Ipecacuanha (U. S. P.)—Ipecac.

Fig. 147. Cephaelis Ipecacuanha, with root. Preparations: Vinegar of Ipecacuanha - Ointment of Ipecacuanha - Fluid Extract of Ipecac - Compound Powder of Ipecacuanha - Powder of Ipecac and Opium - Compound Powder of Ipecacuanha and Opium - Syrup of Ipecac - Tincture of Ipecac and Opium - Troches of Ipecac - Wine of Ipecac - Troches of Morphine and Ipecac - Compound Tincture of Serpentaria
Related entry: Euphorbia Ipecacuanha.—American Ipecac

"The root of Cephaëlis Ipecacuanha (Brotero) A. Richard"—(U. S. P.). Cephaëlis emetica, Persoon; Callicocca Ipecacuanha, Brotero; Uragoga Ipecacuanha, Baillon; Psychotria Ipecacuanha, Müller-Argoviensis.
Nat. Ord.—Rubiaceae.
COMMON NAMES: Ipecac, Ipecacuanha.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 145.

Botanical Source.—Cephaëlis Ipecacuanha is a small plant, with a perennial root, descending obliquely into the ground, from 4 to 6 inches long, simple, or divided into a few diverging branches, about as thick as a goose-quill, ringed, when fresh pale-brown, when dry umber-colored, blackish-umber-colored, or grayish brown; the cortical integument with a reddish, resinous, glittering fracture, and readily separating from a central woody axis. The stem is suffruticose, from 2 to 3 feet long, ascending, often rooting near the ground, smooth and cinereous at the base, and downy and green near the apex. The leaves are rarely more than 4 or 6 on a stem, oblong-ovate, acute, roughish with hairs, from 3 to 4 inches long, from 1 to 2 broad; those at the top of the stem are opposite, those toward the base alternate. Petioles short and downy. Stipules erect, appressed, membranous, deciduous, and 4 to 6-cleft. Peduncles solitary, axillary, downy, erect when in flower, reflexed when in fruit, and about 1 ½ inches long. The flowers are small, white, in semiglobose heads, of 8, 12, or more; the involucre is 1-leaved, spreading, deeply 4 to 6-parted, with obovate, acuminate, ciliated segments. Bracts to each flower 1, obovate-oblong, acute, and downy. Calyx minute, obovate, whitish, adhering to the ovary, with 5 bluntish, short teeth. The corolla is white, funnel-shaped, the tube cylindrical, downy on the outside and at the orifice, the limb shorter than the tube, with 5 ovate, reflexed segments. Stamens 6; filaments filiform, white, and smooth; anthers linear, longer than the filaments, projecting a little beyond the corolla. Ovary with a fleshy disc at the apex; style filiform; stigmas 2, linear. The berry is ovate, obtuse, about the size of a kidney-bean, at first purple, afterward violet-black, 2-celled, 2-seeded, with a longitudinal, fleshy partition. Nucules plano-convex and furrowed on the flat side (L.).

History.—Ipecacuanha inhabits Brazil, in moist, shady situations, and is also found in other sections of South America, generally between 7° and 20° South latitude (Ed.), flowering from December to March, and maturing in fruit between April and June. The root, which is the official part, is gathered by the natives from January to April, who, after removing the stem from it, wash it and dry it by exposure to the sun's rays. (For details regarding its cultivation and collection, see article in Western Druggist, 1897, p. 346.) It is principally imported from Rio Janeiro, in barrels, seroons, and large packages. The bark of the root is its most active part.

Description.—"About 10 Cm. (4 inches) long, and 4 or 5 Mm. (⅛ to ⅕ inch) 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 moldiness, its quality is proportionate to the thickness of the bark, and the thinness of the ligneous portion"—(U. S. P.). Commercial ipecacuanha roots are sometimes distinguished as the grayish-black, the gray -red, and the grayish-white varieties. The true variety is called Rio ipecac commercially.

Ipecacuanha root, when whole, is so characteristic, that it is hardly liable to adulteration. A variety known as the Carthagena, New Granada, or Columbian ipecac (Cephaëlis acuminata, Karsten), is larger, less markedly annulated, and shows a larger number of more conspicuous medullary rays than the ordinary drug. The name radix antidysenterica, was formerly applied to ipecacuanha root. The powder of the genuine article is of a grayish-yellow color, with a faint, bitterish, obscurely acrid taste, and a weak, musty, peculiar odor, which becomes stronger and nauseating during the process of pulverization; in some persons it excites sternutation, in others a difficulty of breathing resembling asthma. It yields its properties to water, and still better to alcohol, spirits, or wines. Boiling impairs its virtues. As regards the detection of adulterants of ipecacuanha, see article on the microscopic examination of ipecac root and its possible adulterants in powder form, by Dr. Alfred Schneider (Amer. Druggist, 1897, p. 3). Likewise, some microscopical and chemical criteria for true ipecac root were laid down by Prof. Tschirch and F. Lüdtke (Archiv der Pharm., 1888, p. 441).

Chemical Composition.—While the root of the ipecacuanha plant is the only official part, its active, emetic principle has been shown to exist also in other parts of the plant, e. g., the stems and the leaves (Hooper, 1892), but not in the seeds (Flückiger, Pharmacognosie, 1891). In 1817 Pelletier and Magendie isolated from true ipecac root an alkaloid which they called emetine, but the fact that they obtained 16 per cent of this principle demonstrates their product to have been merely a concentrated extract. Upon further experimentation, however, Pelletier succeeded in obtaining a pure alkaloidal product in the amount of 60 grains to the pound, which corresponds to somewhat less than 1 per cent. Subsequently, the chemistry of ipecacuanha root was elaborated by Reich (1863), Lefort (1869), Podwissotzky (1879), and others. H. Kunz, in 1887 (Jahresb. der Pharm., 1887, p. 416), found for emetine the formula C30H40N2O5) which is now generally adopted as correct. Kunz also established the dyad nature of the alkaloid emetine in its saturation power with acids, which in 1890 was confirmed by Blunt (Pharm. Jour. Trans., 1890, Vol. XX, p. 809), and W. Simonson (Proc. Amer. Pharm. Assoc., 1890, p. 188); hence the statement in Flückiger (loc. cit.), that emetine is a monad base, requires correction. Kunz also found cholin (C2H4OH.N[CH3]3OH), to be present in ipecac root.

Pure emetine forms a white, non-crystallizable powder which turns brown by exposure to light and air. It is very slightly soluble in water; the solution tastes bitter and is alkaline to litmus paper. It dissolves readily in diluted acids, as well as in chloroform, alcohol, warm benzin, and ether, and is also soluble in fixed oils and benzol, but insoluble in caustic alkalies and in essential oils. With acids, emetine forms neutral, soluble, bitter, acrid, and for the most part uncrystallizable salts. Flückiger obtained the hydrochlorate in crystalline form (Pharmacognosie, 1891). The nitrate dissolves in water with difficulty. The solutions of the salts are precipitated by gallic and tannic acids. Flückiger (loc. cit.), gives the following test for emetine in ipecac root: Shake the root with five times its weight of cold hydrochloric acid (sp. gr. 1.12), filter, and sprinkle some chlorinated lime upon the liquid. If emetine is present, a characteristic fire-red color is produced. By this reaction, the absence of emetine from the wood of the root is established.

In 1894 and 1895 Paul and Cownley (Jahresb. der Pharm., 1894, p. 523, and 1895, p. 163), discovered another alkaloid in ipecac root which they called cephaëline. This is distinguished from emetine principally by its being soluble in caustic alkalies, and by its melting point, which is 102° C. (215.6° F.), while for emetine they found 68° C. (154.4° F.). Pelletier also had observed that emetine was naturally combined with what he took to be gallic acid, but which was recognized later by Willigk as a new substance, and by him called ipecacuanhic acid. Reich subsequently found it to be a glucosid. Starch is present in ipecac root in large amounts, and a trace of a nauseating ethereal oil is also present. In some allied species sugar abounds.

Literature concerning the assay of ipecacuanha is abundant and often discordant, although a satisfactory solution of the ipecac problem seems to have been reached. The proportions of total alkaloids observed by different authors generally range from 1 to 3 per cent. C. C. Keller thinks that 2 ½ per cent may not be too excessive a standard of alkaloidal strength (Proc. Amer. Pharm. Assoc., 1893, p. 400). Dr. A. R. L. Dohme (Proc. Amer. Pharm. Assoc., 1895, p. 269), has found that the part of the root where it merges into the stem (wiry root) is at least as rich in alkaloid as the rest of the root (fancy root), and that the part of the stem adjacent to the root still contains considerable quantities of emetine. (Adapted in part from an article on ipecacuanha in the Western Druggist, 1897, p. 346.) Tannic acid, all astringents containing tannic or gallic acids, iodine, salts of iron, and acetate of lead, are incompatible with ipecacuanha.

Action, Medical Uses, and Dosage.—Ipecac, in material amounts, is irritant to the cutaneous and mucous surfaces. Applied to the skin by inunction it excites irritation, and produces vesicular, pustular, and sometimes ulcerative effects. It is exceedingly irritating to the Schneiderian membrane, causing heat and violent sneezing. In some individuals, the inhalation of the powdered drug provokes decided paroxysms, closely resembling spasmodic asthmatic attacks—the chief symptoms being great dyspnoea, with marked anxiety and prostration, and wheezing respiration and cough. This is often accompanied with violent and prolonged sneezing and spitting of blood. Such attacks are usually followed by a free expectoration of mucus. Ipecac, in doses of less than 1 grain, acts as a gastric tonic and hepatic stimulant, but large doses prove emetic. When it fails to produce emesis, catharsis usually results, though both effects may take place from its employment. The stools produced by this agent are of the so-called bilious type, and have been denominated "ipecacuanha stools." A state of tolerance may be established from the prolonged use of ipecac. Ipecac produces a relaxation of the skin and consequent diaphoresis, and it increases the broncho-pulmonic secretions. Physiologically speaking, ipecacuanha is said to scarcely affect the circulation, but there is no doubt that in minute doses in disease, it stimulates the circulatory apparatus, acting thereby as a special sedative, as that term is employed in Eclectic therapy. Its therapeutic action upon the circulation is well shown in its effects upon hemorrhage; and in acute disorders of the stomach, bowels, and breathing organs. The alkaloid, emetine, the active principle of ipecac, is so severe and uncertain in its action that it is seldom used in medicine. Two grains of it have killed a large dog, and 1/16 grain vomited an old man severely. Observations upon the lower animals prove that death takes place from cardiac paralysis. The post-mortem lesions are: Gastro-intestinal irritation, and sometimes swollen, red, blood-stained, and ecchymosed patches are seen, similar to those produced by some of the metals; the lungs are hyperemic, though occasionally anemic; and hepatized patches are observable. Emetine is eliminated by the way of the bowels.

Therapeutically, ipecac is a very important remedy. It has three chief fields of operation: (1) In large doses it provokes emesis, and for this purpose it may be employed as suggested below; (2) it checks active hemorrhages; (3) it relieves gastro-intestinal and broncho-pulmonic irritation and inflammations. Its specific use, in small doses, is to relieve irritation, no matter what the disease may be. The specific action of ipecac is best observed in acute affections, when there is hyperemia, capillary engorgements, and hypersecretion. Ipecac is often employed to assist the action of other agents, particularly agents to act upon the bowels, and with other agents which control irritation.

The dose of ipecac largely controls its uses. In doses of ¼ to ½ grain, it acts as a tonic, improving digestion, increasing the appetite, and is valuable in irritative dyspepsia. In doses of ½ to 2 grains, administered every 3 or 4 hours, it produces perspiration, and is beneficial in febrile and inflammatory diseases; combined with opium its diaphoretic influence is greatly augmented, as seen in the powder of ipecacuanha and opium.

Half-grain doses are expectorant. From 3 to 10 grains will produce nausea, which may be continued for any length of time, and which is attended with more or less depression of the pulse, languor, moisture of the skin, and an increased mucous discharge from all the mucous tissues of the system, which renders it very useful in pulmonary and hepatic diseases. It has been found very useful in typhoid pneumonia in combination with sulphate of quinine. In doses of from ¼ to 1 grain, rubbed up with sugar to render it pleasant, it has proved efficient in the pneumonia of children. Doses of from 5 to 15 grains have a tendency to move the bowels, while doses of 20 grains or more act as an emetic. It is stated that an infusion of 2 drachms of ipecacuanha in a gill of hot water and strained, will, if drank warm, prove emetic; then if the same quantity of hot water is again added to the residue, strained and drank cold, it will prove purgative; and the same process repeated the third time, and used cold, becomes a valuable tonic. This, however, requires confirmation.

Ipecac is a specific emetic, and the mildest of its class. As such, in 20-grain doses, it operates actively, causing much nausea and continued muscular straining, with a free secretion of mucus; vomiting, however, seldom takes place until 15 or 20 minutes after its administration. It is inferior to no other emetic, being safe even in large doses, seldom producing painful spasms of the stomach or bowels, and causing less prostration of the vital forces than tartar-emetic and similar drugs. It is best employed in combination with other emetics, as in the compound powder of lobelia, which is much used by practitioners, and is preferred to any other emetic in the early stage of febrile diseases, and in other instances where a severe succussion of the system is indicated. Ipecac is the best emetic for the purpose of unloading the stomach of undigested aliment, and "acute indigestion, bilious attacks, accompanied with sick headache, and other forms of headache, depending upon difficult digestion, may be cut short with an emetic dose of the powdered drug" (Locke, Syllab. of Mat. Med., p. 24)." In nausea, with a broad, flabby, and slimy tongue, give ipecac in full emetic doses" (ibid). Repeated doses of the powder in sweetened warm water, until emesis takes place, are useful in the convulsions of children, cramps, colic, etc., arising from intestinal irritation, though it is less effectual than lobelia and gelsemium combined. Small doses of ipecac may follow to relieve irritation. In intermittent fever, and particularly in chronic ague, where quinine is ineffectual, the system may be gradually brought under the emetic action of ipecac, after which the quinine will give better results, and may even not be needed. Ipecac is less useful than zinc sulphate, or, preferably, apomorphine hydrochlorate, hypodermatically, in narcotic poisoning, for which it has been recommended. This is due to the fact that, being a specific emetic chiefly, it must be absorbed before it exerts its emetic effect. In croup and membranous croup, when the secretions are well loosened, ipecac is a useful emetic. In spasmodic asthma (less valuable than lobelia), hysteria, pertussis, sore throat, common catarrh, and stricture of the chest common in phthisis, ipecacuanha, as an emetic, will sometimes be found very beneficial. In menorrhagia, 20 grains of the powder at bedtime, followed by a saline cathartic in the morning, has, in the hands of several practitioners, promptly checked the discharge. As a rule, however, its emetic action is not required, as hemorrhage is best checked with smaller doses. Bronchitis in children, with dry, hoarse, croupal cough, is often cut short by the emetic action of ipecac.

While ipecac is an emetic, it has long been well-known as a remedy to check nausea and vomiting. This is best accomplished by it when the tongue is red and pointed, and shows evidence of irritation. If the condition depends upon foul accumulations within the stomach, the emetic action will be first required, after which the small doses may be continued to control irritation, if present.

The specific use of ipecac, as before stated, is to relieve irritation, no matter what organ is affected. With this may be vascular excitation. This is probably due to the irritated condition of the sympathetic. The patient may be irritable mentally, easily disturbed by noises, and the skin is heightened in color. Fits of weeping are not uncommon. Its beneficial effects are particularly noticeable in acute irritative and inflammatory disorders of the stomach and bowels. It should be said here that in these, as well as in other troubles of a similar nature, the special sedatives—aconite, veratrum, gelsemium, and rhus, and such other irritation-relieving remedies, as matricaria, amygdalus, epilobium, bismuth, magnesium sulphate (small doses), collinsonia, hydrastis, and bryonia, may be indicated with ipecac, In fact, where the indications below given for ipecac are present, it will materially aid the action of these remedies, one or more of which are usually necessary, as ipecac seldom covers the whole range of symptoms present in these cases. The chief indications pointing to the sole or associate use of ipecac, in stomach and bowel disorders, are the elongated and pointed tongue, with reddened tip and edges, with large papillae, or effacement of the papillae; tenderness on pressure; contraction of tissues; pinched countenance, white line around the mouth; tendency to nausea and vomiting, with or without eructations; and marked hyperaesthesia. There is evidence of hypersecretion, sympathetic irritation and capillary engorgement, and the cases are acute. With these indications well in hand, it will be found of great service in gastric irritability, nausea, and vomiting (if not from organic stomach lesions), and acute mucous diarrhoea. In the diarrhoea of teething, with tongue coated white, and stools green, bloody, and offensive, an associated with nausea, ipecac serves a useful purpose. For the offensive element chlorate of potassium may be associated with it, and for t he peevishness and fretfullness usually present, matricaria. In simple diarrhoea, due to undigested and irritating food, an emetic or cathartic is preferable to small doses of ipecac, though the latter should be given to control after-irritation. It is a valuable remedy in muco-enteritis. It should be associated with aconite or epilobium. In acute cholera infantum, with small and frequent mucoid passages, it should be given early. It is of less value where the stools are profuse and watery, Though less valuable in chronic than in acute diseases, it is applicable in chronic cholera infantum, with pallid tongue, nausea, vomiting, abdominal pain, and pallid or yellowish face. But in this case nux vomica should be given with it (Scudder). In simple irritative diarrhoea, nux should be given with it when the preceding symptoms are present. No remedy, with the exception of magnesium sulphate, gives better results in acute dysentery. Combined with proper diet and absolute rest upon the back, the following may be given: Rx Specific aconite, gtt. v; specific ipecac, gtt. x to xv; magnesium sulphate, ʒi; aqua, fl℥iv. Mix. Dose, I teaspoonful every hour. Small doses of diaphoretic powder (containing ipecac) are also useful in dysentery. Ipecac is specially adapted to cases of sporadic dysentery, and is less effectual in zymotic cases, unless associated with antizymotic treatment. Dysentery has been treated with large doses of the powdered drug, sufficient to produce catharsis, but this method is less efficient than that indicated above. Formerly, 1 grain each of dried extract of leptandra and ipecacuanha, and ½ grain of resin of podophyllum, given every 3 hours until it operated freely, was considered an excellent remedy for dysentery.

Ipecac is a remedy of first importance in many respiratory disorders. These conditions are similar to those indicating its employment in gastro-intestinal diseases, viz., irritation, capillary engorgement, and hypersecretion. Thus, associated with the special sedatives and asclepias and bryonia, if necessary, it is a very valuable agent, in hoarseness or congestion of the vocal cords, broncho-pulmonary congestion from colds, irritable and spasmodic coughs, and in the early stage of acute catarrhal affections, dyspnoea of pregnancy, and pertussis. In colds, capillary bronchitis, acute bronchitis, and pneumonia, particularly of children, it has an important place. It acts chiefly on the bronchioles and the parenchyma of the lungs, allaying irritation, relieving cough, and diminishing expectoration when profuse (stimulant doses), and aiding expectoration when scanty (nauseant doses). It also answers well in subacute cases. The use of ipecac (emetic doses) in croup has already been referred to. It is also of value in small doses in mucous croup; it should be combined with aconite. In membranous croup it has been recommended with bryonia. In dry forms of cough it may be given in nauseant doses; in hypersecretion, in small or stimulant doses; in spasmodic cough, with bloody expectoration, frequently repeated doses short of nausea. Ɣ It relieves irritative conditions arising from too frequent or violent use of the voice.

Owing to its evident action upon the capillaries, it is a valuable agent in active hemorrhagespost-partum, hemoptysis, hematemesis, hematuria, epistaxis, and hemorrhages from the bowels. The cases calling for it are usually those of nervous individuals, with marked irritability and vascular excitation. Under similar conditions it is of value in menorrhagia and metrorrhagia. It is sometimes of value in hemorrhoids, especially when of the bleeding variety. It may be associated with hamamelis, aesculus, or collinsonia as indicated.

In fevers and inflammatory affections, small diaphoretic doses of ipecac have been highly beneficial. Its action in these cases is also beneficial upon the nervous system and mucous membranes. Excitability and suppressed secretions being symptoms, it acts favorably in the eruptive fevers. Both Dover's Powder and the Diaphoretic Powder are often indicated in inflammatory and febrile disorders. Both are very efficient in the night-sweats of consumption. Doses of from 1/10 to ⅕ drop of specific ipecac give prompt relief in the majority of cases of phlyctenular diseases of the eye with photophobia, the latter symptom being quickly subdued by it (Webster's Dynam. Therap., p. 588). It will likewise act as a sedative in many local inflammatory diseases, and will be found extremely valuable in peritonitis, even the worst form occurring in puerperal women. It is also of value in acute rheumatism, gout, jaundice from biliary catarrh, and to relax the parts in the passage of small biliary calculi.

A liniment of ipecac (Rx Powd. ipecacuanha, sweet oil, of each, ʒij; lard, ℥ss; mix well together), to be used with friction, 3 or 4 times a day afterward covering the parts with flannel until an eruption was produced, was formerly used in the treatment of incipient phthisis, certain rheumatic affections, chronic hydrocephalus chronic inflammation of the synovial membrane of the knee, and infantile convulsions. It has, however, but little to recommend it. In all cases where this drug as an emetic, can not be given by the mouth, it may be used in injection, adding 2 drachms of the powder to 1 pint of warm water, for an adult—it will operate kindly and thoroughly as an emetic.

The doses of ipecac, for its various uses, have been sufficiently indicated above. However, the range of dosage is from the fraction of a grain to 20 grains; specific ipecac, the fraction of a drop to 20 drops. The usual prescription for specific purposes is Rx Specific ipecac, gtt. v to xx; aqua, fl℥iv. Dose, 1 teaspoonful every 1 or 2 hours. It must be remembered that sometimes powdered ipecac will do that which no fluid preparation of ipecacuanha can accomplish.

Specific Indications and Uses.—An emetic for overloaded or foul conditions of the stomach and other conditions indicating emesis; irritation, whether of stomach, bowels, nervous system, or pulmonary tissues; active hemorrhages; irritative diarrhoea; acute bowel disorders with irritation; long, pointed tongue, with reddened tip and edges, accompanied with nausea and vomiting, and with or without fever; dyspnoea; irritative cough; hoarseness from cold; hypersecretion, with mucous rales (small doses); diminished expectoration (nauseant doses).

False Ipecacs and Related Species.—Several emetic roots of the natural orders Rubiaceae, Polygalae, and Violaceae, have been at times thrown upon the market as varieties of Ipecacuanha. They are all known in Brazil as poaya, or in the remaining parts of South America as Ipecacuanha. These are:

LARGE STRIATED IPECACUANHA.—Derived from the Psychotria emetica, Mutis (Nat. Ord.—Rubiaceae), New Granada. This is also known as Violet striated ipecacuanha, Ipecacuanha of St. Martha, etc. It is larger than ipecac-root, and is marked by longitudinal grooves. The thick, brown bark has constrictions, but is not, like ipecac, annulated. It is tough under the knife, exhibiting a violet-cut surface, and is moist and soft, even when many years old, this being its chief distinguishing feature. It has a sweet taste, due to sugar. It contains no starch (Pharmacographia).

SMALL STRIATED IPECACUANHA.—This is thought by Planchon to come from a species of Richardsonia. It is known also as Black ipecacuanha, Striated brittle ipecacuanha, Black striated ipecacuanha, etc. It resembles the foregoing, but is smaller, and usually tapering at the extremities. It differs in color (being black-brown), and in being brittle. Starch cells are prominent, and the taste is acrid, not sweet.

UNDULATED IPECACUANHA.—Farinaceous, Amylaceous, or White ipecacuanha. The root of Richardia scabra, Linné (Richardsonia scabra, St. Hilaire), Nat. Ord.—Rubiaceae; Brazil. The fresh root is white; the dried, iron-gray. It is sinuous or undulated, appearing knotty, and is alternately fissured on the sides. Its bark is thick, brittle, white, and starchy, enclosing a strong, slender, flexible, ligneous portion. It contains no emetine.

INDIAN IPECACUANHA.—Another asclepiadaceous plant, the Tylophora asthmatica, Wight et Arnott (Asclepias emetica, Linné), furnishes an emetic root. Indian ipecac is a twining, shrubby species, a native of the Indian Peninsula, Ceylon, and the Moluccas. The root has long been used by the Hindus as a medicine; and, in small doses, is cathartic—in large doses, emetic. In consequence of its use as a substitute for ipecac, in India, the plant has acquired the name "Indian ipecac." It has been successfully employed as a remedy for epidemic dysentery, and has also been recommended in humoral asthma. Kilpatrick reports the administration of the leaves, in a great number of cases, with entire satisfaction. The dose of the powdered leaves, as an emetic, is 25 or 30 grains; as a diaphoretic and expectorant, from 3 to 5 grains. Tylophorine, an alkaloid, was obtained from it, in 1891, by Mr. D. Hooper.

The other species yielding emetic roots are as follows: Ionidium lpecacuanha, Ventenat. Nat. Ord.—Violaceae. So-called White ligneous ipecacuanha. Brazil. Solea verticillata, Sprengel, and Ionidium polygalaefolium, Ventenat, have been employed by the Mexicans.

Photo: Asclepias curassavica 5. Related entry: Asclepias curassavica

Asclepias currasavica, Linné, is known as Bastard ipecacuanha. A Senegambian plant furnishes a root known as Batatior, having properties like those of ipecac. A species of Ionidium, variously determined as I. marcucci, I. parviflorum, and I. microphyllum, yields an emeto-purgative root known in South America as cuichunchulli. It has been used in elephantiasis. Gardenia campanulata, Roxburgh (Nat. Ord.—Rubiaceae), of India, yields a purgative and anthelmintic berry.

Naregamia alata, Wight and Arnott. Nat. Ord.—Meliaceae. Naregamia, Tinapani, Goanese ipecacuanha. Western India. This root contains wax, oxidizable fixed oil, and naregamine, an alkaloid (D. Hooper). Asparagine is also thought to be present. It is reputed an expectorant, hepatic stimulant, and emetic. Small doses of it are given in India in bronchitis, fulfilling the indications for ipecac and senega. The natives of Malabar employ it in emetic doses in dysentery, bronchitis, rheumatism, and bilious and dyspeptic states. The ordinary dose of a strong tincture (1 in 4) is from 5 to 10 drops; as an emetic, 15 to 30 drops.

COCILLANA.—Cocillana bark is derived from a Bolivian tree, the Sycocarpus Rusbyi. Its activity is due to a principle regarded by Rusby as an alkaloid; by Eckfeldt, a glucosid. Its action closely resembles that of ipecacuanha, vomiting, heavy headache, sneezing, coryza, depression, and purging having been produced by from 20 to 50 grains. As an expectorant it is reputed more stimulating than ipecac, and in doses of 10 to 20 drops of the fluid extract, it has been employed in bronchial affections, both acute and chronic, and in pulmonary consumption, with reputed success.

Cyperus articulatus, Adrue, Guinea rush.—Antiemetic. Tonic. Dose of fluid extract, 30 drops.

Petiveria hexaglochin, Pipi root.—Reputed diaphoretic and a stimulant expectorant.

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.