Origin and Properties

This is the officinal title of the root or rhizome of Veratrum album, an herbaceous perennial plant, growing wild in the mountainous districts of Continental Europe, and abundant in the Alps and Pyrenees. As found in our shops, it is cylindrical, or in the shape of a truncated cone, from one to three inches long and an inch or less in thickness, externally blackish, wrinkled, and rough with the marks of the rootlets which have been cut off, though these sometimes remain. In this dried state it is inodorous, but has a bitterish taste, which is soon followed by an acrid and burning sensation spreading through the mouth and fauces. Its efficiency as a medicine depends, in part at least, upon the veratria contained in it. There is some reason to suppose that it may contain other active principles, of which, however, too little is known to justify any positive conclusion.

* A method of preparing the tincture, which is likely to yield a more uniform result, has been suggested by Dr. S. R. Percy, in the prize essay referred to in the text. An alcoholic extract of the root is first made by means of strong alcohol (sp. gr. 0.817), and then dissolved in alcohol of the same strength, in the proportion of one part of the extract to ten of the menstruum. The dose of this as an arterial sedative is two or three minims, every hour, two, or three hours. The sedative effect is usually produced before the third hour. Larger doses are apt to produce vomiting with general prostration. Children, Dr. Percy says, bear larger doses proportionally than adults; a child of eight years requiring one-half the adult dose. Dr. Percy also prepares a tincture of the resinoid matter, referred to in the text, by dissolving it in alcohol in such proportion that a minim of the solution contains one-twentieth of a grain of the resinoid matter. This has the advantage over the common tincture that it is especially calculated to reduce the pulse without nauseating or vomiting. (Note to the third edition.)

Effects on the System

In its operation on the system, it bears considerable resemblance to the American hellebore, except that it is much more disposed to purge, at least according to the statements of almost all writers on the subject. It has generally been known and treated of as a violent emeto-cathartic, producing severe vomiting and purging, often attended with griping pain, bloody stools, and tenesmus, and not unfrequently with great prostration. It also stimulates almost all the secretions, and is an active local irritant, producing pain and inflammation in mucous and ulcerated surfaces, and that of the denuded skin, and exciting violent sneezing when introduced into the nostrils. In overdoses it acts as an irritant poison, causing an acrid, burning sensation in the mouth, fauces, and oesophagus, a feeling of constriction of the throat, excessive vomiting, purging with bloody stools, tenesmus, severe abdominal pains, a small, feeble, and scarcely perceptible pulse, cold sweats, giddiness, faintness, blindness with dilated pupil, tremblings, loss of voice, insensibility, sometimes convulsions, and death. Occasionally it is said to produce an eruption on the skin. The reader will have noticed that this series of symptoms is almost precisely the same as that which characterizes the poisonous operation of aconite, and it is probable that they result mainly from the same cause; the absorption, namely, of the active principles, and a sedative influence exerted by them upon the organic nervous centres. It has been ascertained to produce its characteristic effects, not only when taken into the stomach, but when introduced into the rectum, applied to an ulcerated surface, or injected into the areolar tissue. The production of drastic purging, if this be so common an effect as we are led to believe by the almost universal statements of writers, is a point in which this species of Veratrum differs remarkably from the American; but I suspect that the purging is a less constant phenomenon than is generally supposed; for, in three cases of poisoning by an infusion of the root, reported by Dr. Wm. Ray-ner, of Stockport, England, this effect was wanting in all. (Pereira's Mat. Med., 3d ed., p. 1062.) The remedies are the same as those for poisoning by aconite.*

* We may conjecturally ascribe the difference in the effects of the American and the white hellebore, to the existence in the former of a peculiar alkaloid and a peculiar resinous substance, which have the characteristic properties of reducing the circulation, and, in large doses, of nauseating and vomiting without purging, which are also the distinguishing properties of the American hellebore itself; while the Veratria, or veratria-like alkaloid which it also contains, and which is the active principle of white hellebore, exists in small proportion, insufficient to characterize the medicine, though capable of somewhat modifying its action, and bringing it into nearer relation with the European drug than would otherwise be the case. {Note to the third edition.)

Therapeutic Application

White hellebore was considerably used by the ancients; but, on account of its violent effects, occasionally even in small doses, has been to a great extent abandoned. The complaints in which it was most used were those of an obstinate character, as mania, melancholia, epilepsy, dropsy, leprosy, etc., in which its powerful emeto-cathartic effects were supposed to be indicated. it has been employed, at a more recent period, as a substitute for the eau medicinale d'Husson, in the treatment of gout; the wine of white hellebore being given with laudanum; but there are few, I presume, who now continue to use it. As an alterative it has also been given in chronic cutaneous eruptions. I shall hereafter speak of it as an errhine. it has also been employed externally, in the form of ointment or infusion, to destroy vermin about the person, and as a cure for psora. I think it highly probable that, by a proper management of the dose, it might be made to answer, to a considerable extent, the same therapeutic purposes for which the American hellebore has been recommended.

Administration

The dose of powdered white hellebore should not at first exceed one or two grains, which may be repeated or increased if necessary. To produce vomiting, as much as from eight to twenty grains are not unfrequently required; but I think the medicine should never be given with this view. There was formerly an officinal Wine (Vinum Veratri Albi, U. S. 1850; Vinum Veratri, Lond.), the dose of which was ten minims, two or three times a day, to be increased if necessary, but not so far as to occasion vomiting. it was occasionally given in gout, rheumatism, and. chronic cutaneous eruptions; but has been abandoned both by the U. S. and Br. Pharmacopoeias. The same is the case with the Ointment (Unguentum Veratri Albi, U. S. 1850), which was sometimes used in the itch; but has been superseded by the officinal ointment of Veratria. The medicine also entered into the London Compound Sulphur Ointment, employed for the same purpose.