Externally. - Belladonna is used externally to relieve all sorts of pain, - for example, that of neuralgia, pleurodynia, and chronic osteo-arthritis. Chloroformum Belladonnae (Brit. Pharm. Conf.), - the root being extracted with ammonia and chloroform, - diluted with a little olive oil, or the liniment is excellent for these purposes. A glycerin preparation (made by rubbing the alcoholic extract of belladonna leaves, 4; with boiling water, 1; and then adding gradually glycerin, 12), soothes the pain of acute inflammations. This, or the plaster, or the ointment, is very efficacious in preventing the secretion of milk in women who do not for any reason nurse their infants. Pruritus and local sweating of various parts of the body, especially the feet, may sometimes be stopped by the application of belladonna liniment. A solution of atropine sulphate, 4; boric acid, 5; in water to 480; will dilate the pupil for ophthalmoscopic examination. Atropine is often used in ophthalmic practice to paralyze the movements of the iris and ciliary muscle, to break down adhesions, and to prevent the formation of contractions of the iris. It must not be used if the patient is suffering from glaucoma. See also Homatropine Hydrobromate, p. 381.

Internal

Alimentary canal. - Belladonna has occasionally been employed to check salivation, and some use it to overcome constipation and colic. The alcoholic extract of the leaves is then given, and is commonly combined with some purgative in a pill. This extract in the form of a pill is often administered with opium to patients suffering with appendicitis or peritonitis; as it is given several times a day a large amount is taken, and this, as already explained, probably paralyzes intestinal movements, and so aids the opium.

Skin. - Atropine sulphate (1/100 gr.; .0006 gm.) injected sub-cutaneously, or one or two minims .06 to .12 c.c. of the solution of atropine sulphate 1, in camphor water, 100., by the mouth will sometimes arrest sweating, and this treatment may succeed with the night-sweats of phthisis.

Circulation. - There are many cases of heart disease in which belladonna may advantageously be combined with other drugs.

Whenever we wish to empty the ventricle completely it is useful, for it will be remembered that it increases the rapidity of the heart without diminishing the force. But its greatest value is to remove cardiac pain and distress, which it often does most effectually. It may be conveniently applied as a plaster over the cardiac region, or it may be given internally, usually as the tincture of the leaves.

Respiration. - As belladonna relaxes the muscular coat of the bronchial tubes, it is of great value in spasmodic affections of the respiratory passages. Thus, of all the numerous drugs that have been given for whooping-cough, it is the best. It is also very useful to relieve the symptom asthma, and in bronchitis with asthma-like paroxysms; in the last named condition its powerful stimulation of the respiratory centre and its capability of diminishing the secretion will, in properly chosen cases, render it particularly valuable. It is generally given as a tincture of the leaves, and combined with other drugs. A useful linctus contains the tincture, 3; vinegar of squill, 5; syrup of tolu, 10; glycerin to 60 parts.

Genito-urinary diseases. - Belladonna is one of the favorite remedies for the nocturnal incontinence of children, and it occasionally overcomes this trouble in adults when it is not due to organic diseases. It relieves eneuresis because it has an anodyne effect upon the centres in the cord and when excreted in the urine anaesthetizes the neck of the bladder. Its power of relieving the spasm of involuntary muscle is well shown in the effectual manner in which the very painful vesical spasm which accompanies calculus, cystitis, and prostatitis may be benefited by it. It may be given internally as in the form of a suppository, or applied as a plaster to the perinaeum.

It has been tried in many nervous diseases, but without any good results.

Toxicology

Symptoms

If a person takes a moderate dose of belladonna he soon experiences dryness of the mouth and throat, and as the food, therefore, cannot be properly lubricated, there is difficulty of swallowing; the pulse may at first be a little slower than usual. The pupil is dilated; accommodation is defective, and vision confused. The skin feels dry. If the dose has been a large one, these symptoms all come on quickly; the conjunctivae and face, and perhaps other parts of the skin are flushed, and the rate of the pulse is greatly increased, it may even be doubled. The patient staggers, feels giddy, and reels when he walks; the throat soon becomes very hot, the skin still more flushed, the eyelids swell, and there may be a uniform erythematous rash. The temperature is often raised, the respirations are slow and deep. The pupils are very widely dilated. By this time the patient is quite delirious. There may be purging, but this is not common; and sometimes he complains of a frequent desire to micturate, although he is unable to pass any urine. Death takes place from cardiac failure combined with asphyxia.

Post-mortem

The organs are all in a state of venous congestion, which is due to the asphyxia. If recovery takes place the patient may have no recollection of his illness.

Treatment

Give emetics (see p. 139) or wash out the stomach. Inject pilocarpine and stimulants subcutaneously. Employ artificial respiration and hot bottles, and give strong coffee per rectum.

Antagonism

The antagonism between atropine and morphine has already been discussed (see p. 365). It is clear that as pilocarpine stimulates the terminations of the secretory nerves in the salivary and sweat glands, and also excites the terminations of the third nerve in the iris and ciliary muscle, it is a diaphoretic, a sialagogue, and a myotic, and is in these respects antagonistic to atropine. Physostigmine also causes contraction of the pupil and spasm of the ciliary muscle by stimulation of the terminations of the third nerve, and it depresses the respiratory centre almost from the beginning. In these points it is an antagonist to atropine.