Psychotria ipecacuanha. N.O. Rubiaceae.
INTRODUCTION
LOCALLY, ipecacuanha produces dermatitis, going on to pustulation. It is an uncertain antiseptic, destroying, for instance, anthrax bacilli but not the spores. Internally administered in appropriate doses it is a powerful but not a rapidly acting emetic and an expectorant.
PATHOGENESIS.
Most of the pathogenic effects of ipecacuanha are doubtless due to its chief alkaloid (or “active principle”) emetine, which has come of late years to supersede, in some spheres, the use of the powder and the wine. They will be considered together, special reference being made later to some of the uses of emetine. Administered by the mouth salivation quickly occurs and is followed by nausea and vomiting. The usual feelings of weakness, muscular relaxation, faintness, with quickened pulse, increased secretion of the mucous glands of mouth and pharynx, and waves of hot perspiration accompany the nausea and lead up to the act of vomiting.
In the case of ipecacuanha the emetic effect is due to its irritant action on the gastric mucous lining. This is shown by the fact that a much larger dose (of emetine) injected subcutaneously is required to cause vomiting than would be required by the mouth. Large doses so injected, in addition to causing vomiting, induce diarrhoea with blood in the stools and, in the case of experimental animals, produce fatal collapse. Massive doses injected may cause convulsive movements and rapid collapse without vomiting occurring.
These facts indicate a specific influence on the digestive tract, for the vomiting and diarrhoea occur after injection if the dose is regulated so as to give time for excretion, via this route, before collapse and death occur. The mucous membrane is congested, swollen and sometimes ecchymosed, muco-purulent discharge covering the surface. In dogs and in some cases of poisoning in the human subject ulceration is found.
Another digestive tract effect is the increased secretion of bile-and not merely a more complete evacuation from the gall- bladder-causing the drug to rank as a direct cholagogue.
Whether inhaled or administered by the mouth ipecacuanha produces hyperaemia of the respiratory mucosae-bronchial and pulmonary, the secretion of mucus being increased and cough resulting. In some sensitive subjects acute asthma is produced by quantities too small to be mechanical irritants.
There are a few other effects which will be referred to more fully in the provings record; they are: (a) A general tendency to bleeding from mucous surfaces; (b) rigidity, spasms and convulsive movements of various muscular groups; (c) diminished urinary secretion with dark red or bloody urine, and (d) fever without thirst during the heat, worse after 4 p.m. The provings add some details and qualifications to these general statements.
Generalities.-The chief of these are relief in the open air, and sensitive to either extreme of heat and cold. Exertion of any kind aggravates the dyspnoea and the colic.
Mind.-The ipecacuanha patient is irritable and impatient, but not violent or rowdy. If the patient be a child it shows its irritability by constant screaming. Ipecacuanha patients are sensitive to noise, including loud music.
Head.-Shooting pains (vertex) and bruised pain throughout the head from skull to root of tongue, with pain in the occiput and nape are induced.
Eyes.-Redness of the eyes, with lachrymation and shooting pains through the eyes, and mucus in the outer corners are recorded.
Nose.-Paroxysmal sneezing in severe attacks is noticed, with thin mucous discharge, cough and expectoration. Epistaxis is frequent.
Face.-The face is pale, especially during an asthmatic paroxysm, with blue areas under the eyes, and there may be twitchings of the lips and other facial muscles. With pyrexial conditions the face may be bright red, or bluish red, and the lips blue during spasmodic attacks. Soreness and ulceration may be found around the mouth.
Mouth.-Salivation is one of the earliest and most persistent symptoms, causing frequent swallowing. The tongue is fairly clean as a rule, or it may have a thin yellowish coat; there may be a sweetish taste due to oozing of blood from gums or elsewhere.
Stomach.-The outstanding symptom is NAUSEA, which, though located in the stomach, is a true “general”; it is present whether digestive or respiratory symptoms predominate, and whether the former be chiefly gastric or intestinal. Vomiting, of course, may be present, true gastric vomiting, though intravenous injection of emetine may cause it to come on via the medullary centre; there is a good deal of retching. This and vomiting are aggravated by cold drinks and by smoking. The ejecta may be of food (if recently taken), of bile or greenish mucus. Blood may be mixed with them. A dragging feeling in the abdomen suggests that the stomach is too full and heavy, and is “hanging down.” A sharp, cutting pain in paroxysms, so severe that the patient dare not move, is located in the stomach region, above the umbilicus. It passes from left to right. Absence of appetite, loathing of food, is part of the nausea complex; sweets are particularly objected to. Absence of thirst is a definite feature of ipecacuanha (except during the hot stage of intermittents).
Abdomen.-There is cutting, colicky pain in the abdomen, chiefly round the umbilicus. It may be likened to a hand clawing the belly, each finger, as it were, being felt to clutch or grip the bowels. The pains cause shivering, and are worse on movement.
Stools.-There is always diarrhoea if large doses have been administered, even if not given by the mouth, and a frothy, fermented appearance of the stools is frequently present. The evacuations may be (at first) thin faecal matter, or faeces coated with blood-stained mucus; later of white or greenish mucus. Straining may be present, but is not so conspicuous as with some other poisons; smarting and burning in the rectum and anus accompany it.
Genito-urinary system.-The urine is scanty and dark red, and sometimes contains blood. Ineffectual efforts to pass water may be made. Menstruation comes on prematurely, and is profuse, bright and clotted, and associated with a pressing down pain.
Respiratory Tract.-Paroxysmal sneezing with discharge of thin mucus is noticed, especially from irritation by the powder, as in sensitive subjects who have to dispense it. Indeed, this sensitiveness may be so great that sneezing, cough and asthma may come on when ipecacuanha is being handled in another room. The constrictive effect on the bronchial tubes, with tickling in them, causes great dyspnoea and a suffocative cough. It is worse from cold and walking about, but is rather relieved in the open if not very cold, and worse in the house. Loud wheezing, anxiety and oppression felt round the heart or in the epigastrium are present, the anxiety being due to shortness of breath and the annoyance of the wheezing. Any exertion renders the difficulty of breathing worse. Cough at first is dry and spasmodic, but later loose and rattling.
Limbs and Back.-Here the nervo-muscular element is prominent in the shape of spasms in the dorsal muscles, making them hard and bending the spinal column backwards; jerking in the legs and cramps in the thighs. There may also be pains in the bones and joints, variously described as bruised, torn, &c., or numb.
Skin.-Violent itching occurs, without rash, not relieved by scratching, until spots appear.
Fever.-The chilly stage of febrile conditions is followed about 4 p.m. by heat without thirst. One side or one hand is hot, while the other may be cold.
Haemorrhage.-Bleeding from nose, bowel, uterus, &c., are recorded in poisonings and provings, but clinical experience has extended this. Any haemorrhages of bright blood which clots readily may bring up ipecacuanha for consideration.
THERAPEUTICS.
For many years it has been acknowledged that for some cases of vomiting minute doses of an avowed emetic-ipecacuanha-formed a useful remedy. Followers of Hahnemann naturally advanced this as a striking instance of homoeopathy. Opponents answered that the results were due to the “tonic” action of the drug. Against this, evidence was supplied to show that the benefit accrued from doses far too small to be described as “tonic,” and that tartar emetic acted similarly, though no stretch of imagination could describe this as a tonic, unless on the homoeopathic principle. An emetic in a large dose, a stomachic tonic in a small one! Depressants or irritants in large doses, and tonics or sedatives in small ones! It is “the dual action of drugs”-that convenient formula for evading the acknowledgment of homoeopathy.
Digestion.-Taking the therapeutic spheres of ipecacuanha in the order already followed, we begin with the digestive tract. Gastric catarrh, subacute or chronic, is perhaps the commonest of the complaints for which this remedy is required. The cause may vary from alcoholism to cancer, including pregnancy, lactation, acute fevers, whooping-cough, and menstruation. Fats, pastry, &c., may act as exciting causes. The symptoms are less severe than in arsenical cases, and they extend to the intestines; persistent nausea is the most striking concomitant; vomiting may or may not be present. The dysentery-like actions are often found in children, from unsuitable feeding; the stools are as already described;ipecac. will quickly benefit. Cholera infantum, cholerine and entero-colitis are terms applied to such conditions. It is also one of the standard remedies for dysentery, its use being indicated by similarity of symptoms, not by the name of the causative parasites, though the drug is more suited to amoebic cases than to bacterial. The large doses used in orthodox medicine are unnecessary if only those cases with appropriate indications are treated by the drug. Tenesmus is not a striking feature, but griping and bloody mucus are. In the early stage of some cholera cases it has been used with success, i.e., where nausea and vomiting are the chief features.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,