Rhus Toxicodendron

Authorities. 99, Dr. 1). S. Kimball, Hempel’s Jahr’s New Manual, Appendix, p. 1041, effects on Dr. K. of gathering and preparing some of the Tox; l6o, J. H. Sherman, M.D., New Eug. Med. Gaz., vol. xi, 1876, p. 407, a lady was poisoned ; 101, H. M. Logee, M.D., Cincin. Med. Advance, vol. vi, 1878, p. 168, Mrs. W., a healthy woman, aged sixty years, drank a cup of sassafras tea, in which were some roots of Rhus rad., Friday evening, and rather more than a cupful the next morning ; (102 to 105, from J. Murray Moore, M.D., Annals of Brit. Horn. Sac., Ang., 1878 (Amer. Horn. Obs., vol., xv, 1878, p. 465), effects of Rhus diversiloba) ; 102, Dr. Max Werner gives a case of poisoning; 103, E. B. M., a lady, aged twenty-five years, was poisoned by exposure to the shrub; 104, John W., aged twenty-three years, lay down among the shrubs while sweating, and once or twice relieved his bladder there; 105, Wilson K., aged ten years, plucked some leaves.

Mind

Intellect clouded, has little recollection of her suffering

Head

Dull frontal headache (third day)

Shooting semilateral pain from temples to vertex, both sides alike affected; shooting pain from nape of neck to vertex; head feels too large

Mouth

Increase of saliva, with burning pricking pain in the tongue; tongue feels sore at the tip

Stomach

Great desire for raw oysters

Loss of appetite

Anorexia (third day)

Nausea (after third day)

Vomiting (fifth day

Derangement of the whole digestive system was very marked for three weeks (in the fifth attack)

In about an hour after the morning draught, she complained of burning pains in the stomach, sickness of the stomach, with dizziness; the stomach felt as though it were too large, hanging down like a bag; soon followed by chills, running from the feet to the head, followed by flashes of heat; chilled every morning during the inflammatory stage, from 2 to 3 oclock; the pulse was full, varying in frequency from 84 to 98 beats per minute

Abdomen

Shooting pain iu the region of the liver, thence to right shoulder

Stool

Bowels costive

The faeces were unaltered until near the close of the inflammatory stage, when a painless, brown, watery diarrhoea set in ; there was occasionally a little pain before getting up from stool

Urinary Organs p. 626

Urine felt hot when passed

Urine scanty, high-colored, and passed with a feeling of heat in the urethra (fifth to eighth day)

Urine red, frequent, and in small quantities

Upper Extremities p. 626

Stiffness of the limbs (third day)

Rheumatic stiffness of all the joints ; pain shooting through the knee-joints from side to side ; wandering pains, sometimes on one side, and then suddenly appearing on the other; pricking in the feet and fingers; feeling of great weakness ; the flesh feels as though it would drop from the arms and limbs; pain seems deep, or as the patient expressed it Down to the bone ;” all pains aggravated by gentle friction, relieved by hard rubbing only so long as rubbing was continued; wants to move the limbs frequently, which relieves the rheumatic pain, but soon has to change position for similar relief

Generalities p. 626

Extreme languor (third day)

Itching burning (especially in the morning), and vesicular eruption on the hands and wrist and about the eyes, with smarting and redness of the eyes, and photophobia twenty-four hours after gathering, but commencing about eighteen hours previously. Headache through the eyes and temples, with dulness and sleepiness thirty to thirty-six hours after, in the afternoon. Secretion of urine more copious and rather pale. Next day, itching, burning, and extension of the vesicular eruption around the eyes, upper lids, supercilise, mouth, and external orifice of the ears, and drowsiness and dulness of spirits in the afternoon. Headache, slight photophobia, and obscured vision at times, as well as on the previous day. Itching of the scalp. Tongue more furred and appetite not as good. After midnight, on the beginning of the third day, pain, colic, rumbling, and griping in the bowels during repose, with sulphuretted eructations, and discharge of flatus. (Had eaten custard at noon before.) Two or three years ago when similarly affected from preparing some, had loose evacuations in the morning for several days; recurring, in addition to the colic and cutting pains in the abdomen. Rather copious secretion of palish urine continues. Rheumatic pain in the lumbar region and through the hips. Nausea, want of appetite, and loathing of food on rising in the morning, and colic and griping, etc., continue, but better after moving about during the day. Tongue still more coated. Itching of the hands and face still continues, and more extended. Took a dose of Bryonia, and it is proper to remark, that I inhaled Bryonia rather freely the evening of the exposure, otherwise I would probably have suffered still more, as I had done two or three times in as many years before. Fourth day, symptoms all materially relieved, excepting the eruption, which is more extended. Fifth, sixth, and seventh days, first eruption drying up, but coming out on new spots. From a boy up to 1842, I had always been able to handle this and the Rad., and be among it, without experiencing any inconvenience

All the sufferings were aggravated at 2 a.m., gradually improving till about 10 A.M., and growing worse towards evening

Skin p. 626

The eruption made its appearance in the afternoon, after the second cup, of a bright redness, and an intense burning sensation ; it soon covered the whole body from scalp to toes; the head and limbs badly swollen ; the eruption, first smooth, soon assumed a minute vesicular appearance, which, in places, ran together, forming small bulbs filled with serum. On the fifth day the vesicles began to dry up, followed by a desqiiaination of the cuticle, with intense itching; the cervical glands were swollen and sore to the touch when the eruption made its appearance; swelling of the eyelids, with mdeina of the upper lid

Sunday (the third day) there was an eruption of itching red papules behind each ear and on the neck. On Monday these papules enlarged and became more numerous, and the eyelids were red and oedematous. Face was red and swelled ; the cervical glands became tumid and slightly tender. On rising from bed she fainted, and again later in the day syncope came on. On Tuesday the rash had extended all over the face, over the hands, between the toes, and thighs. The itching was becoming more and more intolerable, and partook of a burning character. About the fifth day from their first appearance, the papules had become vesicles, which raj)idly coalesced on the face and burst, emitting an acrid serum, which, on drying, formed a crust, so dense as to make the movement of the facial and buccal muscles painful. The nose and lips were much swollen. The oedema of the eyelids was so great as to close up the left eye entirely and the right partially. The burning and itching were somewhat relieved after the breaking of the vesicles. The acute stage was now over (six days after the commencement), but the cracking of the crusts over the face, etc., occasioned such a disfigurement that the lady was confined to the house for a fortnight more; by that time all traces of the skin erysipelas had disappeared, only an unusual irritability (to flannel, etc.) of the integument remained, and a hypersensitiveness to cold air. After a second exposure to the shrub several months later, there was very intense erysipelas of the face for four or five days. The next month there wei'e two attacks. Five months later there was another attack, without fresh exposure, shortly after taking a bath rather too hot. The vesicles that appeared during the first two days were scattered and few, and strongly resembled the eruption of chicken-pox

A fifth attack came on after taking a bath rather too hot, five months after exposure. One of the earliest symptoms was the peculiar rheumatism of Rhus, affecting the legs chiefly, a stiffness of all the joints on first moving them ; aching pains in the joints, constant feeling of lameness in the legs. This rheumatism continued nearly three weeks

A man was poisoned in California, in September, went back to the Eastern States, had an annual eruption for six successive years, and during the seventh attack was carried off by a pneumonia, which would not have been fatal probably to him when in his ordinary health,'®l

Within eighteen hours his face had become red, inflamed, and hideously swollen, his eyes being both quite closed, and the itching and burning were most distressing. The local erysipelas and oedema lasted one week, the papules developing into vesicles, which became confluent, and followed the same course as in the lady’s case. The general eruption extended over the whole body, and did not disappear for five weeks. A salt-and-water lotion relieved this the first attack, but failed in tAVO subsequent attacks

Her face Avas so swollen, blistered, and mottled, that her best friends could not have recognized her; so badly Averse the integuments of the eyes swollen, that she could not see. She had a high fever and much burning-smarting pain over the face and head

The day after he had last been among these bushes, heat and itching of the scrotum and inner adjacent surface of the thighs commenced, Averse on the hairy parts. Next day the characteristic papules, on a base of diffused redness and oedema, appeared on the forehead and neck, rapidly spreading in all directions, and accompanied with heat, itching, and burning, but with very little general pyrexia. The itching was relieved by cold, but aggravated by heat, warmth, and rubbing or scratching

Sleep p. 628

Restless, sleepless nights, must move about in bed constantly

Fever p. 628

The next day she felt, in the afternoon, chills and feverishness by turns, and general malaise

Slight amount of pyrexia (in the fifth attack)

Head felt hot