Veratrum Viride

American Hellebore

American hellebore. The rhizoma and roots of Veratrum viride Solander (Nat. Ord. Liliaceae).

Extractum Veratri Viridis Fluidum

Fluid extract of veratrum viride. Dose, τη ij—τη v.

Tinctura Veratri Viridis

Tincture of veratrum viride. Dose,

τη ij—τη iv-

Veratbina

Veratrine. An alkaloid or mixture of alkaloids, prepared from the seeds of Asagraea officinalis Lindley (Nat. Ord. Lilia-ceae). Is pulverulent, grayish-white, inodorous, but very irritant to the nostrils. It has an acrid, bitter taste, causing a sensation of tingling with numbness in the tongue. It is very slightly soluble in water, but readily and wholly dissolved by alcohol. It has an alkaline reaction.

Oleatum Veratrinae

Oleate of veratrine. Veratrine, 2 grm.; oleic acid, 98 grm. (For external use.)

Unguentum Veratrinae

Veratrine ointment. Veratrine, 4 grm.; olive-oil, 6 grm.; benzoinated lard, 90 grm. (For external use.)

Composition

"Veratrum album, veratrum viride, and veratrum sabadillas, correspond closely in chemical composition, and the first two in botanical characteristics. Sabadilla is only used as the source of the alkaloid veratrine. The alkaloids of veratrum album are jervine and veratralbine (Mitchell). Veratrum viride contains two alkaloids also—-jervine and veratroidine. The alkaloid jervine is found in both plants, is the same in chemical action and in physiological effects, and may, therefore, be considered identical. There are very close affinities between the veratralbine of Mitchell and the veratroidine first discovered by Bullock, but they are not the same; they differ as respects their chemical relations, and also in physiological properties, veratralbine being much more powerful than jervine and veratroidine. Veratrum album and veratrum viride contain abundance of soft resin, which, when pure, is nearly, if not quite, inert. As the alkaloid jervine is with difficulty separated from the resin, it is probable that the physiological activity, ascribed to the resin by some observers, is really due to the presence of the alkaloid.

Antagonists and Incompatibles

The effects of veratrum viride on the heart are counterbalanced by alcoholic stimulants, opium, and ammonia. When dangerous symptoms are produced, the recumbent position should be enforced, alcoholic stimulants should be administered by the stomach and rectum, and dry heat should be applied to the body. Ammonia may also be given by the stomach or by intravenous injection, and, if nausea and vomiting persist, morphine may be administered subcutaneously. The tincture of opium, in stimulant doses, may be prescribed with the alcoholic stimulants.

Synergists

The vaso-motor depressants—tobacco, lobelia, aconite, etc.—are synergistic. Blood-letting, haemorrhage, purgatives, and all agencies which diminish vital power, increase the effects of veratrum.

Physiological Effects

In the remarks which follow, veratrum viride only is referred to.

Applied to the skin, veratrum viride excites redness and heat, and, to the Schneiderian mucous membrane, it causes violent sneezing. It is a prompt and efficient emetic, but its operation is accompanied with intense nausea and depression, and the vomiting is often violent and persistent. The contents of the stomach are at first evacuated, and afterward of the gall-bladder, so that it has been supposed to possess the power to increase the secretion of bile. It does not generally purge, but occasionally profuse watery evacuations have been produced by it, and rarely severe hypercatharsis. Its alkaloids enter the blood with facility. The power which veratrum viride has to affect the cardiac movements and the vascular tonus is its most characteristic property. It lowers, in a remarkable manner, the number and force of the cardiac pulsations. The pulse may be reduced to fifty, forty, or even thirty-five per minute, and its force correspondingly diminished. According to Linon, the arterial tension is raised, as shown by the sphyg-mograph. By very careful administration, this reduction in the pulse-rate may sometimes be accomplished without inducing nausea and vomiting, but usually vomiting can not be prevented when the remedy is pushed to this extent. When the pulse is reduced very decidedly, the patient being in the recumbent posture, a change to the erect posi. tion at once alters its character, and it becomes extremely rapid, thready, and feeble.

Very great depression of the powers of life is produced by large doses. The action of the heart becomes exceedingly weak, the pulse almost indistinguishable, the vomiting and retching extreme, the surface of the body cold and covered with a cold sweat, the temperature reduced. There are also produced faintness, dimness of sight, dilatation of the pupils, giddiness, great muscular weakness, shallow and slow respiration; sometimes somnolence, coma, and insensibility, with stertorous breathing. Notwithstanding the very formidable symptoms produced by large doses, fatal results have been extremely rare. An ounce of the tincture has been swallowed without causing death (Norwood). The prompt emesis which it produces is probably the explanation of its lethal inactivity; for, in the act of vomiting, the medicine is ejected with the first matter from the stomach. Suspension of the medicine and free stimulation quickly remove the most alarming symptoms of depression.

The experimental investigations into the actions of jervine and veratroidine, made by Wood, Peugnet, and others, have shown that the physiological actions of veratrum viride are the sum of the actions of the alkaloids. The nauseating and emetic qualities of the drug are due, chiefly, to veratroidine, and to a slight extent to the resin. Both alkaloids depress the functions of the spinal cord, and destroy its reflex activity; but they do not impair the excitability of the nerves, nor the contractility of muscles. Veratroidine, according to Wood, first stimulates the inhibitory cardiac nerves to an extraordinary extent, and afterward paralyzes them; but the evidence which he adduces in favor of the singular statements on this point are far from satisfactory. Both alkaloids lower the blood-pressure, by diminution of vaso-motor tonus, and paralyze the cardiac muscle, and probably also its contained ganglia. They cause death by asphyxia— by paralysis of the muscles of respiration. The cerebral effects which have been noted in man, and the convulsions in animals, are doubtless due to the accumulation of carbonic acid in the blood.