Belladonna is found in all parts of the herb Atropa belladonna (known as the “deadly nightshade” plant). It represents a composite of mostly atropine, scopolamine, and hyoscyamine. These three compounds are categorized chemically as “alkaloids” and pharmacologically as “antimuscarinic” and “anticholinergic” drugs. Belladonna has been used as a cosmetic, medicine, and poison for centuries. The belladonna components have characteristic toxicities that can result from ordinary medicinal use and from intentional and accidental poisonings. The toxicities of the belladonna compounds are many and complex. The late, Croation novelist, Daša Drndić, in her novel Belladonna, imagines what it could be like to experience belladonna self-poisoning through the main character in the book. Her character experiences about all the possible effects of belladonna in an apparent suicide attempt, and so she provides a full elaboration on the biomedical descriptions of belladonna poisoning.
Drndić’s book offers an opportunity to compare three classic biomedical descriptions of belladonna poisoning—one from a leading pharmacology textbook, one from a leading toxicology textbook, and one from a published case report of a poisoning—with a literary description of belladonna toxicity.
The Biomedical
From Goldfrank’s Toxicologic Emergencies, 11th edition, New York, McGraw Hill; 2019.
The belladonna alkaloids have potent antimuscarinic effects, manifested by tachycardia, hyperthermia, dry skin and mucous membranes, skin flushing, diminished bowel sounds, urinary retention, agitation, disorientation, and hallucinations…The onset of symptoms typically occurs one to 4 hours postingestion, and more rapidly if the plants are smoked or consumed as a brewed tea. The duration of effect is partly dose dependent and may last from a few hours to days.
Chapter 118 (via AccessPharmacy)
From Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th Edition, New York, McGraw-Hill, 2017.
Small doses of atropine depress salivary and bronchial secretion and sweating. With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited, and vagal effects on the heart are blocked so that the heart rate increases. Larger doses antagonize parasympathetic control of the urinary bladder and GI tract, thereby inhibiting micturition and decreasing intestinal tone and motility. Still larger doses…inhibit gastric motility and particularly secretion, [and can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma.
p. 153
The clinical picture of a high (toxic) dose of atropine may be remembered by the old mnemonic device that summarizes the symptoms: Red as a beet, Dry as a bone, Blind as a bat, Hot as a firestone, and Mad as a hatter.
From a published case history of a married couple poisoned accidentally when they consumed a pie with deadly nightshade berries they had picked. Reported in: Southgate HJ, Egerton M, and Dauncey EA. Lessons to be learned: a case study approach: Unseasonal severe poisoning of two adults by deadly nightshade (Atropa belladonna). Journal of the Royal Society for the Promotion of Health. 2000;120(2):127-130.
On admission the woman was agitated and disorientated [sic] and seemed grasping at imaginary objects. She muttered incoherently and was retching. She was hypertonic, hyperreflexic and had bilateral up-going plantar responses. Clinical examination revealed neck stiffness. Blood pressure was 130/80 mm/Hg and the pulse was regular at 100/min. Her pupils were fixed and dilated. She was sweating profusely and her temperature was 38°C. Her husband was in a similar state, being confused and highly agitated. Signs of vomit were present around the mouth. He, too, was sweating profusely and had a temperature of 38°C. The pulse was regular at 110/min and blood pressure was 150/90 mm/Hg. He was hypertonic, had brisk reflexes and the plantar response was up-going on one side. Both pupils were dilated, equal and responded slowly to bright light…He, as his wife also did, showed neck stiffness. Neither of them displayed photophobia, but both appeared to be hallucinating.
p. 128
The Literary
From Belladonna by Daša Drndić, translated by Celia Hawkesworth, New York, New Directions, 2017.
The main character in this novel, Andreas Ban, looks back over his life and details the many pains he experienced. Some of the pain was physical from cancer, spinal degeneration, and other chronic ailments. Some of the pain was psychic from searing losses (wife, mother), battles with health care institutions, banishments from jobs in academia and journalism, and memories of atrocities during World War II and the break up of Yugoslavia. Without stating why, Andreas acquires a supply of belladonna leaves and berries. Here are excerpts describing what happens to him as he poisons himself with belladonna over the course of an unspecified period of time, probably several hours.
Andreas settles into his gray armchair, takes the dried belladonna leaves…, crumbles them and fills his pipe…Now he puffs it.
Mild dizziness.
Tachycardia.
His pulse quickens.
His face burns.
p. 361
Andreas Ban eats the sweetened belladonna berries. Slowly, one by one, six of them.
His lips become dry.
His vision clouds.
The pain in his back eases.
pp. 362
One berry.
In the distance, someone whispers. Who is whispering? The voice is familiar but distorted…The voice comes closer, slips under the door and rises, stands upright and sways…It is a voice in lines, a voice resembling a prisoner, except that its stripes are red-black with little green dots in between. I am a musical voice, says the voice. Andreas Ban recognizes the voice of Strauss.
His mouth is full of saliva.
Perspiration.
Vertigo.
pp. 362-363
Two berries.
Pain in his eyes. Pulsing in his eye sockets. His eyes sting. The light sends arrows like the prickles of little albino hedgehogs into their whites. His lids flutter. They will not close…
…Through the closed windows enter gigantic crabs…The crabs cover the room…One clambers onto Andreas Ban’s chest. Andreas Ban gets up with difficulty, I’ll nip off your nose, says the crab on his chest, I’ll gouge out your eyes, I’ll break your hips. The other crabs are devouring the room.
pp. 363
Five berries.
Piercing pain in his ears. His parotid glands pulsate, swell. An unbearable din in his head.
The tip of his nose tickles. His nose is red and swollen, blood drips from it.
Andreas Ban would like to say something, words will not come out. They come in waves, from his stomach, a whole ball of hairy words rolls in Andreas Ban’s mouth as though he is about to vomit but they just fall onto his tongue and sink.
p. 363
Four berries.
The radio comes on suddenly. Out of it leaps a Chinese circus with two monkeys and a little curly-haired dog. The Chinese have pigtails and they sing women’s opera arias. Andreas Ban cannot decipher them, a great din.
Pain in his teeth. His gums itch, bleed. His teeth chatter.
His stomach clenches. Nausea.
Small tortoises clamber up toward Andreas Ban’s knees, then the twenty small tortoises line up along Andreas Ban’s tights and settle there. The twenty small bald tortoises raise their heads at the same time and stare at Andreas Ban. All the small tortoises’ faces are Elvira’s face [his late wife], twenty little Elviras smile at Andreas Ban.
His tongue is growing. It is like a gigantic strawberry.
Pain in his spine.
Pain in his stomach. He cannot cough.
Pain in his rectum.
p. 364
Six berries
A window pane shatters, a miniature bronze Glenn Gould falls at Andreas Ban’s feet from the sky, he takes a white piano and his piano stool out of his back pocket, and starts playing Brahms in yellow gloves. You’ve warmed the room up brilliantly, he says, I like it like this. That lasts a while.
p. 364
Three berries.
Andreas Ban has shat himself. A thin green stool spreads over his behind, slips down to his knees. Andreas wets his pants. Worms wriggle in his penis.
On the floor lies an enormous treble clef, splattered with muddy earth. The treble clef stands up and twists, in spasms. It dances. My name is Tranquility, it says. I was exhumed in Transylvania. Three times.
A shaggy white dog lifts its leg and pees against the wall of Andreas’s room…The white dog is sleeping on the rug that Glenn Gould has neglected to take away…Andreas falls onto his knees and eats the dog’s food out of the silver dog bowl.
p. 365
Four berries.
His testicles are hard. Swollen.
His breathing is uneven, spasmodic, rapid. A raising cough causes pain in his left hip. Andreas Ban spits out a blood clot.
Palpitations. His heart drums in his head. His heart swells uncontrollably.
A hearse carries a coffin to an open grave. The road is rutted and the coffin jolts at an indecorously crooked angle. A yellow brocade cover with gold tassels pokes out of the coffin. The cemetery has hillocks overgrown with mauve grass. Through the cemetery float boats full of shoes…Out of the shoes sprout sunflowers.
p. 365-366
Three berries.
His knuckles are shiny, streaked with red lines, they rise like dough.
Jerking of his arms and legs.
His neck stiffens.
p. 366
One berry.
Waterfalls gush down the windows. Out of the floor rises snow, it winds like a stalk and moves toward Andreas. It wraps around him, he is tied in snow chains, he cannot breathe.
His body temperature rises. Thirty–nine degrees.
I am an immortal unicorn, I am looking for my lost brothers who are lying at the bottom of the sea, says a blue animal speckled with the little gold stars. Andreas Ban moves the gold stars, one by one, from the blue unicorn, and sticks them over himself. He is all golden and starlike.
p. 366
Three berries.
His fingers are stiff. They tremble.
Shaking. Convulsions. His carotid glands pulsate. Madness in his eyes. His eyes are sightless.
Andreas Ban sways backward and forward like a paranoid schizophrenic. He waves, catches a ball, swivels his fingers, picks through wheat.
p. 366)
One more berry.
Lilliputians…jump all over Andreas Ban, slip into his trousers, into his pockets, his socks, under his eyelids, they slide down his back and snatch his berries…Andreas Ban defends himself from the Lilliputians’ attack, he yells, but produces no sound…
Then he loses consciousness.
Andreas Ban lies on the floor, soiled, wet, and blind.
p. 367
The table below compares corresponding excerpts from the biomedical and literary texts.
| Biomedical Text | Literary Text |
| Iconic mnemonic: Red as a beet, Dry as a bone, Blind as a bat, Hot as a firestone, and Mad as a hatter.(Goodman & Gillman) | |
| The belladonna alkaloids have potent antimuscarinic effects, manifested by tachycardia, hyperthermia, dry skin and mucous membranes, skin flushing… The onset of symptoms typically occurs one to 4 hours postingestion, and more rapidly if the plants are smoked or consumed as a brewed tea. (Goldfrank) Red as a beet, hot as a firestone | Andreas settles into his gray armchair, takes the dried belladonna leaves…, crumbles them and fills his pipe…Now he puffs it.Mild dizziness.Tachycardia.His pulse quickens.His face burns. |
| Small doses of atropine depress salivary and bronchial secretion and sweating. With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited… (Goodman & Gilman) Dry as a bone, blind as a bat | Andreas Ban eats the sweetened belladonna berries. Slowly, one by one, six of them. His lips become dry.His vision clouds. The pain in his back eases. |
| On admission the woman was agitated and disorientated [sic] and seemed grasping at imaginary objects. She muttered incoherently and was retching. (case study) Mad as a hatter | One berry. In the distance, someone whispers. Who is whispering? The voice is familiar but distorted…The voice comes closer, slips under the door and rises, stands upright and sways…It is a voice in lines, a voice resembling a prisoner, except that its stripes are red-black with little green dots in between. I am a musical voice, says the voice. Andreas Ban recognizes the voice of Strauss.His mouth is full of saliva.Perspiration.Vertigo. |
| With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited… Still larger doses…[can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma. (Goodman & Gilman) Blind as a bat, mad as a hatter | Two berries. Pain in his eyes. Pulsing in his eye sockets. His eyes sting. The light sends arrows like the prickles of little albino hedgehogs into their whites. His lids flutter. They will not close……Through the closed windows enter gigantic crabs…The crabs cover the room…One clambers onto Andreas Ban’s chest. Andreas Ban gets up with difficulty, I’ll nip off your nose, says the crab on his chest, I’ll gouge out your eyes, I’ll break your hips. The other crabs are devouring the room. |
| Her husband was in a similar state, being confused and highly agitated…Both pupils were dilated, equal and responded slowly to bright light…He, as his wife also did, showed neck stiffness…both appeared to be hallucinating. (case study) Blind as a bat, mad as a hatter | Five berries. Piercing pain in his ears. His parotid glands pulsate, swell. An unbearable din in his head.The tip of his nose tickles. His nose is red and swollen, blood drips from it.Andreas Ban would like to say something, words will not come out. They come in waves, from his stomach, a whole ball of hairy words rolls in Andreas Ban’s mouth as though he is about to vomit but they just fall onto his tongue and sink. |
| Small doses of atropine depress salivary and bronchial secretion and sweating. Larger doses antagonize parasympathetic control of the urinary bladder and GI tract, thereby inhibiting micturition and decreasing intestinal tone and motility. Still larger doses…inhibit gastric motility and particularly secretion, [and can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma. (Goodman and Gilman) Dry as a bone, hot as a firestone, mad as a hatter | Four berries. The radio comes on suddenly. Out of it leaps a Chinese circus with two monkeys and a little curly-haired dog. The Chinese have pigtails and they sing women’s opera arias. Andreas Ban cannot decipher them, a great din.Pain in his teeth. His gums itch, bleed. His teeth chatter.His stomach clenches. Nausea.Small tortoises clamber up toward Andreas Ban’s knees, then the twenty small tortoises line up along Andreas Ban’s tights and settle there. The twenty small bald tortoises raise their heads at the same time and stare at Andreas Ban. All the small tortoises’ faces are Elvira’s face [his late wife], twenty little Elviras smile at Andreas Ban.His tongue Is growing. It Is like a gigantic strawberry.Pain in his spine.Pain in his stomach. He cannot cough.Pain in his rectum. |
| Mad as a hatter | Six berries. A window pane shatters, a miniature bronze Glenn Gould falls at Andreas Ban’s feet from the sky, he takes a white piano and his piano stool out of his back pocket, and starts playing Brahms in yellow gloves. You’ve warmed the room up brilliantly, he says, I like it like this. That lasts a while. |
| Still larger doses…inhibit gastric motility and particularly secretion, [and can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma… (Goodman and Gilman) Mad as a hatter | Three berries. Andreas Ban has shat himself. A thin green stool spreads over his behind, slips down to his knees. Andreas wets his pants. Worms wriggle in his penis.On the floor lies an enormous treble clef, splattered with muddy earth. The treble clef stands up and twists, in spasms. It dances. My name is Tranquility, it says. I was exhumed in Transylvania. Three times.A shaggy white dog lifts Its leg and pees against the wall of Andreas’s room…The white dog is sleeping on the rug that Glenn Gould has neglected to take away…Andreas falls onto his knees and eats the dog’s food out of the silver dog bowl. |
| Small doses of atropine depress salivary and bronchial secretion and sweating. With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited, and vagal effects on the heart are blocked so that the heart rate increases. With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited, and vagal effects on the heart are blocked so that the heart rate increases. (Goodman and Gilman) Dry as a bone, blind as a bat, mad as a hatter. | Four berries. His testicles are hard. Swollen.His breathing is uneven, spasmodic, rapid. A raising cough causes pain in his left hip. Andreas Ban spits out a blood clot.Palpitations. His heart drums in his head. His heart swells uncontrollably.A hearse carries a coffin to an open grave. The road is rutted and the coffin jolts at an indecorously crooked angle. A yellow brocade cover with gold tassels pokes out of the coffin. The cemetery has hillocks overgrown with mauve grass. Through the cemetery float boats full of shoes…Out of the shoes sprout sunflowers |
| He was hypertonic, had brisk reflexes and the plantar response was up-going on one side. Both pupils were dilated, equal and responded slowly to bright light…He, as his wife also did, showed neck stiffness. (case study) Blind as a bat | Three berries. His knuckles are shiny, streaked with red lines, they rise like dough.Jerking of his arms and legs.His neck stiffens. |
| The belladonna alkaloids have potent antimuscarinic effects, manifested by tachycardia, hyperthermia, dry skin and mucous membranes, skin flushing, diminished bowel sounds, urinary retention, agitation, disorientation, and hallucinations. (Goldfrank) Dry as a bone, hot as a firestone, mad as a hatter. | One berry. Out of the floor rises snow, it winds like a stalk and moves toward Andreas. It wraps around him, he is tied in snow chains, he cannot breathe.His body temperature rises. Thirty–nine degrees.I am an immortal unicorn, I am looking for my lost brothers who are lying at the bottom of the sea, says a blue animal speckled with the little gold stars. Andreas Ban moves the gold stars, one by one, from the blue unicorn, and sticks them over himself. He is all golden and starlike. |
| Small doses of atropine depress salivary and bronchial secretion and sweating. With larger doses, the pupil dilates, accommodation of the lens to the near vision is inhibited, and vagal effects on the heart are blocked so that the heart rate increases. Still larger doses…[can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma. (Goodman & Gilman) Dry as a bone, blind as a bat, mad as a hatter. | Three berries. His fingers are stiff. They tremble.Shaking. Convulsions. His carotid glands pulsate. Madness in his eyes. His eyes are sightless.Andreas Ban sways backward and forward like a paranoid schizophrenic. He waves, catches a ball, swivels his fingers, picks through wheat. |
| Larger doses…[can cause] ataxia, restlessness, and excitement; hallucinations and delirium; coma. (Goodman & Gilman) Mad as a hatter | One more berry. Lilliputians…jump all over Andreas Ban, slip into his trousers, into his pockets, his socks, under his eyelids, they slide down his back and snatch his berries…Andreas Ban defends himself from the Lilliputians’ attack, he yells, but produces no sound…Then he loses consciousness. Andreas Ban lies on the floor, soiled, wet, and blind. |
Also:
Photo: Atropa Belladonna (deadly nightshade)
Credit: Smithsonian Institution (National Gallery of Art)
https://www.si.edu/es/object/nmnhbotany_10338323
