Rhus toxicodendron (“poison oak, ” called also “poison ivy”) and Rhus venenata (“poison sumach,” called also `poison elder” and swamp dogwood”). N.O. Anacardiaceae. Tincture from the fresh leaves.
THE effects of these two plants are well known, and bear a close resemblance one to the other. They are due to an extremely acrid volatile oil or emanation, and in sensitive subjects the proximity of the plant, without its being handled, is enough to cause at least the cutaneous effects. Some individuals, on the other hand, appear to be immune.1.
An acute dermatitis having features resembling both eczema and erysipelas is constantly produced. The erythema is accompanied with a certain amount of cutaneous oedema, with vesiculation and intense itching. The vesicles are usually small, but may be bullae of
It is only right to add that these statements, supported by a former lecturer on materia medica at the School of Medicine at Westminster Hospital, and by very widespread experience, are regarded by no less an authority than Cushny as popular errors. Toxicodendron is, he states, not volatile. He explains the popular errors by pointing out that the effects are often delayed in their appearance and may (it is presumably argued) be due to contact with the virus on a previous unknown occasion. He throws doubt, without advancing evidence, on the supposed immunity of some persons;as regards toxicodendron as a local irritant this may be true. The suggestions may be made that some of the effects, not due to known contact, may be due to some not yet isolated volatile juices or principle. Considerable size. These effects may be due to handling the plant, to being near it and to consuming the tincture. Exposed portions of skin are not the only parts involved. After testing the tincture by the mouth, the skin becomes dry and even cracked, itching is intense, worse in the evening and in warm room, and after scratching, which is irresistible ; redness and fine vesicles appear on the extremities, neck and scrotum. Where the cellular tissue is loose, ex. gr., lower eyelid, puffy swelling appears. Serous oozing takes place from the inflamed surfaces. Boils may develop on the face and arms. Aching of wrists, ankles and feet causes restlessness and loss of sleep, especially after midnight. Mucous and synovial surfaces may be affected, ex.gr., throat, ankle- joint, &c. Fever is not always present, but when it exists may be attended with delirium of a low typhus-like character; or the fever may be intermittent and accompanied by profuse sweating.
Headache, aggravated by walking and stooping, comes on, with lachrymation, aching of eyeballs, &c., Cutting pain about the umbilicus is produced, and though it is relieved by an action of the bowels, it is not cured. The stool is loose and blackish. These are the main symptoms of acute poisoning.
MInd.-The mental state is chiefly one of depression; sadness, tearfulness, desire for solitude, weariness of life are the predominant features. The patient feels worse in the house, and is relieved by walking in the open air. Other symptoms on the minus side are mental confusion, difficulty of understanding, forgetfulness of even quite recent event, and desire to die. These is disinclination for mental effort. On the side of irritation is fretfulness, ill-humour and impatience. Restlessness is a very marked feature and is compounded of an anxious mental state, and the results of the pain and irritation of kin, disturbing sleep and forcing the patient or prover to rise from bed and walk about-the itching predominating.
If delirium comes on it is low, mild type. The patient may have delusions and imagine he is going to be poisoned.
Head.-With the confused feeling is headache–a fulness, heat and heaviness in the forehead, pressing downwards. There may be a feeling as if something inside the head (“the brain”) were loose and striking against the skull; it is worse when stepping or shaking the head.
Occipital headache is sometimes present, and is relieved by bending the head backwards.
Giddiness is felt when rising from bed, as if intoxicated.” The scalp is sensitive; an eczema-like eruption, which oozes a sticky fluid, drying into crusts, is very irritable and causes the hair to fall out.
Eyes.-Swelling of the loose cellular tissues of eyelids and orbits occurs, and may go on to suppuration. In patients this condition may result from exposure to cold and damp; the lids feel paralysed. The eyeballs feel sore, and the edges of the lids stick together at night, and styes form on them; more pain on pressure or moving the lids and globes.
Ears.-Dermatitis, like erysipelas, of external ears, especially the left, may occur. Hearing is interfered with by a whistling noise, and by a sensation of wind blowing into ear.
Nose.-A free discharge of mucus in the morning is accompanied by violent sneezing; sometimes there is bleeding with it, brought on by stooping. There may instead be ulceration of the nostrils, with offensive discharge of pus.
Face.-In addition to the vesicular eruption due to the fumes (or emanations) of the plant, there may be stiffness and pain in the maxillary articulation, worse when yawning, and pain and swelling of the parotid glands.
Apart from these acute manifestation the complexion is pale and sickly, and the eyes sunken, with blue rings round them; the corners of the mouth may be ulcerated and sore.
Mouth and Tongue.-The typical buccal condition is associated with a febrile state. Blisters form on the tongue, which is dry and cracked, and covered with a dark brown coating. Saliva runs from the mouth during sleep, and the breath is offensive. Taste is perverted; food, especially bread, may taste bitter, or even putrid.
In the less severe cases the tongue may feel sore: its tip show a red triangle, and its sides be indented, and it may have a yellowish-white coating at the back. In the evening shooting toothache may come on, lasting into the night: the lower incisors feel long and loose; warm fluids in the mouth, and warm external applications, give relief.
Throat.-As part of the irritation of the poison the throat may be swollen and swallowing be impeded thereby. Or difficulty in swallowing may be due to a weak, paralysed feeling-a feeling, if not an actual fact, experienced in many other muscular groups. The submaxillary glands may, like the parotids, be hard and swollen.
Stomach, &c.-With loss of appetite there is special aversion from bread and meat, owing, apparently, to the bitter and putrid taste in the mouth. With dryness of the mouth and throat goes unquenchable thirst for cold water, worse at night. Nausea, eructations, and weight in the epigastrium after a meal (“like a stone”) are present. Alternatively there may be an empty feeling.
Abdomen.-Various pains are present, especially soreness in the belly, worse in the hypochondria and whole right side, worse on the side lain on, and worse on the side lain on, and worse from turning over or on beginning to move. Walking about brings relief, even though at first the patient is obliged to walk “bent double.” The cutting, griping pains and tympanites are worse after eating, and better from an action of the bowels, lying on the left side, and from lying on the back. Watery diarrhoea with distinct dysenteric features is induced by the rhus poison; the particular features of it are that it is worse at night, with colic, that some of its pains extend down the thighs, and that it may be involuntary. Or the stool may be merely yellow and frothy. Diarrhoea and constipation may alternate.
Urinary System.-Pyknuria with some urging, both day and night, recurs. The urine may be dark and hot, and soon deposits a whitish sediment on cooling (? urates). Incontinence may occur when the patient is at rest.
Sexual Organs.- There are no sexual symptoms as such. Dermatitis, with swelling or with blisters on prepuce, scrotum and vulva are part of the general cutaneous affection. It is strange that unexposed portions of the body should be affected if there are no volatile properties in the juices of the plants. Minute quantities may be absorbed, perhaps through the respiratory mucosae.
Respiratory Organs.-Tickling in the upper respiratory tract (behind the sternum), with rawness and scraping sensation, causes dry cough and oppressed, hurried breathing. The cough causes pains in the chest and stomach, and a shattering headache. Wet weather and rest aggravate the cough and pains. Sneezing and deep breathing, however, make the shooting pains in the chest worse. They are worse lying down, and in the evening before midnight.
Putting the hands out of bed is said to start a cough. Circulation.-Palpitation while at rest is a marked rhus manifestation, appearing to shake the body, but the pulse is rapid, small and soft. There is a trembling feeling in the chest.
Muscular System.-The back and limbs may be considered together. An aching or bruised feeling in any part is a constant feature, stiffness and a weak, paralysed feeling are also present. The modalities are much the same everywhere, namely: (a) Outstanding relief from continued movement (short of fatigue); (b) temporary aggravation and pain on first moving (as from rising from a seat); (c) lying on something hard seem also to relieve; (d) rest (therefore) generally aggravates, and the pains necessitate constant change of position; (e) aggravation from wet and cold north-east winds is pronounced.
The tissue most affected is fibrous tissue-joints, tendons, aponeuroses and muscular sheaths.
The sites are the neck, back (especially loins), arms, elbows, wrists, hands, fingers, legs, ankles. Cramps and paretic feelings are more common in the lower than the upper extremities.
An apparent exception to the relief from movement is stitches in the back, worse when walking or stooping; and an apparent exception also to the warmth (relief) modality is a “tingling” pain in the shafts of the tibiae. or at night when the feet are covered.
Rhus radicans appears to cause a pain definitely following the course of the ulnar nerve (compare kalmia).
Skin.-The skin lesions have been sufficiently described. It should be stated, however, that the itching and burning, which are common feature, may be accompanied by the sensation of being “pierced with hot needles.” The itching is most in the hairy parts. In rare cases, a measles-like, reddish, mottled rash may be present. Desquamation follows the dermatitis. A certain periodicity may characterize the skin eruptions in patients-they are liable to recur in the late spring.
“The more acid and irritating the eczematous exudation the less marked are the rheumatic symptoms, ” is a useful indication for the rhus venenata.
Sleep.-Sleeplessness is the natural result of the itching and the rheumatic pains, which often drive the patient out of bed. Anxious dreams of the day`s business wake him from his first sleep; he cannot lie on his back. Incessant yawning, with pain and cracking in the mandibular articulation, disturbs rest in the evening.
Fever.-The febrile modalities have been brought out by clinical experience, and will be further alluded to in the therapeutics section.
Rhus as a poison and a remedy, furnishes an apt illustrations of four facts: (1) That the information obtained by the gross poisonous effects is limited, and for therapeutic purposes correspondingly limited in value; (2) that tested on the healthy, a wider and more detailed pathogenesis is elicited; (3) that on the homoeopathic principle, all the pathological effects can be utilized for therapeutic purpose; (4) that when a drug is introduced to the profession as something like a specific (ex. gr., as in the case of rhus for :rheumatism”) it has quickly fallen into disrepute because prescribed indiscriminately for cases bearing a certain name, rather than for an individual suffering from a diseased state, and with clearly defined indications and limitations.
Rhus has been seen to have a wide pathogenetic power, wide in the sense of affecting many areas or sites; but its remarkably consistent. The same is true of its therapeutic powers.
The curative spheres of rhus will be considered as follows: A list of the named diseases or diseased conditions for which it is useful will be given, on the clear understanding that to secure success it must only be prescribed for patients who have not only the named disease or disorder, but who likewise have clearly marked the modalities of the drug. These will be re- stated later.
(1) Rheumatic and rheumatoid affections, chiefly of a chronic or subacute nature, but if the following modalities should chance to be present in acute rheumatic cases, or as part of a toxic or septic :complex,” rhus will still be the right remedy.
(2) Traumatism. -The results of sprains and strains are helped by rhus, taking the former to mean sudden external violence and the later over-exertion, such as too violent exercise in sports, or other forms of taxing the strength of a tissue or organ beyond a legitimate point, as in running, and rowing races, or even too long a walk. Traumatism in the sense of direct bruising is not intended; ligaments and tendons are chiefly involved.
(3) Neuralgia due to implication of the fibrous sheath of nerves, causing numbness, stiffness and cramps.
(4) Neuritis involving the same tissues.
(5) Paresis or muscular weakness is conspicuous, often described as “paralytic.” In some cases it may merit this description, being the due to diminished efferent nerve impulses. More often it is probably due to some “rheumatic” condition having a metabolic origin, and it may be associated with venous stasis, chronic ore subacute fibrositis or myositis. In any case, pain and stiffness “a lame feeling” – are present clinically.
In any of these the pains may be brought on or aggravated by one or more of the following causes; Exposure to wet, cold weather; getting wet; damp seats or beds; north-east winds, especially when the patient is over-heated; living in damps houses, or working in water.
(6) Dermatitis.-The main feature in rhus eruptions-in addition to erythema-is vesiculation; thus is seen in vesicular eczema, with oozing, eczema impetiginodes, herpes, especially herpes zoster, pemphigus, erysipelas. Itching is of a burning and stinging nature, worse on hairy parts. The areas affected are any exposed part (scalp, face, hands, &c.), and genitals (especially scrotum) and trunk.
Acne urticaria, pruritus vulvae, prurigo senilis, are other skin lesions for which rhus is useful.
(7) Boils and carbuncles with dark red margins.
(8) Cellulitis, both before and after suppuration, with dark red cutaneous covering; abscesses.
(9) Glandular enlargements, either lymphatic or salivary (parotitis, &c.) may go on even to suppuration; mammary abscesses.
(10) Fevers of a “low” adynamic type often require rhus, but they are not of the most severe kinds, requiring crotalus, arsenic, &c. It is the condition, not the name of the disease, which influences the choice, but amongst the following named disease rhus cases will from time to time to be found: Scarlet fever, measles and other exanthemata with dark and irregular appearance of rash; typhus fever and typhus-like (“typhoid”) conditions, and diphtheria; typhlitis and perityphlitis, peritonitis, enteritis; puerperal and other sepsis; dysentery . Dengue is especially well simulated by rhus.
Mild delirium, stupefaction, extreme restlessness (in early stages, epistaxis sordes on lips and teeth, dry, red, cracked tongue and oedema of affected parts.
(11) Eyes.-Blepharitis, with sticking of lids, oedema of lids with Cellulitis, orbital Cellulitis; purulent ophthalmia, ophthalmia neonatorum with great photophobia; phlyctenular and “strumous” ophthalmia; iritis, especially rheumatic and gouty; (glaucoma?); ptosis and other ocular paresis brought on or made worse by cold, especially cold, damp winds; pains, &c., after cataract operations.
(12) Otalgia, with throbbing worse at night, otitis media and externa.
(13) Chronic nasal catarrh in rheumatic subjects.
(14) Sore throats, with darkish colour of mucous membrane; swelling.
(15) Dyspepsia, with flatulence and “a lump” in the epigastrium, “like a stone there”, dysentery, with crampy, griping pains, extending down the thighs.
(16) Piles and anal fissure.
(17) Post-operative paresis of bladder, retention of urine; cystitis; oxaluria.
(18) Membranous dysmenorrhoea: threatened abortion, especially from overlifting, straining, &c.; offensive lochia with (mild) puerperal sepsis: phlegmasia alba dolens. In all cases the modalities of rhus should correspond with those of the patient.
(19) The respiratory affection are chiefly those associated with febrile affections-laryngitis or diphtheria, bronchitis and pneumonia with septic symptoms. Haemoptysis may be present.
(20) Cardiac hypertrophy from over-exertion in gymnasts, where muscular failure has temporarily occurred; rheumatic, even organic, heart affections, where the muscular tissue is giving out, with weakness, pain and numbness in the left arm.
(21) Rhus was formerly used in the Southern States of North America as a substitute for “bark”. It may be required occasionally on homoeopathic principles in malaria, where there are rheumatic symptoms, tearing cough and profuse perspirations- chiefly in chronic cases.
(22) Sleep is disturbed by pains which necessitate constant change of position, even driving a patient (if not too ill) out of bd. Fears and suspicious keep him awake before a stage of stupor has been reached. Dreams of undergoing great fatigues are occasionally. Dreams of undergoing great fatigues are occasionally noticed.
(1) Movement Modalities.-(a)Aggravation of pains from rest and on first movement; (b) as a corollary relief from continued gentle movement, short of fatigue-fatigue brings back the pain; (c) a very marked degree of restlessness, necessitating constant change of position, or even getting out of bed and walking about.
(2) Temperature and Weather Modalities.-Next in importance (if not co-equal) are (a) aggravation from damp, cold weather or rooms, from damp beds, cold winds; and (b) corresponding relief from warmth-warm air and warm applications; (c) aggravation in the air (cough, &c.).
(3) Site.-Most of the pains and lesions (in patients) are: (a) right-sided (exceptions are left-sided sciatica and pain in the left arm in morbus cordis cases); (b) hairy parts (itching).
(4) Posture.-Aggravation from lying (vertigo, headache).
(5) Time.-Aggravation at night, especially after midnight. Most of these modalities refer to pains, especially :gouty” and “rheumatic” pains.
(6) AEtiological Conditions.-(a) Due to sprains and strains; (b) to damp and cold; (c) sexual excesses; (d) checked perspiration; (e) chagrin (headaches).
(7) Muscular Weakness with Numbness.-From similar caused and with similar modalities; paresis.
(8) Tissues Affected.-Fibrous tissue, skin, muscular tissue. Parts Affected .-Heart, head, limbs, lungs.
(9) Named Diseases.-Dermatitis, Cellulitis, erysipelas, exanthematous, specific fevers, with low, mild delirium; diarrhoea and dysentery.