

Being desirous to obtain personal knowledge of the medicinal character of this vegetable, I instituted trials with different parcels of the dried root, some of which were gathered by myself, in flower, near Philadelphia, and the rest sent me by friends from Baltimore and Washington. Portions of these roots were given to a variety of patients in the Dispensary and Almshouse by myself and by other physicians, who have obliged me by communicating the results of their observations. These experiments have led to the conclusion that the Euphorbia ipecacuanha in doses of from ten to twenty grains is both an emetic and cathartic; that it is more active than ipecacuanha in proportion to the number of grains administered; that in small doses it operates with as much case as most emetics, in a majority of instances. If it fails, however, at first, it is not so safely repeated as the other emetics in common use. Given in large doses it excites active and long continued vomiting, attended with a sense of heat, vertigo, indistinct vision, and prostration of strength. I have not ventured upon any large dose myself, but have been informed, that such is the effect, by those who have given the root in doses of two scruples and upwards. The plant appears to differ from the South American Ipecacuanha in having the degree of its operation proportionate to the quantity taken; the process of vomiting not being checked by the powder being thrown off of the stomach, as frequently happens, when common Ipecac is given in large doses.

At my request, Dr. James McKeen made this plant and another species, E. corollata, the subjects of an inaugural dissertation at Harvard University, in 1820. As his observations have been made with some care, and illustrate very fairly the action of the medicine, I insert the principal cases from his manuscript.

"Case I. The first experiment," he observes. "made with this species of the Euphorbia was upon a man of intemperate habits, about twenty seven years of age, and who appeared to be a candidate for Delirium Tremens. I gave him ten grains. He told me that it always required powerful doses of medicine to produce any effects upon his stomach or bowels, but as I was then a stranger to the powers of the Euphorbia ipecacuanha, it was thought prudent not to hazard a large quantity until something had been ascertained of its strength. When I called in the morning after it was taken, I learned that the medicine had produced a gentle purging, preceded by a considerable degree of nausea, but that there had been no vomiting.

"Case II. The next fair opportunity which occurred for experiment was in the case of a female about thirty seven years of age. This woman, for a considerable portion of her life, had suffered from syphilis; nothing remained now, however, specifically of this kind, excepting the marked effects of a constitution shattered by disease. I gave her at first ten grains of the Euphorbia ipecacuanha, and in twenty minutes, no signs of vomiting occurring, I gave her eight grains more, and kept adding to the quantity, which she had taken, until it amounted in the whole to forty grains. I remained by this patient until vomiting commenced, which was precisely thirty five minutes after the exhibition of the first ten grains. As the influence of the mind, in contemplating the effects of an emetic, will often induce its more speedy operation, I diverted the patient's attention as much as possible, that no consequences might ensue, but such as were produced by the specific action of the medicine. As soon as I ascertained that this Euphorbia ipecacuanha was likely to produce effectual vomiting, I left the house. About thirty hours afterwards I called to see this patient, and with much surprise found that the quantity I had given her had continued to operate by emesis and catharsis ever since. She was, however, very little exhausted, and there was nothing of cramp either on the stomach or extremities which so often distress those who are too severely vomited. About this time there was a cessation of vomiting without the assistance of remedies. Two days afterwards this woman told me she had not been as well as she then was for a number of years. The powerful vomiting produced a considerable degree of dizziness, but this went off in the course of twenty four hours. I had quite despaired of vomiting this patient with the Euphorbia ipecacuanha. In no instance afterwards was this medicine more than half as long in producing vomiting as it was in this case.

"Case III. A girl of about eighteen years of age, whose manner of living was similar to that of the person mentioned in the preceding case, applied to me for an emetic; I gave her thirty grains of the Euphorbia ipecacuanha, and told her to take half of this quantity, and if it did not operate in half an hour, she might take the remainder. Contrary to my injunctions she took the whole at a single draught. In fifteen minutes her attendants told me she began to vomit, and continued to throw up, at intervals, smartly for five hours, and was purged seven or eight hours more. For some time after this she complained much of dizziness.

"Case IV. As I had found, in the first trial, that ten grains of the Euphorbia ipecacuanha failed to produce vomiting, I tried the same dose upon another subject, which was a woman of about forty eight years of age, to determine if so small a quantity would produce vomiting. In about fifteen or twenty minutes after the medicine was received into the stomach, it began to operate. After she had vomited three times, it commenced purging, and produced three or four evacuations. This woman did not complain of any dizziness, as those did in the two preceding cases.

"Case V. A woman about thirty one years of age took fifteen grains of the Euphorbia ipecacuanha; in seventeen minutes it began to operate, and vomited the patient every few minutes, until the operation amounted to five or six times, and afterwards a moderate purging ensued. The operation, in this case, was more satisfactory than any preceding ones, as it effectually evacuated the stomach and bowels, without a too long continuance of the vomiting.

"Case VI. A man of forty years of age was seized with symptoms of fever. Four grains of sulphate of copper and twelve of common ipecac were given. This dose produced no emetic operation, but occasioned violent purging. Forty eight hours after, I gave him twenty grains of Euphorbia ipecacuanha, in powder, which produced very effectual evacuations from the stomach, vomiting him eight or nine times; after which he had one or two alvine discharges.

"Case VII. In one instance, for experiment, I gave four grains of this plant; but it neither affected the stomach nor bowels, nor the feelings of the patient, nor his pulse."

From what is now known respecting the Euphorbia ipecacuanha, we are justified in considering it an active emetic, and, if prudently administered, more safe than a majority of the species of its genus. It wants, however, the peculiar mildness of the officinal Ipecacuanha, which, in cases of slow operation, permits the dose to be accumulated by repetition, until its due effect takes place, without danger of excessive violence in the length and degree of evacuation, and without an injurious impression on the nervous system. This, indeed, appears to be the common defect of the active North American emetics hitherto examined. And until a more extensive examination has brought to light new substances of this class, or better defined the modes of preparation and use of those already known, we cannot wish that the South American drug should be diminished in our markets, or less familiar to our physicians.

Botanical References.

Euphorbia Ipecacuanha, Linn. Sp. pl.
Willd. ii. 900.
Michaux, Flora, ii. 212.
Pursh, ii. 606.
Botanical Magazine, t. 1494.
Euphorbia inermis, &c.
Gronovius, Virg.74.
Tithymalus flore minimo herbaceo?
Clayton, Phil. trans. abr. viii. 331.

Medical References.

Schoepf, Mat. Med. 74.
B. S. Barton, Coll. 26.
W. P. C. Barton, Veg. Mat. Med. vol. i.

American Medical Botany, 1817-1821, was written by Jacob Bigelow, M. D.