Its chief uses are:

1. As narcotic in the insomnia and excitement of acute mania, uremia, and delirium tremens, in the delirium of pneumonia (especially in alcoholics), and in the insomnia of alcoholism.

2. As a narcotic and peripheral sedative in treating the morphine and alcoholic habits.

3. As an anaphrodisiac.

4. As a mydriatic and cycloplegic - one drop of a 1: 500 solution every fifteen minutes for four to six drops.

5. As a general anesthetic or as a preliminary to general anesthesia.

Scopolamine-Morphine Or Scopolamine-Narcophin Anesthesia

The combination of scopolamine hydrobromide with morphine sulphate or narcophin has been employed in surgery as a preliminary to general anesthesia and as the anesthetic itself, and in obstetrics.

As a preliminary to general anesthesia, a dose of scopolamine hydrobromide, about 1/30 grain (0.00045 gm.) with morphine sulphate, 1/4 to 1/2 grain (0.015-0.03 gm.), given hypodermatically half an hour before the general anesthetic, is favored by a number, especially in operations upon nervous people, because it promotes a tranquil, drowsy state of mind, lessens the amount of general anesthetic required, diminishes the throat and bronchial secretions during the anesthesia, and favors postoperative sleep and freedom from pain.

As a general anesthetic about 1/200 grain (0.0003 gm.) of sco-polamine hydrobromide and \ grain (0.008 gm.) of morphine sulphate or narcophin are injected two and one-half hours, one and one-half hours, and one-half hour before the operation. It is sometimes surprisingly successful, but a great many consider it inefficient and dangerous. In 1988 cases gathered from the literature by Wood the anesthesia proved unsatisfactory in 69 per cent., and in a number of cases had to be supplemented by ether. In addition, though the cases selected for this method were as a rule the less serious ones, there were 9 deaths which could beyond reasonable doubt be attributed to the drug, that is 1 in 221, a high rate of mortality for an anesthetic.

In obstetrics it has come to be known as twilight sleep, though Shears calls it "morphine-stupor." The method elaborated by Kroenig and Gauss at their Freiburg clinic is as follows: When the patient is in active labor with pains every four or five minutes and the cervix admitting two to three fingers, she is isolated in a darkened quiet room and given a hypodermic of scopolamine hydrobromide, gr. 1/130 (0.00045 gm.) with narcophin, grain 1/2 (0.03 gm). An hour later 1/400 grain (0.00015 gm.) of scopolamine hydrobromide is given. After another half-hour memory tests are instituted; if she does not remember the number of injections given, or when last examined, or objects seen within half an hour, she is in the required state of seminarcosis. If there is still no amnesia, a further dose of 1/400 grain (0.00015 gm.) of scopolamine hydrobromide is given, and this is repeated every hour or hour and a half as needed to maintain amnesia. Ordinarily only one dose of narcophin is given, but if the patient is very restless, } grain (0.015 gm.) more is injected. The whole object of the treatment is to abolish retention in the memory of the pains and distresses of the labor. On this account Kroenig recommends ethyl-chloride inhalation as the head is expelled, and the immediate removal of the child from the room lest the cry arouse the mother.

In spite of extensive magazine and newspaper exploitation, the method has been largely abolished. It causes a prolongation of the second stage of labor, lessens the strength of the uterine contractions and so favors post-partum hemorrhage, is the cause of an abnormal number of asphyxiated babies, and is uncertain in result (in 500 cases Zwiefel reports successful amnesia in only 31 per cent.). Furthermore the mother requires constant watching, for there may be nausea, vomiting, headache, great mental excitement or delirium, or collapse. A few maternal deaths and quite a number of infantile deaths are reported.

Homatropine hydrobromide (U. S. P.) is the hydrobromide of an artificial alkaloid allied to atropine. It is made by the condensation of tropine and oxytoluic or mandelic acid. It is soluble in 5.7 parts of water, and is used solely for its ocular effects, one drop of the 1 per cent. solution being dropped in the eye every fifteen minutes for 4 to 6 drops. Dilatation of the pupil comes on quickly, reaches its maximum in one to two hours, and is followed very soon by paralysis of accommodation. The restoration of the accommodation to normal occurs in twenty-four hours, and full restoration of the pupil in forty-eight to seventy-two hours - i. e., much more quickly than after atropine.

Homatropine is, therefore, preferred to atropine for fitting glasses and in ophthalmoscopic examinations; while atropine is preferred where continuous mydriasis is desired, as in inflammatory conditions of the eyeball. Physostigmine will hasten the restoration of the eye, and it is the consensus of opinion among ophthalmologists that, to avoid a possible glaucoma, homatropine should always be followed by physostigmine.

Anhidrotics

An anhidrotic (anhydrotic) is a remedy which tends to reduce sweating. For local sweating, as of the hands and feet, alcohol, eau de cologne, spirit of camphor, a 25 per cent. solution of aluminium chloride, and belladonna liniment are favorites. For odorous perspiration of the feet alcohol may be used as a wash, and a mixture of boric and salicylic acids placed in the shoes or stockings.

The chief use of a general anhidrotic is in the night-sweats of tuberculosis. (See discussion under Antipyretics and Diaphoretics.) The anhidrotic measure may be a hot bath on going to bed, or a body sponge with alcohol, vinegar (or acetic acid), or a solution of alum; or it may be a drug taken internally. Atropine is our most powerful anhidrotic. It has the advantage of stimulating respiration, but it has the undesirable effects of drying the throat and increasing the cough, and may even dilate the pupil. In very extensive tests the author found that for internal administration in tuberculosis the best general anhidrotic is agaricin. Strychnine is also of value. Ergot, which has been highly recommended, seemed to have no effect at all. Calcium chloride is sometimes effective.

Agaricin is an unofficial extract obtained from the fungus, Polyporus albus, which grows on the European larch. It is really an impure form of the crystalline principle, agaric acid. Its dose is 1/10 grain (0.006 gm.). In this dose it strongly depresses the ends of the secretory nerves of the sweat-glands, has no undesirable side-effects, and is strongly anhidrotic; but its effects are not lasting, so it must be given within four or five hours of the expected sweat. If the sweat comes on toward morning, the dose may have to be repeated once in the night. In larger doses it sometimes induces nausea, vomiting, diarrhea, and perhaps dryness of the throat, but it does not dilate the pupil. Doses large enough to produce nausea do not give the anhidrotic action.

Camphoric acid, C8H14(Cooh)2, is an oxidation product of camphor. It is soluble in alcohol and the fixed oils, and slightly in water. Its dose is 15 grains (1 gm.), given in cachet or powder. Its taste is disagreeable, and its systemic action is mildly that of camphor; but practically its sole use in medicine depends upon its anhidrotic property. Roth (1911) found it to be without any direct effect upon the sweat-glands, and was disposed to attribute its action in the night-sweats of tuberculosis to stimulation of the respiratory center.