a Neuralgic Affections. In these belladonna displays its most useful powers; and I know few remedies more effectual in their cure. No matter where the pain is seated, provided it be purely functional, that is, connected with no inflammatory or other organic disease affecting the nerve or its centre, the medicine may be employed. It may be used both internally and locally; and, when the pain is near the surface, or in any position to which near access can be obtained, it is generally advisable either to depend on the topical use of the remedy, or to employ it in the two methods jointly. The general rule is to administer it in quantities sufficient to produce obvious effects, without going so far as to cause delirium, stupor, or dimness of vision approaching blindness. Though these latter phenomena have seldom if ever proved really dangerous, when proceeding from medicinal doses, yet they are not necessary to the anodyne effect, and are, therefore, better avoided. I am in the habit, in neuralgic cases, of giving half a grain of the extract three times a day, and, if no effect is experienced from this dose, of gradually increasing it, until dryness of the throat, dimness of vision, dilatation of the pupil, slight frontal uneasiness, or feelings of fulness or giddiness in the head are produced; and of afterwards so managing the dose that these effects should not be exceeded. Sometimes the first dose will act with unexpected energy; in which case it should be reduced to one-third or one-quarter of a grain, and afterwards increased again if necessary. More frequent repetition than three times a day is unnecessary to maintain a continued operation of the medicine, and might lead to cumulative effects.

Both in the neuralgic and spasmodic diseases belladonna may often be very advantageously associated with those tonics which have the effect of strengthening the nervous centres, as quinia, the chalybeates, and the preparations of silver, copper, and zinc; the narcotic and tonic being administered conjointly in the same pill, or separately, as may be most convenient.

Modes of Application in Neuralgia. Some remarks in relation to the method of using the remedy locally in these cases may be advisable here. A decoction of the leaves may be employed, or the extract; and one or the other of these may be used in the form of lotion, cataplasm, liniment, ointment, or plaster. Of the use of atropia I shall treat under a separate head. The extract may be brought into the state of liniment by simply rubbing it with a little water; and of an ointment by incorporating it with lard. The plaster is officinal. Usually it will be sufficient to make the application upon the unbroken skin; but the effect is more speedy and much more powerful when the remedy is used endermically, the cuticle having been removed by a blister. In this case, the extract should be used mixed with water or lard, and never at first in quantities exceeding two or three grains, which may be increased if necessary. As it occasions some pain if brought into direct contact with the denuded surface, it may be applied, as recommended by MM. Trousseau and Pidoux, spread on a piece of linen with the uncovered surface next the skin, and protected by means of adhesive plaster. The effect is thus gradually produced, and without pain. To the writers just named I am also indebted for some of the following observations in relation to the local use of the medicine in special cases.

In neuralgia of the scalp, a decoction of the leaves made in the proportion of half an ounce to the pint of water may be used locally. With this the hair may be saturated; and a thick linen compress thoroughly moistened with it, having been applied over the head, the whole should be covered with a cap of oiled or waxed linen, or silk. A solution of the extract in the proportion of a drachm to the pint, or the officinal tincture diluted with four parts of water, may be similarly employed.

In supra-orbital neuralgia, or that of the eyeball, from five to ten grains of the extract, mixed with a little water, may be rubbed upon the lids and around the eye, with gentle friction, for ten or fifteen minutes; and the process may be repeated every two or three hours, the part being in the mean time covered with a light compress, until the pain is relieved. Or a cataplasm made with a solution of the extract and flaxseed meal may be applied over the whole eye. The same method may be employed in other forms of facial neuralgia; but in the infraorbital and submaxillary forms, the authors above mentioned prefer the friction to be made upon the gums or inside of the cheeks. Of course, care must be taken that the patient do not swallow the medicine. In painful affections of the ear, a solution of the extract may be injected into the meatus, and cotton afterwards introduced impregnated with the same. In toothache, the extract itself may be introduced into the carious cavity.

In neuralgia of the limbs or trunk, the application should be made as near to the seat of pain as possible; and in these, the endermic method will often be advisable. In sciatica, which is one of the most obstinate forms of the affection, the blistered surface should be made in the course of the nerve as it passes out of the pelvis. MM. Trousseau and Pidoux have met with great success, in very obstinate cases of this affection, by making an incision through the skin, between the great trochanter and ischium, and inserting a ball in the form of a pea, containing from one to live grains of the extract with a little opium; thus gaining the effects of an issue with those of the narcotic.

In angina pectoris the medicine has been used locally with advantage. Dr. Davies relates a case in which a plaster of belladonna was applied to the chest after tartar emetic, and before the ulcers from this had healed. Alarming symptoms were induced; but, on their subsidence, it was found that the angina had ceased. (Lect. on Dis. of Lungs and Heart, p. 49G).

In the internal neuralgic affections of the abdomen, as gastralgia, enteraJgia, nephralgia, etc., the external use of the medicine should be resorted to when the complaint is complicated with vomiting or purging, while opium is used internally. But, in the contrary condition of constipation, it would be better to try the effects of extract of belladonna internally.

Lead colic and nervous colic, which are really forms of intestinal neuralgia, may be advantageously treated in their milder and more chronic conditions, with belladonna combined with alum or iodide of potassium internally, and frictions with an ointment of the extract externally over the surface of the abdomen.

b. Rheumatic and Gouty Disease. Among the painful affections which, in like manner with neuralgia, may be treated with the internal and external use of belladonna, are rheumatism and gout. The medicine has been employed even in acute rheumatism, and is asserted to have proved very successful. After a proper use of the lancet, and in connection with purgatives and arterial sedatives, I have no doubt that it would prove serviceable, given so as to maintain a constant and decided impression; and, in cases where some idiosyncrasy may forbid the use of opium, might be had recourse to with great propriety. But it is in the nervous or neuralgic forms of these diseases that belladonna is especially indicated; and here it is among the most efficacious remedies. It is also frequently serviceable in the shifting forms of subacute rheumatism without fever; and, in the chronic forms of the same disease, is a standard remedy, given in connection with one or more of the various alteratives used. In this form of the disease it may also be advantageously employed locally, in the shape of poultice or plaster: the former being most conveniently applied to the joints, the latter over muscular parts, as to the small of the back in lumbago, and to the side in pleurodynia.

c. Other Painful Affections. There is a number of painful affections. local in their character, in which the topical use of belladonna has been resorted to with more or less benefit. In dysmenorrhoea it has been introduced into the vagina, either by injecting a decoction of the leaves or solution of the extract, or in the form of a pill containing half a grain or a grain of the latter preparation. Fissures of the anus, painful piles, and excessive sensitiveness of the rectum, may often be usefully treated with an ointment made by mixing the extract with lard; not more than from half a grain to a grain and a half of the former being used at the first application, especially if introduced within the sphincter. Phymosis and paraphymosis, swelled testicle, inflamed urethra, and various painful tumours and ulcers, cancerous, scrofulous, or simply phlegmonous, are additional affections in which the extract has been recommended, in the shape of cataplasm or ointment, with the view of relieving pain.