Duboisia

Duboisia myoporoides, R. Br.

Natural order , Solanaceæ.

Common name , (Queensland) Corkwood tree.

Preparation , Preparations from the leaves.

Authorities.

1 , Mr. Gerrard, Pharm. Journ. and Trans., April, 1878, p. 157, Mr. Blake instilled into the eye a solution of the alkaloid; 1 a , injected hypodermically 1/60 of a grain into two patients; 2 , J. Tweedy, Lancet, 1878 (1), p. 304, Dr. Ringer injected subcutaneously 1/2 a grain and 1 grain respectively into two men; 3 , Dr. Tweedy, experiments on himself, by instilling into the eye a drop of a solution of the extract (1 in 20); 4 , W. W. Seely, M.D., Cincin. Lancet and Obs., 1879, p. 125, 3 or 4 drops of Duboisin (4 grains to 1 ounce) were instilled into the left eye of a lady patient; 5 , M. Gaubler, Bull. Gén. de Thérap., May, 1878, quoted by Dr. Seely, ibid., an injection was made into a young man suffering from tuberculosis; 6 , Galezowski, L'Art. Méd., 1879, vol. xlix, p. 149, a person, æt. seventy-three years, operated on for cataract, and suffering from consecutive iritis, with closure of the pupils, could not endure Atropia on account of cerebral symptoms; four months afterwards, after removal of the second cataract, 2 drops of a solution of Duboisin (5 centrigrams to 10 grams of water) ware put into the eye each day; 7 , same, a second case; 8 , Win. F. Norris, M.D., Amer. Journ. of Med. Sci., April, 1879, p. 447, as a mydriatic.

• In ten minutes the pupil was widely dilated, 1.
• The injection caused great dryness of the mouth, 1a.
• I first carefully tested the stage of my vision, and found that I could read No. 1 1/2 of Snellen's type distinctly, from four inches (nearest point) to twenty-one inches (farthest point), and V = 20/20. I then placed a single drop of a solution of the extract (1 in 20) within the lids of the tested eye. A little lachrymation followed, but no smarting. Exactly ten minutes afterwards the pupil began to dilate, and the sight became rather misty for near objects. When once started, dilatation proceeded very rapidly, so that fifteen minutes after instillation the pupil was widely dilated, and the nearest point had receded to ten inches. In twenty-five minutes 1 1/2 Snellen could not be read at any distance by the unaided eye, and the accommodation was therefore for all practical purposes completely paralyzed. By more elaborate tests I discovered that the effect of the extract went on increasing for four hours, when it attained its maximum. Twenty-four hours afterwards there was no appreciable amelioration, either in the pupil or the accommodation, but within the next twenty-four hours the effects began to pass rapidly off, so that forty-eight hours after the instillation I could see 1 1/2 Snellen from five and a half inches to twenty one inches, although the pupil was not much smaller, and reacted slightly to light. From this time the accommodation became stronger and more active every hour, and the pupil gradually diminished until it reached its natural size. Four days after the application the accommodation was restored, and three days later the pupil was active and of its normal size, 3.
• Case I.

-Dr. J. W., æt. twenty-five years, whose left eye had been last year carefully examined under Atropia, and found to have a hypermetropic astigmatism of 1/60. With this corrected, his vision was 20/xx and his near point 4 3/4". Three minute drops of a 4-grain solution of Sulphate of duboisia were instilled into the conjunctival sac of the left eye. In six minutes the pupil had commenced to dilate, and was ovoid, with its long diameter at 50°. At nine minutes pupil is nearly round, and measures 6 mm., and he can read Jaeger VI inside of 20". At twelve minutes is unable to read without convex glass, and with + 1/10 half an inch in front of the cornea cannot bring Jæger I inside of 8 3/4". At thirteen minutes pupil measures 7 mm., and is immobile; at fourteen minutes with + 1/10' punctum proximum is at 9 1/2". At fifteen minutes pupil dilated ad maximum, and measures 8 mm. At eighteen minutes with + 1/10 Jæger I from 9 1/2"-13", sharpest at 11 1/2". At twenty minutes the same. At twenty-five minutes + 1/60 Cy. axis at 15° V= 20/xx', and with + 1/10, combined with same cylinder Jæger I, from 9"-12 1/2", best at 9 1/2". He was examined at thirty-five and forty-five minutes, but there was no further change either in the size of the pupil, acuity of vision, or in the range of accommodation. He complains of dizziness on rising to walk, feels as if his legs would give way under him, and of slight dryness of the throat. Twenty-four hours after the application with + 1/10 + 1/60 Cy., near point at 9". In forty-eight hours, with same glass, near point of 6 1/4", and pupil has contracted to 6 1/2 mm. On the third day, with same combination, near point is at 5 1/2", and without a glass can read Jæger I up to 9". On the fourth day, with his cylinder alone, near point is at 5". On the sixth day, with his cylinder, the near point is at 5", pupil measures 3 mm., while that of the other eye measures only 2 mm. On the ninth day pupil is still a trifle larger than that of the right eye, and with his cylinder the near point is at 4 3/4".

• Case II.

-Miss M. K., æt. twenty-six years, V = 20/xx in each eye, and reads Jæger I from 5"-18". Two drops of a 4-grain solution of the Sulphate of atropia were dropped into the left eye, and as soon as practicable thereafter a similar quantity of a 4-grain solution of Sulphate of duboisia into the right eye.

• Right eye . - Duboisia . In five minutes the pupil is vertically ovoid and irregular; in response to change of light and shadow the least dilated portions show the most movement. It measures 4 1/2 by 7 mm. At ten minutes it is firmly contracted everywhere, except at temporal side, and is irregularly round. At twelve minutes it has contracted evenly all around, and measures 8 mm. At eighteen minutes can read Jaeger XIX with effort, at arm's length, V = 20/lxx, and sees horizontal lines best. With + 1/10 reads Jæger I from 10 1/2"-12 1/2". In one hour and a half V = 20/lxx, with + 1/48 20/xx; sees all lines in Green's dial alike, and rejects cylinders. With + 1/10 Jæger I, from 11" - 13 1/2". The instillation was repeated on the following day; patient picked out + 1/36; and again, on the third day, when she preferred + 1/42. She then returned home, and I did not see her for twelve days, but she informs me that on the evening of the second day, after the last instillation of Duboisia, she could spell out for a moment newspaper print. Twelve days after the last application the pupil in strong light measures 1 1/2 mm., and with her correcting glass + 1/42, could read Jæger I, from 5 1/4" - 18".
• Lefteye . - Atropia . At eleven minutes pupil ovoid and responsive to light, 5 by 3 mm. At fifteen minutes nearly round, 5 mm., with scarcely perceptible motion. At eighteen minutes can read with difficulty Jæger I. At twenty-three minutes pupil 8 mm.; can still read Jæger I at 11". At thirty minutes can no longer read "brilliant," but spells out Jaeger II. At thirty-five minutes Jæger IV, with difficult, at 11", and with + 1/10 Jæger I, from 6" - 9 1/2". In one hour and a half V = 20/1, and with + 1/10 reads Jæger I, from 9" - 12"; pupil measures 8 mm. The instillation was repeated on the following day, and with + 1/10 patient could read Jæger I, from 10 1/2" - 13"; and again, in the third day, with the same result. She says that with this eye she could not spell out any newspaper print until the morning of the fifth day after the last instillation of Atropia. Twelve days after this pupil measured in strong, light 2 1/2 mm., and with her correcting glass + 1/42 reads Jæger I, from 5 1/2" - 16".
• Case III.

-Spasm of the ciliary muscle in a young girl, M. C., æt. thirteen years. She complains of being nearsighted, and obliged to hold her book too close, with inability to see the blackboard at school. At present V in each eye 5/cc, and reads Snellen 1 1/2 from 3 1/2" - 7", and not at any point further off. Nevertheless, after a short sojourn in a dark room, ophthalmoscopic examination shows that the eye is nearly emmetropic, and the fundus can be seen sharply without any glass. Three drops of a 4-grain solution of Sulphate of duboisia were therefore instilled into each eye. The pupils commenced to dilate in eight minutes; in eleven minutes they were vertically ovoid; in eighteen minutes ovoid, sluggish, but still mobile; at twenty minutes they were nearly round, and V had risen to 20/c. In twenty-six minutes pupils absolutely immobile and round, and with + 1/10 read Snellen 1 1/2 from 7" - 9". In fifty-five minutes V = 20/lxx, and with + 1/10 Snellen 1 1/2 from 9 1/2" - 10 1/2". In sixty minutes with + 1/48 V = 20/xxx, and in sixty-eight minutes with + 1/10 Snellen 1 1/2 from 11" - 12". Three days later her accommodation was 1/16.

• Case IV.

-By means of a No. 1 Bowman's probe, I succeeded in placing a small ball of the viscid material (Sulphate of duboisia), about half a millimeter in diameter, in the lower cul-de-sac of the conjunctiva. It caused no irritation or pain, but the patient complained of being dizzy, and feeling as if the room was going around. This soon passed off, and there was no further disagreeable effect. It failed, however, to tear the adhesions between the iris and capsule.

• Case V.

-The patient, J. W., was a healthy girl of eighteen years, and, as in the previous case, an exceedingly minute piece of the Sulphate of duboisia, in substance, was held for a few moments in the retrotarsal fold of the lower lid, until most of it was melted; the probe was then withdrawn, and the superfluous tears saturated with it, pressed out of the eye, and received in a soft handkerchief. A few minutes after I called the patient to examine the state of the pupils, and she complained of feeling dizzy, and very soon after my attention was attracted by the dark flush of her face. She was then mildly delirious, pulse 132, and was laid on a sofa. She had a tendency to pick at surrounding objects, and had one or two slight drawings up of the arms, and was very restless. A thermometer under the tongue, when the pulse was most rapid, showed a temperature of 100 1/5°. No treatment was instituted, and in an hour and twenty-five minutes the pulse had fallen to 100. She now became again more excitable, and tried to get up off the sofa. On being told to keep quiet, she would at once lie down again, but in a few minutes more again try to rise and move off. A subcutaneous injection of 1/8 of a grain of Sulphate of morphia was now given, and in about twenty minutes she went gently to sleep. An hour later she was roused to be conducted to her bed in the upper ward, and was able to walk upstairs with but little assistance. She again fell asleep, and about half an hour subsequently awoke rational. The nurse reported, however, that once or twice during the night she got up out of bed, but lay down immediately on being admonished by her. Next day she had entirely recovered, 8.

• In four minutes near vision growing poor, and in five minutes Nos. 6 and 7 Jæger had to be held at nearly arm's length, and the patient complained of intense fainting symptoms. Very slight nausea. The "strange" feelings in the head and faintness continued very marked for fifteen or twenty minutes, when the worst "fainting" features passed away, the "strange" feelings remained very marked, and "drowsiness" came on. In from one-half to three-quarters of an hour there was dryness of the mouth and throat, though not very marked, and chilliness was complained of. During the next day there was marked faucial and oral dryness, some of the "strange" feeling in the head, and flushing of the face. On the second day she felt nearly well, some little sensation that she seemed to locate in the stomach, the head symptoms having about disappeared, 4.
• In both, the pupils became widely dilated and the mouth dry. After the larger dose the man's throat became so dry that he could scarcely speak. The dryness lasted five hours. Both became rather sleepy in about fifteen minutes after the injection, the drowsiness lasting about two hours. The man with the larger dose complained of some general weakness, and both men suffered from headache lasting about three hours. After the larger dose the pulse rose from 66 to 120 per minute, 2.
• In a few minutes vertigo, then dryness of the throat, then slowing of the pulse. After the slowing of the pulse the patient fell into a sort of stupor, analogous to that produced by Datura stramonium. This stupor lasted many hours; it was not sleep, for if the patient was questioned he replied, though with difficulty it is true; he remained seated in his chair, and appeared indifferent to what was going on about him, and without any energy to move, 5.
• A woman, æt. fifty-eight years, with double chronic iritis, on account of conjunctivitis from Atropia, was prescribed Duboisin. The poisonous effects were slow in appearing, were characterized by frequent desire to sleep, preventing the patient from continuing her work. Heaviness of all the limbs, especially of the lower extremities. Gastric symptoms and complete loss of appetite, 7.
• The poisonous effects observed were characterized by general trembling, the patient was unable to hold up the head; hallucinations and nausea. These symptoms disappeared on stopping the Duboisia, 6.