[From the Medical and Surgical Reporter, 
Sept. 27, 1890.] 
THE USE OF RHUS TOXICODEN- 
DRON.1 
BY JOHN AULDE, M. D., 
PHILADELPHIA, PA. 
Rhus toxicodendron is a remedy of great 
practical utility in the treatment of many 
grave diseases, and, although it has been 
before the medical profession for nearly 
a century, it has 'not been very largely 
employed by regular physicians. It is 
a drug whose peculiar action is not well 
understood, the effects being so marked 
from the use of comparatively small doses 
that many physicians regard the reports fol- 
lowing its exhibition as incredible. It is 
also a remedy claimed as the special prop- 
erty of medical practitioners who style 
themselves homoeopaths, and is regarded by 
them as supplying one of the best illustra- 
tions of the truth of their dogma, " Similia 
similibus curantur." The objects to be at- 
tained in the study of this drug may be 
summarized as follows: A better under- 
standing of the therapeutical indications 
for its employment and a theory to account 
for the results obtained as contrasted with 
the theory of similia. 
I have published two papers upon rhus 
1 Read before the Montgomery County, Pennsyl- 
vania, Medical Society, September 24, 1890. 2 
toxicodendron, the first being a short letter 
in the Medical News, April 20, 1889, in 
which I recorded a number of cases success- 
fully treated by the exhibition of rhus; the 
second was a report of a collective investi- 
gation in the Therapeutic Gazette, October, 
1889. I have used this remedy for several 
years past, and quite a number of others 
have used it at my suggestion in the treat- 
ment of different diseases, but I have never 
claimed the original discovery of the valu- 
able properties of the drug. In my first- 
published paper, I referred to its use in 
1798, eight years before Samuel Hahnemann 
invented the name of homoeopathy, and 
mentioned also that it* was official in the 
British Pharmacopoeia in 1836; but I was 
not then aware that it had been studied by 
Piffard, of New York. Since the publica- 
tion of these papers I have received com- 
munications from gentlemen who have used 
it for other than rheumatic affections, for 
which I especially recommended it. The 
only claim I put forward is, that through 
my influence its value has been brought to 
the attention of quite a number of physi- 
cians, and at the same time new uses have 
been found for it. 
The principle upon which minute doses 
of medicines act seem to me to be best ex- 
plained by what may be called Cellular 
Therapy. I have in previous publications 
foreshadowed my views on this topic, but 
only recently have these ideas been suffi- 
ciently crystallized to warrant their presenta- 
tion to the profession in compact form. 
These notions have been somewhat faintly 
outlined in discussing "Small Doses" 3 
(Medical and Surgical Reporter, De- 
cember^, 1887, June 30, 1888, and July 28, 
1888), a little over two years ago. The 
last two papers were devoted to a discussion 
of the therapeutic considerations connected 
with the administration of small doses, and 
included some remarks upon electricity, 
nux vomica and nitroglycerin. From the 
last of these I quote the following: "A few 
words should be added here as to the value 
of these generalizations and the bearing 
which they may have in the elucidation of 
the theory of the actual value of small doses 
in the treatment of disease. As to strych- 
nine, for example, its value is well recog- 
nized, but the method by which we arrive 
at results is not so well understood, the de- 
ductions of experimental physiologists be- 
ing somewhat contradictory and misleading. 
Its applications (effects), are accounted for 
on the basis of its physio-pathological 
action or, to be more plain, its physiologi- 
cal action in the presence of pathological 
changes involving, we may presume, certain 
modifications of the cell-action. Whether 
the tissues are normal or abnormal, we al- 
ways have to do with cell-action, and when 
a medicament is added we have, as a re- 
sultant, the cell-action and the drug-action ; 
and we may assume that when the latter is 
properly applied, the drug-action is in the 
nature of a complementary action to that of 
the cell. It is certainly not ' substitutive 
action,' nor does the expression, ' elective 
action,' sufficiently cover the ground; 
while in the light of these investigations, 
both homoeopathy and dosimetry are alto- 
gether irrelevant expressions." 4 
Going farther than this, we see that the 
pathological changes following the exhibi- 
tion of lethal doses may be interpreted from 
a therapeutical standpoint, as in the case of 
mercuric bichloride, rhus toxicodendron 
and arsenite of copper, all of which are 
known to be exceptionally active poisons. 
Large doses of the bichloride, acting upon 
the cells of the intestinal mucous membrane 
as an irritant (stimulant), set up inflamma- 
tory processes, which so closely resemble 
the pathological changes occurring in diph- 
theria, that no difference between the two 
can be distinguished under the microscope. 
It is reasonable, therefore, to assume that the 
bichloride may be used with proper caution 
in the case of pathological changes affecting 
mucous structures, because of its known 
stimulant action upon the cells affected. 
The absorption of poisonous products in 
this case is prevented by the increased re- 
sistance of the cells upon the same principle 
as the normal cells prevent the absorption of 
the poisons naturally occurring in the in- 
testinal tract even in health. The medi- 
cament merely increases the resistance of 
the organism by fortifying and strengthen- 
ing the normal functions of the affected 
cells. The danger to be apprehended from 
the use of this remedy is ptyalism; but, in 
addition, there are dangers which may prop- 
erly be classed as intermediate. For exam- 
ple, the amount and frequency of the dose 
may lead to the disorganization of the cells, 
when they are no longer capable of acting 
in the capacity of scavengers, and, although 
nature is conservative, disease gains the up- 
per hand. The minimum dose, repeated at 5 
short intervals, is therefore of prime neces- 
sity, as by this method the cells are con- 
stantly bathed in a fluid charged with the 
medicament, while over-stimulation and the 
consequent destruction or arrest of the cell- 
function are avoided. 
In the case of rhus, instead of the buccal 
mucous membrane bearing the brunt of 
lethal doses, its effects are shown in the form 
of marked inflammatory changes in the in- 
tegument, an illustration of the remote ac- 
tion of the drug. The direct action is upon 
the cells of the intestinal tract, the remote 
effect being manifested in the subsequent 
hyperemia and retrograde changes taking 
place in the cells of the integument. These 
effects have been referred to as the specific 
action of the drug, and it is the toxicologi- 
cal effect of such action that we wish to 
avoid in the treatment of disease. The 
knowledge thus acquired, while valuable 
from a toxicological point of view, it will 
readily be seen, is not of equal value as a 
lesson in therapeutics, unless rightly inter- 
preted. 
In the case of arsenite of copper, we have 
a most fitting illustration of cell-activity in 
the treatment of various disorders of the in- 
testinal tract. It is closely related chemic- 
ally to Paris green, and as a therapeutic 
agent is destined to occupy an important 
position in the medicine of the future. The 
exhibition of minute doses is attended with 
marvellous results, in all cases and at all sea- 
sons of the year, in every climate. That it 
is antiseptic cannot for a moment be doubted, 
but it is also an important alterative, produc- 
ing effects through influences which, except 6 
upon the basis of cellular therapy, we are 
unable to understand or explain. Without 
any undue stretch of the imagination, cata- 
lytic properties may be ascribed to it, as 
through its administration a series of changes 
are started which sooner or later manifest 
themselves by effects which are more or less 
perceptible. 
In the treatment of typhoid fever, I have 
found it superior to any and all other reme- 
dies, when used solely with a view to main- 
tain a healthy condition of the intestinal 
canal, and the only scientific basis which 
can be offered for this beneficent action rests 
upon the theory of cellular therapy. My 
ideas on this subject have been confirmed 
by the opinion of Prof. Dr. Hugo Schultz, 
of Greifswald, Germany, my friend and 
translator, who has arrived independently at 
a similar conclusion. In the course of a 
private communication he says, "It is out 
of the question to suppose the cupric arse- 
nite exerts any germicidal influence when 
given in the doses you advise. The bene- 
ficial action of the drug, however, goes far 
to prove the possibility of a ' cellular ther- 
apy,' with the necessary consequence of a 
pre-existing cellular pathological condition." 
It will be evident, therefore, to the most 
superficial observer, that cellular therapy is 
entitled to more than a passing notice, and 
I have confidence that it will ultimately oc- 
cupy an important place in completing the 
chain of evidence which shall advance the 
art of medicine until it occupies a position 
on a level with surgery, as seen in the last 
decade of the nineteenth century. 
In concluding my reference to the subject 7 
of cellular therapy, I will anticipate some 
objections which may be offered. It may 
be asked why these cells are thus affected 
by different medicaments, and why certain 
drugs are indicated in particular diseases. 
These questions cannot be answered. The 
physiologist cannot tell why a ray of light 
impinging upon the retina produces a men- 
tal picture on the brain, nor explain the 
process by which sound is conveyed to the 
brain; and the therapeutist meets also ob- 
stacles when he tries to explain the action 
of drugs. The entire science of physiology 
is erected upon the function of the cell as a 
basis, and this remains one of the most pro- 
found secrets of nature. Disease, in its in- 
cipiency, is a derangement of function be- 
ginning with the cell; all medicines, as a 
rule, are poisons, and as such produce or 
develop effects in the nature of force when 
introduced into the economy. The aim of 
the physician is to determine the range and 
extent of that power, and at the same time 
to locate as nearly as possible the particular 
cells which are modified, and the manner in 
which they are affected by this force. 
Pharmacology.-The pharmacology of 
any drug includes a study of its physiological 
as well as its toxicological effects, given in 
small, medium and lethal doses. In order 
to obtain a correct knowledge of the prop- 
erties of rhus toxicodendron, I may mention 
some points connected with its preparation, 
which belongs to the department of phar- 
macy. Many valuable medicines are ruined 
in the course of preparation, and unfortu- 
nately rhus toxicodendron forms no excep- 
tion to this rule. 8 
The only reliable form of preparation is 
the tincture made from the fresh leaves, 
which should be gathered during the period 
of efflorescence. It is said that, as far as 
practicable, the leaves should be selected 
from among plants growing in the shade ; in 
case this is found impracticable, they may 
be gathered before the sun strikes them in 
the early morning. The tincture is made 
according to the directions of the U. S. 
Pharmacopoeia for the manufacture of fresh 
herb tinctures-fifty parts of the drug to one 
hundred parts of alcohol; after thorough 
maceration, the liquid is allowed to stand 
for the period of fourteen days, when it is 
subjected to percolation, and is then ready for 
use. The active principle, toxicodendric 
acid, is an exceedingly volatile substance, 
and it is reasonable to suppose that prepara- 
tions made from the dried leaves are practic- 
ally inert. My observations with fluid ex- 
tracts prepared in this manner warrant the 
statement that they are not reliable ; and I 
therefore desire to emphasize the need for 
procuring a reliable product. Dr. J. W. 
Keath, of Schaefferstown, Pa., wrote me 
some time ago that he had used rhus in all 
the classes of cases in which I had recom- 
mended it, in both large and small doses, 
and had failed absolutely to notice any ef- 
fect whatever. I at once made arrange- 
ments to have him supplied with a reliable 
product, and the treatment was repeated 
with the result that not a single failure oc- 
curred. 
The dose of the tincture ordinarily should 
not exceed one-half drop three times daily ; 
if the diagnosis is correct, and the results 9 
are unsatisfactory, the dose should be dimin- 
ished. For convenience the tincture may 
be prepared in the strength of one part of 
the tincture to nine parts of diluted alcohol. 
Each five drops of this solution carries just 
one-half drop of the medicine. In patients 
who are susceptible to the action of the 
crude drug, that is, those easily poisoned, 
it will be advisable to begin treatment with 
a single drop of the ten per cent, solution, 
which may be diluted with a little water and 
taken three times daily. In typhoid fever, 
the dose should be even smaller, but more 
frequent repetition is necessary. 
As some present may have doubts con- 
cerning the possibility of so small a dose 
having any appreciable effect, I call your at- 
tention to some tablet triturates, each con- 
taining one one-hundredth of a drop of the 
tincture, and if you have the temerity to in- 
vestigate the matter in propria persona, take 
one of these tablets and allow it to dissolve 
in the mouth. There is no evidence supe- 
rior to that afforded by one's own senses, and 
at the close of my paper we shall be glad to 
hear the results of the experiment. 
Lethal doses are best antagonized by the 
exhibition of some preparation of lead, and 
you all know that lead water and laudanum 
are the standard remedies in the case of rhus 
poisoning. As an external remedy, no com- 
bination is superior to ordinary white-wash; 
it should be applied freely with a brush, and 
the patient instructed to avoid carrying the 
poison from one part of the body to an- 
other through the medium of the hands. 
To allay the irritation set up in the diges- 
tive tract, olive oil or some other bland oil 
may be freely swallowed. 10 
Absorption takes place very rapidly, 
whether rhus toxicodendron is applied locally 
or taken internally, but it is said that cau- 
tiously chewing the twigs of rhus renders the 
person proof against poisoning from contact 
with the shrub. Elimination is effected 
through the usual channels, the effects being 
most marked in the skin and upon the urin- 
ary tract. 
The general action, when taken in medi- 
cinal doses is that of a stimulant, acting 
upon the cerebral centres, as any of you 
may learn from taking the minute dose sug- 
gested. From small medicinal doses, I have 
never noticed any appreciable narcotic ef- 
fect, although no doubt large dosage will 
show that it has decided narcotic properties. 
Dr. George Kirkpatrick, of La Harpe, Illi- 
nois, wrote me some time ago that he took 
by mistake a swallow of the tincture, and 
almost immediately afterwards, he took ten 
grains of sodium carbonate and a quantity 
of oil, and felt no bad effects until the 
second day, when he noticed that the scarf- 
skin was all peeling off. He suffered no 
serious inconvenience, however, from the 
accident. The form, manner and time of 
taking, are important factors in producing 
therapeutic effects. While in the case of 
chronic rheumatic affections half-drop doses 
three times daily are quite sufficient, typhoid 
fever and erysipelas require smaller doses 
given at more frequent intervals, at least as 
often as every hour during the day. The 
mixing of the plain tincture with water is 
contra-indicated, as a considerable portion 
of the active principle is thus destroyed ; 
by using it in the form of a solution with 11 
diluted alcohol as suggested, this objection 
is removed, and each dose may be combined 
with a teaspoonful of water without injury, 
if not allowed to stand exposed too long. 
The action of rhus upon the nervous sys- 
tem is somewhat peculiar; as, although it is 
not a narcotic in the proper sense, it pos- 
sesses the property of allaying the irritabil- 
ity of the sensory nerves. This is shown in 
a very distinct manner in the case of chronic 
rheumatic affections, where the pain will be 
arrested sometimes in the course of a few 
hours. My impression is, that the effect in 
these cases furnishes an illustration of the 
influence of the cell-action. In sciatica, for 
example, the nerve-cells are bathed in a fluid 
containing the rheumatic poison, which is 
manifested by the sensation of pain ; but as 
soon as the circulating fluid becomes charged 
with the active principle of rhus, elimination 
begins, and at the same time more or less 
stimulant action takes place in the cells af- 
fected, the result being that the pain ceases. 
The demonstration here offered finds an ap- 
parent counterpart when the eye becomes 
tired from gazing at some particular color, 
but as soon as an acceptable shade is pre- 
sented to it a comfortable sensation of rest 
is experienced. For a long time it was be- 
lieved that nothing but opium or some of its 
preparations were serviceable in this class of 
cases; lately, however, the analgesic prop- 
erties of synthetic products have been dis- 
covered, and with the light furnished by the 
cell doctrine, the way is clear to the discov- 
ery of other drugs possessing certain pecu- 
liar properties. We shall then be in a posi- 
tion to understand the claims of the homoeo- 12 
paths in regard to the harmlessness of their 
medicines even when taken in large quanti- 
ties, providing it is not the particular remedy 
which meets the inroads of the disease. 
The effect of medicinal doses of rhus 
upon the circulation, the temperature and 
respiration is not marked. Upon the mus- 
cular system, during the progress of rheu- 
matic changes, the effect is very manifest; 
but this action is undoubtedly through the 
mechanism of the nerve-cells. Thus, when 
a nerve-trunk is stimulated (irritated) by 
some foreign substance, electricity, strych- 
nine, strophanthus, or even by a blow, its 
power over the muscle is arrested and, as 
has been pointed out by Poole, the muscle 
supplied by the nerve exercises its inherent 
property and contracts. In the case of lum- 
bago, we are warranted in assuming that the 
pain may be due to a combination of cir- 
cumstances brought about originally through 
the arrest of tissue-change, by which the 
blood is charged with a poison that suspends 
the function of the nerve-cells. As a con- 
sequence of this arrest of function there is 
increased muscular tension, manifested by 
pain on motion. It is in these cases that 
we have the practical illustration of the 
stimulant properties of rhus exhibited, by 
which the cell-function is promptly restored. 
The true explanation of this " cure " is not 
to be credited to homoeopathy, but to anti- 
pathy. 
In the early history of the use of rhus 
toxicodendron, it was recommended for the 
relief of paralysis; but it will be apparent 
from the foregoing that it does not corre- 
spond with strychnine in the treatment of 13 
this class of cases. The special forms of 
paralysis which it relieves are caused to dis- 
appear solely through the stimulant action 
upon the nerve-cells, and it is necessary to 
exercise care in the selection of cases for 
treatment with rhus toxicodendron. 
Upon digestion the effect of rhus is most 
remarkable; and, from my experience with 
it in the treatment of disorders accompanied 
by derangements of the digestive functions, 
I am inclined to regard it as possessing prop- 
erties allied to that of an antiseptic. It cer- 
tainly has a decided detergent effect upon the 
blood, and persons taking it for the relief 
of rheumatic affections seem to experience 
marked improvement in digestion, the se- 
cretions being perceptibly increased. When 
introduced into the stomach, the eliminant 
action upon the cutaneous system is very 
noticeable. In the course of a few days 
the complexion begins to show favorable 
changes, and with increased activity of the 
cutaneous envelope there is a correspond- 
ingly increased cerebral activity. I recall a 
case in which it was used for its influence 
upon the genito-urinary tract, when indiges- 
tion was a prominent symptom, with indica- 
tions of approaching melancholia. Half- 
drop doses of the tincture, three times daily, 
changed the whole character of the disorder, 
and at the end of a week, indigestion, ure- 
thral irritation and melancholia had disap- 
peared. 
Therapeutical Applications.-A study of 
the physiological actions and the toxicologi- 
cal effects of a drug naturally indicates its 
therapeutical applications ; and after what 
has been said of rhus toxicodendron, little 14 
need be added in pointing out the indica- 
tions for its employment. I have already 
referred to an apparent antiseptic and altera- 
tive action which rhus seems to possess, es- 
pecially in the case of rheumatic and intes- 
tinal disorders, and I desire to call your es- 
pecial attention to its value in the treatment 
of all forms of chronic rheumatic affections. 
The only instances in which I have failed to 
obtain good results were those when the pa- 
tients had become debilitated from insuffi- 
cient or inappropriate food supply, and in 
the case of acute attacks engrafted upon a 
chronic disorder. The physician is fre- 
quently confronted with cases of rheumatic 
joint-affections, sciatica, pains in the shoul- 
der, the ankle-joint, the ball of the foot, 
etc., where other medication has proved 
disappointing. In many of these cases rhus 
will prove effective, often relieving the pain 
within a day or two, and effecting a perma- 
nent cure. In wry-neck due to exposure, 
and in lumbago rhus will prove very valua- 
ble. Hemorrhoids, varicose veins and 
chronic cystitis are usually promptly re- 
lieved by the exhibition of this drug. Occa- 
sionally the close observer will be disposed 
to regard some local disturbance, such as 
ear-ache, sore throat, pain in the bladder or 
rectum, as one of the manifestations of a 
rheumatic tendency; and it will be found 
on trial that rhus is not alone palliative, but 
produces permanent recovery. It is often 
of signal value in relieving paralyses ac- 
companied by a rheumatic history, and, 
while I am not prepared to say that rhus 
would not be useful in the absence of the 
latter, I am disposed to regard the presence 15 
of this neurosis-including, of course, 
gouty and lithemic conditions-as the spe- 
cial indication for the employment of rhus. 
In the treatment of erysipelas small doses 
seem to arrest the tendency of the eruption 
to spread while the fierce character of the in- 
flammation is subdued and the temperature 
and pulse fall. 
Rheumatic and gouty or lithemic tenden- 
cies are liable to manifest themselves dur- 
ing the progress of other diseases, acute 
and chronic. In typhoid fever, especially 
where it assumes the lingering form and 
is accompanied by what appear to be neu- 
ralgic pains, the exhibition of rhus will 
often cause these pains to disappear, and 
will produce a marked change in the course 
of the disease. I may add that this remedy 
will prove of great service in the treatment 
of some of the more common sequelae of 
this disease, such as paralysis or sciatica and 
other pains of a neuralgic character, to- 
gether with the usual depression of the or- 
gans of special sense. 
In conclusion, I have but a word to offer 
relating to the use of rhus in the treatment 
of skin diseases. The chronic varieties re- 
spond most readily to this drug, and espe- 
cially the scaly forms; but it is useful in all 
cases dependent upon an unhealthy condi- 
tion of the digestive tract. As many of 
these affections are to a great extent due to 
the ingestion of improper food-too much 
starchy and saccharine material being eaten 
-it will be sufficient to say that these sub- 
stances must be prohibited during the pe- 
riod of treatment, or but little benefit can 
be expected. 
1910 Arch Street, Philadelphia.