Podophyllum peltatum

Volume III — Main text

PODOPHYLLUM.

Podopkylbtm ptltatum, L. May apple, mandrake. Nat. Ord., Birberidaceee. (The resin, Podophyiiin, is the part mainly used.)

I. Prevings. — i. Dr. Snow made 3VJ of extract from 3"ss of leaves, and formed from this pills of 2 gr. each. Taking one of these, pulse, which was 76, fell in i h. to 65, and continued so for about 2 h. Another time he took 2 pills, pulse being 74, full and strong ; in i h. it had fallen to 61, and 2 h. later it was the same, weak and small. In a third experiment 3 pills were taken, pulse 76, full and strong. In I h. it fell to 64, and in 2 h. more was the same, small and feeble, and there was some nausea. (Thesis, 181 9, from Mat. Med. of Amer, Provings.)

%. Williamson. [The only information given as to this proving is that "the attenuations made use ot in collecting the symptoms were the ist, 3rd, and 15th."] Sudden shocks of jerking pains. Sleepiness in daytime, especially in forenoon, with dulness and headache, and rumbling in bowels j sleepiness early in e. ; restlessness in forepart of n. j too heavy sleep at n. } distress after first sleep ; rising up in bed during sleep, without waking ; moaning in steep with lids half closed ; drowsy and difficult to woke in m. ; unreTreshed in m. Giddiness, with sense of fulness in eyes ; momentary darts of pain in forehead, obliging one to shut eyes, with giddiness ; pain on

top of head, with heat and heaviness of eyes, when rising in m. i pressing pain in temples in forenoon, with drawing in eyes as if strabismus would follow j stunning headache through temples, relieved by pressure j sudden pain in forehead, with soreness of throat in e. ; vertigo with inclination to fall forwards; headache alternating with diarrhoea i heavy dull pain in forehead, with soreness over seat of it j pain in 1. frontal eminence, worse p.m. Smarting of eyes ; pain in eyeballs and temples, with heat, and throbbing of temporal arteries. Teeth are covered with dripd mucus in m. i copious flow of saliva ; taste of fried liver in mouth at n. ; sourness of mouth; dryness of mouth and tongue on waking in m. Soreness in 1. throat, especially painful on swallowing liquids, worse in m. ; dryness of throat ; soreness of throat extending to ears. Indifference to food ; desire for something sour j thirst towards e. i acidity, p.m., with unpleasant sickly sensation in stomach ; extreme nausea, continuing several h. ; vomiting of hot frothy mucus ; heat in stomach ; sense of hoilowness in epigastrium ; throbbing in epigastrium followed by diarrhoea. Fulness in r. hypochondrium, with flatulence ; stitches in r. hypochondrium, worse while eating; sense of weight and dragging in I. hypochondrium, close under ribs; pain in transverse colon at 3 a.m., followed by diarrhoea ; pain in bowels at dayhght in m., relieved by external warmth and by bending forwards while lying on side, but aggravated by lying on back, at first attended with coldness, which is followed by heat and warm perspiration ; sense of heat in bowels, accompanying inclination to go to stool ; twisting pain in r. hypochondrium, with sensation of heat in the part j faintncss with sensation of emptiness in abdomen after stool. Diarrhoea early in m., which continues through forenoon, followed by natural stool in e. ; diarrhcca immediately after eating or drinking ; green stools in m., 6 to 8 evacuations in d. ; stool in m. attended with strong urging in bowels, with heat and pain in anus ; flashes of heat running up back after stool ; too much bearing down at stool, as. if from inactivity of rectum ; secretion of mucus from anus. Scanty urine, with frequent voidings ; sticking pain above pubes and in course of spermatic cords. Pains in chest, increased by taking a deep inspiration ; snapping in r. lung, like breaking a thread, when taking a deep inspiration; inclination to breathe deeply (sigh) ; shortness of breath; sensation in chest as if heart were ascending to throat ; sense of suffocation when first lying down at n. ; sticking pain in region of heart ; palpitation from exertion or mental emotion. Pain in small of back when walking or standing, with sensation of back bending inwards ; pain in lumbar region, with sensation of coldness, worse at n. and from motion ; pain in loins, increased by a miss-step and by walking over uneven ground ; pain between shoulders, with soreness worse n. and m., and increased by motion ; pain under r. shoulder-blade ; stifi^ess of nape, with soreness of muscles of neck and shoulders } pain in nape with soreness, increased by motion. Weakness of wrists, with soreness to touch ; pain and weakness in I. hip, like rheumatism from cold, increased by going^ upstairs ; pains in thighs, legs^nd knees, worse from standing; weakness of joints, especially of knees; cracking in knee-joints from motion ; heaviness and stiffness of knees as after a long walk } stiffness on beginning to move ; aching of limbs, worse at n, ; pain in 1. knee, leg, and foot ; sharp pain in upper and outer portion of 1. foot ; coldness of feet ; perspiration of feet in e. The symptoms generally, but especially the abdominal symptoms, are aggravated in the m., but better in the e. (IbuJ.)

3, a. Dr. PiETRO took 5 centigr., which caused nausea and a little irritation of stomach, but these symptoms disappeared when he went to bed. He had also an evacuation of h'quid yellow matter, and every h. for 5 h. this was repeated.

b. On a second occasion he took 10 centigr. Immediately nausea and attempts to vomit, which lasted 2 h. After 4 h. shivering and a feeling of prostration. Next d. violent colic, followed by liquid stools, which were repeated till 9 o'clock (? a.m. or p.m.). {Brit, and For, Med.'Chir, Rtv.y 1869, ii, 516.)

1. From 3 doses of gr, J each, 1. eye sore, uncomfortable, and red-looking, especially at inner canthus. (Berridge, M. H. S,, xv, 298.)

2. S. A. Moore, student, aet. 21, nervous-sanguine temp., not easily affected by medicine. Took 4 dr. of tinct. before going to bed, and had no unpleasant feeling till about 3 a.m. Was then awakened by violent pains in stomach and bowels of griping stitching character, relieved for a short time by pressure on bowels. About 4 a.m., stool of yellow undigested fxces mixed with mucus, of offensive odour. Temperature was considerably increased; pulse quicker and smaller than usual, with slight palpitation and much feeling of oppression of chest, causing constant inclination to draw a deep breath, which, however, was hindered by a sense of constriction in chest. After rising, sick feeling at stomach ; appetite much impaired, with unusual thirst for cold water ; tongue coated white, with much viscid mucus in mouth. After breakfast, violent burning in stomach, as if caused by hot steam. About 10 a.m. had another evacuation, accompanied with violent tenesmus lasting for some time after; stool was of burning acrid character. After this, feverishness, with frontal headache and sensation of great dryness of forehead and eyes, relieved for a short time by bathing parts in cold water. No more symptoms till after dinner, when same burning sensation was felt in stomach ; thirst also, but cold water caused much oppression and uneasiness, and small quantities of it were ejected, tasting very bitter, and giving rise to much burning in oesophagus. Felt feverish during afternoon, with occasional spells of chilliness, not relieved by heat of stove, but going off on covering up warmly in bed. Before supper empty feeling in stomach, but did not feel hungry. After supper, sensation as if there would be evacuation of bowels, coming and going at short intervals till he went to bed. Nothing now felt till a a.m., when he woke with slight stitching pains in bowels and desire for stool, resulting at 2.30 in an evacuation. Pains continued at times for rest of n., relieved by flexing thighs on abdomen ; with them sense of weakness in epigastrium. Had bad taste in mouth for several d. after the most prominent symptoms had disappeared, with diarrhoea and constipation alternating every d. or two. (Trans, of Amer, Inst, of Horn. ^ 1872, p. 499.)

3. Dr. Walter Smith took gr. \ of resin before breakfast, Oct. 5th. A good deal of flatulence was caused in e., but no purging. 7th. — Took same without decided effect. 8th. — Took gr. , No catharsis. 29th. — Took I gr. No palpable effect till 5 p.m., when he felt some wandering pains in abdomen : at 9 a small solid evacuation was produced, and at 12 a copious loose stool. Next m. two thin dejections, with griping and uncomfortable feeling of chilliness. Nov. oth. — Took gr. i at bedtime. Flatulence in m. and increased action of bowels. 9th. — Repeated dose with like results. (Pharm, Journ, and Trans.y 2nd ser., x, 462.)

4. Same gave i gr. to a young gentleman, in good health, at bedtime. Next m. had a free motion. During d. was annoyed with flatulence, loss of appetite, chilliness, and griping pains, and bowels were opened twice loosely. On following m. and d. after cathartic action was still manifested, and 6 stools in all resulted. {Ibid,)

IL Poisonings, — i. "On August 4th, i860, 1 was called to visit two children who, the messenger said, were vomiting themselves to

death. In J h. 1 reached the house, and found two girls of 6 and 8 respectively stretched upon their beds bathed In cold perspiration ; faces pale as a corpse's, eyes sunken in orbits, noses pinched ; pulse very weak, and scarcely perceptible at wrist ; great thirst ; and stomach contracting so hard and rapidly, in efforts to vomit, that the wrenching pain would cause them to utter hard screams, one after another, for 5 m. at a time. I was told that the vomiting had been going on for the last 4 h. almost without intermission : it was now noon. On examining the matters ejected, I found them to consist, for the most part, of the seeds, pulp, and membranous covering of the ripe May apple, having the pcculiarodour of the fruit." They were treated with morphia, blister or sinapism to abdomen — which was tympanitic and very tender, hot flannels with mustard to extremities, carbonic acid water to sip, and, as bowels had not been moved, enemata of castor oil and molasses in warm water. "In i J h. the younger child had fallen asleep, but the elder vomited bilious matter mixed with blood — the bile dark green and very thick, the blood dark and coagulated. She complained frequentiv of burning in throat. Injections having failed to move the bowels, I gave her 12 gr. of calomel and I gr. of sulphate of morphia, in both extremities were now becoming warm. I left powders of morphine and camphor, one to be given after each vomiting ; and enjoined that the heat was to be kept up in the extremities. I was called next d. at 7 a.m., and found elder child past all hope, — eyes glazed and motionless, the death-rattle in her throat, abdomen swelled almost to bursting, and under jaw fallen. She had continued to vomit thick bile, with more or less blood mixed with it, about every h. during n. At 2.30 p.m. she expired. The younger was much better, save that there was considerable tenderness over stomach. To remove this I applied a blister j gave Dover's powder to keep her quiet, and slippery elm water for drink ; kept the bowels solvent with sulphate of magnesia ; and by m. of the 8th she was convalescent." (D. C. Owen, from Hale*s New Rtmedies^ 2nd ed.)

1. Not a week since the writer was called up at n. to visit a lady apparently seized with a severe attack of cholera, — -watery purging every 2 or 3 m., vomiting, coldness of surface, and great prostration. On inquiry he fouttd that these alarming symptoms were due to a pill containing Podophyllin. (Brit, yourn, of Hornby xxi, 4-54.)

2. Mrs. H., St. 45, strong and healthy, had been constipated for a week, and was feeling badly in consequence. A bottle of Podophyllin was in the house, and from it she took as much as could be held on the handle of a teaspoon, mixed it with a little water, and swallowed it, 5 p.m., April 9th. At 7 she had cutting pains on both sides of abdomen, wiih desire for stool. At 8, feeling very badly, went to bed. Pain had ceased ; there was great exhaustion, with relaxed muscles and feeling as though body was bathed in sweat (which it was not] ; then came a fearful pain in occiput, '^ as though the head was being split open," lasting about % m., and followed by dull throbbing ache and feeling of heaviness so that head could not be raised from pillow. At 8.30 vomiting began, first contents of stomach, then thin, bitter dark green fluid, from Oss to Oj each time. There were 6 or 7 such

attacks between this and 4 a.m. \ with each bowels moved, first constipated, then thin watery stools, but no blood and no pain. Frequent sensations of heat passing over face and head were noticed. With each vomiting exhaustion was so great that patient felt as though dying. She could not raise her head to assist in the act of emesis. Dr. Prentiss was called to the case at i a.m. He found patient in a state bordering on collapse, features pinched, extremities cold, pulse very feeble, disposition to drowsiness. The greatest distress was from the exhaustion and the pains in the head ; the intellect was unaffected ; eyesight and pupils normal ; no involuntary discharges. Mrs. H. kept her t^d on the xoth, but got up on the 1 ith, feeling well, but with tingling in extremities and weak as from a long illness. {Philad, Med. Times, 1883.)

1. A girl, art. lo, took a er. of Podophyllin. After 5 h. severe pain in bowels; after 9 b. vomited contents or stomach, and then much bile; felt better, but after 13 h. vomited again, and bowels were moved twice, not copiously, but with very much pain and deadly nausea. In n. pain in stomach, which continued to increase in severity, and was attended with much thirst and sense of burning, and great feeling of'^prostration. On and d. took a number of drugs to antidote effects. On 3rd d., p.m., had a chill, followed by some fever and headache. The two latter continued on 4th d., pulse being 100 ; great tenderness over stomach and bowels, could scarcely bear pressure of bedclothes ; pain in bowels occasionally, but not severe ; no stool since ind d., but feeling every now and then as if it would come ; urine very red ; tongue white J great thirst. On 5th d., white fur on tongue, except on centre; everything tasted sweet j still great thirst, also tenderness over stomach and bowels, increased by least motion, could not bear to be touched } pulse 100. Soon after eating some toast pain commenced in stomach, extending into bowels, increasing to such severity that she could not resist screaming at every breath ; by afternoon it had extended into lower bowels and r. ovary, pulse being now 116. Spasmodic sensation in r. thigh and leg in m. } p.m., more pain and cramp in r. leg. On 6th d. still very tender over lower bowels; micturition painful ; pain m r. ovary and uterus. On 7th d. two green watery stools. On 8th d. five thin watery green discharges, with considerable pain and griping } intolerable itching of skin on body and arms, scratching produces blotches, as in urticaria. (Knapp, Tram, of Pacific Horn. Med, Sec., i, 55, from Allen.)

5, T. C, act. 17, while powdering the resin got some in his face and eyes. Next m. he noticed that his face and eyes were red, and the skin about the latter discoloured. This discoloration extended during d. over whole face, forehead, and front of neck, and at n. eyes were so painful as to prevent sleep. On following J. all parts which had been in contact with powder were of yellowish-red colour, but not appreciably swollen. The ocular conjunctivae were much injected, the palpebraJ only slightly ; pupils small ; eyes painful, and sensitive to light. (Wkbstbr, Lond, Med, Record, 1877, p. 357.)

1. It appears from the statement of a patient now under Mr. Hutchinson's care at Moorfields that P. dust is well known in the trade to produce " inflamed eyes " and an eruption of " scabs " on the arms and legs of the men who attend the mill in which the root is ground. This man came with extensive superficial ulceration of each cornea, attended by intense general conjunctival congestion. The ulceration of cornea was central and large in extent. He had had several other attacks of the same sort, but not nearly so bad as this one. He showed also one or two dusky spots on the arms where there had been scabby

places a few d. before. The day's work which gave rise to the present attack occurred about lo d. before he came under care at the hospital. No symptoms of irritation appeared while he was at work or during that e., but on waking next m. his eyes were inflamed. He was not purged by the dust.* (Med. Times and Gaz,.^ ^872.)

1. Experiments on animals, — I. Hughes Bennett experimented on dogs. His conclusions are —

a. Doses of Podophyllin, varying from 2 to 8 gr., diminish the solid constituents of the bile, whether they produce purging or not.

b. Doses which purge lessen both fluid and solid constituents of bile. [Brit, Med. Journ., 1869, i, 418.)

2, Anstie made 10 experiments on dogs, cats, and rats, injecting the drug (Podophyllin) in sol. into peritoneal cavity. His conclusions are as follows :

fl. P., when so injected, has no irritant action on the serous membrane unless it remain unabsorbed, lying for some time in contact with it.

b. P., when so injtcted, passes into the blood, and exerts a special influence of an irritant kind upon the mucous membrane of the intestines (usually of the small intestine only).

r. As a secondary result of this irritation, or perhaps as a mere consequence of the squeezing of the gall-bladder by the abdominal muscles, in repeated eflfbrts at defrccation, bile is occasionally poured out in large quantities, but this is by no means necessary.

d. Neither poisonous doses, nor those which produce what may be called a medicinal effect, appear capable of exciting any inflammatory process in the liver.

e, (The following is a typical specimen of the experiments.) Half a fluid drachm of the sol., containing 2 gr. of drug, was thrown into a full-grown dog. The animal was not discomposed by the operation, and a few m. after was eating food. Until 10 h. later he was perfectly lively, and showed no signs of uneasiness. He now commenced retching violently, bringing up only a little mucus. This symptom continued, and was soon accompanied by purging ; stools consisted of glairy mucus, and after a time were mixed with blood ; he whined constantly, and seemed in pain, also drank water eagerly. Four h. from commencement of symptoms breathing was shallow and hurried, pulse rapid and ifccble. After 4 h. later animal was found lying on side, totally insensible, with glazed eyes, heart's action very slow and weak, respiration consisting of 4 — 6 convulsive gasps per m. In this state it lay with little change for the next 8 h. At end of this time a slight general convulsion occurred, and breaching ceased about ij m, later. Thorax was quickly opened, and heart found beating ; it continued to pulsate for 5 m,, and its irritability persisted for some time after this. No fluid of any kind was found in the peritoneal cavity, and the membrane was quite smooth, polished, and transparent. Kidneys were rather congested, and liver moderately so ; gall-bladder contained very little bile. Pharynx, cesophagus and stomach were healthy^ save that last

• Other observations of this kind will b« found in Amgr, Mag., J851, i, 63 ; FAatm, JoMrn,, i86», p. +6j.)

contained some bloody fluid. Mucous membrane of whole small intestine was intensely inflamed, especially that of duodenum ; in latter situation were nine ulcers, rather less in size than a threepenny piece, and there was one smaller ulcer near lower end of ileum. Inflamed surface was covered with tenacious bloody mucus. Inflammation ceased abruptly at ileo-csecal valve ; large intestine was healthy. Nowhere was any bile observed in bowels. Mucous membrane of bladder was slightly congested. (Med, Times and Gaz., 1863, i, 326, 487.)

1. Rutherford finds that Podophyllin introduced into the duodenum of a fasting dog increases both the fluid and the solid constituents of the bile j and this increase is greater when the bile is allowed to flow into the intestines than when it is drained off by a cannula. The augmentation is greatest when the drug does not purge much ; tf the purging be severe, it may lessen the biliary secretion. (Pract., 1879,

», 3350

Volume IV — Appendix

PODOPHYLLUM.

(See vol.

• 679.)

I, 8, Mr, E, J—, at, 26, took 10 gr. of ty trit. “to stir up his liver.” This was at 11 a.m, About 6 p.m. he was taken with an indescribable sick feeling all over, and a persistent dry-rough sensation in pharynx and oesophagus extending along r. Eustachian tube, with dull aching in r. ear; there was also a feeling as though a ball or lump was in upper part of oesophagus, At8 there was dull stupefying headache, chiefly in forehead, worse on lying down ; fulness in region of stomach, with belching of gas and sour eructations ; marked salivation ; offensive odour from mouth. Went to bed sleep disturbed and full of confused dreams ; rolled and tossed about ; bed felt too hard, and gave sensation as if head and shoulders were lying too low. At 3 a. was challenged to stool, which was profuse, watery, and dark green in colour. Subsequently frequent call to stool, with peculiar weak dull griping pain below umbilicus, and fulness in rectum before stool and by stool ; faint weak feeling in region of stomach during stool,

tenesmus and faint feeling after it. These symptoms gradually passed off in course of 2 — 3 d. The looseness of bowels was followed by conitipation, which was soon corrected by nux vom. (E. V. Ross, Hm. !Forld, June, 1890.)

g. A gentleman, jet. 25, in good health, took gr. ^ — ^ of Podophyllin twice daily for a fortnight, and experienced lassitude, nervous depression (especially in m.), vertigo or sense of fulness in head, anorexia, coated tongue, nausea, and occasionally vomiting of mucus and bile, pain in bowels, with copious semi-solid or liquid stools, pale greenish-yellow or brown, which, when frequent, produced excoriation and burning at anus. Three mos. later he took a single dose of i J gr., and, besides many of thcibove symptoms, hjemorrhoids and prolapsus ant occurred, I know several patients who always sufi^er from prolapsus or from haemorrhoids after taking only \ — A gr. (Phillips, op. cit.)

II. 7, A young man chewed off the end of a root while examining

*some herbs. Next m. felt well till he ate his breakfast, when he felt

nauseated, but gulped up tasteless wind only. His tongue was furred

''^e yellow frost on a board. Heavy feeling in stomach, as if full ; it

^ched and seemed full of gas ; he would rub it and try to force the wind

oiit, if he could only pass wind he would (he thought) get relief. Head-

*^hc through forehead, a dull steady ache, worse from eating; eyelids

"cavy, with desire to sleep ; roaring and crackling in ears ; no appetite ;

'^'rst, unrelieved by drinking; water tasted brackish; bad taste in

njouth — dry, slimy, brackish ; weak and prostrated ; customary colour

6one ; blue rings round eyes ; aching in knees and up thighs, a dull

'^c^.'vy, indefinite pain ; arms and back pained, also loins ; urine red and

***«"k. Bowels moved 3 times ist d. ; belly felt bloated and ached — a

steady ache, relieved for a short time by passing flatus or stool, but

^^^Qning on again in 5 — 10 m., better from 2.30 to 3.30 p.m., then

'"^^^urring till after dark, relieved for a short time after eating. Next

^^- aruused at 4 by urgent desire for stool, which gave him scarcely

'*^€ to hurry out of bed ; stool was thin and watery, whitish, no pain.

do

V^ 'Mother stool at 7.30. After breakfast pain commenced, griping, ^^l'iing him up for a m. Stool recurred every l| h., with spasmodic t^scJts of pain after each, and in intervals (3 — 4.). At noon stools

a

"^•*t»ie dark brown and watery, recurring every 2 h. Next d. there

jrj^'"e 3 stools, partly liquid. Though weak he soon recovered. [Monthly

**'»». Rev., xxxiii, 688.)

5^ S. A young woman, 1 h. after preparing the I, trit,, began to feel

,^^^^ at stomach; had pains in bowels and diarrhoea. Pains were in

^1^ *^>lical region, increasing until a movement took place, when relief

ti,.^ *;*Id be obtained, followed by weak ^' gone " feeling in bowels, lasting

g^^ ^*1 another paroxysm of pain would come on. The diarrhoea was

^^.^ ^^~*ing, profuse and watery, and accompanied with headache and

o|;^^*"exia. Recovery in 15 — 20 h. (This train of symptoms was twice

:rvcd from the same cause.) {Ibid.)