Rhus Toxicodendron (U. S. P.)—Rhus Toxicodendron, cont'd.

Cont'd from previous page.

Action, Medical Uses, and Dosage.—Locally, rhus is a powerful irritant poison. The toxic manifestations produced from the different species is of precisely the same nature, differing only in degree of intensity. Rhus Toxicodendron ranks next to poison dogwood in point of virulence. Whilst locally poisonous to some persons, some individuals 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 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 young lady in the employ of Prof. J. U. Lloyd, is always notified to remain at home—not even being allowed in the building—on the days when specific rhus is being bottled, so intense are poisonous effects in this case that mere exposure to the emanations is sufficient to cause the individual to be confined to her bed. Peter Kalm, the Swedish traveler, who visited this country during its colonial days—a man who investigated our plant resources and made large collections of the same—writes: "I was acquainted with a person, who, merely by the noxious exhalation of the Rhus vernix (venenata), was swelled to such a degree, that he was as stiff as a log of wood, and could only be turned about in sheets."

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 5 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 (Barton) that horses eat the plant with impunity. 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 can not 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 poisonous properties are likewise, in a measure, dissipated in drying the plant, hence the necessity of preparing the fluid preparations from fresh material. It is not surprising, therefore, that certain individuals—" eminent therapeutists"—have decried the use of rhus as of no value, when fluid extracts and tinctures from dried materials had failed to give good results.

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 toxirodendrol, 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 (The oil stays on your clothes, shoes, and equipment, so you keep "reinfecting" yourself. See the medicinal herbfaq on poison ivy, oak, and sumach. -Henriette). 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. Chesnut, 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 have not for some time been near the plants or in the neighborhood of their growth? (The oil is fat-soluble. Eat lots of high-fat foods and watch your whole-body poison oak rash develop as the fat hits your blood. This can happen up to two weeks after you touched the plant, so go careful on the cheese enchilada for a week or so after your field trip. -Henriette) There are many agents that might be used for the relief of this species of dermatitis, as lobelia, grindelia, sulphate of iron or copper, both of which have served us well, and the more recently recommended echafolta.

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 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 4 or 5 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. Domestic medication, in the shape of bruised Impatiens pallida and fulva (Jewel weeds) gave great relief in this instance. 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) gives immediate and permanent relief. Occasionally, zinc and copper sulphates, oxalic acid, potassium chlorate, and other salts are effectual. Echafolta has recently been extolled in this affection.

All treatment should be accompanied with a light, cooling regimen, and cooling purgatives or diuretics. The bruised leaves of the Collinsonia canadensis, externally, and an infusion of the Verbena urticifolia, internally, have been successfully used in internal or external poisoning by these plants. A solution of caustic potash, sufficiently strong to render the skin soapy, has been advised as a local application. Sodium carbonate, sodium sulphite, chlorinated lime, weak ammonia solution, and lime-water have been similarly employed.

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 gastro-intestinal symptoms. Rhus Toxicodendron is one of our best medicinal agents. Its range of application, specifically considered, is only excelled by few drugs. It is an ideal sedative, controlling the circulation, and acting primarily and most pronouncedly upon the nervous system. Fortunately specific medication does not require the enumeration of special diseases to show when and where a remedy should be employed. Indeed, the action of rhus is best understood by its fitness for conditions rather than for certain disease-condition groups which we know as particular diseases. The general specific indications and uses for rhus are: The small, moderately quick and vibratile pulse, especially exhibiting sharpness in stroke and associated with burning sensations. There is a peculiar nervous erethism which always indicates it. The sick infant requiring rhus, sleeps disturbedly, frequently starting suddenly from out its slumbers, and uttering a shrill cry (cry encephalique) as if from fright. Many of these conditions are met with in the cerebral irritation of children suffering from cholera infantum and other summer bowel troubles and in cerebro-spinal meningitis. 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, and more especially if confined to the left orbit, and 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 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. Pain of a burning character, whether deep or superficial, is relieved by rhus quicker than by any other agent. It may be of the head, abdominal or thoracic viscera, of the urinary organs, of the eyes, or of the skin, no matter where the pain or what the name may be, neuralgia, rheumatism, erysipelas, pleurisy, or cystitis, etc. If there be burning, and if of the surface an erysipelatoid redness, rhus will cure. Rheumatic pain, aggravated by the warmth of the bed, is usually relieved by it. It is more valuable in acute than chronic rheumatism and is serviceable in rheumatic paralysis and articular stiffness after rheumatic attacks. It is particularly useful to control the feeling of restlessness of rheumatic subjects. Rheumatic toothache, aggravated by warmth or warm liquids, is relieved by it. It is a valuable drug in the bowel disorders of infants, as diarrhoea and typhoid dysentery, with head symptoms, and in typhoid and other fevers, such as remittent and intermittent gastric fever, and especially when typhoid symptoms are present. It is a fine remedy in cholera morbus.

Rhus is a valuable agent 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 controls that restlessness and delirium in adynamic fevers, which is 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. Rhus is an extremely useful remedy in the various disorders of the skin presenting the characteristic rhus indications. Redness, intumescence, and burning are the indications in cutaneous diseases.

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 service 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. Associated with iron it has proved useful in purpura hemorrhagica. Erythematous and erysipelatous inflammation of the vulva, with burning pain, and the itching and vulval irritation following micturition, are permanently relieved by rhus. In the exanthemata, as in all zymotic diseases, rhus appears to exert a special antizymotic 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. Tumid, reddened, and glistening enlargements, and ulcerations with red glistening margins, syphilitic or non-syphilitic, 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 carbuncle and carbunculous furuncles. In ocular therapeutics rhus is an important drug. It is sometimes administered to prevent inflammatory action after cataract operations. Palpebral oedema, with marked redness is relieved by it, while neuralgic and other pains in the globe of the eye, and aggravated by motion and warmth are often banished 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 lachrymation, 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. Rhus has been employed successfully in paraplegia without any actual organic lesion, and in paralysis of the bladder and of the rectum. In paralytic states, however, it is of little value except in those conditions which follow attacks of rheumatism. Its efficiency in sciatica, however, is admitted by some who think the drug practically valueless as a medicine.

The proper dose for specific effects, and it is scarcely employed in any other manner, is the fraction of a drop of specific rhus, thus: Rx Specific rhus, gtt. v to xv; aqua, fl℥iv. Mix. Dose, 1 teaspoonful every hour in acute disorders; 4 times a day in chronic affections.

Specific Indications and Uses.—Small, moderately quick, sharp pulse, sometimes vibratile or wiry; great restlessness; child starts from sleep with a sharp, shrill cry as if from fright; great restlessness with vomiting; tongue red and irritable, showing red spots; strawberry tongue; burning pain; pain in or above left orbit; rheumatic pain aggravated by warmth; bright, superficial redness of the skin with burning, itching, or tingling; bright-red, glistening erysipelas with burning pain; pinched countenance; burning urethral pain with dribbling of urine; redness of mucous tissues; brown sordes; tympanites; acrid discharges from bladder or bowels; inflammation with bright-red tumid surfaces and deep-seated burning pain; inflammation with ichorous discharges, the tissues seemingly melting away; tumid red swellings; old ulcers with shining red edges, induration of submaxillary gland; conjunctival inflammation with burning lachrymation, pain, and photophobia.

Related Species.Rhus venenata, De Candolle (R. vernix, Linné), or Poison sumach, also known as Poison wood, Swamp sumach, Poison ash, and inappropriately as Poison elder and Poison dogwood, has been confounded with the Rhus vernix of Linné, a species which grows in Japan. It is a shrub or small tree, 10 to 20, and even 30 feet in height, with the trunk 1 to 5 inches in diameter, branching at the top, and covered with a pale grayish bark, which is reddish on the leaf-stalks and young shoots. Leaves pinnate, with 3 to 6 pairs of opposite leaflets, and an odd terminal one, which are oblong or oval, entire or slightly sinuated, acuminate, smooth, paler underneath, and nearly sessile, except the odd terminal one; they are about 3 inches long, and nearly half as wide. Flowers dioecious and polygamous, very small, green, and in loose, axillary, pedunculate panicles. Panicles of the barren flowers are downy, the largest most branched. Sepals 5, ovate; petals 5, oblong; stamens longer than the petals, and projecting through their interstices; the rudiment of a 3-cleft style in the center. In the fertile flowers the panicles are much smaller, sepals and petals resemble the last, while the center is occupied by an oval ovary, terminated by 3 circular stigmas. Fruit a bunch of dry berries or drupes about the size of peas, smooth, greenish-yellow or greenish-white, sometimes marked with slight purple veins, and becoming wrinkled when old; roundish, a little broadest at the upper end, and compressed, containing 1 white, hard, furrowed seed (L.—G.—W.).

Rhus venenata grows in low meadows and swamps from Canada to the Gulf of Mexico, flowering from May to August. The milky juice which flows when the plant is wounded, is similar in its action to that of Rhus Toxicodendron, and may, according to Bigelow, be made into a beautiful, shining and permanent varnish, by boiling, very analogous to that obtained in Japan from the Rhus vernix. It is much more poisonous than Rhus Toxicodendron, and its volatile principle taints the air for some distance around with its pernicious influence, producing in many persons severe swellings of an erysipelatous nature; sometimes the body becomes greatly swollen, and the person unable to move. Some persons are hardly, or not at all, affected even by handling it. The affection caused by it generally abates after several days, and may be treated in the same manner as named for the poisonous effects of the Rhus Toxicodendron.

Rhus Michauxii, Sargent (Rhus pumila, Michaux).—This is the most poisonous Rhus in this country. It is an extensively procumbent, villous-pubescent shrub, about 1 foot high, with pinnate leaves; leaflets about 11, oval or oblong, slightly acuminate, coarsely toothed, with a velvety pubescence, the 3 upper leaflets often confluent, the terminal one when distinct attenuate at base. Panicles terminal, thyrsoid, nearly sessile; drupes covered with a red silky pubescence (T.—G.). It is a rare shrub, confined to the south, and is found in North Carolina and Georgia, and was recently rediscovered.

Rhus diversiloba, Torrey and Gray.—Dr. C. A. Canfield describes a very poisonous shrub, growing in California, which is very similar in appearance and poisonous qualities to our Rhus Toxicodendron. It is the Rhus diversiloba of Torrey and Gray, or Rhus lobata of Hooker. The remedy that he has found invariably successful as an antidote to its local poisonous effects is another plant of California, of the composite family, and somewhat resembling a small sunflower, the Grindelia hirsutula. A strong decoction of the herb may be used as a wash to the poisoned surfaces, or the bruised fresh herb may be rubbed over the affected parts. One application often cures, but in obstinate cases several days may be required (Amer. Jour. Pharm., 1860, p. 412).

Rhus Metopium, Linné, is found in the south of Florida, and more abundantly in the West Indies. It is known variously as Coral sumach, Mountain manchineel, or Bum wood. It is a tree about 30 feet high, and its wood contains an abundance of tannin. Its leaves are composed of 5 leaflets, which are entire and smooth, and borne on long petioles. An acrid, red fruit is produced upon the tree. A gum-resin, known as Hog gum, or Doctor's gum, of Jamaica, is said to be yielded by this tree. In aqueous solution, it is reputed purgative and diuretic, and is an ingredient of strengthening plasters (Hogg, Nat. Hist. of Veg. King., p. 241).

For further interesting matter regarding the Rhus family, consult Thomas Horsfield's Experimental Dissertation on R. vernix, R. radicans, and R. glabrum, published in 1798; see also paper on Rhus Family in Medicine, by H. W. Felter, M. D., in Annual of Ec. Med. and Surgery, Vol. V, a portion of which is included in this article.

Comocladia dentata, Jacquin (Nat. Ord.—Anacardiaceae), Guao, Bastard Brazil wood, Toothleaved maiden plum.—A small tree, 6 to 8 feet high, common in Cuba, thriving in stony and barren soils. The leaves are a beautiful deep-green, with a brownish margin. The bluish-brown flowers are small and borne in clusters. The branches and trunk contain a milky juice, which, upon exposure to sunlight, becomes black, and leaves a stain upon clothing and the skin. It is a native superstition that if one sleeps in the shade of this tree, death will be the penalty. The bark is the part employed, preferably when fresh. The action of this agent upon the skin is said to resemble Rhus, ad it has some reputation as a remedy for leprosy.

FUSTIC.—Under this name several woods, from diverse sources, have entered commerce. Thus Young fustic, or Hungarian fustic, is derived from Rhus Cotinus, while Old fustic is the wood of Morus tinctoria (Broussonetia tinctoria). The latter contains the dye-stuff, morin (C15H10O7), or moric acid, and moritannic acid (C14H8O6); the former contains fisetin (C23H10O3[OH]6), which, in combination with sugar (the glucosid, fustin) and tannic acid, forms the yellow coloring matter of the wood. Some of the West Indian Xanthoxylums and allied species enter commerce under the name fustic. Fustic is not used in medicine and pharmacy, but as a dyeing material in the arts.

King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.