Mancinella

But I do nothing upon myself, and yet I am my own Executioner.
[John Donne]

Signs
Hippomane mancinella. Manchineel. Beach Apple. Manzanillo. N.O. Euphorbiaceae.

CLASSIFICATION Hippomane mancinella is one of the five species of the genus Hippomane, a genus native to the West Indies. The genus belongs to the Spurge family or Euphorbiaceae, a large group comprising some 5,000 species of dicotyledonous herbs, shrubs and trees in about 300 genera. Few species have a very wide range, the largest and most wide-ranging genus being Euphorbia with 1600 species. Genera such as Croton, Acalypha, and Phyllanthus are very large but their distribution is predominantly tropical.

DISTRIBUTION In the tropics, the richest concentration of the family is in the Indomalaysian region, with the New World tropics coming a close second; the genus Croton, for example, is remarkably well developed in South America, with about 300 species in Brazil alone.

FEATURES "Glands are a noteworthy feature of many Euphorbiaceae; they are generally associated with the flowers, where they either encircle the base of the ovary, or else they are associated with the inflorescence, as in the tribe Euphorbieae, or with the vegetative organs, as in many other tribes. Latex is present in the tribe Euphorbieae, but is generally absent from the other tribes. The latex is usually poisonous, especially in Hippomane mancinella, and can cause temporary blindness.

"1 A highly specialized cup-shaped type of inflorescence, termed cyathium, is found in members of this family, but chiefly in the genus Euphorbia. The inflorescence resembles a single flower and consists of a female flower in the centre surrounded by numerous simple male flowers enclosed within an involucre. The involucre also bears a number of glands [usually four or five] of varying shape around its rim. The female reproductive organs mature before those of the male [protogyny].

"Cross-pollination is effected chiefly by flies of the order Diptera, which are attracted to the cyathia by the flat gland-platforms which produce copious nectar. After fertilization, the female pedicel elongates, pushing the developing fruit up and out into the open above the gland-platform. It then commonly bends over at a point where there is a gap between the glands, the fruit then occupying a position beside or below the involucre. The fruit is almost invariably an explosively dehiscent three-lobed regma.

"2 USES A number of genera include species of considerable economic importance. The latex of Hevea brasiliensis, the para rubber tree, provides the raw material for most of the world's natural rubber. Manihot also includes rubber-producing species, but this genus is best known for its member Manihot esculenta, cassava, source of a staple food of poorer people in many tropical countries.

The three Vernicia species yield tung oil, used mainly in varnishes and paints. Oils for making soaps and candles are provided by species of the genera Aleurites and Sapium. Members of the tribe Crotoneae provide black, blue, purple, and red dyes. The unripe fruits of Hura crepitans, sandbox tree, were formerly used as containers of sand for blotting ink, or, filled with lead, as paperweights.

Numerous species possess an irritant and purgative latex, or seed oil, best illustrated by the drastic purgative properties of such species as Croton tiglium [croton oil], Jatropha curcas [purging nut], and Ricinus communis [castor oil]. A number of species include species of horticultural merit, e.g. Euphorbia [including the poinsettia, the crown of thorns, and the pencil tree], Acalypha [e.g. chenille plant or red hot cat's tail], Jatropha, Ricinus, and Codiaeum [commonly known as 'garden crotons'].

TRIBES The family is divided into eight major tribes. The species mentioned in the homoeopathic mat. med. belong to the following tribes: Acalypha [tribe Acalypheae]; Croton [3 species] and Mercurialis [2 species] – tribe Crotoneae; Euphorbia [15 species], Hura, Stillingia, and Mancinella – tribe Euphorbieae; Jatropha [2 species] and Manihot – tribe Jatropheae; and Ricinus is the only homoeopathic representative of the tribe Ricineae.

MANCINELLA "Although a useful shade tree for tropical situations – especially in poor soils near the coast – and notwithstanding the fact that Botanic Gardens sometimes grow it, few will wish to cultivate Hippomane mancinella. This is the Manchineel, one of the world's most toxic plants; even dew or rain dripping from the leaves carry sufficient poison to cause dermatitis. A drip in the eyes induces temporary blindness and should any of the latex touch the skin it causes a burning sensation, followed by blistering and painful swelling.

Smoke from the burning wood can cause headache and sore eyes, while eating the green, small, apple-like fruits is to invite terrible internal torment."3 This tree grows exclusively in a narrow belt fringing the seashores of the West Indies, particularly on or near sandy beaches of the Caribbean and Gulf of Mexico. It grows up to 15 metres high with alternate, shiny green leaves and spikes of small greenish flowers; it spreads about 6 metres.

As 'the most notorious of all irritant trees', it has been largely eliminated in southern Florida except from the Everglades National Park. Visitors are only permitted in certain parts of the park if they can prove to Park authorities that they can recognise the manchineel tree and so avoid poisoning.

NAME The name Mancinella is derived from the Spanish name manzanilla, diminutive of manzana, apple, in allusion to the walnut-sized fruits that look and smell like crab apples. A local name is Poison Guava.

TOXICOLOGY The wood is used locally for turnery and cabinet-work, but the sawdust causes rhinitis and cough and some men refuse to work with it. To avoid contact with its caustic milky juice, woodcutters char the bark before cutting the tree down. Dermatitis from contact with the tree reportedly affects principally the face, scrotum, and hands. Soldiers training in the West Indies during World War II developed bullous dermatitis and conjunctivitis after accidental contact with the sap.

The apple-shaped fruit is sweet-scented but highly poisonous; biting in it causes large blisters on the cheeks and lips which become extremely swollen. The sap was used by exiled prisoners in French Guyana to provoke dermatitis and conjunctivitis. Persons also used it on their backs to simulate the effects of a beating.

The irritant can be effectively removed from the skin by soap and water within 30 minutes of contact, or more traditionally by plain seawater as the tree is usually found on or near beaches. The seeds are violently emetic when ingested. 4 The latex is sometimes used in arrow poisons and to poison water holes for the fish therein.

The toxic irritants in the latex resemble those of Croton tiglium and Daphne mezereum. Intoxications are commonly observed in the Caribbean and Central American coastland; amongst them tourists with unfortunate experiences: "While searching for exotic shells and coral fragments, I saw some green fruits among the scattered coconuts and mangoes lying on the beach.

They were round, the size of a tangerine, and had apparently fallen from a large tree with a silvery bole and oblique based leaves. I rashly took a bite from this fruit and found it pleasantly sweet. My friend also partook [at my suggestion]. Moments later we noticed a strange peppery feeling in our mouths, which gradually progressed to a burning, tearing sensation and tightness of the throat.

The symptoms worsened over a couple of hours until we could barely swallow solid food because of the excruciating pain and the feeling of a huge obstructing pharyngeal lump. Sadly, the pain was exacerbated by most alcoholic beverages, although mildly appeased by pina coladas, but more so by milk alone. Over the next eight hours our oral symptoms slowly began to subside, but our cervical lymph nodes became very tender and easily palpable.

"5 DERMATITIS "Out driving one day we came upon quite a grove of these trees, and for the purpose of a closer examination of the innocent looking little apples scattered under the trees, we alighted and were about to pick up a specimen of fruit when we were startled by an excited voice shouting, 'Hi! There, don't touch them, dangerous!' Looking around we became aware of the presence of a benevolent appearing black man, who was gesticulating violently to attract attention.

I had already picked up one of the little apples and held it between the thumb and two fingers, and notwithstanding the warning of our coloured friend smelled of the fruit cautiously and cast it aside. After riding a short distance I was seized with an urgent desire to urinate and for relief entered a dense wayside thicket.

Continuing the drive I soon became aware of a disagreeable irritation in the genital region, which gradually increased to a decided smarting sensation, at the same time my right nostril became stuffed and hot, with a thin watery discharge therefrom; there was also a smarting at the external canthus of the right eye with profuse lachrymation.

Upon local examination at first opportunity, half an hour or so after handling the fruit, I discovered two red streaks extending up the anterior surface of the scrotum where in arranging the clothing the fingers had probably come in contact; there were also other spots and patches arising from same cause, all of which were covered with fine vesicles. At this stage there was little or no itching of the affected surface, but a persistent burning and smarting instead.

The vesicles were easily ruptured by friction of the clothing, and exuded a sticky moisture which speedily dried into crusts, that adhered quite tenaciously to the clothing causing much discomfort in being detached or separated therefrom, particularly the capillary adhesions. For four of five days this annoyance continued, accompanied by smarting and burning; there was relief from hot sitz-baths.

The eruption lasted about ten days, and then these surfaces returned to their normal condition. From many of these conditions carefully described to me, I have no doubt but that Hippomane manc. will be found an excellent remedy in dermatitis accompanied with excessive vesiculation, and the oozing of sticky serum and formation of heavy crusts and moist scabs, such as occur in the different forms of pemphigus.

"6 PROVINGS •• [1] Bute – 'provings with tincture on various persons.'
•• [2] Mure – several provers, 1847; method: tincture of the leaves, manner not stated. "When we were informed that a mancinella had been discovered near Rio, we requested Mr. Ackermann, a pupil of the institute, to repair to the spot for the purpose of verifying the identity of the plant, and collecting its juice. Having accomplished this mission, he drunk a portion of the liquid on the 10th of January, 1847, in a public sitting of the institute. He was joined in the proving by several of our pupils. Some of the symptoms were so violent, that they had to be counteracted by antidotes.

"6
•• [3] Petroz – 3 provers [2 females, 1 male], 1850; dose and manner not stated.
•• [4] Poisonous effects from: 'chewing the fruit'; inhalation of volatile poison while digging the roots; 'vapour while preparing a decoction of leaves in water'; 'external application of the milky juice'; 'eating two dozen apples'; 'effects of dew from the leaves dropping on to the skin'; 'breaking off a small twig'; 'passing some hours under the trees'; getting some sap in eyes while felling a tree.

[1-2] Heywood, Flowering Plants of the World. [3] Perry, Flowers of the World. [4] Schmidt, Botanical Dermatological Database; website. [5] Strickland, My most unfortunate experience: Eating a manchineel 'beach apple'; BMJ 2000; 321:428. [6] Morgan, Mancinella hippomane, Manganeel Apple; Int. Hahn. Assoc., 1902. [7] Mure, Provings of the principal Animal and Vegetable Poisons of the Brazilian Empire.

Affinity

Mind. Surfaces [mucous membranes; throat; skin].

Modalities
Worse: Cold [feet; drinks]. Dampness. Touch. Puberty. Climacteric.
Better: Rubbing. Walking.

Main symptoms
M FEAR of INSANITY.
Can't keep dark or evil thoughts out of one's mind.
Fear < in the dark [delusion of a dark evil inside].

M Fear of the DEVIL. [of being taken by the devil; fear of evil spirits; as if possessed by the devil].
Can be caused or intensified by watching horror movies.

• "This fear of devils and fear of hell can be very strong. These fears usually come up in the evening in bed. Sometimes, there is also a fear of darkness and a fear of ghosts or phantoms; fear of cockroaches [which have two antennas like the horns of the devil] and of extraterrestrials or aliens. The fear of devils can arise after watching movies like 'The Exorcist' or also in fanatically religious families where the parents constantly threaten the children with punishment by God or going to hell. The fear may start at school when they learn about heaven and hell." [Ghegas]
  M Fear of LOSING CONTROL.
  
• "It's a weak intellect where thoughts will intrude and the patient cannot control the thoughts, like Lac-c. and Arg-n.. So it's a weakness of the mental editor, the editing processes in the brain, to filter out unwanted thoughts." [Morrison]
  
  OBSESSIVE thoughts.
• "In adults, there can be a serious fear that they will kill their children because they feel mad. It is only a fear, not an impulse to kill." [Ghegas]
  
• "My experience with this remedy is that most people who need it, tend to be very soft and timid, people with a deep sense of insecurity, and of not being good inside. Their deepest fear is of being possessed by the devil. They will rarely say this to you, but when you read between the lines you will sense that that is what is going on.
  
  When you look into their eyes, it is as though you can get a glimpse of this dark side, it can even remind you of Thuja. There is this constant fight to try and be in control of this dark side in themselves, and therefore often causing them to be religious fanatics. They have a strong fear of insanity, most of which is not outwardly expressed. Many kinds of [religious] rituals may be used, to try and control these negative feelings. Very often these people will have come from a very religious environment. … We often see Mancinella patients wearing dark clothing. …
  
  Fear of evil and of the occult, yet a strong interest in these subjects. … Mancinella is made from a poisonous apple. We all know the bible story of Adam and Eve and the apple tree, the tree of good and bad. After they ate the apple, paradise was lost. It is striking that this is exactly the theme of Mancinella, the theme of good and bad."1
  
  M Fixed ideas of cutting or hurting oneself.
  
  Self-torture.
  M Sudden VANISHING of THOUGHTS.
  Forgets from one moment to next what she wanted to do.
  
  M Bashful timidity.
  [Compare: choking sensation in throat when speaking.]
  M Sensitive to noise; noises are felt as physical pain.
  Reverberation is felt all through body.
  
• "Pain in the right side of the head while listening to strokes on an anvil, he felt as though he were struck with a hammer."
  
• "When hearing the blows with a hammer the counter-shock is felt in the whole body."
  
• "Disagreeable sensation while hearing the noise of a saw." [Mure]
  M Sexual thoughts.
  • "Depressed, with sexual erethism." [Boger]
  
• "Mancinella has many delusions and ideas about sexuality, and often mixed up with feelings of evil." [Morrison]
  G < Puberty or climacteric.
  [Periods of big changes and low self-esteem; "the phase where the intellect is not well-formed"].
  
• "To be remembered in mental depressed states during puberty and climacteric, with exalted sexuality." [Boericke]
  G Warm-blooded.
  < Heat.
  G < Drinking COLD WATER [< burning pains].
  G BURNING pains.
  
• "A burning fire raging in the bowels." [Allen]
  P Empty sensation in head.
  [compare inability to keep out evil thoughts].
  P Aversion to tight collars [due to choking sensation in throat].
  [1] Sneevliet, Hechtel, homoeopathy as a lifestyle! [first three cases]; HL 4/97.
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  Rubrics
  Mind
  [vml5 – Mancinella – Mind] Ailments from excessive joy [2]. Anxiety, for others [1], < walking [1]. Delusions, devil is after her [1], floating in air [1], he will become insane [3], being possessed [3]. Fear, at night, midnight [1], of dark [1], of being taken by the devil [1], of ghosts [2], of insanity [3]. Erotic insanity [1]. Nymphomania at menopause [1]. Mental complaints in puberty [1]. Sadness, with sexual excitement [1]. Sensitiveness to noise, painful sensitiveness [1], noises reverberate all through body [1]. Sympathetic [1]. Tranquillity in morning on waking [1].
  
  Vertigo
  Sensation as if floating [2]. When reading aloud [1].
  
  Head
  Pain, as from a nail, vertex [1]; pressing, brain as if bound up [1].
  
  Nose
  Odours, burnt horn [1*], dung [1/1], gunpowder [1], onions [2].
  
  Throat
  Choking, when speaking [2], on swallowing [1].
  
  Stomach
  Constriction extending to throat [2]. Flushes of heat extending upward [2]. Pain after cold drinks [2].
  
  Rectum
  Diarrhoea after cold drinks [1].
  
  Female
  Menses only on motion [1].
  
  Limbs
  Numbness, hands on waking [1]. Swelling of feet in morning [2].
  
  Dreams
  Ghosts [1].
  
  Generals
  Faintness with pressure about heart [2]. Desire for uncovering [1].
  
  Food
  Aversion: [1]: Alcohol; bread; meat; water; wine.
  Desire: [2]: Salt; strange things. [1]: Cold drinks; sour; tobacco.
  Worse: [1]: Bread; cold food.