Belladonna. Atropa belladonna.

Synonym—Deadly nightshade.

CONSTITUENTS—

Atropine, Atropamine, Belladonine, Atrosin, Hyoscyamine, Cholin, Asparagin, Chrysatropic and Succinic Acids.

PREPARATIONS—

Atropine Sulphae, Atropine Sulphate. Dose, 1-120 to 1-60 of a grain.

Extractum Belladonnae Foliorum Alcoholicum, Alcoholic Extract of Belladonna Leaves. Dose, one quarter to one-half of a grain.

Tinctura Belladonnae Foliorum, Tincture of Belladonna Leaves. Dose, from one to thirty minims.

Extractum Belladonnae Radicis Fluidum, Fluid Extract of Belladonna Root. Dose, from one to five minims.

Specific Medicine Belladonna. Dose, from one-twentieth to one minim.

Administration—The official fluid preparations in most part of Belladonna vary so much in strength that they cannot be relied upon for activity as compared with each other. Using the product of a single reliable manufacturer one ultimately learns the strength of that product and is thus able to adjust it accurately. The normal tincture of The Merrell Company, the Homeopathic mother tincture, and the specific medicine are all reliable preparations, but vary greatly in comparative strength. The specific medicine is very active, and I would advise that each prescriber dilute a given quantity with four parts of alcohol and prescribe this as a strong tincture. Ten drops of this in a four-ounce mixture given in dram doses will be found uniformly active for children. A good U. S. P. tincture will answer in many cases in drop doses in adults.

Physiologic Influence—In its full primary influence, belladonna is an excitant to the cerebrum, promoting active hyperemia—a profoundly full, active condition of the cerebral capillary circulation. I will show later on that this influence of dilating the capillaries, combined with the stimulating influence of the agent upon the heart, with a characteristic influence in contracting the capillaries of the splanchnic area, makes this the most powerful agent known, in its direct influence upon pathologic hyperemia or a tendency to stagnation in any of the capillaries, whatever organ they may be distributed to. I will also show that this influence can serve as a guide in the prescribing of this remedy in a rational manner, more profoundly than any other influence the remedy exercises.

When given in full doses the fullness of the capillary circulation induced produces a flushing of the face, a bright redness of the skin, which in sufficient dose is general over the entire body. This resembles very closely the erythematous rash of scarlet-fever, and from this fact the Homeopathists have one of their guides in prescribing this agent for that disease. It suppresses the secretions of all the organs, especially of the mucous membranes, inducing dryness of the throat and mouth and a tendency toward constipation.

The evidences of cerebral fullness are: restless excitation, mental exhilaration, headache, dilated pupils, intolerance of light, impairment of vision, uncertainty of muscular movement, the latter finally amounting to incoordination, with motor paralysis. There is delirium of a talkative character, in some, cases violent or furious, with illusions and hallucinations. In extreme delirious excitement, if the dose is a fatal one, there is feeble pulse, cold skin shallow respiration, and paralysis of the inhibitory nerves of the heart and heart-muscle, resulting in death.

In the influence of this remedy upon the capillaries of the skin, loading them up so actively, there is a contributory influence upon the capillaries of the spinal cord, which decreases the amount of blood in this locality, exercising often an exceedingly beneficial influence, especially when the patient suffering from spinal or cerebral congestion has cold skin, cold extremities, a cold, clammy sweat, dilated pupils, and great sluggishness of action. In this case, the remedy is absolutely specific and invariable in its influence.

Belladonna acts directly upon the heart. It is a pure stimulant to this organ, through its influence on the cardiac muscle and accelerator nerves. Previously it was thought that this drug increased arterial pressure. This now is considered doubtful, as positive proof is lacking. Notwithstanding the lack of proof in the laboratory, in the individual there is more force in the pulse, and there is extreme activity, as stated above, in the capillary circulation, especially when there is profound congestion, with cold relaxed skin, difficult breathing from pulmonary hyperemia, with a small compressible pulse and a deathlike pallor, followed, in extreme cases, by cyanosis. Then the stimulating influence of 1/80 or 1/60 of a grain of atropine will show itself unquestionably in a very few moments. This influence is very general. Strychnine expends its influence upon the nerve-centers, but the influence of atropine is upon the peripheries in an unquestionable manner, making it probably the most active of the diffusible stimulants. In this rapidity in removing the blood from the lung-cells it increases oxidation. It thus relieves the pulmonary hyperemia, overcomes cyanosis and promotes free, deep breathing.

Specific Symptomatology—There is a characteristic syndrome present in congestive types of many diseases which rationally indicates the need for belladonna. Preliminary congestion is a common condition in very many diseases and the influence of this drug, in antagonizing congestion and in producing a normal and effective equalization of the circulation brings it first to the mind of those who are studying actual conditions, in an endeavor to decide upon the needed remedy.

The syndrome referred to consists in chilliness, mental dullness, and inactivity; dull eyes with dilated pupils, eyes partly open when asleep; skin cool and relaxed, with occasional free sweating; cool extremities; general sluggish capillary circulation.

The Homeopathists claim that belladonna is especially indicated where the patients are full-blooded; seldom in anemic patients. Children, very active and with big brains, who are disturbed nights by night-terrors or dreams or show other evidences of restlessness are relieved by belladonna. The remedy acts best in full-blooded patients, where there is active localized heat, pain, redness, and swelling, evidences of local inflammation. That is a very common indication—local engorgement. When there are a full, bounding pulse, dull flushed face, dull eyes, dilated pupils, and throbbing carotids, the remedy is beneficial. Negroes, and those in warm climates, are especially susceptible to the action of belladonna.

Belladonna is not a specific fever-remedy, but in a febrile disorder there is some local engorgement somewhere; there is local capillary hyperemia and, if the remedy is not contraindicated by an already too active condition of the capillary circulation, it will be found of service in all acute congestive disorders with temperature. I have made it a practice for thirty-five years to combine this remedy with the directly indicated fever-remedy, until the symptoms of local engorgement were overcome, then to continue with the fever-remedy alone. When so prescribed, the influence of the remedy to restrain secretion need not be considered, as this influence is usually antagonized by the agent that is used to control the temperature. This is especially true of aconite administered in conjunction with it, which makes a most reliable combination.

Therapy—Belladonna is indicated at the onset of inflammatory conditions. Given early with aconite, when fever alone is present, hyperemia does not occur and the inflammation is aborted. If the disease is localized in any organ, displaying the phenomena named above, its influence often is quickly apparent.

In diphtheritis, tonsillitis, croup, bronchitis, pneumonia, pleuritis and peritonitis, belladonna stimulates the capillary circulation in the engorged organs, thus quickly preventing the local effects of the acute congestion or inflammation. At the same time it has a marked influence upon the fever when used in conjunction with the other indicated measures. In chronic soreness of the chest, belladonna is a valuable remedy. It is one of our best remedies in whooping-cough. If half a drop of the tincture of belladonna be given every two hours, alternated with one grain of alum in syrup, excellent results often are obtained.

In the therapeutics of all continued fevers this agent has an essential place in some stage of the fever. In fevers of malarial origin, there is no other remedy that will replace it. In the sthenic stage of these fevers, combined with aconite, it is sufficient for many of the indications. If there is an intermission or a marked remission, it may be continued alone, during the period.

In typhoid fever, it is an important auxiliary during almost the entire duration of the fever. Contraindications may arise, when it must be discontinued. It prevents congestion of the intestinal mucous membrane, and of the glands. This is indeed, an important function. It stimulates the heart to diffuse the blood uniformly throughout the entire capillary circulation, and thus prevents cerebral engorgement. The brain symptoms exhibit many of the belladonna indications and are quickly relieved by it. It may not convince the prescriber of its beneficial influence in only a single case, but its continued use, in many cases, is most convincing, as compared with those in which it is not used.

In meningeal inflammation, both of adults and children, it is often sharply indicated. This is especially true in subacute cases, where there is slowly increasing dullness, with a cold, moist skin, although there is an excess of two or three degrees of temperature. The pupils are dilated widely, the eyes are dull, the head is drawn back and crowded into the pillow, slowly and constantly rotated from side to side, the eyes are partly, if not widely, opened when the patient is asleep, and the urine passes involuntarily. These cases are sometimes exceedingly stubborn. Belladonna or its alkaloid in frequent doses is the most directly indicated remedy.

In the milder forms of insanity or other forms of mental disease, the Homeopathist prescribes belladonna where there is violent delirium, with livid face, dilated pupils, protruding eyes, fury, striking or biting, spitting, inclination to throw off the clothing or tear them, intolerance of light, extreme arterial tension; but he gives in high dilutions.

One physician says that in certain forms of obesity, with plethora and an inclination for general stasis, belladonna will assist in reducing the amount of fat.

Erysipelas will yield promptly to belladonna or atropine in small doses. It is given with aconite or alternated with rhus. It should not be omitted. It acts most promptly if the tissues are smooth, dark, and deep-red, with sluggish circulation and burning, the inflammation being confined to the structure of the integument, and not in the areolar tissues, there being no pustulation or vesicles present.

In eruptive fevers, it is a most essential remedy. It quickly determines the eruption to the skin, and retrocession is almost impossible if it is used early. If retrocession has occurred, belladonna is the most prompt remedy known for restoration of the eruption.

In scarlet-fever, it has a salutary influence also upon the fever. It promotes exfoliation and assists in the general elimination of the products of the disease. It is directly opposed to the renal hyperemia or the nephritis so common as a result of scarlet-fever and diphtheria, and is our most reliable remedy with which to overcome this condition when it occurs. For the nephritis, a drop of the tincture may be given to a child ten years of age every two hours, alternated every hour with 1-2 grain of santonin. If there be a large quantity of albumin present, two grains of gallic acid every two hours will facilitate a cure.

Given in small doses after an infectious exposure and before the occur. rence of scarlet-fever this agent will act as a prophylactic of the disease. The writer has administered the remedy to the other exposed children when a single case has appeared in a large family, none of whom had an attack. It must be given in small doses: ten drops of the tincture of belladonna in four ounces of water, a teaspoonful every two or three hours to a child of six years. Some of our writers have claimed that belladonna is just as effective in preventing the development of diphtheria and measles as it is in preventing scarlet fever. They think they have excellent reasons for this conclusion, and I am inclined to believe with them.

Belladonna is of value in congestive neuralgias. Full doses should be given. It will cure some exceedingly stubborn cases. It is an excellent plan to give it with ammonium chloride in stubborn chronic cases.

In prostrating night sweats, with enfeebled circulation and cool relaxed skin, belladonna or atropine is advised. The 1/100 of a grain of atropine at bedtime will accomplish excellent results. It may be given hypodermically. Medicinal doses of belladonna during the day will accomplish similar results.

In headache from fullness of the circulation of the brain dull frontal headache, with indisposition, malaise, and cool skin, with mental torpor and a tendency to unpleasant dreams, this remedy is of value; 1 to 2 drop every hour or two.

The influence of this drug as an antispasmodic against involuntary muscular action gives it some value in spasmodic colic and obstinate constipation. It is in common use in laxative pills, to facilitate the action of the purgatives. In lead-colic, it is advised.

Belladonna in physiological doses is an excellent remedy for the treatment of the conditions present during the passing of biliary calculi. It very materially facilitates the passage of the stone, prevents chronic change occurring in the structure of the duct, relaxes the duct by a paralyzing effect upon the circular muscular fibers, and renders subsequent attacks less frequent and less severe.

It is a remedy of service in the treatment of nephritis. Albuminuria is the result of greatly increased renal blood pressure and capillary engorgement. Belladonna antagonizes all the pathological processes in a direct manner. In acute cases, its influence is apparent from the first. In subacute or chronic cases, its use must be persisted in, but the results are equally satisfactory where structural change has not taken place in too great a degree. Other indicated measures are not to be neglected.

In incontinence of urine, where there is a plethoric tendency, a stagnant capillary circulation or the tissues are relaxed, belladonna is a prompt remedy. It is useful in diabetes insipidus, with cold extremities. In these cases, it should be given in full doses.

Professor Whitford long advised belladonna for painful menstruation. There is an extreme form of this difficulty, in which the patient becomes very cold; the skin is cold and clammy, the pain is extreme, the hands and feet are icy cold, and the temperature subnormal. Belladonna in full doses to its physiological effect is directly indicated here. The patient can be put into a hot bath, with only good results if this is not overdone, but the equalization of the circulation can be accomplished well with belladonna. Occasionally a hypodermic of atropine will accomplish the results more readily.

By stimulating the capillary circulation in the ovaries this agent is directly useful in the milder forms of congestive dysmenorrhea. The direct indications for the agent are nearly always present in the cool skin, cool extremities, dullness, chilliness, and inactivity. It may be given in drop-doses preceding, during or subsequent to the period.

Its influence in stimulating the capillary circulation of the ovaries in stasis renders it of value in the treatment of sterility from inactivity of those organs. If there are hysterical manifestations at the menstrual epoch, with deficient menstruation, pulsatilla may be used in conjunction with it.

The agent will retard the secretion of milk in the lacteal glands, and is of service when, from the death of the child or from acute inflammation, as in severe mastitis, where abscess is threatened , or from other causes, it is necessary to suppress the secretion. It may be given both internally and applied externally, with good results. Its influence is wide and salutary. When restoration of the secretion is desired, it should be promptly discontinued.

Externally, belladonna is used in spinal tenderness, with congestion, also in congestive occipital headaches and lumbago. It is applied in all conditions inducing a lame back and in neuralgia of the spinal and sacral nerves. In violent acute inflammation, it acts as a sedative and anodyne while it exercises its healing properties. It is used in rheumatism, in sprained and painful joints, and in boils and carbuncles.

The extract of belladonna is used in relaxing a rigid os uteri. An ointment is made and applied directly to the os. In this form, it is of value in spasmodic urethral stricture and in painful congestive conditions of the rectum. A prepared belladonna-plaster may be applied over inflamed. organs while the agent is being given internally.

In the treatment of phlebitis, for which we have very few specific remedies, the late Professor Clark, because of its power in overcoming hyperemia of the venous capillaries and venous walls, claimed that belladonna, in the form of a strong ointment made from the concentrated extract and kept hot, would produce very prompt results. He invariably used it, and claimed to have had no failures. He would watch for the physiological effect—the dryness of the mouth, dilatation of the pupils, and dry throat; he would then remove it for a while, subsequently to reapply it in the same manner.

Atropine.

Atropine is the essential alkaloid of belladonna. It is difficult to obtain entirely free from hyoscyamine.

Description—It occurs as a white crystalline body, usually in minute acicular crystals, or as an amphorous white powder of a bitter, acrid, nauseous taste and odorless. Upon exposure to the air it assumes a yellowish color. It is soluble in 130 parts of water and three parts of alcohol, fifty parts of glycerine and quite freely in ether and chloroform.

Atropine Sulphate.

Description—This salt is perhaps more commonly used in medicine than the unsaturated alkaloid, atropine. It is a white crystalline powder, odorless and permanent. It is freely soluble in water and in alcohol, nearly insoluble in ether and chloroform.

Therapy—The uses of atropine and atropine sulphate are those of belladonna. Their concentrated form greatly increases the violence of their action. Belladonna is preferable for constant daily prescribing. These alkaloids are of much advantage in narcotic poisoning and as stimulants in the recovery of patients from shock. The 1/100 of a grain will produce the physiological symptoms in a healthy patient. This dose is seldom exceeded. From 1/150 to 1/200 is usually sufficient. The 1/50 of a grain is the maximum dose. They are best used hypodermically.

Solutions of atropine for hypodermic use should always be made fresh. Old solutions are to be avoided. The fluid becomes infected, and the alkaloid is partly destroyed.

Atropine is used to dilate the pupil in examination of the interior of the eye, and it is useful in acute inflammation of that organ. It empties the capillaries of an excess of blood, abating the inflammatory processes. It prevents adhesions in iritis, and assists in breaking up any that may have occurred. Two grains of atropine are dissolved in an ounce of distilled water, or better yet, in an ounce of castor oil deprived of its ricinic acid. From one to five drops of these solutions may be instilled into the eye. The oleaginous solution has advantages over the aqueous solution.

Atropine is of superior advantage, used hypodermically, in certain emergencies; in narcotic poisoning, and as a stimulant in the recovery of patients from shock. The 1/100 grain dose will produce the physiological symptoms in a healthy patient. This dose seldom is exceeded, and from 1/200 to 1/150 grain usually is sufficient. The 1/50 of a grain is the maximum dose.

Within recent years, the action of atropine given hypodermically for controlling hemorrhage has gained so many advocates that it has now become established as a most reliable remedy for that purpose. Doctor Waugh was among the first to bring this use of it forward. His arguments have been unanswerable until its position is now fairly established. He clearly demonstrates its rational, reliable influence for this purpose. From 1/50 to 1/100 grain is injected, and the doses repeated as needed. It is exceedingly useful in uterine hemorrhages.

Doctor Paulding, writing in The Medical Council, relates some experiments with the hypodermic injection of atropine in acute alcoholism. There were eleven boys less than 12 years old playing in a freight-yard, where some high wines in barrels were standing on open cars. A barrel was tapped with a gimlet and through a straw all of the boys drank freely of the spirits. Doctor Paulding was called to treat one of them. He observed the extreme dilatation of the pupils. This is the characteristic indication for atropine, determined its use, and he gave a hypodermic of 1/200 grain. This one dose saved the boy's life. The other ten boys died. The doctor reports two other cases where death seemed imminent but which were saved by a single hypodermic injection of 1/100 grain of atropine.

Doctor Shadid dissolves 1/60 of a grain of atropine in 2 ounces of water and gives one teaspoonful every ten minutes until there is relief, in certain headaches which follow prolonged worry, excessive mental exertion, with more or less exhaustion.

In acid stomach, where the hypersecretion of the acids is great, atropine, an occasional dose as needed, has been found to exercise a good influence.

Mild solutions of atropine dropped into the ear will relieve earache.

The use of cactus in subnormal temperatures has strong advocates, but its influence is positively enhanced by combining it with atropine, giving the two in comparatively full doses for a time.

The injection of atropine at the constriction, in case of hernia, or the application of the extract of belladonna over the enlarged hernia, has caused the spontaneous reduction in a number of cases. It is a powerful laxative in spasmodic or other constrictions.

Atropine has been used with excellent advantage in the treatment of seasickness.

Homatropine Hydrobromate.

Formula—C₁₆H₂₁NO₃HBr.

Synonym—Hydrobromate of Homatropine.

Description—In the formation of Homatropine the chemical process consists of the decomposition of the amygdalate of tropine by hydrochloric acid. The Hydrobromate is a crystalline powder or minute white crystals. Soluble in six parts of cold water, sparingly soluble in alcohol.

Therapy—The agent is not advised for internal administration, although in doses of 1/20 of a grain it has been given for excessive night sweats. It is used in the determination of refraction, and in examination, in ophthalmic practice. Its advantage is in its promptness of action as a mydriatic and its transient influence. It is used in the strength of four grains of the salt to an ounce of distilled water. It is in common use for complete paralysis. In this it is necessary to use a stronger solution—two per cent generally. A few drops instilled into the eye and repeated a few times, a few minutes apart, will in a short time accomplish the desired result. The pupil begins to dilate about ten minutes after it is first introduced. The effects are completely dissipated in the course of about thirty-six hours, while atropine retains its influence for, perhaps, ten days, and hyoscyamine for six or eight days.

The main objection to the use of homatropine is the hyperemia of the conjunctiva which follows its use. There is seldom, however, any acute inflammation. It does not so readily produce constitutional effects as atropine if absorbed.

In the treatment of inflammations it is not as serviceable as atropine. Because of the increased engorgement of blood in the part, it increases the condition. A further advantage of atropine over this agent in inflammations is its permanency or persistency of action.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.