Gelsemium

Authorities. 35, W. F. Hand, Chicago Med. Journ., vol. xxv, 1868, p. 760, fatal poisoning of a child, set. eighteen months, by an unknown quantity of the fluid extract; 36, A. E. Harden, Rich, and Louis. Med. Journ., June, 1873, p. 621, Dr. J. took about a tablespoonful of the tincture ; 37, Dr. Freeman,. Lancet, 1873 (2), p. 475, a boy, set. three years, took about 50 minims of the tincture (1 in 5), and died; 38, same, a girl, set. nine years, took a dessertspoonful of the tincture, and died in two hours; 39, omitted ; 40, R. N. Taylor, M.D., Rich, and Louis. Med. Journ., 1875 (1), p. 609, a negro, set. nineteen years, took 15 drops of fluid extract at one dose upon an empty stomach ; 41, same, the writer took 5 drops of the fluid extract, and in two hours 10 drops more ; 41a, second experiment; 42, same, a boy, set. nineteen years, took 12 drops of the fluid extract; 43, Ringer and Merrell, Lancet, 1876 (1), p. 661, and (2), p. 569, seventeen observations on six persons ; 44, Geo. S. Courtright, M.D., Ciucin. Lancet and Obs., vol. xix, 1876, p. 961, Dr. Bennett, suffering from urticaria, took by mistake 1 to 2 teaspoonfuls of the tincture, and a little whiskey, cured by ISIorphia u.'=ed hypodermically; 45, Dr. Brewster, Hahn. Month., vol. xi, 1876, Mrs. V. took before breakfast a teaspoonful of a strong decoction of the root; 46, W. Single, M.D., Philad. Med. Times, vol. viii, 1878, p. 150, Mrs. T., set. forty-nine years, took for neuralgia four doses of 5 drops each of the fluid extract; 47, Ringer and Merrell, Lancet, 1878 (1), p. 858, Dr. J. B. Hill relates the case of five men taking from half a pint to a pint of the tincture each ; 48, same, ibid., p. 892, a woman, set. from twenty-five to thirty years, took 15 drops of the tincture ; 49, J. G. Parsons, ibid., p. 953, G. G. P. swallowed about one drachm.

Mind p. 530

Intellect was not impaired at any time, but was slightly confused

Aroused with difficulty,"I

Loss of consciousness

Head p. 530

Giddiness 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 to walk. So giddy was one patient that he nearly fell off the form. Some described their heads as going round and round. They felt and seemed drunk, though without any incoherence, still less mental excitement

Pain in the 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; and others a giddy pain ; and one patient experienced pain over the occiput, with a sensation as though the crown of the head were being lifted off in two pieces. This headache was sometimes absent, and sometimes followed instead of preceding the other symptoms. Dull aching pain in the eyeballs, now and then shooting in character, occasionally worse in one ball, sometimes fellowed and sometimes preceded the headache. The headache and pain in the eyeballs, intensified on moving the eyes, were often severe. When ptosis was well marked, the effort to open the eyes widely caused considerable pain, and the patient seemed to get relief by closing them

I found the doctor sitting on the edge of a lounge, being held by two persons, with the head falling forward, the chin resting on the breast; I at once had his head raised up, but it immediately dropped forward again on letting go of it, showing that the parts were paralyzed ; at breakfast his chin had dropped down, and it was with difficulty he could keep his head from falling on the table; could not eat, and with difficulty, on account of his head falling forward, walked into the next room

Persistent and distressing numbness in the occipital region, which lasted for some hours after the consciousness returned

Eyes p. 530

Eyes staring

Strabismus

Dropping of the eyelids, especially the left

Pupils large and dilated

Pupils largely dilated and insensible to light; eyes had a fixed stare; sclerotic congested; lids drooping, so that it was necessary to pull them apart to see the eye

A few drops of the solution of the alkaloid were put into one eye, and in each case the trial pupil became widely dilated, the dilatation usually beginning in about thirty minutes. Not only does the pupil dilate, but the muscle of accommodation becomes paralyzed and the sight affected. In twenty-four hours vision again becomes nearly natural, but the pupil remains dilated much longer, sometimes, indeed, for a week, or even a fortnight

Dimness of vision

Vision slightly indistinct

Some difficulty in sight before he had walked two squares

In every case the sight was affected. At first the sight without being misty, is not as clear as usual; then slight mist comes before the eyes, one patient comparing it to “a lot of smoke rising before his eyes and another to a “thick veil The sight at last becomes so affected that it fails almost completely, failing first with distant objects, then, as the sight becomes more impaired, nearer and nearer objects become hazy

Double vision

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 minutes, reappearing. In this form images in the median vertical line appeared double, distant objects at first undergoing the duplication. Sometimes the patient was conscious that the diplopia was coming on ; thus one woman said : “ I know that 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, ceased in a few seconds. One image was higher than the other; in this respect the images varied much. The following descriptive notes were taken down rapidly from the patient, the phenomena occurring as fast as they could be written: “One gas-jet appears about six inches above the other, and there is six inches between them horizontally; the upper one is to the left; now the right is uppermost ; DOW the left slightly again ; going over to the right now again ; exactly over one another now, and quite close together ; now again separated, left the highest; now over one another With other patients the two images seemed 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, and continuing to recur from time to time, while the constant form lasted. The phenomena of the constant form of diplopia follow a definite order, and take place in the upper half only of the field of vision. They occurred first with objects held at the extreme right or left of the visual field; and as the patient passed more under the influence of the drug, then with objects held nearer and nearer the middle line, and at last, usually for a short time only, objects in the median vertical plane seemed double. As the effects of the drug wore off, the double vision disappeared in the inverse order. The outer lateral image was the higher, and the further the object was carried to the right or left the greater was the horizontal and vertical distance between the images. When a colored glass was placed before either eye, the outer and higher image was seen by the covered eye. When the object was carried high above the head, the two images gradually coalesced, and the object looked very much thinner, “like a thread With well-developed diplopia there is impaired movement of the eyeball, chiefly affecting, as far as we could ascertain, the external and internal rectus, especially the external, for the outward and inward movement of the eyeball was less free than before the action of the medicine. The ball appeared to be moved by greater effort, so that when carried as far as the weakened muscles are capable, the ball oscillates, as though the patient with great effort moved it as far as he could, and then the tired muscles gave way a little, but being roused to an eff)rt they carried the eye back again ; the frequent repetition of this effort gave rise to an oscillation. The external rectus is generally first affected, and not unfrequently one rectus sooner 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. Then, as the patient becomes still more affected, ptosis supervenes, and a great part of the whole of the upper half of the field of vision is cut off. The loss of power in the eye-muscles is then more marked, but without the occurrence of obvious squinting. At this time the symptoms no longer follow the order previously described, but assume various phases, often changing rapidly. Thus, whilst on one side the outer image is the higher, if the object is carried to the other side of the field the inner image becomes the higher; or, perhaps, for the first few seconds the outer and then the inner is the higher,‘l

Visionless (after one hour and a half)

Face p. 531

Face congested

Face and lips blue and livid

Lips of a livid color

Jaws rigid

Mouth p. 532

The mouth was partially open, and the lower jaw hanging as an almost useless appendage ; could move the tongue slightly, but unable to articulate distinctly

Paralysis of the muscles of the mouth and throat

Foaming at the mouth

Interior of mouth and fauces moist

Muffled speech

Speechless (after one hour and a half)

Throat p. 532

Difficulty of swallowing

Deglutition impossible

Stomach p. 532

Considerable nausea (in three hours)

Retching and vomiting

Urinary Organs p. 532

Abundant flow of urine, this secretion having been scanty for a few days (in five hours)

Respiratory Organs p. 532

Expectoration of a thick yellow pus for six or seven days

Respirations slow

Res[)iratiou 20 (before experiment) ; 14 (in three hours and a half) ; 12 (in four hours and a half)

Slow, catching respiration

Difficulty of breathing, with oppression in the precordial region ; the difficulty of breathing rapidly increased, consisting of a series of short and rapid inspirations, followed by three or four prolonged gasps

Struggles for breath

Thought he was going to die from suffocation, until I had his head thrown back, when he said the air rushed into his lungs and relieved him for a time

Respiration scarcely perceptible

Chest p. 532

Pain in chest

Heart and Pulse p. 532

Pulse 98 to 100, and very weak

Pulse 83 (before experiment); 78 (in three hours and a half) ; 53, rose to 65 on walking across the room (in four hours and a half); 53 (in five hours); 63 (in five hours and a half)

Pulse 87 (before experiment) ; 64 (in three hours) ; 84 (in four hours)

After the lapse of one hour the pulse had fallen twenty beats per minute

Pulse weak

Pulse slow

No pulse at the wrist or carotids

Pulseless at the wrists (after one hour and a half)

Superior Extremities p. 532

Could not pour coffee from a cup

Complete insensibility to pain in both arms

Inferior Extremities p. 532

Staggering gait

Weakness in knees (in four hours and a half)

Generalities p. 532

Paralysis

Extremities cold, the pulse small and feeble, respirations sighing and jerking, pupils dilated, and the eyes suffused. There was paralysis of the bladder, the urine dribbling away constantly, and although there was general muscular enfeeblement, it was most marked on the right side, in the arm, and leg

In a few minutes she said she could not see ; her head felt strangely. She took an emetic of mustard, which caused vomiting before the writer arrived. Found the patient in the following condition : Could not see ; the blindness was complete. Neither could she talk or swallow; the glottis was spasmodically closed. She could moan, which she did almost continually ; but the power of articulation was gone. Great trembling, with anxiety ; was afraid she was going to die, and was very anxious to know if anything could be done. Face swollen and of dark color; eyes distended; pu{)ils dilated; great prostration; pulse small and rapid; tongue and throat very dry

At 4.30 P.M., having swallowed two ounces of whiskey, with a view to its stimulating action upon ray pulse, and having walked rapidly some distance, I had a full, strong pulse of 100 per minute, my normal pulse being 85 per minute. I injected under the skin of my left arm five minims fluid extract. I examined my pulse at 5 oclock, and it had fallen to 84; vision a little indistinct; at 5.30 pulse was down to 80 beats per minute ; vision more disturbed. At 6 oclock pulse 76, aud temperature 98i°; disturbance of vision very great. It seemed almost impossible for me to fix my gaze upon any object, and when I succeeded in doing so, tbe object, whatever it happened to be, would fade away at first, and then reappear again. There was a sensation of fulness in my head, aud a feeling of great weight and heaviness about the eyelids. When I opened my eyes to their fullest capacity, it seemed as though they were but half open. At 6.15 pulse was 72, no change in the other symptoms. At 6.30 pulse stood 69. At 7 oclock I partook of a light supper. At 7.45 pulse was 60, and respiration 15; no change in temperature. The disturbance of vision completely passed off at 8 p.m., after which time no uncomfortable symptoms were experienced. At 8.15 pulse 60, respiration 15, aud temperature 97|-°. At 8.45 pulse 59, and temperature 97-|°. At 9.15 jjulse 60. At 9.45 pulse 60, aud temperature 975°. I then arose from the half reclining position which I had occupied during the experiment, and walked across the room rapidly for five minutes. On resuming my former position, my pulse during the first minute indicated 67, but in ten minutes it had fallen again to the old rate of 60 per minute. The temperature was not at all affected by the exercise, the thermometer recording 97f° as before. At 10.30 pulse 58, and temperature 971°; at this time I passed eight ounces of rather high-colored urine. I now ascended two flights of stairs aud returned, but there was no increase in the pulse or temperature produced by the exercise. At 11 p.m., pulse 63, and temperature 97g°; the former very soft and compressible. At 11.30, pulse 60, and of the same character; temperature 96|°. Retired at 12.30, and slept soundly for five hours. Awaking at 7.30 a.m., I walked about several times, after which my pulse was 61, irregular and compressible; temperature 97.4°. During the forenoon I passed an unusually large quantity of urine, and my pulse did not regain its normal force and frequency until 10 oclock in the morning

Vital capacity, average, 185 (before experiment); 217 (after first dose) ; 230 (after second dose) ; 237 (after third dose) ; 236 (after fourth dose) ; 230 (after fifth dose)

Vital capacity, average, 175 (before experiment); 175 (after first dose) ; 190 (after second dose) ; 185 (after third dose),^l

Vital capacity, average, 193 (before drug); 209 (after first dose) ; 207 (after second dose) ; 205 (after third dose),V

Muscular strength, average, 75 (before experiment); 76 (after first dose) ; 67 (after second and third doses); 68 (after fourth dose); 64 (after fifth dose)

Muscular strength, average, 87 (before experiment); 65 (after first dose); 75 (after second and third doses),^l

Average muscular strength, 89 (before experiment) ; 87 (after first dose); 79 (alter second dose); 80 (after third dose)

A sensation of general weakness and relaxation pervaded the entire system. Upon attempting to walk, the gait was at first slightly staggering, resembling that of intoxication (in three hours)

Loss of muscular power

Complete n)muscular relaxation

Any movement or touch of the head (which seemed greatly enlarged) most intensely aggravated all the distressing symptoms, as also did the application of any fluid to the lips, the dread of which was nearly equal to that evinced in hydrophobia

Skin p. 533

Drowsiness (soon)

Fever p. 533

Temperature 98^° (before experiment); 95|° (in three hours)

Extremities cold

Profuse perspiration