This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
In cases of the accidental swallowing of belladonna fruit, the first step should be to excite vomiting by means of small doses of sulphate of copper, or sulphate of zinc, repeated as often as may be needful. But care must be taken that these remedial agents do not themselves accumulate in the stomach, the torpidity of which is one of the special difficulties to contend with in belladonna cases. Sometimes the torpidity is so profound that to obtain an emetic action from the employment of any drug whatever is next to impossible, and the stomach-pump may not act well in emptying the stomach. Should the stupor induced by the poison be very alarming, it is necessary to relieve the blood-vessels of the head by opening one of the jugular veins, and by cold affusions. By adopting these measures, the stomach is likewise enabled to recover in some degree from its torpor, and the action of the emetic is considerably assisted. Stimulants may also be applied to the eyes and nose, and sinapisms to the feet; and friction may be used over the region of the heart. When, by the judicious administration of emetics, the stomach has been emptied, vinegar or some other vegetable acid may be given to the patient, and be followed up with diluents and saline purgatives.
The above remarks apply chiefly to poisoning with the fruit of belladonna, which is the most common accidental form, at any rate in country-places. But where the poison taken is an energetic preparation of the leaves or root, and we have consequently to deal with atropia in such a form as must be very rapidly absorbed into the blood, it is necessary to think of possible further antidotal treatment. Under these circumstances we shall have to turn either to morphia, or to physostigma, the supposed antidotal powers of which toward atropia will be discussed when I come to speak of these two agents respectively.
Therapeutic Action. - It is a maxim in therapeutics that we may expect to find our most potent remedies among the deadliest poisons; and belladonna, which has been shown to exert such active and all-pervading poisonous influences upon the organism, affords a strong illustration of the truth of this saying. Its great energy makes it a somewhat uncontrollable remedy, even in the hands of those who have long familiarized themselves with its employment; hence by many practitioners it is seldom resorted to until other remedies have been vainly tried. The variety and certainty of its remedial effects are, however, so well established, that its intractableness per se should not be allowed to weigh as an objection to its use; rather ought we to strive more diligently to discover the laws of its therapeutic action, in order that it may be employed with more promptitude and confidence. That in special cases, or in particular temperaments, belladonna may seem not to justify its ancient repute, is quite possible. But, on the other hand, there are plenty of instances in which it can be pointed to as efficacious when other drugs fulfil no good purpose. In estimating the value of a medicine we are not to judge from negatives, which are far more likely to mislead as to its virtues than posi tive results, when the latter are obtained under due precautions against fallacy. It is scarcely necessary to remark that hardly a medicine can be named which is invariably efficacious, and in a uniform manner, even when the constitutions of the patients, and the symptoms, seem identical; and if belladonna does not at all times and under all circumstances accomplish what is justly expected from it, such failure is certainly not a defect peculiar to this remedy, or without a parallel.
In Pain. - One of the most characteristic effects of belladonna is its power to relieve certain kinds of pain. I say "certain kinds" (a necessary qualification), for belladonna by no means ranks with opium in quality as a universal anodyne.
It is interesting to note that the ascertained physiological action of the drug might prepare us for the therapeutic facts which we meet with in practice. Belladonna (according to Lemaire, Meuriot, and Botkin) in poisonous doses paralyzes the peripheral ends of the sensory nerves. Now it is a fact that the pains which we relieve with the greatest certainty by the use of belladonna are those which depend entirely or chiefly upon peripheral causes. Thus the pain of inflamed parts, especially gouty and rheumatic inflammation, can often be more speedily and effectually soothed by this remedy than by any other. And among neuralgic pains those are by far the most frequently and effectually relieved the main source of which is some peripheral disturbance. Belladonna is much more serviceable, for example, in the various painful affections which are produced by an irritated state of the pelvic organs (especially in females) than in neuralgia of the face.
At present there is a tendency to limit the employment of belladonna in cases of true neuralgias to the use of sulphate of atropia in hypodermic injection. A solution should be employed which contains one grain in two drachms of water; each minim thus contains 1/120 grain; and it is advisable to begin with no larger dose than this; for though the great majority of patients will require, and bear quite well, a large dose equal to twice or three times this or more, yet we never know that the actual subject we are treating may not belong to that exceptional class with whom very minute doses cause unpleasant symptoms of atropism: e. g., dry throat, disturbed vision, uncomfortable heat of body, headache, and even delirium; and it is very desirable to avoid the production of symptoms so alarming to the patient.
The local use of belladonna in the form of lotion, liniment, ointment, plaster, etc., has been found of eminent service in the relief of the dreadful pains of cancer. I have myself witnessed great benefit in cases of scirrhus, and also in cancerous and other painful ulcerations, from the use of a lotion composed of two drachms of extract of belladonna to a pint of water, the application being made two or three times a day; and if at the same time the tincture be given internally in five to ten drop doses, at intervals of a few hours during the day, the sufferings of the patient are still further alleviated. The pain of scirrhus of the pylorus, a very distress ing malady, has been greatly relieved by the application of belladonna plaster to the epigastrium; and both in sciatica and lumbago local appli cation of the plaster has done much good.