Preparations: Fluid Extract of Veratrum Viride - Tincture of Veratrum Viride
Related entries: Veratrum Album.—White Hellebore - Veratrina.—Veratrine - Sabadilla.—Cevadilla - Helleborus.—Black Hellebore
"The rhizome and roots of Veratrum viride, Solander"—(U.S. P.) (Veratrum album var. viride, Baker; Melanthium virens, Thunberg).
COMMON NAMES AND SYNONYMS: American hellebore, Swamp hellebore, Indian poke, Itch weed, Green hellebore, Green veratrum; Veratri viridis rhizoma or radix.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 286.
Botanical Source.—This plant has a perennial, thick and fleshy rhizome, its upper portion tunicated, its lower half solid, and sending forth a multitude of large, whitish roots. The stem is from 3 to 5 feet high, roundish, solid, striated, pubescent throughout the greater part of its length, and closely invested with the sheathing bases of leaves. The lower leaves are large, from 6 to 12 inches long, half as wide, oval, acuminate, pubescent, strongly plaited and nerved, the lower part of their edges meeting round the stem; the upper leaves are gradually narrower; the uppermost, or bracts, are linear and lanceolate; all alternate. The flowers are numerous, green, in compound racemes axillary from the upper leaves, and terminal; the whole forming a sort of panicle. Peduncles roundish and downy. Bracts are boat-shaped, acuminate, and downy. Pedicels many times shorter than the bracts. The perianth is divided into 6 green, oval, acute, nerved segments, of which the alternate ones are longest; all the segments are contracted at the base into a sort of claw with a thickened or cartilaginous edge. The stamens 6, with recurved filaments and roundish 2-lobed anthers. Carpels 3, cohering, with acute, recurved styles as long as the stamens. A part of the flowers are barren, and have only the rudiments of styles, so that the plant is strictly polygamous. The seed-vessel is composed of 3 capsules, united together, separating at top and opening on their inner side. Seeds flat, winged, and imbricated (L).
History and Description.—This plant is so closely related to Veratrum album, the European species, that some botanists have regarded the two species as identical. Others have declared it a variety of the latter, while still others seem to regard it as distinct. Though very closely related, it differs somewhat in its constituents, probably sufficiently so as to retain it as a distinct species. American hellebore is indigenous to the United States and Canada, growing in swamps, low grounds, and moist meadows, usually associated with Skunk-cabbage (Symplocarpus foetidus, Nuttall), and flowering in June and July. The medicinal virtues of the drug seem to reside in the rhizome alone. In this connection Mr. Frederick V. Coville, botanist to the United States Department of Agriculture, in a letter to J. U. Lloyd (Jan., 1899), writes: "I have never been able to understand clearly the poisonous character of this plant. Various of the older authors in the East have stated that the stems and leaves were poisonous. In the mountains of Oregon, however, where the plant grows in abundance, it is considered one of the very best of sheep foods, and passes under the name of Wild Indian corn. The sheep fatten on it in the spring and early summer. Either the western plant is a distinct species or variety, which I doubt, or the leaves and stems are not poisonous." At least the dried leaf-stalks which sometimes occur attached to the rhizome were found inert by Prof. Maisch, but contained a saponaceous principle (Amer. Jour. Pharm., 1864, p. 98). The official part is the rhizome, which should be gathered in autumn, after the decay of the leaves. As it rapidly loses its virtues, it should be renewed annually, and kept in well-closed vessels. When fresh, it has a very strong, unpleasant odor; when dried, it is nearly inodorous, and has a sweetish-bitter taste, succeeded by a persistent acridity. Its physical and therapeutical properties strongly resemble those of the White hellebore (Veratrum album). The drug is officially described as follows: "Rhizome upright, obconical, simple or divided, from 3 to 8 Cm. (1 1/5 to 3 1/5 inches) long, and 2 to 4 or 5 Cm. (4/5 to 1 3/5 or 2 inches) thick; externally, blackish-gray; internally, grayish-white; showing numerous short, irregular wood bundles. Roots emanating from all sides of the rhizome, numerous, shrivelled, light yellowish-brown, about 10 to 20 Cm. (4 to 8 inches) long, and 2 Mm. (1/12 inch) thick. Inodorous, but strongly sternutatory when powdered; taste, bitterish and very acrid"—(LT. S. P.).
Chemical Composition.—Thomas R. Mitchell (Amer. Jour. Pharm., Vol. IX, 1837, p. 181) found the rhizome of Veratrum viride to contain gum, resin, starch, red coloring matter, wax, sugar, a bitter principle probably analogous to veratrine, and gallic acid. The alkaloidal constituents were subsequently studied by several investigators, with somewhat contradictory results. (For a summary of these researches see J. U. Lloyd, in The Western Druggist, Oct., 1897.) In 1879 Messrs. Wright and Luff found the alkaloids of Veratrum viride to consist to about one-half of cevadine, the sternutatory, ether-soluble alkaloid of sabadilla seeds; the other half consisted of the ether-insoluble alkaloids jervine, pseudo-jervine, and rubijervine, with a small quantity of veratrine and a trace of veratralbine (compare Veratrum Album and Sabadilla). The total quantity of alkaloids isolated by Wright and Luff was only 0.08 per cent. S. C. Pehkschen obtained from the rhizome 0.08 per cent of crude total alkaloids (Amer. Jour. Pharm., 1891, pp. 196-200, from Pharm. Zschr. f. Russland); they consisted chiefly of jervine, with a small quantity of veratroidine, an ether-soluble alkaloid obtained by Charles Bullock in 1865 (see Amer. Jour. Pharm., 1875, p. 449; also see A. Tobien, ibid., 1878, p. 122).
Action, Medical Uses, and Dosage.—American hellebore exerts an influence upon the system quite similar to that of White hellebore (Veratrum album, which see). Veratrine does not represent the action of this plant, which contains but a small proportion of this body. Applied to the skin, veratrum is rubefacient, and to the nose, excites sneezing. Small doses of veratrum appear, at first, not to affect the frequency of the pulse, but to lower its force; it afterward slows the pulse, it becoming moderately full and soft, and remaining so, unless the patient, during this stage of depression, attempts to rise or makes any exertion when the pulse becomes very rapid, small, thready, and sometimes almost imperceptible. During the stage of depression, there is marked muscular weakness and relaxation, and nausea and vomiting take place, the contents of the stomach being evacuated first, and then those of the gall-bladder. Occasionally, a watery diarrhoea is caused by veratrum, sometimes amounting to hypercatharsis, but, as a rule, purging is not produced. The nausea produced by veratrum is intense, and the vomiting severe and often persistent, making it, therefore, an unsafe emetic. The most characteristic action of veratrum is its effects upon the movements of the heart and upon vascular tonus. The pulse-rate has been lowered to 35 beats a in minute with this agent, a corresponding depression of force accompanying this action. When such depression is reached, it is seldom that emesis can be prevented. In large doses, it is a very dangerous agent, yet, singularly, fatalities from its use are rare. Toxic doses produce an exceedingly weak heart-action, almost indistinguishable, running pulse, reduced temperature, cold, clammy sweat, extreme retching, and incessant vomiting, dizziness, faintness, failure of sight, pupillary dilatation, complete muscular prostration, slow, shallow breathing, sleepiness, coma, and unconsciousness, with sometimes stertorous breathing. The prompt emesis induced by this agent, undoubtedly prevents lethal effects. The exact action of the alkaloidal constituents is yet undetermined, as well as the effect each produces in the sum total of the effects of the root. According to Wood, the drug is a spinal and arterial depressant having no direct action upon the spinal centers; the direct action of jervine upon the heart-muscle, and the stimulation of the inhibitory nerves by veratroidine lower the pulse-rate; the force of the heart-beat is lowered by the direct action of jervine upon the heart-muscle, while the same constituent, according to dose, produces a more or less complete vaso-motor paralysis. The depression of the spinal-motor centers is attributed to jervine. The emetic action of veratrum is said to be due to the combined action of veratroidine and the resin. Death from veratrum is caused by asphyxia. All vaso-motor depressants and all agents which diminish the vital force, favor the action of veratrum. Nausea is always the signal for suspension of the administration of the drug. In poisoning by veratrum, withdrawal of the drug and free stimulation will quickly overcome the depression. Large draughts of warm water may be given to encourage and assist emesis until the stomach has been thoroughly washed out. This should be followed by undiluted whiskey or brandy, to check the vomiting. Opium or morphine may be given by mouth or otherwise, ammonia and alcoholics may be used by enema or hypodermatically, and strychnine or digitalis may be given by the latter method. External heat, sinapisms, friction, etc., must be utilized, and, under no circumstances, must the patient be allowed to rise from the recumbent position, not even to raise the head to vomit.
Therapeutically, veratrum is a remedy of great value and power, though quite transient in its effects. Small doses do good work when indicated, but they must follow each other at short intervals, so that a continuous action may be kept up. Owing to its tendency to induce gastric irritability, with nausea, large doses, are not tolerated, and small doses are contraindicated when the tongue becomes long and pointed and reddened at the tip, and nausea and other unpleasant gastric phenomena are present. Veratrum increases secretion from the lungs, kidneys, and liver, but depresses the circulatory system. It is not adapted to asthenic troubles, but proves an admirable remedy in sthenic conditions, with the full, bounding pulse. Early in the nineteenth century, Prof. Tully called attention to the value of veratrum in gout, rheumatism, etc., declaring it equal, if not superior, to colchicum. Dr. Osgood (1835) affirmed it to be an excellent agent in all diseases in which it is required to diminish the activity of the heart and arteries, and his observations have been subsequently confirmed. It not only lessens excited cardiac action, but lessens temperature and restores suppressed secretions. (For Norwood's account of the action of veratrum, see American Dispensatory, 17th and preceding editions.)
Veratrum is a positive arterial sedative in sthenic inflammations and fevers, when not contraindicated by gastric irritability. The popularity of veratrum, as a specific agent, is due most largely to the writings of Prof. J. M. Scudder, M. D., who believed that veratrum was preferable to aconite in sthenic diseases, high grades of fever, pulmonary and other active inflammations (see Aconitum). He declared it the remedy when there is a frequent, but free, action of the heart, where there is active capillary circulation, and in serous inflammations, when there is a full and hard pulse, a full and bounding pulse, or a corded or wiry pulse. In determination of blood to the brain, and in active delirium, he employed veratrum in conjunction with gelsemium. He also found it of service where it was desirable to increase the action of the excretory organs. He says of veratrum: "It lessens the frequency of the pulse in both large and small doses. In large doses, the sedative action is a real depression of life, and the circulation is really impaired. Such an action may be temporarily borne in sthenic fevers and inflammation, and may be attended with good results. Yet, as it can not be continued for any considerable length of time, and can only be resorted to in high grades of action, it is better to depend upon small doses, which improve innervation through the sympathetic, remove obstructions to the free circulation of blood, also irritability of the circulatory system, the power of which it increases. Veratrum, in small doses, gradually lessens the frequency and hardness of the pulse, and promotes a uniform and equal circulation."
Prof. Scudder further says of veratrum (Specific Medication, pp. 262-63): "In small doses, veratrum is a stimulant to all the vegetative processes. Acting through the sympathetic or ganglionic system of nerves, it removes obstruction to the capillary circulation, gives tone to the vascular system, and strength to the heart. As the obstacles to a free circulation are removed, and the vessels through which the blood is distributed and returned, regain their normal condition, there is less necessity for increased action upon part of the heart, and, as the power of the heart is increased, there is less necessity for frequent contraction. I give this as a theory of the action of veratrum, but whether true or not, there is no question with regard to the facts as above stated."
Veratrum is a remedy for active febrile and inflammatory diseases of the respiratory tract of the sthenic type. In these disorders, it moderates the flow of blood, increases secretion, allays nervous irritation, brings down the temperature, and subdues inflammation. The hard, full, bounding pulse is the guide here as elsewhere. Prof. Webster speaks of it as being specially indicated in the early stage of "inflammation of the area of distribution of the bronchial arteries." A gargle of veratrum is useful in inflamed sore throat. All sthenic inflammations of the throat are controlled by it. It is an excellent agent in acute tonsilitis, when indicated, and often painting the tincture alone upon the tonsils will check the disease. Very small amounts, however, should be used in this manner, and then only in the robust. Veratrum, when indicated by the full, bounding pulse, is an excellent sedative in acute pneumonia in the first stage, but only in markedly sthenic cases. The dose should be small and frequently repeated, until the temperature and circulation respond, when the pain will be lessened, nervous excitation allayed, secretion re-establisbed, and cough controlled. It is equally of value in pleurisy (usually with bryonia), and in acute bronchitis, when specifically used. Veratrum is a valuable expectorant, and is of marked value in chronic pulmonary affections, to control the circulation, and thereby regulate the temperature, besides acting as a powerful and efficient alterative. In phthisis, especially in the early stage, it controls the violent circulation and temperature, facilitates expectoration, and exerts a beneficial influence over the sympathetic system, controlling restlessness and excitement, and quieting cough. It is very frequently of service in chronic bronchitis, and in chronic pneumonia. It is valuable in haemoptysis, when the circulation is strong and violent. Prof. Howe regarded it as one of the best alteratives that could be used in chronic lung troubles, being especially valuable in pulmonary consumption for this, and for the control of the inflammatory condition.
When indicated, veratrum is a remedy of great power in peritonitis, especially puerperal peritonitis and pelvic peritonitis, from septic absorption. Here the inflammation must be speedily checked, and quite large doses may be required—2 drops of specific veratrum may be given every 1/2 hour (if it does not provoke nausea), and continued until sedation is effected, when the remedy may be continued in fractional doses. Veratrum has won laurels in peritoneal inflammations. It is also a remedy of importance in properly-selected cases of nephritis, cystitis, hepatitis, ovaritis, and orchitis. For inflammations, arising from blows or kicks upon the abdomen, it is the best-known remedy. It is often useful in active forms of acute gonorrhoea, and may prevent chordee, and, in acute inflammatory rheumatism, it may be given to control pain and promote elimination. Veratrum has been justly praised as a remedy for erysipelas. It may be used both topically and internally. It is best adapted to that form showing tumefaction and redness, simulating ordinary inflammations. It has been successfully used, internally and locally, for the relief of poisoning by Rhus Toxicodendron. Boils, carbuncles, inflamed pimples, felons, ulcers, with heat and tumefaction, cellular inflammations, and labial herpes are well treated by painting specific veratrum upon them.
Prof. A. J. Howe stated that, "as an alterative, Veratrum viride takes a high rank. It improves the appetite, and favors assimilation by exciting to action the lacteals and lymphatic system generally. In scrofula, constitutional syphilis, cancer, and tetter, it can be employed as an internal remedy to great advantage. It tends to correct the menstrual function, restraining a too frequent and profuse flow, and exciting to greater activity a scanty and tardy menstruation." Veratrum is a useful agent in some nervous disorders. "It relieves irritation of the nervous system, by lessening the momentum of blood to and through the nerve centers" (Scudder). When convulsive disorders depend upon an excited circulation, it proves a powerful remedy. Few remedies have been more praised than veratrum in puerperal eclampsia. There is marked cerebral engorgement, and the indications for veratrum must be present, as in other disorders, for one to get good results from this agent. The dose must be quite large, and be regulated according to the sedation produced. It is of value in other forms of convulsions, especially in children, when active cerebral hyperemia is a feature. It is of special value in undue excitement of the spinal nervous system, in spinal irritation, spinal convulsions, cerebro-spinal meningitis, and acute mania, all with excited circulation. When neuralgia and headache are due to irritation of the nerve centers, with hyperemia, it proves a useful drug; usually, however, it is of little value in headache, unless accompanied with elevation of temperature. It will restore quiet and allow sleep in delirium tremens, when the pulse is full and bounding, and the eyes red and bloodshot, with evidence of inflammation" (Locke).
Beginning with small doses, and progressively increasing to 12 drops of the tincture, and again reducing the dose, veratrum has been accredited with favorably influencing exophthalmic goitre. Veratrum has been given with digitalis in the early stage of dropsy, where there is rapid heart-action, and a sedative is required. It is a good remedy in aneurism, to retard the velocity of the blood-current, and to reduce the vaso-motor tonus. Heart disorders are often relieved by it. Thus it controls palpitation, with violent circulation, and especially the irritable heart, produced by the use of tobacco. Palpitation, due to cardiac hypertrophy, is quieted by it, when valvular incompetence is not a factor. "In these cases, the pulse is full, strong, and intense, the carotids pulsate forcibly, the eyes are bloodshot, and there is cough, headache, and weight in the upper epigastrium, while the heart may beat so violently as to shake the bed, and sleep is entirely prevented. This remedy relieves the excitement, the heart-action becomes normal, the cough improves, and the patient is in every way better" (Locke). The dose for this purpose is 1 drop, in water, 5 or 6 times a day.
Prof. Foltz (Dynam. Therap.) always employs veratrum after cataract operations, and uses, locally, for mastoid disease, the following: Rx Aconite, veratrum, aa, flℨii to flℨiv; aqua, fl℥iv. Mix. The dose of tincture of veratrum is from 1 to 10 drops (gradually increased until some effect is produced), every 2, 3, or 4 hours; of the extract, or inspissated juice (both of which are seldom used), 1/4 grain, carefully increased as required; of the powdered root (seldom used), from 4 to 10 grains; of the fluid extract, from a fraction of a minim to 5 minims; of specific veratrum, from a fraction of a minim to 6 minims.
Specific Indications and Uses.—Pulse frequent and full; tissues full, not shrunken; surface flushed with blood; pulse rapid, bounding; pulse rapid, full, corded, or wiry; marked arterial throbbing; increased arterial tension, with bloodshot eyes; sthenic fevers and. inflammations; erysipelas, appearing like ordinary inflammation; red stripe along center of tongue; irritation of nerve centers, due to an excited circulation; convulsions from active, cerebral hyperemia.
King's American Dispensatory, 1898, was written by Harvey Wickes Felter, M.D., and John Uri Lloyd, Phr. M., Ph. D.