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Poisons, Drugs and Medicine: on the Use of Atropine and Scopolamine in Medicine and Ophthalmology: an Historical Review of Their Applications

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Poisons, Drugs and Medicine: on the Use of Atropine and Scopolamine in Medicine and Ophthalmology: an Historical Review of Their Applications Journal of Eye Study and Treatment ISSN: 2652-5046 10.33513/JEST/1901-13 OCIMUM Scholtz S et al. J Eye Stud Treat 2019(01): 51-58. Historical Review Poisons, Drugs and Medicine: On the Use of Atropine and Scopolamine in Medicine and Ophthalmology: An Historical Review of their Applications Sibylle Scholtz1*, Lee MacMorris1, Frank Abstract Krogmann1,2 and Gerd U Auffarth1 Purpose: For thousands of years all kinds of ingredients of plants were 1International Vision Correction Research Centre used to treat diseases. Among other highly active ingredients, plants like (IVCRC), Department of Ophthalmology, University belladonna, datura, henbane and mandrake contain alkaloids and even highly of Heidelberg, Heidelberg, Germany toxic alkaloids like atropine and scopolamine. Our article will show major 2General Manager and Member of Board of historical facts about the mentioned two drugs and the origin of their names. Directors, Julius-Hirschberg-Society, Vienna, The history of the discovery of atropine and scopolamine, Austria Methods: two highly poisonous alkaloids, was analysed and interpreted based on a selective literature research of books and journal articles via PubMed, Received: 13 June 2019 Google Scholar and Google. Accepted: 26 July 2019 Version of Record Online: 31 July 2019 Results: Both alkaloids, used in antiquity, are essential drugs in modern medicine. Atropine is an extremely potent poison and, as a medicine, was widely used in ancient times. Today it is still an essential drug in today’s Citation medicine and in ophthalmology. The name has its source in the legends of Scholtz S, MacMorris L, Krogmann F, Auffarth Greek mythology and refers to the Greek goddess, Atropos. Scopolamine is GU (2019) Poisons, Drugs and Medicine: On the named after its discoverer, Giovanni Antonio Scopoli, a Tyrolean physician Use of Atropine and Scopolamine in Medicine and and naturalist of the 18th century, who was the first to describe the plant Ophthalmology: An Historical Review of their from which the alkaloid “Scopolamine” was isolated: Scopolia carniolica. Applications. J Eye Stud Treat 2019(1): 51-58. The substance Scopolamine is used in ophthalmology and general medicine. Correspondence should be addressed to Discussion: Plants of the nightshade family, Solanaceae are true masters Sibylle Scholtz, Germany of chemical warfare. Even today alkaloids in medicine are indispensable E-mail: [email protected] drugs in medicine, also in ophthalmology. The name “atropine” has a long mythological history. Apart from its immense importance as a poison and a drug, even a kingdom was named after Atropos: Atropatene, which was Copyright located in the region of today’s Azerbaijan. Giovanni Antonio Scopoli, Copyright © 2019 Sibylle Scholtz et al. This is an as name giver for scopolamine was one of the most respected scholars of open-access article distributed under the Creative the 18th century. His interdisciplinary research has profited the fields of Commons Attribution License which permits ophthalmology, general medicine as well as botany. unrestricted use, distribution, and reproduction in any medium, provided the original author and Keywords work is properly cited. Alkaloids; Atropine; History of Ophthalmology; Ophthalmology; Scopolamine Journal of Eye Study and Treatment [ISSN: 2652-5046] Submit Manuscript .01. Citation: Scholtz S, MacMorris L, Krogmann F, Auffarth GU (2019) Poisons, Drugs and Medicine: On the Use of Atropine and Scopolamine in Medicine and Ophthalmology: An Historical Review of their Applications. J Eye Stud Treat 2019(1): 51-58. DOI: 10.33513/JEST/1901-13 Introduction The dark side of “belladonna” - Antique Greek Mythology meets biology, chemistry - and Using the ingredients of plants to treat diseases has been known for thousands of years. Time and again, young people especially, medicine who are in search of legal drugs, tend to use plants containing In Greek mythology she was the oldest of the three Moirai, the psychoactive ingredients, including angel’s trumpets, datura, personification of the “inevitable”. She chose the mechanism of belladonna and other representatives of the nightshade family the death of each mortal, by cutting the thread of life, which Solanaceae. The alkaloids of these plants, like atropine and her sister Clotho has spun and Lachesis had measured (Figure scopolamine, lead to drowsiness, intoxication and hallucinations 1) [1-9]. She lent her name to an ancient kingdom, a poisonous of flying. They can be obtained quite easily. While these plants plant and a hawk moth. Atropos, the daughter of Zeus, one of grow wild by the roadside, they are popular as ornamental the three Moirai, the goddesses of fate and destiny, from whom plants. What nature offers, however, is by no means, harmless. the legendary poison has its name: Atropine, an alkaloid of Solanaceae are considered as highly toxic - as well as they can the deadly nightshade, Atropa belladonna (Figures 2,3) [1-3]. be essential drugs in medicine. Scopolamine also acts as a Atropine is an extremely potent poison and still an essential parasympatholytic, but in comparison to atropine, rather drug in today’s medicine [10-13]. The name has its source in calming and muffling. It provides a state of lack of will and the legends of Greek mythology [1-3,14,15]. apathy, similar to hypnosis. It was once used as a truth drug [1-5]. Figure 1: The Triumph of Death, or The Three Fates [16]. Submit Manuscript Journal of Eye Study and Treatment [ISSN: 2652-5046] .02. Citation: Scholtz S, MacMorris L, Krogmann F, Auffarth GU (2019) Poisons, Drugs and Medicine: On the Use of Atropine and Scopolamine in Medicine and Ophthalmology: An Historical Review of their Applications. J Eye Stud Treat 2019(1): 51-58. DOI: 10.33513/JEST/1901-13 Figure 2: Chemical structure of (S)- and (L)-Hyoscyamine [17]. Figure 3: Atropa belladonna, fruits [17]. Journal of Eye Study and Treatment [ISSN: 2652-5046] Submit Manuscript .03. Citation: Scholtz S, MacMorris L, Krogmann F, Auffarth GU (2019) Poisons, Drugs and Medicine: On the Use of Atropine and Scopolamine in Medicine and Ophthalmology: An Historical Review of their Applications. J Eye Stud Treat 2019(1): 51-58. DOI: 10.33513/JEST/1901-13 With the pattern of a skull on its back, the Latin name of The physiological effect of atropine was scientifically proved the death’s head hawk moth (Acherontia atropos) reminds in 1819 when the German chemist F. Runge described the one of the deadly effects of Atropos [18]. The Latin name of pupil-dilating effect of extracts of the deadly nightshade in deadly nightshade, Atropa belladonna and its poison atropine his dissertation. In 1831, the pharmacist Mein succeeded remind one of Zeus’ daughter. The byname “belladonna” in preparing atropine in pure crystalline form. Geiger and means “beautiful lady”, since in the Middle Ages the juice Hesse isolated in 1833 hyoscyamine from the plants and in of the berries was used cosmetically to enlarge women’s the same year Merck (Darmstadt) started the production of pupils to make them more beautiful [1-5]. The chemistry is atropine by processing the roots of deadly nightshade [11- confusing: atropine is a mixture of two isomeric varieties of 13,19-25,29,31-34]. the hyoscyamine molecule (right- and left-turning) (Figure 2). In nature, only l-hyoscyamine occurs in Solanaceae, which In 1863, the chemical structure of the alkaloid was defined is the pharmacologically active substance. After isolation it and 1866 Bernstein described its mydriatic effect. Since becomes a racemic mixture of d- and l-hyoscyamine, which 1867, extracts of deadly nightshade have been administered is called atropine. Birds can consume the berries of the deadly with Parkinson (“Bulgarische Kur” [35] [“Bulgarian Cure”, nightshade without being harmed, humans cannot do so. translation by authors]). 1872 it was found that atropine Generally, 3 to 4 berries with children, 10 to 12 berries with could inhibit salivation and 1878 its effect on the intestines adults are considered to be lethal [12,13,19-23]. was discovered. In 1901, Richard Willstätter first synthesized atropine. The production of atropine-sulfate made clinical In ancient times, atropine was widely used in medicine, e.g. as application possible [11-13,19-23,25,31-34]. analgesic for hepatitis, edema, scarlet fever and mental diseases as well as a poison. The poisonous effect on the parasympathetic Today ingredients of deadly nightshades are no longer used nervous system has been known for a long time. Attalos III. in popular medicine. As atropine binds to muscarine type of (171-133 B. C.) grew Solanaceae and proved its effect with receptors in the iris it is used in uveitis or iritis treatment to animals and with persons condemned to death. dilate the pupil which relieves the pain. The sympatholytic function can cause, especially in small children in hot countries Atropine is part of the “belladonna” extract that young overheating leading to death. Nevertheless, there is an increase women in ancient Venice applied to their eyes in order to of intoxication incidents caused by abuse of hallucinogenic have “beautiful” dilated pupils. In antiquity the berry of the drugs [36]. For certain clinical pictures atropine is still a deadly nightshade traditionally was used as analgetic and in the widely used, indispensable drug, especially in emergency Eastern world it was added to beer and wine. Theophrastus of medicine. It can serve as treatment of insecticide poisoning Eresos knew “Atropa” as poison and mydriatic. Atropine was and as an antidote for nerve gases. In the preparation for an also responsible for the outcome of a war. The Scottish king operation, atropine lowers the activity of glands, reduces Duncan I. used “Atropa” as toxic agent against the Norwegian the seizures of the smooth muscles and, is generally used in enemies by poisoning their food and thus winning the battle. ophthalmology to dilate the pupil and inhibit accommodation Both in the works of Hildegard von Bingen in the 12th century [11-13,37].
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