VERATRUM VIRIDE. The sensory track of fibers from this same derangement encountered in the medulla, creates the very characteristic symptom of hyperaesthesia of the skin and of all the other tissues supplied by these fibers. Due to this symptom the information are very painful wherever they occur.

The greatest part of the action of Veratrum viride is exerted on that portion of the base of the brain which is called Medulla Oblongata. Especially is the lower half of this region affected, that half where the nuclei of the glossopharyngeus, vagus, accessorius and hypoglossus nerves lie. If the drugs action becomes more intense, it spreads higher up so as to affect also the nuclei of six other cranial nerves.

These include the motor nerves of the eyes, the motor and sensory nerves, of the face auditory nerves. In this way all the nerves whose origin lies on the bottom of the fourth ventricle become affected. Since the vasomotor and respiratory centers, as well as the thermo-regulating center, are also located under the floor of the fourth ventricle, that is the region of the greatest action of this drug, they also are affected by it.

A little farther away from the floor of this ventricle, that is through the ventral portion of the Medulla, nerve tracts pass down to the spinal cord and thus through sheer proximity become participants in this drugs action. If its toxicity is great, it may even reach the surface of the medulla and attack the meninges, thus causing basilar meningitis. This meningitis is more of a secondary effect, and the disease of the nerve nuclei the primary. In practical therapeutics, however, this may not make any difference. This remedy may be indicated when the basilar meningitis appears to be primary.

There is no doubt that Veratrum viride exerts certain degree of its toxicity also on the rest of the brain, yet how much of it should be ascribed to its toxic powers, and how much to the mere congestion and dilatation of the cerebral blood vessels, would be hard to determine. It is also very possible that the proportions of these two effects are different in different individuals.

With these preliminaries in mind it is easy to interpret and to memorize the whole pathogenesis of Veratrum viride.

Its action is described by writers on materia medica as congestive, but it is more than that. It is congestive, phlogistic, motor, sensory, secretory and decongestive.

While the predominant action is congestive, we sometimes see the opposite, that is the decongestive effect in the circulatory system. The blood vessels are constricted and paleness with local anaemia is produced. The same two antipodal action are seen in glands whose secretions may be either increased or decreased, then in muscles, whose contractions are either strengthened or weakened, and in the sensory nerves with either exaggerated or diminished sensations. In the negative the irritation of the medulla is carried to the degree of exhaustion.

The digestive, respiratory, genito-urinary and circulatory apparatus exactly reflect in their morbid changes the changes which develop in the nuclei of their nerves. What goes on in the central nuclei in miniature, also goes on in all those organs which are supplied by the corresponding nerves, only in larger dimensions.

Whatever happens in the brain is important in relation to the happenings on the periphery. From the behavior of the one we can deduce the behavior of the other.

The central nuclei for these peripheral apparatuses, being located close together in the medulla, come under the influence of the drug more or less equally. Consequently, whenever this drug is indicated, we shall find not only one of these peripheral apparatuses suffering but more or less all of them simultaneously. Lung, head, stomach and bladder symptoms are therefore found together in a bunch and this combination in itself is a keynote. Especially are the circulatory and respiratory systems, whose controlling centers are situated here, affected simultaneously.

The thermal center joints them. Weather the trouble be acute or chronic, there is fever: high fever in acute, subfebrile temperature in chronic cases. It is not a very sthenic fever. The temperatures are high in the evening, subnormal in the morning. This denotes weakness and the patients are workings and susceptible to diseases.

Also the congestion betrays weakness as it is more passive and quite unlike that of Aconite and Belladonna. The skin is not bright-red, but blue-red. The patients are plethoric, but it is not the right color, and even in chronic cases they are always short of breath.

The paleness may be permanent and is often found around the nose and mouth, or it may be temporary and may appear suddenly. A mother going for a walk in the park with her young son notices the face of her son get dead white from the moderate exertion of hopping on the lawn. Suddenness is a keynote of this remedy, especially suddenness of the symptoms of circulation and temperature.

The weakness of the blood vessels may be exaggerated to the point of blueness of the skin. The pale and blue skin is cold and moist which makes the differentiation from Veratrum album sometimes difficult.

After these general considerations we can now proceed to the description of particulars.

The congestive action on the head and its contents manifests itself in hyperaemia with throbbing, fullness, especially fullness in the occiput, aches and pains of kinds, cerebrospinal meningitis, tendency to congestive apoplexy, sleeplessness, restlessness, vertigo, stupefaction and delirium. There last two symptoms appear only in high fever.

The purely mental symptoms of the brain must not, however, be considered as a result of congestion alone, but are undoubtedly caused by a specific toxic action of the drug on the protoplasm of the brain cells. They are very characteristic and important in prescribing. The dual action of the drug on the protoplasm of the brain cells. They are very characteristic and important in prescribing.

The dual action of the drug is expressed in them also. They are positive and negative, positive from irritation or excitation, negative from tiredness and exhaustion. The positive ones are loquacity and an exalted opinion of oneself. He grasps difficult problems easily, he thinks he knows, and understands everything. Among the negative ones are mental depression, suspiciousness, fear of death, reticence, insanity, does not want to get out of bed, coma.

Among the eye and ear symptoms are dimness of vision and diplopia, vertigo and increased sensitiveness to sounds.

Passing now to the digestive system, we find a red steak down the center of the tongue which his a most suggestive and arresting keynote. It comes from a peculiar congestion of the capillaries under the surface of the tongue. This symptom, too, has its antipodal companion in the form of a tongue which is white in part or in too without being coated in the least. This is a result of an intense constriction of the capillaries.

The tongue may also have the sensation of being scalded which is rather characteristic.

The salivation is either increased or decreased and there is constant inclination to swallow:

A very peculiar symptom is that the odor of breath being lie that of ether or chloroform.

In the oesophagus we encounter congestive, motor, sensory and secretory symptoms in the form of oesophagitis, burning, acute stricture, reverse peristalsis and rising of frothy bloody mucus.

After having heard so much about this remedy you will be able to guess the nature of the symptoms affecting the stomach and bowels so that it is unnecessary to enumerate all their multiple varieties. I shall only mention the spasm of the diaphragm which causes hiccough as a frequent keynote. Still another keynote of this area is the sensation of the stomach being tightly drawn against the spine or twisted, which causes pain in the back. This same sensation may affect the bowels and the whole abdomen may be drawn in, as in Plumbum.

The rectum may exhibit tenseness, hyperaesthesia and paraesthesia. The remedy is indicated in acute and chronic enteritis, in bloody stools of typhoid fevers, in cholera morbus and asiatic cholera and in vomiting of pregnancy.

In the circulatory system the palpitations of the heart are violent, the pulse full, hard, bounding or wiry and either slow or frequent and accompanied by the throbbing in the carotids and other arteries. Due to the dual action the other extreme is also possible and the heart can be weak and fluttering with a weak and slow pulse or weak and frequent, sometimes also intermittent or irregular. General weakness, faintness and dizziness accompany this condition.

Acute and chronic congestions of hypertensives with hypertension itself come under the domain of this remedy Oppression, sighing, rapid respiration and gasping for breath are their distressing symptoms and Veratrum viride is the only salvation. Acute and chronic endo-and pericarditis of rheumatics are also amenable to it.

Many attacks of the respiratory system are at first purely central, medullar or bulbar origin. There is nothing in the lungs or bronchial tubes, but the patient gasps for breath. Even death my come before any changes develop in the periphery. These are cases where it is necessary to be acquainted with this remedy. There is no time for repertorizing, much less for reading on materia medica.

If the central attack is not fatal and peripheral congestion followed by engorgement develops, there is still time for this remedy and many pneumonias have been cured where no other remedy was indicated. In these cases there is profuse and bloody expectoration, high fever, stitch in the side, flushed face, burning face and number of the keynotes mentioned before.

In the genital sphere the effects of congestion and decongestion are analogous. The remedy cures metritis, pelvic cellulitis, catarrhs as well as amenorrhoeas, if these are caused by chilling. Its sensory action in the form of hyperaesthesia and menstrual colics accompanies the congestion. Cerebral congestion with drawing pain in the nape of the neck, heavy tongue with sensation of being scalded and acute or chronic fever are also present. It is a mistake to think that the remedy is good only for acute cases. It is indispensable in many chronic cases also.

The action on the bladder is shown in cures of polyuria and anuria and of cystitis with bloody urine. Also bloody tumors of the bladder have been cured.

The irritation of the motor tracts in the medulla creates in the voluntary muscles a complete gamut of muscular spasms from the finest trembling of the hands and nodding of the head to the most violent tetanic convulsions and contortions. Facial twitchings, mouth drawn down at one corner, opisthotonus, tetany, chorea, eclampsia, jerking during sleep, dilated pupils, diplopia, etc., are cured by this remedy. The drawing in the muscles of the nape of the neck which is supplied by the accessory nerve can be considered as a keynote.

The antipodal motor effect exists also and occurs in the form of prostration and sudden collapse, but never in the form of paralysis. The motor tracts are only irritated or weakened, but nerve destroyed.

The sensory track of fibers from this same derangement encountered in the medulla, creates the very characteristic symptom of hyperaesthesia of the skin and of all the other tissues supplied by these fibers. Due to this symptom the information are very painful wherever they occur.

And it it s grand keynote in rheumatic joints and muscles and in erysipelas. Of course, every imaginable variety of sensory disturbances of skin and other tissue can be encountered, such as burning, tingling, pricking, stabbing, itching, boiling water running, sensation of joints being dislocated, numbness, flying pains, excruciating, or galvanic shocks, etc., but never any complete anaesthesia.

In concluding, I wish to say that I have endeavored to make this remedy picture as short a possible. The drawing is coarse and you will have to add the finer shades and finishing touches. If I have persuaded you of the great importance of this remedy. I am satisfied.

F K Bellokossy