Gelsemium (U. S. P.)—Gelsemium.
The rhizome and roots of Gelsemium sempervirens (Linné), Persoon. (Gelsemium nitidum, Michaux; Gelsemium lucidum, Poiret; Bignonia sempervirens, Linné; Anonymos sempervirens, Walter; and Lisianthus sempervirens, Miller).
COMMON NAMES: Yellow jasmine, Yellow jessamine, Wild woodbine, Carolina jasmin or Jessamine.
ILLUSTRATIONS: Johnson, Med. Bot. of N. A., Plate 7; Meehan, Native Flowers and Ferns, I, 9; Bentley and Trimen, Med. Plants, 181; Millspaugh's Amer. Med. Plants, Plate 130.
Botanical Source.—The Yellow jasmine is a handsome climber growing along banks and in lowlands and woods. The stem is smooth and twining; the leaves opposite, entire, ovate, or lanceovate, nearly evergreen, being dark-green, smooth, and shining on top; paler beneath. The flowers are in axillary clusters, showy, and of deep-yellow color, and emit an agreeable, but rather narcotic odor. The calyx is 5-parted and very small, with acute, lanceovate lobes. The corolla is 3/4 to 1 1/2 inches long, with 5-lobed margin; stamens 5, half as long as the corolla, and inserted on it. The style is longer than the stamens, and supports two 2-parted stigmas. The fruit is an elliptical pod, 2-celled, 2-valved, and many-seeded. The seeds are flat, and attached to the margins of the valves. Owing to its evergreen leaves, fragrant flowers, and the shade it affords, it is extensively cultivated in the gardens of the South for ornamentation.
History.—This strikingly beautiful climber, peculiar to our southern cities, furnishes one of the most valued and universally used Eclectic remedies. It is a twining vine, flourishing in great profusion from Virginia to Florida, hanging in festoons from the neighboring trees and shrubs, sometimes growing to the height of 50 feet. The average height, however, is from 20 to 30 feet. The plant blooms in early spring-in Florida during March, and in Mississippi and Tennessee in May and June. During the flowering period it perfumes the air with a delightful fragrance similar to that of the true jasmine. When the vine is abundant, the odor of the flowers is said to be almost overpowering. Gelsemium is known by several popular names, as Yellow jessamine, Yellow jasmin Carolina jessamine, Carolina jasmin, and Wild woodbine. The name gelsemium was given it by Jussieu, and is derived from the Italian gelsomina, meaning jasmine. The plant, however, resembles the true jasmine only in its fragrance, and belongs to an entirely different natural order. Mr. E. M. Holmes (Pharm. Jour. Trans., 1875, p. 481) states that it is rather unfortunate that it should often be called the Yellow jessamine in America, since there is a true jessamine (Jasminum fruticans, Linné) with yellow flowers, which is often found in cultivation. If the name jessamine be applied to Gelsemium sempervirens at all, it should be carefully distinguished as the Carolina jessamine (see also Dr. A. R. L. Dohme, in Drug. Circ., 1897, p. 179). Gelsemium was formerly known botanically as Bignonia sempervirens of Linnaeus, and the Gelsemium nitidum of Michaux and Pursh. The name gelsemium, as used exclusively by Eclectics, arose from a typographical error, and was widely copied in various writings, and accepted as authority before the mistake was discovered (see Prof. J. U. Lloyd, in Ec. Med. Jour., for March, 1892).
While gelsemium is one of our best remedies, yet, like iris, phytolacca, and other plants, it suffers from worthless representatives on the market. These preparations, made from old, dried material, will fail to fulfil the expectations of he who administers them for the specific effect. Specific gelsemium, the preparation employed by Eclectic physicians almost exclusively, fully represents the plant. Prof. J. U. Lloyd informs me that, in the preparation of specific gelsemium, the green root only is used. It is gathered in February or in early spring, cut into small pieces, put in barrels, and to the contents of each barrel is added 10 gallons of alcohol. In this condition it is shipped from the Carolinas (where it is gathered) to Cincinnati. On arrival, it is dumped into the drug mill and ground, alcohol and all, and from this material the specific medicine is made. He further states that, in one season, when the winter was uncommonly mild, the continuous growth of the plant caused a large amount of albuminous material to form in the root, and that preparations manufactured from such a product threw down an unsightly albuminous precipitate, which, though it did not impair the therapeutic value of the preparation, rendered it unsalable.
This plant was brought into notice, as far as we can learn, in the following 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 raise his eyelids, although he could hear, and was cognizant 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. This plant was the Yellow jessamine, and a knowledge of its remarkable effects was not communicated to the profession until a later period (King).
Description.—The best preparations of gelsemium are made from the green rhizome, therefore that official in the U. S. P. is not adapted to the uses of the Eclectic pharmacist and doctor. That work simply states the "rhizome and roots," without specifying whether green or dried, hence it is to be inferred that the dried root is the one intended. For the sake of completeness we give the official description:
"Cylindrical, long, or cut in sections, mostly from 5 to 15 Mm. (1/5 to 3/5 inch), and occasionally 3 Cm. (1/5 inch) (Yes, that's what it says. One of these is wrong.) thick, the roots much thinner; externally light yellowish-brown, with purplish-brown, longitudinal lines; tough; fracture splintery, bark thin, with silky bast-fibres, closely adhering to the pale-yellowish, porous wood, which has fine, medullary rays, and in the rhizome a thin pith; odor aromatic, heavy; taste bitter"—(U. S. P.). Gelsemium yields its virtues to water or alcohol. The rhizome is several feet in length (roots in Fig. 119 are cut off), with scattered fibers, and is from 2 to 3 lines in diameter to nearly 2 inches. The internal part is woody, and of a light-yellowish color; the external part or bark, in which the medicinal virtues are said principally to reside, is of a light snuff-color, and from 1/2 to 3 lines in thickness. The root of this plant has been said to contain a resin which is poisonous in very small doses, and a tincture, made by digesting it in undiluted alcohol, is stated to have proved fatal. This statement is denied, and upon good grounds, for, were it true, death would necessarily follow the use of the tincture made with undiluted alcohol, in consequence of the presence of this resin, which would still be taken up by alcohol in a proportion corresponding to the alcoholic strength of the solvent. Again, it has been asserted, that the deaths, which have occurred where the article was used, were owing, not to the gelsemium., but to the presence of another very poisonous root, somewhat resembling it, which was carelessly or ignorantly collected and mixed with it. Others again, state that they have given large doses without any serious consequences, and, in one case, 6 fluid drachms of the tincture were swallowed by a lad of 20 years of age, without any permanent injury. Notwithstanding these statements, death has followed the employment of what was supposed to be the tincture of gelsemium, in a few instances, and further investigations are required to determine the probable cause, and whether this agent will produce any fatal results in large medicinal doses. Yellow jessamine may be administered in decoction, infusion, or tincture.
Dr. Hiram H. Hill, formerly of the late firm of F. D. Hill & Co., of Cincinnati, has collected many hundred pounds of gelsemium root in the South. I am indebted to him for the following statement of it: "The length of the gelsemium root, in clay soil, is from 3 to 10 feet, and on the Magnolia ridges, and along small streams, I have traced some roots to the extent of 30 feet, although the average length is about 15 feet. Like the roots of many other vines, it is branching, with scattered fibers, and runs horizontally near the surface of the ground, sometimes merely under the leaves, for several feet. When first pulled up it is very yellow, and has a peculiar odor like that of the tincture, with a bitter, rather pleasant taste to most persons, at least people were constantly tasting or chewing it, while I was collecting it. The vine is of a green color, and always runs to the top of the tree or bush on which it fastens, then branches out, covering the topmost branches with its thick foliage. I have seen it on trees that were 50 feet in height, and the size of the vine was the same near the top as at the ground; its general length is from 20 to 30 feet. The bark of the vine is full of a silk-like fiber, which is not found in other vines that I have seen. On old vines, the leaves are about 1 1/2 inches in length, of a dark-green color, lance-shaped, and on short foot-stalks; on young vines or shoots they are longer, and are 4 or 5 inches apart, while on the old ones they are very close and always opposite. The flowers are funnel-shaped and yellow. The vine, the root of which is sometimes gathered by mistake for the gelsemium, resembles it very much in appearance, though it is of a lighter color, and the outer bark is covered with white specks or marks somewhat similar to those on young cherry or peach limbs, and the lower parts of the old vines become rough, and have small tendrils that fasten upon the bark of trees, and which are never seen on the gelsemium. The bark of the vine is also more brittle, and the leaves are always on long foot-stalks, which are opposite, at the end of which are two opposite leaves, almost exactly resembling the leaf of the Aristolochia Serpentaria. The root is almost white, very tough, brittle when dry, not so fibrous as the true root, straight, about the same length of the medicinal root, and has a slightly bitter, disagreeable, nauseating taste. I never saw any of the flowers, though they are said to resemble the others in shape, but are pale, dirty-white, with a slight unpleasant odor, by no means like that peculiar to gelsemium. The vine is called White poison vine and White Jessamine" (King).
Chemical Composition.—Mr. Henry Kollock, in 1855 (Amer. Jour. Pharm., Vol. XXVII, p. 197), found, beside the usual constituents of plant roots, a volatile oil, a dry, acrid resin (the gelsemin of the older Eclectics, see later), and a bitter, crystalline, alkaloidal substance which he named gelseminia. Prof. Maisch and C. L. Eberle (Amer. Jour. Pharm., 1869, p. 35) again obtained this alkaloid; the latter stated its being absent from the wood of the root, which was later confirmed by Gerrard. In 1870 (Amer. Jour. Pharm., p. 1), Prof. Th. G. Wormley, examining a fluid extract of the root, discovered therein a crystallizable acid, which be called gelseminic (or gelsemic) acid, and which is remarkable for the beautiful blue fluorescence exhibited by solutions of the acids in aqua ammoniae or other alkalies, even when highly diluted. Chas. A. Robbins, in Prof. Sonnenschein's laboratory (Amer. Jour. Pharm., 1876, p. 191), found gelsemic acid to be non-nitrogenous, and pronounced it to be identical with aesculin, the characteristic glucosid of horse chestnut bark. Prof. Wormley (Amer. Jour. Pharm., 1882, p. 337) and recently, Prof. V. Coblentz (Proc. Amer. Pharm. Assoc., 1897, p. 225) proved, however, that gelsemic acid and aesculin presented some striking differences in solubilities, etc., and could not, therefore, be identical. In this connection, it may be said that, 15 years ago, Prof. F. A. Flückiger, from gelsemic acid made for him by J. U. Lloyd, and aesculin made by himself, established that they presented certain differences. He communicated his results by letter to Mr. Lloyd, but they were not published to our knowledge. More recently, Prof. E. Schmidt (Archiv der Pharm., 1898, p. 324) has clearly proved the identity of gelsemic acid with the known substance beta-methyl-aesculetin (C10H8O4). In harmony with this result are the researches of Prof. Coblentz, who gave experimental proof of the fact that gelsemic acid contains two hydroxyl groups, which agrees with the constitution of that substance identified by Prof. Schmidt. More doubt exists with regard to the alkaloidal principle, owing to the difficulty of obtaining it in crystallized form. Sonnenschein and Robbins (1876) gave it the formula C11H19NO2, while A. W. Gerrard (Amer. Jour. Pharm., 1893, p. 256), evidently obtaining it in much purer form (from the purified hydrochloride), finds C12H14NO2. Spiegel's results (1893) agree with the latter formula. Finally, Mr. F. A. Thompson (laboratory of Parke, Davis & Co.) (Pharm. Era, 1887, p. 3) believes that, besides this alkaloid, which he calls gelsemine, there exists another in gelsemium root, which he calls gelsiminine; its hydrochloride is more easily soluble in water than that of the first alkaloid. Gelsemine is believed to act as a paralyzing, gelseminine as a tetanizing, medium. A. R. Cushny (Ber. d. Deutsch. Chem. Ges., 1893, p. 1725) corroborates the existence of the two alkaloids mentioned.
Wormley (Amer. Jour. Pharm., 1877, p. 150) gives the following directions for obtaining from the fluid extract of gelsemium root the alkaloid, gelseminine (gelsemine), and gelsemic acid: Acidulate the fluid extract with acetic acid; add this slowly to 8 times its bulk of water, filter from the resins, concentrate the filtrate on the water-bath to somewhat less than the original volume; then abstract gelsemic acid by ether, and, subsequently, the gelsemine by ether or chloroform, after rendering the fluid alkaline with sodium carbonate. In fluid extracts, prepared in the quantity of 480 grains of root to the ounce, Prof. Wormley obtained a yield of 0.2 per cent of gelsemine and 0.4 per cent of gelsemic acid.
Comparative analyses of the rhizome, root, and stem of gelsemium, carried out in the laboratory of Prof. L. E. Sayre (Amer. Jour. Pharm., 1897, p. 234), showed the total absence of the alkaloid and the acid in the stem, while the rhizome contained 0.2 per cent of alkaloid and 0.37 per cent of gelsemic acid, and the root 0.17 per cent of alkaloid and 0.3 per cent of gelsemic acid. The alkaloid, gelseminine (gelsemine of Thompson), is described by Wormley as a colorless, odorless, intensely bitter, basic principle, and was obtained by A. W. Gerrard in crystalline form. When pure, it exhibits no color reaction with sulphuric and nitric acids, as claimed by Sonnenschein. It is sparingly soluble in water, freely soluble in acids, in chloroform and ether (1 in 25). Its nitrate crystallizes best of all its salts (Spiegel, Amer. Jour. Pharm., 1893, p. 381).
Gelsemic acid (beta-methyl-aesculetin of E. Schmidt), according to Prof. Wormley, is a colorless, odorless, nearly tasteless, crystallizable acid, readily dissolving in alkalies with beautiful blue fluorescence; sparingly soluble in cold water (1 in 1000), more easily soluble in hot water; also soluble in chloroform, ether, and alcohol. Its salts formed with heavy metals are soluble, with difficulty, in water.
GELSEMIN, the so-called concentration (resinoid), should not be employed for at least two reasons. First, it is of uncertain strength and quality. Secondly, its name being so similar, both in spelling and sound, to that of the alkaloid, gelsemine, that, through mistake, the latter agent might be supplied and serious results follow. Death has resulted from such a mistake, consequently it should be discarded, especially as it is not equal in therapeutic power to the fluid preparations of gelsemium. It may be of interest to state that nearly all of the so-called concentrations (excepting podophyllin) of the earlier Eclectics have been discarded by the Eclectics of the present day, and are now used almost exclusively by the regular school, and especially by European physicians; also, by that class who believe that all the virtues of a remedy reside in concentrations and alkaloidal principles. Clinical experience proves that such preparations do not fulfil the indications as do the fluid preparations containing all the soluble medicinal ingredients of the plant.
Action, Medical Uses, and Dosage.—Gelsemium powerfully impresses the nervous system, though in man it never produces convulsions. Convulsions may occur in the lower animals. Small (medicinal) doses relax the muscles, especially the levator palpebrae, and allay nervous irritation. A pleasant or languid sense of ease and relaxation is usually experienced, accompanied in the case of larger doses by a tendency of the lower jaws to drop, and a difficulty in managing the eyelids. Sometimes sensation is lost first; again, and usually, muscular paralysis is the first to take place. The continued administration of it effects the brain (indirectly), spinal centers, and medulla, causing marked feebleness of muscular movements, confusion of vision, and vertigo. Large doses paralyze the spinal cord and cause almost complete loss of muscular power. Reflex action is depressed with the loss of muscular power, and these and the lack of sensibility, which usually takes place, are due to its action upon the spinal marrow. Consciousness may be lost, but it is usually retained even when toxic doses have been taken. When fatal, however, dissolution is usually preceded by loss of consciousness. The characteristic toxic symptoms are palpebral relaxation, disturbance of the ocular muscles, the dropping of the lower jaw, and the profound prostration and muscular relaxation. The pupil dilates, there is drooping of the eyelids (ptosis), and double vision (diplopia). Applied locally to the eye, it dilates the pupils and interferes with the action of the muscles of accommodation. The pulse is slowed to 30 or 40 beats, and there is a marked decrease in temperature. Respiration is at first quickened, then slowed, breathing becomes shallow, and the action upon the heart appears to depend upon the effect upon respiration. As a rule, the mental faculties are not directly affected by it, unless it be due to accumulation of carbon dioxide, the result of respiratory paresis. Occasionally, death results from overdoses, and, when it does so occur, is due to asphyxia. Persons are reported to have been poisoned by eating honey gathered by the bees from gelsemium flowers.
Gelsemium is said to increase the tetanizing power of strychnine. The postmortem appearances after death from gelsemium present nothing specially characteristic. Twelve minims of the fluid extract have been asserted to have killed a boy of 3 years, yet recoveries have taken place from much larger doses. Death from gelsemium usually takes place in from 1 to 8 hours. (For report of two fatal cases, see Taylor's Med. Jurisp., 1892, p. 164.)
In poisoning by gelsemium or its alkaloid, gelsemine, evacuate the stomach by emetics or stomach pump, administer, hypodermatically, morphine and atropine, use friction, internal stimulation, hot drinks, external heat, etc. Tannin and the alkalies and their carbonates are reputed chemically antagonistic. Artificial respiration should be resorted to, and the heart should be sustained by digitalis and similar agents. As but few cases of poisoning by gelsemium have occurred, the antidotal treatment is as yet not well established.
Therapeutically, gelsemium acts upon the cerebro-spinal nerve centers, diminishing the blood supply to them, as in determination of the blood to the head and spine, thereby preventing spasmodic action. Consequently, in determination of the blood to the brain and spinal cord and their appendages, or in inflammatory conditions of the cerebro-spinal system, the drug would be clearly indicated. It is never the remedy for congestion. Prof. Scudder has pointed out as the specific indications for it: "The flushed face, bright eye, contracted pupils, increased heat of head, great restlessness, and excitation." With these may be associated a general headache. Bearing these indications in mind, the drug will be found useful in the diseased conditions named in this article. Gelsemium was first employed in febrile diseases, as bilious, remittent, typhoid and malarial fevers. In these conditions, it was found to have such a marked antipyretic action that it rapidly rose in favor among the earlier Eclectics. More pronounced effects were looked for by the Eclectic fathers than are now known to be most desirable. They regarded it as the only agent ever yet discovered capable of subduing in from 2 to 20 hours, and without the least possible injury to the patient, the most formidable and most complicated, as well as the most simple fevers incident to our country and climate, quieting all nervous irritability and excitement, equalizing the circulation, promoting perspiration, and rectifying the various secretions, without causing nausea, vomiting, or purging. They also believed it adapted to any stage of the disease, while the majority of those who now employ it believe it best adapted to the earlier stages of fevers, and seldom of marked value, if not harmful, in the advanced stages, or after the period of excitation has passed. It may follow any preceding treatment with safety. It is best suited to sthenic cases with determination of blood to nerve centers. It is to its controlling influence over nerve irritation that its antipyretic action is mainly due. As soon as its physiological effects are observed, the remedy should be discontinued, lest the relaxation may be too great for the system to recover from. A writer observes that his experience in the treatment of fevers, with this agent, inclines him to believe that when given in doses sufficiently large to produce its full and complete constitutional effects, it impairs the tonicity of the muscular fibers of the heart (which are always weakened in those fevers), and thus retards or prolongs convalescence. Gelsemium is a remedy for elevation of temperature, whether from cold, or due to graver affections, as the fevers above noticed, or whether due to pneumonia, pleurisy, or even puerperal fever, in which it is often of marked value. Chilly sensations upon moving the body are indications for it, and are usually followed by the high temperature and the stage of excitation, in which the drug has earned its reputation.
Gelsemium possesses a most perfect control over the nervous system, removing nervous irritability more completely than an other known agent. Such agents as passiflora increase its efficiency in this direction. Prof. W. E. Bloyer (E. M. J., 1894, p. 532) writes: "There is a species of nervousness that gelsemium always overcomes. The patient says that he is 'nervous.' He is grouchy, touchy, every impulse and feeling, whether painful or pleasant, is magnified or accelerated, and the contracted pupil is not always specially noticeable. If the patient be nervous and without fever or inflammation, give him pulsatilla; with these, give specific gelsemium."
By allaying nervous excitement and restoring the secretions it prepares the system for quinine, for quinine is very frequently associated with gelsemium in the treatment of various conditions. In the fevers and inflammations of children this irritation is often marked, and frequently results in convulsions. These cases are promptly relieved by gelsemium, which, as an antispasmodic, is second to no other drug. Its power is well displayed in convulsions from dentition, and in like conditions from inflammatory states of the digestive tract, as enteritis, gastro-enteritis, especially in bowel troubles of the second summer, as cholera infantum diarrhoea, and dysentery. Its powerful antispasmodic action makes it especially applicable to hysterical females. In hysteria, begin with 1 drop and increase until the muscles relax and diplopia results. In convulsions, with cramping rigidity of the muscles, give gelsemium until its physiological effects are produced. Neuralgia, with powerful nervous twitching, is relieved by it. Toothache, from peridental inflammation, is relieved by it as well as that form of toothache frequently accompanying pregnancy. It is a good agent in facial neuralgia from nerve excitation and darting pain, from cold, or from dental caries. Administer in drop doses. Insomnia is often relieved by gelsemium. It is prominent as a remedy for pain, though the specific indication (nervous tension) should be present or the remedy will be likely to fail. There must also be evidence of increased circulation—hyperemia of the part. In headache, with active circulation, and especially from eye strain, in migraine, in nervous headache, and in myalgia, administer small doses. It also benefits bilious headache and tic-douloureux. For ovarian neuralgia full doses are necessary. It benefits intercostal neuralgia and sciatica. It relieves the tenesmus of dysentery and other spasmodic conditions of the bowels. It is a valuable agent in chorea, and it has been used with marked success in epilepsy and tetanus, its effects in the latter affection having been very favorable. In spasmodic conditions of the urinary tract it is frequently indicated. It produces relaxation during the passage of renal calculi. Scanty flow of urine, with irritation of urinary passages, calls for gelsemium. It should generally, unless specially contraindicated, be given previously to or with the indicated diuretic, when urinal suppression is due to renal or cystic irritation (not congestion). It is the remedy for dysuria from spasmodic urethral stricture. Hot applications to the loins and back aid its action. It acts promptly in the retention of urine in the hysterical woman. It is a good remedy in gonorrhoea, and some cases of spermatorrhoea in plethoric subjects have been cured by it, though as a rule it is far less serviceable than other agents in nocturnal emissions. One of its early uses was for gonorrhoea, for which it was thought to be almost specific. For the early inflammatory stages of this affection, with tendency to chordee, no agent is more prompt than gelsemium. It is frequently given with aconite and cannabis indica for this purpose. Gelsemium quickly relieves the tenesmic pain, ischuria, etc., of irritative catarrhal conditions of the bladder. Inflammation of the kidneys, bladder or urethra, are relieved by gelsemium. In puerperal convulsions it has probably been used oftener than any other remedy, excepting morphine and chloroform.
In the pelvic disorders of women it is a favorite remedy. With the usual indications it subdues ovaritis, metritis, and salpingitis. Severe dysmenorrhoea with colicky pains, and uterine colic are promptly relieved by large doses of it. Rigid os uteri, with thin, unyielding edges, and a dryness of the parts, is relaxed by gelsemium. In fact, it relaxes all sphincters. By rectifying such complications it facilitates labor. Free doses should be administered. Gelsemium, alone or combined with pulsatilla, is invaluable to overcome the marked restlessness evinced by some parturients, and gelsemium will often retard a labor that has begun before the parts are ready for the ordeal, particularly when the woman is excessively excitable and nervous, and the pains are spurious, or at least jerky and ineffectual. The nervous tension following accouchement is quickly relieved by this drug. After-pains are controlled by it, and it is serviceable in some forms of leucorrhoea.
By blunting peripheral sensibility it allays the itching of eczema, and locally applied (diluted) is serviceable in prurigo. Delirium tremens, mania, and paralysis have been treated successfully with this drug. It has also been employed to some extent as a mydriatic in eye practice. Prof. King derived considerable advantage from gelsemium in conjunctivitis, muscular asthenopia, iritis, and in tinnitus aurium, administered in small doses every 3 or 4 hours; being extremely careful not to carry the influence of the agent to depression or relaxation. Dr. J. Parrish, of Philadelphia, derived the greatest benefit from the administration of this drug, in cases of habitual drunkards and opium eaters. Gastro-intestinal irritation and irritative dyspepsia, with feeling of rawness, heat, and pain, with a sensation of knotty contraction in the stomach, call for gelsemium. In the exanthemata this remedy is often indicated by the great beat and restlessness. It is nearly always called for in cerebro-spinal meningitis. In the recent epidemics of influenza (la grippe) probably no one remedy was more extensively used, or oftener indicated. Where there were persistent high temperature and headache, with great excitability, it acted promptly and kindly. Gelsemium has been used quite extensively in whooping-cough, spasmodic cough, spasm of the glottis, asthma, and the cough of hysteria. In excessive action of the heart, especially in hysterial subjects, it is often serviceable. Gelsemium has also proved beneficial in vertigo, hemorrhages, ague-cake, gout and rheumatism, in the latter disease aiding some of the antirheumatic remedies. Bronchitis, laryngitis and albuminuria have also been successfully treated with gelsemium. Externally, gelsemium will be found of service in neuralgic and rheumatic pains. The usual prescription is from 5 to 15 drops of specific gelsemium in 4 ounces of water. Dose, a teaspoonful. For the larger doses begin with 1 drop, and administer cautiously until the physiological effects are apparent. Dose of specific gelsemium, 1/10 drop to 10 drops.
Specific Indications and Uses.—Gelsemium is indicated by bright eyes, contracted pupils, flushed face, great beat, and restlessness; mental irritability; insomnia, with excitation; pain over the whole head; dysuria, with scanty secretion of urine; irritation of the urinary tract; pinched, contracted tissues; thin, dry, unyielding os uteri, with dry vaginal walls; arterial throbbing and exalted sensibility; chilly sensations upon motion; hyperemia; and convulsions.