Phytolacca, Poke Root. Some years ago an alterative mixture compounded from the fresh juices of stil-lingia, sarsaparilla, lappa, xanthoxylum, and Phytolacca was suggested by Dr. J. Marion Sims, and has been used largely in syphilis with a considerable degree of satisfaction. The same combination made from fluid extracts has disappointed. It is a well-known illustration of the advantages of fresh plant pharmaceutics. The drug now under consideration is one I wish I had it in my power to adequately present in such a light as to impress not merely the value of phytolacca, but to use as an illustration of the radical differences between green and dried plants in the making of tinctures and fluidextracts. As a matter of fact, no fluidextract of phytolacca is of any particular therapeutic value unless made of the recent root dug in the early fall. A trial of the matter will soon demonstrate this to the satisfaction of any observing man. This is a very useful drug fallen into disuse, like many other good things, on account of vitally defective pharmacy. In excessive doses phytolacca is cathartic and emetic, and, in very large doses, a narcotic poison, one-half ounce of the berries or root in a fresh state having produced fatal results.

In large doses (ec. tr. or green root, f.e., 3 to 6 I., or 10 I, if for only a few doses) phytolacca might be likened somewhat to the iodides in action. While not taking their place, certainly it works in harmony with them, and is most valuable in following the iodides. It is employed in syphilis, scrofulous affections, ulcerations, and chronic rheumatism. It does not have the power of the iodides over effusions and plastic exudates, but in lymphatic and glandular involvements and to eliminate freely circulating toxines it is of equal value. Its known value in rheumatism may be somewhat due to its narcotic action, and in those cases apparently not due to uric acid rather large doses of phytolacca are demanded and seem to be well tolerated. In acute rheumatism it does not do so well. In ulcers and ulcerating skin diseases it is a most excellent agent, but must be given in full doses.

It seems to have a direct and positive effect upon ulcerations of all mucous surfaces and the outlets of the body. It is not at all probable that it directly opposes the toxic element of syphilis, but it does oppose the suppurative tendencies of the disease and thus limits the development of these toxic elements. Phytolacca is not the only vegetable drug of value in syphilis. It does not eliminate or even antidote these elements, but it appears to clean the field and thus inhibit development. Mercury and the iodides seem to act as antidotes (if indeed there be an antidote). Phytolacca is not very markedly an eliminating agent, and hence is wisely combined with other alteratives and eliminating agents, although, in large doses, it is somewhat diuretic. Syphilitic sciatica, gonorrheal rheumatism, venereal buboes, quinsy, suppurative sore throat, follicular tonsilitis, orchitis, rheumatic periostitis, and diphtheria are all more or less amenable to full doses, not, of course, to the neglect of other indicated measures. In diphtheria, for instance, it is a mere adjuvant to the direct remedies used.

In moderate doses (ec. tr. or green, f.e., I to 3 I,) it manifests its primary action, which is upon the glandular and lymphatic structures. It is the best agent in the materia medica for non-suppurative inflammation of the breasts in nursing women. Give small doses combined with aconite at frequent intervals, and apply the cerate or solution externally and support breast with adhesive strapping. Use equal parts ec. tr. and heated glycerine and apply upon absorbent lint, or else use the Phytolacca cerate, made in 25% strength of the green root by homeopathic pharmacies. This cerate is of value in irritable breasts occurring before and during the menses. Minute doses of phytolacca are not effective. In domestic practice the poke berries are used in chronic rheumatism. The usual formula is 2 5 of the fresh berries macerated in I pint of Holland gin. The dose is from I teaspoonful to a tablespoonful, not too frequently repeated. It is quite effective. The berries are also used to reduce fat. Procure the berries, after having been slightly frosted, and express the juice. Filter this and add about 200/0 of glycerine to preserve, or use less glycerine and a little salicylic acid. Commence with 5 111. doses and increase carefully.