AN INVESTIGATION 
INTO THE 
REMARKABLE MEDICINAL EFFECTS RESULTING 
FROM 
THE EXTERNAL APPLICATION 
OF 
VERATRIA. 
By ALEXANDER TURNBULL, M.D 
WASHINGTON: 
STEREOTYPED AND PUBLISHED BY DUFF GREEN. 
1834. PREFACE. 
It was not the intention of the author to have submitted to the notice of 
the Profession, the plan of treatment to be considered in the following pages, 
until it had been put to the test of greater experience; but, in order to satisfy 
the inquiries which have been made, and to guard against any unfavorable 
impression as to its utility which might arise from want of proper information 
on the subject, he has thought it better to give the results already obtained, 
along with such directions for its employment as have appeared of most 
importance. 
48 Russell Square, 
January, 1834. CONTENTS. 
PAGE 
Introductory Remarks - - - - - 7 
CHAPTER I. 
External Application of Veratria in Affections of the Heart - 11 
CHAPTER IL 
External Application of Veratria in Tic-douloureux and other 
forms of Neuralgia - - - - - • 21 
CHAPTER III. 
External Application of Veratria in Rheumatism - - 30 
CHAPTER IV. 
External Application of Veratria in Paralysis - - 36 
I 
CHAPTER V. 
External Application of Veratria in Dropsy - - - 39 
CHAPTER VI. 
External Application of Veratria in Gout, Amaurosis. &c. - 45 AN INVESTIGATION 
INTO THE 
REMARKABLE MEDICINAL EFFECTS RESULTING FROM THE 
EXTERNAL APPLICATION OF 
VERATRIA. 
There are various individuals of the family of plants, known by the name 
of colchicaceae, which are used in medicine. They have been long acknow- 
ledged to be possessed of active properties, nearly allied to each other; and 
the chemical discoveries of later times have explained the similarity which 
had been observed to exist in their effects upon the animal economy, in health 
and disease, by demonstrating that these depend upon a peculiar principle 
common, in some degree, to all, and which has been distinguished by the 
names of veratrinum, veratrina, veratria, and sabadilline. This new substance 
was discovered by M.M.Pelletier and Caventou.in the year 1819, in the 
seeds of veratrum sabadilla*; and about the same time by Meysner, in 
Germany. It has hitherto been obtained only from veratrum sabadilla, vera- 
trum album, and colchicum autumnale, but there can be little doubt of its 
existence in many other plants of the same natural order. Until very lately, 
the veratria, obtained according to the process employed by its discoverers, 
was considered to be a simple body; but from a memoir recently given on the 
subject by M. Couerbe,t it appears that it is in reality composed of three 
distinct and easily separable principles, on which he has bestowed the names, 
veratrine, sabadilline, and mono-hydrate of sabadilline. This fact is of con- 
siderable importance in the study of the medicinal effects of the veratria of 
commerce, as some kinds of it, when applied externally, are found to be 
possessed of properties by no means so active in the removal of diseases as 
are to be observed in others, although to the eye they may appear precisely 
similar; and this difference may, and in all probability does arise, unless, as 
sometimes happens, there be an admixture of impurities, from the presence or 
absence of some one or other of these principles, in greater or less quantity ; 
it is to be hoped, however, that the researches concerning its chemical con- 
stitution, which are now in progress, will ere long enable the practitioner to 
make use of a medicine, the nature of which he will be better acquainted with, 
and upon the effects of which he may be able to rely with the greatest 
confidence. As these three principles have not as yet been made separately, 
in a quantity sufficient to become the objects of investigation, it is intended 
* Journal de Physique 1819. f Journal de Fharmacie Octobre, 1833 8 
EXTERNAL APPLICATION OF VERATRIA. 
to restrict the following observations exclusively to the veratria in common 
use. 
The veratria of commerce is nearly white in color, and in the form of a 
e powder ; it is without smell, but when accidentally or otherwise brought 
in contact with the mucous membrane of the nose, it induces violent and even 
dangerous sneezing; when applied to the conjunctiva, it produces great irrita- 
tion, accompanied by an abundant flow of tears, which does not subside for 
some hours. Its taste is extremely acrid, but destitute of bitterness ; and it 
acts very strongly upon the mucous membrane of the stomach and intestines; 
if introduced into the stomach, it proves highly emetic and purgative, for 
even in old subjects a quarter of a grain acts powerfully upon the bowels; and 
in some experiments the effects have been so violent as to show that death 
would have followed the administration of a few grains. Occasionally it 
happens, that during the preparation of veratria some of the particles floating 
in the air are inhaled, and when such is the case its effects are generally 
purgative. M. Andral, jun. found that when it was applied immediately to 
the tissues, violent and speedy inflammation was the consequence; that when 
thrown in small quantity into the veins, it acted upon the large intestine; and 
that when introduced in a larger proportion, either into the veins or intestine 
itself, tetanus followed.* From these circumstances, veratria was very 
properly considered to be a medicine possessed of extreme activity, and it 
seems to have been some little time before it was thought safe to introduce it 
into practice ; and although it has been employed by some individuals, yet 
such does not appear to have been the case to any great extent. 
Veratria has been prescribed both internally and externally. For internal 
use, it is given in the form of pill, or in solution, in dropsy, gout, rheumatism, 
&c.; and externally, it is applied either in the form of solution, or, what is 
better, in that of an ointment made with hogs' lard; but as this last mode of 
using it is the one which more particularly comes under review at present, we 
shall confine our attention to it exclusively. The ointment may be made with 
from ten to twenty, or more, grains of the alcaloid to an ounce of lard, and 
of this, a piece, the size of a large nut, may be rubbed from five to fifteen 
minutes night and morning, as nearly as possible over the seat of the disease, 
until relief from the urgent symptoms be experienced ; care being taken to 
observe that the skin over which the ointment is to be rubbed be free from 
injury, otherwise considerable irritation of the part will ensue; and for reasons 
already given, the person who applies it must be careful not to insert even the 
smallest quantity under the eyelids. 
M. Magendie appears to have been the first person who suggested the 
external application of veratria in rheumatism, gout, and anasarca; but his 
proposition does not seem to have been complied with, neither does he himself 
appear to have been fully aware of its great importance in a medicinal point 
of view ; and indeed the weakness of the preparations recommended by him, 
even had they been made use of, must have prevented the very striking effects 
produced upon certain diseases by the veratria, when more freely employed, 
from corning under his observation. 
The first circumstance which must strike every person who prescribes tire 
external use of this medicine, is the very remarkable difference which is found 
to exist betwixt its effects upon the body when so applied, and those which 
result from its internal exhibition. We have seen that when applied to any of 
the mucous membranes, even in the smallest quantity, it produces the most 
Magendie, Journal de Physiologic, tom. i. EXTERNAL APPLICATION OF VERATRIA. 
9 
violent irritation, and that when introduced into the stomach it operates as an 
emetic and cathartic; but when rubbed upon the surface of the body to the 
extent of six or eight grains a day, for several weeks or even months together, 
no such consequences follow; for although the constitution has evidently, 
during the greater part of the time, been under the influence of the veratria, 
so far from acting in that manner, it has been observed to calm irritation, 
remove pain, and produce considerable elevation of spirits. The general health 
and appearance begin to improve, the appetite remains unimpaired or even 
becomes better, the patient experiences not the slightest degree of nausea; 
and the bowels, instead of being acted upon in the manner in which the internal 
exhibition of the medicine would lead us to anticipate, are either altogether 
unaffected, or such a degree of constipation is induced as to render the use 
of purgatives necessary to keep them in the usual state. 
When the veratria is applied externally in dropsical diseases, the emetic 
and cathartic effects which result from its internal employment in these affec- 
tions are exchanged for a diuretic operation, so singular and beneficial as to 
bring about the removal of the effused fluid in a time much shorter than it can 
be accomplished in by any other known medicine; and it has done so in many 
cases after every other means had been previously tried without avail ; but in 
diseases unattended by aqueous effusion, no effect whatever upon the kidneys 
has been observed. 
The skin over which the ointment has been rubbed, even after the friction 
has been continued for some length of time, shows no marks of irritation ; and 
although in certain instances a slight blush sometimes pervades the surface, 
it nevertheless vanishes in an hour or two, and the skin returns to its natural 
color. When the quantity of veratria rubbed in exceeds a few grains, the 
patients generally experience a considerable degree of warmth and tingling 
in the part, and until this takes place the peculiar effects of the medicine do 
not usually manifest themselves; the circumstance, therefore, is one worthy 
of attention, and may serve as a criterion whereby to estimate the extent to 
which the friction may be carried without producing inconvenience, and also 
to judge of the degree of purity of the veratria employed ; for when, as is 
sometimes found to be the case, the medicine is mixed with impurities, these 
sensations are not produced, and its action is by no means either so certain or 
powerful as when it is free from adulteration. This last observation appears 
necessary to prevent the practitioner from laying a charge of failure against it 
in cases where the impure veratria may have been made use of in compounding 
the prescription.* 
After the ointment has been applied a sufficient length of time to put the 
constitution completely under its influence, the feeling of heat and tingling 
extends itself from the place where the friction may have been made, over the 
whole surface of the body, and in some instances involuntary twitchings of 
the muscles of the mouth and eyelids are induced; but these symptoms dis- 
appear so soon as the rubbing has been discontinued for a day or two, and no 
disagreeable consequences follow to the patient. The sensibility of the parts 
over which the application has been made, is increased to such a degree as to 
render them peculiarly susceptible of the presence of certain stimuli, par- 
ticularly electricity or galvanism ; these agents have in some instances been 
applied along with the veratria ointment, but have given rise to sensations so 
acute as to render their further employment almost insupportable, and that 
without the slightest perceptible alteration of the surface. It does not appear 
* Pure veratria 13 entirely soluble in alcohol, and burns without leaving any residuum. 10 
EXTERNAL APPLICATION OF VERATRIA. 
altogether necessary that the friction should be made exactly over the seat of 
the disease ; for two cases have lately come under observation in which the 
individuals who rubbed on the ointment imbibed as much by the hand as 
proved sufficient to cure them of painful affections in distant parts of the body, 
under which they had been laboring for a considerable length of time before. 
Such are a few of the more remarkable effects resulting from the application 
of the veratria to an entire surface, and in the great majority of cases these 
will be found sufficient for every purpose which they are intended to serve: 
in some affections, however, in which the symptoms are more severe, or which 
are seated in parts only thinly covered by integuments, the attempt has been 
made to apply it directly to a part denuded of the cuticle, but although the 
effects upon the disease were much greater than when the surface remained 
unbroken, yet the extreme irritation which followed the practice rendered its 
repetition nearly impossible. 
Having presented to the attention of the reader these few introductory 
remarks, we shall next proceed to the consideration of the diseases, in the 
treatment of which the veratria has been found of such essential service ; but 
before doing so, it may be proper to say a few words on the cases to be 
described. In an inquiring age like the present, it behooves an individual, in 
laying before the profession any new plan of treatment, especially if that be 
applicable to diseases which have heretofore been considered either very 
obstinate or incurable in their nature, not to say more in its favor than the 
facts brought to light during its investigation warrant; for experience teaches 
us that many remedies, the prudent use of which might have rendered the 
most essential service to medical science, have suffered, often irremediably, 
in consequence of the rash and inconsiderate praises heaped upon them by 
their discoverers. On this account it is intended to do nothing more than 
merely to state the cases as they have occurred, in the hope that they may 
not be thrown aside as savoring too much of the marvellous, but that they may 
induce other laborers in the same field to pursue the course of investigation 
which has now been opened up, and which, judging from the success to which 
it has already led, if carefully and cautiously followed out, cannot fail to be 
of the highest benefit to the profession, and to suffering humanity, by placing 
in the hands of the practitioner one of the most energetic remedial means that 
chemistry has ever furnished to medicine, and one which, in the diseases 
admitting of its employment, may be had recourse to at all times, with the 
greatest safety. EXTERNAL APPLICATION OF VERATRIA- 
11 
CHAPTER I. 
EXTERNAL APPLICATION OF VERATRIA IN AFFECTIONS OF THE HEART. 
The first class of diseases in which the use of veratria has been found 
decidedly advantageous, comprehends many of those anomalous affections of 
the heart and circulating system, in which the symptoms, though sufficiently 
distressing to excite alarm in the patient or his friends, are nevertheless 
wanting in some particulars, the presence of which is necessary to make out 
the case to be one of confirmed organic disease. . It is not intended for a 
moment to insinuate that any permanent advantage has arisen from its 
employment in cases where structural alteration has already taken place ; but 
the result of a pretty extensive experience in such affections, warrants the 
hope that an alleviation of the sufferings of the patients may be affected, to an 
extent sufficient to render life not only more easy, but also to enable those 
who are laboring under them to pursue their necessarv avocations. 
These diseases are generally characterized by difficulty of respiration, 
accompanied by cough, expectoration, inability of remaining long in a 
recumbent posture, startings from sleep, swelling and coldness of the 
extremities, palpitation, a rapid small irregular pulse, accompanied by anxiety 
and a sensation of pain, or rather of constriction in the region of the heart; 
occasional faintness and sense of suffocation. It has been successful even in 
worse cases : for one of angina pectoris (to be related immediately) appears 
to have received most marked and permanent advantage from a few rubbings 
with the ointment. 
The ointment best adapted for use in affections of this class, consists of 
fifteen or twenty grains of veratria mixed carefully up with an ounce of lard, 
and of this a piece the size of a nut is rubbed over the region of the heart for 
live minutes once a day. In all the cases which have come under observation, 
a few such applications have generally proved all that was requisite either to 
effect a complete cure, or at least to cause a cessation of the symptoms for a 
considerable time; the friction may then be employed at longer intervals, and 
should any slight accession take place, it may be removed by a repetition of 
the same means. 
During the action of the veratria, the pulse increases in strength and becomes 
more regular in character, the extremities return to their natural warmth, and 
the swelling, when any does exist, rapidly disappears; the lips also regain 
their usual color, and the general health and appearance of the patient are 
materially changed for the better ; almost at the same time the distress and 
anxiety which had previously existed werfr away, and the sleep becomes 
regular, refreshing, and undisturbed ; the cough and expectoration diminish 
daily, the fluttering action of the heart is exchanged for regular and uninter- 
rupted pulsation ; the faintness and sense of suffocation vanish, and the patient 
is in an almost incredible short space of time restored to health. Although 
this be the usual progress of the action of the veratria in these diseases, it 
nevertheless sometimes produces effects of a different kind, at least, during 
the time of its employment. It has happened that from one application the 
symptoms, and particularly the palpitation, have been increased to such a 
degree as to render it impossible to induce the patient to submit to a second ; 12 
EXTERNAL APPLICATION OF VERATRIA 
but what is not a little singular, the irritation has subsided in a day or two, 
and along with it, every trace of the disease itself has disappeared. During 
the whole period the constitution is under the influence of the medicine, the 
functions are but little altered, with the exception of the secretion of the urine, 
which is, upon the whole, more actively carried on than at other times ; and 
this latter circumstance, in all probability, depends upon the existence of 
of watery effusion somewhere in the body, a condition which appears necessary 
before the veratria can produce a diuretic effect. 
CASE I. 
A lady, fifty-five years of age, short, and thickset, and of a florid 
complexion, was attacked seven years ago with what her medical attendants 
considered to be an inflammatory affection of the lungs, and for which she 
was profusely bled, and otherwise actively treated. The violent symptoms 
were by these means removed; but there still remained such a degree of 
weakness and affection of the chest, as to confine her almost constantly to 
her room for nine months afterwards. Since that time, she has recovered 
considerably, but has been under the necessity of remaining in an apartment, 
kept at an equable temperature, during the whole winter; and her state has 
all along been such, as to render it to all appearance probable that she would 
be obliged to pursue the same regimen for the remainder of her life. 
Throughout the whole seven years she has had constant cough, attended 
with scanty mucus expectoration : a difficulty of breathing so great as to 
prevent her sleeping at night, or even remaining irfthe recumbent posture 
for any length of time without bringing on distressing fits of coughing: 
respiration very much hurried, and the lips of a purplish hue : pulse so small, 
rapid and irregular, as to render it difficult to ascertain the number of its 
beats. Over the region of the heart, and over a great part of the anterior 
surface of the thorax, there was a very perceptible undulatory motion, 
altogether different from ordinary pulsation; and the ear applied to the chest 
over the same region, distinguished the heart's action to be extended, indis- 
tinct, and undefined in character. Along the whole length of the left arm, 
from the shoulder to the points of the fingers, she complained of pain and a 
feeling of numbness, w hich rendered the extremity almost useless: this 
symptom had lasted about four years. There was no very marked derange- 
ment in the digestive organs. The bowels were regular, the appetite pretty 
good, but there existed a slight degree of flatulence, not however so great as 
to occasion much inconvenience, and there was nothing very particular in the 
appearance of the tongue. 
The patient had previously been under almost every variety of treatment, 
but without receiving any benefit. Upon the supposition that there might be 
some accumulation in the bowels sufficient, though not to induce, at least to 
aggravate and keep up the symptoms, she was directed to use aperient 
medicine for a few days, but without producing any alleviation. She was 
then put under the influence of small and repeated doses of the tartrate of 
antimony, and along with this treatment, frictions with croton oil w ere applied 
over the chest and down the left arm, until a pretty free eruption was brought 
out. Under this plan the patient, for the first time from the commencement 
of her illness, experienced decided relief; and it should certainly have been 
persevered in until a fair trial had been given to it, had not such a degree of 
debility supervened, as to give rise to considerable doubt whether or not it IN AFFECTIONS OF THE HEART. 
13 
could be continued with safety; the cough and difficulty of breathing had very 
much diminished in severity, but the pain in the arm remained unabated, and 
at the end of ten days she would not consent to the further employment of 
the remedies, and they were in consequence given up. 
Before the time at which this patient came under treatment, the very striking 
effects which the veratria, when applied externally, exercises upon the pulse, 
in removing irregularities and intermissions, and in diminishing its frequency, 
had presented themselves to observation ; and although it was not anticipated 
that very great benefit could arise from its use in a case so apparently hope- 
less, it nevertheless appeared probable that, at least, a temporary relief from 
the violence of the symptoms might be procured, if the medicine only acted 
upon the circulation, without inducing such a degree of general debility as 
had resulted from the means previously had recourse to. A piece, as large 
as a nut, of an ointment composed of fifteen grains of veratria and an ounce 
of hogs' lard, was accordingly directed to be rubbed twice a day over the chest 
and along the affected arm five minutes each time, and the result very far 
exceeded the expectations formed. The first application relieved all the chest 
symptoms considerably. The cough and breathlessness, to a certain extent, 
subsided, and the pulse and action of the heart were greatly improved : the 
most decidedly beneficial effects however were produced upon the extremity; 
the pain and numbness had not altogether disappeared, but these symptoms 
were so much alleviated, as to induce the patient to state that, comparatively 
speaking, she had recovered the entire use of her arm. From this time the 
ointment was directed to be used every evening for about ten days, and then 
only occasionally, as it might be found necessary. 
In about a fortnight from the first application of the veratria, the patient 
was able to leave her room, and walk up and down stairs with facility ; and 
the general improvement of her health was such, that she ventured into the 
open air, but in consequence of incautious exposure, the symptoms returned 
two or three times, though by no means with the same severity as before; 
and when such an occurrence took place, one or two rubbings with the 
ointment afforded complete relief. She is now in comparative health : her 
general appearance is good, the pain and numbness of the arm have entirely 
disappeared, the circulation is much more regular than it has been for a great 
length of time, the cough and difficulty of respiration are almost gone, and 
she can now remain in the recumbent position, and enjoy a good night's rest; 
and the last time I saw her, she had walked about four miles without any 
inconvenience. 
In this case, which is obviously one of such extensive organic disease, it 
would of course be out of the question to expect anything like a complete 
recovery; but surely it must be allowed by every candid observer, that a 
medicine, possessed of powers capable of alleviating the sufferings of indi- 
viduals laboring under diseases the most distressing and hopeless that can 
come under the notice of the practitioner, is worthy of every attention which 
it is possible to bestow upon it. 
CASE. II. - 
Mr. B. aged thirty-six, of sedentary habits, and by profession a banker's 
clerk, was seized about ten years ago, without any apparent cause, with pal- 
pitation on the left side of the thorax, which was soon followed by pain and 14 
EXTERNAL APPLICATION OF VERATRIA 
a sensation of tightness and anxiety over the region of the heart; his pulae 
became very irregular and intermittent; sometimes its beats were strong and 
full, at others small and weak; his breathing, however, has not been to any 
great degree disturbed, and he has been able to take free exercise, not only 
without inconvenience, but even with some benefit. During the course of 
his illness he has had no cough, but his respiration has been occasionally 
interrupted by deep unconscious sighs. 
The digestive functions have been considerably impaired, the appetite bad, 
the bowels disordered, and an almost constant tendency to flatulence has 
been present. The nervous system has also been for some time under much 
derangement, marked by tremors in the hands, irritability of temper, dis- 
turbance of the mental powers, particularly of the memory, which has 
suffered a good deal in its integrity ; for some time past he has experienced a 
disinclination for exertion, and has gone through his business more as a matter 
of duty than of pleasure. His sleep has been disturbed and unrefreshing; 
and he has labored under great depression of spirits, from the belief that his 
complaint, from the number of remedies he had tried without advantage, was 
incurable. 
Under these circumstances, and seeing from the account he had given, 
that to attempt a cure by the means usually employed in such cases, would 
only be a waste of time, and also in consequence of the success which had 
attended the previous trials made with the veratria, it was determined at 
once to employ it in his case; and with this view he was directed to take a 
little opening medicine, a practice always necessary to be pursued during the 
time the veratria is in use, and an ointment of the same strength as that 
applied in the preceding case, was ordered to be rubbed, night and morning, 
over the region of the heart. As the patient lived at some distance he did 
not present himself again until the end of a week, when he returned to 
announce that he was quite well. The palpitation and nervous symptoms 
had entirely vanished, and he was then in the enjoyment of the very best 
health and spirits. I have seen him once since that time, and he has not had 
the slightest return of his complaint. 
This appears to have been a case of simple nervous palpitation, than which 
a more intractable disease, at least in many instances of it, hardly exists; 
and affords a striking illustration of the power which this singular remedy 
exercises in removing such affections, after almost every possible plan of 
treatment has proved without avail. 
CASE. HI. 
Mrs. L., a lady of thirty-six years of age, and of a spare habit of body, 
residing in Bristol, has been suffering for five years from palpitation of the 
heart, attended by considerable difficulty of breathing. She dates the com- 
mencement of her disease from a severe inflammatory affection of the chest, 
occasioned by cold caught during her confinement. To relieve the chest 
symptoms, bleeding and other antiphlogistic measures were had recourse to ; 
but the palpitation continued to such a degree, as to render her incapable of 
taking any exercise without materially aggravating her symptoms. She has 
had many exacerbations arising from slight causes, and yet so severe as to 
render venesection necessary to alleviate the violent throbbing in the left 
side. Her eyes are suffused, her memory much impaired, and she has a 
considerable degree of nervous irritability. Her breathing is difficult, IN AFFECTIONS OF THE HEART. 
15 
accompanied by slight cough and a sense of partial suffocation, along with 
pain across the region of the heart and down the left arm, and these feelings 
are materially increased by walking or any other exertion. Her pulse is 
irregular and quick ; bowels costive ; feet generally cold ; and her sleep 
interrupted by the palpitation. 
While laboring under these symptoms she was put under the influence of 
small doses of tartrate of antimony and blue pill ; and at the same time an 
embrocation of croton oil was ordered to be rubbed over the chest and down 
the affected arm, until a free eruption was produced. So long as the patient 
continued this plan of treatment, and remained quiet, she experienced great 
relief; but the palpitation returned nearly as violently as ever, upon slight 
exertion, and she now began to complain of a degree of debility which she had 
not before been subject to. Under these circumstances, she was ordered to 
have an ointment prepared with twenty grains of veratria to an ounce of lard, 
rubbed in the usual quantity over the region of the heart for five minutes, 
night and morning; and owing to the severity of the pain in the arm, frictions 
with the croton oil were ordered to be made along it, until a raw surface was 
obtained, and over this the veratria ointment was applied. 
On the night after the first application the symptoms were very much 
diminished in intensity, but the veratria had occasioned a degree of heat and 
tingling in the arm, so great as to prevent her sleeping ; the pain, however, 
never afterwards returned. In three or four days she began to take exercise 
without inconvenience; and at the end of three weeks she left town, and 
returned home quite well. 
CASE IV. 
Mr. J., a clergyman, fifty years of age, large chested, robust, and of a 
sanguine temperament, has been affected with severe palpitation for the last 
seven years, accompanied by quickness and irregularity of the pulse, difficulty 
of breathing, loss of voice, cough, expectoration, and a most distressing sense 
of anxiety: he has sometimes been seized in the pulpit with giddiness, succeeded 
by throbbing in the neck and confusion of intellect, and these symptoms 
have occasionally gone on to such an extent as to oblige him to desist from 
his duties for two or three months at a time: his bowels are regular, and his 
digestion generally good. 
He was ordered to take small doses of tartar emetic, and to have a blister 
applied over the chest; and this treatment was pursued with considerable 
advantage for the time, but when it was remitted he soon returned to the same 
state as before. As this seemed a fair case upon which to make trial of the 
veratria, it was ordered to be rubbed on in the manner already described ; 
and with its accustomed success. By making use of the frictions once every 
night he became gradually better, and at the end of a week considered himself 
quite well: he was advised, however, to continue the ointment for a little 
longer, and then to leave it off by degrees: this was accordingly done about 
six months ago, and he has remained ever since in perfect health, free from 
every vestige of his old complaints, and fully able for the discharge of the 
functions of his office. 16 
EXTERNAL APPLICATION OF VERATRIA 
CASE V. 
Angina Pectoris. 
Mr. W., aged fifty-eight, has been affected for seventeen years with palpi- 
tation, which, during the last seven of that period, has been attended by great 
difficulty of breathing, occurring in paroxysms, coming on especially whilst 
taking exercise on foot. The dyspnoea at these times has been so severe, and 
has been accompanied by such extreme pain across the chest, as to compel 
him to lay hold on the nearest object for support. The pain, during the fit. 
extends down the left arm; and is of such intensity, that in the words of the 
patient, "no language can describe it." 
For these and other symptoms he has, during the last ten years, applied to 
all sources for relief, and almost every possible remedy has been tried without 
procuring for him any ease. At the time he came under treatment, he had, 
besides the symptoms mentioned, a peculiar purple blush upon his face, and 
more particularly over his nose and lips; his voice was weak and quivering. 
Upon applying the ear over the region of the heart, a tremulous, confused, 
irregular pulsation was heard ; the pulse was irregular and very intermittent: 
the leftside of the chest appeared much larger than the right, and the ribs 
over the cardiac region seemed pushed out as if to afford a larger space for the 
heart's action. There was considerable distention of the abdomen, along with 
a very evident degree of enlargement on the right side, immediately under 
the margins of the ribs; his bowels had been for some time in a very torpid 
state, and required rather strong medicine to operate upon them ; the lower 
extremities were a little swollen, and the urine deficient in quantity. His 
sleep was unrefreshing, and often disturbed by fits of coughing, which generally 
ended in great exhaustion. 
As it was evident that in a case of such severity and duration, little more could 
be done than merely to relieve the sufferings of the patient, by endeavoring 
to mitigate, as much as possible, the severity of the symptoms, the treatment 
followed was addressed to that end. A course of medicine was prescribed, 
consisting of laxatives combined with antacids, for the purpose of clearing 
out the bowels and removing the distention of the abdomen. These means 
were employed alone, for about a week, and then, with the addition of a little 
squill to the pills previously ordered, it was persevered in for a fortnight longer; 
at the end of which time he felt considerably better. The swelling in the 
legs had diminished, the digestion was improved, and, altogether, he was in 
a more favorable state of health than before. 
During the previous treatment of this case, counter-irritation, by means of 
blisters, issues, tartar emetic ointment, &c., had been freely employed, and 
with so little effect, further than bringing about a temporary alleviation, that 
the patient would, on no account, consent to their repetition now, and he was 
therefore recommended to make use of the veratria ointment, but certainly 
without any great expectations of its producing a beneficial effect. 
An ointment of the usual proportions was ordered to be rubbed, for five 
minutes, night and morning, over the region of the heart; and, in the course 
of three days, the feeling of pain and constriction across the chest had entirely 
disappeared. As the pain in the left arm still remained, he was ordered to 
use frictions with the ointment to it also, and almost immediate relief, from 
that system, followed the application. In the course of a fortnight from the 
time the veratria was had recourse to, the most decidedly beneficial effects IN AFFECTIONS OF THE HEART. 
17 
had been produced upon the disease: the pulse and action of the heart had be- 
come much more regular and natural, the difficulty of breathing had very much 
diminished, the complexion was completely changed, and exhibited signs of 
an unimpeded circulation ; and this improvement went on gradually, under the 
occasional use of the ointment, along with a little medicine to act upon the 
bowels, so that, in about six weeks he could walk about, and go up and down 
stairs without inconvenience. As this case was one in which a cure could 
not be expected, the patient was left to himself, with directions to rub on the 
ointment whenever a return of pain or uneasiness rendered its employment, 
necessary. This, he accordingly does, and, by its means, is enabled to' 
pursue his avocations with ease and comfort. Before taking leave of this 
case it is proper to state, that it was one of those in which the veratria exerted 
its peculiar diuretic effects, for, during the first week it was used, no less 
than six pints of urine a day were evacuated by the patient. 
CASE VI. 
Mrs. C., a lady betwixt fifty and sixty years of age, of a sanguine temper- 
ament and rather corpulent, has been ill about nine years. During the first 
three she suffered from dyspepsia and irregularity of the bowels, and, for six 
years, she has been affected with almost constant palpitation and difficulty of 
breathing ; which symptoms she describes as having been constantly on the 
increase, until at last she was obliged to confine herself to one floor of the 
house, from inability to ascend or descend the stairs, and to refrain from 
walking, under the impression that the exertion might prove fatal. 
She has violent pulsation over the region of the heart, along with an irre- 
gular and intermittent pulse, and complains, at times, of very severe pain 
across the chest, and stretching down the left arm : her lips are of a purplish 
color ; her eyes dull; her countenance sallow ; and she labors under con- 
siderable nervous irritability, accompanied by impairment of the memory ; 
she has a degree of fullness in the right side, under the margin of the ribs, and 
her feet are generally cold, and a little swollen. For these symptoms she 
had previously been treated by bleeding, blistering, purgatives, and, indeed, 
every thing possible appeared to have been done, without procuring any 
abatement of the disease. 
From the disordered state in which the digestive organs evidently were, 
she was put underja plan of treatment similar to the one pursued in the 
preceding case, for about three weeks, but without procuring any abatement 
in the symptoms, and then the veratria ointment, of the usual strength, was 
ordered to be rubbed over the left side of the chest, and down the arm, every 
night. The very first application afforded great relief to the palpitation and 
difficulty of breathing, and the pain in the arm was also considerably allevi- 
ated. In the course of a few days all the symptoms were nearlv gone; the 
ointment was, however, directed to be applied occasionally, for about a month ; 
and at the end of that time, the patient could walk with ease, three miles at a 
time, and returned home quite well. It is now upwards of six months since 
she discontinued the treatment, and she has had no return of the disease 
since. 18 
EXTERNAL APPLICATION OF VERATRIA 
CASE VII. 
The following case is given merely for the purpose of showing the effect 
which the veratria has upon the circulation, in a disease attended by symptoms 
of great development of the heart's action, occasioned by simple hypertrophy 
of the walls of the left ventricle, and not, of course, with any view of holding 
out a prospect of recovery in patients laboring under an organic alteration of 
this nature. Every one must have remarked the difficulty which there exists 
of moderating the pulsation of the heart and arteries, in this disease, and that, 
in consequence, it is no easy matter to procure even a temporary relief from 
the distressing sensations experienced by those who are affected bv it. The 
cases of this kind, in which the ointment has been resorted to, are not 
sufficiently numerous to warrant the assertion, that decidedly beneficial effects 
will result from its application in every instance ; but it will, nevertheless, be 
allowed, that the subject is worthy of attention, from the fact of the medicine 
having already proved successful in doing so. 
Mrs. S., a lady about sixty years of age, has, during the last five years, 
suffered much from violent beating of the heart, attended by strong pulsation 
in the neck, throbbing and giddiness in the head, and a continued whizzing 
noise in the left ear, along with feelings of anxiety, and considerable nervous 
irritability. 
The action of the heart is strong, constant, and concentrated in a space 
over the situation of the apex, and communicates a powerful impulse to any 
thing placed on it; the pulse is very full, throbbing and incompressible ; the 
carotid arteries beat violently, and the patient complains much of the noise 
in her ears, and of giddiness; she has also confusion of ideas, and a feeling 
of heat and fullness in the head. She has considerable anxiety, and her 
sleep is interrupted by palpitation. There is some pain in the region of the 
heart; and all thece symptoms are materially augmented by exertion ; but 
this, from the sensation of lassitude which she almost constantly labors under, 
cannot be made to any great extent. 
The bowels are generally costive, and require the employment of active 
purgatives, which are the only medicines capable of removing the uneasy 
feelings of the patient, to any degree ; the digestive functions are very active, 
and the appetite preternaturally great. She complains neither of difficulty 
of breathing, co igh, nor pain in the arm. In the previous treatment of this 
case nothing had been found useful, and as it did not appear that any bad 
consequence could arise from the external application of the veratria, it was 
ordered to be rubbed over the region of the heart, in the usual manner, after 
purgatives had been administered for a few days to regulate the bowels. 
After the first or second friction with the ointment, all the symptoms were 
materially diminished in intensity; the palpitation had greatly subsided ; the 
pulse had become much softer and weaker; the anxiety, the pulsation in the 
head, the feeling of giddiness, the confusion of intellect, and the sensation of 
whizzing in the ears, had all disappeared, and the general health and 
appearance of the patient were much improved ; but still some of the symp- 
toms remained, not, however, to such a degree as to occasion inconvenience, 
and she is now in a comfortable state, and able to follow her household 
employments; +hough exertion, to any great extent, cannot be used without 
aggravating her complaints. From the manifest benefit experienced from the 
veratria ointment, she uses it herself whenever, from any cause, an increase 
in the symptoms takes place, and always,with the effect of procuring imme- 
diate relief. IN AFFECTIONS OF THE HEW. 
19 
CASE VIII. 
A gentleman, aged about sixty, of a weak constitution, of sedentary habits, 
and given to mental occupations, has labored, for seven years, under slight 
palpitation, accompanied by feelings of anxiety and general languor, coming on 
at intervals, and increased by exertion ; his pulse is feeble, rapid and inter- 
mitting; palpitation over the lower part of the left side, not excessive, but 
attended with a painful sensation in the region of the heart, which is so 
augmented by walking, especially against the wind, as to compel him to stop 
and support himself on the nearest object. Respiration generally unimpeded, 
except under these circumstances. The circulation in this patient is peculiarly 
languid, the face pallid, and the surface of the body cold. The nervous 
system is easily excitable, and he finds that continued exertion of the mind 
very much aggravates all his symptoms. Appetite good, digestion easy, but 
occasionally accompanied by flatulence ; bowels rather costive. 
In the previous treatment of this case the same measures were employed 
as in those already related, but without the least effect. He was ordered to 
take a little opening medicine for a week, and then to apply the veratria 
ointment over the region of the heart as usual. On the night after the first 
friction had been used, the patient got no rest in bed from the excessive 
nervous irritation which it had given rise to ; his feelings of anxiety, and 
palpitation were so very much augmented, that he would on no account repeat 
the application : these symptoms continued unabated for two days, at the end 
of which however the disease began to decline, and went on afterwards to do 
so until every vestige of it had disappeared, although no curative means what- 
ever had been employed after the first application of the veratria; and he still 
continues quite well. 
CASE IX. 
A lady about sixty years of age, stout made, and of a ruddy complexion, 
was suddenly seized with a fit of fainting about sixteen years ago, in which 
she continued for an hour and a half, and ever since that occurrence she has 
been affected with palpitation of the heart, accompanied by frequent returns 
of the syncope. She now complains of palpitation, and difficulty of respiration, 
along with deep sighing, occasioned by a sensation of constriction, which she 
describes as extending over the chest, unattended by cough; and the angles 
of the mouth are slightly bluish in appearance. The action of the heart is 
violent and irregular, and she complains of oppression and weight over the 
lower part of the left side of the thorax. The pulse is intermittent and 
irregular, and does not at all times correspond with the intensity of the heart's 
pulsations. She complains of occasional shooting pains in the arm, reaching 
to the points of the fingers; she is sometimes nervous and low-spirited, and 
at intervals nearly free from all those symptoms; but not for any length of 
time, for they return again from very slight causes. 
The appetite in this patient is at all times pretty good, but the digestion is 
not performed with a corresponding degree of facility, which renders a careful 
selection of the articles of diet as well as attention to their quantity necessary; 
yet, notwithstanding that these precautions are attended to, there is consider- 
able flatulence and pain in the stomach during the process; The bowels are 
habitually costive, and require the employment of active purgatives from time 
to time, to keep them easy; and the lower extremities are generally cold. 20 
EXTERNAL APPLICATION OF VERATRIA 
Almost every form of treatment that could be devised, had in this case 
been resorted to, during the long continuance of the disease; but the palpita- 
tions and faintings never ceased, although the general health by great care had 
been preserved tolerably good. To relieve the disordered state of the stomach 
and bowels, the patient was now directed to take opening medicine, combined 
with antacids, along with small doses of blue pill, for a week ; and by these 
means the dyspeptic symptoms were, to a certain extent, removed, but the 
affection of the heart still remained nearly as violent as ever. The veratria 
ointment was then prescribed of the usual strength, and ordered to be rubbed 
every night over the left side of the thorax. She did not return till the 
end of a week from this time, and from her own account, as well as from 
examination, she then appeared very much better. During the interval the 
palpitation and syncope had been much relieved, and indeed the latter had 
not returned. The feeling of tightness and oppression was quite gone ; the 
pulse was materially improved in character, but still rather irregular. She 
was directed to persevere in the application of the ointment; her health and 
appearance became gradually amended, and at the end of a month from the 
time at which the veratria was had recourse to, she was quite well. IN NEURALGIC AFFECTIONS. 
21 
CHAPTER II. 
EXTERNAL APPLICATION OF VERATRIA IN NEURALGIC AFFECTIONS. 
In no class of diseases have the beneficial effects of the veratria ointment 
been more strikingly manifested than in that which it is now proposed to bring 
under consideration ; for in none are the symptoms productive of more distress 
to the patients, and by no other means can the same degree of relief be 
afforded in so short a period. 
The external application of the veratria has been made use of in neuralgic 
affections situated in every part of the body; and -the cases which have 
hitherto been subjected to this plan of treatment have almost without exception 
yielded immediately to its effects, even after having resisted every other for 
a length of time, amounting in some of them to many years. It is, however, 
in tic-douloureux that the most remarkable and speedy change is effected in 
the state of the patient, for often during the continuance of the first friction 
the paroxysm is brought to a termination, and does not again return; and if 
this be not the case the following interval is at least of much greater length 
than any that may have previously occurred, and the next accession of pain is 
much less severe and more easily removed. 
The principal considerations to be attended to in the employment of vera- 
tria in tic-douloureux, are connected with the part of the face, and the extent 
of surface, in which the pain is situated, and the length of time the patient has 
labored under the disease. With regard to the first of these, it has been found 
that in cases where the affection is not confined to one particular point, but 
has extended itself along the ramifications of the nerve in which it has its 
seat, the symptoms may be removed much more speedily, and by means of an 
ointment containing a smaller quantity of the veratria, than when the con 
trary is the case; and this probably arises from the circumstance of their 
intensity in such instances being much less, and from the surface under which 
the disease is actually situated being greater than where one spot only is 
affected, thereby affording an opportunity of making the application over a 
number of affected points at the same time. In cases, too, of long duration, 
there is more difficulty experienced in performing a complete cure, than in 
those of a more recent date ; but this does not appear to arise from the ointment 
having less power in removing the existing paroxysm in these instances than in 
others, for it almost always affords immediate relief, but from the habit of recur- 
rence at stated intervals, which its previous long continuance seems to have im- 
{>ressed upon the disease: even this, however, may be broken through by a 
ittle perseverance; and a recovery be effected, if not as quickly, at least as 
certainly, as in less obstinate cases. 
For those forms of the disease, which have been characterized as occupying 
the branches of the affected nerve, an ointment, made with twenty grains oi 
veratria to an ounce of lard, must be rubbed, during the paroxysm, over the 
whole seat of the pain for fifteen or twenty minutes, or what is better, until 
the heat and tingling caused by the friction have been so great as to produce 
an impression on the feelings of the patient equal to that arising from the 
disease itself5 and when such an effect has been brought about, the friction 22 
EXTERNAL APPLICATION OF VERATRIA 
may be discontinued for a short time, to allow the irritation occasioned by it 
to subside, so as to enable the patient to form a judgment of the relative inten ■ 
sity of the pain now, compared with what it was before the ointment was had 
recourse to. In most instances the paroxysm will be found to have been cut 
short; but if any degree of uneasiness remain, the part must be again rubbed 
with the ointment until the peculiar sensations, arising from its use, again show 
themselves, and this second application will be succeeded by a remission of 
the pain. Should an instance, however, occur of such obstinacy as to resist 
this repetition, the patient should still persevere until the paroxysm be 
subdued. 
In the great majority of cases to which this form of treatment has been ap- 
plied, the removal of the disease has been effected with the greatest facility : 
and those in which a continuance of the friction, in the manner now recom- 
mended, is found necessary, are almost without exception cases in which the 
affection has been confined to one point; and of all such, the most troublesome 
of cure are those where the pain is seated in the frontal nerve, at the place 
where it escapes from the supra orbital foramen; but even these have yielded 
to an ointment of sufficient strength, without the use of any other means. 
For the purpose of obtaining the full effect of the veratria as soon as possible 
in such instances, it has been used in the proportion of forty grains to an 
ounce of lard, and this may be done either from the very beginning of the 
treatment, or the quantity of the alcaloid may be augmented by five grains 
in each prescription until it attain to that amount. The former method is 
upon the whole to be preferred, because by it an immediate check is put 
upon the paroxysm in severe cases, without the necessity of continuing for a 
length of time the employment of weaker applications. 
It may not be out of place to repeat here the caution already given, against 
allowing even the most minute quantity of the veratria to come into contact 
with the conjunctiva, an accident which may easily happen during the appli- 
cation of the ointment in affec tions situated in the face; as such a circum- 
stance, although it may not be followed by danger, is nevertheless productive 
of so much irritation as to make it an object to guard against its occurrence. 
The general instructions which have now been given, regarding the plan to 
be pursued in the treatment of tic-douloureux, are equally applicable to cases 
of neuralgia, situated in other parts of the body. These last, however, are 
not so difficult of removal; and do not, so far as has been hitherto observed, 
require the ointment made use of to contain more than twenty grains to an 
ounce of lard. There is a form of this affection occurring in the loins, and 
extending down the thighs of women during the menstrual period, in which 
the application of the veratria is found of great service, as affording an easy 
and expeditious means of removing it. 
In a few instances of tic-douloureux the attempt has been made to lengthen 
the interval between the paroxysms by means of friction, with an ointment 
containing twenty grains of morphia to an ounce of hogs' lard, but without 
producing the intended effect. Several cases, however, of neuralgic and 
rheumatic pains, situated in other parts of the body, have been cured by the 
external employment of the morphia alone. 
CASE I. 
A lady, fifty-five years of age, of a spare habit of body, has been affected 
for the last thirty-six years with tic-douloureux in the cheek, and in the fore- IN TIC-DOULOUREUX. 
23 
head above the eyebrow, on the left side. From the commencement of the 
disease, she has had a paroxysm generally once a week, and at no time does 
she remember the interval to have been greater than fourteen days. Her 
sufferings during the continuance of the attack have been extreme, and have 
compelled her to confine herself to bed until its termination, and it has never 
lasted a shorter time than two days. In the intervals, however, she has been 
perfectly free from pain, and her general health has all along been tolerably 
good. 
It appeared from the history of the case given by the patient, that through- 
out the long course the disease had already run, almost every kind of medical 
treatment had been put in practice without giving rise to any permanently 
good result; and in consequence of this circumstance, and as the symptoms 
appeared to admit of nothing but slight alleviation, if even that could be 
procured, she was ordered to keep the bowels open by the use of an aperient 
pill, and at the commencement of every paroxysm to take a small dose of 
acetate of morphia, and to repeat it every hour until the pain abated. She 
persevered in these means for two months, and experienced considerable relief; 
but, although the violence of the symptoms was moderated, neither any 
diminution of the length of the attack, nor any change in the duration of the 
interval, could be observed. 
Seeing that such was the case, and that the general health of the patient was 
beginning to suffer from the employment of the morphia, it was ordered to be 
discontinued ; and she was directed to take small doses of strychnia, for the 
purpose of removing, if possible, a paralytic affection of the levator muscle of 
the upper eyelid, and of the left side of the face, which had come on during 
the previous existence of the disease. This course was persevered in, until 
the convulsive twitchings, brought on by the medicine, became as strong as the 
patient could bear them, but without producing any effect upon the paralysis. 
Her health was now much weaker, but her sufferings continued unabated ; 
and as it became a duty to call into use any means which might afford even 
the slightest prospect of relieving the violence of the pain, she was directed, 
after the manner already stated, to rub over the forehead and on the side of 
the face, a portion of ointment, made with twenty grains of veratria to an ounce 
of lard, till every uneasy sensation was gone. In about fifteen minutes this 
effect was produced; but the paroxysm again made its appearance within two 
hours, and by a renewal of the friction for a few minutes, it was again extin- 
guished, instead of continuing two days as usual. 
To this there succeeded an interval of perfect ease for ten days, when the 
attack again returned, but not by any means so violently as before. On this 
occasion the same plan was pursued as in the preceding paroxysm, and the 
relief afforded was still more marked, for the pain was entirely removed by 
the first application. From this time the patient had only one or two very 
slight accessions, but these were at once cut short by the use of the ointment 
for a few minutes. It is four months since the last attack came on, and she 
is at present quite free from the disease. 
Not the least remarkable circumstance in this case was the rapid change 
which took place upon the paralysis, for immediately after the first friction 
had been made use of, it was observed to have diminished considerably; and 
by the time the patient was cured of the tic-douloureux, it had entirely dis- 
appeared, and has not since in any degree returned. 24 
EXTERNAL APPLICATION OF VERATRIA 
CASE II. 
Mr. C., aged forty, of a sanguine temperament, has labored for sixteen years 
under tic-douloureux over the right side of the face and forehead, but 
particularly along the lower jaw as far as the mesial line, where it terminated; 
and when the paroxysms were severe, the pain also extended itself to the same 
side of the tongue. During the whole course of the disease, this patient has 
hardly ever been free from pain ; and when an interval of ease did take place, 
his sufferings were renewed by the slightest causes, and more especially by 
mastication, which seldom failed to bring on an accession ; his general health 
and appetite have been good, so much so, that he has frequently brought on 
an attack by inattention to proper rules for regulating his diet and regimen. 
In the previous management of this case, under the supposition that the 
pain might depend upon decayed teeth, the patient had had several extracted 
without affording any relief. .He was then bled generally and locally; blisters 
and embrocations were repeatedly employed; but still no abatement in the 
severity of the symptoms took place. Along with these means he had also 
used large doses of carbonate of iron, arsenic, mercury, opium, morphia, 
sulphate of quinine, nux vomica, &c., all without effect; and when he came 
under treatment, he had been taking prussic acid in a quantity sufficient to 
affect the nervous system, and with as little success as from the measures 
which had before been resorted to. 
As it appeared, from the history of the case, that the patient had been in 
the habit of indulging his appetite for food and drink to a considerable degree, 
and as his digestive organs appeared somewhat deranged, he was directed to 
take small doses of blue pill with epsom salts ; and along with these means 
the veratria ointment was prescribed, of the same strength as in the preceding 
instance ; and from the fact of there being no distinct interval observable 
betwixt the paroxysms, he was directed to rub it over the seat of the pain 
twice a day, and to renew the friction at any other time, should the attack 
come on. 
In the course of four or five days he returned, very much improved in every 
way. His general health appeared better; the disease had been greatly 
relieved, for instead of being almost always present, as had been the case for 
so long a time, it had been broken up into two distinct accessions, and these 
were attended with comparatively little pain : he was therefore directed to 
discontinue the regular application of the ointment, and to employ it only 
when threatened with a renewal of the paroxysm : soon after this he gave up 
the use of the internal medicines, which had' been prescribed for him, and 
he went on gradually improving under the influence of the veratria alone ; 
the intervals became longer, and the fits less and less painful, until at the 
end of four weeks from the time he came under treatment, he returned home 
perfectly free from pain ; and although five months have elapsed since then, 
he has had no renewal of his complaint, and is now in excellent health. 
case. nr. 
A lady, forty-eight years of age, of a spare habit of bodv, has been affected 
with severe tic- douloureux, situated in the middle of the left side of the face, 
for a period of twenty-two years. She has made use of every possible 
medicine, particularly of carbonate of iron, which she had taken for three 
months in very large doses, but without experiencing any benefit. IN TIC-DOULOUREUX. 
25 
The paroxysms are irregular in their duration, but never shorter than 
twelve hours, and they return generally at the end of three days, sometimes 
at the end of a week, but seldom longer; and during the interval she is not 
altogether free from pain. 
A short time before this patient came under treatment she had an attack 
of paralysis, from which, however, she had recovered, with the exception of 
a slight palsied appearance of the countenance. There were no very marked 
symptoms of derangement in the digestive organs, but it was thought advis- 
able to put her under a course of medicine for a few days, similar to that 
made use of in the last case ; and the veratria ointment, of the same strength, 
was ordered to be rubbed on in the usual manner when the next paroxysm 
occurred. This was accordingly done; and after the friction had been 
continued for a quarter of an hour, the pain ceased entirely, and never 
appeared afterwards in the shape of a regular attack. 
During five weeks from this date, the disease appeared occasionally in the 
form of slight twinges of pain in the part previously affected, but these were 
at once removed by rubbing on a little of the ointment. It then completely 
disappeared : it is now five months since, and she has had no threatening of a 
return. 
CASE iv. 
A lady about thirty-five years of age, has suffered most severely, and almost 
without intermission for the last eighteen months, from tic-douloureux in the 
cheek and side of the forehead. She has duringall that time, been put under 
the effects of nearly every variety of medical treatment that could be sug- 
gested, without producing any effect whatever upon the disease; and the 
only remedy which has in any degree alleviated her sufferings is galvanism, 
but this also has failed in producing any permanent benefit. 
This patient appeared to enjoy very good health; so that, without any other 
treatment being put in practice, it was determined upon at once to try the 
effects of the veratria ointment. She was therefore ordered to rub over the 
affected part in the usual manner, an ointment made with twenty grains of 
veratria to an ounce of lard, which she accordingly did, and in ten minutes 
from the commencement of the friction, every vestige of the pain had disap- 
peared ; and it has never since returned. 
case v. 
A lady, twenty-five years of age, has been for the last seven years affected 
with severe tic-douloureux, confined to one point, exactly in the situation of 
the supra orbitary foramen of the right side. The paroxysms have varied in 
duration, from sixteen hours to two days ; and intervals, extending from ten 
days to three weeks, but never longer, have intervened between the attacks 
of pain, and these when short, have generally been followed by a recurrence 
of the symptoms in two or three days. 
In this, as in the preceding cases, almost every means of cure appeared to 
have been already had recourse to, but, as usual, without procuring any 
uermanent alleviation of the sufferings of the patient, except that small doses 
of acetate of morphia administered during the paroxysm, sometimes caused an 26 
EXTERNAL APPLICATION OF VERATRIA 
immediate cessation; but it was attended with this inconvenience, that if 
it did not produce the desired effect, all the symptoms were immediately 
aggravated to a great degree. 
The digestive functions in this patient appeared to be considerably impaired, 
her circulation languid, and her extremities cold, especially during the attack. 
On these accounts she was put under a course of laxatives, combined with 
blue pill, for about a week, which was the means of removing these symptoms, 
but without producing any change on the disease itself. As it appeared that 
carbonate of iron was almost the only medicine which she had not previously 
made use of, it was prescribed in pretty large doses, and persevered in until 
it evidently appeared to exercise no effect whatever upon the symptoms; it 
was then given up, and about six weeks afterwards the veratria was applied. 
At the commencement of one of the accessions, she rubbed over the eyebrow 
and forehead of the affected side, part of an ointment made with twenty grains 
of the veratria to an ounce of lard ; and after the friction had been continued 
in the usual manner for about twenty minutes, the paroxysm was cut short. 
During the interval she was directed to apply, in the same way, an ointment 
made with morphia and hogs' lard, in the same proportions as the other, twice 
a day, in order to prevent a return of the attack, but without producing the 
intended effect, for it again made its appearance in ten days. 
With the view of making a decided impression at once upon the disease, 
an ounce of ointment containing forty grains of veratria was ordered to be 
employed as before, whenever a new accession of the pain took place; and in 
a few minutes after its first application, there followed a great increase of the 
symptoms, which continued for about two hours and then subsided, leaving no 
trace of the affection behind, neither has any renewal of it taken place since 
that time. 
CASE VI. 
A lady, aged twenty-six years, who has been subject to occasional attacks 
of hysteria since her fifteenth year, has also since that period suffered from 
tic-douloureux, situated in the left eyebrow and extending itself up the 
forehead, in the course of the ramifications of the frontal nerve. The 
paroxysms in general take place once a month : but if the patient happen to 
expose herself to sudden alternations of temperature, she is almost certain of 
experiencing a violent attack on the following day, and in either instance it 
continues with unmitigated severity for about twelve hours, and not unfre- 
Suently terminates in sickness and vomiting, occurring at intervals for two 
ays after, along with a considerable degree of intolerance of light. 
As no plan of treatment which she had hitherto made trial of, had had any 
effect upon the disease, she was, without any other means being employed, 
directed to rub at the beginning of one of the accessions part of an ointment 
of the usual strength, and in the manner already described, over the seat of 
the pain, and to continue the friction until relief was obtained. She did so, 
and in less than half an hour from the time the ointment began to be used, the 
paroxysm entirely left her. 
On account of the presence, in this case, of considerable visceral derange- 
ment, the patient was treated by gentle laxatives for a short time in the way 
recommended in those previously mentioned, and she was ordered to repeat 
the friction with the veratria whenever the pain returned. But this was found 
to be unnecessary ; for six months have now passed without any second 
paroxysm having occurred. IN NEURALGIA IN THE BACK. 
27 
CASE VII. 
A lady, thirty years of age, has been for several years laboring under 
tic-douloureux, seated in the right orbit, and extending along the course of 
the frontal nerve as far as the top of the head. The paroxysms have been so 
violent, as generally to confine her to bed for a day or two at a time, and have 
made their appearance with the greatest severity at the menstrual period, but 
in other respects she has all along been in the enjoyment of good health. She 
was ordered to rub the veratria ointment, when the attack came on, over the 
whole surface occupied by the pain until relief was experienced ; this she 
accordingly did on the first appearance of it; in a few minutes it was cut 
short, and never afterwards returned. 
CASE VIII. 
Ilemicrania. 
A gentleman, aged thirty-five, of a spare habit of body, subject to nervous 
feelings, and accustomed to sedentary occupations, has for the last seven years 
been seized with excruciating fits of pain, confined to the right half of the 
head, and returning by regular paroxysms at the end of about every third 
week. A short time before each attack comes on, he suffers much from 
restlessness and irritability, his pulse becomes augmented in frequency, and 
he complains much of impairment of memory; and after it has ceased, he does 
not return to his usual state of health for two or three days. 
For this affection he was directed, during the paroxysm, to make use of 
frictions with the veratria ointment, of the usual strength, over the seat of the 
pain ; he first applied it to the forehead, and one rubbing was all that was 
requisite to remove the pain in that situation, but it still continued unabated 
in violence in the remainder of the affected region: to this part he was also 
ordered to apply the ointment, and the pain there, in like manner, yielded to 
one application; this took place four months ago ; no second return of the 
symptoms has taken place, and he is now in good health. 
Along with the hemicrania, there existed in this patient a considerable 
degree of irritability of the heart; but a few frictions with the same ointment, 
made over the left side for five minutes every night, along with an occasional 
aperient pill, sufficed to remove this symptom permanently. 
CASE IX. 
Neuralgia in the Back. 
Mrs. F. about thirty-eight years of age, had for the period of four yearn 
suffered from intense pain, confined to one spot in the loins, and which was 
not increased by motion, It came on in paroxysms, so frequent in occur- 
rence, and of such duration, that she never experienced a longer interval than 
two days betwixt them. And her sufferings were augmented to such a degree 
during the period of gestation, that she was compelled to confine herself to 
bed for a great part of the time. 
To bring about the removal of this affection, the patient had previously 28 
EXTERNAL APPLICATION OF VERATRIA 
submitted to bleeding, generally and locally ; and blisters, tartar emetic oint- 
ment, frictions with stimulating embrocations, along with plasters of various 
kinds, had been made use of, but without in any degree alleviating the pain: 
she had also taken internally almost every medicine calculated in any way to 
procure an abatement of the disease, but still no relief could be obtained. 
When this patient first put herself under treatment, several of the remedies 
previously had recourse to were again employed; and along with these, fric- 
tions with croton oil were ordered over the seat of the pain, until a free 
eruption came out, but without effect. As a last resource, the veratria oint- 
ment, made with twenty grains to an ounce of lard, was directed to be 
applied in the usual way, and in a very few minutes every vestige of the pain 
had disappeared. She had been since entirely free from it, and is now in 
the enjoyment of the best health. 
case x. 
Neuralgia of the Back. 
A young lady, about twenty-four years of age, had been affected with most 
violent pains in the loins and thighs, during the menstrual period, for about 
eight years. The pain has in general continued, without intermission, for 
three days, and has then subsided of its own accord. 
Many attempts have been made in this case to effect a cure ; the patient 
has taken opium, preparations of morphia, Dover's powder, and other sedative 
remedies, but without experiencing any permanent benefit, for at each 
monthly period the pain has manifested itself with the same severity as before. 
From the effects wkich the veratria had been already observed to have upon 
similar diseases, an ointment made with twenty grains of the alcaloid to an 
ounce of lard, was directed to be made use of over the loins, with the effect 
of immediately removing the pain, and it has not again returned. 
case xi. 
The eleventh case happened in a lady about thirty-three years of age ; and, 
except that the disease had in this instance continued for nine years, its 
previous history, course, and termination were so precisely similar to those 
of the preceding case, that any more particular relation appears quite unne- 
cessary. 
CASE XII. 
An elderly gentleman, rather corpulent, and of sedentary habits, had 
suffered severely for nine months from a fixed pain seated in the lower part 
of the spine. It had continued during the whole time almost without inter- 
mission, and at last nearly prevented him from remaining in the erect posture. 
The veratria ointment was directed to be rubbed over the affected part, and 
immediately removed the pain; the patient w as however ordered to apply the 
frictions, night and morning, for two weeks, to prevent a return, and he has 
since had no symptoms of the complaint. IN NEURALGIA. 
29 
case xin. 
Mrs. A., a middle-aged lady, has suffered severely for about five years from 
a painful affection in the situation of the os coccygis, which is much increased 
by sitting, or riding on horseback. For the cure of this disease, she has been 
under every variety of treatment, both internal and external, and has spent 
much time at the principal watering places, but still the pain has continued 
the same. 
She was directed to make use of friction with the veratria ointment over 
the affected part, and the first application afforded complete relief. At the 
end of twelve hours the pain again came on, but was a second time as easily 
removed; and as there seemed to be a tendency to a recurrence of the symp- 
tom, the ointment was ordered to be repeated night and morning, until the 
disease had ceased again to appear. In the course of ten days the patient 
was quite well, and has since continued to be so. 
The preceding cases will serve to illustrate a few of the more important 
forms of neuralgia, as they occur in different parts of the body, and in the 
treatment of which the veratria ointment has been applied. Many others of 
a slighter character, and of easier cure, might have been cited, but it has 
been considered better to relate only such as are of a more severe nature, as 
it is in the treatment of these that the new remedy becomes the most valuable 
acquisition ; for in milder examples there are other means, which may be 
employed successfully without resorting to its use. Before taking leave, 
however, of this part of the subject, it is necessary to mention that there is 
still another class of affections, nearly allied in character to that already 
treated of, and seated in the great cavities, which'receives most marked benefit 
from frictions with the veratria applied over the seat of the pain. Many cases 
of this kind have been cured by means of it, but in none is the relief expe- 
rienced more grateful to the feelings of the patient, than in painful sensations 
occurring along the course of the rectum, coming on after each stool, and 
continuing for some minutes with great severity: such affections are by no 
means uncommon, and appear to be confined to the nerves of the part; and 
for their removal, all that is in general necessary is to rub the ointment along 
the sacrum, during a few successive attacks, and the pain will shortly 
disappear. 30 
EXTERNAL APPLICATION OF VERATRIA 
CHAPTER III. 
EXTERNAL APPLICATION OF VERATRIA IN RHEUMATISM. 
From what has been said in the foregoing chapter on the subject of the 
external employment of veratria in neuralgia, it will not be requisite to 
introduce here any further remarks, except such as are exclusively applicable 
to the effect produced by it upon rheumatism in its various forms. 
In the acute stage of the disease, it does not appear to have been before 
made use of; but if any inference can be drawn from two or three cases, 
which are the only ones that have hitherto been treated by it, the effects 
produced are no less marked and beneficial in this than in the chronic form. 
The ointment in those instances was rubbed directly upon the inflamed surface, 
and instead of producing any additional irritation, the inflammation and 
swelling rapidly subsided, and the pain was quickly subdued. 
It may be a question, in how far it would be useful to apply the veratria 
ointment at the very outset of the inflammatory stage; for in the cases already 
alluded to, it was not employed until the usual antiphlogistic remedies had 
been resorted to ; and from certain facts which have been observed in its 
operation, it appears that the disease must have existed for a short time before 
the veratria can take effect upon it; but further experience on this point wilt 
soon decide the question. 
From the extent of surface affected in acute rheumatism, and from the 
quantity of ointment which is on that account required for the friction, the 
proportion of veratria ordered in the prescription should not be so great as in 
the diseases already treated of; for in this, as in other affections, the strength 
of the ointment should always bear a certain relation to the space over which 
it is to be applied. 
In cases where the rheumatism is general, or where it is seated in several 
joints at the same time, ten grains of veratria to an ounce of lard will make 
an ointment sufficiently powerful for every purpose ; but where it is confined 
to one or two joints, or where it has assumed the chronic form, the quantity 
employed may be varied according to circumstances, from ten to twenty or 
more grains, and the friction may be continued in either case as long as the 
patient can bear it; or if it be requisite to specify a fixed portion of time-as 
a general rule, it may be stated, that in the earlier stages of the disease ten 
minutes, and in long standing examples fifteen or twenty, will be enough to 
remove the existing pain. 
When the case to be treated is decidedly chronic in its nature, particularly 
if extensive organic changes in the partshave taken place, the best directions 
are, to rub the affected joints every night for the time specified, until the pain 
has disappeared ; and at any future period, when from change'of weather, or 
other causes, it again returns. In slight acute affections, arising from cold, 
one application, continued until the heat and tingling manifest themselves, in 
general effects a complete cure. 
The directions which have now been given will, in most cases, prove 
sufficient to enable the practitioner to make use of the veratria ointment in IN RHEUMATISM. 
31 
the more topical forms of rheumatism, as well as in those already pointed 
out: and little more appears requisite than simply to enumerate such as it 
may be applied in with the most evident advantage. 
In lumbago, sciatica, rheumatic affections of the muscles over the chest, or 
in other parts, a removal of the symptoms is effected almost immediately by 
the first friction; and in more obstinate cases, a few more will, in general, 
have the desired effect. 
CASE I. 
Mr. G., a gentleman about forty-eight years of age, had been for some time 
subject to occasional severe attacks of acute rheumatism, affecting chiefly the 
joints of the extremities, and attended with a considerable degree of general 
fever. For several days before he came under treatment he had been laboring 
under very acute symptoms of the disease; he had had a good de.al of fever, 
a quick throbbing pulse, much heat of skin, and the joints of the elbows, 
wrists, knees and ankles were swollen, red, and so very painful as to render 
motion to any extent impossible. 
In this case the most active measures had already been put into practice. 
Venesection had been freely employed, he had used large and repeated doses 
of purgatives, of various diaphoretic medicines, and colchicum; and along 
with these means the antiphlogistic regimen had been carefully pursued since 
the commencement of the attack, but no abatement in its violence had taken 
place. 
As every thing likely to effect a cure in the usual way appeared to have 
been resorted to, the previous internal treatment was ordered to be persevered 
in, and at the same time an ointment, consisting of ten grains of veratria and 
an ounce of lard, was directed to be rubbed upon the affected joints, for ten 
minutes at night, and again the following morning. When the patient was 
visited next day his rheumatism was nearly gone. The ointment had occa- 
sioned a considerable increase in the heat of the parts, but the inflammation 
and swelling were greatly diminished, and the pain almost removed ; he could 
now use the affected joints with perfect ease, and there was no return of the 
symptoms for some days. He then experienced a slight renewal of the 
complaint in one of the ankles; and at the very first appearance rubbed the 
ointment, of his own accord, over the inflamed surface for the usual time, but 
although it produced sensations of heat and tingling as usual, yet no amelio- 
ration of the pain took place: the friction was therefore ordered not to be 
repeated till twelve hours had elapsed, and at the end of that period one 
application entirely removed it. 
CASE II. 
A boy, twelve years of age, and of a delicate habit of body, had been laboring 
for three or four days under an attack of acute rheumatism, attended by a 
good deal of febrile excitement; the pulse was quick, the skin hot, and th® 
tongue dry, and slightly furred ; both his ankles and knees were swollen to a 
considerable degree; had a red and inflamed appearance, and could not be 
moved, on account of the pain. 
On the second day of the disease, leeches and fomentations had been 
applied to the affected joints, and internally he had taken colchicum and 32 
EXTERNAL APPLICATION OF VERATRIA 
diaphoretics, but with very little benefit. He was therefore ordered to have 
an ointment made with twenty grains of veratria to an ounce of lard, freely 
rubbed over the seat of the pain, for about fifteen minutes at bed time. 
Next morning the patient was almost quite well. During the night the 
pain and fever had disappeared, and he could walk about and move his limbs 
with perfect ease ; the inflammation and swelling had to a great degree 
subsided, and the joints were nearly restored to their natural appearance. In 
two days afterwards, although the ointment had been only once applied, no 
trace of the affection was left. 
case in. 
Mr. G., forty-five years of age, and of a robust constitution, was, in 
consequence of exposure to cold and wet, seized with a rheumatic attack, 
which was confined to the knee and ankle of the right side, and accompanied 
with some degree of fever; he was ordered on Ihe evening following the 
accession of the disease to take antimony combined with calomel : but next 
day the symptoms did not appear at all to have diminished. The affected 
joints were swollen, inflamed and painful, and the quickness of pulse, and 
heat of skin still continued the same. 
Part of an ointment made with twenty grains of veratria to an ounce of lard, 
was now directed to be rubbed over the seat of the pain for the usual time ; 
and on the morning after the first application, the patient could walk about 
the house; the pain, inflammation and swelling had almost disappeared, and 
the febrile symptoms were gone ; by continuing the same treatment for two 
days longer, he was able to follow his business, and no relapse afterwards 
occurred. 
f 
X 
CASE IV. 
Mr. S., a stout gentleman, aged about fifty, had been in the early part of 
his life much exposed to cold and moisture, which brought on an attack of 
lumbago, and since that time he has had many returns of the disease. In 
addition to this, he has also been affected with chronic rheumatism, confined 
principally to the joints of the hip and knee of the left side. The motion in 
both is very much impeded: over the hip-joint there is an evident fullness, 
and when any extensive movement is impressed upon it there is a distinct 
crackling noise elicited, and a similar feeling is communicated to the patient. 
The knee is also the seat of considerable swelling, and pain which is 
increased by pressure, but particularly by attempts at motion, and the same 
noise and sensation are present when it is bent and extended as in the hip- 
joint. The swelling in both situations is white in appearance, puffy, and 
somewhat elastic. The sufferings of the patient are much aggravated by 
change of weather; and attempts at motion in the affected joints are attended 
with so much pain, that he is compelled, in walking, to lift the whole 
extremity without bending it, by exerting the muscles of the opposite side. 
For the removal of the disease, he had previously resorted to most of the 
remedies in common use. Besides having taken internally every thing that 
appeared likely to afford relief, he had employed to the parts themselves, 
bleeding, counter-irritation by means of blisters, &c., and embrocations of IN RHEUMATISM. 
33 
every kind, all of which had failed in procuring any other than a temporary 
abatement of the symptoms. 
Under these circumstances this case first presented itself, and with the 
view of giving a fair trial to external applications, the affected parts were 
ordered to be rubbed with croton oil twice a day, until a very free eruption 
came out, and this plan was followed with considerable success for about six 
weeks, during all of which time the irritation was kept up by repeated 
frictions with the oil. Even this, however, at last began to lose its effect; 
and the pain which had at first diminished considerably, now appeared to be 
rapidly on the increase, and as there was no objection to the application of 
the veratria, it was prescribed. 
An ointment made with twenty grains of the alcaloid to an ounce of lard, 
was ordered to be rubbed for twenty minutes twice a day over the knee and 
hip of the affected side, and after it had been made use of a few times, the 
troublesome symptoms began to decline. The pain went quite away, and the 
swelling and rigidity became rather less ; so that at the end of ten days or a 
fortnight, the patient could bend both the diseased joints, and could walk 
almost without inconvenience. The disease itself is, of course, not removed, 
but he can now, at the distance of six months from the first application, take 
exercise on foot, and move the articulations with freedom. 
In changeable weather a very slight return of the pain sometimes takes 
place, but this is at once removed by rubbing the part with the ointment for 
a few minutes; and the patient is now in a comfortable condition. 
case v. 
Mr. B., a gentleman about forty-five years of age, was seized two years 
ago with an attack of rheumatism which terminated in a chronic affection of 
the joints of the right arm and hand. He experienced great difficulty in 
making use of the muscles of the shoulder from the pain which al wavs attended 
upon any efforts at motion : the elbow joint was stiff and painful, and he was 
obliged to carry the fore-arm in a sling. The articulations of the fingers 
were swollen, and also gave pain on motion, so that the patient could not use 
them in writing ; but had been, in consequence, in the habit of employing 
the left hand for that purpose. 
This patient had previously applied many remedies, without obtaining any 
benefit from them, and he was now ordered to rub the affected joints twice a 
day with the veratria ointment; and in a day or two all uneasiness had left 
the shoulder and elbow, and he could now move the arm with facility. The 
disease in the joints of the fingers was also much relieved, but the swelling 
appeared nearly the same : he was directed to continue the application of 
the ointment to them occasionally, until it produced some effect. He returned 
at the end of about six weeks, and at that time the pain and swelling had 
totally disappeared, and he had recovered the entire use of the hand. 
CASE VI. 
Mrs. P., about fifty-two years of age, has been for the last twelve years 
affected with chronic rheumatism in the joints of the inferior extremities, but 
particularly in the hip and knee of the right side. Her sufferings for a 34 
EXTERNAL APPLICATION OF VERATRIA 
considerable time have been augmented by variations in the state of the 
weather; and for the last five years, the joints in which the disease is situated 
have been so painful and rigid, as to oblige her to make use of supports in 
walking : the knee is much swollen, and gives a sensation of crepitus when 
moved. 
In the previous treatment of this case also, remedies of every description 
had failed to do good ; and in order to try the effects of the veratria, it was 
directed to be rubbed on twice a day in the usual manner, and to be perse- 
vered in for some time. At the end of a fortnight the symptoms were much 
relieved, and she could move the limbs with some degree of ease; she went 
on improving, and after six weeks, could walk three miles at a time with little 
difficulty, and without support. 
CASE VII. 
Mr. K., a gentleman thirty-five years of age, has been the subject of 
repeated attacks of lumbago, for several years, and the pain has occasionally 
been such as to confine him to bed for a fortnight at a time. When the 
disease first made its appearance the patient was bled and blistered repeatedly, 
and took many remedies internally, but particularly colchicum, and these 
means were always followed by relief. 
During the two attacks which had occurred previously to that in which the 
veratria was used, he had applied sinapisms to the seat of the pain, and 
taken large doses of colchicum, with the effect of removing the symptoms ; 
but not till the plan had been continued for about three weeks. 
One evening about eight months ago, he had a return of the affection, and 
when visited next day, he was lying in bed in great pain, and could not be 
moved in any direction. An ointment made with twenty grains of veratria 
to an ounce of lard, was immediately ordered to be rubbed across the loins 
for fifteen or twenty minutes, and to be repeated at night; and in the event 
of the second friction failing to procure relief, he was directed to take fifteen 
grains of Dover's powder, with thirty-eight drops of vinum colchici, at bed 
time; this last prescription, however, he did not find it requisite to make use 
of, and next day he could move himself about freely and without experiencing 
any pain. To guard against a recurrence, he persevered in the use of the 
frictions night and morning for a few days, he then discontinued them, and 
has since been quite free from every symptom of the complaint. 
CASE VIII. 
This case was one of severe sciatica, occurring in a gentleman about 
thirty years of age, and bearing a considerable resemblance in its history to 
the foregoing: the previous treatment pursued was much the same, and in 
like manner freed the patient from the existing attack ; but did little towards 
establishing a permanent cure. The veratria ointment in one application, 
removed the pain, and in a few more, completed the recovery of the patient. 
CASE IX. 
A gentleman, thirty-three years of age, had, about eight years ago, an 
attack of acute rheumatism, during which the larger joints became affected, IN RHEUMATISM. 
35 
and after the violence of the disease had been subdued, there still remained 
a degree of pain and swelling around the articulations of the ttrsus and 
ankle, of both sides; and to these symptoms there has latterly supervened so 
much rigidity as to disable the patient almost entirely from walking. When 
an attempt at motion is made, he is compelled to raise the feet from the 
ground without bending the ankle joints, and he experiences great pain in 
pressing upon the ball of the great toe. 
In this case, the patient was directed to rub the veratria ointment over the 
diseased parts twice a day ; at the end of a fortnight the pain was gone, and 
the attack completely removed. 36 
EXTERNAL APPLICATION OF VERATRIA 
CHAPTER IV. 
EXTERNAL APPLICATION OF VERATRIA IN PARALYSIS. 
It notunfrequently happens that in patients affected with tic-douloureux, a 
partial paralysis of the muscles of the eyelids and face of the affected side 
coexists with the other symptoms. Such a condition has been present in 
several cases where the veratria ointment has been applied for the removal of 
the pain, and has almost immediately yielded to its effects, without afterwards 
showing any disposition to return. From this circumstance it appeared to be 
not improbable that similar good consequences might follow upon its employ- 
ment in examples of paralytic affections occuring in other parts of the body, 
and in the anticipation that this might prove to be correct, several cases of 
paralysis have been submitted to the action of the veratria, and the results 
obtained have been so far favorable. 
Although the number hitherto treated in this way, be too limited to allow 
any general rule to be founded upon the effects already observed, it may 
nevertheless be a matter of interest to know to what extent success has fol- 
lowed this new plan of treatment, and what degree of encouragement there is 
held forth to the further prosecution of the subject. 
In the cases referred to, the disease existed in different degrees of severity; 
in two or three, the patients had almost entirely lost the power of motion in 
one side of the body, but recovered it again by making use of frictions with 
the ointment over the affected extremities, and more particularly along the 
course of the nerves. /The greater number has, however, consisted of slight 
paralytic affections, situated in certain muscles, existing either by themselves 
or in conjunction with other affections, and especially with tic-douloureux. 
From the more extensive nature of the disease in the former cases, these 
have required the treatment to be continued for some little time; but in the 
latter, one or two applications have been successful in restoring the muscles 
to their healthy action. 
In either instance, after the frictions have been made, there is a degree of 
warmth and tingling felt in the parts; gentle indeed, at first, but becoming 
more and more manifest at each successive application, until the nerves of the 
affected parts are stimulated to a degree sufficient to enable them to resume 
their functions. 
The proportions of the veratria employed ought, in most cases, to vary 
with the severity of the affections to be treated by it, and also, according to 
the extent of surface over which it has to be rubbed ; but, as a general 
direction, fifteen or twenty grains to an ounce of lard will be sufficiently 
strong, and frictions of ten to twenty minutes, duration will answer every 
purpose. 
CASE I. 
Mr. C., a robust man, about forty-four years of age, was seized nine months 
ago with a fit of apoplexy, from the immediate danger of which he recovered IN PARALYSIS. 
37 
under the employment of the usual means, but there remained a paralytic 
affection of the right side. Five months after this date, he came under treat- 
ment on account of the paralysis, and at that time he complained of giddiness 
and want of recollection; the pupil of the right eye was dilated, and the. 
muscles of the cheek on the same side appeared to have almost lost their 
power of contraction; the tongue, when protruded, was moved towards the 
affected side, and his articulation was very imperfect. 
He had but little power over the muscles of the arm ; when he attempted 
to walk he experienced difficulty in raising the affected leg, and when he 
threw his weight upon it, the whole body shook as if by the action of a 
spring. 
For the previous five months this case had been treated actively. The patient 
had been several times bled generally, as well as locally; had had blisters ap- 
plied to the neck and head, and had besides an issue inserted into the nape of 
the neck, which was discharging at this time. These measures, however, had 
been attended by little success, and on this account, as well as from the effects 
already alluded to, which the veratria had been observed to possess in the 
paralytic affections accompanying tic-douloureux, this seemed to afford a fair 
opportunity in which to make trial of it. 
'rhe patient was put under a slight course of blue pill and epsom salts for 
three days, and then the veratria ointment made with fifteen grains of the 
alcaloid to an ounce of lard was directed to be rubbed along the spine for 
five minutes, and over the paralytic limbs and side of the face three minutes 
for each separate part, twice a day. At the end of a week from this time he 
returned considerably improved ; he could now use the arm tolerably well, 
and the paralytic affection of the face had nearly disappeared, but the inferior 
extremity remained much in the same state. The plan was ordered to be 
persevered in: he continued td improve, and at the end of two months he had 
completely recovered the use of his leg, and was in fact quite free from the 
disease. 
During the time the veratria was applied in this case, the only collateral 
treatment made use of, consisted of regular doses of purgative medicine, so 
as to keep up a slight action upon the bowels. 
An objection may, perhaps with justice, be urged against the preceding, 
being considered an instance of cure from the action of veratria alone, because 
the length of time that had intervened betwixt the period at which the frictions 
were resorted to, and that at which the use of the lower extremity was 
recovered, might of itself afford a sufficient reason for considering the 
removal of the disease to be the effect of time, following upon an impression 
which had been already made upon it by the previous active treatment 
employed; but this supposition will notexplain the speedy removal of the 
paralysis from the arm and face, a circumstance that can hardly be accounted 
for, except by attributing it to the effect of the veratria itself. 
CASE II. 
A gentleman, aged about seventy, was seized in the spring of 1833, with 
a slight paralytic affection of the left arm and leg, and same side of the face. 
For this disease he employed but few remedies until about two months ago, 
when he came under treatment on account of it. At that time he had some 
power over the muscles of the affected extremities, but could not make 38 
EXTERNAL APPLICATION OF VERATRIA 
use of them without much difficulty. The internal means which were chiefly 
employed, were doses of strychnia ; but although they were persevered in for 
a few weeks, no favorable effect was observed to follow, and the medicine was 
discontinued. 
To the paralytic symptoms there supervened an attack of rheumatism, from 
the pain of which the patient suffered considerably, and, after this had been 
removed, the paralysis increased; the opposite leg became so affected that he 
could not move it, and altogether the case appeared rather hopeless. In this 
state he was, one morning, ordered to have the veratria ointment, made with 
twenty grains to an ounce of lard, rubbed over the affected limbs, for twenty 
minutes ; and in the course of an hour or two, he began to use his legs, and 
before the evening he could walk about the room with facility. The arm and 
side of the face were also a good deal better. 
After this the ointment was directed to be applied as before, but only 
occasionally, when the disease showed any tendency to return; and at present, 
the patient can walk short distances with ease, and can ascend and descend 
a stair without assistance. He is going on improving, and makes use of the 
ointment according to the directions given him. 
case in. 
Mrs. W., a lady about thirty-two years of age, had, some years ago, an 
attack of paralysis on the right side, which gradually disappeared, except in 
the side of the face, the muscles of which were still, to a considerable degree, 
affected by the disease. 
As this patient appeared to be in the enjoyment of excellent health, it was 
considered unnecessary to give her any medicine to take internally, and she 
was directed to rub the ointment, made with twenty grains of veratria to an 
ounce of lard, for twenty minutes at a time, two or three times a week, over 
the affected part; and under this treatment, at the end of a fortnight, no 
appearance of the paralysis remained. 
CASE IV. 
A lady, the mother of the boy whose case is related in the foregoing chapter, 
nadhad a paralytic affection of the levator muscle of the upper eyelid, on the 
right side, for several years, for which she had been put under various forms 
of treatment, but without effect. During the night after she had rubbed the 
veratria ointment upon her son, she was seized with violent pain in the affected 
eye, which continued for some hours without intermission; and upon examining 
the organ, to ascertain the cause, it was found that the paralysis had almost 
disappeared: she was ordered to make one application to the temple, and this 
completely removed the complaint. IN DROPSY. 
39 
CHAPTER V. 
EXTERNAL APPLICATION OF VERATRIA IN DROPSY. 
The forms of dropsy which have been submitted to the action of the veratria, 
are hydrothorax, ascites, anasarca, and dropsy of the ovaries: in all of these 
it has been found of service, but particularly in the first three, several cases 
of which have been cured by it in a week or two, even when the severity of 
the symptoms was such as to threaten the life of the patient within a few 
hours. But in the encysted form, the benefit derived from its employment is 
neither so great nor so quickly manifested; in a few instances, however, a 
removal of the disease has been brought about by persevering in the treatment, 
and in several others the bulk of the swelling has been materially diminished. 
There appear to be two states of the disease, in both of which the veratria 
is of use, though in different degrees, when applied to the surface of the skin. 
The one, where the pathological condition of the organs upon which it has 
depended, has been removed; and where, nevertheless, the aqueous effusion, 
from want of action in the absorbing vessels, remains: the other, where the 
organic«change is such as will admit of no remedy. In the former instance, 
the veratria has succeeded in restoring the patient in a short time to a state of 
health ; but in the latter, such an effect is not, of course, to be expected; yet, 
even where this is the case, considerable relief may be obtained from its 
employment, after other means have failed. 
It is, therefore, indispensably necessary, before the veratria be applied, that 
every attention be paid to the state of all the organs, upon a derangement of 
which, either in structure or function, the effusion may depend ; otherwise, the 
anticipated effects will not be produced. If, after a careful examination, 
nothing wrong, of importance, can be detected, the ointment may then be 
had recourse to, and probably with success; but if the contrary be the case, 
the diseased state, whatever that may be, should, if possible, be first removed, 
and then the treatment may be proceeded with. In some instances, particularly 
of encysted dropsy, the presence of an unhealthy condition of the system 
totally unconnected with the disease itself, has very much impeded the action 
of the medicine, and has required removal, before it could go on without 
interruption. 
From these considerations, which are the result of experience on the sub- 
ject, it follows that, in order to procure the full effects of the veratria, the 
constitution of the patient should be, by care and attention, put into as good 
a state as possible before it is made use of; and, if this be not attended to, 
much good is not to be expected from its operation. 
The same rule before laid down, as to the relation which the strength of the 
ointment ought to bear to the extent of surface over which it has to be rubbed, and 
to the state of the patient, must be kept in mind, particularly in dropsy; for 
inattention to this circumstance may give rise to want of success in the cure. 
As the frictions should, if possible, be made over the whole surface under 
which the effusion exists, and as this must vary with the situation and extent 
which it occupies, no prescription applicable in every instance can be given, 
except that the quantity of the ointment rubbed in each time, should not, in 40 
EXTERNAL APPLICATION OF VERATRIA 
adults, contain less than two, nor more than four or five grains of veratria; 
and the friction should be continued for about twenty minutes, and repeated 
once or twice a day, according to the impression produced; this in general 
begins to show itself in a few hours; but not in the manner in which our 
knowledge of the consequences following from the medicine when given 
internally would lead us to anticipate. 
There is no fact in the history of this singular substance more remarkable 
than the opposite effects which it is observed to exercise,, according to the 
method by which it is introduced into the system. When given by the mouth, 
its operation, as has already been stated, is cathartic and emetic; but when 
rubbed upon the skin in dropsical cases it acts powerfully upon the kidneys, 
and at the same time appears to have an astringent effect upon the bowels. 
The quantity of urine evacuated by the patient, in some instances, almost 
exceeds belief, and might be considered as accidental, were it not that it has 
been observed to be an invariable occurrence. This circumstance is followed 
by an almost immediate subsidence of the swelling, which goes on gradually 
to diminish until none of it is left: the patient then gains strength daily, and 
soon acquires his former degree of health. 
Such are the usual consequences observed to follow the external applica- 
tion of veratria in dropsy; and in all the cases which have been treated by 
it, with the exception of one to be immediately related, no unpleasant effect 
has attended upon its employment. In some instances, the powers of the 
medicine themselves have been exclusively relied on; whilst in others, it has 
been deemed advisable to make use of diuretics internally at the same time; 
in all, however, the administration of purgatives, is a measure which should 
not, for reasons already given, be neglected. 
In ovarian dropsy the change in the size of the tumor is much less rapid 
than in the other forms, and in most cases is not attended by any great increase 
of the quantity of urine. The ointment best fitted for use in this particular 
disease is made with from fifteen to twenty grains of veratria to an ounce of 
lard; and it should be rubbed over the swelling about twenty minutes night 
and morning. Under this treatment the circumference of the abdomen 
diminishes generally from an inch to an inch and a half in the course of each 
successive week, occasionally remaining stationary; and the disease, at length, 
either wholly disappears, or becomes less in size: and this event is often 
accelerated by passing galvanic or electric shocks through the tumor at the 
same time that the ointment is employed. 
The following singular case is the first upon which the veratria was tried, 
and the success which attended its application was the cause of the medicine 
having been made use of in the other dropsical cases which are to be presented 
to the reader. For the purpose of ascertaining the state of the patient, and 
whether he had had any return of the disease, a letter was addressed to him 
a few days ago on the subject, and he returned an answer every way satis- 
factory, along with his permission to give the case publicity. 
CASE I. 
J. B., esq., of Pocklington, near York, thirty years of age, came under 
treatment in the summer of 1830. About a year previously, he was attacked 
with ascites, which proved so very obstinate that although he was put under 
almost every plan of treatment which could be devised by his medical IN DROPSY. 
41 
attendants, during nearly the whole time, the disease suffered no abatement, 
but on the contrary appeared to be increasing rapidly. At the time he pre- 
sented himself, the dropsy had become general; his lower extremities and 
scrotum were swollen to an enormous size; the abdomen was completely 
distended with fluid ; and the organs within the chest were much impeded in 
their functions. There was great difficulty of breathing, attended with cough 
and slight watery expectoration ; the pulse was small and intermittent, and 
the patient was unable to remain in the horizontal posture for one minute 
without experiencing the most distressing sense of suffocation; the distention 
of the legs increased to such a degree that serous fluid oozed from them; 
and altogether, the case was one of the most severe ever witnessed. 
The previous treatment of this case had been as active as possible; diuretics 
and drastic purgatives of almost every kind had been employed, without 
producing any other effect than weakening the patient; and a course of 
mercury, continued during some time, had been equally unsuccessful. The 
flow of urine was less than an English pint in twenty-four hours ; and could 
not by any means be made to exceed that quantity. 
For six weeks after he came under treatment, the plan pursued was similar 
to the one already described. Mercury, squill, the acetate and supertartrate 
of potass, digitalis, colchicum, spirit of nitrous ether, juniper, broom seed, &c. 
were all had recourse to without the slightest benefit, and the same want of 
success attended the exhibition of elaterium, gamboge, and other drastic 
purgatives; these last produced large watery stools, but without bringing 
about any apparent diminution of the swelling. There now appeared no hope 
of recovery ; all the means likely to procure relief had been put in force, and 
had only added to the distress and debility of the patient, so that it became 
necessary to abandon them, and look out for some other means of cure. 
In this emergency it was resolved upon to make trial of the veratria exter- 
nally, and a box of ointment made with four grains of the alcaloid and an 
ounce of lard, was accordingly directed to be rubbed over the surface of the 
abdomen at bed-time. The whole quantity was applied ; and in the course 
of the night, and following morning, the patient evacuated no less than eight 
pints of urine, which had caused a marked diminution of the swelling, both in 
the abdomen and extremities, and was attended with considerable relief to the 
breathing and circulation; but, along with these effects, the medicine had 
caused such an alarming prostration of strength as to render the administration 
of stimulants absolutely necessary for three days before the ointment could 
be repeated ; at the end of that time, when the patient appeared somewhat 
recovered from his weakness, a fresh quantity was prescribed, in which, 
however, a less proportion of the veratria was used, owing to the violent 
constitutional symptoms caused by the first. On this occasion, tWo grains 
only were rubbed on, yet the diuretic effects were scarcely less marked than 
before; and these were again accompanied by a degree of debility which, 
although not so great as in the preceding instance, still made it a matter of 
necessity to repeat the stimulants, and to delay the third application for five 
or six days. 
On both occasions, after the first effects of the ointment had subsided, the 
quantity of urine diminished considerably, but the swelling became daily less 
in magnitude, and the patient went on improving in a manner that could not 
have been anticipated. On the fifth or sixth day from the second rubbing, a 
third, with an ounce of ointment, containing two grains of veratria, was 
directed to be made use of, as before ; and from this time, the dropsy rapidly 
disappeared ; the patient gained strength sufficient to enable him to take active 
6 42 
EXTERNAL APPLICATION OF VERATRIA 
exercise; and at the end of three weeks from the first application of the 
veratria, he was completely cured, and has since had no return of the disease. 
The only collateral treatment employed in this case, along with the veratria, 
consisted in the daily exhibition of purgative medicine, not with the view of 
producing any change upon the disease by its means, but only for the purpose 
of obviating the constipating effects of the remedy. 
CASE II. 
Mr. W., a gentleman fifty-two years of age, tall and naturally of a strong 
vigorous constitution, had earlier in life been accustomed to active exertion 
and frequent exposure to inclement weather, and about the age of thirty, after 
having used severe horse exercise during a wet day, he was seized with an 
inflammatory affection of the chest, from which he recovered under the usual 
treatment resorted to in such cases. Ever since that time his general health 
had been good, but his pulse had continued intermittent. 
Six months before he came under treatment he had labored under symptoms 
of disease of the heart; these became more and more urgent, his lower 
extremities began to swell, the respiration became difficult, and for sixteen 
weeks he had been unable to lie in bed. His pulse now beat about 120 in the 
minute, it was indistinct, irregular, and intermittent; the arms and face were 
very much emaciated, and the legs were distended to a great degree. His 
breathing was laborious, the abdomen contained a great deal of effusion, and 
heaved at every inspiration, and the urine was sparing in quantity. Percus- 
sion applied over the chest gave a dull sound, the respiratory murmur was 
indistinct; the action of the heart was at intervals violent, and could be seen 
over nearly the whole of the left side of the thorax ; and along with these 
symptoms he had cough, accompanied with a clear, watery expectoration. He 
could take little sleep, and that only when seated in a chair. 
As it appeared that the previous treatment of this case bad been particularly 
active, without producing any lasting effect, it was not thought proper to carry 
it any farther, but the external application of the veratria was at once 
proceeded with, using at the same time a little opening medicine, as in the 
preceding case, to prevent constipation. The patient was directed to have 
fiart of an ointment, consisting of ten grains of the veratria and an ounce of 
ard, rubbed over the abdomen and left side of the chest, night and morning, 
and the quantity of urine evacuated was ordered to be carefully preserved until 
next visit. 
From the distance of his place of residence it was impossible to see him 
again until the fifth day after the ointment had been first used. He was then, 
however, very much improved ; he had had on the day after the first application 
a considerable flow of urine, and on the second night he had laid down in bed 
and slept soundly ; the pulse was more regular and distinct, and the swelling 
in the legs had diminished so considerably as to make the skin quite loose; 
the abdomen felt soft, and was reduced in size ; the breathing was quite easy, 
and the patient's spirits very much better than they had been for a long time. 
The quantity of urine evacuated since last visit was sixty-four pints, and no 
depressing effect whatever had followed the application of the ointment. The 
same plan of treatment was directed to be persevered in for another week, at 
the end of which the patient was so well that he objected to the use of any 
more medicine. 
During the interval which had elapsed since last visit, the remains of the IN DROPSY. 
43 
dropsy had gradually disappeared ; he had gained strength, and had walked 
out a day or two before; in short, the only symptom which he had left, was 
the irregularity of the pulse, and this was not greater in degree than it had 
been for many years before the attack came on. For about two years after 
this time he enjoyed robust health, and went about his usual avocations until 
his death, which took place suddenly one morning whilst he was at breakfast. 
case in. 
Mr. L., a middle aged man, a miller by trade, naturally of a spare habit of 
body and a little asthmatic, had been laboring for about a year under difficulty 
of breathing, cough, swelling of the lower extremities and other symptoms of 
thoracic dropsy. The symptoms were so violent that apparently he could 
survive only a short time; his respiration and voice were almost gone ; his 
pulse scarcely perceptible; his limbs swollen and cold, and his abdomen 
evidently contained a considerable quantity of fluid. Indeed his sudden 
death seemed so probable, that he was ordered to be carefully watched and 
supported. As the case was a very severe one, and as other remedies had 
not been tried, it was deemed advisable not to trust to the veratria alone ; 
some diuretic medicine was therefore prescribed, along with an ointment 
composed of twelve grains of the alcaloid to an ounce of lard, which was 
directed to be rubbed over the chest and abdomen night and morning. 
The day after he commenced the use of these means he evacuated about ten 
pints of urine, and was so far recovered as to be able to walk about the room. 
He was ordered to continue the medicines, and in three days he was able to 
leave the house and walk in the open air; at the end of a week from the first 
visit, he went home quite recovered from his disease, and complaining of 
nothing but weakness, and he was lately in good health. 
CASE IV. 
Ovarian Dropsy. 
Mrs. F., a middle aged lady, had been laboring for two years under a large 
ovarian dropsy, which had extended across the abdomen, and as high as the 
umbilicus ; she was otherwise in good health. In the previous treatment of 
this case, the usual diuretics had been employed without effect, and she had, 
at the same time, been twice tapped, but the fluid was on both occasions 
rapidly renewed by secretion. 
The patient was now put under the influence of gentle diuretics : and the 
veratria ointment, made with twelve grains to an ounce of lard, was directed 
to be rubbed twice a day over the surface of the abdomen. After this treat- 
ment had been continued for six weeks, the bulk of the swelling had diminished 
considerably, and by persevering in the same means the disease was, to all 
appearance, removed in five months. 44 
EXTERNAL APPLICATION OF VERATRIA 
CASE V. 
Ovarian Dropsy. 
A lady about forty-five years of age, had been affected for four years with 
ovarian dropsy. From the history of the case it appeared that the disease 
when first discovered was about the size of a large orange, and seated in the 
lower part of the abdomen, upon the left side; it then became much larger, 
and extended itself to the opposite side. The tumor in different stages of its 
progress had been very painful, and had frequently required the application 
of leeches on that account. 
From the effects which the veratria had been previously observed to have 
in diseases of this kind, the patient was directed to rub over the abdomen an 
ointment made with fifteen grains of veratria to an ounce of lard, twice a day. 
The heat and tingling produced by the friction were such as to give her 
considerable annoyance, but the internal pain was completely removed; she 
continued the ointment for four months, during the course of which the 
swelling gradually lessened, and at the end of the time, the application was 
discontinued because no trace of it could be discovered, and she is now quite 
well. The only collateral treatment made use of in this case, consisted in 
occasional doses of opening medicine, administered for reasons already given. IN GOUT, AMAUROSIS, ETC. 
45 
CHAPTER VI. 
In addition to the diseases which have been noticed in the preceding 
chapters, it may not be improper to mention, before concluding the present 
publication, that there are affections of a different kind, in the treatment of 
which much benefit has been derived from the external application of veratria. 
The cases of these, which have hitherto presented themselves, are not 
sufficiently numerous to enable them to be arranged under distinct heads, but 
as the results obtained may be interesting, they shall be now briefly noticed. 
Of such, the one that has the greatest claim to consideration is gout, a 
disease in the treatment of which the veratria promises to be a no less 
valuable acquisition than it has proved itself to be in other painful affections ; 
and indeed, so far as experience goes, there is every reason to anticipate the 
greatest advantage from its application, even in long standing cases. The 
best time to employ it appears to be at the very commencement of the acces- 
sion ; and at this period, friction for twenty minutes made over the seat of 
the pain, with an ointment consisting of twenty grains of veratria to an 
ounce of lard, has cut short the paroxysm, and has at once enabled the 
patient to make use of the affected joints. 
The next disease in which it holds out a prospect of being useful is amau- 
rosis, a case of which occurred in the eye of a patient who had been laboring 
under the tic-douloureux for several years, and in which the blindness had 
continued during nearly the whole of the time. The patient could easily 
distinguish light from darkness, but could not perceive an object with any 
degree of distinctness. After having rubbed the ointment once over the 
forehead of the affected side, the amaurosis disappeared at the same time 
with the other disease, and the patient can now read a small printed book 
with ease. 
The only other case of a similar nature that has happened, was in a woman 
in whom tne blindness was also a concomitant of the tic-douloureux : it had 
lasted seven years, but was likewise cured in a short time by the veratria, 
and the patient can now see quite well. From these two cases no inference 
can be drawn as to the general utility of the remedy in amaurotic cases, 
especially as no pure instance of the disease has been, as yet, submitted to its 
action ; it was, nevertheless, considered right to throw out the suggestion, in 
order that the matter might be put to the test of experience. Judging from 
the effects previously observed to be produced by the veratria, it appears that 
an ointment made with thirty or forty grains to an ounce of lard, if it be 
rubbed fifteen or twenty minutes, twice a day, over the temple and forehead 
of the affected side, will cure the disease, provided it be curable in this 
manner. 
The veratria ointment has likewise been found of essential service when 
rubbed along the spine of tibia, and over the situation of other bones, in 
patients affected with syphilitic pains or nodes; in such cases friction, in the 
usual manner, may be ordered every night, at bed-time, and generally with 
the effect of removing the symptoms, after a few applications. 
EXTERNAL APPLICATION OF VERATRIA IN GOUT, AMAUROSIS, ETC. 46 
EXTERNAL APPLICATION OF VERATRIA, ETC. 
The external employment of veratria, as a means of removing, or at least 
of alleviating, diseases which are not, in general, under the control of medi- 
cine, is now placed in a situation in which it must, to some extent at least, 
be adopted into general practice, or be laid aside as inefficacious ; too much 
attention, therefore, cannot be given to the circumstances to be observed in 
its application, which have already been mentioned. 
It is of primary importance that the veratria be in a state of purity, at 
least, in so far as this can be judged of by the tests formerly laid down; for, 
without attention be paid to this point, it will have little effect. Some of the 
varieties which occur in commerce contain large admixtures of phosphate of 
lime and other similar matters, and when these are rubbed upon the skin, 
although the gritty particles they contain may produce more irritation, by 
tearing up the cuticle and allowing the veratria to come immediately into 
contact with the tissue underneath, yet their effects upon the disease for 
which the application has been resorted to, will not, in most instances, 
amount to more than a temporary relief. 
Enough has, perhaps, been already said to show the necessity of guarding 
against the supposition that the new remedy is a specific, in the affections in 
which its use has been recommended; but, in addition to this, it may be 
stated, that the results that have been obtained, especially in dropsy, are not 
the consequences of indiscriminate application, but have followed the use of 
veratria after every circumstance unfavorable to its operation had been 
removed ; and in proof of this, it may be stated that several cases did occur 
before the rule now laid down was understood, in which no effect whatever 
was produced upon the disease, even after the frictions had been persevered 
in for some time. In one case particularly, of ascites, apparently depending 
upon incurable enlargement of the liver, no change could be brought about in 
the state of the effusion, by this or by any other means. 
The only subject which now remains to be noticed, is the possibility of 
applying the salts of veratria in the same manner as the base itself; but the 
investigations which have been made, to determine their comparative activity 
are too limited to afford satisfactory conclusions as to any superior efficacy 
they may be possessed of in the removal of disease. The only salt that has 
been tried, is the sulphate, and it certainly does appear to be much more 
energetic than the veratria; for even half a grain, when rubbed upon the 
skin, gives rise to a degree of heat and tingling, amounting to pain. From 
this circumstance it is not improbable, that in certain cases the sulphate, or 
some other salt, may be resorted to with advantage, especially when the 
veratria, as sometimes happens, has become less efficacious from continued 
use. 
THE END.