Therapeutic Application

Few medicines have suffered such vicissitudes of popularity as sarsaparilla; at one time being in high repute, at another almost entirely neglected, then again revived, to be again depressed; but at no time commanding a unanimous opinion in its favour. introduced about the year 1530 into Europe, from the Spanish West indies, where it enjoyed much repute as an antisyphilitic remedy, it came into considerable vogue; but seems to have afterwards been almost lost sight of until again brought into notice, about the middle of the seventeenth century, by Sir William Fordyce, who recommended it strongly as an adjuvant and corrective of mercury, in the treatment of the venereal disease. Cullen's unfavourable opinion had probably no little influence in setting the current of professional sentiment once more against it; and, at the commencement of the present century, and for some time afterwards, it seems to have been much neglected. Empirics, however, now took possession of the abandoned remedy; and the success they met with, either from the efficacy of the sarsaparilla itself, or of the secret additions they made to it, was striking enough once more to attract the notice of the regular profession, by whom the medicine was again received into a favour, which it has not subsequently lost. it seems to me impossible to resist the conclusion, which this short history suggests, that a remedy cannot be quite inert, which has so often risen into notice after neglect, and which, though considered useless by many, has the voice of the greater number, and those probably the most experienced, in its favour. One cause, probably, of the unfavourable opinion has been the ignorance of what gives real efficacy to the medicine, and the consequent vicious methods of pharmaceutical treatment to which it has been subjected. it is not strange that practitioners have been often disappointed, when they estimated a specimen of the root, not by its acrimony, but by the proportion of starch it contained, and, in order to extract this inert starch for use, tortured the medicine with an amount of boiling, sufficient almost wholly to drive off or destroy the proper active principle.

Secondary syphilis is the affection in the treatment of which sarsaparilla has always enjoyed the highest reputation. it is on all hands admitted to be inadequate to the cure of the primary disease; and there are probably few who would venture to trust the secondary symptoms to sarsaparilla alone. But, associated with mercury, it seems to have produced effects which could not always be obtained from that medicine unaided; and it is thought very often to have corrected that cachectic state of system, or depraved health, which has remained in syphilitic cases after the use of mercury, and which it has been customary to ascribe to that medicine; as we daily see, in miasmatic regions, the shattered health produced and left behind by intermittent and remittent fevers, ascribed to the quinia by which the febrile paroxysms had been subdued. The curative effect of sarsaparilla is very slow, because the alterative change of tissue, upon which its efficacy probably depends, is also slow; and this very slowness may constitute one of its real merits; as it seems difficult seriously to abuse a remedy of such feeble physiological action. But gradually, under its use, the appetite often increases, the general nutrition improves, the secretions assume their normal state, and the morbid phenomena disappear, one after another, till finally health is restored. A new and healthy tissue has taken the place of the old and diseased.

As a remedy for the unhealthy condition, thought to be sometimes left behind by mercury acting excessively or too long, it may be supposed to operate by the slow removal or disintegration of the morbidly mercurialized structure, which has taken the place of that previously existing, and to the removal of which the prostrated energies of the system may be inadequate.

Chronic rheumatism, various forms of scrofulous disease, and chronic cutaneous eruptions, are the other complaints in which sarsaparilla has been used with supposed advantage; and, in any case of general cachexia, or depraved condition of health, which can be traced to no special cause, and for which there is no known special remedy or set of remedies, this medicine may be appropriately used, in connection with others which may seem to offer some hope of benefit.

Administration

The powder of sarsaparilla may be given in the dose of from thirty grains to a drachm, three or four times daily, to be gradually increased until a slight effect on the stomach is experienced, and then somewhat diminished so as to be kept within the nauseating point. One drachm of the most efficacious parcels will sometimes produce nausea. But this is not an eligible form for administering the medicine, in consequence of the large proportion of useless matter. The following are the several officinal preparations used.

The Simple infusion (infusum Sarsaparilla, U. S. 1850) is prepared by digesting an ounce of the bruised root in a pint of boiling water for two hours; or, preferably, by the process of percolation, the same proportions being used. This is probably as efficient a preparation as can be made of sarsaparilla alone, by means of water as the menstruum. But, as water is incapable of taking up all the virtues of the root, unless used in very large proportion, the preparation is not a very strong one. The dose of it is three or four fluidounces, three times a day.

A simple decoction may be prepared by macerating two ounces of the bruised root in a quart of water for an hour, then boiling for ten or fifteen minutes in a covered vessel, and straining the liquid. This is essentially the decoction of the British Pharmacopoeia (Decoctum Sar-sae, Br.), and, in reference to its strength, may be considered as identical with the former U. S. infusion. The long boiling formerly directed by the British Colleges has been entirely abandoned, as not only needless, but injurious.

The Compound Decoction of Sarsaparilla (Decoctum Sarsaparilla Compositum, U. S.; Decoctum SarsaeCompositlm, Br.) is made, according to the U. S. Pharmacopoeia, by macerating six troyounces of bruised sarsaparilla, a troyounce, each, of bark of sassafras root sliced, guaiacum wood rasped, and liquorice root bruised, and three drachms of mezereon, in four pints of water, for twelve hours; then boiling for fifteen minutes, straining, and adding, through the strainer, sufficient water to make the decoction measure four pints. This is an imitation of a preparation formerly in great repute, under the name of Lisbon diet drink, and is one of the best forms in which sarsaparilla can be prescribed. Guaiacum wood yields very little of its virtues to water; liquorice root merely serves by its demulcent properties to obtund somewhat the acrimony of the other ingredients, and the sassafras bark answers little other purposes than to impart flavour; so that the efficiency of the decoction depends mainly on the sarsaparilla and mezereon. The dose is about four fluidounces, three or four times a day.

The Compound Syrup of Sarsaparilla (Syrupus Sarsaparilla Compositus, U. S.) is made by first forming a tincture, with diluted alcohol, of sarsaparilla, guaiacum wood, roses, senna, and liquorice root, then evaporating off most of the alcohol, and incorporating sufficient sugar with the residue to form a syrup, which is flavoured with a minute quantity of the volatile oils of sassafras, anise, and partridge-berry. This syrup was prepared in imitation of the famous sirop de Cuisinier, and differs from the decoction mainly in the omission of mezereon, and the introduction of senna, which renders it slightly laxative. it is very much used, and perhaps the most popular preparation of sarsaparilla employed in this country. it is an entirely different preparation from the syrup formerly directed by the British Colleges, in which sarsaparilla was the only active ingredient, and that probably rendered inert, or nearly so, by long boiling. The dose of the compound syrup is half a fluidounce, three or four times a day.

The Extract of Sarsaparilla (Extractum Sarsaparilla, U. S. 1850) was made, according to our former code, by first forming a tincture of sarsaparilla with diluted alcohol, by means of percolation, then distilling off the alcohol, and evaporating the residue to a proper consistence. The diluted alcohol thoroughly exhausted the root of its active matter, while it left the inert starch; and the heat necessary for the concentration of the preparation, if properly regulated, was not sufficient to drive off or decompose the sarsaparilla. The extract may, therefore, be considered as having had all the virtues of the sarsaparilla in a concentrated state, and was an excellent preparation. it has, I think unfortunately, been abandoned in the recent revision of our Pharmacopoeia; as it gave the opportunity of exhibiting the medicine in the solid form, which is sometimes desirable. The dose is from ten to twenty grains, three or four times a day.

The Fluid Extract of Sarsaparilla (Extractum Sarsaparilla Fluidum, U. S.; Extractum Sarsae Liquidum, Br.) is prepared by first forming a tincture of sarsaparilla, by means of percolation, then evaporating the tincture sufficiently, and adding a considerable proportion of sugar, which contributes to the preservation of the fluid extract. Each minim represents a grain of the root, and the dose is therefore from thirty to sixty minims. The British preparation is made from an infusion instead of tincture; a little rectified spirit being added, at the end, in order to preserve it.

Compound Fluid Extract of Sarsaparilla (Extractum Sarsaparilla Fluidum Compositum, U. S.) is a compound preparation, in making which, all the ingredients of the compound decoction, except the guaiacum, are treated with diluted alcohol so as to form a tincture, which is afterwards very much reduced by evaporation, and then incorporated with enough sugar to enable it to keep. This is an excellent preparation, and may be considered as representing the compound decoction in a very concentrated state. The dose is a fluidrachm, equivalent to a drachm of the root.