Ipecacuanha

Lecture XXXVI — Ipecacuanha and Coffea

Ipecacuanha.

' Bry. , Puis., Nux v., Cinch.

Ant. crud., Tabacum.

Ars., Ant. tart., Veratr. alb.

Ipecacuanha. \ ^obelia infiata - V Cuprum met.

>Tabacum, Ars., Nux v.

Ipecacuanha ckphaeus is a small shrub growing in Brazil. It is bitter, acrid and nauseous, and possesses a peculiar odor which, in some persons, excites sneezing and even asthma. In many cases the conjunctivae are injected, with puffiness under the eyes, profuse coryza and tension over the eyes.

Ipecacuanha contains as its active principle a substance called Emetin, which gives to the drug its property of producing vomiting. It also contains an acid called Ipecacuanhic acid, and a small quantity of a foetid volatile oil. The latter constituent probably has something to do with the action of the drug on the pneumogastric nerve and its consequent use in the treatment of asthma. Ipecacuanha is easily studied. It acts upon the nerves (especially the pneumogastric) and mucous membranes. It has been employed by allopathic physicians as an anti-spasmodic in asthma and in pulmonary catarrhs. In the latter class of troubles it is used to provoke vomiting, and, of course, gives temporary relief.

Ipecacuanha seems to have a special affinity for the mucous membranes lining the bronchial tubes and alimentary canal. One of the most prominent features of this drug is its property of producing nausea and subsequently vomiting. So prominent is this symptom that you will find it present in almost all the cases in which Ipecacuanha is required.

Studied more particularly, Ipecacuanha is found suitable for patients who are easily irritated, full of desires, but know not for what. If a child, the patient cries and screams almost continually. As an adult, he is irritable and morose, holding everything in contempt. Thus you will find Ipecacuanha indicated in headaches. These are of rheumatic origin. The characteristic sensation is a pain as if the head or bones of the head were bruised or crushed, this feeling seeming to go down into the root of the tongue. This headache is accompanied by nausea and vomiting. Ipecacuanha may also be used in unilateral sick headaches with deathly nausea. In these cases the face is usually pale, blue rings surround the eyes, and the expression about the mouth betrays the intensity of the nausea. Now, these symptoms are not so necessarily present in the adult as they are in the child. You see the corners of the child's mouth drawn, and a line extending from the alse of the nose to the corners of the mouth, giving to the child an expression of nausea, and at once suggesting to your mind such remedies as Ipecacuanha, Antimonium tartaricum and especially SEthusa cynapium.

In that bursting headache of Ipecacuanha compare Veratrum album, which has that bruised feeling here and there in the brain. There is still another drug which has this symptom, and that is Ptelea. The gastric symptoms of Ipecacuanha, in addition to those already mentioned, are such as would call for the exhibition of this drug after indulgence in rich food, such as pastry, pork, fruits, candy, ice-cream, etc. Nausea is constant with all complaints; vomiting of bile; vomits just after eating (like Arsenicum); vomits after eating rich or indigestible food; vomiting of mucus; morning sickness. The tongue is usually clean, a symptom which differentiates Ipecacuanha from Nux vomica, Antimonium crudum, etc. Distress in the stomach; it feels relaxed as if hanging down (like Staphisagria, Theine, Lobelia, Tabacuni) .

These gastric symptoms of Ipecacuanha should be compared with those of three other remedies, the most important of which is Pulsatilla. You will at once recognize the similarity of the two drugs. They are both useful for gastric disturbances caused by indulgence in mixed diet, pastry, ice-cream, pork, fatty food, etc. Pulsatilla may be considered the better remedy of the two early in the attack, when the stomach still contains the food which disagrees, while Ipecacuanha is better when the stomach is empty and the effects only of the indulgence remain. The best distinction between the two remedies, however, lies in the condition of the tongue. In Ipecacuanha, the tongue, as above stated, is clean or only slightly coated, whereas in Pulsatilla the tongue is almost always foul, white or yellow, with a very disagreeable taste in the mouth.

Arsenicum album must follow or supplant Ipecacuanha, when an actual catarrh of the stomach has been produced by indigestible food, especially after sudden chilling of the stomach with ice-cream or ice-water. There are vomiting, burning pains in the stomach, diarrhoea, restlessness, etc.

Antimonium crudum, like Ipecacuanha, is suitable for gastric catarrh, following a mixed diet of pastry, etc. The tongue is thickly coated white, as if it had been whitewashed.

Ipecacuanha may be indicated when, in the case of children, indulgence in rich food has produced convulsions. It may even be useful in the convulsions of teething children, or convulsions following suppressed eruptions, cold, etc. They are of the rigid tetanic form. Sometimes the rigidity alternates with flexing of the arms and jerking of the arms toward each other.

Colic may occur, and this is of a griping character. Either the pain is situated about the umbilicus, as though a hand were tightly clutching the intestines; or the colic consists of cutting pains which shoot across the abdomen from left to right. The stools are either green, as in diarrhoea of infants, or they are yellow and liquid, and covered with mucus and blood. Sometimes they have a fermented appearance and look like molasses. That is as good a comparison as I can give you; the stool looks just like molasses when it is frothy. At other times the stools are black from admixture of bile. Some of these diarrhoeas are associated with tenesmus, indicating catarrh of the lining membrane of the bowels.

Ipecacuanha is frequently indicated in the commencement of cholera infantum. You find present pallor of the face, with blue rings around the eyes; the fontanelles are still open, showing defective nutrition; the child may have nose-bleed with the pale face; it is drowsy, with starting and jerking of the muscles during sleep. The child is subject to frequent attacks of nose-bleed. The condition already simulates that of hydrocephaloid. You must not think because Ipecacuanha is associated so closely with stomach symptoms, that it cannot be indicated in this reflex cerebral state. You will find nausea and even vomiting usually present. The child eats or drinks and vomits what it has taken almost immediately afterward. Particularly is Ipecacuanha indicated in these cases as a remedy preceding the exhibition of Arsenicum album. Arsenicum, as already indicated, is complementary to Ipecacuanha in these abdominal affections.

In some of these cases of gastro-intestinal troubles in children Ipecacuanha and the other remedies just mentioned will sometimes fail you. Then it will be well for you to bear in mind the following remedies, which, though infrequently indicated, may prove themselves to be of inestimable value.

Oenothera biennis, the evening primrose, commonly seen in the fields and waste places, is an invaluable remedy in exhausting, watery diarrhoea. It does not act, as has been suggested, as an astringent, by its tannic acid, but is a genuine homoeopathic remedy, producing and curing diarrhoea. The evacuations are without effort, and are accompanied by nervous exhaustion, and even by incipient hydrocephaloid. Gnaphalium causes a watery, offensive morning diarrhoea, which recurs frequently during the day. The provers were children, and well have they portrayed a very common group of cholera infantum symptoms. They had rumbling in the bowels, colicky pains, and were, at the same time, cross and irritable. The urine was scanty, and the appetite and taste were lost. A writer in the Homceopath mentions having used this drug very successfully, and Dr. Hale refers to it in his Therapeutics.

Geranium maculatum is also a successful baby's remedy. Dr. Hale devotes eight pages to Geranium and other astringents, dividing their action according to his rule of primary and secondary symptoms, and deducing thence two propositions for use in practice. The provings, brief though they are, help us in the choice of the drug; constant desire to go to stool, with inability for some time to pass any faecal matter, then the bowels move without pain or effort; mouth dry; tip of the tongue burning. The Allopaths use Geranium as an astringent. Paullinia sorbilis has been suggested for diarrhoea, which is green and profuse, but odorless.

Opuntia comes to us recommended by so careful an observer—Dr. Burdick—that, although I have not used it, I do not hesitate to present it anew. Nausea in stomach and bowels; feels as if the bowels were settled down into the lower abdomen (confined in adults). In infants we may, perhaps, look to this drug when the lower part of the abdomen is the seat of disease, as this seems to be its characteristic seat of attack.

Niiphar luteum causes a yellow diarrhoea, worse in the morning, either painless or with colic. It has been employed for diarrhoea during typhoid, and indeed seems to cause nervous weakness. Whether it will be of service for infants remains to be seen. We should look to it when Gamboge, Chelidonium , etc., fail, and when exhaustion is a prominent attendant.

Kali bromatum has been given successfully several times in cholera infantum, when there were great prostration, cool surface and symptoms of hydrocephaloid. Compare Cinchona (incipient hydrocephaloid, following prolonged or oft-repeated diarrhceic discharge), Calcareaphos., Carboveg., Veratnim album, Camphor, etc.

Returning now to Ipecacuanha, we should note another effect of the drug which is just as characteristic as its action on the bowels, namely, its action on the mucous membrane of the respiratory tract. Thus it may be used in coryza. The nose feels as if stuffed up; there is often epistaxis, loss of smell, nausea and some catarrh of the bronchial mucous membrane.

You may compare here Allium cepa, which is an excellent remedy for simple nasal catarrh when the nasal secretion is watery and acrid and the lachrymation mild. There are rough raw feeling in the throat and cough provoked by tickling in the larynx. I may say in qualifying these symptoms of Allium, that although it quickly stops the nasal catarrh, it frequently seems to drive the trouble to the chest. Phosphorus appears to stop this action of Cepa.

Euphrasia is very similar to Cepa in nasal catarrh. Here, however, we have excoriating lachrymation and bland nasal discharge. Arsenicum album follows Ipecacuanha, in the catarrhs of fat, chubby children.

Affecting prominently, as Ipecacuanha does, the pneumogastric nerves, we should expect it to be useful in affections which involve these nerves, such as asthma, in which disease it is indicated when there is a sensation as of constriction of the chest, worse from the least motion. When the patient coughs you hear the rattling of mucus in the chest, yet none is expectorated. Especially will you find this kind of asthma calling for Ipecacuanha in stout persons of lax fibre, either adult or child, who are particularly sensitive to a warm moist atmosphere.

Very similar to Ipecacuanha in asthma is Arsenicum album, which often follows it well either in catarrhal or nervous asthma. Cuprum metallicum is useful in asthma when the spasmodic element predominates. The face gets blue; there is constriction of the throat; the patient almost goes into convulsions.

Another drug closely allied to Ipecacuanha is Lobelia inflata. This has, with the asthma, a weak sensation in the epigastrium, spreading Wp into the chest, nausea, profuse salivation and a feeling as of a lump in the stomach.

Ipecacuanha is one of the best remedies we have for capillary bronchitis in infants, especially if caused by the kind of weather I have described. There is a great accumulation of mucus in the chest. The examining ear hears rales all through the chest, both anteriorly and posteriorly. The cough is spasmodic and usually attended with vomiting of phlegm. There may be fever and Ipecacuanha still be indicated. The child may have difficulty in breathing from the marked accumulation of mucus in the chest. In such cases, I have used the remedy in all potencies; that is to say, from the third to the twenty thousandth, and I have been well satisfied with its action. When Ipecacuanha is indicated, the stage for giving Aconite has passed, because exudation has begun. If you adhere to the principles of homoeopathy, you will not give Aconite and Ipecacuanha in alternation. After giving Ipecacuanha, you will notice that the mucus does not adhere so firmly to the walls of the bronchial tubes, but it becomes less tenacious and is raised more readily.

Let me warn you that there are two or three changes of symptoms which will call for concordant remedies. One of these changes calls for Antimonium tartaricum, and that is when the cough grows less and less frequent, the quantity of mucus in the chest not diminishing in amount. The infrequency of the cough is not a good symptom, although the mother will think so. The chest is so filled with mucus that the child cannot cough. He grows more and more drowsy. In giving Antimonium tartaricum in these cases, give it in frequent doses until the cough increases.

Another change calls for Phosphorus. This should be given when the inflammatory symptoms increase, the substance of the lungs becomes involved and pneumonia supervenes. Then Ipecacuanha ceases to be the remedy. Any one who practices in the colder parts of the country will find these catarrhs frequent, and with Aconite, Ipecacuanha, Antimonium tartaricum and Phosphorus, he can manage the great majority of his cases.

Still other remedies may be needed. In some cases Aiitimonium tartaricum, though apparently well indicated, fails to control the symptoms. Then we may have recourse to Sitlphur, which produces in the healthy a catarrh of the bronchial mucous membrane with loud rales all through the chest, particularly in the left lung. Especially is it indicated when there is atelectasis. I have used Sulphur with great success in just such cases.

Another remedy is Terebinthina , which I have used when the child was drowsy and the lungs seemed to be all clogged up. The urine is apt to be scanty and dark from the admixture of blood. Terebinthina must be given repeatedly.

Still another remedy is Lycopodium, which affects more markedly the right lung. Loud rales are heard all through the affected part. The expectoration is yellowish and thick.

We may be called upon to give Ipecacuanha frequently in whoopingcough, by virtue of the spasmodic character of the cough and the action of the drug on the pneumogastric nerve. You will find in addition to the symptoms already mentioned, that spasmodic convulsive symptoms are present. During the cough the child stiffens and becomes rigid from tonic spasm of the extensor muscles; loses its breath and turns pale or blue in the face. Finally it relaxes and vomits phlegm, which of course relieves. While Ipecacuanha is of excellent service here, you are reminded of two other drugs which are similar. One of these is Cina, which I must ask you to remember as being something more than a mere worm remedy. This remedy is useful in whooping-cough with the same kind of rigidity that I have described for Ipecacuanha, but there is in addition a clucking sound in the oesophagus as the child goes out of the paroxysm. If in addition to this symptom you also have grinding of the teeth, Cina is certainly a

better remedy than Ipecacuanha.

Cuprum metallicum is the complement of Ipecacuanha in spasmodic affections and in whooping-cough. It is especially indicated in convulsions from worms and during the course of whooping-cough. Spasms of the flexors predominate.

In fevers we may use Ipecacuanha, especially in those of an intermittent type. It is one of the best drugs to give when your case is mixed up. It is particularly indicated when there is a short chill, followed by long fever with nausea and vomiting, especially after the abuse of Quinine.

Ipecacuanha is an excellent drug for hematuria, for haemorrhage from the kidneys when the trouble is attended with nausea, oppression of the chest, hard breathing, and cutting pains in the abdomen. In some cases those who work in Ipecacuanha are affected with a violent inflammation of the conjunctiva. Now this fact led Jousset to apply the drug in the treatment of ophthalmia, and he claims many cures with it in the intense conjunctivitis of scrofulous children. There are tearing pains in and about the eyes and copious lachrymation. Tears gush forth ever}' time the lids are separated. When, however, there is marked keratitis, he prefers Apis.

In closing let me give you the Ipecacuanha temperament. Studied as a homoeopathic remedy, you will find it indicated in patients who are full of desires they know not for what. The child cries and screams continually. The adult is irritable and morose, holding everything in contempt.

Bismuth seems to hinder the action of Ipecacuanha.

Opium increases its action on the bronchial mucous membrane. COFFFA ARABICUM.

Coffea is extensively used as a beverage. Its alkaloid, Caffeine, is identical chemically with several others, such as Theine, the active principle of tea, and is related chemically to the purin bodies, xanthin, uric acid, etc.

Caffeine lessens the amount of urea excreted in the urine. It is useful when there is an extra drain on the system, particularly after hard work in hot weather, at which time the system is doubly exhausted by the fatigue and the heat combined.

Then a cup of coffee is a very good thing. So, too, it may be used after loss of sleep, when fatigue is more marked than it is after labor. Other things being equal, coffee is not so useful for the young as for the old. A man in active business life or one who works hard all day, or an elderly man in whom waste is out of proportion to repair, finds great benefit from coffee. In fact, it is almost instinctive on the part of workmen to fall back on coffee as a beverage, because it gives them what their food will not, a certain amount of strength and an antidote to the wear and tear of labor.

The effects of Caffeine on the system bear a certain resemblance to Strychnia. It seems to excite reflex action, and, if persistently given, tetanus as well. It produces sudden starting from the slightest touch of the surface of the body (like Strychnia), and increased susceptibility to all external impressions. This increased '

' excito-motor "

action explains many of its symptoms. Violent emotions, whether of pleasure or of pain produce symptoms. Patients experience sudden joy, and they are at once sick from the excitement. They awaken at night without any desire whatever to return to sleep. Coffea also produces an ecstatic state of mind. Here it finds a concordant remedy in Cypripedium. Especially is the latter remedy indicated in children who awaken at night from sleep, and are unnaturally bright and playful, and evince no desire to go to sleep again. Such symptoms are often preliminary to some brain affection, which the timely use of Cypripedium may avert.

Apoplectic congestion may be cured by Coffea, particularly if an excited state of the mind has been the cause of the excessive fulness of the cerebral blood-vessels. So, too, an animated conversation in which the party interested becomes greatly warmed up and has cerebral congestion will call for Coffea. This remedy is of value, however, only in the beginning of these cases; then it is all-sufficient. But if the. trouble goes on to effusion (not inflammatory effusion, but effusion of serum by oozing through the distended capillaries), you must have recourse to Belladonna, Bryonia or some remedy more adapted to effu-