Helleborus niger

Lecture XXXIII — Helleborus and Staphisagria

HKIvIvKBORUS nigkr.

f Sweet spirits of nitre, ~" ""7'

-I Phosphoric acid, depression.

] .

Sensorial Helleborus niger. <{ Opium.

Apis, Digitalis, Zin- Dropsies. -j cum (Brain), Terebinthina.

I propose considering first, to-day, Helleborus niger. This is also termed the Christmas rose, because it blossoms in midwinter. It has a dark brown root, which contains two active principles, Helleborin and Helleborei?i. The latter is said to be the poisonous constituent of the plant. It is an active cardiac poison, and also causes violent purging, vomiting, abdominal pains, and finally collapse. This purgative action resembles Veratrum album, and the collapse, Camphor, Ca? rbo veg., China, etc. Veratrum album has not the apathy of Hellebore; Carbo veg. has cold feet and cold knees, rarely unconsciousness; Camphor has most .prominently the coldness, sometimes with an internal feeling of heat, impelling the patient to throw off the clothes. The Helleborin is either inoperative, or, according to some authors, exerts a narcotic influence, and produces paresis of both sensation and motion.

The action of Helleborus has been marked out for you on the board. It blunts the sensorium, producing sopor, typhoid symptoms, paralysis of muscles, collapse, and lastly dropsies. Before going any further I wish to say that by collapse I mean not a simple weakness, but a condition in which there is a positive diminution of temperature, so that the thermometer, instead of registering 98^° registers 96 , or thereabouts, according to the intensity of the collapse. In its action on the sensorium we find that Helleborus blunts or depresses sensorial activity. This condition is exhibited in a variety of symptoms; for instance, we note diminished power of the mind over the body; the patient is slow in answering questions, as though he did not comprehend what was asked him; he sees imperfectly, or does not seem to comprehend what -he sees; hearing is imperfect; taste is absent, or nearly so; he has the desire to work or to occupy himself, but lacks the muscular strength to do so. So you see that all the senses are benumbed by the action of Helleboras. Even what has been termed the muscular sense is affected by it. Muscles do not obey the will readily unless the mind is strongly exerted. If, for instance, the patient is holding anything in his hand and you speak to him, and so divert his mind, the muscles in action relax and he drops what he is holding. Even the heart muscle does not escape these paretic effects, and we have slow action of that organ. The patient feels a heaviness or weight over the entire body. There is a pressing headache of a stupefying character. Sometimes there is a sensation as though the contents of the head were bulging at the forehead and eyes. Belladonna is thus not the only remedy that has the sensation as though the brain were being pushed through the forehead. The face is expressive of the stupidity under which the patient is laboring. We may find Hellebore indicated in typhoid fever, or in other conditions in which this sensorial depression, with the symptoms already enumerated, is present. In these cases you will also note the following symptoms: there is a dark soot about the nostrils; the nostrils are dry ; the tongue is yellow and dry, with red edges; the breath is horribly offensive; drinks roll audibly into the stomach. The fever accompanying these symptoms is most marked in the afternoon, from 4 to 8 p. m. The face is at times pale and almost cold, and the pulse faint, weak, and almost imperceptible. There is also meaningless picking at the lips or clothing.

In this sensorial depression Helleborus is similar to Phosphoric acid, Sweet spirits ofnitre and Opium. Like Phosphoric acid, it has sensorial depression, apathy, and perfect indifference. The patient is wholly indifferent as to his fate; he cares not whether he lives or dies. The difference between the two drugs is that under Phosphoric acid there is drowsiness from which the patient is easily aroused, and then is perfectty conscious; this is not the case with Helleborus, which has a condition more nearly approaching the stupor of Opium. Phosphoric acid lacks the complete muscular relaxation belonging to Helleborus. It also has not so markedly black soot about the nostrils. Sweet spirits of nitre is a remedy recommended by Hahnemann in these cases of typhoid fever when the key-note to the whole case is sensorial apathy, there being, of course, no other symptoms present to indicate any other remedy. The patient seems to be in a sort of torpor, from which he may, by exertion, be aroused, but he falls back immediately into the same indifference. In these cases Hahnemann dissolved a few drops of the crude drug in half a glassful of water and administered it every two or three hours until reaction was manifested or some other drug indicated. You will find that Sweet spirits of nitre and Phosphoric acid differ from Helleborus in degree only, Sweet spirits of nitre having apathy in the lowest degree, Phosphoric acid coming next, while Helleborus has it most marked.

Opium, the last drug on the list, you will recognize at once as similar to Helleborus. The cerebral congestion is more profound under the Opium. The breathing is loud and stertorous, a symptom not marked in Helleborus. Then, too, the face is dark, brownish-red, or often blue; under Helleborus it is pale, and often cold or at least cooler than natural, and at times livid and covered with a cold sweat. The pulse will help you to discriminate between these two remedies, it being full and slow under Opium, and small, weak, and almost imperceptible under Helleborus.

Arnica is also to be thought of as a remedy producing this drowsy stupid state, from which the patient may be temporarily aroused. Hydrocyanic acid and Cina have the symptom, " drinks roll audibly into the stomach." Cina has it in whooping-cough, but when it occurs in approaching paralysis of the lungs and brain, Hydrocya?iic acid is the best remedy. Phosphorus has it in typhoidal conditions. Cuprum has gurgling in the oesophagus when drinking.

In muscular exhaustion you may compare Helleborus with Muriatic acid, Opium, Gelsemium, Saponin, Conium, Curare, and Kali carb. Next, we find Helleborus called for in meningitis when exudation has taken place. You have present all or some of the symptoms of sensorial apathy already mentioned, showing you the depressed condition of the system. In addition you have shooting pains in the head. If the patient is a child, it will, of course, be unable to describe this last symptom, but you will notice by the sudden screaming or crying out that it has these sharp shooting pains. The child bores its head into the pillow; the head is hot, and the forehead wrinkled into a frown from contraction of the corrugator supercilii muscles. There is automatic motion of one arm and one foot. This automatic motion may recur at regular intervals. I remember one case in which, every three minutes, the child's head was jerked to one side and the arm thrown up over the head, it would then utter a half-pitiful cry and become quiet again. In the Helleborus child, the eyeballs are drawn upward, so that you can scarcely see the cornea; the face becomes flushed, and then gradually turns pale. When offered a drink of water the child seizes the proffered glass with avidity, as though it were thirsty; this it does, not only on account of the thirst, but also because of the nervousness. The bowels are usually constipated, or, if there is any stool, it is white, scanty, and jelly-like. The urine is dark, scanty, and loaded with albumen.

We can readily conceive that summer-complaint may demand Helleborus if these symptoms are present. In addition we may have sore mouth, salivation, rubbing of the nose, etc.

The nearest remedy to Helleborus in tuberculous meningitis is Apis. This drug has more of the cri encephalique and more excitement and irritability than Helleborus, which has, characteristically, sensorial depression. In Apis we often find spasms of the flexors, so that the big toes are drawn upward. This symptom has not been noticed under

Helleborus.

Digitalis is very similar to Helleborus in dropsies of the brain. Both remedies cause great depression of the sensorium, both are suited to post-scarlatinal dropsy, and both cause meningitis with effusion. Digitalis is to be chosen by the scanty, albuminous urine, and by its characteristically slow pulse, which may be even slower than the beating of the heart. In addition to these symptoms there may be a cold sweat on the surface of the body.

Ziyicum is useful in cases where one of the exanthemata has been checked, or has not developed properly. The child is so enervated that it has not sufficient strength to develop an eruption. It arouses from sleep as if in fear; it has constant fidgety motion of the feet. Other forms of dropsy in which Helleborus is indicated are general dropsy or anasarca, and especially ascites. Here you may give Helleborus when the trouble has arisen from post-scarlatinal nephritis. The urine is dark and scanty, or smoky from the admixture of decomposed blood. On standing it deposits a sediment looking like coffee-grounds. The stool contains jelly-like mucus, and is passed with much straining. The nearest remedy here is Terebinthina, which cures dropsy dependent on congestion of the kidneys, as indicated by dull aching in the renal region and by the smoky-looking urine.

In dropsies compare also Arsenicum and Apocynum.

As illustrative further of the depression of Helleborus, I may mention its successful employment in a case of shock from a blow on the head. Arnica had failed, and the patient became drowsy; one pupil was larger than the other; the patient answered questions slowly as if comprehension were imperfect; one leg was dragged in walking. The pulse was scarcely fifty per minute, and the patient in general was worse from 4 to 8 p. m. Helleborus cured the case.