To the Editor:-The following material is meant to complement Holzman's article on Atropos. [1]Datura stramonium, from the Greek strychnomanikon (causing madness), [2]is another of the atropine-containing herbals.

It is said that Apollo's priestess Pythia, under the influence of Datura, had her incoherent responses interpreted by a priest. [3]Dioscorides was also familiar with Datura [4]:

The root being drank with ye quantity of a dragm, hath ye power to effect not unpleasant fantasies. But 2 dragms being drunk, make one beside himself for three days & 4 being drank kill him. But ye remedy of this is Melicrate, much being drank, & vomited up again.

Porta's Magia Naturalis mentions the belladonna alkaloids as useful for making people "... mad for a day, without injuring their health in anyway, for the amusement of guests at feasts." [5] 

One must be careful extrapolating animal data to humans. Cat, rat, and rabbit livers have a rapid rate of atropine metabolism. In addition, 20-25% of rabbits have an atropine esterase [6]capable of inactivating from 1 mg to 20 mg of atropine/cm3serum. No human correlate exists. [7] 

Atropine's mydriatric effects have been used clinically. Hughlings Jackson distinguished belladonna poisoning from postepileptic delirium by placing a drop of the patient's urine into a cat's eye. Subsequent rapid dilatation of the cat's pupil confirmed the diagnosis. [8]Birds may not be substituted, as their irides are composed of striated muscle. [9] 

Atropine toxicity therapy had a surreptitious origin. During medical school, Forrer [10]saw a patient become comatose after receiving presumed procaine for local anesthesia. He later initiated atropine toxicity therapy (32-200 mg atropine sulfate, 4 days a week, for 6-30 treatments) for psychiatric therapy. Patients often had hallucinations and disturbing illusions before going into coma. [11]Similar treatments were also used for Parkinson disease, [12]with up to 195 mg hyoscine (scopolamine) used. [13] 

In 1700, the founder of American psychiatry dealt with Datura. [14]Sixty years later, Storck hinted at the psychiatric use of Datura:

If the thornapple, by disordering the mind, causes madness in sound persons, may we not try whether, by changing and disturbing the ideas and common sensory, it might not bring the insane, and persons bereft of their reason, to sanity, or soundness of mind, and, by a contrary motion, remove convulsions in the convulsed. [15] 

The classic description of anticholinergic poisoning is: "hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hen." [16] 

Several of Datura nicknames have dark overtones: Devil's apple, Devil's trumpet, herbe aux sorciers au de diable. [17] 

Gerard notes that Datura is "of greate use in surgery" and "of a drowsie and numming, qualitie, not inferior to Mandrake." He also relates Theocritus' observations: "... even all the Colts and agile Mares in mountains mad do fall." [18] 

Other examples of atropine in the popular literature are Castaneda's use of Datura inoxia ointment [19]and Hawthorne. [20] 

Finally, Datura was used as an anesthetic [21]42 years and 3 days before the famous events of the Ether Dome. [22] 

David C. Lai, M.D.

Visiting Instructor; Department of Anesthesiology; University of Rochester Medical Center; Rochester, New York;; Currently: Instructor in Anaesthesia; Harvard Medical School; Attending Faculty in Anaesthesia; Beth Israel Deaconess Medical Center; Boston, Massachusetts;

(Accepted for publication February 6, 1999.)

Holzman RS: The legacy of Atropos, the Fate who cut the thread of life. Anesthesiology 1998; 89:241-9
Millspaugh CF: American Medicinal Plants. New York, Dover Publications, 1974, pp 498-50
Burger A, Wolff ME: Burger's Medicinal Chemistry, 4th Edition. Edited by Wolff ME. John Wiley & Sons, New York, 1981
Gunther RT: The Greek Herbal of Dioscorides, Englished by John Goodyer, A.D. 1655. New York, Hafner Publishing Company, 1968, p 470
Straub W: Lane Lectures on Pharmacology: Intoxicating Drugs. Stanford, Stanford University Press, 1931, pp 18-21
Godeaux J, Tonnesen M: Investigations into atropine metabolism in the animal organism. Acta Pharmacol Toxicol 1949; 5:95-109
Pilcher JD: Atropine tolerance in infants and children: The negative action of the serum of tolerant subjects. J Pharmacol Exper Ther 1934; 52:196-205
Coates W: Belladonna poisoning. BMJ 1947; 2:886
Lumb WV: Small Animal Anesthesia. Philadelphia, Lea & Febiger, 1963, p 93
Forrer GR: Symposium on atropine toxicity therapy: History and future research. J Nerv Ment Dis 1956; 124:256-64
Miller JJ: Symposium on atropine toxicity therapy: Pharmacology, procedure and techniques in atropine toxicity treatment of mental illness. J Nerv Ment Dis 1956; 124:260-4
Hall AJ: The results of high atropine dosage in chronic epidemic encephalitis, with comments. BMJ 1937; 1:795-9
Cohen H, Craw JW: High hyoscine dosage in chronic encephalitis. BMJ 1937; 1:996
Rush B: An account of the effects of the stramonium, or thornapple. Clin Pediatr 1973; 12:50-3
Gunn J: Gunn's Domestic Medicine or Poor Man's Friend, 4th Revised Edition. New York, Saxton & Miles, 1844, pp 628-34
Morton HG: Atropine intoxication: Its manifestations in infants and children. J Pediatr 1939; 14:755-60
Dunglison R: Dunglison's Medical Dictionary. Philadelphia, Henry C. Lea, 1874, p 293
Gerard J: The Herball or General Historie of Plantes. London, Norton & Whitakers, 1633, pp 347-9
Castaneda C: The Teachings of Don Juan: A Yaqui Way of Knowledge. New York, Pocket Books, 1974
Khan JA: Atropine poisoning in Hawthorne's The Scarlet Letter. New Eng J Med 1984; 311:414-6
Matsuki A: Seishu Hanaoka; A Japanese pioneer in anesthesia. Anesthesiology 1970; 32:446-50
Matsuki A: The correct date of the first general anesthesia. Anesthesiology 1973; 39:565