Introduction
Alkaloid obtained from Jaborandi.
Provings
The first and most constant action of pilocarpinum muriaticum, even in small doses (0.5 cc. of 1/2 percent. solution) is increased secretion of saliva; it comes on in from 3 to 5 m. after hypodermic injection in upper arm, and lasts hours longer than the increased secretion of sweat, more rarely does it cease simultaneously with the latter, and it occurs after doses that cause no diaphoresis. The duration and quantity of the salivation are proportioned to the strength of the dose. The diaphoresis, which very seldom fails to occur (and then from doses not exceeding 0.5 cc. of 1/2 per cent. solution), speedily follows the ptyalism, rarely 5m. later; it begins generally in the head and gradually spreads all over body, accompanied often by an intense feeling of cold, so that the patients’ teeth chatter and they wrap themselves up with warm coverings. The duration of this diaphoresis varies with strength of the dose; with our usual dose, 1 degree cc. of a 2 per cent. solution, the duration of the sweating is on an average I hours if the patient remains our of bed, but can last 2 or 3 hours if he goes to bed. There is usually a slight quickening of pulse by from 5 to 10 beats, but with cessation of diaphoresis it reverts to the normal. Rarer is an increase of the temperature from 0.5 degree to 1 degree, which was observed when the patient complained of intense feeling of cold. The feeling of great faintness is only in short fits, and does not last longer than the other symptoms (when the infusion of Jaborandi leaves is taken this symptom lasts 4 or 5 hours longer). Nausea only occurs when the saliva is not completely ejected. (There is no vomiting, which, again, is a marked symptom when the infusion is taken.) Contraction of the pupils occurs later, and survives all the other symptoms by, on an average, 12 h. On dropping into eye left dr. of the 2 Percent solution the contraction begins in 10 m., attains its maximum in 20 to 30 m., lasts at that degree 3 hours, and perceptible contraction remains for 24 h. The loss of weight from a copious secretion for 2 to 3 hours is on an average 2 kilogr., once it was 4 kilogr. (WEBER, Centralbl. f. day med. Wissensch., Berlin, 1879, 769.)
2. Made 12 experiments on 10 persons. 3 m. after hypodermic injection (quantity not stated, probably 1.0 cm. of 2 per cent, solution) there came on salivation. This gradually increased, attained its maximum in 20 m., and remained there I hours, then gradually declined, but after 5 hours it was still somewhat increased. In one case the ptyalism was so great that in 100 m. after the injection 550 cm. saliva was collected, of sp. gr. 1005. The amount of sweat during same period was from 500 to 700 cm. Almost constant was an increase of the laryngeal secretion. From the flow of tears into nose the nasal secretion seemed to be increased. Once there was dysuria with violent but transient pain in glans penis. At the height of the diaphoresis the temperature in anus sank 0.5 degree to 0.6 degree; as the diaphoresis declined the temperature rose gradually to its normal height. The pulse is at first quickened. Sphygmographic observations showed a marking sinking of arterial tension a few m. after the injection and before the commencement of the sweating. Three of the provers had some eructation. In one case in which the patient expectorated no saliva and probably swallowed it, he vomited a meal taken 2 hours after the injection. In another case (saturnine paralysis) where there were profuse salivation and diaphoresis, the patient had intense cold feeling, with trembling of limbs and constriction of chest. (BARDENHEWER, Berliner klin. Wochensch., 1877,7.)
3. After injection (hypodermic) of 1 cm. of 2 percent. solution, the action commenced in from 1 1/2 to 10 m. The action commenced soonest when the injection was performed on temporal region, latest when done on outside of thigh. The first symptom is a quite sudden salivation. The salivation attains its maximum in about 15 m., continues there 1/2 to 2 hours, and there flows from 1/4 to 3/4 litre of the watery saliva. Almost simultaneously, sometimes some m. later there occurs, along with increase of pulse by from 10 to 20 beats and feeling of warmth chiefly in the forehead, at the hair border, sweat, which in a short time extends over face, neck, chest, trunk, arms, and lastly, legs, lasts about 1 1/2 hours, but if the patient is wrapped up, from 2 to 3 h. The weight of the increased secretions is from 1 to 2 kilos. After a few m. the pulse rises, and as the symptoms of the drug decline the pulse falls till it regains its normal velocity. When the pulse began to rise some of the patients complained of throbbing in temples. The sphygmographic curve shows at the beginning an increase of the systolic elevation and a more perpendicular up – stroke, quicker descent of the necrotic limb, and distinctly marked reflex elevation, showing that the artery swells quickly and strongly and falls together rapidly, signs of relaxation of artery and quickened cardiac action. This is most distinctly seen after from 10 to 15 m., and then it gradually returns to the normal state. The temperature showed a slight elevation, 0.5 degree to 1 degree at the commencement of the quickening of the pulse, remained thus until the perspiration was profuse all over the body, then sank slowly from 3 to 4 hours to from 1 degree to 2 degree below the normal. Sometimes at the commencement of the sweating, sometimes during the course, there was cold feeling up to marked rigor (whilst the thermometer showed no decrease of temperature). Some had, after the occurrence of the ptyalism, great chilliness, that sometimes lasted 1 h. After the remission of the chilliness the perspiration then set in. In another case the feeling of coldness only occurred when the ptyalism and diaphoresis had attained their maximum. In some there was urging to urinate and occasionally even violent pains in urethra even when not passing urine. Occasionally there was increased secretion of urine. Nausea and vomiting were rarely seen. In women whose menses were always regular they came on 2 day too soon. Contraction of the pupil after injection was not very obvious, but when instilled into the eye it commenced in 3 to 5 m., and attained its maximum in from 15 to 20 m. After I dr. only the action on the pupils lasted only 2 to 3 hours, but when several drops were inserted the contractions lasted 24 hours (SCOTT, Ibid., 141.)
4. Action begins 2 to 5 m. after injection of 2 per cent. solution. First, the forehead and face grow red, the veins of forehead swell, then sweat appears on face and all over body, and becomes very profuse. Salivation occurs often before the diaphoresis. There is often an increase of other secretions, lachrymation (the tears come through the nose), bronchial secretion increased, with loose cough and expectoration, then almost always increased urging to urinate and increased secretion of urine; but this is only transient. On the whole, the amount of urine passed during the 24 hours diminished. Sometimes there is great sickness, followed by vomiting. Frequently there is great weakness and a kind of collapse. The proper effects of the drug last 2 to 3 hours, then there ensues a feeling of exhaustion, during which the patient generally falls asleep and wakes refreshed. But this exhaustion sometimes lasts till next d. Before the outbreak of the sweat there is a dilatation of the blood – vessels, both arteries and veins, of the face and forehead. The temporal arteries, before scarcely visible, form a thick projecting cord whose pulsations are visible. The diameter of the arteries is increased to the double. The veins of the forehead appear as thick blue vessels. Radial arteries also dilated, and veins of forearm and hand. The pulse becomes more frequent, sometimes slightly, as form 80 to 84 or 88, usually to 100, and sometimes from 80 to 120. The sphygmographic tracing shows increased elevation of the systolic impulse. An increase of the temperature at the commencement of the action of the drug from 0.1 degree to 0.2 degree and even 0.5 degree was sometimes observed, sometimes not. After the sweating the temperature gradually declined. With Mosso’s instrument (plethysmograph) it was found that the forearm increased in size owing to the increased distension of its blood – vessels. (LEYDEN, Ibid., 385.).
Poisonings
1a. Although it has been found in the course of time that the use of this agent is attended with a number of unpleasant symptoms, its quality of developing its activity hypodermically causes it to present such great advantages over the leaves of Jaborandi, that the latter must be placed much below P. as a diaphoretic. According to Weber I cm. of a 2 percent. solution of the muriate=an infusion of 5 grm. of Jaborandi leaves. The quantity of saliva secreted after an injection varies, according to Losch, with the individuality of the patient. The saliva itself is tough, viscid, and often as thick as the white of egg. The salivation follows immediately upon the diaphoresis. In this last also the individuality of the patient plays a part, as is shown by the fact that some are bathed in sweat, while other transpire but slightly after the same dose. Rigors are now and the observed during the sweating. Intimately associated with these phenomena is increase is frequency of pulse, by 30 – 40 beats. The patients often complain of palpitation, and very sensitive persons of a feeling of anxiety, which, however, speedily passes away. Vomiting also occurs, and becomes very violent when it once begins. According to Losch, this symptom occurs once in 5 times in women, but only once 10 times in men. It is usually followed by collapse. In children, in addition to vomiting, Demme saw weakness approaching to fainting, pallor of face, and distressing hiccup. Burning sensation in urethra or glans penis was also frequently noticed, usually associated with frequent micturition. Federschmidt also observed dysuria in 2 instances. During diaphoresis and salivation, patients sometimes complained of feeling as if their bladder was too full, and unable to empty itself. The injections were again practiced upon the same persons, these abnormal sensations failed to appear. Disturbance of vision, characterised by mistiness, frequently occurs. In some persons this becomes so intense that they are unable to read large print 6 in. from the eye. There was not necessarily any coincident increase in the lachrymal secretion. The most unpleasant of all the incidental effects of P. is the collapse which appears both during the stage of secretion, and after it, even in robust persons. It may even have a fatal result. The heart must also be watched with the greatest care, particularly in persons with lesions of this organ, on account of the well – established enormous acceleration of its action, which is often attended with irregularity.
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.