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ease or interstitial nephritis. If there is acute renal inflammation
it should not be prescribed. [According to See, sparteine sul-
phate is of very great value in producing regularity in cases of
irregular cardiac action. It accelerates the beats when a weak,
atonic state is present, and has the great advantage of acting
quickly, is not cumulative, on the whole is probably inferior to
digitalis in power, but it is useful in uncompensated cardiac,
especially mitral, disease.]

ERYTHROPHLCEUM.

SASSY BARK. (Not official). Synonyms. [Manama Bark.] Or-
deal Bark. . Casca Bark. The bark of Erythrophlceum guineense (nat. ord.
LeguminoscE). [ Habitat. ] Africa.

CHARACTERS. [In flat or curved pieces of irregular siie, about 6 mm.



ORGANIC MATERIA MEDICA.

thick, covered externally with an uneven warty and fissured corky layer, or
deprived of the same, of a dull brown color. It is hard, brittle, of a fibrous
texture, internally with pale yellowish brown spots, inodorous, of an astringent,
somewhat bitter and acrid taste, and when powdered excites sneezing.]

COMPOSITION. The active principle is Erythrophlceine, a [colorless alka-
loid, soluble in water and Alcohol ; this is a local anaesthetic (Koller)].

ACTION AND THERAPEUTICS OF ERYTHROPHLCEUM.

The action of erythrophloeum [of which a 10 per cent, tincture
has been recommended in dose of from 5 to 10 m. ; .30 to .60
c.c., by the British Pharmaceutical Conference] is the same as
that of digitalis, and it may be used for the same class of cases.
[In organic cardiac disease its effect in strengthening the pulse
and in increasing the urine is by no means constant nor lasting.]
It is, however, more likely to cause vomiting, and the action on
the inhibitory cardiac mechanism is much more marked than
that on the cardiac muscle.

[ADONIDINUM.

ADONIDIN. (Not official). A glucoside obtained from Adonis Ver-
nalis (nat. ord. Ranunculacece). Synonym. False Hellebore. Habitat.
Northern Europe and Asia.

CHARACTERS. This glucoside occurs as a somewhat hygroscopic, canary-
colored powder, of intensely bitter taste ; soluble in water and Alcohol ; in-
soluble in Ether, Chloroform and Benzin.

Dose, */(> to J/j gr. ; .01 to .02 gm.

ACTION AND USES OF ADONIDIN.

Adonidin markedly increases the arterial pressure while de-
creasing the pulse rate. The primary rise is chiefly of cardiac
origin, the slowing of the rate is due to stimulation of the inhibi-
tory nerves. The late fall of blood-pressure is due, at least in
great part, to vaso-motor paralysis. In its action it is more
prompt than digitalis, and, according to Durand, does not have
a cumulative action. If it is diuretic, it is chiefly through its
effects upon the circulation. It is used for the same class of
cases as digitalis. Its irritating properties prevent its subcu-
taneous use and even prolonged administration by the mouth.]



DRUGS ACTING CHIEFLY ON THE HEART. 437



CLASS II. THE ACONITE GROUP.

ACONITUM.

ACONITE. [Synonyms. Monkshood. Wolfsbane. The tuber of
Aconitum Napellus Linne (nat. ord. Ranunculacea}. Habitat. Mountainous
districts of Europe, Asia, and Northwestern North America.

CHARACTERS. From 10 to 20 mm. thick at the crown ; conically con-
tracted below ; from 50 to 75 mm. long, with scars or fragments of radicles ;
dark brown externally ; whitish internally ; with a rather thick bark, the cen-
tral axis about seven-rayed ; without odor ; taste at first sweetish, soon becom-
ing acrid, and producing a sensation of tingling and numbness, which lasts for
some time.] Resembling Aconite. Horseradish (<]. v. ).

COMPOSITION. -The active principle is the very poisonous alkaloid Aco-
niline (see [below] ). Two other alkaloids are present, Aconine [C^H^Ou]
and Benzaconine. Other principles are, perhaps, Pseudo-aconitine, [C 3a H 49
NO n , or Napelline, (dose, }4 to % gr. ; .01 to .03 gm., Merck), Pseudo-
aconine, C 27 H 41 NO 8 , Picro-aconitine, CjjH^NOjQ, combined with Aconitic
Acid, H,C,H 5 6 .]

Dose, y z to 2 gr. ; [.03 to .12 gm.]

Preparations.

[i. Extractum Aconiti. Extract of Aconite. By maceration and
percolation with Alcohol, and evaporation.
Dose, T ^ to % gr. ; .006 to .015 gm.

2. Extractum Aconiti Fluidum. Fluid Extract of Aconite.
By maceration and percolation with Alcohol and Water, and evaporation.

Dose, ', to 2 m. ; .03 to .12 c.c.

3. Tinctura Aconiti. Tincture of Aconite. Aconite, 35. By
maceration and percolation with Alcohol and Water to 1000.

Dose, % to 5 m. ; .03 to .30 c.c.

It should be remembered that Fleming's Tincture of Aconite, which is
found in the shops, is nearly twice as strong as the official tincture. ]

ACONITINA. Aconitine. (B. P., not official). C 33 H 45 NO 1!I ?=

[645.54.?]

SOURCE. [It is precipitated from an aqueous solution of an alcoholic ex-
tract of the powdered root by Ammonia, and then purified.]

CHARACTERS. Colorless, hexagonal prisms of the rhombic system. Causes
tingling when placed on the tongue. By partial hydrolysis it yields benzaco-
nine, and on further hydrolysis it forms aconine and benzoic acid. Solubility.
Readily in Alcohol and Chloroform, less so in Ether ; nearly insoluble in
water.

[Dose, ^ gr. ; .0003 gm.]



438 ORGANIC MATERIA MEDICA.

Preparation, \_B. P., not official.]

Unguentum Aconitinae. [Aconitine Ointment.] Aconitine dis-
solved in Alcohol, I ; Oleic Acid, 8 ; [Benzoinated] Lard, 41.



ACTION OF ACONITE.

The action of aconite, which has lately been studied by Cash
and Dunstan, is due chiefly to the aconitine in it, and therefore
they may be considered together.

External. Applied to the skin, to a mucous membrane, or
to a raw surface, aconitine and therefore aconite, first stimulates
and then paralyzes the sensory nerves ; it therefore causes first
tingling, then numbness and local anaesthesia, which last
some time. Unless the skin is sound a dangerous quantity may
be absorbed. It is intensely irritant to the nostrils, causing,
when it is inhaled, sneezing and much secretion with an icy
cold sensation.

Internal. Gastro-intcstinal tract. Unless it is very dilute,
numbness and tingling are produced in the mouth. There are
no other gastro-intestinal symptoms unless the dose is very large,
when there may be vomiting and purging.

Heart. If small doses are given, the rate of the beat is soon
very decidedly steadied and slowed, shortly after that the
force and tension become less, and these effects are mainly
due to a stimulation of the roots of the vagus. But after larger
doses the pulse quickens, misses beats, and becomes irregular.
Many of the ventricular beats have no corresponding auricular
contraction, although the two auricles always contract together
and the two ventricles contract together. As the irregularity
and frequency of ventricular contractions increase, the blood-
pressure rapidly undergoes great variations. It is not until
quite the end of its action that aconite influences the heart
muscle. The ventricles, always more affected than the auricles,
pass into a condition of delirium. Even small doses lead to a
fall of blood-pressure, but all the effects on blood-pressure
are almost entirely secondary to the action on the heart or its
nerves. The vaso-motor centre is only slightly affected. [Clin-



DRUGS ACTING CHIEFLY ON THE HEART. 439

ically it would appear that the peripheral vessels are dilated.
Aconite has been named the vegetable lancet.]

Respiration. The respiration, after a transitory quickening,
is slowed, expiration and the pause after it are considerably
prolonged. The movements become more slow and dyspnoeal,
the respiratory centre is powerfully depressed, but it is not easy
to decide whether death is due to this or to cardiac failure.

Nervous system. It appears clear that aconite, whether given
internally or applied locally, depresses the activity of the
peripheral terminations of the nerves ; the nerves of com-
mon sensation and temperature are affected before the
motor. Any pain that may be present is relieved. Large
doses in man cause clonic convulsions, chiefly respiratory. Later
on, the paralysis of the motor nerves gives rise to muscular weak-
ness. It is doubtful whether the cord is influenced. The brain
is not. The pupil is dilated.

Temperature. Aconite causes a febrile temperature to fall,
This is in part due to its action on the circulation and respira-
tion, but probably other causes are at work.

Skin. Aconite is a mild diaphoretic ; in this case also we
do not understand how it acts. [The cutaneous blood-vessels
are generally dilated.] Occasionally it produces an erythema-
tous rash.

Kidneys. It is said to be a feeble diuretic, but its effect is
very slight, Aconitine is excreted in the urine.

Benzaconine is bitter, and does not cause tingling or numb-
ness of mucous surfaces ; in large doses it slows the pulse-beat
very strikingly because the auricular beats are frequently not fol-
lowed by ventricular contraction. Its action is probably chiefly
on the heart muscle itself. It does not paralyze sensory nerves,
but greatly interferes with motor nerves and causes a semi-coma-
tose condition. The fall of temperature produced by it is very
slight. It will be noticed that it is in almost all respects contrary
in action to aconitine.

Aconine is bitter, but does not produce numbness. It is
non-toxic as regards the heart, and opposes the cardiac inco-
ordination and asequence caused by aconitine. It depresses



44O ORGANIC MATER I A MEDICA.

motor nerves and respiration very strikingly, probably acting
like curare.

It is worth noting that, whilst the introduction into aconitine
of two additional acetyl groups (as in diacetyl-aconitine) gives
rise to a derivative very similar in action to aconitine, the loss
of the acetyl group, as in benzaconine, almost entirely abolishes
all physiological resemblance to aconitine. On the other hand,
the removal of the benzoyl radical from benzaconine (aconine
remaining) produces much less alteration in action, although it
does not diminish the toxicity of benzaconine.

THERAPEUTICS OF ACONITE.

External. As aconite produces local anaesthesia, it is ap-
plied externally and often with great benefit in cases of neuralgia,
especially facial neuralgia. Frequently it fails, and we cannot tell
beforehand whether it will succeed. A small piece of the oint-
ment [B. P.] maybe rubbed in till numbness is produced, but as
this is a very expensive preparation it is usually better to paint
on the liniment [B. P., a 40 per cent, solution of the powdered
root in alcohol, to which 2 per cent, of camphor is added],
with a camel's-hair brush. The pain of chronic rheumatism is
sometimes relieved by aconite. Linimentum Aconiti Composi-
tum, commonly called A. B. C. liniment because it contains
equal parts of Aconite, Belladonna and Camphor liniments, is
an excellent preparation for external use. Aconite should never
be used externally unless the skin is quite sound.

Internal. It may be given internally for neuralgia, but it
does not succeed nearly so well as when applied externally. It
is not used internally as much as formerly, when it was admin-
istered in almost every febrile disease, with the object of decreas-
ing the force and tension of the pulse. Certainly it does this
very effectually, and the only reason why it is not so popular at
the present time is, that it is not now thought desirable to reduce
the force and frequency of the heart in these diseases. Perhaps
it is used too little, for many believe that the milder febrile
diseases, such as tonsilitis, laryngitis, or a common cold, are dis-
tinctly benefited by aconite, especially if they occur in children.



DRUGS ACTING CHIEFLY ON THE HEART. 44!

In addition to retarding the pulse it increases perspiration and
lowers the temperature. As large doses diminish the force of
the heart, it is usually given in doses of two or three minims
[.12 or .20 c.c.] of the tincture every hour or so till the pulse
falls to nearly normal ; for the same reason it is not advisable to
use it for prolonged fevers, as typhoid, nor when the heart is
diseased, except in the few cases in which there is sufficient
compensative cardiac hypertrophy. In such cardiac cases it is
sometimes useful to slow the pulse, even when there is no fever.
It will occasionally relieve the pain of aneurism. A common
practice was to combine with it one or two minims ; [.06 or .12
c.c.] of Vinum Antimonii, as that has much the same action on
the heart. Formerly it was much used in surgery if it was feared
that inflammation might set in after injuries.

TOXICOLOGY.

Symptoms. They come on quickly ; in a few minutes there is a severe
burning, tingling sensation in the mouth, followed by numbness. Vomiting
[is not common, but may] begin in an hour or so, and [then] is very severe.
There is an intense abdominal burning sensation. The skin is cold and
clammy. Numbness and tingling, with a sense of formication of the whole
skin, trouble the patient very much. The pupils are dilated, the eyes fixed
and staring. The muscles become very feeble, hence he staggers. His pulse
is small, weak and irregular. There is difficulty of respiration. Death takes
place from asphyxia, or in some cases from syncope. The patient is often con-
scious to the last. Post-mortem. The usual signs of death from asphyxia are
seen.

Treatment. Wash out the stomach promptly, give emetics (see p. 139).
Use artificial respiration early. Inject stimulants, as ether or brandy, subcu-
taneously ; apply warmth. Atropine and the tincture of digitalis should be
given subcutaneously. Hot blankets and bottles [are useful].

AMYL COLLOID. (Not official.) Synonym. Anodyne Colloid.
The composition of this is Amyl Hydride, 480 ; Aconitine, I ; Veratrine,6 ;
Collodion to 960. It is a fluid preparation.

ACTION AND THERAPEUTICS OF AMYL COLLOID.

Amyl colloid is painted on the skin over painful areas in neu-
ralgia, sciatica, etc. It is an elegant method of obtaining the
local anaesthetic action of aconitine and veratrine, which is aided
by the evaporation of amyl hydride ; [but it is extremely diffi-



44 2 ORGANIC MATERIA MEDICA.

cult to make a clear solution.] When the collodion has formed
a film, a piece of warm, moist spongiopiline helps the anaesthetic
effect of the alkaloids.

[VERATRUM VIRIDE.

VERATRUM VIRIDE. Synonyms. American Hellebore. Green
Hellebore. The rhizome and roots of Veratrum viride Solander (nat. ord.
Liliacea). Habitat. North America, in rich woods.

CHARACTERS. Rhizome upright, obconical, simple or divided, from 3 to
8 cm. long, and 2 to 4 or 5 cm. thick, externally blackish-gray, internally
grayish-white, showing numerous short, irregular wood-bundles. Roots ema-
nating from all sides of the rhizome, numerous, shrivelled, light yellowish-
brown, about lo to 20 cm. long, and 2 mm. thick. Inodorous, but strongly
sternutatory when powdered ; taste bitterish and very acrid. Resembling
Veratrum, Valerian, Serpentaria, and Arnica, but Veratrum has thicker
rootlets, and no odor.

COMPOSITION. The chief constituents are (i) Jet-vine C^H^NOj, an
alkaloid, non-sternutatory. (2) Pseudojervine, an alkaloid, resembling Jer-
vine. (3) Veratroidine, sometimes called Cevadine, uncrystallizable, and
sternutatory, is probably mostly Rubijervine. (4) Resin.

Dose, i to 5 gr. ; .06 to .30 gm.

. Preparations.

I. Extractum Veratri Viridis Fluidum. Fluid Extract of
Veratrum Viride. By maceration and percolation with Alcohol, and
evaporation.

Dose, i to 5 m. ; .06 to .30 c.c.

a. Tinctura Veratri Viridis. Tincture of Veratrum Viride.
Veratrum Viride, 400. By maceration and percolation, with Alcohol
to 1000.

Dose, 2 to 10 m. ; .12 to .60 c.c.

It should be remembered that Norwood's Tincture of Veratrum Viride,
which is found in the shops, is one-tenth stronger than the official.

ACTION OF VERATRUM VIRIDE.

The action of veratrurn viride is very complex, as it contains
so many alkaloids, but experiments have only been made on two
active principles. These are jervine, and a substance, vera-
troidine, which further analysis shows to consist chiefly of ru-
bijervine, resin, and, perhaps, some other bodies. Jervine,
veratroidine, and veratrum viride will be considered separately.



DRUGS ACTING CHIEFLY ON THE HEART. 443

Jervine. Gastro-intestinal tract. When administered in-
ternally this substance produces profuse salivation, but neither
vomiting nor purging.

Circulation. The pulse is markedly lessened in frequency
if the animal is quiet, but often the convulsions produced by the
jervine cause a rapid pulse. The force of the cardiac beat is not
at first altered. The blood-pressure falls at once, and con-
tinues to fall till death. Experiments made by excluding dif-
ferent parts show that these effects are produced by a powerful
direct depressant effect on the cardiac muscle itself,
and that the vaso-motor nerve-centres are powerfully para-
lyzed.

Respiration. This is i rofoundly depressed, and death takes
place from asphyxia.

Nervous system. Early in the case there is muscular
weakness, and this becomes more and more marked, so that
the animal cannot stand, and reflex action is abolished. Yet,
weak as these muscles are, they are soon violently convulsed,
and it is found that jervine produces these apparently contrary
effects by energetically stimulating the cerebral motor centres,
but at the same time paralyzing the anterior cornual cells of the
spinal cord, although not sufficiently to prevent the very strong
impulses from the cerebral centres reaching the muscles and
causing convulsions. The muscles themselves and the motor
and sensory nerves are not affected ; or, if they are, they are de-
pressed a little, just before death. Consciousness and the pupils
are uninfluenced.

Veratroidine. Gastro-intestinal tract. This substance
always produces vomiting and sometimes purging.

Circulation. At first it lessens the pulse-rate because it
stimulates the pneumogastric, consequently the blood-pressure
falls, and if artificial respiration is kept up these effects continue
till, if very large doses have been given, the stimulation of the
vagi passes into paralysis, and then the pulse rises in frequency.
Veratroidine probably has no action on the vaso-motor centres.
Its influence on the respiratory centres is so intense that if arti-
ficial respiration is not maintained, the effects of the asphyxia so



444 ORGANIC MATERIA MEDICA.

mask those of the drug on the vagi that the blood-pressure rises,
and the pulse becomes rapid.

Respiration. The function of respiratory centres is power-
fully depressed, the animal soon becomes asphyxiated and
dies.

Nervous system. The action is the same as that of jervine.

Veratrum Viride. The symptoms produced by this drug
in man are as follows. They are easily explained by the com-
bined action of jervine and veratroidine : The frequency and
force of the pulse are profoundly depressed. There may be
severe nausea and vomiting. After large doses the pulse becomes
very feeble and uneasy, there is difficulty of respiration and
intense muscular weakness. Convulsions are not common in
man. The temperature may fall several degrees.

THERAPEUTICS OF VERATRUM VIRIDE.

It is the opinion of most authorities that veratrum viride
should be prescribed with great caution, as it is such a powerful
poison. Veratrum viride has been successfully employed for
many years in the treatment of puerperal eclampsia, and of the
drugs generally employed for this purpose it is the most reliable.
It has been given as a cardiac depressant, but antimony and
aconite are much safer. Some have, however, claimed that it is
a better cardiac depressant than aconite, because the vomiting it
induces quickly indicates that too large a dose has been adminis-
tered ; but if the pulse is carefully watched, too much aconite
need not be given, and the vomiting itself is objectionable.]

VERATRINA.

VERATRINE. [A mixture of alkaloids obtained from the seed of
Asagrcea officinalis ( Schlechtendal et Chamisso, Lindley (nat. ord. Liliacea).
Habitat. Mexico to Venezuela.

SOURCE. (i) The seed is exhausted with Alcohol, and the Alcohol re-
covered by distillation. (2) The residuary liquid is diluted with water to pre-
cipitate the resins and filtered. (3) Ammonia is added to the filtrate when
veratrine is precipitated. (4) It is then re-dissolved, decolorized, and re-pre-
cipitated.

CHARACTERS. A white or grayish-white, amorphous or semi-crystalline
powder, odorless, .but causing intense irritation and sneezing when even a



DRUGS ACTING CHIEFLY ON THE HEART. 445

minute quantity reaches the nasal mucous membrane ; having an acrid taste,
and leaving a sensation of tingling and numbness on the tongue ; permanent
in the air. Solubility. Very slightly soluble in water ; soluble in 3 parts of
Alcohol ; also soluble in 6 parts of Ether, and in 2 parts of Chloroform.
Dose, ^ to y 1 ^ gr. ; .002 to .006 gm.

Preparations.

1. Oleatum Veratrinae. Oleate of Veratrine. Veratrine, 2;
Oleic Acid, 98.]

2. Unguentum Veratrinae. [Veratrine Ointment. Veratrine,
4 ; Olive Oil, 6 ; Benzoinated Lard, 90.]

ACTION OF VERATRINE.

External. Veratrine, if it is applied to the unbroken skin,
and especially if it is rubbed in, produces tingling and numb-
ness, followed by a sensation of coldness, and anaesthesia to
pain, touch, and temperature. Given subcutaneously, it causes
violent pain and irritation.

Internal. Gastro-intesttnal tract. Inhalation of the minu-
test portion causes great irritation of the mucous membrane of
the nose, violent sneezing, and a free discharge of mucus,
which may be bloody. A [minute portion] upon the tongue
gives rise to burning pain and profuse salivation. On arriving
at the stomach and intestine it produces great epigastric pain,
vomiting and diarrhoea. These results also occur if it is
given subcutaneously.

Blood. Veratrine is quickly absorbed. It is not known to
affect the living blood, but it kills the white corpuscles in drawn
blood.

Heart. It acts directly on the cardiac muscle as it does upon
voluntary muscle ; that is to say, the contractions of the heart
become fewer, but each lasts a very long while until
ultimately the heart stops in systole. It also acts on the vagus
as on spinal nerves, the functional activity being first exalted,
and this is partly the reason of the slowing of the heart ; after-
wards the vagus is depressed, but this does not cause a quickening
of the pulse because of the action of the veratrine on the cardiac



446 ORGANIC MATERIA MEDICA.

muscle, but it may make the beat irregular. The blood-pressure
at first rises from the increased force of the beat, but when the
heart becomes very slow it falls. Possibly these effects are also,
in part, owing to the action of the drug on the vaso -motor
centres.

Respiration. Small doses quicken respiration, large ones re-
tard it, producing long pauses, and finally arresting it. These
results are probably due at first to stimulation, and afterwards to
paralysis of the ends of the vagus in the lung, and to paralysis
of the respiratory centres. The temperature is lowered.

Nervous system. The brain is unaffected, and probably vera-
trine has no influence on the spinal cord. Motor nerves are
first excited and then paralyzed ; and the same is true
of sensory nerves and their endings, but here the primary
stimulation is very marked, hence the pain produced by the local
inunction of veratrine.

Muscles. The effect of veratrine is pecular and characteristic.
In animals to which it has been given, or in excised muscles to
which it is applied, it is found that the period during which a
single contraction lasts is enormously prolonged. If a
tracing of the contraction be taken it will be seen that the latent
period and the time of the ascent of the curve are unaltered, that
the height is greatly increased and the descent is extraordinarily
extended. This is a genuine lengthened contraction, which is
neither rigor nor tetanus, but it almost exactly resembles the
contraction of the muscles met with in Thomsen's disease. This
effect of veratrine disappears if the muscle is cooled.

THERAPEUTICS OF VERATRINE.

External. Veratrine [as an oleate or ointment] has been
much used as an inunction for neuralgia, and sometimes it suc-
ceeds admirably, generally in the same class of cases as are bene-
fited by the local application of aconite. [See also amyl colloid,
p. 441.]

Internal. It is rarely given internally, as it has such a
powerful and pecular action on the heart.



DRUGS ACTING CHIEFLY ON THE HEART. 447

[CLASS III. THE CACTUS GROUP.



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