A. Flushes the face, and increases the heat and perspiration of the head, face and neck, 5, 311.

C. Ringer (7th Am. Ed. p. 370) makes the following statement: "A woman, perhaps from the sudden arrest of menstruation, or through depraved health, or nervous depression, or more frequently, at the change of life, suffers from frequent attacks of flushings or ' heats' starting from various parts, as the face, epigastrium, etc., thence spreading over the greater part of the body. The face and even the back of the hands, are deeply reddened, the veins of the hands in some cases dilating to double the previous size. Although the patient feels deeply flushed, sometimes the skin remains natural. The sensation of heat may be so urgent that the patient opens her clothes, or removes the greater part of the bed covering, and even throws open the window in the coldest weather. These heats may last a few minutes only, or an hour or more, and may be repeated many times a day. They are generally followed by perspiration, often very profuse, at other times the skin remains dry, the attacks are then commonly termed ' dry heats.' The 'heats'are often accompanied by great throbbing throughout the whole body and followed by much prostration, the patient seeming scarcely able to rouse herself. After the heats pass away, the skin becomes cold and clammy, and may turn very pale. The heat, exertion, or excitement may bring on these heats, and such a patient generally complains of cold feet, and sometimes cold hands. The flushings are occasionally peculiarly and abruptly limited, reaching to the thighs, knees, or elbows, and while all the parts above these feel burning hot, the parts below feel icy cold; sleep too is often broken, the patient waking with frequent starts, and in the morning feeling unrefreshed. Sometimes they occur chiefly at night. In many cases palpitation or flutterings at the heart occur on the slighest excitement, or even without apparent cause.

"Nitrite of amyl will prevent or greatly lessen those flushings or 'heats' and avert the profuse perspiration, throbbing of vessels, and great prostration. . . . For the symptoms just described I have generally administered this drug by the stomach, though inhalation answers as well. ... It may be dissolved in rectified spirits, two minims to the drachm, and of this the dose is three to five drops on sugar every three hours, with an additional dose as soon as the flush begins. Relief generally ensues immediately, but sometimes not till the medicine has been taken for a week."

Remarks

Cases of rosacea sometimes present themselves to the physician in which these frequent flushings of the face are a marked feature of the trouble, and one of which the patient is apt to complain. There is little doubt that they aggravate the cutaneous lesion, and tend to prolong its continuance. The chronic congestion of the skin is temporarily increased by each attack and if they are of frequent occurrence, increase in severity, and extension of the disease may be anticipated. They naturally oppose an obstacle to the success of what would ordinarily be rational and effective treatment. It is of the first importance, then, that the tendency to them should be checked. Among the means adapted to this end I have found the nitrite of amyl, as pointed out by Ringer, occasionally successful. I usually administered from one to five minims of a 1 per cent. alcoholic solution in a teaspoonful of water, or else give sugar globules (each 3 or 4 mm. in diameter) which have been saturated with the pure nitrite. A closely corked vial of such globules is the most convenient form for the administration of the remedy, one or two being taken at a dose.