Case of Idiosyncragy from Ipecac, 
WITH REMARKS, 
BY 
EDWIN L. MORGAN, M.D., 
OF WASHINGTON, D. C. Art. IV.-CASE OFIUIOSYNCRACY FROM IPECAC, WITH REMARKS.* 
By| 
EDWIN L. MORGAN, M. D., 
of Washington, D. C. 
[REPRINT FROM THE VIRGINIA MEDICAL MONTHLY, OF RICHMOND, VA., JULY, 1892.] 
While stationed on the frontier at an Indian agency, I was called in to see Mrs. 
K , a handsome quarter breed woman, aged about 48 years, who was suffer- 
ing from a violent attack of bronchitis, which confined her to the house. I gave 
her a six ounce cough mixture containing one ounce of the syrup of ipecac. She 
was immediately seized with a violent, obstinate, and prolonged attack of vomit- 
ing each time she took a teaspoonful of the mixture. I had to omit ipecac in her 
cough medicine, so susceptible was she to the smallest quantity of it. I had tried 
in her case a number of experiments, always with the same result, though some- 
what modified by the quantity used in each dose. She suffered from no other bad 
effects of the ipecac. 
Mrs. K was always a sufferer more or less during >the winter and early 
spring from laryngitis (losing her voice for several weeks), bronchitis, frequent 
attacks of coryza, and occasionally rheumatism. Her grandchild (about a year old), 
sick about the same time, showed a remarkable tolerance of the syrup of ipecac, 
having been given, at different times,' in doses varying from a teaspoonful to a 
tablespoonful, and repeated. In fact, I gave one dose of more than a half an ounce, 
and another still larger. I was unable to vomit this child with the syrup of ipecac, 
but used another emetic with the desired effect. This preparation of ipecac in the 
child's case acted as a sedative. I'he only effect it had was to make it drowsy and 
cause sleep for several hours. It caused no action on the bowels, nor did any bad 
effects follow the use of the drug. When the large doses were given to the child, 
previous experience told me it would be useless to use a small dose. The toler- 
ance and intolerance in the child and grandmother were well marked so far as the 
syrup of ipecac was concerned. The same preparation was used in .each case. 
The subject of idiosyncracy from ipecac has so much of interest in it to me that 
I have thought mention of other cases would not be without interest to others. 
Mr. F- , a druggist of this city, age 50 years, has kindly given me a history * 
of his own case regarding ipecac. He began the study of pharmacy when a boy. 
He had always enjoyed good health, never being susceptible to catarrhal affec- 
tions of the respiratory tract, nor had he ever suffered from any of these diseases. 
On one occasion, while weighing powdered ipecac root, he was immediately seized 
with paroxysms of sneezing, followed by asthma, which caused him in his alarm 
to rush out so as to get fresh air, so intense was his suffering. So susceptible is 
he to the unpleasant effects of the drug that he Cannot take any of its prepara- 
tions, nor can he remain in his store when powdered ipecac is being dispensed, 
for he is immediately seized with paroxysms'of sneezing, running from the nose, 
accompanied with itching of a most aggravating type, which extends to the nose, 
pharynx, mouth, and especially affects the tonsils. Owing to the itching princi- 
pally, he felt as if he would like to tear out his tonsils, for the agony located in 
these glands was indescribable, and caused him to grasp the outside of his throat 
during his intense sufferings. His eyes itched, were inflamed, and large pouches 
formed on and under the lower lids; there was also a profuse secretion of tears. 
The itching extended along the Eustachian tube to his ears. Dyspnoea was well 
marked, with a sense of impending suffocation; there was a sensation of stricture 
around the chest, accompanied with a feeling of precordial oppression; the body 
was also bathed in profuse perspiration. Finally, from exhaustion, he would sihk 
into a deep sleep. These attacks would last about four hours, leaving him with a 
cough and profuse expectoration, lasting for several days. On several occasions 
he had taken both the syrup of ipecac and the wine; as a result, he suffered with 
the same train of symptoms as were caused by inhaling the powdered ipecac, the 
itching extending down the oesophagus into the stomach. 
*Read at a meeting of the Medical and Surgical Society of the District of Colum- 
bia, May 9,1892. Some years ago this gentleman had a clerk in his store who was, in a mild de- 
gree, susceptible to the unfavorable effects of powdered ipecac root. He could 
neither weigh nor handle the drug without being seized with paroxysms of sneez- 
ing, accompanied by an excessive secretion from the nose, lasting several hours. 
He had no other symptoms than those already mentioned. 
Dr. William H. Ward, of this city, having heard his preceptor, Dr. Chas. H. 
Stevens, of Baltimore, say that the smallest quantity of powdered ipecac would 
produce an unpleas&it train of symptoms in his case, tried the experiment of tak- 
ing out the cork of a bottle of powdered ipecac root while the old doctor's back was 
turned, giving it a slight shake, whereupon Dr. Stevens, exclaimed, "You young 
rascal, yo^t-have opened that bottle of ipecac." The doctor was at once seized with 
paroxysms of sneezing, accompanied by a watery discharge from the nose, fol- 
lowed by an attack of asthma, which confined him to his bed two or three days. 
This attack occurred during the month of September, which was clear, warm and 
pleasant. 
In the "Annual of the Universal Medical Sciences" for 1890, Volume V, page 85, 
Section A, is reported a condensed account of Ernest Sangree, case copied from 
"Times and Register," August 10th. Idiosyncracy to ipecac. Nausea, vertigo and 
flushing of the face, caused by a dose little less than two drops of the wine of ipecac. 
"Remarkable case of poisoning through the swallowing of inhaled dust of ipecac 
roots." Dr. Prieger. Rust Magazine fur das gesammelte Jleilkunde,1830, pages 182 
to 184. A man who was pounding the roots.of ipecac, having occasion to cough, 
removed the handkerchief that protected his mouth and nose. He blew his nose 
several times and so breathed the dust and swallowed it with the saliva, upon 
which he vomited thi;ee times and had palpitation. He immediately stopped his 
trituration, yet an hour later had a heavy suffocating spasm of the glottis and 
oesophagus, death colored face, severe mental anxiety, which attack increased in 
severity every minute. A physician was called in, who gave him a number of 
remedies, besides bleeding the man. The attack diminished, but after five hours 
returned with increased severity, so that for several hours he,was threatened with 
stiffocation from spasm of the glottis. After an hour's treatment he could breathe,but 
the difficulty of breathing persisted for several days,although the man was able on 
the second day to go out. The doctor supposed the ipecac to have been swallowed. 
Dr. Sohon, who translated and condensed the above history of this case, be- 
lieves inhalation to be the cause of his attack. 
In the Boston Medical and Surgical Journal, December, 1843, Dr. Ashbell Patter- 
son mentions the fact that Uriah Turner wrote an account of his own case: 
"Asthma caused by Ipecac." In Volume XXIX (of this same journal), page 13, 
Dr. Patterson narrates his own case as follows: He was a dyspeptic, having a 
tendency to diseases of the respiratory system. At the .age of twenty he had a 
catarrhal affection, which "impaired" his sense of smell, and he was unable to 
perebive odors unless very pungent. When twenty-five years old, he had occa- 
sional paroxysms of sneezing; the attacks coining on suddenly, "the convulsive 
effort was sudden," and often "painfully violent." Occasionally these paroxysms 
were accompanied with "dyspnoea, or a suffocating sense of stricture of the chest," 
"a most distressing oppression at the precordia"; there was a "harassing titilation 
of the nostrils"; at times nausea and convulsive but ineffectual efforts to vomit. 
On one occasion, having to administer ipecac as an emetic^ he suffered the symp- 
toms already mentioned. In ten to fifteen minutes "severe and convulsive parox- 
ysms of asthma occurred, with a sense of suffocation, paroxysms of sneezing," last- 
ing two hours, gradually subsiding with cough and expectoration. 
At another time he entered a drug store where some powdered ipecac had been 
spilled on the counter and then brushed off with a brush. For half an hour the 
doors and windows had been open, and a current of air was passing through the 
store. In two minutes he was attacked as usual with sneezing, etc., and he was 
laid up for a day. 
"A young man in Ris' office transferred from a paper to a jar some powdered 
ipecac; in half an hour from that time he returned to his office, and his usual 
symptoms returned." He had a sense of exhaustion, suffocation, precordial op- 
pression, extreme nausea, ineffectual efforts to vomit, spasm of the diaphragm, and 
muscles of the chest and abdomen. He could not use "Dover's Powder" without 
causing a convulsion and harassing cough, dyspnoea; spasm of the muscles of res- 
piration on attempting to talk; "the predisposition to asthma was unquestionably 
produced by the early catarrhal affection already medtioned." The doctor goes 
on to state that fogs caused asthma in his case, but these paroxysms were in a great 
degree free from that sense of sinking, nausea, and spasms as caused by ipecac. 
tn the Western Journal of Surgery and Medicine, Vol VIII, 1843, 2nd Series, 
pages 85-97, Felix Robinson, M. D., of Nashville, Tenn., relates the following case: While putting up a dose of powdered ipecac " was suddenly seized with a violent 
attack of asthma, attended with distressing dyspnoea and oppression at the pre- 
cordia." Some time afterwards he became liable to asthma from other exciting 
causes, gave up his practice, traveled in Texas, sleeping out of doors in the open 
air, etc., He was gone from home six months; during this time he had no return 
of attacks of asthma. Roughing it would seem liable to cause the disease, yet it 
had no effect whatever. "He returned home and resumed practice. His stomach, 
on one occasion, being deranged, he thought it advisable to take an emetic," the 
preparation being wine of ipecac. The moment he swallowed it, there was in his 
"throat and stomach a sensation" "indescribable, but as intolerable to be borne," 
which he discribed to be as if he had "taken a drink of melted lead." His suf- 
fering was so great that he was unable "to think of any method for relief ; but 
with great agony he leaped out of bed and rolled on the floor from side to side of 
the room." He drank large quantities of warm water, which produced vomiting 
and somewhat relieved his intense suffering. "The distress subsided slowly," 
which was followed by an attack of asthma. Powdered ipecac by inhalation caused 
attacks, fuifies of burning sulphur, "and the exciting causes seem to multiply with 
every return of the disease." If he entered a drug store shortly after ipecac had been 
handled, he occasionally had dyspnoea. He was compelled to give up practice, 
used snuff to lessen the irritability of the muchous membrane of the nose (as it 
seemed to commence there, extending to the bronchial tubes and ramifications.) 
In a year's time he was " nearly, if not entirely, well." 
About three years after, he put some liquid on his tongue taken from a bottle 
supposed to contain wine of ipecac, "having about forgotten his previous experi- 
ence." Instantly "that peculiar burning, indescribable sensation was felt in the 
mouth, which rapidly extended itself to the fauces, and down the throat and 
bronchia." For two hours he was a great sufferer; had considerable dyspnoea, 
which gradually disappeared. The most remarkable fact is that ipecac was a 
favorite remedy with him, which he had always freely used until he had these 
attacks as a result of the use of the drug. One of the interesting points in his case 
was the great quantities of mucus-in fact, mouthfuls (which expectoration was 
free)j would be thrown up in the morning, resembling transparent worms, which, 
on examination, proved to''be thickened mucus that had collected in the small 
ramifications of the bronchial tubes during sleep, and were discharged as casts of 
those tubes. It is remarkable how the man could breathe, much less sleep, owing 
to the large quantities of mueus discharged in the morning on his stirring around. 
Medical and Physical Journal, 1810. pages 199-203, Volume XXIII, Mr. B. refers 
to Mr. Spencer's statement, the "pernicious effects of ipecac upon his apprentice"; 
he then narrates his own case: In 1787, while powdering ipecac roots, he was 
seized with sneezing, profuse "clefluxion from the eyes and nose"; "these symp- 
toms continued without intermission for many hours, accompanied by great heat 
and anguish throughout the cavity of the thorax, and the most oppressive dys- 
pnoea." being exhausted by this violent attack, he was carried to bed, and was 
supported, being unable to lie down. The next morning he was still suffering, 
and was very weak, "with all the usual appearances of a severe catarrh." Pre- 
vious to this attack he had never been affected by ipecac; if so, he was never aware 
of the fact, but attributed the effects to a cold. From the first attack he suffered 
from catarrh. The slightest motion of the "simple or compound powder of ipe- 
cac" induced precisely similar, but more gentle effects. In weighing the powder, 
he was compelled to cover his nose and mouth, wearing the covering for half an 
hour after, for if he removed the cloth he had another attack. Finally, he had to 
leave his shop while ipecac was being handled. Should he enter the drug store of 
another;ldng after it had been handled, distantly he had a recurrence of these 
very distressing sensations. He had tried various methods of relief without suc- 
cess, except "copious draughts of warm water, which appeared to promote expec- 
toration; as this increased, the symptoms became gradually less irksome." 
Being already aware of the effects of the drug if inhaled, about a year from the 
first attack he took a dose of "compound powder of ipecac in the form of a bolus." 
He at once felt pains in the chest, dyspnoea, "but mot so acutely" as when inhaled, 
and there was no sneezing in his case nor defluxion. 
On, one occasion, while coughing on the street, a friend presented him with a 
few "lozenges." On taking one, it had scarcely dissolved in his mouth, whenhd 
" felt a pungent roughness*in every part of the mouth," causing a great secretion 
of saliva. This was not the case in preceding attacks, as the "excretory ducts 
uniformly denied their offices," there being a disagreeable dryness of the mucous 
membrane. "As this acrid sensation extended to the lips, they became prodigi- 
ously swollen and inflamed." On the fauces he "experienced the like effects," with a teasing, itching irritation. "It descended into the trachea," causing pain 
and dyspnoea. Likewise it proceeded down the oesophagus, causing slight heat in 
the stomach, passing ''with moderate gripings," throughout the intestinal canal. 
Of all the symptoms, the swelling and soreness of the lips lasted the longest. 
Some powder was brought to his house, with an order to prepare some more of 
the same kind. Placing a small quantity on his tongue, he experienced the same 
symptoms as the case of the lozenges, but in a milder degree. The prescription 
contained one grain of ipecac and ten of calcined magnesia. Afterwards he dis- 
covered that the lozenges contained ipecac, which idea suggested itself after tast- 
ing the prescription of ipecac and magnesia. He was liable to take cold, and his 
susceptibility to the action of ipecac varied but little until he was thirty years of 
age. The violence of the effects of ipecac has considerably diminished. The 
catarrhs occur-at longer intervals, with increased difficulty of breathing and serious 
derangements of health. One of his parents was liable to catarrh, and at the age 
of forty had a severe attack of asthma." 
The editor of the journal just quoted states that his father could take Dover's 
powder without having any bad effects, while the inhalation of ipecac affected him. 
In the Philosophical Transactions of London, Volume IV, page 168. Dr. Wm. 
Scott narrates the history of his wife's susceptibility to the "effluvia of ipecac." 
When Mrs. Scott was in another room adjacent to one in which ipecac was being 
powdered, or dispensed, she would suffer from a certain train of symptoms, which 
she attributed to ipecac. Her husband regarded this idea as a fancy. Previous 
to her marriage, she enjoyed good health except about the time of her sickness, 
when she had nervous headaches that used to affect her temples. Some time after 
marriage, she complained of shortness of breath, stricture about the throat and 
breast; also a wheezing noise. These attacks came on suddenly; were often so 
violent as "to threaten immediate suffocation," causing spasm of the throat and 
chest. The duration of these symptoms were sometimes longer, and sometimes 
shorter. 
June 3rd, 1775.-The doctor, forgetting'his wife's susceptibility to the influence 
of ipecac,put into another bottle some of this powdered drug,she "not being far off at 
the time." Before the bottle was filled, she "called out she felt the ipecac." At 
once her throat was affected; she was seized with a sense of stricture about the 
breast and difficulty of breathing. She was advised to walk out in the air, but 
this did not have the desired effect. She shortly retired to bed, being ill the 
whole night. At 3 A M., she was gasping for breath at the window; " was pale 
as death;" her pulse could scarcely be felt. A number of remedies were tried for 
her relief without avail. She continued in this condition, "with few or no inter- 
vals of ease, till 9 o'clock that morning." Being almost exhausted, she fell into a 
"disturbed sleep;" "the difficulty of breathing, with wheezing noises, still con- 
tinued, vpth little abatement." About 11 A. M., her breathing was still difficult, 
and her eyes looked red and inflamed. 
Dr. Brown, "an eminent physician of Newcastle-on-the-Tyne, called on Mrs. 
Scott, and said he knew of "pretty much a similar case." Mrs. Scott was very 
ill, as the result of her Idiosyncrasy to ipecac, for eight days. About five days 
after she was affected, her sickness came on, "although it was then only about the 
middle of the usual period." She sometimes coughed up small quantities of 
blood; occasionally a small amount was found in her stools and urine. 
Dr. Scott goes on to say; "Quincey, however, if I remember right, mentions its 
producing asthma." 
Also Mr. Leighton, a surgeon and apothecary in Newcastle, says his wife is af- 
fected by the "effluvia of ipecac," and she suffers from the same effects as in the 
case of Mrs. Scott. 
In the Medical Physical Journal, London, Volume XXIV, page 233-236, Dr. Wm. 
Scott also reports the history of his wife's idiosyncrasy in this journal (see Edin. 
Med. and Ph. Com., Volume IV, page 75). In addition to the symptoms already 
mentioned, he says she expectorated a tough phlegm and had a disagreeable me 
tallic taste in her mouth. She had several children. 
In the same journal, page 60, T. Trotter, M. D., reports the case of the wife of 
his preceptor, who was seized with asthma when "ipecac root was pounding in the 
shop.',' Even when in a distant part of the house she was effected. She was a very 
nervous woman. 
The wife of Dr. Buckland, of Wooler, in the same journal, page 233: Dr. Hall 
gives a history of this lady, and says the "effluvia of ipecac," when being handled, 
caused dyspnoea, etc , even when she was not in the room. She was not suscepti- 
ble to other powders. He had heard of other ladies being affected by ipecac. 
In the Boston Medical and Surgical Journal, 1850, Volume XLII, page 391, T. W. Sheriff relates his own case, having himself been affected by ipecac when respiring 
particles of the powder, as also when taking it internally; having had an attack 
of rubeola, attended with a cough and severe dyspnoea, being the second- time he 
was affected with this disease. He had several attacks of severe catarrh, attended 
with asthmatic symptoms. In the spring of 1841 these attacks became frequent, 
and, although severe, lasted twelve hours, ending in a "copious secretion of mu- 
cus." He was alarmed at his condition, and was often puzzled to account for the 
asthma, the attacks coming on unexpectedly. His general health was good. 
In the ,l Cyclopaedia of Practical Medicine,'' he read an article stating that ipecac 
frequently caused asthma. He immediately prepared Dover's powders, and "was, 
in a few minutes, violently affected." He frequently repeated this experiment 
with the same result. When affected on former occasions, he obtained relief by 
smoking tobacco. Until the last six years he had oft en taken large doses of ipecac, 
and had constantly been compounding the drug without any bad effects. He at- 
tributed his idiosyncrasy to this drug as the result of the attack of measles. (Ameri- 
can Medical Journal.} 
In the Medical News of Philadelnhia, Volume LIX, No. 24, page 629. Dr. James 
Mitchell gives an account of his idiosyncrasy to the drug ipecac. The smallest 
quantity of ipecacuanha in the atmosphere caused violent sneezing-' 'severe coryza" 
-accompanied with asthama. He abandoned the use of the powder, using the 
tincture. If, in dispensing it, he soiled his hands with a drop or two of the tinc- 
ture, and failed immediately to wash them, a decided irritation was set up in those 
parts which the solid fingers came in contact. Having taken the drug internally 
several times, he "suffered with excessive nausea, violent vomiting and retching, 
accompanied by a sense of burning pain and colic in the abdomen." "Speedy re- 
lief " was obtained from the ingestion of castor oil." 
Sydney Ringer, in his Hand-Book of Therapeutics, gives one of the best accounts 
of the physiological action of ipecac that I know of, which seems to apply, in nearly 
all its details, to the cases reported this evening. In speaking of ipecac, he says : 
"When applied to the skin, ipecacuanha, after sometime, produces a sensation of 
warmth, attended with redneus and the formation of papules. Sometimes, it even 
produces pustules, which, on healing, are not followed by pitting or scarring." . . 
"Excites the flow of saliva." .... "In some persons, the minutest quantity 
produces peculiar effects on the membrane, covering the eyes and lining the nose and 
respiratory tract. On smelling the drug, or even entering a room where it is kept, 
they are affected with swelling of the loose tissue around the eyes, with injection of 
the conjunctiva, repeated sneezing, abundant discharge from the nose, severe tensive 
frontal pain of the head, much oppression at the chest, with frequent cough, and the 
signs and symptoms of bronchitis. Ipecacuanha thus excites symptoms and appear- 
ances similar to those occurring in hay fever-that is, it excites a certain catarrhal 
inflammation in the mucous membrances. It is highly probable that ipecacuanha 
produces similar results in all persons, and that its action on individuals differs only 
in degree." 
There is no doubt that many persons are affected by ipecacuanha in the same wray 
as those cases already reported. Yet comparatively few cases have been recorded 
during the last one hundred years. 
There is another case reported in the Medical News that I have not mentioned. I 
examined the catalogues at the "Army and Navy Medical Museum Library" for all 
the cases to be found under the heading of icTiosyncrasies to ipecac, and I have en- 
deavored to give a condensed occountofthe history of those affected unfavorably 
by the drug. Doubtless many of these cases have not been catalogued, which I 
found to be the case in my researches, while still others may have escaped my notice. 
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