Ipecacuanha Fever Symptoms


Allen gives the therapeutic indications of the remedy Ipecacuanha in different kinds of fevers like: Continued, Bilious, Intermittent, Malarial, Remittent, Pernicious, Typhoid, Typhus, Septic fever, etc…


Fever

Characteristic – Adapted to cases where the gastric symptoms predominate (Ant-c., Nux vomica, pulsatilla).

In all diseases the constant nausea is guiding.

Nausea: with profuse saliva, vomiting of white, glairy mucus in large quantities, without relief, with distended abdomen, sleepy afterwards, worse from stooping.

Stomach feels relaxed as if hanging down (Ignatia, Staphysagria).

Stool: grassy green, white mucus (Colchicum), bloody, fermented, preceded by griping, pinching pain about the umbilicus, as from a hand, each finger seemingly pressing sharply into the intestines, aggravated by the slightest motion, cutting colic about umbilicus.

Hemorrhage: bright red from all the orifices of the body (Erig., Millefolium), uterine, profuse, clotted, heavy oppressed breathing during, stitches from navel to uterus, cutting across from left to right (from right to left, Lycopodium), large accumulation of mucus in the bronchi, difficult to raise (Ant-t.).

Cough: dry, spasmodic, constricted, asthmatic.

Difficult breathing from least exercise, violent dyspnea, with wheezing and anxiety about the stomach.

Whooping – cough: child loses breath, turns pale, stiff and blue, strangling, with gagging and vomiting of mucus, bleeding from nose or mouth (Ind.). Cough, with rattling of mucus in bronchi when inspiring (Ant-t.), threatened suffocation from mucus.

Pains as if bones were all torn to pieces (Lac-c., Tuberculinum – as if broken, Eup.).

Intermittent dyspepsia, every day or every other day at same hour, fever with persistent nausea.

Oversensitive to heat and cold.

Relations: Complementary: Cuprum. Nux and Pulsatilla follow well when gastric symptoms correspond.

Aggravation: Slightest motion, worse in winter and dry weather, warm, moist south winds (Eup.), warm room, night.

Amelioration: Rest, closing the eyes.

Type: Quotidian, tertian, quartan. Apt to postpone and become irregular, bilious, remittent, malarial, yellow.

Time: 9 or 11 A.M. (10 to 11 A.M., Nat.) and 4 p.m.

Fever, without chill, at 4 p.m.

Cause: Irregularities and indiscretions in diet. Cases drugged with Quinine and Arsenic.

Prodrome: Violent retching, yawning, stretching, backache, headache, and profuse flow of saliva. Nausea.

Chill: Without thirst. Chilliness, he is always worse when in a warm place. External coldness with external heat. Chill Worse in a warm room, or from external heat ( Apis – by external heat, Arsenicum, Ignatia ), lessened by drinking and in the open air ( Causticum – aggravated by drinking, Caps., Cinchona, Eup. Nux ). Shivering, then chilliness, with coldness without thirst, at 4 p.m. The hands and feet are icy cold, and wet with cold sweat, with redness of one cheek and paleness of the other. Chill short and usually not severe, with or without nausea and vomiting. Paroxysm begins by an internal chill, made worse by external heat. Oppression of the chest.

Heat: With thirst, usually long – lasting, over whole body, with alternate coldness and paleness of face nausea and vomiting, anxious, oppressed breathing, and dry, hacking cough, often exciting nausea and vomiting (cough with pleuritic stitches, Aconite – dry, teasing cough, before and during chill, Rhus – cough during chill and heat, Bryonia ), cold hands and feet. Sudden heat about 4 p.m., with sweat on arms and back, heat of entire body in the evening. External heat without internal heat (see Ignatia ). One hand cold, the other hot (Digitalis, Lycopodium). Heat about head and face, sometimes with, often without, redness of cheeks, with dilated pupils and prostration of body and mind.

Sweat: Sudden attacks of sweat in a room, on upper parts of body, increased by motion and in the open air ( Bryonia ameliorated by motion, Caps. ), by being out of doors, cold on the forehead, sour sweat with turbid urine, stains yellow. Nausea and vomiting may be present. Always worse during sweat, better after it (ameliorated by sweating, Eup., Gelsemium, Nat. ). Light sweat in uncomplicated cases, but may be sour. sweat becomes profuse only after abuse of Quinine. May cough in sweating stage. Sweat may only amount to a cold, sticky, clammy feeling of the skin in some cases.

Tongue: At first clean, then coated yellowish or white, pale in all cases. Taste bitter, sweetish, like rancid oil. Desire for sweets, dainties.

Apyrexia: Never clear, disturbed by more or less gastric trouble (Ant.c., Pulsatilla), loss of appetite, nausea and vomiting. Stomach feels relaxed and seems to hang down loose (Staphysagria). Aversion to food (aversion to meat, Arnica ), bad taste in the mouth, languor and debility, with absence of sleep. Bitter taste of everything eaten (Bryonia everything tastes bitter except water, Aconite ), profuse secretion of saliva, and vomiting after eating. Herpes labialis.

“Short chills, long fever, cold hands and feet, great oppression of the chest, he can hardly breathe. Always after previous drugging with Quinine.” – N.A. Roth.

“Intermittent fever, nausea and vomiting predominate, slight chills are followed by much heat, with thirst and no subsequent perspiration. Fever consequent upon abuse of Quinine, slight chilliness without thirst, afterwards violent heat, with thirst, nausea and vomiting, dyspnea, stitches in the chest, finally copious perspiration.” – Lippe.

If paroxysm has been suppressed by Quinine, Ipecacuanha is all the more indicated.

Relapses from improprieties in diet always an additional indication for Ipecacuanha. This is a very common cause of a return of paroxysm and one frequently overlooked by physicians. In all forms and types of fever, reckless or over eating is perhaps the most frequent cause of relapse.

The persistent nausea, which does not always amount to vomiting, that is usually present in every stage, is the “guiding symptom” of Ipecac., although it may be and often is indicated when neither nausea nor vomiting is present. When fever returns in another form, after suppression by Quinine, and symptoms do not clearly point to any remedy, if nausea or vomiting were present in first onset of disease, Ipecac. will often cure.

In this “Forty Years’ Practice,’ Jahr places Ipecacuanha at the head of the list of remedies in the treatment of intermittent fever, and recommends its administration in commencing the treatment of every case. He says: “I almost always commence the treatment with Ipecac 30., unless some other remedy is distinctly indicated. I give a few globules in water, a teaspoonful every three hours, beginning immediately after the chill. By pursuing this course I have cured many cases of ‘fever and ague’ by the first prescription, thus saving myself a good deal of unnecessary seeking and comparing. If it does not help altogether, it changes the character of the fever so that Arnica, Arsenicum, Ignatia, Nux vomica, etc., will complete the cure.”

This advice is also given by J.S. Douglas in his work on Intermittent Fever, p. 80, and a number of our closest and most successful prescribers have adopted it, with apparent success. H.V. Miller says: “I am apt to give Ipecac. when I do not clearly see the indications for another remedy. Then it serves to clear up the case and prepare the way for some other remedy to complete the cure.”

I cannot endorse the above indiscriminate use of Ipecac., on principle, it is empiric practice, and will certainly be attended with many mortifying failures. That it is infinitely superior to the more prevalent, empiric and indiscriminate use of Quinine, and attended with less failures and less constitutional derangements, I have no doubt at all. If the attack can be traced to dietetic irregularities, this advice of Jahr is undoubtedly sound, the best proof being its success at the bed side. A case like the following very often occurs in practice:

A messenger is sent many miles for some medicine for “ague,” and that is all the information we can obtain. If we do not prescribe some one else will, and rather than lose a patient and have it said that we cannot cure “so simple a thing as ague” we make a “chance shot,” and, unless we have found the genus epidemicus” of the season, are as apt to fail as to cure.

This is, in my opinion, the opportunity to follow Jahr’s advice and exhibit Ipecac., and it would be infinitely better for our patient, our school of medicine, and our professional reputation, if we did so instead of sending Quinine. Ipecac. covers a much larger range of symptoms than Quinine, and, in a case like the above, will cure more patients.

In regard to this routine habit of prescribing Ipecac., Dr. Charge says: “I have known practitioners, highly commendable in other respects, who always began with Ipecac, under the pretence that, after it, the case was better outlined and the choice of the true specific was consequently easier. This is simply an encouragement to indolence. Ipecac. presents itself to us with so clearly defined features, that it is impossible with a little attention not to recognize at once the cases which call for it.”

Analysis: Persistent nausea. Indiscretions in diet may have caused the original attack, or the relapse. Chill Aggravated in a warm room and from external heat. Suppressed by abuse of Quinine. When the paroxysm is changed and masked by drugging.

H. C. Allen
Dr. Henry C. Allen, M. D. - Born in Middlesex county, Ont., Oct. 2, 1836. He was Professor of Materia Medica and the Institutes of Medicine and Dean of the faculty of Hahnemann Medical College. He served as editor and publisher of the Medical Advance. He also authored Keynotes of Leading Remedies, Materia Medica of the Nosodes, Therapeutics of Fevers and Therapeutics of Intermittent Fever.