Gelsemium, Gelsemium sempervirens.
- Gelsemine, Gelsemic Acid, Gelseminine, Volatile Oil, Gum, Starch, Resin.
- Extractum Gelsemii Fluidum, Fluid Extract of Gelsemium. Dose, from one-half to ten minims.
- Tinctura Gelsemii, Tincture of Gelsimium. Macerate and percolate with dilute alcohol. Dose, from five to thirty minims.
- Specific Medicine Gelsemium. Dose, from one-third to ten minims, prescribed, ten minims to five drachms in four ounces of water. Teaspoonful every half hour to two hours.
Administration—Gelsemium is a prompt remedy if given in sufficiently active dosage. The excellent results obtained by the older physicians were obtained from full doses. Children are more susceptible to its action than adults, and with them the smaller dosage is applicable. In spasms the maximum dose is needed. If toxic effects are obtained, they can be readily observed and antagonized with no harm to the patient.
Gelsemium is quickly eliminated from the system, largely through the kidneys, consequently the effects of single doses are quickly dissipated, and medicinal doses must thus be given frequently, especially in childhood, to insure good results. Single full doses should be given only to adults.
The remedy can be given in single doses of from fifteen to twenty minims, but any dose of three drops or more must be watched for physiological effects, and diminished when these appear.
Physiological Action—Usually upon the administration of an overdose of this agent there is at first some excitement, followed by depression of the nervous system, with dizziness, amblyopia, double vision, dilated pupils, exophthalmos, complete prostration, with drooping of the, upper eyelids from paralysis of the levator palpebrae superioris and inability to keep the jaw closed. The temperature is reduced, the force and frequency of the pulse is lowered, with dyspnea, the breathing being accomplished with much effort, and death usually results from paralysis of the respiratory muscles, including the diaphragm. The influence appears to be exercised upon the base of the brain, on the brain, on the splanchnic nerves and on the spinal cord. It inhibits the nerve force of all the visceral organs and relaxes the sphincters. Convulsions are one of the results of poisonous doses in animals. In man, while there is loss of sensation and motion, the patient is conscious of what is going on around him, unless the symptoms are prolonged, when deficient oxygenation of the blood, with accumulation of carbonic acid, will produce coma.
In experiments made upon pigeons the effects are very similar to those resulting from destruction of a portion of the cerebellum. There are irregular backward movements, tremblings, flutterings of the wings, preceding complete paralysis.
Gelsemium in lethal doses paralyzes the nerves, both sensory and motor. The motor nerves are first influenced, the paralysis of sensation more slowly following. The writer observed a case of poisoning where the patient had taken sixty minims of the fluid extract within forty-five minutes. A sensation of general oppression occurred rather suddenly. The patient rose to her feet, noticed that vision had failed almost completely, walked two or three steps, then fell in a mass upon the floor in a state of complete muscular relaxation. There was no alarm or fear, a rather tranquil feeling mentally, and in this case there was no great difficulty of breathing, although we have observed dyspnea from single doses of two or three minims of the fluid extract. The recovery of this patient was rapid, although muscular weakness was present for several days.
The primary influence of gelsemium—that which probably always underlies its remedial influence upon any condition—should be borne steadily in mind in its administration. Its direct action is upon the central nervous system. It diminishes the blood supply of the brain and spinal cord by lessening nerve power, inhibiting the nerve control, slowing, retarding or staying the functional action of the nerve centers over the nerves themselves, influencing them steadily in the line of their physiological activities. It thus subdues all forms of nerve excitation of whatever character, or wherever located. It inhibits excessive nerve action. Nerve irritation, whether direct or reflex, comes uniformly under its influence.
There must be, then, increased nerve tension, with its consequent irritation, and usually, local hyperemia or increased and undue blood supply in sthenic conditions. It is not the remedy when asthenia prevails.
It may be well to introduce a caution which is most important, if good results be secured from the action of this remedy. Gelsemium, more than perhaps any other of our agents, suffers from the fact that the market may be supplied by worthless preparations of the remedy. Any fluid extract or tincture made from the dried drug does not contain the full virtues of the plant, and if the drug has been long gathered will be almost inert. The green root should be gathered in the early spring, and its medicinal virtues should be immediately extracted. The green root fluid extracts, normal tinctures, and the specific medicine gelsemium represents the fullest possible virtues of the drug. Further. more, fluid preparations alone, of gelsemium, are prescribed by our physicians, as clinical experience has conclusively demonstrated to us that the alkaloid gelsemin does not contain the full virtues of the drug.
Specific Symptomatology—The characteristic syndrome which demands the administration of gelsemium is found in acute determination of blood to the brain—acute cerebral hyperaemia— manifested by a bright flush upon the face, bright eyes with contracted pupils, with a busy restlessness and excitability. With these there is a high degree of nerve tension and consequent irritation, with increased heat of the head and face. There is present in acute cases, elevated temperature, hot skin, usually dry, a sharp and quick pulse, but not always hard. Given in sufficient doses it slows the heart's action, reduces the temperature and quiets the respiration, speedily producing a restful sense of tranquility.
Increased arterial and nervous tension and local or general irritation present in many cases of local inflammation, especially of the kidneys, are specifically met by this agent.
Therapy—In the acute fevers of childhood, some evidences of nerve irritation are seldom absent. Here the agent exercises its happiest influence. Muscular twitchings with the above specific symptoms demand this remedy. If spasms supervene, the dose is increased in size and frequency until they are controlled. Often no other agent need be given.
The direct contra-indication is congestion, either of the nerve centers alone, or of any organ. The phenomena of dullness, hebetude, obstructed circulation, whether local or general, with normal or lowering temperature, with increasing weakness—asthenia—must be treated with the antitheses of gelsemium.
In acute inflammation of whatever organ or part, there is likely to be a time during its early course when gelsemium is the positively indicated remedy. Its administration should cease when its indications are no longer apparent.
In acute inflammations, especially those of childhood, or in persistent fevers, where reflex irritation threatens to induce convulsions, other fever remedies should usually be suspended for this until all irritation has abated, or until its beneficial action is no longer conspicuously apparent. If its physiological effects appear at any time during prolonged or protracted fever or inflammation, it should be suspended temporarily, or permanently, within the judgment of the prescriber, as its full physiological influence persisted in may impair nerve tonicity, and general tonicity of the muscular system, or of the heart, to such a degree as to retard recovery, or at least to prolong convalescence.
Fevers of nearly all kinds in adults, in the early and sthenic stage, are influenced by gelsemium, because the above conditions to some degree may be a part of the pathology of increased temperature.
The late Mr. Adolphus claimed that gelsemium exercised its first influence upon the heat centers in the cord and medulla. He always gave gelsemium for its influence here, in cerebro-spinal meningitis. It's indications were the bright eyes, contracted pupils, the patient inclined to crowd the back of the head in the pillow. His results were highly pleasing. Recent reports in the treatment of cerebro-spinal meningitis in children are proving that gelsemium given in conjunction with echinacea is proving to be the very best treatment. The results from a large number of observers is very convincing. Where the opisthotonos is extreme, they give both this and lobelia—in some cases hypodermically. The relaxation is definitely induced by this method, and the spasms controlled. The use of these remedies in this disease is very rational.
In acute cerebral, spinal, cerebro-spinal, or meningeal inflammations, its symptomatology is usually strongly marked at first. If in adults, it may be given at first in pronounced doses, lessened as the symptoms abate or as its physiological action appears. In later stages of these disorders the dosage should be much smaller, or some remedy more directly indicated should be substituted. It should not usually be continued beyond the sthenic stage.
There are some forms of nervous wakefulness in which no better soporific can be given than this agent. Begun early in the evening, a few full doses will produce tranquillity and restful repose. If there be busy excitability and extreme restlessness, its influence will be greatly enhanced by combination with hyoscyamus. Nervous headache, which drives away sleep, can often be removed and sleep satisfactorily induced with this remedy. The nervous system is in part restored during sleep so induced, and the patient is rested.
In nervous excitation of women consequent upon acute peritonitis, ovaritis, salpingitis, metritis, puerperal fever, or mastitis, this agent has no peer. It is especially commended in the early stages, and if hysterical phenomena develop. Given in the early stages in pronounced, but carefully watched dosage, it will occasionally abort the entire condition, especially if the cause has been removed by proper methods. Extreme full doses are sometimes admissible at first.
In puerperal convulsions this agent has a conspicuous place. If given in accord with its exact symptomatology, in sufficiently large, often heroic doses, but it must be exactly given. The symptomatology of veratrum is more often present than that of this agent in eclampsia or the two may be combined.
In intestinal inflammation it has not seemed to me to be often indicated for the actual fever, and yet the reflex nerve phenomena, especially of children, often quickly demand it. It controls nervous or spasmodic pain in these conditions, and I have found it of great service in appendicitis. It seems to retard the inflammatory processes. It is of great advantage in the tenesmus of dysentery, sometimes allaying this troublesome symptom in a single full dose. Usually several frequent, pronounced doses are demanded.
In inflammation within the chest I have not used the agent as often as bryonia and aconite. Others speak highly of it, and there are conditions when the demands for them are too plain to be ignored. Certain forms of asthma are relieved by it quite promptly. Others have had good results from its influence in whooping cough and in laryngismus stridulus. It controls certain forms of spasmodic cough and cough from reflex irritation.
Dr. Bugg, of Georgia, reported a case of hiccough which developed with a severe bronchial cough from a cold. It had continued without cessation for forty-eight hours until the patient was in a condition of exhaustion. The doctor gave him—a previously strong negro—fifteen drops of gelsemium, because his eyes were "very bright and the pupils contracted to pin heads." This medicine was repeated until the spasm was relieved.
In acute cold, the whole system is influenced by it, the coryza being marked and all the usual symptoms pronounced. Gelsemium given in two or three drop doses, every half hour for a few doses, will often give relief most promptly and satisfactorily. In epidemic influenza it has been generally used with signal results in nearly all cases.
In acute nephritis it is certainly a sovereign remedy. It at first meets a wide range of the symptoms in a pronounced manner. It reduces the arterial tension, often at once, and consequently the quantity of albumin. It exercises a permanent, soothing influence upon nerves of the entire urinary apparatus in a most satisfactory manner. The quantity of urine is increased, the general nervous phenomena are delayed, the fever abates, and any pain or spasms are controlled. My practice has been to give cimicifuga with the gelsemium in acute nephritis from cold, but I am positive the beneficial influence could not be obtained without gelsemium .
In post diphtheritic or post scarlatinal nephritis it controls any undue irritation, but belladonna acts upon the actual condition more satisfactorily than gelsemium. In post puerperal nephritis, I should certainly fail of a cure without this agent. In three very bad cases I gave gelsemium in full, large doses with the best results. It anticipates the uremic symptoms, preserves tranquility of the nervous system, and wards off the otherwise almost inevitable convulsions. It is of especial service in the spasmodic retention of urine of hysterical women, or in acute urinary irritation.
Spasmodic pain in the urinary organs has no more reliable antidote than gelsemium. Spasmodic pain in the bladder, or in the cystic sphincter, is controlled quickly, and acute cystitis should be treated with gelsemium from the first. The soothing influence of the agent upon the entire nerve distribution of these organs is soon evident. In spasmodic urethral stricture, where pain is excruciating and nothing but a catheter will apparently do any good, gelsemium in full doses is often all sufficient. I have had two marked cases where the catheter could not be passed, in one case, even under chloroform, where full repeated doses of gelsemium relieved the irritation and retention within two hours. I give from two to five drops of the Specific Medicine every twenty or thirty minutes, even if mild physiological symptoms appear. In the tenesmus of chronic catarrhal cystitis, it is excellent.
In Gonorrhoea, in the acute stages, it is a very prompt remedy, especially if used in conjunction with irrigation of the urethra. This remedy alone will often produce much relief in twenty-four hours. Where there is much excitement with chordee no remedy is more prompt.
Spasmodic types of ovarian neuralgia and neuralgic dysmenorrhea are controlled with gelsemium. It relieves uterine colic and exercises a satisfactory influence in many cases as an emmenagogue, where nervous excitability is present.
In vomiting of pregnancy, Dr. Henderson has given ten drops of gelsemium hypodermically in extreme cases, controlling the vomiting when the physiological influence appeared. Caution is necessary, especially in asthenic cases.
In confinement it dilates a rigid os uteri, especially when the parts are dry and hot, and the edges of the os are hard, thin and unyielding, where nervous excitability is present. It soothes the general nervous system at this time, overcomes erratic, sharp, cutting, nagging pains, that seem to be of no benefit, preserves the integrity of the nerve force, and if the pains are exaggerated, and the labor does not advance, the labor is sometimes satisfactorily suspended or retarded until all parts are ready for the expulsive effort.
It is a most soothing remedy after labor, relieving nervous excitability preventing or controlling after pains, but I do not consider it a proper or safe remedy with which to control these pains, as I am confident that its influence upon the normal muscular contractility of the uterine fibre, causes relaxation, permits uterine hemorrhage, and retards normal involution. Dr. Broadnax made this observation also.
It is a valuable remedy for hysteria. It is combined with pulsatilla to advantage in young girls. In pregnant women with frequently recurring paroxysms, cimicifuga, in small doses, will facilitate its action, as will viburnum or aletris.
Bloyer says "if the use of gelsemium be extended to those parts of the organism involving unstriped muscular fiber, we will find that it acts directly upon this class of muscles. These occur in the liver and its ducts; in the kidneys and the ureter, the bladder and the urethra, as we find also, on the womb and ovaries and in the heart. Upon the. pelvic organs, especially if used with pulsatilla, viburnum, helonias, or cimicifuga, its influence is satisfactory. It certainly conduces to the relief of high tension."
In diseases of the nervous system of a chronic character, the influence of gelsemium is beneficial, but not so pronounced. In excitable mania it exercises a controlling influence, and if sleeplessness be present its influence is enhanced by combination with hyoscyamus. It has exercised a beneficial influence in epilepsy, especially in those cases where acute cerebral hyperiemia is present.
This agent has its place in chorea, but only when its specific indications are present, not in those cases characterized by anemia.
In the treatment of facial neuralgia, especially of the fifth pair, its influence is pronounced. It should be used hypodermically over the sciatic nerves in the treatment of sciatica. It controls headaches from cerebral engorgement with nervous irritability and excitability.
It is a serviceable remedy for migraine and tic douloureux. In persistent stitchlike pains, in the deep muscles of the back, which often completely incapacitate a man for work of any kind, full doses, just short of its apparent physiological action, will act in a most specific manner.
In rheumatic stiffness of the muscles of the neck, often accompanied with sharp pain, this agent should be freely given. In acute rheumatism and in rheumatic fever it is often sharply indicated. Given in connection with aconite, bryonia or rhus tox, as these are indicated, no better treatment can be instituted.
I consider gelsemium a most important heart remedy. The cases are those of rapid heart from over excitability; from irritability, with exaltation of nerve force, but where the patient is in full strength. No other remedy need be given in some of these cases. It relieves palpitation so induced and cures cardiac neuralgia. It is especially useful in the irritable heart of hysteria, influencing the entire train of symptoms at once. It is contra-indicated in weak heart, and where there are valvular lesions of any considerable character.
In seasickness specific gelsemium has been used with marked success. A teaspoonful of a mixture of thirty drops in four ounces of water is taken at the time of sailing, and repeated hourly the first day. Afterward it is taken less frequently. In this connection, be it said, in sea-sickness the remedy that cures one person may fail in another, and it is not to be expected that gelsemium will affect all alike.
I am inclined to the belief that in the South, its natural habitat, the conditions assumed by acute disease are more directly and specifically influenced by gelsemium than in the colder climates. Perhaps those factors of disease in which gelsemium is specifically indicated are more frequently induced or increased by the climatic influences of that locality. At least, our physicians in the South, who use the remedy to any extent, use it much more freely, and seem to find its indications present more often than we do in the North.
Recently a number of observations have been made on the action of gelsemium in epilepsy. One writer used it with veratrum in his cases, and has had unusually good results. He endeavors to anticipate the spasms, whenever possible, and gives the remedies in combination between times.
Many physicians have treated stage fright, or fear in meeting the public, or of students in fear of examinations, and have abolished it entirely with five drop doses of gelsemium, repeated two or three times, according to the susceptibility of the patient. Aconite also acts well here, but in smaller doses.
In the treatment of tetanus, Dr. Lewis of Illinois prevented the development of three cases, with echinacea for the toxemia, and gelsemium and passiflora for the spasms, used by the mouth and hypodermically. Dr. Matthew combined twenty drops each of gelsemium, phenol, and water as a hypodermic injection. In twelve cases he injected this entire quantity every three to six hours, saving all the patients. This combination has been subsequently used with much success. In 1880 Dr. J. Marion Sims gave gelsemium for tetanus and produced very satisfactory cures. He gave forty minims of the tincture every hour or two, reducing it to twenty minims, as the convulsions decreased and continuing this to full convalescence. In the tetanus of horses, it has been frequently used, hypodermically, by veterinarians throughout America. They claim that it cures many cases.
Dr. Smith, of Leesburg, Florida, told me that in the malarial disorders which prevail in his locality he found indications for its use in nearly all acute cases and almost invariably obtained prompt and satisfactory results. He has occasion to prescribe larger quantities of it than of all other fever and sedative remedies combined. Dr. Wm. M. Durham, of Atlanta, Georgia, and several other physicians of the South confirmed Dr. Smith's opinion as to the frequency of the occurrence of its indications.
All these physicians unite in the opinion that gelsemium quickly brings about that condition in periodical malarial disorders in which the antiperiodic, quinine, can exercise its happiest influence. It restores secretion, softens and slows the pulse, reduces nerve excitation and irritation, causes a mild transpiration from the skin, and assists in cleaning the tongue. All these conditions must be present if quinine be given to marked advantage and with no unpleasant results.
These physicians claim further, that given during the time of the administration of quinine, it prevents undue stimulation of a sensitive nervous system, does away entirely in most cases with the tinnitus aurium, and other unpleasant phenomena, and enhances the influence of the quinine in all lines of its action, the desired effect being obtainable by a less quantity of this antiperiodic than would otherwise be required. These suggestions are no doubt applicable in other localities to a degree.
I have heard physicians say that they believed there were times or seasons when gelsemium influenced their patients with the same indications much more directly and positively than at other times. Perhaps this is in line with the theory of "epidemic remedial influence" or "epidemic remedial conditions" advanced by Rademacher and referred to by Scudder and other writers.
Co-operative Agents: Cimicifuga racemosa is an excellent remedy with which to combine gelsemium where the muscular system is involved. It promotes the action of gelsemium in all heart troubles, and in irritable and inflammatory conditions of the entire urinary tract. Opium intensifies the effects of this agent, but is slower in its action and its effects are not so quickly dissipated. They are not often prescribed together by those who are familiar with the action of gelsemium.
Lobelia and this agent will be found to act well together in certain selected cases; in severe convulsive manifestations especially. When morphine is given for relief of pain during powerful spasms, it acts as an antispasmodic. Gelsemium combined with it when indicated will be found to exercise all of its influence and control the pain which would otherwise continue, and thus prevent the antispasmodic effects of the remedy to an extent. Dr. Owen of Texas dissolves one grain of morphine in 240 grains of specific gelsemium. He gives this for premature labor pains in doses of from ten to fifteen drops, and in other conditions where both remedies are indicated, he gives from ten to twenty drops, as in severe persistent lumbago, sometimes with immediate results.
Other agents which act harmoniously with it to a greater or less extent are passiflora incarnata, the bromides, and chloral hydrate, conium maculatum, physostigma, veratrum, and Jamaica dogwood. It works nicely in fevers in careful combination with aconite.
Antagonists—This agent is antagonized by alcohol, by strychnine, nux vomica, digitalis, ammonia and, to a certain extent, by caffeine and belladonna.
Antidotes—In overdoses, heat applied, with electricity, and alcoholic stimulants, friction, artificial respiration, and hypodermics of atropine or strychnine should be administered. Strong coffee and the physiological salt solution are active antidotes also.
The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.