Haemorrhages.-Passing from the bleeding of dysentery to that of other conditions it is only necessary to mention the following: Menstruation, regular and irregular, post-partum haemorrhage, haematemesis, melaen, haemoptysis, epistaxis. In them all the prime qualitative indication is that the blood, whether flowing actively or passively, is bright red and quickly clotting; it may be profuse in some cases. In post-partum bleeding, unless kept up by mechanical means, haemorrhage as described, coming in gushes, accompanied with nausea and faintness, ipecac. may be relied on to act quickly. Ipecac. of course does not rank as a local haemostatic such as tannin or perchloride of iron, or like adrenalin, pituitrin or ergot by contracting the bleeding vessels. The rest of the patient’s symptoms must correspond with those of the drug if success is to be guaranteed. In cases where deeper conditions underlie the bleeding (such as tuberculosis or cancer) the remedy may be only palliative. In enteritis cases it may be curative, and the same is true of some cases of menorrhagia, epistaxis, haematemesis and pertussis. Menorrhagia or metrorrhagia from chill or shock and having ipecac. concomitants will be rapidly controlled.
Respiratory Diseases.-Ipecacuanha is useful in this sphere when catarrhal and spasmodic conditions, as indicated by the symptoms of the case, are combined. In coryza it is not of much use unless paroxysms of sneezing accompany the “cold”; in laryngeal or tracheal catarrh with spasmodic suffocating cough, dry at first, and with mucous discharge later, it is useful, especially if nausea be persistent. In the “croupy” cough early in measles it is sometimes indicated. In bronchial catarrh, acute or chronic, with a suffocating cough and dyspnoea, worse from the slightest exertion, ipecac. is invaluable, whether it has the specific pertussis element or not. In whooping-cough where epistaxis is present ipecac. will probably be required. Bronchial asthma is benefited, not only by palliation of the asthmatic attack, but also curatively. At the extremes of life for acute bronchitis ipecacuanha deserves consideration; for capillary bronchitis with patches of broncho-pneumonia in children, an in old people for emphysema with bronchitis an asthma. Where these cases are complicated by digestive derangements, with nausea, colic and frothy stools ipecacuanha would be additionally indicated. One author quotes a case where strings of tough mucous were brought up on coughing after an asthmatic paroxysm which resembled casts of the bronchi. A feeling of oppression and distress about the cardiac region is another indication.
Nervous Diseases.-The only named disease in this sphere for which ipecacuanha has been recommended is cerebro-spinal meningitis; in an epidemic “at Avignon in 1846-47″(Hughes, op. cit. p. 569), it was adopted as a specific with considerable success. In neuralgia of the eyes and head it has been used, but chiefly when the pain was part of a wider spread condition, such as conjunctivitis, lachrymation, sneezing, &c.
As complicating other maladies, stiffness amounting to slight opisthotonos, retraction of head, rigidity of muscular groups, even convulsive movements in acute diseases of children with red face, may be confirmatory symptoms. Tetanus is said to call for ipecac. at times.
Indolence and mental depression are the chief mental characteristics. Restlessness with spells of prostration with rank as a “general” symptom.
Pyrexia.-Without its possessing any very striking indications in the pathogenesy ipecac. has acquired reputation in the homoeopathic treatment of recurrent malaria. It is most useful where the type is irregular, where the characteristic nausea and salivation are well marked, where the hot stage is marked by an absence of thirst and by flushes of heat, sometimes limited to one coldness is worse from a warm room. The sweat is sour-smelling and is mostly on the upper part of the body. Movement, stooping and sweating all aggravate the patient. The attacks often being in the evening or early night. The use of this remedy in intermittents is not confined to homoeopathic ranks, though it is now out of fashion. It counteracts the abuse of quinine in intermittents.
Further, it was recommended by Hahnemann as an antidote to chronic opium poisoning.
The headaches of ipecac. are rheumatic or gastric, with the features already described.
LEADING INDICATIONS.
(1) The one striking red thread running through the string of ipecacuanha symptoms is PERSISTENT NAUSEA, unrelieved by vomiting.
(2) Retching with empty stomach.
(3) Vomiting.
(4) Abdominal pains shooting left to right.
(5) Stools: (a) dysenteric; cholera infantum.
(6) Haemorrhage from many parts; bright, clotting, and possibly in gushes (uterine).
(7) Respiratory mucosal catarrhs with spasmodic breathing, suffocative cough, &c.; bronchial asthma.
(8) Intermittent fevers-irregular, hot stage without thirst.
GENERAL AGGRAVATION: Movement, stooping, sweating, evening or early night, warm room. Oversensitiveness to both extremes of temperature, dry, cold weather.
EMETINE.-The Brazilian ipecacuanha contains a considerable proportion of emetine, more than that from New Grenada (the Uragoya granatentis). It deserves mention here because of its use in amoebic dysentery, thought it cannot be described as a direct anti-amoebic, for it does not affect the Entamoeba histolytica, in vitro. It may therefore be assumed to act by increasing the resistance of the blood-serum or the tissues against this amoeba, and it is not be specially noted that if given too long or in too large doses it causes intractable dysenteric diarrhoea with weak pulse, prostration and even collapse. It appears to cause a dermatitis with desquamation in fine flakes. If we regard the prescription of emetine or ipecacuanha as unconscious or unconfessed homoeopathy, it must at the same time be confessed that the results of treatment show that infinitesimal doses are not always necessary. It is given as hydrochloride by injection, in doses of 1 gr. daily for about ten days. This is usually followed by emetine-bismuth-iodide by the mouth in cachets, of which 3 gr. daily are given for about a fortnight. These doses may cause vomiting or diarrhoea, and opium is necessary in sensitive subjects to enable the course to be continued. The patient is kept in bed and on a light diet, chiefly milk. Repeated examination for cysts in the stools should be made before declaring a chronic case or a carrier cured-a second course, after an interval, may be needed. There is some incompletely understood relationship of a specific nature emetine and the Entamoeba histolytica which does not exist between the drug and other amoebae. The influence of the drug reaches even to the amoebae of a liver abscess. “In amoebic liver abscess Rogers removes the pus by aspiration and then injects into the cavity a grain of emetine dissolved in 1 to 2 oz. of sterile saline solution to destroy the amoebae” (Cushny, “Pharmacology,” p. 481).
Emetine hydrochloride has also been used by local injection (into the sore) in cutaneous leishmaniasis (oriental sore)with some results. Similarly it has been given intramuscularly or intravenously for urinary schistosomiasis (bilharziasis), 1 gr. in water 2 c.c.
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,