(a) Veratrine has been largely used in France and Germany; to a much less extent in this country.

1. The external application may first be mentioned, as this mode of employment produces results concerning which there is no dispute.

In Neuralgias, and other severe localized pains, the ointment of veratrine is frequently applied with much benefit. In average cases the pharmacopoeial (B. Ph.) unguentum (eight grains to the ounce) answers well; it produces a slight pricking numb sensation, and speedily relieves pain.1 It seems, however, to be frequently forgotten that in high concentration veratrine is intensely irritant to the skin, and that on susceptible skins even the pharmacopoeial ointment will produce inflammation, and sometimes pustulation. The stronger ointments which are sometimes carelessly recommended, are still more likely to produce such effects, and in a very severe and unpleasant degree.

1Med. and Surg. Reporter, 1870.

2Gaz. Hebdom., iii. 7, 1868.

3 Practitioner, 1870, vol i., p. 211 et seq.

2. The internal uses of veratrine are much more varied, and are also much more the subject of difference of opinion.

In acute Inflammations, veratrine has been largely employed of late years.

In Pneumonia, more especially, it has been considered by many one of the most valuable additions to our resources that have ever been made. One of the earliest authorities on this subject is Vogt,2 of Berne, who gave it in doses of 1/13 of a grain (five milligrammes) every two or three hours, till it produced vomiting or retardation of the pulse, and found it very effective. If the stomach proved too irritable the dose was reduced, and the veratrine was given either with opium or in an effervescing draught. The mortality was eight per cent.

Aran3 highly recommended veratrine in pneumonia, and this recommendation was afterwards indorsed by Trousseau. Aran gave it in pills, with small doses of opium, which possibly mitigated the local effects.

Biermer4 tried veratrine extensively in pneumonia, and highly recommends it. Doses of 1/20 grain, in pill, were employed, and produced decided effects in reducing pulse and temperature. But he remarks that its effects are very variable, and that it is often apt to cause a troublesome amount of nausea and vomiting, and sometimes diarrhoea.

The collective results of foreign experience seem to agree with my own, to the effect that veratrine may produce striking alleviation in pneumonia, but is on the whole so unmanageable a remedy as to be of doubtful applicability. I shall have to speak rather more favorably of veratrum viride.

In acute Rheumatism there is much evidence in favor of veratrine. It was highly recommended fortius purpose by Trousseau, Alies, Bouchut, Leon, and others. Yet, after all that has been said upon the subject, it does not appear to be proved that veratrine acts in any other way than in reducing the febrile phenomena.

It is as an antipyretic, in fact (or this together with some special influence in reducing pain), that veratrine effects, or seems to effect, some good in the treatment, not only of acute rheumatism, but of a number of pyrexial diseases for which it has been recommended. Some, indeed, of the maladies for which it has been specially prescribed are very unfit subjects for its operation; thus it was once particularly praised in the treatment of typhoid fever, but careful investigation of the recorded results of its use in this disease gives no encouragement; and, on the other hand, the treacherous qualities of the alkaloid as a depressor of the heart's action have led to many disastrous consequences.

(b) Veratrum viride no doubt stands in a somewhat more favorable position than veratrine, yet it is necessary to be cautious in estimating the worth of the various statements that have been made in its favor.

1 (The Unguentum Veratriae of the U. S. Ph. contains twenty grains to the ounce.) 2Bull. Gen. de Therap., I860. 3 Ibid., xiv., p. 385. 4 Quoted by Niemeyer.

The American authors, in particular, are not always free from suspicion of exaggeration in this matter, although, as I have shown, some of the most trustworthy information which we possess concerning the veratrums was first published in an American journal by Dr. Peugnet.

As an Antipyretic in general, V. viride certainly possesses considerable power. 1 may say of it (as I might have said of veratrine) that, however doubtful may be its efficacy to lower temperature in the healthy body, there can be no doubt at all of its potency in reducing febrile heat, together with abnormal rapidity of pulse and breathing. Nor are these results to be despised, even though the course of the disease were not shortened, if we can but satisfy ourselves that the remedy is otherwise safe; since the mere reduction of fever is in itself a source of great comfort to the patient. There is much evidence to show that veratrum viride is more manageable than veratrine.

In acute Rheumatism it was strongly recommended by Dr. Osgood, and his commendations of it for this purpose are probably better justified than some of his statements as to its effects in some other acute diseases. It should be given in small doses, and may often be advantageously combined with opium.

In Pneumonia a strong case seems to have been made out for the use of veratrum viride. The experience of Dr. Kiemann1 forms perhaps one of the most favorable testimonies; he gave V. viride in forty cases, and, although five of these proved fatal (making a mortality of 12.5 per cent.), he says that they were in a desperate condition from the first, and that the results were otherwise decidedly good. The reduction of fever was marked and constant, and although Kiemann acknowledges that V. viride is a powerful remedy, never to be intrusted to any one but a skilled physician, he states that he has not observed it produce collapse, as some authors have reported.

By Drasche,2 also, the antifebrile power of V. viride in pneumonia is fully acknowledged. He observes, however, that if the use of the medicine be ceased at all before the moment of defervescence, the pulse at once rises again. And he states that, so far from forwarding the process of subsequent resolution, V. viride rather delays it.

Perhaps the testimony of Oulmont is the most important that we possess to the fact that in pneumonia, and indeed in pyrexial diseases generally, V. viride is more effective than veratrine.

In chronic Rheumatic and Neuralgic affections modern experience does not appear to encourage the expectations that were formerly entertained of the usefulness of V. viride, any more than of the internal employment of veratrine.

Preparations And Dose. - Extr. Veratri. Viridis Fluid., m i. - v. (.06 - .30); Tinct. Veratri. Viridis, m ij. - x. (.12 - .60); Ungt. Veratriae.

1 Prag. Vierteljahrssch.,Bd. iii., 1868. 2 Quoted in Ringer, "Handbook," p. 349.