American Hellebore, Veratrum viride, the only veratrum official in the U. S. P. IX. White Hellebore, Veratrum album, official in six countries, has been deleted from the U. S. P.

Pharmacology

The general action of drugs of this class is given under "Aconite" and "Sabadilla." As regards veratrum viride it may be said that few of the recent text-books give it separate consideration; they unite in ascribing dangers to it that apply to veratrine, which is not derived from veratrum at all, and, to a less degree, to veratrum album, an uncertain drug now happily deleted from our standards.

Most physicians of experience base their estimate of veratrum upon Norwood's tincture, and it is assuredly not the dangerous agent that the texts upon veratrum might lead one to think. Laurence Johnson, who discussed veratrum viride as a separate entity, said of it:

"Taken internally, it reduces the fullness and frequency of the pulse, and, if the dose be large, or long-continued, excites nausea, vomiting, and purging, and causes great prostration. It is used chiefly in inflammatory affections of a decidedly sthenic type, particularly those of the respiratory organs. . . . It is plainly contraindicated in cardiac debility and in all asthenic conditions of whatever nature."

This is a fair estimate of veratrum. To it may be added that excessive doses depress both circulation and respiration; that even coma may be induced, but that fatal results are very rare. Veratrum is prompt in action, and a dose continues its effects rarely over two hours. For this reason, when pushing veratrum to effect, keep the patient recumbent and administer doses only an hour apart, watching the pulse and stopping the drug at the first indication of nausea. If the patient seems susceptible and vomits from ordinary doses, a little opium may be given along with the veratrum. Cases are rare in which veratrum should be given over a longer period than thirty-six to forty-eight hours. Also veratrum is an early-stage remedy for sthenic cases, and it has no place in chronic conditions except transiently.

Therapeutics

Large doses are employed in the treatment of puerperal convulsions or eclampsia. I have given as high as 30 minims of a concentrated tincture in this condition, repeating the dose on a descending scale as the pulse came down. Such dosage, of course, is extreme. It is common practice to give hypodermatically 10 drops (5 minims) Norwood's tincture at intervals depending on the case. A little morphine is commonly given with the veratrum. This treatment has long been very favorably viewed; but objections are now arising. Recent writers are urging the employment of morphine, and no chloroform, croton oil or veratrum, in eclampsia. Venesection and hypodermoclysis, with enemas of 1 part glycerine, 2 parts magnesium sulphate, and 3 parts water, is a line of treatment coming into vogue.

Average doses (fl. 1 1/2 minims, tr. 8 minims) are given to slow the pulse and reduce the blood-pressure in sthenic conditions; this it does not do by dilating the vessels, but by its stimulating the central cardio-inhibitory mechanism (Wood). Many parenchymatous and serous inflammations are sthenic in type, and veratrum is of value in treating their early stages. However, the old theory that, in pneumonia, veratrum dilated the vessels will not hold. There is considerable difference of opinion regarding the use of the drug in pneumonia.

In aneurism, irritable heart, and simple cardiac hypertrophy, rather smaller doses are cautiously employed.

Sthenic cases of erysipelas, uremic convulsions with high blood-pressure, acute tonsillitis, acute bronchitis, and other inflammatory conditions may have veratrum as a symptomatic remedy.

Veratrum, well diluted, may be used externally. I employ lead-water and veratrum externally in place of lead-water and laudanum, to which it is much superior. Opium applied externally is not analgesic, or so it is claimed.