VERATRUM VIRIDE. 
BY 
G. W. MOODY, M. D., 
SHELBYVILLE, TENN. 
Reprint from the Transactions of the Medical Society of the, State, of Tennessee, 
April, 1887. 
HASSLOCK & AMBROSE, PRINTERS, NASHVILLE. VERATRUM VIRIDE. 
BY 
G. W. MOODY,D., 
SHELBYVILLE, TENX. 
Reprint f rom the Transactions of the Medical Society of the State of Tennessee, 
April, 1887. VERATRUM VIRIDE. 
BY G. W. MOODY, M.D., SHELBYVILLE, TENN. 
Mr. President and Gentlemen of the Tennessee State Medical Society: 
This paper is not intended to be an exhaustive treatise on the sub- 
ject, but a short, practical article on the physiological action and 
therapeutic properties of veratrum viride, or American Hellebore. 
The writer believes that a great many practitioners do not appre- 
ciate the value of veratrum. He is sustained in this statement by the 
fact that in reports of proceedings of leading medical societies, it is 
sometimes noticed in the discussions on the treatment of diseases in 
which veratrum is pre-eminently useful, this remedy is not mentioned. 
The same may be said of articles contributed by prominent practi- 
tioners to leading medical journals, and also of some of the text- 
books. 
To those who are practically acquainted with the therapeutic powers 
of veratrum, it seems strange that a remedy capable of accomplishing 
so much should not be in general use fifty years after its introduction. 
The earliest record of the use of veratrum that the writer has any 
knowledge of is by Dr. Bayard, of Savannah, Ga., who prescribed it 
for rheumatism in 1811. About 1815, Dr. William Tully, of New 
Haven, Conn., used and recommended it for rheumatism and other 
diseases. About twenty years later, Dr. Charles Osgood, of Provi- 
dence, R. I., advocated its use; but little attention was given to it, 
however, until it was brought forward more prominently by Dr. W. C. 
Norwood, of Cokesbury, S. C. Dr. Norwood claims that he is en- 
titled to priority in the use of veratrum as a cardiac sedative. Ac- 
cording to his own statement, he first prescribed it in a case of pneu- 
monia in July, 1844. From about 1850 to 1870, he repeatedly brought 
it into public notice through the medical press. 
Perhaps the most elaborate and able, as well as the most practical, 
treatise on veratrum is a contribution to the American Medical Asso- 
ciation by Dr. S. R. Percy, of New York, in 1864. 
Among the records of this Society is a valuable contribution on the 
use of veratrum in the treatment of peritonitis by our honored ex- 4 
President, Dr. Thomas Lipscomb, of Shelbyville, Tenn. He also 
contributed an article on the same subject to the Nashville Journal of 
Medicine and Surgery in April, 1867. 
Dr. H. C. Wood, of Philadelphia, has published valuable infor- 
mation on the action and use of veratrum in medical journals and in 
his Treatise on Therapeutics. 
The above-mentioned literature embraces only a small portion of 
the valuable publications on veratrum. 
The drug is the root of an herb that is indigenous to America. It 
contains a resin and two alkaloids, jervia and veratroidia. Experi- 
ments have been made by Wood, Percy, and others as to the physio- 
logical effects of the resin and alkaloids The resin is said to be inert, 
and the alkaloids are each both spinal and cardiac sedatives, but differ 
in other minor physiological effects. The sum of the effects of the 
two alkaloids is about the same as that of the root, so that the vera- 
trum is the most satisfactory for use. 
The most characteristic effect of veratrum is its power to control the 
cardiac movements. ' ' It lowers in a remarkable manner the number 
and force of the cardiac pulsations." The pulse may be reduced 
from 120 or more to 70, 60, 50, or lower, at the same time that the 
force is decreased. Under its influence the blood vessels are dilated, 
increasing the general vascular area. These effects upon the circu- 
lation are due to its sedative action upon the vaso-motor nervous sys- 
tem, and also upon the muscles of the heart. It is a decided emetic, 
and, if pushed far enough, the emesis is prolonged and exhausting. 
The contents of the stomach arc first evacuated, and afterward the 
gall-bladder. It is said that it increases the secretion of bile. The 
skin is moist, and wherever exposed to the atmosphere is cool. The 
temperature is reduced. It does not generally purge, but has been 
known to do so. Large doses produce great depression of the powers 
of life. The action of the heart becomes exceedingly feeble, the pulse 
small and weak, the skin cool and bathed in perspiration, the vomiting 
and retching extreme. There is faintness, dimness of vision, dilata- 
tion of the pupils, drowsiness, and sometimes coma. These extreme 
symptoms are never seen from therapeutic doses, but only where large 
doses have been taken by accident, or the remedy has been admin- 
istered recklessly, or for purposes of experimentation; and when pro- 
duced, suspension of the drug and the administration of stimulants 
and opium soon relieves the extreme condition. 
From the physiological action of veratrum, we see that it is indicated 5 
whenever a cardiac sedative is needed. A safe and efficient cardiac 
sedative is a great desideratum in the treatment of those inflammatory- 
diseases which are characterized by increased frequency and force of 
the heart's action. Hypersemia is the first appreciablea ccompaniment 
of inflammation and a constant attendant upon inflammation. The 
old phrase "redness, swelling, heat and pain," applied to inflammation 
gives a very fair idea of its pathology. While increased vascularity is 
not the essence of inflammation, yet the cellular changes occasioned 
by the inflammatory process are due mostly to too much blood in the 
tissues. The systemic disturbances associated with inflammation are 
manifested by increased temperature and excitement of the vascular 
system. It has long been a maxim in the treatment of inflammation 
to diminish the blood in the tissue involved. With a strong, bound- 
ing heart, driving the blood like an engine into the inflamed tissues, is 
not a remedy indicated that will control the heart, and in its effect say 
to the heart, "Thus fast shalt thou go and no faster?" Veratrum will do 
this, and it will dilate the blood vessels, thus increasing the general vas- 
cular area and diminishing the blood-pressure. This dilatation of the 
blood vessels and increase of the vascular area has been likened by 
Fothergill to bleeding the patient into his own vessels, thereby securing 
the beneficial effects of blood-letting without the loss of blood. Such a 
remedy is demanded where the inflammatory process imperils life, and, 
if not speedily arrested, will destroy life. Veratrum is a valuable 
remedy in pneumonia, peritonitis, meningitis, and all that class of dis- 
eases, and for inflammation following injuries and surgical operations. 
It has the power, when administered in connection with opium during 
the first stage of these diseases, to limit the extent and duration of the 
disease, and in some instances to abort it. 
The history of cases could be presented here showing the successful 
use of veratrum in the the treatment of these diseases, but it would 
be tedious, and the writer considers it unnecessary. 
Dr. H. C. Wood, in his Treatise on Therapeutics, says: "When 
true sthenic arterial excitement is to be combatted in any disease, ex- 
cept it be gastritis, veratrum viride may be employed as a prompt, 
thoroughly efficient, and at the same time very safe remedy." Bar- 
tholow says: "Excellent results are sometimes obtained in aneurism 
by the use of veratrum. It is a powerful adjunct to rest and other 
means of treatment. It acts by lessening the force with which the 
blood is propelled and the number of cardiac contractions. In this way 
coagulation of the blood in the aneurismal sac is greatly favored." 6 
Veratrum is highly recommended for puerperal eclampsia. Dr. S. 
S. Boyd, of Dublin, Ind., contributed an interesting article to the In- 
diana State Medical Society in 1874 on the use of veratrum in puer- 
peral eclampsia. He gives the history of several cases in which vera- 
trum proved successful in doses of ten to twenty drops, repeated every 
half hour until the pulse was lowered to sixty, when the convulsions 
ceased. In an article published in the American Practitioner of Jan- 
uary, 1878, Dr. Boyd reports other cases which confirm his former 
experience. It has been recommended by Barker, of New York, and 
Sullivan, of San Francisco, and others, in the treatment of puerperal 
convulsions. Its favorable action in this disease is due to a sedative 
influence upon the spinal column and its power of controlling the 
circulation. 
Veratrum has been recommended to control the circulation and re- 
duce the temperature in typhoid fever and other adynamic diseases. 
This is ill advised, and is due to a mistaken notion of the pathology of 
these diseases. 
Cardiac weakness, whether functional or organic, or caused by a 
state of adynamia incident to disease, is a contra-indication for the 
use of veratrum. 
In rare instances an idiosyncrasy of the patient may prevent the 
characteristic effect of veratrum, and it may produce unpleasant nerv- 
ous phenomena. 
Some patients may be made to bear the use of veratrum who would 
not otherwise do so by giving stimulants in connection with veratrum. 
In these cases stimulants sustain the heart while veratrum exerts its 
peculiar effect. The writer has frequently administered stimulants 
with veratrum with a happy effect, especially in pneumonia. 
In cases where veratrum lessens the frequency and force of the 
pulse without lowering the temperature, it will generally do no good, 
and ought to be abandoned. 
The writer believes the reason why veratrum is not in general use is 
that those who do not use it have not tried it sufficiently to prove its 
value. They have not tried it, either because they think a car- 
diac sedative is not needed, or because they consider veratrum to be 
an unsafe remedy. A case of interest on this point is found in the 
appointment of a committee by a Massachusetts Medical Society to 
investigate the properties of veratrum. The committee adopted the 
plan of sending samples to physicians. It is said that "four hundred 
two-ounce vials of the tincture were distributed within the bounds of 7 
the Society, accompanied by a circular asking co-operation in the re- 
searches. But thirty responses were received, and a large portion of 
the replies were unsatisfactory. Some were afraid to thoroughly test 
the drug; others had too little faith in its virtues to give it a fair trial." 
When intelligently administered, the writer believes veratrum is as 
safe a remedy as any in the materia medica that possesses such positive 
and certain therapeutic properties. There are but few fatal cases re- 
ported as caused by veratrum, and they have occurred where it has 
been recklessly administered or taken through mistake in enormous 
quantities. As much can not be said of some remedies that we un- 
hesitatingly use in our daily practice 
Dr. S. R. Percy, in reporting an extensive series of experiments 
with veratrum upon dogs, says that when the drug was pushed in 
poisonous doses until the dog was reduced to a condition of extreme 
prostration, the animal when left to himself invariably rallied slowly, 
and under the influence of stimulants rapidly recovered. He states 
that tincture of cantharides is the best stimulant for prostration caused 
by an overdose of veratrum. He also gives the history of a case in 
which veratrum produced long-continued vomiting, which alarmed the 
patient's friends, who, in Dr. Percy's absence, summoned another 
practitioner, who was not acquainted with the properties of veratrum, 
and he was also alarmed. Dr. Percy, arriving soon afterward, assured 
the friends there was no danger, and would not allow any restoratives 
to be used, and the unpleasant effects soon passed off without any 
treatment. 
Dr. H. C. Wood says "it is almost incapable of producing death 
in the robust adult, unless used with great recklessness and in repeated 
doses." Wood also says that it is a safer remedy than aconite. 
The investigating committee of the Massachusetts Medical Society 
report that "not a single instance is found in which serious harm has 
resulted from the use of veratrum viride." 
Upon the proper administration of the remedy depends its efficiency 
and its safety. It should be commenced in small doses. Give from 
three to six drops of the tincture to an adult, and repeat the dose 
every three hours, increasing the dose one drop every three hours 
until the desired effect is produced. In robust cases, where the symp- 
toms are extreme and time is important, this dose may be exceeded. 
The object in commencing with small doses is to avoid undue effect 
of the remedy, as some persons are more susceptible to its influence 
than others. It has been recommended to give smaller doses and re- 8 
peat the dose every hour or .every two hours; but the writer thinks 
every three hours the best interval, because it about reaches its full 
effect in an hour and a half, and maintains its effect for another hour 
and a half, and, if repeated at intervals of an hour or two hours, it is 
liable to accumulate in the system, and a fuller effect be produced 
than is desired. When the pulse has been lowered to 80, or 70, or 
60, as may be desired, it should be continued in the same dose, or 
diminished as may be necessary to keep the pulse controlled. If vom- 
iting should at any time ensue, the quantity should be reduced to the 
original commencing dose; and if the pulse has not been sufficiently 
lowered in frequency and force, the dose should again be gradually in- 
creased as before. Opiates, alcoholic stimulants and aromatic spirits 
of ammonia are the best remedies in the author's experience to re- 
lieve vomiting and prostration caused by veratrum. It is always best 
to administer an opiate with veratrum unless opium is contra-indicated. 
Opium alone is a good remedy for inflammation, and given with vera- 
trum it prevents the nausea and vomiting that sometimes attends the 
use of veratrum alone. 
The author desires to emphasize the following conclusions: A car- 
diac sedative is indicated in the treatment of a certain class of inflam- 
matory diseases as defined in this paper, and experience corroborates 
this physiological indication. 
Veratrum viride is the best cardiac sedative we have, because it is a 
safe remedy and is almost certain in producing its physiological effect. 
Opium should in most cases be administered with veratrum. Stim- 
ulants need to be given with veratrum in some cases. 
Veratrum administered with opium, and especially with opium and 
stimulants, will rarely be attended with nausea and vomiting, and in 
this way does not interfere with taking nourishment. HASSLOCK & AMBROSE, 
SPRINTERS PUBLISHERS,^ 
122 CHUBOH STREET, 
NASHVILLE, - TENN. 
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