resist the desire to vomit. With the same object in view, when saliva begins to collect in the mouth, as it is apt to do in such circumstances, it must not be swallowed; on a slight sign from the patient the nurse should remove the accumulating saliva with a handkerchief. If much saliva be swallowed, it is sure to provoke vomiting. In some instances these precautions suffice to avert emesis. Should, however, the ipecacuanha be brought up within an hour of its being swallowed, the dose had better be repeated so soon as the nausea has subsided, the same precautions against vomiting being observed.
After six or eight hours, and when all feeling of nausea has subsided, small quantities of food may be given, and frequent and fractional feeding persisted in for six or eight hours, or until the following day, when the dose of ipecacuanha must be repeated. In many instances one or two such doses abort the dysentery, and the acute symptoms rapidly subside. It is wise, however, to go on with the ipecacuanha once or twice a day for at least a week or longer. It is a good practice to reduce the ipecacuanha by 5 gr. every day. If the drug is doing good, copious fseculent pultaceous yellow stools will be passed after a day or two. This diarrhœa, unless excessive and attended with straining or other dysenteric symptoms, must not be checked or regarded as an indication for stopping the drug.
Thus I wrote in previous editions of this work. My opinion of the value of ipecacuanha is still unshaken, but the use of the crude drug, which is attended by many inconveniences, has been superseded in great measure by the hypodermic or intramuscular injections of its alkaloid emetine, as advised by Leonard Eogers. The hydrochloride of emetine is given in doses of ⅓ - 1 gr. in distilled water hypodermically up to 1 gr. a day. The stools generally become normal on the third day, but it is advisable to continue the injections for a week or longer. Unfortunately, one course of the drug does not always prevent relapses, but in such cases, if the injections be persisted with, a permanent cure will generally
