Internally.-Digestive System.-No special action has been noted, though when excessive doses have been taken nausea and vomiting may ensue.

Circulatory System.-Medicinal doses of gelsemium produce no marked effect, but toxic doses reduce the heart's action, rendering the pulse slower and weaker and lowering arterial tension.

Nervous System.-The drug has no effect upon higher cerebral centers, the mind remaining clear to the last. In large doses it paralyzes the roots of the motor cerebral nerves and the motor areas of the spinal cord, with consequent paralysis of all the muscles of the body. This condition is succeeded by cutaneous anesthesia, due to depression of the receiving center and the sensory tract in the spinal cord. The motor nerves and muscles are unaffected. Convulsions rarely result in man from a poisonous dose, but occur in animals, with backward movements. The exact cause of this action is undetermined.

Respiratory System.-The breathing is rendered slower and shallower, being frequently irregular. Death results from asphyxia, caused by depression and ultimate paralysis of the respiratory center.

Absorption and Elimination.-Gelsemium is speedily absorbed and readily excreted, chiefly by means of the kidneys. Untoward symptoms produced by immoderate amounts of the drug practically subside within three hours after ingestion.

FIG. 8.-Diagram showing how gelsemium produces convergent strabismus: A,A, superior rectus; B,B, external rectus-too weak; C,C, internal rectus; D,D, third nerve; E,E, sixth nerve; F,F, optic nerve; G,G, lesser wing.

Temperature.-Poisonous doses cause a reduction in temper

ature.

Eye.-Under full dosage the pupil is widely dilated and diplopia and marked ptosis ensue. The mydriasis and ptosis are caused by

paralysis of the third nerve. The sixth, which innervates the external rectus muscle, is often depressed more than the third nerve, supplying the internal rectus, producing convergent strabismus, as shown in Figure 8.

The diplopia is caused by the squint and incoördination of the ocular movements. In strabismus the eyes are not directed exactly to the object, and the image does not fall on corresponding parts of the retina; consequently, two perceptions are received in the visual center and two objects apparently seen.

Uterus.-No important action has been observed.

Untoward Action.-This does not essentially differ from that observed in poisoning, though the symptoms may be of a milder form.

Poisoning. In toxic doses gelsemium is quickly fatal. The early symptoms include drooping of the eyelids, wide dilatation and immobility of the pupils, extreme muscular weakness, affecting first the muscles of the upper extremities, and incoordination of movements. Diplopia and dimness of vision may ensue, accompanied by difficulty of speech, coldness of the body surface, and general cutaneous anesthesia, with decidedly lower temperature. Meanwhile, there is marked diminution in the force and frequency of the pulse and respiration.

While the patient may be drowsy, the mind is unaffected until carbonic-acid narcosis supervenes. Death is usually the result of respiratory failure, due to paralysis of the muscles of respiration. (See Plate I.)

Treatment of Poisoning.-The evacuation of the stomach is of the first importance, either by the stomach-pump or by the use of emetics. Washing out with a solution of tannic acid is probably the best method to pursue. External heat should be applied and diffusible stimulants administered, followed by digitalis and strychnine. The hypodermic injection of morphine and atropine is highly recommended in gelsemium-poisoning.

Therapeutics.—Externally and Locally.-The drug is seldom used externally, although it has been employed by ophthalmologists as a mydriatic.

Internally. Clinically, gelsemium is now considered less valuable than formerly. It has been favorably mentioned by certain authors in the treatment of tetanus, mania with motor excitement, and paralysis agitans. Theoretically, it would seem to be of value in certain convulsive disorders, like chorea, pertussis, etc., yet its

use has not met with the success which its action upon the muscular system would indicate.

The drug appears to be more serviceable in trifacial neuralgia, and it seems to be even more efficient in neuralgia with involvement of the inferior dental nerve. In these disorders, as in ovarian neuralgia, dysmenorrhea, etc., for which it has been employed with some success, the drug should be pushed to its physiological limit. Bartholow praised the action of gelsemium in cerebro-spinal meningitis and “acute inflammations of the lungs and pleura." Bulkley is responsible for its use in pruritus and eczema, the itching of which it certainly appears to alleviate.

The therapeutics of gelsemium would perhaps be incomplete without mentioning hemoptysis, remittent fever, acute coryza, migraine, Ménière's disease, and spermatorrhea, in all of which the drug has been used and recommended.

Contraindications.-Diseases accompanied by exhaustion and great muscular weakness.

Administration.-Any of the preparations may be given, the initial dose being small, and the amount increased gradually until dilatation of the pupil or drooping of the eyelids is manifest.

Grindēlia-Grindēlia-Grindelia. U. S. P.

Origin.—The leaves and flowering tops of Grindelia robusta Nutt, and of Grindelia squarrosa Dunal, herbaceous or suffruticose perennials indigenous in the western part of North America and Mexico.

Description and Properties.-Leaves about 2 inches (5 Cm.) long, varying from broadly spatulate or oblong to lanceolate, sessile or clasping, obtuse, more or less sharply serrate, often spinoustoothed or even laciniate-pinnatifid, pale-green, smooth, finely dotted, thickish, brittle; heads many-flowered, subglobular or somewhat conical, the involucre hemispherical, about inch (10 Mm.) broad, composed of numerous imbricated, squarrosetipped, or spreading scales; ray-florets yellow, liqulate, pistillate; disk-florets yellow, tubular, perfect; pappus consisting of two or three awns of the length of the disk-florets; odor balsamic; taste pungently aromatic and bitter.

The principal constituent is probably a resinous substance. It also contains an alkaloid principle, grindeline, and a volatile and a fixed oil.

Dose.-10-60 grains (0.6-4.0 Gm.).