IPECACUANHA. 269 



the direct (gastric) action already mentioned. The ord:: 

 doses (15 to 30 gr. of the powdered root, 3 to 6 fl.dr. of the 

 vinum for adults) produce free evacuation of the stomach, and 

 respiratory passages in 20 to 30 minutes, the dose often having 

 to be repeated in 15 minutes, and the vomiting act probably 

 occurring but once. But little nausea precedes, and moderate 

 depression follows, the emesis. The circulation and respiration 

 are disturbed and finally depressed by ipecacuanha, chiefly 

 through the vomiting. 



This drug is suitable as an emetic in cases -where the 

 necessity for evacuation of the stomach is not very urgent, and 

 the subject is likely to be benefited by moderate but injured by 

 great depression. It must not be given, therefore, in poisoning 

 by alkaloids, such as morphia, but to children and weakly 

 subjects in cases where the after effects of the drug will be also 

 useful. It thus occupies a position amongst emetics between 

 sulphate of zinc or copper and tartar emetic. Ipecacuanha may 

 be used to empty the stomach in the early stages of sthenic 

 fevers (less commonly than before) ; in cramp, whooping- 

 cough, and the bronchitis of children, to expel membranes or 

 mucous products from the air passages ; and in acute dyspepsia 

 with biliousness and heat of skin. 



The skin is stimulated to increased secretion by ipecacuanha, 

 which is used as a diaphoretic, especially combined with opium 

 (Dover's Powder), in common colds, sore throat, and mild 

 rheumatic attacks. 



4. REMOTE LOCAL ACTION AND ' 



Emetin is excreted by the various mucous membranes, 

 including those of the bronchi, the stomach, and bowels, and by 

 the liver. On the bronchi it produces the same remote as 

 immediate local action, namely, stimulation of the nerves, 

 reflex cough, increased secretion, and, in large doses, even in- 

 flammation of the mucous membrane and lungs. Ipecacuanha 

 is thus an expectorant, increasing at once the expiL 

 and the amount, that is, the liquidity, of tho sputa. It is the 

 most generally used of all this class of m> 

 in acute and chronic bronchitis, in phthisis, and in most cases 

 of cough when the phlegm is scanty and tough. Important 

 advantages of ipecacuanha are, that, if taken in excess, it causes 

 sickness, which is often beneficial in the bronchitis of child: 

 and that as a diaphoretic and moderate depressant of the 

 circulation, i.e. a sedative expectorant, it controls the fever at 

 the same time. 



Acting remotely on the liver, this drug is a direct chola- 

 gogue, increasing the secretion of bile ; and has long been a 



