Atropa belladonna. Deadly Nightshade. N.O. Solanaceae. Tincture of the whole plant.
BELLADONNA owes its properties to the alkaloids it contains; they are atropine, hyoscyamine and scopolamine (hyoscine), which are present in varying proportions in different specimens of the plant. Atropine is the predominant alkaloid, and , as there is a great similarity in the physiological action of all three, the provings and poisonings of belladonna and atropine have been taken together to construct the pathogenetic schema of the drug. The phenomena caused by atropine are more exclusively on the nervous system, while belladonna adds to them a certain amount of tissue irritation. Atropine is broken up by the action of alkalis into tropine and tropic acid, and various compounds have been made with the former of these substances, the principal being homatropine, which is so largely used in ophthalmic practice as a mydriatic.
Small toxic doses of belladonna cause congestion of blood to the head and face, with throbbing or bursting feelings, and a sensation of heat, giddiness and confusion; the eyes are bright and staring, the conjunctivae injected, vision is disturbed, especially for near objects, accommodation is difficult and the pupils become dilated.
The lips mouth, tongue and throat are very dry, the papillae of the tongue are elongated and red, there is thirst, but drinking does not relieve the dryness, and swallowing is difficult and painful. Pain shoots up into the ear on swallowing and the tonsils are pharynx are swollen and of a bright red colour. There are hoarseness, dryness and painfulness of the larynx. Nausea and often vomiting come on, the pulse becomes rapid, the breathing quickened and deepened, and the skin, especially that of the head and neck and upper part of the body, is hot, dry and covered with a smooth, red rash.
With the congestion to the brain, the mind is excited and exhilarated, and the patient becomes garrulous and restless, and inclined to use extravagant language, gesticulations and mimetic actions. There may be frequent desire to pass water, which is voided spasmodically and guttatim.
When larger doses are taken these symptoms become accentuated and pass into a further stage; ability to swallow is abolished, speech becomes very difficult, the pupils are so dilated that the iris almost disappears, accommodation is completely paralysed and diplopia often occurs, while all effectual vision is lost and replaced by brilliant photopsies and hallucinations. Restlessness and garrulity give place to active delirium, in which the patient wants at first to be in constant motion, he is furious, bites, strikes at people, sees cockroaches, dogs, hideous faces, or other fantastic objects, tears things to pieces and tears off clothing (not to expose his person as in hyoscyamus but in anxiety to flee away). This active stage passes into depression and then into coma. Tremors of the muscles occur and eventually convulsions come on, which may cause death through failure of the respiration; or, if this does not happen, the respiration and the pulse become slower, weaker and more irregular and the patient dies in asphyxia (without convulsion).
The physiological action of belladonna which brings about the above conditions is essentially a stimulation of the central nervous system followed by depression. The part which is most affected is the brain, rather than the cord, and, in the brain, the higher centres as well as the medulla oblongata. But belladonna has also an important action on the peripheral nerves, as it paralyses their terminations in the secretory organs, and is unstriped muscle, with the important exception of the muscular fibres of the arteries and arterioles, which are on the contrary stimulated through the action of belladonna on the vasomotor centre. Thus the secretion of saliva is abolished through paralysis of the terminal fibres of the chorda tympani, that of the gastric juice is diminished or arrested through paralysis of the secretory fibres of the pneumogastric in the stomach and the skin becomes dry, due to paralysis of the terminations of the nerves that regulate the secretion of the sweat glands. In the same way the glands of the mouth, throat and bronchial mucous membrane have their secretion inhibited by a local depression of the terminal nerves that normally excite secretion of mucus on these mucous surfaces.
The paralysis of the terminal fibres of the nerves controlling unstriped muscle fibre is seen in that, after the injection of atropine, stimulation of the pneumogastric does not cause contraction of the bronchial muscles, the unstriped muscles of the oesophagus cease to act, and so cause inability to swallow, and the inhibitory terminations of the vagus in the heart are paralysed. In this last instance, as the accelerator nerves of the heart are unaffected, the pulse is quickened, and, since the action of atropine on the central nervous system is primarily a stimulating one, the vasomotor centre is excited and the blood pressure raised. There are increased duration of the systole of the heart, and diminution of the diastole with augmentation of its output for each minute. Likewise, through stimulation of the respiratory centre, breathing becomes quicker and deeper and the amount of air inspired per minute is increased. The terminations of the motor oculi in the iris are paralysed, so leaving the dilating fibres of the sympathetic unopposed, with resulting dilatation of the pupil, and paralysis of the ends of the same nerve in the ciliary muscle causes loss of the power of accommodation.
A similar action on the nerves to the unstriped muscle of the bladder leads to paralysis of that organ, though belladonna also seems at first to exert an irritating influence on it.
The movements of the stomach and intestines, of the uterus and of the thoracic duct are believed to be depressed by atropine. The terminations of the sensory nerves are also paralysed or depressed by its purely local action. Anaesthesia does not occur from internal administration but only from local application. A small proportion of the alkaloids in belladonna are excreted in the urine but most undergoes complete oxidation in the tissues. Belladonna congests and inflames skin and mucous membrane, causing redness, heat, swelling and pain. It is also able to produce genuine fever, with a rise of temperature amounting to four or even five degrees.
Post-mortems in cases of fatal poisoning showed great congestion of the brain, especially of the base and the medulla oblongata, with considerable serous effusion. The lungs were congested. Other organs showed no material change.
Belladonna has been employed in medicine in doses sufficient large to utilize its physiological properties in order to arrest or lessen secretion, ex. gr. to stop salivation, and to lessen the sweats of phthisis. It has also been used to relax spasm of involuntary muscles, such as spasm of the intestines in hernia or volvulus, of the ureter in the passage of calculus, of the bile-ducts in cases of gall-stone colic, and of the bronchial muscles in spasmodic asthma. It has been used to paralyse the cardiac inhibiting terminations of the vagus, in some forms of bradycardia and intermittent pulse, but chiefly in these cases as a diagnostic measure to differentiate functional disorders from the more serious cardiac troubles that arise from disease of the auriculo-ventricular bundle. Its principal employment, however, has been in ophthalmic practice to paralyse the iris in order to obtain dilatation of the pupil to prevent adhesions in cases of iritis, and to paralyse the accommodation to facilitate examination in cases of errors of refraction, For this latter purpose homatropine is preferable in most cases as, though it does not abolish accommodation so thoroughly as atropine, it is more quickly recovered from. Great care must be exercised in the local application of atropine of homatropine to the eye, when there is any increase of ocular tension, as these substances increase the tension, and may bring on an attack of glaucoma. Belladonna is also used as liniment, ointment or plaster locally to the skin to relieve pain. It has been employed in doses of considerable size for nocturnal enuresis and for epilepsy.
HOMOEOPATHIC USES.-The above are diseases in which belladonna has been employed in order to obtain the advantage of its direct physiological action. Its use homoeopathically open up a much wider field.
Nervous System.-As will be inferred from its pathological action, the diseased states in which it has been found most valuable are those where the brain shows symptoms of hyperaemia and excitement, where the circulation is stimulated and where certain secretions are suppressed. In short, the symptoms described above as resulting from small and afterwards from large doses should be,in greater or less degree, present in the illness. Belladonna is not a remedy that acts deeply or has a long-lasting effect, nor does it effect permanent changes in the tissues; it is a short but violently acting drug, causing turmoil of the circulation and general excitement of the central nervous system. The symptoms caused by it proceed in most cases from the brain, as there is the centre of its action. Accordingly the delirium of belladonna cases is a furious delirium, the patient bites and strikes the attendants, tears everything to pieces, is constantly talking and laughing insanely, or springing out of bed trying to escape; there are heat of the head and face, and wild, protruding eyes. This is the kind of delirium that would indicate the remedy in fevers, such as typhus (?), pneumonia, puerperal sepsis, erysipelas, or the first stage of meningitis. Also, in less severe conditions, without delirium but with considerable mental excitement and heat in the head and face, such as might occur with a tonsillitis or even a catarrh, belladonna will be equally useful. The mental symptoms are all active, never passive. The “acute mania with redness of face and heat of head,” found in cases of poisoning, is rare clinically, but in the violent delirium of acute infections the drug may be very useful.
The headaches for which belladonna is suitable are those where the face is red and hot, the pulse bounding, the head throbbing, the pains burning or shooting, and mainly in the front part of the head; there is often a feeling of expansion outwards, or a stabbing from one temple to the other. The headache is worse from lying down flat, stooping, noise, light, odours, motion, any jar or touch, or from cold; it is better from sitting upright, perfect stillness, strong pressure, and wrapping the head up warmly and tightly. The scalp is exceedingly sensitive, so that even the weight of the “done up” hair causes pain and the patient lets it hand down. This kind of headache may be the result of concussion or reflex from the uterus or ovary, it may be caused from catching cold, from having the hair cut, or from exposure to the rays of the sun. Vertigo is often present, worse on stooping, rising, or any change of position.
The eye affections calling for belladonna are those inflammations that come on suddenly with great redness and swelling of the conjunctivae, and pain and intolerance of light. The eyes feel dry, as if sand is in them and the lids are stiff and heavy. There are bright flashes of light, and often a halo, usually of red colour, around artificial light. It is not necessary that the pupils should be dilated to render this drug a suitable remedy in eye affections. It is useful in iritis and retinitis when other symptoms agree.
Ears.-Belladonna is suitable for acute otitis in the early stage and is indicated by acute, tearing pain, intolerance of noise and by ringing and roaring in the ears.
Nasal.-Symptoms referable to the nose, indicating this remedy, are great sensitiveness of smell, shining redness of the tip of the nose, frequent sneezing and nose-bleeding (acon., bry.) with congestion of the head.
Digestive System.-It is a remedy for inflammations of the first part of the alimentary canal-of the gums, palate, great thirst which drinking does not relieve, by dryness of the mouth and a red, dry tongue, the papillae of which are elongated, producing the so-called “strawberry tongue,” by scarlet redness of the fauces and pharynx, and by great difficulty in swallowing, which is very painful. The tonsils are red and swollen, especially the right; and the whole throat is red and shining. The constant efforts to swallow set up spasms which almost choke the patient. The cervical glands become suddenly inflamed. For acute sore throats of this description, for the early stage of quinsy and the sore throat of scarlet fever, belladonna is a notable medicine.
Toothache in the right upper teeth, worse at night and from cold air, and nervous prosopalgia, with cutting pains and the same modalities, are cured by belladonna (puls.)
It is not much used as a stomach medicine, but has been employed for gastritis with violent vomiting (an indication for it in measles), when there is great desire for lemons and lemonade.
It is one of the first remedies to be thought of in inflammations of the peritoneal covering of the abdominal viscera. The abdomen is distended, painful, and very sensitive to touch or the least jar. It feels pungently hot to the hand. The pains are clutching and come in spasms. It thus is a remedy when peritonitis is threatening or is recent, in such conditions as appendicitis, hepatitis, metritis, and puerperal peritonitis, and during the period awaiting operation for them, or in such accidents as volvulus, strangulated hernia and intussusception. The abdominal pains are better from bending forwards slightly, and worse from bending backwards and strongly forwards, as either of these positions increases pressure on the inflamed parts. The stools are usually green mucus (arg. nit., merc., puls., sulph.), but they may contain lumps like chalk; there is much spasmodic constriction of the sphincter ani and some tenesmus. It has been found useful in dysentery in children when these characteristics have been present. The patient gets red in the face when straining.
In the urinary sphere there may be paralysis of the vesical sphincter with involuntary escape of urine, which would be an indication for its used in enuresis, or there may be paralysis of the bladder with retention when there is generally frequent desire, but the urine can escape only drop by drop on account of mingled paresis of the sphincter and painful spasm of the walls.
Sexual Organs.-Belladonna has scarcely a place in the treatment of diseases of the male sexual organs, but is of great value in those of the female, especially for dysmenorrhoea in strong plethoric girls, when the menses are premature and profuse, and consist of bright red blood intermingled with clots, and are badly smelling. The pain is severe, of a constricting character, is felt more towards the right side and comes in spasms. The flow, which follows each spasm, comes in gushes. There is present also a forcing down as if the pelvic contents would protrude at the vulva, which is worse in the morning (lil. tig., nat. mur., plat., sep.). The uterine region is sensitive to the least jar or sudden movement, and the patient cannot bear the legs to be stretched straight out as that position increases the pressure of the abdominal walls on the underlying organs. In parturition belladonna will promote delivery when there is a rigid os uteri, and it is very useful after delivery for haemorrhage of bright red blood that comes in gushes and feels hot to the patient. It is a remedy to be used when the lochia are offensive or suppressed. It has also been used spread on plaster to suppress the milk when it is desired to wean the child, but in this case it acts merely by affording support to the breasts, and adhesive plaster would have the same effect. “The secretion of milk is not materially changed by atropine, whether the alkaloid is carried to it by the blood or is applied locally.” (Cushny, “Pharmacology,” eight edition, pp. 340. 352.)
Respiratory System.-Belladonna causes dryness, hoarseness and congestion of the larynx, and is most cough is dry, short and barking, it started by a tickling or feeling of dust in the larynx, it comes in paroxysms with intervals of rest, and is quieted for a time by the expulsion of a small pellet of mucus. The larynx is painful to pressure, and the cough is worse from lying down. It will often disturb the patient just as he is going to sleep, or will awake him from sleep. The larynx is sore, there is hoarseness of voice, the the voice changes its key.
It has been found a good remedy for acute pleurisy in the early stage before effusion has taken place, and is indicated by a sharp pain from breathing or movement, that is worse from lying on the affected side (bry. the reverse).
Spinal Symptoms.-Belladonna is a medicine to be thought of for irritability of the spine due to congestion of the spinal nerves. There are cuttings as from knives in the bones of the spine, which are aggravated by pressure on them, also lumbago pains which come on suddenly and shoot down over the hips into the thighs and legs. The hyperaemia of the spine causing these symptoms is often associated with inco-ordination, but, as there is no organic lesion of the cord produced by belladonna, this symptom is only transitory and must not be taken as warranting the use of the drug and locomotor ataxia.
In the extremities are various shooting and pressive pains and a sensation of stretching and twisting. There are also tearing and swelling in the joints, with redness and great sensitiveness to motion or jar. The joint pains are relieved by hot applications, and the patient cannot bear them to be uncovered. These are the local indications for the employment of belladonna in rheumatic fever.
It is a valuable remedy in convulsions, especially those occurring in children. The convulsions indicating it are those which occur suddenly with head troubles and cerebral irritation, they are symptomatic, as in the teething or worm affections of children, and do not arise from deep-seated causes. It is unsuitable for convulsions arising from brain tumours or permanent organic lesion; it avails for epileptiform convulsions rather than for true epilepsy.
Sleep, &c.-Belladonna is indicated for irritability of the nervous centres, shown by jerkings and startings of the limbs, especially when they occur on dropping off to sleep or wake the patient out of sleep, also for twitchings of the facial muscles, which may or may not be associated with neuralgia. Sleep is restless, interrupted by the above-mentioned jerkings and by anxious dreams of fire or murder, from which the patient awakes frightened, or talks or moans in his sleep. He may be sleepy and yet unable to sleep. The feet are cold and the sleeplessness is from hyperaemia of the brain. Anything that will draw blood away from the brain will promote sleep in belladonna cases.
The skin, when this drug is required is red, hot, dry and shining; there is dermographia. This state of skin is an indication for it in scarlet fever and erysipelas, in both of which it has been much commended. The coincident throat and tongue symptoms of scarlet fever make belladonna very homoeopathic to that disease, and it has found favour not only in the treatment of the attack but as a prophylactic. In erysipelas it is suitable for the cases where the skin is smooth, tense and shining and very sensitive to touch. It there are vesicles, rhus tox. is called for Belladonna is useful to abort commencing boils and pustules when the surrounding skin is red and sensitive.
Cellular Tissue.-Early stages of cellulitis, e.g., whitlow.
The fevers demanding belladonna are those in which there is much cerebral hyperaemia, which are sudden in their onset, are sthenic and not long continued, but are a concomitant of local inflammations, of chills or other causes of sudden disturbance of the circulation. They are violent while they last, are frequently accompanied with delirium and there is nearly always thirst.
Belladonna poisoning presents many of the symptoms of exophthalmic goitre, such as the protruding eyes, the rapid pulse and the tremors, and it has been sometimes successfully employed for these symptoms, but it would be mainly suitable for the sympathetic enlargement of the thyroid in puberty or during pregnancy. The more severe cases of exophthalmic goitre require a deeper acting remedy.
(1) Congestions and inflammations of a violent and intense character.
(2) Pains and symptoms come and go suddenly and are violent.
(3) Tendency to delirium of an active violent kind; hallucinations, fears of imaginary things (“a black dog”) with desire to escape.
(4) Tendency to twitchings, jerkings and convulsions (teething in children).
(5) Burning fever and rapid pulse, which is strong and bounding; early stages of inflammations.
(6) Hot, red face and head (with cold feet); after exposure to sun.
(7) Dryness and heat of the skin and mucous membranes.
(8) Hypersensitiveness to all impressions, draughts, noises, pressure, &c.
(9) Great thirst not relieved by drinking.
(10) Aggravation of symptoms in the afternoon and till after midnight.
(11) Predominance of affections on the right side.
(12) Symptoms are worse in a horizontal position (especially head).
(13) Wide awake at night, or sleepy but cannot sleep.
(14) Plethoric lymphatic constitutions. Young, full blooded people; children and women of delicate light complexion and hair.
(15) Symptoms pass from above downwards.
(16) Tendency to rapid formation of pus in external inflammations.
From lying down; stooping or bending backwards or forwards (the vertical position is the best), from noise, light, touch, pressure, lying on the affected side, effort, movement, jars, draughts, cold air and cold applications, having the hair cut, drinking, at 3 p.m. and onwards till after midnight. Though cold aggravates, exposure to direct sunlight does not same (e.g., headache).
From sitting still and upright, warm applications and wraps.