In Spasms. - The action of belladonna in relieving spasms, while very decidedly established as regards certain classes of affections, is more in dispute with regard to others. There is no doubt, for instance, that the local application of belladonna will calm spasms of particular muscles; and in this manner it comes to be of the greatest service in particular cases; as, for example, in the painful spasms of the sphincter which so aggravate the misery of fissure, or irritable ulcer of the rectum. Moreover, in spasmodic stricture of the urethra I have usefully assisted the effect of belladonna given internally by applying the fresh extract to the penis. The internal use of belladonna has a wider and more beneficial antispasmodic action; though there are very great differences in its relative success in particular cases.

The pelvic organs are an especially favored site of the antispasmodic action of belladonna, as in cases of spasms of the bladder, in which it is most useful. When there is simply much vesical irritability, with frequent micturition, without organic change, the tincture in five to twenty drop doses every three or four hours will give gradual but sure relief. If organic disease be present, the question of belladonna is more complicated, and a variety of individual circumstances must decide whether it shall be used. The power of belladonna to relieve general convulsions is much disputed, but upon this point I hold a strong affirmative opinion.

In General Convulsions. - Belladonna is useful in epilepsy, and especially when the attacks are brought on by fright. Trousseau long ago recommended it, while prescribing the treatment to be adopted for this disorder generally, though he does not specify the particular form of the disease in which the belladonna would prove most useful. "During the first month the patient takes a pill composed of extract of belladonna and of the powdered leaves of belladonna, one-fifth of a grain of each every day, if the attacks occur chiefly in the day-time; but in the evening, if they be chiefly nocturnal. One pill is added to the dose every month, and, whatever be the dose, it is always taken at the same period of the day. By this means the patient may reach the dose of five to twenty pills, or even more."

In enumerating the circumstances under which belladonna is specially useful, it is important not to overlook puerperal convulsions. The value of its action in many cases of the occurrence of such convulsions I can testify; but long before my own time it had been pointed out by M. Chaus-sier, and by various other distinguished practitioners. M. Chaussier, so far back as 1811, was accustomed to apply belladonna ointment to the uterus. This first and experimental employment of the drug for the purpose under consideration was followed, however, by uncontrollable uterine haemorrhage, with other perilous symptoms, and the propriety of resorting to it was warmly and very reasonably disputed. Of late years quite a different method has been adopted, and to this there appears to be no possible objection, while the advantages are obvious. I refer to the internal administration of the tincture and the hypodermal injection of atropia, and it is of these that I desire to speak in terms of approval, their utility having been verified in my own experience.

In connection with this subject, I may remark that as a topical remedy belladonna is unquestionably of great service in those long-protracted and wearisome labors which arise from rigidity of the os and cervix uteri. In these cases, however, it is now seldom employed; other remedial agents usually claiming the preference. Dr. Conquest recommended that in such labors as those referred to, about half a drachm of the extract should be rubbed into the neck and mouth of the womb; the result of the application being, he assures us, that unproductive uterine action is suspended, and that there is an immediate relaxation of the parts, so that upon the recurrence of expulsive pains the os yields, and passage is allowed to the head of the child.

In all hypercemic conditions of the brain and of the spinal cord, belladonna is one of the best medicines we can have recourse to. Among many admirable results which ensue on its employment, I may specify its beneficial effects in certain congestive kinds of convulsions, especially in fits produced by the irritation of teething. This kind of congestive convulsion may arise in various constitutions; for example, it may occur in apparently robust and healthy children; and, at the other extreme of the scale, it may frequently be met with in scrofulous and feeble children, with precocious development of cerebral activity; but, in fact, it may occur in all shades of temperament. In all these varied circumstances - granting a congestive origin - belladonna is of the highest possible utility; and its employment cannot be too highly recommended.

So with convulsions referable, proximately, to whooping-cough, and which often depend, like the former, upon a congested condition of the brain. In these, just as when induced by the excitement arising from dentition, belladonna rarely fails to give relief. On the other hand, I may add that when convulsions arise from irritation of the intestinal canal, the use of belladonna is relatively small.

Nocturnal Enuresis. - The very unpleasant nocturnal enuresis, to which children are so liable, is very usefully treated with this drug. I must acknowledge that I formerly experienced much disappointment in the effects of belladonna in this malady; but the failures were probably due to my using an insufficient dose - only five minims three times a day. It is only lately that I have been led to employ larger doses; the effect of these has given me confidence in the efficacy of the treatment.

Dr. Sydney Ringer states that, "in the incontinence of urine in children, belladonna acts more speedily and efficiently than any other medicine;" but that in order to be successful, it must be administered in full doses, namely, ten to twenty drops of the tincture thrice a day. "Small quantities," he continues, "often fail, while large ones immediately succeed." This positive assurance seems to explain my own ill-success when the quantity employed was only five minims.