Gelsemium Sempervirens - General symptoms - T.F. Allen

GENERAL

General

After breakfast dull aching in the head, becoming more severe as the day advanced, in the occiput.

headache increased till after dinner, when it was much relieved, but about 4 P.M. returned worse than before, and seemed to increase in severity until in the evening it became excruciating, accompanied with slight nausea.

shaking the head seemed to slightly relieve it (sixth day),.

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 followed 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,.

When writing, headache in the top of the head.

afterwards in the left occipital region, directly on both sides and in the upper cervical region, and again on the top, and then in the left side, all whilst engaged in writing a few minutes.

afterwards a settled, dull, dragging headache, mainly in the occiput, in the mastoid and upper cervical region, extending to the shoulder, relieved while sitting, by reclining the head and shoulders on a high pillow.

in the afternoon (seventh day),.

(As usual, after exercise without breakfast, headache on the right side, with occasional throbbing from exertion; better after a sleep of a few hours, but renewed by exertion; ceased in the evening when sitting, as at other times (ninth day); the semilateral headache returns (tenth day); continues, doubtless caused by the exciting news of the day (twelfth day)),.

Severe pain in the forehead and vertex, with dimness of vision.

roaring in the ears. a sensation of enlargement of the head, and a "wild feeling," a confusion, almost amounting to delirium.

these pains would in turn leave, and the pain in the head would recur immediately after,.

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,.

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 above the other, and there is six inches between them horizontally.

the upper one is to the left.

now the right is upper most.

now 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, 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 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 effort 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,.

Confused vision, especially of distant objects (following vertiginous sensations after breakfast), when turning the eyes the sight is tardy in following the movement, things for several seconds seem to be blurred, the eye remains unfixed in its, new direction, yet no sensation of gauze or film, in part, and finally cured by Aconite ^Acon, it is accompanied with a disposition to partially close the eyes, as if to steady the eyeballs by the pressure of the orbicularis palpebrarum muscles.

the visual confusion might be compared to that produced by alcohol, and gradually wore off by night (second day),.

Burning upon the tongue immediately, which after a few minutes went over the whole mouth and throat, feeling hot like an oven, and thence through the oesophagus into the stomach and abdomen, when the same burning pain passed around in all the intestines.

simultaneously with the descent of the burning pain into the oesophagus, burning in the chest came on, following soon by a stitch in the anterior left lower side of the chest, going through the chest into the left shoulder-blade, and accompanied by weakness and a fluttering and beating of the heart, irregular as to quantity and quality.

these symptoms lasted about three hours (first day),.

Gelsemium produces a peculiar and very marked eruption in most of the provers.

it appears most on the face, less frequently and less conspicuously on the back between the shoulders, etc.

it is papulous, very much the color of the eruption of measles, which it considerably resembles, but the papulae are larger, more distant and distinct.

although very conspicuous, they are attended with little or no sensation, the subject being unaware of their existence until he happens to see himself.

persons have frequently been asked what was the matter, if they had the measles, etc., when they were not aware of the eruption.

this generally appears on the second or third day of the proving, and would seem to be more constantly produced by the 2d or 3d dilution than by the tincture.

the eruption continues one or two weeks, or longer,.

A sore pimple on the left side of the neck at 8 A.M.

the pimple is sore, and has an areola embracing the diameter of a pea, quite red and inflamed (such an eruption not experienced at any other time), (sixth day). Two more pimples, on at the right corner of the os hyoides, the other at the left anterior temporal ridge, above the brow (eighth day). Another pimple, sore to touch, on the left side of the larynx.

the first one less sore, like a small cutaneous induration.

these are like minutes furunculi.

thus far no suppuration (ninth day). The first pimple sorest, the other less so (tenth day),.

Burning in the chest, with fulness, sighing, and anxiousness, going into the pit of the stomach, and radiating all over the whole abdomen like a tree the stem of which is in the pit of the stomach, and the branches of which burn asunder towards the abdomen.

this burning is different in kind from the one observed on the first day.

it is to her feel, not in the intestines, but in the parts covering them.

at 12 M. (fifth day),.

Burning under the lower part of the sternum, with heaviness of the chest, drawing towards the place of the stitch in the left lower anterior side of the chest, which also now is repeated, and pain like ulceration, tender to touch.

as soon as the burning went over to the left side, the chest felt easier.

in the afternoon (eighth day),.

On the 12th of November, at 9 P.M., six drops were taken, at 9.30 six drops more, and at 10 o'clock ten drops.

the results, which were as follows, more also indicated on the chart. Not being perfectly well, there existed either a recoil or dicrotic wave in the preliminary tracing, which in thirty minutes seemed rather to become more prominent, and, but for the records that follow, might be at once set down as a true dicrotous wave, as at this time there will also be seen diminution of compressibility, as shown by diminished amplitude under the same pressure.

the prominence of the waves, whatever its explanation, must be ascribed to a morbid condition, viz., that produced by the influence of the poison administered.

the pulse at this interval has reached a minimum as to frequency, and in ten minutes more shows slight impairment of rhythm.

the new dose of ten drops exhibits its first influence in the tracings in thirty minutes, by increased arterial tension and nervous stimulation, followed however in five minutes by diminution of both, and great decrease in frequency.

from this time on to the end of an hour the tension in the arterial system slowly increased, although the frequency remained nearly the same, and after one hour and a half the appearance of some obstruction, as shown in the flattening of the conjoined apices of the first and second events, was manifest, and irregularity of impulse and of rhythm exhibited the effects of the poison upon the heart. The simple deduction from this investigation, apart from what is already known of the remedy, lies in this, that while reducing the frequency of the pulse, it does so with an increase of arterial tension, and after awhile impairment of the heart's action, indicating a toxic influence upon the nervous system,.

Pulse very uniformly depressed, and rendered less frequent by 10 to 20 beats per minutes, within the last five or ten minutes, if the subject remains quiet, but subject to great variations from exercise.

in one case the pulse increased from 60 to 70 in the first five minutes, but in the next trial it was diminished 10 beats in five minutes,.

After experiencing chills, headache, feverish and prolonged sweating seventeen hours after taking the drug, awakened by severe moving pains in the lower abdomen, soon followed by a very large but natural stool, without relief of the pains, and soon after a deeply bilious discharge, with instant relief of the pain.

nine hours afterwards another bilious evacuation without pain (one case),.

Could not get asleep for a long time.

on falling asleep, a sort of nightmare awoke me again, so that no sleep came.

at last it was like falling asleep, when a second time a kind of nightmare came on, never experienced before.

it was as if the whole left side from the neck along the chest, trunk, and thigh, as far as the knee were a kind of soft muscle, spasmodically jerking up and down, somewhat with the elasticity of a mass of jelly.

this motion extended deep into the interior of the chest, and the centre of this motion seemed to be in the region of the heart.

it was, indeed, one great motion which concerned the whole left side as a mass, with the exception of the head and foot.

this whole half of the body seemed to me to be going up and down, while the right side of the back, on which I lay, was quiet.

I wondered in my mind at this turmoil going on in my body, but was unable to stir.

when I wake up from this condition, I was well aware of what had happened, and found myself quietly lying on the same spot where I had fallen asleep, and the pulse, with everything else, was quiet.

I certainly had not moved, and all, then, was my imagination.

I only felt a drawing pain in te lower third of my left thigh, which was repeated the next day,.

At 10 A.M. I went to the Penn Hospital, where I saw a number of severe wounds.

I am not usually affected much by the sight of wounds, but to-day, that or something else caused very unpleasant sensations.

I became very weak, and my friend remarked that I was very pale, accompanied with nausea and trembling of the lower extremities.

these continued some ten minutes, but disappeared in the open air (sixth day),.

In my own provings, I have frequently experienced a succession of acute, sudden, darting pains, evidently running along the single nerve branches in almost every part of the 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 down the outside and front of the tibia for over half an hour, leaving a line of considerable tenderness marking its track,.

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. pupils 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 my 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 o'clock, 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 o'clock pulse 76, and temperature 98 1/5°.

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, the object, whatever it happened to be, would fade away at first, and then reappear again. There was a sensation of fulness in my head, and a feeling of great weight and heaviness about the eyelids. When I opened my eyes to their fullest capacity, it seemed as through 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 o'clock 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, and temperature 97 2/5°. At 8.45 pulse 59, and temperature 97 2/3°. At 9.15 pulse 60. At 9.45 pulse 60, and temperature 97 2/5°. 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 97 2/5° as before. At 10.30 pulse 58, and temperature 97 1/5°.

at this time I passed eight ounces of rather high-colored urine. I now ascended two flights of stairs and returned, but there was no increase in the pulse or temperature produced by the exercise. At 11 P.M., pulse 63, and temperature 97 1/5°.

the former very soft and compressible. At 11.30, pulse 60, and of the same character.

temperature 96 3/5°. Retired at 12.30, and slept soundly for five hours. Awaking at 7.30 A.M., I 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 o'clock in the morning,.