This section is from "Scientific American Supplement Volumes 275, 286, 288, 299, 303, 312, 315, 324, 344 and 358". Also available from Amazon: Scientific American Reference Book.
Dr. Edgar Kurtz, of Florence, has found this medicament so useful in the various aches and pains of every-day life that he has persuaded many families of his acquaintance to keep it on hand as a domestic remedy. It is an excellent external application for stomach-ache, colic, tooth ache (whether nervous or arising from caries), neuralgia of the trigeminus, of the cervico-brachial plexus, etc. It is superior to anything else when inhaled in so-called angio-spastic hemicrania, giving rapid relief in the individual paroxysms and prolonging the intervals between the latter. No trial was made in cases of angio paralytic hemicrania, since in this affection the drug would be physiologically contraindicated. It has a very good effect in dysmenorrhoea, especially when occurring in chlorotic girls; in mild cases external applications suffice, otherwise the drug should be inhaled (when complicated with inflammatory conditions of the uterus or appendages the results were doubtful or negative). Its physiological action being that of a paralyzing agent of the muscular tissue of the blood vessels, with consequent dilatation of their caliber (most marked in the upper half of the body), nitrite of amyl is theoretically indicated in all conditions of cerebral anaemia. Practically it was found to be of much value in attacks of dizziness and faintness occurring in anæmic individuals, as also in a fainting-fit from renal colic, and in several cases of collapse during anaesthesia by chloroform.
It has been recommended in asphyxia from drowning, hanging, and in asphyxia of the new born, but the first indication in these cases is the induction of artificial respiration, after the successful initiation of which inhalations of nitrite of amyl doubtless assist in overcoming the concomitant spasm of the smaller arteries.
One of the most important indications for the use of the drug is threatening paralysis of the heart from insufficient compensation. In such cases it is necessary to gain time until digitalis and alcoholics can unfold their action, and here nitrite of amyl stands pre-eminent. A single case in point will suffice to illustrate this. The patient was suffering from mitral insufficiency, with irregular pulse, loss of appetite, enlargement of the liver, and mild jaundice. Temporary relief had been several times afforded by infusion of digitalis. In February, 1879, the condition of the patient suddenly became aggravated. The pulse became very irregular and intermittent. The condition described as delirium cordis presented itself, together with epigastric pulsation and vomiting. Vigorous counter-irritation, by means of hot bottles and sinapisms to the extremities, etc., proved useless. Digitalis and champagne, when administered, were immediately vomited. The pulse ran up from seventy until it could no longer be counted at the wrist, while the beats of the heart increased to one hundred and twenty and more per minute. The extremities grew cold, and the face became covered with perspiration. The urine was highly albuminous. Nitrite of amyl was then administered by inhalation: at first, three to five drops; then, ten to twenty; and finally, more or less was poured on the handkerchief without being measured. During each inhalation the condition of the patient rapidly improved, but as quickly grew worse, so that the drug was continued at short intervals all night, ten grammes in all having been used. In the morning the patient was better, and 0.5 gramme of digitalis was then given in infusion per rectum, and repeated on the following day, after which the patient remained comparatively well until a year and a half later, when a second attack of the kind just described was quickly cut short by similar treatment.
Another noteworthy case was that of a robust man of thirty years, who was attacked with acute gastro intestinal catarrh. The patient had as many as one hundred watery evacuations in forty-eight hours, with fainting fits, violent cramps in the calves of the legs, two attacks of general convulsions--in short, he presented the picture of a person attacked with cholera. Opium, champagne, hypodermic injections of sulphuric ether, counter-irritation, etc., proved useless. The doctor was on the point of injecting dilute liquor ammonii into the veins, but, none being obtainable, it occurred to him to try nitrite of amyl as a last resort. A considerable amount was poured on a handkerchief and held before the patient's mouth and nose, while the legs were also rubbed energetically with the same agent. Respiration soon became deeper and more regular, while the pulse gradually returned at the wrist. These procedures were repeated again and again, without regard to the quantity of the drug used, as soon as the radial pulse became weaker, and kept up until the patient complained of a sense of fullness in the head, and requested the discontinuance of the drug. The evacuations became less frequent, and in a week the patient was able to be up. Resuming then, Kurz concludes that nitrite of amyl is indicated in cardiac affections when the capillary circulation is obstructed and the cardiac muscle is threatened with paralysis from overwork; further, in cases of impeded circulation occasioned by cholera or severe diarrhea, particularly in the so-called hydrocephaloid (false hydrocephalus) of children. It is worthy of trial in tetanic and eclamptic seizures, and in tonic angiospasms such as occur during the chill of malarial fevers, although in the last-mentioned condition pilocarpine is perhaps more suitable, provided the energy of the heart be unimpaired.
As regards the dose, Kurz's experience demonstrates that we need not restrict ourselves to a few drops. The quantity may be increased, if necessary, until symptoms of cerebral congestion show themselves, when the drug should be momentarily or permanently discontinued. Usually from three to five or ten drops are sufficient, sometimes even less. Kurz has met with no unpleasant consequences, much less serious complications, from the application of nitrite of amyl. But the drug is contraindicated in cases associated with cerebral hyperaemia, in atheromatous conditions of the arteries, and in the so-called plethoric state--Beta's Memoabilien, March 24, 1881.