Rhus diversiloba

Volume IV — Appendix

Bhus diversiloba,

Il, Poisonings—t. a. In Feb., 1876, Miss M—, a slight, brown haired, but fair-complexioned lady of 25, walked up a hill at San Raphaél, 15 miles north of San Francisco, on a warm morning, and while perspiring freely gathered ferns which grew among the poisonoaks, She did not handle the leaves of the latter, though she must have often touched them. About this time of the year the young leaf shoots are beginning to sprout, and, the California sun-rays being as powerful in February as in July, their virus is pretty energetically developed. Miss M— proved very much infected—quite unknown to herself, for on the next day (Saturday), having returned to the city, she felt in the afternoon chills and feverishness by turns, and general malaise, Next day (Sunday) she awoke feeling really ill. She hada dull frontal headache, anorexia, nausea, stiffness of limbs, extreme languor, and an eruption of itching red papules behind each ear and on the neck, On Monday these papules enlarged and became more numerous, and the eyelids were red and aedematous, Face was red and swelled ; the cervical glands became tumid and slightly tender. On rising from bed she fainted, and again later in the day syncope cameon. On Tuesday the rash had extended all over face and hands, and between toes and thighs. The itching was becoming more and more intolerable, and partook of a burning character ; the nausea continued, and vomiting occurred this d. ‘During this d. and the two following urine was scanty, high-coloured and passed with a feeling of heat in urethra, Bowels were costive all through the attack. About the sth d. from their first appearance the papules had become vesicles, which rapidly coalesced on the face and burst, emitting an acrid serum, which, on drying, formed a crust, so dense a3 to make the movement of the facial and buccal muscles painful. Nose and lips were much swollen, Edema of eyelids was so great as to close up |. eye entirely and r. partially, The burning and itching were somewhat relieved after the breaking of the vesicles, The acute stage was now over (6

d. after the commencement), but the cracking of the crusts over the &ce, &c., occasioned such disfigurement that the lady was confined to die house for a fortnight more ; by that time all traces of the skineryaipelas had disappeared, only an unusual irritability (to flannel, &c.) of'^tbe integument remained, and a hyper-sensitiveness to cold air. She feic very weak afterwards.

k A second attack in Aug. from a slight exposure to the shrub at

Af enk> Park, an open flat country 30 miles south of San Francisco,

abounding in scrub-oak, poison-oak, tarantulas, and gophers (a kind of

mole), was promptly checked by the local use of camphor dissolved in

arz&ica tincture. The erysipelas of the face, however, was very intense

for 4—5 d. A third and a fourth attack in Sept. were promptly

checked (as to the face symptoms) by the same lotion ; and, so far,

it has proved the only abortifacient of the Rhus-erysipelas I have

known or heard of; but it is too strong for many people's skins, and

must be used with great caution. The virus must have remained in

lAist M — 's system, for, about 5 months afterwards, when in the city,

a filth attack came on, without any fresh exposure, shortly after taking

a bath rather too hot. One of the earliest symptoms this time was the

peculiar rheumatism of Rhus, affecting the legs chiefly, a stiffness of

*U the joints on first moving them ; aching pains in the joints, con-

^^t feeling of lameness in the legs. The vesicles that appeared

dunog the first two days were few and scattered, and strongly re-

•cnibled the eruption of chicken-pox. There was a slight amount of

'^'cxia. After an illness of nearly three weeks, during which the

raeuQiatism and derangement of the whole digestive system was very

'^^'marked, a course of four Turkish baths rapidly restored the health and

™c atnoothness of the integument. For three successive springs, 1878,

'^79, and t88o, crops of itching pimples came out on the neck and

"jl'^^s. All manifestation of Rhus poisoning then ceased. (J. Murray

*^*H>jLB, Jnnals tfBrit. Hem. Soc.y viii, 470.)

1. John W — , a light-haired, robust Englishman of 23, with pock. Ij^^ked face, a newly arrived emigrant, was travelling as colporteur in ^*p(i Valley, one of the most fertile in the State, about 50 miles north ^ San Francisco, during the middle of January, 1876. The weather "^ng warm in the intervals of the showers, he got much heated while Carrying his pack up and down the hills, on which the poison-oak was abundant } he lay down among them while sweating, and once or twice itlieved the bladder there, quite ignorant of the risk he was running. He proved to be a sensitive, for on 13th Jan., the day after he had last been among these bushes, heat and itching of the scrotum and inner adjacent surface of the thighs commenced, worst on the hairy parts. Next day the characteristic papules, on a base of diffused redness and oedema, appeared on the forehead and neck, rapidly spreading in all directions, and accompanied with heat, itching, and burning, but with very little general pyrexia. The urine was not high coloured, but felt ** hot '' when being passed. The digestive system was not disturbed much, only loss of appetite being experienced. The itching was relieve! by cold, but aggravated by heat, warmth, and rubbing qc ycxatcbio^; his head fek hot^ but did not aicVie. He cotv%\A\a^ \ea Vst

erysipelas ; but I was by this time familiar enough with tl mena of poison-oak to identify the nature of this pecuhar "a the history of the attack making the diagnosis absolutely cert having had a case to treat thus far, I gave him veratrum v rt_^ doses, without hunting about for a more exact similli ordered also a lotion of magn. sulph. (jss to Jj of tepid assuage the irritation locally. After commencing this trea erysipelas continued to spread for a few h., reaching ears ai and then seemed entirely checked, gradually subsiding from i after the first dose of veratrum viride. Within 3 d. all rash symptoms had completely disappeared, leaving only slight sfl forehead. But the poison still lingered in the system, forj ceasing the medicine, a relapse, not severe, occurred, and onc< same remedy quickly arrested it. No return has been e% The papules in this case did not develop into vesicles, an this not so much to the possibly less intensity of the infectioi cfFects of the remedy. {Ibid.)

1. Wilson K — , aet. loycars, of pure blond type, with th skin, born in England, was poisoned while playing on som in the rear of Post St., San Francisco, in Feb., 1876. ffl some of the leaves, but threw them away quickly. Howeirt 18 h. his face had become red, inflamed, and hideously si eyes being both quite closed, and the itching and burning I distressing. The local erysipelas and oedema lasted one papules developing into vesicles, which became confluent an the same course a» in No. i. The general eruption cxO the whole body, and did not disappear for five weeks. A mi of the old school attended, and ordered a saltand-water loti occasional saline aperient. The salt lotion relieved the itch the first attack, but failed in two subsequent attacks. I month that the boy had now apparently attained immunit] poisun-oak. [Ibid.)