ATROPINE. 
§ 458-1 
395 
and the voice hoarse. 1 The inability to swallow, and the changed voice, 
bear some little resemblance to hydrophobia—a resemblance heightened 
to the popular mind by an inclination to bite, which seems to have been 
occasionally observed ; the pupils are early dilated, and the dilatation 
may be marked and extreme ; the vision is deranged, letters and figures 
often appear duplicated; the eyeballs are occasionally remarkably 
prominent, and generally congested ; the skin is dry, even very small 
quantities of atropine arresting the cutaneous secretion ; in this respect 
atropine and pilocarpine are perfect examples of antagonism. With the 
dryness of skin, in a large percentage of cases, occurs a scarlet rash over 
most of the body. This is generally the case after large doses, but 
Stadler saw the rash produced on a child 3 months old by -3 mgrm. of 
atropine sulphate. It appeared three minutes after the dose, lasted 
five hours, and was reproduced by a renewed dose. 2 The temperature 
of the body with large doses is raised ; with small, somewhat lowered. 
The pulse is increased in frequency, and is always above 100—mostly 
from 115 to 120, or even 150, in the minute. The breathing is at first 
a little slowed, and then very rapid. Vomiting is not common ; the 
sphincters may be paralysed, so that the evacuations are involuntary, 
and there may be also spasmodic contractions of the urinary bladder. 
The nervous system is profoundly affected ; in one case there were clonic 
spasms, 3 in another 4 such muscular rigidity that the patient could with 
difficulty be placed on a chair. The lower extremities are often partly 
paralysed, there is a want of co-ordination, the person reels like a 
drunken man, or there may be general jactitation. The disturbance of 
the brain functions is very marked ; in about 4 per cent, only of the 
recorded cases there has been no delirium, or very little—in the majority 
delirium is present. In adults this generally takes a garrulous, pleasing- 
form, but every variety has been witnessed. Dr H. Giraud describes 
the delirium from datura (which, it may be necessary to again repeat, 
is atropine delirium) as follows :—“ He either vociferates loudly or is 
garrulous, and talks incoherently ; sometimes he is mirthful, and laughs 
wildly, or is sad and moans, as if in great distress ; generally he is 
observed to be very timid, and, when most troublesome and unruly, can 
always be cowed by an angry word, frequently putting up his hands in 
1 A friend of the senior author’s was given, by a mistake in dispensing, 16 minims 
of a solution of atropine sulphate, equivalent to 4 grain of atropine (or 9*3 mgrms.). 
Ten minutes after taking the dose there was dilatation of the pupil, indistinctness of 
vision, with great dryness of the throat and difficulty in swallowing ; he attempted to 
eat a biscuit, but, after chewing it, he was obliged to spit it out, as it was not possible 
to swallow ; the throat was excessively sore, and there was a desire to pass urine, 
but only a few drops could be voided. In forty-five minutes he was unable to stand 
or walk. There was a bright rash on the chest. In two hours he became insensible, 
and was taken to the Middlesex Hospital, recovering under treatment in about 
eight hours. 2 Med. Times , 1868. 
3 Lancet, 1881, i. 414. 4 Ibid., 1876, i. 346. 
