Pilocarpus. Pilocarpus jaborandi.

Synonym—Jaborandi.

CONSTITUENTS—

Pilocarpine, jaborine, volatile oil, tannic acid, volatile acid, potassium chloride.

PREPARATIONS—

Extractum Pilocarpi Fluidum. Fluid Extract of Pilocarpus. Dose, from five to sixty minims.

Specific Medicine Jaborandi. Dose, from one-fourth of a minim to three minims.

Administration—In the administration of this agent the characteristic results may be obtained almost equally well, either from an infusion of the leaves, or from any of the preparations named. The hypodermic administration of the alkaloid pilocarpine, is preferable in many cases, especially where the promptness of its action is desired. The liquid preparations are often unacceptable to a disordered or sensitive stomach and then minute doses of the alkaloid in pellets or granules will be, found a most desirable form for administration.

The action of the fluid extract or tincture of jaborandi and impure pilocarpine is sometimes disappointing, failing entirely to produce their characteristic influence and perhaps producing results contrary to those anticipated. This is due to the presence of the alkaloid, jaborine, which acts antagonistically to pilocarpine, having in its therapeutic influence many of the characteristics of atropine, an antagonist of pilocarpine.

The nitrate and hydrochlorate of pilocarpine carefully prepared are free from jaborine and are thus reliable in their action. Solutions of pilocarpine should be made fresh when needed, as the salts decompose in aqueous solution. They are not permanent but will precipitate at once in alkaline solutions.

Physiological Action—Near the point of the administration of a hypodermic injection of the alkaloid, a few drops of sweat appear within from four to six minutes after the injection, to be immediately followed with moisture on the forehead, neck and chest, and in quick succession the entire body is bathed with a most profuse perspiration.

It is a powerful anti-diphtheritic and sialogogue, acting profoundly as a stimulant upon the secretions of the entire glandular system. No one known remedy stimulates every secretion of the body simultaneously as profoundly as does this agent.

The depression of the agent should not be allowed to progress; after the sweating has continued a few minutes profusely, a little whisky, brandy, tincture of ginger, or tincture of capsicum should be given in hot water, and occasionally repeated while the transpiration progresses. If the heart shows the influence of the depression, a hypodermic of strychnine may be given, or a few drops of the tincture of cactus, strophanthus, digitalis, or nux vomica. If it is desirable to stop the sweating abruptly, atropine hypodermically may be resorted to.

The extreme effects of the agent need not be obtained in many cases, but owing to the susceptibility of some cases a small dose will sometimes produce extreme results. It is safe to obtain these results in extreme sthenic cases—in robust patients. The reaction will be prompt and satisfactory.

Most observers state that it is best to quench the thirst with weak coffee or milk and not with-cold water. It is undesirable that the patient swallow the saliva when the agent is administered after the bite of venomous snakes or in threatened hydrophobia or if given as an antidote to poisons.

When the agent fails to act upon the skin it often expends its force upon the salivary glands, kidneys, stomach, intestines or lungs, producing extreme secretion or excretion from these organs. In some cases this agent produces nausea, vomiting, diarrhea, contracted pupil, extreme weakness, dimness of vision, sighing respiration, palpitation and collapse; but these symptoms of alarming nervous depression rarely occur and are easily combated with atropine.

Specific Symptomatology—The direct indications for this agent are acute suppression of the secretions, especially of those of the skin in sthenic conditions usually with distress, elevation of temperature, sharp, hard pulse, dry skin, dry mucous membranes, constipation, and small quantity of urine with dark color and high specific gravity.

Kinnett gives the specific indications for its use, as dry hot skin, dry parched mouth, pulse full and very strong, patient restless and uneasy, suppression of the secretions, especially of the kidneys, which seem to be unable to act properly. His contra-indications are feebleness, weak pulse, weak heart action, tendency to depression.

Contra-Indication—Jaborandi should be avoided in asthenic conditions, or where there is feeble or dilated heart, and used with care in old people and-young children. Except in its influence on laryngeal and bronchial disorders, and in the sthenic stage of diphtheria when it loosens the membranes.

Therapy—At the onset of acute febrile and inflammatory conditions, especially if there be rigors, hot, full head, and a bounding, hard pulse, a foot bath of hot water and a full dose of jaborandi with proper supportive treatment subsequently will often end the attack abruptly. The stage following the influence of the agent if the temperature has subsided, has all the conditions in which quinine works to its best possible advantage.

Several recent writers have written enthusiastically on the action of jaborandi or pilocarpine in establishing a favorable crisis early in the severe forms of acute disease. Pernicious malarial fever, typho-malarial fever, inflammatory rheumatism, and other of the severer forms of inflammatory disease they claim may be aborted by the use of full doses of this remedy. Where jaborandi can be administered by the mouth, it is preferable, although some claim that pilocarpine hypodermically invariably produces better results.

A number advise the use of this remedy in comatose, delirious and colliquative forms of pernicious intermittent fever. These writers agree upon the surprising influence of the remedy, where at the onset of this disease or of other acute specific fever there is great excitable mania— extreme violent delirium, which in its seriousness overtops all other conditions. The above indications of Kinnett will usually be exaggerated at these times. If an eighth of a grain of pilocarpine be administered hypodermically, the delirium disappears at once, quiet and restfulness obtain without the occurrence of the physiological action of the remedy upon the skin or salivary glands. There is a disagreement of opinion as to its value in the treatment of convulsions. Kinnett claims that where the intestinal tract is overloaded with irritating material, it produces both emesis and active free bowel movement, at the same time stimulating the action of the kidneys and skin.

In a case of extreme malarial poisoning, in a strong man, the bowels had not been moved for three days, nor the urine voided for eighteen hours. The temperature was 107 degrees, and the pulse 140, full and bounding. The skin was of a jaundiced appearance and the conjunctivae was distinctly yellow. One-half grain of pilocarpine hypodermically, caused salivation in three minutes, perspiration stood on the neck and forehead in great drops, the face and skin became extremely red at first and pale as the perspiration advanced. He immediately passed a large quantity of dark-colored, highly offensive urine. He vomited, and had a movement from t he bowels, large and copious. The doctor claimed that more was accomplished by this one dose of medicine in one hour in the way of elimination, than he could have accomplished otherwise, in forty-eight hours. Vomiting from pilocarpine is not at all severe. There is no violent straining. The act is more like one of regurgitation.

This agent can be used to good advantage in alcoholism. Administered hypodermically, it has a prompt sobering effect. It induces sleep, from which the patient awakes rational and subdued. The transformation in the physical appearance of the patient is marked. The tense red, bloated countenance, the bleared congested eyes, the general repulsive facial aspect pass away, and the skin assumes a clean and soft appearance, the features are calm, and the eyes clear. It has been used with good advantage in the treatment of gall stones, one-eighth of a grain three or four times a day has relieved severe cases.

In inflammations, of the lungs or pleura, with exudation, it promotes resolution and quickly removes the exudate. In bronchitis with dry, irritable, or hoarse cough, with imperfect secretion, it acts admirably as an expectorant. It lessens the cough as well as influencing the temperature. In laryngitis, tonsillitis or diphtheritis it is used by many physicians as the most important factor in the treatment. It is especially indicated in stridulous laryngitis.

In the treatment of epidemic influenza it has been given in small doses with persistency. It is said to render important service in the cure by restoring secretion.

In laryngeal diphtheria and in membranous croup, given in doses of from two to five drops every two hours, in conjunction with antiseptic treatment, it increases the mucus and salivary secretions and loosens the membrane and causes its exfoliation promptly and satisfactorily. It can be relied upon if the forces of the system can be sustained and if it does not produce too great prostration. Feeble children will not do as well under this treatment as robust and vigorous ones.

In bronchial asthma or in dyspnea, from acute pulmonary engorgement, it gives prompt relief.

The agent in doses of from one-half to one drop often repeated during the afternoon or evening has controlled most satisfactorily the night sweats of slow convalescence and of pulmonary phthisis.

Dr. Standlee gave jaborandi for stiffness of the joints, five drops with one drop of rhus in a teaspoonful of simple elixir, three times a day.

Dr. Lass gave jaborandi for pruritus as a functional affection of the skin with itching, burning and prickly sensations, especially winter itch, so-called, or frost itch with curative results.

Jaborandi in diphtheria and in membranous croup must be used constantly to be appreciated, but it certainly is a very efficient agent. It removes the membrane sometimes in a few hours, and given with echinacea or inhalations of eucalyptus and turpentine in the early stages, no membrane will be formed.

The agent is a heart sedative of acknowledged ability and is reliable. It controls the heart's action, the pulse, and the temperature similarly to aconite or gelsemium, with either of which it may be well combined and its influences heightened by the combination. In febrile conditions where nervous complications are anticipated, and where spasm has occurred, it has a sedative and direct anti-spasmodic influence, operating synergistic ally with gelsemium or the bromides.

Webster lays great stress upon the specific sedative properties of this remedy. He also believes that in certain cases it has a place distinct from that of aconite or veratrum. He believes that it can be adjusted even to asthenic cases. It imparts a cooling sensation to the skin, relieves headache arising from the fever, calms nervous irritation, and soothes local inflammatory action. It dissipates the surface heat, and acts immediately upon the secretion of saliva and overcomes sordes very quickly, cleaning the mouth completely, restoring all secretions.

In inflammatory diseases of the chest he believes that it does all that asclepias does, and more. He combines it with echinacea in erysipelas. He believes that it relieves irritability of the heart and blood vessels, and induces normal equilibrium. The dosage for these purposes is invariably small—not to exceed one or two minims, and frequently repeated.

The agent has been used in hydrocephalus, and in other effusions into the membranes of the brain or spinal cord, but there are apt to be contraindications and it must therefore be used discreetly, and combined with other agents as indicated, and the strength of the patient supported.

It is useful in all local or general dropsies with discriminating judgment in its administration.

In acute inflammatory rheumatism or in rheumatic fever it should not be neglected as few agents will take its place. A single sufficient dose of pilocarpine will often relieve the pain, at the onset, promptly. It will be indicated during the course of chronic rheumatism as its influence in eliminating urea, uric acid and other morbific products is of excellent service here. It may be given in full doses once or twice each week or oftener, in much the same manner as a Turkish bath would be administered. Its influence is much wider than any baths.

In acute mastitis with suppression of milk after confinement it quickly relieves congestion and restores the lacteal secretion. It is a prompt and efficient galactagogue at any time. Sufficient doses to induce active transpiration need not be given, but five to ten drops of the tincture four times daily for a few days will accomplish the result. If the milk is entirely suppressed it may sometimes be restored if this remedy is administered immediately. In such a case a full dose should first be given, followed subsequently by smaller doses at longer intervals.

It has been used to advantage also in acute orchitis, and it will serve a good purpose in some cases of acute ovaritis or metritis.

A writer in the Medical and Surgical Reporter says that having observed that parturition progresses most favorably when there is diaphoresis, he now produces that condition early by the use of jaborandi; he gives one-third of a teaspoonful of the green fluid extract in half a wineglass of water every half hour until perspiration occurs. The effect is a soothing one, often relieving the severity of the pains. The os rapidly dilates, the soft parts assume a more favorable condition, and the labor is soon terminated favorably. He has seen only good results from its use. Many writers agree on the action of the remedy in rigid os uteri, where the pains are hard, the muscular system tense, and. the skin dry.

If prostration occurs from the profusion of the perspiration the skin is thoroughly dried, the patient is given a stimulating drink and warmly covered, and there are no further unpleasant results. It does not necessarily increase the danger of post-partum hemorrhage unless the effect of the agent is severe, in which case a full dose of ergot at the completion of the second stage of labor or a hypodermic of strychnia will insure prompt uterine contraction.

These facts are especially true if during confinement the skin is hot and the os unyielding, rigid and painful, the pains hard and unsatisfactory, the pulse sharp and hard, and perhaps the temperature rising. A full dose of jaborandi will often change the entire condition, at once producing relaxation of the os, free secretion, more expulsive and less irritating pains and a general soothed and quiet condition.

Many writers confirm the value of this agent in puerperal eclampsia. A French authority treated ten consecutive cases with satisfactory results, with the hydrochlorate of pilocarpine. He concludes that feebleness of the pulse, as long as the convulsions reappear, is not a contra-indication to a repetition of the dose.

When permissible it should be given in a single, full, prompt dose. Its best influences are directed toward elimination of the urea, thus relieving the uremia and reducing dropsical effusions. Its anti-spasmodic influence, while not always, perhaps, to be depended upon alone, is exercised harmoniously with the indicated anti-spasmodic, whether it be veratrum, chloral, the bromides, morphia, passiflora or gelsemium.

In exanthematous fevers of all kinds jaborandi in small doses is the remedy par excellence. In robust cases, with scarlet fever, the determination to the skin and the elimination from the skin is so prompt and efficient that post-scarlatinal nephritis need not be anticipated.

Waugh is authority for the statement that the agent is efficacious in acute sthenic erysipelas. It may be given in twenty drop doses, every four hours, and any prostrating influences antagonized. Local applications should not be neglected, but should be selected with care, and prompt tonics and restoratives should be administered in conjunction. In asthenic cases the agent should not be unqualifiedly discarded, but it may be adapted in small doses to the case in hand.

Pilocarpine has a selective action for the skin, and is prescribed by specialists in a number of skin diseases, notably in pruritus, eczema, prurigo, and in hyperhidrosis pedum. It is given in small doses long continued.

Its continued internal use for other conditions has been known to result in an increased growth of the hair with restoration of the original color of gray hair.

Pilocarpine in the proportion of two grains to the ounce of lanoline is a common application to the scalp to restore the hair and prevent baldness. It may be combined with cantharides.

Ophthalmologists claim excellent results from its use in a number of diseases of the eye. In iritis it overcomes inflammations and removes adhesions. It causes rapid absorption of all exudates. It is of benefit in detachment of the retina and in optic neuritis. In all inflammatory conditions it is of service. It is beneficial after extraction of the lens, and is said to promote the absorption of opacities in the vitreous humor which have resulted from recent infiltration. It acts upon the pupil much after the manner of eserine.

Dr. Kent O. Foltz employed the drug regularly in iridocyclitis, in plastic and traumatic iritis, in rheumatis iritis, in hylatis, in simple glaucoma and in some cases of optic neuritis; also in traumatism of the eye, where there is effusion of the blood into the aqueous or vitrious humors, in retinal hemorrhage, in chorio-retinitis, and in detachment of the retina. It has been beneficial in beginning atrophy of the optic nerve. In interstital keratitis, and in chronic conjunctivitis, also in croupus and diphtheritic conjunctivitis.

In the treatment of ear disease, it has a more limited use. In dry catarrh of the middle ear, and in eczema of the external auditory canal it has some beneficial influence. In effusion into the labyrinth it facilitates absorption. In atrophic rhinitis, and pharyngitis, it increases the activity of the glands, and produces general salutary results.

A few doses of from twenty to thirty drops of jaborandi are given internally in cases of severe rhus poisoning, combined with proper external applications.

In the treatment of the bite of venomous snakes and in anticipated hydrophobia, and in poisoning from canned fish and other meats—in ptomaine poisoning, the salts are administered in maximum doses.

The patient will show but little of the prostrating influences of the drug. It is eliminative in its influence, only the poison must be antidoted by the proper remedy, and in organic poisons the permanganate of potassium is an efficient remedy.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.