The root of Veratrum viride.—U.S.
Preparation.—A tincture of the fresh or recent root gathered in the Autumn in low and damp lands.
Dose.—The dose of Veratrum will vary from the fraction of a drop to gtt. x. to gtt. xx., according to the condition of disease, and the object for which it is administered. Whilst in a case of violent puerperal fever, with a temperature of 107°, or an intense inflammation of the lungs or some other part that imperils life within a few hours, the large dose may be demanded, in the larger number of cases the usual gtt. x. to water ℥iv., a teaspoonful every hour, will be a sufficient quantity.
Specific Indications.—The pulse is frequent and full, the surface flushed, the temperature above the normal standard.
The indications are very simple, yet as true as simple. The pulse frequent and full; it may be bounding or it may be hard, but the touch gives the sense of a large current of blood running rapidly. Aconite is the remedy for a small and frequent pulse. Rhus for the small pulse vibratile, or with sharp stroke. The flushed surface is a characteristic symptom, whilst increase of temperature is met by a large number of remedies.
In very minute doses, it may be sometimes administered when the pulse is small and frequent, the surface pallid and cold, and the temperature below the normal standard. But in my experience, when the remedy has proven beneficial in these, the patient has the sense of extreme heat, though deathly cold.
Therapeutic Action.—The Veratrum viride is an arterial sedative, but if given in large doses it will produce emesis and irritation of the stomach. Mr. Worthington tested it upon himself. "He took the fourth of a grain of the alcoholic extract, which caused an acrid burning sensation in the mouth, and communicated to the throat and fauces a sense of dryness and heat, which finally reached the stomach. In the course of an hour, this dryness and burning sensation in the throat and stomach became intense, and a disposition to hiccough was excited, which soon commenced, gradually increasing in frequency till it reached fifteen or twenty times per minute. This was attended with some sickness and retching till vomiting took place. This was violent, and seemed to come on about every ten or fifteen minutes for the space of an hour. During this time, dizziness and tremor were created, which passed off with the dose. With the hiccough there was a copious secretion of saliva, and discharge of mucus from the stomach and the nose. During the action of this dose, the pulse was weakened so as to be scarcely perceptible, and reduced from sixty-eight to fifty-two pulsations per minute." We have observed similar symptoms, only more severe, in a case in which fʒss of the tincture was taken by mistake in place of tincture of Gelseminum; in this case the pulse was reduced from about 100 to 40 beats per minute. The prostration was extreme, and there was such great irritability of the stomach, that it seemed for a while that he must die from the impossibility of retaining the necessary stimulus. The fever did not return, though for some days the patient was much prostrated; the irritation of the stomach continuing for some three weeks.
Dr. Norwood makes the following statement in regard to its properties (Southern Medical and Surgical Journal, January, 1853), which I give as a matter of history.
"1st. It is acrid. This property is very limited, and confined to the fauces.
"2d. It is adenagic, deobstruent, or alterative; this property it possesses in a marked and very high degree, not equaled by calomel or iodine in this particular, which will adapt it to the relief and cure of many diseases hitherto beyond the reach of any remedy.
"3d. It is actively and decidedly expectorant, so much so that we rarely add any other article.
"4th. It is one of the most certain diaphoretics belonging to the materia medica; it often excites great coolness or coldness of the surface; in some cases the skin is rendered soft and moist; in other instances the perspiration is free; and at other times it is most abundant; but notwithstanding its profuseness, it does not exhaust the system as many diaphoretics do when in excess, and therefore need not excite alarm, or be suspended on that account.
"5th. It is nervine, not narcotic under any circumstances, as since our first article we have taken it twenty times to test its varied powers, and we have taken it in all quantities from the production of free emesis down to the minimum dose. This property renders it of great value in the treatment of painful diseases, and such as are accompanied with convulsions, morbid irritability and irritative mobility. For example—pneumonia, rheumatism, puerperal fever, convulsions generally, palpitation of the heart, etc.
"6th. It is one of the most certain and efficient emetics known, and is peculiarly adapted to meet that indication in whooping-cough, asthma, croup, scarlet fever, and in all cases where there is much febrile and inflammatory action. It often excites severe nausea and frequent vomiting, which when taken in connection with great paleness, often alarms the patient and bystanders; but these effects, when in excess, are readily relieved by two full portions of morphine and tincture of ginger, or of laudanum and brandy. One grand and leading feature is, that the exhaustion that follows is not excensive and permanent, but confined merely to the effort. Again, the matter first ejected is a large quantity of thick slimy mucus, and soon after the liver is called on to pour forth its own fluid in abundance.
"7th. The seventh property is its most valuable and interesting, and for which it stands unparalleled and unequaled as a therapeutic agent. So much has been written on what we call the sedative—arterial sedative—properties of this agent, or the power it possesses of controlling and regulating arterial action, that we shall not run over the amount of evidence on this part of the subject."
We employ Veratrum in the treatment of all classes of fever, if the indications named are present. It lessens the frequency of the pulse, and gives a free and equal circulation. It lessens the temperature in the proportion that it influences the pulse, and is directly antipyretic. It relieves irritation of the nervous system, by lessening the momentum of blood to and through the nerve centers. It places the skin, kidneys and bowels (in proportion as it influences the pulse, temperature and innervation) in condition to perform their functions, and frequently without the use of other remedies secretion is established. With a better pulse, temperature, innervation and excretion, the appetite, digestion, blood-making and nutrition are restored.
We employ Veratrum in the early treatment of all forms of inflammation, without reference to the part involved, if the named indications present themselves. As is the frequency of pulse, increase of temperature, excited innervation, and arrest of secretion, so is the progress of inflammation. Bring these fondions back towards the normal standard, and the inflammatory action is lesseued. Thus Veratrum influences the inflammatory process, tending to abort it, by its influence upon the body at large.
But Veratrum has a direct influence upon the part involved in the inflammation, and this whether it is locally applied, or given internally. It controlls determination of blood to, and increased circulation of blood in the inflamed part; its action is to lessen the local as well as the general heat, and to relieve pain. Thus an inflammation of the lungs, or other part, may be wholly controlled by this remedy, it doing all that needs be done to rectify the wrongs of function, both general and local.
Veratrum has proven a powerful remedy in convulsive disease, when dependent upon an excited circulation. The reader will readily see why the morbid activity of brain and spinal cord ceases, when the wrongs of circulation and temperature are relieved.
Veratrum is a remedy in such forms of chronic disease as have an increased temperature and frequent pulse. For it is as true in chronic as in acute disease, that the departure from health, and the danger of death, are in proportion to the increase of heat and frequency of pulse. A case of phthisis with a temperature above 100°, and a pulse of 100 beats per minute, is certain to prove fatal. And no amendment of the local disease will take place until pulse and temperature are brought down towards the normal standard.
As a topical application we use Veratrum of full strength, or diluted with water, to arrest the inflammatory process in its early stage. A boil, a felon, a carbuncle or cellular inflammation anywhere may be thus aborted in many cases.
In one phase of erysipelas, especially active in form, Veratrum seems to exert the same specific action as tincture of muriate of iron, or Rhus. These cases are marked by the usual flush and intumescence of an ordinary inflammation. In these cases it is administered internally, and locally applied.
It is regarded by some as one of our best alteratives, and has been employed, with other means, to facilitate the removals of waste and worn-out material. In its direct influence upon any part of the sympathetic nervous system, and upon all the vegetative functions, we can see why it should do this work.