Fig. 194. Phytolacca decandra. Photo: Phytolacca americana 3. Preparations: Poke-Root Poultice - Extract of Poke - Fluid Extract of Phytolacca Root - Ointment of Poke - Compound Pills of Poke - Compound Syrup of Poke - Tincture of Phytolacca - Compound Wine of Poke

The root, leaves, and berries of Phytolacca decandra, Linné.
Nat. Ord.—Phytolaccaceae.
COMMON NAMES: Poke, etc. (see below).

Botanical Source.—Phytolacca is a handsome plant growing from 3 to 9 feet high. It is indigenous, with a perennial root of large size, frequently exceeding a man's leg in diameter, usually branched, fleshy, fibrous, whitish within, easily cut or broken, and covered with a very thin brownish bark or cuticle. When young the stem is green, but as the plant matures it becomes more or less purple. The stem is annual, about 1 inch in diameter, much branched, smooth, stout, and hollow. The leaves are opposite, scattered, ovate, entire, 5 inches long by 2 or 3 wide, smooth on both sides, with ribs underneath. The flowers are numerous, arranged in long racemes opposite the leaves. There are no petals, but 5 rounded, incurved, petaloid sepals, whitish, or greenish-white in color. Stamens 10, shorter than the sepals. Styles 10, recurved. Ovary of 10 carpels, green, and united in a ring. The fruit is a handsome, flattened, black, or blackish-purple berry, 10-seeded, and contains a beautiful crimson juice.

Official Parts.—PHYTOLACCAE FRUCTUS (U. S. P.), Phytolacca fruit (Phytolaccae bacca, Pharm., 1880; Poke-berry). "The fruit of Phytolacca decandra, Linné (Nat. Ord.—Phytolaccaceae)"—(U. S. P.).

PHYTOLACCAE RADIX (U. S. P.), Phytolacca root, Poke-root.—"The root of Phytolacca decandra, Linné (Nat. Ord.—Phytolaccaceae)"—(U. S. P.).

Fig. 195. Poke-root. History.—Phytolacca is the North American representative of a small family of plants—the Phytolaccaceae. The plant also grows in North Africa, China, southern Europe, the Azores, and in the Sandwich Islands. Phytolacca is known by many common names, as Poke, Poke-weed, Poke-root, Virginian poke, Garget, Garget-weed, Scoke, Scokeweed, Coacum, Coakum, Cocum, Mechoacan, Pigeon-berry, Cancer-root, Jalap cancer-root, Red nightshade, American nightshade, Redweed, and Scoke jalap. The name Phytolacca is derived from the Greek phyton—a plant—and Fig. 196. Section of Poke-root. the modified Latin lacca, or French lac, meaning lake, having reference to the crimson color of the juice of the berries. Poke is common in the United States, growing in hedges, and along the borders of fieldsand clearings, along roadsides and in uncultivated fields and moist grounds. Its root is very tenacious of life. In this country it is regarded only as a weed, but in Europe is valued as an ornamental garden plant. The plant flowers from July to September, and the berries ripen in autumn. The young, green shoots, as they start in the spring and before the leaves have developed, are used as a table vegetable, being considered the best substitute for asparagus. They become cathartic as they advance to maturity. E. Preston (1884) calls attention to the peculiar and little-known property of phytolacca leaves to emit, in autumn, a phosphorescent light in the dark. Prof. E. Schär found the phenomenon to be due to an oxydizing enzyme, which he succeeded in isolating (see Jahresb. der Pharm., 1896, p. 534). The official parts of this plant are the root and berries. The root, which is more commonly employed, should be gathered in the latter weeks of autumn, cleansed from dirt and impurities, sliced transversely, and carefully dried. The leaves, if they are to be used medicinally, should be gathered just previous to the ripening of the berries. The berries must be gathered when they are fully matured; they have a disagreeable, mawkish taste with a faint degree of acrimony, and are nearly inodorous. They contain an abundance of a beautiful dark-purple juice, which is turned yellow by an alkali, while an acid reinstates its purple color; the latter is of a very fugitive nature. The juice is said to have been used by the Turks for tinting sweetmeats (Landerer). The berries, though poisonous, lose their toxic qualities somewhat when cooked, and some have gone so far as to make pies of the fruit—a practice which, however, should be condemned. Severe purging has followed the eating of the flesh of pigeons which had fed upon the berries. Poke has long been used in domestic practice, principally as a poultice to discuss tumors. The berries steeped in gin have long been popular as a remedy for chronic rheumatism. The American Indians made use of this plant, but it must not be confounded with the plant known as Indian poke, which is the Veratrum viride. It is much used for the inflammatory condition of cow's udders, known as "garget," hence one of the names for this plant. Phytolacca yields its virtue to water and alcohol. The leaves and berries possess some medicinal activity, but the root is the part principally used. This root loses its medicinal properties with age, consequently only recent material should be used for making the fluid preparations. According to E. H. Cressler (Amer. Jour. Pharm., 1875, p. 196), the inhalation of the powdered root produces soreness of the throat and chest, severe coughing and inflammation of the eyes.

Description.—I. PHYTOLACCAE FRUCTUS (U. S. P.), Poke-berries. "A depressed-globular, dark-purple, compound berry, about 8 Mm. (1/3 inch) in diameter, composed of 10 carpels, each containing 1 lenticular black seed; juice purplish-red; inodorous; taste sweet, slightly acrid"—(U. S. P.).

II. PHYTOLACCAE RADIX (U. S. P.), Poke-root.—"Large, conical, branched and fleshy; mostly in transverse or longitudinal slices, wrinkled, grayish, hard; fracture fibrous, the wood-bundles in several distinct, concentric circles; inodorous; taste sweetish and acrid"—(U. S. P.).

Chemical Composition.—The berries, according to Terreil (Comptes Rendus, 1880), contain phytolaccic acid, which is gummy, non-deliquescent, soluble in water and alcohol with acid reaction, hardly soluble in ether. Haverland (Dissert., 1892) likewise obtained it, with small quantities of acetic, citric, and tartaric acids. W. Cramer (Amer. Jour. Pharm., 1881, p. 598) found the juice of the berries to contain gum, sugar, malic acid, and coloring matter. The coloring matter was isolated in comparatively pure form by Herman Harms (Amer. Jour. Pharm., 1893, p. 1) as a purplish-red powder insoluble in absolute alcohol, ether, and chloroform, but readily soluble in water. It is destroyed by ferric chloride, chlorine water, hydrogen sulphide, etc. It reduces Fehling's solution direct. Alkalies dissolve it with yellow color which is turned red by acids. Phytolaccin is an indifferent crystallizable principle isolated by Edo Claassen (New Remedies, 1879, p. 326) from the seeds of phytolacca berries; it is soluble in chloroform and alcohol, slightly soluble in water. It was also obtained by Harms (loc. cit.) and analyzed by Haverland (1892), who found it to be free from nitrogen and related to the tannins.

The root of phytolacca is remarkable for the great amount of potassium it contains. A splinter of the root imparts to the Bunsen flame a violet coloration. G. B. Frankforter (Amer. Jour. Pharm., 1897, p. 134) found in the dried root 13.38 per cent of ash, of which 41.6 per cent, or 5.56 per cent of the dried root, are potassium oxide. Part of the latter exists in the form of potassium nitrate (Pape, Amer. Jour. Pharm., 1881, p. 597). A quantitative analysis of poke-root by G. F. Frankforter (ibid., p. 281), showed it to have the following percentage composition: Fatty oil and wax 0.6, bitter resin 1, non-reducing sugar 9.46, reducing sugar 0.4, proteids 1.94, amido compounds 1.6, probably free formic acid 0.36, potassium formate 1.9, starch 11.68, calcium oxalate 6.2, nitrates 2.4, cellulose 16.4, lignin 3.2, gum coloring matter, ash, moisture 42.75. The absence of acetic, citric, malic, tartaric, benzoic, and salicylic acids are affirmed, likewise the absence of tannin and of chlorides. Phytolaccic acid is possibly present, but no alkaloid or glucosid could be isolated, although reactions were obtained with some alkaloidal reagents. Edmond Preston (Amer. Jour. Pharm., 1884, p. 567) had obtained an alkaloid from the root, which he named phytolaccine, while N. Coscera (Chem. Centralbl., 1887) found a glucosid. The root contains a substance probably closely allied to saponin (see H. Trimble, Amer. Jour. Pharm., 1893, p. 273).

Action, Medical Uses, and Dosage.—Physiologically, phytolacca acts upon the skin, the glandular structures, especially those of the buccal cavity, throat, sexual system, and very markedly upon the mammary glands. It further acts upon the fibrous and serous tissues, and mucous membranes of the digestive and urinary tracts. The drug is principally eliminated by the kidneys. Applied to the skin, either in the form of juice, strong decoction, or poultice of the root, it produces an erythematous, sometimes pustular, eruption. The powdered root when inhaled is very irritating to the respiratory passages, and often produces a severe coryza, with headache and prostration, pain in chest, back, and abdomen, conjunctival injection and ocular irritation, and occasionally causes violent emeto-catharsis. Phytolacca slows the heart's action, reduces the force of the pulse, and lessens the respiratory movements. It is a paralyzer of the spinal cord, acting principally on the medulla. In poisoning by this agent tetanic convulsions may ensue. Death results from carbonic acid poisoning, the result of respiratory paralysis. Upon the gastro-intestinal tract doses of from 10 to 30 grains of it act as an emetic and drastic cathartic, producing nausea which comes on slowly, amounting almost to anguish, finally after an hour or so, resulting in emesis. It then continues to act upon the bowels, the purging being prolonged for a considerable length of time. It is seldom used for emeto-cathartic purposes, on account of its tardy action, which, when established, continues for some time. It rarely causes cramps or pain. Large doses produce powerful emeto-catharsis, with loss of muscular power-occasionally spasmodic action takes place, and frequently a tingling or prickling sensation over the whole surface. Dimness of vision, diplopia, vertigo, and drowsiness are occasioned by large doses not sufficient to produce death.

Therapeutically, phytolacca is emetic, cathartic, narcotic, and alterative. In certain conditions of the system which might come under the head of dycrasia, it proves a most valuable alterative. Scrofulous, syphilitic, and rheumatic conditions are invariably benefited by it. It is best suited to chronic rheumatism, and syphilitic and rheumatic joint affections. As an antirheumatic quite large doses are necessary. The specific phytolacca may be used, or a saturated gin tincture of the berries. Preparations of the root are excellent for the removal of those severe pains attending mercurio-syphilitic affections (osteocopus), often being more beneficial than opium.

Phytolacca plays an important part in dermatological practice. It destroys the "itch" insect, consequently it is of value in scabies. The condition which calls for it is one of indolent action of the skin, usually associated with vitiated blood. There is a glandular difficulty—a scrofulous condition. There maybe scaly, vesicular, pustular, or tuberculous eruptions, and lymphatic enlargements with pain. The skin maybe inflamed, but does not itch because there is not activity enough in the part. It is often indicated in chronic eczema, syphilitic eruptions, psoriasis, tinea capitis, favus, and varicose and other ulcers of the leg. Associated with iris, it is a valuable agent in acute sycosis, fissures, fistulae, boils, carbuncles, dermal abscesses, and all ulcerations of the outlets of the body. It relieves the pain of burns and promotes rapid healing. For skin diseases it should be employed internally and locally. Rx Specific phytolacca ʒss, aqua ℥iv. Sig. Teaspoonful every 3 hours. Locally: Rx Specific phytolacca ʒij, glycerin ℥j. Mix. Apply.

In diseases of the mouth and throat it is highly esteemed. It is useful in acute and chronic mucous affections, as in tracheitis, laryngitis, influenza, catarrh, and especially in those affections where there is a tendency to the formation of false membrane, as diphtheria. There is a pallid, somewhat leaden-colored tongue, with but little coating, being a slick, glutinous coat, if covered at all. The mucous membranes present whitish erosions, or vesicular patches. With these conditions it may be employed in tonsillitis, follicular pharyngitis, stomatitis, aphthae, nursing sore mouth, or ordinary sore mouth, and syphilitic faucial ulcerations. It should be taken internally and used locally as a gargle. It is one of our most valuable agents in non-malignant diphtheria. It is indicated by diphtheritic deposits. It stimulates, the mucous surfaces, promotes glandular activity, and removes the diphtheritic membrane. It is a good remedy in chronic tonsillar hypertrophy. It is beneficial in difficult respiration produced by bronchocele (iris is useful here also) and associated with baptisia, does good service as a local wash in ozena and other forms of nasal catarrh. Cough resulting from inflamed or irritated sore throat is cured by it when the other indications for the drug are present.

In diseases of the glandular apparatus phytolacca and iris are our best drugs. Unlike iris, though, the former is best suited to hard, lymphatic enlargements. It is not the remedy for suppurative conditions of the glands. In such cases iris with baptisia renders the best service. No other remedy equals phytolacca in acute mastitis. If employed early it prevents suppuration, yet it acts kindly even when the abscess has to be opened, and the diluted specific phytolacca may be injected into the cavity. The remedy should be administered internally, alternated with specific aconite. Locally, specific phytolacca and glycerin may be applied when suppuration has not begun. Or the powdered root may be employed, moistened with water. Parotitis is almost always cured with phytolacca and aconite. Metastasis of mumps to the testes, as well as orchitis, from other causes, indicate this drug. Sore nipples and mammary tenderness, or morbid sensitiveness of the breasts during the menstrual period call for phytolacca. It is a good remedy for ovaritis. Lymphoma has been cured by it. Subinvolution of the uterus, uterine and vaginal leucorrhoea, and some cases of membranous dysmenorrhoea are cured by this agent. Applied as a poultice it has been greatly beneficial in the treatment of felons, and internally administered has cure bronchocele when iodine has failed.

Ulceration of the mucous crypts of the stomach and of Peyer's patches call for phytolacca. Nasal catarrh, ozena, and other ulcerated conditions of the nasal membranes are benefited by phytolacca associated with specific baptisia. It has been used with success in gonorrhoea and copious nocturnal urination. It relieves conjunctival inflammations, and gonorrhoeal and syphilitic sore eyes. In granular conjunctivitis I have derived much advantage by bathing the eyes daily with a decoction of the root, applying it to the affected conjunctiva by means of a camel's hair pencil, at the same time administering the tincture of the recent root internally (J. King). It has been used for the cure of piles, hydrophobia, and angina pectoris, but we possess better agents for these conditions. Headache, whether rheumatic, nervous, syphilitic, or sympathetic (as, sick headache from gastric acidity and debility), is much benefited by it. It is also one of our most useful remedies in asthenic hyperemia of the uterus, spleen, liver, and other organs. Good results have followed its internal administration in albuminuria, and in those dropsies attended with albumen in the urine. The root, roasted in hot ashes until soft, and then mashed and applied as a poultice, is unrivaled in felons and tumors of various kinds. It discusses them rapidly, or, if too far advanced, hastens their suppuration. Associated with iris it may be employed in mesenteric and splenic tuberculosis. Several years ago it was noticed that birds lost their adipose tissue when feeding upon poke-berries. Recently, this agent, in the form of an extract of the berries, has been employed to reduce obesity. Reports for and against its virtues in this line are now appearing in journals, but its action is still doubtful. Some, believing that it does act in this way, have suggested its use in fatty degeneration of the heart. Probably it would be more clearly indicated if associated with a rheumatic diathesis. The root or leaves finely powdered, and added to lard to form an ointment, in the proportion of 60 grains to 1 ounce of lard, is very efficient in scaldhead, and many other obstinate skin diseases, occasionally causing a slight degree of irritation when applied.

An infusion of the leaves taken internally is slightly cathartic; when bruised and applied locally, they are beneficial in indolent ulcers. A strong decoction of the leaves is of much benefit in hemorrhoids; if injected into the rectum 2 or 3 times a day, and a fomentation of the leaves applied to the part, it will almost always give relief, and eventually effect a cure. A fluid drachm or two may be taken internally at the same time, and repeated 2 or 3 times a day; should any narcotic effects be produced, its use may be omitted for 1 or 2 days, and then commenced in smaller doses. The inspissated juice of the leaves has been recommended in indolent ulcers, and as a remedy in cancer; in this last disease, Dr. Bone combined it with gunpowder. Quite recently, the inspissated juice of the leaves has been lauded as a new local remedy for the removal of carcinoma. The treatment, however, is not new, having been referred to by American medical writers early in the present century (see Felter, Ec. Med. Jour., 1896, p. 335). The usual prescription for specific uses is: Rx Specific phytolacca gtt. x to xxx, aqua ℥iv. Mix. Sig. Teaspoonful every 1, 2, or 3 hours. As a glycerole: Rx Specific phytolacca ʒii, glycerin ℥i. Mix. Apply in chronic skin diseases. The dose of specific phytolacca ranges from 1 to 10 drops.

Specific Indications and Uses.—Pallid mucous membranes with ulceration; sore mouth with small blisters on tongue and mucous membrane of cheeks; sore lips, blanched, with separation of the epidermis; hard, painful, enlarged glands; mastitis; orchitis; parotitis; aphthae; soreness of mammary glands, with impaired respiration; faucial, tonsillar, or pharyngeal ulceration; pallid sore throat, with cough or respiratory difficulty; secretions of mouth give a white glaze to surface of mouth, especially in children; white pultaceous sloughs at corners of mouth or in the cheek; and diphtheritic deposits.

Related Species and Pharmacal Preparations.Phytolacca dioica, Linné (Pircunia dioica, Moquin-Tandon). A tree about 25 feet high and from 6 to 10 feet in circumference; native of Brazil or Mexico, and naturalized in Algeria. The wood is spongy. The berries grow in racemes, are yellowish-green, 12 to 15-celled, each cell containing a flattened seed. According to Balland (Jour. Pharm. Chim., 1881, p. 232), the berries are sweet and edible, and yield by expression 74 per cent of a juice which contains resin, volatile oil, dextrose (3.20 per cent), saccharose (11.2 per cent), an undetermined organic acid (perhaps phytolaccic acid) (2.6 percent), gum (4.4 percent), etc. The resin is soluble in ether, and very acrid, but exists only in minute quantity. (Also see Amer. Jour. Pharm., 1882, p. 13.)

Phytolacca acinosa.—This plant is said to be violently toxic. The Japanese use it as a diuretic. A non-crystalline resin, phytolaccotoxin (C24H38O8), has been isolated from it by Dr. Kashimura. It produces spinal convulsions and is reputed to impress the vasomotor system, acting thereby as a stimulant to the circulatory apparatus.

ARTHROSIA.—This specialty of Win. R. Warner & Co. (Philadelphia and New York) is a combination in pilular form of salicylic acid, extracts of colchicum and phytolacca, resin of podophyllum, quinine, and capsicum. It is antirheumatic, antilithic, tonic, and alterative, and is prescribed in acute and chronic gout, rheumatism, neuralgia, sciatica, rheumatic headache, and in some renal and hepatic affections. Dose, 2 pills, 3 times a day, an hour before meals.

SUCCUS ALTERANS is a combination of vegetable alteratives prepared after the formula of Dr. George W. McDade, by Eli Lilly & Co., of Indianapolis, Ind. It is very extensively used as an alterative in syphilis, scrofula, anemia, eczema, and other diseased conditions the result of impoverishment of the blood. It contains in combination, the juices of Stillingia sylvatica, Smilax Sarsaparilla, Phytolacca decandra, Lappa minor, and Xanthoxylum carolinianum.

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.