Pilocarpus (U. S. P.)—Pilocarpus.
The leaflets of Pilocarpus Selloanus, Engler (Rio Janeiro Jaborandi), and of Pilocarpus Jaborandi, Holmes (Pernambuco Jaborandi) "—(U. S. P.).
COMMON NAME: Jaborandi.
ILLUSTRATIONS: Pilocarpus Jaborandi—Pharm. Jour. Trans., 3d series, Vol. V, 1874-75, p. 582; and H. Geiger, Berichte der Deutsch. Pharm. Ges., 1897, p. 424, Plates. P. Selloanus and P. pennatifolius—Pharm. Jour. Trans., 4th series, Vol. I, p. 521.
Botanical Source and History.—The jaborandi shrub is a native of Brazil, and grows to the height of from 6 to 10 feet. The genus is represented by about 19 described species, for an enumeration of which, see Pharm. Jour. Trans., Vol. I, 1895, p. 541. They are natives of South America and the West Indies. Jaborandi was introduced to the medical profession by Dr. S. Coutinho, of Pernambuco, in 1874. The leaves were examined by Prof. Baillon, and the plant referred to the Pilocarpus pennatifolius of Lemaire, described by him, in 1852. Engler (1874) states that its leaves are pilose (hairy) beneath, while E. M. Holmes (1875) calls attention to the fact that commercial leaves are glabrous (devoid of hair). However, not much importance can be attached to this distinction, because Planchon (1875) has observed that the leaves of Pilocarpus pennatifolius, grown in Paris, may occur partly in the glabrous, partly in the pilose form. In 1875 (Pharm. Jour. Trans., Vol. V, pp. 581 and 641), Mr. E. M. Holmes referred one of the two grades then in commerce (Rio Janeiro jaborandi) to Pilocarpus Selloanus, Engler, and, in 1893 (ibid., Vol. XXIII, p. 1008; also, ibid., Vol. I, 1895, p. 520) established for the other (Pernambuco jaborandi) a new species, Pilocarpus Jaborandi, Holmes, which be described from a specimen grown in the Cambridge Botanical Garden.
Engler's botanical description of P. Selloanus, as communicated by E. M. Holmes, is as follows: The stem is covered with thin, purple bark, and leafy toward the apex. The leaves are imparipinnate. The petiole of the leaf is semiterete, flattened a little above, quite glabrous. The leaflets are trijugate, oblong, distinct, nearly equal, obtuse, margin reflexed, membranaceous or subcoriaceous, grayish-green, quite glabrous on both sides, pellucid-punctate; mid-rib sulcate above, very prominent beneath; lateral nerves rather prominent beneath; petiole of leaflets short. The raceme is terminal, nearly three times longer than the leaves, terete, purple, quite glabrous, with slender pedicels, horizontally patent and slightly hairy, six times longer than the buds, and furnished at the middle and base with 2-minute, ciliolate bracts. The calyx is very short, with broad, rounded lobes, which are ciliolate. The petals are coriaceous, lanceolate, acute, furnished with a prominent mid-rib, inflexed at the upper margin and at the apiculus. The stamens are shorter than the petals. The ovary is depressed, globose, very smooth; half included in the disk, and crowned with a short, rather thick style (Pharm. Jour. Trans., Vol. V, 1875, p. 641).
The new species, P. Jaborandi, Holmes, differs from P. Selloanus, to which it is most nearly allied, in having 4 pairs of leaflets; in the elliptic-oblong shape of the leaflets and their more fleshy consistence; in the veinlets being more prominent on the upper surface; in the slender, glabrous pedicels, only three times longer than the leaf-buds; in the minute bracts, being situated near the apex of the pedicel; in the rose color of the ovate petals, pedicels, and upper part of rachis; and in the rugose-crenate disc. The calyx is pentagonal, not lobed (Pharm. Jour. Trans., Vol. XXII, 1892, p. 875).
The subsequent investigations of E. M. Holmes (ibid., 1895, pp. 520 and 539), and, more lately, those of H. Geiger (Berichte der Deutsch. Pharm. Ges., 1897, pp. 356 and 425), have shown that commercial jaborandi leaves, at present in the market, are to be referred to the following 5 species:
- P. Jaborandi, Holmes (Pernambuco jaborandi), identical with P. officinalis (Poehl, 1879);
- P. pennatifolius, Lemaire (Paraguay jaborandi), which, according to Geiger, is identical with P. Selloanus, Engler;
- P. trachylophus, Holmes (Ceara jaborandi);
- P. microphyllus, Stapf (Maranham, or Small jaborandi); and
- P. spicatus, Saint-Hilaire (Aracati jaborandi).
In 1896, a spurious jaborandi was referred, by Holmes, to a hitherto unknown plant, Swartzia decipiens. The nomenclature, according to the places of export, as adopted by Holmes, is abandoned by Geiger, because the commercial bales rarely even contain leaves of a single species.
Description.—Official jaborandi is thus described by the U. S. P: "About 10 to 15 Cm. (4 to 6 inches) long, and 4 to 6 Cm. (1 ⅔ to 2 ¼ inches) broad, short-stalked, oval or ovate-oblong, entire, and slightly revolute at the margin, obtuse and emarginate, unequal at the base; dull-green, coriaceous, pellucid-punctate, mostly smooth; when bruised slightly aromatic; taste somewhat bitter and pungent"—(U. S. P). Commercial jaborandi is usually mixed with leaf-stalks, twigs, and bark. The leaflets are almost odorless when entire; have a slightly aromatic taste, followed by a persistent acridity. (For a comparative histological study of jaborandi leaves, see Albert Schneider, Journal of Pharmacology, 1897, p. 141.)
Chemical Composition.—The active principle of jaborandi leaves is the alkaloid pilocarpine, which was discovered almost simultaneously by E. Hardy, in France, and A. W. Gerrard, in England, in 1875. Several other active principles were subsequently isolated from the mother liquors of pilocarpine-namely, the alkaloids jaborine (Hardy, 1875; Harnack and Meyer, 1880), pilocarpidine (Merck, 1885), jaboridine (Harnack, 1885), and volatile jabonine (C9H14N2, Hardy and Calmels, 1887), as well as jaboric and pilocarpic acids; but it is somewhat doubtful whether these derivatives of pilocarpine preexist in the leaves. Other constituents are a volatile oil (0.56 per cent, Hardy), an acrid resin, tannin, and a volatile acid, forming large crystals.
Pilocarpine (C11H16N2O2, Hamack and Meyer, 1880) may be obtained as described under pilocarpine hydrochlorate (which see). It forms a viscid liquid, optically dextro-rotatory, soluble in water and alcohol, slightly soluble in cold ether or chloroform, and in acids, forming a series of salts, of which the acetate is soluble in ether. The nitrate crystallizes well; the hydrochloride is very deliquescent. Pilocarpine, boiled with water, is decomposed into trimethylamine (N[CH3]3) and beta-pyridine-alpha-lactic acid (C5H4N.C[OH.CH3].COOH). Its synthesis was effected by Hardy and Calmels, in 1887 (see graphic formula in Pharm. Jour. Trans., Vol. XVIII, p. 89). These observers, as well as Merck (1885), consider it to be methyl-pilocarpidine (see below). According to J. van de Moer (1895), pilocarpine also stands in close connection with the alkaloid cytisine (see Baptisia).
Jaborine (C22H32N4O4, Hardy and Calmels, 1887) is a strongly basic, amorphous alkaloid, indicated by Hardy (1875), and shown by Harnack and Meyer (Chem. Centralblatt, 1880) to correspond in its physiological action with atropine, while pilocarpine in this respect resembles nicotine. It is formed when alcoholic or acid solutions of pilocarpine are concentrated by evaporation, and is not contained originally in the fluid extract of jaborandi. Its formation explains the lack of uniformity of the physiological action of pilocarpine as first obtained. When pilocarpine is rapidly heated to 175° C. (347° F.), and kept at this temperature for half an hour, it is decomposed into ether-soluble jaborine and water-soluble pilocarpidine and jaboric acid (C19H25N3O5) Hardy and Calmels, Pharm. Jour. Trans., Vol. XVII, 1887, p. 550). Jaborine is a brittle mass, insoluble in water, soluble in alcohol, ether, and a solution of jaboric acid. Its salts are uncrystallizable. Boiling with aqueous solution of caustic potash, converts it into pilocarpidine.
Pilocarpidine (C10H14N2O2, Harnack, 1885) was discovered by Merck (1885), and was considered by him and others to be the lower homologue of pilocarpine. This simple relation, however, does not seem to exist between these two bases (E. Merck, Archiv der Pharm., 1898, p. 141), nor are they isomers, as was asserted by Petit and (Pharm. Jour. Trans., Vol. V, 1897, p. 83). The aqueous solution of its salts is not precipitated by chloride of gold (difference from pilocarpine). It is a syrupy liquid, forming a well-crystallizable nitrate. The formula of nicotine being C10H14N2, pilocarpidine may be regarded as dioxy-nicotine. It has been obtained synthetically as an intermediary product in the synthesis of pilocarpine (see above). It is easily converted into jaboridine (C10H12N2O3, Harnack, Chem. Centralblatt, 1885), which is probably identical with jaborandine of Parodi (1875) from Piper Jaborandi. It may also be formed from pilocarpine by treatment with fuming nitric acid (Chastaing, 1882). The chemistry of pilocarpine and derivatives is held by Petit and Polonowsky (1897) to be still doubtful.
The following table states the yield of total alkaloid and nitrate, as recorded by several observers:
|Analyst.||Source of Jaborandi.||Per cent Pilocarpine.||Per cent crystallizable nitrate. Melting point.||Per cent recrystallizable nitrate. Melting point.|
|A. Poehl, 1879||Hairy||1.97|
|F. Budee, 1880||I. Hairy||..||1.26||0.77||Arch. d. Pharm., 1880, p. 25.|
|III. Mostly non-hairy||0.67||0.34|
|F. Miller 1880||Hairy||1.21
|A. Dohme, 1893||P. pennatifolius||0.33||..||..||Proc. A. P. Assoc., 1895, p. 266.|
|A. Dohme, 1894||P. pennatifolius||0.18|
|A. Dohme, 1895||P. pennatifolius||0.19|
|A. Dohme, 1894||P. microphyllus||0.16|
|A. Dohme, 1895||P. microphyllus||0.19|
|Paul & Cownley, 1894||P. Jaborandi||..||0.5 to 0.8 pil. nitrate||..||Phr. Jr. Trans., Vol. I, 1895, p. 542.|
|P. pennatifolius||..||0.18, 0.19; 0.38 pil. nitrate|
|P. microphyllus||..||0.16 to 0.19 pil. nitrate|
|P. microphyllus||..||Up to 0.8 alk. nitrate|
|P. trachylophus||0.02 (new alkaloid)|
|Paul & Cownley, 1896||P. spicatus||0.16||..||0.03 at 151.5° C.
0.04 at 130.5° C.
|Ibid., Vol. III, 1896, p. 1.|
|P. Jaborandi||0.72||0.67 at 161° C.||0.37 at 162.7° C.
0.30 at 158.3° C.
|P. microphyllus||0.84||0. 45 at 160° C.||0.23 at 162.7° C.
0. 22 at 147.7° C.
Action, Medical Uses, and Dosage.—Jaborandi acts upon the glandular system, increasing the secretory action of the glands; however, its influence is more especially exerted upon the sudoriferous and salivary glands. A drachm or two of the powdered leaves and smaller branches infused in a cupful of boiling water, and the whole taken at a draught, will, in about 10 or 20 minutes afterward, occasion a tingling sensation with redness of the cutaneous surface; this sensation is at first experienced in the face, but soon extends over the whole surface, and is quickly followed by an abundant perspiration, which is apt to continue for 4 or 5 hours. Almost simultaneously with the sweating, the secretion of saliva increases to such an extent as to greatly embarrass speech, the person being often obliged to assume an inclined position that the escape of the saliva may be facilitated. During its salivary action 1 or 2 pints of saliva, and even more, may be secreted, and, not infrequently, there will be, in addition, an augmentation of the bronchial and lachrymal secretions. At times the mucous glands of the intestines will be so influenced as to occasion a diarrhoea, and it is not a rare circumstance that the submaxillary glands enlarge. After the administration of jaborandi, patients are often attacked with nausea, vomiting, vertigo, hiccough, heaviness of the head, and contraction of the pupils. According to S. Ringer and A. Gould, the temperature of the body becomes greatly lessened during the sweating, falling 1.4° F.; on the other hand, Green, Rabuteau, Gubler, Robin, Ambrosoli, and Riegel, state that it becomes considerably elevated. As the rule, at the termination of the diaphoresis, the temperature becomes the same as it was at the time the jaborandi was administered; in a few cases it has been slightly lower, but returned to the normal degree in the course of from 12 to 24 hours. From the commencement of the perspiration, the face becomes pale, the pulse fuller, and more frequent; the pulsations of the heart become irregular, and, with persons laboring under some cardiac affection, a kind of asystolia is observed. The effects of this agent have been found to occur more readily with adults than with children. In the exhibition of this article as a diaphoretic, the use of warm drinks, and other aids toward facilitating the sweating, are not required.
During the sudorific action of jaborandi, the quantity of urine is lessened, to a greater or lesser extent, and micturition frequently proves painful. As urea exists to a large extent in the saliva and sweat caused by jaborandi (no uric acid being found), a diminution of it occurs in the urine voided; but, after sweating, it gradually returns to its normal figure in the urine, and from this it would appear that the drug does not increase the combustions of the economy. Experiments with the sphygmograph, made at various periods during the action of the drug, have shown an almost complete asystolia with a very considerable diminution of vascular tension. M. Robin is led to believe that jaborandi has an especial action upon the vasomotors, which it paralyzes; from whence results the cardiac asystolia and the copious secretions of sweat and saliva. M. Gubler, while admitting this paralyzing action upon the vasomotors, maintains that it has, in addition, a special irritating influence upon the sudoriferous and salivary glands, and upon the renal glomerules, which stimulates their functional activity. Dryness of the mouth and throat, with a sense of fatigue and depression, most usually follow the cessation of its active effects. Administered in divided doses, jaborandi, instead of acting as a diaphoretic and sialagogue, becomes an active diuretic. When given in cases where there is a diminished secretion of milk, contrary to what might be anticipated, it increases the quantity of this mammary secretion. Martindale dissolved extract of jaborandi in glycerin, and applied it around the eye; a marked contraction of the pupil ensued. A similar result, with impaired vision, is apt to follow its internal administration in large doses, but this disappears on the cessation of the medicine. Pilocarpine is the active principle of jaborandi, having an action nearly identical; however, it causes less salivation, less vomiting, and is more certain in its effects—the hydrochlorate and the nitrate of this alkaloid are used; they may be employed internally, or by subcutaneous injections.
Therapeutically, jaborandi has been found of value in the removal of serous effusions, as in hydrothorax, anasarca, ascites, chronic pleurisy, etc., whether these be due to disorders of the heart, liver, kidneys, to chronic inflammatory conditions, to albuminuria, or exist as a sequence of exanthematous affections, etc. While in certain of these effusions it acts as a curative agent, in others it will prove useful as affording temporary relief, from time to time, until other indicated remedial agents have been enabled to overcome or to modify the abnormal conditions giving rise to such effusions. In cardiac diseases, from its tendency to diminish the contractility of the heart and arteries, and to favor their dilatation (diastole), thus conducing to dyspnoea and even to asphyxia; if used at all, great care and prudence should be observed. In those disorders, in which its employment from time to time is followed by persistent debility, it is contraindicated.
Jaborandi has been used with more or less success in the following diseases: Asthma, bronchitis (with or without emphysema), albuminous diabetes, dropsies, in cases of poisoning and diseases due to miasms or morbid poisons (puerperal septicemia?) eruptive fevers impeded in their evolution, etc. (Gubler); in metastatic orchitis (Czernicki); in polyuria (Laycock); in chronic rheumatism, syphilitic rheumatism, and in acute articular rheumatism, but in which the endocarditis was aggravated (Fereol)—this author has also observed an attack of gout, and an increase of the intensity of hemicrania, in cases where it was administered; in the albuminuria of pregnancy its use was followed with hematuria (Langlet); in acute albuminous nephritis (Bloch)—this author likewise states that jaborandi will be found efficient in chronic parenchymatous nephritis, especially when the renal lesions are not of long standing; that the existence of uraemic phenomena is not an absolute contraindication of the drug; that it is seldom of service in interstitial nephritis; and that it should be employed with the greatest caution when cardiac lesions are present. Petithau advises its employment in all subacute or chronic catarrhal or rheumatic affections; in dropsies, when there is no morbid change of the kidneys, and anemia is but slight; in pernicious intermittent fevers; in psoriasis and other dry forms of cutaneous diseases; in chronic syphilitic affections, etc.
According to M. Rabuteau, coffee is an antagonist of jaborandi; when given concurrently with it, it will prevent the nausea and vomiting, and likewise appears to diminish the perspiration as well as the excretion of the urea. The effects of jaborandi upon the human system are also counteracted by subcutaneous injections of solution of atropine; while those of belladonna or atropine are overcome by subcutaneous injections of pilocarpine. But this antagonism does not invariably appear, as the symptoms following the administration of one of these substances, are not always counteracted by the employment of the other besides while the dose of jaborandi or pilocarpine may always be readily determined, that of belladonna, and especially of atropine, is so difficult to regulate, that extreme circumspection is required (J. King). Where depressing effects are produced by jaborandi, as sometimes occurs where there are valvular disease or fatty degeneration of the heart, or morbid pulmonic circulation, strychnine hypodermatically may sustain the heart-action. Digitalis, cactus, caffeine, or strophanthus may also be used. The profuse sweating may be checked by atropine. When pilocarpine acts like atropine, such effects are probably due to contaminating jaborine.
Since the foregoing uses, as recorded by the earlier investigators of jaborandi, were established, the drug has come into prominence in Eclectic practice chiefly through the writings of Webster, Ketchum, and Foltz. Added to its diuretic and sudorific qualities, jaborandi is sedative and antispasmodic, many preferring it to veratrum for the former purpose, and to lobelia or gelsemium for the latter. The indications for this drug, specifically considered, may be summed up as follows: It is a remedy for sthenic conditions, and must be avoided, or its use carefully guarded, in weakened conditions of the heart. Jaborandi is efficient in disorders exhibiting a dry, hot skin, with febrile reaction, especially when accompanied by acute suppression of the secretions, dry, parched mouth, full, strong, hard, and sharp pulse, deficient renal activity with deep-red urine, scanty in quantity and of high specific gravity; restlessness, and, with any of these symptoms, pain. Jaborandi is claimed by Prof. Webster to be adapted to almost any febrile or inflammatory condition, sthenic or asthenic, with or without a dry skin. Most observers however, prefer to limit its use to sthenic conditions only. As a remedy for pain and inflammation it has been highly endorsed in mammitis, with dry skin and suppressed lacteal secretion, in acute articular inflammation and acute articular rheumatism, the joint being extremely painful and swollen. In erysipelas with dry skin and elevation of temperature, it has rendered good service, and is particularly of value when locally applied. Webster declares that in cerebro-spinal meningitis, it has no equal. In rheumatic complaints its value is enhanced by its power to eliminate urea and uric acid from the system. Jaborandi is indicated by stiffness, soreness, and swelling of the joints, whether the parts show redness or pallor. One of its chief indications in such disorders is puffiness of the tissues. For acute (preferably) or chronic muscular pain, pleurodynia, lumbago, muscular spasm, cardiac rheumatism and angina pectoris, few remedies are more efficient. The specific indications, must, of course, be observed.
Jaborandi is recommended for cough when the throat is very dry and secretion checked. It is well recommended in bronchial asthma and whooping-cough with dryness of the respiratory passages. Small doses relieve "winter cough," and the cough of chronic bronchitis with lack of secretion, and dry, irritable, hoarse cough. In the early stage of bronchitis, and in the congestive stage of pneumonia, it rapidly relieves the local inflammation, and reduces the fever if it be given in diaphoretic doses. In respiratory troubles it does best service when associated with other indicated remedies, as bryonia, asclepias, lobelia, etc. In acute tonsillitis with secretion of tenacious pharyngeal mucus, it serves an excellent purpose. Foltz values it highly in pharyngitis sicca (Eclectic Med. Gleaner, Vol. V, p. 193). When exudation has taken place in pleurisy, jaborandi is one of the best agents to effect the removal of the fluid and promote resolution. It finds also, a place in the treatment of dry croup, laryngismus stridulus, laryngeal diphtheria, and so-called membranous croup. In the latter two affections, if the child is strong, jaborandi may be administered in doses sufficient to increase the secretions of the throat, and thus loosen the false membranes. Jaborandi has given good service in metastatic and gonorrhoeal orchitis, ovaritis, and metritis, the specific indications for it being present. Jaborandi is one of the most useful of agents in properly selected cases of la grippe or epidemic influenza, and of catarrhal fever. In fact the drug acts admirably as a non-stimulating diaphoretic and sedative in many inflammatory and febrile conditions, provided the stomach is not too irritable to retain the medicine.
In diseases of the kidneys, jaborandi does effective work in throwing a part of the burden of elimination upon the skin. In this way the kidneys are relieved of excess of watery secretion, and of the elimination of a portion of urea. For this reason it has been employed in various forms of nephritis, particularly in acute albuminuria, and in so-called Bright's disease. It is undoubtedly the best remedy (using pilocarpine preferably) we possess for uraemic poisoning, but the full diaphoretic action must be obtained if good results are to be expected. Diaphoretic doses also benefit the albuminuria of pregnancy. It has been successfully employed in conjunction with ergot to control the excessive secretion of urine in diabetes insipidus.
Acting upon the theory that the act of parturition is favored by free diaphoresis, jaborandi and its alkaloid have been successfully used in cases of tedious labor due to a rigid, hard os uteri. In these cases the pains are severe yet ineffectual, the skin dry, pulse full, sharp, and hard, and there is some febrile reaction. These conditions are rectified by diaphoretic doses of the drug. A full dose or a couple of broken doses of jaborandi is accredited with the cure of puerperal eclampsia. In such cases it may be advantageously combined with other indicated agents.
Jaborandi has proved a useful drug in exanthematous diseases with tardy appearance or tendency to recession of the eruption, and by this action has been thought to avert the danger of post-scarlatinal dropsy. Many skin disorders of a dry character appear to be benefited by the internal and external use of jaborandi. Among these disorders are eczema, pruritis, particularly when occurring in a jaundiced skin, prurigo, hyperhydrosis pedum, psoriasis, and rhus poisoning. In the latter affection grindelia has been employed locally with jaborandi. This drug is accredited with the rather singular effect of causing the hair to become darker in color; and it is likewise said to be useful in alopecia to promote the growth of the hair. For this purpose pilocarpine may be employed, with or without cantharides, and mixed with lanolin. Copious and annoying night-sweats are said to be relieved by minute doses of jaborandi. Locally, the drug has given relief in burns and scalds, and internally and locally is of considerable value in parotitis. In small doses it has been lauded as an effective agent in ptyalism and aphthous stomatitis. In local and general dropsies the drug is sometimes useful, but as cautioned by Ellingwood, it should be used discretely, particularly in hydrocephalus, lest harm be done to the patient.
Pilocarpus and its alkaloidal salts have been used to counteract the poisonous effects of belladonna, atropine, stramonium, daturine, and poisonous bites or stings, and in ptomaine poisoning from canned fish and meats. In the latter instances it has no antidotal power, but favors elimination of the offending material. While often failing to counteract the toxic effects of atropine, it nearly always relieves the unpleasant dryness of tissue following the use of that alkaloid or of belladonna.
Prof. Foltz is an enthusiastic advocate of the use of jaborandi in eye, ear, nose, and throat disorders, particularly where there is a lack of the natural secretions of these parts. Full doses of jaborandi contract the pupils, impair accommodation, diminish intraocular tension, and increase secretion. Locally applied, the action is similar, the effects upon the pupil, however, being much less pronounced when the drug is internally administered. Dr. Foltz praises it in rheumatic iritis, and for the absorption of "non-organized vitreous opacities." In iritis he always uses it, and believes that it shortens the duration of the disease, and if adhesions are present, assists in their absorption. Optic neuritis, retinal detachment, choroiditis, episcleritis, tobacco and alcoholic amblyopia, and atrophy of the optic nerve are also conditions in which he advises its use. After traumatism, with increased ocular tension, the latter as well as the pain, will be relieved by the local use of pilocarpine hydrochlorate. Instilled in the eye the same is useful in keratitis and phlyctenular conjunctivitis, both in the early stage. For ocular affections Foltz advises as a dose from 3 to 10 drops of specific jaborandi, every 2 or 3 hours; and as a collyrium, 1 to 2 grains of pilocarpine hydrochlorate to 2 fluid ounces of water. In ear disorders jaborandi improves by increasing the secretions of the aural cavities and canals. Unhealthy cerumen is frequently restored to its natural condition by the continued use of jaborandi. Jaborandi is the best remedy in non-suppurative inflammation of the middle ear, of the proliferous type (Foltz), and it proves a good drug for nervous deafness, deafness following scarlet fever and diphtheria, and with appropriate adjunct treatment, in inner ear diseases of syphilitic origin (Foltz). The alkaloidal salts (⅓ to ⅙ grain subcutaneously) have been employed in these disorders, but the parent drug is to be preferred in doses of 3 to 10 drops every 3 or 4 hours.
PILOCARPINE.—The alkaloid pilocarpine has been used in the forms of hydrochlorate and nitrate in the same diseases as the infusion and alcoholic preparations of the leaves. The effects of the alkaloid are said to be more certain than when the leaves are used, and the tendency to nausea and vomiting is greatly diminished. Pilocarpine may be used in many of the aforementioned disorders, although jaborandi is preferred by the Eclectic profession. Outside of the special mentions of the use of the alkaloids given above, they may be used in the following conditions: For uraemic convulsions and in puerperal convulsions it is preferred by many to jaborandi. Oedema of the larynx is said to be promptly relieved by pilocarpine.
Beranger considers the hydrochlorate of pilocarpine of great value, therapeutically, in certain eye diseases; he uses it in instillations, and in subcutaneous injections, two very distinct effects being obtained, according to the methods employed. By injections, profuse discharges follow, accompanied with a diminution of ocular tension, and a more rapid renovation of the media of the eye; this form of use he considers indicated in acute and chronic glaucoma, iritis, floating bodies in the vitreous humor, certain opacities of the cornea, and in poisonings. Sometimes complete recovery will ensue; at others, great relief follows. His solution was made by dissolving 3 grains of the hydrochlorate of pilocarpine in 75 minims of cherry-laurel water, of which solution from 10 to 15 drops were injected at a time. It must be remembered, however, that pilocarpine injected into a tumor of the eye, has produced great weakness and emaciation, without in the least affecting the size of the growth (see Armaingaud, in previous editions of this Dispensatory). By instillations, he employs it as a powerful myotic in mydriasis, and prefers it to eserine, as it is accompanied with no irritation. He likewise prefers it in instillation, to eserine, in disturbances of vision associated with secondary paralysis and characterized by asthenopia, with feebleness of the intrinsic muscles of the eye, and also in certain cases of presbyopia which is not constant but returns at different periods. Dr. Landesberg, of Philadelphia, found both the fluid extract of jaborandi, internally, and the hydrochlorate of pilocarpine, by subcutaneous injection, more effective and reliable than any other known remedy, in intraocular hemorrhages, and in opacities of the vitreous and aqueous fluids; but he prefers eserine to pilocarpine, as a myotic, on account of the increased action of the lachrymal and salivary glands occasioned by the latter, when absorbed. Gillet de Grandmont, of France, has used the nitrate of pilocarpine, by subcutaneous injection, in the forearm, of from 1/7 to ½ grain, in solution; and has found surprisingly good results to follow in specific or rheumatic iritis, either simple, or complicated with alterations of the cornea, in the keratitis of Hutchinson, in dimness and hemorrhage of the vitreous body, in glaucoma, in atrophy of the choroid, in hemorrhages and plastic exudations of the retina, and in commencing atrophy of the optic nerve. In all the above-named affections, the agent produced its usual results, as sweating, increase of the cardiac pulsations, etc.
The dose of jaborandi in infusion (45 grains to 2 fluid ounces of water) is 1 fluid ounce, which may, if necessary, be repeated every 10 or 15 minutes; of the fluid extract, from 10 drops to 1 drachm; of specific jaborandi, 1 to 30 drops; of pilocarpine or its salts, internally, from ¼ to ¾ grain; by subcutaneous injection, 1/20 to ¼ grain, in solution. In cases where the internal exhibition of jaborandi by mouth, occasions nausea or vomiting, this may be avoided in giving the dose by rectal enema.
Specific Indications and Uses.—Deficient secretion; marked dryness and heat of skin and mucous tissues; pulse full, hard, sharp, and strong; muscular pain; muscular spasm; urine suppressed, of deep color and high specific gravity; elevated temperature, with deficient secretion; puffiness of tissues; rigid, hard os uteri; marked restlessness; dry, harsh cough; tenacious sputum) oedema; uraemic poisoning and convulsions; increased ocular tension; itching, with jaundice. Adapted chiefly to sthenic cases. Minute doses relieve colliquative sweating.