Rhus toxicodendron

Volume III — Main text

Rhus radicans, poison-ivy or -vine, Rhus toxicodendron, poison-oak.

[There seems no real distinction between these two, and most of the observations of Rhus poisoning belong to the radicans variety.]

1. Provings, — I. Hahnemann, Mat. Mtd. Pura^ vol. ii of original and translation. Contains 976 symptoms, from self, 9 fellow -provers, and 16 authors. [It is here described as " R. radicans or toxicodendron."]

2. a. Dr. JosLiN, March 9th, 1846, took 3 glob, of 3rd pot. of Rh. radicans. 3 m., burning in throat j 6 m., burning and smarting of tongue, with (7 m.) flow of saliva ; 8 m., mucus in throat and posterior nares ; 15 m., pressive pain in r. chest, and in 1. lumbar region, with nausea ; 17 m., pain at middle of 1. radius (recurring at 28 and 35 m.) ; 18 m., pain under r. scapula (recurring at 21-2 m.) \ 24 m., rheumatic pain in 1. shoulder and deltoid ; 25 m., pain in 1. thigh ; 30 and 35 m., pain in r. wrist ; 35 m., pain in ascending colon j 38 m., pain in middle joint of I. index \ 40 m., pain in metacarpal joint of 1. index and in middle of r. upper arm ; 41 m., pain in I. forehead; 43 m., pain in middle joint of r. ring finger j 45 m., pain in 1. chest. On same d., having dissolved 7 pellets of same in as many teaspoonfuls of water, he took a tcaspoonful every m. from 12.42 p.m. In 3 m. after commencing it, nausea and great disgust j 12.56, pressive pain in I. occiput and pain in 1. chest (latter also 4 and 7 m. later) ; 1.5, pain in middle of 1. ulna 3 1.30, pressive pain 2 in. to r. of mid-sternum;

• The smooth sumach docs not cause poisoning by contact or emanations.

2.15, pain above ]. tendo Achillis when walking upstairs ; 3.8, pain in rectum when urinating ^ 4, itching in I. calf while walking. loth. — Transient pain in rectum. [After this practical absence of symptoms on and d., a number are reported as occurring during the next 9 d. ; but as they begin with a bad nightmare on 4th, they are more likely to be of idiopathic than of medicinal origin, and are omitted here. — Eds.]

h. Dr. J — collected, June 17th and i8th, 1846, some leaves when vine was in flower, and made a tinct. from them. After handling plant and inhaling its effluvia, he had — in i8th and 19th — pain at outer edge of I. patella on going upstairs after sitting for some time ; and pimples, large, deep-seated, and somewhat irritable to touchy on fold of nates.

c, June a3rd, at 9 p.m., took 3 pellets saturated with 3rd dil. 30 m., transient pain in r. shoulder. 40 m., pressure near middle of sternum, 1. side. 24th. — Slight cutting in urethra when urinating, at 5 p.m. 25th. — Dull pain in forehead, temples, and occiput, 6.30 — 7 a.m. 9.30, pressive pain in 1. inner canthus and neighbouring root of nose, 26th. — Woke at 5.30 a.m. with remittent burning pain through middle phalanx of r. little finger, with pain in r. temple. During forenoon (as also on previous d.) burning in oesophagus. A pimple (like those before described] came this d. on upper lip. On July ist repeated dose at 6 a.m., 12.20 and 11 p.m. After 8 m. tingling pain almost simultaneously in rectum and 1. hip when lying on 1. side, — tingling was as if in rapid vibrations. After 15 m., pain in ulnar edge of r. hand. 1 1 a.m., sleepiness, yawning, and indisposition to mental or bodily labour. 2nd. — Woke at 3 a.m. with (transient) burning semilateral pain just above zygoma and in occiput on same side. At I p.m. erysipelatous appearance of face below 1. eye, which returned for 4 d. after, without repetition of medicine. 1 1 p.m., burning and pressive pain, with sense of excoriation, behind upper sternum, and tickling there causing cough. 3rd. — Stinging below r. nipple, with itching there and in various parts of body, m. in bed. 4th. — Fain in r. lumbar region on rising from recumbent position, and in 1. calf at each step (weather cold and wet) ; transient burning and pressive pain in 1. neck and stomach on swallowing moderately cold water (also some d. before). 5th. — Tough unsuppurating pimple i in. above 1. nipple ; burning pain in 1. shoulder when walking. {Amer. Horn. Review^ ,

553 i »» 325)

1. Three persons, indicated by the abbreviations " Mllin.," " Gk.," and " Nfc.." but no information respecting whom or their mode of testing the medicine is given, are credited with the following symptoms (from Rh. tox.) :

a. Mllin. After awaking, m., and again falling asleep, it seemed to her that her head hung out of the bed, and the blood streamed into it like water from a pipe, so that she imagined she heard it j at the same time a hideous figure appeared to her, with whom she must go. Shooting in occiput when stooping. Her thinking power sometimes leaves her, and she turns giddy. Pain in head as though it would burst, worse when moving, she must remain quite quiet. At first bloody taste in both nose and mouth ; later, bitter bilious taste. Heat tn head down to neck. Great thirst. Pain in abdomen as if diarrhoea were imminent. She passes much urine. The flesh of the limbs pains as if beaten, aggravated by movement. Great weariness, especially when walkine in open air. Sensation as if drenched in cold water. Pain, especially in tcrob. cordis, renewed by coming from cold air into warm room. Lachrymose.

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b. Gk. Drawing ami paralysed feeling in I, arm, n.

(. Nk. Shooting and drawing in I. arm from upper part to finger-tips. (Helbic, HtraklUes^ i, 55.)

1. SCRRETER. [Tlic following symptoms are stated to have been observed by him ; manner unknown.] Pertutlical cutting in eyes, with heaviness*^!. of lids making it difficult to open them ; a sudden drawing pain in ears, a& if a thread were drawn through them ; a watery blifitcr on glans pcnik ; itching on head \ crampy drawing togcthet of toes. (HrtRTL. u. Trinks Ar%n.^ iii, 360.)

II. Po'iionings. — i. Two children, «t. 6 and 8 respectively, ate about a pint of the frutt of Rh. tox. In a few h. they became drowsy and stupid, and in a short time vomiting commenced, Arst of the partially digested fruit, afterwards of a thick tenacious fluid of a wine colour. Then followed convulsions of different parts of the body, accompanied by slight delirium. Respiration was hurried \ pulse at first full and strong, but slow, afterwards small, frequent, and compressible \ pupils dilated. Emesis was promoted, and carbonate of soda in solution freely administered. Both recovered, though younger convalesced very slowly. {Am. Joum, of Med. Sd.^ N. S., li,56o.)

1. Mr. WiLKE:>, a medical student, took a gill of a strong decoction of the leaves and vine after supper. Next m. his face was much swollen, becoming increasingly so till his eyes were completely closed. He used liq. hydrarg. bichl. as a wash, and in 36 h. swelling had disappeared. He slept nearly the whole time his eyes were closed. (Trans. of Am. Med. Ass.^ v, 755.)

2. A boy drank a tea made from the root, and had delirium ; suffused and watery eyes ; soreness of throat, with intense burning extending to stomach \ nervous twitchings \ he was covered with a rash like measles, face, neck, and throat being swollen ; intolerable itching of skin ; hieh fever. {Med. and Surg. Reporter^ 1 867 ; from Allen.)

3. a. The effects produced by Rh. when absorbed by the skin, either from exhalations from the plant or otherwise, are redness and swelling of the affected parts, and, if referable to exhalations, more particularly in the face and eyes, in which last there is burning, with inflammation of the lids, and agglutination of them in the m. Subsequently there is swelling, with pain, and often a considerable increase of temperature, and the inflamed surface is generally studded with vesicles. Combined with these symptoms there is an almost unbearable amount of itching, which is not confined to the patches of inflammation, but diffuses itself more or less over the entire surface of the body, the hairy portions appearing to be very specially affected. The condition induced thus appears to be of an erythematous or erysipelatous type. It is superficial, but spreads rapidly over the surface, and speedily involves large areas of the body, eventually extending to the mucous membranes, as indicated by redness and swelling of the throat and mouth, with, ordinarily, great thirst, irritable cough, nausea, vomiting, vertigo, dulness and stupefaction of head, and colicky pains throughout the abdomen. These last are chiefly experienced during the n., and are aggravated by eating and drinking. Diairhoea frequently ensues, accompanied by tenesmus, and the stools are often bloody. There is often retention of urine, or else diuresis, and the water is frequently accompanied by blood.

h. Rh. also induces pains, apparently of a rheumatic kind, which are felt not only in the limbs but in the body, though most especially about the joints. Pain and stifFness in the lumbar region are often induced, and to these affections is often added a sense of numbness in the lower extremities. The structures most powerfully affected seem to be the fibrous ones. The pains in question are accompanied by a very slight amount of swelling ; and, singular to say, they become intensified by rest and warmth. Sleep is greatly disturbed, the patient becoming restless, constantly turning about, and often suffering from great nervous depression.

€. The fever which sometimes accompanies the effects of Rh., though by no means a universal symptom, usually occurs, when present, in the later stages^ and generally partakes of a typhoid character. It is often attended by delirium, the lips are apt to become dry and parched, and to be covered with a brownish crust. Sometimes it assumes an intermittent character, and is then usually marked by profuse perspiration.

d. The above-described effects of Rh., though so distressing to whomsoever may have to endure them,appear, however, to be veryseldom fatal } and it is remarkable that a certain constitutional predisposition appears requisite to their occurrence, so that it is only individuals who are in danger. I have myself witnessed several instances of its poisonous influence, and can personally vouch for the manifestation of nearly all the phenomena that have been indicated. (Phillips, op, at.)

1. a. In June, 1871, Mrs. V. suffered very severely from a burning and itching eruption covering entire face and neck, both mammae, external genitals and neighbouring parts of thighs and abdomen, also both hands and wrists. Her husband at the same time suffered from a similar eruption, though not so severe, on both hands ; and an infant had it very slightly about mouth and chin. A week previous to the appearance of the eruption husband and wife had been to a picnic, and he had fastened his horses to a bush covered with a vine, the character of which he had not observed. The wife did not approach the plant, and the child had been left at home. The disease ran its course^ terminating in desquamation, without any benefit from treatment. Her suffering was so intense for several d. that I was compelled to keep her under the influence of morphia.

h. On May 6th, 1872, the eruption again broke out, appearing simultaneously in all the localities attacked the previous year. It began with swelling, redness, intense burning and itching. During the next 24 h. the inflamed surfaces became densely covered with very minute vesicles, which soon ruptured and poured out very copiously a yellowish serous fluid, which collecting in the most dependent parts desiccated into amber-coloured semi-translucent incrustations. Nothing relieved till carbolic acid with glycerine was applied. No trace of disease finally remained to mark its localities.

f. May 31st, 1873, eruption appeared for third time. It began with burning and itching on r. temple, slight redness, but no swelling. Next d. r. eye was entirely closed, and its swelling extended over adjoining parts of face ; it was red, firm and inelastic, no pitting. Part

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first attacked was covered with minute vesicles ; exudation very copious and seems to irritate inflamed face; burning and itching intense; no fever. Swelling (without redness) extended still further, and vesiculation occurred in parts about eye. Improvement set in after bathing surface with solution of carbonate of soda. (BusEY, /fm, y^urn. of Mtd. Sd., N. S., Ixvi, 436.)

1. In the spring of 1865 I attended a lady who, a few d. after exposure to the poison, suffered from swelling and inflammation of her r. cheeic, attended with intense burning and itching. The inflamed surface was covered with large blisters, containing a yellowish serous fluid. In the succeeding spring she was seized with a precisely similar attack, without being able to trace it to any renewed exposure to the poisonous plant. {Ibid,)

2. The perfect insusceptibility of some individuals and peculiar susceptibility of others is very remarkable. One may require the direct application of the expressed juice or of the distillate to produce its local effects. Another will resist the toxic action however applied. A third will suffer to an intense degree from simply going into the vicinity of the growing plant ; and, occasionally, persons are so easily affected that the smoke of^ the burning plant will poison them. . . . Another of its peculiarities is the readiness with which the eruption can be conveyed to other parts of the body by contact of the part which may have

cceivcd the poison from the plant, and from one individual to another, even though the first may not, or very slightly, suffer from its poisonous action (II, 5). . . . Sometimes I have thought the disease was extended by permitting the exudation to flow upon healthy parts, but more careful observation has satisfied me of the innocuousness of the latter, at least when applied to a healthy skin. . . . I am convinced that in many cases a week will pass before the appearance of the local symptoms, and the cases are very rare where any morbid condition is apparent within 48 h. ... I have witnessed no sequela other than the annual recurrence of the characteristic eruption. {Ihid.)

1. I had under my care a child who was poisoned, after bathing on a hot July day, with Rh. rad. The symptoms were all those belonging to septicemia ; suppuration had taken place in the ankle, which was aflfiected with severe synovitis. Besides this the patient had vesicles in mouth and throat ; constant picking at scrotum and penis ; large and purple bullae over the leg, which was immensely tumefied and red \ together with a tox:cmic appearance, which was remarkable in every respect. (Helmuth, System of Surgery ^ 4th ed., p. 67.)

III. Experiments en animals. — I. Clarus made physiological trials of Rh. on 2 men and 10 rabbits. A small quantity of the freshly bruised leaves was tied on to the arm, but after i h. no effect was observed. ^j of the extract was swallowed bv a man, but caused no effect. The rabbits were treated by injection of 3j of the juice, of ^ij of the distilled product of the resinous matter which remained after evaporation of the alcoholic solution rubbed up with sugar and then mixed with water, of _^S5 of the officinal extract. No effects were observed. {ff'ochenhL d, Zeitseh. d, i. *. Ges, d, AerxU in IVien^ 1862, No. 18.)