Gelsemium in Obstetric Practice.
By J. L. FURBER, M. D., Appanoose, Kan.
Whenever and wherever in the human body I need a relaxant of muscular fibre, and a relaxing antispasmodic, unless the drug is contra-indicated by some disease or idiosyncrasy of the patient, my main reliance is upon tincture of gelseminum. (Gelsemium sempervirens tincture) I prefer the tincture obtained from the green root as is done by Wm. L. Merrell & Co. (Later to become Lloyd Brothers) In my thirty years' use of it I have invariably found that preparation trustworthy while other brands were sometimes worthless.
When I was a boy in New England we used to make a ball that would rebound by taking an ivory marble and winding tightly over it an inch or more of well-stretched fibres of India rubber, cut from one of my mother's old shoes, then a half-inch of woolen yarn, and the whole enveloped with firm, soft calf-skin. I sometimes see a girl that appears to be constructed in a similar manner; she has an elastic bone, thickly covered by a flexible muscle, a half inch or so of fat over that and the whole enveloped in a firm soft skin. Such a one bounds gaily along through her girlhood, and also about her household duties after she has become a wife, and when in labor with her first child bounds more than ever. Prof. A. J. Howe described such a one last year, in the American Medical Journal, that came near bounding out of the room with his forceps, himself, two or three assistants who were trying to hold her, and the bed on which she was lying.
The year 1875 will long be remembered in these parts for the difficult labors in child-birth. I attributed them to electrical disturbances in the atmosphere. We had severe electric storms, beginning in January and continuing through the entire year; the electricity displaying itself close to the ground, and several persons being killed by lightning. I attended more than sixty cases of child-birth that year, some of which were the patients of other physicians who sought my assistance. There was but one case of cephalic presentation in the first position; that is to say: with the crown of the occiput to the left acetabulum. In the majority of the cases the verlex presented to the right acetabulum making the second position. I attended eighteen cases of shoulder-presentation that year—more than I have ever attended aside from that year in a quarter of a century's experience. Let me relate several incidents:
I.—In the month of March Dr. J. G. Wharton, an intelligent and experienced physician, some years my senior, sent a messenger on a fleet horse a distance of seven miles, with a request to me to come as soon as possible and bring my instruments, in order to help him in a bad case of protracted labor. On reaching the house my first question to Dr. W. was: "what presentation have you?" "Right occipital; the crown of the occiput to the right acetabulum," was his answer. On entering the lying-in room I found two excellent midwives assisting. The Dr. was himself nearly worn out. I perceived that his patient was one of the rubber-ball kind; about twenty years old, very vigorous. This was the first child and she had been in constant labor for about twenty-four hours; the waters having passed off early. The head had been for the last twelve hours fast locked in the upper strait. The bearing-down pains had been incessant, and were now rapidly exhausting her strength and courage. I remarked to Dr. W. that I could deliver her without instruments. I then administered one hundred drops of tincture of Gelseminum, repeating the dose within thirty minutes. She was safely delivered, without instruments, in two hours, of a bouncing girl-baby weighing eleven pounds, that could out-yell her mother. The patient was up within a week.
II.—In the month of March my wife, after a protracted pregnancy of ten months and four days' duration, was suddenly taken in labor with twin boys. When I came to her bedside she was flooding terribly, with the right hand of a child presenting at the vulva. The case was one of a right-shoulder presentation. Immediately I gave her a teaspoonful of tincture of Gelseminum to relax the muscular fibres of the womb, I next pushed up the intruding arm, turned the infant and brought down the feet and delivered it. As I was disengaging the umbilical cord from his neck to prevent suffocation, the second child was by the contractions of the womb forced in a doubled position, back first, through the upper strait into the cavity of the pelvis, and had to be delivered in that position. Both children were attached to one placenta. A tablespoonful of the fluid extract of ergot was now administered to the patient; the uterus contracted firmly and the danger was over. The mother and children did well.
III.—In that same month of March a gentleman rode on the cars six miles to my house, and desired my professional service. His brother's wife, then at the sixth month of her second pregnancy, was flooding to death with a premature labor. Riding my horse at full speed for four miles I met the husband. It was two miles from his house and he had brought a fresh horse for me. I was soon at the bedside of the patient. A hasty examination showed the case to be one of placenta previa. The os uteri opened not larger than a quarter of a dollar. The dilatation was slowly detaching the placenta, causing a hemorrhage that was certain to result fatally unless arrested. The patient was a Christian lady of sublime courage. Though greatly weakened by loss of blood she promised to try to live. I began by soaking a little cloth in one once of tincture of Gelseminum and inserting it in the vagina against the womb; and also administering a large tablespoonful by the mouth. The os uteri was sufficiently dilated in five minutes for me to introduce my fingers far enough to push aside one edge of the placenta. The right shoulder was presenting. I pushed the arm back and delivered by the feet. It was a six months' child, barely alive, and died nine hours afterward. After the placenta had been removed I administered fluid extract of ergot, as in the preceding case, in order to promote uterine contractions. The mother recovered promptly.
IV.—This patient was a strong, vigorous Irish woman, whose husband had been killed by lightning. She was taken in labor in the month of April, and continued for a whole week. Three good midwives and a host of other women rendered her their services but were unable to relieve her. In her five previous labors she had succeeded nicely with the help of a midwife, and she positively refused a physician. At the end of a week of constant labor, one of the midwives came to me. The pains she declared all seemed to be pains of contraction of the further extremity of the womb, and that the mouth had not dilated at all during the labor. At her request I went with her to her own residence, one mile distant from the home of the patient, so as to be within reach if needed. The course pursued was the same as already described. I told her to give the patient a tablespoonful of tincture of Gelseminum at one dose, and to repeat it within one hour, unless the mouth of the womb opened. Within thirty minutes after the first dose was swallowed, the feet of the child presented at the vulva to the great surprise of the individuals present. One of the ladies rode a horse rapidly over to the house where I was to ask what to do.
"Catch hold of the feet and pull the child out," was my reply.
They did so and the labor was over. No other medicine was given the mother and the mother made a good recovery.
V.—In the month of August a young farmer living four miles from my residence called me to attend his wife. She was one of the rubber-ball kind, reared on a farm. She in her girlhood had often driven a four-horse reaper in the harvest-field. She was now in labor with her first child. just as we were setting out a messenger came to me from Dr. Wharton, requesting my services to help him in a bad case ten miles distant in another direction. It was now three o'clock in the afternoon. I promised to go to him by midnight if possible. I found the patient at the farmer's house in labor that had begun with rupture of the waters twenty-four hours before, and had continued wrong-end first ever since. I mean that there were repeated contractions of the fundus of the womb, but no dilating pains whatever. Finding the os uteri as tightly closed as though by a gutta percha string, I at once made the patient swallow a teaspoonful of tincture of Gelseminum to quiet the spasmodic pains of contraction. An ounce of the tincture was applied by a soft linen cloth to the mouth of the uterus. The sphincter muscles of the womb were soon relaxed, enabling an exploration by the hand. The right shoulder was presenting. The head of the infant was pressed up, the feet brought down, and the patient delivered of a bouncing boy within two hours from the time of my arrival.
Unfortunately, this patient took cold in a storm a few days afterwards, and had a violent attack of puerperal fever. It was subdued, however, within five days, by Norwood's tincture of Veratrum viride. I always employ this preparation in inflammations of serous membranes and erysipelas. A week after I had dismissed the case the patient, thinking that her bowels were not loose enough, swallowed six of Ayer's cathartic pills. I had expressly forbidden any such thing. The pills had probably been made for several years and were as hard as gravelstones. She repeated the dose every six hours till twenty-four pills had been taken. No catharsis ensued, however, but a violent inflammation was induced.
I was again summoned. The abdomen was enormously distended, and the bowels angulated, as I thought, in three places. The lower stoppage was relieved by injections of tincture of Gelseminum and chloroform combined, so that some of the contents of the small bowels from near the ileococcal region passed away by the rectum. The upper angulation, was relieved by spirits of camphor, chloroform, and tincture of Gelseminum, given in chicken oil, by the stomach. The fecal matter passed up through the stomach and out the mouth. The mass in the middle could not be reached in time to prevent mortification, and the patient died.
VI. This seventh patient, a tough old maid, hard as a burr-oak fence-rail, aged forty-four, had married a preacher. I was called to attend her in her first confinement. She lived ten miles from my house, and the day was just breaking when I arrived on the ground. I was told by the women in attendance that she had been in labor two nights and a day, without any progress that they could discover. She was not one of the rubber-ball kind. Single life unnaturally prolonged had made her muscles rigid and her disposition frigid. Examination showed the os uteri not dilated at all, and as hard as sole-leather. I applied a cloth, as before, wet with tincture of Gelseminum and made the patient swallow a tablespoonful. Thirty minutes afterward I introduced my hand and found the left shoulder presenting. I managed, however, to press up the body and bring down the head into the second position. Two hours of hard work were successful to deliver her of a girl baby without instruments.
VII.—One terrible cold night in December of that year, a farmer routed me up at one o'clock, to attend his wife. She had been taken in labor at noon the day before, and was supposed to be getting along well, though slowly for her. At nine o'clock, P. M., however, the left hand of the child protruded from the vulva greatly swollen. A rapid horseback ride of ten miles across a bleak prairie, facing a gale from the northeast, brought us to the place. I found the patient to be a vigorous woman, of the rubber-ball kind, in labor with her ninth child. The first labor she had been delivered by forceps by a surgeon in Chicago. At her seven subsequent labors here in Kansas, however, she got along without any trouble, under the charge of a midwife, who was now attending her. It was now two o'clock in the morning. The bearing-down pains were incessant, and the patient was nearly worn out. I saw at once that the child was dead, but I did not tell any one. The womb was contracted down upon it like a rubber-bag. I immediately gave the patient as I had the others a tablespoonful of tincture of Gelseminum, repeating the dose in thirty minutes. An hour later I succeeded in pushing up the arm, turning the infant, bringing down the feet and delivering without instruments. It was a very large female child, dead and enormously swollen. The mother recovered promptly.
In that form of painful dysmenorrhea caused by contraction of the muscular fibres of the womb, I have made application of a teaspoonful of tincture of Gelseminum on a little roll of soft linen, per vaginam to relax the sphincter muscles of the mouth and neck of the womb; and prescribed a teaspoonful of the same at bedtime. If the pain is very severe, it may be profitably combined with a teaspoonful of fluid extract of Jamaica dogwood. This treatment has given more relief to my suffering patients than anything else that I have ever tried.
Transactions of the National Eclectic Medical Association, Vol. X, 1882-83, edited by Alexander Wilder.