ket. The powder is of a light grayish-fawn color, and has a peculiar nauseous odor, which in some persons excites violent sneezing, in others, dyspnoea. Ipecacuanha imparts its virtues to both water and alcohol, but they are injured by decoction. Its emetic property depends on the presence of an alkaloid, termed emetine (C30H40N2O5) (Kunz*), which exists in combination with ipecacuanhic acid. Emetine is a whitish, inodorous, slightly bitter substance, sparingly soluble in water and ether, and very soluble in concentrated alcohol and chloroform. It produces vomiting in the dose of gr. 4, and in overdoses may occasion dangerous and even fatal symptoms. Occasionally a sophisticated root, that of Psychotria emetica, derived from New Granada, is found in the markets; this is not annulated, but longitudinally striated, and contains less than half the quantity of the emetine found in the genuine root (11⁄2 per cent.).

Physiological Effects.-Locally, powdered ipecac is an irritant to raw surfaces and to the mucous membranes, causing violent sneezing, etc. When rubbed into the sound skin it causes pustulation and even ulceration. Nervous system: it stimulates the centre of the medulla oblongata which presides over the act of vomiting, and somewhat diminishes the reflex activity of the cord. The following observers, viz. : D'Ornellas,† Phillips,‡ and Duckworth,§ ascertained that emetine, in animals, always caused vomiting, given either by the stomach or subcutaneously. D'Ornellas (loc. cit.) and Duckworth (loc. cit.) found, too, that when the vagi were divided in the neck the alkaloid was powerless as an emetic. Toxic doses (in animals) generally destroy life by paralyzing the respiratory centres, the nerves probably remaining unaffected. Circulation: moderate doses probably do not affect the circulation; very large doses injected into the jugular vein of dogs have killed by cardiac paralysis. Temperature in the mouth and on the surface the temperature falls in cases of emetine poisoning, but in the intestines it rises (from the irritant action of the poison). Secretion: repeated small doses

*Arch. der Pharmacie, 1887, p. 461.

+ Bull Gén. de Thérap., LXXXIV, pp. 193, 244, 348: Du Vomissement, etc. Practitioner, London, III, p. 276. "On the action and uses of ipecacuanha." Ibid., Vol. v, p. 218, and Vol. VII, p. 91. "Observations upon the action of ipecacuanha," etc.

relax the skin and increase the perspiration, saliva and the bronchial and gastric mucus. Rutherford states that it has the power of stimulating the secreting apparatus of the liver (in dogs), and that the consequent augmented secretion of bile is normal in composition as regards the biliary matters proper. also increases the secretion of intestinal mucus. Gastro-intestinal tract: it is an irritant to the stomach, producing vomiting by local irritation as well as by direct action on the medulla. Elimination takes place by the gastro-intestinal mucous membrane, and also by other secretions.

Post-mortem appearances: after death from ipecac, the stomach and small intestines are found intensely congested, as are the lungs with patches of hepatization; sometimes, however, the lungs are exsanguine.

Medicinal Uses.-In full doses, ipecacuanha is a mild and certain emetic, well adapted to the treatment of spasmodic croup and acute bronchitis in children, and to all cases where a simple evacuation of the stomach is desired. In smaller doses it produces nausea, depression of the pulse, expectoration and diaphoresis, and with these views it is employed in the treatment of pulmonary affections, dysentery, and inflammatory disorders generally. In still smaller doses it is useful as a tonic and stomachic.

Ipecacuanha was first introduced as a remedy in dysentery, and, after being for a time laid aside, has been again used with marked success. It is particularly of value in epidemic dysentery, and in India is used in very large doses in this affection, as much as 3ij being sometimes given every few hours. The editor has seen much good follow its use in acute dysentery of sporadic kind, especially when occurring in puerperal women, given in doses of gr. xv-xx combined with opium every three or four hours. If no effect is produced by the ipecac-treatment of dysentery in two days, it is best to abandon it (H. M.). It is also used with advantage in the vomiting of sick headache, and will sometimes, when given in small doses, frequently repeated, arrest the nausea and even the vomiting of pregnancy (Fuller*). The wine or fluid extract (in drop doses) is best for

* Lancet, London, Dec. 4th, 1869, p. 268.

this purpose. Given in pills containing gr. 4-34 before meals, it is of service in dyspepsia accompanied by deficiency of gastric and biliary secretions. As it stimulates the secretory apparatus of the stomach and liver, the rationale is obvious.

Administration.-Dose, as an emetic, gr. xv-xx; as a nauseant, gr. ss-ij, three or four times a day; as an expectorant or diaphoretic, gr. 4-, repeated; as a tonic, gr. 1, repeated. The fluid extract is used as an addendum to expectorant and diaphoretic mixtures, and in bronchitis is advantageously combined with the syrup of wild cherry and morphine (B). As an emetic, the dose is f3ss-j; the wine (vinum ipecacuanha) contains fluid extract 7 parts in stronger white wine 93 parts; dose, as an emetic, f3ss-j ; fluid extract, 5 parts, mixed with simple syrup, 95 parts, makes syrupus ipecacuanha, an excellent preparation for children-f3j containing gr. xxx of ipecacuanha; for a child a year or two old, f3ss-j may be given as an emetic, and gtt. v-xx as an expectorant. Pulvis ipecacuanha et opii (formerly called pulvis ipecacuanha com- . positus, or Dover's powder) contains powdered ipecac and opium each gr. j, sugar of milk gr. viij (see Opium, p. 82); a tincture of ipecac and opium is also officinal (see p. 83). Troches of ipecacuanha (contain also sugar, tragacanth, and syrup of orange-peel), each troche contains ipecac gr. 4. Troches of morphine and ipecac each contain morphine sulphate gr. 6, ipecac gr. 12, with sugar, oil of gaultheria and mucilage of tragacanth.

SANGUINARIA.

The RHIZOME of Sanguinaria canadensis, or Bloodroot (Nat. Ord. Papaveracea), a small indigenous plant, with radical, cordate, lobate leaves and a handsome white eight-petaled flower, which appears in early spring, is usually classed with emetics. When dried it is in flattened pieces, much wrinkled and contorted, of a reddish-brown color, with a faint narcotic odor and bitterish, very acrid taste. It yields its virtues to water and alcohol, and loses them rapidly by keeping. An alkaloid, sanguinarine (C19H7NO), has been obtained from it which possesses the properties of the root.

Effects and Uses.-Bloodroot is an acrid emetic, and, in large doses, an acro-narcotic poison. Locally, it acts as an irritant, and upon fungous surfaces, as an escharotic. When inhaled, the

powder causes violent sneezing. In large doses it causes collapse, dilated pupil, and sometimes convulsions of spinal origin, and diminishes reflex activity. After nauseating doses the pulse and arterial pressure are increased, but when enough is taken to pro

duce vomiting the pulse is slow and irregular and the arterial tension is lowered. After poisonous doses the respiration becomes shallow and slower, and death takes place from asphyxia, due to paralysis of the respiratory centre.

Sanguinaria produces salivation and increases the secretion of the gastric mucous membrane. It stimulates the liver and intestinal glands, increasing the secretion of bile, but at the same time rendering it more watery (Rutherford). It is an active systemic emetic, causing much depression and irritation of the mucous membrane. It is not much used as an emetic, but is occasionally employed with this view in croup and diphtheria, or as an expectorant in pulmonary affections. In duodenal catarrh and secondary catarrhal jaundice it has been used with advantage. It has also been used as an emmenagogue in amenorrhoea. Dose, as an emetic, gr. x-xx, in pill. Tincture-dose as an emetic, f3iij or iv; as an expectorant, v-xxx. The vinegar (acetum) contains ten per cent. by weight of the powdered drug. The fluid extract should be used with care, as it is a powerful preparation; dose, as a nauseant, mij-v; as an emetic, xv-fɔ̃j.

APOMORPHINE HYDROCHLORAS-APOMORPHINE HYDROCHLORATE.

Apomorphine (C7H7NO2) is an artificial alkaloidal substance. obtained by heating morphine with hydrochloric acid under pressure, the acid subtracting one molecule of water from a molecule of morphine, and leaving apomorphine (C17H19NO,= H2O + C17H7NO2). When apomorphine is treated with hydrochloric acid it combines to form the officinal salt. When pure it is a white powder, but it absorbs moisture readily, becoming green, which change, however, is said not to impair its therapeutic properties.

Physiological Action.-Given to animals in large doses, it at first stimulates the nerve centres and afterward paralyzes them. Convulsions are produced, but their origin is not precisely determined, and it is a poison to the muscular system.† Small doses increase the cardiac action and elevate the pressure, but when large doses are taken, the cardiac movements are probably slowed and the pressure diminished. According to Reichert (loc. cit.), it quickens the heart's beats by stimulation of its accelerator fibres, and slows it by a direct depressing

* For the details of a complete investigation of the action of Sanguinaria, consult Am. J. M. Sci., Oct., 1876, p. 346, by R. M. Smith, M. D.

+ Phila. Med. Times, Dec., 1879, E. T. Reichert. "Physiolog. Action of Apomorphine hydrochlorate."