Pilocarpinum

Pilocarpinum, muriaticum, and nitricum.

An alkaloid obtained from Pilocarpus pinnatus (Jaborandi).

Preparation , Solutions.

Authorities.

1 , Ringer and Jaunson, Pharm. J., ser. III, 5, 965, effects of the injection of 0.0325 grams of the nitrate of P.; 2 , Weber, Med. Central. Blatt, Wien, 1876, p. 769, experiments on himself with small doses of 5 c.c. of a one-half p.c. solution; 3 , Bardenheuer, Berlin Klin. Woch., 1877, p. 7, effects of subcutaneous injections of small quantities in several persons; 4 , Leyden, ibid., p. 85, effects of subcutaneous injections of a one-half to two p.c. solution; 5 , Scotti., ibid., p. 141, subcutaneous injections.

HEAD

• A sensation of throbbing in the temples frequently accompanies the acceleration of the pulse, 5.

EYE

• Increased secretion of tears, 4.
• Profuse lachrymation, 3.
• One drop of a solution of the nitrate in the proportion of 1 to 480 was put into the eye. In about twenty minutes the pupils were contracted to the size of a pin's head, without pain or discomfort. Previous to the instillation the patient was barely able to see Snellen's type 4 1/2 at the distance of five feet; after the contraction of the pupil had taken place, he was able to see easily the same type fully nine feet distant, 1.
• Contraction of the pupil commenced, lasted for twelve hours after all the other effects had passed away (from subcutaneous injections); from the local application to the eye of one drop of two per cent. solution contraction commenced in ten minutes; reached its maximum in twenty to thirty minutes, lasted about three hours, and the pupil did not return to its normal size until after about twenty-four hours, 2.
• Myosis caused by local application of the two per cent. solution; this continued after three or five minutes, and reached its maximum in fifteen or twenty minutes, and continued two or three hours or longer, according to the amount; during this contraction of the pupils there was but slight change in the refraction of the eye; the far point approximated somewhat, but was overcome by concave glasses of 1/40 to 1/36; Atropia seemed to be a perfect antidote, 5.

NOSE

• Increased secretion from the mucous membrane of the nose, 3.

MOUTH

• Very sudden salivation, without the prodromal stage; the secretion reached its maximum in about fifteen minutes, usually continued an hour and a half to two hours, and amounted to from one-fourth to three-fourths of a liter of thin saliva, very poor in specific constituents, 5.
• Profuse salivation accompanied the perspiration, 4. [10.]
• Increased secretion of saliva occurring in from three to five minutes after the subcutaneous injection, and lasting usually longer than the perspiration, 2.
• Increased salivation (after three minutes); gradually increasing and reaching the maximum in about twenty minutes, then slowly decreasing, 3.
• In a case of lead paralysis, it caused profuse salivation and perspiration, accompanied by a sensation of great coldness and excessive tremors of the extremities, 3.

STOMACH

• Nausea occurs only when the salivation is complete; this nausea does not amount to vomiting, as is often the case after the infusion of Jaborandi, 2.
• The violent, repeated vomiting noticed after Jaborandi, does not occur after Pilocarpin, 3.

RECTUM AND ANUS

• Urging to stool was sometimes noticed, 5.

URINARY ORGANS

• Increased desire to urinate, 4.
• Desire to urinate, with violent pain in the urethra, without ability to pass urine; increase of the urinary secretion was occasionally noticed, but was not the rule, 5.
• Violent dysuria, with violent pains in the penis, 3.
• Increased secretion of urine, though only transient; the aggregate amount of urine passed during twenty-four hours after the drug is not increased, indeed, rather diminished, 4.

SEXUAL ORGANS. [20.]

• Menses two days earlier than usual in a woman who menstruated regularly, 5.

RESPIRATORY ORGANS

• Increased secretion of bronchial mucus, usually accompanied by moist cough and expectoration, 4.

HEART AND PULSE

• Weakness of the heart (after two or three hours), 4.
• Slight acceleration of the pulse from 5 to 10 beats during the perspiration, 2.
• In its primary effect it causes slight increase in the frequency of the pulse, and slight diminution of the blood, pressure, from small doses; after larger doses the pulse becomes slow, with great diminution of the blood pressure, 4.
• The pulse curve exhibits at first an increased systolic elevation, a more abrupt curve, a more sudden downfall, and a very decided recurrent elevation; the artery is filled rapidly and violently, and collapses suddenly; symptoms of relaxed tone of the vessel and accelerated heart's action; the character of the pulse-curve is most pronounced after ten or fifteen minutes; it gradually returns to the normal; the pulse-curve of a rather rigid and unyielding radial artery in a patient sixty three years old was very interesting; the elevation was stronger and more vertical, but was not much higher than normal; the curve did not immediately descend after reaching its highest point, but continued for some time almost horizontal, and then suddenly fell; the recurrent elevation, which normally could scarcely be noticed, was now very pronounced, 5.
• Increased frequency of the pulse by 10 to 20 beats, coincident with or a little later than the salivation, 5.
• Diminution of the arterial tension a few minutes after the injection, even before perspiration, 3.
• After the perspiration the pulse falls and gradually sinks to the normal, 5.

GENERALITIES

• The dilatation of the vessels began after two or three minutes, and lasted from half an hour to an hour, accompanied by redness of the skin, and soon followed by perspiration; there was speedily noticed a decided swelling of the bloodvessels of both the arteries and veins; the temporal artery, which before the injection could scarcely be noticed, became a thick prominent cord, with visible pulsation; its diameter doubled; at the same time the veins in the forehead became swollen and appeared as large blue vessels, so that as the perspiration began the patient had the appearance of one excessively heated; the same dilatation is noticed in the radial arteries; the veins on the forearm and hand frequently seemed swollen; the pulse was fuller and more rapid, sometimes decidedly dicrotic; the pulse rose from 80 to 100, or even 120, 4. [30.]
• The loss of weight, after two or three hours of copious secretion, varies from about four and a half to nearly nine pounds, 2.
• Before the injection, temperature 24.7, pulse 104. The drug began to exhibit its effects in forty-five minutes, when the face and chest became red, and covered with slight perspiration; five minutes later the whole body was covered with profuse sweat, together with copious salivation; temperature 37.1°, pulse 100. The salivation and perspiration lasted about five hours, after which the patient was very thirsty, but in other respects well, 1.
• Exhaustion, during, which most of the patients fell asleep (after two or three hours), 4.

FEVER

• Chilliness.
• A sensation of coldness and even shaking chill was experienced by some patients during the perspiration, though the thermometer showed no fall of temperature, 5.
• Heat and Sweat.
• Increase of temperature from 1/2° to 1° C., in some cases, during the feeling of intense cold, 2.
• The temperature was almost always increased by 1/2° to 1°, at the commencement of the acceleration of the pulse; it usually continued so until the whole body was bathed in copious perspiration, then slowly returned during the course of two or three hours to 1° to 2° below the normal, 5.
• The forehead and face become red, the veins on the forehead swollen, when the perspiration begins on the face and over the whole body; the perspiration is thin, odorless, slimy, acid, or neutral (after two to five minutes), 4.
• Redness of the face, with a sensation of warmth, with perspiration at first over the forehead, along the margin of the hair, then extending in a short time over the face to the neck, chest, trunk, arms, and at last over the lower extremities, continuing an hour and a half. The patient usually loses from one to two kilogrammes in weight, during the perspiration, which, however, he recovers after twelve or twenty-four hours, 5.
• The variation in the temperature is somewhat as after an infusion of Jaborandi; during the maximum of perspiration it fell from 0.5° to 0.6° Cent.; as the perspiration diminished, it gradually rose to its former height; this was a constant effect, 3.
• The temperature at first showed a slight variation of 0.1° to 0.5° in some cases, in other cases no rise at all; as soon as the perspiration began the temperature slowly sank, 4. [40.]
• Excessively profuse perspiration, 3.
• Profuse perspiration, so that it stood in drops on the forehead and face (after five to ten minutes), 4.
• Perspiration commences later than the salivation by about five minutes, occurring first on the head, gradually extending over the whole body, often with a feeling of intense cold, so that the patient chatters and wishes to be wrapped up; the duration of the perspiration varies, according to the size of the dose, from one to three hours, 2.
• Perspiration (much less marked than from the infusion of Jaborandi), followed by a feeling of great relief and increased vigor, 2.