Poison – oak. [There seems no real distinction between these two, and most of the observations of Rhus poisoning belong to the radicans variety.].
1. HAHNEMANN, Mat. Medorrhinum 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.”]
2a. DR. JOSLIN, March 9th, 1846, took 3 glob. of 3rd pot. of Rh. radicans. 3 m., burning in throat; 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 right chest, and in left lumbar region, with nausea; 17 m., pain at middle of left radius (recurring at 28 and 35 m.); 18 m., pain under right scapula (recurring at 21 – 2 m.); 24 m., rheumatic pain in left shoulder and deltoid; 25 m., pain in left thigh; 30 and 35 m., pain in right wrist; 35 m., pain in ascending colon; 38 m., pain in middle joint of left index; 40 m., pain in metacarpal joint of left index and in middle of right upper arm; 41 m., pain in left, forehead; 43 m., pain in middle joint of right ring finger; 45 m., pain in left chest. On same day, having dissolved 7 pellets of same in as many teaspoonfuls of water, he took a teaspoonful every m. from 12.42 p. m. In 3 m. after commencing it, nausea and great disgust; 12.56, pressive pain in left occiput and pain in left chest (latter also 4 and 7 m. later); 1.5, pain in middle of left ulna; 1:30, pressive pain 2 in. to right of mid – sternum; 2:15, pain above left tendo Achillis when walking upstairs; 3.8, pain in rectum when urinating; 4, itching in left calf while walking. 10th. – Transient pain in rectum. [After this practical absence of symptoms on 2nd day, a number are reported as occurring during the next 9 day; 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.]
2b. Dr. J – collected, June 17th and 18th, 1846, some leaves when vine was in flower, and made a tinct. from them. After handling plant and inhaling its effluvia, he had – in 18th and 19th – pain at outer edge of left patella on going upstairs after sitting for some time; and pimples, large, deep – seated, and somewhat irritable to touch, on fold of nates.
2c. June 23rd, at 9 p. m., took 3 pellets saturated with 3rd dil. 30 m., transient pain in right shoulder. 40 m., pressure near middle of sternum, left 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 left inner canthus and neighbouring root of nose. 26th. – Woke at 5:30 a. m. with remittent burning pain through middle phalanx of right little finger, with pain in right temple. During forenoon (as also on previous d.) burning in oesophagus. A pimple (like those before described) came this day on upper lip. On July 1st repeated dose at 6 a. m., 12:20 and 11 p. m. After 8 m. tingling pain almost simultaneously in rectum and l. hip when lying on l. side, tingling was as if in rapid vibrations. After 15m., pain in ulnar edge of right hand. 11 a. m., sleepiness, yawning, and indisposition to the 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 1 p. m. erysipelatous appearance of face below left eye, which returned for 4 day after, without repetition of medicine. 1 p. m., burning and pressive pain, with sense of excoriation, behind upper sternum, and tickling there causing cough. 3rd. – Stinging below right nipple, with itching there and in various parts of body, m. in bed. 4th. – Pain in right lumbar region in rising from recumbent position, and in left calf at each step (weather cold and wet); transient burning and pressive pain in left neck and stomach on swallowing moderately cold water (also some day before). 5th. – Tough unsuppurating pimple 1 in. above left nipple; burning pain in left shoulder when walking. (Amer. Hom. Review, i, 553; ii, 325.)
3. Three persons, indicated by the abbreviations “Mllin.,” “GK.,” and “Nk.,” but no information respecting whom or their mode of testing the medicine is given, are credited with the following symptoms (from Rh: tox.):
3a. 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; at the same time a hideous figure appeared to her, with whom she must go. Shooting in occiput when stooping. Her thinking power sometime leaves her, and she turns giddy. Pain in head as though it would burst, worse when moving, she must remain quite. At first bloody taste in both nose and mouth; later, bitter bilious taste. Heat in head down to neck. Great thirst. Pain in abdomen s if diarrhoea were imminent. She passes much urine. The flesh of the limbs pains as if beaten, aggravated by movement. Great weariness, especially when walking in open air. Sensation as if drenched in cold water. Pain, especially in scrob. cordis, renewed by coming from cold air into warm room. Lachrymose.
3b. GK. Drawing and paralysed feeling in left arm, n. 3c. NK. Shooting and drawing in left arm from upper part to finger – tips. (HELBIG, Heraklides, i, 53.)
4. SCHRETER. [The following symptoms are stated to have been observed by him; manner unknown.] Periodical cutting in eyes, with heaviness of lids, making it difficult to open them; a sudden drawing pain in ears, as if a thread were drawn through them; a watery blister on glans penis; itching on head; crampy drawing together of toes. (HARTL. u. TRINKS, Arzn., iii, 360.).
1. Two children, aet. 6 and 8 respectively, ate about a pint of the fruit of Rh. tox. In a few hours they became drowsy and stupid, and in a short time vomiting commenced, first 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. Journ. of Medorrhinum Sci., N. S., Ii, 560.)
2. Mr. WILKES, 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 hours swelling had disappeared. He slept nearly the whole time his eyes were closed. (Trans. of Am. Medorrhinum Ass., v, 755.)
3. 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; high fever. (Medorrhinum and Surg. Reporter, 1867; from Allen.)
4a. 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 as indicated by redness and swelling of the throat and mouth, with, m 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. Diarrhoea 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.
4b. 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.
4c. The fever which sometimes accompanies the effects of Rh., though by no means a universal symptom, usually occurs, when present, in the latter 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.
4d. The above – described effects of Rh., though so distressing to whomsoever may have to endure them, appear, however, to be very seldom 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. cit.)
5. a. In June, 1871, Mrs. V. suffered very severely from a burning and itching eruption covering entire face and neck, both mammae, external genitals nd neighbouring parts of thighs and abdomen, also both hand sand 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 day that I was compelled to keep her under the influence of morphia.
5b. 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 hours 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.
5c. May 31st, 1873, eruption appeared for third time. It began with burning and itching on right temple, slight redness, but no swelling. Next day right eye was entirely closed, and its swelling extended over adjoining parts of face; it was red, firm and inelastic, no pitting. Part first attacked was covered with minute vesicles; exudation very copious and seems to irritate inflamed race; burning and itching intense; no fever. Swelling (without redness) extended still further, and vesiculation occurred in part about eye. Improvement set in after bathing surface with solution of carbonate of soda. (BUSEY, Am. Journ. of Medorrhinum Sci., N. S., Ixvi, 436.)
6. In the spring of 1865 I attended a lady who, a few day after exposure to the poison, suffered from swelling and inflammation of her right cheek, 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.)
7. 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 received 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 hours… I have witnessed no sequelae other than the annual recurrence of the characteristic eruption. (Ibid.)
8. 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 septicaemia; suppuration had taken place in the ankle, which was affected 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 toxaemic appearance, which was remarkable in every respect. (HELMUTH, System of Surgery, 4th ed., p. 67.).
Experiments on animals
1. 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 1 hours no effect was observed. 3j of the extract was swallowed by a man, but caused no effect. The rabbits were treated by injection of 3j of the juice, of 3ij 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 3ss of the officinal extract. No effects were observed. (Wochenbl. d. Zeitsch. day k. k Ges. d. Aerzte in Wien, 1862 No.18.).