The differences in physiological action between these alkaloids are infinitely greater than the chemical. There does not exist a finer illustration of the importance of molecular arrangement to physiological action. Given two alkaloids having the same ultimate constituents, their actions become antagonistic by reason of an unknown molecular arrangement. Jaborine, in its effects on the heart, lungs, pupils, and salivary glands, is identical with atropine. In the whole range of physiological antagonisms, there is none more complete than that existing between atropine and pilocarpine. As in some specimens of pilocarpine—owing, doubtless, to faulty pharmaceutical processes—there is more or less jaborine, it is no longer difficult to explain how some observers have differed in their observations. As the effect of pilocarpine on the circulation and the sweat-glands is so completely antagonized by jaborine, it is in a high degree important, in prescribing the former, to secure a specimen free from the latter.

Pilocarpine and Jaborine Therapy

Pilocarpus, acting as it does on the salivary glands, has been used with varying success in mumps, sometimes succeeding well, and then failing. According to Testa, if used in time it may arrest the development of the disease, and later may prevent metastasis.

In salivation of pregnancy, it has succeeded in a few instances, but more frequently fails; atropine is generally much more certain and effective. It is contraindicated in all affections of the gastrointestinal mucous membrane, and in weak heart due to disease of its muscular substance, or of its contained ganglia, or of the valves. It is a remedy of great value in cardiac dropsy, provided the contraindications above mentioned do not exist; its therapeutic power being much the same as the vapor, hot-air bath, and other means for promoting free diaphoresis. The effusions of recent pleuritis, hydro-thorax, and ascites, have been quickly removed by this agent. In asthma with profuse expectoration (humid asthma), and in bronchitis with abundant, non-purulent exudation, it has often been very beneficial. It must be used with caution, or not at all, in the difficult breathing due to dilatation of the right cavities and great venous trunks. According to Berkhart, pilocarpine, injected subcutaneously, arrests the most violent paroxysms of spasmodic asthma, and the relief persists for some time. It is equally effective, in the author's experience, in singultus or hiccough, but there may be incurable lesions underlying the spasm, when, of course, the paroxysms may be expected to recur again.

Probably the most conspicuous good results from the administration of pilocarpine have been obtained in eclampsia, from the albuminuria of pregnancy, of scarlatina, or of acute Bright's disease. The powerful action on the sudoriparous glands, and the excretion of the urinary solids by the sweat, are the causes of the extraordinary relief obtained from this remedy in suitable cases. It should be borne in mind that pilocarpus tends to excite uterine action, and hence its administration may, under some circumstances, be improper; but in most cases this effect is desired. There are, however, two important contraindications: a weak heart, from thinning and atrophy of the walls of the organ, or from fatty degeneration, and a tendency to pulmonary congestion and aedema. In some instances, in a few minutes after the injection, the respiration became embarrassed by congestion and oedema of the lungs and by enormous bronchial secretion (Sanger, Napier, G. Thomas). It may be well to mention that atropine, subcutaneously, in one case in which it was administered, removed these symptoms and saved the patient's life. In renal dropsy, especially scarlatinal, there being no contraindication in the state of the heart, it is a remedy of the greatest utility.

Pilocarpine has proved to be an important addition to the resources of the ophthalmologist. In inflammatory affections with effusion and exudation it brings about resolution and absorption (Wecker). According to Coursserant, there is no remedy comparable to it in the amblyopia of alcoholism and of tobacco-abuse. It has produced excellent results in detachment of the retina, chronic iritis, keratitis, haemorrhages into the vitreous, floating bodies, glaucoma, atrophic choroiditis, haemorrhages and exudations of the retina, commencing atrophy of the optic nerves, etc. (Gillet de Grandmont, Meyer, Gubler, Wecker, and others). The first-named author affirms that we find in pilocarpine "an absolute remedy against white atrophy." Beranger, following Gubler, proposes to use this remedy as a substitute for eserine in certain ocular affections requiring a myositic—an effect produced by pilocarpine when instilled in the eye. It has been used successfully de novo and as a substitute for eserine in certain paralyses of the ocular muscles—those consecutive to the fevers and other acute diseases. After the operation for cataract extraction, pilocarpine is used by Chalot to prevent exudations and other inflammatory changes. In the discussion which ensued before the Geneva Congress where this paper was read, various adverse opinions were expressed regarding the exhibition of this remedy in different ocular maladies. Especially was the danger emphasized—the danger in cases of cardiac and arterial diseases, and of pulmonary engorgement.

Ringer has used jaborandi with success to increase the secretion of milk. As the milk-glands correspond in structure to the sudoriparous glands, and are merely differentiated and specialized for their particular office, the effects of this drug in increasing the production of milk might have been, a priori, expected. The author has used recently a fluid extract of jaborandi successfully in a case of deficiency in the secretion of the milk of a nursing-woman. But Dr. Max Strumpf denies that it has such power.

In two cases of that very intractable disorder, diabetes insipidus, or polydipsia, Laycock has used jaborandi with the effect to reduce the quantity of urine in one case from three hundred ounces to one hundred and twenty ounces per diem, and, in the other, from one hundred and fifty-eight ounces to ninety-eight ounces per diem. M. Huchard reports the cure of a case of the same kind, and also one of glycosuria; on the other hand, Vulpian declares it to be useless. Murrell has found it to be useful in some cases of the sweats of phthisis and of other nocturnal sweats, but yet far inferior to atropine and picrotoxin.