In the practice of English and American physicians, atropine (atropia) has been hitherto used chiefly as an external application, to dilate the pupil, but, as far as we know, has never been administered internally. In France, the powdered belladonna root has been strongly recommended as affording a reliable and efficient preparation; in this country, the leaves and the extracts and tincture derived from them are alone officinal. Dr. Lusanna, an Italian physician, has ventured upon the internal use of atropia, and, according to our notions, in very large doses. He commences its administration in doses of one-thirtieth of a grain every three or four hours, gradually increasing the dose according to the effect produced. In some instances he went so far as to give one-third of a grain five times a day.
It may be given, according to Dr. L, in solution in alcohol, or in acetic or some other mild acid. Pills and powders, from the difficulty of apportioning the dose he deems unadvisable. The alcoholic solution has a taste somewhat like that of quinine, but feebler, and not particularly disagreeable. The patient soon becomes habituated to the remedy, and the dose has to be increased. In cases of neuralgia he recommends the application of one-fourteenth to one sixth of a grain to a blistered surface, in the form of pomade. Dr. L. carries the administration of atropia so far as to produce what we would call its toxicological effects.
1st. Dilatation and immobility of the pupil. Between fourteen and fifteen minutes after the exhibition of from one-twenty-fourth to one-thirtieth of a grain of atropia, the pupil becomes enormously dilated. If the remedy be persevered in the dilatation passes of, but the iris becomes immoveable, and the pupil no longer contracts on exposure to light. When the remedy is stopped, as the other phenomena produced by its exhibition subside, the pupil again becomes extremely dilated. Previous to this it commences to oscillate, contracting slightly when exposed to strong light, and dilating again in the shade. This indicates that the {126} effects of the remedy are disappearing. The dilatation of the pupil is the last of the phenomena to subside, being sometimes met with eight days, or more after the suspension of the atropia.
2. Disturbance of vision. Objects at first seem hazy and ill-defined, persons are not recognized, and it is impossible to read or write. If the dose be increased, objects seem covered with a dark shade, and vision may be wholly lost. Every fresh dose has a sudden and marked effect in diminishing vision, and on its suspension the disturbance of vision disappears with equal rapidity. In one or two days the sight is perfectly restored.
3. Disturbance of Intellect. At first the patient appears dull and stupid, then there is vertigo and confusion of ideas.
4. Hallucinations of sight and hearing. Objects are seen double or greatly magnified; motes and insects flit before the eyes; well known objects assume strange and monstrous forms, or horrible phantoms are seen. The hearing is more rarely affected. Buzzing, tinkling, hissing and whistling are sometimes heard.
5. Anaesthesia. Touch remains apparently perfect, but pain is relieved or blunted. The patient does not seem to suffer from painful tactile impressions.
6. Dryness of the mouth and throat were invariably felt. At first this seemed a purely nervous phenomenon, but if the medication was continued, from the diminution of the salivary secretion it became real.
7. The appetite is early lost, and there is no thirst; but on the cessation of the remedy it returns sharper than ever. Speech is early embarrassed, and the power of swallowing early diminished, becomes finally lost.
8. Delirium alternating with stupor or succeeded by it, is produced by one-tenth of a grain of atropia at the commencement of the treatment, or by one-fourth of a grain later, or by any sudden increase of the dose. The delirium is commonly gay and ridiculous; in one instance only was it mournful. When these phenomena are at all intense, they subside slowly. For several days after the cessation of the medicine, there is confusion and slowness of thought.