Rhus aromatica, Fragrant Sumach (the bark of the root), contains a terebinthinate balsam and tannin. Naturally, its action is on the kidneys. How much of its tannin may reach the kidneys is problematical, but its balsamic association renders the systemic effect of the tannin more probable than would be the case with uncombined tannin.

On the improbable supposition that its tannin does reach the kidneys, rhus aromatica is used in the treatment of diabetes insipidus and incipient albuminuria, as well as in incontinence of urine and vesical irritation.

I have carefully tried the fl. aromatic rhus and found it frequently useful in the nocturnal enuresis of children. It is hard to judge its value in albuminuria. Certainly in inflammatory states such an agent should not be used, and most cases of transitory albuminuria recover without any drug. I have seen albumin disappear from the urine while the patient was taking aromatic rhus; but that does not necessarily mean anything. I can say the same regarding diabetes insipidus. I have seen patients preparatory to using the cystoscope void such immense quantities of urine that I had great difficulty in using the instrument. As a matter of fact, the term "diabetes insipidus" should be dropped. We have a symptom, polyuria, associated with syphilitic meningitis, hypophyseal disease, structural defects of the kidney, and various transitory forms of nerve stress.

The first thing to do in a case of "diabetes insipidus" is to make a Wassermann test. Furthermore, if the test is negative and no hypophyseal involvement exists, the case is structural and demands shutting down on the salts, and a definite proteid reduction in the diet. Drug treatment is purely symptomatic. Valerian and cannabis indica have done most in my hands, and they did little. An established "diabetes insipidus" is one of the most baffling problems in therapeutics unless the case is syphilitic, and that is bad enough.

These remarks are made simply to show how vague many of our therapeutic recommendations are. Certainly it is foolish to contend that aromatic rhus is indicated at all in an established polyuria. Nevertheless it is not fair wholly to discredit the drug. The astringent terebinthinates fill a useful place. See "Abies."

The dose of fl. aromatic rhus is 15 to 30 minims. Give it on sugar, since the preparation is not miscible with water.

Sumach Berries, Rhus glabra. Was official in the U. S. P. VIII. The diluted fl. is a simple but effective astringent, used in the treatment of aphthae, salivation from mercury, and as a gargle.

Chinese Galls, Rhus semialata, official in Japan; used for the contained tannin. Rhus diversiloba, of the Pacific slope, Poison Oak, and Rhus toxicodendron, the Poison Ivy of the Eastern States, have similar toxic effects. The Japanese Poisonous Sumach, R. vernicifera, the American Rhus vernix or R. venenata, and some tropical species, are closely allied if not similar as regards toxicity.

"The toxic principle is an amber colored nonvolatile liquid resin which has acidic and phenolic properties, and which may be readily oxidized to a black, lustrous, durable varnish."1

Pharmacology

The poisonous principle is preserved for a long time in alcohol. Many animals can eat this plant with impunity, but it is asserted some of the smaller animals are poisoned by it. Man is not constantly affected by the plant. I have taken the drug in large doses without any symptoms whatever; but, in pulling the vines out of a fence row, inoculated a scratch on my finger and have since been slightly susceptible to the local action of the drug, and more especially to the growing plant.

1Stevens and Warren: Am. Jour. Pharm., 1907, CXXIX, 518. Pfaff: Jour. Exper. Med., 1897, ii, 188. Syme and Acree: Am. Chem. Jour., 1906, XXXVI, 301. McNair: Jour. Am. Chem. Soc, 1916, XXXVIII, 1417.

There is no recorded instance of a human being dying from the effects of Rhus toxicodendron.

The local effects upon susceptible persons are too well known to require description; but it must be added that fever, sore throat, diarrhea, and hematuria follow in some cases. There are some instances of convulsions resulting.

I have induced three persons proven to be susceptible to the local influences of the drug to swallow capsules I carefully filled with 10 drops of a fresh Homeopathic mother tincture of the plant retained by coating the capsules with paraffin over the joint but not over the body of the capsule. None of these persons developed any symptoms whatever; but it would be folly for me to assert that none other of the susceptibles would develop symptoms by introducing the drug into the stomach; in fact, it is probable some hypersensitive persons would do so.

But the outstanding fact is that Rhus toxicodendron has no pharmacology except with persons who are naturally sensitive or, as I believe, have been sensitized to it, and just as the pollens of ragweed, golden-rod, etc., have no pharmacology except with persons sensitized to them. For a discussion of this view, see "Pollen Extracts." How, or by what mechanism, one may become sensitized to Rhus toxicodendron I am not prepared to say; but there is, at least, some resemblance to anaphylactic shock.

Therapeutics

Homeopathic and Eclectic literature asserts that the drug is valuable in certain typhoid and rheumatic states, herpetic eruptions, conjunctivitis, restless febrile conditions, and certain nervous diseases; and many gentlemen whose views I respect esteem the drug highly.

Some years since I became mildly enthusiastic over some neurologic cases in which I employed rhus tox., seemingly with good results. Indeed, to this day, I believe the drug did markedly benefit some of my cases. But the difficulty is this: As nearly as I could differentiate in diagnosis, the same type of cases usually failed to be influenced by the drug in any way. One sees some striking results he feels fully justified in ascribing to rhus tox., and yet he can seldom repeat those results with apparently similar cases. I have accurately followed Homeopathic methods with their low dilutions, Eclectic indications with their own drug preparations, and my own judgment with all kinds of dosage; and to this day I don't know the indications for rhus tox., or if it is justified as a remedy in any indication; nor do I know the proper dosage, either for a susceptible person or one not susceptible. I am inclined to the view, however, that the drug is active only in persons who are susceptible to its external toxic influences and irregularly with them. So I never employ the drug without telling my patient that it is purely experimental, since he may not react to it at all.