IPECAC 349 



ulceration, according to their strength and the mode of application. 

 Emetine kills amebae in 1 to 100,000 solution and is a powerful antiseptic, 

 being 5 times more powerful than phenol in 5% solution. 



Action Internal. — Digestive Tract. — Ipecac is naturally a local irri- 

 tant in the alimentarj' canal as well as externally. It increases the flow 

 of saliva and gastric juice, besides dilating the blood vessels of the 

 stomach. Small doses are stomachic, improving the digestion and tone of 

 the gastric mucous membrane, and, in some cases, minute quantities are 

 anti-emetic in allaying vomiting. Large doses, on the other hand, cause 

 ri little nausea and free vomiting. It is probable that emetine is not, as 

 frequently stated, a specific emetic; that is, does not act directly on the 

 vomiting centre, although, when emetine is thrown into the blood, vomit- 

 ing is produced, by means of its elimination through the stomach. This 

 is substantiated by the following facts: (1) Emetine is recovered in the 

 first vomitus after its subcutaneous injection. (2) Vomition does not 

 occur so rapidly, and more emetine is required, when the alkaloid is in- 

 jected in place of being ingested. (3) Furthermore, when the vagus is 

 previously divided, vomiting does not follow hypodermic medication of 

 emetine. The act does, however, follow the administration of apomor- 

 phine and tartar emetic under similar conditions. Therefore it is probable 

 that in whatsoever way ipecac is exhibited, vomiting proceeds from 

 direct irritation of the stomach or the vagus endings situated therein. 

 Ipecac and emetine do not act sopromptlj^ as zinc sulphate or apomor- 

 phine (under the skin). The latter are accordingly preferable as evacu- 

 ants in poisoning. Compared with tartar emetic, ipecac is less persistent 

 and prostrating in its effect. It is probably the mildest emetic at our 

 command. Ipecac and emetine increase secretion and cause hyperemia 

 and purging, sometimes of a bloody character, in their passage through 

 the bowels. Gastro-enteritis may follow the administration of large quan- 

 tities to dogs. Experimental evidence has apparently shown that ipecac 

 is an hepatic stimulant (cholagogue), increasing the secretion of bile. 

 This action is doubtful. 



Circulation. — Emetine has been given subcutaneously to stop internal 

 hemorrhages. Its mode of action is uncertain and its use for this purpose 

 is now uncommon. The drug is specially toxic if given intravenously. 

 There is a slowing and weakening of the heart and fall in blood pressure 

 from toxic amounts. Lethal doses paralyze the heart muscle. 



Respiratory Organs. — The lungs are often found intensely hyperemic 

 after death by ipecac poisoning. Not only this; portions are seen to be 

 collapsed and consolidated. In therapeutic doses the pulmonary mucous 

 membrane is stimulated during its elimination and is made more vascular; 

 the secretion of bronchial mucus is increased and cough is reflexly excited. 

 Ipecac is thus strictly a stimulating expectorant in so far as its action on 

 the bronchial mucous membrane is concerned; but it is, perhaps unfortu- 

 nately and misleadingly, classed by some (Brunton) as a depressing 

 expectorant because of the side influence on the circulation. 



Skin. — Ipecac is mildly diaphoretic in addition to and independent of 

 this action common to nauseants in general. 



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