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Urushiol is the toxic poison in poison sumac, and is the common term for the substance in the sap that causes contact dermatitis in humans (Armstrong & Epstein 1995). What is amazing is specimens 100 years old have been known to cause dermatitis in humans, because urushiol is a relatively stable compound, and can remain potent for years in the absence of oxidation (Armstrong & Epstein 1995). Urushiol got its name from from the Japanese word "urushi" which was the lacquer produced from the sap of the Japanese lacquer tree (Armstrong & Epstein 1995).
Urushiol is a combination of phenolic compounds called catechols and potent benzene ring compounds with a long side-chain of 15 or 17 carbon atoms (Armstrong & Epstein 1995). Urushiol is transferred from the plant to human skin by direct contact, contaminated clothing or objects, and animal fur, by penetrating to the epidermal layer of the skin where it binds to proteins of deeper skin cell membranes (Armstrong & Epstein 1995). Dr. Lisa A. Gartner (1999) explains that, "These substances elicit a classic type 4 cell mediated immune reaction...The typical clinical lesions are erythematous papules and plaques, often with vesticles or bullae; the lesions commonly occur in a linear patters indicating lines of contact with the plant." The reaction of urushiol and humans is a red crusty, weeping, bumpy and annoying rash. It usually lasts from two to five weeks, although some have had it for longer. Dr. Gartner (1999) also added that, "Blister fluid does not contain urushiol and is therefore not contagious." However, urushiol residue is difficult to wash off and may be spread by scratching (Armstong & Epstein 1995). Urushiol causes a delayed dermatitis reaction with the human body, and the most uncomfortable of the effects may not be felt for days or weeks (Armstrong & Epstein 1995).
Armstrong and Epstein (1995) note, "Poison oak and ivy do not spare age, sex, race or economic status. Each year thousands of people are afflicted with moderate to severe dermatitis from touching the foliage of these plants."
Fifty to seventy percent of the population are prone to dermatitis from exposure to urushiol (Arriola & Lee 1999). Urushiol is so incredibly toxic that it would take only one ounce of it to effect everyone on the earth with a rash (Brooks 2001).
Urushiol may have an evolutionary significance by sealing wounds on the plant, or it may retard the growth of infectious fungal or bacterial spores (Armstrong & Epstein 1995). Since the leaves are eaten by a wide variety of animals, urushiol as a chemical defense strategy is an un-favored scenario (Armstrong & Epstein 1995).
There are other species in the Sumac family that have urushiol. The cashew nut shell, mango, Rengas tree, Burmese lacquer tree, India marking nut tree, and Ginkgo biloba have all been reported to cause dermatitis (Armstrong & Epstein 1995).
In California, Oregon, and Washington, close to one third of firefighters and forestry workers will suffer from rashes and lung irritations due to burning poison oak (Stehlin 1997). It is the smoke from burning poison oak that is toxic. The effects from urushiol will result in more workers compensation claims for lumberjacks, park rangers, and firefighters than any other source (Brooks 2001).
Hale MM (Reference Works):
toxical provings of Dr. P. B. Hoyt, of Danbury, Conn:
March 18th, 1857. Wishing to prepare a tincture of this plant, I went into a swamp and procured some sprouts of the Rhus free. I put upon my hand's pair of buckskin gloves, and carefully kept on the windward side of the plant; notwithstanding this precaution, in one and a half hours I began to feel a most intense itching and burning of the scrotum and penis; the burning sensation was rather in the preponderance. The glans penis was very painful; slight friction relived the itching for a moment, but not the burning.
19th. The symptoms continue in the same severity; at 11 o'clock I scraped off the bark, using great caution to escape its poisonous effects, if possible; at three PM, itching and burning commenced on the back of my right hand, between the thumb and index finger, also between the index and middle fingers.
20th. Have been very restless all night. Awoke this morning with itching and burning in various parts of the body, particularly on the palmar sides of both wrists, attended with slight swelling; slight itching and burning of the face, with a sensation as if it was much swollen; it was red, but not shining. Both hands were considerably swollen and very clumsy to use. Feeling of uneasiness in consequence of the continual itching and the burning, which were very severe, almost insupportable. PM - The itching and burning were somewhat relieved by exercise. The itching and burning appears on the face, particularly about the eyes (right). All the symptoms were aggravated by rest. Hands, face and wrists became covered with little pimples of the same color as the skin (red); when broken, or the points scratched off, they exude a clear, watery fluid. Fingers very stiff and much swollen, feel very much as though they had been scalded; excessive burning of the face; right eyelid swollen and stiff. The scrotum is the seat of paroxysms of severe itching and burning Stool at two AM loose, which is unusual; had a stool early in the morning, rather loose, with pain in the bowels before the discharge. Abdomen sore to the touch and pressure.
21st. Symptoms all increased; face much swollen, red, and covered with multitudes of little papillae. Dizzy sensation at times, much worse at evening; wrists much swollen, the swelling extending half way to the elbow; arms very red and covered with innumerable vesicles, which exude a clear, watery fluid. My hands were in the same condition; the pain was excessive.
22d. Diarrhoea at 3 o'clock, a copious stool of a lighter color than that of the night previous. Another stool at seven AM, not as copious, and again at 9 o'clock. Pain in the hypogastrium before every stool; have but little warning before each stool. Hands and wrists are much worse this morning; face also more swollen. The itching and burning continues with unabated vigor, and are aggravated by the warmth of the bed, and in a warm room. Mental labor increased the pains even the recording of these symptoms aggravates them. Mouth feels rough, as though sand was under the mucous membrane, which is very red. I experienced no feelings of despondency at first, for several days previous to my poisoning, a sense of dullness and weight in it. (I notice in the proving of Rhus vernix, given in Jahr. "intolerable heaviness in the head," as a prominent symptom, which indeed was the case with me after the first week of the proving.) Evening - my wrists and hands are still more swollen, and excessively painful. Face a little less swollen and rather less painful. Incrustations appeared to - day on the inside of my thighs, extending down one half the length of the femur. A feeling as if from flea bites, on different parts of the body. Slight dimness of sight; lachrymation, and a livid circle under the eyes; considerable deafness, which is quite troublesome. Chills run up the back, even when warm, and in a warm room, or in bed. The rough feeling in the mouth increases, with redness; same appearance of the faces; difficult deglutition; throat feels sore and swollen; the eruption also appeared on the gums of the upper incisors. About nine o'clock, smarting and burning of the eyes, as though washed in alcohol, attended by profuse lachrymation. Colic quite severe in the umbilical region. Very restless all night.
23d. Dull feeling in the head; headache in the fore part of the head, sore head, so severe that I took Belladonna with some relief. The severity of all the other symptoms had somewhat abated, except the diarrhoea, which is more severe, and the stools of a dark brown color. (This was the only time they were of this color, although attended with the same pain in the hypogastrium which extends to the inside of the thighs. During the first five days the pulse was increased from ten to twenty strokes. The poison seemed to have a considerable effect in relieving me from dyspeptic symptoms, and also benefitted a chronic inflammation of my eyes.
Hale MM II (Reference Works)
Dr. F. G. Oehme, of Plymouth, Mass., in 1858 - 9:
These experiments were made both by contact and by taking the drug internally. He made two trials of it - a year apart. He has made use of it in several cases of disease with most happy results. (See his "Clinical observations upon erysipelas, urticaria, prurigo, erythema, morbilli, scabies, impetigo nodosum, and furunculi. ")
He thus sums up his article: "Before closing, we must say that there are but very few medicines which will cause so many, so well marked, and so complete diseases as Rhus vernix (ven.); but in spite of this fact, it is very little used. Perhaps some consider its properties of the same nature, but inferior to Rhus tox. This opinion is not correct I need scarcely say that I have by no means exhausted the list of cutaneous diseases in which this species of Rhus might be used with success, as, for instance, in eczema solare for which it is frequently indicated. "
The first knowledge we obtained of the medicinal virtues of this plant was by hearing or seeing cases of poisoning, or being called to treat the same.
Upon some individuals or temperaments its influence is powerful. Dr. Bigelow considers that the "following circumstances have considerable influence in varying in the same person the aptitude to the reception of the poison";
First . A warm or cold climate; in Southern more active than in Northern.
Second . Different seasons of the year. The Rhus vernix (he means the ven.) never affects me in the smallest degree, except on very hot days in Summer.
Third. - Infancy or manhood: children are more readily poisoned than adults.
Fourth . Exposure before or after a meal. Dr Barton, in his edition of Cullen's Materia Medica, states that the plants more readily poison immediately after than before a meal.
Fifth . The presence of moisture: country people generally believe that the effluvia of plants, when combined with moisture, are most apt to produce the eruption.
Sixth . A state of increased perspiration at the time of exposure has a most powerful influence in favoring the eruption; "if my skin was perfectly dry while collecting the juice of the Rhus vernix (ven.), it had not, the least effect upon me." The most formidable cases in persons subject to this poison usually commerce within twenty - four hours after exposure, sometimes longer, more frequently shorter. The symptoms usually begin by itching and tumefaction in the hands and face, the swelling gradually spreading over different parts of the body.
Rhus from provings ANTHONY CAMPBELL, MRCP, FFHOM (Reference Works):
(British Homoeopathic Journal, vol. 70, no. 04, Oct, 1981, page no. 179-182)
This species has the largest number of reports; there are detailed contributions from 10 provers and also a number of reports of poisonings.
The provings give evidence of toxicity in both the main Rhus spheres of action-mucocutaneous and musculoskeletal, but there seems to be some tendency for skin symptoms to be more prominent when tincture was taken, and muscle and joint pains to predominate when dilutions were taken. There is also fairly clear evidence that taking the substance by mouth can render an individual hypersensitive to subsequent exposure to the plant.
Dr Burt began with 50 drops of the 3rd dilution and gradually increased the dose; he then took tincture in increasing doses until he reached 150 drops daily. The symptoms included a hot dry skin, severe itching, and a swollen red scrotum; severe depression; thirst, sore throat, and tonsillar enlargement; and very severe pain in hands, knees, and ankles, together with a stiff back.
Dr. Wallace McGeorge prepared a tincture by macerating leaves, and took 2 or 3 drops of this in water. Two days later he took another dose. This very modest dosage elicited a severe illness in the unfortunate prover, lasting at least three weeks. The symptoms affected mainly the gastrointestinal tract from mouth to anus and also the skin. Itching of hands and anus was particularly troublesome. The anal itching was relieved by a brandy compress after 2 to 3 minutes, though when it was first applied it caused such a terrible burning that he almost went into convulsions. The itching of the hands was relieved for some hours by soaking them in water as hot as could be borne.
After recovering from the proving, Dr McGeorge happened to pass by a swamp where Rhus venenata grew. He had often passed the same swamp in the past without ill effects, but on this occasion it induced a recurrence of his illness, with intense itching and burning in the skin of penis and scrotum for several night. A curious observation is that, after intercourse two nights later, his wife complained of a terrible prickling and burning in the vagina, lasting several minutes.
The following summer this prover again passed a swamp and had a recurrence of symptoms, though not quite so badly. Two years after the proving, while preparing some of the tincture, he accidentally touched the cork of the vial and had a severe recurrence of poisoning.
In all these episodes the itching was relieved by hot water. His appetite was increased, and the catarrh and belching after meals to which he had been subject were much diminished. He tried Pulsatilla, Croton tiglium, Rhus toxicodendron, and Clematis erecta as antidotes, the last being the most effective. He had never been sensitive to Rhus poisoning before undertaking the proving.
A prover named Kunze took various doses of Rhus venenata, in preparations ranging from tincture to 5x, over a 3-week period. He had very few mucocutaneous symptoms but a great many musculoskeletal ones. The pains were always worse for rest. They persisted for some time after the end of the proving, and did not totally disappear until two months had passed. During the proving Kunze had vivid dreams, a feature which appears in a number of the provings and so may be significant.
Dr Clary held a stick of Rhus venenata in his hand for half a minute, and, a small piece of its cuticle being shaved off, touched with his tongue the minute drop of juice which exuded. There were no symptoms for the next seven days, and Clary forgot about his experiment. On the evening of the seventh day, while at dinner, his tongue felt as if scalded, and this sensation spread to the entire mouth and throat. At night he had an attack of diarrhoea, and over the next few days he suffered hemorrhoids, generalized dermatitis which was especially severe on the genitals, muscular aching, malaise, laryngitis and cough. All these symptoms continued for more than two weeks.
This case is remarkable both for the minuteness of the dose in proportion to the severity of the symptoms (there is unfortunately no information about whether Clary was known to be sensitive to Rhus previously) and for the long delay between exposure and onset.
The provings of Rhus, especially Rhus venenata, are very impressive to read and might in may respects be described as model provings. This reflects the undoubted toxicity of the substance, together with its relative safety in the sense that it does not appear to have caused any fatalities, even in children and in people who took large doses or were severely exposed. There is a considerable degree of uniformity in the symptoms of the various subjects, so that we may feel confident that they are mostly genuine. Moreover, the agent gives rise to numerous very obvious objective manifestations, which is by no means the rule in provings.
The well-known Rhus modalities (amelioration from warmth and movement) are confirmed by a number of subjects. The clinical indications which arise from these reports are in general in line with those generally recognized for Rhus, but it is worth emphasizing the frequency with which genital swelling and itching occurred.
An interesting points is that most of the reports relate to Rhus venenata rather than Rhus toxicodendron, which is course the variety generally used clinically. While the difference between the two species or sub-species may not be great, it could well be worth while trying out Rhus venenata more widely.