SIR, It may be useful to other practitioners to record the following recent case.
A 19-year-old trainee teacher presented in surgery experiencing some vivid and alarming hallucinations. He was hyperactive, disorientated, garrulous, and very anxious. He had motorcycled to the surgery and reported that he had had difficulty 'negotiating a path through the white lines on the roads, which had been jumping about and lashing at his legs. On closer examination his pupils were dilated, he had a warm periphery, a tachycardia of 104/min, blood pressure 100/70 mm Hg, and hyperreflexia.
Initially he denied taking any medication but had brought a sample of vomitus in a 35-mm film container by way of supplementary medical evidence. The box contained the remains of a cigarette which was, he later admitted, an asthma cure given to him by some friends. When asked how many he had smoked, he, incredulous at his medical adviser's naivety, replied that they were to be swallowed, not smoked, and that he had taken one and a half. It transpired that he had become associated with a group of students who were experimenting with various drugs and that the ingestion of patent stramonium-containing asthma cigarettes was their latest discovery. It took 48 hours for this patient to recover completely. He received no specific treatment but simple supportive nursing care in the college sick bay. On recovery he was sufficiently scared by the experience for it to be a deterrent for the future.
The use of Datura stramonium (thorn apple of Jimson weed) for the anticholinergic properties of its principal alkaloids (hyoscyamine, hyoscine, and atropine) is centuries old. The medicinal effects are obtained by smoking, inhaling, ingesting, or drinking an infusion of the plant. Its chief uses have been in treating bronchospasm and for its psychotropic effects.
Reports of intoxication (including some fatal cases') have been published more often in the USA than here.'4 However, seven cases have been reported in Britain-7 in which abuse of stramonium-containing cigarettes has occurred. Unpleasant hallucinations were characteristic.
It would be complacent to assume that the horror of the hallucinations is sufficient to dissuade further abuse of the cigarettes. Presumably those who experience enjoyable hallucinations never seek medical advice and continue with the habit.
Whereas restricting the free sale of traditional and well-tried remedies imposes further on our personal freedom, I believe there is a case for making cigarettes containing stramonium less easily available, perhaps by requiring a register of the purchases, as is now the practice for other patent- medicines.
R G H BETHEL
Old Windsor, Berks
1 Mikolich, J R, et al, Annals of Internal Medicine, 1975, 83, 321.
2 Dean, E S,J7ournal of the American Medical Association, 1963, I85, 882.
3 Goldsmith, S R, et al,_Journal of the American Medical Association, 1968, 204, 169.
4 Gowdy, J M, Journal of the American Medical Association, 1972, 221, 585.
5 Harrison, E A, and Morgan, D H, British Medical Journal, 1976, 2, 1195.
6 Ballantyne, A, et al, British Medical Journal. 1976, 2, 1539.
7 Barnett, A H, et al, British Medical J7ournal, 1977, 2, 1635.