57. Veratrum album, Linn.—White Hellebore.
History.—This is, I think, the ελλέβοζος λευκός of Dioscorides (lib. i v. cap. 150), and probably, therefore, of other ancient writers, as Hippocrates and Theophrastus. On this point, however, considerable difference of opinion has existed. Schulze, [Diss, inaug. sist. Toxicol. Veterum, Halae. 1788.] while he acknowledges the great similitude between Veratrum album, Linn. and the white hellebore of Dioscorides, is of opinion that the true hellebore (both white and black) of Theophrastus is wholly lost. And Dr. Sibthorp, [Prod. Fl. Graecae, l. 439.] who found both V. album and V. nigrum in Greece, [Neither Fraas, nor any other botanists, whose collections in Greece he examined, found either of the above-mentioned species of veratrum.] regards Digitalis ferruginea as the white hellebore of Dioscorides—an opinion from which Sir J. Smith, the editor of the Prodromus, expresses his dissent. [For some interesting information respecting the ancient hellebore, consult Dierbach, Arzneimittel. d. Hippocrates, p. 107.] The term veratrum is said by Lemery to be derived from vere atrum (truly black), in reference to the colour of the rhizome; but this etymology is improbable.
Botany.—Gen.Char.—Flowers polygamous. Perianth six-parted; segments broad, concave, imbricating, nearly equal, striated, not excavated at the base. Stamens six, equal, inserted into the base of the segments; filaments subulate; anthers reniform, with confluent cells. Ovary with three divaricating stigmas. Capsule three-horned, separating into three many-seeded follicles. Seeds compressed, winged at the apex. (Lindley.)
Sp. Char.—Panicle decompound. Bracts equalling the flowers. Pedicels pubescent. Segments of the perianth somewhat erect and obtuse, serrulate. Leaves ovate-oblong, plaited. (Sprengel.)
Root composed of numerous fleshy brownish-white fibres, arising from a perennial, cylindrical, fleshy, subterraneous stem or rhizome, which is brown externally, brownish-white internally, and is placed obliquely in the earth. Stem one to four feet high. The plant flowers from June to August.
Two varieties (by some considered distinct species) are included here:—
α. albiflorum (V. album, Bernh.) with decompound raceme and white flowers.
β. viridiflorum (V. Lobelianum, Bernh.) with compound raceme and greenish flowers.
Hab.—Mountainous regions of Europe. Abounds in the Alps and Pyrenees.
Description.—The rhizome or cormus (radix veratri, offic., radix hellebori albi) is single-, double-, or many-headed, having the form of a cylinder, or, more frequently, of a truncated cone. It is from two to four inches long, and about one inch in diameter, rough, wrinkled, grayish, or blackish-brown externally, whitish internally. Portions of the root fibres are usually attached to it, as well as some soft, fine hair-like fibres. At the upper extremity of the rhizome we frequently observe the cut edges of numerous concentric, woody, or membranous scales: they are portions of the dried leaf-sheaths. When cut transversely, the rhizome presents a large central portion (frequently called medulla), which varies in its qualities; being woody, farinaceous, or spongy, in different specimens. This is separated by a brown fine undulating line from a thick woody ring, in which the root fibres take their origin. On the outside of this is a narrow but compact brown epidermoid coat. The odour of the dried rhizome is feeble; the taste is at first bitter, then acrid. By keeping, the rhizome is apt to become mouldy.
The rhizome of Veratrum viride is used in the United States as a substitute for that of Veratrum album (see p. 186).
Composition.—White hellebore rhizome was analyzed in 1820 by MM. Pelletier and Caventou, [i>Journ. de Pharm, vol. vi. p. 343.] who obtained the following results: Fatty matter (composed of olein, stearin, and a volatile [cevadic?] acid), supergallate of veratria, yellow colouring matter, starch, ligneous matter, and gum. The ashes contained much phosphate and carbonate of lime, carbonate of potash, and some traces of silica and sulphate of lime, but no chlorides. They could not obtain the volatile [cevadic?] acid in a crystalline form.
1. VERATRIA. (See p. 190).
2. JERVIN (so called from Jerva, the Spanish name for a poison obtained from the root of white hellebore); [Bauhin's Pinex, p. 186.] Barytin.—A white crystalline, fusible, and inflammable substance, discovered by Simon. [Poggendorff's Annalen, xli. 569; and Pharmaceutisches Central Blatt für 1837, S. 191.] It is soluble in alcohol, but not in water. With acetic and phosphoric acids it yields readily soluble salts; but, on the contrary, with sulphuric, nitric, and hydrochloric acids, it forms difficultly soluble compounds. [Pharm. Central Blatt für 1837, S. 753; also, Berlinisches Jahrb.für d. Pharm. Bd. xxxiii. S. 393; and Lond. and Edinb. Phil. Mag. vol. xii. p. 29.] On account of its resembling baryta in being precipitable from its solution in acetic acid by sulphuric acid, it was called at first barytin. Its composition, according to Will, is C60H45N2O5.
Chemical Characteristics.—A decoction of the rhizome undergoes, on the addition of a solution of gelatin, no change, showing the absence of tannic acid; but with the sesquichloride of iron, it becomes olive green (gallate? of iron). With tincture of galls, it became slightly turbid (tannates of veratria and starch). With acetate and diacetate of lead, and protonitrate of mercury, it formed copious precipitates. Oil of vitriol reddens the concentrated decoction, owing to its action on the veratria. The rhizome left after the decoction had been prepared from it, becomes, on the addition of a solution of iodine, black (iodide of starch).
Physiological Effects. α. On Vegetables.—Not ascertained.
β. On Animals generally.—"The best account of its effects is contained in a thesis by Dr. Schabel, published at Tübingen, in 1817. Collecting together the experiments previously made by Wepfer, Courten, Viborg, and Orfila, and adding a number of excellent experiments of his own, he infers that it is poisonous to animals of all classes—horses, dogs, cats, rabbits, jackdaws, starlings, frogs, snails, and flies; that it acts in whatever way it is introduced into the system—by the stomach, windpipe, nostrils, pleural membrane of the chest, on external wounds, or the veins; that it produces in every instance symptoms of irritation in the alimentary canal, and injury of the nervous system; and that it is very active, three grains of the extract applied to the nostrils of a cat having killed it in sixteen hours." [Christison's Treatise on Poisons, 3d edit. p. 790.]
γ. On Man.—Its local action is that of a powerful acrid. Applied to the Schneiderian membrane, it excites violent sneezing. Epistaxis even is said to have been induced by it. Its operation, when swallowed or placed in contact with the skin, is also that of an energetic irritant.
Its remote action is on the secretory apparatus, the stomach and intestines, and the nervous system. In small and repeated doses, it promotes secretion from the mucous surfaces, the salivary glands, the kidneys, and the uterus, and increases the cutaneous exhalation. [Greding Sämmtl. med. Schrift. Th. 1, S. 179.] In larger doses, it causes vomiting, purging, pain in the abdomen, tenesmus, and occasionally bloody evacuations, and great prostration of strength. In some instances, a few grains even have had these effects. Schabel says there is no substance which so certainly and promptly provokes vomiting; and Horn [Archiv. B. x. H. 1, S. 161.] employed it as a sure emetic. In addition to the local action which it exercises, when swallowed, on the stomach and intestines, it possesses a specific power of influencing these viscera: for Etmuller [Opera omnia, tom. ii. pt. ii. p. 144.] has seen violent vomiting result from the application of the rhizome to the abdomen; and Schröder [Orfila, Toxicol. Gén.] observed the same occurrence where the rhizome was used as a suppository. In excessive doses, it operates as a narcotico-acrid poison, producing gastrointestinal inflammation and an affection of the nervous system. The symptoms are violent vomiting and purging (sometimes of blood), tenesmus, burning sensation of the mouth, throat, oesophagus, stomach, and intestines, constriction of the throat, with a sense of strangulation, griping pain in the bowels, small, and, in some cases, almost imperceptible pulse, faintness, cold sweats, tremblings, giddiness, blindness, dilated pupils, loss of voice, convulsions, and insensibility, terminating in death. A cutaneous eruption has, in some instances, followed the use of white hellebore.
I am indebted to Dr. Wm. Rayner, of Stockport, for notes of three cases of poisoning by infusion of white hellebore. The symptoms resembled those just mentioned, except that there was no purging. All three cases rapidly recovered.
Hutchinson [Schwartze's Pharm. Tab 2te Ausg.] remarked that, when death did not occur, palpitation and intermitting pulse, besides dyspeptic and nervous symptoms, remained for some time.
These effects were not observed in Dr. Rayner's cases.
In its action on the system, Veratrum album is more closely related to cebadilla and meadow saffron than to any other medicinal agents. It is more acrid aud less stupefying than Helleborus niger, with which it has been so frequently compared both by ancients and moderns. Orfila [Toxicol. Gén.] ascertained, by experiment on animals, that it is more active as a poison than the last-mentioned substance. It exercises no known chemical influence over the tissues by which it is distinguished from the mineral irritants, as baryta and emetic tartar, with which Schabel compared it.
Uses.—It is but rarely employed, principally on account of the alleged uncertainty of its operation. But, from the few trials which I have made with it, I suspect this uncertainty is much exaggerated, and is principally referable to the varying lengths of time which the rbizome has been kept after its removal from the earth, for, like Colchicum, it deteriorates by keeping. The following are the principal cases in which it has been employed:—
1. In affections of the nervous system, as melancholia, mania, and epilepsy. [Greding, Sämmtl. mediz. Schriften. T. 1, S. 179.] As an emetic, purgative, and promoter of the secretions generally, we can easily understand that it may prove occasionally beneficial.
2. In chronic skin diseases, as herpes, Dr. C. Smyth [Med. Communications, vol. 1. p. 207.] gave the tincture internally with benefit. As external applications, the decoction and ointment are used in scabies (hence the Germans call the rhizome Kratzwurzel, i. c. itch-root), tinea capitis, &c.; but their use is not quite free from danger.
3. In gout, it was given in combination with opium, by Mr. Moore, [Two Letters to Dr. Jones, 1811.] as a substitute for, or in imitation of, the Eau Médicinale. The dose, in a paroxysm of gout, was from forty minims to two drachms of a mixture composed of three parts of Vin. Veratri albi and one part of liquid laudanum.
4. In amaurosis and chronic affections of the train occurring in torpid habits, it is employed as an errhine or sternutatory (hence its German name, Niesswurzel, i. e. sneeze-root). It is usually diluted with some mild powder. The German snuff called Schneeberger is said to contain it.
5. To destroy pediculi, the decoction is used as a wash.
6. As an emetic, it was employed by Horn.
Administration.—The following are the principal modes of exhibition:—
1. PULVIS VERATRI; White Hellebore Powder.—The dose of this at the commencement should not exceed one or two grains. This quantity will sometimes occasion nausea and vomiting; but Greding found that in some cases eight grains, and, in a few instances, a scruple of the bark of the rhizome in powder were required to excite vomiting. As an errhine, not more than two or three grains, mixed with eight or ten of some mild powder (as starch, liquorice, Florentine orris, or lavender) should be employed at one time. It is a constituent of the Unguentum Sulphuris compositum (see vol. i. p. 360).
2. VINUM VERATRI, L.; Tinctura Veratri albi; Tincture of White Hellebore.— (White Hellebore, sliced, ℥viij; Sherry Wine Oij. Macerate for seven days, and strain.)—As a substitute for Colchicum in gout and rheumatism, the dose is ten minims twice or thrice daily. This quantity is to bo gradually increased. A full dose acts as an emetic and cathartic.
1. DECOCTUM VERATRI, Ph. L. 1836; Decoction of White Hellebore.—(White Hellebore, bruised, ʒx; Distilled Water Oij; Rectified Spirit f℥iij. Boil the hellebore in the water down to a pint, and when it is cooled, add the spirit.)—This preparation is only used as an external application in skin diseases (scabies, lepra, tinea capitis, &c.), and to destroy pediculi. When the skin is very irritable, the decoction will sometimes require dilution. If the surface to which it is applied be denuded, absorption of the veratria may occur, and constitutional symptoms be thereby induced; hence it is a dangerous application, especially to children.
4. UNGUENTUM VERATRI, Ph. L. 1836 [Unguentum Veratri albi, U. S.]; Ointment of White Hellebore.—(White Hellebore, powdered, ℥ij; Lard ℥viij; Oil of Lemons ♏xx. Mix.)—This ointment is used in the treatment of the itch as a substitute for the disagreeable, though far more effective, sulphur ointment. Like the decoction, there is danger of the absorption of the active principle of the rhizome when the ointment is applied to raw surfaces; it is, therefore, an unfit remedy for children.
Antidotes.—Astringent solutions have been recommended; and in one case, which fell under my notice, infusion of nutgalls seemed to give relief. The supposed benefit has been referred to the union of tannic acid with veratria, by which the solubility and activity of the latter are diminished; but Schabel [Quoted in Brandt and Ratzburg's Giftgewächse, Abt. 1, s. 28.] found that three drachms of a tincture of white hellebore, given with infusion of galls, to a cat, proved fatal in twenty minutes. Hahnemann recommends coffee, both as a drink and in clyster. Demulcent liquids, and, in some cases, opiates, may be useful. The other parts of the treatment must be conducted on general principles. Stimulants will be usually required on account of the failure of the heart's action.