Stramonium (Datura spp.).

Botanical name: 

The dried leaves of Datura Stramonium, Linné, or of Datura Tatula, Linné (Nat. Ord. Solanaceae). A common weed everywhere in the United States, especially the latter. Dose, 1 to 2 grains.
Common Names: Jamestown Weed, Jimson Weed, Thornapple.

Principal Constituents.—The chief datura alkaloids are hyoscyamine, and some atropine, and hyoscine. Daturine is probably a mixture of the first two. (See also Hyoscyamus and Belladonna.)
Preparations.—1. Specific Medicine Stramonium. Dose, 1/30 to 5 drops.
2. Unguentum Stramonii, Ointment of Stramonium. Best preparation is that carefully prepared by simmering fresh stramonium leaves with petrolatum, on a water bath, so that burning cannot take place. The official ointment is prepared from extract of stramonium.

Specific Indications.—Cerebral irritation; furious raging and destructive delirium; face deeply congested, red, and bloated; loquaciousness; restlessness and fearfulness; superficial and localized pain; spasms with pain; convulsive cough; purely spasmodic asthma; the opium habit.

Action and Toxicology.—The action of stramonium is closely similar to that of belladonna. If anything, it has a more profound effect upon the sympathetic system and upon the vagus. If the dose be large enough it will disturb the rhythm of the heart action and induce delirium, exerting these effects more readily and more powerfully than does belladonna. Stramonium is probably the most violent deliriant of the solanaceae. Its alkaloid daturine is closely akin to, if not identical with, hyoscyamine. American manufacturers are now utilizing stramonium for the preparation of atropine from daturine, and during the year 1917 of the great World War this source practically prevented an atropine famine in the American drug markets.

Therapy.—External. Fomentations of stramonium leaves, or the bruised fresh leaves may be applied to inflamed and painful parts to reduce swelling and relieve pain. In this manner it is often useful in mammitis, orchitis, swollen joints, and painful external hemorrhoids. An ointment of stramonium, carefully prepared without burning it, is an excellent application for painful and engorged piles, or as the ointment basis for other agents to be used for the same purpose. It is also soothing in cutaneous hypertrophy around the anus with intolerable itching and sometimes semipurulent secretion. It is rendered more effective by incorporating with it 5 to 10 per cent of salicylic acid. Stramonium leaves, alone, or with tobacco, lobelia, grindelia, and nitrate of potassium are universally employed as an "asthma powder". It is used by igniting the powder and inhaling the vapors, or by smoking it in a pipe or in the form of cigarettes. It is among the most prompt of measures for the temporary relief of the paroxysms of purely spasmodic asthma.

Internal. The specific indications for stramonium are those indicating impaired innervation. The face is red and bloated and of a deeper congestive appearance than that for belladonna; there is continual talking and the patient is uneasy, cannot rest well in any position, and is possessed of an ungrounded fear. There may or may not be furious, enraged, or destructive delirium. Localized and superficial pain, or spasm with pain, is experienced. It is also indicated by convulsive cough, and purely spasmodic asthmatic attacks. When the dyspnea is dependent upon respiratory or cardiac lesions it is less useful. In all stramonium cases there is cerebral irritation—causing most often violent excitability or less frequently depressive irritability. The dose, therefore, should be governed accordingly; medium doses for the former, minute doses for the latter. In no instances are the full physiologic doses necessary except in the cure of the opium habit, when the drug may be pushed to the full limit of endurance. It remains to be seen whether permanent damage may be done to the intellectual faculties from such dosage, as is the case with atropine.

In medicinal doses stramonium is an anodyne antispasmodic, without causing constipation or lessening of the excretion of urine, and will prove serviceable in many instances where opium cannot be given. Unlike hyoscyamus it does not readily produce sleep, but if sleep results from its administration, it is generally due to the fact that the stramonium alleviates the pain, or allays the nervous irritability upon which the insomnia depends. It is quite remarkable that a plant so closely allied to belladonna chemically should be so different in some of its therapeutical effects, and particularly in regard to alleviating pain. Thus for deep-seated pain, as of neuralgia, it is far less effective than belladonna, but for superficial neuralgia, and especially when locally applied, it is more effective than the former. It illustrates well the fallacy of claiming certain effects from a medicine because of the known physiological action of the drug—the therapeutical effects often being widely at variance. Bartholow well expressed the situation and unconsciously forecast collodial therapy when he observed: "Identity of chemical constitution does not always mean identity in physiological action and in therapeutic power. Differences in molecular arrangement, not appreciable by chemical analysis, may influence to a great extent mode of action".

Stramonium is useful for the relief of pain, but less so in general than belladonna. When pain is due to irritability, as in enteralgia, gastritis, and enteritis, neuralgic dysmenorrhea, spasmodic intestinal pain, tic douloureux, sciatica, and the pains of chronic rheumatism, it is useful but does not compare with either belladonna or hyoscyamus, either of which are incapable of subduing severe pain. Stramonium serves well, however, in headache, with dizziness and hyperacidity of the stomach, and in gastric headache when associated with nervous erethism and unsteadiness.

Like hyoscyamus, stramonium meets two classes of nervous and mental disorders—the mentally excited, with furious delirium and motor-excitability; and the depression of nervous debility. The first requires medium doses; the last the small dose. In the acute delirium of acute mania it quiets the violent, boisterous and angry patient bent upon destruction of everything and everybody, including himself. Equally effective is it in the quieter and busy delirium of acute fevers. It finds a use in delirium tremens, nymphomania, in epilepsy followed by maniacal excitement, in hysterical mania with alternate fits of weeping and laughter, and in globus hystericus.

Stramonium has been revived in recent years as a remedy to assist in breaking away from the opium habit, and considerable success has attended its use. This is now possible since the nature of the alkaloidal contents of this and the allied solanaceous drugs are better understood. Many years ago Locke advised the following formula: Rx Specific Medicine Stramonium, ½ fluidounce; Tincture of Cardamom, 3 ½ fluidounces. Mix. Sig.: Begin with ten drop doses and increase as may be necessary.

Stramonium is invaluable in convulsive forms of cough and should have wider recognition for this purpose, in which it is fully equal to hyoscyamus. It is the best agent we have used to control whooping cough where the paroxysms are severe and bleeding from the mouth or nose occurs. As a general cough medicine it is better and safer than opium, because it does not restrain the excretions. Like atropine it is useful in hemoptysis brought on by fits of coughing or during spasms.

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