White-flowered veratrum. White hellebore. N.O. Melanthaceae. Tincture of the root-stocks collected before flowering.
The active principal of veratrum album is an alkaloid called proto-veratrine, C32 H51 NO11, the alkaloid of veratrum viride being veratrine, C32 H49 NO9. Though much alike in their physiological action there are important differences between them, as veratrine, unlike proto-veratrine, paralyses the terminations of the motor nerves and also has a characteristic effect on striated muscular fibre, in that if a muscle is stimulated after the application to it of veratrine it contracts as rapidly as usual, but its contraction is greatly prolonged; the period necessary for its relaxation to be completed is twenty to thirty times that of unpoisoned muscles and the whole contraction lasts from five to ten seconds. consequently resistance is offered to the contraction of opposing muscles and movements of co-ordination cannot be properly performed, so that locomotion and other movements are slow and awkward. With these exceptions the action of the two alkaloids seems to be very much alike.
The symptoms of veratrine commence with prickling and burning in the mouth, tongue and throat, on which follow marked salivation, nausea, warmth in the stomach and vomiting. Violent purging with severe colic occurs. the prickling sensation spreads to the skin and profuse perspirations ensue. The pulse becomes slow and irregular, the respirations are slow and laboured. The muscles exhibit fibrillary contractions and convulsions come on. Collapse follows, with subsequent unconsciousness, and finally, failure of the respiration.
Applied locally, veratrine, like aconitine, stimulates the terminations of sensory nerves and causes a warm, pricking sensation. the stimulant effect is followed by diminution of sensitiveness and a feeling of cold and numbness. Protoveratrine causes less irritation but more complete anesthesia than veratrine. The local action of small quantities on the nose and throat is to produce violent sneezing and coughing. The nausea, vomiting and purging caused by the alkaloid are due to its influence on the nervous system, for it causes no sign of irritation or inflammation of the alimentary tract. Likewise the perspiration and probably to a large extent the salivation are due to nervous influence. The circulatory symptoms arise from stimulation of the medullary centres, viz., of the cardiac inhibitory centre, which causes slowing of the heart and decreases of output, and of the vasomotor centre, which contracts the peripheral blood-vessels. Larger quantities paralyse the terminations of the vagus and at the same time depress the vasomotor centre, the pulse then becomes quicker and the blood pressure is lowered. The central nervous system is stimulated at first and then paralysed. The cord and medulla are more affected than the higher centres, for complete consciousness usually remains almost to the last moment. Death is due to paralysis of the respiratory centre, as is the case with aconitine. The provings of veratrum album are in conformity with these physiological findings and add some important symptoms.
Digestion.-In the mouth the sensations of prickling and burning are mixed with a cold sensation, like that caused by peppermint, and sneezing with catarrhal symptoms and an odour of manure or smoke occurs in the nose. Great increase in the quantity of saliva takes place, and the mucous secretion of the fauces and throat is also stimulated, so that the throat becomes full of mucus and the patient hawks up large lumps of it. The tongue feels burning and is sometimes swollen, the throat is hot and may be spasmodically contracted, and there is burning in the stomach, in which pressive and tearing pains occur, with extreme nausea and vomiting of bitter or sour green mucus or of food. The vomiting is violent and copious, and when the stomach has been emptied nausea and retching continue. Notwithstanding the nausea there is often hunger, with craving for fruit and juicy, acid things. Thirst is excessive, especially for cold water (acon., ars., bry., phos.). There is aversion from warm things. Hiccough is frequent. Vomiting is attended with great exhaustion, the countenance looks pale and sunken, the nose pinched, and cold perspiration breaks out on the face, especially on the forehead. The abdomen is distended and sensitive to touch, griping and cutting pains occur, especially about the navel, and pains as if the intestines are twisted in a knot; a sensation as if a hernia is being pushed through the abdominal walls is sometimes felt, and there may be internal coldness in the abdomen. The colicky pains are relieved by stool (aloes, coloc.). Diarrhoea of a violent and painful character of watery, very copious, greenish or rice-water stools, accompanied by shivering and profuse, cold perspirations and followed by collapse and an all-gone feeling in the abdomen are the rule, but sometimes there is constipation, in which case the stools are hard and too large in size (bry., sulph.) and are accompanied by ineffectual desire felt in the upper abdomen (in the rectum, nux).
Urine.-The urine usually shares in the increase in all the secretions common with veratrum album, but it may be suppressed if diarrhoea is excessive.
Sexual.-The menses are too early and too profuse.
Respiration.-Paroxysms of constriction take place in the larynx, with a sensation of suffocation accompanied with protrusion of the eyes. There is a dry, hacking cough, excited by a tickling low down in the trachea, felt behind the mid-sternum, and a deep, hollow cough occurring in shocks. The chest feels tight and breathing is laboured, interrupted and may be rattling. Spasmodic hiccough occurs.
Circulation.-The pulse is very slow or quick, weak, and intermittent, or it may be imperceptible. Attacks of violent pulsation occur and stitches are felt in the cardiac region, which extend back to the spine. Fainting is a prominent symptom and is induced by pain (cham., hepar, valer.), emotions, slight wounds, vomiting and purging.
Head.-Veratrum album causes vertigo, as if everything is turning round in a circle, with cold sweat on the forehead and loss of vision. Headache frequently occurs, with nausea and vomiting; heat of the head is followed by cold sensations, or heat and cold are intermingled. There may be heaviness, numbness and confusion of the head, a sensation as if cold wind is blowing through it, or as if ice is applied to the vertex or occiput. Pains in the forehead are better from bending the head backwards, and those in the occiput from bending it forwards.
Limbs.-The face may be flushed when the patient is lying down, but becomes pale and covered with cold sweat if he attempts to get up and move about.
Back and Limbs.-The neck is so weak he can hardly hold the head up, and there is painful, paralytic weakness in the upper and lower limbs. The limbs feel heavy, especially about the ankles and knees, as if heavy weights are attached to them. Bruised, heavy pains are present in the shoulders and arms, and various neuralgic and rheumatic pains are experienced in the limbs, which are worse in a warm bed, and compel the patient to get up and walk about. Sudden jerks occur in the legs at night in bed, and the patient must sit up and let them hang down. All pains are better from movement. The feet and hands are cold and blue. Cramps are felt in the feet and calves; they often accompany the colic and profuse stools. The arms tremble and feel cold on raising them and the hands and fingers tingle. Convulsions may occur.
Sleep.-The condition with regard to sleep is one of drowsiness, but it is often an anxious sleep, interrupted by dreams of being drowned, hunted or bitten by a dog, or of robbers, from which he awakes with the fixed idea that the dream is true.
Chill, Fever, &c.-The general state of the body is that of prostration, stiffness and coldness. There is restlessness, and movement. Rigors may occur, followed by flushes of heat, but coldness predominates. In one case of poisoning a chronic midnight fever occurred for a long time afterwards. Cold and clammy perspirations over the whole body frequently accompany the other symptoms of veratrum album.
Skin.-A minute papular eruption has been observed on the face, neck and thighs, and spots like flea bites have occurred on the skin, which is cold and blue and may be numb or anesthetic.
Mental.-The provers become sad, gloomy, restless, irritable and disposed to anger.
The chief use of veratrum album is in cholera and affections resembling cholera. On hearing the description of the symptoms of Asiatic cholera, Hahnemann, without having seen a case, suggested this remedy as one of three likely to be curative in that disease. The other two were camphor and cuprum. Experience has shown the correctness of his forecast. It is indicated in cholera when the vomiting and purging are very copious, and with the coldness and prostration from the most striking features of the disease. Camphor is indicated when collapse and coldness are even more extreme, but vomiting and diarrhoea are scanty. Cuprum is to be given when cramps and colic are more severe and painful than with veratrum. Veratrum is equally useful for all kinds of choleric diarrhoea, especially when the characteristics of violent retching and vomiting, with cold sweat on the forehead, prostration and painful colic are present. In this category may be placed choleric diarrhoea brought on from taking cold, from eating fruit and vegetables, summer diarrhoea and diarrhoea from fright. It may be usefully given sometimes in cases of typhoid and remittent fever and in some intermittents.
Veratrum album is useful in constipation characterized by stools that are hard and of large size.
Mental.-It was highly esteemed by Hahnemann for mental diseases, especially for melancholia, religious or sexual, and for mania. With the melancholia, there is a feeling of discouragement, despair about his or her position in society, anxiety, as after committing a crime, or there is much talking about religious matters, praying, cursing, weeping aloud, or there is a mania for kissing everybody (especially before the menses), lewdness and lascivious talk. The maniacal delirium is of a furious kind, with desire to destroy, especially to cut and tear his clothes. These states may come on during the debility following severe illness, after parturition or from suppressed menses. If the characteristics of veratrum album are present it will be a valuable remedy in these cases. Recognized mental diseases exhibiting these symptoms, and for the treatment of which veratrum album should be considered, are acute delirious mania with collapse, acute confessional psychosis, puerperal mania, acute alcoholic confusion, melancholia, dementias praecox (especially with cyanosis and coldness) and adolescent instability.
Sexual.-It is useful for dysmenorrhoea, chronic metritis and endometritis when accompanied by vomiting, purging cold sweat.
Respiratory.-Veratrum album is a remedy for whooping-cough when the attacks are followed by great exhaustion, and the cough is worse on entering a warm room from the open air (bry.), also for spasmodic cough with suffocating fits from constriction of the larynx, and for some cases of chronic bronchitis.
Circulation.-It is very valuable in cardiac debility following acute disease, there is a tendency to faint on moving, sudden pallor on sitting up suddenly, a weak, thready pulse and cold sweat.
An indication for the convulsions for which veratrum album should be prescribed is “violent tonic spasms drawing the feet inwards;” puerperal convulsions may require it.
With the exception of the choleric complaints veratrum album is not specific to any classified disease, but can always be given with great advantage in any case where the leading indications of the drug are present, no matter what its name, and will not infrequently rescue the patient from what appears to be a desperate situation.
Coffee is the best antidote to veratrine poisoning, other antidotes are aconite, camphor and cinchona.
(1) Extreme prostration; rapid sinking of vital forces; collapse.
(2) Coldness; cold sensations in many parts, as if cold water running through veins. Cold sensation on vertex.
(3) Cold perspirations, especially on the forehead.
(4) Copious discharges; vomit, stools, saliva, sweat.
(5) Easy fainting: from emotions, pain, retching, &c.
(6) People who are habitually cold and deficient in vital reaction.
(7) Skin cold, blue (especially hands and face), perspiring.
(8) Profuse and violent vomiting.
(9) Violent and copious, watery stool.
(10) Green colour of discharges.
(11) Cramps; colic.
(12) Convulsions, with violent tetanic spasms where by the hands feet are “drawn inwards” (?flexed).
(13) Melancholia and mania, especially if religious or sexual.
(14) Children, and lean, choleric or melancholy persons.
(15) Cholera and choleric diarrhoea.
From least motion (except pains in limbs), heat, wet weather (rheumatism), cold drink (cough and colic) before and during menses.
From moving about (neuralgic and rheumatic pains), uncovering.