Anne of Green Gables is a children’s classic and deservedly so. In one dramatic scene its heroine, Anne Shirley, uses ipecac to save a dying child. Here’s what ipecac would actually have done, and why it fell out of favor.

Anne Shirley, the orphan girl taken in by a couple of curmudgeonly old siblings, has been an inspiration to bookish nerds with a lot of imagination for over a hundred years. We enjoyed her impulsive adventures, her seemingly implacable hatred of the boy she would of course eventually fall in love with, and her occasional moments of true heroism. The most famous of these happens one snowy night when her friend Diana rushes in and announces, “Oh, Anne, do come quick. Minnie May is awful sick—she’s got croup. Father and Mother are away to town and there’s nobody to go for the doctor!”

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Anne grabs a bottle of ipecac and runs to save the day. She doses Minnie May with ipecac, which makes the girl bring up the phlegm that’s choking her. Minnie May lives, despite the late arrival of the doctor, and Anne is a hero.

Historically, it’s correct, since ipecac was used to treat croup. Medically, Anne probably wasn’t so much saving the toddler as making her worse.

Syrup of ipecac is made from the powdered root of the Carapichea ipecacuanha. It contains alkaloids, which are nitrogen-rich and slightly basic natural compounds that do a variety of things. Caffeine and nicotine are famous alkaloids. They have much better effects than the alkaloids in ipecac. One in particular is called emetine, and induces emesis—otherwise known as vomiting. Ipecac was also used as a cough syrup, because it was believed to be an expectorant. And expectorant causes the body to dump water into the chest and nose, which waters down mucus and in theory lets people bring it up better.

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The problem is, doctors don’t all agree on how much expectorants help people suffering from congestion. Few think expectorants alone can help those in life-threatening situations. And, technically, croup isn’t a problem with mucus in the lungs anyway. Croup tends to come on in the middle of the night, and very suddenly, not because of a build-up of mucus in the lungs, but because of an inflammation, due to infection, of the larynx. It constricts the airway and makes breathing difficult, which is terrifying. Panic causes the sufferer’s throat to get tight and increases their breathing problems. But even severe croup is rarely fatal.

If it gets bad, doctors will prescribe steroids as a way to reduce inflammation. Most often, though, doctors recommend opening a window and filling the bathtub with hot water. The hot water creates steam, which cools when it hits the night air. Cool moist air reduces the inflammation and lets the kid breathe again. A lot of parents grab up their kids and rush to the hospital in the middle of the night, and find that the trip to the hospital itself has helped the child’s throat clear. Diana would have gotten better results if she’d picked up Minnie May and run her to Anne’s house instead of getting Anne to come to Minnie May.

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And now for ipecac itself. It’s a poison, but that doesn’t necessarily make it bad. Many things are poisons if they aren’t given out at reduced concentration. Well into the mid-1900s, parents kept bottles of ipecac in case their kids ingested things like pills or household chemicals. The idea was that ipecac would make the child vomit like crazy, and reduce their exposure to the poison.

Over time, doctors noticed a problem. Some poisons, like gasoline, do as much damage to the throat coming up as they do going down. Often children would vomit so long that charcoal tablets, meant to absorb the poisons they’d taken, wouldn’t stay down. And if there was some question about what the kids had taken, the symptoms brought on by ipecac itself would obscure the symptoms of the poison. What truly got ipecac off the shelves, though, was the death of Karen Carpenter, who struggled with bulimia and anorexia and used ipecac to make herself vomit.

Ipecac is, today, a medical remnant. Even when it was popular, it probably helped only a few of the people who took it. So those who love Anne of Green Gables will have to enjoy her heroics as a function of the plot, not a real representation of medicine.

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