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.
Contrary to the opinion expressed by Dr. Sidney Ringer, I believe that in the febrile state of the disease the value of belladonna is obvious; and that when whooping-cough is complicated with dentition, the action of this medicine is doubly valuable, the inflammation of the gums being removed. Belladonna relieves the congestive irritability of the respiratory passages; also the determination of blood to the head - both such common accom-.paniments of whooping-cough.
That belladouna is exceedingly useful when the severity of the convulsive attacks is abating, is generally acknowledged. I believe, for my own part, that it is equally useful during the previous or febrile stage.
The dose should be from three to ten drops of the tincture, administered every one to three hours, both quantity and interval being regulated by the susceptibility of the patient to the action of the drug.
As a Prophylactic against Scarlet Fever. - As a prophylactic against scarlet fever, I may add that, after many trials, I consider belladonna is often efficacious, provided the doses be sufficiently large to cause soreness or dryness of the throat, and provided also that the action be kept up during the time of exposure to the infection. The readiest and quickest process for bringing the individual under its prophylactic influence 1 believe to be the hypodermal injection of the sulphate of atropine. With children, of course, this is somewhat objectionable, on account of its giving some pain.
(The mooted question as to the prophylactic power of belladonna in scarlatina has given rise to much discussion and also to some very careful and thorough observations. When Hahnemann first asserted this power,2 but five years had elapsed since the publication of his peculiar ideas concerning the remedial action of drugs. Nevertheless so strong was the feeling against him that his statements in this connection were almost unheeded, and little effort was made either to confirm or refute this pretended discovery, so important if true. Hufeland was one of the first to examine the question experimentally, and as a result gave his adhesion to the affirmative view. Since then much evidence has been collected, on the subject, and the preponderance is certainly in the same direction.
Cazin3 in 1823 attended twenty-five indigent families, huddled together in contracted quarters at Calais. He admininistered the tincture of belladonna to sixteen children, of whom but one contracted scarlet fever, and this one but lightly, although they were in intimate association with other persons suffering from the disease.
Stievenart,4 in an epidemic near Valenciennes (1840-'41), which had already claimed ninety-six victims, administered belladonna to four hundred persons, all of whom, without exception, escaped; while many others in the same locality, and subjected to the same influences, who did not take the drug, contracted the disease. Stievenart employed the tincture of belladonna in doses of two drops daily in children from one to three years of age, three drops to children of from two to six years, and after that age one drop additional for each year. Stille,1 after stating the evidence, concludes as follows: "On a review of the whole subject, we feel bound to express the conviction that the virtues of belladonna, as a protection against scarlatina, are so far proven that it becomes the duty of practitioners to invoke their aid whenever the disease breaks out in a locality where there are persons liable to the contagion, particularly in boarding-schools, orphans' asylums, and similar institutions, and among the families of the poor; whenever, in a word, it is difficult to place the healthy at a distance from the sick. The dose which it is proper to prescribe under such circumstances may be thus stated: dissolve from one to three grains of fresh and well-preserved extract of belladonna in an ounce of cinnamon-water, adding a few drops of alcohol to prevent fermentation. This solution may be given two or three times a day, a drop for each year of the child's age, to be so administered for two weeks or longer if the danger should continue.")
1 See also the very interesting paper of M. See (Practitioner, July, 1869), in which belladonna is strongly recommended in asthma, and its action explained by its physiological relation with the vagus nerve.
2 Heilung u. Verhutung des Scharlachfiebers, Nurnberg, 1801.
3 Les plantes medicinales, 4th Ed., Paris. 1876, p. 165.
4 Bouchardat: Annuaire, 1845.
Antagonism between Belladonna and other Physiological Agents. - I have reserved to the last the very important subject of the antagonism between belladonna and other physiological agents. Three drugs, at least, are supposed, on more or less convincing evidence, to be antagonized by atropia, viz., opium, physostigma, and hydrocyanic acid.
The antagonism between belladonna and opium first began to be spoken of some twelve years ago; and from that time to the present there has been a steadily accumulating influx of affirmative evidence, intermingled with occasional attacks tending more or less to throw discredit upon the fact asserted. At present the state of the case is such that to me doubt seems no longer possible; and this appears to be the prevailing opinion. No doubt the manner in which the first suggestion of the antagonism was raised was such as might well have misled inquirers; for it was merely the fact that opium contracts and that belladonna dilates the pupils, which gave rise to the idea. It might well have happened that this was the only point of difference between the action of two drugs which, on the whole, were synergic; and, in fact, this position has been taken up by some objectors. But there is now too large a body of cases recorded in which life has been saved by the use of belladonna under circumstances of severe opium-poisoning (coupled with the fact that belladonna-poisoning has been relieved by opium), to allow me to doubt that there is a general antagonism between the main features of the action of the two drugs. This does not prevent my believing that there may be some, perhaps many, individual points in which the action of the drugs is far from actually opposite, or even that they may occasionally be used in conjunction with advantage. The general view, which is taken up by Dr. John Harley, the principal opponent of the antagonism-theory, is, however, in my opinion, unjustifiable. According to this author, the recorded cases show that belladonna has no influence whatever in accelerating recovery from the poisonous effects of opium. He says that somnolency, stupor, narcotism, and coma are both intensified and prolonged by the concurrent action of belladonna; that belladonna is powerless to relieve the depression of respiration, which is the chief danger from opium; and that the results of the combined action of belladonna and opium are the same, whether given in medicinal or in toxic doses: in short, that belladonna will never antagonize opium by its poisonous action, but the reverse; though it is possible that the use of very small doses may aid to support the failing action of the heart. I am at a loss to know how these conclusions can possibly have been drawn by Harley from the recorded facts. The cases which he cites, and others which have been adduced, seem to point distinctly enough to a conclusion at least as strong as that expressed by Professor Fraser,1 that "such knowledge as is already possessed renders it probable that a general antagonism does really exist, to the extent, at any rate, of the primary lethal action of opium or morphia being preventible by the physiological action of belladonna, hyoscyamus, or stramonium." Certainly, in the present state of things, no one would be warranted, I think, in omitting the free use of belladonna in any severe case of opium-poisoning. And even down to smaller (therapeutic) doses there can be no doubt that the general effect of opium on the blood-vessels, at any rate, is opposite to that of belladonna (i. e., in doses of the two medicines which could fairly be compared with each other). Very positive testimony to the antagonism of belladonna and opium is given by Dr. Johnston in his Shanghai Hospital Reports, March, 1872.