BELLADONNA (Atropa belladonna)^ATROP
   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) 1/4 to 1 grain; (2) 1/4 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 countenance¹