Temperature

In poisoning it is characteristic that the temperature may rise several degrees. The author saw a case with a temperature of 106o F. (41.1° C). According to Ott, this is due to the absence of sweating, for no rise of temperature takes place in animals, such as dogs, which do not sweat, and are therefore not dependent upon sweating as a means of lowering temperature. Others think it is an effect upon the heat-regulating centers. (See Cocaine.)

Elimination

A considerable portion of the drug is oxidized, the remainder being eliminated rapidly by the kidneys. It is said to disappear from the body inside of thirty-six hours, but the prolonged effect on the eye indicates that some is retained in that location.

Urinary Organs

The effect from therapeutic doses on the amount of urine is uncertain and unimportant; but in poisoning, both suppression and retention are reported. As the urine is a weak solution of atropine, it will exert a remote local action in the urinary tract to lessen pain and spasm. In poisoning, the urine, concentrated by boiling, will dilate the pupil of an animal's eye; hence this may be employed as a test for the poison.

Fig. 51. - General eruption following application of a belladonna plaster (W. S.

Gottheil in Archives of Diagnosis).

Tolerance

To a certain degree tolerance may be set up in man by gradual increase in the dosage, so that as much as 1/2 grain (0.03 gm.) may be borne without ill effects. Children can take proportionally large doses; in fact, a child of eight may be given the same dose as an adult. I have seen a man of forty-five more affected by doses of 10 minims (0.60 c.c.) of the tincture of belladonna than was his son of eight by the same amount. Among subhuman mammals it is found that the carnivora are especially susceptible to the drug, while the herbivora are markedly resistant. A cat, for instance, is readily poisoned, while a horse or a rabbit may feed on belladonna leaves with comparative impunity, though their flesh becomes poisonous to the carnivora. Successive litters of healthy rabbits have been reared entirely on belladonna and stramonium leaves, and Calmus found that it took about 15 grains (actually 0.972 gm.) of atropine to kill a small rabbit. In rabbit's serum Doblin and Fleishmann have found a ferment which annuls the toxic action of atropine.

Toxicology

In practice, the dilated pupil, the dry throat, and mild cerebral symptoms are the regular warnings of overdosage. In full poisoning there is a stage of central stimulation followed by collapse. In this stage of stimulation the skin is warm and dry; the face and neck are flushed, either uniformly or in blotches, to resemble the skin of scarlet fever; the pupils are widely dilated, and accommodation paralyzed, so that vision is disordered; the throat is very dry and red, and there is a feeling of constriction, so that swallowing, even of water, is difficult, though the patient may be thirsty; the breath is foul; the pulse is rapid, with arterial pressure above normal; respiration is rapid and deep; the patient is wide-awake, excitable, restless, and loquacious or overcheerful, and may pass into a chattering delirium with confused ideas, or even into a condition resembling mania. The temperature may rise several degrees. The concentrated urine dropped in a cat's eye, two drops every five minutes, will dilate the pupil. Belladonna poisoning has been mistaken for scarlet fever and for acute mania; with the latter diagnosis patients have been confined in asylums for the insane.

Following this stage of stimulation comes collapse, with heart very feeble, blood-pressure low, respiration slow and shallow, etc. The warm, dry skin may change to a cold, clammy one, and death take place from failure of respiration.

A single dose of 1/100 grain (0.0006 gm.) of atropine sulphate will in some patients cause dryness of the throat and dilated pupil; 1/56 grain (0.0012 gm.) has produced the delirium, \ grain (0.03 gm.) has proved fatal, and 3 grains (0.2 gm.) have been recovered from. Poisonous symptoms have followed the use of atropine in the eye.

Atropine may remain in the dead body for a long time unchanged. This is of importance from a medicolegal point of view, for the atropine may be mistaken for a ptomain, ptomatro-pine, which has similar chemic and pharmacologic properties.

Treatment Of Poisoning

The stomach may be lavaged, with or without a solution of tannic acid or tea (Sollmann says that tea is an inferior precipitant for alkaloids). For the delirium and mania an ice-cap may be applied to the head, whisky or bromides administered, and, if necessary, ether inhaled to lessen the excitement. (Morphine, chloral, and chloroform should be avoided because of their tendency to precipitate respiratory failure.) In the collapse stage the regular treatment is that for severe collapse. Pilocarpine and physostigmine antagonize the atropine action on certain nerve-endings, but as the poisoning is dependent upon the cerebral and medullary effects, these peripheral antagonists are not antidotes of any great value.

Therapeutics And Administration

A. To Diminish Secretion. -

1. Of mucus - as in excessive secretion from nose, throat, and bronchi. In bronchitis, in the free running stage of cold in the head, the rhinitis tablets, full or half strength, one every hour for 6 doses, are favorites.

2. Of sweat - as the liniment of belladonna in sweating of hands and feet, and atropine internally for the night-sweats of tuberculosis.

3. Of milk - when excessive, or when it is desired to dry up the breasts - liniment or ointment externally; or the drug internally.

4. Of saliva - as in profuse salivation from any cause - the drug internally.

5. Of gastric juice - as in hyperacidity and hypersecretion, 1/100 grain (0.0006 gm.) of atropine sulphate or 3/5 grain (0.04 gm.) of extract of belladonna fifteen or twenty minutes before meals.