From doses insufficient to vomit, along with the epigastric uneasiness, or independent of it, there are sometimes feelings of chilliness, and considerable diminution in the frequency and the force of the pulse, with a sense of weakness in certain muscles, or want of due command of them, which are probably the results of a direct sedative influence upon the nervous centres.* As a proof that it is not from the depressing influence of nausea that the reduction of the pulse takes place, Dr. Norwood states that he has reduced it as low as thirty-five in the minute, without the least nausea and vomiting. (Chariest. Med. Journ. and Rev., Nov. 1852, p. 768.) He also speaks of a feeling of numbness and tingling, which he had experienced about the joints previously to vomiting, as well as during and after that process. (ibid., p. 770.) We are told by Dr. Osgood that the farmers in New England, in order to protect their crops from birds, were in the habit of scattering in their fields grains of corn, which had been soaked in an infusion of the root of the American hellebore. Soon after eating this grain, the birds became incapable of running or flying, so that they were readily caught; but, if left undisturbed for a time, they recovered from the paralyzing effect, and flew away. it is seen, then, that a reduction of the circulation, and a partial paralysis of sensation and motion, are produced by the medicine independently of nausea; and it is a very probable inference, that the higher degrees of these sedative effects, though associated with nausea and vomiting, and possibly increased by them, are still mainly dependent on the same depressing power over the organic, and, to a certain extent, the animal nervous centres.

When the medicine is carried so far as to produce nausea and vomiting, its depressing effects on the circulation and nervous system are often very striking. The pulse falls from 15 or 80 down to 35 or 40, and at the same time becomes small and feeble, and occasionally almost imperceptible. The surface is pale and covered with a cool sweat; the patient at the same time experiencing a sense of chilliness, and sometimes of tingling or numbness. Headache, vertigo, dimness of vision with dilated pupils, faintness, a feeling as of stiffness of certain muscles, and a want of command over them, are other symptoms evincive of the sedative operation of the medicine. These signs of prostration are sometimes so great as to become alarming; and a considerable number of cases of poisoning by the medicine have been published, in which life seems to have been saved only by the emetic effect of the medicine itself in large doses, and by the energetic use of opiates and stimulants. Until recently, however, no fatal case of the poisoning had been observed in man, though experiments on the lower animals proved that the poison had the power of destroying life. But in the Boston Medical and Surgical Journal (April 27, 1865, p. 249), the case of a child of eighteen months is reported by Dr. J. C. Harris, of West Cambridge, Mass., in which death resulted from about thirty-five drops of the tincture, given by mistake, in divided doses, in the course of two or three hours. Severe and repeated retching came on, but vomiting only once, and then but in very small quantity; so that there was reason to think that little if any of the poison had been ejected in this way. Seven and a half hours after the first dose, the symptoms were apparent unconsciousness, paleness, laboured breathing, almost stertorous, diminution of the pulse, coldness of the extremities, and profuse sweats. The treatment was of a supporting character, but without any attempt to vomit, as it was supposed to be too late. The stimulants used were carbonate of ammonia, camphor, and brandy, with sinapisms externally. Death occurred thirteen hours after the first dose.

* Dr. James Watson, of Edinburgh, from some experiments made by him with what he supposed to be the veratrum viride, asserts very positively that it is not a proper arterial sedative, and, when it reduces the frequency of the pulse, does so in consequence of its great prostrating influence on the system, and irritant action on the alimentary canal. But his results were in such direct opposition to the experience of hundreds of American practitioners, that there can be little doubt that the substance with which he experimented was something different from the veratrum viride. (See Edin. Med. Journ., Jan. 1864, p. 621.)-Note to the third edition.

All agree in the statement, that the general depressing effects on the nervous system and circulation are attended with stimulation of the secretory functions. The salivary, pulmonary, biliary, and urinary secretions are increased, it is asserted, by doses insufficient to occasion nausea and vomiting; and, during the existence of this condition, the same effect is produced upon the function of the skin.

An excessive action of the medicine is easily controlled by opiates and alcoholic stimulants. in cases of extreme nausea and vomiting, the opiate should be administered by enema.

Though, when taken internally, the American hellebore differs essentially from its European congener, the veratrum album, in rarely if ever operating on the bowels; yet, according to Dr. Percy, when given to the lower animals, dogs, for example, by subcutaneous injection, it purges actively; and the inference is that the same difference of effect from the mode of administration exists also in the human subject. {Prize Essay, etc., p. 10.)

Therapeutic Application

The indications which American hellebore seems to be capable of fulfilling, are to reduce the circulation when morbidly excited, and to calm nervous irritation. it has been used chiefly in inflammations, fevers, and nervous diseases.

1. in inflammation the medicine acts only as a sedative, and not probably by changing the character of the blood. it should not, therefore, be used to the exclusion of the lancet, and other measures calculated to meet the latter indication. But, when the state of the system does not admit of depletion, it may sometimes, I have no doubt, be employed with advantage. This remark applies to the phlegmasiae generally, excluding gastric inflammation. But it is in the treatment of pneumonia and rheumatism that the medicine has acquired most credit.