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_.
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