Violent Asthmatic Fits, Occasioned by the Effluvia of Ipecacoanha. By William Scott, M. D. of Stamfordham, Northumberland

IX. Violent Asthmatic Fits, occasioned by the Effusvia of Ipecacoanha. By William Scott, M.D. of Stamfordham, Northumberland. R. Dec. 21, 1775. Mrs. S. of Stamfordham, in Northumberland, married a person of the medical faculty in the year 1759, being then about twenty-six years of age. She had been always remarkably healthy before that period, and quite free from all nervous or other complaints, except a trifling nervous head-ach that used to affect her temples and forehead, sometimes for a night or so, about the time of her menstruation. The first year or two after marriage she enjoyed her usual good health and spirits in general; but at times she was afflicted with a very troublesome shortness of breathing, attended with a remarkable stricture about her throat and breast, and with a particular kind of wheezing noise. These fits came on very suddenly, and without any previous cause that at first could be assigned; and were often so violent as to threaten immediate suffocation. The duration of them was uncertain, sometimes longer and sometimes shorter; but in general they went off in two or three days, and commonly with a spitting of a tough phlegm, which, she said, had a disagreeable metallic taste. When these fits were off, she enjoyed her usual good health and spirits: had children; but suffered as little as any woman could do, either in breeding or lying-in; and it was not observed, that she was more subject to these fits when with child than at other times. She was blooded, and took some common pectoral medicines for them; but without any benefit. About a year and a half, or two years, after her marriage, she told her husband, that she observed these fits always attacked her when any *Ipecacoanha* was powdered in his shop; and that she was certain the effluvia of that medicine immediately brought them on. This was looked upon at first as a fancy, and little regard paid to it for some time. However, frequently after this, when any of that medicine was powdering or putting up, she used immediately to call out, perhaps from a different room, that she found the *ipecacoanha*, and that they would see her immediately affected by it. This I, and several others, saw frequently happen as she had said; so that we were at last convinced, to a demonstration, that the effluvia of the medicine, somehow or other, so affected her nerves, as to bring on a very great and remarkable degree of spasm all about her throat and breast. Having thus had several repeated proofs of the effects the medicine had upon her, great precaution was therefore taken for several years never to pound any of it, but to purchase it powdered; and also care was taken, when weighing or putting any of it up, to send her out of the way, or to some distant part of the house. By these means she was kept pretty clear of it for seven or eight years together, during which time she enjoyed perfect good health. Vol. LXVI. Betwixt nine and ten o'clock in the evening, June 3, 1775, her husband happening to have got a quantity of the pulv. ipecacoanba home, without considering opened it out, and put it into a bottle: his wife not being far off at the time, and then in perfect good health, immediately, almost even before it was got quite into the bottle, called out that she felt the ipecacoanba affect her throat; on which she was immediately seized with the stricture upon her breast and difficulty of breathing. She was advised to walk out into the air, to try if that would remove it; but it had little or no effect. She went to bed some little time afterwards; was exceedingly ill all night; and betwixt two and three o'clock next morning (June 4th) I saw her, when she was gasping for breath at a window, was as pale as death, her pulse scarce to be felt, and in short seemed evidently to be in the utmost danger of suffocation. She had seven or eight ounces of blood taken from her arm, her feet put into warm water, an anodyne draught with seven or eight drops of laudanum given her, and took frequently a table spoonful of oil of almonds. None of these seemed to have the least effect: and she continued much in the same way, with few or no intervals of ease, till about nine o'clock that morning; when, being in a manner almost exhausted, she fell into a kind of disturbed sleep, the difficulty of breathing with a wheezing noise still continuing with little abatement. She slept some little time, and got out of bed again about eleven o'clock that forenoon; her breathing still very difficult, and her eyes looked red and a little inflamed. After she got up, she became easier towards the afternoon, and it was then supposed it would go off. Dr. Brown, an eminent physician of Newcastle upon Tyne, happening to be in the neighbourhood, called upon Mrs. S.; and being told what had happened, said he had known a case, pretty much similar, from the same cause; and hoped, as she then seemed better, it would soon go off; recommended to her riding out as soon she was able, and to be kept open. Towards bedtime the same evening (June 4th) the difficulty of breathing returned, and she was again exceedingly ill all night; had flannel cloths wrung out of warm water applied to her feet, breast, and throat, with little or no advantage; was blooded again about four o'clock next morning (June 5th), and had also a blister applied to the back part of her neck, still continuing to take now and then a spoonful of the oil of almonds. She again fell into some sleep about nine in the morning, and continued in bed till betwixt eleven and twelve: got up, and was again a little easier during the day; but at night was as bad as ever. And the same scene was continued for eight days and nights successively; that is, she was generally a little easier from about eleven o'clock of the forenoon, although still far from well, till towards ten or eleven at night, when the shortness of breathing always returned very violently. However, after eight days she began to get better rest at nights; the asthmatic fits were neither so long nor so violent; and in about fourteen days from the accident were almost entirely gone. gone off; and at the writing of this letter, August 1, 1775, although she is now in very good health, she has not yet quite recovered her usual flesh, strength, and colour. Besides the abovementioned medicines, she took at times, during the first eight days, small quantities of an emulsion of sperma ceti, lac. ammoniac. and succ. liquorit.; had a dose of cooling physic; rode and walked out a little sometimes; had a few anodyne draughts with seven or eight drops of laudanum; but it could not be observed that she got any benefit from them, except that she sometimes thought the oil of almonds gave her a little ease. She had a slight appearance of the menses about four or five days after the accident happened, although it was then only about the middle of the usual period; coughed up at times some small quantities of blood, and had also some mixed with her stools and urine. The reason why the laudanum, the most effectual and universal anti-spasmodic, was used in such small quantities, was, that it was known before that, she could never bear above eight or nine drops of it, as the common dose used to affect her with violent sickness at stomach, giddiness and pain in her head, &c. to so great a degree, that for some years past, she neither would take, nor durst her husband administer, a larger dose to her. At the time the above accident happened, she was neither with child, nor had had any for some years before. The above effects of ipecacuanha, I believe, very seldom happen, and no doubt arise from some peculiarity of constitution. Medical writers, at least as far as I can recollect recollect at present, seem to have taken little or no notice of its ever producing such an effect as the above. QUINCEY, however, if I remember right, mentions its producing asthmas; but then he seems to mean, that it has that effect sometimes when taken internally, but not by means of its effluvia. Mr. LEIGHTON, a reputable surgeon and apothecary in Newcastle, told me, that the effluvia of ipecacoanha had the very same effect upon his wife, as it is above described to have had upon Mrs. S.; and that he had once, in particular, very near lost her from having some of it powdered in his shop. The ipecacoanha which had the above effects upon Mrs. S. was the common officinal ash-coloured or grey kind, Mrs. S. has now (Oct. 20, 1775) quite recovered her flesh, strength, colour, &c. I have sometimes thought since, that perhaps musk in pretty large doses might have been of service to her.