Belladonna produces its characteristic effects upon the system, to whatever part it may be applied, whether to the stomach, the skin, the rectum, the cellular tissue, or the blood. When it is given in small doses, repeated two or three times daily, so as to bring the system gradually under its influence, the first effect usually noticed is a feeling of dryness and stricture in the fauces, soon followed, if the medicine be continued or increased, with alight uneasiness or pain in the forehead, vertiginous sensations, some dimness of vision, and occasionally dilatation of the pupil. The system may be kept long under its influence, with little other observable effect, by a careful management of the dose. In some very susceptible persons, however, the quantity usually given will act more powerfully; in one, producing blindness with large dilatation of the pupil; in another, decided pain in the head, flushed face, perhaps slight delirium, and an excited pulse.

From larger quantities, the effects are more quickly induced and more severe. A dose sufficient to bring the system at once decidedly under its influence, generally begins to show its effects in about half an hour. Dryness of the mouth and fauces, a feeling of stricture of the throat, difficult deglutition, thirst, dimness of vision sometimes amounting to blindness, dilated pupil, vertigo or headache, flushed face, suffused eyes, morbid sounds, irregular muscular contractions, and hallucination or delirium, sometimes followed by a disposition to sleep, sometimes attended throughout with wakefulness, are symptoms which most frequently appear, though not all generally in the same case, and which, having continued for twelve hours or more, gradually subside, without leaving any ill consequences behind. Along with more or less of the effects mentioned, there is generally some frequency of pulse and febrile excitement: but sometimes the circulation is at first little affected; and, when the cerebral phenomena are at their height, it is in a greater or less degree depressed. According to Lemattre, even when most excited, the pulse is diminished in tension or force. Not unfrequently there is an increase either of perspiration or urine, sometimes an eruption of scarlet rash on the surface, or irritation of the urinary passages. Occasionally, also, there is some nausea or griping pain with diarrhoea, intimating an irritating influence on the alimentary mucous membrane.

A curious fact in relation to the tolerance of belladonna by children has been made known by Dr. H. W. Fuller, of London. Having prescribed the extract in a case of chorea, and observing no effect to follow, he gradually increased the dose, and was surprised to find that very large quantities were borne without effect. He tried the medicine in other cases of chorea with the same result. In one girl of ten years, seventy grains were given daily with little effect. It was satisfactorily ascertained that the extract used was active; and, in one instance, atro-pia escaped copiously with the urine. He then tried the medicine in healthy children from five to twelve years old, and found the same tolerance evinced; and hence came to the conclusion that this singular phenomenon was ascribable to peculiarity in the systems of children. The quantity which was quite harmless in a child could not be borne by an adult. (Med. Times and Gaz., July, 1859, p. 95.) Nevertheless, this experience of Dr. Fuller should not be hastily acted on; as peculiar unknown circumstances may possibly have influenced the result, and a similar tolerance might not be found in other instances.

Belladonna Poisonous Effects

When poisonous quantities are taken, the effects described are experienced in a still greater degree. The circulation is accelerated and the heat of skin increased. The lips, tongue, and fauces are very dry, with a burning sensation in the throat and stomach, a sense of severe constriction of the throat, great difficulty of swallowing, and intense thirst. Not unfrequently there is nausea with ineffectual retchings; and sometimes strangury and bloody urine. The dimness of vision is extreme, and total blindness not uncommon, with the pupil greatly dilated, immovable and quite insensible to the brightest light. The hearing is also defective, and not unfrequently there is great difficulty of speaking, amounting sometimes to aphonia. General sensibility, which is at first somewhat exaggerated, after a time becomes blunted, and at last disappears. (Lemaltre.) The face is red and swollen, and the eyes suffused with blood, sometimes as it were projecting, sometimes with a fixed meaningless stare, sometimes haggard, or wild and fierce. Vertigo soon comes on with visual deceptions, and the patient fancies that he sees objects in his vicinity which have no real existence, and makes motions accordingly. There are occasionally illusions of hearing, but they are much rarer than those of sight. In one case, complete somnambulism was observed; the patient imagining that he was a tailor, and for twenty-four hours making gestures as if working at his trade. The delirium is generally cheerful or gay; agreeable or ludicrous ideas present themselves; and the patient smiles or bursts out into laughter, or makes whimsical gesticulations. Sometimes, however, he is wild or even furious. The intoxication is not unlike that of alcohol. Stupor or coma at length supervenes, sometimes alternating or mingling with delirium, and even in sleep the dreams are occasionally ludicrous, producing bursts of laughter. Partial spasmodic contractions take place; the jaws being closed, the muscles of the face working, and those of the hands moving irregularly; but convulsions, though they sometimes occur, are very rare. On attempting to rise, the patient is unable to maintain the erect position, staggers, or moves with his body bent forward. Sometimes dysury has been noticed; but no increase of urine unless when the patient has indulged his great thirst. The pulse is now very feeble, the extremities cold, a disposition to syncope evinced; and, if the case is to terminate fatally, death is preceded by great prostration, subsultus ten-dinum, and profound coma. If, on the contrary, recovery takes place, which happens in the great majority of cases, even without medical interference, the symptoms gradually disappear, and, in two or three days, the patient is restored, usually remembering nothing of what had passed.*

The poisonous effects have been experienced from belladonna injected into the rectum, applied to blistered surfaces, and even employed in the form of a large cataplasm over the abdomen, with the cuticle unbroken.

* The symptoms above given, as characteristic of poisoning by belladonna, must not be considered as all occurring in every case, nor at the same time in the same case; but the affection of the pupil and of vision is probably uniform. Many of the symptoms have been drawn from an account, by M. Gautier de Claubry, of one hundred and fifty French soldiers, who, in one of the campaigns in Germany, ate the berries of the belladonna plant by mistake, and all suffered in greater or less degree. Many of them perished. (Journ. General de Med., xlviii. 335).

Its influence extends to the contents of the womb in pregnancy; and it is said that the aqueous humor, taken from the foetus of one of the lower animals poisoned with it, will expand the pupils in another animal, if dropped into the eye.

The quantity necessary to destroy life varies so much, according to the constitution of the patient, and the strength of the preparation, that it is impossible to fix the poisonous dose, with an approach to precision Two grains of the extract have produced alarming symptoms; six grains administered by enema have had a similar effect; while it is asserted that a pound of the berries were eaten by a man on one occasion, who nevertheless recovered under treatment. (Christison on Poisons).

Accurate accounts are wanted of the appearances left behind by the poisoning of belladonna. In general the stomach exhibits signs of some irritant action, and, in a case recorded by Gmelin, the vessels of the head were found engorged, and the blood was fluid. According to Lemattre, no lesions are found in the larynx or pharynx, or in the proper nervous tissues; and the only ascertained signs of disorder are offered in congestion. Hyperemia of the pulmonary tissue is generally presented, but always in small foci, which sometimes unite, and are more frequent on the surface than in the depths of the lungs. There is also congestion of the meninges, especially at the base of the brain, and in the choroid plexus of the lateral ventricles. The pia mater is strongly congested; and the same is the case with the retina in chronic poisoning. The congestion, however, is not inflammatory, but rather hemorrhagic. No signs of exudation are discoverable. (Arch. Gen., Aout, 1865, p. 173).

The treatment of this poisoning is exactly the same as that for opium, to which the reader is referred. As the insensibility of the stomach and bowels is often great, though not equal to that from opium, the same measures must be had recourse to, in order to favour the operation of emetics, including the loss of blood if the symptoms of cerebral congestion should be very prominent. The stomach-pump should never be trusted to, when the berries have been taken. In the state of coma, the electromagnetic machine may be employed. In addition to the other measures, it may be advisable to use animal charcoal as an antidote, as in poisoning by hyoscyamus. (See page 779).

Much has been said of an antagonistic relation between opium and belladonna, in their effects on the system, which is supposed to render them, to a certain extent, mutually antidotal in cases of poisoning from either; opium being considered as an antidote in poisoning by belladonna, and belladonna in poisoning by opium. The idea seems to have originated in the marked difference in their action on the pupil, which is dilated by belladonna, while it is often contracted by opium in large doses. It was supposed that there might be a similar opposition in other respects. Indeed, opium had been long previously employed, and advantageously, in the treatment of belladonna poisoning. But the application of belladonna to opium poisoning seems to have originated with Dr. Thomas Anderson, who, in a paper offered to the Physiological Society of Edinburgh, in 1854, gave the details of two successful cases in which he had used belladonna. Afterwards, Mr. Benjamin Bell, of Edinburgh, derived advantage, in a case of excessive action of atropia. from injecting a solution of morphia into the subcutaneous areolar tissue. (Ed. Month. Journ., July, 1858, p. 6.) A few other cases of similar significance had been published in the journals of Europe and this country; but it was not till 1862, that the attention of the profession was generally aroused to the subject, by a paper of Dr. Wm. F. Norris, of Philadelphia, published in the American Journal of the Medical Sciences (Oct. 1862, p 395), describing two cases of opium poisoning, in which belladonna was employed with other measures, and giving a brief account of what was known on the subject up to the time at which he wrote. Since then, numerous cases have been published in which these medicines have been employed with apparent success as antidotes, the one of the poisonous effects of the other; and the general sentiment of the profession is probably favourably inclined to the idea of their mutual corrective powers.

I have examined many of these reported cases, and have come to the conclusion, that we should not be justified, by anything which has yet been published, in relying practically upon the entire adequacy of either of these narcotics to the prevention of the poisonous effects of the other, and especially upon that of belladonna to obviate the danger from excessive doses of opium. In the first place, very many of the cases of poisoning from these narcotics, even from large quantities, end favourably, without any aid from the physician, sometimes in consequence of the spontaneous occurrence of vomiting, sometimes from a remarkable insusceptibility of the patient, but still more frequently from the dose taken having been sufficient to produce very alarming symptoms, and yet not large enough to destroy life; and it is very obvious, from a perusal of the published cases, that many of them belonged to this category. Secondly, in a large proportion of the cases recorded, measures had been successfully used for the evacuation of the poison, even at an early period; and this measure alone, if complete, is often sufficient to save life Thirdly, in almost all instances, other remedies were employed in connection with belladonna, in opium poisoning, such as had often before proved efficient; so that it would be impossible to determine to which one, or to what combination of them, the favourable result was really ascribable. Besides, cases of failure have been recorded as well as successes;* and experiments have been performed, which, if confirmed, must, as appears to me, be decisive against the opinion of a mutual antidotal power. Dr. Bois has published, in the Gazette des Hopitaux, an account of experiments, in which large doses of morphia and atropia were injected successively into animals, with consequences which induced him to conclude that, so far from neutralizing each other, they produced conjointly more powerful poisonous effects than could proceed from either acting separately. {Arch. Gen., Aout, 1865, p. 203.) Nor is this otherwise than might be reasonably expected a priori.

Both poisons operate with a powerfully congestive influence on the brain; and both destroy life in the same way; that is, either by suspending respiration, or by the vast secondary prostration consequent on their primary excitant action. It is true that in some points they actually are antagonistic. Thus one contracts, the other expands the pupils; one agitates and greatly disturbs the cerebral functions, the other has a composing influence on these functions. This probably happens in consequence of a special direction of each poison to separate nervous centres; while, in regard to their fatal effects, they operate upon the same. Therefore, though belladonna may expand a pupil contracted by opium, and partially rouse a patient from the torpor produced by the latter; yet, in their fatal action on the respiratory centres, and in the secondary prostration, they coincide, and augment each other's effects; and at least in one of the fatal cases on record, it seems to me highly probable that death, which was caused by great debility, was really the result of the conjoint prostration from excessive doses of the two narcotics. To produce a decided impression in opium poisoning, large doses of belladonna are considered needful, and the quantity sometimes exhibited has been such as under other circumstances might endanger life. This fact has been advanced in support of the idea of antagonism; but the fact is that, when the nerve centres are under any powerful impression, much larger doses of one of the narcotics is required to produce a given effect than under ordinary circumstances. The enormous doses of opium tolerated and required in tetanus, delirium tremens, and some cases of neuralgia are familiar to every one.

So, when the system is under a strong influence from opium, much more belladonna is required for the production of its own peculiar phenomena than in ordinary health. From all this it results, that it would be very hazardous to trust a case of poisoning from belladonna or opium exclusively to the supposed antidotal powers of either. Still, both of these narcotics may be. advantageously used, with due attention to their special influences. Thus, the excessive agitation of belladonna poisoning, and the prostration of its advanced stage, may be relieved by the composing and stimulant influence of opium; while the stupor and depression which mark the later stage of the effects of opium, may be counteracted by the agitating and supporting action of belladonna; but care should be taken that the two should not coincide in their poisonous effects; that is, that neither the early nor the advanced stages of their action should come together. As has been before mentioned, one of the great dangers of opium poisoning is the secondary prostration. Here belladonna may be used as a stimulant, in like manner as brandy, carbonate of ammonia, etc. In the similar stage of belladonna, when the great danger is debility, opium may sometimes perhaps save life by its stimulant action, in the same manner as the alcoholic stimulants.

* A case is recorded in the Bost. Med. and Surg. Journ. (lx. 468), in which overdoses of sulphate of morphia and extract of belladonna were by accident taken simultaneously, and in which instead of any material counteraction, there was an exaggeration of effect, which could scarcely have arisen from any other cause than the conjoint influence of both. In the Med. Times and Gaz. (Nov. 1866, p. 473), there is an account of a case in which the two poisons were taken in connection; a liniment intended for external use, containing extract of belladonna and laudanum, having been swallowed by mistake. The symptoms of the two narcotics were jointly produced; and, though there was scarcely enough of either or both together to et death, yet the symptoms were alarming. (Note to the third edition).

On the lower animals the effects of belladonna vary greatly. The herbivorous eat the plant with apparent impunity, while the carnivorous are affected like man. Instances are mentioned in which the horse, the ass, and rabbits have eaten of it freely, with no observable symptoms, while dogs are poisoned. A rabbit was fed on it for eight days, and was not observed to suffer. (Journ. de Pharm., x. 85.)*