Atropa belladonna. Deadly Nightshade. N.O. Solanaceae. Tincture of the whole plant.
INTRODUCTION
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.
PATHOGENESIS.
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.
THERAPEUTICS.
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.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,