United States Dispensatory 1926
A Modern Herbal. Mrs. M. Grieve. F.R.H.S.
Boericke�s Homeopathic Materia Medica
Compiled and edited by Ivor Hughes.

United States Dispensatory 1926
GELSEMIUM Gelsem. [Yellow Jasmine Root, Yellow Jessamine]

" Gelsemium consists of the dried rhizome and roots of Gelsemium sempervirens (Linne) Persoon (Fam. Loganiaceae). Gelsemium contains not more than 2 per cent, of foreign organic matter." N. F.

" Gelsemium Root is the dried rhizome and root of Gelsemium nitidum, Michaux." Br.

Gelsemii Radix, Br.; Gelsemium Root, Yellow Jasmine, Yellow Jessamine, Carolina or American Yellow Jessamine, Yellow or Evening Trumpet Flower; Gelsemium, Fr. Cod.; Jasmin sauvage, Fr.; Gelsemie, Giftjasmin, G.; Gelsemio, Sp

The yellow or Carolina Jessamine (Gelsemium sempervirens) is one of the most beautiful climbing plants of our Southern States, ascending lofty trees, and forming festoons from one tree to another, and during its flowering season, in the early spring, scenting the atmosphere with its delicious odor. The stem is twining, smooth, and shining; the leaves opposite, nearly persistent, short, petiolate, lanceolate, entire, dark green above, and paler beneath; the flowers in axillary clusters, large, of a deep-yellow color, and fragrant, with a very small, five-leaved calyx, and a funnel-shaped corolla, having a spreading, five-lobed, nearly equal border. The fruit is a flat, 2-loculed, compressed capsule containing flattened seeds. The plant grows in rich, moist soils along the sea-coast from Virginia to the south of Florida and Texas. The flowers are said to be poisonous. The drug is collected in autumn, washed and dried. The commercial supplies come chiefly from Virginia, North and South Carolina and Tennessee. Gelsemium elegans Benth., of upper Burma, is an extremely poisonous creeper which contains gelsemine or an allied alkaloid. This official plant must not be confounded with the true yellow jasmine of Madeira, often planted in the Southern States, which is the Jasminum odoratissimum L., which also has very fragrant yellow flowers.

Description and Physical Properties. � " Unground Gelsemium.�Rhizome cylindrical, usually in pieces from 3 to 20 cm. in length and from 3 to 30 mm. in diameter; externally light yellowish brown, longitudinally wrinkled, with purplish brown longitudinal lines and transverse fissures; the upper surface with a few stem-scars; fracture tough, splintery, internally light brown or pale yellow, bark thin, wood distinctly radiate, excentric, pith disintegrated. Roots light brown, fracture one-half transverse, the other oblique or splintery. Odor slight; taste bitter.

" Structure.� Rhizome with a strong development of cork, the walls being grayish or yellowish brown and more or less lignified; a cortex made up chiefly of parenchyma containing starch and having in the outer portion small scattered groups of stone cells or fibers, and in the inner portion in the region of the medullary rays prisms of calcium oxalate; woody portion made up of broad wedges consisting of large tracheae and thick-walled tracheids and separated by medullary rays, the cells of which are usually strongly lignified in the xylem but non-lignified in the phloem and contains starch or prisms of calcium oxalate; an internal phloem, the cells forming distinct, more or less rounded groups, the latter being partly surrounded by a thin-walled starch-bearing pith.

" Powdered Gelsemium. � Dark yellow, tracheae with bordered pores numerous and conspicuous; spiral trachea and bast-fibers few; thick-walled tracheids long and narrow, strongly lignified; starch grains spherical, from 0.004 to 0.012 mm. in diameter; calcium oxalate in monoclinic prisms from 0.015 to 0.032 mm. in length; occasional groups of stone cells or fibers, the walls being very thick, porous and strongly lignified." N. F. ,

" In nearly cylindrical pieces about fifteen centimetres or more long, and usually from six to eighteen millimetres thick; occasionally with fibrous rootlets attached. Fracture splintery. In transverse section, a thin cortex, and a porous, yellowish, distinctly radiate wood with numerous, conspicuous, straight medullary rays. Rhizome usually with a brown or dark brownish-violet cork, often much fissured; nearly straight, and exhibiting silky fibres in the bast. Root yellowish-brown, finely wrinkled, and somewhat tortuous. Slightly aromatic odor; taste bitter." Br.

The chief diagnostic feature of gelsemium rhizome is seen in its cross section which shows four masses of internal phloem on the inner face of the xylem zone. For studies of the structure of gelsemium, see A. J. P., 1898, 398; A. J. P., 1899, 422; D. C., 1901, 244; Merck's Sep., 1908, p. 86. Tunmann (Ph. Zentralh., 1907, p. 679) has made a pharmacognostic study of gelsemium and has proposed its identification through the micro sublimation of aesculin. Tutin (P. /., Feb. 10, 1912) has shown that the sublimate obtained by Tunmann from gelsemium root must have consisted of scopoletin. Tutin further states that " The detection of scopoletin in gelsemium may prove to be a valuable means of distinguishing this drug from others of a similar appearance, such as that derived from Gelsemium elegans Benth., but it is doubtful whether the sublimation method is the most convenient one. If 0.5 gramme of ground gelsemium be heated in a test tube with chloroform, the mixture filtered, and the filtrate shaken with water to which a few drops of dilute ammonia have been added, the aqueous layer, on separation, will be found to show a distinct, blue fluorescence, thus indicating the presence of scopoletin."

Sayre {A. J. P., 1897, 8) found specimens of the rhizome mixed with considerable proportions of the stem. The latter differs microscopically from the rhizome in possessing collenchyma-containing chloroplastids in the outer region of the cortex and sclerenchyma fibers in the pericycle. Ingham (A. J. P., 1897, 234) found that there was not much difference between the root and rhizome in alkaloidal value, but the stem does not appear to contain either gelsemine or gelsemic acid. (See also A. J. P., 1897, 140.) Gelsemium yields its virtues to water, and readily to diluted alcohol.

Constituents. � In 1855 Henry Kollock found in gelsemium gum, starch, pectic acid, albumen, gallic acid, fixed oil, a fatty resin, a dry acrid resin, yellow coloring matter, volatile oil, extractive, lignin, a peculiar alkaloid called gelsemine-, and mineral salts. The alkaloid, however, was not obtained sufficiently pure to admit of a full investigation of its properties. Theo G. Wormley (A. J. P., 1870) obtained pure gelsemine from the root and a peculiar acid, which he called gelseminic (gelsemic) acid.

Wormley obtained the acid by acidulating a concentrated aqueous solution of the drug and extracting with ether. (For details of his method, see U. S. D., 19th ed., p. 578.) The acid, when pure, is colorless, inodorous, almost tasteless, and readily crystallizable, usually in groups or tufts of fine needles. The action of concentrated nitric acid upon gelsemic acid or any of its salts, produces a yellow, reddish, or red solution, which, if treated with ammonia in excess, becomes of a deep blood-red color, lasting for hours. The one-thousandth of a grain will exhibit these changes. Potassium, sodium, or ammonium hydroxide, added to the acid, cause it to become intensely yellow, and form with it highly fluorescent solutions. The acid is fusible, and, at a high heat, volatilizable without change. Robbins (B. Chem. G., 1876, 1182) stated that it was identical with aesculin (the glucoside of the horse-chestnut), and gave it the formula C15H16O9 + 1� H2O. But Coblentz (Proc. A. Ph. A., 1897, 225) showed that it differs from aesculin in several particulars, and gave for its formula C13H11O5, which melts at 206� C. E. Schmidt believes that Wormley's gelsemic acid is identical with scopoletin derived from scopola root, and gives the name as β-methylaeculin, C9H5 (CH3) 04.

Gelsemine as obtained by Wormley is a brittle, transparent solid, crystallizing with difficulty from alcohol. Boiling water sparingly dissolves it. It softens at 38� C., and fuses at 45� C. The pure base gives no color reaction with strong nitric acid, and the mixture is scarcely changed in color by heating. Strong sulphuric acid has no apparent action upon it; but if to the mixture a little manganic oxide be added and then rubbed with a glass rod, a deep crimson-red is obtained, passing to green. This reaction is so delicate that it can be demonstrated with a solution of 1 in 100,000. If this reaction be performed upon the pure alkaloid, the color may be sufficiently intense to cause it to be mistaken for strychnine, but if a parallel experiment be carried on with strychnine, the two alkaloids cannot be mistaken, for the strychnine gives an intense purple, passing to red. It was probably not a pure substance. Moore (Tr. Chem. Soc., 1910, xcvii; 1911, xcix) gives the formula as C20H22O2N2. He also confirms the presence of a second alkaloid gelseminine, originally announced by F. A. Thompson (Ph. Era, 1887, p. 3).

Sayre (J. A. Ph. A., 1912, p. 458; 1913, p. 436; 1914, p. 314, and 1915, p. 60) has found two alkaloids differing in physiological activity and color reactions, the one of which he called gelseminine (the former name for the combination of the two), and the other gelsemoidine, which was later changed to sempervirine. This latter alkaloid is similar in some of its_properties to cinchonamine, particularly in the matter of the insolubility of its salts in water. Sayre also calls attention to the fact that the alkaloid commercially supplied under the name gelseminine is usually the crystalline alkaloid gelsemine. He states that the principles obtained by him show the following color reactions with sulphuric acid and manganic oxide: Gelsemine, at first crimson, then green, and finally yellow; gelseminine, at first brown, then pink, and finally yellow; gelsemoidine, at first purple and finally blue.

Uses. � According to the researches of Cushny (A. E. P. P., 1892, xxxi, 49) gelseminine is so much more powerful than gelsemine that it is improbable that the latter alkaloid plays any part in the effect of the whole drug in mammals. Gelseminine is a depressant to the centers in the spinal cord and, in large doses, also paralyzes the peripheral motor nerves. Gelsemine acts, in the frog, much like strychnine, causing convulsions, by stimulating the spinal cord, which are followed by paralysis due to an effect on the motor nerves. In toxic quantities gelsemium lowers the blood pressure, probably by a direct action on the heart, but death is usually brought about through respiratory failure. When locally applied, or if given internally in poisonous dose, it causes dilatation of the pupil with loss of accommodation.

Formerly gelsemium was used as an arterial sedative and febrifuge in various sthenic fevers, but is probably useless for this purpose. Bartholow (Pract., 1870) has recommended it in spasmodic disorders, as asthma and whooping cough. It is, at present, rarely used except in the treatment of neuralgias, especially those involving the facial nerves. The mode of its action in these cases is obscure, but there is considerable clinical evidence of its utility.

Toxicology. � The symptoms of gelsemium. poisoning are: dizziness dimness of vision, dilated pupil, general muscular debility, and universal prostration, reducing the frequency and force of the pulse, and the frequency of respiration. After very pronounced poisonous doses the symptoms which have just been enumerated are intensified; double or impaired vision, ptosis, dilated insensible pupils, falling of the lower jaw, loss of power of enunciation, and excessive muscular relaxation are associated with slow, labored breathing, which in some cases is interrupted by violent spells of dyspnea; consciousness is long unimpaired, but is apt to be lost before death, and in rare cases unconsciousness has been present, even although recovery followed.

Of the various symptoms of gelsemium poisoning the most characteristic are the dropping of the jaw and the ocular manifestations, combined with general muscular relaxation. The effects usually begin in half an hour, but sometimes almost immediately. According to "Wormley, death has occurred at periods which vary from one to seven and a half hours. Twelve minims of the fluidextract are said to have proved fatal to a boy three years old, and thirty-five drops of a tincture of the bark have caused death in one hour and a half. In several instances a drachm of the fluidextract has, under treatment, been recovered from.

The treatment of poisoning by gelsemium should consist in evacuating the stomach, maintaining absolute rest in the horizontal position, keeping up the bodily temperature, if required, by external warmth, and administering spinal and arterial stimulants. We have very little experimental data as to the physiological antidotes to gelsemium. Our general knowledge indicates that ammonia, strychnine, and digitalis given hypodermically should be of service in the treatment of the poisoning. Artificial respiration is of service.

Dose, of gelsemium, one-half to two grains (0.03-0.13 Gm.).
Off. Prep. � Tinctura Gelsemii, Br., N. F.; Elixir Sodii Salicylatis Compositum (from Fluidextract), IV. F.; Fluidextractum Gelsemii, N. F.

A Modern Herbal. Mrs. M. Grieve. F.R.H.S
GELSEMIUM. Gelsemium nitidum (MICH.)
N.O. Loganiaceae
Synonyms. Yellow Jasmine. Gelsemium Sempervirens (Pers.). False Jasmine. Wild Woodbine. Carolina Jasmine
Part Used. Root
Habitat. Gelsemium is one of the most beautiful native plants of North America, occurring in rich, moist soils, by the sides of streams, along the seacoast from Virginia to the south of Florida, extending into Mexico.

The important drug Gelsemium, official in the principal Pharmacopoeias, is composed of the dried rhizome and root of Gelsemium nitidum (Michaux), a climbing plant growing in the southern States of North America and there known as Yellow Jasmine, though it is in no way related to the Jasmines, and is best distinguished as Caroline Jasmine, as it belongs to the Loganiaceae, an order that forms a connecting link between the orders Gentianaceae, Apocynaceas, Scrophulariaceae and Rubiaceae. The plant is not to be confounded with the true Yellow Jasmine (Jasminum odoratissimum), of Madeira, which is often planted in the southern States for the sake of its fragrant flowers and has also been known there under the name of Gelsemium; this has only two stamens, while Gelsemium has five.

Description. Its woody, twining stem often " attains great height, its growth depending upon its chosen support, ascending lofty trees and forming festoons from one tree to another. It contains a milky juice and bears opposite, shining and evergreen lanceolate leaves and axillary clusters of from one to five large, funnel-shaped, very fragrant yellow flowers, which during its flowering season, in early spring, scent the atmosphere with their delicious odour. The fruit is composed of two separable, jointed pods containing numerous, flat-winged seeds. The stem often runs underground for a considerable distance, and these portions (the rhizome) are used indiscriminately with the roots in medicine, and exported from the United States in bales. The plant was first described in 1640 by John Parkinson, who grew it in his garden from seed sent by Tradescant from Virginia; at the present time it is but rarely seen, even in botanic gardens, in Great Britain, and specimens grown at Kew have not flowered.

Description of the Drug. The drug in commerce mostly consists of the underground stem or rhizome, with occasional pieces of the root. The rhizome is easily distinguished by occurring in nearly straight pieces, about 6 to 8 inches long, and � to � inch in diameter, having a small dark pith and a purplish-brown, longitudinally fissured bark. The root is smaller, tortuous, and of a uniform yellowish-brown colour, finely wrinkled on the surface. Both rhizome and root in transverse section exhibit a distinctly radiate appearance, the thin cortex or bark enclosing a large, pale, yellowish-white wood, which consists of narrow bundles with small pores, alternating with straight, whitish, medullary rays about six or eight cells in thickness. In the case of the rhizome, a small pith, frequently divided into four nearly equal parts, is also present, particularly in smaller and younger pieces. The drug is hard and woody, breaking with an irregular splintery fracture, and frequently exhibits silky fibres in the bast, which are isolated, or occur in groups of two or three and form an interrupted ring, whereas in the aerial stem, they are grouped in bundles. The drug has a bitter taste, due to the presence of alkaloids, which occur chiefly in the bark. The slight aromatic odour is probably due to the resin in the drug.

Collection. Adulterations. The drug is commonly collected in the autumn and dried. Though consisting usually of the dried rhizomes with only the larger roots attached, sometimes smaller roots are present, and it is often adulterated with the aerial portions of the stem, which can be easily detected by the thinness and dark-purplish colour of the latter. It is stated to be destitute of alkaloid and therefore of no medicinal value. Similar roots of Jasmine, especially those of Jasminum fruticans, are sometimes intermixed, and can be distinguished by the absence of indurated pith cells, which occur in Gelsemium, by the abundance of thin-walled starch cells in the pith and in the medullary ray cells (those of Gelsemium being thick-walled and destitute of starch), and by the bast fibres round the sieve tubes.

Constituents. Gelsemium contains two potent alkaloids, Gelseminine and Gelsemine. Gelseminine is a yellowish, bitter and poisonous amorphous alkaloid, readily soluble in ether and alcohol, forming amorphous salts.

The alkaloid Gelsemine is colourless, odourless, intensely bitter and forms crystalline salts. It is only sparingly soluble in water, but readily forms a hydrochloride, which is completely so. This alkaloid is not to be confounded with the resinoid known as 'Gelsemin,' an eclectic remedy, a mixture of substances obtained by evaporating an alcoholic extract of Gelsemium to dryness. The rhizome also contains Gelsemic acid, a crystalline substance which exhibits an intense bluish-green fluorescence in alkaline solution; it is probably identical with methyl-aesculatin or chrysatropic acid found in Belladonna root. There are also present in the root 6 per cent, of a volatile oil, 4 per cent, of resin and starch.

Poisoning by Gelsemium. The drug is a powerful spinal depressant; its most marked action being on the anterior cornus of grey matter in the spinal cord. The drug kills by its action on the respiratory centre of the medulla oblongata. Shortly after the administration of even a moderate dose, the respiration is slowed and is ultimately arrested, this being the cause of death. Poisonous doses of Gelsemium produce a sensation of languor, relaxation and muscular weakness, which may be followed by paralysis if the dose is sufficiently large. The face becomes anxious, the temperature subnormal, the skin cold and clammy and the pulse rapid and feeble. Dropping of the upper eyelid and lower jaw, internal squint, double vision and dilatation of the pupil are prominent symptoms. The respiration becomes slow and feeble, shallow and irregular, and death occurs from centric respiratory failure, the heart stopping almost simultaneously. Consciousness is usually preserved until late in the poisoning, but may be lost soon after the ingestion of a fatal dose. The effects usually begin in half an hour, but sometimes almost immediately. Death has occurred at periods varying from 1 to 7� hours.

The treatment of Gelsemium poisoning consists in the prompt evacuation of the stomach by an emetic, if the patient's condition permits; and secondly, and equally important, artificial respiration, aided by the early administration, subcutaneously, of ammonia, strychnine, atropine or digitalis. An allied species, G. elegans (Benth.) of Upper Burma, is used in China as a criminal poison; its effects are very rapid.

Medicinal Action and Uses. Antispasmodic, sedative, febrifuge, diaphoretic.

The medical history of the plant is quite modern. It is stated to have been brought into notice by a Mississippi planter for whom, in his illness, the root was gathered in mistake for that of another plant. After partaking of an infusion, serious symptoms arose, but when, contrary to expectations, he recovered, it was clear that the attack of bilious fever from which he had been suffering had disappeared. This accidental error led to the preparation from the plant of a proprietary nostrum called the 'Electric Febrifuge.' Later, in 1849, Dr. Porcher, of South Carolina, brought Gelsemium to the notice of the American Medical Association. Dr. Henry, in 1852, and after him many others, made provings of it, the chief being that of Dr. E. M. Hale, whose Monograph on Gelsemium was an efficient help to the true knowledge of the new American drug.

In America, it was formerly extensively used as an arterial sedative and febrifuge in various fevers, more especially those of an intermittent character, but now it is considered probably of little use for this purpose, for it has no action on the skin and no marked action on the alimentary or circulatory system. It has been recommended and found useful in the treatment of spasmodic disorders, such as asthma and whooping cough, spasmodic croup and other conditions depending upon localized muscular spasm. In convulsions, its effects have been very satisfactory.

It is, at present, mainly used in the treatment of neuralgic pains, especially those involving the facial nerves, particularly when arising from decaying teeth. It is said it will suspend and hold in check muscular irritability and nervous excitement with more force and power than any known remedy. While it relaxes all the muscles, it relieves, by its action on the general system, all sense of pain.The drug is also said to be most useful in the headache and sleeplessness of the drunkard and in sick headache. It has been used in Dysmenorrhaea, hysteria, chorea and epilepsy, and the tincture has been found efficacious in cases of retention of urine. Some recommend its use in acute rheumatism and pleurisy, in pneumonia and in bronchitis, and it has been advocated, though not accepted by all authorities, as of avail in the early stages of typhoid fever.

Boericke�s Homeopathic Materia Medica
Yellow Jasmine)
Centers its action upon the nervous system, causing various degrees of motor paralysis. General prostration. Dizziness, drowsiness, dullness, and trembling. Slow pulse, tired feeling, mental apathy. Paralysis of various groups of muscles about the eyes, throat, chest, larynx, sphincter, extremities, etc.. Post-diphtheritic paralysis. Muscular weakness. Complete relaxation and prostration. Lack of muscular co-ordination. General depression from heat of sun. Sensitive to a falling barometer; cold and dampness brings on many complaints. Children fear falling, grab nurse or crib. Sluggish circulation. Nervous affections of cigar makers. Influenza. Measles. Pellagra.

Mind. � Desire to be quiet, to be left alone. Dullness, languor, listless. "Discernings are lethargied." Apathy regarding his illness. Absolute lack of fear. Delirious on falling to sleep. Emotional excitement, fear, etc., lead to bodily ailments. Bad effects from fright, fear, exciting news. Stage fright. Child starts and grasps the nurse, and screams as if afraid of falling. [Bor.]

Head. � Vertigo, spreading from occiput. Heaviness of head; band-feeling around and occipital headache. Dull, heavy ache, with heaviness of eyelids; bruised sensation; better, compression and lying with head high. Pain in temple, extending into ear and wing of nose, chin. Headache, with muscular soreness of neck and shoulders. Headache preceded by blindness; better, profuse urination. Scalp sore to touch . Delirious on falling asleep. Wants to have head raised on pillow.

Eyes. � Ptosis; eyelids heavy; patient can hardly open them. Double vision. Disturbed muscular apparatus. Corrects blurring and discomfort in eyes even after accurately adjusted glasses. Vision blurred, smoky. [Cycl; Phos.] Dim-sighted; pupils dilated and insensible to light. Orbital neuralgia, with contraction and twitching of muscles. Bruised pain back of the orbits. One pupil dilated, the other contracted. Deep inflammations, with haziness of vitreous. Serous inflammations. Albuminuric retinitis. Detached-retina, glaucoma and descemetitis. Hysterical amblyopia.

Nose. � Sneezing; fullness at root of nose. Dryness of nasal fossae. Swelling of turbinates. Watery, excoriating discharge. Acute coryza, with dull headache and fever.

Face. � Hot heavy, flushed, besotted-looking. [Bapt.; Op.] Neuralgia of face. Dusky hue of face, with vertigo and dim vision. Facial muscles contracted, especially around the mouth. Chin quivers. Lower jaw dropped.

Mouth. � Putrid taste and breath. Tongue numb, thick, coated, yellowish, tremble, paralyzed.

Throat. � Difficult swallowing, especially of warm food. Itching and tickling in soft palate and naso-pharynx. Pain in sterno-cleido-mastoid, back of parotid. Tonsils swollen. Throat feels rough, burning. Post-diphtheritic paralysis. Tonsillitis; shooting pain into ears. Feeling of a lump in throat that cannot be swallowed. Aphonia. Swallowing causes pain in ear. [Hep.; Nux.] Difficult swallowing. Pain from throat to ear.

Stomach. � As a rule, the Gelsemium patient has no thirst. Hiccough; worse in the evening. Sensation of emptiness and weakness at the pit of the stomach, or of an oppression, like a heavy load.

Stool. � Diarrhoea from emotional excitement, fright, bad news. [Phos. ac.] Stool painless or involuntary. Cream-colored [Calc.], tea-green. Partial paralysis of rectum and sphincter.

Urine. � Profuse, clear, watery, with chilliness and tremulousness. Dysuria. Partial paralysis of bladder; flow intermittent. [Clematis.] Retention.

Female. � Rigid os. [Bell.] Vaginismus. False labor-pains; pains pass up back. Dysmenorrhoea, with scanty flow; menses retarded. Pain extends to back and hips. Aphonia and sore throat during menses. Sensation as if uterus were squeezed. [Chain.; Nux v.; Ustilago.]

Male. � Spermatorrhoea, without erections. Genitals cold and relaxed. [Phos. ac.] Scrotum continually sweating. Gonorrhea, first stage; discharge scanty; tendency to corrode; little pain, but much heat; smarting at meatus.

Respiratory. � Slowness of breathing, with great prostration. Oppression about chest. Dry cough, with sore chest and fluent coryza. Spasm of the glottis. Aphonia; acute bronchitis, respiration quickened, spasmodic affections of lungs and diaphragm.

Heart. � A feeling as if it were necessary to keep in motion, ir clue heart's action would cease. Slow pulse. [Dig.; Kalm.; Apoc. can.] Palpitation; pulse soft, weak, full and flowing. Pulse slow when quiet, but greatly accelerated on motion. Weak, slow pulse of old age.

Back. � Dull, heavy pain. Complete relaxation of the whole muscular System. Languor; muscles feel bruised. Every little exertion causes fatigue. Pain in neck, especially upper sternocleido muscles. Dull aching in lumbar and sacral region, passing upward. Pain in muscles of back, hips, and lower extremities, mostly deep-seated.

Extremities. � Loss of power of muscular control. Cramp in muscles of forearm. Professional neuroses. Writer's cramp. Excessive trembling and weakness of all limbs. Hysteric convulsions. Fatigue after slight exercise.

Sleep. � Cannot get fully to sleep. Delirious on falling asleep. Insomnia from exhaustion; from uncontrollable thinking; tobacco. Yawning. Sleepless from nervous irritation. [Coffea.]

Fever. � Wants to be held, because he shakes so. Pulse slow, full, soft, compressible. Chilliness up and down back. Heat and sweat stages, long and exhausting. Dumb-ague, with much muscular soreness, great prostration, and violent headache. Nervous chills. Bilious remittent fever, with stupor, dizziness,

faintness; thirstless, prostrated. Chill, without thirst, along spine; wave-like, extending upward from sacrum to occiput.

Skin. � Hot, dry, itching, measle-like eruption. Erysipelas. Measles, catarrhal symptoms; aids in bringing out eruption. Retrocedent, with livid spots. Scarlet fever with stupor and flushed face.

Modalities. � Worse, damp weather, fog, before a thunderstorm, emotion, or excitement, bad news, tobacco-smoking, when thinking of his ailments; at 10 a. m. Better, bending forward, by profuse urination, open air, continued motion, stimulants.

Relationship. � Compare: Ignatia (gastric affections of cigar makers); Baptisa; Ipecac.; Aeon.; Bell.; Cimicif.; Magnes.phos. (Gelsem. contains some Magnes. phos.) Culex � (vertigo on blowing the nose with fullness of the ears.)

Antidotes: China; Coffea; Dig. Alcoholic stimulants relieve all complaints where Gelsem. is useful.

Dose. � Tincture, to thirtieth attenuation; first to third most often used.

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