Ipecacuanha: the South American vomiting root.

The story of ipecacuanha, derived from the plant Cephaelis, is a fascinating one. It was discovered in Brazil in the 1600s and then transported to Paris in the latter part of the same century. It was used there by the physician Helvetius on various members of the French royal court to treat the flux (dysentery) with some success. Later, in the eighteenth century, it was taken up by the physician and privateer Thomas Dover and became, with opium, a fundamental constituent of his celebrated powder, which was used widely to treat fevers and agues for the next 200 years. Progress was then delayed until the early 1800s when the School of Chemistry at Paris established that the dried root of ipecac contained two powerful alkaloids, emetine and cephaeline, that consistently caused vomiting and diarrhoea. The discovery of the pathogenic amoeba, Entamoeba histolytica, in the latter part of the nineteenth century, allowed a distinction to be made between the two main forms of dysentery (amoebic and bacillary). Emetine was shown to be active against the amoebic form of dysentery but ineffective against that caused by bacteria. Ipecacuanha, its root and the pure alkaloid emetine have now been abandoned on the grounds of toxicity. They have been replaced by safer, more effective compounds. Nevertheless, they deserve an honoured place in the history of medicine, especially in the search for an effective treatment for amoebic dysentery.

[Lessons from the history of therapy--therapeutic optimism and its pitfalls]. / Lehren aus der Therapiegeschichte--der therapeutische Optimismus und seine Tücken.

If we are to help patients effectively, our understanding of diseases and our therapeutic potential should, again and again, just be somewhat better than they actually are. Throughout the ages this has been the fundamental situation in medical practice. The response on the physician's part has nearly always been an attitude of therapeutic optimism. At all times physicians--and patients also--have relied on therapeutic principles and remedies based on professional experience and medical theory. In conjunction with the (generally recognized) healing powers of nature, and of (unrecognized) autosuggestion, this has led to many satisfactory and even remarkable cures. Examples from antiquity to the 19th century are quoted, and the snags of an over-optimistic attitude become evident, viz. a rational therapy is no better than the underlying pathogenetic theory; exaggerated therapeutic activity may cause useless torment to the patient (a point already made by Hippocrates); the optimistic physician or the enthusiastic pioneer of a new remedy may be blind to toxic side effects or the development of addiction. To sum up: therapeutic optimism is fine--but don't overdo it!