Gelsemium sempervirens

Volume II — Main text

Gelsemium sempverirens, Gray. Yellow Jessamine. Nat. Ord., Loganiacee. I. Provings.- 1 . JOSHUA STONE, æt. 27, black hair and light skin, am strictly temperate in my habits oflife, using no intoxicating drinks of any kind, coffee, tea, or tobacco. I am subject to occasional attacks of indigestion, and suffer much from cold hands and feet. Otherwise than this, I enjoy a very good degree of health. On Nov. 21st, 1852, at 10 p.m. , I took 6 dr. of tinct. (prepared from flowers) in water. 22nd. During last n. was quite restless, and much annoyed with unpleasant dreams. Duringd. dull,aching pain in occipital region, much aggravated by movement, especially on bending the head downwards. This pain was much increased towards e. 23rd.- Experienced dull pains in head and extremities. 24th.-No symptoms. At 10 p.m. took 10 dr. oftinct. No symptoms. On 29th took 50 dr. at 10 p.m. 30th. During n. was very restless, with unpleasant dreams after midnight. Dull pain in bowels,which became quite severe towards m. Pain ofsimilar character in sacral and lower lumbar regions. Dull, heavy pain in region ofocciput. Involuntary emission ofsemen without erection. Urine much increased in quantity. 10a.m., dull pain in l. humeral region, also in lower extremities : these are deep seated in muscles. Have felt chilly all d., particularly in m. Dec. 1st.-Dull aching pain in back, particularly in lumbar and sacral region, which came on about 3 a.m. Also similar pains (deep seated) in upper and lower extremities and joints generally. Yellowish-white fur on tongue. Sensation as of something wanting in epigastric region. Emission of semen without erection. All pains much aggravated by heat of bed, and are much worse after midnight. The pains spoken of above continued during d. but in a much less degree. In e., eyes felt quite sore, and as if there was some foreign substance irritating conjunctiva. 2nd.--Very restless during n., especially towards m. Rheumatic pains in bones and joints of extremities and in the back, as in n. previous : also pain in bowels towards m. Headache of dull aching character in occipital region, occasionally extending to os frontis. At n. eyes quite sore ; not much pain, but merely soreness with sensitiveness to light and lachrymation. Slight chills during d. 3rd.-Awoke about 3 or 4 a.m. with severe pains in both upper extremities ; seemed to be deep seated in muscles, most severe in 1. arm and forearm, and in calves of both legs. General restlessness with chills in m. after breakfast. Rather

dull and stupid for some d. with disinclination to conversation. This was remarked by my friends, who knew nothing of my taking med. 4th.- Rheumatic pains in extremities as heretofore, but less severe. Soreness of eyes at n. 5th .-Symptoms similar to those experienced yesterday. Eyes quite sore at n. 6th.-About 4 a.m., awoke with pain of rheumatic character in extremities. After breakfast, experienced dull aching pain in head in region of occiput, which increased in severity as d. advanced. At 10 a.m. I went to the Penn Hospital, where I saw a number of severe wounds. I am not usually affected very much by the sight of wounds, but to-day that, or something else, caused some very unpleasant sensations, which were as follows :-I became very weak, and my friend remarked that I was very pale ; there was also slight nausea and trembling of lower extremities ; these continued some 10 m., but disappeared on going into the open air. Headache continued to increase in severity until after dinner, when it was much less severe . But at about 4 pain again returned, and was more severe than before, and seemed to increase in severity until e., when it became excruciating, accompanied with slight nausea ; pain seemed slightly mitigated by shaking head. I also felt quite chilly. Went to bed about 9, but recumbent position did not mitigate pain at first ; I, however, succeeded in getting sleep from about 10.30 to 2.30 a.m., when I awoke with most intense aching pain in l. frontal extending to r. occipital region, and occasionally over almost entire head. This continued about 1 h., and then left me entirely. After this, I experienced dull aching pain in umbilical region, which continued until I got up. Deep-seated aching pains in muscles of extremities, relieved by motion. After breakfast had sharp shooting pain from r. shoulder to dorsal vertebræ. 8th.-During last n. pains as heretofore, in extremities, which come on mostly after midnight. These pains also continued during d., but in much less degree. Some headache as before in occipital region. Palpitation of muscles of abdomen, which continued about 3 m. Dull pain in lower lumbar and sacral region. 9th.- During n. pains in extremities much as usual, particularly in forearms and calves of legs, also in elbow- and knee-joints. All symptoms of extremities similar to those experienced before, but less severe. 10th.- Early in m. sharp shooting in last phalangeal joint of r. thumb. Have experienced dull pains in muscles of r. arm and shoulder, and some of the time in l. arm and lower extremities. 11th.-Slight pains in extremities during n. 3 p.m., sharp shooting pain in calf of r. leg. 6, sharp pain in r. wrist. 7, dull pain in l. thigh, and under 1. scapula. 7.30, severe aching pain in l. elbow. Have experienced dull pains of shifting character all d. 12th.-Symptoms of last n. were not prominent. Some slight pains in muscles of extremities. During d. felt extremely dull and stupid, but little pain in muscles of extremities. Dull pain in head in region of occiput. 9 p.m., pain in r. wrist, ofdull character, with great weakness of same. 13th.-Pain in wrist less severe, but quite weak. 14th and 15th.-No symptoms. 16th, 10 p.m., took 50 dr. 17th. During n. very restless. During d. tendency to headache on movement, particularly on going upstairs. 18th.-Slight pain in 1. hypochondriac region. 20th.-About

It a.m., severe aching pain in occipital region for a few moments. Very dull and stupid, with aversion to study. (HALE'S New Remedies, 2nd ed.*) 2. Dr. HENRY, of Montgomery, Alabama, April 3rd, 1852, took 30 dr. of tinct. The first symptoms felt were pains over whole top of head, extending back to occiput, with general dizziness and disagreeable pain in whole head. Melancholy and desponding mood. Pains of shooting character in frontal sinus extending to eyes and jaw ; pain in eye is of pricking character, extending from centre to angles . In r. pains seem to wind round eye. Pain extending from bridge of nose to eye. Pains deep in the ball of l. eye, extending from above downwards. Paroxysmal pain 1. lower extremity. Violent shooting pain in leg, which comes on in paroxysms ; every one is more violent ; pain is half-way between knee and ankle. Pain in 1. hip confining itself to the joint ; it at times extends down outside of thigh ; it is of a drawing, sharp character, and is much worse on motion. Pain in flexor muscles of r. forearm, in little and ring fingers, in foot and ankle, with spasmodic contraction and drawing pains in the toes. Pains in neck which confine themselves to upper part of sterno-mastoid muscles, directly behind parotid glands. On r. side pain extends from last back tooth up to temples. Short paroxysmal pain in superior part of r. lung ; on taking a long breath it strikes from above downwards ; this pain is one of the most prominent symptoms. Rumbling and rolling in abdomen with emission of flatus above and below. Periodical pains in abdomen, with yellow diarrhea coming on in e. Pain in 1. iliac region. Bowels loose, but great difficulty to discharge anything ; there seems to be great strength in sphincter muscles. Yellow coat on tongue. 5th.-Took 30 dr. Experienced pain over whole top of head, extending back to occiput. General dizziness and disagreeable pain in whole head. Melancholy and desponding mood. Pains of shooting character in frontal sinus extending to the eyes andjaw as before, but more severe. Spasmodic pain extending from inner condyle of r. arm to axilla. Smoky appearance before eyes, with pain above them. Total blindness ensued in a very short time after taking the 30 dr., with violent dizziness . A band-like pain which surrounds head, with shooting pain in each jaw and parietal bone. Pain in 1. side of head extending from parietal eminence to mastoid process of temporal, periodically recurring. Periodical pains in pectoral muscles. The med. was now taken for a week, dose being increased daily. There resulted, besides above symptoms, chilly sensation over entire body appearing at same time every d.; complexion yellow, also eyes ; complete prostration of system with emaciation. ( Ibid.) 3. Mr. FRANKLIN Bigelow, æt. 24, sanguine, nervous temperament, took 20 dr. tinct. Effects at first were so slight that he did not think them worth noting, but 8 d. after taking it he experienced sensation of heaviness and oppression of head ; severe and oppressive pains in forehead and vertex ; headache very distressing ; gloomy and indisposed to exertion of any kind ; became tired and greatly exhausted very * Taken from a thesis presented by Dr. Stone to the Hom. Med. College of Pennsylvania, communicated by Dr. Neidhard.

easily ; headache comes on after dinner and continues till e. Atsame time excessive drawing and crampy pains in lower limbs, extending from thigh to toes ; pains seem to proceed from bones as well as the muscles. Excessive crampy pains in whole r. foot. During and after a walk symptoms are all much aggravated ; it seemed as if limbs could not be made to move another step. When the pains are felt above knee they are not felt below, and vice versa. Excessive drawing and contracting pains in l. gastrocnemius. The other pains in the limbs all abate while sitting , this does not,-no position seems to relieve it. Drawing and aching pains, which seem to come from bones. Heaviness and feeling of weight in the limbs. But little inclination to sleep ; when it does come on dreams much of business, &c. Eyes much inflamed and weak, with great flow oftears at intervals. (Ibid. ) 4. I commenced my proving of this drug in 1858. I have since proved it on at least 50 persons. The tinct. of the root was employed, in doses of 1-5 dr. A few provings were made with the 3x dil. (in all these the characteristic eruption was developed). The following is a brief digest of its pathogenesis : a. Pain of head is a very constant symptom, generally dull, stupefying, and pressive ; most frequently in forehead and temples ; bruised pain above and at back of orbits ; tightness of brain ; often more or less nausea with headache ; giddiness pretty constant ; an intoxicated feeling and tendency to stagger, often with dizziness or imperfection of vision. The head symptoms are aggravated by smoking ; they are felt very soon, sometimes within 5 m . b. Mind irritable, impatient ; incapacity to think or fix attention ; confusion ; stupid intoxicated feeling ; dulness of all mental faculties. In one case, great and almost uncontrollable mirthfulness, but it is not said at what stage. c. Great heaviness of lids ; difficulty of opening eyes or keeping eyes open ; eyes close in spite of him, on looking steadily at an object ; fulness and congestion of lids. Diplopia when inclining head towards either shoulder, but single vision when holding head erect (I case ) ; objects seemed double upon raising head from stooping position or on looking sideways, but not when lookingdirectly at them (I case). Dryness of eyes. Misty or glimmering appearance before eyes. Pain in orbits, sometimes excessive. d. Mawkish taste in mouth ; clammy, feverish feeling and taste ; great hunger ( I case) ; feeling of emptiness and weakness in stomach and bowels ; eructations ; hiccup ; slight pain in transverse colon, with yellow colour of face (I case) ; gnawing pain in region of transverse colon all afternoon ; slight pain in l. iliac region (2 cases) ; frequent sharp darting pain through 1. hypochondriac region ; after experiencing chills, headache, fever, and prolonged sweating, 17 h. after taking drug was awakened by severe moving pains in lower abdomen, soon followed by a very large but natural stool, without relief of pain, and soon after by a deeply bilious discharge, with instant relief of pain,-19 h. after, another bilious evacuation, without pain, rumbling in region of umbilicus.

GELSEMIUM . 587 e. Urine increased in quantity, clear and watery ; frequent micturition, as often as every h. f . In a few cases, watery discharge from nose ; paroxysms of hoarseness, with dryness of throat ; voice seems weak ; stitching sensation in region of heart ; stitches in chest ; shuddering pain in r. breast ; constrictive pain round lower part of chest. g. Pain in back, as in cold stage of ague (many cases) ; coldness of extremities, especially feet (often severe) ; feet felt as if in cold water. This symptom occurs early, and is generally accompanied with heat of head and face, and with headache, with aguish feeling, pain in and between bones of l. leg ; not able to go downstairs without holding on to something. Pain under r. knee when walking. Pain in lower limbs (very common) . h. Febrile chilliness, with cold extremities and heat of head and face, with headache (an early symptom in most cases). Pulse very uniformly depressed, and down by 10-20 beats, within first 5 or 10 m., if subject remains quiet, but liable togreat variations from exercise. In one case pulse rose from 60 to 70 in first 5 m., but in next trial fell 10 beats in same time. In many cases, pulse soon becomes very feeble, sometimes scarcely perceptible, with chilliness, cold feet, heat and pain of head, &c. After I to several h. chilliness subsides, general heat supervenes, mostly about head and face, with full pulse of 80- 100. In most cases, perspiration follows, sometimes profuse, lasting a few h. to 2 h., with thirst, languor, and prostration. One feels as ifhe had had " a fit of sickness." Another speaks of " every symptom of ague ; would have thought he had the ague." i. Disposition to yawn ; a sort of stupor; cannot keep eyes open ; is obliged to lie down and sleep. Sleepiness, and long and sound sleep, are very general symptoms. j. The drug produces a peculiar and very marked eruption in most of the provings. It appears chiefly on face, less frequently and less conspicuously on back, between shoulders, &c. It is papular, of much the same colour as that of measles, but the papulæ are larger, and more distant and distinct. They are attended with little or no sensation, the subject being unaware of their existence until he happens to see himself. This eruption generally appears the 2nd or 3rd d. of the proving, and continues one or two weeks, or more. k. General symptoms were-weakness and trembling through whole system ; listless and languid ; great lassitude ; feeling of lightness of body and sense of instability of whole system ; feeling ofdanger of stumbling or falling; fugitive or fixed pains here and there ; easily fatigued, especially in lower limbs ; general feeling of illness, as in fever. (J. S. DOUGLASS, M.D., United States Fourn. ofHom. i, 1 bis.*) * In a later communication (Nov., 1861 ) Dr. Douglass writes : a. My experience does not perfectly coincide with your remark upon the action of G. upon the nerves of sensation. It does not, certainly, " cause the numbness, tingling, prickling, and crawling sensations " of aconite, but, in my individual experience, it causes the pains. In my own provings I have frequently experienced a succession of acute, sudden, darting pains, evidently running along single nerve. branches in almost every part of body and limbs, sometimes so sudden and acute as to make me start. At one time a quick succession of these acute sudden pains coursed

1. Dr. W. E. PAYNE proved fluid extr. in 1859. a. April 7th, 9.30 p.m., took 4 dr. in water ; on 8th, 5 dr. in m. and 6 in forenoon ; on 9th, at 5 a.m., 6 dr.; and on 10th , at 6.30 a.m., 10 dr. At 2 p.m. of 10th, when lying down, pain under 1. floating ribs , suddenly, as from thrust with a sharp instrument. In an instant pain disappeared but appeared as suddenly in 1. temple, causing involuntary contraction of brow. At 2.30 there was full and crowded feeling in whole head, and sensation of feverish heat in face ; nevertheless temperature of skin did not appear augmented. At 3 took 6 dr. on sugar. In h. pulsative pains in 1. hypochondrium, continuing I h. 11th. At 9 a.m. 6 dr. In 1 h., while sitting, sensation as if galvanic current were passing down forearms and hands ; same also in feet. At 2, when lying down, pulsative pains in l. hand and finger-joints, and at same time in r. foot, more severe in ball of great toe, continuing for 2 h. 12th. At 6 a.m., 6 dr. Fulness about head. 13th.-At 9 a.m., 10 dr. 14th -At 3 p.m., 10 dr. Feverish heat in face ; full and crowded feeling in head, with pain as if brain were bruised, and accelerated pulse (90) ; general fatigue ; aching in loins ; soreness of trapezius muscles on moving. At 6, sensation as if galvanic current were passing through forearms, continuing forth. The sensitive and bruised feeling of the brain continued for 2 d., the aching and soreness in muscles of neck and shoulders for4 d. b. May 8th, at 9.30 p.m., took 3 dr.; on 9th, at 6 and 10 a.m., 5 dr., and at 9.30 p.m., 6 dr. Ioth.-At 6 a.m., 8 dr. One h. after, confusion of sight ; light-headed and dizzy, much worse from sudden movement of head and walking ; gait staggering and very infirm ; full, crowded feeling in head and heat in face. At 9.30, violent cramp-like pains in epigastrium, causing a momentary cry, lasting but a moment and then subsiding, leaving a constricted sensation for 1 h . This was followed by sensation of heat and burning in stomach. At 2.30 p.m. , 8 dr. At 3, pressive pain in r. temple, with dizziness and blurred vision, such as may follow use of intoxicating liquor, but without exhilarating effects. The dizziness and blurred vision were attended by nausea, and continued for 3 h. There were also pains in 1. elbow, wrist, and knee, and in both ankles ; and pulse remained accelerated. The sensitiveness of brain continued for several h., and it appeared as if every step and sudden movement of head would excite down the outside and front of the tibia for h., leaving a line of considerable tenderness marking its track. b. You remark that you have not been able to elicit such marked symptoms in your provings as were experienced by me. The symptoms particularly referred to are the chills, the reactive febrile heat with headache, and the sweat. You suggest that I am probably very susceptible to the action of this drug. This remark suggests an important fact which has gradually unfolded itself in my successive fragmentary provings on some seventy persons, and on myself. It is that the degree of chill, of febrile reaction, of headache, and of neuralgic pain, bears a very uniform ratio to the nervous sensitiveness of the patient. In several highly sensitive subjects the chill has been equal to a respectable fit of ague, the reaction and pain of head corresponding, and the sweat profuse. These symptoms have been most marked in some female provers of this temperament, taking dr. doses. (Monograph on Gelsemium, by E. M. HALE, M.D., 1862.)

pain; but this did not occur. 12th . At 6 a.m., 6 dr., and at 2.30 p.m., 8 dr. At 3.30, dizziness and blurred vision returned, and gradually increased so that all objects appeared very indistinct till 6.30, when it as gradually abated. Face was flushed and hot to touch ; eyes suffused. (Amer. Hom. Rev., ii, 80.) 6. a. I have at various times, when in health, taken a few pellets saturated with the tinct. dry on the tongue. No symptoms save some fulness of anterior part of head, felt within a few m. of each dose, and soon disappearing. b. April 3rd, 1864, just before going to bed, took 4 dr. of tinct. on tongue. In 15 m., stitch traversing r. eyelids vertically ; afterwards, sense of contraction in scalp at centre of forehead. Sound sleep till 8 a.m. On rising, again 4 dr., and same at II a.m. Insufficient stool at 10 a.m. Walking and other exertion easily induced perspiration. At noon, slight heartburn and pain at cardia, while reading. At 8 p.m. 4 dr., and at 11 p.m. 5 dr. In afternoon and e. some irritability of r. testis, and, afterwards, dragging pain in same, extending to both groins and hypogastrium, followed by escape of flatus, and relief of pain. At 11.30 p.m., eructations of wind and bland fluid ; intense but transient itching of small points on face and at edge of hair at several spots ; itching about elbows and forearms ; aching in 1. rectus femoris, and drawing in r. calf; sneezing, followed by tingling and sense of fulness in nose. At midnight, 6 dr.; sound sleep till 7 a.m. , difficult weary waking. 5th.-After rising, 7 dr. General vivacity ; at breakfast, dull ache on r. side of head ; gastric oppression, had to loosen waist-bands, after which colicky sensation to 1. of navel as if stool would shortly pass. After breakfast, transient vertiginous sensation, followed byconfused vision,especially ofdistant objects ; when turning eyes, sense of sight is tardy in following movement, things appearing for several seconds to be blurred, and eye remaining unfixed in its new direction (no sensation of gauze or film). This gradually wore off by n. Sound sleep during most of n. 6th. At 8 a.m. took of a new specimen 5 dr. General vigorous feeling. After breakfast, marked renewal of confusion of sight, with heavy-looking eyes. Found this symptom much less when holding a finger verticallybeyond nose, also when either eye was closed. When reclining some languor and drowsiness ; on rising, dull pain in occiput, and slight tendency to throbbing in r. side of head (previously, at breakfast, transient and slight cutting pressure on 1. side). Some heat and dryness of hands at 10 a.m.; at II , pulse, sitting, 76. P.m., languor and drowsiness on attempting to study in reclining position ; slept an h., and on being aroused felt at first unwilling to move, eyes transiently bloodshot. After moving about awhile has languor. Pulse, lying, 54-60, sitting up, 64-68 ; hands, especially palms, hot and dry. E., pulse 72, when sitting-always full and strong, as usual. Wakeful till I a.m., with desire to study. Irritation of small spots on mucous surface of prepuce with surrounding congestion. Sound sleep latter part of n.; weary waking. 7th. At 10 a.m., 5 dr., and at 2 p.m. , 7 dr. At 4, swallowed a dessert-spoonful of red wine. Directly after, for first time to-day, return of confusion of sight, lasting but an h., but so

extreme that it seemed as if someone must suspect inebriation. Previously, depression of spirits with dull uncertain pains in head; coincident with intoxicated feeling gastralgia and colic. During e., colicky pains below navel, extending to testes, and caused by flatus, being relieved by its expulsion. 8th.-At 8 a.m., 8 dr. Sight more or less confused all d. At II, cardialgia, while riding. Dulness of head. At 3 p.m., whilst reading excitable news, transient chilliness in upper half of body, especially back and nape of neck. At 11.30, 9 dr. At 12.30, rising of tasteless, semi-solid matters in œsophagus, with flatus and a sense asof something lodged therein, slightly painful, while sitting at study. Sound sleep. 9th.-Found sore pimple on 1. side of neck. Took to dr. Exciting news caused urging to stool ; stool was deep yellow and papescent (as it was yesterday). Dull pain in r. head ; transient cramping pain in inner thigh when walking; eye symptoms as before. At 5.30p.m., 15 dr. In an h. rheumatic pains in r. knee and 1. neck-latter while lying down, former when walking ; soon passed off. Confusion of sight much increased during e. At 9.30, sneezing and dull headache ; continued cardialgia and eructations while sitting ; pulse 72. Pimple is sore, with areola, altogether size of pea, quite red and inflamed-an eruption not previously experienced. 10th . -At 8.30 a.m., 21 dr. Till 4 p.m. disturbance of sight was great ; mind listless and incapable of reflection, with dull (not severe) headache all d., and digging in r. ear all p.m. At 9.30, soft bilious stool, preceded by threatenings of diarrhea-latter renewed at noon by exciting news and afterwards in walking. When walking, also, feeling in kneejoint as ofpartial luxation. Several times during d. saliva was found yellowish as if from blood ; and all latter part ofd. bad, sour, spoiled taste and breath, with frequent need to rinse mouth or spit, light whitish coat on tongue. At 5, contractive sensation in r. neck ; afterwards while writing headache, first on vertex, then in l. occiput, subsequently on both sides, in upper cervical region, and again on top-all in a few m. Finally, settled, dull, dragging headache, mainly in occipital, mastoid, and upper cervical region, extending to shoulders, relieved while sitting by reclining head and shoulders on a high pillow. Early sleep after dinner. When roused some headache still ; mind composed and clear (11.30p.m.). After writing a while, pulse 64- 68 ; palms dry and hot, as also lips. 11th.-Three more pimples, like minute boils. No more med. was taken ; and prover's normal condition being disturbed by a professionally broken night, his symptoms to-day are not recorded. Pimples were not disappearing by 15th. (J. C. MORGAN, M.D., in Hale's New Remedies, 2nd ed.) 7. To see what the effects of the drug would be when pushed, I gave to a patient, a sailor, convalescent from periostitis, 3 doses of 20 min. of tinct. each,-2 h. intervening between Ist and 2nd doses, and I h. between 2nd and 3rd. Abouth. after 2nd dose, usual complaint was made of difficulty of keeping eyes open from heaviness of lids. He saw things double, one image appearing beside the other. During this time pulse did not appear to be much affected, remaining at 77 ; but after 3rd dose it became quickened, rising gradually to 96. About 2 h. after taking 3rd dose he got out of bed to go to lavatory, being

perfectly conscious. He reached the room, but found himself then powerless, and quietly sank first on his knees and then at full length . He was quite unable to raise his lids ; his lower jaw dropped, and he could not articulate. He was put into bed, and some warm stimulating drink given him, when he soon became better. He told me when I saw him, with the most open-eyed simplicity, that the medicine had done him a great deal of good, for he could make water very much better since he had had it (I should observe that he had previously suffered from the effects of a troublesome stricture) ; that he knew everything that was going on around him when he sank tothe ground, but was unable to move, and that his feelings were like those which he had experienced after commencement of intoxication. (Lancet, 1874.) 8. a. I gave it to 6 persons on 17 occasions, in doses sufficient to produce decided toxic effects. The tinct. used was made with I part of root to 4 of rectified spirit. To excite the symptoms characteristic of this drug I found it generally necessary to give drachm doses hourly, for 3 h .- a quantity which may be given with perfect safety. Some individuals, however, are much more prone to be affected than others. Thus, a woman suffered from diplopia, headache, and hazy sight after a second dose of 10 min.; and in another case 2 doses of 20 min., at 2 h. interval, produced well-marked symptoms. On the other hand, I have given drachm doses hourly, for 6 h., with very slight effect ; and in one instance I gave 20 min. to a delicate young woman every 3 h . for several d., finally causing only slight heaviness of eyelids. b. Unless given in dangerous doses, G. ordinarily affects first and chiefly eyes and brows-pain in brows followed soon by giddiness, then by pain in eyeballs, and soon after by dimness ofsight. A larger dose produces double vision without apparent squinting, with sense ofgreat heaviness of upper eyelids, and somewhat contracted pupils. A still larger dose causes drooping of upper lids, sometimes so marked that edges become nearly closed, and can be opened only by strong and painful effort ; and, after straining to open them, sometimes the lid is so tired that ptosis for a short time becomes complete. The movements of the eyeball are restricted (associated in one case with a strong double internal squint) . The patient next complains of weakness in his legs, and we have never pushed the drug beyond the production of this symptom. When decidedly under drug's influence, patient is pale, with a heavysleepy look. Some say their eyes feel sleepy; others yawn frequently, and say they can hardly keep awake, and when left to themselves fall asleep. Others complain of dryness of mouth, though tongue looks moist, and to finger feels so. Some keep moistening mouth with a little water even hours after discontinuance of medicine. These symptoms (except the squinting) were all produced in the greatest number of cases ; but in some instances even large doses of tinct. induced only a few of the slighter symptoms. Thus, a woman took a drachm dose hourly, for6 h., without exciting headache,diplopia, or giddiness-onlygreat heaviness of eyes, and dimness almost amounting to temporary loss of sight ; though on a former occasion, in this verywoman, we produced extreme diplopia with giddiness with four 3j doses. In one instance diplopia occurred without precedent head

ache, giddiness, and dimness of sight ; though subsequently, in this same woman, we produced with six 3j doses hourly much giddiness and mistiness without diplopia. c. The symptoms from G. come on early and soon subside. A single drachm dose rarely produces any marked symptoms ; but in 10- 15 m. after the second hourly dose the symptoms appear, and reach their highest point in about h., then quickly subsiding, so that most ofthem have ceased in an h. After 4-6 hourly drachm doses the symptoms may persist 6-8 h. after last dose ; but they are most marked h. after each . I shall now describe each symptom separately and fully. d. Pain in head and eyes. Patients described this pain variously. It was generally limited to the forehead, and most marked just over the eyes. Some called it a dull sensation over the eyes ; others, a heavy pain ; others, a giddy pain ; and one patient experienced pain over the occiput, with sensation as if crown of head was being lifted off in two pieces. This headache was sometimes absent, sometimes followed instead of preceding the other symptoms. Dull aching pain in eyeballs, now and then shooting in character, occasionally worse in one ball, sometimes followed and sometimes preceded the headache. The headache and pain in eyeballs were often severe, and were intensified on moving eyes. When ptosis was well marked, the effort to open the eyes widely caused considerable pain, and patient seemed to get relief by closing the eyes . e. Giddiness . This was another prominent and early symptom. Some felt it over the whole head ; but by far the larger number said it was limited to the brows. Standing or walking made it much worse. When well marked, the patients staggered, and were afraid even to stand, much less walk. So giddy was one patient that he nearly fell off the form on which he was sitting. Some described their heads as going round and round. They felt and seemed drunk, though without any incoherence or mental excitement. f. Sight. In every case the sight was affected ; indeed, dimness of sight and giddiness appear to be the most constant symptoms, and may exist without headache, pain in eyeballs, or double vision. At first the sight, without being misty, is not so clear as usual ; then slight mist comes before eyes, one patient comparing it to smoke, and another to a thick veil. At last sight fails almost completely, and first with distant objects ; with further impairment of vision, nearer and nearer objects look hazy. g. Diplopia. The drug seems to produce two kinds of diplopia, one much more persistent than the other. As to the transient kind, we find it, on many occasions, a very passing phenomenon, lasting only a few seconds, then disappearing, then after a few m. reappearing. In this transient form images in the median vertical line appear double, distant objects first undergoing the duplication. Sometimes the patient was conscious of the onset of the diplopia ; thus one woman said, " I know it is now coming on ; I feel such a heavy weight under my upper eyelid. " The double vision then came on ; and, with the heaviness, passed away in a few seconds. One image was higher than

the other, the images in this respect varying much. Mr. T. Fox rapidly recorded, from the patient's lips, the phenomena occurring, as fast as they could be written : " One gas jet appears about 6 in. above the other, and there are 6 in. between them horizontally ; the upper one is to the l.; now the r. is uppermost, now the 1. slightly again ; going over to r. now again ; exactly over one another now, and quite close together ; now again separated,1. highest ; now over one another." With other patients the two images seem on a level. Sometimes the drug produces only this transient kind of diplopia ; at other times both kinds ; and sometimes one kind preceded the other, the transient usually preceding the more constant form, recurring from time to time, while the constant form persisted. The phenomena of the constant form follow a definite order, and take place in the upper half only of the field of vision. They occur at first with objects held at the extreme r. or l. of the visual field, and, as the patient comes more under the influence of the drug, with objects held nearer and nearer the middle line ; and at last, usually for a short time only, objects in the median vertical plane seem double. As the effect of the drug wears off, the double vision disappears in the inverse order. The outer lateral image is the higher, and the farther the object is carried to r. or l. the greater is the horizontal or vertical distance between the images. When a coloured glass is placed before either eye, the outer and higher image is seen by the covered eye. When the object is carried high above the head, the two images gradually coalesce and the object looks very much thinner, " like a thread." h. With well-developed diplopia, there is impaired movement of the eyeball, chiefly affecting, as far as could be ascertained, the external and internal rectus, especially the external, for the outward and inward movement of the eyeball is less free than before the action of the medicine. The ball when carried as far as the weakened muscles are capable of it oscillates ; as though patient, with a great effort, moved it as far as he could, and then the tired muscles gave way a little, but, being roused to an effort, they carried the eye back again, the frequent repetition of this effort giving rise to an oscillation. The external rectus is generally first affected, and one not infrequently sooner than, and in excess of, the other. Even when the diplopia is strongly marked, the loss of power over the muscles is not very great, and there is no obvious squinting. But as the patient becomes still more affected, ptosis supervenes ; and a great part, or the whole of the upper half, of the field of vision is cut off. The loss of power in the eye-muscles is then moremarked, and the symptoms are irregular and variable. i. To test the effect ofG. on the circulation, I made 33 series ot observations on patients in whom we induced the full toxic effects. The observations were taken every h. whilst patient was fully under the influence of the drug, and subsequently, as its effects began to decline, at hourly intervals. In 22 instances pulse remained unaffected in frequency, whilst in 11 it was quickened, increase ranging from 6 to 12 in m. Curiously enough, even in same patients, effects were variable ; for although on some occasions drug quickened pulse, on others it failed to affect it. This was not a mere question of dose, for an VOL. II . 38

increase in the dose did not affect the result. With a patient fully under influence of drug we were inclined to think pulse became a little smaller and softer. j. I have carefully watched for, but have been unable to detect, any influence on the mental faculties. Patients under its influence look dull and heavy from the drooping eyelids, and often feel sleepy ; but when asked if they are conscious of any mental depression they always answer decidedly in the negative. Nor is cutaneous sensibility affected. I have tested sensibility roughly by pricking and pinching, and also in 2 cases by compasses, but was unable to detect any loss of sensation in face or forearm, though patients had taken for 6 consecutive h. drachm doses of tinct. One patient, on both occasions on which I experimented upon him, complained spontaneously of a numb pain and a little tenderness along teeth and edges of gums of upper jaw. k. G., in the doses in which I have employed it, does not affect the temperature. 1. Strange to say, the effect of an internal dose of G. is opposite to that occasioned by application to eye itself. When given by mouth in doses sufficient to produce symptoms, the drug, in every instance but one, caused contraction ofpupils (in one case to a pin's point). In the exceptional instance there was a rapid alternation between dilatation and contraction, without any apparent cause; and in another, pupils strongly contracted when exposed to light, but dilated freely in a darkened room, and when recontracting on exposure to light seemed in an unstable condition, oscillating a good deal. The contraction of the pupil does not cease on the disappearance of diplopia or dimness ; indeed, when the dimness passes away, the myosis may increase. On the other hand, the topical application to the eye dilates the pupil, especially when the alkaloid gelsemia is employed. Accommodation also becomes paralysed and the sight affected. Vision becomes nearly natural in 24 h., but pupil remains dilated much longer, sometimes, indeed, for a week, or even a fortnight. In three instances I thought I detected slight primary contraction, lasting only a few m. (RINGER, op. cit. , 10th ed.) 8. a. Dr. Edw. N. AMoss put a drop of 6th dil. into half a tumblerful of water, and took a teaspoonful every 2 or 3 h. for 2 d. He reports following symptoms : - Dull full feeling, with severe aching, in whole of orbits; feeling as if something remained behind in urinating, stream stops and commences again; dull full aching, extending from ensiform cartilage along under free ends of r. false ribs to lumbar region, as if liver was congested,-worst pain about a hand's breadth from sternum ; continued jerking in r. sartorius muscle, about middle of thigh ; slight sharp cramplike pain in l. gastrocnemius, about largest part of muscle ; cramp in instep of r. foot, also in r. side about last false ribs; dull and light headache over all front and top of head, after drowsiness and sleep in forenoon; also, after sleep in e., light head; slight dryness of mouth and throat (as after salt bacon), with disposition to swallow frequently; feeling of relaxation of whole body, especially of hands and feet, with indisposition to move, breathing slow and superficial, with now and then a deep inhalation; pulse slow and weak ; hacking cough, with feeling as though a drop of liquid had entered windpipe, with frequent clearing of throat; in eating, food drops into trachea, causing strangling ; sharp stitches through eyeball and about origin of gluteus maximus (here like cramps) ; drawing pain in hamstrings, extending across joint; drawing stitches in dorsum of r. hand, down middle and ring fingers ; pain

frompyloric end of stomach to axilla and under scapula and down (r.) arm to outer side of forearm, terminating about a hand's breadth from elbow, this passed off after taking biscuit and coffee; sore feeling during deglutition about root of tongue and larynx, with accumulation of mucus in upper trachea, causing frequent clearing of throat; slight griping pain through abdomen, mostly in umbilical region, after supper; r. inguinal gland swollen and tender; two little painful spots on each side of umbilicus, extending down into bowels, pain increased by pressure. b. Continued proving, 2 dr. in half a tumbler of water, 2 teaspoonfuls for dose. Slight jerking in r. rectus and vastus externus ; burning sensation at inner canthus of r. eye ; full feeling in whole head, with some throbbing and uneasiness in occiput ; head feels full and excited, feverish ; sharp stitches around umbilicus ; weak nauseated feeling in bowels ; mucus accumulates innose and upper part of trachea, keeping up hacking cough; languid feeling of whole body, especially ofhands and feet. (HALE, op. cit.)

II. Poisonings.- 1 . Some barrels of G. tincture being on board a grounded vessel, several deck hands tapped them, and drank (it is supposed) from Oss-Oj each . " They looked very much like dead men ; their eyes were closed, circulation very feeble, no pulse perceptible, and breathing so low it could hardly be discovered." Stimulants were given and all (five) recovered. (HALE, op. cit.) 2. A convict in N. H. State prison swallowed Ziss of fluid extract with intent to poison himself. The effects were,-great prostration, nausea and vomiting, dilated pupils, inability to speak or move, coldness of surface, feeble pulse. These symptoms passed off, with proper antidotes, in about 24 h. (Ibid.) 3. A child, æt. 4, suddenly complained that it could not see, and died in h . P.M. , a great quantity of flowers of common wild jessamine was found in stomach. ( HERING, Brit. Fourn. of Hom., xxi, 405.) 4. A gentleman was in his garden transplanting yellow jessamine. After he had cut off some roots and thrown them aside, two of his children, about 3 and 5 respectively, picked them up, and (beyond doubt) chewed and swallowed some. Shortly after the younger one came to his mother, lay down near her, and, as she thought, fell asleep. After a while she wished to awaken it, but found it dead. The other also fell ill and died in like manner, in a few h. ( Ibid.) 5. A woman, several weeks pregnant, took 3 teaspoonfuls of tinct. In 2 h. she complained of pain in stomach, nausea, and dimness of vision. These symptoms were soon succeeded by great restlessness, ineffectual efforts to vomit, and free perspiration over body. After 5 h. pulse was found feeble, irregular, and sometimes intermittent ; there was great prostration, with irregular and slow respiration. Skin was dry ; extremities cold ; pupils expanded and insensible to light ; eyes fixed, with inability to raise lids. The vital powers rapidly gave way, and without convulsions death occurred in about 7 h. after poison had been taken. P.M., lungs were found slightly collapsed, and cavities ofheart greatly distended with dark grumous blood. (Amer. Fourn. of Pharm., Jan. 1870, p. 14.) 6. a. Two men took by mistake each a tablespoonful of Tilden's fl. extr. of G. First, B-, was found lying on his 1. side ; face somewhat congested ; pupils dilated, but responsive to light ; eyelids half closed, with apparent inability to move them ; lower jaw drooping, and

his tongue (to use his own expression) " s o thick that he could hardly speak ; " skin warm and moist ; pulse small and feeble, and respirations somewhat diminished in number. He had neither purging nor vomiting. Second, S-, complained of blindness, and staggered in walking ; was inclined to sleep, with deep inspirations, and a numbness of whole body. b. In a private communication with which Dr. Davis has favoured me, he states that pupils of both were widely dilated, and that both had double vision. Dizziness and vertigo were also experienced by both, but no impairment of intellect. Consciousness was not lost by S-, who recovered ; but B- was unconscious an h. before death . Eyelids were paralysed in B-'s case, only partially so in S- 's. Loss of muscular power in B- complete ; partially so in S-. Great numbness of extremities. Action of heart very feeble ; respiratory movements diminished in both cases . Dr. D. describes condition of B-just before death as follows :-" Pupils widely dilated, spasmodic breathing, surface cold and congested, pulse almost imperceptible, and total unconsciousness ." There occurred no evacuation in either case except cold perspiration. Death ensued in the fatal case in 24 h. B- was a very small, nervous, delicate man ; S-, large, stout, sanguineous. Further, being unaware that he had swallowed a poison, B- was not given an emetic until absorption had fully taken place. S-, on the other hand, received an emetic soon after swallowing poison. (BARTHOLOW, Pract., v, 206.*) 7. a. On Dec. 31st, 1875, about 3 p.m. , on returning home with a vial of fl. extr. of G., I incautiously applied bottle to my tongue, with view of ascertaining flavour, when carriage gave sudden jerk, which caused me to swallow about 3j. On reaching home a few m. after, I felt giddy and drowsy, but satedown and ate some sandwiches. During this time strabismus gradually came on, with paralysis of muscles of mouth and throat, muffled speech, and dropping of lids, especially 1. These symptoms gradually increased, until deglutition became impossible, and I had to remove the last morsel taken with my fingers ; voluntary muscles being at this time perfectly unimpaired, also sensation and consciousness. I now became somewhat alarmed,and asked for coffee and brandy. This condition continued to increase, and my wife sent in alarm for our friend Dr. -. He endeavoured to administer an emetic, but power of deglutition being entirely gone, gave up attempt. I now stated, with difficulty, that I thought paralysis about face was subsiding, but feared it was extending to muscles of respiration. Dyspnea soon came on with præcordial oppression. Being placed in recumbent position, mustard poultices were applied to neck and chest, and brandy and ammonia given. I now became semi-conscious; and the dyspnea continued rapidly to increase, a series of short quick respirations being followed by three or four prolonged gasps. Breathing then ceased, and I became livid, and rolled in agony from sofa to floor. I was at this time so far conscious as to feel myself becoming rigid, and try to say, * For original detailed report see Am. Fourn. of Med. Sc., 1867, p. 271 (also Brit. Fourn. of Hom., xxv , 521). The above gives all that is essential therein, and adds the facts contained in the later communication from the observer.-EDS .

" Over." After this consciousness entirely left me. Cold water douches, stimulation of skin and artificial respiration were used. My pulse was a mere flutter, and had almost ceased. In 3 or 4 m. I so far recovered as to perceive light, consisting of myriads of stars, as on recovery from chloroform. The lights of chandeliers could now be distinguished, and consciousness had so far returned that I was soon able to speak, and shortly after to sit up. The dyspnea did not return, and I was soon able to swallow a little coffee. Muffled speech continued for some h . b. Pulse, up to moment of becoming insensible, continued regular and rather full. Any movement of head (which seemed greatly enlarged) most intensely aggravated all the distressing symptoms ; as did also application of any fluid to lips, dread of which was nearly equal to that evinced in hydrophobia. During semi-consciousness there was but little loss of voluntary motion ; and sight, hearing and touch were never entirelylost up to time of unconsciousness. L. side seemed more paralysed than r. During most of time there was frequent struggling, and face was flushed until lividity commenced. During later action there was profuse perspiration. But the most marked symptom was persistent numbness in occipital region, which lasted some h. after consciousness returned. (PARSONS, Lancet, June 29th, 1878.) 8. A student of mine, who by mistake swallowed 2 gr. of gelsemin [" concentrated preparation "-EDS.] experienced following symptoms : -In 2 or 3 m. he felt strange sensation in head, and involuntary closure of eyelids occurred. In 2 or 3 m. more this paralysis appeared to extend to all parts of body. He attempted to walk, but fell immediately to floor ; whenever he attempted to move, he felt a peculiar, strange sensation in head ; on lying quiet, though entirely powerless, he was conscious of everything about him. His respiration was at first hard, but in a few moments it became slow and somewhat difficult. Circulation was sluggish, and pulse exceedingly feeble. Extremities became cold, and in course of 15-20 m. surface was completely immersed in cold perspiration. He was restored by use of gr. doses of camphor, large doses of brandy, and a zinc emetic. After partial recovery, he experienced for several d. a feeble, languid state of muscular system ; he also passed large quantities of urine, and was troubled with tenesmus and some bloody discharges from bowels. (PAINE, Concentrated Medicines, p. 53. ) 9. Dr. B-, suffering from severe toothache, took what he guessed to be about 30 dr. of tinct. In 10 m. he said, " I cannot see you." His eyes were wide open, pupils dilated, pulse 80-90. He attempted to walk, but staggered like one intoxicated. He was immediately given an ipecacuanha emetic. He wrote with pencil on paper, for he could not speak, " I am very sick, wish to vomit, but cannot." In a few moments he vomited, but discharge passed through nostrils. Hands and feet became icy cold; pulse regular, 80-90. Under warmth and ammonia in an h. he was able tospeak, and soon recovered. (HALE, op. cit.) 10. A young married lady took in m. before breakfast a teacupful

of strong decoction of root. In a few m. she said she could not see ; her head felt strangely. She called in some of her neighbours, who gave her an emetic of mustard, which caused vomiting before the writer arrived. On reaching house, he found the patient in following condi. tion :-Could not see, talk, or swallow ; glottis seemed spasmodically closed. She could moan, which she did almost continually, but power of articulation was absent. Great trembling, with anxiety ; was afraid she was going to die, and was very anxious to know if anything could be done. Face was swollen and of dark colour ; eyes distended ; pupils dilated ; great prostration ; pulse small and rapid; tongue and throat very dry. (BREWSTER, Hahn. Monthly, xi, 563. ) 11. On n. of Dec. 5th, 1869, I was called in great haste to see Mrs. F-, who was supposed to be dying. In a few m. I reached her bedside, and found her totally unconscious ; breathing stertorous and very imperfect; countenance of livid paleness ; lower jaw drooping, leaving mouth wide open ; eyelids partially closed and motionless ; pupils moderately dilated ; pulse 100, regular, but weak. I attempted to administer an emetic, but owing to the dysphagia could not get enough down to induce vomiting. Friction and stimulants were then resorted to, and in about 12 h. consciousness began to return. Recovery was not complete for some d., principal complaint being of great prostration and muscular weakness, particularly of lower jaw, eyelids and arms . After return of consciousness, intelligible speech was at first possible only whenjaws were supported ; tongue also was stiff, and voice thick and guttural. Patient stated that before she became unconscious , objects appeared double, and then she grew by degrees perfectly blind, and thought, naturally enough, that she was dying. (It was ascertained that she had taken in the course of a few h. more than 40 min. of the extr.) (PINKHAM, Bost. Med. and Surg. Journ., N. S., vol . vii.) 12. In summer of 1866 I took, through mistake, 3j of fl. extr. , and immediately started to see a paralytic patient residing some 8 miles off. Before arriving I became nearly blind. Control over upper eyelids was almost lost. Flexors of hands and arms were paralysed, extensors nearly so. Sensation was blunted in hands and arms, but not in proportion to loss of motion. My speech was somewhat affected. A very disagreeable sensation of head was felt, even before muscles came under influence ofdrug ; but mind was quite clear. In this condition I arrived at the house of my patient, and as I was incapable of using my hands, I directed the nurse to apply the galvanic battery to the patient; and as she was about putting the instrument aside, I asked her to apply the poles to my hands, which she did, and I was instantly relieved, and moreover perfectly and permanently. ( MAIN, Ibid, lxxx, 185.) 13. F. R-, æt. 24, suffering from neuralgic pain, took at I a.m. a teaspoonful of Tilden's fl. extr., and in 15 m. repeated dose. Pain was soon relieved and his eyes felt heavy ; but in about h. he began to complain of choking, and soon arose struggling for breath, pushing his fingers into his throat, as if trying to tear it open. He staggered, reeling from one room into another, as though intoxicated ; and in a short time after these symptoms came on he threw himself upon the

floor and became unconscious. I was summoned about 3.45 a.m., and reached house at 4. I found patient moribund, respiration gasping-3 or 4 per m ., pulse rapid and feeble. He was totally unconscious, and could not be roused ; pupils were dilated, not responding to light, and eyes could be touched without causing any contraction of lids ; muscles relaxed, lower jaw drooping, skin moist, extremities rather cold. Artificial respiration was kept up for h., but without avail, and he died at 4.30. No convulsions at any time. P.M. 5 h. after death. Body well nourished ; rigor mortis marked. Blood very fluid and dark coloured, showing no tendency to coagulate or turn red on exposure to air, even after standing in a large tub for 2 h. Heart, lungs, spleen, kidneys normal ; liver dark coloured, and containing much fluid blood. Stomach contained 4 oz. of light-coloured fluid, mixed with glairy mucus ; its internal surface was deeply congested, and marked by tortuous dilated vessels. Brain rather pale, sinuses not congested. Internal substance of cerebral lobes was dotted here and there in small red points ; but these were not sufficiently large or numerous to be considered of much pathological importance. No collection of fluid in ventricles. (BOUTELLE, Ibid, xci , 371.) 14. a . To a coloured servant, æt. 28, Dr. Lodge gave 15 min. of a tinct. freshly prepared from the dried root. Soon after she came into his room breathing very hard, exhibiting in her countenance intense fear, and exclaiming, " Oh ! doctor, I'm dying, I'm dying ; do something for me." She attempted to lie down upon the bed, but her head barely touched the pillow when she sprang up, convulsively calling out in a loud whisper, " My breath ! my breath ! " She clapped her hands across her chest rapidly, and seemed unable to retain one position for more than a few moments . Pulse was 40, extremities cold. Stimulants were given ; she rallied for a few m., then struggled as if for breath, and cried out. Presently she was taken with an excruciating chest pain. In a suffocative spasm she sat down upon the floor, went into an apoplectic stupor, breathing hard and foaming freely at the mouth, and died within 10 m. of the coming on of the spasm. Previous to this she was conscious and rational, but after it she did not speak. b. One of the medical men called in found patient lying on floor, with extremities cold, no perceptible pulse, eyes staring, jaws rigid. There was at first slow catching respiration, but this soon ceased, and she died within 10 m. of his arrival. P.M., substance of brain was found healthy, but there was much venous congestion of membranes . Pericardium contained about 3 oz. of serum. (Lancet, 1878 , i, 892, from American papers.) 15. Dr. SINKLER gave to a lady of 49, suffering from neuralgia, 5 dr. of fl. ext., 3 times a d. At first each dose caused dimness and some loss of power over bladder ; but after 2 weeks he was called to patient, who was reported as " very ill and sinking." He found her lying on a sofa, unable to sit up or to move at all. Extremities were cold, pulse small and feeble, respirations sighing and jerky, pupils dilated, and eyes suffused. There was paralysis of bladder, urine dribbling away constantly ; muscular enfeeblement was most marked on r. side. Symptoms had been observed the d. previous, but had become rapidly

worse that m. Onsuspension of med., and administration of bromides and morphia, they were soon relieved. (Phil. Med. Times, viii, 150.) 16. I once observed the following symptoms, which occurred in a woman to whom G. had been given to arrest daily hysterical convulsions. The tinct. was given in doses of 10 dr. every 4 h. The spasms were much relieved, and their periodicity broken up; but on the 2nd d. of its administration there appeared dryness and burning of fauces; red tongue inflamed in middle ; severe burning in œsophagus, from mouth to stomach ; spasmodic sensation and cramp-like pains there ; hawking up of bloody matter. During the spasms, bloody brown foam would run out of the mouth. The burning sensations at times seemed intolerable ; deglutition was painful ; food and drink, taken warm, aggravated. This condition resisted arsenic, but yielded to phosphorus 2. (As the G. was largely diluted with water, these symptoms were not mere local effects. Patient had never experienced them before.) (HALE, op. cit.) III. Experiments on animals.- 1 . a . To a small spaniel I gave, at 9 a.m., 3ss of Tilden's fl. extr. No symptoms appearing after 30 m., repeated dose. In about 15 m. noticed slight twitching of eyelids ; some dilatation of pupils ; increased action of heart, 120 in m. Afew m. more, and muscles of head, face, and neck were affected with twitching ; heart beat with irregular force, now hard and full, now very weak. Dog became giddy, and staggered; there was drowsiness on closure of lids, with occasional starting as if frightened. It remained in state of stupor about 30 m . At 10.30 ziss was given. In less than 5 m. spasmodic contraction of nearly all muscles of body took place ; limbs were drawn against trunk, head to one side. L. side seemed most affected. There was also laboured breathing, as in asthma ; trembling of whole body, especially limbs ; great dilatation of pupils, obliterating iris; heart's beats 140. Then came clonic opisthotonos. All this time eyes were closed and animal remained drowsy and stupid ; tongue appeared of bright red, with purple tint. These symptoms gradually ceased till about 12, when zij more were administered. This was immediately followed by great tremor of whole body. He walked backward for some distance, staggering from side to side. In about 15 m. he sank into a stupid condition, with nodding and inability to open res. For next 15 m. this state continued, with occasional jactitation of muscles. At 12.30 3j was given, followed by renewal of spasms. Whole body and limbs became severely convulsed ; complete blindness, with greatly dilated pupils ; tongue a dark purple and hanging from mouth . At this time (about 30 m. after 4th dose) pupils contracted very much, sight still absent ; then nausea and efforts to vomit, for first time. Heart's action 120 ; resp. 90. After a while he became quiet, when 30 dr. were given. In about 5 m. muscles of thorax seemed entirely paralysed; respiration seemed carried ononly by violent efforts of abdominal muscles. Heart's action weak and fluttering, too rapid to be counted. He tried to walk, but hind legs dragged as if paralysed. Involuntary urination. In a m. or two he fell down, and there was entire paralysis of whole voluntary muscular system. He lay completely motionless ; aleg lifted fell dead and heavy. Respiration very slow and laboured, long sighing inspirations. In this state he remained about 20 m., when, at 1.30, another dose of 30 dr. was given, followed by gasping ; he seemed to be dying. Fornext h. respiration

was alternatelygasping and stertorous ; it then became natural. Blindness and paralysis continued about an h.; but by 4 animal was lively and well . b. In a second experiment made on same animal 2 d. later, 3j was given in all, 3j every h. During first 7 h. symptoms were very similar to those obtained on first trial ; but during last h., from paralytic and partially insensible condition, dog for a brief space became furious, and seemed during that time to regain all its strength. It ran across the room ; leapt upon the lounge, over a chair ; ran howling under a table, and glared out at us with bloodshot and protruding eyes. This transient excitement as suddenly subsided, and he became convulsed, with heavy, stertorous breathing, dull expressionless eyes, and some rigidity of limbs. Beating of heart was very feeble and slow, hardly perceptible. Respiration became more and more stertorous, finally rapid and short, and the animal died without any struggle or convulsion. c. P.M., I found brain in high state of hyperæmia ; and 3 large drops of dark blood were effused under arachnoid. I did not notice any change in medullary structure of brain, but substance and membranes of cord were congested. Lungs were hyperæmic, and much heavier than natural. R. side ofheart was filled with dark coagulated blood ; in 1. side some thin watery blood was found. Substance of heart showed slight unnatural redness. (HALE, Monograph, p. 12.) 2. On dissection of animals killed by large doses of G., I observed a constant hyperæmia of lungs and brain ; r. side of heart and large vessels were distended with blood, and there was considerable congestion of capillaries in mucous coat of intestines. Muscular fibre of heart was dark-red and soft. Blood within ventricles was fluid. Substance and membranes of cord filled with blood. (MILLER, quoted in Ibid.) 3. a. BERGER experimented on frogs by injecting subcutaneously 0.1-0.3 grm. of watery extract. After a short stage of general restlessness, though often without this, gradually increasing heaviness of movement sets in. On drawing away feet but slight resistance is offered, and they are drawn up again, at first slowly, and finally only on being irritated ; the animals when laid upon the back only succeed in turning over after many and fruitless attempts, and after 10-30 m . even these were ineffectual. They now appeared incapable of any voluntary motion, and remained in any given position except under very strong stimulus, when they made clumsy attempts to move. The cornea retained its sensitiveness, and sensibility to pain also seemed unimpaired : nerves and muscles were also capable of being irritated by a weak induction current. As a constant symptom ofthe poisoning a rapidly increasing retardation ofbreathing showed itself; this inone case ceased entirely even before mobility was quite gone, and detached respiratory movements were then only obtained by reflex irritation. The heart-beats seemed at first unaltered; in later stages there was slight decrease of frequency ; but heart continued to beat regularly for some h. after cessation of respiration. Reflex irritability was almost always very much heightened within 15-20 m. after injection, inmany cases almost to same extent as from strychnia. The slightest touch, shaking the table, or any loud noise, caused strong tetanic convulsions.

These reflex spasms remained even after decapitation. If sciatic was divided before experiment leg on that side was free from spasm, whilst ligature of external iliac showed no protective influence. This increased reflex excitability gradually diminished till it fell below the normal point, and lastly ceased altogether. The electrical excitability of the motor nerves and muscles appeared to be lessened, and disappeared several h. earlier than in unpoisoned frogs . b. Rabbits received 0.08-0.3 grm. of extr. in same manner. After 10-15 m. they became restless ; blinked at times ; pricked up their ears ; and after slight tremors of these and of one or other of the anterior extremities had commenced, in most cases there set in, in a very characteristic manner, movements of progression of the anterior extremities following one another in rapid succession, whilst the animal remained stationary. These symptoms reached occasionally such a pitch that the animal raised itself upon its haunches into a more or less vertical sitting posture. The movements soon ceased, and the animal slid down with its forepaws on the table, and let the head sink till the muzzle reached the table. On strong stimulation they succeeded at first in raising the forepart of the body,during which occasional striking out with the forepaws took place ; this soon ceased, however, till finally they were unable to do even this much, and they allowed the hinder part of the body also to stretch out, generally with previous symptoms of irritation, and the animal lay completely paralysed, with convulsions (varying in intensity) of the extremities, especially anterior. The frequency of respiration was always diminished within a short time after the commencement of the experiment ; soon after the motor paralysis became complete, rapidly increasing dyspnea set in, and after a short convulsive stage the animals died with all the symptoms of asphyxia. The action ofthe heart was only affected by large doses, after which a slight diminution of frequency of pulse was noted, and this after previous section of the vagi equally with cases where the nerves had been left intact. On p.-m. examination heart was always found pulsating vigorously and regularly. Sensitiveness of the cornea, and to pain, remained intact until death. Reflex irritability was at first increased, but not by any means so sensibly as in the cold-blooded animals ; finally diminished. In the stage of asphyxia only did anesthesia of the cornea with dilatation of pupils and protrusion of eyeball set in. It was possible, by means of artificial respiration, to obviate the effects of asphyxia, even where after stoppage of respiration these symptoms, and finally unmistakable slowness and intermittence of the beats of the heart, had set in ; the heart very soon resumed its normal functions. After section ofboth vagi death from suffocation occurred ; there was only wanting the slowing succeeding the dyspnea. Artificial respiration always succeeded in keeping the animal alive even after enormous doses of the drug. If it had been previously commenced, even direct injection into veins of largest quantities of poison caused no appreciable change in heart's action. Manometric experiments, however, showed, in the case of large doses, a moderate sinking ofblood pressure. P.M. examination showed all signs ofdeath from asphyxia, especially the venous character of the arterial blood. The electric irritability of the peripheral nerves

and muscles was preserved. ( Centralblatt f. d. med. Wiss. , 1875, p. 803.) 4. a. Injected under skin of back of frog 3ss of sol. of extract. In 10 m. decided loss of muscular power ; could not jump, but drew up hind legs when placed in inconvenient position. Apparently complete sensory paralysis, for no movements of limbs took place on application of irritants. In 15 m. complete motor paralysis, but muscles of calf contracted on direct irritation. Opened chest by division of sternum ; heart was found in rhythmical action, 20 per m. After I h. from beginning of experiment, action of heart continued, 14 per m . There was then complete sensory and motor paralysis. After 2 h. action of heart had entirely ceased, but it could be made to contract by pricking. b. Passed ligature round thigh of frog, including all parts save sciatic nerve, which was carefully separated. Then injected 15 min. ofsol. In 10 m. muscular movements were observed to be feeble, and sensibility to irritants diminished. In 20 m. sensibility to pain appeared to be abolished, but muscular movements could still be executed. Then pinching of upper extremity, a strong galvanic current, and chemical irritants applied to other parts excited no reflex movements in ligatured limb. Galvanic, chemical, and mechanical irritants applied to sciatic of ligatured limb induced active contractions ofgastrocnemius. Direct irritation applied below the ligature to the muscles of the ligatured limb also caused them to contact. (This experiment indicates that G. destroys the excitability of the sensory nerves before that of the motor, that it does not impair the muscular irritability, and that its action as a paralyzer is upon the centre and not upon the peripheral nerve- fibres.) c. Pigeon: temp. ofgullet 107°, resp. 48. Injected under integument ofthigh 30 min. ofsame sol. In 5 m. voluntary movements-walkingdisordered ; resp. 30, laboured, expiration jerky and prolonged. In 10 m. legs were paralysed, so that standing was no longer possible. Soon after wings were widely expanded, resting on floor, and agitated by a succession of short tremors, which at length extended to whole body. Eyelids partly closed. Still manifested consciousness, and attempted to move away head when approached. Sensibility was finally completely abolished, so that no form of irritant excited resistance or movement. Death occurred at end of h. in a general convulsive tremor, in which eyes were closed, head drawn down, feet extended backwards, and wings widely expanded. Action ofheart continued for several seconds after total suspension ofrespiratory movements. Just before respiration ceased, thermometer in gullet registered 104°. d. Kitten : axillary temp. 102°. Injected 30 min of sol. In IO m. head depressed, resting on forelegs, which were doubled up ; respiration laborious, expiration jerking, abdominal wall falling in towards diaphragm suddenly ; pupils dilated and eyes drooping ; in attempting to walk forelegs are weak and relaxed, but hind legs are less affected ; when tail is pinched, cat cries out and attempts, but ineffectually, to strike with foreleg ; lips and tongue are dry, and tongue is frequently protruded ; tail in constant vibration. In 15 m. after injection, began a series of backward movements, which were repeated irregularly every few m. This backward movement is accomplished chiefly by the hind

extremities, claws of forefeet catching in floor from loss of power to retract them. Cat is yet conscious of impressions, for reflex winking takes place on touching ear and face, and she cries out when tail is strongly pinched. At end of 20 m. convulsive backward movements more frequent and irregular ; jaws widely separated, mouth parched ; forelegs drawn up and folded under chest, and hind legs rapidly flexed and extended, without (at last) moving body. In 30 m. after injection complete muscular relaxation ; respiration ceases, but heart continues tobeat for 5 m. longer. Axillary temp. before respiration ceased, 98°. (BARTHOLOW, Pract., v. 203.) 5. a. G. is a powerful paralyser. Its paralysing action is best studied in the frog. In these animals it often produces tetanus as well as paralysis. Whether we produce paralysis alone, or paralysis followed by tetanus, depends upon the dose. Thus, as a rule, with small doses of the alkaloid, we only get paralysis ; with rather larger, quiverings and tetanoid movements ; and only after larger doses, decided tetanus. Is the paralysis due to influence on brain, cord, motor nerves, or muscles ? It paralyses cord, leaving nerves and muscles unaffected. The tetanus is due to the action of the poison on the cord ; and I draw special attention to the fact that the paralysis always precedes the tetanus, that gelsemia has the property of first weakening and then tetanising the cord,thus corresponding tojaborandi, buxus sempervirens, and other drugs. b. G. is also a powerful respiratory poison ; indeed, this drug generally, if not always, destroys warm-blooded animals before it produces complete paralysis. It causes no primary quickening of respiration, and does not paralyse the phrenic or the intercostal nerves, and it acts after division ofboth vagi. It asphyxiates, as Dr. Burdon Sanderson has shown, by paralysing the automatic respiratory centre. c. G. affects the sight in animals as in man. Thus we poisoned a dog, and, after the production of slight muscular weakness, the sight became almost lost, for the animal ran straight against objects without trying to avoid them, evidently not seeing them. d. Dr. Burdon Sanderson concludes, from a kymographic experiment on a rabbit, that G. exerts no influence on the blood pressure ; and in 6 temperature experiments of my own upon rabbits the results obtained were simply nil. e. The local application dilates the pupils ofrabbits and cats. The pupil of a cat being extremely sensitive, I thought that if the local application did cause primary contraction I should detect it best in this animal. In 5 observations the pupil in each instance became decidedly contracted before dilating. Its average time ofcommencement was 10 m., of duration 24 m.; and it was followed by wide dilatation. f. I have said that the internal administration ofG. contracts the pupil in man and the lower animals, and that dilatation occurs only on the supervention of asphyxia, disappearing under the employment of artificial respiration. It occurred to me that the direct action of the drug would ultimately dilate the pupil, but that a dose adequate to produce this effect so quickly paralyses the respiratory centre that before the drug has time to effect dilatation the animal dies asphyxiated.

To ascertain the validity ofthis conjecture I made a rabbit insensible with 7 gr. of chloral,then inserted a canula into its trachea, and injected into the subcutaneous tissue of the axilla 30 dr. of the fl . extr., at once commencing artificial respiration to prevent the advent of any asphyxia. In 17 m. I thought pupils were a little contracted ; in 26 m. wellmarked signs of paralysis set in, shown at first by difficulty in keeping up head ; in h. animal could not raise head off table, while it still retained considerable power over trunk and extremities. At this point eyes became prominent and pupils began to dilate, and in 34 m. animal tumbled over on its side, and then I noticed that pupils were decidedly larger and eyes more prominent ; but as after I h. pupil had not become widely dilated I repeated dose, injecting it in two places. Paralysis rapidly increased, till it became complete in anterior part of body, though over its hind legs rabbit still had power ; at last these also became almost completely paralysed, and animal lay on its side in a helpless state. As paralysis advanced pupil dilated somewhat, till at last it became above double its original size, though it never reached the degree of dilatation observable in man and cats after the local application of the alkaloid. I noticed that the animal retained the power of closing the eyes quickly and strongly, even after almost complete general paralysis, whence I conclude that the seventh or some of its branches is one of the last nerves to undergo paralysis. ( RINGER, op. cit.)

Volume IV — Appendix

17-

GELSEMIUM.

(See vol. ii, p. 583,) A patient gives the following account of his inrariaW*

experience after taking any potency of G., from the 3rd to the I003th» during the last twenty years : — " A few moments after takisg the medicine there is an extreme feeling of restlessness, inability to be suU for a second, constant twisting and turning. This is succeeded bf intense pain over the (always r.) eye ; it seems as if my foreheai would come down over my eyes and close them, my eyes feeling ««»^ they were rolling upwards and turning into my head. Then comes*

strong inclination to commit suicide } I want to throw myself from a height or out of window, and feel it would be a relief. This is succeeded by an inclination to weep, and I generally have a good cry ; but before this, and while the feeling lasts of wishing to throw myself from a height, I clench my hands, and nervous rigors or sensations run all over my body, down to my fingers and toes ; it seems as if I would lose my senses. Then a great dread of being alone seizes me, and I am afraid of what may happen, thinking I may lose all self-control. The pain still continues over the r. eye, and often at back of head there seems a spot 4 in. square that is turning to ice. These feelings are followed by a strong inclination to talk or write, very great exhilaration, and a better opinion of my mental capacity ; indeed, it seems as if my memory was better, that I can recall almost anything I ever read, and can nearly always repeat to myself long passages of what I have read years before. It appears as if I can remember anything I choose to recall. As I am getting over the effects of the drug I have to urinate every few m. I am left much exhausted, thoroughly tired, and with a wish to be quiet." (Patient states that he writes under the influence of the drug, that he may give the symptoms the more accurately. He also, to exclude the idea of imagination, informs us that he has more than once been given the drug unwittingly.) (Logan, Medical Advance^ Aug., 1889.)

1. I had been treating a case of phthisis, in which I gave G., 3 dr. of tinct. every 3 h. during first part of n., to procure rest for the patient, who was a mild, nervous woman of 32. After a week of this, she asked me if there was anything else that could be substituted for the G. I asked her if it did not agree. She replied. Oh yes t but it made her feel as though some one else was sick, and not herself; she worried about some other person having her sickness. I asked her if it produced this effect every time she took it ; and she said it did. (A case of melancholia is appended, in which the presence of this symptom led to a curative use of the drug.) (W. W. Day, 17. S. Mtd. Inv.y March ist, 188 T.)

2. A girl of 14 took by mistake a teaspoonful of the fluid extr. She had immediately giddiness, headache, great prostration, muscular relaxation, convulsions, staggering gait, want of co-ordination throughout the entire system, widely dilated pupils, double vision, paralysis of upper lids and lower jaw, overflow of saliva from corners of mouth, congestion of face, difficulty of speech, marked dysphagia ; the heart's sounds were heard as if far distant. A semi-comatose state supervened ; the face from congested became pale and death-like, surface of body cold, clammy, and finally covered with cold sweat. There was marked fall in temp, of body ; resp., at first normal, became gasping ; and patient lost consciousness altogether. She eventually recovered, from stimulants, mustard, and artificial respiration. (rRiSDRiCH, Med. Press and Grcular^ April 18th, 1883.)

3. Suffering severely from facial neuralgia last n., I took 10 min. of the fluid extr. of G. (U. S. P.), and in \ h., feeling very little better, repeated dose. In 15 m. I was so drowsy that I could scarcely keep awake. There was great pain over frontal region— no neuralgia.

Pulse was weak and intermittent ; I had cold shjverine; and dizzincMj pupils were slightly contracted ; and there was general feeling of collapse. I took a cup of strong tea, and in 5 m. was very sick, vomiting freely, but not feeling any better. I then had a glass of strong brandy and water, which was repeated in ^ h. In 2 h. I was all right again. (De Wolfe, Brit. Med. Jaurn.y 1881, I, 193.)

III. 6. Administered to animals under the form of gelsemine it acts upon the motor system. The animal becomes at first dull, it moves only when excited ; placed upon its back it recovers a normal position with slowness and awkwardly, and finally ends by no longer reacting, becoming completely inactive and deprived of movement. At the same time the respiration, which was accelerated in the begin* ning, becomes slower, and finally ceases before the paralysis may be complete. Sometimes there can be observed upon the limbs— during the progress of the paralysis — a peculiar fibrillar trembling. This picture may be troubled, however, by brusque tonic contractions, which place the members in extenso, the fingers spread apart, with true tetanic movements, spontaneous or provoked, which last for a short time, and again reappear after an interval. The heart is attacked last, and exhibits a lessening in its beats more and more marked, but it continues to beat several hours after the paralysis is complete, and finally is arrested during a diastole. In a rabbit, with a dose of i gramme of the extract of G., or 10 centigrammes of gelsemine, the same phenomena are obtained. After an interval of a few m. the animal is seen to crouch, its ears are thrown back ; the respiration becomes dyspnoeic ; the pupil dilates, the lids are paralysed, the eye seems full, it fills with tears, becomes glazed, and presents upon the cornea a depression often very marked. The sphincters become relaxed, and there is sometimes an emission of urine and faecal matters. Then the paralysis progresses, the respiration becomes embarrassed, asphyxic convulsions occur, and the heart is soon arrested. (RouCH, C0ii^t. rend, de la Sac. de Biol.., Dec, 1882.)

(On p. 594, 1. 18 from bottom, for " 8 " read " 9.")