As a remedy in pneumonia, it was recommended by Dr. Osgood; but did not come into extensive use until after Dr. Norwood's publication. Since then, it has been much employed, especially in the South, where pneumonia often assumes a form which does not well bear depletion; and the testimony in its favour is so strong, and from so many sources, that it is impossible to refuse it credence. The plan originally recommended by Dr. Norwood was to commence with eight drops of the saturated tincture, to be repeated every three hours, with the addition of a drop to each successive dose, until the pulse should be reduced sufficiently, or nausea and vomiting supervene; and afterwards the dose was to be so managed, in respect to amount and interval, as to sustain tho depressed state of the circulation with as little disturbance of stomach as possible. When the medicine is more than usually disposed to nauseate, the effect may be counteracted by a little morphia. it is asserted that the symptoms of inflammation decline with the reduction of the pulse, and the patient in due time enters into a very favourable convalescence. in a pamphlet, however, published in 1858, at Albany (page 8), Dr. Norwood recommends a much smaller dose than the one just mentioned to begin with, and gradually increases till the desired effect is produced. Mixing equal measures of the tincture and simple syrup, he gives from four to six drops of the mixture, as a commencing dose, and increases by one or two drops, each successive dose, until the pulse is reduced, or nausea occurs.

In acute rheumatism the remedy would seem to be no less efficacious; being, as in the former case, employed with a due regard to the necessity for depletory measures. in this disease it may often be advantageously associated with opiates, which afford ease to the patient, while tho sedative remedy reduces the excitement. it should be given every three or four hours, in such doses as not to occasion vomiting, and gradually increased as the stomach is found to tolerate it. Dr. Osgood states that he knows of no medicine, except perhaps cimicifuga, to which the disease more easily yields.

It has also been recommended in chronic rheumatism, but is not considered so efficacious as in the acute, and must be used several days before benefit can be expected. I should suppose it, from its physiological properties, to be peculiarly adapted to the neuralgic form of rheumatism.

In gout it has been equally praised; and Dr. Tully thinks that, with proper management, it will effect cures in a majority of cases. He considers it better adapted to that affection, in feeble constitutions, than colchicum, because less apt to weaken by exhausting operations on the bowels.

Dr. Tully recommends it also in dysentery when not malignant.

In a case of puerperal peritonitis, it was employed with favourable results by Dr. J. R. Murphy, of Chesterfield, Illinois. (St. Louis Med. and Surg. Journ., xiii. 255.) Dr. Norwood has found it "to rob puerperal fever of its terrors." (Pamphlet, Albany, 1857, p. 7.) He has also found it very useful in dysmenorrhoea.

Cerebral meningitis is another of the phlegmasiae in which it is thought to have proved useful; but the tendency to vomiting in this complaint should be borne in mind, and especial care taken not to give the remedy in emetic doses.

2. Of the idiopathic fevers, the one in which the medicine has been employed with the greatest supposed success, and in which it has been strongly recommended by Dr. Norwood, is enteric or typhoid fever. Having never used it in this complaint, I may not perhaps be considered as entitled to the expression of an opinion as to its efficacy or appropriateness; but, being much in the habit of seeing and treating typhoid fever, and often in its worst forms, and finding it to yield to agents much less powerfully depressing than the one in question, and much less likely to provoke irritation of stomach, which is especially to be avoided, I cannot but entertain great doubts, at least of its necessity, in that affection. Dr. Norwood has employed it, "with the most favourable results," in measles and scar-let fever. (Loc. cit.) it has also been recommended in typhus fever.

3. Of the nervous diseases, neuralgia in its various forms, but especially when occurring in rheumatic and gouty patients, may be treated by this remedy both internally and externally. I should, however, expect less from it, than from the cerebral stimulants. in severe or frequently recurring palpitations of the heart, it would be an appropriate remedy. it is said also to have proved useful in spasmodic asthma, hooping-cough, and croup. Dr. P. D. Baker, of Alabama, employs it successfully in the convulsions of children, chorea, and puerperal convulsions. (South. Med. and Surg. Journ., Sept. 1859) Dr. A. B. Clarke has used it advantageously in puerperal mania. (Bost. Med and Surg. Journ., lix. 238.) Dr. A. Geiger, of Dayton, Ohio, recommends it highly in delirium tremens, and thinks that it will supersede all other remedies in this complaint. (Med. and Surg. Reporter, July 22, 1865, p. 49.) Dr. H. C. Wood, however, states, in the edition of Pereira's Materia Medica revised by himself (a. d. 1866), that it had been tried in this complaint in the Philadelphia Hospital, when he was a resident physician there, and failed entirely. " indeed," he observes, "one death was attributed to it," (Page 347.)

4. in all cases of organic disease of the heart and of the great bloodvessels in which it is desirable to repress the circulation, and in which there is no irritability of stomach to contraindicate its use, it may be employed with the hope of benefit. I have known it to reduce the frequency of the pulse under such circumstances, after failing to obtain that effect from digitalis.

In reference to its influence over the secretions, except as an incidental effect, it has been comparatively little employed; but it seems to have proved useful as a Cholagogue, in deficient hepatic secretion, with dyspeptic sensations and mental depression. it might be tried in jaundice when the ordinary measures fail.

Dr. Percy has called attention to the advantage which may be derived from the quieting influence of this remedy over the circulation and respiration, in facilitating the physical diagnosis of diseases of the heart and lungs. He has often been able to distinguish the characteristic sounds of certain morbid states of these organs, when the patient was under the influence of veratrum viride, which he had been unable to do satisfactorily before. {Am. Med. Journ., N. Y., July 11, 1863.)

Administration

American hellebore may be given in substance, tincture, extract, or fluid extract. The dose of the powder is one or two grains, to be repeated every three hours, and increased if necessary. From four to six grains, according to Dr. Osgood, will generally vomit.

The extract may be made by inspissating the expressed juice of the root at a low temperature, or by carefully evaporating the tincture to dryness. The dose of it is from one-quarter to one-half of a grain, repeated as above.

The Fluid Extract (Extractum Veratri Viridis Fluidum, U. S.) is nothing more than an exceedingly concentrated tincture; and, considering the great strength of the proper tincture, was scarcely a desirable addition to our officinal list. The commencing dose should not exceed two or three minims.

The tincture, however, is the preferable preparation; as it will keep unchanged for a long time. in order to ensure uniformity of strength, as far as possible, it should be saturated. Dr. Osgood prepared the tincture with six ounces of the fresh root to a pint of diluted alcohol. Dr. Norwood's tincture is made with eight ounces of the dried root and a pint of officinal alcohol; maceration being continued for two weeks. I prefer the latter, as alcohol is probably a better solvent than diluted alcohol; and, by the use of the larger proportion of the root, the menstruum is more likely to be saturated. The proportion is larger relatively to Dr. Osgood's tincture than it seems to be, because the dried root is employed instead of the recent. But care should be taken that the root has not become deteriorated by long keeping. Happily, at the late revision of our national code, Dr. Norwood's tincture was adopted, and is now officinal under the name of Tincture of American Hellebore (Tinctura Veratri Viridis, U. S.). The dose is from three to six drops, to be repeated every three or four hours, and increased if necessary; but, as the medicine acts in some persons with unexpected violence, it might be better to commence with the smallest quantity mentioned, or even a still smaller one, and increase each succeeding dose until the medicine begins to act.* in exhibiting any one of the preparations, the increase of the doses successively is to be continued until some obvious effect is produced. The occurrence of nausea and vomiting, or a sufficient reduction of the pulse without these symptoms, should be the signal for refraining from any further increase; and, should the former effects continue, the medicine should be suspended, and, if resumed, should be given in smaller doses.

An ointment was formerly officinal, but has been discarded from the U. S. Pharmacopoeia as superfluous.

Should the effects of the local application of the remedy be desired, they may be most conveniently obtained by the use of the saturated tincture. it may be applied by friction to neuralgic and rheumatic cases.