Gelsemium Semprevirens is a yellow-flowering plant indigenous to the South. It is an evergreen, and puts forth its fragrant flowers among the earliest in 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.
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. The mind at first is clear, or there may be a slightly stupefied condition as in case of one intoxicated, a sluggishness in thought and in emotion. Still 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. 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 cerebrospinal 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 I would like to say that this congestion may be either venous or arterial. Passive congestion is generally of venous origin; but under Gelsemium this passive hyperaemia 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, this 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, and KALMIA. 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 the disease is associated with menstrual irregularities.
KALMIA is also useful in ptosis of rheumatic origin, when attended with sensation of stiffness in the lids.
CAUSTICUM, in ptosis of rheumatic subjects.
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.
Aphonia, or want of voice, may be present; 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 after emotion, 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."
The heart is affected by Gelsemium; the patient, on going to sleep, is suddenly aroused with the 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 just the reverse of that of Gelsemium above mentioned, 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 the 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 backwards. 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. Sensation was nearly perfect. I ordered the patient to be stripped twice a day, and laid on the bed, and well rubbed. I gave her Gelsemium internally. Under the use of this remedy, she made a perfect recovery.
I doubt if Gelsemium will cure paralysis of organic origin, when there are 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 Gelsemium causes a passive congestion and by that I" mean, not a violent, sudden afflux of blood to a part, but that condition of the bloodvessels in which they are dilated, just such a condition as I mentioned, the other day, 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. The patient cannot think effectively or fix his attention. He becomes listless and stupid; 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. The face is a suffused red. 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, too, is slow, so that the patient answers questions either slowly or imperfectly.
This condition is accompanied by a pulse which is full and round, which seems to flow under the fingers like a current of water. It is exactly like the ACONITE pulse, except that it lacks tone, i.e., the hard, unyielding pulse that Aconite has.
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 ! This remedy has, in addition to the symptoms already mentioned, another which is characteristic of spotted fever; that is, depression. The system seems to be laboring under some poison which it cannot overcome. So, you have every indication here for the use of this drug in that dreaded disease. When the case advances to active inflammation, when there is effusion, Gelsemium steps out and gives place to other remedies.
In addition to the form of headache above described, there is another which is associated with a feeling as though there were a band around the head, or across the forehead.
Now for the fever Gelsemium produces. Gelsemium 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. You find the patient drowsy and tossing about the bed in agony. (You cannot give ACONITE in these cases, unless the mental symptoms of that remedy are present.) The face is red ; it has this suffused redness, of which I spoke a few minutes ago. When the child is aroused from this drowsy state, it is peevish, irritable, nervous, or somewhat excitable, but never has 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 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 upwards. It is sometimes associated with copious urination and with bruised aching feeling 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, there is irritability exhibited. The patient can bear neither noise or 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 non-malarial 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 same portal stasis that you find under NUX VOMICA, but it is a lazy flow of blood. Thus the liver becomes overcharged with blood, the bile cannot be properly secreted, and you have 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 lost 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 sneezing 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 this latter remedy the difficulty comes from the extent of the swelling, and also from spasmodic contraction of the fauces, owing to the hyperaesthesia of the nerves. The minute water touches the throat it is expelled through the nose. With Gelsemium, the dysphagia 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. You find general prostration, and often, too, neuralgia of the face.
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 an itching and redness of that tissue, this itching being violent enough to prevent the patient from falling asleep. A little 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 present the coryza of the remedy; watery discharge from the nose, excoriating the wings of the nose 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 find 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.
PULSATILLA is not the remedy if there be any fever.
When moisture breaks out with the fever, BELLADONNA is more likely to be the remedy.
If there is drowsy state and suffused face you may give Gelsemium in the beginning of 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, Gelsemium produces a condition very nearly approaching impotence, frequent involuntary emissions at night, with relaxation of the organs, no lascivious dreams, and often cold sweat on the scrotum. The organs are relaxed. 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 ; when there is a passive state, two or three dreams in a night with emissions of semen. 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, afterwards 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 whatever.
AGNUS CASTUS is the remedy for spermatorrhoea in old sinners.
Other remedies which may be compared with Gelsemium in its action on the male organs are DIGITALIS, PHOSPHORUS, NUX VOMICA, CALCAREA OSTR., LYCOPODIUM, 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 line of the urethra. The discharge as yet is slight, not having become purulent. The disease may have been suppressed, and, as a result, is complicated with epididymitis. In gonorrhoeal 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. This rigid os calls for Gelsemium.
Another condition, exactly opposite to this, 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. 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 patient is usually drowsy, and has 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. Pain seems to go right through the stomach, and then backwards; sharp cutting pains that seem to go right through the neck of the uterus, and then upwards. With these pains, 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 hand. Now these 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 pains in the uterus extending to the hips and back, and even down the thighs. Gelsemium is often useful in neuralgic and congestive dysmenorrhoea when bearing down coexists.
CAULOPHYLLUM is similar to Gelsemium in dysmenorrhoea and follows it well.
ACTEA RACEMOSA has headaches reflex from uterine irritation.
Gelsemium is useful for the effects of emotions, particularly after fright or fear. A suddenly appearing diarrhoea coming on from the effects of excitement 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 OPIUM, VERATRUM ALBUM, ARGENTUM NITRICUM, and PULSATILLA.
OPIUM in cases coming on as a result of fright.
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.
PULSATILLA in diarrhoea from fright, when the stools are greenish, yellow and slimy, or very changeable.
Gelsemium may even avert an impending abortion from depressing emotions.
CONIUM, PHYSOSTIGMA, and TABACCUM intensify the action of Gelsemium.
Gelsemium is antidoted by stimulants, BELLADONNA, DIGITALIS, etc.