Introduction - Uppsala Monitoring Centre

species and Veratrum (lily family, Liliaceae), with 45 species.
(i) Black Hellebore (Helleborus niger, Christmas Rose, Helleborus officinalis)
Dating from 585 BC and in frequent use as a purgative but with serious type A
reactions. It contains the glycosides: helleborin, C 36 H 42 0 6 a potent narcotic,
helleborein, C 3 H 44 0 15 , helleboresin, C 3 0H 38 0 4 , and helleboretin, C 14 H 20 0 3 ,
hellebrin, C 36 H 52 O 15 , a digitalic narcotic. Used for purging and as an
abortifacient and emmenagogue.
Its action is due to enhanced sodium ion conductivity, which activates the
Bezold-Jarish reflex 4 causing slowing of the heart rate and lowering of the
blood pressure. The high amounts of ranunculin or protoanemonin in the
leaves, stems and flowers of H. niger are responsible for dermatitis, which can
follow exposure to bruised root material, leaves, stems and flowers. The
cardiac glycosides present are responsible for toxic digitalis-like effects:
bradycardia, prolonged P-R interval, idioventricular rhythm, bundle-branch block,
ventricular fibrillation, slow, irregular pulse and asystole. These are thought to be
more with the other species of the hellebores rather than with H. niger.
(ii) Any of various plants of the genus Veratrum, especially V. viride of North
America, having large leaves and greenish flowers and yielding a toxic
alkaloid used medicinally. The name was given to a number of toxic plants,
whose precise identification still causes confusion.
(a) White Hellebore, now known as Veratrum album
The plant is highly toxic, containing veratrine, protoveratrine A and B,
and the teratogen cyclopamine and jervine. Used as an emetic
Veratrum is irritating and ingestion can result in a burning sensation in
the upper abdominal area followed by salivation, vomiting, purging,
sneezing, gastric erosion, hypotension, and bradycardia. There have
been several poisonings reported in humans with the different species.
Although the plant is highly toxic, it is believed to be the ‘hellebore’
used by Hippocrates as a purgative. Reveratrol was isolated in 1940
from the roots of white hellebore.
(b) Green hellebore or Veratrum viride or American hellebore.
Not too dissimilar from Veratrum album, but with slightly different
constituents. It causes sneezing, watery eyes, excess saliva, vomiting,
diarrhoea, a burning sensation in the mouth and throat, and inability to
swallow. These symptoms are followed by a tingling sensation, dizziness,
4 Bezold-Jarish reflex = when the cardiac sensory receptors are stimulated by stretch or drugs there is
increased parasympathetic activity and inhibition of sympathetic activity promoting reflex bradycardia,
vasodilatation and hypotension and at the same time modulating renin release and vasopressor
secretion(Mark,1983).