RHUS TOXICODENDRON

The drug of which I wish to speak this morning, is the chief member of the Anacardiaceae, namely, the poison-ivy or RHUS TOXICODENDRON. You must remember it as complementary to Bryonia, a fact discovered by Hahnemann in his experience with an epidemic of war-typhus, during which he treated many cases, losing but two; the success which he then gained was acknowledged on all sides. Many lives have since been saved by the exhibition of these two remedies in alternation ; i.e., an alternation which consists in giving Bryonia when Bryonia symptoms are present, and Rhus tox., when the patient manifests symptoms calling for that remedy. This is a legitimate alternation. We must also remember a fact of which I have spoken before, but which is so important that I here reiterate it, namely, that RHUS TOX. BEARS AN INIMICAL RELATION TO APIS MELLLFICA. Although the symptoms of the two are superficially similar, for some reason which I cannot explain, they do not follow each other well.

We find Rhus tox. forming the centre of a very large group of medicines. If we were to study them all comparatively, it would take several hours. For example, holding as it does important typhoid relations, it has radiating from it many drugs employed in typhoid states of disease. Bryonia, as I have already said, stands close to it. Then we have diverging in another radius ARSENICUM, in still another MURIATIC ACID, PHOSPHORUS, CARBO VEG., etc., with BAPTISIA and quite a number of others.

First we will study the action of Rhus tox. on the circulatory system. We find that it causes an erethism, an increase in the circulation or, in other words, ebullitions of the blood. It acts on the central organ of the circulation, the heart. Thus we find it indicated in uncomplicated hypertrophy of that viscus, i.e., hypertrophy not associated with valvular lesions. From what cause ? From the effects of over-exertion, as may frequently happen in athletes and in machinists who wield heavy tools. Other remedies useful in this condition are ARNICA and BROMIUM. These remedies, when indicated, must be given persistently for days and even weeks, until you have succeeded in bringing about a proper absorption of the surplus cardiac muscular fibres. We also find Rhus indicated in palpitation of the heart, following over-exertion. When Rhus tox. is the remedy in heart disease, you usually find accompanying the disorder a sensation as of numbness of the left arm and shoulder. The patient experiences a weak feeling in the chest, as if the heart muscle was tired. This is worse after any exertion. Palpitation may be felt even when he is sitting still.

ACONITE has tingling in the fingers in association with heart disease. The fingers feel as if they were going to sleep. Anxiety is always present with this drug.

So too with KALMIA, which has the same symptom in the left arm, with cardiac affections.

PULSATILLA has numbness, particularly about the elbow, very frequently with hypertrophy or dilatation of the right ventricle.

ACTEA RACEMOSA has the sensation as though the arm was bandaged tightly to the body.

PHYTOLACCA, however, affects the right side of the body. It has the same sensation in the right arm that Aconite, Kalmia and Rhus have in the left.

Now the pulse of Rhus tox. : Rhus produces a depression of the system, hence, its pulse is not apt to be full and strong as we find under Aconite. It is accelerated, but with this acceleration there is apt to be weakness of its beat. At other times, it is irregular or even intermittent ; all these are characteristic of Rhus tox. With these different kinds of pulse, we often find the numbness of the left arm which I have just mentioned.

Let us next take the typhoid symptoms of Rhus; by this I mean typhoid-like symptoms, symptoms which indicate sinking of the vital

forces such as appears in diseases assuming a low type. Other tilings being equal, you may rely on Rhus whenever acute diseases take on a typhoid form. You will find that dysentery assuming this form may call for it. You will find the same to be true for peritonitis, pneumonia, scarlatina and diphtheria under similar conditions and when no other remedy is positively indicated. Rhus must, therefore, act on the blood, poisoning that fluid.

The symptoms which indicate it in typhoid fever proper are these : In the first place, the temperament helps you a great deal. The patient is of a rather mild temperament. The delirium is of a mild character, and not violent. At times, it is true, the patient may exhibit a disposition to jump out of bed or to try to escape, but when he is more or less conscious, he manifests little petulance or irritability. It is not, then, a violent anger that characterizes Rhus tox. You will notice that this delirium is associated with restlessness, not only mental, but physical as well. The patient constantly tosses about the bed. He is first lying on one side of the body, then on the other. At one moment he is sitting up, during the next he is lying down. You observe then a constant desire to move, and it is even possible that the patient is relieved by the change of position. Sometimes we find exceptionally, in the beginning of the disease, that the patient wants to lie perfectly quiet. This is on account of the great weakness. He feels perfectly prostrated. He is indifferent to everything. This sense of debility is entirely out of proportion to all the other symptoms. Sometimes the patient has hallucinations. He fears that he will be poisoned. He will not take the medicine you leave him, or the food and drink that is offered him, as he fears that his attendants desire to poison him. (HYOSCYAMUS has this symptom even more marked than Rhus tox.) As the stupor progresses, the patient answers very slowly, as if reluctantly or else in a petulant way; but he is not violent. He has violent headache, the pain of which he compares to a sensation as of a board strapped to the forehead. This is often associated with a rush of blood to the head, as shown by sudden flushing up of the face. He has epistaxis, and this relieves the headache. The blood that escapes is dark in color. The typhoid poison may affect the lungs and produce pneumonia, with the usual cough attending that affection, difficult breathing, rust-colored sputum; with all these symptoms you find the tongue dark brown, and dry and cracked. The cracks gape considerably, and even bleed at times. Sometimes the tongue and mouth are covered with a brownish, tenacious mucus. At other times you find the tongue taking the imprint of the teeth. Now, let me beg of you not to give Mercurius. Mercurius has very little application to typhoid fever; it will spoil your case unless decided icteroid symptoms are present. The tip of the tongue (I am again speaking of Rhus) very often has a triangular red teat. There is disturbance of the stomach and bowels. The patient has diarrhoea with yellowish-brown stools of a cadaverous odor. Stools may come involuntarily during sleep. The urine escapes involuntarily, and sometimes leaves a reddish stain. The patient complains of tearing pains in the limbs with almost intolerable backache. If he falls asleep he is restless, and he dreams of roaming over fields and undertaking arduous labors. Sometimes (like BRYONIA) he dreams of the business of the day.

AURUM, CAUSTICUM, and AURURN MUR., also have this restlessness of the limbs, worse at night. The surface of the body is dry and hot, and often redder than natural. Sometimes red spots will be found on the skin. If he has sweat, it is copious and sour-smelling, and is accompanied by a miliary rash. The abdomen is tympanitic ; and it is especially sensitive over two important points, the right iliac region and the region of the spleen, which organ, by the way, is swollen. Finally, the stools become scanty and greenish and are unattended by tenesmus. In women a uterine hsemorrhage may appear, but this gives no relief to the symptoms. Symptoms of pulmonary congestion appear. Rales are heard all through the chest. Especially is the trouble marked in the lower lobes of the lungs. The cough is at first dry, and then becomes more frequent and loose with expectoration of blood-streaked sputa. These, then, are the main symptoms which lead you to prefer Rhus in the treatment of typhoid fevers. Very briefly let me show you how it may be distinguished from its concordant remedies; and first, I will speak of some of the remedies that may follow Rhus tox.

PHOSPHORUS follows Rhus well when the pneumonic symptoms have failed to yield to that remedy, and when the diarrhoea continues. The stools are yellow and blood-streaked, sometimes looking like “flesh-water.”

ARSENICUM is to follow Rhus in the erethistic form of typhoid fever. Notwithstanding the terrible prostration, the patient is still irritable and anxious, even to the last hours of life. The profound weakness continues, the mouth grows blacker and the diarrhoea persists, notwithstanding Rhus. Here let me give you a word of caution. Beginners are apt to give Arsenicum too soon. If this is done, they only hasten the troubles that they are endeavoring to prevent. Arsenic is an excellent remedy when indicated, a horrible one when misused. I, therefore, say do not give it early in the course of typhoid affections, unless the symptoms clearly call for it. Like Rhus, Arsenicum has restlessness, prostration and prominent abdominal symptoms. Thirst is intense. Pains are of a burning character. The stools are dark brown, offensive and bloody, and more frequent after midnight.

MURIATIC ACID is also useful in the erethistic form. It has many symptoms in common with Rhus. It is to be preferred when the decomposition is still more evident; the prostration is great, the patient being so weak that he slides down toward the foot of the bed. The stool and urine escape involuntarily.

But we also find Rhus similar to remedies which suit the torpid form of the disease. Foremost in this list is CARBO VEG. The Rhus patient often runs into a Carbo veg. state, in which case he lies perfectly torpid, without sign of reaction. The limbs are cold, especially the legs from the feet to the knees, and are covered with a cold sweat. The pulse is rapid and with little volume. The discharges from the bowels are horribly offensive.

Still another remedy is BAPTISIA. This is indicated when we have, as under Rhus tox., brown or blackish coated tongue, and well-marked fever. The face presents a dark red, besotted appearance, like that of one intoxicated. The discharges from the bowels are dark, fluid and very offensive. The patient is drowsy and stupid; he goes to sleep while answering questions ; or he is restless, tossing about the bed with the illusion that he is double, or is scattered about, and he must try to get himself together again. He complains of the bed feeling too hard. The tongue is often studded with aphthous ulcers.

ARNICA and Baptisia both have a drowsy, stupid state, the patient complains of the bed feeling too hard, and goes to sleep while answering questions. But, under Arnica, there is complete apathy; ecchymoses and bed-sores appear on the body. Arnica also has involuntary stool and urine; and, if the lungs are affected, the sputa are bloody.

PHOSPHORIC ACID follows well after Rhus when there is increased debility or prostration with perfect apathy. The stools are bloody and slimy. Nose bleed, when it occurs, brings no relief.

TARAXACUM should also be borne in mind. Boenninghausen’s son was taken with typhoid fever and was attended by his father. Among his symptoms was the restlessness I mentioned as characteristic of Rhus tox., yet that remedy gave no relief. Looking up the materia medica, Boenninghausen found that Taraxacum had this same restlessness of the limbs and with tearing pains, and in addition it also had a symptom which was present in his son’s case, mapped tongue. He gave Taraxacum with prompt result.

The indications for Bryonia in typhoid states I will defer until next month, when I lecture on that drug in detail.

Next we see disturbances in the circulation produced by Rhus exhibited in another form of fever, namely, intermittent fever. Rhus is suitable for intermittent types of fever when the chill begins in one leg, usually in the thigh. In some cases it starts between the scapula?. (It is very important to always note the point at which the chill starts in this disease. Under NATRUM MUR. and EUPATORIUM, it begins in the small of the back; under GELSEMIUM, it runs up the spine.) During the chill there is a dry, teasing cough, which symptom you will also find under CINCHONA and SULPHUR. Along with the external chill there is internal heat. Thirst is absent. Often, too, we find skin symptoms, as urticaria and fever blisters, the latter being situated about the mouth. The sweat is very general, excepting about the face.

We now come to the study of the action of Rhus on the fibrous tissues. Allow me to include under this tissue the aponeuroses and tendons of muscles, the ligaments about joints and the connective tissue. No remedy has a more profound action on the fibrous tissues than has Rhus tox. First of all, I will speak of its action on the tendons of muscles. We find Rhus useful whenever these tendons are inflamed, whether it be from over-exertion or from a sudden wrenching, as in the case of a sprain. We find, also, that we may give Rhus in many affections arising from over-exertion. For example, if a musician from prolonged performing on wind instruments suffers from pulmonary haemorrhages, Rhus will be his remedy. If from violent exertion a patient is seized with paralysis, his trouble may yield to Rhus tox.

Let me here speak of a few other remedies applicable to the bad effects of over-exertion, in order that you may differentiate them from the drug which is the subject of this lecture.

ARNICA acts more on the muscular tissue than on the ligaments. Hence, we would find it indicated when, as a result of long exertion, there is a great soreness of the muscles. The patient feels as if he had been pounded. It has not that strained feeling of Rhus. When a joint is clearly sprained, Arnica is not the best remedy, unless there is considerable inflammation of the soft parts other than the ligaments.

ARSENICUM is to be thought of for the effects of over-exertion, particularly if that exertion consists in climbing steep hills and mountains. Here you have the effects of breathing rarefied air as well as those of the exertion.

The general characteristic, however, which helps you to decide for Rhus in all these cases is this: THE PATIENT HAS RELIEF OF HIS SYMPTOMS BY CONTINUED MOTION, WHILE HE EXPERIENCES AGGRAVATION ON BEGINNING TO MOVE. The reason for this symptom is that the fibrous tissues become limbered up as the patient continues to move.

I may say that there is somewhat of an exception to this characteristic, and that is in that painful disease known as lumbago. I find that in the beginning of this affection Rhus is the remedy, whether the patient is better from motion or not. The symptoms calling for Rhus are great pains on attempting to rise, stiff neck of rheumatic origin from sitting in a draught, rheumatic pains in the interscapular region, better from warmth and worse from cold. There may also be constrictive pains in the dorsal muscles, relieved from bending backwards.

SULPHUR also has rheumatic pains with stiffness in the lumbar region, with sudden loss of power on attempting to move.

PETROLEUM and RUTA are useful when these rheumatic pains in the back are worse in the morning before rising.

Under STAPHISAGRIA, the lumbar pains compel the patient to get up early.

KALI CARB. has sharp pains in the lumbar region, worse at 3 A.M., and compelling the patient to get up and walk about. The pains shoot down the buttocks.

LEDUM has pain in the back, which may be compared to a feeling of stiffness after sitting still for a long time. There is a crampy pain over the hips in the evenings. In the morning the feet are stiff and rigid.

VALERIAN causes, and therefore will cure, violent drawing, darting, jerking pains in the limbs, which appear suddenly. They are worse from sitting and better from motion. The patient also has a strained feeling in the lumbar region, subject to the same modality as the pains in the limbs.

In rheumatism, Rhus is indicated, not so much in the inflammatory form as in the rheumatic diathesis, when the characteristic modality just mentioned is present, and when there is aggravation during damp weather, or from dwelling in damp places. Another peculiarity of Rhus is that prominent projections of bones are sore to the touch, as for example, the cheek-bones. This shows you that Rhus affects the periosteum. Still another characteristic is that the patient cannot bear the least exposure to cool air.

Rhus may also be used for either horse or man when the patient, from exercise, has become warm and has been in a free perspiration, which was checked by rain or dampness.

In these various rheumatic affections, I wish you to compare, first, ANACARDIUM, which has a stiff neck, worse from beginning to move.

CONIUM has worse from beginning to move, but relief from continued motion.

Under LYCOPODIUM and PULSATILLA the relief is from slow motion.

FERRUM has neuralgic and rheumatic pains, relieved by slowly moving about at night.

RHUS RADICANS also has the drawing, tearing pains in the legs. It has also rheumatic pains in the back of the head. It is useful in pleurodynia or false pleurisy, when the pains go into the shoulders.

KALMIA LATIFOLIA has tearing pains down the legs, without any swelling, without fever, but with great weakness. You see that it here resembles COLCHICUM.

RHODODENDRON has great susceptibility to changes in the weather, particularly to changes to cold winter weather, and to electric changes in the atmosphere. The rheumatic pains in the limbs, like those of Rhus tox., are worse during rest. Rhododendron is particularly useful in chronic rheumatism, affecting the smaller joints. It is one of the best remedies for what has been termed gout, when there is a fibrous deposit in the great-toe joint, and not the usual deposits of urate of soda.

LEDUM is an invaluable remedy in gout and in rheumatism affecting the smaller joints. The pains characteristically travel upwards. There are nodes about the joints. In gout, Ledum is useful when the pains are worse from the warmth of the bed; when there is an oedematous condition of the feet; when Colchicum has been abused, and the patient has become greatly reduced in strength by this asthenic remedy. You will find that both Ledum and Colchicum cause acute tearing pains in the joints, with great weakness of the limbs, and numbness and coldness of the surface.

You note from the schema on the board that Rhus has an action on the cellular tissue. It is useful in cellulitis, in that accompanying diphtheria, in orbital cellulitis with the formation of pus. Herein lies a positive distinction between Rhus and Apis, which NEVER produces cellulitis with abscess.

In carbuncle, another form of connective tissue inflammation, Rhus is indicated in the beginning, when the pains are intense and the affected parts are dark red. If given early, Rhus may abort the whole trouble. If not, you may have to resort later to ARSENICUM, CARBO VEG., or even ANTHRACINUM.

Rhus has a most remarkable action on the skin. It produces an erythema, this rapidly progressing to vesication, often accompanied with oedema and with the final formation of pus and scabs. The cutaneous surface about the eruption is red and angry-looking.

Rhus is indicated in eczema. If the face is attacked, there is oedema of the loose cellular tissue about the eyelids, with pains which we may denominate burning, itching, and tingling, to make a nice distinction between it and Apis, which has burning and stinging pains.

Rhus gives us also a perfect picture of vesicular erysipelas. The structures for which this drug has a special affinity, are the scalp and the skin of the face, and the genital organs. The affected parts are dark red, and the inflammation (in the sick) travels from left to right.

The erysipelas of APIS travels from right to left; the affected parts are rosy-red, pinkish, or dark purple. Thirst is absent. Apis requires the presence of oedema.

In scarlatina, Rhus is indicated, especially in the adynamic forms, and should very quickly supplant Belladonna when these symptoms appear : The child grows drowsy and restless. The tongue is red and sometimes smooth, a very unusual symptom in scarlatina. The fauces are dark red and have a peculiar cedematous appearance. The cervical glands are enlarged, and there may be enlargement of the left parotid. There may even be impending suppuration of these parts. The cellular tissue about the neck is inflamed, so that the cutaneous surface here has a dark red or bluish erysipelatous hue. If the child is delirious, the delirium is always mild. The eruption does not come out fully, but when it does appear, it is of a dark color, and is apt to be miliary. Rhus, you see, thus acts on the vital forces. It depresses the sensorium, as shown by the drowsiness and mild delirium. The secretions are altered, becoming acrid. Not only the cervical glands, but the glands in all parts of the body may become enlarged, and especially those of the axilla. The body is emaciated, and the patient grows weaker.

LACHESIS and AILANTHUS follow Rhus well in this condition, but they give an even more adynamic picture. Ailanthus is especially indicated when the skin is covered with a scanty dark bluish rash. The throat inside is swollen. The cellular tissue of the neck is infiltrated. There is excoriating nasal discharge. The child is drowsy and stupid.

ARUM TRIPHYLLUM is similar to Ailanthus in that it has the excoriating coryza. The corners of the mouth, are sore, cracked and bleeding. The saliva even is acrid. The child is irritable and restless. (See lecture on ARACEAE.)

BELLADONNA also has this enlargement and induration of the axillary glands, but it is not often thought of in this condition. It is especially useful for this symptom occurring in females at the climaxis.

In variola, you will find Rhus indicated when the pustules turn black from effusion of blood within, and when there is diarrhoea with dark bloody stools.

In eczema you should compare with Rhus, MEZEREUM, especially in scrofulous cases when hard, thick crusts form, and these crack and ooze copiously of pus. Itching is most intense at night when the patient is warmly wrapped up. Sometimes pimples surround the main seat of the disease.

NUX JUGLANS is one of our very best remedies in tinea favosa, especially when it occurs on the scalp and behind the ears. Itching is intense at night, so that the patient has difficulty in sleeping. Scabs appear on the arms and in the axilla.

In scarlatina, compare CALCAREA OSTREARUM. The parotid glands become affected. The rash recedes, leaving the face puffed and pale.

We next study the action of Rhus on the mucous membranes. It produces a copious coryza with redness and cedema of the throat. It is indicated in influenza with severe aching of all the bones, sneezing and coughing. The cough is dry in character, and is worse from evening until midnight (MEZEREUM has the same modality with the cough), and from uncovering the body. Especially is Rhus indicated when the trouble arises from exposure to dampness.

In diarrhoea calling for Rhus, the stools consist of blood and slime mixed with reddish-yellow mucus. Thus you see that it is of a dysenteric character.

With this character to the stool, Rhus is indicated in dysentery when there are tearing pains down the thighs during defecation.

In other abdominal inflammations assuming a typhoid type, Rhus may be indicated as I have already said, whether that affection be peritonitis, enteritis, typhlitis, perityphlitis, or metritis. In diseases of the puerperal state, Rhus is a capital remedy when the symptoms are of a typhoid type.

There is a colic curable by Rhus. It may or may not be of rheumatic origin. This colic is relieved by bending double AND MOVING ABOUT. It thus differs from Colocynth, which has relief from bending double.

Now, the head symptoms of Rhus. There is a form of vertigo, common with old people, which comes on as soon as the patient rises from a sitting posture. It is associated with heavy feelings in the limbs. It is doubtless indicative of some senile changes in the brain. Rhus tox. is one of the remedies which can palliate this condition. Sometimes they have a swashing feeling in the brain when moving about. In this swashing feeling in the brain, compare with Rhus the following : CINCHONA, SULPHURIC ACID, BELLADONNA, SPIGELIA, and CARBO ANIMALIS.

Rhus is of value in many affections of the eye. We find it useful in scrofulous ophthalmia when phlyctenules form on and about the cornea.

Most intense photophobia is present. The eyelids, which are also involved in the inflammatory process, are spasmodically closed. If you force the lids apart, there will gush forth a yellow pus. The pains in the eyes are worse at night.

You may also use it in conjunctivitis caused by getting wet (also CALC. OST.).

Rhus may also be used in iritis when either of rheumatic or traumatic origin. The inflammation may extend to and involve the choroid, and still Rhus will be the remedy. Pains shoot through the eyes to the back of the head, and are worse at night. On opening the eyes, there is a profuse flow of hot tears. In some cases, the inflammation may go on to suppuration.

In glaucoma, Rhus has sometimes proved useful.

In orbital cellulitis, Rhus is almost a specific. It should always be given in cases in which the symptoms indicate no other remedy.

It is also one of the best remedies we have for ptosis in rheumatic patients after exposure to dampness.

CAUSTICUM is here the nearest concordant remedy of Rhus., but you must also think of GELSEMIUM, SEPIA, and KALMIA in this symptom. The last-named remedy has sensation of stiffness in the eyelids and in the muscles about the eyes.

A local symptom of the face calling for Rhus in rheumatic patients is pain in the maxillary joints as if the jaw would break. Every time the patient makes a chewing motion with the mouth the jaw cracks. Easy dislocation of the inferior maxilla calls for Rhus. IGNATIA and PETROLEUM are here similar.

In toothache, Rhus may be indicated when the pains are made worse by cold and relieved by warm applications. There is an exception to this, however, i.e., in jumping toothache, when the pain is momentarily relieved by the application of the cold hand. The teeth feel loose, or as if they were too long. The gums are sore and feel as if ulcerated.

In various forms of paralysis, Rhus may be indicated especially in rheumatic patients when the trouble has come on from over-exertion or exposure to wet, as from lying on the damp ground. In the latter case, the trouble probably finds its origin in a rheumatic inflammation of the meninges of the cord.

If, however, the exposure to wet excites a myelitis, DULCAMARA is the remedy.

Rhus may also be used in the acute spinal paralysis of infants.

In these different forms of paralysis, SULPHUR holds a complementary relation to Rhus.