M. F. BETTENCOURT, M. D., GLADEWATER, TEXAS
During the course of a medical career of but a meager three years, one can hardly state from experience much that is original with him, or much that he can vouch for as positive in medicine. He is merely a novice in the art, a typical medical tyro undergoing the ups and downs of his probationary period. He sets out fresh from college on his life-saving mission, buoyant with pride, "medical wisdom" and egotism. Subsequent failure to fulfill his unreasonable promises and extravagant claims, soon makes him skeptical and dissatisfaction with his means and methods naturally results.
Thus this probationary period results finally in one of two things—it either makes us novices become more cautious in our promises; more studious in our own resources and methods; more observant in the action and adaptability of our remedies; and, above all, do things first and talk about them afterwards; or, it induces us, to our eternal detriment, to delve in the other fellow's fields rank with nihilism and neglect the immense resources of our own.
Possibly more than some others I have had my full share of disappointments and moments of discontent, but so far they have not impelled me to follow false gods. I have had also many little Tom Thumb successes, and to my share of these, phytolacca decandra, amongst a number of other drugs, has very materially lent its aid.
The old saying, "Familiarity breeds contempt," may serve to explain one of the reasons why the familiar poke-root is not lauded throughout medical journals considerably more than what it is. We find it growing practically throughout the United States. We see it flourishing along moist road-sides, at the edges of cultivated fields and in fertile cleared lands. Yet, though so common, it is undoubtedly one of the leading success makers of the materia medica; but, one seemingly very little appreciated and used only to a very limited extent by other than our own physicians.
Guaiac for tonsillitis— "Guaiac!" the very name of which you can hardly say aloud without disgust, yet phytolacca within reach! Iodine tattooing and Indian war-painting for acutely swollen lymphatic glands when phytolacca would relieve that glandular blood-stasis and clean up and flush out the clogged lymphatic sieves with unexcelled rapidity. But then when you do an artistic piece of iodine mopping the people can see what you have done.
Fly-blisters for inflamed ovaries, or more likely ovariotomy or more likely still pan-hysterectomy for the poor, unpitied little descendant of Eve who must be thus tortured, scarred, butchered, unsexed, all because of downright criminal ignorance. Why shouldn't it be thus when materia medica and therapeutics are so insignificant in their minds as to have no consideration whatever in the examinations of "mixed" state examining boards.
Ignorance of phytolacca is only a sample of the general imperfect knowledge of really essential drugs made from American medicinal plants. On suggesting to one the use of echinacea angustifolia in a certain case, he immediately with a contemptible air of superiority turned up his nose and stated that he wished it to be for ever clearly understood that he did not make a practice of doping his patients on the worthless patent medicines that flood the drug market.
Phytolacca is a member of a rather small family of plants. In our own country it is known in different parts by quite a variety of names, of which the most common are: poke-root, poke-weed, pigeon-berry, cancer root and American night-shade. The root is perennial, sprouting up year after year. The young spring shoots are edible but after the leaves have developed they assume a cathartic action which becomes more marked as the plant nears maturity. This cathartic action is one of the symptoms of its poisonous action. The ingestion of half an ounce of the berries or of the root has proved fatal. In large doses it is a depressant to the spinal cord affecting very markedly the medulla oblongata and causing death by carbonic acid poisoning, the result of cardiac depression and respiratory paralysis. The presence of carbonic acid in abundance in the blood is stimulative to the respiratory center in the medulla, but it fails to respond to the stimulation when depressed by a lethal dose of phytolacca.
The peculiarity of phosphorescence of the autumn phytolacca leaves when in the dark is claimed to be due not to the presence of phosphorus but to an oxidizing enzyme.
The extract of phytolacca berries is used for its claimed anti-fat properties, it being claimed a better preparation for fatty heart than a preparation from any other part of the plant. It is also claimed valuable in membranous croup. Steeped in gin or brandy the berries form a popular home remedy for chronic rheumatic affections. The inspissated juice from the leaves is preferred for local applications but the recent fall-gathered root carefully dried is the part usually employed.
The most direct action of phytolacca is upon inflamed glandular structures, especially the lymphatic glands. The more markedly lymphatic the structure, and the more acute the trouble, the more marked the action of phytolacca.
In acute tonsillar inflammation it is certainly as near a specific as there can be for any ill. It must however be given in larger doses than is usually recommended. A four ounce mixture containing twenty drops of phytolacca and administered in dram doses will not bring about the desired results. Our late Professor Foltz who was undoubtedly a master in his line would invariably treat tonsillitis by giving to an adult hourly doses of from three to five drops, and claimed that if the case was not of more than twenty-four hours duration and no additional cold was taken, the patient however bad would be practically well in twenty-four hours. I haven't yet had cause to disbelieve the statement.
With phytolacca, he almost invariably administered aconite because of its specific action upon acute inflammation of the naso-pharyngeal region. He gave this also in material hourly doses of from one-sixth to a half drop, always advising either the smaller dose or the same dose less often, if the characteristic tingling of the throat should develop. In chronic enlargement of the tonsils, unless hypertrophic, phytolacca is very useful; but, as in all other chronic troubles, it must be administered for a long time. (In these cases it may be used in conjunction with thuja.—ED.) In scarlet fever he used phytolacca throughout the entire course of the disease to prevent the suppurative otitis media which so commonly follows this disease if the drug is not given.
In acute mastitis of the nursing woman, if treatment is begun within the first twenty-four hours following the chill, phytolacca in appreciable doses, usually with the addition of aconite, will reduce the high fever and tenderness of the mammae with wonderful rapidity. The same medicament will be found beneficial for morbidly sensitive and tender breasts, occurring at menstruation, and for the swollen and tender breasts of infants it is equally efficacious.
In acute ovaritis phytolacca is directly indicated. Its action will be materially augmented by the use of the proper sedative with bryonia, macrotys or any other remedy for which there may be a call.
In acute infection (so called blood-poisoning) characterized by the acutely swollen lymphatic glands, red cordy streaks, pyrexia, etc., incision at the point infected and the use of phytolacca and echinacea, both in full doses with the proper sedative, will reduce the entire train of symptoms in a most satisfying manner.
In acute orchitis, phytolacca and the small dose of pulsatilla with the appropriate sedative (which will usually be veratrum) with possibly the application of belladonna ointment, and firm strapping of the testicle will give very satisfactory results.
Phytolacca however does not affect only glandular structures; serous, cutaneous and mucous tissues are within range of its curative action. It is of material value in peritoneal inflammation. Its action upon cutaneous tissues is demonstrated by its effect upon old sores, cracked nipples and troubles of an epitheliomatous nature. We know that the different varieties of carcinoma are disseminated through the lymphatic system and the potent action of phytolacca upon this system may at least in part explain its action upon such troubles. Wonderful results are claimed from it especially upon epithelioma, one authority gives it the first place amongst all other remedies used for the malady. The juice expressed from the leaves is applied locally and a good preparation of the root administered internally.
The effect of phytolacca upon mucous surfaces is manifested by its action upon the different forms of stomatitis, follicular and ulcerative troubles of the oro-pharyngeal region. Its action upon the mucous membrane is such as to lessen the tendency toward formation of false membranes. Recently great results have been claimed for it with other indicated remedies in conjunction with the hypodermic use of lobelia in diphtheria. The specific lobelia is administered in doses of from ten minims to a syringeful repeated as often as three hour intervals till relief. It does not act as a nauseant even in dram doses hypodermatically but acts as a powerful capillary stimulant, and while in proper doses it produces relaxation it does not act as a depressant and improves the action of the heart immediately.
Of phytolacca, Professor Foltz used to say that it is adapted to increase the activity of the mucous glands, therefore its usefulness in atrophic rhinitis and pharyngitis. He further stated that loaded mucous glands is as great a call for phytolacca as enlarged lymphatics and that its tendency is to bring about a normal state of the glands, it being equally useful in glandular enlargement as in atrophy.
It is a powerful eliminative agent and very potent in bringing about destructive metabolism, making it a useful adjuvant in the various dyscrasias. It thus renders good service in so called scrofulous affections, in syphilitic troubles and in the different manifestations of chronic rheumatism. In rheumatic troubles it must be given in large doses. In chronic diseases in which the action of the skin is sluggish, the blood vitiated and the lymphatics inactive it is directly called for.
In skin troubles calling for it, which are usually of a scaly variety, the cuticle is not hypersensitive though it may be inflamed.
In threatened glandular suppuration it is very useful but after suppuration has taken place better results are obtainable from iris and baptisia or echinacea.
Phytolacca is not always the remedy when there are enlarged lymphatics. It is called for when the glands are swollen, hard and painful on pressure—a condition which exists chiefly in acute ills. When the glands are swollen but not painful, inclined to be soft or non-indurated with sluggish lymphatic circulation, as indicated by a chain of swollen lymphatics, iris is the remedy called for.
When the glands are chronically enlarged, not painful, indurated, the patient anemic, arsenic iodide should be used in preference. Such a condition exists in subjects of a "scrofulous"" tendency. These are some of the things which phytolacca is capable of doing; is it worthy of study? We have numerous others equally as good.
Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.