Belladonna (Atropa belladonna).

Botanical name: 

The (1) dried root and the (2) dried leaves and tops of Atropa Belladonna, Linné (Nat. Ord. Solanaceae). Europe and Central Asia; also cultivated. Dose, (1) ¼ to 1 grain; (2) ¼ to 2 grains.
Common Names: Deadly Nightshade, Dwale. (1) Belladonna Root (Belladonnae Radix); (2) Belladonna Leaves (Belladonnae Folia).

Principal Constituents.—The poisonous alkaloids atropine, hyoscyamine, belladonnine, and hyoscine. There is much confusion concerning the constituents of belladonna, hyoscyamine, with conversion products, probably being the chief alkaloid. This is readily convertible in atropine. The alkaloids probably exist as malates.
Preparations.—1. Specific Medicine Belladonna (prepared from the root). Dose, 1/20 to 1 drop. Usual method of administration: Rx Specific Medicine Belladonna, 5-10 drops; Water, 4 fluidounces. Mix. Sig.: One teaspoonful every 1 to 3 hours.
2. Unguentum Belladonnae. Ointment of Belladonna. (This is prepared from the Extract of Belladonna, which in turn is prepared from Belladonna leaves. Tincture of Belladonna is also prepared from the leaves, while the fluidextract is prepared from the root.)

Specific Indications.—Dull expressionless face, with dilated or immobile pupils, dullness of intellect, drowsiness with inability to sleep well whether there is pain or not; impaired capillary circulation either in skin or mucous membranes; dusky, deep-red or bluish face and extremities, the color being effaced by drawing the finger over the parts, the blood slowly returning in the whitish streak so produced; circulation sluggish, with soft, oppressed, and compressible pulse; cold extremities; breathing slow, labored, and imperfect; hebetude; the patient sleeps with eyes partially open; coma; urinal incontinence; free and large passages of limpid urine; fullness and deep aching in loins or back; spasm of the involuntary muscles. In 3x dilution the indications are: Pallid countenance, with frequent urination; nervous excitation, with wild and furious delirium. Large doses: mydriatic.

Action.—The action of Belladonna depends largely upon its chief alkaloid Atropine.

Therapy.—External. Belladonna, and more rarely atropine, may be applied for the relief of pain and spasm, and especially for spasmodic pain. A lotion of belladonna (5 to 10 per cent) may be used to allay itching in general pruritus, eczema, and urticaria. The tincture, painted upon the feet, controls local bromidrosis. A weak lotion is effectual in general hyperhydrosis and in the colliquative sweating of phthisis and other debilitating diseases. The ointment and liniment may serve a similar purpose. This use of belladonna is less desirable, however, than other medication on account of the dryness of the throat and mouth, and the ocular disturbance it is likely to occasion.

Ointment of belladonna and the liniment are extremely useful in local inflammations and swellings, having a wide range of efficiency. Thus they may be applied to painful and swollen joints, forming abscesses, incipient and recurrent boils, buboes, hemorrhoids and fissures, inflamed glands, and in neuralgia, chronic rheumatism, lumbago, myalgia, pleurodynia, the chest pains of pulmonary tuberculosis, and in acute mastitis. In many of the surface conditions mentioned the plaster may prove most effectual. The liniment is especially useful to alleviate cramps in the calf of the leg.

The ointment is effectual in relaxing rigid os during labor, and carried into the urethral canal of male or female it relaxes spasmodic constriction of that canal and cystic spasm and relieves pain. Rubbed on the under surface of the penis it has given marked relief in chordee. A suppository of belladonna relieves spasmodic dysmenorrhea and may be applied either in the vagina or the rectum. A similar application, with or without tannin or geranium, may be inserted into the vagina for painful menstruation, with leucorrhoea. The liniment and the ointment may be used as antigalactagogues and are especially serviceable after weaning the child or when mastitis threatens. All local applications of belladonna should be made with judgment and carefully watched lest poisonous absorption take place. In many of the conditions mentioned the conjoint internal use is advisable—provided the specific indications for the drug are present.

Therapy.—Internal. Belladonna is employed in Eclectic Therapeutics in doses which produce exactly the opposite effects from the gross or physiologic and toxic action. Large doses paralyze; small doses stimulate. While employed for its physiological effects in some instances, the chief use of the drug with us is in conditions showing impairment of the capillary circulation in any part of the body with congestion or tendency to blood stasis. The size of the dose is of great importance in administering belladonna. Ordinary drachm doses of a dilution of 5 to 10 drops of the specific medicine in four ounces of water meet conditions of dullness, hebetude, and congestion, as first pointed out by Scudder. Others claim that the use of infinitesimal doses, of the 3x dilution, acts promptly in conditions of nervous exaltation, with great irritability and impressionability of all the senses; in some cases the hyperaesthesia amounts to delirium and it is then claimed to be most efficient to control both mild and furious outbreaks of delirium. Others again (and this agrees with our personal experience) find marked pallor of the surface, with contracted pupils, the indication, for minute doses of the drug. Following a law which appears to be commonly borne out in therapeutics, that opposite effects are produced by large or by minute doses respectively, belladonna seems a possible therapeutic agent in many varied conditions. The cases, however, in which belladonna appears to have rendered the best service are in those in what might be called medium doses, as advised by Scudder, in which the drug is employed to overcome dullness, hebetude, expressionless countenance, tendency to congestion, dilated pupils, and a dusky redness effaced upon pressure, the blood slowly returning. For specific medication purposes the drug should not be given in doses sufficient to produce mydriasis. At the risk of repetition of some of the conditions and to make the belladonna picture more complete, we quote from a former article in the American Dispensatory (not the version that's online here, sorry. --HeK):

The first and great use for belladonna in specific doses is for congestion. It is a prompt remedy in throbbing congestive headache, or nervo-congestive headache; or a dull, heavy headache with a feeling of drowsiness, as if, were it not for the pain, the patient would drop off to sleep. When a dull, dusky or livid condition of the surface showing capillary feebleness and hebetude is threatened in typhoid fever or in pneumonia, belladonna is of the greatest importance as a stimulant, and in the latter assists in sustaining the respiratory function. While it is a remedy for blood-stasis in any part of the body, due to dilation of the capillaries, it is perhaps more pronounced in its effects when the impairment of the circulation takes place in the nerve centers. It is the first remedy to be used when there is cerebral or medullo-spinal congestion as evidenced by dullness and coma. Though oftenest demanded in acute diseases, it is of equal value in chronic cerebral disorders with dizziness, drowsiness, and dull heavy aching or fullness in the head. When the eye is dull and the pupil dilated, and drowsiness is marked, and there are other signs of congestion that may lead to engorgement of the brain, a threatened attack of apoplexy may be warded off by the timely use of small doses of belladonna.

Belladonna is a remedy for pain and for spasm. It sometimes relieves deep-seated pain, as in facial, intercostal, visceral and sciatic neuralgia. If there is an elevation of temperature, it should be associated with aconite if the circulation is much excited. It is better, however, to relieve spasmodic pain of the involuntary muscles of the tubular organs-spasm of the anus, uterine, cystic, urethral, and other visceral spasms. If any of the parts can be reached it is well to apply the drug locally at the time it is given internally, but care must be had not to overdose the patient. Its value in spasmodic dysmenorrhea, when otherwise specifically indicated, is unquestionably great.

Belladonna is conceded one of the best of our remedies for whooping cough. It will fail here unless otherwise specifically indicated. Spasmodic cough alone does not indicate it; there must be the tendency to congestion and the capillary impairment to make it act beneficially. No remedy, probably, cures pertussis, but many shorten its duration, lengthen the intervals between paroxysms, and render it less severe. Belladonna is one of the best for this purpose. When cough is purely nervous and when due to irritability of the tubular musculature it is an important drug. This is shown in its power to relieve nervous cough from laryngeal irritation and in spasmodic asthma.

Belladonna relaxes spasm. It sometimes overcomes constipation in this manner, has served fairly well in spasmodic constriction of the bowels, and has relieved both pain and spasm in lead colic and spasmodic intestinal colic. When epilepsy is associated with congestive symptoms it has assisted other remedies to lessen the severity and lengthen out the intervals of attack. The same is true in chorea. Little dependence can be placed upon it in puerperal convulsions, a condition for which it has been commended.

Few medicines act better in severe sore throat with redness, rawness, swelling, intense soreness, difficult swallowing, and dryness of the throat, with or without fever. Usually aconite is to be given with it. In such conditions it will promptly do good in tonsillitis, especially of the quinsy type, and in pharyngitis and faucitis. If there is an associated coryza it will relieve it, though it acts more promptly in acute coryza when the throat inflammation is absent and it can be given in slightly larger doses than are required for general specific purposes. Many maintain it valuable in diphtheria and believe that it interferes with the formation of the membranes. We question its value for that purpose, though it certainly helps to sustain the breathing and circulatory powers in a disease threatened from the very start with a depression of these functions. In acute inflammations, such as non-vesicular erysipelas, with deep redness of the skin, capillary impairment, and sense of burning, belladonna should be given with confidence. It acts best where the inflammation is very superficial and does not subsequently extend deeply into the subcutaneous tissues.

The value of belladonna in the exanthemata ranks with the most certain of therapeutic results. It is practically always indicated in scarlet fever and very frequently in measles. Chicken-pox does not so often demand it; while in the congestive stage of small-pox it is claimed to be a most certain aid for many therapeutic purposes. We rely upon it absolutely in scarlatina, and the more malignant the type the more it is indicated. We do not recall a case of scarlet fever in which we have not employed it, and always with the desired effect. Often no other agent has been required. Its use should be begun early. It then brings out the eruption, re-establishes the secretions of the kidneys and bowels, alleviates the distressing throat symptoms, and protects against congestion and subsequent nephritis. The dose must be small, however. If too large it favors congestion. Never more than teaspoonful doses of a dilution of 5 to 10 drops of the specific medicine in four ounces of water should be given every 1 or 2 hours. More often from 2 to 5 drops in the mixture are preferable. It serves much the same purpose in measles, and helps also to control the cough. After the eruption has appeared it is less often demanded in the latter disease, but in scarlet fever it may be needed from start to finish. When one observes the power of belladonna to arouse the patient from a stupid or drowsy state, or even from unconsciousness, or sees it quiet delirium, bring out the eruption, and incite the kidneys to natural action, the power of small doses of powerful medicines becomes convincing even to the most skeptical who believe only in near-toxic or physiological actions of drugs. The action of belladonna in scarlet fever is one of the strong arguments in favor of specific as compared to gross medication. To accomplish desired results without the least danger with a drug capable of great damage constitutes true or specific medication. Belladonna meets many of the complications attending or following scarlet fever, and is probably a preventive of many unpleasant sequelae. While especially a child's remedy it should be cautiously used. We have observed the scarlatinoid rash from very minute doses of belladonna.

Many physicians believe that minute doses of belladonna are prophylactic against scarlet fever. This view is shared by many good therapeutists, among them Scudder, Fyfe, Ellingwood, and many others. Perhaps it is a matter of faith, but we have never had reason to feel it an established fact. Whether true or not, we do believe, however, that an advantage will have been gained by its early administration should an attack of scarlatina ensue, and certainly it can do no harm if given in infinitesimal doses.

Belladonna stimulates and at the same time relieves the irritability of weakened conditions of the kidneys and bladder. Under its influence both watery and solid constituents are increased. It is the remedy for enuresis in small children when the fault depends upon poor pelvic circulation or chronic irritability of the bladder. It is best adapted to diurnal dribbling of urine. When due to a "cold," and there is marked pallor, and dullness of the eye so characteristic in children with enuresis, and the patient voids urine every quarter or half hour, belladonna is promptly helpful.

Belladonna is a remedy of power in acute congestion of the kidneys, and in the early or congestive stage of kidney disorders tending to chronicity. It is indicated by the sense of fullness, weight and dragging in the loins. In the early stage of tubular nephritis, and in scarlatinal nephritis, and in fact in renal capillary engorgement accompanying or following any disease, belladonna is a remedy of first importance.

It is one of the best of remedies for polyuria or so-called diabetes insipidus. A belladonna plaster should be applied while giving the remedy internally. Sometimes quite full doses are required to effect results. Full doses are also required to check the colliquative sweating of phthisis pulmonalis and other debilitating diseases, and its well-known quality of causing dryness of the mouth is taken advantage of in mercurial and other forms of salivation, especially the ptyalism of pregnancy.

Spermatorrhoea, with feeble pelvic and genital circulation, is sometimes better treated by belladonna than any other remedy. In such a state pulsatilla is a valuable aid to the belladonna.

It is sometimes effectual in urticaria, especially when sluggish cutaneous circulation is a prominent feature.

The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.