1 Des Characteres, du Traitement et de la Cure des Dartres, et de la Paralysis des extrumites inferieures .... par l'usage du Rhus Radicans, etc. Paris; An VII. de la Republique.

This led Dufresnoy to experiment freely and successfully with rhus in this class of affections.)

Rheumatic Affections. - Rhus is a very powerful therapeutic agent in various subacute and chronic rheumatic affections of the fibrous tissues generally. The synovial membranes are less amenable, however, than the fibrous tissues outside of them, such as the tendons, the ligaments, and the fascia. When the muscles seem to be affected and relieved by rhus, it is through the extension of the rheumatic affection from the joints and not from rheumatism primarily in the muscular substance.

In the after stage of acute rheumatic fever, when aconite may have been employed, and when the temperature has fallen to 100°, or below it, and where the patient still suffers from wearing stiffness, and aching, of a subacute character, in the neighborhood of the joints, rhus is positively invaluable. It should be applied externally, in the form of lotion, with compresses, and be given internally, in small doses, every two to four hours.

In cases of scarlatina, accompanied or followed by rheumatism of a type more or less acute, rhus is often of the greatest service, especially if typhoid symptoms are present.

(Our own experience fully coincides with that of the author as regards the effect of rhus in subacute rheumatism. For several years we have been subject to subacute muscular or tendinous rheumatism, the pain usually occupying the right shoulder, and most severe in the neighborhood of the insertion of the right deltoid, shifting thence to other parts, sometimes apparently to the fascia of the outer and posterior aspects of the leg. The pain was always worse at night, and during the winter of 1877-8 became so continuous and severe as to interfere with sleep. After four months of serious discomfort, complete relief followed the use of a few doses of rhus. At the Charity Hospital it not unfrequently happens that patients complaining of rheumatism, "worse at night," are sent to the venereal wards on the hasty diagnosis of syphilitic rheumatism. In a number of these cases in which we have been unable to verify the diagnosis of syphilis, we have obtained most decided and prompt relief from rhus. In private practice many cases of chronic eczema have been encountered in which this form of rheumatism has been present as a complicating or alternating symptom. Some of them had been dosed, ad nau-seum, with colchicum, alkalies, iodide of potassium, and salicylic acid without much, if any, benefit. In these cases prompt and decided relief was obtained from rhus.)

Paralysis. - Dufresnoy administered the dried leaves, in doses of half a grain or a grain, twice a day, in cases of paralysis. The patients recovered, so it is said, to a certain extent; the first symptom of improvement consisting in an unpleasant sensation of pricking or twitching in the limbs, analogous, apparently, to that induced by strychnine. Subsequent experience had not at that time defined the exact class of paralytic affections amenable to rhus. It is now certain, however, that this medicine is efficacious in cases that depend upon a rheumatic condition.1 It is a curious fact, pointed out by Dufresnoy, that persons not constitutionally susceptible to the disorders induced by rhus, regarded as a poisonous agent, are not so likely to receive benefit from it if used as a medicine. This circumstance is important to be borne in mind by those who would try the therapeutic powers of this remarkable drug.

1 (Eberle reports a case of paralysis cared by rhus. (Western Jour, of the Med. and Phy8. Sciences, 1831.))

(The statement of Dufresnoy and others that those who are not subject to rhus poisoning (by external application) are likewise not likely to receive benefit from its internal administration, we are not prepared to unreservedly accept. Personally we have handled the fresh leaves of both the R. toxicodendron and the R. venenata with impunity, and have frequently daubed the tinctures on our skin without the slightest result; tinctures that we had experimentally found active when applied locally to others. On the other hand, we have experienced decided physiological effects from the internal use of very small quantities. Similar experiments with other irritants (cardol, succus euphorbia), cantharides, etc.), lead us to suspect that the unsusceptibility may be local and not general, as asserted by most writers.)

When semi-poisonous effects have to be dealt with, the treatment should be lowering, and consist in rest, low diet, and laxatives. The extreme irritability and the burning sensations may be greatly alleviated by the use of opium and of strong black coffee; and externally by the use of ice or a solution of acetate of lead. Fomentations and lotions of lime-water and linseed-oil are likewise useful. (In the editor's experience, the most serviceable local applications are a solution of bichloride of mercury, originally recommended by Barton (Thacher's Dispensatory, 1810), and the fluid extract of Grindelia robusta.

Botanists are pretty well agreed that the plant called Rhus radicans is the same as the one under consideration; its differing form and characters depending on the circumstances of its habitat. Besides these there is met with in this country a Rhus venenata (formerly called R. vernix), which is even more poisonous than the others. The writer possesses a tincture of R. ven. made by Dr. Manlius Smith, of Syracuse, in 1847. A drop of this applied to the arm of a medical friend, produced an active dermatitis. From California we have accounts of a Rhus diversiloba, the poisonous powers of which are said to exceed those of the Eastern varieties.)

Preparations And Dose. - Non-officina - The dried leaves, Toxicodendri Folia, were included in the second edition of the U. S. Ph. (1830) - the dose usually assigned being from one to two grains. These leaves when freshly dried are doubtless reasonably active, but if long kept become comparatively inert and cannot be depended on. It is perhaps to this cause or to the fact that physicians of that day did not know how or when to use them, that the drug fell into disuse and was discarded from the Pharmacopaeia. A tincture made by macerating one part of fresh leaves in two parts of alcohol is the only preparation that we have employed. Of this preparation we cannot definitely formulate the most useful dose. In general, however, it may be stated that in rheumatic and cutaneous affections a small fraction of a minim has proved most serviceable. In suitable cases of paralysis, however, the drug may be pushed to the limit of tolerance. The Tinct. Toxicodendri of the Ger. Ph. is made from five parts of the fresh leaves to six parts of alcohol. The Extract. Toxicodendri of the older pharmacopoeias is an unreliable preparation on account of the variability of its strength. Fifty years ago the late Dr. Jacob Bigelow declared that:1 "It is one of the most uncertain of medicines, sometimes having been carried to the extent of an ounce of the extract at a dose without effect; at other times having produced alarming consequences in an almost imperceptible quantity." The latest pharmaceutical writer, Bernatzik,1 dismisses the extract in a few words: "In der Regel ganz unwirksam." A good tincture, however, will be found sufficiently active.)

1 A Treatise on the Materia Medica, Boston, 1822, p. 378.