IPECACUANHA IN DYSENTERY.

TO THE EDITOR OF THE " INDIAN MEDICAL GAZETTE."

Sib,?Dr. Hutchinson, in his letter to you which appears in the July number of the " Indian Medical Gazetteand in which he notices my paper,?" How does ipecacuanha cure dysentery ?" states his concurrence in the opinion expressed to him by Dr. Farquhar that the curative action of this drug in dysentery "depends on its direct stimulating action on

the liver in inducing a copious flow of bile, which secretion, in passing along, exerts a calmative action on the coats of the

intestines, protecting them from the irritant action of semi-

digested food?also, " that the flow of bile, instead of being

ejected in the action of vomiting, passes downwards in its sedative and curative course."

We all agree, I think, with Dr. Hutchinson, when he writes " that the first sign of amendment is the re-appearance of bile in the stools." But whether the bile in its downward flow exerts a calmative and sedative action is, I fancy, open to

question. When bile, after being in the li^er for some days, appears in the stools, it is generally very acrid; so much so, that complaints are often made that it scalds the anus, on

being passed. Healthy bile, as is well-known, has a stimulat-

ing effect on the intestines; and apparently the acrid inspis- sated bile would irritate the mucous membrane instead of

soothing it.

I conclude that this bile is more irritating than the half-

digested food from which it is supposed to protect the coats of the colon; and even to do this effectually, it would have

to spread itself in a continuous layer over the whole mucous surface, which it is difficult to imagine it does.

I think we must look for something more than the action of ipecacuanha on the liver to account for its value in dysentery. Other well-known cholagogues, as calomel, taraxicum, &c., will cause a copious flow of retained bile, and yet they will not cure that disease. As I have stated in my paper, I still think that its general action oil the nervous system, and its local action on the intestines, are the principal causes of its curative

properties. I am, &c.,

A. K. Hale, Assistant Surgeon, R.A.

Seetaporet Oudh.