Gelsemium sempervirens.

By GEORGE WILLIAM WINTERBURN, PH. D., M. D., New York.

The yellow jessamine, or woodbine, is one of the most interesting climbing plants of our Southern States, and is cultivated in gardens both North and South for its beauty and fragrance. It belongs to the natural order Loganiaceae, the same as Spigelia, nux vomica, Ignatia, woorari and upas. It is a slender vine, growing luxuriously in native groves and forests. The root is, in the largest specimens, two inches in diameter and several feet in length. The bark of the root is the part used in medicine, and should be tinctured while fresh; it is of a light snuff-color, about the fifth of an inch in thickness; and contains an alkaloid, a resinoid, and a neutral principle.

Physiological Effects.

The earliest effect of full doses of Gelsemium is aching across the brows, pain in the eyeball, dimness of vision, and ptosis, or paralysis of the upper eyelid, so that the eyes can hardly be kept open; with this is giddiness on standing, passing off on lying down. Then follows diplopia, or double vision. At first the sight is merely hazy, then as if the atmosphere was densely smoky, and at last vision fails completely, failing first for distant objects. In gelsemized animals the sight became totally extinct, so that they ran straight against objects without trying to avoid them, evidently not seeing them. Another marked eye symptom of gelsemism is the approach and retrocession of objects of vision. The person under the influence of this drug will look at an object, and suddenly it will begin to recede until it vanishes to a point, and then apparently returns, until, becoming larger and larger, it almost seems to strike the eye itself. A patient of mine who had taken large doses of Gelsemium described the effect as if the pavement rose up and almost touched her face, and then fell, as into an abyss. The double vision varies in different individuals. In one it is a mere transient phenomenon, appearing and disappearing at short intervals, distant objects being the first to be affected.

"One gas-jet appears about six inches above the other, and there are six inches between them horizontally; the upper one is to the left; now the right is uppermost; now the left slightly again; going over to the right now again; exactly over one another now, and quite close together; now again separated, left the highest, now over one another."—Fox.

Usually, however, in my cases the two images seem on a level, from four to nine inches apart, gradually coalescing, and then again separating.

In the other form of diplopia there is impaired movement of the eyeball, the external rectus muscle being generally first affected, and often one external rectus markedly more than the other. In this form usually the entire upper portion of the object of vision is cut off, and the eye oscillates from right to left. The pupil is always contracted, and in some cases to a mere pin's point. Nor does this disappearance of the pupil depend upon the dimness nor diplopia, as it often happens as these pass off the contraction of the pupil is increased.

"Dilatation of the pupils in poisoned animals occurs only when asphyxia from paralysis of respiration has set in, and artificial respiration at once causes the pupils to contract."—BERGER.

The topical application of the drug to the eye produces, however, a very different series of manifestations. Nineteen experiments made by Ringer with a one-twenty solution of alkaloid show that invariably the pupil dilates, the dilatation lasting sometimes a week or longer. Accompanying this, but lasting only a few hours, is dimness of vision and paralysis of accommodation.

Shortly after the diplopia sets in from internal administration, if the dosage be sufficient, there ensues paralysis more or less general; more markedly of the arms, legs and jaws, and the patient becomes unable to stand, move or speak. This was discovered in the following accidental manner:

"A planter of Mississippi, whose name we have forgotten, while laboring under a severe attack of bilious fever, which resisted all the usual remedies, sent a servant into his garden to procure a certain medicinal root, and prepare an infusion of it for him to drink. The servant, by mistake, collected another root, and gave an infusion of it to his master, who, shortly after swallowing some of it, was seized with a complete loss of muscular power, unable to move a limb, or even to raise his eyelids, although he could hear, and was cognisant of circumstances transpiring around him. His friends, greatly alarmed, collected around him, watching the result with much anxiety, and expecting every minute to see him breathe his last. After some hours he gradually recovered himself, and was astonished to find that his fever had left him. Ascertaining from his servant what plant it was the root of which acted in this manner, he collected some of it, and employed it successfully on his own plantation, as well as among his neighbors. The success of this article finally reached the ear of some physician, who prepared from it a nostrum called the "Electrical Febrifuge," which was disguised with the essence of wintergreen. The plant was the yellow jessamine, and a knowledge of its remarkable effects was not communicated to the profession until many years after."—KING.

Another illustration of this is taken from the London Hospital reports:

"To see what effects the drug would have when pushed, I gave to a patient, a sailor, convalescent from periostitis, three doses of 20 minims each-two hours intervening between the first and second doses, and one hour between the second and third. The first dose (probably from being given soon after a meal) produced but little if any effect. About half an hour after the second dose the usual complaint was made of difficulty of keeping the eyes open, from the heaviness of the lids. He saw things double, one image appearing beside the other. During this time the pulse did not appear to be much affected, remaining at 77; but after the third dose it became quickened, from 80 at 8:15 to 96 at 9 P.M. At 7 P.M. (about two hours after taking the third dose) he got out of bed to go the lavatory, being perfectly conscious. He reached the lavatory, but found himself then quite powerless, and quietly sunk first upon his knees, and then at full length. He was quite unable to raise his lids. His lower jaw dropped, and he did not articulate. The pulse fifteen minutes previously (viz., 6:45) is marked at being 80 and the same at 8:15—no registration being given of its actual value at the time of the failure of power. The patient was put into bed and some warm stimulating drink given to him, when he soon became better. He told me when I saw him, with the most open-eyed simplicity, that the medicine had done him a deal of good, that he could make water very much better since he had had it. I should observe that he previously had suffered from the effects of a troublesome stricture; that he knew everything that was going on around him when he sank to the ground, but that he was unable to move, and that his feelings were like those which he had experienced after commencement of intoxication."

The question now arises, is this paralysis due to the influence on the brain, the spinal cord, the motor nerves, or the muscles? Dr. Ringer answers this affirmatively as to the spinal cord, and says the muscles and motor nerves are unaffected. Horatio Wood, summing up what Ott, Bartholow, Ringer and Murrell have written, says the paralysis is evidently spinal in its origin, as its development is not affected by tying an artery before poisoning so as to protect a limb, and as the afferent and motor nerves and muscles preserve their functional activity until death. Bartholow says the disorders of voluntary movements, and the more or less complete paralysis of the motor and of the sensory functions, are due to the effects of Gelsemium on the motor and sensory portions of the spinal cord, the functions of the sensory columns resisting longer the action of the drug. It must also be remembered that consciousness is unaffected both in animals and man, at least until the period when the whole organism sinks under the attack, proving that it has little influence over the sentient portions of the brain.

Besides this paralysis we have a convulsive stage of gelsemism, and Murrell argues that this proceeds from another active principle in the drug, the first of which is more immediate and positive in its action; although it yet remains a question whether this is not a mere sequence of the earlier paralysis, and, like jaborandi, Gelsemium first weakens and then tetanises the spinal fibres. Certainly, as a rule, the tetanoid movements are observed only after very large doses.

Death is produced by asphyxia, there having been no previous stimulation or quickening of respiration, nor paralysis of the intercostals; according to Sanderson, it ensues from paralysis of the automatic respiratory centre.

As to the dose necessary to produce gelsemism, there is wide differences in individuals; some persons coming under its influences with comparatively a small quantity—that is, having the characteristic eye-symptoms from ten minims; others may take five or six drachms in the course of twenty-four hours with but slight effect. Ringer speaks of giving twenty minims to a delicate young lady every three hours for several days, finally causing only slight heaviness in the eyelids.

Gelsemism quickly appears and soon subsides. That is, given in ten-minim doses every quarter-hour the effects will begin to appear after the third or fourth dose, and may persist for eight or ten hours after the final dose, but greatly modified and alleviated within two hours after the last of the drug is taken. When completely gelsemized, the prover is pale, and has a sleepy look; he yawns audibly, and if left alone will sink into slumber; he complains of dryness of the mouth, although it is actually moist, and wishes continually little sips of water; this latter symptom sometimes continuing for many hours.

Gelsemism produces no change on blood-pressure, according to Sanderson's experiments with rabbits; and Dr. Ringer's cases show the pulse only a little smaller and softer. Dr. Douglas states, however, that he has seen it produce in sensitive persons a decided febrile chill, with a subsequent reaction; the pulse, not very rapid, inclines to be full and soft, tongue moist and white; dull pains in head, back and extremities. Temperature seems little, if any, affected by the drug given to healthy subjects, though Bartholow has observed reduction of temperature in animals when physiological doses have been given.

Gelsemism abolishes sexual power without affecting desire, and we have in consequence sexual emissions without erection; and on the female organs, spasmodic neuralgic pains, cramps of the uterus, uterine ligaments, and thighs. It paralyses all the sphincters, causing enuresis and involuntary stools. Electricity (faradaic) is the best antidote of the toxic effects.

Therapeutics.

Gelsemium has been found of use in acne upon the forehead and neck, and in papulous eruptions on various parts of the body—used topically as a vaserole, one part of green tincture to nine of vaseline. It will not be found of value in phlegmonous nor vesicular erysipelas, but in a mild type, with the characteristic soft compressible pulse, and muscular pains, I have found it curative in drop doses hourly, keeping the affected parts covered with cloths wet in a very dilute tincture.

In measles, when uncomplicated, and especially when the catarrhal symptoms are prominent, it is my only remedy. In one hundred and fifteen successive cases I found no other remedy needed. The fever of measles is rarely high enough to require aconite. The tincture, diluted with ten parts of water, is an excellent antidote when applied to the eruption caused by poison ivy.

In neuralgic otalgia, particularly when remittent or periodical, and in earache from cold, a few drops of the tincture on cotton, put in the ear, will relieve.

It is one of the most important of our optic remedies. In acute ophthalmia it is rarely of service, save in that form which occurs as a symptom of masked intermittent, and in which the congestion, more or less intense, returns at stated intervals. In asthenopia, with oscillation of the eyeball on the slightest fatigue, I have seen in one case an almost miraculous cure. In hemiopia and diplopia it is frequently of service, not only in simple paralysis of the ocular muscles (characteristically acting on the recti through the sixth nerve), but where the affection is of deeper origin. It has removed the amaurosis caused by tobacco or by masturbation (Heh. I don't believe it. Next they'll say the furry palm legend is true, too.—Henriette), or succeeding to diphtheria; ptosis where it was symptomatic of grave cerebral disorder; photophobia from long-continued exposure to sun or electric light; retinitis from albuminuria; detachment of the retina, when recent; strabismus, when recent; and choroiditis with hyperaemia of the optic nerve and retina.

It is of value in gingival neuralgia, if the pain is of a shooting character, and there is difficulty of separating the jaws. In diseases of the mouth and pharynx you will find it of practical benefit in cases where loss of motion through nerve-failure is a prominent feature of the disease; therefore, in paralytic dysphagia and dysphonia from paralysis of the tongue, buccal cavity, pharynx, or glottis, unattended with numbness or prickling, you will find Gelsemium curative. I have seen beautiful results follow its administration in laryngismus stridulus, spasmodic croup, and spasms of the pharynx and glottis. It is the best remedy we have for post-diphtheritic paralysis.

In tonsillitis, with yellowish coating of the tongue, absence of thirst, compressible pulse, although the temperature may run high, it surpasses aconite in the celerity with which it controls and modifies all the symptoms

In esophagitis, either catarrhal or spasmodic, with that peculiar vomiting characteristic of disorders of this tube, as well as in similar conditions of the stomach, Gelsemium is often the only remedy.

Its action upon the bowels is marked and positive, not only in neuralgize of the intestines from malarial or other causes, but in diarrhea (acute catarrhal enteritis), caused by exposure to wet, either in cold or warm weather; as well as in diarrhea from emotional excitement, such as disappointments, bad news, or, in soldiers, from the excitement of battle. Sometimes nervous excitement causes paralysis of the sphincter ani and involuntary diarrhea; Gelsemium will cure this tendency. Again, in mucous dysenteries, spasmodic colic and tenesmus are sometimes associated with stools of green biliary matter, or with jaundice and light-colored stools; in either case Gelsemium will cure.

Gelsemium has no specific influence on the kidneys; but patients who, whenever mentally disturbed, are troubled by a profuse watery urine, will be helped by this drug. It has cured nocturnal enuresis of children; paralysis of the bladder in old men; and spasms of the bladder, with alternate dysuria and enuresis.

It is of frequent service during pregnancy, and as a parturifacient. Before labor, its use will relieve false pains when spasmodic, cramps in abdomen and legs, nervous irritability, and insomnia. During labor it will be found serviceable in controlling apoplectiform convulsions, rigid os uteri, inefficient pains from uterine debility, and menorrhagia from lack of contractility. After labor it will ameliorate the severity of the pains which follow delivery.

In neuralgic or spasmodic dysmenorrhea, when the pains centre in the uterus and shoot upward along the back and down the thighs, Gelsemium will cure. It will cure vaginismus.

The opinion has been advanced that Gelsemium given during pregnancy will produce abortion. This I do not believe, unless given in large doses as actually to endanger life. In small doses it does produce moderate uterine contractions; if, however, the dose is decidedly increased, it will arrest the progress of labor. In proper doses it may be given safely at all stages of utero-gestation.

In the acute stage of gonorrhea, when there is much inflammation, scanty discharge, and tendency to chordee, it is one of our best remedies. After the fever is reduced it may be followed well by Cannabis sativa.

In spermatorrhea it is of great utility, when the emission of semen occurs, either during the waking or sleeping hours, without an erection, or from irritability of the seminal vesicles.

In spasmodic stricture the introduction of a greased bougie, which has been dipped in tincture of Gelsemium, and permitting it to remain in the urethra a few minutes, will, after several repetitions of the operation, prove successful.

The catarrhal condition in which Gelsemium has proved almost specific, affects the nose, eyes and ears; and in those severe coryzal attacks in which the whole head seems involved Gelsemium owns hardly a rival. Acute catarrhal bronchitis, accompanied by tickling in the pharynx, severe cough with vomiting, tenderness in the epigastrium, and pain in the chest, Gelsemium will cure; but it is to be doubted if it can arrest inflammatory action, such as is present in pneumonia, pleuritis, or pericarditis, being here superseded by aconite and Veratrum viride. The value of Gelsemium in diseases of the respiratory organs is probably limited to such disorders of the mucous membrane as are occasioned by exposure to cold and damp.

Gelsemium, in diseases of the heart, reaches cases the reverse of those for which Digitalis is usually administered, and the most characteristic symptom is a feeling that it is necessary to keep moving about the room or else the heart's action will be stopped. This reminds us of Conium maculatum, where life is actually prolonged by movement in persons suffering from its toxic influence. When from plethora, neuralgia, rheumatism or hysteria, the action of the heart is abnormally increased, and the pulse is full and soft, with stitches in the cardiac region, worse when lying down, Gelsemium is indicated and will probably do good.

In intermitting fever it will be found useful if the chilliness is especially along the back, with cold extremities, and very marked decrease in the frequency of the pulse; there is, however, little shaking, and the chill does not last long. This is followed by fever, with rapid pulse, but without thirst; flushed face, stupor, and severe pain in the back and extremities. The fever usually lasts for hours, sometimes as long as twelve or fourteen, and is accompanied or followed by profuse perspiration. The quotidian type is the one most frequently calling for this remedy. In the condition known as "dumb ague," where there is much soreness in the muscles, great prostration, and violent headache, Gelsemium and canchalagua in equal proportions, thoroughly triturated together, I have found a most valuable remedy. In the early stages of typhoid; in intermittents following typhoid; in irritative fever from abscesses; in acute muscular rheumatism; in scarlet fever and other eruptive fevers of children, when there is a tendency to convulsions or retrocession of the rash, Gelsemium will be found useful. But especially in what is known as "infantile remittent," which although it may be denied as a pathological entity, is certainly a clinical reality, I have seen the most gratifying results from the use of this medicine.

In cerebro-spinal meningitis it should be studied and will often prove a valuable intercurrent remedy.

In all fevers, the pyrexia, advancing as night approaches, is a further indication of Gelsemium as a remedy. So, also, is a tendency to stupor or to hemicrania.

On muscular tissue we have already noted its peculiar effects in producing intense functional prostration of muscular fibre, so that a person under its influence, on attempting to walk, sinks down all in a heap, like a drunken man. In the treatment of myalgia it vies with Arnica and Cimicifuga. When the muscle-pain arises, from over-exertion or other causes, and is accompanied with decided rise of temperature, Gelsemium is a never-failing remedy; but when the fault is in the trophic ganglia, and the pain is caused not by overwork, but by local starvation, it will be necessary to give Cimicifuga.

Gelsemium is also a useful remedy in muscular rheumatism, when there is a feeling of numbness and heaviness, the muscles fail to obey the will, the extremities feel heavy and bruised, the feet seem as if in cold water, the pains grow worse toward night and by the warmth in bed, but are relieved by motion, and the whole trouble was occasioned by exposure to cold and damp.

Gelsemium is of value in certain purely nervous affections. In sudden darting neuralgic pains, especially if recurrent or remittent; in tetanus and trismus; in hysterical convulsions from suppressed menses; in nervous chills unconnected with variations of temperature; in epilepsy; in hydrophobia; and in locomotor ataxy, it will be useful in proportion as the general condition approaches that of gelsemism.

In headache it is often quickly curative. The pain for which it is indicated is a dull, heavy feeling, extending to the occiput and down the neck, throbbing and fullness in the temples, vertigo on rapid movement stupid expression, and the whole condition is aggravated by lying with the head low, but relieved by the use of a high pillow.

Transactions of the National Eclectic Medical Association, Vol. X, 1882-83, edited by Alexander Wilder.