The delirium is generally extravagant, and also most commonly of the pleasing kind, sometimes accompanied with immoderate uncontrollable laughter, sometimes with constant talking, but occasionally with complete loss of voice, as in the cases of the 150 soldiers. At other times the state of mind resembles somnambulism, as in the instance of a tailor who was poisoned with a belladonna injection, and who for fifteen hours, though speechless and insensible to external objects, went through all the customary operations of his trade with great vivacity, and moved his lips as if in conversation.[[2136]] Sometimes frantic delirium is almost the only symptom of consequence throughout the whole duration of the poisoning. Thus a gentleman at Perigueux in France, who took by mistake a mixture containing a drachm and a half of extract, was attacked in half an hour with delirium, which soon became furious, and continued till next day, when it gradually left him.[[2137]] In others the delirium is attended with a singular and total loss of consciousness, but without coma, as in the following case which occurred not long ago at St. Omer. A young man having taken by mistake an infusion of two drachms of dried leaves, was seized in an hour with great dryness of the mouth and throat, afterwards slight delirium, loss of consciousness, and dilatation of the pupil, next with retention of urine, convulsive twitches of the face and extremities, and incessant tendency to walk up and down. In three hours, after the action of an emetic and a clyster, he lay down, but still in a state of total unconsciousness and muttering delirium. Blood-letting being at last resorted to as a remedy, he speedily recovered his senses, and eventually got well, after suffering for some time from headache, fatigue, and much debility.[[2138]]
The pupil is not only dilated in all cases, but likewise for the most part insensible;[[2139]] and, as in the soldiers at Dresden, the eyeball is sometimes red and prominent. The vision also, as in these soldiers, is generally obscure; sometimes it is lost for a time;[[2140]] and so completely that even the brightest light cannot be distinguished.[[2141]]
The sopor or lethargy, which follows the delirium, occasionally does not supervene for a considerable interval. In a case related by Munnik it did not begin till twelve hours after the poison was taken.[[2142]] Sometimes, as in the same case, the delirium returns when the stupor goes off. A patient of my colleague Dr. Simpson, after using a belladonna suppository consisting of two grains of extract, was attacked with dryness of the throat and delirium, followed soon by drowsiness and stupor; and in five or six hours more, as the stupor wore off, the delirium returned, prompting to constant movements as if she was busy with her toilette and various other ordinary occupations. Sometimes the relation of the delirium to the coma is reversed, as in a case related by Mr. Clayton, where sopor came on first, and delirium ensued in six hours. The dose in this instance was forty grains of the extract.[[2143]] Frequently the stupor is not distinct at any stage.—Even the delirium is not always formed rapidly. A man whose case is described by Sir John Hill did not become giddy for two hours after eating the berries, and the delirium did not appear till five hours later.[[2144]] In Mr. Brumwell’s cases, the delirium was not particularly noticed till the morning after the berries were taken.
Convulsions, it has been already stated, are rare. In the case from the 24th volume of Sedillot’s Journal, the muscles of the face were somewhat convulsed: there is also at times more or less locked-jaw,[[2145]] or subsultus tendinum;[[2146]] and occasionally much abrupt agitation of the extremities.[[2147]] But well-marked convulsions do not appear to be ever present.
The effects now detailed are by no means so quickly dissipated as those of opium. Almost every person who has taken a considerable dose has been ill for a day at least. The case from Sedillot’s Journal lasted three days, delirium having continued twelve hours, the succeeding stupor for nearly two days, and the departure of the stupor being attended with a return of delirium for some hours longer. One of Mr. Brumwell’s patients, too, was delirious for three days; and Plenck has noticed several instances where the delirium was equally tedious.[[2148]] Sage has related a case in which the individual was comatose for thirty hours.[[2149]] Blindness is also a very obstinate symptom, which sometimes remains after the affection of the mind has disappeared. This happened in Plenck’s cases. In two children whose cases have been described in a late French journal, the eyes were insensible to the brightest light for three days.[[2150]] In general, the dilated state of the pupils continues long after the other symptoms have departed. It further appears from an official narrative in Rust’s Journal, that dilated pupil is not the only symptom which may thus continue, but that various nervous affections, such as giddiness, disordered vision, and tremors, may prevail even for three or four weeks.[[2151]]
Hitherto little or no mention has been made of symptoms of irritation from this poison. They are in fact uncommon, and seldom violent. In the cases related by Gaultier de Claubry and by Mr. Brumwell, dryness and soreness of the throat and difficult deglutition were remarked, and appear not unusual. These symptoms were especially noticed by Buchner, who by way of curiosity took half a drachm of seeds digested in beer. The sense of dryness and constriction of the throat were such as to prevent him swallowing even the saliva.[[2152]] Sage’s patient passed blood by stool; and after the symptoms of narcotic poisoning ceased, he had aphthous inflammation in the throat, and swallowing was so difficult as for some time to excite convulsive struggles. Aphthæ in the throat and swelling of the belly also succeeded the delirium in Munnik’s case. Mr. Wibmer alludes to the case of a man who, besides difficult deglutition at the beginning, had violent strangury towards the close.[[2153]] An instance of violent strangury with suppression of urine and bloody micturition is also related by M. Jolly. In the early stage, the patient had redness of the throat and burning along the whole alimentary canal, combined with the customary delirium and loss of consciousness. The symptoms were caused by forty-six grains of the extract given by mistake instead of jalap.[[2154]] Nausea and efforts to vomit are not infrequent at the commencement.
If the accident be taken in time, poisoning with belladonna is rarely fatal; for, as the state first induced is delirium, not sopor, suspicion is soon excited, and emetics may be made to act before a sufficient quantity of the poison has been absorbed to prove fatal. Hence few fatal instances have occurred in recent times. Mr. Wilmer, however, has mentioned two fatal cases occurring in children, and terminating within twenty-four hours.[[2155]] M. Boucher, a writer in the old French Journal of Medicine, has referred to several cases of the same nature;[[2156]] Gmelin has described the particulars of a good example;[[2157]] and many others have been succinctly quoted by Wibmer, chiefly from the older authors.[[2158]]
Cases of poisoning with this plant have occurred in man through other channels besides the stomach. Allusion has already been made to the instance of a tailor who was poisoned by an injection. A small quantity will sometimes suffice when administered in that way. A woman, whose case is mentioned in Rust’s Journal, was attacked with wild delirium, flushed face and glistening eyes, in consequence of receiving, during labour, a clyster, that contained six grains of the common extract;[[2159]] and Dr. Simpson’s patient, who was severely affected, had only two grains.
Perhaps the berry is in some circumstances not very active. A French physician, M. Gigault of Pontcroix, says he has frequently had occasion to treat cases of poisoning with it, as accidents of the kind are extremely common in his neighbourhood; that he never knew it prove fatal; and that in one instance a young man took a pound of the berries before going to bed, and was not subjected to treatment till next morning, when he was found in a state of delirium, but speedily recovered after the free operation of emetics.[[2160]]
Morbid Appearances.—I have hitherto seen but one good account of the appearances after death from poisoning with belladonna. It is described by Gmelin. The subject was a shepherd who died comatose twelve hours after eating the berries. When the body was examined twelve hours after death, putrefaction had begun, so that the belly was swelled, the scrotum and penis distended with fetid serum, the skin covered with dark vesicles, and the brain soft. The blood-vessels of the head were gorged, and the blood every where fluid, and flowing profusely from the mouth, nose, and eyes.[[2161]] In the only other fatal case I have read, where the body was inspected, there appears to have been no unusual appearance at all.[[2162]]