THE ordinary conception of Podophyllum as a drug for summer diarrhoea is far too restricted. Although it is immensely useful in summer diarrhoea, it has a sphere of action very much greater than that.
The type of summer diarrhoea in children in which Podophyllum is so very useful is that in which there is the most profuse, very offensive, watery diarrhoea, accompanied by the passage of a quantity of very offensive flatus, associated with acute abdominal colic and with signs of very acute prostration.
It is usually associated, in these summer diarrhoeas, with signs of a certain amount of meningeal irritation, sometimes amounting to no more than a constant rolling of the head from side to side, though there may be actual retraction of the neck. Very commonly, this is associated with a constant chewing motion of the jaw, there may be actual grinding of the teeth if the child is a little older; and, not infrequently, there is a definite squint. It is not a true meningitis; on lumbar puncture there may be slightly increased pressure, but no abnormal cerebro-spinal fluid.
This type of summer diarrhoea does respond very well to Podophyllum, but it is only a very small part of the story. You get indications for Podophyllum in all sorts of gastro-intestinal catarrhs, very often with an extension up the bile ducts and a definite cholecystitis. Occasionally there may be indications for it in gall-stones, although that is not so common.
The patients mainly complain of constant discomfort after any food, and feel as if they were stuffed full. With this feeling, they say that they cannot digest anything, everything seems to turn sour. Associated with the spoiled sensation in the stomach they have frequent attacks of acute salivation and belch up a quantity of sour wind. They often have a burning sensation in the throat and a burning tongue, accompanied by intense thirst and a desire for cold drinks.
In all digestive disturbances, these patients get a very thickly coated tongue, particularly at the root. The tongue as a whole is often somewhat soft, flabby and pale, with a very thick yellow coating at the base.
The vomit may be anything from sourish fluid to definite bile, depending on the extension of the catarrh-whether it is merely gastric or has spread down into the duodenum or involves the liver. When the liver is involved, they usually have pretty extreme nausea and aversion to every kind of food-they simply cannot bear the sight of it.
They get a good deal of pain in the liver, which is very much worse from pressure, the pain extends right through to the back and is somewhat relieved by gentle stroking, particularly stroking from behind forwards in the region of the liver. These somewhat jaundiced patients often sit up in bed, just stroking the liver, trying to shift something. They find some relief from it, although the sub-costal region will be very sensitive to pressure.
In the catarrhal attacks, the patients tend to be very depressed, almost melancholy; and, if the pain is troublesome, they may becomes very fidgety and restless. In acute attacks, they frequently run a temperature, and may then have profuse night sweats.
There is a more chronic condition with a history of the patients having “liver upsets” as they call them-digestive upsets with a feeling of fullness in the upper abdomen and a general dragging sensation in the lower abdomen. With an attack of diarrhoea, they get a severe dragged sensation in the abdomen and feel extremely faint.
Before the bowels act, there is a sensation of fullness in the rectum, with a good deal of generalised abdominal and gurgling, After the bowels have moved, they have a feeling as if the rectum would prolapse, an increase of the dragging sensation and a horrible feeling of faintness.
In spite of their distress, they often say they prefer to have an attack of diarrhoea because if they become at all constipated they are liable to suffer from very severe occipital headaches. It is a sort of bilious, sick headache which these people describe, with a loathing for all food, general depression and a disinclination to do anything.
Typical Podophyllum patients are sensitive to cold. Their attacks of colic are relieved by externally applied warmth. Their attacks of diarrhoea are likely to be precipitated by any acid fruit, sometimes by milk, and very often by vegetables of the cabbage type.
Not infrequently these attacks of diarrhoea occur in the early hour of the morning, between 2 and 5 o’clock. The diarrhoea is very urgent and, if the call is not attended to at once, there is liable to be incontinence.
Occasionally, Podophyllum is indicated for women who suffer from recurring attacks of diarrhoea at their periods. Where the patients has made rather a slow recovery after a confinement and has a sensation of abdominal drag all the time.
She probably has a bulky uterus, and at the period the uterus feels very heavy; she may even have the sensation of a prolapse developing. This, associated with recurring attacks of diarrhoea at the periods, will very often be controlled by Podophyllum which materially improves the pelvic condition.
One other condition in which Podophyllum can be very helpful is the constant urging to stool accompanying rectal carcinoma. There is a history of alternating attacks of diarrhoea and constipation, of pretty violent tenesmus at stool with difficulty in passing stool; of feeling as if the rectum were being forced out and a prolapse were developing, and of violent straining to pass a little offensive blood and mucus.
This condition is frequently controlled by Podophyllum. Several rectal carcinomas have very materially diminished under the action of Podophyllum; it not only controls the discomfort but seems actually to control the growth.
One old man had an extensive, inoperable carcinoma. He had known that he had it for about eighteen months before I saw him. His story was that he got recurring attacks of diarrhoea and constipation, and when he was developing an attack of diarrhoea he used to get awful rumbling and gurgling in his abdomen and then a sudden urge to stool, which he could hardly control. The stools were very offensive; he nearly collapsed after each action and often had pretty violent and painful tenesmus.
He went on for two to two and a half years on occasional doses of Podophyllum. He went slowly downhill (incidentally, he died from an intercurrent pneumonia which he developed while he was in the country) but from the time of my first seeing him, his carcinoma certainly diminished in size. When I first saw him, I could not insert the tip of my finger into the annular stricture: when I last saw him, about two and a half years later, I could pass my forefinger through quite comfortably. And, from being incontinent, he had regained complete control.
He died of an intercurrent disease, and whether he would have recovered from his carcinoma had he survived, I do not know; but the amount of relief he got from Podophyllum was simply astonishing.