Gelsemium sempervirens. Yellow Jessamine N.O.Loganiaceae.
GELSEMIUM contains a mixture of two or more alkaloids known as gelseminine, which is the active principle of the drug. It acts powerfully on the motor nervous system, both voluntary and involuntary, congesting it and causing depression of nervous function, ultimately going on to paralysis. Death is brought about by gradual depression of the respiratory centre, resulting in asphyxia, and in mammals this occurs before paralysis of the motor nerves is complete. It paralyses the inhibitory cardiac fibres and the chorda tympani through acting on the ganglionic nerve fibres in their course and not on their extreme terminations as is the case with atropine. Locally applied in solution to the eye it causes complete paralysis of accommodation and wide dilatation of the pupils. Taken internally it may at first cause contraction of the pupils, dilatation comes on at an advanced stage. Diplopia is produced by paralysis of the recti, especially the external recti.
Mind-Gelsemium produced in the provers extreme relaxation and prostration of the whole muscular system and also of the intellectual faculties; a certain amount of erethism precedes or accompanies the prostration in both instances. The mind is dull and stupid, disinclined for conversation and averse from study. The patient is melancholy and desponding but at the same time irritable and impatient, he desires to be quiet and does not wish to speak or to be spoken to, yet does not like to be left alone, as he is afraid that he will lose his self-control. He is apprehensive, and the emotions are easily stirred and when this happens physical ailments follow, as for example the approach of a thunderstorm or the anticipation of having to pass through any usual ordeal with bring on enuresis or uncontrollable diarrhoea; a child starts, his chin quivers; he grasps the nurse and screams as if afraid of falling. The melancholy mood may cause an inclination to commit suicide, the form of which tends to be to throw himself from a height or to jump out of the window. In some cases there has been violent delirium, but as a rule the mind remains clear. Gelsemium causes giddiness, which begins in the occiput and spreads over the whole head: it is accompanied by blurred vision and is increased by sudden movement and by walking.
Nervous system-The prostration of the motor nervous system caused by gelsemium is manifested by weakness and trembling,by the ease with which the patient gets tired, by general languor and disinclination to move, and in bad cases by the inability to do so. Gelsemium produces nervous sensations and shiverings that run all over the body down to the to the fingers and toes and are especially apt to be brought on by emotions. The patient trembles and wants to be held so that he may not shake. There is want of power to make the muscles obey the will and,if there is not paralysis, there will be inco-ordination. Paralysis, there will be inco-ordination. Paralyses are seen in the muscles of the eyes, the tongue, throat, larynx, limbs, especially the lower limbs, and the sphincters. Convulsions may occur in the extremities and cramps in the fingers and toes and in the muscles of the back. rigidity of the muscles of the back of the neck and retraction of the head are common symptoms. The muscles feel bruised, aching occurs under the left shoulder-blade;dull, deep- seated muscular pains are present in the extremities and sometimes, though more rarely, paroxysmal shooting pains. Sudden, acute dartings may run along single nerve trunks in any part of the body. There are heaviness and a sensation of weight in the limbs. Numbness of the extremities, nose, ears, tongue, gingers, hands and feet are produced by gelsemium.
Head-The headaches caused by gelsemium are congestive or neuralgic, more often the former. The head feels heavy,. with a sensation of weight and pressure in it. There is a settled, dull, dragging pain, mainly in the occipital and mastoid regions, which extends to the occipital and mastoid regions, which extends to the upper part of the neck and down to the shoulders. It is worse lying flat and is relieved by sitting still with the head reclined on a high pillow, it passes off with a copious flow of pale, watery urine. an icy-cold spot may be felt on the back of the head. Another type of headache is as if a band were tied tightly round the head above the root of the nose and above the eyes: it is a dull, heavy pain and is associated with giddiness and blurring of sight.
Face and Eyes-The patient has a heavy, sleepy look, his face is flushed, of dark colour and besotted expression, the upper eyelids fall; and and can with difficulty be kept open, there may be complete ptosis. The extrinsic and intrinsic muscles of the eyeballs are weak or paralysed, leading to diplopia, nystagmus, loss o accommodation and sometimes dilatation of pupils (always dilated from local application). The external rectus is more affected than the others, so that there is internal strabismus.
Digestive system-The tongue is coated with a yellowish white fur, feels thick and stiff and may be paralysed. It trembles when protruded. a numb pain may be felt along the teeth and the edges of the gums in the upper jaw. There is difficulty or impossibility of swallowing from paralysis of the pharyngeal muscles, and from this cause food may get into the trachea and cause choking. A painful sensation is often felt in the oesophagus, as of a sore lump there. Hiccup and eructation of semi-solid matters occur. In the stomach is a sensation of emptiness and weakness, as if something is wanting (ign., sep) or a violent cramping pain is felt in the epigastrium, followed by heat and burning in the stomach. Rumbling and rolling, with emission of flatus upwards and down wards, with various pains, are observed in the abdomen, chiefly in the transverse colon and left side. The stools are loose or diarrhoeic, of bilious character, deep yellow and their evacuation relieves abdominal pain. In patients under the influence of gelsemium, diarrhoea is caused by exciting news or other emotion.
Respiratory-sneezing and watery discharge from the nose and a pain at the bridge, extending to the eyes, a weak voice, stitches in the chest and dyspnoea with precordial oppression are the principal respiratory symptoms caused by gelsemium which,though it caused death through paralysis of the respiratory centres, producers no inflammation of the lungs.
Circulatory-The pulse is frequent, soft and weak, sometimes irregular, or slow and full; there may be palpitation. There is a sensation as if the heart will stop beating unless the patient moves about.
Urinary-Gelsemium causes frequent micturition with increased flow of clear, watery urine, “nervous” urine. Paralysis of the bladder occurred in some cases of poisoning accompanied by constant dribbling from over flow. Incontinence may take place from paralysis of flow. Incontinence may take place from paralysis of the sphincter vesicae. In urinating the stream may be intermittent with a constant feeling as if something remained behind. the urinary phenomena arise from the condition of the nervous system, there is no organic affection of the kidneys or bladder.
Sexual-The male sexual organs, again,l illustrate the nervous prostration of gelsemium in th importance produced by it and the involuntary emission of semen without erections. In women severe, labour-like pains occur in the uterine region, extending to the back and hips (actaea).
Fevers,&c-the drug causes a true fever with a temperature that may reach 102 degree F. or more. The chill begins in the hands and feet and runs up the back,it come on with a sense of fatigue every afternoon at 4 to 5 o’ clock. With cold extremities there is heat of the head and face. In the feverish stage there is great drowsiness and prostration. Sweats are profuse and exhausting.
Sleep-Though the patient is drowsy he cannot compose his mind to sleep and is restless, especially in the latter part of the night. Excitement will easily keep him awake. In febrile conditions sleep is usually profound and may be comatose.
Skin-The skin itches and there is an eruption like measles in colour but the spots are larger and more discrete, more like rubella.
Nervous-Gelsemium has not been shown to produce any organic changes in the brain or spinal cord, its effects are functional and it is for functional disorders and paralyses of the nerves that it has obtained its reputation as a remedy in nervous complaints. It is useful in functional paralyses of all descriptions. It will be sufficient to enumerate some of them: (1) cases left behind from fevers, such as enteric: (2) Postdiphtherial-paralysis of eye, tongue, throat, larynx, limbs: (3) Hysterical dysphagia and aphonia after emotion, loss of voice during menstruation: (4) paralysis of sphincters, ex.gr., enuresis in old people from paralysis of the sphincter vesicae; (5) ptosis, paralysis of the sixth cranial nerve, diplopia, strabismus, loss of power of accommodation: (6) paraplegia, not of organic origin; (7) occupational paralyses, like writer’s cramp. In these cases it is equally useful when there is mere weakness short of paralysis.
Gelsemium has been employed with benefit for the inco- ordination of locomotor ataxia. It is a medicine of great service for nervous symptoms that are caused by emotions, as for instance, when involuntary urination or defecation is brought on by a shock or occurs during the excitement of danger, as when a soldier goes into battle, when the apprehension of a thunderstorm or of having to go a journey or undergo any unusual ordeal brings on an attack of diarrhoea, when the patient becomes prostrated from being suddenly overwhelmed by some great surprise or shock, in fact the state of exhaustion and paralysis of function that may occur from nervous excitement of many kinds,such as anger grief, bad news, “funk,” & c. Drooping of the eyelids often accompanies the nervous symptoms.
Gelsemium is also a good remedy for some convulsions, for those occurring during teething, eruptive fevers, from suppressed menses and hysteria, but its main province is in diseases of a paretic or paralytic nature. It is useful for nervous chills and tremblings, nervous affections of the heart, nervous palpitation, oppression, &c., brought on by fright, grief, or any other emotion. A distinctive indication for gelsemium in heart affections is that the patient feels that the heart will stop beating if he does not continually move about.
The headache for which gelsemium is the remedy is a congestive headache with a feeling of great weight in the head, pressing it downwards, and a dull aching felt mostly in the back of the head and extending down the neck, where the vertebra prominens is sensitive; it compels the patient to sit with the head raised and resting back on a pillow, and he must keep perfectly still. With the headache the face is congested and flushed and the upper eyelids droop. It is preceded by a blur before the eyes and drowsiness, is associated with stiffness of the neck, is worse in the morning and passes off with the discharge of large quantities of clear, watery urine. It is aggravated by mental labour, smoking tobacco, lying with the head low and in the heat of the sun, and is ameliorated by pressure, stimulants and the flow of urine,. the pain may extend forward over the head and cause of bursting pain in the forehead and eyeballs. the rigidity of the neck muscles, the drowsiness and headache, the facial and ocular paralyses and the febrile condition indicate gelsemium as a remedy in cerebrospinal meningitis, in which it has often been curative.
Nervous diseases for which gelsemium is likely to prove useful are encephalitis lethargic, the depression of paralysis agitans, and possibly in the insomnia of excited confusional states.
Neuralgia-It is useful for neuralgia of many parts, especially for that over the right eye, for orbital neuralgia associated with paroxysms of twitching in surrounding muscles,and for pain in the anterior crural nerve.
Eyes-Besides the ocular paralyses for which gelsemium is so useful, it is very valuable for internal congestions and serous effusions into the eyeballs, and is therefore one of the principal remedies for glaucoma, detachment of the retina, serous choroiditis and choroido-retinitis.
Sexual-Gelsemium is employed to relieve the pain of spasmodic and neuralgic dysmenorrhoea accompanied by vertigo, headache and faintness; the pains are in the uterine region and shoot up to the back and down the legs. It is useful for labour pains that are cutting and extend from before backwards and upwards impending the natural pains; it is serviceable for after- pains. Gelsemium is a remedy for sexual neurasthenia and impotence caused by masturbation and for debility following involuntary seminal losses.
Digestive-The complaints of the alimentary system requiring the remedy are of nervous origin, such as dysphagia from hysteria or that following diphtheria; the diarrhoea resulting from fright, apprehension or other emotion; the stools are yellow, pappy and watery. Gelsemium may sometimes to be use in passive congestion of the liver with giddiness, blurred vision and jaundice.
Fevers-One of the chief spheres for the employment of this remedy is pyrexia. Many forms of fever need it; catarrhal, eruptive, remittent, bilious, & c. There is less restlessness with i than is the case with aconite and more prostration, the pulse instead of being tense is soft and full, there is less violence than with belladonna and less and cerebral excitement, the patient is more drowsy and listless with gelsemium and less likely to be delirious. The chill is without thirst and the fever is accompanied by a tired feeling, aching in the back and limbs and an entire disinclination to move, not because it is painful to do so, as is the case with bryonia, but because the patient feels too weak to take the trouble. In the early stage of typhoid fever, and in recent malarial fevers, these conditions may be present and indicate gelsemium. Another fever for which it is much used is catarrhal fever; the extremities are cold, the head and face hot, there are dull headache, suffused eyes, sneezing, stoppage at the root of the nose and sore throat with the before-mentioned languor, prostration and dull pain in the back and limbs, all the symptoms, in short, which distinguish many cases of influenza. In this variety of the complaint there is no remedy that acts so promptly and successfully as gelsemium. It is also very useful in remittent fevers, especially the remittent fever of childhood that comes on every afternoon and departs without perspiration in early morning. The catarrhs for which it is indicated usually come on in calm, moist, relaxing weather; it is sometimes useful in hay fever and in nasal and Eustachian catarrh. It has been much used in the catarrhal stage of measles and rubella.
Circulatory-Gelsemium is a remedy for nervous palpitation and for the weak, slow pulse of old age.
Sleep-It is a good medicine for sleeplessness when caused by mental emotions or excitement; the patient involuntarily goes over and over again the events that have distributed him.
Gelsemium is antidoted by china.
(1) Weariness, heaviness of limbs, disinclination and disability to move.
(3) Functional paralyses of voluntary and involuntary muscles. Muscular inco-ordination.
(4) Occupation paralyses.
(5) Ocular paralyses. Serous exudations into interior of eyeballs. Glaucoma. Detached retina.
(6) Ailments caused by emotions; fright, grief, apprehension, the apprehension of any unusual ordeal.
(7) Catarrhal fevers with drowsiness and headache in warm, relaxing climates.
(8) Occipital headaches involving the neck and extending forwards, with ptosis.
(9) Complaints relieved by profuse emission of watery urine.
(10) Nervous persons; young people; children; debilitated and old people.
From damp weather, warm, damp atmosphere, fog, heat of sun, summer, sudden change to damp air, before a thunderstorm, motion (except muscular pains and heart), playing piano (causes tired sensation in arms), lying with head low (headache), fright, before, during and after menses.
From cold, open air, keeping still, flow of urine (headache), stimulants.