Ammonium Muriaticum

[HYDROCHLORATE OF AMMONIA, MURIATE OF AMMONIUM.]

A compound of hydrochloric acid and ammoniacal gas. It may be obtained artificially by the double decomposition of sulphate of ammonia and muriate of soda. It is the old sal ammoniac, on a large scale. Sal ammoniac is obtained from coals and bones ; in Egypt it is obtained by sublimation from the soot afforded by the combustion of camel's dung.

The muriate of ammonia is a white and volatile salt, and dissolves in three parts of cold water and in one part of boiling water.

Wibmer experimented with this salt upon himself ; he took from ten to thirty grains for a dose, which he repeated at the end of an hour. The effects were a sensation of warmth and oppression in the stomach, headache, and increased desire of passing the urine.

Sundelin says: "In large doses it purges like other salts, but in small ones rather constipates." It is wonderful that even a consum- mate therapeutist like Sundelin, does not seem to be aware of the cause of this apparently contradictory phenomenon. A homoepathic

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physician would consider it strange indeed, if small doses and large doses of a drug did not produce opposite effects. To develop the direct or primary action of the drug, we have to give large doses ; small doses develop the manner in which the organism reacts against the drug, and the symptoms of organic reaction must necessarily be directly opposed to the primary action of the drug. An inherent' defect of our own materia medica, such as has been published by Hahnemann and his disciples, is this : that the symptoms are all huddled up together in one confused mass, so that the symptoms of the primary action of drugs, and those of the organic reaction, cannot be distinguished from each other, and we are led to believe that a drug is capable of developing two opposite series of phenomena, which is impossible, except upon the principle of primary drug-action and secondary or organic reaction.

The muriate of ammonia may be useful in

CHRONIC CATARRHAL IRRITATION of the bronchial lining membrane. Dr. Hoyne says that it is called for, when there is frequent sneezing, accompanied with tearing from the nape of the neck to the shoulder. Phlegm in the throat, mostly early in the morning, with frequent hawking and expectoration of small clots of mucus. In such cases there is usually considerable thirst at night. [Medical Investigator, April, 1870.) In

ACUTE CATARRH of the Schneiderian membrane we have in this drug one of the best remedies at our command. Where there is a profuse, watery discharge from the nose, stopping up of the nose, with hoarseness and burning in the larynx, it acts like a charm.

CATARRHAL IRRITATION OF THE STOMACH and bowels, with heat in these parts, nausea, loss of appetite, constipation or diarrhoea, and increased urging to urinate.

CONSTIPATION Dr. Lilienthal (Medical Investigator, May, 1870,) recommends it also in constipation. "It causes a scorbutic state of the blood, a diminution of the blood globules and fibrine, and excites a more active state of all glandular organs.

The gastro- intestinal mucous membrane is covered with tough, glaring mucus, which is discharged with the stool ; the hard scybala can only be expelled by bearing down, followed by soft stool ; hard stools, crum- bling to pieces when evacuated ; the hard and costive feces are cov- ered with a glairy, tough mucus, and are accompanied by the discharge of a quantity of this mucus. (See Aloes.) "

DYSPEPSIA. — Charge mentions the muriate of ammonia among

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the remedies for dyspepsia, recommending it for sympathetic subjects with soft skin and without energy. Bitter eructations ; thirst only quenched by lemonade. Kegurgitation of food; hawking up of mucus in the morning. Heat and fulness after eating. Distress imme- diately after eating. Augmentation with retention of the mucous secretions. Lascivious or frightful dreams.

CHRONIC CATARRH OF THE BLADDER, with burning and stinging in the urethra, discharge of mucus, increased desire to urinate ; in

BALANITIS, the muriate of ammonia has effected brilliant cures. Canstatt recommends it for profuse suppuration generally, saying : "why this salt has such marvellous effects in cases of profuse sup- puration, is as inexplicable to me as the effects of our best known specifics ; in the place of learned theories I can assure my colleagues with perfect confidence, that it is so !"

A healthy man, aged fifty, and habitually cheerful, had become desperate in con- sequence of a balanitis which had been treated without any success for the last six weeks. The prepuce on the glans was fissured and ulcerated, fistulous canals reached as far as the pubic bone, discharging pus which seemed to proceed even from behind the abdominal integuments. Other symptoms were : general exhaustion, evening- fever, oedema of the feet, loss of appetite. He took every day two drachms in some mucilaginous vehicle, and, after having consumed three ounces of the muriate, the cure was completed.

Many other similar cases might be reported.

I have mentioned this case in detail, for the reason that the treat- ment of balanitis with infinitesimal doses of our antipsorics is some- times a very hard matter. A much smaller dose of the muriate than was used in this and similar cases, may prove sufficient for a cure.

Premature and profuse menstruation, often painful; there is much pain in the back ; the flow is increased while at stool ; diarrhoea ; languor ; moodiness ; gastric derangements, as nausea and hiccough ; stools hard and crumbling, as previously described ; coldness of the feet in bed ; profuse flow of urine ; fat, indolent, flabby women.

LEUCORRHCEA. — Discharge albuminous, like the white of an egg ; preceded by pain around the navel. Brown, slimy discharge after making water, painless or preceded by pinching around the navel. Leucorrhcea with distention of the abdomen, without accumu- lation of wind. (Dr. Minton in Am. Jour, of Horn. Mat. Med., vii., 2.)

PHTHISIS. — In incipient phthisis pulmonalis, with profuse expec- toration of a glairy or even purulent mucus, the muriate of ammonia is prescribed, more particularly by German practitioners, with good success in many cases. It is given in unnecessarily large doses, from ten to twenty grains every few hours.

312 AMMONIUM MUKIATICUM.

If this pulmonary disease is accompanied by colliquative diarrhoea, or even if this diarrhoea is the main indication, as a symptom of phthisis of the bowels, the muriate may prove so much more useful.

Dr. Hawley {Halm. Monthly, Feb. 1878,) mentions a case of con- sumption cured by ammonium muriaticum. The remedy was suggested by the marked coldness between ihe scapulas. Patient had to wear a shawl to keep her back warm.

It may. not be amiss to state here, that in a discussion on this remedy during the session of the Central N. Y. Horn. Med. Society, 1878, Dr. Boyce stated that with it, he had cured a case of supra orbital neuralgia, appearing in the morning at 11 a. m., and con- tinuing all day. Patient had to go to bed. Pain constant. Dr. Martin, when an alloeopath, often gave it in neuralgia. He put a drachm in half a glass of water and gave a teaspoonful at a dose with good results.

Poisonous doses are antidoted by exciting vomiting with warm water, and afterward giving mucilaginous and demulcent liquids. Gastro-enteritic symptoms have to be combated with aconite.

LIQUID AMMONIA.

Before parting with ammonia, I have to mention an article which we do not use in our practice, but which, being a very poisonous agent, may sometimes place you in a position to prescribe for the bad effects of this substance. The word ammonia is taken from Jupiter Ammon, near whose temple in Asia Minor sal ammoniac was first found. Liquid ammonia is water by which ammoniacal gas has been absorbed.

Liquid ammonia is often used by German physicians in mania-a- potu instead of opium ; it seems to have a tendency to tranquillize the brain, and is undoubtedly preferable to the former opiate prac- tice of the old school. In some forms of mania-a-potu it may even be said to be homoeopathic to this disease. Several cases are men- tioned by Frank ; in two, the brain was excited ; in one, the patient was insensible. All recovered speedily by the use of twelve or fifteen drops at a dose every five, ten, twelve minutes, in a few ounces of water and sugar.

The poisonous action of liquid ammonia merits a few remarks. A very interesting case is given in detail, in the Edinburgh Med. and Surg. Jour., 1841.

A young man who usually slept in a chemical laboratory, was

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poisoned by the fracture of a vessel containing nearly fifty pints of volatile alkali (liquid ammonia). The accident occurred in the night, without his knowledge, and he was exposed to the vapors nearly an hour. He was aroused bv violent constriction of the throat and dyspnoea. He arose, but felt suffocated, and would have perished, if a woman, who heard his feeble cries, had not come to his rescue, and dragged him out at the risk of her own life.

When seen by the physician, the patient's countenance was extremely anxious. His face was covered with livid streaks, espe- cially about the nostrils. The mucous membrane of the mouth and nostrils appeared to be destroyed; and bloody, frothy matter flowed from the mouth and nose. The tongue was of a bright red color, and had lost most of its cuticular covering.

The voice was very feeble, and the man complained of a sharp pain in the throat, which soon extended to the breast. The dyspnoea was extreme, and fits of suffocation frequent. He had great thirst, and deglutition was almost impossible. The pulse was feeble, irregular and quick.

Bleeding was resorted to liberally, and water, acidulated with vinegar, injected in large quantities. At the end of two hours the symptoms abated in severity, excepting the difficulty of swallowing, which increased. By frequent frictions and leeches to the throat, gargles, injections and baths, he was declared to be out of danger at the end of forty-eight hours. Loss of voice continued for six days, but after this he recovered rapidly.

Instead of resorting to venesec- tion, we would have to use aconite ; the acidulated drinks and injections to be used as stated.

ANTIDOTAL TREATMENT— Vinegar or vegetable acids of any kind, diluted lemon-juice, or a solution of tartaric acid are the best antidotes in a case of poisoning.

AMYL NITRITE.

[NITKITE OF AMYL.]

This is an inflammable liquid, lighter than water, boiling at 182° F., having a fruity, pear-like odor, and the composition C10 H11, NO3 +HO. It may be prepared by heating fusil oil, gently, in a retort with nitric acid, removing the heat as soon as bubbles form, repress- ing effervescence, if too strong, by cold water, rectifying from potassa the distillate passing over under 212° F., and collecting apart the product which distills under 177° F. From the experiments of Dr. Richardson, on animals, it appears to find an entrance into the sys- tem from any point of application.

When inhaled, it acts im- mediately as a powerful stimulant to the heart, more powerful,

314 AMYL NITKITE.

indeed, than any other known agent ; and a little applied to the nostrils causes an instantaneous and extraordinary flushing of the face. This excitement of the heart is followed by diminished but not extinguished power of that organ, and contraction of the external vessels. Given to animals by inhalation, it is capable of suspending respiration and producing death ; but short of the latter result it may produce, when properly regulated, a reduction of the respiration and circulation so extreme, that a condition analogous to trance may be induced and sustained for many hours.

It does not seem to have anaesthetic properties. Consciousness is never lost, unless a state of approaching death is induced from which the animal rarely, if ever, recovers. Its force is directed especially to the muscular action, which it at first mildly excites, then subdues. The appearances after death differ according to the mode in which the fatal effect has been produced.

If the nitrite be given very rapidly, the lungs and brain are free from congestion and even blanched, and the left side of the heart is empty, though the right cavities are engorged with blood. If slowly administered, it leaves a congested state of the lungs and brain, and blood is found in both sides of the heart. No distinction of color is observed between the arterial and venous blood. Notwith- standing the violent action of the heart, Dr.

Richardson has never known it to cause rupture of a blood-vessel, or extravasation. Though no therapeutic use of this fluid has yet been made, so far as we know, yet its extraordinary rapid and powerful action on the heart suggests important applications of it in threatening cases of syncope and others of great failure in the heart's action. (U. S.

Dispensatory.) Permit me to call your attention to a few experiments made with this highly interesting drug :

N. F. 0., aged forty-nine years, nervo-sanguine temperament, an inveterate smoker, an habitual coffee drinker, and in excellent health. Took two strong inhalations from a vial containing four ounces of crude amyl nitrite. Immediately he felt a sense of fulness of the heart and flushing of the face, which increased during one minute to positive agony, without pain.

A violent palpitation of the heart now began, which shook the whole body ; consciousness was still perfect and there was no feeling of alarm. He now felt himself sinking to the floor, which seemed a voluntary act, for he eased his descent by means of two tables between which he was standing, lowering himself gently until stretched at full length ; his last con- scious act was the endeavor to hold the head erect, lest the surcharged cerebral vessels should become yet fuller. His first act of returning consciousness was to recognize his attendant, who was giving him

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chloroform by inhalation, in accordance with previous instructions. Not five minutes elapsed between the first inhalation of the nitrite and complete restoration — complete save for anaesthesia at the second phalanges of the middle and ring fingers of the left hand. This symptom continued about one hour. He says: I was informed that my " face and eyes were of a deep, livid red color," and that I looked "horribly." This proving was made about two weeks ago. * * I was astonished at the crescendo scale in which the

symptoms developed during fully two minutes after ceasing the in- halations. {Gin. Med. Advance, Sept., 1878.)

Dr. Morrison published an accidental proving in the Monthly Horn. Revieiv, May, 1877, substantially as follows :

March 10th. Entering the room at 10:23 p. m., I noticed the pungent odor of the nitrite. The effects were : An increasing sense of stupefaction, with flushing of the face and scalp. A sudden smarting of the conjunctivae, with injection of the ocular con- junctivae, and dimness of vision, as if caused by a film.

Subacute smartings in the praecordial region ; then in the right renal region ; then in the right axilla ; then at mid-sternum ; then in the lumbar region ; then in the lower lobe of the right lung, at the apex of .the heart, and in the lower lobe of the left lung, with tenderness on pres- sure. Increasing dyspnoea, with sneezing, nasal catarrh, and sighing respiration. Pulse (sitting) 68, small, feeble. The smartings changed position rapidly, being most persistent in the eyes, bases of the lungs and spine.

After enduring the increasing discomforts for some twenty minutes, respiration became a series of gaspings, where- upon I beat a retreat.

March 11th. On awaking, the pains returned with increased in- tensity, especially in the spine, lungs and conjunctivae. * * * These and other shifting pains returned during the day, at times accompanied by sighing respiration. Urine clear, acid. Specific gravity, 1014; free from albumen and phosphates ; light cloud of an oxalate (probably lime) and distinct traces of sugar.

Pulse (when sitting) 78 to 84, feeble. (A few drops of the nitrite on cloth, held before the nostrils of a small dog, caused violent sneezings and injection of the conjunctivae.)

The prover made observations during the next nine days without repeating the inhalations. The most prominent symptoms were : Occiptal headache, aching in the renal region ; smarting of the con- junctivae ; increase of the specific gravity of the urine during the first three days, lessening after that, falling from 1020 to 1012. Traces of sugar in the urine.

Dr. Waldo {Med. Union, Dec, 1874,) administered to a cat about twenty drops by the mouth with the following effects : dizziness, frothing at the mouth, spasmodic movements of the head and fore- legs, violent opening and closing of the mouth, constant moving of

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the tongue, and, in just an hour, vomiting of the contents of the stomach, followed by a nap, after which the animal appeared per- fectly well. The animal died in a fit just one week after taking the drug.

A study of the physiological action of amyl nitrite presents some serious difficulties ; its prompt and violent action, causing symptoms which are singularly alarming if this substance is administered in fairly large doses, stands in the way of conclusive experiments upon man.

The rapidity with which it produces its characteristic effects is remarkable. The first symptoms experienced by provers consist in fulness of the head and flushing of the face ; the writer has seen the administration of a few globules, moistened with the first centesimal dilution, produce these symptoms within a few seconds. These are followed by a deep, labored breathing and rapid, violent action of the heart.

Experiments upon animals show that progressive muscular weak- ness and a great diminution of reflex action develop, if the admin- istration of amyl is pushed further, and that death takes place from failure of respiration.

The effect of amyl nitrite upon the circulation has given rise to varied and interesting experiments and views. Observers agree that a decided decrease of the arterial pressure is always present. This decrease of pressure is probably due to capillary dilatation, for the heart continues to act regularly, and even with increased rapidity and force, until the heart muscle yields finally to the general muscular paralysis which is developed during the later stages of amyl poison- ing. Whether the capillary dilatation depends upon a direct action upon the vaso-motor nerve-centers or upon its power to weaken the muscular coat of the arterioles, is still an open question.

The loss of muscular power is due to the effects of the amyl upon the spinal cord. The motor centres of the cord are especially affected by it ; the sensory centres and nerves suffer little. Among other facts of interest connected with amyl poisoning, we may mention the appearance of sugar in the urine and greatly lessened oxidation. With the elimination of the sugar from the system there has been noticed a decided increase in the amount of urine voided ; but it is probable that large doses only yield this result.

The retarded oxida- tion is accompanied with marked decrease of the temperature of the body.

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The immediate increase of the heart's action, which is uniformly observed in experiments with amyl, has given rise to the belief that the remedy is a motor-stimulant. Filehne claims this increased action of the heart is due to a depressing influence upon the inhibi- tory centres. Dr. H. 0.

Wood (Therapeutics, Materia Medica and Toxicology, 2d edition, p. 335,) offers the following possible expla- nation : " When the nitrite is taken into the lungs it instantly arrests or diminishes oxidation, and a thrill of impending suffocation runs through the system, in obedience to which the respiratory and cir- culatory organs gather up and exert to the utmost their forcas. The central impulse sent to the cardiac and respiratory muscles is at first much more than sufficient to overcome any direct action of nitrite upon them ; but, the inhalation being persisted in, the impulse is con- stantly growing weaker, and the direct influence of the drug stronger, so that there soon comes a time when the reverse is true, and the heart's power is more or less nearly extinguished."

Amyl nitrite has been employed, by physicians of all schools, for angina pectoris, epilepsy, headaches, syncope, etc.

ANGINA PECTORIS. — A cure of angina pectoris, it is generally acknowledged, is almost out of the question, for while various theo- ries are advanced concerning the pathological condition which gives rise to the spasms of intense agony which form its subjective symp- toms it is quite probable that it consists in an organic lesion of the heart. This remedy palliates with a degree of promptness which is not equaled by any other remedy ; and the power to shorten the duration and to lessen the intensity of each paroxysm, must neces- sarily increase our chances for curative treatment of the primary cause. A few inhalations of pure amyl on cotton will be found the most convenient and successful mode of administration.

ASTHMA Dr. D. H.

Kitchen has employed nitrite of amyl with great success in the paroxysmal cough and dyspnoea of acute bron- chitis, and in the suffocative attacks of spasmodic asthma. He gives it by inhalation, in doses of from six to fifteen drops, poured into a small cup-sponge, and applied immediately to the nose, the mouth being kept shut. He believes the beneficial effect to be due partly to the sedative action on the muscular system through the motor-nerves, and partly to its power of diminishing blood pressure and causing contraction of the capillaries.

He details four cases, in all of which a variety of other remedies had been unsuccessfully tried, nitrite of amyl giving prompt and entire relief.

3 1 8 AMYL NITKITE.

SYNCOPE and other conditions, characterized by a depressed state of the heart's action.

A patient, who had locomotor ataxia of some years' duration, was suddenly taken from a condition of usual health to that of impending death. There was the hippo- cratic expression well-marked ; general pallor, with complete unconsciousness. Res- piration was stertorous and irregular. Arterial beat imperceptible at the radial, and but faintly recognized at the femoral pulse.

The pupils were insensible to light and somewhat dilated. The extremities and exposed parts of the body became cold and clammy. It was decided that nitrite of amyl should be tried, but with no idea ^f permanent relief, for the patient was evidently approaching his end. The ordinary method of inhaling a few drops from a piece of muslin was adopted ; no effect being produced, recourse was had to a hypodermic syringe, with which three minims were injected.

In a few moments the heart responded, as evinced by the appearance of a more natural hue of the cutaneous surface. The pulse was recognized in the radial artery. Respiration became much better, and the temperature felt normal. The effect of the medicine seemed to pass off in a half hour, when the drug was again administered — this time giving five minims hypodermically.

The action was similar in kind, but more vigorous in character, than the former dose. The pulse became almost as strong as normal. The patient lasted for nearly twenty-four hours, during which time amyl nitrite was frequently given. * * * * So long as the vital powers were able to respond, the administration of the medicine was followed by reaction, which seemed marvellous. (Dr.

Minor in Virginia Med. Monthly, March, 1878.)

In the Practitioner, of December, Dr. Wm. O'Neill reports a case of syncope, occurring in a gentleman of seventy-five years of age, who suffered from hypertrophy of the heart, in which amyl nitrite was administered by inhalation, from 4 p. m. to midnight, about two drachms in all being consumed. Giving a few drops at a time on a handkerchief produced so little effect, that the patient was allowed to inhale the fumes from the open bottle.

The next day his face was much flushed, and this, with fever, lasted for a couple of days. With the amyl, warm applications to the limbs and general surface were found to be very useful. (Nezu Remedies, January, 1878.)

EPILEPSY. — The Medical Press and Circular mentions as fol- lows a paper on the use of amyl nitrite in epilepsy, by Dr. Crichton Browne :

"Being engaged in tracing out the areas of blushing as induced by nitrite of amyl in different individuals and under different cir- cumstances, with a view to elucidate the law regulating the diffusion of that form of emotional expression, Dr. Brown was struck by the fact, that the degree and extent, to which the blushing caused by nitrite of amyl is manifested, are influenced by certain pathological states. He found that general paralytic patients may inhale a con- siderable amount without displaying any marked flushing, even of the face, and that epileptics cannot breathe the smallest quantity without exhibiting extreme cutaneous hyperemia over the face, neck and chest. Guided by these observations and by an ingenious argu- ment founded upon them, he was led to conclude that if the nitrite of amyl could be given immediately before an epileptic fit, the spasm of the vessels might be prevented, and so the whole sequence of morbid events averted. 'And,' as he forcibly remarks, a 'fit averted in epilepsy is no slight gain ; it is, in fact, a step made

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toward recovery, and a postponement of those degenerative conse- quences which are, as a rule, developed in proportion to the fre- quency and severity of the fits. To interrupt a pathological habit is to give a chance of recovery ; to control the fits is to limit the destructiveness of epilepsy. In several cases in which the nitrite of amyl was administered immediately after an aura, the usual fit did not supervene ; and in one case, in which it was administered regu- larly three times a day, a series of fits, from which the patient was suffering, was abruptly interrupted.

The result of all my experi- ments is to convince me that it will be found invaluable in many cases in not only postponing, but in altogether preventing epileptic seizures. The utility of an agent possessing this power can scarcely be exaggerated. It will, I believe, supersede other methods of attempting to avert the fit by acting upon indications afforded by the aura. * * * A vinaigrette or small stoppered bottle, contain- ing a sponge soaked in nitrite of amyl and carried in the pocket, so as to be at hand at the occurrence of an aura, will, I think, be found a safeguard to many sufferers from epilepsy.

Whenever there is time after the initiation of the aura, and before the develop- ment of the proper phenomena of the fit, to breathe the nitrite of amyl freely, the fit with its terrible accompaniments and disastrous sequelae, may, in many instances, be not merely postponed, but abolished. But there is another epoch in epilepsy besides the pause between the aura and the fit, when the nitrite of amyl may prove beneficial ; that is, at an advanced stage, when the alarming condition, the status epilepticus, is developed.

In ten cases of the status epilepticus the nitrite of amyl has been used, and eight of these have terminated in recovery. Under its influence several patients have rallied from what was apparently a hopeless condition. Whenever it is inhaled, the breathing becomes freer, the circulation is relieved, and the seizures are diminished in frequency and severity. It appears to act with a directness and certainty that cannot be ascribed to any other remedy hitherto employed in the status epilepticus. [Med. and Surg.

Reporter.)"

The remarks just quoted show a power of observation which does honor to the author and a species of reasoning which we might well call ingenious. But we are inclined to think, that the learned writer has after all not hit the nail upon the head. If nitrite of amyl is homoeopathic to any one of the diseases for which it has been given, it is so to epilepsy. Provings made accidentally and otherwise,

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demonstrate this. Dr. H. B.

Waldo, arguing this point, quotes from Dr. Kitchen the following : " In a few seconds after inhaling five to fifteen drops, there is flushing of both cheeks, suffusion and red- ness of the eyes, giddiness, numbness and ' coldness of the hands, seeming loss of power to articulate, increased heat, small and rapid pulse, the number of beats being sometimes double the normal state." Again, Dr. Flagg [Med. and Surg. Journal), having given inhalations of it to a consumptive patient, says : " The patient's head fell back ; his face had an anxious, pinched expression ; slight twitchings of the muscles of the face ; respiration became very slow, the heart's impulse was almost imperceptible."

I cannot deny myself the pleasure of quoting a few sentences directly from Dr. Waldo's article, in the hope that they will still farther serve to give a clear understanding of the question under consideration. "Epilepsy is the result of nervous irritation, which is reflected upon the vaso-motor nerves, producing contraction of the cephalic arteries, causing diminished supply and irritation of mnsculo-motor nerves, which manifests itself by convulsions, and that, when this irritation ceases, relaxation of the spasm o^ the arteries takes place, and paralysis of the vaso-motor nerves, and hence there results congestion. It is for this reason that the epileptic, during an attack, first becomes deadly pale, and that there is a tonic spasm of all the voluntary muscles, followed in a few seconds by a returning color to the face, which soon becomes livid and purple, in- dicating the congestion ; then the tonic spasms become clonic, which in turn yield to coma, until the circulation becomes re-established by the recovery of tone on the part of the vaso-motor nerves and the contraction of the arteries."

Harvey Trotter, colored, aged eighteen years, has for the past two years had epileptic convulsions. The attacks recurred every two weeks regularly, and accord- ing to the notion of the patient at the new and full of the moon. A day or two before each attack he had what he described as the "jerks" — muscular twitchings in his legs, arms and face. The attacks were characterized by the usual symptoms.

The patient showed no evidence of disease, except perhaps slight indigestion from occa- sional over-indulgence in eating, for he confessed to having an " awful good appetite." Six or eight weeks ago I gave him amyl nitrite ix in half ounce vial, to be carried in his pocket, to be inhaled three times a day and every hour when the "jerks " came on, until the twitcnings disappeared. Thus far there have been no "jerks" nor con- vulsions, notwithstanding the moon has "rolled on," waxed and waned the past two months.

(Dr. J. W. Vance in Cin.

Med. Advance, September, 1878.)

A lady had been suffering with epilepsy for four years. An attack would come on once in ten to twenty days. She would feel suddenly dizzy and have to sit or lie down immediately. She uttered a slight cry before the attack, and the upper limbs were convulsed with clonic spasms. She did not sleep after the attack. She fre- quently had twitchings of the muscles of the neck and back, and sometimes of the extremities. No premonitory symptoms. Nine inhalations of the nitrite of amyl

AMYL NITRITE. 32t

were administered two or three times each week, for eight weeks. Three inhalations being given at a time with a few minutes' intermission and then three more and so on, with the effect of entirely curing her. The only symptom noticed from the ad- ministration of the drug being a slight spasmodic cough and a considerably increased number of beats of the pulse. (Dr. Waldo.)

TETANUS For tetanus amyl nitrite has also been used. Dr. Kichardson, in a study of the action of the drug, concluded that its peculiar effects were largely due to its causing extreme relaxation of the blood vessels and, later, of the muscular fibres.

Experiments made by him showed that the amyl could even overcome the convul- sions produced by strychnine. Hence Dr. Kichardson recommended its use in diseases, characterized by severe spasmodic action, among them : angina pectoris and tetanus. In two cases of lockjaw the drug produced effects so remarkable, that they were equivalent to a cure.

The New England Med. Gazette, October, 1878, copies an article from the N. Y. Med. and Surg. Journal, in which amyl is mentioned as a highly useful agent in the treatment of

MELANCHOLIA. "At my suggestion," says the writer of the article, "Dr. James 0. Kiernan tried* the remedy in doses varying from five to fifteen drops in a series of cases of that peculiar form of melancholia, which currently passes under the title melancholia attonita, more recently denominated katatonia by Kahlbaum.

In this form the inactivity of the patient reaches the degree of veritable catalepsy; the pupils are almost maximally dilated and here the effects of the remedy were magical. As soon as the patient had inhaled, the pale face was suffused by a flush ; the pupils contracted, and the patient, who had not responded to questions before, now conversed rationally. Several other patients in the city asylum, in Dr. Kiernan's division, were treated by this remedy, and the cataleptic fits became less frequent and less intense, the psyche more rational, and three cases passed out of the asylum cured.

In one older case, which had been treated for years by the ordinary asylum routine, the remedy had merely a symptomatic effect on the cataleptic fits, but failed to influence the mental condition. The remedy is given until the patient comes out of the cataleptic state, and is repeated when- ever there are any indications of a return. The dose may be much larger than in ordinary cases, especially as the patient, on account of the lack of muscular energy, does not make deep or powerful inspirations."

" I have arrested," says Dr. E. M. Hale, " violent cardialgic, enter-

VOL. I. — 20.

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algic, and even the pain from the passage of renal and hepatic calculi. Several of my dysmenorrhmc patients would not pass a period with- out it, for they know a few inhalations of the first or second will dissipate the intense pain as soon as it appears. There is a variety of headache in which the amyl is very efficacious. It occurs in weak, nervous subjects, usually women.

The pain is so severe, that it is almost agonizing ; the face is cold and pale, as well as the hands and feet, and the subject lies almost unconscious of everything but pain. A few inhalations of the pure amyl, or the lower dilutions, will often arrest the great suffering immediately. In case of sudden syncope or collapse from mental or nervous shock, no remedy acts so quickly as amyl. It excites the heart to immediate action, and allows the blood to circulate freely in the brain ; but after the first effect or re-action is over, its use should be supplemented by ignatia, camphor or veratrum alb." (American Homceopathist, p. 87, 1877.)

Dr. Hale is not alone in his fondness of amyl nitrite as an alleviator of pain. Sir James Simpson uses it and claims to have done so with the utmost success in tic doloureux, neuralgia, sciatica, etc., giving a few drops of the crude by inhalation, as he would give chloroform.

Dr. Hale says that there are types of dysmenorrhcea due to con- traction of the uterine arteries. "In this form the flow is very scanty, and the pains are cramp-like, spasmodic, agonizing, appear- ing in paroxysms, with vomiting, fainting, vertigo and other reflex symptoms. I have now treated five cases of this character and have not failed to relieve a single case.

I had previously given them viburnum and caulophyllum. . . . Amyl is essentially a vaso- motor remedy, and while its primary action is to dilate the arterial system of blood vessels, its secondary action is to cause spasm, and this is felt especially in the arteries of internal organs. ... In all the cases treated, the menses were scanty. The action of amyl was, to cause them to become natural in quantity and of a bright color.

The method of administering it is generally by inhalation. Till a one- or two-drachm vial with cotton, and drop upon it five, ten or fifteen drops of pure amyl. Instruct the patient to commence as soon as the pain appears, and to inhale with deep inspirations eight or ten times from the vial applied to the nose. On the eighth or tenth inspiration the face and neck flush, the head feels full and the temples throb, and with these symptoms there is a complete dis- appearance of the uterine pain.

These patients say, that the feet

AMYL NITRITE. 32' >

and hands become warm after inhaling the amyl. One patient who could not inhale it from timidity, I ordered five drops of the ^th dilution every ten minutes during the pain and every half hour afterward. This plan was successful." (Halm. Monthly, March, 1877.)

FLUSHING OF THE FACE.— Amyl nitrite has been recom- mended in flushing of the face in women during the climacteric period. Occasional doses of the third (or higher) attenuation act with much promptness. It has been found of value in removing the ill-effects of the prolonged inhalation of chloroform and as an anti- dote in poisoning by chloral.

A gentleman, aged sixty-two, late in the evening of April 23d, took a large, but unfortunately unascertained, dose of chloral. Within a few minutes he became completely insensible. When Dr. Ooghill saw him, two hours later, artificial respiration had been kept up for some time, with the effect of inducing feeble, gasping respira- tion at the rate of four per minute ; the surface was cold and deeply cyanosed ; the pupils strongly contracted ; the pulse eighty, full, but soft and compressible.

Twenty drops of nitrite of amyl were admin- istered by inhalation, which induced an immediate return of warmth and natural color to the surface, even of the extremities. The res- pirations became deeper, and gradually increased in frequency. The amyl was repeated in a smaller dose in about two hours, with permanent effect. The next morning the general condition had improved, but consciousness had not returned.

It was found impos- sible to administer nourishment by the mouth, and nutritive and stimulant enema were consequently resorted to. After the second enema he became sensible, recognized and spoke to those around him, and swallowed some food with little trouble. He continued to improve until 9 p. m., when he suddenly started up, as from sleep, and fell back dead.

"Dr. Coghill accepts Liebrich's theory of the decomposition of chloral in the system into chloroform and formic acid, attributing its effect to the chloroform. The state of the pupils, he thinks, de- pends upon the manner of administration : as with chloroform, when an overdose is taken, the respiratory centers are paralyzed, the pupils contracted, but the pulse not affected ; but when the poison- ing is due to the too frequent repetition of smaller doses, the cumulative action of the drug is manifested, and we find the heart yielding earlier than the respiration, and the pupils dilated. He suggests that nitrite of amyl will be the appropriate remedy, when the drug has been administered in such quantities as to act rapidly on the respiratory centers, with contracted pupils, and that strychnine

324 ANACARDIUM ORIENTALE.

should bo given when the drug has acted slowly as a cumulative poison, when the heart has succumbed, and the pupils are found dilated." [Med. Record, Aug. 16, 1879, from Brit. Med. Journal, June 28, 1879.)