Gelsemium sempervirens

Lecture XV — Gelsemium sempervirens

Gelsemium sempervirEns is a yellow-flowering plant indigenous to the South. It is an evergreen, and puts forth its fragrant flowers among the earliest in the spring. It is highly poisonous; especially active in this respect is the bark of the roots. During our late civil war this plant was largely used in the South as a substitute for Opium as a narcotic.

It is a member of the Loganiaceae, all of which are more or less poisonous. From this order we obtain also Nux vomica, Ignatia and Spigelia.

Its alkaloid, Gelsemi?ie, is a mydriatic like Atropine and Duboisine. Applied locally or used internally in large doses, it dilates the pupil. Given internally in small doses, however, it contracts the pupil. To acquire a thorough knowledge of Gelsemium will not tax you much. Its sphere of action is well defined. In poisoning cases we find that the prominent and universal symptom is paralysis of the motor nerves. Keep this fact before you and the symptoms of this remedy will be readily understood, especially if you apply the paretic action to both voluntary and involuntary muscles. The mind is at first clear; or there may be a slightly stupefied condition as in the case of alcoholic intoxication, a sluggishness in thought and in emotion. Later in the toxic effects of the drug you will note that the sphincters become relaxed; the anus remains open, permitting the escape of faeces. Urine escapes freely and involuntarily. Still later, respiration becomes labored, as though the muscles had not the power to lift the chest. Finally, the heart-muscle gives out, and the patient dies. Looking, then, at these symptoms as presenting in a nutshell the action of this drug, we find that it is a depressant. It acts upon the cerebro-spinal system, particularly upon the anterior columns of the cord. We also see that, by producing this sluggishness of thought, this stupid state of the mind, it must have an action on the vascular system. It is through the vaso-motor nerves that it produces passive congestion, and this congestion may be either venous or arterial. Passive congestion is generally of venous origin; but under Gelse??iium the passive hyperemia refers to both arteries and veins. In addition to this nervous action of the drug, it has something of an affinity for the mucous surfaces, giving rise to catarrhal inflammations. It is not difficult with this outline of the drug to fill in the characteristics. We find that, in obedience to its paralytic action, it causes diplopia. This double vision, when Gelsemium is the remedy, comes from paresis of the muscles of the eye.

Ptosis, or paralysis of the upper lid, calls for Gelsemium when it is associated with thick speech and suffused redness of the face. The eyeballs feel sore, the soreness being worse on moving the eyes. In this last symptom it is similar to Bryonia.

In ptosis we may compare Gelsemium with Causticum, Rhus toxicodendron, Sepia, Kalmia, and Alumina. Rhus tox. is useful in ptosis, or, in fact, in paralysis of any of the ocular muscles, when the disease occurs in rheumatic patients as a result of getting wet. Sepia is indicated in ptosis when it is associated with menstrual irregularities.

Kalmia is also useful in ptosis of rheumatic origin, when attended with a sensation of stiffness in the lids.

Causticum, in the ptosis of rheumatic subjects.

Alumina is indicated in ptosis associated with rectal inertia and consequent constipation.

Returning now to Gelsemium, we find that there is difficulty in swallowing, dysphagia, as it is called. This symptom is due to defect in the muscles of deglutition.

Gelsemium also acts upon the larynx, causing aphonia, or want of voice; the patient may be able to whisper, but he can scarcely utter any sounds on account of the paretic state of the laryngeal muscles. This symptom is frequently observed in hysterical women especially after emotions of a depressing character. Paralysis after emotion is noted under other drugs; for example, under Natrum mur., which has, " the arm almost loses its power after a fit of anger;" Stannum, paralysis mostly left-sided with perspiration of the affected part; Staphisagria, paralysis of one side from anger.

The heart is affected by Gelsemium; on going to sleep the patient is suddenly aroused by a feeling that the heart will stop beating. He feels that the heart would cease to beat if he did not move about. Here the heart-muscle is in a weakened state, and there is a sort of instinct on the part of the person to move about to stimulate it to act. Digitalis has a symptom which is just the reverse of this, namely, the patient fears that the heart will cease beating if he makes any motion.

Grindelia robusta has great weakness of the heart and lungs. When the patient drops off to sleep he wakes up suddenly with a sensation as if respiration had ceased.

In post-diphtheritic paralysis, Gelsemium is our most valuable remedy. In one very severe case of this disease under my care, Gelsemium effected a perfect cure. The child did not have sufficient strength to hold herself up. The spine in the upper cervical region was bent backward. One side of the body was paralyzed. In attempting to walk, the child would shuffle along as though she had no control over the muscles. If she attempted to turn around, she would fall. The speech was thick and heavy, as though the tongue were too large for the mouth. There was marked strabismus. But sensation was nearly perfect. I ordered the patient to be stripped twice a day, laid on the bed, and thoroughly rubbed. I gave her Gelsemium internally, and under the use of this remedy she made a perfect recovery. I doubt whether Gelsemium will cure paralysis of organic origin, where there are tissue alterations in the brain, the spinal cord, or the peripheral nerves themselves.

Gelsemium is useful in some cases of headache. I said a few moments ago that it causes a passive congestion, and by that I mean, not a violent, sudden afflux of blood to a part, but a dilated condition of the bloodvessels, such as may be found under Ferrum phos. The headache begins in the nape of the neck, passes up over the head, and settles down over the eyes. It is usually worse in the morning, and is accompanied by stiff neck, or it begins at 2 or 3 a. m. and reaches its acme in the afternoon. The patient cannot think effectively or fix his attention. He becomes listless and stupid; he has dizziness with blurred sight and heaviness of the head. These symptoms are alleviated by the discharge of watery-looking urine.

Oleum animale has cured megrim with polyuria, the urine being perfectly clear. Compare also Ignatia, Sa?iguinaria } Kalmia, Melilotus, Aconite and Silicea.

The face is a suffused red color. The eyes grow heavy and bloodshot. There is great difficulty in lifting the upper lids; often, too, the speech is thick, as though the tongue were unwieldy. Altogether, the face has the appearance of one under the influence of liquor. Thought is slow, so that the patient answers questions either slowly or imperfectly. This condition is accompanied by a pulse which is full and round, and seems to flow under the fingers like a current of water. It resembles the Aconite pulse, but lacks the tone of the latter. It is not hard and unyielding like the pulse of Aco?tite. Not infrequently the headache is preceded by blindness, as under Psorinum.

Here, then, you have symptoms which suggest Gelsemium in a variety of diseases. How useful it ought to be in the congestive stage of spotted fever! In addition to the symptoms already mentioned, there is another which is characteristic of spotted fever, namely, depression; the system seems to be laboring under the effect of some poison which it cannot overcome. So you have every indication here for the use of Gelsemium in that dreaded disease. But when the case advances to active inflammation, or when there is effusion, Gelsemium gives place to other remedies.

In addition to the headache above described, there is another form which is associated with a feeling as though there were a band around the head, or across the forehead.

Let us now consider the fever of Gelse?nium. It causes a fever which is remitting or intermitting in its type. You will find it a valuable remedy in the remitting types of fever in children. During the febrile exacerbation they are very nervous and restless, tossing about continually. (You must not give Aconite in these cases, unless the mental symptoms of that remedy are present.) The face has the suffused redness I mentioned above, and there is drowsiness. When aroused from this drowsy state the child is peevish, irritable, nervous, even somewhat excitable, but there is never the violent tossing about of Aconite. In extreme cases the drowsiness may give place to convulsive motion. The muscles of the face twitch; the child becomes rigid, as though it were about to have a convulsion. There is usually not very much thirst, but there is great prostration, so that the child seems too weak to move. Every part of the body seems to be so sore that he cries out if you move him. These symptoms will remit and, possibly, the next morning, slight perspiration will show itself. The next afternoon the symptoms return as before.

In intermittent types of fever you may select Gelsemium in the beginning. The chill runs up the back or starts from the feet and extends upward. It is sometimes associated with copious urination and with bruised aching all over the body. The patient wants to be held so that he will not shake so much. Then comes the fever with the symptoms that I have already mentioned. Sometimes irritability is exhibited. He can neither bear noise nor light. The sweat is slight or partial, but it relieves all the pains. The tongue is coated white or yellow. Speech is thick. The bowels are constipated and the stools are yellow. It is especially indicated in intermittent fever of nonmalarial origin.

In adults we find Gelsemium the remedy in bilious fever, particularly bilious remittent fever. The reason that it is useful in bilious fever is that it causes a passive congestion of the liver. The blood flows sluggishly through the liver. This is not the portal stasis found under Nux vomica, but it is a lazy now of blood. Thus the liver becomes overcharged with blood, the bile cannot be properly secreted, and there is a bilious type of fever.

In typhoid fever Gelsemium is indicated, particularly in the initial stages; when, during the first week, the patient feels sore and bruised all over, as if he had been pounded. He dreads to move. He has headache. More than that, he has loss of muscular power. He is drowsy, and has this same suffused red face. In these cases Gelsemium will so modify the course of the fever that the patient will pass through it with comparatively mild symptoms.

We may find Gelsemium indicated in catarrhs excited by warm, moist, relaxing weather, with excoriating discharge from the nose, making the nostrils and wings of the nose raw and sore. There are frequent paroxysms of sneezing, especially in the morning, and sore throat, the tonsils being red and somewhat tumefied, with difficulty in swallowing. I would remind you, in passing, that this difficulty in swallowing is not what it is under Belladonna. Under the latter remedy the difficulty comes from the extent of the swelling, and also from spasmodic contraction of the fauces, owing to the hyperesthesia of the nerves. No sooner does water touch the throat than it is expelled through the nose. With Gelsemium the d3<sphagia is the result of the paretic state of the muscles, or the patient was muscularly weak when he caught cold. With this cold you will find dry, teasing, tickling cough, with very little expectoration. There is a sensation of dryness in the mouth, although it is not dry, which reminds us of Nux moschata and Nat? tint mur. The right nostril is red and sore; there is a feeling as if hot water were passing over the mucous membrane of the nostrils; relief comes when near the fire. You find general prostration, and often, too, neuralgia of the face.

Quillaya (or soap bark) cures colds contracted in warm relaxing weather. Like Gelsemium there are muscular languor, desire for rest and quiet, general bruised feeling, even of the eye-balls, etc. The former, however, has more of a stuffed sensation in the nose; the latter a fluent, excoriating coryza with neuralgia of the face and head. Now in prosopalgia Gelsemium may be of use when the disease affects one side, and is intermitting in its type. The seventh pair of nerves is involved, and the patient makes all sorts of grimaces. Gelsemium has some slight action on the skin. It produces redness and an itching which is violent enough to prevent the patient from falling asleep. A fine eruption, consisting of small pimples, and somewhat resembling that of measles, may appear. Gelsemium may, therefore, be used in measles in the beginning, when fever is a prominent symptom, and we have the watery discharge from the nose, excoriating the alse nasi and the upper lip. There is apt to be associated with this a hard, barking, croupy cough and hoarseness.

Aconite, other things being equal, is the best remedy we have for the beginning of measles. If you have a case that you presume is going to be measles, with fever, restlessness, photophobia, coryza, sneezing, and hard, croupy cough, you are justified in giving Aconite. If there be any fever Pulsatilla is not the remedy.

When the skin is moist with the fever, Belladonna is more likely to be the remedy.

When the characteristic drowsiness and suffused face is present, you may give Gelse?niu?n in the beginning of any eruptive disease, even if there be convulsions present.

Next I want to speak of the action of Gelsemium on the genital organs. On the male organs it produces a condition very nearly approaching impotence. There are frequent involuntary emissions at night, with relaxation of the organs, no lascivious dreams, and often cold sweat on the scrotum. It is indicated especially in those cases which arise from masturbation.

I would have you note here another remedy, namely, Dioscorea. This is excellent for what we may term atonic seminal emissions. The organs are so relaxed that two or three dreams, with emissions of semen, occur in a single night. The day following the emissions the patient feels weak, particularly about the knees In these cases I know of no remedy like Dioscorea. I usually give it first in the 12th potency, and afterward in the 30th.

Caladium seguinum is indicated for the bad effects of sexual excesses, when wet-dreams occur without any lasciviousness or any sexual excitement whatsoever.

Agnus castus is the remedy for spermatorrhoea in old sinners. The parts are cold and relaxed; the sexual appetite is gone and the patient is melancholic.

Other remedies which may be compared with Gelsemiurn in its action on the male organs are Digitalis, Phosphorus , Nux vomica, Calcarea ostr. , Lycopodhim and Camphor.

Sepia, Selenium, and Conium produce a similar seminal weakness, with erethism and easy emissions.

In gonorrhoea, Gelsemium is indicated in the beginning when there is marked urethral soreness. There are also burnings at the meatus and along the course of the urethra. The discharge as yet is slight, not having become purulent. The disease may have been suppressed, and, as a result, may be complicated with epididymitis. In gonorrhceal rheumatism it may be a useful remedy.

In diseases of the female organs, Gelsemium is an invaluable remedy. First of all, we find it useful in rigid os uteri. You must not confound this condition with the more common spasm of the os, which calls for Belladonna. Often we find in labor, after it has lasted several hours, that there has been tardy dilatation of the os. The examining finger finds the os unyielding, hard and thick. The patient is hysterical and full of nervous excitement. The pains leave the uterus and fly all over the body or shoot upward and backward. At other times the pains go from before backward and the uterus seems to push upward. Or there is a sensation of a wave rising from the uterus to the throat, ending in choking. This condition calls for Gelsemium.

Another condition, exactly opposite to this, also calls for Gelsemium, namely, complete atony of the uterus. The neck of the uterus is as soft as putty. It is perfectly flabby. The body of the uterus does not contract at all. The bag of waters bulges freely from the os, but there is no attempt whatever at expulsion. In such cases, give a few doses of Gelsemium.

In the premonitory stages of puerperal convulsions Gelsemium is an admirable remedy. Albuminuria may be present. The convulsions are preceded by drowsiness, and twitching of different parts of the body. The os is either rigid, as I first mentioned, or else everything is perfectly inactive; the pulse is full and large, but soft. Sharp, distressing, cutting pains in the abdomen go from before backward and then upward, and with every pain the face flushes.

Gelsemium may also be used in the non-pregnant state. The uterus is markedly anteflexed and feels as if squeezed by a band. The uterine symptoms are associated with a frontal headache and dim vision. The head feels enormously enlarged, with a wild confused feeling in it. These symptoms alternate with sharp labor-like pain in the uterus extending to the hips and back, and even down the thighs. Gelsemium is often useful in neuralgic and congestive dysmenorrhcea when bearing down coexists.

Caulophyllum is similar to Gelsemium in dysmenorrhcea and follows it well.

Actea racemosa and Sepia have headaches reflex from uterine irritation.

Gelsemiurn is useful for the effects of emotions, particularly after fright or fear. A suddenly appearing diarrhoea, coming on from excitement, as for instance '

' stage-fright '

' or the anticipation of some trying ordeal, calls for Gelsemium. The stools are copious, yellow and papescent. The tongue is coated white or yellowish.

Other remedies coming into play in cases of diarrhoea arising from^ emotional influences are Opiu?n y Veratrum album, Argentum nitricum and Pulsatilla.

Opium in cases coming on as a result of fright, especially when the image of the thing which caused the fright constantly appears before the mind.

Veratrum album in diarrhoea after fright, associated with cold sweat on the forehead.

Argentum nitricum when diarrhoea follows great excitement, especially when the imagination has been played upon. Diarrhoea from anticipation.

Pulsatilla in diarrhoea from fright, when the stools are greenish, yellow and slimy, or very changeable and worse at night; trembling; weeping.

Gelsemium may even avert impending abortion from depressing emotions, with the peculiar pains mentioned above in connection with labor. In this condition you should compare Aconite and Opium. Conium, Physostigma and Tabacum intensify the action of Gelsemium. Gelsemium is antidoted by stimulants, and by Belladonna, Digitalis, China and Cojfea.