Forms of Veratrum. Veratrum viride, American Hellebore or Poke root, (nat. ord. Liliaceae);—Veratrum album, European Hellebore;and Veratrum sabadilla, or Asagraea officinalis, the Mexican variety. Of these the first alone is official in the U. S. Phar., though an alkaloid or mixture of alkaloids from the Veratrum sabadilla is recognized under the name Veratrine.
Alkaloids in each plant, are as follows,—
- In Veratrum viride,—Jervine, Pseudo-jervine, Cevadine, Rubijervine.
- In Veratrum album,—Jervine, Pseudojervine, Veratralbine, Rubijervine.
- In Veratrum sabadilla,—Veratrine, Cevadine, Cevadilline.
- Veratroidine is now considered a mixture of Rubijervine and a toxic Resin.
- Extractum Veratri Viridis Fluidum,—from the root. Dose, ♏j-v.
- Tinctura Veratri Viridis,—40 per cent. of the root. Dose, ♏ij-x.
- *Norwood's Tincture of Veratrum Viride,—has a very high reputation for efficiency. Dose, ♏v, increased by ♏j every three hours, until the pulse is down to 65, when the original dose will keep it there.
- Veratrina, Veratrine,—a mixture of alkaloids, prepared from the seeds of Asagraea officinalis. Dose, gr. 1/50-1/10.
- Oleatum Veratrinae,—strength, 2 per cent. in Oleic Acid.
- Unguentum Veratrinae,—strength, 4 per cent. For local use.
Physiological Action. The action of Veratrum Viride is closely allied to that of Aconite, being a powerful cardiac depressant and spinal paralyzant. It differs from Aconite in affecting the respiration to a much less degree,—in being a systemic emeto-cathartic-in paralyzing the motor system centrally, -impairing the reflexes, but leaving sensation unimpaired,—and in having little or no diaphoretic or diuretic action. It causes great depression, but is seldom fatal; when death does result from its use it usually occurs by paralysis of the heart. In small doses it reduces the force of the pulse, but does not at first affect its rate. If continued for some time, the pulse becomes very slow, soft and compressible; rising, on the least exertion, to be very rapid and feeble. At the same time there is great muscular weakness, and frequently nausea and vomiting. Large doses increase these symptoms very much, the pulse becoming very rapid and so small as to be almost imperceptible; the skin is cold and clammy, and constant vomiting, extreme debility, giddiness, impaired vision, and partial unconsciousness ensue.
Jervine represents in part the depressant action on the circulation and on the central nervous system. It does not, however, affect the vagus, and but very slightly the voluntary muscles or the motor nerves. It irritates the motor centres in the brain, causing convulsions; and lowers the functions of the cord, of the centres in the medulla, especially the vaso-motor, and those of the cardiac ganglia,—slowing the heart by direct depression either of the cardiac muscle or its motor apparatus. It always causes salivation, but never vomiting or purging; and kills by asphyxia, the heart beating after respiration has ceased.
Veratroidine, on the contrary, always causes emeto-catharsis, and produces less violent convulsions. It stimulates the vagus centre and paralyzes the vagus ends, depresses the cord, and paralyzes the respiratory centre,—but at the same time increases the excitability of the vaso-motor centre. The result is great slowing of the pulse-rate and of respiration, and lowering of blood pressure, until the carbonized blood irritates the vaso-motor centre, when the blood-pressure rises greatly. It probably consists of Rubijervine and a toxic resin.
Veratrum Album contains a very powerful alkaloid, Veratralbine, and also an irritant poisonous resin (?). Its general action is similar to that of its congener, but it is much more irritant to the gastro-intestinal mucous membrane, causing violent vomiting and purging, intense abdominal and oesophageal pain, greatly reduced temperature and pulse, collapse, and death from cardiac and respiratory paralysis.
Veratrine is an acrid, intensely irritant powder, consisting of a mixture of alkaloids. It causes violent sneezing, a burning sensation, and free salivation. It affects the heart and circulation similarly to the other Veratriae, and in addition seems to be a direct poison to muscular tissue, and to cause violent convulsions before the muscular paralysis sets in. The alkaloids Jervine and Rubijervine both depress the circulation, while the latter produces the emeto-catharsis.
Treatment in Veratrum Poisoning,—is similar to that for Aconite. Morphine and Atropine antagonize the cardiac depression,—also Alcohol, Ammonia, etc. The recumbent position should be maintained, and dry heat applied to the general surface.
Therapeutics. Veratrum Viride is inferior to Aconite in fevers and inflammations, by reason of its lack of power over excretion, but is used as an arterial sedative with excellent results in—
- Aneurism,—to depress the circulation to the lowest point; the recumbent posture must be strictly observed, to secure safety to the heart.
- Cardiac Disorders, such as simple hypertrophy, irritable heart,—Veratrum Viride is often used with great benefit.
- Acute Mania and Puerperal Convulsions, it has frequently been employed with remarkably good results, but has often failed.
- Parenchymatous and Serous Inflammations, in their early stages,—Veratrum Viride renders good service, especially in Pneumonia.
- Superficial Neuralgiae,—the Oleate or Unguentum Veratrinae externally.
- Myalgia and Headaches may often be relieved by the same application.
- Puerperal Fever,—when due to metritis Veratrum Viride is highly extolled by Fordyce Barker and other authorities of standing.
- Cholera, during the algid stage, Veratrum Album has been used, but other agents are far more efficient.
A Compend of Materia Medica, Therapeutics, and Prescription Writing, 1902, by Sam'l O. L. Potter, M.D., M.R.C.P.L.