Botanically and, in a measure, therapeutically, Hyoscyamus is similar to Belladonna. This interesting drug, though innocuous to some animals, is poisonous to fowls, and has received the name of henbane.
Hyoscyamus seems to be especially adapted to acute mania, to mania without any evidence of absolute inflammation, to mania which has for its keynote extreme excitation of the sensorium. The patient, under such circumstances, has many flexible notions, all arising from these abnormal impulses. He imagines, for instance, that he is about to be poisoned. Possibly he will refuse your medicine, declaring in angry tones that it will poison him. Or he imagines that he is pursued by some demon or that somebody is trying to take his life. This makes him exceedingly restless. He springs out of bed to get away from his imaginary foe. The senses, too, are disturbed. Objects look too large or else are of a blood-red color. Sometimes objects appear as if they were too distinct; that is, they have an unnatural sharpness of outline. The patient talks of subjects connected with everyday life, jumping from one subject to another pretty much as in Lachesis; all this time the face is not remarkably red, possibly it is only slightly flushed. The pupils are usually dilated, sleep is greatly disturbed, the patient lies awake for hours. As the mania advances he seems to lie in a sort of stupor and yet it is not a real stupor, because the slightest noise rouses him into all these forms of violent mania. Every little impression causes excitement of the sensorium. Accompanying these symptoms we find characteristic debility, this debility showing itself in the great prostration on every attempt to move or walk about and in paralysis of one or more muscles following the maniacal attacks. As the sensorium becomes more and more depressed he answers questions slowly or else gives irrelevant answers. Sometimes he will be in a stupor from which he can be readily aroused and will answer your questions quite correctly, but he will relapse into the stupid state immediately. With this there is a sort of adynamic condition of the brain resulting from this prolonged over-excitement, and in this condition we still find delirium, but the patient is greatly prostrated, stool and urine pass involuntarily, the pulse is no longer full and accelerated, but is quick, rapid and without volume, and irregular. Stupor is now complete, sordes appear on the tongue and around the teeth, the lungs are engorged, not from a pneumonic process but because of hypostatic congestion. Associated with this we have snoring-rattling during breathing. The mouth is open, the lower jaw dropped, and the patient lies quietly with occasional twitching of groups of muscles. This condition will soon be followed by death unless relief can be obtained. At other times we find the delirium returning anew and the symptoms take another form. The patients are silly and laugh in a flrapant manner. Sometimes, for hours at a time, they will have a silly, idiotic expression on the face. Again they become exceedingly lascivious, throw the covers off and attempt to uncover the genital region. The abnormal movements accompanying these symptoms are rather angular; they are not at all of the gyratory character significant of the Stramonium.
Still another form in which the cerebral symptoms of Hyoscyamus may appear, particularly in women, is jealousy, and also the effects of powerful emotions, as disappointed love, fright and other emotions that are more or less exciting and at the same time depressing.
Coming now to inflammation of the brain or meninges, we find Hyoscyamus sometimes indicated when we have present some of the symptoms already enumerated and in addition to these symptoms, relief from shaking the head or sitting with the head bent forward. Here it is exactly opposite to Belladonna. The patient complains of pulsating waves through the head.
We have a cough quite characteristic of Hyoscyamus. This cough comes from elongation of the uvula, the result of relaxation or inflammation. The uvula hangs down and rests on the root of the tongue causing irritation and the consequent cough. This cough is worse when lying down, the patient having almost complete relief when sitting up. It is usually worse at night and also after eating and drinking and from talking.
There are two or three remedies to be compared with Hyoscyamus here. One of them is RUMEX CRISPUS. This is a splendid remedy for tickling cough from an annoying tickling in the supra-sternal fossa. The patient wants to breathe warm air. Anything which disturbs the temperature of the respired air excites the tickling and hence the cough. The tickling may extend down into the chest and still Rumex be indicated.
There is another remedy which has this same symptom and one which has been confirmed too. It is MENTHA PIPERITA. It is inferior to Rumex, however. I have heard it said that eating apples will relieve this kind of cough.
Hyoscyamus is also to be considered as a remedy for sleeplessness. It is useful in the sleeplessness of children when they twitch in.sleep, cry out and tremble, and awaken frightened.
It is also a valuable drug in convulsions. It is one of the most reliable remedies we have for epileptic convulsions, that is if there is no other remedy indicated. In the Hyoscyamus convulsion, we find the patient twitching and jerking. These angular motions that I have described seem to be provoked by eating. Especially is this to be noted in children; the child will wake up from sleep hungry; the face is apt to be of a deep red color, almost on the purple. There are also frothing at the mouth, and biting of the tongue. These symptoms are almost always followed by profound sleep.
We have Hyoscyamus indicated also in chorea. The patients are very weak with tottering gait. They seem to have abnormal impressions of distances. They reach for something that seems to be just within their grasp when in reality, it is on the other side of the room.
STRAMONIUM is also a remedy to be thought of in chorea, particularly if the brain is affected. The child awakens from sleep with a scream. It sings and laughs without reason.
Still another remedy is VERATRUM VIRIDE, which is particularly indicated when there is great congestion in the nervous centres. The pulse is much overexcited.
Now let me speak of the fevers of Hyoscyamus. I have already given you the symptoms which would indicate the drug in typhoid fever. We have to see how we may apply it in the treatment of fevers with skin symptoms, as scarlatina. In scarlatina, Hyoscyamus is indicated although not very frequently; but yet it may be called for in cases that have been spoiled by Belladonna. The rash is of a miliary type and is dark or dark red in color. It is rather scanty, too, from partial repercussion. There are also picking at the bed-clothes, crying out in sleep, and stupor, all denoting the alarming progress made by the disease.
STRAMONIUM is indicated in scarlatina when we have violent symptoms present, something like those we have seen in Belladonna. The face is very red, the rash seems to be scattered over the surface, the prostration is excessive, the skin is apt to be very dry and hot without as much of the hot sweat as we found under Belladonna. If sweat does come, it does not relieve.
Now let us compare the three remedies, Belladonna, Stramonium and Hyoscyamus, one with the other. In general, we find that Belladonna causes more congestion or inflammation of the brain, Stramonium congestion with more sensorial excitement, and Hyoscyamus more nervous irritation with less congestion and inflammation than either of the others.
The type of the delirium in Belladonna is wild ; there is a desire to escape; the patient bites and strikes; the face is red, and the eyes suffused with violent throbbing of the carotids. He either complains of these hallucinations on closing the eyes or. he stares at one point with eyes WIDE open. Then too, there is sleepiness with inability to sleep. If there is stupor, it is rather the result of the congestion and inflammation of the brain, and is attended with some symptoms of irritation so that the patient when aroused is violent or he alternates between delirium and stupor, there being no evidence of serious blood changes.
Hyoscyamus has a similar desire to escape; the patient attempts to bite and strike those about him ; he has the same desire to uncover, but he lacks the violent throbbing of the carotids and intensity of the redness of the face and suffusion of the eyes. The Hyoscyamus patient has a particular aversion to light and has especially marked this fear of being poisoned or of being betrayed. Lying quietly in the bed, he suddenly sits up and looks around as if looking for some one whom he expected to see in the room. At a word from the nurse, he lies down again and goes off into a sleep. He may expose his sexual organs. His wakefulness is very different from that calling for Belladonna. He is nervous, whining, crying and twitching.
Hyoscyamus is used very extensively in insane asylums for acute non-inflammatory mania. These patients you find always weak; the pulse often lacks volume ; they either have no appetite whatever or else an enormous appetite. Eating is at once followed by an aggravation of the symptoms. Allopathic physicians use very largely the alkaloid Hyoscyamia. This is very similar to KALI BROMATUM, having the power of exciting the sensorium without inflaming the brain. Thus we find Kali bromatum indicated in the acute mania of children when they arouse from sleep with screams and imagine that some one is going to hurt them. The patient may also have the insane impression that he is to be murdered or that his honor is at stake, or that those in his house dislike him and intend to hurt him.
Hyoscyamus is particularly indicated in these cases if they are puerperal in their origin. We also find these symptoms of Hyoscyamus in typhoid fevers. The tendency you will see is to a low type of disease ; it is a more adynamic remedy than Belladonna.
Belladonna may be indicated in the beginning of the disease when there is the wild and furious delirium. Hyoscyamus comes in later when the stupor becomes more marked; when the patient picks at the bed-clothes or at his fingers in a somnolent sort of way, and occasionally he will reach out as if grasping for something in the air. You will find the tongue in such cases, dry and red; speech, of course, is difficult; and as the case progresses, we have the sordes on the teeth with involuntary stool and urine and dropping of the lower jaw. I would like to say here by way of caution that although a case for Hyoscyamus is clearly made out by these symptoms, yet it does not always act. I cannot tell you why. I can see no cause except that the drug does not act deep enough. In such cases, I usually look up LACHESIS, LYCOPODIUM, MURIATIC ACID and ARSENICUM.
Stramonium differs from Belladonna and Hyoscyamus. The patient sees objects which seem to rise in every corner of the room and move towards him. He has a mania for light and company, which is just the opposite to Belladonna, is excessively loquacious and laughs, sings, swears and prays almost in the same breath. The desire to escape is present; there is sudden spasmodic lifting of the head from the pillow and then dropping it again; he awakens from sleep in fright and terror, not knowing those around him; the motions that he makes are quite graceful and easy, although they may be violent. At times, the body is bathed in a hot sweat which does not give any relief to the patient. The desire to uncover is similar to that of Hyoscyamus, but it is more an uncovering of the whole body rather than of the sexual organs. The tongue is often soft, taking the imprint of the teeth ; screaming in sleep often with hiccough ; the face is usually bright red, but not as deeply congested as in Belladonna.