BELLADONNA
Symptoms.—Taken internally or applied externally, belladonna, Atropa Belladonna (N. O. Solanacea), or its alkaloid atropine, causes dryness of the mouth and throat, with intense thirst. Nausea and vomiting are present in most cases, accompanied with giddiness, double or indistinct vision, active delirium, convulsions, ending in stupor and coma. In the majority of cases an erythematous rash appears on the skin, with elevation of temperature resembling scarlet fever. A very marked characteristic of poisoning by solanaceous plants is dilatation of the pupil, the iris in some cases being reduced to a mere line round the pupil. The symptoms in some cases which have been recorded are almost identical with those of delirium tremens. In other instances there has been little or no delirium, the patient at once passing into fatal lethargy. Alarming symptoms have followed from drinking a decoction of belladonna leaves, which were mistaken and supplied for those of the ash. Accidental poisoning has also frequently occurred among children from their eating the ripe berries of the belladonna plant. Slight symptoms of poisoning are sometimes met with from the use of belladonna plasters to remove the milk from the breasts of women delivered of still-born children, or in cases where the child has died soon after birth. In these cases the patients complain of intense dryness of the mouth, dimness of vision, and itching of the skin. The removal of the plasters will at once arrest the unpleasant symptoms.
In the Gazette des Hôpitaux, July 1859, a case is recorded of poisoning by the outward application of belladonna in the form of the following liniment: Camphorated oil of henbane, ten ounces; extract of belladonna, four scruples. The patient was seriously ill for some days, but ultimately recovered.
Poisoning has also resulted from the use of a solution of atropine (four grains to one ounce) dropped into the eye in the treatment of iritis. (See British Medical Journal, 1876, vol. i.)
Post-mortem Appearances.—Congestion of the vessels of the brain, sometimes with fluid blood, at other times with thick black blood. The stomach may or may not be congested; but in cases where the ripe berries have been taken, the mucous lining may be seen deeply dyed by the juice of the berries. The pupils are usually found dilated.
Fatal Dose.—One teaspoonful of belladonna liniment and one drachm of tincture have proved fatal. Recovery has taken place after half an ounce of liniment and extract. Children are less affected than adults. Of atropine half a grain has proved fatal. Recovery has taken place after five grains of the sulphate.
Fatal Period.—Twelve hours to several days.
Chemical Analysis.—From organic mixtures the alkaloid may be obtained by Stas‘s process, and treated according to Vitali with a little fuming nitric acid, and then dried in a water bath: when cold, it must be moistened with a drop of potassæ dissolved in absolute alcohol. A violet colour changing to red is produced, the violet being characteristic, as strychnia when treated as above gives a red colour. The physiological action on the pupil must also be noted. When the berries are taken, the mucous membrane of the stomach may be found dyed of a purple colour, turned green by alkalies and red by acids. Fragments of the berries may also be found in the stomach.
To a small quantity of solid atropine add a drop or two of strong sulphuric acid, then a crystal of sodium nitrite; a yellow colour is produced, which alcoholic solution of potash changes to reddish-violet and then pale rose.
Free atropine gives a red colour with phenolpthalein; the colour is discharged with alcohol, but reappears on evaporating it.
Gerrard‘s Test.—Mercuric chloride dissolved in alcohol gives a red colour.
Blyth‘s Test.—To the solid alkaloid add strong solution of baryta, evaporate, to dryness, and heat the residue, when the smell of hawthorn blossom is given off.
Wormley‘s Test.—An alcoholic solution of bromine gives a crystalline yellow precipitate.
Treatment.—Wash out the stomach and give hypodermic injections of one-third of a grain of pilocarpine, which is the best antidote. Emetics and purgatives, castor-oil and animal charcoal may be administered. The symptoms as they present themselves must be treated on general principles.
N.B.—Belladonna has been stated to act in antagonism to opium, and its administration recommended in poisoning by that drug.