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Veratrum. Veratrum viride.

Botanical name:

Related entry: White hellebore

Synonym—American Hellebore.

CONSTITUENTS—
Veratroidin, Jervine, Pseudo-Jervine, Rubi-Jervine, Cevadine, Starch, Resin.
PREPARATIONS—
Tincture Veratri Viridis, Tincture of Veratrum Viride. Dose, from two to ten minims.
Specific Veratrum. Dose, from one-tenth to five minims.

Physiological Action—Taken in moderate doses, Veratrum Viride reduces the pulse rate in a marked degree, which becomes extremely rapid and feeble on any exertion; this condition is followed by severe nausea and vomiting, together with muscular weakness. Taken in a poisonous dose these symptoms are increased in severity, the pulse becomes almost imperceptible, the skin cold and clammy together with vomiting, retching, hiccough, faintness, dizziness, blindness and unconsciousness. These symptoms indicate that the drug is a powerful spinal and cerebral depressant.

Although veratrum is a powerful poison, it is so regular and uniform in its action, and so devoid of erratic and unaccountable or uncontrollable influences, that it can be given within the limits of its maximum dosage with safety.

In overdoses it produces vomiting, usually before enough is absorbed to produce serious results. It is not rapid or violent in its first effects and is not cumulative. It is quickly eliminated and the effects of single doses are transient. It can be watched even when the doses are large, and stopped before harm results. It is really the safest of our active agents. Its poisonous effects are easily antidoted. It is better given in small doses, repeated every half hour or hour, in acute cases, as its influence is exercised in a more uniform manner, is more permanent, is more easily controlled and is not so apt to disturb the stomach. A large dose produces quick depression, although the effect is transient. If the dose be often repeated, the stomachic irritation quickly becomes so great as to interfere with all medication.

Veratrum is a better remedy for adults than for children. It is not as easily adapted to infants and the feeble as aconite, and its manner of action is not as satisfactory.

Veratrum, in its direct heart depression, resembles the coal-tar depressants, although much more regular and uniform in its action and perfectly controllable. It steadily slows the heart and circulation, the temperature declining correspondingly. Its influence upon the emunctories is not marked. Aconite influences the heat production and heat-radiation, stimulates all emunctories and the function of all the glandular organs and hastens the removal of inflammatory products. Effusion or suppuration are thus prevented, and if this agent is begun early, when the temperature has declined, there will be no local lesions remaining to contend with as the results of the inflammatory action.

Veratrum will assist in the removal of morbific products, but not with the immediate influence upon the results of inflammatory actions that are apparent from the use of aconite. It is an active eliminant which provides for its own elimination. Veratrum should not be given when inflammation has resulted in marked structural change and the products of inflammation are plainly present. Here aconite may be given as long as no general depression occurs.

Specific SymptomatologyVeratrum is indicated in the onset of sthenic fever when the pulse is full, large and bounding, and the tissues are engorged, where there is fullness of the capillary circulation.

It is especially serviceable when there seems to be obstruction of the venous capillary circulation. The face and skin are flushed, but usually of a full, dull, dark hue, and not always the bright-red flush with hot, dry skin which indicates aconite and gelsemium. The following indications suggest it.

  • Tongue coated white or yellow with a red streak down the center.
  • Congestion that occurs at the base of the brain.
  • Convulsions that occur as a result of septicemia.
  • Tissues full, not shrunken; marked arterial throbbing with bloodshot eyes.
  • Erysipelas appearing like ordinary inflammation (red).

The skin is usually soft and covered with warm perspiration. In these cases Veratrum reduces the arterial pressure and permits, or even assists, the more rapid removal of the venous obstruction.

In administering veratrum, because of its direct action on the heart it is necessary, if given for a short time only, in full doses, that the patient remain in a recumbent position. In sthenic inflammations, especially such as results from infections—and this includes a long list—and exophthalmic goitre, it exercises a most delightful influence when given in small doses, frequently repeated, the patients should thus get the best results when in a recumbent position, but that position is not then obligatory.

Therapy—The characteristic indications for veratrum are found in the onset of pneumonitis in strong men previously healthy and vigorous. In these cases, given in doses of a drop of the tincture every half hour, it will slow the pulse and slowly reduce the temperature after four or five hours. This effect can be continued for a few doses longer, and then the doses should be smaller or given farther apart. The pulse should be slowed, in a case with violent premonitory symptoms, down to the normal beat and held there for awhile, and if the symptoms do not quickly abate, the influence may be continued until a pulse of sixty or fifty-five, or even, in a strong man, fifty beats is reached, if the stomach be not yet irritated.

In pleuritis, in bronchitis, in peritonitis, especially pelvic peritonitis from sepsis; in hepatitis and nephritis and cystitis always at the beginning of the acute stage before much structural change has occurred, it may be given, and will retard and often throw off the attack. It is of value in the earlier stages of meningitis and cerebritis, if given understandingly. If the violent heart action be controlled, the processes of disease and any tendency to convulsive action will be at once restrained.

In continued fevers this agent, like other depressants of nerve force, is not always the best remedy to use. The reactionary power of the nerve centers is greatly lowered by disease, and if depressants are given they are apt to still further decrease the nerve force and minimize its restorative influence over the system. Advantage will sometimes follow its early use in a case of extremely high temperature with violent and noisy delirium, but it is not the remedy to persist in nor to continue when the prostrating influence of the fever is apparent.

In tonsillitis aconite as an internal remedy is almost specific, but its influence is greatly heightened and the inflammatory stage shortened by applying veratrum with a camel's-hair pencil over the tonsils. Diluted-one dram in a half-glass of water it is an excellent gargle in any inflamed throat. In these cases it aborts the inflammation and determines immediate resolution.

In erysipelas it is of value both internally and externally. For external use in this disease a somewhat dilute non-alcoholic preparation is preferable, or the fluid extract, full strength or diluted one-half.

It is seldom that other applications will be needed, and the force and frequency of the heart's action can well be restrained by its internal use. If begun early in erysipelas, there are few conditions likely to arise that will contraindicate its use.

The first investigators into the properties of veratrum pronounced it an excellent alterative. It has not been generally used as such, but those who have so used it have expressed the strongest confidence in it. Prof. A. L. Clark, writing on the subject in 1889, said: "As an alterative, especially as an antisyphilitic remedy, there is no better agent in the vegetable kingdom. Indeed, there is room for doubt whether the animal, vegetable or mineral kingdoms furnish a better remedy in purely syphilitic cases. If the patient has been already saturated with mercury, as is too often the case, doubtless the administration of some of the preparations of iodine will be a necessary, adjuvant. In the uncomplicated secondary forms of the disease it will be seldom that any other remedy will produce as satisfactory results as can be obtained with the veratrum alone.

Of a reliable fluid extract four or five drops three times a day will be usually well borne by the stomach, and the sensitiveness of that organ is my sole guide in dosage. If four drops disturb the stomach use three for a few days, then increase to four, then perhaps to five. Its smallness of bulk, not disagreeable taste, and, above all, its satisfactory effects, constitute strong recommendations for its use." Perhaps its power in this line increases its efficacy the treatment of puerperal convulsions.

Its alterative and eliminative influence as well as its sedative power caused the older writers to say that veratrum would positively cure puerperal fever.

Other observers have spoken most highly of its action in developing phthisis pulmonalis. Positive claims are made that, judiciously administered, it has aborted the disease.

While I have spoken against its use in continued fevers, there are several writers who have given it in full doses at the onset of typhoid fever, while sthenia was yet present, and have had most salutary results.

In the early stages of acute rheumatism, its indications are present sometimes quite conspicuously, and if given in emphatic doses, it will sometimes quickly terminate the disorder. In articular rheumatism, it may be applied freely, externally, over the swollen and inflamed joints.

In the treatment of rheumatic fever, one writer says that when with the fever there is rapid strong pulse, caused by the toxines, veratrum used as a sedative is especially valuable because of its alterative properties, exercising a double influence, removing the causes of the disorder as satisfactorily as any other known remedy.

It is given in sthenic inflammations with the above symptoms, in erysipelas with general symptoms of inflammation, with a red stripe through the center of the tongue; in nervous irritation, with threatened convulsions; usually those which have suddenly appeared. In these cases the pulse is rapid, but may be full, or it may be corded or sharp, hard and wiry.

In cases where there is previous gastric irritation usually shown by a long, narrow and pointed tongue, with red tip and red edges, the agent will not be of benefit, but will increase that condition. Where there is nausea from the presence of undigested or foreign matter in the stomach, the rapid pulse, etc., being present, its action may be beneficial. In these cases the tongue is usually pale, broad and thick.

For bilious colic Dr. Bates wrote some years ago that he relied upon this remedy.

There are some cases of chorea in which veratrum will serve an excellent purpose. These cases are more or less acute in development, and are usually very violent. The heart is irritable and the pulse rapid.

Dr. Woodward speaks very highly of veratrum in the treatment of asthma. In spasmodic cases he is confident of its beneficial influence, but he has given it principally in those sthenic heart cases where asthmatic breathing has developed within a few days and persists. He gives one or two drops every hour unless unfavorable symptoms occur. He expects favorable results within a few hours. It is a remedy for some cases of hay asthma.

The old writers cautioned against giving large doses of quinine and veratrum, at the same time, as their influences were antagonistic, and Dr. Percy claimed that it was a positive antidote to strychnine poisoning, quickly controlling the spasms and assisting the elimination of the poison.

A satisfactory cure of tetanus, with veratrum and gelsemium, has been reported. The case was one of a young girl, 14 years old, attacked after an operation, for the removal of the ovaries, with a most severe form of tetanus. The case presented the classic symptoms in the extreme. When paraldehyde, morphine, chloral and the bromides had failed, the antitetanic serum was used. This also failed, and the patient was put upon veratrum. Small doses failing, larger doses were given in conjunction with gelsemium. Eight minims of each every hour was given per rectum. The effect was prompt and satisfactory, but the agent was discontinued because of vomiting, when the symptoms returned. Ten minims of veratrum and eight minims of gelsemium were then given every hour, and the symptoms were promptly controlled. There is no doubt that the powerful alterative properties of veratrum add greatly to its efficacy in the control of tetanic mid puerperal convulsions.

It is useful in acute gonorrhea, preventing chordee and abating the activity of the symptoms. It is as useful also in orchitis from whatever cause.

It is a valuable application in localized inflammation, such as boils, carbuncles, felons, ulcers with heat and swelling, "cold sores" on the lips and inflamed pimples.

The use of veratrum as an antispasmodic is now quite common. It may be given in convulsions with active cerebral hyperemia It is especially reliable as an emergency remedy in persistent cases of convulsions in childhood while the cause is being removed, its influence often assisting in the removal of the cause. From one drop to three or four may be given at a single dose, according to the age of the child, and repeated with caution.

In puerperal convulsions the mass of evidence in favor of veratrum is overwhelming. One old physician reported in the Medical Record (1888) an experience in the treatment of an average of eight cases per year for twenty-eight years, without the loss of a patient, with veratrum alone. Another treated twenty-three cases with veratrum, with recovery in all. In these cases full doses are given, closely watching the effects on the stomach, if given per os, and always watching its effects upon the heart. A dose of five drops can be repeated every half hour for three or four doses. At times five drops have been given every half hour for four or five hours. This important influence is exercised through its power to control blood pressure-reducing arterial tension. It is best used hypodermically.

In many severe cases with active cerebral engorgement as much as fifteen drops have been given hypodermically and repeated after a time.

Three drops of the tincture of veratrum twice daily, gradually increasing the dose to twelve drops, then gradually reducing, may be given with care in a desperate case of exophthalmic goiter with tachycardia. This agent at such a time is important. It will usually control the rapidity of the pulse in a satisfactory manner while it materially assists in antidoting the toxins, and thus conduces to the action of other indicated remedies.

In its influence upon exalted activity of the heart, veratrum is of service in palpitation from temporarily increased functional power of the heart—the irritable heart of otherwise strong, vigorous men—the violent action induced by the use of tobacco in some cases inducing high arterial pressure and the palpitation of hypertrophy without valvular incompetence. It is likewise valuable in aneurism, restraining hyperactivity by reducing the vasomotor tonus. In these cases a dose of from three to four drops four times each day will do better than the small and frequently repeated dose.


The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.



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