Podophyllum Peltatum. Mandrake, May-Apple.
Description: Natural Order, Berberidaceae. In the same Family with caulophyllum and jeffersonia. Perennial roots, with annual stems. Roots smooth, jointed at intervals of four to seven inches, umber-brown without, grayish-white within, creeping a few inches below the surface, several feet long, one-fourth of an inch thick, with a number of rootlets from the joints. Stem single, simple, round; yellowish-green, smooth, pithy-succulent, eight to twelve inches high, dividing at the top into two round leaf-stalks. Leaves two and opposite on flowering stems; only one on flowerless stems, and more distinctly peltate in the latter than the former; yellowish-green and smooth above, slightly pubescent beneath, palmate-veined, deeply lobed five to nine times, very large. Flower solitary, rising on a peduncle two inches long in the fork of the long petioles, the bud enveloped by three thin green bractlets, which are caducous; sepals six, fugacious; petals six to nine, white, obovate, spreading, a little concave, an inch long, scarcely fragrant; stamens twice as many as the petals; stigma thick, sessile. Fruit a fleshy berry, ovoid, one to two inches long, pale yellow when ripe, white and pithy within, of a mawkish-sweet taste. Blooming in May and ripening in July.
This plant is common in nearly all parts of the United States, growing in woods on rich soils, and sending up its large leaves in masses early in spring. The root is used in medicine; contains a large amount of extractive matter and a considerable portion of resin; forms a dense and grayish-white powder; and has at first a sweetish-bitter, and afterwards an unpleasantly acrid taste. Water extracts a considerable portion of its virtues; but alcohol acts much more fully upon it.
Properties and Uses: The root of podophyllum, when fresh, is an acrid and excoriating poison, producing nausea, severe vomiting, burning at the praecordia, and violent catharsis, with tormina and watery (sometimes bloody) stools. These symptoms are liable to continue for eight or twelve hours; and to be followed by swelling, redness, dryness and tenderness of the lips and whole mouth, tenderness and heat throughout the bowels, extreme prostration, with perhaps bloating of the face and other parts of the body. These feelings sometimes are not recovered from for several days, and the gastric tenderness may last a number of weeks. Age slowly lessens this acridness; and roots two years old are much less irritating than those which have been dried but a few weeks.
When slowly and thoroughly dried, this root is a stimulant of very concentrated powers, acting slowly and persistently, influencing the salivary glands, mucous membranes, gall-ducts, liver, and even the kidneys. The whole round of the secretions are thus distinctly stimulated by it; yet the gall-ducts, and the mucous and fibrous structures of the bowels, are the parts most prominently acted on; and it is more valuable for securing a discharge than a secretion of bile. (§174.) Full-sized doses, as fifteen grains, usually secure catharsis in from six to eight hours, the stools being moderately thin, often frothy, and ejected with some force. Not uncommonly its influence continues for twelve or more hours; and large doses cause griping, distress, liquid stools, and much weariness or even exhaustion. Not unfrequently, a large dose will excite persistent retching with much prostration. Following its full cathartic use is, in most persons, a sense of weight and uneasiness in the bowels, with a tendency to costiveness, and that peculiar heavy and bloated feeling which the patient is quite sure to construe into an indication of the need of another dose of physic. By stimulating the lower bowels, it commonly excites the uterus, ovaries, and bladder; whence a discharge of the catamenia, the expulsion of the placenta, and an evacuation of urine, may at times follow its use. Small doses, influencing the secretory organs gradually, lead to the classification of this agent as alterant.
From the great positiveness and reliability of its action, mandrake has come into extensive use as a common cathartic, and has been called a "substitute for calomel"which is a questionable form of praise; and it has been employed with as little discrimination as any article in the Materia Medica. The intensity and persistency of its stimulating power, at once forbid its use in any case where there is cither irritability or inflammation of the stomach, liver, bowels, uterus or bladder. Only in sluggish and apathetic conditions of the abdominal viscera, is it desirable to employ it; and even moderate sensitiveness is by it soon converted into irritability and congestion. The best places for employing it are, costiveness arising from hepatic and intestinal atony, with a similar condition of the stomach; in such forms of biliousness, jaundice, and dropsy as arise from tills condition of the hepatic organs; and to a limited extent in uterine and ovarian atony. This agent never leaves behind a tonic impression, no matter how satisfying may be the sense of relief enjoyed by the thorough evacuation of the liver and bowels; but it invariably leaves a sense of tiredness on the organs. When the stomach is weak and sensitive, the liver engorged and tender, and the bowels congested and tender, I can not, from years of extensive experience in its use, assent to the opinion that it is a suitable physic. Though highly praised without reference to the presence of these conditions, and even pronounced valuable in these very conditions, my large acquaintance with it justifies me in pronouncing it an unadvisable and exhaustive article under all such circumstances. By its repetition there, digestion is made worse, the liver becomes more tender, and the mass of intestines feels puffed and dragging. Also if the bladder, prostate gland, or uterine organs are sensitive, it should not be used as a physic. These discriminations materially curtail the field of usefulness which the agent is generally made to occupy; but I am thoroughly convinced that the truth fully justifies this curtailment, and that the extravagant laudations bestowed upon mandrake belong only to that kind of practice which makes violent purgation the acme of professional wisdom, and seeks active catharsis without any regard to the laws of Physiology.
When used in typhoid fever, or in any malady tending to congestion and putrescence, (as scarlatina or erysipelas,) this article is almost at once followed by dryness, darkness, and fissures of the tongue; increasing tenderness of the bowels; and a much greater liability to intestinal ulceration than is common in these maladies. If used in the later stages of these affections, dryness and glassiness of the tongue, and ulceration of the bowels, are almost inevitable, even when but small doses are given. Such has been my invariable experience with it; while I have rarely met ulceration or hemorrhage, since abandoning the use of podophyllum in such maladies; and my experience has been abundantly confirmed by many active physicians, especially by a communication from I. J. Sperry, M. D., of Hartford, Conn. In the Western States, these results are even more uniform than in the Eastern States; and it is no uncommon observation to find a case of ordinary bilious fever speedily present typhoid symptoms when podophyllum is used–even in quite small quantities, and in combination with much milder agents. When used as an alterant, and added in very small proportions to alterative sirups, tenderness and redness of the gums and fauces many times follow in a few days, with an offensive form of ptyalism; and this especially in scrofulous and mercurial subjects, where the state of the frame is generally made the scape-goat for the action of the podophyllum. The powder, applied upon chancres or other indolent ulcers, removes the hard base by a sort of escharotic action; but, as careful observation will always show, leaves a smooth and not a granulating surface. The moist powder will blister the skin. Mr. W. S, Merrill tells me that, when pulverizing the roots in his mills, the workmen soon suffer an erysipelatous inflammation of the scrotum and eyes from the lodgment of the powder; and it is a well-known fact that a concentrated tincture will excite pain, burning, and somewhat phlegmonous erysipelas, on the skin of most healthy people. The late Dr. F. D. Hill, of this city, told me he could scarcely prepare podophyllin without danger of erysipelas; and twice he suffered severely in the face, and nearly ruined his sight, by this tincture. These facts, with the well-known exhaustive character of the catharsis it induces, certainly casts a strong suspicion upon the sanativeness of this agent, to say nothing more. As a physic, it certainly is not admissible to such a large variety of conditions as many suppose; and it is not good practice to cover it up with good articles to "neutralize" its harsh effects. While this opinion is widely at variance with that commonly received, it has not been reached hastily, nor on any trifling acquaintance with the agent. Formerly I employed it in every imaginable form, and in every variety of case where a cathartic was desirable, and that for several years; and, while its use may be appropriate in the atonic conditions above named, I have done far better without it in the last twelve years of my practice, than ever I could do with it. This experience is also confirmed by a number of elderly and skillful practitioners.
The cathartic dose of the powder varies from ten to twenty grains. A dose should not be repeated in less than six hours if the first one should fail to act; and it is generally best to wait eight or ten hours. The practice of repeating a medium dose every three or four hours, is liable to cause such an accumulation of the drug as will be followed by diarrheal action of a prostrating nature for twelve or more hours. From the intensity of its stimulation, it is best to associate it with some relaxant in excess, as leptandra. Caulophyllum seems peculiarly effective in obviating the tormina it is liable to occasion. At the present time it is rarely employed in any other form than that of its resinoid, podophyllin.
Pharmaceutical Preparations: I. Tincture. Macerate three ounces of the crushed root for fourteen days in a pint of diluted alcohol; express and filter. Or treat by percolation in the usual way. From twenty to forty drops are a dose; but it is even more wearisome to the bowels than the root is.
II. Podophyllin. Macerate a sufficient quantity of well-crushed root in absolute alcohol for three days. Place in a percolator, and exhaust with absolute alcohol. The common practice is to employ a very close apparatus and use hot alcohol. Distill off the alcohol from this tincture till the residue becomes almost sirupy; and then slowly pour this into three volumes of cold water, with constant stirring. A copious yellowish-white precipitate at once forms, most of which falls in from twenty-four to thirty-six hours; and a small quantity of diluted muriatic acid will speedily cause the precipitation of the remainder. This precipitate is caught on a filter, and well washed; and afterwards dried at a moderate temperature. A pound of good roots yields from an ounce to an ounce and three drachms. If not dried at too high a heat, its powder is a light yellow; but heat causes it to become brownish. Alcohol dissolves it nearly all, and ether dissolves the remainder; but it is not acted on by water or diluted alkalies. It is a very excellent representative of the plant, probably better than any other resinoid; yet the dregs that have been exhausted by alcohol, will yield to water a quality that acts on the kidneys, much as in the case of jalap. (Some persons assert that the joints are diuretic, and their internodes cathartic; but this seems only speculative.) Podophyllin has almost entirely superseded the root; and is a most efficient cholagogue cathartic of the stimulating class, usable for the same purposes as the root, and almost as objectionable in sensitive conditions. It is certainly the most positive of all cathartics in its own limited field; but, like the root, when lauded and magnified in dysentery, typhoid fever, puerperal fever, after parturition, in phrenitis, irritable prostate, etc., the praise is most unwisely bestowed. The cathartic dose is from one to two grains. Large doses excite persistent and severe vomiting. The better mode of using it, is by thorough trituration with five or more times its own weight of sugar, with a little ginger or caulophyllin. By far the best combination of it is with three parts of leptandrin and one of caulophyllin, either triturated with sugar, or made into pills with a suitable extract.
III. Fluid Extract. This is prepared by treating the crushed root with seventy-five percent alcohol, and proceeding as in the fluid extract of leptandrin. By the use of alcohol of this strength, the qualities of the drug are most fully extracted, yet the resinoid is liable to fall to some extent on adding the watery concentration to the alcoholic product. On this account, most manufacturers now consider it preferable to use fifty percent alcohol; and to reserve the first eight fluid ounces which pass. It is a strong preparation, not often advisable. Dose, ten to twenty drops.
IV. BunneI's Pills. Root of podophyllum, four ounces; hydrastis, blood root, and lobelia seeds, each, two ounces. Make into four-grain pills with softened extract of juglans. Dose, three to five. The original recipe of Dr. Bunnel directed gamboge instead of hydrastis, and used molasses instead of extract. The formula here given is less harsh and more tonic; and is much valued by many physicians as an efficient stimulating and relaxing hepatic.
Compound leptandrin pills, (often called compound podophyllin pills,) are mentioned among the pharmaceutical preparations of leptandra.
The Physiomedical Dispensatory, 1869, was written by William Cook, M.D.
It was scanned by Paul Bergner at http://medherb.com
