by John Jean Bruneton. Lavoisier Publishing Inc., Cachan Cedex, France. 1999. 545 pp. Hardcover. $163. ISBN 1-898298-62-9. ABC Catalog #B422.

One of the oldest concerns of humans is being able to identify toxic plants. Ever since the dawn of humankind, people have had to differentiate, often by trial and error, between edible and poisonous plants. Of course, a common maxim of pharmacology is that dose makes the poison, and thus, potentially poisonous plants can also be medicinal, depending on dosage and mode of preparation. Many readers will immediately recognize the author as an authority in the field of medicinal plants, having written Pharmacognosy, Phytochemistry, Medicinal Plants -- one of the consistent best-selling pharmacognosy reference books in the American Botanical Council's Herbal Education Catalog. Professor Bruneton is one of France's leading experts in the field of medicinal plants and this present volume attests to his expertise.

This book is one of the most up-to-date compilations of the issues related to toxicity associated with plants and plant-based products in the English literature. It contains over 1,300 references and recent epidemiological statistics covering over 50 botanical families with over 350 plant species organized in 100 monographs.

This work deals primarily with toxic plants that are reported by various poison control centers and related forms of pharmacovigilence. The book starts with general information regarding pharmacovigilence data from France, the UK, the United States, and other parts of the world. The second, larger part, deals with monographs on numerous medicinal plants organized by plant families: 48 families in the Angiospermae plus four gymnosperms and one in the pterodophyta (bracken fern). The book also contains appendices, including a glossary of botanical terms, information on phytochemistry, lists of illustrations, and an extensive general index. Each monograph begins with a black and white drawing of the plant.

The author states that the book's priority is to provide the reader useful statistical data to develop one's own judgment. Next is the qualitative aspect, circumstances surrounding the actual poisoning event, with particular emphasis on unsupervised self-medication with plants. In each monograph, case reports of adverse reactions are described, plus the presentation of symptoms, the proposed treatment, and, sometimes, toxic dosages are discussed. Extensive bibliographic information is provided for each chapter and monograph.

In the section of statistical data from the U.S., the author notes that regarding the annual reports from the American Association of Poison Control Centers (AAPCC), the data shows that although plants are "frequently incriminated, in most cases there are not consequences." Only 7.8 percent of the plant-related poisonings were managed by a healthcare facility versus 25.9 percent of all other poisoning cases. 12.6 percent of the cases resulted in minor effects (i.e., limited gastrointestinal symptoms, irritation of the skin or mucosas, transient cough, rapid heart beat without hypertension). In the U.S. with respect to major adverse effects associated with plant-related poisonings that are life-threatening to the patient -- these were noted in only 0.023 percent of the cases reported in 1991. Of a total of 112,564 patients reporting adverse reactions to poison control centers from plants, four died. In six years (1987-1993) there were 11 deaths associated with plants, out of 699 ,232 recorded calls to the poison control centers -- a percentage of 0.00157 percent! Accordingly, it is apparent that deaths associated with the ingestion of plants -- all kinds of plants from toxic houseplants to dietary supplements -- are exceedingly small, at least according to the data reported to the AAPCC. Other interesting statistics from the U.S., France, and the U.K. are also included. The conclusion drawn from the epidemiological data suggest the following: Plant poisonings are not rare; they usually affect very young children; they are generally without serious medical consequences; the potential medical consequences are usually digestive disorders in about half of the cases; fatal outcomes occur in only very few cases. (The author notes that of the 598 deaths by total cases of poisoning in children under the age of 10 reported over a 20 year period in Great Britain, only two of these poisonings were associated with plants.) The relative harmlessness of toxic plants as pr esumed by the epidemiological data is due to the fact that usually only relatively small quantities were ingested in the various incidents. Had larger quantities been consumed, the consequences would have been more serious.

Bruneton devotes several pages to "Risks Associated with Herbal Medicine and Traditional Medicines," including a section of side effects of medicinal plants and the difficulty in assessing such side effects. He asks the following question, which is more than rhetorical: "Is there a particular risk to the increasing popularity of herbal remedies?" Answer: Compared to the scope of the phenomena, the risk associated with the use of plants and plant-based products appears to be very low. Assessing this danger is difficult and cannot be done in a global fashion. However, European phytomedicines are given a relatively clean bill of health: "The nature of the risk is not the same with extract-based pharmaceuticals that have undergone clinical trials and safety testing...and with phytomedicines. The risks differ for whole plants and extracts and depend [on] the route and form of administration."

This book is an important and necessary addition to the library of every herb company, poison control center, plant nursery, and anyone else interested in the issue of the potential toxicity of various ornamental and/or medicinal plants.

Article copyright American Botanical Council.

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By Mark Blumenthal