This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
Active Ingredients. - The researches of Dr. Eugene Peugnet1 have satisfactorily settled many vexed questions in regard to this subject. He shows that the principal alkaloid is veratrine,2 identical with that which is obtained from the album, but different from the veratrine in cevadilla seeds. The second alkaloid (called viridia by Bullock) proves to be identical with Simon's jervine. There is no irritant poisonous resin corresponding to that which is found in V. album. Peugnet considers that the combination of the two alkaloids which is present in V. viride forms the best representative of the medicinal virtues of the genus veratrum.
Physiological Action. - Having regard to the distinction, rendered probable by Peugnet, between veratrine (procured commercially, as at present, from cevadilla) and the veratroida which is the true therapeutic ingredient of veratrum, we shall have to describe first the properties of veratrine and then those of the veratrum viride.
(a) The action of veratrine has received a great deal of investigation of late years. It has been shown to possess in high degree those irritant properties which are characteristic of all the species which contain it. Upon the skin it acts in very dilute dose somewhat as an anaesthetic; but in concentrated form it is highly irritant, producing erythema, or even pustular eruptions. Applied to the true skin, or to the mucous membranes, it produces a violent sense of heat. Taken into the stomach, or injected subcutaneously, it is absorbed with great rapidity, and produces spasmodic action of the intestines, mucous outpour from their glands, and salivation. At the same time the patient experiences curious sensations of heat and cold in various parts of the body. Many of the occasional effects are very uncertain and irregular in their occurrence; thus on one occasion there may be much diuresis, on another much sweating, on a third much sneezing and lachrymation. Purging, again, which is sometimes a marked symptom, is absent in the great majority of instances. One of the most constant phenomena is the steady descent of the pulse, which often reaches a very low level.
Given in fatal doses, veratrine produces violent vomiting and collapse, intense depression of the pulse, and a kind of tetanic spasms which usher in asphyxia and death. The spasmodic condition of the muscles has been the subject of much discussion. Gubler, without any sufficient reason, as it appears to me, regards this phenomenon as the reflex effect of the irritation of the intestinal canal. The excellent researches of Prevost, of Geneva, demonstrate, I think conclusively, that the muscular spasm is due to direct irritation of the muscles by the alkaloid: veratrine is a heart poison because it is a muscular poison. Other views of the cause of death are, that the heart spasm is due to stimulation of the vagus, or even that death is not dependent on the heart at all, but on spinal paralysis. It seems very unlikely that the latter is the case, or that the central nervous system is affected at all. The convulsions which occasionally occur, and also the alterations in sensibility, can at present be only imperfectly explained. Nor is it possible to say why vomiting or diarrhoea should occur,
1 Medical Record, 1872.
2 Peugnet calls it "Veratroida." as it does in a considerable number of cases. At any rate, it is not the result of inflammatory irritation, for none such takes place. No signs of inflammation are found in the alimentary canal after death: the later researches have proved this conclusively, although a contrary belief formerly prevailed.
(b) Veratrum viride has been reported on by several observers. Dr. Hadlock 1 says that in large doses it causes nausea and vomiting, complete relaxation of the system, copious sweat, and a pale, cool skin. The pallor is apt to become extreme, and to be accompanied by syncope, especially if the patient rises suddenly from the recumbent position. There was no evidence of any primary action on the nervous centres; no delirium, coma, or stupor; nor was there any effect on the kidneys or bowels. Opium and morphia act very happily as antidotes to the severer symptoms. Hadlock considers that the primary action of V. viride is on the heart.
Oulmont,2 who used a resinous extract of V. viride, found that in man, dogs, rabbits, and frogs, it affected chiefly the respiratory, circulatory, and digestive systems, rapidly causing nausea, vomiting, diarrhoea, and almost immediate slowing of the pulse and breathing. Even in cases where the vomiting and diarrhoea were excessive, there were no inflammatory lesions to be found after death.
Oulmont further observed a remarkable reduction of temperature: sometimes this amounted to two, three, or five degrees in the course of an hour and a half or two hours, and this low temperature would be maintained during as much as twenty hours.
This latter effect was not observed by Dr. Squarey3 in some very interesting experiments which he made on patients in University College Hospital. Squarey used a tincture of V. viride; the patients, four in number, were suffering from slight maladies. In no case was there any notable depression of temperature, which fact was the more striking because the pulse was decidedly reduced. In all other respects Squarey's observations agreed with Oulmont's. Nausea and vomiting were produced in every case where more than twenty minims were given at once, and in one case there was a little diarrhoea. The respirations were also reduced in correspondence with the pulse, and in all cases there was a sense of great general loss of power when under the influence of the drug. Squarey concludes that V. viride acts specially on the heart, and that it is very analogous in its effects to digitalis. Ringer, on the other hand, considers its action more closely allied to that of aconite than to that of digitalis.
Therapeutic Action. - Both veratrine and veratrum viride have attracted much attention as remedies during the last fifteen years.