Helleborus niger

A dark, dusky remedy; dark face; sooty nostrils; dark lips, hands, etc. Serous effusions. Gradual onset, with advancing weakness, blunted senses and sluggish responses; drops things, staggers, etc. Automatic acts. Lies on back with knees drawn up. Muscle pains, spasm or paralysis. Feeble and delicate. .................... Inattention. Stupid, obtuse or apathetic. Brain symptoms, with anorexia. Blank, somber despair. Won't eat or speak. Fixed ideas. Things look new. Heavy, numbing headache. Rolls head or bores it into pillow for relief. Congestion. Hydrocephalus. Stupid, staring or tired look. Eyes half open. Pale face. Chewing motions. Fetor oris. Numb, dry, trembling tongue or covered with yellow ulcers. Ptyalism. Averse to vegetables. Distended abdomen. Watery or gelatinous stool. Urine, scanty, with dark flecks or sediment; retained. Nephritis. Uræmia. Dropsy. Amenorrhœa from cold. Small, soft pulse. Sopor; with cries or starts. Coldness. Chill, with fever or heat; with sweat.

Cold air. Puberty. Dentition. Suppressions. Exertion. Evening (4-8 P.M.).

Strong attention.

MIND. BRAIN. Sensorium. Nerves; motor; sensory. Membranes: Serous. Mucous. Kidneys. Muscles. Exudations.

Complementary: Zin. Related: Bry. Op. Zin.

Helleborus niger

Christmas Rose. Ranunculaceae.

Weakly, delicate, psoric children; prone to brain troubles (Bell., Cal., Tub.) ; with serous effusion.

Melancholy: woeful; despairing; silent; with anguish; after typhoid; in girls at puberty, or when menses fail to return after appearing.

Irritable, easily angered; consolation < (Ign., Nat., Sep., Sil.) ; does not want to be disturbed (Gels., Nat.).

Unconscious ; stupid ; answers slowly when questioned; a picture of acute idiocy (of chronic. Bar. c. ).

Brain symptoms during dentition (Bell., Pod.) ; threatening effusion (Apis, Tub.).

Meningitis : acute, cerebro-spinal, tubercular, with exudation; paralysis more or less complete; with the cri encephalique.

Vacant, thoughtless staring; eyes wide open; insensible to light; pupils dilated, or alternately contracted and dilated.

Soporous sleep, with screams, shrieks, starts.

Hydrocephalus, post-scarlatinal or tubercular which develops rapidly (Apis, Sulph., Tub.) ; automatic motion of one arm and leg.

Convulsions with extreme coldness of body, except head or occiput, which may be hot (Arn.).

Greedily swallows cold water ; bites spoon, but remains unconscious.

Chewing motion of the mouth ; corners of mouth sore, cracked ; nostrils dirty and sooty, dry.

Constantly picking his lips, clothes, or boring into his nose with his finger (while perfectly conscious. Arum).

Boring head into pillow; rolling from side to side; heating head with hands.

Diarrhoea: during acute hydrocephalus, dentition.

pregnancy; watery; clear, tenacious, colorless mucus; white, jelly-like mucus; like frog spawn; involuntary.

Urine : red, black, scanty, coffee-ground sediment ; suppressed in brain troubles and dropsy; albuminous.

Dropsy: of brain, chest, abdomen; after scarlatina, intermittents ; with fever, debility, suppressed urine; from suppressed exanthemata (Apis, Zinc.).

Bry., Dig., Lach., Sulph., Tub., Zinc, in brain or meningeal affections.

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.

Slow in answering. Thoughtless; staring. Involuntary sighing. Complete unconsciousness. Picks lips and clothes.

Snow-rose Produces a condition of sensorial depression. Sees, hears, tastes imperfectly, and general muscular weakness, which may go on to complete paralysis, accompanied by dropsical effusions. Hence, a remedy in low states of vitality

and serious disease. Characteristic aggravation from 4 to 8 pm (Lycop). Sinking sensation. State of effusion in hydrocephalus. Mania of a melancholy type.

Worse, from evening until morning, from uncovering.

Forehead wrinkled in folds. Cold sweat. Stupefying headache. Rolls head day and night; moaning, sudden screams. Bores head into pillow; beats it with hands. Dull pain in occiput, with sensation of water swashing inside. Headache culminates in vomiting.

Pale, sunken. Cold sweat. Wrinkled. Neuralgia on left side; parts so tender he cannot chew.

Eyeballs turn upwards; squinting, vacant look. Pupils dilated. Eyes wide open, sunken. Night-blindness.

Dirty, dry nostrils. Rubs nose. Smell diminished. Nose pointed.

Horrible smell from mouth. Lips dry and cracked. Tongue red and dry. Falling of lower jaw. Meaningless picking of lips. Grinding of teeth. Chewing motion. Greedily swallows cold water, though unconscious. Child nurses greedily, with disgust for food. Ptyalism, with sore corners of mouth.

Gurgling, as if bowels were full of water. Swollen, painful to touch.

Jelly-like, white mucus; involuntary.

Suppressed; scanty, dark; coffee-grounds sediment. Frequent urging. Child cannot urinate. Bladder overdistended.

Frequent sighing. Respiration irregular. Chest constricted; gasps for breath. Hydrothorax (Merc sulph).

Automatic motion of one arm and leg. Limbs heavy and painful. Stretching of limbs. Thumb drawn into palm (Cupr). Vesicular eruption between fingers and toes.

Pale, dropsical, itching. Livid spots on skin. Sudden, watery, swelling of skin. Falling off of hair and nails. Angio-neurotic œdema.

Sudden screams in sleep. Soporous sleep. Cri encephalique. Cannot be fully aroused.

(Hellebor fætidus, or, Polymnia-Bear's foot––Acts especially on spleen (Ceanothus); also rectum and sciatic nerve. Splenic pains extend to scapula, neck and head, worse left side and evening; chronic ague cake; hypertrophied uterus; glandular enlargements; hair and nails falling off; skin peeling). Hellebor orientalis (salivation). Antidote: Camphor; Cinch. Compare: Threatening effusion; Tuberc; Apis; Zinc; Opium; Cinch; Cicuta; Iodoform.

Tincture, to third potency.

Helleborus Niger

Brain and mind: in all the complaints of Helleborus stupefaction occurs in greater or less degree. Sometimes it is a complete stupor, sometimes a partial stupor, but it is always stupefaction and sluggishness.

Hellebore is useful in affections of the brain, spinal cord, the general nervous system and mind, but especially in acute inflammatory diseases of the brain and spinal cord and their membranes, and in troubles bordering on insanity. There is a peculiar kind of imbecility or stupefaction of the body and mind.

The extreme state is unconsciousness. Complete unconsciousness in connection with cerebral congestion, or inflammation which has gone on to hydrocephalus, cerebro-spinal meningitis, or inflammation of the brain, with stupefaction. Even early in the disease Hellebore lacks the wildness and acute delirium found is Stramonium and Belladonna. It is passive. Again, it fits in after the wildness of the delirium has passed away and, the patient has settled down into a state of stupefaction. The patient lies upon the back, eyes partly open, rolling the head, mouth open, tongue dry, eyes lusterless, staring into space. Staring at the individual talking. Waiting a long time to answer, or not answering at all. Violent attacks of brain trouble frequently come to a sudden end, but those that are more passive linger, and that is where Hellebore comes in. The Hellebore case will linger for weeks and sometimes months in this state of stupefaction, gradually emaciating.

He lies upon the back with the limbs drawn up; he looks pale and sickly. When questioned he answers slowly. The text says:

"Stupefaction bordering on insensibility." Another common expression is:

"Diminished power of the mind over the body." The muscles will not act; they will not obey the will. It is a sort of paralytic state, but "stupefaction" expresses it. Cannot project ideas; cannot rivet the attention, cannot concentrate the mind. The patient appears semi-idiotic. Delirium is not common, and when present it is muttering. There is more stupefaction, more "do nothing," more "say nothing," than delirium. Yet there is evidently confusion of mind; he cannot think. In many instances, very late in the disease, the patient can be roused up, and he will act as if he were attempting to think, as if he were attempting to answer, attempting to move. But he simply stares at the doctor with eyes partly open, with a dazed expression on his face, and picks his finger ends.

When questioned the Hellebore patient is not able to tell you what he has in mind, unless considerably aroused and agitated. But when so aroused he will talk about spirits, or say that he sees devils. He sees in his imagination those images that he has read about, or seen pictured, as the devil, with horns and a tail. A young person who has never heard of the devil, or of spirits, would not have that form of hallucination in his delirium. The hallucinations are shaped in accordance with what he has been taught to imagine.

Hellebore has a peculiar quasi-hysterical condition - a form of insanity. She imagines she has sinned away her day of grace. Like Aurum, she believes that she is doing wrong, that she is committing an unpardonable sin. That is as near as the remedy approaches to insanity, "An old woman having been accused of theft by the women around took it so much to heart that she hanged herself. This suicide produced such an effect on the women of the village that one after another accused herself of having caused the death of the old woman."

Child: The most striking type in Hellebore is the sick child. It comes in especially in children between two and ten years of age. The staring lying on the back and staring with half-closed eyes, is typical of the remedy. Sometimes the lips move without any sound. The lips move as if the child wishes to say something, but on further questioning the words he wished to speak are lost, forgotten.

In hydrocephalus there is a sharp scream, the brain cry. The child will cry out in sleep. He will carry the hand to the head and shriek, like Apis. But the Apis hydrocephalus is far more active and acute.

The Apis patient kicks the covers off; this patient does not mind the covers, he does not mind anything. He is not easily disturbed. He lies upon his back with the limbs drawn up; often making automatic motions with the arms and legs. Sometimes one side is paralyzed, but the other keeps up automatic motions.

Hellebore is useful in the low form of disease known as "apathetic typhoid." These same symptoms guide to the remedy. Indifferent to all external impressions.

Rarely much disturbed by being touched, or by being covered too warmly, or by not being covered at all.

He does not seem to be sensitive to heat, or cold, or pricking, or handling or pinching. Listlessness. What is called in the text "stubborn silence" is more an apathetic silence, an inability to speak. It appears as if he refused to answer, but he does not; he does not know how to answer; he cannot think.

Fixed ideas in persons who are said to be just a little "off their balance," a little queer. And that fixed idea will stay; there is no use trying to argue him out of it. The woman gets a fixed idea that she is going to die on a certain day, and nothing can get it out of her head. This is not like Aconit, because there is no fear of death. Aconite has fear of death and fixes the time of death. Fixed idea that she has committed some sin, which she will at times name and describe, or perhaps only mention vaguely - but it is very real to her, Mind 2: When able to be about the patient appears to be sad, because she sits and says nothing, and seems to be in a woeful mood. But there is not that great lamentation, with walking the floor and wringing the hands that we find in Aurum.

It is an apathetic state; she appears sad and melancholy, whereas perhaps she does little thinking. Any attempt at consolation, so long as the patient is able to think, only aggravates the trouble. Like Natrum muriaticum, the complaints are aggravated by consolation, but the complaints of Natrum muriaticum are not at all like these.

If the Hellebore patient is able to meditate upon his symptoms, they seem to grow better. Sometimes there are convulsive motions in this remedy, but they are more likely to be automatic. Motions that seem to have nothing to do with the will. He simply makes motions, like one moving in an absent-minded state.

The Helleborus patient is benumbed everywhere. The whole sensorium is in a benumbed state, a stupefaction, a blunting of general sensibility. The text says:

"Vision unimpaired."

Nevertheless he sees imperfectly; he does not regard the object his gaze is fixed upon; that is, his range of vision appears to be correct, yet if questioned a little as to what be saw, he has no recollection of it; it has made no impression upon his memory or his mind.

Vertigo and head: Vertigo, with nausea and vomiting. Vertigo from stooping. With the general stupefaction the head rolls and tosses. The child lies upon the back and rolls the head from side to side. The eyes are partly open, arid he keeps boring the back of the head into the pillow. This is partly unconscious and partly to relieve the drawing in the muscles of the back of the neck. These muscles keep shortening, as the disease progresses, just as they do in cerebrospinal meningitis; until the head is drawn back as far as it can go.

There is burning heat in the head; shooting pains; pressive pains in the head from congestion. Violent occipital headache. Dull aching in the occiput; benumbed feeling in the occiput. A feeling like wood fullness, congestion and pressure.

The headaches, the motions of the head and the appearance of the face are those occurring in congestion of the brain. I have seen children, after passing through a moderately acute but rather passive first stage, lie in this stupid state, needing Hellebore for weeks before they received it.

When it was given repair set in; not instantly, but gradually. The remedy acts slowly in these slow, stubborn, stupid cases of brain and spinal trouble. Some. times there is no apparent change until the day after the remedy is administered or even the next night, when there comes a sweat, a diarrhea, or vomiting - a reaction.

They must not be interfered with no remedy must be given. They are signs of reaction. If the child has vitality enough to recover, he will now recover. If the vomiting is stopped by any remedy that will stop it, the Hellebore will be antidoted. Let the vomiting or the diarrhoea or the sweat alone, and it will pass away during the day.

The child will become warm, and in a few days will return to consciousness and then what will take place? just imagine these benumbed fingers and hands and limbs, this benumbed skin everywhere. What would be the most natural, thing to develop as evidence of the rousing up of this stupid child?, it is necessary for you to know this.

It is not really a part of the teaching of the homoeopathic Materia Medica, but you must know what to expect after giving this remedy.

Clinical observation: It is a clinical observation which you will - see if you see Hellebore cases, and Zincum cases.

Zincum is, if possible, even more profound in its dreadful state of stupefaction than Hellebore. Well, that child's fingers will commence to tingle. As he comes back to his normal nervous condition, the fingers commence to tingle, the nose and ears tingle, and the child begins to scream and toss back and forth and roll about the bed. The neighbors will come in and say, "I would send that doctor away unless he gives, something to help that child;" but just as sure as you do it you will have a dead baby in twentyfour hours. That child is getting well; let him alone. You will never be able to manage one of these cases if you do not take the father into a room by himself and tell him just how the case will proceed.

Do not take the mother; do not tell her a word about it, unless she is an unusually excellent mother, because that is her child, and she is sympathetic, and she will cry when she hears that child cry; she will lose her head and will insist upon the father turning you out of doors. But you take the father aside beforehand and tell him what is going to happen; explain it to him so he will see it for himself; and tell him that if this is not permitted to go on, that if the remedy is interfered with, he will lose his child. It is not so much the awful pains, but it is the itching, tingling and formication that cause the appearance of extreme agony. Sometimes in every part of the child's body it is a week before all these symptoms go away of themselves but they will go away, if left alone.

All this will make you nervous. Do not stay and watch the case too long, because if you do you will change the remedy. I never heard of one solitary cure like, these in the hands of an Old School doctor, The face has a very sickly appearance; sunken, gradually emaciating. It has a sooty appearance, just as if soot had settled in the nostrils and in the corners of the eyes. You will say that the patient is going to die. Quite likely without Hellebore. The remedy fits the kind of cases that the allopath knows nothing about and has no remedy for.

His prognosis is always unfavorable. The face, of course, expresses the mental symptoms. Wrinkled forehead, bathed in cold sweat. Paleness of the face and heat of the head. Twitching, of the muscles of the face. We find that knitting of the brow and wrinkling of the forehead in just this kind of brain trouble. We find a similar kind of wrinkling in Lycopodium, but the trouble is in the lungs. In this remedy the nostrils are dilated and sooty. Nor much flapping, but extremely dilated. The eyeballs are glassy and the lids sticky.

There is violent thirst in these fevers, and unusual canine hunger. The nausea and vomiting are nondescript. In the early part of the proving there are diarrhoea and dysentery; with copious white gelatinous stool; stool consisting solely of pale tenacious mucus. And then comes paralytic constipation, and these prostrated, emaciated brain cases, such as described, will lie for days without stool, or any action of the bowels. After a day or two they will not even respond to injections. Little, hard, dry stool. Again, when reaction comes, it very commonly comes with a diarrhea, or a sweat, or vomiting; perhaps with all three of these conditions.

The urine is retained or suppressed; sometimes it dribbles away passes unconsciously. Urine passed in a feeble stream; bloody urine. The patient lies on the back, with his limbs drawn up; or slides down in bed. Great debility; great relaxation; the muscles refuse to act. Convulsions of sucklings. Epilepsy with consciousness. Traumatic tetanus. Constant somnambulism cannot be roused to full consciousness. Soporous sleep.