Extracted from The American Journal o" the Medical Sciences, November, 1896. 
THE THERAPEUTIC VALUE OF HYDROBROMATE OF 
SCOPOLAMINE IN PLASTIC IRITIS. 
By Charles A. Oliver., A.M., M.D., 
ONE OF THE ATTENDING SURGEONS TO THE WILLS EYE HOSPITAL; ONE OF THE OPHTHALMIC 
SURGEONS TO THE PHILADELPHIA AND PRESBYTERIAN HOSPITALS; HONORARY 
MEMBER OF THE DETROIT ACADEMY OF MEDICINE, ETC. 
The findings in this brief paper, which are but a few of a series of 
results that represent nearly two and one-half years' careful clinical re- 
search with this drug, are limited to a study of its therapeutic action 
upon this form of special ocular disease. These have been published 
separately because it has been found that in this class of cases the drug 
proved itself as one of the most efficacious and one of the most valuable 
agents that has been employed for quick mydriatic purposes and prompt 
reparative action. Both the private and public practices of the writer 
have been freely drawn upon to study the different effects of the drug, 
and quite a number of cases, especially the private ones, which, without 
exception, have been personally studied in every detail, have been 
submitted to varying modes of administration, until now, after a most 
extended experience, the results as given below are unhesitatingly 
offered. 
Not endeavoring in this communication to solve the problem as to the 
absolute identity of the drug, either in its isomeric relations, as has been 
attempted by some, or to the question of its being but an admixture of 
the two bases hyoscine and atropine, as has been done by Lewin,1 or even 
as yet to compare its physiological workings,2 which are said by others to 
be identical3 with other alkaloid products in the tropine series, the 
writer has here sought only to determine its relative workings upon 
inflamed iris-tissues, especially in the incipiency of the disturbance and 
when the inflammatory reaction has been thoroughly established. 
The writer prefers the hydrobromate salt to the hydrochlorate, as he 
has found the former to be less irritating, and the solution, especially if 
prepared with a small quantity of boric acid, as Murrel? has suggested, 
1 Deutsche medicinische Wochenschrift, 25 April, 1895, S. 269. 
2 The writer expects to engage himself in a series of experimental studies that are intended 
to place the drugs duboisine and hyoscine in the same relation with atropine as these experi- 
ments with scopolamine. He also intends to make investigations as to the actions of definitely 
graded mixtures of the drugs with atropine. 
3 Peters: Centralblatt fiir praktische Augenheilkunde, 1893, S. 500. 
4 Annals of Ophthalmology and Otology, October, 1895. 2 
OLIVER: HYDROBROMATE OF SCOPOLAMINE. 
to remain most certainly free from any fungoid degeneration for greater 
periods of time, even for several weeks.' 
Whilst personally employing the drug the writer has never seen any 
serious general intoxicant effects2 even where he has found it necessary, 
on account of slow and difficult endosmosis through the infiltrated 
tissues of the cornea and incomplete action upon the rigid and tense 
structures of the iris, to repeat the instillation several times during the 
course of an hour. He attributes this in a measure not only to the les- 
sened absorption of the drug, but to the care that he takes to have the 
lower lid everted and the lower canaliculus pressed upon while the fluid 
is slowly dropped upon the superior limbus of the cornea. His own 
experience is that it acts much more quickly upon inflamed tissues than 
stronger solutions of atropine, and that in accordance with the experience 
of Raehlmann,3 Bellarminow,4 and Grossman,5 cocaine primarily em- 
ployed (or, as he has' tried in some instances, conjointly) markedly 
increases the promptness of one of the most important desired-for results, 
the breakage of freshly formed synechia. 
In the great majority of cases the best and most decided results were 
obtained by a double instillation of a one-tenth of a 1 per cent, solution 
at a minute or two interval, rather than by a single instillation of one 
drop of a one-to-five hundred solution (i. e., one-fifth of a 1 per cent, 
strength). In each instance the dose employed was the same ; but in the 
former plan, where it was divided into two administrations, the amount 
received by the organ was most certainly greater, as was proved by the 
result. 
In regard to its slight anaesthetic qualities upon the cornea, referred to 
by Gutmann,6 the writer cannot give answer affirmatively or negatively, 
as his cases presented so many types of irritation and inflammation that 
no dependence could be paid to this one of the most uncertain subjective 
findings ; to him the subject still remains subjudice. 
As to the certainty of its effect upon intraocular tension as clinically 
studied by Grossman,7 Hobbs,8 Ritchie,9 and others,10 the writer, as pre- 
viously hinted, is engaged in determining this question in another and 
more scientific way. He can, however here assert that he has never had 
1 In private work, where everything is under personal supervision, the writer has preferred 
to make repeatedly fresh solutions of all such drugs. 
2 In many neurasthenic subjects, especially women, the drug used in the amounts here 
given for refractive purposes produces a giddiness of a few minutes' duration. The most refresh- 
ing somnolence is frequently obtained whilst the patients are waiting for the drug to obtain 
its maximum effect upon the ciliary muscle. 
8 Klinische Monatsblatter fiir Augenheilkunde, February, 1893. 
4 Vrach, 17,'1893. 6 Gazette medicale' Sciences de Bordeaux, 17 Mars, 1895. 
6 Therapeutische Monatshefte, Marz, 1894, S. 126. 
? Loco citato. 
8 The Atlanta Medical and Surgical Journal, September, 1894. 
9 The Journal of Ophthalmology, Otology, and Laryngology, January, 1895. 
10 Vide Raehlmann, Illig, Lobassow: Revue generale d'Ophthalmologie, Mars, 1894. OLIVER: HYDROBROMATE OF SCOPOLAMINE. 
3 
any untoward symptoms or seen any bad results from such a cause in all 
of the cases in which he has employed the drug. 
Its great cost,1 unfortunately, has prevented its more frequent use in 
the writer's public practice,2 and thus debarred him from prescribing it 
as a house-remedy in such cases; but this factor will be necessarily ex- 
cluded if there should be an increased demand for the drug. 
In regard to the permanency of its effects, repeated examination has, 
in the writer's experience, verified the opinion that although it accom- 
plishes primarily more than is done by four to five times3 the strength of 
sulphate of atropine in cases that are seen early and during the incip- 
iency of the attack, yet the atropine seems to hold on to its effects for 
much longer periods of time, thus necessitating the alternate use of the 
two drugs in gradually lessening amounts and greater intervals after the 
scopolamine has attained its utmost primary action. 
Conclusions. 1. Hydrobromate of scopolamine is of the greatest 
value in the local treatment of the various forms of plastic iritis. 
2. The primary reparative action and quieting power of hydrobro- 
mate of scopalamine as compared with those of similar doses of sulphate 
of atropine in the treatment of plastic iritis are much more promptly 
obtained with the former than with the latter drug, this being true in 
the majority of cases even when the latter drug is used in dosages that 
are equal to quadruple or quintuple the strengths that are employed of 
the former drug. 
3. The duration of the healing and soothing powers of hydrobromate 
of scopolamine as compared with those of equal doses of sulphate of 
atropine in cases of plastic iritis does not seem to be so lasting with the 
former as with the latter drug, this being true in the majority of cases 
even when the latter drug is used in four or five times the strength-doses 
as the former. 
4. For quick and active measures, which are so eminently necessary 
in incipient cases of plastic iritis, and during the early stages of inflam- 
matory reaction, hydrobromate of scopolamine is to be preferred to sul- 
phate of atropine. 
5. Where prolonged use of such drugs is necessary, as in many cases 
of the chronic form of the disease with subacute exacerbations, the alter- 
nate employment of hydrobromate of scopolamine and sulphate of atro- 
pine seems empirically to be the best method of local administration 
that has been devised. 
6. As clinically employed, the best salt of the alkaloid seems to be 
the hydrobromate ; the best method of instillation appears to be that 
1 Vide Schiirmayer: Medicinische Neuigkeiten fiir praktische Aerate, 14 July, 1894. 
2 Seventy-five cents per grain at present writing. 
3 Vide Raehlmann (loco citato), and comments by Illig in the Mtinchener medicinische 
Wochenschrift, 15 August, 1893, xxxiii. 4 
OLIVER: HYDROBROMATE OF SCOPOLAMINE. 
which is accomplished by dropping the solution upon the upper corneal 
limbus whilst the lower punctum is everted and the corresponding canal- 
iculus is pressed upon; and the most efficient amount to be used at one 
sitting is two drops of a one-tenth of 1 per cent, strength (1 to 500), 
repeated, if necessary, as often as three times during the course of an 
hour, and preceded, when desired, as in some instances where there are 
much irritation and pain, by two drops of a 2 per cent, solution of hydro- 
bromate of cocaine a few minutes before each instillation of the scopo- 
lamine.