Rhus Toxicodendron | Materia Medica by Carrol Dunham
Dr. Dunham (1828-1877) graduated from Columbia University with Honours in 1847. In 1850 he received M.D. degree at the College of Physicians and Surgeons of New York.
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Rhus Toxicodendron or Rhus Radicans, these two plants are now regarded by botanists as identical, differing only in their modes of growth. The former was proved by Hahnemann ; the latter by the late Dr. B. F. Joslin. I can perceive no essential differences in the symptoms ascribed to them by provers. For ten years I have used them interchangeably in my practice, and have seen no differences in their effects. I shall therefore treat them as identical substances.
This plant is a native of North America. It was known to the Indians as possessed of medicinal properties. Dufresnoy, a French army surgeon, published in 1788, An account of its supposed virtues in the cure of cutaneous eruptions, and of nervous paralysis. He also, as well as the traveler Kalm, described its property of causing inflammatory swelling of the skin, followed by vesication, in persons who touch the leaves, and even in susceptible persons who are exposed to its exhalations at night.
Indeed, it is well known that contact with the leaves of the Rhus radicans or “poison vine” produces, not merely in the parts touched, but also often in other parts of the body, as the neck and face, a swelling, with redness, oedema and vesication, that bears a marvelous resemblance to vesicular erysipelas. This eruption is attended by constitutional symptoms which resemble those of erysipelas. It is well known, too, that in this form of vesicular erysipelas, homeopathicians long ago found reason to look upon Rhus toxicodendron or radicans as their most valuable remedy. The striking confirmation of the homeopathic law of cure which these facts afford, has caused some bitter opponents of homeopathy actually to thrust Rhus out from the materia medica. We find Dr. Stille, after giving a very imperfect summary of the effects of Rhus and the opinions held respecting it, coolly remarking: It, however, does not really appear to deserve sufficient confidence as a medicine to entitle it to retain a place in the materia medica.
Very different are the judgment and method of Prof. Trousseau, who, though no advocate or friend of homeopathy, is yet too wise and honest a man to refuse to learn from an opponent.
He relates an interesting proving of Rhus: Dr. Savini applied two drops of the juice of Rhus radicans to the first phalanx of his forefinger; he left it there only two minutes, and yet, at the end of an hour, it had produced two black spots. Twenty-five days afterward, the following symptoms suddenly manifested themselves: great heat in the mouth and gullet; rapidly increasing swelling of the left cheek, of the upper lip and of the eyelids. The following night, swelling of the forearm, which had acquired double its normal volume; the skin was rough, the itching intolerable, the heat very great, etc.
“This singular action of Rhus radicans, continues Trousseau, upon the human economy, has induced the homeopathists to use it in skin diseases ; but already before them, Dufresnoy, of Valenciennes, had published a pamphlet in which he extolled the virtues of this plant against cutaneous diseases, and subsequently against paralysis.
Since that time a number of essays on this subject have appeared in medical periodicals, and many respectable physicians have confirmed Dufresnoy’s experiments.
We have ourselves, continues Trousseau, often used Rhus radicans for paralysis; but the experiments we have made in skin diseases are too few and too little conclusive to admit of our referring to them here.
The only forms of paralysis which we have seen treated by M. Bretonneau, of Tours, and which we have ourselves treated, are those of the lower extremities which succeeded a concussion of the spinal marrow, or a lesion of that organ, which did not destroy its tissue. On this point we have collected facts enough to place beyond a doubt the therapeutic efficacy of Rhus radicans.
We shall see that the symptoms clearly point to the use of Rhus in paralysis of the lower extremities. The powerful testimony of Trousseau is an indorsement of our law for the selection of remedies.
Our knowledge of the positive effects of Rhus toxicodendron upon the human organism is derived from the proving by Hahnemann and his pupils, published in vol. ð. of the ” Materia Medica Pura,” and from the proving of Rhus radicans conducted by the late Dr. Joslin, and published by him in the ” Philadelphia Journal of Homeopathy,” and in ” Jahr’s New Manual”; also later in the “American Homeopathic Review.”
Hahnemann, in the introduction to his proving, remarks that a careful study of the symptoms will enable us to discover many characteristic peculiarities of this remarkable and very precious drug one of which (possessed by very few other drugs, and by none in so high a degree), he describes as follows: It excites the strongest symptoms when the body or the limb in question is in the greatest repose and is kept as free as possible from all motion.
He further remarks that whoever has studied the symptoms of Bryonia will observe a great similarity in them to the symptoms of Rhus toxicodendron, and at the same time a great contrariety. Thus, for example, how remarkable is the aggravation under Bryonia by motion, and the amelioration during repose, of the very same symptoms which under Rhus are ameliorated by motion and aggravated by repose.
Taking a general view of the action of Rhus before we proceed to examine its special action upon each apparatus and organ of the body, we find: The sphere of action of Rhus to be extensive. Upon the system of nutrition it acts as a depressent, retarding all the functions. The secretion of the mucous membranes is altered and increased, as is shown by diarrhoea and by the sputa attending the cough as well as by secretions from other mucous membranes. The lymphatic glands, are affected throughout the body, as, for example, the cervical, the inguinal and the mesenteric, which are all enlarged and inflamed. Emaciation is produced. Perspiration is abundant and is sour.
From the character of the fever symptoms which it produces, it would be reasonable to infer that: Rhus affects the composition of the blood.
But it acts quite as decidedly upon the system• of animal life. The sensorium is depressed, and the capability of the mind for continuous thought is absolutely destroyed; thus a patient meaning to write the number 12 will write the figure 1, but cannot recollect the figure 2 Which should follow it. Like the typhus patient, who begins his sentence coherently and intelligibly, but allows it to dwindle away into an inarticulate murmur.
Listlessness and horrible depression possess the mind. This marks a more profound depression than that produced by Bryonia, for the latter results in fretful peevishness and irritability. Rhus has listlessness, a feeling of helplessness and profound despondency. A similar feeling pervades the whole apparatus of voluntary motion, expressing itself in a sense of physical prostration, of inability to move, of powerlessness, approaching paralysis. So great is this that, on first attempting to move after a repose of some length of time, the limbs tremble, the joints are stiff, and there seems to be actual inability to move. This condition is more pronounced in the lower extremities than in the upper.
The special senses are dulled, but not perverted.
The skin, as we shall see, is the theater on which are displayed some of the most powerful, characteristic and valuable properties of Rhus. Rhus, then, acts prominently on the mucous membranes, on the lymphatic glands, on the organs of animal life, and on the skin. To this list must be added the tissues which compose the joints.
The sensations which are characteristic of Rhus are:
Soreness, as if beaten; this is felt in the muscles and in the neighborhood of the joints.
Heaviness and pressure; this is felt in the head and eyes and eyelids and in the limbs.
Lassitude and languor and weight; felt in the extremities, especially the lower limbs.
The action of Rhus may be summed up as follows : It produces a kind of rheumatic affection of the muscles and ligaments, alleviated by motion; a paralysis aggravated by motion; an apparent passive congestion of head, relieved by repose; a debility of the organs of nutrition, marked by deficient and depraved appetite and by tympanitis; a serous infiltration of the cellular tissue in various parts, as face, fauces, genital organs, feet; a vesicular eruption generally; an acrid state of the secretions generally, as tears, nasal mucus, gastric mucus, intestinal mucus, urine, menstrual flow, contents of cutaneous vesicles; general depression of sensorium.
We shall gather evidence of these generalizations as we proceed.
Periodicity is not marked in the symptoms of Rhus.
PECULIARITIES. The great and characteristic peculiarity of the symptoms of Rhus is that, with few exceptions, they occur and are aggravated during repose and are ameliorated by motion.
This statement, however, requires some degree of explanation. In addition to the symptoms of Rhus which resemble paralysis, there are also groups of symptoms resembling muscular and articular rheumatism. These rheumatic symptoms come on with severity during repose and increase as long as the patient keeps quiet, until they compel him to move. Now, on first attempting to move, he finds himself very stiff, and the first movement is exceedingly painful. By continuing to move for a little while, however, the stiffness is relieved and the pains decidedly decrease, the patient feeling much better. But this improvement does not go on indefinitely. After moving continuously for a longer or shorter period and finding comfort therein, the paralytic symptoms interpose their exhausting protest, and the patient is compelled from a sensation of lassitude and powerlessness to suspend his movements and to come to repose. At first this repose after long-continued motion is grateful, since it relieves, not the aching and severe pains, but only the sense of prostration. Before long, the pains come on again during this repose and the patient is forced to move again as before.
This will explain seeming contradictions in the symptoms of Rhus.
The amount of it is that the pains of Rhus are aggravated by repose and relieved by motion. But the paralysis and languor of Rhus, like all such symptoms always, when real, are relieved by repose and aggravated by long-continued motion.
The sensorium is affected as follows: There is vertigo, which occurs when standing and walking; but also when sitting and even comes on when lying down. In this particular it corresponds with the conditions of the rheumatic pains of Rhus toxicodendron. It is described as if something kept going around in the head; one feels as if drunken, as though one would fall forward or backward. On rising in the morning, one can hardly support one’s self. This is not only from dizziness but also from the paralytic condition and from the stiffness and lassitude which follow long repose.
Excessive vertigo on lying down, with fear of dying.
Memory is markedly impaired even for the most familiar facts. The thinking power almost suspended, with absence of mind. Head confused; he cannot write nor remember what it was he wished to write.
HEADACHE. Among the pains in the head, properly so called, we notice first pressure, both in the temples and in the forehead and behind the orbits, where it feels sometimes like a wearisome pressure downward; sometimes as if the eyes would be pressed outward; sometimes as if the brain were pressed together from both sides. Also a radiating pressure in the temples, worse during repose; sometimes a burning pressure in the temporal bone.
The sensation most closely allied to the above is heaviness, which is felt in this way: that when the patient stoops it seems as though he could not rise again. There is a sensation as if a quantity of blood shot into the brain ; as if a weight fell forward in the forehead and drew the head downward, or as if the head were being pressed asunder.
Sometimes there is a tearing in the head in every part and direction ; or on awaking and opening the eyes a violent headache, as if the brain were torn, worse on opening the eyes.
A singular sensation characteristic of Rhus is noted on shaking the head and when walking, when jarring the body, etc., namely, a sensation of swashing and jarring in the brain, and each step concusses the brain. China has a similar symptom. Externally the scalp is sore to the touch. There is itching on the scalp, face and lips, and the formation of a vesicular eruption.
To recapitulate: The vertigo occurs when standing and walking; is worse when lying down, though there is a tottering when walking, with which, probably, the paralysis is connected.
The pains in the head are pressure, heaviness, tearing and swashing. They affect chiefly the forehead, temples and post-orbital regions, and, unlike the rheumatic pains, are generally worse on motion, although some are aggravated by repose.
FACE. The face may be pale and sickly-looking, with the features distorted; or red, and covered with sweat without thirst. As regards the skin, there has been observed an erysipelatous redness of the face, swelling of the face and eyelids, with burning pain or itching. On this surface, after a few days, vesicles make their appearance, which discharge and leave a fine, mealy scale. This resembles so exactly the vesicular erysipelas of the face that it is often mistaken for it.
EYES. In the eyes a burning pressing pain; they itch and bite. The white of the eye is reddened ; they lachrymate and are agglutinated in the morning. The lids smart, as if excoriated by the tears, or else they have a sensation of dryness. There is often a sensation of heaviness or of paralysis in the lids, so that they can hardly be kept open.
As regards the sense of vision, there seems to be something like a veil before the eyes, preventing distinct vision.
EARS. Earache and a feeling as if some one were blowing into the ear. There is a whistling, a squealing noise heard, or a ringing when walking, which changes to a loud resonance when lying down, as if the membrana tympani were burst.
NOSE. Nose-bleeding, the blood being dark; it occurs at night; also when stooping and when clearing the throat. A scabby eruption about the nares, with itching, burning pain.
CHEEKS AND JAWS. A peculiar phenomenon is noteworthy: A cramp-like pain in the maxillary joint, as if beaten, as if it would break, and on each motion of the jaw it cracks and snaps audibly. There is a constant desire to yawn, until it seems as though the jaw would break. (This corresponds with, and is analogous to, the stretching and twisting so characteristic of Rhus.)
The toothache of Rhus is a jerking pain extending into the head. It is relieved by applying the cold hand. The gums burn and are sore. The teeth are loose.
In the mouth a sensation of dryness, which persists notwithstanding all the patient may drink.
In the throat a sensation of swelling, with aching pain when speaking, and independently, but attended by sticking on attempting to swallow. There are also sticking pains when swallowing saliva or food, sensations of soreness in the muscles of the root of the tongue and when yawning; pressure on empty swallowing.
The action of Rhus on the digestive organs is not very characteristic. It produces a bitter, sour or coppery taste, a total loss of appetite, a sensation as if the stomach were always full; nothing tastes good. Or, on the other hand, a kind of canine hunger, along with which there is a soapy, slimy condition of the mouth; everything tastes like straw, and there is an immediate feeling of fullness. Frequent eructations; occasional nausea, relieved by lying down and by eating; sometimes nausea and retching at night; pressure in the epigastrium, as if swollen ; throbbing, cutting, pinching pains in the abdomen ; great accumulation of flatus in the abdomen, with great distention.
STOOL. As regards the stool, we notice; Constant tenesmus, with nausea, tearing and pinching in the intestines; the stool is scanty, consisting of mucus, or a watery, jelly-like substance, yellow or streaked with white, frothy, and often mixed with blood. Before stool a burning in the rectum. After stool all pains are relieved. Itching and burning in the rectum, with smarting, blind haemorrhoids.
The urine is dark, soon becomes turbid, with a white sediment (probably urate of ammonia). It is evacuated frequently with sticking pain in the bladder.
With regard to the genital organs we find, as in various other distensible parts of the body, the characteristic effects of Rhus, viz.: Swelling, produced by serous infiltration of the cellular tissue, redness of the cutis, followed by vesicular eruption, which forms a light scab or small white scabs. The moisture exuded is limpid and acrid. Moreover, the natural secretions are acrid. Hence the menstrual flow which Rhus makes to appear earlier and more copiously than is normal, is acrid.
RESPIRATORY ORGANS. Sneezing ; free nasal secretion.
Respiration impeded. Cough, dry, hacking, worse evening and before midnight, or in the morning after waking.
Sensation of heat in the chest and of weakness there, hindering speech. Stitching pain here and there.
It cannot fail to be remarked how much less action on the respiratory organs Rhus has than Bryonia.
Sometimes violent palpitation, sometimes weakness in the cardiac region and a feeling of trembling in the heart.
NECK AND BACK. In the region of the neck and back we find stiffness of the nape and entire neck, with tensive pain and crying out on moving. The sacral region is stiff when he moves, but pains when sitting, as if he had been stooping and bending the back too much. Stitching and pressing pains.
In the extremities we have, most frequently, sticking pains. They may occur in all parts. Also tearing pains, aggravated by hard labor. When felt of, the bones feel sore. The salient osseous processes, condyles, olecranon, etc., are sore to pressure.
Drawing pains are frequent. They go from the elbow to the hand. In Dr. Joslin’s proving of Rhus radicans a pain is described as following the ulnar nerve. I have twice met this in patients and relieved it permanently with a dose of Rhus radicans. Tensive pain ; aching and pains as if luxated are common under Rhus. They affect all parts of the extremities and all the joints.
Besides the above pains and sensations there is a feeling of creeping, formication and numbness as if the fingers were asleep. This is allied to the paralysis.
Also a sensation of great weakness in the limbs; a trembling of the arms and fingers on moderate exertion; a heaviness and lassitude of the lower extremities so that one can hardly move.
There is painless swelling of the feet at evening, evidently oedematous.
Also swelling and pain of the axillary glands.
SLEEP. There is great sleepiness during the day, and also early in the morning, with indisposition to rise and dress. Constant desire to lie down. Incessant yawning, spasmodic, fatiguing, and almost breaking the jaw. Yet the patient can’t get asleep before midnight, partly from sheer wakefulness, partly from heat and restlessness or anxiety; tumultuous coursing of the blood, without thirst.
On going to sleep, shuddering and twitching in the body. The sleep is restless with tossing and unpleasant thoughts and dreams about the business of the day or of things recently done or heard. The gastric symptoms are apt to be felt or to be worse at night.
FEVER. The proving of Rhus is rich in fever symptoms. The cold fresh air is not tolerated; it seems to make the skin painful. (This symptom is of inestimable value in treating rheumatic patients.)
The chill occurs early in the morning. It is characteristic of the chill that it is accompanied by cough, dry and fatiguing. I have often cured intermittent with Rhus, guided by this symptom alone. More frequently the paroxysm is mixed up. External chill with internal heat, without thirst, followed by general sweat. The sweat often appears on the whole body, except the head and face. In this respect the opposite of Silicea.
As regards the disposition, it is depressed and despondent, averse to all exertion, full of sad anxiety and care-taking, depressed, lonesome and prone to weep; anxiety is so great he thinks he shall die or lose his mind; the forces sink; he gets fits of trembling; then comes restlessness; the patient can’t sit still but must always keep moving; becomes fearful, thinks he has been poisoned; the anxiety goes to such an extent that he feels as though he should take his own life; at the same time a sense of dyspnoea and yet relief from deep inspirations.
A better picture than this of the mental and moral condition which ushers in one form of typhoid or nervous fever—the erethistic as distinguished from the torpid form—could hardly be conceived.
We come now to the practical applications of Rhus, in which department, for lack of space, we shall restrict ourselves to its application in fevers, in rheumatism, in paralysis, and in cutaneous diseases, including the exanthemata and glandular affections.
In fevers Rhus has had a most successful and extensive application. As the symptoms indicate, the forms of fever which require it can only be what used to be called the nervous fevers, and are now known as typhoid or typhus.
Comparing it with Bryonia and Eupatorium, we miss at once the whole train of gastro-hepatic symptoms, the vomiting of bile, soreness and pain at the pit of the stomach, constriction around the epigastric zone, fullness and tenderness of the hepatic region, etc., which indicated those remedies in bilious remittent fevers. On the other hand, we find Rhus producing some degree of tenderness of the abdomen, great flatulent distention of the abdomen, amounting to tympanitis,—occasional watery or mucous diarrhoea,—symptoms which, though not so strongly pronounced as similar symptoms are under Phosphoric acid, yet decidedly resemble the symptoms of typhoid fever, or, as the Germans call it, abdominal typhus, and indicate the use of Rhus in that disease.
With this indication, the depressed and collapsed sensorium, the absent-mindedness, the inability to think of what one wishes to do or say, to remember even familiar circumstances, the depression of spirits, the lassitude and actual muscular feebleness, exactly coincide. So do the restless nights and sleepy days, the mixed-up fever and the partial sweats which give no relief.
Hahnemann, in writing of the epidemic of 1813, gave the following directions for selecting Rhus: “This fever has two principal stages: In the first period (which is all the shorter, the worse the disease is to be) there are present, full increased sensation of the pains usually present, with intolerably bad humor, sensation of heat in the body and especially in the head, dry feeling or actual dryness in the mouth, causing constant thirst, bruised feeling in the limbs, restlessness, etc.; but in the second period, that of delirium (a quasi metastasis of the whole disease upon the mental organs), no complaint is made of all those symptoms, the patient is hot, does not desire to drink, he knows not whether to take this or that, he does not know those about him, or he abuses them; he makes irrelevant answers, talks nonsense with his eyes open; does foolish things, wishes to run away, cries aloud or whines, without being able to say why he does so; has a rattling in the throat, the countenance is distorted, the eyes squinting; he plays with his hands, behaves like a madman, passes faeces and urine involuntarily, etc.
In the first period of pain and consciousness, two remedies are of use and generally quite remove the disease at its commencement,— Bryonia alba and Rhus toxicodendron. If, for instance, the patient complain of dizziness, shooting pains in the head, throat, chest, abdomen, etc., which are felt particularly on moving the part; in addition to the other symptoms, the haemorrhages, the vomiting, the heat, the thirst, the nocturnal restlessness, etc., we give him a dose of Bryonia, and give no other medicine, nor even repeat the same as long as he continues to improve.
If now, he proceeds,—”if now, the amendment produced by the Bryonia goes off in the course of a few days; if the patient then complains of shooting pains in one or other part of the body while the part is at rest; if the prostration and anorexia are greater; if there is harassing cough, or such a debility of certain parts as to threaten paralysis, we give a single drop of the Rhus toxicodendron.
Or the Rhus may be given at the very commencement, if the symptoms I have described occur at the commencement of the attack. Indeed, Rhus is suitable more frequently than Bryonia in this disease, and hence can more frequently be used first and alone in treating it.
Observe, first, the clear and sharp distinction which Hahnemann draws between the indications for Bryonia and Rhus respectively ; how carefully he advises us to give each remedy only when the symptoms which specially call for it are present in the case; and how different these symptoms are! Could you gather from this statement that Hahnemann advises the giving of Rhus and Bryonia, in alternation, in typhoid fever ? It would seem to me impossible. And yet the majority of homeopathicians will tell you, and the majority of works on practice will teach you, that the standard prescription in typhoid fever is “Bryonia and Rhus in alternation,” and that this was recommended and used by Hahnemann! There is no better foundation for alternation in any case than there is for this assertion.
Dr. Wurmb, in his “Clinical Studies of Typhoid Fever,” has given us some exceedingly valuable summaries of the action of Rhus and its cognate remedies, so valuable that I cannot do better than to quote freely from his work. Speaking generally of the therapeutics of fevers, he says:
In typhoid epidemics, inasmuch as the cases present at given times and in given localities, apart from all special peculiarities of individual cases, a determinate and distinct general character, and are thereby clearly distinguishable from those which occur at other periods and in other localities, we must regard it as our first problem to get an accurate knowledge of the character of the prevailing epidemic.
When we have done this, the second problem remains for solution, viz.: The discovery of the group of remedies which most closely corresponds in the similarity of their effects upon the healthy to the character of the epidemic. If we succeed in this, then is the most difficult part of our labor done; for the number of remedies contained in this group cannot be very large, and it cannot consequently be very difficult to select from it the most suitable remedy, that is to say, the remedy of which the individual peculiarities coincide most nearly with those of the case to be treated.
Acting upon this rule Dr. Wurmb has described the peculiarities of several groups of drugs and pointed out their adaptations to different forms of typhoid fever. The first of these groups consists of Rhus toxicodendron and Phosphoric acid, the similarities and peculiar differences of which are finely depicted by him. He remarks first that the cases of fever in which these drugs are required and were used by him, are not very grave and severe forms,—the epidemic could not be called a malignant one. The disturbances in the vascular and nervous systems, though often tolerably severe, were never excessive, and the tendency to decomposition of the organic substance, although it existed and was developed, was not very striking. The appropriate remedies, consequently, were such as, in large doses, in healthy subjects, act powerfully, it is true, on the life of blood and nerve; pervert the latter, but do not completely suspend it; cause disturbances in the vital chemistry but do not entirely supersede it !
Rhus toxicodendron and Phosphoric acid, being drugs which act in an equal degree upon both the vital force and the organic substance, and which act powerfully but not destructively, were suitable to an epidemic of this character.
Now, the distinction between these two drugs may in a word be stated as follows: Rhus is characterized by symptoms of erethism, excitement, orgasm ; Phosphoric acid by symptoms of torpor, collapse, sluggishness. This is the proposition which, in so far as Rhus is concerned, we proceed to elaborate in the words of Dr. Wurmb.
INDICATIONS FOR RHUS. The patients are generally strongly built persons who have hitherto been healthy; the typhoid for the most part comes on suddenly, runs a rapid course, and reaches in the course of a few days a high degree of development. At the same time with the disturbances in the vascular system, there is felt a strong sensation of illness, which advances at a more rapid rate than the other symptoms do ; for example, the actual debility is not so great as the sensation of debility, inasmuch as tolerably rapid and forcible motions are still capable of being made. (i.a.— During convalescence, the contrary condition obtains; the patients take themselves to be stronger than they really are.)
Soon, however, the forces fail; movements become difficult and feeble and the patients are constrained to lie quietly in bed, in one place. They complain of aching in the limbs and, sometimes, of violent pain in some joint or other, as in rheumatism.
These disturbances in the general condition do not long continue alone; there are soon associated with them irregularities in the vascular system, viz.: in the beginning, gentle, fugitive chills and heat, but especially heat of the head; at a later period the heat predominates, and at last it becomes continuous and is very violent; there is tendency to rush of blood to the head; roaring pains in the head; the temperature is elevated; the face is burning hot to the touch; the eyes shine and are moderately injected; the cheeks, lips and tongue are of a deep red color; the thirst is very great; the pulse no—112 in a minute. Even at the very beginning of the vascular excitement haemorrhages occur, especially from the nose, and in women, from the genitals. The former almost always afford relief, the latter, which are generally mistaken for the menstrual flow, last but a few hours, or, at the most a day, and produce no change in the condition of the patient.
The symptoms of a change in the composition of the blood (of a sort of decomposition, being the first evidence of action upon the organic substance) appear in a moderate degree only and somewhat later. There appear upon the skin small ecchymoses; the expectoration has a bloody tinge; the stools rarely contain blood.
The nervous functions are always powerfully affected; they are oppressed and restricted. The organs of sense are, in the beginning, in a condition of over-excitability. There is a great sensibility to light, noise, etc.
At a later period the opposite condition obtains; the patients become insensible to external influences, complain of nothing whatever, and lie in a condition of atony.
The sensorium is oppressed and ratiocination is difficult even in the very beginning of the disease. The patients are aware of this fact, but endeavor to prevent its being observed; and to this end, when a question is put to them, they evidently gather themselves up and reply hastily, but correctly; at a later period, when their imagination has become too lively, they cannot quite succeed in this, and hence their answers are in part correct and in part incoherent; finally the incoherence increases; the patients murmur and keep talking to themselves, or they are disquieted by very lively phantasies of the most various sorts, especially at night. Sleep for the most part fails entirely; or when for a moment it visits the patient, there comes in its train a host of disquieting and burthensome dreams.
The abnormal condition of the vascular system is distinctly reflected upon the external skin. This is at first reddened, dry and hot; spots appear, resembling rubeola or measles, upon the thorax and abdomen; if the vascular excitement has subsided, copious sweats occur and along with them, almost always, a miliary eruption.
The mucous membranes are always involved. The tongue is more or less coated, becomes rough, dry, cracked and woody; the lips and teeth are sometimes covered with brown sordes; the taste is gone. The condition of the gastric and intestinal mucous membrane is such as to produce want of appetite; aversion to food; nausea, retching, vomiting. Gases are developed in the intestinal canal, which distend the abdomen. The abdomen becomes sensitive to external pressure under the margins of the left ribs and in the right iliac region. The stools are at first scanty and infrequent, indeed there may be none for several days; generally, however, they soon become fluid and occur three or four times daily without tenesmus or other discomforts; and at a later period, when they are still more frequent, they pass involuntarily. They consist of serum and of a greenish-brown substance, which, at a later period of the disease, is mixed with white flocculi.
Resulting from the affection of the mucous membrane of the air passages, there is a sensation of dryness in the trachea; the somewhat accelerated respiration is, at first, somewhat louder, sharper, the expiration audible; at a later period, mucous rales set in, or large crepitation. The cough, which at first is moderate and dry, becomes gradually more violent and looser in sound, but accompanied by only a very little tenacious sputa, now and then streaked with blood.
The parenchyma of the lungs is congested with blood, especially in the lower lobes, and pneumonic infiltrations often form there, which explain the following symptoms, not infrequent in typhoid: Constriction of the chest; short, anxious respiration; sticking pains in the sides, etc. The spleen is almost always enlarged. The urine is scanty ; it is deficient in chloride of sodium and in urea; rich in sulphates, phosphates and other salts which are always abundant in diseases which are characterized by a tendency to decomposition of the blood. The urine, moreover, is turbid, looks like whey, deposits an abundant white sediment, and shows, by the albumen which it contains, the hyperaemic condition of the kidneys.
The condition above described may last many days. The patient may pass from it into a state of health, or into a still higher grade of erethism, or into the opposite condition of torpor.
In the former case, viz., that of a return to health, the febrile movements slacken; sleep again visits the patient; the sensorial phenomena become less abnormal; the patient gets his appetite again, and congratulates himself on his fine condition; the diarrhoea and tympanitis may last a few days longer than the other symptoms, but they then vanish and there remain only a moderate degree of weakness and emaciation, and paleness of the skin.
In the event, however, of the development of the disease to a still higher grade of erethism, we have not generally long to wait. In this case it is probable that Arsenicum will be our remedy.
For Arsenicum, as we shall see by and by, affects both the vascular and nervous life on the one hand, and the blood composition on the other hand; it acts, with almost equal energy, on the vital forces and on the organic substance. It is, hence, appropriate for such a form of fever as that described as requiring Rhus. But Arsenicum acts with greater energy, with a wider swing and deeper penetration than Rhus. It perverts more thoroughly, excites more profoundly the vital functions; it alters more extensively and more completely the blood and the organic substance than Rhus does. It is, therefore, appropriate for more malignant epidemics of fever, for more severe cases of the same form of fever than Rhus.
Thus, as regards the erethistic form of typhoid fever, a group is formed consisting of Rhus and Arsenic, which, instead of being contrasted as Rhus and Phosphoric acid were, are analogous and allied. They stand related to each other as less and greater, Rhus being the less and Arsenic the greater.
But if the fever change from the erethistic into the torpid form, then Phosphoric acid will probably be required as the correlative of Rhus; or if the torpor be extreme, Carbo vegetabilis may be required, as the correlative of Arsenic.
To show, now, the applicability of Rhus toxicodendron to the form of fever which has been described, Wurmb proceeds to say:
If we hold up beside this picture of the disease, the picture of the action of Rhus toxicodendron, so striking is the similarity that it will not be easy to mistake it. They agree not alone in this, that in both, the same symptoms and groups of symptoms appear, but also that they have in both the same significance. The similarity is therefore not simply apparent, it is real. For, as in typhus, the blood-life is especially affected, the same is the case in the Rhus disease. As in typhus, by reason of the changes in the blood, a violent excitement occurs in the vascular system, the same is the case with Rhus; as in typhus, the sensorial functions are depressed, and in consequence of this depression the imagination is unchained and set loose to work its fancy, and the representations of the general perceptive faculty no longer correspond to the phenomena upon which this faculty is exercised; as in typhus, the mucous membranes, especially those of the intestinal canal, in which deposits and irritations never fail, are especially involved; in short, just as typhus, in spite of the erethism which is present, is an adynamic, morbid process, in the exact sense of the word, and tends to produce, even in the beginning, a decomposition of the blood and an exhaustion of the vital force; the very same is true in all these respects of the morbid affection produced in the healthy subject by Rhus toxicodendron.
Having thus treated very fully the subject of Rhus in fevers, I should, perhaps, in strict deference to the unity of subject, proceed to treat of Rhus in relation to other diseased conditions. But lectures of this kind are worth nothing if they are not practical. I cannot hope, in the short time accorded me, to treat of all the drugs in the materia medica, nor to treat fully of many, if indeed of any. The most I can hope for is to show you how to study drugs in a practical way, and how to reason upon and to apply the knowledge gained by study and observation. Now, the essence of the study of the materia medica is comparison,—the comparative study of one drug beside another drug, with a view of noting their resemblances and differences; the successive study of each drug of a group, in comparison with the picture of some disease to which you suppose the group, or some member of it, to be applicable as a remedy.
We have studied in detail a certain form of typhoid fever, and I have stated that the remedies most similar to that form and degree of intensity are Rhus toxicodendron and Phosphoric acid. I have stated the special similarity of Rhus, but the practical question for you is to know also what cases require Phosphoric acid, that you may be in a position when you meet this form of fever to discriminate between the indications for these two remedies respectively, and may be able to give each in just the case which requires it.
I shall help you then, I think, if now, while the subject is fresh in your minds, I introduce into my lecture on Rhus an episode upon Phosphoric acid,—the correlative of Rhus toxicodendron,—and in this, as before, I shall follow my excellent friend and teacher, Dr. Wurmb. Indications for Phosphoric acid in typhoid: The morbid condition corresponding to Phosphoric acid agrees in essential points with that which requires Rhus. In both we find the same relations to the blood and nerve life; the same tendency to decomposition of the blood and to a waste of the forces; the same changes in the mucous membranes generally, but especially in that of the intestinal canal, etc.
The difference between them consists in this, that in the Rhus affection there is more prominent an erethism of one portion of the vital phenomena and a depression of another portion, a one-sided excitement and a one-sided depression, whereas in the Phosphoric acid affection there is a general and simultaneous depression, letting down, atony of the entire series of vital phenomena. Whereas in the Rhus affection, we see excitement and overactivity in the functions of vegetable life, and simultaneous depression in the functions of animal life ; we see in the Phosphoric acid affection simultaneous and immediate depression in the functions of both of these departments of the patient’s organism. Generally this depression appears in the very beginning of the sickness, though not always, for sometimes partial phenomena of excitement usher in the disease; these, however, are of short duration and very moderate intensity; and after their disappearance the torpid character of the attack is all the more distinctly perceptible.
Cases of this kind are most frequently observed in debilitated subjects who have passed the prime of life; they require a longer time for their development into a distinct form of disease. Thus, for example, there are often noticed loss of appetite, feeling of illness, and a host of other preliminary symptoms which indicate an impending illness but give no clue to its particular form and character,— these, for weeks together, before the peculiar and really important symptoms set in which assure the diagnosis. When these latter have at last made their appearance we observe the following:
The sensations of illness and prostration reach speedily a very high grade, and PARI PASSU with these sensations goes an actual want of power, and hence the patients even in the very beginning of the malady are content to lie quiet, because every movement is a heavy tax upon them. The disturbances in the vascular system do not advance in the same ratio, but lag behind; the pulse is often accelerated, it is true, though sometimes it is not, and in the former case it is generally feeble and small. The temperature is but seldom elevated ; indeed it sometimes sinks below the normal grade. If it is increased the increase is confined to isolated parts of the body, especially the head, while other parts, the extremities in particular, are cold to the touch ; the patients hence are pale, or have only sometimes a flush of redness. Haemorrhages, as for example from the nose, are much more frequent, but they afford no relief; nay, they commonly aggravate the condition of the patient. Ecchymoses are likewise common occurrences, and these are particularly apt to occur on the spots on which the patients lie,—livid spots, which at a later period become sloughing bed-sores.
The patients, for the most part, lie in a constant slumber, which is apt to pass into a higher grade of stupor; the expression of face is stupid; the sensorium is oppressed, the delirium, if it exist, is never lively or active; it takes only the form of an unintelligible murmuring. If the patient be aroused from this stupor it takes him a long time to come to his senses, he looks around him in a kind of dull, stupid wonder, answers slowly, even though it be correctly, and soon sinks back again into his former apathetic condition.
The special senses become dull, but especially the sense of hearing. The patients are influenced and affected by nothing. They complain of nothing but weakness and confusion of the head.
The skin soon loses its plumpness, takes on a shriveled aspect and is loose and wrinkled; the cheeks become sunken ; the nose pointed ; the skin is constantly clammy, moist, and even often covered with a copious sweat and with countless miliary vesicles.
The affection of the mucous membrane is evidenced chiefly by increased secretions; the tongue is moist but pale.
In the thorax are heard large crepitation and rhonchus. Cough is rare, because the need to expel the mucus is not felt by the patient. A similar condition obtains in the mucous membrane of the stomach and intestines ; the stools are copious, often involuntary and passed unconsciously. They are very liquid, contain but little sediment and show sometimes traces of blood.
The pneumonic infiltration is not rare, but it is by no means so frequent as the hypostatic congestion.
Enlargement of the spleen never fails; the diarrhoea, even when it is ever so copious, has no influence upon this symptom.
The urine contains many protein compounds, much albumen, but few salts.
This state of things may pass off into health or may merge in a still higher grade of torpor. If the former change takes place, the recovery is a slow one and relapses commonly take place even when the improvement has been for some time in process.
If, however, the latter change takes place, and the state of things above described gives place to a still more complete and absolute torpor, then it is probable that Carbo vegetabilis will be the remedy indicated. For, just as we have seen that in the erethistic form of typhoid fever, Rhus and Arsenic bear to each other the relation of less and greater, so in the torpid form of the disease do Phosphoric acid and Carbo vegetabilis bear to each other the same relation of less and greater. And the proving of Carbo vegetabilis, I may here remark, is the very type and representative of an asthenic and torpid pathogenesis.
These remarks will suffice to give an idea of the application of Rhus in fevers. They have included no name except that of typhoid fever— but surely, I need not at this hour remind you that, no matter how different may be the names that are applied to morbid conditions, if the conditions be similar the remedy may be the same. Now, it often happens that in the course of the exanthematous fevers, measles and scarlatina, a similar train of symptoms to those already described makes its appearance and calls for Rhus. Especially is this the case in scarlatina, a disease in which the value of Rhus is not well understood by the profession. It will be more ably expounded than I can do it by Dr. Wells in some of the forthcoming numbers of the “American Homeopathic Review.”
The indication for Rhus in scarlatina is still stronger if, in addition to symptoms already detailed, there be an oedematous condition of the fauces, soft palate and uvula, with vesicles upon these parts and a singularly annoying itching, smarting and burning. Independently of scarlatina, epidemics of influenza often occur presenting this oedematous condition of the soft parts of the fauces and pharynx, and even threatening oedema glottidis. The curtain of the palate is puffed and pink; the uvula is elongated, puffed, translucent, and the end is often nearly spherical, looking like a great drop of fluid or jelly just ready to fall off. Vesicles stud the pharynx. The rawness and roughness of pharynx and larynx are almost intolerable. Such an influenza is generally attended by symptoms of great debility; in any case, it finds a suitable and prompt remedy in Rhus, as I have often experienced.
In paralysis, especially of the lower extremities, Rhus is an important remedy. But the paralysis for which it is appropriate is not that form which results from a lesion of the spinal cord. It is rather of the motor than of the sensitive nerves; for I believe sensation is not much impaired. In the form known as rheumatic paralysis, where the paralysis supervenes upon rheumatism, Rhus is especially called for. So, likewise, as would be expected, in cases resulting from undue exposure to cold and dampness, especially exposure of the back or limbs.
This explains the value of Rhus in a form of paralysis not rare in very young children. It affects only the lower extremities, and comes, I am persuaded, though it is difficult to trace these things, from nurses allowing children to sit down on cold stone steps. If these paralyses last long they produce deformity by arrest of development. They are, in general, easily cured with Rhus and an occasional dose of Sulphur.
As regards the application of Rhus in rheumatism, I believe enough has been said of the characteristic action of Rhus to solve all doubts on this subject. Just as Rhus produces in the mucous membranes an inflammation which is not phlegmonous only inasmuch as it does not go on to suppuration, so does it act on the serous membranes of the joints and muscles. The serous secretions are increased and oedematous swellings are produced. The local manifestations, therefore, resemble those of rheumatism.
The fever has been described. The general condition must be of an erethistic typhoid character. The joints are swollen, cedematous, the pains worse during repose and stimulating the patient to constant exertion and motion of the part, both day and night (restlessness only at night requires Causticum).
The condyles and salient points of bone are sore. The pains and soreness are relieved by warmth. Perspiration is copious and does not relieve.
The skin is the part most obviously affected by Rhus. It produces a most remarkable imitation of vesicular erysipelas, and is our most valued remedy in this affection. Anyone who has seen a case of Rhus-poisoning (for which, by the way, the best remedy is Sepia) will recognize the similarity to eczema, for which, in its various forms, Rhus is a most valuable remedy. But its grand role is in the treatment of the pustular form,—impetigo eczematodes or eczema impetiginodes, or baker’s itch, as it is called.