A NOTE ON THE TREATMENT 
OF 
VITREOUS OPACITIES 
WITH THE 
FLUID EXTRACT OF JABORANDL 
BY 
G. E. DE SCHWEINITZ, M.D., 
Professor of Ophthalmology in the Philadelphia Polyclinic; Ophthalmic 
Surgeon to the Philadelphia Hospital. 
REPRINTED FROM THE THERAPEUTIC GAZETTE, JULY 15, i8g2. 
DETROIT, MICH. : 
GEORGE S. DAVIS, PUBLISHER. 
1892. A Note on the Treatment of Vitreous 
Opacities with the Fluid Extract 
of Jaborandi. 
DR. JAMES A. SPALDING contributes 
an excellent practical paper on idio-. 
pathic vitreous hemorrhages in the Archives of 
Ophthalmology for April, 1892,! and, together 
with other recommendations, describes the 
treatment of this affection as follows : " In 
the first place, I should put hypodermic use 
of pilocarpine, hydrochlorate or nitrate. This 
is to be given in grain doses, once a day, 
for two weeks. Perhaps fewer doses may do 
as well. If any dose produces weakening 
effects upon the heart, then the next dose may 
be decreased or omitted for two days. In 
case no visible effect is produced, the dose 
may go as high as although I have never 
seen the need of more than It is not 
necessary to produce visible physiological 
effects for the remedy to be useful to the eye. 
It may also be given by the mouth, though it 
is not so efficacious when thus administered. 
The fluid extract of jaborandi may be sub- 
stituted, but it is more disagreeable to take 
than the alkaloid." 
The following cases, illustrating various 
types of vitreous disease, accompanied by 2 
hemorrhagic or other type of opacity, and 
favorably modified by the administration of 
small doses of the fluid extract of jaborandi 
or the nitrate of pilocarpine, are reported in 
confirmation of Dr. Spalding's indorsement 
of this drug. 
Case I.- Vitreous Opacities in the Left Eye, 
Hemorrhagic in Origin. - Mrs. P., aged 65 
years, with incipient cortical cataract and 
some woolliness of the choroid, after the cor- 
rection of a simple hypermetropic astigma- 
tism, obtained an acuity of vision = in 
each eye. On the third of June, 1891, she 
noted a mist before the left eye. There was 
no pain and no external manifestation of 
trouble. On examination the vision of the 
right eye was found to be f-, rather better 
than it had been when the original correction 
was made, three years before. In the left 
eye the vision was barely A- There was an 
extremely dim view of the fundus, owing to 
a dense haze in the posterior layer of the 
vitreous ; the vessels which could be seen 
appeared to be tortuous and darker than 
normal. With -J- 7 D numerous large, dark, 
string-like opacities were visible in the ante- 
rior layers of the vitreous humor. Locally, 
the sulphate of eserine, of a grain to the 
ounce, was ordered, and internally, the fluid 
extract of jaborandi, 10 drops three times a 
day. Nine days later the patient expressed 
herself as seeing better with the left eye, al- 
though with test-types there was no improve- 
ment in vision, and the ophthalmoscopic ap- 
pearances were about the same as at the 
original examination. The treatment was 
continued, and seventeen days later the 3 
vision in the left eye had risen to |, the en- 
tire vitreous humor had practically cleared, 
and the dark clots were represented by fine, 
floating opacities. The patient has not re- 
ported in person since this time, but has sent 
word on several occasions that the eye con- 
tinues in a satisfactory condition. 
Case II.- Vitreous Hemorrhage ; Throm- 
bosis of the Upper Temporal Vein and Retinal 
Hemorrhages.-Thomas S., aged 73, on the 
23d of May, 1891, suddenly appreciated a 
dark spot before the left eye, and that all 
objects had a very much blurred outline. 
There was no pain, and there had been no 
previous illness. In the right eye the pupil 
was prompt, the disk oval, with its upper and 
inner edges hazy, and containing a shallow, 
dish-like excavation. There was slight milki- 
ness of the central portion of the lens, and 
one dark, floating, vitreous opacity. In the 
left eye only a dim view of the fundus was 
possible. The vitreous contained numerous 
web-like opacities, dark-colored, like clots of 
blood. The disk could be faintly seen, and 
its upper and inner edges appeared veiled 
and the vessels tortuous. The vision was T6?. 
The temporal arteries were hard, the second 
sound of the heart accentuated, and with 
Heller's test there was a distinct reaction of 
albumin. Locally, eserine was ordered, and 
internally the fluid extract of jaborandi, 10 
minims three times a day. At the end of six 
days the vision was and the vitreous much 
clearer. Two weeks later the vision was still 
■fa but there was now a clear view of the 
fundus. The upper temporal vein was col- 
lapsed in its course over the disk and for 4 
some distance beyond its margin, and beyond 
this point was unevenly beaded, and on each 
side of it there were several irregularly- 
shaped retinal hemorrhages. In two weeks 
from this date the vision had risen to There 
were still a few large, floating opacities, but 
the retinal hemorrhages had absorbed. The 
patient was seen once after this, and ex- 
pressed himself as feeling entirely comfort- 
able and unannoyed by the dark spots before 
his eyes. 
Case III.-High Myopic Astigmatism ; Vit- 
reous Opacities of the Right Eye, probably 
Hemorrhagic in Origin, following an Attack of 
Influenza.-Mrs. W., aged 55 ; has always 
been myopic, having begun the use of glasses 
at the age of 11. When first seen, with the 
best correction, her vision in each eye was f. 
The ophthalmoscope revealed slightly irregu- 
lar disks, with myopic crescents and some ab- 
sorption of the pigmented epithelium. After 
a siege of nursing, followed by a severe at- 
tack of bronchitis, which was diagnosticated 
as a pulmonary type of la grippe, she ob- 
served, preceded by a number of flashes of 
colored light, numerous floating spots before 
the right eye and dimness of vision. The 
ophthalmoscope showed, in addition to a few 
striae in the lens, numerous, rather fine, dark- 
colored floating vitreous opacities. At first 
the patient was given iodide of sodium, which 
she did not take very well. The vision sank to 
partially, and then, in addition to the small 
doses of the previously-mentioned drug, fluid 
extract of jaborandi was ordered, and nitrate 
of pilocarpine locally (a twentieth of a grain 
to the ounce). This treatment was continued 5 
for nearly a month, when the vision had risen 
to 76---, and, although the patient still com- 
plained bitterly of the floating spots before 
her eyes, the vitreous had materially cleared, 
and those opacities which remained had lost 
their former dark color. 
Case IV.- Vitreous Opacities of the Right 
Eye, Inflammatory in Origin ; Later an Attack 
of " Quiet Iritis."-Mrs. W., aged 58, has al- 
ways suffered from severe headaches, usually 
confined to the region of the right eye and 
the right side of the head, but unassociated 
with nausea, and apt to come on in the after- 
noon. There has been no recent illness, but 
the patient is anaemic and has never been 
very strong. In the right eye, with the best 
possible correction of an astigmatism con- 
trary to the rule, the vision was There 
were numerous, large, floating, web-like 
vitreous opacities. The optic disk was gray, 
but there was no visible choroiditis or retinal 
change. In the left eye there was a healthy 
fundus, and with the correction of a slight 
astigmatism, contrary to the rule, the vision 
was f. Five-grain doses of iodide of potassium 
were ordered, and slowly the vision of the 
right eye rose to 
In January of this year there was an attack 
of la grippe of mild nature, associated with 
some increase in the vitreous opacities. Fluid 
extract of jaborandi was given, after the con- 
valescence from the influenza was complete, 
in the dose previously mentioned. At the end 
of two weeks there was distinct clearing of the 
vitreous, but numerous opacities could still be 
found. Four days later, unassociated with 
pain, a faint, pericorneal injection appeared, 6 
there was some discoloration of the iris, and 
several soft synechiae were evident at the lower 
and inner margin of the pupil. Under the in- 
fluence of repeated instillations of an atropine 
solution and the use of iodide of potassium, 
these were torn loose, and the pupil became 
round. With the iritis, however, the vitreous 
opacities materially increased. A relapse of 
this iritic complication occurred two months 
later, and again the vitreous opacities increased 
in amount. During the interval between the 
two attacks of iritis the patient had been taking 
a drachm dose of the elixir of the succinate of 
iron, without, however, influencing the opaci- 
ties. After the second attack of iritis, which, in 
fact, amounted only to a hyperaemia of the 
iris, had passed away, the patient was put 
upon the nitrate of pilocarpine, a of a 
grain three times a day. This produced 
slight sweating, and the dose was reduced to 
grain. In two weeks very material improve- 
ment occurred, and the vision returned to its 
best previous acuity,-namely, This case 
is still under observation and is doing well. 
Case V.- Vitreous Opacities, probably In- 
flammatory in Origin, associated with Moderate 
Myopia.-Mrs. W., aged 35, has been my- 
opic from childhood. Since the birth of her 
last baby, two and a half years ago, she has 
suffered much with her eyes,-ciliary neural- 
gia, asthenopia, some photophobia, and at 
times general headache. In the right eye 
there was an oval disk, no crescent, the 
upper and lower margins veiled, the choroid 
woolly, but no absorption of the pigmented 
epithelium. In the left eye there was a simi- 
lar disk, but less disturbance of the eye- 7 
ground. In each eye, but most marked in 
the right, there were numerous, fine, web- 
and string-like, floating vitreous opacities of 
the usual color seen in myopic eyes. It is 
probable that they existed more or less from 
the date of the birth of the child before men- 
tioned, and may have been associated with 
retino-choroidal changes at that time, as the 
labor had been a difficult one, followed by 
some puerperal complication, the exact nature 
of which is not clear. With the best correc- 
tion the vision in each eye was |. 
The patient was put upon iodide of sodium 
and the fluid extract of jaborandi, and, locally, 
eserine was employed. Gradually the eyes im- 
proved, and at the end of three weeks of treat- 
ment she expressed herself as better than she 
had been for two years. The asthenopia had 
subsided, the vitreous was clearer, the vision 
was f in each eye, and moderate reading was 
readily accomplished ; in fact, it was prob- 
ably overdone, for during a siege of domestic 
trouble, during which she was obliged to un- 
duly exert herself, and probably unduly use 
her eyes, there was a relapse, so far as the 
asthenopia was concerned, but without any 
demonstrable increase in the vitreous opaci- 
ties. Under the influence of the treatment 
these opacities had materially decreased, al- 
though it was always possible to see some faint 
threads by examining the vitreous chamber 
with a 16 D. This case is at present under 
treatment, and again improving under the 
same measures. 
These cases will suffice to illustrate the 
value of small doses of the fluid extract of 
jaborandi, or, as Dr. Spalding prefers, of 8 
small doses of the nitrate of pilocarpine. As 
he has pointed out, it is quite unnecessary to 
produce visible physiological effects ; in fact, 
this is a disadvantage. In my experience the 
value of the remedy consists in an effect just 
short of the production of diaphoresis. On 
the other hand, in nearly every case, one of 
the physiological actions of small doses of 
jaborandi became manifest,-namely, a de- 
cided increase in the quantity of the urine 
during the twenty-four hours. It is difficult 
to state exactly how the remedy acts, except, 
perhaps, by taking refuge in the term " alter- 
ative." 
I would like to call attention in this con- 
nection to the value of weak solutions of 
eserine as a local measure. 'The well-known 
influence of this drug in relieving accommo- 
dative asthenopia is one reason for its em- 
ployment, but there is another,-namely, that 
eyes with vitreous disease, especially when 
hemorrhagic in origin, are not without dan- 
ger of passing into a glaucomatous state, or, 
at all events, into a state associated with in- 
creased intraocular tension. Thus there is a 
definite physiological reason for its employ- 
ment. Be this as it may, however, the value 
of the drug in connection with the other rem- 
edies seems undoubted. 
Under many circumstances it is advisable 
to use pilocarpine in vitreous disease for its 
full physiological effect. It is not the inten- 
tion to refer to cases of this character at 
present; they belong to quite a different 
chapter in ocular therapeutics. 
Some of the cases were treated in conjunc- 
tion with small doses of iodide of potassium 9 
and iodide of sodium, and no doubt the al- 
terative influence of these drugs may have 
added to the efficacy of the treatment; but, 
on the whole, I am inclined to ascribe the 
good results to the jaborandi, and I would 
always try it, at least for a week or two, either 
with the iodides or by itself. In the event 
of failure, other more vigorous measures are 
indicated,-full doses of iodide of potassium ; 
if the patient's nutrition will permit it, free 
diaphoresis ; and perhaps the use of inunc- 
tions of mercury. It is understood that syphi- 
litic cases are excluded from this list. If this 
diathesis is present, the natural and rational 
treatment is indicated. 
It is worth while to call attention to one 
point,-namely, the uselessness of the succi- 
nate of iron. Whether it really exerts the 
beneficial influence which has been ascribed 
to it in synchisis scintillans, I cannot say. 
My own experience does not lead me to think 
that it does.