Preparations: Alcoholic Extract of Belladonna Leaves.
- Fluid Extract of Belladonna Root.
- Tincture of Belladonna Leaves
- Belladonna Ointment
- Belladonna Liniment
- Juice of Belladonna
- Belladonna Plaster - Compound Plaster of Belladonna
- Pills of Aloin, Strychnine, and Belladonna
- Pills of Podophyllum, Belladonna, and Capsicum
Related entries: Atropina (U. S. P.)—Atropine - Atropinae Sulphas (U. S. P.)—Atropine Sulphate - Duboisia.—Duboisia - Hyoscyamus (U. S. P.)—Hyoscyamus - Stramonium.—Stramonium
I. BELLADONNAE FOLIA (U. S. P.), Belladonna Leaves.—"The leaves of Atropa Belladonna, Linné"—(U. S. P.).
II. BELLADONNAE RADIX (U. S. P.), Belladonna Root.—"The root of Atropa Belladonna, Linné"—(U. S. P.).
COMMON NAMES: Deadly nightshade, Dwale, Black cherry.
ILLUSTRATION: Bentley an Trimen, Med. Plants, p. 193.
Botanical Source.—Atropa Belladonna is a perennial herb, with a thick, branched, fleshy, creeping root, and annual, erect, round, dichotomously branched, leafy, slightly downy stems, about 3 feet high. The leaves are lateral, mostly two together, of unequal size, ovate, acute, entire, soft, of a dull-green color, smooth and borne on short petioles. The flowers are imperfectly axillary, solitary, stalked, large, drooping, dark, dull-purple in the border, paler downward. The calyx is green, 5-parted, permanent, and nearly equal. The corolla is campanulate, with a short tube, and limb divided into 5, shallow, nearly equal segments. Stamens 5; filaments nearly as long as the corolla tube; anthers cordate and 4-lobed; stigma capitate and 2-lobed. The fruit is a 2-celled, many-seeded berry, subtended by the enlarged calyx; it contains reniform seeds (L.—Smith). When bruised the whole plant exhales a fetid odor.
History.—This plant is common to Europe, growing among ruins and in waste places, blossoming from May to August, and maturing its berries in September. It is also found as far east as Central Asia. It is often found growing in woodlands, and especially in the woods of high elevations, as of mountains. It is cultivated to some extent in this country, in France, and in Britain. The whole plant possesses poisonous properties. The leaves must be gathered while the plant is in flower. The British Pharmacopoeia directs the leaves (gathered at the beginning of the fruiting season and separated from the stems, and dried with care) of the wild or cultivated plants growing in Britain. The British or imported dried German root is directed under Belladonnae Radix. Leaves in as fresh a state as possible should be employed, as the older leaves are said to absorb moisture, causing decomposition of the active constituents, with the liberation of ammonia. The stems should be rejected, also musty leaves, if the herb is desired for the preparation of the alkaloids, or if a full-strength preparation is desired. The leaves yield their virtues readily to alcohol and water. The root should be taken up in the spring or late autumn from plants at least three years old. In the recent state it is pulpy and juicy.
Description.—The U. S. P. demands belladonna leaves and root conforming to the following description:
BELLADONNAE FOLIA (U. S. P.), Belladonna Leaves.—"Leaves from 10 to 15) Cm. (4 to 6 inches) long, from 5 to 10 Cm. (2 to 4 inches) broad, broadly ovate, equilaterally narrowed into a petiole, tapering at the apex, entire on the margin, smooth, thin, the upper surface brownish-green, the lower surface grayish-green, both surfaces whitish punctate; odor slight; taste bitterish, disagreeable"—(U. S. P.).
BELLADONNAE RADIX (U. S. P.), Belladonna Root.—"In cylindrical, somewhat tapering, longitudinally-wrinkled pieces, 10 to 25 Mm. (2/5 to 1 inch) or more in thickness; externally brownish-gray, internally whitish; fracture nearly smooth and mealy, not radiating or showing medullary rays in the thicker roots, only in the layer near the bark; nearly inodorous; taste sweetish, afterward bitterish, and strongly acrid. Roots which are tough and woody, breaking with a splintery fracture, should be rejected; likewise the hollow stem-bases which are sometimes present"—(U. S. P.).
The following excellent descriptions, with illustrations, are kindly allowed for publication by the firm of Johnson & Johnson, being extracts from the monograph on belladonna, edited by Dr. F. B. Kilmer:
BELLADONNA LEAVES.—Macroscopically: "Belladonna leaves are of two sizes, the larger about 1 1/2 d. m. long, the smaller being about one-half this size. They are brownish-green upon the upper surface and gray-green below, broadly ovate or ovate-long, narrowed into a petiole; apex acute or acuminate; margin entire, the petioles and nerves of the underside of the leaf particularly are downy, hairy, and glandulous. Both surfaces of the leaf possess trichomes, numerous cells are apparent, filled with crystal-like contents, giving the leaf the peculiar spotted appearance it possesses. The leaf is membranaceous, odor narcotic, and taste bitter and disagreeable.
Microscopically: "The epidermal cells, on making a surface section, appear undulating. On the under surface the stomata are more numerous, near to which arise trichomes, which tend to cover and protect the stomata by preventing too great evaporation and so assist the work of transpiration. The hairs are of three kinds: (a) Simple-jointed cells; (b) short, glandular cells, with one or more (3 to 4) celled apex; (c) hairs with long stalks and a spherical-celled apex. In the mesophyll are cells containing an innumerable number of granule-like or crystal-like bodies.
Belladonna Leaves of the Market: "As found in the market, belladonna leaves, especially the finer grades, when crumpled or broken up, look very much like the mints, but are easily distinguished from them by the narcotic odor and disagreeably bitter taste. They also resemble somewhat the narcotic herbs, stramonium and hyoscyamus, but from these may be easily distinguished.
"Belladonna leaves, compared to the other official leaves of the Solanaceae, are comparatively smooth and the margin is entire. The upper surface is darker than the lower surface. The undeveloped fruit, a calyx with an unripe berry, is often present.
"Stramonium leaves are dark-green and not quite so smooth as belladonna, the hairs shorter, with a many-celled apex, and in the mesophyll are numerous cells containing large, single crystals of calcium oxalate. The perforations and cork formations in the leaves are numerous. The base of the leaf is unequal and does not taper into a petiole. The fruit is a capsule, and very often a few reniform seeds will be found present.
"Hyoscyamus leaves are furnished with long hairs, which tend to become tangled and matted, so giving the leaf a hairy appearance. There is an absence of petiole and a presence of stem-stalks. The fruit is a pyxis enclosed in an urn-shaped calyx. The seeds are much smaller than stramonium.
"Solanum nigrum leaves are much smaller than belladonna, with a repand dentate margin (Wigand).
BELLADONNA ROOT.—Macroscopic characters. "The root of belladonna is a fleshy, spindle-shaped, primary root. When fresh it is about 5 decimeters long, and about 5 centimeters in diameter. It then possesses a number of stout branches, the remnants of which are sometimes seen attached to pieces of commercial root. The bark contains the largest amount of alkaloid, therefore roots are selected by careful buyers which possess the larger portion of bark compared to the woody portion. Young roots of but 2 or 3 years are preferred. Chemical analysis shows that the amount of alkaloid in roots collected about the time of flowering is twice as much as in spring, so roots should be collected about the flowering and fruiting season, carefully dried and preserved.
The commercial root, to hasten the drying, is invariably split into smaller pieces. It occurs in rough, irregular pieces, from a few inches in length to 6, 8, or even 12 and 15 inches, varying in diameter according as the root is split. Externally, it is longitudinally wrinkled, of a pale-brown, or grayish color; internally, brownish, or whitish; odor heavy and licorice-like; taste peculiar, characteristic, sweet at first, and afterward acrid or bitter. The fracture may be mealy, born-like, or woody, and from these characters may be distinguished 3 commercial varieties:
1. Mealy Belladonna.—"Is lighter externally and internally than the other two, and on cross-section it is of a nearly uniform, dirty-white appearance. The bark is about 1/7 of the cross-section. At the periphery of the fundamental tissue of the pith are yellowish, vascular bundles scattered apparently indiscriminately. These finally disappear beyond the cambium. Starch is present throughout all the cells of the wood and bark, which is colored blue by iodine. In spring and autumn roots the starch is present in the largest amount.
2. Horn-like Belladonna.—"Is very dark. On cross-section it looks brownish and waxy, or horn-like. The bark is separated by an indistinct cambium from the woody portion, of which the fibro-vascular bundles are arranged in single groups, and separated from each other by one or more broad bands of a horn-like tissue (keratrenchym). In the tissues of both the wood and bark occur numerous cells filled with crystal-like contents, appearing to the eye as white spots. This variety looks more like inula root, and is much smaller generally than the other two. The starch grains are replaced by a dark, resinous material.
3. Woody Belladonna.—"This form possesses characters between the other two. The color is more of a light-brown or gray. In cross-section the bark resembles the horn-like variety. Inside of the cambium ring is found a prominent radiating, woody zone, with the largest duct in the very center. The wood bundles have prominent, yellow ducts, and are separated by equally prominent, broad medullary rays. This variety is generally figured in text-books. Starch grains are not so numerous as in the mealy variety, still they are abundant.
Microscopically.—The cork consists of thin layer of cells, next to which is arranged the cortex. In the latter are numerous cells filled with crystal-like particles, called by Wigand krystallmehl, and by Moeller krystallsand. These are very common characteristics in both the roots and the leaves of belladonna. The sieve tubes are scarcely perceptible in the bark of young roots, but later are formed in groups more or less wedge-shaped like the wood bundles. These sieve tubes show a beautiful sieve plate in longitudinal section. Stone cells are wanting. As regards the bast in belladonna authors disagree. Wigand (4th ed., 1887) mentions the presence of bast. Prof. Schrenck announced in the American Druggist (1887, p. 2) that he had detected bast cells in belladonna root, but found it necessary to remove the starch and stain the cells. The writer examined a mount made by Prof. Schrenck from the belladonna root of commerce (October 16, 1886) mounted in glycerin jelly, and stained apparently with phloroglucin, and readily made out, bast cells. Upon further investigation he found it unnecessary to use clearing and staining agents to discover them. The ducts are provided with elliptical pores. The wood bundles are surrounded by wood parenchyma (colored yellow by potassium hydroxide solution), the bundles separated from each other by radially broad, medullary rays. Both the wood and bast parenchyma contain starch. The starch grains are of medium size, in shape round, irregular or hemispherical, or even 2 or 3-sided; single and sometimes compounded of 2 or 4 starch grains. Some of the grains possess a distinct cross-cleft or a stone-like nucleus; in others, however, the stratifications are scarcely apparent. With sulphuric acid alone large numbers of prismatic crystals are produced. With sulphuric acid and bichromate of potassium a greenish coloration is immediately produced, remaining sometimes 24 hours or more" (Kilmer, in Belladonna).
Chemical Composition.—The chief and most interesting constituent of belladonna is the alkaloid atropine (C17H23NO3) (see Atropina), first obtained in crystalline condition from the root by Mein and from the herb by Geiger and Hesse (Pharmacographia). On the history and constituents of this plant Dr. Kilmer, the editor of "Belladonna" (Johnson & Johnson), offers the following data herewith:
"Galen is the first author who refers unquestionably to the mydriatic action of two species of Solanaceae. Dr. Ray, in 1686, reported the case of a lady who had placed a belladonna leaf upon a small ulcer beneath the eye and afterwards was annoyed by an excessive dilatation of the pupil. Evers independently, in 1773, discovered the mydriatic power of belladonna. These writers were followed by Davies (1775) and Loder (1796). After this the specific action of belladonna, upon the eye became generally accepted. Runge, in 1819, approximately isolated the alkaloid of hyoscyamus and called it koromegyn (meaning magnifier of pupil). In 1830 the apothecary Mein isolated the alkaloid atropine from the root. Independently Geiger and Hesse, in 1832, isolated the crystallized alkaloid from the herb, while Liebig, in 1833, determined its chemical formula"—(Belladonna).
The main constituents of belladonna are as follows: Atropine (C17H23NO3) (see Atropina). Hyoscyamine (C17H23NO3), sometimes the principal constituent of belladonna root. It is convertible into atropine by heat; conversion also takes place in the plant itself. Atropamine (C17H21NO2) is identical with the apoatropine obtained by Pesci, in 1882, by the action of nitric acid upon atropine (O. Hesse, 1893). It is convertible into belladonnine by the action of HCl or KOH. Belladonnine (C17H21NO2) (Hübschmann) is an amorphous alkaloid, and is obtainable from hyoscyamine or atropine by heating these alkaloids from 120° to 130° C. (248° to 266° F) for several hours. By raising the temperature gradually, transformation takes place with products resulting in the following order: Hyoscyamine, atropine, atropamine, and belladonnine. Ɣ Hyoscine (Cl7H17NO4), discovered by Ladenburg in Hyoscyamus niger, occurs in belladonna root in small amounts (Schuette, 1892). O. Hesse, in 1893, showed its identity with scopolamine, an alkaloid obtained from the root of Scopolia atropoides, B. and P. (S. carniolica, for which E. Schmidt, in 1892, had found the formula, C17H21NO4. Earlier analyses show the presence in belladonna of chrysatropic acid (Kunz), the concentrated solutions of which show green and blue fluorescence, atrosin, a red-coloring principle in the root (Hübschmann), succinic acid in the herb, malates, and oxalates, combined with sodium, potassium and magnesium salts, gum, wax, asparagin, chlorophyll (in the leaves), starch, and albuminous bodies.
The Production of Atropine in the Plant.—"Messrs. Schering, in 1888, stated that belladonna roots contain practically only hyoscyamine, and that atropine was a decomposition product produced during the process of manufacture. Drs. Will and Schmidt (1887) proved that the mere contact of an alkali with hyoscyamine was sufficient to produce this change. Dr. Schuette (Arch. der Pharm., 1891, p. 492) found that the same result is produced by repeated crystallization from acidulated water. He also investigated the influence that age and period of vegetation exerted upon alkaloids in the roots, leaves, and berries. He found that fresh roots (1 to 2 years old), collected from a basaltic district, whether gathered in the spring, summer, or autumn, contained only hyoscyamine, but. the older roots (8 years and upwards) always contained, besides much hyoscyamine, a little already-formed atropine. Similar results were obtained with roots from old cultivated plants that had been kept for several years. Spring and autumn leaves of belladonna contained principally hyoscyamine, with equal quantities of ready-formed atropine. The unripe berries of the wild plant contained chiefly hyoscyamine and a little atropine, but the ripe fruit contained only atropine. The ripe berries of cultivated plants, however, yielded both hyoscyamine and atropine. His investigations upon other members of the Solanaceae indicated that hyoscyamine is the primary base from which other alkaloidal products may be formed"—(Belladonna).
Conclusions.—"Regarding the time of collecting and variation of alkaloid in the plant, investigators have drawn the following conclusions:
"The first year's growth of belladonna contains but one-half the quantity of atropine present in older plants, and so are unworthy of collection. Young roots contain only hyoscyamine. The older roots contain both hyoscyamine and atropine, the latter predominating. In young leaves atropine is present, but hyoscyamine is the predominating alkaloid. The length of keeping after gathering appears to have no influence on the alkaloid present (Maisch). From the second to the fourth year the quantity of alkaloid is fairly uniform. At these ages, and during the period of flowering, the plants should be collected. The plant before flowering, is not rich in active principle, but at the period of flowering the full development is reached and maintained, both in roots and leaves (Gerrard). Wild-grown belladonna contains a larger quantity of alkaloid than the cultivated kind. The process of flowering and leafing does not exhaust the root of its alkaloid, there being a simultaneous development in the root and leaf; therefore the roots may be gathered at the same time as the leaf.
"Gerrard's analysis of the freshly -gathered plant shows the highest percentage of alkaloid in the leaves; following them the root, fruit, and stem, and the wild plant contains the largest amounts of alkaloids. Later investigators, however, have shown that the root will show a much higher average. The results of analysis of the commercial dry root and leaf of belladonna indicate that the roots yield a much higher percentage of alkaloid than the leaves (.82 per cent has been found). A chalky soil favors the formation of atropine, which may account, to some extent, for the superiority of the English leaf. Belladonna leaves in pressed packages several years old do not show evidence of loss of alkaloids (Lyons). Both the root and leaf of belladonna show great variations in strength, and, as has been said, appearance alone is not a sufficient criterion as to the relative value of one lot as compared with another. The peculiar acid and acrid taste of belladonna, which is more apparent as the sense of taste is cultivated, together with general physical characters already described, are fair indications to an expert of the value of a sample of belladonna. Chemical analysis is, however, the only certain and reliable test as to the full value"—(Kilmer, in Belladonna).
Action and Toxicology.—Belladonna is an energetic, narcotic poison. While fatal to carnivorous animals and to man, the same doses have but relatively little effect upon fowls and herbivora. Dogs, however, stand relatively large amounts of this drug and its alkaloid. Children are often poisoned by the berries, mistaking them for cherries. In large doses, according to Pereira, it acts upon the cerebro-spinal system, as manifested by the symptoms, "dilatation of the pupils (mydriasis), presbyopia, or long-sightedness with obscurity of vision, or absolute blindness (amaurosis), visual illusions (phantasms), suffused eyes, occasionally disturbance of hearing (as ringing in the ears, etc.), numbness of the face, confusion of head, giddiness, and delirium. The mouth and throat become dry, with difficulty of deglutition and articulation, constriction about the throat, nausea, vomiting, swelling, and redness of the face, and sometimes irritation of the urinary organs, or an exanthematous eruption." If the dose be very large, the above-named symptoms will be produced, but in a more violent form, with extravagant delirium, followed by sopor. Convulsions are rarely present; when it causes death it is commonly by coma. The effects of belladonna and atropine are practically identical. Therefore, for further remarks concerning the action of this drug, see ATROPINAE SULPHAS.
The proper remedies in poisoning by belladonna are the stomach-pump, emetics and purgatives, cold to the head; and in the comatose stage, ammonia internally, with external stimulants, electro-magnetism, etc. (C.) Belladonna and opium appear to exert antagonistic influences, especially as regards their action on the brain, the spinal cord, and heart; they have consequently been recommended and employed as antidotes to each other in cases of poisoning; this matter is now positively and satisfactorily settled; hence in all cases of poisoning by belladonna the great remedy is morphine, and its use may be guided by the degree of pupillary contraction it occasions. Bouchardat and Suiz Rioya recommend iodine as an antidote, even when the symptoms of poisoning with belladonna are of long duration; the compound solution of iodine may be given for this purpose.
Medical Uses and Dosage.—Therapeutically employed belladonna exerts precisely opposite effects from those of its toxic doses. Large doses paralyze, small doses stimulate, the nervous system. Belladonna, as chiefly used in our school, is selected in conditions in which there is impairment of the capillary circulation in any part of the body, with congestion.
Dr. J. Harley, from a series of experiments instituted by himself, was led to consider belladonna: 1. As a direct and powerful stimulant to the sympathetic nervous system, or to the heart, being superior to all agents in its simple, direct, immediate, and powerful influence in exalting the force and rapidity of the heart's action, and therefore useful in cases where there is a depression of the sympathetic nervous influence, as in syncope from asthenia or shock; in the collapse of cholera; in failure of the heart's action from chloroform, or other cardiac paralyzers. 2. As a diuretic in cases of suppression of urine, whether accompanied by uremic symptoms or not. He has likewise found it efficient in acute nephritis, in which it calms the nervous irritation, and at the same time contracts the dilated blood-vessels; in chronic albuminuria, in which it stimulates the kidneys to healthy action, and diminishes the albumen gradually. He also considers it useful in rheumatic fever and in the uric and lactic acid diathesis. According to Prof. Brown-Sequard belladonna diminishes the blood in the spinal cord, and hence diminishes the vital properties of it and its nerves; dilates the pupil, causes the secretion of milk to cease; is useful in strangulated hernia, nocturnal incontinence of urine, etc. It has a depressant influence upon the pneumogastric nerve, excites the sympathetic, depresses the cerebro-spinal system, touches the secretions, and is slightly aperient. It imparts tone to most involuntary muscles, causes wakefulness, restlessness, is a powerful excitant of the blood-vessels, and in large doses causes delirium; it is useful in external neuralgia, in congestive headache, and coma, with contracted pupil, in paraplegia, with symptoms of. irritation of the motor, sensitive and vaso-motor or nutritive nerve-fibers of the spinal cord, or of the roots of its nerves, as in spinal congestion, meningitis, myelitis, etc. It is a dangerous agent in paraplegia, without symptoms of irritation, as in cases of white softening, or of the reflex paraplegia.
Prof. J. M. Scudder, who based his investigations upon the experiments of Brown-Sequard, and to whom we are indebted for the chief indications for the use of belladonna, employed it to relieve congestion of the nerve-centers, in which malady he considered it a specific wherever there is an enfeebled circulation in the cerebro-spinal centers, as manifested by enfeebled innervation, sluggish circulation, tendency to coma, and to congestion of internal organs, a soft, oppressed pulse, dilated pupils, pasty, soft skin, coldness of the extremities, and involuntary micturition, acting by causing contraction of the blood-vessels of the spinal cord and the capillary blood-vessels, and which action may be effected by stimulation through the sympathetic nervous system. He adds from 5 to 10 minims of specific belladonna to 4 fluid ounces of water, of which the dose is a fluid drachm every 1, 2, or 3 hours, according to the symptoms and influence of the agent (see Diseases of Children). In doses large enough to dilate the pupil it exerts an opposite influence, and then becomes useless as a remedy, and fails to produce its specific action. The indications for this agent as a specific are a full, oppressed pulse, tendency to congestion, diminished heat of parts distant from the heart, a labored, slow, and imperfect respiration, expressionless countenance, dullness, hebetude, sleeping with the eyes partly open, drowsiness, dilated or immobile pupil, and coma. A deep color pervades the skin—a duskiness often—which, when the finger is drawn over it, is effaced, leaving a persistent, white streak, the blood very slowly returning. This is one of its best indications in the severer exanthemata. Involuntary urination and copious passages of limpid urine are also indications for its use; also deep aching in loins or back, with a feeling of fullness. When much pain is present, it may be combined with specific aconite. We employ minute doses of belladonna with confidence in congestive disorders. Throbbing, congestive, or nervo-congestive headaches are quickly relieved by it; or it may be a dull, heavy headache, with a drowsy feeling, as if, were it not for the pain, the patient would drop off to sleep. While it is a remedy for blood stasis, due to dilated capillaries in any part, its operation is perhaps more pronounced in impairment of circulation in the nerve-centers. In cerebral or spinal congestion, as evidenced by dullness and coma, it is the first remedy to be selected. In chronic brain diseases, with dizziness, drowsiness, and dull, heavy aching, with a sense of fullness in the head, its effects are pronounced, and when the dull eye, with dilated pupil and drowsiness, are present in threatened apoplexy this remedy should be selected.
Perhaps with no remedy is the size of dose so important as with belladonna. For the above-mentioned conditions and those similar to follow the proportions above mentioned are preferred. Webster, however, calls attention to the fact that the 3 x dilution (flℨss to flℨj; aqua, fl℥iv. Teaspoonful every two or three hours) serves better in certain nervous disorders. The condition in which he uses belladonna in these attenuated doses is in "nervous exaltation-great irritability and impressionableness of all the senses." Such a condition accompanying spasmodic disorders—chorea and epilepsy—indicates it, while in febrile disorders, where the "hyperaesthesia of the senses amounts to delirium," he declares it the remedy. According to this author, wild and furious delirium is met by the attenuations; dullness and hebetude by the larger doses above-mentioned, keeping within the bounds indicated by Prof Scudder.
Belladonna is one of the most important remedies for bladder and kidney diseases. It stimulates and at the same time relieves irritation of the urinary tract. Both the solid and watery constituents of the urine are increased in amount. It is the remedy in urinal incontinence in small children when the fault depends upon a poor pelvic circulation or chronic irritability of the bladder (Locke). Should the latter condition result from rectal ascarides santonine will correct the trouble. It seems best adapted to that dribbling of urine in the young, which occurs chiefly during the day. We have seen marked benefit from minute doses of belladonna in children who urinate every twenty minutes or half hour, marked pallor of countenance and dullness of eye being present, and the condition evidently depending upon "a cold." Diabetes insipidus is well treated by applying a belladonna plaster and administering the drug internally. It is the remedy in the congestive and early stages of kidney disease, with a sense of fullness, weight, and dragging in the loins. Tubular nephritis (early stage), scarlatinal nephritis, and all cases of renal capillary engorgement are promptly benefited by belladonna. Belladonna is well known to cause dryness of the mouth, and in full doses it checks salivation, especially in that salivary overactivity accompanying pregnancy. Full doses likewise check the exhaustive sweating of phthisis and other debilitating diseases. Its good effects in this direction, however, are overbalanced by the dry condition of the mouth and fauces produced.
Belladonna is a remedy for pain and for spasm. Certain forms of neuralgia, particularly trigeminal neuralgia, are relieved by ordinary doses of belladonna. Intercostal, visceral, and sciatic neuralgias are sometimes amenable to it. If there be excitation of the circulation and increase of temperature aconite should be given with it. It overcomes spasm of the involuntary, but is less effectual in spasm of the voluntary, muscles. Spasm of the anus, biliary spasm, uterine, cystic, intestinal and urethral spasms, and spasm of the ureters are relieved by it. Such of these parts as can be reached should be treated locally with the extract. It is a remedy for spasmodic asthma, whooping-cough, and nervous cough from laryngeal irritation. In whooping-cough it is usually indicated in the latter stage, where it lessens the severity of the paroxysms and increases the intervals between them (Locke). Obstinate constipation, spasmodic colic, lead colic, spasmodic constriction of the intestines, and spasmodic dysmenorrhoea are conditions often met with belladonna. It is often serviceable in chorea and in epilepsy, with congestion. It is also recommended in infantile convulsions of an epileptiform character. Hay fever is said to be palliated by belladonna, and its influence is good in spermatorrhoea, with enfeebled pelvic circulation. It is useful, but less valuable than morphine, in puerperal convulsions. In various forms of sore throat belladonna is an important remedy. In non-diphtheritic faucial inflammation, with redness, swelling, soreness, difficult deglutition, with dryness of the throat and more or less fever, it should be administered in alternation with aconite every half hour. If given early it often greatly benefits in diphtheria, interfering with the formation of the membrane. In non-vesicular erysipelas, with burning and deep redness of the skin, where the subcutaneous tissues are not much involved, it is an efficient remedy.
Perhaps in no class of diseases has the action of belladonna been appreciated more than in the exanthemata. That it is a prophylactic, in minute doses, against scarlatina has long been maintained. On the other hand this view has been vehemently assailed. Whether true or not, and testimony is mainly in its favor, it certainly can do no harm, and if scarlet fever supervenes an advantage will have been gained in its early administration. In both scarlet fever and measles it is nearly always indicated, and its effects are certain and prompt. The more congestive the form the more satisfactory the effects from this remedy. It awakens the little patient from his stupid or drowsy state, or even from unconsciousness, quiets delirium, and favors the eruption and renal activity. Undoubtedly it also possesses some power over the poison producing the disease. Urticaria and erythema are often relieved by it, an it is a remedy in all febrile states tending to congestion. It is particularly a child's remedy, but must be cautiously used. We have observed the scarlatinoid rash from very minute doses of specific belladonna.
Belladonna is valued in the complications attending or following scarlatina. It readily relieves these troubles and tends to prevent sequelae. Small doses of the specific medicine should be administered every hour.
The antagonism of belladonna and opium now seems well established, both physiologically and clinically. It is therefore, like atropine, used as an antidote to opium and morphine narcosis, as well as for the toxic action of physostigma and its alkaloid, eserine Here it must not be used to over-stimulation, for its narcotic effects are to be avoided. Small and oft-repeated doses of belladonna (or atropine hypodermatically) should be given until respiration becomes stronger, the pulse more forcible, and pupillary dilatation begins. Here the action should be maintained until the danger is past.
Externally it was formerly applied in extract to the parts around the eye, to dilate the pupil, before operating for cataract, in iridectomy, to relieve internal ocular pressure in ulceration of the cornea, and also in iritis to prevent adhesions. For these purposes a drop or two of an aqueous solution of the extract is sometimes placed upon the conjunctiva. The sulphate of atropine has now superseded the use of the extract. Both locally and internally belladonna is a prompt agent for the relief of photophobia. The ointment, or extract, has also been applied locally In spasmodic stricture of the urethra, and of the sphincters of the bladder and rectum, in great pain along the female urethra, in strangulated hernia, spasmodic contraction of the uterus, hemorrhoids, etc. Belladonna plasters, or the extract with vaseline, are applied to relieve pain in forming abscesses, recurrent boils, neuralgia, and lumbago, with gratifying results. No remedy is of more value to check the secretion of the mammary gland when prompt action is desired. One part of the specific may be added to 3 parts of glycerin, and the breast painted with it once or twice a day. Care should be had to see that the surface is unbroken or constitutional effects will be produced. A belladonna plaster over the heart relieves pain in that organ. The following has been recommended in neuralgia of the uterus: Mix together 1 1/2 grain of alcoholic extract of belladonna and 3/4 of a grain of opium. Place the two extracts in the center of a little pledget of carded cotton, and fold it up so as to inclose the extract; tie it up with a very strong thread, and leave a double thread 8 inches long attached to it. The plug is to be introduced into the vagina by the physician or patient, and placed upon the neck of the uterus, where it is to be retained from 12 to 24 hours. In very painful menstruation, accompanied by leucorrhoea, from 8 to 15 grains of tannic acid, or extract of geranium, may be added to the tampon.
Belladonna is said to retard schirrous growths, and when applied to cancerous tumors it relieves pain. It is a remedy for local or external inflammation, acute mastitis, inflammatory glandular swelling, sympathetic buboes, gouty and rheumatic inflammations, etc. Apply the belladonna plaster.
Dose of the powdered leaves, 1 to 2 grains once or twice a day, and gradually increased till the peculiar effects of the medicine are produced; of the extract, 1/4 of a grain to 1 grain; tincture of belladonna, 1 to 7 minims; fluid extract of belladonna, 1 to 2 minims; specific belladonna, gtt. v to x; to aqua, ℥iv. Teaspoonful every 1 to 3 hours for congestive states and general uses; for nervous disorders, with furious delirium, specific belladonna (3 x dilution), ℨss to ℨi; to aqua, fl℥v. A teaspoonful every 2 or 3 hours.
Specific Indications and Uses.—Dull, expressionless face, dilated or immobile pupils, dullness of intellect, impaired capillary circulation of skin or internal organs; drowsiness, with inability to sleep on account of pain; cold extremities, dusky, bluish face and extremities; skin soft, doughy, or pasty; circulation sluggish, with soft, full, oppressed, and compressible pulse; slow, labored, and imperfect breathing; sleeping with eyes partially open; hebetude; coma; urinal incontinence; copious passages of limpid urine; deep aching in loins or back, with sense of fullness. The remedy for congestion, with dilated capillaries; a deep redness of the skin, effaced by the finger, leaving a white streak, the blood slowly returning to the part; spasm of the involuntary muscles. In 3 x attenuation the remedy for nervous excitation, with wild and furious delirium; also in pallid countenance, with frequent urination.
Related Species and Adulterants.—I. Adulterations or Admixtures of Root: "JAPANESE BELLADONNA (Scopolia Japonica, Maximowicz) is a rhizome from 5 to 10 d. m. in length, and on an average 1 d. m. in diameter, cylindrical, slightly compressed, rarely branched or knotty; on the upper surface marked by circular, slightly alternate stem-scars. Externally brown, internally paler, speckled with numerous white dots; odor mousy and narcotic.
"SCOPOLIA CARNIOLICA, Jacquin, is obtained from Bavaria, Austro-Hungary, and Southwestern Russia. The genus Scopolia is interesting, as it forms a connecting link between hyoscyamus and atropa. Scopolia is a rhizome and resembles the genus atropa in containing peculiar, crystal-like contents; but they are less prominent. Neither the bark nor the fibrovascular bundles are so large or so numerous. The starch grains are likewise smaller. There is a close alliance in the anatomy of these two plants, but all of the important characters are less pronounced than in belladonna. Belladonna scopolia is also a rhizome, and, like Japanese belladonna, maybe distinguished from true belladonna, which is a root. Where a preparation claims to represent the Pharmacopoeia, which explicitly calls for the use of true belladonna, this drug should not be used. Messrs. W. H. Cole & Co., drug merchants, London, make the statement that "Scopolia carniolica is always picked and rejected as useless by makers of atropine."
ELECAMPANE (Inula Helenium, Linné) is the root of Inula. This root possesses resin cells, the taste is aromatic, and it is stained yellow by iodine—being free from starch.
MEDICAGO ROOT (Medicago sativa, Linné) has been noticed as an adulterant in Europe. It is distinguished from belladonna by a solid crown; the bark is thinner, and the meditullium is tough and woody and traversed by numerous fine medullary rays.
MARSHMALLOW (Althaea officinalis, Linné) is said to be used as an adulterant for belladonna. It resembles the young uncut root. It is easily distinguished by its radiating wood, numerous bast fibres and mucilage. Holmes noted that belladonna root of the market had been found to contain as high as 50 per cent marshmallow root. It has been stated that some time ago the herbalists in Madrid offered for sale as belladonna a plant which was not belladonna, nor even belonging to the order Solanaceae. It was called in the Madrid market "Belladonna Silvistre de la casco, de campo ares botanica cucubalus" (A. P. A., Vol. 21).
LAPPA (Arctium Lappa, Linné) root is sometimes admixed with belladonna. It is distinguished by its peculiar pith, its distinct radiating bark and being colored yellow by iodine and blue by ferric chloride" (Kilmer, in Belladonna).
Mullein, foxglove and henbane leaves are said to be occasionally present as admixtures.
Scopolia carniolica (Hyoscyamus Scopolia, Linné) Jacquin and Scopolia Japonica, Maximowicz. The first of these plants has been shown to contain the principal constituents of belladonna, namely: Atropine, hyoscyamine, hyoscine (scopolamine); furthermore choline and a fluorescent body, scopoletin (E. Schmidt), and has been used in this country for the production of atropine and in the preparation of belladonna plasters. The identity of scopolamine (scopoleïne) (C17H21NO4) and hyoscine is above alluded to (see Belladonna constituents). Boiling with baryta water decomposes scopoleïne into atropic acid (C9H8O2) and crystalline scopoline (C8H13NO2), which E. Schmidt believes to be identical with methyl-aesculin. The alkaloid scopoline may be synthetically combined with organic acids to form a series of compounds called scopoleines, of which scopolamine is a member (compare Tropëines under Atropina). Scopoline is declared a more powerful mydriatic than atropine, causing dilatation sooner and lasting longer than that from the latter body. Internally, according to Sir Dyce Duckworth, it fails to affect the pupil and does not, like belladonna, produce dryness of the throat. Mr. Gordon Sharp (Brit. Med. Journ.) states that his personal experience leads him to believe that scopolamine, hyoscine, daturine and duboisine differ but little in effects from atropine (E. M. J., 284, 1896). The drug needs further study.
Atropa Mandragora, Linné (Mandragora officinalis, Miller; Mandragora vernalis, Brotero) and Mandragora autumnalis are Southern European stemless plants known as Mandrake, or Mandragora. Their roots, which are seldom seen in America, are sharp, bitter and narcotic. The root of Atropa Mandragora is spindle-shaped, and often divided below into two or three forks so as to somewhat resemble the human shape. On this account animal sensations were attributed to it by the ancients, who also fabulously declared that when torn from the earth it uttered shrieks like those of a human in distress. Dr. T. H. Silvester (1848), according to Lindley, was the first in recent years to call attention to the fact that it was formerly used like chloroform and other anaesthetics now are, so that operations might be painlessly performed. Dioscorides describes the use of wine of mandragora before actual cautery and even amputation, and that a suppository of the juice and also emanations from the fruit were employed to induce sleep. A vulgar superstition attributed the power of promoting fecundity to amulets made of it. Botanically and therapeutically mandragora is related to belladonna. It contains two mydriatic alkaloids—one of which, called mandragorine (C17H23NO3) is isomeric with atropine (Crouzel). This is without odor or color, and is deliquescent. Alkalies do not convert it into atropine. Mandragora and its alkaloids are not used in this country.