Rhus Toxicodendron.

The fresh leaves of Toxicodendron radicans (L.) Kuntze (Rhus radicans, Linné, Rhus Toxicodendron, Linné) (Nat. Ord. Anacardiaceae) A common indigenous plant in fields, woods, and fence rows.
Common Names: Poison Ivy, Poison Vine, Poison Oak.

Principal Constituents.—A volatile toxicodendric acid, and the poisonous toxicodendrol, a non-volatile oil soluble in alcohol, and forming an insoluble lead compound with lead acetate, hence the use of an alcoholic solution of the lead salt to remove it and prevent poisoning or its extension. It is allied to cardol found in cashew-nut.
Preparation.—Specific Medicine Rhus. Dose, 1/20 to 5 drops.

Specific Indications.—The chief and most direct indication is the long pointed tongue with prominent papillae, associated with burning heat, and redness and great unrest. Others are: The moderately quick, small, sharp pulse, sometimes wiry, sometimes vibratile; great restlessness with or without vomiting; child starts from sleep with a shrill cry as if from fright; tongue red and irritable, exhibiting red spots; strawberry tongue; pain over left orbit; burning pain; rheumatic pain aggravated by warmth; pinched countenance; burning pain in the urethra with dribbling of urine; acrid discharges from the bladder or bowels; tympanites; brown sordes; bright, superficial redness of the skin with burning, itching, or tingling; red glistening erysipelas, with burning pain; redness of mucous surfaces; conjunctival inflammation with pain, photophobia, and burning lachrimation; inflammation with bright-red tumid surfaces and deep-seated burning pain; tumid red swellings; inflammation with ichorous discharges, the tissues seemingly melting away; old ulcers with shining red edges; induration of the submaxillary glands.

Action and Toxicology.—Internally, administered in small doses, Rhus Toxicodendron is slightly stimulant, increasing the renal and cutaneous secretions, and proving feebly laxative. Employed in paralytic states it is reputed to have effected a return of sensation and power of movement, the good effects being ushered in with a sensation of pricking and burning, with twitchings of the affected parts. Large doses occasion stupefaction, or a sort of intoxication, exhibited by vertigo, impairment of the special senses, pupillary dilatation, chilliness, sickness at the stomach with thirst and burning pain, and a feeling of constriction in the temporal regions. The pulse becomes slow, irregular and small, the activity of the skin and kidneys increases, weakness, trembling, and fainting occur, and sometimes convulsions ensue. A pint of rhus berries induced drowsiness, stupor, delirium, and convulsions in two children who partook of them. The infusion of the root taken internally is asserted to have produced the characteristic local eruptions, besides producing a harsh cough, scanty urine, and severe gastrointestinal symptoms.

Locally, rhus is a powerful irritant poison. The toxic manifestations produced by the different species are of precisely the same nature, differing only in degree of intensity. Rhus Toxicodendron ranks next to poison dogwood (Rhus venenata. in point of virulence. While locally poisonous to some persons, others are totally unaffected by it. Many are but mildly poisoned by it; many more, however, show serious evidence of its great activity. Contact is not always necessary to obtain its effects. Indeed, many individuals apparently are poisoned merely by exposure to an atmosphere contaminated with the toxic exhalations of the plant. This is especially true when the air is heavy and humid, or when the susceptible individual is freely perspiring. Alcoholic solution of the toxic principle retains its virulence for many years (Johnson). The dried leaves are, as a rule, inert.

A singular feature connected with rhus poisoning is its recurrence from month to month, and from year to year, even when the affected individual is far remote from all exhalations of the plant. This was early noted by Barton, who personally experienced such recurrence for five successive years-a portion of which time was passed in Europe far from proximity to the plant in question. We have also observed this phenomenon. The smoke from burning rhus wood was noticed as early as 1720 by Sherard, Wangenheim, and Kalm, to produce poisonous effects. It appears that horses eat the plant with impunity (Barton). According to William Bartram, they are very fond of the leaves. Cows are wholly unaffected by the ingestion of the plant. Thunberg observed that sheep ate of the leaves of Rhus lucidum, a similar species, without harm. To dogs and guinea pigs, on the other hand, poison vine is fatal. The statement that the infusion of the leaves was administered to consumptives with non-poisonous results may seem contradictory, but we cannot but believe that a portion of the poisonous principle is volatile, in spite of the assertion that non-volatile toxicodendrol is the toxic agent, and consequently driven off in heating.

The nature of poisoning by rhus has always partaken somewhat of the mysterious, and it has been the subject of much speculation. Various reasons have been assigned as to why it poisons at all, and as to why it affects only certain individuals. It has been customary to attribute the deleterious effects to emanations from the living plant. Later, Prof. Maisch announced a volatile substance of acid character as the offender, and named it toxicodendric acid. Still later, a bacterium was charged with creating the mischief. The latter cause, however, has now been satisfactorily disproved. An oil has now been isolated, and this, even when purified, excites exactly the same form of dermatitis as the growing plant. This discovery was made in 1895 by Dr. Franz Pfaff, of Harvard University. It is present in every part of the ivy plant, and even the dried wood is said to retain it. It has been named toxicodendrol, and is asserted to be in reality the only tangible substance found thus far to which may be attributed the toxic effects of the vine. Still, this does not explain why individuals are poisoned when not in contact with the plants. Alcohol freely dissolves this oil, but water, as with oily bodies, does not, nor does it wholly remove it from the skin; hence the reason why washing after contact with ivy does not prevent the appearance of the characteristic eruption. Experimentation (see V. K. Chestnut, United States Yearbook of Department of Agriculture, 1896, p. 141) has shown that if the oil be placed upon the skin, and immediately removed with alcohol, but slight effects are observed. The longer the interval, however, the more pronounced the effects become. In all, the effects were less marked than when no such treatment was given. From the fact that several portions of the skin could be impressed without coalescence of the areas, it has been concluded that the action of the oil is wholly local, and that the poison does not enter the blood. We are not, however, satisfied with this view of the matter, for if so, how are we to explain the recurrence of the trouble after weeks and months, and even years, in persons who for some time have not been near the plants or in the neighborhood of their growth?

The local effects of rhus are well known. Briefly stated, it occasions an eczematous, sometimes erysipelatoid, inflammatory eruption, characterized by intense itching, redness, and tumefaction, followed by burning pain, sympathetic febrile excitement, and vesication. The vesicles are at first small, closely aggregated in characteristic patches, and filled with a watery fluid; sometimes they become yellow, as if pus were present. Finally, as they mature, they rupture, when a yellow scab forms. The tongue is coated white, and headache and delirium are often symptoms. The effects are observable a short time after exposure to the poison, the affection usually spending its force in the course of four to five days, and is followed by desquamation of the cuticle. The face and genitalia seem to be favorite localities for the most pronounced swelling to appear. One case of poisoning by Rhus venenata came under our observation, in which the swelling of the face was so great as to wholly obliterate the features, giving to the individual a swine-like, rather than human, appearance.

Treatment.—Domestic medication, in the shape of bruised Impatiens pallida and fulva (jewel weeds) gave prompt relief. Lack of space forbids more than the partial enumeration of the many remedies that have been extolled for the cure of this malady. The chief, however, are lobelia (infusion), veratrum, gelsemium, hamamelis, grindelia, stramonium, eupatorium, serpentaria, lindera, sassafras bark, dulcamara, oak bark, tannic acid, alnus (boiled in buttermilk), carbolized olive oil, sodium bicarbonate, borax, alum curd (especially to be used near the eyes), and, perhaps the best of all, solution of ferrous sulphate (green vitriol) . Sugar of lead (lead acetate) has long been a favorite agent for the relief of this trouble, but as it has most frequently been applied with water, it has very often failed to give relief. It has now been shown that a solution in weak alcohol (50 to 75 per cent) often gives immediate and permanent relief. Occasionally, zinc and copper sulphates, oxalic acid, potassium chlorate, and other salts are effectual. Sodium carbonate, sodium sulphate, chlorinated lime, weak ammonia solution, and lime-water have been similarly employed. Echafolta has recently been extolled in this affection.

In our opinion, the following are among the best:

Aqueous solution of sodium salicylate and colorless hydrastis, freely applied. Aqueous solution of specific medicine lobelia., to which is added a little glycerin. An alcoholic solution of lead acetate sometimes relieves promptly. An aqueous solution of ferrous sulphate is excellent. It has the disadvantage of staining. A weak aqueous solution of potassium permanganate often relieves remarkably, but it, too, stains the skin and linen.

If obtainable, fresh alder bark (Alnus serrulata) in decoction gives quick relief in many cases.

Another effective application is the so-called "Eclectic Wash" composed of lobelia, baptisia and zinc sulphate, a preparation which is now marketed under the name "Citcelce".

In every instance, if much skin is involved, the diet should be light and cooling, and the bowels should be kept well opened to relieve the kidneys of some of the extra work put upon them through insufficient cutaneous action. In fact all treatment should be accompanied by a light, cooling diet, and cooling laxatives or diuretics.

Therapy.—Rhus is a medicine for nervous irritation, nervous tension, and the typhoid state. Its range of application is wide but distinct. Acting primarily and most pronouncedly upon the nervous system, it proves secondarily an ideal sedative to control excited circulation. The action of rhus is best understood, as with other well-worked-out specific medicines—by its fitness for conditions rather than for disease-condition groups which we know as particular diseases. It is especially of great value in children's diseases, and as far as our observations go is less required in patients past fifty years of age, except as a stimulant after paralytic attacks. Its value in irritative conditions of the brain and sympathetic nervous system, as well as in disorders of the gastro-intestinal tract, is very apparent, especially 'in the summer bowels affections of the young. It is a remedy best adapted for infants, young children, adolescents, and for those in the prime of manhood and womanhood.

The patient requiring rhus has a small, moderately quick and vibratile pulse, especially showing sharpness of stroke and associated with burning sensations. There is always a peculiar state of erethism which indicates it. The tongue is long and narrow, with marked redness, or reddened edges and tip, and prominent papillae, clearly disclosing a state of decided irritation and involvement of the brain centers. There may be only gastric irritability, there may be headache, there may be a jerky condition bordering closely upon a convulsive state, there may be delirium. The most noticeable symptom, however, is the great nervous unrest displayed, the little patient being excessively nervous and explosive. In this respect it somewhat resembles the great unrest which gelsemium relieves, but the latter is usually accompanied by bright eyes and contracted pupils and high temperature. The gelsemium patient is hot and agitated and the mental excitement is great. With rhus the nervousness takes on the form of twitching, jerking, and seems motor rather than mental alone. The rhus patient sleeps fretfully and disturbedly, frequently starting suddenly from out its slumbers, and uttering a sharp, shrill cry, as if in fright—the brain cry (cry encephalique)—which, once heard, will never be forgotten. For the condition which this cry announces no agent is equal to rhus. Brain cry is often heard in grave disorders, as typhoid fever and meningitis. The rhus patient may have some elevation of temperature, or have normal or subnormal heat. He is jerky, apprehensive, but when very ill, apathetic. His secretions, unless it be a diarrhoea, are in abeyance. His mouth is dry and the tongue is long, narrow, red at tip and edges, and inclined to dryness. In grave disorders indicating a dissolution of the blood there is a marked glutinous character to the secretions of the mouth, or they may be nearly absent and replaced by dry, black and fetid sordes. In this will be recognized the "typhoid state".

The circulatory disturbance requiring rhus upon which the nervous phenomena chiefly depend is usually localized and not general; small areas of the brain or nerve centers only may have a disturbance of the blood supply. As a rule the marked restlessness is all out of proportion to the apparent circulatory derangement. Frontal pain, sharp in character, is a prominent indication for this drug. The rhus tongue is reddened on the tip and edges, and even may take on the strawberry character, typical of gastric irritability, typhoid, and scarlatinal states. Associate this with the kind of pulse mentioned, and with tympanites, brown sordes, and reddened mucous surfaces, and the indication is still more direct. Discharges of an acrid character, and ichorous flow from tissues which seem to disappear by mere drainage, are further guides to its use. It is a certain remedy for vomiting when the tongue is of the kind above referred to. In fact, great unrest with vomiting is one of the most direct indications for its selection.

Rhus is of value in gushing diarrhoea, with or without vomiting. It has served well in cholera infantum with copious gushing, watery stools, both to control the discharges and to relieve irritability. In muco-enteritis it may be used to alleviate nervous disquietude, and to some extent to restrain the evacuations. During dentition it is extremely useful when the nerve stress borders upon the convulsive, but for the fretful and peevish and worn-out, teething patient matricaria is the better drug.

Rhus is a drug of the very greatest value in typhoid fever. We have successfully carried many cases of enteric fever through with no other medicine than rhus-the indications being the dry tongue, low muttering delirium, sordes on the lips and teeth, and diarrhoea. Should the urine become suppressed its use should be stopped until renal activity is improved. In typhoid dysentery, fortunately now rare, it is often serviceable when associated with the head symptoms indicating rhus. Nor should rhus be overlooked in the treatment of remittent and intermittent types of fever showing a typhoid element.

Rhus is frequently a remedy for pain. The more burning in character the better it relieves. Thus it relieves deep and superficial neuralgic and neuritic pains, the pain of pleurisy, and that of cystitis. Rhus is an aid, seldom a master, in acute rheumatism, but it helps to control pain when of a burning character, and the surfaces present an erysipelatoid redness. There is swelling, tension, and a glistening skin. When rheumatism is aggravated by the warmth of the bed, rhus appears to be indicated. Acute cases are more benefited than so-called chronic rheumatism, though it is especially useful in both to control restlessness. In toothache not due to caries, occurring in a rheumatic subject, rhus often relieves. These cases are said to be aggravated by warmth or by warm liquids. There are two forms of rheumatism especially benefited by rhus, whether they are acute or chronic. One is that induced by dampness and having pain of a subacute type; the other, so-called rheumatic involvent of the fibrous tissues of the body-the tendons, fasciae, ligaments, and muscle sheaths. The latter cases are probably not rheumatic, but due to toxic impression through retained poisons which impress the nervous system and produce pain. Only indifferent results attend its use in lumbago-though it should be tried when general rhus indications are present. Administered for a long period in small doses, rhus is one of the most satisfactory drugs for the articular stiffness resulting from rheumatic inflammation.

Rhus is frequently administered to relieve headache. That occurring in the frontal region is most amenable. Many contend that left-sided headache is that in which it is indicated, but we have never been able to verify this contention. With the rhus tongue and sharp stroke of the pulse and nervous tension present, we have found it to act equally well on either side of the head, or for that matter, upon any part of the body. The same may be said in neuralgia, whether in sciatic, facial, inter-costal, or other forms. When it does relieve headache and neuralgia it usually acts promptly.

Rhus is a valuable aid in pneumonia, bronchitis, la grippe, and phthisis, when the patient is extremely irritable and suffers from gastric irritation. With the small wiry pulse as a guide it often controls restlessness and delirium in these disorders and in adynamic fevers, which are probably caused by irritation and local hyper-vascularization of limited areas in the cerebral and other nerve centers. It is indicated in typhoid pneumonia, with red, glazed tongue, and offensive muco-purulent expectoration. Uncontrollable, dry, spasmodic, and tickling cough is frequently relieved by it.

In the exanthemata rhus appears to exert a special antagonizing influence, for which it may be given in scarlatina and measles where the vital powers are greatly depressed, and in variola, with livid color of the surface and foul discharges.

Rhus has been employed successfully in paraplegia without marked organic lesion, and in paralysis of the bladder and of the rectum. In paralytic states, however, it is usually of little value except in those conditions which follow attacks of rheumatism. We have, however, found it of great value in restoring power after hemiplegia and paraplegia. It should be given in liberal doses for a continued length of time. Its efficiency in sciatica, however, is admitted by some who think the drug practically valueless as a medicine.

Rhus is a remedy in the various disorders of the skin presenting the characteristic rhus indications—redness, intumescence, and burning. For vivid, bright-red, glistening erysipelas, especially when confined to the upper part of the face, with marked puffiness, it is one of the most successful of remedies. In fact in acute inflammations of the skin it is often more serviceable than aconite and veratrum. It is of great value in herpes where there are burning, itching, and exudation of serum. Eczema, pemphigus, and many irritable and inflammatory skin affections are relieved by it when redness, intumescence, and burning are prominent symptoms. It frequently proves the indicated drug in urticaria and functional pruritus. Erythematous and erysipelatous inflammation of the vulva, with burning pain, and the itching and vulval irritation following micturition, are often permanently relieved by rhus. Tumid, reddened, and glistening enlargements, and ulcerations with red glistening margins, syphilitic or nonsyphilitic, likewise call for rhus. In the ulcerative forms the parts seem to melt away without sloughing. It is of much value in parotitis, and in swelling of the submaxillary gland with great induration few remedies are better (Locke). Its constitutional effects are often manifested in slow-forming carbuncle and carbunculous furuncles. By some rhus has been used internally to hasten the cure of cutaneous rhus poisoning. Of this antitoxic power over poisoning by itself we have never been satisfactorily convinced.

In ocular therapeutics rhus is considered by many Eclectic oculists as an important drug. It is sometimes administered to prevent inflammatory action after cataract operations. Palpebral edema with marked redness is said to be relieved by it, while neuralgic and other pains in the globe of the eye, and aggravated by motion and warmth, often vanish under its use. Acute and subacute forms of conjunctivitis are relieved by it on account of its special affinity for the blood vessels of the orbit. In the catarrhal ophthalmia of scrofulous children with strongly inflamed palpebral edges and conjunctivae and marked photophobia and burning lachrimation, the action of the remedy is decided and prompt. There is usually a sensation as of foreign particles, such as sand, etc., in the eye.

The proper dose for specific effects, and it is scarcely employed in any other manner, is the fraction of a drop of specific medicine rhus, thus; Rx Specific Medicine Rhus, 5-15 drops; Water, 4 fluidounces. Mix. Dose, One teaspoonful every hour in acute disorders; four times a day in chronic affections. Rhus should, as a rule, be given unmixed with any ingredient but water.

The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.