Pilocarpinum

Volume I — Appendix

(Jaborandi.)

Description. — The name Jaborandi is applied in South America to several plants possessing diaphoretic properties. The Pilocarpus jaborandi is a shrub growing in Brazil. It is about five feet high ; the root is cylindrical and slender; the leaves alternate and resemble those of the cherry-laurel.

Preparation. — Tincture of the leaves. Triturations of the alkaloid pilocarpin.

Head.

Confusion of mind. Vertigo slight. Headache almost every day just about noon, for over two weeks after taking. Headache returned about noon, dull aching pain same as before hurried breathing, pressure on the chest, great anxiety, palpitation of the heart, and pain in the region of the heart. Throbbing pains in the forehead and top of the head ; next came pains in chest and around the heart; pain in the forehead became less, but increased in severity in the chest and above the heart. Dull pain in the occiput, extending over left side of head to the forehead.

Bye.

Eyelids stiff and heavy. Augmentation of the lachrymal secretion. Eyeballs feel sore on moving them. Contraction of the pupil. When the perspiration and flow of saliva were at their height, sight became so dim that objects held near the face were imperceptible. Sight became blurred; at a distance of four feet could see a person, but could not distinguish the eyes. Impaired vision continued but only affected the sight of distant objects, near objects were distinctly seen. Swimming of distant objects. During the sweating and salivation, appearance as of numerous white spots before the eyes like flakes of snow. Dimness of vision returns. The state of the vision is constantly changing, becoming suddenly more or less dim every few minutes.

Nose.

Profuse, watery, bland discharge from the nose.

Face.

Slight increase of color. Redness and heat of face. Throbbing of the temporal arteries, and increased warmth of face, but skin still dry. Flushing of the face, ears, and neck. In those instances in which sweating took place the face became flushed, and was most marked when the perspiration was greatest.

Mouth.

Primarily. Increased secretion of saliva, for a time requiring constant ejection; the secretion of this from the glands in the cheeks caused a kind of collapsed feeling in them; saliva distinctly alkaline; measured sixteen ounces in addition to that which flowed on the pillow while asleep. Salivation, commences, and in a few minutes the mouth is literally

flowing with water; this continues for four or five hours, during which period ten to sixteen ounces can be collected. Free salivation, with profuse sweating. Salivation and sweating continued to be profuse until the sight became blurred. The salivation, when it occurred to a marked extent, began simultaneously with the sweating, was greatest when the sweating was most profuse, and lasted as long as the sweating. Salivary secretion extremely active. Submaxillary gland especially enlarged; on pressing it there was a gush of saliva under the tongue. Sat with forehead resting on edge of table, and let saliva run into a vessel on the floor. Tried to sleep, but had to clear the mouth of saliva every two or three minutes. Secondarily. Great dryness of the mouth. Speech so affected that articulation was both difficult and indistinct.

Throat.

Throat dry and inflamed. Quite a sore throat, smarting pain. Moderate swelling of the submaxillary glands.

Stomach and Bowels.

Eructations and vomiting. Hiccough. Was sick and vomited a quantity of saliva which was swallowed. Dull, heavy distress in the pyloric portion of the stomach, as though some hard, indigestible substance was lying there, relieved by eating a full meal. Empty, gone feeling in the bowels.

0 Nausea, vomiting, with salivation of pregnant women. (Hale.)

Primarily. Diarrhoea for several days, very loose; came with a gush; thin, watery, and yellow. Gone, empty feeling from the diarrhoea, but no pain whatever. Eleven copious, watery, undigested stools since 7 a.m. Continues to have from five to ten yellow, watery, painless stools a day.

Secondarily. Constipation.

Urinary Organs. Buring in the urethra, with urging to urinate. When administered in fractional doses, Jaborandi does not produce either perspiration or salivation, but becomes a powerful diuretic

Respiratory Organs. Augmentation of bronchial secretions. Hurried breathing.

Chest.

Pains in the chest, around the heart. Pressure on the chest; great anxiety, with palpitation of the heart and pain in the cardiac region. Sense of heavy pressure on the chest, hurried breathing, and great prostration.

Heart and Pulse. Pains about the heart, very severe, accompanied with severe palpitation.

Sphygmographic tracings, taken at different stages of the administration of the drug, showed almost complete asystolia, with a very noticeable diminution of vascular tension during the sweating stage. In each experiment the pulse became rapidly quicker, the increase varying from 40 to 50 a minute.

Pulse rose from 88 to 120.

General Symptoms. Very soon the face becomes red; the temporal arteries throb more strongly ; then there is a peculiar feeling of heat in the mouth and face, and the flow of saliva commences. In a little while the forehead becomes moist, and the face more red; then beads of perspiration appear on the forehead, cheeks, and temples. The flow of saliva increases, all the salivary glands successively contributing to this effect. The mouth is filled with immense quantities of fluid, and expectoration is incessant; at the same time perspiration covers the face and neck; then the whole body becomes red and moist, and a pleasant warmth is experienced; in a few minutes perspiration breaks out over the whole surface, and soon runs down on all sides. Meantime, other symptoms have supervened. The eyelids first become moist, then the lachrymal secretion gradually augments, and, after collecting in the canthi, rolls slowly over the cheeks; at the same time there is a copious discharge from the Schneiderian membrane, increased by the tears which escape through the nasal canal ; moreover, there is a heightened activity of the mucous

glands of the back-throat, trachea, and bronchi. All these effects reach their maximum of intensity in about threequarters of an hour after taking the drug, continuing thus for thirty or forty minutes. Lying on one side, that the saliva may run more freely, the patient spits ten or fifteen times a minute; the flow is so rapid that he can scarcely speak; the salivary glands are enlarged, and the mouth becomes hotter. From time to time the mucous accumulations in the bronchi are cleared away by a slight cough ; the sight is dimmed by the flow of tears. The body is bathed in perspiration ; a shirt is wet through in a few minutes. Now a feeling of comfort or of weakness, as the case may be, is experienced. Thirst is intense. The pupils are slightly contracted. By degrees the excessive activity of the secretory processes is diminished; in an hour and a quarter, or an hour and three-quarters, the lachrymation, the nasal discharge, the bronchial expectoration, and, finally, the flow of saliva and the perspiration are sensibly lessened, and the parts involved gradually return to their normal condition. When the perspiration and flow of saliva have ceased, the subject is prostrated and drowsy. The parts which secreted so copiously are now very dry, especially the mouth and back-throat. There is also much thirst. Tried to walk about the room, but felt very weak, his legs giving way under him.

Prostration of strength, even a short walk causing weariness, hurried breathing, and palpitation of the heart; these symptoms lasted four days.

Sleep.

Sleeplessness at night from restlessness, and on account of a sensation of firm pressure on the chest, with hurried breathing.

Fell asleep at 9.30 p.m., and spent a most wretched night; a smart fever; increased pain in the head; general malaise; no thirst; very restless, talking, moving, with some delirium.

Fever.

Chilliness. A decided fall in temperature occurred. At the moment the sweat was produced, there was an increase of

the temperature and of the pulse; then, during the period of active sweating, it was sometimes noted that these elements remained at the same point as at the outset of the experiment; sometimes there was slight diminution, but after the sweating a very notable lowering of the temperature and of the pulse was observed, which sometimes lasted two days after the experiment. (This was true in thirty-two experiments.)

Sweat breaks out on the face and upper part of the chest, which

have been quite red for five or six minutes. Simultaneously with the flow of saliva, the perspiration breaks

out on the forehead and over the whole body; it extends to

the limbs, but is most marked on the trunk. Sweat quite profuse. Excessive perspiration from all parts of

the body. ° Nightsweat.

Volume II — Special Therapeutics

Jaborandi has but few if any close analogues in our Materia Medica. I shall not attempt to give a complete account of its pathogenetic or therapeutic power. I will merely mention that it has been found to be curative in rheumatism, asthma, bronchitis, dropsy, ascites, uraemia, desquamative nephritis, and other diseases of the mucous membranes.

It has been useful as an aid to labor, and of value in diseases of the breasts and other glands.

This new and unique drug has not yet attained any considerable prominence in the therapia of the homoeopathic school. Dr. Allen, in the “ Encyclopedia of Materia Medica,” has given us a very extensive pathogenesis, and in due time we shall probably have some trustworthy clinical experience. From this pathogenesis we learn that its general primary symptoms all point to paralysis of the vascular centres, resulting in general arterial congestion. This congestion, however, is not active, i. e., it is not attended by increased blood-pressure. There is really a lowering of the vascular tension. There is also a lowering of the temperature, often as much as 2° F. But its specific and peculiar action is the extraordinary effect which it has on the end-organs of the excito-secretory nerves. Shortly after taking the drug a general flushing of the whole body takes place (as in Amyl), and then all the cutaneous and glandular secretions are increased. Profuse and drenching perspiration sets in ; an enormous amount of saliva is poured out, often several pints ; the nasal and bronchial mucus is increased ; tears flow abundantly.

Often the intestinal mucous membrane is excited, and a severe diarrhoea occurs. The urine is often greatly increased, as are the uterine and vaginal mucus.

The above is a picture of the prominent primary effects of the drug, but by consulting the various experiments made, I find a series of secondary actions, as follows: After the perspiration, etc., ceases, a chilliness sets in; this is often followed by headache,

pains all over, feverish heat, dry skin, suppression of cutaneous and glandular secretions, etc.

The homoeopathic use of the drug is therefore not confined to those diseases having symptoms similar to its primary action, but to those possessing symptoms similar to both its primary and secondary. Let us imagine a case wherein Jaborandi is fully indicated. A man exercises violently until he perspires freely. His face and whole body is flushed ; his eyes are red and tearful ; his saliva fknvs freely. He then sits down in a cool place, and soon feels chilly. In a short time his skin becomes hot and dry, his mouth and throat are dry, and he has slight dry cough, with oppression of breathing. In such cases some active internal congestion is to be found. Aconite is usually given in such cases, but I believe Jaborandi in the lx dilution is the more appropriate remedy.

With this preamble, I propose to mention some of its uses in obstetric practice. Dr. Allen gives no clue to its action on the genital organs, but of late several German experimenters have investigated its action in that direction.

Reasoning from analogy, we must conclude that Jaborandi must cause passive arterial congestion of the uterus, with stimulation of its excito-secretory nerves. It must excite theglandular and mucous tissues to pour forth a large amount of secretion, and excite its muscular tissues to involuntary contraction.

Experiment has substantiated this view. Dr. Ssenger, of Leipsic, reported to the German Gynsecological Society, that he has given Pilocarpin* to many women in labor, and to the non-pregnant, and finds that it causes “ premature occurrence of menstruation,” and “ the inception of ecbolic activity.” In women in labor “ the genitalia become softer and more moist and diarrhoea sets in.” Dr. S. says: “ Ergot produces spasmodic, pilocarpin rhythmical contractions of the uterus ” (in this resembling Caulophyllum). “ Pilocarpin, therefore, has a qualified ecbolic influence.” “ Atropia,” he says, “ arrests the pain caused by Pilocarpin.” He further explains the sphere of Pilocarpin : “ If a tendency to expulsion be already present, for instance, pathological relations between the

• Pilocarpin is the concentrated active principle of Jaborandi.

uterus and ovum, then Pilocarpin is an ecbolic. Practically, therefore, it would be advantageously used when a labor has already imperceptibly begun. During labor proper it regulates and stimulates uterine activity”

I would further define its scope by adding that it would seem that to be fully indicated the labor must have been some time progressed, but that owing to some disordered condition of the vascular or nervous systems, the pains become irregular in force and rhythm , the vagina becomes dry and hot, the cervix dry and unyielding, and there is a general condition of feverish restlessness.

In other words, the primary normal state, simulating the primary symptoms of Jaborandi, has passed away, and a secondary abnormal state has set in. In such cases, doses of 1 or 2 grains of the 1* tincture of Pilocarpin will doubtless act curatively, and carry the labor to a normal termination. I hope my colleagues will test the remedy and report the results. My own experience with it in labor is not sufficient to enable me to report formally.

I have, however, used it in a class of cases which had heretofore given me much trouble. I allude to those women who have a constant dry, non-perspiring skin, a dry mouth, and a generally deficient glandular inactivity. Such women usually suffer from very scanty menses, and in proportion as the menses are scanty, symptoms of arterial fulness obtain.

In such cases a few drops of Jaborandi, or a few grains of Pilocarpin 2X tincture, given four times daily, fora week before the expected menses, frequently causes them to appear in proper amount, and at the same time induces a soft perspiring condition of the skin. Experience has proved it to be of great value in the lyingin room, when the lochia becomes scanty or suppressed, and the flow of milk ceases or refuses to appear. After its administration the lochia returns and the milk appears abundantly in the breasts*

In confirmation of the power of Jaborandi on the impregnated uterus, I quote the following from a German journal :

Dr. Chadzvnki, after stating that he has witnessed very favorable results by treating skin diseases, such as psoriasis, syphilis, etc., with hypodermic injections of Pilocarpin, says : “ In one of these cases, the patient, a syphilitic girl aged twenty-one, was in the fourth month of her pregnancy. After the ninth injection had been made, labor suddenly began, and the foetus was born. Three other similar cases have already been observed. It would, therefore, be highly instructive

to submit this particular effect of the drug to careful study, as it may prove very useful in cases where premature confinement is indicated. Great care should, however, be observed in administering subcutaneous injections of Pilocarpin to pregnant women.” — Allgem. Median. Central- Zeitung.

In diseases of the kidneys Jaborandi will soon be classed among our best remedies, provided we do not stupidly adhere to the symptoms of the pathogenesis we have, but are guided by the clinical experience which is every day accumulating.

The following illustrates its power in this direction :

Acute Bright’s Disease cured by Jaborandi. — A. W., aged fifty-five, single. Admitted on March 20th. Has never suffered from rheumatism, and has never had any specific disease. Has always been regular in her courses. The patient states most positively that she has been perfectly well all winter, and that her illness only began one week prior to her admission. She then noticed that being exposed to the vicissitudes of the weather, her feet and then her face began to swell. Finally, a general anasarca came on. She had, at the same time, some loss of appetite, with gastric pain and cough. When she was admitted to the hospital her whole body was greatly swollen, and she was somewhat feverish ; the temperature in the mouth being 99°. The heart was beating feebly, or rather the sounds of the heart were feeble. She complained of pain and weight in the pit of her stomach, and considerable dyspnoea. She passed but little urine. There was no heart murmur to be heard, although we made a very careful examination of that organ. The tongue was clear, and the digestive disturbances not much marked.

What was the cause of the dropsy ? A clue was at once afforded us by an examination of the urine, which was found to contain an enormous amount of albumen ; the albumen, when precipitated, filling at least one-third of the test-tube.

The microscope taught us that the urine also contained blood-corpuscles, epithelial and hyaline casts, and a few oil drops. Most of the casts were, however, epithelial.

I at once diagnosticated the case as one of acute Bright’s disease — Bright’s disease complicating acute renal dropsy. All this was self-evident. Only one doubtful point remained to be cleared up. Was or was there not prior organic disease of the kidneys ? This was at first hard to determine off-hand. We had to wait until the acute attack had passed away under the proper treatment. The presence of casts and blood- corpuscles in the urine seemed to answer the question in the affirmative at that time.

To-day we have the best of reasons for concluding that no disease of the kidneys pre-existed. The case has ended in perfect recovery. The abnormal constituents of the urine have almost entirely disappeared. This case has been an extraordinary one, on account of the patient’s very rapid recovery.

And now you will, of course, want to know what our treatment has been — how we have brought it about that in the course of two weeks after her admission the patient is entirely recovered. The general dropsy, albumen in her urine, and

dyspnoea all gone together. I ascribe all my success in the treatment of this case to the free use of Jaborandi. Five days after the Jaborandi treatment was begun, the whole face of the case was changed. The dose I ordered was one drachm of the fluid extract of the Jaborandi thrice daily. This dose produced excessive diuresis and diaphoresis. I am convinced that in Jaborandi we possess a most valuable agent for combating the dropsical complications of Bright’s disease. It should be given either in the form of infusion or the fluid extract. In cases where uraemic poisoning is a factor, and where the drug is consequently not well borne by the stomach, I have administered Jaborandi by injecting it into the bowel. Though the effects of the drug when injected were not so striking as in the present case, I yet see no reason why it should not be given by the bowel as well as by the mouth. I have also tried the drug hypodermically, but I prefer not to speak positively at present of its effects when so used. In one instance I will say that it did produce considerable irritation of the skin.

How are we treating this woman, now that the dropsy is all gone ? She is taking dialyzed iron internally and hypodermically. This treatment is improving vastly her general health and nutrition.

The origin of the disease in the present case is a very common one. It was brought on by cold and exposure. In children, acute Bright’s disease generally follows scarlet fever. In adults it usually comes on immediately after exposure to dampness and vicissitudes of weather. — J. M. Da Costa, M.D.

Treatment of the Albuminuria of Pregnancy by Jaborandi. — Dr. Langlet, of Bheims, publishes an elaborate account of a case of albuminuria during pregnancy, which he has treated successfully by the administration of Jaborandi. The patient, three months advanced in pregnancy, showed the ordinary symptoms of albuminuria. The action of the Jaborandi on the salivary glands became apparent on the day of administration. The patient took the drug continuously for a period of sixteen days, during which time the oedema disappeared, and the general symptoms were improved. The albumen was likewise lessened to such an extent that not the slightest trace could finally be detected, and the lying-in occurred under the most favorable circumstances. Dr. Langlet has noticed that the administration of the Jaborandi caused an increase in the urinary secretion, and this coincides with a somewhat similar observation of M. Rendu, who found that in a case of acute nephritis the drug caused polyuria. On the fifteenth day of the administration of the drug haematuria occurred, so as to give the urine a disagreeable odor and a bright-red color. This accident, which did not retard the recovery, is to be attributed to the excessive work imposed upon the kidney by the increased secretion leading to congestion, and the congestion to actual haemorrhage. — “ Union Medicale du Nord-Est,” No. 6.

The Use of Jaborandi. — Within the past year or two Jaborandi has become a very popular and useful drug at Bellevue Hospital. In uraemia and in acute and chronic parenchymatous nephritis it has accomplished especially good results.

In uraemia it is a very effective substitute for the old hot-air bath, acting more quickly and surely. As it has been shown to increase markedly the excretion of urea, it is probably more efficient than the baths in relieving uraemic phenomena.

A patient was brought into the hospital some weeks ago, suffering from convulsions and delirium. She had no oedema, but her urine was nearly solid with albumen, and contained small casts and blood. She was given a drachm of the fluid extract of Jaborandi, hypodermically, and ten minims of Magendie’s solution. In fifteen minutes she was sweating profusely, and the convulsions had ceased. She was restless and wandering in mind for the next twenty-four hours, but had no other bad symptoms. A drachm of Jaborandi was given every other day subsequently, and in a week the albumen had nearly disappeared from her urine, and she felt quite well.

Cases of chronic nephritis have been treated with the drug very satisfactorily. Some who did not improve or get rid of the oedema under Digitalis or Potassium, have shown immediate improvement under Jaborandi. It is given in drachm doses every other morning, the patient being kept in bed until dinnertime, when the sweating is over. It is better not to give it at night, as the bedclothes become saturated with perspiration, and sleep is disturbed and uncomfortable.

Jaborandi weakens the heart. It is dangerous when the pulse is poor and the system debilitated. If given to a patient in this condition with uraemia he falls into a cold perspiration, and oedema of the lungs, coma, and death follow.

Yet it has been used several times in the treatment of pulmonary oedema in doses of ten to fifteen minims every one or two hours. The autopsies have shown the usual changes.

It has been used also in pleuritic effusions, but does not seem to “ sweat out ” the intrathoracic liquid very much. Besides, it produces a nausea and salivation not at all pleasant.

The drug loses its effect in some cases, and the dose has to be increased. The usual variety in its action has been noted. Sometimes it causes salivation only ; most frequently salivation and diaphoresis. If the dose is carefully regulated, nausea and vomiting need not be a frequent complication. The urine is, in cases of chronic Bright’s disease, somewhat diminished in amount, unless renal congestion or an acute nephritis is complicating the case. Jaborandi has proved, so far, of most certain service in the chronic stages of Bright’s disease, and in uraemia brought on during its initial attacks. When an acute attack is lighted up on a chronically inflamed organ, and when the system has already become weakened and anaemic, the drug may be useful, but it will also be dangerous. — “ The Medical Record,” Nov. 9th, 1878.

Jaborandi in Obstinate Hiccough. — Dr. Ortille, of Lille, relates a case of most obstinate hiccough in which he had tried a great variety of means, including electricity and hypodermic morphia injections — the hiccough even continuing during the sleep caused by this last. He then tried the Hydrochlorate of pilocarpin, on account of its action on the phrenic nerve. A hypodermic injection of two centigrams and a half was inserted with almost immediate effect, so that in a quarter of an hour the patient was bathed in a sweat, salivation was established, and the hiccough disappeared never to return.