The best preparation for administration is the tincture. As the therapeutic properties of veratrum viride depend, chiefly, on the jervine, an attempt may be made in the future to supply this alkaloid in sufficient quantity for administration; but, at present, the processes involved in its preparation are too intricate and expensive. As the effect of veratrum viride quickly reaches its maximum, if it be desired to maintain the pulse-rate at a constant level, the doses must not be at a longer interval than two hours. The effect must be maintained by increasing doses, if necessary, and the recumbent posture must be rigidly enforced.

The emetic property of veratrum viride is never applied in practice; too much depression is produced by it. The chief use of this agent is to depress the action of the heart and to lower the vaso-motor tonus. In simple hypertrophy of the heart, without valvular lesion, it diminishes the overaction and thus gives relief to the most distressing symptom. The irritable heart, so frequently found associated with and dependent on the excessive use of tobacco, on mental excitement and irascibility of disposition, and on overstrain, is relieved by this remedy, provided no valvular lesions coexist. The hypertrophy of the cardiac muscle, and the abnormal arterial tension, which accompany the chronic form of albuminuria, are alleviated by veratrum viride. Moderate doses of the tincture (five drops ter die) usually suffice in these cases. When there are valvular lesions, and when the cardiac muscle is enfeebled from any cause, this agent is inadmissible.

Excellent results are sometimes obtained in aneurism, by the use of veratrum viride. In the various surgical expedients for the cure of aneurism (forced flexion, compression, ligation), this remedy, used to depress the circulation, renders an important service, by lessening the force with which the blood is propelled, and the number of the cardiac contractions. In this way, coagulation of the blood in the aneurismal sac is greatly favored. In the case of large internal aneurisms—of the innominata, aorta, etc.—veratrum viride is a powerful adjunct to rest and other means of treatment. Some precautions are necessary, however, in the administration of this remedy. As the utmost slowing of the circulation consistent with safety may be required, a sufficient quantity of the tincture must be administered to accomplish this object, and the effect produced is the only measure of the amount to be given. The result must be accomplished, if possible, without causing vomiting. The patient should, therefore, remain absolutely in the recumbent posture, and a little opium should be prescribed with the veratrum viride. Active haemorrhage, occurring in the plethoric, is sometimes stopped by full medicinal doses of this drug.

There can be no doubt that veratrum viride renders an important service in acute parenchymatous congestion—of the brain, lungs, liver, and other organs. Its utility ceases when exudations have taken place: its action is confined to the influence which it has in diminishing the blood-supply to the affected organs. The changes produced by inflammation are in no wise affected by veratrum viride. Much that is extravagant has been written in regard to its curative influence in pneumonia, but we need not be surprised at this, when we reflect that our knowledge of the natural history of this disease is only of recent origin. Those who knew nothing of the period of crisis of pneumonia naturally attributed the defervescence of temperature to the effect of the remedy. It is not to be denied that in the very incipiency of pneumonia, before fibrinous exudation has taken place, veratrum viride, by lessening the amount of blood circulating in the lungs, may render an important service, but when hepatization occurs its good effects cease. The same observations are true of other parenchymatous inflammations, and equally so of serous inflammations.

Veratrum viride has been much extolled as a remedy for reducing the pulse-rate and the temperature in typhoid and other fevers (Norwood). It is true, these effects may be procured by it, but that any influence is exerted in this way, over the course and duration of a fever, seems highly improbable. The chief dangers in fever being the occurrence of cerebral or cardiac paralysis due to the persistent elevation of the temperature, it is unwise to use a powerful cardiac depressant, although it has the power to lower the temperature somewhat. There is, however, a condition of things arising in the course of fevers —viz., delirium ferox—in which, when dependent on arterial excitement, much good may be accomplished by the use of veratrum viride.

The excitement of acute mania, of maniacal delirium, and other forms of mental disorder in which a condition of cerebral hyperaemia may be supposed to exist, is successfully combated by veratrum viride. In a private communication, Dr. Sullivan, of San Francisco, informs me that this agent ( 3 ss of the fluid extract every fifteen minutes until nausea or vomiting ensues) is "invaluable in puerperal convulsions." Barker, in his "Puerperal Diseases," had already called attention to its utility, and Boyd confirms the previous observations. Increasing experience adds to the testimony regarding its exceptional value in the relief of this formidable malady.

Veratrine is used only externally, and for the relief of neuralgia, headache, myalgia, etc. The official unguentum veratriae is the form in which it is employed—a small quantity being rubbed in over the seat of pain.

Authorities referred to:

Boyd, Dr. American Practitioner, January, 1878.

Briesemann, C. Mikroskopische Untersuchtmgen über die Wirkung des Digitalin, Veratrin u. Ergotin auf die Cirkulation, Rostock, 1869.

Linon, M. Gazette Medicale de Strasbourg. Bulletin Général de Thérapeutique, vol. lxxvi, p. 94.

Mitchell, Charles L. Transactions of American Pharmaceutical Association, vol. xxii, p. 397. The Active Principles of the Officinal Veratrums.

Norwood, Dr. W. C. The Authorship and Therapeutical Powers of Veratrum Viride more fully examined, Albany, 1868, p. 39.

Oulmont, M. Bulletin Général de Thérapeutique, vol. Ixxiv, p. 153. Ibid. Communication of paper by MM. Zuber and Hirtz to Society of Therapeutics, Bulletin General, vol. lxxvi, p. 468, et seq.

Percy, Dr. S. R. Transactions of American Medical Association, 1864.

Peugnet, Dr. Eugene. The Medical Record, May, 1872.

Squarey, Dr. The Practitioner, 1870, vol. i, p. 211.

Wood Dr. H. C. The American Journal of the Medical Sciences, January, 1870.