Gelsemium.
The dried rhizome and roots of Gelsemium sempervirens (Linné,) Aiton (Nat. Ord. Loganiaceae). Dose, 1/10 to 1 grain.
Common Names: Yellow Jasmine, Yellow Jessamine, Carolina Jasmin.
Principal Constituents.—Two bitter alkaloids—crystallizable gelsemine, the paralyzing agent, and amorphous gelseminine, a very toxic and tetanizing principle, and a volatile oil. There is also present gelseminic acid (beta-methyl-aesculetin).
Preparation.—Specific Medicine Gelsemium. Dose, 1/10 to 10 drops. Usual method of administration: Rx Specific Medicine Gelsemium, 10 drops to 1 fluidrachm; Water, enough to make 4 fluidounces. Mix. Sig.: One teaspoonful every 1 to 3 hours.
Specific Indications.—Hyperemia; bright eyes, contracted pupils, great heat, and nervous unrest; mental irritability; insomnia, with nervous excitation; pain over the whole head; tremulousness, with great nervous excitement and high temperature; irritation of urinary tract; dysuria, with scant secretion of urine; arterial throbbing, with exalted sensibility; pinched, contracted tissues; convulsions, with hyperaemia; thin, dry, unyielding os uteri, with dry and hot vaginal walls.
Action.—Gelsemium acts chiefly upon the spinal cord, first impressing the sensory tract, even to the extent of producing complete anesthesia; later, its dominant action occurs, that of expending its force on the motor neurons, causing paralysis of motion. Sometimes this sequence is reversed. Upon the higher brain it has but slight effect, but upon the motor filaments of the nerves of the head, particularly the third and sixth cranial pairs, its action is profound. This is well shown by the resultant palpebral ptosis and relaxation of the jaw. Respiration is first stimulated, then depressed. Moderate doses do not appreciably disturb the circulation. Toxic doses, however, depress both the pulse rate and the blood pressure. In man convulsions do not occur. Both gelsemium and gelsemine, when dropped into the eye, cause violent dilation of the pupil, with accompanying paralysis of accommodation. The mydriasis is not so lasting as that from atropine. Gelsemium is quickly absorbed and spends its force in about three hours. The alkaloid gelsemine, correspondingly more active, is eliminated unchanged by way of the kidneys. Death from gelsemium is due to asphyxia. Gelsemium does not affect all human beings alike, some' being but slightly influenced by it while others are profoundly impressed. The smallest active doses (ranging from 5 to 15 minims of the specific medicine or fluidextract, according to susceptibility) occasion a languid sense of ease and slight lowering of the force and frequency of the pulse. Larger doses induce a desire to lie down, and cause vertigo, disturbed sight, and sometimes orbital pain. Continued small doses may, after several hours, provoke vomiting; otherwise it has little or no effect upon the stomach or bowels.
Toxicology.—Toxic doses produce extreme muscular relaxation and prostration, double vision (sometimes blindness), widely dilated and immovable pupils, internal squint, and the eyelids droop and are raised with difficulty, or complete paralytic palpebral ptosis occurs. Often the patient sinks in his tracks, or if he stands he staggers. Sensibility is greatly impaired, the jaws drop and speech fails. Breathing becomes slow, labored, and shallow; the pulse rapid, weak, and thready; the skin is wet with cold sweat, and the body-heat markedly depressed. Drowsiness may be felt, but consciousness is usually retained until just before death, evidence that the higher cerebral centers are but slightly involved. Death takes place from centric respiratory paralysis, and almost simultaneous arrest of the action of the heart.
The cardinal symptoms of poisoning by Gelsemium, therefore, are ptosis, diplopia, dropping of the lower jaw, and absolute muscular prostration.
In poisoning by gelsemium or its alkaloids, the emetic or stomach pump should be used if the patient is not too weak. Tannic acid (or strong infusion of store tea) should be administered, external heat applied, and artificial respiration attempted as soon as breathing shows signs of failure. Stimulation of the respiratory function should be enforced by the hypodermatic use of atropine, and that of the heart by ammonia, ether, alcohol and digitalis, the first three in the order named, to sustain the organ until the digitalis, which should be given at once, can act.
It has been asserted that morphine completely antidotes the poisonous effects of gelsemium. As gelsemium poisoning is quite rare the antidotal treatment is none too well established and is, therefore, based mostly on general principles.
Therapy.—Gelsemium is primarily the remedy for acute hyperemia of the brain and spinal centers. All through the woof and warp of its therapy runs the thread of nervous excitation and unrest; and often fever, spasm, and pain. In proper doses it relaxes high nervous and muscular tension. By diminishing the velocity of the blood current to the head and spinal tract it prevents spasmodic action. It is, therefore, a remedy for hyperaemia; never a remedy for congestion. It is the specific agent for relief in the nervously excited and highly feverish state, for the child with hot head and tremulous and jerky muscles, for great restlessness with elevation of temperature; for the touchy and grouchy but feverish individual who magnifies his ailments; and for those who dread even the simple ordeals and trials of life. The most direct indication for its employment is exaltation of nervous function. It is contraindicated by a weak heart and feeble circulation. As an antispasmodic it stands unrivaled save by lobelia and bromide of potassium, with both of which it acts kindly and harmoniously. "The flushed face, bright eye, contracted pupil, increased heat of head, great restlessness and excitation" are the classic indications for it as first formulated by Scudder, and these stand among the truest of specific guides ever recorded for the use of a medicine.
Though not classed as an antipyretic, gelsemium softens blood pressure, slowly reduces the pulse, and overcomes hyperaemia associated with exalted nervous action, thus making it indispensable in some kinds of inflammation and fevers. This period of excitement usually obtains early in the febrile state. When this nervous tension has been relieved by the drug, then its usefulness is practically at an end. To continue with it would imperil the integrity of the heart, which, while apparently but little affected during health, appears to be readily endangered by it during the advanced stages of febrile process. Only in sthenic fevers is it indicated; never when the heart is weak or degenerate or the patient is prostrated by debility. A soft, open pulse, moist skin, cleaning moist tongue and nerve calm being essential to the effective use of quinine, gelsemium is administered in the febrile stage of malarial or intermittent fevers to produce these effects and prepare the way for the kindly action of that great antiperiodic. This it does with directness and dispatch. Even before this preparatory use gelsemium alone was employed in these diseases with asserted success by early Eclectic practitioners, and in doses which we of to-day would hesitate to administer. In other forms of fever, as remittent and so-called bilious types, which tip the balance one way or the other toward malarial fever or typhoid fever, the drug is efficient if the indications above noted are strictly observed. For the febricula of children, with great and tremulous agitation, high fever, headache, and near spasmodic explosiveness, it is unsurpassed both to allay the fever and to give rest and sleep. Scudder remarks that in fevers "we find many times that its influence is very decided; it causes relaxation of the system; the pulse is less frequent and softer; the respiration is slower; the skin becomes cooler, soft and moist; there is less determination of blood to the head, and if there is pain in it, it is reduced or entirely ceases, while at the same time we frequently notice an increased secretion of urine." In typhoid or enteric fever its use should be more guarded. When of the robust type with vigorous onset, it is serviceable if used early, but when the slightest evidence of enfeeblement of the heart or disintegration of the blood is apparent it should be withheld at once. Under such circumstances we have seen a rapidly dicrotic and irregular pulse and prostration ensue, even though but small doses were being administered. By no certain means can this result be wholly attributed to the drug, yet surely the stage for gelsemium medication has then passed. In puerperal fever it is useful as long as exalted nervous tension calls for it.
As stated gelsemium is a remedy of marked usefulness in the sthenic fevers of childhood. The more these tend to convulsive complications the stronger becomes the indication for this agent. Infants, however, are quite susceptible to the drug and the dose for them should be minute—even fractional. In inflammatory bowel disorders of children, particularly during dentition, it is one of our most direct medicines, and is then most potent in enteritis, gastro-enteritis, cholera infantum, and diarrhoea and dysentery, both with tenesmus—all of which derangements are so often the blight of the child's second summer. Here the direct guide will be the exalted nervous tension, the increased heat of head and body, the brilliant, shifty eyes, great restlessness, and the near explosive state. If convulsion occur, then larger doses will control the spasms.
Observing the indications undeviatingly gelsemium will be found one of the best remedies for the spasms of childhood, or infantile convulsions. Though single remedies are preferred in Eclectic practice, the following combination is the most effectual we have used for such attacks: Rx Specific Medicine Gelsemium and Specific Medicine Lobelia, 1 fluidrachm each; Potassium Bromide, 1 drachm; Water enough to make 4 fluidounces. Mix. Sig.: One teaspoonful every five minutes until the spasms cease. Then administer one teaspoonful of the solution every two hours for one or two days. The bowels should be thoroughly emptied by a copious enema of soapy water and the child immersed in a warm bath (tested by the attendant's bare elbow), with a cold pack to the head. If the convulsions are due to gastro-intestinal abuse, the spasms are soon controlled; if they are the precursors of infectious or other diseases, and centric in origin, an advantage will have been gained by the early use of the gelsemium.
Gelsemium is an important sedative in the early stage of acute bronchitis, broncho-pneumonia, lobar-pneumonia, and pleurisy. In pneumonia it is less often required than veratrum, but in all acute respiratory inflammations, of a sthenic type, it may be required to meet the nervous manifestations and to give rest. In acute febrile and inflammatory diseases it is frequently effective in quieting delirium and overcoming insomnia. This is particularly evident in la grippe. Of the few remedies that offer any therapeutic hope in acute cerebro-spinal meningitis and acute poliomyelitis gelsemium has been favorably considered. Its administration should not be continued in the former when effusion takes place, nor in the latter when paralysis is established.
Gelsemium is a remedy for pain, provided it is dependent upon or associated with nervous tension. For pain in the weak and apathetic it has no value. It has fully justified its reputation in simple neuritis and various types of neuralgia when there is hyperaemia, nervous irritability and sharp, muscular twitching. Under these conditions it may be used in intercostal neuralgia (often the precursor of herpes zoster), ovarian neuralgia, and is sometimes effectual in sciatic neuritis or neuralgia, though too much reliance must not be placed upon it in this affection. If sciatic and other forms of neuritis are purely nervous and hyperaemic, it is most likely to be of service, but if dependent upon sugar toxemia, pressure, injury, loaded caecum, or pelvic sublaxation, other measures must be resorted to. The best results from gelsemium in neuralgia are obtained in trigeminal or facial neuralgia, dependent upon cold, dental caries, or peridental inflammation. Toothache in apparently sound teeth, but with violent throbbing from active circulation, frequently yields to this drug. Liberal doses of gelsemium are required to ease neuralgic pain. It gives relief in recent tic douloureux with active circulation in the head, but when the Gasserian ganglion becomes permanently impaired it fails, as do other medicines. Surgical relief is then the only rational procedure. In acute inflammatory rheumatism gelsemium is serviceable chiefly to allay excitement and to some extent alleviate the pain. It is adapted only to the initial stage and when sthenic conditions prevail, and then only as an aid to the more direct antirheumatic remedies. It is one of the commonest and best remedies for myalgia due to the strain of muscular exertion, or to recent colds from exposure to inclement weather.
Various forms of headache yield to gelsemium. It is best adapted to nervous headache with active circulation and throbbing pain. Occasionally it serves well in migraine, but is less effectual than the synthetic analgesics. It is more efficient when headache is caused by eye-strain.
Limited to the indications of nervous excitement with increased vascularity and spasmodic or colicky pain, gelsemium is of very great utility in dysmenorrhea in robust subjects, as it is also in so-called uterine colic. Full doses are required. It acts favorably, when similarly indicated, in ovaritis and metritis, and in salpingitis before suppuration sets in; after that it is of no other value than to quiet the nervous phenomena.
Scanty urine, with hyperaemic irritation of the renal organs and urinary passages, is a direct indication for gelsemium. It should then be given preceding or with the desired diuretics. Renal suppression is then promptly relieved by it, but not when there is congestion, for which belladonna is far more effectual. For the dysuria of spasmodic urethral stricture it is the remedy. It allays the irritation and temperature excited by the passage of catheters, bougies, and divulsors. We rely upon it in cystic irritation from cold when the urging to pass urine is frequent and the passage difficult. For this purpose, together with apis or eryngium, it gives the happiest results in this annoying complaint in women. It may also be satisfactorily employed for suppression of urine in hysterical women. In acute nephritis it is one of the surest remedies, and is just as serviceable in acute cystitis when due to colds and not dependent upon the retention of putrid urine. Its relaxant powers sometimes facilitate the passage of small renal calculi and cystic gravel.
In the inflammatory stage of gonorrhea no agent is more salutary than gelsemium. It prevents and relieves chordee, eases urination, and gives comfort when burning and irritation are pronounced. For this purpose it may well be combined with cannabis and aconite as follows: Rx Specific Medicine Gelsemium, 1 fluidrachm; Specific Medicine Aconite, 10 drops; Specific Medicine Cannabis, 1 fluidrachm; Water, enough for 4 fluidounces. Mix. Sig.: One teaspoonful every two or three hours.
Obstetric therapy would be impoverished without gelsemium. One should not be reckless with it, however, as many believe that it favors hemorrhage. Our experience does not verify this view. It is the remedy to relax rigid os when the rim is thin and unyielding, holding the head as in a vise, and there is dryness of the parturient canal. It very promptly removes this impediment, favors normal secretion, and facilitates labor. In fact, all sphincters acutely contracted are relaxed by full doses of gelsemium. During labor it is most valuable to overcome the great restlessness, fear, and excitement experienced by nervous women, and by its calmative power rectifies jerky and ineffectual contractions. It also mitigates the severity of the pain and relieves the sense of heat and dryness complained of by the patient. Indeed, this is one of the most praiseworthy effects of this drug. It also controls after-pains and the nervous agitation that follow a few days after parturition. For puerperal convulsions it is inferior only to veratrum and shares with this drug and morphine and chloroform in being the most generally effective remedies in this form of eclampsia. In no way does it interfere with the recently introduced Fischer's alkaline intravenous treatment.
