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.

F K Bellokossy